[T]he clinician schedules the occurrence of the patients symptoms so that they are exhibited by the

patient under systematic and specific conditions (Newton, 1968, p. 95).

SYMPTOM SCHEDULING
Symptom Scheduling (the least offensive term) is also known as:
- Paradoxical Intervention
- Symptom Prescription
- Reverse Psychology
- Negative Practice
- Therapeutic Paradox
- Reactive Inhibition

Principles Relevant to SymptomsThey need to be:

- Expandable
o In intensity, duration, frequency
- Current
o Those presently experienced are more likely to be changed.
- Interpersonal
o They need to involve and influence others.
- Stressful
o Clients must feel the distress at time of treatment.
Therapist Scheduling Principles (those with * are the author's favorites)Scheduling should
have/needs:
- Expandability
o "Have an argument with your wife at 8 every night for 10 minutes." This can be
expanded or shrunk (e.g., 5 minutes or 15 minutes; at 9 or 7:30).
- Interpersonal Components
o Schedules involving people with the IP facilitate the effects of the technique.
- Stress
o The schedule needs to stress the client.
- Rationale
o Explain to clients why you're doing this but be careful. "You said you had some
crazy things happening to you. Now, you're going to do something crazy to get rid
of them."
- Humor*
o "I want you to have the worst case of X symptom possible. It should be so bad that
I will be able to document it in the next psychology journal."
- Specificity*
o Be very detailed as to when and how they should be prescribed.
- Within-Session Timing
o Make sure you allot enough time to prescribe symptoms
- Changing Sessions
o Arrange clients' schedules to shorten sessions/increase frequency
- Office Exercises
o If clients don't do it on their own, you can use session time.
- Patient-Associate
o If need be, bring in a success story or have therapist disclose.
Therapist Principles
- Patience
o Obvious, right? However, wait for the right time to prescribe them.
- Understanding the Symptom
o Know fully the extent of how and when symptoms present.

[T]he clinician schedules the occurrence of the patients symptoms so that they are exhibited by the
patient under systematic and specific conditions (Newton, 1968, p. 95).

Treatment Goal(s)
o This is a commitment to symptom change.
Orientation
o The therapist often has to be directive/authoritativesome people might not want
to do thistheir loss.
Relationship
o As in all approaches, one of the most important components is the therapeutic
alliance.
Follow Up
o Booster session

When not to
- With chaotic families that have loose/variable structures
- child-like families where all members are immature and seek parenting from the therapist
- impulsive families with overtly hostile members
- families that accept responsibilities/offer minimal opposition (Cade, 1984).
- Clients who are not committed/involved in therapy, sociopaths, paranoid clients who
might see the 'deceit', potential for destructive behavior (Weeks & L'Abate, 1982).
Advantages
- Engages both partners in the cure process
- Presented in such a reasonable way that, as the behavior problem disappears, the
individuals regain confidence in themselves as well as respect for their partners.
- Important/enhancing experience for both partners to discover they can control their own
behavior (Zuckermann, 1995)
- Forced purposeful repetition eventually associates behavior with unpleasant reactions; it
is abandoned (Asokan & Priya, 2013)
As all therapy is manipulation, the question becomes not whether to manipulate, but how
much and in what way will be best for any particular case. This can be viewed as being
deceitful, but if it works, don't the ends justify the means?
References
Asokan, S., & Priya PR, G. (2013). Symptom prescription. British Dental Journal, 215(12), 601.
doi:10.1038/sj.bdj.2013.1196.
Cade, B. (1984). Paradoxical techniques in therapy. Journal of Child Psychology and
Psychiatry, and Allied
Disciplines, 25(4), 509-516.
Newton, J. R. (1968). Considerations for the psychotherapeutic technique of symptom
scheduling. Psychotherapy:
Theory, Research and Practice, 5(2). 95-103.
Weeks, G. & L'Abate, L. (1982). Paradoxical psychotherapy: theory and practice with
individuals, couples and
families. New York, NY: Brunner/Mazel.
Zuckermann, S. (1995). A paradoxical intervention to control anger in couple counseling. The
Family Journal, 3(4),

[T]he clinician schedules the occurrence of the patients symptoms so that they are exhibited by the
patient under systematic and specific conditions (Newton, 1968, p. 95).

355-357. doi:10.1177/1066480795034012.