Jacob Levy Moreno (1889–1974), who developed Sociometry and psychodrama, emigrated as a psychiatrist from Vienna to the USA in 1925. He is one of the founding fathers of group therapy and has been significant in promoting its development in the USA from 1931 onward. According to Moreno, group therapy is not to be equated with psychodrama (Moreno, 1959, p. 69 f.). Instead, he understood “group therapy” to be “simply” a group process in which “the immediate and sole focus is on the psychological health of the group and its members” (Moreno, 1959, p. 53). With this in mind, Moreno worked with existing groups in social institutions such as schools, dormitories, and prisons from 1932 onward. He supervised the employees there, provided organizational consultation, and worked sociotherapeutically using sociometric methods (Moreno, 1974) and role-plays.

In 1936 he founded a small psychiatric clinic in Beacon/New York. At that time, psychotherapy was still in the early stages of its development worldwide. In his 12-bed sanatorium, Moreno treated his mentally ill patients based on the fundamental principles of a therapeutic community. He integrated into the treatment of his patients his earlier experiences of role-playing with children and improvisational theater with adults in Vienna (Moreno, 1970), as well as his insights from his work in social institutions in the USA.

As a psychotherapist, Moreno treated his patients primarily in an individual setting (Straub, 2010, p. 28) (see Sect. 2.6.1) and used role-plays. He let patients develop their own roles or those of others on stage, initially without any role reversal (Moreno, 1945, p. 11 ff.; 1959, p. 221 ff.). Assisting therapists supported the patients as auxiliary egos in the various complementary roles. It was not until later that Moreno (1959, p. 210) integrated role reversal between the protagonist and an auxiliary into his therapeutic work. That was the birth hour of psychodrama as a psychotherapy method as we know it today.

The psychodrama psychotherapy described in this book is based on the concept of the creative human.

Important definition

The concept of the creative human is based on understanding humans as living beings who are constantly adapting to external living conditions. However, in doing so, humans have to maintain their own complex structures in order to be not adversely affected. For this purpose, humans use an internal creative process of self-development. This includes the systemic development of internal self-image and internal object image in the current external situation. These development processes control their external behavior in the current situation. Humans perform these processes of self-development through mentalizing. As a result, they become an actor in their own internal conflict processing.

This view of the creative human ascribes “great importance to the self-regulating processes on all levels of human living and experience” (Kriz, 2012, p. 318). It sees humans as “systemically organized holistic structures” (Kriz, 2014, p. 128 ff.). Psychodrama accomplishes this mentalizing in the as-if mode of play. In this way, psychodrama therapy proves to be a method of humanistic psychotherapy (Kriz, 2012). Psychodrama therapists do not find suitable approaches for their current practical work with their patients in books. Instead, they find the appropriate psychodrama technique within themselves as the patient’s implicit doppelganger. They playfully identify with the patient as an implicit doppelganger and want to ‘understand themselves’. They want to find an appropriate solution in ‘their own’ conflict on the patient’s behalf and therefore use the appropriate psychodrama technique in the patient’s play (see Sect. 2.5).

Central idea

Psychodrama promotes the internal self-development of humans in external conflicts. Therefore, a theory of psychodrama is also a theory of self-development of humans applicable across all psychotherapy methods.

All psychotherapy methods try to understand persons in psychological distress and to jointly work on finding solutions to their conflicts. Therefore, there are similarities in the thinking and the approaches between various psychotherapy methods. For example, mentalization-oriented psychodrama therapy (see Sect. 2.2) also incorporates depth psychology, behavioral, systemic, and transpersonal therapy.

  1. 1.

    The psychodrama therapist uses, for example, depth psychological concepts when she connects and justifies currently inappropriate behavior or an inappropriate affect with difficult childhood experiences through scene change. She uses the concepts of transference, countertransference, and resistance when dealing with disturbances in the therapeutic relationship (see Sect. 2.7). But the psychodrama therapist also thinks systemically in mentalization-oriented psychodrama therapy.

  2. 2.

    The therapist helps the patient to further develop his inner self-image and object image through role reversal and, thus, dissolve blockades in internal conflict processing. In doing so, she views the patient’s conflicts (see Sects. 8.4.1–8.4.7) and the therapeutic relationship (see Sect. 2.7) systemically (see Sect. 2.4.3).

  3. 3.

    Elements of behavioral therapy can also be of value. Once the patient understands his old ways of dysfunctional self-regulation, he practices discarding the old way and looking for new, more appropriate behavioral opportunities depending on the situation. In the therapy of persons diagnosed with personality disorders, the therapist changes metacognitive processes through psychodramatic chair work, similar to the work in schema therapy (see Sects. 4.7–4.11). For example, she represents the patient’s self-censorship with a chair symbolizing his ‘inner blind soul killer’. The patient should symbolize it with a hand puppet and lock him up in a cupboard at home. He is supposed to look at it once daily and write down a list of his sadistic superego’s statements. Over time, this helps him notice the ‘soul killer’ actions quicker.

  4. 4.

    Many psychodramatists also make use of transpersonal psychological knowledge. For example, the therapist actively recognizes and supports the patient’s passage through initiatory experiences (Dürckheim, 1984, p. 39 f.). These are profound inner changes that can occur when passing through one of the primary fears of man: the fear of death, the fear of absolute loneliness, the fear of becoming crazy, or the fear of absolute emptiness (see Sects. 5.9, 5.10.5, 5.13, 5.14, 8.8, 9.5 and 10.7). The passage through these basic fears can evoke a feeling of the specialness of life, the experience of security in extraordinary love, the knowledge of greater meaning, or the experience of the fullness of being.

Depending on the current situation, the therapist in mentalization-oriented psychodrama therapy focuses her practical psychodramatic work on.

  1. 1.

    the patient’s cognitive thought content

  2. 2.

    the metacognitive processes of mentalizing

  3. 3.

    the individual identity of the patient

  4. 4.

    his systemic identity

  5. 5.

    his social identity or

  6. 6.

    his transpersonal identity.

Figure 1.1 depicts these different focus areas as the poles of the diagram. In this way, the patient potentially develops his personal and ideal identity further. The focus of the work is not an either-or but a both-and approach. I have therefore illustrated the movements between the different focal points of the work as circles.

Fig. 1.1
A diagram of the focal points of the therapeutic work in mentalization-oriented psychodrama. Personal identity and ideal identity are interrelated. Personal identity has cognitive, individual, and metacognitive identities. Ideal identity has social, systematic, and transpersonal identities.

The focal points of therapeutic work in mentalization-oriented psychodrama

Full size image

Over time, various schools of psychodrama have developed different focus areas in their work. Classical psychodrama, according to Moreno, works metacognitively, without really saying it (see Sect. 2.14). It promotes the concept of spontaneous and creative humans and the progressive development of individual groups and the whole society. It is often determined by transpersonal values. The mentalization-oriented, metacognitive psychodrama presented here follows the overarching concept of mentalizing. It justifies the disorder-specific application of psychodrama techniques against the background of a holistic systematic theory.

Central idea

The composer Gustav Mahler (1860–1911) once said: “Following tradition is not to preserve the ashes, but to pass on the flame.” The mentalization-oriented theory in psychodrama helps preserve Moreno’s passion and pass it on. However, mere admiration of Moreno’s ashes prevents us, psychodrama therapists, from being spontaneous and creative. The therapist must find and admit Moreno’s creativity in herself.

Since my first encounter with psychodrama, I have concerned myself with two questions: “How does psychodrama work?” “How does healing occur?” I came a step closer to answering these questions when I discovered the analogy between the central psychodrama techniques and the mechanisms of nocturnal dreams (Krüger, 1978, see Fig. 3 in Chap. 2, Circle C). I had a creative breakthrough in 1995, which helped me further understand the effects of psychodrama techniques (Krüger, 1997, S. 11 f.). In five months, I developed a cross-sectional theory of metacognitive processes. The uniqueness of psychodrama lies in the fact that the psychodrama techniques used in a play implement the internal metacognitive tools of the patient, which produce their thoughts and feelings. They release these tools from their blocked state and further develop conflict processing (see Chap. 2). Psychodramatists work directly metacognitively using psychodrama techniques.

“Metacognition” is thinking about the processes of thinking. In my understanding, the therapist works in a metacognitive manner when she, together with the patient, uses psychodrama techniques to change the metacognitive process, which creates the patient’s thought contents. In doing so, she does not focus simply on the content of the patient’s thoughts, for example, his feelings, the events, and his memories of his marital conflict. Together with him, she also improves the functioning of the tools he uses in creating these thought contents (see Sects. 2.2 and 2.7). In psychoanalysis, metacognition finds application in defense mechanisms, dream analysis, and mentalization theories. In behavioral therapy, firstly, therapists oriented themselves toward the patient’s external behavior and then developed cognitive-behavioral therapy. This approach attempts to alter the contents of thinking, detect dysfunctional presuppositions and convictions, and replace them with more appropriate thought contents. In the third wave of behavioral therapy, therapists are now focusing their attention on the metacognitive processes that create the dysfunctional content of the client’s thinking. It is, for example, the core concept in Schema therapy.

Central idea

The mentalization-oriented theory of psychodrama helps us understand ‘what we do in Psychodrama when we do what we do’ (Marineau, 2011, p. 43). This understanding leads to a flexible, metacognitive disorder-specific therapy (see Sect. 2.14). The encounter between the therapist and patient or the group becomes the starting and end point of therapy.

In this book, I first describe theoretically what we do in psychodrama when we do what we do. Then, I explain disorder-specific psychodrama methods for different illnesses based on this theoretical foundation. The mentalization-oriented theory makes it possible to apply psychodrama in individual as well as in group therapy settings (see Sect. 2.6.1).