psychodrama and systemic therapy
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SYSTEMIC THINKING
N D PR CTICE
S RI S
Edited by David Campbell and Ros Draper
Psychodrama
and Systemic Therapy
CHRIS FARMER
oreword by
Ze rka T M oren o
K A R N A C B O O K S
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PSYCHODRAMA
A N D
S Y S T E M I C T H E R A P Y
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Other
titles in
the
Systemic
Thinking
and Practice Series
edited y Dav id
Cam pbe ll Ros Draper
published
nd distributed
y
Karnac Books
B e n t o v i m A . Trauma -Organized Systems: Physical and Sexual
buse
in
Families
B o r R., M i l l e r R. Internal Consultation in Health Care Settings
B u r c k C . D a n i e l G .
Gender and Family Therapy
C a m p b e l l
D .,
D r a p e r
R.,
H u f f i n g t o n
C .
Second Thoughts o n the Theory
and Practice
of
the Milan Approach to Family Therapy
C a m p b e l l
D . D r a p e r
R
v
H u f f i n g t o n
C .
Teaching Systemic Thinking
C e c c h i n
G ., L a n e G
v
R a y W. A. The Cybernetics of Prejudices in the
Practice of Psychotherapy
C e c c h i n G., L a n e G., R a y W. A . Irreverence: Strategy for Therapists
Survival
D r a p e r
R.,
G o w e r
M.,
H u f f i n g t o n
C .
Teaching Family Therapy
F r u g g e r i
L. , et
al. New Systemic Ideas from the Italian Mental Health
Movement
H o f f m a n
L .
Exchanging Voices:
Collaborative Approach to Family
Therapy
I n g e r I . I n g e r
J.
Co-Constructing Therapeutic Conversations:
Consultation
of
Restraint
I n g e r
L
I n g e r J. Creating an Ethical Position in Family Therapy
J o n e s
E .
Working with Adult Survivors
of
Child Sexual buse
M a s o n
B.
Handing Over: De veloping Consistency across Shifts in
Residential
and
Health Settings
R a y W . A. , K e e n e y B. P. Resource-Focused Therapy
S m i t h
G .
System ic Approaches to Training
in
Child Protection
Work with Organizations
C a m p b e l l
D .
Learning Consultation: Systemic Framework
C a m p b e l l D ., C o l d i c o t t T . K i n s e l l a K. Systemic Work with
Organizations: New Model for Managers and Change Agents
C a m p b e l l D .,
D r a p e r R.,
H u f f i n g t o n
C .
Systemic Approach to
Consultation
H u f f i n g t o n
C
B r u n n i n g
H .
Internal Consultancy in the Public Sector:
Case Studies
M c C a u g h a n
N.,
P a l m e r
B.
Systems Thinking
for
Harassed Man agers
Credit
Card orders Tel: 0171-584-3303; Fax: 0171-823-7743
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PSYCHODRAMA
AND
SYSTEMIC THERAPY
ris
armer
Fo r ewo rd
y
Zerka T. Moreno
Systemic
Thinking
and Practice Series
Series ditors
David
Campbell Ros raper
London
K R N C
B O O K S
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First publ ished in 1995 by
H. Karnac Book s) Ltd ,
1 1 8 F i n c h l e y R o a d ,
L o n d o n N W 3 5 H T
Copyr ight © 1995 by Chri s Farm er
Th e r igh t s o f Chr is Farm er to be ident i f ied as au thor of th is wo rk h av e b ee n
asser ted in accordance wi th §§ 77 and 78 of the Copyr ight Des ign and Paten ts
Act 1988 .
Al l r ights res erv ed. N o part of th is pub l icat io n m ay b e
rep rod uce d , s tore d in a re tr ieva l sys tem , or t ransm i t ted in any form
o r b y a n y m e a n s , e l e c tr o n i c , m e c h a n i c a l , p h o t o c o p y i n g , r e c o r d i n g
or otherwise , wi thout the pr ior perm iss ion of the pub l i sher .
B r i t i s h L i b r a r y C a t a l o g u i n g i n P u b l i c a t i o n D a t a
A catalogue record for th is book i s avai lable from the Bri t i sh Library.
ISB N 978 1 8557 5 089 0
Printed in Great Britain by BPC Wheatons Ltd, Exeter
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CKNOWLEDGEMENTS
I
am grateful to Marcia Ka rp and Ken Sprague, w ho introd uced me
to psychodram a at the H ol w el l Centre for Psychodrama and
Sociodrama, in N or th Devon, England, where I d id most of m y
training;
I
also
owe much to the work
done
there
w i t h
my fellow
trainees.
Wi th
regard to family and
systems
therapy in Guernsey, I am
particularly indebted to those w ho have visited the Island to
lead workshops. They include John By ng -H all, Rosalind Draper,
and Max Van Trommel. A workshop undertaken in Guernsey by
Francis Batten also enhanced the stan ding of psychodram a i n the
Island.
The application of
systems
theory to psych odram a was
first
pre
sented to me by An tho ny W illia ms at a bicentenary conference i n
Australia, an d its influence has
een
crucial to my work.
I
owe my understanding of Bowen s theory and practice to
Marcia
Geller at the Carm el Fa mil y Ther apy Center, N e w Yo rk ;
w it h her, I also gained particular
experience
i n working
psycho-
dramatically w i th
families.
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V i
C K N O W L E D G E M E N T S
I thank Olivia Lousada for m y interest i n the imp ortanc e of the
dyna mics inv ol ve d in the selection of protagonists.
I
am very
thankful
to Lisa
King
for her secretarial assistance an d
to Peter Le Vasseur and Angie Parker for the
illustrations.
For the clinical ma terial up on w hi ch the book is based I am
greatly
ind ebt ed to the staff and patients w i t h w ho m I have wo rke d
in
Guernsey.
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CONTENTS
ACKNOWLEDGEMENTS V
EDJTORS FOREWORD
ix
FOREWORD X i
erk
T Moreno
PREFACE xv
Introduction
C H P T E R O N E
Psychiatry
systems
and dram a 7
C H P T E R T W O
A
psychodram a in action 29
C H P T E R T H R E E
The psychodrama
tic
exploration
of transgeneration al psych iat ry: sins of the fathers'
53
v
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V l l l ONTENTS
CH PT ER FOUR
Strategic
psychodrama: help ing an abusive m other
to
onverse
w i t h
her children s social w ork er
CH PTER F IVE
Psychodrama as a sour e of
information
CH PTE R SIX
Summary:
the effect of one th erap y role up on another
in
a public
mental health
service
REFERENCES ND BIBLIOGR PHY
INDEX
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EDITORS FOREWORD
e are ve ry pleased t o publ ish
this
book as the w ay that
D r Farm er looks at the interface of systemic thinking
and practice an d psychodrama represents we believe
some original w o r k .
I t is our
hope that
both systemic
practitioners
and dra m a therapists alike as well as other mental
health
profes-
sionals w i l l f ind the
exploration
of the relationship between the tw o
perspectives and
treatment interventions exciting
and stimulating.
The reader
w i l l
w e hope appreciate the
skills
w i t h
whi ch
D r
Farmer
describes his
synthesizing
of the tw o approaches and at the
same
time
is able to
clarify
their
distinctiveness.
For m an y years D r Farm er has developed the use of a systemic
approach to adult
mental health
problems amongst mult idiscipl in-
ary staff group s in Guernsey Channel Islands.
Dur ing
the past few
years we have met and w ork ed
w i th
D r Farmer bo th on the ma in -
land at workshops and conferences that we convened and on
Guernsey and Jersey as the
interest
there in systemic
thinking
and
practice
has develope d. A t the same t ime D r Farmer has gained an
international
reputation
in the field of psychodrama. I t is our hope
as editors
that
this
book
w i l l enthuse practitioners to explore the
ix
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X E D I T O R S F O R E W O R D
interface and relationship among a variety of systemic interventions
in mental health thus creating both a r ich
exchange
of
ideas
and an
opportuni ty
for
n ew
ideas
to
emerge.
the meantime, Dr Farmer s book demonstrates ably th roug h
the presentation of wel l -thought-through
ideas
and clinical exam
ples what a dedicated c linicia n can do i n the complex environment
of psy chiatry i n ad ult mental health.
David ampbell
Ros raper
London
September
995
EDITORS
NOTE
In the interest of confidentiality names and
details
used in the cases discussed in this
book have been altered by the
author
who
accepts full
responsibility for the preserva-
tion
of
confiden tiality.
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FOREWOR
Psychotherapy . W hi le not yet speaking of fa m ily therapy as such,
Ackerman wrote:
The two-person psychoanalytic relationsh ip prov ides a unique
experience in which the earlier patterns of ch ild -pa ren t relations
are relived and
their
destructive elements removed. Group
Psy
chotherapy, involving three or more persons, however, has its
dynamic
base
in the fact
that
the child's character is influenced,
not only by the moth er, bu t all the interacting relationships
within the fam ily group, especially the relationship between the
parents.
These
multiple interpersonal patterns,
each
affecting the
other, also contribute to the distortion of personality.
n psychodrama, these interpersonal, interactional patterns are
explored in action, not merely analysed, a nd redirected in action.
To indicate how much resistance Ackerman
also
met when he
ventu red int o the gro up psychotherapy arena, he wr ote i n the
above-named article:
A t
a luncheon meeting of the American Orthopsychiatric
Asso-
ciation, at which the plan for the American Group Therapy
Association was launched, I
timidly
suggested
that
a study of the
process of Grou p Psychotherapy might provide a
natural
setting
for the acquisition of sorely
needed
knowledge in a new
science
social psychopathology. M y remark was not then received with
favor, but I s t i l l cling to that same prejudice. I believe careful
study of the process of group psychotherapy may yet give sub
stance to the now-emerg ing science of social psychopathology.
t is
easy
to see how Ackerman was drawn to Moreno's
ideas
and
how he began to take
steps
that culminated, some years later, i n the
organization of the Ackerman
Institute
for Family Therapy i n N ew
York
City.
Since then, gro up psychotherapy and psychodrama have bot h
become
accepted
procedures in many areas of interpersonal and
inter-
and intr agr oup conflict , with family therapy a
f i rmly
estab
lished branch. Dr Chris Farmer is here, and in the
sequel
to
this
book
presenting a very thorou gh overvie w of the ma ny way s he
has been able to use psych odrama in a num ber of settings.
t strikes me that perhaps the term psy choth erap y itself
should be revised. Are we certain that we heal psyches? Moreno
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FOR WOR i i
was of the opinion that
psyches
are particularly difficult to in f lu -
ence
H e felt that i t was
relationships
that do the
influencing,
and i t
was
through
relationships
that
healing
might
take place. Sh ou ld we
start
calling ourselves rela tion sh ip therapists' '? I t was especially
w it h
the sociom etric system that Moreno was concerned as the
basis for
charting,
diagnosing, and changing interpersonal
rela-
tions. Sociometry has been difficult for psych iatrists to grasp,
com ing , as they do, fro m medical
training
and the concern for one
particular indiv idual
at a time. It took a lon g time for the idea to
penetrate that a ll hu m an relations are inv olv ed i n psychotherapy.
Moreno placed sociometry as the
umbrella
under whic h group psy-
chotherapy and psychodrama
fell.
He thought that i t was basic to
gro up psychotherapy and psychodrama to understand the under ly -
ing hu m an relations, w h ich sociometry—th e measurement of
human
relations—could best reveal, like a microscope on the gr ou p,
whereas psychod rama was the microscope of the psyche with its
interrelations. Most psychotherapists who use group psycho-
therapy and psychodrama have
lifted
these approaches fr om un der
th e
um brel la.
D r
Chris
Farmer
has made sp len did use of sociometry
as well as role theo ry an d presents the
k ind
of systems
thinking
and
operations
that
form the gro un d of his ow n w ork . A l though
litera-
ture on psychodrama is proliferating in many languages, this use of
social systems is s t i l l
fairly rare,
an d therefore
this
book is a contri -
bution
to wh at is
s t i l l
in man y ways, a pione ering effort.
Beacon, New York
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PREF CE
C
om plex social
interaction within a small and clearly defined
geographical area provides fertile gro un d for a systems
therapist and for a
psychodrama
practitioner wh o wor ks
w it h families.
a small community, to be close to the action is to be pr ov id ed
with a
mult ipl ic i ty
of
perspectives
from wh ich to view the evo lution
of family systems.
Guernsey,
having a relatively
dense
population
within a well-defined physical bound ary, contains a high degree of
complexity
with
regard to the interrelationships of its residents.
Family
stories
extend over long
periods
of time and in one
place,
enabling clinical material to be put into context, both historically
and
contemporaneously.
The closer an observer is to the action, the
more specific
the inform ation
that
is
received;
i t is wha t is particular
that
is of importance wh en it comes to definin g
differences—a
task
necessary
for learning about
complex
interaction. What is specific,
however ,
is defined in relation to wha t is general, and wh at is
general is, in turn , an abstraction from similarities. Psychodrama
explicitly addresses
the specific: Who? , What? ,
Where? ,
or
When —these
are the
questions
that enable the stage to be set.
X
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i
PREF CE
The
scene,
howev er, is also a group-therapy room , and the cast are
gr ou p members, or perhaps are sym bolized by chairs;
their
mean
ing
is determined b y w ha t or w h o m they refer to, specifically, in the
minds of
those
present. Specificity, however,
does
not require a
faithful tran scrip tion of all phenomena so mu ch as a po rtra ya l of
the relationships am ong them . The mo st specific of all personal
information—the names o f people and
places—have
been
changed
throughout
this book
to preserve con fid en tia lity , an d the stories
have
been
fictionalized sufficiently to render
their
subjects u n i d e n
tifiable.
This
book
is about
l inking
systemic thought
with
action in psy
chiatry.
I t
consists
of descriptions in the form of narratives—my
o w n accounts of oth er
people s
stories.
Similarly,
as observers, sys
tems therapists and psychodrama practitioners
also address
the
observations of other
observers.
Different clinicians could have to ld
different stories concerning the same case material reported in
this
book. The patients and relatives, yet again, m ig ht have
covered
the
same
ground w i t h different narratives of
their
own. There
is,
however, an im porta nt distinction between narratives
that
are
deliberately invented to illustrate an idea— regard ed as t rue only
in a mythical
sense—and
those that are written as an historical
document. Even so, history can be regarded as a record of selected
observations.
If,
i n systems terms, what is more complex can help to explain
what is sim ple r, it is essential to decide what to include and what
to
leave
ou t to preven t the description itself fro m becom ing too
intricate
to be compreh ensible. The selection is person al a nd
subjec-
tive; i n keeping with a social constru ctionist view of real i ty , the
material
can be regarded as a ma p (m y ow n vers ion) of other map s.
Also, all narratives require selectivity w i t h regard to what is left
out. If every thing that happened were reported , there w o u ld not be
history ;
there w ou ld be but a record without meaning or interpre
tation.
The historian,
like
the family therapist, m us t punctu ate data
to pro vide useful inform ation . In real
life,
events in themselves do
not have beginnings or
ends.
These
are ma rke d according to w here
people choose
to define them . W hile aim in g to preserve the auth en
ticity of the ma teria l by refe rrin g to
sequences
of events and to
patterns
of clinical and family
interaction, this
selective process also
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PRE F E
X i i
serves to safeguard the con fide ntia lity of the
people
who were
involved
by m ak in g them unrecognizable.
n a sequel to this book the themes are elaborated i n m ore com -
plicated
stories that include work carried out
w i th
different
generations of fam ilies over extended perio ds of
t ime
yet
within
the
context of the
same
public health service.
Case
histories may
refer as far back in tim e as one is able to reco rd ; i t m ight be though t
that
the
Second
World War would have acted as a suitable his-
torical
l imit
i n tim e to the events cover ed yet the ve ry features of
the
Occu pation and the Evacuation figure significantly in the case
material
an d the stories con tinu e after the
wr i t ing
of this book.
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PSYCHODRAMA
A N D
S Y S T E M I C T H E R A P Y
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ntroduction
M
oreno,
the pioneer of interpersonal relations in the
fields of sociometry, g rou p therapy, psycho dram a, an d
sociodrama,
entered the dom ain of fam ily therapy wh en
he pub lishe d Inter-p erson al Therap y and the
Psychopathology
of Inter-personal Relations (Moren o,
1937a).
As Com pernolle
1981)
poin ts ou t, M ore no had i n 1973 presented form ula tion s of a
true systems
orienta tion, bu t he is not w id el y m entioned i n the
literature
of
systemic
therapy. I
believe
this
to be in
part because
he
had developed his own language of interpersonal relations and
therapeutic techniques, to
cover
wider
areas
than
family therapy,
before the adve nt of G eneral
Systems
Theory and its influence up on
th e
thinking
of later family and
systems
therapists. He has
been
most w ide ly kn ow n as the originator of psychodrama, w hi ch
until
recent
years
was no t appreciated i n terms of
systems
theory.
A f u l l
an d defi niti ve exposition of psychod rama as a
systemic
therapy was undertaken by Williams
1989)
when he defined its
techniques and its rationale in the language of
systems
and
cyber
netics. I t was also pointed out by Chasin, Roth, and Bograd
(1989),
w h o
described
a
means
to em ploy action techniques i n po st- M ila n
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2
P S Y C H O D R M N D S Y S T E M I C T H E R P Y
systemic interviewing, that action methods of various kinds have
had
a rich tradition i n family
therapy.
Tomm (1991) has developed
the
techniqu e of en coura ging patients to speak
from
the
inner
voice of family m embers by asking internalized other questions .
t resembles a psycho dram atic techn ique, such as role-rev ersal,
except that there is no phy sical interaction.
One ove rall vie w of therapy as
ch nge
concerns the association
between belief, perception, and behaviour; what we believe is
affected by
what
we see,
which,
i n
turn, depends
u p o n
what
behav
iour
is taking place.
Likewise,
ou r beliefs affect the w ay w e see the
w o r l d — h o w
we draw
distinctions
b y creating me anin gful
differ
ences
between the phenomena that we perceive (Bateson, 1979).
Our interpretation
of events, in
turn,
affects our behaviour
(Campbell , Draper, & Huff ington, 1989).
this w ay , ou r beliefs, an d thus our beha viour, can be vie w ed
as arising
from
the way we see the w o r l d and by the m eanin g
that w e attach to phenom ena. Such a recursive pattern impl ies that
our
beliefs are socially created, o r — i n the languag e of social ps y
c ho lo gy— c o nst r uc te d
(Kelly,
1955).
Psychodrama can be regarded as a medium for
proliferating
perspectives and making available mult iple ways of defining
phenomena.
It
is co-constructed (And erson, Goolish ian, & W in de r
m a n d ,
1987) by the protagonist, the
director,
and the grou p, and it
allows for a
mult itude
of p ossible scenarios to be e xp lor ed . I t is
grou nd ed in action, and i t allows behaviour to be experienced at
different
levels and vie we d from m an y angles by bo th the observers
and
the subjects of the actio n. A s experience an d pe rce pti on affect
belief, which, i n turn, influences behaviour, psychodrama, by
incorporating
the ideas, perceptions, and behaviour of many
people besides those of the prot ago nist , pro vid es recursiv e loops
that reflexly
influence the
relationships
between belief, perception s,
and behaviour.
Psychodram a exp loits the abundance of possible ideas, feelings,
and actions to create opp ort un itie s to determ ine the m anne r by
which
these can be
interrelated.
Instead of separating phenom ena
or beliefs
into dualities
or pluralities, systemic thinking involves
seeking the connection between appa rently indep enden t phe no m
ena or ideas and subsuming them into an overall pattern that
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3NTRO U TION
includes dich otomies an d distinction s at a highe r level of orga niza -
tion
or fro m a wid er v iew poin t (Fruggeri &
Matteini ,
1991).
this way , the
events
and
experiences
in a psychodrama are set
into a context fr om w hi ch they can more re adi ly be defined an d
understood.
Psychodrama
is par
excellence
a ma rke r of contexts
Boscolo,
Cecchin, Ca m pbe ll, & Drap er, 1985) insofar as the stage i s
precisely the place to create and shift contexts. F urth erm ore , as a co-
creative endeavour, it allo ws for socially assembled meanings to
emerge
fro m the intera ction of belief, perception , an d beha viour.
M y ideas about psychiatry and therapy were influenced by the
position
that
I adop ted as a practis ing medical clin ician . Th is, i n
turn, affected the app ointm ents I took an d the wa y
that
I worked.
This book is an account of the application of systemic
thinking
to
the unde rstand ing of psychodrama and of how I app ly
each
of
these
approaches
to general psychiatric practice.
The
ideas
developed as m y w or k as a psychiatrist
began
to
cover
a variety of treatment modalities from a
traditional
medical
approach, th rou gh various in di vi du al and grou p psychotherapy
models ,
to a way of conceptualizing mental health
care
that
incor-
porates different theoretical
perspectives
and styles of working.
This development of though t and
methods
of wo rk ing wen t
ha nd i n ha nd as theory and practice
co-evolved
through their
mutual
in tera ction , an d it led m e to reflect up on the relatio nsh ip of
one to the other.
I
see psychiatric w ork as inv olv ing both an ind iv id ua l
d o c t o r -
patient dialogue and various
models
of mu ltip le interaction
that
include, for example, a team of staff
colleagues
families,
groups
of
patients (in a therapeutic m ili eu ), and vario us
agencies.
To avo id
splitting
and pluralism, there has to be an approach to conceptualiz-
ing these
different methods in such a way that they are connected
through
one unified presentation
that
encompasses
them a ll. This
must apply both to the psychiatric
service
and to the in di vi du al
people
(staff, family members, and patients), so
that each
of the
ways of working has a relationship to the others. For a number of
years
I
have
carried tw o
titles:
Consultant Psychiatrist and Co n-
sultant
Psy chotherap ist ; one a pplies to m y status an d the tasks I
am expected to perform, and the other refers to particular ways i n
which
I wo rk. I
have
been
happy to
retain
both
titles
i n
that
I wo ul d
not wish to
have
on ly one of them w it h ou t the other.
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4
PSYCHODRAMA
AND SYSTEMIC THERAPY
Systemic thinking began to be
helpful
to me wh en I wo rke d
wit h
families. Later, i t also enab led m e to
link
together other ways of
w o r k i n g
with
patients,
staff,
families,
and
referring
agencies.
After
reading
a paper by
Fruggeri
and
Matteini
(1991), th er ap y i n a
state-run system of mental
health
care began for me to have a
distinctive
m ean ing accord ing to the context of the service in which
the therapy
was carried out: the
mental health
service cou ld oper
ate therapeutically if the w ay the meth ods of mental health care
were
thought
abou t had an effect up on h ow the service fun ctio ne d
and
vice versa. Psychodram a is rega rded as a me thod o f treating a n
indiv idual
and a grou p
concurrently.
I t
is ,
therefore,
a
paradigm
for
the
task of keep ing in m i n d simultaneously both what is specific to
indiv idual people and what is in comm on
with
others, be i t a pa r
ticular diagnostic category, an inevitable life problem (such as
grief), or the experience of bei ng a mem ber of a family, a patient in
an acute
ward
or day unit , a
staff
member of a particular
discipline,
or a participant in group
therapy.
Psychodrama, more than any other medium
that
I employ,
addresses
the need to conceptualize
individual ity
and genera lity
at the same time. I t illustrates ways of thinking systemically, and it
can,
i n
itself
an d in its o w n right, be reg arde d as a
form
of systemic
therapy that
eminently
allow s for
dov e-tailing
with other therapeu
tic med ia.
I n
writ ing about psychodrama as a systemic therapy, therefore,
I shall also be referring to way s of us ing systemic thinking i n
the
general managem ent of p atients i n a
state-run mental health
service.
This
is no t a
book
about
psychiatry
as such, nor is
i t
a
treatise
on
systemic thinking as applied to family therapy or
consultation
(for
which
see Cam pb el l et a l. , 1989, an d Jones, 1993).
Neither
is it a
manual or
treatise
on psychodram a, for which I suggest Blatner and
Blatner
(1988), Goldman and Morrison (1984), Kipper (1986), and
Kellermann
(1992). For the
distillation
of
the writings
of the fou nd er
of
psychodrama,
J
L . M ore no , I refer to
The ssential Moreno
(Fox,
1987) an d for a recently pu blis hed account of the use of psy cho
drama
in the
treatment
o f a family,
undertaken
b y
J
L. Moreno an d
Zerka
T . M oreno , I recommend the chapter Tim e, Space
Reality,
and the Family , written by Zerka Moreno, the greatest l iving
exponent of J. L . M oreno's w o r k , in Holmes and
Karp
(1991).
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5N T R O U T I O N
The
definitive
exp osition of the most mo de rn practice of psych o
drama is to be fo un d in Psychodrama
Since
oreno (Holmes, Karp, &
Watson,
1994).
is assumed that the reader is already acqu ainted w it h systems
theory, though
this
does not presuppose any
prior
knowledge of
psychodrama.
The psychodrama
sessions
described in
this
book invo lved
groups of between twelve and twenty-two
participants, including
tw o nursing staff, plu s the dire ctor; 20 of patients were fr om
the
ward ,
and the remainder were day
patients.
In most
sessions
approximately
60 of
patients
were female.
Ages
va ried from 16 to
65.
I
begin
with
a history of m y experience i n psy chia try an d i n
w o r k i n g
with differ en t ideas abo ut th erapy. I then focus upon a
description of psychodra ma in systemic language.
Later
I provide
illustrations with narratives
using
psychodramatic material. Finally,
in discussing how psychodrama relates to other
aspects
of patient
care I exam ine wa ys of thinking systemically abou t psychiatric care
in
general.
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CH PTER ONE
sychiatry
systems
nd dr m
SYSTEMIC F MILY THER PY
F
amily
the rap y look s at the system as it appears to the
thera-
pist and to the family members as they interact in a session.
I say i t appears bec use i t does not exist, except in the
minds of the indiv idual mem bers. Each mem ber a nd thera pist
w o u l d regard the system fro m a different vi ew po in t; if it were a
psychodrama and no t a
family
therap y session, each w o u l d present
his o w n distinct indiv idual representation of the family. There is no
correct portrayal. The family system is an abstraction that is
derived from each individual 's perceptions and form ula tion s as
these evolve together in the minds of the family members and the
therapists whi le
they participate together in dialogue (Anderson et
al., 1987).
Systemic family therapy seeks to enable the family t o define itself
in
such a way as is congruent for the
individual
members. The
feedback gained fr om such techniques as circular and reflexive
questioning helps each person to see himself more clearly in
rela-
tion to other family members. Together they utilize the knowledg e
of differences that feedback provides to construct a redefinition of
7
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P S Y C H O D R A M A A N D S Y S T E M I C T H E R A P Y
the family
system
that encomp sses
the descript ions of each
ind i
vidual mem ber. Thus , at the end of a per iod of systemic family
therapy,
one w ou ld i n theory expect that i f each indiv idual member
were to enact a psychodram a,
t
w o u l d
portray
a
family picture that
is more akin to that of other family members
than
i t w ou ld have
been before family
therapy
began.
This,
of course, is the
ideal—that
family members would have
recognized shared mean ings abou t ho w their
family
sh ou ld operate
and w o u l d then have interpreted the attitudes and behaviour of
each other in ccord nce
with
their beliefs. Such belief systems,
however, are not
static;
when recognized and expressed in dia
logu e, the shared configu ration s of belief evolve as the
family
members seek to incorporate their different ideas into a more al l
embracing pattern of meaning.
Like
a
f igure
i n gestalt psy cho l
ogy, beliefs never stay the same; as they are apprehended, they
merge into the g r o un d from which they ha d arisen and are re
placed i n the perce ption of the subject by different images.
For a family system to sur viv e and develop, i t
needs
to have
ccess to ,
and to utilize information from , the
wider
social system o f
which t
is a
part
a nd
which itself
is subject to
flux.
The family b ou nd ary is permeable to a varying degree, b u t entry ,
growth ,
an d separation or death is inevitable. As a family evolves
through time,
beliefs change to accom mo date to
transitions
i n its
life cycle an d to the vicissitudes of society outs ide the family. Fur
thermore,
individual members become more
differentiated
from
their
original family
b eliefs as they adap t themselves to life outside .
W ere people to vi ew themselves the same wa y i n
their
relationships
outside the family as the y do
inside, t
is likely that neither they nor
their family could develop
appropriately.
I f family members share
and
ccept each other's individual developm ent, they can evolve
together
w i t h relatively congruent ideas; if they can ccept differ
ences
and yet stay connected, they do not have to split off their
individual ity
from
their
family
life, and the other
family
members
also can deve lop
their
ow n autonomy.
What
is important is a unity
(but
n ot a uniformity) that a llow s for
differences. The
ideal family
model for systemic
therapists
includes
a shared belief about al lowing for or encouraging individuality
within a fram ew ork of m embers belongin g together b u t respecting
differences. T his I
w l l term
a m eta-belief of system ic therapists: the
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9S Y C H I T R Y S Y S T MS N D D R M
notion that
fami ly
members
can be different and have different
beliefs but
s t i l l
be
connected,
be attached, or be lon g to one
another in
some
way.
f systemic
family therapy
seeks
to av oid the
limitations
of treat-
ing one member rather than the fam ily as a wh ole, then i t m ig h t
appear
that psychodramas
by ind ividu als about fam ily problems
would be a contradiction to family therapy. Both media,
however,
promote differentiation of
self.
Thus, w hi le psychodrama has
everything
to do with
individual ity ,
i t is also a gro up activ ity and is
grou nde d i n com mu nal ity. In fact, it is the very structure and rules
of a psychodrama gro up
that
enable
a person to
find
his
ind iv idua l -
ity.* Whether we are in family groups or in stranger grou ps, our
selves
evolve i n relationship; it is thr oug h the process of
interacting
that
we
develop
and
become
aware of
ourselves
as individuals.
Moreover, we can only comprehend differences if there are also
similarities
from which the differences can be distinguished
(Agazarian, 1993). We gro w as families and as in div idu als thr oug h
both identification and differentiation.
PSYCHODR M
n addition to presenting dramatic action on the stage,
psycho-
drama exemplifies the dramatic qua lity of hu m an interaction in
general i n the way
that people
relate to one another and then reflect
upon their
exchanges.
[Throughout the
book
I refer to
psycho-
drama in a clinical context and in relation to its direct use in
elucidating
and resolving problems
that
relate to present or past
family
situations.] In life we are constantly engaging dramatically
w it h one another when we encounter
each
other in defined situa-
tions.
Our personal narratives are of
news
and not of routines.
Stories require the
interruption
of routines (Johnstone, 1979). Wh at
becomes meaningful and interesting is the way
connections
are
made between otherw ise commonplace or predictable events. Our
life
stories are about the inte rac tion of the expected with the unex-
pected—the
stuff of
comedy
and tragedy.
Hopes
become
dashed,
or
T h r o u g h o u t , i n general situations he is used for both masculine and
feminine pro ou s to keep the text as clear and as unc lutte red as possible
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10
P S Y C H O D R M N D S Y S T E M I C T H E R P Y
they are
fulfilled
despite obstacles. We are a ll dra m ati c inso far as
w e think of ourselves in drama tic terms; we are aware of b ein g
observed or experienced by those
with
w h o m w e
interact
(Brittan,
1973). Together we
each
conspire to create in
life
our own roles of
vict im
and
tyrant,
loser and w in ne r, an d so on . Th is is also the
language of staged dram a.
Analytic psychotherapy is a dialogue. For some peop le, i t is
sufficient
i n
itself
to gain
access
to feelings and to
l ink
them
with
thoughts to
find
me anin g. Others also requ ire actio n; they
express
themselves non -verba lly to sh ow as well as to
te l l .
Everyday
gestures
indicate
how we
express
ourselves
in
mo ve me nt— in
space
as
well
as i n time. As an amateur pianist, I am very mu ch aware that
music I rem emb er is not in m y head in a form in whi ch
t
can be
written on manuscript paper; t is recalled as I use m y h ands . W i t h
out the mov emen t of m y hands on the key board , I w o u ld not even
k n o w that
I remembered the details of the music. Thus from
action I
learn
f rom my self as well as about m yself.
Moreover,
with
action I can pu t a narrative into a fram e of refer
ence
w i thout
having to contextualize my conversation
with
additional language. Actio n can pu t wo rds into a framew ork
w i t h
out the use of yet more w ord s as me ta-dialog ue. Conv ersely, w or ds
can be the index of action: if the content of a communication is
words ,
then action is the
process
and vice versa. In drama, the
index of context and the context
itself
occur simultaneously
with
an immediacy that establishes an impact upon both actors and
observers.
Movement also
changes
the circumstances of the actor as
observer of himself. As a
pianist
hears his music
whi le
his fingers
are operating, so the self-reflective actor experiences him se lf roused
as he acts. Insofar as he sees the same scene differently as he
changes pos iti on , he experiences the others on the stage i n a nov el
aspect.
There are
important
differences between the contexts of
psychodrama and family therapy. Psychodrama is us ua lly a
stranger-group
activity,
even though
t
is very often about
families,
whereas family therapy involv es people who already belong to
a well-organized and long-established human group. The i m p l i
cations of this distinction are considerable. A prota gon ist w o u ld
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1 2 P S Y C H O D R M N D S Y S T E M I C T H E R P Y
Stereotype ©
ifferences
within
Groups
Subgroups
etached Men Involved Women
Women
Emot iona l l y warm
At t rac t i ve bu t impor tuna te
sensi t ive
c a r i n g but smothe r ing
empa th ic bu t d is tan t
i ndependen t
h ierarch ica l ly compet i t ive ^ e m o t i o n a l l y w a r m
-
spi r i tua l bu t a loo f
po l i t i ca l l y pass iona te
Funct ional Subgroups:
Behav iou r in c lose
re la t ionships.
Pursuers
IGUR 1 1
A
psychodrama is usually a
story
an d so i t has a
beginning
a
middle
and an end. It is n ot a
routine
an d unlike a play i n the
theatre the end is no t
k n o w n
to anyone unti l it has been reach ed.
The
m idd le
is th e breaking-up of set patterns. The
story
is that of
the protagonist.
I t evolves
as
i t happens
on
the stage.
N o t h i n g
is
pre-ordained. t is no t planned in advance. The protagonist usu ally
has a general idea of what he wants t o do bu t neither the prota go
nist
n or anyone else
w i l l
k n o w h o w
scenes w i l l
be experienced an d
ho w people w i l l respond
unti l
the actual
episodes
come to pass.
This
is no t to say that there is no structure. There is a psycho
dramatic
process which the
director
f o l l ows to enable the
protag
onist to
f ind
his way to tell
h is
story.
The
director has rules
and
techniques
to
a l low
the
p rotagonist
to
attain
the
required
roles
and
then i n portraying
them
to feel to act an d to think. Insight
and understanding
come
through
integration of experience shared
w it h other gro up members.
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13S Y C H I T R Y
S Y S T E M S N D D R M
PSYCHODR M
S
SYSTEMS THER PY
The first function of the directo r is to set bounda ries in space and i n
time (Fig. 1.2). There
is a stage, a
place
for
the actio n. There
is a
group. There
is an
over all con text—a n expectation
of
dramatic
action in the group. There
is a
time sequence: the warm-up,
the
action, and the
closure with
sharing.
Wi th
regard
to
the overall spatial structu re, the director attends
to a
permeable
boun dary between
those
on the
stage
and the other
members
of
the gro up . He d raws u po n the members for participa
t ion
in the scenes and he
scans
the gro up for its
response
d ur ing the
action; the audience is an essential par ticip an t whose contributions
the director taps. W it h ou t an audience—either real
or
implied—a s
witness to the action , there is no dra ma .
During
the action, the director helps the protagonist to m a ni pu
late
time and space in the
choice of
settings an d in the
starting
and
finishing
of indiv idual
scenes. He organizes scenes to take place in
the present,
even
thoug h they may represent the past, a h yp ot he ti
cal future,
a
pretend situation,
or an
impossible
scene
(termed
surplus
reality ) .
Scenes initially may portray wha t rea lly hap -
T H E
DIRECTOR REGUL TES
TH E
BOUND RIES
SP CE
ST GE
GROUP MEMBERS
D
= Director
°
P =
Protagonist
UX ~
uxiliary
oo
TIME
i
i
I
W R RM CTIOCTION
SH RINH RING
t
UP
1
F I G U R E 1.2
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14 P S Y C H O D R M N D S Y S T E M I C T H E R P Y
pened; later, howe ver, the director is more interested i n w ha t d id
not happen bu t m ig ht or should have taken place.
The director has
people
from the gr ou p act as the au xil iar ies
and take on the roles that represent aspects of the protagonist's
l i fe—inside or outside of the bou nd ary of his indiv idual self.
Al though
mainly
chosen
by the prota gon ist, they are regarded as
tools of the director to help the protagonist to demonstrate himself
in his life situation. These auxiliaries ty pic all y represent the signif i -
cant other people in the protagonist's life
with
whom he enacts his
drama. As an example, the action may
start
in the present d ay with
people
at work and then be followed by a family
scene
in wh ich
there is found to be a fundamental and unresolvable conflict of the
same
pattern. The
similarities
are exp laine d, and the prot ago nist has
the opp ort un ity to wo rk th roug h the origin al drama to a more
satisfying conclusion. From the experience of ach ieving
this
and the
process of struggling
with
the forces with in himself that have
h i th -
erto
been
out of contact or awareness, he gains
insight
and a
sense
o f
pow er. H e is able to accomplish
this
by ex ternalizin g w ha t is inside
and thu s seeing and therefore con fron ting w ha t he has
been
trying
unsuccessfully to grapp le with
internally.
Typical ly,
these
patterns
of conflict have
been
internalized du ri ng early fam ily
life.
The a uxilia ries are th us also manifestations of the protagonist's
inner life. The drama usually begins with an outside representation
of an un de rly in g repetitive and unresolved struggle with in the pro-
tagonist;
once
it is externa lized, he can encounter i t dir ect ly and
change
i t I n alter ing wh at is outside, the protagonist is also m o d i -
fied
internally
as he confronts the strugg le by enga ging him self
in
i t
The director makes the task possible by helping the protagonist
to invoke the characters of his story and then allowing him to
encounter them in a mann er
that
had not appeared
possible
or
desirable before. The director is a magician who
creates
possibi l i -
ties. The pr otagon ist is constantly give n choices. O n a psychodrama
stage, e ve ry thi ng an d any th in g is possible. Tim e can
pass
in any
direction and at any speed. I t can be
compressed
or interrupted at
any moment.
Space
can be contracted or expa nde d, an d it can be
filled
with any thin g— from the protagonist 's ow n inner ima gination
to his perceived outer w o rl d . Th rou gh the director's exp loitatio n of
meta phor, an yth ing can represent an yth ing
else
and, by a process
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P S Y C H I T R Y S Y S T MS N D D R M
15
termed concretization , ideas or images may be p u t in to spatial
dimensions i n the for m of objects or of
people
on the stage.
The protagonist must apprehend and
acknowledge
new possi-
bilities, and he must
also
learn to accept the impossibilities. He
mu st make the
choices.
The director
shows
w ha t is
conceivable.
The
protag onist mu st explore and understan d before he can choose, and
then he has to choose for hims elf. To accomplish som ethin g hitherto
regarded as impossible or undesira ble, he mu st see thing s i n a
new way . This is accomplished th ro ug h action. Instead of passively
accepting wha t is presented to hi m , he acts, and he inve nts as he
actively
creates
his own drama.
With
spontaneity, he
wil ls
as he
moves,
and he discovers as he explores.
Finally,
i n drama tic action,
as he
experiences,
so he
becomes.
Mental and bod ily action
become
one.
For the prota gon ist to see new possibilities, the directo r employs
(apart
from a m ult itu de of
secondary
procedures) certain basic
techniques
that
in vo lv e the use of other gr ou p m embers i n the roles
of auxi l iary
egos —tools
of the director, used to represent other
people
i n the dram a or p arts of the patie nt's self (real or i nv en ted ).
The protagonist, in addition to presenting himself (as he is, was,
should have been, wishes to be, etc.) (Fig. 1
.3
also
steps
into the
role of the other personalities in the dram a as he introdu ces them to
the
group. Group members, chosen by the protagonist, then be-
comes the
auxiliaries, taking
the roles of the
persons
portra yed (Fig.
1.4). In these roles, each auxi l iary w i l l
behave
as
seems
natural to
himself as a group member; the protagonist or director can correct
n
auxiliary
if the role is not su fficiently auth entic.
As well as the other people i n a scene, the director may
suggest
that
the protagon ist shou ld have a dou ble w ho stands just
beside
and behind the protagonist to empathize and to put into words
what the protagonist may be feeling but for which he has not yet
fo und a verbal expression (Fig . 1.5). The pro tag on ist has the oppor -
tunity
to modify or
negate
wh at the double has said, bu t the doub le
has in tro du ce d mor e possibilities. The dou ble, w ho is experienced
as a su ppo rtiv e pa rt of the prota gon ist, can distance him self just a
little
from the action and reflect aloud at the
same
time as the
protagonist is acting or speaking;
these
roles can alternate, so
that
the double can act or speak while the protagonist reflects.
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1 6 P S Y C H O D R M N D
S Y S T E M I C
T H E R P Y
PRESENTATION
O F SELF
o °
o o
Q
o o
Q
George as himself:
"I
have a
headache
which
I
get when my
mother
will
not
eave
me alone. — S
FIGURE
1 3
another technique, the protagonist
steps
outside the scene to
vi ew i t fro m a distance, wh ile an au xilia ry— refe rre d to as a m i r -
ror —represents the protagonist (Fig.
1.6 .
The protagonist is thus
able
to perceive
himself and
to
reflect about, comme nt up on ,
or
address
the mirror. The difference i n perspective allo ws the p ro -
tagonist to discern more possibilities or options for proceeding with
the
action. This interaction
with
th e mirror epitomizes the refle xiv -
ity (Hol land,
1977
of dra ma . The actor o n the stage,
typi fy ing
the
dramatic
aspect
of the hum an condition ,
keeps
the
audience
(real or
ima gined) i n consideration as he performs;
with
the m i r r o r , the
subject
literally
steps
outside h imself, as thou gh in to the audience,
to visualize his ow n situation .
The most powerful of
all
the techniques available to the director
is
that
of role reversal. The protagonist a nd an a ux ilia ry
change
places (Fig. 1.7 . I n the role of the auxiliary, the pro tag onis t interacts
w it h the au xilia ry po rtr ay ing the protagon ist. The protagon ist,
therefore,
sees
himself through the eyes
of
the
auxiliary
and at the
PRESENTAT ION
O F
MOTHER
Q
/
* X
George
as his
mother : ^
X
D
-
| r
)
Be your mother What
always
need
to know
f
p ] V
i
y ° nam e? How old
y
v
what George
is
up to .
V
—
are you?
What is your
^ — relationship
with
your so n?
O O O O O
o
o °
'Choose
someone
to
Dir J
be
your mother."
FIGURE 1 4
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17S Y C H I T R Y S Y S T MS N D D R M
T DOU LE
o o
o o o o o
o o
©
Choose
a doub le :
someone
to be a
second y o u
If you
didn't
pester me,
Td be more inclined to
tell
you.
M
Aux
FIGUR 1.5
same time puts himself into the shoes of the
auxiliary.
Typ ically ,
this role reversal is repeated a number of times. Among its many
functions—the
movement
itself
intensifies the int era ctio n— it
evokes
the
hitherto
unacknowledged and perhaps
unfulf i l led
rela
tionship between the protagonist as subject and the other
also
as a
subject. I n other w or ds , it puts into bodily form the protagonist 's
perc eptio n of the other person as a subjective be ing. In the language
of Buber (Inger, 1993), the I - T h o u relatio nship , w hi ch has been
internalized
by the pro tago nist, is giv en tangible expression as i t is
depicted on the stage.
Role reversal
also addresses
the relatio nship between the p ro
tagonist's own subjective and objective
selves
The protagonist is
TH E MIRROR
o o o o oo
0
o o o
the situation "
(Auxiliary
as G eorge's
mother}.
(Auxiliary as mirror
of George the
protagonist).
FIGUR
1 6
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18
P S Y C H O D R M N D S Y S T E M I C T H E R P Y
not only a subject; he is
also
an
object
of his own observing subjec-
tivity. I n other wor ds , fro m the role of another person he not on ly
engages
with
himself, bu t he
also
sees
h ow he relates to him sel f as
an object. In role reversal the prota gon ist i n the role of another
person regards him self bo th as an object of the other's gaze (an It )
an d as a T h o u of the other person. Thu s, in role reversal the
protagonist through his interaction w i t h others, is
made
aware of
his own relationships with himself. For example, his self may have
been
regarded as split into an actively observing m i n d and a pas-
sively experiencing body . There are many other
possible
conceptual
divisions of
this
kind.
The misconception that the self is a unity operating under the
control
of, or in direct relationship
with ,
the I (o r ego ) has
recently
been
reviewed by Symington (1993), who
describes
how
some of the inne r persona lities or part s of the self can be re la -
tively independent sources of action. The body itself, how ever, is
often
conceived
of as a
th i n g
or an
i t
(Laing, 1959).
I t
is an interes ting feature of role reversal
that
a chair or an
auxiliary
can be brought
in
to represent the
bo dy ,
a
part
of the
body
ROLE REV ERS L
o o
o o o o
n
o o O
F I G U R E 1 7
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PSYCHIATRY
SYSTEMS AND DRAMA
19
IGUR 1.8
or an inner self or personality; if the protagonist role-reverses with
his body (represented by a
chair or
by
an
auxiliary), he finds that,
as his body , he can speak to himself . In other words, he be
comes identified
with
the
people
and the parts of himself that he
invokes, and when externalized on the
stage,
these parts can engage
in dialogue (Fig. 1.8).
To
take mind and body as an example, these are sometimes
regarded as a duality, but in reverse-role they
operate
as a recursive
complementarity
(Keeney,
1983).
Indeed, the
person of
the protago
nist
is more than the sum of mind and body: role reversal can be
viewed
as a second-order cybernetics. It is no accident that role
reversal
is regarded as the engine , powerhouse, or motive force
of
psychodrama. The interaction becomes more concentrated and
dynamic
as the role reversal proceeds. The dialogue becomes
sharper and the content more specific.
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PSYCHODR M ND SYSTEMIC THER PY
TH E PSYCHODR M DIRECTOR
S SYSTEMIC OPER TOR
W h i l e the psycho dram atic approa ch i n itself is an effective thera
peutic medium, it is the way that the director actual ly
uses
the
techniques that
makes
the method powerful . A
scene
can
some-
times proceed w i t h the protagonist alone setting the stage
in t roduc ing
the auxiliaries, and role-reversing
w i t h each
as the dia
logue
proceeds;
the protagonist, on his own initiative,
uses
the
m e d i u m to explore what he
needs
to
discover
and to
fulfi l
wh at
requires c om pletion . Usu ally the protagonist eventu al ly becomes
lost. First he finds i t very
difficult
bo th to be the protag onist a nd , at
the same time, to negotiate w i t h the other members of the group.
The
essence
of drama is that one can act and speak
w i t h o u t
hav ing
to
comm ent u po n or qual i fy w ha t is being said; i t is usua l ly prefer
able
no t to have to engage in a me ta-dialogue. Al so , the
status
of the
protagonist in the group is such that he should not have to be b ot h
protagonist and director at the same time; the role of protagonist
demands
that he m ust be
free
to rel inquish co ntrol .
Second
psychodrama is as m uch about wha t
does
not or d i d not
happen as about what actual ly
happens
or happened in
life.
The
protagonist
needs
another pair of
eyes
that
sees
what is missing
from
his own vis ion.
The directo r, therefore, punctuates the action. H e in ter rup ts. H e
extends.
He connects what
appears separate.
Furth erm ore, as a tru e
systemic opera tor, he finds sim ilarities in the app aren tly different
an d differences i n the
supposedly
similar—whether this pertains to
specific
samples
of the action, such as a symmetrical escalation of
dialogue, or to the overall
shape
of the dra m a, wh ere, for exam ple,
he ma y
observe
an isom orp hic patt ern between a present-day office
scene
and a child ho od family incident.
By stop ping the action, by questioning the protag onist, the au xil
iaries, or the group, the director clearly is regarded as controlling
the proceedings.
It
m ig ht be thoug ht that the protagon ist can ha rd ly
f ind
his
i n d i v i d u a l i t y
und er such circumstances. It is, ho w eve r, the
director's control that al lows the protagonist to be
aware
o f what
otherwise are the hidden restraints—to seeing choosing, acting—
that
are
w i t h i n
himself or
bear
up on himself . The mean ing of the
w o r d
co n tr o l is i tself a social constru ction.
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21
SYCHIATRY
SYSTEMS AND DRAMA
In
syst em i c t h ou g h t , the notion of ph ysi c al c on t rol of one l i v i n g
t h i n g by another is not c o n s i d e r e d h e l p fu l w h e n it refers to one
m a k i n g the other
do,
t h i n k,
or
feel som ething .
The wa y an
o r g a n
i s m r e s p o n d s to s t im u l i is d e t e r m i n e d b y its o w n st ru c t u re
( M a t u r a n a & V a r e l a , 1980). A prot ag on i st may r e s p o n d to i n f o r m a
tion if it is p r e s e n t e d in a way that is m e a n i n g f u l to him , but
w h e t h e r he r e s p o n d s and ho w he does so is a matter that d ep en ds
u p o n the protago nist him self . The director, in fact , only co nt ro ls
w h a t he h i m s e l f does or s a y s . H i s power comes from the status
g i v e n to h i m by the g r o u p , one role of w h i c h i n c lu d e s an o b s e r v i n g
st an c e (M at u ran a
&
V a r e l a ,
1980). He is the
o n l y
one wh o is e m -
p o w e r e d to w a l k a b o u t the stage i n d e p e n d e n t l y of the action of the
a uxi l i a r i e s . The group h a v e i n v e s t e d h i m w i t h the role of a m o v i n g
observ er. The di rec t or can c h o o s e w h e r e to observ e f rom . Fu rt h er
m o r e , he can el icit other observations from any one else in the
group
or on the stage.
If observ at i on s are m a d e by detecting differences, then the d i r e c
tor is a l s o s e a r c h i n g for new v i e w p o i n t s f ro m w h i c h to d i s c o v e r
s u c h
differences.
In
o t he r w o r d s ,
he is
also
a
m e t a - o b s e r v e r
of
differences. H e creates conditions for feedback. As the protagonist
a n d
the gro up , together, acq uire new inform ation from fresh
s o u r c e s
of
feedba ck, they
evolve
into
a
mo re self -correcting sy ste m .
It is, then, the protago nist un de r the cond itions of this group s y s t e m
w h o m a k e s his ow n c on n ec t i on s and who finds his ow n m e a n i n g .
Th e di rec t or h el ps h i m to f ind the clues.
Th e di rec t or a l so h el ps to m ak e t h i s wh ol e p roc ess po ssi bl e . He ,
w i t h
the
p e r m i s s io n
and
cooperation
of the
gro up , creates
the
c o n
di t i on s for p s y c h o d r a m a . H e a l so m a r k s the c on t ex t (B osc ol o et
al. , 1985) as he pu n c t u at es the action. H e d e c i d e s w h e n to presen t
m ore c h oi c es to the prot ag on i st or w h e n to h el p the prot ag on i st to
n ot i c e wh en he is a v o i d i n g a choice or a c o m m i t m e n t to a cho ice.
W h e n e v e r the di rec t or i n t erru pt s the ac t i on , he is m a k i n g an
i n t erv en t i on .
H e talks to the protagonist , an a u x i l i a r y , or p e r h a p s to
t he g r o u p , a s k i n g for c om m en t s f rom part of the o b s e r v i n g s y s t e m .
A piece
of
ac t i on c an
be
r e p e a te d , p e r h a p s
in a
different
way
(it
can
be argued that in a repetition there w i l l not be an exact repl i c at i on ;
there w i l l be som e difference, w hi ch may be u s e d as a resou rc e) .
Th e prot ag on i st
can be
a s k e d w h a t
he is
e x p e r i e n c i n g — w h a t
he
wan t s f rom the sc en e an d wh at is m i s si n g . Th e prot ag on i st a l so can
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PSYCH ODR M N D SYSTEMIC THER PY
stop at any t ime to c o m m e n t or to talk, as can the au x i l i ari es .
S o l i l o q u y
as a
theatrical device
is
a l so v ery pow erf u l .
It not
on l y
conveys
" p r i v a t e " t h o u g h t s
to
the gro up ;
it
a l so prov i de s t i m e an d
s p a c e for the protagonist to reflect d ur in g the m i d d l e of a sc en e o r
c on v ersat i on .
It is in the use of m etap ho r that the dire ctor is m o st i m a g i n at i v e.
As prev i ou sl y st at ed, on the stage a n y t h i n g can r e p r e s e n t s o m e
t h i n g
el se . W h ere possi bl e , use is m a d e of the prot ag on i st 's own
symbols, and often these point
to
the essence
of
t he p s y c h o d r a m a .
F o r e x a m p l e , a prot ag on i st m ay feel "bo xe d i n at w o r k . L a t e r
an ot h er
bo x may be
f ou n d
in
fam ily life
or in
c h i l d h o o d e x p e r i
en c e.
Th e box is
c reated w i t h c h ai rs
or
w i t h p e o p l e . T h i s
is a n
i n st an c e of the director's use of concretization to m ak e the a bstract
tangible. The protagonist can c o n v e r s e w i t h the box, rev erse-rol e
w i t h
i t, an d ph ysi c al l y grapple w i t h i t. If th e box represen t s p art i c u
la r peopl e, t h en au x i l i ari es
can
represen t them
as the
protagonist
wrest l es , u si n g h i s bodi l y power, to b e c o m e in touch w it h feelings
t h u s far l oc ked i n si de h i m an d perh aps h i t h erto u n re c og n i z ed.
T h e r e
is
an ot h er f u n dam e n t al propert y
of
p s y c h o d r a m a t ha t
goes to the roots of the relations hip betw een families, rel igion,
a n d
the State. When
I
beg an s l ow l y
to
b e c o m e i n v o l v e d
in
p s y c h o
drama, its particular attraction for me was its apparent universality,
i t s appeal to wh at dee pl y m at t ered to peopl e, an d its power
throu gh its vital ity and intensity to ho ld their ima gina tion at a deep
le ve l . L i k e t h e prea c h i n g
of
J oh n W e s l e y
or
the rheto ric
of St P a u l or
o f M a r t i n L u t h e r
K i n g ,
it ha d the influence to touch the hearts and
move
the spirits
of
m e n a n d w o m e n . T h e cl u e
was
the sign ifican ce
of dr am a an d i t s beg i n n i n g s i n an c i en t Greec e.
Plato w as n ot en t h u si asti c abou t dr am a bec au se of th e u n b e c o m
i n g
e m o t i o n s it
gave
to p l a y e r s of ignoble roles and the base
p a s s i o n s
it gave to the
spec tat ors. D ra m a
was
c r i t i c i z ed
for not
being true to l i f e . O t h ers , h owev er, saw that it was prec i sel y the
am bi g u i t y bet ween the as if an d the " r e a l " (the p l a y i n g w i t h
differences ) that dr ew people
to
d r a m a . G r e e k d r a m a
is
s a i d
to
h av e st art ed wi t h
the
f irst c it izens' jury,
wh o
t r i ed O rest es
for
kil l in g C l y t e m n e s t r a , his m o t h e r (a " co u r tr o o m d r a m a " was p e r
h a p s the arc h et ypal pl ay ) . I n st ead of h a v i n g O r e s t e s p u n i s h e d by
t h e av en g i n g Fu ri es , t h e State took over the responsibil ity
for
d e a l
i n g w i t h the p u n i s h m e n t of h o m i c i d e . I n d i v i d u a l and family
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3
S Y C H I T R Y S Y S T E MS N D D R M
retribution
was given over to the social management of equity. The
first plays were adversarial
battles
over rights and wrongs, respon
sibilities, and injustices.
It is interesting to remember this historical background in a
courtroom sentencing scene (a device of modern psychodrama),
when a protagonist is given the power to avenge his adversary.
Very often this happens when the protagonist is an adult victim of
child
abuse
and is expressing
outrage
at the perpetrator. Revenge
and retribution are no longer the prerogative of family members in
the civilized Western world, where such passions are denied ex
pression and justice is at the disposal of the courts.
Nowadays it is not so much the murder of parents by children
for which justice is assigned to the institutionalized mediation of
the courts; it is decidedly more often the abuse of
children
by their
parents that is supposed to be dealt
with
by socially established
methods of jurisdiction. It is not murdered parents who are
unavenged, but injured children who have to assign retribution
over to society and who, deprived of an outlet for their rightful
anger, are also thereby denied the working-through of their
indi
vidual grief.
THE
CONTEXT OR CLINIC L PSYCHODR M
Despite the universality of dramatic engagement, psychodrama is
not itself the epitome of therapy for everyone. Family therapy has
addressed the problem of treating in isolation an identified
patient who is the
scapegoat
or symptom-bearer for the rest of the
family.
Psychodrama might often clarify the position if given suffi
cient
information from the protagonist, but it has to contend with
the power of a family—particularly one with which a patient is in
constant contact—to overcome any
efforts
of
even
an insightful and
motivated individual to differentiate himself.
Furthermore,
the
reci
procity between the protagonist and the other family members
could well
entail the latter requiring help in adjusting to the chang
ing
pattern of relationships.
With
a need to modify the universality
of psychodrama with the systemic framework of family therapy,
breadth as
well
as depth is required.
In
Guernsey, where
I work, I have the autonomy to
operate
in an
unconventional
way for a consultant psychiatrist in a general adult
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24
PSYCHODR M ND SYSTEMIC THER PY
psychiatric practice. The island also has a very circumscribed po pu
lation, thus making it
possible
to make
contact
w i t h different family
members
or to fol low them up
over
long
periods
of time. Another
effect
of wo rk in g in a small and we ll-defined environm ent is
that
there are
l ikely
to be
fewer levels
of hiera rchy i n a therapeutic
system. This makes
i t
possible for me to wor k in and f ro m differe nt
positions: in the home of a family, in
one-to-one
w o r k w i t h an
indiv idual ,
w i th a multidisciplinary team at ward level, in
group
therapy and
psychodrama,
with the
courts
and care
agencies, liais
ing with
the
physicians
in the hospital, working
w i th
the family
doctors,
the charities, and
occasionally
at the political level. The
significance of exercising
choice
in terms of the observational field
in the area of mental health is pointed out by Telfner (1991).
Working in
these
various areas, I noticed
that
different time
spans were
appropriate to the various
levels
in the hierarchical
system fr om wh ich I was op erating. If the situation
needed
immedi
ate attention , it was probab ly in the fam ily
home,
whe re, for
example,
the children s officer, a fam ily doctor, or the police had
been
called i n , i n
response
to a crisis. The interaction of the two
systems—family and
agency—required
a quick
decision,
as there
was l ittle time for a ll to be
together
in the hom e.
On the wa rd also, how ever, the
need
for a pr om pt
decision
migh t
have arisen
such
as when the nursing staff
were
required to decide
how to manage a patient who had suddenly changed his mind
about
being a patient. Could
such
a
person
be restrained? Was it
legal? Was it
dangerous?
W ou ld the patient
come
to harm if he left
the
hospital?
These
were
major
decisions,
and there was
l ittle
time
to reflect or to
engage
i n
dialogue about
them.
Unfortunately,
such moments
often encapsulate i n a ver y short
period of time the essence of the pro blem re qu irin g the patient to be
in the ward; the patient might have
been
attempting to determine
the point in time and the length of time over which a
decision
was
to be made. The staff
were
feeling
responsible,
but the patient was
setting the
agenda
and demand ing action —in other words, a deci
sion. (For a
systemic
exposition of this dilem ma at the wa rd level,
see Mason,
1989.
This
incongruous
hierarchy
could
have
resulted from an earlier
failure to
negotiate
with the patient (and
possibly
his family
a n d / o r
the referring agency an agreed rationale for his stay on the ward.
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25
S Y C H I T R Y
S Y S T E M S N D D R M
"Urgent " problems of this
kind
do not
seem
to appear when the
reason
for admission is
agreed
upon by the staff, the patient, the
family,
and the referring
agency;
all then
have
the
same
plan and
hop efu
top related