Flummoxing Together: Redefining Therapy with Improv

Improvisation creates more spontaneous and collaborative therapy sessions.

Posted Jun 01, 2020

Photo by Jon Tyson on Unsplash
Source: Photo by Jon Tyson on Unsplash

Sometimes therapy sessions don’t work. I’ve seen quite a few therapists in my day. Sometimes I've had an instant connection and rapport with my therapist, where I’ve been able to open up immediately. Other times, it’s taken more time, and still other times, I just never got anywhere with a therapist. There are modalities, techniques, and frameworks to help therapists connect and support their clients, but that doesn’t stop the relationship between patient and therapist from being a relationship. And as we all know, humans are complicated, and relationships are messy.

Improvisation can give therapists a model to make their sessions more spontaneous and connected. Fortunately, there is an increasing number of therapists, psychologists, researchers, and educators who are examining just how to integrate improvisation into therapeutic sessions.

Dr. Philip Ringstrom, Ph.D., Psy.D. is a Senior Training and Supervising Analyst and Faculty Member at the Institute of Contemporary Psychoanalysis in Los Angeles and one of the earliest proponents of improvisation in therapy. He talks about what he calls improvisational moments during sessions. These are those breakthrough moments that come from therapist and client verging off the path of prescriptive sessions.

During one session, Ringstrom's usually nonconfrontational client confronts him about their previous session. Instead of trying to get to some sort of resolution or prescriptive answer or get the session back on track, Ringstrom invites what he calls “improvisational play” into the session by going along with his client’s complaints about his own competence. Ringstrom explains that this playfulness allowed his client to eventually open up and explore his grief in later sessions.  

Photo by marianne bos on Unsplash
Source: Photo by marianne bos on Unsplash

In Favor of Flummoxing

One way Ringstrom describes his use of improvisation in psychotherapy is “flummoxing.” Besides being an all-around incredible word, I think it cuts right to the heart of why improv can be beneficial in therapeutic settings. 

Instead of purporting to have all the answers, Ringstrom invites his clients to join him in flummoxing. This reminds me of Keith Johnstone’s approach to teaching improvisation. 

Johnstone is one of the famous improvisation pioneers. His seminal books, Impro and Impro for Storytellers, explore facets of improvisation such as status, narrative, spontaneity, and trance. 

I took a Johnstone workshop in Berlin as part of my research for my book Theatrical Improvisation, Consciousness, and Cognition and noticed right away that Johnstone fumbled his words and openly admitted that he didn’t know how certain exercises would pan out. Seeing him struggle, students were quick to offer their help and volunteered as guinea pigs whenever asked.

The next day, he let us in on the secret. It was all an act. Johnstone told us that he had purposefully lowered his status to make us more likely to try new things and feel a sense of ownership in our own learning. Just as Ringstrom does with his clients, Johnstone invited us to flummox with him. Johnstone explained to us that he plays up the role of the bumbling old man to lower his status when he’s teaching. This encourages his students to raise their status to help class run more smoothly. 

If Johnstone entered the class as the ultimate expert and confident, all-knowing authority, he would most likely intimidate his students, which would inhibit them. So he purposefully bumbles and fumbles and tells students that if exercises don't work, it's his fault, not theirs. 

This invitation to flummox and figure things out together allows everyone, client and therapist or teacher and student, to play and explore together. 

Photo by Javier Molina on Unsplash
Source: Photo by Javier Molina on Unsplash


Another aspect of improvisational play in therapy is accepting and blocking offers. Assael Romanelli, MFT, MSW, couples and family therapist, and the artistic director of the Playback Theater company in Jerusalem incorporates improvisation into his classes and sessions. He and Ronald Berger describe improvisational therapy as a kind of thirdness, which is a mental space where both parties accept each other’s points of view or realities. This enhances connection, but it doesn’t mean disregarding differences. 

I’ve written before about how social work refers to this as "meeting clients where they are." In improv terms, it’s called accepting offers.

For example, if my client tells me they don’t want to live anymore, I accept that offer. That is my client’s reality. However, I can accept their offer without discarding my point of view: that I do want them to live. 

Improvisational therapy is all about accepting clients' offers while maintaining one’s professional point of view. 

Romanelli and Berger categorize offers as either horizontal or vertical. A horizontal offer occurs when the therapist accepts the client’s reality or point of view to deepen the conversation. Ringstrom accepting a critique about his own abilities is an example of a horizontal offer in which the therapist takes what the patient is currently saying and runs with it in order to get more detail and understanding about the present topic.

A vertical offer accepts and redirects. Instead of simply accepting that your client is talking about something mundane to avoid getting emotional, a vertical offer might stop them to call back something more substantial from earlier in the hour or from a previous session. A vertical offer can also be what Romanelli describes as a new emotional beat that pushes the session forward.

Photo by Fredy Jacob on Unsplash
Source: Photo by Fredy Jacob on Unsplash

Callbacks and Edits

In improv, callbacks are when players repeat something from earlier in the performance. This creates patterns and themes. By using callbacks, you might get a performance where everyone walks funny or characters all have strange names. This repetition gives improvised performances a sense of cohesion.

Callbacks also show that improvisers are listening to each other and storing the information they think is important. Vertical offers in therapy sometimes work similarly. They can bring details from the past back into the mix to deepen and enhance the therapeutic scene.

Photo by Matthew Kwong on Unsplash
Source: Photo by Matthew Kwong on Unsplash

There is also something called editing in improvisation. Editing is when players decide a scene is over or should change in some way. Unlike a scripted performance, no one knows beforehand when an improvised scene should end or needs a new character. Improvisers are in charge of editing their own scenes, which sometimes means running off stage or running in front of a scene to indicate to the players and the audience that it’s over. When I took the summer intensive at iO Theater, we spent a lot of time on editing, because it took us a lot of practice to be able to determine when our fellow improvisers needed the space to find new discoveries, and when they needed us to just cut them off.

Romanelli and Berger’s vertical offers are a way for therapists to think about their callbacks and editing. Sometimes patients need therapists to ask a probing question to deepen the current conversation. Other times, the therapeutic scene needs to be edited with a callback to get us where we need to go. Knowing the difference requires practice, but at least improvisation gives us a language and framework for more spontaneous and collaborative sessions.

Improvisational Therapy 

Romanelli also led a study with Orya Tishbi and Galia S. Moran that qualitatively measured improvisation's effects on therapists. Using extensive interviews, the study showed that improv helped therapists increase intuitional thinking, playfulness, awareness of emotions, relaxation, presence, animation, daring, and use of improv exercises and personal disclosure during sessions.

When therapists accept their clients’ offers and invite them to flummox, they are inviting a more emergent, less prescriptive kind of therapy. Luckily, there are professionals who are currently exploring this more spontaneous and collaborative therapy, and in future posts, I will feature some of their experiments and discoveries about improvisational therapy.


Drinko, Clay. “Meet Them Where They Are.” Psychology Today, Sussex Publishers, 4 Mar. 2020,

Drinko, C. (2013). Theatrical improvisation, consciousness, and cognition. Springer.

Johnstone, K. (2012). Impro: Improvisation and the theatre. Routledge.

Johnstone, K. (2014). Impro for storytellers. Routledge.

Ringstrom, P. A. (2007). Scenes that write themselves: Improvisational moments in relational psychoanalysis. Psychoanalytic Dialogues, 17(1), 69-99.

Romanelli, A., & Berger, R. (2018). The ninja therapist: Theater improvisation tools for the (daring) clinician. The Arts in Psychotherapy, 60, 26-31.

Romanelli, A., Tishby, O., & Moran, G. S. (2017). “Coming home to myself”: A qualitative analysis of therapists’ experience and interventions following training in theater improvisation skills. The Arts in Psychotherapy, 53, 12-22.