Elizabeth Wolfson, Ph.D.
It is commonly understood that the acts of writing and reading can be transformative. It may also be understood, that every story is itself transformed by being read. Here I will discuss how the encounter of writer and reader with text parallels the encounter of patient and therapist with the patient’s story. To illustrate the analogy, I will draw from D.W. Winnicott’s paradigm of the “holding environment,” and discuss the significance of language and metaphor in psychoanalysis and psychotherapy (referred to interchangeably for these purposes). I believe this discussion offers an enriched perspective on the transformative aspects of psychotherapeutic processes.
Writers in all genres express what is remembered or invented, although these distinctions are in fact, rendered arbitrary by the unreliability of memory. A writer who finds her “voice” is empowered by discovering his/her most authentically felt vehicle of expression and, more so, when art results from that expression. The writer whose work is read is gratified by the essential human desire to be “seen” and “heard” and additionally gratified or empowered when what is read is validated and appreciated. This is, arguably, why a writer writes.
Every reader is impacted and changed in the act of reading by virtue of absorbing new information. The impact varies insofar as it may be barely discernible or, so dramatic the result is shattering, healing or transforming in other ways.
Finally, the text itself is transformed in the process of being read through the unique, subjective lens of the reader. In this sense, every reading of a story transforms what is read into a new story as it is absorbed, claimed, and owned by any particular reader.
Susan Sontag (1980) saw writing as a “series of transformations” and said, “The function of writing is to explode one’s subject – transform it into something else” (p. 408). She went on to say:
The language of literature must be…the language of transgression, a rupture of individual systems, a shattering of psychic oppression. The only function of literature lies in the uncovering of the self in history. (p. 501)
The uncovering of the self through writing is therapeutic in its very nature and not unlike the self-discovery that occurs in psychotherapy. In describing the process of memoir writing, the psychologist and writer Lauren Slater (2013) said, “You are really reinventing what you have already invented, and, in the process of reinvention, you find angles and screws and coils and cogs that you missed the first time around.”
From this perspective, every act of writing is revisionary and in every telling of a story, a new story is being told. Edmond Jabes (1993) described the writer’s transformation through the emergence of the story by observing, “What he (the writer) has written is read in the process, hence constantly modified by his reading” (p. 10). Moreover, the writer who is not writing, is “..as if in prison contained by what is not being written and can get free of his writing only by using it, that is, by reading himself” (p.10). For the writer, the act of writing is a necessary act that releases constraints, transforms and engenders action beyond the story. A central premise of psychoanalysis is that patients who fail to examine or who withhold the story of their inner life are imprisoned in their neurosis freed only through the expression of the inner life that is their narrative. It is by “reading himself,” that the patient is able to connect to the authentic self who can move freely in the world.
The idea that books and words transform and heal is well documented in the psychotherapeutic literature. Bibliotherapy for example, draws on text for self-reflection to build upon and enhance the patient’s experiences, life narrative and therapeutic goals. Poetry therapy, or “psychopoetry” centers around the patient’s own poems to evoke feelings and associations. As the therapist attends to the patient’s use of language, imagery and affective experience, “self-actualizing creativeness” is activated (Maslow, 1959). These techniques, like psychotherapy as a whole, are conceptually grounded in the valuing of spontaneity, language, metaphorical thinking, and poetic attitude. The assumption of a poetic attitude on the part of the therapist or “practicing poetically,” relies not on the therapeutic use of poems per se, but on the practitioner’s engaging in a poetic stance (Wolfson, 1998). This includes the practitioner’s openness to being influenced by all that the patient brings including the creative manifestation of dreams, symbols and metaphor.
Metaphor in particular, plays an important role in Freud’s case studies and in all of psychoanalytic theory, through such fundamental concepts as primary process, parapraxis and wit, free association, and dream content. Freud and other analysts, particularly Jung, focused on the connection of metaphor to narrative and to the universal qualities which serve to transcend cultural and other differences. Universal metaphors, symbols, and myths as well as patients’ associations to them are carefully attended to and interpreted as part of the psychotherapeutic process. The language of metaphor in psychotherapy serves the important purpose of simultaneously revealing and disguising the patient’s inner life and vulnerabilities. One essential difference between the writer-reader encounter and patient-practitioner encounter of the story is the actual presence of both participants in the latter as the patient’s story is unfolded. Sanville (1991) notes that in this regard, a writer has opportunities for ambiguity and concealment that the patient may not have as both parties to the encounter are present as the story unfolds.
The practitioner’s attentiveness to narrative and language affirms the patient’s unique experience while allowing the patient to “own” his/her narrative. The patient as writer offers symbols and ideas through language (which is itself symbolic) presenting and playing with language to formulate and present the untold story, as a story for the therapist to read.
As Jung tells us, “The patient who comes to us has a story that is not told, and which as a rule no one knows of” (1963, p.117). The story’s symbols are “…bridges thrown out towards an unseen shore” and it is the analyst’s work to meet the symbolic bridges in the interpretation that uncovers the story” (1966, p.76). The patient and practitioner are joined at this bridge through universally recognized, uniquely experienced symbolic language, in a shared, altered space of resonance. It is here that the patient’s epiphany or transformation may occur. Similarly, the coming together of the writer’s proposed intent and the reader’s integration of what has been presented is an altered space of communion. It is this encounter which allows the story to come into being, transforming the writer, the reader, and the story. As Jabes (1993) said, “The book comes into being by allowing itself to be read” (p. 10).
The power of metaphor’s universality lies in its direct impact on affective processing so that the patient’s story may emerge free from the constraints of cognition. The practitioner’s empathic attunement is crucial in attending to the patient’s language and meaning as well as to nuanced verbal and non-verbal expressions, as Arlow (1979) noted:
The analyst’s listening must be exquisitely sensitized to the various aspects of the patient’s speech, to what is being said, to how it is being said, when and in what context it is being said, to what is not said. This refers not only to the emotional tone or quality of voice used by the patient but also the figurative constellations employed in his language. (p.366)
Empathy, creativity, and play are frequently linked in psychotherapeutic literature. Freud (1914) described transference as a playground that serves as an “intermediate region between illness and real life through which the transition of one to the other is made” (p.154). Winnicott (1971) focused on the interaction occurring on that playground as stated, “Psychotherapy takes place in the overlap of two areas of playing, that of the patient and that of the therapist. Psychotherapy has to do with two people playing together” (p.38). The attuned practitioner empathizes and resonates with what is presented by the patient and is subsequently mobilized to offer creative response. The practitioner’s creative responsiveness allows for the patient’s expression and capacity to ‘play’, free from constraints. As such, the practitioner’s empathy, resonance and creativity are constructs with which the safe “play space” is erected for the patient. In this space, the patient can tell write the story as remembered and also to play with it—to reconsider, modify, and reconstruct it. In being creative and affirming the creativity and validity of the patient, the therapist provides freedom for the patient not only to tell the story, but also to reconstruct a new narrative. Similarly, a reader’s openness to engaging with what is presented by the writer and whatever emerges by engaging with the writer’s story is a creative act of playing with reality as disbelief is suspended. Resonating with the story, the reader is impacted, transformed or mobilized by it.
Meares (1992) posited that the first task of the therapist is to “establish the field of play” (p.26). Zerbe (1990) suggested that the play of the practitioner is to allow for projections and projective identifications to uncover complex dynamics. The range of meanings presented by the patient can be understood only when the therapist’s empathy and creativity are activated. Significantly, the practitioner must have the “ability to play in an area between reality and illusion in order that the patient can begin to play” (Zerbe, 1990, p.13).
The interaction is alternatively defined as intersubjective, with regard to the reciprocal play between the participants (Atwood & Stolorow, 1984). In the reader/writer paradigm it can be said that a writer devises his creation in conjuring the idea of the reader’s responsiveness to the work. In this sense the intersubjectivity of the reader’s role in “playing with” that creation is a crucial driver of the writer’s inspiration. Saari (1994) juxtaposed Kohut’s conceptualization of “accurate empathy” with that of clinical empathy, which is, “to imagine and refine a patient’s perspective of him- or herself through the negotiation of meaning and the creation of a narrative truth rather than through the uncovering of an historical truth” (p.38). What matters then, is not so much the therapist’s correct interpretation of the story’s meaning, but the therapist’s ability to “play” with the patient’s story. Clinical empathy from this perspective is the therapist’s ability to move back and forth from one’s own context to that of the patient in the “trans-contextual” play space (Saari, 1994). This dynamic interchange of play between patient and practitioner allows for the patient’s discovery of his/her creativity and the “True Self,” where the patient’s story can be newly constructed (Winnicott, 1965).
Throughout the professional literature the patient’s experience of the therapist’s attunement has been alternately described through a myriad of concepts including those of being “merged,” “contained,” and “held,” in an “oceanic,” “self-object state,” all stemming from the infant
experience with the primary object. Unlike the infant who is initially merged with the mother, the patient and practitioner are in communion, as two separate beings coming together.
Buber observed that to see the other, one must step back and be separate and that “to merge with another person is not to encounter him or her, as one cannot encounter something that one is” (Cooper, 2003, p.137). Buber’s conceptualization of the I-Thou meeting assumes two separate entities remaining separate. The I meets the other (Thou) in the present, with full acceptance of its wholeness, otherness and also, potentiality beyond the present. A reader of text enters the space of potentiality in which the story will unfold, while maintaining separateness from the story. In psychotherapy the patient and therapist are distinct entities joined through the language of the patient’s text. It because of this separateness that they are able to appreciate one another and the story emerging in the potential space between them.
It is critical that the space be experienced by the patient as safe, because what will unfold in that space is unknown, and, for this reason- potentially dangerous. Jung (1966) emphasized that psychotherapeutic encounter had to be “a safe container,” and Winnicott delineated criteria for a confirming “holding environment,” in which the yet unknown story might freely and safely emerge. In the safety of this space, the patient’s openness to the unknown and willingness to not know what will happen activates creativity and growth.
“Potential space” was Winnicott’s term for the safe interpersonal field in which one can be spontaneously playful in the presence of the other. The negotiation of the space is in the hands of the “good-enough” mother who is attuned to the infant’s nuanced needs for dependency and autonomy, and knows when and how to step in and out of the space. The “good-enough” therapist comes forward, or steps back as needed, allowing the patient to present and own the story through creative, genuine discovery-paralleling the infant’s discoveries in the presence of the mother, in this case discovering the story from which other stories will emerge. The potential space is a dynamic and flexible space insofar as the story is not only “held” but expanded as it is expressed. In Winnicott’s infant-mother situation, the infant who is free to play and create develops the capacity to be alone, so that the creative self can emerge. In psychotherapy, the “potential space” allows for expression of the patient’s inner life and for the telling and reconstruction of his/her story. Here, the patient finds his/her writer’s “voice,” as the story is read in the presence of the therapist.
The therapist as reader is impacted and responds to the patient in ways that engender creative play and meaning-making. The growth process is a movement towards self-discovery and a new discovery—and as in writing, the author/patient finds and uses his/her authentic voice. Just as in the encounter of writer, reader, and story- all three entities are changed, in the patient/practitioner encounter of patient, practitioner and patient’s story, all three entities are impacted and a new story is formed. The therapist’s engagement with the narrative as a reader is a validation of its coherence and potential as a change agent and, as a story that can be changed. Through this process, the patient becomes connected to what Winnicott (1965) terms the “True Self,” who is “a creative and spontaneous being.”( p. 150). As Winnicott (1965) tells us “Only the True Self can be creative and only the True Self can feel real,” ( p. 148). In discovering the voice of the authentic or True Self the patient arrives at a re-constructed narrative-a new “story of I.”
The authors Parker and Wiltshire (2003) drew from an object-relations perspective to distinguish between story and narrative. Contrasting story with narrative, they define story as something told, and perhaps recorded or chronicled, to another. In contrast, the narrative is coherent insofar as “…relations are found between things that are recalled or represented. It involves reflection upon the material” (p. 100). From this understanding, it is the “re-storying” of life experience into narrative that transforms and facilitates greater acceptance of what has happened.
Building on this distinction, it is understood that while a person can reflect on his/her own story, the therapeutic process serves to make sense of a story so that it becomes narrative. Patient and therapist unfold the patient’s text together for purposes of revision into something from which meaning can be derived. Just as true art, while infinitely expansive, must resonate for the listener or viewer, in psychotherapy the patient’s constructed narrative must ultimately be understood insofar as meaning is made of it.
Dimaggio, Salvatore, Azzara, & Catania (2003) suggest that a fundamental aspect of psychotherapeutic change is the re-constructed self-narrative emerging from “the modification of the dialogue that takes place between the characters inhabiting a patient’s self” (p. 156). They posit that the new narrative is that which “arises out of a relationship between characters negotiating the meaning of events with each other, with one of them emerging as the dominant one and taking control of the situation” (p. 158).
The patient’s new narrative is the coherent narrative connected to and owned by the authentic self. This ownership coincides with and is facilitated by the “good-enough” therapist stepping back and allowing for the patient’s letting go.
Lobb and Amendt-Lyon (2003), describe this phase from a Gestalt perspective, as “post-contacting,” in which “both therapist and patient withdraw from the contact boundary to allow the possibility of digesting the acquired novelty, in order to integrate it…” (p. 42). It is a place of opening space “where the partners disengage from the specific meeting and can be alone in the presence of the other” (Lobb & Amendt-Lyon, 2003, p.44). Winnicott viewed the “capacity to be alone in the presence of the other” as central to healthy development, entailing full ownership of one’s inner life–the willingness to read, write, and revise one’s own narrative.
Winnicott described the conditions of this environment as one of holding, handling and object-presenting as the mother holds the child, handles it and presents objects to it, whether it is herself, her breast or a separate object. The practitioner is tasked with holding the patient’s story as it is told, handling it (illuminating, probing, questioning, suggesting) and being available to participate in the creative play of re-telling and revising the patient’s story. The “good-enough” practitioner supports the gradual autonomy of the patient at play, letting go in small steps. The transitional object of the infant-mother dyad plays a significant part as the mother allows the infant freedom to play, interact with, and fantasize about it imaginatively, and/or within the realm of reality. Its “transitional” status is between the child’s imagination and the real world outside the child so that it is both real and made-up at the same time. The transitional object allows the child to enter the experience of both creating and discovering the object, not unlike that of the writer who creates and discovers at once. Over time, Winnnicott’s transitional object changes and loses meaning, and the “neither forgotten nor mourned” child is able to let go of the mother and the object and develop a more independent existence (1953, p. 92). In the therapeutic holding environment, the patient is empowered to expand his/her creative capacities, discover and test his/her story. The new narrative is both imagined and real insofar as it is uniquely and subjectively produced by the creator, while also meaningfully connected to the world. The patient is able to let go of the therapist but is never completely isolated as the story connects to the world beyond therapy. When the patient leaves therapy, the revised or re-created story of “I” is the transitional object to future stories. This transitional object, like the writer’s story, is a bridge between playing and reality, from the inner life of fantasies and projections, to the social world.
The story of “I,” while owned by the patient, is not a fixed object, but rather a preparation for what happens next in the patient’s life-the writing of future stories. As Jabes (1993) tells us, it is as if “..the aim of writing were to use what is already written as a launching pad for reading the writing to come” ( p. 10). The patient ending psychotherapy owns the new narrative of the true creative self as a transitional object into the world and as a launching pad from which all future stories will begin.
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Elizabeth Wolfson can be contacted at: email@example.com