By Bill Coleman, LMSW, TEP
Psychodrama at Sierra Tucson has a long history. It has been offered since the opening days in 1983 and long considered one of the most powerful forms of group therapy.
Not easy to describe, psychodrama can be classified as experiential therapy. It is essentially role-playing, where disturbing and inhibiting forces on the inside of an individual are manifested on the outside, in the form of roles. It works with any condition, including addiction, mood disorders, trauma, pain, and eating disorders.
The method was created by J. L. Moreno (1889 – 1974), a Romanian-born physician trained in Vienna, Austria. Moreno was intrigued with ancient Greek theater and the concept of catharsis; yet, he felt it was too rigid and scripted. Over a 10-year period, he combined what he called psychodrama with the fundamental dynamics of spontaneity and creativity. He brought the method to the United States in 1925 and continued to expand and refine the process. Shortly after his death in 1974, a formal regimen of training and certification was instituted by the American Board of Examiners in Psychodrama, Sociometry, and Group Psychotherapy. Full certification as a certified practitioner currently involves 780 hours of training, facilitating a group under supervision for a year, and a five-hour written essay exam, as well as being observed by certified trainers and maintaining a graduate degree in mental health or a related field.
Why It Works
Most therapies work from the top down. First, identify the dysfunction and then use a variety of cognitive, analytic, or symbolic therapies to modify the accompanying behaviors. These approaches are well established and thoroughly researched, and Sierra Tucson residents engage in many of them with considerable success.
Psychodrama, as practiced at Sierra Tucson, works from the bottom up. It incorporates current neuroscience discoveries and seeks to drill down to the most fundamental developmental structures that are driving the dysfunctional states, even into adulthood. All children, when victimized by intolerable stress, will create psychological defenses designed to explain and protect. Such defenses will be created from the child’s world and thus, seem irrational to an adult. Nonetheless, they are some of earliest neural pathways formed in the child’s nervous system. Also, the child’s brain (again, when subjected to intolerable stress), converts itself from being a learning system to becoming a survival system. The resultant fear-driven and shame-based neural pathways (roles) are carried through regardless of age and they remain irrational. Psychodrama seeks to ameliorate these fundamental primitive conditions by treating them as unwanted neural pathways and building new ones. This is done by presenting the unwanted pathways as roles, extracted from the mind and placed in an empty chair. From there, they can be interviewed and the resident begins to develop autonomy over the role.
How It Works
In a group setting, an individual sits in a chair – separated from the other group members – and is asked to become the very thing he or she wants to change. This is initially confusing, but with a series of simple questions from the Director, the person quickly assumes the role. An example of such questions might be:
Director: “Please tell us what you are.”
Resident: “I am Alicia’s shame.”
Director: “Are you a big thing in her life?”
Director: “Did you get up with her this morning?”
Resident: “I’m always there.”
Director: “Did you go to breakfast with her?”
The interview progresses from there, with questions about what you, Alicia’s shame, do for her, how long you have been around, how you came into existence, etc. It is important to note that the interview is not designed to explore the resident’s past traumas, but rather, the outcome of his or her trauma (in this case, shame).
The Director then asks the group if they would like to ask Alicia’s shame a question. This serves to draw the group into the process. Finally, at the end of this section of the psychodrama, the resident selects a group member to sit in the “shame” chair. The Director re-interviews “shame,” having the group member repeat what was originally said by the resident.
But that is not enough. The resident must begin to create new neural pathways experientially. The resident, as herself (in this case, Alicia), moves through three positions or empty chairs, which resemble the Procashka Stages of Change. The objective is for the resident to complete three different statements that represent neural pathways. These statements are: (1) “I am not willing to give up my shame because ____________”; (2) “I might be willing to give up my shame if I ___________”; and (3) “I am now completely willing to give up my shame because ________________.” The resident asks group members to sit in these chairs, in the role of the resident herself, and repeat what was said while the resident listens.
There is a very critical end-piece. All the chairs are removed with the exception of the shame chair still occupied by a group member playing that role. The resident is asked to identify actual people in her life who truly “get it” and can be helpful in overcoming her shame (i.e., sponsor, therapist, family member, friend, Higher Power, etc.). These people, chosen from the group, form a line in front of the resident, blocking shame. The resident is asked to stand behind each group member and give a supportive statement, which the group member then repeats.
Finally, holding hands, the group forms a circle around the resident and repeats their unique statements while rotating the circle. The resident is asked if she wants shame inside her circle. The final action is to have the group “group hug” the resident.
As mentioned above, simply describing this process in a narrative may not make it easier to understand and cannot communicate the extraordinary power of the psychodrama experience. Of course, this is true in all therapies.
A Healing Place
There is no one single therapy that resolves life-long difficulties, which is why Sierra Tucson is centered on the idea of integration. Truth be told, we don’t know exactly what combination of therapies are going to work for any one individual. We are, however, confident that, when given a little willingness, our residents will find their own pathways to health and wholeness. Or, put in recovery terms, a place in which they are happy, joyous and free.*
*Alcoholics Anonymous (“The Big Book”), p. 133