On Play and Enjoyment and Laughter in Psychotherapy

  As Arthur Leonoff commented in his necrology for Dr Louise Carignan, who was my psychoanalyst for seven years, she had a very memorable and infectious laugh. I don't remember what provoked it on one particular afternoon while I was lying on her couch, but the memory of that laugh has stayed with me more than twenty years later. It helped me realize that psychoanalysis and psychotherapy were not solely about solemnly entering into deep, dark waters of trauma, but should allow for occasions of laughter and enjoyment. 

This is a theme I first found in the great Nina Coltart, about whom I wrote here at some length, reflecting my longstanding gratitude to her. Her book Slouching Towards Bethlehem was what inspired me to seek out Dr Carignan in the first place, and in that book she stoutly and rightly insists that patient and therapist should be able to find humour in situations and therefore to laugh together.

More recently, I have been hugely indebted to Adam Phillips, including his recent book The Cure for Psychoanalysis. It is in that book (about which more another time) that he reminds me of what Winnicott (whose biography Phillips wrote more than thirty years ago now) said about the role of playing and enjoying in psychotherapy. 

Though I wrote earlier this year a few jottings on D.W. Winnicott on the fiftieth anniversary of his death, I had not then quite managed to finish Playing and Reality, which I now have thanks to Phillips drawing on it in his recent book, where he says that "what appeals to me about Winnicott is his wish to enjoy the patient's company." Just so. 

Reading DWW is always such a wonderful experience. You never have to worry about being bamboozled by theory or assaulted by polemics, or confused by turgid and abstruse sentences. I really do have the feeling, through Phillips' portrait and others I have read over the years, that you could indeed see DWW making and enjoying a cup of tea with his patients. This still comes through even today in his writing, many of whose basic insights seem to age really well. (I have recently found some of his writings in Through Paediatrics to Psychoanalysis on the possible meaning of adolescent stealing helpful to thinking through a very difficult case I am involved with clinically.) 

In Playing and Reality, DWW stoutly opens his third chapter by insisting: "Psychotherapy has to do with two people playing together." He goes on to say that if the patient is incapable of playing, then this must be the primary clinical task: to help them get to the point where they can play. In other words, modifying a famous Freudian saying, I would say "Where inhibition was, there shall playing be!" Or--if you will indulge me one more--modifying an equally famous saying of Ferenczi, the patient is not cured by playing but is cured when s/he can play (and do so, presumably, on his or her own). 

Later in the chapter, DWW says that health can be defined by the extent to which one is capable of playing, and that such playing "is itself a therapy." But in a clinical setting, there is a particular type of playing: "the playing has to be spontaneous and not compliant or acquiescent if psychotherapy is to be done." It cannot be coerced, in other words, but creative (a word DWW makes much of throughout this book) and always free. 

This, of course, requires certain things from the therapist, and here DWW is again equally direct: "If the therapist cannot play, then he is not suitable for the work." Therapists can also wreck the play of therapy, DWW warns, if they behave like experts who understand all the possible configurations of a game and act from this position of presumed omniscience instead of being at one with the patient in not knowing in advance how the game will play out. 

This, we know from several sources, is very much how DWW was with his patients, not just because he reports this to us, and his wife also noted this in a moving and important essay she wrote after his death, but also from some of his analysands including, perhaps most famously, Marion Milner, who charmingly recounts of DWW that was "on excellent terms with his primary process"! 

It is of course common today for therapists to have websites on which they advertise their philosophy of treatment, location, fees, etc. But in all my perusing of these, I have never once come across anybody who says that "Psychotherapy has to do with two people playing together." Imagine having that on a banner atop your website, or framed on your waiting room wall! 

Nor have I seen any self-descriptions by therapists today that they are on excellent terms with their primary process! Their websites sometimes groan under the weight of degrees and credentials, yes, and additional certification and training in whatever the acronym du jour is--certainly. But to advertise oneself as being on excellent terms with one's primary process?

If we cannot be playful and find the work enjoyable, and laugh at ourselves and with our patients, then it seems hardly likely that we will be able to keep at it for long or to do it very well. Thank God we have the witness of Donald Winnicott even fifty years after his death to save us from such ponderousness and to remind us of playing and enjoying not just outside our consulting rooms but within them.