PSYCHODRAMA IN INDIVIDUAL THERAPY: PSYCHODRAMA A DEUX Dale Richard Buchanan and Antonina Garcia

Jacob Levy Moreno began experimenting with using a rudimentary form of psychodrama in individual treatment in 1914.  Since then there has been considerable development in the use of psychodrama a deux. Listed below are a few tips for using action and experiential methods in one to one therapy.  An excellent resource is Stein, M.B. & Callahan, M.L. (1982). The use of psychodrama in individual therapy. Journal of Group Psychotherapy,Psychodrama and Sociometry, 35, 118-129.

WARM-UP, ACTION & CLOSURE Each individual session will have a warm-up, action and a closure segment.  During the warm-up, the client (re)gains, rapport with the therapist, discusses what issues will be the focus of the session, and readies him/herself for action.  The action phase is the actual psychodramatic portion. The closure is the time succeeding the action when the client de-roles and cools down from the role playing. Occasionally, the therapist shares from his own life experience to assist the client in normalizing, in reducing isolation, or in presenting new possibilities for further thought and integration.  If you choose to share with the client, remember that the sharing is directed toward the client's therapeusis.

Sometimes directors and clients are skittish about moving into psychodrama in individual therapy.  Here are some ways to gently warm yourself and the client up to action.

1) As the client is talking to you, shift your seat to the client's double position, explaining to the client that you want to be sure you understand fully what she means and feels.  Once in the position, note that you'll be speaking as the client and that if what you say is correct the client is to repeat it; if incorrect, to change it.

2) As the client discusses a significant person in his life, ask him to imagine the person sitting in an empty chair in your office.  Ask the client to describe the person in detail so that you can have a sense of him/her.  Then ask the client to step over into the seat so that you can ask a couple of questions, again to better understand what the person is like.  You can ask the client to choose a scarf or prop to symbolize the role.

3) When a client is recounting a story vividly and is saying first what she said and then what the other person said, ask her to shift her body position when she shifts roles.

4) If you have used artwork with a client, ask him to hold the work and speak from one of the elements of
the drawing.  You can interview him as the drawing.

5) When a client is uncertain about the future, ask her to imagine that there is an imaginary clock face on the floor, each of whose numbers represents a month in the future.  Let's say it's currently April.  Ask the person to stand at 3 (months from April), and tell you what's happening to her in July.

6) Time line: When a client begins to describe a long chain of events, ask him to stand and begin at a spot on the floor and walk forward (or around the perimeter of the space) and stop at specific, important times and tell you what happened on that date.  You can use objects in the room, scarves, or labeled pieces of paper to mark off the times.  When the exercise is complete ask the client to stand back and see if he can see any patterns; what sense he makes of all the events when considered from this perspective; or if any specific time is more crucial than the others. This may also be done at the beginning of treatment when taking a history from a client.

7) If a client remarks about or is drawn to an object in your office, ask her to reverse roles with the object and interview her in the role of the object.

8) When working with a client whose spontaneity or creativity are blocked, concretize the Canon of Creativity, marking out areas on your floor for Creativity, Spontaneity, the Conserve and the Warming Up Process.  Ask the client to walk the Canon focusing on the issue (conserve) in relation to their spontaneity or creativity or where they are in the warming up process.

SOCIAL ATOM Make the social atom a regular and routine part of the one-to-one experience.  Remember the therapy maxim, "Treat the individual as a group and the group as an individual."




Think systemic.  Assess, intervene and evaluate within the client's social network.  Other useful tools are the Food Atom, Addictions Atom, Future Atom.

HERE AND NOW Most of the session should be focused on the here and now.  Remember that all enactment takes place in the here and now.  Remember that scenes from the past, when enacted, take place in the "present" of that time; e.g., a client re-enacts an event that occurred when he was 22.  In the scene, he is 22; not his current age of 40. 

SET UP THE SCENE As in a group psychodrama enactment, you will want the client to identify the time and place of the scene.  You will also want the client to describe the other (e.g., three characteristics of the other) before proceeding with the action.  You may also want to interview the client in the role of the other to gain more information.  This is contra-indicated if the client is very angry at the other or if the other is a perpetrator.  Take your time and do a thorough and complete warm-up.  Use empty chairs for the characters so that the client can do the role reversals and sit in the other person's chair.  Two or three characters are plenty.

SUPPORT AND ENCOURAGEMENT Where abuse and/or trauma form the base of the client's issues, the majority of the action phase of the session should be conducted with others who support and encourage the client. Create and bring the positive other (someone who is in the protagonist's corner) into the room prior to bringing in the negative actor.  Create a balance, so that the positive energy is at least as potent as the negative energy.  Sometimes it is necessary to have more than one positive figure available.  Also it is helpful to ask the client to define some area of the room as a safe, time-out space, where she can go if the action seems overwhelming at any point.  She might use pillows, scarves or props to define the area.

COACHING Clients can frequently derive much help from interacting with wise and caring figures.  These can be intrapsychic roles like one's own inner guide, inner counselor, inner friend, one's future self.  The coach can be a supportive figure from the client's past and present: best friend; loving grandparent; caring youth group leader.  Coaches can also be transpersonal guides whom the client has never met, such as a fantasy or historical figure.  An all-purpose figure that embodies many energies is very useful: the Goddess, god, Buddha.  Archetypal energies can also be useful, but each has its own limitations (e.g., the Lover will always say the solution is to love, while the Warrior will always tell you the solution is to fight).

DOUBLE Start and end the action phase with doubling the client.  Doubling is one of the most important and client satisfying actions to take in any one to one session.  Use a variety of doubling techniques (e.g., cognitive, containing, expressive, etc.) The deepening double is especially useful with timid clients, those who have difficulty accurately labeling feelings, and with those who have difficulty tapping into the depth of feeling.  With the deepening double the client becomes her own double.  To utilize the deepening double, do the following: After the client makes a statement to her significant other in the empty chair, place another empty chair behind the client in her own double position.  Ask her to sit in the chair and make another statement on the same subject to the significant other.  Then place another chair behind the double chair. Ask the client to sit in that chair and speak from this deeper place inside herself.  If necessary, place still another chair in the double position behind the other ones and reverse the client into that seat to make a statement.  You can put pillows, stuffed toys or scarves in the empty chairs to hold the spot for the client.  After the client has said all she needs to say from the deepest double spot, move her gradually forward to the outer self, first making another statement from each double position and ending with a statement from her outer self to the significant other.  Another wonderful aspect of this technique is that you can double for the client in each of the double positions, providing support and encouragement for expression.  For example if Bob is speaking to his wife about an affair she just concluded, he may say, "That really irritates me," from his outer position. From his first double position, he may say, "How could you do this to me, you bitch?"  From his second double position, he may say, "I feel so betrayed.  I feel so helpless."  From his third position, he may say, "I'm heartbroken.  How can we ever repair this?" Doubling is especially useful if a client is overtly angry at the therapist.  Simply evacuate your seat and move to the client's double position.  Assist the client in fully expressing whatever he feels.  In this way, the client feels supported and is often able to unravel the transference that may be at the base of his feelings.  (Certainly, if the therapist has made an error that deserves an apology, e.g., double booking a client, it is important to acknowledge the error and make a sincere apology.  Obviously, this is not simply the client's transference operating, although that may indeed be in the mix).

ROLE REVERSAL Role reversal is the sine qua non of psychodramatic intervention techniques, and it is used differently in individual therapy sessions.  The director rarely, if ever, assumes the role of the other.  The director can repeat a last line of the other, but it is wise to do so either from your chair or from behind the chair of the other, and not sitting in that chair.  You can speak from the client's role when the client is in the role of the other, either from the double position, or from the client's seat. Playing the role of the other can lead to negative transference and premature termination from therapy.  Role reversal can be used effectively with a client when a client asks you for advice.  Reverse roles with the client and have him answer his own question.

FUTURE PROJECTION Psychodrama provides the wonderful option of time travel since everything takes place in the present in psychodrama.  A scene from 1956 happens in the "now' of 1956 and a scene from 2010 takes place in the now of 2010.  When clients feel their present problems are unresolveable, it is helpful to place them into some future time when their problem has been solved.  This works well also when the client is holding a grudge and wants to move toward forgiveness of the wrong.  Place him into some future time when he has forgiven the wrong.  Ask him what steps he took to move toward forgiveness.  One can also ask the solution-focused therapy "miracle question:" "If some miracle happened and your life were as you wished (or your problem solved), what would it look like?"  Place the client into that future of life as desired, interview them, and ask them what they did to get there.  Continue with dialogues mentioned above, role reversing the present and future selves.

HUMANIZE RATHER THAN DEMONIZE The ultimate goal in therapy is for the client to experience everyone in the universe humanely.  The key is compassion for self and others.  Psychodramatists believe that people do the best they can at the time of action.  Hampered spontaneity and creativity create inadequate judgment, inflexibility, and inadequate action.

CHANGE AGENT The goal of psychodramatic therapy is to help the individual change how he/she is in the world and in so doing, change the world.  Challenge the client to make the world a "bigger" place by thinking outside him/herself and incorporate the thoughts and feelings of others.  One of the exciting areas of opportunity in psychodrama is in the realm of atonement.  Sometimes we have regrets, though at the time we acted as best we could.  Psychodrama provides us with the opportunity to re-enact a past situation and practice how to better complete it, so that we can go forth in our lives and make the necessary amends. It also provides us with the opportunity to re-enact the past with people who are no longer available (through death, for example) and finish unfinished business that would otherwise have no outlet.

ADVICE GIVING The desire to give advice is often a signal of counter-transference.  When the urge to give advice hits, breathe, refrain and say nothing.  After the session, process your desire to give advice. 

HOMEWORK Make behavioral homework assignments a regular and routine part of the session.  The obvious purpose is to re-enforce empowerment outside the session and integrate and further the work of the session in the client's general life experience.  Our most difficult job is to help the client chunk down here and now goals that are RUMBA (realistic, utilitarian, measurable, behavioral and achievable).  Unattained goals may result in shame, hopelessness and premature termination from therapy.

ADAPT A VARIETY OF GROUP TECHNIQUES TO INDIVIDUAL WORK
There are many sociometric and psychodramatic intervention tools that can be adapted to psychodama a deux: spectrograms, behind-the-back, high chair, metaphors, myths, magic shop, trial scenes, dream re-enactment, locograms, etc.

DIAMOND OF OPPOSITES The Diamond of Opposites was created by Linnea Carlson Sabelli and Hector Sabelli.
The method moves from linear sociometry (A chooses B) to a multidimensional sociometry (A chooses and rejects B).  The method allows for the illumination of both positive and negative feelings that individuals have about a person, situation or thing.  It also illuminates the degree to which a person experiences those feelings.  It is very useful for exploring ambivalence, for example, the degree of positive feelings towards dating (or a particular person) and the degree of negative feelings towards dating (or a particular person).  The model postulates that conflict comes from having equal and high tensions between positive and negative forces. Let's say that Mary wants to get a new job, but she fears leaving her old job because her position is secure and familiar. If she has a 90% desire to leave and a 10% desire to stay, she will leave.  However, if Mary has a 100% desire to leave and a 100% desire to stay, there will be high tension and no resolution.  The director's job is to help her increase or decrease the tension on one end of the diamond so that she is released from the ambivalence and can move toward choice.  We have also noticed that sometimes people feel conflicted and tell themselves they feel equally about two options, but when they concretize their ambivalence on the Diamond of Opposites, they realize that in fact they feel, say, 60% that they do want to do something and 40% that they don't.  When working with the Diamond, an additional question we like to ask clients who seem constitutionally ambivalent, is, "Whose voice is speaking the message from Pole A and whose voice is speaking the message from Pole B?"  Frequently it is the voice of each of the client's parents.

DIFFERENTIAL DIRECTION John Raven Mosher and Brigid Yukman have written on the need for differential directing styles, and they have identified four primary styles: caring leader, emotional stimulator, director, and meaning attributor.  When clients are dealing with abandonment and telling stories of lovelessness, the director needs to be caring (e.g., protective, genuine, encouraging, providing unrequested unconditional acceptance for being, etc.).  When the client is dealing with issues of betrayal and stories of joylessness, the director needs to be an emotional stimulator (e.g., charismatic, playful, intimate, creative and emotionally available and transparent).  When the client is disempowered and telling stories of disempowerment, the director needs to be challenging (e.g., setting limits, norms and direction, challenging current behavior, asking the client for answers, etc.).  When the client is in chaos and telling stories of meaningless, the director needs to provide structure (e.g., interpreting reality, naming, normalizing and identifying emotional states and experiences, teaching cognitive techniques, providing a framework for change, identifying experiences).

EVALUATION From time to time with some regularity it is helpful to ask your clients to evaluate you as a therapist and take stock of their own progress. Encourage positive and negative expressions.  This helps to keep the process on track.  It helps the client and therapist to look at the work, see what goals have been accomplished and which ones haven't so that objectives can be revised if appropriate and new plans can be made. 


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