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

Medication vs Psychodrama

Medscape: How important a role do you think pharmacotherapy should play in psychiatry, and how should it be integrated with psychodramatic approaches?

Dr. Blatner: I think the medicines available to the modern psychiatrist are great advances in the treatment of mental conditions, but they must be used wisely. They offer invaluable tools that reduce oversensitivity to negative emotions and enable a patient to have more of their mind available to do the therapeutic work of developing healthier coping responses to a range of stresses.

When I was teaching at the University of Louisville Medical School, I always emphasized the need for these medicines to be carefully monitored by adjusting the dosage up or down in order to achieve the optimal level for the individual patient. Thus, another component in the true art of healing is establishing a rapport so that patients are not inhibited from giving feedback to their psychiatrists. "Doubling" with a new patient to help them express their problem begins to build that sense of, "Here's someone who is really listening to me and cares and wants to help me." That is what you need to get a patient to give you honest information about the medication and continue to trust you if there are side effects, so that they keep taking it.

In terms of psychodramatic methods, I would simply say that just as it's good for psychiatrists to know about a wide range of possible medications, so too they should know about a wide range of psychotherapeutic techniques. Physicians are expected to have a broad range of responses or methods. You wouldn't want them to have, for example, only 5 options when there hundreds of different medicines and other kinds of nondrug treatments that can be prescribed. To illustrate this point, I often quote the statement by Abraham Maslow (who has been called the "father of humanistic psychology") that people who only know how to use a hammer have a tendency to treat every problem as if it's a nail.

Using psychodrama has developed for me a heightened sense of each person having their own particular life story. This idea of discovering a patient's story really helps in taking an initial good history for diagnostic purposes. And then if a particular course of treatment isn't working, I always take the history again.

The therapist's ability to more vividly imagine the story as if it were performed as a drama generates the cues as to what to ask. For instance, the patient might say that they moved from a town a year ago and are having a hard time adjusting to the new city. If the therapist is imagining this themselves, several ideas occur: "I miss what I had back where I used to live," or "I remember going into that store and they knew me." Might there be something or somebody that merits a "goodbye" process? These thoughts can lead to possible directions in future therapeutic work.

Also, just the care implicit in taking a more detailed history is itself therapeutic. Often, clients have not admitted to themselves the truth of their own story. Going through that story again in detail allows them to realize that "Hey, this was really stressful and painful and traumatic!" Because of the way I've cared about the client's story, I've been accused of being more like a social worker. I took it as a great compliment.

Medicines can help cope and reduce symptoms, but they don't address what is actually making a person upset. This is the key component of good treatment: talking about what disturbs a person's functioning and exploring in the therapeutic context new ways of reducing the stressors. As I've already mentioned, action methods are efficient in clarifying and testing thoughts and actions. Psychiatrists have a responsibility not to be merely prescribers of medications. We should know better than that.

Medscape: So, a multimodal approach is essential?

Dr. Blatner: Absolutely. Again, I want to say that I'm not expecting your readers to become psychodrama directors. But I'm hoping they will try some of these techniques and find out how they can amplify and expand their treatment repertoire. It's like the fun of adding new colored crayons to your set.

Resources abound for interested readers. The main one for English-speaking professionals (and the oldest group therapy society in the world, founded in 1942) is The American Society of Group Psychotherapy & Psychodrama. They have an annual conference (the next one is April 11-14, 2013, in Alexandria, Virginia) that affords opportunities to learn the methods in topical workshops and sessions. For training programs and trainers who offer workshops around the United States, see the American Board of Examiners in Psychodrama, Sociometry and Group Psychotherapy Website. I have an active email correspondence with colleagues around the world and would enjoy personally answering any questions: adam@blatner.com. Finally, I heartily invite people to visit my Website, which provides many papers about psychodrama methods, among many other useful topics.

Medscape: Last question: Are you also an actor?

Dr. Blatner: Good question! You might think so, but no! And you definitely do not need a background in drama to learn and apply these methods. The role of the director or therapist using psychodramatic methods is closer to that of a skilled midwife than an actor.

I will say that in my retirement from active practice, I have taken a few roles in variety shows with our local community theatre, and a few years ago I played the role of Linus in You're a Good Man, Charlie Brown. I guess I was good enough, because I was told that the audience accepted me as a boy and forgot about the fact that I have a beard!

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