Antisuggestion, prescribing the symptom

Domain I · Psychodynamic & depth psychology · Alfred Adler, Rudolf Dreikurs

What it is

This is not a manualised therapy. Antisuggestion, or prescribing the symptom, is a set of tactics used inside Adlerian (Individual Psychology) psychotherapy. It has no stand-alone protocol, session count or fidelity scale. The practical steps below come from the authors' descriptions and case…

Format

• The paradoxical tactics sit inside Dreikurs's four phases. They are not a separate sequence. Dreikurs and Mosak describe the phases as overlapping, not strictly sequential. Session numbers below are: no primary source fixes them.
• Format: individual, couple or family interview, often weekly. Typically sessions 1–2, then maintained throughout.

Who practises it, and how they are trained or regulated

• Includes "The Question" and Dreikurs's differential diagnosis of psychogenic versus somatic complaints.

Questions to explore with your client

• What drew you to it, and what are you hoping it will change?
• Is there physical contact? Was it explained beforehand, and do you feel free to say no or stop at any point?
• Does it involve any substance, plant preparation, remedy or supplement? Has your doctor or prescriber been told, especially about any medication you take?
• Is it a group, retreat or community? How do they respond if someone wants to leave or raises a concern?
• How do you and the practitioner understand what is happening, in spiritual or cultural terms? Is that a source of comfort, worry, or both?
• Who runs it, and what training or registration do they hold?
• What actually happens in a session or meeting, and how often?
• What does it cost, and is there pressure to commit to more?
• How do you feel afterwards, in the hours and days that follow?
• Does it fit with, or clash with, the work we do here?

What practitioners of it watch for

• Shared laughter is the classic sign of success. Escalation, contempt or fear in one partner means stop and reassess safety.
• The reframe must be believable and not sarcastic. It is working when the client considers the direct decision the symptom was standing in for.
• Self-criticism ("I did it again, I'm hopeless"). Reframe it as a catch, which is progress. It is working when the gap between act and catch shrinks.
• Tasks set too big (the client fails and feels discouraged) and tasks set by the therapist's ambition. It is working when the client generates their own next task.
• Hopelessness ("nothing will help"), which should prompt re-screening for suicidality. It is working when the client reports any outward attention or small act of giving.

When to involve someone else

• New or worsening physical symptoms, or advice to stop or change prescribed medication: involve the client's doctor or prescriber.
• Signs of coercion, isolation from family and friends, escalating costs or secrecy: discuss openly and consider safeguarding.
• A crisis or thoughts of suicide: follow your crisis protocol. In the US, call or text 988; in the UK and Ireland, Samaritans on 116 123.

Drawn automatically from the guide's own sections. Stay curious: neither endorse nor dismiss what the client values, and check anything that matters against the full guide and its sources. Not medical advice.