Intervention
Paradoxical Directive Planner
Design a formal prescription for a client's refusal before you offer it in session — so the mechanism is sound and the delivery is clinical, not ironic.
A paradoxical directive prescribes the behavior you want to change. When refusal has become a fixed pattern in the therapeutic relationship, prescribing the refusal removes the relational contest that maintains it. The client who was refusing to comply is now complying by refusing — and the client who defies the prescription does so by accepting a suggestion. Both outcomes move the work forward.
This planner walks you through the design and delivery of a paradoxical directive for a specific refusal pattern. Complete it before the session in which you plan to introduce the prescription. The preparation matters: a paradoxical directive offered without a clear clinical rationale sounds like irony, and irony destroys the mechanism.
Paradoxical Directive Planner
Client (initials or identifier): Date of planning: Planned session for delivery:
The refusal to prescribe
Describe the specific refusal pattern precisely — the behavior you intend to prescribe:
How long has this pattern been present in the treatment?
Clinical rationale
What function does this refusal serve in the therapeutic system? (What does it accomplish for the client in the relationship?)
Why does prescribing it address that function rather than reinforcing it?
Framing language
Write out the prescription as you would deliver it in session. It must be offered with clinical seriousness — not as a challenge, not with irony, not as reverse psychology:
What clinical rationale will you give the client for the prescription? (The client should understand why this makes clinical sense, even if the mechanism is not explained in full):
Predicted responses and your replies
If the client complies with the prescription (refuses the next suggestion as directed):
What you will say:
If the client defies the prescription (accepts the suggestion instead):
What you will say:
If the client asks why you are telling them to refuse:
What you will say:
Relational preconditions
Is the therapeutic relationship currently strong enough to carry this intervention? What has to be in place before offering it?
Is there any active rupture or unresolved tension in the relationship that should be addressed first?
( ) Yes — address before proceeding ( ) No — proceed as planned
Next session follow-up
What will you track in the session after the prescription is introduced?
What would indicate that the prescription is working?
What would indicate that it needs adjustment?
Generated with Rapport7 — rapport7.com