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Resolving Painful Emotional Experience During Psychodrama Charmaine S. Mcvea. a Dissertation Submitted to the School of Psycholo

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Resolving Painful Emotional Experience During Psychodrama Charmaine S. Mcvea. a Dissertation Submitted to the School of Psycholo Resolving Painful Emotional Experience during Psychodrama Charmaine S. McVea. B.A. Dip.Psych. M.Psych.(Applied) MAPS A dissertation submitted to the School of Psychology and Counselling for the degree of Doctor of Philosophy. Queensland University of Technology Brisbane, Queensland 2009 i Keywords Brief Structured Recall Interpersonal process recall Catharsis Morenian role theory Change process research Psychodrama Comprehensive process analysis Painful emotional experience Emotion Multiple case studies Enactment Social atom In-session resolution Spontaneity theory ii Abstract Unresolved painful emotional experiences such as bereavement, trauma and disturbances in core relationships, are common presenting problems for clients of psychodrama or psychotherapy more generally. Emotional pain is experienced as a shattering of the sense of self and disconnection from others and, when unresolved, produces avoidant responses which inhibit the healing process. There is agreement across therapeutic modalities that exposure to emotional experience can increase the efficacy of therapeutic interventions. Moreno proposes that the activation of spontaneity is the primary curative factor in psychodrama and that healing occurs when the protagonist (client) engages with his or her wider social system and develops greater flexibility in response to that system. An extensive case-report literature describes the application of the psychodrama method in healing unresolved painful emotional experiences, but there is limited empirical research to verify the efficacy of the method or to identify the processes that are linked to therapeutic change. The purpose of this current research was to construct a model of protagonist change processes that could extend psychodrama theory, inform practitioners’ therapeutic decisions and contribute to understanding the common factors in therapeutic change. Four studies investigated protagonist processes linked to in- session resolution of painful emotional experiences. Significant therapeutic events were analysed using recordings and transcripts of psychodrama enactments, protagonist and director recall interviews and a range of process and outcome measures. A preliminary study (3 cases) identified four themes that were associated with helpful therapeutic events: enactment, the working alliance with the director and with group members, emotional release or relief and social atom repair. The second study (7 cases) used Comprehensive Process Analysis (CPA) to construct a model of protagonists’ processes linked to in-session resolution. This model was then validated across four more cases in Study 3. Five meta-processes were identified: (i) a readiness to engage in the psychodrama process; (ii) re-experiencing and insight; (iii) activating resourcefulness; (iv) social atom repair with emotional release and (v) integration. Social atom repair with emotional release involved deeply iii experiencing a wished-for interpersonal experience accompanied by a free flowing release of previously restricted emotion and was most clearly linked to protagonists’ reports of reaching resolution and to post session improvements in interpersonal relationships and sense of self. Acceptance of self in the moment increased protagonists’ capacity to generate new responses within each meta-process and, in resolved cases, there was evidence of spontaneity developing over time. The fourth study tested Greenberg’s allowing and accepting painful emotional experience model as an alternative explanation of protagonist change. The findings of this study suggested that while the process of allowing emotional pain was present in resolved cases, Greenberg’s model was not sufficient to explain the processes that lead to in-session resolution. The protagonist’s readiness to engage and activation of resourcefulness appear to facilitate the transition from problem identification to emotional release. Furthermore, experiencing a reparative relationship was found to be central to the healing process. This research verifies that there can be in-session resolution of painful emotional experience during psychodrama and protagonists’ reports suggest that in-session resolution can heal the damage to the sense of self and the interpersonal disconnection that are associated with unresolved emotional pain. A model of protagonist change processes has been constructed that challenges the view of psychodrama as a primarily cathartic therapy, by locating the therapeutic experience of emotional release within the development of new role relationships. The five meta-processes which are described within the model suggest broad change principles which can assist practitioners to make sense of events as they unfold and guide their clinical decision making in the moment. Each meta-process was linked to specific post-session changes, so that the model can inform the development of therapeutic plans for individual clients and can aid communication for practitioners when a psychodrama intervention is used for a specific therapeutic purpose within a comprehensive program of therapy. iv Statement of Original Authorship I, Charmaine McVea, declare that this thesis has not previously been submitted, either complete or in part, to meet the requirements for an award to this or any other institution of higher education. This work results from original research and to the best of my knowledge or belief, contains no material previously published or written by another person except where due reference is made in the text of the thesis. Signature …………………………………………… Date ………………………………………….... v Acknowledgments Many people have assisted me in the creation of this body of work and the opportunity to work with each of them has made the often solitary journey of completing a PhD personally and professionally enriching. I am immensely grateful for the guidance and encouragement I received from my primary supervisor, Professor Kathryn Gow. She has a remarkable capacity to hold the big picture and still have an eye for details. Her steadying hand and confidence in the research have enabled me to see the project through. I would also like to thank my associate supervisor Dr Roger Lowe for his insights and suggestions and the QUT School of Psychology and Counselling for supporting this research. The openness and generosity of the workshop participants, sharing what were at times very painful experiences, made this project possible. It is inspiring to walk along side people who are on a journey of personal growth and I thank them for their willingness to make their experiences available for the benefit of others. Likewise, I would like to thank the psychodramatists who conducted the workshops, Chris Andrade, Brigid Hirschfeld, Kate Hudgins and Mary Anne Cox, for their willingness to reflect on their own practice with honesty and humility. I have gained enormously from working with such dynamic and skilled therapists. To my colleagues who contributed time and enthusiasm over a number of years – Jenelle Watson, Jan Patty, Brenda Lack, Melody Krok, Jane-Ellen Corkeron, Maria O’Leary and Kathy Uzsoki – I am very grateful. As well as their professional involvement reviewing transcripts, auditing or editing, they offered personal support and their continuing faith that this was a project worth completing. I thank my peers in the Australian and New Zealand Psychodrama Association for their warm response to the research, in particular Don Reekie, who has discussed psychodrama theory with me, and Elizabeth Synnot and Peter Howie for the use of their venue. Finally, my family have continued to provide me with love and encouragement throughout. My husband, Ralph Allan, gave me unwavering personal support and was also my principal editor, reading numerous drafts over the years. Our daughter, Kathryn, has helped to give me a balanced perspective. She rightly suggests that we should have lots of parties to celebrate being finished. vi Table of Contents Page Keywords i Abstract ii Statement of Original Authorship iv Acknowledgments v Table of contents vi List of Tables xii List of Figures xiv List of Abbreviations xviii Glossary of Psychodrama Terms xix Chapter 1: Introduction 1 Purpose of the research 1 Background to the research 1 Overview of the thesis 5 Chapter 2: Theoretical Foundations of Psychodrama 7 A model of healthy functioning: spontaneity theory and role theory 7 Social atom repair: the psychodramatic construction of healing and personal development 11 The application of spontaneity theory and role theory within the structure of a classical psychodrama session 13 Summary 16 Chapter 3: Empirical Evidence for Psychodrama Theory and Practice 17 The current state of psychodrama outcome research 17 Psychodrama process research: Models of therapeutic agency 21 A need for research to build theory and inform psychotherapy practice 26 vii Chapter 4: Emotion and Emotional Processing 28 Defining emotion 28 Emotion and healthy functioning 29 Emotional pain 30 Emotional processing 31 The relationship between emotion and spontaneity 32 Summary 33 Chapter 5: Overview of the Research 35 Rationale 35 Research plan and research questions 37 Chapter 6: Research Design and Methodological Approach 40 Multiple case study design 40 Psychotherapy change-process research as an approach to model building 41 Multiple sources of data 45 Team-based analysis and the consensus decision making approach 47 The participation of the investigator at all stages of the research 48 Ensuring credibility and coherence of the findings
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