Corey Chapter 8 and 9 Yalom Chapter 7

The Warm-Up Phase

Increasing involvement of entire group through initial activities Establishing an atmosphere of spontaneity Certain principles underlie the use of psychodrama action methods. First, it is not appropriate to move into action without warming people up lest they feel overwhelmed by the ambiguity of the situation. Warming up consists of the initial activities required for a gradual increase in involvement and spontaneity. This is aimed at encouraging maximum involvement. It includes the director's warm-up, establishing trust and group cohesion, identifying a group theme, finding a protagonist, and moving the protagonist onto the stage Physical techniques for warming up a group are commonly introduced and may include using music, dancing, and movement or other nonverbal exercises. In settings in which a psychodrama is to be the primary mode for exploration, the following warm-up methods have been used: The director gives a brief talk about the nature and purpose of psychodrama, and participants are invited to ask questions. Each member is briefly interviewed by the director. A lead question may be, "Is there a present or past relationship that you'd like to understand better?" As each person in the group responds to this question, a basis for group cohesion is being established. Members can form several sets of dyads and spend a few minutes sharing a conflict that they are experiencing and that they'd like to explore in thesession. The go-around technique, in which each member is asked to make some brief comments about what he or she is experiencing in the moment, can facilitate group interaction. Making the rounds can also focus members on personal work they would like to do during the session. In a long-term group with functional people, a nondirective warm-up is often used to get members ready for a session. For example, members may be asked to briefly state what they were aware of as they were coming to the session or to make any comments about their readiness to work. In addition to structured techniques aimed at warming up a group for action, unstructured warm-ups such as the process by which a protagonist emerges from the spontaneous interaction at the beginning of a group session, may be used. The leader needs to pay close attention to verbalandnonverbal cues as the protagonist describes the issue to be explored. Leveton (2001) states that a successful warm-up encourages members of the group to actively participate and assures members that all contributions will be rewarded. During the warm-up phase, members need to be reassured that the working environment is a safe one, that they are the ones to decide what they will reveal and when they will reveal it, and that they can stop whenever they want to. The techniques are less important than the spirit and purpose of the warm-up; anything that facilitates the cohesion of the group, establishes trust, and enhances individual and group spontaneity is a useful tool for the initial phase ofa psychodrama. According to Blatner (1996), the most important task during the warm-up phase consists of creating an atmosphere that fosters spontaneity. In his view, these four conditions are necessary for spontaneous behavior to occur: A sense of trust and safety A receptivity to intuitions, images, and feelings An element of playfulness A willingness to take risks and engage in novel behavior

The Audience

The audience includes others in the group before whom the problem is explored. Even group members who are not engaged in the action play a role. As members witness the self-disclosure of others, they function psychologically as a kind of externalized "mirror." This gives the protagonist the experience of knowing that others share in looking at the world from his or her point of view. Psychodrama benefits the whole group, not just the protagonist. Almost always some group members find a particularly moving resonance in the enactment, identifying with either the protagonist or one of the other roles.

The existential tradition

The existential tradition seeks a balance between recognizing the limits and tragic dimensions of human existence on one hand and the possibilities and opportunities for humans to transcend those limits to achieve a vital existence on the other hand. It grew out of a desire to help people engage the dilemmas of contemporary life, such as isolation, alienation, and meaninglessness. The focus is on the individual's experience of being in the world alone and facing the anxiety of this isolation.

Psychodrama in Groups Introduction

n a broad sense, psychodrama is a complex of technique, philosophy, and theory that weaves together imagination, intuition, physical action, and various dramatic devices to explore a wide range of psychological problems. Integrating psychodramatic methods, often referred to as enactments, can amplify the effectiveness of all the approaches described in this book. Drama therapy and other therapies also involve enactment, improvisation, and collaborative creativity aimed at expanding role flexibility and insight, and psychodrama is a significant source ofideas for many of these approaches. Psychodrama is primarily an action approach to group therapy in which clients explore their problems through role playing, enact situations using various dramatic devices to gain insight, discover their own creativity, and develop behavioral skills. Classical psychodrama An approach that requires specialized training on the director's part, adequate time for orientation and follow-up, a supportive group atmosphere, and members who are appropriate for these methods. Classical psychodrama involves a group setting, is client-centered, and is a complex and intense method that requires two or more hours of group work. It involves warming up the group, selecting the main player, warming up and working with the client as the main player, returning to a deeper involvement of the group-as-a-whole, and sharing this experience. Psychodrama allows group members to explore various roles and aspects of themselves, and to experience their perception of others with whom they have a relationship. The techniques of psychodrama encourage people to express themselves more fully, explore both intrapsychic conflicts and interpersonal problems, get constructive feedback on how they come across to others, reduce feelings of isolation, and experiment with novel ways of approaching significant others in their lives.

Spontaneity

s people grow older, they tend to become less and less spontaneous. To remedy this tendency, Moreno developed methods for training spontaneity aimed at freeing people from limiting "scripts" and rigid and stereotyped responses. He considered spontaneity training to be a prime way of enabling people to meet new situations from a fresh perspective. It could be said that spontaneity is Moreno's definition of mental health because we learn to live in the here-and-now; we stop throwing our old solutions onto new problems (Nicholas, 2009). From Moreno's perspective, spontaneity is an adequate response to a new situation or a novel response to an old situation. Spontaneity should not be thought of as impulsive behavior or as a license to act out; spontaneity involves reflection and gives people the ability to act according to the situations they face. Instead of encountering a new situation with anxiety, spontaneity fosters a sense of being capable of approaching a challenging situation It is important to create a climate that will facilitate the unfolding of spontaneity—part of an activity that Moreno called "warming up." People cannot will themselves to be spontaneous and cannot effectively be pushed into being spontaneous. We rely on physical, mental, emotional, and relational "starters" to help us warm up our innate spontaneity. In psychodrama, the group leader helps facilitate group members' spontaneity by modeling spontaneous behavior and a sense of playfulness. Sometimes the leader also creates structured activities to help reduce anxiety and promote a climate of safety, trust, risk-taking, and playfulness. To be able to create a climate that fosters the development of spontaneity, group practitioners must be aware of their own feelings and draw upon them in intuitive ways. In psychodrama, play is recognized as a valid need, a part of health, so that people can enjoy a wider range of experiences than they might in everyday life. Play involves imagination, creativity, spontaneity, and self-expression

Self-Determination

Sartre's view: We are constantly faced with having to choose the kind of person we want to become As Sartre (1971) put it, our existence is a given, but we do not have, and cannot have, a fixed, settled "nature," or "essence." We are constantly faced with having to choose the kind of person we want to become, and as long as we live, we must continue to choose. Frankl's view: Ultimate freedom cannot be taken from us. We can choose our attitude toward any given set of circumstances Frankl's brand of existential therapy, logotherapy (logos = meaning), teaches that meaning in life cannot be dictated but can be discovered by searching in our own existential situation. Frankl speaks of "discovering meaning" and "creating meaning. Frankl believes the goal is not to attain peace of mind but to experience meaning in a healthy striving. We are also responsible for (but not to blame for) the symptoms that restrict our ability to live freely and fully. It is essential that we recognize and accept our part in creating the quality of our existence, for life does not simply happen to us. Accepting this freedom and responsibility generates anxiety, and so does the risk associated with making choices. Another goal of the existential group is to help participants face and deal with these anxieties. The main task for the group leader is to confront members with the reality of their freedom and of the ways in which they are restricting or denying it. Group participants sometimes present themselves as victims, talk about their feelings of helplessness and powerlessness, and place the blame for their unhappiness on others and on external circumstances. A good place for members to start on the road to greater self-determination is to become aware of the roles they have chosen to play. When people come to believe they can make choices, they can direct their own destiny, and ultimately assume control of their life. Through feedback, members learn to see themselves through others' eyes, and they learn how their behavior affects others. Building on these discoveries, members can take responsibility for making changes in their everyday lives. The group work "not only allows individuals to change their way of relating to one another but also brings home to them in a powerful way the extent to which they have created their own life predicaments—clearly an existential therapeutic mechanism".

Focus of Existential Therapy

A phenomenological approach It focuses on understanding the person's subjective view of the world Therapists allow themselves to be affected by their clients' therapeutic experiences Clients are challenged to stop deceiving themselves about their lack of responsibility for what is happening to them excessive demands on life Aims of therapy to set clients free for clients to accept life in all its complexities and paradoxes to help people face up to the difficulties of life with courage

Encounter

An encounter occurs when individuals connect with one another in a meaningful and authentic way. This encounter occurs in the context of the here-and-now, regardless of whether the enactment relates to a past event or to an anticipated future event. It involves a great degree of both directness of communication and self-disclosure. There is great power in encountering. Even when done only symbolically in the form of role playing, it is still more effective than merely reporting an incident. In addition to directness of self-expression, Moreno envisioned an ideal encounter as involving both parties opening their minds and hearts to the viewpoint of each other through role reversal, imagining what it might be like to be in the other's predicament. Encountering is at the very core of psychodrama; through this process people not only meet but also understand one another on a deep and significant level. Most clients with some psychological-mindedness need to be helped to reverse roles with those in their lives whose behavior may have caused them pain. Group members should have a number of opportunities to feel validated in their own experience before this is attempted.

Soliloquy

At times protagonists are asked to imagine themselves in a place alone where they can think out loud (soliloquize). The director may ask a protagonist to stop the action at some point, turn aside, and express her feelings at the moment. Or the director, on sensing ambivalence on the part of another protagonist, may stop the action and ask him to walk around the stage and say what he is thinking and feeling. Or the protagonist may be engaged in a solitary activity, such as walking home. Like the doubling technique, soliloquy facilitates an open expression of what the protagonist may be thinking and feeling but not verbally expressing.

The Search for Authenticity

Authentic living is a process, not a static end result This approach to living can provide a deep sense of inner peace Living authentically entails knowing and accepting our limits, which is captured by the "Serenity Prayer" Existential guilt is rooted in the realization that we inevitably fall short of becoming what we could become Existential therapists challenge clients to become their full and authentic selves Deurzen (2012) suggests that such authentic living is more of a process than a static end result. Living authentically entails engagement in doing what is worthwhile as we see it. Authenticity involves claiming authorship—taking responsibility for our actions and the way we are living (Deurzen & Adams, 2011). Briefly put, it means that we are true to ourselves. This kind of living can provide a deep sense of inner peace, yet authenticity is no easy matter. Living authentically entails knowing and accepting our limits. Existential guilt is rooted in the realization that we inevitably fall short of becoming what we could become, which means that we are always in debt to life to some extent. Existential guilt grows out of a sense of incompleteness and the realization that we are viewing life through someone else's eyes. Members can openly share their fears related to living in unfulfilling ways and come to see how they have compromised their integrity. The group offers many opportunities for tackling the tasks of life. Members can gradually discover ways in which they have lost their direction and can begin to be more true to themselves. Certainly, existential group leaders will not prescribe simple solutions, for they know that this is inconsistent with helping members live in authentic ways. It is also important for group leaders to be vigilant for members who may try to persuade others in the group to live in a certain way.

The Auxiliary Egos (Supporting Players)

Auxiliary egos, often simply called "auxiliary," "auxiliaries," or "supporting players," are those in the group other than the protagonist and the director who take part in the psychodrama, usually by portraying the roles of significant others in the life of the protagonist. These persons may be living or dead, real or imagined. Auxiliaries may also play the roles of inanimate objects, pets, or any emotionally charged object or being that is relevant to the protagonist's psychodrama. Z. T. Moreno (1987) notes four functions of the auxiliary: (1) to play out the perceptions held by the protagonist, at least in the beginning; (2) to investigate the interaction between the protagonist and their own roles; (3) to interpret this interaction and relationship; and (4) to act as therapeutic guides in helping the protagonist develop an improved relationship. Effective auxiliary egos (or supporting players) can give a psychodrama greater power and intensity. Afew ways in which they do this are by helping the protagonist warm up, by intensifying the action, and by encouraging the protagonist to become more deeply involved in the here-and-now of the drama. The main player generally selects the group members who will serve as supporting players. These choices are made for both conscious and unconscious reasons. Some choices are made on the basis of characteristics of group members that are perceived as similar to those of the other figures in the scene. When a choice is made on this basis, the interaction between the main player and the supporting players is likely to be more spontaneous, real, and effective. Directorsmay make an exception to this rule if they want a group member to assume an auxiliary role with particular therapeutic potential. Although the protagonist has ideas about a problem, both the protagonist and the director have the function of coaching the supporting players in how to carry out their roles. This task sometimes entails giving a supporting player some background on the person he or she is to play and a feeling for the style of that person. The director has the task of assessing whether the auxiliary's role playing is working more for the protagonist's benefit or meeting the auxiliary's needs. In the latter case, the auxiliary may be redirected by the director. The director needs to discuss this development during the sharing phase of the group because it usually has significant therapeutic implications for the auxiliary. It is important to remember that psychodrama is a group process and that auxiliary work has great therapeutic potential. Playing someone else's role often serves as a vehicle for getting in touch with parts of the self not uncovered while playing one's own role.

Self-Awareness

Awareness is realizing that: We are finite—time is limited We have the choice to act or not to act Meaning is not automatic—we must seek it We are subject to loneliness, meaninglessness, emptiness, guilt, and isolation Schneider (2008) explains that the core existential position is that we are both free (willful, creative, expressive) and limited by environmental and social constraints. We are all subject to the deterministic forces of sociocultural conditioning and to the limitations imposed by our genetic endowment, but we are still able to choose based on our awareness of these limiting factors. In group work, the basic existential goal of expanding self-awareness and thereby increasing the potential for choice is pursued by helping members discover their unique "being-in-the-world." The task for group members is to become aware of their existence as fully as possible, which includes realizing their possibilities and learning to act on the basis of them. A central theme of the existential approach is taking existence seriously. In the group situation participants have the opportunity to express their own unique feelings and their subjective views of the world. They are also explicitly confronted by others, and they learn to deal with the anxiety that arises from being without the security of their everyday roles. Group leaders would do well to alert the members of their groups to the price that is involved in seeking greater self-awareness. As people become more aware, they find it increasingly difficult to "go back home again." While living in ignorance of the quality of one's existence can lead to staleness, it can also provide a certain degree of contentment or, at least, security. A higher degree of self-awareness permits us to recognize that we can make choices for ourselves. For example: We can choose to expand our awareness or to limit our vision of ourselves. We can determine the direction of our own life or allow other people and environmental forces to determine it for us. We can use our potential for action or choose not to act. We can choose to establish meaningful ties with others or choose to isolate ourselves. We can search for our own uniqueness or allow our identity to be lost in conformity. We can create and find meaning in our life or lead an empty and meaningless existence. We can engage in certain risks and experience the anxieties that accompany deciding for ourselves or choose the security of dependence. We can make the most of the present by accepting the inevitability of our eventual death or hide from this reality because of the anxiety it generates.

The Empty Chair

Basically, the empty chair is a vehicle for the technique of role reversal when an auxiliary ego may not be available, or the actual person is too threatening to engage in an encounter. The empty chair is most easily adaptable to working in one-to-one therapy sessions. This technique is useful in bringing into consciousness the fantasies of what the "other" might be thinking or feeling. The empty chair can be a useful technique when a psychodrama involves someone who is absent or who is dead. This role reversal gives Adeline a chance to verbalize what she would like to have heard from her mother. In this way the empty chair technique can serve as a way to complete unfinished emotional work

Existential Approach to Groups

Best considered a way of thinking rather than a style of practicing group therapy Rejects determinism and emphasizes our freedom to choose what to make of our circumstances Focuses on the four ultimate concerns that are rooted in human existence: Freedom Existential isolation Meaninglessness Death Our freedom to act is limited by external reality, yet our freedom to be relates to our internal reality Schneider and Krug identify four essential aims of existential-humanistic therapy: (1) to help clients become more present to both themselves and others; (2) to assist clients in identifying ways they block themselves from fuller presence; (3) to challenge people to assume responsibility for designing their present life; and (4) to encourage individuals to choose more expanded ways of being in their daily life. The aim of existential therapy is to invite clients to take action that grows out of their honest appraisal of their life's purpose. The therapist's basic task is to encourage clients to consider what they are most serious about so they can pursue a direction in life. An existential group therapist accepts the premise that clients must play an active role in the therapeutic process and that they have the capacity to make well-informed choices about living.

The Basic Elements of Psychodrama

Classical psychodrama involves a director (the group leader), a protagonist (the main player), auxiliary egos (the supporting players), the audience (other group members who watch the action), a stage, and a number of psychodramatic techniques used to further the action.

Psychodrama in Schools

Classical psychodrama is too intense for children and adolescents Role playing can help students develop psychosocial skills Self-confidence and self-efficacy can emerge from successful rehearsals of future challenges The action-oriented methods build group cohesion Role reversal can help students understand the world of others and assist in the development of empathy The magic shop technique may help students to clarify their core values Classical psychodrama is too intense for use with children and adolescents, but role playing, which is derived from psychodrama, can be very effective for developing psychosocial skills that are essential for adapting to contemporary life. Role playing is an experiential mode that involves active integration of the imaginative and emotional dimensions of human experience, and it is widely used in education from preschool to professional graduate programs Certain other psychodrama methods also can be useful with children and adolescents who are experiencing a conflict or a problem situation that can be enacted or dramatized in some form (Bannister & Huntington, 2002; Green & Drewes, 2014). Not only does the young person who is the focus of the action benefit, but other students in the group benefit as well. These action-oriented methods build group cohesion, offering opportunities for young people to become aware that their struggles are shared by others. Dramatic role play of previous or anticipated situations can be enacted by the children, and younger students can utilize dolls, puppets, or masks in their portrayals. Just as cathartic release can occur as children reenact painful experiences, feelings of self-confidence and self-efficacy can emerge from successful rehearsals of future challenges. Role reversal gives a young person a chance to understand the world of others by experiencing his or her situation through others' eyes. This method expands a member's vision and assists in the development of empathy. The future projection technique has many possibilities for children and adolescents, especially as a vehicle for clarifying their concerns about their future. Group members can create the kind of relationships that they would hope for with others, they can rehearse for future encounters, and they can get helpful feedback on how they are coming across to others. The magic shop technique can assist young people in identifying some of their core values and clarifying how their values are related to their behavior.

Pitfalls of Therapist Transparency

Consider the issue of timing. The fully open neophyte therapists I just mentioned overlooked the fact that leadership behavior that may be appropriate at one stage of therapy may be quite inappropriate at another. If clients need initial support and structure to remain in the group, then it is the therapist's task to provide it. The leader who strives only to create an atmosphere of egalitarianism between member and leader may in the long run provide no leadership at all. Effective leader role behavior is by no means unchanging; as the group develops and matures, different forms of leadership are required. Research on group members' attitudes toward therapist self-disclosure shows that members are sensitive to the timing and the content of disclosure. 53 Therapists' disclosures that are judged as harmful in early phases of the group are considered facilitative as a group matures. Furthermore, members who have had much group therapy experience are far more desirous of therapist self-disclosure than are inexperienced group members. Content analysis demonstrates that members prefer leaders who disclose positive ambitions (for example, personal and professional goals) and personal emotions (loneliness, sadness, anger, worries, and anxieties); they disapprove of a group leader's expressing negative feelings about any individual member or about the group experience (for example, boredom or frustration).54 Not all emotions can be expressed by the therapist. Expressing hostility is almost invariably damaging and often irreparable, contributing to premature termination and negative therapy outcomes.† Thus, your raison d'être as group therapist is not primarily to be honest or fully disclosing. You must be clear about why you reveal yourself. Do you have a clear therapeutic intent or is countertransference influencing your approach? What impact can you anticipate from your self-disclosure? In times of confusion about your behavior, you may profit from stepping back momentarily to reconsider your primary tasks in the group. Therapist self-disclosure is an aid to the group because it sets a model for the clients and permits some members to reality-test their feelings toward you. When considering a self-disclosure, ask yourself where the group is now.

Psychodrama Contributions and Strengths

Contributions and strengths of psychodrama An action-oriented approach Active techniques that foster direct experience Provides alternative ways of dealing with life's problems Can be integrated with other therapies Promotes catharsis, healing, and self-understanding Psychodrama offers a dynamic approach to life's problems and provides members with alternative ways of coping with their concerns. People often do not see alternatives for dealing with the significant people in their lives. In psychodrama, group members can demonstrate other ways of responding and thus provide the person with different frames of reference.

Countertransference

Countertransference is defined as redirection of a therapist's feelings toward a patient, or more generally, as a therapist's emotional entanglement with a patient. A therapist's attunement to their own countertransference is nearly as critical as understanding the transference.

Existential Group Work in Schools

Crisis-oriented groups give students opportunities to express feelings related to violence In crisis, themes involving death and nonbeing, life's meaning, and existential anxiety become very real Most existential concepts have relevance for a wide variety of groups with children and adolescents The existential approach has a great deal to offer when counseling adolescents in groups because they face so many existential challenges today. From elementary to high school level, violence is becoming more commonplace, and school counselors are called upon for crisis intervention and to devise programs to prevent violence. It is not necessary for those who conduct a school group to process feelings surrounding violence, to come up with answers, or to bring closure to such issues; rather, the leader can provide a valuable function by encouraging students to give full expression to their feelings and thoughts. Group members can acknowledge their common concerns and provide support in a time when it is sorely needed. Young people struggle with issues of freedom and responsibility, existential anxiety around the unpredictable nature of life, the reality of death, question the true purpose of their lives, and reflect on striving for authenticity. Even a psychoeducational group or a short-term school group can reach more depth if the group leader learns to listen for the existential underpinnings that form the concerns of the members. In addition to teaching coping skills or acquiring certain information, a group can be instrumental in beginning a reflection process that encourages young people to take seriously the existential challenges of their existence.

Death and Nonbeing

Death is essential to the discovery of meaning and purpose in life The present is precious because it is all we really have Death awareness is an awakening experience that can be a useful catalyst for making significant life changes The concern with living life fully is a recurrent theme in existential groups The concept of physical death can be extended to other kinds of death or loss The reality of our finiteness can stimulate us to look at our priorities and to ask what we value most. The present is precious because it is all we really have. It is our temporal nature that makes us feel the urgency to do something with our life, to make a choice between affirming life by trying to become the person we are capable of becoming or allowing life to slip by us and eventually realizing that we've never given ourselves a chance to be different. Death awareness is an awakening experience that can be a useful catalyst for making significant life changes. Reflecting on the reality of death can teach us how to live fully. Deurzen and Adams (2011) state: "Life is a taskmaster, while death is a master teacher". Confronting the idea of one's personal death can result in a major shift in the way one lives in the world Awareness of death and the anxiety it generates has significant implications for the practice of group work. The concern with living life fully, rather than merely existing, is a recurrent theme in many groups. One way to address this theme is by encouraging group members to ask themselves honestly how they feel about the quality of their life. The process of change entails allowing parts of us to die to make room for new growth. Growth often demands that we be willing to let go of familiar ways of being. We may need to experience a period of mourning over our losses before we can move forward and establish new patterns. Groups offer a safe place to express this sadness, to explore the ambivalence that generally accompanies change, and to experiment with new ways of being.

Existential Techniques and Procedures

Emphasizes understanding client's subjective reality rather than diagnosis, treatment, and prognosis Interventions are based on the leader's philosophical views about the essential nature of human existence Interventions may include the use of silence, questions, and interpretations Existential group leaders never use techniques as the main menu When the deepest self of the group leader meets the deepest part of the members in the I/Thou encounter, the group process is at its best Deurzen (2010) suggests several kinds of interventions, including the therapeutic use of silence, questions, and making interpretations: Silence is one of the most significant interventions a therapist can make. There needs to be a breathing space in between dialogue. Therapists have the task of listening with a receptive attitude so that clients can move forward in a way of their choosing. Questions have a place in therapy, yet they need to be based on what clients are saying rather than probing for more information. It is best for therapists to ask open-ended questions that are implied in the client's words and in the subtext of their messages. Interpretations are used in existential therapy as a way to make sense of the client's overall story by connecting individual statements and experiences to enhance meaning. "The puzzle to be completed is the client's, not our own". Many of the procedures used by Adlerians and the techniques used by psychodramatists fit with an existential philosophy beautifully. Furthermore, the techniques of action-oriented therapeutic approaches such as transactional analysis, cognitive behavior therapy, rational emotive behavior therapy, reality therapy, and solution-focused brief therapy can be grounded on existential concepts.

Purpose of Existential Groups

Enabling members to become truthful with themselves Widening members' perspectives on themselves and the world around them Clarifying what gives meaning to each member's present and future life Successfully negotiating and coming to terms with past, present, and future crises Helping members understand themselves and others better and learning better ways of communicating The therapeutic process involves encouraging members to begin listening to themselves and paying attention to their subjective experience. Attention is given to clients' immediate, ongoing experience with the aim of helping them develop greater presence in their quest for meaning and purpose (Sharp & Bugental, 2001). This phenomenological self-searching emphasizes what members discover within their own stream of awareness when this stream is not directed by the therapist. To a large degree, the task of therapy is to help clients return to a position of openness to themselves, to their world, and to life itself

The Action Phase

Enacting and working through a past or present situation or an anticipated event Encouraging protagonist to move into action The action phase includes the enactment and working through of a past or present situation or of an anticipated event. The goal of this phase is to assist members in bringing out underlying thoughts, attitudes, and feelings of which they are not fully aware. It is useful to facilitate the process so that the protagonist can move into action as soon as possible. In doing this, the leader can draw on important cues that the protagonist gave in presenting his or her situation, including facial expressions, figures of speech, and body posture. Once the protagonist has a clear sense of what he or she would like to explore, it is possible to create the scene and coach the auxiliary egos. After this focusing process, protagonists act out their problems and relationships on the stage. A single action phase may consist of one to several scenes. Scenes are constructed and enacted as they relate to the protagonist's issues. They may be interpersonal or intrapersonal in nature and usually progress from peripheral issues (presenting problems) to more central issues (the real or deeper problems). At times most of a session may be devoted to the group as a whole working through interpersonal issues among members. At other times a common theme such as loneliness, fear of intimacy, or feelings of rejection seems to touch everyone in the group. With skillful facilitation by the group leader, the work of many group members can be linked and a common themecan be pursued. At the end of the action phase, it is important to help protagonists acquire a sense of closure for any work they have accomplished. One useful way to facilitate closure is to arrange for behavioral practice to help the protagonist translate group learning to everyday life. The function of behavioral practice is to create a climate that allows for experimentation with a variety of new behaviors. Later the person can implement some of these new behaviors with significant others outside the group and cope with situations more effectively.

The Sharing and Discussion Phase

Encouraging members to share their feelings and reactions Discussing the process after personal sharing Helping the main player, auxiliaries, and other members find closure after a piece of work The third phase of psychodrama involves sharing and discussion. Sharing, which comes first, consists of nonjudgmental statements about oneself; a discussion of the group process follows. After a scene is enacted, the psychodrama leader invites all the group members to express how the enactment affected them personally. Sharing is a deeply personal process, not a cognitive reflection, and Moreno has some excellent guidelines for making the sharing session a therapeutic experience: Group members should not offer advice or analysis to the protagonist but instead talk about themselves and how they were affected by the enactment. The main player has engaged in open sharing, and he or she deserves more than an analysis or critique. Sharing has healing effects. The disclosure of others' experiences gives people a sense that they are not alone and leads to bonding. Interpretation and evaluation come later, when the main player is not so vulnerable. During the sharing phase of psychodrama, the director's function is to initiate and lead a discussion that includes as many participants as possible to maximize feedback. The director must reinforce the kind of sharing that entails self-disclosure, support, and emotional involvement on the part of the members. The sharing is best structured so that members discuss how they were affected by the session, and in this way their own involvement, transparency, and growth are fostered. Sharing has another use for the director, especially in ongoing groups. New information group members reveal should be noted because this might well become the source for further therapeutic exploration, which the director could use with the relevant person's prior permission. During the sharing time, group cohesion is typically increased, for members are able to see commonalities. Leveton (2001) stresses the importance of the director in helping the main player, auxiliaries, and other members find closure after a piece of work. Closure does not necessarily mean that a concern is resolved, but all who were involved in a psychodrama should have an opportunity to talk about how they were affected and what they learned. A key aspect of closure is the process of shedding the roles (debriefing) of the main player and auxiliaries. Although the emotional aspects of an enactment are of great therapeutic value, a degree of cognitive integration will maximize the value of experiencing emotions. Main players can be asked to express what they have learned from the particular enactment and the insights they have acquired. It is also a good practice to encourage main players to talk about the personal meaning of reliving a situation. Here are some of the tasks for closing a session that Blatner (1996) lists: Assist members in applying what they have learned in the group to daily living. Summarize some of the highlights of the session. Invite members to raise questions about the group process. Identify unfinished business. Make plans for the next session or identify future themes. Provide additional support. Engage in some kind of closing ritual (if appropriate). Deal with feelings about separation. Members need to be warned of the danger of attempting premature and forced closure of an issue. It is essential that main players have ample opportunities to express their feelings, experience their conflicts, and explore the meaning of their emotional release. Clinicians, out of their own anxiety for wanting to see problems solved, sometimes suggest behavioral practice and an action plan before members have had a chance to ventilate and identify an area of personal concern.

Existential Anxiety

Existential anxiety is normal—life cannot be lived, nor can death be faced, without anxiety Anxiety can be a stimulus for growth as we become aware of and accept our freedom We can blunt our anxiety by creating the illusion that there is security in life Anxiety is basic to living with awareness and being fully alive If we have the courage to face ourselves and life we may be frightened, but we will be able to change Existential therapy does not aim to eliminate anxiety Once facing our anxiety, it is essential to make a commitment to action Existential anxiety is the unavoidable product of being confronted with the givens of existence: death, freedom, existential isolation, and meaninglessness (Vontress, 2013; Yalom, 1980). Existential anxiety is the basic unease that we experience when we become aware of our vulnerability and our inevitable death (Deurzen, 2012). Anxiety is part of the human condition, but failure to move through anxiety results in neurotic anxiety. From the existential viewpoint, anxiety is an invitation to freedom and not just a symptom to be eliminated or "cured." At the core of therapy, clients eventually come to terms with the underlying conditions of being human. These sources of existential anxiety must be faced and worked through in therapy; they involve recognition of our separateness and our need to be with others, of our guilt over not living authentically, of the emptiness in the universe and lack of meaning, of the burden of responsibility associated with choosing for ourselves, and of our fear of death and nonbeing. As therapy progresses, group members often painfully recognize how much energy they have put into maintaining an idealized image of themselves that is impossible to achieve. They also see that they must let go of static images of themselves that lead to a restricted existence. As group participants give up their inauthentic roles, they are able to bring a renewed quality to their living. This process typically results in anxiety because clients are giving up ways of being that are familiar.

Aloneness and Relatedness

Existential isolation refers to our aloneness in the universe: We enter the world alone and leave it alone We must manage the tension between our wish for relatedness with others and the reality of our aloneness The paradox that we are existentially both alone and related describes the human condition Solitude, unlike aloneness, is something we can choose for ourselves In solitude, we make time to be with ourselves, to discover who we are, and to renew ourselves At their best our relationships are based on our desire for fulfillment, not based on deprivation Existential group practitioners believe that even though we have close friends we are ultimately alone—that only we can give a sense of meaning to our lives, decide how we will live, find our own answers, and decide whether we will be or not be. Existential isolation refers to our aloneness in the universe. We must manage the tension between our wish for relatedness with others and the reality of our aloneness (Yalom & Josselson, 2014). Because awareness of our ultimate aloneness can be frightening, some of us try to avoid it by throwing ourselves into casual relationships and frantic activities, trusting that they will numb us to our fears and anguish. When we make this choice and succeed at establishing our own identity, we can relate genuinely and meaningfully to others. We must stand alone before we can truly stand with another. Solitude, unlike aloneness, is something that we can choose for ourselves. In solitude, we make time to be with ourselves, to discover who we are, and to renew ourselves (Corey & Corey, 2014). There is a paradox in the proposition that we are existentially both alone and related. Yet it is this very paradox that describes the human condition. The relationships that participants establish within the group are valuable also because they teach people how to relate to others outside of the group. In a group, people recognize their own struggles in others, and this often results in a bond. Even though they may accept that ultimately they are existentially alone, they also come to realize that they are not alone in their struggles and that others, too, are courageously looking at themselves and trying to establish their own identities. In short, groups offer distinct possibilities for members to intimately relate to one another that individual therapy does not offer.

The Search for Meaning

Finding meaning in life is a by-product of creating, loving, working, and suffering The struggle to find significance and purpose is part of human existence Existential neurosis is the experience of meaninglessness An existential vacuum is the inner void that results from not fully addressing issues of meaning With group support, members can find the strength to create an internally derived value system that is consistent with their way of being existential neurosis Feelings of despair and anxiety that result from inauthentic modes of living, the failure to make choices, and an avoidance of responsibility. existential vacuum A condition of emptiness and hollowness that results from meaninglessness in life. There are many ways of creating meaning—through work, through loving, through suffering, or through doing for others. According to Frankl, the therapist's task is not to tell clients what their particular meaning in life should be but to encourage clients to develop meaning for themselves. He believes that even suffering can be a source of growth and that if we have the courage to experience our suffering we can find meaning in it. One of the tasks of the therapeutic process is to confront group members with evidence of the fact that they may be living by unexamined values that no longer contribute to a meaningful existence. We may not be responsible for having acquired values that do not give us a sense of meaning, but we are certainly responsible for retaining them and for failing to find new ones. With the support of the group, participants can find the strength to create an internally derived value system that is consistent with their way of being.

THE THERAPIST: TRANSFERENCE AND TRANSPARENCY

In group therapy the problem is not the importance of transference work; it is the priority of this work relative to other therapeutic factors in the treatment process. The therapist cannot focus solely on transference and at the same time perform the variety of tasks necessary to build a group that can make use of the important group therapeutic factors. 1. Transference does occur in therapy groups; indeed, it is omnipresent and radically influences the nature of the group discourse. 2. Without an appreciation of transference and its manifestations, the therapist will often not be able to understand fully the process of the group. 3. Therapists who ignore transference considerations may seriously misunderstand some transactions and confuse rather than guide the group members; therapists who attend only to the transference aspects of their relationships with members may fail to relate authentically to them. 4. There are clients whose therapy hinges on the resolution of transference distortion; there are others whose improvement will depend on interpersonal learning stemming from work not with the therapist but with another member, around such issues as competition, exploitation, or sexual and intimacy conflicts; and there are many clients who choose alternative therapeutic pathways in the group and derive their primary benefit from other therapeutic factors entirely. 5. Transference distortions between group members can be worked with as effectively, and perhaps even more effectively, than transference reactions to the therapist.15 6. Attitudes toward the therapist are not all transference based: many are reality based, and others are irrational but flow from other sources of irrationality inherent in the dynamics of the group. (As Freud recognized, not all group phenomena can be explained on the basis of individual psychology.)16 7. By maintaining flexibility, you may make good therapeutic use of these irrational attitudes toward you, without at the same time neglecting your many other functions in the group.

Self-Presentation

In the self-presentation technique, the protagonist gives a self-portrait to introduce the situation. Let us say that in the group Jack wants to explore his relationship with his daughter, Laura. The group is interested in this and wants to have it enacted. The director (group leader) has Jack stand up and come onto the stage area, and they begin to establish a scene in which Jack interacts with Laura. Jack picks someone from the group to be the auxiliary playing his daughter. Jack states the problem as he sees it, and the director helps to translate the narrative into an action so that "talking about" becomes "show us how you and your daughter interact."

THE PSYCHOTHERAPIST AND TRANSPARENCY

In unlocking the shackles of this ancestral role, the overly disclosing therapist of today has at times sacrificed effectiveness on the altar of self-disclosure. However, the dangers of indiscriminate therapist transparency (which I shall consider shortly) should not deter us from exploring the judicious use of therapist self-disclosure.

Surplus Reality

Instead of talking only about what actually happened or what might in fact yet occur, it is often more important to help the client become clear about what was hoped for or feared, even if it is not realistic. Psychodrama includes the portrayal of such scenes, and Moreno gave the name surplus reality to these enactments that reflect the psychological world of the client apart from any concern for the limits of ordinary reality (Z. T. Moreno etal., 2000). These concrete expressions of the imagination enable psychotherapeutic exploration of dimensions of events that do not occur in actuality. Using surplus reality, individuals can encounter lost others to talk out previously unexpressed emotions and ask and answer questions. Surplus reality can also be used to replay an unfortunate or even traumatic event so that the individual experiences a more empowered or satisfactory ending. Moreno called psychodrama a "theater of truth" because the most poignant and central truths in the minds and hearts of people often go beyond ordinary reality and involve the extra dimension of what could have been or what might have happened if things were different. Helping clients to become conscious of their own repressed emotions and implicit beliefs and attitudes requires a context that evokes spontaneous responses and bypasses tendencies to defend oneself through verbal distancing, narration, describing circumstances, and explaining.

Evaluation of Existential Approach Contributions and strengths of the approach

It is largely about empowerment of individuals It humanizes psychotherapy It stresses that techniques follow understanding Although I agree that people can indeed be victims of forces outside of themselves, I also believe that existential therapy can help such individuals reclaim or acquire a sense of power so they can become survivors. lliott and colleagues have argued that the existing research is now more than sufficient to warrant positive evaluations of these approaches when applied to these client populations: depression, relationship problems, anxiety disorders, eating disorders, coping with chronic medical conditions, psychotic disorders, and substance abuse. Deurzen (2002, 2012) identifies the clients and problems most suited to an existential approach as those who are interested in and committed to dealing with their problems about living. The approach has particular relevance for people who feel alienated from the current expectations of society or for those who are searching for meaning in their lives. It tends to work well with people who are experiencing transitions, or who are at a crossroad, coping with the changes of personal circumstances such as bereavement or loss of employment. A particular strength of the existential approach is its focus on spirituality and meaning in life. Some group members cannot be understood without appreciating the central role their religious or spiritual beliefs and practices exert in daily life. Unless people confront their fears and the sources that are blocking their ability to live fully, they are likely to strive in vain to numb the pain created by this inner void. An existential group can be instrumental in encouraging members to face themselves courageously and deal with the inauthentic aspects of their lives. Group members can learn that the greatest peace of mind comes from listening to themselves and being true to themselves (Vontress, 2013). Exploring the deeper layers of human existence is an involved process best suited for a long-term group, but the basic concepts of the existential approach can form the foundation of a short-term, structured group. . Bugental (2008) states that short-term work in existential therapy requires a clearly defined purpose and a limited goal of treatment. A carefully thought out structure is required to maintain maximum gain from such a limited opportunity. Members are asked to present their concerns in a succinct form, and a contract might be designed to work toward resolution of a particular concern.

Limitations of the approach

It is not relevant for those who lack an interest in examining their basic assumptions about being human It is not relevant for people who want immediate solutions or relief from symptoms The existential group therapist needs a great deal of maturity, wisdom, life experience, and training t is not particularly relevant for people who are uninterested in examining their basic assumptions and who would rather not explore the foundation of their human existence. Those clients who want relief from specific symptoms or who are seeking problem-solving methods will generally not find much value in this orientation. The existential therapist functions in the role of a consultant who can provide clients with support in facing up to the truth of their lives. For those who are looking for a therapist who will direct them or who will function as a substitute parent, this approach will have little to offer.

Transference in the Therapy Group

It radically influences group process. Therapist must not ignore transference considerations Transference distortions between group members are more amenable too work than those between member and therapist "Not all attitudes toward the therapist are transference based; many are reality based" (pg. 205). Equality: "If one cannot be the favorite, then there must be no favorite at all". Leaders words, wisdom are given extreme weight, power, due to transference. All-knowing leader vs leader needs to be challenged. Important to understand so as not to counterattack due to countertransference (Example of only male in survivors group, p. 210-211). "By decentralizing your position in the group, you hasten the development of group autonomy and cohesiveness...it fosters deeper exploration on the clients part." Feedback from group members: Take it seriously Obtain consensual validation Check internal experience Pitfalls: Timing Be clear as to why you reveal yourself Most common charge: Group leader is too aloof, cold, uncaring. Transference will always occur once a therapist assumes leadership. How to deal with it? Consensual Validation: Use the group to reach consensus or no consensus according to client view Increased Therapist Transparency: "Gradual metamorphosis...use of self, interacting more personally

Key Concepts

Key concepts of the existential approach include self-awareness, self-determination and responsibility, existential anxiety, death and nonbeing, the search for meaning, the search for authenticity, and aloneness/relatedness.

Initial phase

Leaders assist members in identifying and clarifying their assumptions about the world Members define and question the ways they perceive their existence . During the initial phase, group counselors assist the participants in identifying and clarifying their assumptions about the world. Group members are invited to define and question the ways in which they perceive and make sense of their existence. They examine their values, beliefs, and assumptions to determine their validity. For many group members this is a difficult task because they may initially present their problems as resulting almost entirely from external causes.

Final phase

Members are assisted in putting what they have learned about themselves into action Members become more consciously aware that they can choose to be the authors of their lives The final phase focuses on helping members put what they are learning about themselves into action. The aim of a group experience is to empower the participants to implement their examined and internalized values in concrete ways.

Middle phase

Members are encouraged to fully examine the source and authority of their present value system During the middle phase of existential group counseling, the members are encouraged to more fully examine the source and authority of their present value system. This process of self-exploration typically leads to new insights and some restructuring of their values and attitudes. Group members get a better idea of what kind of life they consider worthy to live. They develop a clearer sense of their internal valuing process. Existential exploration addresses a spiritual dimension of finding meaning. The focus is on core life issues, and clients deal with moral issues of living

Creativity

Moreno was unique in his belief that a major function of the therapeutic process is to promote the client's creativity in exploring life, expanding oneself, and in coping with life. Creativity often emerges best not from careful, reasoned planning but as surges of inspired action, and creativity is often generated through active experimentation (Blatner, 2001). Psychodrama aims at fostering creativity in the individual, the group, and ultimately in the culture as a whole.

Limitations of the Approach

Need to exercise caution in using techniques Essential that group leader receives training and supervision Leaders need to know themselves Research on the effectiveness of psychodrama is limited Blatner (1996) emphasizes that psychodrama is no panacea and that it must be used with good judgment and in a balance with other group therapy skills. Indeed, because enactment can evoke powerful emotions, therapists need to exercise humility in their commitment to continuing their professional and emotional education and in refining their own skills in the understanding and use of this most valuable method. Practitioners who use psychodrama need to exercise caution in working with people who manifest acting-out behaviors and with individuals with serious disturbances. It is critical that leaders have the experience, competence, and knowledge to deal with underlying psychopathology. lthough group counselors who employ psychodramatic methods assume an active and directive role in facilitating a group, these methods will be most effective when the leader maintains the person-centered spirit (Blatner, 1996). Group leaders who are authentic, who are successful in making good contact with members, who are able to be psychologically present, who demonstrate empathy, and who exhibit a high level of respect and positive regard for their clients are most effectively able to implement a range of psychodrama techniques. One of the best safeguards for using these techniques appropriately is for a leader's practice to be grounded on a person-centered philosophical foundation. Research on the effectiveness of psychodrama has been limited, and few controlled studies have been attempted (Wieser, 2007). It is difficult to separate the curative effects of group from the specific effects of psychodrama, and this has led some psychotherapists to discredit the efficacy of psychodrama when evaluating outcomes

Replay

One obvious technique, used widely in musical or dramatic rehearsals, is that of simply redoing an action—refining it, replaying it with more expressiveness, or varying it in some other fashion. In psychodrama the replay technique may be used to accentuate the sense of awareness in an action, to intensify the sense of ownership and responsibility, or to broaden the protagonist's role repertoire. Replay is a fundamental technique that has been modified and used in other approaches, especially in behavior therapy and Gestalt therapy.

Psychodrama with Multicultural Populations

Psychodrama has interesting applications for people who speak English as a second language Inviting members to speak in their first language can lead to powerful work Not all psychodrama techniques have to be emotionally based The leader should fully explore members' cultural values and hesitations to participate in certain techniques For many people who have English as a second language, psychodrama has some interesting applications. My colleagues and I have often asked group members to speak to a significant other in their native language as they are engaged in a role-playing situation in a group session If group members are very uncomfortable in talking about personal issues, let alone displaying their emotions in front of others, some psychodrama techniques are most likely not appropriate. However, some of these techniques can be adapted to a problem-solving approach that makes use of cognitive and behavioral principles. It is possible to combine both didactic and experiential methods in structured groups with multicultural populations. All psychodrama techniques do not have to be used to elicit emotions and to encourage members to express and explore their feelings. Role-playing techniques can be productively adapted to structured situations dealing with trying on a new set of specific behaviors. For those members who have grave cultural injunctions against talking about their family in a group, role playing that involves "talking" to their mother or father may be met with reluctance. This reluctance can be lessened with adequate warm-up procedures and by creating a sufficient level of trust and safety.

Application: Therapeutic Techniques and Procedures

Psychodrama is an integrative approach that provides a context for applying its methods in a variety of therapeutic group settings (such as outpatient clinics, inpatient units, residential treatment centers, and private practice). Psychodrama uses a number of specific techniques designed to intensify feelings, clarify confusions and implicit beliefs, increase insight and self-awareness, and practice new behaviors. These techniques should be used for specific purposes related to what the protagonist and other group members need to experience to optimize relearning. Directors have latitude to invent their own techniques or to modify standard psychodramatic ones. It is of the utmost importance that group leaders bring caution and commitment to the practice of their technical skills, and they need to know when and how to apply these methods. Some principles of psychodramatic techniques serve as useful guidelines for the practitioner (Blatner, 2000): Whenever possible, use physical action rather than talking about a situation. Promote authentic encounters as much as possible. Group members should speak directly to each other rather than explaining to the director. Look for ways to promote the active behavior of other members by getting them involved in an enactment as much as possible. Make abstract situations more concrete by working with specific scenes. Encourage participants to make affirmative statements about themselves by using sentences beginning with "I." Encourage members to deal with situations in the past or the future as if they were happening in the present moment. Recognize and tap the potential for redecisions, renegotiations, and corrective experiences in the present. Pay attention to the nonverbal aspects of communication. Work toward increasing levels of self-disclosure and honesty. When appropriate, weave in a degree of playfulness, humor, and spontaneity in a situation. Utilize symbols and metaphors, personifying them and making them morevivid. Include other artistic principles and vehicles, such as movement, staging, lighting, props, poetry, art, and music. Exaggerate or amplify behavior to explore a wider range of responses. Recognize and use the warming-up process as a prelude to facilitating creative and spontaneous behavior. Utilize the therapeutic factors of a group. Integrate psychodrama with other therapeutic approaches and the creative arts.

Role Reversal

Role reversal, considered one of the most powerful tools of psychodrama, involves looking at oneself through another individual's eyes. In role reversal the protagonist takes on the part of another personality portrayed in his or her drama. Through role reversal, people are able to get outside of their own frame of reference and enact a side of themselves they would rarely show to others (Z. T. Moreno et al., 2000). Once an enactment is set up, the director may wish to have the protagonist use this technique (1) to better portray how he or she imagines or remembers the other personality and (2) to reach a fuller understanding of the viewpoint or situation of the other. The second and more important function of role reversal is to encourage protagonists to empathize with a significant person in their life. In assuming the role of that person in the psychodrama, they begin to develop a deeper appreciation for the person's world. This reversal allows them to experience the environment from a different perspective. Typically, the director suggests a role reversal when it appears that the protagonist would benefit by attempting to "walk in the shoes" of the person with whom he or she is experiencing conflict. To warm the protagonist up to this role shift, the director can interview Jack as he plays the role of his daughter. This technique also gives the director and the group a clearer picture of how Jack perceives his daughter and how he thinks she perceives him. Z. T. Moreno (1983) maintains that this technique encourages maximum expression in conflict situations. Protagonists' distortions of these relationships can be brought to the surface, explored, and corrected in action. First, clients must "own" their emotions through ventilation, or catharsis. Then, by reversing roles, protagonists can reintegrate, redigest, and grow beyond situations that constrain them. Role reversal allows members to fully express their perceptions of reality, to get feedback from others in the group about their subjective views, and to make modifications of their perceptions to the extent that they discover distortions.

Role training

Role training involves a more systematic use of techniques such as replay, mirror, role reversal, and feedback and modeling from the group to help clients develop more skill and confidence in dealing with situations that had previously felt awkward or threatening. Role training allows a person to experiment with new behaviors in the safety of the group. Protagonists have many opportunities for replaying a scene until they discover a response that fits them personally. They are given support, reinforcement, and feedback on the effectiveness of their new behaviors. As a part of working through a problem, the director typically focuses on acquiring and rehearsing specific interpersonal skills, which are often learned through the modeling of other members.

TRANSFERENCE IN THE THERAPY GROUP

Some members characteristically address all their remarks to the therapist, or speak to other members only to glance furtively at the therapist at the end of their statement. It is as though they speak to others in an attempt to reach the therapist, seeking the stamp of approval for all their thoughts and actions. They forget, as it were, their reasons for being in therapy: they continuously seek to gain conspiratorial eye contact; to be the last to leave the session; to be, in a multitude of ways, the therapist's favorite child. Some members characteristically address all their remarks to the therapist, or speak to other members only to glance furtively at the therapist at the end of their statement. It is as though they speak to others in an attempt to reach the therapist, seeking the stamp of approval for all their thoughts and actions. They forget, as it were, their reasons for being in therapy: they continuously seek to gain conspiratorial eye contact; to be the last to leave the session; to be, in a multitude of ways, the therapist's favorite child. As a result of transference, the therapy group may impute superhuman powers to the leaders. Therapists' words are given more weight and wisdom than they carry. Equally astute contributions made by other members are ignored or distorted. All progress in the group is attributed to you, the therapist. As a result of transference, the therapy group may impute superhuman powers to the leaders. Therapists' words are given more weight and wisdom than they carry. Equally astute contributions made by other members are ignored or distorted. All progress in the group is attributed to you, the therapist. When several members of a group share this desire for an all-knowing, all-caring leader, the meetings take on a characteristic flavor. The group seems helpless and dependent. The members deskill themselves and seem unable to help themselves or others. Deskilling is particularly dramatic in a group composed of professional therapists who suddenly seem unable to ask even the simplest questions of one another. Then, at other times or in other groups, the opposite occurs. Members challenge the leader continuously. The therapist is distrusted, misunderstood, treated like an enemy. Many irrational reasons exist for these attacks on the therapist, but some stem from the same feelings of helpless dependency that result in the worshipful obedience I have described. Some clients ("counterdependents") respond counterphobically to their dependency by incessantly defying the leader. Others validate their integrity or potency by attempting to triumph over the big adversary, feeling a sense of exhilaration and power from twisting the tail of the tiger and emerging unscathed. The most common charge members level against the leader is that of being too cold, too aloof, too inhuman. This charge has some basis in reality. For both professional and personal reasons, as I shall discuss shortly, many therapists do keep themselves hidden from the group. Also, their role of process commentator requires a certain distance from the group. But there is more to it. Although the members insist that they wish therapists to be more human, they have the simultaneous counterwish that they be more than human. As long as a group therapist assumes the responsibility of leadership, transference will occur. I have never seen a group develop without a deep, complex underpinning of transference. The problem is thus not evocation but resolution of transference. The therapist who is to make therapeutic use of transference must help clients recognize, understand, and change their distorted attitudinal set toward the leader.

Tele

Tele refers to degrees of feeling of attraction and is Moreno's term for a dynamic similar to rapport. It is a two-way flow of feelings between people (J. L. Moreno, 1964). He calls it a "feeling of individuals into one another, the cement which holds groups together". For many people, this dynamic operates at a preconscious or even unconscious level. Tele and helping people to become more explicitly aware of their interpersonal preferences is a major component of developing self-awareness. Tele is a therapeutic factor related to change that promotes healing through a reciprocal empathic feeling. The level of positive tele in a group correlates with its cohesiveness. People naturally, or for not-so-obvious reasons, feel attracted to certain people and are put off by others. Addressing the attraction or lack of attraction among the people in a group is essential to understanding the dynamics of a group. Moreno believed the therapeutic relationship required the development of positive tele.

Potential for Integration With Other Approaches

The concepts and methods of psychodrama offer imagery, action, and direct interpersonal encounters to psychodynamic, humanistic, and cognitive behavioral approaches. Most of the approaches covered in this book can be enriched by making the group process more experientially meaningful. As was discussed earlier, psychodrama frequently involves catharsis, yet this catharsis is not the main goal of psychodrama. Instead, catharsis is a natural product of the process of integration or healing. Although there is value in catharsis, my experience with groups has taught me how essential it is to provide a context in which members can come to an understanding of how their unexpressed emotions have affected both themselves and their relationships. Psychodrama can foster a healing catharsis when that is what is needed, and it can also be a useful force in integrating insights and developing and practicing more effective behaviors. From my perspective, deep personal changes will come about only if members are taught how to transfer what they have learned in their sessions to everyday situations, which is a vital part of psychodrama.

Double

The double involves an auxiliary playing a special role—that of the protagonist's "inner self." The double represents another part of the protagonist by expressing the thoughts and feelings that might otherwise go unexpressed. Doubling performs the function of the "voice over" in cinema or television. The double stands to the side of the protagonist (so as to be able to see and mirror the protagonist's nonverbal communications and yet not intrude on the protagonist's perceptual field) and says the words that aren't being spoken. The director may introduce the technique by saying: "This is your double. If she says what you're thinking, repeat it. If it's not what you're thinking, correct it." It is often wise to ask the protagonist if he or she wants a double. It is important that the protagonist accept the double. Then, as the encounter proceeds, the director might ask: "Is this double right for you? Is this what you are trying to express?" Doing this empowers the protagonist. Even if the protagonist wants someone to stand in as a double, it is important that the double not overwhelm or take over for the protagonist Doubling is not an avenue for the supporting player to vent personal emotions unless those emotions are intuitively sensed as being what the protagonist is probably feeling. The double needs to pay close attention to cues given by the protagonist and to follow the lead of the protagonist rather than doing the leading. Doubling is one of the most powerful tools in psychodrama, and it must be used cautiously Once an alliance is developed between the double and the protagonist, the director may coach the double to insert some expansions or confrontive statements as a way of facilitating expression of feeling and the clarification process. It is useful for the double to assume both the posture and the attitude of the protagonist as this can help the protagonist increase his or her awareness of inner conflicts and repressed feelings and even express them. Multiple doubles may be used to represent and embody the various sides of the protagonist. They can represent the protagonist's different conflicting sides or various roles he or she plays in life.

The Magic Shop

The magic shop is occasionally used as a warm-up technique and may also be elaborated on throughout the action phase. The magic shop technique involves imagining and "creating" a shop that has many bottles and other exotic containers on the various shelves, each containing a different kind of personal quality. These qualities in their imagined containers can be obtained like magic wishes, but only if there is an exchange for some other quality that the protagonist already possesses. The key device is the bargaining the main player does with the auxiliary playing the "shopkeeper" for some imagined quality in one of the containers on the shelves. The magic shop technique may be useful for protagonists who are unclear about what they value, who are confused about their goals, or who have difficulty assigning priorities to their values. This is a powerful technique, but Leveton (2001) indicates that it is of limited use: it must be timed appropriately, and it cannot be repeated very often with the same group.

Mirror Technique

The mirror technique is aimed at fostering self-reflection. It involves another member mirroring the protagonist's postures, gestures, and words as they appeared in the enactment. This technique may be particularly useful if others in the group see Jack differently from the way he sees himself or if he has difficulty presenting himself verbally or in action. Blatner (2000) cautions that mirroring can be a powerful confrontational technique and must be used with discretion. It must be given in the spirit of concern and empathy rather than making the protagonist the object of ridicule.

Increased Therapist Transparency.

The other major approach relies on the therapeutic use of the self. Therapists help clients confirm or disconfirm their impressions of the therapists by gradually revealing more of themselves. The client is pressed to deal with the therapist as a real person in the here-and-now. Thus you respond to the client, you share your feelings, you acknowledge or refute motives or feelings attributed to you, you look at your own blind spots, you demonstrate respect for the feedback the members offer you. In the face of this mounting real-life data, clients are impelled to examine the nature and the basis of their powerful fictitious beliefs about the therapist. However, the pace, the degree, the nature of the therapist transparency and the relationship between this activity of the therapist and the therapist's other tasks in the group are problematic and deserve careful consideration. More than any other single characteristic, the nature and the degree of therapist self-disclosure differentiate the various schools of group therapy. Judicious therapist self-disclosure is a defining characteristic of the interpersonal model of group psychotherapy.29

The Protagonist (Main Player)

The person who is the focus of the enactment Protagonist selects the event to be explored he protagonist, or main player, is the person who is the focus of the psychodramatic enactment—the one who presents a problem to be explored. As members interact with each other, a group member may raise an issue. If that person, the therapist, and the group agree that a psychodramatic exploration is warranted, the person for whom the issue is most relevant generally becomes the protagonist of the ensuing psychodrama. The main player's role is assumed voluntarily although it may be suggested by the therapist or by the group. In general, it is important that members feel free to decline to be placed in the position of increased demand for disclosure. The main player selects the event to be explored. He or she, in negotiation with the director, chooses a scene from the past, the future, or an alternative present, and that scene is played as if it is happening in the here-and-now. In the case of a past event, it is not necessary to remember exact words, but rather to portray the essential elements as experienced by the protagonist. The main player is the source of the imagery but requires the assistance of the director to explore a problem and to create a psychodrama. As soon as possible, the director encourages the main player to move spontaneously into action rather than merely talking about the event. As the main player acts out a situation, it is important that he or she have the freedom to explore any aspect of the scene (and related relationships) that seems significant. Although the director may encourage the main player to reenact a situation or deal with an anticipated event, the main player decides whether he or she is willing to follow the director's suggestions.

The Effect of Therapist Transparency on the Therapy Group

The primary sweeping objection to therapist transparency emanates from the traditional analytic belief that the paramount therapeutic factor is the resolution of client-therapist transference. This view holds that the therapist must remain relatively anonymous or opaque to foster the development of unrealistic feelings toward him or her. It is my position, however, that other therapeutic factors are of equal or greater importance, and that the therapist who judiciously uses his or her own person increases the therapeutic power of the group by encouraging the development of these factors. In doing so, you gain considerable role flexibility and maneuverability and may, without concerning yourself about spoiling your role, directly attend to group maintenance, to the shaping of the group norms By decentralizing your position in the group, you hasten the development of group autonomy and cohesiveness. We see corroborating evidence from individual therapy: therapist self-disclosure is often experienced by clients as supportive and normalizing. It fosters deeper exploration on the client's part.† Therapist self-disclosure is particularly effective when it serves to engage the client authentically and does not serve to control or direct the therapeutic relationship.† There are many different types of therapist transparency, depending on the therapist's personal style and the goals in the group at a particular time. Therapists may self-disclose to facilitate transference resolution; or to model therapeutic norms; or to assist the interpersonal learning of the members who wanted to work on their relationship with the group leader; or to support and accept members by saying, in effect, "I value and respect you and demonstrate this by giving of myself"? These clinical episodes illustrate some general principles that prove useful to the therapist when receiving feedback, especially negative feedback: 1. Take it seriously. Listen to it, consider it, and respond to it. Respect the clients and let their feedback matter to you; if you don't, you merely increase their sense of impotence. 2. Obtain consensual validation: Find out how other members feel. Determine whether the feedback is primarily a transference reaction or is in fact a piece of reality about you. If it is reality, you must confirm it; otherwise, you impair rather than facilitate your clients' reality testing. 3. Check your internal experience: Does the feedback fit? Does it click with your internal experience? Note that these therapist disclosures are all part of the here-and-now of the group. I am advocating that therapists relate authentically to clients in the here-and-now of the therapy hour, not that they reveal their past and present in a detailed manner— A study of the effects of therapist disclosure on a group over a sevenmonth period noted many beneficial effects from therapist transparency.43 First, therapist disclosure was more likely to occur when therapeutic communication among members was not taking place. Second, the effect of therapist disclosure was to shift the pattern of group interaction into a more constructive, sensitive direction. Finally, therapist self-disclosure resulted in an immediate increase in cohesiveness.

Role and Functions of the Psychodrama Group Leader

The psychodrama director (or main group therapist who facilitates the psychodrama) has a number of roles. According to J. L. Moreno (1964), the director has the role of producer, catalyst/facilitator, and observer/analyzer. Directors help in the selection of the protagonist and then decide which of the special psychodramatic techniques is best suited for the exploration of the person's problem. Directors organize the psychodrama, play a key role in warming up the group, and pay careful attention to what emerges in the drama. Directors function as catalysts and facilitators in that they assist the protagonist in developing a scene or series of scenes and facilitate the free expression of feelings. One of the main skills of the psychodramatist involves appreciating the protagonist's reluctance as insufficient warm-up rather than "resistance." An effective warm-up can do a great deal to create a safe climate within the group, whereas pushing the protagonist to give up his or her defenses inhibits spontaneity. The director works to bring into explicit expression those concerns that might induce hesitation, such as a worry that group members might assume a judgmental stance. The director can then weave these ideas into a supportive exploration with the group, enabling the protagonist to feel more connected to the other group members and thus be ready to courageously disclose yet another facet of his or her inner truth.

Reality Testing

The psychodramatic group offers an opportunity to find out how others feel and what the results of certain behaviors might be. The group is like a laboratory that offers a relatively safe setting for reality testing, or trying out behaviors that may not generally be socially acceptable in "real-life" situations.

The Stage

The stage is the area where the enactment takes place. It represents an extension of the life space of the protagonist, and as such it should be large enough to allow for movement of the protagonist, the auxiliary egos, and the director. The stage is generally empty, but it is helpful to have available as props a few chairs, perhaps a table, a variety of pieces of colored fabrics for costuming and other uses, and other items. In most cases, a special psychodrama stage is not available, but a section of the room can be designated for "as if" action, a dedicated area in which those involved in the action are not expected to be particularly reflective or to function as interactive group members while playing parts in the psychodrama.

Future Projection

The technique of future projection is designed to help group members express and clarify concerns they have about the future. In future projection, an anticipated event is brought into the present moment and acted out. Z. T. Moreno (1983) contends that the future has typically been a neglected dimension in therapeutic practice. When participants in psychodrama enact anticipated events as though they were taking place in the here-and-now, they achieve an increased awareness of their available options. Rehearsals for future encounters, coupled with constructive and specific feedback, can be of real value to those members who want to develop more effective ways of relating to significant people in their lives. Once members clarify their hopes for a particular outcome, they are in a better position to take specific steps that will enable them to achieve the future they desire.

Consensual Validation

The therapist may encourage a client to validate his or her impressions of the therapist against those of the other members. If many or all of the group members concur in the client's view of and feelings toward the therapist, then it is clear that either the members' reaction stems from global group forces related to the therapist's role in the group or that the reaction is not unrealistic at all—the group members are perceiving the therapist accurately. If, on the other hand, there is no consensus, if one member alone has a particular view of the therapist, then this member may be helped to examine the possibility that he or she sees the therapist, and perhaps other people too, through an internal distorting prism. In this process the therapist must take care to operate with a spirit of open inquiry, lest it turn into a process of majority rule. There can be some truth even in the idiosyncratic reaction of a single member.

Role and Functions of the  Group Leader

Therapy is a partnership and a shared venture between therapist and client Existential group leaders help to maximize each member's capacity to transform themselves The leader's presence and subjectivity are essential to develop a working relationship with the client The main task of the leader is to increase the range and depth of the client's awareness The leader encourages members to: assess ways their freedom may be restricted reflect on how they might increase their choices assume responsibility for their choices Existential therapists must bring their own subjectivity into their work, and it is essential that they demonstrate presence if they are to develop an effective working relationship with members. High priority is given to the quality of the therapeutic relationship as a healing force. Bohart and Wade view the client as the center of the healing process, which implies that therapists need to reinforce the role of the client as an active learner and problem solver who contributes to the therapy process and outcome. Bugental (1997) sees the main task of existential therapy as being to increase both the range and the depth of clients' awareness. He adds that a therapist's function is to display to clients the ways in which they constrict their awareness and the cost of such constrictions. A primary role of the leader is to foster meaningful relationships among participants by having members focus on key existential concerns and by providing a climate in which these concerns can be fully explored. Existential group therapists value being real and are willing to make themselves known through appropriate self-disclosure Existential group leaders assume a basic role of encouraging members to assess ways their freedom may be restricted, reflect on how they might increase their choices, and assume responsibility for their choices.

Existential Group Work with Multicultural Populations

This approach emphasizes presence, the I/Thou relationship, and courage Particular values or meanings are not imposed on members Emphasis is placed on choosing a meaningful existence Existentially-oriented leaders are encouraged to address members' similarities and differences Wide-ranging international interest is focused on the existential approach Deurzen and Adams (2011) point out that existential therapists are willing to shift their stance when the situation requires it, especially in cross-cultural counseling situations. Existential therapists attempt to free themselves of their preconceptions and prejudices as much as possible and appreciate that there are different ways of living. The existential approach is particularly relevant for multicultural situations because it does not impose particular values and meanings; rather, it investigates the values and meanings of group members. In an individual's search for a meaningful existence, spiritual values should be viewed as a potential resource. For many clients, spirituality can be a powerful force in fostering healing through an exploration of self by learning to accept oneself, forgiving others and oneself, admitting one's shortcomings, accepting personal responsibility, letting go of resentments, and dealing with guilt. Vontress (2013) believes existential therapy is especially useful in working with culturally different populations because of its focus on universality, or the similarities we all share. He encourages counselors-in-training to focus on the universal commonalities of clients first and secondarily on areas of differences. Faced with a crisis and feeling helpless, they often experience their lives as being out of their control. Some individuals simply believe that they do not have a choice or that choice is mainly a middle-class notion. Even if they do have some freedom, societal factors (such as racism, discrimination, and lack of opportunity) may severely restrict their ability to choose for themselves. Existentially oriented group leaders would do well to take into account the sociocultural factors that restrict choices. Clients who come from the barrio or an inner-city environment, for example, may be motivated primarily by the need for safety and survival and may be seeking help in getting these basic needs met. Simply telling people they have a choice in making their life better will not help, and it is likely to have a negative impact. Premature assurances that we are all free to give meaning to our lives will seem like insensitive clichés. It is real-life issues that provide grist for the mill for group work, assuming that the leader is willing to deal with them.

Transference

Transference refers to redirection of a patient's feelings for a significant person to the therapist. Transference is often manifested as an erotic attraction towards a therapist, but can be seen in many other forms such as rage, hatred, mistrust, parentification, extreme dependence, or even placing the therapist in a god-like or guru status.

Role Theory

Using psychodrama, we can examine the roles we play, renegotiate them, and choose different ways to play these roles. In psychodrama the members are given the freedom to try out a diversity of roles, thereby getting a sharper focus on parts of themselves that they would like to present to others. Playing roles also enables participants to get in contact with parts of themselves that they were not aware of. They can recognize and explore stereotyped ways of responding to people and break out of behaving within a rigid pattern, creating new dimensions of themselves. Moreno's role theory taught that we are all improvisational actors on the stage of life, creating our parts without scripts. We thus become not only actors but also playwrights. By thinking of our behavior patterns as roles in a drama, we are encouraged to bring a measure of reflection to the task, much as an actor stands back during rehearsal and considers how best to play the role assigned. We can go further and question which roles we want to take on or which roles are to be played out. More than merely performing social roles, we are able to actively modify certain roles. Indeed, we have the capacity to break out of roles when we discover that they no longer serve us.

Catharsis and Insight

When these complexes reconnect, emotions tend to be released—tears, laughter, anger, vulnerability, guilt, hope—and this is the catharsis that often accompanies the experiential aspect of therapy. Catharsis is a natural part of the psychodramatic process, but it is not in itself a goal. Simply rediscovering buried emotions will not bring about healing; these feelings must be worked through for integration to occur (Bemak & Young, 1998; Young & Bemak, 1996). For those who have lost awareness of the roots of their feelings, emotional release may lead to insight, or to an increased awareness of a problem situation. Insight is the cognitive shift that connects awareness of various emotional experiences with some meaningful narrative or some growing understanding. Insight adds a degree of understanding to the catharsis. The experience itself often provides sufficient "action insight." J. L. Moreno did not find it necessary for his patients to have verbal insight in order to get well. Instead he talked about action learning and action insight and saw healing as an internal state not always attainable by verbal means. For Moreno, learning was more affective than cognitive. It should be noted that protagonists can be helped to find the words that express their feelings through the use of various psychodramatic techniques and so achieve insight in this fashion. Insight, for the protagonist, might also occur following the enactment when other group members are sharing their own feelings and reactions to what happened on the stage. Often the other players (auxiliaries) and audience members also experience varying degrees of insight regarding their own life situations.

Working in the Present Moment

Working in the present moment is a concept closely related to creativity and spontaneity. Pioneered by Moreno years before it became fashionable, action in the here-and-now is an important element of psychodrama. Clients talk about situations in the past or the future to distance and defend themselves against experiencing their feelings. By re-creating those difficult situations as if they were happening in the present moment, encountering each other in the here-and-now, the actual encounter is brought into consciousness. A basic tenet of psychodrama is that reliving and reexperiencing a scene from the past gives the participants both the opportunity to examine how that event affected them at the time it occurred and a chance to deal differently with the event now. By replaying a past event "as if" it were happening in the present, the individual is able to assign new meaning to it. Through this process, the client works through unfinished business and reframes that earlier situation. The past, present, and future are all significant tenses, yet the action is played out in the present moment. When members engage in showing others what they are thinking or feeling, they move toward concrete experiencing and cut through defenses. They also move away from abstract and intellectual discussions about a topic when they plunge into personal enactment of a concern.