Journal of ContemporaryPsychotherapy

Voi. 11, No. 2 Fall/Winter I980

Paradoxical Experiential Therapy:

A Description of the
Technique and Rationale of a
Nonbehavioral Therapy for an
Unselected Patient Population
ALICE KUTZIN, M.D., Ph.D.

ABSTRACT: Paradoxical Experiential Therapy, a new technique of psychotherapy,

is a nonbehavioral, short-term, experiential form of individual psychotherapy which
produces long-lasting changes in ego strength, anxiety, depression, guilt, anger, and
other common psychiatric symptoms, in an unselected patient population, in
approximately 40 to 60 hours of therapy. This is accomplished by the use of
structured fantasies accompanied by feelings which are instantly paradoxical to the
content and nature of the fantasies themselves, and by other structured fantasies with
paradoxical input from the therapist.

p aradoxical Experiential Therapy (PET) is a nonbehavioral, short-term,

intensive form of experiential therapy which produces changes in ego
strength, self-esteem, anxiety, guilt, anger, depression and other common
psychiatric symptoms. This is accomplished in 40 to 60 hours of therapy
over a four-week to six-week period of time, during which the patients live at
the Institute on a residential basis.
Session One. The patient experiences a new and stronger sense of self
through the use of structured anxiety fantasies accompanied by the Anxiety
Paradox; as a result the patient perceives anxiety-provoking fantasies, but does
not experience anxiety during these fantasies. The Anxiety Paradox is explained
later in this paper.
Sessions Two, Three and Four. Aboriginal anger towards parents, siblings, and
displaced aboriginal anger towards love objects and all other people, is
abreacted by a structured fantasy in which the patient kills and mutilates the
subject of the fantasy, conducts a long conversation with the deceased subject
of the fantasy (the therapist assumes this role), undergoes an all-important
fantasy within a fantasy in which he relives and re-experiences the life of the
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732 journal of ContemporaryPsychotherapy

deceased experientially, and then forgives and resurrects the subject of the
fantasy.
Between Sessions. New anger is automatically experienced and verbally
expressed, thus abreacting it, by means of a paradoxical anger assignment.
The assignment enables the patient to both feel and verbally express new
anger without anxiety, thus ameliorating any depression remaining after the
first session and preventing its recurrence, preventing guilt, preventing grief,
preventing explosions, precluding sarcasm, and preventing both the con-
scious and unconscious acting-out of new/future anger.
The assignment is finite, and, in patients who practice it conscientiously
between sessions as they live at the Institute, can be completed in three to
four weeks, with variations in time depending on the age of the patient and
his previous experiences in verbal/insight therapies.
Penultimate Session. A positive self-image is experienced as the patient
defines himself experientially by means of a structured fantasy in which he is
placed in an isolated environment with nothing to draw upon but his inner
resources which, by this time, are strong and positive, and paradoxically
arrives at an experiential definition of his fundamental personality character-
istics.
Final Session (Fifth or Eighth). Intermediate anger is removed by structuring it
into a verbal format known as Structured Anger which is then expressed to
the object of the anger, first in fantasy in the office, then in the real world.
Intermediate anger recurs throughout life and frequent structuring becomes
a part of the new life-style of the patient.
PET has been developed for approximately five years. It has been used on
an unselected patient population of more than 192 patients in the neurotic,
psychotic, psychophysiological, personality disorder, chronic alcoholism,
homosexual, and drug abuse diagnostic categories. There have been seven
drop-outs in the middle of therapy, but there have been no failures in the
patients who have completed both the therapy and .the between-session
assignments. The drop-outs are ascribed to the acting out of displaced
aboriginal mother-anger towards the therapist before said anger could be
abreacted, which normally takes place in the third 6r fourth session.
There are complete tape recordings o f all sessions, including follow-up
sessions of many of these patients. During the follow-up sessions, patients
report significant positive changes in virtually every area of their lives,
including behavioral, ideational, and emotional, and express a feeling of
having been psychologically "reborn."
Treatment requires a total of 40 to 60 hours, with a follow-up session two
to three months after discharge. Six-month, one-year, and longer follow-ups
have also been recorded on tape. Minor variations in the duration of
treatment are related to the age of the patient, his ability to correctly perform
Alice Kutzin 133

the between-session assignments, the severity of the presenting symptoms,

and the existence or not of younger siblings, step-parents, and important
love relationships. The first session, however, usually requires ten to fourteen
hours over a period of two days. In this session, a five- to six-hour history is
taken and a forty-five minute to one-hour explanation of the forthcoming
therapy is given. The remaining portion of the first session is devoted to
actual therapy.
The nucleus of the idea which has been developed into PET is credited
indirectly to a publication by Watzlawick, Weakland, and Fisch (1974). In
their book, Change: Principles of Problem Formation and Problem Resolution, they
describe the "Be Spontaneous!" paradox briefly, pointing out the absurdity
of the statement, "I command you to be spontaneous!" PET does not
employ the paradox as briefly mentioned by these authors, nor do they do so
in their therapy known as Paradoxical Intervention, but the basis for the
"Anxiety Paradox" used in PET is an indirect derivative of the "Be
Spontaneous!" paradox.
A number of other paradoxical techniques have been described in the
literature, but they are designed to deal with specific symptoms such as
obsessions, compulsions, phobias, and tics. They are behavioral, as distinct
from PET, and the patient actually experiences anxiety during them as
distinct from PET. These techniques include, among others, implosion,
flooding, systematic desensitization, paradoxical intention, paradoxical inter-
vention, directive therapy, symptom redefinition, and gestalt therapy. PET,
on the other hand, is a nonbehavioral therapy which is directed at causes,
not symptoms, and which thereby abreacts symptoms without symptom-
specific therapy.
Implosion involves overwhelming the patient with anxiety by exposing him
to the conditions or stimuli he most fears. The patient does not confront the
actual source of his anxiety or phobia, but rather evokes it in fantasy. The
patient experiences anxiety, as distinct from the anxiety fantasies in PET
during which the patient experiences no anxiety.
Flooding is also a learning-based therapy, with the goal of specific
symptom-eradication. The patient directly confronts the feared situation or
object in reality, rather than facing it in fantasy. He experiences anxiety, as
distinct from the lack of anxiety in PET, and the object of the therapy is
specific symptom-eradication, as distinct from PET, which effectuates a
psychological "rebirth," according to the nearly 200 patients who have been
treated with this method.
Both implosion and flooding differ from PET, since the latter is not a
learning-based therapy, nor does it aim merely at symptom-eradication. It is
a psychotherapy which uses structured fantasies accompanied by feelings
which are paradoxical to the content and nature of the fantasies, and other
13d Journal of ContemporaryPsychotherapy

structured fantasies with paradoxical input from the therapist, to produce

experiential changes in ego strength, to abreact anger, and to experientially
redefine self-image.
PET is directed towards producing an experiential change in self-concept
(ego); in abreacting anger (aboriginal, new/future, and intermediate); and
in experientially defining the patient's self-image. The change in self-concept
is produced in a short time, and is accomplished without the experience of
anxiety by the patient. This change is accompanied by the disappearance of
symptoms without symptom-directed therapy. Herein lies the difference
between PET and therapies which use paradoxical techniques to change
symptoms.
PET is directed to causes (ego strength, fear of anxiety, aboriginal anger),
not symptoms. To reiterate, PET is not a behavior therapy, nor is it a verbal/
insight therapy. It is a new form of therapy which uses structured fantasies
accompanied by feelings which are paradoxical to the content and nature of
the fantasies, and other structured fantasies both with and without paradox-
ical input from the therapist, to produce experiential changes in ego-
strength, to abreact all anger, and to experientially redefine self-image.
One of the early developments in PET was the formulation of the Anxiety
Paradox. The Anxiety Paradox refers to the fact that it is impossible for an
individual to force himself (on command from himself or anyone else) to
experience anxiety. If you try to force yourself to experience anxiety, or any
other emotional feeling, you experience the opposite (paradox) of that
feeling, e.g., trying to force anxiety evokes calm, trying to force anger evokes
love, trying to force love evokes anger, trying to force guilt evokes self-approval,
etc. This is not to be confused with the deliberate evocation of a symptom, as
is attempted in Paradoxical Intention (Frankl, 1967). When a patient is
asked to try to force the feeling of anxiety (which is impossible to do), he is
not being asked to force a #ymptom, but a cause. Further, when a patient
fantasizes a catastrophic, devastating fantasy without accompanying anxiety,
which is achieved by trying to force anxiety during the fantasy, the fear that
has been associated with the content of that fantasy is gone in a short time.
After a few such abortive attempts to force anxiety, which is not to be
confused with letting oneself feel anxiety, clinical evidence indicates that fears
have disappeared--both present, past, and future. It seems no longer possible
for the individual to feel afraid in the future, even about matters having
nothing to do with the content of the few fantasies already done.
The fears eliminated in PET include phobias but only as a minor function
of the therapy; the majority of fears on which fantasies are done are wide,
sweeping, and universal fears such as fear of failure, fear of rejection, fear of
death, and other universal fears as will be explained later in this paper.
A paradoxical technique in wide use is systematic desensitization, devel-
oped by Wolpe (1958) in which a patient attempts to tolerate ever larger
Alice Kutzin /35

increments of a particular phobia. At the same time the patient undergoes a

pleasing relaxation of tensions. Unlike PET, desensitization is focused on the
treatment of phobias, while PET has the broader object of producing a
change in the patient's self-concept without the experience of any anxiety.
The use in desensitization of fantasy to produce a relaxation of tensions is of
a different character than that required by the forcing of PET. Desensitization
also takes considerable time, while attempting to force produces results in a
short time.
Paradoxical intention was developed by Victor Frankl (1960) as a method of
implementing his concept of log0therapy, which emphasizes man's spiritual
dimensions and the need for meaning in life. It is of existential and
philosophic dimensions rather than psychotherapeutic. In paradoxical intention
the patient is urged to produce the unwanted symptom, again usually a
phobia; or the therapist might help him do so. There are no fantasies
involved. The unrealistic nature of his anxiety is demonstrated to him as the
feared consequences of his phobia fail to eventuate.
Paradoxical intention is limited in scope and in applicability. Unlike PET it
does not change self-concept, eliminate fear, guilt, depression, abreact anger,
and experientially enhance self-esteem. PET evolved in response to strictly
psychiatric concerns, whereas paradoxical intention grew out of a particular
philosophical (existential) viewpoint. Nor should the Anxiety Paradox of PET
in any way, shape or form be confused with the deliberate evocation of a
symptom, which is characteristic of paradoxical intention and other behavior
therapies.
Paradoxical Intervention, which is practiced by the Palo Alto group at the
Mental Research Institute, founded by Milton H. Erickson, is a strictly
short-term behavioral therapy consisting of paradoxical statements and
suggestions from the therapist. Although they briefly mention the "Be
Spontaneous!" paradox in their book, Change: Principles of Problem Formation
and Problem Resolution, they do not follow up on this paradox or use it in their
therapy, which is limited to ten hours of direct paradoxical intervention on
the part of the therapist, in the life and specific, particular problems of the
patient. A classic example involved a young couple, in which the husband's
parents were constantly and excessively "helping out," and the son and his
wife were unable to reject this help. The couple were advised that when the
parents next visited they should let their house remain dirty, suggest the
parents pay for the groceries, theatre tickets, etc. The couple followed this
advice, with the result that the father called the son aside and told him to
behave in a more independent fashion. The show of dependence and
unconcern produced the desired effect in the son and his wife--the recogni-
tion of independence, and allowed the parents to save face by feeling that
they were "helping" the children to achieve independence.
Paradoxical Intervention and PET differ broadly. The former is a behav-
136 Journal of ContemporaryPsychotherapy

ioral therapy and its applicability is limited to isolated symptomatic changes

and isolated problems. To repeat, PET is not a behavioral therapy, and its
scope and applicability cover the entire range of psychiatric problems seen
in everyday private practice and in institutions.
Directive therapy, based on the work of Haley and Erikson, calls for the
therapist to accept and even encourage the patient's particular symptom.
Like PET, directive therapy is not aversive. Unlike PET, it is strictly
behavioral and thereby limited in scope. The use of fantasies is not employed
in directive therapy. An example of directive therapy involves a patient who
complained of insomnia. He also happened to dislike doing housework,
especially waxing floors. He was directed to forget about sleep entirely and
spend his nights polishing floors. He did this or three nights, but on the
fourth night he was so tired that he slept. The fact that he was waxing floors
while wearing pajamas made it that much easier. Again, directive therapy,
like other paradoxical techniques aside from PET, is directed at symptoms,
not causes. Unlike PET, it is aimed at the specific eradication of specific
symptoms.
Symptom redefinition is a therapy which encourages the patient to change his
perception of his symptom's affect. According to Raskin and Klein, (1976),
changing the perception of affect enables the patient to live and cope with
the particular symptom (depression, for example), until drugs or psychother-
apy or both can help alleviate or overcome the problem. But to change such
perception requires the patient not to fight the symptom, but to face it and
experience it, realizing that such experience could be valuable. Symptom
redefinition, as its name implies, deals with specific symptoms only; it is
behavioral, it is aversive, it does not use fantasies, it is limited in scope and
applicability, and, unlike PET, does not effectuate a feeling of psychological
"rebirth."
Gestalt therapy has been described as one which pays no attention to why an
emotional problem exists or how it developed. It is concerned with the here
and now. It lays particular stress on the principle that the whole is greater
than the sum of its parts. According to its chief exponent, Frederick Perls, it
is existential in a broad sense. It sets great store by dreams which, to Perls,
are existential messages, and, as such, is somewhat mystical. The Gestalt
view holds that frustration is valuable in fostering growth, and the therapist
may therefore deliberately frustrate the patient, thus helping the latter find
his own way out of his impasse. The Gestalt therapist contends that you
" o w n " your fear by accepting it as part of yourself.
There is no similarity between Gestalt therapy and PET. Gestalt therapy,
like paradoxical intention, is built on an existentialist philosophical base,
although there is no paradoxical technique employed in Gestalt therapy.
Gestalt therapy uses fantasies, but these are not structured fantasies, with
Alice Kutzin 137

paradoxical feelings accompanying them as in PET. Unlike PET, Gestalt

therapy does not offer abreaction of the entire range of psychiatric symptoms
seen in private practice and in institutions.
PET can be explained by discussing it in three parts. The first and most
important part deals with what appears to be a new concept in the
psychogenesis of emotional illness; namely, the fear of anxiety (emotional
pain) and the subsequent compulsion to avoid experiencing this anxiety. This is not
to be confused with the concept of anticipatory anxiety. In PET, the patient
gains control over anxiety by finding that he can fail to produce it at will. This is
the opposite of his former feeling of being controlled by anxiety (emotional
pain; i.e., pure anxiety, guilt, anger, grief, etc.). When the patient can control
a negative emotional experience, he no longer fears it. The control of anxiety
with its attendant elimination of the fear of emotional pain and motivation to
avoid it, occurs as the cumulative effect of the 8 to 14 fantasies in the first
session, in which the patient fantasizes terrible situations but experiences no
simultaneous anxiety.
The second part of the therapy is devoted to anger. In PET, three types of
anger are distinguished. Aboriginal anger is defined as anger associated with
a patient's parents, siblings, and long-standing lobe objects, even though the
latter is not aboriginal in theory but is displaced. This anger is removed
during PET. It is not coped with, dealt with, or worked through as happens
in insight therapies.
New anger is anger which is not cumulative but experienced for the first
time. It is treated with a paradoxical assignment which is carried out by the
patient between sessions. The assignment is monitored by the therapist both
during therapy and after therapy if the assignment is extant. The third type
of anger is intermediate anger. This is anger which is cumulative, but not
displaced. It is treated by structuring (see below). The anger portion of the
therapy varies in duration depending on the existence of siblings, stepparents,
and the existence of long-standing love relationships, either current or past.
The third part of the therapy is devoted to self-image. This aspect of PET
involves enhancing self-worth, self-confidence, and self-respect. This is
accomplished during a very long (8 to 12 hours) structured fantasy with
paradoxical input from the therapist. During this part of the therapy,
patients acquire an experiential definition and understanding of their value
as persons. They discover the qualities whch compose their personality.

Part One
Part One of PET coincides with the first session, which usually lasts 10 to 14
hours. During the first 5 hours or so, an extensive history is taken. Direct,
structured questions are asked in a nonthreatening manner about the
738 Journal of ContemporaryPsychotherapy

patient's love relationships, marriage(s), sex relationships, work/career

history and goals, educational background, psychiatric history, medical
history, alcohol and drug use, patterns of human relationships, relationships
with parents, siblings, and grandparents, antisocial behavior if any, intensity
and duration of depression, guilt and anxiety, nature of self-image, what the
patient perceives of and experiences as his problems, etc. A history of his
parents' childhoods is also obtained. This is done to elicit information and is
not therapeutic. In addition, a long list of fears is elicited.
After concluding this history, the therapist employs a technique to enable
the patient to differentiate between experiencing a feeling and thinking he is
experiencing a feeling because he should be doing so based on the content of
his perceptions at a given moment. The therapist is attempting to help the
patient to differentiate between the cognitive and the experiential. This is
accomplished by having the patient close his eyes and visualize the face of
someone he dislikes or hates. The patient is asked what his emotional feeling
is as he looks at the hated face. After he replies that he feels anger (or any
euphemism therefor), he is asked to point to that part of his anatomy in
which he feels this anger. He points to his upper abdominal area just under
the sternum. He is then asked to try to feel that anger in his head. After
trying for a short while, he replies that this is impossible. The same is done
with feelings of love, guilt, grief, etc. After these short fantasies the patient
usually distinguishes quite readily between the cognitive (head) and the
experiential (stomach). I t is then illustrated to the patient that in addition to
emotional feelings, the stomach is also the site of "stomach knowledge,"
which is differentiated from "head knowledge." The patient is guided
through a brief fantasy in which he removes his head and locks it up, then
walks back into the office (in fantasy) headless, with a stump of a neck. He
states that he can "feel" his anatomical stomach. He is then told to ask his
stomach a "yes" or " n o " question to which his head does not know the answer,
and to see if he gets a positive or negative reply from his stomach. In all
cases, such a stomach response is forthcoming. "Ask your stomach" are the
three words most frequently used by the therapist throughout the entire
therapy. The patient is told to take the therapist's word for nothing, but to
check out everything the therapist says with his own stomach, to see if it is
valid or not. At this point, the patient is aware of the input he is constantly
getting from his stomach for the first time. He practices communicating with
his stomach throughout the therapy and between sessions, in the "stomach
assignment," until, at the end of therapy, he no longer has to make a
conscious effort to receive his stomach input, but receives such input without
a conscious effort.
The Anxiety Paradox is now demonstrated to the patient. He is asked to
Alice Kutzin 139

think of something that has always frightened him, and to try to force himself
to be anxious about the image. In attempting to force anxiety, the patient
experiences none. Although therapy has not yet begun, this is done to show
the patient that the therapy will not be painful, and that the Anxiety Paradox
works. The Anxiety Paradox applies to all other emotions, which can not be
experienced by virtue of trying to force them. The patient is now guided
through 8 to 14 fantasies which deal with fairly universal fears as well as
patient-specific fears. The fantasies do not have to seem real to the patient,
nor do they have to relate to the patient's actual life situation, although in
the large majority of cases they do. During each fantasy, the patient is asked
to try to force his anxiety, and consequently, experiences none. The universal
fears with which the fantasies deal are death, cancer, rejection, failure (work
or career), expressing anger to a loved one, latent homosexuality, physical
torture, gang rape, guilt, being old and alone, death of a loved one (child,
parent, mate), extreme poverty, physical handicap such as blindness, public
speaking on an unfamiliar topic, impotence in men, and other universal
fears. In addition to universal fears, structured fantasies are given on patient-
specific fears, i.e., infidelity by a specific love-object, loss of a specific job,
etc. The patient does not experience anxiety during the fantasies. Each
fantasy takes two or three minutes. As the patient perceives each fantasy
without experiencing simultaneous anxiety , the specific fear portrayed in
the fantasy disappears. It is to be noted that we are talking about wide,
sweeping fears and not phobias. Moreover, at the end of the 8 to 14 fantasies,
even fears which have not been portrayed in the specific fantasies are gone,
since fear of anxiety, as distinct from anxiety itself, is hypothesized to be the
basis for all fears. This conclusion was demonstrated during the course of the
fear fantasies of PET.
The fantasies must be extremely exaggerated and presented in their most
grotesque form. Repeatedly, a patient is asked to try to force the experience of
anxiety in the face of these catastrophic fantasies. Thus, he experiences no
anxiety. This is implicit in the nature of paradox. After experiencing these 8
to 14 fantasies without simultaneous anxiety, a patient's sense of self is
drastically altered. Perhaps for the first time in conscious memory, he now
feels that he is in control of himself and his life. On a psychodynamic level,
he is now in control of anxiety (perhaps for the first time), by virtue of being
capable of not feeling anxiety at will. Thus, he no longer fears anxiety and
must no longer base his entire intrapsychic structure, emotional system,
human relationships, ideation, and behavior on the compulsion to avoid
emotional pain. This shift in control produces a strong sense of self, and is
responsible for the disappearance of symptoms.
A second phenomenon occurs after experiencing the 8 to 14 fantasies.
l dO Journal of Contemporary Psychotherapy

Patients experience a temporary and pleasant feeling of disorientation. This

experience is described as being "spacey," "on a trip," or "spaced out."
This is a temporary, nonthreatening experience and can be likened to a rapid
expansion of consciousness. Accompanying this "spacey" state, a patient
experiences an acute awareness of self. When the question, " W h o is Number
One?" is posed to the patient, he answers, "I a m ! " or " M e ! " As a result of
the dramatically enhanced ego-strength, patients also make such statements
as " F o r the first time I feel real!" and " F o r the first time I know that I am,
that I exist!" In layman's terms, they have become " N u m b e r O n e " to
themselves experientially. In psychodynamic terms, their ego strength has
been dramatically enhanced, and, in some cases, experienced for the first
time.
At this point in the session, the therapist uses some metaphors to explain
the changes which have occured in the patient, and the factors which make
them long-lasting. The patient's spaciness and new perception of himself are
explained to him both metaphorically and literally, thus demonstrating the
aforementioned long-lasting effect.
A small plastic animal is placed on top of a cassette recorder on a table,
and the patient is asked to pretend that this is a rat in a maze, running down
corridors, bumping into walls, running down other corridors and bumping
into other walls, etc. The patient is asked if, before therapy began, he would
have staked his life on the fact that there was no way out of this "box of his
life," but that life merely consisted of finding ways to get less bumps as he
cavorted around the maze. Then a key is placed next to the plastic animal,
and the "Eject" button of the cassette recorder is pushed, plummeting both
animal and key to the remote side of the table. The patient is asked if he feels
spacey because he is now "out of his box" for the first time in his life. The
recorder is removed from the table and the patient (animal) is seen as being
"in outer space, where none of the old rules or guidelines apply any longer."
He is asked what the " k e y " says on it, and patients reply, "It says, 'I'm
Number One!' " The patient is requested to ask his stomach if he really has
such a key or if it is just a prop the therapist is using. The patient replies
that he really "feels" such a key. He is asked to try to get "Back into the box
of his life," namely, to try to feel the way he felt a few hours ago, before
therapy began, about life, about himself, about people, about problems. He
tries and replies that he can no longer feel the old way, and can no longer
return to the box of his life.
He is then asked to do a fantasy in which he is driving "the car of his life,"
namely, the car that symbolizes his life, and is asked who is driving (the
patient says he is), who is in the car with him (the patient says nobody else),
who is in control of the car/life (the patient says he is), who is responsible if
the car smashes into a tree (the patient says he is), and to continue driving
Alice Kutzin 141

the car of his life to see where he does not feel free to go, what turns he can't
make, what exits he can't get off at, what lanes he does not feel free to drive
in, what speed he is not free to drive at, etc. Patients reply that they feel free
to drive anywhere. The patient is told to ask his stomach if he now has
freedom, control, and responsibility for his own life for the first time, and he
replies that he does. The "box of his life" is then shown to him again and he
is asked if the old rules by which he guided his life still exist for him or if they
remained inside the box after he plummeted out--namely, he is asked if there
are any more "Musts, mustn'ts, shoulds, shouldn'ts, can'ts, ought to's,
oughtn'ts, dasn'ts," etc. Patients reply that the old rules of their lives no
longer apply. The patient is told to make a sincere effort to "lose" the key in
fantasy, to give it away to people who are dear to him and make them
number one and himself number two. The patient is told to pretend in
fantasy that he wakes up one day with total amnesia, in a hotel room with
strange clothing and no identification, that he has no recollection of what his
name and address are, and to walk over to a policeman and say he has
amnesia and needs help. He is told to make this fantasy extremely vivid. At
the height of the fantasy, the therapist asks the amnesic patient, "Are you
still Number One?" and the patient replies that he is. The therapist then
asks the patient if the " k e y " he has is in his " h e a d , " as a function of
memory. The patient replies that it is not, since he is still number one with
all memory gone. The therapist asks the patient where his " k e y " is located,
and patients reply, " I n my stomach."
Following these metaphors, the 30 to 50 fears on the list which were
elicited during the history are read back to the patient and he is told to listen
with his stomach to see if he still feels any of these fears. Patients report that
their fears are gone. The long list of the patient's problems is then read to
him, leaving out only those problems pertaining to anger and depression,
and the patient is asked if he has any problems left. Patients answer no. The
anger/depression problems are left out because Part One of the therapy
abreacts fear of emotional pain (hence fears and inner problems) but does
not yet abreact anger. However, between 40% and 60% of the patient's
previous depression does in fact go away during the fear fantasies, even
before the anger part of the therapy is begun and despite the fact that the
patient has not yet begun to do his anger assignment. This is ascribed to the
fact that the patient felt unrecognized anger (namely depression) at having
been at the mercy of all his fears throughout his life, and when the fears
disappear, as they do in the first session during the fear fantasies, a
substantial, and, to the patient, recognizable portion of his previous depres-
sion disappears as well, along with the disappearance of fears, fear of
emotional pain, and compulsion to avoid it, and along with the appearance
of his subjective, experiential feeling of being " N u m b e r O n e . "
ld2 Journal of ContemporaryPsychotherapy

Part Two
The second part of PET is devoted to aboriginal, new, and intermediate anger.
As mentioned above, aboriginal anger is defined as anger directed towards
parents, stepparents, siblings, and love-objects (displaced aboriginal).The
state of being a child carries with it the state of total physical and emotional
dependence upon the parents, and it is impossible to feel dependent without
feeling angry towards the object of one's dependence. Although there are
certainly additional reasons for anger towards parents, (rejection, abuse,
abandonment, etc.), dependency-caused anger accounts for the fact that
extreme parent anger is re-experienced in this therapy even by patients who
report warm, loving, giving parents towards whom they are not aware of
feeling angry. Moreover, the parent, who usually largely denies his own
anger and is incapable of expressing it on an as-felt basis, expressing it only
in periodic explosions after it has already become cumulative, does not allow
the child to express his own anger; thus the child's anger at the parent
becomes cumulative. The vicious cycle of anger in the child producipg guilt
towards the parent, producing a need for punishment by the parent (more
anger), producing greater anger in the child and more guilt, etc., is thus
established. The child is taught, both directly and by example, the equation,
"Anger equals bad," and lives with this equation throughout his life.
Aboriginal anger is implicit in the parent-child relationship in a two-
parent or a one-parent family. Aboriginal anger cannot be verbally expressed
as described above, and, therefore, becomes cumulative and must be dis-
placed. This displacement is directed towards peers, mates, authority figures,
and children. It does not have to be sex-specific. For example, anger toward
an authoritarian mother may be displaced onto a male supervisor. Younger
sibling anger is displaced onto peers, mates, and children. The reason that
aboriginal anger must be eliminated is that it is displaced, thus destructively
permeating most, if not all, human relationships.
Aboriginal anger is removed during a long (3 to 5 hours) structured
fantasy which consists of three parts: (1) physical violence in fantasy; (2) a
conversation between the therapist (who assumes the role of the deceased
subject of the fantasy) and the patient, in which the patient fantasizes
growing up as his own parent; and (3) forgiveness and resurrection of the
deceased by the patient. Each of the three parts of this fantasy consists of
certain fundamentals which must be accomplished by the therapist, and
which are described later in this paper. The content and specifics vary
slightly for each patient, based somewhat on the answers to a few standard
questions which are asked when the history is taken, but largely on what the
patient reveals during the fantasy. These questions asked during the history
concern the relationship between the patient and his parents, siblings, and
mate, and spceific details of the parents' own childhoods.
Alice Kutzin ld3

The re-experiencing of suppressed and repressed aboriginal anger requires

physical violence which must be acted out in fantasy. In aboriginal anger
fantasies, the patient is asked to kill the subject of the anger. Patients may
not experience guilt during this fantasy killing because they are extremely
angey and therefore feel the killing is justified. Just as with the anxiety
fantasies, the physical violence fantasies are grossly exaggerated. It appears
that it is not enough to simply kill, but the patient must "overkill." This
"overkill" involves not only the actual death of the subject but excessive
mutilation. During this fantasy, the patient experiences extreme anger
towards the subject of the fantasy, and, in many cases in which it is
repressed, re-experiences it for the first time since childhood. He expresses
his anger not only by physical violence in fantasy, but by actual shouting
aloud at the subject of the fantasy. The verbal expression of anger towards
the parent in fantasy is not to be confused with Reality Therapy in which
constructive argument takes place (Glasser, 1964). The physicat violence in
fantasy serves the following purpose: some patients are not conscious of their
anger towards the subject of the fantasy. When they perform acts of physical
violence on the subject of the fantasy, these patients re-experience their
anger for the first time. They become aware of the anger that they have been
repressing since childhood.
The second part of this long aboriginal anger fantasy involves the
therapist's assuming the role of the now deceased subject of the fantasy. The
patient has been told that a conversation will occur with the deceased and
that the deceased will be speaking from the dead. The deceased will have the
clarity of thought and understanding brought about by death. The following
are some of the fundamentals which must occur during this conversation
between the therapist, as the deceased, and the patient, in order for
abreaction to take place:

1. The patient must be shown, experientally, in fantasy, that he is loved

by the deceased, that he was always loved, that he is still loved even in death,
but that the deceased, for varying psychodynamic reasons, was incapable of
showing his love. If there are siblings the patient feels the siblings were loved
more (whether older or younger); conversely, if the patient is an only child,
he felt, as a child, that his parents didn't love him, because if they had really
loved children they would have had more than one; he feels his parents were
disappointed in him. On the part of the parents, they feel loved by the
children they bear, and fulfilled by them, as by no other experience in their
lives, and this parent-to-child love is sustained despite the periodic explosions
at the children and the acting-out toward the children. It is absolutely
essential that this love on the part of the parent, which existed whether or
not the parent was consciously aware of it, be made credible to the patient,
74d Journal of Contemporary Psychotherapy

so that aboriginal anger may be replaced by aboriginal love. This, in turn, is

then displaced to other people in the world with a most salutary effect on the
lives of the patients. The credibility of the parents' love for the patient, which
is not artifactual to the therapy but a reflection of the true state of affairs on
the part of the parent, is accomplished by a fantasy within a fantasy.
The patient is asked to fantasize going through the actual experiences of
his parents' own childhoods, and to see how these experiences made him feel
(i.e., depressed, angry, guilty, withdrawn, etc.) and how these feelings on the
part of the parents carried through to adulthood and even parenthood,
despite their love for their children. The therapist narrates the details of the
structured fantasy of the parents' childhoods based on a history of the
parents' true childhood which the patient is asked to obtain directly from his
parents, and which most parents are eager to give. The fantasy within a
fantasy is continued through the parents' marriage and the birth of their
child (the patient), then throughout the childhood of the patient and
continuing to the present.
In effect, the patient becomes his own parent, experiencing more or less
exactly what the parent experienced. During the fantasy within a fantasy,
the patient pictures his own fantasy child as it is being born and experiences
the love for it that his parents felt for him; he experiences the continuance of
this love as his fantasy child attains various childhood ages and misbehaves
in various ways; he experiences the continuance of this love as he (the
patient/parent) is shouting at his fantasy child or spanking it; and he finally
comes to realize, experientially, that this love for his fantasy child does not
disappear when the fantasy child misbehaves, for example, or when he gets
bad marks at school, or when he spanks it or yells at it, or when a younger
sibling is born. The patient experiences this love and this is then compared
(by the therapist, during the fantasy, still speaking as the deceased), to the
love the deceased had for the patient, even though he (the deceased) was
incapable of showing it due to the traumatic experiences he himself
experienced as a child which left him feeling depressed, angry, guilty,
withdrawn, alcoholic, etc.
2. The patient is asked what made him angry enough to kill, permitting
partial catharsis on the part of the patient. The therapist must not argue
with the patient's reasons or deny what the patient accuses him of doing,
even it it represents a misperception or a distortion of facts by the patient.
3. The therapist must apologize for the reasons given by the patient. This
is a repetitive apology and must convince the patient that the deceased is
genuinely sorry for having hurt the patient. The apology must be made
credible. Credibility is established by returning repeatedly to the fantasy
within the fantasy, in which the patient says or does the same things to his
fantasy child that the parent did to him in real life, and experiences the fact
Alice Kulzin ld5

that he continues to love the child even though, for example, the child does
" b a d " things.

After these fundamentals are accomplished, the therapist guides the

patient through forgiveness and resurrection of the deceased.
It is believed that this may be a unique contribution to the psychothera-
peutic abreaction of anger. In aboriginal anger, it is apparently not enough
to experience and express anger and to know, experientatly, that one is loved
by the object, but, for abreaction to occur, a resolution of the anger must take
place. In aboriginal anger, the resolution of choice is forgiveness, manifested
by resurrection.
The therapist, still assuming the role of the deceased, asks if the patient
wishes to resurrect the deceased. The patient is cautioned that once
resurrected, the deceased will not recall the conversation, but the patient
will. With no exceptions, the patient wants to resurrect.
In the third part of this fantasy, the therapist becomes himself again. He
asks the patient how resurrection will occur. Usually, patients answer "by
forgiveness" or "by love." The patient is given freedom to resurrect in any
way that he wishes. The patient is asked to tell the therapist the exact details
of what is happening in the resurrection fantasy. When this is concluded, the
patient ends the fantasy.
The aboriginal anger fantasies are performed during the second through
fifth sessions. With a female therapist, mother-anger is abreacted first to
prevent acting-out of displaced aboriginal mother-anger in the patient-
therapist relationship. At the beginning of the second session, aboriginal
anger is explained briefly to the patient. It is explained that "overkill" is
necessary, that a conversation with the deceased will occur, and that if the
patient forgives the deceased, he will have the power to resurrect him. The
deceased will not remember the conversation, but the patient will, though it
will not be necessary to remember. Patients are told that they do not have to
forgive if they do not wish to. This is not said paradoxically.
The actual fantasy begins by asking the patient to close his eyes and start
shrinking until he is a child. Most patients regress to ages 4, 5, 6, or younger.
The therapist talks with the patient as if he were a child, and most patients
respond as if they were children. The therapist guides the patient through
the actual killing and mutilation of the subject of the fantasy. It is important
for the patient to kill as a child because of the feeling of helpless anger that
he experienced as a child.
Most patients kill in fantasy with great relish. They give reasons for their
anger which, to the untrained ear, may sound trivial, but which are not; i.e.,
"You broke my dolly." However, the major reason given by the majority of
patients is, quite simply, "You didn't love me." The reasons given at this
/dO Journal of ContemporaryPsycholherapy

point in the fantasy are what patients think have made them angry. It
becomes apparent that the actual reason for the anger is that the deceased
was angry with the patient. This therapy breaks into the cycle of anger that
exists between the patient and his parents, siblings, etc.
As the patient fantasizes, the therapist is inevitably fantisizing the same
fantasy to a certain extent, while at the same time narrating the structured
fantasy for the patient and at the same time speaking as the deceased parent.
This requires intense participation by the therapist in the aboriginal anger
fantasies; however, after a certain amount of clinical experience in doing
them, the therapist learns to rely on the accuracy of his own intuitiveness
(stomach) in conducting the aboriginal parent fantasies, and they become
easy and fun to do for both patient and therapist.
A special problem may occur when the patient's anger at the parent
results largely from guilt-provocation by the parent. It is to be noted that
this is anger resulting from guilt, a reversal of the usual dynamic of guilt
resulting from anger. These patients are often unaware of their parent anger
until the fantasy. This guilt is ameliorated during the aboriginal anger
fantasy, when the patient is made to feel blameless. This is accomplished by
the fantasy within the fantasy in which the patient visualizes his own child,
or imaginary child, doing something wrong, i.e., breaking a vase, and is
asked if the child is responsible for the parent's (patient's) unhappiness. The
patients respond that the child is not responsible (guilty). This abreacts
aboriginal guilt on the part of the patient.
The resurrection fantasy is much less structured than the earlier portions
of this fantasy. Patients are given freedom to resurrect in any way they wish,
and their changed feelings towards the subject of the fantasy are often
manifested symbolically in the resurrection fantasy, with many parents seen
as physically smaller than the patient, a manifestation of the patient's new
feeling of protectiveness (love) towards the parent.
After a five-minute break, the therapist tests the results of this fantasy.
The patient is asked to fantasize himself in the geographic location of the
now-resurrected deceased. He is asked what his feelings are as he looks at
this person. We have found that the feelings have changed dramatically, and
words of love are exchanged which are then acted out in real life. The results
are also tested by having the patient visualize people onto whom the
aboriginal anger has been displaced. With the patients who have experienced
the aboriginal anger fantasies, it has been found that they no longer feel the
displaced anger.
The aboriginal anger fantasy is completed for the mother, father, occa-
sional stepparents, if any, younger siblings, and 'loveobject,' in that order.
Anger towards older siblings is displaced from the parent and disappears
along with parent anger. In rare cases, an older sibling must also be killed
Alice Kutzin 7,f7

and conversed with in fantasy, then forgiven and resurrected. The sibling
and love-object fantasies are basically the same as the parent fantasies, but
with some changes in the fundamentals for each.
New anger is anger that is experienced for the first time (not Cumulative). It
is treated with a paradoxical anger assignment, which enables the patient to
experience and verbally express both new anger and future anger (new/
future anger). The assignment is carried out between psychotherapy sessions
while the patient is in residence at the Institute. It is paradoxical and consists
of two parts :
1. The patient tries to force himself, whether alone or with people, not to
feel anger. The patient is not to wait for an anger-provoking situation to do
the assignment, but to try continuously not to feel anger, by force. Since this
is a paradoxical assignment, the patient experiences anger. The anger he
experiences is new anger.
2. When the patient feels the anger as a result of trying to force himself not
to feel it, he is to force himself not to want to express it. Again, since this is a
paradoxical assignment, the patient wants to express the anger, and expresses
it freely and without guilt, as a result of both the anger assignment and the
inner freedom resulting from the first session.
The assignments are monitored daily by the therapist by means of a
system of written reporting of numbers which are tabulated daily by the
patient and observed by both himself and the therapist, showing his progress.
Successful completion of the paradoxical anger assignment gives the patient
freedom to relieve new anger by expressing it verbally, which he does
automatically and effortlessly. Anger is now a good emotion, and the equation
learned in childhood is erased. New/future anger does not accumulate,
because it is experienced instantly and simultaneously expressed verbally.
Intermediate anger is handled in the final session. This is done to prevent
patients from confusing the types of verbal responses which occur during the
anger assignment (spontaneous responses) and the structuring of intermedi-
ate anger (a cognitive activity which the patient does in fantasy, then acts
out in the real world).
Intermediate anger is not displaced anger but anger remaining in ongoing
relationships after the displaced aboriginal anger has been removed. At this
point in the therapy, aboriginal anger and displaced aboriginal anger have
been removed by the aboriginal anger fantasies, and new anger is being
experienced and expressed as a result of the anger assignment. Moreover,
changes in the self (ego) which occurred during the first sessiofa of P E T have
given the patient control over the expression of the new anger. A patient is
now free to express new anger if he chooses to do so, or not to express it if he
chooses not to do so. Should he choose not to express it in an ongoing
relationship, new anger becomes intermediate anger.
ld8 Journal of Contemporary Psychotherapy

Intermediate anger, like all anger, needs to be removed to prevent acting

out, explosions, displacement, sarcasm, and other destructive effects of anger
which is experienced but not expressed. Intermediate anger is removed by a
process of structuring it verbally. The structuring process serves three
purposes. First, it removes intermediate anger on the part of the patient.
Second, it removes anger (of whatever type) on the part of the recipient of
the structured anger. Third, it improves the actual circumstances of a
patient's life. Subjects of intermediate anger, rather than feeling threatened
when anger is expressed to them in the structured verbal format, report
feeling greatly relieved.
The four-part structuring process was derived inductively. It was derived
from discharged patients who expressed intermediate anger in this format
and reported this to the therapist in follow-up sessions. It is now a formal
part of the therapy, and patients report that this format allows maximum
relief from intermediate anger both to themselves and to the subject of their
anger.
Preparation for the actual structuring is a very important part of this
session. Since intermediate anger is to be verbalized by the patient, his
attitudes and feelings about the verbalization of anger must be very carefully
shaped. This shaping is accomplished by a series of structured fantasies in
which the patient experientially realizes that his verbal expression of anger
brings relief not only to himself but to the recipient of his anger. This
realization is usually contrary to everything he has always believed about
anger.
At the beginning of the session, the patient is asked to visualize a person
who is angry at him but who has not (or not yet) verbally expressed this anger. The
patient is asked if he knows the person is angry, and replies that he (the
patient) does because he can "feel" it. When asked if he feels good or bad
about this situation, he replies " b a d . " The therapist then asks the patient to
fantasize that person expressing his anger to him (verbally, in loud, angry
tones), and is asked if he feels better or worse than before the verbal tirade
which occurred in the fantasy. Patients reply that they feel better. The
patient is then asked if the person still appears to be angry at him and replies
in the negative. Finally, he is asked if he (the patient) feels angry at the
fantasized person, and similarly replies in the negative.
So far, no experiential change has taken place in the patient. However, the
therapist now reverses the fantasy by asking the patient to visualize a
situation in which he (the patient) is extremely angry at someone, but has not
(or not yet) expressed it verbally. The patient, who is now identifying with the
recipient of his anger as a result of his prior fantasy, is now asked if the
recipient of his anger knows he (the patient) is angry even though nothing
has been said. The patient replies, "Yes," and again the patient is asked
Alice Kutzin 749

whether that person feels good or bad, to which the patient replies, "He feels
bad." The therapist then has the patient fantasize expressing his own anger
verbally (in loud, angry tones) to the person at whom he feels anger and to
signal the therapist when his verbal tirade is completed. At the signal, the
therapist immediately asks the patient, "Does he (the recipient) feel better
or worse?" Patients answer, " H e feels better." This is the patient's first
experiential discovery that the verbalization of anger provides relief not only
to himself but to the recipient of his anger.
Preparation continues as the therapist illustrates a second way in which
verbalization is necessary in intermediate anger. The patient is asked to tap
his experiential (stomach) response to the following three statements made
by the therapist: (1) you (the patient) did something rotten; (2) you said
something rotten; (3) you are rotten. Patients respond that Statement 3
makes them "feel terrible." Under questioning by the therapist, the patient
reveals that Statements 1 and 2 do not "feel" bad because they are reversible,
correctable, and explainable, while Statement 3 "feels" irreversible. The
patient is again asked to fantasize a person who he senses is angry at him,
but who has not expressed it verbally, and is asked whether he experiences
Statements 1, 2, or 3. The patient replies Statement 3--that is to say, he
"feels" he is rotten. Subsequent questions by the therapist elicit from the
patient that when anger is present, but not expressed, it is sensed, but that
when it is sensed but not verbally expressed, it makes him feel the anger is
unspeakable (viz., Statement 3), because it is not spoken. If a person is angry
because of what he has said or done, the patient feels it can be undone or
unsaid. If, on the other hand, a person is angry because of what he is, his
situation feels hopeless. Verbalization of what the person has done or said, as
in Part Three of the structuring, allows the patient (and the recipient of his
anger) to reverse, correct, and explain what he has done or said, and the
subject of the anger no longer experiences Statement 3. In this manner the
patient experientially (and correctly) concludes that if he expresses his anger
verbally he is providing relief for the subject of his anger, rather than
alienating him. This usually represents a direct reversal of his previous
feelings about the verbal expression of anger, and contributes greatly to his
experiential certainty that "anger equals good," gained in the first part of
therapy through the anger assignment.
The verbal structuring consists of four parts:

1. The Announcement: In this portion of the structuring, the patient demon-

strates his psychological posture to the subject of his anger ("See here, Tom,
it's time we had a talk" or "Mr. Simpson, there is something I'd like to say
to you," etc.). The announcement may or may not include a statement made
by the patient to the subject in which he expresses his simultaneous positive
150 Journal ofContemporaryPsychotherapy

feelings for the subject. This statement is particularly important when

expressing intermediate anger to children. For example, the patient may say
to a child "You know ! love you, but," and this begins the structuring by
announcing that the patient has more to say.
2. The Statement of Anger: In this portion of the structuring, the patient
must state explicitly that he is angry. This precludes sarcasm. In addition, he
must make a statement which satisfies the need for physical violence that
accompanies cumulative anger. This statement of physical violence takes a
psychologically nonthreatening form by the use of the word "could." For
example, the patient may say, "You make me so angry that I could knock
your block off."
3. The Reason(s)for the Anger: The patient must state the specific and
personal reason(s) for his anger. The structuring process demands that the
patient determine experientially (from his stomach), what is making him
angry. The patient must determine exactly what is being done to him,
personally, or what is being said, or what is being not done or not said, that
shows the other person's anger towards him, and for each item thus expressed, he
must state the different ways these items make him feel, eliminating the fact
that they make him feel angry since this has already been expressed in Part
Two. For example, a patient may say, "You constantly talk down to me, and
this makes me feel as if you think I am a child. It also makes me feel as if you
think you are better than ! am," etc. This part of the structuring is derived
from the stomach, not the head. In effect, the patient is structuring out the
ways in which the other person acts out anger, either consciously or
unconsciously.
d. The Resolution: Intermediate anger is cumulative. Cumulative anger
(aboriginal, aboriginal displaced, and intermediate) requires a resolution.
The resolution of choice in intermediate anger is an ultimatum. This
ultimatum which is also derived from the stomach, may take many forms.
For example, the patient may make a statement like, "If you keep on
treating me like a child I will start acting like a child," or, "if you don't stop
treating me like a lackey, I will quit this job." However, it is demonstrated to
the patient that many options exist for ultimata short of terminating a
relationship. Carrying out the ultimatum is prevented by its being spoken.

Part Three
The third part of P E T is devoted to what may be termed self-image, self-
confidence, self-esteem, or self-respect. This portion of the therapy is to be
distinguished from the experiential change in ego strength that occurred in
the first session. The thrust of this portion of the therapy is to enable the
patient to define his personality experientially. A technique is employed
Alice Kutzin 757

which allows the patient to feel himself in isolation, in fantasy, and arrive at
a fairly complete experiential definition of himself without depending on
anyone except himself and his inner resources.
This part of P E T involves a very long (8 to 12 hours) paradoxical fantasy
in which the patient is asked to fantasize that he is on a tropical island with
only the usual flora and fauna and a monkey. The patient experiences this
long fantasy in which he paradoxically arrives at between 15 and 40
personality characteristics, inner feelings, and qualities described below.
Since these are derived experientially, they become a permanent part of the
patient's self-definition. As the list is built by the patient (with guidance
from the therapist), the therapist writes down each characteristic and the list
is repeated as each quality is added to it. The means that some lists are
repeated from the beginning 25 or 30 times.
The fantasy begins by having the patient close his eyes and imagine that
he is shipwrecked on an island with no hope of rescue. Paradoxically, the
therapist asks the patient to look inside himself at the vacuum that is there.
The therapist suggests paradoxically that the patient is not even " h u m a n . "
The patient is asked to try to experience not being human and to force himself
not to feel human. Since the paradox works, the patient feels human and
experientially knows what this means. The therapist then moves on to other
qualities such as manliness, womanliness, intelligence, compassion, inner
freedom, etc. Again, the paradox is employed and the patient experiences the
quality. In this manner a list is built. During each activity which takes place
on the island, the patient must describe in exact detail what he has done.
Thus, the qualities are demonstrated by the patient before they are labeled. In
this way, the therapist does not take the word of the patient for any quality
or characteristic.
After the list is completed, the patient is asked to fantasize being in
solitary confinement in the dark with only a rat for a companion, in order to
make it as terrible for him as possible. The list is repeated to him and he is
asked if he has experientially (stomach) retained each quality. Most patients
retain all but one or two qualities. The patient is then transferred back to the
island and given several chances to repeat the list from his stomach, as
distinct from repeating it from memory, which is in the head. Most patients
repeat all but one or two minor qualities.
In the fantasy, a helicopter appears and rescues the patient and the fantasy
ends. After the patient opens his eyes, he is asked a series of questions :
1. Did I tell you the qualities that you have, or did you tell me?
2. Did I take your word for it, or did you have to prove it?
3. To whom did you prove it?
4. Do you think you will ever forget the list?
5. Is it necessary to remember the list? (It is not.)
152 Journal of Contemporary Psychotherapy

Answers to these questions give the patient an experiential knowledge of

who he is. The patient no longer feels the necessity to play a role and can be
himself, since he now knows experientially what he is.
This completes the treatment by PET, except for the six-week or two-
month follow-up session, which some patients cancel because they feel so
well. However, tape recordings are available of many two-month follow-ups.
There are also some tape recordings of six-month, one-year, and longer
follow-ups.
Resistance is overcome by having the patient attempt to force anger
towards the therapist, both during sessions and on a regular basis between
sessions (in extreme cases, sometimes as often as once every half-hour
between sessions while doing assignments). Since the paradox works,
attempting to force anger towards the therapist results in the patient's
experiencing love towards the therapist (hence. a desire to cooperate), and
thus resistance is dissolved.

Summary
A new technique of psychotherapy based on a new concept of psychody-
namics, Paradoxical Experiential Therapy, has been used successfully with
more than 192 unselected patients over a period of five years. The therapy is
short-term (40 to 60 hours), but is not behavioral in scope, thus permitting
unlimited applicability. Therapeutic results, documented by tape recordings
of all patient sessions, have been: achieved in many different diagnostic
categories. Results appear to be long-lasting. The therapy is not aversive in
nature, and patients experience no anxiety.
The therapy employs structured fantasies, but is different from other
fantasy therapies in that these fantasies are accompanied by feelings which
are instantly paradoxical to the fantasy content, i.e., an anxiety-provoking
fantasy accompanied by a feeling of total calm. The thrust of the paradox
employed is that it is impossible to experience any emotion (i.e., anger,
anxiety, guilt, grief, etc.) by trying to force oneself to experience it. Long-
lasting changes are reported in ego-strength, self-esteem, depression, guilt,
cumulative anger, and in other, specific symptoms without symptom-directed
therapy.
The therapy taps the patient's experiential self by directing his awareness
to his intuitive feelings and intuitive knowledge, and by making it possible
for him to volitionally receive such intuitive knowledge without meditation.
No suggestion, hypnosis, medication, verbal insights, negative conditioning,
or other artifacts are employed. As a result of the intensely enhanced ego-
strength which takes place upon beginning the therapy, symptoms disappear
without symptom-specific therapy. Although motivation is an important
Alice Kutzin /53

factor in traditional therapies, in Paradoxical Experiential Therapy the

patient does not have to be motivated for the therapy to work since the
therapy is self-motivating from the instant of change, which takes place
during the first session, nor does the patient have to believe in advance that
the therapy will work.

REFERENCES

Frankl, V.E. Paradoxical intention: A logotherapeutic technique. American Journal of Psychother-

apy, 1960, 15, 520-535.
Frankl, V.E. Psychotherapy and existentialism: Selected papers on logotherapy. New York: Washington
Square Press, 1967.
Glasser, W. Reality Therapy. New York. Harper and Row, 1965.
Raskin, D.E. and Klein, Z.E. Losing a symptom through keeping it. Archives of General Psychiatry,
1976, 33 (5), 548-555.
Watztawick, P., Weakland, J., & Fisch, R. Change: Princz[)les of problem formation and problem
resolution. New York: W. W. Norton and Co., Inc., 1974.
Wolpe, J. Psychotherapy by reciprocal inhibition. Stamford, Cal., University Press, 1958.

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