Advancing Theories Of Psychodrama: Preliminary Notes

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Advancing Theories Of Psychodrama: Preliminary Notes

Adam Blatner, M.D., TEP
First written August, 2004, Posted on Website November, 2005

A book is in preparation, “Advancing Theories of Psychodrama,” to be published, it is hoped, by Routledge. This anthology of articles on different approaches to the frontiers of theory in psychodrama, edited by Manuela Maciel, Jorg Burmeister and Clark Baim, will be part of a series of books about advancing theories in psychotherapy, the series in general being edited by Keith Tudor, in the U.K. In Dr. Tudor’s instruction sheet, he posed a number of themes he’d like to have written about, and this stimulated me to write out the ideas below. (When Dr. Tudor approached me to be the editor, I referred him to the others as being more able to offer an international representation of the field. These editors in turn have arranged to have leaders in psychodrama write about different aspects of the field. Before all that happened, however, I had jotted down these notes.)

Theory of Human Nature:
What is the theory of human nature implicit in this theory? First, I submit that there can be and should be NO SINGLE Theory, but rather an entertainment of many theories. Speaking from a meta-theoretical viewpoint, the idea of a single theory is itself profoundly misleading and oversimplifying. To begin with, there are so many different frames of reference involved with thinking about the mind (including conscious, unconscious, interpersonal, and collective dimensions) that no single theory can adequately begin to address. Humor, spirituality, politics, fantasy, art, romance, and the like all advance by probing the boundaries of any matrix of ideas or beliefs. Nevertheless, having noted this impossibility in this preamble, I am intrigued by the question.

The whole philosophical movement that later came to be called existentialism, as I understand it, stands as an antithesis to the idea that there is a human nature, that it can be described, and in so describing, limitations are then affirmed. Anything we say about human nature implies that certain actions are beyond the boundary, inhuman, whatever that means. It can be an insult–sub-human, unworthy; or a statement of near worship, super-human. Either designation implies a range of political responses. What is morally permissible to inflict on one who is sub-human? What authority and prerogatives are to be given to those deemed superhuman. The whole question of definition generates ethical conundrums. (To Dr. Tudor: Since you mentioned critical theory, may I assume that you have some sensitivity to issues of oppression, and as a corollary, to questions that look at the political implications, the power gradients, the social policy implicit in any seemingly neutral theoretical stance, and indeed, in any way we “language” (as a verb) a particular experience or phenomenon?) Given all this, I’ll nevertheless venture some speculations:

I find the concept of creativity to be enormously heuristic in today’s world–creativity as a core of theology (in Moreno’s or Whitehead’s philosophy), creativity as a core value in society. (“Heuristic” is a term that indicates the capacity of an idea to generate useful further ideas, practices, questions.) I find the concept of creativity to be a most open-ended concept, allowing for radical transformations of consciousness. (In contrast, more deterministic theories address a humdrum norm that doesn’t include a passion to reflect, know itself, philosophize, and creatively revise.)

Applied to psychodrama, we could say that the method rests on a philosophical view that humans are creative, and the job of education as well as therapy is to help people be more creative in their lives. While the early psychoanalyst, Otto Rank, hinted at this, looking at life as a work of art (perhaps because he was an artist before becoming a psychoanalyst), Moreno was more explicit in this regard.

Theories of Child & Adult Development
Again, I am reluctant to presume that there are or should be less than a host of component theories, and I don’t suppose that these theories compete, but rather complement. To begin with, the general idea of “role expansion” can to offer a useful frame for thinking about the many elements that maybe involved in development.

Speaking at the meta-theoretical level to the need for complexity in theory, just as in medicine, in physiology, there are scores of new mechanisms being identified at every level, atomic, molecular (e.g., Nitric Oxide), sub-cellular (e.g., transport mechanisms, cell membrane structures), cellular (immunologic cells, functions of astrocytes in brain), tissue, organ, and organ systems, as well as psychosomatic dynamics, still ill-understood (i.e., mind-body interactions); so, too, a theory is needed that is broad and complex enough to include a wide range of dimensions– play, spirituality, art, social creativity, temperament, different learning styles and types of intelligence, genetics, neurophysiology, cultural norms, humor, politics, etc.

Psychodrama offers a number of component sub-theories to the overall mix. Personally, I hold with a mixture of Adlerian, Jungian, Freudian, and other kinds of ideas. From psychoanalysis, I find the concepts related to the defense mechanisms particularly useful, and think that their striving to identify basic motivational systems mildly fruitful, mixed with their also being mildly misleading. (I’m reminded of a saying about philosophy by a philosopher friend of mine, that every philosophy is valid in what it affirms and mistaken in what it denies.) So, for example, there is much of use in Kohut’s “self psychology,” and this may be employed along with rather than instead of, say, “Object Relations” theory, or “Ego Psychology.” And that’s just for psychoanalysis, and an small sector of that field, to boot. That said, from psychodrama I would first note that Moreno’s own writings are, in my opinion, un-systematic and under-developed, and must be subjected not only to interpretation, but to free revision and further development.

Second, a key concept that I think is most useful in thinking about child development is the idea of role expansion. This recognizes the gestalt (in the sense of whole complex or ecological field rather than Perls’ particular therapeutic approach) implied by role, how it carries cultural, personal, family, and many other elements all at once. Kids learn roles more than specific motor or perceptual or cognitive elements. These have further elements of style, sly compromises of different motives, and a greater potential for dramatic enactment (which, for children, takes the form of make-believe play).

The roles that need to be included in an adequate theory of child development go way beyond Freud and Jung, and perhaps even beyond Maslow. I think we must include music and humor, theatricality and naughtiness (i.e., the puncturing of the constructed social norm systems inherent in manners, proper language, and various taboos), as well as spirituality, philosophy, art, poetry, fashions, personal adornment, social status, and many other dimensions. Indeed, the idea of role-shifting, breaking out of earlier or fixed definitions–perhaps exemplified by the archetype of the trickster–may also be a type of virtual or meta-role function.

A third concept–and I can think of many others, but want to note this one–that is hardly noticed by other theories, derives from Moreno’s theory of “sociometry.” Historically associated with psychodrama, in fact it represents a parallel complex of issues and methods that can stand alone: What are the psychological and social dynamics associated with fluctuations in rapport (Moreno called it “tele”), interpersonal preference, a sense of connectedness, liking and being liked? (For example, how much of what Freud called the Oedipal Complex really has its roots in the triangulations of kids playing together? With no sex involved, there are still many issues of jealousy evoked.)

Fourth, again not adequately addressed by most other theories, is the need for an audience, for self-expression, theatricality. Kohut’s theories of the need for “mirroring” come close, but, as with most psychoanalytic approaches, over-values the impact of the parent and under-values the influences of peers and others in the neighborhood, plus more distant others. An adequate theory of child development needs to be more sharply inclusive of how kids play and thrive, and how play deficits can be most problematic.

A fifth dynamic mentioned by a few theories, being given more importance lately, but more implicit in drama, is the power of physicality, touch. I’ve proposed that more fundamental to babies than “orality” (as Freud wrote about it) is what might be called the “dermal,” the power of holding, touch, the squeeze on the shoulder, the pull of the arm, the caress of affection, whether one’s diaper is changed roughly or with gentleness. A great deal of psychodynamic richness can be found here, and therapeutic implications abound.

A variation of touch is action, and the feelings associated with doing should be integrated into holistic programs as being as relevant–and often more relevant–than any degree of talking, insight, thinking “about,” working through, mere verbal therapy. To hear and feel oneself speak forcefully, shout, affirm, gaze directly into another’s eyes, is profound, and many have never experienced it. Moreno called the motive for this experience act hunger. This applies also in thinking about children and their sheer physicality, and theory needs to include its implications. Of course, psychodrama builds on this, and it is through action that psychodrama with children overlaps with play therapy and drama therapy.

Imagery is yet another dimension, given a bit of attention as fantasy to be interpreted by psychoanalysts, to be more respected by Jungians, but insufficiently used therapeutically. (There have been a few pioneers writing about the conscious use of imagery as a major tool in psychotherapy–Shorr, Ahsen, Sheikh, Desoille, Leuner, etc., but their important work remains insufficiently recognized.) Yet, along with fantasy and action and touch, when combined with enactment, imagery becomes drama, and the symbolic enactments of various events can generate a surprisingly effective degree of reparation and healing.

The use of people to play off of, and especially playmates, represents another element in theory and practice. It may be too threatening to confront a parent or teacher, so behavior and play is displaced to playmates, and this becomes even safer if the playmates are “in role.” That way, the other kids don’t take it personally. Applied to doing therapy, the psychodramatic technique of having a third person–not the therapist, but an “auxiliary ego”–who becomes the antagonist, takes much of the transference away from the therapist. It may be argued that it’s good to have transferences onto the therapist that then need to be analyzed; but it may also be perhaps more cogently argued that it is safer, more supportive of the working alliance, and in the long run, faster (and hence less expensive) to not support transference. I hold with Jung in acknowledging that some degree of transference will always happen, and there’s enough there to work through; there’s no need to do anything that will promote further transference, which only obscures the problem. All this is by way of noting the theoretical foundations of the use of the auxiliary role in psychodrama.

A Theory of Psychological Disturbance (“Pathology”) and Health (“Sane-ology”)
Whitehead said, “we should try to make things as simple as possible, but not simpler.” I strongly believe there are literally hundreds of different sources and types of disorder, and they operate at and among all levels of human function, from the atomic and cellular to the organismic, social systems, and cultural and economic levels. Almost always multi-factorial, again, there can be and should be no attempt at constructing a single theory. With that preamble, I can note that psychodrama offers a number of perspectives that add to the observations of thousands of other thinkers and innovators over the last century and the many centuries preceding that.

Moreno saw a major source of disturbance arising from a tendency to rely on what has been created in the past, on social structures, given norms, internalized beliefs, and the habitual and unthinking carrying forth of these instructions–what have more recently been called “programming” in light of current computer technology metaphors. Yet humans are capable of the opposite, what Moreno called “spontaneity,” a fresh view, a capacity to approach what has been given with a spirit of creativity. The more habitual mode he called “robopathy,” and it is similar in, say, cognitive therapy, to the concept of “automatic thoughts.” (Therapy, then, is aimed at bringing what is automatic into present consciousness and thus subjecting these inner rules to “re-programming.”)

Another disturbance is hinted at by Moreno’s emphasis on the encounter in the here-and-now. Perls makes much of this in Gestalt therapy, but he minimizes the degree to which he may have been influenced by Moreno, who preceded Perls in this attention to the present moment. Many people are hobbled by their fixations on resentments or remorse about their past or anxieties about their future. Fearing disappointment, they avoid daring to dream onward, to set goals and allow themselves to clearly imagine those goals. Moreno utilized all three time dimensions, with emphasis on the “now,” but, using drama, being able to address the past as if it were now, and also the future. Health involves being able to flexibly address past, present, and future, and to work with each as it seems more useful. Sickness involves any fixations, the opposite of flexibility.

There is no definable set of qualities that can easily be articulated about health, either. I hold with Adler, whose concept of social interest or community feeling probably is the best succint point of reference, and also share with a range of other theorists. Another pioneer in psychiatry in the 1950s was Sandor Rado, in New York City, who added the concept adaptation to the developing theory in psychoanalytic ego psychology.

An important development beginning in the 1970s has been the appreciation that trauma and addiction have their own psychopathologies, aside from the previous view that they served as stressors that brought out early childhood issues. It’s now appreciated that many people can have a perfect childhood and still be deeply disturbed by the processes involved in trauma and/or addiction. Indeed, moving away from the myth that insight into early childhood dynamics is necessary for healing has been a major bit of progress that, alas, a large number of therapists have not yet recognized.

Eric Berne offered an incomplete concept of health–intimacy in the interpersonal field. I have formulated intimacy as being a balancing of consciously applied skills relating to gaining access while also forming boundaries, and negotiating these satisfactorily. Yet intimacy may be too precious for the full range of roles. It would be better to recognize that with most people, a fair degree of cordiality, manners, and clarity suffices.

A Theory of Change:
Again, should be many theories, for different ages and stages. A major form of change is educational, the person consciously acquiring concepts and skills and applying them to a point of mastery. I weight this highly, if the person is adequately motivated and able to engage a capacity for self-change, which involves refusing to be inhibited by the currents of shame that are evoked as a by-product of creativity and experimentation.

For many people, though, the defensive system, the fear of devaluation, the low-grade narcissism, if you will, interferes with a direct acceptance of the prevalent influence of regressive tendencies. (Ideally, I think we need to learn to recognize our vulnerabilities and “inner child” complexes for what they are, without defensiveness, and then to consciously sublimate them through art, drama, play, humor, and the like. But this requires an infrastructure of learning attitudes and skills that is still rare in our culture.)

For such persons, my theory is that they need a way to marshal their compensating strengths and bypass tendencies towards getting fixated in coping with waves and currents of regression and the many feelings aroused by life stress. Again the theme here is appreciating the sheer complexity of mental activity, and the presence of many affirming and striving complexes that balance their opposites, the doubting and giving-up complexes.. My theory is that folks need to allow about 10-15% self-pity, some inner nurturance, cutting them some slack. To this end, therapies that result in at least temporary symptom remission–and religious experiences, too–operate through constructing symbolic metaphors that allow the psyche to construct, in response, a way to compromise their deeper aims with their overall social values.

Cutural change is an important element here, written about by many advanced thinkers in philosophy, economics, and other fields. For example, the contemporary philosopher, Ken Wilber, has more recently written about Cowan’s “spiral dynamics” and observed the evolution of cultural world-views and how they might continue to evolve. The noted psychoanalyst Erik Erikson wrote about eight psychosocial stages. Now, applied role theory, which I think is a major foundation of psychodrama, can utilize and translated many of these theories, articulating the positions and definitions as components of various roles. Roles evolve, what we expect of a teacher or parent or even God changes with the times and the general worldviews, and dialogues about such expectations make the process of change a more interactional, political process.

Generalizations about change in psychotherapy depend on diagnosis, and often a number of different changes are involved, some being rather simple on the surface, such as just entering a helping relationship. There hasn’t been much evidence that the type of therapy or theoretical orientation of the practitioner makes that much difference.

Theory of Therapy
I believe in differential therapeutics–in contrast to one method being applied indiscriminately. (That is, I agree with Maslow–I think it was–who said, “Those who only know how to use a hammer tend to treat everything as if it were a nail.”) I disagree with a few of my colleagues in psychodrama who think psychodrama can stand as a full therapeutic approach. I think it needs to be integrated with many other approaches. Basic social work, assessment and management, support for basic life skills where they’re missing (and we shouldn’t assume that normal people have a full repertoire), and other factors are involved. Elsewhere I note that more than any of the diagnostic categories in the official manual, the variables of voluntariness, psychological mindedness, overall ego strength, and access to socio-economic resources together are more closely correlated with prognosis.

So I think we need a meta-theory that allows for eclecticism. I challenge boldly and strongly the idea that any separate theory alone is adequate or even justifiable, because elements in theory A may be quite useful for patient X, even if the practitioner is mainly oriented to theory B. I hold with an intelligent integration, similar to Lazarus’ mulit-modal therapy. I think, in spite of Lazarus’ objections, that there is a way of unifying the different therapies at a theoretical level.

Nevertheless, I think that the role theory that derives from (but need not be tied to) psychodrama is a uniquely suited to provide a foundation linguistically and conceptually for such an integrative and eclectic theory! Within role theory, there is a concept of the meta-role, the role that modulates how the other social roles are played. I submit that all theories implicitly develop the meta-role functions. I think that psychodrama offers the possibility of making these meta-role functions even more effective by making this activity explicit, naming it, and helping the client or patient to identify with this role beyond the roles, the choosing self, inner director, etc. This dynamics allows for an integration of all the therapies! (A bold proposition, but one I’d be willing to argue.)

Issues of Bias and Power
Dr. Tudor, the series editor, wondered about our field’s appreciation of issues of bias and power in therapy. This is certainly relevant because it reflects recent challenges to the practices of psychiatry and psychotherapy, such as by the Scientologists. Who has a “right” to declare others to be okay or not? What are the ethical dilemmas regarding social policy for the problem of “involuntary hospitalization.” (Nowadays, one might argue in the USA, at least, about the opposite problem, the difficulty in keeping people in hospital, voluntarily, even.) Also, the semantic implications of the word “oppression” are loaded, because although the word calls into question the norms and basic assumptions in various social and cultural systems–a useful function–it also, alas, fosters a victimized and blaming stance.

Ideally, psychodrama offers a type of group work that empowers the various group members, develops assertive skills, and acknowledged these issues of power gradients in groups, not just between group leader / therapist and group members / “clients,” but also among various sub-groups, such as two men and seven women, etc. (See my paper on implications of postmodernism for psychotherapy).

Contributions of Psychodrama to Modalities of Theory:
Here is where psychodrama is outstanding, because it can inform the practice of all kinds of psychotherapy, and education, too, in a number of ways:

First, at a time when most therapeutic approaches were “talk” approaches, Moreno introduced the idea of having patients be more physically active. The idea of simple role playing, without any use of other aspects of psychodrama, has become a part of behavior therapy, cognitive therapy, and a variety of other approaches.

Another form of action has family or group members portraying their perception of the relationships in the group as a kind of tableau or living sculpture. This technique, originally titled “action sociogram,” has become a part of a variety of approaches to family and group therapy, used by Virginia Satir, for example. Bert Hellinger uses these scupltures also in his family-dynamic group approach, and Albert Pesso has a slightly different but related method derived from his dance-movement approaches in the 1960s.. In the nonscripted applied theatre approach called Theatre of the Oppressed, the pioneer, Augusto Boal also uses living tableaux.

Along with action on the patients’ part, the therapist need not remain passive. More directorial therapist styles have been evolving, beginning with Moreno in psychodrama, but more influentially modeled by Salviador Minuchin, Virginia Satir, and others.

Psychodrama draws on the group members’ imaginations, and other approaches that suggest more specific imagery have also emerged and comprise a sub-field, with different styles being expressed by different innovators. From Jung’s use of active imagination to Desoille’s guided fantasy, Shoor’s psycho-imagination therapy, or Sheikh & Ahsen’s work with eidetic imagery, alternative approaches have emerged that carry forth the activity of the therapist in a variety of ways.

Psychodrama implies role theory, a dramaturgical perspective, and this in turn involves a pluralistic model of psyche: Psychotherapy that treats each part of the psyche as a role that can be enacted has been more notable when there was a fashion for the treatment of “Multiple Personality Disorder” around the early 1990s. A variety of innovative therapies absorbed this perspective, such as Hal Stone’s “Voice Dialogue,” Richard Schwartz’ Internal Family Systems Therapy, and the “ego state” therapies of Shapiro, Watkins, and others.

Another derivative of psychodrama is the idea of the encounter in here-and-now, which came to influence Fritz Perls in his development of Gestalt Therapy, the early T groups that evolved into “encounter groups,” and other trends. (The philosophical writings of Martin Buber were also influential in the 1960s.)

Drama in general became more acceptable as a more directorial style in play therapy became respectable, and drama therapy emerged as a field, drawing as one of its roots a foundation in psychodrama. Some people can’t handle the sense of personal responsibility involved in classical psychodrama and need to explore problems through more distanced roles, so role playing, sociodrama, the use of puppets, masks, and other dramatic modes become necessary so as to help people work at whatever level of defensive structure they can manage. Many of the arts therapies also allow for more symbolic forms of expression.

Psychodrama was one of the truly interactive group therapies, and Moreno spoke about its value, even if no psychodrama is involved. Gradually, group work became more mainstream, and used by therapists of all sorts. Beyond group therapy proper, the process of therapy also opened to include others, breaking the semi-sacred dyadic model, so that families could be seen conjointly, and also friends and others in the social network might be included.

The value of imagining, using the “as if,” as a tool, became more extensive in part because Moreno’s approach challenged the hegemony of understated talking-about therapy. For example, in the 1950s, George Kelly had people construct a role consciously and enact it as a kind of role-playing practice, anticipating some constructivist approaches that re-emerged in the 1980s. Postmodern trends may also be seen in the idea of re-telling a story, the narrative approaches. (One of that field’s pioneers, Ted Sarbin, started out working with Moreno in the 1940s.) Another way we see this use of imagination is in the A.A. Twelve Step doctrine called “fake it till you make it.”

I mentioned creativity at the outset, and making creativity a core value and aim generates a particularly useful climate in therapy, strengthens the treatment alliance, and sets up the frame for the other concepts and techniques. Deriving from this, the associated concepts of spontaneity as an especially useful way to develop creativity, play as an especially useful way to foster creativity, and drama as a useful adult context for promoting play, all apply to many therapies, not just psychodrama. Psychodrama thus introduces these and other concepts that have been ignored or under-emphasized by most other theories, and should be viewed not as competing with or supplanting other ideas, but enriching our view of what human nature and development should consider. For example, Helping people to flow, to be more spontaneous, has been articulated apart from psychodrama, but Mihaly Czikszentmihalyi’s theories of “flow” and creativity resonate strongly and support Moreno’s writings about spontaneity and its place in life. And attending to the rich dynamism associated with the realm of liking, preference, and rapport (i.e., sociometry) also can enrich the general fields of psychology, sociology, and therapy.

Contributions to Theories of Society
Psychodramatic group work can be ideal for exposing bias, assigning roles to critique leader, addressing postmodern themes (e.g., Pam Remer’s book on feminist therapy). Role theory again more clearly notes the way roles are cultural constructs and subject to constant re-definition. As such, the process of asking about how different roles and sets of expectations, norms, entitlements, etc. are established is part of the process. Psychodrama notes through sociometry that society often is structured in ways that interfere with the natural affiliations of people, and seeks to develop ways of opening that function. (It is to my knowledge unique in this regard)

Role theory is exceptional because it is most resilient and capable of absorbing and incorporating a wide range of theories from other approaches, such as, for example, the culturally-oriented neo-Freudian, Erich Fromm, who considered the cultural norms and underlying tendencies involved in Western culture’s over-valuation of property, of “having,” and its impact on life, on “being.” Similarly, scores of others also offer value and my vision of psychology must transcend the foolish narrowness of sectarianism.

Alas, most of the criticism leveled at psychodrama is shallow and misinformed, generally aimed at Moreno’s own style or his problematic writing. That others since have built upon his work and written about it is ignored, perhaps because that would require a bit more serious study.

Not that psychodrama should be free from criticism. First, it is not a method that is so structured that it can’t be conducted poorly, used by untrained people in clumsy and harmful ways. For this reason, in the late 1970s, more formal requirements for training were established, Board Certification programs, as are found in many specialty areas. So some of the criticism is not about the method, but about its injudicious use.

Second, the method should not be used without appropriate selection and especially follow-up. The idea of the “one-off” session being therapeutic was not really all that responsible. Actually, Moreno’s open sessions had no reported casualties that I’ve heard about, and these went on for decades. However, in our present age of more diligent attention to patient autonomy, confidentiality, and more subtle forms of coercion, such approaches seem less safe.

Another source of criticism rested on a simplistic ignorance about the actual nature of psychotherapy. Not knowing about its integrative potential, or providing direct followup, many psychiatrists in the 1940s through the 1990s felt that re-visiting upsetting or traumatic scenes potentially re-traumatized the patient. Those who bothered to learn more about the method soon had their fears allayed. Others just didn’t want their patients “upset”–as if being in a psychiatric hospital wasn’t upsetting in itself, and the reason they came in wasn’t because they were deeply upset. To think of therapy as not examining the issues directly is like thinking of medicine as never doing surgery. Well, before there were safeguards, perhaps that was somewhat true, but there are ways of following up and working through the insights gained in psychodrama, but the uninformed don’t know this.

A variation of this criticism is based on the misunderstanding of the nature of catharsis, thinking that the method rests on mere expressiveness of strong emotion. Actually, psychodrama aims at re-integrating parts of the self that had been disowned, and this process often is accompanied naturally by tears, anger, and other modes called cathartic.

From within, a variety of criticisms abound. For example, I have noted that good psychodrama practice doesn’t rely only on action. Participants need time for discussion.

Another criticism I bring to psychodrama and most other forms of psychotherapy is an al-too-common prejudice against the potential value of integrating psycho-pharmacology in a total treatment program. The presumption that all psychopathology can be managed without these new tools is akin to believing that faith can cure and no medicine is needed.

Future Directions:
I think we need to re-formulate psychodrama not as a single approach to therapy, but rather as a complex of techniques and concepts that can generally be applied by all the other approaches, enriching them, and helping the field as a whole move towards a more eclectic and integrative approach.

Further, we need to apply these approaches, and, indeed, all psychotherapeutic approaches, with appropriate modification, beyond the context of healing, the sick role, to include helping ostensibly healthy people become healthier, more resilient. Thus, these methods need to be applied in personal development programs, adult education, business and management training, community building, team building, and throughout the school systems, plus for recreation and the arts.

I see psychodrama’s fundamental model, the idea of drama in human life, as embodying a tool for increased reflexivity: To take on the role of inner director as well as actor means that we are no longer, as Shakespeare’s character of Jacques said in his “All the world’s a stage” speech, no longer “merely players.” We become co-playwrights, also.

Adam Blatner, M.D., TEP