Table of Contents
Title Page
Copyright Page
Healing a Broken Heart
The Difference between Being Lost and Found
The Balance between Ambiguity and Relevance
An Unexpected Assignment
There Will Always Be Creeping Devils
Creating Meaning
Playing with Spoons: An Ambiguous Function Assignment
Counseling in the Dark
A Birthday Party That Doesn’t Make Sense
The Deer Head That Hadn’t Been Named
The Deer Head Writes a Letter
The Fish Get Named, Too
The Deer Head Starts a Business
Creating Nonsense
Staring out the Window
Special Delivery in the Mailbox
Creativity as Transformative
Getting Out of a Rut
Asking Some Counterviewing Questions
Stubborn Hope
A Letter-Writing Campaign
A Community Defeats the Problem
From Personal Experience, an Idea Is Born
Creativity Is Contagious
The Perfect Son
Don’t Ask People for What They Don’t Have
Hypnosis to Cement the Gains
Perceiving Unhabitually
The Primacy of Experience
The Lingering Effects of the Story
Opening the Blinds
Far End of the Curve
A Run of Bad Luck
Hoping for Magic
It’s the Clients Who Are Creative
Utilizing Client Resources
So, the Devil Was Strolling through Hell
Moments of Utilization
Hands Do the Talking
Moment-to-Moment Creativity
Intervention Is the Assessment
What Is Creativity?
Relational Creativity
It’s All about Relationships
Betrayal by Diagnosis
Mystery, Doubt, and Uncertainty
Staying Fully Present
Hello rather than Goodbye
An Interesting Shift
Mother Speaks Words of Wisdom
Experiential Intensity
Relishing Uncertainty
Honoring the Creative Work
Stuck in a Box
Hobbit Courage
Walking Off a Cliff
“Oh Dear. Bad Me.”
Early Years
The Call to Be Creative
Gardening the Nut Grass
Blissed Out
Leap of Faith
1. Diagnosis: Artistic Temperament
2. Mixing Work with Pleasure
3. It’s All about Love
Against Conventional Wisdom
The Birds Flew Away
It’s Not about Me
Awakening Memories
Frozen on the Floor
Taste of Chocolate
A Cross-Cultural Exorcism
Whose Side Are You On?
A More Mature Version of Empathy
Mistakes of the Heart
First, a Bit of History
The Couches Are Taken Away
We Started Listening
Struggle for Survival
Self-Actualizing Creativity
Creative Attitudes
Historical Legacies
What It Takes to Be More Creative as a Therapist
Creativity among Mortals
Jeffrey Kottler: A Study of Creativity in Action
Jon Carlson: They All Inspired Me
Creativity for Its Own Sake
Just One More Point before We End


Whereas the experience of being a therapist can often seem routine—dealing with similar issues, telling well-worn stories, using standard skills, applying favored methods—occasionally there are moments, even whole sessions, that appear miraculous in their innovation. During such creative breakthroughs, therapists find themselves saying or doing things that have never been done before. They have crossed a threshold from the familiar into completely unknown territory, a place where it feels as if a new voice has been discovered.
In theory, therapists are supposed to treat each client as a unique individual. Each session is supposed to be a novel experience in which the strategy formulated, and the means to carry out that treatment, is custom-tailored to fit the requirements of the situation and particular needs of the client at that moment in time.
Unfortunately, after years of practice, clinicians sometimes slip into familiar patterns, doing what has essentially been done before, albeit in slightly new formulations. Yet there are also those rare circumstances when we are faced with situations we haven’t seen before, or when we have already exhausted everything we already know how to do—all without noticeable effect. We may feel frustrated and confused, at a loss as to what to do next.
It would be nice under such circumstances if there were a supervisory team on the other side of a one-way mirror, always available to offer brilliant new ideas for us to introduce. But, alas, we are on our own, feeling stuck and discouraged.
All therapists have had the experience, admittedly rare, when everything we already know how to do has failed us, and worse, failed the client. We can hear the voices in our heads of all our previous and current supervisors giving advice. We take inventory of our repertoire of interventions and find the stores are now empty. Yet the client waits. For something. For relief. For deliverance.
It is then that we are faced with opportunities to create something wholly new, to cross into another whole realm of possibilities. We are no longer following a familiar path, imitating a mentor, or repeating what we have seen or done previously. We have become our own guide.
The best therapy we have ever done, and will ever do, is like creating a work of art, if not a masterpiece. We weave together disparate themes that begin to form patterns. We create new ways of explaining things. We invent alternative ways to make a difference. We speak in ways so powerful that we can hardly believe that the voice is our own.
And it is not just our clients who experience breakthroughs that alter their reality forever after, but we are different as well—not just in the ways that we work, but also in the ways we relate to the world.
In this volume, we have recruited many of the world’s most accomplished theoreticians and practitioners in the field, especially those who are known for their creative innovations in theory or technique. We have selected them based on the breadth and depth of their clinical experience and the influence of their published work, as well as their diversity in approach, style, and personal characteristics. We invited psychiatrists, psychologists, counselors, social workers, and family therapists to participate. We selected therapists representing many of the major schools of thought, including Adlerian, existential, narrative, feminist, cognitive-behavioral, relational-cultural, Ericksonian, constructivist, psychoanalytic, solution-focused, and person-centered. Some still work exclusively as clinicians, while others now spend the majority of their time as supervisors, academics, researchers, authors, and consultants. They represent different ages, generations, cultures, genders, sexual orientations, geographical regions, clinical settings, and perspectives. What they all have in common is a commitment to pushing the edge of their work, devising new, more creative ways to make a difference in people’s lives.
We have asked them to tell us a story of their most creative breakthrough. Each was asked to talk to us about a baffling case that led to a breakthrough for them, as well as for their clients. These stories demonstrate out-of-the-box thinking that frees people to create alternative ways of meeting their needs.
This book is all about how to be creative and a constructive risk taker, going to places where others have not gone before. Each chapter explores some of the following questions:
• How and why did the situation call for such a radical, innovative approach to a problem?
• How do extraordinarily talented and creative therapists give themselves permission to experiment as change agents?
• How did their clients respond to their unusual interventions?
• What adjustments were made to customize the approach to the client?
• Where did the germ of this novel idea originate? How did the creative process unfold?
• What is the best understanding for how and why this approach actually worked (if it did)?
• What were some of the concerns, apprehensions, reservations, feelings, and thoughts after attempting this intervention that crossed the usual boundaries of what is expected or acceptable?
• How does this particular case example instruct and inform others to be more creative in their own change efforts or to promote them in others?
After presenting the 18 stories that we have written, based on interviews with the participants, we then discuss the universal themes that emerged, as well as the implications for professionals wishing to infuse greater creativity in their lives and work. We hope you will agree that the cases in this book are not only interesting and entertaining, but that they inspire and encourage each of us to promote more creative breakthroughs.

We are most grateful to Lisa Gebo, our original editor and friend, who helped craft the idea for this project in collaboration with our agent, Claire Gerus. Special thanks to Peggy Alexander and Marquita Flemming at Wiley, who have worked with us to complete the project.
Debbie Nelson and Suzanne Lindner were instrumental in this project, typing all the transcripts based on interviews with some very fast talkers. Finally, we are grateful to all our contributors, who were so generous and open in sharing their stories of creative innovation.
Jeffrey Kottler Huntington Beach, California
Jon Carlson Lake Geneva, Wisconsin

Fred Bemak, Ph.D., is a professor in the Graduate School of Education and the director and cofounder of the Diversity Research and Action Center at George Mason University. Bemak has done extensive consultation, training, and supervision with mental health professionals and organizations throughout the United States and internationally in more than 30 countries. He is a past Fulbright scholar, World Rehabilitation Fund Fellow, Kellogg International Fellow, and American Psychological Association Visiting Psychologist. He has published more than 80 book chapters and professional journal articles and coauthored four books.
Laura Brown, Ph.D., is a clinical and forensic psychologist specializing in culturally competent work with survivors of trauma. In addition to her many publications, she is featured in three APA psychotherapy videos. She is the founder and director of the Fremont Community Therapy Project, a low-fee training clinic in Seattle, where she lives with her partner and her canine cotherapist, and is moving slowly through the belts of aikido.
Nicholas A. Cummings, Ph.D., Sc.D., a past president of the American Psychological Association, is known for predicting the future of psychology practice during the past 60 years and also for helping to create it. Cummings not only designed and implemented the nation’s first prepaid psychotherapy insurance, but also launched the professional school movement with the four campuses of the California School of Professional Psychology (now Alliant University). He founded American Biodyne, the first and only managed behavioral health organization completely managed by psychologists. He is now Distinguished Professor at the University of Nevada, Reno, and president of the Cummings Foundation for Behavioral Health. He is the author or coauthor of 46 books and has published more than 450 refereed journal articles.
Samuel T. Gladding, Ph.D., is chair and professor in the Department of Counseling at Wake Forest University in Winston-Salem, North Carolina. His leadership in the field of counseling includes service as president of the American Counseling Association (ACA), Association for Counselor Education and Supervision (ACES), the Association for Specialists in Group Work (ASGW), and Chi Sigma Iota. He is the former editor of the Journal for Specialists in Group Work and the author of more than 100 professional publications, including 29 books.
Judith V. Jordan, Ph.D., is the director of the Jean Baker Miller Training Institute and Founding Scholar of the Stone Center at Wellesley College, where she and her colleagues have been developing Relational-Cultural Theory (RCT) since the late 1970s. She is an assistant professor of psychology at Harvard Medical School, served as the director of Psychology Training at Mclean Hospital, and was the founding director of the Women’s Treatment Program there. Jordan coauthored Women’s Growth in Connection and edited Women’s Growth in Diversity and The Complexity of Connection. She is committed to shifting the prevailing paradigm in psychology from one that reveres separation and “the separate self” to one that appreciates the centrality of connection in people’s lives.
Bradford Keeney, Ph.D., has followed an academic career as a systems theorist and psychotherapist. He spent over a decade traveling the globe, living with spiritual teachers, shamans, healers, and medicine people to study and describe their experiences. The result of Keeney’s work is one of the broadest and most intense field studies of healing and shamanism, chronicled in the book series Profiles of Healing, an 11-volume encyclopedia of the world’s healing practices. Keeney presently conducts his clinical work at the Center for Children and Families, Monroe, Louisiana. He also serves as professor of Transformative Studies, California Institute of Integral Studies, San Francisco; Honorary Senior Research Fellow, Rock Art Research Institute, University of Witwatersrand, Johannesburg, South Africa; and founding director of the Bushman (San) N/om-Kxaosi Ethno-graphic Project, Institute for Religion and Health, Texas Medical Center, Houston.
Stephen R. Lankton, M.S.W., DAHB, is a licensed clinical social worker in Phoenix, Arizona. He is editor of the American Journal of Clinical Hypnosis and executive director of the Phoenix Institute of Ericksonian Therapy. Lankton is faculty associate at Arizona State University, Diplomate in Clinical Hypnosis, past president of the American Hypnosis Board for Clinical Social Work, and a Fellow and Approved Consultant of the American Society of Clinical Hypnosis. He is author of 17 books, with translations in several languages, regarding techniques of hypnosis, family therapy, and brief therapy. He has a clinical practice in Phoenix and trains professionals internationally.
Cloé Madanes is a world-renowned innovator and teacher of family and brief therapy and one of the originators of the strategic approach to family therapy. She has authored five books, including Strategic Family Therapy; Behind the One-Way Mirror; Sex, Love, and Violence; The Secret Meaning of Money; and The Violence of Men. She has won several awards for distinguished contributions to psychology and has counseled outstanding individuals from all walks of life. Her books have been translated into more than 10 languages.
Stephen Madigan, M.S.W., Ph.D., opened Yaletown Family Therapy in Vancouver, Canada, as the first narrative therapy clinic and training site in the Northern Hemisphere. In June 2007, the American Family Therapy Academy (AFTA) honored Madigan with its Distinguished Award for Innovative Practice in Family Therapy Theory and Practice. He has worked with the American Psychological Association (APA) to write the “primer” for narrative therapy and to produce a seven-part DVD featuring his “live” narrative therapy work. Madigan designs and produces the Therapeutic Conversations conferences and teaches narrative therapy training workshops worldwide on a regular basis.
Nancy McWilliams, Ph.D., teaches at Rutgers University’s Graduate School of Applied & Professional Psychology and has a private practice in Flemington, New Jersey. She is author of Psychoanalytic Diagnosis, Psychoanalytic Case Formulation, and Psychoanalytic Psychotherapy and is associate editor of the Psychodynamic Diagnostic Manual. She is president of Division 39 (Psychoanalysis) of the American Psychological Association and is on the editorial boards of Psychoanalytic Psychology and The Psychoanalytic Review.
Scott D. Miller, Ph.D., is a cofounder of the Institute for the Study of Therapeutic Change, a private group of clinicians and researchers dedicated to studying what works in mental health and substance abuse treatment. Miller, the author of numerous articles, is also coauthor of several books, including Working with the Problem Drinker: A Solution-Focused Approach; Escape from Babel: Toward a Unifying Language for Psychotherapy Practice; The Heart and Soul of Change: What Works in Therapy; and The Heroic Client: A Revolutionary Way to Improve Effectiveness through Client-Directed, Outcome-Informed Therapy.
Alfonso Montuori, Ph.D., is professor and department chair of the graduate programs in transformative studies and leadership at California Institute of Integral Studies. He was a Distinguished Professor in the School of Fine Arts at Miami University in Oxford, Ohio, and taught at the Central South University in Hunan, China. A former professional musician, he is the author of several books and numerous articles on creativity and complexity. Montuori is principal of Evolutionary Strategies, a consulting firm focusing on creativity and executive development. He lives in San Francisco.
Robert A. Neimeyer, Ph.D., is a professor and director of psychotherapy research in the Department of Psychology, University of Memphis, where he also maintains an active clinical practice. Neimeyer has published 20 books, including Meaning Reconstruction and the Experience of Loss; Lessons of Loss: A Guide to Coping; and Rainbow in the Stone, a book of contemporary poetry. The author of more than 300 articles and book chapters, he is currently working to advance a more adequate theory of grieving as a meaning-making process, both in his published work and through his frequent professional workshops for national and international audiences.
Bill O’Hanlon, M.S., LMFT, has authored or coauthored 29 books, the latest being A Guide to Trance Land; Write Is a Verb; Pathways to Spirituality; Change 101: A Practical Guide to Creating Change; and Thriving Through Crisis. O’Hanlon is a Licensed Mental Health Professional, Certified Professional Counselor, and a Licensed Marriage and Family Therapist. He is known for his storytelling, irreverent humor, clear and accessible style, and his boundless enthusiasm for whatever he is doing.
Len Sperry, M.D., Ph.D., who has practiced, taught, and researched psychotherapy for nearly 40 years, is a professor of mental health counseling at Florida Atlantic University and a clinical professor of psychiatry at the Medical College of Wisconsin. Sperry is a Distinguished Fellow of the American Psychiatric Association, a Fellow in the American Psychological Association, and board-certified in both psychiatry and clinical psychology. He serves on the editorial boards of 10 professional journals and has published some 500 articles and books.
Michael D. Yapko, Ph.D., a clinical psychologist and marriage and family therapist in Fallbrook, California, is the author of numerous books, book chapters, and articles on the subjects of hypnosis and the use of strategic psychotherapies in treating depression. Internationally recognized for his work in outcome-focused psychotherapy, Yapko routinely teaches professional audiences all over the world. He is the recipient of numerous awards honoring his lifetime contributions to the fields of clinical hypnosis and psychotherapy.
Jeffrey K. Zeig, Ph.D., is the founder and director of the Milton H. Erickson Foundation. He has edited, coedited, authored, or coauthored more than 20 books on psychotherapy that appear in 11 foreign languages. Zeig is the architect of The Evolution of Psychotherapy Conferences, which are considered the most important conferences in the history of psychotherapy. He organizes the Brief Therapy Conferences, the Couples Conferences, and the International Congresses on Ericksonian Approaches to Hypnosis and Psychotherapy. A psychologist in private practice in Phoenix, Arizona, he conducts workshops internationally (40 countries). He is president of Zeig, Tucker & Theisen, Inc., publishers in the behavioral sciences.

I (Jeffrey) was waiting to appear onstage, ready to deliver a speech at a conference. I was restless with nervous energy, ready to do my thing so I could relax and enjoy some unscheduled time. But I still had a few hours to go.
I looked up from a couch where I’d been reviewing my notes and organizing slides. I didn’t really need to rehearse what I was going to say, but I wanted to be as prepared as I could be because I knew it was going to be a tough audience: They’d be tired after lunch.
I noticed the organizer of the conference pacing back and forth and talking into a phone. She looked panic-stricken. How did I know this? Based on my superior therapeutic skills I deduced many symptoms of extreme anxiety. Besides, she was screaming loudly enough for me to hear: “What the hell do you mean you’re not coming?!”
When the conference organizer finished the call, I observed that she looked like she was about to burst into tears. My perception was confirmed when she muttered to herself, loud enough for me to hear: “I just want to cry.”
“Something the matter?” I said to her with real concern. I liked this person a lot and appreciated all she had done to bring this conference together.
She just shook her head, unable to speak, so I waited. “I’ve heard ’em all,” she said, shaking her head in disbelief, “this takes the cake.”
“What’s the matter?” I asked again.
“Oh, no big deal. It’s just that there’s a program set to start in fifteen minutes—just over there.” She gestured with her arm in the direction of a room where people were filing in.
“Yeah? So, what’s the problem? Looks like a good crowd to me.”
She nodded her head. “Would you believe that the presenter just called me?” She looked down at the phone she was still holding in her hand, squeezing it tightly, practically strangling it for bringing her unwanted news. “She said she won’t be able to make it here.”
“You mean the person who’s supposed to be doing this program isn’t showing up?”
“Exactly. So I’ve got a roomful of people sitting in there waiting for a workshop, and the person they came to see is a no-show.”
“What’s it called?” I asked her, not sure what else to say.
“Art therapy. It’s a workshop on art therapy. Now what the hell am I going to do? These people are going to be bloody upset and I don’t blame them.”
I don’t know what made me do it. But before I could stop myself, I heard a voice come out of my mouth, as if someone else were inside my body: “Well, if you need someone to bail you out, I can do the workshop for you.” As soon as I said the words I had this sickly smile on my face, feeling both amused and horrified at what I had just volunteered to do.
The woman looked at me with stunned surprise. “You mean you can do a workshop on art therapy? I didn’t know you knew anything about that.”
As a matter of fact, I hadn’t a clue what the topic was about. I can honestly say that in my whole life I’d never even done a single minute of art therapy, unless I count the time I stopped a kid from drawing on the wall of my waiting room.
“Well, sure, I can take the group for you. I’m sure we can come up with something that we could do together, but . . .”
Before I could finish the thought, the organizer had raced off to the room and was making an announcement that they were going to have a special treat. She was telling them that the keynote speaker was going to do a special session for them and he’d be right in.
I took a deep breath and started walking toward the room. Immediately, I had a flashback to another time in my life, at the very beginning of my career. I had been added as the fifth presenter to a program at my very first national conference. I was a lowly student at the time, just starting my classes. My adviser, who was quite well known, decided to add me to his program as an afterthought. Along with a friend of his, who had just authored a best-selling book, and two doctoral students, we were going to present together. This was to be my first public presentation, and my role was going to be fairly limited with all these big guns to carry the weight.
As it turned out, the famous author never showed up at the conference. My adviser had been out drinking all night, so when I went to his room to get him out of bed, he refused to answer the door. That left me and the two doctoral students. Since they were both experienced counselors and supervisors, and one of them was even a champion athlete who had won a gold medal in the Olympics, I still wasn’t that worried: I would follow their lead.
When we showed up at the room, there was a crowd packed into the space. It was not just standing room only, but people were literally sitting in the aisles—hundreds of them had come to catch a glimpse of the famous author and my adviser. I peeked in the room, feeling my heart pounding, wondering what the heck we were going to do. I skipped over a few bodies blocking the door, nudged my way through the crowd, and fought my way to the front of the room. There were dirty looks all along the way, since nobody could imagine that someone as young and innocent looking as me (I was only 23) could possibly be one of the presenters.
When I turned around to face the audience, I saw only one of my partners standing next to me. It seems that one of the doctoral students, the Olympic champion, absolutely freaked out when he saw the huge audience: He fled, leaving just the two of us to handle things. We stood before these hundreds of people, all of whom were expecting someone quite different, and looked at one another with a shrug. Somehow we would get through this.
I had exactly this same feeling as I now approached the roomful of expectant people at this international conference 25 years later. They wanted a program on art therapy and I didn’t have any idea about what that involved; I couldn’t even begin to fake it. I reviewed every option within my extensive repertoire and still came up utterly blank. Instead, I asked the group, now growing restless, what it would be like to participate in a workshop without a name. “What if you could be part of an experience that addressed something you’d always wanted to study?”
“I thought we were here to do art therapy,” someone called out from the audience.
“I already explained that to you,” I said as patiently as I could. Damn, I knew this wouldn’t work! Then I said, a little more forcefully than I intended: “I know that is what you came for, but that isn’t going to happen. After all, being a therapist is about being flexible, isn’t it? It’s about going with whatever clients bring us, no matter what we’ve prepared. It’s about improvisation and creativity, that is, devising solutions to problems that had previously seemed unsolvable. It’s about letting go of things outside of your control and going with the flow. And that’s what we’re going to do today.”
“You mean we aren’t doing art therapy?” the voice asked again.
I counted slowly to myself. “That’s right. No art therapy. So, what do you want to do instead?”
We spent the next few hours talking to one another about what we needed most, and what was getting in the way of reaching those goals. I had no idea where things were going or where we would proceed next. I just listened carefully, not only to the people speaking, but to the voice inside my head that had gotten me into this situation. Or perhaps I should say that differently: This was the voice helping me to find my way in a situation without markers or signs, without even a trail. But then, that is often what it feels like to me when I do therapy in the beginning stages, and especially when the client and I are venturing into new territory. That is what makes the process so exciting and such an adventure. We may have encountered what appears to be a familiar situation, and yet the best work that we do takes place during creative breakthroughs when we go far beyond the boundaries of where we have trod before.
I wouldn’t say that the presentation I did at that conference was the best program I’d ever done. How could it be, without a minute’s preparation, no structure, and an audience that had some rather highly defined expectations about what they’d come for? Still, I think it was one of the most satisfying workshops I’d ever done. I don’t think many of the participants left disappointed, at least those who were willing to surrender their initial expectations and go with what unfolded.
In many ways, I did the perfect “anti-workshop” workshop. It was a program completely without structure, without an agenda, without handouts or slides, without any defined goals or outcomes. It was just an opportunity for a group of professionals to let go of their expectations and embrace what was available.
This experience was a major breakthrough for me, not only as a presenter, but as a therapist, supervisor, and author. I had finally found my voice and had learned to trust my own ability to be helpful without needing to plan so intentionally what I was going to do next. Just as I somehow managed to take care of business in my very first professional presentation 25 years earlier, this time I was able to do a workshop on art therapy without knowing a single thing about the subject. Instead, we examined how we could all be more creative in our work, and what was blocking us from being even more innovative.

Healing a Broken Heart

When Jeffrey shared this story, it reminded me (Jon) of all the ways we have to push beyond the boundaries of what we already know, and can already do, in order to reach new levels of creative effectiveness. This doesn’t happen every day, and perhaps not every week, but these breakthroughs represent the most exciting and challenging aspects of our work when we are operating without a map, or even a compass, in explored territory.
Frank was severely depressed and suicidal, so much so that he required almost daily sessions for a period of time in order to keep from hurting himself. Even with this unusual level of support, as well as antidepressant medication, his condition was worsening. And no wonder: His grief was literally eating him alive. Just a few months earlier, his eight-year-old son had been run over by the school bus right in front of their home. Understandably, this devastated the family, Frank perhaps worst of all, who felt somehow responsible for the accident.
Everything I tried, everything I knew how to do, failed to have much of an impact on Frank. After referring him for medication without success, I tried hypnosis, meditation, cognitive therapy, spiritual interventions, and every other therapy I could think of, all without noticeable effect. As one of the world’s leading experts in Adlerian therapy, I introduced every action method within my repertoire—again with no observable impact. If anything, Frank sank deeper and deeper into his depression.
I came to dread our sessions as an exercise in futility, imagining that things couldn’t possibly be worse. I was wrong: Frank suffered a life-threatening heart attack. He almost died, quite literally, of a broken heart.
I not only felt sorry for Frank, but also for myself. I felt inept. His hopelessness and despair were beginning to seep into my own soul, leading me to question what I do and how I do it. Yet I couldn’t just give up on him; I had to do something. So I went to the local sporting goods store and purchased a pair of running shoes in Frank’s size, asking that they be delivered to his hospital room.
A couple of weeks later, Frank had been released from the hospital and was back in my office. He said he was feeling physically better but was desperately afraid that his broken heart would collapse once again. “By the way,” he mentioned as the session was about to end, “how come you sent me those shoes? I mean I appreciate it and all, but you could have sent flowers.” For a second, he almost smiled—not quite, but the left upper lip moved upward just a little.
I smiled back at him. “Because we are going to start training for a marathon.”
“Are you drugs on or something? For Christ’s sake, I just had a heart attack and almost died!”
“I know that you almost died, but I also know that your heart is a muscle that can be strengthened through exercise. So I plan to be at your house each morning at 7:00 a.m. to go for a walk. Each week we will go a little farther, and eventually we’ll be able to do the local 26.2-mile run.” Frank knew that I had a history of being a competitive distance runner and had frequently honked at me when he drove by in his car.
Frank was more than reluctant about this plan, and to tell you the truth, so was I. There are rules about how therapy should be conducted, strict ethical guidelines that enforce clear boundaries regarding time, place, and the kind of relationship that can take place. By taking the therapy outside of the office and onto the streets, I was realigning the nature of our alliance. Yet with his life at stake and all conventional methods proving ineffective, I knew I had to try something radical and unusual to get through to him. I certainly felt misgivings, but I could justify that what I was doing was for my client’s best interests.
The next morning I showed up at his door at 7:00 a.m. as promised. We walked one block, painfully slowly, before Frank said he’d had enough and wanted to go home. He complained the whole time about how stupid this was, how tired he felt, how cold it was, how I was going too fast for him, and how he was crazy to trust a therapist who couldn’t even help him. Nobody could help him. His heart was broken and that’s just the way it was.
Our routine continued for the next several weeks. We would walk a few blocks with Frank complaining and grumbling the whole time and then insisting we go home. Yet we both persevered, and eventually he could walk several miles (but still complaining). I began to notice some improvement in his mood. Occasionally he would smile, or even laugh at jokes I would tell him. His gait had more bounce in it. He appeared more alive.
A month later, we were up to a slow jog, going five miles or longer. Frank began to lose weight and gain confidence. He returned to work. He stopped taking the antidepressants, as he felt they weren’t needed any longer. Six months after that, he was ready for his first marathon. We got special permission from the organizers to start three hours before the official beginning, knowing that he would need extra time to complete the 26-mile course. Indeed, it took him seven hours to finish, with me at his side the whole way, offering encouragement and support. We both had tears in our eyes when we finally crossed the finish line.
Soon after this, our “therapy” ended, although we agreed to meet each year for our annual marathon, which continued for the next nine years.
As I reflect on this case, I learned, or actually relearned, that doing the same thing (talk therapy) over and over again and expecting a different result is pretty crazy. You can’t solve a problem with the same thinking that created it. It was necessary to let go of the logical and rational in favor of the novel and creative.
I guess it isn’t so creative these days to suggest exercise for depression, but 20 years ago it was not at all well accepted. It was also one thing to tell a client to go and exercise but a much different prospect to be knocking on his door at 7:00 a.m. in my shorts and running shoes.
All of my previous therapy experiences had been done in the safety of my office with a set 45-minute time limit. I frequently found myself worrying, “What if he has another heart attack? Maybe I am pushing him too hard? What are other people saying about our helping relationship outside the boundaries of my office?
I know that it wasn’t just the running that helped Frank. He was deeply moved that I cared enough about him to invest this kind of time and effort to help him through the most critical time in his life. He felt my caring, my compassion, and my confidence that he could rejuvenate himself. Although at one point I myself had started to lose hope, it was this creative breakthrough that helped me find my own faith in his self-healing powers.
This case became the first of many instances afterward when I learned to trust my own intuition and my own wisdom. Certainly, these creative hunches evolved from long experience, but until this point in my work, I had been imitating my mentors, doing what I imagined they would do in similar circumstances. Finally, I gave myself permission to write my own textbook instead of following those written by others.
Since that first experience with Frank many years ago, I have worked with delinquent teens, getting them outside of my office and volunteering to work with handicapped children. Since the prognosis for addictions is so poor in traditional therapy, I have used meditation retreats in lieu of a traditional rehab program. I have suggested that some conflicted couples stop coming to therapy and instead volunteer their time on behalf of a social justice project they both value.

The Difference between Being Lost and Found

Each of these nontraditional activities described is a valid treatment suggestion that resulted in a successful outcome. As a friend of ours, Frank Pittman, mentioned in a previous book we wrote about failures in therapy (Kottler & Carlson, 2002), you can’t do good therapy unless you do bad therapy, meaning you have to take risks, to invent new methods that perhaps were never tried before. Sometimes it works out, sometimes it doesn’t. Yet if you have developed a solid enough relationship with clients, then they will be patient enough to stick around long enough for you to collaborate together on a satisfactory outcome.
The clients we see are all so different that each one requires an individualized approach, one that has been customized for his or her unique needs, complaints, and preferences. This is one of the aspects of our work that makes it so exciting and creative, yet those feelings are acknowledged only after the problems are resolved. Doing therapy is among the hardest, most bewildering, most challenging jobs on the planet (at least among those that can be conducted in an office). We are constantly being tested, never sure what is real and what is not. Our own issues are just on the edge of the conversations, gently (sometimes forcibly) pushed aside. We enter such intimate, personal relationships, yet must continuously guard against any self-indulgence. We are expected to care deeply about our clients, but not so much that we lose perspective or control.
Crossing creative boundaries often occurs during periods of our work in which we feel most lost. Yet the state of being—or feeling—lost is not as easy to define as one might imagine. Scientists who study lost behavior variously describe the state of “lostness” as (1) not knowing where you are, (2) not being able to locate your position in relation to your destination, (3) spending more than 30 minutes without a known location, (4) being the subject of a search. Although they are referring to being lost in a wilderness area, this is still a familiar condition to most therapists a good portion of the time.
The first step to being “unlost,” or “found,” is admitting that you don’t know where you are going in the first place. In the examples mentioned earlier, Jeffrey freely admitted that he didn’t know the first thing about the subject of the workshop, and then invited participants to co-create with him a new experience. Jon surrendered to his feelings of being stuck with Frank, and that made it possible for him to invent a new way of being a therapist, one who crosses boundaries that had previously seemed impermeable.
Many stubborn wanderers have literally walked off cliffs because they refused to acknowledge that they had no accurate mental map of their location. When they don’t recognize familiar landmarks, the natural tendency is to speed up one’s pace, to hurry up and find the correct path that may be just over the next ridge. Therapists, as well, persist in doing what they are already doing, even though it is clear that it may not be working very well.
In studies of lost behavior in the wilderness, there are distinct stages of disorientation, beginning with denial there is a problem. During those times, when people don’t know where they are going, or where they are in relation to where they hope to be, they try to make the terrain fit their imperfect mental image. This is similar to therapists insisting that their clients fit their theories in spite of compelling evidence that the situation and context don’t appear to apply to them.
Panic sets in next. The urgency to find familiar landmarks leads to a sense of bewilderment and acute stress. Most of us became therapists in the first place because we enjoy the illusion of making sense of things, of finding (or creating) meaning in circumstances beyond our control, of acting as confident guides through a chaotic world. As apprehension grows, so does the capacity for clear, rational thought. Those who are lost at sea or in mountains, clouds, or woods, start making poor decisions that become progressively more rigid, unproductive, and dangerous. Their range of options appears increasingly more limited. They persist in doing what is clearly already unhelpful.
In a state of frustration and disordered thinking, people (and therapists) who feel lost make poor decisions. They follow a path of convenience rather than one that leads home. Eventually, it feels like all viable strategies have been tried and there is nothing left to be done. Clients are sometimes “fired” at this point, or helped to discover alternative resources (“Let me give you a referral”).
Creative breakthroughs take place when, during these lost experiences, clinicians are required to invent new ways of navigating through a wilderness in which they have had no previous experience. Everything they know has failed them. All their route-finding skills, all their internal resources, all their technical equipment, all their strength and conditioning cannot save them. They wander in circles—or walk off cliffs. In the language of orienteering, they are “bending the map,” trying to make reality conform to expectations.
The stories that follow represent seminal cases in which boundaries were crossed. The most eminent theorists in therapy and related fields share some of the creative breakthroughs that led them to find their own unique voices as clinicians and writers and inspirational figures. We hope their experiences will inspire you to discover your own creative path.

There is something altogether contrived about asking a creative professional not only to tell us about a story, but to show us what he or she does, to demonstrate innovation in action. Steve Lankton was our very first interviewee for the project, and we hadn’t yet worked the bugs out. Thus, after spending well over an hour hearing the most remarkable story of a case, we discovered to our horror that the recorder hadn’t been functioning: All was lost to posterity.
It was with considerable hesitation that Lankton agreed to talk to us again, not because of any disappointment with the lost dialogue, but because we insisted that he tell us the same story again. It had been so perfect for the intent of this project that we couldn’t imagine anything better. The problem was that for Lankton creativity is a spontaneous moment, one that can never be repeated in the same way. Rather than trying to re-create a conversation that already took place, Lankton preferred to begin anew with whatever seemed present at the time. That is, after all, what good therapy involves: honoring whatever is going on in the moment.

The Balance between Ambiguity and Relevance

Creativity, to Steve Lankton, is doing something outside the norm of the way you typically operate or what is expected of you by others. It is based on discovering new resources, both within yourself—and your client. He isn’t just referring to intellectual or emotional factors, but also bodily sensations that become present and lead to an epiphany. It all begins with increased awareness and focused concentration.
Lankton remembered a case from several years ago that occurred during a demonstration in front of an audience of a thousand people. The client had been dealing with chronic pain for many years and had volunteered to come onstage because she heard that Lankton might be able to hypnotize her to make the pain go away.
“I was sitting there,” Lankton remembered, “watching her sitting down and being strapped into the microphone and I was thinking, oh my god, what if I can’t hypnotize her? What if I can’t get rid of her pain in front of all these witnesses?”
Those feelings of doubt, accompanied by mild tremors within his body, signaled to Lankton that if he wanted something useful, if not wonderful, to result from this encounter, he had better concentrate on letting go of everything else except the moment.
“I felt all the details and distractions fade away to a softer focus, which included increased awareness, a wider peripheral vision. I sat in the chair up onstage and reminded myself that I can’t make anybody go into a trance and I can’t make anyone’s pain go away. It is all about indirect suggestion, binds, confusion, and metaphors—tools that I’ve learned to use really well. That’s all I can do; the rest is up to her. And that often is enough for most people . . . maybe for her. If not, I’ve done all I know to do.”
Lankton could feel his anxiety and fear of performance melt away. Maybe this would work for her, maybe not. But he remembers that moment as a landmark related to performing under pressure, and he has never felt such anxiety again in those circumstances. “Instead I feel tremendous relaxed alertness that is as much a physical sensation as it is a sense of confidence in what I do. It allows me to pay a great deal of attention to the client and trust what might unfold between us that might be useful. This goes hand in hand with creativity in that I can shift more readily into new resources.”
Rather than going back into the far past for an example of a creative breakthrough, Lankton mentioned a client that he had seen this very day. Brian’s brother had died when he had been a boy, and he had been talking about how he never felt any closure because his parents didn’t take him to the hospital to see his brother before he died. All he remembered is that he was dressed up one day and taken to the funeral to say goodbye. At the time, he wasn’t even clear about what a funeral was except that it was a sad place where everyone cried.
“My parents never told me what was going on,” Brian related. “They never sat me down and explained that my brother was dead. They never told me how they felt about it. They never asked me how I felt. They never reassured me it wasn’t my fault. They never said a damn thing. They just left me in my room alone.”
Lankton pointed out that it wasn’t the first time his parents had neglected him. “They were experts at neglect, weren’t they?”
Brian talked about how he had felt ignored throughout much of his childhood, a predicament that somehow left him feeling he had earned and deserved punishment. Ever since, he had chosen women to date who would be certain to censure and berate him for everything he did and make it seem wrong—living out the familiar pattern that had been established when he was young.
“You know,” Brian admitted in the session, “after that trance we did last week when you were talking about me letting go of images that were bothersome. I thought we were just talking about my ex-girlfriend that I just broke up with. But later that night I woke up flooded with all these memories of my brother’s death and I was sobbing and crying and something came to me.” He stopped to catch his breath.
“What’s that?” Lankton prompted him gently. “What came to you?”
“I was just remembering how the last time I ever spoke to my brother he was talking to me while we each lay in our beds. Rather than listening to him I just told him I was tired and wanted to go to sleep.” Brian broke down in tears. “That’s the last thing I ever said to him. He was dead the next day. And I just wish . . . I wish . . .”
“You wish you could have listened that one time,” Lankton finished.