138 CHAPTER 4
In certain cases, a systems therapist might employ paradoxical intention—by
suggesting that the problem behavior be allowed to continue, or even increase in
intensity or frequency. This technique is paradoxical because it seems at odds with
the general goal of treatment; it is also called prescribing the symptom(Stanton,
1981). With Lena’s family, the systems therapist might use paradoxical intention
by suggesting that Lena continue to behave in ways that make her mother andConsider an example of the methods of systems therapy in action: A mother and
stepfather and the mother’s two daughters from a previous marriage, Maria, age 17,
and Lena, age 14, come to family therapy. Lena has taken to wearing all black and,
despite her mother’s clear admonition against it, has gotten tattoos and nose rings.
Although she’s doing okay in school, she frequently fi ghts with her mother and her
stepfather about her dress and her attitude. Lena likes her stepfather, but he and
Lena’s mother have been squabbling a lot for the last couple of years, and there’s
been a lot of tension between them, which makes Lena uncomfortable. Maria is a
high school senior and is planning to go to college next year; she’s just biding her
time until she leaves home. During a therapy session, a systems therapist might
rephrase what each family member has said in order to validate their experiences—
demonstrate that the therapist understands each one’s feelings and desires. The
therapist may also try to ensure that each family member understands every other
member’s experience. In addition, the therapist might reframe—offer new ways to
conceive of, or frame, the problem—in this case, Lena’s behavior. Instead of viewing
her behavior as a bad thing, the therapist might point out that what Lena is doing
is trying to bring her mother and stepfather together by having them focus on her.
If she is the focus of their negative attention, then they’ll get along better with each
other. The therapist might then suggest that perhaps Lena fears that if her behavior
and attitude improve, the anger and tension between the mother and stepfather will
increase. The therapist might praise Lena’s willingness to be a lightning rod for the
family tension.
Case 4.2 illustrates family systems therapy for a marital confl ict.Validate
A systems therapy technique by which the
therapist demonstrates an understanding of
each family member’s feelings and desires.
Reframe
A systems therapy technique in which the
therapist offers new ways to conceive of,
or frame, the family’s or identifi ed patient’s
problem.
Paradoxical intention
A systems therapy technique in which the
therapist suggests that the problem behavior
be allowed to continue or even increase in
intensity or frequency.
CASE 4.2 • FROM THE OUTSIDE: Family Systems Therapy for Depression
Ruben, a Cheyenne Native American, and his wife, Angie, a Hungarian, were at an impasse.
Living on the East Coast and childless, with fi nancial problems, they came to therapy when
Ruben was offered an apprentice job with a large manufacturer, a position arranged by a
member of Angie’s family. Angie worked as a secretary, while Ruben held a series of temporary
jobs. Instead of being happy about the new position, Ruben had become depressed and even
was thinking of turning it down. Furious, Angie was threatening to leave him.... Angie came
from a family in which women typically made decisions about work and fi nances, and thus
helped direct the family’s mobility. For her, fi nancial stability was critical.
Ruben became depressed because he faced a major conflict. On the one hand, in his
family, asking for guidance and direction through healing rituals was a way to begin to fi nd
answers to problems. Before he and Angie married, Ruben made a commitment to partici-
pate in a year-long purifi cation ritual, both for the blessings he hoped it would bestow on his
family, and to maintain his traditional ways while living as a part of the dominant American
culture. Ruben felt strongly about his prior commitment to perform the ritual, and he realized
that if he takes the job, he might not be able to perform the ritual as he originally intended
(and thus be unable to fulfi ll part of his commitment to his heritage); on the other hand, his
wife desired that he take the job, and he felt that the future of his marriage might be at stake
if he did not take it. The goal of systems therapy was not to reduce Ruben’s guilt should he not
perform the Cheyenne ritual; rather, it was to help Ruben more clearly identify the confl ict
and his feelings, and explore acceptable ways that he could resolve the situation. This may
involve helping Angie to understand the ritual and its signifi cance to Ruben.
(Adapted from Sutton & Broken Nose, 1996, pp. 38–39)