Direct, indirect and paradoxical prescriptions in psychological therapy

When we talk about prescription in psychology we refer to Specific recommendations that therapists give to customers to help change or handle behaviors, thoughts, or emotions that may be causing anguish or problems in their daily lives.

The prescriptions can be very varied and adapted to the specific needs of the individual. They can be as simple as suggesting that a person does more physical exercise to improve their mental health, or they can be as complex as asking someone to carry a diary of the negative thoughts he has during the day and looking for ways to challenge or change those thoughts.

There are different types of prescriptions, including direct, indirect and paradoxics. We will deepen each of them.

Content

• Direct prescriptions
  • An example case
• Indirect prescriptions
  • An example case
• Paradoxical prescriptions
  • VARIOUS EXAMPLE CASES
    • Case 1
    • Case 2
    • Case 3
  • References

Direct prescriptions

Direct prescriptions are Clear and specific instructions that a therapist gives to his patient to perform certain actions or changes in his behavior, thoughts or emotions. These instructions are intended to encourage difficulties, personal growth and resolution of emotional or psychological conflicts.

These prescriptions may vary greatly, depending on the situation and needs of the patient. They can include tasks to be performed between the therapy sessions, changes in daily behavior, coping techniques to use in difficult situations, etc.

An example case

José is a 40 -year -old man who is a large company manager. Go to therapy to request professional help, because it is dealing with a high degree of chronic stress due to an excessive workload.  I usually work late most days, even on weekends to meet the demands of your work. He arrives at therapy because he feels constantly exhausted and stressed, and he is costing him a lot to maintain his concentration during the day. It does not seem to have time to relax or take care of yourself.

The therapist realizes that José is neglecting his own well -being in favor of his work. As a result, he decides to use a direct prescription to address this problem.

The psychologist tells Joseph: "Apparently your work is occupying most of your time and energy, and it seems that it is costing you to take care of yourself. During the next week, I want you to try at least 30 minutes a day to a self -care activity that you enjoy. It can be anything that helps you relax and be dismissed. You can choose to read a book, take a walk, practice yoga, meditate, or even simply take a hot bath. The important thing is that this activity is something you do only for yourself and help you relax."

Here, the psychologist's direct prescription is specific and clear. It provides a specific time frame (30 minutes a day during the next week), offers suggestions of activities and emphasizes the importance of this time for self -care.

José, who until now had not taken time to himself, now has a specific task to perform, with specific instructions. The direct prescription of the psychologist gives you a starting point to start taking better care of yourself and handling your stress. This prescription can be reviewed and adjusted in future therapy sessions, according to José's progress and changing needs.

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Indirect prescriptions

Indirect prescriptions in psychology are suggestions or advice that the therapist offers his patient in a less explicit way than in direct prescriptions. These are usually Designed to take the patient to discover the solution to their problem, stimulating introspection and self-discovery.

An example of indirect prescription could be the use of metaphors or analogies for the patient to reach their own understanding of your situation or to promote a change in your way of thinking.

An example case

Suppose Laura is a patient who is trapped in a pattern of harmful and toxic relationships. However, she fails to fully understand why she looks constantly trapped in such relationships. Instead of telling you directly that you should stop seeing people who treat it badly, the therapist could use an indirect prescription.

Laura is a 30 -year -old woman who has been attending therapy due to her tendency to get involved in toxic romantic relationships. Despite her best intentions, she seems to end again and again with couples who treat her wrong or not value her well -being.

His therapist has been working with her on this issue, but he has noticed that when he gives him direct advice (such as "you should stop seeing that person"), Laura tends to resist or defensive.

Deciding to take a more indirect approach, the psychologist decides to use a metaphor to help Laura see her situation from a different perspective. In a session, he tells Laura:

"Laura, imagine for a moment that you are a gardener and that your life is your garden. As a gardener, you have the responsibility to decide which plants cultivate and what weeds eliminate. If weed seed plants constantly allow weed. How does this analogy feel? Do you think there could be any connection with the relationships you have had?"

Here, the therapist is not telling Laura what to do. Instead, she is using a metaphor to help her see her situation in a new way. He hopes that Laura can make the connection between the metaphor and her own life, which can allow you to better understand your own behavior patterns and make healthier decisions in the future.

In subsequent sessions, the therapist can visit this metaphor again and explore how Laura has applied it in her life. This could involve talking about the "weeds" that Laura has identified in her life and the strategies you are using to "start" these weeds and "plant" healthier relationships.

Paradoxical prescriptions

Paradoxical prescriptions in psychology are therapeutic techniques in which the patient is asked to do something that seems to contradict the therapeutic objective. It is a strategy that is often used in systemic therapies. The idea is that when asking the patient to intentionally behave in a way that exaggerates or emphasizes his problem, a change can be induced.

In this type of prescriptions it is essential that this technique is closely supervised by the therapist and that its effectiveness is evaluated. Not all people will respond in the same way to paradoxical prescriptions, and it is important that the therapist is prepared to change strategy if it is not useful or if it causes additional anguish to the patient.

VARIOUS EXAMPLE CASES

Case 1

A classic example of a paradoxical prescription is the "paradoxical intention"What is used in the treatment of anxiety and phobias. Suppose a patient is afraid of speaking in public and becomes very nervous when he has to do it. Instead of suggesting relaxation or coping techniques, the therapist could use a paradoxical prescription and tell the patient that in his next presentation he tries to get as nervous as possible. In this way, he could begin to realize that his fear is something he is controlling, which could reduce his anxiety.

The idea behind this approach is that when trying to increase their anxiety, the patient can realize that he actually has a certain degree of control over his emotions. On the other hand, by directly facing your fear, you can begin to desensize the situation and, therefore, reduce your general anxiety.

However, paradoxical prescriptions should be used with care and experienced therapists, since they can be confused for the patient or even exacerbate the problem if they are not used correctly. The monitoring and constant review of the effects of these prescriptions are also essential to ensure that they are useful and do not cause harm.

Case 2

Let's imagine a patient named Ana. The patient suffers from chronic insomnia and has difficulty falling asleep. Despite having tried various strategies to improve its dream, such as limiting caffeine and establishing a regular sleep routine, continues to fight.

Your therapist then decides to use a paradoxical technique at your next meeting. Instead of continuing to suggest traditional methods to foster sleep, he tells Ana to do the opposite.

The psychologist prescribes the following: "Ana, for our next session, I want you to try something different. Instead of trying to sleep, I want you to try to keep you awake all night. Accept and host the idea of ​​not sleeping instead of fighting her. Do everything possible to keep your eyes open and stay awake ".

Here, the therapist is asking Ana to do exactly the opposite of what she wants to achieve. At first glance, this prescription seems to contradict Ana's goal to sleep better.

However, the logic behind this paradoxical prescription is that by eliminating the pressure of having to sleep, Ana could reduce her anxiety around sleep. When trying to stay awake, it is possible that Ana removes the pressure of "having to sleep", which could allow him to relax and, paradoxically, fall into a dream more easily.

Case 3

Paradoxical prescriptions in family therapy are also used. Let's imagine a family in which parents, called Marta and Luis, are worried about their teenage son, Pedro, who is increasingly rebellious and challenging. The constant fight for control has created an environment of tension and conflict in the house.

In this case, the family therapist can opt for a paradoxical prescription. Instead of suggesting that Marta and Luis increase their control and discipline over Pedro (which seems to be the obvious solution), the therapist could suggest otherwise.

The therapist could say: "Marta and Luis, instead of trying to control Pedro more, I would like that during the next week they would give him more freedom. Let it make your own decisions about your free time, your tasks and your study schedule. They do not put any restriction or limit, and do not recriminate by their decisions ".

At first glance, this prescription seems contradictory. Not Pedro already out of control? Shouldn't Marta and Luis try to implement more discipline instead of giving him more freedom?

But the idea behind the paradoxical prescription is that by changing family dynamics and eliminating the struggle for control, Pedro may feel less inclined to be rebellious and challenging. In addition, giving him more autonomy, Marta and Luis could foster in Pedro a greater sense of responsibility and maturity.

Main types of psychological therapy or psychotherapy in psychology

References

• Haley, j. (1993). Therapy to solve problems: therapeutic techniques that work. Barcelona, ​​Spain: Paidós.
• Minuchin, s. (1974). Families and family therapy. Buenos Aires, Argentina: Gedisa.
• Madanes, c. (nineteen ninety five). Family therapy techniques. Buenos Aires, Argentina: Paidós.
• Watzlawick, p., Beavin, J., & Jackson, D. D. (1981). Theory of human communication: interactions, pathologies and paradoxes. Barcelona, ​​Spain: Herder.