Brief Therapy Based on Interrupting Ironic Processes: The Palo Alto Model.

This article describes a parsimonious therapy approach based on identifying and interrupting ironic processes that occur when repeated attempts to solve a problem keep the problem going or make it worse. “Brief problem-focused therapy” was developed over a quarter century ago by Richard Fisch, John Weakland, Paul Watzlawick, and their colleagues at Palo Alto’s Brief Therapy Center (Watzlawick, Weakland, & Fisch, 1974; Weakland, Fisch, Watzlawick, & Bodin, 1974). Although these authors have not themselves used the term “ironic process,” it captures well the leitmotif of their work—namely, that problems persist as a function of people’s attempts to solve them, and that focused interruption of well-intentioned solution efforts is sufficient to resolve most problems.1 The Palo Alto model is “strategic” because the therapist intervenes to interrupt ironic processes deliberately, on the basis of a case-specific plan that sometimes includes counterintuitive suggestions (e.g., to “go slow” or to engage in behavior the client wants to eliminate). Calling it only “strategic therapy” may be misleading, however, because this label gives undue emphasis to intervention style and detracts attention from the more fundamental principle of ironic problem maintenance on which interventions are based. From the perspective of the Palo Alto group, ironic processes are ubiquitous: They happen, for example, when trying harder to fall asleep keeps a person awake, when trying to suppress an unwanted thought increases the thought’s intrusion, when encouraging a depressed partner to cheer up results in more despondency, or when reasoning with a difficult two-year-old intensifies the child’s temper tantrums. Whether occurring within or between people, these processes persist because problem and attempted solution become intertwined in a vicious cycle, or positive feedback loop, in which more of the solution leads to more of the problem, leading to more of the same solution, and so on (Fisch, Weakland, & Segal, 1982). Most important, formulations of ironic problem-solution loops provide a template for assessment and strategic intervention: They tell us where to look to understand what keeps a problem going (look for “more of the same” solution) and suggest what needs to happen for the problem to be resolved (someone must apply “less of the same” solution). In contrast to most of the other brief therapies described in this special series, the Palo Alto model of brief therapy is non-normative and complaint based: It makes no assumptions about normal or abnormal functioning; in fact, if no one registers a complaint about a behavior, there is no problem (Fisch & Schlanger, 1999). Nor does this approach attach importance to working through underlying emotional issues, teaching clients new skills, promoting developmental insights, or challenging dysfunctional cognitions: The therapist aims simply to resolve the presenting complaint as quickly and efficiently as possible so that clients can get on with life. Also in contrast to most other therapies, strategic intervention is deliberately minimal, and therapy is brief by design rather than default (Gurman, this issue)—less is best. It is assumed that interrupting current patterns of problem maintenance, even in some small way, can lead to further positive developments. More therapy (even of the same kind) confers no additional benefit once the complaint is resolved and can inadvertently contribute to continuance of the problem. To accommodate the special-series format, we will first review the historical background of the Palo Alto model, then describe the formulations of problem maintenance that guide intervention, followed by the intervention techniques themselves. Subsequent sections consider selection criteria (whether there are any) and several lines of supporting research, both directly and indirectly relevant to the model. We conclude with some observations about possible future directions, not only for clinical applications of the ironic process idea but also for much needed empirical research.