This article explores the concept of improvisation in the therapeutic setting as a complex construction when elaborated in the idiom of jazz music. A composite clinical case is offered that illustrates an impasse and how improvisational thinking offers a way forward. Improvisation has recently been conceptualized through the metaphor of theater improvisation, dance, and rhythm. The therapeutic hour is considered an improvisational dialogue with the main theme (melody) and counter melodies, and harmonic possibilities that underlie the rhythmic pulse of the hour. Improvisation requires a reflective/interpretive process that draws on patterns, structures, and experiences reformulated in the relational field of the participants. The client initiates the call and response pattern, from which improvisation emerges as a mutual process of discovery. A more relaxed, receptive, and reflective posture extends Winnicott's 1971 notion of play to integrate classic understanding and relational interaction.
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