Addiction, traumatic loss, and guilt:
A case study resolving grief through psychodrama and sociometric connections

by Scott Giacomucci, DSW, LCSW, TEP

Highlights

Psychodrama offers a process for speaking directly to the deceased person in surplus reality and an opportunity for closure.

Sociometry can help normalize the experience of loss while connecting with others in the group.

Sometimes telling the story of loss is not enough. Many clients will need a more embodied and multi-dimensional experience in treatment in order to transform their grief.

These sociometric processes provide a group facilitator with the tools needed to develop group cohesion, promote mutual aid, identify similarities between individuals, and enrich interpersonal relationships.

A case study of a psychodrama scene is presented with clinical processing and discussion of the potential effectiveness of the psychodramatic method in working with grief and loss.

Abstract

Traumatic loss, complicated grief, and addiction can be difficult and complicated clinical issues. Many clients share their losses, self-blame or feelings of being stuck in their grief. However, verbal processing is not always adequate to stimulate change. Experiential sociometry provides refined tools for promoting strength-based connections between group members around their experiences of loss. The surplus reality of psychodrama offers unique opportunities to renegotiate the relationship to a deceased loved-one and offer the possibility of closure through role reversal. This article outlines four types of sociometric processes for cultivating connections between group members – the spectrogram, step-in sociometry, locograms, and floor checks. These experiential sociometry tools can be used independently as group processes or as a structured warm-up to a psychodrama enactment. A scene from a psychodramatic vignette is offered depicting a case study of a client working through complicated grief in an addictions group psychotherapy context. Sociometric and psychodramatic theoretical considerations are presented in the context of short practice depictions presented throughout this article. Psychodramatic letter writing is also introduced as an alternative for time limited groups or clinicians without extensive psychodrama training.

Introduction

Sociometry, psychodrama, and group psychotherapy, together make up the triadic system of Jacob Moreno (Moreno, 2019). Sociometry and psychodrama are uniquely situated group approaches for working with grief and loss. Sociometry, which includes a focus on the nature of inter-relations within a group, can help normalize the experience of loss while connecting with others in the group (Hale, 2009). Psychodrama, an experiential form of psychotherapy, offers a process for speaking directly to the deceased person and an opportunity for closure in surplus reality. These approaches, when used together, create a potent group healing experience. As a therapist working with grief and loss on a regular basis, I have found no other modality that can create transformation after loss as efficiently as sociometry and psychodrama.

Every psychodrama group involves the three phases of warm-up, action, and sharing, which mirror the three aspects of Moreno’s triadic system: sociometry, psychodrama, and group psychotherapy (Dayton, 2005). The warm-up phase of a psychodrama group is most often facilitated using sociometry warm-ups, case examples of which will be described below (Giacomucci, Gera, Briggs, & Bass, 2018). The action phase of a psychodrama group uses various psychodrama interventions and the sharing phase of a group resembles a more traditional talk therapy group process. Each phase of a psychodrama group is equally important, and the group process is incomplete without each (Giacomucci, 2019). Therefore, the format of the descriptions below will follow the same phases that a psychodramatic group would, from sociometric warm-up cases, to a psychodramatic case vignette, and ending with group sharing and clinical processing.

There are few populations that know death, traumatic loss, and guilt as much as persons with drug addiction histories. This is especially true because we are in the midst of an opiate epidemic in the United States. Consequently, the leading cause of death for young adults in the United States is drug overdose (Smith, Lee, & Davidson, 2010). Neuroscience research has discovered that physical pain and social pain look identical in brain scans, which highlights one of the reasons that opiates and other drugs effectively numb both physical and social pain (Eisenberger, 2012). Many have argued that attachment, connection, and community are of the utmost importance in addiction recovery (Alexander, 2008; Flores, 2011; Mat, 2010; Morgan, 2019). For these reasons, it is important that the issues around connection and loss be addressed for those with addiction histories.

All forms of trauma are characterized by losses, such as the loss of safety, loss of sense of self, loss of hope, loss of relationship, loss of a loved-one, etc. At the same time, grief and loss are a normal part of life. While everyone may not experience trauma, everyone will experience loss throughout their lifetime. Grief is the natural and adaptive response to loss. It is important that we do not pathologize grief (Horwitz & Wakefield, 2007). The lifestyle of addiction increases one’s vulnerability to experience losses and confrontations with death. Addiction is a complex condition that influences one’s psychological and social life, including one’s sense of control and sense of responsibility. Addiction is often characterized by shame, guilt, and powerlessness. These conditions make the grieving process more complex when they are combined with an experience of death. The social nature of addiction increases the likelihood of an individual in one’s social circle to experience a traumatic death. However, addiction decreases one’s capacity to be physically and emotionally present at grieving rituals. As a result, there is a greater tendency for guilt, shame, and grief to permeate one’s relationship to the loss. Therefore, a crucial objective for bereavement therapy is to bring about reconciliation and transcend the associated feelings of guilt and shame connected to the loss, while still remembering the bereaved (Hiltunen, 2003, p. 221). For these reasons, it is imperative for addiction counselors to have competencies in working with trauma, grief, and loss.

Sociometric connections after loss

Connection is the opposite of loss. The field of sociometry provides a variety of experiential group processes that focus on exploring, uncovering, and deepening connections within a group (Giacomucci et al., 2018). One of the common therapeutic factors in group therapy for bereavement is the connection with other group members with similar experiences of loss (Bartone, Bartone, Gileno, & Violanti, 2018; Rice, 2015). This is articulated by Vajentic and Calovini (2001) stating, group members benefit from shared experiences with those similarly bereaved and regain hope for their own futures as they see others surviving (p. 281). These sociometric processes provide a group facilitator with the tools needed to develop group cohesion, promote mutual aid, identify similarities between individuals, and enrich interpersonal relationships. Research has demonstrated that when there is stronger group cohesion, the group has a more positive influence on its members (Northen & Kurland, 2001). Yalom & Lesczc argue that group cohesion is as important to group work as the therapeutic relationship is important to individual work (2005). Sociometry tools quickly and efficiently provide the group cohesion necessary for effective and transformative group therapy. A comprehensive outline of sociometry is beyond the scope of this manuscript; however, J. L. Moreno and others have undertaken this task (Dayton, 2014, 2005; Giacomucci et al., 2018; Giacomucci, 2019; Hale, 1981; Hudgins & Toscani, 2013; Moreno, 1953; Wysong, 2017). In this paper, I will outline four sociometric tools and possible applications with groups that have experienced loss, followed by a protagonist-based psychodrama group case presentation.

Spectrograms

A spectrogram is an experiential sliding scale in the room. One end of the spectrogram represents 0 % and the other 100 %. The walls of the room, objects, or other professionals can be used to hold the two poles of the spectrogram. The facilitator asks questions while group members physically place themselves on the spectrogram based on the answer to the questions. For example, the facilitator could ask how comfortable do you feel talking about your loss(es), how much loss have you experienced in your life, or to what degree do you think you can help others deal with their own losses? Facilitators can also integrate other grief scales that have been validated in grief literature, such as the Hogan Grief Reaction Checklist (HGRC) (Dalton & Krout, 2005; Hogan, Greenfield, & Schmidt, 2001). The HGRC is made of up six sub-scales, including despair, blame, anger, detachment, disorganization, and personal growth (Dalton & Krout, 2005, pp. 133-34; Hogan et al., 2001). Facilitators can include some of the HGRC’s 60 descriptive statements, such as “I feel like I am in shock” or “I believe I should have died and he or she should have lived” (Dalton & Krout, 2005, pp. 133-34; Hogan et al., 2001). Instead of group members circling their responses on a piece of paper, the spectrogram allows them to place themselves on the HGRC 0-5 scale spectrogram, where 0 is does not describe me at all, 2 is describes me fairly well, and 5 is describes me very well (Dalton & Krout, 2005, pp. 133-34; Hogan et al., 2001). As group members place themselves on these spectrograms, they get a sense of where they fit in within the group based on the criteria. Group members can be instructed to share with the person closest to them about where they put themselves on the spectrogram. The sharing could be done at the group level, or sharing could be through body posture, movement, sound, or a creative mix of any of these. When selecting criteria for any sociometry tool, it is helpful to follow the clinical map offered by the Therapeutic Spiral Model (TSM) of trauma-specific psychodrama. TSM’s clinical map can be simplified into three stages:  safety/strengths, trauma, and transformation (Giacomucci, 2018; Hudgins, 2017). This clinical map mirrors the three-stage model of trauma processing outlined by others (Courtois & Ford, 2016; Herman, 1997). The implementation of this clinical map when choosing sociometric criteria strives to provide participants with a safe experience of connection.

Step-in sociometry

Another useful sociometry tool for working with grief and loss is called Step-in Sociometry, or Circle of Similarities. This process helps participants uncover shared experience and identity in a safe way, while the therapist assesses the group-as-a-whole based on the chosen criteria (Buchanan, 2016). Participants are invited to stand in a circle and take turns stepping into the circle while making a statement about themselves based on the given criteria. When a group member steps in and offers a statement, others who identify with the statement also step into the circle. Each participant can offer a step-in statement for each round of criteria, or it can be done by volunteers. Through this process, the group inevitably discovers that they have much more in common than they anticipated, providing an experience of inclusion (Giacomucci, 2017). Some possible step-in criteria that is focused on grief and loss might include: self-care activities, the person and relationship that group members lost (parent, sibling, friend, colleague, client, etc.), and future rituals or actions that one plans to do in honor of their deceased.

Locograms

A third sociometric tool, called a Locogram, measures the group’s choices or experiences based on categories. To facilitate a locogram, the director offers multiple options or categories and designates different places in the room to represent these options. A simple example of this related to grief and loss is to designate each of the four corners of a room as different types of losses: loss of a family member, loss of a friend, loss of an identity or part of self, and loss of material objects. It is also important to offer an option for other, where group members can stand if their experience does not fit in any of the provided options. In this case, the option for other could be designated to the center of the room or anywhere that distinguishes it from the four corners of the room.

Floor checks for psychosocial metrics

The Relational Trauma Repair Model (RTR), another trauma-specific experiential model, offers an additional sociometric process called the Floor Check (Dayton, 2015). This process is based on the locogram but offers a more dynamic experience exploring psychosocial metrics within a group. Conducting a floor check begins with the facilitator or group members writing categories on pieces of paper. This can be different feelings, different defense mechanisms, types of losses (as outlined above), the stages of grief (Kubler-Ross, 1997), the goals of building resilience after ambiguous loss (Boss, 2006), or any other criteria. The stages of grief are often criticized for their lack of empirical evidence, limited cross-cultural applicability, and suggested linear progression; for these reasons, the strength-based tasks of resilience after ambiguous loss are highly recommended as an alternative. The process of facilitating a floor check with a group taps into mutual aid, which is the capacity for group members to support and contribute to healing one another (Steinberg, 2010). This experiential sociometric process moves the group into action, while normalizing group members’ experiences. Group members begin to warm-up physically, emotionally, and socially. The floor check creates a process by which group members become physically clustered based on their psychosocial experience of loss.

Each floor check structure has the potential for multiple prompts. For example, using Kubler-Ross’s (1997) five stages of grief, the therapist could prompt group members to stand at the stage that you feel you are in today, the stage in which you find yourself most often, the stage in which you find yourself least often, the stage you have difficulty tolerating when someone else is experiencing it, and the stage that you are getting better at handling. Each one of these prompts creates movement in the room and forms new clusters of group members, who stand together to share with each other about their common experiences. In this process, group members are able to physically see and hear that they are not alone, while emotionally and socially connecting with others who share a common bond. The RTR floor check is an efficient warm-up to a psychodramatic enactment, such as the psychodrama case outlined below.

Psychodrama case study of addiction, grief, and guilt

Foundations of psychodrama theory

Psychodrama is a therapeutic process which uses role playing techniques and dramatization to work through interpersonal and intrapsychic issues. The clinical practice of psychodrama is guided by multiple underlying theories including Action Theory, Spontaneity-Creativity Theory, and Role Theory (Giacomucci, 2019). Psychodrama both has its own comprehensive theoretical system and can be integrated within other theoretical approaches (Giacomucci, 2019). Psychodrama means “psyche in action”; Moreno’s action theory suggests that healing and learning takes place in action while spontaneity-creativity theory proposes spontaneity as the curative agent in treatment (Moreno, 1972). Spontaneity is defined as the ability to adequately respond to new situations and to respond in new ways to old, reoccurring situations. Psychodrama’s role theory offers a non-pathologizing understanding of personality that simplifies behavior or parts of self in a way that is easy for clients to comprehend (Moreno, 1953). A psychodrama takes place on the psychodrama stage, in surplus reality, which is the imaginal space where the group spontaneously acts as-if something were real in the here-and-now (Giacomucci & Stone, 2018). In surplus reality, non-physical things, parts of self, or other people can be made symbolic represented by role-players. The lynchpin of the psychodrama process is the intervention of role-reversal, where an individual leaves the role of self to inhabit the role of someone or something else on the psychodrama stage (Moreno, 2012). The following vignette depicts how the surplus reality of psychodrama may allow opportunities for closure for grieving clients and for individuals to spontaneously renegotiate self-blame by stepping into the role of the deceased loved ones whose death they blame themselves for.

Aim & method

This case presentation and evaluation aims to present psychodrama as a potentially effective approach to working with addiction, guilt, grief, and loss. The depiction to follow offers a scene of a clinical psychodrama with a protagonist within a group session. The following vignette took place during a psychodrama group at an addictions inpatient center unit; client names and non-essential details have been altered for confidentiality purposes.

John is a 35-year-old man who is addicted to heroin and has been in and out of addiction treatment centers for many years. His mother died 5 years ago, when his drug use escalated significantly. He shared the story of his mother, in her last days, requesting that John come visit her. John, immersed in his addiction, couldn’t overcome the shame preventing him from visiting his mother. She lived her last few days and died. John felt torn apart by his shame and guilt for not visiting his mother, his grief from the loss, and his regret from missing out on the final conversation with his mother. He started to believe that the cause of his mother’s death was her broken heart because of his drug addiction. He was stuck in the cycle of grief, guilt, shame, and addiction. After a few weeks of inpatient treatment, John attended a psychodrama group.

The psychodrama scene

Following a sociometric group warm-up (see aforementioned warm-ups), John volunteered as the psychodrama’s protagonist sharing his story of loss, where he stated, “I know it is not my fault that she died, but it really feels like it is my fault and I haven’t been able to cry about it.” Though other topics were proposed from group members, the majority of the group indicated that they identify most with John’s issue. This was decided democratically using a simple locogram of proposed topics. Other group members briefly shared their own experiences of loss and indicated their willingness to support John in the psychodrama. The use of sociometry to choose a group topic and a protagonist ensures that the psychodrama reflects the warm-up of the group-as-a-whole, rather than falling into the trap of doing individual therapy in a group setting (Giacomucci, 2019).

John was invited by the psychodrama therapist to choose a group member for support during his psychodrama and other group members to play the roles of strengths that he may need in order to face his loss and corresponding feelings. With each strength-based role, the therapist facilitated dialogues between the strength and John using role playing techniques, and role-reversals. One by one, John reversed roles becoming his strength, his courage, his willingness, and his supportive community to speak to himself from these places with their unique perspectives. These roles provide the safety and containment needed to create change in the scene and safely access feelings. After these supportive roles were designated, John was asked to choose a group member to hold the role of his deceased mother. The therapist stated, “although you were unable to have a dialogue for closure with your mother before her death 5 years ago, today you can have that dialogue.” John was instructed to speak to the role-player as if she were his mother present in the room right at that same moment.

He immediately accessed his grief as tears filled his eyes. He expressed his overwhelming feelings of guilt, shame, and grief while being supported and encouraged by other group members. “I can’t stop blaming myself for your death. I should have been there with you, I have so much regret.” After John’s emotional release, the therapist gave John a black scarf in order to represent and externalize the guilt. He expressed his feelings of self-blame and guilt, and then he was instructed to reverse roles and become his mother who could respond to himself. In the role of his mother, he appeared to have a major change in affect as he spoke to himself. “Oh John, please stop blaming yourself for my death. I can’t stand to see you like this. You are my son and I love you unconditionally.” The therapist kept John in the role-reversed position and began to interview him as he played the role of his own mother:

Therapist: So, you have heard how John blames himself. Can you tell him if you blame him for your death or not?

John’s mother (played by John): (to the role of John) Of course I do not blame you. It is okay. It was my time to go.

Therapist: Tell John, how is it for you to see him blaming himself?

John’s mother (played by John): It is so sad to see you hurting yourself like this. I just want for you to be happy.

Therapist: Well, maybe you can help him by taking this guilt from him?

John’s mother (played by John): Yeah, the guilt really doesn’t belong to you John, and it is only an excuse to continue using drugs. If you let me, I will relieve you of this guilt (reaches out to take the black scarf).

At this point, the therapist directed John to reverse roles, so he could return to the role of himself in order to replay the scene. This allowed John to experience the scene from his own role this time.

John’s mother (now played by another group member): If you let me, I will relieve you of this guilt.

John: I don’t want to carry this any longer (physically hands the scarf to his mother)

The moment he lets go of the guilt, his entire body posture and affect changes.

Therapist: John, tell your mother what you are experiencing right now.

John: I feeI, feel lighter, freer. Like a huge weight was lifted off my shoulders. Thank you mom, I’ve been holding that for years.

After having a minute to savor this moment of change, the therapist instructed John to continue his dialogue with his mother.

Therapist: Great. Now let’s see what we can replace that guilt and grief with¦. John, going forward from today on, is there a commitment to change that you can make directly to your mother here?

John: Mom, going forward, I am going to take care of myself instead of beating myself up. I am going to stay sober, no matter what. I am going to dedicate my recovery to your memory. I love you.

The therapist gave John a bright, colorful scarf to represent his new commitment to change.

Therapist: John, take a moment to see where you feel this commitment, this new purpose, in your body.

John: (takes a deep breath) In my shoulders and my heart. Earlier, my shoulders felt heavy with guilt and my heart broken with grief, but right now my heart feels love and I feel purpose in my shoulders. (adjusts his posture to confidently place his shoulders back and head up).

Group sharing

After the completion of the psychodrama, it is essential that group members are instructed to return to the role of themselves; this is called de-roling, and can be as simple as a group member saying “I am no longer John’s mom; I am Mary, a group member here”. After group members de-role, each group member has an opportunity to share about their experience during the psychodrama. The sharing phase of a psychodrama group is the final, integrative phase which allows participants to reconnect with each other and make sense of their experience during the psychodrama (Nolte, 2014). The group member who played the role of John’s mother happened to have a son struggling with addiction. She shared about how fruitful the psychodrama had been for her because she felt like she was speaking to her son the entire time that John’s mother was speaking to him. In a similar manner, the other group members that played roles of strengths felt as though they were speaking to themselves as they offered John supportive messages. Group members who were present but did not play an active role in the group shared that witnessing the psychodrama was a powerful experience for them too. They indicated feeling as if they were going through the same emotional process with John. Some have suggested that this phenomenon of audience catharsis is a result of mirror neurons (Giacomucci, 2019; Hug, 2013). The group shared one by one about their own experiences of guilt, grief, and loss, while making commitments similar to John’s about maintaining sobriety. After all group members had shared about their own connections to the psychodrama, a closing exercise was conducted, and the group ended.

Clinical processing and discussion

In this psychodramatic vignette, the protagonist, John, suggests that he was using drugs to numb his feelings of grief and guilt around the death of his mother. He demonstrated a disconnection between his emotions and cognitions – often described by clients as “a disconnection between the head and the heart.” Previously, other group members had attempted to convince John that his mother’s death was not his fault, but he needed an experiential and emotional knowing in order to feel that it was not his fault. From his initial perspective, he could not access this realization. However, from the role of his mother, it became very apparent that his self-blame was a distortion of reality. Darrow & Childs (in-press) articulate this phenomenon well:

The client is tapping into their stored knowing of the loved one and speaking as if they are the other person. The words reflect how the person remembers or experiences the essence of the loved one from within him or herself¦ In our experience, that compassionate aspect of the one who has died is available to the client, in spite of ambivalence or issues of complicated grief. When the client in role reversal becomes the compassionate, loving, and wise aspect of the one who has died, there is nothing short of transformation in resolving the difficult grief issues (pp. 24“25).

The neuroscience research has clearly demonstrated that new experiences change the brain (Cozolino, 2014; Siegel, 2012). Although John could not actually have this corrective experience with his mother because she died, the psychodramatic experience had the power to help him renegotiate this relationship (Giacomucci & Stone, 2018). Sometimes telling the story of loss is not enough. Many clients will need a more embodied and multi-dimensional experience in treatment in order to transform their grief (Darrow & Childs, in-press; Dayton, 2005).

Many psychodrama therapists may be tempted to skip the warm-up, skip the strength-based roles, and go right for the cathartic dialogue with the deceased person. However, this is likely to cause harm or simply re-enact the trauma/loss. The other aspects of the group are essential to the transformation. It should be emphasized that it is essential for the facilitator to recognize the importance of creating a circle of safety for the bereavement sessions, and this can be created by offering empathy, non-judgment, unconditional acceptance, and focused listening and hearing (Hiltunen, 2003, p. 220). The sociometric warm-up provided the group holding environment, within which this psychodrama was contained. Through the sociometric warm-up and protagonist/topic selection, John became a representative of the group and their collective clinical issue of unresolved grief. Throughout the psychodrama enactment, each group member could potentially see themselves in John’s enactment and thus move towards resolution of their own losses. Psychodrama allows clients to actively renegotiate their internalized relational images and object relations with deceased loved ones.

The psychodrama therapist’s choice to begin with support and strengths in the scene provides the protagonist and the group with additional containment and support to avoid retraumatization (Hudgins & Toscani, 2013). The Therapeutic Spiral Model, a trauma-focused psychodrama approach, prescribes that all psychodramas begin with resourcing the protagonist, so they are not set up to re-enact the trauma. With support and strengths, the enactment can be different. Jacob Moreno, psychodrama’s founder, described two types of catharsis experienced by protagonists in psychodrama catharsis of abreaction and catharsis of integration (Nolte, 2014). Abreactive catharsis is characterized by a release and discharge of emotion while the catharsis of integration is a new insight, reorganization, or transformation. While the catharsis of abreaction and expression of grief is important in recovering from loss, it must be followed up with a catharsis of integration (Hug, 2013; Nolte, 2014). In this psychodrama, there were two primary moments of integration for John. The first came while he was in the role of his mother and convinced himself that it was not his fault. The second integration came when he made a commitment to dedicate his recovery and self-care to his mother. The future commitment allows John to create meaning from his loss and use it for positive motivation and post-traumatic growth. The strength-based roles allowed for a warming-up process to the spontaneity that John demonstrated in the psychodramatic dialogue with his mother. John’s new response to his grief and self-blame are indicators of spontaneity, a new response to an old situation.

Psychodrama has its limitations as well; it requires extensive training to be facilitated safely and often requires a longer group session because of its intensity. In individual sessions, cases where time is limited, or if the facilitator doesn’t have extensive psychodrama training, psychodramatic letter writing is an alternative intervention which operates upon similar psychodrama mechanisms as described above (Dayton, 2005). With this intervention, clients could be instructed to write a letter to their deceased loved one, to write a letter they wish to receive from their deceased loved one, to write a letter to the defenses mechanisms preventing them from expressing their grief, to write a letter to/from themselves in the future having found more peace with their loss, or a variety of other possibilities. Psychodramatic letter writing can be facilitated in several different ways, such as in a group session, individual session, or a suggestion for work in-between sessions. Psychodramatic letter writing is simple, efficient, provides containment, and offers opportunities to renegotiate loss (Dayton, 2015; Stepakoff, 2009). This form of letter writing also assists clients with externalizing these components of their loss and narrative, so they can begin to integrate the new relationship with the deceased person and bring this forward into their ongoing lives (Lister, Pushkar, & Connolly, 2008, p. 249). It is recommended that clinicians be sensitive to the client’s stability, ego strength, and level of resourcing before encouraging them to write a letter to a deceased loved one. This type of letter provides the client with an opportunity for expression and catharsis of abreaction (Stepakoff, 2009). A follow-up letter that the client writes from their deceased loved-one to their self will often provide the integration necessary to resolve guilt and renegotiate grief.

Conclusion

The application of sociometry and psychodrama in the context of group psychotherapy provides facilitators with a blend of clinical tools for helping clients renegotiate grief and loss, while reconnecting to others with similar experiences. Sociometric and psychodramatic tools are especially impactful for addictions counselors who, by the nature of addiction, are working everyday with clients who are experiencing loss. It is particularly important for these clinicians to recognize that bereavement does not end after some magical year, and it differs over time for each client; it is a life time of reworking the death, the relationship, one’s identity, and future relationships (Lister et al., 2008, p. 249). Many clients are unable to find the words to articulate how loss and trauma has impacted them, so psychodrama and the creative arts therapies “help survivors move from formless anguish to symbolization, from isolation to connection, from destruction to creation, and from silence to speech (Stepakoff, 2009, p. 112). When one feels stuck and unable to process feelings of grief, sociometry creates interpersonal connection in action and psychodrama provides opportunities for closure in surplus reality.

Acknowledgement

I wish to thank and recognize Katie Lacenere for the editing support she provided on this manuscript.

Dr. Scott Giacomucci, DSW, LCSW, TEP is the Director, Founder, & Owner of the Phoenix Center for Experiential Trauma Therapy. He is the autor of numerus articles and books on the used of psychodrama and experiential treatment of trauma and addictions. His latest book is “Trauma-Informed Principles in Group Therapy, Psychodrama, and Organizations Action Methods for Leadership”.

Originally published: The Arts in Psychotherapy, Volume 67, February 2020, 101627

References

B.K. AlexanderThe globalization of addiction: A study in poverty of the spiritOxford University Press, New York, NY (2008)

P.T. Bartone, J.V. Bartone, Z. Gileno, J.M. ViolantiExploration into best practices in peer support for bereaved survivorsDeath Studies, 42 (9) (2018), pp. 555-568

P. BossLoss, trauma, and resilience: Therapeutic work with ambiguous lossW.W. Norton & Company, New York, NY (2006)

D.R. Buchanan, Practical applications of step-in sociometry: Increasing sociometric intelligence via self-disclosure and connection, Journal of Psychodrama, Sociometry, and Group Psychotherapy, 64 (2016), pp. 71-78

C.A. Courtois, J.D. Ford, Treatment of complex trauma: A sequenced, relationship-based approachThe Guildford Press, New York, NY (2016)

L.J. Cozolino, Attachment-based teaching: creating a tribal classroomW.W. Norton & Company, New York (2014)

T.A. Dalton, R.E. Krout, Development of the grief process scale through music therapy songwriting with bereaved adolescents, The Arts in Psychotherapy, 32 (2) (2005), pp. 131-143

L.S. Darrow, J. Childs, Life, death, and transformation: Experiential action methods and tools for healing grief and trauma, Routledge Publishing, London, UK (2020)

T. Dayton, The living Stage: A step-by-step guide to psychodrama, sociometry, and experiential group therapy, Health Communications Inc, Deerfield, FL (2005)

T. Dayton, Relational Trauma Repair (RTR) therapist’s guide, revised edition, Innerlook, Inc, New York, NY (2014)

T. Dayton, NeuroPsychodrama in the treatment of relational trauma: A strength-based, experiential model for healing PTSD, Health Communications, Inc, Deerfield Beach, FL (2015)

N.I. Eisenberger, The neural bases of social pain, Psychosomatic Medicine, 74 (2) (2012), pp. 126-135, 

P.J. Flores, Addiction as an attachment disorder, Jason Aronson, New York, NY (2011)

S. Giacomucci, The sociodrama of life or death: Young adults and addiction treatmentJournal of Psychodrama, Sociometry, and Group Psychotherapy, 65 (1) (2017), pp. 137-143

S. Giacomucci, The trauma survivor’s inner role atom: A clinical map for post-traumatic growth Journal of Psychodrama, Sociometry, and Group Psychotherapy, 66 (1) (2018), pp. 115-129

S. Giacomucci, Social group work in action: A sociometry, psychodrama, and experiential trauma group therapy curriculumDoctorate in Social Work (DSW) Dissertations(2019), p. 124

S. Giacomucci, A.M. Stone, Being in two places at once: Renegotiating traumatic experience through the surplus reality of psychodrama, Social Work with Groups (2018),

S. Giacomucci, S. Gera, D. Briggs, K. Bass, Experiential addiction treatment: Creating positive connection through sociometry and Therapeutic Spiral Model safety structures, Journal of Addiction and Addictive Disorders, 5 (2018), p. 17

A.E. Hale, Moreno’s sociometry: Exploring interpersonal connection, Group, 33 (4) (2009), pp. 347-358

A.E. Hale, Conducting clinical sociometric explorations: A manual for psychodramatists and sociometrists, Royal Publishing Company, Roanoke, VA (1981)

J.L. Herman, Trauma and recovery: The aftermath of violence: From domestic abuse to political terror, Basic Books, New York (1997)

S.M. Hiltunen, Bereavement, lamenting and the prism of consciousness: Some practical considerations, The Arts in Psychotherapy, 30 (4) (2003), pp. 217-228,

N.S. Hogan, D.B. Greenfield, L.A. Schmidt, Development and validation of the hogan grief reaction checklist, Death Studies, 25 (1) (2001), pp. 1-32

A.V. Horwitz, J.C. Wakefield, The loss of sadness: How psychiatry transformed normal sorrow into depressive disorder, Guilford Press, New York, NY (2007)

K. Hudgins, PTSD unites the world: Prevention, intervention, and training in the therapeutic spiral model, C.E. Stout (Ed.), Why global health matters: How to (actually) make the world a better place (2017) Retrieved from

M.K. Hudgins, F. Toscani, Healing world trauma with the Therapeutic Spiral Model: Psychodramatic stories from the frontlines, Jessica Kingsley Publishers, London, UK (2013)

E. Hug, A neuroscience perspective on trauma and action methods, K. Hudgins, F. Toscani (Eds.), Healing world trauma with the therapeutic spiral model, Jessica Kingsley Publishers, London (2013)

E. Kaler-Ross, On death and dying, Scribner, New York, NY (1997)

Lister, D. Pushkar, K. Connolly, Current bereavement theory: Implications for art therapy practice, The Arts in Psychotherapy, 35 (4) (2008), pp. 245-250

G. Mat, In the realm of hungry ghosts: Close encounters with addictionNorth Atlantic Books, Berkeley, CA (2010)

J.L. MorenoWho shall survive? Foundations of sociometry, group psychotherapy and sociodrama (2^nd edition), Beacon House, Beacon, NY (1953)

J.L. Moreno(4th edition), Psychodrama, Vol. 1, Beacon House Press, Beacon, NY (1972)

J.L. MorenoE. Schreiber, S. Kelley, S. Giacomucci (Eds.), The autobiography of a genius, North West Psychodrama Association, United Kingdom (2019)

Z.T. Moreno, To dream again: A memoir, Mental Health Resources, New York (2012)

O.J. Morganz, Addiction, attachment, trauma and recovery: The power of connection, W. W. Norton & Company Publishing, New York City (2019)

J. Nolte, The philosophy, theory and methods of J. L. Moreno: The man who tried to become god, Routledge (2014)

H. Northen, R. Kurland, Social work with groups, Columbia University Press, New York (2001)

A. Rice, Common therapeutic factors in bereavement groups, Death Studies, 39 (3) (2015), pp. 165-172

D.J. Siegel, New York: Guilford Press, Developing mind: how relationships and the brain interact to shape who we are (2012)

D.E. Smith, D.R. Lee, L.D. Davidson, Health care equality and parity for treatment of addictive disease, Journal of Psychoactive Drugs, 42 (2) (2010), pp. 121-126

D.M. Steinberg, Mutual aid: A contribution to best-practice social workSocial Work with Groups, 33 (1) (2010), pp. 53-68

S. Stepakoff, From destruction to creation, from silence to speech: Poetry therapy principles and practices for working with suicide grief, The Arts in Psychotherapy, 36 (2) (2009), pp. 105-113

A. Vajentic, B. Calovini, A model of bereavement support for organ and tissue donor familiesThe Arts in Psychotherapy, 28 (5) (2001), pp. 281-288

W.H. Wysong, The psychodrama companion, (N.P.): Author(2017)

I.D. Yalom, M. Leszcz, The theory and practice of group psychotherapy, (5th ed.), Basic Books, New York, NY (2005)