The use of paradoxical interventions within a prison psychiatric facility.

Abstract

A brief history of paradoxical interventions and a rationale for applying paradoxical techniques to the cases of inpatients at a prison psychiatric facility are outlined. Common inmate personality characteristics and type of paradoxical techniques indicated are discussed. Four case studies are presented, as well as indications and contraindications for the utility of such interventions.An inpatient psychiatric hospital located within a prison setting often conjures up images of "mass murderers'" and "criminally insane'" individuals. While such cases do exist, they represent a small percentage of the clients seen at the South Carolina Department of Corrections Mental Health Unit (MHU). The majority of inmates fall into three categories: those with severe thought or affective disorders, individuals who are attempting to manipulate their environmental circumstances for secondary gain, and inmates who have been management problems at other institutions within the Department of Corrections.As a result of fiscal realities, staff of such an inpatient facility are limited. Interventions need to be short-term, problem-focused, and typically incorporate a crisis intervention model. It is interesting to note that at any given time about twothirds of the inmates being treated have been patients in state mental hospitals and have thus been exposed to previous attempts at psychotherapeutic Requests for reprints should be sent to Jeffrey Chase, P.O.

Paradoxical Interventions: A Review of the Recent Literature

“…In the case of an elderly couple who were spending increasingly less time together due to their frequent arguing, Gilewski, Kuppinger, and Zarit (1985) found that SP resulted in the couple spending more time together and arguing less. Chase, Shea, and Dougherty (1984), in their study of paradoxical interventions on prison inmates, commented that a wide range of pathological behavior may be resolved through SP. They also noted the beneficial impact such interventions can have on therapists, since these approaches help therapists avoid power struggles typically encountered with a prison population and make therapy less frustrating and more enjoyable.…”

The intrapersonal and systemic ramifications of symptom prescription.

“…Unfortunately, many case studies in which symptom prescriptions are utilized neglect these common clinical realities. Both controlled (e.g., Kolko & Milan, 1983) and uncontrolled (e.g., Chase et al, 1984; Haley, 1973) case studies frequently convey the impression that the removal of the target symptom resulted in the successful termination of treatment. Comparative treatment outcome studies (e.g., Michelson et al, 1985) also rarely report on the treatment of problems that are revealed during the course of therapy.…”