The Mutual Creative Process of Psychotherapy

Creativity consists of the production of entities that are both new and valuable (useful, meaningful, aesthetic, or constructive). Creativity in the practice of psychotherapy consists of both therapist and patient being engaged in mutual production (creation) of new and valuable attributes in the patient.

When a radically innovative artist, such as Paul Cezanne, creates a new mode in painting, this is not totally divorced from anything that was ever done before. We appreciate the accomplishment of Cezanne partly because his work has links and continuity with that of past artists, especially the Impressionists. Creativity in psychotherapy produces changes that are continuous with aspects of past personality and emotional constitution.

In the course of creative psychotherapy, what the patient chooses may often not coincide with the therapist's own personal preferences. Nevertheless, at the points when such choices are made, it is incumbent on the therapist to be facilitative or, at least, not to interfere. Such points are not always easy to identify; they are manifest when the patient indicates thoughts and feelings involving freedom from past restrictions and determinants and active pursuit of self-directed and self-defining goals. When these emerge, the good therapist knows that he or she must listen in a way that allows them to develop and evolve. In a similar way, creative artists interact in a facilitative or a noninterfering way with developing forms and structures in their materials.

In order to collaborate in the mutual creative process, the therapist uses a variety of cognitive procedures and approaches. The Janusian (1) and homospatial (2) processes were previously described here at Psychology Today as well as the sep-con articulation process (3). This latter process consists of actively conceiving and using separation and connection concomitantly.

As dynamic psychotherapy is based on science, the therapist must derive his or her technical, cognitive approaches from a systematic body of knowledge and theory. He or she translates assumptions into hypotheses, which are tested in an ongoing way through the work with patients. While a freeing-up from the past is one aspect of psychotherapy that facilitates creation, particular additional factors must be involved. An example excerpt is the following:

Patient: I’ve been thinking about my problems with handling money [pause]. I’ve always had money; money has always been given to me, but I don’t know how or why. Having money that way has stopped me from learning to do anything.

Therapist: Is it too late to correct this?

Patient: I’m scared shitless of taking responsibility for myself.

Therapist: How does that make you feel afraid?

Patient: I’m afraid I might fail.

Therapist: Are you really afraid of failing? [separation]

Patient: Maybe I’m… actually afraid of doing… well, that’s possible... [in saying this, the patient has paused and hesitated repeatedly].

Therapist: You also seem to be afraid of doing well in this session with me—afraid of doing well in therapy.[connection]

Patient: I seem to feel that I must punish myself for something.

Therapist: Is it just one thing?

Patient: I am not sure. I think it’s one thing. It has to do with sex, I think [pause]. I always liked climbing trees; I did a lot of that in my life.

Therapist: What is the connection?

Patient: [several pauses] There was a tree in front of my house. I climbed it when I was three years old… never was able to climb to the top, but later I did a lot of tree climbing. [At this point, the patient looked very anxious and began staring.]

Therapist: What happened just then?

Patient: I feel vacant.

Therapist: Perhaps that feeling in here has something to do with a feeling that you are climbing high up and succeeding in something.[connection]

The therapist’s connecting interpretation, just stated, served to relieve the patient’s anxiety. He then went on to clarify that he had a sexual sensation when climbing the tree. The issue became further clarified in the sessions throughout the remaining months of therapy as the patient increasingly separated out his fears of success and simultaneously connected those with forbidden sexual feelings about his mother.

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An understanding of the particular psychological factors involved in the creative process enables the therapist to apply creative outcomes directly in his therapeutic work.

Although therapists correctly discourage patients' attempts to become just like or a carbon copy of themselves, some degree of modeling seems unanalyzable and is, therefore, an inevitable component of the therapeutic process. Given such inevitable modeling, could a therapist expect the patient to undergo the enormous risk of changing himself and of actually engaging in creation if the therapist himself is unwilling to take any risks? To move with the patient toward the valuable and the new, the therapist should take risks, think flexibly, and engage in the highest degree of creativity of which he or she is capable.