LINDA K. OXFORD AND DANIEL J. WIENER
The case featured in this chapter illustrates the application of psycho- drama and narrative therapy, specifically John Byng-Hall’s (1995) approach to revising family stories and scripts, to treatment of a family reeling from the death of the family matriarch. Because of the difficulties inherent in working with multiple protagonists, psychodrama is not typically conducted with a family system, rather with an individual, as the client. However, as this case convincingly illustrates, a modified psychodramatic approach to treatment of family systems can be both efficient and effective. The strengths-based, solution-focused theoretical orientation of the therapist also contributes to the success of her approach to addressing this family’s grief, loss, and disorga- nization.
PSYCHODRAMA AND FAMILY THERAPY
J. L. Moreno’s application of his psychodramatic methods to treatment of couples and families in the 1930s introduced a long tradition of action methods in family therapy and offered a clear theoretical rationale for mov-
Editors’ Introduction: Linda K. Oxford and Daniel J. Wiener present “family
narrative therapy in action” with a personal and unique method of using psychodramatic techniques to invite and sustain a high level of engage- ment with all members in collaborative defeat of the common family problem. Unlike the highly linguistic, sometimes formulaic, traditional applications of narrative therapy, this action approach is highly improvi- sational and driven by the clients’ experience in the moment. Through psychodramatic enactments, family members are engaged at multiple lev- els of experience, enabled not only to externalize but also to concretize and interact with the family problem, experientially assess its influence on their family, and alter their relationships with it and with one an- other.
ing beyond the verbal description of family interactions and relationships to physical enactment of family dynamics in the therapy session (Compernolle, 1981; J. L. Moreno, 1969; Z. T. Moreno, 1991). Virginia Satir (1964, 1972) drew from psychodrama, gestalt, the encounter movement, and communica- tions theory to develop her unique and dynamic methods of family therapy. Salvador Minuchin (Minuchin & Fishman, 1981), Walter Kempler (1973, 1981), Fred and Bunny Duhl (Duhl, Kantor, & Duhl, 1973), Peggy Papp (1980, 1990), and Richard Chasin and Sallyann Roth (Chasin & Roth, 1994; Chasin, Roth, & Bograd, 1989) were also influenced by psychodrama. Psychodramatic enactment is particularly suited to the narrative therapy ap- proach developed by David Epston (White & Epston, 1990) and Michael White (1995) of exploring a family’s cocreated roles and stories, externaliz- ing the problem, promoting collaboration in challenging and defeating the problem, and cocreating new family scripts (Williams, 1989, 1994).
THEORETICAL FOUNDATIONS
The presenting problem that the family brings to therapy may be less problematic than the family’s story about the problem, which may itself be maintaining or escalating the problem. The problematic story then becomes the therapist’s primary target for systemic change.
According to John Byng-Hall (1995), family scripts develop when a family resolves a predicament in a way that is remembered. The family cre- ates a story that makes meaning of the solution and establishes it as a model for solving similar problems that arise. This story, after being reenacted on several occasions and incorporated into the family’s repertoire of roles and behaviors, evolves into a script.
As explained by Byng-Hall (1995), “Scripts prescribe the action to be taken now and in the future, whereas the stories give an account of the ac- tion that was taken in the past” (p. 25). That is, stories support and perpetu- ate the family’s beliefs about the problem and its solution, while scripts define what the family is to do in response to their beliefs about a particular prob- lem. Conflicts arise when family scripts are dysfunctional, prescribing a course of action and sequence of interactions that fail to resolve the problem. Pre- senting problems, or symptoms, result when the price for adhering to familiar patterns of interaction is too high, either in emotional pain or failure to achieve desired outcomes.
As does Byng-Hall, we view family problems as arising from the family script and help families explore ways to revise dysfunctional scripts. In prob- lematic family stories, one or more family members typically are blamed for creating or maintaining the problem. The family’s rigid adherence to an in- adequate family script supported by this story has become the primary prob-
lem. Fundamental change in the problem-solving script is necessary for the family to become more resourceful and adaptive.
When scripts are “rewritten” through dramatic enactment, family sto- ries also change as new stories, or narratives, are cocreated to support these revised scripts. While most family therapy approaches attempt to alter sto- ries and relationships through verbal discourse, dramatic enactment enables families to revise scripts and stories by altering their here-and-now interac- tions.
Narrative therapy begins with separating the identified patient from the problem by naming and externalizing the problem, explores the family’s cocreated stories, and challenges the ineffective roles and scripts adopted by family members (White & Epston, 1990). Psychodramatic methods take this process a step further by separating the problem experientially, rather than simply linguistically, from the person, thereby creating immediate opportu- nities for altering family members’ relationships with the problem and with one another. Integrating these two approaches allows the therapist and fam- ily to explore in action the family’s relationship with the problem and how it has disrupted their lives and relationships.
When the family confronts the externalized problem and exposes its “hidden agenda,” family members are quickly motivated to develop coopera- tive strategies to challenge and defeat the problem. Attribution of malicious intent to the problem rather than to family members increases their cohe- sion, empathy, and mutual support and encourages them to view themselves and one another in new ways. New roles and behaviors that prove effective are validated and retained. The family’s successful solution is then confirmed through the cocreation of new stories, which in turn give rise to new family scripts.
Combining psychodramatic and narrative techniques can rapidly move family members from antagonistic to collaborative positions and encourages the family to experience themselves as allies and victors in their struggles against a common adversary. The technique of mirroring reflects back to fam- ily members their problematic interactions and the script that sustains their self-defeating roles by allowing them to observe their enactment of present stories and scripts and obtain new perspectives on their relationships with the problem and one another. The technique of role reversal lets family mem- bers literally step into one another’s shoes and experience the effects of the problem from another’s perspective. Finally, through the technique of future projection, the family can discover what their lives might be like without the problem, exploring through dramatic enactment their expectations, goals, and ways to develop and nurture new behaviors, roles, and stories.
In the assessment phase of therapy, we seek to identify the patterns and themes of the family story revealed in the presenting problem and to under- stand the dynamics of existing family scripts. We then prepare (“warm up”) the family for enactment by establishing a context of play and experimenta-
tion, fostering a willing suspension of reality testing, and providing an envi- ronment of psychological and physical safety and security. The voluntary nature of participation is emphasized, and family members are encouraged to think of dramatic enactments as “rehearsals” rather than as “performances,” allowing them to try out new roles and behaviors with minimal risks. This climate of exploration and experimentation facilitates improvisation by family members when their previously scripted actions prove unsuccessful in resolv- ing the problem. As Byng-Hall (1995) put it, the family begins with what is “too much familiar” and is then compelled to search “for something outside and beyond the known” (p. 54).
Family interaction patterns can be viewed as simply the enactment of established family roles. A role, defined as a set of related behaviors designed to carry out a specific act or function, is by nature relational and interac- tional, dependent on reciprocal role enactment by others to achieve its goals. Antony Williams (1998) noted that “roles, and then the self, are continu- ously being created in interaction” (p. 143). Role relationships in families may become scripted so that everyone knows what will happen next in the interaction sequence. “The concept of family scripts posits that everyone has the whole family drama encoded in their minds but identifies more with certain roles, and, in turn, is identified by others as playing particular roles” (Byng-Hall, 1995, p. 24).
Adaptive functioning of an individual or family results both from hav- ing a sufficiently large repertoire of available roles and the ability to move from one role into another as the need arises (Moreno, 1946). Healthy indi- viduals and families exercise flexibility, creativity, and spontaneity in the roles they assume in interactions and can successfully meet a wide range of challenges and demands.
Roles that have proven to be socially effective and have been fine- tuned through practice tend to be retained and with continued use become “conserved” (Moreno, 1965). Conserved roles, characterized by automatic, predictable behaviors, are supported by role consensus, the general agree- ment among members of a group or family regarding their perceptions, ex- pectations, and enactments of these roles. This agreement implies coordina- tion with other conserved roles and is another way of describing a family script.
Psychodrama provides role-training techniques that encourage individuals to create and expand their roles. Role-training involves exploration in ac- tion of alternative role interpretations, perceptions and interactions, includ- ing behavioral rehearsal of roles in actual and simulated scenarios. Byng- Hall (1995) achieved role-training through improvising, editing, or rewriting family scripts; generating strategies to increase family security; and increas- ing family collaboration by altering their problem-solving methods (p. 75).
External circumstances or developmental changes may precipitate a role crisis, in which the role of one or more family members no longer fits a par-
ticular need or goal of the family. In a role crisis, family members, acting within familiar roles and established scripts, cannot respond adequately to the new situation. They must (a) expand their role repertoire, developing and manifesting alternative roles more appropriate to the specific need or goal, or (b) change the family script, altering habitual interaction sequences.
RATIONALE FOR ACTION METHODS OF FAMILY THERAPY J. L. Moreno, widely credited with being the first to use action methods of psychotherapy, conceived psychodrama in the early 1920s. He posited two distinct aspects of healing, one of which is role expansion through role-train- ing. Moreno believed that achieving role expansion required dramatic en- actment of the problem in settings evocative of those in which the original limitations arose (locus nascendi) yet which provided a safe and supportive environment in which the dilemma can be resolved.
Moreno understood that verbal description of an experience is not syn- onymous with that experience. The client’s most painstaking description of behaviors and roles that he or she enacts in life is usually an inaccurate re- flection of how he or she actually manifests these behaviors and roles in situ. Similarly, verbal descriptions of other people that interact with the client are incomplete and often distorted in the client’s report to the therapist. In dramatic enactment of the client’s life experiences in the here-and-now therapy session, a fuller story emerges. Therefore, Moreno considered physi- cal action within the therapy session not only acceptable but also necessary to the therapeutic process. We share his belief in the superiority of dramatic enactment to verbal communication in illuminating the client’s situation and rapidly fostering change at behavioral, cognitive, and affective levels, transcending the inherent limitations of “talk therapy” through the here- and-now co-creation of new roles, stories, and scripts.
The following clinical case presentation demonstrates the effective ap- plication of psychodramatic methods of conjoint therapy to Byng-Hall’s nar- rative approach to revising family stories and scripts.
CASE OF THE HUDSON FAMILY
The Hudson family, comprised of Sarah, age 36; Les, age 37; Marla, age 15; and Nicholas, age 7, presented for therapy five months after the death of Sarah’s 74-year-old mother, Elaine. Five weeks after the death of her alco- holic husband, for whom she had served as primary caretaker for several years, Elaine came into the family home to assist her daughter following the diffi- cult birth of Nicholas. She had remained there with her daughter’s family until her death.
Nicholas had been extremely close to his grandmother and, according to his parents, had been having great difficulty coping with her death. He had resumed soiling himself at school, a problem he had previously experi- enced for 2 years but that had been resolved for 18 months before the death of his grandmother. Nicholas’s teachers reported that recently he had be- come increasingly oppositional, had refused to do assignments, and was ag- gressive toward other students. At home, he was withdrawn from his parents, aggressive and impatient with the family’s pets (2 cats, 3 kittens, 1 dog, and 3 rabbits), and unwilling to talk about his grandmother or to enter her room.
Sarah admitted that she had become very depressed since the death of her mother, with whom she had a very conflicted relationship. Sarah experi- enced periods of withdrawal and occasional “crying spells.” Les had recently left his job of 8 years as a food service deliveryman and had begun selling insurance. The family income was seriously reduced by this job change, but Les insisted that in the long run this job would be more lucrative than was his previous one. At the time the family sought treatment, however, he was largely unoccupied during the day and usually engaged in sales calls during the evening.
Marla reportedly showed no change in functioning following her grandmother’s death and appeared to be adjusting well to this loss. She was popular with teachers and peers, was active in the school band and on the volleyball and basketball teams, and maintained above-average grades. At home, she was generally quiet, good-natured, and responsible. However, she and her father often argued over household chores, with each complaining of having to do the other’s work.
During the first session, the family was asked to identify the problem and describe how each of them had been affected by it. Their initial responses labeled Nicholas’s behaviors as the problem and characterized Nicholas as stubborn, demanding, and oppositional. As the discussion continued, the family admitted that Nicholas was simply reacting to the grief that each of them was feeling in response to Elaine’s death and to the effects of this grief on each family member. The Hudsons then agreed that their main problem was their inability to deal successfully with their feelings of grief and loss.
The family was informed that often the goal of therapy is not to get rid of the problem but rather to find new and better ways to manage it. The therapist asserted that any family would have difficulty adjusting to the loss of a family member and that often problems develop as the family struggles to find a way to deal with this loss. The family then was asked to unani- mously decide on a name for the problem with which they were currently struggling. “Sadness” was described by the family as “a black hole that sucks you in” (Sarah); “a thick, dark fog” (Les); “a heavy weight” (Marla); and “like a big, mad monster” (Nicholas).
Noting that “one picture can be worth a thousand words,” the therapist suggested that, rather than family members telling how the problem had been
affecting them, they show how the problem was affecting each of them by concretizing and enacting their experiences with the problem. The family, who had successfully worked with the therapist 18 months to 2 years earlier to address Nicholas’s encopresis and adjustment difficulties at school, was largely unfamiliar with psychodramatic techniques but comfortable with the therapist’s sometimes unorthodox approach to problem resolution, and so they agreed to this suggestion.
Proposing that the family “try something different” that “may seem a bit strange or unusual but could prove helpful” is a generally successful means of engaging clients in action methods by piquing their curiosity and appealing to their sense of adven- ture. Externalization and concretization of the problem serve to separate the person from the problem not only linguistically but physically. Introducing the problem into the family’s space as a physical entity breaks the identification of any individual with the problem and permits the relationship between the family and the problem to be explored and altered. Directing encounters between the family and the problem lets family members “see” how the problem manipulates and maintains power over them.
The character and intentions of Sadness began to emerge through the family’s descriptions of this entity as large, dark, heavy, and threatening. Each family member’s description of Sadness suggests that this entity was some- how antagonistic toward the family. The relationship of Sadness with each member of the family was explored in a scene in which Nicholas was asked to take the role of Sadness (reversing roles with Sadness) and show in action how Sadness was affecting the family. The family agreed to cooperate in the production, and Nicholas was invited to use available props such as pieces of cloth, pillows, toys, and so forth in the scene.
The technique of role reversal involves an exchange of roles and positions between the major participants in an interaction and is a means of transcending the habitual limitations of egocentricity through identification with the other. Role reversal is used to demonstrate how another character in a scene behaves, to increase empathy or insight into another’s perspective, or to challenge the client’s assumptions and beliefs. It is generally easier to move the family beyond talk and into action by inviting the child closest to “play age” to assume a role other than that of self and allowing other family members to remain in their own roles and respond to the child’s new role during the initial enactment. Most children become quickly bored with “talk therapy” and readily accept invitations to “show” rather than “tell.” The family’s witnessing of the dramatic enactment fosters a heightened sense of projec- tive identification with the protagonist and facilitates greater cohesion and empathy than does simply hearing a verbal description.
Nicholas quickly selected a large black cloth square and tied it around his neck like a cape, announcing that he, as Sadness, “is bigger and stronger than anyone.” He then energetically began to push his mother under a table,
where he had her curl into a ball with her face in her hands. He commanded her to “Stay there and don’t come out!” He next placed his father in a corner of the room and built an enclosure around him with chairs, stating “You can’t come home!” He growled, scowled, roared, and made faces at his sister