How paradoxical is ‘paradoxical’ outcome? : Different pathways and implications

Abstract

The present special issue includes single and multiple case studies which report on the phenomenon of ‘paradoxical’ outcomes in psychotherapy, operationalized as discordant outcome assessments within the same case. In an attempt to find ground for my published response, I endeavored to juxtaposition the cases from the different studies, and by doing that gain an overview of the contributions and arguments. As a result of that exercise, I suggest three different types of paradoxical outcome with different pathways and implications. Discussing the concept of ‘illusory mental health’ as a possible explanation for paradoxical outcome, I suggest that self-ratings within a nonclinical range, given by respondents assessed as psychologically distressed, could be perceived as ‘genuine’ markers of a tolerable level of coping and symptom relief, not only as an indication of a defensive attitude. I conclude that it might be more advantageous to relate ‘paradoxical’ outcomes to aspects of the therapeutic process, rather than to psychological dispositions of the clients.