Psychotherapist Steve Silverton offers a passionate defense of the improvisatory freedom of therapeutic professionals -- and consequently the freedom of those seeking care -- against the increasing pressure on those practicing beyond the currently validated therapeutic modalities.
Last Updated on Sunday, 27 October 2013 20:37
Written by Steve Silverton
A Tailor In The Cyclops’ Cave?
Some Reflections On Authority And Improvisation In The Practice of Psychotherapy
Core Process Psychotherapist practicing in London.
The phone rings. A potential client is on the end of the line and a conversation ensues, covering the practicalities of time, place and fee and, at a more implicit level, including a mutual ‘sniffing out’. As part of this comes that question from the potential client at the end of the phone line: 'How do you work?'
Not exactly a curve ball. A fair and reasonable question. Why, then, do I find it so hard to answer?
This experience has occurred a number of times over the years in which I have been a practicing psychotherapist, now more than a decade. I feel the need to understand this more. How do I work? And why do I find this question so difficult?
What follows is, in effect, a piece of heuristic research—'a process of internal search through which one discovers the nature and meaning of experience and develops methods and procedures for further investigation and analysis’1—in which I engage deeply with this question. There is a more than personal context for this, formed by the coming State regulation of the psychotherapy profession in the UK, and the Improving Access to Psychological Therapies (IAPT) and National Institute for Health and Clinical Excellence (NIHCE) agendas here, which focus on the social and economic costs of ‘depression’ and the provision of cost-effective ‘solutions’. It also relates to my own process of moving towards offering supervision to fellow psychotherapists.
Let me begin with some reflections on why the question 'how do you work?' is so difficult to answer.
Firstly, the question implies a 'you' that is separate-from the context of relationship, from the 'I' that asks the question and that will be in relationship in the therapeutic dyad. Secondly, it implies a system, a theory and set of procedures that is independent of this relationship.
In therapeutic practice, of course, there is a relationship that unfolds between two people. As I get to know the client I do form tentative ‘hypotheses’ about the problems and issues they bring and a tentative ‘theory’ about how best to work with that person and these issues. But these always remain provisional and subject to revision, so that I tend to improvise with what's in front of me, rather than work from pre-set procedures.
Yet perhaps that is not satisfactory. Even if I do improvise I do not do so 'from scratch' every time. An analogy: I play some (amateur but—I like to think—competent) guitar with group of other musicians, where I improvise all my guitar solos. But I do so according to principles—certain notes, scales and ‘chops’ fit over certain chords—and the principles behind these (musical theory) are certainly explainable and communicable. So, when I work in therapy, even if I do improvise according to the particular client in front of me and what they bring in that moment, surely I do so on the basis of certain principle—sanalagous to the scales, chords, rules of harmony and composition in music—even if these are implicit?
What is so difficult about articulating these? Just as there are different musical forms, different genres – say classical Spanish Flamenco, Klezmer, Chicago blues, English folk, etc- could I not in principle give some kind of taxonomy of different clients, problems and appropriate working methods? Yes, in principle, I suppose I could, but the answer would be a vast and ever-expanding textbook, itself containing extensive references and bibliography!
So, the answer I have evolved now goes along these lines:
That’s a fair question, but hard to answer. How I work depends on what you bring. So perhaps I could ask you, ‘what brings you into therapy'?
From here a dialogue ensues. If the client still wants a better idea of my theoretical orientation, I refer them to my website, which has some of my articles as well as links to my professional trainings. Since this article, once published, will appear on my website I hope that I can discover what this is!
In the spirit of phenomenological enquiry, I would like to begin with the experience. When I have found myself faced with the question 'how do you work?' I feel somewhat shaky, as if faced by Someone or Something intimidating, much more powerful than myself, yet unable to appreciate the depth and subtlety of the questions involved here; something like being faced by a Cyclops: a dull-witted, brutal giant with monocular vision. This ‘felt sense’ (Gendlin, 2003, 1996 )2 is brought by the implicit narrowness of the terms of reference of the question (it has the implications outlined above, of a separate ‘you’ and an independent ‘system’) and the cultural context which contributes to this narrowing: the culture of consumer capitalism and associated technicism in which therapy must take its place as a commodity, a kind of technology, with associated branding, marketing, price and description of product benefits. Related to this is the UK State's coming regulation of psychotherapy. The narrow vision of the authorities—by which I mean NIHCE—with respect to therapeutic outcomes, measurement, evidence and so on has been well discussed elsewhere3 and I do not intend to re-visit that here. For those of us who practice outside the currently validated modalities (as I write these are Cognitive Behavioural Therapy (CBT), psychodynamic and family systemic approaches) our livelihoods and our most deeply felt values and commitments are felt to be potentially under threat. And so, there is a lot of anxiety around.
We are dealing here with what Heidegger described as ‘calculative mind’, which he contrasted with ‘meditative mind’. The former is suited to problem solving but is unable to penetrate or illuminate questions related to experience and being, which of course all psychotherapy is to some extent concerned with. Stephen Batchelor (1990) quotes the French philosopher and artist Gabriel Marcel, who expresses this eloquently:
A problem is something which I meet, which I find complete before me, and which I can therefore lay siege to and reduce. But a mystery is something in which I am myself involved, and it can therefore only be thought of as a sphere where the distinction between what is in me and what is before me loses its meaning and initial validity. A genuine problem is subject to an appropriate technique by the exercise of which it is defined: whereas a mystery, by definition, transcends every conceivable technique.4
Or as Jung says, ‘I cannot experience myself as a scientific problem’.5 To approach a mystery, we need not calculative mind but meditative mind.
Here we are in the territory of what Keats called 'negative capability':
when a man is capable of being in uncertainties, mysteries, doubts, without any irritable reaching after fact and reason6
This has by now become a cliché in psychotherapy, being so often quoted. The very fact that it has become cliché suggests that therapists have needed to find some kind of authoritative voice with which to protect for themselves a kind of radical opennessa fertile ground of possibility, free of preconceptions, free of the intrusions of calculative mind. I feel that, were I to attempt to reduce my working practices to a set of procedures—to a technology in effect I—would be complying with the dictates of some collective calculative mind. This would involve distorting myself, and here the image that comes to me is the statue of Newton after William Blake which can be seen outside the British Library in London, which shows a wonderfully huge, embodied, muscular, human-animal Isaac Newton hunched over, as if concentrating intense mental attention, pouring over some paper, compasses in hand… .7
After much reflection it seems like my only axiom is this: the self is a process, and a multiplicitous, many layered, non-linear, indeterminate, complex one. This is in tune with both a Buddhist understanding as well as aspects of Western psychology from the process perspectives of Gestalt, transpersonal and body psychotherapy. Limitations of space here prevent a fuller exposition, but this may be found in, for example, Sills (2009)8, Gendlin (1996)9, Spagnuolo Lobb, Amendt-Lyon (eds) (2003)10, Macy (1991)11, Kurtz (1990)12, Grof, Wilkinson (2008)13, Watson (1998)15.
If the self is an open—ended and indeterminate process, then people are perhaps much less structured and fixed than musical forms. Whereas there are principles of harmony (but in fact even these vary across cultures and historical periods) and, once written, the song remains (more or less) the same, we humans tend to make ourselves up as we go along, not only our present but our past and our future as well. We are always re-writing ourselves and whatever the current story or pre-occupation is tends to change our sense of our past, present and future selves. The figure creates the ground and the ground creates the figure. We are constantly losing the plot and re-writing it now as comedy, now as tragedy…(See Wilkinson (2008)16 for a much fuller exploration of this and its implications for psychotherapeutic theory and practice.)
If this is so, then a psychotherapy that is non-dogmatic, pluralistic, and flexible, characterised by not knowing, negative capability, is really the only tenable theoretical ‘position’.
Ironically the empirical research on therapeutic outcomes suggests that not theory, but relationship and client variables are the most important ones affecting therapeutic outcomes17. Paradoxically, this would tend to offer a ‘scientific ‘ basis to confirm that a pluralistic and non-dogmatic approach is the best one.
So, although market and social pressures might in their Cyclopsian way demand brands and technologies, I am going to resist this. I prefer story and parable, capable of multiple readings, as suggestive of my approach.
Following on and expanding the felt image of the Cyclops gives us the story of Odysseus in the Cyclops’ cave. Odysseus and his men escape by getting the giant drunk, plunging a hot stake into his eye and then hiding themselves under the giant’s sheep as he lets them out to graze18. This is of course a tour de force of creative improvisation!
We also have the Grimms tale of ‘The Brave Little Tailor’ who outwits powerful giants with a series of brilliantly improvised and quick-witted manoeuvres, successfully rising to every challenge placed before him before gaining the hand of the king’s daughter in marriage and eventually reigning as king for the rest of his life.19
The tailoring metaphor is a particularly resonant one for me, coming from Jewish ancestry and a long line of tailors! I had imagined myself as having departed from this tradition, being a psychotherapist, but there is something in therapy work, as I am presenting it here, and tailoring, which is more akin than I had realised: working with the material in front of us, attending to the detail, as it were ‘stitch by stitch’, responding in the most fitting way to the particularity of this client, this moment… .20 This brings to mind Heidegger again, as elucidated most helpfully by Robert Glass (1995: 17), on meditative thinking as
not a “floating” thinking which “loses touch”. It requires work, and may even demand more effort and practice than calculative thinking. As Heidegger staes, in meditative thinking we “dwell on what lies close…upon what concerns us, each one of us, here and now”21
Glass elaborates by means of Heidegger’s metaphor of the woodcutter and the traveler:
The woodworker learns to be sensitive to the particularities of each piece of wood, and to allow what is best in it to guide his or her skill. Part of thinking, then, is being open, or opening, to the potential of the particular. The traveler is one who sets out on a never-ending journey. This is not a negative image but a positive one, for the purpose of traveling is never to arrive but always to be on the way. Part of the definition of thinking, then, is always being open or opening to the next step. With reference to obedience, a woodworker is one who is obedient to the wood while the traveler is one who is obedient to the nature and direction of the path. Questioning arises from a waiting upon that is sensitive to the particular.22
This is entirely consonant with Gendlin’s philosophical-therapeutic practice of Focusing.23
To hope for a grand, all-encompassing theory would not only fail to do justice to the uniqueness and complexity of client and relational process but would also be to practice a kind of idolatory in which the discomfort and difficult (and endless, but richly rewarding) work of phenomenological enquiry would be compromised by taking refuge in some falsely comforting, external authority. I am here reminded of Nietzsche’s ‘death of God’:
"Where is God gone?" he called out. "I mean to tell you! We have killed him, you and I! We are all his murderers! But how have we done it? How were we able to drink up the sea? Who gave us the sponge to wipe away the whole horizon? What did we do when we loosened this earth from its sun? Whither does it now move? Whither do we move? Away from all suns? Do we not dash on unceasingly? Backwards, sideways, forwards, in all directions? Is there still an above and below? Do we not stray, as through infinite nothingness? Does not empty space breathe upon us?24
Here ‘God’ would be that over-arching Theory. But if we can stand the uncertainty of that horizonless, groundless place, without authorities, there is the possibility of using it creatively—becoming the traveler-woodcutter, as it were, in every session.
Perhaps the kind of artistry at stake here is the art of living, continually crafting a self and a life. In practicing as a therapist from this perspective, I have the possibility of enabling the client to get to know what gods they worship and perhaps to have more choice in the matter. The aim of therapy in this sense would be to foster an inner authority that would give the client the ability to think meditatively in Heidegger’s sense of that term (Gendlin might say, to foster the ability to open to their own ‘felt sense’) and to act from this source of inner authority. Authenticity in this sense would be the capacity to improvise from the felt sense in any given moment and individuation would be the process of gaining a certain virtuosity in this.
I write this shortly after the death of one of my literary heroes, Harold Pinter. Pinter was born in Hackney, London, where I currently live and work. (Interestingly, he came from a family of Jewish tailors!) In his work and in his life Pinter was a vociferous opponent of tyranny, of both the psychological and political kinds. One of my favourite Pinter works is his early play ‘The Birthday Party’. The play is set in a seedy seaside boarding house where Stan, a depressed lodger, possibly a former concert pianist, lives with the landlady, Meg, and landlord, Petey. Two sinister strangers, Goldberg and McCann, come to stay, seemingly looking for Stan. During the course of a birthday party held for the unwilling Stan and its aftermath, the two strangers subject Stan to intimidation and interrogation, leading to Stan’s apparent emotional and psychological collapse. The play ends with Stan being led by Goldberg and McCann outside to their waiting car, in which he will be taken to the anonymous but seemingly authoritative “Monty”. It is almost impossible to provide a summary of this extraordinarily rich and resonant work (but c.f Billington25 for an excellent and accessible perspective on it), which is open to multiple readings and which, 50 years after it was first performed, remains immensely powerful and disturbing, as well as blackly comic.
In one of the final scenes, Goldberg and McCann ‘woo’ Stanley:
GOLDBERG. We'll watch over you.
MCCANN. Advise you.
GOLDBERG. Give you proper care and treatment.
MCCANN. Let you use the club bar.
GOLDBERG. Keep a table reserved.
MCCANN. Help you acknowledge the fast days.
GOLDBERG. Bake you cakes.
MCCANN. Help you kneel on kneeling days.
GOLDBERG. Give you a free pass.
MCCANN. Take you for constitutionals.
GOLDBERG. Give you hot tips.
MCCANN. We'll provide the skipping rope.
GOLDBERG. The vest and pants.
MCCANN. The ointment.
GOLDBERG. The hot poultice.
MCCANN. The fingerstall.
GOLDBERG. The abdomen belt.
MCCANN. The ear plugs.
GOLDBERG. The baby powder.
MCCANN. The back scratcher.
GOLDBERG. The spare tyre.
MCCANN. The stomach pump.
GOLDBERG. The oxygen tent.26
As noted by many critics, Pinter has an extraordinary ear for the currents of struggle and power in social life and particularly for how these are present in spoken language—and, famously, in silence. Note the character of the language that Goldberg and McCann use here, delivered in a borderline comic-terrifying music hall rhythm. (Pinter reminds me here and in similar scenes throughout his work of the experience of being tickled as a child. As Adam Philips27 (1993:2) points out, the childhood experience of being tickled exists on the borders of delight and anguish. Pinter uses this technique to deliver not a punch line, but a punch, which is all the more windingly effective for all which has preceded it.) The language, with its sequence of intimidatory-seductive sales pitches for a banal (and submissive) adjustment to social ‘reality’ is pure ‘boilerplate’: ‘a copy made with the intention of making other copies from it; a set of instructions incorporated in several places in a computer program or a standard form of words used repeatedly in drafting contracts, guarantees, etc.’28
Such language excludes the possibility of thinking new thoughts—and thus has a subtly coercive and authoritarian aspect, which is made explicit in the last lines here, with their disturbing associations of deafness, poisoning and incapacity.
Almost at the end of the play, Petey, ostensibly the ‘man of the house’ but absent and passively compliant throughout, confronts Goldberg and McCann—but backs down as they take Stanley away, calling out a line that Pinter would later describe as the most important he ever wrote: ‘Stan, don't let them tell you what to do!’.29
As psychotherapy in the UK faces state regulation and as CBT receives a massive funding boost under the auspices of IAPT, I think it is vitally important that we protect open-ended experientially based psychotherapy from the intrusions of calculative mind and its boilerplate procedures.
It is the space between the notes that permits music to happen, and the white of the page is as important as the black of the text in allowing meaning to be read. In psychotherapy, negative capability is the equivalent of this space. As Gendlin says, ‘theories are neither true nor false. […] They are not true because the kind of entities they assert do not exist in concrete human experiencing. But they are not simply false, because they sometimes enable people to locate experiences they would otherwise have missed’.30
This article has evolved as a patchwork, unique and bespoke—much as a psychotherapy relationship evolves. As such, it has helped to bring home to me something about my theory and practice of psychotherapy too. It has enacted this, in Wilkinson’s31 sense of that term. This open, tailor-made rather than ‘off-the-peg’ approach may be the best suited to facilitating the client to be an artist, composer, improviser of themselves. It protects the freedom and inner authority of the individual—both practitioner and client—at a time when these things seem increasingly threatened.
Don’t let them tell you what to do.
1 Moustakas, C (1990) Heuristic Research: Design, Methodology, and Applications, Sage Publications.
2 Gendlin, E.T, (2003) Focusing: How to Open Up Your Deeper Feelings and Intuition. Rider. (1996) Focusing-Oriented Psychotherapy: A Manual of the Experiential Method, Guilford Press.
3 See, for example, Bohart, A and House, R, Chapters 16 and 17 in House, R and Loewenthal, D (2008) Against and For CBT, PCCS Books.
4 In Batchelor, S (1990). The Faith To Doubt, p 43, Parallax Press.
5 Jung, C.G., 1995, Memories, Dreams, Reflections, p17.
6 In Gittings, R., (ed) (1970).
7 The sculpture is by Sir Eduardo Paolozzi (1924-2005) and a photo of it can can be seen at http://farm3.static.flickr.com/2340/2208556052_9e981289d1.jpg?v=0
8 Sills, F., Being And Becoming: Psychodynamics, Buddhisn, and the Origins of Selfhood (2009). North Atlantic Books.
9 Gendlin, E., 1996, op.cit.
10 Spagnuolo Lobb, Amendt-Lyon (eds) (2003) Creative License: The Art of Gestalt Therapy, Springer Verlag-Wien.
11 Macy, J., (1991). Mutual Causality in Buddhism and General Systems Theory. State University of New York Press.
12 Kurtz, R., (1990) Body-Centred Psychotherapy. LifeRhythm.
13 Grof, S., (1975) Realms of the Human Unconscious: Observations from LSD Research. Ed. 1979. Souvenir Press.
14 Wilkinson, H., (2008). The Muse as Therapist: A New Poetic Paradigm for Psychotherapy. Karnac Books.
15 Watson, G (1998). The Resonance of Emptiness: A Buddhist Inspiration For A Contemporary Psychotherapy Practice, Curzon.
16 Wilkinson, H., (2008), op.cit.
17 Aveline, M., Shapiro, D.A., (eds) (1995) Research Foundations for Psychotherapy Practice, Wiley.
18 Homer, The Odyssey. Translated by E.V. Rieu. Ed. 2003. Penguin Classics.
19 Complete Fairy Tales of the Brothers Grimm (1992), Bantam.
20 Only after writing this did I discover the following Jewish joke:
Q: What’s the difference between a Jewish tailor and a psychotherapist?
A: A generation
21 Glass, R., (1995), Working Emptiness: Toward a Third Reading of Emptiness in Buddhism and Postmodern Thought, Scholars Press.
22 Ibid, p18.
23 Gendlin, E., 1996, op.cit.
24 Nietzsche, F., 1882. The Gay Science section 125. Translated from German by T. Common ed. 2006, Dover Publications.
25 Billington, M., (1996).The Life and Work of Harold Pinter, Faber and Faber.
26 Pinter, H., (1959). The Birthday Party. Ed. 1988, Methuen, pp.82-83.
27 Phillips, A., (1993). On Kissing, Tickling And Being Bored. Faber and Faber.
28 The Collins English Dictionary (1992). HarperCollins.
29 See Billington (op. cit.): 79
30 Gendlin, 1996: 2
31 Wilkinson (2008) op.cit.