Adam Blatner, MD

Those who are experienced in the art of psychotherapy know that a good measure of creativity is needed to adapt whatever methods one uses to each patient's individual needs and abilities. However, the idea of promoting the patient's own creative potential has not been much addressed in the professional literature. Otto Rank, Ph.D., indirectly alluded to it as one of the themes in his writing, in part associated with his own background as an artist and his use of the metaphor of neurosis as a form of failure in the challenge of making one's life a work of art. Carl Jung, M.D., hinted at it in his conception of the unconscious not only as a repository of ego-dystonic, repressed ideas and feelings, but also as a source of potentially creative inspirations and images.

Perhaps the one who was most directly an advocate of the idea that therapy should promote patients' creativity was Jacob L. Moreno, M.D. (1889-1974). Moreno was the innovator who developed psychodrama and sociometry (a method of applied social psychology), was one of the pioneers of role theory, and was one of the earliest and most persistent promoters of all forms of group psychotherapy (Blatner, 1995a; Moreno, 1987). Moreno thought that a major source of psychopathology was habitual thinking--an idea that anticipated the later insights of rational emotional behavior therapy of Albert Ellis, Ph.D., and cognitive-behavioral therapy by Aaron Beck, M.D.--the latter becoming more recognized in recent years. For Moreno, however, the antidote to habitual or automatic thinking was not simply noting and correcting such patterns, but generating a more flexible capacity for creative thinking in general.

It was Moreno's unique insight that creativity is best promoted not through contemplative planning, but rather in the interactive process of improvisation, becoming physically active as a way to warm up to becoming mentally more involved (Blatner, 1996; Moreno, 1947, 1964). He called this gradual process of opening up to the delicate sources of intuition and imagination 

. For Moreno, spontaneity was a key not only to creativity, but also to vitality, a source of deep enjoyment and a reminder of the most authentic aspects of the self. Spontaneity was, in some ways, related to what has also been called 

 (Csikszentmihalyi, 1997). Spontaneity is also the opposite of the tendency to rely on what has already been created. Moreno recognized the need to continuously revise the subtle role definitions that pervade our lives, anticipating also those who have observed the psychosocial predicament of the individual in the "postmodern" world (Blatner, 2000).

Other therapies have also shifted in this direction, especially those utilizing the arts media. They were originally applied to help structure time and build useful capacities, and later as vehicles for producing symbolic material that could, like dreams, then be analyzed. Beginning in the 1960s or so, the "creative arts therapies" have emerged as their own fields--art, dance and movement, poetry, music, drama--all of which now give increasing emphasis to the experience of improvising itself and the benefits that accrue thereto (Blatner, 1992; Leveton, 2001).

In family therapy, a powerful strategy is that of reframing the task away from the more mechanistic issue of solving a problem, the often not-so-unconscious desire to have the therapist act as a "judge" in hearing, blaming and counter-blaming, and shift the focus toward the challenge of everyone becoming more creative, and experimenting with novel approaches. Talking about how everyone may be more creative to this end also counters their shame at being in the sick role, at having "a problem" (Blatner, 1995b).

Becoming creative and improvising have certain dynamics that can foster a more healing process.

. Playfulness allows for the creation of fail-safe contexts. Scenarios may be explored actively, using role-playing, or even just imagined. There is great power in applying the magic of "if" in language, as patients are helped to consider alternative situations, out of which can also come new insights about their actual predicament as well as discoveries of alternative ways of breaking away from habitual reaction patterns. The conditional nature of play, in which responses are not taken "seriously," and therefore "don't count" the way mundane discourse seems to, allows people to try out saying things they would not ordinarily say (Blatner, 2002).

Playfulness thus functions as a buffer against the anxiety of making a mistake, or saying something and worrying about how it might be "taken" by the other person. Spontaneity cannot emerge when the patient is feeling anxious. A corollary is that this receptivity to intuition cannot be forced or willed. Generating a bit of humor, a tone of looseness, an openness to a measure of the outrageous or unexpected, all help to promote this avenue to creativity (Blatner and Blatner, 1997).

. Imagination and more pointedly, entertaining imagery also promote creativity. In contrast to abstractness, imagery demands more concreteness. One cannot picture the specific behaviors being talked about when a patient says that a child is loving, aggressive, acting-out or kind. The behaviors being described are thus filtered through the interpretation and preferences of the person speaking. What a parent thinks of as aggressive might be fairly normal self-assertion; what is perceived as loving might be grossly placating. So one of the ways to cut through the subtle defensive function of abstract talk is to encourage patients to describe the scenes in great detail--or, better, to physically get out of their chair and imagine setting up a scene, showing where the door or couch was in the scene being described, and playing the role of the other person, showing how they behave, what words were used, and, most important, adding the nonverbal communication, the way in which the statements were expressed.

. This is another tool for fostering creativity. There is an immediacy about it, using the oft-encouraged "I messages" in speaking directly to the other person, even if that other person is only imagined, as if they were present in, say, an empty chair. (This technique, commonly used in Gestalt therapy, was adapted from psycho-drama.) In contrast, talking "about" a situation, narrating it to a therapist, tends to be contaminated with explanations and other defensive maneuvers. In the directness of an encounter, though, feelings and intuitions--as well as insights--about what might be the actual issues in a problematic relationship occur. In couples and family therapy, one application of this is the therapist's direction, "say that directly to your daughter," or "look right at your husband and say that to him."

These two elements--dialogue and imagination--can also be combined to explore scenes that deal not just with what happens, but with the deeper inner situations, those interactions that never happened and perhaps never could happen. (Moreno called these explorations 

, and noted that it was because of the potential of psychodrama to offer opportunities for this kind of artistic creation, it should be considered a "Theatre of Truth." It was the psychological truth--not the factual-historical truth--that mattered from this existential-phenomenological viewpoint.) Patients can bring to the surface a host of insights by directly encountering a parent who has died, or a child who was never born or perhaps never even conceived. Yet these figures live in the drama of the subconscious or, in terms of the object-relations school of psychoanalysis, as "inner representations."

. This describes the activity of shifting between levels of concreteness and abstraction, and among roles and different frames of reference, that develops a host of ancillary techniques which may be applied in everyday life. For example, patients will learn to recognize different levels of self-disclosure, and just knowing that they exist can lead to an inclination to explore them and share them with selected others. The more people learn such skills, they more they develop an infrastructure for creativity in their own minds and in interpersonal and group relations.

. The idea that people's predicaments can be better appreciated when viewed as if they were stories in process also promotes a more creative attitude. Instead of thinking about problems as quasi-mechanical dysfunctions to be "fixed," the fractal nature of memory and life is recognized: It is impossible to trace most psychological disorders down to the single trauma, or to determine the "truth." The truth is too complex and requires an ever-extending horizon of effort--an asymptotic limit or "analysis interminable." Instead, the trend within psychotherapy, arising from innovative approaches in family therapy, has been to help clients frame their experience as a kind of story, and to participate actively in re-thinking the themes, as a biographer crafts a subject's life, into an artistic and coherent whole. The way the story is framed needs to lead the patient toward a more adaptive present and future response.

. Related to the theme of narrative, another current trend in therapy has been to integrate the patient's spiritual beliefs, and often this process, too, requires a creative synthesis. Many patients have either lost their faith or have ongoing conflicts with their religious background so that it doesn't offer the sustenance needed to promote optimal resilience. Working with this transpersonal dimension in therapy also invites patients to creatively engage in finding some satisfactory creative synthesis that will support a sense of meaning and purpose in life--the existential challenge.

Creativity is needed, and often talking about creativity itself as a spiritual theme aids in promoting the existential process of deepening a sense of meaning, belongingness and purpose in life. While I find that few patients include such issues in their presenting complaints, they emerge as secondary and compounding factors in most people with significant emotional problems. The theme of creativity is a most effective tool for addressing this predicament; it reframes life, as Otto Rank suggested, as a work of art, and the patient as an artist. This is even more valid in a world characterized by nothing so much as change itself, and that happening at an accelerating rate (Blatner, 1997).

. One of the most important aspects of the theme of creativity in therapy is for the therapist: All of the aforementioned principles, as well as a wide range of psychodramatic methods, can be creatively synthesized and integrated within almost any approach to psychotherapy--psychodynamic, interpersonal, cognitive-behavioral and so forth. These are principles that operate at the meta-level in therapy, informing most of the underlying processes.

Creativity is itself a powerful metaphor and adds a dimension of vitality and positivity to what can be an otherwise somewhat painful and almost tedious process, inviting the participants to entertain their aesthetic intuition as an aid in the life-enhancing engaging of re-creating a meaningful and productive life.

 Blatner A (1992), Theoretical principles underlying creative arts therapies. The Arts in Psychotherapy, 18(5):405-409.


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 Blatner A, Blatner A (1997), The Art of Play: Helping Adults Reclaim Imagination and Spontaneity, 2nd ed. New York: Brunner/Mazel.


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 Leveton E (2001), A Clinician's Guide to Psychodrama, 2nd ed. New York: Springer Pub. Co.


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Articles

Becoming more creative and improvising have certain dynamics that can be used by therapists in fostering a more healing process. Playfulness, imagination, dialogue, skill-building, narrative, inspiration and integration can all be employed in clinical settings. These tools create an environment where spontaneity can arise, anxiety is reduced, and patients are more receptive to their own intuition.

Author | Adam Blatner, MD

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Using Creativity to Explore in Psychotherapy