Some time ago I was speaking with one of my academic mentors about therapeutic approaches and he said, “You should be experimenting in therapy.” I was surprised to hear this, even a little unsettled. At the time, I was working for a governmental organization and experimentation was not encouraged. Evidence-based practice (EBP) was the advanced paradigm. Cognitive Behavioural Therapy (CBT) was the go-to technique.
Of course evidence-based practice. Of course. Though definitions of EBP abound, this one suits well: “the conscientious, explicit, and judicious use of current best evidence in making decisions about the care of individual patients”. What could be wrong with that? Nothing, really. But perhaps there’s more to consider.
For one thing, the therapeutic methods that are thoroughly researched are generally the ones that gain institutional respectability. CBT is the most funded and researched therapeutic model that exists, and therefore also the most promoted. And it’s great – I use it often. However, as a therapist I can confirm that CBT is good for what it’s good for, and falls short in other ways.
Before I studied counselling, I studied Chinese Medicine. Through that education, I learned that if you look at something one way, you will ask certain questions and get certain answers based on those questions. Western medicine approaches the body from the perspectives of pathology, physiology, microbiology, and pharmacology; it directly targets pathogens; and it’s evidence-based. Chinese medicine, on the other hand, considers disease to be an obstruction of qi, or an imbalance of qi or yin-yang. It’s a holistic approach, and not always as strongly evidence-based as Western medicine.
However, to say that a 5,000-year-old system of medicine is nonsense because it lacks the EBP backing of the much younger Western medicine would be an error of hubris. They are two different systems of medicine that approach the body in fundamentally different ways. If I break my leg, I’m going to my local emergency room – no question. But when I’m healing my bones afterwards, I’ll consult a TCM practitioner. They’re good at different things. Complementary rather than contradictory.
I’ve come to understand that while the evidence-based lens is useful, it has its limitations. Just like skills in therapy, if you plug the wrong skill into the wrong situation, you will think that the skill doesn’t work. Context matters. So it is with EBP: not all systems are quantifiable. Some are qualitative, and evidence-based measures may not be up to the task of determining their value.
Geez, Deirdre, I thought this article was about play in therapy. This is b-o-r-i-n-g. Fair enough! I wanted to lay that foundation first. One more time for the people in the back: the point I want to make here is that there is a time and place for evidence-based practice. It’s just not all there is.
Enter curiosity. Enter experimentation. Enter play. It took some time for me to unlearn the concept of colouring within the lines, so to speak. To step outside the conventions of a therapeutic model or an employer’s mandate felt a little….irresponsible. Like flying through the air without a net. Yet it’s like I used to tell my daughter when she didn’t want to follow the rules of grammar that she was forced to learn: you have to know the rules before you can break them. Or at least, before you can break them responsibly. But once you have the skill, you invite the potential for artistry.
Because that’s the thing as well: the whole art of therapy is holding space in a skillful way. So yes, I do believe it’s important to know the rules and undertake learning them in a comprehensive way. Many things can go sideways in therapy. Understanding this and tending well to those potentials is an ethical imperative. Once you’re able to do that skillfully, you’re ready to welcome play.
Recently, I moved into my own office – the first office of my own since I’ve been in private practice. That alone is exciting, and what’s even more exciting is that I’m getting to colour outside the lines of conventional therapy. Convention might say something like, “You’re not trained as an art therapist: you can’t do art therapy.” But I think about what my mentor said about experimentation…and it gives me license to try. I make art myself, and I’ve transformed one of my two office rooms into an art studio. Let the play begin! There are so many amazing resources out there to guide the way with art therapy ideas, too, that I’m never alone. I’m in good hands.
And then there’s the second room – my counselling space. It’s another expression of this desire for curiosity, experimentation, and play. In the last year I have been formally studying relational somatic therapy – a body-based approach to working with trauma. Remember what I said about asking certain questions and getting certain answers, and asking other questions and getting different answers? After working with cognitive approaches to therapy for several years, I came to understand that not everything can be adequately addressed with these techniques. Simply put, some things cannot be approached mentally.
Certain things must be approached through the body. Traumas that happened preverbally and cannot be resolved with words; other events get stuck in the body and can’t be unwound through reason. We need other ways to meet this, other skills.
Recently I was reading a yoga nidra meditation to the members of an eating disorder group I was running over Zoom. It’s an ancient practice that has more recently been rebranded as the modern-sounding iRest. It’s used by the US military to help soldiers with PTSD. Knowing that my group clients express – among other things – trauma through their eating disorders, I just thought I’d try it out.
The script took about 20 minutes to read. As is directed by the practice, I had them lie down, close their eyes, and cover themselves with a blanket. Every so often I would say, “True awareness has never been traumatized.” When I finished the script, I gave them a few moments to stir so that we could carry on with the rest of the hour.
…and the most interesting thing happened. Nothing at all. They didn’t stir at all. I sat on the Zoom call for the remaining 40 minutes and turned my mute on. I simply held space for them until the hour was up. Even as I signed off from the meeting, they lay still – silent in their own beings.
If it doesn’t surprise you, you’re making it up. As my mentor said, as therapists we ought to be experimenting. So my second room, the counselling space, is an ode to experimentation. To curiosity, humility, and play. I have a yoga mat and pillow, a meditation cushion and blanket. Tools and skills I’ve gathered across disciplines, whether evidence-based or not: Chinese medicine; yoga; somatic, narrative, dialectical, and cognitive behavioural therapies. Each one of these systems of thought and experience has something to offer – the art and the skill is in knowing when and how to apply them.
Occasionally, someone tells me that they dread therapy. At those times, I feel like I imagine a dentist sometimes does: like the last person someone wants to see! What I want people to know is that, yes therapy is hard work. And also, it can be a joy. When I hear laughter from a client, I know some healing work is being done.
You know, what I really imagine is that someday everything will be measurable. What is qualitative will be quantifiable, and vice versa. And I also understand that – just like yoga nidra being rebranded as iRest – regardless of what you call it, if it works…it works. So whether you’re a client or a practitioner, invite curiosity into your therapeutic experience. If something’s not working it doesn’t necessarily mean you’re doing it wrong: maybe a different skill would work better in that moment. Think outside the box. Experiment. Play.