Let me tell you the relief I felt when it clicked for me that acting like a therapist with patients was not the way to go — that actually being a real person would be far more therapeutic. The idea of needing to look, sound, and even dress a particular way was the perfect storm for imposter syndrome. And I was constantly fearful that I would be found out in the act. It was clearly unsustainable. I watched my peers gain confidence in their own therapeutic work and realized that it was not just increasingly necessary, but quite possible to find my own style, and have it be unique.


But being freed of that anxiety naturally brought with it a whole new feeling of uncertainty. While helping my patients find their own sense of self, I had to find my own. And quickly! Coming from an immigrant South Asian background, I grew up with the message that praise follows being able to figure out unsaid expectations and meeting them, prioritizing the collective rather than myself. I became far too skilled at fitting into a mold. I hadn’t stopped to think about who I was or how I wanted to relate to others and myself. I really didn’t have to until I was sitting across from my patients, one on one, and they looked to me to discover their own sense of self. Working with my patients and being more mindful in my personal relationships has been so instrumental in figuring out the parts of me that could also exist. A big part of this is my playfulness.

Ask anyone who knew me before my 20s, and they wouldn’t exactly describe me as funny or playful. I had been highly judgmental of these parts of myself in efforts to tone them down. But in challenging these judgments, I finally found an affinity for sarcasm, cleverness, and wit. I enjoyed gently teasing others in a way that helped them to feel seen as well as better about themselves, not worse. This side of me has been tremendously helpful in my work to the point of becoming a crucial clinical intervention and the hallmark of what it means to work with me. For starters, playfulness as an approach to hot topics has been a way for me to move past sticky spots with the intention of revisiting them with more seriousness at a later juncture. It has also allowed me to foster a sense of trust so that my patients have been willing to take on deeper and more painful topics. Doing so has also allowed them to prepare for addressing difficult emotions and pacing those experiences. Playfulness through metaphor, chuckling, and coyness have opened doors to more, rather than less therapeutic progress. And this has been especially so when patients have been resistant or apprehensive, opening them to the guidance I have been able to provide.

Playfulness and humor are parts of real and healthy relationships, especially those I form with people naturally. Relating to my patients as authentically and therapeutically possible means having to let this come through in some way. I’m very aware that I have an affinity for puns and cheesy humor. I get excited by thought exercises and how metaphors can be extended to perfectly capture added experiences. I don’t shy away from these parts of me; I own them. I want my patients to experience me as comfortable in my own skin so they can laugh at me and with me at first, and then at and with themselves. This is especially helpful with patients on my caseload who are struggling with depression. These patients usually harbor intense judgment and criticism toward themselves. Demonstrating an alternative way to approach the self can be reparative.

Authentic relationships also have a playfulness to them that can function as a reprieve. People generally present to treatment to feel better, to be able to experience feelings opposing chronic distress. Relationships, much like individual people, have range, with seriousness on one end and humor on the other. A therapeutic space must have range, too. The therapeutic space is not simply a reflection of what a patient’s inner experience currently is, but what it could be and hopes to become as well.

In deciding between a tone of playfulness rather than seriousness as an intervention, I often take the lead from my patient. Some patients bring entirely new material altogether, seemingly unrelated to what we’ve been working on, signaling some heightened discomfort and a need for a break. Others directly ask for a lighter session, subtly warning me that they can’t handle more that day. Some patients may need to be pushed, but some simply need to be held. My instinct is to highlight the growth in expressing their needs and implementing boundaries, especially with me. I joke that we could talk about shoes if it would be more therapeutic. I’ve had a few patients actually take me up on it.

I have found that this range in the therapeutic space may even help with patients’ attendance to session and that the playfulness I encourage contributes to a relatively low attrition rate. While at the start, I’m the one to introduce levity into the session, as patients tend to increasingly benefit and join in the playfulness, they begin to initiate this on their own, and the space already begins to feel lighter. That lightness can then be internalized over time when patients are ready.

The intervention is successful when we start playing together. The goal of any treatment includes using the therapeutic work between sessions, a result of being able to internalize the therapeutic relationship. When patients begin to refer to earlier sessions, observations I’ve made with them, or metaphors we’ve developed together, I know something is working. They may pay more attention to my reactions or anticipate what I might ask and answer the question before I pose it. Patients may even introduce their own language or metaphor, presenting with excitement to share with me, knowing I will very obviously appreciate it.

My work with Vaani is a nice example of how effective playfulness can be in breaking through self-imposed barriers to progress. Vaani presented to treatment feeling completely defeated and at odds with herself. She struggled to make sense of her opposing emotions, citing mood swings and difficulty showing her needs and, thus, feeling unsupported by others. Vaani tried to distance herself from her thoughts and feelings by criticizing herself, leading instead to an extremely negative self-view.

At the start of treatment, Vaani looked to me for direction and approval, some sign that she was doing therapy right. I sensed her discomfort with focusing inward and could feel her need to have the spotlight on me. In addition to my usual emphasis on affect, language, and thought patterns, I started to respond with inquisitive and teasing facial expressions when Vaani escaped into not knowing. I would lightheartedly suggest, “That’s such a Vaani thing to say,” and she would laugh along and try again. She started to anticipate moments I would challenge her further, eventually anticipating these stuck points and refusing to take any more comfort in her resistance. She seemed to find some relief in finding metaphors and analogies; in fact, she typically lit up when she could express herself more effectively than ever. Through our work together, Vaani has come to express a feeling of wholeness, a result of being able to approach the judged parts of herself with curiosity, compassion, and humor, rather than shame. Our relationship remains playful as she continues to reflect inward from a place of safety and security.

***

We all want to play. I did for so long but didn’t know I did or didn’t know how, in part due to my cultural upbringing. In realizing this, and the powerful reflection that came with it, I was able to find an authenticity that felt right. I wouldn’t be the same without it, and neither would my work. I thoroughly enjoy working with people who might benefit from this or a similar discovery to feel better, gain perspective, and move toward healing.  


File under: A Day in the Life of a Therapist, Musings and Reflections