Psychodrama and Systemic Therapy

8/17/2019 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


24/138

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).


26/138

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.


27/138


28/138

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


29/138

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


30/138

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


31/138

10


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


32/138


33/138

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.


34/138

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


35/138

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


36/138

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.


37/138

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


38/138

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


39/138

18


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.


41/138

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.


42/138

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


43/138

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


44/138

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


45/138

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.


46/138

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

Documents

Psychodrama and Systemic Therapy