Good Psychotherapy Is Not “Cognitive”: It’s An Experience

Dave: I have been thinking, “There is more to life than Trump.” So I am going to get off the Trumpoline for a bit. We can be assured the thing called Trump will not be going away for at least 1513 days. So I am going to deflect your attention back to the world from which we came, the un-Trump world, and pay some attention to the realm of Psychotherapy.

I thought I’d reflect a bit on the question of what a therapeutic experience looks and feels like, from the therapist’s vantage point.   I first presented these ideas in an essay I wrote for “The Use of Self in Therapy”, a book for therapists. I believe that therapeutic experiences occur in all lives. Some therapeutic experiences occur in therapists’ offices, most occur in our experience in the world. Therapeutic experiences are experiences that affect who we are and how we think of ourselves. Many are painful, or challenging, some are gratifying. A therapeutic experience might be an encounter with someone who results in our feeling we are more than we thought we were.

In my work teaching therapists to be therapeutic I suggest they think of five experiences that have made a difference in who they are. I tried doing this with a group of about 8 therapists I was supervising. One of the men told a story of an experience in seminary that resulted in him thinking the priesthood was not for him. I told one that happened when I was 20 taking seven kids on a canoe trip and got caught in a situation, a prolonged rain storm, where I discovered at 1:00 AM the river was rising and about to flood our camp site. No one else told a story. I am not certain why. The group was made up of six women and two men. My guess was that there were too many stories that had to do with some kind of traumatic or abusive event, something too personal to report. But think about that, write down five experiences that you would regard as therapeutic experiences.

When I think about The Self in Therapy,  the “Self”  I am considering is a capital ‘S’ core Self. The Self I cannot know because I am that Self. I have other selves that act in the world; these are social roles, including Father, Husband, Diagnostic Psychiatrist, Therapeutic Psychiatrist, etc. Personhood is the dynamic tension between the Core Self and the social roles.

To risk meaning nothing is to start to play (Jacques Derrida).

Play leads to rhythm and harmony (Huizinga).

The Self appears and is most accessible in play and its variations. The Self in Personhood emerges in play. When we risk meaning nothing, the energetic Core Self is needed. The German poet/ philosopher Friedrich Schiller said:  “Man only plays when he is in the fullest sense of the word a human being, and is only fully a human being when he plays.”

Let us play! Let us risk meaning nothing!

In his magical essay A Theory of Play, British psychoanalyst/pediatrician Donald Winnicott suggests “All Psychotherapy is play”. In another essay he says that “Psychotherapy takes place in the overlap of two areas of play, that of the patient and that of the therapist.  If the patient does not know how to play, then the therapist’s job is to teach them how to play. If the therapist does not know how to play, and can’t teach the patients to play then the therapist is not well-suited to this work (Winnicott, 1971). Playing is an experience, it reaches into zones of experience and thought, out of reason’s reach, the spontaneity of play gives access to the mysterious and the unspoken in human experience.

In a psychotherapy session, structure is critical. The therapist is like a parent who establishes the structure which makes play safe. The therapist, a symbolic parent, sets the structure for the therapeutic experience. The structure in our therapeutic style is implicit in the personhood of the therapist. I am not an authority on their lives, but I am an authority on psychotherapy and how it works. The structure of our therapeutic pattern has a ritualized quality that allows more spontaneity inside the structure. There is a magical quality to the place where psychotherapy takes place which implicitly expands the scope of what can be considered.

Therapy always rests in dynamic interpersonal experience, with the therapist as focal point, but not always in an accessible or obvious way. In the playroom, the child is always projecting onto the therapist. The flow and context of his play is partially shaped by this projection and the therapist’s presence. The family’s projection on the therapist has an impact on how explosive the family fight can get and how loving the parents are willing to be with each other. The child’s process in the play therapy room is changed  by the therapist’s presence. The family’s process is likewise affected.  From this pattern, we talk of the relationship of the therapist to the family as that of a supra-family. The therapist, or co-therapists,  becomes the symbolic parent(s)   to the marriage of the family unit.

Psychosomatic (Body) language in a therapy session is always implicit. Body language includes how patients move, and what kind of symptoms they report. But it also includes the psychosomatic experiences of the therapist. I have a headache during a particular session. I pay attention to why now, why with this particular family? I mention it and discover the father has a headache as well. Or an obscure image comes to mind several times during an interview. It does not make sense but I share it with the family  anyway. A fragment of the image may trigger something, or sometimes family members refer back to it in a later interview because it stimulated them to think more deeply.

What I just described offers a brief glimpse into the  blend of Family Therapy and Play Therapy and how the play therapy components unfold in the therapeutic setting. It is our belief that fundamental family functioning occurs at the nonverbal level. When the family comes into therapy they are like actors in a drama. They have set lines and a single theme. Therapy ought to be able to change them into playwrights so that they have access to their self-actualizing potentials. Play is the medium for expanding their reality.

Here’s a snapshot from a case: 

 Case: I saw a musician’s family three times as a consultant in a Family Medicine clinic. The mother brought the 12 year old daughter to their doctor because of abdominal pain. The thoughtful doctor sensed distress in the mother, learned of marital upset and suggested a consultation. Mother and Father were both lively reflective persons. Father’s long-awaited success had put considerable pressure on their togetherness. Both felt guilty and were alienated from one another. At the third family therapy session, the daughters, 10 and 12, said they had something for me. They looked at their father. “Sure,” he said. They stood together and sang “Wind Beneath My Wings”. The sterile, clumsy Medicalized Exam room cum Family Therapy Office was transformed. I was deeply touched. The marriage was back in tune.

To be continued..