Moreno and Beck: Psychodrama and CBT Aaron T. Beck Jacob L. Moreno Jenny Wilson, 2009 A thesis presented to the Board of Examiners of the Australian and New Zealand Psychodrama Association Inc. in partial fulfilment of the requirements towards certification as a psychodramatist. This thesis has been completed in partial fulfilment of the requirements toward certification as a practitioner by the Board of Examiners of the Australian and New Zealand Psychodrama Association Inc. © 2009 Jenny Wilson. The Australian and New Zealand Psychodrama Association has the right to publish. All rights reserved. Except for the quotation of short passages for the purposes of criticism and review, no reproduction, copy or transmission of this publication may be made without written permission from the author or the Australian and New Zealand Psychodrama Association Incorporated. No paragraph of this publication may be reproduced, copied, stored in a retrieval system, or transmitted, in any form or by any means, electronic, mechanical, photocopying, recording or otherwise, save with written permission of Australian and New Zealand Psychodrama Association Incorporated or the author. The development, preparation and publication of this work have been undertaken with great care. However the publisher is not responsible for any errors contained herein or for consequences that may ensue from use of materials or information contained in this work. Enquiries: Jenny Wilson, Christchurch New Zealand. E-mail [email protected] or to ANZPA, PO Box 232, Daw Park, South Australia 5041, Australia Photographs: Photo of Aaron T. Beck used with permission, photo of Jacob L. Moreno is in the public domain. ii Table of Contents Abstract...........................................................................................................................................iv Preface............................................................................................................................................vi Acknowledgements......................................................................................................................viii INTRODUCTION...........................................................................................................................1 How does a therapist combine two vastly different therapies?...................................................1 Literature review: Therapists who have combined CBT and Psychodrama...............................2 The Men......................................................................................................................................4 PHILOSOPHY, THEORY AND PRACTICE................................................................................7 Philosophy...................................................................................................................................7 Therapy Goals.............................................................................................................................8 Basic description.........................................................................................................................9 Spontaneity, Creativity and Surplus Reality.............................................................................10 Warm up....................................................................................................................................11 Roles, Schema Modes and Personality.....................................................................................12 Psychopathology.......................................................................................................................13 Therapeutic relationship and encounter....................................................................................16 Group considerations................................................................................................................18 Catharsis....................................................................................................................................19 Action........................................................................................................................................20 Thoughts ...................................................................................................................................21 Therapy content and therapist stance........................................................................................22 Techniques................................................................................................................................25 A CBT PSYCHODRAMA............................................................................................................25 CBT enriched with Psychodrama.............................................................................................25 Philosophy and theory behind the techniques...........................................................................29 IMPLICATIONS...........................................................................................................................33 Clinical practice........................................................................................................................34 Research and future directions..................................................................................................34 CONCLUSION..............................................................................................................................37 REFERENCES..............................................................................................................................38 iii Abstract This thesis introduces the work of Jacob L. Moreno, founder of Psychodrama, and Aaron T. Beck, a key founder of Cognitive Behaviour Therapy (CBT). I propose that although Psychodrama and CBT are vastly different therapies they have enough similarity and compatibility that Psychodrama can enrich CBT and CBT can make a contribution to Psychodrama. Introducing the founders and considering philosophy, goals, and theory lays the foundation for successful integration of CBT and Psychodrama as demonstrated in an example of supervised therapy. iv We give thanks for the invention of the handle. Without it there would be many things we couldn't hold on to. As for the things we can't hold on to anyway, let us gracefully accept their ungraspable nature and celebrate all things elusive, fleeting and intangible. They mystify us and make us receptive to truth and beauty. We celebrate and give thanks. AMEN Michael Leunig v Preface My friend Tania and I are walking on the ridge above Kaiteriteri. The walk is easy, companionable with just a little pleasant exertion on the uphill bits. With our eyes on the golden beach far below, we miss a junction in the track. We continue to the point of the ridge until the track peters out. There is a rough track of sorts heading straight down. It is steep, greasy with mud and deeply channelled. We push branches out of the way and hold tightly to shrubs and stalks to halt our downward decent. Then there is gorse, dead and prickly and we soon find that the ªtrackº runs underneath it in a grooved slippery slick. Should we continue? Can we get back? We turn around and find the way back easier than expected; climbing up is easier than the downward slide. Laughing we make our way to the top, backtrack a short distance and find easy steps cut into the hillside that take us to the beach. My Psychodrama track has been ill formed at times, muddy, scratchy and prickly. Detours and false trails have kept goals tantalisingly out of reach. Some stretches of this path have been joyous and pleasurable, some extremely difficult but made bearable by the company. I have been an Information Prospector for as long as I remember with a tendency to be goal focused, persistent, efficient and wanting to ªget a handleº on things; qualities that became overdeveloped during my clinical psychology training. Psychodrama training assisted me to develop strong complimentary abilities, so I can also be an Easy Companionable Explorer, highly valuing relationship, being more accepting of not knowing, more willing to try a variety of ways and even find pleasure in the surprises of detour. When I first started training in CBT and Psychodrama in the 1990's, distrust between the two camps was evident in dismissive comments made by senior people and peers on both sides. In response I automatically put something of myself aside as I entered the university buildings or the Psychodrama group room. My employment as a research therapist, an asset in my identity as a clinical psychologist, initially complicated my Psychodrama identity. I am trained in three different research protocol therapies (Cognitive Behaviour Therapy, Interpersonal Therapy and Schema Therapy). For several years I worked in a research setting and was required to use each of these therapies in a way that emphasised their unique characteristics and minimised overlap - a situation that I found interesting and satisfying but at odds with the holistic approach of vi psychodrama. This background influenced me to ask the specific questions about theory and practice that have structured my thesis. Now a clinical educator in a university clinic, my background contributes to me being a well informed, confident and influential advocate of Psychodrama. I have found reading about Psychodrama akin to reading the musical score of a great symphony;