Action therapies help addicts (of all kinds) face their direct experience

By Karen Carnabucci, LCSW, TEP

Experiential therapy —  a broadly based description of therapeutic modalities that employ here-and-now experiences —  are greatly effective when working with people in recovery.
 
Within recent years, many treatment centers and other clinical programs are re-inventing and re-informing their programs to show recognition of the particular needs for special populations and introducing a number of holistic treatment components like yoga, meditation, Reiki, nature walks and the like. Many of the same professionals also are re-evaluating the need for experiential learning and broadening experiential programs with psychodrama, metaphor, ritual and ceremony, the creative arts and work with animals as defined by distinct clinical objectives.

And addiction to alcohol and other drugs are no longer the only focus of recovery. People are struggling with gambling problems, video gaming, workaholism, binge eating and sugar addictions, pornography, compulsive shopping and compulsive use of the internet and social media, and other kinds of addictive behaviors.

​Because addicts of all kinds habitually use these compulsive behavior to avoid experience of self -- particularly experiences of pain, discomfort and trauma -- experiential therapy offers opportunities to have direct  experience of self and feelings in a safe and structured setting. In addition, experiential therapy offers multi-modal opportunities for learning, so that people who have difficulty thinking, writing or speaking can learn and express themselves in a variety of ways.
 
Experiential therapy is based on psychodrama, an action method developed in the 1920s and 1930s by Dr. J.L. Moreno, the European-born physician who was a younger contemporary of Dr. Sigmund Freud, and later with his third wife Zerka T. Moreno. He adapted theatrical principles for working with people so that they could begin to experiment with solving problems differently, improvising behaviors to move away from the victim roles and  self-defeating behaviors and into cooperative, flexible and creative new ways of living in the world. 
 
Although most people look at experiential therapy as role playing, it is far more complex. In psychodrama, we identify a  specific three-part process for maximum involvement with both the enactment and the group experience.
 
Counselors who hear groans when they suggest a role-taking exercise in sessions are likely neglecting the very important “warming up” part of the process, the activities that warm the group members to genuine, rather than compliant, action.
 
And action is not just limited to role play, but may include art work, choice-making, movement, therapeutic sculpture, anger reduction exercises, simple ritual, writing, work with animals, map making and  guided imagery.
 
Finally, a specific non-judgmental sharing process in the therapeutic setting helps people discover meaning in the experience as well as positive connection with others.

The healing value of group

Dr. Moreno also understood the healing value of the group as early as 1913 —  long before 12-step recovery-oriented groups got their start — and coined the phrase “group psychotherapy.”

In group therapy, it is also important to observe the sociometry in the group, which is the measure of social relationships among the group members. People tend to say involved and motivated in group because of the high level of sociometry that is present and may leave group — we often call this “against medical advice” — when they are not sufficiently connected.

Knowledge of sociometric theory and judicious use of sociometric exercises will improve connections in group and serve as great warm-up exercises to a dramatic vignette --or even longer session, for the protagonist, who is the person exploring an issue through action.
 
In the individual session, action methods increase the richness, depth and understanding of a recovery issue. The method is adaptable to diverse clinical specialties, and philosophy and techniques can be easily integrated into traditional talk modalities.
 
Action therapy has the potential to help people quickly address hidden issues, feelings and patterns that would take months or even years to address in conventional  talk therapy. A psychodrama session focusing on addiction might look at the addict's relationship with the addictive substance or behavior by concretizing the substance (heroin) or the addictive behavior (gambling) with a prop, such as a pillow or chair, or an real-live human being in the group, playing the role. The same can be done with many other concepts common to addiction treatment:  resistance, recovery, a recovery group, relapse, a sponsor and more. 

We could also activate a timeline exploring the addict's history or put into action the well-known principles of Alcoholics Anonymous Twelve Steps.  These activities, when presented with clinical sensitivity, are a lot more interesting than slide shows or worksheets.
 
However, the Morenos’ method is not just a set of techniques but a highly complex way of thinking about working with people, groups, roles and relationships. It is important that counselors and other clinical staff, including supervisors and auxiliary staff members, understand the basics of the theory of this method, both in educating the clients of its use and in the actual  safe practice of the method in groups and individual settings for the most effective treatment.
 
When raw emotions are not appropriately resolved after the dramatic vignette for the protagonist and the other group group members, we can expect confusion and lack of truly effective treatment at the least; at worst, retraumatization of the individual or group.
 
Counselors should never push or shame people into a particular mode of action work but rather hone their skills to respond creatively and spontaneously when a client appears either compliant or resistant.
 
Individuals who have experienced abuse and other trauma can be affected negatively, even if they do not appear to show the negative effects at the time. In fact, assessment of people in treatment for addiction and addictive behaviors invariably shows some kind of trauma in their lives or in the lives of previous generations, or both.

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Karen Carnabucci, LCSW, TEP, is a nationally board-certified practitioner of psychodrama, sociometry and group psychotherapy and the founder and director of the Lancaster School of Psychodrama and Experiential Psychotherapies. This article is excerpted from Karen's book Show and Tell Psychodrama: Skills for Therapists, Coaches, Teachers, Leaders.  You may subscribe to Karen's e-letter here.