Therapeutic Improvisation: "Therapy is the art of capitalizing on disciplined spontaneity to make more interesting music and art together.".

• Author: Alcee, Michael
• Position: PSYCHOLOGY

OUR MENTAL HEALTH system categorizes the many varieties of our clients' psychological problems, but it is less inclined to draw attention to an essential feature of our human condition: our capacity for creativity. We are quick to forget and surrender our creativity and mistakenly believe it is only the province of artists. Even artists themselves--writers, musicians, actors, dancers, painters--sequester their artistic powers from their personal lives. It is a fundamental mistake on our part as individuals and as a collective, and most importantly as a field, to jettison these riches.

We have neglected to factor in our multiplicity--our inner multitudes, as Walt Whitman would have it--the alarming and maddening complementarity and contradiction we each are built with that provides the necessary tension, dissonance, and spark to keep our fluid natures happily in motion. We forget how to live a life of psychological creativity.

Therapists use their therapeutic voice to encourage, inspire, and activate our patient's voices; it provides the circular flow of mutuality that is essential to the creative process of improvisation.

Therapeutic presence is a specialized listening that therapists cultivate to sensitively tune in to the real-time adjustments we need to make in order to be in sync with our patients' ever-shifting multiplicities. Therapeutic authority is the confidence and competence to pinpoint and express the multiplicity in our patients just as it is a sharper and more refined understanding of our multidimensional experience with them. Both become the features of a responsive and improvisational art that we nurture, cultivate, and enjoy together.

The mismatches and ruptures in our relationship and in their internal ones--the tests, struggles, and confusing symptoms of anxiety, depression, and social disconnection--are the necessary dissonances of working this music.

Like the improvisational musician, actor, comedian, or dancer, a therapist can form and synthesize the big picture and the details while simultaneously being able to just as easily let them go to allow other new forms to emerge in the moment. As psychotherapy outcome researcher Jeanne Watson concludes, "This quicksilver, malleable way of interacting, while remaining grounded and centered, may be the essence of being responsive in psychotherapy."

At the close of a very illuminating and productive session with Ben, I was talking about how silly it was that we were not all taught about the harmonic changes he knew inside and out as a musician. "Isn't it a shame we aren't all taught how to read the changes of the psyche?"...