EP90 Workshop 26 - Psychotherapy "As If" - Paul Watzlawick, PhD

Description:

This workshop will present a brief therapy approach, based on the interaction between those involved in the problem, and on the interventions aimed at changing this problematic interaction by motivating the client(s) to behave "as if" the situation were different from the way it is perceived.

Educational Objectives:

1. To show the relevance of Vaihinger's Philosophy of As If and of Korszybski's Science and Sanity to psychotherapy
2. To list four examples of practical applications of these principles 

*Sessions may be edited for content and to preserve confidentiality*

Outline:

Evolution of Psychotherapy and Introduction to the Presentation

• Paul Watzlawick begins his presentation, referencing Hans Vaihinger's The Philosophy of As If

• Vaihinger argues that humans function based on useful fictions (e.g., free will, mathematical points)

• His idea that “truth is the most expedient error” shocked contemporaries but influenced Alfred Adler

Examples from Vaihinger's Book and Their Implications

• Legal fiction of freedom: used in sentencing without examining its validity

• Mathematical point: a non-sensuous abstraction foundational to geometry

• Truth as expedient error reiterated as useful for therapeutic framing

• Reference to Korzybski’s Science and Sanity: "The map is not the territory"

Constructivist Epistemology and Its Relevance to Psychotherapy

• Reality is constructed, not objectively existing

• Epictetus: "It is not things that worry us, but our opinions about them"

• Constructivism helps explain mental health phenomena and therapeutic strategies

• Changing constructed realities is central to therapy

Literary Examples of Relative Reality

• Hesse’s Steppenwolf: Magic Theater illustrates multiple realities

• Fowles’ The Magus: protagonist’s understanding of reality is undermined

• Both demonstrate constructed, not fixed, realities

Theoretical Introduction to Constructivist Epistemology

• Contrast between objectivism and constructivism

• Therapy as the transformation of painful constructed realities

• Joke about the wine bottle (optimist vs. pessimist) used to illustrate differing perspectives

Practical Application of Constructivist Epistemology in Therapy

• Phobic avoidance illustrates the persistence of maladaptive constructions

• Four interventions: trust, origin discovery, object introduction, “accident” exposure

• Corrective emotional experiences can catalyze shifts in perception

Behavior Prescriptions and Systemic Therapy

• Behavior prescriptions: clients asked to act “as if”

• Example: fear of a boss resolved through behavioral reframing

• Systemic therapy focuses on dyadic relationships and emergent qualities

• Simple interventions often more effective than complex analyses

Variety Reducers and Systemic Interventions

• Variety reducers help manage complexity (e.g., thermostats, traffic rules)

• Gauss’s method as a mathematical example

• Emphasis on small, peripheral therapeutic changes

• Therapist explores past attempted solutions and advice given

Case Examples and Practical Interventions

• PTSD client helped by reconnecting with emotional experience

• Importance of understanding the client’s own framing of the problem

• Paradoxical interventions used when straightforward methods fail

• Example: woman compelled to comply with others helped via paradox

Conclusion and Final Thoughts

• Emphasis on small, ethical, non-intrusive behavioral prescriptions

• Avoidance of violating client’s moral/religious framework

• Ethical awareness central to applying constructivist interventions

Positive Connotation Intervention

• Originated by Mara Selvini Palazzoli

• Used when clients report prior therapeutic failure

• Therapist suggests change would make things worse, prompting client to prove them wrong

• Often evokes change through paradox

Case Study: Whiplash Injury

• Woman continued to complain post-healing

• Psychiatrist told her pain wouldn’t go away

• Despite pessimism, symptoms improved

• Demonstrates power of reframing through paradox

Behavior Prescription Techniques

• Prescriptions delivered slowly and with monotony

• State of expectancy is critical for effectiveness

• Compliance discussed in follow-up sessions

• Noncompliance handled with therapist apology and revised directive

Handling Client Compliance

• Clients may: not follow, misunderstand, or report improvement

• Therapist should respond accordingly—simplify, reframe, or probe for insight

• Goal is for client to feel responsible for the change

Preventing Relapses

• Clients asked to anticipate what could cause relapse

• Encouraged to proactively plan for preventing it

• John Rosen’s technique of demonstrating symptoms to others referenced

Termination of Therapy

• Clear expectations set at the start (e.g., max 10 sessions in brief therapy)

• In private practice, termination is collaborative

• Avoid implication that the therapist is “giving up” on the client

Application to Different Cases

• Not all cases (e.g., psychosis) are suited to the approach

• Criticisms acknowledged (e.g., superficiality or manipulation)

• Instead of lecturing on constructivism, therapist uses client’s own framing

• Example: professor with anticipatory anxiety uses metaphor of pushing safety zone

Externalizing the Problem

• Inspired by Gregory Bateson’s systems thinking

• Focus is on how the problem interacts with context and relationships

• Seen as a broader ecological/systemic issue, not just internal pathology

Handling Addictions

• Chronic alcoholism addressed via systemic interventions

• Focus on modifying spouse’s behavior rather than confronting the addict

• Overeating example: wife’s change prompted husband’s improvement

• Reference to Herbert Spiegel’s work on tobacco addiction

Consulting with Businesses

• Corporate consultation parallels family systems therapy

• Complexity is greater, but principles remain the same

• Begin by identifying attempted solutions

• Aim is to resolve systemic dysfunction, not assign individual blame