358 Chapter 41
Paradox and counterparadox
Aparadoxis set up by the family’s acceptance of the therapist’s pos-
itive connotation: why does a good thing, family cohesion, require a
symptom in its member? The therapist spells out the dilemma the family
are in.
Acounterparadoxmay be presented by the therapist as a message de-
signed to help the family find a way out. Rather than saying that the
symptomatic patient should change and the rest of the family should
not, the counterparadox is designed to break up the dysfunctional,
paradoxical pattern, for example, by prescribing no change. The family
is then left on their own to resolve the paradoxical absurdities after the
session.
The invariant prescription
This task was developed by two of the four original Milan four, Selvini-
Palazzoli and Prata. It aims to unhinge collusive parent–child patterns,
in which a ‘game’ is played out by family members and keeps the child
symptomatic. This is often achieved by the child or adolescent siding with
the ‘weaker’ parent and defeating the ‘winner’ through illness behaviour.
The parents are told to plan a few evenings out, departing before dinner
without forewarning, leaving only a note saying ‘We’ll not be home
tonight’. On return, they are not to give any explanations to their chil-
dren, saying ‘These things concern only the two of us’. Each parent is
asked to keep a private notebook of the verbal and non-verbal behaviour
that follows carrying out the prescription. This procedure is designed to
strengthen the parental alliance and break pre-existing coalitions, blocking
‘games’ of control that had perpetuated abnormal behaviour.
Narrative approach
This approach to therapy is a recent development that has been adopted by
some strategic and systemic therapists. It focuses on the stories people have
which guide their lives. John Byng-Hall combines this with an emphasis
on attachment theory in his variety of family therapy based onRewriting
Family Scripts, the title of his 1995 book. Adults and children in a secure
enough setting can construct a new way of seeing their future and be
helped to live it, liberated from past constraints and expectations. David
Epston uses letter writing as part of theNarrative Means to Therapeutic
Ends, the title of his 1990 book with Michael White. Often harrowing
life stories and problems are rewritten using the person’s terminology, but
emphasising how all along they fought the incredible strains they were
put under with heroism. Evidence is found of instances when they were
not dominated by the problem, and they are encouraged to think about
the future from the strong, competent person that has emerged from the
interview so far. The person is encouraged to create or seek out a receptive
social group from their immediate circle so as to be able to live out their
new story and identity.