STRATEGIES OF PSYCHOTHERAPY,

by Jay Haley, 1963, Grune & Stratton, Inc.

There have always been persons in the world who

wanted to change their ways of life, their feelings and their
thinking, and other persons willing to change them. In the
Eastern world, change was brought about within the
framework of a religious experience. In the West, a shift has
taken place.... With the shift to secular therapy, an
assumption developed, coincident with ideas of the rational
man, that the individual changes when he gains greater
understanding of himself. (p. 1)
When one person communicates a message to the
other, he is by that act making a maneuver to define the
relationship. (p. 8)
If one took all the possible kinds of communicative
behavior which two people might interchange, it could be
roughly classified into behavior which defines a relationship
as summetrical and behavior which defines a relationship as
complementary. A symmetrical relationship is one where two
people exchange the same type of behavior.... A
complementary relationship is one where two people are
exchanging different types of behavior.... The kind of
message that places a relationship in question will be termed
here a "maneuver." (p. 11)
A woman sought therapy because she was forced to
ritually wash her hands many times a day. ... her ritual
washing could be seen as a defense against various types of
ideas... However, in this case, her husband was brought into
the therapy and an examination of the interpersonal context
of her handwashing revealed an intense and bitter struggle
between the patient and her husband over the

compulsion. ...the husband insisted on being tyrranical

about all details of their lives.... Although the wife objected
to the husband's tyrranical ways, she was unable to oppose
him on any issue-- escept her handwashing. ...as a result of
the handwashing, she could refuse to do almost anything he
suggested. ...he was dethroned by the simple washing of a
pair of hands. (pp. 13-14)
....the crucial aspect of a symptom is the advantage it
gives the patient in gaining control of what is to happen in a
relationship with someone else. A symptom may represent
considerable distress to a patient subjectively, but such
distress is preferred by some people to living in an
unpredictable world of social relationsships over which they
have little control. A patient with an alcoholic wife once said
that he was a man who liked to have his own way but his
wife always won by getting drunk. (p. 15)
A relationship becomes psychopathological when one
of the two people will maneuver to circumscribe the other's
behavior while indicating that he is not.... The formal term
for such a communication is a paradox. (p. 17)
If the patient gains control in psychotherapy, he will
perpetuate his difficulties since he will continue to govern by
symptomatic methods.
Hypnotic interaction progresses from "voluntary"
responses by the subject to "involuntary" responses. (p. 25)
The hypnotist must ask the subject to do something and
at the same time tell him not to do it. (p. 33)
It would appear that certain people respond with
hypnotic behavior when faced with paradoxical

directives. ...neurotic and psychotic symptoms occur in

relationships where paradoxical directives are common. The
directive that someone do something "spontaneously"
appears often in human life, and the appropriate response to
such a paradoxical request is to qualify one's response as
"just happening." Such a response is a formal definition of a
symptom. (p. 39)
The brief therapist attempts to induce change from the
moment of his first contact with a patient. In the initial
interview, information gathering is combined with maneuvers
to point the direction of change.... There is less concern
about the past and more concern with the present
circumstance of the patient and the function of his
symptoms. (p. 41)
The brief therapist must gain the information he needs
quickly. It would be convenient if patients were willing to
offer all the necessary information at once, but they are not.
In fact, they characteristically withhold information which is
important to the therapist and will do so even if they are
asked not to withhold information.... Erickson may directly
advise the patient that this is only the first interview and, of
course, there are things the patient will be willing to say to
him and things he will want to withhold, and he should
withhold them. Usually the patient withholds them until the
second interview. (p. 42)
An indirect suggestion that the patient withhold
information is implicit whenever a therapist deals delicately
with a patient who is inhibited in his offerings. (p. 42)
Rather than first getting the information and then
proceeding, the therapy begins with the way the information
is gathered. For example, a history may be taken in such a

way that the idea is established of progressive improvement

occurring in the patient.... Quite the reverse situation may
also be utilized. If a patient is indicating a consistent
worsening of his situation, the brief therapist may accept this
idea fully and completely and then follow it with the
suggestion that since things have become worse and worse
it is certainly time for a change.
The encouragement of a patient's commitment to a
change is established as quickly as possible. Erickson was
once asked what information he would want from a woman
who entered therapy because she had lost her voice 4 years
previously and was unable to speak above a whisper. "For
brief therapy," said Erickson, "I would immediately pose her
several questions. 'Do you want to talk aloud? When?
What do you want to say?'..." (pp. 42-44)
One does not use hypnosis to suggest away a pain, but
to establish a certain kind of relationship and to convince a
patient that his symptomatic behavior can be influenced....
Erickson's work is replete with examples of relieving a
symptom in trance and then suggesting that it recur later
under controlled circumstances. For example, in patients
with functional pain, he will accept the pain as real and
necessary but shorten the time of it, change the moment of
occurrence, shift the area in which it occurs, or transform it
into a different sensation. (pp. 44-45)
As stated by Erickson, the patient must be told to do
something and that something should be related to his
problem in some way. ...it is not enough to explain a
problem to a patient or even to have the patient explain a
problem himself. What is important is to get the patient to do
something. Erickson points out that it is insufficient to have a
patient with an oedipal conflict discuss his father. Yet, one

can give the patient the simple task of writing the word
"father" on a piece of paper and then have him crumple it up
and throw it in the wastebasket and this action can produce
pronounced effects. (p. 45)
There would seem to be several factors involved in
Erickson's success in getting suggestions followed. One
factor is Erickson's sureness.... Often the patient will be
encouraged to follow Ericson's suggestions to prove him
wrong. Erickson also encourages patients to follow his
directions by emphasizing the positive aspects of the
patient's life so that they are pleased to cooperate with
him.... Besides this context, he makes suggestions which
the patient can easily follow and, in fact, emphasizes how
the patient is doing this anyway. (p. 46)
Typical of Erickson's directives to patients is his
accepting the patient's behavior, but in such a way that a
change is produced.... Typical of Erickson's directives to a
patient is that given to a patient who came to him reporting
that he was lonely and had no contact with other people. All
he did was sit alone in his room and waste his time.
Erickson suggested he should go to the public library where
the environment would force him to be silent and not have
contact with others. At the library he should waste his time.
The patient went to the library and, since he was an
intellectually curious fellow, he began to idle away his time
reading magazines. He became interested in articles on
speleology, and one day someone at the library asked him if
he was interested in exploring caves too, and the patient
became a member of a speleological club which led him into
a social life. (p. 46)
A common Erickson technique is to have the patient not
only go through his symptomatic behavior, but also to add

something to it as he does so.... Although this method must

be designed for the individual patient, in general, it involves
committing the patient to wanting to give up his symptom,
drawing him out on some activity which he does not like (but
preferably feels he should accomplish), and persuading him
to go through with the activities as directed. (p. 49)
Erickson... likes to direct patients in such a way that
they cannot recognize that they are being directed and so
cannot resist the directive. At times he may do this by
dropping a casual comment, at other times he may arouse
the patient emotionally on one topic and then mention
another, apparently unrelated topic at that moment. The
patient will "unconsiously" connect the two topics.
Another way Erickson will use to get over a suggestion
indirectly is to tell anecdotes to patients.... Often they will
include an idea which the patient can recognize and defent
himself against, but while defending himself against that idea
he is accepting others which encourage change.
Similarly, Erickson may persuade a patient to accept a
suggestion by making it seem quite minor in nature. He will
induce a cumulativce change but base it upon so small a
change that the patient can accept it. He may ask a patient
with insomnia to report to him next time that he believes he
slept one second longer one night....
Erickson may also bring in the relatives of a patient to
enlist their cooperation in producing a change. Since most
symptoms are embedded in a relationship, a change can
often be worked more rapidly by wroking with an intimate
relative of the ostensible patient. (p. 50)
He gains control of a patient's symptomatic behavior by

encouraging it, thereby posing a paradox, and then he shifts

his direction. (p. 53)
Paraphrase: A woman came to him for help in losing
weight. He instructed her to go out and gain from 15 to 25
pounds. While she was gaining this weight she could
organize her thinking to be prepared to lose weight. She
gained some weight and didn't want to gain more. Erickson
finally permitted her to stop gaining weight at 20 pounds.
She then went on a diet and lost the weight she wanted to.
(p. 53)
The basic rule of brief psychotherapy would seem to be
to encourage the symptom in such a way that the patient
cannot continue to utilize it. One of the quickest methods is
to persuade the patient to punish himself when he suffers
from the symptom, thereby encouraging him to give up the
symptom. (p. 55)
Ostenisbly the best self-punishment would be that
which is of benefit to the patient and/or meet his
psychodynamic needs. If the man who feels he should
exercize more is required to get up in the middle of the night
and do a number of deep knee bends whenever he
experiences his symptom, then he is benefiting whatever he
does. (p. 56)
When a symptom is seen as a way a patient gains an
interpersonal advantage, it seems logical to resolve the
symptom by arranging a situation where the symptom places
the patient at a disadvantage. (p. 56) Paraphrase: a patient
came in with an involuntary squint. The therapist squinted
back at him each time he squinted, and in one session the
squint was gone.

From Freud onward it has been acknowledged that

"understanding" or "insight" of the cause of a phobia is not
sufficient for a cure; the patient must enter the phobic area
behaving differently than he has in the past. (p. 59) He was
not reinforcing his fear by his bhavior, he was extinguishing it
by behaving differently. (p. 61) ...a patient's anxiety can
decrease if it is encouraged. In fact, the more one asks a
patient to become anxious, including helping him become so
by asking him to think of anxious situations, the less anxious
he becomes.... Fearful behavior can be seen as a style of
maneuvering other people, although the results subjectively
may be distress. To control such a person's maneuvers, it is
necessary to acknowledge and accept his behavior and
thereby "take it over." (p. 63)
One of the more entertaining examples of taking control
of a patient's behavior appeared in Lindner's article "The Jet
Propelled Couch." A borderline psychotic patient presented
delusionary material to Lindner about his contact with other
planets. He presented this in such a way that Lindner was
excluded and the patient was in charge of this subject....
Linder... encouraged the patient to bring in the material and
then proceeded to correct him on it and suggest additions.
The more Lindner took the initiative with the planetary
discussions, thus gaining control of the behavior the patient
offered, the more reluctant the patient was to make an issue
of the matter, and eventually he abandoned this psychotic
behavior. (p. 64)
The procedure was developed by Frankl as a technique
of logotherapy and he calls is "Paradoxical Intention." ...the
patient is asked to have his symptom right there. As Gerz
reports, in a case of a patient afraid to pass out, "To evoke
humor in the patient I always exaggerate by saying, for
example, 'Come on, let's have it; let's pass out all over the

place. Show me what a wonderful "passer-out" you are.'

And, when the patient tries to pass out and cannot, he starts
to laugh." (pp. 65-66)
It now appears generally recognized that a patient's
productions are always being influenced by a therapist,
which is why patients in Freudian analysis have dreams with
more evident sexual content and Jungian patients dream in
appropriate Jungian symbolism, thus substantiating the
theroies of the therapists. (p. 82)
Some kind of explanation for undergoing change seems
necessary for all methods of treatment. In psychoanalysis
the responsibility for change is placed upon the patient, as it
is in brief therapy. (P. 83)
A more rigorous science of psychotherapy will arrive
when the procedures in the various methods can be
synthesized down to the most effective strategy possible to
induce a person to spontaneously behave in a different
manner. "Spontaneous behavior would seem to occur when
a person is caught in an impossible situation-- that is, a
situation which he cannor resolve by his usual manner of
behaving. He is thereby provoked to respond in ways which
he has never responded before. From this point of view,
psychotherapy can be seen as similar to the ways of
achieving "liberation" or "enlightenment" in Eastern religions.
Discussing this problem, Alan Watts says, "....we must look
for a simplified and yet adequate way of describing what
happens between the guru or Zen master and his student
within the social context of their transaction. What we find is
something very like a contest in judo: the expert does not
attack; he waits for the attack, he lets the student pose the
problem. Then, when the attack comes, he does not oppose
it; he rolls with it and carries it to its logical conclusion, which

is the downfall of the false social premise of the student's

question." (p. 85)
It is not the existence of delusions or hallucinations
which cause a patient to be hospitalized; a person can have
those and still make his living in society. The schizophrenic
is placed in a hospital in those periods when he cannot
maintain the ordinary types of relationships. One ordinary
relatioship he will not form is that type where one person
tells another what to do and he does it. (pp. 101-102)
A human chile, by the nature of the organism, must be
taken care of or he will die. He must be offered food and
accept it, he must be supervized and respond to that
supervision, he must be directed and follow that direction if
he is to live with others. At the same time that he is learning
to define his relationship with his parents as complementary,
he must also begin to learn to behave symmetrically in
preparation for that day when he leaves his parents and
establishes a family himself....
Current research on the families of schizophrenics
indicates that the schizophrenic child does not have that
opportunity. (p. 107)
In cooperation with his parents, the child who becomes
schizophrenic does not have independent relationships
outside his family. For many years he experiences only the
responsive behavior peculiar to his family and suffers an
almost total lack of experience with people who respond
differently. When he is ultimately of the appropriate age to
leave home and go out into the world, he is incapacitated for
normal human intercourse. (p. 108)
It is the contention of many investigators that
schizophrenia in the child serves a supportive, or

homeostatic function in this type of family. If the patient

behaves more "normally," the parents become disturbed or a
sibling may begin to develop symptoms. The continual
conflict between the parents may also come out more openly
and separation may be threatened.... Therefore therapeutic
change may threaten a patient not only with a different way
of life for himself, but the responsibility for a shattered family
and the collapse of someone else. (p. 108)
Typically, if the child behaves in a way which indicates
he is initiating a complementary, or "taking care of,"
relationship, his parents will indicate he should be less
demanding and so behave more symmetrically with them. If
he behaves in a symmetrical way, they indicate that he does
not seem to appreciate their desires to take care of him.
This constant disqualification of his bids for relationship is a
theme of their life together. If the child seeks closeness, he
is encouraged to be at a distance. If he attempts to place
some distance between himself and his parents, they
respond as if they have been criticized and indicate he
should seek closeness. If he asks for something, he is too
demanding. If he does not ask, he is too independent. The
child is caught in a set of paradoxical relationships with all of
his responses labeled as wrong ones. What other parents
would consider normal behavior, such as the child making
demands upon them, criticizing them, objecting to what they
do, asserting his independence, and so on, these parents
consider impossible behavior. Even positive, or affectionate
behavior by the child, is responded to by these parents in a
negative way as if they feel that too much more will be
expected of them. This constant disqualification may occur
immediately in response to a patient, particularly those who
later give up trying to reach their parents, or the
disqualification may be delayed. Paranoid patients would
seem to have experienced an apparent acceptance of their

behavior and a later disqualification when what was

previously done is labeled as something else, and so they
live in a world of booby traps. (p. 109)
When a therapist becomes "too involved" with a
schizophrenic, the therapy is in difficulty. The play-like
quality is gone and the patient can easily place the therapist
at a disadvantage or provoke him to behave in ways he
would rather not. At this point, supervision of the therpist
becomes important to help him detach himself from too
personal an involvement and reinstitute a psychotherapeutic
frame to the interchange. (p. 115)