The Ten Coolest Therapy Interventions series kicks off with supernaturalpower.

Many clients
come to therapy looking for a miracle. Here's a technique built on miracles. I'm honored to speak
with Dr. Linda Metcalf, expert on the Miracle Question and Solution Focused Therapy.
The therapeutic intervention is a critical element in most forms of psychotherapy. In this series I
survey ten diverse techniques that are, in my opinion, cool. For more information on the series
take a look at the introduction.
Solution Focused Therapy (aka Brief Therapy) emerged in the 1980's as an branch of the systems
therapies. A married therapist couple from Milwaukee, Steve de Shazer and Insoo Kim Berg are
credited with the name and basic practice of SFT. The theory focuses not on the past, but on what
the client wants to achieve today. By making conscious all the ways the client is creating their
ideal future and encouraging forward progress, clinicians point clients toward their goals rather
than the problems that drove them to therapy.
The Miracle Question fits perfectly with this model. Imagining an ideal future and connecting it
to the present immediately actualizes the work. Clients are challenged to look past their obstacles
and hopelessness and focus on the possibilities.
It's cool because it's a relatively simple intervention that can have a powerful impact. Just take a
look at the question (response #2). You're probably crafting your response already. It's creative,
bold, healing, a bit mysterious and definitely has a cool name. The Top Ten designation is well
deserved.
Don't just listen to me, hear it from an expert. Linda Metcalf, Ph.D. is founder of the Solution
Focused Institute of Fort Worth, Texas and author of ten books including The Miracle Question:
Answer It and Change Your Life. Beyond writing and therapy, she speaks internationally to
schools, agencies and universities. She was kind enough to share her wisdom with us today.
1. When would a clinician use the Miracle Question?
The Miracle Question is a goal setting question that is useful when a client simply does not know
what a preferred future would look like. It can be used with individuals to set the course for
therapy, with couples, to clarify what each person needs from each other and with families, who
too often see one person as the culprit. By using the Miracle Question and asking each person
what a better life would look like, the system sees perhaps for the first time, what others need
from each other.
2. What does it look like?
"Suppose tonight, while you slept, a miracle occurred. When you awake tomorrow, what would be
some of the things you would notice that would tell you life had suddenly gotten better?"
The therapist stays with the question even if the client describes an "impossible" solution, such as
a deceased person being alive, and acknowledges that wish and then asks "how would that make a
difference in your life?" Then as the client describes that he/she might feel as if they have their
companion back, again, the therapist asks "how would that make a difference?" With that, the
client may say, "I would have someone to confide in and support me." From there, the therapist

would ask the client to think of others in the client's life who could begin to be a confidant in a
very small manner.
3. How does it help the client?
It catapults the client from a problem saturated context into a visionary context where he/she has
a moment of freedom, to step out of the problem story and into a story where they are more
problem free. But, more importantly, it helps the therapist to know exactly what the client wants
from therapy...and this is what makes Solution Focused Therapy so efficient and brief.
4. In your opinion, what makes the Miracle Question a cool intervention?
It helps the therapist see where the client wants to go. Too often, therapists assume that a client
needs to grieve, leave their spouse, quit their job, after the client describes why he/she has come
to therapy. The Miracle Question helps the client and therapist to address exactly what the client
wants, not what the therapist thinks is best.
You know, this contribution to the Ten Coolest Therapy Interventionsisn't very interesting. I
wouldn't waste your time reading about the fascinating and controversial world of paradoxical
interventions or the interview with one of psychology's living legends: Cloe Madanes. Kindly
move along to the next blog. Okay, read if you must, but definitely don't send it to a friend. Or
leave a comment.
Paradoxical interventions involve prescribing the very symptom the client wants to resolve. It's
a complex concept often equated with reverse psychology. For example: the client fears failure,
so the therapist asks the client to fail at something. A man has problems with procrastination, so
the therapist asks him to schedule one hour a day to procrastinate. Your four year-old resists
brushing her teeth so she's told she isn't allowed, and may end up doing it out of spite. Or a
woman who can't initiate sex with her husband is advised not to initiate for a month. Don't think
about a purple elephant. It's asking for something in order to achieve the opposite result.
City or Zip

The underlying principle is that we engage in behaviors for a reason, which is typically to meet a
need (rebellion, attention, a cry for help, etc). In prescribing the symptom the therapist helps the
client understand this need and determine how much control (if any) they have over the symptom.
By choosing to manifest the symptom, they may recognize they can create it, and therefore have
the power to stop or change it.
You can see how this might get a bit dicey. If the symptoms could cause harm to the client or
anyone else, nudging the client toward it would pose an ethical problem. In fact, much has been
written to establish guidelines for paradoxical interventions. Only clinicians well-trained in the
technique should consider using it.
It's a privilege to interview Cloe Madanes, a pioneer in the field of familytherapy and a prolific
writer, speaker and fellow PT blogger. She wrote the book on Strategic Family Therapy, a
modality that looks at the balance of power within the family and the hidden function of
symptoms. Her work continues to grow and evolve - she's recently joined forces with Anthony

Robbins to find solutions to interpersonal conflict, violence prevention and creating a civil
community (watch them work together atwww.madanesfilms.com). On to her interview:
1. When would a clinician use a paradoxical intervention?
A clinician would use a paradoxical intervention when there is a clear symptom or presenting
problem that the patient believes is an involuntary behavior, such as depression, fears, pain, even
seizures.
2. What does it look like?
The therapist asks the patient to deliberately have the symptom at the therapist's office and/or
outside the office. Family members may be asked to encourage, advise or reward the behavior.
The idea is that, if a symptom is involuntary, having it voluntarily means the behavior can be
controlled and is no longer a symptom. If the person can have it voluntarily, this means he/she
can also not have it voluntarily. A variation is to ask the patient to pretend to have the symptom.
When a person is pretending to have a symptom, they are not having the real symptom.
Secondary gain or positive reinforcement can be arranged for the pretend behavior, so that it
replaces the involuntary behavior. The involuntary behavior is no longer needed in order to
obtain the secondary gain.
3. How does it help the client?
It helps the client to be in control of his/her behavior and experiences. It's based
on humor because the intent is for the patient to laugh at the idea of bringing on an unpleasant
symptom voluntarily and humor is always therapeutic.
4. In your opinion, what makes paradoxical interventions cool?
Paradoxical interventions are cool because they are painless and funny.