Creative Process in Psychotherapy: Form and Structure as A Basis of Treatment

Because of the structural nature of psychotherapy, the particular unfolding structure or form of each therapy session, including cognitive methodology, requires special focus and attention.The sequence and pattern of communications within the session provide an understanding of the patient's interpersonal responses and intrapsychic meanings.Also, sequences and patterns between therapy sessions, such as when a therapist makes a mistake at the end of one session and the patient begins the next session vaguely angry and complaining, require attention and possible interpretive intervention.Broader patterns involving the beginning, middle, and end phases of therapy are reflective of the patient's characteristic ways of experiencing the phenomena of encounter, growth, and separation, respectively.When the therapist intervenes on the basis of his understanding of such structural factors or, going further, when he or she points out such sequences and patterns to the patient, he or she is focusing on structure or form to generate meaning in a therapeutic making and creative process. MethodsI will present specific interchanges from actual psychotherapy treatments to illustrate the focus on form and structure.Following these I shall describe findings from investigative interviews with prizewinners authors from the research program "Studies in the Creative Process" that illustrate the focus on form and structure in literary creative work.A young female patient whose therapist was about to go on vacation, for example, began a therapy session talking about her anger and fury at a florist who had been taking care of her plants.She herself had been away from home and the florist had put her plants in a greenhouse, used a pesticide, and they died.While listening to her continuing vituperation, the therapist thought there might be some connection with angry feelings about his upcoming vacation [desertion] but little she said suggested any direct relationship.Baffled by her furious diatribes but, picking up on the plant care issue, the therapist simply commented that she seemed concerned about caring "today."(i.e.his upcoming vacation).Without a moment's hesitation, the patient then became angry.She said that the therapist was wrong and she was only reporting on the events in her life since the last therapy session.Then, she shifted to describe a recent discussion she had had with a male friend and reported his comments in detail.At one point in the discussion, she said, she became very annoyed at the friend because he was just "making conversation."Noting that the patient shifted to talk about this young man immediately after his comment, the therapist surmised a connection with the complaint.He commented that she seemed to feel that he too had just been making conversation earlier, but he knew she really was concerned about caring and being cared for.In response, the patient became thoughtful and then began to talk about her angry feelings about the therapist's lack of care, his impending vacation, and desertion.The focus on the sequence of the patient's productions had therefore provided understanding which, when conveyed to the patient, allowed her to talk about her problematic concerns in a mutually collaborative creative process.In another instance, an adolescent male patient spent the early portion of a session on a series of complaints: not being able to sleep; feeling he had to come to therapy that day; having to sit for a time in the therapist's office.Thinking there was something more to what was going on, the therapist said that he understood that the patient felt like complaining but they both didn't know what he was really complaining about that day.At that, the patient became angry at the therapist and denied that he was complaining at all.Moreover, he had all his life been constantly told that he complained too much and he couldn't take any more of that.He shifted to talk about another topic and his anger dissipated by the end of the session.However, he missed the next scheduled appointment.