Wednesday, April 10, 2013

Play and Therapy


“On the seashore of endless worlds, children play.” Tagore misquoted by Winnicott

“Thought, language, now appear to us as the unique correlate, picture, of the world. These concepts:  proposition, language, thought, world stand in line one behind  the other, each equivalent to each. (But what are these words to be used for now?  The language-game in which they are to be applied is missing.)”  Wittgenstein

“The play’s the thing.”  Shakespeare

From Peter Ossorio’s Place, 1998/2012:

A1. A person requires a world in order to have the possibility of engaging in any behavior at all.

D11. The world is subject to reformulation by persons.

E1. A person requires a community in order for it to be engage in human behavior...

E7. When a person is in a pathological state there is a significant restriction in his ability to participate in the social practices of the community.

F4. If C has a given relationship to Z, C’s behavior potential is different from what it otherwise would have been.

F5. If C makes the first move in a social practice, that invites Z to continue the enactment of the practice by making the corresponding second move. (Move 1 invites move 2.)

H5.  All the world’s a stage (Shakespeare).

A Person is an individual whose history is, paradigmatically, a history of Deliberate Action in a Dramaturgical pattern.” Peter Ossorio

People have the roles of actor, observer and critic, and these roles are a necessary feature of being a person among people and engaging successfully in the social practices of our communities.  We are socially and emotionally competent when successfully doing what comes naturally, when we spontaneously and effectively do the done thing in our shared improvisational performances. We know how to play along. Usually, playing along is managed with no more than tolerable strain. If the strain is too much, people may come looking for psychotherapy.

“Psychotherapy has to do with two people playing.  The corollary of this is that where playing is not possible then the work done by the therapist is directed towards bringing the patient from a state of not being able to play into a state of being able to play.” Donald Winnicott

Play is ambiguous.

1. Play is an essential aspect of psychotherapy revealing an actor’s world maintenance and attempts at world expansion and reconstruction. We play with what we have and with what we want (and with what we want to avoid). We imagine. Imagination incorporated into play expands the world.

2. World maintenance defends against coercion and contraction of the actor’s desired status in his or her scheme of things. World maintenance is a product of successful action verifying that a person’s values, knowledge, and competencies effectively establish the distinctions and boundaries of the person’s world.

People do not choose less behavior potential over more.

Some of what people do involves claiming or asserting their place in the world. Status claims successfully made tend to persist and are defended when they involve importantly held values.

(World maintenance feels “natural” or “in character” to an actor. The actor spontaneously does what comes naturally. But the actor in a psychotherapeutic drama may need or want to change status given the problematic nature of their circumstances. Significantly changing one’s world may involve acting in ways that feel awkward, unnatural or out of character, actions that involve the role of critic. The critic moves with Deliberate Action, i.e., recognizes or considers options. If practiced successfully and sufficiently, awkwardness brought about by critical intervention can vanish.

3. A person’s actions in the world are limited by what they find motivationally relevant and thinkable, and what they know how to do and can tolerate.  People are guided by what they find significant. People respond to what they recognize as opportunity and dilemma. People worry or are anxious when they doubt their competence to deal with what they take to be opportunity or dilemma. Toleration and competence usually go hand in hand. People generally tolerate what they believe they can manage effectively.

What the actor avoids as unthinkable, intolerable, or behaviorally irrelevant, an audience may view as pointing to pathology or as evidence of unfortunately restricted or distorted social practices. What the actor finds “out of bounds” or “off the stage” may be seen as relevant context from the vantage point of the outside critic.

4. What is intolerable is what violates a person’s significant values or requires competence, skill, or know how that the actor lacks, especially when that person believes, correctly or not, that they are without the relevant competence, etc.

Actors may incorrectly evaluate their relevant state of affairs including their actual powers and dispositions.

Actors may think they know how to develop increased or new competence and recognize this about themselves. This knowledge makes an absence of present competence more or less tolerable.  (“I don’t know how to play this game, but I believe I can learn the moves.”)

5. A person may want (or need) to act on what they believe they cannot competently manage and this sets the stage for worry, anxiety, fear, panic and depression. When a person values what they cannot competently manage, anxious hostility may result when provocation is also present, anxious envy when inequity is also recognized, agitated depression when loss is also significant, and so on. Mixed emotion and mixed mental states involve a mix of recognized relevant circumstances. The “mix” may involve complementary, antagonistic, conflicted, and independent elements. Emotionally complex states follow from a complex recognition of circumstances that the actor thinks demand immediate response.

6. From an observer's perspective, the domain where the actor’s self-assigned and self-recognized status differs from what the observer attributes to the actor may correspond to the actor’s “dynamic unconscious” i.e., may involve motivations that the actor does not or cannot claim as his or her own. A person may be unaware of how they actually weigh their reasons for acting on circumstances and/or they may be reluctant to acknowledge the truth.  Self-deception can serve world maintenance but at the cost of a restriction in the potential for Deliberate Action.

What is unthinkable to the actor (what the actor is unable to conceptualize as self-relevant) is different from what the actor is reluctant to acknowledge, but both may look to the observer as involving self-deception or unconscious motivation.

But on interpreting the unconscious: who is to say who is right? Given that there is no pipeline to the truth, interpretation can only involve building a case that may be accepted or rejected regardless of merit.

In making a judgment, the actor as self-critic can renounce or reorder self-recognized motivational priorities. Non-acknowledged priorities are not open to deliberation and can be problematic when the self-regulation of those values is critical to the actor’s place in the community.

Communities commonly find unacknowledged sexual and hostile behavior problematic. Whatever is problematic when not adequately self-regulated is especially problematic when it is also unacknowledged.

7. Skill at improvisation is a central feature of health. Improvisation requires the acknowledgment and the acceptance of each participant’s behavior incorporated into the moves of other relevant participants.

8. Psychotherapy as an improvisational drama expands the thinkable and the tolerable by enacting the already thinkable and tolerable and then creating new versions and options given the safety to improvise without penalty. (“Let’s imagine, let’s pretend.”  “Have a do over. Take a Mulligan.”)

What the actor finds painfully reluctant to acknowledge may be easier to consider if playing with the idea is not penalized.

Play counts by not counting.

The therapist has the option of playing with the unthinkable and the intolerable through deliberately dosed communication that get across a problematic idea while minding the consequences of taking the lead. When opening up intolerable or unthinkable themes, the therapist’s job includes keeping it safe enough to do so. If it proves not safe, the therapist needs to be mindful that the therapeutic relationship now has elements of a potential degradation ceremony.

9. Deliberate and authentic degradation ceremonies are not part of play, although mock degradations might be. Accreditation ceremonies, accomplished or imagined, are part of play. Simply playing together is a mutual accreditation of shared community. Accreditation of eligibility, accomplished or imagined, expands behavior potential including the potential to imagine the change. Effectively imagining change is change. Play is magical in this regard.

10. Therapists mindfully attempt empathic neutrality, knowing that they will frequently fail to maintain such a stance. (Therapists, having their own values, know they are seldom neutral. Instead, they are careful about how their values and judgments are expressed. Therapists are attentive to how the appearance of their judgment shapes the ongoing improvisation. They bite their tongue).

11. Failures that produce a crisis intensify the drama.  A crisis is an opening for significant world expansion or reconstruction if successfully negotiated in the service of an enhanced relationship and a corresponding world reconstruction. Recovery from crisis is a significant accomplishment and an accreditation of a shared relationship that persists through change and strain.  Conflict and loss are inevitable given the multiplicity of motives and lead to crisis when it becomes clear that there is no simple way to proceed. Finding a new path is the job of therapy.

Paul Russell called this “the crunch.” Successful recovery from the crunch builds resiliency.

12. Psychotherapies using the concepts of “holding environment” and “transitional object phenomena” (Winnicott), and “self-object phenomena” (Kohut), deliberately involve social practices that create a safe place to expand a status otherwise defensively maintained.  Such play involves improvisation. The therapist shows that when it is safe, defenses are options rather than necessities.

(We may call this the playground and the playtime).

13. The “holding environment” is maintained by the therapist’s attention to the client’s safety, comfort and competence while facilitating a toleration of what is uncomfortable. (“You can take it.” “I’ve got your back.”)

Psychotherapy is guided by polices  and bounded by laws. Polices guide and suggest. Boundary conditions concerning potential therapist and client violation serve to maintain the place where the therapeutic policies are practiced. Such proscriptions appear as laws. Laws have coercive power and restrict and inhibit “acting out” or acting in ways that endanger the therapy. Laws bind improvisation. Laws insist.

Empathic confrontation and play are employed against “insistence” that a person’s world or status has particular limits when those limits unfortunately restrict or inhibit that person’s actions. Some restrictions may be fortunate. See “laws”.

14. Insistence protects the “done thing” and is a pathological defense when the done thing is pathological. The “done thing” may be an ordinary feature of common social practice, for better or for worse. Insistence is often unexamined when it feels like a natural feature of ordinary culture (e.g., in religion, shared prejudice, stereotyping, gender relations, taboos and so on).

People are members of multiple, diverse, and overlapping communities. Insistence on the “done thing” may appear pathological when a shared life space involves members of different communities with different values or when members of a common community recognize that the community’s choice principles are unfortunately restrictive. When the done thing is brought to question, hostile reaction to raising the question is to be expected.

15. “Open or free play” offers an antithesis to insistence. (“Hmmm, the monkey bars, the swings, or just kicking up dirt clouds?”)

16. The unthinkable and the intolerable are boundaries of spontaneity.

Play therapy is liberating. Play therapy invites both free association, i.e., verbal behavior that attempts utter honestly, and freedom of association, i.e., the freedom to attempt new social practices.

17. World expansion is facilitated by an empathic (and sympathetic) relationship.

(It is good to have a partner in crime).

World expansion is at times transgressive.

18. Empathic confrontation of insistence can “relax” boundaries. (“I'm coming along side. Yes, I see what you see and I see why you see it this way. But consider this alternative, just think about it, since there is no need to do anything else for the time being.”)

19. Psychotherapists are informed and limited by the statuses they maintain. These understandings and limitations have an inhibiting and socializing function, for better or for worse.

Psychotherapeutic behavior reflects professional judgment regarding limit setting, boundaries, directive and nondirective responses, and so on, for better or for worse.

20. Psychotherapeutic conversation attempts to symbolize or instantiate new actions and new social practices, which in turn facilitates further behavior potential given the freedom and potential safety of just thinking about it and talking it over.

Thought can be of what is not the case.  Ludwig Wittgenstein essentially an experimental kind of acting.... Sigmund Freud

21.  Psychotherapeutic dialog is empathic and intimate. Intimacy involves a shared appreciation and care of the other’s vulnerability. Empathy involves an accurate understanding of the significance of the vulnerabilities represented in a manner that the other can tolerate.

22. The therapist as self-object and transitional object allows and facilitates improvisation through mutual incorporation of the other’s moves (transitional object phenomena) and the provision of safety and support (self-object function) for actions that the actor previously found unthinkable or intolerable. Final-order appraisals (reality testing) of the limits and utility of the new action may be suspended during play.

The self-object doing the job of critic maintains an empathic stance and attributes to the actor a status or behavior potential that is an expanded or more serviceable version of the actor’s ordinary self-status assignment.  The self-object is sympathetic to the actor’s desired achievements and vulnerabilities. (This is the heart of both cognitive behavior therapy and psychoanalytic interpretation.)

The therapist as self-object communicates primarily through interpretations of the significance and further potential of the actor’s performances. The therapist’s interpretative comments uttered with supportive intention are close to the actor’s current awareness and toleration.  The self-object functions to provide safety and support for the new behaviors that occur during the new improvised performance, the shared practices developed during therapy. This might look like “baby steps”; it might also look like encouragement, reassurance, or buttressing.

Interpretation during play is effective when it becomes part of the ongoing improvisation. Its worth is demonstrated when new practices are informed by its message.

23. Self-Objects and Transitional Objects are actual other people or imagined other people. The illusion of support can be supportive.

24. Since improvisational play involves each player incorporating the other player’s moves, the person with the greater freedom and ability is in a good position to demonstrate how the other person's actions can appear in new form given the manner in which the "more advanced" actor's improvised response elaborates or expands on the "less advanced" actor's previous move. The therapist secures the practice stage and supports her client's expanding potential.  This may look like modeling, coaching, imitating, bantering, daring, containing, limit testing, cheerleading, and so on.

The therapist provides the client with an alternative observer and critic perspective (without desperation). The therapist avoids desperation as best he or she can. Knowing how to cool desperation is a fundamental therapeutic competence. Play cools desperation when available as an option. The therapist keeps an eye open for this option.

In the real world it turns out, from time to time, that therapist and client exchange positions.

Every difficult therapeutic and intimate encounter is an opportunity for significant world maintenance, reconstruction, or expansion. Therapists and clients maintain and reconstruct each other’s worlds as they successfully improvise and negotiate the existing terrain. Therapists and clients expand each other’s worlds as they mutually develop serviceable new social practices.

Therapeutic change is often against the grain, rarely smooth.

Therapists get paid to work against the grain; it is the hard part of the job.

Therapeutic work is hard. It concerns the difficult.

The hard work pays off when the actors find themselves playing.

25. When life is good we dance alone and together, even when awkwardly or painfully learning the steps.

Life is sometimes hard and that is why we have growing pains.

Growing pains provoke growth and are an affect produced in growth’s wake.

26. Play should be fun. Competent play is. Surf the wake.


  1. “We don't stop playing because we grow old; we

    grow old because we stop playing”.
    ~ George Bernard Shaw

    Play is truly “…an essential aspect of psychotherapy”. Especially when one works with children, play therapy needs to be at the heart of sessions. Most children are able to speak more while engaged in play and even if they don’t speak at all, their non-verbal aspects of communication are equally (if not more) telling then their verbal dialogue.

    Play brings out inner thoughts, helps express feelings, and lets us, the therapist, really see how the child unfolds as an actor, observer and critic right in front our eyes. I always make sure to dedicate a portion of my sessions with children to play or art therapy. Children are very creative and often times it is during play that they curiosities, inquisitiveness, and perhaps troubles and concerns are highlighted. While we sit on the floor with the children, they get a sense that we too are active players in their game.

    ~ G. Cruz

  2. To further expand on the idea of play, I am also reminded of transitional objects and its importance. The unit to a society is the dyad and an infant never exists in isolation. The infant has its mother or other care giver who can ideally provide a safe, holding environment. One can mirror that holding environment in psychotherapy sessions with adults as well. In a transitional space, images of improvisation go on where the therapist meets the client and vice versa as both try to decipher a common language of terms.

    Consequently, the therapist influences the client while the client influences the therapist. Both are co-creating something together, somewhat like an interpenetrated joining of some sorts. Ultimately, the therapeutic domain becomes the transitional play space.

    ~ G. Cruz

  3. I appreciate the content of this post, as well as the comments of G. Cruz above. I will admit a secret pet-peeve of mine when engaging in play therapy: sitting on the ground with the child-patient. However, though I would be much more comfortable resting in a desk chair, I find this small task to be almost therapeutic in-and-of itself. In so doing, the therapist demonstrates his active participation in the play (and therapy) at hand. He literally and figuratively brings himself down to the child's level, getting his hands dirty in the co-constructed play-- something which seems to serve as what Thomas Ogden referred to as the "Analytic Third".

    Another personal play therapy pet-peeve is the pace. I am a learning clinician, and often have to remind myself to maintain patience during sessions that don't seem all that "clinical". At times, weeks may pass without my perception of much therapy getting done at all in my play therapy sessions (for the sake of this comment, I am overlooking the level of projection that occurs in play therapy). For this reason, I appreciate the above line: "The therapist shows that when it is safe, defenses are options rather than necessities." To me, this means in part that the creation and maintenance of a holding environment for the patient is, in-and-of itself, therapeutic. In other words, the therapist may create a place where the child can simply "be", no defenses required. This idea fuels my belief that simply being a present and consistent individual in the life of a child may at times be all the intervention that is necessary. This may include meeting regularly and being willing to follow the child's lead...even if that does mean having to sit on the floor.

    -Rob DiGiammarino