Songwriting and Psychotherapy

(This essay is in the Summer 2010 issue of The Illinois Psychologist, the newsletter of the Illinois Psychological Association)

I’m a singer-songwriter, and I subscribe to a folk music listserve on which a singer-songwriter posted this question: “How do you separate ‘songwriting’ from ‘performance’ when listening to a song that you wish to evaluate for it’s merit?” He continued: “There are some aspects of the performance of a song that you can think of as purely ‘writing’ (clever use of metaphor), and some that are purely ‘performance’ (great voice). But some of the finer points of a song include ‘phrasing,’ ‘dynamics,’ and ‘emotional connection.’ Are these related to writing or performance?”

This question sparked a lively discussion, capped by this comment from another singer-songwriter, just returned from a major folk festival: “Having just witnessed many outstanding singer/songwriters, I truly believe that you can’t separate the performance from the song.”

It seems to me that the question of the quality of a song compared to how it is performed is similar to the question of the quality of a therapy compared to how it is actually done.

Take Gestalt Therapy. Fritz Perls cleverly selected aspects of psychoanalytic theory and practice, Gestalt psychology, Zen meditation and philosophy, psychodrama, and existential humanism, and amalgamated them into a form of therapy which, when he did it, was often very powerful. People who’d been in other forms of therapy for years suddenly found themselves having insights and making breakthroughs. Perls thought he was creating a new form of therapy which would create a kind of revolution in therapeutic practice, but it hasn’t really caught on.

Why hasn’t it? Perhaps because its practitioners haven’t enjoyed the same success that Perls did. And why not? The answer seems to be that, in addition to the structure or form of Gestalt Therapy--the empty chair, the free-floating and focusing of attention, the role playing, and the view of human nature--there was Perls‘ own personality, his therapeutic skills honed over a lifetime of intensive questing and practice, including his fluency at catching and using patient imagery and transference. There was also the special mileau that evolved around him at Esalen, the growth center in California where he did much of the work which he is most famous for, which facilitated a self-organizing population of patients who were mostly well prepared to work with him.

I like Gestalt Therapy, and continue to find it useful with some patients at some times, but it has not become the presence in the therapeutic marketplace that Perls hoped for. There is the “songwriting” of Gestalt Therapy, and the “performance” of it, and no one “played” it like Perls.

The metaphor of the “song as written” and the “song as performed” applies across forms of psychotherapy. I recently read (and wrote a continuing education test on) “Cognitive Behavior Therapy and Eating Disorders,” by Christopher G. Fairburn, in which Fairburn discusses a form of therapy that he calls ““enhanced cognitive behavior therapy,” or “CBT-E.” Describing the steps of CBT-E, which is expected to resolve eating disorders in most patients within 20 weeks, Fairburn emphasizes that “Engaging the patient is the top priority.” To achieve engagement, he recommends that therapists “Be empathic and engaging in manner; Ask the patient what name he or she would like you to use and state your name; Be professional but not intimidating; Actively involve the patient in the assessment process; Instill hope; Avoid being controlling or paternalistic; Repeatedly...check back that the patient is ‘on board’...(and) “Enquire about any concerns that the patient might have.” Clearly, before even getting to the steps of CBT-E, Fairburn is focusing on therapist “performance” here. It is as if he were saying, “My song will work for you as well as it works for me if you sing it the same way I do.”

Psychologist Jonathan Shedler, giving the keynote address at the recent Division 39 (Psychoanalytic Psychology) conference in Chicago, referred to research indicating that most of the effectiveness of psychotherapy is due to the alliance between patient and therapist. Looking at the work of Perls and Fairburn, we see two therapists who are expert at establishing a relationship in which patients feel hopeful, encouraged and engaged with a person and a method that can help them transcend their emotional suffering and behavioral pitfalls and get on with their lives in a better way. Yet the therapies practiced by Perls and Fairburn could hardly be more different.

If we can’t really separate the “song” from the “performance,” the form of a therapy from how each therapist practices it, then every therapist is, in a way, co-creating, or at least modifying, the form of therapy, every time she or he does it, with every patient.

How about that!