Perspectives on
Adam Blatner, M.D.

Supplement to a presentation given on September 19, 2012, at the California Institute for Integral Studies in San Francisco. 

(Note, I kept making changes and this paper is thus provisional, not fully polished. Bear with me and use this to ask questions in person or via email.)

A number of books about different approaches to psychotherapy neglect the power of the arts to bring people out in ways that more word-oriented therapies cannot. Some people---maybe you---do better in expressing themselves through various non-verbal, non-languaged media. Poetry has words, but they draw on images rather than abstract logical constructs. Drama partakes of the immediacy of both nonverbal and verbal modes and also is more in the form of dialog rather than presentation. Indeed, many associated with the field of narrative psychology argue cogently that people experience their lives more as stories than as case studies. The problem is that few people have encountered significant others who have noticed, accepted, and validated non-languaged forms of expression. But you have recognized how valuable all this can be, and so I view you not just as therapists, but also as pioneers. I'm a physician and I've been interested in the history of medicine. (I went to U.C. medical school only a few miles from here at the beginning of the 1960s.) Many breakthroughs in anesthesia, bacteriology and germ theory, the idea that some diseases can be caused by nutritional disorders---all are examples also of the way a field might need to open to a relatively unexplored side-field in order to advance. I believe that psychology and psychotherapy need to open to the power of the constructive non-rational modes of experience and expression.

What this offers is not just communication to others: More, what people discover is that they themselves have sources of imagery and inspiration, movement and vitality that transcend standardized modes of education. If no one notices or validates these modalities---and for many---perhaps most people---they are not validated---then their value cannot be integrated. They seem to the person to be oddities, eccentricities, quirks, and are either stifled or enjoyed alone. What if we can acknowledge these facets as values! Wow!

I've looked through your textbook on multicultural counseling; it's on the whole pretty good, but it omits the potential of the creative arts as a vehicle to promote mental health. The closest it comes to it is a vague mention of creativity within the section on positive psychology. So I’ll say something about creativity.

Many people don’t think of themselves as creative. And in truth they aren’t, at least to their way of thinking. Actually in a subtle way they are creating all the time insofar as improvising variations to ordinary tasks and conversations. But creativity to most folks implies truly impressive performances.

So in my role of psychiatrist and mainly psychodramatist, I want to zoom-in on Moreno’s philosophy of creativity, because the promotion of the true spirit of creativity through psychodrama was in fact only one of many methods to this end. In his journals were some of the earlier papers on art and dance and poetry therapy. The thing was to be creative—and to do that one improvised.

So part of the misunderstanding of creativity was the focus on the product as impressive. Another part was to focus on the product at all, rather than the process. In fact, most creativity in the world does not result in a product that is really even effective. Part of the creative process is doing it again, persistence, revision, fiddling with it, or as Edison put it, 1% inspiration and 99% perspiration.

Aside from the product, to focus this on therapy, most people don’t know what it feels like to channel genius—not big genius, but just in the original Latin—the tutelary spirit that inspires, in- spirit— the feeling of the flash of what Moreno called “spontaneity.” Many of you have had this experience of losing yourself and being in what Csikszentmihalyi calls “flow.”

What you allow people to do, help people to do, is to experience the action of the creative subconscious, to be filled with a certain kind of spiritual energy that is essential creativity. People don’t know they have this. There are few or maybe no other theories that talk of it. It’s pretty obvious.

The Axis of Inspiration

In Kundalini Yoga they have the chakras, and you probably have all seen these diagrams of the seven chakras. The logo of the CIIS captures that in a sense, the shree yantra viewed from the top. A discourse on the chakras is irrelevant at this point and undoubtedly incomplete, but there’s a hint of a frame here: People learn to love at second chakra and to become competent at third and to open their hearts to include at 4th—but what you help people do is open to the spirit at 5th, to surrender to being inspired.

My point is that this offers a powerful root of healthy self-esteem. Sure you mess up, sure you’ve got a lot to learn in life, but most people don’t know and maybe you partially know—you’ve got a friend, as the song goes. You’ve got a part of you that heals and glows and gets glorious and this is what Moreno sensed, too. When you open to your creativity, it’s as if you’ve got a team of angels devoted to you and they want to and are able to help you. It’s partly a healing of the gap of uncertainty that people have about parental love or other people love and whether or not you deserve it. It charges you energy field and everyone can do it; but very few people know that they can and know how to. That’s what the creative arts opens up.

This is difficult to explain because it is sensed intuitively, but it’s amazing. It’s one of the reasons you often love others and one of the things that others love about you—that you to some little or moderate extent at times become transparent to this holy energy of creativity. How did you do that. You are jaw-dropping-ly amazing-mentey! It’s so sweet, and perhaps you’ve on occasion noticed this about your own self.

Helping people to discover it repeatedly until they know they’ve got the angle of warming up to spontaneity, to a kind of surrender, and to the magic holy flow that comes with it—this is hugely therapeutic, and I know of no books on therapy that mention it. Not having access to this flow is in turn a very subtle, inexplicable downer—and this is described very crudely as feeling dry rather than juicy.

The Types of Expressive Therapy

It’s an exercise of your visual imagery to discover that you can create interesting figures. One approach I encourage is the idea of the mandala. There are hundreds of these on my website. You make a circular diagram—it need not be exact. You put  a rough or relatively more exact geometric figure in it in light pencil and then with that structure you doodle. When it comes out even roughly symmetrical, it ends up looking good. You’ve made a mandala. You can do this in pairs, too.

It’s an exercise of musical imagery to hum a melody and then evolve it improvisationally into a larger simple tune. Maybe you can do this in pairs, too. It’s nice to start and for the other to discover how to make it sound like a tune; and then with a little practice, you change parts. The key is not to have to elaborate it with great finesse. Most folks have no idea they can do this with the fragments of tunes that come to them.

Dancing can be like this, improvised. If that’s too much, just learn a few steps and find a partner who likes to explore. It may be a circle dance.

Poetry, too, borders on creative writing for kids. Let go of your expectations that it has to be great or why bother. Get innocent and open to letting the words come, and being a little surpised as they flow in. And so forth, you’ve got a wealth of tools to discover that you’re pretty amazing. None of this has anything to do with doing it right.


Expressive Arts Therapists bring to the table a number of viewpoints that are insufficiently appreciated by most psychologists, teachers of counseling, or practitioners. You are learning a number of modes of people-helping that other approaches either don’t know at all about or only in a very crude fashion. You are learning that empowering people to access their sources of creativity, their non-rational sources, their creative arts resources, can deepen their sense of self-esteem and open the sense of what life is about.

I use the term people-helping to note right off that what you are learning transcends the context of therapy, of helping people who are aware they are troubled or are referred for help because they are insufficiently aware that it is they who are troubled. This is the sick role. But people helping transcends that, includes teaching, educating, group leadership, coaching, facilitating social action, promoting various forms of adult education and professional training, recreation, spiritual direction, and so forth. I am suggesting that these people-helping roles will expand in the next few decades and the skills you’re developing speak to contexts broader than treatment.

In short, you are offering more ways to raise consciousness.

Related to this, realize that the fields we are developing are by no means fully developed, and it is possible or perhaps even likely that you will add to what is know, techniques, ideas, perspectives, over the course of your career. Empower your own creativity. You are not merely pupils, but potential co-creators who may well reveal in time the limitations of your teachers’ awareness.

Considering Expressive Therapies

Expressive therapists bring to the psychotherapy a number of perspectives not widely appreciated by most counselors and teachers of counseling:
  - An emphasis on being creative, and learning to recognize, enjoy, and cultivate those elements in yourself and your surroundings that foster creativity
  - An awareness of the kinds of things that inhibit creativity
  - Appreciating the nature of improvisation and spontaneity in all this. (Many practitioners of the arts are sadly lacking in this awareness.)
  - Giving yourself permission to take it over, to not achieve full success, to revise, to fool around, to play, to explore in safety
  - Setting up small learning teams so that each individual need not feel overwhelmed with all the role components in creativity. One facilitates; one explores; one offers supporting-role functions and audience; maybe a fourth offers audience roles. This differs from the hyper-individualistic demand that people must create on their own.
  - Setting up specific places and equipment and perhaps people or role functions for experimentation and, then, evaluation and re-planning. This breaking down the process makes it more workable. The laboratory differs from the office.
  - Generating a variety of “surplus reality” contexts, scenes, different frames of reference that have to do with time, point of view, people involved, etc.

These components derive from psychodrama but apply to all forms of experiential learning. 
— and I’ll note in a bit what those are; and second, what you’re learning has applications far beyond the context of therapy per se. You’re learning a technology that with some tweaking to adapt to the kinds of population and task, speaks to the overall challenge of facilitating the raising of consciousness.

It’s about more than learning stuff, information, things that can be acquired now from reading about them on some webpage or blog. Information was hard to find in the olden days—that phrase may apply to activities only twenty years in the past—but it’s immediately available now. Indeed, there’s too much of it and the skill is filtering out that which is less relevant, useful, and of course less accurate. But accuracy is not as crucial as one might wish in a world that is asking just to get oriented.

What the expressive arts as therapy offers is simple and complex. The simple idea is that people can learn to express themselves better using a wide range of media, often involving relatively non-rational or non-languaged elements. You may know in your own lives or those you’ve encountered that we live in a relatively logocentric culture—and that big word refers to words, the ability to come up with words, use them skillfully, be articulate, highly literate. You can finagle loopholes in the law and still delude yourself that you’re ethical. People who are skilled with words are treated as if they’re smarter than people who are skilled with other media, their bodies (unless they’re fabulous, then they’re highly paid), their intuitions, their art, or music, etc.

But most folks are somewhat skilled or have talent in a couple of non-word-saturated areas, and your helping them to discover these and value and enjoy them is an important function in restoring the mental health of many people. For those who are good at words, discovering they can also loosen up and be poetic is empowering. The key word is empowerment, and what we’re speaking to are folks who are by no means fully empowered. You yourselves may not have fully discovered your own talents.

Another poison in our culture is how good you are competitively. But I live in a community and there are some who aren’t that great, but they deeply, deeply enjoy themselves at the level they’re at. Being better than, or living up to external standards, is not that big a deal. Doing your thing, discovering what you enjoy doing—this may seem obvious, but lots of people in the world have hardly discovered this and found others who support them in their enjoyments.

In other words, it’s more than expressive, it’s also experiential. It’s dancing and not caring how good you are at it, because you enjoy it. You may enjoy getting better, and you may enjoy pushing yourself a bit—you enjoy the challenge. And you may enjoy not pushing yourself! There’s a concept. And so in this way you overlap with elements of recreational and occupational therapy and I’m not at all sure that most folks in these fields have had a chance to reflect on such matters. This is a very product-oriented culture, and process for its own sake is less noticed—but I’m highlighting it right now.

I want to emphasize this because finding what you’re good at that is also what you like doing is what Joseph Campbell, the comparative mythologist who died in the late 1980s called “following your bliss.” It’s important to understand it. There are people who are good at some things but really don’t like doing them much—and these folks get channeled into jobs and roles and clubs where they do well, but they also lose the sense of how fun life can be. It’s an important diagnostic category: Doing well because they have some ability in this way but not really liking it. Not all kids who are tall like to play basketball. Not all kids who play piano well like it, or they don’t like what they’re told they should play.

This leads to another category: Our culture also values product and values copying someone else’s product and calls that creativity. For some this works, but there are many who want to enjoy creating from scratch, improvising, opening their psyches and allowing the muses to create new stuff through them. Many of you have experienced the joy of improvisation. It’s pretty obvious—Winnie the Pooh, a bear of very little brain—made up song lyrics and melodies. They were pretty simple, but there are concert performers who have never made up zip. Alas for them.

So another of your skills is that you have some special exposure to people who dare to just make up stuff and it doesn’t have to be absolutely great right off or even ever. This confronts all the perfectionists—and for every perfectionist there are ten subclinical perfectionists—who really don’t know that it’s fun just doing stuff and not even caring about not being perfect. Bless their hearts, they’ve been brainwashed, and the culture needs folks like you to remind other folks that the unspoken rule that one must be perfect or the best if anything is to be done is deeply phony.

Theoretical Background

People-helping is a more inclusive, cross-disciplinary term that recognizes that a fair amount of psychotherapy, coaching, spiritual guidance, education, management, parenting, and other tasks involves helping people to make use of their creative resources. As an ancient writer noted, education is not about filling a vessel, but lighting a candle. We now live in an era in which being educated doesn’t mean amassing facts, but rather learning a wide range of skills for coping with information overload.

Psychotherapy and spiritual guidance and other forms of being “brought forth” also notes that some of those skills involve noting which facts are relevant, which themes deserve attention, and this in turn involves a more multi-dimensional form of insight. Insight isn’t just about articulating formulations about inner processes, but also includes a sense of more and less, what feels more true for oneself even if many others feel differently; what feels less so even if many others find that the same thing is true for them? So we need to add the more feeling elements that are to some degree mobilized by the various creative arts.

There was a time for departments, compartments, disciplines, separations, boundaries. Knowledge was still being elucidated. Now were shifting into holism, integration, trans-disciplinary endeavors. (This happens in normal cognitive development: There’s a time for learning that sheep are not cows, and neither are horses; and there’s a time for learning about the ways that these animals are alike in certain ways.)

Psychotherapy, counseling, guidance, education, family systems work, organizational systems work, personal development, recreation, social action, empowerment, politics, and other endeavors all have as a common denominator the many-faceted dynamics of consciousness-raising. More, we are increasingly becoming aware that this is not just a matter of sharpening the abilities of the left brain for critical thinking. Learning to access, integrate, and utilize the non-rational dimensions—the expressive arts being one set, transpersonal exercises, being another, and other forms of imagination, intuition, and emotion—is beginning to be more widely recognized.

It isn’t yet fully accepted because teachers still identify their self-esteem with what they know, and what they know tends to be based on their own experience as shaped by what they learned ten to fifty years ago, which in turn was shaped by what their teachers thought they knew. Ironically, this whole idea is on the edge of being overturned by a world-view shift in combination with a disruptive technology—and one that you will be learning about—action explorations—a form of collaborative learning that addresses creativity rather than knowledge. Or, it privileges knowledge of methods over knowledge of facts.

In the not-too-distant past information was hard to find, acquire, compile, and much of academic work and status involved how much was known (memorized) rather than a more subtle skill in noticing what information was relevant and which methods for exploring further were indicated—but these kinds of “knowledge” are quickly becoming more relevant. The word “knowledge” should not be thought of as one kind of thing, but recognized as involving rather different skills, perhaps more than contents. Teaching, then, shifts from mere instruction in information to skill development, and considering the growing awareness of differences in cognitive style, learning styles, and other variables of individuality, teaching becomes less scholastic and more art. The structure of academia will not change soon, but it will have to as people seek not teachers who know everything that was known in the field last year, but rather those who can help them discover for themselves what is coming to be known or has yet to be discovered or applied in the field next year!

(This may involve the collapse or re-structuring of major academic institutions, also because they have become so expensive and effectively unaffordable—increasingly so in an era in which the middle and lower classes are becoming squeezed.)

Back to the nature of the task: It, too, transcends single endeavors. It’s like thinking about how something so basic as electricity changed every institution! Historically, your expertise arises out of the endeavor to reduce the impact personally and collectively of major and minor mental illnesses. The medical model took over psychotherapy in the 1930s, but really we should see beyond this context and recognize that even though you’re in training to be therapists, what you’re really about is bringing people forth. Exciting, motivating, encouraging, enticing, exploring, and structuring experiences is becoming as vitally important than merely transmitting information. That can be done online, through Google, through books. This is bigger.

In terms of Piaget’s developmental psychology, we’re shifting from an overemphasis on assimilation to a greater expansion of accommodation. Filling in the gaps in the mental map with details is closer to memorization, and the problem is that the details become often irrelevant or they change. Developing, expanding the inner maps to include body, spirit, emotion, play, and a willingness to enjoy stretching—that is an educational act that you may be doing more of. What is therapy is becoming often too close to coaching, spiritual guidance, enlightened “teaching,” good management, ideal parenting, and so forth. Sure, each context has its own sub-body of information, relevant knowledge, and sub-skills. But the underlying principles and skills support people as they clean up this problem in counseling, and then use the same techniques for addressing other life challenges as they arise.

So I’m suggesting that your education partakes of ideas and complexes that many of your elders and their teachers never heard of: “integral” appproaches, “postmodernist” ideas, and the aforementioned “trans-disciplinary” endeavors. Many folks don’t yet understand what all this is about.

“Systems” Thinking

The term has been around for more than a half century, but it isn’t yet widely understood. You may be learning about family systems theory, but you’re also learning a perspective that is a bit subversive or transgressive of conventional modes of thought. The relevance of systems thinking has grown in proportion to our many ways to appreciate the innate complexity of the micros-systems we explore, and by extension, to realize that we, too, live in loosely functional larger systems. There’s plenty of room for small and even medium freedoms in these systems we live in, but that does not detract from the awareness that there are implicit guidelines if not strict rules.

Most folks think very little of al this—and only think as much as they absolutely need to and little more. Systems thinking overlaps with other approaches, because it notices such thing as the way—in human systems—there are common patterns of irrational traditionalism. These patterns involve some subgroups enjoying more “privilege” than others. Of course, those who are so privileged rationalize their perks by imagining (often quite sincerely) that they are taking on a burden of responsibility over the non-privileged. There’s no admission that a pitifully small and relatively weak fraction of the privileged actually think and take true responsibility. Most are involved in getting what they can in terms of vacations, luxury, and other advantages. So systems theory in its deepest sense ends up noting that we are all in this together, and a full appreciation of this bridges over into philosophy and spirituality.

Intellectual Foundations

There are as yet still not widely known voices, but increasing attention is given to these thinkers who are looking more closely at the way people construct their experience of reality through story, “narrative,” a spate of books dealing with emerging fields of neuroscience and cognitive science, how whole fields of thought are affected by political and economic assumptions, gender roles, and ideas about the nature of consciousness. I’m taken with ideas about “positive psychology,” given new life in the last decade, but really having been anticipated by many thinkers before and after Freud. My own influence by the fellow who developed psychodrama—Dr. Jacob L. Moreno—was key—he emphasized the need to build a range of deep skills in imagining, becoming more spontaneous, playing, and cultivating creativity. These in turn offset the hegemonic power of pathology—a big word meaning that if you just focus on what’s wrong and trying to untangle the knots—the emphasis in psychoanalysis—it won’t be enough. It’s important—far more important—to build into the system a variety of skills for emphasizing positivity in many forms.

There’s an assumption that the psyche can—in theory—be known, understood, and in so doing, brought into consciousness. That’s so 20th century. The mind is a hundred or a thousand times more complex so that we have to work with the non-rational mind in a more indirect, nudging fashion. I’m still enough of a product of my background that I think that a fair amount of exploration is good—but more than whatever contents are brought to the surface to be examined is the general idea of “mulching the mind,” generating a cooking process as part of ordinary living, not just therapy. We should all get a bit curious and enjoy the process of self-discovery. We should all throughout our lives play with looking at that which we hadn’t noticed or had avoided previously. It’s the equivalent of stretching our body or cleansing our skin.

Another theme that needs to be emphasized because we’re still in transition is the awareness of the individual in the group and the relationship of family or group to larger groups. This is part of the power of systems theory, and it hasn’t been half appreciated by more than a tiny fraction of people: We are social beings, and the mind is to some large degree an organ of subtle social perception—perception of attention, performance, status shifts, frames of reference, and many other variables. That we pick up and respond to micro-communications has been only one fragment of this growing understanding.

The problem here is that we become more sharply aware of the way we collectively agree to traditions, economic systems, political establishments. We become more aware also of the many forms of rhetoric, propaganda, distraction, manipulation, and our own tendency to lapse into passive acceptance in the face of this veritable barrage. Nor is it easy to blame one source; everyone seems to be colluding in if not perpetuating “the system.” Systems can indeed grow in certain directions when there are fifty or a thousand different causes and influences—the idea that some one or some group must be to blamed is again so early 20th century—not that there aren’t still demagogues wanting to gain our allegiance by blaming single external “enemies” or, from within, scapegoating marginalized sub-groups.

Creativity: A Key Dynamic

This elusive quality was at the core of Moreno’s work. Jacob L. Moreno, M.D. (1889-1974) was the fellow who invented psychodrama and much more:
  - He was a pioneer of role theory in social psychology.
  - He was a pioneer of thinking about creativity and spontaneity.
  - He supported the integration of play and laughter, and in other ways was one of the precursors to the present fashion in positive psychology.
  - Moreno was also a pioneer in looking at group dynamics and interpersonal networks from a variety of viewpoints, one of which—sociometry—became more popular in the 1950s. Now it’s gaining new life as social network analysis and also looking at the dynamics of rapport. (Many current researchers haven’t bothered to examine the roots of this effort in Moreno’s writings.)
  - Moreno was a pioneer of group dynamics and group psychotherapy, of self-help groups and looking at teamwork. His own group method differed from more psychoanalytic group work in having more structure and role distribution (versus all patients being in the sick role and one or two therapists being group “leaders”)
   - Moreno was also a pioneer in the realm of improvisational theatre, impromptu drama, which again gained new life independently with the Second City people who then branched off into consultations with business. But role playing in business and industry was around since the 1950s!
What we’re talking about, then, goes way beyond therapy, which is, it must be acknowledged, a valid application, but only one of many. Similarly, what you’ll be learning is already being applied beyond the models of “therapy” and the medical model.   

In closing, here are some principles developed by Dr. Sue Jennings in England—one of the pioneers of drama therapy there and the editor of a number of books about this work: She calls her approach “Sesame,” as in the “Open, Sesame” phrase used in the children’s story. The expressive arts therapist, ideally:
  - Uses a non-performance bias towards drama and movement as a vessel for the creative healing process
 - Works obliquely through symbol and metaphor rather than confronting pathology directly or making interpretations.
 - Values the unconscious inner world of the psyche and the health of each individual which emerges spontaneously in play.
 - Unique combination of Jungian psychology, Laban movement analysis, Slades Play principles, and Marian Lindqvist’s Movement with Touch and Sound
  - Promotes the use of a ritualized session play, which is sufficiently flexible to meet identified needs of individual participants
  - Affirms that people carry their own solution to problems within; it is the work of the therapist to draw these out. The therapist is not the expert.


What you're learning about is important and has a goodly number of implications. It is rare and wonderful to begin to open to the intuitive and imaginative sources inside you, and to learn ways to help others do likewise. That opening is in some ways the opposite of what most college and ordinary school classes are about---i.e., learning what the teacher thinks are "right" answers---and instead opens the mind to creativity---a realm where "right" answers don't exist. Oh, admittedly, some ideas work better than others in some situations and you can use that feedback for continued improvisation, but that doesn't make those ideas "right" in any absolute sense. This is a good warm-up for the learning you're commencing.

Theories in Counseling & Psychotherapy: A Multi-Cultural Perspective
$100.00 7th Edition   ISBN: 1412987237   June 2011
SAGE Publications
 Theories of Counseling and Psychotherapy: A Multicultural Perspective / Edition 7 by Mary Ivey, Michael J. D'Andrea, Allen E. Ivey, Mary Bradford Ivey
5th ed.
Boston : Allyn and Bacon, c2002.

Intentional Interviewing and Counseling: Facilitating Client Development in a Multicultural Society (with CD-ROM) by Allen E. Ivey, Mary Bradford Ivey and Carlos P. Zalaquett(Apr 3, 2009)