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These notes were first presented at The Developing Group, 3 Dec 2005


When the Remedy is the Problem

Penny Tompkins and James Lawley 


“Now that you have broken through the wall with your head,
what will you do in the neighbouring cell?”
S.J.  Lec, New Unkempt Thoughts

This paper investigates how attempting to apply a remedy to a problem can sometimes perpetuate or exacerbate that problem or create another problem. When that happens, the attempted remedy is itself a problem.  

We will draw heavily on the work of Paul Watzlawick and his colleagues at the Brief Therapy Center of the Mental Research Institute in Palo Alto, California, established in 1966.  The Palo Alto Group developed under Gregory Bateson’s theoretical and Don Jackson’s clinical leadership. They were in turn deeply indebted to Milton Erickson.

But before we do, let's look at two bedfellows:

Persistence and Change

Systemically speaking, persistence and change need to be thought of as a unit rather than two separate things. This is a challenge because:

When we focus on either, the other recedes into the background. When persistence is the figure, change is the ground. When change is the perceived, persistence withdraws into the context.
and
They can occur simultaneously at different levels of organisation. The molecules and cells that make up our body are constantly being replaced and yet our body and in particular our identity remains much the same.

In the broadest of terms and in the context of change-work there are only a few categories of experience: Resources, Problems, Remedies and desired Outcomes:



The 4 categories above lead to four methods for approaching change:

Start with a Problem
  • Fix the symptom, often by adding a resource.
  • Identify and remove or otherwise change the cause of the problem.
  • Identify a desired outcome for the problematic situation.1
Start with a Resource
  • Introduce a bit of the problem to the resource.
  • Introduce resource to problem only as fast as resource can be maintained.2
Start with a desired Outcome
  • Do what is needed to implement it.
  • Solve problems on the way.
  • Bring in resources as called for.
  • Create conditions such that achieving the desired outcome is a natural response.
Start with a Remedy
  • Just do it! However, if a client could apply their own remedies they wouldn’t seek help; so what's preventing them in this case?
  • Explore previous attempted solutions to know what not to do.
  • Behind many unproductive remedies are assumptions which ‘coincidentally’ mean nothing has to change; so address these assumptions.
  • Recognise that many people cannot give up a ‘good remedy’ until they have proved to themselves it will never work in this situation (this is a form of self-deception).

Difficulties and Problems

The following is quoted from Change: Principles of Problem Formulation and Problem Resolution, Paul Watzlawick, John Weakland and Richard Fisch, (1974), pp 38-39:

We draw a clear distinction between our use of the terms difficulties and problems.  When we speak about difficulties, we shall simply mean an undesirable state of affairs which either can be resolved through some common-sense action (usually of the first-order change type, e.g. [adding heat when cold]) for which no special problem solving skills are necessary, or, more frequently we shall mean an undesirable but usually quite common life situation for which there exists no known solution and which - at least for the time being - must simply be lived with.  We shall talk about problems when referring to impasses, deadlocks, knots, [binds], etc., which are created and maintained through the mishandling of difficulties.  There are basically three ways in which this mishandling can occur:

A.  A solution is attempted by denying that a problem is a problem; action is necessary, but is not taken.

B.  Change is attempted regarding a difficulty which for all practical purposes is either unchangeable (e.g. the generation gap or a certain percentage of incurable alcoholics in the general population) or nonexistent; action is taken when it should not be.

C.  An error in logical typing is committed and a Game Without End established.  This may occur either by attempting a first-order change in a situation which can only be changed from the next higher logical level (e.g. the nine-dot problem) or, conversely, by attempting second-order change when a first-order change would be appropriate (e.g. when people demand changes of ‘attitude’ and are not content with changes of behaviour); action is taken at the wrong level.

Unproductive remedies

As a rule, the longer we’ve had a problem the more likely it is that the way we try to remedy it maintains and/or exacerbates it. Watzlawick et. al say the most common kinds of unproductive remedies/solutions are:
  • When more of the same doesn’t work.3
Going on yet another diet, or going to yet another therapist. We continue to do ‘it’ by doing ‘it’ more intensely, and/or more often. This works well for problems that can be remedied with a first-order change, but it compounds problems that require a second-order change, e.g. if the outside temperature falls, then your heating system will have to work harder to keep the status quo. If the temperature continues to fall then more of the same will produce the desired result. On the other hand, when an alcoholic drinks to relieve stress, drinking more has serious unwanted side effects, and the body adapts to the extra alcohol and so the same amount of drink has less effect and the original problem is compounded.
  • Oversimplifying a complex situation (and vice versa).
For example, assuming there is a ‘root cause’ which, when removed, will solve everything (e.g. The NHS is under-funded, so give it more money and it will work well, or someone who believes that, ‘If I could only understand all of it, then I could solve it.’)
  • Not seeing a problem when there is one (and vice versa).
A client can come with a ‘problem’ that isn’t one, while denying something that is a problem (e.g. 'I could stop drinking if I wanted to'; or on a more disastrous scale, seeing weapons of mass destruction in Iraq when there weren’t any).
  • Setting grandiose, esoteric or utopian outcomes.
Many good things have happened because people weren’t realistic. We are wary of goal-setting processes that insist on the goal being 'realistic' (realistic according to whom?). A grandiose desired outcome becomes an unproductive remedy if the person beats themselves up when they don’t achieve the outcome within a ridiculously short time – and they don't learn from their experience.
  • Attempting to solve paradoxes at the same level of thinking.
For example, keep flipping between the two sides of a dilemma and thinking that one or the other must be the answer; or wanting another person not only to change but to want to change.

We have encountered other examples of when remedies are the problem are:
  • Fixing the wrong problem.
  • Delaying solving the problem, thereby making it worse.
  • Solving the problem too quickly, thereby making it worse.
  • Solving the problem but only temporarily (e.g. yo-yo dieting).
  • Attempting to resolve an unsolvable problem.
  • Assuming there is a ‘root cause’ which, when removed will solve everything.
  • Self-defeating remedies (e.g. attempting to remember not to forget).
  • Needing to know ‘why?’.4

“For every complicated problem
there is a solution that is simple, direct, understandable ... and wrong.” 
H.L. Mencken

First-order and Second-order Change

Watzlawick et al, p. 10:

There are two different types of change: One which occurs within a given system which itself remains unchanged, and one whose occurrence changes the system itself.  To exemplify this distinction in more behavioural terms:  a person having a nightmare can do many things in his dreams - run, hide, fight, scream, jump off a cliff, etc. - but no change from any one of these behaviours to another would ever terminate the nightmare.  We refer to this kind of change as first-order change.  The one way out of a dream involves a change from dreaming to waking.  Waking, obviously, is no longer a part of the dream, but a change to an all together different state.  This kind of change will be referred to as second-order change. Second-order change is thus change of change.

A more extensive example is given on page 73:

In general, the problems encountered in marriage therapy more often than not have to do with the almost insurmountable difficulty of changing the quid pro quo on which the relationship was originally based.  Of course, this quid pro quo is never the outcome of overt negotiation, but is rather in the nature of a tacit contract whose conditions the partners may be quite unable to verbalize, even though they are extremely sensitive to any violations of these unwritten clauses.  If conflict arises, the partners typically attempt to solve it within the framework of the contract, and thus they get caught in a nine-dot problem of their own making.  For whatever they do within the frame leaves their overall pattern of relationship unchanged.  The necessary change has to be a change of the contract itself (i.e. a second-order change) and not merely a first-order change within the bounds of the contract.

We note that first-order and second-order change are equivalent to Ken Wilber’s translation and transformation. See our article, Modeling the Structure of Binds and Double Binds and our book, Metaphors in Mind.

More of the Same

Watzlawick points out that one of our most cherished methods of solving problems is “more of the same”. This works well for problems that can be remedied with a first-order change, but it compounds problems that require a second-order change.  For instance if the outside temperature falls, then your heating system will have to work harder to keep the status quo.  If the temperature continues to fall then more of the same will produce the desired result (of course there are limits to this, because there are always limits to everything).  However when an alcoholic drinks to relieve stress, drinking more to relieve more stress not only has serious unwanted side effects, but the body adapts to the extra alcohol (poison) and so the same amount of drink has less effect.  In this case more of the same can lead to a downward spiral sometimes only limited by premature death.

The work of John Gottman highlighted at the October 2005 Developing Group, Learning from Relationship, was a good example of how more of the same (e.g. criticising  and defending or stonewalling in a relationship) produces more of the same, and eventually the dissolution of a marriage may result.

Four-Step Procedure

Watzlawick and his colleagues identified a four-step procedure in their pioneering of Brief Therapy – a maximum of 10 sessions (pp 110-113):

1.  A clear definition of the problem in concrete terms.
2.  An investigation of the solutions attempted so far.
3.  A clear definition of the concrete change to be achieved.
4.  The formulation and implementation of a plan to produce this change.

With reference to the first step, it is obvious that in order to be solved, a problem first of all has to be a problem. What we mean by this is that the translation of a vaguely stated problem into concrete terms permits the crucial separation of problems from pseudo-problems. In the case of the latter, elucidation produces not a solution, but a dissolution of the complaint. This admittedly does not exclude the possibility that one will be left with a difficulty for which there exists no known cure and must be lived with.  For instance, nobody in his right mind would try to find a solution to the death of a loved one, or to the scare produced by an earthquake - except perhaps some drug companies which in the product descriptions convey the utopian implication that any manifestation of emotional discomfort is pathological and can (and should) be combated by medication. If on the other hand, a complaint is not based on a pseudo-problem, successful completion of the first step reveals the problem in as concrete terms as possible, and this is an obvious precondition in the search for its resolution.
    
[In] the second step, a careful exploration of these attempted solutions not only shows what kind of change must not be attempted, but also reveals what maintains the situation that is to be changed and where, therefore, change has to be applied.  

The third step, with its implicit demand for a concretely definable and practically reachable goal, safeguards the problem-solver himself against getting caught up in wrong solutions and compounding rather than resolving the problem. ... The therapist who introduces, or who accepts from his patient, a utopian or otherwise vague goal unwittingly ends up treating a condition which he has helped to create and which is then maintained by therapy. It should hardly surprise him that under these circumstances the treatment will be long and difficult. If the presenting complaint is typically seen as the tip of that mythical iceberg, a negative reframing is accomplished through which an existing difficulty becomes so complex and deep-seated that only complex and deep-going procedures hold any promise of producing change.  ... Many people seeking help for a problem describe the desired change in seemingly meaningful but actually useless terms: they want to be happier or communicate better with their spouses, get more out of life, worry less, etc. etc.  It is the very vagueness of these goals which makes their attainment impossible. If pressed for an answer as to what specifically would have to happen (or stop happening) so that they would then be happier, or communicate better, etc. they are very often at a loss. This bewilderment is not primarily due to the fact that they have simply not yet found an answer to their problem, but rather that they are asking the wrong question in the first place.

This brings us to step four.  The first three steps are necessarily preliminaries that in most cases can be accomplished rather quickly; the actual process of change takes place in the fourth. 

Although Watzlawick talks about 'goals' in the third stage we would still characterise this  procedure as problem-solving, in contrast that is to an outcome-orientated approach. The two approaches are not mutually exclusive. The inability of facilitators to distinguish between the two approaches was a significant driver in our creation of the Problem-Remedy-Outcome (PRO) model.


“We all desire happiness and wish to overcome suffering,
and despite this natural aspiration,
we tend to create the conditions for more suffering.” 
The Dalai Lama, The Four Nobel Truths, p. 72

NOTES
1 Note the difference between:
And what do you want instead of [the problem]?
And when [problem], what would you like to have happen?

Using our Perceiver-Perceived-Relationship-Context model we can see that:
The first makes the problem the perceived and asks for an alternative.
The second makes the problem the context, and the desired outcome the perceived.

The second, clean question, also acknowledges that these kind of problematic contexts occur and that more important than eliminating them is having a way of handling them. This is the syntax recommended in our PRO model.

2 These form the basis of Robert Dilts' model of Generative Change. pp. 437-441 Encyclopedia of Systemic Neuro-Linguistic Programming and NLP New Coding, Robert Dilts and Judith Delozier (2000) nlpuniversitypress.com/html/G03.html


3 We were sitting next to a young couple in Starbucks. The woman spent the entire time attempting to convince the man not to smoke. The man spent the whole time stonewalling and defending. As they were about to leave James was curious to know how aware were they of the dynamics of the conversation:

James:      Would you like some advice?
Woman:    Looked bemused and nodded.
James:      Do you know that what you are doing isn't working? 
Woman:    What do you mean?
James:      You can’t make him to give up smoking.
Woman:    I’ve been trying to get him to stop for years and I’m not going to stop now.
Man:         Stop trying to control my life.

This is a beautiful example of the mirror principle: She is not going to give up trying to get him to give up smoking. He is not going to give up trying to get her to stop controlling his life.

Also, her remedy of trying to get him to stop smoking only increases his ability to think of reasons to not stop smoking. On the surface it was about smoking; but by now it had become about who controlled whose life. The result? A game without end. At some level it seems they were very aware of the dynamics involved.

4 Robin Norwood wrote: Why Me, Why This, Why Now?: A Guide to Answering Life's Toughest Questions, perhaps they don't need to be answered. At the Findhorn Spiritual Community they say 'knowing why is the booby prize'.


Penny Tompkins & James Lawley
Penny and James are supervising neurolinguistic psychotherapists – registered with the United Kingdom Council for Psychotherapy since 1993 – coaches in business, certified NLP trainers, and founders of The Developing Company.

They have provided consultancy to organisations as diverse as GlaxoSmithKline, Yale University Child Study Center, NASA Goddard Space Center and the Findhorn Spiritual Community in Northern Scotland.


Their book,
Metaphors in Mind
was the first comprehensive guide to Symbolic Modelling using the Clean Language of David Grove. An annotated training DVD, A Strange and Strong Sensation demonstrates their work in a live session. They have published over 200 articles and blogs freely available on their website: cleanlanguage.co.uk
 
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