Excerpt from Somov's article on the Use of a Psychodrama Group for Substance Use Relapse Prevention

ARTICLE CITATION:

Somov, P. G. (2008) A Psychodrama Group for Substance Use Relapse Prevention Training. The Arts in Psychotherapy, 38 , 151-161.

 

ABSTRACT

 

The article reviews utilization of psychodrama group therapy in the context of drug and alcohol treatment and introduces a specific application of psychodrama group therapy for the purposes of relapse prevention. The proposed psychodrama group format features facilitator guidelines for directing relapse prevention behavioral role plays, substance-use specific role plays, and a format for post-role-play processing of group participants’ experiences.

 

PSYCHODRAMA IS GROUP THERAPY

 

Psychodrama is an action method pioneered by Moreno, one of the founders of group psychotherapy (Corsini, 1955). A therapeutic modality in which “people enact scenes from their lives, dreams or fantasies in an effort to express unexpressed feelings, gain new insights and understandings, and practice new and more satisfying behaviors” (Garcia & Buchanan, 2000, p. 162), psychodrama would appear uniquely positioned to allow individuals in substance use treatment to practice relapse prevention skills. And yet psychodrama, as a clinical modality, appears to be underutilized by the mainstay of substance use group work. For example, Brook and Spitz, in their otherwise comprehensive review of group modalities in the field of substance use treatment, “ The Group Therapy of Substance Abuse” (2002), did not include a description of psychodrama. Their book makes a few “one-word mentions” of psychodrama in passing and devotes only one free-standing paragraph on the history of psychodrama with substance use population tucked away at the end of the book. Robert Landy, professor and director of the Drama Therapy Program at New York University, in his 1997 pre-millennium status report article entitled “Drama Therapy – The state of the Art,” enumerates at least sixteen specific client populations but fails to mention the population of substance use. Similarly, Frances, Miller & Mack, in their authoritative and much anticipated 2005 “Clinical Textbook of Addictive Disorders, Third Edition” fail to mention psychodrama. Coombs and Howatt, the authors of “The Addiction Counselor’s Desk Reference” (2005), a truly panoramic resource, offer only a two-line definition of psychodrama in the back-matter of the four hundred plus pages book. Their definition of psychodrama as “adjunct to psychotherapy in which the patient acts out certain roles and incidents” (p. 373) offers a clue to the short shrift given to psychodrama in the substance use literature: despite a rather substantial history of the use of psychodrama with the substance use population, psychodrama is still viewed as an “adjunct to psychotherapy” for substance use, not as a bona fide group treatment modality.

One possible explanation for the underutilization of psychodrama in the group-work driven drug and alcohol rehabilitation field might be a failure to appreciate that psychodrama is, unambiguously, a form of group therapy. Another possible explanation is that while some attempts have been made to extend the practice of psychodrama to the field of addiction treatment, the psychodrama literature has largely failed to crystallize a psychodrama application that is specific to the goals of relapse prevention. Furthermore, psychodrama has historically relied on psychoanalytic and interpersonal frame of reference which places psychodrama, as a clinical modality, somewhat at odds with the fact that most of the present drug and alcohol treatment, in general, and relapse prevention training, specifically, in the U.S. appears to be informed by the cognitive-behavioral paradigm. Avrahami’s 2003 article on the interplay between CBT and psychodrama is an encouraging but largely isolated attempt to formally shift the vector of psychodrama practice and psychodrama literature towards the cognitive-behavioral orientation. Finally, psychodrama in its classic form, both in its conceptual postulate of spontaneity and creativity as well as in its theatrical and improvisational logistics, does not quite fit in with the outcome-oriented rehabilitation culture that emphasizes canned protocols.

The present article proposes a psychodrama application that is specifically designed for the purposes of substance use relapse prevention training, that has been adapted to the cognitive-behavioral frame of reference, and that offers the director (group facilitator) more ways to direct and manage the outcome of what happens on the psychodramatic group stage. The proposed modality, originally described in Somov & Somova (2003) and piloted in a residential correctional drug and alcohol treatment program in an American county jail, represents a psychodramatic treatment modality that can be used as a relapse prevention skill-practice group as part of the overall relapse prevention training curriculum or as a stand-alone relapse prevention group modality.

 

AN INCOMPLETE EVOLUTION OF PSYCHODRAMA IN ADDICTION TREATMENT

 

Since Moreno conducted the first psychodrama session on April 1st, 1921 in his Vienna Theatre of Spontaneity and throughout the 20th century, psychodrama evolved from a kind of broad-band psychoanalytic action method (in which “audiences suggested topics” and “the troupe” of professional actors “enacted them to explore and resolve the underlying social issues”) to a set of progressively population-specific “practical applications for everyday use” (Garcia & Buchanan, 2000, p. 162). The evolution of psychodrama, however, appears to be somewhat incomplete...