Important Concepts and Techniques of Psychodrama

Important Concepts and Techniques of Psychodrama

Psychodrama is created and developed by J. L. Moreno, is a primarily group therapy approach in which the client acts out or dramatizes past, present, or anticipated life situations and roles in an attempt to gain deeper understanding, achieve catharsis, and develop behavioral skills. It can help client get in contact with unrecognized and unexpressed feelings, to provide a channel for a full expression of these feelings and attitudes, and to encourage new behavior. It is designed to facilitate the expression of feelings in spontaneous and dramatic way through the use of role playing.T It is processing without any script before enactment. In proceeding the psychodrama, five elements are essential and exist: The stage, the protagonist ( A person who is the subject of the psychodrama and its principle actor), the director ( A person who will use his professional skill to facilitate the psychodrama), the auxiliary ego ( Someone who assist in enacting some role ) and the audience. Each one has its own role and responsibility in the psychodrama.

Also, there are many concepts and techniques which is important in psychodrama. Here I will list out few components which I want to share as below.
Psychodrama's most important characteristic is its emphasis on spontaneity and creativity. Moreno noticed that anxiety decreased with the increase of spontaneity in a person's behavior. He found that in most spontaneous situations, there seem to be lower levels of thinking about self. To capitalize on this observation he used a stage where people could act out scenes from their inner world or past experiences. The goal was to lead them to an emotional catharsis

Spontaneity
Moreno (l953) emphasized that ". . . spontaneity is the essential principle of all creative experience." People become anxious and neurotic when their spontaneity is blocked. The principal aim of Psychodrama is to help people bring back into their lives a continuous flow of spontaneity. All participants are encouraged to experiment with their roles and a means for enlivening their character. The reason for this, is that "hamming it up" and becoming "playful" with their roles can stimulate the protagonist. By spontaneously acting-out roles, people will motivate the protagonist to be less restrictive and more natural. Moreno (l953) stressed strong relationship among spontaneity, creativity, and anxiety, for there is no ". . . distinction between conscious and unconscious . . . in a psychology of the creative act. The unconscious is a reservoir which is continuously filled and emptied by the individuals" (p.59). When there is an increase in spontaneity there is a decrease in anxiety. Essentially, anxiety is with the person, because spontaneity has been lost. When creativity has no spontaneity, it has no life or substance. Spontaneity is life's catalyst, the energy that makes everyone in the group come alive and be uniquely creative as human beings.

- http://education2.uvic.ca/Faculty/hfrance/chap-7.htm

Encounter and Tele
The encounter is defined by Greenberg (1974) as that which occurs when individuals immediately and meaningfully confront significant others on the psychodrama stage. Through the process of psychodrama, people can understand others in a deeply level. Also, a related concept is Tele, which is in the course of an authentic encounter. Moreno defines tele as the two-way flow of feelings between people, or “therapeutic love”. T When people can feel or empathy and feel on others, tele is strong and positive and they can link up with each other like as bonding. The positive tele may affect participants to feel the others and once it work, the group cohesion is stronger. Gradually, participants can enact it more spontaneous and easily to find a creativity way to encounter the interpersonal conflicts. To me, the essential on tele is the empathy on others. Once you can feel the others, you are not only feel what she feels, but also feel her situation. Also, the similar experience may increase the occurrence of tele. It may because when it fall into the similar situation, psychodrama may brought people experience gain and people may have those feeling before or until now. In the latest experience, I view the tele in the last lesson. When our classmate( protagonist) share about her mother’s dead, I view there is a tele between director and the classmate.

Catharsis
In a psychodrama, once protagonist can express the feeling which is store or suppressed in her heart, catharsis occurs. It can be express by verbally or physically acting out in the process, to ventilate their negative feeling through psychodrama. Refer to T, Blater(1985) points out that this emotional release reflects an expansion of the sense of self on four level: abreaction and awareness of previously disowned feelings, integration of those feelings, experiencing a sense of being a part of social network, and participating meaningfully in the universe. When people can ventilate their negative emotion, they will get a new insight, not only on their feeling, but also get a new insight on the problem.

Role reversal
Refer to Kipper(1986)-L , role reversal is the act of reversing role involves physically changing places and stance with other, who change places with you and each goes into and explores the others role. Sometimes auxiliary ego is invited to do some role. To aims at keep the drama true, protagonist may demonstrate the role to the auxiliary ego. Unless the role is more clear by the demonstration, protagonist can also fall into the situation of the others, to experience, feel and understand more on the significant others.

Double and Mirror
In the technique of double, T said that double can mirror the inner thoughts and feelings of protagonist. It can facilitates client to explore their unexpressed thought and feeling. So when the protagonist hearing something which can double her, some hidden feeling and thought will appear from their psyche. To me, doubling is so miracle and powerful, it can stimulate our hidden grief or hidden experience. But if the double is expressed by all participants, as said by Dr Lo, because director don’t know what they said, there is a opportunity to harm people ( not only on the protagonist, or the audience). So I agree to use Dr Lo’s doubling method. Once director is the controller of doubling, that means to control what they say and inspire more on protagonist’s psyche. For the effectiveness of psychodrama, doubling can help similar experienced people to get more insight and feeling, to facilitate on facing their interpersonal conflict.

Psychodrama in local context
In local context, psychodrama is useful both on treating client’s thinking o feeling. It is a powerful and miracle therapeutic method. Refer to T, its active technique and role playing can lead the participants to the direct experience of real conflicts. People can enact difference role in the psychodrama, especially the protagonist, to experience their conflict again. Unless the chance of experience by the participants, they may gain some insight through enact the role. Sounds like the last lesson, Dr Lo let the classmate to review her memory with mother and experience the event again. In the process, classmate ventilate her sad feeling, keep crying, catharsis function occurs naturally. In the therapeutic process, Dr Lo do his interpretation on her mother’s thinking and feeling, one sentence shock us and classmate seems like get new insight. Although she has say nothing, but after the feedback part with her mother, she smiles and become peace than before.

Also, when other participant assisted to portray the role, they will show their different way ( or their perspective) of responding the problem, it may explore more new insight on their conflicts. Certainly, except members show their way out to the protagonist, double or mirror effect can also help protagonist more understand on other’s concern and thinking. For the same case, one classmate portray her mother, to speak out her thinking and feeling on daughter( classmate). It doubles our classmate’s heart, sounds like a new feeling and insight to her and us.

Furthermore, through participate the psychodrama, protagonist can ventilate their negative feeling by verbally or physical action. It is free for them to express their negative emotion when real situation is re-experience by them. Hong Kong people is so stressful in their life, once they can ventilate the negation emotion, it is a good way to release their stress and become better. Otherwise, it is more easier to get frustrated.

Although psychodrama is a powerful therapeutic method, but for local context, it is not easy to work it well because there are some limitations when using it. It base on the enough knowledge, experience, sensitivity on the worker who want to do a psychodrama. J. L. Moreno and Elefthery(1982)-T said that psychodrama should be used only very carefully, with acting out individuals, with a seriously disturbed population.’ So when the practitioner use the psychodrama without a good knowledge and experience, there is a risk of stimulate people’s grief feeling which cannot handled well by practitioner and the result can be severe.

Secondly, except practitioner’s knowledge and experience is important, there is a danger of leader’s being attracted to psychodrama to gratify their own psychological needs. –T Practitioners sometimes do a psychodrama due to their own needs. So they should be aware of their thinking and needs which may interfere the functioning. Also, countertransference may occurs in the group. So before running the psychodrama, practitioner should aware of themselves and decide whether it is appropriate to do a psychodrama or not.

Also, ‘Sensitivity is also important to practitioner so that they do not push the disturbed clients past a point that is therapeutic’. I also think this is important in psychodrama because if practitioner has no sensitivity on client’s readiness and appropriateness on receiving a therapeutic process, their grief feeling may deeper.

Base on above three reasons to work well in psychodrama, there are few people who can fulfill those condition. ( STATISTIC in HK)

Cognitive Behavior Therapy
Cognitive-Behavioral Therapy is an empirically supported treatment that focuses on patterns of thinking that are maladaptive and the beliefs that underlie such thinking. While the person in distress likely holds such beliefs with great conviction, with a therapist’s help, the individual is encouraged to view such beliefs as hypotheses rather than facts and to test out such beliefs by running experiments. Furthermore, those in distress are encouraged to monitor and log thoughts that pop into their minds (called "automatic thoughts") in order to enable them to determine what patterns of biases in thinking may exist and to develop more adaptive alternatives to their thoughts. 2. It aims to solve problems concerning dysfunctional emotions, behaviors and cognitions through a goal-oriented, systematic procedure.1.

Cognitive behavior therapy is a structure, directive therapy implied by therapists. They mainly listen, encourage and help client to explore more on their irrational thought and client’s role is to express their thought directly to therapists and share their point of view on their own, others and the world. In the whole interventions, therapist is the main persons holding the interventions with their plan and goal. Client always follow therapist’s planning and direction. In the theories, it has some characteristics in this therapy. Here I list out some points one by one.

Firstly, it is based on the idea of our thought which is irrational, affecting our emotion and behavior, not external things, like people, situations, and events. . It mainly focus on hearing what client say and encourage client to recover more in a rational way. It can let the therapist know more about client’s though in which is rational or irrational.

Secondly, CBT is a time limited therapy. Compared with other therapy, for instance, the psychoanalysis, those can take the therapy counted by yearly. But for possessing the CBT, the average number session for client is around 16.3. So the therapy usually finished within a specific sessions for the client and the period will not be a long time.

Furthermore, this therapy is a collaborative effort between therapist and client. The role is described as above, both parties needs to do their roles to achieve the goal of client. So the role identification is so clear for both and the components of achieving the therapy into a smooth way is fulfilling to their own roles.

Also, CBT always use a Socratic method. It always asking questions to client and encourage client to ask question of themselves. 3. It also includes the educational method to teach the client how to do it to achieve their goal, not what to do is.

Lastly, CBT has the homework to client in each session, to let them understand more after practicing some technique, on the aspects of changing the irrational thinking, or to review what they improve from their habitual and rigid belief in their past experience.

CBT in local context
In summary, CBT aims to help individuals with social
anxiety: (1) to understand and correct negative and biased
interpretations of social events; (2) to understand and modify
dysfunctional beliefs; (3) to learn to abstain from engaging
in safety behaviours; and (4) to gradually approach and adapt
to anxiety-provoking social events.
Application of Cognitive-behavioural Therapies for
Chinese
Lin maintains that cognitive-behavioural therapies may
be appropriate for Chinese.
20
It has been suggested that
Chinese people tend to be less tolerant of ambiguity and
prefer structured counselling sessions with practical and
immediate solutions to their problems.
21
Therefore, CBT
which emphasises a structured and systematic counselling
process with the step-by-step learning of new cognitive
and behavioural skills would suit the cultural orientations of
Chinese people.
20
Moreover, Chinese people prefer therapists
who employ a directive rather than a non-directive approach.
As suggested by Lin, therapists are perceived as effective
by Chinese clients when they take partial responsibility for
the process and play an active role in providing suggestions
and advice and facilitate clients'actions.
20
Thus, CBT which
stresses the directive and collaborative roles of a therapist
may be suitable for Chinese people.
For the application of using CBT, the therapeutic process is focus on client’s cognition. Sometimes client’s has their maladaptive thinking on the others and world which directly affect their emotion and behavior. In the sharing session, when therapist find out the irrational thinking, they will use Socratic method such as asking question directly, more easy to teach client explore more on the irrational thinking. It can let client understand more on their thinking pattern and aware on their daily life, so that clients will not only depends on the therapist and can be role as the therapist to help themselves.

CBT is structure, clear, concrete and quick therapy. The intervention is clear for therapist to do it. With the agenda planned by therapist, clients are more easier to participate the therapy. Also, therapist always hold a non determine stance, client will be encourage to take responsibility for their individual and empower themselves.

Finally, when client comes to seek for therapy, CBT can focus on the present problem and the goal is to solve the existing problem by adjust client’s irrational thought, we can say CBT is problem oriented therapy, therefore therapist has the same goal with the client, it is to solve their existing problem.

Comparison between psychodrama and Cognitive Behavior Therapy
Above is focus on psychodrama and cognitive behavior therapy which have its contribution and limitation when using in local context. But when we view on both therapy, it is so difference on the the structure and the focus aspect.

Firstly, in running a psychodrama, director have the goal in each session which they want to achieve. There is no planning before they start the psychodrama. It base on director’s sensitivity on protagonist and facilitate them to express their thinking and feeling more smoothly and spontaneously. During the process, client is free and natural to express what they think and feel. When compare with CBT, it is structure, planned and led by the worker. In the role identification, therapist always lead the direction to the clients on how to achieve the goal or how to think it rationally. Client can do is only follow the procedures planned by worker Refer to T, ‘group leader will assume that it is their function to decide if someone’s beliefs are irrational.’ Therapist seems be the leader in the therapy process, even client want to express their thought naturally, it will be affected by therapist follow their own agenda and plan. Unless the above reason, when therapist start to confront on client’s irrational thought, with the intimidate feeling from the therapist, client will easier to stop sharing and retreated.

Secondly, CBT is mainly focus on treating client’s cognitive, that means to change their irrational thought. It emphasis on the cognitive thinking and ignore client’s real feeling. In the therapeutic process, therapist focus on treating their cognitive thinking, client’s feeling is suppressed at that moment or negative emotion can’t be ventilate and treated in the whole process. There is a similarity with psychodrama, here I mean they will both treat on client’s cognition. But one difference between it is that except psychodrama will treat on client’s cognitive part, they will also treat client’s feeling, to let them ventilate their emotion. To me, it is necessary for client to solve both aspect.

Moreover, client can enact in psychodrama, to re-experience their problem and get new insight from the psychodrama and others .Unless gaining new insight, it also has the function of catharsis, to let client ventilate their negative or unexpressed emotion. But to CBT, because worker mainly focus on client’s irrational belief, the chance for ventilate client’s negative emotion become less.

In CBT process, the goal is to solve the present( here and now) problem and ignore the past experience of client. According to T, ‘ there is a possibility of group pressure against members who resist certain changes’. To me, Some people may stick on their irrational thought in the past. Under those pressure by the group, it is a risk of the withdraw the group when the problem still exist. It is so vary with psychodrama because they will concern on client’s past, present and do a future projection when in needed.

For the intervention of CBT, therapist and client are easier to build up the warmth relationship than . For CBT, therapist listen, teach and encourage clients on how to aware of their thinking, through the encouragement to client, the warmth relationship establish gradually and each parties has their own role in the whole process, it facilitates the process smoothly. But for psychotherapy, worker is responsible for facilitate the therapeutic process for client, so there is less opportunity to interact with client directly. So the warmth relationship may not build up in the process.

Harmony and face-saving
Harmony and face-saving are two important
104 Asian Journal of Gerontology & Geriatrics Vol 2 No 2 August 2007
Wong and Chong
communication characteristics among Chinese
people.17 In order to maintain harmony and
face-saving, Chinese people prefer indirectness,
implicitness, and non-verbal expressions instead
of aggressive, argumentative and confrontational
modes of communication.18 That was possibly
why both Sin and Lee were initially hesitant
about revealing their concerns and true emotional
responses. They considered it a loss of face to reveal
their personal problems to people who are not their
family members, relatives or friends. Moreover,
they worried that their problems were too trivial to
take up the counsellor’s time. In response to these
communication characteristics, the counsellor
needed to be alert to their every verbal and nonverbal
communication, and was active in exploring
their hidden problems and emotional reactions.
External locus of control
Most Chinese people believe that they are controlled
by external forces such as fate, luck, or chance; hence
they tend to de-emphasise themselves in favour
of the group. Lee was silent and not motivated to
join any outdoor programmes. After some rapport
had been built between her and the counsellor, she
admitted that once, during a New Year celebration
dinner, she experienced dizziness and the institution
had to spare a staff member to take her to see a
doctor immediately. She saw her sickness as creating
a nuisance for the staff and residents, considered
herself a burden and never participated in any
outdoor activities again. So, to encourage Lee’s
involvement in activities, the counsellor told her
that no one can stop herself from feeling sick and
staff members were actually always ready to provide
help in time of need. Lee’s disclosure demonstrates
the importance of support; it could help Lee face
negative experiences squarely and see them in a new
light.
Unfamiliarity with psychotherapy
Older Chinese people seldom go to counsellors to
handle their emotional problems. There are far fewer
psychotherapists and counsellors than physicians in
Chinese societies, including Hong Kong. Because
there is little understanding about counselling
and a lack of access to the service, very few older
Chinese look to psychotherapists for professional
help; they usually only approach physicians for their
emotional problems.19,20 This also happened with
the 10 clients the first author worked with. None
of them voluntarily sought the counselling service;
all were referred by nurses in the home. To enhance
the clients’ acceptance of the counsellor as a member
of the helping professions, the counsellor paired up
with the nursing staff and took health issues as the
entry point for the counselling work.
Providing a well-structured and hierarchical
environment
The Chinese socialisation process emphasises
hierarchy and defined roles and responsibilities.17,21
Most Chinese traditionally exhibit deference to
those in power.22 The counsellor therefore played an
active role in providing Sin and Lee with concrete
suggestions and advice when they could not identify
options and different perspectives. This form of
relating corresponds to the authoritarian nature of
social relationships in Chinese culture.23 Nevertheless,
the ultimate target is still to empower clients to see
that there are alternatives and that they are capable
of solving their own problems.
Good client-counsellor relationship
In CBT, the therapeutic relationship is seen as an
essential ingredient, but, unlike other psychotherapies,
it is not taken as the main vehicle of change.16 Our
clinical experiences suggest that establishing a good
and reliable client-therapist relationship is important
for effective intervention. The rapport helps clients
become willing to venture out, to reveal their
concerns and to identify their underlying schema to
the counsellor. It also fits the clients’ needs as, facing
losses in health and being of advanced age, these
clients long for concern and support.
How do therapists build up relationships with
older clients?
- http://www.hkag.org/Publications/AJGG/v2n2/p99-SP200731.pdf

Reference

1. http://en.wikipedia.org/wiki/Cognitive_behavioral_therapy#Criticism

2.http://www.nami.org/Template.cfm?Section=About_Treatments_and_Supports&template=/ContentManagement/ContentDisplay.cfm&ContentID=7952

3.http://www.nacbt.org/whatiscbt.htm
4. www.hkjpsych.com/journal_file/0602_v16n2_50-56%20Preliminary.pdf
5. http://www.hkag.org/Publications/AJGG/v2n2/p99-SP200731.pdf

Blater(1985) T
Kipper(1986)-L
J. L. Moreno and Elefthery(1982)-T

Title Counseling and psychotherapy : theories and interventions / [edited by] David Capuzzi, Douglas R. Gross.
Publisher Upper Saddle River, N.J. : Pearson Merrill/Prentice Hall, c2007.
Edition 4th ed.

Author Goldman, Elaine Eller.

Title Psychodrama : experience and process / Elaine Eller Goldman, Delcy Schram Morrison.
Publisher Dubuque, Iowa : Kendall/Hunt Pub., c1984.

Author Feasey, Don.

Title Good practice in psychodrama : an analytic perspective / Don Feasey.
Publisher London ; Philadelphia, Pa. : Whurr, 2001.

Author Blatner, Adam.

Title Foundations of psychodrama : history, theory, and practice / Adam Blatner.
Publisher New York : Springer Pub. Co,. c2000.
Edition 4th ed.

Author Werner, Harold D.

Title Cognitive therapy : a humanistic approach / Harold D. Werner.
Publisher New York : Free Press, c1982.

Author Sharoff, Kenneth.

Title Cognitive coping therapy / Kenneth Sharoff.
Publisher New York : Brunner-Routledge, 2002
Author Kottler, Jeffrey A.

Title Introduction to therapeutic counseling / Jeffrey A. Kottler, Robert W. Brown.
Publisher Pacific Grove, Calif. : Brooks/Cole Pub., c1996.
Edition 3rd ed.

Psychodrama / Paul Wilkins.

Reference
Browne, K 2002, Early prediction and prevention of child abus : a handbook, Wiley,
New York

Crosson-Tower, C 1999,Understanding child abuse and neglect,4th edn, Allyn and
Bacon, Boston

"Child Abuse: An Overview" was written by C. J. Newton, MA, Learning Specialist and published in the Find Counseling.com (formerly TherapistFinder.net) Mental Health Journal in April, 2001.

Doyle, C 2006, Working with abused children : from theory to practice, 3rd edn, : Palgrave Macmillan, New York

Hong Kong:Dept. of Social Work and Social Administration, The University of Hong
Kong 2005, Study on child abuse and spouse battering : report on findings of
household survey

Macdonald, G 2001, Effective interventions for child abuse and neglect : an
evidence-based approach to planning and evaluating interventions, Wiley,
New York

New York Times 2009, The New York Times, Hong Kong, viewed 9 Dec 2009, .