The case study “Soiled Underwear Again” demonstrates a symptom prescription in the form of homework to carry out a ritual. This paradoxical intervention follows the Milan tradition of systemic family therapy.

Paul was six years old. Almost every day he waited until he was alone, found a quiet spot in the house where he could hide in peace and take his time, and then soiled his underwear. His excuses were many and varied, and often he had none at all. He only used the toilet reluctantly and under protest. None of the doctors who had examined him had found any problems. His mother had tried both being patient and being strict.

When I met Paul and his mother, I asked him whether he thought he could deliberately soil himself on a particular day. He responded in the affirmative, both to this question and to the question of whether he could deliberately not soil himself on a particular day. So I came to an agreement with Paul and his mother that he should deliberately soil himself, today if possible, and that his mother should allow him to do so. Tomorrow could then be the day when he deliberately did the opposite. Or he could soil himself today and tomorrow, with his mother’s express permission; what mattered was that he had soiled himself at least once before our next meeting. He could tell his mother beforehand or afterwards, or simply let her work it out for herself. And I discussed the details with Paul; on how many days of the following week he would soil himself, and on how many he would not. His mother offered to note down every time when he soiled himself on the calendar so that I could see whether he had done his job properly. The young boy protested that he would never soil himself again. I made a point of telling him that it was much too early to be thinking about that. I implored him to try and soil himself at least one more time