Adam Blatner, M.D.

January 23, 2005

(Click on the question you want answered below and you'll be taken directly to that question.)

1. Drama therapy and psychodrama–commonalities & differences?

2. What is the difference between psychodrama and psychodramatic methods?  

3. Are other terms used for psychodrama?

4. Psychodrama is sometimes called a "cathartic" therapy. What about this?

5. Problems with psychodrama: About "negative reports."

6. Has there been much change in psychodrama since Moreno?

7. Why is psychodrama not more widely recognized?

8. Why do professional psychotherapists resist learning this method?

1. Drama Therapy & Psychodrama: What is the difference?

There are a number of areas in common and also several differences: They both use drama as a vehicle for psychotherapy.
    Psychodramatists generally have no background as theatre artists while drama therapists do.
    Psychodramatists are generally psychotherapists who have gone on to sub-specialize in a particular approach to therapy, just as other therapists sub-specialize as analytical psychologists (or "Jungians"), psychoanalysts, cognitive-behavior therapists, etc. (However, I like to emphasize that in addition to being its own approach–especially for classical psychodrama–many psychodramatic techniques and associated underlying principles can also be integrated with other therapeutic approaches.)
   Drama therapists are generally theatre artists who take extra training in psychology and psychotherapy in order to apply drama in a therapeutic fashion.

   Psychodrama generally works with the protagonist in role as himself, in various situations.
    Drama therapists often work with patients in a more "distanced" role, a role not of the individual in his actual life situation. However, often this is done for patients who aren't ready to work with the more intense context of self-reflection.

    Psychodrama doesn't generally use ritual as much as drama therapists, but in fact there are increasing degrees of cross-over, so that many drama therapy techniques are being integrated into psychodrama; and vice versa.

   (Interestingly, in this respect, Moreno in his early work often used approaches that were more like drama therapy, having patients take roles other than themselves. Some of his "classical" case reports were quite unlike what came to be considered "classical psychodrama" in the last half of the 20th Century.)

2. What is the difference between psychodrama and psychodramatic methods?  

The former term is used in several senses: (1) Classical psychodrama–a (usually) 2-3 hour process in group including a warm-up, action, sharing, and closure phase; (2) a general field deriving from the work of J.L. Moreno that includes classical psychodrama, psychodramatic methods, sociodrama, sociometry, role training, spontaneity training, and the like; and (3) as any action modality that has a significant derivation from Moreno's work, even if it differs in many respects, such as Bibliodrama, psychoanalytic psychodrama (used more in Europe and South America), and some forms that merge with drama therapy.

Psychodramatic methods involve the integration of the techniques and principles of psychodrama in other forms of psychotherapy. While classical psychodrama requires more specialized training by (ideally) accredited trainers of psychodrama, some psychodramatic methods may be utilized without having to undergo specialized training.

3. Are other terms used for psychodrama?

For many people, the term "psychodrama" is threatening for various reasons. The "psycho-" for some people carries a negative association with mental illness, or a deep exploration of emotional depths. The suffix,  "-drama" also implies a more emotionally intense process. Settings that are wary of intensity thus are turned off by this term. Yet schools, businesses, and other settings can make use of the methods when they're called "action methods," "experiential techniques," "role playing," "behavioral simulations," or some similar mixture of words. This is by no means deceitful, because these approaches need not be deeply emotionally evocative.

4. Is psychodrama a cathartic therapy?

While catharsis has been associated with psychodrama, there are many aspects of this method that are not particularly concerned with catharsis per se.
   The processes of warming up and behavioral practice often have little to do with catharsis, except in a broader sense of there being a minor, not-particularly-emotional sense of "aha" or "whew" that goes with the integration of any learning experience. This corrects a talk by Prochaska in which he assigned psychodrama to the action phase of therapy, but not to the pre-contemplation, contemplation, or, following the action phase, homework phase. In fact, psychodramatic methods can be helpful and adapted to all phases of the work.

5. Problems with Psychodrama: Usually people are impressed and pleased with psychodrama, both group members and professionals who observe the method. On occasion, though, I've heard someone report that they either had a terrible experience with the method or they know someone who felt bad about the method. What explains this discrepancy?

Psychodrama, like any method, can be done badly. This is one reason the field tried to build in some quality control by establishing a Board of Certification, just as is done in many specialty areas in the professions. Still, there are many people who use psychodrama who have taken little actual training, and there is no legal way to stop them. It's not a big enough field to lobby for a requirement in licensing. Also, as mentioned, many professionals integrate the methods into their other types of counseling or therapy, and when this is done judiciously, it's usually quite helpful. But it can be done injudiciously, clumsily, or partially.

For example, I've heard a number of people who had negative experiences with "role playing." When these experiences were asked about in greater detail, usually it turns out that the group leader failed to adequately warm up either or both the participants and/or the group as a whole. Under such circumstances, being pressured to perform without being warmed up generates anxiety and is awkward and unpleasant. Some group leaders don't think there's that much to it.

I hear tell of undergraduates who are asked to demonstrate psychodrama in classes on psychology! This would be like asking high school students to demonstrate surgery! It's necessary to recognize that psychodrama–especially classical psychodrama–is in fact as complex as surgery!

6. Has there been much change in psychodrama since Moreno?

Some writers about group therapy or the history of psychotherapy–mainly those whose background is psychoanalytic–tend to be remarkably method-centric, treating non dominant approaches as if they were insignificant. This "marginalization" may be modified by giving a slight acknowledgment. I've seen textbooks that mention psychodrama, but only cite the original books by Moreno, written fifty or more years ago, and giving the impression that there has been little evolution in the field since then. In fact, there have been thousands of articles, chapters in books, and books published, with many new advances in theory and practice.

7. Why is psychodrama not more widely recognized?

It continues to be marginalized for a variety of reasons.
   1. There are increasing numbers of competing forms of psychotherapy, new ones emerging every few years.
   2. There is a continuing demand for "evidence-based" approaches, requiring hard research. Many forms of therapy are not readily amenable to more current requirements of research, while a few other approaches are more amenable–especially those that can be described in a manual. (The problem with such approaches is that they address some common denominators in most psychiatric problems, such as sloppy and self-defeating thought patterns. It is not surprising that tightening up thinking would be shown to be statistically effective in most problems, but that doesn't mean it gets to the roots of the problem!)
    3. Much of the writing in psychodrama–and especially Moreno's own writing– becomes ever more out-of-date in its style and coherence. The demands for clarity have sharpened.
    4. The method was most widely used in hospitals or clinics where patients could stay and work for weeks. Sessions required more time and ideally patients benefitted from a series of experience. Modern practices of short-term hospital stays don't allow for many of the effects of group therapy, much less psychodrama.
    Up into the 1980s, many hospitals prized their psychodrama program, and patients often said that experience was a highlight of what was felt to be most beneficial. But with the introduction of "managed care" (an oxymoron) by insurance companies, hospital treatment has become Spartan indeed, and even the types of psychotherapy allowed have become crisis-oriented.
     Other reasons are addressed in chapter 3 of my book, Foundations of Psychodrama.

8. Why do professional psychotherapists resist learning this method?

It's a little scarey, like learning how to swim–but once you get the knack of it, it's fun! And you can move more efficiently in a different medium. It also takes about as long to learn, and has as many awkward and mildly scarey moments. Then, again like swimming, consider how long it takes to progress from merely knowing how to swim to becoming a swimming instructor, for knowing how to learn different strokes, to dive, and so forth.

The skills involved–improvisational acting, mainly, involve a degree of risk-taking, making inferences, guessing, playing hunches, channeling imagination, and these skills are rarely taught in the course of most people's education.

One must also learn to overcome those moments of awkwardness in the process, to allow embarrassment to be temporary, and to be open and relaxed about this as a natural part of any truly improvisational and exploratory process–and that requires a de-sensitization to a certain kind of self-consciousness.

Fears of insight must be overcome. One must become aware that negative complexes will be discovered, and these need not become occasions for burdensome guilt or shame. One's quirks may be put in the proper perspective, self-forgiveness and forgiveness of others is integrated into the process, and issues worked through. Courage, faith, and trust are exercised–the rewards are rich, but the process harrowing when the trust in others, the trust of oneself, and the trust in the method are still new or unfamiliar.

Finally, the illusion of competence is sorely tested. One becomes a beginner in a new environment, away from the familiarity of conventional education–books and study and "knowing" things–and instead plunged into a realm where working from impulse and intuition is more important. One must re-learn the skill of being a beginner, and allow oneself to be awkward and make mistakes.

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This is just a beginning. Please suggest other questions and your answers. If I use them, and with your permission, I'll append your name to the answers. If you'd like to modify or revise my answers, please let me know. If your critique is cogent and I use it, again I'll mention your name if you like.  Email me at adam@blatner.com  

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