Paradox in psychotherapy: a cybernetic perspective

Recent uses of the term "paradox" in the field of psychotherapy have distracted attention from the concept's broader implications. All therapy can be seen as paradoxical because of the recursive nature of self-evaluation. Using agoraphobic problems as illustrative, and starting from the notion that the core issue for the agoraphobic is a demand for absolute control of his environment, we argue that therapy requires the bonding of two observers--the therapist and the "client-as-observer". Negotiations issuing from this bond are crucial to outcome, even when behavioral techniques, often considered to have automatic effects, are used. Behavior therapy, like all other psychotherapy, is not simply action--it is action contextualized by a specific, negotiated social contract.     

AI Assistants and the Paradox of Internal Automaticity

Neuroethics - What is the ethical impact of artificial intelligence (AI) assistants on human lives, and specifically how much do they threaten our individual autonomy? Recently, as part of forming...     

Paradox of a better test for Huntington's disease

OBJECTIVES: To describe the consequences of the identification of the Huntington's disease (HD) mutation on predictive and prenatal testing. METHODS: A retrospective study was performed considering the test applicants, procedures, and results before and after the identification of the mutation. 1032 people at risk for Huntington's disease in The Netherlands were included, of whom 741 applied for the predictive test in the period 1987 to 1997 in Leiden at the Department of Clinical Genetics, and after 1994, also in the other seven clinical genetics departments in The Netherlands. Uptake, sociodemographic variables, and test results, taken before and after the mutation was identified, are described. RESULTS: The uptake of the predictive test in the period studied was 24% and for the prenatal test 2%. No differences were noted in numbers and sociodemographic data between the period before and after the mutation was identified. After an initial increase in test applicants, a decrease was seen after 1995. After 1993 a significant increase of 25% at risk test applicants and a significant decrease of prenatal exclusion tests was noticed. Only 7% asked for reassessment by mutation analysis. New problems arose after the identification of the mutation, such as the option of reassessing the risk obtained by linkage analysis, direct mutation testing of 25% at risk persons with a parent who does not wish to know, new choices regarding reproduction, and new uncertainties for carriers of intermediate and reduced penetrance alleles and for their offspring and relatives. CONCLUSIONS: Although predictive testing has become reliable and available for every person at risk since the mutation has been identified, the uptake of predictive and prenatal tests fell short of expectation, no change in sociodemographic variables was seen, and a decrease in number of applicants was noted. Furthermore, new uncertainties, psychological problems, and questions arose.     

Paradox Regained: Conversion,Conversation, and Conservation

I offer the view that the source of therapeutic action in psychoanalysis is a shared minding of the dissociative gap—a process that simultaneously decreases the mind's fear of otherness and the vulnerability of the brain's neural networks to potential affect dysregulation. Through a patient's “me” and “not-me” self-states becoming more at home with each other, the automatic neurosynaptic warning signal that triggers immediate dissociation as a protection against potential hyperarousal becomes more selective at the brain level and, through a feedback loop, allows the patient's mind to support increased development of intersubjectivity. Little by little, the patient's capacity to bear internal conflict is increased by easing the mental struggle to hold it cognitively. For a classical psychoanalyst, taking this seriously does not lead to abandoning Freud, but it does lead to a different listening stance. It requires listening to clinical process not only dyadically, but listening to it as an inherently confusing affective event to be processed together, rather than as content to be “understood”; that is, organized by the analyst into something he deems cognitively conceptual and then made available for potential interpretation. Clinical examples are provided for consideration.     

Paradox, reprimand and extinction in adults with mental handicap

To assess the efficacy of paradoxical directives, levels of challenging behaviour during 2 weeks of paradox, reprimand and extinction were compared with baseline levels in four adults with mental handicaps attending a day centre. Paradox was the most effective procedure for reducing the frequency and severity of challenging behaviour by an average of over 70% by the end of 2 weeks and up lo 90% m certain subjects; extinction was least effective. Paradox was most effective with more defiant subjects, when staff rated treatment success as low., when improvement using extinction and reprimand was poorest, and in reducing aggressive behaviour. The present authors suggest the overjustification effect offers an explsnation for the effects of paradox.     

From Out of Nowhere - The Paradox of Unconscious Experience

Abstract

Using material from physics, linguistics, philosophy, and other disciplines, I hope to introduce a view of unconscious experience that can expand our view of the unconscious and its clinical utility beyond our present psychoanalytic orientations and metapsychological perspectives. Central to this presentation is the examination of the at once nebulous and possibly direct relationship between unconscious experience and the apprehension of reality, a relationship that challenges, as I see it, the current psychoanalytic emphasis on subjective experience (as in the view, for example, of perception as interpretation), and of our use of the concept of psychic reality.     

Vagus Nerve Stimulation and Atrial Fibrillation: Revealing the Paradox

Background and ObjectiveThe cardiac autonomic nervous system (CANS) plays an important role in the pathophysiology of atrial fibrillation (AF). Cardiovascular disease can cause an imbalance within the CANS, which may contribute to the initiation and maintenance of AF. Increased understanding of neuromodulation of the CANS has resulted in novel emerging therapies to treat cardiac arrhythmias by targeting different circuits of the CANS. Regarding AF, neuromodulation therapies targeting the vagus nerve have yielded promising outcomes. However, targeting the vagus nerve can be both pro-arrhythmogenic and anti-arrhythmogenic. Currently, these opposing effects of vagus nerve stimulation (VNS) have not been clearly described. The aim of this review is therefore to discuss both pro-arrhythmogenic and anti-arrhythmogenic effects of VNS and recent advances in clinical practice and to provide future perspectives for VNS to treat AF.Materials and MethodsA comprehensive review of current literature on VNS and its pro-arrhythmogenic and anti-arrhythmogenic effects on atrial tissue was performed. Both experimental and clinical studies are reviewed and discussed separately.ResultsVNS exhibits both pro-arrhythmogenic and anti-arrhythmogenic effects. The anatomical site and stimulation settings during VNS play a crucial role in determining its effect on cardiac electrophysiology. Since the last decade, there is accumulating evidence from experimental studies and randomized clinical studies that low-level VNS (LLVNS), below the bradycardia threshold, is an effective treatment for AF.ConclusionLLVNS is a promising novel therapeutic modality to treat AF and further research will further elucidate the underlying anti-arrhythmogenic mechanisms, optimal stimulation settings, and site to apply LLVNS.     

Paradox as Symptom in the Borderline Patient's Struggle for Self-Differentiation

Topic. Paradox as symptom in patients diagnosed with borderline personality disorder (BPD).
Purpose. To conceptualize the nature of difficulties arising in psychotherapy with patients diagnosed with BPD.
Sources. Review of the literature and clinical data from the author's work.
Conclusions. The borderline dilemma is inherently paradoxical and, in some ways, reflects the human condition. Psychoanalytic concepts can further our understanding of the therapeutic difficulties encountered in the struggle to make sense of life's inherent dualities. The borderline patient is acutely sensitive to these dualities, which the therapist must tolerate and understand. Often, a negative therapeutic reaction may impede progress.