Table Of ContentPARADOX
AND
COUNTERPA RADOX
PARADOX
AND
COUNTERP ARADOX
A New Model in the Therapy of the
Family in Schizophrenic Transaction
MARA SELVINI PALAZZOLI, M.D.
LUIGI BOSCOLO, M.D.
GIANFRANCO CECCHIN, M.D.
GIULIANA PRATA, M.D.
translated by Elisabeth V. Burt
A JASON ARONSON BOOK
ROWMAN & LITTLEFIELD PUBLISHERS, INC.
Lanham • Boulder • New York • Toronto • Oxford
A JASON ARONSON BOOK
ROWMAN & LITTLEFIELD PUBLISHERS, INC.
Published in the United States of America
by Rowman & Littlefield Publishers, Inc.
A wholly.owned subsidiary of The Rowman & Littlefield Publishing Group, Inc.
4501 Forbes Boulevard, Suite 200, Lanham, Maryland 20706
www.rowmanlittlefield.com
POBox317
Oxford
OX29RU, UK
THE MASTER WORK SERIES
English translation copyright © 1978 by Jason Aronson Inc.
First softcover edition 1994
First Rowman & Littlefield edition 2004
Originally published in Italy by Feltrinelli Editore, Milan, 1975.
All rights reserved. No part of this publication may be reproduced,
stored in a retrieval system, or transmitted in any form or by any
means, electronic, mechanical, photocopying, recording, or otherwise,
without the prior permission of the publisher.
British Library Cataloguing in Publication Information Available
Library of Congress Cataloging-in-Publication Data
ISBN: 0-87668-764-8 (hardcover)
l-56821-305-0 (softcover) ISBN 978-1-56821-305-7
Library of Congress Catalog Number: 84-45862
Printed in the United States of America
8"'
The paper used in this publication meets the minimum requirements of American
National Standard for Information Sciences-Permanence of Paper for Printed Library
Materials, ANSIINISO Z39.48-1992.
CONTENTS
Foreword by Helm Stierlin
Vll
Preface xi
Part One
I Introduction 3
2 Working method 9
Part Two
3 The couple and the family in schizophrenic
transaction 21
4 The identified patient 35
Part Three
5 Therapeutic interventions: a learning process
through trial and error 47
6 The tyranny of linguistic conditioning 51
7 Positive connotation 55
8 The prescription in the first session 67
vi Contents
9 Family rituals 83
10 From sibling rivalry to sibling sacrifice 99
II The therapists take upon themselves the dilemma
of the relationship between parents and child 105
12 The therapists accept without objection a
questionable improvement 113
13 How to cope with the absent member maneuver 117
14 Getting around the disconfirmation 125
15 The problem of secret coalitions 135
16 The therapists declare their impotence without
blaming anyone 147
17 The therapists prescribe to themselves the
ultimate paradox 157
18 The therapists give up the parental role, paradoxically
prescribing it to the members of the
last generation 163
Notes 173
Bibliography 183
Index 187
FOREWORD
Paradox and Counterparadox demonstrates the revolutionary
thrust of the new paradigm of family therapy. Its authors have
been working as a team for approximately eight years, and
have rightly been hailed as pioneers in the treatment of severe
psychiatric conditions which have until now defied most
therapeutic endeavors.
We read at one point in the book that its senior author, the
Milanese psychoanalyst Mara Selvini Palazzoli, is seen as a
wizard in certain circles of patients and colleagues, i.e. as
someone who can cure a patient and his family in one mere
hour. Understandably, the author rejects such an imputation.
And yet-someone like myself, who has followed Doctor
Selvini's career and writings over the years, has a hard time not
believing in at least a little wizardry.
Approximately ten years ago she published in Italian a book
on her psychoanalytic experiences with patients suffering
from anorexia nervosa. In that book she showed an unusual
insight into the intrapsychic dynamics and object relations of
her anorectic girls and, in spite of her investment, in many
cases, of more than one hundred individual sessions, reported
honestly on her modest therapeutic successes. That book is
now available in English (Self-Starvation, Jason Aronson, 1978)
with several additional chapters covering subsequent family
therapy with these patients. And here, all of a sudden,
viii Foreword
wizardry seemed to operate: in the approximately one dozen
families seen in conjoint sessions, the anorexia of the
presenting patient disappeared for good after no more (and
often far fewer) than fifteen sessions, while the whole family
changed deeply and lastingly.
Paradox and Counterparadox, a natural successor to her book on
anorexia, increases rather than decreases this impression of
wizardry. We learn that she and her team, having become a
little bored with anorectic families (who always present the
same dynamics), have now turned to families with schizo
phrenic members. So far their successes with" schizo-present"
families have been just as striking as with families of
anorectics. The authors limit these psychotic families to a total
of twenty sessions spaced approximately a month apart.
However, families with seriously chronic patients, damaged by
long hospitalizations, have so far been excluded.
A thorough reading of this book reveals the "wizardry" to
have a solid theoretical base. This base was laid by Gregory
Bateson, Jay Haley, Paul Watzlawick, Harley Shands, and
others who took seriously the cybernetic revolution of our
century and who developed a "transactional epistemology"
that replaces a monocausal, linear model with a circular model.
This circular model has sensitized us to those paradoxes which
inhere in healthy as well as pathological relationships,
paradoxes which normally elude us because we lack the
linguistic tools to grasp them.
For we all remain, willy-nilly, bound up with a language
which programs us more or less for a monocausal, linear way
of thinking. Even so, most of us can somehow cope with our
transactional world, while many-perhaps all-families with
schizophrenic members seem unable to do so. For they get
caught up in formidable "relationship traps" and hence get lost
in a relational and communicational labyrinth sans exit. The
consequences are deepest mutual alienation, exploitation and
counterexploitation, and relational and developmental stagna
tion.
Paradoxical injunctions, as introduced into family therapy
by Haley, Watzlawick, and others, offer a therapeutic strategy
Foreword ix
for entering such labyrinths. This strategy is at the heart of
Doctor Selvini's and her team's therapeutic endeavors. They
acquaint us here with a potent therapeutic instrument that
utilizes two main elements:
1. The therapists establish a positive relationship with all
family members. To do so, they accept and "connote
positively" anything the family offers, avoiding even the
faintest hint which might be construed as a moralizing
stance or accusation, or which might otherwise induce
anxiety, shame, or guilt.
2. The therapists aim at a radical reshuffling of the relational
forces operating in these families: they shake the family out
of its destructive clinch, as it were, and try to give all
members a new chance to pursue their own individuation
and separation.
Like any other potent instrument, such injunctions can
harm as well as help. To be therapeutic, careful preparation,
extensive experience in family therapy, and empathy toward
all family members are needed. In addition, Dr. Selvini and her
team demonstrate one more quality that seems indispensable:
the courage to develop and adopt new models and concepts
when those one has learned no longer suffice.
Helm Stierlin, M.D.
