Literature - Books and Articles

The last book I could find on paradox was compiled by Gerald R Weeks, PhD in 1985 and revised in 1991 - Promoting Change Through Paradoxical Therapy. Back then, the significance of attachment theory was not yet fully realized. While clinicians knew that pdxi was quite powerful, attempts to explain the method in logical-linear terms got stuck on ‘how it affected behavior’. The linear focus of trying to explain ‘behavior’ turns out to be an endless ‘rabbit hole’ that leads to no further understanding of what is happening. Since attempts to figure out pdxi through the ‘behavior route’ always turned out to be unsuccessful, clinicians gave up trying to explain the approach. However at the same time, few educators were willing to teach something they couldn’t explain. For this reason few clinicians today are comfortable with pdxi, and many recent graduates with masters and doctorates are not even aware of the method.

In my book Paradox Psychology - It’s Not What You Think, the intent is not to explain the method in a linear behavior focused manner. Rather, the book addresses the exponential impact of facilitating change through attachment-joining within the context of the therapeutic alliance. When pdxi is understood as an intervention based on attachment then the ‘light bulb’ goes on and suddenly the pdxi process makes sense.

Research - 5 Key Questions

What does the research show? 

A)      Which is the best psychotherapy?

B)      How does paradox compare with behavioral, cognitive, and psychodynamic approaches?

C)      How important is the therapeutic alliance in determining treatment outcome?

D)      How does resistance impact treatment outcome?

E)      Does treating secondary non-criminogenic behaviors impact primary targeted volatile behaviors (such as: problem sexualized behaviors, etc.)?

A) Which is the best psychotherapy?

Findings: Unbiased research indicates that behavioral, cognitive, and psychodynamic therapies have success rates that are statistically equal.

Seligman (1995) The Effectiveness of Psychotherapy: The Consumer Reports Study, American Psychologist, Vol. 50, Num: 12, 965 – 974

Smith, Glass, & Miller (1980) The benefits of psychotherapy. Baltimore MD:  John Hopkins University Press

B) How does paradox compare with behavioral, cognitive, and psychodynamic approaches?

Findings: Behavioral, cognitive, and psychodynamic methods work well with motivated and voluntary clients. Paradoxical Interventions have a higher rate of success with treatment resistant and oppositional clients.

Sheras, P. L. & Jackson, S. R. (1978) Paradox as an Intervention Strategy with Emotionally Disturbed Adolescents. Paper presented at the Annual Convention of the American Psychological Association, Toronto, Canada, August 1978

Shoham-Salomon, Avner, & Neeman, (1989) You’re changed if you do and changed if you don’t; Mechanisms underlying paradoxical interventions, Journal of Consulting and Clinical Psychology, 57, 590-598

Horvath & Goheen, (1990) Factors mediating the success of defiance and compliance based interventions. Journal of Counseling Psychology, 37, 363-370

C) How important is the therapeutic alliance in determining treatment outcome?

Findings: The strength of the client-clinician alliance is the most important predictor for treatment success.

Horvath & Symods (1991) Relation between working alliance and outcome in psychotherapy: A meta-analysis. Journal of Counseling Psychology, 38,  139- 149 

Keijsers, Schapp, & Hoogdoin (2000) The impact of interpersonal patient and therapist behavior on outcome in cognitive-behavior therapy. Behavior Modification, 24,264–297

Safran & Muran (Eds.) The therapeutic alliance (Special Issue). Session Psychotherapy in Practice, 1, (1)(Reissued as millennial issue, February 2000)

D) How does resistance impact treatment outcome?

Findings: There is a negative relationship between resistance and prognosis.

Beuter, Moleiro, & Talebi (2002) Resistance in Psychotherapy: What conclusions are supported by research, Journal of Clinical Psychology, 58 (2), 207-217

E) Does treating secondary non-criminogenic behaviors impact primary targeted volatile behaviors (such as: problem sexualized behaviors, Violence, etc.)?

Findings: Yes. When treatment influences issues related to anger, depression, self-esteem, etc. there is a measurable reduction in deviant and criminogenic sexual fantasies.

Marshall W. (1997) The relationship with self-esteem and deviant sexual arousal in non-familial child molesters. Behavior Modification, 21, 1, 86-96

Marshall, Cripps, Anderson, & Cortoni (1999) Self-esteem and coping strategies in child molesters. Journal of Interpersonal Violence, 14.

Ward & Stewart (2003) The treatment of sex offenders: Risk Management and Good Lives. Professional Psychology: Research & Practice 34. 4,

www.ParadoxPsychology.com                                      EPK Revised: 6-5-21