PSYCHODRAMA

by Milos Lazarevic

 

Brief historic overview

Psychodrama is a method of psychotherapy developed in the mid-1930s by psychiatrist Jacob Levy Moreno (1889– 1974) born of Sephardic Jewish parents in Bucharest, Romania (Blatner, 2005) (Davies, 1988). From the age of four, Moreno lived in Vienna (Davies, 1988).

The experiments in which he encouraged individuals to work on their emotional problems by acting them out in a controlled and supportive group setting, were the outcome of his life-long enthusiastic commitment to the creative arts, in particular poetry, philosophy and theatre, and an equally powerful determination to study social behaviour (Davies, 1988). Moreno said that his “most important beginning was in the gardens of Vienna” where as a medical student he learned psychodrama from watching children play, encouraging them to take action to challenge their circumstances, sometimes also involving parents in the process (Haworth, 2005). Later he initiated discussion groups

among the prostitutes of the “red light” district of the city and noted how these groups exhibited autonomy and structure, and how the collective dynamic interacted with the individuals’ need for self-expression and recognition (Davies, 1988). Upon qualifying as a doctor, Moreno found himself in charge of patients in a refugee camp for three years during which time his informal observations of group structure led him to suggest to the authorities principles that should be used actively in organising the community. Between 1921 and 1923 he worked with a group of young actors in Vienna using improvisation to dramatize current events in the “Theatre of Spontaneity” (Das Steigreftheater).

He took up residence in USA in 1925. His classic work Who Shall Survive? Foundations of Sociomery, Group Psychotherapy, and Psychodrama, was published in 1934 and in 1936 the Moreno Sanatorium at Bacon, New York was set up (Davies, 1988).

Description

The objective of psychodrama was, from its inception, to construct a therapeutic setting that uses life as a model, to integrate into the setting all the modalities of living – beginning with the universals of time, space, reality, and the cosmos – and moving down to all the details and nuances of life (Moreno, 1972). Definition of time, space, reality and cosmos universals as Moreno defined them is out of scope of this chapter. It is so far left to your imagination.

The method is applicable mainly in groups, but with modifications can also be used in family therapy and with individuals (Blatner, 2005).

The psychodrama session has three parts: the warm-up, the action and the sharing.

The warm-up serves to produce an atmosphere of creative possibility. It makes it possible for people to feel freer to trust the group, and to present their problems in an atmosphere of love, caring and creativity. Group discussion may be an expedient catalyst to get the group into action (Karp, 2005). The therapist then invites a client (later to become protagonist) to enact some aspect of the problem with the help of the therapist (in psychodrama called the director), and other group members (in the group setting) (Blatner, 2005).

The action part starts when the director of psychodrama group selects the protagonist – person that will bring out the internal drama, so that the drama within becomes the drama outside oneself. The director, with the protagonist, sets out to create scenes that give examples of the problem in the present, past or future with an eye to a possible behavioural pattern. Within the action there are five main tools or instruments that distinguish the method of psychodrama from other group methods (Karp, 2005).

The stage provides the actor with a living space which is multidimensional and flexible to the maximum (Moreno 1953:81 cited in Karp, 2005). If a conversation takes place in the kitchen, we set out the tables and chairs and give imaginative space to a window, sink, door, fridge, and other objects. Constructing the reality of an individual’s space helps the person to really be there and warms them up to produce the feelings that do or do not exist in that space (Karp, 2005).

The subject or actor (protagonist) is asked to be himself on the stage, to portray his own private life (Moreno 1953:81 cited in Karp, 2005). The protagonist simply states an aspect of life she/he wants to work on: my fear of death, my relationship with my daughter, my authority problem at work. The director, with the protagonist, sets out to create scenes that give examples of the problem in the present, past or future with an eye to a possible behavioural pattern (Karp, 2005).

The audience (group members) is a sounding board of public opinion as well as the subject itself—it becomes healed by taking part (Moreno 1953:81 cited in Karp, 2005). There are many societal roles represented in any given group.

The auxiliary egos (group member that took some role) have a double significance; they are extensions of the director, exploratory and guiding, and extensions of the subject, portraying the actual or imagined (Moreno 1953:81, cited in Karp, 2005).

The director is a trained person who helps to guide the action (Karp, 2005). The director has three functions: producer, counsellor and analyst (Moreno 1953:81 cited in Karp, 2005).

Sharing is a time for group catharsis and integration. It was meant as a ‘loveback’ rather than a feedback, discouraging analysis of the event and encouraging identifications. Points of most involvement by individual group members are identified, and each member finds out how he or she is like or unlike the protagonist. People are much more alike than different in behavioural responses. Often, as in Greek drama, the audience member is purged by watching the enactment of another’s life story. The sharing is meant to capture this learning process and allow the group members to purge themselves of emotions or insights gained (Karp, 2005).

Some techniques used in psychodrama the way Moreno presented them are: therapeutic soliloquy, self-presentation, self-realization, hallucinatory psychodrama, double, multiple double, mirror, role reversal, future projection, dream presentation, improvisation, didactic psychodrama, family psychodrama (Moreno, 1972).

Main uses (indications)

Kellerman stated that psychodrama, whether behaviouristic, psychoanalytic or existential-humanistic can make a contribution either on its own or as an adjunct to many branches of psychotherapy. He has emphasised that the method should be used with individuals who have adequate ego-strength, psychological-mindedness and a capacity for adaptive regression. (Kellermann, 1992 cited in Karp, 2005). It is rather individuals’ capacity for the method or for being a part of the group than a categorical diagnosis that make the indication for the use of psychodrama with patients.

Psychodrama can also be applied in many non-clinical contexts, schools, businesses, spiritual development programs, etc (Blatner, 2005).

Efficacy

Studies of Holmes et al. (1994) and Leutz (1985) proposed that psychodrama may be helpful for a wide variety of disorders including: relational, neurotic, psychotic and psychosomatic problems (Holmes et al. 1994; Leutz: 1985 cited in Karp, 2005).

The Cochrane Database of Systematic Reviews conducted a review that included all randomised controlled trials that compared drama therapy, psychodrama and related approaches with standard care or other psychosocial interventions for schizophrenia. Although they concluded that randomised studies are possible in this field and should continue to be under evaluation, benefits, or harms, are unclear (Ruddy & Dent-Brown, 2007).

A meta-analysis conducted by Kipper and Ritchie on the basis of 25 experimentally designed studies showed an overall effect that points to a large improvement effect similar to or better than that commonly reported for group psychotherapy in general. The techniques of role reversal and doubling emerged as the most effective interventions (A. Kipper & Ritchie, 2003). Although the authors concluded that their findings appear to shed a positive light on the validity of psychodramatic techniques, and they should be researched further and integrated into psychotherapy practice. The Centre for Reviews and Dissemination stressed that the limited reporting of the included studies and methods used mean that these findings may not be reliable (CRD, n.d.).

Future well designated studies considering effects of psychodrama are needed.

Comment from an expert

In 1972 Moreno wrote:

“The author met Sigmund Freud for the first time in 1912, while working at the Psychiatric Clinic in the University of Vienna. Dr. Freud ended one of his lectures with his analysis of a telepathic dream. As the students filed out of the lecture hall, he asked the author what he was doing. “Well, Dr. Freud, I start where you leave off. You meet people in the artificial setting of your office. I meet them on the street and in their homes, in their natural surroundings. You analyse their dreams. I try to give them the courage to dream again. I teach people how to play God” Dr. Freud looked at the author as if puzzled” (Moreno, 1972).

Comment from a trainee

“The theatrical aspect of psychodrama and the way in which unconscious and psychological become live and visible is what made me to start a psychodrama training. Training in psychodrama consists of personal experience in group, hours in theory, and practice under supervision which all together lasts approximately 2000 hours or 5 years to complete” Milos Lazarevic

Books, manual, videos, application, published online courses or international association

Federation of European Psychodrama Training Organisations (http://www.fepto.com/) – The Federation wishes to support the development of psychodrama training in Europe, and the Mediterranean countries, by promoting scientific and social exchanges between trainers and training institutes, to establish minimal training standards, to give ethical guidelines and to promote research.

Bibliography of Psychodrama © Inception to Now (http://pdbib.org/) – is an attempt to compile an exhaustive list of citations of scientific works on psychodrama since its creation by J. L. Moreno. It now contains more than six thousand entries.

Milos Lazarevic, trainee in Psychiatry, PhD student of neurosciences, RE&CBT counsellor -Belgrade, Serbia.