Annotated Review of Cognitive Behavioral Psychodrama Group Therapy
Thomas Treadwell Ed.D. T.E.P. CGP
This brief review combines Psychodrama and Cognitive Behavioral Techniques (CBT) in an applied group setting. The cognitive psychodrama group therapy (CPGT) model focuses on identifying conflicted situations, activating moods, negative thoughts, balanced thoughts, and recognizing distortions in thinking initiating a negative interpretation of an event. Thus, the blending of the two models yields a complementary eclectic approach to multiple problem-solving strategies. The CPGT environment provides a supportive and safe climate to practice new thinking and behaviors (Treadwell, Kumar, & Wright, 2004). AA brief case is reviewed below.
Case
Aaron Smith is a 56-year-old man who recently decided to change his career style and take on a new professional career. He joined a therapy group for professionals who are dealing with depression and anxiety. He disclosed to the group about his situation during the fifth group session and volunteered to place this thought record on the whiteboard.
Warm-Up
During the fifth group session, he completed the automatic thought recordon the whiteboard during the warm-up phase of the group session. His situation; changing lifestyle and career. After identifying his moods, the facilitator addressed his automatic thoughts. Using the downward arrow technique and Socratic questioning to evoke automatic thoughts. Additionally, the facilitator helped Aaron identify thoughts evoking feelings of discomfort and eventually, Aaron identified his negative self-thought as ‘a lost person’. Aaron accepted the role of Protagonist.
His situation: “I have to change my life”. His Moods: scared, afraid, lonely. Immediate thoughts were: “people could not love me if they knew the real me.”
Action
Protagonist, Aaron, selected Josh, another group member, to be his double. Aaron experienced trouble expressing his defeatist attitude. The facilitator used the soliloquy technique to help him calm down and express his feelings of rejection. Aaron walked around the room, thinking/talking aloud, expressing his concerns, discomfort, and hopes. Aaron chose Josh as his double who (in the soliloquy) walked with him, saying thoughts he felt he was thinking but not expressing. Aaron echoed the thoughts he agreed with and dismissed those not on target. The technique enabled him to relax, focus, and prepare for action allowing other group members to engage and focus on the upcoming action.
As Aaron walked around the room with his double, he realized he needed to let Janet, his wife, know that a lifestyle change was in his best interest. When the facilitator asked him what he needed to do to address the way he felt, Aaron was confused, but eventually recognized he felt he had no self-confidence and was desperate to make a life change. He mentioned he had a childhood friend he confided in, but he has not been able to establish close relationships in adulthood.
The facilitator asked Aaron to select a group member to play one of his childhood friends whom he trusted. He chose Nicole to play his friend Chelsea. The facilitator used the interview in role reversal to help Nicole understand Chelsea’s role. Aaron told Chelsea he was sad because he felt he didn’t have anything to offer and would never make new friends. He and Chelsea reversed roles many times, attempting to get Aaron to recognize his strength and good qualities. However, even with the assistance of Josh, his double, Aaron wasn’t able to see himself as anything but a flawed person. The facilitator suggested Aaron explore a role opposite his perceived ‘flawed’ role. Aaron was interested, and the facilitator asked him to identify the roles he currently plays in the workplace, Aaron quickly responded: unhappy professional, lost man, and perfect Fortune 500 executive. Thinking about his current roles, Aaron recognized that he needed to develop a confident role to see clearly what he can offer others.
To explore Aaron’s roles, the vacillator placed chairs in the middle of the room and had Aaron sit in each role expressing what he thinks and feels in each role. His double, Josh, sat with him. Another member of the group, Brian, was chosen, as an auxiliary, to play the lost man role. Continuously, Aaron, in his confident role, was unable to shut down these powerful roles. A group member, Tyler, was chosen to play the confident role. After seeing Tyler model this role, Aaron was able to shut the negative roles down. The final step in the action phase was to have Aaron, using the empty chair technique, address his feelings of a lost man to Janet. He was able to tell Janet that he had lived in fear of misrepresenting himself for many years. Letting her know he desired a lifestyle change was extremely hard. It was at this point the confident role emerged letting her know his real feelings.
Before the final stages, the double, all auxiliaries, and Aaron were de-roled. This de-roleing technique is an important procedure which allows members of the action group to transition from the role they were assigned and return to their own identity. They share their sense of being in character and let go of any negative emotions that may have arisen from their participation.
Sharing
Following the action phase, group members share and discuss what occurred and how the situation affected them. No advice is to be offered by group members, only sharing from personal experiences. For Aaron, sharing is critical for both the protagonist and group members as they reflect, share, and learn from each other. Sharing is the fundamental component of group cohesion. During the sharing, two group members shared their lifestyle changes and how difficult it was for them.
Alternative Behavior Plan (Homework)
Assigning homework to the protagonist is essential, as it encourages the practice of the new role explored in the session. Role development needs practice for habituation to occur and for the protagonist to feel safe in a new role. It is the job of the facilitator to address the protagonist’s core beliefs and schemas with a behavioral strategy that takes the form of homework. Homework encourages members to practice learned strategies in their own environment (J. Beck, 2011).
The focus of Aaron’s homework was asking group members to discuss changing careers and life-style before the next session. Although initially reluctant to ask anyone, he asked Josh and Jenny, the two members that shared life style changes if they were willing to spend time with him. Both enthusiastically agreed.
REFERENCES
Beck, A. T., Rush, A. J., Shaw, B. F., & Emery, G. (1979). Cognitive therapy of depression. New York: Guilford Press.
Treadwell, T., Kumar, V.K & Wright, J. (2004). Enriching Psychodrama via the Use of
Cognitive Behavioral Therapy Techniques. Journal of Group Psychotherapy,
Psychodrama, & Sociometry 55, 55-65.
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