Learn More. The original theory of psychodrama proposed by Moreno in has been adjusted and re-interpreted by several authors over the last three decades. This resulted in the proliferation of techniques whose definitions and contexts of application are unclear and poorly documented in the literature.
The purpose of this review was three-fold: 1 to identify the psychodramatic techniques currently used for research and clinical purposes, 2 to extract and create a list of core techniques which are consensually used by psychodramatists, and which reflect the main principles of the Morenian theory of psychodrama, and 3 to propose an operationalised definition of the core psychodramatic techniques identified.
The search was conducted between June and September of in the main electronic databases e. Of these, a preliminary list of 30 techniques was selected, which was reduced to a total of 11 core techniques: soliloquy, double, mirror, role reversal, resistance interpolation, sculpture, social atom, intermediate objects, games, sociometry, role training. The credibility of this final core list was first checked with an expert in Morenian psychodrama, and later discussed with a network of 22 European psychodramatists to ensure full consensus.
Overall, this review provides a contemporary framework for psychodramatists that reconciles the current approaches to psychodrama with the core techniques proposed by Moreno, and updates the definitions of these techniques, by merging the interpretations of different experts in the field.
To have a list of core techniques which is consensually accepted from an international point of view is paramount not only for future research, but also for training purposes. The implications of this review for clinical practice are also discussed. Because of this, psychodrama has been accredited by the European Association of Psychotherapies EAP and is also recommended by several European governments as a good health practice, such as in Austria and Hungary.
In the last decades, the growing popularity of psychodrama has led to the proliferation of over 60 psychodrama training and accreditation schools over 26 European countries. FEPTO aims to develop training, create ethical standards and promote scientific knowledge sharing across trainers and schools.
However, it is unclear which psychodrama techniques are currently being used and taught, and whether this proliferation of schools has fragmented the original theory proposed by Moreno, to which the present review will contribute. Psychodrama is a group format of psychotherapy with deep roots in theater, psychology and sociology. Although preferably performed in a group format, it focuses on the particularities of the individual as the intersection of various relational roles, e. The majority of the techniques found in the literature, such as role reversal, soliloquy, or double mirroring, are used to assist the protagonist in the dramatization of the conflict that needs to be solved.
Others, however, can be used both as a warm-up for the action phase and emergence of the protagonist, as well as to work out a common topic for the whole group and to constitute the stage of the drama itself. This is the case of dramatic games and sociometry. From the early s, several authors suggested deviations from the original psychodramatic theory. With this separation from the original formulations, a deviation from the traditional dynamic of the session also occurred warm-up, action, sharing , with the application of specific psychodramatic techniques as independent interventions within the more traditional, verbal psychotherapy Kipper, The dissemination of psychodrama across the different countries of Europe and America and the absence of clear definitions has resulted in a diversity of applications of the techniques and concepts introduced by Moreno within psychodrama itself.
Therefore, the practice of psychodrama has evolved in an isolated and distinct way across various countries and schools, and there are no common definitions of some of its components, namely the techniques.
Also, when it comes to the operationalization of the model, the techniques seem to be its component that meets less consensus. Hence, in a time when it is considered important to study psychodrama and to stimulate research, a fundamental and key step is to operationalize the model.
It is essential to realize, within Morenian Psychodrama MP , what is being done and how, which techniques are being used and which techniques constitute the basis of the theory.
The present review aims to contribute to the understanding of how MP has evolved and the way it has been practiced since the launching of its theoretical roots. We will achieve this through the systematization of core techniques used at an international level.
More specifically, our review aims:. To identify and describe the techniques that gather consensus across the community of researchers and practitioners of MP.
Additionally, internet search engines were also searched such as Google , as well as gray literature e. This contact was made in person and via e-mail. After the systematic search, the texts were selected according to the following inclusion criteria: 1 texts that described or indicated psychodramatic techniques; and 2 available in Portuguese, French, English, and Spanish. These criteria were chosen because the goal was to identify all existing techniques, even if their definition was not entirely clear see section on quality assessment of texts selected for review.
As for languages, the research team included those in which they had fluency to understand and review. The following exclusion criteria were adopted: 1 information from websites without peer review; 2 texts of unknown origin e. These exclusion criteria aimed to ensure that all selected texts came from reliable sources, included reliable contents from an academic and scientific point of view and referred to the original MP model.
Finally, the preliminary list of selected studies was verified by an expert in psychodrama. Selected texts. Adapted from Moher et al. MP techniques were identified and extracted from the texts selected for review. The following techniques were excluded from the preliminary list: techniques mentioned only once in the literature; specific techniques for certain pathologies; and techniques that were directly related to therapeutic modalities 2.
This list was then discussed with a psychodrama expert, until a final list of core techniques, which were consensual and could be traced back to the model proposed by Moreno, was prepared.
The final step involved the validation of the final list of MP techniques by international experts in psychodrama. For this, the relevance of the techniques and their definition were discussed by experts in a bi-annual meeting of the FEPTO Research Committee in October In this meeting, all techniques were discussed by 22 members of FEPTO, representing a total of 11 countries 3 , until a consensus was reached on the completeness of the list and the operational definition of each technique.
The quality of the papers selected for review was evaluated according to two criteria: the reliability of the source, considering peer recognition in the scientific and clinical community; and the clarity of the definition of the techniques provided in each paper. Books and gray literature e.
All sources were classified according to these parameters. One point was assigned when the definition was clear and 0 points when the definition was considered incomplete or unclear. A total of texts were found in the systematic search, of which were excluded. Out of this search, 21 texts were initially selected for review, which comprised of 15 books and six articles.
Beacon: Beacon House. Gershoni, J. Psychodrama in the 21st century : Clinical and education applications. New York: Springer. Goldman, E. Living according to the principles of psychodrama, however, involves creation, spontaneity, research and the search of The living stage: A step-by-step guide to psychodrama, sociometry, and experiential group therapy.
Psychodrama in the 21st century : Clinical and educational His publications include chapters in Psychodrama in the 21st Century and Healing Collective Trauma through sociodrama and drama therapy, in addition to articles in Journal of Group Psychotherapy and Psychodrama, The British Psychodrama The living stage: A step-by-step guide to psychodrama, sociometry and experiential group therapy.
The essential Moreno: Writings on psychodrama, group method and spontaneity. New York, NY: Wiley. Coon, D. Find a Psychodramatist. Find a Psychodrama Therapist. Find a Training Workshop. Find a Psychodrama Trainer. The Journey Toward Certification. Why Become Certified?
Each institution offers a course based upon the interests and competence of its trainers - the Northern School of Psychodrama emphasizes a person-centred approach, the London Centre for Psychodrama and Group Analytic Psychotherapy adopts a psychodynamic framework and so on - but there are agreed broad similarities and each course leads to individual professional recognition by the United Kingdom Council for Psychotherapy.
In this context, Langley 12 refers to the importance of boundaries: these she lists as: 1 Knowing what you are doing and why. Personal and professional relationships. Preparing to Work with Clients Successfully completing a course of training is the first step in a psychodrama practitioner's warm-up.
The second is preparing psychologically and emotionally for client contact. It is a matter of becoming ready to be a facilitator of a particular group in a particular place at a particular time. This preparation precedes any meeting with clients or potential clients.
This familiarization may involve reading, reflection, talking to others who know something of the client group or any other process which aids the practitioner to feel less anxious and appropriately informed.
In their preparation to act as co-therapists for a group of women survivors of sexual abuse, Corti and Casson 38 brainstormed the issues, thought about techniques and exercises they might use and met with a specialist supervisor. They also took time to meet informally 'to get to know each other more' and 'discussed possible problems, our hopes and fears and also did some reading'. Costa and Walsh also emphasize the importance of their pre-group preparations.
An important part of these preparations is supervision. As for other branches of counselling and psychotherapy, there is an ethical and professional obligation for psychodramatists to have their clinical practice supervised.
She says too, 'We look together at gender, race, age, and often importantly hierarchical status, especially if they work for the same organization. We look at imbalances of experience, especially at working with a particular client group. It does not matter that the client group, the setting, perhaps even the individuals are familiar; good preparation is the foundation of successful therapy and complacency is its enemy.
There are also a number of practical issues to be settled before pyschodramatists begin their work with any particular group of clients. Questions to answer include: 1 Who are the potential clients, how may they be informed about the group and what will attract them to it? What is the nature of the space and what must I do to prepare it for psychodrama? Are there problems of access and, if so, how may they be overcome?
If they are to be charged a fee, how will this be collected? Is there to be a formal assessment process? Is there any paperwork which must be dealt with? The answers to these questions will vary between individual practitioners, the client group and the working setting.
I do not conduct a formal assessment but I do like to offer potential clients the chance to get to know me before committing themselves to working with me. Other psychodramatists prefer to work alone, some work in a purposely designed psychodrama space with a designated stage and for some referral and assessment are an important part of the process. For some practitioners, a group which is closed that is, attended by the same people throughout its life, admitting no new members after an agreed initial period and which meets regularly is seen as most effective; for others, it is the ability to work intensively over for example a day or a weekend, perhaps in a residential setting, which offers the greatest likelihood of change.
Many combinations are possible and each has its advantages and disadvantages. For example, when two psychodramatists work together as equals, they are co-therapists - this offers different opportunities from facilitating a group alone.
It is important to emphasize that, regardless of whether they favoured it as a way of working or not, almost all of the seventy respondents to this sUIVey stressed the importance of clarity, openness and good supervision in the co-therapy relationship.
As with so many things in psychodrama and other approaches to psychotherapy , it seems that, as long as the potential clients are able to make an informed choice, what works best is what the practitioners are most comfortable with and believe in. Meeting the Clients A psychodramatist who is adequately trained, is psychologically prepared, has decided upon the nature of the group, is familiar with the working space and has answers to a host of practical issues is at last in a position to recruit, meet with and select potential clients.
Some psychodramatists favour a formal process of referral and assessment, others take an informal approach. This may reflect the philosophy of the practitioner. For example, formal assessment may be seen as an essential part of psychodynamic practice but many person-centred practitioners would see it as imposing something from the perspective of the therapist and therefore to be avoided.
It may be about the work setting and accountability. When he recruits people for psychodrama workshops which are not aimed at a 'patient' population he does not formally assess but treats 'all group members as my equal and [expects] them to act in an appropriate manner and to take responsibility for their own actions'.
However, he believes that for his on-going treatment groups 'more formal' assessment is necessary 'for the sake of the individual and of the group'.
These are: 1 Establishing a rapport with the patient. S Arranging for further assessments. Although these goals are stated in the language of the medical and psychoanalytic models, a person-centred practitioner would have serious reservations only about point 2 but would approach points 7, 8, 9 and 10 with caution.
Whatever the nature of assessment procedures, the intention of the ethical practitioner is to ensure a 'good fit' between therapist s and client.
It is a mutual process and is about giving clients enough information to make an informed consent as to whether this way of working, this group, this psychodramatist is right for them at this time. This is not always an easy process. They had advertised their group on noticeboards in community centres, public libraries, local coUeges and through leaflets distributed to friends and coUeagues.
There was also information about the place and time of meeting, the duration of the group and its cost and an address and telephone number with an invitation to contact the co-therapists to find out more or to ask questions. Anyone expressing an interest in this was individually invited to meet with BiU and Jean in the room in which the group would meet. These meetings were for about twenty minutes and held in the two weeks before the group was due to start.
In principle, they saw this as a process by which the potential client could make an informed choice about joining the group. As they believed that client This was their usual way of introducing themselves to clients and, normally, it seemed to work. On the second day of these informal meetings, Bill and Jean were waiting for Kirsty; their last potential client. Jean tried to interrupt to introduce herself and Bill and to acknowledge Kirsty but the torrent of words continued.
The tale was of Kirsty's sexual harassment by others, her own sexual predation, of torture, isolation and desperation. Somehow, it was less the content of what Kirsty said and more the way in which she said it that was disturbing and disorienting. Although both experienced therapists, Bill and Jean were in some sense overcome by Kirsty, not knowing how to respond to her.
Kirsty left as abruptly as she had arrived saying that she was sure that psychodrama was rightfor her and that she would be at thefirst session the next week.
After Kirsty left, Bill and Jean just stared at each other for a while, uncertain as to what had happened or what to say about it. Eventually Jean broke the silence airing her grave doubts about Kirsty's suitability as a group member.
Although it was rapidly clear that Bill and Jean agreed that they would not, indeed ethically could not, take Kirsty into the group, the discussion went on for some time. They decided to phone Kirsty and to explain that they thought that at this time the kind of psychodrama they could offer was not what she required.
In their view it is about enabling the potential group member to make a choice. Only exceptionally do they make a decision as to the suitability of the client. For others, assessment is a much more structured activity. Based on her own experience and what she knew from others, she decided that psychodrama would be an effective way of working with people who have an eating disorder.
After talking over her ideas with her clinical supervisor and her line manager, she was able to create time in her working week in which she could offer psychodrama to this client group. Alison then set about informing her colleagues and other professionals psychiatrists, community psychiatric nurses, general practitioners, specialist services and so on of this opportunity, explaining to them what might happen in a psychodrama group and why it was an effective way of working with people with an eating disorder.
This she did by talking to people she knew and by circulating an explanatory leaflet in which she referred to the evidence in the literature making it clear that she sought appropriate referrals.
In Alison's view this is a necessary professional courtesy. In these initial meetings for which a whole hour was allowed , as well as explaining about psychodrama and checking that the potential client saw it as relevant to their needs, Alison conducted a formal assessment, of which she made a written record. This included biographical detail, a contact address and telephone number, a note of any other professional or service with whom the client was involved and the name and address of the general practitioner with whom the client was registered.
Alison also asked about the nature of the eating disorder and how it affected the client's life. If Alison had doubts about the suitability of the proposed group for the potential client then she said so, stating her reasons clearly and carefuUy. She also discussed what other options there were. Whatever the nature of the assessment or introductory process, it is only when it is completed and some kind of contract agreed between the prospective participants and the psychodramatist s that a psychodrama group is ready to meet.
What follows is an illustration of some of the issues to be addressed and examples of what might happen in the first two or three sessions with a group of people new to psychodrama. In some groups this will happen more quickly, in others more slowly. The First Group Meeting When a psychodrama group first meets it is likely that at least some and possibly all of its members will be new not only to each other and to the group leader but also to psychodrama.
The immediate task of the psychodramatist is to facilitate some sense of group identity and to enable the establishment of a trusting atmosphere in which change, growth and healing may occur. In this, the beginning stages of a psychodrama group are like the beginnings of any other group meeting for psychotherapy or personal growth.
It is a time of getting acquainted, determining how the group will function and a time for each member to find a place and a way of being in it. Group members and perhaps the therapist will be to a greater or lesser extent anxious, uncertain of what will happen and, because of this, tentative as they attempt to discover and test boundaries and wonder whether they will be accepted. Alongside this is the need to introduce the techniques and processes of the psychodramatic method.
Understanding of the techniques is a necessary precursor to psychodrama proper and a gentle, systematic introduction to them is the best way of helping to overcome any anxiety and disbelief group members may have.
Some of these will be predetermined for example, time and place of meeting, duration of sessions but others must be agreed. These may include some decisions about late arrival and absence and, most importantly, a definition of confidentiality. Although an appreciation of the importance of confidentiality is widely held by group therapists of all kinds, there is sometimes an assumption that an understanding of the term is universally shared.
This is not necessarily true. Additionally, group members often have unrealistic expectations of themselves and others with respect to confidentiality. Psychodrama is exciting, challenging, awakens feelings, brings to mind unfinished business, raises doubts and uncertainties not only for protagonists but for auxiliaries and audience too - it is a group approach involving everybody present. Also, they may relate to other people in an individual group member's life - and this may have to be dealt with outside the group.
Finding a safe and respectful way of doing this to which all the group members can agree is important. The interweaving of personal stories characteristic of psychodrama makes it very difficult for group members to talk about only their own experience. How can group members tell a partner about their experience as auxiliary which may have crucial bearing on their own development without some reference to the protagonist?
If it is allowable to make reference to others, how can this be done in a way which protects them and preserves their anonymity? People are identified by their names but also their roles, where they work or live, their ages, their character etc.
If group members cannot speak freely about the group during its lifetime, can they do so at a specified time in the future? There are many other questions and each group will have its own solutions to the problems they raise.
As a group leader, I like to make sure that the group is aware of the issues and to stress the importance of respecting each other, what we say and how we say it. I also point out that whatever contract we establish may, if necessary, be revisited and renegotiated. He points out that the consensus amongst writers is that trust is essential to the continued development of a psychotherapy group. None of these arises as a matter of course.
The agreed group rules provide a framework but it is not until these are experienced as upheld and seen to work that they can contribute to an atmosphere of trust. Trust has to be learned and earned. What most facilitates and promotes trust is the group leader's ability to show that the group can be a safe place in which to be real, open and honest. For me, this is about being empathic that is sensitive to the inner experience of others , congruent real, present without artifice and with my outer self being an accurate reflection of my inner self and most importantly accepting.
Other psycho dramatists may express this differently but the basic aims and strategies will be similar. In the context of psychodrama, earning trust is also about introducing its techniques at a pace appropriate to the particular group and in such a way as to allow group members to express their doubts and reservations.
Coombes 1: writes about trusting the method in psychodrama and discusses how to promote this trust and what might interfere with its establishment. In psychodrama, as in other group approaches, this is an early task. It is also useful to facilitate the expression of doubts, fears and expectations and to allow group members the opportunity to express how they feel about being in the group.
The following example is drawn from my own practice; others would do it differently. It was the first meeting of the psychodrama group. The eight members and the leader, Paul, had already learned each other's names and agreed a group contract. Paul moved to the centre of the room dragging a chair with him.
What I would like you to do is to find a place in the room which somehow reflects how you feel about whatever this chair represents to you now. I suggest you just walk around the room until you find the place thatfeels most comfortable to you. Don't think about this too much, just follow your instinct, your intuition. This might be about where other people put themselves as well as the chair, the group, psychodrama or whatever it is.
Paul was towards the edge of the room, a few paces from the centre of a wall. I'll go first - that seems only fair. I am a little way away from it at the moment but I amfacing it and can see it clearly - that is important to me. I can see all of you too and I like that. Standing here Ifeel ready to move. Ready to move towards the group and into action. He placed his hand upon her shoulder and she said, 'I am here because I really wanted to be by the window.
I don't know why, it just seemed right. I can see the group and that's nice - but I don't want to be any closer at the moment. As Paul bent and touched her shoulder, she said, 'I'm feeling really laid back and easy. I just want to jtop around on the jtoor. I tried standing up but it wasn't right. I like being here. I can't see many of you but I know you 're there. He was standing almost in the middle of the room with one foot touching a chair leg.
He said, 'I'm here because I feel that I really want to reach out and touch the group. I'm already beginning to feel that I know you and I really want to get on with some psychodrama. It is all I can do to prevent myself from rushing out the door and going home. I quite like it here. I can see everybody and I am quite close to Betty and to Paul. I like that. She said, 'I just didn't want to move.
I don't seem to have any energy. I thought about going a bit nearer to the group but I'm all right here. As Paul touched his shoulder, talking to the chair, Bernie said, 'I put myself here because I really want to get to know you. It was important to be on your level which is why I got my chair and although I want to be close, I'm not yet - so I wanted to stay at a bit of a distance. I'm feeling curious, excited and a bit scared.
Paul went back to his own place and asked if anyone had anything else to say and did anyone want to change their position. Dorothy took two paces away from her corner and smiled shyly. OK, let's get back into a circle and we'll carry on.
Reaching into the tattered supermarket carrier bag he had brought with him to the session, Paul pulled out a crumpled felt hat and placed it on the floor. Some fear or worry you have about being in the group. Don't sign it or indicate who you are on it - the idea is that this is anonymous.
When we have all done that I'll come round and we will each take one out and then take turns to read it to the rest of the group. If you get your own don't worry - the rest of us won 't know. You can read the one you take out but wait until everybody has got one and had a chance to look at it before we read them alOUd.
One by one, what was on the pieces of paper was read out: 'I am frightened that I will get upset or emotional in this group. And what was it like to read the one you got? I could have written any of them. There was something really comforting in hearing that all my fears were shared by the rest of you. It is still real for me but hearing it read by somebody else makes it easier to live with somehow. And I agree with Donna and Bernie too - knowing that I am not the only one scared of all those things makes a huge difference.
I really did think it was just me. It seemed that everybody was surprised that their fears were shared, and was comforted by this. Somehow hearing their --own fears voiced made them less threatening. The story above revolves around only two of many possible introductory exercises and they are not unique to psychodrama. In it an inanimate object the chair takes on a role - that things can represent people and people represent things is basic to psychodrama.
Also the shape of a psychodrama session has been introduced. There has been a warm-up getting to know names and setting a contract , enaction the group sculpt and 'Fear in a Hat' and sharing the opportunity to say what it was like to voice the fear of another and to connect with the fears heard. Members of a psychodrama group have to become familiar with the ideas of for example taking roles, setting scenes, role reversal and doubling.
Fundamental to psychodramatic action is the establishment of a scene, that is, the creation of a place and time, real or imagined, from past, present or future within the confines of the group space. A basic scene-setting exercise can introduce many elements of psychodrama and continue the process of building group cohesion. When they and the group members had each said a few words about how they were feeling that evening and what had happened since the last session, they explained that the group would do some scene-setting.
Perhaps it is somewhere you know, perhaps you go there a lot, perhaps it isn't real but somewhere you would like to be able to go. It doesn't really matter - what is important is that it is a special place to you and that you feel good about being there.
What we invite you to do is take some time to think about this place. Then there will be an opportunity to talk to someone else in the group about your special place.
Finally, one or perhaps two of you will have the chance to show us your place using the people and things here to do that. I know that is hard to imagine and don't worry about it just now. If you want to do it, one of us will help you - that's our job! Pete got to his feet and walked to the centre of the room. If it doesn't, just ignore me and do your own thing. A place where you feel safe and comfortable. What can you see?
What shapes and colours? What can you hear? What can you taste and smell? Is there anyone or anything else with you? How does it feel to be in your special place?
Take your time, allow yourself to really be there. Now find a partner, someone to share something about this place with. In your pairs, each of you will have the opportunity to say as much or as little about your special place as you wish. You 'll have twelve minutes and we suggest you take it in turns - one of you listens while the other speaks.
We will tell you when you are half-way through. Jo went over to where Pete was sitting and sat beside him. Some pairs were laughing, some looked intensely engaged with each other, but all seemed engrossed. Do you need more time? To share it with us?
There were a few minutes of silence. Well I guess, if you still want to Sandra, the floor is yours. Who would you like to work with you, me or Jo?
Where is it? Does it have a name? I used to go there a lot with my mum. We'd have picnics and go swimming. It was always warm and sunny and I miss the sun! Shall we have a go at bringing it here? Can we start by finding a place in the room to be the beach? Whereabouts in the room would you like to make Pink Bay? We're standing in Pink Bay are we?
It's aU shady and woody up to here and then all of a sudden there is aU this pink and gold and blue and it's so bright it almost makes your eyes hurt. Tell me what you can see. There is an old raft out there - we used to swim out to it and dive off ' As Jo stood at Sandra's side it was as if she too could see Pink Bay, awash with sunlight.
Would you like it in your scene? Don't think about it too much. It often seems that it works best if you just go with thefirst thing that occurs, ' Jo said. Bob nodded. Perhaps you could go and be the raft for a minute. This will give the rest of us some idea about what it was like and I guess that will be particularly helpful to Bob. I'm old - I have been here ages. Children swim out to me and climb on to my back - then they jump off laughing and screaming.
But I hear a lot. The children, their parents calling from the beach, the seagulls. Is there anything else you need to know about yourself as the old raft Bob? Well please come and be the old raftjloating in the sea at Pink Bay - just take up the place and position that Sandra showed us.
How could I haveforgotten? We used to spend hours climbing that when it was too hot to sit in the sun and we were tired of swimming. It was tall and shady and strong. Can I have more than one person?
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