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(First written in 1992 and revised, posted August 2, 2002.)
Abstract:Psychodramatists will need to become more involved using Morenean methods as modes of overall consciousness-raising in educational, religious, and community contexts, shifting away from the more individualized and cost-ineffective medical contexts and more to a skill-based "sociatry." A number of social and technical developments have emerged so that this trend can become an occasion for "a truly therapeutic method" having benefits for "all mankind."The thesis to be presented here is that Morenean methods--group dynamics, psychodrama, sociodrama, sociometry, action approaches, and the various concepts associated with these--will be most useful in the coming years as the field of psychotherapy is to some large extent squeezed out of the medical setting and must take root in another social context, such as education, spiritual programs, or other kinds of community activities.
Our society is being subjected to increasing fiscal constraints, and the health care field is coming under special scrutiny. Psychotherapy, arising mainly out of the field of medically-based psychoanalysis, has flourished in part because medical insurance has covered treatment for a wide range of problems. Remember that until fairly recent times psychotherapy has been a relatively long-term proposition. However, increasing fees and the emergence of brief therapy approaches, as well as the impact of pharmaceutical agents, when mixed with the overall socioeconomic picture, has been leading increasing numbers of both health maintenance organizations and third-party payors to press for more crisis-oriented approaches.
I am not saying that I personally like or advocate these trends, but only that I see no end to them; indeed, all the evidence I encounter leads me to see this process becoming even more extensive. For example, I envision a time when, say in ten to twenty years, you and I will be community representatives on a committee whose role it is to help allocate resources. We'll have, say, several hundreds of millions of dollars to pay for all types of health care, from immunizations or dental care for children, prenatal care for mothers, general medical care, psychiatric care, and of course, we'll be asked to prioritize our allocations of funds.
Now the problem is that psychotherapy is in fact a process which partakes of both the medical and the educational model. A certain amount of psychotherapy is involved in most acute psychiatric disturbances, at least working with the family to stabilize the psychosocial system. Another significant amount of psychotherapy is devoted to a more long-term, almost rehabilitative process, learning assertion skills, self-affirmations, and scores of other components of most people's personal growth. The majority of people in psychotherapy today have become somewhat stressed before they entered treatment, but in fact haven't developed the kind of crisis which would necessitate hospitalization; nor in all likelihood would they have decompensated that much had they not entered therapy. Certainly they would have continued to suffer, and even perhaps compounded their own self-defeating behaviors and attitudes.
The question is whether all these "problems of living" should be considered strictly "medical," or is this perhaps an elitist, upper-middle class way of tapping into a health insurance system which was really designed for more medical or acutely psychiatric types of problems? Whatever your preferences in answering this question, it is likely that our society at large is moving towards reducing most ordinary mild psychological or family disturbances to a low-priority status. Those who wish to avail themselves of these services can do so, but they'll have to pay themselves; the health care dollar is to protect against a different category of phenomena.
The entire psychotherapy field, mainly practiced today by psychologists, social workers, psychiatrists, and various kinds of counselors, may be subject soon to the kinds of dislocation occurring now in Eastern Europe as they move towards a free market economy. The point I wish to make today is that those acquainted with action approaches and Morenean methods are especially positioned to benefit from--or at least not be so hurt by--these socioeconomic changes.
First, there will be a major premium placed on the development of relatively intensive types of diagnostic and treatment procedures, which are more cost-effective than the more traditional non-directive, open-ended approaches. Action techniques can move sessions along, bringing out more material and addressing practical approaches to solving problems. Professionals knowing how to use psychodramatic techniques in individual, family and group treatment will have an advantage over others and should begin to focus their practice towards a briefer type of work.
Second, outside the arena of the medical model, more group and quasi-educational approaches will be in demand because they're less expensive. Morenean approaches have the advantage of being interesting and able to catalyze a good deal of insight and discussion, intensifying and making more efficient any ongoing group process.
A Skills-Based Psychotherapy
Much of insight oriented therapy operates on the assumption that becoming aware of underlying emotional needs, patterns of self-deception, and the realities which cannot be evaded leads to a release of psychic energy which then enables patients to more creatively engage their life problems. This is valid, as far as it goes, but it doesn't go far enough. And I'm concerned that most traditional therapists have little idea how therapy could be even more effective. Here's how: People need to acquire actual skills for dealing with those insights. This is what Moreno meant by his dictum that every catharsis of abreaction must be followed by a catharsis of integration (Blatner, 1985).Furthermore, I strongly suspect that lacking a sense of how some awareness can be turned into something useful rather than a source of shame or anxiety reinforces the powers of avoidance and self-deception. Put differently, people tend not to think about things they can't think about effectively.
The idea of skills includes not just the knowledge of various techniques, but also concepts, consciously and explicitly entertained. There can be different levels of skills, also. For example, the skill of defensive driving includes at its most elementary level the awareness that driving can be dangerous; more pointed is the awareness that there exists a skill known as "defensive driving" which can be learned, that one can be pro-active rather than merely reactive. (This wasn't generally considered in our culture until the last generation or so.) The next level up is the learning of the various specific dangerous situations which can be avoided, and then learning the techniques which can avoid or minimize those situations when they happen.
We need to start thinking of our basic repertoire of skills for dealing with our own emotions and the complexities of interpersonal and group situations with this same proactive attitude. People can learn these skills, and Morenean approaches have a great deal to offer in this regard.
First of all, we need to be willing to make our psychodramas and sociodramas learning experiences, and in group psychotherapy, the basic principles of mental hygiene need to be clarified as understandable principle. For example, the underlying therapeutic factors in group work have been noted by Yalom and others in the last few decades, but as I read the literature on group therapy, it seems not to have occurred to most group leaders to let the participants in on these ideas. They seem to believe in the old cliche that it's best to let people discover everything themselves. This principle needs to be challenged, and with discrimination we as therapists should reframe our role to include that of education.
Another point is that learning the methodology of psychodrama tends to instill the idea that creatively exploring one's problems will be more productive than sustaining any attempts to avoid or circumvent them in devious fashions. I've found that when people have experienced the role of protagonist a number of times, they begin to use the idea of role reversal, re-play, increasing self-disclosure by talking about "part of myself is feeling...while another part is feeling..." and other ways to integrate the power of the imagination in a more focused way in one's own life. People begin to do their own mini-psychodramas on their own or with significant others in their lives.
Much of this skill acquisition needs to happen in non-medical settings. At best the process can be begun in acute settings, but for the most part, patients are caught up in admissions and medical evaluation procedures. Nowadays discharge planning begins at admission, and there is hardly time to build a therapeutic alliance. I try to help the staff where I work at least give the patients a better understanding of the nature of the problem and some positive directions for follow-up.
That follow-up will be held increasingly in various institutes and centers, perhaps associated with churches, schools and colleges. More, I hope these places can begin to provide preventive services, basic education that will help people live their lives more creatively and effectively.
Skills for Today
One idea I hope will be found useful is to reconceptualize much of dynamic psychology as skills, and as a start, I find it helpful to describe three general categories of life skills as (1) interpersonal problem-solving, (2) communications, and (3) self-awareness. These skill areas really address very basic psychological issues, but their context makes them more understandable to people. In other words, people feel less mystified by psychology, less placed into the one-down "patient" role when they reframe the learning process as educative.Yet education can involve people holistically. Learning the aforementioned skills cannot be done by reading books, and the learning cannot be tested by multiple-choice questions. These skills involve risk taking, committment, an ongoing process of confronting and dissolving one's childhood residues of vanity, egotism, and other illusions, and replacing them with more mature forms of cognition and emotional reaction patterns.
Indeed, I foresee a time when this process of re-working one's personal repertoire of subtle mental habits becomes a normative procedure, considered as necessary for true maturity as any rite of passage. This "second graduation" or "second initiation" generally occurs between the ages of about twenty-five and fifty, a few people engaging in the process on either side of this range. It's getting too expensive for each person to attempt this in one-to-one therapy, and furthermore, I'm not so convinced that many therapists are delivering optimal learning experiences.
So I think there need to be learning groups, addressing the kinds of re-alignment issues which tend to be core themes in most therapies. These themes would be addressed as psychodramas and sociodramas, and group issues worked with using sociometric and other action techniques. (See papers on this Website on Drama in Education; on Role Playing in Education; and on references to Emotional Intelligence.)
The cognitive orientation given people by framing these therapeutic procedures as educational, skill-building groups empowers them to participate more actively, evokes a more mature, self-directed, self-responsible attitude, rather than the passivity of "pupils" which arises from not really understanding the nature or significance of the process.
Another useful tool in this regard is the language of "role dynamics," a more systematic way of describing psychosocial phenomena in terms of the roles being played and how they are defined. This derivative of Moreno's role theory can be worked with as a "user-friendly" language, and has many advantages (Blatner, 1991). It's most important purpose is to carry forth that same principle: The more people can know about their own learning process, the more they are empowered; and the more they feel a sense of mastery, they more they are motivated.
Psychological Literacy
Learning communications, interpersonal problem-solving and self-awareness skills is not merely a form of preventive mental hygiene and ongoing therapy, but represents a type of learning which I believe will become a basic requirement for adaptation in the next century.At the present time, psychological mindedness is still a minority phenomenon. The majority of people still view psychology in all its forms as vaguely nefarious, perhaps some kind of "racket." Practitioners remain undifferentiated in the popular mind: psychiatrists, psychologists, social workers, counselors, etc.--they're all just "those people who mess with your mind." I assure you that these attitudes are common among many educated people, many legislators, many physicians.
Part of this rejection of introspection of course arises out of personal anxiety over repressed material; but part is due to the fact that much of dynamic psychotherapy is still viewed as classical psychoanalysis, obscure, narrow in scope, expensive, lengthy, and in many other ways not particularly acceptable to those who think of themselves as "down to earth." In a way, this is due to our inability as a profession or a field to demystify this almost archetypal image because we don't have anywhere near as fascinating of a cultural cliche to replace it with.
I like to use the analogy of the computer revolution. Psychoanalysis is like the first generation of vacuum tube based computers that took up entire rooms and used up thousands of kilowatts of electricity. The therapies designed to streamline the process that came out in the 1950s and 60s were like the transistor based computers, but still they required highly trained specialists to address their workings. Now we are entering a new era: In computers, the chip-based technology allows for a miniaturization which in turn invites an explosion of new applications. Also, some "user-friendly" software breakthroughs now make it possible for ordinary people with hardly any training to utilize these machines. In psychotherapy, the human potential movement and encounter group marked a move towards the popularization not just of psychological ideas, but also of techniques for personal growth.
Yet many people still own their computer phobia shamelessly--and their lack of psychological mindedness. It reminds me of a hundred and fifty years ago when physicians arrogantly belittled those early pioneers who were talking about the emerging field of bacteriology, and the need for sterility to avoid infection. They operated in their everyday work clothes with unsterilized instruments. At the end of the last century, many people were illiterate, but instead of being ashamed, they were wary about the need for "book learnin'." After all, they could work successfully as factory workers, homemakers, farmers, craftspersons, without having to read or write.
Yet in the succeeding half century, technology complexified, mobility increased, and along with other factors it became increasingly important to acquire literacy, and now it's a necessary skill for almost all but those in marginal socioeconomic roles. In the near future we are coming to a point that the skills of interpersonal flexibility and psychological mindedness will be as necessary as the ability to read and write.
This requirement for psychological literacy is in part a result of rising expectations. People want themselves and their spouses to function at a level beyond that of their parents, and similarly they want to raise their children with a degree of sensitivity and empathy that they may have never enjoyed. In the workplace and community, people are demanding more respect: Bosses can't be as free in their sexism or petty tyrannies. Racism, ageism, all the other subtle prejudices are being subjected to collective and individual processes of consciousness-raising.
There's also an economic need for more mental flexibility: We can no longer afford the waste and inefficiency caused by the disruption of work arising out of people's characterological difficulties. Passive-aggressive, narcissistic, histrionic, sadistic, chronically depressive, and other problematic issues are now occupying an inordinate amount of management and work time--trouble or friction with one's supervisor, subordinate, or co-worker.
Certainly all defects in human nature cannot be easily corrected with one approach, but even a beginning would be helpful, and a beginning is possible. We have developed concepts and techniques which may be distilled from the hundreds of different therapeutic approaches and applied in more efficient, educational formats-- an experientially-based education, though, not just didactic methods.
Empathy can be taught. I challenge those who deny this, because the technique involves a sustained, repeated exercise of the imagination through the psychodramatic technique of role taking, of wondering "what it's like to be..." in a given role.
Learning empathy and other self-development skills in a supportive context also tends to build pro-social attitudes, for if a person feels safe and effective in being honest and direct, it's a relief not to have to engage in the intuitively-sensed danger of manipulation.
(Since this was first written, there has been a good deal written about "emotional intelligence," an a renewed movement to teaching social and emotional skills in the classroom. I comment on these approaches more in related papers.)
Metacognition and the Evolution of Consciousness
The development of mental flexibility is not only a practical skill, but actually represents what I believe to be the next step in the evolution of consciousness. Mental flexibility involves the capacity to shift among a variety of roles, and to include among those roles the roles of self-observation and re-evaluation. Using a dramatic metaphor, there are not only the roles we play, but also, in the play, we can shift into the meta-roles of critic, playwright, director, agent, and audience. From these positions, we can revise our attitudes and behaviors. This working from the meta-position is what makes psychodrama different from what so many popular press distortions of the term refer to as psychodrama when what they really mean is psychologically-loaded drama. It's the pausing and reflecting that doesn't happen in the course of most novels or movies, but really what should be happening more often.We need to help people think about the way they think. The technical term for this is metacognition. When people actually develop a habit of thinking this way, of looking at things from several points of view, of considering situations also from the other person's perspective, they become more personally and socially mature--indeed, I question if we've ever had even a large group (much less a society) that's operated in this fashion.
Yet a large number of developments in the last century have all had this self-reflective frame of reference as a key theme: Linguistics, non-verbal communications, artificial intelligence, anthropology, child development, neurophysiology, literary and historical criticism, philosophy, and of course psychodynamic psychology--these and other fields all question the mind's capacity for self-deception, tendencies to become immersed in one's own mythological world-view, in short, the unconscious limitations on consciousness.
The act of metacognition is practiced through the exercise of Morenean methods. They cultivate an analytic attitude, a willingness to call oneself and one's group norms into question. Sometimes this is done seriously, sometimes through the practice of integrating playfulness and the willingness to reach into the realms of fantasy and the outrageous in order to access the kernels of creative truth which lie in the "shadows" of the unconscious.
In summary, Moreno introduced a number of concepts which seem diverse, yet have as their unifying function the idea of promoting creativity. He found the most powerful source of creative thinking to be the process of spontaneity, improvisation. And he also found that the medium of drama, especially playful, creative, improvised drama--in contrast to rehearsed and scripted theater--served as the most powerful source of spontaneity. Associated ideas about group dynamics and sociometry, techniques which warm up people to spontaneity, a more pluralistic model of psychology based on role theory, all these could be integrated in the holistic endeavor of personal and social development.
In the last generation, trends towards integration among the psychotherapies have shown that Morenean ideas can be synthesized with the best insights of the other theories. The time for competing schools of thought is past, and further, we continue to expand and include other disciplines in our growing understanding of the complexities of human experience.
Morenean ideas have a place in this, the place of offering a "praxis", a system of operationalizing the theoretical insights, of putting them into practice not just in therapy, but in a more preventative, educative fashion. Even if the medically-based psychotherapy industry becomes constricted because of financial pressures, we are in a position to move laterally into schools and churches and other community contexts. It will require some initiative and salesmanship, but I hope this talk will encourage your in this endeavor. I'll close with Moreno's classic statement, his opening line to his magnum opus, his first book on sociometry written in 1934, Who Shall Survive?: "A truly therapeutic method should have as its goal nothing less than the whole of mankind."
Blatner, A. (January, 1985). The Dynamics of Catharsis. Journal of Group Psychotherapy, Psychodrama & Sociometry, 37(4), 157-166. References
For responses, email me at adam@blatner.com