Academic journal article American Journal of Psychotherapy

Exploring the Therapist's Use of Self: Enactments, Improvisation and Affect in Psychodynamic Psychotherapy

Academic journal article American Journal of Psychotherapy

Exploring the Therapist's Use of Self: Enactments, Improvisation and Affect in Psychodynamic Psychotherapy

Article excerpt

Psychoanalytic psychotherapists, drawing upon intersubjective and attachment theories, recognize that mutual influence impacts the treatment process. Mutual influence generates enactments-emotionally intense joint creations stemming from the unconscious of both therapist and patient-which often leave both patient and therapist feeling confused and stuck. The author presents a case in which the therapist's use of improvisational role play was a critical therapeutic response to an enactment. The therapist's self-expression through the displacement of the role play 1) modeled a safe, affectively genuine engagement in relationship, 2) provided the patient with an unexpected and powerful window into the therapist's emotional world, 3) shifted the patient's fundamental belief that fathers and men are cold and unfeeling, and 4) led the patient to uncover "new" early memories and to become aware of his role as an agent of vitality and intimacy. The author concludes that using improvisation as a flexible response to rigid patterns of enactment may provide a catalyst for therapeutic change.

Keywords: improvisation; enactment; affect; role play; psychodynamic psychotherapy

INTRODUCTION

Enactments are a well-known, nearly universal factor present in psychoanalytically oriented psychotherapy (Jacobs, 1986, McLaughlin, 1991, Chused, 1991). While the therapeutically effective response to these complex events is at the forefront of current debate and exploration, I argue that the therapist's use of self through playful improvisation is a critical and often necessary vehicle for change and growth in the patient. Enactments can be confusing and may lead to stalemates in treatment that result in distress for both the patient and therapist. The ubiquity and tenacity of enactments are generally understood by contemporary psychodynamic theorists to arise from the power of the unconscious to recreate familiar (and thus secure) patterns of relationship (Mitchell, 1988) wherein the therapist unconsciously participates in a re-experiencing of the patient's dysfunctional attachment patterns. While the therapist's selfawareness and self-reflective process is sometimes sufficient to understand, manage, and utilize countertransference forces (see McLaughlin, 1991), unconscious enactments are often difficult to see, curtail, and use to therapeutic advantage.

Improvisation, a concept that is relatively new to the psychoanalytic psychotherapy literature, has been written about most persuasively by Ringstrom (2001, 2007). He summarizes its use and effectiveness in the following quote: "improvisational moments seek not to replace the rest of the work of analysis, such as empathie exploration, affect attunement . . . insightfulness . . . but in fact to enliven all of these. By humanizing the dyad's engagement, improvisational moments facilitate the dyad's connection amidst its necessary faltering when confusion, uncertainty, deadness, detachment, avoidance, or frightening combat must hold sway" (Ringstrom, 2007, p. 94). I will present a detailed case study supporting Ringstrom's formulation that improvisation can be a critical and necessary complement to a careful analysis of transference in a psychoanalytically oriented psychotherapy. Furthermore, I will argue that improvisation is most effective when it emerges from a countertransference-transference enactment and is rooted in the therapist's genuine struggle to reach and know the patient's darkest struggles. Improvisation is a therapeutic mode of interacting that is effective because it represents a shift in the therapist's mode of being, and as such, activates a parallel shift in the patient. Improvisation draws upon the importance of the patient's experience of the analyst's subjectivity (Aron, 1991), an aspect of psychoanalytic epistemology that increasingly is understood as critical to an effective treatment. In short, using intuition developed through a careful, empathie immersion into the patient's worldview, the therapist takes the lead by responding to the patient's rigid pattern of relating with an emotionally authentic improvisation. …

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