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How Psychodrama Heals Trauma

September 24, 2019

The Adverse Childhood Experiences (ACE) study, touted by Oprah Winfrey as one of the most important studies of our time, has successfully made the connection between emotional and psychological childhood trauma and physical health problems later in life. In other words, what begins in the mind alters the body’s capacity to fight off illness and disease.

“What begins in the mind alters the body’s capacity to fight off illness and disease.” – Dr. Tian Dayton

Much of the time, the kinds of problems that bring people to therapy as adults, have some if not many of their roots in childhood. Healing relational childhood trauma is the work I have done for three and a half decades. In truth, it is the work many therapists do. And in healing these emotional wounds in the inner child, we heal them within the adult. We create resilience in the body as well as the mind.

What Is Psychodrama?

I have found psychodrama to be a direct and effective path toward working with these kinds of issues. A role-based method, psychodrama therapy allows us to heal laparoscopically as we deal only with the part of a role relationship from yesterday, for example, that might be giving us problems today. And we leave those parts that are working well to continue to do so. We do not pathologize the whole person. 

In the same way as you might go into a particular part of the body to remove scar tissue so that blood can flow more freely, allowing the body to continue to heal itself, in psychodrama we go into the part of the inner world that is blocking a free flow of feeling. We remove emotional scar tissue so that emotion, and hence thought and behavior, can flow more freely too. The psyche and the relationship can continue to heal themselves.

Why Is Psychodrama So Effective in Healing Trauma?

We need to feel our feelings in order to translate them into words, elevate them to a conscious level, and think about them. Paying attention to the effects of trauma —  those parts of us that are hurt and hidden, the emotions that are frozen and keep us stuck — free up energy that can be used to enhance our resilience and allow it to strengthen. Until they are felt and put into language, they remain locked in the body in the form of unprocessed sense impressions, in which case they can contribute to muscle holding and illness.

Talk therapy can make us want to come up with a story that fits our free-floating feelings of fear, anxiety, and/or depression. We want to explain our intense emotions to ourselves or someone else. But when we don’t know what they are, we guess or go along with another person’s interpretation or ideas. Psychodrama therapy gives us an opportunity to authentically connect with our own, internal reactions by reconstructing the actual role relationship in which they occurred.

Memories Stored in the Body

Because the limbic system, our fight-or-flight system, processes emotion, and sensory data, the feelings and sense impressions that surround any experience, painful or otherwise, become part of our bodies. Why does a sound or a smell take us back to semi-conscious memories in a split second? The senses are a direct pathway to the unconscious, to body memories — and to feelings.

When we’re traumatized, says Bessel van der Kolk, a Meadows Senior Fellow, bestselling author, and expert on PTSD, our thinking mind, the prefrontal cortex shuts down, which means that we do not think about what is happening. Our limbic system however revs up, which means that our feelings and sense impressions are recorded by the body but with no storyline attached. We have not translated them into words, thought about them, ordered them, and made meaning out of our experience. So later when we’re asked to “talk about the trauma” in therapy, we go blank. We may remember bits and pieces of a painful of frightening moment or repeating relational dynamic, but the details are fuzzy because the part of our brain that would have made meaning out of them, was shutting down at the time of the trauma. They are not however fuzzy to the body. Those feelings and sense impressions remain stored in our unconscious mind/body waiting to get triggered.

Psychodrama lets the body talk as well as the mind. Rather than say “tell me about,” it invites the protagonist to say what they need to say to the person to whom they need to say it.

Role-play or psychodrama therapy acts as a stimulus that brings the feelings forward so that we can attach words to them as they emerge, so that we can think about and then “process” this unprocessed experience.

For example, maybe we’re asked in therapy to talk about our mother. As we describe her, we may or may not attach much feeling or sense of immediacy to the story. However, if we encounter someone who reminds us of some of our mother’s qualities that were difficult for us, we may react with anger or even withdrawal in a split second. We may see them as problematic and never make the connection between our intense reaction and why it’s so oversized.

Psychodrama gives us a direct path to that unconscious material with one simple question:

“If your mother were sitting here, what would you want to say to her?”

This is the beauty of role-play. Through role-play we can talk TO rather than ABOUT. When we talk ABOUT, we get caught back in that thinking mind that never made sense of a hurtful interaction to begin with. We swim and search.

When we talk TO, we put our feelings simply and directly into the words we longed to say but, because of our size and dependency, could not. “Why can’t you just love me? Why won’t you just see me? How can you say these things to me that hurt me so much?” The then and there become the here and now and our authenticity emerges.

It will often happen that once someone has had the opportunity to honestly confront someone who has hurt them, they will also come in touch with the part of that person who they loved to be with. And psychodrama can move into that space with ease by asking something like, “what would you like to say to that part of your mother, do you need another chair to represent her or can both or all parts sit in the same chair?”

“Too often we block love because we’re afraid it will hurt.” – Dr. Tian Dayton

By offering the protagonist the chance to embrace and deal with their own pain, they can also become more willing and open to allow themselves to experience what feels good about the relationship. They can become vulnerable again, less self-protective. Too often we block love because we’re afraid it will hurt. But psychodrama gives us the confidence that we can “live through” the painful effects of trauma that we have spent decades running from. In fact, it teaches us that in sitting in and with that pain, it changes, it dissipates and it becomes less primary. It moves from the foreground to the background, it becomes less important and we feel more in charge of our inner world, less afraid of it.

In these brief but often deep exchanges, we can exhale. We can say what we could not say then and take ownership of our own pain and sense of vulnerability. And as these feelings are felt in the role relationship in which we felt them, we find the words to express how we felt then. We make sense of what we felt in the past so we can reframe it in the light of who we are today, no longer a dependent or even trapped child, but a fully grown adult.

We see our inner world concretized through role-play and its grip on us lessens. We develop compassion for who we were then and an understanding of how we may have been carrying old relational pain and projecting it onto our relationships of today. As a result, we are able to leave the past where it belongs. We take our power back, not through yanking it away from someone else, begging for it, or waiting for another person to hand it to us. We get it back through inviting these parts of ourselves from the past, to come with us into the present and express ourselves fully and authentically.

I have long been a fan of doing this kind of deep work at treatment centers. Initially, it came into focus that unresolved trauma issues tended to be drivers of relapse for those who have substance use or process addictions. So, while doing the work seemed intense and challenging, not doing it seemed so, too. And as the field has grown to recognize that family members often need treatment for relational trauma, having lived for years with addiction in someone they love, psychodrama in trauma resolution has also become a therapy of choice. We have learned a lot about containment and professionalism and just how to use role-play to be most effective and healing.

Unblocking Trauma Reactions with Psychodrama Techniques  

Unblocking trauma reactions allows clients to voice their emotions without reacting, such as hitting something. This can reconnect them with their blocked feelings without returning them to a traumatizing event. 

Role Reversal 

Role reversal is one of the most challenging psychodrama techniques to execute, but it can be the most effective. It allows clients to talk to themselves, an addiction, their abuser, or the people they have abused.

Many people’s blocked feelings stem from childhood trauma. One powerful approach to this technique is inner child work, where clients create an emotional connection back to their younger self to address their trauma. 

Doubling 

Doubling occurs when the therapist helps the client voice their feelings, starting to uncover their blocked emotions. When the therapist and client are doubling feelings, the therapist can join in with the client to free the blocked emotions together. 

Future Projection

Future projection is a psychodrama technique that has clients envision their future. This allows them to think about different scenarios to overcome the effects of trauma. For example, if the client is in a codependent relationship, the therapist might ask them to think of a scenario whether they choose to continue the relationship or not. Another example would be to ask the client to think of their future three years down the road and envision what that looks like. 

Mirroring 

Mirroring allows clients to see themselves in action. Body language often doesn’t fully represent what we’re trying to portray. This technique will enable individuals to evaluate their body language. They can pull back or step up their presentation to match what they’re feeling, giving immediate feedback at the moment.  

Trauma Treatment at The Meadows

The kinds of five- to eight-day programs, like those I have designed for Meadows Behavioral Healthcare’s Rio Retreat Center (such as Mending Heartwounds and Thrive) or in MBH’s inpatient addiction treatment programs, offer the kind of containment and professional depth and expertise that makes it safe to do this kind of work. The feeling of being surrounded by others in a similar boat makes it feel easier to do the work, watch, and be a part of others doing it, too. It normalizes the feelings of sadness and isolation that can be part of childhood pain and the impact of trauma. It also creates a camaraderie that not only helps to hold tears but laughter as well. A special and even playful bond develops easily as we let our guard down and our natural selves show.

This photograph makes the simplicity of this process clear. The unassuming act of putting a role relationship that lives inside of us into concrete form, where we can move it from our inner world into our outer world and deal with it in the here and now, changes the way it lives inside of us. We develop what we call in psychodrama “action insight,” where we see with clarity what has been foggy and indistinct, giving shape and form to something that has felt shapeless and formless. Then, as it returns to our inner world, it does so with added transparency. We see into it, we understand.

For more from Dr. Dayton on Psychodrama, check out this video where she demonstrates two-chair role-play.