PSYCHODRAMA ACTIVITY GUIDELINES

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NOTE: Psychodrama is typically done with the supervision of a license therapies. A nurse role is to
facilitate, organize, supervise and create an outlet for patients to allow the process of healing to occur.

Definition:

Psychodrama is a therapeutic art form in which counselors encourage clients to use their bodies as
mediums for unearthing personal truths and healing from traumatic experiences instead of traditional
verbal participation (Fong, 2007). Psychodrama is, in one way, unique from other therapies; although it
utilizes verbal communication, it is not overly dependent on such modes of treatment. Rather, speaking
through body movement is primary. By physically re-enacting experiences, the past is brought into the
here-and now, allowing the client to process the memories with the counselor’s guidance and, perhaps,
the participation of group members with similar traumas (Kipper, 1998).

Psychodrama therapy is a creative therapeutic approach developed by Jacob Levy Moreno, who also
coined the phrases, "group therapy" and "group psychotherapy." Psychodrama therapy may be used
with individuals or groups. In this type of therapy, therapists use guided drama and role-playing to work
through problems. With psychodrama therapy, the goal is to bring new insight, resolve issues, and
practice new life skills and behaviors. Psychodrama therapy can be a good complement to cognitive
behavioral therapy (CBT) or a good alternative to other therapies

Jacob Levy Moreno 1889-1974: Father of Psychodrama

Uses:

 In group setting
 can be used on a one-to-one basis
 works especially well for people who are victims of trauma or who struggle with substance
abuse or alcoholism.

Benefits Of Psychodrama

Psychodrama can be a very powerful therapy because it allows the participants in the group to
experience thoughts, feelings, and emotions in an active, real-time environment. This type of therapy
can help them improve their relationships and communication skills.

Participants in psychodrama will learn how to improve their communication skills to improve their
current situations and relationships. Members of the group will also learn how to overcome grief and
loss while restoring their confidence and well-being. A therapeutic group setting provides a safe,
supportive environment for participants to express their feelings and emotions. In addition to enhancing
their learning and life skills, members of the group will have a chance to experiment with new ways of
thinking, acting, and responding.

The Role Of Families In Psychodrama Therapy

Family members don't usually participate in psychodrama therapy, but they play an important role in
support. Clients develop a greater sense of self-awareness and perspective, which helps them to
reconnect with family members they've hurt. Psychodrama therapy teaches people how to express their
needs healthily and fosters emotional, spiritual, and psychological growth.

Conditions That Are Suited For Psychodrama Therapy

1. Psychodrama Therapy For People Dealing With Traumatic Experiences

2. Psychodrama Therapy For People Dealing With Addiction
3. Individuals experiencing difficulty with relationships, social and emotional function, trauma
or unresolved loss or addiction might find psychodrama a helpful approach.
4. Those who are diagnosed with mood, personality, or eating disorders and are challenged
by identity issues and/or negative self-image, as this technique may provide those in
treatment with a safe space and format to communicate pain and challenges faced.

Objectives:

 Psychotherapy aims to help individuals and groups gain insight into emotionally distressing
situations, practice emotional release and help to establish healthier patterns of behavior.

What Happens In Psychodrama Therapy?

During a psychodrama therapy appointment, participants in the group are asked to reenact specific
scenes or past experiences, as the therapist guides them. The therapist uses deep action methods and
asks the group to identify issues for the group to explore - other therapeutic methods to help the group
learn how to correct issues.

The scenes that they act out maybe along the lines of past situations, dreams, or preparation for a
future event. The therapist begins by guiding the group through some warm-up exercises. When they're
ready to begin the main exercise, the therapist chooses a protagonist that will represent the main
elements or problems of the group. The others in the group enhance the scene by playing the roles of
significant others or the audience. Their role is to offer support, bring out underlying beliefs, and bring
issues to the surface.

After the scene has been played out, it gives all participants the chance to recognize and express feelings
that they weren't able to express during a previous time of trauma or distress. At this time the group
discusses what their true emotions and responses would have been if they'd been able to express them
at the time.

For example, if a small child was a victim of abuse or neglect, his or her young body was incapable of
processing feelings of fear, anxiety, stress, and trauma. Such children feared that they wouldn't have
food to eat, a bed to sleep in and that they wouldn't be safe. They lacked the closeness and nurturing
that they're entitled to from loving parents. The child may have been frozen in fear and too afraid to
scream or cry. Fear turned into disassociation rendering the child unable to express any emotion.

As the child grew, the unresolved feelings of the trauma harbored in the child's body and exploded in
aggressive behavior when the child reached the age of puberty.

After the warm-up exercises, the child victim who is now an adult would re-enact the scene when they
were too little and too frozen to express their emotions. When the scene is over, all participants have
the opportunity to discuss and process the feelings and emotions the child victim would have
experienced if there were able to at the time.

The group would then do the scene again with alternate endings. The overall process would empower
the client or clients to correct the scene in some way so that it ended better.

Psychodrama therapists use the following techniques to guide the group.

Psychodrama therapists use the following techniques to guide the group.

1. Mirror-a person in the group acts as a stand-in for the protagonist so he or she can see the
situation from a more objective, outside perspective. It provides a better chance for the person
to see themselves as others do.
2. Double-a person speaks for another person in the group using a supportive tone. This is helpful
when the person isn't able or willing to speak for themselves.
3. Role reversal-participants get to reenact the scene multiple times, playing various roles each
time so that they can experience the situation in a fresh, new way.
4. Future projection-many of the scenes are around issues and experiences than the participants
have already lived through. A future projection scene is one that a participant will soon
experience or will experience in the future. This approach gives participants the chance to
demonstrate how they will act when the situation occurs.
5. Playback Theater-the group spontaneously acts out one person's particular life story or life
experience. The therapist allows the drama to unfold in unpredictable ways. This process allows
the group to understand that situations may be different, but they still have patterns. The
previous experiences we've had have created us into the individuals that we are. Current
problems and issues often stem from things that happened during childhood.

TECHNIQUES USED IN PSYCHODRAMA

A session is typically executed in three phases: the warm-up phase, the action phase, and the
sharing phase. Through role and drama-based play, the protagonist and other participants develop
insight into past issues, present challenges, and future possibilities.
The goal of the warm-up phase is to help establish trust, group cohesion, and a sense of safety among
members. Without trust, group members may not feel comfortable performing action methods or
exploring raised issues or conflicts. One technique often used in warm-up is role presentation, where
members of the group adopt a certain role in order to introduce themselves. Because in psychodrama,
members of the group often act out roles in other members' lives, this technique can help provide
insight to those in the group. As the members get to know one another, one member may volunteer to
act as the psychodrama protagonist, or the main focus of the psychodrama.

In the action phase, the protagonist—with the therapist's help—creates a scene based on significant
events in the protagonist’s current life. The therapist directs the session, while other group members
serve as auxiliary egos, or individuals from the protagonist's life. The rest of the group members act as
an audience.

The following techniques are most commonly used as part of the action phase:
 Role reversal: The protagonist steps out of their own role and enacts the role of a
significant person in their life. This action can help the protagonist understand the
other person's role and help the director (therapist) better understand relationship
dynamics. Doing so may also help increase the protagonist's empathy.
 Mirroring: The protagonist becomes an observer while auxiliary egos take up the
part of the protagonist, acting out an event so the protagonist can watch. This
technique can be helpful when a protagonist is experiencing extremely negative
feelings or is feeling separated or distanced from feelings or emotions about the
scene.
 Doubling: A group member adopts the protagonist's behavior and
movements, expressing aloud any emotions or thoughts that member believes to be
the protagonist's feelings and thoughts. This technique can be used to build
empathy for the protagonist or to challenge, in a constructive and non-aggressive
way, some aspect of the scene or the protagonist's actions.
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 Soliloquy: The protagonist relates inner thoughts and feelings to the audience. This
may be done when speaking to a double, or at the encouragement of the director
(therapist).
During the sharing phase, the director shifts back to a therapist role in order to facilitate the processing
of the scene. Processing the meaning of the feelings and emotions that have come to light is believed to
be essential for transformation to occur. The sharing phase provides time for a group discussion about
the events that took place in the action phase. The audience might consider, among other topics, how
their thoughts or observations could have an impact on the protagonist’s ways of interacting or relating
with others?

CONCERNS AND LIMITATIONS

Professionals who offer the psychodrama approach typically report the effectiveness of the
practice based on anecdotal experiences of working with groups and experiencing the
transformations. However, there is little empirical research to date supporting the impact of
psychodrama. Over the past decade there has been a shift to provide more empirical research
demonstrating the effectiveness of psychodrama in motivating change in the participants’ lives.
Current research in psychodrama focuses on the impact of group trust and safety and the
effectiveness of the sharing phase.
Because psychodrama places heavy emphasis on trust and safety, counselors generally prescreen
and prepare group members for the psychodrama process. The purpose of prescreening is
important to psychodrama and any form of group psychotherapy because it ensures the group
members are open to working on sensitive issues. If a person is determined to be not ready for a
psychodrama method, the therapist is ethically bound to refer this person for individual therapy.
Selecting individuals who would be a good fit in a group together may become a time-
consuming process for the counselor.

The experiential component of psychodrama can require a lengthy warm-up phase in order for
group members to develop enough trust in each other to be comfortable spontaneously acting out
aspects of their lives, particularly their concerns and challenges. Counselors are typically required
to use specialized skills simultaneously in order to facilitate the trust-building process and
transition into guiding the dramatic scene.

Confidentiality can also be a concern in psychodrama. Whenever a group format is utilized, it is

vital for the counselor to discuss confidentiality with the group members and work to ensure the
psychodrama events are kept within the group. In the beginning of the group psychodrama
experience, each group member will sign a contract of confidentiality. However, there are
currently no legal implications if a group member breaks confidentiality. If a group member does
divulge group information, typically the counselor will hold a group meeting to democratically
decide whether to keep that person in the group or refer them out to another program or
therapist. Any threat to confidentiality can impact trust and safety among the group, which can
further hinder the effectiveness of the psychodrama for those involved.

Implementation:

1. Determine who would benefit from the sessions.

2) Develop a topic that will trigger residents involvement either verbally, physically or nonverbal or
physical interaction

3) These will vary according to your condition but may refer to past trauma, future events that you are
worried about or situations that fill you with apprehension and worry. If this is done as part of a group
then others can fill the roles of key people in your past or future, enabling you to bring to the surface
any worries buried deep within your subconscious.

4. Prepare a short script and assign roles.

5. Make a video of your psychodrama.

Evaluation:
1. Document in your resident participation records for each resident their level of participation.
2. Note if there was a change in participation.

References:

1. American society of group therapy and psychodrama. (2014). Retrieved from

http://www.asgpp.org/asgpp-education.php
2. Bellofatto, M., & Kirsner, N. (2013). Eating disorders; The iaedp symposium 2012
reveals real life benefits for psychodrama experience. Mental Health Weekly Digest.
3. Carbonell, D., & Parteleno-Barehmi, C. (1999). Psychodrama groups for girls coping
with trauma. International Journal of Group Psychotherapy, 49(3).
4. Certified practitioner standards. (2013). Retrieved from
http://www.psychodramacertification.org/docs/CPStandards.pdf
 5. Chimera, C., & Baim, C. (2010, August 29). Introduction to psychodrama. Workshop
presented at IASA Conference, Cambridge. Retrieved from
http://www.iasa-dmm.org/images/uploads/Chip Chimera and Clark Baim Workshop on
Psychodrama.pdf
6. Chung, S. F. (2013). A review of psychodrama and group process. International Journal
of Social Work and Human Services Practice, 1(2), 105-114.
7. Karp, M., Holmes, P., & Tauvon, K. B. (Eds.). (2005). The Handbook of Psychodrama.
Taylor & Francis.
8. Kellermann, P. F. (1987). Outcome research in classical psychodrama. Small Group
Research, 18(4), 459-469.
9. Kipper, D. A., & Ritchie, T. D. (2003). The effectiveness of psychodramatic techniques:
A meta-analysis. Group Dynamics: Theory, Research, and Practice, 7(1), 13.
10. Photo Directory of Psychodramatists. (2003, June 2). Retrieved from
http://www.blatner.com/adam/pdirec/hist/hist72.htm
11. Propper, H. (n.d.). A concise introduction to psychodrama, sociodrama, and
sociometry. Retrieved from http://www.asgpp.org/pdf/psychodrama.conciseintro.pdf
12. What is psychodrama? (n.d.). Retrieved from
http://www.psychodrama.org.uk/what_is_psychodrama.php

Prepared by:

FESANMIE D. AMARILLO, RN, MAN