Monday, June 4, 2012

Paradoxical intervention - Haley

As you can see from this and my previous posting I have been rereading some of my Jay Haley books. This actually comes from a book written in 1976. Yikes!!
“in summary, one of the reasons for failure of some therapies has been that they assume one can go from an abnormal state directly to a normal state. It is more productive to think in terms of stages between abnormality and normality. Faced with a malfunctioning system, one can think of how to transform that into another malfunctioning system that can then be shifted to normal.” Jay Haley  
As I mentioned before I have some books in my library that I have kept for many years as you can see. 2012 - 1976 = 36 years. Of course I have thrown out many books over the years but there are some that I have just intuitively kept and some of them are the Haley books. In my view they have a creativity, insight and simplicity that is rare. 

camel woman

Haley’s proposal is where one suggests the client goes from abnormal state 1 to abnormal state 2  and then to normal. I find I use that approach some of the time. I was doing supervision the other day and I suggested this approach to my supervisee. And then I read about it in Haley again today!
The supervisee’s client was suffering panic attacks. I suggested to the supervisee that she request the client experience a panic attack in the session. As the client is sitting in their chair they begin to experience the panic attack symptoms and has a panic attack there and then in the room with the therapist. Some clients will do this and some will not. Clients usually find this suggestion surprising which needless to say my supervisee did as well.
What is being suggested is the client move from abnormal state 1 to abnormal state 2.
Abnormal state 1 = client in everyday life spontaneously experiences a panic attack
Abnormal state 2 = client voluntarily produces a panic attack in the counselling session.

Mud people

Abnormal state 2 will tend to disempower abnormal state 1. Often in the clients mind the panic attack is seen as this large ogre that looms in the background only to make an appearance as it wishes. If the client voluntarily produces the panic attack they are at least in part taking charge of it. Or they are at least seeing that they can voluntarily control it. They see that as they have a panic attack in front of the therapist the therapist sits there with them not panicking and simply being sympathetic to the clients plight and probably nurturing to them at the same time. The panic attack does not frighten the therapist is experienced first hand by the client. In my view this will then make it easier for the client to move to the third stage which is the diminution of the panic attacks (what Haley calls the state of normality)
Another example where I could use this approach is with the patient who presents as being highly controlled or controlling of others. The usual basis for this is the person is frightened of loosing control of them self. They have created a myth in their head where they believe they can suddenly go out of control, run amok doing all sorts of weird, embarrassing and possibly dangerous things.
Abnormal state 1 = being highly controlled
Abnormal state 2 = experiencing a sense of being out of control

face stripes

The client is invited to become precisely the thing they fear most. In the counselling session the client is invited to loose control. Let go of their tight grip on control, give it up for a period of time. Experience what it is like being in the counselling session with the therapist and feeling out of control. 
If the client does this then they are more likely to move to the state of normality where the need to be in control is lessened.


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