Psychodrama

“It gets people to explore and express feelings they have been totally unable to access,” said Bill Coleman, LMSW, TEP, a psychodramatist at Sierra Tucson’s residential treatment center in Arizona. “It’s the world’s oldest form of group therapy.”

Psychodrama is a form of role-playing during which people in the group act out scenes from one person’s life in order to help them process a painful issue. Each session, which can last two to three hours, begins with a warm-up to get people relaxed and engaged. It also allows the people in the group, who are likely to be strangers, to connect so they can better work together.

“By lowering anxiety, we can increase trust and spontaneity, which allows patients to go very deep in treatment,” said Coleman, who is also the founding director of La Jornada Institute in Arizona, which trains mental health professionals in the art of psychodrama.

“Through psychodrama, which is typically done in conjunction with other forms of psychotherapy, patients can explore their histories and more quickly work to resolve their issues,” Coleman said.

“It makes the insides come alive, whether that’s feelings, facts, behaviors, beliefs, or histories,” he continued. “It makes everything come alive in the moment.”

Psychodrama was introduced by J.L. Moreno, M.D., in Vienna during the early part of the 20th century. He brought the practice to the United States in the 1920s, working around the concept that one’s true self emerges from the roles he or she plays. There are now several hundred psychodramatists around the country.

Each session of psychodrama includes several basic players. According to the American Society of Group Psychotherapy & Psychodrama (ASGPP) website, those players are:

• The protagonist: the person(s) selected to “represent the theme” of the group in the drama.
• The auxiliary egos: group members who assume the roles of significant others in the drama.
• The audience: group members who witness the drama and represent the world at large.
• The stage: the physical space in which the drama is conducted.
• The director: the trained psychodramatist who guides participants through each phase of the session.

Psychodrama sessions are made up of three parts, as listed on the ASGPP website:

1. The warm-up, when the group theme is identified and a protagonist is selected.
2. The action, when the problem is dramatized and the protagonist explores new methods of resolving it.
3. The sharing, when group members are invited to express their connection with the protagonist’s work.

During the action state, the protagonist decides what issue she would like to act out and selects people in the room to play the other parts in the scene. For example, the psychodramatist may ask the protagonist to recall the youngest age she can remember, and then become that age. The protagonist will then reconstruct the scene, complete with any family members and family pets.

Through the act of setting up the scene, the protagonist can more clearly see what was wrong in that picture. The protagonist may step back and watch other people act out the scene instead of participating in it, which allows him to process how he feels about what he’s watching.

During a scene, roles may also be reversed, so that the protagonist may start out playing himself, but may later switch roles — for example, exchanging with the person who played his sister so he can gain a different perspective on the scene.

Doing this forces patients to address their past so they can process it and move forward. “You can’t move ahead if you are cutting out parts of your life,” Coleman said.

Scenes are played out using very few props other than people. The props used in a session of psychodrama depend on the psychodramatist. Coleman just uses chairs and scarves, which can be anything the players want them to be.

“I prefer to let it come out in their imaginations,” he said.

Each person will get a different experience out of psychodrama, though many enter the therapy with the same reservations. “Initially, everybody is scared to death,” Coleman said. “But by the time they leave, they can’t wait to come back.”

Bullied by Classmates

Coleman recounted the story of one patient with a mood disorder who was having trouble being bullied by a female counterpart at work. The patient was a successful businessman, but he was unable to deal with the bullying and became very depressed.

During psychodrama, Coleman had the patient regress to a time when he felt similarly oppressed and discovered that the patient had been bullied by classmates when he was 6 years old but hadn’t told anybody about it. By helping the patient realize the root of his depression and behaviors and address them as the 6-year-old boy, Coleman was able to guide the patient through his issues and help him regain his confidence.

Psychodrama is also very effective for treating drug and alcohol addiction. Coleman often has patients in treatment for substance abuse perform an enactment called “The Relapse Trail,” which takes a patient from the present through the stages of relapse while concurrently creating recovery resources along the trail. He will also have patients engage in dialogue through role-play with their substance of choice.

“In these enactments, the patient can explore their relationship with their addiction,” Coleman said.