Articles

The Role of Psychodrama, Issue 11, Spring 1999
by Gail Smith, Leeds
Psychodrama is the unique creation of Dr Jacob Levy Moreno (1889 - 1974). He defined it as: 'The science which explores the truth by dramatic methods' (1953, cited Hare and Hare 1996, p45).
  It is an action based method of group psychotherapy that explores real life experiences within the group context.
  Any type of experience may be the focus of a psychodrama session, including issues such as intrapsychic conflicts, physical ailments, relationship difficulties, family discord or personal development, dreams and fantasies etc. Psychodramatic explorations take place through the enactment of various scenes, which may be from the person's past, present or possible future life experiences within the 'here and now'.
Where is it practiced and who benefits from it?
Psychodrama is practiced all over the world and has been found to be successful with many client groups, including people with eating disorders, drug and alcohol addictions, mental health problems, terminal illness and sexual abuse.
Five Core Tools of the Trade
One: Director
This is a trained psychodramatist who leads/facilitates the session.
The director has three functions:
Producer - as co-creator of the psychodrama with the protagonist (client), every verbal and non-verbal clue is turned into action which must be as concrete and real for the protagonist as possible. The director gives support and direction to the auxiliaries (other group members) involved in the protagonist¹s work. This provides the protagonist with experiences as close to their perspective as possible.
Therapist - the director establishes therapeutic relationships with the protagonist and others in the group and maintains connections between group members, the protagonist and herself. She facilitates deep exploration of the problem, enabling emotional release or catharsis to take place. Repair work enables old scripts, messages and behaviours to be changed. Alertness to the needs of all group members is essential.
Analyst - the director examines group dynamics, transferential experiences and the stages of group process in order to identify points of group resistance, energy and blocks. She helps the protagonist to make connections between present difficulties and past experiences using specific techniques and by being open to the messages coming from group members. She is aware of the protagonist's/group's pace and boundaries.
Two: Protagonist
The protagonist is the subject of the psychodramatic session, the person whose life experiences are explored.
Three: Auxiliaries (Auxiliary ego)
Auxiliaries are extensions of the director and therefore guided by her to assist the protagonist in their psychodrama. They are group members who have been chosen by the protagonist or director to play a specific part in the enactments. For instance, they may be asked to portray the role of mother, dog, or girlfriend. They may also represent a significant object such as a teddy, kitchen table or garden gate. At other times they may be requested to externally represent some internal aspect of the protagonist's psyche such as the critical self, constant worrier etc. They are an essential and therapeutically invaluable ingredient of any psychodrama.
  Moreno describes auxiliaries as 'The representation of absentees, individuals, delusions, symbols, ideals, animals and objects. They make the protagonist's world real, concrete and tangible.' (Moreno 1969/1975:17, cited Karp et al 1998).
Four: Audience
The audience consists of those group members who have not been allocated any specific role in the psychodrama. However, they maybe called upon at any point during the session. Their role is not static, Moreno (1972) refers to the audience as,'the sounding board of public opinion.' (Pitzele1992).
  They may be asked to respond spontaneously to the enactments taking place. They provide both verbal and non-verbal clues to the auxiliaries and director.
  Collectively, they may act as a container for the protagonist's strong emotional expressions or they may themselves become the protagonist, as a whole.
  It is essential to point out that psychodrama is not individual therapy within a group context, it is group psychotherapy. Dayton (1994) states, 'Moreno believed that in a group, each person becomes a therapeutic agent of the other. He viewed the group as rich in healing potential.'
Five: Stage
This is a safe area to accommodate the number of people in the group with enough space to move around in. A part of the space is designated as the psychodramatic work area. This represents the protagonist's living space throughout the session.
Psychodramatic Method
This consists of three main phases, warm-up, action (or enactment) and sharing. The order of these phases is fixed, forming a process that is therapeutically unique.
Warm-up
Moreno believed we all warm up to every event in life whether it is going to work or getting up in the morning. Warm-ups involve cognitive, sensory, verbal, behavioural and physical components and each person's warm-up will be unique. They prepare us mentally and physically for action and daily life experiences (Goldman and Morrison 1984.) A warm-up may involve material from past experiences that occurred ten years ago, or only yesterday at work. It may include fantasies, ambitions, dreams for the future or simply mentally preparing tomorrow's dinner - all brought into the moment, the 'here and now'. The director must be aware when bringing together a bunch of people who will be working in depth on personal issues, regardless of whether they are an established group or not. Warm-ups involve simple group games or exercises of a verbal/non-verbal kind. They may or may not be pre-planned. Many psychodramatists use a verbal check-in to see what's happening for people at that moment. For instance, some may report nervousness in the group, others, being tired or angry about an argument prior to attending. Sometimes check-ins may be focused on a theme, e.g. intimate relationships. A warm-up is essential for the following reasons:
1     To establish safety, trust, rapport and group cohesion.
2    For the director to encounter individuals and help create connections between herself and the group members.
3    It gives the director the opportunity to pick up on main themes and concerns within the group and helps to facilitate the emergence of a protagonist.
4    It enables people's self consciousness to decrease and aids the move into action.
5    It encourages the development of spontaneity and creativity  -the feeling that all is possible! Spontaneity is essential for creating change.
6    It provides the opportunity for the director to observe group dynamics that are emerging.
  The director must also warm-up. The importance of the warm-up phase must not be underestimated and should neither be rushed nor left incomplete.
Action (Enactment) Phase
Once the protagonist has been selected, the director needs to help him and the group move into action. Protagonist's are not chosen at random, group processes are operating. The individual who has been chosen to work will be holding the group's central concern. The protagonist's issue will enable the group to explore this central concern. An example of this might be where the protagonist presents his negative relationship with his mother. The underlying concern for him and the group might be that of abandonment. It is likely that the director will be unconsciously representing the role of mother for both the protagonist and the group. It is vital for the director to be aware of this happening and to attend to it within the group. Throughout the session she will be careful not to repeat the primary experience of abandonment of the protagonist.
  If attention to this process isn't given then the original experiences of childhood will be played out in the relationship between the director and protagonist, blocking the therapeutic work.
  In this phase the director and protagonist form a working alliance. A contract to explore a specific aspect of the protagonist's life is made. Enough information about the issue is gleaned in order for the initial scene to be set. Simple props such as cushions, tables, chairs and objects are used to make the situation as real as possible and to bring the issue into the present moment. Auxiliaries are chosen to represent people who are important to the issue/scene. The presenting problem is experienced through enactment in the here and now.
  The director gathers clues and information from the initial assessment and enactment of the first scene to create future enactments, taking the protagonist deeper into explorations. Scenes are negotiated between the protagonist and director. Holmes and Karp (1991) report,'There is no script, the drama is spontaneous, created in the moment by the protagonist, auxiliary egos and the director.'(p9)
   They explain further, 'Each scene is linked to the next by a logic specific to the protagonist's psychology and difficulties.' (p10)
  Psychodramatists are concerned with the process not the content of the session. The psychodramatic process involves moving the client from the periphery of the problem to the core - and back out again. Goldman and Morrison (1984) explain, 'As we move from the outer edges of the protagonist's problem, the story, to the core underneath, we are dealing with process rather than content. From the outer surface of armour of the individual, we are progressing to his/her core of sensibility.'(p27)
  Psychodramatic work involves explorations at cognitive, behavioural, emotional, sensory, linguistic/paralinguistic, spiritual and interpersonal levels. The work is carried out within the dimension of 'surplus reality'. This allows for the exploration of hidden thoughts/feelings. There is opportunity for re-living important moments in our lives to get unmet childhood/adult needs met and to re-write old scripts. Future roles, situations and experiences can be rehearsed, conversations with significant others that never occurred in real life can be brought to life and experienced within the here and now.
Sharing
The sharing phase of the session allows group members the opportunity to share aspects of their own life experiences in relation to the work they've just witnessed. This open sharing allows all group members to be heard and to gain insights into their own difficulties, often bringing about emotional release.
  Group members who held a role during the psychodrama are encouraged to share from the role taken as well as from their own personal experiences. Sharing from role allows auxiliaries to de-role and ground themselves in the present again, whilst also bringing further insights for the protagonist and continuing his integration and learning process.
  At this point in the session the protagonist is 'raw' from engaging in self disclosure and expressing intense emotions. Therefore, it is vital that the director prevents any analytical or judgmental statements. The protagonist needs to be re-integrated into the group again and the sharing helps the protagonist feel that he is not alone, others share similar problems and experiences. Holmes and Karp (1991) state, 'The open sharing of these issues within the group encourages and facilitates support, caring and understanding between group members.'
How might psychodrama blend with stammering therapy?
   Psychodrama is a highly creative, powerful and extremely versatile method that can be successfully applied within our profession. Many fields could benefit from it, including stammering and voice therapy, and work with those suffering a terminal illness. Psychodramatic methods can also be used to provide invaluable learning experiences for professionals and trainees.
  The application of psychodrama to stammering therapy, under the direction of a trained psychodramatist, would be invaluable. Unfortunately, there is only space here to give you some general ideas and tasters that will hopefully whet your appetite.
  Let us consider a few ways in which just one of the specific techniques could be useful in working with people who stammer.
Role Reversal
This is a most central and deeply therapeutic tool in psychodrama. It requires the protagonist to exchange places with the auxiliary who holds a key role, (e.g. mum, protagonist's internal critical self), or a significant object (e.g. kitchen table, teddy.)
  The protagonist actually steps into the shoes of a significant other and experiences himself and his issue from this standpoint. The auxiliary reverses into the protagonist's role. Crucial moments are re-enacted in role reversal, for example, the family meal at the kitchen table where the protagonist was always told to speak slowly and repeat any stammered words may become the focus. As an example, in role as 'dad', the protagonist may learn about his father's experiences of being bullied because of a mild stammer and find that the perceived harsh treatments were dad's way of trying to protect his son from the same painful experiences.
  Role reversal allows the protagonist to empathise with the other's point of view. Major shifts in understanding and behaviour can take place. Role reversal thus helps to repair all kinds of relationships.
  Holmes (1998) states, 'The idea that a person can actually take on the role of another person and behave as if they were this person is a technique at the core of the practice of psychodrama.' (p130, cited; Karp et al 1998.)
  In isolation or within a psychodrama session, this technique can be of enormous value in working with people who stammer. Childhood experiences from school or within the family that were internalised by the protagonist as traumatic, hurtful, enjoyable or liberating can be re-enacted. Old messages that may still be active in adult life such as 'I'm stupid and not normal because I stammer' can be explored to find their origins and replaced with new messages. In psychodrama protagonist's re-live these moments at a deep emotional level and can thus heal emotional wounds.
  I have used role reversal with children for a variety of reasons, for instance to create a healthier relationship between the child and a family member, to develop an unseen or underdeveloped characteristic of the child, or a role, that can help them to cope with their stammer on a daily basis (e.g. the internal advocate who always disagrees with the bullies and helps to protect the vulnerable self.) Those children who have presented with very mild stammers that are not always noticed by teachers, have used role reversal as a way of identifying how the teacher feels about them, how they can be supported in school and how to open up to teachers and friends. Simple objects - teddies and chairs - are used as props or required auxiliary roles where other children or adults are not available in the session.
  Many other techniques would be invaluable to the therapist who works in stammering therapy. Some of these include: 'mirror', 'soliloquy', 'magic shop' and 'double'. A trained psychodramatist can utilise these during a psychodramatic session to help produce specific therapeutic effects. They may also be taught as individual techniques to be used alongside other methods such as personal construct psychology, art therapy etc.
  Any technique should only be applied where there is clear understanding of the theory it belongs to, the purpose for which it is being used and how to use it!
  This article offers a tiny insight into the method and use of psychodrama psychotherapy. Moreno's theories, philosophy, core concepts and techniques have been largely left out. My intention was to provide a taster and this represents a reflection of my own learning and development of skills in my second year of a training which usually takes between four and seven years!

References
Blatner. A. (1988) 'Acting-In, Practical Applications of Psychodramatic Methods.' (2nd ed.) Springer Publishing Co.
Dayton. T. (1994) 'The Drama Within, Psychodrama and Experiential Therapy.' Health Communications Inc.
Goldman E. and Morrison D. (1984) 'Psychodrama, Experience and Process.' Kendall/Hunt Publishing Co.
Hare, P. A. and Hare, J. R. (1996) 'J. L. Moreno.' Sage Publications.
Holmes, P. and Karp, M. (1991) 'Psychodrama, Inspiration and Technique.' Routledge.
Karp, M., Holmes, P. and Bradshaw Tauvon, K. (1998) 'The Handbook of Psychodrama.' Routledge.
Pitzele, M. S. (1992) 'Moreno¹s Chorus: The Audience in Psychodrama.' Journal of The British Psychodrama Association 1992, (Vol 7, no1.)

For information regarding psychodrama, contact:
The British Psychodrama Association,
The Administrator,
Heather Cottage, The Clachan, Rosneath, Helensburgh, Argyll and Bute, G84 0RF.