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Jacob Levy Moreno’s Psychodrama As a Work Technique For Treating
Patients in Group and Individual Psychotherapy
ABEF
Chair of Educational and Family Psychology, John Paul II Catholic University of Lublin
Abstract
Introduction. The basic purpose of this article is to present Jacob Levy Moreno's psychodrama method as the psychotherapeutic
technique useful in work with patients during individual and group psychotherapy.
Material and Method: The author presents the analysis of case studies of patients treated in individual and group
psychotherapy. He instances the examples of psychodramatic work on the stage as well as monodramatic and reports their
importance in the process of patient psychotherapy. He discusses the effects of these act ivities in the context of changes in the
emotional and interpersonal functioning of patients.
Results: The given examples of monodrama and psychodramatic works illustrate the mechanisms of the changes offered
by the method, e.g. insight, abreaction, acceptance of internal impulses, confrontation with the feelings of other people, training
thanks to the play on the stage, can be named and experienced by them.
Conclusions: Psychodrama, used in the psychotherapeutic work of the group and in individual work with the patient (in the
form of a monodrama), gives great opportunities to broaden the insight of the patient into very complicated internal mechanisms
permanent reparation of traumatic experiences, even from early childhood.
Keywords: psychotherapy, psychodrama, monodrama
Streszczenie
Wyniki:
Wnioski: Psychodrama, wykorzystywana w pracy psychoterapeutycznej grupy oraz w pracy indywidualnej z pacjentem (w
psychoterapia, psychodrama, monodrama
Curr Probl Psychiatry 2018; 19(4):
DOI:10.2478/cpp-2018-0019
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Introduction
Doctor Jacob Levy Moreno (1889-1974) was a
distinguished psychiatrist, theorist, and pedagogue,
recognized by the Harvard University as an outstanding
scholar in his lifetime. Moreno is known as the founder of
psychodrama, sociometry, and pioneer of psychotherapeutic
groups. He studied medicine, mathematics, and philosophy
at the University of Vienna, obtaining his medical degree in
1917.
in their natural surroundings. You analyze their dreams.
I give them the courage to dream again" [1]. He proposed
psychotherapy which based on role play, acting out roles,
and experimentation. He worked on the psychodramatic
stage, encouraging patients’ creativity and spontaneous
development of their blocked personality traits. In May
1927 he gave a speech at the International Psychodrama
Congress in New York: “Play yourself as you never were, so
you can begin to be what you could have been. Be your own
inspiration, your own author, your own executor, your own
By introducing psychodrama as a method of
treatment, Jacob Levy Moreno led the third revolution
in psychotherapy, following Pinel, who changed the
understanding of a psychiatric patient, and Freud, who
introduced psychoanalysis as integral part of medicine and
psychotherapy which later emerged from it. Psychodrama
successfully implemented in group psychotherapy and
individual therapy as monodrama [3].
Psychotherapy
health disorders which concerns one or several persons
affecting the psychical state of the patient in order to
[4]. Apart from elimination of the disorder, another effect
of psychotherapy observed in patients is increased life
satisfaction, sense of agency, individual and social success.
One of the objectives of the psychotherapeutic process for
the patient is to gain insight into the mental processes which
were previously not realized, especially those which led to
the disorder. The psychotherapist encourages the patient
to venture changes in his life, e.g. try self-dependence away
from parents, undertake work, etc.
In individual psychotherapy, the therapist and the
patient are focused on the patient’s inner life, that is the
individual mechanisms of dealing with emotions, relations,
life challenges, and the way of thinking.
Group psychotherapy consists in a treatment process
a small group of 8-12 people, providing the possibility of
the ways in which they enter relationships, the degree
The therapeutic function in a psychotherapeutic group is
carried by the group leader and other group members as
well. Numerous interactions which take place during the
group’s period of activity trigger factors effecting change,
such as universality, interpersonal learning, corrective
recapitulation of the primary family group, etc.[5, 13].
Psychodrama
The word drama derives from Greek and means action,
deed, activity, movement. Hence, psychodrama is described
as a method which provides the possibility to explore the
principles and mysteries of our psychical life by action.
This method not only allows for the investigation of human
behavior, but also for shaping it, which may be used both for
treatment and education [6].
As a form of psychotherapeutic treatment,
psychodrama formulates assumptions regarding the
conditions for its effectiveness, personality development
theory, and the origin of psychopathology. It assumes that
therapeutic change may happen in a relationship between
the patient and other people, which follows from our very
existence in a social world that shapes our personality.
Moreno sees the patient’s emotions as consequences of
interaction processes taking place in the so-called “social
relationships.
Psychodrama carries the idea of activating the patient’s
spontaneity and creativity, owing to which, the person can
easily experience, construe, and express the authentic
aspects of his own self.
Moreno formulates the personality theory as a role
theory. Personality and the self in particular, is shaped
by undertaking social roles: the richer the repository of
personality. The self is a composition of body (somatic
roles), psyche (psychical or psychodramatic roles), and
enacted, and created [7].
A person’s development consists of three stages – the
with the caregiver, experiencing reality in terms of “here
itself. In this period, the infant functions in somatic roles.
In the next phase, the child’s self becomes separated from
the caregiver’s self; owing to the sense of security, the child
experiments with psychical and social roles. Then, the child
integrates the already arisen identity, shapes its worldview,
learning to recognize and comprehend itself and others.
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Moreno describes integrated personality – sound and
mature – as an adult who is able to discover this child in
himself so as to experience the unknown by using fantasy
(the ability to adjust to new situations) and therefore, gain
Moreno views patient psychopathology as the
pathology of a role which has not been fully mastered (not
tried out, not practiced), as, for example, in the case of
schizoid disorders, where a person has not undergone social
skills training to a satisfactory degree. Neurosis results from
Health is progression, unfolding and developing being, while
disease is regression, blockage, hindrance to the track of life.
Hence, the treatment of patients consists in supplying the
triggering spontaneity, vitality, and creativity [3].
Psychodrama was invented as a form of group
psychotherapy and is most often used in group work
on account of the multiplicity of relationships, which
allows for using a number of techniques. It is a complex
form of therapeutic theater where the patient (called the
protagonist) on stage acts out and experiences his trauma
and solves the problems it caused with the help of the
therapist (psychodrama leader) and the group. On stage as
well, in a psychodramatic game, the patient tries out new
behaviors and social roles and experiences catharsis. The
work is bound with rules concerning a ban on interpretation,
judgment, mutual offending of group members, and the
assumption that every group member is therapeutically
useful [8].
5 elements 5 techniques 3 phases
In a psychological sense, the stage serves as an
inner area of the protagonist’s experiences, frequently
unconscious, concerning the people in his life. These people
are symbolically introduced on stage as psychodramatic
roles called auxiliary egos. From the intrapsychic viewpoint,
acted out by group members chosen by the protagonist. The
warm-up in psychodrama is conducted by the leader and can
be performed by means of physical exercises, visualization,
pantomime, etc.; its objective is to encourage the group
members to therapeutic intrapsychic or interpersonal
work. The warm-up and the emergence of protagonists
are followed by the selection of one protagonist. In the
game phase beginning with interview, the leader and the
protagonist settle what situation will be covered by the
game. The protagonist builds up a scene related with this
situation by recalling emotions and evoking memories.
Psychodramatic roles are introduced, to which the
protagonist adds movement and voice. A double can be
added as the protagonist’s representative, replacing him in
the mirror technique when the leader takes the protagonist
from the stage to the audience to be able to see it “from
the catharsis state, unblocking and releasing powerful
emotions. The leader aids the protagonist with experiencing
catharsis using the doubling technique: he speaks and uses
body movement to reveal thoughts and feelings which
have not been expressed by him in situations for fear of
the prospective reaction or because of their unconscious
nature. The protagonist is able to perceive his own issues
from the other roles’ perspectives. It is possible to act out on
stage a situation from the past, expand the reality by adding
situations that have never happened, or set the action in the
future.
The action phase is concluded with closure – a return to
reality from the symbolic level and to the present concerning
the biological age if the game included moving back in time.
The protagonist releases the members of the game from
their roles, clears the stage, and returns to the circle. Then
follows sharing, where the group members share their own
memories and related experiences which emerged while
watching the psychodrama, and role feedback, where the
gained while enacting the role [3,9].
A distinctive characteristics of psychodrama lies in a
years and permanent overcoming of traumatic experiences,
even those concerning early childhood.
Monodrama is a psychodrama technique applied during
an individual session with the patient. In this situation, the
auxiliary ego is represented by various objects chosen by
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the protagonist, while the leader spares them his voice and
participates in sharing needed by the patient.
A group game involves the entire group spontaneously
Psychodramatic group work – case study
The analyzed case of psychodramatic work took
place in a psychotherapeutic group led by two therapists
(psychodrama leader and psychodrama assistant) in
private practice [8]. The group was mixed, included both
women and men, and worked with the use of psychodrama
supplemented with discussion sessions. The group met once
a week for three hours (12 hours of work per month). In
the group, Ms. Agata represented a mechanism of constant
group and receiving kindness from other members. Agata
sought treatment displaying symptoms of anxiety, lowered
stating that the world was bad, people – mercenary, and she
herself did not need and could not enter closer relationships.
Agata had experienced tremendous violence from her father,
who had abused her physically and mentally. Her mother left
home to work abroad when Agata was 13, regardless of the
her father had been deceased for a year, and her mother
was intending to return to Poland. Agata has mixed feelings
for her mother – daughter’s loyalty, compassion, anger for
could not imagine living with her, especially that her mother
had suffered in a car accident and needed care; what is more,
while staying abroad, the mother became addicted to pain
relievers. In the group, Agata functioned alternately on two
behavior extremes: one time she was a victim (“her tragic
story explains everything, she should meet with compassion
ongoing projections of anger, feeling that everyone wanted
to hurt and abuse her. Agata was frequently selected for
the roles of bad, aggressive characters in psychodramas. In
times claiming the group’s attention for constant reiteration
stopped – no member of the group dared to interrupt her.
The patient caused a lot of anxiety in others, the overgrowth
Agata’s work in the group was aimed at expanding the
repertoire of roles concerning the need for care and support.
avoided, having made the victim susceptible to harm. Love
must be felt in order to admit to consciousness and, at the
same time, weaken the terrifying heritage of monstrous
hatred that has become too hard to bear without destructive
the scene of her mother’s departure abroad. The mother
kept convincing her that it was the only solution. Agata
and she stood there motionless and helpless. Following the
application of the mirror technique, Agata observed the
scene (with a double in her role) and the leader proposed
that Agata enters the role of an expert – child psychologist
and speaks with the Agata on stage (the one from the scene
of her mother’s departure).
does she need?
Then Ms. Agata said that the little girl must not stay
with the father-tyrant and that she needed care. To the
question who could help the little girl, she responded that
her aunt could, with whom she connected a lot of happy
arranged a situation with the good aunt (surplus reality).
the person in the role of the aunt) what she herself had said
before in the role of the aunt. The aunt took her from her
father under her own care.
Another crucial element of Ms. Agata’s group work
was the moment of escalation of her aggression during a
group game. It was the moment when resistance appeared
in the group, followed by some undirected massive anger.
(she placed herself in the women group) over child custody.
Ms. Agata was very aggressive in the game, aiming at the
elimination of men as useless and threatening. The game
men and women started to cooperate. Discussion of the
game resulted in numerous remarks aimed at Ms. Agata
rage. Agata realized the vast amount of anger inside her; she
saw how this anger hindered her relationships, just as it was
present in transference and projections. To the following
session she came sad and kept returning to the previous
often experienced that in her life, and that people stood by
her only when she was the one to give.
on stage, she recalled the feelings which kept bothering
connection with security loss when her mother had left. This
can rely on no one! People are egoists! You’ll end up alone.
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always accompanied Agata, making her safe in her own
world, insusceptible to harm from other people. It protects
her from any activity, so that she suppresses her desires. The
message of solitude: “You’re better off on your own! You’re
for help. Agata has been harmed by fate and even by God,
who mocked her by making her suffer. The sense of harm
feels rejected. The voice of despair: “Everybody let you
down, people always let you down! Do not expect anything,
her that something is wrong and appearing when Agata
envy. There is anger at her parents, but also at herself for her
better off than you! Destroy them! You don’t deserve to be
the feelings passed by the auxiliary ego, Ms. Agata seemed
express her feelings. In her soliloquy the protagonist said: “I
feel overwhelmed. I can’t vent my despair and anger. I can’t
express my anger, because if I do, I will be rejected. I fear
that this anger will build up so much I won’t be able to stand
the protagonist in her right to be angry and to channel the
anger towards its proper recipient – the father.
The leader suggested: “I have a right to be angry, but
I don’t want to keep my anger anymore. I want to get even
with whoever deserves it! Agata said: “Yes, it’s all my father’s
with her father, she answered: “I want to, but I fear this
“It doesn’t matter that he’s dead, I will always remain under
to confront with her father. During the scene with the father,
she tried to blame him for all the harm she suffered, but did
not allow herself to fully express anger. The leader suggested
that Agata takes the role of her father. Interviewing Agata as
her father, the leader knew she had to escalate the father’s
aggression by provoking him (Agata). The provocation
worked out and Agata started to shout out the words she
had been hearing from him: insults, invectives, humiliating
abuse, judgments. The leader’s objective was to trigger
anger in the patient, which turned out easy when she was in
her father’s role. Further work was the protagonist’s anger
with her father, almost comparable to a volcano eruption.
Agata’s fury was tremendous when she heard all this
from her auxiliary ego in the father role. Agata kept hitting
every blow she stated what it was for. The number of blows
was settled beforehand with the leader. The group did the
the leader what she would need then. The protagonist said:
“This should not have happened, I shouldn’t have had to
In the next scene Agata wished to converse with him. It was
Agata, saying that he loved her.
Agata can be illustrated by the fact that in further group
work, she started to be chosen for supporting, caretaking
roles. In her life, after numerous confrontations with her
mother, she decided to put her at a nursing home, visited
her, and after a while began to receive support and positive
feelings concerning the lack of care let Ms. Agata vent anger
at her guardians. The obligation to take care of the child,
which appeared in the group game, as well as experiencing
to constructively release and express anger towards her
stopped to poison Ms. Agata who, in consequence, ceased to
suppress the needs for love and care.
Monodramatic work – case study
The following includes one of the sessions of an
individual psychotherapy of a 38-year old man, Mr. Andrzej.
The psychotherapeutic process was conducted by a woman
psychotherapist [10]. The patient is an IT specialist, he is not
university, he has been experiencing the feelings of grief,
emptiness, the sense of no control over his life, and problems
symptoms – stomach ache, diarrhea, cardiac ailments,
especially in stressful situations. The patient undergoes
psychiatric treatment for depression. He irregularly took
joining psychotherapy were symptoms of depression after
ending a 3-year relationship with his girlfriend. Though
8 years before the patient had undergone individual and
group psychotherapy, he claimed it did not yield any positive
results. Asked about the motivation for treatment, he said: “I
am hopeless, I feel worthless, I’m good for nothing, I lost my
job a year ago, the second time actually. I work on temporary
contracts, it’s been very hard, my girlfriend broke up with
me… For a long time now, life has been endless struggle and
effort, struggle with myself, I keep being afraid, keep evading
prospective failures… I can’t go on…, I keep playing some
a lot for others, even against himself, he conceals his fear and
anger from others trying to live up to their expectations. His
own needs and impulses are a sphere to which he has a very
own apartment, often visiting his parents; he feels closely
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connected with his mother, while the relationship with the
father is appropriate yet quite distant. During therapy, the
patient disclosed some problems in sexual life: he has never
had a full sexual intercourse with penetration, sometimes
he experiences erectile dysfunction. The patient says: “I feel
surgeon, he was given a clean bill of health. The patient
is the only child and holds a close relationship with his
mother who, though very warm and caretaking, was always
concerned that he might fall ill, not cope with problems,
son when he did not manage to please her. He had to be good
and obedient.
development theory, the patient represents a symbiotic and
narcissist character style. The symbiotic adaptation hinders
the prospect of abandonment, yet disallowing for building
a genuine sense of safety. The narcissistic adaptation results
in a constant pressure of tension between grandiosity
and worthlessness. Frail self-esteem is contingent upon
achievements. The patient experiences troubles with
separation-individuation. Additionally, the patient’s lack
of sexual satisfaction involves blocked aggression, weak
changed into reluctance to becoming close to a woman and
satisfying her sexually [11,12].
During therapy, the patient started to grow attached to
the therapist and felt increasingly safe with her. His mood
oscillated between depression and moments of complacency.
The patient’s self-awareness on a cognitive level kept
increasing. In one session, when there appeared the issue of
the patient’s relationship with his mother, his entanglement,
sense of being controlled, anger at her and the feeling that he
couldn’t express it, the therapist asked him what he expected
from his mother. The patient replied: “I would like her to
understand that I am a grown up man. But do I have a right
to, since I don’t put my adulthood to use and I’m not trying to
with a sense of emptiness. He was hardly able to determine
what it meant. The therapist suggested that they work on
the emptiness using monodrama. The patient consented.
On stage, the patient marked the sense of emptiness
with a large, grey scarf. In the role of emptiness, he said:
“I am the kingdom of an evil goddess, she is vicious and
fascinating (strong). Andrzej knows her well, she brings
suffering and hopelessness. He is doomed to this kingdom,
doomed because he’s inert, he’s not trying. He can’t help
leader (therapist) repeated the message asking the patient
after Mr. Andrzej wanted to back down, afraid of feeling
anger towards his mother. The leader proposed to contact
Considering the patient’s resistance from expressing anger,
the leader proposed a so-called future projection (moving to
grave in a hundred years. Until his death no change occurred
the perspective of the long dead Andrzej. In the role of the
deceased Andrzej, the patient said: “it’s a very sad and
good life, he said: “don’t be concerned with what others say,
do your thing, you can be strong, you know what’s good for
also said that he had to move away from his mother.
secret from his mother. The sessions that followed included
strengthening the patient in his undertaken separation
efforts and working on establishing his own boundaries in
contacts with parents.
Conclusions
Psychodrama, used in psychotherapeutic group
work and individual work with the patient (in the form of
monodrama), provides vast possibilities of expanding the
patient’s insight into very complex internal mechanisms of
and impulses gives patients some space for understanding
and change. In psychodrama – when working on stage
and in group games – extremely powerful emotions reveal
themselves safely. The patient has the opportunity to try
out new behaviors, play out new roles, enact them, and
experiment.
The psychotherapist – the leader – encourages patients
to creatively and spontaneously develop their blocked parts
of personality. The outstanding feature of psychodrama
consists in a relatively quick solution of a long-lasting
even if they are traced back to early childhood.
przez Harvard University za wybitnego naukowca. Moreno
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162
po zmianie koncepcji pacjenta psychiatrycznego przez
Pinela i po wprowadzeniu przez Freuda psychoanalizy
stosowana w psychoterapii grupowej oraz indywidualnej,
jako monodrama [3].
Psychoterapia
jednej, lub kilku osób na stan psychiczny chorego w celu
indywidualne mechanizmy radzenia sobie z emocjami,
Psychoterapia grupowa jest procesem leczenia
intensywnej pracy nad relacjami interpersonalnymi
grupie psychoterapeutycznej funkcje terapeutyczne, obok
Psychodrama
Psychodrama jako forma leczenia
Moreno traktuje emocje pacjenta jako pochodne procesów
towarzyskie.
Psychodramie towarzyszy idea uruchamiania u
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163
psychoterapii grupowej i w pracy grupy jest wykorzystywana
grze psychodramatycznej wypróbowuje nowe zachowania
grupy [8].
5 elementów 5 technik 3 fazy
Jest prowadzona przez lidera a jej celem jest pobudzenie
psychodramatyczne, którym protagonista nadaje ruch i
[3,9].
Monodrama to technika psychodramy na sesji
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Praca psychodramatyczna w grupie – analiza
przypadku
Opisywany przypadek pracy psychodramatycznej
przez dwie terapeutki (lider psychodramy i asystent
scenie ( z momentu wyjazdu matki)
dziewczynka? Czego ona potrzebuje?
kontaktach, tak jak jest obecna w przeniesieniu i projekcjach.
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165
wybuch wulkanu.
Praca monodramatyczna – analiza przypadku
Jest to opis jednej z sesji w przebiegu psychoterapii
ze strony serca, szczególnie w sytuacjach stresu. Pacjent
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nie pozwala na zbudowanie autentycznego poczucia
cierpienie i brak nadziei. On jest skazany na to królestwo.
Podsumowanie
Psychodrama, wykorzystywana w pracy
psychoterapeutycznej grupy oraz w pracy indywidualnej z
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Otrzymano: 21.11.2017
