Wednesday, February 1, 2012

Learning to Play

When I ask clients what they enjoy, the vast majority stare at me blankly. Indeed, for many/most people who have had mental health problems for any period of time, the idea of "fun" seems a little far-fetched. People may be too depressed to enjoy anything, or not have the energy or motivation, or be too constricted by anxiety, or too preoccupied with compulsive/problem behaviors...etc. 

Yet, I keep asking the question for the simple fact that having positive experiences, no matter what those experiences are, provides some antidote to suffering. Even though we can't often make people's suffering "go away," we can change it, or even dilute it, with its opposite. I use the metaphor of paint: I can't take the blue out of blue paint, but if I add some red, I can turn it into purple. The Positive Psychology movement is rooted in this idea.

As a result, I see it as not only legitimate, but down-right important, therapy to help clients find ways to build in positive life experiences - in other words, to help them learn to play. If I get a blank stare when I ask clients what they enjoy, I ask what they used to enjoy, when they were doing well, or before the problem started, or when they were young. I also ask if they ever thought something sounded interesting or enjoyable, even if they've never done it. With both questions, I'm looking for any kernel of interest that could be cultivated into a positive activity (i.e., a hobby or pastime). For the fun-challenged, Marsha Linehan compiled a useful list of "adult pleasurable events" in her DBT skills manual.
My supervisor, who is a psychoanalyst, would never pursue this line of inquiry with a client...unless the client was psychotic. For psychosis, however, he considers one of the most beneficial interventions to be helping the client organize themselves around a "project" - an interest that can be cultivated to organize thoughts, structure daily life, and provide a sense of purpose and meaning. I think we all need those things.

Sometimes I help clients learn to play by modeling humor, playfulness, imagination, curiosity, and yes, even actual play. This isn't always appropriate - therapy has more serious than playful moments, after all - but when timed correctly, can break through some of clients' barriers to fun.

It is, of course, true that the biology of problems such as depression make it physically difficult to have fun. However, researchers have found that, while people with depression expect not to have fun (and therefore don't do fun things), they are actually able to have fun when they "go through the motions" of doing potentially enjoyable activities. Similarly, "going through the motions" of life by structuring time around activities (what CBT calls "behavioral activation") can produce improvements in mood similar to medication.

Do you think adding positive experiences should be part of therapy? If so, how do you go about it?

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