Encounters with the Self and the Group: Psychodrama, Sociometry and Experiential Group Therapy for Resolution of PTSD

Psychodrama allows complexes and conflicts to be concretized by casting group members to play roles from the life of the protagonist. It allows the protagonist to have a physical “encounter” with the self; to see and experience what he carries within his mind and body, so that it can be made explicit, concrete and can be dealt with in the here and now.

“A picture is worth a thousand words.” The purpose of psychodramatic role-plays is to resolve through action insight rather than talk alone. Through role play, thinking, feeling and behavior emerge simultaneously to allow for a fuller picture of what is being carried in the psyche to come into view. The “double” acts as an inner voice putting words on interior thoughts, sensations and emotions that may be less than conscious. This “doubling” from others helps to enhance awareness of self and provide the protagonist with a feeling of being seen, supported and understood. “Role reversal” allows the protagonist to actually stand in the shoes of other persons in the role play in order to see the self from the position of the other and to actually experience being “in the skin” of someone else.

The Basic Elements of a Psychodrama

The Stage: The designated area where the enactment is occurring, which can be a studio made to look like a group or therapy room.
The Protagonist: The person whose issues are being explored, this revolves through and around the group as each person does their psychodramas while others witness, identify and share.
The Director: The facilitator or therapist, who leads the group and directs the psychodramas.
The Auxiliary Egos: The role players in the protagonist’s drama, these are group members engaging in spontaneous role plays. They become the person that the protagonist carries inside.
The Audience: The group who witnesses the action and is part of the constantly evolving and interactive process. The group is active, engaged and part of the dialogue: The Human Dialogue

Encounters with the Self: The protagonist can select a role player to represent any part of themselves e.g. their inner addict, crazy person, wounded self, dreamer, fraud, star, etc. They can also dialogue with the person they were or the person they want to become.

Encounters with Others: The protagonist can explore and unravel conflicts with real or imagined others, e.g. their partner or their wished for partner that they want to meet.

Encounters with Group Members: Group members encounter each other in very direct ways and can explore their feelings toward and with each other openly and through the lens of therapy, thus the interactions provide not only entertainment but insight and growth.

Encounters with Real or Imagined Situation, Past or Future Selves: Through role play, protagonists can literally construct past scenes and talk to themselves about what they regret having done or been like or what they see now but didn’t see then. They can talk to themselves as a child, an adolescent or young adult. Or they can meet a future self, the person they are afraid of becoming or want to become. The protagonist can dialogue with a feared self, a wished-for self, a hidden self, a denied self, a wounded or humiliated self, a grandiose self or literally any aspect of self that they can imagine encountering.

Encounters with Disowned Parts of Self: Through role plays, protagonists and group members can talk with their addiction, their dissociated self, their resentment. They can talk “as” themselves to the addiction, then reverse roles and talk “as” the addiction back to themselves. They can be interviewed by a therapist in the role of addiction or self in order to deepen their understanding of the role. They can stand behind themselves and “double” for either role in order to speak the inner life of the role.

Encounters with Dream Characters: Psychodrama allows the characters from a dream to come alive, even including dream symbols. Role players can, for example, play a bird, a rock or a flood, and the protagonist can both talk to the bird then reverse roles and talk as the bird back to themselves, exploring and deconstructing the deeper meaning and messages their dream is trying to tell them from all angles and directions.

Sociometry

Sociometry is essentially the group dynamics system of psychodrama in which member-to-member connections, disconnections and relationships can be concretized and examined in group. Sociometry can also be used to build group cohesion and explore issues relevant to and shared by group members.

I have created an interface between sociometry and educational research in the form of the exercises below. For some 20 years, I have tried to come up with user-friendly ways to make experiential work psycho-educational so that clients can have a therapeutic experience while learning about current research related to issues they may be struggling with.

Relationship Trauma Repair (RTR)

A model for addictions facilities, clinics and therapists in working with PTSD, Addiction and Codependency.

RTR is a multisensory and experiential model created to help those suffering from relationship trauma or post-traumatic stress disorder (PTSD). RTR is designed to be used in treatment centers, clinics or as an adjunct to one-to-one therapy. It’s user-friendly and helps therapists to have an easy-to-follow format to work with groups around the issues that surface throughout the treatment of addiction, PTSD and codependency.

RTR Includes 8 Units. Each Unit has:

  • Psycho-educational DVDs with psychodramas of living case studies.
  • A Therapist’s Guide of psychoeducational/experiential exercises for groups.
  • A Personal Journal for each client to use in treatment and take home.
  • Guided imageries with specially composed music for healing trauma and learning skills of self-regulation for use in treatment and to take home.

The exercises below are from the first unit of the model. The full model can be seen at relationshiptraumarepair.com.

Feeling Floor Check:

Examining and Expanding My Feeling Palette

Goals:

1. To expand a restricted range of affect that can be the result of trauma.

2. To allow the group to become comfortable identifying, articulating and sharing emotion.

3. To allow the group to connect with each other around vulnerable emotions, share and take in sharing and support.

4. To teach and develop emotional literacy and emotional intelligence.

5. To help clients learn to tolerate and talk about painful emotions so that they are less likely to act them out and relapse over them.

6. To help clients learn to tolerate and talk about positive and self-affirming emotions so that they are less likely to relapse over them.

Notes to Therapist: Learning the skills of self-regulation and regulation of basic emotions, thoughts and behaviors is core to trauma treatment and relapse prevention. The feeling floor check is designed to facilitate this learning process. Those who have experienced relationship trauma can have trouble tolerating their intense feelings without acting out, imploding, exploding or self-medicating. The feeling floor check allows clients to get in touch with both what they are feeling and how much they are feeling (i.e., emotional intensity). They learn to share emotions and listen to others do the same. Trauma shuts down emotions; the feeling floor check reawakens and categorizes emotion. One of the main tasks of recovery from trauma is to learn how to feel strong emotions and translate them into words, so that the thinking mind can bring order and balance to the limbic brain/body (read: emotions and sense impressions) through insight and understanding.

As with all parts of this model, keep interpretation and advice to a minimum. The idea is for clients to take a hold of their own inner world and learn to manage it without the use of substances or compulsive behaviors. As much as possible, allow the healing group to work its magic through mutual sharing, identifying and support. The more that clients come to their own ahas and learn to get in touch with their own internal healer and teacher, the more they will be able to bring themselves into balance when triggered once they leave treatment. That is what this experiential model is designed for, to create an experience that has teaching and therapy inherent within it, so that clients feel that they are learning organically and coming to know and manage themselves, in a sense, on their own.

Steps

  1. On 8×10 pieces of paper, write feeling words, such as angry, sad, anxious, content, hopeful, frustrated, desperate, happy. Always leaving a few pieces of paper blank for the group members to write in their own feeling words. Have one paper marked Other so clients can write in their own emotion.
  2. Place the words a couple of feet apart from each other, scattered around the floor.
  3. Ask participants to stand on or near the feeling that best describes their mood of the moment.
  4. Say, “Whenever you are warmed up, share in a sentence or two why you are standing where you’re standing.”
  5. After all who wish to have shared have done so, allow the group to repeat the process and stand on another feeling that they might also be experiencing (Note: learning to “hold” more than one feeling at a time helps clients to tolerate living in gray rather than black and white), then share as before.
  6. At this point you can vary the next criterion questions by asking, “Which feeling do you avoid feeling?”
  7. If the group still has energy to continue to explore more questions, you can further vary criterion questions by asking, “Which feeling do you have trouble tolerating in someone else?” Or, if you want to build resilience you might ask, “Which feeling would you like to experience more of in your recovery?”
  8. Next, invite the group members to “place their hand on the shoulder of someone who shared something with which you identified.” Group members can share directly with the person why they chose him or her. The entire group can do this at once.
  9. Psychodramas may emerge out of the sociometry at any point in this process.
  10. Next, sit down and share about the entire process and what came up throughout.

Variations: For each question asked, group members can share so that the entire group can hear them or, if the group is large, they can share with those who are standing on the same word that they chose. If they share on the same word they are sociometrically aligned and sharing with those who are feeling the same as they are, this helps to train clients to take in sharing and support and reduces isolation. The word choosing can go on as long as it is useful, depending on the needs of the group. Generally, the group is saturated by the third or fourth choice and needs to move into the sociometric-choosing phase.

Talk to the characteristics: The client can also enroll several of the characteristics that they feel most troubled by and talk to each of them, one at a time incorporating role-reversal, doubling and any other psychodramatic techniques that the director wishes to use (see The Living Stage: A Step by Step Guide to Psychodrama, Sociometry and Experiential Group Therapy).

Symptom Floor Check: Learning About and Assessing PTSD Issues and Emotions

Goals:

  1. To educate clients as to the range of symptoms that can accompany relationship trauma.
  2. To provide a format through which clients can decide for themselves which symptoms they identify as experiencing in their own lives and relationships.
  3. To create opportunities to hear about how symptoms manifest for other people and in other people’s lives and relationships.
  4. To encourage connection, sharing and support around facing difficult personal issues.
  5. To educate clients as to how to trade a pathological symptom for a healthy trait.

Notes to Therapist: This is a cornerstone exercise. It will help to educate clients about the pathological characteristics that are a part of the PTSD syndrome so that they can develop a language through which to understand and work with them. The idea here is to normalize symptoms by making them conscious, translating them into words and sharing them with others and to bring them out into the open, hear others share and accept identification and support. This process helps to breakdown isolation and make feeling intense, split-off or repressed emotions less threatening. What we don’t know can hurt us. While these symptoms remain subconscious, they can exert significant power over the lives and relationships of clients.

Steps:

  1. On large pieces of paper write these symptoms or characteristics of relationship trauma:
  • Emotional Constriction
  • Relationship Issues
  • Somatic Disturbances: Body Aches and Pains
  • Learning Issues
  • Loss of Trust and Faith: In Relationships and an Orderly World
  • Hypervigilance/Anxiety: Waiting for the Other Shoe to Drop
  • Traumatic Bonding
  • Unresolved Grief
  • Cultivation of a False Self
  • Problems with Self-Regulation
  • Hyper-reactivity/Easily Triggered
  • Learned Helplessness/Collapse
  • Depression with Feelings of Despair
  • Distorted Reasoning
  • Loss of Ability to Take in Caring and Support from Others
  • Tendency to Isolate or Withdraw
  • Cycles of Reenactment: Repeating Painful Relationship Patterns
  • High-Risk Behaviors: Speeding, Sex, Spending/Debting, Working
  • Survival Guilt: Shame
  • Development of Rigid Psychological Defenses: Denial, Dissociation, Splitting, Minimization, Intellectualization
  • Desire to Self-Medicate With Drugs, Alcohol, Food, Sex, Money, Work
  1. Place the papers with symptoms on them a couple of feet apart scattered around the floor.
  2. Ask participants to stand on or near a characteristic that they identify as being a problem for them in their lives.
  3. Once group members are standing on the characteristic that they identify with, invite them to share a sentence or two about why they are standing where they are standing.
  4. Next, invite group members to stand on or near a trait or symptom that they feel was present either in someone in their family of origin or in their family of origin as a whole that created problems.
  5. Once group members are standing on the characteristic that they identify with, invite them to share a sentence or two about why they are standing where they are standing. A resilience-building question might be, “Which characteristic do you feel used to be a problem for you but you have worked your way through?”
  6. After group members have shared about one, two or three characteristics say, “Walk over to someone who shared something that you identified with or that moved you, place a hand on their shoulder and share with them what moved you.” (Note: the sharing will be taking place in dyads and subgroups that will naturally and spontaneously form as a result of this question.)

At this point the group may be ready to 1) sit down and share about the experience so far; or 2) move into psychodramas.

Variations:

When doing #7, group members can share so that the entire group can hear them or, if the group is large, they can share with those who are standing on the same characteristic that they chose. When they share around their characteristic or symptom, they will be sociometrically aligned by symptom: i.e., all those experiencing a particular symptom will be sharing with others experiencing that symptom. This subgrouping can make sharing feel safer and can allow clients to feel seen, supported and more open. The symptom-choosing can go on as long as it is useful, depending on the needs of the group. Generally, the group is saturated by the third choice and needs to move into sharing, journaling or psychodrama.

Questions can be varied. For example, the therapist may ask “which symptom do you have the toughest time dealing with in other people?” or “which symptom seemed to be the most present in your family or origin?” or “which symptom do you feel you re-create the most in your present-day life?” A resilience-building question might be, “walk over to someone from whom you feel you could learn something and ask them for help.”

Talk to the characteristics:

The client can enroll several of the characteristics that they feel most troubled by and talk to each of them, one at a time incorporating role reversal, doubling and any other psychodramatic techniques that the director wishes to use (see The Living Stage: A Step by Step Guide to Psychodrama, Sociometry and Experiential Group Therapy for in-depth information on these techniques).

Silver Linings and Upgrades:

There are always silver linings present in adverse circumstances, qualities of strength and resilience that we develop in going through painful circumstances. Invite clients to share what qualities they feel they developed through adversity, or what the silver linings are for them in having gone through a particular circumstance. You may also invite group members to “upgrade” their symptoms, to trade in one for a trait they would like their symptom to morph into such as: “I would like to trade learned helplessness for a chosen position of surrender”, or “hyper-vigilance for awareness”, or “a loss of trust and faith with renewed faith in Higher Power” and so on. As they do this, let them write their new upgrade on a sheet of paper and place it next to or on top of the symptom. Allow them to do this for any symptoms with which they identify.

JOURNALING

  1. Letting the Child Speak. Mentally reverse roles with yourself while in the throws of any one of the trauma characteristics and journal from that place. For example, “I feel helpless… I get this way whenever…” and so on. Or “I am feeling so emotionally constricted I just want to…”
  2. A Moment of Repair. Journal about a time when repair occurred; write about how you felt during or after a moment of repair (apology, reconnection, repair of some sort) within the relationship and what positive lessons you learned about relationship repair from it that you might still be living out today. Journaling in this way helps to build new neural wiring for repair that can help to ameliorate and regulate the painful experience. It also builds resilience, strength and new learning about how to operate in close relationships. For example, “I was feeling completely ashamed and like withdrawing or just running away or screaming at someone, and then someone…  And that helped me to…”
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