Presentation for the Bulgarian Assoc. of Psychotherapy, by Göran Högberg
Dear Bulgarian Psychotherapists
The event of this gathering signals hope for suggering psychiatric patients. The hope of united efforts to find helpful methods in spirit of co-operation and ecumenical attitude. This is my first point. In the last century psychotherapy was a field of sectarian struggles between clan like schools of therapy Freudians, Adlerians, Jungians, Reichians, Hypnotherapists and so on and so forth. This was a time of group loyalty disguised as quasi science. I hope we are now in a situation where we can study common pathological and curative factors and acknowledge that different concepts are covering the same aspects of reality. We must study and compile knowledge from both clinical studies, experimental animal studies and from the emerging neurocognitive science. From this will emerge an eclectic and multimodal scientifically based psychotherapy.
This being said I am going to expound on the place of psychodrama in such a broad based treatment approach. The importance of the early bonding between parent and child are being highlighted in regard to subsequent mental health. Dr Moreno stated that the baby was an actively relating human being from the very start of life. Modern research on babies and parents are supporting theview of Dr Moreno and the interaction and attachment pattern of the baby is a rich source of understanding how early communication and bonding as well as pathologies thereof-is evolving. So now there is a broader theoretical understanding between psychodramatists and psychological research. Does psychodrama have anything to add in the practical work?
Actually Dr Moreno described how he worked at a well-baby clinic when he took the role of the baby and developed a dialogue with the mother. Psychodramatic dialogue with role reversal can enhance the communication with both the unborn and the newborn.
Furthermore, early psychoanalytical theory proposed that the communication between therapist and patient was characterized by transference and counter transference. Dr Moreno called in another concept that of tele or zweifulung, two-feeling. He talked about the co unconscious.
A similar modern concept is sympathy feeling together. Morenos tele concept
describes the interpersonal interaction as a field of rapid simultaneous exchange of perception and reaction. Actually lately this concept as taking center stage in psychotherapy exploring and working with the inter-subjectivity the process in-between persons. The emerging concept of metallization is a new label for this capacity to reverse role and take the perspective of the other. Again, common theoretical ground is emerging but does this have any consequence for the meeting with the patients? Indeed that is the case, in order to work with the inter-personal field the tool of doubling and role reversal are indispensable.
Doubling is the training and practice of non-verbal emotional communication and role-reversal is the physical and emotional exercise of the bilateral flow of meaning in a human dialogue.
Psychodrama should be defined as the method of dialogue and role-reversal, as an active technique of exploring and transforming the inter-personal field. This means that psychodrama can be used along the full spectrum beginning with the autodrama of inner personal drama of the individual struggling in isolation with different aspects of the self in phantasy, over the monodrama in individual therapy with one patient and one therapist, further on with couples, families and groups and all the way to larger groups in sociodramatic endeavour. In all these different settings the psychodramatic method can be used to increase and change the emotional communication between the involved entities.
The event of the system of mirror-neurons in the brain are an important contribution to the understanding of the way humans interact and form social bonds. This system implies that the observation of another person creates an inner imitation and thus also understanding of the actions and feelings of the other. This is a biological underpinning of the role-reversal and it hard to conceive of better tools than doubling and role-reversal to practice and develop the system of mirror neurons.
We also learn from learning theory, especially when it comes to post-traumatic stress, that repetition strengthens memory also of emotional events. Thus post traumatic stress develops in the aftermath of major psychological trauma, after a period of acute stress disorder. The recurring flashbacks of the trauma engraves the memory traces and each new flashback becomes a new traumatic memory. Thus the natural process of attenuation of the emotional response is altered into increasing sensitization to trauma related triggers. The obvious risk with psychotherapy is that the traumatic memory is remembered and repeated, in psychodrama by enactment and in psychodynamic therapy by talking; and that this repetition actually aggravates the symptomatology. In order to come to rest with the traumatic memories there must be a conscious work with positive memories and positive experiences in therapy.
On the psychodramatic stage the conclusion must be that there should well balanced focus on all the three aspects of working through a trauma: (A) the way it was, (B) the way it was not, which means that unexpressed emotions and frozen actions are activated and (C) the way it should have been, ie enacting a positive phantasy of an alternative scenario.
In order to increase the learning of positive emotional expression I believe we could also increasingly dramatise so called safe places as a resource to be used in the drama to counter the negative emotions in a counter-conditioning paradigm. Also working with enactment of positive future templates will lead to training of positive actions and feelings.
A common aim in psychotherapy is to replace repetitive contraproductive ways of experiencing the world and reacting to it. This means leaving old patterns, scripts and fantasies. There are different wordings for this in different schools of psychotherapy and I believe we could find a uniting factor in focus on this so-called response-flexibility. In psychodrama this is defined as the s-factor, the factor of spontaneity, and spontaneity is defined precisely as increased response-flexibility; meaning the individual who has become stuck in destructive patterns needs to learn how to react adaptively to new situational demands. To increase the response flexibility it is not enough to understand the reasons behind the negative responses but it in practical therapy necessary to develop new skills both in the area of perception as well as action both of which can readily be practiced on the psychodramatic stage.
A final reflection on new neuro-cognitive knowledge baby and the about the neuropeptide oxytocin. This small molecule is of utmost important in close personal relations affecting the bonding between for instance the baby and the mother. But there is also another side to oxytocin. The closeness is directed inwards and increases the coherence, love, mutuality etc of the inner circle but this is paired to a distancing and negative appraisal of the outer world, of potential enemies. The lioness as a great mother and a formidable foe. In therapy the phenomenon of oxytocin effects, creates by feelings of safety, relaxation, intimacy, touch, a safe haven. I believe that all psychodramatists have experienced the feeling after in intense weekend or week of psychodrama a closeness and familiarity with the members of the group and after the ending of the group have experienced non-group people as strange, cold and different. This effect of a safe haven in psychotherapy can be counterproductive because what we aim for is not creating addiction to a psychotherapeutic safety in any therapeutic setting but a change of relations and actions in real life. Therefore I believe that there was a wisdom in the comment of Dr Moreno that it was preferable to work with real auxiliary egos, people in actual real life relations rather than stand-in auxiliary egos. This means that we should think about ways to open up the therapy rooms and the psychodramatic stage to invite friends, partners, families and work-mates and develop our ways of working with natural social constellation.
Thank you for your attention and good luck with the conference