A Moment of Creativity
Picture a moment that arises in the midst of a patient’s psychotherapy: he has just recounted a memory from his childhood that resurfaced near the end of a session in which he has been telling me about his dual frustration with his work environment’s demands upon him for compliance and the momentary periods of intense self-deprecation that break through his narcissistic armor and make him feel like he’s “for shit.” He reacts with a mixture of curiosity and momentary amusement as he relates how, when he was a young boy, he used to stand by the side of the road and yell the word “DOODY” at passing cars. He described his sense of being filled with a mixture of pleasure at its naughtiness and dread that he would be punished for the act, as well as his relief at simultaneously yelling the naughty word at the top of his lungs and having its expression muffled to the point of extinction by the roar of the passing traffic. He wonders what it means, and expresses his befuddlement at its apparently sudden emergence. I, too, am curious, and more than a little intrigued at this first sign of this man’s potential for lightheartedness.
After several failed attempts at encouraging the patient’s own associative process (which felt like a stubborn refusal to play with the image), I settled back and let myself focus on the patient’s description of the scene. As I did, something began to take shape in my mind: the word “DOODY.” I repeated it, varying my cadence rhythmically until the word DUTY suddenly came into sharp relief. This word then gave way to a multitude of associations to the DOODY-DUTY wordplay’s relevance to significant themes from this man’s life: his own lifelong feelings of being “for shit,” in part due to his failure to live up to his own exceedingly high expectations (an introject of his stepfather); a key element of his childhood history (his father’s death due to medical misdiagnosis when the patient was four – a physician’s failure to “do his duty”); the enactment in the moment of the session of the prototypical resistance to the parental performance demands (the production of doody during toilet-training), as suggested by his reluctance to “do his duty” as a patient by way of producing his associations to the material. These and other thoughts play on the thematic interchange of word pairing, images in my mind that I used as guideposts in my successive exploration and interpretations to this patient regarding this memory and its “meaning” as we revisited it repeatedly in the subsequent sessions.
The event depicted is familiar to all clinicians engaged in the practice of psychoanalytic psychotherapy, occurring with some regularity in the passing sessions of our workdays. The creative process involved in the detailed clinical session seems to rest on one’s ability to let go of the confines of particular meanings in moments of spoken words and instead allow the flow of associations not only to sounds, but also pictures and images as well. The example reveals the day-to-day (but still highly creative) clinical exercise of our capacities for moving beyond what is before us in its present form, and instead allowing for the constructive play that creates its new form and subsequent meaning.