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REFLECTIONS
ON PSYCHOTHERAPY AS ACTION
By
Robert Aberg, Ph.D.
I arrive at this topic by way of my
interests in play therapy, improvised music, and, lately, golf. Also, it
seems to me that much of the intensity that characterizes the conflict
between the intersubjective and classical positions (oh no, not that
again!) reflects our ambivalence that we psychoanalytically oriented
therapists actually do things other than think, reflect,
and--occasionally--understand.
I’m starting from the position that all
of our behaviors—including “passive” behaviors like sitting still
and listening—define our participation in co-creating the therapeutic
relationship. Thus, “action” refers broadly to behavior in both active
and passive modes. While there are perhaps innumerable elements that go
into making a relationship therapeutic, I am most concerned with those
that allow for moments of shared subjectivity. (Lest this sound too
mystical, think of dancing or laughing together.) Behaviors relating to
these elements can be thought of as “tuning in” behaviors and they
occur in both patient and therapist. I am also assuming that all
behavior—whether the patient’s or the therapist’s—is multiply
determined by conscious and unconscious factors. In this sense, therapists
do not have the ability to behave in a fundamentally different way than
patients. Behavior is behavior, after all. In this sense, everything that
occurs within the therapy can be viewed as an enactment of some kind. This
can get confusing!
For example, as a psychoanalytically
oriented play therapist I often find myself in the midst of a
kaleidoscopically changing world where the boundary of real and imagined
has all the substance of a flame. The pace and focus of the play may
become patterned and concentrated (more like a burning coal) but always
there’s some hoped for heat, a hoped for access to something vital,
something operating on its own terms, always beyond description or
knowing. As this experience takes shape, and as my patient and I begin
finding ourselves in it, our awareness and—perhaps--understanding of
what it is like for this child to be this child grows and develops. That
part of my psyche that is trying to cast some sort of theoretical net over
what’s going on from a developmental point of view is like the general
figuring out how he might best fight the last war, i.e., always left
behind. But that effort is also crucial in the sense that—assuming
I’ve achieved any insight into the structure and dynamics of the
patient—it can afford me paths and landmarks to follow to get up to
where the action is. It’s like trying to figure out where to stand along
a parade route to have the best chance of getting a glimpse of the patient
as they (the “multiple” selves of the patient—not multiple
personalities!) go marching by—and maybe run along side them for awhile
and get them to notice me and wave back… For me, this running alongside
is an active, highly engaged process. As we act out the play together,
that’s me in the guise of the ship captain fleeing the Bad Batman team;
that’s me crashing the F14 Tomcat into the carpet after being shot down
by the invisible and invincible Stealth; that’s me contemplating my
financial demise after landing on New York Avenue (with a hotel…) one
too many times. But that is also me noticing when they have begun to
notice me noticing (and responding to) them. And at those moments (“Did
you just see what I just saw?”) our play has the potential to become
something more than mere acting out. Interestingly, we don’t halt our
play and have a nice chat about what the play is revealing about the
structure and dynamics of the child’s psyche. Rather, the play typically
moves forward in an invigorated way. One could say that greater
integration and awareness of split off experiences develops and a
strengthening/healing of the ego takes place. That is, through a play
enactment of the split off experience the split off material has a chance
to be made less threatening (“detoxified”), more conscious, and to
thereby enrich the patient’s conscious attitude--as evident in a more
flexible and creative approach to the play themes. Or one could say that
we are exploring the patient’s transitional space. Or we could say that
we are having some serious fun.
Does all this action or, really, enactment,
mean a loss of authority or legitimacy, or that when we act, we are simply
contaminating the patient’s pristine psychic space with our
multiply-determined and fundamentally subjective take on things? How can
we distinguish acting therapeutically from acting-out?
The word “asymmetry” is often used to
describe an essential difference between psychotherapy and, for example, a
conversation between friends or simply playing with a child. Certainly
there is asymmetry with regard to the focus and intention of the
therapist. We wish to know, first of all, what is it like for this patient
to be this patient; secondly, how is it that the patient may be stuck or
severely hampered in some developmental task; thirdly, is there a way of
talking about and working through these stuck bits in the therapeutic
relationship. In other words, it’s all about the patient. There is also
asymmetry in experience and expertise. The therapist knows something about
how these explorations of self (or self states) and others go. Therapists
have been trained and supervised and, most importantly, have been on their
own therapeutic journey. Having picked up a few things from our own
training, supervision, and therapy, we are able to offer ourselves as
willing to join and help guide the expedition into the patient’s unknown
territory, i.e., their subjectivity. Like Lewis and Clark, we start out
with our rough ideas about where and how to proceed and what we think we
may find; but, also like Lewis and Clark, we must be ready, willing, and
able to stand corrected by what we discover. We must be willing to be open
to our experience because, after all, we don’t know what we don’t
know. So, one thing that distinguishes acting therapeutically from acting
out is that, whereas acting out is a defense that functions to obstruct or
constrict conscious awareness, acting therapeutically carries the
condition that the action (or enactment) will be examined from the
standpoint of our previous understanding with an eye towards elaborating
or changing our understanding so as to increase our shared awareness of
the patient’s experience. Thus, it seems to me that what we are offering
is a certain kind of mastery with regard to being able to get at where
psychic life is happening.
One similarity between being a
psychoanalytically oriented psychotherapist and being a jazz musician is
the sense of living on the cutting edge of being an anachronism (as my
brother-in-law—a book editor—has described his own job). We live in an
extroverted, market-driven culture that tends to view self-expression and
subjective pursuits generally as, well…boring. Indeed, our culture seems
to view the Self principally from an instrumental perspective. (Do you
have a “winner” sort of self or are you still trying to sport around
in one of last year’s “loser” models?) There is a kind of cultural
splitting between the notions of Self as Object versus Self as Subject.
We—as a culture dedicated to a consumerist ideology--seem to be able to
run endless laps around the quest to either capture or become the Self as
Object of admiration and desire. ($250 million for a baseball player?)
Yet, when it comes to the Self as Subject, few of us can be bothered to
take much interest--even though it is in this domain that we experience
our closest, most intimate connections with each other and with ourselves;
even though it is in this domain that meaning and personal development are
experienced; even though it is in this domain that learning and decisions
to act (or not act) are made; even though it is in this domain that we can
seek and sometimes experience the Self (our own and others’) as
authentic and true (cf. Winnicott’s notion of the False Self). Why?
Speaking for myself, I find that working through the maze of resistance,
distractions, temptations, conflicts, and miscues is extremely
frustrating. Much of the time it’s just too hard--and/or I’m just too
lazy. But this kind of learning (expanding awareness/integration) happens
only in patience and humility. It can only be done on its own terms and on
its own schedule; it simply will not yield to wishes for grandiosity—no
matter how intense. Authenticity is its own reward and there are no short
cuts on the road to Truth or Beauty. Nuts!
The culture clash between objective and
subjective views of the Self was best put in perspective for me by a now
deceased friend, James Clay. James was a wonderful tenor saxophonist.
He’d been a rising star in the 60’s jazz scene but had fallen on hard
times and dropped out of the national scene. I got to know him because he
continued to play locally. In the late 80’s James re-emerged with a
nationally distributed recording, which, while not a best seller, was
quite favorably reviewed in the New York Times. At about this time we were
playing a private party and, during a break, I mentioned how I’d seen
the review and how great I thought it was that he was getting some
well-deserved recognition. He made it clear that it hadn’t meant that
much to him, but then told me about the one “review” he’d really
cared about. As a young man he was playing in a local club. At the time he
was a relative “unknown” and there was no publicity about his
appearance. But one of the club’s regulars happened to be walking by
outside during a solo and, recognizing James’s tone and musical style,
the man came in to listen. That was the point at which James felt he’d
truly begun to establish his own musical voice. While James’s life was
anything but free of misfortunes and miscues, he had an uncanny ability to
lock onto that open, authentic place from which all jazz musicians want to
play. James could open up and swing.
Which brings us to golf. While an objective
observer might file my golfing exploits under the heading, “Sisyphus
goes for a walk,” my subjective experience of the game is that it is
full of beauty, pathos, exhilaration, and frustration, punctuated by
hilarity. While I freely admit that it is, objectively speaking, probably
the most amazingly silly game ever invented, no other endeavor has so
spectacularly revealed to me the futility of grandiosity, the rewards of
patience, and the Truth of humility. I find it an ongoing object lesson in
the deviousness of my ego, which is always seeking ways to strut about in
Thor-like splendor. And the best thing about the
“swing-hard-in-case-you-hit-it” approach to golf is that it never
works. Like the most disciplined and unshakable therapist, the little
white ball is immune to being manipulated, psyched-out, or coerced by
tantrums. Instead, it provides instant feedback in the form of psychic and
somatic aches and pains as well as objective confirmation of the futility
of my grandiose wishes in the form of zinging away left, fading away
right, or--perhaps most dramatically--serenely sitting right where it was
before I took my mighty swing. So, for me, it’s a psychological game
about submitting (or not) to the reality principle in the form of the
biomechanics of one’s physical being as it interacts with a golf club
(that most absurd of all inventions!) while executing the Golf Swing. I
succeed to the extent that I recognize and accept the limits imposed upon
me by Reality. And, as for most of us hackers, the reward is simply in
having the awareness of where I am and what I’m doing. (I, obviously,
find golf courses exceedingly beautiful places to be!)
The idea of awareness is a common thread in
all of this. Whether it is doing therapy, playing music, or searching for
golf balls, the common goal is to expand awareness. Awareness in this
sense is not the same as ability, insight, or understanding. Indeed, our
abilities or ideas about things often serve to foreclose or delimit
awareness. These are, in other words, always available to be used
defensively. Whereas awareness always includes everything we know, it is
also open to the idea that everything we know may, at a moment’s notice,
be put into some new perspective that provides greater integration and
richness to experience. And, we can take heart from the fact that there is
no way through this maze by thought alone, that, at some point, we must
jump in and act. This is because we know that our mistakes and
always-imperfect efforts will, eventually, lead us to some new
appreciation of where we are, what we’re doing, and who’s doing it.
Dr.
Aberg is a clinical psychologist in private practice. He
is a past president of DSPP and has presented at our monthly meetings.
© DSPP Bulletin, January 2001
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