Σάββατο 24 Νοεμβρίου 2007
Psychoanalytic Psychodrama: current models and fundaments
Moreno himself stimulated the creation of an analytic psychodrama approach (Moreno, 1944) while he was fascinated by the potential of co-operation, cross-fertilization and mutual exchange between different ideas and concepts. In France Lebovizi and Anzieu started to develop the first analytic psychodrama method in a systematic way in the early 50s. Their efforts were pursued in Germany by Ploeger and Schmidt and in Spain by Valiente like in many other countries during the 60s and 70s. Apart from the Freudian approach especially the Jungian psychodrama was able to prosper in the last decades in Italy, Argentina and Switzerland (Scategni, Gasca, Gasseau, Menegazzo, Barz). Besides the “natural” sympathy between analytic group psychotherapy, analytic interpersonal concepts (H.S. Sullivan) and psychodrama the object relationship theory and the new validation of inter-personal relationships and attachment aspects embedded in the analytic mainstream theory have facilitated in the last two decades a slight approximation between the two approaches in the framework of several authors. Although all the “combined approaches” use psychodramatic and psychoanalytic concepts and techniques they differ according to the “amount” of each integrated in them.
The analytic psychodrama of S. Lebovici
Psycho-dramatic enactment clarifies / visualizes the significance and the function of defensive and repair mechanism (after all projective mechanism) in a “natural and self-experiential way”. The concept of the “constraint interpretative” (Green) claims that Catharsis due to action alone is not enough to guarantee an therapeutic effect. There should be also insight due to interpretation while “fatal disaster may occur if action anticipates the insight of the truth (the example of Oedipus)”. The symbolic value of the play is identical with the theatre but in Psychoanalytic-Psychodrama the function and significance of all the roles will be clarified.
Format and Techniques
In the individual Psychoanalytic–Psychodrama a team of analysts enact the scene of the client (auxiliary-ego) which is directed by the analyst. In every moment the therapist may interrupt the representation giving his interpretation of the enactment and confronting the patient with his lecture of the scene. In the group format of the Psychoanalytic–Psychodrama a team of analysts and a group of clients come together working with a two phase model. In the first phase the whole group is searching actively a topic to present by an individual (protagonist). In the second phase the topic is first enacted on the stage and then or meanwhile the representation interpreted. In the final part of the session the question is raised what are the functions of the enactment for each member of the group evaluating each individual participation and contribution. One of the main problems is the handling of the transference for Lebovici understanding that the transference will be divided or lateralized. He emphasizes the need to handle especially the individual and team counter-transference (“not play the play of the client” inside of the team: e.g. rivalry issues, oedipal guilt issues) defining as the ideal relationship for a participating team member a “free” way to respond to the stimulus of the patient (not being disturbed by counter-transference finding the “correct” answer or action for the client).
Following Lebovici it is especially indicated to overcome the deceleration of the therapeutic process due to inhibition or projective phenomena. The role reversal is able to facilitate the expression of the blocked energy/feelings and to differentiate the experience for the patient itself. It is also very useful for the treatment of psychotic disorders fostering a way of “symbolic fulfilment of wishes” (Sechehaye) which might be completed in a second phase of treatment by verbal and insight directed interventions. Psychodrama at large also enriches the group work in general and especially those with families being beneficial for communication purposes and mutual identifications. On the other hand the therapist must guarantee a considerate handling of all techniques while the mirroring of images and projection may provoke the same narcissistic injuries like the real action outside of the therapy.
Case example 1: a young female patient with obsessive-compulsive behaviour is admitted at an indoor psychiatric hospital due to her severe symptoms. She is totally frozen in her symptoms appearing even sometimes as catatonic. There is no way to contact her in a therapeutic sense unless she is invited to participate in a psychodramatic session. Only when she accepts to play the role of her mother making shopping for her she starts to show up a quite different behaviour shouting with the store keeper and her daughter (which is enacted by a team member). Thus it is not longer possible for the patient to maintain that she has no conflict with her mother at all giving way to a verbal reflection of the inter-personal conflict.
Case example 2: Edouard is a very sensitive, inhibited and quiet young man who run away every Friday in order to hide his bad school marks in front of the eyes of his father. Those intentions to escape lead him always to the next police station where he is fetched again by his father. His father usually feels terrible in those situations while he himself is a very successful police man. Edouard can only tell the therapists that he is so much frightened by his father and his possible accusations. But when this same shy young man enacts the role of his father it is astonishing to see how much brutality and violence he is attributing to this role with a very load voice. And it is even more surprising seeing him in the role of himself as a father in the future being even more brutal than his own father. This it becomes evident not only for the team but for Edouard himself how he is projecting his own underlying guilt feelings on the father assuming an “identification with the aggressor”. It was only than possible to work through with him his own castration and annihilation anxieties.
Psychoanalysis and Psychodrama – fundaments
A short Definition of Psychodrama
The classical, morenian psychodrama is a triadic system including group psychotherapy, sociometry and psychodrama. It encompasses a specific anthropologic model of human development which is inseparably connected with relational experiences and its inherent interpersonal matrix. Inter-action is centred upon action which thereby constitutes human development. The relational experience has a scenic character. Its intra-psychic imprint is stored in the CNS as a learning experience in the way of specific actional, emotional, imaginary and cognitive patterns forming behavioural roles. Roles are target oriented, operational and functional regarding the interests of the individual. The theoretic complexity of the role system will be diminished by the tendency to repeat those roles which have been tested positively coping with reality demands. In a concrete relationship the selection of a certain role/response pattern depends on the subjective perception, the emotional validation and the cognitive interpretation of a situation activating certain attractors and clusters in the internalised network of the role system. During human development certain role or behavioural competences arise culminating in the possibility to perform role reversals. Those competences guarantee the coordination between individual interests and needs on the one hand and the relational or social demands in a certain context on the other hand. The internalised relational world of the individual, his role system or role repertory marks his or her identity. Therefore Moreno called the relevant individual social network (in his words: the social atom of an individual) the smallest unit of identity.
Role patterns tend to be stable and can be activated in different relational systems like 1. the actual therapeutic relationship including its diversification in groups 2. the “real” relationships in families or other social systems 3. the reconstructed relationships inside of psychodramatic inter-actional sequences 4. the relational equivalents on corporal or on symbolic-imaginary level. Therefore in Psychodrama the group and the related group psychotherapy is the ideal agent for changes kindling the expression of the individual role system and its problematic, failing or not satisfying responses as well as the re-experience of trust and understanding/social support by others. The complex matrix of interactions in the group, its dynamic and process is approached and visualized in Psychodrama not only during the „normal“ course of the group but also in addition by sociometric means measuring for example attraction and rejection between different group members.
The fundamental contribution of Psychodrama to Psychotherapy is the creation of an intermediate space facilitating a scenary and an auxiliary world as a new dimension for the exploration of significant role patterns and its cognitive, emotional or situational assumptions. Nevertheless it determines also a serious of problematic challenges including the partial loss of control, the exposure to potentially shaming experiences, the unusual way for adult persons to investigate relational experiences (not only sitting and talking) and the emotional impact for the person which is often useful, but sometimes difficult to handle. In order to enable persons to take advantage of this specific working model and to dare to question their dysfunctional role responses the psychodramatic psychotherapy offers a so called “warming-up” process in the beginning of the session trying to empower group members by addressing their specific needs in a reassuring, self-effective way.
Psychoanalysis and Psychodrama: Converging Concepts
For Foulkes the analytic understanding of the individual situation requires the understanding of its inherent social background. “It’s not the individual which shapes the last unit of the analytic research. It’s on the contrary the group, the community to which the individual belongs which generates this last, primary unit. Individual processes arise from internalised forces proceeding from the group to which the individual belongs.” (Foulkes, cited in Brandes, 1993, p. 23). The intra-psychic dynamic of the individual will be reflected in the inter-actional patterns of the group. “Society is as well inside of the individual as outside of him. The limit between of what is inside and what is outside changes constantly.” (Foulkes, cited in Brandes, 1993, p. 23). Moreover Foulkes dissolves as well the dichotomy between language and action while he incorporates non-verbal actions in the analytic reflection of the communication process as a whole.
For Krüger Psychodrama can be regarded as a “method of communication” which amplifies the possibilities of mutual understanding by the means of the scenic play. (Krüger, 1997, p. 239). The scenic – and not only the verbal – interpretation is a common achievement of client, group and therapist opening as a key the deeper understanding of actual conflicts nurtured by the present or past social environment or the therapeutic alliance as well. The scenic part of the “creative inter-actional” process can be integrated as well in the analytic phase of the “working through” of conflicts. Finally Krüger has established his own model of a joint practise of psychodrama and psychoanalysis assigning to each psychodramatic technique a specific psychoanalytic defensive and repair mechanism and a specific function in the frame of the organization of the Self and its internal relational representations. He is taking a clear stand for an integration of psychodrama and psychoanalysis using both methods as folios of interpretation and intervention depending on the therapeutic process.
Winnicott understands the play as an activity located in the intermediate space between internal and external reality. In the frame of the play the child – as in later years adult persons – use external objects to represent, explore and process their internal reality. These intermediate objects transcend the limit between internal and external reality facilitating creative experiences for adult persons in the context of arts, religion, imagination or even scientific work. Therefore he emphasizes on the one hand the significance to allow patient’s “to play”. On the other hand he is afraid that the premature interpretation without recognizing the potential of the play might turn into an indoctrination stimulating instead of insight only the adjustment of the patient. Holmes (1992) describes with explicit reference to Winnicott the capacity of the psychodramatic procedure as a way to recreate the magic world of the childhood for the patient inviting him to “play” again with his internal world. Due to the intervention of auxiliary egos representing intermediate objects the scenic process may favour change and growth.” (p. 159) The so called Surplus Reality of psychodrama provide after all a frame to explore psychic contents in a playful way while the limitations of reality do not interfere in its production.
The dynamic of human relationships builds the centre of Stierlin`s work. While the implicit “split” between individual and society might be hidden behind the concept of “static symptoms or disorders” Stierlin tries to detect and overcome them focusing on the reciprocal process between the social and the personal and the meaningfulness of human existence at all in terms of “his time” and “his position in the world” (Heidegger). Although he recognizes the importance of the thorough analysis of the transference-counter-transference dynamic he always advocates the importance of the encounter for human relationships as well. Encounter goes beyond the mere transference and counter-transference relationship. It refers more to the notion of the “loving human carry and support” relationship by L. Binswanger (Stierlin, 1975, p. 28). In his concepts of “familial delegation”, “trans-familial transference” and the interactive modes of “attachment” and “ejection or expulsion” Stierlin suspends moreover explicitly the artificial split between society and individual creating a dynamic, inter-personal look on human behaviour.
Pohlen is after all interested to maintain and develop the “ability of modern analysis to formulate a critical position on society” evoking its immanent potential of change. He is referring this criteria even to the own roots of analysis emphasizing the “creative discussion” in relationship with the original work of Freud. For him all the words, articles, psychic inter-actions and innovations generated due to this debate by Freud’s followers are flowing together as the dynamic script of modern analysis. Words like treason or betrayal belong to an orthodox understanding of analytic values which hinders its recreation. For him body states, sensuality and fantasy has to belong to a real scientific discourse of modern analysis. (Pohlen, 1995, p. 95f) Besides the language modern analysis should re-conquer again the field of a true natural science of the human being involving as well action as an essential part of human nature. (Pohlen, 1995, p. 31) For him the main goal to which analysis should be directed is to facilitate the development of the patient choosing always the most appropriate means to foster it. In this way it is not always necessarily the interpretation, but after all the human relationship on which the analytic cure is built.
Meanwhile for Freud the “royal way” to reach the primary experiences of the patient follows the free association, the analysis of the counter-transference and the dreams for Lorenzer the analytic process of gaining insight and knowledge obeys to a different double strategy. The analyst interprets the observations and statements of the patient always as belonging to a “unknown” inter-active scene. This scenic experience starts first as a narcissistic fusion of different dimensions of the concrete relationship and its context (action, emotion, situation), in later years as a more distinct storage of the different dimensions without being abandoned or replaced by verbal means: under the verbal symbolic layer lies always another non-verbal symbolic layer of communication. Following this idea the therapist tries to create a “scenic frame” in which he will be enabled to complete the ruptures and fragments of the story of the patient. On the other hand he will become part of a direct, immediate inter-action due to the transference relationship. Nevertheless the unconscious reproduction of the scenic material (“enactments”) turns into one of the primary materials for the analysis and the understanding of the patients behaviour.
Lorenzer recognizes that this double insight operation between the scenic interpretation of the related material and the reflected inter-action in the Here-and-Now surpass the classical analytic setting. “Not one of the characteristics of the analytic setting is given for eternity: not the two person situation, nor the power or authority gradient creating an unequal relationship between analyst and patient nor the privilege of interpretation of the therapist which induces the commandment of abstinence for him.” (Lorenzer, 1974, p. 314)
Complementing the idea of Freud that the relational orientation of individuals is only a servant for the satisfaction of the overall dominant individual drives the object relational theory assumes that the primary object relationship (Balint, 1968) constitutes the basis for the further psychic and social development. Disorders in this significant first relationship may conduct towards splits between different, incompatible psychic representations of the same significant other (e.g. the “good” and the “bad” mother). For Powell the psychodramatic part of the psychotherapeutic treatment of patients foster the disclosure and the integration of those split partial identities. Instead of relying only on the projection of the internal objects and the attached affects on the therapist the psychodramatic procedure stimulates and mobilizes the internal object world of group members lowering the threshold for its expression. Afterwards those split objects can be converted and represented during the scenic experience by auxiliary egos in the frame of an “outer reality”. Thus it is possible to confront “evil or bad” objects in the intermediate psychodramatic space without having to experience this confrontation as a self-confrontation directed against ones own self. For Powell the psychodramatic procedure in the frame of the object relational theory is ideal to restructure the internal world of the patient.
Psychoanalysis and Psychodrama: pertaining Differences
The classical anthropologic model by Freud emphasizes the fight against sexual and aggressive drives on the one hand and against the rigid demands of the Super-Ego on the other hand as natural and inborn forces creating neurotic conflicts, structural defects and defensive mechanism in all human beings. Moreno emphasizes in his anthropology on the contrary the creative capacity and its social background of human beings including the unconsciousness as a source of wellness and not only as the motor of destructive desires. Pathology derives for Moreno from pathogenic influences from the relational/social environment and not from any innate, general human condition. These differences nevertheless have been readdressed smoothening its opposite tendencies by the followers of both mentors in the last decades.
The risk of any kind of destructive Acting-Out of the patient is much higher in Psychodrama building resistance with unconscious means against the shameful insight in ones own psychic or relational reality. Moreno himself acknowledged this risk differentiating between the controlled and the uncontrolled Acting-Out of patients. Still the fear towards any kind of action can become also a rationalization while the spontaneous action diminishes control and power over the therapeutic situation. Moreover Leutz, Blattner and others have systematized the correct and cautious handling of this aspect which is stressing the psychodramatic practise in order to guarantee a process of “Acting-In” instead of “Acting-Out”.
The handling of the transference is one of the primary ways to access the unconscious relational reality of patients in the analytical treatment and is fostered by the abstinence technique of the therapist. Although its practise has been modified in the last decades (e.g. “therapeutic alliance”, Greenson, 1995) the psychodramatic model is always advocating a mutual empathic relationship between Patient and therapist or different group members (“Tele” relationship) considering transference as a “pathologic” and disturbing aspect of relational experiences. Meanwhile psychoanalysis tries to maximize its appearance Psychodrama tries to minimize it exploring it only in the intermediate space of the stage and not in the real therapeutic relationship of the group. The same is true for the handling of resistance which will not be addressed directly in Psychodrama but understood as a lack of trust which must be respected and addressed in a different way (“how can trust be increased”).
In spite of all the differences and considering the ways how psychodrama and psychoanalysis and moreover group analysis do share synergies it seems to be absolutely meaningful to challenge the traditional split and polarisation between language and action, insight and change, individual and group, analysis and drama integrating both perspectives in a common practise of looking on, understanding and intervening in the group and in relationship with its process.
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