Dramatherapy and Psychodrama Similarities and Differences

Some excerpts from Anna Chesner's chapter in The Handbook of Dramatherapy, Routledge 1994

Introduction

'What is the difference between dramatherapy and psychodrama?' This question is often asked by newcomers to either method, and the two are often muddled. Before focusing on their differences it is important to acknowledge that there is common ground...

Similarities

Drama

The most immediate similarity ... is the central place of drama in both methods ... Drama is a creative art form, and both therapeutic methods draw on the use of artistic form to give shape and stimulus to the therapeutic process. Therapist and client use their internal creative resources and shared cultural sources in the therapy. The implicit message is that we are, in our healthy state, creative beings, and that creative action is central to the process of becoming whole.

Drama involves doing ... These therapies involve the use of action methods, ways of engaging participants in action. This is in contrast to the verbal, non-action psychotherapies that have their origin in the work of Freud.

Drama and the body

When we express ourselves through action we engage at a physical level...

There is also a connexion between the body and the unconscious...Physical symptoms reveal themselves to be communications of inner pain ... a doorway to a series of significant memories that make sense of current difficulties...

The use of space in theatre and therapy

The therapeutic space corresponds in some ways to the theatrical stage. It is a space where illusion and play are acceptable, and where they can be given three-dimensional expression in action...

The particular quality of reality held by the theatrical stage and the psychodramatic or dramatherapeutic space can be described in terms derived from anthropology and rites de passage as 'liminal', existing between one state and another ... 'transitional', operating as a bridge between inner and outer worlds. The dramatic idiom relates closely to the experience of play, and the agreement to play can be as facilitative of exploration and change in the adult as it is in the child.

Drama and dream

The drama of the inner world is familiar to us through our experience of dream. Freud called dreams the 'royal road to the unconscious'. It is interesting that the unconscious chooses to speak to us not through words alone, but through an essentially dramatic mode of communication. In dream we find dramatic elements such as story, location, plot, scene changes, spatial relationships, characters and dialogue...

Drama and role

The dramatic concept of role has an important place in dramatherapy and psychodrama. Moreno defined role as: "the actual and tangible forms which the self takes. We thus define the role as the functioning form the individual assumes in the specific moment he reacts to a specific situation in which other persons or objects are involved." (Moreno [founder of psychodrama] 1961, quoted in Fox 1987)...

Differences

There are two key differences between dramatherapy and psychodrama: the way in which they operate as group therapies, and the specificity of technique, structure and therapeutic intention within psychodrama compared to the broader range open to the dramatherapist...

The focus of the psychodrama session is on the psychodramatic journey of one group member, the protagonist, and once this person is identified the roles taken by the other group members are largely a reflection of the protagonist's inner world. In dramatherapy the focus may come to rest on one individual for most of a session, but it is more likely that the focus will move freely around the group...

A core difference of technique between dramatherapy and psychodrama stems from the historical fact that psychodrama originated in the work of one man, Moreno (with some significant developments made by his wife Zerka Moreno). The practice of 'classical psychodrama' is still in use and is a central reference point for variations such as strategic psychodrama, analytic psychodrama, person-centred psychodrama etc. Dramatherapy, by contrast, has its sources directly in a variety of dramatic and theatrical traditions, such as shamanic ritual, story-telling, dramatic and creative play...

In practice this means that the psychodramatist (also called the psychodrama director) uses a more precise map in structuring the psychodramatic journey, and this reflects a more precise therapeutic intention...

The role of the therapist

The relationship between psychodrama director and protagonist during a psychodrama involves a strong empathic link on the one hand, and a clear analytic mind on the other. The empathic link is essential if the protagonist is to regress to early vulnerable states for psychodramatic exploration. The director must sense their emotional needs, even when the protagonist has difficulty expressing these. At the same time the director is the map-reader. This involves making therapeutic judgments and influencing the direction the psychodramatic journey takes...So the director takes responsibility for guiding the work away from some paths that could be counterproductive or irrelevant to the agreed goals of the psychodrama...

In dramatherapy ... the general sweep of the work is broader than that of pyschodrama. This enables the dramatherapist to be less directive and less prominent in the detailed working through of material...

Summary [of differences]

1. The focal point of the session. It is usual for psychodrama to work through one protagonist, as the holder of group concerns, while dramatherapy often focuses on the whole group.
2. Methods used. Dramatherapy draws on any aspect of the full range of dramatic activity as a therapeutic source. Psychodrama exploits the particular techniques developed by Moreno to direct a precise therapeutic journey.
3. The pace and intensity of the therapeutic process. Dramatherapy addresses issues obliquely and gradually, through the use of metaphor and a variety of projective techniques. Psychodrama confronts issues more directly. It defines itself clearly as a psychotherapy, while dramatherapy is as yet ambivalent about this label.
4. The relationship with the group matrix [network of group concerns]. The group matrix is explored in a free-floating way in dramatherapy. In psychodrama it is identified within the first few minutes of a session and informs the choice of protagonist.
5. The role of the therapist. The nature and pace of the process tends to lead to a more directive therapeutic presence from the psychodramatist than the dramatherapist, who may be more facilitative.

Abridged May 2006

For examples of these techniques in action within sample therapy sessions see the chapter in full.

Psychodrama: Working Through Action
"My thank you is for your concern"
Jinnie Jefferies

First Published in the Institute of Group Analysis Journal 2005

The debate on what can be effectively done to reduce crime, protect members of the public and lower recidivist rates continues in many quarters. As a result there are now several behaviour programmes delivered by the Home Office. In this article I intend to discuss psychodrama as a treatment approach that has been used for the past twenty years at HMP Grendon Underwood and how its application can change the disruptive internal worlds of those who offend.

HMP Grendon Underwood is a category B prison housing some of the most dangerous and disturbed offenders held in the prison system. It is run on therapeutic community principles with a dedicated multi-disciplinary group of staff working together with prisoners in an atmosphere of tolerance and understanding. A therapeutic dialogue of a mutative kind leads to prisoners acquiring a greater understanding of their regular habitual behaviour and forms a basis and reason for experimentation with alternative forms of expression and behaviour. This atmosphere of tolerance derives from an agreement that inmates will aspire to an expectation that they will talk about their impulses to act in an aggressive way, rather than repeat such behaviour. Prisoners are housed on wings and are offered a therapeutic programme of small analytic groups, large groups, art therapy and psychodrama.

Psychodrama developed by Dr. J.L. Moreno integrates emotion, intellect and imagination through the development of spontaneity and creativity. Central to the understanding of psychodrama as a method of treatment is the theory of role. Moreno defined role as

" The functioning form the individual assumes in the specific moment he reacts to a specific situation in which other persons and objects are involved. The form is created by past experiences and the cultural patterns of the society in which the individual lives... every role is a fusion of private and collective elements" (Moreno 1996 in Fox 1998, p.62). As a treatment process psychodrama concerns itself with the way an individual responds to a particular situation by focusing on the individual’s behavioural responses, his belief system about himself, the other and the world in which he inhabits, his feelings and the consequences of such a response.

The process:

• Begins by establishing a contract with the client as to what is wrong and what needs to be addressed in the session.
• Moves on to examining the present problem as it relates to the client in the here and now, examining the client’s responses to the specific situation in which other persons and objects are involved. It is at this stage that a role analysis is made.
• Finds similarities in the recent past in order to check the role analysis and confirm the internal working models operating.
• Discovers linkages in the deep past.
• Helps the client understand his or her own process in life.
• Achieves a catharsis if necessary with regard to repressed emotions.
• Concretises the issues: the choices and action that keep the client in the dysfunctional state.
• Helps the client see the choices and option in life
• Aids integration of the cognitive & the affective states.
• Achieves closure so that the client can apply what he has learnt within the therapeutic situation.

Psychodrama relies on Vaihinger’s "as if" concept by creating in action the moment when a particular response took place (Vaihinger 1911). In Psychodrama the client is encouraged to show us the problem rather than tell us about it and group members are used as auxiliaries to play significant others in the client’s drama. There is no script, the drama is spontaneous created in the moment by the protagonist, group members and the therapist and as such the there and then of the moment is created in the here and now of the psychodrama space. John will play Fred’s perception of his abusive father, Pete his abandoning mother whilst other group members may come up to double the emotions that Fred may be feeling but not stating. Psychodrama techniques, such as role reversal, doubling and mirroring are all used in the therapeutic process.

Each psychodrama session starts with a warm up, using creative techniques to increase a sense of trust and encourage interactions between group members. It stimulates the creativity and spontaneity and helps focus on personal issues. The warm up phase leads to the selection of the prisoner whose work will be the focus of the enactment. In this way the protagonist works for himself and the group.

The enactment stage explores the issues heightened by the warm up process. During this phase of the work the prisoner will place on the psychodrama stage characters, which form part of his internal world. Because psychodrama is intrinsically an action method the protagonist is encouraged to move quickly into action, creating the space in which events took place. The physical setting of scenes and their portrayal evokes memories and emotions associated with the space and counter the distortions and evasive manoeuvres that may be introduced by verbal disclosure. Pete relentlessly stuck to his account of how his victim accidentally drowned in the bath despite being constantly challenged by his group, that is until in a psychodrama as he played out the scene in which the event took place his distorted version of events could no longer be sustained.

At the end of the enactment stage the group comes together to share what they have resonated with. Jim shared with George who had been working on his sister’s murder that his own sister had died some twenty years ago and that it wasn’t until George’s work had he realised that he had never mourned her death. Marvin wept the tears he failed to weep as a child as he remembered his mother’s death. On another occasion Paul shared with Simon his own brutal beating at the hand of his father.

Psychodrama offers a forum for prisoners to consider in detail how their modes of procuring and dealing with others may be influenced by the experiences they have had in earlier childhood. As a therapeutic method psychodrama employs action methods to encourage the expression of suppressed and repressed emotions and to introduce the possibility of change by correcting the maladaptive learning that has taken place. It helps the prisoner understand how he has projected negative feelings and transferred his inner disruptive world onto other persons and situations.

Within the context of the group the prisoner is encouraged to find new ways of perceiving and reacting to past and present life experiences.

Kernberg (1984) emphasises the dangerous violence inherent in paranoid attitudes of some offender patients. He states that it is therefore difficult to work with ordinary psychotherapeutic approaches because such approaches rely on the therapeutic relationship to represent symbolically the client’s internal world, a world full of destructive feelings that places the therapist at considerable risk. Psychodrama is also concerned with the symbolic representation of the offender’s external and internal reality but the representation takes a different route, the "as if ness" developed between client and therapist through the transference is achieved through the enactment itself, relying on auxiliaries and scene setting to represent time, place and other. The therapist’s interpretations are expressed through the psychodramatic interventions themselves, thus relieving the therapist of the task of becoming everything to the protagonist and thus enabling her to stand alongside the expression of aggression rather than becoming the recipient of these primitive emotions. John for example was helped within the psychodrama session to understand how his early experiences with mother and his angry feelings about her treatment of him had been displaced onto someone he perceived as weaker than himself. Within the session he was taken back to the scene of his mother’s ill treatment and dealt with his anger directly. He had an opportunity to speak to her about how she would abuse him and his brothers and his sisters, "All I wanted to do when you were drunk and in a bad mood was go up and hold you, but I was so scared...all I wanted was for you to love me. All I wanted was a wife and three kids that all I wanted... but I always questioned when people said I love you I always pushed them away. I couldn’t take it. I thought they were going to do things you did, be all lovey-dovey and then kick me in the teeth." By role reversing with his mother in an attempt to understand her actions he was able to reduce the internal rage. The psychodrama session ended with him placing a flower on her grave stating, "I love and forgive you". John’s mother died whilst he was serving a previous prison sentence. He had failed to make peace with her and therefore with himself.

In its use of "surplus reality" Psychodrama offers the emotionally hungry prisoner the experience, perhaps for the first time, of finding out what it would have been like to be held, to be told he was loved, to receive tenderness rather than the cruelty. In John’s psychodrama as his mother lies dying in hospital. John hears what he thinks and hopes she might have said before she died. The auxiliary holding mother’s role takes his hand.

Nigel at the end of his psychodrama when asked what he wanted but never had says, "To sit on my father’s lap and have him read me a story." In the "as if ness" of the moment Nigel sits on the lap of the prisoner who holds his father’s role and hears the story he never heard. Such experiences in psychodrama have the potential of reducing the persecutory internalised figure that often drives the inmate’s sadistic behaviour.

Many of the men who come to Grendon have been abused against as well as having abused. Some of them experienced extreme cruelty in their childhood. There are tales of children beaten, degraded and abandoned by one or both parents or by care workers. There are stories of violent incest, of children who were fed their own faeces, whose hands were placed on electric fires or who were required to give sexual pleasure to fathers and mothers. Many helplessly witnessed scenes of violence between parents or became the chosen object of redirected anger. Traumatised by these early experiences as adults they have grown up with little trust in relationships and are resentful and angry at what has happened to them. In some cases they have internalised and identified with the aggressor and have come to despise that part of themselves that they perceive as weak and helpless. There is often a frightening similarity between their own sadistic behaviour and these early experiences.

Zane having been regularly sexually abused by his social worker often talks in his psychodrama group about despising weakness in others. When others shed their tears he physically withdraws, his face-hardens and he has great difficulty in staying in the room. He hates himself for, as he sees it, allowing the abuse, for not doing anything about it. He has hidden his vulnerability behind a facade of extreme cruelty and is serving a sentence for attacking an old woman. "I hated her for being so weak and helpless." Zane hasn’t yet undertaken the important work of seeing how he has projected his despised weaker self onto his victim and attacked it in her. He truthfully says he has no empathy and wishes that he had but he will never do so until he can find empathy for his own vulnerability and helplessness. At present he chooses to distance himself from the little boy who used to sit on the doorstep hungry to be loved and noticed. He blames his emotional neediness for his abuse.

Other inmates when they re-experience rejection and abandonment displace their primitive rage onto their victims. John in the middle of his psychodrama in which he was attempting to understand his rape of an innocent woman broke down in tears saying, " Every time I start thinking about what I did to you I just want to pick up a glass and smash it into my arm... It sounds crazy but I want to rip myself to bits. I hate myself for what I have done to you. The only person I wanted to hurt was my Mum. God knows what was going through my head that night because I don’t... I did worse to you than my mother ever did to me" (Jefferies in Holmes 1991 p.195).

The work of John Bowlby, Mary Ainsworth and Mary Main support and provide a framework for my experience as a Psychodramatist at Grendon. Bowlby’s Attachment Theory states that the kinds of experience a person has in childhood and the kinds of attachments created are crucial to the development of the personality (Bowlby 1979). Research supporting Bowlby’s ideas indicates that many people suffering from anxiety, insecurity or showing signs of dependency, immaturity and low concept have been exposed to pathogenic parenting resulting in much partially unconscious resentment persisting into later life and usually expressed away from parents towards someone weaker (Henderson 1974).

The concept of "Internal working models" derived from Bowlby’s attachment theory is also significant in understanding criminal behaviour. "Internal working models" are mental maps an individual has about himself and his environment, in particular about self and relationship to other. They act as a filter by which the individual makes sense of himself, of other and his world. The quality of the model will be based on two judgements: - whether or not the individual sees himself as worthy of support or care and whether or not important others are seen as people who will give support or care. Attachment theorists argue that it is not the experience alone but what the individual does with their early experience that is significant. Internal working models are dynamic and as such can be can be changed through psychodrama and other psychotherapies.

Roy presented two scenes in the early part of his psychodrama, in the visiting room where his girlfriend boasted of her sexual exploits with men she was seeing and the scene of his offence where the prostitute he had murdered had laughed at his inability to have an erection and terrified him by having an epileptic seizure (he was unaware at the time of the offence that this is what happened). Both scenes held memory traces of his early experiences of a humiliating, rejecting, terrorising mother and his belief or " working model", that women were bitches, they were out to hurt him and therefore could not be trusted". With this internal working model his response was one of anger and violence. "Roy was helped to see how the present situation and his offence held memory traces of past experiences, how his actions were influenced by distorted belief systems and negative feelings associated with early childhood experiences" (Jefferies in Cordess & Cox 1996 p.247). It was important for him to have an opportunity to trace his anger back to its source, to confront his persecutory mother, to speak his anger as well as to cry his tears. He also needed in the session to differentiate between anger at mother from present anger towards self for maintaining patterns developed in the past and transferred onto his victim. Finally in the psychodrama Roy was given an opportunity to address his victim and explore new ways of dealing with the situation with his girlfriend free from the internal persecutory figure of mother.

Expression of aggression for many offenders has been their only form of survival and meaning. To take the offender beyond their manifest aggression to the latent despair about what they have done to others and what has been done to them is a journey to be taken with caution. Guy unable to live with what he had done and what had been done to him made a decision to end his life. His last message written before his death reminded us that no one was to blame or at fault but himself and as such was obsessed by a death wish which he finally turned upon himself becoming the last victim in a line of victims. "My thank you is for your help and for your concerns". Sadly our concern for him did not prevent him from taking his life. His final message made me reflect on Zuletta’s statement when commenting on Bolwby, "Human infants are pre-programmed to develop in a socially co-operative way: whether they do so or not turns to a high degree on how they are treated (Bowlby 1988, p9). In other words the forensic patient does to his objects what was once done to him", (Zuletta in Cordess & Cox 1996, p186). Guy not only destroyed the life of others as his own life had been destroyed but by taking his life he completed the full circle by re-enacting the ultimate abuse.

If we are to reduce crime and protect members of the public it is essential that we go beyond the offence and seek not only to understand the contributing factors that lead to crime but also heal the disruptive internal worlds of those who offend against others. I believe Psychodrama both develops victim empathy and provides a forum for this to happen. It provides a human and constructive approach to the treatment of those convicted of serious crimes. I conclude with a statement from an inmate,

"What we are doing here is defusing bombs. What do you think you are going to get from me if you put me in a cage for eight years and pump me with a stick, what do you think you are going to get? You are going to get me worse than when I came in and the same goes for everybody else, but give me love well I don’t know what to do about that. It’s a serious business, this. ("Actuality" BBC Radio Four, in Holmes 1991, P199)

References:

Bowlby, J (1979) Making & Breaking of Affectional Bonds: London Tavistock

Bowlby, J (1988) Secure Base: Clinical Application of Attachment Theory: London, Tavistock

Cordess, C and Cox, M (1996) Forensic Psychotherapy: London, Jessica Kingsley

Fox J (1987) The Essential Moreno: New York, Springer Press

Henderson, A (1974) Care Eliciting Behaviour in Man: Journal of Nervous and Mental Diseases.159: 172-81

Holmes, P (1991) Psychodrama Inspiration & Technique: London, Routledge

Kernberg, O (1984) Severe Personality Disorder: Psychotherapeutic Strategies: New Haven & London, Yale University Press.

Vaihinger, H (1911) Philosophie des Als Ob. Reutner & Reinhard, Berlin (English Translation: The philosophy of As If.)

Biography:

Jinnie Jefferies is a counselling psychologist and UKCP registered psychodrama psychotherapist. She is presently head of Psychodrama at HMP Grendon Underwood. She has pioneered training in Greece, Ireland and London and has written widely on Psychodrama, in particular its use with treating eating disorders and personality disorders. Over the past decade she has made several television programmes using psychodrama and action methods.