Cultivating the Improvisational in Psychoanalytic Treatment

Philip A. Ringstrom, Ph.D., Psy.D.

This article juxtaposes two orientations to psychoanalytic theory and clinical action—the prescriptive, embodied in the metaphor of classical theater, and the improvisational, embodied in the metaphor of improvisational theater. The metaphor of classical theater is analogous to how the theoretical predilections of each school of psychoanalysis has its own set of prescriptions (“sets," “roles,” and "scripts”) for how an analyst influences mutative moments of change with a patient. In contrast, the metaphor of improvisational theater refers to actions that arise on the spur of the moment, without preparation These improvisational moments ineluctably communicate to the patient a special instance of authenticity, which may well be antidotal to the crushing reality of the patient’s life of pervasive inauthenticity. They also enable analysts to more readily engage disparate, often dissociatively disconnected parts of the patient through imaginative intersubjective engagement with each. This may take the form of reverie within the analyst—from which his own mental state of play informs his interpretation. Still, at other times, it may involve a form of spontaneous engagement that conveys not only a moment of deep recognition but also the purest stare of authentic engagement—that is, one that cannot arise with comparable impact when reflection precedes the analyst’s action. In sum, the capacity for engaging in improvisation may well be one of the most defining capacities for the development of a genuine psychoanalysis.

All growth is a leap in the dark. A spontaneous unpremeditated act without benefit of experience.
—-Henrv Miller

Jonathon was a 42-year-old aerospace engineer who could have readily fit the diagnosis of a borderline personality disorder, His ideation and affect tended to markedly split himself, others, and relationships into being either “all good or all bad.” He was riveted throughout his life with intermittent bouts of depression and plagued by obsessive-compulsive symptoms over his guilt-ridden “evil” thoughts. Several years before seeing me, he had had a “highly traumatizing” therapeutic experience with a conventionally trained female analyst. It seemed that her abstinent manner left him spiraling downward into a world of unremitting shame. After a year of “evading” her, he abruptly quit treatment. Eventually, a series of incapacitating migraine headaches led to his contacting her and asking for a referral to a male therapist, whereupon she sent him to me. It was apparent from our first appointment that, for Jonathan, any bad thought regarding another human being was grounds for unremitting self- attack.

Jonathan’s conviction about his evil arose primarily in relationship to his mother, who was quite possibly the most saccharine woman to have ever graced the face of the earth. In the lineup of “living saints,” Mother Teresa would have easily been a distant second. Because his mother had staked out the “moral high ground” every moment of his youth, Jonathan was left feeling perpetually inferior and filled with rage over it. His antidote was to be as “pure in thought and deed” as he could possibly be. In trying to do that, he tightly concealed his private competition with his mother over which of them was the “nicest, most caring” human being. To his chagrin, however, he perpetually lost the contest, for he had many “evil” thoughts about others.

During one session, Jonathan anxiously discussed his worries about his 11-year-old son Andrew’s pattern of obsessional thinking. Like his father, Andrew perseverated ad nauseam about even the slightest ill- tempered thought he had had or misdeed he had committed. Sometimes this involved a current infraction; other times, it involved an infraction that had happened in the past, even years before, such as when at age seven, he had stolen a girl’s pencil because he was angry with her.

Jonathan was becoming ever more frustrated In his failed attempts to soothe his son. Interventions such as saying, “Andrew, everyone does bad things at some point in their life. Just don’t do it again. It’s okay to forget about it now,” fell on deaf ears. This made Andrew worry all the more that his father was being insincere and placating, as Andrew immediately sensed the duplicitousness of a father so beset by his own obsessional anxieties. (1)

Jonathan wondered how I thought he should talk with Andrew. After exploring his fantasies, I acknowledged his request by suggesting that perhaps Andrew also was having difficulty accepting his own “evil” thoughts—that maybe he needed to be helped to discuss them instead of suppressing them. No matter how benign they seemed to Jonathan— “Stealing a girl’s pencil isn’t any big deal,” he had exclaimed to his son—for Andrew they were difficult-to-contain expressions of his hatred and malice toward others.

Jonathan responded that my idea was not only “perfect” but that he was astonished at his own “stupidity” for not having considered this himself, especially in the light of what he had learned about his own obsessions in our three years of psychotherapy. With this, he began lambasting himself with repetitive and adamant assertions about his “stupidity.”

I started to feel trapped by Jonathan’s vitriolic self-abuse. Although this old transference—countertransference script was doubtlessly familiar to me, I blurted out, “But of course, Jonathan, your stupidity was sooo understandable!"  He howled with laughter more intense than I could remember witnessing; he also looked relieved. He immediately repeated my words three times—tone and inflection—in a state of astonishment and childlike glee. “But of course!” he said, “My stupidity was sooo understandable!” Before the end of the session, he repeated the comment several more times with great appreciation and expressed his wish to remember it exactly as I had said it.

We might wonder what “worked” here. I think it was that Jonathan naturally did not expect my outrageous therapeutic response. If anything, he expected me to “serve up” the same kind “pabulum” his mother would have—or he would have to Andrew. This was, after all, the well-worn material of the maternal transference in which Jonathan repeatedly “dressed” me. I was expected to say the “therapeutically correct” thing, even though I could not possibly mean it.

Of course, embedded within this transference construction, Jonathan also expected me to privately lord over him from the superior position of my “therapeutic moral high ground.” He had on many occasions acknowledged this privately hated transference conviction about me. Indeed, that I was privy to his deeply personal shameful thoughts and deeds perpetually humiliated him, and that he “had nothing on me” enraged him, so much so that, one time, when I was caught in traffic and was seven minutes late to a session, Jonathan refused my offer to extend our time by seven minutes because he was overjoyed with the pleasure of having “finally gotten something to lord over” me.

In this context, it was likely that any “conventionally” therapeutic interventions, such as empathizing with Jonathan’s worry over his son, would have been taken as another covert means of putting him down. Instead, my spontaneously saying what he could only imagine as the “wrong sort of thing for a therapist to say’’ was in fact far more deeply and genuinely empathic. In fact, Jonathan did feel that he was stupid, and any other assertion at that moment would have felt entirely disingenuous to him. On the other hand, recognizing this, it is also true that his “stupidity” was understandable! To the extent that our parental identifications from our own upbringing both aid and encumber our own parenting style, Jonathan could hardly expect not to have some of his mother’s inability to tolerate the expectable evil thoughts of his son. It made it deeply empathic, therefore, to recognize that Jonathan’s oversight of the “obvious” way to respond to Andrew s problem was in fact perfectly understandable.

This example, though somewhat unorthodox, is hardly rare in psychoanalytic practice. (2) Although we can speculate about why it was so dynamically affecting, we nevertheless are limited in our technical ways of discussing it. Indeed, in relation to the historical technical ideals of abstinence, anonymity, and neutrality, it would be regarded as anathema. How then, are we to understand it?

My approach to these questions has over the past decade taken shape through an invocation of theater as a metaphor of psychoanalytic practice and in particular through a comparison of classical and improvisational theater. Whereas classical theater can be a useful metaphor for grasping traditional metapsychological models and the technical principles they prescribe (Peddar, 1977; McDougall, 1985, 1986; Modell, 1990, 1991) improvisational theater can be a useful metaphor for grasping key elements in the moment-to-moment unfolding of any analytic process.

Indeed, these two systems of metaphor richly describe quite disparate though not always mutually exclusive dimensions of the psychoanalytic enterprise. Stated briefly, classical theater corresponds to that aspect of psychoanalytic practice that pertains to sets of givens—to what is "prescribed,” if you will. Examples of givens in theater are a set or stage, actors with defined roles and relationships, scripts, props, and even the ubiquitous plot with the story unfolding in three acts. Parallels in psychoanalysis include the cloistered consulting room, designated roles of doctor and patient (each with his or her historical script), props such as the couch, and a treatment with a time line and narrative involving a beginning, a middle, and an end. Such givens, as well as many more, have been richly studied, codified, and theoretically consolidated into refined sensibilities of how the analyst and analysand are to behave analytically. Langs’s (1973, 1974, 1978, 1980, 1981) voluminous work on the psychoanalytic “frame” is just one of many examples (Greenson, 1967; Arlow, 1991) of a kind of conceptual and technical edifice that prescribes what should occur within the analytic setting and the relationship, such that deviations from these givens can be used as signals of unconscious analytic resistance by one or both parties.

Like all professions, psychoanalysis is mandated by society to define its activity—that is, to publicly share its theories and its mode of practice and, above all else, to forward a methodology that will do no harm in cases where it is ultimately unable to do any good. Public safety is the first consideration of all professions. Indeed, the profession of psychoanalysis has had a long and sometimes costly history of needing to prove its efficacy while stringently defining its metapsychology and its technique (Richards, 1999). The need to muster such self-assurance both publicly and privately can often manifest itself in cultivating an attitude of “what one knows” by virtue of an analyst’s theoretical predilection. Brenner (1995) captured this quite forthrightly:

One knows some things about what one sees and hears from a patient....One knows that wishes are always ambivalent....One knows that they have both a sexual and an aggressive aspect.  Wherever there is hatred there is sexual desire and vice versa; however concealed one or the other may be.  By the same token, one knows that sadism and masochism always go together....One knows that ideas of abandonment, of being unloved, of genital injury or damage, and of being punished are what trigger every patient's conflicts and defenses.  One knows that part of every defensive effort is to avoid punishment and to win forgiveness in the form of pity [p.416].

From such confident assertions of "what one knows" often also grows a world of prescriptions, evident not only in classical psychoanalysis but in other schools as well.  For instance, one knows that, for the Kleinian (Caper, 1995), "it is not aggression that is important developmentally and in psychopathology, but anxiety, whic can arise either from hatred and aggression (anxiety about the safety of the self in the face of one's own hatred and aggression, or of aggression from another) or from love (anxiety on behalf of the loved object)" (p. 465).  Hence, Kleinian technique directs its analysts not to shy away from investigating the depths of a patient's anxieties.

"One knows" as a self psychologist that the treatment is about the elucidation of the traumatic disruptions of selfobject functions requisite to the patient's development of self-cohesion, continuity, and esteem.  Therefore, the self psychologist, though not necessarily the purveyor of the functions themselves, is at least the compassionately, empathically attuned interpreter of the patient's understandable frustration over their failure.  But in so doing, he is less likely to pursue sources of anxiety (which may activate stultifying fragmentation) than to empathically respond to the deficiencies they illuminate.

In these brief and limited examples, I try to capture how theory in all cases attempts to "write" scripts that define an analyst's "desired role" (her character's central curative motivation, if you will), the perimeters of her "set design" (her consulting room), her "blocking" (movement within her office), and even the timing in the delivery of her lines (her interpretations).

Of course, it is to each theory's credit that it conceptualizes its clinical interventions in a manner to both safeguard the patient and help emancipate him from that version of his unconscious that each given theory holds sacrosanct. All to some degree stake out what they feel is both crucial and precious and therefore what must be guarded in strong measure by each theory’s “rules of engagement,” (3)

Thus, each theory vehemently argues with the others and would not be worth much if it did not. But the degree to which the therapist uses any theory to prescribe in what manner he should engage his patient is the degree to which his theory is dictating more of a position of preparation that is in contrast to a position bursting forth from “the moment” (i.e., arising from the improvisational).

By contrast, there is a considerable and important divide between classical and improvisational theater and this becomes significant in relation to each one’s use as a metaphor of psychoanalytic practice. The givens alluded to in classical theater are largely absent in improvisational theater. In the latter, the emphasis has little to do with “what one knows,” as it is all about what one does with what one does not know. There are no set roles, no defined scripts, no anticipated props, seldom even a fixed stage. Use of time and space is largely undetermined. The act begins from the unknown, draws from the unknown, and thereafter unfolds from some unknown into a cocreated setting and relationship that eventually lead to a plausible end—an end that, like psychoanalysis, is quite understandable in retrospect though impossible to have divined in advance. This quality of improvisational theater captures precisely much of what is most unique in the psychoanalytic enterprise.

How a psychoanalytic drama unfolds, of course, involves episode after episode of analysis, or scene after scene (Foote, 1975). These countless scenes, often obscured by their very overlapping, may occur within a fragment of a session or may stretch inestimably throughout all the phases of an analysis. Over and over, the same dramatic themes of the patient’s psychic reality, which have been played endlessly throughout his life, with or without real others, now become replayed in the analysis. The analyst must be improvisationally open both to assume his role in them and to help enable a different ending. Doing so means remaining open to the patient and unfettered by theoretical consideration, and the patient optimally stimulates, awakens, and invites within the analyst those elements of the patient’s unconscious script he has been loathe to know. But to be optimally open to this, the analyst must be able to assume, as in the zen master’s ideal, the retention of the “beginner’s mind” (Suzuki, 1970). (4)  Many analysts have intuitively gotten this, and it is important to take a moment to signify the works of just a few.

Improvisational Thinkers

The work of many authors in psychoanalysis qualifies them as cultivators of an improvisational attitude. Certainly among the earliest is Bion (1967), who admonished analysts in what has become his most cited paper, to enter all sessions “without memory and desire.” For the analyst, this means to treat each session as if it were an initial consultation with a new patient—to eschew the known for the unknown, as the unknown is the only place where real transformation can occur. Deeply influenced by Bion’s article, (5) Lindon (1991) pointed out that the analyst’s defensive use of theory can be a counter-transference reaction to a fear of the unknown and an attempt to “pigeonhole” the patient for the analyst’s own comfort.

In one of his most famous quotations on the role of play in psychoanalysis, Winnicott (1971) counseled, “If the therapist cannot play, then he is not suitable to work. If the patient cannot play, then something needs to be done to enable the patient to become able to play after which psychotherapy may begin. The reason why playing is essential is that it is in playing that the patient is being creative" (54). This clearly places Winnicott at the improvisational center of psychoanalysis, especially given that, just as the infant must play with "destroying” its mother to find out in reality that she is still alive, so too must the patient be able to ruthlessly play with the analyst to discover the analyst’s “going-on-being-ness.” Similarly, Ehrenberg’s (1990, 1992) elaboration of play suggests “that. . . [it] can become a basis for experimentation and exploration as it provides an opportunity for the discovery and integration of disavowed or repudiated aspects of one’s personality, and for the discovery of undeveloped resources” (p. 76).

Those undeveloped resources correspond with Stern’s (1989, 1990, 1992, 1994, 1998) “unformulated experience,” Stolorow and Atwood’s (1992) “prereflective unconsciousness,” Bollas’s (1987) “unthought known,” Gendlin’s (1964) “felt meaning,” and James’s (1890) “feelings of tendency.”

The unformulated straddles the experiential realms of discovery and creation not only for the patient but for the analyst as well. It emerges primarily when the parties “break the grip” of repeating the familiar —that is, the patient’s age-old routine for relating and/or the analyst’s rigidified prescriptive manner of treatment. However, to do so means that, just as in improvisational theater, both parties must be prepared “to court surprise” of the “unbidden” and the “unanticipated” (Levenson, 1988; Stern, 1998).

All this entails the analyst’s unique venture into using his subjectivity and even in using self-disclosure in ways that bridge gaps, cultivate openings, and engage dissociated parts of the patient’s sense of self. Examples of this abound in the works of authors such as Aron (1996), Bromberg (1998), Davies (1994, 1998a, b), Gabbard (1996), Gabbard and Lester (1995), Gerson (1996, 1998), Mitchell (1993, 1997), and Renik (1995).

No author has captured the sense of the “balance” between the world of prescription in psychoanalytic treatment and its realm of spontaneous engagement as eloquently as Hoffman (1994a, b, 1998). Designating the prescriptive system of clinical rituals “the Book,” Hoffman playfully asserted the necessity of sometimes “throwing the
Book away” but never abandoning the dialectical tension inherent in such a spontaneous clinical decision.

Dialectical thinking about ritual versus spontaneous action preserves crucial dynamic tension between neither treating the Book as the analyst’s exclusive oedipal partner, forbidding the patient intimate engagement with the analyst, nor abandoning the Book and perilously courting the patient’s pyrrhic victory of overthrowing the analyst’s relationship to his professional identity and to all that that entails.

The Preimprovisational: Enactment and
Projective Identification

In contrast with the authors just mentioned is another dimension of the “seemingly spontaneous,” which is theoretically the opposite of improvisation (insofar as it is an automatic, uncreative, and fixed form of “spontaneous” engagement) but which is often necessary to set the stage for improvisation. By this I am referring to the clinical phenomenon described under projective identification (Heimann, 1950; Bion, 1967, 1992; Rosenfeld, 1983; Joseph, 1987; Sandler; 1987; Spillius, 1992) and enactment (Boesky, 1982, 1990; Jacobs, 1986, 1991; Chused, 1991; McLaughlin, 1992; Renik, 1993a, b). Projective identification, when considered in terms of a two-person psychological construct (as opposed to Klein’s original one-person construct), may even be regarded as a substage of enactment (Bromberg, 1998).

Grotstein (1994a, 1995, 1997) noted that, in the circumstances of projective identification, there is a collapse of the two parties’ subjectivity in terms of whichever half of the “self” or “other” role the patient is ascribing to the analyst. If the analyst can catch this, he is able to “play” with this “trial identification,” having immersed himself in understanding its unconsciously “rule-bound” system. When he is not able to achieve this, he is vulnerable to engaging in an “introjective identification” (Scharff, 1992) or, in other words, becoming stuck in perpetuating the enactment (this most often happens when what the patient “projects” actually does capture something about the analyst’s organizing principles, such that he actually acts his part rather than plays his part; Ogden, 1982; Stolorow and Atwood, 1992). In introjective identification, instead of the play opening up to “courting surprise,” there is a collapse into this closed dimension. Hence, the creation of a play space in which mutual recognition of the parties’ subjectivities unfolds is thwarted (Benjamin, 1988, 1992, 1995). One can see the process of closing down versus opening up illustrated in the following two examples of improvisational theater.

Player A says to player B, “What kind of cab driver are you? You’re driving slower than my grandmother!” Player B kills the improvisation when he retorts, “I’m not a cab driver. I’m a farmer driving a tractor!”

Player A grabs an imaginary strap in midair, signifying he’s riding a bus or train, and blurts out, “Nice tie! Where did you get it?” Player B responds, “It was my father’s. After he died, he left me his entire wardrobe of Armani suits and ties, but Nothing else!” Player A: “That must have sucked!” Player B: “What are you, a therapist?” Player A: “A bartender actually—same thing, I s’pose.”

In the first example, Player B does not play. Instead, he violates one of the fundamental guidelines of improvisational theater (Spolin. 1963), which is to never negate the “reality” another actor has initiated.(6) Player B’s mind is made up; thus, he denies the reality the player A has created (Grotstein, 1994a, b, 1997). In the second example, however, there is opening after opening. The actors’ creative imaginations are bursting forth; they are using what they know from their broad repertoires of human experience, but they are taking what they know to places heretofore unknown within each, freshly awaiting creation/discovery.

What the second improvisation illustrates is not only good theater but good analysis. In contrast to this, either the patient or the analyst can kill the play.” In the patient’s case, this often involves a defensive or characterologic need to exert control over all dialogue by coercing the analyst into roles prescribed by the patient’s organizing principles. Similarly, the analyst may end up killing the play out of his own neurotic organization or out of a style of fixed, prescribed behavior regarding how he is supposed to react. In either case, each party contributes to the collapse of the potential play space and in so doing demolishes the creative, psychically opening forces embedded in the process of improvisation.

The patient’s killing the play concurs with Mitchell’s (1993, 1997) definition of psychopathology, which pertains to the inability (or inhibition of the ability) to imagine something other than what continuously and repetitively vexes the patient. Such a patient’s imagination has failed him; there has been a collapse in the “life script” dimensions he had relied on to organize how he might respond creatively, flexibly, imaginatively, and with vitality to certain vicissitudes of his life (Sanville, 1991). (7)

This brings to mind what I think Ogden’s view of psychoanalysis potentially shares with improvisational theater. That is, when both actors (analyst and analysand) unconsciously open up to their own and each other’s authentic imaginative process, something greater emerges than either on his own would likely have created. Ogden (1994) wrote:

Analysis is not simply a matter of uncovering the hidden; it is more importantly a process of creating the analytic subject who had not previously existed [p. 47].

The interplay of subjectivities is never entirely one sided; each person is being negated by the other while being newly created in the unique dialectical tension generated by the two. [p. 102].

More fully stated, one finds oneself unconsciously both playing a role in and serving as author of someone else’s unconscious fantasy [p. 103].

In effect, the “psychoanalytic third,” the intersubjective reality developing between analyst and analysand, becomes itself the essence of the improvisational scene from which the two authors/actors are compelled to grow lest they retreat into their pathologically fixated scripts. In other words, the phenomenon that Ogden (1994) called the “subjugating third” is what negates both parties’ subjectivities.

But how does improvisation in practice deepen our clinical engagement? To set the stage for this answer, we must address a contemporary issue in psychoanalytic thinking. Contemporary psychoanalytic theory is in the fascinating throes over the degree to which we are treating a singular patient with a relatively integrated version of self versus a patient with multiple versions of selves. Whether one sides with the multiple selves argument (Slavin and Kriegman, 1992; Mitchell, 1993, 1997; Slavin, 1996; Harris, 1997; Bromberg, 1998; Davies, 1998b; McCarroll, 1999) or with the singular self argument, with great complexity manifesting in hierarchically arranged motivational states (Lichtenberg, Lachmann, and Fosshage, 1992, p96; Lachmann, 1996a, b), I still think that, for the individual to feel expansive vital, alive, or real, the individual’s aspect that is in ascendancy in any experiential moment must feel that it “speaks” optimally for the other aspects in whatever context—that is, in whatever experiential point in time and space the individual finds himself.

Central to psychoanalytic treatment, then, is the analyst’s capacity to engage that dimension of the patient’s self-experience that embodies the experiential foreground but not to lose sight of other parts or aspects of the patient’s self in the background. Ultimately, what is crucial is the patient’s experience of a sense of “fitness” (Ringstrom, 1998; Stern, 1998) of the therapist’s engagement with his “sense of the real” (Stolorow and Atwood, 1992; Ringstrom, 1999b; Coburn, 2001) such that it effects within the patient a sense of, “My doctor understands me, recognizes me, can relate to me in a way others have not—or perhaps in a way even I have been unable to up to now.”

Achieving such “authorization” of any self-state arises only from reckoning with the dissociated parts of the patient—his disparate self-states—and then gradually enabling them all to coexist first within consulting room and then within the patient’s mind. In lieu of this, however, versions of self, or self-states, become sequestered, dissociated, and separated—that is, potentially appearing like narcissistic islands” in and of themselves (Bromberg, 1998). For them to coexist, each must find its place in the psychoanalytic play space— each forming an intersubjective relationship with the therapist or, more precisely, with the many versions of himself that the therapist can bring to bear. I believe that improvisational engagement is a crucially important vehicle for making this happen.

It is precisely in good improvisation that one gets a flavor of this "fit.“ Consider another illustration, from the case of Jonathan. After a couple more years of treatment, Jonathan was beginning to loosen up and at times was tolerating the simultaneity of the pervasive good—bad splits of his personality. Part of this had emerged from his repeated assertion of my being “evil” and “without any moral fiber”—points he might allude to when I invoked a swear word or when he had the slightest inclination of my possessing a “politically incorrect” thought. I had listened to his points of condemnation with considerable nondefensive interest, and, in time, as Winnicott might have predicted, some transformation was emerging through Jonathan’s ruthless treatment of me—and through my “going-on-being” (i.e., surviving his “destruction”). This proceeded throughout our work with many mini-tests (Weiss. Sampson, and Mount Zion Psychotherapy Research Group, 1986), all of which seemed meant to try to flesh out the “reality” of who I “really” was, which of course was not the “same me” but authentic versions of me engaging increasingly more authentic versions of Jonathan. Implicit in all this was, “Would I he a character from his ‘old script’ or an ‘agent of change,’ an ‘improvisational actor’ in the theater of our psychoanalytic work?”

Through telling me more and more about my “evil,” Jonathan became emboldened to tell me about his. One day, he told me with considerable glee about his poisonous “genocidal” attack on the ground squirrels that were decimating his backyard. He became quite animated while describing a playful exchange he had had with his next-door neighbor, who had taunted Jonathan, by sending him a Polaroid photograph of a baby squirrel that had survived Jonathan’s holocaust. In the photo, the neighbor was resuscitating the squirrel with an eyedropper full of milk.

After no further discussion of the squirrels. for several months, Jonathan, rising to leave a session, commented in a seemingly innocent and kindly tone, “Oh, what a cute squirrel in your backyard!” As it turned out, I was fond of the squirrel he pointed out, as it had often come visiting on the brick patio next to the French doors, which were just to the right of my seat behind the analytic couch. On many occasions, the squirrel and I had caught each other’s attention and taken a moment to speculate on each other’s occupation. That squirrel had seemed to be saying to me, “So, you work with nuts? I work with nuts too.” (8)

For an instant, I started to acknowledge Jonathan’s comment about my cute little furry friend, but then I did a double-take and exploded aggressively but playfully, “You keep your fucking hands off my squirrel!” Jonathan burst into laughter and smiled broadly. This “doorknob-exit enactment” became one of those little tests, unbeknownst to either of us, that boiled down to whether I really knew him or not. Could he trust that his aggression could be more than known—could be embraced by me and sanctioned by an engagement of my own? Could I survive his aggressive thoughts and feelings as they pertained not only to me but also to all that was potentially of importance to me? Could this relationship, for the first time in his life, be one in which the split-off part of his personality was as welcome as all the rest?

What happened that was so improvisationally rich? Our session, our “scene” if you will, was coming to an end, and, in a moment of unconsciously playful experimentation—the classic doorknob-exit enactment—Jonathan “turned into” his preachy “Church Lady” persona to see how it would play with me. I started to respond to this version of Jonathan when I suddenly recognized that a part of him was missing—the aggressive, potentially sadistic version of Jonathan that was heretofore always being crushed by his Church Lady persona. In fact, the liberation of that version of Jonathan was soon followed by the cessation of his immobilizing migraines—headaches that were so intense that they had even intermittently required hospitalization. On this day, however, both “Church Lady Jonathan” and “sadisticgenocidal Jonathan” were able to coexist on the same improvisational stage.

What is so crucial in such an example is the sense of recognition the patient acquires. I believe that this recognition has a “performative” quality—that improvisation leads to this performative recognition, which in certain moments can be more penetrating than other forms of recognition such as affect attunement or empathy. How different would our engagement have been, for example, had I said to Jonathan during his “staged exit,” “Perhaps there is another feeling you have about my squirrel. As squirrels have been a particular menace in your life, maybe you’d like to ‘kill’ my squirrel.” I think that such a carefully manicured engagement leads some patients to say, “Would you please stop sounding like a therapist!”

Performative acts of recognition (Muller, 1999) may be essential, in fact, for breaking down the extreme barriers between the incommunicado if not in fact invisible parts, units, versions, or whatever descriptive constellations of self-experience one favors. In our improvisation, there could he no denying the presence of Jonathan’s Church Lady and sadistic-genocidal selves. These parts did not become integrated so much as they ultimately “negotiated” (Pizer, 1992, 1998) with each other for the same authentic space. Certainly, sometimes a “kinder, gentler” Jonathan prevailed, and other times his more aggressive version wanted/needed to be in ascendancy.

A central tenet of this paper, then, is that, whereas the realm of prescription found in traditional analytic discussions of clinical theory attempts to create safety and predictability, improvisation potentiates the development of trust in a fashion that conventional technique is not always capable of doing. In other words, it is not always either necessary or helpful that the analyst reflects at length about his reaction before sharing it. Indeed, when a psychoanalytic approach is bereft of spontaneity, it becomes tiresome, inauthentic, affectively dead (Bernstein, 1999).

What I am advocating, then, is keeping in mind that at times the most direct route to developing trust and having a penetrating impact on patients, especially those suffering from a history fraught with suspicion, is to respond spontaneously—to leap before you look, so to speak (Tabachnick, 1998). These improvisational acts of engagement can he antidotal, specifically because the patient immediately experiences the analyst’s response as utterly unpremeditated. That response represents the clearest statement of what is true of the analyst at the moment. Authenticity, after all, is always contextual and cannot be determined a priori (Mitchell. 1993, 1997; Davies, 1994, 1998b; Hoffman, 1994a, b, 1998; Aron, 1996; Bromberg, 1998). There is no technique for authenticity. It arises freely or not at all, whereas “efforts to be authentic” invoke the same paradoxical failure as “efforts to be spontaneous” (Watzlawick, Weakland, and Fisch, 1974).

Fear of “Structureless Chaos”:
Whither the Psychoanalytic Third?

With spontaneity, however, may come a natural concern among analysts that I am promoting an “anything-goes,” “wild-analytic” mode of treatment. Stirred within these analysts may be “fear of structureless chaos” (Stolorow and Atwood, 1994). Several recent critiques of relational and intersubjective theory pertain to these concerns. One is that enacting and playing may obstruct analyzing by colluding with the analysand’s desire to avoid the analysis. Similarly, by seemingly focusing the analysand’s attention more on “relational realities" than on the organization of his intrapsychic world and how it influences his fate, the patient may be left perpetually feeling shaped by others rather than coming to terms with his own self-design (Greenberg, 2001). Further working In what seems like an Interpersonal mode of dramatic relating may also keep the analytic dyad focused on Its more conscious "roles” or “dramatic personas" rather than on investigating the "structure of unconsciousness that rules both of them” (Bernstein, 1999). This point segues to fears about working In the analytic dyad without consideration of some version of a "psychoanalytic third”’(9)— that Is, an Independent theory of mind (Aron, 1999; Benjamin, 1999; Bernstein, 1999; Cooper 1999; Crastnopol 1999a, b; Knoblaugh, 1999; Moccia and Nebbiosi, 1999; Pizer, 1999) that "structurally grounds” the analysand and analyst In a symbolic order that stabilizes their relationship while preventing their collapse either into a folie a deux or into unremitting love-hate quarrels over who will get recognized and who controls the process of recognition (Muller, 1999). Still another concern Is that dramatic focus on one “part" of the patient may push other “parts of the patient” Irrevocably “out of sight.” Lastly, enacting a new form of relationship is no lees of a potential trap than reenacting the old version, if the former does not also produce insight to the patient’s intrapsychic organization (Greenberg, 2001).

In the context of these important concerns, some thoughts about Improvisation and its relationship to psychoanalysis are crucial. First, as one cannot be improvisational all the time, one cannot conduct an analysis improvisationally all the time. The rich “cornucopia” of psychoanalytic technique (Mitchell, 1997) is never totally eliminated, and the study of theory is never to he eschewed. What one does in improvisational theater, however, as I am also recommending in psychoanalysis, is to open one’s mind to potentially being improvisational. Doing so does not lead to “structureless chaos,” as there are in fact many implicit “third” elements in improvisational theater, just as there are in psychoanalysis, that have a shaping or structuring effect on what unfolds. (10) But how the improvisational differs from the “givens” of both classical theater and more traditional analytic thinking is that there are no theoretical presumptions of what such third elements mean before their enactment.

Thus, in both improvisational theater and in psychoanalysis, each "scene" or context of engagement entails unknown implications about the relationship, activity, and environment of the “actors.” Within this construct, the players are in fact cocreating, moment to moment, intersubjective realities that by definition symbolically reveal something about the unconscious nature of each of them as well as the nature of their relationship. Of course, given the “asymmetrical mutuality” of the analytic dyad (Aron, 1996), the tilt of active engagement and use of the relationship balances in favor of a focus on the analysand. Put differently, although the analyst might he an initiator of play, as in Winnicott’s notion of how the analyst needs to help the analysand learn to play in his treatment, the analyst usually defers to the patient to initiate the improvisation. This is illustrated by my picking up on Jonathan’s doorknob-exit enactment and then playing with it improvisationally. It is the patient’s analysis, after all, that one is contracted to facilitate. But having said this, the clinical activity of an analysis is similar to how an actor creates his character for theater:

The first . . [principle of building a character] is [found] in the principle of activity, and [is] indicative of the fact that we do  not play character images and emotions, but act in the images and passions of a role. The second . . . [principle is that] the work of an actor is not to create feelings but only to produce the given circumstances in which true feelings will be spontaneously generated. The third cornerstone is the organic creativeness of our own nature, which we express in the words: Through conscious technique to the subconscious creation of artistic truth. . . . In our exercises and rules we constantly base ourselves on [working with] conscious [ness]... [because, doing so leads] us to the unknown world of the subconscious which for moments comes alive inside of us [Stanislavsky, Hapgood and Stanislavsky, 1989, p. 24]. (11)

I believe that what Stanislavsky depicted is how, in their very engagement, actors (and psychoanalytic participants) immerse themselves in the “deep structure” of unconscious language—that is, the unconscious drama that is built into life, acting, and psychoanalysis. A kind of “deep structure,” illustrated by Gentile (1998), is the basis for much that is common in human life drama and that historically underpins the basic premises of our theoretical formulations. The spontaneous substance of the improvisation, though perhaps not growing out of expressed knowns, rests on the shoulders of a great deal of knowledge (albeit unarticulated or unformulated) that both parties have of each other. As spontaneously as I reacted to Jonathan, such a reaction is unlikely to emerge from me with a new patient—a patient with  whom I lacked a certain intuitive sense that might enable me to engage in this “high-risk, high-gain” response with some instantaneous faith that it would more likely yield the latter than the former (Gabbard, personal communication). The larger question remains whether as analysts we improvisarionally engage in these dramas interpersonally or hold them within our own state of reverie (Ogden , 1997a, b). I believe that there is considerable efficacy in both applications, with the understanding that the context of engagement (Orange. Atwood, and Stolorow, 1997) in the moment is the best dictate as to which path to take.

An example of this form of holding (Ringstrom, 1999a; Slochower,1999) in improvisation occurred during the first year of my working with a patient who biannually became floridly psychotic for a week at a time. During one of this patient’s earliest episodes, I found myself terribly frightened that he might become violent, even though I had no overt evidence of that happening either in or outside treatment. But, because he was six feet, four inches tall and weighed more than 250 pounds, I found myself increasingly anxious as I imagined our thrashing around on the carpet, with me futilely reaching for something with which to protect myself.

Suddenly, the scene dissolved into my realization that the “gentle giant” sitting in front of me was the terrified one. Given that his very framework of reality dissolved during his psychotic episodes, it was he who was terrified of being dominated and bf having his mind overthrown. I elected, of course, not to share my reverie; instead, I used it soothingly and interpretively to address his unspoken fears of me, which rapidly restored a sense of safety in both of us.

I believe there are many, many episodes of such improvisational work evident in all forms of psychoanalysis. Indeed, perhaps this internalized form of improvisation may come closest to an ideal for more traditionally trained psychoanalysts who value the crucially nonintrusive role of abstinence but who favor more experientially based interpretations rather than ones drawn from experience-distant texts.

Still, we must also consider the importance of more active, direct forms of improvisational engagement. As Bromberg (1998) noted, not only do patients reveal their fantasies to their analyst—but they also live them. In so doing, however, certain enacted dimensions of self can remain dissociatively remote from others. It is therefore in the fast-paced interaction of improvisation (as in the illustration with Jonathan) that one sees the analyst’s heightened effectiveness in his ability “to move freely between different complementary positions in response to a fast-moving interpersonal field” (p. 193). Absent this, the dissociated life of certain patients can seem like a sea of “narcissistic islands,” none of which the patient can freely choose to engage and each of which he must protect from potential traumatic connection from within and without.

Likewise, trauma may just as much be a consequence of the fear of changing oneself. This very fear of change (Bromberg, 1998; Davies, 1998b) may be an element in what keeps parts of the patient’s self-experience incommunicado. For example, Jonathan’s stable image of himself, found in his competition with his mother for earthly sainthood, must dramatically be perturbed if he is to come to terms with the aggressive, split-off side of himself—a part that in its sequestration was implicated in his crippling migraines. This lifelong personal script no doubt gave him considerable purpose and structure, despite carrying with it a sense of futile misery and at times incapacitating psychosomatic pain.

Our conventional, nonimprovisational work together had certainly helped illuminate this, but it had not yet allowed Jonathan to live out his aggression with me. Our analytic stage was primarily crowded out by the nice Church Lady Jonathan. Thus, my aggressively playful complementary reaction (Benjamin, 1999) to his aggression enabled him to feel that his aggressive version could be present as well, without having to be destructive or having to cast him into a dark abyss of sin. As Bromberg (1998) noted, it is crucial for “the patient to hear in a single context the voice of other self-states holding alternative realities that have been previously incompatible” and, when the patient succeeds in doing this, “the fear of traumatic flooding of affect decreases along with the likelihood that opposing realities will automatically try to obliterate each other” (p. 288).

Davies (1998c) in her own dramaturgical fashion captured how this is accomplished:

The play, itself, that action which we can witness at the outermost layers of experience, becomes a compromise that orchestrates and organizes a multiplicity of separate lives, distinct but inextricably intertwined potentials, which may or may not see the light of day, depending on the bargains that have been struck among the players. This play, indeed, will tolerate no single author, for the play itself is nothing more than that on which its characters can agree, it is an action scripted by committee or by those renegades who chose to break form and undermine the agreed upon narrative. Forrelational analysts, “the play” is most decidedly “not the thing.” We are far more concerned with the endless auditions and rehearsals, the needy, yearning, envious, greedy, sometimes diabolical, sometimes poignant maneuvering that goes on behind the scenes; the struggle to explore and resolve oftentimes conflicting systems of internal motivation, that which determines the character and content of center stage, as well as those who become compelling and oftentimes pivotal bit players driving the play’s action in very small almost imperceptible voices. Indeed, the action that holds our attention is more likely to resemble a three-ring or, better yet, a multiring circus [pp. 64—65].

Another question is whether these kinds of improvisational moments are more representative of truly “corrective emotional experiences” than are the kinds initially proposed by Alexander (1944). Whereas Alexander prescribed that the analyst consciously assume a contrived complementary role “antidotal” to the patient’s neurotic drama—a tactic broadly attacked as “manipulative” by the analysts of Alexander’s day—the improvisational moment represents an irreducible moment of unpremeditated, authentic connection that cannot be mitigated by intentionahty and therefore contrivance. In this vein, we find the particular capacity of the improvisational moment to penetrate both parties’ normal defenses and thereby to capture an especially important and memorable moment of “antidotally curative” engagement—a movement that each party can subsequently reference in the ensuing analysis as a “model scene” of change (Lichtenberg et al., 1992, 1996).

Yet another dimension of working in an improvisationally informed manner is tracking what becomes of the improvisations. Two broad themes emerge. First, there may be a tendency on the part of either patient or analyst to repeat the alive, improvisational engagement and allow it to become a recited, hackneyed expression or a canned scene— to bind the very growth-induced anxiety it fostered by its disruption of the patient’s personality organization. One begins to see this emerging in Jonathan’s attempt to master his reaction to my statement, “But of course, Jonathan, your stupidity was sooo understandable!” By repeating that statement over and over, he not only allowed it to penetrate his prereflectively unconscious organization in a manner he found deeply empathic, he also began to dissolve its potency and to render it somewhat less effectual.

Jonathan’s repeating the statement also relates to the second theme of reactions to improvisations—that they, though meaning something very potent one moment, may later take on different meanings. In a subsequent session, Jonathan reintroduced my statement of his “understandable stupidity” as potential evidence that I really felt he was stupid! We were both struck by his “reintroducing” my statement this way, because, as he then freely exclaimed, “It’s weird that I’d do that, because at the time, I really did know that you didn’t think I was stupid!” Several sessions later, deeper exploration revealed that, in that previous moment. Jonathan had actually hoped that I saw him as stupid and therefore beyond the reach of our analytic work. That way, he could be released from exploring the pain inherent in our endeavor.

This theme shows the multiplicity of selves that may “vie for center stage” in analytic treatment, wherein that self-state that is drawn to growth is often counterbalanced by another that seeks stability through a thwarting of exploration, elucidation, and change (Davies, 1998b; Bromberg, 1998). Cultivating the improvisational potentially creates a stage on which these selves can encounter one another—undermining the patient’s tendency to split and disavow.

Conclusion

In advocating for improvisation in psychoanalytic treatment, I am asserting that improvisational moments can ineluctably communicate to the patient a special instance of authenticity that may well be antidotal to the crushing and pervasive inauthenticity of the patient’s inner life and his life with respect to others. The approach I am advocating further provides a powerful engagement that communicates the analyst’s deep involvement with the patient. An involvement that enables the analyst to more readily engage disparate, often dissociatively disconnected parts of the patient through imaginative intersubjective dialogue with each of the parts. Further, it enables the analyst to more readily engage disparate, often dissociatively disconnected parts of the patient through imaginative intersubjective engagement with each. This may take the form of the analyst’s internal reverie, from which his own mental state of play informs his interpretation. Still, at other times, it may involve a form of spontaneous engagement that conveys not only a moment of deep recognition but one of the purest states of authentic engagement-what cannot arise with comparable impact when reflection precedes the analyst’s action. In sum, the capacity for engaging in improvisation may well be one of the most defining capacities for the development of a genuine psychoanalysis.

Footnotes

1.  Jonathan and I discussed the possibility of referring Andrew for a psychiatric evaluation as well as treatment, which I encouraged. as the intensity of Andrew’s obsessions was increasing markedly. Obsessive-compulsiveness had after all exhibited itself in both Jonathan and his wife as well as among some of the boy’s grandparents. In several cases in this family system, medication was somewhat helpful. (back)

2 SImiIar examples are evident in classical literature (Oremland, 1991) as well as self psychology (Kohut, 1984). Oremland (1991) pointed out that, in an initial session with a highly positioned businesswoman, her querying him about what were obviously restroom keys made her “appear stupid” (p. 72). Kohut (1984) made what he stated was his “deepest interpretation” to dare in a third-year analysis of a psychiatric resident—that his patient was “a complete idiot” (p. 74) for having dangerously sped to his appointment to avoid being any later than he already knew he was going to be. (back)

3 As a consequence, theories preoccupied with the idea that the goals of psychoanalysis are elucidation and emancipation of the constricting vicissitudes of overdetermining unconscious conflict may be somewhat less sensitive to the fragmenting quality of a potentially shaming interpretation—especially when compared with theories preoccupied with elucidation of ones sense of self. enhancement of one’s sense of cohesion, and restoration of one’s vitality to pursue development that had been foreshortened by disruptions. Neither of these theories necessarily holds as sacrosanct the relevance of attachment or the meaning of relationships. (back)

4 ”The ,mind of the beginner is empty, free of the habits of the expert, ready to accept, to doubt, and open to all the possibilities” (Suzuki, 1970). I deeply appreciate Jeffrey Rubin for having drawn my attention to the parallelism between my ideas regarding improvisation and Suzuki’s thesis on the “beginner’s mind.” (back)

5 As creator and editor of The Psychoanalytic Forum. Lindon in fact encouraged Bion to write his seminal and most often cited paper, “Notes on Memory and Desire” (1967), which first appeared in that journal (Lindon, personal communication). (back)

6 Of course, as to following all improvisational guidelines, one is advised not to do so unless one has a strong improvisational intuition about how "rejecting the other’s ‘reality”’ and supplanting it with your own will be an important aesthetic move in the unfolding improvisation. (back)

7 Sanville (1991) wrote: “At its best, psychotherapy can afford the patient a benign illusion of time as unbounded possibility:  the past as resource rather than burden, the present as full of significance rather than empty, the future as open rather than closed” (p. 90). (back)

8 Although! reflected on the possibility that this line might stir the fantasy of my expressing contempt for my patients, I decided to keep it in with the hope that readers would appreciate the playful vein of improvisation consonant with the theme of this paper. The journal’s editors concurred with my decision. (back)

9 The psychoanalytic third is a relatively new and popular psychoanalytic term that Is, unfortunately, riddled with all the vagaries and multiplicities of meaning that beset other high-level abstractions such as the concepts of transference and projective identification. Authors of a more Lacanian persuasion (Bernstein, 1999;  Muller, 1999) seem to treat the "third” as a system of rules that preexist the union of the dyad. The third, then, is the unconscious medium, usually exhibited through the deep structure of language itself that enables the dyad to relate and that thereby also "structurally grounds them." For others, the third Is an unconsciously cocreated state of intersubjectivity that Is unpredictable and that therefore seems less tied to an emphasis on a priori structure than to an emphasis on a posteori engagement of the dyad (Ogden. 1994). For still others. the third seams to be more of a professional association or Identity to which the analyst Is “married," and therefore it Imposes some sort of symbolic oedipal partnership on the analyst—one that. de facto, must be addressed by analyst and/or analysand (Hoffman, 1994a, b, 1998; Aron, 1999; Crastnopol, 1999a, b). (back)

10 In a similar vein, Rubin (1998) argued that the analysts authority lies neither in his rigid adherence to rules nor in his own independent abandonment of them, but in his being more like a “jazz improviser who plays with, improvises upon, and extends what he or she inherits. The analyst knows and respects the basic notes but is able to create new and generative combinations” (pp. 180—181) The jazz improviser was also invoked by Knoblauch (personal communication). (back)

11. I am indebted to Dr. Loretta Polish (1998) for this passage. (back)

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*Do Not Reproduce Without Permission* 

Philip A. Ringstrom, Ph.D., Psy.D. is Training and Supervising Analyst, Institute of Contemporary Psychoanalysis, Los Angeles; Member, International Council of Self Psychologist; and International Penelist, www.psybc.com .

E-Mail: Ringsite@aol.com