Paradoxical Interventions: A Meta-Analysis

This article outlines the evidence base for the use of paradoxical interventions (PIs) in individual psychotherapy. Often misunderstood, PIs have shown long-term (distal) impacts on clinical outcomes, yet a review of the existing literature on these interventions illustrates a trending decline in consideration and use within both research and applied settings. Definitions of PIs and their constituent elements are presented along with clinical examples. We conducted one meta-analysis comparing PIs with a placebo or control and another comparing PIs to other therapeutic methods. PIs demonstrated a large effect (d = 1.1, k = 17 studies) compared to controls and a medium effect size (d = .49, k = 17 studies) compared to other therapeutic methods. We included a review of several case studies using PIs as well. Among the salient findings, there is a lack of assessment measure to track the implementation of PIs in session or a method to track their in-session effects. Further, there is a dearth of contemporary quantitative experimental research and development of PIs. We further advocate for the development and integration of PI training and supervision into clinical education and posteducation programs, given the current data demonstrating clinical utility. Clinical Impact Statement Question: This article provides a review of the existing research investigating the clinical utility and efficacy of paradoxical interventions (PI) in psychotherapy. Findings: PIs were shown to have positive effects on patients' symptoms compared to either a control group or when compared to other techniques. Meaning: PIs are useful techniques that can be employed by clinicians in appropriate settings. Next Steps: Based on this study, the researchers advocate for continued research on and the development of PIs for modern practice, as well as the inclusion of PIs in modern training and supervision programs.