Theoretical Development and Various Applications of the Group-Analytic Psychodrama

Theoretical Development and Various Applications of the Group-Analytic Psychodrama

Vassiliou O., Livas D., Karapostoli N., Papadakis Th., 2006. “Theoretical Developments and Various Applications of Group-Analytic Psychodrama”. International Journal of Therapeutic Communities, Vol,27 (2), p.p. 275-290.

ABSTRACT: Group Analytic Psychodrama is an original approach which is derived from the dynamic interaction of the classical psychodramatic procedure and the group analytic principles. It was applied in 1980, in the context of the Psychotherapeutic Community of the Open Psycho­therapy Centre (OPC). According to this approach we suppose that two distinct processes occur within the group: the group process and the stage action. The emphasis is laid on the link between them, which results from the continuous transition between the group as a whole (matrix) and the action on stage (acting out the group matrix). The matrix of the group contains the undesired and destructive impulses of the self, which can be acted out through playing. The group’s potentiality to ‘play’ with personal and trans­personal conflicts and to incorporate them in the thera­peutic process seems to allow the possibility of resolving transpersonal as well as inner conflicts. The above procedure is essential as it offers the opportunity for corrective emotional experience in a short period of time, especially for severely disturbed patients, who have difficulty in expressing themselves in groups, where verbal communication is prominent.

Initially, Group Analytic Psychodrama groups functioned in the Psychotherapeutic Communities of the OPC with the so-called ‘difficult adult patients’ (borderlines, psychotics etc.). Later, their function expanded to the therapy of children, adolescents, and young adults as well as in several training activities of the organisation in a non-clinical population. During a 25-year period, Group Analytic Psycho­drama attained a sound theoretical basis and was established as an integral therapeutic approach.

Introduction

Psychodrama is composed of elements which are implicit in the term itself: from the Greek word psyche, meaning breath, spirit, soul; and drama, which according to Aristotle is the imitation of people in action, of people doing things (Poetics, 1, 5). Aristotle attributes the origins of poetry to two particular causes: the instinct for imitation through which man learns his first lessons and the amusement people always get from imitations: we enjoy seeing similarities because, as we look, we learn and infer what each one is (Poetics, 4, 5-6). Two thousand years later, play and action were introduced into the psychotherapeutic scene in an attempt to deal with the monopoly of biological and verbal therapeutic methods, dominating psychiatry until the onset of the 20^th century. New approaches, such as Psychodrama and Therapeutic Community, adopted active methods as a therapeutic means.

Psychodrama is the most significant and well-known contribution of Jacob L Moreno, who mentions that, from a historical point of view, psychodrama represents the movement from individual to group psychotherapy and from the therapy through speech to therapy through action (Moreno, 1946). More specifically, “psychodrama is a method of psychotherapy in which patients enact the relevant events in their lives instead of simply talking about them” (Blatner & Blatner, 1988: 1).

Group Analysis also refers to action, since it considers the group as providing a setting for action, reaction and interaction. Foulkes (1975) said that the most powerful factor in bringing about change is based on the “ego training in action” and not so much on insight or interpret­ation. He pointed out the significance of relating within the group matrix as a means of corrective emotional experience. The psycho­dramatic action also occurs in the present situation and the emphasis is on the transforming of non-spontaneous ‘there-and-then’ actions into more spontaneous ‘here-and-now’ actions.

The connection between Group Analysis and Psychodrama is rather old. Foulkes mentioned that “the group analytic situation has socio-dramatic and psycho-dramatic qualities and has certain affinities to the technique elaborated by Moreno” (Foulkes, 1964: 95). Other authors have discussed the similarities between these two approaches (Papadakis, 1984; Pines, 1986; Kellerman, 1986).

Group analytic psychodrama

Before proceeding any further, it is necessary to present the framework within which Group Analytic Psychodrama was initiated. The Open Psychotherapy Centre is a private, non profit organisation, which has been operating in Athens since February 1980 as a psychiatric day-care unit. The services which are provided by the OPC are addressed to individuals who face any type of psychiatric problems, and are coming of their own free will. The Therapy Department, among its other activities, includes three Psychotherapeutic Communities (the Daily, the Fortnight and the Summer TC), each one of them suitable for the various therapeutic and practical needs of our clients. The Therapeutic Communities include sociotherapy groups, psychodrama and large groups and their main therapeutic approach is influenced by the principles of Group Analysis. They constitute a new version of the democratic model suitable for the treatment of severe psychiatric disorders (i.e. psychotics, borderline personality disorders, psycho­somatics etc.), which has been first described by Tsegos (1982) as a Group Analytic Psychotherapeutic Community.[1]

Psychodrama was one of the first groups to function within the context of the Psychotherapeutic Community of the OPC (1980). Thalis Papadakis, who had been already trained in Psychodrama, and at that period was a trainee in the Institute of Group Analysis (Athens), was the person who created the first Group Analytic Psychodrama group and was theoretically preoccupied with the new approach. The main characteristic of this group was the inevitable and catalytic influence that both the Psychotherapeutic Community and Group Analysis had on the psychodramatic process. The result of this influence was the successful synthesis of the group-analytic dynamics with the psycho­dramatic process, so that an original psychodramatic approach was created.

 The Group-analytic Psychodrama as well as the Group Analytic Therapeutic Community setting, as they both have been developed at the OPC, contain a lot of qualitative resemblances, while their main difference seems to be only of a quantitative nature. They both result from the same theoretical ‘wet nurse’, Group Analysis, though they have been nurtured mainly with the sociological or community kind of foodstuff. Group Analysis on the other hand has been nurtured by psychoanalysis, sociology and T.C. (Foulkes has been an outstanding figure of the Northfield experiment) (Tsegos et al., 1997).

 A Group-Analytic Psychodrama group is following the group analytic theory and, to some extent, its practice: it is comprised by a group of 3-10 persons, the frequency of the group is either once a week or twice a month, its duration is one hour and a half and it is usually a quick-open group. It is coordinated by one conductor and usually a co-conductor, who also participate actively in the acting. The psychodramatic procedure consists of the:

Initial Phase: The Group Space (Matrix). The group space is marked out by the circular arrangements of the chairs, the members, the fixed place and time, the frequency and the duration of the sessions. The group has a specific purpose during this phase: to find the topic, to make the scenario, to distribute the roles among the members. Through free floating discussion, a high degree of communication (verbal and non-verbal) develops among the members. This dynamic exchange of ideas, thoughts, emotions, wishes, and fantasies forms a network of communication, the group matrix according to Foulkes (1957), which is the shared common ground of the group members. We assume that the finally selected theme does not only express one member but the group as a whole. It is an expression of the group matrix.

Second Phase: The Stage Action. When the enactment begins the circle opens, the audience remains silent on the one side of the room and the stage is created on the other side. The space of the stage is neutral and it is usually formed imaginatively. It contains all the group action, the part previously agreed upon as well as the part which will arise spontaneously.

Third Phase: Returning to the Group Space. After the enactment, protagonists and audience get together in the group space, which again finds its circular form. The group talks about whatever was expressed through action. It is the beginning of an internal dialogue and the phase of corrective emotional experience which takes place within the enriched group matrix.

Thus, the topography of the psychodrama room is hypothetically divided into three important parts: the group area, the ‘stage’ and the intermediate space in between. This imaginary intermediate space is defined by the two other places of the room, where structured procedures take place. Despite the fact that nothing perceptible is happening in the intermediate area, this space is considered as equally important in the Group Analytic Psychodrama to the other two clearly defined spaces, as we will discuss later.

Therapeutic procedure

Each patient enters the group bringing along his own pathological patterns of behaviour and manners of relating, destructive more or less towards himself or the others. Sooner or later, these behaviours will become explicit to the group. One of the main characteristics of mental patients is that they have established a rigid and concrete role: they may be pathetic, weak, destructive, passive or extremely energetic, difficult to deal with etc. So, the first step of the therapeutic procedure is to re-orientate the patient from his illness to himself as a person (Tsegos, 1982) and to extend his/her repertoire of roles. Psychodrama facilitates this re-orientation through the enactment of multiple roles. The structured stage action offers the opportunity of experimentation with new roles, of learning by action, while simultaneously the group is supportive and confrontative.

Furthermore, stage action offers an additional means of communication with others, an attractive and playful way of relating, especially for patients who have difficulty in expressing themselves in groups, where verbal communication is prominent. Through action, members get involved with the therapeutic procedure and establish a relationship with the group.

After the establishment of a relationship with the group, follows the need for change of those behaviour patterns which are disturbing to the individual’s life. Fortunately, the group always provides a lot of material to work with in the here and now situation. There is a paradox going on in the psychodramatic procedure: the group makes destructive behaviours explicit and, through the enactment, legitimates them, by restraining them to the rules of play. During the enactment and within the rules of stage action, the members of the group may express, in a dramatic way, their fears, inner conflicts and destructive impulses. It is as if the group thinks instead of a person, as if the whole group stands there as an auxiliary ego for each member. “The matrix of the group has the capacity to contain the undesired and destructive impulses of the self, providing the group members with the psychological space, within ” (Pines, 1984).

The group’s ability to play with destructive impulses and to incorporate them in the therapeutic process seems to allow the possibility of resolving transpersonal as well as inner conflicts. The psychodramatic procedure facilitates catharsis and insight; but these are not the optimum therapeutic factors. “Psychodrama is therapeutic because it is an attractive point of reference for participating in a procedure which has to do with structural elements of psychism, which mental patients usually lack” (Tsegos, 1993b).

According to Winnicott (1971), the whole psychodramatic procedure offers the potentiality of multiple transitions, which are crucial for the identification procedure. In each session we may observe several transitions: from the group space (structured procedure, fantasy, matrix) to the stage (enactment, acting out conflict situations, symbolic dramatisation of some parts of the matrix). The emphasis is laid on the link between the group procedure and the stage action. It is a psychological play between the transitional phenomena of Winnicott, which are closer to external reality (such as action, play, imitation, role symbolism) and mental phenomena, which are closer to inner reality (such as fantasy and matrix).

James (1982) mentions that “the involvement of the patient in a space of transitional phenomena has an effect on his own transitional space and structures.” The materialisation of the transitional space in Group Analytic Psychodrama is made by the existence of clear boundaries between the group procedure and the stage (Papadakis, 1984).

Therefore, we assume that the main therapeutic factor in group analytic psychodramatic procedure is based on the multiple transitions. During these transitions “the person remains for a while in a situation which is bounderless and unstructured and where he lives in a kind of ‘vacuum’ experience. We can assume, then, that during this time the person is somehow ‘lost’ and therefore ‘forced’ to become aware of his/her own strengthening elements, as he/she is obliged to mobilize the procedures in order to acquire the sense of srength, or even to further develop boundaries and harden his/her own structure” (Tsegos, 1995b).

The crucial differentiation between Group Analytic Psychodrama and classical Psychodrama is the full utilisation of the group’s therapeutic potential, since we consider that the enactment is not a representation of the inner conflicts or impulses of one person (the protagonist), but of the whole group. We suppose that, in the first phase, the internal reality of each member is identified with the group matrix. In the second phase it is externalised through dramatic representation (as repetition of action and not real action), and during the third phase it is reconstituted (as a group and individual matrix) and enriched with the experience of action conflict (Papadakis, 1984).

Theoretical approach:  Historical development (1980-2005)

In the past 25 years, Group-Analytic Psychodrama acquired a solid theoretical basis and it was established as an integral therapeutic method, which was also successfully applied in other fields. Some crucial theoretical points of this development were:[2]

Transition

The Dissertation of Thalis Papadakis for the Institute of Group Analysis, Athens (1984), entitled “The Group-Analytic Psychodrama: the Enactment of the Matrix”, constitutes the first important step through which the new approach acquires theoretical basis. The author discusses the significance of the transition from one space to the other; that is, from the group space, with the specific characteristics which constitute the context and the structure, to the space of the action on stage, which includes movement and action, as well as verbal and non-verbal communication. In each group session there are one or more transitions from one space to the other and during this short passing members are experiencing an unboundaried condition; it is during this passing that they ‘strip’ themselves from the previous role (i.e. patient, or conductor or student). The same applies, when the ‘actors’ come back from the stage to the group, as now they ‘strip’ themselves from the character they have played on the stage. Thus during one Psychodrama session we have the opportunity to experience several transitions and alternations of the matrix: from the group matrix to the enacting matrix of the stage and back to the matrix in the group.

On the basis of the above theory, the Group-Analytic Psychodrama is defined as a representation and not as a repetition of accidental facts and actions. Substantially, it seems to be a play as a whole, and not only as concerns the actions which are enacted on stage. And, as it has a clearly structured group procedure, it becomes the context through which the Matrix and the Fantasy element can be cultivated. Consequently, the therapeutic factor lies in the constant interchange between the two poles, the ‘Fantasy’ and the ‘Symbolic’, through the transition from one pole to the other (Papadakis, 1984).

Aristotelian concept of drama

According to Papadakis (1984, 1986, 1987) in the Group-Analytic Psychodrama, the Aristotelian formulation of Drama and the concept of Winnicott’s Transitional Space (Winnicott, 1971; James, 1982) meet with the concept of Foulkes’ Matrix (1957, 1964, 1975). The influence of the Aristotelian concept of Drama in the Group Analytic Psychodrama was discussed again some years later in the Dissertation of Christoforou (1995) for the Institute of Psychodrama-Sociotherapy, entitled “Elements of Ancient Drama in the Group-Analytic Psychodrama”. She concludes that most of the elements which define the Classical Tragedy are met and applied in the Group-Analytic Psychodrama. In this way, the latter functions as a miniature of the ancient drama, though with much more tension, as its aims are therapeutic and developmental. Additionally, they both serve and reflect the community (ancient democracy or Therapeutic Community). Through this comparison, the Greek character of the Group-Analytic Psychodrama becomes apparent, not only because of its common elements with the Ancient Drama, but also because of their common native place, Greece.

Training in sociotherapy-psychodrama

In 1985 the four-year postgraduate Training in Sociotherapy began, and two years later, in 1988, Psychodrama was also added in the title of the training (it was an integral part from the beginning). The Institute of Sociotherapy and Psychodrama, which is entrusted to provide the specific training, belongs to the Training and Research Department of the OPC. In this phase three articles were written by Tsegos concerning the Training of Sociotherapists-Psychodramatists, in which special emphasis was laid on the decision to include the Psychodrama Training into the TC Training as an element of equal importance for the training of a prospective TC worker or a Psychodramatist. According to Tsegos:

By comprising Psychodrama in the Training of Sociotherapy, we acquire among others a kind of a microcosm of a Therapeutic Community’s setting. As the participation in a Therapeutic Com­munity setting increases the potential for communication in differ­ent roles and different levels between the individuals, it is the same that occurs in the Group-Analytic Psychodrama. Both sides (patients and staff) can be taught that they are also capable of assuming several roles. And, apart from the roles which they are enacting, they become aware that they are individuals who need to communicate as persons (Tsegos, 1996, 1997, 1999).

More recently, in his book “The Disguises of the Psychotherapist” (2002) a whole chapter is dedicated to the Training Community in Psychodrama-Sociotherapy.

The role of the therapist

As has been described, the Group-Analytic Psychodrama’s conductors do not restrict their participation into a kind of director’s role but they participate actively in the process of acting, and do not function as an authority or director, as is the case with the classic Psychodrama.

Tsegos, in his presentation (1993b) “Moreno’s Fracture (or about ‘God’, Director and Conductor)” attempts to examine the role of the Classical Psychodrama Director in comparison to that of the Conductor in the Group-Analytic approach: “the therapist’s role must be limited only in providing the necessary conditions for the unforced emergence of wishes, intentions or pursuits of the group members as persons. It is his/her job neither to choose the material, nor to suggest scenarios or ways of playing the different parts.”

While the role of the psychodrama conductor is, on the one hand similar to that of the Morenian Conductor, on the other it is distinctly differentiated both qualitatively and quantitatively by the influence of Group Analysis. For example, in the Group-Analytic Psychodrama there is no role that constitutes an exclusive privilege of the Conductor. On the contrary, any role is a possibility for all the group members (Papadakis, 1984; Gyftopoulou, 1996).

Other therapeutic factors

Apart from the therapeutic value of multiple transitions, other therapeutic elements of the procedure were examined, such as the significance of the Role (learning of, or familiarisation with, a frightening role). “Psychodrama facilitates the creation of relationships with the other group members, which facilitates the closer contact with the repulsive or repressed parts of the self. In this way, the importance of Psychodrama lies in the playful character of its procedure” (Tsegos, 1993b).

Another important issue was brought up by Tsegos: “the issue of the person has not been given the attention it deserves, for we use it mainly in juxtaposition to the statistical notion of the individual in order to emphasise its uniqueness, the particular qualities of the personality and so on. The corresponding Greek word prosopon draws its etymological origin from the verb ‘I see’ or ‘I face’” (Tsegos, 1995a: 320). Considered in a quantitative dimension, the man is an individual in relation to a group of people (membership). The concept of the person presupposes the presence of others and involves a real encounter of two or more people without any semantic implications or deceptive suggestion of roles. The person uses critical, intellectual and abstractive ways of expressing himself and, in particular, intuition, emotional and sensory expression (Tsegos, 1993a).

“When an individual is placed in the cyclical setting of the group and is under the influence of several eyes, we may assume that being under the illumination of these constant looks and gazing upon the face by several spectators, with whom he or she creates several hypothetical as well as also real (visible) relationships it is then that he or she emerges and is stabilised as a person” (Tsegos, 1995a: 320). This statement of course is mainly referring to the Group-Analytic group, but we believe that this can apply to any group and most particularly to the Group-Analytic Psychodrama, since its procedures take into consideration concepts such as exposure, representation, and gazing. The exposure is taking place in multiple ways and not only verbally as is the case during the participation in the cyclical setting of the group, where participants communicate usually under one permanent role. On stage, communication involves a great deal of experimentation through role interchange, participation in the ‘drama’ of the other member and, furthermore, physical exposure and occasionally bodily contact. The interchange of experiences between all members of the group (fellow actors and spectators) creates a new image of the self and the person’s way of relating, which of course increases the confidence to the group. The whole process is considered as contributing decisively to the emergence of the person. Moreno used the technique of psychodrama to help people become authentic, spontaneous and creative. He believed that by enriching the repertoire of roles this would lead to an authentic behaviour. In the Group-Analytic Psychodrama is added the importance of interchange between levels of functioning and roles as a means to approach, to disclose and to strengthening oneself, leading to the emergence of the person (Tsegos et al., 1997).

Korfiati (1999) approaches the meaning of the role in the Group-Analytic Psychodrama and its contribution to the members’ social adaptation through group-analytic theory. The interchange of roles also contributes to the creation of relationships within the group, through the continuous transition from one role to the other. In this way, the multidimensional position of each member is promoted beyond conventional symbolism and behaviour patterns and, finally, the differentiation of the person from the role is accomplished.

Another issue that is also examined is the enactment of the destructive impulses. It is mentioned that the group’s potential to ‘play’ with its destructive impulses and to integrate them in the therapeutic procedure seems to allow for the possibility of transpersonal and interpersonal conflicts (Karapostoli et al., 1996). In this way the modification of acting out to acting in sums up the character and the function of psychodrama.

In 1998 Psychodramatic Techniques were redefined. It was pointed out that, though these techniques constitute an integral part of the classical psychodramatic heritage, the way in which these are applied to the Group-Analytic Psychodrama underlines its theoretical Group-Analytic direction and lays emphasis on its substantial differences in comparison to the Classical Psychodrama (Gyftopoulou, 1998).

In 2000, the Therapeutic Factors of the Group-Analytic Psychodrama were examined more extensively. According to Yerasi (2000), on a first level, the Group Therapeutic Factors of Yalom, which operate for all the group psychotherapies, are applied. In addition, there are more factors that have appeared in the Group-Analytic Psychodrama, which have been divided in two categories: the general psychodramatic and the special group-analytic. Among the first, catharsis, insight through action and the ‘overflowing reality’ are included. The second category includes the communal factors and the transition, play, the interchange of roles, silence and the modification of acting out to acting in.

Applications of Group-Analytic Psychodrama

During the last 25 years, following the creation of the first Group-Analytic Psychodrama Group (1980), psychodrama groups have not only increased in number but in different areas of application too. Today there are six groups functioning within the Daily Psychotherapeutic Community, three groups within the Fortnight and two within the Summer Community. We assume that this expansion within the communal setting is not accidental; their therapeutic value, proved in clinical practice and discussed theoretically, gradually offered a distinguished place in the communal life. Nowadays it is almost necessary for every member of the TC to participate in a psychodrama group. Apart from the therapeutic factors, already discussed above, we should underline that important issues of the community life are usually the subject of the enactment, such as the change of the community leadership, vacations of the community, political events etc. This phenomenon proves that the described psychodramatic procedure is not individually-oriented but primarily group-centred and furthermore gives emphasis in the interaction between the group and its context (TC, organisation, social environment).

Beyond the TCs there are two Young Adults’ Psychodrama Groups functioning within the Adult Therapy Department, and four Childrens’ and Adolescents’ Groups within the Family and Childrens’ Therapy Department. More specifically Psychodrama for Children and Ado­lescents aims at the development and socialisation through the peer group, while, at the same time, constituting an evolutionary and learning experience which facilitates the strengthening of children’s and adolescents’ ego. These groups have been adapted to the special needs and the developmental characteristics of children and adolescents (Terlidou et al., 1993; Tsergas, 1999). It is pointed out that the Group-Analytic Psychodrama for Adolescents, without claiming to be the only therapeutic approach, is the most suited to this life period as, on the one hand, it maintains the attraction of adolescents to emotional tensions and the unexpectedness and fluidity in life and, on the other hand, provides the meaning of the context, safety and stability of an adult figure (Natsiou, 2000). A psychodrama group for the parents has also been applied, where the members have the potentiality to enact different roles and behaviours, which mainly relate to their children.

Moreover, in 1993, the Oneirodrama Group also began functioning within the context of the Fortnight Psychotherapeutic Community and later on a second one was created within the Daily TC. This group, which is a special application of the Group-Analytic Psychodrama, has the same contract, structure and boundaries but its content derives mainly from the world of dreams. The main characteristics of this group are the enactment of the dreams’ content and a ‘playful’ attitude towards them. “The Oneirodrama Group is a kind of a free verbal sculpting of a dream theme by the group, according to the narration of the dreamer. The enactment of dreams and the disclosure of feelings expose the reality, as well as the familiarisation with the absurd and the irrational and also with madness, which is important for the patients, but equally beneficial for therapists” (Tsegos et al., 2002).

In addition to the above, since 1990, Group-Analytic Psychodrama groups have started functioning in the private practice of collaborators who have been trained in it. It seems that, while Psychodrama was applied in combination with other therapeutic methods, now it has been established as a therapeutic method in its own right.

Besides the applications in clinical practice, there are also applications in training activities, such as Experiential Groups of Group-Analytic Psychodrama in the Introductory Courses of the OPC, in Seminars organised for the Administrative Executives of Mental Health Services in 1994, in Programmes of Health Training in Secondary Education with teachers and students (1995-96), while experiential groups were carried out in multiple congresses, meetings etc.

The aim of this paper has been to provide a detailed description of the Group-Analytic Psychodrama during all these years, by examining its various theoretical aspects as well as its applications. However, we consider that there are further potentialities and perspectives for its evolution, some of which are currently being investigated.

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[1] More details on the Group Analytic Psychotherapeutic Community in Tsegos 1996, 1997, 1999; Tziotziou et al., 2002, 2005.

[2] We should point out that there are also a lot of significant papers that we had to leave out for economy of space.