The Issue of Psychodrama for Therapy - Case Study Example

Psychology Issues and Topics of Psychodrama From the previous case study we have seen that music therapy has proved a blessing to the septuagenarian patients. But there are other significant psychological therapies, which can cure them from their dysfunctional state of mind. Psychodrama is what I would like to focus in my second case study. It is interesting to see how dramatic sessions can have a therapeutic use. So my area of concentration is psychological uses of drama. It will assist me in effective follow up of my group in first case study. Psychodrama, the brainchild of Jacob L. Moreno (1889-1974), has a significant role as group therapy. (Rifkin, 2010, p.400) This concept was developed in 1920’s by Moreno in Vienna. “The therapist invites a client to role-play some aspect of the client’s problem, and the therapist uses psychodramatic techniques to draw the client out”. (Blatner, 2007, p.1) Through dramatic action psychodrama tries to explore various problems, issues and concerns of human life. It focuses on a set of people that is its action is directed on organizations, groups and systems. Psychodrama entails a group work method, which facilitates human development. Through psychodrama one can portray multiple roles. It includes several aspects and elements of theater; the dramatic actions uses a lot of props and when it is played on the stage it keeps the audience hooked to it. In the group work method of psychodrama an individual member of the group becomes a therapeutic agent for another individual. People suffering from various psychologically harmful diseases like dementia, Alzheimer’s disease, amnesia, depression and temporary loss of memory are subjected to this unique group work method. Active participation (because the participants are the patients themselves) in the dramatic action sorts out the psychological issues that seem to bother their life. On stage they try to explore their internal conflicts by acting out emotions and feelings. Psychodrama involves a lot of interpersonal interactions. The protagonist is shown to interact with other actors and director, also known as the leader. The techniques applied on psychodrama are doubling along with soliloquy, mirrors, role reversals and sociometry. “Psychodrama is an active form of group psychotherapy, where an individual’s life situations are presented on stage with support from group members” (Djuric, 2006, p.9) In short psychological nuance is the prime focus of psychodrama. Psychologically affected individuals have a dysfunctional mindset; psychodrama aims to restructure the mindset and encourage them to face challenges for finding solutions to some of the situations in their life. From the perspective of humanistic psychology there are three approaches, namely a) psychodrama, b) drama therapy, and c) theater games. It has an advantage over the other two approaches. It combines the “flexibility of theater games” and “all the group quality (what Moreno called ‘tele’) of drama therapy”. (Rowan, n.d.) Jacob Levi Moreno’s psychodrama “employs guided dramatic action to examine problems or issues raised by an individual (psychodrama) or a group (sociodrama)”. His model comprises of basic elements like a) the Protagonist (who represents the group theme to be dramatized), b) the Auxiliary Egos (members who take on significant roles in the context of protagonist’s problem), c) the Audience (they are members of the group who play the role of spectator and represent the outer world), d) the Stage (the physical space where the drama gets enacted), and e) the Director (he or she is the trained psychodramatist who provides guidance to the participating members throughout the different phases of the session). Psychodrama targets the behavioral level and ensures personal growth and emotional health of an individual. It also enhances learning skill and acquirement of new skill set. The therapist takes “a life situation which is loaded with feelings” (Rowan, n.d.) for the protagonist as well as the auxiliary ego and the audience. The protagonist “who presents in front of the group a situation from his life” can be a patient, an educator or a layman keen to share his thoughts and emotions. The protagonist becomes the hero of human drama since this character is the “initiator of action”. (Djuric, 2006, p.13) The Auxiliary Ego is a significant person in the life of the protagonist. This group can comprise of family members or friends or someone we know on a personal or a professional level; they “portray the protagonist’s social atom”. (Djuric, 2006, p.14) Although this group acts as per the instructions of the protagonist, they are free to raise questions and share their thoughts and emotions. In some cases an auxiliary member takes on the role of a psychodrama protagonist; this is called the technique of ‘double’ in psychodrama. When an auxiliary opposes the protagonist he or she is called an antagonist. The Group Audience also plays a crucial role in psychodrama; they are not mere spectators unlike designated audience of a theater. They “enact diverse roles assigned to them by the protagonist and the director” (Djuric, 2006, p.13) In fact their understanding and sensing of the dramatic situation “contributes to the resolution of the protagonist’s conflicts”. But it’s a two-way traffic since they also realize their “repressed or unrecognized thoughts and feelings”. (Djuric, 2006, p.13) The group audience of psychodrama can be likened to Chorus of Greek dramas as in the plays of Sophocles and Euripedes. But group audience of psychodrama is “far more active than any theatrical audience who are watching and listening”. (Djuric, 2006, p.13) The Director is the conductor of entire dramatic action. He or she ensures “a spontaneous and creative progression of dramatic action” (Djuric, 2006, p.13) and “guides the protagonist towards the resolution of his problem”. (Djuric, 2006, p.14) He encourages the protagonist to recreate scenes from his or her life and help him or her to reach mental catharsis at the end of the action. So the director is also the therapist. Usually two directors guide psychodrama. (Termed as ‘co-therapeutic couple’) (Djuric, 2006, p.14) In general the director has three major functions- that of a producer, a counselor and an analyst. We cannot ignore the role of Stage in the process of conflict resolution. The stage of psychodramatic action can comprise of a crude setup of a classroom, a lounge or an outdoor area. There should be chairs for the members to sit and share their thoughts. Chairs, tables, bed, wardrobe, and piano serve as the props of the drama. But Moreno’s designed stage was “reminiscent of a wedding cake, each of its levels having a clearly defined purpose; one for daily life scenes, one for fantasy situations, and one where passions reigned” (Djuric, 2006, p.15) The essential elements of psychodrama are speech and body language. “There is no script” since scenes are emulated from personal life and “enacted the way he or she has experienced them”. (Djuric, 2006, p.9) Human relationships are explored and the protagonist gets the chance to realize “the thoughts and emotions that inhibit him, and also the new patterns of behavior” (Djuric, 2006, p.9) that might help him to freely express him or her. Through inhibiting thoughts and unspoken words psychodrama aims to deal with situations, which could have happened in the life of the protagonist (in real life the actor had never encountered such a situation). The actor is taken to a new world of perception about the past and the present. He or she can explore ‘”extraordinary dimension of reality” (Djuric, 2006, p.9) because “everything is possible in psychodrama: to play God, to talk to a deceased person, to ask for a divorce, to steal, to love the one we otherwise are not allowed to, to pour it all out to the boss”. (Djuric, 2006, p.9) We are “unable in our real life to give free rein to our imagination, in psychodrama we can do that”. (Djuric, 2006, p.13) Our “hidden roles, untried possibilities, suppressed energies are given a chance on the stage to arise and revel themselves to the full” (Djuric, 2006, p.13) Psychodrama is undoubtedly cathartic. There is an initial problem, which the protagonist faces. He comes to confrontation and interaction with significant others in his life (actually the other participating members as already discussed). They share, they contradict, and they sympathize with the protagonist’s work or problem: an attempt to connect with the issue is the primary aim. The end result of it is that the protagonist experiences a catharsis; his or her disturbed state of mind is brought to rest by sharing and counseling action of the director or the psychodramatist. In short there is an emotional release. Psychodrama also leads to group catharsis, which is achieved in the phase of sharing. In Greek drama the audience is purged out of his emotions when he witnesses the enactment of the drama. But ‘sharing’ in psychodrama “is meant to capture the learning process and allow the group members to purge themselves of emotions or insights gained”. (Karp, 1998, p. 9) The therapeutic effect of psychodrama is beneficial because the patients can “work out their fears and conflicts”. (Djuric, 2006, p.10) They can also have a new perception about relationship with other human beings. Studies have found out that “insight, catharsis and interpersonal relations are therapeutic factors central to psychodramatic group psychotherapy”. (Karp, 1998, p.11) The group for psychodrama can be formed on the basis of age and on similar situations. The aged patients suffer from a similar distress situation due to diseases like memory loss, Alzheimer’s and dementia. The group that I have chosen comprise of five septuagenarian women plagued with psychological issues as a consequence of their disease. In the process of psychodrama group therapy they will be subjected to three distinct phases of it, namely a) the warm-up (selection of group theme and protagonist is done here), b) the action (the theme or problem is dramatized and protagonist seeks solution), and c) the sharing (other members in the group are invited to participate in the work of the protagonist and express their connections with the theme dramatized by the protagonist). One of the women will be selected as the protagonist to play out his or her role (or problem) in the warm up session. Advantage of group discussion in this session is to urge the group to get into quick action. Hence warm up session is a catalyst to the dramatic action. Through a process of behavioral simulation the problem or inner conflict is sorted out. It acts as a channel for releasing their pent up emotions as a result of their malfunctioning mind. Diseases and Psychology Issues Mental diseases like dementia, short-term memory lapse, Alzheimer’s, amnesia and depression affects the psychology of men and women. In the process they become vulnerable to various psychological disorders and what results is a dysfunctional mindset that fails to obey reason and logic. All these mental disorders have overlapping signs and symptoms; yet there are some intrinsic differences that identify them as unique clinical conditions. The psychological issue that connects all these diseases is disorientation or disorganization of mind. Depression is one of the psychologically debilitating diseases, which in medical terms is defined as “a condition of intractable low mood and dispirited attitude that is associated with sluggish use of brain (as in retardation of thought) and body (in particular, poor appetite, constipation, loss of weight, lack of libido, and a reversal of the diurnal rhythm of sleep and energy patterns)”. (Farmer, 1998, p.231) Depression is a leading psychiatric illness in adult population because of several contributing factors like lifestyle, personality, genetic disposition, personal relationship and precipitating events. When a person is depressed the “joy of living is replaced by hopelessness, abject despair and suicidal intimations”. (Farmer, 1998, p.231) There is a sense of futility, which affects such people. They become irritated and short-tempered. Some cases of depressions show certain clinical conditions like headache and nausea. The physical well-being and social behavior gets affected because depression changes one’s though process and their basic feelings and emotions. Psychodrama can help one come out of depression because it analyzes the past and present mental condition and relationship of an individual. What usually happens is scenes oscillate “between present and past to provide a narrative report of the development of deep conflicts” (Farmer, 1998, p.239) residing in the mind of the protagonist. Such a dramatic action helps the protagonist to “find new roles to replace redundant ones, re-edit previous life narratives and create a fourth area of new possibilities for the future”. (Farmer, 1998, p.232) The protagonist adjusts and repairs his or her relationship with the ‘social atom’ discussed before. Basically there are two types of depression, namely I) Psychological Depression and II) Existential Depression. The first one results when an individual gets strongly affected by failures and disappointments. The second one results from the collapse of comforting life-illusions. Alzheimer’s disease is a common mental disease affecting the senior citizens. Clinically, it is a kind of brain degeneration resulting from the formation of abnormal particles (neurofibrially tangles and neuritic plaques) in the brain that kills healthy brain cells or neurons. (North Western University) It affects the working of the brain and hence it brings radical changes in thinking power, memory and overall behavior of the person. The response faculty of an Alzheimer patient gets disorganized. The affected person suffers from a prolonged bout of memory loss; its aggravated condition can be fatal. People fail to recognize family members or remember the name of a person. They also find trouble in doing daily activities like reading, writing, speaking, combing and brushing their teeth. (Medline Plus, n.d.) Such people tend to have a misperception of their surrounding. Psychiatrist and psychologists often resort to group psychotherapy to cure a patient out of this disease. Studies have shown that this disease appears in three stages. In the first stage the memory is affected. People develop problem in communication and doing daily activities in the second stage and the third or final stage worsens the condition of such patients. Physical decline onsets and patients find difficulty in feeding and walking. (The CopperRidge Institute, n.d., p.1) Another disease that affects well-being of an individual is amnesia, which results in partial or complete memory loss. People suffering from this disease have a tendency to forget about the past events of their life. They cannot even recall recent happenings in worst cases. They find utmost difficulty in picking up new information. Usually physical injury or trauma or accidental ingestion of toxic substance can affect the working of the brain. Sometimes brain tumors and seizures can result in amnesia. In a similar fashion short-term memory loss affects the mental health of an individual. In the initial stages a person starts forgetting small things but gradually fails to concentrate or retain any new information. It affects the social life of a person too because one suffers from memory loss in midst of an action, an event or a conversation. Dementia has its roots in memory loss. But it has a graver significance that short-term memory loss and amnesia because it affects the personality and behavioral aspect of the individual. Memory loss can be of a short or a long duration. Such individuals become easily irritated and furious in nature. There is disorientation in thought process. Dementia means ‘deprived of mind’ as it refers to chronic decline in mental abilities. Psychodramatic Sessions and Its Effect on the Patients We are all aware of the cases of the septuagenarian patients. Music therapy sessions had shown its good result as it rejuvenated mind, body and soul of the individuals. The soothing sound of the music made them more focused. It created an independent space for them. It also boosted up their confidence. So, I experimented with two sessions of psychodrama on them. Their emotional problems were set to rest with role-playing and group dynamics. The sessions clarified all their doubts and registered their physical and emotional health. I wanted my group to avail the benefit of psychotherapy; so what I initially did was to convince them for a self-presentation on the stage of psychodrama. Willingness for the dramatic action has to be brought out amongst the group. From the case history of the group of patients it is clear that post-traumatic stress, eating disorder, family stress and change in lifestyle have resulted in the illness. My aim is to identify the root cause of the mental illness and see whether it can be cured with psychodrama. The counseling sessions, which I intend to undertake, is with the goal to bring the five women patients back into the mode of normal life. Effort will be towards alteration of the thought process of these individuals. But before we move into the counseling sessions it would be better to refresh our mind with the clinical mental disorders of the five septuagenarian women (or patients). Samantha Wayne, the 79-year-old lady is affected with one of the serious mental disorders called Alzheimer’s disease. Her family comprises of a daughter, who is a widow school teacher. She has become extremely dependant on the daughter and the nurse who attends her. Samantha has lost appetite, which has taken toll on her physical health. Polly Cromwell, the 75-year-old lady is suffering from amnesia and she is in the stage of ‘Retrogade Amnesia’. This makes her forgetful even of the recent events of her life. The 78-year-old lady, Michelle Burke is a victim of short-term memory loss. She is a professor of English in the University of Colorado. After her voluntary retirement she has been residing with her eldest son, who owns a grocery store. Lucy Dawson aged 76 years is suffering from dementia, which has affected her intellectual process. She has a hallucinating mind; this gradually resulted in quick loss of behavioral control in her. After her husband’s death she is in the custody of sons. In their absence a nurse attends Lucy Dawson. The 77-year-old Amanda Wilson is a patient of depression. Her depression is a case of psychological depression, since it was precipitated by loss of eyesight and her inability to perform daily chores with ease. After the traumatic accident she has confined to the four walls of the room. Her family is facing problems because she has developed a habit of skipping meals and has stopped socializing with others. Her unwilling dependence on others makes her irritated soon. I will be the director or leader of the group for my psychodrama. My intention is to resolve the inner conflicts of the protagonist. For the first of my counseling session I choose Amanda Wilson as the protagonist because her chances for overcoming the odds of depression is quite high. The emotional anxiety of the depressed person can hardly be shared by other person, which leaves the patient’s family members in a state of trouble. When her family members approached me for counseling I thought she would rightly fit in the scheme of pscyhodrama I asked Amanda to be the initiator of action in the drama. I guided her in enacting a piece out of her life. She would be emulating the scene of accident, which led to loss of eyesight. She is perturbed by the thought that she is a burden on others for her blindness. The other members of the psychodrama group formed her social atom comprising her loved ones and society friends. The intervention or dramatic technique that I intend to use in the first session of psychodrama is role reversal. For which I asked Michelle, the protagonist’s auxiliary ego, to play the role of a blind person. This technique is called ‘double’ in psychodrama terminology. Such a role reversal will make Amanda view blindness from a different perspective. She will see that Michelle’s behavior is opposite to her behavior. This will make her undergo catharsis that blindness in not the end of everything. It all depends on a person’s strong will to tide over crisis times, rather than plunge into the depths of depression and nurture negative tendencies and thoughts. I found that my first session with Amanda as the protagonist proved a blessing for her. She learnt to take blindness in her stride and got rid of her psychological depression. She once again became a highly sociable person and started taking regular food in the coming days. One thing I noticed in the due course of the dramatic action that when the auxiliary ego and the group audience shared their thoughts on the protagonist’s main problem, she was already in the process of achieving mental catharsis. During warm-up of my second psychodramatic session I selected Michelle Burke as the protagonist and place her against Polly Cromwell as the antagonist. Their situations are similar to certain extent. Polly, a Retrogade Amnesia patient finds difficulty in learning new things alike Michelle who finds it problematic to remember new things. Michelle is burdened by the plight of lack of concentration; she feels that her forgetful nature has made her the dumbest person. Polly feels that her state is more confusing because she cannot recollect any past events or pick up new skills in her present life. As an antagonist she can oppose the statements of the protagonist. The protagonist may or may not accept what the antagonist says. If Michelle finds Polly’s statement to match with her emotion she will repeat her words; otherwise would sternly say that she is wrong. Drama has the power to rivet the attention of the participants and the audience. Unlike the normal theater here the audience is an active participant instrumental in transforming the initiation of action to the level of catharsis. The audiences of the two counseling sessions have been instrumental in bringing a radical psychological change in the protagonist. But unfortunately, Samantha Wayne could not respond much to the psychodramatic sessions because she was Alzheimer’s has led her to a totally disoriented frame of mind. My goal has been realized with effect to some of the group members. Actually it is a time consuming affair. In fact few other counseling sessions might prove beneficial for those suffering from acute psychological condition. Psychodrama is a sociometric experiment. The rules of sociometry have been realized because each of the participants has identified with the theme of the protagonist as their thoughts. They have provided an opportunity to the protagonist to become an active agent in the reconciliation of her troubled life situation. In fact my psychodrama has effectively explored the concept of group psychotherapy. They have mutually co-coordinated with each other and have tried to be a therapeutic agent for one another. Conclusion In a nutshell “psychodrama means literally action of the mind, and it brings out the internal drama, so that the drama within becomes the drama outside oneself”. (Karp, 1998, p.4) When J.L. Moreno founded psychodrama in the early part of 1900 in Vienna he made a famous statement about psychodrama; it is defined as “a scientific exploration of truth through dramatic method”. (Karp, 1998, p.3) Since the stage or living space pf psychodrama allows a person to do anything they wish, Moreno has aptly phrased psychodrama as ‘the aesthetic demonstration of freedom’ (Casson, 1998, p. 73) Psychodrama is an art that “includes the recognition of a person’s private and metaphorical language and the use of multiple perspectives to elicit the subjective experiences of the protagonist, the director and the group members” (British Psychodrama Association, n.d.) Psychodrama and its techniques have been absorbed into the domain of several other contemporary systems like family therapy, behavior therapy, and gestalt therapy. It has made significant contributions “to our thinking about creativity, spontaneity, social psychology, play imagination, catharsis, self-expression, experimental learning, and the power of actions as a way of deepening insight and feeling”. (Blatner, 2007, p.1-2) We can conclude that psychodrama offers psychological cure to the disturbed mental state of an individual. It’s an effective psychological medicine that addresses all the specified mental illness referred in this analysis. Psychology, we all know is a scientific study that focuses on mental process and behavior. It explores the depths of the mind to find out remedies for many psychological or mental disorders. The approaches are wide-ranged but psychodrama has made a mark for itself in the field of humanistic approach towards psychology. References 1. ASGPP “Psychodrama” n.d. Available at http://www.asgpp.org/pdrama1.htm (accessed on January 1, 2010) 2. “Alzheimer’s Disease” (n.d.) Medline Plus, Available at http://www.nlm.nih.gov/medlineplus/alzheimersdisease.html#cat4 (Accessed on 4th January, 2010) 3. “Alzheimer’s Disease” (n.d.) North Western University: Feinberg School of Medicine. Available at http://www.brain.northwestern.edu/mdad/ad.html (Accessed on 5th January, 2010­) 4. Blatner, A. (2007) “Psychodrama”. Available at http://academic.cengage.com/resource_uploads/downloads/0495097144_80596.doc (Accessed on 4th January, 2010) 5. Casson, J. (1998) “The Stage: the Theater of Psychodrama” In Karp, M. & Holmes, P, & Tauvon, K.B. (3-15). The Handbook of Psychodrama. New York: Routledge 6. Djuric, Z. & Veljkovic, J. & Tomic, M. (2006) Psychodrama: A Beginner’s Guide. Philadelphia: Jessica Kingsley Publishers 7. Farmer, C (1998) “The Psychodramatic Treatment of Depression”’ In Karp, M. & Holmes, P, & Tauvon, K.B. (231-247). The Handbook of Psychodrama. New York: Routledge 8. Karp, M. (1998) “An Introduction to Psychodrama” In Karp, M. & Holmes, P, & Tauvon, K.B. (3-15). The Handbook of Psychodrama. New York: Routledge 9. Park, J. (1999). “Being Depressed in Spirit: Deeper than Psychological Depression”. Opening to Grace: Transcending our Spiritual Malaise, Existential books 10. Rabins, P.V. (n.d.) “Caregiving and Psychological Issues”. Alzcast.org. Available at http://www.alzcast.org/pdf/transcript_rabin.pdf (Accessed on 5th January, 2010) 11. Rifkin, J. (2010) Empathic Civilization, New York: Polity. 12. Rowan, J. (n.d.) “Drama Approaches” A Guide to Humanistic Psychology. Available at http://www.ahpweb.org/rowan_bibliography/chapter10.html (Accessed on 5th January, 2010) 13. “What is Psychodrama?” (n.d.) British Psychodrama Association, Available at http://www.psychodrama.org.uk/what_is_psychodrama.php (Accessed on 4th January, 2010) Read More