Twenty-eighth Annual Conference: Developing Clinical Momentum

PANEL III
A Focus on Dramatic Moments and Improvisation

Leonard Bearne, Psy. D.

(Please note that due to issues of confidentiality this Panel was not recorded. This report will therefore focus on the theoretical issues raised in the discussions and presentation and will omit any details about the patient except those absolutely necessary to clarify the points addressed herein. This is done with the knowledge of, and in consultation with, Dr. Alan Kindler. I would like to thank all the participants for their cooperation in making their material available to me for purposes of this report.)

To begin, I would like to say how rich I found all three panels to be, unified as they were by the theme of the conference - Developing Clinical Momentum. The focus of Panel 3 was on Dramatic Moments and Improvisation. The Panel was Chaired by Bernard Brickman, M.D., the main paper was by Alan Kindler, M.D., and the discussants were Philip Ringstrom, Ph.D., Psy.D., and Daniel Stern, M.D.

Over 25 years ago a documentary appeared, entitled "No Maps on My Taps." The title is taken from the great tap dancer Chuck Green ("I got no maps . . . on my taps . . .") and as noted by one reviewer, it is about ". . . great dancing that is so "in the moment" there is no residue, and hence "no maps." This phrase conjures the spontaneous, unplanned expression of rhythm that is what makes this form so exciting to watch and so invigorating to perform. In this it contrasts with the choreographed steps with which most of us are familiar. Let us be clear that to be able to improvise in this way requires years of disciplined, dedicated practice of fundamentals until those fundamentals become so natural that they can be subsumed into the unplanned, unscripted expression of this form of dance.

Yet improvisation is not simply that which we do automatically once a level of technical mastery has been achieved. Just because a dancer has done the requisite years of practice, there is no guarantee that s/he will ever be able to improvise. Why is that? To improvise requires a leap beyond mastery or perhaps a willingness to be in a particular way, which has a separate path for coming into being. I will return to these ideas in a moment but first I would like to discuss the three presentations.

In the main presentation, "Improvisation and Spontaneity in Psychoanalysis" Dr. Alan Kindler has provided us with a case that courageously allows us to share in his thinking and responses in the midst of the treatment of a successful, yet emotionally constricted middle-aged woman. This report of his case comes four years into a largely 5x/week analysis.

Dr. Kindler begins his presentation by discussing the question of improvisation in analysis and suggesting that it may well be something we do all the time. He cites many authors (Nachmanovitch, Knoblach, Ringstrom, Chaplin-Kindler, Lachmann, Lichtenberg, Meares, Gabbard, Stern et al) who are all considering the role of the improvisational in psychoanalysis. Foci of interest for these analysts have included the prevalence of improvisation in treatment, its desirability, how this type of spontaneity may have been discouraged in the early years of psychoanalysis, how it is part of the implicit relational context of analysis, how it needs to be used carefully, and how it can be seen in the context of traditional modes of interpretation.

What Dr. Kindler stresses as a pivotal point in this case is the way in which, by calling attention to some little decorative animals on his desk that had been rearranged without his knowledge, by a four year old the previous day, he was able to introduce the idea of "play" into the analytic relationship. By referring to the rearranging of the animals, a personal, spontaneous act by the child, Dr. Kindler is able to make it easier for his patient to consider his idea that they play, something the patient says she would not have been able to do even at the age of four.

In their next session, following the weekend break, his patient is unable to speak about her feelings. As they sit in silence, Dr. Kindler expressed,

"out loud my musings during the silence. I told her about the fantasy I had in response to the child's game, that we would have a game in which, for a few minutes, she would say whatever comes into her mind without any responsibility for what she was doing."

The patient takes to this idea and soon they are engaged in a discussion about the other doctors, whose offices the patient walks by to get to Dr. Kindler's door and how they appear to be not yet in, while Dr. Kindler is already at work. She thinks this means that her analyst is more successful and this feels good to her. Her musings are then interrupted by the thought that hearing this might be a burden for Dr. Kindler. They are able, however, to resume their discussion about the corridor of "losers," a phrase introduced by Dr. Kindler in the spirit of the mutual play and which she accepts.

The patient is able to talk about several other topics and before finishing the session states that she hopes that they can play again, though she is not sure that she will be able to repeat it the next day. She is in tears as she notes how totally unfamiliar this is for her. Dr. Kindler tells us that her tears are a,

"response to the fact that I had suggested the game to her, that it had allowed her to do something she had never done before, and (and this was most difficult to say) that it had seemed important to me."

Over the next several sessions they are able to "play" together, though this play alternates with periods when her sense of burdensomeness and worry re-emerges. Nevertheless, as Dr. Kindler notes, "it did seem to be a transition point to novel ways of being together." They had created a "play space," something new in the patient's world.

While this clinical vignette is stimulating on its own, it really serves to illustrate the larger point of Dr. Kindler's paper. He states,

"Contemporary psychoanalytic theory (Boston Group, Lichtenberg, Ringstrom, Bacal) seems to suggest that improvisation and spontaneity are intrinsic to the analytic dialogue and contribute significantly to the therapeutic process at all times. These developments seem to point in the direction of a model of psychoanalytic participation that includes an acceptance of, and a more careful consideration of, the improvisational dimension of responsiveness. Perhaps this will occupy more of our attention as we continue to develop our skills in the art of psychoanalysis while maintaining our allegiance to the science."

This idea, that psychoanalysis needs to pay more attention to the improvisational dimension of responsiveness, is taken up by Dr. Philip Ringstrom in his discussion of Alan Kindler's presentation. Dr. Ringstrom begins with a quote from D. W. Winnicott:

"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 psychoanalysis may begin."

In Dr. Kindler's presentation, the emphasis seems to be on the latter part of this quote (if the patient cannot play . . .). But Dr. Ringstrom seems most interested in the earlier part of the quote (if the therapist cannot play . . .). He says, "Accordingly, I am proposing that working improvisationally should be regarded as an evolutionary leap in revising our thinking about the very process of free association," proposing what he calls "bi-directional free association" by which he means " becoming improvisational . . . drawing both parties' free associational process into the analytic play space."

Dr. Ringstrom is talking about an interactive process. He distinguishes this improvisation from psychoanalytic spontaneity and suggests that while spontaneity, "involves acting from a natural feeling, one expressed without constraint, effort or reflection, occurring through internal causes," improvisation,

"certainly involves spontaneity, but more importantly it plays off of and with patterns that are linear and non-linear, verbal and non-verbal, allowing contexts of experiencing to influence their development,"

however, it, "requires playing with something that arises between two or more people." "Thus, working improvisationally involves ensemble work, wherein both parties play off of and with one another's spontaneous gestures."

The other discussant, Dr. Daniel Stern, focused on spontaneity in the infant-mother dyad. He presented a beautiful rendition of the "I'm gonna get you" game noting the breaking of the child's expectations through the unpredictability of the timing of the care-takers responses, leading to a joyful experience on the part of the infant. He stressed that this joyful experience, that he called positive excitement, is something you cannot induce in yourself. He also stressed the need to be able to tolerate this experience and pointed out that this seemed to be problematic for the patient in Dr. Kindler's case. He said he would want to ask her about her experience of over-excitement and the dangers of that for her.

There are a number of interesting points raised in this panel. As Dr. Bernard Brickman, the Panel's moderator noted, the classical "tilt" toward content has had the effect of lending itself too easily to a kind of analytic deadness. He sees spontaneity and improvisation, in their emphasis on process as providing a corrective to this deadening tendency. I would like to note Dr. Brickman's recognition of the tension between a potentially deadening focus on content and the potentially liberating focus on process and return to the beginning of this report.

The idea of "no maps on my taps" seems to me to suggest an attitude that allows for a wider range of possibilities for what can occur in our treatment rooms. Some readers may be reminded of Bion's puckish dictum that analysts should have neither memory nor desire. However, it may well conjure up for others the specter of a kind of "wild" analysis where anything goes. Can we walk this line between the Scylla of analytic deadness and the Charybdis of wild analysis? If we are to walk this line there are several issues we must bear in mind.

Many of our most revered teachers, such as Heinz Kohut, broke the analytic rules at some point to give us new insight into our ways of being with patients. Yet they were well versed in the traditional understandings, often, as Dr. Kohut was himself, being seen as paradigms of those practices. In encouraging the emergence of a new analytic focus - and it seems to me that Drs. Kindler and Ringstrom as well as several of the authors they cite are doing just that - we need to be mindful that for the use of spontaneity to be not "wild" we must find ways to ensure that our training leaves candidates grounded in an understanding of practice and theory that allows them to feel comfortable in improvisation. One small caution may suffice. There are patients I have known who would not have reacted favorably to the kind of intervention that Dr. Kindler used so masterfully. This kind of systemic "perturbation" should not be enshrined. Indeed, the very notion of spontaneity indicates that in every situation something unique is happening. And our responses need to be unique as well. Spontaneous quiet, anyone?

The tap dancers I referred to at the beginning of this report had repeated, thousands of times, the basic rhythmic patterns that made up the vernacular of that style of dance. They knew the territory. Once that knowledge was established (in our modern terms as procedural memory) they were free to explore, secure in their own bodily abilities. Likewise, we must ensure that our training leaves our candidates, and ourselves, equally well grounded.

That being said, I also noted at the beginning of this report that some talented and well-trained dancers (or musicians, or analysts) never seem to be able to improvise. I asked why that was? If there is a Scylla of deadness and a Charybdis of wildness that we must walk between as a profession, there is likewise one we must walk individually. The importance of this panel lies in its legitimizing, for us as individuals and for us as a profession, the notion of spontaneity in analysis. Without such validation by serious analysts, teachers and supervisors, it will be hard to overcome our anxieties about being judged, about appearing "wild", about breaking the rules. About, in the end, being spontaneous.

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