Saturday, May 11, 2013

On Getting Stuck and Unstuck: Empathy and Improvisation in Psychotherapy




Therapy can feel stuck, stymied and aimless, but fits and starts may be a necessary aspect of transformative therapeutic processes.  

Therapy feels stuck when the domains of choice are too restricted or rigid, when the people involved are unable or unwilling to engage in the options each party invites and attempts.

How does the process of being stuck and unstuck proceed?  This depends partly on how and whether the therapist and client can engage in a co-constructed improvisational activity. Empathy is necessary since its absence may be why the therapy is stuck in the first place. Empathy is required for therapeutic improvisation.

Some of the therapist’s activity might be seen as setting the stage for improvisation to be possible.  A way of thinking about the therapist’s stance of patience, empathy, waiting and toleration is that it serves attempts at getting unstuck.

Improvisation involves an expansion of possibility and requires flexibility. (Your move 1 invites and is incorporated into my move 2, and your move 3 incorporates what has just transpired and so on.) If improvisation is successful both people have done something they have not done before. They have incorporated aspects of the other’s behavior into their own.

In improvisation, a space is created for moves and choices, spontaneous gestures, that neither party has made before.  Winnicott called this the transitional phenomena. Since the improvisation is something already accomplished, it becomes behavior potential, something a person might want to do again.  

I take for granted that we get something of value from improvisational interaction. At the very least, we now have done something we might not have done otherwise.  

Change may involve fundamental, profound or trivial alterations in a person’s powers and dispositions. Usually real change is slight and hardly noticed to the point of being, practically speaking, not much change at all.  But part of the therapist’s job is to notice and accredit these shifts. This doesn’t need to be said out loud but it must find its way into action so that it has a chance of being incorporated into the next set of unfolding acts.

Therapy is difficult since it may require establishing empathy and developing an improvisation with a person one would not ordinarily choose as a companion.  This holds for both participants.  Empathy is easy when the going is easy.  This is often not the case in therapy. Therapy frequently involves difficult people under difficult conditions. This is why people are in therapy rather than successfully working matters out with friends, lovers, parents, and so on.

Therapy brings together people who under other circumstances might not easily understand each other. This is the therapeutic dilemma and opportunity. An empathic relationship requires negotiation, a moral dialogue, for misunderstanding to be corrected. Knowing how to accomplish this reaching out in the service of being understood is a valuable skill.  But this is difficult.

The participants in therapy will be changed when they accomplish something difficult because the players themselves have to overcome the difficulty of getting along. Freud, long ago, knew this and saw it as essential for progress. He called it the “transference neurosis”.  Working it through may require change in values, knowledge and competence for each participant.  Since one or both parties may not yet have what is needed it is no surprise they find themselves, from time to time, stuck.

Getting unstuck has a liberating effect.  We were lost but now are on our way. If this occurs we may have faith and competence not present before.  It is good to know we can weather a storm.



(In weathering the storms of difficult engagement, therapist and client are both transformed: Empathy, Improvisation and the Growth of the Therapist.

For a method of regaining empathy, see April’s Regaining Empathy

For the behavioral logic of how improvisation can facilitate each party acquiring strength from the other, see April’s Play and Therapy.)




5 comments:

  1. This is very helpful for young clinicians like myself to follow. Thanks Wynn

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  2. This is a beautiful piece that made me think of a couple of things. As an MSPP doctoral candidate and future psychologist, empathy plays a major role in the profession I have chosen.

    First, your blog made me realize that feeling empathy towards a client is only fulfilling half the job. The full job would be to make sure the client is aware of our genuine attempt to be with them in the moment. I completely agree with your statement observation that, "Empathy is necessary since its absence may be why the therapy is stuck in the first place". I think I would extend it in saying that often times empathy on our (the clinician) behalf if there, however, it is the client who is unaware or unconvinced of its existence. This ultimately is what I believe causes therapies to become "stuck". Empathy is what helps the client's experience of being heard and it is what generates a sense of realness, a sense that they exist. To be genuinely in the moment and be spontaneous should be the goal for the therapist.

    Secondly, your blog Dr. Schwartz, has made me revisit Winnicott. You state that, "In improvisation, a space is created for moves and choices, spontaneous gestures, that neither party has made before. Winnicott called this the transitional phenomena". Undoubtedly, this resonated with me as I immediately thought of Winnicott's idea of transitional space and holding environment. The transitional space idea is really powerful because such a space is where I feel therapy really focuses on. It is a place that can be utilized to explore and wrestle with new ideas while bringing in information that you already have. I believe that most of the healing takes place in this transitional space.

    Additionally, I also thought about the concept of the holding environment for clients. Creating a nurturing and trusting environment where a client doesn't feel judged is key to building rapport in an empathetic and therapeutic setting. As you poignantly observe, "The participants in therapy will be changed when they accomplish something difficult because the players themselves have to overcome the difficulty of getting along". Creating a therapeutic dyad with a client may be challenging but it's possible (and highly necessary) for the viability of future sessions.

    ~ G.Cruz

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  3. "The participants in therapy will be changed when they accomplish something difficult because the players themselves have to overcome the difficulty of getting along. Freud, of course, knew this and saw it as essential for progress. He called it the “transference neurosis”. Working it through may require a change in values, knowledge, and competence for each participant."

    I'm having trouble understanding the concept of the "transference neurosis". My understanding of transference is that the term refers to the analysand's unconscious projection of thoughts and feelings toward another significant individual onto the person of the analyst. Does this tension result in a "transference neurosis", subsequently leading to the need for analysand and analyst to overcome the challenge of getting along?

    -R. DiGiammarino

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  4. On the contrary, it looks like you have an excellent understanding. The concept of a "transference neurosis" involves 2 notions: "transference", a projection or assumption of sorts that may not fit or be serviceable, and "neurosis", which suggests a conflict with some rigid, insistent, or otherwise non cognizant aspect. So yes, the problem would show up in how the therapist and client get along since a transferential misunderstanding can bollox up their encounter. The classical solution is to interpret the transference, to make it conscious, so that the people involved have a better chance of negotiating or reframing their understanding and interaction. This is also partly why it is through the analysis or interpretation of transference that "resistance" is overcome, dissolved, or clarified. If resistance involves unnecessary barriers to psychological freedom or choice, then the misguided perceptions and interactions produced by transference point to the rigid and unexamined barrier.

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  5. I have a hard time describing my thoughts on content, but I really felt I should here. Your article is really great. I like the way you wrote this information.
    Skokie Psychotherapy

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