Book Review: Improvisational Therapy

RfG Newsletter, Volume 2, Number 2, Winter/Spring 1993

Improvisational Therapy
by Bradford P. Keeney
Guilford Press, New York, 1991.

In this slim (121 pages) volume the author first calls for and then presents an innovative and promising way to re-conceptualize psychotherapy as a performing art instead of a medical or scientific enterprise. Additionally, he champions the therapist’s use of Self to be spontaneous and original, both to the development of his/her own, unique approach and to each case and each session.

Keeney’s view of the therapist as an improvising artist, rather than impersonating devotee, leads him to characterize existing schools, orientations and models of psychotherapy as:

“…portraits, exteriorizations, or rationalizations for the people who invented them. They are simply examples of different people’s ways of evolving a style that fully utilizes their own unique resources in a particular context.” (p. 3).

He then goes on to trace the progression of existing schools from their “originating insight” through a written canon to the foundation of bureaucratic (and, I would add, theocratic) institutions, and finally, to the deification of “master therapists;” all of this constitutes a danger to the freshness (and creative insecurity) of clinical artistry.

The book is organized as a coherent sequence of strategies for understanding and acquiring the tools of a custom-tailored therapeutic style, one which Keeney describes as improvisational, or “being creative with what you know.”

In Chapter 2 he uses the analogy of a jazz musician who uses a song or tune as a basic structure for improvising; the chapter is described as a songbook of a variety of strategies from different therapies. Thus, the improvising therapist need not play the same song endlessly as would therapists wedded to one school. The examples offered all involve metaphor, ritual, and/or re-contextualizing the experience of therapy; I found them intriguing and worth trying out.

In Chapter 3 Keeney presents a method of creating interventions out of the verbal metaphors clients offer and illustrates the process with numerous case examples. In Chapter 4 he first utilizes the analogy of scriptwriting to guide the reader into an appreciation of the importance of attending to the underlying “story” of the therapeutic session. Then, he begins to introduce a notational method of scoring therapeutic conversation, which is compared to the “fake books” musicians use to access the outlines of songs. Next, he likens a psychotherapy session to a walk through an art exhibition, where frames, the contexts that therapists and clients offer one another, are organized into galleries. At the beginning of the session, the client typically leads the therapist around the presenting gallery, which contains the client’s problem definition and problem explanation frames. Conceived in this way, the therapist looks for openings, or doors by means of which conversation can be moved into the more resourceful therapeutic galleries. Diagrams assist the reader to follow the application of this method to three successively more complex case examples.

Chapter 5 elaborates the method developed in the preceding chapters to classify the therapeutic moves that therapists can use to make a difference in their conversations with their clients. Keeney likens these to chord progressions and embellishments used by jazz musicians. Chapter 6 is a detailed, annotated clinical case which illustrates the application of the previous chapters’ material.

In the next-to-last chapter, titled “Creating One’s Own Clinical Style,” Keeney first returns to his warnings of the dangers of inflexibility and orthodoxy in therapy and then offers a 58-question self-assessment to bring out personal resources and identify the uniqueness of the therapist. I found many of these questions provocative and useful; three of my favorite ones are: (a) Fantasize directing a movie entitled, “The World’s Most Successful Psychotherapist.” Use a brief phrase to describe this therapist’s work. (b) What are the most outrageous things you’ve ever done in your therapeutic work? (c) In one sentence, what is the most mysterious aspect of psychotherapy?

The answers to these questions constitute a comprehensive list of resource frames that are to be sorted into the two groupings of beliefs and understandings and therapeutic actions. With the aid of an example Keeney next guides the reader to identify the patterns of his/her therapeutic style by attending to the orchestration and sequencing of one’s own resource frames when conducting therapy. The stated advantages of utilizing this process are: that it allows the therapist and/or supervisor to draw upon the therapist’s own natural resources; that new resource frames may be identified, leading to the design of a new approach; that (eventually) the therapist may become resourceful enough to design a unique therapy for each unique client.

In his final chapter, “Being an Improvisational Therapist,” Keeney once again extols the virtues of creativity, that enemy of tradition and institutional politics. Improvisation invites playfulness and unpredictability; paradoxically, knowing oneself too well can undermine spontaneity. He closes by offering a ritual of discovery and renewal of such a self-understanding, ending with the question: “Do you really want to know?

While admiring its ingenuity and usefulness, I nonetheless have some reservations about this book’s claim to being about improvising. For one thing, the presented universe of therapeutic echnique is The Verbal; there is no mention of emotional expressiveness, nor of movement, nor of enacted fantasy. The techniques offered may be, at best, taken as a preparation or foundation for improvising but they do not include the therapist’s warming up to playfulness or spontaneity in the moment.

To be sure, the printed page cannot be a sufficient teacher of experiential learning, yet a book like Keith Johnstone’s Impro (reviewed in our first issue) inspires at a level not reached in Keeney’s book. This work will offer the therapist-reader concrete methods of inquiry regarding his or her therapeutic style and useful ways of guiding clinical sessions, but the tone is too didactic and programmatic to lift the spirit. As an improvising musician in the Broadway musical Jelly’s Last Jam exclaims, “That’s not music, where the notes be written down– that’s like gettin’ up in the mornin’ knowin’ you’re gonna be alive at the end of the day!”