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Hiring Intake Coordinator!

We are Hiring and Intake Coordinator at the Phoenix Center!

Intake Coordinator Role and Expectations

Our growing trauma therapy practice is seeking an efficient, consistent, empathetic, and detail-oriented Intake Coordinator to join our team. The ideal candidate will have experience in administrative support, strong organizational skills, and the ability to multitask. This position requires a confident professional who can work independently, communicate effectively, and collaborate with others to ensure the smooth functioning of the practice. This position is diverse in its skill requirements including aspects of clinical assessment, crisis intervention, suicide assessment, networking, marketing, admin, customer service, and coordinating with our staff. This hybrid position requires some in-person hours but is flexible.

This is a part-time position (20 hours per week employee) with flexible hours and could evolve into full-time hours in the future if desired. We are seeking a long-term committed professional that we can invest in, train, and welcome as part of our close-knit organization. This non-benefits eligible position has an hourly range between $22-30 depending on applicant’s experience and skill set.

As an organization of trauma therapists, we place considerable emphasis on meaningful work relationships, work-life balance, and self-care. As a smaller and quickly growing organization, we are expanding our inner organizational processes and seeking a professional who can actively contribute to our growth with creative ideas. This role is an important part of our team, managing and coordinating many essential organizational tasks and processes. As our organization continues to expand, the responsibilities, leadership, and compensation with this role will also expand. Below are some of the duties of the Intake coordinator:

Admin and Customer Service 

  • Help maintain and coordinate logs for intake calls, therapist/intern client availability, and trusted referrals in the community
  • Track trends in intake demands and communicate with Director
  • Communicate with potential clients via phone/email
  • Maintains ‘on call’ hours to respond to intake calls as they come in
  • Responds to missed calls and emails
  • Updates website to reflect therapists availability 
  • Attend occasional community events to represent and promote our organization and meet with community partners as needed
  • Maintain relationships with referral partners 
  • Engage in in outreach to develop new community partners

Clinical

  • Provide brief intake calls with prospective clients to gather info related to their treatment goals, preferences, presenting issues, emotional stability, and financial limitations. 
  • Promoting our therapists, interns, groups, and workshops to callers
  • Relaying necessary clinical and logistical info from intake call to therapist or interns for initial session
  • Assessment for clinical appropriateness and level of care
  • Suicide assessments as needed
  • Child abuse reporting as needed
  • Crisis management as needed
  • Referring clients to outside providers when appropriate 
  • Maintaining list of trusted referrals 

Other requirements

  • Strong self care habits 
  • Occasional evening and weekend hours for events
  • Other duties as assigned
  • Possibility to co-create aspects of the role based on your skills and interests
  • Strong commitment to diversity, respect, and inclusion
  • Ability to work independently and prioritize tasks in a fast-paced environment
  • Strong digital skills and experience with WordPress, Google voice, Google docs, and Google sheets
  • Training in Confidentiality laws, suicide assessment, and child abuse reporting pertaining to our work

Education and Experience Requirements 

  • Experience and knowledge of mental health, trauma, and substance use required
  • 2-3 years of experience in a clinical support role within a healthcare or mental health setting
  • Bachelor’s degree in psychology/social work or similar – or peer support certification strongly preferred

This is a part-time position with competitive compensation and flexibility. If you are a motivated and experienced clinical support professional with a passion for supporting mental health services, we encourage you to apply for this exciting opportunity to join a growing psychotherapy practice. Please submit your resume and cover letter for consideration to Dr. Scott Giacomucci at Scott@PhoenixTraumaCenter.com. In your cover letter, please outline how your past experience and training has positioned you to be a good applicant for this open position.

EMDR Trauma Therapy: Overcoming Flashbacks, Nightmares, and Other Disturbing Images

Offering EMDR at the Phoenix Center in Media, PA or via TeleTherapy!
484-440-9416 | Support@PhoenixTraumaCenter.com

Flashbacks, nightmares, and intrusive images from past experiences can cast a long shadow on our lives, making it challenging to move forward. Flashbacks are vivid and distressing recollections of traumatic events that can feel as if you’re reliving them. Nightmares are unsettling dreams that often revolve around past traumas or adversity. Disturbing mental images can pop up unexpectedly and cause significant distress in our lives long after an experience is over. Sometimes these disturbing images are related to violence, trauma, death, or other painful moments in our lives.

If you’re grappling with these distressing symptoms, there’s hope in the form of Eye-Movement Desensitization and Reprocessing (EMDR) therapy. EMDR therapy is a structured approach that has shown remarkable effectiveness in alleviating these symptoms. Here’s how it works:

How EMDR Therapy Helps:

  1. Resourcing: First we begin by helping you connect with some positive memories and positive images that can be used as helpful tools when we feel stressed, overwhelmed, triggered, or anxious. These positive resources are tools you will take with you and can use on your own in-between sessions to manage difficult emotions.
  2. Desensitization: EMDR therapy helps desensitize your emotional responses to traumatic memories. By gently processing these memories in a safe environment, their emotional intensity diminishes over time. While you will not forget the image or memory, EMDR works by reducing the emotional and physiological charge that we experience when thinking about a particular memory or image. EMDR effectively helps us change our relationship to the image or memory.
  3. Reprocessing: During EMDR sessions, therapists use bilateral stimulation, such as eye movements, to guide your brain in reprocessing traumatic memories. This helps you view them from a different perspective, reducing their impact on your daily life. The bilateral stimulation is based on neuroscience research and seems to activate the memory processing mechanisms in the brain (the same process that happens naturally each night during rapid eye movement (REM) sleep). The EMDR process helps your nervous system and your brain maintain dual awareness of the past memory and the present moment at the same time which in a gentle and titrated manner, which allows the brain to process the previously stuck memory.
  4. Integration: As EMDR therapy progresses, you’ll find that the disturbing images and emotions associated with your past experiences become less intrusive or disturbing. This allows you to regain control over your thoughts and feelings. The EMDR process involves identifying negative beliefs about ourselves and actively working to change those into new positive core beliefs. After processing past memories with EMDR, we will then work to desensitize present-day triggers, and finally to create some future templates imagining and practicing what it will be like to encounter previously triggering experiences in a new way.

The Result: Relief and Healing: EMDR therapy offers hope for those struggling with flashbacks, nightmares, and disturbing images. It can provide substantial relief by addressing the root causes of these symptoms and helping you build resilience. Many individuals experience a significant reduction in the frequency and intensity of these distressing experiences, paving the way for healing and a brighter future. For clients who are already engaged in an ongoing personal growth journey, connected to social support in their life, and otherwise mostly stable emotionally and psychologically – EMDR can provide relief after just a handful of sessions.

Seek Help Today: If you or someone you know is grappling with flashbacks, nightmares, or disturbing images from past experiences, consider reaching out to a qualified EMDR therapist. They can provide the guidance and support needed to embark on a journey of healing and relief.

Remember, there’s no need to suffer in silence. EMDR therapy is a powerful tool that can help you regain control over your life and find peace from the grip of past traumas.

Who is appropriate for EMDR therapy?

It is important to note that not everyone is the best fit for engaging in EMDR therapy. The best candidates for EMDR are individuals who have already established a social support system, developed self-awareness, are able to regulate their emotions when overwhelmed, have already learned coping skills, and who are otherwise relatively stable in terms of suicidality, alcohol/substance abuse, other addictive behaviors, self-harm, and overall mental health.

We also offer EMDR intensives, which may be best for clients who seek a more immersive treatment experience and can afford the time and financial cost of scheduling multiple hours or days of consecutive sessions with one of our specialists.

Why Choose the Phoenix Center for EMDR trauma therapy?

Our staff is composed entirely of therapists who specialize in trauma therapy and have devoted their careers to learning, practicing, and teaching trauma therapy. While our staff have training and certifications in various trauma treatments, every therapist and graduate student on our team is trained in EMDR. EMDR is a common language and shared treatment philosophy and modality amongst our team which has over 25 EMDR providers. The Phoenix Center started in 2015 as a practice primarily offering EMDR therapy and has become recognized by many in the professional community as an agency providing high-quality and ethical EMDR treatment on a larger scale than nearly any other organization in the Philadelphia area.

We also offer low-cost EMDR and trauma therapy through our internship program. We have 10 advanced graduate interns that we host at our center who we support in participating in EMDR basic training and provide 3-4 hours of weekly supervision and EMDR consultation to. Often of our graduate students have more hours of training in trauma therapy than other experienced therapists in the field. Sessions with our interns start at $85/hour and can be flexible based on our sliding scale options.

Offering EMDR at the Phoenix Center in Media, PA or via TeleTherapy!
484-440-9416 | Support@PhoenixTraumaCenter.com

Benefits of EMDR Therapy as an Addition to Your Ongoing Individual Therapy

In the realm of therapeutic healing, embracing a diverse range of approaches often leads to profound transformation. A compelling fusion gaining momentum is the integration of Eye Movement Desensitization and Reprocessing (EMDR) therapy alongside ongoing individual therapy. EMDR is a unique and specialized therapy for treating PTSD and reprocessing disturbing memories. At the Phoenix Center for Experiential Trauma Therapy, we not only offer EMDR, but we specialize in it and nearly every therapist and intern on our team is trained in EMDR. It is the most commonly employed therapeutic modality at our center.

Offering EMDR at the Phoenix Center in Media, PA or via TeleTherapy!
484-440-9416 | Support@PhoenixTraumaCenter.com

Let’s dive into the benefits of incorporating EMDR therapy as an adjunct to your current therapeutic journey, fostering a dynamic collaboration for deep healing and focused EMDR work.

  1. Gaining Additional Perspective and a Specialized Approach: Ongoing individual therapy provides a nurturing environment for self-discovery and personal growth. The infusion of EMDR therapy from the Phoenix Center introduces an additional and specialized perspective. With a specialized EMDR therapist, you’re granted the privilege of a fresh outlook on your challenges. This distinct approach illuminates your healing from a new angle, offering novel strategies that enrich your therapeutic experience.
  2. Streamlined and Focused EMDR Experience: EMDR therapy, renowned for its precise focus on trauma and emotional distress, becomes even more impactful when seamlessly integrated as an adjunct to ongoing individual therapy. Enlisting a dedicated EMDR specialist from the Phoenix Center ensures that your sessions are highly focused on the reprocessing of traumatic memories. This streamlined process expedites the journey to healing, appealing to those seeking rapid relief from distressing symptoms. Often when the EMDR therapist is one’s only professional support, week-to-week stressors or other therapeutic issues slow down progress and draw the focus of therapy away from EMDR.
  3. Embracing EMDR Benefits While Sustaining Ongoing Work: Integrating EMDR therapy as an adjunct doesn’t have to replace your ongoing individual therapy; it can enhance it. Partnering with an EMDR specialist from the Phoenix Center allows you to reap the rewards of both therapists concurrently. This arrangement empowers you to experience the potent effects of EMDR without disrupting your ongoing therapeutic relationship, ensuring a seamless transition back to your primary therapist. By adopting EMDR therapy as an adjunct, you open the door to transformation without bidding farewell to your current therapist. The continuity of your ongoing sessions remains intact, while you harness the power of EMDR techniques to target specific traumatic memories and emotions.
  4. Collaborative Support for Enhanced Healing: Integrating EMDR therapy as an adjunct encourages a unique collaborative dynamic between therapists. The Phoenix Center’s EMDR specialist and your primary therapist combine their expertise to provide comprehensive and tailored support. This collaborative synergy facilitates the exchange of insights, strategies, and observations, fostering a holistic treatment plan that nurtures your well-being.

The fusion of EMDR therapy as an adjunct to ongoing individual therapy, offered by the Phoenix Center for Experiential Trauma Therapy, is a potent recipe for transformation. By embracing diverse therapeutic modalities, you can cultivate fresh perspectives, encounter the focused efficacy of EMDR, maintain the momentum of ongoing therapy, and access collaborative support from a team of experts. Embark on your journey of healing and growth with the multidimensional approach that EMDR therapy as an adjunct offers, propelling you towards lasting emotional well-being.

We recognize too that engaging in therapy with two different therapists may be cost prohibitive and expensive to many. We are happy to share that we also offer low-cost EMDR therapy at the Phoenix Center through our low-cost trauma therapy program, staffed by our advanced graduate students.

Offering EMDR at the Phoenix Center in Media, PA or via TeleTherapy!
484-440-9416 | Support@PhoenixTraumaCenter.com

Who is appropriate for EMDR therapy?

It is important to note that not everyone is the best fit for engaging in EMDR therapy. The best candidates for EMDR are individuals who have already established a social support system, developed self-awareness, are able to regulate their emotions when overwhelmed, have already learned coping skills, and who are otherwise relatively stable in terms of suicidality, alcohol/substance abuse, other addictive behaviors, self-harm, and overall mental health. We also offer EMDR intensives, which may be best for clients who seek a more immersive treatment experience and can afford the time and financial cost of scheduling multiple hours or days of consecutive sessions.

EMDR Intensives: Rapid Relief and Healing

Trauma can leave deep scars on our minds and bodies, impacting our daily lives and overall well-being. Fortunately, therapeutic approaches like Eye Movement Desensitization and Reprocessing (EMDR) have proven to be highly effective in addressing trauma and facilitating healing. While traditional EMDR therapy sessions typically last for an hour on a weekly basis, there is an alternative approach known as EMDR intensives. EMDR intensives are unique in that they are scheduled for multiple hours or days at a time instead of one hour a week. For example, you could engage in a half-day or an all-day EMDR intensive where you spend 3-6 hours with your therapist individually. This allows us to quickly and efficiently engage in EMDR therapy which means you can experience the relief and healing that you’ve been craving quicker.

Now Offering EMDR Intensives at the Phoenix Center in Media, PA!

Contact us for more info or to schedule:

484-440-9416 | Support@PhoenixTraumaCenter.com

Why Choose the Phoenix Center for EMDR Intensives?

Our staff is composed entirely of therapists who specialize in trauma therapy and have devoted their careers to learning, practicing, and teaching trauma therapy. While our staff have training and certifications in various trauma treatments, every therapist and graduate student on our team is trained in EMDR. EMDR is a common language and shared treatment philosophy and modality amongst our team which has over 25 EMDR providers. The Phoenix Center started in 2015 as a practice primarily offering EMDR therapy and has become recognized by many in the professional community as an agency providing high-quality and ethical EMDR treatment on a larger scale nearly any other organization in the Philadelphia area.

Here’s some of the benefits of EMDR intensives compared to an hour of weekly EMDR therapy:

  1. Immersion in the Healing Process: EMDR intensives provide a concentrated and immersive experience for trauma therapy. Unlike weekly sessions, which often include weekly updates on life, EMDR intensives allow clients to delve deeper into their traumatic experiences and work through them in a more comprehensive and accelerated manner. Continuous engagement over consecutive hours or days helps maintain momentum in the therapeutic process and prevents interruptions that may occur between weekly sessions.
  2. Efficiency and Financial Savings: The extended session lengths, which can range from several hours to multiple days, offer a safe and contained space for individuals to engage with their trauma and explore the associated emotions and memories. In weekly sessions, there is a natural warming up and cooling down process that happens each session which limits the amount of time available for trauma processing. In a focused 4-hour EMDR intensive, we might be able to realistically accomplish what would take 8-10 weeks of weekly hour sessions. This means you can receive the EMDR treatment quicker and save money in the long run. EMDR intensives condense the therapeutic process into a shorter timeframe. This compacted schedule allows clients to make rapid progress and experience substantial shifts in their healing journey.
  3. Deepening of the Process: The concentrated nature of EMDR intensives provides an opportunity for clients to experience transformative breakthroughs without being slowed down or interrupted by the end of the hour session. Through the extended sessions, clients can establish a heightened sense of safety and trust with their therapist, allowing for a more continuous and naturally paced exploration of their trauma.
  4. Availability: EMDR intensives can be particularly beneficial for individuals who are seeking immediate relief or who have limited availability for long-term therapy. This is often the case for professionals who travel often for their careers or for students who have limited time before moving out of town for school. Many clients will even travel out of town to engage in an EMDR intensive when their local area is lacking in high-quality trauma treatment options.

Who is appropriate for EMDR intensives?

It is important to note that not everyone is the best fit for engaging in EMDR therapy or EMDR intensives. The best candidates for EMDR intensives are individuals who have already established a social support system, developed self-awareness, are able to regulate their emotions when overwhelmed, have already learned coping skills, and who are otherwise relatively stable in terms of suicidality, alcohol/substance abuse, other addictive behaviors, self-harm, and overall mental health. Logistically, EMDR intensives are best for clients who can afford the time and financial cost of scheduling multiple hours or days. More on who is the best fit for EMDR here.

EMDR intensives offer a powerful and transformative approach to trauma therapy. With their immersive nature, extended sessions, deeper insights, rapid progress, and comprehensive care. While weekly EMDR sessions remain valuable and effective, intensives can be particularly beneficial for those seeking a more concentrated and accelerated healing experience. If you are ready to embark on a journey of healing and transformation, EMDR intensives may be the ideal option for you.

Now Offering EMDR Intensives at the Phoenix Center in Media, PA!

Contact us for more info or to schedule:

484-440-9416 | Support@PhoenixTraumaCenter.com

Benefits of Joining a Therapy Group

by Dr. Scott Giacomucci, DSW, LCSW, BCD, CGP, FAAETS, TEP

As human beings, we are inherently social creatures, and our ability to connect with others is vital for our overall well-being. However, mental health problems can often lead to feelings of isolation and disconnection from others, making it even more difficult to seek help or feel supported. Joining a therapy group can be a powerful way to address this isolation and receive the support and connection we need to heal and grow. Therapy groups are an excellent adjunct to individual therapy and can help combat the isolation and shame that we might feel related to past experiences. In this article and video, we’ll explore some of the benefits of joining a therapy group.

Free online support groups offered through the Phoenix Center
and
Therapy groups at the Phoenix Center in Media, Pennsylvania

Are you familiar with the difference between therapy groups and support groups?  The video below will outline the benefits of group therapy while also offering clarity on the differences between support groups and therapy groups.

Research is showing that group therapy is at least as effective as individual therapy but much cheaper!

Mental health issues can be overwhelming and isolating, leaving people feeling like they are alone in their struggles. Joining a therapy group can provide a sense of connection, extra support, and the opportunity to use one’s experiences to help others. Below, we will discuss some of the benefits of joining a therapy group, including increased support, a sense of community, and the unique opportunities for growth that group therapy provides.

  1. Connection in groups:

Mental health problems can fuel isolation, which can further exacerbate one’s mental health. Group therapy provides a space to connect with others who are struggling with similar issues. This sense of connection can help reduce feelings of isolation and loneliness, as well as provide a sense of community.

  1. Extra support:

Group therapy provides an additional layer of support to individual therapy. In group therapy, members can share their struggles and receive feedback and support from their peers. This can be particularly helpful in moments when one is feeling overwhelmed and may need extra support.

  1. Peer support can feel safer:

In a therapy group, members are surrounded by peers who understand their struggles, creating a sense of safety and understanding. The group therapy experience can also provide a level of anonymity that individual therapy may not offer. Members can share their experiences without fear of judgment or repercussions. Some people may have experienced trauma or abuse from people in power in the past, thus finding it difficulty to trust a therapist or doctor today.

  1. Opportunity to use your experiences to help others:

In group therapy, members can use their experiences to help others. This can be incredibly empowering and therapeutic for both the individual and the group as a whole. Being able to offer support and advice to others can provide a sense of purpose and meaning.

  1. More dynamic than individual therapy:

Group therapy is often more dynamic than individual therapy. Members can offer different perspectives and feedback, which can help one see their struggles in a new light. The group dynamic can also help members learn new skills and coping strategies while practicing new social skills in real time.

  1. More input and feedback from others:

Group therapy provides a space for members to receive feedback and input from others. This can be particularly helpful when one is struggling with interpersonal relationships or communication issues. Members can practice new communication skills and receive feedback in the moment.

  1. Power in numbers:

There is power in numbers, and this is true for group therapy as well. Members can draw strength and support from the group, and the group can also provide a level of accountability. Knowing that one is not alone in their struggles can be incredibly empowering.

  1. Cheaper, but equally effective:

Group therapy is often more cost-effective than individual therapy. In addition, group therapy sessions are typically longer than individual therapy sessions, which can provide more time for members to process their experiences and receive support. The research on group therapy is demonstrating that it is at least as effective as individual therapy in the treatment of most mental health problems or social issues.

In conclusion, joining a therapy group can provide numerous benefits for those struggling with mental health issues. Group therapy provides a sense of connection, extra support, and the opportunity to use one’s experiences to help others. It can be a more dynamic and cost-effective alternative to individual therapy, providing a unique opportunity for growth and healing.

Check out our free online support groups at the Phoenix Center – https://www.phoenixtraumacenter.com/community-peer-support-groups/

Consider joining one of our therapy groups at the Phoenix Center in Media, Pennsylvania – https://www.phoenixtraumacenter.com/group-services/

#trauma #groups #grouptherapy #therapygroups #supportgroups #mutualaid #peersupport #traumainformed #traumagroup #grouppsychotherapy #socialwork #groupcounseling

The Benefits of Psychodrama Training

Psychodrama training offers numerous benefits for professionals looking to expand their therapeutic skills and personal growth. Through group work and action-oriented techniques, psychodrama training helps professionals learn how to effectively facilitate groups and manage group dynamics. Unlike some other therapeutic approaches, psychodrama training emphasizes personal strengths and post-traumatic growth, providing a supportive and non-judgmental environment for self-exploration. Participants describe psychodrama training as fun and engaging, offering a unique credentialing process, and providing an attractive blend of learning, self-care, community, and personal growth. Overall, participating in psychodrama training can be a rewarding and transformative experience for professionals seeking to enhance their therapeutic skills and self-awareness.

This video outlines the many benefits of participating in psychodrama training:
  • Learn Group Work Skills
  • Learn how to use Action Methods
  • Less Pathologizing Theories
  • Self-Care Opportunities
  • Personal Growth Opportunities during the training
  • Fun and Engaging Training
  • Unique Credentialing

Psychodrama training offers numerous benefits, some of which include:

  1. Learn Group Work Skills: Psychodrama training involves working with groups, which helps participants learn how to effectively facilitate groups, establish group norms, and manage group dynamics.
  2. Learn how to use Action Methods: Psychodrama training emphasizes the use of action-oriented techniques, such as role-playing, to help individuals explore their emotions, behaviors, and relationships.
  3. Less Pathologizing Theories: Unlike some other therapeutic theories, psychodrama emphasizes personal strengths and growth, rather than focusing on pathology and illness.
  4. Self-Care Opportunities: Psychodrama training provides a safe and supportive environment where participants can explore their own emotional and psychological issues, develop self-care strategies to help maintain well-being, and work through our own sources of countertransference so that we can show up as the best version of ourselves for our clients
  5. Personal Growth Opportunities during the training: Psychodrama training provides an opportunity for personal growth and self-exploration, as participants are encouraged to explore their own thoughts, feelings, and behaviors in a supportive and non-judgmental environment. We learn psychodrama from the inside-out, by doing psychodrama and experiencing its power firsthand.
  6. Fun and Engaging Training: Psychodrama training is often described as fun and engaging, as it involves a lot of interactive activities and role-playing exercises that help participants learn and grow. While the trainings always prioritize professional learning, many participants share that it doesn’t feel like being at work!
  7. Unique Credentialing: Psychodrama training offers a unique credentialing process, which allows participants to become certified psychodramatists and work as practitioners, educators, or trainers.

Our psychodrama training events at the Phoenix Center are primarily led by Dr. Scott Giacomucci, DSW, LCSW, BCD, CGP, FAAETS, TEP who is a leading expert in trauma-focused and trauma-informed psychodrama. Scott is board-certified as a Trainer, Educator, and Practitioner of psychodrama and also is internationally recognized as a psychodrama scholar. He has experience implementing psychodrama across the entire treatment continuum (inpatient, PHP, and outpatient), while also employing psychodrama in non-clinical settings such as universities, activism, community work, and business consulting. While other psychodrama training offerings have been critiqued for feeling like therapy groups without much didactic teaching, he is known for blending psychodrama history, theory, philosophy, and practice in an integrated manner in his trainings. Training with Scott is a holistic experience that includes experiencing the power of psychodrama firsthand, learning psychodrama history, theory, and research, while also gaining practical skills to integrate into your own work setting. Our center is conveniently located 20 minutes from Philadelphia International Airport.


For more information on psychodrama and psychodrama training, consider the following resources:
  • Join us for our national psychodrama conference – www.ASGPP.org

Psychodrama as a Treatment for Complex PTSD

APA Article Division 49 Newsletter October 2022

Experiential Group Psychotherapy & Psychodrama Column

 

This is an author preprint, published article available at:

Giacomucci, S. (Oct 2022). Psychodrama as a Treatment for Complex PTSD. Experiential Group Psychotherapy & Psychodrama Column. The Group Psychologist. Division 49: Society of Group Psychology & Group Psychotherapy. American Psychological Association. Washington, D.C. Accessible at – https://www.apadivisions.org/division-49/publications/newsletter/group-psychologist/2022/10/issue.pdf#page=13

 

Psychodrama as an Effective Treatment for Complex PTSD

By Scott Giacomucci, DSW, LCSW, BCD, CGP, FAAETS, TEP

Complex trauma and Complex Post-Traumatic Stress Disorder (CPTSD) are increasingly becoming recognized as commonly presenting clinical issues in group therapy. Though it has not been recognized in the DSM-5 as a mental health disorder, it was recognized in the ICD-11. CPTSD is caused by repeated experiences of trauma and is characterized by disruptions in 1) sense of self, 2) relationships, and 3) emotional regulation – in addition to the PTSD symptom clusters of reexperiencing, avoidance, and arousal, reactivity, and current sense of threat. CPTSD most often manifests as a result of reoccurring relational trauma in childhood while PTSD is more often caused by single incident traumas and shock trauma such as an experience of violence, a natural disaster, or motor vehicle accident. Preliminary research on CPTSD suggests that it may be even more common than PTSD in some clinical samples (Karatzias et al., 2017).

The unique nature of CPTSD strongly reflects many of the primary concerns of clients who seek psychotherapy and group psychotherapy services – struggles related to sense of self, relationships, and emotional regulation. Chances are good that every group therapist has participants in their groups (and likely also staff on their team) who are survivors of complex trauma and/or experiencing CPTSD symptoms. As such, it is important that clinicians be familiar with the treatment of CPTSD in group settings. In my own experience facilitating groups in inpatient substance abuse treatment and at an outpatient trauma therapy center, the majority of clients seeking services are survivors of complex trauma.

The neurobiology of trauma points to its impact to non-verbal parts of the brain (and body) that are only marginally impacted by cognition or talking (van der Kolk, 2014). Trauma is largely stored in the right hemisphere of the brain and coded in implicit memories. This may be particularly true for complex trauma, relational trauma, and attachment trauma – and especially when the memories are pre-verbal or repressed. Many trauma survivors are unable to remember their trauma or unable to tolerate the overwhelming emotions that accompany retelling the stories. Group therapists are faced with the same limitations of talk therapy in the treatment of trauma and are encouraged to also consider integrating action methods into their group processes.

This article focuses on psychodrama as one of the oldest group therapies (developed in 1921) and the first formalized creative arts therapy or body-oriented psychotherapy. Psychodrama emerged within Jacob Moreno’s triadic system – sociometry, psychodrama, and group psychotherapy – each of which parts can be effective in addressing complex trauma. Group therapy, with its emphasis on relationships and social learning, provides complex trauma survivors with significantly more opportunities to renegotiate relational trauma and what Yalom and Leszcz (2020) describe as the “recapitulation of the primary family group” in their therapeutic factors. This essentially describes the process by which the therapy group, and the matrix of relationships within it, can provide a safe holding environment and corrective renegotiation of internalized relational trauma from childhood.

Sociometry offers various action-based group tools for group leaders that may be useful when working with complex trauma – such as spectrograms, step-in sociometry, locograms/floor checks, and sociograms (which were detailed in previous articles of this newsletter column). Sociometry is intrinsically focused on the nature of relationships within one’s life and within the group itself. Considering that complex trauma primarily is experienced through harmful interpersonal relationships, it makes sense that sociometric analyses and interventions targeting the sociodynamics within groups would be important to consider. Experiential sociometry tools offer participants with a multitude of opportunities to reflect on their social choices, better understand themselves and others, see how others experience them, prevent retraumatization or unhelpful reenactments in the group sociodynamics, and consider the patterns of attractions and repulsions in their social life. Action sociometry provides the group with opportunities to move around the group and interact with each other in new ways while uncovering shared identity and experiences in an emotionally titrated manner that promotes emotional regulation (for a more in-depth description of action sociometry, see Giacomucci, 2021a).

The surplus reality of psychodrama affords limitless potentialities for renegotiating complex trauma (Giacomucci & Stone, 2019). Courtois & Ford (2016) outline a three phase approach in the treatment of CPTSD – 1) safety, stabilization, and engagement, 2) processing trauma, and 3) (Re)Integration. Following this triphasic model of trauma treatment, we might focus initial psychodrama sessions on developing strengths and resources to face trauma, promote affect regulation, and reconnect to a sense of safety beyond the hyperarousal (Giacomucci, 2018, 2021c). Trauma-informed psychodramatic interventions such as the double, mirror, and role reversal directly address CPTSD symptoms including reexperiencing, avoidance, arousal and reactivity, distorted sense of self, disruptions in relationships, and emotional regulation (Giacomucci, in-press). Once phase 1 objectives have been accomplished, psychodrama can be used to revisit moments of complex trauma, psychodramatically undo, then redo the memory in a new and corrective way. This provides clients with an embodied experience of completing survival responses that were unfulfilled in the moments of complex trauma while renegotiating traumatic memory networks with developmental repair and healing (Giacomucci, 2019, 2021b). As part of phase 3 trauma work, psychodrama can be used to envision and embody posttraumatic growth and role train or rehearse future templates for life situations that may trigger CPTSD symptoms. This provides a client with the opportunity to develop new social skills, confidence, spontaneity, and reformulate attachment styles and ways of being with others and the world.

Currently, there are very few research studies on the effective treatment of CPTSD (especially group therapy treatments of CPTSD), however some suggest that research on PTSD can guide our understanding of effective treatments for CPTSD as well (Karatzias et al., 2019). The emerging research on psychodrama as a treatment for PTSD continues to support its effectiveness with various traumatized populations (Giacomucci, 2021b). My own ongoing research on psychodrama and PTSD in an inpatient drug and alcohol center is primarily with complex trauma survivors and suggests high treatment effects (Giacomucci & Marquit, 2020; Giacomucci, Marquit, Miller Walsh, & Saccarelli, in-press). Interestingly, when past treatment outcome data using the DSM IV PTSD criteria are compared with newer (yet to be peer-reviewed or published) data from the same program using the updated DSM-5 PTSD criteria, the treatment effect nearly doubled from a mean decrease in PTSD of 20-25% to a mean decrease of about 45%. There may be other reasons for this change, but a primary reason appears to be the use of the updated PTSD diagnostic criteria. The primary change in the new DSM 5 PTSD symptomology is the inclusion of a new symptom cluster of “Negative Cognitions and Moods” which appears to overlap with the ICD-11 CPTSD symptoms of disruptions in sense of self, relationships, and emotional regulation. This suggests that psychodrama may be an effective treatment for CPTSD, but more research is needed to validate this hypothesis.

 

References

Courtois, C. A. & Ford, J. D. (2016). Treatment of Complex Trauma: A Sequenced, Relationship-Based Approach. New York, NY: The Guildford Press.

Giacomucci, S. (2018). The trauma survivor’s inner role atom: A clinical map for post-traumatic growth. Journal of Psychodrama, Sociometry, and Group Psychotherapy. 66(1): 115-129

Giacomucci, S. (2019). Social group work in action: A sociometry, psychodrama, and experiential trauma group therapy curriculum. Doctorate in Social Work (DSW) Dissertations. 124. Retrieved from https://repository.upenn.edu/cgi/viewcontent.cgi?article=1128&context=edissertations_sp2

Giacomucci, S. (2021a). Experiential sociometry in group work: Mutual aid for the group-as-a-whole. Social work with groups44(3), 204-214.

Giacomucci, S. (2021a). Social work, sociometry, and psychodrama: Experiential approaches for group therapists, community leaders, and social workers (Vol. 1). Springer Nature.

Giacomucci, S. (2021b). Traumatic stress and spontaneity: Trauma-focused and strengths-based psychodrama. In J. Maya & J. Maraver (Eds), Psychodrama Advances in Psychotherapy and Psychoeducational Interventions. Nova Science Publishers

Giacomucci, S. (in-press). Trauma-Informed Principles in Group Therapy, Psychodrama, and Organizations: Action Methods for Leadership. Routledge.

Giacomucci, S., & Marquit, J. (2020). The effectiveness of trauma-focused psychodrama in the treatment of PTSD in inpatient substance abuse treatment. Frontiers in Psychology, 896.

Giacomucci, S., Marquit, J., Miller-Walsh, K. & Saccarelli, R. (in-press). A Mixed-Methods Study on Psychodrama Treatment for PTSD and Depression in Inpatient Substance Use Treatment: A Comparison of Outcomes Pre-Pandemic and During Covid-19. Arts in Psychotherapy.

Giacomucci, S., & Stone, A. (2019). Being in two places at once: Renegotiating traumatic experience through the surplus reality of psychodrama. Social Work with Groups42(3), 184-196.

Karatzias, T., Cloitre, M., Maercker, A., Kazlauskas, E., Shevlin, M., Hyland, P., … & Brewin, C. R. (2017). PTSD and Complex PTSD: ICD-11 updates on concept and measurement in the UK, USA, Germany and Lithuania. European journal of psychotraumatology8(sup7), 1418103.

Karatzias, T., Murphy, P., Cloitre, M., Bisson, J., Roberts, N., Shevlin, M., … & Hutton, P. (2019). Psychological interventions for ICD-11 complex PTSD symptoms: Systematic review and meta-analysis. Psychological medicine49(11), 1761-1775.

Van der Kolk, B. A. (2014). The body keeps the score: Brain, mind, and body in the healing of trauma. New York: Viking Press.

Yalom, I. D., & Leszcz, M. (2020). The theory and practice of group psychotherapy. Basic books.

 

APA Div 49 Column Oct 2022 revised2

Workplace Mental Health and Well-Being: Experiential Workshops for Trauma-Informed Organizations

The United States Surgeon General just released new guidance for all organizations in upholding workplace mental health and well-being.  Dr. Scott Giacomucci and the Phoenix Center for Experiential Trauma Therapy offer interactive workshops and trainings for your organization’s leadership team and frontline staff focused on helping you better embody these essential principles for healthy organizations. See the image below for the five essentials published by the Surgeon General and the US Department of Health & Human Services.

Is your organization already implementing these essential principles and practices? Could your organization better uphold these essential principles?

We can help! 

Each workshop is uniquely tailored to your organization. We have experience presenting training and workshops to a wide range of organizations including healthcare systems, treatment centers, corporate businesses, financial institutions, security firms, non-profit agencies, government departments, and various professional societies.

Don’t hire another industry expert to come lecture to your team from a boring PowerPoint – our experiential workshops are engaging and action-based. Our offerings are based on experiential learning components that provide an interactive, reflective, and meaningful experience for attendees. Our workshops will help your team to connect in new ways, critically examine your processes/practices, and rejuvenate your organization with new passion and purpose towards your mission.

Reach out to us now for more info – Scott@PhoenixTraumaCenter.com | 484-440-9416

We are experts in trauma-informed care and can also help you incorporate trauma-informed care principles into your agency. Dr. Scott’s new book on the topic will be available in Spring 2023 and offers additional insight into trauma-informed principles in organizations!

Dr. Scott Giacomucci, DSW, LCSW, BCD, CGP, FAAETS, TEP is an internationally recognized expert in trauma-informed care, experiential group work, and trauma-focused psychodrama. He is the Director/Owner of the Phoenix Center for Experiential Trauma Therapy in Media, PA, Director of Trauma Services at Mirmont Treatment Center, and an Adjunct Professor & Research Associate at Bryn Mawr College Graduate School of Social Work & Social Research. Scott is a Board-Certified Diplomate & Doctor of Clinical Social Work specializing in trauma, group facilitation, and experiential education. His 2021 textbook, Social Work, Sociometry, & Psychodrama: Experiential Approaches for Group Therapists, Community Leaders, and Social Workers (Springer Nature) has received multiple awards and over 190,000 downloads. His next book, expected early 2023, is titled Trauma-Informed Principles in Group Therapy, Psychodrama, and Organizations: Action Methods for Leadership.

 

 

Feedback from Prior Workshops:

“You did a fantastic job. I was impressed with the structure of the day that encouraged participants to “warm up” to the exercises so that they could engage and benefit from the experiential work. It was great to see some of the underlying group dynamics come to the surface through the experiential work and gain insights to the relationships within our organization. While there were some clear “lessons learned” I feel the true benefit of the day will be reflected in the subtle strengthening of relationships and commitment to our organization’s mission that were encouraged through the program.”

-CHIEF EXECUTIVE OFFICER, FINANCIAL INSTITUTION (CHESTER COUNTY, PA)

“The feedback from all who attended was very positive. Everyone who attended felt that they were loved, supported, and better understood after the sessions. We truly appreciate all you are doing and are so grateful you gave us immediate support with the trauma our organization experienced.”

-EXECUTIVE VICE PRESIDENT, FINANCIAL/CORPORATE INSTITUTION (DELAWARE COUNTY, PA)

“Dr. Scott and his team are the go-to experts in the field of Trauma. Following a workplace fatality, the first person we reached out to was Scott. Even though we have a number of professionally licensed counselors on staff, it was important for us to speak to the experts in the field of trauma to make sure we were doing the best that we could do for our client. As always, Scott was kind, compassionate and understanding.”

-DIRECTOR, EMPLOYEE ASSISTANCE PROGRAM OF LARGE HOSPITAL SYSTEM (PHILADELPHIA AREA, PA)

Psychodrama as an Effective Treatment for Depression

Psychodrama as an Effective Treatment for Depression

By Scott Giacomucci, DSW, LCSW, BCD, CGP, FAAETS, TEP

Published July 2022 in The Group Psychologist – newsletter of APA Division 49: Group Psychology and Group Psychotherapy – https://www.apadivisions.org/division-49/publications/newsletter/group-psychologist/2022/07/newsletter-july-2022.pdf

Depression is one of the most common mental health conditions impacting millions of people each year. Studies in the early phases of the covid-19 pandemic suggested that the prevalence of depression tripled in samples in the United States from 8.5% pre-pandemic to nearly 27.8% in 2020 and 32.8% in 2021 (Ettman et al., 2020, 2022). Prior to the pandemic, depression was already a significant mental health concern; yet covid-19 has increased the need and demand for effective interventions in the treatment of depression. Group therapies, including psychodrama, offer practitioners with effective and efficient interventions for treating depression. The demand for mental health services and increased isolation from the pandemic position group therapy approaches as ideal due to their cost effectiveness, ability for one professional to provide treatment to multiple clients at once, and inherent emphasis on social connection. Experiential group methods not only highlight connection but also promote action, spontaneity, and playfulness which many find as important qualities in overcoming depression.

Depressive symptoms include changes in mood and appetite, diminished interest, pleasure, movement, activity, energy, and ability to think or concentrate, as well as an increase in depressed feelings, suicidal ideation, guilt, and worthlessness (APA, 2013). Depression is often paralyzing and debilitating. It impacts one’s ability to cultivate meaningful relationships, function in life, and maintain a positive sense of self. The feelings of hopelessness and worthlessness that come with depression are prone to fueling thoughts of suicide. Prolonged and chronic depression also leads to a layered experience of loss and ambiguous loss in that relationships, opportunities, and time tend to pass by unfulfilled. An individual experiencing depression is weighed down by the heaviness of a disheartened mood, slowed cognitive processing, fatigue, and the lack of interest or pleasure in activities. Depression results in a divorce of spontaneity, a disengagement from life, a rupture in one’s relationships with humor, joy, and playfulness.

Group therapy is an effective treatment for depression (McDermut, Miller, & Brown, 2001). There are unique benefits to group work compared to individual work when treating depression as groups offer a multiplicity of social interactions that are absent in individual work. A group for folks experiencing depression offers a sense of normalization, validation, and cohesion that would be tough to cultivate anywhere other than in a group setting. The worthlessness, isolation, and hopelessness related to depression can be alleviated by the connective group process. Groups provide opportunities for connection, cohesion, and solidarity. Group work actively counter acts depressive symptoms through psychoeducation, mutual aid, collective empowerment, and the eradication of loneliness. Groups help depressed clients see that they are not alone. The all-in-the-same-boat phenomenon that emerges in groups initiates existential validation and interpersonal comfort.

Group psychotherapy is part of Jacob Moreno’s triadic system – sociometry, psychodrama, and group psychotherapy (Giacomucci, 2021). Psychodrama is primarily a group approach, though it can be used in individual settings as well. As such, the benefits of general group therapy are as present in psychodrama group therapy. Psychodrama psychotherapy, however, includes more active, creative, dramatic, and body-oriented interventions than traditional group therapy. The action methods involved in psychodrama may be particularly useful in combatting symptoms of depression that include a reduction in physical activity, loss of energy, and diminished interest and pleasure in activities. These three specific depressive symptoms are actively addressed through the experiential nature of psychodrama groups which warm participants up to action through spontaneity training, improv games, experiential sociometry, and role-playing techniques. Moreno’s tombstone reads “the man who brought laughter into psychiatry” (Nolte, 2014), a notion which is further supported by recent research findings demonstrating that participants experience the psychodrama groups as fun (Giacomucci & Marquit, 2020). The inherent incorporation of playfulness, humor, and spontaneity in psychodrama treatment may further contribute to its effectiveness in treating depression. The current research literature on psychodrama psychotherapy as a depression treatment supports its effectiveness, though more research is needed (Costa et al., 2006; Dehnavi, Hashemi, & Zadeh-Mohammadi, 2016; Erbay et al., 2018 Giacomucci, Marquit, Miller-Walsh, & Saccarelli, under-review; Souilm & Ali, 2017; Wang et al., 2020). Furthermore, some evidence has emerged depicting an inverse relationship between spontaneity and depressive symptoms (Testoni et al., 2016, 2020). While more research is needed in this area, the relationship between spontaneity and depressive symptoms deserves further exploration.

Spontaneity is the curative agent in psychodrama psychotherapy (Moreno, 1953). Spontaneity is defined as an energy that helps us facilitate new responses to old, reoccurring situations, and adequate responses to novel situations. The emerging spontaneity research demonstrates spontaneity’s positive relationships to various measures of well-being and social functioning, as well as its inverse relationship to other psychosocial problems or mental health disorders (see summary of the spontaneity research in Giacomucci, Marquit, & Miller-Walsh, 2022). Depression, through the lens of spontaneity theory, would be conceptualized as an absence of spontaneity – stuckness, inability to live freely, and reoccurring response to the often chronic symptoms of depression. The infusion of spontaneity, accessed through a warming-up process, helps patients reconnect to the vitality of life and develop new responses to their inner experience and social circumstances. Spontaneity seems to be a remedy for depression and other mental health conditions.

Spontaneity is only accessed through a warming-up process – this is depicted through Moreno’s Canon of Creativity (Moreno, 1953). In psychodrama practice, the warm-up phase of a group most often involves spontaneity games and/or sociometry processes (see Giacomucci, 2021 for a comprehensive overview of experiential sociometry and the Canon of Creativity). Simple sociometry processes, such as locograms, floor checks, spectrograms, and step-in sociometry, can be employed in groups focused on the topic of depression to provide psychoeducation, connection, normalization, and develop new insight for clients. One example is to employ a floor check of depression symptomology. This would entail printing out the symptoms of depression on different pages and distributing them throughout the group room while providing brief psychoeducation (Dayton, 2015). Then, asking participants to physically place themselves at the symptom that answers a prompt – for example, “which symptom do you experience the most often?”, “which symptom feels the most disruptive to your life?”, “which symptom do you experience least often?”, “which symptom do you feel you have gotten better at coping with?”, etc. With each new prompt, a new constellation of clustered group members emerges. In between prompts, participants are directed to share with the group-as-a-whole, or to share with each other about their choices. This promotes mutual aid, connection, validation, self-awareness, and group cohesion (Giacomucci, 2020). These sociometry processes can be employed as stand-alone group processes or as warm-ups to a psychodrama or other group activity.

The psychodramatic process has the power to help participants access their spontaneity, address underlying issues, confront their depression, and develop hope for the future. In a psychodrama enactment, patients could externalize the negative beliefs related to their depression to renegotiate their relationship to core beliefs and actively or symbolically replace them with new positive cognitions. Strength-based psychodrama vignettes can help clients enlist their personal strengths and develop new strengths or resources that may be needed to recover from depression and related hopelessness or unworthiness. A client could have a direct conversation with their depression in psychodrama, explore their relationship and practice new intrapsychic responses to depressive symptoms in the safety of the group with the support of others. Psychodrama allows patients to travel into the future and engage with themselves in remission/recovery from their depression – embodying a new self, living with hope, peace, and purpose. The interpersonal focus of psychodrama and sociometry provides clients with opportunities to practice implementing new social skills, role train for future situations, and experiment with new versions of self in the group.

The very nature of depressive symptoms impacts an individual’s sense of interest, pleasure, energy, and physical movement. With this in mind, it makes senses that interactive, engaging, and action-based approaches would be desired in the treatment of depression. Sociometry, psychodrama, and group therapy provide clients with tools for combating the stigma, isolation, shame, guilt, and loss often associated with depression. Experiential sociometry processes allow group workers to bring the process to life through dynamic and engaging psychoeducation and inherently connecting group activities. Psychodrama offers participants with opportunities to externalize parts of self, develop new roles or strengths, practice for future social situations, and envision a hopeful future.

References

American Psychiatric Association, D. S., & American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders: DSM-5 (Vol. 5). Washington, DC: American psychiatric association.

Costa, E. M. S., Antonio, R., Soares, M. B. D. M., & Moreno, R. A. (2006). Psychodramatic psychotherapy combined with pharmacotherapy in major depressive disorder: an open and naturalistic study. Brazilian Journal of Psychiatry28, 40-43.

Dayton, T. (2015). NeuroPsychodrama in the treatment of relational trauma: A strength-based, experiential model for healing PTSD. Health Communications, Inc

Dehnavi, S., Hashemi, S. F., & Zadeh-Mohammadi, A. (2016). The effectiveness of psychodrama on reducing depression among multiple sclerosis patients. International Journal of Behavioral Sciences9(4), 246-249.

Ettman, C. K., Abdalla, S. M., Cohen, G. H., Sampson, L., Vivier, P. M., & Galea, S. (2020). Prevalence of depression symptoms in US adults before and during the COVID-19 pandemic. JAMA network open3(9), e2019686-e2019686.

Erbay, L. G., Reyhani, İ., Ünal, S., Özcan, C., Özgöçer, T., Uçar, C., & Yıldız, S. (2018). Does psychodrama affect perceived stress, anxiety-depression scores and saliva cortisol in patients with depression?. Psychiatry investigation15(10), 970.

Ettman, C. K., Cohen, G. H., Abdalla, S. M., Sampson, L., Trinquart, L., Castrucci, B. C., … & Galea, S. (2022). Persistent depressive symptoms during COVID-19: a national, population-representative, longitudinal study of US adults. The Lancet Regional Health-Americas5, 100091.

Giacomucci, S. (2020). Experiential sociometry in group work: Mutual aid for the group-as-a-whole. Social work with groups44(3), 204-214.

Giacomucci, S. (2021). Social work, sociometry, and psychodrama: Experiential approaches for group therapists, community leaders, and social workers (Vol. 1). Springer Nature.

Giacomucci, S., & Marquit, J. (2020). The effectiveness of trauma-focused psychodrama in the treatment of PTSD in inpatient substance abuse treatment. Frontiers in Psychology, 896.

Giacomucci, S., Marquit, J., & Miller Walsh, K. (2022). A controlled pilot study on the effects of a therapeutic spiral model trauma-focused psychodrama workshop on post-traumatic stress, spontaneity and post-traumatic growth. Zeitschrift für Psychodrama und Soziometrie21(1), 171-188.

Giacomucci, S., Marquit, J., Miller-Walsh, K. & Saccarelli, R. (under-review). A Mixed-Methods Study on Psychodrama Treatment for PTSD and Depression in Inpatient Substance Use Treatment During Covid-19.

McDermut, W., Miller, I. W., & Brown, R. A. (2001). The efficacy of group psychotherapy for depression: A meta‐analysis and review of the empirical research. Clinical psychology: Science and practice8(1), 98-116.

Moreno, J. L. (1953). Who shall survive?. Beacon House.

Nolte, J. (2014). The philosophy, theory and methods of JL Moreno: The man who tried to become god. Routledge.

Souilm, N. M., & Ali, S. A. (2017). Effect of psychodrama on the severity of symptoms in depressed patients. American Journal of Nursing Research5(5), 158-164.

Testoni, I., Bonelli, B., Biancalani, G., Zuliani, L., & Nava, F. A. (2020). Psychodrama in attenuated custody prison-based treatment of substance dependence: The promotion of changes in wellbeing, spontaneity, perceived self-efficacy, and alexithymia. The Arts in Psychotherapy68, 101650.

Testoni, I., Wieser, M., Armenti, A., Ronconi, L., Guglielmin, M. S., Cottone, P., & Zamperini, A. (2016). Spontaneity as predictive factor for well-being. In C. Stadler, M. Wieser, & K. Kirk (Eds.), Psychodrama. Empirical research and science 2 (pp. 11-23). Springer, Wiesbaden.

Wang, Q., Ding, F., Chen, D., Zhang, X., Shen, K., Fan, Y., & Li, L. (2020). Intervention effect of psychodrama on depression and anxiety: A meta-analysis based on Chinese samples. The Arts in Psychotherapy69, 101661.

Psychodrama as a Treatment for Anxiety

Psychodrama as a Treatment for Anxiety

By Scott Giacomucci, DSW, LCSW, BCD, CGP FAAETS, TEP

Published March 2022 in The Group Psychologist – newsletter of APA Division 49: Group Psychology and Group Psychotherapy – https://www.apadivisions.org/division-49/news-events/anxiety-treatment

Psychodrama is an experiential psychotherapy approach that utilizes role playing techniques and other action methods to address psychosocial issues. Psychodrama appears to be a promisingly effective treatment for anxiety disorders and can be particularly useful in reducing fear and anxiety (Abeditehrani et al., 2020; Erbay et al., 2018; Tarashoeva, Marinova-Djambazova, & Kojuharov, 2017; Wang et al., 2020). The philosophy and practices within the triadic system of sociometry, psychodrama, and group psychotherapy offer helpful instruments for conceptualizing and addressing anxiety in action. Some of these tools include spontaneity theory, the warming-up process, group therapy, sociometry, psychodrama, and role training.

Psychodrama’s founder, Jacob Moreno, theorized nearly 100 years ago that anxiety and spontaneity were inversely correlated (1934). He writes that when our anxiety is high, our spontaneity is low; and when we are able to increase our spontaneity, our anxiety diminishes (Moreno, 1953). In psychodrama theory, spontaneity is defined as the capacity to respond to new situations with adequacy and to respond to reoccurring situations with novelty (Moreno, 1946). The term spontaneity has a specific meaning in the psychodrama community. It is less associated to the pop-culture use of the term which has become somewhat related to impulsivity. Instead, psychodramatists approach spontaneity more as a competence for skillful living and aliveness (Giacomucci, 2021a).

Moreno’s spontaneity theory affirms that spontaneity can only be accessed through a warming-up process (1953). The warming-up process manifests differently based on the situation at hand but often involves a warm-up on multiple levels such as physically, emotionally, psychologically, socially, spiritually, and warm-up specific to the content and process at hand (Giacomucci, 2021b). The lack of attention to the warming-up process may be a major shortcoming in work with anxiety. Anxiety can start to feel like resistance. However, in psychodrama, ‘resistance’ is reframed as a lack of warm-up or a suggestion that the individual is simply warmed-up to something else. This reconceptualization of anxiety and resistance can help group workers respond to anxiety with an extended warm-up to help mobilize clients to action. It seems likely that someone struggling with anxiety would need even more focus on the warming-up process as their anxiety or stress is likely to prevent a quick and efficient warm-up (Giacomucci, 2021b). Remembering this can help group therapists support their groups by meeting them where they are at and extending patience for their slower warm-up process.

Though some clients may struggle with groups due to their anxiety, group therapy research has highlighted its effectiveness in treating anxiety disorders (Barkowski et al., 2016; Barkowski et al., 2020). Group therapy is unique compared to individual therapy due to its more dynamic social elements. The ‘group’ aspect of group therapy may initially be a barrier for clients with social anxieties but with increased warm-up and preparation many clients with social anxiety are successfully able to participate in groups. Group therapy offers the ability to actively combat isolation which tends to characterize the experience of clients with anxiety disorders. The group atmosphere provides opportunities for clients to see others demonstrate social skills and also to practice implementing new social skills. The support system within the group often becomes an important modulator of anxiety for clients whilst also offering them opportunities to help others which increases their sense of confidence in themselves. While group therapy is an effective approach for treating anxiety, the other aspects of Moreno’s triadic system (sociometry and psychodrama) offer avenues for advancing the group process.

The clinical practice of sociometry focuses on utilizing an enhanced sense of group dynamics, sociodynamics, group assessment, group development, and interpersonal phenomena to implement interventions that promote cohesion, healing, inclusion, equity, mutual aid, and interpersonal learning (Giacomucci, 2020; Hale, 2009). Sociometry practice involves particular attention to the system of attractions and repulsions between group members and the distribution of social wealth – both of which are likely to fuel the anxiety of group members if uncontained by the facilitator. A sociometrist works towards group goals by employing various experiential sociometry tools such as sociometric tests, spectrograms, sociograms, locograms, step-in sociometry, and small group work (see Giacomucci, 2021a for detailed explanations on each of these sociometry tools). Though it can be used alone, experiential sociometry is most often used as a warm-up to a psychodrama enactment.

Psychodrama can be used to fortify the client in the here-and-now through intrapsychic scenes focused on engaging the strengths needed to face anxiety. Psychodrama offers multiple avenues for addressing anxiety, perhaps two of the most significant include 1) using psychodrama to find closure with unresolved past experience that may be a source of present anxiety, and 2) using psychodrama to enact future situations and provide role training to quell anxiety about anticipated experiences. With the first avenue, psychodrama allows us to revisit the underlying fueling factors of anxiety, such as childhood trauma or past adversity, to renegotiate how those experience have been internalized (Giacomucci, 2018; Giacomucci & Stone, 2019). For example, we could facilitate a client, who experienced childhood physical abuse, to psychodramatically nurture and protect themselves as a defenseless child while standing up to the perpetrator and the associated negative cognitions introjected from the perpetrator. In the second approach, psychodrama can be used to develop future scenes that provoke anxiety to help clients practice responding to them before being confronted with them in real life. This is called role training in psychodrama. The role training process allows clients to experiment in the safety of the group and try multiple methods of responding to the situation. The role training experience helps to mitigate anxiety while increasing spontaneity and confidence so that clients feel better prepared to face future situations having role played multiple responses already.

Moreno’s triadic system offers a multitude of methods to address anxiety and anxiety disorders. The integrated application of sociometry, psychodrama, and group psychotherapy provides group therapists with a theoretical framework and actionable interventions for dynamic groups while cultivating safety, spontaneity, cohesion, connection, social skills, mutual aid, healing, integration, resolution, growth, and role training for group participants. While psychodrama would benefit from more research to further validate its effectiveness as a treatment for anxiety, it offers group psychotherapists innovative tools to enhance group practice.

References:

Abeditehrani, H., Dijk, C., Toghchi, M. S., & Arntz, A. (2020). Integrating cognitive behavioral group therapy and psychodrama for social anxiety disorder: An intervention description and an uncontrolled pilot trial. Clinical Psychology in Europe2(1), 1-21.

Barkowski, S., Schwartze, D., Strauss, B., Burlingame, G. M., Barth, J., & Rosendahl, J. (2016). Efficacy of group psychotherapy for social anxiety disorder: A meta-analysis of randomized-controlled trials. Journal of anxiety disorders39, 44-64.

Barkowski, S., Schwartze, D., Strauss, B., Burlingame, G. M., & Rosendahl, J. (2020). Efficacy of group psychotherapy for anxiety disorders: A systematic review and meta-analysis. Psychotherapy Research30(8), 965-982.

Erbay, L. G., Reyhani, İ., Ünal, S., Özcan, C., Özgöçer, T., Uçar, C., & Yıldız, S. (2018). Does psychodrama affect perceived stress, anxiety-depression scores and saliva cortisol in patients with depression?. Psychiatry investigation15(10), 970.

Giacomucci, S. (2018). The trauma survivor’s inner role atom: A clinical map for post-traumatic growth. Journal of Psychodrama, Sociometry, and Group Psychotherapy. 66(1): 115-129

Giacomucci, S. (2020): Experiential sociometry in group work: mutual aid for the group-as-a-whole, Social Work with Groups, Advanced online publication. https://doi.org/10.1080/01609513.2020.1747726

Giacomucci, S. (2021a). Social Work, Sociometry, and Psychodrama: Experiential Approaches for Group Therapists, Community Leaders, and Social Workers. Springer Nature. https://doi.org/10.1007/978-981-33-6342-7

Giacomucci, S. (2021b). Traumatic stress and spontaneity: Trauma-focused and strengths-based psychodrama. In J. Maya & J. Maraver (Eds), Psychodrama Advances in Psychotherapy and Psychoeducational Interventions. Nova Science Publishers

Giacomucci, S., & Marquit, J. (2020). The Effectiveness of Trauma-Focused Psychodrama in the Treatment of PTSD in Inpatient Substance Abuse Treatment. Frontiers in Psychology11, 896. https://dx.doi.org/10.3389%2Ffpsyg.2020.00896

Giacomucci, S., & Stone, A. M. (2019). Being in two places at once: Renegotiating traumatic experience through the surplus reality of psychodrama. Social Work with Groups. 42(3), 184-196. https://doi.org/10.1080/01609513.2018.1533913

Hale, A.E. (2009). Moreno’s sociometry: Exploring interpersonal connection. Group, 33(4): 347-358.

Moreno, J. L. (1934). Who Shall Survive? A new approach to the problems of human interrelations. Washington, DC: Nervous and Mental Disease Publishing Co.

Moreno, J. L. (1946). Psychodrama Volume 1. Beacon, NY: Beacon House Press.

Moreno, J. L. (1953). Who shall survive? Foundations of sociometry, group psychotherapy and sociodrama (2nd edition). Beacon, NY: Beacon House.

Tarashoeva, G., Marinova-Djambazova, P., & Kojuharov, H. (2017). Effectiveness of psychodrama therapy in patients with panic disorders: Final results. International Journal of Psychotherapy21(2), 55-66.

Wang, Q., Ding, F., Chen, D., Zhang, X., Shen, K., Fan, Y., & Li, L. (2020). Intervention effect of psychodrama on depression and anxiety: A meta-analysis based on Chinese samples. The Arts in Psychotherapy69, 101661.

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