Psychotherapy as a Mutual Creative Process

A therapist facilitates personality change through metaphor and creative empathy

Posted Jan 07, 2020

Psychotherapy is a mutually creative process involving new and productive personality characteristics in the patient and the use of creative thinking and effects by the psychotherapist. The use of a type of creative cognition by the therapist, designated the homospatial process, involves a specific type of manipulation of mental imagery at one phase of its course.

Identified initially through a series of empirical studies with highly creative writers, visual artists, and scientists, and assessed experimentally with these and other less prominent but definitively creative persons, the process has also been documented in published material regarding important creative and artistic and scientific achievements of the past.  Further research indicates that the homospatial process has specific application to the practice of psychotherapy as a means of enhancing a psychotherapist's creative interventions.

The homospatial process consists of actively conceiving two or more discrete entities as occupying the same space or spatial location. This conception and manipulation of images is followed by synergy and mergers, and leads to the articulation of new identities and creations. In the course of creating art, literature, or a scientific theory, the creative person actively conceives elements that ordinarily are fully distinct and independent—multiple entities in space—as being superimposed, semi-fused, or otherwise occupying the same spatial location.

Images of entities such as rivers, houses, and human faces, as well as sound patterns and written words, are brought together and totally fill conscious mental perceptual space. Such a conception is nonliteral and abstract in the sense that it represents nothing that exists (or can exist) in concrete reality. The image consists of a physical impossibility, because discrete elements never can occupy the same spatial location. However, the creative thinker deliberately brings two or more entities together in order to produce new and valuable ideas, images, and sound patterns.

One of the prime functions of the process is to produce vital and effective metaphors. Such metaphors may be particular constructs or broader structures, and they may be verbal, visual, or auditory in type. They may range from minor to major factors in creative products and achievements.

Usually a rapid and fleeting mental experience, the homospatial image of multiple entities occupying the same space is hazy and diffuse rather than vivid and clearcut. Although frequently involving the visual sensory modality with the production and manipulation of visual mental imagery during the course of the creative process, these superimposed and merged entities may be derived from any of the sensory modalities. There may be entities and sensations from the gustatory, olfactory, auditory, kinesthetic, or tactile spheres. It is an active, conscious, and deliberate form of cognition and is not to be confused with mechanisms of the primary process mode as described by Freud.

In the practice of psychotherapy, the homospatial process functions in two major ways: (1) the production of therapeutically effective metaphorical interventions; (2) the facilitation of empathic understanding of the patient and the construction of empathic therapeutic interventions. Metaphorical interventions by the therapist are potentially effective because of the following: They characteristically have both conceptual and concrete components; they promote patient insight both on an affective and a cognitive level; they are vital and stimulating as in artistic and literary experience; they penetrate to unconscious levels.

For example, in response to a patient's constant insistence that she made it  "impossible" (says her mother) for her mother to touch her when she was an infant, the therapist said, "Your mother is a Brahmin [upper-caste Indian], for without Brahmins, there would be no Untouchables [lowest caste]." In this case, the therapist had created a metaphor, "Your mother is a Brahmin," along with an aphorism regarding the relationship between Indian castes. In retracing the steps in the metaphor's creation, the therapist remembered that the patient herself had been talking of her long-term interest in East Asian religion and culture some sessions before this interchange. When she spoke of her mother's assertion about her as an infant, he conceived the word, "Untouchable," and the image of a shrunken Indian man looking somewhat like Mahatma Gandhi came to his mind.

 Getty images. Used wit permission
Untouchables caste
Source: Getty images. Used wit permission

Actively superimposing this word and the accompanying image with his mental percept of the patient's words and physical presence, he conceived the metaphor, "Your mother is a Brahmin," and almost simultaneously he thought of the aphorism as an elaboration as well. In a homospatial process, the therapist had created an apt metaphorical intervention. Although he had earlier thought fleetingly of asking the patient whether she believed what her mother said, he rejected that flat, prosaic formulation for the metaphorical one.

Following his comment, the patient became thoughtful and then said, "Those people really do treat the Untouchables badly." Gradually over the next few therapy sessions, she returned to this comment, and began to realize that any infant always wanted to be touched if it were done properly, and that it was her mother, not she, that had had trouble with the early touching.

Although some literature on the use of metaphor in therapy emphasizes a nonspecific and nonthreatening quality of metaphors and a facilitation of indirect and quasi-defensive discussion of anxiety-provoking material, the example here demonstrates the simultaneous intellectual and affective specificity of a metaphorical intervention and the facilitation of productive therapeutic work and insight on many levels. Such use differs from both guided imagery therapy and more traditional exploration of patients' metaphors and figurative language.

The creation of therapeutic metaphors through the homospatial process operates in many different and seemingly disparate types of therapy. In gestalt therapy, the creative therapist superimposes and fuses images of deceased and absent parents, lovers, and others, onto the spatial setting where he is conducting therapy in order to encourage or work through feelings connected with the absent person. In the gestalt approach to reported dreams, the following use of a homospatial process in order to help the patient develop and work through her own interpretation is especially striking:

Patient: "I dream of tarantulas and spiders crawling on me. And it's pretty consistent."

Therapist: "You are a spider now. It's your dream. You produced this dream."

Patient: "I wanna get somewhere, and you're in my way, and so I'll crawl over you. That was very symbolic."

And later, the patient says: "Spiders are necessary because they keep the insect—the flying insect—population down. Spiders are fantastic because of the webs they can build." Here, the gestalt therapist induces the patient to conceive of herself as superimposed or fused with a spider in order to create her metaphorical experience. That she experiences the metaphor as an interpretation is seen in her reference to "symbolic,"—i.e., the symbolic order. She is then able to clarify emotional elements related to the dream.

In behavior therapy, too, the creation of metaphor plays a role, albeit not manifestly an interpretative one, in the behavior therapy approach to phobias—for instance, the procedure of desensitization. In this desensitization procedure, a patient who is phobic about dirt may be asked to imagine scenes such as seeing himself opening the top of a garbage can and finding it swarming with cockroaches. Although the behavior therapist might not explain the process in these terms, one can characterize this in part as a metaphorical intervention.

In choosing an appropriate desensitizing scene or image for the particular patient, initially, the therapist spends a good deal of time trying to understand the conditions and circumstances of the phobic reaction. The choice of an appropriate scene, then, depends on the therapist's ability to superimpose a concrete symptomatic image onto an image of the source of the patient's conflict.

The cockroach scene idea might pertain particularly to the patient's fear of dirt, because it represents emotions of unbridled aggressiveness or sexuality. The extent of the success of the desensitization procedure may generally depend a good deal on the therapist's appropriate initial choice of metaphor. This can be true for positive images or scenes as well as negative ones.

With regard to empathic communication in psychotherapy, it is assumed that a therapist must possess a base of systematic knowledge along with a readily available storehouse of experience with human conflict, crisis, and suffering, and also that definite shared elements in the ongoing therapeutic interaction with a particular patient play an important role. Such experience, however, is not alone sufficient for creative empathy; particular modes of listening and activity are necessary.

To apply creative empathy, a therapist actively conceives himself as occupying the same space as the patient. Mentally, he superimposes himself, or numerous images of himself, onto a patient's spatial location. These images may involve several or all sensory modalities, and a therapist may conceive what a patient sees, hears, smells, feels, tastes, and how a patient moves. Furthermore, because space is not experienced merely as a physical factor, but as a complex phenomenon involving subjective psychological experience, a therapist naturally includes feelings, thoughts, and perceptions intrinsic to a patient's spatial habitus and location. As one actively conceptualizes one's own posture, movements, and voice superimposed onto a patient's posture, movements, and voice—along with accompanying memories, ideas, and feelings—one begins to articulate new formulations. These new formulations are particular and specific empathic interventions.

In order to use the homospatial process to facilitate creative empathic intervention, a therapist must possess a strong sense of his own separateness as he superimposes images of himself onto the patient's space or spatial location. In order to use the process to produce effective metaphors, a therapist superimposes separate imaginal elements from the patient's experience, the therapist 's experience, or from both together. Both types of applications of the homospatial process, metaphorical intervention, and creative empathy, should serve to facilitate the therapeutic endeavor rather than merely to demonstrate a therapist's cleverness or creativity.