Dave: I found a paragraph about surrealism in the New York Times a couple of weeks ago which characterizes part of what I am up to as a therapist. I will paraphrase and quote. Art  is created not to be interpreted but instead to act upon us, in order to “open up in us a little dormant space of weirdness where we can hopefully feel more free.”

“Open up a little dormant space of weirdness where we can feel more free.” This characterizes part of what I seek to do with psychotherapy. Interpretation is less important than ironic therapeutic action. An example follows.

Several years ago I had a fascinating phone conversation with a former patient, Isabel, 24 at the time of the call. She had been my patient 2 ½ years earlier when she was attending college though deeply depressed. She left school a year earlier because of emotional distress that ultimately led to two hospitalizations for “reactive psychosis”. I began working with her when she returned to college. She was in the midst of a post psychotic depression and was referred because she did not want to take medication. I have a reputation for being willing and able to work with patients who do not want to take medication.

The post psychotic depression took the form of dulled thinking and emotion. She was a hesitant patient. My sense was that she was not trying to “understand” her depression. She was trying to find her way out of her head and back into the social world, attempting to prove to her mother and sister that she was not “sick”. She feared that if she opened her mind to too much self-questioning the psychosis would return. Her depression represented both a grieving of the psychosis and a fear of psychosis.

She came to weekly sessions, but was quiet, awkward, uncomfortable, very careful about how to put her ideas or experiences into words. Though ambivalent she came to sessions but was hesitant about allowing the therapeutic relationship to become important to her. It was as though she was simultaneously hungry for a relationship but phobic of letting a relationship be meaningful. My intention was to shepherd her toward change, helping her to discover how to be in charge of herself.

At one point in the series of ten sessions she expressed frustration about a photography project with which she was involved. She was stuck. She didn’t like what she was doing and found herself unable to think. The thought blocking increased when there was pressure. She was an art major with emphasis in photography. In an effort to be helpful her teacher had given her a suggestion for a project. She was working on the suggested project but didn’t feel it belonged to her. It felt like a duty, like homework, rather than her own work.

I listened. An image came to mind. “I have a crazy idea.  Can you stand a crazy idea?” “What is it?” she asked. “You could go around and take pictures of people’s belly buttons.” She smiled, amused but said nothing (Just to add a reality dimension to my primary process idea, this occurred in an era when fashion exposed many belly buttons, especially around a college campus).

In session a month later she said, “Do you remember the day you said you had a crazy idea?”

“I do remember, and I am a little embarrassed about it. I probably shouldn’t have suggested what I did.”

She said, as if not hearing me, “Well, I did it.” She described how she began taking pictures of belly buttons on campus. She was surprised by the willingness of people to have their belly button photographed, men and women. She went on to say the project was even more interesting because the belly button is what’s left over from our attachment to our mothers. The project had her thinking about how we have all been babies and the belly button reminds us of that simple truth. Maybe you could say it reminds us we are all human. This comment is not at all profound unless you take into consideration it came from a woman who a month previously was almost mute and phobic of thinking.

I saw her two more times. She left school for the summer without saying good bye. I didn’t hear anything from her until the phone call 2 ½ years after the last interview.

She called because her therapist thought she should be on medication. She was having trouble studying at times, her therapist thought it a symptom of depression. She wanted to know what medication I had given her because it had helped so much. I reminded her I had not given her medication, that she had come to see me because she didn’t want to take medication. I told her I thought the medication had been the therapeutic relationship with the creativity that emerged and all she became involved with around the belly button photography project. I thought the medication was the experience.

We continued with a conversation about being a patient. She said she did not feel like she was depressed. She loved what she was doing as an art student adding her drawings to her photographs, but every once in a while something happens “that makes me think too much.” “At times like that, I start to cry when I am talking. I hate the way people treat me when I start crying.”

One of the difficult pieces of having gone through what she went through is getting out of the role of patient. This is an issue I work on with people who have had a serious disruption in their experience, or people who have been in therapy for a long time. They do not know how to leave the role of patient and I help them get over being a patient.

Being a patient is a role a person agrees to, so they can have experiences which contribute to growth or to change. But the changeful experience is not complete until they leave the role of patient and assume responsibility for their own life once again. I assumed when I first worked with Isabel that she was attempting to get out of the patient role. I think my work with her was helpful in that regard.

I had a 20-25 minute phone conversation with Isabel. It was surprising given her over-cautiousness when she was a patient. As we neared the end she said, “I feel good talking to you. Thanks very much.” I told her I enjoyed the conversation. I was impressed by her thinking, it felt very creative to me.

She asked if I had published any articles because she wanted to go to the library and look them up. I told her they would be hard to find, so I would send her a few.

She had an experience as a result of my primary process wandering into the realm of belly buttons. My crazy non sequitur of an idea opened up that dormant space of weirdness where she could feel more free.

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