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性创伤的经验性心理剧治疗(英文版)
 
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Experiential Psychodrama with Sexual Trauma

   
      Kate Hudgins, Ph.D., TEP
(1998). In L. Greenberg, J. Watson, & G Leitaer (Eds.), The Handbook of Experiential Psychotherapy.  New York:  Guilford Publications, Inc.
 
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Abstract
This chapter presents a clinically-driven model of using experiential therapy with clients who have a history of sexual trauma.  Classical psychodrama, which is the seminal action method, is structured to promote perceptual, affectual, and behavioral organization during assessment, intervention, and processing.  Several clinical structures are presented to guide the enactment of core trauma scenes with re-traumatization:  1)  the types of re-experiencing drama, and 2)  the priniciples of conscious re-experiencing with developmental repair.  A composite case example is used to demonstrate the safe use of psychodramatic methods with a client/protagonist actively working on core trauma repair.
 

 
      The effects of childhood sexual trauma (CST) present both conceptual and treatment challenges to the practicing clinician (Beutler & Hill, 1992;  Briere, 1992;  Green, 1993;  Terr, 1991). The particular clinical configuration that has gained prominence--denial and/or flooding of body sensations, distorted perceptual processes, interruptions in information processing, dissociated intense affects, primitive defenses, and behavioral reenactments--points to the use of experiential psychotherapy as a treatment method of choice with patients with a history of severe trauma, specifically sexual abuse ( Ellenson, 1986; Gelinas, 1983).  Experiential psychotherapy targets interventions directly at the somatic, perceptual, cognitive, affective, adaptive and behavioral processes that are of a critical nature in healing for these patients (Courtois, 1988; Ratican, 1992).
      While classical psychodrama has the power to treat core trauma, many clinicians do not use experiential methods with survivors of sexual trauma because of the potential for uncontrolled regression or retraumatization. To avoid these pitfalls the therapist must always emphasize safety and utilize clinical judgment and modify classical psychodramatic methods as needed. While there has been little empirical research on psychodrama specifically with sexual trauma (Karp, 1991), the model presented in this chapter has been developed carefully over 15 years of clinical practice with survivors of sexual trauma and eating disorders, as well as, in discussion with the clinicians who have participated on our treatment teams (Hudgins, 1989; Hudgins, In press).  Patient’s self-reports, therapists’ assessments, and videotapes of actual psychodrama sessions substantiate the effectiveness and safety of this approach.
      A number of recent theoretical and empirical studies do validate many of the psychodramatic interventions and therapeutic constructs used in this model (Blatner & Blatner, 1988; Buchanan, 1984; Holmes, 1992;  Hudgins & Kiesler, 1987;  Kellerman, 1992;  Kipper, 1989;   Taylor, 1986). Recent research also documents clearly that group psychotherapy is often the preferred method of treatment with sexual trauma (Mennen & Meadow, 1992;  Van der Kolk, 1996).
      This chapter presents clinical goals, the use of an action trauma team, types of re-experiencing dramas and advanced action interventions (Hudgins, 1993b, Hudgins & Toscani, 1995). A composite transcript of a psychodrama session also walks the reader through the steps of conscious re-experiencing developed to prevent uncontrolled regression and re-traumatization (Hudgins, 1993a)
Theoretical Framework of Psychodrama
      Psychodramatic techniques seek to tangibly present all aspects of the client's internal experience, both verbal and nonverbal (Moreno, 1977). Concretization and enactment are the main tools to produce new experience in psychodrama (Moreno & Moreno, 1969). Concretization covers the use of expressive arts materials, visualization, projective objects, and personification of abstract qualities. Enactment includes role playing of parts of Self, significant others and living beings, such as dogs or cats. 
      Psychodrama changes experience in the here and now so that sensations, perceptions, images, feelings and behaviors from the past can be accessed and modified at the core level (Holmes, 1992). Developmental repair is a key ingredient of change. What did not happen in the past--a comforting mother, a protective father--can be created in psychodrama so that the new experience can be integrated into new meaning structures. 
Structure of a Psychodrama Session
      A psychodrama session consists of warm-up, action and sharing (Hollander, 1969). The warm-up focuses the group’s attention on a certain theme or process and may include structured experiential tasks.  For example, the therapist/director (in psychodrama, the therapist is called the director) might begin the group by asking group members to “draw their trauma” on a piece of paper and discuss how that felt in dyads.  Action begins when a client chooses to be the protagonist for the session.  The protagonist is the person who enacts a personal story using other group members to role play significant others and abstract qualities. Sharing of group members experience ends the psychodrama.
      In classical psychodrama the first scene is an assessment of the problem in the here and now (Goldman & Morrison, 1984). 
For example, a protagonist with a history of CST began by  describing and enacting how emotion-laden, intrusive memory fragments interrupted a conversation with her boyfriend. The protagonist picked another group member to be her boyfriend and demonstrated how he responded to her when they were at a restaurant.  Group members enacted internal roles for the protagonist, such as: “the voice inside telling me I’ll get hurt” and/or “the feeling of turning into a little child I’m so scared”. 
      Additional scenes are guided by clinical judgment of what aspect of the protagonist’s reality needs to be experienced, explored, expressed, and processed. In this case, we followed the thread of primary affect and changed the enactment from the scene with her boyfriend to a scene with the teacher who sexually abused her at age 8.  Exploring this earlier scene allowed the protagonist to adaptively release primary feelings that had been dissociated, allowing new meaning structures to emerge from the new experience in the psychodrama. 
      The final scene in a psychodrama is one of developmental repair and can let the protagonist experience a healing scene that did not happen in life.  Here the protagonist watched as a group member played her mother confronting the teacher and reporting him to the principal.  With these new experiences, the protagonist gained a sense of self-protection and being cared for by a “good enough mother” which changed her core sense of self, as well as, her cognitive and emotional schemes for the future.  
       Additionally, role training can be practiced for the future. This protagonist created the role of “calm self-supporter”, and practiced saying: “This is the present.  I am here with John, not that teacher.  I can breathe and look at John and feel safe and calm today”.
      Sharing is the final stage in the structure of a psychodrama session. It is important that all group members verbally share what they experienced during the drama in order to cognitively anchor new awareness and/or adaptively release feelings.  The man who played the protagonist’s boyfriend shared that he is a survivor of CST and that this role helped him understand what his partner experiences with him. The group member who played the protective mom shared that she found out that her mother probably wanted to protect her from her uncle’s abuse, but that she didn’t know how.  Sharing helps integrate the protagonist back into the therapeutic community by connecting her story with others’ experiences.
Clinical Therapeutic Goals
Goal 1:  Establish intrapsychic roles of safety and build interpersonal connections among group members to support enactment.
      The protagonist must be safely anchored into the interpersonal support of the group, as well as, connected to an experiential sense of personal safety.  Even if the protagonist does not spontaneously produce roles of safety, the director prescribes them prior to further enactment (Toscani & Hudgins, 1996).  As director, I say to the protagonist who wants to enact a confrontation or uncover further memories:  “Well, OK, but let’s begin by building a safe place to do that.  Pick someone to be the part of your Self that is healthy, whole, and supportive.  What roles/parts of Self do we need here with you to be able to confront your uncle?” Positive roles need to be available to director and protagonist when needed for containment.
       Concretizing interpersonal roles also increases safety for the protagonist.  Putting in a supportive friend or good enough mother gives the protagonist permission to explore unknown areas with less fear.  If he or she has difficulty accessing personal roles of intrapsychic safety or interpersonal support, the director can also intervene with the suggestion that the protagonist bring his or her spirituality in for additional support. For many people in 12-step programs this is a known and valued role.  
Goal 2:  Structure enactment to promote regression in the service of the ego in order to access dissociated material while preventing retraumatization.    
     In psychodrama scenes, the protagonist can return to the original traumatic moment when fixation in self-development occurred.  Intense dissociated primary affect can be adaptively released supported by the director’s clinical judgment and the protagonist’s informed consent, resulting in changes to meaning structures. Added spontaneity and creativity support this regression in the service of the ego by providing roles that were not available at the time of trauma.     
      An important clinical assessment is: does the protagonist have enough positive roles and adaptive capacity to stay conscious and able to observe the action while re-experiencing a core trauma scene?  If so, the psychodrama progresses to the original trauma scene by following the Principles of Conscious Re-experiencing with Developmental Repair (Hudgins, 1993a). Unprocessed emotion laden experiences become consciously experienced and are integrated into present reality step by step with the support of a trained clinical team to prevent retraumatization.
Goal 3:  Enact original core trauma scenes so the protagonist can consciously re–experience dissociated material for the purpose of developmental repair.
      The clinical question when conducting conscious re-experiencing of core trauma scenes is: in which role does the protagonist need to experience developmental repair?  Psychodrama scenes can focus on self-repair where one or more parts of the Self or internal role relationships enact a dialogue and find a compromise solution for co-consciousness and/or integration.  An auxiliary can create a healing experience of the “good enough father”, “the friend who never leaves” or “the forgiving god”.  For others, a present centered scene of interpersonal support from the group members themselves may be the moment of developmental repair. 
      There is a theoretical and clinical rationale for a protagonist to re-experience original trauma scenes from the role of the child who actually experienced the horror.  Due to state dependent learning, dissociated material must be accessed through the state in which it was learned.  Primary emotions must be released and cognitive structures changed from the point of the original decision making.  This level of conscious re-experiencing is always done with the support of a Containing Double, the protagonist’s positive roles, and full informed consent to prevent re-traumatization. 
       The developmental repair scene must always be generated from the protagonist and be congruent with the individual set of internal object relations.  This repair scene is never contrived or forced by the director.  The protagonist’s spontaneity creates what is needed for repair and healing.
Use of An Action Trauma Team
      As the clinical work I did with sexual trauma survivors became more experiential, I found these methods to be exceptionally healing and simultaneously found the need for structure imperative to prevent retraumatization.  This level of depth required a team, so The Action Trauma Team was developed to guide the safe re-experiencing of core traumatic material with modified psychodramatic methods. (Hudgins & Toscani, 1993). 
      The Action Trauma Team includes a Director, an Assistant Leader, and a minimum of two Trained Auxiliary Egos. Each clinician is educated in traditional methods of healing--medicine, psychology, social work, counseling, education--with post­­–graduate training in psychodrama, sociometry and group psychotherapy.  All Team Members are Board certified as Practitioners or Trainers of Psychodrama, Sociometry and Group Psychotherapy or are working on these national graduate certification levels under clinical supervision.  Team Leaders are certified at the national level as a Trainer in psychodrama and group psychotherapy.
 
Director/Team Leader
      The therapist uses his/her clinician skills in the role of psychodrama director to provide safety and guide enactment for protagonist, group and team.  The director assesses protagonist’s strengths and self-support and makes directing decisions based on clinical knowledge of diagnosis, adaptive functioning, treatment planning, timing, and goals of the session. S/he contracts with protagonist and group for the Type of Re–experiencing Drama and establishes safety precautions needed for enactment and expression of intense emotion and dissociated material prior to action. The director then concretizes trauma scenes using the step by step Principles of Conscious Re–experiencing and Developmental Repair.  S/he adeptly utilizes the Action Trauma Team to provide containment of experiencing and support affective expression as clinically indicated.
Assistant Leader
     The role of Assistant Leader (AL) was developed to provide extra clinical support to the director, protagonist and other group members. It is a team effort to allow the protagonist to enact the chaos of the inner symbolic world while integrating group members who may become triggered into their own unconscious material. The AL is the gatekeeper between the spontaneous action of the audience and the enactment by the director and protagonist, and, like the director, utilizes clinical skills to prevent retraumatization.
      The AL assesses group members’ levels of personal safety, positive roles, and interpersonal support throughout the drama and intervenes for containment or expansion of intense affect and/or dissociation. S/he co–directs the trained auxiliary egos to implement the director’s interventions through use of the team. The AL integrates spontaneous auxiliary roles from group members and team members and makes therapeutic role assignments.
Trained Auxiliary Egos
     Trained auxiliary egos (TAEs) are a rich resource for protagonist and group alike when re-experiencing past trauma scenes, promoting adaptive release of primary affect, and achieving developmental repair. TAEs provide structure for safety, expansion, and integration.  For example, often while the protagonist is disclosing abuse, an audience member will start to shake and cry.  In this case, a TAE will sit beside the group member and intervene with specific gentle instructions to reduce the intensity of the primary emotion that has been triggered.
      Trained auxiliaries also support exploration and release of primary affect that has been stored in unconscious awareness. When directed to do so by the Assistant leader, a TAE stands beside the protagonist and gives encouragement in a role, such as best friend and says “it’s OK to express your feelings.  You can handle it.  You are not alone here.”  Intense primary emotion is then released with conscious support and is not only a purging of dissociated affect, but integrated into future meanings.
      A third function of the TAE is to promote cognitive integration of affect at the moment of emotional release.  Emotional expression of dissociated affect can result in time distortion and uncontrolled regression placing the trauma survivor at risk of retraumatization.  To prevent this from happening, a TAE stands beside the protagonist and supports a level of conscious awareness with statements from the cognitive role of the Self when directed to do so by the AL.  For example, “I can feel my rage and also remember what it is about now as I express it.  I can stay present and say what I mean”.  By making cognitive statements while the protagonist is in the process of intense affect the TAE helps keep the dual awareness of emotion and thought alive and integrated into new meaning structures.
Types of Re-experiencing Dramas
     The Types of Re-experiencing Dramas are a further structure developed in this approach to prevent re-traumatization (Hudgins, 1993b). Each type of drama has a contract, clinical session goals and action descriptions to guide experiential methods of treatment.
Renewal and Restoration
Session GoalTo access the protagonist’s active experience of a sense of personal and collective renewal and restoration. 
Action Description.  In this first and most general type of drama, the protagonist contracts to focus on building and experiencing positive roles in order to build strength to:  1) begin the work of uncovering, 2) get refueled during the process,  and/or 3) celebrate termination and progress.  This is an often overlooked, though very necessary type of drama when working with trauma survivors, who need the positive role development to balance out the attentional focus on traumatic roles, intense primary affect and problematic interpersonal relationship.
Dreams & Metaphors
Session Goal:  To explore unconscious symbols of past trauma that are projected into dreams, metaphors, or myths as the vehicle for increased awareness and change in meaning structures.  
Action Description. When the protagonist contracts for a drama to enact a dream or metaphor, the director keeps the enactment at the level of symbolic projections.  Relying on this contract for structure maintains a level of safety for the protagonist.
Many survivors report becoming consciously aware of childhood trauma for the first time through recurring dream images that contain elements of trauma. Dissociated thoughts, feelings, defenses, and behaviors will, no doubt, intrude upon the symbolic projections concretized in dreams and metaphors, but the director must not be tempted to follow the strands of unconscious awareness to deeper levels of experiencing.  A metaphor may also yield unconscious fragments of dissociated material in a safe and abstract manner.  
Initial Discovery and Accurate Labeling of Core Trauma
Session Goal:  To enact partially conscious memories, feelings, and behaviors, in order to connect them with accurate meaning arising from the client’s own experiential awareness and processing.
Action Description.  The contract is not for emotional expression, but for the emergence of experiential meaning.  The protagonist enacts consciously remembered experiences–thoughts, images, feelings, behaviors, even ego states–for the purpose of exploration and clarification.  The protagonist explores his or her internal reality and works with primitive images, defenses and feelings, which promotes working through of perceptual distortions and inaccurate labeling of past experience.  Doing it in a group setting both lifts shame and presents an immediate opportunity for feedback from others.
Uncovering and Exploring of Core Trauma
Session Goal:  To access, consciously re–experience, express and work through unconscious elements of the core trauma scene for the purpose of memory retrieval, emotional processing and integration into information processing systems.
Action Description. The protagonist contracts to find the unconscious affect and meaning behind repetitious trauma symptoms after sufficient spontaneity, positive roles, adaptive strategies, and interpersonal support are established. The director and protagonist begin with some conscious fragment of memory––demonstrated in the body, mind, emotions, defenses, and behaviors––and contract to move into active experiencing and expression of unconscious awareness. The use of an Action Trauma Team is necessary for clinical safety when conducting Uncovering and Exploring dramas, as well as dramas where the contract is for Conscious Re-experiencing..
Conscious Re-experiencing and Developmental Repair
Session Goal:  To support the protagonist to consciously re–experience all aspects of past trauma in order to retrieve, experience, express, and process unconscious material to achieve developmental repair.
 
Action Description.  During the action of this type of drama, the protagonist contracts to re-experiences core trauma scenes with the safety of positive and prescriptive roles available to prevent retraumatization.  After core trauma scene is experienced, primary affect is expressed and new meanings made, the final scene is one of developmental repair.
      This level of psychodramatic enactment should only be made by an experienced protagonist who has the spontaneity, adaptive functioning, and group support needed for conscious re–experiencing of the full horror of trauma.  When the protagonist and group are ready, it is very healing to honor the true intensity of the past, and find new creative solutions in the present.
Advanced Action Interventions with Trauma
      Several modifications of classical psychodramatic interventions are detailed below to increase safety and treatment effectiveness when working with survivors of sexual trauma. All of the presented interventions are woven into the clinical vignette that follows.  A fuller description of the role structure and manualized interventions used to guide action with trauma survivors is found elsewhere (Hudgins & Toscani, In press;  Toscani & Hudgins, 1996).
The Containing Double
      When working with trauma, a group member takes the role of the Containing Double (a modification of the classical Double)--an inner voice of the protagonist-- and is instructed to only make affirming, supportive, and healing statements using "I" such as, "I know this is difficult and I know that today I can take some small steps toward my healing;" or "I know that today this is a safe group and I can tell a little bit of my story."  The Containing Double supplies internal support and cognitive balance when needed by the protagonist. The technique is further defined and operationalized elsewhere (Hudgins & Toscani, 1995).
Concretizing the Observing Ego
      The protagonist can be role-reversed into an observing-ego role to prevent uncontrolled regression at any given moment. The director asks the protagonist to take the role of his or her observing ego while a trained auxiliary takes the role of protagonist who is slipping into the trauma scene from the past.  The director asks: “What do you see happening now with yourself?  How can we slow your feelings down?  And the protagonist in the observing role answers:  “I see myself slipping into the past but I know I can feel the support of my Containing Double and stay present even though I’m terrified”.  The balance of experiencing and observing roles keeps primary affects from overwhelming cognitive functions and prevents retraumatization.
Holder of Dissociation     
       A third intervention that helps prevent retraumatization is to have someone take the role of “holder of the dissociation” for the protagonist. There is a paradox in enacting the role of holding dissociation that decreases dissociation and creates consciousness. This group or team member is instructed to make statements such as “I can feel myself floating up to the ceiling, but I can stay here” to alert both the protagonist and director that dissociation is increasing. The protagonist can also be role reversed into this role for assessment and distance from the trauma if indicated. 
Role Reversal with the Victim and Perpetrator Roles
      In this approach, trained auxiliaries (TAEs) are initially used for victim and perpetrator roles unless, through careful assessment of group members' strengths, the director determines that it is therapeutic that the protagonist and/or other group members take these roles.
      Enacting the Role of Victim.  The victim/child role holds the primary emotions that were experienced, but not expressed during the original trauma--terror, horror, rage, shame, despair. These primary emotions are usually well-known to the protagonist who may collapse into them early on in the drama. If this happens, a TAE is brought in to enact this role and free up the protagonist for other positive roles.
      However, the child role may be enacted by the protagonist when there is sufficient strength, support and positive roles to uncover and explore core trauma material that is unconscious. A Trained Auxiliary then supports the protagonist in this role so that s/he is not alone as happened in the original trauma.  Enactment of this role can allow memory retrieval to happen, intense affect to release, and healing to occur.
         It is in this child/victim role that the protagonist needs to be rescued and protected, which often occurs from the role of Observing Ego or one of the Positive Strengths. The director does not allow the protagonist in any child role to fight or confront the perpetrator.  That would be recapitulating the original trauma because of the powerlessness of that role, but as you can see, there are clinical indications for when and how to enact the child role.
      Enacting the Role of Perpetrator  The Perpetrator Role is also concretized in psychodrama with trauma survivors, but initially the role is enacted by a trained auxiliary in this model. The enactment of the perpetrator role is structured in short experiences, so the warm-up to the role is broken into manageable experiential chunks.  This structured role playing allows the protagonist the opportunity to master the role––without losing the Observing ego to the experience of the perpetrator role. 
      The TAE develops the perpetrator role in response to the demonstrated strength of the protagonist so as not to overwhelm his or her adaptive capacities.  This auxiliary enactment allows the protagonist to engage in interpersonal dialogue, confrontation, and healing as strength builds, affect is expressed, and new meanings emerge.
      The protagonist can play perpetrator roles when there is enough containment to prevent uncontrolled regression. Clinical indications for enactment of the perpetrator role are:  1)  to gain accurate information about state dependent memories, 2)  to work through idolization of the aggressor, and 3)  to re-integrate personal power that the perpetrator role holds in the experiencing of self.
Principles of Conscious Re-experiencing with Developmental Repair
      The Principles of Conscious Re–Experiencing with Developmental Repair were developed to guide the safe enactment of dramas dealing with unconscious trauma material (Hudgins, 1993a). Step by step the protagonist is guided to the core scene which ends with developmental repair.  The steps are:  Talk, Observe, Witness, Re-enact, Re-experience and Repair and can be completed in a single protagonist’s psychodrama or over a period of several dramas. This section describes each step using one protagonist and details the director’s clinical judgments.
Talk
      After a contract is negotiated for a Conscious Re-experiencing drama, the first step is for the protagonist to verbally describe the core scene to be enacted. Talking allows both the protagonist and the group to warm-up to what they will see, hear, feel and experience during the enactment, while the Director and Action Trauma Team assess safety and plan ahead for interventions to control regression and dissociation.  
      In this example, the protagonist, Judy states that she wants to re-experience a childhood scene where she was forced to have oral sex with the male neighbor next door when she was 5 years old in order to “make the pictures stop in my head”.
Director:  Judy, Let’s start by you telling us the scene you remember as if it is here in the present.  What happens?  How old are you?   
Judy:  The man next door used to talk to us sometimes. One day he comes over and asks me if I want to see his new kittens?  I say yes and he takes my hand and leads me down the basement stairs. (She stops and looks up at me with fear in her eyes.)
Director:  Would you like a Containing Double to help?  She picks Susan who knows the role from previous group participation. OK, what happens next?
Judy:  Just as we get to the bottom of the stairs, he pushes me ahead into the wall.  He grabs my ponytail and puts his hand over my mouth. I start to cry. I’m so scared.  I want my mommy. (Judy starts to tear up in the session).
Containing Double:  It’s OK, I can say what I remember.  I’m scared but I’m not alone now.  It’s not happening now, I’m only talking about it to the group. 
Judy:  (Takes a deep breath).  Yes, I can talk about it now...(pause). He whispers that he will take his hand off my mouth if I stop crying.  No noise, just do what he says and then I can go home.  He says not to tell anyone what happens here or he’ll kill my dog and tell mommy I am a bad girl and she won’t love me anymore...(pause) I nod OK.  He jerks me around and makes me sit down against the wall.  (Starts crying again).
Containing Double:  I’m OK, these are normal feelings.  I was little and scared then, but I am an adult now... 
Judy:  Yes, I am scared.  He starts unzipping his pants and his thing comes out (speaking rapidly).  It’s big and red and he pushes it at me...against my head...in my face.  Then he kneels down and grabs my cheeks and squeezes...really hard and says I better open up and do as he says or my dog is dead. (Starts coughing and crying and a group member brings her a glass of water).
Containing Double:  I can breathe and take a drink of water.  I’m OK.  I’m here on the psychodrama stage and I’m OK.  I can feel scared and I still feel safe.
Judy:  (Takes a deep breath and drinks a sip of water).  Yeh, I’m OK.  The water helps.  Anyway...he is hurting my mouth so I have to open it up and....he    pushes it in...just keeps doing it (voice gets little girlish and goes up) til ...til... (pause)... til it’s yucky all in my mouth (speaking rapidly).  I want to throw up.  I want to go home.  He throws a dirty shirt at me and tells me to clean up, go home and never tell anyone or I know what will happen.
Director:  Then what happens?  What do you do when you are so scared and so little?
Judy:  I go home and run and hide in the bushes.  I just sit there in a little ball until my mommy lets Chris, our beagle out, and he comes and licks my face and my mommy is calling me. I hug him and kiss him and then I go inside for dinner. I don’t tell her ‘cause I love Chris and I don’t want him to be hurt.
Director:  Take a breath.  That’s a lot to talk about.  Let’s walk around the stage (to decrease affect and increase cognition) and you tell me what you want to get out of the session today.  What do you want when we go through this scene? 
Judy: This scene goes over and over in my head, especially at night when I’m trying to sleep and I want to stop it.  Put a new ending on it.  Can we do that?
Director:  Yes, we can. Step by step, we’ll go back through what you just told us and you can stop the action whenever you want, change whatever you want.  You are in control of what happens now. You’ll have your Double and other supports with you so you won’t be alone. 
Observe
      In the second step the protagonist sets up the scene with trained auxiliaries in the victim and perpetrator roles and group members in prescriptive roles of safety. We begin with the prescriptive roles to establish safety as part of the pre-trauma scene, and then move to the trauma scene itself.  The goal is to have the scene set up on the stage and have the protagonist watch it for accuracy without affect added.
Director:  Before we concretize the scene you told us about, let’s get some more help up here.  Pick someone to be a support for you.
Judy:  Can I have my mommy up here?
Director:  You can have your mommy up here if that will help.  The mother you have today, or the mommy from when you were little?  Pick someone for the role you want.
Judy:  Evie, will you be my mommy?  My mommy was a good mommy and I know if I had told her what happened she would have protected me.
Director:  Evie, is that OK?  Come up here and stand in the protagonist’s space.  Judy you role reverse and become your mommy when you were five.  Be your mommy so Evie can see how she’s supposed to be. What are you wearing?  What are you like?  Talk like mommy.
Judy in the role of Mommy: Judy, honey...I think there’s something wrong.  Do you want to tell me something?  It’s OK.  I can hear you. Look, I have some Kleenex here in my apron. 
Director:  Reverse roles and come back to your protagonist role.  Evie, just remember those lines and stand there close to Judy til we see the scene she wants to tell you about.  Do we need anyone else to help you?
Judy:  It’s silly but I want my dog, I want Chris here.  He licked my face clean.  He loved me no matter what. 
Director:  Pick someone to be Chris.
Judy:  John, will you be Chris?  (She laughs).  Chris used to howl...you know how beagles do? Ahh roo...with your nose up in the air.
Director (does not role reverse into this role as she has already increased the experience of safety with her laughter).  Where do you want Chris to be?  John, come up and let’s hear you give a beagle howl! 
Judy:  Laughing...good...that’s good...you stay by your water bowl. 
Director:  Now, let’s pick someone to be your Observing Ego.  We want to make sure you have a part of you here that can observe at all times so you can make sense of this scene and not get overwhelmed with your feelings.  Pick some one for that role.
Judy:  I’ll pick, Tim.  Tim, you’re always so serious.  Can you be my Observing Ego?
Director:  Judy, reverse roles with Tim and enact your Observing Ego.  Are you serious?  Funny?  What are you like as Judy’s Observing Ego?
Judy in the role of Observing Ego:  I can see whatever happens here.  If it’s get scary, I’ll just move over to where Chris is, pet him and we can watch together.I already know what happened anyway. 
Tim as Observing Ego (role reverses and starts off by Judy’s side and slowly walks over to where Chris and the water bowl are):  I can see whatever happens here.  If there’s alot of feelings going on, I can pat Chris and we’ll all be OK.  
Director:  Now, let’s move toward the scene itself.  Where on the stage is the basement going to be?  Where is the wall?  Mark it off with some scarves and put a scarf or a pillow for the wall (this is for containment). 
Director:  (Pre-trauma scene is complete and the trauma scene is ready to be set up).  Pick someone to be 5 year old Judy and someone to be the neighbor next door.  The trained auxiliaries can take these roles or you can ask a group member.
Judy:  I’d like Ann (a trained auxiliary who has a young, innocent face) to be my little self.  I had blond hair like that when I was 5.  And I want Stephen (a trained auxiliary) to be the guy next door.  His name was Mr. Martin.
Director: Now, Ann and Stephen, I want you to slowly walk through the scene just like Judy told it. 
Director:  Judy...before little Judy and Mr. Martin come on stage.  I want you to feel the support of your Double, your mommy, Chris, and your Observing Ego. (Judy gathers them all close to her...).
Director  OK, Mr. Martin...go ahead.  (The scene is walked through slowly without any violence or sexual contact.  When it is time for the push toward the wall, Peter gently nudges    Ann and she falls against the wall and sits down.  When it is time for the oral sex scene, Peter stands about a foot away from Ann who is seated and moves his body slightly back and forth.)
Judy (As Mr. Martin says he’ll kill her dog, she sits down and starts to pat Chris).  I love you.  I don’t want anything to happen to you.  That’s why I didn’t tell.  I love you. 
Director(to decrease affect at this point):  Reverse roles into your Observing Ego and watch the rest of the scene from there.   
Witness
      In the third step the protagonist witnesses the core trauma scene and moves into action. The director increases the spontaneity and affective expression in the scene by the auxiliaries, and the protagonist responds to the enactment of victimization from one of the positive roles on stage.  Witnessing the past horror often results in the protagonist spontaneously rescuing the victim Self. The protagonist must be able to demonstrate the ability to rescue the child self from the core trauma scene before the re-experiencing proceeds further in order to prevent re-traumatization.
Director:  Judy, in this next part of consciously re-experiencing your trauma scene, you can witness it from any role you want for safety.
Judy:  I want to be in the role of my mommy.  I wanted her there when it happened and now she can be here today. 
Director:  Judy, pick someone to be the adult you. (Picks Cindy) Now, take the role of your mommy when you were five. 
Judy as Mommy:  Says to adult Judy:  It’s OK, I am here this time.  I won’t let you down.  To little Judy she says:  It’s OK, honey, I won’t let him hurt you this time.
Director (to trained auxiliaries):  Start the scene and play it with feeling this time. (Affect is increased through movement, tempo and voice tone).
Judy as Mommy (turns to adult Judy as Mr.Martin whispers that her mother won’t love her).  That’s not true!  If you had told me I never would have stopped loving you.  This is not right!
Director:  Mommy...tell that to Mr. Martin.  Speak to him directly for little Judy. 
Judy as Mommy (goes in and grabs Mr. Martin’s arm and demonstrates ability to rescue self).  Stop that...stop that...you leave my little girl alone.  You are a dirty old man!  I thought you were a friend of our family!  Now I see what you were really like.  You stop that!
(to little Judy) Come here, honey....you’re safe.  Mommy won’t let him hurt you. 
Director (to further expand the witnessing role and to check for introjection of the mother’s caring):  Judy, reverse roles back to your adult self.  Evie, be mommy just like we saw and Judy you respond from the adult role as mommy helps little Judy.
Judy (watches as Mommy goes in and brings little Judy out of the basement):  Mommy, mommy, thank you.  I knew you loved me.  I knew you would help!
Director (The director assesses she is in the child role and needs to develop the adult role a bit more):  Judy...good that is what the 5 year old might say.  What do you as the adult you are today say?  Do you respond to your mother, to your little self, to Mr. Martin?
Judy (kneels down and embraces the auxiliary in the role of little Judy):  It’s OK.  I’ve carried around that image of Mr. Martin hurting me for years and years and now it’s over.  He can’t hurt you again.  Mommy took care of that.  It’s OK now.  You don’t have to keep going through that again and again.
Re-enact 
       This fourth step is the switch from the protagonist’s experience of observing the scene, to actively experiencing the roles of victim and perpetrator. This time Judy experiences the scene from the more vulnerable role of the child.  Her Containing Double is always with Judy no matter what role, so re-traumatization is prevented.
      The director gives the protagonist a chance to “walk through” the enactment from the wounded child/victim role, before moving fully into re-experiencing. The director increases the level of active experiencing gradually, so there is a clear distinction between the processes of re-enactment and of re-experiencing with full informed consent.
Director:  Judy, this is good.  You have rescued your child self from the role of good mommy and as your adult self. Often, as we step into re-enactment and re-experiencing the protagonist or group may start “floating around the room”, so I’d like you to pick someone to be the holder of dissociation for you (prescriptive role).
Judy:  I’ll choose Gertrude.  She’s the most grounded person in the group so maybe she can keep us all here.
Director: Direct Gertrude in the role of dissociation where you want her to be as we re-enact the entire trauma scene.  (There is no role reversal here as this is a preventive intervention and the protagonist is not showing dissociation).
Judy:  You can stand over by the wall there in the scene.  When I see you, I can remember not to dissociate...that my goal is to stay present, feel what is here, make some meaning out of it all, so I can let it go.
Director:  Now, let’s set up the scene. We are going to slowly walk through the entire scene as you originally described it, but you know there will not be any violence or sexual touching here.  It is just a walk through and you can stop at any time you want.  OK?
Re–experience
     The fifth step deepens the protagonist’s active experience of all roles in the drama--victim, perpetrator, self, mother--to reach a controlled regression, expression of primary affects, and changed perceptions.
      After Judy walks through the core trauma scene from the role fo the five year old, she extends her active experiencing by going more fully into re-experiencing the vulnerability of being a child, but this time with support.
Director:  OK Judy, you take the role of your five year old self, and Ann, you stand beside her to support the role if she needs help.
Little Judy (begins to dissociate almost immediately in the child role):  I want my mommy...I’m scared...and then is quiet and looks up to the ceiling. 
Containing Double:  I’m OK, I am in my psychodrama.  I can see and feel what is happening to me as a little girl and I can feel my hand on my Double and I know Ann is here to support me.  I’m scared and I’m determined to do this work and stop this memory.
Holder of Dissociation:  I am holding the dissociation here.  It’s me that can’t see and feel.  You’re OK, you can tolerate what you know...you have support.
Little Judy:  Yes, I know where I am and that Ann is here.  I can do this.  I am OK.  It’s just really scary to be so little. (Judy now goes back through the scene with her supports keeping her anchored in the dual awareness of past and present).
Director (as the scenes ends and she runs up the stairs from the basement).  Judy, little Judy, come here to your adult self and your mommy.
Little Judy (rushes toward her mommy, embraces her and starts crying).  Mommy, mommy, he hurt me.  He’s a bad man.  I love you.  Do you love me?
Mommy:  Honey, of course I love you.  I’m glad you’re telling me about him, about what happened.  Now we can keep you and Chris both safe.

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