DOI: 10.31038/PSYJ.2023573

Abstract

The development or diagnosis of a mental illness is often a traumatic event. People who undergo a mental crisis and/or are diagnosed with a serious, chronic mental illness often experience a sharp disconnection from their previous life and self-image. A person living with mental illness may adopt the identity of a “sick” person and experience self-stigmatization, diminished enjoyment of life, and loss of hope in realizing their plans for the future. This review of literature attempts to contribute to our understanding of the unique qualities of group therapy and of the therapeutic method of psychodrama in particular, and its ability to act as a receptacle for empathic sharing among participants and to increase the coping competence of patients with severe mental illness (SMI).

Keywords

Group therapy, Mental illness, Psychodrama, Sharing, Support

Introduction

Many studies deal with the experience of coping with severe mental illness (SMI). Mental illness may cause changes in an individual’s personality, behavior, thoughts and feelings, both during the disease’s active phases and in its aftermath. This can result in a feeling of alienation from one’s own recognizable self [1,2]. Patricia Deegan, one of the forerunners of the recovery movement, describe how a diagnosis of mental illness “paints” a person’s entire perception and subjective experience. She and others describe the self-stigmatization, social isolation, the feeling of failure, the detachment and alienation, that take over a patient [3-7].The experience of coping with mental illness is often accompanied by a loss of internal and interpersonal dialogue, and a personal experience of one-dimensionality and emptiness. Patients suffering from these conditions can benefit from therapeutic methods that provide opportunities for group sharing and rich dialogue, offering partners to mirror one another, and providing visibility and a voice to convey the patient’s inner narrative [8,9]. This review attempts to illuminate the unique qualities of group therapy and psychodrama, and the potential of the therapeutic circle of sharing within it to create a supportive space enabling self-expression and enpathy, and to increase the ability of patients with SMI to cope with the sense of isolation and distress they experience.

The Therapeuric Group and the Psychodramatic Sharing for Patients with SMI[1]

Numerous studies have revealed the immense benefit of group therapy in people coping with shared distress, especially patients with SMI [10-13]. Unlike traditional therapy in which the structural power imbalance between the therapist and the patient could potentially perpetuate feelings of powerlessness, group therapy provides the participants with an experience of equality of status with the other participants and even with the therapist [14,15], and a sense of acceptance and belonging [16]. Dreikurs emphasized the above-mentioned dimension of equality that exists in group therapy, in which individuals are valued for who they are in the group and for their self-disclosure and honesty, and not for what they have achieved in their lives (14). Others have found that individuals who felt understood and protected in group therapy reported greater improvement in overall well-being [17].

A number of studies that have examined the effect of psychodrama as a therapeutic method, have noted its efficacy in reducing depression [18,19], anxiety and stress [20,21], and treating trauma and PTSD [22,23]. The unique nature of psychodramatic group therapy is beneficial in ways that traditional psychotherapy is often inadequate. The psychodrama group acts as an accommodating space for coping with experience of distress of the participants by creating a space for self-expression and a human encounter, mutual support, and sharing [24,25]. Roine and others describe the ability of psychodrama to evoke spontaneity and uncover creativity in challenging patients [26,27]. The psychodramatic stage allows patients to approach their feelings and thoughts in situations where the verbal dialogue of analytic psychotherapy is limited [9].

J. L. Moreno, the founder of psychodrama, was the first to highlight the potential of psychodrama as a tool even for people coping with SMI. Contrasting his approach to Freud’s, Moreno claimed that the focus of the psychodynamic therapy process, that which also allows it to be of value in working with difficult mental illnesses and psychotic cases, does not take place in the transference between the client and the therapist, but rather in the encounter that takes place between people and between roles. Using the “tele”, the emotion that arises in interpersonal encounters and in the interaction between different roles, psychodrama aspires to induce the recovery process even in those people with mental illness that Freudian psychoanalysis avoided addressing [28]. This therapeutic dimension of interaction and interpersonal encounter is expressed via various components of the psychodrama work, among them the auxiliary ego, the double, role reversal, encounter, and sharing [24].

Sharing is a fundamental concept in the therapeutic sphere and culture. John [29] dubbed the contemporary era “the age of sharing” and connected the prominence of the therapeutic ethos of sharing emotions to, among others, the digital culture and sharing on the internet, especially on social networks. This, in a manner that corresponds to the Lacanian notion of extimacy (extimité) as a human condition in which the center of the subject is both external and internal to itself simultaneously. John and others argue that the subject only gets in touch with their selfhood by making it public and sharing it with others [24,29,30]. John dates sharing’s initial formulation as a therapeutic concept—as it relates to the context of sharing emotions in a group—to the Oxford Group founded in 1922, out of which emerged Alcoholics Anonymous (AA) about a decade later. This notwithstanding, we should note that during that period the notion of sharing was already quite clearly a component of Moreno’s approach to psychodramatic group work.

The psychodramatic sharing, also known as the sharing phase, is the phase in which the group members share their experiences and issues from their lives that relate to the work of the protagonist [25,31]. Moreno describes sharing as the phase in which the focus moves from the stage to the audience, the phase in which “the strangers” in the group reveal their emotions and cease to be strangers. They repay the protagonist with love and gift both the protagonist and themselves the experience of group catharsis [32]. By sharing personal experiences relevant to the protagonist’s work, the group members ensure that the protagonist does not feel lonely or embarrassed at the end of their work, rather they feel like one of the many people who experience similar challenges. The sharing helps the protagonist break free from their role and expedites their return to reality and to the group as one of its members. The protagonist, who was detached from the group during the psychodramatic work, undergoes an accelerated reintegration back into the group structure via the sharing [33]. Sharing is an important phase for the group members as well. It grants them the opportunity to speak their own minds as if each and every one of them is the protagonist for a moment.

The psychodramatic sharing is rarely dealt with in the research literature, and there is little evidence-based study that sheds light on the influence of this therapeutic component. A recent qualitative action research study following an open inpatients psychodrama group in a psychiatric hospital demonstrates the role of group sharing in enabling self-expression, and mutual support, which offers a relief of the distress of psychiatric inpatients coping with SMI [24]. In another study that measured the ongoing influence of the psychodramatic therapeutic process on the participants [34], the HAT (Helpful Aspects of Therapy) test was used to help the participants report on the events that occurred in the therapeutic framework as events that either helped or hindered the therapeutic process. The results of the HAT test revealed that out of ten therapeutic categories—which included the main psychodramatic tools and the performance of psychodramatic vignettes on the stage—the two therapeutic components that comprised the largest number of events reported as helpful to the process were “the sharing of other group members” (24% of the therapeutic events reported as helpful) and “the participant’s own sharing in the group” (18.5% of the therapeutic events reported as helpful). Combined, these two categories that are related to sharing comprise 42.5% of the events reported as helpful to the treatment.

Conclusion

The aim of this article was to provide a theoretical framework for understanding the unique qualities of psychodrama group therapy and the potential of the therapeutic circle of group sharing within it to create an accommodating space of self-expression and mutual support, which offers relief for the experiences of isolation and distress of patients with SMI. The findings described above attest to the beneficial influence that group sharing should have in the framework of psychodrama therapy; however, these are isolated findings, and there is clearly room for further research addressing the contribution of the psychodramatic sharing to the therapeutic process of patients with mental illness.

[1] For a more complete and detailed overview of the sharing concept, including empirical data, see Ron, 2022.

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