Dynamic perspectives of paradoxical intervention.

This paper describes the use of paradoxical intervention with a patient who, despite his persistent appeals for help, remained uncooperative. It endeavors to show an understanding of the patient's destructiveness as an expression of his neediness and envy, which he expresses via his repeated use of projective identification and suggests this intervention as a way out. From a dynamic perspective the paradoxical intervention encompasses two contrasting aspects: On the one hand, it rechannels the patient's destructiveness and envy in a beneficial direction. In that sense the intervention fulfills the patient's wish for an omnipotent therapist and for painless therapy, while appearing to prevent personality change. On the other hand, the intervention interferes with the continued use of projective identification, it facilitates the expression of non-destructive aggression, creates an ambiguity surrounding the question of who is in fact in control of the therapy and, finally, it possibly facilitates the creation of a potential space. In that sense the paradoxical intervention assists in achieving both the experience of separateness and the ability to use symbolization. Parallel processes are described in the therapist's countertransference.