Psychodrama the Ways in Which

Psychodrama

The ways in which the mind processes and stores information, and how it works with the human body as a whole, remains a mystery not yet completely solved. Science does have an informed understanding of the brain, but its intimate relationship in protecting the body from the psychological damage of traumatic experience is only in the process of being unraveled by science. The human brain remains one of great mysteries, like the unexplored regions of ocean depths, or the universe around us. What is understood by science is that the brain responds to physical and environmental stimuli, especially psychological disasters or traumatic events. Those kinds of human experiences are often hidden within the subconscious, so that the person who experienced the event can function without that event in the forefront of their thoughts. This is not to say that the events do not inhibit or pose a problem for the individual having experienced the event.

Psychotherapy is about the process of working with patients whose lives have been adversely impacted in some way that prevents them from achieving their fullest potential in their own lives, work, community, and socially. In order for psychotherapy to be successful, Danie Beaulieu, PhD (2006) writes, the therapist must be able to change the patient's thought perceptions, patterns, and behaviors in exchange for healthier ones that facilitate the patient/client's life and goals. While this may seem an easy enough exercise, there is no prescribed exercise between client/therapist for success, because the therapist and client are dealing with issues that may be locked deep within the client's subconscious memory. This can take long periods of time to bring the memories to the point where the client can work through them in a way that is no less harmful to the client than keeping them repressed.

Employing the tool of psychodrama is not one that is easily employed in a one hour session, or within the confines of the therapist's office. Beaulieu says:

To incorporate the concepts underlying these specialized approaches into a more accessible and readily applicable method, Impact Techniques were developed. Recognizing that a primary goal of psychotherapy is to generate and reinforce new insights and life-skills that can stand up to the challenges of the rich, stimulating, multisensory experiences of daily life, Impact Techniques aim to make the experience in the therapist's office an equally rich, stimulating, and multisensory experience."

Psychodrama, or "drama therapy," proves especially useful when working through issues of childhood trauma, or military personnel's post traumatic stress disorders.

Psychodrama as a Tool

Chris Farmer (1995), author of Psychodrama and Systematic Therapy, says that psychodrama is useful with psychotic patients who cannot bridge the present with past events in their lives. 'Action-methods," Farmer says, allow the patient to depart from the question and answer method of intake, and he or she can then use action methods to bring to the surface experiences and memories that are buried in the subconscious, and which are preventing him or her from achieving the highest quality of life medically possible. It is interesting to consider how this visualization of events and acting out those events might facilitate the patient's goals in putting those events into an expression that informs the therapist of what issues need to be worked through with the patient. Farmer goes on to provide case histories that demonstrate the usefulness of the psychodrama as a tool in therapeutic treatment of patients.

Farmer cites the case of a schizophrenic, whose life was altered when her younger brother died as a young child. There was a history of events that, in the era when Farmer's patient was being raised, which was a World War II era, such horrific events as suicide and illegitimacy were indeed issues about which people did not speak publicly on, and which families had a tendency to keep close as guarded family secrets. Today, of course, we know that such events, tragic as they may be, are events that occur in the lives of many families. People are not alone in those events, and there is no shame that should be attached to them. The birth of a child, regardless of whether or not a parent is married today, is a celebration, a blessing of new life. While suicide is tragic, it is to be understood in terms of the individual, and not necessarily the family - although accomplishing such an understanding might in and of itself require therapy, even psychodrama in demonstrating the relationship between the patient and the suicide victim.

That is what Farmer's patient's therapist did; employed psychodrama as a tool by which the patient could link the timeline and events to their proper perspectives. This is what was described by Beaulieu as providing the expression for the patient to make the necessary links with which she might be able to express the events. As Beaulieu stated, it helps provide the change in the patient's perception, and the process of thinking and behavior in responding to the memory.

Farmer's schizophrenic patient had lapsed into a state of muted catatonic unresponsiveness. The clinical team working with the patient made observations about the patient's relationship and physical responses when the patient's family members, two sisters, visited the patient, often times together.

In family sessions, the sisters and their husbands attended (but never both husbands at the same time; legitimate reasons were given, but it was postulated that there might have been some conflict between them). Some of their own separate anxieties were addressed, but there was great resistance to this; they wanted to focus upon Edith's illness. When it was perceived that the more they did this, the more intense Edith's ambivalence over being "ill" would become, a structural/strategic intervention was made the sisters' visiting Edith on the ward was restricted, and they were to visit Edith only when she was at her own home (to which the community psychiatric nurse was taking her for increasing periods of time during the day)."

This is a psychodrama, and the patient's clinical team was able to take this drama, and make changes that allowed the patient to relate to her sisters in a different way, thusly, changing the patient's perceptions, her way of thinking, and, by changing her reaction to the family members based on the dynamics of the new perceptions, changed the patient's physical reaction to the family members that had caused her to go into the muted and catatonic state.

Farmer provides other case scenarios, but the one cited here is poignant, in that the patient was a schizophrenic suffering the worst possible manifestations of psychosis. It demonstrates the usefulness of psychodrama, and demonstrates, too, that it can prevail in cases of the worst imaginable suffering by patients.

Therapeutic psychodrama has been used in work with children, too. In the book Creative Therapies with Traumatized Children, Anne Bannister (2003), discusses the use of psychodrama in working with children who have had traumatic childhood experiences. Bannister says that in her work using creative therapy with children, part of the clinical creative team includes a dramatherapist and a psychodramatist. Bannister refers to the work as "interactive therapy." For today's technological world, that is really a self-explanatory term. For clarification, though, it means that the therapist and patient and the treatment interact with one another. Bannister cites a creative bonding between the team, and between the team and the patient. The suggestion is that the bond is different than in psychotherapy that does not rely upon the creative skills of the team members. In fact, Bannister says that the creative element of their therapeutic skills are an element beyond that of the therapist who does not have the skill, and who does not utilize the tool of psychodrama in their work. That is not to suggest that the psychotherapy work of those who do not employ psychodrama is less effective, only that this skill and the employment of it is as a therapeutic tool that the therapist is able to avail themselves of in order to accomplish a full integration of skill, therapy, patient, and therapist interaction. It is "interactive" therapy. Bannister, too, cites the change in behavior in the children that comes about as a result of the interactive psychodrama.

Psychodrama would, then, be of particular use in dealing with children, because there is the interactive element, and because it seems a way of providing children, whose own ability to express their thoughts, is limited to start with. Also, as it brings to the present and helps rearrange the time line of the events vs. The reality, psychodrama helps put that concept in terms that the child can relate to. Without psychodrama, grasping that concept could take the child much longer in therapy. It quickly becomes apparent to understand the psychodramatist's skills as being both unique and necessary when working with children.

For sexually abused children, Bannister provides this model:

The Regenerative Model

Phase One - Assessment

Development Attachment Coping Safety

Embodiment play Interaction child/carer strategies Home Situation

Projected play Sociograms Internal / Self-Protection

Role play External

Locous of Control,

Dissociation

Phase Two - Action

Building Attachment Creativity

Acceptance Interactive Play

Boundaries Child Centered

Body/mind connections Drama (role play/rehearsal)

Balance of power Art, music, poetry, dance, story

Confirming feelings & identity Doubling, mirroring and role reversal

Witnessing

Phase Three - Resolution

Self-redevelopment

Ability to Understand and express feelings

Awareness of self-identity

Ability to make, maintain, or terminate relationships

It should not be taken for granted that psychodrama is the end solution to every suffering child's problems. Bannister readily acknowledges that the creative group noticed that some children did not respond to the therapy in a way that showed it was a productive approach for those particular kids. The team's initial response was to reassess how they were interacting with those particular children. The final assessment the team made was that they, as an outside source, could not provide the complete or total stimuli for the children to react in the way that would help the team to identity the therapeutic direction for those particular kids, and that it required the participation of family members to do that.

It is interesting to note, too, that even with psychodrama, the therapists recognized it as a tool, one of many in the repertoire of psychoanalysis and psychotherapies. Their work with children was challenging, and there was really no quick fix to the problems the children they were working with faced. Psychodrama did, however, prove useful in bringing those problems to the surface so that, together, the patient and therapist could work through them. Assessing and reassessing the progress of psychodrama is tangential to its success. Recognizing the need for a different approach, or bringing into the interactive process other participants is essential. It is important to always keep sight of the child's life, the participants and supporting players in the child's life.

Psychodrama has proven useful in therapeutic work with people who suffer from post traumatic stress disorders (PTSD). M. Katherine Hudgins (2002) looks at how psychodrama helps victims of PTSD move towards successful therapeutic recovery of their traumatic war experiences. Hudgins says that after the terrorist attacks against the World Trade Center in 2001, members of their therapeutic team that she worked with that was responsible for developing the Therapeutic Spiral Model (TSM) responded to the needs of the public and rescue people and police officers following the events. The model is the product of twenty years of research, and Hudgins reports that it has been used to success in cases of PTSD stemming from imprisonment, torture, and grief stemming from the events surrounding September 11, 2001.

For those whom might be surprised by the use of TSM in treating PTSD, Hudgins points out that the patient/client has a choice, and, like Farmer and Beaulieu, Hudgins looks at TSM as a tool, psychodrama as a choice to be presented to the patient, or to be decided upon therapeutically in order that the patient/client is able to benefit from everything that psychotherapy has to offer the patient in managing their condition. Hudgins says that it is useful in managing the PTSD, but that it does not "treat" the core trauma that causes these very symptoms.

Flashbacks from the past interrupt the present moment. Body memories crash through during moments of intimacy. Feelings of being a little child in an adult's body are frequent. People with PTSD often have a sense of simultaneously inhabiting two worlds - the "real," outside world and what occurring in it, and a world comprised of the happenings inside them: their thoughts, feelings, and reactions."

Hudgins' says that psychodrama provides the way to communicate the chaos that the PTSD client is experiencing with others. This is consistent with what Beaulieu and Farmer said, and when considered in terms of the patient to precipitating factor relationship, it just makes sense. It is the inability to communicate to others the chaos that exacerbates the patient's condition to a level that exceeds the patient's ability to manage. In addition to being stressful and frustrating for the patient, it can be equally as frustrating and stressful to the people in the patient's life. In the case of PTSD, there is always the concern that it can manifest itself in ways that are harmful to the patient or to others.

The TSM intends to help the patient by:

Client friendly constructs that internal, self-organization for trauma survivors.

Clear clinical action structures for safe experiential practice with trauma survivors.

Advanced action intervention modules for containment, expression, repair, and integration of unprocessed trauma material.

Traumatic experiences bring on changes in individual cognition and emotion, which in turn manifest in developmental delays, a disconnect between the reality of time as to when the traumatizing event(s) occurred, and the present; a depleted sense of hope, lack of spirit, and a resulting human dysfunction. It is to these individual losses and changes in personality that the tool of psychodrama is intended to, perhaps not cure, because, as Hudgins said, the core of the traumatic experience continues to exist; but it is possible to re-establish the connection in time, event vs. The present. It is possible to affect the perception, and the behavioral reaction to the reality of the event. Hudgins writes that the individuals affected are "prone to action and deficient in words."

This is the tool of psychodrama. It is a tool that is interactive, and that "plays out" the therapeutic re-enactment, or the way in which the client tells of the events through a story, by way of physical interaction with the expression.

The Images of Psychodrama

Understanding psychodrama as a tool does not necessarily help to gain an overall understanding of the tool. it's to have perhaps a book, but the game plan has to be executed in order to gain the sense of what it is in reality. Wilma Scategni (2002) describes the processes and dreams of psychodrama. Scategni briefly delves into the history of psychodrama, making it come across as somewhat obscure, perhaps even an "art" whose origins is lost in history.

The ancients had no psychology, properly speaking, but they had myths, the speculative tellings about humans in relation with more-than-human forces and images. We moderns have no mythology, properly speaking, but we have psychological systems, the speculative theories about humans in relation with more-than-human forces and images, today called fields, instincts, drives, complexes."

When put into this perspective, it is easy to gain a sense of what Scategni is talking about, because we have the hieroglyphics to reference as visual understanding. The hieroglyphics played, psychodrama, the dynamics of what the rulers wanted to convey to their subjects, be it conquest, or their interaction with their deities. But they provide the visualization that demonstrates that psychodrama - even though it was perhaps not called that - was being employed since the time of the ancients.

As a tool of psychotherapy, Scategni says, psychodrama is attributable to Jacob L. Moreno, in 1889. Moreno described what he considered his own first psychodrama experience, while playing with friends. It is the late 19th century version of little boys who play cowboys and Indians, or the war game, or the game of young children playing tag, acting out the first emergence of attraction that can not be explained by the young girl or boy, in part because they lack the vocabulary, and for those that have the vocabulary, they cannot bring themselves to admit it. So they push, instead of tag.

It is becoming easier now to gain the visual of psychodrama. When used in psychotherapy, psychodrama is perhaps more specifically related to the trauma or the event that is too difficult for the individual to cope with on a conscious level. Some of those events have already been introduced here, and there is no single gender, age, or profession that trauma hits; because it can strike any one at any given moment.

A person's entrance into a psychodrama group is often marked by a sort of initiatory entrance through a 'narrow door'. Emotions, tears, and a heightened potential for empathy sanction his or her emotional entrance into the group. For psychodrama, entering through the 'narrow door' means that a participant brings some deeply meaningful piece of himself and of his life history to the group. He may feel as if he is giving himself or his dreams 'to the group to feed on' and is letting himself be chewed or ripped up into pieces in the hope of being put together again at a higher level of consciousness."

Dreams, too, are a form of individual psychodrama, where in an obscure way the mind acts as the therapist, attempting to help the individual sort through the myriad of images that have a meaning in the life of the individual.

While these are perhaps the more traditional approaches and images of psychodrama, Jose Fonseca (2004) looks at the more contemporary applications of psychodrama. New approaches to psychodrama do not forego the knowledge that brought it into the therapeutic realm as a tool. Instead, Fonseca begins by acknowledging that Moreno is still serve to inform the practice of psychodrama, but so do the theories of attachment that were formulated by the work and research of Bowlby (1958). Fonseca is building upon the existing body of work and knowledge to the contemporary. He is not throwing away the past experience and progress. Role reversal is one of the things that Fonseca sees as important to contemporary psychodrama.

Acting out a role always suggests the presence of "another." For each role there is a complementary role or counter-role. The relationship (mother-son, doctor-patient, etc.) emerges from the meeting of the two. Role and counterrole are "co-existent," "co-acting," "co-dependent" (Moreno, 1977). The presence of a great number of psychotic elements (during an outbreak or severe regression) in a personality would correspond to a total inability to play and reverse roles. Likewise, the total absence of psychotic elements (the ideal model) would result in a perfect role-reversal performance. Between these extremes lie the myriad variations. The "sign of not reversing roles," means some healthy process has been altered. This is in agreement with Moreno's theory of the development of the matrix of identity (see diagram on p. 22), where, in regressive order, we would first have the "loss of role reversal." Alteration of the intermediate phases would then take place, followed by the inability to perform one's own role (recognition of I) leading to "indifferentiation." An alteration in the ability to reverse roles would be the first indication of "sickness."

Role reversal, then, allows the patient the ability to put the problem onto another, perhaps even the source of the trauma or the event or condition; and in that way to learn to react to it differently, or to acknowledge it. It doesn't make the problem go away, but it creates, again, a method of communication that is necessary in order to be of therapeutic benefit to the patient. It facilitates the necessary link between the patient and the person engaging in role reversal, and also serves to inform the therapeutic process.

Fonseca, rightfully and perhaps respectfully, cites Moreno when advising that there is a need for a level of caution when involving the patient in the role reversal. The contemporary contribution - and there must be something unique to describe it as such - is what Fonseca calls "relationship psychotherapy."