(PDF) Enhancing Creativity in Cognitive Therapy

Journal

of

Cognitive Psychotherapy:

An

International Quarterly,

Volume

14,

Number

2,

2000

Enhancing Creativity

in

Cognitive Therapy

Kevin

T.

Kuehlwein

University

of

Pennsylvania

This article explores

the

nature

of

creativity

in

psychotherapy

and

offers

several

methods

and

frameworks with which

to

enhance creativity

as a

cognitive therapist.

It

reviews

the

methodologically permissive parameters

of

Beck's model, while

providing

a

framework

for

enfolding methods from

other

models

so as to

retain

the

cognitive

character

of

these

interventions when

used

within

the

cognitive

therapy

session.

It

also extrapolates

from

Edward

deBono's

model

of how to

improve

the

quality

of

thinking

to

suggest specific interventions

as

well

as

general principles that

can

be

used

or

adapted

in

cognitive therapy treatment. Numerous

case

examples

are

given

and

further

resources

for

nurturing

and

generating creativity

are

provided.

The

Nature

of

Creativity

by its

very nature somewhat eludes

firm

definitions. However, concepts

associated

with greater creativity

in my

mind include novelty; play; flexibility; shifting

levels, tracks,

or

modalities; possibility; exploration;

usefulness;

humor; transforma-

tion;

uncertainty;

and

surprise. Concepts associated

with

less creativity include

rigidity,

predictability, sureness, stubbornness,

frozenness

in

time, repetition,

a

singular per-

spective, narrowness

of

constructs

or

their inability

to

expand, stereotyping,

and an

inability

to

appreciate context.

The old

definition

of

neurosis (doing

the

same thing

over

and

over

and yet

expecting

different

results)

is a

great polar opposite

to

more

creativity.

Special Resonance

for

Cognitive Therapists

Creativity

is

especially

important

for

cognitive therapists

to

explore

in

that

it

represents both

an

in-the-moment

shift

in

perspective

and a

skill

to

repeatedly

engender such adaptive

shifts

in

life.

Many

of our

clients

are

indeed somewhat

creative

in

some spheres

of

their lives,

but

find

it

difficult

to

apply these tendencies

to

arenas where their

dysfunctional

schemas intrude. Creativity involves breaking

©

2000

Springer

Publishing

Company

175

176

Kuehlwein

out

of

this

cycle,

often

in a

counter-intuitive way.

This

is why

cognitive

therapists

encourage clients

to act

against their schemas:

to

"feel

the

fear

and do it

anyway"

(Jeffers,

1992). Here

the

creative response

is to

disobey

the

very strong internal

injunction that

tells

us to

flee

or

fight

but

instead

to

stay

the

course

to see

what

we

may

thereby learn. Clients then

can

experience dreaded feelings without

the

dreaded

nonemotional consequences (e.g., absolute

failure).

This discrepancy helps estab-

lish

new

associations

to old

feelings

and

behaviors,

freeing them

to do

other

things.

Moreover,

the

Beckian cognitive model itself

is

very methodologically permissive,

allowing almost

any

technique

to be

used that promotes enduring cognitive change.

If

one

works

within

an

individualized

cognitive

conceptualization

and

toward

promoting enduring cognitive change,

the

methods

one

chooses

to

achieve those

ends

are

only

as

limited

as

one's

imagination. Cognitive therapy

can

therefore

borrow

freely from

other

systems

of

psychotherapy

(Weishaar,

1993)

or

other

models

(e.g.,deBono,

1982,1991;Langer,

1989).

Of

course,

the

true

test

of

whether

an

intervention

has

been really creative

in the way I

mean

it

here

is

whether

it

significantly modifies

the

client's

belief

system.

The

most clever intervention fails

if

it is not

congenial with

a

good individual case conceptualization. Creative

interventions must therefore

be

assessed later: "How

did the

client understand

the

meaning

of the

intervention? What will

she go

away with

from

this session?

How

will that help

him?"

Ideally clients will

be

able

to

articulate well

and

with

a

sense

of

hope

at

least

a

seminal message

of

meaning transformation.

Obstacles

to

Creativity

I

conceptualize creativity

as

existing

on a

continuum

to

avoid seeing

it in all or

nothing terms, which

I

believe obscures current creative achievements

and

frus-

trates those seeking

to

become more creative.

If we

view ourselves

or our

clients

as

noncreative, this attitude

in

itself hampers

the

creative spirit, which

in my

mind

suggests that many exciting options beyond

our

current vision

are not

only possible,

but

definite.

As a

cognitive therapist

I

further

view clients

as

having problems

largely

due to

their current meaning-making systems being inadequate

for

their

goals. Ironically, however,

one

problem

is

that

a

client's

current meaning-making

system

is

both inadequate

but not yet

inadequate enough

for the

client

to

discard

it.

The

current construction

of a

problem

often

helps

explain some parts

of a

client's

experience

and may

feel viscerally accurate because

of

prior positive associations

of

this framework with other experiences

in the

client's

life.

DeBono notes that

"contentment with

an

'adequate'

solution

or

approach

is the

biggest block there

is

to any

search

for a

better alternative" (1982,

p.

27). This partial adequacy, then,

impedes

a

search

for

more creative options. Furthermore, some clients believe that

change equals admitting being wrong, which

is

bad. Skilled therapists respect

and

work with

the

attachment, acknowledging

the

partial adequacy

of

constructions

the

client clings

to as

well

as the

feelings behind them. Splitting

the

ambivalence about

change into

two or

more sides

can

help. Thus

a

therapist might say:

Enhancing

Creativity

177

So as a

child this tendency

to

assume

the

worst

of

people

kept

you

pretty

protected

in

a

quite

hostile

environment.

I

wonder

whether

your

older

self

ever

appreciated

or

thanked

the

child

for

protecting

you in

this way?

. . . Now

that your younger self

has

received

that acknowledgment what might help

him

pass

the

guard duty

on?

...

How

would

the

older

self know

if the

danger

had

gone

away?

Extrapolating

From

a

Model

of

Thinking

In

thinking

how to

make

my own

thoughts

and

work more creative,

a

number

of

years

ago I

discovered

the

ideas

of

Edward deBono

(1982;

1991).

He

does

not (as

far

as I

know) directly address psychotherapy applications,

but he

describes

models

of

less

and

more creative thinking.

In

extrapolating

from

the

better model

I

hope

to

awaken readers

to

some exciting, provocative possibilities open

to

cognitive therapists. DeBono

offers

many exercises (only

a few

discussed here)

for

stimulating

more effective thinking,

a

central

aim of

cognitive therapy (1982).

I

will present

some

of

these

and

then discuss principles

and

examples

not

drawn

from

his

work.

DeBono

has

greatly enriched psychology

by

elucidating characteristics

and

patterns

of

both

dysfunctional

and

creative thinking.

A

chief characteristic

of

poor

thinking

to him is

arrogance,

the

idea that,

of

course,

our

current thoughts

are

right

and

unassailable: "Nothing

is

more dangerous than

an

idea when it's

the

only

one

you

have,"

as a wag

once said. DeBono

further

observes that much cognitive

training

in

schools focuses

not on how to

think well,

but how to

think quickly

and

singlemindedly, warding

off

other perspectives that might conflict with

the

ones

we

have already committed

to

(however

good

or bad

these

may be in the

circumstances)

(1982).

In

this

way we

essentially

close

off

exploring

more

fruitful

options simply

because they arrived

after

our

initial thought. Potential behavioral

and

cognitive

side roads then remain outside

our

awareness because they

are

temporarily sup-

pressed

by the

dominant road (see also Langer,

1989

for

related ideas).

I see

this

as

quite

analogous

to the

cognitive therapy model

of

dysfunction.

We

know

from

research that

the

more exploratory type

of

thought process

is

much slower

and

more

effortful

than

the

more stereotypic, automatic thought process

in

those

who are

depressed (Hartlage, Alloy, Vazquez,

&

Dykman, 1993). Therefore much

of

what

first

occurs

to

clients when they

are

upset

is

considerably less

functional

than later,

more considered thought. DeBono

offers

some exercises

for

making thinking more

of

a

conscious

and

balanced

process

so

that

we can

counteract some

of our

natural,

though

dysfunctional

tendencies

in the

arena

of

thinking (1982).

His

Plus, Minus,

Interesting

(PMI),

for

example,

is an

exercise that

can be

done about

any

situation.

This

exercise

(which might,

at

first

glance,

be

confused with

the

more

simple cost-

benefit

analysis) involves considering

an

issue

and

then

focusing

all of

one's

attention

on the

Plus

or

positive aspects

of it;

then

focusing

all of

one's

attention

on

the

Minus

or

negative aspects;

and

lastly focusing

all of

one's

attention

on the

Interesting questions that arise

from

it. I

used this exercise with

a

woman

who

often

pouted

in

reaction

to her

husband's angry outbursts. Using

the PMI

avoided

a

178

Kuehlwein

simplistic yes/no answer

of

whether

to

pout

and

helped

her to

sight many unexplored

possibilities that might emanate

from

her

choosing pouting

as a

standard reaction:

"I

wonder

if

pouting might become less

effective

over time?

I

wonder

if he

might

start

to

pout, too?

I

wonder

if the

more

I use

pouting

the

less

I

would explore other

ways

of

handling conflict?

I

wonder

if

there could

be

different

levels

of

pouting?"

All of

these expedited

a

more full-bodied appreciation

for the

current

and

possible

future

role

of

pouting

in her

relationship. This approach

further

circumvents much

of

the

either/or entrenchment that sometimes occurs with therapists

and

clients

who

are too

attached

to

"their"

different

viewpoints.

The

Creativity

of

Humor

Creativity

often

involves switching from

one

track

to

another, very

often

by

surprising (i.e., nonlinear) methods. Most creative ideas when viewed retrospec-

tively

can be

seen

to

dismantle

an

assumption that seemed completely reasonable

at

the

time.

We

need, thus,

to

develop

techniques

by

which

we

break

out of

normal methods

of

construing

our

world. DeBono observes that humor

is a

prime

example

of how we can

stimulate

new

ways

of

thinking,

for it

involves

apparently moving

in one

direction while actually moving

in

another. "Humour

tells

us to

beware

of

absolute dogmatism because suddenly something

can be

looked

at in a new

way," (deBono,

1991,

p.

45). (This,

of

course,

is why

political

satire

has

rarely been accepted

in

autocratic states.) Humor

by its

very structure,

then,

involves

multiple

meanings

and

possibilities.

One way

therapists

can

make

use of

this

is to

evoke concepts

in

session

of a

surprising

or

dramatic nature (e.g.,

via

exaggeration)

to

stimulate this other jocular track

of a

client

who may be

depressed. When

the

client's

affect

shifts

toward

the

more positive,

the

therapist

can

then

use the

cardinal cognitive therapy question,

"What's

going through your

mind?"

to

access this movement. Often

a

client will then realize

how

other

explanations

of her

situation

exist.

Humor

can

thereby

help

liberate

us

from stuck

places conceptually. Example:

a

mother

often

criticized

a son for not

seeing

all

possible

bad

scenarios. When this

man

showed

her an

enlarged room

to

accom-

modate

the

ailing mother-in-law,

the

mother

rebuffed

positive replies

to her

queries

of

whether

the

room would

be

able

to

handle

a

wheelchair

and

persisted

in

asking, "How about

an

electric wheelchair?"

The

client

felt

quite inadequate

and

deflated

reporting

this.

I

then

asked

the

client

if he had

planned sufficiently

to

accommodate

the

second wheelchair

of a

projected disabled caretaker.

We

both laughed heartily

at

this,

as he

easily glimpsed

how his

mother would almost

always

find

something silly

to

criticize.

One can

also

focus

on the

client's

own use of and

response

to

humor. When

a

client (especially

a

depressed

or

anxious one) expresses mirth

in

session,

I

often

zero

in on

this,

asking

the

client

to

reflect

on the

shift toward

positive

affect:

"You just

did

something very important there.

How

were

you

seeing

the

criticism from your boss just

then?"

Usually

the

client will name

a

framework

Enhancing

Creativity

179

that substantially

steps

away

from

the

initial dysfunctional one,

often

one

that

casts

the

light

of

absurdity onto

the

situation.

This

type

of

questioning directs

the

client's

attention toward

how her

thinking

and

feeling

can and do in

fact

shift,

even though they

often

feel static

and

unyielding.

Addition

of

Random

Elements

DeBono notes

the

facilitative

effect

of

random elements

to

evoke creative responses

to a

situation (1982). Serendipity

has

long been

an

impressive contributor

to our

advancement

as

individuals

and in

science.

Often

what

we

stumble across jostles

our

thinking just enough

to

provide

a key

shift

in

perspective.

Similarly,

we are

very

good

at

justifying

a

position once reached. DeBono, therefore, suggests combining

these

two

facts

to

think

how a

random element might

be

issue

in

question.

So one

might ask,

"What

might

a

shoe [randomly chosen element] have

to do

with

the

solution

to my

problem

of

being away

from

home

so

much?"

This

introduces

a

creative search

for

answers

and

could produce responses such

as

these:

Maybe

I

could

find

a job

closer

to

home where

I

could walk

to

work; Maybe

my

partner would

get a

nice article

of

clothing every time

I

have

to

work late; Maybe

my

partner

and I

could experiment with being

in

each

other's

shoes

by her

going

away

for a

work conference

to

find

out how

much

she

misses

me and how

much

I

might

miss

her

when

I am

home alone; Maybe

we

could make

it a

point,

no

matter

how

much work

I

have,

to

walk together

and

talk

at

least

4

times

per

week.

The

cognitive therapy point

of the

exercise

is for the

couple

to

explore

creatively beyond

the

current meanings

and

contexts, which

are

causing pain

in the

relationship. This

more deliberate approach

to

meaning-making moves

the

couple away

from

the

automaticity

and the

associated

rigidity of

dysfunctional

thought

and

behavior.

Similarly deBono

often

invents words

to

escape

old and

perhaps

unhelpful

associations with hackneyed terms. Neologisms

by

their novelty help evoke

curiosity

and

allow

new

thinking.

He, in

fact,

much prefers

his

term

"lateral

thinking"

to

"creativity"

because

of

people's

prior biases

with

the

latter term:

"I

invented

the

term lateral thinking specifically

to

cover changes

in

concept

and

perception obtained

by

moving laterally across pattern" (deBono, 1991,

p.

89).

Quite interesting

is

that

the

jump

one

makes across patterns

(just

as in

jokes) looks

perfectly

reasonable

in

hindsight. This discrepancy between

how

things look

at the

time (impossible

or

baffling)

before

one

does them

and how

they appear

in

retrospect

after

they have produced

an

important

shift

(obvious

and

even simplistic)

shows both

how

creativity operates outside

the

realm

of

pure rational thought

and

how the

route back

from

the

solution

is

different

from

that

toward

the

solution.

I am

reminded here

of

Dean

Radin's

"Four

Stages

of

Adopting

a New

Idea":

1.

It's impossible,

2.

Maybe it's

possible,

but

it's weak

and

uninteresting,

3.

It's true

and I

told

you so,

4. I

thought

of it

first,

(quoted

in

Langer, 1997,

p. 4)

180

Kuehlwein

DeBono

offers

countless other creative exercises

to

improve thinking that

I

invite

the

reader

to

explore

and

adapt

for

cognitive therapy purposes (1982).

Unfortu-

nately space limits

me

here.

OTHER

TECHNIQUES

Socialization

Toward

Greater

Creativity

is

something that

can

begin from

the

first

time

you see a

client.

A

few

years

ago I

started adding some

new

topics less frequently tapped

in

initial interview materials: "Often

people

have

had

things they felt particu-

larly good about during their lives: achievements, especially good coping

during times

of

crisis,

or

ongoing relationships. Describe

any

especially

positive experiences you've

had in

your life."

Or:

"Sometimes people have

been especially moved

by a

particular book they've read

(or

film

they've

seen).

What

was the

last book

you

read

(or

film

you

saw) that really

'spoke'

to you or

which made

you

think quite

differently?

How did it

affect

you?"

Not

in

themselves terribly creative, such questions represent

the

search

for

data

outside

the

norm

in

initial interviews.

For

this reason, they assist clients

in

looking

at

themselves

in a

less

all-or-nothing, more balanced

way

(versus

seeing

their life

as a

narrative

of

problems

and

pain). Eliciting these

other

data

further

balances

the

picture that both therapists

and

clients have

of

clients, thus setting

the

stage

for

bridging

to the

clients' strengths,

and

reconnecting

to

these. This communicates respect

for a

client's

strengths

and

identity

apart from

his

problems

and

helps suggest mechanisms

of

change

congruent with

the

client's history

and

values.

By

actively encouraging clients

to

envision what things could

be

like

in

the

future

at the end of

therapy, therapists

can

further

begin

to

trace

the

steps

necessary

to

support these goals.

One way of

doing this

is in the

beginning

of

therapy

to

clarify

with great specificity positive goals across several

dimensions: behavior, beliefs, emotions, bodily symptoms. DeBono dis-

cusses "asymmetry

of

patterns" (1991), whereby

the

path back

from

the

solution

may be

quite

different

(e.g., more quick

and

direct) than

the

steps

toward

it

from

the

problem.

The

creative approach

is

therefore

to

start

first

with

the

solution

and

work

one's

way

backwards. Taking

a few

moments

to

sit

back

and

imagine

in

full

sensory detail specific goals achieved

a

year

from

the

start

of

therapy

can

therefore help clients

"visit"

a

positive

future

and

retrieve

a

sense

of

hope

to

bring back into

the

here

and

now. This draws them

forward

somewhat

in the

same

way

that aromatic tendrils

of a

delicious,

cooling

pie

pull

one

inexorably toward eating

it.

Example:

a

client

who was

in

his

12th

year

of

college

typed

out the

title

page

of his

penultimate

article.

Suddenly

the end of the

article

did not

seem

so

impossible

or

distant

and he

was

energized

to

complete

the

rest.

Enhancing

Creativity

181

Creative

Play

With

the

Presenting Problem

Helping

a

client

to

negotiate

a

less

frightening,

Enhancing Creativity in Cognitive Therapy

Abstract