I do have concerns, though, about those children who have been taught to play a sport, a musical instrument, or a complex board game, to the exclusion of playing which is the freer, more creative, and developmental activity.  = Being With and Saying Goodbye, Ch 5 Thinking

I joined Oxford Improvisers in 2018 because I am a musician as well as a clinician and was in need of stimulation and a new direction. This turned out to be a brilliant move, and further explanation is perfectly relevant to Therapeutic Attitude.

In Oxford Improvisers I found myself immediately welcomed, and at home. Home, of course, is a secure place from which one can venture.

Exploration requires a secure base, as attachment theory has taught us, but there is no certainty* in terms of the anticipated outcome. The confidence shown by the clinician, then, must be a confidence in process coupled with an optimistic acknowledgement of the uncertain future” (BWSG Ch 4).

In that chapter, which is on Uncertainty, I consider “an appropriate analogy [for the practising clinician] to be that of the improvising musician who uses landmarks and artistry, and is confident that the result will be music whilst not being at all sure what will actually come next”. I was already describing clinical work in child and adolescent mental health as improvisation, though I had little experience of musical improvisation at the time.

The picture above, taken by Gabriele Pani and tweeted for @OX_Improvisers , shows overlaid objects; a piano (barely visible in this version), toy piano, guitar, watch, plastic spoon, drum sticks and mallets. What moves me about this picture is that each of these objects is taken seriously and lightly at the same time. The same is true of participation.

The difference between participants is respected; indeed this difference is essential to the activity. At the same time participants are valued equally; valued to the same extent, but for different reasons or qualities.

Uncertainty is not only accepted; nor even simply embraced; it is encouraged and nurtured. Any “rules” introduced are not to constrain movement, but to provide something to bounce off.

From the conclusion of Chapter 3, The Nature of evidence, I have selected the following points:

  • For the development of an individual existence there must be freedom of movement.
  • If statistics and “facts” are to be used in relation to human growth, they must be understood such that the individual’s room for manoeuvre can be demonstrated.
  • This amounts to an attitude of irreverence towards the apparently immovable.
  • Humour in the clinical setting reveals the creative space between how things are and how they might be.
  • Despite humanity’s constant search for certainty, possibility and hope can only exist where there is uncertainty.

This all contributes to the attitude of clinical practice that evolved through my own working mid-life and that I have come to call Therapeutic Attitude. Small wonder that I found myself a new home with a group of free musical improvisers on retirement from my NHS job. Therapy has to be creative and for therapeutic creativity one requires freedom of movement within a safe space.

♫♪♫♪♫♪♫♪♫♪♫♪♫♪♫♪♫♪♫♪♫♪♫♪♫♪♫♪♫♪♫♪♫♪♫♪♫♪♫♪♫♪♫♪♫♪♫♪♫♪♫♪

*PS in the lines quoted above I actually wrote “security” but “certainty” gets us closer to what I was thinking.

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