Action Methods in Addiction Treatment:

1
Presents Action Methods in Addiction
Treatment An Introduction to Psychodrama,
Sociometry Group Psychotherapy Addictions
Ontario June 3rd, 2008
Fiona G. Roche, B.Sc., CQSW, RSW, CGPA(dip),
TEP Therapist, Trainer Educator and Practitioner
of Psychodrama
www.bellwood.ca
2
Bellwood Health Services

• Founded in 1984 by Dr. Gordon Bell and Linda
  Bell
• 60 bed facility located in Toronto
• Treatment available on residential, day, or
  out-patient basis
• Accredited by the Canadian Council on Health
  Services Accreditation

3
Treatment Programs
Alcohol Drugs Gambling Sexual Addiction Eating
Disorders
4
Who Is Eligible?

• Males and females 19 years of age and over from
  across Canada

5
Treatment Philosophy

• Abstinence based program of education, therapy
  and physical healing.
• Holistic approach to treatment
• Physical
• Mental
• Social
• Spiritual

6
Staff

• Interdisciplinary team has extensive medical,
  counselling and therapy experience in addiction
  and lifestyle enrichment.

• Physicians
• Psychiatrists
• Clinical psychologists
• Registered nurses
• Psychotherapists
• Addiction counsellors
• Drama therapists

• Nutritionists
• Physiotherapists
• Fitness coaches
• Massage therapists
• Spiritual health counsellors
• Social workers
• Life skills coaches

7
Psychodrama at Bellwood

• An integral part of weekly Group Therapy program
  the 4th group
• Clients in the residential program meet for
  2-hour drama sessions ... maximum 12 clients per
  group
• Staffing 2/3 Team members - psychodrama director
  and supporting team members

8
(No Transcript)
9
Definition of Psychodrama

• J.L. Moreno, the creator of Psychodrama, defines
  it as the science which explores the truth by
  dramatic methods.

10
What is Psychodrama?

• A method of learning through the spontaneous
  enacting of life-situations
• May be from past, present or future
• May be real or hypothetical
• Uses guided dramatic action to examine problems
  or issues raised in groups or individual sessions

11
How?

• A group member (the protagonist) acts out
  significant life scenes
• Other group members play the supporting
  characters (auxiliaries) of the story
• The director, a trained psychodramatist, guides
  participants in the action as the drama develops

12
Use of Psychodrama

• Can be used in individual and group treatment
• Involves action methods as well as verbal methods
• It is a powerful action method of group
  psychotherapy

13
Mind-Body Connection

• The mind in action draws insight from the bodys
  knowing the spirit encountered calms the
  troubled heart. - Liz White, The Action Manual

14
Psychodrama
Sessions are either

• Interpersonal
• Intrapsychic
• Role Training

15
Where and For Whom

• Broad range of mental health, educational and
  industrial environments throughout world
• Proven effective with low and high functioning
  populations
• Improves awareness, self-esteem, effectiveness in
  relationships

16
Treatment of Alcoholism

• Psychodrama has been used in the treatment of
  alcoholism since 1944 at the Psychodrama
  Institute in New York, founded by J. L. Moreno.

17
Value of Psychodrama

• Especially valuable in working with addicted
  population and family members
• Psychodrama -gt one of 1st treatment methods to
  recognize an addicted persons interpersonal/
  intergroup relationships as essential elements of
  their problem

18
Psychodrama and Self-Help Programs

• Psychodrama is primarily a group action method
• Logical treatment extension of 12 Step programs

19
Supportive Environment
Both

• Provide a trusting/ mutually supportive
  environment
• Encourage exploration, sharing of feelings and
  concerns with others
• Reduce feelings of isolation, fear, anger and
  loneliness
• Can be a temporary Higher Power until deeper
  spiritual role developed

20
Components of Treatment

• Both AA and Psychodrama foster mutual sharing and
  self-disclosure -gt emotional connectedness
• Group members relate to the feelings and personal
  experiences of the psychodramatic enactment
• Each is a therapeutic agent for the other
• Mutual healing occurs
• Opportunity to live twice

21
Value of Psychodrama in Therapy

• Can be used in conjunction with other therapies
• Immediate emotional involvement
• Helpful in working with addicts who can be
  withdrawn, reticent, isolated and in need of
  social reconnection
• Ideal vehicle for reversing passivity and denial

22
Confronting Denial
Using Empty Chair Technique

• Encounter the drug
• Find new solutions

23
Witnessing

• Recovering person may

• Tell story of addiction and of life
• Have story witnessed by others
• Without interruption.
• Without it being fixed.

24
Goals in Early Recovery Groups

• Confront the drug/ addictive behaviour
• Recognize and express feelings
• Develop and rehearse new solutions to situations
  and problems
• Increase self-esteem, empathy and spontaneity
• Examine attitudes, relationships and roles
  related to addiction
• Increase group interaction and cohesion

25
Participation

• May be significant accomplishment for some
  individuals
• Work with a sense of humour!

26
Development of Addiction
Use
Misuse
Abuse
Dependency
Compulsive Use/ Addiction
27
Addictions

• Behaviours
• Gambling
• Work
• Shopping
• Food
• Exercise
• Sex
• Computer

• Substances
• Alcohol
• Drugs
• Tobacco

28
What is Sociometry?

• Definition A science which studies the formation
  and construction of groups
• Uses methods to describe and account for
  interpersonal relations within groups
• Makes the covert, overt
• Reveals underlying connections
• Used for group building

29
Group Building
Sociometry exercises and methods enhance

• Belonging
• Cooperation
• Cohesion
• Openness
• Access to roles

30
J.L.Morenos Concept of Mental Health

• Spontaneity
• Creativity

NEW CULTURAL CONSERVE
An adequate response to a new situation or a new
response to an old situation. - J.L. Moreno
31
The Five Elements of Psychodrama

• The Director
• The Protagonist
• The Auxiliary Ego
• The Stage
• The Audience

32
Psychodrama Evolves in Three Stages
STAGE 1 THE WARM UP

• To self
• To others
• To theme
• Suggested by the Director usually through an
  exercise
• A protagonist emerges

33
Psychodrama Evolves in Three Stages (Contd)
STAGE 2 THE ENACTMENT

• A star or protagonist comes forward to act out
  their dilemma
• Generally related to a group theme
• Dramatizes the protagonists dilemma
• Director initiates interactions between
  protagonist and group members

34
Psychodrama Evolves in Three Stages (Contd)
STAGE 2 (Contd)

• Group members, selected by protagonist, play
  significant roles
• Continues until protagonist achieves a shift in
  perception and tests a new approach

35
Psychodrama Evolves in Three Stages (Contd)
STAGE 3 SHARING

• Group members share their emotions and
  associations evoked by the enactment
• Auxiliaries share the feelings experienced in the
  roles played
• Often these remarks have deep significance for
  the protagonist
• Reduces feelings of exposure for protagonist

36
The Hollander Curve
Catharsis of Abreaction
Catharsis of Integration
Scene 2
Surplus Reality
Integration Closure
Scene 1
.
.
.
.
.
.
.
.
.
.
PSYCHODRAMATIC ENACTMENT
SHARING DIALOGUE
WARM UP
37
The Social Atom

• A sociometric exercise
• The participant explores on paper and in action
  the nucleus of persons to whom he/ she is
  connected
• It observes and measures the nearness and
  distance which exists in the relationships
• It accounts for inclusion or exclusion from
  participants social circle

38
Morenos Social Atom
Male
Female
x
39
Social Atom-Collectives
Relatives
NOTATIONAL SYSTEM
School
a.Attraction b. Rejection c.Indifference
Friends
Church
Me
Work
Social Groups
Family
40
Applications in Addiction Treatment

• Atoms can measure an addicts relationships with
  people, places or things
• For example
• Work
• Cocaine
• Food
• Sex
• Exercise
• Family
• Friends

41
Application in Recovery

• Recovering persons can explore support and
  recovery resources
• For example
• Sponsor
• 12 step programs
• Therapy
• Journaling skills
• Family
• Friends
• The two atoms can be compared in action

42
(No Transcript)
43
Sobriety/Magic Shop
Description

• Sobriety Shop variation of classic Magic Shop
• Structured exercise where unwanted, dysfunctional
  qualities magically transform into
  desired/beneficial qualities

44
Sobriety/Magic Shop (Contd)
Style/Setting

• Mutually agreed fantasy/surplus reality
• Language of metaphor
• Bargaining process

45
Sobriety/Magic Shop (Contd)
Qualities

• Lying, stealing, grandiosity, people-pleasing is
  highly valued in addiction. This is
  dysfunctional in recovery.
• Honesty, self-esteem, serenity, self-care. These
  are helpful new qualities in recovery.

46
Sobriety/Magic Shop (Contd)
Process

• Problem to the Solution
• Solution 60 of action time
• Willfulness and Willingness Motivation

47
Sobriety/Magic Shop (Contd)
Players/Characters

• Shopkeeper -gt Action Director
• Customers seeking exchange qualities -gt
  Protagonists
• Assistants in action -gt Auxiliaries
• Audience -gt Commentators/Greek Chorus

48
Sobriety/Magic ShopAction Steps

• Scene Setting
• Qualities/ behaviours stocked in shop
• In/ Available signs
• Barter system
• In Brainstorm qualities contributing to
  addiction/ dysfunctional in recovery. Available
  Brainstorm qualities helpful in recovery.

49
Sobriety/Magic ShopAction Steps (Contd)

• Action exploration of qualities. Methods are the
  following
• Interviewing
• role-reversals
• Doubling
• Mirroring
• Sculpting
• role-training
• Bargaining quantity of quality

50
Sobriety/Magic ShopAction Steps (Contd)

• Customer receives new quality
• Anchoring -gt in body
• Psychodrama photo
• Concretize in object
• Contract for use
• Report to 12-Step Meeting/Sponsor
• Sharing

51
Sobriety/Magic ShopConclusion

• Metaphor for death
• Re-birth
• No gain without loss
• Group therapeutic agent
• Creativity through spontaneity/ play
• Optimistic view of human potential

Source Sobriety Shop - A Variation on Magic Shop
for Addiction Treatment Patients. Terry A. Rustin
and Peter A. Olsson. Volume 46/1. Psychodrama and
Sociometry. Spring 1993.
52
Resources

• The Action Manual (Elizabeth White)
• Available by contacting actioninfo_at_rogers.com
• The Living Stage (Tian  Dayton)
• Trauma and Addiction (Tian  Dayton)
• Drama Games (Tian  Dayton)

53
Presents Action Methods in Addiction
Treatment An Introduction to Psychodrama,
Sociometry Group Psychotherapy Addictions
Ontario June 3rd, 2008
Fiona G. Roche, B.Sc., CQSW, RSW, CGPA(dip),
TEP Therapist, Trainer Educator and Practitioner
of Psychodrama
www.bellwood.ca