Protection, paradox, and pretending

This paper proposes that psychopathology in children can be the result of an incongruity in the hierarchical organization of the family. The parents are in a superior position to the child by the fact of being parents, and yet the problem child assumes a superior position to the parents by protecting them through symptomatic behavior that often expresses metaphorically the parents' difficulties. The paper describes three paradoxical strategies for arranging that the parents solve the presenting problem of the child and the incongruity in the family hierarchy. The therapeutic techniques described are characterized by the use of communication modalities, such as dramatizations, pretending, and make-believe, that are appropriate to children.