Sex, Psychotherapy, & the Nature of Play

I was recently scouting around for a personal therapist and expressed during a consultation that I wasn’t sure what my goals were—I was just looking to develop a relationship with a therapist and take it from there. The therapist said in response, “Okay, but therapy is about work. What would you like to change about yourself?”

I found this to be a thought-provoking idea, and one that I wasn’t sure I agreed with. Is therapy about work? At the time, I wasn’t looking to do work—I was looking to explore (even if, at previous times in my life when I sought therapy, I had been more goal-oriented.)

I thought about this conversation when I recently read famed British psychoanalyst D.W. Winnicott’s book, Playing and Reality, in which he writes that therapy, at its best, is more about ‘play’ than it is about ‘work.’ “Psychotherapy has to do with two people playing together,” writes Winnicott, “The corollary of this is that where playing is not possible then the work done by the therapist is directed towards bringing the patient from a state of not being able to play into a state of being able to play.”

For me, this is an exciting if slippery concept--what does it mean to play in therapy? And how does a therapist bring a client into a state of being able to play? I know that playfulness is a quality that I value—in relationships, in people, and in literature and art. I value it in therapy, as well, but I wasn’t sure in what ways I play as a therapist.

For clients struggling with depression or severe anxiety, playing is almost unimaginable—the same way that the thought of flirting with a romantic interest might be out of reach to a very shy person. When the stakes feel too high, playfulness eludes us. But, according to Winnicott, the process of therapy is about re-learning to play.

Winnicott writes that to make sense of one’s own life in a creative manner is a form of play called ‘creative living.’ “We find either that individuals live creatively and feel that life is worth living,” writes Winnicott, “or else they cannot live creatively and are doubtful about the value of living.”

Working with clients to perceive their lives in a creative way requires both a sense of gamesmanship on the part of the therapist, as well as an active restraint. To me, playing as a therapist involves exploring relevant themes, helping clients to connect some dots, asking thoughtful questions rather than making statements, and, sometimes, using humor and irony to share with a client a sense of joyful awe at some instance of absurdity. Sometimes playing involves giving a bold and surprising homework assignment to a client.

As a psychotherapist with a specialization in sex, I wonder how Winnicott’s ideas relate to sex therapy. It seems to me that Winnicott’s thinking is essential to not only good sex therapy, but also good sex. He emphasizes the therapist creating an open space in which clients can explore. According to Winnicott, therapy isn’t about solving problems; it’s about learning to engage creatively.

Therapy can be like sex in a way. Ideally, the emphasis isn’t on achieving orgasm, it’s about having a healthy sense of play and discovery. Yes, we want sex to be erotically intense and gratifying, just as we want therapy to be meaningful and have impact (we are paying for this, aren’t we?) But this gratification and impact, in sex and in sex therapy, comes more from openness, presence, and a sense of willingness than it does from trying hard.

Sex shouldn’t feel like work. I guess therapy is work in the sense that progress is being made and it requires focus; but the spirit, I think, should be one of playfulness.