Sara London, M.A. is a freelance journalist, Substack columnist, author, and satirist-when-convenient. She has a graduate degree in a specialized psychoanalytic research program from New York University’s Gallatin School. Additionally, she writes articles about psychology, wellness, pop culture, and the future of work. Her first book, The Performance Therapist and Authentic Therapeutic Identity: Coming into Being will be released August 14th, 2023.
In an era when the identity of the modern therapist is shifting, therapeutic authenticity is, in layman’s terms, a bit of a nightmare. Everyone with a degree that enables them to do therapy is expected to be everything from marketers to writers, public relations specialists, scheduling experts, research fiends, or crusaders for justice. While therapy used to exist within the confines of one room – the treatment room – now, it’s on the internet, in ListServs, in group supervisions, and in Zoom meetings. Psychiatrists may be a bit more familiar with the sentiment of multiple work identities, as many (especially those practicing from a psychoanalytic perspective, which is where my focus lies) have to keep one foot in the medical realm and one foot in the psychotherapeutic realm. But many young clinicians can find it hard to establish an authentic sense of identity when there are so many different niches, responsibilities, and skills vital to build a semi-successful private practice or move up the academic ladder. So how does a clinician begin to think about who they are in their careers so they can work towards thriving as the professionals they’ve always dreamed of being? Simple: through the tenants of performance art.
Now, hear me out. I understand there’s already a huge debate about psychoanalysis being considered a science or an art (and I think I know which side psychiatrists predominantly fall on!). But by comparing the therapist’s identity to the performance artist’s, my intention is not to take a position on this issue at all. I’m not saying that psychoanalysis is an art. I’m not even saying it’s a science. Rather, I think it’s important that we compare the foundational tenets of each discipline to help understand them both a little better, independent of their pre-existing constructs. Think of it like a little interdisciplinary jaunt, if you will. A frolic through the garden of being.
Performance art
Not many people know about performance art, and those who do look at someone hibernating inside of a bear carcass as simply bizarre for the sake of being bizarre. Some performance art lovers go in with open minds, expecting that they’re going to see something reflective of an “intellectual challenge, aesthetic stimulation, moral instruction, emotional experiences, or entertainment.”1 But often, Yoko Ono screaming into a microphone at the MoMA is seen as more of a joke than a serious artistic endeavor. So what can a therapist learn from a weirdo?
But it’s not just one weirdo – it’s a long and storied history of weirdos. There’s Futurist Filippo Marinetti, Dadaist Hugo Ball, The Living Theater, Carolee Schneeman, and many, many others who set the stage for how to create art without …well, a stage. Marina Abramović and Laurie Anderson shocked audiences with their expressive pieces, and YouTuber Emilia Fart or banana-eating menace David Datuna entertained the world with their outlandish acts. And like the performance artist, the therapist too can perform – a necessity in their work.
The works of a performance artist often carry three qualities. They are shocking, engaging, and pro-self (in which the self is both a necessity for the piece and an afterthought, used only as a shell to transport and relay the message of the work). Fundamentally, these three things align with the goals of a clinician. To shock isn’t necessarily to disgust; instead, it’s to come in and shake up the existing system, to stir things up from a status quo, a life the patient has gotten used to that’s riddled with symptoms and pain. The patient is then engaged with the treatment and must be for the treatment to be a success. Engagement – anything from completing their homework or taking their medications to building rapport with their therapist. And, of course, the therapist is a necessity for the treatment. They create the frame, they hold the frame, they can prescribe medications, provide emotional support, grant insights or interpretations, and everything in between. Without them, there’s no therapy. But they’re not bringing their whole identities into the dyad if they’re doing therapy, as that creates an unhealthily boundaried dynamic. They’re instead bringing their professional identities into the relationship, ones they’ve cultivated over time.
Identity — professional and otherwise
What a great segue for us to jump back to the notion of identity. Who are you in your work ego? Who am I in my work ego? And where did I leave my car keys? I believe that performance is a way identity is expressed, making it an inherent part of personhood. It’s not a dirty word, it’s not the same as ‘performative,’ and it’s not always to be equated with fakeness or disingenuousness, which we’ll get into later. As I’m a psychoanalytic personality (according to my Twitter biography, anyway), I’m interested in seeing identity through the lens of psychodynamic thinkers. And to me, some of the greatest examples of how individuals consciously and unconsciously perform their personhood are to be found in psychodynamic texts. So let’s get into it.
Without Freud’s tripartite structure of the id, ego, and superego, psychoanalytic theory as we know it would not exist – let’s start there. The foundation of psychoanalytic theory rests on an interesting notion: that the self attacks, struggles with, and feels shame about its various parts despite being unified by personhood. No matter what, there will always be parts of an individual in a power struggle with other parts, with powerful drives and the strong urge to repress them. To Carl Jung, this repression came in the form of the persona, the masks worn by ancient Greek actors to indicate their characters. The persona represents bonds and ties one has to who they believe they should be, informed by the collective unconscious. And many maintain their personas – an ‘act,’ as it were – to uphold and express the characteristics of who they want to be without looking at what they might truly want underneath.
There’s more. D.W. Winnicott’s got his False and True selves, in which the lack of balance between subjective omnipotence and objective reality creates a child who performs in adult life.2 And Karen Horney’s theory is of the idealized image, where a child who felt misattuned to or unloved can turn into an adult who imagines their identity as something grandiose or unrealistic.3 The False Self serves to protect the True Self, and the idealized image serves to defend against the notion that one might be anything less than the person they wish they were.
So, I know what you’re thinking (or, at least, I can guess). If we’re all walking around with psyches that inherently project certain images of ourselves and hide more vulnerable ones or features of our egos we haven’t quite worked out yet, does that make us all inauthentic? After all, especially as clinicians, some believe that actively constructing a professional persona as a therapist can be manipulative or dishonest and that it’s more important to self-disclose, as that’s seemingly a key to rapport.
But performing as a professional is not inherently inauthentic, nor is it manipulative to strategically utilize features of your own personhood to benefit your patients. Authenticity is measured and co-constructed by the patient and the therapist in the dyad, and it’s highly situational – mainly, it’s determined by considering moments that feel inauthentic and analyzing why that might be. Additionally, authenticity is also influenced by the external environment, namely a clinician’s professional identity outside the session in places like supervisions, groups, and the like. So whether you’re thoughtfully displaying your False Self or unconsciously relaying your idealized image, the performance you give to your patient is made up of your own parts; parts you wish you had, parts you wish you didn’t have, parts you conceal, and parts you reveal.
Performing as a professional is not inherently inauthentic, nor is it manipulative to strategically utilize features of your own personhood to benefit your patients. Authenticity is measured and co-constructed by the patient and the therapist in the dyad, and it’s highly situational… whether you’re thoughtfully displaying your False Self or unconsciously relaying your idealized image, the performance you give to your patient is made up of your own parts; parts you wish you had, parts you wish you didn’t have, parts you conceal, and parts you reveal.
Performance
In my book, the resulting phenomenon that occurs when mixing psychoanalysis and performance art is what I like to call the performance therapist.4 Anyone can be a performance therapist – psychiatrist, psychiatric assistant, really anything with the psych- prefix – as long as you’re practicing psychotherapy, even if it’s not an especially psychoanalytic kind. Fundamentally, the performance therapist’s constitution can be broken down into two parts: the structural performance and the emotional performance.
One’s structural performance includes how they’re trained — their schools, supervisors, and theoretical orientation. It also includes the timing of sessions, scheduling, billing, and other practical matters; the structure of one’s practice, and the building blocks from which the frame is built and maintained. Like the structure of a performance art piece that begins with tangible pieces, moving parts, logistics, times, and places, a practicing clinician must have parameters that delineate how they function in their role. The emotional performance, however, is much more personal. It includes a clinician’s past, present, weaknesses, strengths, psychic life, insecurities, and conflicts. And like the performance artist who uses their body as the medium of relaying a message, the clinician must leverage the workings of their psychic life with the case in front of them to provide the patient with the best care possible.
These ‘performances,’ so to speak, that therapists do in session can be in line with or opposed to their authentic internal drives (or, rather, Winnicottian True Selves). This manifests in a couple different presentations. People are sometimes trained to act in ways they wouldn’t outside the session; ways that are less reactive or more neutral, especially for psychodynamic clinicians. This results in the ‘performance’ of those behaviors until they become integrated into their authentic therapeutic identities. And insofar as the emotional performance, when someone gets caught in an enactment, there’s a chance that they’re not necessarily acting like ‘themselves’ as they know themselves to be. They’re instead acting out in roles they unconsciously believe they’re meant to play.
These two ways in which clinicians express themselves to patients aren’t just flat-out, substance-free performances without any personal involvement, like a middle schooler begrudgingly playing Hamlet in the school’s production. A therapist isn’t acting like they have experience or seeming like they have countertransference – they have both. It’s just a matter of how that all gets expressed in the session. Additionally, neither of these two forms of performance exists in a vacuum. They interact with each other, stepping on each other’s toes and complicating the whole process. Sometimes, things aren’t entirely structural or emotional; they’re a complex mix of both fueled by each patient’s inner life. Just as every relationship in life is different, every dyad is different.
Now, you may be wondering: isn’t this kind of complex, messy personal interaction already pretty well-recognized in psychotherapy literature? This fun little interdisciplinary jaunt is less about what performance art adds to psychotherapy and more about how it can be used to better conceptualize what happens in psychotherapy. Think of it like a looking glass or a frame with which to view these theories — sure, it’s a given that all these facets interact with a patient’s inner life, but sometimes it can be hard to understand and digest that in an actionable way. Having something to compare it to (in this case, performance art) helps contextualize some of the dynamic’s more complicated features.
Mom, dad, I’m a performance therapist
So let’s say you ascribe to this wacky idea. You agree that therapeutic identity can be analyzed through aspects of performance art, and you’re ready to take this idea off the page and begin working with it in real time. How does that look? And what purpose does it serve?
Odgen liked the phrase ‘coming into being’ for something along those lines, and I like it too. The performance therapist, like the performance artist, creates and experiences a relationship like no other. And inevitably, the relationship that’s built is the most telling factor in any therapy that will lead to positive outcomes for the patient.
Taking on the ‘performance therapist’ identity doesn’t necessarily dictate how a clinician should interact with their patient in psychotherapy, as a performance therapist can ascribe to any modality or technique. Performance therapy is more about how one’s identity is understood and expressed as a therapist, both inside and outside the session. The ultimate byproduct of the performance therapist, we find, is the same inexplicable byproduct of performance art – the magic of relating or coming into being. Like a performance art piece can be moving, repulsing, fascinating, or engrossing, so too can the therapeutic experience. Balancing your professional persona and the expression of your deepest inner vulnerabilities that may emerge in the dyad isn’t easy. But when it’s done right (or even if the attempt is there), there also lies the beauty of intimacy, the mystery of being known and knowing, immersion in the tableau – dare I say it, a cathexis to the whole therapeutic process. Odgen liked the phrase ‘coming into being’ for something along those lines, and I like it too. The performance therapist, like the performance artist, creates and experiences a relationship like no other. And inevitably, the relationship that’s built is the most telling factor in any therapy that will lead to positive outcomes for the patient.5
References:
1. Zolberg, Vera. L. (1990) Constructing A Sociology of the Arts. New York: Cambridge University Press
2. Winnicott, D. W. (1965) The Maturational Processes and the Facilitating Environment: Studies in the Theory of Emotional Development. The Maturational Processes and the Facilitating Environment: Studies in the Theory of Emotional Development 64:1-11
3. Lubell, Richard Alan, “The idealized self-image and the reaction to social criticism: a study of Karen Horney’s theory of neurotic personality.” (1981). Masters Theses 1911 - February 2014. 1741. https://doi.org/10.7275/vzvn-xg67
4. London, S. (2024). The Performance Therapist and Authentic Therapeutic Identity: Coming into Being. Routledge.
5. Martin, D. J., Garske, J. P., & Davis, M. K. (2000). Relation of the therapeutic alliance with outcome and other variables: a meta-analytic review. Journal of Consulting and Clinical Psychology, 68(3), 438.
Insightful and interesting article, helpful to be aware of this aspect of clinical work. I think the family therapists especially the strategic family therapists, Haley, Madanes, Minuchin, used similar understandings in their practices.