The Role of Group Sharing: An Action Research Study of Psychodrama Group Therapy in a Psychiatric Inpatient Ward
Abstract
:1. Introduction
1.1. Psychiatric Hospitalization and Group Therapy in Psychiatric Wards
1.2. Psychodrama and Group Sharing for Patients with Mental Illness
2. Materials and Methods
2.1. Action Research and the Single Case Study
2.2. The Study Setting and Participants
2.3. Materials and Data Analysis
3. Results
3.1. Manifestations of Distress in the Group
Rachel, a new participant, talks about the fact that she is very alone, and that for a lengthy period of time she had not left her rented room; that she has an internal voice (“not psychotic”, she emphasizes, “an internal voice like everyone has”) that makes her despair.
I ask: “What does the internal voice say?” Rachel answers: “It says that it will be bad”.
Michael says that he does not know what it is like to not be alone, he had not learned how to get help from others, he lives his entire life with a fundamental sense of being alone, even when he had good periods and even though he has a family. He took part in the wars in 1967 and 1973 and that did not help him at all. Now, at the age of seventy-two, he feels like he has no friends. It is something deep in the soul, he says.
Rachel responds emotionally to Michael’s words, saying that she feels exactly the same way.
“Letter to David: David has no more strength, I’ve lost all hope, these horrible feelings won’t let me be, and every day in this ward is hell for me. I feel I might go insane, I want to go home. Every day my mother fights with me, that I’ll agree to stay here longer. In the ward, everything feels sad and gloomy, and I just cross my fingers and hope that I’ll have the patience to last until I can be discharged”
I place a chair across from David, and ask him to sit in it. I ask him how he would respond to himself.
He says, “You need to be patient.”
As he returns to his own seat I ask him if he was persuaded—he says he was not.
I offer a double for him—“It’s difficult, I don’t have the patience.”
3.2. Patients Supporting One Another
Sara talks about her suicidal thoughts: “I’ve been here for two months already and nothing is better. I want to die every day, but I promised that as long as I am here, I will not do anything…People always tell me I look better, but I don’t feel any better”.
Hannah shares that she sees Sara’s suffering and depression and her wish for Sara is that she will feel better, that it is difficult for her [Hannah] to see Sara this way. She says that Sara is wonderful and she deserves to feel well.
Jacob also speaks about despair, about his depression that arises from the fact that he has destroyed himself and lost everything, on his immense weariness; about the fact that he just wants to hide here from reality and sleep. Ethan speaks about faith and tries to encourage Jacob.
3.3. Universality
In the psychodramatic vignette Lisa describes the great difficulty she causes her mother because of her illness. [She tells about] the guilt she feels towards her mother. She becomes emotional and cries.
[In the sharing phase] we discuss feelings of guilt surrounding illness, as Lisa has expressed; how it is an experience that other participants share as well. Nastya and Rachel say they also feel guilt towards their families.
…At the end of the session Lisa hugs Nastya. She thanks her and says she feels much better now.
The group members share how they are doing this morning. Aaron shares that he is confused about his place in the world. When he doesn’t observe the commandments of Judaism he feels emptiness, yet when he tries to observe the rituals he becomes unbalanced and triggers manic episodes. Another participant, Abraham tells him that when a person brings oneself closer to religion, at first God gives a push forward, but afterwards one is left [to struggle] with it alone. I ask Abraham if this is something he has personally experienced; he says yes, and adds: “We are souls attached together, souls that speak.”
3.4. Sharing as a Ritual
I take jars of paint that are in the room, and we begin placing them in the center of the circle, each one representing one of the bad feelings that had been expressed: sadness, anxiety, depression, stress, the wish to die, weariness, boredom, confusion, lack of control over one’s needs….
Afterward, I ask each group member, in turn, to remove a jar of paint from the circle and share what the feeling/the thing is that they would like to expel. The group does this: Each participant takes a jar of paint out of the center of the circle and shares what it represents and what they would like to do with it. We all repeat their words as if they were a mantra: “I wish this weariness would go away”, “I wish this sadness would depart”.
We place a circle of hoops in the room, and each hoop represents a feeling that arose during the encounter: sadness, confusion, optimism, depression, partnership, joy, shame, fatigue … Each participant chooses a hoop and tells the group what he would like to do with it.
Ethan chooses the hoop labeled “despair,” to tell Sara not to lose hope. Jacob chooses (Ethan’s) optimism. Abraham chooses faith and optimism. He addresses his words to Sara and Jacob, and talks about God, who, even if it is difficult to understand, always has our interests in mind.
Finally, I take the partnership hoop, and say that I’ve felt a lot of that partnership within the last hour.
4. Discussion
5. Limitations
6. Conclusions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
- Deegan, P.E. Rethinking Rehabilitation: Freedom. In Proceedings of the 20th World Congress of Rehabilitation International: Rethinking Rehabilitation, Oslo, Norway, 22 June 2004. [Google Scholar]
- Lysaker, P.H.; Lysaker, J.T. Dialogical Transformation in the Psychotherapy of Schizophrenia. In The Dialogical Self in Psychotherapy; Hermans, H., Dimaggio, G., Eds.; Routledge: London, UK, 2004; pp. 205–219. [Google Scholar] [CrossRef]
- Corrigan, P.W. How Stigma Interferes with Mental Health Care. Am. Psychol. 2004, 59, 614–625. [Google Scholar] [CrossRef] [PubMed]
- Corrigan, P.W.; Rao, D. On the Self-Stigma of Mental Illness: Stages, Disclosure, and Strategies for Change. Can. J. Psychiatry 2012, 57, 464–469. [Google Scholar] [CrossRef] [PubMed]
- Mueser, K.T. The Trauma of Psychosis: Posttraumatic Stress Disorder and Recent Onset Psychosis. Schizophr. Res. 2010, 116, 217–227. [Google Scholar] [CrossRef]
- Yanos, P.T.; Roe, D.; Lysaker, P.H. Narrative Enhancement and Cognitive Therapy: A New Group-Based Treatment for Internalized Stigma among Persons with Severe Mental Illness. Int. J. Group Psychother. 2011, 61, 577–595. [Google Scholar] [CrossRef] [PubMed]
- Orkibi, H.; Bar, N.; Eliakim, I. The Effect of Drama-Based Group Therapy on Aspects of Mental Illness Stigma. Arts Psychother. 2014, 41, 458–466. [Google Scholar] [CrossRef]
- Holloway, F. Acute Wards: Contexts, Pressures and Satisfactions. In Psychological Groupwork with Acute Psychiatric Inpatients; Radcliffe, J., Hajek, K., Carson, J., Manor, O., Eds.; Whiting & Birch: London, UK, 2010; pp. 51–70. [Google Scholar] [CrossRef]
- Morrison, A.P.; Frame, L.; Larkin, W. Relationships between Trauma and Psychosis: A Review and Integration. Br. J. Clin. Psychol. 2003, 42, 331–353. [Google Scholar] [CrossRef]
- Ayer, L.; Venkatesh, B.; Stewart, R.; Mandel, D.; Stein, B.; Schoenbaum, M. Psychological Aspects of the Israeli–Palestinian Conflict: A Systematic Review. Trauma Violence Abus. 2017, 18, 322–338. [Google Scholar] [CrossRef]
- Rosler, N.; Hameiri, B.; Bar-Tal, D.; Christophe, D.; Azaria-Tamir, S. Current and Future Costs of Intractable Conflicts—Can They Create Attitude Change? Front. Psychol. 2021, 12, 681883. [Google Scholar] [CrossRef]
- Kanas, N. Group Therapy for Schizophrenic Patients; American Psychiatric Association: Washington, DC, USA, 1996. [Google Scholar]
- Fagin, L. Is It Possible to Make Acute Wards into Therapeutic Communities. In Psychological Groupwork with Acute Psychiatric Inpatients; Radcliffe, J., Hajek, K., Carson, J., Manor, O., Eds.; Whiting & Birch: London, UK, 2010; pp. 21–36. [Google Scholar]
- Shulman, L. The Skills of Helping Individuals, Families, Groups, and Communities, 6th ed.; Thomson Brooks/Cole: Belmont, CA, USA, 2009. [Google Scholar]
- Whitaker, D.S. Using Groups to Help People, 2nd ed; Routledge: London, UK, 2001. [Google Scholar] [CrossRef]
- Wise, S.; Nash, E. Healing Trauma in Group Settings, 1st ed.; Routledge: New York, NY, USA, 2019. [Google Scholar] [CrossRef]
- Dreikurs, R. Group Psychotherapy and the Third Revolution in Psychiatry. Int. J. Soc. Psychiatry 1955, 1, 23–32. [Google Scholar] [CrossRef]
- Fehr, S.S. Introduction to Group Therapy, 2nd ed.; Routledge: New York, NY, USA, 2003. [Google Scholar] [CrossRef]
- MacKenzie, K.R.; Tschuschke, V. Relatedness, Group Work, and Outcome in Long-Term Inpatient Psychotherapy Groups. J. Psychother. Pract. Res. 1993, 2, 147–156. [Google Scholar]
- McDermut, W.; Miller, I.W.; Brown, R.A. The Efficacy of Group Psychotherapy for Depression: A Meta-Analysis and Review of the Empirical Research. Clin. Psychol. Sci. Pract. 2001, 8, 98–116. [Google Scholar] [CrossRef]
- Yalom, I.D. Inpatient Group Psychotherapy; Basic Books: New York, NY, USA, 1983. [Google Scholar]
- Yalom, I.D.; Leszcz, M. The Theory and Practice of Group Psychotherapy, 6th ed.; Basic Books: New York, NY, USA, 2020. [Google Scholar]
- Holmes, P.; Karp, M. Inspiration and Technique. In Psychodrama: Inspiration and Technique; Holmes, P., Karp, M., Eds.; Routledge: London, UK, 1991; pp. 1–6. [Google Scholar]
- Yaniv, D. Dynamics of Creativity and Empathy in Role Reversal: Contributions from Neuroscience. Rev. Gen. Psychol. 2012, 16, 70–77. [Google Scholar] [CrossRef]
- Cheribeth, T.; Basta, J.; Sullivan, C.M.; Davidson, W.S. The Role of Social Support in the Lives of Women Exiting Domestic Violence Shelters: An Experimental Study. J. Interpers. Violence 1995, 10, 437–451. [Google Scholar] [CrossRef]
- Ron, Y.; Yanai, L. Empowering Through Psychodrama: A Qualitative Study at Domestic Violence Shelters. Front. Psychol. 2021, 12, 600335. [Google Scholar] [CrossRef] [PubMed]
- Kellermann, P.F. Focus on Psychodrama: The Therapeutic Aspects of Psychodrama; Jessica Kingsley: London, UK, 1992. [Google Scholar]
- Azoulay, B.; Orkibi, H. The Four-Phase CBN Psychodrama Model: A Manualized Approach for Practice and Research. Arts Psychother. 2015, 42, 10–18. [Google Scholar] [CrossRef]
- White, M. Maps of Narrative Practice; W. W. Norton & Company: New York, NY, USA, 2007. [Google Scholar]
- Ter Avest, I. “I Experienced Freedom within the Frame of My Own Narrative”: The Contribution of Psychodrama Techniques to Experiential Learning in Teacher Training. Int. Rev. Educ. 2017, 63, 71–86. [Google Scholar] [CrossRef] [Green Version]
- Sharma, N. Effect of Psychodrama Therapy on Depression and Anxiety of Juvenile Delinquents. Int. J. Indian Psychol. 2017, 5, 38–47. [Google Scholar] [CrossRef]
- Souilm, N.M.; Ali, S.A.O. Effect of Psychodrama on the Severity of Symptoms in Depressed Patients. Am. J. Nurs. Res. 2017, 5, 158–164. [Google Scholar] [CrossRef]
- Nooripour, R.; Afrooz, G.A.; Rahmani, S.; Hosseinian, S.; Tavalaei, S.A.; Alikhani, M. Effectiveness of Psychodrama on Aggression of Female Addicts with Bipolar Personality. J. Addict. Prev. 2016, 4, 4. [Google Scholar]
- Erbay, L.G.; Reyhani, İ.; Ünal, S.; Özcan, C.; Özgöçer, T.; Uçar, C.; Yıldız, S. Does Psychodrama Affect Perceived Stress, Anxiety-Depression Scores and Saliva Cortisol in Patients with Depression? Psychiatry Investig. 2018, 15, 970–975. [Google Scholar] [CrossRef]
- Wieser, M. Studies on Treatment Effects of Psychodrama Psychotherapy. In Psychodrama: Advances in Theory and Practice; Baim, C., Burmeister, J., Maciel, M., Eds.; Routledge: London, UK, 2007; pp. 271–292. [Google Scholar]
- Bucuţă, M.D.; Dima, G.; Testoni, I. When You Thought That There Is No One and Nothing”: The Value of Psychodrama in Working with Abused Women. Front. Psychol. 2018, 9, 01518. [Google Scholar] [CrossRef] [PubMed]
- Giacomucci, S.; Marquit, J. The Effectiveness of Trauma-Focused Psychodrama in the Treatment of PTSD in Inpatient Substance Abuse Treatment. Front. Psychol. 2020, 19, 00896. [Google Scholar] [CrossRef] [PubMed]
- Dogan, T. The Effects of the Psychodrama in Instilling Empathy and Self-Awareness: A Pilot Study. PsyCh. J. 2018, 7, 227–238. [Google Scholar] [CrossRef] [PubMed]
- Karatas, Z. Investigating the Effects of Group Practice Performed Using Psychodrama Techniques on Adolescents’ Conflict Resolution Skills. Educ. Sci. Theor. Pract. 2011, 11, 609–614. [Google Scholar]
- McVea, C.S.; Gow, K.; Lowe, R. Corrective Interpersonal Experience in Psychodrama Group Therapy: A Comprehensive Process Analysis of Significant Therapeutic Events. Psychother. Res. 2021, 21, 416–429. [Google Scholar] [CrossRef]
- Ron, Y. Psychodrama’s Role in Alleviating Acute Distress: A Case Study of an Open Therapy Group in a Psychiatric Inpatient Ward. Front. Psychol. 2018, 9, 2075. [Google Scholar] [CrossRef]
- Røine, E. Psychodrama: Group Psychotherapy as Experimental Theatre, 1st ed.; Jessica Kingsley: London, UK, 1997. [Google Scholar]
- Blatner, A. Foundations of Psychodrama: History, Theory and Practice, 4th ed.; Springer: New York, NY, USA, 2000. [Google Scholar]
- Schacht, M. Spontaneity-Creativity: The Psychodramatic Concept of Change. In Psychodrama: Advances in Theory and Practice; Baim, C., Burmeister, J., Maciel, M., Eds.; Routledge: London, UK, 2007; pp. 21–40. [Google Scholar]
- Farmer, C. Psychodrama and Systemic Therapy; Routledge: New York, NY, USA, 1995. [Google Scholar]
- Karp, M. The River of Freedom. In Psychodrama Since Moreno: Innovations in Theory and Practice; Holmes, P., Karp, M., Watson, M., Eds.; Routledge: London, UK, 1994; pp. 39–60. [Google Scholar]
- Orkibi, H.; Azoulay, B.; Snir, S.; Regev, D. In-Session Behaviors and Adolescents’ Self-Concept and Loneliness: A Psychodrama Process-Outcome Study. Clin. Psychol. Psychother. 2017, 24, 1455–1463. [Google Scholar] [CrossRef]
- Moreno, J.L. Psychodramatic Treatment of Psychoses. Sociometry 1940, 3, 115–132. [Google Scholar] [CrossRef]
- John, N.A. The Age of Sharing, 1st ed.; Polity: Cambridge, UK, 2017. [Google Scholar]
- Mateus, S. Public Intimacy. Sphera Pública 2010, 10, 57–70. [Google Scholar]
- Giacomucci, S. Social Work, Sociometry, and Psychodrama: Experiential Approaches for Group Therapists, Community Leaders, and Social Workers; Springer Nature: Singapore, 2021. [Google Scholar]
- Moreno, J.L. Psychodrama and Sociodrama. In The Essential Moreno: Writings on Psychodrama; Fox, J., Ed.; Tusitala Publishing: New Paltz, NY, USA, 2008. [Google Scholar]
- Lipman, L. The Triadic System: Sociometry, Psychodrama and Group Psychotherapy—An Overview. In Psychodrama in the 21st Century: Clinical and Educational Applications; Springer: New York, NY, USA, 2003; pp. 3–13. [Google Scholar]
- Gonzalez, A.J.; Martins, P.J.; Lima, M. Studying the Efficacy of Psychodrama with the Hermeneutic Single Case Efficacy Design: Results from a Longitudinal Study. Front. Psychol. 2018, 9, 1662. [Google Scholar] [CrossRef]
- Lewin, K. Action Research and Minority Problems. J. Soc. Issues 1946, 2, 34–46. [Google Scholar] [CrossRef]
- Neilsen, E.H. But Let Us Not Forget John Collier: Commentary on David Bargal’s ‘Personal and Intellectual Influences Leading to Lewin’s Paradigm on Action Research. Action Res. 2006, 4, 389–399. [Google Scholar] [CrossRef]
- McIntyre, A. Participatory Action Research; Sage: Thousand Oaks, CA, USA, 2008. [Google Scholar]
- Mertler, C.A. Action Research: Improving Schools and Empowering Educators, 5th ed.; Sage: Thousand Oaks, CA, USA, 2017. [Google Scholar]
- Meyer, J. Qualitative Research in Health Care. Using Qualitative Methods in Health Related Action Research. Br. Med. J. 2000, 320, 178–181. [Google Scholar] [CrossRef] [PubMed]
- Koshy, E.; Koshy, V.; Waterman, H. Action Research in Healthcare; Sage: Thousand Oaks, CA, USA, 2011. [Google Scholar]
- Hutchinson, A.; Lovell, A. Participatory Action Research: Moving beyond the Mental Health “service User” Identity. J Psychiatr Ment. Health Nurs. 2013, 20, 641–649. [Google Scholar] [CrossRef]
- Stringer, E.T. Action Research, 2nd ed.; Sage: Thousand Oaks, CA, USA, 1999. [Google Scholar]
- Greenwood, D.J.; Levin, M. Introduction to Action Research: Social Research for Social Change, 2nd ed.; Sage: Thousand Oaks, CA, USA, 2007. [Google Scholar]
- Kazdin, A.E. Single-Case Research Designs: Methods for Clinical and Applied Settings, 2nd ed.; Oxford University Press: New York, NY, USA, 2011. [Google Scholar]
- Yin, R.K. Applied Social Research Methods. In Case Study Research: Design and Methods, 4th ed.; Sage: Thousand Oaks, CA, USA, 2009; Volume 5. [Google Scholar]
- Crowe, S.; Cresswell, K.; Robertson, A.; Huby, G.; Avery, A.; Sheikh, A. The Case Study Approach. BMC Med. Res. Methodol. 2011, 11, 100. [Google Scholar] [CrossRef]
- Stake, R.E. The Art of Case Study Research; Sage: Thousand Oaks, CA, USA, 1995. [Google Scholar]
- Harrison, H.; Birks, M.; Franklin, R.; Mills, J. Case Study Research: Foundations and Methodological Orientations. Forum Qual. Soc. Res. 2017, 18, 1. [Google Scholar] [CrossRef]
- Miller, R.; Mason, S.E. Open-Ended and Open-Door Treatment Groups for Young People with Mental Illness. Soc. Work Groups 2012, 35, 50–67. [Google Scholar] [CrossRef]
- Turner, H. Concepts for Effective Facilitation of Open Groups. Soc Work Groups 2011, 34, 246–256. [Google Scholar] [CrossRef]
- Corbin, J.; Strauss, A. Basics of Qualitative Research: Techniques and Procedures for Developing Grounded Theory, 4th ed.; Sage: Thousand Oaks, CA, USA, 2015. [Google Scholar]
- Berg, B.L.; Lune, H. Qualitative Research Methods for the Social Sciences, 8th ed.; Pearson: Boston, MA, USA, 2012. [Google Scholar]
- Forman, J.; Damschroder, L. Qualitative Content Analysis. In Empirical Methods for Bioethics: A Primer; Jacoby, L., Siminoff, L., Eds.; Advances in Bioethics; Elsevier: Oxford, UK, 2008; Volume 11, pp. 39–62. [Google Scholar]
- Vaismoradi, M.; Snelgrove, S. Theme in Qualitative Content Analysis and Thematic Analysis. Forum Q. Soc. Res. 2019, 20, 23. [Google Scholar] [CrossRef] [Green Version]
- Roth, W.M. Bold Visions in Educational Research. In Doing Qualitative Research: Praxis of Method; Sense: Rotterdam, The Netherlands, 2005; Volume 3. [Google Scholar]
- Moore, O.; Cassidy, E.; Carr, A.; O’Callaghan, E. Unawareness of Illness and Its Relationship with Depression and Self-Deception in Schizophrenia. Eur. Psychiatry 1999, 14, 264–269. [Google Scholar] [CrossRef]
- Roe, D.; Lachman, M. The Subjective Experience of People with Severe Mental Illness: A Potentially Crucial Piece of the Puzzle. ISR J. Psychiatry Relat. Sci. 2005, 42, 223–230. [Google Scholar] [PubMed]
- Neff, K.D. The Development and Validation of a Scale to Measure Self-Compassion. Self Identity 2003, 2, 223–250. [Google Scholar] [CrossRef]
- Lupton, D. The Emotional Self: A Sociocultural Exploration; Sage: London, UK, 1998. [Google Scholar]
- Moskowitz, E.S. In Therapy We Trust: America’s Obsession with Self-Fulfillment; Johns Hopkins University Press: Baltimore, MD, USA, 2001. [Google Scholar]
- Olsson, P.A. Adventures in Psychodrama; CreateSpace: Houston TX, USA, 2017. [Google Scholar]
- Moreno, J.L. Who Shall Survive? Foundations of Sociometry, Group Psychotherapy and Sociodrama, 2nd ed.; Beacon House: Beacon, NY, USA, 1953. [Google Scholar]
- Fox, J. The Essential Moreno: Writings on Psychodrama, Group Method, and Spontaneity; Fox, J., Ed.; Tusitala Publishing: New Paltz, NY, USA, 2008. [Google Scholar]
- Moreno, Z.T.; Blomkvist, L.D.; Rutzel, T. Psychodrama, Surplus Reality and the Art of Healing; Routledge: London, UK, 2000. [Google Scholar]
- Vieira, F.; Risques, M. Psychodrama and Psychopathology: Purposefully Adapting the Method to Address Different Pathologies. In Psychodrama: Advances in Theory and Practice; Baim, C., Burmeister, J., Maciel, M., Eds.; Routledge: London, UK, 2007; pp. 247–260. [Google Scholar]
- Blatner, A. Acting-In: Practical Applications of Psychodramatic Methods, 3rd ed.; Springer: New York, NY, USA, 1996. [Google Scholar]
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Ron, Y. The Role of Group Sharing: An Action Research Study of Psychodrama Group Therapy in a Psychiatric Inpatient Ward. Psych 2022, 4, 626-639. https://doi.org/10.3390/psych4040048
Ron Y. The Role of Group Sharing: An Action Research Study of Psychodrama Group Therapy in a Psychiatric Inpatient Ward. Psych. 2022; 4(4):626-639. https://doi.org/10.3390/psych4040048
Chicago/Turabian StyleRon, Yiftach. 2022. "The Role of Group Sharing: An Action Research Study of Psychodrama Group Therapy in a Psychiatric Inpatient Ward" Psych 4, no. 4: 626-639. https://doi.org/10.3390/psych4040048
APA StyleRon, Y. (2022). The Role of Group Sharing: An Action Research Study of Psychodrama Group Therapy in a Psychiatric Inpatient Ward. Psych, 4(4), 626-639. https://doi.org/10.3390/psych4040048