Pivotal Moments in Psychotherapy - Part 1.

During the last couple of weeks, I've been thinking about defining, or pivotal moments in psychotherapy.

At the end of April, I attended a conference entitled: Interpersonal Neurobiology with Innovative Therapeutic Practices, organized by the Hincks-Dellcrest Centre in Toronto.

The conference took place over three days.  The first day featured Dr Dan Siegel speaking to a sold-out audience about the basic principles of Mindsight and Interpersonal Neurobiology.  I won't review the subject matter of his talk in detail here today.  Many readers will already be familiar with his work, and more undoubtedly will be over the years to come.  One thing I have to say about Dr Dan is that he knows how to attract a big audience, although I think he does this less by guile than by mastery of his subject matter.  His emphasis on the "neurobiology of we", revealing us as deeply social beings, and his clear explanations of mind, neuroscience and the importance of integration, make his work accessible and relevant to mental health practitioners, spiritual seekers and the general population all at once.  I was pleased to meet many colleagues on this full day presentation - I think that at one point I counted fifteen GP psychotherapists in the theatre.

The next two days included lectures and various workshops which aimed to take the theory and practice of interpersonal neurobiology (IPNB) into our daily clinical work.

I was excited to sign up for one of the workshops co-led by Jim Duvall, about whom - over the years - I've heard so many good things said.  The workshop was evocatively entitled: Hemishphere Dancing: Inviting Pivotal Moments, Streams of Consciousness and Transport in Narrative Conversations.  I especially liked the term hemisphere dancing.  I'm primarily trained as a somatic psychotherapist, so for me, the idea of two parts of the brain dancing together has an almost kinaesthetic feel to it.

The idea of hemisphere dancing, based on IPNB theory, is that the therapist, while witnessing the unfolding narrative, assists the patient in moving back and forth between fact and feeling, thought and sensation, in such a way that the unfolding process becomes a more whole brain process.

I know, intuitively, and from experience, what a pivotal moment is, or at least resembles, but I do find it somewhat difficult to put into words.  So I will leave you with the the description written by Jim Duvall and his co-presenter, Robert Maclellan:

Pivotal moments are those rewarding junctures - the smallest chunk of lived experience that occur in the moment-to-momentness of therapeutic conversations -when a particular question cracks open a door that shines light on possibilities only thinly imagined.  Michael White described these moments as "epiphanies that are in harmony with what is precious to people, that is beautiful, that they want to rush toward" (Duvall and Young, 2007).  Such pivotal moments, hidden in full view, form associational narratives in which people experience transport and are able to connect with a strong sense of "myself".  What makes them stick is how they are responded to in the outside world."

The workshop helped me to gain a clearer understanding of how I "engage and sustain these otherwise fleeting, meaningful experiences", where a smaller story of self momentarily breaks open, leaving the patient exposed to a larger story and to a self-sense more open to new and deeper possibilities.

Here we find brief glints of colour in the narrative of the depressed person, or "sparkles" emerging in an otherwise quiet tale.  And here, it is the role of the good therapist to identify these moments and to reflect them back to the patient.  Done well, new gifts emerge from ambiguity and uncertainty.  Too much certainty on the part of the therapist will actually close the process down, thus robbing the patient of this rich opportunity for change.

Research has shown, over the years, that there is a very brief window of opportunity in making contact with a pivotal moment.  The range is between four and ten seconds.  The clinical qualities in a therapist that incline them toward identifying and contacting pivotal moments are that they go slow, that they stay mindful and present, and that they utilize imagery and metaphor in their language.

At the pivotal moment, the patient enters what Dan Siegel calls the open plain of possibility.  Here, by activating the open areas of the pre-frontal cortex, the possibility of new insights and of bridging connections between different brain regions is potentially infinite.

We wouldn't want to spend too much time in pivotal moments and Dr Siegel correctly notes that good health means the ability to move between evoking certainty in some moments and possibility in others.  Both are necessary for a life that allows for wholeness and change.

Jim Duvall, in his talk, quoted Emmanuel Kant, who put it another way:
Concepts without intuitions are empty.
Intuitions without concepts are blind.

In Part 2 of this post, I'm going to give some case examples, one from Jim Duvall and one from my own practice.

In the meantime, why not reflect on your own experience, on your own pivotal moments and the patient pivotal moments you've witnessed and deepened in your own clinical work.  Feel free to share one or the other, if it feels right.  This may even be a chance to return to a past moment, and to travel even further on the open plain of possibility.  Who knows what new experiences and ideas are awaiting you at the wild frontiers of self and other.