Amy Schaffer, Ph.D

 (One of the presentations on the panel moderated by Adam Blatner (on this topic)
at the 2010 annual conference of the American Society of Group Psychotherapy & Psychodrama)

See main introduction to this panel.  (which also describes the qualifications of the author)
Presented as part of a panel (moderated by Adam Blatner) on this topic at the ASGPP Annual Meeting in Philadelphia, April 17, 2010: Posted on Adam’s website 4/22/10.

Here is a story about Dan, who is terrified to get on a plane and decides he needs help. In scenario one, he goes to a psychopharmacologist, gets a prescription, takes an ativan, and sleeps through his flight. In scenario two, he goes to a behavior therapist and through a process of systematic desensitization, exposure and relaxation training is able to lower his anxiety on planes. In scenario three, he goes to a cognitive behavioral therapist and learns to identify and diminish his catastrophic thinking so that he can fly with less distress.

This is in sharp contrast to what he will meet if he seeks either psychoanalytic or psychodramatic treatment. In each of these modalities he may start by looking at what it feels like to be on a plane. Attention may then move to relationships in his life, present and past, to his early experiences, his dreams and fantasies. It may then emerge that he expects the pilot to be as unreliable as his alcoholic father, the stewardess to deny incipient problems, the way his mother ignored his father’s alcoholism, and his fellow passengers to steal the parachute he has hidden in his carry-on, the way his siblings hampered his efforts to free himself from the family. No wonder he hates to fly.

This exploration may help Dan in ways he did not foresee when he decided to tackle his fear of flying. He may, for example, recognize that his difficulties at work stem from his poorly veiled contempt for the boss, with whom he adopts the role he played with his alcoholic father. He may begin to take note of his aggressive behavior toward fellow-workers, motivated by the expectation that they will stab him in the back unless he stabs them first. And he may recognize that in an attempt not to be his uninvolved father he has become too controlling of his son. Thus in both psychoanalytic and psychodramatic treatment, Dan will emerge with enhanced self-understanding, improved relationships, and “working through” of issues arising from his difficult childhood environment.

Now I am not here to disparage methods which provide symptom relief. In fact Dan may benefit from two forms of treatment–one for rapid symptom relief and one for deeper exploration and more profound change. Rather, my point is simply that psychodrama and psychoanalysis both offer this deeper exploration. In contrast with many other forms of psychotherapy, they share important commonalities in the way they view human beings, in their goals, in their depth, in their complexity. Thus, although psychodrama and psychoanalysis rely on entirely different interventions, they are much more similar than is immediately apparent.

I believe that the time is ripe for affiliation rather than the animosity which for too long characterized the relationship---in this country, at least---between these modalities.  Why collaborate? Part of the answer lies in the way these two professions are beset by a common enemy: Both face a mental health environment dominated by insurance companies which rake in enormous profits by maintaining a laughably reductionistic view of what human beings need to achieve emotional well-being. (The enemy of my enemy is my friend.) But another answer lies in changes in the two fields which make them more compatible.

Let me start with advances in psychoanalysis which make it more compatible with psychodrama. Moreno was brilliant in his early identification of phenomena only belatedly recognized by psychoanalysts–but they are now catching up. Most of the schools of contemporary psychoanalysis have shifted in ways which have brought them closer to psychodramatic thought. Psychoanalysts, especially relational psychoanalysts, now display:
   1) An increased recognition of and interest in the social underpinnings of human behavior including a view of the self as derived from relationship
   2) A change from viewing the analyst as an authority with the answers to a co-creator who works more democratically with those she is treating
   3) A greater awareness of the importance of non-verbal behavior and a recognition that aspects of therapy other than insight are healing
   4) A wider acceptance of departures from standard technique
   5) Modification of the concept of transference to include not only of elements from the past but also a recognition of actual qualities of the therapist. (In other words, the concept of transference has moved closer to that of tele.)
   6) Increased focus on topics such as spontaneity and emotional expressivity.

Meanwhile, psychodrama has also advanced in ways which make it more compatible with psychoanalysis. First, psychodramatists now accept that there is transference to the psychodrama director. For years the psychodrama literature reported that since transferences were displaced onto group members, transferences to psychodrama directors were a rarity. When I wrote a paper on this topic in 1995, that was the accepted view. But, judging by recent writings, contemporary psychodramatists are more likely to recognize that psychodrama directors do indeed evoke transference. Second, psychodrama has increasingly been applied in ways which depart from classical psychodrama technique and which involve integrations of concepts from other theories. Gershoni (2003), for example, devotes a whole section of his book, Psychodrama in the 21st Century to the fusion of psychodrama with other methods. Combining psychodrama with psychoanalysis is no longer a stretch.

What would a collaboration between psychoanalysis and psychodrama look like? Psychodrama and psychoanalysis each encompass both a defining technique and a theory. The least radical way of combining these approaches, the approach on which I’ll focus here, would involve no alternation of technique, but simply a borrowing of ideas to create a blend of theories. An example can be found in Paul Holmes’ book The Inner World Outside, which uses psychoanalytic theory to provide a conceptual base to the psychodramatist.

I believe learning can go in both directions. That is, psychodramatists can learn conceptually from psychoanalysts and vice versa. Regarding the vice versa, I think, for example, that psychoanalysts could benefit from an understanding of Moreno’s concepts of warm-up and surplus reality. And they are only beginning to catch up to psychodramatists in their understanding of the value of spontaneity in clinical work. But here I will emphasize in particular the way psychoanalytic concepts can be helpful to the psychodramatist. I do this both because I am speaking at a  conference of psychodramatists, and also because in comparison with psychodrama, psychoanalysis has a much more completely articulated theory with a truly enormous, at times overwhelmingly enormous, vocabulary of concepts. Now some of psychoanalytic conceptualization is outmoded, based on 19th century science, and some of it is irrelevant to the psychodramatic endeavor. Nevertheless, I believe that psychodramatists can benefit by supplementing their Moreno with psychodynamic theory. My own history has convinced me of this.

At the time I began psychoanalytic training I had been practicing psychodrama for close to 20 years.What were my reactions to embarking on psychoanalytic training? First, I was surprised at how compatible I found psychodrama and psychoanalysis. The anti-psychoanalytic culture in which I had been immersed so far had misinformed me about psychoanalysis. Second, and most relevant here, was a frequent thought, “So that’s what I have been doing.” That is, as I mastered the psychoanalytic vocabulary, I recognized that intuitively and spontaneously my psychodramatic work had incorporated many psychoanalytic concepts. Learning psychoanalytic theory provided some tools for thinking about my psychodramatic work in a new and fruitful way.

Let me raise two problems which may interfere when psychodramatists try to make use of psychoanalytic theory. The first stems from the fact that Freud and the early Freudians used language and metaphors which can be off-putting to contemporary sensibilities. As part of the psychoanalytic cultural conserve, this language has persisted despite the evolution of psychoanalytic ideas. (In fact the psychoanalytic literature contains some interesting descriptions of the way innovative psychoanalysts managed to make their new ideas acceptable to the conservative mainstream by cloaking new concepts in old vocabulary!)  I believe that psychodramatists studying psychoanalysis are likely to experience psychoanalytic language as mechanistic and pathologizing if not outright dehumanizing. It may comfort them to know that over the years I have heard many psychoanalysts, highly eminent ones at times, make the same point. More than once I have heard someone at a psychoanalytic conference exclaim, “For heaven’s sake, could we stop using the word ‘object’ when we mean person.” Hasn’t happened yet. So the psychodramatist seeking to learn psychodynamic theory faces the challenge of recognizing that humane, psychodrama-friendly ideas may be couched in words they find disagreeable.

A second hurdle faced by the inquisitive psychodramatist may be an assumption that  developing a theoretical formulation will somehow interfere with spontaneity and human relatedness. Not so. Doing therapy of any sort is both a science and an art. Developing a greater conceptual repertoire is for the therapist what practicing scales is for the musician or working on his swing, for the golfer. It allows one to build up a muscles and reflexes which are automatically available at one’s most creative, spontaneous moments. I call this “informed spontaneity.”

In the interest of fostering “informed spontaneity” I will now turn to some psychoanalytic concepts of countertransference. Time constraints force me to present these at a breakneck speed here. But I hope that even a brief overview of these ideas will demonstrate first, their utility and second how truly compatible they are with role theory.

 Psychodramatists are trained to scrutinize which of their own issues and roles are activated in any treatment situation. They routinely ask themselves the question, “Who are you in my drama?” And this is a very important question, necessary if we are to keep our own conflicts and histories from derailing our work. The psychoanalytic concepts I would like to introduce here all revolve around a second, a supplementary, question: “What is my feeling state telling me about the hidden (unconscious) aspects of your drama?” The idea here is that the therapist’s role responsiveness (a psychoanalytic concept!) means that her countertransference contains information not only about her own drama but about her patient’s drama as well.  Heinrich Racker posits that the therapist’s feelings may echo those of an early relationship. For example, in what he names a concordant identification, the therapist might feel what the protagonist felt as an infant toward someone important in his early life—say his mother. Thus a psychodrama director’s strong emotional reaction to a group member’s sporadic attendance might echo the group member’s young feelings towards his abandoning mother.

In contrast, in what Racker terms a complementary identification, the therapist’s feelings might be a clue to the mother’s feelings towards that group member during childhood. For example, if a psychodrama director finds herself wishing to lean on one group member to make the coffee, move the chairs, etc., she might wonder if she is identified with the group member’s needy mother, a mother who parentified  her child. Racker also described the indirect counter-transference, meaning the feelings present in the therapist which stem from relationships with others. An example, might be the feeling of urgency to change the patient (get her to ditch her crazy husband and get a new job—all in two months) so as to impress your referral source.

Here’s another view of what the therapist’s emotional state might be telling us. In this view, stemming from Melanie Klein’s ideas, countertransference is seen as an aspect of projective identification, in which the patient disavows unbearable experiences which are projected onto and may be picked up by others. An example: A psychodrama director might find herself feeling helpless and inadequate when interacting with a protagonist who seems to have it all together, because the protagonist protects himself at all costs from ever experiencing his own helplessness and inadequacy.

I’m going to move on now, because I want to end with an invitation. Thus far I have spoken only about the ways psychodramatic and psychoanalytic theories might enrich each other. But in addition to the mixing of theories, I believe there is enormous potential in the mixing of methods. In fact while attempts to integrate the two methods have lagged in this country, they have been more prevalent in others. For example, I recently learned of a unique synthesis of psychodrama and psychoanalysis, used in Poland in the 1970's, in which the director and all the auxiliaries were psychoanalysts and the action segment of the treatment was limited to 10 minutes.

In this country, I know of some cases in the 70's, the heyday of marathons, where a psychodramatist and a psychoanalyst co-led weekend intensives. And currently, the major proponent of combining these methods has been Sandra Garfield, a former president of the ASGPP and skilled psychoanalyst in California. She has outlined a way of working, which she terms “analytic psychodrama,” in which she uses psychodramatic techniques, combining them with verbal interpretations, transference analysis and resistance analysis. I am sorry that she was unable to be on this panel as originally planned, but fortunately, she has a written up her method and it appears in Gershoni’s edited book. Anybody interested in this topic should read her chapter. And I believe this is just the beginning of what could be a creative explosion. The time is ripe for combining two powerful methods and theories. There are many ways this can be accomplished…and I hope some of you will join in this exciting endeavor.

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If you have questions or comments, email me at adam@blatner.com  

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