Embodying Unconditional Positive Regard through the Rule of “Always Say Yes”

As a therapist working on inpatient psych at a hospital deep in Brooklyn, I am faced with the wondrous challenge of doing psychotherapy with unique individuals from the community our hospital serves. Many of our patients have never engaged in self-searching, transformational work in a supportive environment. Some of them view service providers and clinicians as “the enemy”. They have experienced feeling not only misunderstood, but also colonized when dealing with the mental health system. Imagine being an immigrant kid who attempts to deal with underlying mental illness by using heroin. Small and unassuming, he gets attention by acting clown-like, bragging about “getting high and getting bitches.” Well meaning service providers understandably get fed up with patients who present like this and his resistance to change. By rejecting him, his negative attention-seeking cycle simply continues. Or imagine the old man whose manic episodes keep him in the role of the “lecherous fool” who keeps his spirits high by making inappropriate comments to unexpecting female nurses. He does this because on the other side of his mania lives a depression so harrowing he can hardly move. Or, imagine another elder who has bypassed looking within for his entire life, and has subsequently developed the hardy defense of relentless, stinging sarcasm. He throws verbal darts whenever he starts to feel challenged or vulnerable causing others to easily give up on him.   


When, as service providers, we only have an average of a few days to work with our patients, we have to be scrupulous in our efforts to reach them in a deep way. One of the principles I call upon as a drama therapist comes from one of the fundamental rules of improvisation - the rule of “always say yes”. Comedian/Feminist Tina Fey has described this in her book,Bossypants.  When improvising, she suggests, “You are required to agree with whatever your partner has created…otherwise our improvised scene will come to a halt.” If one partner is unwilling to say yesto what the other offers as a dramatic action, the scene cannot take root. For instance, if the therapist asks someone about how they feel, and the answer they get is, “I feel like a cow shot dead by a million greedy cow poachers! Everyone in the world is a greedy poacher!” The therapist has a choice. She can affirm the patient by “accepting” the answer, or poo-poo it with easy disregard. If she affirms the patient, she might say something like, “Yeah, It’s HARD out there for a sweet, gentle cow, I hear you!” Or, “There’s a lot of greed in the world, for sure.” If the therapist responds by stating or suggesting that the patient’s answer was off-putting, she risks rejecting him and closing the window of connection.


 As therapists, we need to validate our clients by accepting the way they present themselves, as long as we feel safe enough to do so. When we do not respond to someone as beastly or monstrous, we open doors for them to not feel monstrous or beastly to themselves. If we are in a therapy session and someone responds to us with quirky answers or defenses we risk shortchanging the therapeutic experience if we respond in a way that feels unallowing or judgmental. Most likely a person who behaves this way has been rejected for the same behaviors before and looks for others to reject them. They are used to it. This is one of the reasons they remain stuck. Yet, if we apply the rule of always say yeseven just momentarily, and accept the offering, we validate someone at the most basic level. This creates a feeling of safety. If, for example, the Sarcastic Elder throws verbal darts whenever someone points out a truth about him, a therapist might be more impactful by initially joining him in the game of darts than shutting it down. This requires us therapists to develop dexterity both in the way we communicate, and also to work with our own ego and sense of self-identity. We must risk decentering ourselves in the moment and forgoing our preferred ways of communicating. 


Drama therapists regularly practice this kind of decentering so that we can engage more effectively with our clients. As seminal drama therapist Robert Landy wrote in Persona and Performance, “Role is the form of one’s dramatic action. The content of that action is embodied in stories. The story is the container of one’s role.” When first meeting a client we can learn many things by identifying the roles she is playing.  We do this by carefully listening to how she tells her stories and watching how she behaves. We can then determine her presenting roleand discern the best way to engage with her in the story she is trying to work out. Instead of having her don our language, or see herself through our eyes or the eyes of the medical model, we meet her in a place where she feels validated for being who she is, where she is right now. Once the client feels heard, seen, and accepted the real “work” of therapy can begin. 


The great humanistic psychologist Carl Rogers used the term unconditional positive regardto refer to the therapist’s basic acceptance and support of a client regardless of how they present in the moment. As therapists we can embodythis concept by applying the “always say yes” rule of improvisation by “accepting” the client’s offering. By doing this we can let our clients teach us who they are instead of telling them who they should be. We can then guide them to approach their own desire for change in a way that fully embraces their authentic self.