Category: Uncategorized (Page 2 of 7)

APA Article Division 49 Newsletter October 2022

Experiential Group Psychotherapy & Psychodrama Column

 

This is an author preprint, published article available at:

 

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 groups, 44(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 Groups, 42(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 psychotraumatology, 8(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 medicine, 49(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

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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.

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Psychodrama as an Effective Treatment for Depression

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

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 Psychiatry, 28, 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 Sciences, 9(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 open, 3(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 investigation, 15(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-Americas, 5, 100091.

Giacomucci, S. (2020). Experiential sociometry in group work: Mutual aid for the group-as-a-whole. Social work with groups, 44(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 Soziometrie, 21(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 practice, 8(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 Research, 5(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 Psychotherapy, 68, 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 Psychotherapy, 69, 101661.

Psychodrama as a Treatment for Anxiety

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

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 Europe, 2(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 disorders, 39, 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 Research, 30(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 investigation, 15(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 Psychology, 11, 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 (2^nd 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 Psychotherapy, 21(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 Psychotherapy, 69, 101661.

Free Downloadable Handout here – https://www.phoenixtraumacenter.com/wp-content/uploads/2021/08/Post-Traumatic-Growth-Handout.pdf

Dr. Scott Giacomucci, DSW, LCSW, BCD, FAAETS, PAT

What is Post Traumatic Growth?

Post traumatic growth (PTG) is the phenomenon of growing after trauma or hardship.

This idea is depicted throughout literature, history, religion, legends, and philosophy. It is certainly not a new idea, though the term “post traumatic growth” and the study of it are new. The fact that growth often occurs as a direct result of difficulties, losses, traumas, and changes is evidenced throughout time. One might even argue that all of our personal strengths are a result of surviving and finding our way through difficulties, struggles, and hardships.

Post-Traumatic Stress Disorder, & Post-Traumatic Growth

A traumatic experience is one that overwhelms our ability to cope and process. One event may be traumatic for one person and not traumatic for another person – it is a subjective experience. An inclusive definition of trauma includes violence, abuse, death/loss, neglect, abandonment, collective trauma, discrimination based on identity, and witnessing trauma. Post-traumatic stress (and PTSD) is characterized by avoidance, numbing, hyperarousal, hypervigilance, dissociation, reexperiencing (flashbacks, nightmares, intrusive images, etc), and negative thoughts, beliefs, and emotions. Many trauma survivors experience aspects of post-traumatic growth and symptoms of post-traumatic stress disorder at the same time.

About 25% of adults that experience a traumatic event will develop Post-Traumatic Stress Disorder (PTSD). However, because of the increased vulnerability of children, childhood trauma is even more impactful resulting in 50% of children developing PTSD symptoms after a traumatic experience. At the same time, Post-Traumatic Growth research found that over 65% of trauma survivors report some type of growth after trauma.

After surviving a traumatic event, you are significantly more likely to experience post-traumatic growth than post-traumatic stress disorder.

Five Common Areas of Post-Traumatic Growth

The literature on post traumatic growth demonstrates five distinct areas that trauma survivors identify as common domains of growth. The five domains of post traumatic growth are:

1. A new sense of opportunities after trauma

Trauma and loss shake us to our core and challenge us in ways that we might not have imagined as possible. As a result, many survivors begin to see new possibilities in life and the opening of new doors of opportunity.

2. New value in relationships

The process of coping with trauma requires relationships – friends, family, therapists, support groups, etc. As humans, we are neurobiologically wired to regulate our emotions through relationships. The experience of utilizing support after trauma increases these connections and helps us remember how important they are.

3. New sense of personal strength

Surviving trauma and asking for help to cope with its aftermath requires incredible strength. Trauma survivors demonstrate extraordinary courage, resilience, vulnerability, trust, hope, and compassion, among other strengths. When an overwhelming event forces us to utilize all the strengths we have (and often develop new ones), we are much more aware of them going forward. “If I survived that trauma, I can survive anything”

4. Greater appreciation for life

Trauma, by its nature, threatens our safety, security, and often our lives. Trauma and loss remind us how precious life is and how fragile it can be. It has the ability to help us see the big picture and reconsider our priorities in life.

5. Deepening of spiritual/religious views

Because trauma is so often experienced through relationships and involving other human beings, many trauma survivors turn to spirituality or religion for strength, hope, and inspiration. Trauma is an existential crisis that challenges us to make sense of it, often through spiritual, religious, or existential belief systems.

These five domains of post-traumatic growth are sometimes simplified further into three categories: 1) Quality of Life, 2) Perception of self, & 3) Experience of relationships and others

Examples of Post Traumatic Growth

Examples of post traumatic growth exist all around you – and in your own life story. Chances are that you have grown in some way after a difficult experience in your life. Some common examples of post traumatic growth include: valuing relationships more after death; appreciating life more after working through a hardship; helping others that are experiencing something you went through previously; positively changing your perception of yourself after getting through a difficult time; creating change and new possibilities in your life after trauma; starting your own support group; creating changes in your community after a painful experience; advocating for policy changes and social change; etc.

Examples and metaphors of post traumatic growth even exist in nature: the extraordinary pressure that creates diamonds; an irritant in an oyster creates a pearl; volcanos that create new islands; forest fires that give way to new growth; stars in the darkness; sunrise after the dark night; and even plants growing from manure and dirt!

Post-traumatic growth is also something that professionals experience as a direct result of vicarious trauma and working with trauma survivors. For more info an vicarious post-traumatic growth, visit this link – https://www.phoenixtraumacenter.com/vicarious-post-traumatic-growth/

#trauma #traumarecovery #traumahealing #traumatherapy #posttraumaticgrowth #vicariousposttraumaticgrowth #ptsd #ptsdrecovery #ptsdtreatment #experientialtherapy #growthaftertrauma #traumacounseling #traumapsychology

By Dr. Scott Giacomucci, DSW, LCSW, BCD, FAAETS, PAT

Published by APA Div 49, The Group Psychologist

“Recent findings have challenged trauma therapists to consider alternative and adjunctive approaches to talk therapy and cognitive approaches. At the same time, these new findings serve to validate experiential philosophy, theories, and approaches that Jacob Moreno proposed decades prior.”

Read the full article here on APA’s website – https://www.apadivisions.org/division-49/news-events/psychodrama-trauma-treatment

Defining & Explaining Trauma-Informed Principles

This video offers an introduction to trauma-informed principles and why they are important for all organizations. The difference between “trauma-informed” and “trauma-focused” is outlined while commenting on trends in the mental health treatment field. Leaders, supervisors, professionals, students, and others interested in learning about trauma will find this video helpful.

Or, click here to access Dr. Scott’s new ebook for free (see chapter 7 on trauma, trauma-informed care, and trauma-focused services) – https://link.springer.com/book/10.1007/978-981-33-6342-7

Don’t forget to explore our other videos on this channel which include educational content on trauma, ptsd, addiction, and experiential trauma therapy.

#trauma​​ #traumaticstress​​ #traumaticexperience​​ #ptsd​​ #posttraumaticstress​​ #posttraumaticstressdisorder​​ #traumainformed​​ #traumafocused​​ #traumatreatment​​ #traumaeducation​​ #traumawork​​ #traumacounseling​​ #traumareaction​​ #traumasymptoms