SAM IKSA JOURNAL OF THE INDIAN PSYCHOANALYTICAL SOCIETY

EDITOR SARADINDU BANERJI

Volume 41

EDITOR

Saradindu Banerji

ASST. EDITORS G. B. Sana Mallika Akbar

CONTENTS COLLABORATORS 1. A Contribution to the Negative Therapeutic Reaction S. K. Mitra —by S. Eorbe* I Rafael Moses. 2. A Technique to cope with Psychoanalytic Resistance : Venkoba Rao Paradoxical Intention—by Harold Kenneth Fink 23 G. M. Carstairs B. Desai Jerome D. Oremland

REVISTA DE PSICOANALISIS Official organ of the Volume 41 1987 Number 1 Argentine Psychoanalytic Association is issued every three months. It publishes articles of interest in the field of psycho-analysis. It also contains abstracts and reviews. Annual subscription $.. 10..-u. s. Back volumes ...$.. 12...u. s. Addriss la ; 14, PAR SIB AG AN LANE Rodriguez Pena 1674, CALGUTTA-9 Buenos Aires-Republica Argentina SAM1KSA, 1987 Vol. 41, No. 1

A CONTRIBUTION TO THE NEGATIVE THERAPEUTIC REACTION* S. FORBES

Freud introduced his concept of negative therapeutic reaction in 1923 (S. E. 19 Pg. 49) vyhere he said : "There are certain people who behave in a quite peculiar fashion during the work of analysis. When one speaks hopefully to them or expresses satisfaction with the progress of the treatment they show signs of discontent and their condition invariably becomes worse. One begins by regarding this as defiance and as an attempt to prove their superiority to the physician, but later one comes to take a deeper and juster view. One becomes convinced, not only that such people cannot endure any praise or appreciation, but that they react inversely to the progress of the treatment. Every partial solution that ought to result, and in other (people does result, in an improve- ment or a temporary suspension of symptoms produces in them for the time being an exacerbation of the illness ; they get worse during treatment instead of getting better." Freud thought that there was a strong unconscious sense of guilt in such patients which found satisfaction in illness and refused to give up the punishment of suffering. I describe three clinical cases to examine Freud's concept further. I attempt to demonstrate how all three cases'showed a direct expre- ssion of Negative Therapeutic Reaction (NTR).

* This paper was read at the First National Psychoanalytical Congress, held in Calcutta on 5th,. 6th and 7th April, 1985. S. FORBES SAMIKSA Vol. 41, No. l NEGATIVE THERAPEUTIC REACTION

PATIENT 'A' towards me he was protecting himself, that there was a fear in him My first case, Patient 'A' is an 11 year old boy. His father that I would behave in the same way, with contempt towards him, himself is in analysis, and when he voiced growing concern for his to shoot him down. He responded well to my interpreting this, with son to his analyst, he was referred to me. a smile, and he visjbly softened, but then quickly put his hand to Father gives the impression of being a very masculine man, fond cover his smile and turned away. At the same time he played with a of sports, guns, collects them, goes hunting regularly. He works in very thin fragile thread, put it on his thigh, seemed to forget about a position of authority. Hs has three sons, patient'A'is the middle it, then placed it on my table and turned to something else. I one and there is a couple of years, difference in age between them. noticed that this thread often got 'lost'. I felt that this was our Father told me of a tragedy in his family which occurred a year ago. relationship with each other, a fragile link which could snap or His wife was killed in a fire, two of his sons were badly burned but 'A' disappear at any moment. escapsd unhurt since he had been sleeping in a cornet bedroom at the However, after some months went by, although he would not time. This incident has particularly affected 'A' who has night- talk to me, and hardly used the paper, pencils, and crayons kept mares and screaming fits in the daytime when he would suddenly only for him, he did communicate material through drawings, start screaming for.no apparent reason. His grades in school had writing, and other forms of behaviour. Mostly always using his own dropped to the extent that he had to repeat a year. 'A'was also paper, pencils; etc. described as stubborn, defiant and provocative. At such times 'A' also made me aware that he had a learning problem, a father found it difficult to control his temper and would hit out at difficulty in taking in and remembering. He brought this to my his son. notice when for days he would try to memorise from various books, One worry of the father's was 'A's dressing up in his mother's he brought in, tried to remember spellings after he had just looked clothes, wearing lipstick, and so on. 'A' had been doing this even at the words and so on. Once when I was talking to him about before his mother died hut it had specifically intensified after her this, he picked up a thick new exercise book and began numbering death. the blank pages one by one. It was a monotonous and seemingly 'A' began analysis with me with great reluctance. He was endless activity. I thought he was showing me through this blank defiant, rude and disdainful. book the shock at his mother's death, how the days go on, and how For a large par! of the analysis he behaved towards me with can he possibly start to think about and take it in. complete contempt. I was to feel unwanted, rubbish and of no Around this time father came to see me on his own. He was value. T attempted to verbalise this for him as his communication to pleased with 'A's progress at home and school. His screaming fits me, as his wanting me to realise and understand how unwanted he had stopped, along with dressing in women's clothes. School felt, and how awful and vulnerable it felt to be in that position. I grades were improving. But his provocativeness continued—at a remembered that at the start of the .first session his father had asked religious function to respect his dead mother he turned to his me how long the session would last and when T told him 'A' had run father and said father was full of shit. away shouting ; "he has changed the time, he doesn't want me". Although 'A' had been coming on his own to analysis an incident Father hnd run after him to try to convince-'A'that I had not chan- occurred which changed this. A child relative was hospitalised, after ged the time. which he refused to come to analysis unless his father brought For the first month in the analysis he had worn a badge of the him. World Wild Life Preservation. It had a picture on it of a mother Responsibility for getting to analysis was now deposited into panda protecting her baby. I felt that in his disdain and contempt father. He himself continued to mock it. I explored this with him. That he felt guilty that he shouldn't have anything, shouldn'thave S. FORBES SAMIK.SA Vol. 41, No. 1 NEGATIVE THERAPEUTIC REACTION help. That he has a terribly twisted super-ego that says "you should first, by trying to turn his father against me, when father still sup- have died too". And when he deposited the responsibility on some- ported me he attached father, as if attempting to tear into father's one else, to bring him to analysis, he did not have to acknowledge good feelings about the analysis—after all, the responsibility for the that he wanted or received help. All the wanting to come to analy- analysis was deposited in father, and 'A' had to try to get inside sis was sent off far away, into father. physically and tear it to pieces. He also meant to provoke father to He appeared to respond well to this interpretation. He would hit him, and then, for father to feel so guilty about it that he would hardly ever look at me or acknowledge my presence, but in a session, have to give up the idea of analysis for his son, which in fact did such as the above, he did. I felt I had touched on something happen. Father felt guilty and very worried now, frightened for his important. son falling seriously ill if he continued with me. And then it all tumbled. After the above session of his acknow- The delicate thread or link with me had totally snapped and I ledging what I was saying, in the following session he was completely had changed for 'A.' by being smeared, turned dirty, and he could withdrawn. Throughout the session he was studying a music sheet now leave me. I think my ash tray also represented a good link of the movie'Grease'. He was in tune with something greasy and between his father and me - it was me as container of father's worries slimy (as it turned out) and slipping away from me. which had to be smashed. And he succeeded because I felt it was no The following day he arrived with his father. They were both in longer possible for me to deal with father's immense guilt and a terribly upset state. 'A'looked furious and was crying. I learnt anxiety. that 'A' had tried to stir up his father, to turn him against me by telling him that I was talking dirty to 'A', on sexual matters. Father PATIENT B' said that at first he felt upset and spoke to his analyst but was rea- Patient 'B', my second case, is a middle-aged married woman ssured when he was told I was reliable and not to worry. Later at with two sons. She phoned me in a state of desperation to give her home finding that his father, supported me, 'A' lost all control and an appointment because she was seriously ill. In the first few sessions furiously attacted his father, tearing up father's shirt buttons and she continuously complained about her husband, that he was a scratching his chest. Father responded by punching him so hard monster, unfaithful, having affairs with secretaries, waitresses etc., that 'A' somersaulted over the dining table. In fact 'A' was carry- and painting a picture of her abject misery. She also spoke of a baby ing an ugly bruise on his face. Father insisted 'A' continue his who lived only for five days, starving and not taken care of. Spoke analysis, reminding him of his improvement, 'A' refused. Father of herself having an abortion, all alone, couJd not get someone to asked whether he would like to go to another analyst and 'A' replied be with her. When I made tentative interpretations about her "if you want to see my funeral you will send me to analysis". - feeling ill and emotionally starved, wanting me to understand this While relating this, father had been smoking a cigarette and and feel concerned for this baby in her, her reaction was intense and asked for an ash tray. I pointed to my cupboard from where he took frightening. I was unprepared for what followed. She responded out the ash tray (a heavy glass one) and stubbed out his cigarette. by banging on the couch, having a temper tantrum. Viciously said I wanted to speak to 'A' alone, bur the moment father left the that she would scream, graphically illustrated how she would run room, 'A' attacked the play material, which he knew was kept only down the corridor screaming and throw herself over the banister for him. He methodically tore most of the paper, broke all the rails. The fact that I have my rooms on the 20th floor did little to pencils and crayons. He then opened out my cupboard and attemp- ease my anxiety. ted to tear my books, when I stopped him. The rest of the time I She warned me to slow down and said that "the baby cannot had to guard my ash tray because he seemed intent on smashing it. take in such rich food". That "one does not give Taj food to a We could see how he systematically tried to destroy the analysis, starving beggar or he would die of indigestion". She affected me to S. FORBES SAMIKSA Vol. 41, No. 1 NEGATIVE THERAPEUTIC REACTION such an extent thut I was temporarily silenced and much more lened her son that if he went out with his girl friend, who she called careful. repulsive, she would slit her wrists. She would tell me that I tried Another area where she had the same sort of reaction was when- to show her a different world where everyone was supposed to be ever I reminded her of my existence as another person in the room gentle, refined, like a tea party, but her world was fuJl of barbarism, with her. She insisted on my being 'a professional', and if I insisted violence and death and she insisted that she belonged there and that on my presence being felt she was certain I was trying to seduce her, was where she would stay. and dramatically insisted that we could not be lovers. In the transference, so long as she showed she was never satis- The material she brought was so vivid and graphic that it felt fied she therefore remained starved. And I remained someone who like I was either watching a pornographic movie or a violent, was not giving anything. She had to keep me as a frightened mother bloody one. or a violent father, and she clung onto this even though the analysis I got some history from this patient, but always wondered how was so unlike what she said had happened to her when she was much was true and how much was exaggerated for dramatic effect. little. Once, later in the analysis, she related to me how she had She has an elder brother and whenever she spoke of him it was all visited her school where there was a carnival to collect funds for romantic and sexual. construction of a new wing. She looked at some steps leading some- Her father was described as a tyrant. A violent man who had where and thought how big they had seemed when she was little, but had people killed off. The family had to walk on tip-toe around now seemed so small. She said she had fallen when little, on these him. Her mother always used to be very frightened and kept telling steps, the sharp edge had hurt her. And then she paused, took a her never to anger him or he would kill them both. deep breath, and began her graphic description, that it had hurt She had a boy friend in college and when her mother found out, bstwecn her legs. She had bled, mother was terrified that she had she was terrified and told'B'to give him up otherwise father would broken her hymen and had said father would kill her. Took her to a have them all killed. doctor, not to care about her, but to make sure she was still a virgin, When she was eleven she was engaged to a prince. This was that her hymen was intact. Here 'B' showed how she started out announced to her at her birthday party. Instead of a doll she got an out with a pleasant feeling of constructive work done between us, that engagement ring, she said that she screamed and ran away threaten- her worries did not seem so big to her as when she was little, but ing to kill herself. But then she liktd the idea and showed her ring then she turned back, and got caught up again in fear, violence, to everyone in school. The engagement was finally broken off. etc. She could not stay in contact with something good for long and She not only has extremely morbid phantasies of gory happen- took flight into attacking and being attacked. I think I was often ings to her children, husband, and herself, but also involves her supposed to feel awful, and it would excite her to be able to do this family by relating these phantasies to them and getting excited in to me. She made me the audience, made me feel that there was hurting them. For instance, her husband touring abroad was con- nothing in the world I could do. I was to feel helpless, worried, but cerned about how she was progressing in Bombay arid she sent him a not able to do anything. post-card with a picture of tombstones. Interpretations along these lines appeared to help her and *^ She has tremendous separation fears and someone has to be gradually there were positive changes. She went through two near her all the time. She often would tell me how she had a terrible successive weekends without her usual intense feelings of illness. She time during the weekend and that the best thing was to die, and she began to visit people, go to concerts, etc. -In the sessions themselves described the various ways she would kill herself. Her husband her morbid and erotic phantasies reduced. She no longer made me when on tour, would phone to ask her how she was. She would tell feel cold and worried. She herself was quite pleased and hopeful him he was a homosexual, or tint she wanted a divorce. She threa- about the change. And then the sessions became dull and insipid. S. FORBES SAMIKSA Vol. 41, No. NEGATIVE THERAPEUTIC REACTION

As if, there was no real work being done. A little after this, quite herself as a cruel mother. Anything [ said she called it "misunder- suddenly in a session, she said she was feeling much better now, she standing" and told me it was the opposite of what she wanted to was going to stay with an aunt in Madras and that this would be our convey. She would say "obviously you don't know me" ; "I have last session. Her reason was that she could no longer bear the dirt not told you anything about me so how can you understand" ; She and filth of Bombay. would cruelly tease and mock what shefelt was my "being defensive"; After this abrupt end she continued to keep in touch with me by she would say "I have got you in a corner, admit it". Once when I phone and letters. One and a half months later she asked to come pointed out how she was trying to shake my confidence in my convic- back. tions, she said very emphatically "one day I will" ; Whenever I Although I did not get the same intense feelings of worry and would talk to her about her showing me how it felt to live with such anxiety about her, as when she had first started with me, I continued a self-centred (internal) mother, she would reply "this is your to get a dull, helpless feeling. She left after six days of analysis, i magi nation" or "you do not experience anything". This was always said she would return when she felt she wanted to, leaving me with most difficult to deal with, that I was all alone suffering these experi- the feeling that it had been a waste of time. ences and that she did not know or want to know about them. I continued interpreting to her about her giving me her experi- PATIENT 'C ence of Jjeing with such a bad mother who would say to the child, Patient 'C is a good looking young woman. She has a younger "what did you say?" or "what are you talking about ?" or, a bad sister and lives with her parents. Her main problem, she said, was mother who would say "you are a selfiish crying baby who does not her mother. She pictured the mother as an awful person, self- want to admire an attractive mother", And I as this child part of centered, possessive and jealous. The implication was that it v as her was meant to feel that it would be mad or preposterous of me to her mother that she wanted to solve through therapy. protest at this kind of treatment. I was to experience this child part Her attitude in the therapy would be to come in smiling with of her who felt that no one knew that I was having these experiences. great eagerness, but the moment she lay down all that vanished. These interpretations with me holding the child-her's experience There were long silences often of 20 minutes duration after which 1 did make her feel better. would get a couple of sentences. I experienced quite painful She began to feel improvement in her life, and she began to longings in me to have her talk to me. It was a very frustrating grudgingly acknowledge that I was helping her. Although there was experience. All I was supposed to do was to sit and admire her a part of her which was out to spoil any good feelings between us, attractiveness. and try to turn it false, yet, I observed there was now an open Most of what she related was how horrible her mother was and conflict in her. Where before she would just completely try to knock described her self-centredness, how her mother always expected to me down, now she was struggling against doing so. be paid attention to and praised. She was also certain that mother And then came a day when through her associations she spoke was looking for some excuse to get rid of her, and that 'C could of wanting to help and give something to me since she appreciated never voice any protest at being so badly treated. our work together. When I interpreted to her about her wondering In one association she had mentioned not liking to drive her how she could help me for the help that she received, she clearly own car, which had the seat quite low down, where she fell small showed the struggle and conflict within her when she answered ; "I behind the wheel. She preferred to drive her mother's car and felt could raise your fees, but at least I pay them". One could see how secure with it. This is what she was doing with me in the therapy, half of her wanted to show gratitude and the other half was out to she preferred to be in the position of the mother with me as the child. spoil it by telling me that I should be thankful she at least paid me. I was often to be the child-daughter completely at the mercy of It is important to note here that when she was referred to me I was 10 S. FORBES SAMIKSA Vol. 41, No. 1 NEGATIVE THERAPEUTIC REACTION li asked by the person who referred her to charge her a low fee. I regret his mother) was the chief, or only, cause of his violent attack on the having agreed to this because I later discovered that she was quite analysis which led to his breaking off. What led to the analytic wealthy and could easily afford a reasonable fee. breakdown was a smearing of the analyst, so that I changed for him, After the session about raising my fees she completely avoided became dirty, torn, messed up and he could then leave me. One direct discussion of this. I myself experienced some anxiety in brin- could perhaps say that this might be a covering up or getting rid of ging her back to it. But through her associations she would point his guilt feelings - a relief from a cruel super-ego if he destroys all out that it was my responsibility to discuss this issue, and that she hope. But I think that this would be more a defence against guilt herself could not stand up to the side of her which did not went to rather than an expression of it. And it would have felt ridiculous at pay me at all. such a moment of violence to talk to him about his guilt. Finally, when I did confront this issue she reacted by telling me Freud (1924) himself seemed to reach this view when he spoke she would stop the analysis at the end of the month. And, yet I also of the uselessness of talking to such patients about guilt. His felt that once again she was making me go through a child-hers patients, he said, instead felt that it was the treatment which was experiences, that whenever a need is expressed it would lead to being unsuitable for them. Freud's further investigations along these lines abandoned by the parents. She finally did interrupt the analysis but led him to discover the importance of masochism and the death showed clearly her struggle about this. She said she would return instinct in patients displayiag NTR. later on and I think she will. But let us for the moment not stray too far from the three cases I described and try to discover what they do have in common. The common factor is that hope is destroyed, both in the outside world (that is, in the analyst) and the internal world (that is, inside the patient since there was improvement). In the transference situation DISCUSSION one could say that it is the positive link between the patient and analyst which is attacked, twisted and changed to a negative link. I think the above three cases show direct expression of NTR. All Further, the hope that is expressed includes a perception of the three patients soon after showing hopeful signs in therapy, began to analyst as a mother who has a capacity to feed the baby in the deteriorate. At the European Psycho-analytical federations'confer- patient. And subsequently something in these patients is determined ence on NTR (1979) Dr. Sandier emphasised that Freud's original to spoil this state of affairs. concept of NTR should include these two attitudes, improvement This was clearly demonstrated by all three cases. For instance, and deterioration, in quick sequence. In all three cases there was the attack on my capacity to give good interpretations, turned dirty hopeful improvement and then a back-tracking leading to an interrup- by patient 'A'. As also my good link with his father, who had the tion of the treatment. responsibility to bring him to treatment, was attacked. I think the I would now like to examine some of the elements around NTR, attempt to smash my ash tray which contained father's cigarette was using material from these three cases. evidence of that. Freud's explanation of NTR being caused by an unconscious Patient 'B' openly threatened me with dire consequences (for e.g. sense of guilt, or a need for punishment, is not quite borne out with suicide), if I dared to speak of helping her. And so the same with my three cases. Although Patient 'A' I think displayed a cruel Patient 'C who once promised me, with the scathing remark, ihat twisted super-ego, out to wreck any success, the latter two cases did one day she would destroy my confidence in myself and my work. not have this in common. In fact, even with patient'A'I do not I think that the above common factor showed that a narcissistic think that guilt {for e.g. to the real traumatic event of the death of organisation was present in all three cases. And that envy was a 12 S. FORBES SAMIKSA Vol. 41, No. 1 NEGATIVE THERAPEUTIC REACTION 13 strong component in their NTR. Many authors have reached this used Freud's ideas of primary destructiveness and connected il to her conclusion : Abraham (1919); Horney (1936) ; Klein (1957) and own idea of primitive envy as being the most destructive derivative Rosenfeld(1975) ; etc. of the death instinct, because it attacks the good object and therefore Mrs. Klein (1957) described the sequence of hope and progress spoils and depletes the self's internal and external resources. followed by deterioration in analysis as characteristic of envy. She In his paper on Analysis Terminable and Interminable (1937) regarded envy as intrinsic to the NTR. She said, "Needless tosay, Freud returns to the theme of NTR. Although at first glance this our patients criticise us for a variety of reasons, sometimes with paper may seem unduly pessimistic in his doubts about the c\native justification. But a patient's need to devalue the analytic work which factors in analysis, on closer inspection I think it abounds with very he has experienced as helpful, is the expression of envy" • ..."envy thought-provoking and honest questioning. This is Freud at his best, and the defences against it, play an important part in the NTR, in not letting what is already known stifle his scientific curiosity. He addition to the factors described by Freud .... ". says : "Instead of an enquiry into how a cure by analysis comes However, Freud, in contrast to Mrs. Klein, did not appear to (a matter which I think has been sufficiently elucidated) the question feel that the attack on the analyst was the real issue in NTR, he should be asked of what are the obstacles that stand in the way of thought the explanation about unconscious guilt was " .... a deeper such a cure ?". and juster view " that the attack on the analyst was a by- • He reaches the conclusion that it is in a firm analytic setting, product, rather than an intrinsic part of NTR. with the exploration of the transference analytic setting, that the At the European Psycho Analytical Federation's Conference on most effective means of reducing the chance of future conflict has NTR (1979) it was Mrs. Spillius who suggested that Freud at the . to be worked through. But he bemoans the fact that the level of time of defining his concept was quite concerned about showing understanding and recognising latent conflicts in the transference at evidence for the usefulness of the concept of the super-ego. In fact the time that he wrote this paper, was not powerful enough to avoid Freud first discussed NTR in his paper on the Ego and .the Id where future illness. he discussed primarily the usefulness of structural theory in psycho- In another part of this paper we also note Freud's uneasiness analysis. Mrs. Spillius therefore felt that Freud's clinical description in only explaining aft unconscious sense of guilt as being responsible of NTR, where he described patients with the sequence hope and for NTR. With the death instinct in mind he said, "No stronger then deterioration, should be viewed apart from his psychological impression arises from the resistances during the work of analysis explanation of the role of the super-ego which Freud, she thought, than of there being a force which is defending itself by every possible was too eager to connect to NTR. —i.e. that guilt was the cause. means against recovery and which is absolutely resolved to hold on to Mrs. Spillious then sets out through her clinical cases to show ihat illness and suffering. One portion of this force has been recognised narcissism and envy are the factors most often associated with Freud's by us, undoubtedly with justice, as the sense of guilt and need for clinical description of NTR. punishment and has been localised by us in the ego's relation to the Although my clinical material agrees with Mrs. Spillius, about super-ego. But this is only a portion of it other quotas of the the central importance of envy and narcissism, I do not think that same force may be at work in other unspecified places ". even Freud himself was quite satisfied with his 'psychological expla- In connection with this he emphasises'the importance of future re- nation'. He investigated NTR further in his paper on the Economic search on the life and death instincts and says, "these are problems Problem of Masochism (1924), where he extends his investigation to whose elucidation would be the most rewarding achievement of psy- the area of life and death instincts and of primary destructiveness. chological research". I think Mrs. Klein and her followers have He also touches on destructiveness as having a pleasurable component, made substantial contributions in this area. even destructiveness of the self. It is noteworthy that Mrs. Klein Returning to my three cases I think another common element in 14 S. FORBES SAMIKSA Vol. 41, No. l NEGATIVE THERAPEUTIC REACTION 15 their NTR was, at times, a total lack of awareness of their destruc- husband was not satisfactory enough and she would get caught up in tiveness. It was as if at that moment there was little or no obser- destructiveness which she found tremendously exciting. Sometimes ving capacity in recognising their demolition of the analyst and watching her like this I felt she herself could not stop it, analysis. As if they were in the grip of something so totally destruc- that it would just take over all hold on her own perception and tive that the saner parts of their personality went along with it or thinking. were completely taken over. This cruel excitement taking over saner parts of the personality, With Patient 'A' sometimes in the session when I particularly especially awareness, was particularly noticeable in Patient 'C. She felt cruelly thrown aside by him and verbalised this for him, his face was often smiling ingratiatingly, and terribly destructive. She would would slowly change into a blissful cruel smile which is difficult to come in with a smiling face and in the end leave her analyst with the describe without sounding too dramatic-but it had a quality of evil. feeling of wanting to blow his brains out. I think she actually did Remembering that smile I feel sure that there was an intense perverse not know why she was being so terribly cruel to her analyst. delight with a strong erotic component, at destroying both the nour- She would often twist what I said so quickly that she hardly ishing analyst and the needy part of himself. One thinks of Freud's recognised that she was doing it. At times she eagerly knocked words that (1924) " even the subject's destruction of himself crn- down every interpretation given to her. Occasionally she showed not take place without libidinal satisfaction". There was a mindless worry about the way she was going on but could not stop it and violence in Patient 'A' when he set about ruining the play material conveyed a feeling that she was caught in it. given to him. It was when he opened out my cupboard to try to I think this perverse quality in all three cases is a sense of trium- destroy my books that I had to stop him. He angrily said I should phant excitement in seducing the good and saner parts of the self and not stop him, my protecting my own books was felt by him, he said, defeating the analyst. Dr. Meltzer in his paper (1968) on 'Terror as proof that I was against him. Persecution and Dread' shows that the destructive part of the perso- Here one could note that a perverse part of him had taken over nality aims to create confusion and chaos so that the good infantile completely, attacking his own possessions and was in a fury that I too self will abandon psychic and external reality and willingly submit to did not succumb to his hypnotic command. the voluptuous despair offered by the bad self. Dr. Rosenfeld (1971) Patient 'B' also demonstrated getting herself caught up in the describes "destructive narcissism" which he says is rased on an grip of violent and erotic phantasies. She could not really shake idealisation of the bad self. them off. She showed the power of this grip on her, once, when she The authors'mentioned above and others who have studied this was talking to me about her husband's efforts to reduce her worry destructive organisation which gets pleasure from omnipotence, about the coming weekend (weekends always terrified her). After cruelty, and triumph, feel that it is motivated and created by envy. she felt nice about her husband's concern she paused for a moment, And is simultaneously a defence against it. That this destructive and then began, "he is a mother-fucking bullsliitter. He acts awful organisation is a compromise formation, that it is simultaneously an with me because of his frustration of having always wanted to fuck expression of the death instict and a defence against it. his mother but never being able to do so" and she went on in this I think a very important contribution of just how such a des- way. And while she was caught in the grip of the excitement of tructive organisation arises is offered by Dr. Bion (1962). He bases her attacks I was just supposed to be the audience watching this, his model on Freud's Formulations on the Two Principles of Mental feeling awful, but never being able to do anything. Wherever she Functioning" (S. E. 12). Freud described the aim of the pleasure prin- was able to show a different picture of someone, e.g. her husband ciple as the avoidance and discharge of unpleasurabie tensions and as being nice, she could not stay in contact with this for long and stimuli. Bion combines this idea with Mrs. Klein's idea, which is would take flight into attacking him. It was as if the idea of a nice similar to Freud's on the discharge of unpleasurable stimuli, but from 16 S. FORBES SAMIKSA Vol. 41, No. 1 NEGATIVE THERAPEUTIC REACTION 17 an object relations perspective—that the young infant defends his ego from intolerable anxiety by splitting off and projecting unwanted to show superiority, not to put anything right. This envious stripping impulses, feelings, etc. into his object. Bion made the discovery, that internal object does as complete a takeover of the ego as it can. The this sort of projection (which Mrs. Klein termed 'Projective Identifi- ego becomes identified with it. cation') apart from being a mechanism of defence, was the very first Hsre Bion has attempted to tackle the problem of how an orga- means of communication between mother and infant. He felt that nisation so destructive, cruel and triumphant arises, which now the very young infant communicates his feelings, his fears, etc. to his brings me to examining the situation of the analyst faced with such a mother by projecting them into her for her'to receive and know them. bad and destructive part in the patient. I think the analyst's feelings The mother uses her capacity, Bion calls it her reverie, her capacity are bound to be extremely painful confronted with the cold brutality with love to think about her infant, to pay attention, to try to under- of these patients. stand. Her thinking transforms the infant's feelings into a known One element which makes it more uncomfortable for the analyst and tolerated experience. The infant will then introject and identify is that he cannot expect any help from the patient, since the sane with a mother who is able to think, and he will introject also his own parts of the patient are caught up in this whirlwind of cruelty. now modified feelings. Yet, if seen from a different angle, the analyst's reactions obser- ved in the countertransference can also be useful, to examine what Each such projective—introjective cycle between infant and the" patient has had to face, and continues to do so. mother gradually transforms the infant's entire mental situation. If we take a look at Patient 'C's analysis in the situation of rai- Instead of a pleasure ego evacuating unpleasure, a new structure is sing her fees—I had to face the difficult situation of confronting a bad gradually achieved ; a reality ego which has unconsciously interna- internal object who would, if any need was expressed, abandon me. lised at its centre an object with the capacity to think, that is, to When I had in fact managed to face such an object and was interpre- know and perceive psychic qualities in itself and others. ting this to her, she replied that it should not really be so difficult for Failure to develop a reality ego may be due to, on the mother's me. And in a way I thought she was right—that although I had side, her failure of reverie, to accept her infant's communications by faced this cruelty in the analysis, she, was the one who had to live his raithod of projection. She then deprives him of a fundamental with such a cold heartless internal object. I think if one keeps this need for an object different from himself—a need for an object who in mind it becomes easier to face the cruelty in such patients— does not evacuate the unpleasurable, but, instead, retains it and knowing that no matter how painful it is for the analyst, it is much thinks about it. The consequence of such a failure is that the infant more difficult for the patient who carries this destructiveness around then internalises an object who is experienced as denuding him and with him. , . stripping him of all goodness. Another factor worth looking at, in my reaction, is that I some- Failure to develop a reality ego may also be due to the infant's times felt it quite impossible to face the terrible destructiveness in all own excessive envy of his mother, capacity to tolerate what he the three cases. I found myself acting out the patient's own internal cannot. This would lead to the infant projecting, into the breast, state of avoiding, not*truggling with, and facing (he truth- Just as envy and hate of the breast. Because of this projected envy the saner elements (especially reality perception) would be helplessly the breast is now felt as enviously removing good elements from the handed over by these patients to the bad part of themselves, so also infant and forcing in worthless residue. Even attempting to take I found myself, at times, beginning to avoid and hand over my away the infant's will to live. When reintrojecfed this object be- awareness and perception. comes an extremely destructive internal object, bent on stripping the infant, or what is left of the infant, of any qualities he still posse- With Patient 'A' I have always wondered whether I should have sses, enviously asserting moral superiority, arousing guilt but only encouraged the father to bring him back to the treatment instead of getting caught up with the father's fears that his son would fall 18 S. FORBES SAMIKSA Vol. 41, No. 1 NEGATIVE THERAPEUTIC REACTION 19

seriously ill if he continued the treatment. Father's fears were a In the second dream she is turning a corner in her car, taking a result of 'A's projections 'threat of suicide, etc.) which father in road on the wiy to therapy. She notices a loiry driver going along- turn projected into me. Perhaps I too readily agreed to forget about side her, together with her, but then he suddenly turns and bangs 'A's coming back. Even when father later phoned, and asked me into her. whether I felt he should bring him back to analysis, I left the decision In the third dream she is driving down a hill. She sees a mother to him. It was a relief for me not to have him back- and child crossing the road and has to brake to stop from knocking With Patient 'B' I do wonder if I should have been firmer in not them down. compromising the analytic setting, when she asked to return to treat- We could now quite clearly see the three ways that she tried to ment, since I knew it was going to be very temporary. This did lead get rid of her analyst. Either she would succeed in seducing me and to a strengthening of omnipotent and triumphant feelings in,her. In lose the therapy—that is the two girls in the dream, or the analytic fact, after discontinuing, treatment for the second time she wrote to breasts, wiped out. Onshe would viciously attack me for following me that she had visited the city where her ex-analyst lived but did not alongside her, when I tried to understand her. Or I would find all meet him. (Her ex-analyst had for years accepted her on a short this so unbearable that I would put on the brakes and stop the term therapy basis whenever she wanted). She wrote that when she therapy, which if you will remember I had actually contemplated told her son she has now got me as her new 'Doc', her son laughed. doing. She^ added, "these children are so disrespectful ". I think she From these experiences I do feel that the important task for the was telling me that she had lost respect for me for agreeing to take analyst is to stand up to this destructiveness in the patient, and not to her whenever and whatever length of time she wanted, and that she succumb to their threats and blackmail, Because, I think, that such could flit in and out of the analysis whenever it pleased her Her own patients need a different object from themselves who can stand up to triumphant laughter at what she felt was my helplessness showed them, and not bs the same as them in avoiding and getting taken through. over. With Patient'C in the first month of therapy T felt quite stuck, I feel such patients test the analyst's strength to the limit—try to particularly because I found it impossible to verbalise her seductive- crush his hopes, strip him of his confidence, seduce him into avoiding ness in the transference. Whenever I felt that I was close to under- his work, and so on. standing about this situation she would cruelly try to shake me up There have been some authors on NTR (W. Reich, 1933, Olinick^ and unbalance me by saying I knew nothing. I was seriously deba- 1964; Langs, 1976) who felt that faulty technique was the cause of ting whether she was right, whether I should stop this therapy and NTR, and that it is not a function of the patient's psychopathology. refer her to someone else. Finally I decided to discuss this situation In fact, some of these analysts •are critical of the concept of NTR with a colleague. This helped a lot in getting the thera"py moving bscause they think it is an excuse for bad technique, I think this again because I felt strengthened enough to confront what she was would bs true if one misused this concept, and used it in a loose and doing to me with her seductive and cruel ways, that is, trying to turn general way to cover any sort of intractable resistances or negative me helpless and knock me out. Confronting her in this way also behaviour. I think if one follows Dr. Sandlers' caution (European enabled her own worry of what she was doing to emerge. She men- Federation 1979) that we should stick to Freud's original definition tioned her worry about driving dangerously these days and brought of NTR, with its biphasic aspect—improvement or success, followed three dreams. by relapse or failure, so that a misuse of this concept would be In the first dream she is driving down a main road and sees two avoided. girls running across the road—a bus had obstructed her view and she • Yet, although I think faully technique is not the cause of NTR, has to put on her brakes to keep from running them down. there are certainly numerous pitfalls for the analyst which could lead 20 S. FORBES SAM IKS A Vol.41, No. 1 NEGATIVE THERAPEUTIC REACTION 21 to bad interpretation in cases of NTR. But I think it is the destruc- of the one to say good-bye first. tive component in the patient with NTR which attempts to pull the In Patient 'C an excruciatingly painful state of waiting was pro- analyst into acting out with him. And if the analyst allows himself jected into me continuously. In mostly all her sessions I was kept to get caught up in despair, persecution, excitement, etc. then only a waiting for her to talk to me, with long gaps in between words and in misunderstanding and a destruction of true perception would remain. between sentences. I was supposed to experience the frustration..of I think in this way NTR may sometimes cause faulty technique and waiting and longing for an object who was not there. She recreated not the other way around. this time and again in the transference. In fact, it was after she inter- I now come to the last part of my paper. To the question why rupted the analysis that I discovered with some certainty that she does NTR occur, we have discussed envy and a destructive narcissis- knew, through someone we both know, that I was leaving for a mon- tic organisation in such patients. We have heard of this as being a th's vacation in April. She left the analysis end of February before simultaneous compromise -of direct expression of envy, and also of I had a chance to tell her of my holidays, and before we had any its being used as a defence. We have already examined the direct opportunity to talk about or explore this further. She would rather expression of cruelty and envy towards the analyst in my three cases. get rid of the analysis, which she acknowledged was helping her, I think what remains is the question : what were my patients in their than undergo any sort of experience of having to wait for a month. NTR defending themselves against ? On the last day she told me that she might probably come back to Although not very much has been uncovered in these three patients analysis later on. because so much time was taken up with their direct expression of It is this sort of perverse logic which these patients try to get 4 cruelty and triumph, not to mention that Patients A' and 'B' were excited and feel triumphant about, which prevents any real progress hardly in analysis for six months. Yet one factor emerged quite towards investigating, understanding and growth. clearly. This was an absolute inability to bear waiting. Any sort of Betty Joseph ended her paper on "Addiction to Near Death" awareness that they had to wait might lead to such unbearable frus- (1981) with the words : "It is very hard for our patients to find it tration that it was I think the most heavily defended against. I think possible to abandon such terrible delights for the uncertain pleasures the sense of omnipotent destructiveness was meant to wipe out any of real relationships". I think this shows her deep sympathy for such perception of their having to wait, and their need therefore to knock patients, and I will end my paper too on this sympathetic note. me down, devalue me, and get rid of me. With Patient 'A', if I kept him waiting even for two minutes when he had rung my bell early, he would then disappear and keep REFERENCES me waiting for him. Often for exactly the same amount of time that Abraham, K. (1919) "A Particular Form of Neurotic Resistance he had to wait. And if he was on time he would ring my bell franti- against the Psycho-Analytic Method". In selected cally if I delayed by more than five seconds. Whenever T would inform Papers on Psycho-Analysis. him about my holidays, shortly after, he would tell me that he too was going to take a break. Bion, W. (1962) "A Theory of Thinking". In Second Thoughts. With Patient 'B', she openly verbalised a terror of weekends. Freud, S. (1923). "The Ego and the Id". S. E- 19. But it was the sort of terror meant to get us both caught in its grip. I Freud, S. (1924). "The Economic Problem of Masochism, was hardly allowed to investigate this problem further. Family members S. E. 19. of her family had to remain with her or she threatened to slash her wrists. Tn fact we were nearing the Christmas break when she Freud, S. (1937). "Analysis Terminable and Interminable". decided to interrupt her analysis the first time. She always had to be S. E. 23. S. FORBES SAMIKSA 22 SAMIKSA, 1987 Vol. 41, Ko. 1 Homey, K. (1936) "The Problem of the Negative Therapeutic Reaction". Psychoanalytic Quarterly, 5. Joseph, B. (1981). "Addiction to Near Death". Bulletin of British Society. Klein, M. (1957). "Envy and Gratitude". Langs, R. .(1967). "The Negative Therapeutic Interaction". The Therapeutic Interaction, 2. Meltzer, D. (1968). "Terror, Persecution, and Dread". In A TECHNIQUE TO COPE WITH PSYCHOANALYTIC Sexual States of. Mind. RESISTANCE : PARADOXICAL INTENTION* Olinick, S. (1964). "The Negative Therapeutic Reaction". Inter- HAROLD KENNETH FINK national Journal Psycho-analysis, 45. Reich, W. (1933). "Character Analysis". London : Vision Press, 1950. . Rosenfeld, H, (1971) "A Clinical Approach to the Psycho-analytic Introduction Theory of the Life and Death Instincts : "An Investi- gation into the Aggressive Aspects of Narcissism". Psychoanalysis has been criticized as being too lengthy and expensive, International Journal of Psycho-Analysis, 52. because it delves "too deeply" into the psyche (Fink, 1956). But it is more thorough and fact-finding than a more cursory or superficial Rosenfeld, H. {l^TSy. "Negative Therapeutic Reaction". In Tactics approach. Paradoxical intention can get rid of the presenting symp- and Techniques in Psychoanalytic Therapy, 2. toms, thus allowing the analyst more time for a deep penetration into Sandier, J. (1979). "The Negative Therapeutic Reaction : An the storage matter of the unconscious mind. Introduction." European Psycho-analytical Federa- When I first came across the term paradoxical intention, in tion's Third Conference. therapeutic literature years ago, I realized that I — like others— Spillius Bott, E (1979) "Clinical Reflections on the Negative The- had used this method on occasion when it seemed intuitively appro- rapeutic Reaction". European Psycho-analytical priate, not realising that it had been labeled paradoxical intervention Federation's Third Conference. or intention, symptom prescription, etc. It is an intriguing approach, one that surprisingly works in most cases if accomplished carefully and with finesse. All of us, whether child or adult, have some natural built-in resistance to the pressure of authority figures, whether to parents, spouse, siblings, relatives, teachers, bosses, policemen, etc. We call this "human nature," something we quickly learn as a baby for survival, in order to protect our own interests, integrity, and power, and to avoid beeoraeing completely dependent on others. We thus

* Formerly called "paradoxical intervention," now simpified to "paradoxical intention," (Frankl, 1960). 24 H. K. FINK SAMIKSA Vol. 41, No. 1 PARADOXfCAL INTENTION 25 at all ages— resist pressure from others in order to feel that we are safely drink again, aad can be truly motivated enough to want help not merely passive "tools" in an overwhelming environment. (Fink, 1959 ; Fink, 1961c). His rare A.A. visits were without invol- Ask your son to take out the garbage and he will invariably make vement, but just to satisfy his family. a fuss, complain anfl put it off for as long as he can get away with disobedience. The quickest way to have children develop feeding Definitions problems and refuse to eat healthy vegetables, etc. is to order them to The patient may resist the analyst by "forgetting" appointments, eat. Forcing causes immediate withdrawal from the food as a show coming late, childish arguments and complaints about principles and of power and because of the resentment toward the pressure to con- progress, refusal to talk, etc. (Fink, 1985 ; 1986). A California form. Psychologists learn that quiet approaches work best on a more woman once fought a suggestion I had made for her benefit by refu- subtle level: "Would you like to wear this suit (or dress) to school sing to talk for a full session. She felt this would rattle me, but, tomorrow or that one ?" Given a choice, the child maintains his instead, I read a reprint I had received from a doctor. At the close (alleged) control of the situation, and he may agree to one or the of the time for her session, she begged for another session and never other possibility, since the pressure of authority is seemingly absent. gave me this kind of trouble again. In fact, it was one of the most All family member behaviors, including pathological ones, are constructive sessions we had had, probably because she realized that viewed as "preserving the cohesion of the family group," or by (he stubornness gave her nothing of value and that she could not always need for hoineostasis in the family organization (Palazzoli et al, 1978, have her way and be in control in life. in Dowd & Milne, 1986, p. 253). This means that even neurotic Paradoxical intention is used to deal with such resistance to change behaviors of family members become woven into the tapestry of the (Fink, 1954b). The word "paradox" comes from the Latin parcdo- family's unity and intra-dependence. xin, and the Greek paradoxon, meaning ''contrary to received opinion, Paradoxical intention depends on the tendency for certain basic incredible," according to the American College Dictionary (1955, aspects of human nature to be more or less universal. The "natural" •Random House, N. Y.). The doctor pursues an unexpected approach reaction to a direct order, whether at home or at work, is resistance : which surprises the patient and deprives him of his neurotic or psy- "Why do I have to do the dirty work all the time ! Why not Harry chotic omnipotence (attained through the free reign of his symptoms), for a change ? How is it that I always get the unwanted jobs ?" so the patient fights the doctor, doing the opposite of what he One of the basic Stumbling blocks in psychoanalysis is ccunter- suggests. If the therapist suggests continuing the syndrome, the acting the patient's immediate resistance, particularly if she is asked patient rights the suggestion by refusing to continue the symptom,, to get help by his or her family or the courts, against his or her will. which of course is what the doctor really wants ! False pride prevents him or her from admitting any presenting This valuable technique should be taught in psychoanalytic and problems. For example, I worked with an alcoholic,deferred by his psychotherapy training institutes and universities (Fink, 1961b). son, who, at the end of treatment, still would not admit being a true Years ago, the term, "reverse psychology," came into the language alcoholic : "I can still drink whenever I want to, without losing from radio lingo and amateur psychologists, an example of paradoxi- control," which was not true from what I heard of his home environ- cal intention : "I don't want you to set the table (or vacuum the rugs) ment. When he went shopping with a family member—since he because you are unable to do a neat job of it." The teenage girl was not allowed to drive a car for obvious reasons..—he pushed his suddenly has a strong urge to do the forbidden act just to defy her own car in the supermarket so he could hide liquor bottles under the mother's wishes and prove that she can do the job right. bread and other foods. There is a wise saying that alcoholics have Paradoxical therapy involves a "pathological double-bind" to "hit bottom" before they will admit they have a real drinking (Bateson et al, 1956, in Kercher & Smith, 1915, p. 786). One of the problem and realize they will always be alcoholics and never able to "contributing factors to the onset of schizophrenia is paradoxical 26 H. K. FINK SAMIKSA Vol. 41, No. 1 PARADOXICAL INTENTION 27 communication between parent and child-••...(A) therapeutic double- viously involuntary responses. For example, a patient with a head- bind is a mirror usage of the pathological double-bind (Watzlawixk ache would be asked to imagine a second, more painful, headache, et al, 1967, in Kercher & Smith, 1985, p. 786). The treatment double- which would erase the first one (Dunlap, 1928, quoted in Driscoll, bind puts the patient in a no-lose situation. "Symptom prescription 1985, p. 775). is a form of the'be spontaneous' paradox. Clients who describe Frankl was the first to "conceptualize paradoxical intention as a their symptoms as involuntary (i.e. spontaneous) are asked to per- separate class of therapeutic technics---(H)e developed--paradoxical form- ••{them) on purpose- --and surrender their symptoms," by refusing intention, which consisted of encouraging clients with anxieties and to cooperate with the doctor's orders (Italics added). phobias to wish to happen precisely that which they feared and Frankl (1975, in Dowd & Milne, 1986, p. 240) stressed the im- encouraging clients with obsessions and compulsions to do what they portance of humor in the practice of paradoxical intention in that it feared" (Italics added) (Frankl. 1939, in Dowd & Milne, 1986, p. 246). aids in "distancing and self-detachment from one's anxieties*-(and Frankl hypothesized that a major component of emotional distress fs decreases the) absorption with self and the consequent centering of "anticipatory anxiety--leading to a 'flight from fear' in which the life around fears." Frankl distinguishes between paradoxical inten- the patient avoids anxiety-arousing situations. The cycle of antici- tion andsymptom prescription (Dowd & Milne, 1986, vW): "Whereas patory anxiety is interrupted when the client faces the object of the in symptom prescription, clients are told to exaggerate their symptom, fear directly and does or wishes to happen, that which is feared" in paradoxical intention, clients are asked to wish for or >to per- (Frankl, 1975, in Dowd & Milne, 1986, p. 246). form the object of those fears." This is a moot point and does not remove ambiguity from the definitions. Specific Approaches In my adult education classes in Floria over a period of over two Riebel (1985) lists four technicques for paradoxical therapists : decades, I emphasized that a sense of humor was a very important, 1. Prescribing the Symptom: Frankl (1984) states that the though often overlooked or ignored, personality trait (Fink, 1962a ; "effect is to disarm that anticipatory anxiety which accounts for much Fink, 1962b\ It keeps us from taking ourselves too seriously, thus of the feedback mechanisms that initiate and perpetuate the neurotic easing our ego wounds. It gives us new perspectives on our own condition" (Frankl, 1984, p. 320). behaviour, and that of others. If the patient feels it's "funny" that 2. Restraining; The analyst tells his patient: "Don't expect he disobeyed his doctor so quickly and thus gained improvement, all too much from this treatment; it may fail!" the better ! Then there is less chance that the patient will complain that his analyst is playing tricks on him and gave him a foolish order. 3. Positioning : The doctor pessimistically discourages the The formula for paradoxical intention is simple : You tell your patient : "Your situation is pretty hopeless." The patient is patient to do the opposite of what you want him to do, or what is motivated to provs his doctor wrong by getting well ! not best for him. His natural rebellion against your authority causes 4. Preempting: The doctor predicts that the patient will con- him to do the correct thing. He fights you by disobeying your sider the doctor's suggestions as stupid and overly simplistic. The suggestion, and thus improves despite himself, by behaving in just the patient wants to prove otherwise by improving ! way you wish him to ! Although the patient does not normally rea- Other approaches include : lise that you are using a therapeutic technique, he fights your advice 5. Symptom Scheduling: The doctor sets up a schedule (e.g.) and acts contrary to your suggestion, leading to progress in mental for the compulsive hand-washer to wash his or her hands once each (and physical) health. You congratulate him and this wards off his half hour. The chore becomes such a nuisance that the patient criticisms of you for making so strangely illogical an order. gives up his symptom. In the arranged hierarchy of a phobia, the Dunlap used "negative practice," as he called it, to control pre- •28 H. K. FINK SAMIKSA Vol. 41, No. 1 PARADOXICAL INTENTION 29 patient is asked to be overwhelmed by his fantasies about snakes, patient believes his doctor really understands and commisserates with spiders, or the dark as in flooding or implosion therapy, until the' him, and begins to question his own delusions. The doctor becomes fear weakens and disappears. the patient's ally so that the patient feels less hopeless, stupid and 6. In Ref ranting or Relabeling, there is a "shift of meaning inadequate. This natural resistance causes the patient to oppose his attached to a problem or event" so that behaviour-•once viewed as own neurotic or psychotic symptoms. When the doctor accepts the negative is now viewed as positive" (Dowd & Milne, 1986, p. 263). patient's delusions, this shocks the patient since he had assumed that his therapist would oppose these beliefs just as his family had In Restraining, ( 2, above), the doctor may "prohibit client done. Now resistance to the analyst can only result in something change" (Dowd & Milne, 1986, p. 264). The resistant patient ex- beneficial: the patient giving up his symptoms and irrational beliefs. presses his freedom by ignoring the therapist's request and thus Not having to defend his delusions any more, the 'patient is free decreases the negative behaviour. The therapist may state that change to relinquish them. As Riebel (1985, p. 601) puts it, "(A)ll distur- is "impossible," thus motivating the patient to fight all the more for bances are forms of delusion .'. . (or) false beliefs . . . , mental sets change. We should also mention that Positioning (3, above) should with which individuals navigate life ... Entering the patient's world not be used with depressed patients who have a severely negative in a nonjudgemental way makes it easier for the patient to visualise self-image. It involves full agreement by the therapist with the his problems more clearly. patient's negative view of himself. To resist, the patient must adopt a more positive attitude toward himself, thus permitting change to Symptom prescription encourages the patient to increase the occur (Dowd & Milne, 1986, p. 265). frequency of the expression of his symptom, thus helping the paijent realise how foolish and useless it is. If the patient tries to avoid his 7. Negative Practice : This technique was originated by Knight symptom, he is under pressure and anxious, and feels frustrated in Dunlap (Peyser, 1984, p. !92) : The analyst asks the patient to his endeavour. But symptoms prescription removes the pressure and "repeat the maladaptive behavior or thought to fatigue,"' i.e., till it anticipation of failure as in stuttering, impotence, insomnia, etc. loses its power on the patient through the repetition. One approach that I find works well in family therapy is to Some people criticise psychoanalysis as taking too long and cost- enthusiastically encourage the negative attitude or behaviour. An ing too much (Fink, 1956), but some cases require depth therapy example would be the husband who neglects his wife at night by rather than a more symptomatic and superficial approach. Paradoxi- spending too much time with his cronies at a bar. (Some men who cal intention saves time in analysis by removing presenting symptoms prefer the macho companionship of other men,should not be married, in the beginning so that deeper problems can be given more time and because of the hardship they cause their wives who end up alone all attention. day—while the husband works—and most of the night while he gets Gestalt psychologists "encourage clients to intensify (heir symp- an ego boost from his male friends.) The wife is instructed to tell toms with the expectation that ... this will lead to the ... polar the husband to stay out even longer at night. She might say to him : opposite behavior" ( Polster & Polster, 1974, in Hills, Gruszkos, & 1 "Honey, you work so hard all day, you should have more time of Strong, 1985, p. 78") . My strong conviction ( though some doctors your own with your friends, so stay out as long as you wish. I'll disagree with me) is not to explain the method to the patient, which leave supper in the 'fridge' for you to heat up when you come home." can only cause him to question every other technique that the doctor The husband is now given permission to do what he did to prove his might use. "(P)aradoxical interventions . . . (are) not improved and dominance. Since his action no longer expresses power or control possibly diminished by extensive elaboration" to the patient (Hills, over his wife, the satisfaction is attenuated, and he rebels against her Gruszkos, & Strong, 1985, p. 784). pronouncement by coming home earlier ! By joining rather than criticising the patient's fantasies, the 30 H. K. FINK SAMIKSA Vol. 41. No. 1 PARADOXICAL INTENTION

RATIONALE : Why the method works "I doubt if I have ever worked with anyone so sad and miserable, la paradoxical intervention or intention, the therapist join* the and unfortunate as you !" Almost immediately, the patient adtnks patient's delusions (called by Riebel, "usurpation";. Entering the that other people may be worse off than he is and that he does not patient's belief system occurs in other therapy [systems: "acceptance, really suffer that much ! His perspective improves. exaggeration, provoking, preempting, restraining, role-playing, The cognitive dissonance (Festiner, 1957), caused by the patient's humour. Paradoxical intervention "has evolved for . . . (many) condi- illogical behaviour results in anxiety and tension that he can only tions, including family pathology, phobias, compulsions, and obse- anihilate through renouncing his symptoms. If the patient learns to ssions" (Riebel, 1985, 1985, p. 595). control his symptoms, then he realises that he is responsible for them Paradoxical intervention or intention could be considered an and thus induced to change them, thus reducing the anxiety-causing example of "negative reinforcement or of extinction of the feared dissonance. ' response, "similar to that of certain behavioral techniques such as Symptom prescription may make obeying the symptom a terrible' flooding and in vivo sensitization ... in that both methods propose ordeal. Haley (1963, in Dowd and Milne, 1986, p. 250) instructed that one should do the thing one fears and that, in doing so, one will an elderly man who got'only two hours sleep at night to spend his change" (Johnson, 1986, p. 299]. tims waxing the kitchen floor, a task he hated. After a few nights, Logically, the patient sees himself as less sick if the doctor the patient began to sleep so as to avoid the chore ! agrees with him by encouraging his symptomatic expression as a "rational" method of cure. . Rosen (1953) was one of the first to Examples of the method in practical use ' - encourage sympton exaggeration, so that the patient would come to The patient, in my opinion, should not be told ^about the para- see how foolish his behaviour was. In a workshop at New York City's 1 doxical technique or s/he might distrust the analyst from then on. Postgraduate Centre for Mental Health, Rosen, a few years earlier, Driscoll (1985) believes the doctor should inform the patient of the demonstrated how he would sit on the floor with a very sick psycho- rationale of the method : "in most cases, we can explain the ratio- tic patient and agree with all his delusions, even enlarge upon them, hale direetly to the clients so that the suggestions make sense and they gaining rapport with the individual until he would come to see the see the reason to comply" (Driscoll, 1985, p. 775). But I feel that ridiculousness of his beliefs. The patient appreciated the doctor this attenuates the impact of the approach, since the patient now listening to him respectfully without criticism or ridicule andjeven- knows why he is acting paradoxically and thus may fail to cooperate ! tually would discard his invalid beliefs. As a teenager, growing up in New York City, I would sometimes An important facet oLthis technique isthat continuing the symp- be alone weekends when my parents were on a lecture tour and have tom gives the patient control over it. It is no longer happening to him, to feed their dog. Since they spoiled it with special food scraps like but he is causing it to happen ! Thus he now has the power to kill the chicken, Tibby would refuse ordinary dogfood. When Tibby symptom. Creating a written hierarchy of fears (e.g., of animals or sniffed the food and walked away, I would pick up the dish, blow my embarrassing situations) allows the patient to practice control over breath on it so he would smell my breath, and I'd pick up some of the these situations, through fantasising each step in the hierarchy till food, making mouth movements as if eating it. When he saw that fear is no longer experienced by these successively more serious mental he was going to lose his dinner, he suddenly grew interested and rush- steps. ed to thedish when [ replaced it on the kitchen floor. (Havipg two The therapist thus mirrors the patient through imitation and dogs, incidentally, helps even more to remove hesitancy because one exaggeration, entering into his/her fantasies- I sometimes say to a djg, eating, cajjses ths other to compete before the food is all gone.) patient who complains a lot about inconsequential trivia in his life : Adler would predict to the patient that a phobia, fainting spells. 32 H. K. FINK SAMIKSA Vol. 41, No. 1 PARADOXICAL INTENTION 33 or other symptoms would get worse, and this caused them to actually sexual expsrtise is 95% mental and only about 5% physical! When decrease (Adler, 1923, in Dowd & Milne, 1986, p, 244). The the rain is insecure about his ability, this tends to nullify his perfor- patient had to prove that the doctor was wrong by relinquishing his mance. The doctor does not reveal his technique or he might create own symptoms ! A patient may cling to his idee fixe till someone distrust concerning later suggestions that he might make in the agrees with it. Adler examined a man who claimed he had syphilis, future. The marriage counsellor tells the couple how pleased s/he is and told him that he did have the disease, whereupon the patient, with their success and lets it go at that. alarmed, denied it (Bottome, 1985, p. 596). A male, college-educated schizophrenic hated his father for Riebel narrates a trick by Erickson who asked a patient, claiming dying and thus "deserting" him to the control of his powerful, over- to be Jesus, if he had experience as a carpenter. The man, loyal to hearing mother. (I worked for a few sessions with the mother ar.d his delusion, said he had and was put to work at the hospital in cons- she was actually passive,,meek, and far from aggressive—quite diffe- truction ! (Haley, 1973, in Riebel, 1985, p. 595). rent from the distorted picture created by the patient). He expressed Strean (1964) had a patient who boasted of space journeys and tension and hostility by pacing the floor of my La Jolla California licking supermen. Stream confided that he had trained Superman, office and, as he neared the end wall, he kicked it. I did not forbid climbed higher mountains than he had, etc. The patient finally him from defacing my wall, but, in effect/ by my silence, gave him called the doctor a liar: 'Most of (these things) are impssible permission to pace and kick the wall as long as it helped give him anyway !" he confessed (in Riebel, 1985, p. 595). release. If the office had been bigger, I could have joined him and The analyst, using Ellis's direct approach, Rational-Emotive this wbuld have seemed silly to the patient and he probably would Therapy (Ellis, 1985) might tell the patient who was afraid to speak have quit this behavior sooner (Fink, 1954a ; Fink, 1961a). Erickson out in a community meeting because he might make an ass of him- (1959) calls this joining the resistance. self: "So you say something foolish? Big deal ! Who cares and • A young male patient had a phobia about riding in New York who will remember the next day ! What is so terrible about saying Cjty elevators. I asked the mother's permission to bring him to a something foolish ? We all do that from time to time. It's better tall building and, while his mother waited on the first floor to add than being silent and frustrated." By facing the feared condition emotional support, I asked the boy : "Would you rather go up aafrd, head-on, paradoxical intention lessens the fear and develops inner down alone or with me ?" He asked me to accompany him. cried at strength in the individual. first because of his intense fear, obviously not wanting to enter the In marriage counselling, we often get cases of temporary psychic elevator at all, but we started going up with him holding my hand impotence, where there is no physiological or organic eJiolcgy : The with a fierce grip for security.. Since I showed no fear, he felt husband may be reading, to his wife's nagging after a recent fight, to reassured that it was safe. Soon he was pushing the floor buttons a trautni such as having been fired from his job or refused an expec- himself, making a game out of the elevator's movements. According ted raise in salary or position, or even, perhaps, to guilt about an to his mother, he never again avoided elevators—certainly easier than extramarital affair. I order- the couple not to have intercourse for walking up those long flights of stairs in a big city. Some months two weeks/but my prescription allows for other intimate behaviour later, I phoned the mother who assured me there was no return of such as kissing, caressing, fondling, etc. In a week or so, without She the phobia (Fink, 1P81). performance pressure the husband had suffered, the couple confesses When I had my first private practice in New York City in the to disobeying the doctor's prescription, as a result of which they had 4Ts, after getting out of the Navy in WW2, my mother phoned me successful intercourse. The wife had cooperated by not expecting one night when I was working late : "Ken, I can't sleep. I play the success and the husband, more relaxed, was successful. This technique radio but that doesn't help. I have terrible insomnia." I relaxed works almost every time ! Which only proves that in homo sapiens 34 H. K. FINK SAMIKSA Vol. 41. No. 1 PARADOXICAL INTENTION 35

her mind by informing her that people don't die from lack of sleep TLC, had baa hospitalized over 50 times to have toothbrushes, (except in the unusual conditions of a concentration camp in WW2), darning needles, pens, etc. removed from her stomach. She admit- that older people often (though not always) need less sleep than ted that she swallowed these objects in order to "escape the inner younger people- She admitted she usually got by with 4-5 hours mental pain through the amnesia of the anesthesia" used to remove sleep and then was up at dawn for early breakfast. Most the objects from her digestive tract. In one of my Hospital group insomniacs who claim they "never sleep" are not aware of the brief therapy units, I once offered my pen cap as I took notes : "Here, try catnaps they take during the night. She drank Sanka coffee (without this !" She got angry briefly and then started to laugh, •understand- caflfeine) so caffeine was not involved. Lastly, I pointed out that ing my motivation and realising the silliness of her behaviour. She "Even if your mind stays alert, your body benefits from the rest on stopped swallowing things at the Hospital except on rare occasions the bed." when she*was mad at the staff. When I left to work at another Then I made my "prescription :" I asked her when she went to island (the Maui Mental Health Center), she began to swallow things bed each night: "I go to bed at 9 : 30 pm to be sure I get enough again, in order to get attention and pity. Whenever she got leave sleep." I told her to read in bed at night (She enjoyed reading from the Hospital, alcohol was her escape, and she was discovered about political issues in Time and Newsweek and solving difficult one time on the steps in front of a stranger's house as she tried to crosswordpuzzles from The New York Times), but to stay awake at sober up after a night of drinking in order to gain oblivion. It is a least till midnight. She later confessed that she could not stay up wonder that her boyfriend stuck by her. As an alcoholic, she that late, but would fall asleep earlier while reading. She never attended several treatment programs which only temporarily helped agiin complained about insomnia. her. Her self-image was so low that she did not value herself enough A male agoraphobic patient in 1950 in New York City was to take care of her body, although, externally, she was usually clean induced to accompany me and his supportive family to Central Park and well-groomed, spending a lot of time particularly on her long, one Sunday afternoon. He had not been out of his apartment curly black hair. for years, and he thoroughly enjoyed the outing, feeling reassured Being suicidal increased her risk-taking in drinking and in while surrounded by supportive people I explained that I did not swallowing objects. Sinj;e she had always desperately craved love, have time to take him out on a regular basis but he agreed to venture much of her self-abuse stemmed from times when her boyfrierd grew the "risk" of leaving his apartment again from time to time with his intolerant and frustrated, and threatened to give up their apartment family until he gradually overcame his fear of the streets. His fan- where they lived outside the Hospital, When he was good to her, tasy, when outdoors, was : "I'm afraid1 that, when alone, I might she gave up her symptoms and regained her sense of humour rush up to a beautiful woman and seduce her!" This was a At a hospital team meeting one afternoon (psychiatrists, cover for inferiority feelings because his wife (enjoyably) went out to psychologists, nurses, and social workers), I suggested something work to support the family, and he was at the time unable to help pay but added : "You will probably not approve of this idea because of the bills. On the other hand, he loved being home with his children, the current litigious tendence of patients." My plan was to sit her so perhaps this was a case where the switch in roles was best left at a table and put a lot of toothbrushes, pens, etc. on the table in alone. front of her and tell her to swallow them all just to prove she could I wanted to try paradoxical treatment at Hawaii State Hospital do it. My hunch is that she would have refused to obey the some time ago when I was chief psychologist on the entry ward—but "command." The team (of course) was afraid to take the risk so I was afraid to do so because of the danger of being used. The we will never know what the outcome would have been, but it might patient, an attractive, 23-year-old woman, had suffered a miserable have provided insight to her concerning her irrational and unpro- childhood, marriage, and divorce, without adequate affection and ductive actions. 36 H. K. FINK SAMIKSA Vol. 41. No. 1 PARADOXICAL INTENTION 37

The psychiatrist who supplied her medications had her sign a does not swallow anything now because her behavior is ignored and she contract for a month stating, in essence, that if she did not swallow no longer gets one-to-one attention through suicide watch. Without any alcohol or foreign substance for 30 days, she would be released attention, there is less to gain from swallowing objects, no solicitous to the alcoholic treatment programme at St. Francis Hospital. On attention except for the anesthesia. She has to learn to gain atten- the very last day of her contract, she sabotaged it by swallowing an tion in normal, sociable ways. Again, she needs a tolurent and eyebrow pencil a nurse had entrusted with her. At Castle Hospital empathic lover or husband who would give her the TLC she despera- where the pencil was removed from her stomach, the surgeon went tely needs so she can feel ^worthwhile, bnild up her self-esteem, and out of the room to study the Xr,ays of her stomach, during which no loigsr feel the need for unproductive attention-getting games. time she drank some rubbing alcohol from the table beside her and also swallowed a wire from her underwire support bra. Her game Cautions in the use of paradoxical intention is always sneaky, gives her delight for outwitting the hospital staff, There is implicit danger in using this technique in alcoholics, suici- and provides the following secondary gains : dal cases, sociopaths, paranoids, crisis situations, etc. for obvious 1. Swallowing objects obviously provides her with attention and reasons. Mentally retarded individuals may be too confused by the concern. doctor's "orders" to know how to react (Fink, 1970). In any case, 2. She gets a ride to the surgical hospital and the pleasure of being paradoxical intention should not be used un^jl a strong transference drugged by the anesthesia, thus achieving oblivion for a time relationship is developed between doctor and patient (Fink, 1986) so from her troubles. that the patient does not quit treatment in disgust. The approach is 3. She gets fussed over by a frightened and caring staff— afraid risky, even dangerous, with sociopaths because they are basically she'll break her promise again and swallow something else and moral without sufficient guilt about their behaviour, so that Ihey are get herself and them in trouble. (It is obviously impossible in apt to do almost anything that appeals to them. When you appeal any hospital to keep all objects locked up, since other patients to the negative side of a personality, this side is apt to display itself ! have the right to use nailfiles, combs, toothbrushes, etc.) If a teenage sociopath, intent on hurting his parent, threatens suicide I told this young woman, who could be charming and flirtatious "to show them : They'll be sorry when I'm gone !" the doctor must and easily influence others around her, that some day something take this seriously rather than ask him how he plans to kill himfelf. might catch in her colon, rupture it, causing peritonitis and possible and suggesting ways to make the deed more effective. With a neu- death, but she is overconfident or frankly does not really care \o Jive. rotic patient you can, on the other hand, sometimes get him to Her psychiatrist intelligently refuted to go through another con- think more rationally by saying : "May be suicide IS the answer tract wilh her the following month. She now has jewelry she could since this world is such a rotten place for you !" The patient may swallow—One can't keep everything from her and if we did, olher then reply : "Oh, it really isn't that bad. I don't really think I'd patients would secretly supply the objects ...a pen which she carries want to kill myself !" But the sociopath who has difficulty with any to write complaining letters to local newspapers about mental health depth of feeling or concern for anyone, including himself, might standards in Hawaii, and beautifnl poetry (which she has given me accept paradoxical encouragement and actually kill himself just for permission to publish some day/, plus a secret diary which I'm sure the joy of making his parents and friends weep. would be revealing to read. She carries around the ward a bag with In everyday life, paradoxical intervention or intent can work a baby blanket she is knitting for someone -and the knitting needles. againt our interests. The professional ice-skater who tells herself "I She even carries around her tooth brus.li to unnerve the staff, but she must not stumble on the ice,' may self-consciously do just that. The novice actor or public speaker commands himself to be calm, but 2 See Appendix for examples. hyperventilates on the stage and forgets his lines. 38 H. K. FINK SAMIKSA Vol. 41, No. 1 PARADOXICAL INTENTION

One must be careful in treating the elderly who may believe they Paradoxical intention in non-therapeutic situations have little to live for, particularly if they have poor health or even a This approach, obviously, should not be restricted to the treat- terminal illness : "Doctor, I feel so hopeless. I see no point in ment of patients alone. A boss may find that he has to tiptoe around living any more, since my wife is gone and I'm a burden to my chil- an employee who has become somewhat paranoid because of some dren and relatives. Few people bother to visit me any more, so I am incident at the company that bothered him. He refuses to take just waiting here to die !" For the analyst—with such a patient—to orders any more from supervisors, oi else sabotages them through say something critical of the patient's realistic attitude could push careless work. We have already mentioned the choice technique : him over the brink, e.g., "I realise you feel miserable, are perhaps "Would you like to take over the floor tomorrow or go with me to the most depressed person I've ever met. Life really IS hopeless for Hana to push a real estate deal ?" Choice always seems less pushy, you !" One might say this to a younger person who has more to even though the third choice of not doing either of the first two live for, to get him to realise how exaggerated his complaints are ar.d suggestions is not offered. that he does not suffer alone in this world. The young person might The strange compulsion of resistance is such that a person may reply : "Oh, my life is not THAT bad. If I make more of an effort, even refuse something pleasant that he wants very much ! On a New I'm gonna make it.youMl see !" and he works harder to achieve some- York City Street, I saw a little boy refuse an ice cream cone thing with his life atari prove the doctor wrong in his pessimistic preferred by his mother. She was melting down her wrist. To outlook. exert his "power" over her, he refused something he really wanted. The elderly patient, on the other hand, may feel convinced For the same reason an adult may refuse a gift from another adult by the doctor's own (authoritative) words that his life IS hopeless. just for spite, so as not to become beholden to that person. Adler's Although he may not necessarily kill himself, he may become more need for power takes precedence over Freud's basic drive for pleasure depressed, neglecting proper diet and eating habits, give up seeking and satisfaction in such a situation. new friends, activities, and hobbies, and avoid sports and searching Paradoxical suggestions work with both children and adults. for a new ladyfriend to replace his dead wife in his declining years. The child who refuses to practice the piano is told "You cannot stay Instead, convinced of his uselessness, he becomes a vegetable, indoors today to practice because it is too nice outside and you need physically alive, but dead in spirit. This may bring on death the exercise." Feeding problems are common in children of overly prematurely. nervous, highstrung, and fussy parents. Many children decide they The point is that one must be careful not to abuse this technique, hate vegetables or other foods, even before they taste them. One never using it either universally or frivolously, for it is not an male adult patient told me he refused to eat tomatoes because his approach appropriate for every patient. E.g., one has to have gcod father hated them. So he had never bothered to try them. (His rapport with a patient who talks aboul suicide, and know him long father died of a heart attack, but not from to ma toes !) I once made enough to know that his talk is a cry for help rather than an actual a home visit where I unhappily observed the physician's wife feetMrg accepted plan to do away with himself. If the doctor is sure of his their little daughter by hand, with the mother narrating : "This is patient's motivation, he may suggest additional methods of suicide Mr. Green Bean entering the tunnel," as she placed it in her child's which the patient will then label "far-fetched," thus mobilising the mouth. The daughter got so much attention by being a difficult healthier direction of his ego. In a word, is your patient intelligent eater that it was natural for her to want to keep up the game ! I enough to get your hidden message or does he take your suggestions took the mother aside and said: "You can save yourself a lot of literally, uuble to see the point bshind them, in which case you need work and help your daughter grow up by simply putting her food on to. quickly back off ! the table, telling her it will be removed in 15 minutes if she does not eat it." This worked like a charm, much to the surprise of the 40 H. K. FINK SAMIK.SA Vol. 41, No. 1 PARADOXICAL INTENTION 41 overanxious mother! It helps to say something like this to a child patients txr b-suave (and so think and feel)j different... Paradoxical wh.o is av picky aad diflSfluk eatet: "Yc*u cannoi have-peas far dinner intervention ••• enables the patient to assume^responsibility *or change tonight since thereare not.enough of them to gaatound '." Suddenly .,... ( mi thm,), LnsreAses his self-respect, self-estee», and-cofifidjence the. peas or other, previously ignored, vegetable, has gained new in his ability- to- contrQhhi& own behaviour . . .. (As.a msult), be feels ... value and the child must campete f»r his sha;re ! At this point,, he mate normal. Intentionally removing the restrictions o.n the unwan- normally insists on his share and the problem is ended. ted bshavior — enables the patient to view his, behavior from a — The. choice-technique again, comes, in handy with children and with new perspective . . . (and) allow some detachment . . . from symptom usually; excelleni results.. When the mother tells her child; "It's and, perhaps through laughingat his own behaviour . . . (attain) time for bed," thece is: usually automatic rebellion, even La the best greater self-acceptance . . . fP)aradoxical intervention . . . shortens of families, like waving a flag at a bulJ. The child whia.es : Can't treattnsnt" Fishman, 1981) (Italics added). I stay up a little longer?" Famous, emspa.thic child psychologist, the, late Dr. Haim Ginott, would say, simply : "Roy, would you rather go> to bed at 7 or 7 : 30 pirn. !" Roy, of coarse,,says the later References time, thinking he has made a decision for himself and saved fate Adler, A. (1923). The Practice and Theory of Individual" Psychology. from the. disgrace of giving in to .authority. He thus feds more London : Routledge & Paul. manly and independent. With the teenager, "Would you rather take out the garbage before or after dinner—or do the dishes ;" Parents Bateson, G., Jackson, D., Haley, J., &Weakland, J. (1950). Toward I have worked with are always amazed, taw well this approach usually a theory of schizophrenia. Behavioral Science, 2. 4. works with a child who foimesly argued about everything the pascals Bottome, P. (1939). Alfred Adler: A Biography. New York : Putnam. asked him or her to do. Dowd, E. T. & Milne, C. R, (1986). Paradoxical interventions in Giving children (or adults'a choice not only avoids mest fights counseling psychology. The Counseling Psychologist ; 14(2) at hotnsbut atecj shows respect forthe child'sintegrity byallowing him 237-282. to make decisions for himself. The. mother who nightly lays out the Driscoll, R. (1985). Common sense objectives in paradoxical inUr- clothes for her young child for school- the next day keeps aim overly ventions. Psychotherapy, 22(4), 774-778. passslve and dependent an her, perhaps even fearful because of his or Dunlap, D. (1928). A revision of the fundamental law of habit for- hei self-image of hopeless dep&ndency, for he is not allowed to benefit mation. Science, 57, 360-362. by learning from his own decisions. The mother can ask the chiM Ellis, A. (1985). Overcoming Resistance. New York : Institute for which suit h« wants to wear or even let him put together an outfit Rational Emotive Therapy. for himself. (She can check it to make swe the cl&tfoes ate colour— Erickson, M. H. (1959). Further clinical techniques of hypnosis : and style-appropiiatefor the typeof cla.ss ansd school fee is Utilization techniques, American Journal of Clinical Hyponasis, Summary 2,'23-21. Festinger, L. (1957). A Theory of Cognitive Dissonance. Evanston, Paradoxical tntervntion or indention is''symptom. piescripttcE, or directing the patient to continue what he is already doing, even III. r Row, Peterson. encouraging the patient to carry oat and exaggerate Iris usual (mala- Fink, H. K- (1954a). Long Journey. A Verbatim Report of a case of daptive or dysfunctional) behaviour ••• (R)eframe the symptom or Severe Psychosexual Infantilism. New York t Julian Press. problem La a positive way ••• as a reasonable, understandable,positive Fink. H. K. (1954b). The will to change. New York : Happiness effort on the part of the patient Our therapeutic goal is to get our Exchange Open Forum. 42 H. K. FINK SAMIKSA Vol. 41, No. 1 PARADOXICAL INTENTION 43 Fink, H. K. (1956). An answer to certain critics of psychoanalysis. Frankl, V. E. (1934). Logstherapy, in Encyclopedia of Psychology Psychological Newsletter, 8, 37-48. (Raymond J. Corsini, Ed.),, p. 320. Fink, H. K. (1959). To accept the alcoholic patient or not: Problems Haley, J. (1973). Uncommon Therapy : The psychiatric Techniques in psychotherapy with alcoholics. Samiksa, 13(2) : 47-74. of Milton Ericson. New York : Norton. Fink, H K. (1961a). Psychosexual infantilism. Real Life Guide (New Hills, H. I., Grusskos, J. R., & Strong, S. R. (1985). Attribution and York City), 49-69. the double bind in paradoxical interventions. Psychotherapy, Fink, H. K. (1961b). Training of psychotherapists and treatment of 22(4), 779-785. mental disorders in America. Annual Review. Calcutta : City Johnson, M. (1986). Paradoxical interventions : From repugnance to cautious curiosity. The Counseling Psychologist, 14(2); Health and Welfare Association, 1-5. 297-302. . . Fink, H.K. (196!c) Treatment of the alcoholic. Act a Psychothera- Kercher G. & Smith, D. f 1985,). Reframing paradoxical psychothe- peutica, 9, 183-192. rapy. Psychotherapy, 2l(4), 786-795. Fink, H. K. (1962*). Teaching technics, Florida Adult Educator, 12(2), Palazzoli, S., Cecchn, Prata, & Boscolo 1978. (Paradox and counter- 18-21. Paradox, quoted in Dowd & Milne, 1986, p. 253. '••• Fink, H. K. (1962b). Teaching technics, Part 2, Florida Adult Educa- Peyser, C. S. (1984). Negative practice. In Encyclopedia df Psychology tor, 12(3), 6.19. (R. J. Corsini, Ed.). New York : Wiley, 192. Fink, H. K. (1970). Motivating a mental defective teenage girl, Devereux Schools Forum, 6, 27-30. Polster, E. & Polster, M. (1974). Gestalt Therapy, Integrated. New Fink, H. K. 1981). Should psychologists do housecalls ^ Nevada York : Vintage Books. Personnel & Guidance Journal, 2\2), 85-87. Riebel, L. K. (1985). Usurpation : strategy and metaphor. Psycho- Fink, H. K. (1985). A dictionary of defence mechanisms used in therapy 22(3), 595-603. psychoanalysis and life Samiksa 39(4), 91 115. (Also : Adden- Rosen, J. (1953). Direct Psychoanalysis. New York : Grune & Stra- dum. Samiksa, 39(3), 71-72. tton. Fink, H. K. (1986) The function in the doctor-patient relasionsliip of Strean, H. S. (1964).The contribution of paradigmatic psychotherapy transference and countertransference in psychoanalysis. to psychoanalysis. Psychoanalytic Review, 51(4), 29-45. Samiksa, 40(2), 46-74. Watzlawick, P., Beavin, J., & Jackson, D. (1967). Pragmatics af Fishman, R. (1981). When push comes to shove : The case for psy- Human Communication, New York : Norton. chiatric judo. Honolulu, HI : Unpublished manscript, 1-2. CAvailable from Dr. Fishman at 46 369 Haiku Road, H-6, Acknowledgment Kaneohe, HI, 96744). I wish to thank my wife, Sue C. Fink, for her encouragement and suggestions in the format of this article. Fnnkl, V. E. 1960). Paradoxical intention:* A logotherapeutic technique. American Journal of Psychotherapy, 74,520-535. Appendix * The term, "intervention, " implies interference, whereas the method involves not We present here four of the poems written by the patient.. The interfering with the status quo of the expression of the patient's symptoms ; there-. fore, I believe that '•intention" is a m >re accurate, appropriate term, meaning that poems provide insight into why a person would feel so lonely and the doctor encourages the patient's intention to continue the status quo of his despairing as to swallow objects in order to achieve secondary gains symptom complex. of attention and temporary oblivion (under anesthesia). i44 H. K. FINK SAMJKSA Vol. 41, Nfe. 1 PARADOXICAL INTENTION

1 Locked Ward People whom I trust and love .-.-. and within, I see people : hungry, thirsty, agitated, and angry ; These are with mej, as < ; 1 hear noise all around me, Aloneness I feel, but alone I am not! Screaming for everything, anything, Crying far a .kind of Jove, 3. Subtle Progress Scarce and almost non-existent I'm hooked, cooked, and shook ; -Within these walls, I've swallowed, wallowed, generally followed ; Wh'hin my inside serf I've been here teased, even appeased, and overfy seized ; There is a kind of hunger too, I'm afraid, I've nayed, and on my way here, got laid ; That wants to touch and feel much warmth I've resisted, insisted, existed ! And., oh, thirsty too, And myself committed ; and That wants to. fill an tfmpty spot Ambulated down lonely, noisy, cramped corridors. Within—not these walls—.but ME ! Now dry, but often confused, angry, Hurting and lost—vegetating, immigrating, I approach this Monday's discharge, 2. Aloneness As around my environment I gaze Around me noise continues ; And see others, despairingly crazed and dazed ; Within me pain persists ; As in a grateful mindset Encompassed by hostility In my own self I focus upon : Within me ; Soberly I look out and Looking forward to outside treatment, so I As I see confusion and Can use all my assets most willingly As I hear much noise, Within In a life of useful sobriety, which— I try to remember that Each day ahead— I choose to find I don't wish to lose ! A happy, hopeful strength therein. As they say in A.A. "This too shall pass." 4. Mother's Day As forever here in this place 'Tis Mother's Day today ; I shan't continue my life ; What is it that I tbink ? Away from all this commotion and nonsense, How do I feel ? Friends I do have and like a lot; And what can I say ? . • • 46 H. K, FINK SAMIKSA SAMIKSA : JOURNAL OF THE INDIAN PSYCHO-ANALYTICAL SOCIETY This phenomenon called "Mother Love" 1. Samiksa is published by the Indian Psycho-Analytical Society Ciairmdas "unconditional, eternal, and complete,' four times a year, and the journal is supplied to members and To me seems quite elusive, associates of the Society free of any charges. Realistically obsolete. 2. The annual subscription, payable in advance, is Rupees But I reflect with thrill Twenty for inland subscribers and $ 6 for overseas subscribers. Special rates may be allowed to students and research workers. The price Those first thumping kicks of single numbers may be ascertained on application. Subscriptions Of a miracle inside .... should be sent to Indian Psycho-Analytical Society, 14, Parsibagan I remember the pleasure and warmth Lane, Calcutta-9, India. Of his tiny mouth Cheques should be made payable to "Indian Psycho-Analytical Nibbling on my breast; Society or Order." Then the utter accomplishment : 3. All editorial communications should be addressed to the The rejoicing which accompanied Editor, Samiksa, Indian Psycho-Analytical Society, 14 Parsibagan Lane, Calcutta-9, India. Those initial wobbly steps; 4. The management regrets its inability to return the manuscripts The tears on his first spanking of unpublished articles. (For biting his daddy's leg) 5. Articles published in the journal become the copyright of the As my own tears I could not hide. Indian Psycho-Analytical Society, and cannot be re-published elsewhere And whilst recalling either in the original or in any translated form without the permission Experiencing my own emotional pains, of the Council of the Society. I remember the feel of two little arms, 6. The editor reserves the right to accept or reject the whole or portions of contributions and will not enter into any correspondence in Struggling to reach around my neck, this matter. The editor does not assume any responsibility for the To comfort and to ease. opinions and statements expressed by the contributors. I wonder where he is today, 7. Every contributor will receive a copy of the issue of the journal And if he's still the "Little Man," in which his article appears along with 20 reprints of the article free of Loaned to me by God, any charges. Postal expenses will be charged when copies are wanted by air-mail. Not as a gift, "belonging," Nor as an asset—or even extension of me, 8. Contributors arc requested to submit type-written manuscripts. But rather a tangible indication Of the inevitable and essential Contents of life itself, That love and pain, joy and sadness Simultaneously thrive and grow, Almost always hand in hand. SAMIKSA VoL 41. No. 1

Printed by Di. T. K. Chatterjee, at the Mudran Kendra, 11-B, Thakurdas Palit Lane Cataitta-12 and also published by him from 14, Panibagan Lane, Calcutta-9