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Unformatted text preview: s from prior generations, can be expressed through the child.
Regardless of how the parent responds to the child (soothing, demanding,
punitive, concerned), it focuses the parents on their child and away from their
Assessment and Treatment
The first task of treatment is to decide who is being protected by the child’s
behavior and how. The therapist then designs a directive to change the pattern of
interaction to reestablish the parents in a superior position by helping the parents
take back power from the child. The changed structure no longer supports the
child’s problem behaviors. The emphasis is not on helping the family understand
how or why the problem behavior is occurring, but rather on solving the
problem. Directives are developed to fit the unique needs of the family. The
strategic paradoxical interventions are: dramatizations, pretending, and makebelieve play.
Dramatizations. A parent is directed to request that his/her child intentionally
perform the problem behavior. Here the relationship between the parent and the
child is based on benevolent helplessness in which the child’s symptom helps the
parent by diverting attention from the problem as the parent helps the child try
to overcome the symptom. For example, a mother is worried she may lose her job
(the real problem) and the child develops a headache. The child is protecting the
mother and trying to “solve” her problem. The strategy works in that the mother
ignores her own problem to attend to her son’s headache. To alter the pattern,
Madanes directs the parent to encourage the child to have the symptom. In this
way the symptom will not draw as much parental attention, no longer serves a
purpose, and will usually be dropped. The mother’s fear will resurface, and she
can address the real problem with the therapist’s help.
Pretending. Madanes directs parents to ask the child to pretend to have the
symptom and the parents to pretend to help the child. This intervention makes
the child’s need to ac...
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This document was uploaded on 04/03/2014.
- Spring '09