Running head: Psychodrama
1
Psychodrama and the Psychiatric Nurse
Chantal Aubin
Stenberg College
Psychodrama
2
Psychodrama and the Psychiatric Nurse
Every client is a complex person with unique experiences; each has lived through things
that have shaped them to be the person that they have become; some experiences may have been
beautiful while others may have been dark and twisted and continue to challenge the client today.
It is important that psychiatric nurses appreciate this fact, and are able to utilize the best
therapeutic approach or therapy for each individual circumstance. One particular therapy that
every psychiatric nurse ought to be aware of is psychodrama. It’s a widely accepted form of
therapy. It has a rich history, can be used in various situations, and its benefits can be felt by
many.
First established by Dr. Moreno during the 1920s, psychodrama is a holistic type of
therapy that appreciates the individualities in a person, including the experiences that have
molded them to become the people they are as adults (Dayton, 2009). Dr. Moreno believed that
anything learned through action, must be unlearned the same way (Dayton, n.d.). In doing so, the
protagonist, “the person whose issues are being explored” (Dayton, 2009), would undo negative
patterns of thinking and feeling, and would allow themselves to learn effective coping
mechanisms, and ways to express themselves rationally (Dayton, n.d.). Psychodrama teaches its
participants to identify emotions and feelings in order to be able to regulate them (Dayon, n.d.).
The therapeutic milieu utilized during psychodrama provides a stage for those who are unable to
express their emotions and experiences fluently (Dayton, n.d.).
Psychodrama
3
A psychodrama therapy session itself consists of three phases. These phases include the
warm-up phase during which the group warms up to one another, and to the issues to be
discussed, the action portion or the enactment which is the actual role play portion of the process,
and finally the sharing which enables group-sharing discussion and processing (Dayton, 2009)
(Moreno & Moreno, 1959). Psychodrama includes the protagonist; this is the person whose
issues are being self-explored (Chimera & Baim, 2010). There are then members of the group
that play the role of important factors in the protagonist’s life. These members are called the
auxiliary egos (Chimera & Baim, 2010). The audience is made up of the rest of the group, the
stage is where the psychodrama is conducted and the director is taken on by the therapist,
psychiatric nurse, doctor or social worker (Basavanthappa, 2007). Throughout the session, the
protagonist comes face to face with an event or a situation that has caused them to have issues
such as “difficulties in relationships, self-management and social and emotional functioning”
(Chimera & Baim, 2010, p 3). “Psychodrama is also particularly useful for helping people
experiencing unresolved loss, trauma or mood disorders such as anxiety or depression” (Chimera
& Baim, 2010, p 3). Psychodrama has also been used when dealing with individuals suffering
from personality disorders, psychosis and other issues in mental health (Chimera & Baim, 2010).
It is particularly important for the director; in this case for example, the psychiatric nurse, to be
aware of the history of the protagonist, to allow the psychodrama to take place on an appropriate
stage.
There are numerous techniques utilized during a psychodramatic session, which include
role reversal (the enactment of another person (Dayton, 2009)), role playing (which consists of
acting
Psychodrama
4
out an important part of the protagonist’s life (Dayton, 2009)) and doubling (this entails the
therapist acts as the inner voice of the protagonist and stands behind them during the session
(Dayton, 2009)). Doubling is considered a fundamental technique of psychodrama, which
permits the therapist to try to enter the protagonist’s inner thoughts and emotions, and address
them directly (Chimera & Baim, 2010). The therapist acts as the inner voice of the protagonist
(Chimera & Baim, 2010). Doubling has many benefits for the protagonist, such as support, selfinterpretation, and self-awareness (Chimera & Baim, 2010). Soliloquy is another fundamental
technique for psychodrama. This is when a dialogue in sues between the protagonist and the
double, thus revealing inner emotions and thoughts with the audience (Chimera & Baim, 2010).
As a perspective psychiatric nurse, it is very important to be aware of the various types of
therapy, including psychodrama. Psychodrama is incredibly client-centered as each individual
will have different life courses, and different coping mechanisms, while permit every client to
have interpreted experiences differently. It is essential for the psychiatric nurse to take into
account client-centered approach at all times, but in particularly when utilizing psychodrama. In
order to have a successful breakthrough for the protagonist in psychodrama, the psychiatric nurse
needs to be empathetic, as the protagonist will often find themselves feeling vulnerable, as
psychodrama has “no means of hiding behind feelings or leaving emotions unfinished or without
closure” (Basavanthappa, 2007, p 307). During this time, the psychiatric nurse must offer
support and encouragement, and utilize effective non-verbal communication skills in order to
establish a therapeutic trust. This is especially important as one of the characteristics of
Psychodrama
5
psychodrama is that the protagonist is enabled by the “less-threatening atmosphere in which to
express true feelings” (Basavanthappa, 2007, p 307).
Psychiatric nurses need to be aware of the history of the protagonist as well, in order to
successfully play the role of the director. If the psychiatric nurse were to double for the
protagonist, a certain amount of empathy and prior knowledge would be necessary to facilitate
self-awareness and realization for the protagonist.
There are also other types of psychodramatic techniques that may be utilized when
providing client-centered care. These may include guided imagery, the writing of letters, social
atom exploration, the utilization of photographs, or speaking to objects as if they were persons
(Clark & Davis-Gage, 2010).
Guided-imagery allows the protagonist to remain “closely in touch with the emotions
evoked” (Edwards, 1990, p 40). This allows the underlying issues to become exposed (Edwards,
1990). During this technique, the psychiatric nurse needs to be able to educate the protagonist on
the processes to allow the protagonist to submerse themselves fully in the therapy (Edwards,
1990). Otherwise, the full benefits will not be attained. By focusing on the emotions and
explaining them to the psychiatric nurse, the protagonist explores the situation further (Edwards,
1990).
When writing letters, the protagonist is able to write to another person involved in the
traumatic event, or is able to write a letter directed at themselves (Clark & Davis-Gage, 2010).
This letter is personal in nature and should not be sent to the person to which it is directed
(Vander May, 1980). The writing of the letter allows the author to escape reality, and focus
Psychodrama
6
solely on the issue or a particular situation (Casson, 2004). The psychiatric nurse could propose
that the letter be written when the protagonist is alone, and be brought to the next meeting
between nurse and protagonist. The psychiatric nurse would then be able to utilize the letter as a
tool in the session, to guide the direction of the drama (Vander May, 1980). The psychiatric
nurse could use the letter as a means of encouragement and motivation for the protagonist
(Vander May, 1980).
A third technique is called social atom exploration. To use this technique, the psychiatric
nurse would request that the client or protagonist make a diagram including positive and negative
relationships in their life (Vander May, 1980). This diagram will enable the client and the nurse
to become aware of the relationships that are closest to the client; this may be supportive
relationships, or negative relationships. When exploring the social atom and other sociometric
techniques, the psychiatric nurse can bring awareness to the client’s spontaneity and assist them
in improving their spontaneous thinking and behaviour (Blatner, 2006). As the psychiatric nurse
brings awareness to his or her client’s social atom, the client can begin to analyze specific roles
and begin with the conflict resolution, all while receiving support and feedback from the
psychiatric nurse (Blatner, 2006).
Another tool utilized as a technique in psychodrama is photographs. Typically,
photographs will be taken and kept of people who are important to the protagonist, therefore
serve as a starting point for the psychodrama (Carnabucci, n.d.). Discussing the persons within
the photograph may allow the protagonist to build sociometric connections with other members
of the group or one-
Psychodrama
7
on-one with the psychiatric nurse (Carnabucci, n.d.). Together, the psychiatric nurse and the
protagonist may begin to soliloquize about the photograph and discuss any hidden secrets or
feelings in regards to the photograph or its contents (Carnabucci, n.d.). The photograph can be
used in conjunction with other techniques in psychodrama to further explore the scene in the
picture, therefore giving a greater description of the situation and providing a more in depth
exploration of the emotions involved (Carnabucci, n.d.).
The final technique explored in this paper is the usage of inanimate objects in
psychodrama. This can be a chair which is used to represent the person included in the trauma, or
it can be a mirror during which the protagonist seems themselves as others see them (Casson,
2004). This enables the protagonist to evaluate their relationship with themselves. This may be
extremely beneficial for those with psychotic issues, as it will permit them to make the clear,
visual distinction between their true self and others (Casson, 2004). Thus, this creates a greater
self-awareness (Casson, 2004).
Psychiatric nurses can play a key role in psychodramatic therapy. It is important for the
psychiatric nurse to be aware of the history of the client, and to be aware of psychodrama and its
numerous techniques. During psychodrama, psychiatric nurses must pay special attention to their
own methods of communication, and the communication whether verbal or not, of the
protagonist and other group members. This will provide the nurse with a clearer picture of the
situation, allowing for the nurse to push the protagonist to self-reflect further on the issue being
explored.
Psychodrama
8
Psychodrama has a rich background and continues to be explored and improved. It is
used for a wide variety of circumstances regardless of age, mental health status or background. It
is as complex as the protagonists that utilize it. It consists of three main stages and has numerous
techniques to choose from. Psychodrama is based on self-exploration and self-awareness. The
fact that every person has their own experiences to mold them causes psychodrama to be a clientcentered affair in which the psychiatric nurse needs to demonstrate empathy and support. When
guided properly by the psychiatric nurse, protagonists will grow and experience emotional
changes that may affect their everyday life. Psychodrama can be utilized by psychiatric nurses as
a tool to provide holistic care for their clients, and as a therapy that will continue to impact the
client long after the end of the therapeutic relationship.
Psychodrama
9
References
Blatner, A. (2006). Creating your living: Applying psychodramatic methods in everyday life
[PDF Document], American Creativity Association.Retrieved from
http://amcreativityassoc.org/ACA2006%20Resources/ACA2006%20Blatner%20Creating
%20Your%20Living%20Paper.pdf
Basavanthappa, B.T. (2007). Psychiatric Mental Health Nursing. New Delhi, India: Jaypee
Brothers Medical Publishers Ltd.
Casson, J. (2004). Drama, psychotherapy and psychosis: Dramatherapy and psychodrama with
people who hear voices. East Sussex, England: Brunner-Routledge
Carnabucci, K. (n.d.). Photos and psychodrama: A great match. Retrieved from
http://www.scribd.com/doc/12912796/Photos-and-psychodrama
Chimera, C., & Baim, C. (2010, August 29). Introduction to psychodrama [PDF Document].
Retrieved from
http://www.iasadmm.org/images/uploads/Chip%20Chimera%20and%20Clark%20Baim
%20Workshop%20on%20Psychodrama.pdf
Clark, T.L., & Davis-Gage, D. (2010). Treating trauma: Using psychodrama in groups [PDF
Document]. Retrieved from http://counselingoutfitters.com/vistas/vistas10/Article_59.pdf
Dayton, T. (n.d.). Emotional repair through action methods [PDF Document]. Retrieved from
http://www.tiandayton.com/wpontent/uploads/pdf/EmotionalRepairThroughActionMethods.pdf
Psychodrama
10
Dayton, T. (2005). The Living Stage: A Step-by-Step guide to Psychodrama, Sociometry and
Experiential Group Therapy. Deerfield Beach, FL: Health Communications, Inc.
Dayton, T. (2009). Psychodrama. Retrieved from http://www.tiandayton.com/psychodrama/
Edwards, D.J.A. (1990). Cognitive therapy and the restructuring of early memories through
guided imagery [PDF Document], Journal of Cognitive Psychotherapy: An International
Quarterly, 4(1), 33-50. Retrieved from http://eprints.ru.ac.za/1515/1/Early_memories.pdf
Gibbs, S. (n.d.). Experimental therapy: Psychodrama and the concepts of sociometry. Retrieved
from serendip.brynmawr.edu/bb/.../SociometryPsychodramaHandout.doc
Moreno, J. L., & Moreno, Z. T. (1959). Group Psychotherapy – Psychodrama [PDF Document].
In The Discovery of the Spontaneous Man. Retrieved from
http://stenbergcollege.mrooms3.net/pluginfile.php/24833/mod_resource/content/0/Group
_Psychotherapy.pdf
Vander May, J. (1980). Psychodrama “a deux”. Retrieved from
http://www.blatner.com/adam/pdntbk/vandrmyadeux.html