Exploring the Therapist’s Use of Self: Enactments, Improvisation and Affect in Psychodynamic Psychotherapy

Psychoanalytic psychotherapists, drawing upon intersubjective and attachment theories, recognize that mutual influence impacts the treatment process. Mutual influence generates enactments—emotionally intense joint creations stemming from the unconscious of both therapist and patient—which often leave both patient and therapist feeling confused and stuck. The author presents a case in which the therapist’s use of improvisational role play was a critical therapeutic response to an enactment. The therapist’s self-expression through the displacement of the role play 1) modeled a safe, affectively genuine engagement in relationship, 2) provided the patient with an unexpected and powerful window into the therapist’s emotional world, 3) shifted the patient’s fundamental belief that fathers and men are cold and unfeeling, and 4) led the patient to uncover “new” early memories and to become aware of his role as an agent of vitality and intimacy. The author concludes that using improvisation as a flexible response to rigid patterns of enactment may provide a catalyst for therapeutic change.