a blog of The Menninger Clinic

I play jazz piano and have composed about 70 songs over the past 50 years – a small number in the 1960s and many in the 1990s. My playing isn’t that great, but lots of the songs are really good.

Given my enduring interest in jazz, it’s not surprising that I occasionally have thought that psychotherapy is like jazz: We must improvise. Yet, after a recent dialog with my son, Clifford – a jazz historian and critic – I started to take this analogy more seriously.

Similarities between psychotherapy and jazz

A caveat: In making the analogy to jazz, I am referring (egocentrically) to what I think of as “classic” jazz – a style in the 1960s when I was a teenager and got hooked on jazz. Miles Davis’s Kind of Blue is a prototype. To the uninitiated, such jazz might seem freewheeling. On the contrary, it is highly structured in many respects: time signature, tempo, rhythm, harmonic organization and divisions into fixed numbers of measures.

Moreover, this “classic” jazz often resembles classical music (prototypically, “classical” classical, as in Haydn, Mozart and Beethoven). We are presented with themes and variations, with a difference: In jazz, the themes are written down, and the variations are improvised.

With the caveat comes the distinction between “classic” jazz and “free” jazz, which is loosely structured at most and (to my uneducated ears) can sound like cacophony. Of course, this distinction lies in a broad continuum from more to less structure. I like ample structure along with lots of freedom to improvise.

First effort with psychotherapy

My first effort to conduct psychotherapy (in 1968) was fateful. As a novice, I could undertake this endeavor legitimately, because I was to conduct a highly structured procedure: systematic desensitization for a person with a speaking phobia.

It’s simple. You ask the client to construct a graded series of increasingly frightening speaking scenarios (e.g., from making a point to a few friends to addressing a stadium full of critics). You teach relaxation, and the client imagines the scenarios (from least to most frightening) while maintaining a state of relaxation. Amazingly, it works. It was an “evidence-based” therapy.

But something troubling happened insidiously: The client wanted merely to talk to me about his life. I was stumped, stuck with the written score. I didn’t know how to improvise.

After decades of practicing psychotherapy, I’ve given up looking for the score, embracing improvisation and declaring myself a practitioner of “plain old therapy” – talk therapy.

Prompted by my dialog with Clifford, I looked up “improvise” in the Oxford English Dictionary:

“Compose (music or verse) or utter or do (anything) on the spur of the moment.”

This definition encompasses the whole continuum from classic to free jazz.

I’ve declared myself a plain old therapist because I don’t like too much structure. I find myriad “brands” of “evidence-based” therapies too constricting. From my critical vantage point, they are turning what should be improvised (i.e., intuitive and spontaneous) into a score – too technological, excessively governed by procedures, techniques and rules.

Learning to improvise

I acknowledge a caricature here, which I employ to make a point: Even the most structured of psychotherapies cannot be conducted without improvisation, as I discovered with my first client.

In psychotherapy as in jazz, I am a classicist, preferring improvisation within a structure. I like to have a focus for the therapy: one main theme – or at most a few themes – to explore in an improvisatory way. Often, I like to have a written formulation agreed with the client to provide some handholds for improvisation.

Sometimes, despite my best efforts, I wind up conducting a process more akin to free jazz, freewheeling without structure, everything “on the spur of the moment,” within and between sessions. Sometimes it can seem helpful to the client; I can do it, but I don’t like it.

Now for my tendentious point, based on my first experience as a therapist: Have we constructed all these therapy brands and procedures because we are not good at improvising or too timid to do it?

As I discovered in psychotherapy as in jazz, we can learn to improvise. We have many good teachers and models. As I learned at the outset, to some degree, we must learn to improvise. But many therapists, like me, will need a structure and a style. Kind of Blue works for me, and the title is apt for much of my work.

Tagged as: evidence-based, jazz, phobias, psychotherapy, therapist, therapy

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