The Development of Psychodrama Enactment Themes Throughout the Life of the Group: A Collective Case Study
In this study, an aspect of psychodrama, a little-known, action-oriented form of group psychotherapy, will be examined. Psychodrama was founded by the psychiatrist Dr Jacob Moreno in the 1920s, and was regarded as a major alternative to Freudian psychoanalysis in the United States of America during the 1930s and 1940s. Today, although practised worldwide, psychodrama has been overshadowed by less action-oriented and more talking-oriented, non-psychoanalytic psychotherapies, and therefore lacks visibility. Further, due to a lack of outcome research published in scholarly journals, it is not being included among evidencedbased psychotherapies.
Reviews of outcome studies published between 1970 and 2016 have shown that psychodrama researchers regard the single psychodrama enactment as the basic therapeutic unit, while other group psychotherapies regard the whole multi-session group process as such. Although some psychodrama researchers acknowledge the possible influence of group process on psychodrama outcomes, none have studied this influence. The reviewers saw this as a gap in the research. They also noted that no researcher has mentioned client psychosocial themes that arise during single enactments or during multi-session psychodrama groups.
This study examined the development of client psychosocial themes in a multisession psychodrama group, and used Young’s early maladaptive schema (EMS) framework to assess these themes. A collective case study approach was used with both within-case and across-case data being analysed. As no other universally accepted theme theoretical framework exists, schemas—which comprise cognitive, affective and somatic elements—were used to assess psychosocial themes. Young’s EMS framework was chosen because it offered an accepted, standardised system of naming and defining schemas, and his EMS questionnaires have been shown to be valid and reliable.
Ethics approval was obtained to video-record a multi-session psychodrama group that ran for nine three-hour sessions over three consecutive days. There were nine participants. The psychodramatist and group leader was a registered psychotherapist accredited with the Australian and Aotearoa New Zealand Psychodrama Association (AANZPA). The researcher was not present in the group.
The group leader, who was recruited through an email sent from the AANZPA research committee to its members, recruited participants from among his clients and psychodramatist trainees. All participants consented to being video-recorded for research purposes. The contents of each video-recorded session were catalogued in detail. Researcher-developed schema rating sheets based on Young’s EMS were used to assess and record each client’s schemas arising in psychodrama enactments. Two raters completed the assessment separately and achieved significant inter-rater agreement.
A qualitative descriptive approach was used to analyse the within-case and across-case data. Due to the paucity of multiple enactments for most participants, it was not possible to examine within-case schema development. However, it was possible to examine across-case data for the nine sessions as a whole.
The data was also examined as possible support for Moreno’s assertion that there is a deficit of spontaneity among people in the civilised world. He saw spontaneity as a pre-requisite to finding new solutions to old, dysfunctional, psychosocial problems and adequate solutions to new ones, in a creative way. The occurrence of the emotional inhibition schema in 92% of enactments supported his assertion.
The data was also examined to assess whether the psychodramatic techniques of doubling, mirroring and role-reversal effectively reduced emotional inhibition and increased spontaneity. Most enactments demonstrated this through a reduction of dysfunctional interpersonal behaviours and increase in new functional ones. Transcripts of three enactments are provided to support this. This change did not occur as strongly as a result of member-to-member group interaction outside the enactments. The next most frequently occurring schemas came from the disconnection and rejection domain, which had implications for the participants’ ability to establish and maintain intimate relationships.
This study is significant for future research into the connection between the therapeutic effects of psychodrama and group process, and moves psychodrama closer to becoming accepted as evidence-based. It will also add to the knowledge and skill base of psychodrama practitioners.
Increasing confidence of emergency department staff in responding to mental health issues: An educational initiative
Introduction: This paper reports on one major finding of an educational initiative aimed at improving the care of persons presenting to emergency departments (EDs) with mental health issues. This goal, to improve care, was based on the premise that enhanced knowledge and skills of ED staff in mental health, including drug and alcohol issues, would result in increased confidence and competence of staff. The outcome of this would be that they could provide more effective and efficient service and thus better facilitate triage of persons with these problems. Objective: To increase the confidence of staff in working with increasing numbers of mental health presentations in EDs. Methods: Pre and post Emergency Mental Health Alcohol and Other Drugs (EMHAD) course questionnaires assessed self-ratings of clinical confidence in working with people with mental health issues. Follow-up interviews assessed if new found confidence in mental health had been integrated into daily ED practice. Results: Self ratings of clinical confidence, including knowledge and skills, showed a significant improvement on all questions following the course. Responses to the follow-up interviews suggest that participants in the course had retained and integrated information into practice. This was especially evident in their ability to talk to people about mental health problems and to triage more appropriately. Conclusion: Since attending the course staff feel more confident and competent to deal with mental health, including alcohol and other drug presentations, in the emergency department.
Background for the Development of the New England 4G Framework of Guided Self-Health for People in Rural Areas with Physical and Psychological Conditions
In this paper we describe the development of the New England 4G Framework of Guided Self-health including rural health and workforce issues, models of care, and the United Kingdom's (UK) 'Improving Access to Psychological Therapies' (IAPT) initiative from which the Framework was derived. With a long history in the UK of CBT delivery by workforces such as mental health nurses, we have adapted the IAPT model to fit rural environments of Australia and included physical as well as mental health conditions as part of a low intensity approach to helping. Health workers in the New England Framework assist individuals to select and use self-administered cognitive and behaviorally-based (CB) interventions specific to health problems. The worker in the New England Framework goes beyond dispensing health information or brokering services and guides the person to identify a specific problem and make change. The framework includes information gathering information, generating a CB plan, giving self-health materials and guiding with follow-up.