Paradoxical change and the therapeutic relationship

In my previous writing, we examined one model of change: the transtheoretical model (TTM). TTM is a way of conceptualizing change as a process that unfolds throughout a number of stages. It’s particularly popular amongst the more behaviorally inclined orientations and frameworks for psychology and counseling. However, the more humanistic and the more existential approaches to counseling, to psychotherapy, look at change through a different lens: namely, paradoxical change.

The theory of paradoxical change, in a word, is exactly what it sounds like at its heart. It puts forth a simple idea: the more you try to change, the more you stay the same. I realize that this idea is often at odds with how people think of therapy and the role of the therapist in the therapeutic relationship. Therapists are often seen as an expert and an authority figure, someone who knows things that I (read: client) do not know. To some degree, this is true. Therapists must have a number of years of higher education to practice, they regularly continue to pursue, must pursue, further education for the duration of their career, which at least in Louisiana comes out to be 40 hours every two years, and they often appear on the news and other outlets making declarations about mental health from the perspective of their profession, as an authority figure for their profession. And as I am writing this, I think this paper will become more about how paradoxical change shapes the therapeutic relationship and the practice of therapy more so than a theoretical discussion about what paradoxical change is.

In the previous paragraph, I mentioned that therapists are often seen as an expert and an authority figure. I think this is generally true, both for the public at large and for the folks pursuing therapy. This relational setup: expert—client is what we will be looking at. There is a long historical tradition of the mental health discipline acting as a system of oppression for any number of vulnerable populations, and this is still the case today. The relationship I have with my clients as a therapist will never be equal. I, with a call, can have my clients institutionalized against their consent. I, with a call, can have the police involved with my client. And generally speaking, people are more willing to believe me (read: the therapist) because, as mentioned earlier, I am seen as an expert, an authority figure, and therefore my word matters more than my client’s word. It is in this relational setup that one can see the paradoxical theory of change begin to shape and inform how therapy is done.

One, I would say, aspirational goal of the flavor of therapy work I do is the horizontalization of the relationship—to make equal. As noted above, no matter what I do, our relationship (read: the therapeutic relationship), at its core, is unequal. In spite of this, I strive to make it as close to equal as I can. This manifests in a number of ways. Historically, the role of the therapist in therapy has been one of the change agent: the person enacting change on to some thing, in this case the client, through, say, behavioral interventions, not unlike a medical doctor and medication or surgery. These behavioral interventions are guided by some preconceived idea as to what constitutes healthy, or, in general, some sort of desired outcome. At the core of this idea is a simple premise: the therapist knows best. I do not think this is true, if anything it is directly opposed to how I think of the work. And to get closer to how I think of the work, we need to look at how we think of people and the way we exist in the world. James Simkin (1976) once said

“There is no prescribed way to be. There is no “adjusted” way to be. The way to be is to be you—whoever you are. If you swallow in the beginning the lie that there is no room in this world for you the way you are, then you’re stuck with having to play a phoney game the rest of your life. And that lie, I think, is the most immoral lie of all—whether it is laid on you by a parent, or a theologian, or whoever. You have a right to be in this world the way you are; there is plenty of room in the world for everybody. (pg. 50)”

Said in different words, you are enough just the way you are. And I think that at the heart of paradoxical change is this idea, this implicit respect for the way people exist and move through the world and a desire to honor it. In some existential and humanistic circles, they talk of protective ways of being-in-the-world—these sort of patterned and characteristic ways of navigating through and reacting to life. And these tendencies that we have, these ways of being, have been shaped and informed by all of our life experiences that have preceded this moment. There’s a lot to be said about that, about the value there is in the way we are now. A foundational premise of paradoxical change is that “one must stand in one place in order to have firm footing to move” (Beisser, 1970). We must know who we are before we can change who we are. We must accept who we are before we can grow. To grow, we need support, and “a major aspect of self-support is identification with one’s state. Identification with your state means knowing your state, i.e., your actual experience, behavior, situation” (Yontef, pg. 26, 1993). And who knows that best? You do. Not me. I think this is why if you read older literature, you’ll find the phrase “fellow traveler” come up. Our relationship (read: therapeutic relationship) is not one of expert—client. Our relationship is one where two human beings commit to trying to figure things out together. We figure things out through developing awareness, through our interactions and what happens between us (read: therapist and client), and through experimenting and playing with the way we are.

Earlier I said that my striving towards an equal relationship manifests in a number of ways. We have looked at how we define the roles of the relationship that we make between therapist and client. Perhaps now we can shift our focus to how the therapist shows up as an authentic person in the therapeutic space. If we were to look at the historical context of how therapists have shown up within their relationships with their clients, we would need to start at the beginning: traditional psychoanalysis. Back in the days of old, the dominant take on how the therapist ought to be is that of the blank slate—tabula rasa. In practice, a blank slate entails a therapist that discloses very little, remaining, overall, a neutral figure. This neutrality provides a space that affords the client an opportunity to project onto the therapist their thoughts, their feelings, and, perhaps especially, their relational patterns, and those things become grist for the mill, they become the focus of the work. Over time we have learned and become aware of the significance of the quality of the relationship between therapist and client, particularly as it relates to clinical outcomes. This, in turn, has resulted in alternative takes as to how the therapist ought to show up in a therapeutic encounter with a client. For example, moving away from being a neutral and passive figure that the client projects onto and towards being a real authentic human being that is an active participant in the process. For our purposes here today, I would like to look at the concept of presence. I would describe presence as the degree to which one is able and willing to invest themselves in the present moment, allowing space and being curious about what emerges between the therapist and client as a result of their interactions and their dialogue. And this, I think, relates to the term I mentioned earlier when I said “fellow traveler”, as “such an approach requires that the counselor work to suspend ideas and judgments about what the client should bring up, or the direction in which the counseling should go” (Clarkson & Cavicchia, pg. 20, 2014). Being present in this way is about showing up as I am, as honestly and authentically as I can, and allowing myself to be impacted by, moved by, and touched by the interaction between me and my client. As Yontef (1993) mentions, “it refers to a lively involvement in which the therapist appropriately and regularly shows his or her own feelings, experiences, etc.” (pg. 35). Joyce & Sills (2018) speak to presence as well when they noted

“The counsellor, of course, has the subtle task of being present to herself, the client and the relationship. To practice presence, the therapist brings all her senses and awareness to bear and gives herself fully to the encounter. In a way, presence is a quality that emerges when you let go of (or bracket) all your concerns and strivings and allow yourself to ‘be there’. It is the antithesis of playing a role or trying to give a certain impression. (pg. 50)

In sum, it’s about stripping ourselves of as much pretense as possible, showing up as real people, and allowing what happens between us to matter to us. I’ve spoken, generally, in reference to how this affects how the therapist shows up in a therapeutic encounter, but presence is also an aspirational goal for the client as well, as it is a necessary aspect of being in dialogue with someone or something.

I feel drawn in many directions as writing this, and yet I want to reel myself back in and keep this writing more focused. There will be time for other topics later. Paradoxical change is the idea that “change occurs when one becomes what he is, not when he tries to become what he is not” (Joyce & Sills, pg. 43, 2018). Implicit in this idea, this principle, is an attitude of self-acceptance. As a therapist, it invites me to show up as I am, a real person, and to be open to how it is you (read: the client) show up. It inspires me to see the value and utility in the way you are and to honor how it has served you up until this point. It reminds me that change is a natural process that is always unfolding and that I need not push the river, because it flows by itself.

Thank you for reading. Cheers and take care.

Works Cited

Beisser, A. (1970). The Paradoxical Theory of Change. Gestalt Therapy Now, ed. J. Fagan & I.L.

Clarkson, P., & Cavicchia, S. (2014). Gestalt counselling in action (4th ed.). SAGE.

Joyce, P., & Sills, C. (2018). Skills in gestalt counselling & psychotherapy (4th ed.). SAGE.

Shepherd, Harper & Row, New York

Simkin, J. S. (1976). Gesalt Therapy Mini-lectures. Celestial Arts.

Yontef, G. M. (1993). Awareness, Dialogue & Process: Essays on gestalt therapy. Gestalt Journal Press.

Image provided by Milada Vigerova

Image provided by Dylan Leonard