Another Color in the Psychiatric Crayon Box

An Expert Interview With Adam Blatner, MD

Bret Stetka, MD; Christine Vuolo; Adam Blatner, MD

Disclosures

August 30, 2012

In This Article

Editor's Note:
Medscape recently interviewed Adam Blatner, MD, a psychiatrist and expert on psychodrama and related therapies, about the origins, techniques, and applications of psychodramatic approaches in mental health care (including some easy-to-implement therapeutic methods).

What Is Psychodrama?

Medscape: What exactly is psychodrama, and how did it originate?

Dr. Blatner: We should note right off that there's classic psychodrama, which is a form of group therapy, and there are psychodramatic methods, which are taken from psychodrama but can and should be used far more widely. Psychodrama is a method for exploring problems, not only in therapy but also for education, organizational development, dealing with social issues, and so forth.

In psychodrama, instead of "telling us" about the problem, the main player (or protagonist) -- in psychotherapy, the patients or clients -- are guided by the director (usually the therapist) to express their inner experience by enacting the circumstances of their problems. This is fully improvised; there is no rehearsal or effort to "act well." The therapist functions as the director or facilitator, suggesting different scenes to explore the problem from different angles. So, to say again, even though classical psychodrama is a group method, its component techniques can be adapted to one-to-one, couple, or family therapy.

The method was invented primarily by Jacob L. Moreno, MD (1889-1974) in the late 1930s. Moreno attended medical school in Vienna from 1912-1918 and moved to the United States in the mid-1920s. He had experimented with impromptu theatre as a hobby, and then in the late 1930s integrated elements of drama into a type of group treatment at his sanitarium in upstate New York. In the ensuing decades, Moreno also took his role-playing methods into business, community organizations, and schools. (A more extensive history can be found on my Website.)

Medscape: What disorders is psychodrama most often used to treat, and in which is it most effective?

Dr. Blatner: Today, psychodrama is most commonly and most effectively used to treat addictions, trauma, anxiety, and depression. As is true of most therapeutic approaches, the healthier one is, the more one tends to benefit from this method. Psychodramatic methods are also helpful for exploring associated issues, such as problems with the family, role training in simulated situations (such as applying for a job), assertion training, conflict resolution, and many others.

Medscape: Can you review some of the major psychodramatic techniques?

Dr. Blatner: There are many, many techniques, but the most common ones are:

  • Doubling, which helps clients to find words for feelings or ideas that they had previously avoided or weren't aware of consciously;

  • Replay, which offers clients an opportunity to redo, or to take over, a certain response in a role-played situation;

  • Role reversal, in which clients imagine what someone else in a scene might think and feel (especially those with whom one is in conflict);

  • Asides or soliloquy, 2 techniques that draw on established dramatic techniques for letting the audience in on what would not be outwardly expressed in ordinary circumstances;

  • Exaggeration, emphasizing nonverbal tendencies by having people speak much more loudly and forcefully, or in the other direction, to express more overtly the pressures to deny, disown, suppress, or stifle, for example; and

  • Future projection -- playing a scene that might yet happen about which one has worries, or using the question, "What would make this event even better?" to make more concrete what one hopes for.

Really, there are hundreds of techniques! Improvisational drama can be used not just for performance but also for exploration, so that people show what they are experiencing; to rehearse future possibilities; or to deepen their awareness of feelings. Patients are helped in this by others who play "voice-over" roles or the role of other people, and that "confrontation" evokes emotions and responses that might not come with just talking about their situations. So you improvise your approach to the patient. If you mess up, then you think about what went wrong and improvise -- you keep being persistent until it works.

Replay is one of the great techniques. Say you come home and say the wrong thing, and your spouse gets angry at you. You say, "Excuse me, could I come in the door and take that over again?" It's so refreshing, because by doing so, you say, "I admit that I messed up, and please let me try again." So if you're running a group and somebody is trying to learn self-assertion skills, you do it again and again until it works.

Then there's role-training. You ask, "How did that come across?" A participant in the group says, "Well, he was still kind of mealy-mouthed, kind of whining." You say, "Well, show us how you would do it."

Another technique that is really powerful, which many psychiatrists and psychotherapists have never heard of, is that after you've blown off steam and talked through your problems, it's good to look at this from the other person's point of view -- a role reversal. If you've ever done that, it is profoundly growth-producing. You help them realize what it's like to be the other person. But keep in mind, you don't just ask a person this and expect an answer; it's a slow process.

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