From: The Art of Play: Helping Adults Reclaim Imagination and Spontaneity, by Adam Blatner, M.D. & Allee Blatner.
(Published by Routledge, 1997, now out of print and being revised into 3rd edition. ) Comments welcome: Email to adam@blatner.com
Posted August 25, 2008 (Click here to link to other chapters)Chapter 14: PLAYFULNESS, AND PSYCHOTHERAPY
Although psychodrama is a recognized psychotherapeutic technique, and there are many other approaches that have integrated action techniques, there are other dimensions to Moreno’s vision that transcend mere technique. At a deeper level, he wanted to promote the whole idea of increasing spontaneity, creativity, and playfulness, not only in therapy, but in the world. Indeed, the epitaph on his gravestone says (in German): “The man who brought joy and laughter into psychiatry.” (Alas, that didn’t actually happen—but the line—Moreno’s choice of words—reflected his intention, not just for his profession, but for his vision of what the world needed for healing.) (Blatner, 2007)
Having Fun
As discussed in the chapters on the cultural attitudes that inhibit playfulness, the idea of fun has held a rather ambivalent status. We should more actively affirm, though that playfulness itself should have an important place in a truly holistic program of psychotherapy. In the last ten years, the “positive psychology” trend within the field of psychology has reinforced this general idea (Niemiec, 2008). The dimension of spontaneous self-expression is one of the healthiest parts of the personality, and its neglect alone can create an imbalance in the ecology of the psyche. In other words, it's important to have fun.
R. D. Laing, the noted English psychiatrist and family therapist wrote a poem on this topic:
They are not having fun.
I can't have fun if they don't.
If I get them to have fun, then I can have fun with them.
Getting them to have fun is not fun. It is hard work.
I might get fun out of finding out why they're not.
I'm not supposed to get fun out of working out why they're not.
But there is even some fun in pretending to them that
I'm not having fun finding out why they're not ... (Laing, 1970, p. 2)
Although this is a perceptive passage, it also reveals a common limitation in psychotherapy. In attempting to create an atmosphere of sympathy for the genuine suffering of patients, the realm of fun is often ignored or avoided. A grave, concerned expression on the therapist's face may be appropriate at some points in the work, but if it becomes habitual it tends to suggest that the problem is more insoluble than it is, This in turn creates an undue dependency on the part of the patient who comes to rely on the therapist's indications of when things have improved.
Another misleading feature of focusing on the problem to the exclusion of the other healthier parts of the patients' lives is that it may perpetuate the "illness." If the patients begin to focus excessively on "solving the problem," they may neglect cultivating several other dimensions of their lives that would be able to help compensate for the weaknesses. Applied role theory emphasizes the variety of simultaneous channels of personal development, and from this perspective a person may be "sick" in some roles and "healthy" in others (Blatner, 2000, pp. 150-187). This allows for a better diagnosis of the problems than that provided by dualistic thinking. For example, there are any number of variables which can be problematical in psychological disturbances, such as nutrition, social network, variety of interests, range of strengths and abilities, etc. Difficulties might occur in only a few or in several dimensions. Other areas may be continuing to function quite well (Blatner, 2006a).
As an analogy, the psyche can be likened to a garden with the different plants and sections representing the various aspects of the personality. One garden might have good drainage, nutritionally rich soil, and adequate exposure to sunlight. Yet its vigorous and varied plants have become overgrown and infested with insects. This could represent a person who has many areas of strength, even in the face of major conflicts or stresses. With some pruning and cleaning it can flourish again (Blatner,, 2006b).
In contrast, imagine a garden with hard, dry, and infertile soil, poor lighting, and old, sparse plants, Even if it has no insects and has been weeded meticulously, its general level of vigor is poor. It re-quires far more work involving general conditioning of the soil and replanting the kinds of vegetation that would do well in shady lighting. In psychological terms, this could describe a person who has few strengths with which to compensate for the stress of life. There would need to be a development of a variety of resources for psychological and social vitality, and this is where the adjunctive aspects of therapy are needed.
Strengthening the healthy parts of the personality is as important as focusing on the person's problems. An important part of the work in therapy can be strengthening the repertoire of roles in a person's life that provide activities for expansiveness and fun. Without remembering the joys in life, there are few real motivations for responsible action. Life-enhancing issues such as nutrition, spirituality or philosophy of life, exercise, and recreation are often neglected as people sink into despair and demoralization. They lose touch with what they like about themselves and forget that anyone else could like them either. Working together to strengthen the overall personality helps a person escape from this debilitating vortex. Further-more, the theme of playfulness softens the task of therapy, and re-minds patients that they are not expected to work continuously on their problems in a direct fashion. Taking time to experience more pleasurable activities becomes identified with a valid healing approach.
Play as a Goal
Learning to have more fun can be discussed as one of the goals of psychotherapy at the very outset of the process. If the patient has fun in ways that are self-defeating, as through alcoholism or delinquency, then the goals of the therapist and patient can include emphasizing the theme of searching for truly enjoyable alternatives. If the patient is unable to have fun, then creating this as one of the goals generates a touchstone for the ongoing process.
Discussing the theme of play allows for the introduction of psychodramatic or action techniques. Resistance to fantasy or dramatic encounters may be lessened when there have been discussions about how pretending and being serious can occur in the same context. This issue should be addressed in a straightforward manner at the beginning of therapy. A natural bridge can be shown by relating use of the psychological device of the "if" dimension when considering the possibilities of various aspects of a problem. The same "if" dimension is also the essence of play.
The role of humor and playfulness in the healing process has become increasingly recognized in the last several years. The approach described above sets the stage for judicious modeling by the therapist and encouragement to the patient for breaking out of the sick role and engaging in playful behaviors that might at first seem in-congruous with the state of being in psychological pain.
Play as Part of Personal History
Inquiring about the patient's experiences with play and sources of recreational satisfaction, both past and present, offers an immeasurably rich vein of relevant material for discussion. First of all, the number and scope of enjoyable activities that comprise the patient's role repertoire are perhaps the single best correlation of overall mental health and resiliency. The more playful a patient is, the more there is a capacity for imagination, emotional flexibility, and what Alfred Adler called "social interest."
Simply reviewing the types of playful activities is a good reminder to patients of what might be neglected in their life-styles, as well as being a pointer to pleasurable directions to explore. For instance, talking about noncompetitive forms of play with a person who has become fixated on competitive concerns plants a seed that there are valid and acceptable alternatives. (The questions noted in Chapter 10 are also applicable in the psychotherapeutic consultation and may serve as an example of the types of issues to pursue.)
In taking the patient's history, reviewing experiences of play produces fruitful material about parents, siblings, schoolmates, and others. Key interactions regarding play often contain the earliest and most influential experiences. Issues of shame, guilt, triumph, cruelty, showing off, the feelings of mastery or competence, cheating, perfectionism, and many others may be addressed in such a discussion. Early events relevant to sexuality and aggression are also remembered more vividly when accessed through an exploration of the patient's history of play.
Most important in terms of catalyzing healing forces, positive experiences are rekindled in the memory when early forms of play are reviewed. As patients remember their clubhouses, forts, and hideouts, their eyes light up as they talk about the roles they played, inspired by their favorite heroes and villains on television, radio, or in the comics. Moreover, in remembering their friends, they may be helped to internalize the good feelings and validate the good parts of themselves that were evoked in their pleasant child-hood pastimes.
In talking about imaginatively playful activities, there are often genuinely interesting moments for the therapist to reflect feelings of enjoyment. Patients are quite sensitive to this shift from feeling accepted to feeling enjoyed, and seeing the twinkle in a therapist's eyes strengthens the working relationship even more. A focus on material such as this in therapy helps patients restore their sense of self-esteem through knowing they can give pleasure simply by being themselves. Because discussing past and present forms of recreation of-ten involves relatively healthy and successful aspects of the patient's personality, it tends to shift the therapist-patient relationship toward a feeling of greater equality. At least for a while, in considering the roles of play, there is a freedom from the fixed elements of the sick role. This also reduces some of the transference and resistances inherent in any helping relationship, which in turn strengthens the therapeutic alliance.
The place of play in therapy offers an ongoing acknowledgment that the therapist is an advocate of the inner child of the patient, which sustains motivation and rapport. Adjustment, responsibility, and social acceptability are obvious goals, but without the additional goals of developing creativity and having fun, the others tend to be perceived as associated with all the authority figures of the past. There's a greater sense of nurturance when the therapist and patient together reaffirm the desirability of a pleasurable solution.
Expanding the Playful Repertoire
One part of a total program of holistic therapy is the development of a variety of challenging, exciting, and pleasant activities that suit the patient's individuality. Patients often need to be encouraged to engage in an ongoing process of shopping and testing various recreational forms and groups. As mentioned earlier, people with emotional difficulties often need to address the specific problems in their lives, and at the same time to strengthen the other facets of their overall mental health, The two elements can work together, in the same way that treatment using surgery also requires the components of good nutrition, exercise, and other general hygienic measures in order to effect a full recovery. Similarly, the verbal psychotherapy sessions can benefit from the support, courage, and material generated for the patient in creative arts experiences. The following list indicates some of the therapeutic programs and general directions that may facilitate the patient's exploration:
• Drama Therapy, involving a wide variety of exercises
• Poetry, dance, art, music, and other expressive therapies
• New Games and other forms of recreational therapy
• Biofeedback, meditation, body/movement approaches
• Guided fantasy, Ericksonian Hypnosis, Gestalt Therapy
• Psychodrama, sociodrama, and role-playing in group settings
• The Art of Play and creative dramatics based on imaginary characters
These may be modified, applied, and integrated into a variety of situations:
• Alcohol and drug abuse rehabilitation programs
• Psychiatric facilities, residential treatment centers, day treatment programs, and outpatient clinics
• Rehabilitation programs for developmental disabilities, physical handicaps, senior citizen centers, and nursing homes
The creative arts therapies provide patients with an opportunity to experience their own active expressiveness, and this then serves as a model for ways of dealing with their psychological and social problems. Whether patients are playing a role in enactments dealing with the real events in their lives (i.e., psychodrama) or in those using more imaginary characters and situations (i.e., drama therapy or the Art of Play), they are challenged to enter into encounters with the other players. The repeated experience of making interpersonal decisions in these settings increases the patients' recognition of an ability to make some choices about their behavior in their primary relationships in life.
This is especially helpful for people who have a tendency to experience themselves as helpless victims of circumstance, such as those whose behavior includes anorexia nervosa, alcoholism, or depression (Seligman, 1975). In a supportive group context of play, an inherent message is conveyed that it's appropriate and effective to ask for help and make use of the nurturing behaviors of others, which in turn often becomes a powerful corrective experience (Trower, Bryant, & Argyle, 1978).
Play and Addiction
A generation ago, the most commonly described emotional problem was the "neurosis," a behavioral complex usually arising out of conflicts between impulses and conscience. Today the most common problems involve a relative lack of conscience, or at least a weakened sense of the ability to take responsibility for living a well-balanced life. Many people today live as if they were mildly addicted to certain habitual roles or behaviors (Peele, 1975). The point is that the complaints and problems are more like addictions than neuroses. The essential dynamic of addiction involves a narrowing of the role repertoire and a fixation on certain familiar sources of satisfaction. Because there is a concurrent loss of faith which views other sources of gratification as ineffective, the fixation is self-perpetuating and resists correction, even in the face of self-defeating experiences. Put quite simply, addiction is the continuation of a behavior even when there have been repeated negative consequences.
In this sense, almost any area of human behavior can become not only a fixation, but even a psychological addiction. When examining the histories of people with these kinds of role imbalances, many of them simply don't know how else to have fun. Furthermore, it's most difficult to treat them unless the issue of another payoff can be successfully addressed. Consider the following list from this point of view:
alcohol tobacco sex money health food television
drugs pets cars decorating danger crime housecleaning
fashion news sports gambling power work video games
dieting romance religion children recognition gossip computers
Play and the Demystification of Psychology
When the therapist and patient share the same language, relatively free from jargon, then there is a mutual understanding of the nature of the problem and the overall treatment plan. This enhances the patient's sense of mastery, self-esteem, and responsibility as a co-creator of the process. The therapist, in turn, becomes more of a teacher and consultant, which reduces some of the aura of mystery which is actually more intimidating than helpful in the majority of cases. The power of the therapist doesn't come from hidden knowledge, but rather from a capacity for courageous, authentic engagement with the patient in a search for alternatives.
As mentioned in the previous chapter, talking about social and psychological phenomena in terms of roles offers an excellent, simplified language for working with group and personal experiences. Our theory of role dynamics which includes the importance of play, imagination, and spontaneity, presents how the role-playing in dramatic enactment helps people to begin to understand the dynamics of the roles played in real life. In addition, this approach emphasizes the patients' abilities creatively to modify and develop their roles, and so leads to the introduction of concepts such as improvisation, strategy, skills, negotiation, redefinition, and other process-oriented forms of mature and responsible adaptation.
Play as Metaphor
Language itself can become an instrument of mental flexibility, and the use of metaphors and poetic images which are encouraged in play then helps patients build a selection of concepts with which to think about themselves and their world. Often the imagery generated in fantasy or artistic activities can serve as important bridges to more healing experiences.
In many emotional problems or types of mental illness, the patients may be thought of as having become demoralized or having lost their spirit and vitality. Along with being burdened with worries or fears, there is also a sense of a corresponding loss of access to the sources of personal power in the forms of helpful resources, initiative, and faith. In many cultures not donated by the Western tradition of medical or psychotherapeutic practices, the local healing approaches respond to both of these levels of illness: the intrusion of foreign influences (or "spirits") and the loss of the person's soul-power. Their healing practices thus include a combination of exorcism and re-connection of the patient with the myth, tribe, or other sources of personal healing (Harner, 1982).
In modern Western psychotherapy, the equivalent of the belief that illness is caused by the intrusion of foreign spirits is the concept of either microorganisms or internalized images of parental figures. Our therapies, therefore, are aimed at freeing the person from the germs in the first case, or the unrealistic influences of the intrusive spirits of the patient's childhood. However, the healing process, if it is to be as successful as that of more "primitive" cultures, needs to consider how to help those who are demoralized to reclaim their natural heritage of personal power (Torrey, 1972).
One practical approach is available in improvisational drama because it helps patients to rediscover their own sources of imagery and spontaneity, and to receive validation in the process. Finding a song to sing or whistle in times of stress can be the equivalent of the shamanistic practice of finding a "power song." Developing images to express aspirations is another way to utilize the power of metaphor as a support for identity. It's similar to developing an internalized "cheering section" to express individuality and effectiveness which can be accessed in times of stress.
The Art of Play may be used as an activity in treatment programs to augment psychotherapy and rehabilitation. The techniques associated with psychodrama and character development can facilitate other forms such as play therapy, group therapy, family therapy, etc.' Imaginative enactment offers a vehicle for broadening patients' role repertoires and for strengthening their sense of mastery and of being creators of their own lives. Other benefits include the learning of interpersonal skills and the language of role dynamics. Finally, validating pleasurable enjoyment as an important dimension of life can shift the tone and direction of therapy from narrow problem solving to holistic healing and ongoing growth and development.
References
Blatner, A. (2000). Applied role theory (Chapters 15-17). In Foundations of psychodrama: History, theory and practice (4th ed.). New York: Springer.
Blatner, A. (2006a). Factors in human development. Retrieved from website: http://www.blatner.com/adam/psyntbk/factors.htm
Blatner, A. (2006b). Metaphors in psychotherapy. Retrieved from website: http://www.blatner.com/adam/level2/metaphors.htm
Blatner, A. (2007). Photograph of Moreno’s gravestone in Vienna and epitaph: http://www.blatner.com/adam/pdirec/hist/moreno2.html (Actually, he was cremated in the USA, so perhaps only a few of his ashes are there, if any. It’s more of a monument.)
Harner, M. (1982). The way of the shaman. New York: Bantam.
Laing, R. D. (1970). Knots, New York: Pantheon Books.
Niemiec, R. (2008). Playfulness, meaning, and positive psychology. Retrieved from: http://pos-psych.com/news/guest-author/20080804925
Peele, S. (1975). Love and addiction. New York: Taplinger.
Seligman, M. E. (1975). Helplessness. San Francisco: W.H. Freeman & Co.
Torrey, E. Fuller. (1972). The mind game: Witch doctors and psychiatrists. New York: Emerson Halt.
Trower, P., Bryant, B. R., & Argyle, M. (1978). Social skills and mental health. Pittsburgh: University of Pittsburgh Press. pp. 73-95.
Storm, H. (1972). Seven arrows. New York: Ballantine.
A Few Further References on Play in Psychotherapy
Irwin, E. C. The use of a puppet interview to understand children. In C. E. Schaefer, K. Gitlin, & A. Sandgrand (Eds.), Play diagnosis and assessment (pp. 617-635). New York: John Wiley & Sons, 1991.
O'Connor, K. J. The play therapy primer: An integration of theories and technique: New York: John Wiley & Sons, 1991.
Schaefer, C. E., & Carey, L. J. (Eds.). Family play therapy. New York: Jason Aronson, 1994.
Singer, D. G. Play as healing. In D. G. Singer (Ed.), Playing for their lives: How troubled children are helped by play therapy (pp. 147-165). New York: The Free Press, 1993.
Solnit, A., Cohen, D. J., & Neubauer, P. B. (Eds.). The many meanings of play: A psychoanalytic perspective. New Haven, CT: Yale University Press, 1993. (Many of these articles were first published in the book series, Psychoanalytic Study of the Child, 1987, 42, 3-219,)
Warren, B. (Ed.). Using the creative arts in therapy. Cambridge, MA: Brookline Books, 1984.