The following subsections will depict different one-to-one psychodrama vignettes with Mary, whose social atom was included in Sect. 16.1. The development of her social atom helped warm her up to new work around grief and loss, as well as childhood trauma. The social worker slowly began to introduce psychodramatic interventions into their individual therapy sessions. Short psychodrama vignettes with strengths-based roles were introduced to set the foundation for later scenes. The first vignette below depicts a strengths-based scene, the second vignette describes an intrapsychic psychodrama scene, and the third vignette offers a portrayal of an interpersonal one-to-one psychodrama. The exploration of a single case over time shows the utility of individual psychodrama work and its unique potential to build upon past psychodramas in a linear manner.
3.1 Strengths-Based Scenes
The social worker first ensures Mary’s consent, permission, and warm-up to engage in a psychodrama vignette. When asked which strengths she would need to heal from her trauma, loss, and work through her anxiety and depression, Mary indicated that she would need more courage. The social worker invites Mary to choose an object in the room to represent courage, and she chooses the painting on the wall. The therapist invites her to role reverse with courage—becoming courage. Mary steps into the role of courage, standing in front of the painting and begins speaking to herself as if she were still sitting on the couch.
MARY AS COURAGE: Hi Mary, remember me? You used to use me so much in your life, but we have not been so close lately.
THERAPIST: Courage, can you remind Mary of some of the times she did use you throughout her life? remind her of the times that you were close.
MARY AS COURAGE: Well… Mary, I know it is difficult for you to talk about things in your life so I help you do that… (Mary appears stuck).
THERAPIST: Courage, is it okay if I offer a doubling statement for you? If it is accurate you can repeat it to Mary, if it does not fit, you can simply change it to make it fit for you.
MARY AS COURAGE: Okay.
THERAPIST AS DOUBLE: Mary, you have a lot more courage than you realize. You use me (courage) every time you come to therapy.
MARY AS COURAGE: (a soft smile emerges as her body loosens up) Mary, you have way more courage than you can see right now. Every time you come to therapy, you use me.
THERAPIST: (steps out of double role) Yes. That is right, every time Mary comes to the office here, she brings you. Seems like you are a pretty important part of Mary. Tell her more about you and how she can connect with you.
MARY AS COURAGE: When you feel scared to do something, I am what helps you push through and do it anyway Mary. I have helped you have meaningful relationships, a successful marriage, to ask for help, to thrive as a woman in your career, to survive your childhood, and to live a good life. You might not realize it, but I am an important part of you. I’m especially important now because I can help you walk through your anxiety and depression. When you feel scared or stuck, just tap into me.
THERAPIST: Can you tell Mary how she can tap into you?
MARY AS COURAGE: You can tap into me by standing up proudly, taking a few deep breathes, and remembering the many other times you have been courageous in your long life.
THERAPIST: Great job courage. Go ahead and reverse roles.
(Mary moves back to her place sitting on the couch).
THERAPIST: Okay, Mary, just take a minute to look over here at courage (pointing to the painting on the wall) and take in all those messages and reminders of your courage—especially the advice on how to tap into courage. When you are ready, lets practice implementing the advice from courage about standing proudly, taking deep breathes, and remembering past experiences of courage.
Mary stands up, takes a few deep breathes and closes her eyes. As she recalls previous moments of courage, her posture and facial expression begin to depict confidence and courage. She begins to smile gently, opens her eyes, and comments on how surprised she is about her current sense of courage. Following the enactment, Mary and the therapist organically shift into a reflective discussion about the scene.
In the sharing phase of the one-to-one psychodrama, the therapist shares more of themselves, while maintaining their professional boundaries (von Ameln & Becker-Ebel, 2020). This is a time for the Mary to cool down from her psychodrama experience and to integrate the learning from the enactment. In the ongoing individual psychotherapy context, this is the time for the therapist and Mary to also discuss a concrete plan for how she will implement their new learning in between sessions. Mary agrees to take time each day to practice standing proudly and taking deep breathes while remembering memories of courage.
Having completed this strengths-based psychodrama above, every time Mary returns to the office, she sees the painting on the wall and is reminded of her courage. This may happen unconsciously or consciously—and the therapist now has another strengths-based tool to weave into future sessions. In subsequent sessions, Mary completes similar strengths-based psychodrama vignettes using the office plant to symbolize compassion for self, the lamp to represent her hope, the clock to play the role of her future self no longer stuck in depression or anxiety, and the pillow to represent God. With each journey into surplus reality, Mary increases her level of connection to the therapist, her trust and familiarity with the psychodramatic method, and her psychological stability or ego strength. The office becomes inherently resourcing after a few psychodrama sessions as Mary experiences the positive projections with the previously chosen objects in each session. Every time she walks back into the space of the office, she is greeted by her strengths and reminders of previous therapeutic successes through psychodrama.
3.2 Intrapsychic Scene
Having spent time resourcing her with strengths-based roles and enhancing the therapeutic relationship, Mary becomes more willing to share and be vulnerable with the therapist over time. She begins to talk about feeling stuck in anxiety and depression and that there is a part of her that just wants to stay stuck and be taken care of by others. She describes it as an old feeling that resembled her experience as a child with a depressed father and an abusive mother that were not always able to adequately fulfill her developmental needs. Mary and her therapist schedule a longer session with the intent of doing a more intensive internal psychodrama scene exploring her relationship with a wounded/younger self role. The psychodrama scene begins with an integration of the strengths from previous enactments with a focus on their utility for today’s topic. Mary is instructed to reverse roles and offer a statement to herself from each of the roles of courage, self-compassion, hope, future self, and God.
MARY AS COURAGE: You have the courage to explore your past and heal from it. You can do it!
MARY AS SELF-COMPASSION: I am so proud of you for the work you are doing to better yourself. You are a good, kind woman.
MARY AS HOPE: Mary, although your depression
, anxiety, loss, and trauma may seem overwhelming at times, none of it has to define you today. You can heal from it and work though all of it, one step at a time.
MARY AS FUTURE SELF: Though you are unsure about today’s psychodrama, trust me when I say that it will be worth it.
MARY AS GOD: I am with you always. You are perfectly imperfect—I created you in this way so you could walk this unique path that I have laid out for you. This is the next step today.
After giving voice to supporting message from each of these strengths-based roles, Mary returns to her own chair and is encouraged by the therapist to take a moment to ground herself in the support and presence of all of her strengths-based roles. Then, the therapist pulls out an empty chair and instructs Mary to imagine that her wounded self is in the empty chair. When working with trauma-based roles in individual work, it is often best to avoid concretizing them with objects in the room as it could encourage negative projections in future sessions when the client sees the same object.
THERAPIST: Mary, here is the part of yourself that did not get her needs met as a child and was hurt and neglected by her parents at times. Perhaps this is the same part of yourself that today feels paralyzed with depression and anxiety. What is it you need to say to this part of yourself?
MARY: I know how hard it was for you growing up and that at times it felt like nobody cared about you. I know you felt stuck and afraid—that you think you are trapped forever in this situation. It is okay. You did the best that you could and I am so happy you survived and got out of that family. I know you still exist within me because I can feel your pain and your anxiety all the time. I just want to find a way so you don’t have to hurt so much.
THERAPIST: Great job Mary. You are really using that strength of self-compassion here. I am wondering if there are other strength roles that have anything to say this hurt part of you?
MARY: Yes, I think wounded Mary needs to talk to hope.
THERAPIST: Okay, reverse roles with hope. What do you have to say to wounded Mary?
MARY AS HOPE: (speaking to wounded Mary) Hi Mary, I know you feel hopeless sometimes but I am here to remind you that thinks will get better. There is always hope. Don’t give up on yourself. This is all just temporary, and you have a good life ahead of you.
THERAPIST: Go ahead and role reverse with wounded Mary. From this role, can you articulate the feelings and thoughts you experience?
MARY AS WOUNDED SELF: I just feel so trapped and stuck all the time. I don’t feel like trying sometimes— would rather someone else take care of things for me. It is so unfair that I have to deal with all this loss, depression, and anxiety. My life has been hard enough. I feel so shameful for having these problems. I am afraid that things won’t get better and instead they will just get worse until I die.
THERAPIST: Is there more that you need to say? It sounds like you have been neglected for a long time and have accumulated a lot of hurt over the years… What haven’t you been able to say about your parents?
MARY AS WOUNDED SELF: Well, yeah. I am so angry at my mom for how she treated me and upset that my dad never gave me attention and love when I wanted it. I was just a kid and they were supposed to love me. I had to grow up so early and figure out how to take care of myself. (Mary begins to cry) I still hear the voice of my mom shaming my dad for being depressed. She always told him to stop being selfish and to suck it up. She thought depression wasn’t real, and so did I. I can imagine my mom saying the same things to me today because of my depression. I feel worthless when I think about it.
THERAPIST: You have waited a long time to express these feelings Mary, just let them out here. What else is there?
MARY AS WOUNDED SELF: (Mary continues tearfully) I just feel so upset with myself. How did I end up so stuck and depressed? I feel like I’ve wasted so much of my life and I hate myself for it.
THERAPIST: Sounds like you are really hurting here. I’m wondering what Mary’s relationship with you has been like?
MARY AS WOUNDED SELF: She ignores me and pretends that I don’t exist, or she shames me for the feelings I have.
THERAPIST: Can you tell her what it is that you need from her?
MARY AS WOUNDED SELF: Mary, I need you to pay attention to me. Stop ignoring me or shaming me for how I feel. You are doing the same thing that Mom did to Dad. I need your help or we both are going to be stuck. Will you help me?
THERAPIST: Reverse roles. Mary, you’ve heard everything this wounded part of yourself has to say, she is asking you to help her, pay attention to her, and stop shaming her. How do you want to respond?
MARY: (begins to cry) Mary, I’m so sorry that I’ve treated you like this for so long. You have already been through so much and you deserve better…
THERAPIST: Don’t forget that all of your strengths are here to help you with this too Mary.
MARY: (looks around the room remembering her strengths. Then she stands up, takes a few breathes and steps closer to the empty chair containing her wounded self) Mary, I’m sorry for shaming you for your feelings. I’m sorry for ignoring you. I see how much you are hurting, and I am going to take care of you from now on. I can see why you felt so stuck and hopeless. I was afraid of your feelings and afraid of accepting you. I’m going to give you the love you deserve. You are a precious part of me, and I am going to treat you like that going forward.
THERAPIST: As we move towards closure Mary, I wonder if there is a commitment you can make to yourself about something concrete you can do to put this love into action?
MARY: I am going to commit to you that I will take time to journal about you at least twice this week. If it is helpful, then I will make it a regular habit to write about you.
THERAPIST: I think that is a great commitment and a good plan for implementing this work into your life going forward. You can use the psychodramatic letter writing and psychodramatic journaling tools that I’ve shown you previously.
From here, the therapist and Mary de-role the empty chair and transition to the sharing phase of the psychodrama process. Mary expresses her experience as the protagonist while remembering the different roles and dialogues she just engaged in. She comments on how helpful it was to have the strength roles present and that she does not know that she would have been able to have the discussion she had if it were not for her courage, hope, and self-compassion. The therapist frames this inner scene between her, her strengths, and her wounded self as an ongoing dialogue that will continue within her beyond this session. The therapist celebrates Mary’s work today while also reminding her that it will take practice and consistency to change the internalized messages that she has been carrying with her for several decades.
In psychodramatic terms, Mary has accessed the spontaneity to change her intrapsychic relationship with this part of herself. She responded to in a new and adequate way while creating a new cultural conserve for a more accepting in loving relationship with herself. Now that she has engaged in the strengths-based work and internal work, she is more prepared for the interpersonal psychodrama that is to come.
3.3 Interpersonal Scene
Based on Mary’s ongoing clinical work, it became clear that she had unresolved issues with her mother. This was apparent in her social atom depiction (see Sect. 16.1), within which her deceased mother was nearly the same size as her husband and her depression
/anxiety. The previous, intrapsychic psychodrama enactment revealed the internalized shame that Mary carries about having depression and anxiety because of her mother’s comments to her depressed father. She describes a common situation to involve her father watching television on the couch, while her mother yells at him for being lazy, depressed, and a poor husband. Mary describes how as a child, she would hide in her room during these instances and wait for it to be over, wishing that her father would stand up for himself. Mary and her therapist set an intention to engage in a psychodrama enactment to work through some of the unfinished business with her mom.
When Mary arrives to the session, the therapist instructs her to connect with her strengths by role reversing with each and offering herself a message of support. The messaging from her strengths and supportive roles fortifies her and affirms her commitment to moving forward with the clinical contract. Mary is invited to recreate the scene described above using pillows or chairs in the office to represent her mother, father, and herself as a child. From the mirror position, she is asked to describe the scene, including the messages and actions of each person. The therapist, having assessed her as emotionally capable of re-experiencing the scene, directs her to step into the role of her mother.
THERAPIST: Mom, what is it that you feel about your husband here, tell him.
MARY AS MOM: You are pathetic. You barely can hold a job because you call out all the time and stay home watching television. I can’t believe you. This depression is all in your head. You need to snap out of it and act like a man before I leave you.
THERAPIST: Sounds like you are pretty angry that he can’t just be normal?
MARY AS MOM: Yeah, I’m furious at him. I have to work twice as hard around the house and at my job in order to pick up the slack.
THERAPIST: Are you afraid that he will lose his job? Sounds like his depression has created additional burdens for you. Can you give us an internal soliloquy of mom?
Mary AS MOM (soliloquy): Of course. I’m afraid he will lose his job and how it will impact our family. I feel like I am the only adult in the home, and I have to take care of him too. It’s not fair. I’m upset that my husband isn’t able to be fully present with me. I feel stuck in this situation too.
THERAPIST: Okay. Mary—reverse roles with your father. Now, show us how you respond to your wife.
MARY AS FATHER: (lays on couch with detached expression—says nothing).
THERAPIST: You have nothing to say huh?
MARY AS FATHER: What’s the point. Nothing I say or do will be good enough.
THERAPIST: I see. So, you are pretty stuck in the depression and this unhealthy dynamic. Do you know your daughter is in the other room hiding and wishes you would stand up for yourself?
MARY AS FATHER: (affect changes and eyes become tearful) I know. I don’t know how to change this. I feel stuck and I’m afraid of how my depression and my wife’s anger will impact Mary.
THERAPIST: What do you want to say to Mary that you never had the chance to?
MARY AS FATHER: Mary, I’m so sorry about all of this. This wasn’t the type of house I wanted you to grow up in. I wish I could have been there for you more and I wish I could have provided a safer home.
THERAPIST: Dad, do you know Mary grew up to struggle with depression just like you? What do you want to tell her about depression?
MARY AS FATHER: Mary, it’s okay to be depressed. It’s not your fault that you have depression—it runs in the family. There is no shame in having a mental health issue. But now you have an opportunity to change this generational pattern and take care of yourself.
THERAPIST: Can you tell Mary what you think about all the work she has been doing to take care of herself lately?
MARY AS FATHER: I’m so proud of you Mary. You are handling your depression in a way that I couldn’t.
THERAPIST: Reverse roles. Mary what do you want to say to dad in response?
MARY: (tearful) Thank you dad. I always wanted to hear you say you are proud of me. I can see how much you suffered because of your depression and because of mom. I wish you were more available to me growing up, but I understand what it’s like to be stuck in depression. I am going to get better for both of us.
THERAPIST: Reverse roles. Mary, as your father, can you show us how you wish he would have stood up to mom?
MARY AS FATHER: Okay. (turns to role of mom) I’m sorry how my depression impacts you. Regardless, I am not going to allow you to talk to me like that anymore. You are scaring Mary. And just because I am depressed, doesn’t make me any less of a man. I have a mental illness and there is no shame in that. Your yelling at me and shaming me doesn’t help at all—it only makes things worse. And you clearly have some of your own issues to work out.
THERAPIST: Okay, Mary. Reverse roles with yourself today. What is it that you’d like to say to mom?
MARY: (presents as emotional and unsure about what to say to mom).
THERAPIST: Mary, take a look around at all of your strengths in the room (pointing to the plant, the painting on the wall, the lamp, the clock, and the pillow—representing compassion, courage, hope, herself in the future, and God).
(As Mary looks around remembering her strengths, she stabilizes emotionally).
THERAPIST: I’m going to offer a doubling statement for you Mary, if it fits you can repeat it. If not, simply change it…
THERAPIST AS DOUBLE: I’ve never stood up to you before mom, but I’m going to do it today with the support of my strengths.
MARY: Mom, I’ve never done this before, but today I’m going to stand up to you because I have all these new strengths and supports.
THERAPIST AS DOUBLE: I am so damn angry and upset!
MARY: I am so damn angry and upset at you Mom. You were so mean and abusive to dad and I. Half a century later I am still impacted by your behavior. You were so hard on dad and it wasn’t fair. You clearly didn’t understand depression or mental illness. Do you think he wanted to be depressed? I grew up believing that it was shameful to have a mental illness because of you. This belief has made it so difficult to ask for help or to tell my friends that I am depressed.
THERAPIST: Mary, choose one of these scarves to represent this belief that it is shameful to have a mental illness.
(she chooses a gray scarf from the therapists’ collection of scarves).
THERAPIST: Now, tell mom how this has impacted you and when you are ready, I want you to give it back to her. It sounds like you’ve been carrying around this belief that you inherited from Mom which hasn’t been so helpful.
MARY: See this mom? This is yours, not mine. I’m sick of carrying this around. It has done nothing but make me judge other people, hate myself, and stay stuck. Because of this belief, I’ve isolated myself from my friends. This is yours—not mine.
(Mary physically places the scarf on the chair representing her mom).
THERAPIST: Mary, take a moment to notice what it feels like to no longer carry this belief around.
MARY: I feel much lighter. That belief has weighed me down for so long. I feel like I don’t have to be shameful for my mental illness, or for needing help to work through it.
THERAPIST: Tell your mom how things will be different now that you won’t carry this belief any longer.
MARY: Mom, I not going to shame myself for needing help. It’s your burden for not understanding mental illness, not mine. You should have educated yourself. I’m not going to carry that burden for your ignorance—or anyone else’s. This is a part of who I am and if you or someone else can’t accept that then I don’t want them to be in my life anyways. I wish you would understand.
THERAPIST: Reverse roles. Okay mom, I know you didn’t understand mental illness when you were alive, and you were pretty hurtful to Mary and her father. Now that you’ve died, where are you? What has God said to you about your life?
MARY AS MOM: Well, I am dead and have moved onto the afterlife. I spent some time in purgatory being punished for my sins, but God has forgiven me and I am in heaven now.
THERAPIST: Okay, sounds like you have changed. Now that you have shed the imperfections of character and are in heaven, what would you like to say to Mary?
MARY AS MOM: (tearful) Mary I made many mistakes in my life. Now I can see how hurtful and selfish I was with you and your father. I was really just scared and in a lot of my own pain that I didn’t know how to deal with. I hope you can forgive me for not being the best mother and for how I hurt you in my life.
THERAPIST: Reverse Roles. What do you want to say to Mom?
MARY: Mom, you were so angry and abusive to me. I just wanted a loving mom. (Begins to cry) Honestly, I felt relieved when you died because I thought I would be free from the trauma and negativity, but I wasn’t. I’ve been so angry at you and I’m ready to let that go so I can move on and be free (continues to cry). This is the first time I’ve really felt sad about your death. I wish we could have had a better relationship while you were alive. I still think about you regularly. There were times that you were loving and fun to be around and I cherish those memories. Although you were hurtful, there were also important things you taught me about life which have been helpful. I was so focused on the negative experiences with you that I forgot about the other positive parts of you. I think I can see all of you now.
THERAPIST: Good Mary. As we move towards closure, is there a final statement to say to mom?
MARY: Mom, thank you for the positive things you’ve taught me. I am going to let go of the negative parts of our relationships so I can move on and be free going forward.
After this final statement, Mary de-roles the scene and the session moves into sharing and processing the experience. Mary shares that she feels exhausted but also much lighter and accomplished. She reports that she was surprised at being able to remember positive memories with mom after expressing her anger and equally surprised at being able to access her sadness at mom’s death. She shares about her newfound commitment to taking care of herself and her mental illness after connecting it to the larger generational history and her father. She says that the negative memories of her family dysfunction are still present but that they do not have the same emotional charge that they used to have for her. Mary describes her plan to stop hiding her struggles with mental illness from her friends that she had been avoiding and that she plans to trust that they will understand. Finally, she describes her new insight of how her depression and anxiety may have impacted others in her life and that she will use this as increased motivation to take care of herself.
In the case at hand, it is also important to highlight how cultural factors may have impacted the process. The closure with Mom was accessed by conceptualizing a scene based on Mary’s spiritual/religious beliefs. When directing a psychodrama, it is essential to enter the reality of the protagonist rather than to instruct the protagonist to enact a scene that is incongruent with their religious or cultural belief system. Similarly, some cultural belief systems might inhibit an individual from psychodramatically expressing anger toward a parent or saying anything that might be seen as disrespectful. There are other creative ways of navigating this such as splitting Mom into two parts—a “good mom” and “bad mom” or seeing if the mother role might offer permission to the protagonist about expressing anger. When directing a protagonist, it is important to consider interventions or suggested actions/scenes that reflect the cultural realities for the protagonist. The trajectory of Mary’s psychodrama would look very different depending on her religious/spiritual beliefs as well as her cultural values around family, anger, and parental role relationships.