Using the Gestalt Technique of Psychodrama in the Treatment of Patients with Relational Issues

Gestalt therapy, developed out of Gestalt psychology and philosophy by Fritz Perls, is an experiential form of psychotherapy with the main goal of bringing the client’s unresolved issues from the past into the here-and-now, or the present moment. The main idea behind Gestalt therapy is that it is impossible to resolve issues by simply talking about them. The therapist must help the client to bring the issue into the present through various experiential techniques in order to fully work through and let go of the issue. Harman (1974) defines the basic goal of Gestalt therapy to help the client develop healthy, holistic functioning, fully accept his present self, and gain coping mechanisms (p. 178). Psychodrama, a type of therapy using re-enactment techniques to bring relationships and issues into the present moment, is one Gestalt therapy that has been widely proven to be effective in clients with unresolved issues including childhood memories, abuse, early childhood trauma, or relational issues.

Definition of Psychodrama

Psychodrama is a form of experiential therapy developed by Jacob Levi Moreno in the late 1930s and early 1940s (Blatner, 2000, p. 12). Moreno (1948) explained the term he created as “the science which explores ‘truth’ by dramatic methods” (p. 902). Moreno uses quotation marks around the word “truth” because reality is subjective, and psychodrama allows patients to explore their own version of truth in various situations. Through enacting past traumas, relationships, and personal situations in a play-acting approach, psychodrama follows Gestalt founder Fritz Perls’ basic tenant of the therapeutic value of bringing the unconscious into the conscious. Psychodrama re-enacts problematic personal situation to “help a patient get in touch with and express feelings she may not have realized that she had” (Corsini & Wedding, 1973, p. 20). The therapist uses a variety of experiential techniques to help the patient become aware of his or her thoughts and emotions regarding the situation, express him or herself, and discover coping tools to help resolve feelings about the event. These techniques include attempt to create a tangible experience of the client’s inner thoughts and feelings in verbal and nonverbal ways. Greenberg et al. (1998) explain two main tools, concretization and enactment. “Concretization covers the use of expressive arts materials, visualization, projective objects, and personification of abstract qualities. Enactment includes role playing of parts of self, significant others, and various living beings such as dogs or cats” (p. 329).

Roles in Psychodrama

The Stage

In individual therapy, the work is done strictly between the therapist and patient. Even in some family or group therapy, focus is on one member at a time. In psychodrama, therapeutic work is done not only with the patient experiencing the issue but also with the other players in the psychodrama. The enactment is set on a “stage” which provides a safe space for the patient to explore the issue being explored. “The living space of reality is often narrow and restraining, he may easily lose his equilibrium. On stage, he may find it again due to its methodology of freedom from stress and freedom for experience and expression. The stage is an extension of life beyond the reality of life itself” (Moreno, 1948, p. 902). The stage creates a space in which the patient is buffered from the realities of the situation as it exists in real life. If the patient is confronting an abuser, there is no danger of being hurt. If the patient is practicing self-expression, there are no immediate negative responses to deal with. Essentially, the stage is the safe therapeutic space just as the therapist’s presence is the therapeutic space of individual therapy sessions.

The Players

The patient who is bringing the issue to the psychodrama enactment is also referred to as the protagonist. The protagonist describes the scene to the rest of the group including an overview of the situation, his or her feelings and thoughts, and the other people who will be represented in the psychodrama. The protagonist traditionally plays him or herself within the enactment, but “a protagonist may reverse roles, playing the role of the other person with whom there is an encounter; play the hidden and unexpressed feelings; leave the scene and become a kind of co-director; and in other ways shift positions in order to further the investigation” (Blatner, 2000, p. 3).

The protagonist chooses other group members to play the other people in the psychodrama. “Protagonists often experience situations more vividly and interact more spontaneously if they can interact directly with other people, who may take the parts of others in the scene being enacted, or even the parts of themselves, such as the inner unexpressed feelings” (Blatner, 2000, p. 4). Additionally, as the psychodrama experience can be emotionally difficult for the protagonist, Baim et al. (2007) recommend using a “body double” to take the place of the protagonist if there is a risk of re-traumatization in the psychodrama.

The protagonist may choose these auxiliary players because they resemble the person or part being represent or based on projection. For instance, a protagonist may choose another group member who he or she views as nurturing and caring to perform the role of a mother. Interestingly, the auxiliary may experience the psychodrama as intensely as the protagonist or even more so. A group member may end up playing a role which triggers his or her own past or inner turmoil. Through the scene and the discussion time afterwards, the auxiliary members may potentially process some meaningful issues and insights.

The director of the psychodrama is a facilitator who is trained to lead psychodramas. This is usually the therapist or group leader. The role of the director is to provide prompts to keep the psychodrama going, elicit expression from the protagonist, and manage the scene so as to not create re-traumatization or harm to any other group members. The role of the director is complex and requires great competency.

The Audience

The group members who are not playing a role in the psychodrama are important to the experience as well. The audience members often relate to the enactment from a situation in their own lives. Even if they cannot directly relate, “it may still evoke some powerful emotions. This is because, in a broader sense, all humans share the ongoing process of separation and re-integration, being lost in some way and then found” (Blatner, 2000, p. 116). All people experience the experience of the struggles inherent in the human condition and can thus relate to most scenes in a vicarious way.

Additionally, the audience performs an important function in witnessing the psychodrama. The players in the scene often have emotional experiences related to their roles and therefore cannot provide objective feedback to the protagonist in regards to the situation. Audience members, having a layer of removal from the scene, can provide insight into the relational patterns being displayed in the psychodrama. Audience members are able to share their experiences in similar situations and offer suggestions on coping tools or methods of expression. Additionally, these feedback sessions create an on-going, self-reflective group dynamic which creates coherence within the group (Blatner, 2000, p. 197).

A Psychodrama Session

Greenberg et al. (1998) explain the three main goals of a psychodrama. Before the psychodrama begins, roles must be established and interpersonal connections made among group members. During the psychodrama, structural enactment is performed to promote regression in the protagonist and access dissociated material. Lastly, traumatic scenes are enacted so that the protagonist can “consciously re-experience dissociated material and developmentally repair the trauma” (p. 330-331).

Before the scene begins, the group engages in a warm-up activity which focuses the group’s attention on a certain theme or situation. The protagonist is selected during this time and the stage is set for the action. The first scene of the psychodrama brings the problem into the here-and-now, and subsequent scenes, guided by the director’s clinical judgment, allow the trauma or situation to be worked through. “The action portion ends with one last, post-catharsis scene that brings closure. The application of this directional strategy must proceed with extreme caution lest the treatment cause re-traumatization” (Baim et al., 2007, p. 47). This final scene is crucial as it allows the developmental repair to conclude and helps the protagonist apply the psychodrama to his or her current life. It is also important for the auxiliary members to de-role. A member might say to the protagonist, “I am not your mother, I am Jane.” In this way, the protagonist is less likely to carry lingering projections, and the auxiliary member is able to let go of the emotional experience of playing this person.

Applications of Psychodrama

Psychodrama entails a variety of methods used to work with different aspects of a patient’s psyche. Most typically, psychodrama is conducted to replay and reprocess a scene from a patient’s past. A common scene is one in which, when the situation actually occurred, the patient did not have the ability to stand up for him- or herself such as in a domestic abuse relationship, a childhood scenario, or an attack situation. Because Gestalt therapy believes that it is not the event itself but the way the patient holds onto the event that is creating problems, the other person or people from the initial scenario do not need to be present. Blatner (2000) reminds that “psychodrama is meant to be a corrective approach” (p. 2), and re-enacting the situation with a different result can be cathartic and healing.

Psychodrama can also be used in role training or rehearsal scenarios (Blatner, 2000, p. 9). If a patient wants to request a pay raise at work, psychodrama can be used for the patient to practice being assertive and explaining why he or she deserves the raise. Additionally, if a patient struggles with emotional expression, self-control, or problem solving, a scenario can be staged in order for the patient to practice these.

Another effective use of psychodrama is to allow a patient to explore an important dilemma or decision. For instance, if a woman is trying to decide whether to move to a different state to be with her boyfriend or remain in her home town to pursue a promising career, the stage can be set for her to act out and explore both options. By having a virtual experience of each side of her decision, the woman can gain insight into the pros and cons of both side.

Psychodrama is sometimes used to explore dreams. In the warm-up, the protagonist explains a dream and chooses auxiliary members to play the roles of people, animals, or objects in the dream. The players re-enact the dream as told by the protagonist, and through this experience, the protagonist often gains insight into the hidden meanings of the dream.

Lastly, psychodrama can be used in family therapy. In family sessions, emotions can run high, and sometimes family members have a difficult time hearing and understanding each other’s thoughts and feelings. Psychodrama in a family therapy setting can create a safe therapeutic space for family members who often do not express themselves to find a voice and explain their feelings to the rest of the family. Psychodrama can also be used to help family members practice communication and develop appropriate coping tools to use in escalated situations outside of the therapy room.

Specific Interventions

Greenberg et al. (1998) explain three specific interventions which are modifications of classic psychodrama interventions: the containing double, concretizing the observing ego, and the holder of dissociation (p. 336-337).

Sometimes, a group member will take on the role of the containing double in order to serve as an inner voice of the protagonist. This containing double provides support for the protagonist in emotionally difficult psychodramas through affirming statements, emotional or physical support, and reminders of safety in the present moment.

If the protagonist is starting to regress into an unhealthy emotional state, he or she can be asked to move into an observing ego role. Here, the protagonist answers questions from the director about what he or she sees occurring in the scene. This allows the protagonist to stay present while observing the pull to dissociate into past trauma. This technique keeps cognitive functioning stable and prevents re-traumatization.

The holder of dissociation is a group member who plays the role of dissociation. This person reminds the protagonist that he or she does not need to dissociate, because the other group member is playing that role. The holder of dissociation reminds the protagonist that he or she can tolerate what is occurring in the psychodrama since all dissociation and emotional pain is being held by this member. This auxiliary member is one of the most important ones to have de-role and process after the psychodrama in order to keep him or her from holding onto vicarious trauma from the protagonist.

Blatner (2000) also explains the mirror technique in which “the flow of action is interrupted, just like a director in a movie may call ‘cut’ and draw the main player to the side to watch the scene being re-played by someone else who takes the main player’s role” (p. 2). With this technique, the protagonist is able to observe the scenario from the outside and possible gain insight into others in the situation as represented by auxiliary members.

Results

Gestalt therapy in general and psychodrama in specific, being highly experiential in nature, often produce significant emotional discharge. In a study of 60 patients in a psychodrama study, Kellerman (1987) found that most patients report having marked improvements in cognitive insight and emotional catharsis (p. 408). Psychodrama has been found to be particularly healing with patients with a history of severe trauma and sexual abuse. “Experiential psychotherapy targets interventions directly at the somatic, perceptual, cognitive, affective, adaptive, and behavioral processes that are of a critical nature in healing” (Greenberg et al., 1998, p. 328). Many patients’ self-reports substantiate the effectiveness of experiential psychodrama.

Conclusion

Psychodrama, being one of the most utilized and effective Gestalt experiential therapies, combines a variety of techniques in order to set a stage and re-enact situations, dreams, and possibilities in order to provide insight, catharsis, and healing for a patient struggling with past trauma, relationship issues, decision making, or unresolved emotional pain. As it grows as a therapeutic technique, psychodrama finds ways to help more and more patients with a wide variety of presenting problems.

References

Baim, C., Burmeister, J., & Maciel, M. (2007). Psychodrama: Advances in theory and practice. London: Routledge.

Blatner, A. (2000). Foundations of psychodrama history, drama, and practice. (4th ed.). New York: Springer Publishing Company.

Corsini, R. J., & Wedding, D. (1973). Current psychotherapies. Itasca, IL: F.E. Peacock Publishers.

Greenberg, L., Watson, J., Lietaer, G., & Hudgins, K. (1998). Experiential psychodrama with sexual trauma. Handbook of experiential psychotherapy (pp. 328-348). New York: Guilford Press.

Harman, R. L. (1974). Goals of Gestalt Therapy. Professional Psychology, 5(2), 178-184.

Kellermann, P. F. (1987). Psychodrama participants' perception of therapeutic factors. Small Group Research, 18(3), 408-419.

Moreno, J. L. (1948). Psychodrama and group psychotherapy. Annals of the New York Academy of Sciences, 49(6), 902-903.