Mentalization-Oriented Metacognitive Theory of Psychodrama

Abstract

Psychodrama therapists need to explain better what they do in therapy when they do what they do (Marineau 2011, p. 43). The role theories are not sufficient to justify the specific therapeutic effects of psychodrama therapy. The cross-analytical concept of mentalizing gives a new scientific basis to the profound emotional experiences in classical psychodrama: Psychodrama is inner mentalizing through external play in the as-if mode.

1. The therapist intuitively uses the patient’s metacognitive tools of inner mentalizing as external action modes. Doing this, inner representing, interacting, rehearsing mentally, and integrating become external scene construction, role play, role reversal, and scene change. This knowledge helps to treat the patient's disturbed metacognitive processes directly in a disorder-specific manner with a lot of time in the right place.

2. The psychodramatic external action in the as-if mode completes the associated neuronal resonance circuits between the various memory centers with new elements. According to Moreno (1970, p. 77), this gives rise to the “true second time, which liberates from the first”. The concept of mentalizing explains why psychodrama therapy is not only used in groups, but also in individual settings. Behavioral therapy, systemic therapy, and depth psychological therapy are increasingly integrating the disorder-specific psychodramatic action methods into their own therapeutic work.

2.1 The Creative Process as the Basis of Life

All living beings have to be creative and keep making little inventions. Otherwise, they cannot survive in their constantly changing environment. The idea is to find creative solutions that preserve one’s own complex structure in the process of adaptation. For example, sexuality, reproduction, culture, and the development of social and political systems are creative solutions for maintaining one’s own complex structure, adapting to new environments, and ultimately even overcoming death.

A creative process always includes four consecutive phases (see Fig. 2.1): (1) First, there is a particular order with dynamic equilibrium. (2) An internal or external compulsion to adapt causes a conflict in the balance. In the conflict phase, the person or the institution concerned attempts to overcome the conflict by applying old familiar solutions. When the old solutions prove inadequate for the present conflict, it leads to inner conflicts, resulting in symptoms. Inappropriate old solutions in a new situation are called defenses in psychotherapy. (3) When the inner conflict increases progressively, at some point, it leads to a collapse of the old equilibrium. As a result, the individual or the institution enters a phase of crisis and chaos in his conflict processing. He regulates himself temporarily as per the principle of trial and error. In psychodrama, this phase of conflict processing is termed ‘status nascendi’ or the ‘state of spontaneity’ (Moreno, 1946/1985, p. 104, Schacht, 2009, p. 72). (4) Time and again, new solutions emerge spontaneously in this phase. If one of these new solutions is positively confirmed, externally and internally, it stabilizes. (5) The individual integrates this new solution as a new pattern in his repertoire of conflict management strategies. He develops a new dynamic equilibrium and new order in his mental self-organization. His inner structures thus grow in complexity (see Fig. 2.1) (Schacht, 1992, p. 100, 2003, p. 21).

Fig. 2.1

The four phases of a creative development process

Central idea

The sequence of the four phases of a creative process is present in all development processes, in the process of evolution, and also in natural human conflict resolution. For example, a new finch species emerged on the Galapagos Islands within 30 years. In contrast to the other finches, this one had long beaks. Apparently, the increasing number of birds with short beaks were experiencing food scarcity (conflict phase). As a result, fewer young birds per pair survived (crisis). However, there were some with longer beaks among the bird parents. They could dig deeper into the trees and soil for insects and find more food for their young ones. As a result, they had more offspring. External confirmation of the new solution (long beaks) led to the development of the new long-beaked finch species within 30 years. The long-beaked finches extended the dynamic balance of nature in the Galapagos Islands.

A fundamental principle of evolution is to save energy. “In evolution, what consumes less energy in reaching the same goal, survives in the long run.” (Ciompi 2021, p. 182). Whoever has an advantage prevails over the others. The evolution of the nervous system was a new solution used by animals and humans to conserve energy. The ability to internally model, process and resolve conflicts in the working memory in the as-if mode replaced the high-energy-consuming method of trial and error. Successful solutions are stored in the brain’s memory centers through neuronal interconnections. They are actualized and recalled in a new, similar situation with minimal energy consumption and reapplied to the current situation. We don’t need to reinvent the wheel in every new situation. Inner thinking and solving conflicts in the as-if mode is now called mentalizing (see Sect. 2.2). Humans are currently dominating the development of animal and plant life because they have perfected this new solution. Saving energy in resolving conflicts has given humans an evolutionary advantage over other living beings. Humans have multiplied from 1 million to 8 billion in the last 4000 years.

However, the multiplication of humans in a relatively short time and their demand for a good life for themselves and their offspring has turned energy saving upside down compared to earlier times. For fifty years, we have been at a turning point that has never existed on Earth before. Humans are the first beings to consume excessive amounts of energy resulting in the destruction of the basis of life for humans and animals on Earth. The climate is changing rapidly because of us. Many species of living beings are already facing extinction. In the context of climate change, we are currently transitioning from the conflict phase to the chaos phase. We have the choice of deciding whether to continue using only old solutions at the beginning of the chaos phase of the current climate crisis and inevitably act more and more destructively. We continue to have more and more wants. Our demands keep getting bigger and bigger, whereas our planet’s natural resources are increasingly becoming scarce. We, humans, are waging wars over increasingly scarce resources.

Central idea

Mere knowledge about the impending climate catastrophe is not enough. The pure knowledge content is not neuronally interconnected with action sequences, physical sensations, and affect (see Sect. 2.7) in human memory. The impending suffering of people must occur so that we also experience it psychosomatically. It is our psychosomatic experiences that make experiences real for us. People who swap roles with their conflict partner in psychodramatic self-supervision (see Sect. 2.9) often say afterward: “I only thought my colleague was afraid of me. But now I felt that too!” The colleague’s fear becomes a reality for them only when they have felt their conflict partner’s physical sensation and affect in the role reversal in their own body.

The increasing suffering is now gradually leading to a change of perspective and a more comprehensive view of one’s life as part of humanity. In the context of the climate crisis, we are looking for new solutions at all levels of society that consider our planet’s limited resources. It’s no longer about winning or losing. The new solutions require cooperation instead of war. The new solutions must serve not only the interests of individuals but also the interests of the community, one’s own country, and other countries on Earth. Moreover, they must be systemically equitable (see Sect. 8.4.2).

Psychodrama therapy cannot solve the climate crisis. However, it can help to link the individual symptom formation of patients with the climate crisis (see Fig. 2.1 above) as well as with current social concerns and not just with everyday conflicts and childhood deficits. This is because psychodrama can promote cooperation in relationships in a unique way through the instrument of role reversal (see Sects. 2.2, 2.9, and 8.4.2).

The conflict processing of human beings is a complex creative process. Therefore it is helpful to distinguish between the four different aspects of conflict processing: (1) the perspective of structural development, (2) the perspective of the processes of energy exchange, (3) the perspective of interaction in the inner structures, and (4) the perspective of the functional organization (Krüger, 1997, p. 24 ff.) (Fig. 2.2).

Fig. 2.2

The four different aspects of creative conflict processing (Krüger, 1997, p. 25)

2.1.1 The Structural Aspect of the Process of Self-organization

Central idea

The natural creative process of working through conflict differentiates and expands the internal images involved in the conflict and integrates them to form a comprehensive, meaningful structure. “All therapeutic methods introduce complexity” (Kriz, 2014, p.133).

In disorder-specific psychodrama therapy, patients with psychotic disorders, for example, ‘think’ through their delusional scene in the as-if mode of play (see Sect. 2.6) to form meaningful stories (see Sects. 9.8.4 and 9.8.8) with the help of dialogues with their doppelganger and the auxiliary world method. In doing so, they develop more complex structures in their conflict processing. The more complex one’s inner relationship images or process structures are, the more capable they are of dealing with conflicts. This is because the scope and the differentiation of the spontaneous-creative processes in the inner structures grow with an increase in the complexity of the internal systems (Sabelli, 1989, p. 166 f.; Schacht, 1992, p. 127). On the other hand, a person is less capable of co** with conflicts and more likely to decompensate in times of crisis if his internal mental structures are less complex.

2.1.2 The Process of Energetic Exchange

When a person is in a conflict, it causes psychophysical and emotional tensions in his internal representation of the conflict system. His mental energies center themselves on this internal representation. For example, in the event of an impending job loss, his associated thoughts, images, and feelings are energetically so charged that he may have difficulty concentrating on playing with his children at home. High energy potentials in a conflict system activate a person’s holistic process of intuition and cause him to seek new solutions through mentalizing (Ciompi, 2019, S. 125). The lower the energy potential, the lower his psychological stress, and therefore the smaller the chances of him overcoming the conflict. Conversely, the ‘louder’ his symptoms are, the better chances he has of finding a new, more complex solution for his conflict.

In psychodrama, the theory of energy potential in conflicts is referred to as ‘warming up’ (Leutz, 1974, p. 95 ff) and ‘catharsis’. The therapist can help the group members activate the energy potential of their mentalizing by engaging in warming-up activities at the beginning of a therapy session. This increases the energy potential in their inner conflict systems. The energy potential in a person’s conflict system is therapeutically amplified further through the therapist and the group members: (1) They see him, understand him, and accompany him in the context of his conflict processing in a supportive manner. (2) They double him if needed. (3) As auxiliary egos, they stimulate the creative process of his inner conflict processing in their respective complementary roles. The protagonist uses his therapeutically amplified conflict energies to activate, complete, and connect the contents of his different memory centers of acting, feeling, thinking, and perceiving (see Sect. 2.7). This increases the number of neurophysiological process structures involved in his mentalizing. High energy tension in the neuronal circuit of the memory centers can discharge through an integrative catharsis in the form of crying or laughter. Already Moreno (1959, p. 251) established: “Every pathogenic warming up process that affects a small area of the personality can be absorbed and nullified by a warming up process that has a broader scope but includes this smaller part.” Moreno defined this principle as the ‘warming up rule’.

2.1.3 The Aspect of Action in Creative Processes

The lesser a person acts in reality and fantasy, the less capable he is of co** with conflicts. Acting and interacting help to create connections in internal images, to understand reality in a conflict system, and differentiate this reality from fantasies and inaccurate interpretations. Schulte-Markwort once reported a longitudinal study (Schulte-Markwort, 2002, a oral communication of the Kauai longitudinal study by Werner & Smith, 2001) in which they had tried to identify criteria, as early as infanthood, that would enable therapists to predict how the person’s mental health would be in adulthood. According to their findings, the activity level of the children was the most significant criterion: The higher the activity level of an infant was, the lesser the likelihood of them experiencing psychological difficulties later in life. This correlation can be explained by the simple fact that one must act internally and externally to process and overcome conflicts. People with a low activity level are at a greater risk of being traumatized by overwhelmingly stressful situations. A traumatizing situation is defined by the fact that the person concerned is not capable of fighting or fleeing in this situation and, therefore, cannot act (see Sect. 5.2).

2.1.4 The Functional Aspect

A fourth aspect of the creative process is the point of functional process organization. The functional process organization in human conflict processing is fulfilled by the tools of mentalization (see Sect. 2.2).

2.2 The Creative Process of Mentalizing and Its Management via Intuition

Living beings need to develop a creative inner process of self-development so that they can adapt to the constant changes in their environment and their own body without their highly complex structure disintegrating.

Central idea

The inner process of self-development in the external situation is mediated through the process of inner mentalizing. As a metacognitive process, it produces the thought content in our awareness.

It was a creative leap for me to move from the cognitively oriented approach to psychodrama techniques to the metacognitive approach (Krüger, 1978, 1997, 2015). I relearned the way conflict resolutions materialize in psychodrama.

Central idea

Psychodrama is mentalizing through external play in the as-if mode. It is derived from nature and, in this sense, a biological method of psychotherapy. Psychodrama works on a person’s internal images and processes them in the as-if mode. The events on stage are not to be equated with external reality (see Sect. 2.14). Psychodrama has its roots in children’s play and the theater (Leutz, 1974, p. 28 ff.). In 1795, Friedrich Schiller (2009, p. 64) said: “Man... is only fully human where he plays.” From this, I derive the insight: “Man is only fully human where he mentalizes.”

Important definition

I define mentalizing as a partly conscious and partly unconscious creative process of constructing internal reality images which helps people (1) internally follow the external interactions in the current situation and, thus, control their own actions, (2) understand themselves and others in a given situation, (3) process conflicts, (4) search for adequate or new solutions to conflicts, as well as (5) plan their actions.

Mentalization is the result of mentalizing; mentalizing is a process leading to this result. “Mentalizing is intrinsically linked with the development of the self, with its increasingly differentiated internal organization and its participation in human society” (Fonagy et al., 2004, p. 10 f.). Therefore, psychodramatists have their patients externalize the creative process of their mentalizing on stage (Buer, 1980, p. 99; Holmes, 1992; Kellermann, 1996, p. 98; Moreno, 1965, p. 212 and 1959, p. 111; Seidel, 1989, p. 197; von Ameln, 2013, p. 9) to “think” through their conflict with the help of psychodrama techniques in the as-if mode of play (see Sect. 2.4). It is for this reason that psychodrama belongs to the group of mentalization-based treatment methods (MBT).

Its creators consider mentalizing a crucial point of reference and a concept for improving and refining therapeutic work in all psychotherapy methods (Allen et al., 2008, p. 7 f.). “We mentalize when we become aware of our own or others’ mental states—for example when we think about feelings. […] More specifically, we define mentalizing as an imaginative mental activity that lets us perceive or interpret human behavior in terms of intentional mental states” (Allen et al., 2008, p. xi). “Very often, we mentalize quickly without being aware of it. […] Mentalizing makes it possible to understand and predict social situations as well as to modulate our own emotions” (Brockmann & Kirsch, 2010, p. 279). “Skillful mentalizing does not alone solve problems or free one from disorders; rather, it increases the concerned person’s capacity to do that” (Williams et al., 2006, quoted in Allen et al., 2008, p. 7).

Central idea

Mentalizing is a holistic creative process involving representing, interacting, rehearsing, and integrating (see Fig. 2.3). I understand these four steps as metacognitive tools of mentalizing. Human intuition guides the work of their four tools of mentalizing. Therefore, the image of the man is the image of a creative human for psychodramatists.

Fig. 2.3

The four metacognitive tools of mentalizing

Earlier, I used to refer to the tools of mentalizing as “organizational functions” of the self (Krüger, 1997, pp. 84ff). However, I now integrate my theory of organizational functions with the theory of mentalizing by Fonagy et al. (2004). This facilitates the scientific discussion and helps to further develop the mentalizing theory of Fonagy et al.

Exercise 1

I invite you to familiarize yourself with the metacognitive tools of your mentalizing:

• 1. Think of a conflictual relationship in your private or work life.

• 2. Spend two minutes thinking about this conflict.

• 3. What conflict did you think of?

• 4. Now reflect on how you thought about this conflict in these two minutes.

The seminar participant, Ms. A., answered these questions: “I was thinking about the conflict with my boss in my counseling center.” In doing so, she shares the content of her conflict. However, the fourth question captures the metacognitive tools the individual uses in mentalizing their conflict:

• 1. At the beginning of conflict processing, the person represents himself and his conflict partner as an inner image and looks at his conflict partner from his own perspective. His thoughts about the conflict thus contribute to his inner perception. He takes note of who and what belongs to the conflict picture. In the case of patients with severe structural disturbances or patients suffering from psychosis, the inner representation of the conflict is often already distorted. For example, people with psychosis sometimes experience their own affect as a voice from outside. The mere use of disorder-specific techniques of scene construction and doubling can therefore have a huge therapeutic effect on these patients (see Sects. 9.2 and 10.5). For example, Ms. A. internally saw her boss in front of her: “She is pregnant and acts as if nothing has changed. But we should plan how things should continue when she goes on maternity leave.”

• 2. The person interacts in his inner conflict image, recreating the interactional events from memory, like in a film. In this way, he visualizes the reality of the relationship (Plassmann, 1999). Through inner interaction, the energy in the conflict can be felt as an affect. For example, Ms. A. reported: “In my mind, my boss just sat there. That’s the problem.”

• 3. One often mentally rehearses his inner image. In doing so, he tries to explore the conflict beyond reality in his imagination and find a new solution. The individual self-actualization in the conflict thus becomes dialogic-systemic self-actualization in conflict. He reflects in the as-if mode: “If I do this, the other will do the following. If the other says so, I will do the following.” In his imagination, he makes his wish or will clear to his conflict partner and acts alternately in his and the conflict partner’s roles. He differentiates and expands his self-image and the image of the conflict partner in relation to each other and frees them from their fixations. Through this, he recognizes the conflict partner’s motivation behind why he behaves the way he does. He takes stock of his contribution to the conflict. He gains a systemic understanding of the cause and effect of the conflict. Ms. A. replied: “I’ve already thought about speaking to my boss. I could ask her how the counseling center should continue during her maternity leave. But I’m afraid that she will dismiss me.”

• 4. The person also spontaneously looks for personal experiences from the past and higher-level connections that causally determine the current relationship conflict. In doing this, he links and integrates experiences from other times and places with current experiences. By integrating a current conflict with an experience from another time, the person concerned creates the process quality of meaning (Plassmann, 1999). For example, Ms. A said: “I’m afraid to ask my boss because my relationship with her is not that good. She’s quite authoritarian. Everything has to be according to her rules. But I can’t stand the uncertainty. It’s always been like that for me. I need to know where I am. My boss is similar to my mother in that regard. She doesn’t care about my feelings.”

Conflicts are accompanied by emotions. The emotions disrupt concentration in accomplishing current everyday tasks. The tension of the conflict and the emotions trigger a process of mentalizing. This process aims to liberate the emotions from the inner conflict and enables the person to act appropriately in the external conflict. Those who can mentalize well live “more economically and are therefore more capable of surviving” (Ciompi, 2021, p. 153). Humans control their inner mentalizing with intuition. Through the holistic process of intuition, one tries to achieve a coherent gestalt closure in his mentalizing process: “Until one’s perception merges to form a closed gestalt, the ego continues to be compelled to execute its synthesizing function, requiring a certain quantum of neutralized energy. This quantum is set free once the gestalt has been closed and the expenditure of neutralized energy can be reduced” (Lorenzer, 1970, p. 86). Those who learn to mentalize more complexly also develop their intuition on and on. Intuition-led mentalizing often requires only a few seconds to reach gestalt closure. But it can also take minutes, hours, or even days to finally get to the end of the process and for the feeling to arise: “That’s it!” The intuitive insight, the “aha!” moment, results from successful mentalizing.

Question

What is this intuition?

Important definition

Humans use their intuition to steer the process of their mentalization toward a subjectively consistent solution (see Fig. 2.1 in Sect. 2.1). According to the emergence principle, the process of intuition is more than the sum of its parts. The holistic process of intuition (see Fig. 2.4) is more than the sum of the work of the individual tools of mentalizing (see Chap. 1). It is precisely this “more” that is the secret of intuition.

With this understanding of the term “intuition”, I agree with Allen et al. (2008, p. 27), when they say: “We construe implicit mentalizing as intuition.” “Intuition […] forms the basis of our ability to react appropriately to non-verbal communication; many of these reactions occur outside our explicit perception. […] When we mentalize, we constantly move back and forth between the implicit and explicit processes” (Allen et al., 2008, p. 27 f.).

Fig. 2.4

The holistic process of intuition

2.3 The Interrelationship Circuit Between the Tools of Mentalizing and the Eight Core Psychodrama Techniques

“What psychodramatists do when they do what they do?” (Marineau, 2011, p. 43). A therapy method must be able to explain its specific therapeutic interventions against the backdrop of a self-contained, systematic theory. All psychodramatists have one thing in common—they all employ psychodrama techniques in their work. For many years, it was common in psychodrama literature to describe the different psychodrama techniques one after the other, each with its particular application and effect, without relating them to one another. Moreno and Moreno (1975b, p. 239 ff.) described thirteen or rather seventeen techniques (Moreno, 1959, p. 99 ff.). One of his employees, T. Renouvier, described 351 techniques (Moreno, 1959, p. 99), and Schützenberger-Ancelin (1979, p. 79 f.) described 76 techniques. For a long time, doubling, mirroring, and role reversal were the only techniques defined as ‘central techniques’ (Leutz, 1974, p. 43 ff.) because Moreno had associated these three techniques with the ‘most important phases’ in child development (Moreno and Moreno, 1975a, p. 135 ff.; Moreno, 1959, p. 85 f.). As a matter of fact, doubling, mirroring, and role reversal do distinguish psychodrama from role play.

In order to develop a systematic theory of psychodrama techniques, it is helpful to look at the function of each psychodrama technique in the overall creative process of a psychodramatic enactment. Which psychodrama techniques are necessary to create and holistically conclude the creative process of a psychodramatic enactment? The answer is: There are eight central psychodrama techniques (Krüger, 1997, p. 11 f.): scene construction, doubling, role play, role change, role reversal, mirroring, change of scene, and sharing (see Fig. 2.5). All other psychodrama techniques are merely specific application forms or combinations of these eight central techniques.

Central idea

The eight central psychodrama techniques build on each other in their therapeutic effect (see Sect. 2.6). As a whole, they mediate the creative process of conflict processing in a psychodramatic play (Krüger, 2002a). Limiting to the eight central psychodrama techniques makes it possible to develop a psychodramatic play theory and describe the therapeutic effects of psychodramatic plays differently.

Fig. 2.5

Functions of the metacognitive process work and its relation to psychodrama techniques (Layout by Sturm, 2009, p. 123, revised)

Figure 2.5 gives an overview of the different theoretical concepts of metacognitive process work. You will notice a relationship between a person’s holistic process of intuition, the eight central psychodrama techniques, the eight defense mechanisms of psychoanalysis, the four functions of mentalizing, the four mechanisms of dream work, and the four functional process qualities (Plassmann, 1999).

Central idea

The four tools of mentalizing implement the four process qualities of space, time, logic, and sense in the process of inner mentalizing. The function of the four tools of mentalizing is guided by intuition (see Fig. 2.5). They turn into defense mechanisms if their work is blocked (see Sect. 2.4). They turn into mechanisms of dream work if they are drawn into the whirlpool of self-disintegration in patients with psychosis (see Sect. 9.3) and then produce delusional content.

In Fig. 2.5, you will find for each tool of mentalizing, in the same quadrant of the circle, there is a psychodrama technique, defense mechanism, or mechanism of dream work completing or blocking the same step of mentalizing. Thus, for example, the disorder-specific application of the psychodrama technique of scene construction is indicated when the defense of splitting blocks the appropriate inner representing of the conflict. Therefore, you’ll find the setting of the scene, representing, and splitting in the same lower left quadrant. The different structural levels according to the OPD (working group OPD, 2006) are not included in the circle model. This is because the structure levels describe deficits, not the metacognitive tools or functions of conflict processing and mentalizing.

Central idea

The central psychodrama techniques are metacognitive tools of inner mentalizing (see Fig. 2.5 in Sect. 2.3) implemented in the as-if mode of the external play (Krüger, 1997, p. 84 ff.). The central psychodrama techniques do not change the content of thinking right away. Instead, they implement the metacognitive processes we humans constantly use to produce our content of thinking (see Chap. 1). This knowledge is key to understanding the therapeutic effects of psychodrama. The direct metacognitive work of psychodrama techniques is a unique selling point of psychodrama. In other psychotherapy methods, the therapist cannot directly change the work of the metacognitive tools of conflict processing (see Sect. 2.6), until they use psychodrama techniques.

During psychodramatic play, an interrelationship circuit exists between the inner mentalizing of the protagonist and his drama process on the outer stage (see Fig. 2.7 in Sect. 2.5). The patient controls his outer psychodramatic play with his inner mentalizing. But he differentiates and also expands his inner mentalization with the help of the external drama process. The psychodrama techniques use this interrelationship circuit to free the patient’s metacognitive tools of inner mentalization from his fixations (see Sect. 2.4). As a result, the protagonist experiences himself as self-effective in his internal images in the psychodramatic play.

Psychodrama is a natural healing method. In psychodrama, the therapist connects her own natural psychological processes with the patient’s natural psychological processes. In psychodrama, the therapist, as an implicit doppelganger, lends her soul to the patient (see Sect. 2.5). She mentalizes on behalf of the patient when the patient’s tools of mentalizing are blocked by defenses and freely employs the tools of mentalizing as psychodrama techniques in his psychodramatic play.

Central idea

Psychodramatists should not do psychodrama; they should allow psychodrama within themselves.

2.4 Defenses, Spontaneity, and the Resolution of Different Types of Defenses Using Psychodrama Techniques

Question

Why should psychodramatists consider the depth psychology concept of ‘defense’?

In the course of evolution, more than any other living being, humans have developed the ability to resolve conflicts internally simply by thinking in the as-if mode (see Sect. 2.6). They no longer have to search for solutions to internal conflict only through external trial and error. That’s why humans have large forebrains. In a new conflict situation, people automatically use the old solutions stored in their memory first. This saves mental and physical energy. However, the problem arises when people are fixated on their old solutions and do not notice that they do not fit the new situation. They then project the inner image of the old conflict situation onto the new situation and do not perceive the difference between the old and the new situation. They, therefore, also act according to the old situation. Thus, they act neurotic. The ability to imagine the current situation appropriately in the as-if mode is blocked. Their tools of mentalizing no longer work freely. This block in internal conflict processing is called a defense. In role theory, defense is described with the linguistic concepts of ‘role fixation’ and ‘insufficient’ role distance (Leutz, 1974, p. 177). The theory of defense deals with the same question that Moreno answered with the theory of spontaneity more than 60 years ago: According to Moreno (1974, p. 13), they are spontaneous who behave in a new way in an old situation or behave appropriately in a new situation. In this sense, only those whose tools of mentalization work freely in the current situation and are not fixed in an old solution are spontaneous. Moreno (1970, p. 77) described the benefit of spontaneity in conflict through psychodrama with the phrase: “Every true second time is a liberation from the first.”

Central idea

When the tools of mentalizing are blocked in a current situation, they become defense mechanisms. However, psychodramatists freely use the tools of mentalization in the as-if mode of play as psychodrama techniques (see Sect. 2.3). They thereby dissolve the blocks in the tools of mentalization. The resolution of a specific defense through the appropriate psychodrama technique (see below) follows the principle of similarity in medicine (Moreno, 1939, p. 5). As early as 1796, Samuel Hahnemann (1796) said: “Similia Similibus Curentur,” which means “Similar subjects have to be treated with a similar approach.”

Exercise 2

As a training leader, you can let your group members experience spontaneity directly through a spontaneity exercise. In groups of two, the participants tell each other a short episode from their life for 10 min each. But this story should be a lie from beginning to end. You will notice: The group members come back to the whole group laughing. They became spontaneous as they imagined a new solution to an old life experience with the help of a fictional story. “Lies reveal a man’s deepest truth. For lies are like the dreams that lend words to the voices of the unseen” (Kamphovener 1975, p. 27).

Important definition

Defense mechanisms are blocked tools of mentalization that repeatedly produce the same old solution in processing conflicts. The different defense mechanisms describe different types of blocked spontaneity. The central defense mechanisms each block a specific mentalizing tool in conflict processing.

Understanding defense mechanisms as blocked tools of mentalization prevents a narrow deficit-oriented view of the human being and promotes spontaneity in the therapeutic relationship. In therapy, patients usually resolve the superficial blocks in their mentalization first and only later their core defense. The theory of defense mechanisms helps the therapist promote change for the patient in the right direction with a lot of time and patience.

Psychoanalysts are aware of more defense mechanisms than those depicted in Fig. 2.5 (see Sect. 2.3) and described below in Sects. 2.4.1–2.4.4. I have only mentioned those defense mechanisms that block a specific metacognitive tool of mentalizing (see Sect. 2.2). Some well-known defense mechanisms are a special combination of several central defense mechanisms. Somatization, for example, is a combination of defense through introjection, repression, and denial (see Sects. 2.4.1–2.4.4). Regression is a combination of projection and repression. Idealization is a combination of projection and denial.

Central idea

The analogy between the tools of mentalizing, psychodrama techniques, and defense mechanisms makes it easier to understand how each defense mechanism changes the way conflict is processed.

2.4.1 Disturbances in Internally Representing the Conflict System

The process of representing answers the question “Who with whom?”, interacting sheds light on the question “How?”, the mental rehearsal answers the question “Why?” and integrating answers the question “What for?” In case of disturbances in internal representing, the affected person cannot, at least not holistically, internally represent his inner self-image and object image in their external situation. This leads to a disruption of inner self-development (see Sect. 2.1) in the external situation. The human self is a constant creative process of development including the development of inner self-image and object image in the external situation.

In psychodrama, the internal representation is realized by naming the conflict and external scene construction. The external representation of the conflict system helps him also represent the conflict internally (see Sect. 2.2). The first step of psychodramatic play is the external representation of the people or parts of the self interacting in the conflict system. They are represented with auxiliary egos or objects. In the case of an interpersonal conflict, the conflict system consists of the people involved in the conflict, and in the case of an intrapsychic conflict, it consists of the parts of the self or ego states involved. The natural ability to internally name and represent the conflict system can be blocked and thus lead to incorrect results: (1) In psychosis, the patient’s process of self-development has disintegrated (see Chap. 9). For example, the patient experiences his own emotion related to his self-image or his self-reproaches as a voice from outside. In mentalization-oriented therapy, the therapist and the patient use the doppelganger dialogue and the auxiliary world method (see Sect. 9.6.5) to construct the patient’s delusional scene and interact in the as-if mode of play. In this way, the patient can stop the disintegration of self and his delusional production. (2) Defense by splitting manifests as splitting of the inner self-image into two contrary ego states that alternately and seemingly arbitrarily determine the external interaction. (3) Defense by introjection blocks the development of self-image in interpersonal relationship conflicts.

Setting the Scene and Splitting

Definition of defense by splitting

(Krüger 2020, p. 137): There are two types of defense through splitting: (1) The inner process of development of self-image in the external situation is divided into two contrary inner self-images: “During the course of an interaction, two opposite sides of a conflict dominate the scene alternately... with the patient being in blatant denial of the other side” (Kernberg, 1991, p. 49). In his inner reality construction in the current conflict, the patient represents only one of the two opposing sides of his self-image without realizing it. His two internal reality constructions are organized around two opposite emotions: sad and angry or needy and pseudo-autonomous. (2) Dissociation in patients with trauma-related disorder separates the observing ego with its thoughts and linguistic concepts from the acting ego with its sensorimotor interaction patterns, physical sensations, and affect. In a traumatizing situation, dissociating is a form of self-protection. However, later, it converts into a clinical symptom known as a flashback.

Where does defense by splitting occur?

For example, patients with borderline personality disorder unconsciously switch back and forth between a needy, clingy ego state and a pseudo-autonomous, arbitrary ego state (see Sect. 4.3). Patients with trauma disorders alternate between their healthy adult thinking and their trauma film (see Sect. 5.4); those suffering from addiction alternate between the ego state of everyday thinking and their addictive thinking (see Sect. 10.5); patients with psychosis alternate between their healthy adult thinking and their dream ego (see Sect. 9.6.4). Dissociating is an indication of trauma-related disorder (see Sect. 2.5).

How is splitting resolved?

Splitting is resolved therapeutically by naming and externally representing the opposing ego states using the two-chair technique. “The psychodramatic splitting of self-representation helps the patient to overcome his defensive splitting” (Powell, 1986). The therapist sets up, next to the chair of the patient’s self-representation in the external situation, a second empty chair for the patient’s currently inactive contrary self-representation. The temporal succession of the two contrary inner self-images thus becomes a spatial juxtaposition. The two contrary self-images are concretely visible next to each other on the outside. This undoes the denial of splitting. The two-chair technique is also the basis for the psychodramatic resolution of dissociation (see Sect. 5.10). In psychodramatic trauma processing, the patient switches back and forth between the chairs in the trauma scene, the narration room, and the safe place.

Important definition

Self-representation is the process of internally representing the self-image in the current situation. Object representation is the process of internally representing the object image in the current situation.

Central idea

The external psychodramatic role change between the contrary ego states in the as-if mode of play resolves the internal unconscious switching between the two contrary ego states. The patient switches from the chair of one ego state to the chair of the other and back again, all the while looking at his conflict partner. Thus, the patient gradually frees his internal process of self-development (see Sect. 2.1) in the external situation from fixation in the defense through splitting.

Doubling, Role Feedback, and Introjection

In defense through introjection, there is a partial or complete blockage of the development of self-image in the external situation. The affected person automatically accepts his conflict partner’s one-sided misperception of him and thinks just like this one, for example, that “he is stupid and always wants to fight”. He experiences the suffering of another as if it were his own (Ferenczi, 1970, p. 126), or he blindly assumes his conflict partner’s expectation.

Where does defense through introjection occur?

In people who defend by introjection, the creative inner development of self-image in the external situation is blocked, and so is the appropriate self-actualization during the conflict. It often makes them depressed. Mrs. B.’s husband devalued and accused her in disputes: “You’re crazy! I can’t stand your emotional talk!” Mrs. B. made his perception her own. Like him, she believed that she was abnormal and conformed to her husband’s wishes. Her defenses through introjection blocked her perception of her own emotions of hurt, disappointment, and loneliness.

Through their natural empathy, children who have incurred secondary trauma from their traumatized parents often have introjected their parents’ traumatic, pathological self-organization as if the trauma were their own. Some others think, feel, and act in self-injurious and masochistic ways because they appropriated the inappropriately destructive attributions of their caregivers during childhood. For example, as a little girl, a patient with obsessive-compulsive disorder had heard from her mother, “You were aggressive when you were a child. You always wanted to hurt your little brother. That’s why I could never leave you alone with your brother.” She blindly introjected her mother’s inappropriate attribution into her self-image, remained fixed in the biased self-image, and developed a destructive superego. When she wanted to follow her inner impulses, thoughts of death and doom would come to her mind. The patient then had to calm her “sadistic inner tormentor” (see Sect. 7.2) by accepting his incorrect interpretations of the current situation and attempting to override the supposed “danger” through compulsive actions.

How is defense through introjection resolved?

The therapist asks the patient about his affect in the conflict situation or helps him to consciously perceive the interactional events in the situation and to feel and name his own feelings through doubling, interview, and role feedback. When doubling, the therapist mentalizes the patient’s experience on his behalf and verbalizes it. The patient tentatively absorbs the sensations, feelings, and thoughts verbalized by the therapist and “introjects” them into his self. Affective resonance is the basis for appropriate doubling (Plassmann 2019, p. 47) between patient and therapist. The therapist activates the current resonance pattern (see Sect. 2.7) in the patient’s inner self-image by doubling, and completes it with missing elements such as the impulse to act, the sensorimotor interaction patterns, physical sensations, affect, appropriate linguistic concept, or associated thought (see Sect. 2.7). There are two types of doubling—verbal doubling and the doppelganger technique.

• A. Verbal doubling (Krüger, 1997, p. 116 ff.): The therapist lets the protagonist engage in a soliloquy (Moreno, 1945b, p. 15). She enters his soliloquy internally with her own thinking and feeling and verbalizes, on behalf of the protagonist, what she perceives, thinks, and feels toward the “conflict partner”: “He just doesn’t respond. That makes me angry. I hate him!” In verbal doubling, the therapist fills gaps in the patient’s psychosomatic resonance circle between the memory centers of sensorimotor interaction patterns, physical sensations, affect, linguistic concepts, and thoughts (see Sect. 2.7).

• B. The doppelganger technique (Krüger, 1997, p. 120 ff.): The therapist interacts shoulder to shoulder with the protagonist in psychodramatic play and speaks directly with his ‘adversary in the conflict’: “I am so angry with you! Stop it! This is violence!” The doppelganger technique is indicated when the patient has lost ego control over the workings of his mentalizing tools, for example, in the event of loss, rigid fixation in an old adaptive attitude, self-disintegration, or frozen affect. Then, as a doppelganger, the therapist directly represents the patient’s right to life and dignity to his interaction partner if necessary (see Sects. 4.8 and 9.8.8). Thus, she brings the patient’s self to birth in his conflict scene and activates his self-actualization and conflict processing.

Central idea

In my understanding, the interview and role feedback can be assigned to the psychodrama technique of doubling. In role feedback, the protagonist doubles themselves. During the interview, the protagonist gives role feedback for his immediate thoughts and feelings.

The therapist uses role feedback during the debriefing of the psychodramatic enactment. She asks the patient: “What did you experience in the play?” The patient then subsequently verbalizes his feelings and perceptions during the play. The therapist doubles him verbally if necessary. In doing so, she helps him to differentiate his emotions and explicitly marks the patient’s sensations, feelings, behavioral impulses, and thoughts that fill in gaps in the mentalization of his conflict. The technique of role feedback is not tied to a psychodramatic play. For example, in the psychodramatic conversation (see Sect. 2.8), the therapist asks the patient what he experienced during the argument with his wife the day before. In response, the patient gives role feedback for the fight with his wife the day before without re-enacting the fight psychodramatically. The therapist can also ask the patient directly in the play situation or the current encounter: “What do you feel in your body when you say that and do that?” This technique is called an interview in psychodrama.

Healthy people can resolve their defense through introjection when they feel unwell or are in a lousy mood by internally naming their affect.

Exercise 3

Look inwards when you are feeling bad and name your current affect: “I am afraid”, “I am sad”, “I am helpless”, “I am exhausted”, “I am angry”. Authorize your current feeling without prejudice. You will notice: Naming the affect will resolve your discomfort or resentment within 1 to 3 days (Shödrön, 2008, p. 174 f.) because, over the three days, your feeling intuitively searches for the associated conflict situation that triggers you. The internal representation of the conflict then promotes your inner conflict processing. Your inner conflict processing dissipates your general discomfort.

Central idea

The psychodramatic introjection of elements of the psychosomatic resonance pattern (see Sect. 2.7) during doubling helps the patient resolve his defense through introjection. The disorder-specific doubling frees the internal development of self-image from fixation in the external situation. Thus, a patient once again becomes spontaneous in the external situation when defending through introjection.

2.4.2 Disturbances in Inner Interacting

Inner interacting with the conflict partner builds on the internal representation of the conflict system. In inner interacting, the person imagines the chronological sequences of interaction in his internal conflict image like in a film from his memory and develops his subjective reality in his conflict. The process of inner interaction in the conflict can be blocked in two ways: (1) defense through denial and (2) defense through projection. When defending through denial, the affected person filters out unpleasant or guilt-ridden interaction sequences from his perception. When defending through projection, he is fixated on a particular image of his conflict partner.

Role Play and Denial

Definition of denial: A healthy person can adequately retrace the chronological sequence of interactions in a recalled event or a plan. However, when defending through denial, the affected person filters out important interaction sequences from his memory or planning (Mitscherlich, 1967, S. 39). According to Freud, it’s like “a visual impression falling on the blind spot of the retina” (Freud, 1975, p. 348). The wish is then the father of the thought. Or the fear or a feeling of guilt determines how reality should be perceived in the inner conflict image (Mitscherlich, 1967, p. 39). The affected person acts according to the motto: “… and so he came to the harsh conclusion that what must not be cannot be” (Christian Morgenstern). I once presented my patient’s protagonist-centered psychodramatic play in supervision. He was a physically fit man but drowned while diving in a swimming pool a few days after the group session. I re-enacted the interaction sequences of the treatment. This resulted in a clear causal connection between the psychodramatic play and the patient’s ‘suicide’. Fortunately, my co-director was also present and said: “But Reinhard, the play was completely different!” She then psychodramatically demonstrated the entire protagonist-centered play with all interaction sequences. I had hidden important details from the play due to my defense through the introjection of guilt. It became clear that there was no causal relationship.

Where does denial occur?

Defense through denial is common. For example, it ensures the defense through introjection. Patients with borderline organization deny the contradiction between their two alternating, contrary ego states and demand that their conflict partner also ignore this contradiction. People who suffered relationship trauma in their childhood often assume the role assigned to them in the current interaction system and deny the inappropriate behavior of their current interaction partners. Or they develop a compensatory role, such as helper syndrome. As a superb helper, the girl, who was lonely in childhood, sees all those she cares about as needing help and blocks the exploitative or abusive behavior of her attachment figures from her perception. The outsider humiliated in childhood behaves arrogantly and cool in adulthood.

How is denial resolved psychodramatically?

When defending through denial, one unconsciously filters out certain interaction sequences from his perception or memory. Therefore, the therapist lets the protagonist re-enact the temporal sequence of the interactions in his dispute with his conflict partner step-by-step from memory in a psychodramatic role-play (see Sects. 2.8, 8.4.2, 8.6.2, 8.6.3, 8.8.5) In doing this, the therapist promotes the development of appropriate self-image in his conflict through doubling, interview, and role feedback. For example, she doubles him verbally: “When I look at my brother, I realize that he … That makes me angry.” Acting in the as-if mode of play, the protagonist fills gaps in the psychosomatic resonance circuit between his sensorimotor interaction patterns, physical sensations, affect, linguistic concept, and thought (Krüger, 2021). Acting along the red thread of time allows forgotten or repressed interaction sequences to resurface. Understanding the inner construction of reality in role-play resolves the protagonist’s fixation on a particular self-image. The patient perceives the reality of his conflict more fully.

Case example 1

A depressive patient was fixated in the role of a helper. Therefore, she automatically felt guilty when a work colleague took her own life. She had been the last person who had spoken with the work colleague. In group therapy, the patient re-enacted the last meeting she had with her work colleague in the parking lot step-by-step. During the play, she remembered: she had noticed that her colleague was not doing well. But she didn’t know anything about her colleague’s suicidal thoughts. She tried different ways to start a conversation with the “colleague”. She even offered to help. But the “colleague” didn’t want any help. In the psychodramatic play, the protagonist remembered the colleague’s dismissive and rejecting reactions. She perceived anew that, despite her best efforts, there was no chance to reach her colleague emotionally. Her denial of rejection dissolved. The therapist then had the protagonist search for the reason for the colleague’s suicide in a fictitious psychodramatic dialogue (see Sect. 8.4.2). In the role reversal, the patient realized that the colleague had killed herself because she had been desperate because of the separation from her long-term partner. The patient then said goodbye to her “colleague” in a psychodramatic dialogue (see Sect. 8.4.7).

Central idea

A person who defends through denial hides certain interaction sequences from his memory or planning and thus changes his internal perception of reality. Re-enacting the temporal sequence of interactions in the creative psychodramatic role-play helps to complete the defensive ‘false’ sequence with missing actions and thus to resolve the defense through denial. The disorder-specific interaction in the role play frees the patient’s inner self-development in the conflict situation (see Chap. 1) from its defense through denial and allows the patient to become spontaneous again.

Role Change and Projection

Definition of projection: People constantly construct an internal image of their external reality in life. In doing this, they also playfully ascribe certain feelings, actions, and thoughts to their conflict partners. The inner construction of their object images then controls their current outer actions. This attribution becomes a defense through projection when they rigidly hold on to a specific object image of their conflict partner. Defense through projection is a multi-stage process: (1) A certain external stimulus triggers an affect, which updates an old positive or negative interaction pattern. König (1982) sees a need “for intimacy, for familiarity … in an environment that reproduces familiar inner parts in ourselves” in the defense through projection. (2) The projecting person inappropriately ascribes a motivation to his current conflict partner, allowing him to retain his affect. (3) He, therefore, always reacts to him in the same inappropriate way. (4) In doing so, he forces the current conflict partner into a complementary counter-role and fights in him what he fights off in himself. According to Greenson (1975, pp. 197, 137), “When a person projects, he transfers something of his self-representation out into or onto another person.”

Where does projection occur?

Projection secures other forms of defense. For example, patients with borderline organization often feel manipulated when the therapist comes too close to them with an offer of help. In reacting to the therapist, the patient then automatically shifts from their needy ego state to their autonomous ego state. He does not see that he himself is “manipulating” the therapist by alternating between his contrary ego states and acting in equivalence mode. The more disturbed a patient is, the more he has to project to maintain his own psychological balance. But even people with “only” neurotic conflict patterns defend through projection in conflicts. For example, they suffer because of their conflict partner, but they inappropriately cling to the fact that their conflict partner means well and is also suffering. Or they project their own rejection onto the conflict partner, although the latter may “only” protect themselves from feelings of chaos through their distanced behavior (see case example 10 in Sect. 2.9).

People often develop inappropriate enemy images during social or economic crises or war. Enemy images develop through a fixation in a certain biased negative object image. Projecting aggression onto enemy images “helps” people find a simple explanation for the emergence of the crisis and to see themselves as victims. This fixation of the object image is often determined by old social myths. Those affected then fight, for example, those who flee to their country because they assume they want to conquer their country. Centuries ago, however, they themselves conquered their country and expelled or killed the locals. Projection helps people in the present to hide the reality that triggered the current social and economic crisis, for example, corruption, and the unequal distribution of wealth. But the drama is: If one doesn’t perceive the problems appropriately, one can’t solve them sustainably either. Society is increasingly split into “the good guys” and “the bad guys”. For example, the conspiracy theories during the Corona pandemic helped some people see themselves as victims of the “aggressive, authoritarian” rulers. In doing so, they projected their own egoistic desires for power onto those in power.

How is projection resolved?

In childhood, role change and role-playing with high-energy counter-roles helps to differentiate and realistically develop the inner object image in conflict. In doing so, the internal cliché of the ‘bad father’ or ‘good father’ is turned into a holistic person with good and bad sides.

In the case of projection, the therapist lets the protagonist psychosomatically differentiate and expand his inner object image in the as-if mode of play through role change and role-playing in the role of his conflict partner. She doubles him in the opposite role and thus helps him. In the opposite role, the protagonist develops a connection between the conflict partner’s external behavior and internal physical sensations, affect, linguistic concepts, and thoughts. As a result, the inner object image of the conflict partner becomes free from fixation. In group therapy, some patients solely heal as a result of the opportunity to differentiate and expand their fixed inner object images and self-images as auxiliary egos in the protagonist-centered plays of other patients (see case example 66 in Sect. 8.4.5).

At the beginning of his psychodramatic work, Moreno (1945b) did not know about role reversal. However, he had his patients switch to other roles and enact them in role-plays. For example, he had his patient Robert role-play the inner object images of his mother, father, and other authoritarian males. But he did not yet use role reversal, where the patient stands opposite himself in his antagonist’s role and perceives himself as if he is looking in a mirror. In the case of intrapsychic conflicts, the therapist has the patient switch to the counter-role of another ego state. For example, people with a borderline organization can explore the counter-role of their conflicting pseudo-independent, authoritarian ego state and bring it under their ego’s control. Role change also occurs in fairy tale plays, for example, when a patient takes on the opposite role of the “wicked witch” in the fairy tale “Hansel and Gretel”.

Case example 2

As a child, 45-year-old Mrs. C did not receive any validation for her feelings, and her mother narcissistically abused her. She survived by taking on the role of helper assigned to her by her mother. She continued to play the role of helper even as an adult in her small family. She was the good, helpful partner and mother, projecting her own needs onto her selfish, degrading husband and selfish, adolescent daughter. The therapist had her re-enact an argument with her teenage daughter and change into her daughter’s role. As a daughter, the patient screamed at the mother, devalued her, and “howled like a wolf”. She refused any pressure from outside and saw everything in a negative light. In the daughter’s role, Mrs. C. expanded her inner object image of her daughter in the conflict. She experienced that the “daughter” did not take the mother seriously with her offers of help and played off her power with relish. As a daughter, the patient did not feel depressed or suicidal, contrary to what she had previously assumed. This expansion of the internal object image dissolved the patient’s projection of helplessness. She looked at her daughter’s provocative, aggressive behavior with fresh eyes and could name it as such.

Case example 3

The father of a 10-year-old boy had killed himself. The boy then participated in a psychodramatic child therapy group. During symbolic play, he committed about thirty “suicides” in different ways over eighteen months. In this way, without knowing it, he differentiated his inner object image of the suicidal father in the metaphor of the symbolic play, expanded it into a holistic image with good and bad parts, and thus resolved his traumatic fixation.

In therapy, children enact their role as well as their counter-roles through role play in symbolic plays. Thus, they learn to indirectly free their self-image and object image in conflict from their biased fixations, and to shape their inner self-image and object image in conflict more appropriately (Krüger, 2017a, p. 133ff; 2017b, p. 273ff.).

Case example 4

A 40-year-old woman told: She was betrayed by her partner. She had to unconsciously “play” the opposite roles in the triangular conflict in her real life too. First, she was the betrayed victim. But then, in real life, she unconsciously switched to the role of the lover of a man who was in another relationship. Finally, she also “played” the role of a woman cheating on her steady partner with another man. Only then could she be free and content in a stable partnership. By acting out the object images in her everyday life, she further developed her inner object images in the triangular conflict and liberated them from fixation.

Central idea

The free and creative psychodramatic role play in the role of one’s conflict partner helps to resolve the defensive fixation in a certain object image. Changing roles and acting out the inner object image in the role-play frees the inner development of the object image from its fixation by projection and allows one to become spontaneous again.

2.4.3 Disturbances in Internal Rehearsing

The patient explores the cause and effect in his conflict through internal interacting and rehearsing between his inner self-image and object image and frees them from their fixations. He recognizes his conflict partner’s motivation and also his own involvement in the conflict. Thus, he gains a systemic understanding of the relationship. The naturally existing ability to appropriately rehearse mentally (see Sect. 2.2) can be blocked in two different ways and thus lead to incorrect results: 1. Defense through identification with the aggressor and 2. defense through rationalization.

Role Reversal and Identification with the Aggressor

Definition of defense through identification with the aggressor: Anna Freud (1984, p. 92) defined defense through identification with the aggressor as an “exchange between the aggressor and the attacked”. Identification with the aggressor is a combination of introjection and projection (Freud, 1984, p. 88). Introjection and projection are mutually dependent defenses and thereby stabilize each other. Identification with the aggressor secures and strengthens the defense through introjection, denial, and projection. In the end, the patient perceives himself, the victim, as the perpetrator, and the conflict partner, the perpetrator, as the victim. The cause and effect are reversed. As a result, one’s perceptions of reality and the cause and effect in the conflict are blocked.

Where does the defense through identification with the aggressor occur?

The confusion between cause and effect in relationship conflicts can arise in everyday relationship conflicts, in interpreting relationship conflicts from childhood, in a grief reaction, etc. For example, the husband of the patient in case example 63 (see Sect. 8.4.2) repeatedly devalued her in disputes and accused her: “You’re crazy! Always this emotional talk!” The patient blindly accepted her husband’s causal construction and projected her own role as a victim onto her husband. She believed: “He suffers because I’m not normal.”

Defense through identification with the aggressor masks more basic forms of defense in the case of traumatic identification with a perpetrator introject from the past. The affected person then masochistically devalues himself in the present, just as he was devalued in childhood by the damaging caregiver, and thinks about himself: “You are nothing, you are not able to do anything, you’re not good for anything” (see Sect. 8.5). In this case, the inner causal construction is blocked by “complicated and multi-stage defense processes” (Thomae, 1985, p. 406), including the defense through splitting. A psychodramatic dialogue with role reversal with a “perpetrator” from the past is contraindicated in such cases (see Sect. 5.10.9). The therapist must first address the splitting and post-traumatic disorder.

How is the defense through identification with the aggressor resolved psychodramatically?

The psychodramatic dialogue with role reversal is the indicated method. The therapeutic effect of external role reversal in the as-if mode of play builds on the therapeutic effect of scene construction, doubling, role-playing, and role change (see Fig. 2.6 in Sect. 2.4.3).

Fig. 2.6

The complex therapeutic effects of role reversal

In the psychodramatic dialogue with role reversal, the protagonist represents his conflict partner with the help of an auxiliary ego or an empty chair. He then explores the reality in the inner conflict image by role-playing in his role, changing roles, and role-playing in the role of his conflict partner. Additionally, the protagonist tries, of his own volition, new behavior in his role in the old situation in the as-if mode of play. In a role reversal, the individual actions of the protagonist and the individual reactions of the “conflict partner” should interlock like the links of a zipper in frequent role reversal. For example, he tells the “conflict partner” what he feels and why he feels it. Or he negotiates with the “conflict partner” to achieve a fairer balance between giving and taking in the relationship (see Sect. 8.4.2). In doing this, the protagonist reverses to his conflict partner’s role after each action and acts the way he thinks he would react to his new action. In this way, the protagonist recognizes which of his own behavior and that of his conflict partner could enable or prevent a new solution to the conflict. The external role reversal helps him complete both psychosomatic resonance patterns of his inner self-image and object image, separate from each other, into holistic psychosomatic resonance patterns. This helps him to psychosomatically experience whether his conflict partner is acting in this way to protect himself internally or to externally reject the other (see case example 10 in Sect. 2.9). He thus learns both his and his conflict partner’s true motivations and knows how they both tick in the relationship. Thus, he knows more clearly whether creating a systemically fair relationship balance is possible. He knows more about cause and effect in the conflict.

The therapist can resolve the mutual stabilization of defenses through introjection and projection using the seven steps of the psychodramatic dialogue (see Sect. 8.4.2). The first step resolves the defense through projection. This also automatically weakens the defense through introjection (see case example 15 in Sect. 2.14 and case example 63 in Sect. 8.4.2). Steps 3 and 4 resolve the defense through introjection. This also weakens the defense through projection (see Sects. 2.9 and 8.4.2). Steps 6 and 7 weaken the mutual stabilization of defenses through projection and introjection.

Central idea

In the case of defense through identification with the aggressor, the external psychodramatic role reversal helps to overcome the defensive inversion of cause and effect in the inner role reversal. Rehearsing with frequent role reversal frees the internal development of self-image and object image in the external situation from its fixation in the defense through identification with the aggressor.

Mirroring and Rationalization

Definition of rationalization: People often identify the causes of a conflict by looking internally at the interaction from a metaperspective and interpreting and assessing the interactions in the situation. However, this internal change into the metaperspective can be blocked by the defense through rationalization. The affected person then secures his inappropriate understanding of cause and effect by providing an inappropriate interpretation or assessment. “Rationalizations are equally used to ward off anxiety and deny instincts: people with neurosis concoct a system of justifications which help them categorize their neurotic feelings and reactions as ‘right’ or ‘necessary’, perhaps even ‘reasonable’ and ‘valuable’” (Dührssen, 1972, p. 31, 187).

Where does defense through rationalization occur?

In every new situation, people first use old and familiar explanatory models because it takes more psychological energy to form a new, personal opinion about the causes of the conflict. However, it is crucial to notice when the old explanation does not fit and to look for a new, more appropriate one. After all, if one does not appropriately identify the cause of a conflict, one cannot resolve the conflict appropriately. Inappropriate explanations of the situation are primarily based on the individual’s affect and protect their special defense. The affect looks for a suitable explanation. For example, a depressed patient often assesses himself with the assumption “Everything I did today was bad. I am a loser.” But, the affected person is perhaps simply exhausted at this point and would assess his actions differently at other times. Or he underestimated the dimension of the problem.

How is rationalization resolved psychodramatically?

Rationalization can be resolved only if the more basic forms of defense have been resolved beforehand. When rationalizing, the affected person holds on to a particular view of the conflict from the metaperspective. The therapist, therefore, uses the psychodramatic technique of mirroring. She stands with the patient outside the interaction scene acting psychosomatically in the observer position and asks him to look at the conflict from a metaperspective: “How do you feel about what you did?” “What happens between you as a boy and your mother?” The protagonist then internally recreates the interaction in his relationship conflict from the outside from a metaperspective. He describes what he sees and names and evaluates the interaction holistically from the yes-but position of the expert: “The mother is not interested in what the boy feels and thinks. She’s using him!” As a cognitive doppelganger, the therapist supports the patient in mirroring to call a spade a spade and to develop his own assessment of cause and effect in his conflict. When mirroring, the patient develops a systemic understanding of the relationship conflict.

The mirror technique is often used unnoticedly in psychodrama:

• 1. The therapist engages in a psychodramatic conversation with the patient (see Sect. 2.8) and represents his self-image and object image with two additional chairs externally in the therapy room (see Fig. 2.9 in Sect. 2.8). The patient then narrates what happened in the argument with his boss. He looks at the two chairs of self-image and object image from a metaperspective. The method can strengthen the cognition in the conflict (see Fig. 2.8 in Sect. 2.7).

• 2. In the role reversal, the patient sees his self-image in his conflict from outside through the eyes of his conflict partner.

• 3. The therapist also uses the mirror technique in step 5 of the psychodramatic dialogue (see Sect. 8.4.2). Looking at the symptom scene (see Sect. 2.8), she helps the patient to name his external perceptions of himself and his conflict partner with the appropriate linguistic concepts. The use of other linguistic concepts, such as, ‘egoistic and selfish’ instead of ‘not careful’ and ‘not mindful’, activates other psychosomatic resonance patterns (see Sect. 2.7). The patient then classifies his interaction pattern in his memories under a different linguistic concept.

Case example 2 (continued)

Mrs. B. had re-enacted the argument with her aggressive pubescent daughter. During debrief, the therapist pointed to the two chairs representing the mother and the daughter and asked: “How do you assess your behavior towards your daughter? How would you describe your daughter’s behavior?” Mrs. B.: “Friederike is disrespectful.” Therapist: “Please don’t say what isn’t, that she is disrespectful! Please tell me how you perceive your daughter in real!” Suddenly Mrs. B. bursts out: “Friederike is an egomaniac. She pisses me off! I can’t stand to be near her!”.

• 4. When processing the trauma (see Sect. 5.10), the patient shall tell his trauma story primarily from a metaperspective, from the narration and observation space. Auxiliary therapists enact the narrated interactions as doppelgangers and auxiliary egos.

• 5. Even with crisis intervention using the table stage, the patient and the therapist look at the development of his crisis together from a metaperspective and thus get an overview of his current life situation. This strengthens the patient’s cognition.

Viewing a conflict from a metaperspective is not the same as metacognitive therapy (see Sect. 2.14). When mirroring, the patient looks at the interactions in his relationship conflict from the outside. In metacognitive therapy, however, he looks at his dysfunctional defense pattern from the outside (see Sect. 4.8). Metacognition is thinking about the way you think and not thinking about an interactional event.

Central idea

Psychodramatic mirroring helps to overcome a ‘false’ assessment of an external situation. It frees the systemic process of the patient’s internal self-development in the external situation from fixation in the defense through rationalization.

2.4.4 Disturbances in Internal Integrating

In conflict processing, current actions, affect, interaction patterns, and defense patterns do not always match the current conflict. One, therefore, naturally associates inappropriate actions and affect spontaneously with appropriate experiences from the past and gives them a positive meaning in the past context. This association is the result of integrating, the fourth tool of mentalizing (see Sect. 2.2). Integrating helps one understand himself better while thinking, acting, and feeling in a neurotic manner. The naturally existing ability to integrate appropriately can be blocked (1) by defense through repression and/or (2) by defense through projective identification.

Change of Scene and Repression

Definition of repression: “In repression, the ego confirms its power in two ways: the instinctual representative feels one side of its power expression, whereas the instinctual impulse feels the other” (Freud, 1931, p. 215; Krüger, 1997, p. 199). In repression, a feeling or an action from the past (the instinctual impulse, according to Freud) is inappropriately attributed to a present interaction. One cannot remember the threatening past conflict associated with the neurotic feeling or action. It is repressed. The inappropriate thinking, feeling, or acting that made sense in previous contexts is acted out blindly in the present.

Case example 5

A patient always panicked in the present, even if her husband frowned. She, therefore, repeatedly acted unreasonably in her current marital relationship and withdrew from it. She withdrew the same way she did in childhood when she panicked because her father had a choleric attack. “If you want to explain the hysterical attack, you only have to look for the situation in which the motions in question were part of a justified behavior” (Freud, 1931, p. 256).

Where does repression occur?

There are two different types of repression. (1) In repressing a past interaction pattern that matches the current inappropriate affect, the patient inappropriately acts out his affect from the past in the present. (2) In repressing the past affect that fits the current inappropriate interaction pattern, the repressed feeling shows up in the present only as a psychosomatic reaction, for example, a racing heart, and the patient interacts inappropriately in the present.

How is repression resolved?

The therapist helps the patient mentally connect the inappropriate affect or interaction pattern in the present to the appropriate, “true” interactive relationship from the past:

• 1. The therapist asks him if he knows the inappropriate affect or interaction pattern from his past.

• 2. In the psychodramatic play, she has the protagonist switch to an appropriate childhood scene in order to actualize his repressed affect or interaction pattern and integrate it into the genetic conflict.

Central idea

The external linking of the inappropriate interaction pattern and affect with an interaction pattern from the past helps the protagonist to neuronally classify his current sensorimotor interaction pattern, physical sensation, and the affect in his memory under another descriptive linguistic concept (see Sect. 2.7): “I know this from my mother!” This frees the current interaction pattern with his wife from the old psychosomatic experiences. He can freely develop his inner self-image and object image in the relationship with his wife. On the other hand, the interaction pattern “mother” gets an update. Self-image and object image in his relationship with the mother become from their old fixations through a psychodramatic dialogue with role reversal and develop further (see Sect. 8.4.6).

Goldmann and Morrisson (1988, p. 29ff.) called this procedure “the psychodramatic spiral”. The protagonist first plays a current conflict and then, by changing scenes, integrates the inappropriate feeling into a relevant childhood scene. He subsequently looks for a new appropriate behavior in the psychodramatic encounter with his current conflict partner.

• 3. The therapist connects the patient’s current neurotic interaction pattern with his childhood experiences and verbally communicates this connection as an interpretation. In doing this, the scene change happens only internally.

• 4. The patient writes a fictional letter to an attachment figure from childhood (see Sect. 4.12). The patient must never post the letter. In the letter, he explains to the attachment figure all that he has now learned about the connection between his current problems and his childhood experiences.

• 5. The patient integrates, with the help of the psychodramatic dialogue and role reversal, his newly gained self-image into the internal image of a relationship with a close attachment figure from his childhood (see Sects. 4.12 and 8.4.2).

Case example 5 (continued)

The patient mentioned above, who reacts with panic to her husband’s frown, first re-enacted the scene with her husband psychodramatically. Then, the therapist asked her: “You panic when someone frowns. Where does that stem from?” So he named the interaction pattern. The patient replied: “It was the case with my father. He was very short-tempered and often hit me!” The therapist then had the patient perform an external psychodramatic scene change to the appropriate childhood scene and re-enact the childhood scene, taking into account the boundaries of trauma therapy (see Sect. 5.10.11). Acting in this way, the patient appropriately linked (integrated) her present inappropriate affect of panic with the past relationship conflict with her father. Thus, she experienced the original positive meaning of her panic reaction. The patient could separate the real conflict with her husband from the transference conflict with her father because of the new link.

• 6. The therapist also uses integrating through scene change in fairy tales and impromptu plays in group therapy. In debriefing, the therapist asks the group participants: “Did you behave similarly to how you do in everyday life, even in the play? Or did you do the opposite?” Thus, their experience in the fairy tale play amplifies their experiences from everyday life or childhood conflicts.

Case example 6

A seminar participant spontaneously chose the role of a star box in the impromptu play “A Garden in Spring” and played it. But his star box was “half collapsed”. In debriefing, the participant suddenly realized that this image symbolized his current psychological state of mind in his life crisis. As a result, he began engaging in psychotherapy after the seminar.

Central idea

The psychodramatic linking of the inappropriate affect or interaction pattern with the appropriate conflict from the past through scene change helps to overcome an inappropriate linking with a ‘false’ conflict. The disorder-specific psychodramatic scene change frees the internal creative process of self-development (see Sect. 2.1) in an external conflict situation from its fixation in the defense through repression.

Sharing, Amplification, Projective Identification

Definition of projective identification: Defense through projective identification is a complex process that stems from childhood and serves to adapt to difficult family circumstances. (1) The affected person took on the role assigned to him in his family by the family and split off his sense of self (Parin, 1977): “External adaptation takes place automatically … A necessary ego split is usually not noticed … The adaptation offers a narcissistic satisfaction that one is someone who corresponds to one’s role …”. (2) The affected person identified with the family’s explanatory patterns. He did not distinguish between the systemic role implicitly assigned to him by his family and the self-directed personal role. (3) The affected person also blindly identified with the values and goals of the family system. His ego developed the ability to “occasionally or temporarily use external authorities or institutions instead of his internalized superego.” Parin speaks of the “externalization of conscience”, “clan conscience,” and “identification with the group ego”. “Extreme living conditions … and … also imposed or highly charged ideologies … favor such ego development”.

The defense through projective identification is stabilized in the present by the fact that the person concerned and other members of his current relationship system mutually narcissistically affirm each other in the splitting of their self. Those affected then reinterpret their own inappropriate thoughts, feelings, and actions through ideological rationalization, for example, submissiveness to Christian humility, violence against immigrants in loyalty to the fatherland, or an attitude characterized by resentment into a socially critical attitude (Dührssen, 1972, p. 31) (Krüger, 1997, p. 217).

People who defend themselves through projective identification are fixed in a defense system in the process of their inner self-development in the therapeutic relationship, for example in defense through grandiosity combined with masochistic self-censorship. The therapist, who inwardly accompanies the patient in the process of his self-development in the situation, unconsciously identifies with the patient’s defended part of self and inwardly protests against his grandiose claims or his masochistic self-devaluation. The patient’s rigid defense pattern and the therapist’s vicarious feelings are mutually dependent. In the end, the therapist experiences the patient’s split-off affect as her own. According to König, 1991 (quoted from Heigl-Evers et al., 1997, p. 351), the therapist is “unconsciously manipulated” to become similar to a part of the self that the patient has delegated to her.

Where does projective identification occur?

Those affected usually suffer from a structural disorder (see Sect. 4.4). They have often experienced childhood relationship trauma in a family shaped by traumatized parents. For example, they grew up as a child in a disintegrated family. Or they have internalized their parents’ defense system and thus stabilized the family. However, those affected don’t attach any appropriate meaning to these deficient interaction experiences. This is only possible if one has had positive relationship experiences through sufficient resonance from their caregivers in childhood and is, therefore, able to internally compare negative and positive experiences.

Affected persons are usually insecure and emotionally unstable. Therefore, they often stabilize themselves by taking on a role in an overtly or latently authoritarian community. A religious sect, a criminal gang, or a right-wing extremist party gives them inner support. However, authoritative organized communities are not flexible in their relationships and prevent further growth of the person. A mature step in puberty or midlife can lead to an identity conflict between the systemic role in the authoritarian community and the self and a breakdown in blind identification with the system. As a result, the affected person loses the inner support that the community gives him and must once again confront his old insecurities surrounding his identity. Sometimes, he experiences existential fear of absolute emptiness, loneliness, going mad, or death. For example, people who decompensate into psychosis have previously stabilized by assuming their ascribed role in a rigid family system (see Sect. 9.4). They identified with the group ego of their family or community. Even severely psychosomatic patients defend themselves through projective identification. Unlike patients with psychosis, however, they have already developed more mature, complex inner structures before the collapse of their psychological balance. As a result, their mental breakdown does not lead to a dissolution of the ego boundaries between internal and external but is “only” dealt with as a conflict between the body and soul.

How is projective identification resolved?

When defending himself through projective identification, the affected person is stuck in a rigid defense system. He comes for counseling, coaching, or therapy when the narcissistic gratifications for his adjustment are missing in his relationship system or the current situation requires that one’s emotions be justified. Perhaps, he may no longer be able or willing to fulfill the systemic role expected by the authoritarian community or institution. He experiences an identity conflict between his systemic role in the community and his own self.

In the case of defense through projective identification, the therapist implements the same approach as in the therapy of people with personality disorders (see Sect. 4.8). In doing so, she goes back with the patient along the path of defense through projective identification: (1) The therapist internally justifies the disturbance in the relationship caused by the patient’s defense. (2) She internally names her own affect. (3) She considers the specific defensive behavior with which the patient triggers this affect in her. (4) She attributes this specific behavior to a particular defense pattern of the patient. (5) She names this for the patient and represents it as an ego state with an empty chair and a hand puppet outside in the therapy room. Thus, looking at his externally represented defense pattern, the patient himself feels the emotions that he had delegated to the therapist before. (6) She describes the positive meaning of the patient’s defense pattern in the holistic process of his self-regulation. (7) She integrates his defense pattern with his childhood conflicts (see Sects. 4.8 and 4.10).

Case example 7

In the therapy of a patient with panic attacks, the therapist represents the rigid defense pattern of self-protection through perfectionism as a second chair next to her and asks: “When you experience difficult feelings, how long do you pretend as if nothing is wrong and fight those feelings?” The patient replies: “Always!” Therapist: “When was the first time?” The patient then narrates various traumatizing stories from her childhood without any emotional involvement and then cheerfully asks: “Do you want to hear more such stories?” Therapist: “No, this is too much for me because I really internally imagine the events you experienced back then!” The patient begins to cry: “It’s too much for me too!” As a child in a broken family, the patient had not learned to perceive and classify her own emotions because of her identification with the systemic role ascribed to her. She had tried to perfectly meet the family’s expectations. Therefore, the therapist experienced the patient’s loneliness and abandonment on her behalf and shared it with her: “I can’t take it anymore. It’s too much for me!” In identifying with the therapist, the patient absorbed the therapist’s emotion, which was her own suppressed emotion, into her self-image and only now realized: “I can’t do it anymore either.”

The therapist can clarify the inadequacy of the patient’s defense pattern by amplifying the rigid defense pattern: “American President Gorge W. Bush’s grandiosity led him to believe that he had to ward off all evil in the world. He destroyed the society in Iraq through war and thereby causing what he wanted to fight against: the mullah regime of Iran gained great influence in Iraq and the Islamic State terrorist group emerged. The therapist can explain the distancing from an old rigid defense pattern by amplification too. For example, the therapist shares about other patients or fairy tale characters who have experienced similar conflicts between a massive pressure to conform and their sense of self and have found a solution, such as Cinderella or the “Girl Without Hands”. The patient can identify with the role of the heroine or hero in the fairy tale. He feels seen and validated through the sharing or amplifications. Fairy tales usually have happy endings. Therefore, such amplifications encourage patients to search spontaneously and freely for a self-determined life, like the heroine of the fairy tale.

Exercise 4

If you want to experience amplification, you can do so by rehearsing the method of fairy tale association (Krüger, 1992, p. 230 ff.): (1) search for the name of a fairy tale. (2) Choose a specific person or character from this fairy tale. (3) How do you see this figure in front of you? What is it doing right now? Pause the inner film and describe the situation you see in front of you. (4) Write down the result of this exercise. Your fairy tale association is an amplification of a core personal conflict of your own with a probability of at least 80%.

During the psychodramatic work on defense through projective identification, the therapist or the group members confirm the patient’s attempt to free himself from his old defense system through personal sharing. For example, they report how they let go of an old conformist attitude and find themselves. The patient learns that other humans have experienced similar existential fears and identity conflicts and dealt with them differently. Amplificatory interpretations are also helpful.

Central idea

The psychodramatic split between the systemic role and the self helps the patient resolve the defensive split between the systemic role and the self through projective identification. The disorder-specific sharing and amplification free the internal creative process of self-development in the external conflict situation from its fixation in the defense through projective identification.

Recommendation

Psychodrama techniques specifically free tools of mentalization from their blockages. The therapist should supplement this theoretical knowledge with her intuition in her practical work (see Sect. 2.5). This helps her to appropriately develop the relationship with this particular patient in this situation, here and now. The present moment is more true than any theory, technique, or method. The therapist is allowed to not know and does not have to know everything immediately when directing a psychodrama play. Her apparent ignorance helps her become a midwife in the patient’s self-development in the psychodramatic play.

2.5 The Attunement and Agreement Process Between the Patient and the Therapist During Psychodramatic Play

Humans develop their inner self in conflict through mentalizing. In Psychodrama, the tools of mentalizing become psychodrama techniques (see Sects. 2.2 to 2.4). Psychodrama therapists promote the patient’s internal self-development in external conflicts (1) verbally and by using psychodrama techniques as an implicit doppelganger and (2) by participating in the psychodramatic play as an interacting doppelganger.

Exercise 5

If you are a psychodramatist, notice what you pay attention to in your practical work as a therapist: direct a psychodrama following only your intuition! When and how do you use which psychodrama technique, and why?

Fig. 2.7

The Shared Mentalization Process of a Patient and Therapist in a Psychodramatic Play (Krüger, 2012, p. 300, revised)

Central idea

The intuitive impulse of the therapist to use a specific psychodrama technique results from an intuitive, semi-conscious, semi-unconscious creative attunement and agreement process with the patient. During the psychodramatic play, the psychodrama therapist and the auxiliary therapists accompany the patient internally as implicit doppelgangers in his holistic process of internal self-development in the external situation. This process includes the systemic development of inner self-image and inner object image in the external situation (see Sect. 2.2).

Important definition

Every therapist is an implicit doppelganger when she tries to understand the patient and promote his self-development. She identifies with the patient’s self-development and mentalizes on his behalf. If she does not know how to continue, she verbally asks for the necessary information

She says: “You say you are exhausted. How does your exhaustion affect your everyday life? Since when are you exhausted?” Patient: “Since I lost my job.” Therapist: “How did this happen?” The therapist spontaneously tries to internally understand what causes the patient’s exhaustion and how it affects him in the present. She searches for the relevant external conflict that caused the exhaustion. But, she would also like to know how the patient perceived reality in his triggering conflict. She wants to understand what happened in the triggering conflict. She, therefore, asks the patient to psychodramatically enact his systemic process of internal self-development in the conflict with his boss. The therapist, as an implicit doppelganger, uses her own tools of mentalizing as psychodrama techniques (see Sect. 2.4) in directing the play. However, she then does not know what the patient’s boss answered. She, therefore, asks the patient to change his role and respond to himself from the role of his boss.

Central idea

Moreno once said: “I had two teachers, Jesus and Socrates” (Yablonsky, 1986, p. 241). In directing the psychodramatic play, the therapist realizes the Socratic attitude: “I know that I don’t know, but I would like to know.” But alternately, she also acts internally as the patient’s implicit doppelganger and realizes the Jesus attitude: “Bear one another’s burden.” The therapist alternates again and again between the Socratic and Jesus attitudes.

Important definition

In psychodrama play, the therapist and auxiliary therapists of the group take over, as interacting doppelgangers, the roles of the patient’s self-image or object image and help him to shape his inner process of self-development and to free it from his fixations.

In acting psychodramatically, the patient expands his inner conflict images with the help of the therapist and the auxiliary egos to include the psychosomatic experience. In the role of his inner self-image and object image, he develops a holistic psychosomatic resonance pattern between sensorimotor interaction patterns, physical sensations, affect, linguistic concepts, and thoughts (see Sect. 2.7). The therapist and the auxiliaries physically act and complete his self-development in the as-if mode of play. The patient’s conflict is jointly choreographed so to speak. The auxiliary egos assume the same posture as the protagonist in his complementary roles. In terms of content, they say the same thing and intensify the affect through sound modulation. They reverse roles and interact with the protagonist. The therapist also dances along with the protagonist, so to speak. If the protagonist reverses roles, she positions herself on the protagonist’s side in his respective role (see Sect. 8.4.4). In doubling verbally, she positions herself diagonally behind him and, thus, gives energy to the patient’s mentalization. If she wants to get an overview of the situation, she looks at the scene from a metaperspective. Dancing along with the protagonist’s story as implicit and interacting doppelgangers makes it easier for the therapist and the auxiliaries to understand the protagonist’s self-development in his conflict and to free him from fixations in defense.

Children sometimes communicate solely through sensorimotor interaction and psychosomatic expression of affect, without saying a word. A three-year-old girl was playing alone in the garden. A boy of the same age walked up to the girl from the street. The girl looked at him skeptically. The little boy danced in front of her for ten seconds. The girl looked at him with interest and repeated his dance movements. Then she hesitated and danced in her own way in front of the boy. The boy looked at her and imitated her dance. Afterward, they both turned around, went to the sandbox, and played together. It seemed like they knew each other well. They hadn’t said a word to each other since they met.

Central idea

By definition, psychodrama works psychosomatically because the patient physically acts on the stage in the as-if mode of play.

Recommendation

In only verbally performed video therapy, the psychosomatic encounter level is lacking to a great extent. Therefore, the therapist should let the patient use two chairs in his room to represent his internal self-image and object image in his conflict and, if necessary, a third chair for his dominant defense pattern (see Sect. 4.8). At least the patient himself should act psychosomatically in his room with role reversal and act out his defense pattern in the as-if mode. This improves the therapeutic effects of video therapy.

Many psychodrama psychotherapists are tempted to look for new and impressive psychodrama techniques when they encounter disturbances in attunement and agreement process with the patient during the psychodramatic play. In doing this, they leave the role of implicit doppelganger and treat the patient as an object. But understanding psychodrama as a method of mentalizing through psychodramatic play helps the therapist avoid her own confusion. As an implicit doppelganger, she lets the patient retrace the paths of his mentalizing in psychodramatic play. In the case of disturbances in play, she intuitively slows down the work at the right point and uses less complex psychodrama techniques to dissolve a less complex defense (see Figs. 2.5 and 2.6).

The therapist can only use a particular psychodrama technique if she, as an implicit doppelganger, can freely use the appropriate mentalizing tool in her own conflict processing. For example, if she doesn’t think of her own conflicts systemically, she will not use role reversal freely in the patient’s conflict. Likewise, if she has not processed her own trauma, she will not have the impulse to represent the patient’s flashback with a chair next to him and thus make his unconscious change between his trauma film and his healthy adult thinking the subject of therapeutic communication (see Sects. 4.8 and 5.8).

Central idea

If a therapist has a problem using a particular psychodrama technique, it may indicate a gap in her self-experience. An increase in her self-awareness can then lead to a dissolution of the block in using the respective psychodrama technique appropriately. An increase in self-awareness, progress in the application of psychodrama techniques, and the theoretical understanding of her own therapeutic actions are mutually reinforcing.

2.6 Develo** the Modes of Mentalization

Fonagy et al. (2004) have defined the developmental steps of mentalization as the development of ‘modes of mentalization’. In what follows, I integrate the theory of Fonagy et al. with Schacht’s theory (2009, p. 22 ff.) of childhood development. In his theory of development, Schacht combined Moreno’s (1946/1985, p. 64, p. 74 ff.) theory of role development with the ‘psychoanalytic findings of operationalized psychodynamic diagnostics on personality structure (working group OPD, 2006)’ (Schacht, 2009, P. 13), the ‘psychoanalytic studies on structure-related psychotherapy by Rudolf (1998, 2006)’, and the developmental levels of Selman (1984). With this in mind, I have developed a concept of seven different modes of mentalization (Table 2.1).

Central idea

The process of mentalizing involves the use of seven different modes of mentalizing that build on one another: the dream mode, the equivalence mode, the as-if mode of play, the as-if mode of thinking, the systemic mode, the metaperspective mode, and the narrative mode (Krüger, 2017a, 2017b, p. 135 ff.).

Table 2.1 Develo** the modes of mentalization

• 1. When the inner process of self-development disintegrates, one uses the tools of his mentalization in the form of mechanisms of dream work (Krüger, 1978, see Sect. 9.3): (1) The inner representation becomes the dream mechanism: ‘Inner thoughts are perceived as external reality’, (2) the inner interaction becomes the dream mechanism of ‘displacement’, (3) the inner rehearsal and inner role reversal becomes the dream mechanism of ‘reversal into the opposite role’ and (4) the inner integration becomes the dream mechanism of ‘condensation’. Thinking in the dream mode is similar to thinking in the teleological mode (Brockmann & Kirsch, 2010, p. 280): When thinking in the teleological mode from the 9th month of life “the child can interpret its own and others’ actions as goal-oriented, but it cannot yet see the underlying causes and motives. Only what can be observed counts”.

  People with psychosis experience delusions because their mentalizing tools work as mechanisms of dream work (see Sect. 9.3). Mentally healthy people become creative in a unique way when mentalizing in dream mode because they are able to control their thinking in dream mode when awake. They know that their absurd fantasies are only inner fantasies that do not reflect external reality. Their mentalization in the dream mode takes place in the service of their ego (Balint, 1970, p. 187 f.). The dream mode extends our perceptions and experiences in an illogical manner, thereby leading to freedom of thought, which is necessary for creating new solutions (see Sect. 9.4). In the psychodramatic play, the dream mode is developed through scene construction, doppelganger dialogue (Krüger, 2013b, p. 221 ff.), and auxiliary world technique (see Sects. 9.8.4 and 9.8.8).

• 2. Children develop the ability to think in equivalence mode from 15 to 18 months of life. They learn to organize their thoughts in space and time. They internally develop a rudimentary inner self-image and object image in the external situation. However, they do not yet distinguish between their inner reality construction and their external perception of the conflict. Thinking in the equivalence mode is still linked to the external action and therefore depends on the supportive interaction with attachment figures or objects like puppets. According to Schacht (2009, p. 24), small children then mentalize on the psychosomatic role level. ‘Toddlers behave as if their and others’ thoughts reflect the real world in its original form …What small children believe is, in their opinion, really the way things are’ (Fonagy et al., 2004, p. 264).

Important definition

Adult patients who think in the equivalence mode unconsciously assume that their defensive inner reality construction adequately reflects the external reality in the conflict. As stated by Fonagy, Gergely, Jurist, and Target (2004, p. 96 ff.), they confuse ‘internal states (such as thoughts, fantasies, and feelings) with outer reality. They experience these thoughts and feelings as reality—not as mere internal representations of reality.’ As a result, patients who are fixed in a defense and inadequate internal reality construction also act inappropriately in external reality. But not every person who acts in the equivalence mode is also structurally disturbed. His conflict processing is only characterized by a defense.

• 3. From 15 to 18 months, a child also learns to think in the as-if mode of play. According to Schacht (2009, p. 24), that is the psychodramatic role level. Unlike the more complex modes of mentalization described below, thinking in the as-if mode of play is still connected to the external interaction with external objects. It serves the inner differentiation between the self-image and object image in the external situation. The child needs real objects such as a puppet, a stuffed toy, wooden blocks, or even attachment figures who support him. The child creates his own fantasies by acting externally in the as-if mode of play and learns to control them independently in the play.

  Three-year-old children can differentiate ‘between ... thoughts and real things in play; they begin to play with as-if games and can easily recognize when somebody is acting “as-if”—for example when daddy is pretending to be a dog’ (Fonagy et al., 2004, p. 262). They can reflect on inner states and false, alternative, or changing convictions in play and develop their internal ideas. According to Fonagy et al. (2004, p. 268), they are not yet able to also do this outside of play, only in their inner thinking. ‘When playing, the child is always ahead of his average age and daily behavior! He appears to be more mature than his age’ (Vygotsky, 1978, p. 102, quoted after Fonagy et al., 2004, p. 266). Role-playing has a Surplus-Reality-Effect (see Sect. 2.6). However, the child is still unaware that ‘in thinking about events and holding convictions relating to these events, he is merely forming subjective, interpretational constructions of these events’ (Schacht, 2009, p. 25). From 15 months to 4 years, a child thinks either in equivalence mode or in the as-if mode of play (Fonagy et al., 2004, p. 262).

• 4. From the 4th to the 6th year of life, the child gradually integrates the as-if mode of play in his internal thinking and develops the as-if mode of thinking. Fonagy et al. (2004, p. 268) have broadly named this function of mentalization as the ‘reflective mode’ of mentalizing or the ‘mentalizing mode’.

Important definition

According to Fonagy et al. (2004, p. 297 f.), in contrast to the state of psychic equivalence, the ‘as-if’ mode of thinking is ‘characterized by an awareness of the representational character of internal states: by separating or ‘dissociating’ […] his mental representations from reality, a child can distinguish his thoughts and fantasies from reality.’

The child now uses his existing inner self-images and object images to let them interact internally. He develops his self-images and object images into small stories with interaction sequences in the imagination alone without the help of external objects. He thinks in scenes. In free psychodramatic role play, a child playing the role of a mother will seek someone to play the complementary counter-role. The child verbally negotiates his role expectations with the other person. For example, as a ‘cowboy,’ he needs an ‘Indian,’ and as an ‘Indian,’ he needs a ‘cowboy’. The child recognizes that his views and feelings are subjective and that others can hold differing views. According to Schacht (2009, p. 24, 30), this is level 1 of the sociodramatic role level.

By 1946, Moreno (1946/1985, p. 70 ff.) had already developed a theory of the development of mentalizing in childhood. He named it ‘the theory of role development in children’. In this, he explained the development from mentalizing in the mental equivalence mode to mentalizing in the as-if mode of thinking (Moreno (1946/1985, p. 72). He used different linguistic concepts, but his thoughts were similar to those of Fonagy, Gergely, Jurist, and Target. Instead of the psychic equivalence mode, he spoke of the stage of ‘all-identity’ (Moreno, 1946/1985, p. 70). According to Moreno (1946/1985, p. 73), reality and fantasy are not separate in the stage of all-identity. Those who mentalize at this level of development are acting in their ‘psychosomatic role’. With the beginning of the ‘second universe’ in the child’s fourth year of life, fantasy and reality become separate (Moreno, 1946/1985, p. 72). ‘Two stages of warm-up process emerge, one for action in reality and the other for action in fantasy, and these begin to organize themselves.’ Both run parallel to one another. ‘The problem is not that one could give up fantasy in favor of reality, or vice-versa’ (Moreno, 1946/1985, p. 77). The trick is instead to establish means and ways of overcoming life situations such that one can ‘switch back and forth between these different paths’.

Central idea

According to Fonagy, the reflective mode of mentalizing in the theory I describe here also includes the systemic mode presented below, the metaperspective mode, and the narrative mode.

• 5. The systemic mode of mentalizing develops from around the age of ten. Children develop the ability to role reverse internally and to assume a self-reflective and reciprocal perspective. When interacting with their caregiver in everyday life, they repeatedly change into the role of their associated inner object image in external situations and constantly develop them further. They can also see themselves through the eyes of the other in the current situation. Thus, in a relationship, they can think reflexively about themselves and therefore recognize the mutual conditionality of their own and their interaction partner’s behavior. They learn to assume joint responsibility for the conduct of their conflict opponent. Schacht (2009, p. 25 ff.) states this is the sociodramatic role level. The systemic mode of mentalizing is achieved through inner role reversal.

• 6. Youngsters develop the metaperspective mode of mentalization from around the age of 15 years. They learn to see themselves and their interactions internally from a metaperspective and to observe themselves ‘from the perspective of an impartial third party’. This helps them assess the conflict using values and norms: “That is fair”, “That is unfair”. Schacht (2009, p. 33) says they reach the sociodramatic role level 3.

• 7. At 15–20 years, people develop the ability to think of their conflicts even in the narrative mode of mentalization. They reach the sociodramatic role level (Schacht, 2009, p. 33). Usually, people automatically synthesize ‘new information with previous knowledge as they take it in. When the event is of personal importance to them, they unconsciously rewrite these feelings into a story’ (van der Kolk et al., 1998, p. 72). Thinking in the narrative mode, the person determines how the conflict began and how it ended. They integrate personal experiences from other times and places into their history. They give meaning to their own experiences against the background of universal human experiences, the society as a whole, ecological contexts, or spiritual experiences. When processing conflict, they come to a subjectively coherent gestalt closure. They gain clarity on what is important in the conflict. The unimportant information can then be forgotten. Thus their narration becomes a true personal story that evokes a sense of identity. The autobiographical self emerges (Damasio, 2001, p. 210), constructing the contents of the conflict processing into a “story of the self…”.

The modes of mentalizing describe the stages of psychic development in children. They must not be equated with the tools of mentalization in adults. In an acute conflict, everyone thinks more or less in equivalence mode (Fonagy, 2021, https://www.youtube.com/watch?v=dheWephlvkg, October 3, 2021) because he is more or less severely fixated on a certain defense. But he is not disturbed in the beginning. He ‘only’ equates his internal image of the conflict with the external reality of the conflict. A person who projects rejection onto their conflict partner also perceives them as someone who rejects them and acts accordingly (see case example 10 in Sect. 2.9).

Psychodrama transforms thinking in equivalence mode into thinking in the as-if-mode. The patient thus gains ego control over his inappropriate thinking, feeling, and acting in the current situation. He becomes spontaneous in Moreno’s opinion (1974, p. 13). This is the starting point of psychodrama as a psychotherapy method. Moreno discovered this healing effect of the psychodramatic play in his improvisational theater. He has told the story many times (Marineau, 1989, p. 74).

Case example 8 (Moreno, 1959, p. 14 f.)

“We had a young actress who was particularly successful in portraying saints, heroines, and romantic tender creatures”. One of her admirers fell in love with her, and they married. One day her new husband came to Moreno, very depressed, and stated that his wife was unbearable in the marriage. “She behaves recklessly, is quarrelsome, uses the most vulgar expressions, and if he reprimands her in anger, she even acts violently.” Moreno wanted to help the man and his wife. He asked him to come to the theatre in the evening as usual. However, Moreno suggested that the actress play a completely different role that evening. He offered her the role of a street girl. She enthusiastically took up the suggestion. She “played the role with such genuine vulgarity that she was unrecognizable. The audience was fascinated, it was a huge success. […] From then on, she preferred to perform in similar roles. Her husband understood immediately”.

The husband went to see Moreno every day. After a few days, he told him: “There has been a change […], she still has her outbursts of anger, but they have lost their intensity. They are also shorter; sometimes, she suddenly smiles because she remembers similar scenes she plays on stage. And I laugh with her for the same reason. […] Sometimes, she starts to laugh even before she has a fit because she knows exactly how it will go. Even now, she gets worked up sometimes, but in a much weaker form than before”.

The actress initially thought, felt, and acted toward her husband in equivalence mode. If she felt angry in his presence, she assumed that her husband was currently making her mad and, therefore, vented out her anger on him. She took it for granted that her internal image of the marital relationship, created through mentalizing, adequately reflected external reality. Thus, as Fonagy et al., (2004, pp. 96ff.) say, she “confused inner states (such as thoughts, fantasies, and feelings) with outer reality and perceived it as reality rather than as mere inner representations of reality”. But Moreno then let the actress act out her anger outbursts in the improvisational theater in the roles of offensive women, for example, in the role of a prostitute. Indeed, the actress still had to play out angry scenes with her husband at home. But even before that, she noticed that her angry behavior would correspond to her actions on stage, and thus laughed at the absurdity of the situation. She realized that her anger outbursts were part of her own character. As a result, she became aware of the inappropriate acting out of her anger. This improved their marital relationship.

When used appropriately, psychodrama techniques integrate the as-if mode of play into the equivalence mode of thinking. One thus becomes a director in his internal conflict processing.

Case example 9

A patient with borderline personality disorder, pornography addiction, and major depressive disorder (F33.3, F60.31, and F63.9) was narcissistically abused by his mother as a child and youth. He was also severely humiliated in his school frequently. According to the patient, the mother had aimed to raise him to become the prime minister someday. At the end of therapy, the patient said: “I now have more trust in my intuition. My ‘shoulder mother’ (the mother who breathes down his neck) is no longer there. Now, I have become the prime minister. But not the way my mother wanted it in the outer world, instead of in my inner world!” At the end of therapy, he could make adequate use of his good intuitive and cognitive abilities. He celebrated his new freedom and spontaneity with friends by throwing a party. He summed up his therapy outcome: “I have found myself!”.

Moreno described the therapeutic effect of psychodramatic play in 1923 in his book ‘Das Stegreiftheater’ (Moreno, 1970, p. 77 f.) with the following words: “Every true second time is the liberation from the first. Liberation is an ideal term because total repetition ridicules its object. We gain the aspect of being the creator in our own life, in everything we have done and continue to do—the feeling of true freedom, the freedom from our nature. The second time makes you laugh about the first time. The second time too—people appear to—speak, eat, drink, beget, sleep, wake, write, argue, fight, acquire, lose, and die. But […] every form of being is lifted by itself in the as-if mode, and being and as-if are lost in a laugh. […] This as-if is the unleashing of life. […] Prometheus has grabbed the bonds, not to overcome or kill himself. He brings himself out again and, through as-if, proves that his existence in bondage was the act of his free will”.

Central idea

In psychodrama, people can gain ego control of their dysfunctional thinking, feeling, and acting and become free to behave differently. They develop (1) the aspect of being a creator in their own life, (2) the aspect of being a creator in the cognitive processes of their thinking, and (3) the aspect of being a creator in their metacognitive processes of thinking.

2.7 The Neurophysiological Foundations of Psychodramatic Play

Important definition

In the course of life, humans record their physical and psychological experiences and conflict resolutions as neuronal connections between their different memory centers (Ciompi, 2004, p. 215; Roth, 2001). They create psychosomatic resonance patterns between individual sensorimotor interaction patterns, physical sensations, affect, linguistic concepts, and thoughts. The existing psychosomatic resonance patterns help to react quickly in the current situation, thereby saving the brain cells some work and energy. As a result, people don’t have to keep reinventing the wheel again and again in similar situations.

Fig. 2.8

The psychosomatic resonance circuit between the various human memory centers

Sensorimotor interaction patterns emerge when playing the piano, during sexual intercourse, when mountaineering, etc. Physical sensations include pain, exhaustion, or tiredness, for example. Political parties and states try to claim and occupy linguistic concepts such as ‘solidarity’ or ‘democracy’ for themselves. The words ‘freedom’ or ‘god’ activate a different psychosomatic resonance pattern shaped by personal experiences in each person. In psychodrama, shared language helps when mirroring (see Sect. 2.4.3) to classify personal perceptions in the memory stores under a different linguistic concept: A ‘beautiful childhood’ then becomes the experience of the ‘abandoned inner child’. Some psychodramatic warm-up exercises use the activation of sensorimotor interaction patterns through acting to activate inner energetic images and feelings that are then acted out. In contrast to the inner role reversal in thinking, the individual develops two different holistic psychosomatic resonance patterns, one of his inner self-image and the other of his inner object image, separate from each other, in the external role reversal in the as-if mode of play (see Sects. 2.9 and 8.4.2). In this way, he understands himself and others on a psychosomatic basis and psychosomatically recognizes the difference of inner self-protection and external affective release or the inner motivation for acting a certain way. He then knows how he and the opponent in the conflict tick in the relationship.

Exercise 6

You can do this exercise to experience how your psychosomatic resonance circuit works. (1) First, sit upright in your chair with your arms on your knees and close your legs. What does this posture evoke in you emotionally?—You are likely to feel a little fear, be highly alert, full of expectation, and more adaptable. (2) Now sit casually in your chair, half-lying and at an angle, with your arms crossed. What does this attitude evoke in you emotionally?—You probably feel more self-confident, superior to the person you are talking to, and more like someone who waits things out and not wants to go ahead. Through your psychosomatic resonance circuit, you have activated a connection between your physical posture and the associated physical sensations, affect, and thoughts.

Roth (2001, pp. 185 and 187) thinks that “creative people have more favorable features of the neuronal networks” than others and that “a lack of plasticity of the cognitive and executive system is a consequence of a lack of plasticity of the involved neuronal networks.” Psychodrama play helps the five different memory centers of sensorimotor interaction patterns, physical sensations, affect, linguistic concepts, and thoughts to participate more comprehensively in conflict processing: (1) Psychodramatic play activates the psychosomatic resonance circuits of the inner self-image and also of the inner object image and frees them from their fixation through interaction and role reversal (see Sects. 2.4.2 and 2.4.3). (2) It differentiates and completes the psychosomatic resonance circuit of inner self-development in the external conflict situation and loads it with energy. (3) New connections to other similar psychosomatic resonance patterns arise spontaneously and autonomously. In this way, people integrate current experiences with their past experiences (see Sect. 2.4.3). They spontaneously check whether they can also use the old solution in the current situation. (4) Psychodramatic play increases the complexity of the neurophysiological processes of conflict resolution. More complex structures achieve the same goal with less energy and, in the long run, become an advantage for survival (Ciompi, 2021, p. 114). (5) It frees the psychosomatic resonance circuit from fixations in obsolete psychosomatic resonance patterns. This is what Moreno (1959, p. 98) meant when he said: “However important verbal behavior may be, action precedes and encloses the word.”

In psychodrama, the therapist works together with the patient on the conflict level at which the dysfunctionality of his conflict processing arises. As an implicit doppelganger (see Sect. 2.5), she repeatedly carries out the inner conflict processing of the patient in herself via her own psychosomatic resonance between her five memory centers and thus understands what the patient communicates. If she doesn’t understand him, she asks the patient for the missing information: “What are you feeling in the role of your mother right now?” In the case of blockage through a defense, she uses the appropriate psychodrama technique (see Sect. 2.4) to free the patient’s internal self-development from its fixation in the current situation. In this way, the patient develops new, more suitable, and complex psychosomatic resonance patterns and more appropriate links between them of his own volition.

Important definition

The creative ego is the driving force and the integrating authority in the systemic process of inner self-development of humans in the current situation (see Sect. 2.1). According to Blanck and Blanck (1980, p. 32), this ego is “a metaphor. For it has neither form nor place—only function”. It is a “metapsychological construct that serves to facilitate understanding in theory formation and discussion, but which does not exist as such, because one can only speak of the existence of the ego if it functions.”

The concept of the psychosomatic resonance circuit is helpful in understanding the neurophysiological processes of conflict resolution. However, it still represents these processes in a simplified way. In reality, they are much more complex. The psychodramatic play intervenes in the interplay between the unconscious ‘Proto Self”, the consciously capable ‘Core Self,” and the ‘Autobiographic Self” (Damasio, 2001, p. 210). This interplay is characterized by ‘wide-ranging possibilities for the meta-representation of the information processing processes […] (for example in the prefrontal cortex): The brain models its own functioning’ (Schiepek, 2006, p. 11 f.). There are ‘structural and functional loops and recursive interrelated representations’ that ‘temporally and spatially coordinate the cerebral maps of reciprocal links, integrate sensory and motor events, and connect them to circuits, thereby giving rise to representations and metarepresentations. From a synergetic perspective, this is a result of multiple, parallel-networked, and hierarchically integrated systems that relate their self-organizing dynamic to one another and create synchronization patterns (folders) over widely ramified areas of the brain’. I call these synchronization patterns ‘psychosomatic resonance patterns’.

Psychodramatic play promotes the development of spontaneity and creativity in the conflict processing of humans and thus enables them to react adequately to a new situation and in a new way to an old situation (Moreno, 1974, p. 13). The liberating effect of self-determined play is evident not only in humans but also in animals. In the Süddeutschen Zeitung (1st/2nd March 2008, No. 52, p. 22), under the heading ‘Play is of apparent significance—it helps master life in the complex world,’ Breuer wrote: “The impulse to play is innate in most mammals; it is also to be found in some bird species, and sometimes even tortoises will play with a ball to pass the time. […] The roles of the hunter and the hunted are constantly reversed in the fight performed by young rats, lions, or foxes.” However, the play of animals is certainly not, as commonly assumed, a behavioral training for the seriousness of adult life. Kittens prevented from indulging in any form of play later demonstrated hunting skills equivalent to those allowed to play (Tim Caro, University of California).

On the other hand, Pellis (Sergio Pellis, the University of Lethbridge in Alberta, Canada, 2007) discovered that rats not allowed to play rough and tumble up to the age of puberty had a significantly underdeveloped medial prefrontal cortex in comparison to other rats permitted to play. Breuer continues, “This brain area is partly responsible for social competence. Therefore, Pellis believes that these animals would have difficulty dealing with numerous tasks in their lives.” Without play, animals are “less adaptable than would normally be the case”. Bekoff (Marc Bekoff, University of Colorado) claims to recognize “the evolutionary purpose of playfulness as being training for the unexpected.” Instead of simply learning specific patterns of movement for predictable situations, it is more about being able to physically and mentally adapt one’s behavior in a new situation quickly and adequately—and this talent is developed only in free play. Everything else could be learned, if need be, in other ways. Several indications support this point of view: Pellegrini & Kato (2002, p. 991 ff.) noticed that “boys who exhibited better skills at games involving fighting and clamor were also socially more competent. Children who were playful at a pre-school age were more adept at dealing with psychologically stressful situations”. In many studies, “three-year-old children […] who enjoyed taking part in make-believe games with others also performed well at tasks that required mind reading and emotional understanding” (Fonagy et al., 2004, p. 55). According to Lillard (1993, quoted by Fonagy et al., 2004, p. 56), “symbolic play can serve as the ‘zone of proximal development’ for those competencies […] that underlie the ability to read others’ thoughts.”

The significance of play in the development of mentalizing also becomes apparent in psychodrama psychotherapy for children. Moreno (1985, p. 132 f.) established that role play in spontaneity training made them appear more “intelligent” to others. When children with psychological symptoms participate in non-directive psychodramatic group therapy, they are mostly unable to play at the beginning of their treatment. They take on roles only for a short time and often stand outside the stage ‘simply’ as observers. But once they have learned to play, after sixty group sessions, most of them no longer display any symptoms. In symbolic plays, they developed their metacognitive tools of mentalizing and resolved the blocks in their conflict processing. They have now become freer to understand themselves and their conflict partner suitably in present conflicts and are able to find adequate solutions spontaneously. They have learned to appropriately shape the inner systemic process of their self-development as well as the development of their inner self-image and inner object image in the external situation.

Central idea

According to Winnicott (1985, p. 63), the ability to play is a central prerequisite for the success of therapy, even in adult psychotherapy: “Those who are not able to play must first learn to play. Interpretations made too early are simply useless or have an unsettling effect. […] They lead to adaptation.” To understand an interpretation, the patient must be able to expand the verbal interpretation to include the associated psychosomatic resonance pattern and link it to other similar psychosomatic resonance patterns. In doing so, the patient thinks in the as-if mode, internally moves back and forth between different interaction patterns, and creates meaningful contexts between them. He plays internally in this process. The psychoanalyst Winnicott, therefore, let some of his severely disturbed patients, who couldn’t play, learn to play in three-hour therapy sessions.

2.8 The Diagnostic Psychodramatic Conversation

The diagnostic psychodramatic conversation is a standard psychodrama method employed in individual therapy, counseling, and coaching. It helps a patient to mentalize his conflict (see Fig. 2.9 below). I use this method in almost every individual session, including the first session.

Fig. 2.9

The external psychosomatic separation of the patient’s symptom scene from the therapeutic relationship in the diagnostic psychodramatic conversation

• 1. Before your conversation with your patient, place two additional empty chairs for the symptom scene in your therapy room at a small distance from where you will be sitting with your patient (see Fig. 2.9). The chair next to the patient symbolizes his inner self-image in his recalled conflict, and the other chair opposite this chair symbolizes his inner object image, for example, his internal image of his conflict partner. Both the empty chairs should be placed such that they directly face each other. They should not face the patient and the therapist because the chairs represent the patient’s inner conflict image in another place and time.

• 2. You can start with a standard, verbal therapeutic conversation about the patient’s argument with his conflict partner. In doing so, the patient shouldn’t move to sit on the empty chair as he would in a psychodrama role play. You will intuitively look for a scene that creates or amplifies the patient’s symptom or shows how the patient deals with the symptom.

Central idea

The two additional chairs in the therapy room represent the patient’s inner process of self-development in his everyday conflicts, separate from the therapeutic relationship (see Chap. 1). This process includes the development of the inner self-image and the inner object image. The patient and the therapist thus answer the question of who interacts with whom and how in the patient’s conflict.

• 3. During the conversation, as a therapist, point with your hand to the empty chair that symbolizes your patient’s internal self-image while discussing his thoughts, feelings, and actions in his conflict. But please point to the empty chair representing the internal object image when you both discuss his conflict partner’s thoughts, feelings, and actions. Stretch out your arm entirely in doing so. In the event of a mood disorder, create a suitable interaction frame for the patient in the symptom scene for his depressive mood in his everyday life. The chair for the self-image then symbolizes, for example, the depressed, listless patient in his bed. The chair for the object image symbolizes his wife, who takes care of him, or his boss, who waits in vain for him at work.

• 4. Look at the respective chairs when pointing toward them. This is a prerequisite for the patient to look at the two chairs in his symptom scene. Imagine the interactive process in the conflict scene internally as if you were watching a movie.

• 5. During the conversation, let your patient reconstruct the chronological sequence of interaction patterns step by step in his conflict from memory while looking at the two empty chairs. Ask him: “How did this conflict with your partner begin? What is the current situation of your conflict? What did you think, feel, and do? What happened next?”

• 6. Ask the patient step by step: “What did you think? … feel? … do in this situation?” “What do you think your partner felt? What did she think? What did she do?” Thus, the psychodramatic conversation also includes the technique of circular questioning from systemic therapy.

• 7. If necessary, extend the representation of the symptom scene to a full circle of 3–8 empty chairs when counseling a family or a team. These would then represent all those involved in the conflict.

Recommendation

You cannot understand the therapeutic effect of the psychodramatic conversation just by reading. This is because your therapeutic impulses to act also emerge psychosomatically. Therefore, try to apply the method of diagnostic psychodramatic conversation in your practical work with patients.

You will notice that your therapeutic work or counseling becomes therapeutically more effective through this seemingly simple technique of “psychodramatic conversation”. The reasons are:

• 1. The patient’s emotionally meaningful conflict or symptom and its energy shift become externally visible on the other two chairs. The therapist and the patient can define the conflict to be discussed more efficiently and keep the focus of their conversation on that one conflict. It is more difficult for the patient to jump from one subject to another.

Important definition

But some patients change the subject in the psychodramatic conversation again and again. That indicates a structural disorder in the patient. Changing the subject helps the patient protect himself from emotional conflict energies that arise as a result of him concentrating on one individual conflict. Perhaps he might struggle in dealing with the conflict because of insufficient ego strength.

Central idea

In the psychodramatic conversation, the patient and the therapist look, from the observer’s position, at the patient’s everyday conflict on the other chairs and retrace the interaction sequences in his inner conflict image chronologically in the as-if mode of thinking. They look, from a metaperspective, similar to psychodramatic mirroring. They develop a joint new assessment of reality in his everyday conflict. This frees the patient’s inner self-development in the everyday conflict from the defense through rationalization (see Sect. 2.4.3).

Recommendation

The psychodramatic conversation method systematically improves the patient’s cognition in his everyday conflict by resolving the defense through rationalization. It could therefore make cognitive behavioral therapy more effective.

Question

Why do the patient and therapist feel more free to relate to each other in the psychodramatic conversation than in a normal verbal conversation without the two additional chairs?

• 2. During the psychodramatic conservation, the therapist and the patient internally project the patient’s conflict from his everyday life externally on the two empty chairs. In doing so, they separate the patient’s psychosomatic resonance pattern (see Sect. 2.7) in the current therapeutic relationship from his psychosomatic resonance pattern in his everyday conflict then and there by representing them externally with chairs. As a result, the patient can easily speak about emotionally intensive conflicts, panic attacks, or delusions. A psychosomatic resonance pattern connects the sensorimotor interaction pattern, physical sensations, affect, linguistic concept, and thought in the current situation (see Fig. 2.8 in Sect. 2.7).

• 3. But the therapist also internally projects the patient’s psychosomatic resonance pattern from his everyday conflict onto the other two chairs. She sees ‘two patients’: the patient in the current relationship with her and the ‘other patient’ in conflict with his opponent then and there. This reduces the emotional pressure of conflict in the current therapeutic relationship. The therapist feels more free and creative. She can make better use of her therapeutic skills. Transferences and countertransferences occur less quickly.

• 4. Looking at the two empty chairs in his symptom scene repeatedly, the patient focuses less on whether he is being understood by the therapist and what the therapist could be thinking of him. This reduces his distrust of the therapist. As a result, he feels more free in dealing with himself and his relationship conflict.

• 5. The patient sees the inner object image of his everyday conflict on the other chair in front of him in the here and now. This actualizes his perception of his feelings toward his “conflict partner”, thereby intensifying the experience of the therapeutic conversation.

• 6. The patient and therapist stand shoulder to shoulder and look at the external representation of the patient’s conflict. The therapist helps the patient retrace the confrontation in his externally represented relationship conflict from his memory in the as-if mode of thinking. She accompanies him as an implicit doppelganger in the inner interaction with his conflict partner in his everyday conflict and verbalizes her perceptions in his conflict on his behalf, if necessary. She may even allow the patient to rehearse the potential future mentally and consider the impact of her new behavior. The shared differentiated mentalizing of the patient’s conflict takes time. It enables, differentiates, and expands the patient’s inner conflict processing. The psychodramatic conversation improves the patient’s cognition in his conflict.

Central idea

Shoulder to shoulder means: The therapist implicitly becomes a doppelganger for the patient in his inner process of self-development in his everyday conflict. The therapist and patient together look at a third person or an object, shoulder to shoulder,

• 7. The patient and the therapist focus their joint attention on the inner development of the patient’s self-image and object image in his everyday conflict. They experience that the development of his self-image and object image are mutually dependent. Thus, they gain a systemic view of his everyday conflict. As a result, the therapist is less likely to identify unilaterally either with the patient or his opponent in his conflict situation.

The therapist can also use psychodramatic conversation in group therapy. She sits together with the group members in a semicircle. She represents the inner self-image and object image of an individual group member with two empty chairs on the stage (the open side of the semicircle). She alternatingly points to one of the two empty chairs when talking about the individual’s conflict. The psychodramatic conversation then focuses only on one theme for group discussion and activates the mentalizing of the protagonist as well as of other group members.

2.9 Psychodramatic Self-Supervision and Supervision

The effect of the psychodrama techniques is not dependent on the therapist’s direction. You can try it out. Try to solve a relationship conflict from your everyday life on your own, with the help of psychodrama techniques, without any guidance from a psychodramatist. In doing this, apply the method of psychodramatic self-supervision (Krüger, 2011, p. 201 f., Krüger, 2017a, 2017b).

Case example 10

40 years ago, I was working as a doctor in the polyclinic of the Hannover Medical School. I had been suffering increasingly for months due to the conflicts with our chief physician. He seemed to reject me. Our relationship was tense. As a psychodrama trainee, I finally decided to clarify the problematic relationship for myself using psychodrama. In my living room at home, I placed an empty chair in front of me and imagined my chief physician sitting on the empty chair opposite me, as I had learned: What does he look like, sitting there? What is his posture like? What gestures is he making? Then I told my ‘chief physician’, beyond the boundaries of reality, everything that had been bothering me about him: “I am hard working. I think about what I’m doing. But you keep dismissing me. Am I doing something wrong? I don’t even know what you want anymore!” Then I changed to the role of the chief physician. I sat on his chair and assumed his posture: I sat up straight as a rod. I became paternal in my gestures. I suddenly noticed: “Ah, that’s what it’s like! It feels like I have a walking cane inserted in my back instead of a spine!” In the role of my chief physician, I felt bothered by this spontaneous, lively assistant. I struggled to maintain my composure when faced with him. I was afraid of forgetting myself and losing track of things. Back in my role, my anger at the chief physician had disappeared. I thought: “If the cold shoulder treatment I’m receiving from this man is merely self-protection, and he isn’t rejecting me, then I don’t have a problem with it. I can leave him to it!” My tensions in the relationship with my chief physician were gone the very next day in the polyclinic. They also never came back later.

The enactment process helped me mentalize and think through the conflict to the end. As a result, my internal image of my chief physician expanded to include the knowledge of his “self-protective behavior”. I had reenacted the body posture of my senior physician and, in doing so, experienced his psychosomatic sensorimotor blockade (see below and Sect. 2.7). My changed inner object image allowed me to see him with fresh eyes in everyday life.

Exercise 7

Please apply the method with psychosomatic acting. You can’t understand the great therapeutic effect just by reading about it. Engage in a fictional psychodramatic dialogue with your’ conflict partner’ using role reversal. You can use this exercise even if you are not a psychodramatist. This work requires only 5–20 min. Apply the 12 rules given below when you do psychodramatic self-supervision:

• 1. Choose a room for your self-supervision in which you will be alone and undisturbed.

• 2. Place an empty chair in front of you for your conflict partner or a problematic patient, and imagine this person is sitting on the chair.

• 3. Look at your ‘conflict partner’ on the empty chair. First, determine internally what overall impression you have of this person. Notice the object image on the second chair in the here and now. Don’t imagine a situation from the past.

• 4. Name the affect that the sight of your conflict partner triggers in you. This is exhausting because a conflict partner often forbids you to feel what you feel. Communicate this feeling verbally to your conflict partner.

• 5. The ensuing psychodramatic dialogue should be purely fictional. Express everything you think and feel toward your conflict partner and ask all the questions you would like to ask them. Get everything out! For example, if you are a therapist, do not treat your ‘patient’ therapeutically. Instead, speak freely and authentically to him in the psychodramatic dialogue. You cannot hurt him in reality because your conflict partner is not sitting on the other chair in reality. You “only” imagine him.

• 6. During the dialogue, speak out loudly in both roles.

• 7. After every action, reverse roles and respond from your conflict partner’s role as you think they would react. In the conflict partner’s role, ensure that you always assume their posture. It is essential to do this because you enter the subjective role experience of your conflict partner also psychosomatically.

Exercise 8

You can check this observation with an exercise. Sit on your conflict partner’s chair and, as an experiment, take on a completely different posture; for example, sit in an extremely relaxed manner or very upright. You will notice that a different posture creates a different physical and mental state in you. As a result, another psychosomatic resonance circuit is activated in you (see Sect. 2.7).

• 8. Make sure that you reverse roles frequently. This is important because if you say too many things to your ‘partner’ at once without reversing roles, you will not be able to react to each statement when you change into his role.

• 9. Check again and again what you physically feel in your own role. Name the affect that you are feeling. In doing this, be careful not to confuse your feelings with your thoughts. Tell your’ conflict partner’ what you feel during the dialogue, openly and often.

• 10. Try and feel, at least once, exactly what you feel in the role of your conflict partner, too. Name his affect for yourself also. In doing this, the point is not to learn to empathize better with your conflict partner but to understand how he steers himself in the relationship.

• 11. End the dialogue when you intuitively get the feeling: “Now I have understood what it is all about,” or after 15 to 20 min if you realize: “I can’t go any further right now!”

• 12. At the end of the psychodramatic dialogue, immediately write down the answers to the following questions on a piece of paper: 1. What was new for me in the actual enactment in my experience in my conflict partner’s role or my role? 2. What became clearer for me during the dialogue? Please write down your experience from the play without any interpretations! It is important to note down your answer immediately! Otherwise, within a few hours, you will forget your psychosomatic experiences in your and your conflict partner’s role, along with the new findings. Even seemingly trivial experiences in the play can be significant for your inner conflict processing (see case example 10).

Central idea

You can recognize the success of the psychodramatic self-supervision based on three indices:

• a. Your internal state of tension subsides in your relationship with your conflict partner.

• b. Your negative feelings toward him disappear.

• c. You become curious about the next real encounter with your conflict partner. The twelve steps of psychodramatic self-supervision correspond to the instructions that a psychodrama leader would give. They are a synthesis of many years of practical experience with psychodramatic dialogue in various fields of work. Therefore, each of the twelve steps is important. Psychodramatic self-supervision helps the protagonist extend his individualistic view of the conflict to a systemic view (see case example 10).

Recommendation

In psychodramatic self-supervision, take your psychosomatic experience in the role of your conflict partner seriously. Indeed, this is “only” your inner construction of your object representation. But this experience is much more differentiated and psychosomatically more comprehensive than if you try to solve the conflict just by thinking. For example, during the role reversal in the as-if mode of play, you psychosomatically experience the connections between his sensorimotor interaction patterns, physical sensations, affect, linguistic concepts, and thoughts (see Sect. 2.7) when in the role of the conflict partner (unlike in a real encounter). In this way, you differentiate and complete your inner object representation and develop a more complete and coherent inner object image.

Some psychodrama therapists say: “I practice self-supervision only in thought. That works too!” Of course, it works. But the result will remain unclear. Therefore, it is better to practice self-supervision with the help of two chairs!

Central idea

In the psychodramatic self-supervision, you complete the two holistic relational psychosomatic resonance patterns of your inner self-image and also your inner object image in the relationship through the external role reversal. In doing so, you use your five neurophysiological senses: sensorimotor acting, physical sensations, feeling your affect, searching for linguistic concepts, and develo** associated thoughts. And you guide them with your intuition. Completing a holistic psychosomatic resonance pattern helps you to psychosomatically experience whether your conflict partner is acting a certain way on the outside because he wants to protect himself internally, or whether he really rejects you (see case example 10). You then know his true motivation and how he ticks.

The frequent external role reversal realizes the interacting and rehearsing in your conflict processing. You will learn to identify and differentiate the cause and effect and your and your conflict partner’s share in the conflict in your relationship.

Empirical evidence demonstrates that psychodramatic self-supervision when used per the above guidelines, leads to progress in inner conflict processing in 80–90 percent of conflicts. This also applies to long-term conflicts. The reasons for this are:

• 1. In psychodramatic self-supervision, you use three psychodrama techniques to freely implement three tools of mentalizing in your conflict processing in the as-if mode of play, namely representing, interacting, and rehearsing (see Sect. 2.2).

• 2. In a conflict, the inner role reversal is more or less blocked by the defense through projection and introjection. Otherwise, you would know how to resolve your conflict. In self-supervision, however, you free your inner role reversal from its fixation through frequent external role reversal (see Sect. 2.4.3). In doing this, you will discover the cause and effect of your relationship conflict (see Fig. 2.5 in Sect. 2.3). In addition, you will recognize your own part as well as your conflict partner’s part in the conflict.

• 3. In acute conflicts, everyone defends themselves more or less through introjection and projection. Humans defend through introjection if they inappropriately internalize an attribution or expectation of the conflict partner in their self-image. In doing this, the conflict partner’s statement “You are a difficult person” becomes “I am a difficult person!” In the fictional dialog, however, the protagonist names his own true affect and expresses it openly to his “conflict partner”: “I am hurt and angry at you.” He expands his inner self-image of “I am difficult” to include his affect “I am angry”. In doing so, he breaks the taboo imposed by his conflict partner and allows himself to feel what he feels. In this way, he can freely develop an appropriate inner self-image again in a new, real encounter and reassess whether he is really difficult in this situation. His defense through introjection is resolved (see Sect. 2.4).”

• 4. Humans defend through projection when they are fixed in a biased inner image of the object, for example: “He only wants to assert his interests.” However, in the external role reversal, the protagonist enters his conflict partner’s inner world and psychosomatically experiences: “I try very hard to make everything work! I mean well!” In this way, the protagonist supplements his inner object image of “He only wants to assert his interests” with the feeling “I’m trying very hard and mean well!” The development of his inner object image is thus set in motion again. In the next real encounter, the protagonist notices those actions and feelings in the conflict partner which he had previously suppressed. The defense by projection is resolved.

Central idea

After the psychodramatic self-supervision, the protagonist usually does not yet know how he will behave in a real encounter with his conflict partner. So he checks again in the next real encounter: ‘Is my conflict partner who I thought he is? Or is my experience in his role in self-supervision true?’ The protagonist spontaneously reorients (see case example 10) and tries to deal with himself and his conflict partner in a new and appropriate way. This makes the relationship more collaborative.

Important definition

Psychodramatic self-supervision frees the internal systemic process of self-development in the current situation (see Sect. 2.1) from its fixation in defense. This process includes the constant further development of internal self-image and object image in the course of external interactions. Humans complete the internal process of self-development through mentalizing: the inner representing of self-image and object image in the current external situation (see Sect. 2.4.1), interacting and mentally rehearsing between self-image and object image, and integrating. The further development of the inner self-image also changes the inner object image, and vice versa (see Sect. 8.4.2).

10–20% of people do not progress in their conflict processing by psychodramatic self-supervision because they suffer from deficits in the ability to mentalize (see Sect. 4.4). As a result, they cannot adequately work out the difference between their own and their conflict partner’s experience in the external role reversal. In such a case, the affected person should get therapeutic help to re-develop his mentalization tools and the ability to reverse roles.

Most people make remarkable progress in less than 20 min when using psychodramatic self-supervision to process their conflicts internally. And yet, everyone has an inner resistance to this work. The reason is: The affected person has to be interested in the needs and motivations of his opponent when reversing roles. That provokes displeasure. The displeasure makes one find excuses: “Self-supervision will offer me nothing new. I can manage the conflict by reflecting on it.” People usually succeed in doing this. However, the old way of processing conflicts usually takes longer and costs more energy overall.

A high degree of psychological strain in the conflict or the desire to learn to think systemically in conflicts are good motivating factors to overcome the natural resistance against psychodramatic self-supervision. I decided to practice the method of psychodramatic self-supervision at least once weekly, always on a Monday. Sometimes I do it two to six times a week. I use it in private relationship conflicts, to prepare myself for a difficult conversation, or as self-supervision in relationships with patients. It takes only 2–10 min because I am well-trained to do it.

Central idea

Regular psychodramatic self-supervision makes me braver and more humble in private relationships and therapeutic relationships with patients. I practice it as a spiritual exercise, with the same sincerity I meditate daily. Thus, I try to take responsibility for the development of my inner object images and inner self-image in difficult relationships and to resolve my projection and introjection again and again. The constant liberation of my self-development from its fixations makes me more alive and creative (see Chap. 1).

Try it out for six months! You will become more spontaneous, more lively, and more capable of managing your relationships. In doing this, you materialize again and again the psychodramatic vision of the spontaneous-creative human (see Sect. 2.1) and develop it further within yourself. I often recommend the exercise for participants of introductory seminars, therapists, or students for their own personality development and their “psycho-hygiene”. I also teach the method to patients, sometimes at the beginning of a course of therapy but usually within the last third of the therapy process (see Sect. 5.11). When patients practice psychodramatic self-supervision at home once a week, they save themselves valuable therapy sessions.

In the last ten years, private and social human conflicts have intensified energetically through the climate crisis, the Ukraine war, and Corona crisis. These crises result in social splits and the development of enemy images. I recommend opposing these destructive developments. Psychodramatic self-supervision helps to resolve enemy images and promotes cooperation instead of confrontation because the protagonist systematically gives the conflict partner the right to exist. The protagonist fully verbalizes her own truth in the relationship beyond reality. But she also explores the truth of the conflict partner in role reversal. Gandhi says: “Truth is God.” Realizing the truth in a relationship is the basis for every sustainable conflict resolution.

Central idea

Regular psychodramatic self-supervision is peace work. During the Cuban Missile Crisis, Moreno demanded: Kennedy and Cruschtschow should make role reversal with each other. I think, according to Gandhi, we should only ask of others what we do ourselves.

Recommendation

In the case of purely online therapy, the therapist should carry out self-supervision with the “patient” in her room after four sessions. This is because the interpersonal psychosomatic resonance between the therapist and the patient is partially blocked in the online encounter via video. Psychodramatic self-supervision helps the therapist close any gaps in her psychosomatic perception of the patient by playing the patient’s role (Krüger, 2021).

Therapists can use the psychodramatic self-supervision even in the case of disturbances in the therapeutic relationship. Thus therapists can solve approximately 40 percent of their supervision cases without the help of a supervisor. In a further 50 percent of cases, it may be that they gain a new insight or something becomes evident to them, and they resolve countertransference. But in these cases, their state of internal tension and their primary negative feelings concerning the patient remain unchanged. This can be a diagnostic indicator that the emotional reaction of the therapist is an appropriate reaction to splitting processes within her patient’s self-regulation: By acting in the therapeutic relationship, the patient delegates a split-off part of self to the therapist. The therapist, however, unconsciously introjects the patient’s split-off part of self into her ego through her empathy for the patient. For example, she vicariously feels the negative affect split-off from the patient (see Sect. 4.8). In such cases, the therapist should therefore not respond inappropriately to her own appropriate negative affect as that would result in the acting out of countertransference. Instead, she should continue the psychodramatic self-supervision with the following five additional steps: (see Sect. 4.8):

• 13. The therapist makes an internal paradigm shift and focuses her attention no longer on the patient but on herself. She acknowledges her own disorder in the relationship.

• 14. Before going through the 12 steps of self-supervision, she felt a negative emotion toward the patient. She remembers this negative affect and names it, for example: “I was afraid”, “I felt powerless”, “I felt confused,” or similar. It is difficult to name one’s own affect because the patient unconsciously forbids the therapist from perceiving and feeling.

• 15. The therapist determines the actual external behavior of the patient that triggered this negative affect in her. She internally attributes this external behavior to one of the six possible dysfunctional ego states (see Sect. 4.7): the patient’s self-injurious thinking, his ‘self-protective behavior through adaptation or grandiosity’, ‘his inner traumatized or abandoned child’, ‘his inner angry child’, his ‘traumatized self’ (see Sect. 5.8) or his ‘addictive thinking and feeling’ (see Sect. 10.5). In doing so, she grasps, for example, not the contents of his self-deprecation (“It’s always like that with me! I just take a back seat then. I can’t do it any other way! I’m just incapable!”). Instead, she centers her attention on the dysfunctional metacognitive process, his ‘self-injurious thinking’ (see Sects. 4.7 and 4.8) which creates different thought contents of his self-deprecation, and responds: “I call that, what you are doing right now, as self-injurious thinking. You have a self-deprecating voice within you that says to you: ‘What? Do you have a will of your own? Shame on you!’”

• 16. The therapist continues the self-supervision. She represents the patient’s dysfunctional ego state with an empty chair externally in the therapy room (see Sect. 4.7). She places the chair for self-injurious thinking opposite him or the chair for one of the other ego states next to him (see Fig. 4.1 in Sect. 4.2). It may be that the therapist suspects the patient may have a borderline organization. She then places a second chair next to the patient for his ‘dependent and needy side’ when the patient is acting in an authoritarian, independent manner. If he is currently acting in his dependent and needy ego state, she places next to him a second chair for his ‘authoritarian, independent side’ (see Sect. 4.9).

• 17. The therapist continues the psychodramatic dialog of self-supervision. In doing so, she integrates the second chair for the dysfunctional ego state of the patient into her outer perception. Perhaps the internal state of tension and the therapist’s negative emotion toward her “patient” dissipate through steps 13–17 of the self-supervision. That is a diagnostic indicator that the patient is fixated on a rigid defense system and suffers from a personality disorder. The therapist frees herself from her complementary counter-reaction by naming and representing the patient’s dominant rigid defense pattern with a second chair beside him.

Central idea

If the internal state of tension and the therapist’s negative affect in the therapeutic relationship are resolved by going through steps 13–17 of self-supervision, she can also use these steps in the patient’s real therapy as intervention techniques.

In psychodramatic self-supervision, the therapist often speaks of subjects to which she fears the patient would react allergically in a real encounter. In role reversal with the ‘patient’, she notices that sometimes her intervention positively ‘reaches’ her in the role of the ‘patient’ and that she, as the patient, is not hurt by the intervention and considers terminating therapy. This gives her the courage to also use these interventions in real encounters.

You can also use steps 13–17 of the psychodramatic self-supervision to clarify personal conflicts, for example, in a professional relationship with a colleague. You will become more spontaneous toward your conflict partner and find new solutions in the relationship. You will also become more tolerant of a difficult trait of your conflict partner without betraying yourself. In the encounter with your conflict partner in everyday life, always imagine the chair for his dysfunctional ego state next to him. Your cooperation will improve.

In an experimental effectiveness study, Marlok et al. (2016) proved the efficacy of self-supervision for the practice of counseling. The authors compared psychodramatic self-supervision with a supervision technique based on the writing paradigm by Pennebaker (1997). According to Pennebaker, the consultant writes down all of his thoughts and feelings from a consultation session without any control or censorship. Both techniques contribute ‘to a reduction in feelings of emotional strain and blockage… In the case of psychodramatic self-supervision with role reversal, however, there was a considerably greater improvement in the ability to care for the client and to counsel him in a truly helpful manner.’

Recommendation

As a therapist, practice psychodramatic self-supervision once a week with your “patient” or “client” for just 5–10 minutes. You will notice: (1) You attune yourself to the patient’s mood (Johann Braun 2022, only verbal communication!) and orient yourself in the therapeutic relationship. (2) You become more brave and humble in the real encounter with your patients. You are more clear in your communication because you are more certain of what you trigger in the other person with your answers. (3) You believed that you didn’t have any problems with your patients. But, in choosing a patient, you intuitively and unintendedly will have selected a problematic relationship. (4) Your therapeutic work becomes Encounter-Focused Therapy.

A qualitative study that I coordinated confirms the findings of Marlok et al. even for the field of psychotherapy: Six therapists carried out psychodramatic self-supervision for three of their patients after every fourth session, for 10–20 min over five months. They noted down the results. Finally, they compared the process of these three treatments with three others with a similar degree of severity and for which they carried out no self-supervision.

The psychodramatic self-supervision changed the therapeutic relationship. But, of course, the changes did not always occur in all cases and not in the same way. Below, I summarize the therapists’ responses:

• 1. In the therapy sessions using psychodramatic self-supervision, the therapists felt more strongly connected to their patients in the sense of unconditional acceptance. Their communication and the encounter was deeper. The therapists were less afraid of being pulled into the patient’s suffering due to their empathy. They could be genuinely compassionate toward the patient due to a secure relationship with their own self.

• 2. They often resolved their own defense through introjection or projection and their countertransference reaction, sometimes their own transference.

• 3. As a result of the physical-emotional experience in both roles, the therapists could diagnostically understand the inner dynamic processes of the patients better.

• 4. The therapists did not become latently irritated as quickly. They adhered less to preconceived hypotheses. As a result, the real encounters with the patients became more spontaneous and creative. The therapists were often astonished, more curious, and authentically interested in their patients.

• 5. The therapists were able to notice their emotional reactions more easily and spoke about them with their patients more frequently. They showed more courage, for example, in empathetically confronting their patients. Their patients felt understood and supported nonetheless.

• 6. The patients became more open and sincere, too. They also dared to mention their irritations in the therapeutic relationship. The patients experimented more in their everyday life.

• 7. The therapists became more patient with their clients and with themselves. One therapist, for example, felt helpless and incompetent in working with a person with trauma and chronic pain. He had seen no progress in therapy. However, self-supervision helped him realize that the patient highly appreciated him and his work nevertheless.

Psychodramatic self-supervision is therapeutically more effective than self-reflection (Marlok et al., 2016) because it applies the metacognitive tools of mentalizing as psychodrama techniques in its free form.

The research findings for psychodramatic self-supervision without guidance from a professional are astoundingly similar to those of a qualitative study on the effectiveness of role reversal in one-to-one supervision directed by a supervisor (Daniel, 2016). The 17 steps of psychodramatic self-supervision are also a model for psychodramatic supervision by a supervisor.

In supervision, the therapist or counselor usually presents a case in which a patient’s defense and the therapist’s countertransference have caused a disturbance in the therapeutic relationship. The patient acts out old, inappropriate solutions, and the therapist responds in a more or less complementary way. Many supervisors let their supervisees verbally narrate their cases in supervision with findings, anamnesis, and their therapeutic experiences. Together they search through a wealth of information to find the heart of the patient’s and the relationship’s disorder. This process is tedious and prone to error.

It is easier and less prone to disruption if the supervisor lets the supervisee conduct a fictional psychodramatic dialogue with her “patient” using the 17 steps similar to psychodramatic self-supervision because the core disturbance of the patient is often reflected as a disturbance in the current therapeutic relationship. The first 12 steps of the fictional psychodramatic dialogue systematically liberate the therapist from her defenses through introjection or projection and, thus, from her own countertransference through unconscious concordant identification with the patient or complementary identification with his conflict partner.

The first 12 steps of self-supervision for patients with a personality disorder reveal the heart of the disorder. Indeed, the supervisee becomes empathetic again. But usually, she does not know how to proceed therapeutically. She is trapped between her “patient’s” rigid pattern of defenses and her own negative emotional reaction to his defense. Therefore, the supervisor asks the supervisee to go through steps 13–17 of psychodramatic self-supervision. The supervisee thus makes the patient’s rigid defense pattern the object of therapeutic communication. In doing this, the supervisee uses mental rehearsal in the psychodramatic dialogue. Thus she finds out which therapeutic interventions can dissolve the patient’s personality-specific rigid defense and which interventions leave his defense untouched or even strengthen them. In individual supervision, the supervisor as a doppelganger can take on the role of the supervisee and the supervisee plays the role of his own patient. In doing so, they testify whether new therapeutic interventions could be helpful or not. In group supervision, other group members, as doppelgangers, take on the role of the supervisee, not the supervisor herself.

2.10 Disturbances in the Therapeutic Relationship, Transference, Countertransference, and Resistance

The psychodrama techniques implement the tools of inner mentalization in the as-if mode of play. During the play, the therapist internally accompanies the protagonist’s systemic process of self-development (see Sects. 2.4 and 8.4.2) in his conflict processing as an implicit doppelganger by develo** the patient’s inner self-image as well as his inner object image in his conflict.

Central idea

A prerequisite for appropriate psychodrama techniques is that the therapeutic relationship flows without any fixation. If the relationship between the protagonist and the therapist is disturbed, the therapist’s spontaneity is blocked. For example, she ‘forgets’ to use role reversal if she unconsciously identifies with the protagonist or his opponent. Addressing the disturbances in the therapeutic relationship, therefore, takes precedence over protagonist-centered plays.

I first used the method of psychodrama in group therapy in 1974. In the beginning, I let the patients present their problems in long protagonist-centered plays. But four of my patients discontinued therapy during the first four weeks. Today I think they were right to leave because I overwhelmed the protagonists for my learning. This experience resulted in me engaging with the topics of defense and resistance (Krüger, 1980). I had to learn: that psychotherapy is about the people first and only then about the psychodrama method. Unlike in psychodrama training groups, I have to proceed with small steps in a therapy group. The souls of the patients do nothing without a purpose.

How shall a psychodrama psychotherapist deal with disturbances in the therapeutic relationship? Moreno was known for having a rather directive leading style as a group leader. He believed that “Resistance simply means that the protagonist does not want to participate in the production. It is, therefore, a challenge for the therapist to overcome this initial resistance” (Moreno, 1946/1985, p. VIII). What Moreno referred to as ‘resistance’ is called ‘defense’ in depth psychology. A patient who fixates on a defense in the current relationship subconsciously uses an old solution pattern learned in childhood, even though this pattern does not fit the current situation. In terms of depth psychology, I understand resistance as a combination of transference from the patient and countertransference from the therapist. The combination of transference and countertransference interferes with therapeutic progress.

There are four different disturbances in a therapeutic relationship, (1) disturbances caused by the patient’s defense, (2) disturbances caused by the patient’s transference on the therapist, (3) disturbances that are brought about by the therapist’s transference on the patient and (4) disturbances caused by the patient’s transference as well as the therapist’s countertransference. By definition, the therapist and patient always act out their transference and countertransference unconsciously.

If the patient is acting out transference in the therapeutic relationship, he subconsciously acts out an old interaction pattern that he learned in childhood or its opposite. If the transference is positive, he perceives the therapist, for example, as the good mother he did not have. In doing so, he imposes a taboo on the therapist, preventing her from develo** any negative feelings toward him. In such a case, the therapist is enticed to continue to be loving and caring, even though she no longer wishes to. If she doesn’t notice this, she reacts with positive countertransference. Her positive countertransference interferes with further progress in therapy. She then doesn’t justify her own feelings and acts out her countertransference.

If the patient’s transference is negative, the patient experiences the therapist similarly to an inadequate caregiver in childhood.

Recommendation

The therapist should first resolve her countertransference before working on the patient’s transference. Otherwise, the work on the patient’s transference will be distorted by the therapist’s defense through projection or introjection. When the therapist recognizes her countertransference and dissolves it, she perceives the patient in a different light. As a result, the patient’s ‘resistance’ sometimes disappears on its own (Dieckmann, 1981, p. 56; Klüwer, 1983, p. 830 f.).

It is therapeutically not helpful to consider the therapist’s every emotional reaction to the patient as countertransference. I recommend defining countertransference as the therapist’s unconscious reaction to the patient. I distinguish three different levels of countertransference: (1) conflict-related countertransference, (2) character-related countertransference, and (3) disintegration-related countertransference.

• 1. Conflict-related countertransference: The therapist accompanies the patient internally as an implicit doppelganger in his inner systemic creative process of self-development. If the patient is stuck in a certain inner object image or inner self-image through projection or introjection, the therapist becomes curious about how the patient’s conflict partner would react if the patient behaved differently. However, the patient considers it taboo to question his own view of things. This fixes the therapist in the complementary counter-reaction. Therefore, if the patient has a fixed inner object image, she defends by projecting it onto the patient, fixes it onto her own biased object image, and hides the patient’s unsuitable actions from her perception. Accordingly, when the patient defends through introjection, the therapist is often fixed in her own defense through introjection and adapts to the patient’s expectations. The 12 steps of psychodramatic self-supervision (see Sect. 2.9) can help the therapist to resolve an unconscious identification with the patient or his conflict partner.

• 2. Character-related countertransference: Patients with personality disorders defend through projective identification (see Sect. 2.4.3). The therapist accompanies the patient in his internal systemic process of self-development in the current situation. But, this process is blocked through a rigid defense. Thus, the therapist automatically identifies with the patient’s defended part of self and tries to enforce its right. But, the patient fights it by acting out his defense. The therapist then reacts to the patient’s rigid defense with an appropriate negative affect (helplessness, anger, resignation) (see Sect. 4.8). When the therapist suppresses her appropriate negative affect, she acts out her character-related countertransference. She then devalues the patient or herself: “The patient is too ill.” “He’s acting like a kid.” Or, “I’m incompetent”, “I don’t have enough experience.” The therapist can resolve the disturbances in the therapeutic relationship through steps 13–17 of psychodramatic self-supervision (see Sect. 2.9).

• 3. Disintegration-related Countertransference: The patient’s communication or actions indicate self-disintegration and arouse anxiety in the therapist. She fixes her biased inner object image on the patient’s strange communication, stops her empathy process, and ascribes a diagnostic term to the patient’s strangeness, for example, the term “psychosis”. She blocks out from her perception the communication and actions that do not fit the diagnostic term. The therapist’s inner distancing from the patient leads to a vicious cycle between the therapist’s projection (‘a psychotic’) and the patient’s projection (‘the therapist doesn’t like me’) in therapy. Disintegration-related countertransference occurs in patients with psychotic disorders. The therapist can free herself from the countertransference through a doppelganger dialogue (see Sect. 9.8.2).

In the case of negative transference, the therapist resolves the transference by differentiating between the transference conflict and the real conflict.

Case example 11 (Krüger, 1997, p. 256 f., abridged)

In a five-day seminar, the director does not immediately respond to 34-year-old Ralph’s wish to be the protagonist, even though the group chose him to be the protagonist through sociometric selection. In the following session, Ralph complains to the director: “You are just like my father! He was also never there for me!” The director makes Ralph an offer: “Would you like to show me what your father was like? We can then compare the similarities and differences between your father and me!” This develops into a protagonist-centered play. Ralph enacts a scene from when he was five: the ‘father’ is sitting in an armchair in the living room and reading a religious book. The five-year-old Ralph is sitting on the floor building a large ship with building blocks. He proudly says to his ‘father’: “Look, daddy!” The ‘father’ ignores the boy and continues reading. The boy repeats: “Daddy, look what I have built!” The father reacts dismissively. He looks out the window, becomes very stiff, and has obvious difficulty suppressing an outburst of anger. Ralph is disappointed and goes to his mother in the kitchen. Later, when his younger brother follows him back into the living room, Ralph destroys the ship he had built so carefully as a precautionary measure. The group is emotionally very moved in the follow-up discussion.

Following the protagonist-centered production of a childhood conflict, the protagonists usually receive so much attention, understanding, and compassion from the director and the group members, that they often forget to return to the original plan of treating the relationship between the protagonist and the therapist. In this case, the director must actively remind the group of the original aim of the collaborative work, even if he subjectively sees no similarity between himself and the negative transference figure of the patient. During the treatment of the disturbance in the relationship, the director and the group members trace the group interactions sequentially based on what they remember. The therapist internally actively looks, from the patient’s perspective, for his external actions that were similar to those of the transference figure of the patient.

Case example 11 (continued)

During the debriefing of the play, the therapist asks the protagonist, as was agreed: “Where did you find me being similar to your father, and where was I different?” The patient and the therapist agree that the following actions of the director resembled the father’s behavior: (1) Just like the father did in his childhood, the director dismissed Ralph when he did not respond to Ralph’s wish to be the protagonist. In doing this, his external behavior was very similar to the father’s behavior. The director’s intention, however, was different from that of the father. He had just joined the group after a change of directors. The group had unconsciously chosen Ralph to find out how the director works. The director wanted to protect Ralph from being used by the group. (2) Like Ralph’s father, the director had the habit of looking out the window. However, the director explained: “I can then sense better what is happening within the group more freely”. (3) The day before, the director gave a lecture to the seminar participants on the topic “Religiousness in Psychodrama”. That was similar to the father reading a religious book. (4) The director remembered that in the previous group session, he was still internally occupied with the content of this lecture. He shared this openly with the group: “Ralph, it is your protagonist play and your request for undivided attention that managed to bring me fully into the group after the strenuous lecture”. It wasn’t until the comparison with Ralph’s father that the director recognized Ralph’s transference to him also included a real conflict. He invited Ralph at the end of the group session: “Unlike in your childhood, you are allowed to overreact here. You can freely express how you feel even in the future, especially if you feel rejected. You shouldn’t let yourself be treated the same way in the group as you were in your childhood by your father?”.

The therapeutic approach to resolving a patient’s negative transference includes the following steps:

• 1. The therapist openly names her emotion toward the patient and specifies the behavior that triggered this emotion in her (see Sect. 4.13).

• 2. This often changes the patient’s positive transference into a negative or strengthens his latent negative transference. As a result, the patient experiences the therapist as an absent caregiver from his childhood, helpless, disoriented, sad, disappointed, dull, or powerless. The patient had had enough of that in childhood.

• 3. The therapist addresses a negative transference as soon as possible.

• 4. She describes her own actions which triggered the patient’s negative transference and his emotional response to her actions. She then asks him about his past experiences with a similar interaction pattern: “Where do you think it comes from when you feel afraid when someone frowns at you?”

• 5. The therapist places an additional empty chair in the therapy room, three meters away from her, to represent the patient’s negative transference figure (see Fig. 4.4 in Sect. 4.13).

• 6. The therapist helps the patient describe the recalled interaction with his transference figure. Then, if necessary, she encourages him to show this interaction in a protagonist-centered play (see case examples 11).

• 7. The therapist and the patient work together in delineating the similarities and differences between her and the transference figure (see case example 11). The therapist may have behaved similarly to the negative transference figure, but mostly her motivation behind this behavior was quite different. For example, she wanted to be honest with him and take him seriously (see Sects. 4.13 and 4.14). She did not want to offend the patient and doesn’t leave him alone.

• 8. The therapist and the patient deliberate actively: “Which of your actions would be an old behavior, and what would be a new and progressive behavior in the therapeutic relationship?” The mutual understanding and agreement result in a tele-relationship between the two (Krüger, 2010c, S 231ff.).

• 9. The therapist concludes a contract with the patient: The patient may feel sensitive about his neurotic wound. However, unlike in his childhood, he should try to tell the therapist if his wound is activated in the therapeutic relationship in the future. The therapist then promises to honestly share with him how she feels and the motivation behind her actions in that situation.

Central idea

Every conflict resulting from a transference also includes an actual conflict (Blatner, 2010, p. 7; Holmes, 1992, p. 45 f.; Kellermann, 1996, p. 104). Resolving transference in the therapeutic relationship can only be considered successful (Krüger, 2010c, p. 228) when the therapist and the patient can, in the end, agree on what they understand as the real conflict and the product of transference in the disturbance in the therapeutic relationship. The confirmation of reality in the conflict has an ego-strengthening effect on the patient and promotes their autonomy development.

Recommendation

Psychodrama therapists should know a range of therapeutic options that can help to resolve a patient’s transference, their own countertransference, and resistance in the case of disturbance in the therapy process. Without such options, they will actively try to deny disturbances in the therapeutic relationship and often act out their countertransference. Thus, they will no longer remain spontaneous in the therapeutic relationship and cannot fully utilize their therapeutic abilities.

2.11 Group Dynamics, Transference, Countertransference, and Resistance in Group Psychotherapy

The participants in a group develop a “socio-dynamic distribution of function” (Heigl-Evers, 1968, p. 290) within the first five to eight sessions. “For a group to be able to optimally use its possibilities and personal resources to achieve the (self) set goals, it needs someone who takes the initiative and demands new concepts. It needs people who participate, show allegiance, and support the initiatives loyally and with commitment. And it needs someone to stand up against it, to oppose competently and to get the drivers to review their concepts” (König & Schattenhofer, 2006, p. 53). Raoul Schindler (1973, p. 30 ff.) has divided the sociodynamic functions of the group into the omega position, the alpha position, the beta position, and the gamma position.

• 1. A group member in the omega position protests against the group’s current goal “based on inferiority and weakness” (Heigl-Evers, 1968, p. 283). The Omega is recognizable by his actions: He eventually wants to stop group therapy, often comes too late, or misses the group. He almost falls asleep during the session, clowns around, or is the most silent group member.

• 2. The group member in the alpha position leads the group action overtly or latently. He represents the group against external opponents and expresses through his actions “Follow me! This is how we achieve success!”

• 3. A group member in the beta position observes what is happening in the group from a reasonable distance and intervenes as an expert in an integrating manner. The beta position is, therefore, also the default position of the therapist: “Taking up the beta position enables the therapist to adopt the attitude of benevolent neutrality desirable for every treatment … The beta is the representative of Yes-but! He is someone who doubts from a largely neutral position, expresses concerns, and gives appropriate advice and pointers” (Heigl-Evers, 1967, p. 95).

• 4. According to Schindler (1957/1958, p. 311), in the gamma position, one is “without one’s own responsibility, lives in the alpha’s affectivity, and occupies the place that the unconscious of the alpha demands. As gamma, one’s experience of group events is based on identification with the alpha.” As followers, the gammas support the alpha, protect him, give him emotional strength through their like-minded will, and control him.

Central idea

The ideal protagonist in a psychodrama group is the group member in the alpha position or the gamma position.

The group participants in the alpha or gamma position promote the current group topic with their protagonist-centered plays and benefit from each other through similar conflict dynamics. At some point, however, a group topic will be exhausted. The group then searches for a new group topic by trial and error. This leads to group conflicts, in which a new group topic is constellated. With the new group topic, those group members who are most sensitive to it because of their own problems then take on the alpha and the omega position. Group conflicts are just as important for the development of the group as protagonist-centered plays (see Sect. 8.4.5). The director also allows group conflicts to be dealt with psychodramatically (see case example 12). Group conflicts help to work out the latent group topic negotiated in the conflicts. The group members in the Alpha and Gamma positions can then further advance the group action in protagonist-centered plays.

Case example 12

In the 28th session of group therapy, Dora berates the group moodily and loudly: “It’s all pointless here, the group doesn’t help anyone.” The group members respond to her and report small successes that have already occurred. Waltraud gets involved and accuses Dora of “unreasonably high expectations”. But Dora protests: “I hate this cuddling!” From the inferior omega position, she draws the group members’ attention to the fact that they treat each other kindly. As the alpha, Waltraud defends the way relationships are formed in the group.

The director does not ascribe Dora’s criticism of the group to himself. Instead, he suggests that Dora and Waltraud clarify their relationship with one another: “Waltraud, please take a close look at the posture Dora is sitting in. And you, Dora, please note Waltraud’s posture!—Now, please switch roles and sit on the other chair in the posture you just saw the other one hold. —Now, reenact your discussion from the other role, just as you experienced it!—After that, play the roles a little beyond reality!”.

In the debrief, Waltraud says, “It was a strange experience playing Dora. I was afraid. I had to yell and be aggressive so as not to let the others get to me.” In the role of Waltraud, Dora felt: “I didn’t feel comfortable as Waltraud, I always had to be satisfied, I wasn’t allowed to criticize anything!” The therapist asks Dora as an omega (mirror question): “How did you experience yourself from Waltraud’s role?” Dora says thoughtfully: “Yes, she actually seemed helpless.—That’s right, sometimes I feel that elsewhere too. I yell so that others don’t get too close to me.” The therapist turns to Waltraud as an alpha: “And how did you perceive yourself from the other role?” Waltraud: “Waltraud seemed to me as if she could not harm a fly!” The therapist asks Waltraud the transference question: “Do you recognize this about yourself from other relationships, that you cannot harm a fly?” Waltraud immediately remembers her workplace problems. As a social worker with disabled children, she had completely overburdened herself: “I never fought my superiors. I finally quit to save myself.” The group members report who can identify more with Dora or with Waltraud. The therapist requests Dora to tell how someone made her helpless and aggressive by getting close to her. He recommends that Waltraud deal with her workplace conflict psychodramatically in the next group session.

The relationship between alpha and omega is characterized by reciprocal complementarity (Heigl-Evers, 1967, p. 88 f., 1968, p. 289): The patient in the alpha position represses what the patient in the omega position expresses openly. However, the patient in the omega position represses what the patient in the alpha position expresses openly. In the case example, Dora, as the omega, played out her mistrust of “cuddling” in the group, while Waltraud, as the alpha, suppressed this skepticism. However, as alpha, Waltraud acted out her willingness to be content irrespective of the group circumstances, which Dora, as an omega, repressed in herself. The latent group theme was the conflict between the two polarities “I want to live in harmony forever, and I don’t fight back” and “I always want to be honest, even if that makes me an outsider.”

When choosing the protagonist, the director supports those group members who want to work on a problem as alpha or gamma. In the case example, these were the people who brought up the problem of always desiring to live in harmony and being there for others even if they fail, are overwhelmed, or let themselves be taken advantage of. The director can also participate in choosing the right protagonist. If he has little or no desire in leading a particular protagonist’s play, it is an indication that this play is not suitable in the context of current group dynamics. In choosing the protagonist, the director looks for the latent group theme: (1) He first determines the group member in the omega position. It is easier to recognize the omega than the alpha because he protests against the goal or the setting of the group through his actions. (2) The director internally grasps the positive sense in the helpless acting of the omega. (3) He formulates the complementary counterposition to the omega and looks for the group member who is most likely to represent this counterposition. (4) He supports the group members in the alpha or gamma position in their desire to play in the following sessions because they further the development of the group. (5) Or the director lets one of the two conflict partners work out the difference between the real and the transference conflict in their relationship (see case example 11 in Sect. 2.10). Differentiating between transference and reality in a relationship helps the group members to define their old neurotic behavior as ‘their old behavior’ and look for new behaviors.

The protagonist-centered plays of group members in the alpha and gamma positions are also helpful for the omega because the omega’s protest is indirectly represented by the protagonist’s conflict partners in their play. The omega is thus integrated into the group with his protest. He indirectly learns and develops his own identity in the group’s plays. The group participants should get to know the consequences of their own actions in a psychotherapy group. They have to experience these consequences directly in the group as a reality. When choosing the protagonist, for example, the approval of the group members matters. But it is just as important that the protagonist himself feels the suffering and has enough courage and energy to play the game. Only then there is a chance that he will process his conflict in his play. If a patient is reluctant to embark on a journey, there is a reason. The director, therefore, asks him with interest: “What makes it difficult for you to play here today?” The patient’s anxiety may be due to a neurotic defense. But it may also be realistic. Perhaps the patient realistically feels that he cannot work on his problem successfully at this point in this group situation. The therapist then works on the relationship conflicts in the group first (see case example 12). Many psychodramatists let the group members select the protagonist for the current session sociometrically. They believe then they act abstinent.

Central idea

A director is always part of the group dynamic and changes it through his actions, personality, therapeutic interventions, feedback, and the rules and values he represents. So the question is not whether he has a sociodynamic function in the group but how he deals with it and whether he is aware of the group position he occupies. His default position is the beta position, both in conflicts between the group members and in the protagonist-centered play in the conflict between protagonist and antagonist.

If the director unilaterally favors self-assertion in the group, over time, he will push anxious group members into the omega position. On the other hand, a director with a helper attitude pushes those group members into the omega position in particular, who no longer feel like empathizing with the suffering of others. A director with a biased value system ends up in the alpha position of the group over time. The more biased he is, the more likely it is. He should then integrate the omega’s protest as a complementary truth in his understanding of cause and effect in the group. Otherwise, the group and the director will get stuck in a shared group resistance.

The sociometric selection of the protagonist is problematic in the case of group resistance because the group members act out their conflicts in their relationship with the therapist. In such a case, they often choose the patient in the omega position to be the protagonist. But he protests helplessly against the group's resistance. Leading his play, the group director then tries to free the protagonist from his helplessness. That usually doesn’t work. He thus finds himself in the omega position (Krüger, 2011, p. 198f.). He feels overwhelmed and powerless when directing. In such a case, the therapist continues as follows: (1) He makes a paradigm shift and justifies his own feeling of being overwhelmed and powerless in the context of the group situation. (2) He stops the protagonist’s play at an appropriate point and does a normal debriefing. (3) He centers his attention on the current relationships between the group members and actively promotes the interactions between the group members and the protagonist in the omega position. The alpha is the one who most strongly defends the omega’s protests through their attitude or actions. (4) The director asks the group members in the alpha and the omega positions to resolve their relationship difficulties psychodramatically.

As a psychiatrist, Moreno was an ingenious psychotherapist, healer, artist, and prophet. However, as is well known, he had a directive leadership style. Directors with a directive leadership style take the alpha position in group dynamics. They pay too little attention to disruptive reactions from group members and tend to defend through projection (see Sect. 2.4.2). A director in the alpha position can “use the great opportunity to support the development of the super-ego of group members, as would be the case with abandoned people” (Schindler, 1957/1958, p. 311). However, patients in group therapy are usually not abandoned. A director in the alpha position tends to overlook his subconscious contribution to the disturbances in the group’s relationships. As a result, the disturbances cannot be resolved. This will hinder the further development of the group members. “When the director finds himself in the alpha position, the group presents itself as his unconscious, and he is only able to analyze himself in the group” (Schindler, 1957/1958, p. 311). A director in the alpha position is at risk of narcissistically abusing the group members. The longer the group runs, the more the risk. He’s the star of the group, his followers in the gamma position dazzle in his glow. The group members more or less openly develop a hierarchy among themselves. The director uses the group members who adopt his goals to support him. However, he will dump them if they develop desires or beliefs that differ from his own.

Moreno, who developed psychodrama, was trapped in this alpha trap. He did not conduct long-term group psychotherapy himself (Leutz, 2013, verbal communication). However, he often came to a training group and took over the group’s leadership for this one session. He would even call participants from a training group to his office individually (Marcia Karp, 2002, only oral communication) and tell them: “You are a genius!” Each of the chosen ones believed they had a very special relationship with Moreno. But Moreno often dumped his students again. In the introduction to his book “Das Stegreiftheater” (Moreno, 1970, p. XIV), he writes: “The task of the psychodrama academy is … to discover and train directors of the highest culture. Unfortunately, not all directors we have trained have the same quality. We, therefore, have to remove many directors from the practice.” Moreno’s son (Moreno, 1995, p. 6f.) stated: “Moreno saw himself as the father of therapeutic action methods. However, his demands for loyalty often jeopardized relationships with promising students.” Moreno’s son removed many accounts of Moreno’s “incredibly active love life” from Moreno’s extensive autobiography for publication (Moreno, 1995, pp. 12f., p. 33). In a MeToo debate today, Moreno would not get away unscathed (Moreno, 1995, p. 22 and p. 33).

In a directive leadership style in a group, the director projects his own blocked impulses into the group member in the omega position.

Case example 13

In a training seminar in Budapest, a psychodrama director demonstrated the seven steps of psychodramatic dialogue with role reversal using the example of a participant’s marital conflict (see Sect. 8.4.2). In the debrief, three participants said: “It would have been important also to explore the protagonist’s childhood. She could have explored why she is adjusting in her marriage in such a way.” Another group member, Mr. A., added: “It makes me angry when you, as the director, are also discussing the whole play theoretically now!”.

Mr. A. had repeatedly irritated the director with critical remarks before. The director felt increasingly annoyed with Mr. A. He noticed that he can no longer pay attention to the other group members sufficiently. That’s why he practiced psychodramatic self-supervision by conducting a fictional conversation with “Mr. A” in his hotel in the evening (see Sect. 2.9). In the psychodramatic dialogue, he shared with “Mr. A.”: “I’m angry with you. You always have something to criticize. I find you arrogant!” The director switched roles and responded as Mr. A: “I find you arrogant too!” The director switched back to his own role. He wondered what Mr. A. could see as arrogant about him. But he understood: “I am enthused by the effectiveness of the psychodramatic dialogue. When it comes to marital conflicts, in particular, it is important to always look for solutions directly in the current relationship. But the group participants are experienced therapists! After all, they might have some success exploring childhood events in protagonist-centered plays of marital conflicts. If I present my way of working as the only way, I’m actually arrogant!”.

The director suddenly became curious: “What would have been different in the approach practiced here in Hungary in exploring childhood?” He thus went from the alpha to the beta position and adopted the “Yes-but” attitude with the help of the psychodramatic self-supervision. The following day he suggested that the protagonist replay her marital conflict and go back to her childhood: “Perhaps one of you group members would like to direct the play. Then we can compare the advantages and disadvantages of the two approaches.” The protagonist was ready for the alternative play. But no group member wanted to direct it. The director was a little disappointed. However, the relationship problems in the group were resolved by his offer. In the following sessions, the group members continued to work with interest on the given seminar topics.

In the training group, the director had, without realizing it, found himself in the alpha position of the group. Mr. A. protested against the director because he perceived that he was using the group members for his own purposes. He was the action leader of the group’s resistance against the director’s goals. If a director is involved in group conflict, he should attempt to resolve the group conflict on his own after the group session through psychodramatic self-supervision (see Sect. 2.9). In doing so, he chooses the group member that disturbed him the most in the group, the action leader of the group resistance. He then looks for the positive meaning in the action leader’s thinking and feeling in the group resistance in self-supervision with role reversal. The contents of the disruptive group member’s protest are often the complementary truth that the director himself suppresses in his perception of the situation. In the case example, the director realized that he himself had also behaved arrogantly without realizing it. He incorporated the group’s complementary truth, “You’re not being mindful of us!” in his perception of the group situation. He thus internally reached the therapeutically favorable beta position of Yes-but again (see Sect. 2.9.5, Krüger, 2011, p. 310 ff.; Schindler, 1957/1958, p. 310 ff.): Yes, he wanted to convey the agreed content of the seminar, but he was also curious about the group members’ contrary experiences. He offered to clarify these other experiences in a protagonist-centered play exploring childhood too.

Directors can also capture and work on the latent group theme with the help of fairy tale plays. The group participants sociometrically choose a fairy tale, look for a role in it, and act out the fairy tale together. Experience shows that in groups that have existed for some time, the hero or heroine of the fairy tale usually represents the truth suppressed by the group. For example, a group that works sensibly and effectively enacts the “Hans in Luck” tale, in which the hero lives in the moment and enjoys life, contrary to social norms. A director in the alpha position of the group can see the complementary truth repressed by himself in the action impulses of the hero of the fairy tale. His own truth and the truth of the hero in the fairy tale often stand in a reciprocally complementary relationship. This brings the director back into the therapeutically favorable beta position of the group. He understands and spells out the latent group theme. He then asks the group participants how they each deal with the latent group issue. For example, this can be the conflict between the position “I always act purposefully” and “I like to live in the moment”. Next, the director asks the group members to make a sociometric constellation on the latent group theme. He symbolizes the two opposing positions of group dynamics, each with a chair in two opposite corners of the group room. He then asks the group members to find their place on the line between these two opposite poles. This place is intended to symbolize the respective intrapsychic balance between the two poles of the conflict. Each group member justifies their choice of position on the line between the two extreme positions.

Central idea

Resolving disturbances in group relationships requires the director to be willing to consistently review his self-image in the mirror of the group members’ reactions, examine his attitude, and learn something new about himself. The reality in group relationships is always inter-subjective.

2.12 The Implications of Mentalization-Oriented Theory for Psychodramatic Work

Central idea

The mentalization-oriented understanding of psychodrama psychotherapy differentiates and expands the theory and practice of psychodrama and changes it.

2.12.1 Psychodrama is More Than a Method of Group Therapy; It is a Form of Psychotherapy

Many therapists understand psychodrama psychotherapy as a psychotherapy method dependent on the group therapy format for its therapeutic efficacy. Moreno (1959) himself once said: “Psychodrama is depth therapy in and of a group.” But psychodrama is a psychotherapy method that can be applied to various formats. A format (Buer, 2005, p. 289) is a setting such as group therapy, individual therapy, supervision, coaching, or team development. But, different methods can be applied to the group therapy format, for example, psychodrama, psychoanalysis, theme-centered interaction, behavioral therapy, group dynamics, and others. Psychodrama therapists who bind the psychodrama psychotherapy method to the group therapy format, unnecessarily limit their options for therapeutic action. It is not ‘the group’ but the direct work on the metacognitive processes which is the hallmark of psychodrama.

Central idea

Patients are fixated on defense patterns in individual therapy sessions in the same way as in group therapy sessions. The therapist can, therefore, dissolve the patient’s defense with the help of psychodrama techniques, even in individual therapy (see Sect. 2.4). Psychodramatists, who understand the metacognitive effects of psychodrama techniques, use them in 50–80% of their individual therapy sessions.

Moreno mainly used psychodrama in the individual therapy format to treat his severely ill inpatients. Straub (2010, p. 28) reported that she worked for eight months as an intern in Moreno’s sanatorium in Beacon in 1954. Of the twelve patients in the clinic, approximately eight were diagnosed with psychotic disorders at a time. While Straub worked there, Moreno did not once put these patients together in a therapy group. The only psychodrama case examples in Moreno’s standard works (Moreno, 1959; Moreno & Moreno, 1975a, 1975b; Moreno, 1946/1985) are those in which Moreno worked in an individual therapeutic setting. Indeed, according to Leutz (2013, only oral communication), Moreno often participated in group therapy sessions led by his students, but only ever for one sitting. He would take over the directorship of the group in this one session, and then the psychodrama psychotherapists led the group on their own in the following sessions.

The definition of psychodrama as a group therapy method has had negative consequences: (1) It blocked the development of theory. (2) Psychotherapists and counselors who work with outpatients treat 95 percent of their patients in an individual setting. Therefore, Psychodrama as a group therapy method is attractive only to a few therapists. (3) Many psychodrama training institutes teach psychodrama primarily as a group therapy method. Therefore, future psychodrama therapists learn too little about the use of psychodrama in individual therapy.

Recommendation

The more severe the patient’s difficulty in mentalizing, the stronger the indication to use psychodrama as individual therapy. The therapist should decide on the setting of psychodrama therapy after considering the patient’s ability to mentalize.

Patients with severe deficits in their mentalizing will only benefit from psychodramatic group psychotherapy after they have developed an awareness of their dysfunctional conflict management in disorder-specific individual therapy (see Sect. 4.8). But in a hospital setting, the therapist can offer disorder-specific group psychotherapy. For example, Sáfrán and Czáky-Pallavicini (2013) developed a structured method for the group psychotherapy of patients suffering from post-traumatic stress disorder. Waldheim-Auer (2013, p. 196) and Waniczek et al. (2005) worked with a group of people suffering from addiction disorders.

2.12.2 The Interrelationship Circuit Between the Patients’ Mentalizing and Their Psychodramatic Play Must not Be Interrupted

It is important that, at the end of the therapy session, the patient’s internal conflict images have been enhanced by external psychodramatic play. But if the connection between the patient’s internal mentalizing and external play is interrupted, the inner images remain unchanged. This can happen, for example, when a patient enacts a traumatic scene on the stage. The therapist often doesn’t notice that the patient has dissociated (see Sect. 5.10). In such a situation, his conflict processing during the play is blocked by a state of shock.

Case example 14

A psychodrama psychotherapist complains in supervision: “I have psychodramatically worked with a traumatized patient and addressed her experience of being physically abused by her mother for two hours in a group. I let her do everything, including a fictional conversation with her mother through role reversal. But then, in the follow-up discussion, the patient said: ‘That was nothing new for me. I already knew it all!’” The therapist felt devalued and helpless. She did not notice that the protagonist had dissociated during the psychodrama play and was, therefore, unaware of her emotions. As a result, she was emotionally absent for the duration of the play. She performed the play only at a cognitive level. In such a case, the therapist herself experiences a lot during the enactment of the trauma experience, but the patient does not feel anything. While dissociating, she simply adapts and conforms to the therapist’s instructions. The supervisor recommended that a disorder-specific approach would help resolve dissociation when working through trauma (see Sect. 5.10).

2.12.3 The Use of Psychodrama Techniques Becomes Easier

Psychodramatists who use mentalization-oriented thinking in psychodrama (see Sect. 2.2) closely follow the path of natural internal conflict processing in their practical work. They thus make fewer detours. Psychodrama is highly complex, even if it appears simple from the outside. A psychodrama therapist needs the courage to work with the patient along the path of his dysfunctional conflict processing in the as-if mode of play.

The mutual creative process of a psychodramatic play is sometimes akin to a shared trip during white water rafting. This is why many psychodrama psychotherapists protect themselves from the play’s undercurrent and gather as much information as possible from the protagonist about the conflict before the enactment. When constructing the scene, for example, they let the protagonist “double the auxiliary ego” by playing the role of his conflict partner. The protagonist stands behind the auxiliary ego representing his wife, and the therapist asks him: “How old are you as your wife?” “How do you feel standing here opposite your husband?” “How long have you two been married?” “Are you employed?” ‘Doubling the auxiliary ego’ interrupts the patient’s internal warm-up process for his protagonist play. This is because, when ‘doubling’ in this manner, the patient shifts internally from his role into that of his conflict partner. In doing so, he opposes his own impulse to act and blocks it internally. Then, when the protagonist begins playing his role, he must first reactivate his own feelings and desires.

If the therapist gets too much information beforehand, she is tempted to develop some hypotheses before the play has begun and decide in advance what the content of the patient’s enactment could be. Such assumptions can easily block the therapist’s free creative process of mentalizing on behalf of the patient, thereby leading to disturbances in the creative process of attunement and agreement with the patient during psychodramatic play.

Recommendation

The therapist should not have the patient relate the events of his conflict before the play. She is thus better able to remain spontaneous and curious and to assume the Socratic attitude, which will help her employ the right psychodrama techniques (see Sect. 2.5).

Before the actual play, the therapist can limit herself to four questions and instructions (see Sects. 2.9 and 8.4.2): (1) She asks the protagonist when constructing the scene: “Who is or was involved in the conflict?” Then, she lets the protagonist choose a group member to take on the opponent’s role or represent it with an empty chair. (2) She addresses him in his role and asks: “How old is your wife?” (3) “What is your general intuitive impression of her?” (4) “What posture is she in?” The auxiliary ego who is playing the protagonist’s “wife” should then use this limited information to intuitively develop an idea for the formation of the wife’s role. In doing so, the auxiliary ego does not always get the reality of the role right the first time. Therefore, the therapist asks the patient, if required, to reverse roles with the auxiliary ego, enact parts of the scene, and ‘show’ how his wife is, how she reacted, or how she would reply.

Some therapists restrict the spontaneity and creativity of the psychodramatic work by practicing other habits. When doubling, for example, they always lay their hand on the shoulder of the patient. In exceptional cases, this can be an important gesture that testifies to the closeness of the therapist. However, one should avoid laying hands on the shoulders regularly when doubling.

Exercise 9

If you are a psychodramatist, work with a colleague to explore the similarities and differences between doubling with a hand on the protagonist’s shoulder and doubling without physical contact with the protagonist. Check whether you experience a difference between the two types of verbal doubling, both as a director and in the role of the protagonist. You will notice that when you are in the role of the protagonist, the physical contact caused by the therapist’s hand distracts you from being yourself and your spontaneous inner mentalizing. It shifts your attention from yourself to the therapist’s words. Doubling without laying on of hands, on the other hand, activates your own inner mentalizing.

Similarly, the regular ‘de-rolling’ of auxiliaries after a psychodrama is also questionable. Leutz (2013, oral communication) introduced this technique in her practical work with psychodrama. De-rolling is necessary when a group member has had to remain in a challenging auxiliary ego role for an extended period. In all other cases, however, the group members spontaneously find their way out of the auxiliary ego roles and go back to being themselves as they formulate their role feedback in the past tense: “In the play, I felt annoyed when in the role of your wife.” The sharing also helps them find their way back to themselves as they report some of their own similar experiences and thus gain distance from the protagonist’s experience.

Some therapists ask the protagonist to ‘de-role’ their auxiliary egos by ‘brushing off the roles’ with their hands, from the shoulders down along the body. This is supposed to ‘prevent the development of transferences’. However, this is a naïve assumption because transferences are always unconscious. A transference will continue to exist after the protagonist de-roles his auxiliary.

Central idea

Psychodramatic work is highly complex, even if it appears simple from the outside. Psychodramatists who introduce too many rules and an extensive, complicated repertoire of techniques in their practical work impress their audience and themselves. But, they don’t follow the patients’ inner mentalizing processes. In mentalization-oriented psychodrama psychotherapy, the therapist does not attempt to ‘do good’. Rather, she intuitively lets go of ‘doing wrong’ and omits the superfluous.

2.12.4 The Therapist Thinks in a Systemic and Process-Oriented Manner

In mentalizing, conflicts are naturally ‘structured as dyads or dialogues’ (Dornes, 2013, p. 79). They must therefore be systemically understood as a relationship conflict between the patient’s inner self-representation and corresponding object representation (Sect. 2.2) or as an intrapsychic conflict between two parts of the self or two ego states (see Sects. 4.3, 4.10, and 10.5). The psychodrama therapist intuitively pays attention to the interplay of energetic forces and counterforces in the patient´s conflict management in her practical work. She constantly conceives this as an action and reaction in the conflict system of the patient. In group therapy, the focus of the conflict processing can be on the interaction in (1) the systemic self-organization process of the individual patient, (2) the relationship between the therapist and the patient during their real encounter, (3) the relationship between the therapist and the protagonist during the psychodramatic play, or (4) the systemic self-organization of the group.

Central idea

The human self is a self-organizing system. If the patient progressively changes his self-image in a conflict, he will distance himself further from his conflict partner or assert himself better against him. The change in his self-image automatically changes the conflict partner’s behavior. Conversely, if the patient changes his inner image of the conflict partner, it automatically changes the patient’s own behavior (see Sect. 8.4.2).

The therapist also understands the therapeutic relationship with her patient as a self-organizing system. Changing her self-image will automatically also change her patient’s behavior. Likewise, a change in her internal image of the patient automatically changes her own behavior.

Central idea

The therapeutic relationship succeeds when the therapist does justice to her patient and to herself. The soul of the patient does not do anything for free. But the soul of the therapist doesn’t do anything for free, either. Therefore, in practical work, the therapist always pays attention to her emotions.

Disturbances in the therapeutic relationship hinder spontaneity and creativity in a psychodramatic play. In such a case, the therapist cannot freely follow the patient’s mentalization process in the play (see Sect. 2.10).

2.12.5 The Group is to Be Understood as a Self-organizing System

Central idea

In psychodrama group therapy, the idea of the creative human transforms into the concept of the creative group as a self-organizing system. The therapist sees herself as part of this system.

With a systemic and process-oriented style of direction, the therapist avoids determining the course of a group session through methodological guidelines. She understands the group as a living, self-organizing system (Krüger, 2011). She applies the psychodrama techniques only when they are indicated and follows her intuition in doing so. For example, the group members shall learn to offer their sharings spontaneously. The therapist asks the group to offer their sharings only when she feels that the protagonist needs to be reintegrated, as an equal among equals, into the human community of the group. The therapist asks the protagonist and his auxiliary egos for role feedback only when she observes that the protagonist has not yet adequately mentalized his experience of the external drama. The psychodrama techniques should be indicated in the actual process of conflict processing. If they are not, the therapist should try to hold back. She then lets group members learn from the consequences of their actions or inaction in the group. In doing so, the therapist remains in the therapeutically valuable beta position (Heigl-Evers, 1967, p. 95). This is the position of the specialist who intervenes with a systemic orientation and actively mediates between the interpersonal interactions in a group from a yes-but attitude.

Rules can help create a sense of safety for the participants at the beginning of a closed group. Consequently, the participants find it easier to overcome their neurotic withdrawal while getting to know each other and establish trust more readily. However, these rules become problematic at a later stage, when the issues of inferiority, power, and rivalry actualize or when the issues of autonomy and detachment finally rise to the surface. The leader then finds herself in the alpha position. Over time, a therapist in the alpha position will hinder and not encourage the development of the group members. She would deny her subconscious contribution to the disturbances in the therapeutic relationship. Sooner or later, these disturbances will block the patient’s and therapist’s mentalizing processes, thereby hindering the group’s therapeutic progress and giving rise to group resistance (see Sect. 2.11).

2.12.6 The Mentalization-Oriented Theory Strengthens the Effects of Psychodrama Therapy and Counseling

Grawe (1995) has identified four general mechanisms of change that are the basis for the efficacy of all psychotherapy methods: problem actualization, resource activation, clarification of motivation, and problem-solving. These mechanisms are valid for every psychotherapy method, regardless of the therapeutic techniques used. However, these general mechanisms of change in each psychotherapy method are repeatedly blocked in the therapy of patients experiencing mental health difficulties. Different psychotherapy methods have developed a variety of therapeutic interventions to prevent or resolve such disturbances in the therapeutic relationship.

Psychodrama is particularly well suited for this because, when adequately used, psychodrama techniques follow the path of the patient’s natural mentalization process in the as-if mode of play (see Fig. 2.3 in Sect. 2.2). Thus, psychodrama can implement the general mechanisms of change even in psychotherapy of severe mental disorders:

• 1. Problem actualization: Through psychodramatic play, the patients realize the inner process work of their conflict outside on the stage of the therapy room or the desk in the as-if mode of play. The therapist uses the three-stage model (see Fig. 4.1 in Sect. 4.2), where interpersonal conflicts, intrapsychic conflicts, and conflicts in the therapeutic relationship are present side by side. The processing of conflicts is updated experientially. The conflicts become tangible in the here and now and change for the better.

• 2. Resource activation: The therapist focuses on the person’s capacity to be creative. She activates the natural tools of mentalization using psychodrama techniques. The therapist’s basic attitude is, “Why not? A person’s soul does nothing for free.” This also applies to therapy in the context of people with psychotic disorders (see Chap. 9). If necessary, the therapist works with the patient to radically work out the positive meaning of old defensive behaviors and integrate it into the appropriate framework. She recognizes and names the patient’s positive abilities, appropriate co** strategies in the present and as a child, possible transpersonal experiences, and positive stabilizing factors in childhood and his current relationship network. She gives them all appropriate meanings.

• 3. Clarification of motivation: The patient gains the ego’s control over its unconscious defense processes in the as-if mode of play. He thus clarifies his motivation for his conflict resolutions in his inner conflict images. He works out the subjectively positive sense of his deviant thoughts, feelings, and behavior. In doing so, he understands himself better. He learns to distinguish between old and new solutions to his conflicts and to actively influence what happens to him.

• 4. Problem solving: The patient doesn’t just re-enact his conflict in the psychodramatic play. The therapist accompanies the patient in processing the conflict, mentalizes on his behalf if necessary, dissolves his fixations in old solution patterns in his conflict image, intervenes as a doppelganger if the patient loses himself, introduces a fictional supportive doppelganger into the interaction or encourages him to rewrite traumatic events as co** stories. In this way, she creates a surplus reality. An example of this is the seven steps of the psychodramatic dialogue in the treatment of people struggling with depression (see Sect. 8.4.2). The play progressively changes the patient’s inner conflict image. As a result, he perceives the reality of his conflict in his everyday life in a new way. According to Moreno, he becomes spontaneous and automatically finds a new, more appropriate solution to his old conflict (see Sect. 2.6).

2.13 Comparison Between the Self-Image-Focused and System-Focused Style of Directing Groups

In my understanding, the self is a systemic process. It includes the development of the inner self-image and the inner object image in the current situation (see Sects. 2.1, 2.9, and 8.4.2). In psychodramatic play, many therapists focus their attention solely on the development of self-image. This can lead to a cognitively oriented leadership style that does not fully exploit the direct metacognitive effect of psychodrama techniques (see Sect. 2.14) (Table 2.2).

Table 2.2 Different styles of direction

2.14 Similarities and Differences Between Mentalization-Orientated Theory and Other Theories of Psychodrama Therapy

Question

How do you explain the therapeutic effect of psychodrama therapy?

The following problems arise in the theoretical explanation of the practical work in psychodrama: (1) the spontaneity trap, (2) the before-after trap, (3) the diffusivity trap, (4) the cognition trap, (5) the equivalence trap, (6) the self-image trap, and (7) the technique trap.

• 1. The Spontaneity Trap

Psychodrama is effective even without theory. One can experience psychodrama in a seminar and then apply the psychodrama techniques in their own work. This is because psychodrama techniques are metacognitive tools of the natural inner conflict processing and they realize the holistic process of intuition in the as-if mode of play (see Sect. 2.2). Psychodrama is effective even when the explanations for its effects are inadequate. A psychodrama training teacher said 20 years ago: “I gave up trying to explain what I do in psychodrama. I just apply it. That’s fine!” But, the application of psychodrama techniques without theory means that the therapist cannot adequately justify her own effective practical procedures with psychodrama to other therapists. As a result, she may even have doubts about the efficacy of her own method.

This textbook justifies the practical approach in psychodrama with the multidisciplinary theories of self-development (see Chap. 1 and Sect. 9.3), mentalizing (see Sects. 2.2 to 2.4), play (see Sects. 2.4 and 2.6), metacognitive processes (see Sect. 2.4 and Chap. 4), and psychosomatic resonance (see Sect. 2.7). These theories help to systematize the therapeutic experiences of Moreno and other psychodramatists and to compare them with the experiences and theories of other psychotherapy methods.

For example, the mentalization-oriented theory of psychodrama makes it possible to justify the method-specific therapeutic interventions of psychodrama against the background of a holistic systematic theory. The mentalization-oriented, metacognitive psychodrama, therefore, fulfills an essential condition for being recognized as an independent psychotherapy method.

Central idea

Psychodrama has a unique feature when compared to other psychotherapy methods: Psychodrama techniques freely implement the naturally existing metacognitive tools of the human inner conflict processing in the as-if mode of play (see Sect. 2.3). Psychodramatists oriented to role theory cannot describe this unique feature of psychodrama.

• 2. The Before-After Trap

Many psychodramatists following the Moreno tradition (Moreno, 1946/1985, p. II ff., 153 ff.) explained their practical approaches using various role theories (Hochreiter, 2004, p. 128 ff.; Leutz, 1974, p. 36 ff. 153 ff.; Petzold & Mathias, 1982; Schacht, 2009; Stelzig, 2004, and others).

Important definition

Moreno (1985, P. IV) defined “role” as “the functioning form the individual assumes in the precise moment in which he reacts to a specific situation in which other persons or objects are involved.” Moreno thus described the externally visible role.

Moreno’s definition of role describes the externally perceptible role in a situation at a given point in time. This ‘role’ is the result of the metacognitive process producing this functioning form of the role (see Fig. 2.10). But, psychodrama techniques don’t work on the result of a metacognitive process. They work on the metacognitive process itself that produces the externally perceptible ‘role’. Therefore, one cannot use the linguistic concept of ‘role’ to explain what psychodramatists do when they use psychodrama techniques.

Fig. 2.10

The process of mentalizing and the role as the externally perceptible result of mentalizing

This is evident in Moreno’s theoretical concept of role pathologies. A person’s external role exercise can be disturbed by a ‘role deficit’, an ‘insufficient role repertoire’, a ‘role deficiency syndrome’, a ‘role confusion’, an ‘intra-role conflict’, an ‘inter-role conflict’, or a ‘lack of role flexibility’ (Leutz, 1974, p. 153 ff., Stelzig, 2004). When the therapist uses terms of role pathology, she describes deficits in the patient’s thinking, feeling, and acting in the current situation in a person-centered manner from the outside. The concepts of role pathology are useful in formats in which all the conflict partners are present, such as in team supervision, or organizational consulting. In doing so, the psychodramatist and her clients deliberate on how the clients could feel, think, and act more appropriately in the current real situation. They may practice that in role training, if necessary.

Central idea

A psychodrama director, who directly tries to change the role pathology of a patient using psychodrama techniques, automatically converts the psychodrama into cognitive-oriented psychodrama therapy. Unfavorable thought content should be replaced with favorable content. A therapist who allows the psychodramatic play to unfold freely despite a role pathology also achieves metacognitive changes in the protagonist. This is because the psychodrama techniques he uses are metacognitive tools.

• 3. The Diffusivity Trap

  Many psychodramatists who explain their actions with role theories, act purely intuitively in their practical work and use individual theoretical concepts from depth psychology, behavioral therapy, or systemic therapy. For example, some psychodramatists in training only use the role theories after the play so that they conform to the rules of the psychodramatic training institutions when in discussion with other psychodramatists. Moreno’s quotations or personal anecdotes about the effect of psychodrama help the psychodramatists bond with one another. For example, Burge (2000, p. 307); Karp (2000, p. 70); Leutz (2000, pp. 190, 195) and Roine (2000, pp. 95f.) consider role reversal to be an ‘important technique’ when working with traumatized people. But none of them asked any of their traumatized patients to swap roles with their perpetrators (see Sect. 5.10.9). The more psychodrama therapists base their practical work directly on role theories, the less they rely on their intuition and the metacognitive effect of psychodrama techniques (see Sect. 2.2), and the more likely it is that they work only with a cognitive orientation.

• 4. The Cognition Trap

  In the therapy of people with trauma disorders, Hudgins (2000, p. 240 f.) interprets the metacognitive process of dissociating (see Sect. 5.10.2) as an unconscious splitting of parts of self. She looks at the patient as an object and not as an implicit doppelganger. She treats the consequences of dissociating, not the cause. The dissociating patient must learn, with help from an interacting doppelganger, to collect his split-off parts of self so that they are available to him again. She illustrates her approach using the example of a fictitious patient named ‘Greta’. The therapist has the group members take on eleven stabilizing roles in the patient’s trauma processing. When ‘Greta’ dissociates nonetheless, the therapist “asks a trained auxiliary to take on the role of the one containing the dissociation. Collette […] took up the role and started drifting around the room with a white scarf. She swished it in the air and said: ‘I can pick up and hold all the dissociations in the room. Greta, help me gather it together so I can keep it here. You can have it back if you need it, but I think it’s safe now to see what´s happening.’ The director … said: ‘Yes, Greta, pick up the pieces of fuzziness that are floating around the room and put them concretely in the white scarf there. Tell the collector what to do with them.’” Hudgins let the fictitious Greta respond: ‘I am not dizzy or dazed right now, but you can stand over there in the corner with your scarf just in case I get too scared.’

The traumatized patient should reduce the consequences of dissociation in this way. Hudgins doesn’t treat the cause of dissociation. Dissociating is an inner dysfunctional metacognitive process that results in the symptom of dissociation. This process comprises three steps (Wurmser, 1998, p. 425 f.) (see Sect. 5.10.2): (1) When dissociating, the patient’s ego splits into an observing and an acting ego (Wurmser, 1998, p. 425 f.). The therapist, as an implicit doppelganger, therefore, sets up a second chair next to the patient for ‘her traumatized ‘ego’ when beginning to process trauma in the therapy room. In doing so, she externally separates the psychosomatic resonance pattern (see Sect. 2.7) of the trauma experience from the patient’s psychosomatic resonance pattern in the current therapeutic relationship. The therapist and the patient stand shoulder to shoulder, look at this traumatized part of the patient’s self from an observer position (see Sect. 5.10.6), and, thus, identify with the patient’s cognition. The split between an observing and acting ego is thus psychodramatically realized externally in the therapy room. (2) Dissociation also includes the defensive process of denying this split (Wurmser, 1998, p. 425 f.). The therapist resolves the denial of the trauma by representing the patient’s ‘traumatized ego’ with an empty chair. The result is that the patient consciously perceives his “traumatized ego”. His denial of the splitting is thereby resolved. (3) Dissociating also includes a positive counterfantasy protecting the denial of splitting (Wurmser, 1998, p. 425 f.). Therefore, the therapist helps the dissociating patient to stabilize herself through a positive counterfantasy. For this purpose, she and the patient develop a ‘safe place’ together (see Sect. 5.10.5). In trauma processing, the patient alternates between his psychosomatic ‘acting ego’ in the trauma scene, the ‘cognitive ego’ in the observation and narrative room, and the supportive ‘safe place’. Thus, he gains ego control over his dissociation in the as-if mode of play (see Sects. 4.8 and 5.10). He becomes the creator of his life (Moreno, 1970, S. 78) in his dissociation.

Similarly, Schwehm (2004, p. 139, 146 ff.) uses a cognitive approach in the therapy of patients with alcohol dependency. Schwehm interprets the inability of persons with addiction to control themselves as a ‘role deficit’ for the ‘role of a director’. He, therefore, suggests training in the ‘role of a director’ to improve the patient’s ability to control his thinking, feeling, and acting. For this purpose, the therapist goes with the patient into a ‘control room’ which is separate from the stage. He then invites the patient to view his problematic addictive acting from a metaperspective. As a ‘director,’ the patient is now required to suggest to himself how he can think, feel, and act more appropriately in a given situation. This approach resolves the defense through rationalization (see Sect. 2.4.3) and confronts the patient with the reality of his own actions. In this way, it strengthens the patient’s cognition.

But, in people with addiction disorders (see Sect. 10.5), the deficit in self-regulation is a result of a metacognitive disorder, namely the result of defense through splitting. In a conflict, these patients unconsciously alternate repeatedly between the ego state of healthy adult thinking and the contrary state of addictive thinking, feeling, and acting. In the addictive ego state, their addictive inner reality construction determines their perception of external reality: “My wife is grumbling again. But I have only had one beer. Living with such a bossy woman certainly forces me to drink! So now I will go to the pub and drink properly with my friends!” The next day, the patient feels guilty about drinking. He has returned to the ego state of healthy adult thinking.

Therefore, the therapist works explicitly metacognitively in mentalization-oriented psychodrama therapy for people with addiction disorders (see Sect. 10.6.1). She lets the patient realize his unconscious alternation between healthy adult thinking and addictive thinking in the as-if mode of play: (1) The therapist represents the patient’s addictive ego state with an empty chair placed next to him in the therapy room. (2) She names the chair he is sitting on as the chair for his healthy adult thinking. (3) When the patient internally moves to his addictive thinking, she gestures to the second chair. In this way, she draws his attention to the change in his addictive ego state. (4) If necessary, she lets him perform the inner movement into his respectively contrary ego state by changing to the other chair and enacting it externally in the as-if mode of play.

In this way, the patient learns also to internally separate his addictive thinking and feeling from his healthy adult thinking, to internally recognize his addictive thinking in the as-if mode as ‘dry drinking’, and to visualize the negative consequences of any addictive acting. That makes it easier for him not to drink again. The patient develops ego control of his alternation between his contrary ego states. He thus really becomes a ‘director’ of his conflict between his healthy adult thinking and his addictive thinking (see Sects. 10.6.1 and 10.6.4) (Fig. 2.11).

Fig. 2.11

Gaining ego control over one’s actions in equivalence mode

• 5. The Equivalence Trap

70 years ago, Moreno (1947, p. 9; Schwehm, 2004, p. 140) assumed that the human memory contains ‘inner roles’ and ‘role clusters’. In a psychodramatic play, these would go from the inner world to the stage and are therapeutically modified by the psychodramatic play in a meaningful way. The roles could then be retrieved in this therapeutically modified form in real everyday life. The ‘inner roles’ theory equates the patient’s role in his real everyday life with his inner symbolic images in the psychodramatic play and assumes that when a protagonist enacts his marital conflict psychodramatically, he shows how he behaved toward his wife and how his wife reacted in reality.

However, one should be careful not to confuse “internal roles” with external roles. Neurophysiologically, “it makes no sense […] to compare the brain with a serial computer or the memory with a process by which data is stored and retrieved” (Schiepek, 2006, p. 5). People change their memories of a conflict through the half-conscious, half-unconscious inner conflict processing sometimes even within one day. The longer the recalled event, the more the recalled conflict will deviate from the original reality of the conflict. As a result, the conflict depicted in the psychodramatic play is less likely to reflect the reality of the conflict in the past. This is why, for example, teachers always ask pupils involved in violent actions in school to relate and write down their experience of the events immediately. The ability to process memories in such a way that we see ourselves as the hero of the story or as a victim of evil has been advantageous in human evolution. In addition, the ability to act internally is a prerequisite for any further internal conflict processing.

Central idea

In the psychodramatic play, we work systemically on the inner self-image and the inner object image in an inner conflict image, i.e. on inner representations of reality, and not on external reality itself (see Sects. 2.9 and 8.4.2). If we free our inner self-image or inner object image from its fixations, we perceive reality differently in the next real external encounter with the conflict partner and spontaneously behave in a new way. What appears as reality to the patient in the play is “only” the current state of processing the reality he remembers.

Many psychodramatists let their patients or clients represent parts of the self with objects or chairs and deal with them psychodramatically. The linguistic concept ‘parts of self’ is used very vaguely. Therapists use it to describe negative affect, symptoms, resources, or character traits, i.e. what Moreno called “inner roles”. For example, the therapist asks the patient to represent their “grandiosity” (see Sect. 4.8) with an empty chair or an object. The patient should then engage with this part of the self in a psychodramatic dialogue with role reversal. In addition, he should also put the negative parts of his self in their place, and with the help of the therapist, recognize the positive value of other parts of his self and interpret them as helpful (see Sect. 6.8.3). The evaluation of the parts of one’s self is dependent on the benefit of those parts for the patient. This method of psychodrama therapy is oriented toward the cognitions of the patient and the therapist. It is therapeutically successful in situations requiring cognitive psychodrama therapy. However, it is rather unsuitable for the treatment of metacognitive disorders.

• 6. The Self-Image Trap

Central idea

In mentalization-oriented therapy, the therapist focuses her attention on the systemic creative process of self-development in the current situation. This process includes the inner representing of inner self-image and inner object image and its appropriate development through inner interacting and mental rehearsing (see Sects. 2.9 and 8.4.2).

Case example 15

Mrs. Castle, a patient with neurotic depression, feels resigned and tells her fellow group therapy members: “My husband forbids me from meeting with my girlfriend and going to an Italian restaurant with her!” The group members object: “You can’t let him do this to you!” The therapist invites Mrs. Castle to enact her marital conflict and to psychodramatically show how her husband forbids her. But Mrs. Castle declines: “No, I cannot do that!” The therapist is disappointed because he can’t internally imagine the scene where the husband forbids the wife. Therefore, he invites group members with the strongest objections to representatively enact the conflict between Mrs. Castle and her husband on the stage. The group members oblige. Two group members set up the scene in Mrs. Castle’s living room as they imagined. One group member acts as the patient’s doppelganger, while another group member plays the role of her husband. During the play, Mrs. Castle offers corrections from the outside. When the second group member acts ‘incorrectly’ in the husband’s role, Mrs. Castle objects: “My husband doesn’t behave like this!”. Thus, the therapist invites Mrs. Castle to take on her husband’s role. Without being aware of it, Mrs. C. explores what her husband feels towards her and thinks about her and how he would react to her changed behavior. When her doppelganger articulates her wish clearly and distinctly, she, as her husband, reacts in a disgruntled and indignant manner. Nevertheless, she, in the role of her husband, allows her doppelganger to go out to dinner with her friend.

Fourteen days later, Mrs. Castle reports that she went out to dinner with her friend at an Italian restaurant. The therapist is surprised: “How did that happen!” Mrs. Castle answers: “But I still knew he would agree with my wish.” When she presented her wish to him, indeed, her husband made a sullen face. But he hadn’t forbidden her from going out with her friend.

Question

How do you theoretically explain this patient’s change in behavior without her enacting and develo** her own role in the psychodramatic play? Try explaining this therapeutic progress with role theories!

Two psychodrama training leaders speculated: “She saw the successful behavior of her doppelganger and then imitated it in reality.” However, this speculation disregards the fact that the intelligent patient cognitively knew how to behave more courageously before the play. But she was afraid because of her defense through identification with the aggressor. So what was the reason she suddenly did it anyway? The patient expanded her inner object image of her husband during the play. In the role of her husband, she psychosomatically experienced that he would agree to her wish if she stood her ground. This new knowledge resolved her unconscious identification with the aggressor (see Sect. 8.4.2). The resolution of her defense through projection (“he forbids me”) also weakened her defense through introjection. Thus, she dared to translate her wish into action. The change in her internal object representation automatically changed her behavior as well. She did not need to rehearse a new behavior in a role play. Psychodramatists often don’t fully utilize the therapeutic power of role reversal. A psychodrama training leader even strongly objected to this theory: “In psychodrama, we work with the person who comes, not with the antagonist!”.

Central idea

In fifty percent of cases, the therapeutic effect of the psychodramatic dialogue in relationship conflicts is based on the change in the internal object image by role reversal.

Role theories change the practical psychodramatic approach more or less strongly toward a more cognitively oriented psychodrama. For example, Schacht developed a theory of role development in children (see Sect. 2.6), from which he derived a development-oriented approach to psychodrama therapy. In the psychodrama play, the patient shall go through the next step in his role development. The therapist helps him to do this. She mirrors the patient verbally, as a good mother would do. In doing so, she playfully engages with the patient’s structural level in her thinking and feeling (Schacht, 2009, p. 319), adapts her facial expression and gestures to the patient’s suffering, and answers verbally as a supportive interaction partner would (Schacht, 2009, p. 270 f.). This practice leads to individual “renourishing” (Wicher, 2014, p. 56 f, 85) of the patient in his play and the interaction with the therapist.

Schacht is not interested in the direct metacognitive effect of psychodrama techniques and therefore does not use this effect consciously. He does not distinguish the patient’s external role behavior in everyday life from the patient’s role play in his inner conflict image. He only looks at the development of the self-image in the play, but not at the development of the inner object image. The systemic approach of psychodrama, which is naturally present in the form of role reversal, is lost. For example, in a psychodramatic confrontation with a conflict opponent, Schacht doesn’t resolve the projection and introjection through rehearsing during role reversal (see Sects. 2.9 and 8.4.2). Instead, he repeatedly asks his patients in their role of self-image if they believe to ‘have the upper hand’. He explains to them that they “should only try to pursue a goal contrary to the interests of others if this is the case” (Schacht, 2009, p. 325). In this approach, the direct promotion of inner role reversal during the enactment replaces the outer role reversal in the as-if mode of psychodramatic play. The more a psychodrama therapist conforms to the role development-oriented psychodrama theory in her practical work, the less she allows the direct metacognitive effect of the psychodramatic role reversal. For this reason, even psychodramatists who do not justify their actions theoretically are more likely to use a metacognitive approach than the role theory.

Psychodrama therapists with orientation in role development are not concerned with the direct metacognitive effects of psychodrama techniques (see Sect. 2.4). As a result, when treating people with personality disorders, they do not take into account the positive function of a rigid defense as part of the holistic process of self-regulation. They look at the deficit in role development and try to remedy it cognitively in the play. Thus, the therapist becomes the enlightened one, while the patient becomes the one who does not know. However, metacognitive disorders should be treated metacognitively. In metacognitive therapy, the therapist explicitly makes the patient’s rigid defensive behavior the subject of therapeutic communication:

• 1. The therapist grasps the patient’s dominant defense pattern as an ego state (see Sect. 4.7–4.11).

• 2. She names it, represents it with an empty chair on stage, and explains the positive function of his rigid defense in the holistic process of the patient’s self-regulation.

• 3. The patient moves into the chair of this other ego state and psychodramatically plays the dysfunctional work of this ego state in the as-if mode.

• 4. He moves back to the chair of his healthy adult thinking.

• 5. In this way, he gains the ego control over his dysfunctional self-development in the current situation. As a result, he no longer needs to act it out in the equivalence mode.

Case example 16

In the first therapy session, a 20-year-old patient, Mr. Banks, reported excruciating compulsive thoughts. When driving, he would be stricken by the fear that he had run over a pedestrian at every bump on the road. He would check the road in his rear-view mirror but also often turn around and drive back to make sure he was mistaken. He did this even though he “knew that running over a pedestrian would feel very different and that he would have seen the person”. The therapist uses empty chairs to represent the patient’s rigid defense system, which metacognitively controls the patient’s obsessive thoughts and actions: He positions a “sadistic tormentor spirit who infused him with the threatening thoughts” opposite Mr. Banks. He places a hand puppet of an aggressive-looking devil on the chair symbolizing the ‘sadistic tormentor spirit’. The therapist then places a second chair for his compulsive actions next to the patient and reinterprets these positively as self-protective behaviors: “These actions help you to actively check whether you have done what the tormentor spirit states. By doing this, you protect yourself from the accusation of failing to stop after causing an accident and losing your driver’s license.” The therapist then points to Mr. Banks: “Moreover, there is you who engages in healthy adult thinking. As you said, you know that running someone over would feel different; you knew these frightening thoughts are unrealistic.” Mr. Banks is astonished by this interpretation of his internal psychic processes and feels relieved. Before setting up the constellation with the chairs, driving back with the car would have seemed senseless because he knew he couldn’t have run anyone over. The arrangement gave meaning to each of his contradicting ego states in the overall context of the creative process of his conflict processing. The patient gained access to himself as a director in his dysfunctional metacognitive processing. He acquired “the perspective of the Creator of his own life” (Moreno, 1970, p. 78). During his further therapy, Mr. B recognized that the “blind tormentor” was a result of his childhood traumatic experience caused by his sister. The compulsive thoughts and actions of the patient proved to be the masochistic actions of a trauma film in the guise of a substitute fantasy (continued in Sect. 7.2).

• 7. The Technique Trap

The belief in the method of psychodrama cannot replace the knowledge of what we do in psychodrama when we do what we do. Without theoretical knowledge, the therapist’s understanding of psychodrama is limited to what can be achieved with the psychodrama techniques, and nothing else. If she fails to treat psychosis with the usual psychodrama method, she believes:”Psychodrama is not a suitable method for this purpose.” Moreno’s amazing successes in treating psychosis can then be attributed only to his special personality (see Sect. 9.6). When a psychiatrist succeeds in stop** a patient’s delusions in a single session with disorder-specific, metacognitive psychodrama therapy (see Chap. 9), he is not surprised, but simply delighted (see Sect. 9.8.5). He couldn’t have justified his actions meaningfully without a proper theoretical explanation.

Central idea

By understanding psychodrama techniques as mentalization-oriented metacognitive therapeutic interventions, we psychodramatists regain and retain the sovereignty of defining and interpreting our psychodrama intervention techniques. Psychodrama is no longer just a toolbox that serves to improve other psychotherapy methods in their practical work.

Therapists from other schools of psychotherapy often intuitively recognize that there is something special about psychodrama. They may even integrate individual psychodrama techniques into their own methods. They then interpret their psychodramatic approach within the frame of the conventional theories from their own schools. As a result, they understand psychodrama techniques as therapeutic interventions that are part of their own methods. This happens, for example, in systemic therapy (Bleckwedel, 2008; Klein, 2010; Lauterbach, 2007; Liebel-Fryzer, 2010), integrative therapy (Petzold, 2004), Pesso therapy (Pesso 1999) or drama therapy (Jennings et al., 1994). Half of the therapeutic interventions in schema therapy (Arntz & van Genderen, 2010) are psychodrama techniques. I consider the integration of psychodrama techniques in other psychotherapy methods to be desirable because it eases their direct work on metacognitive processes.