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Using Psychodrama With Addicts And ACOAs

~ by Tian Dayton, Ph.D.
From the book: The Living Stage: A Step by Step Guide to Psychodrama, Sociometry, and Experiential Group Therapy
Publisher: Health Communications

"In search of my mother's garden I found my own."
   ~ Alice Walker

Addicts, alcoholics and adult children of alcoholics (AcoAs) have grown up in environments with many common features that cross both cultural and economic barriers. It is no accident that those who grow up with these similar influences shaping their lives tend to choose one another as friends and latter as marriage partners. In their homes looming problems were managed through various types of denial behavior from rigid and controlled discipline to ungoverned chaos — a sort of "survival of the fittest" atmosphere. The family experienced erratic behavior; often they achieved "normalcy" by denying their pain and entering a cooperative delusion.

The Alcoholic Family System

Alcoholic family systems are characterized by denial, repression and delusion. Because family members rightly sense that alcohol is a threat to their very survival (coupled with the insidious slow onset of the disease of alcoholism), they silently close ranks and attempt to ride out the storm. But alcoholism is not like most other problems that befall families. It is socially mortifying; it destroys the consistency and trust of close relationships; it turns otherwise functional people into frightening, out-of-control monsters; and it renders those involved senseless with pain. It cannot be stopped by getting a prescription from a doctor or going to a hospital for an operation. The alcoholic family, when it does not know how to stop the drinking behavior or how to look at its own underlying pathology, is forced to sit back and watch itself be destroyed.

Because the helplessness and hopelessness of this situation are too painful to endure, these families deny that they have a problem. They delude themselves into thinking that the bizarre and twisted behavior that they live with is normal, and they repress their ever-deepening feelings of shame, rage, despair, desperation and isolation. Spouses in these families learn to focus the problem onto the alcoholic and can develop and unwillingness to look at their own behavior. They are caught in the emotional bind of feeling like martyred victims while overflowing with self-recrimination and self-loathing. Sexias describes the situation succinctly:

If you listen to an articulate adult tell how it was to be raised in a family in which one or both parents regularly and/or continually drank too much, you become outraged and mystified. The account will sound like a nightmare because time is distorted and reality challenged. Alice in Wonderland had it easy! At least eventually awakened from her dream. But the child of an alcoholic lives unremittingly with the illogical.

For family members to allow themselves to actually to feel what Sexias describes would be intolerably threatening. They may choose one child as a scapegoat and project their unconscious feelings of self-hatred onto that child; they may choose a hero to live out the family dreams and aspirations that they feel are now lost to them. Other roles may emerge — that of the lost child who silently goes about taking care of herself and becomes spiritually invisible within the family or that of the mascot who constantly sacrifices his own needs and identity on the family altar of dysfunction, flying into action to make people feel better and take away their pain. Children in these families grow up being systematically trained to lie to themselves and others about how they really feel. Of such a child, psychoanalyst Karen Horney has said:

To the extent that safety has become paramount, his innermost feelings and thoughts have receded in importance — in fact, have had to be silenced and have become indistinct. (It does not matter what he feels, if only he is safe.) His feelings and wishes thus cease to be determining factors.

He idealizes, to begin with, his particular "solution" of his basic conflict: compliance becomes goodness; love, saintliness, aggressiveness becomes strength, leadership, heroism, omnipotence; aloofness becomes wisdom, self-sufficiency, and independence. What — according to his particular solution — appear as shortcoming or flaws are always dimmed out or retouched. Imperceptibly he becomes this image; the idealized image becomes an idealized self. And this idealized self becomes more real to him than his real self... . Because it answers all of his stringent needs. This transfer of his center of gravity is an entirely inward process; there is no observable or conspicuous outward change in him. The change is in the core of his being, in his feelings about himself.

Men and women who walk into adulthood with an idealized self rather than a real self are not equipped to live life spontaneously, for in order to be spontaneous we need access to our core feelings, likes and dislikes. Children of alcoholic families who have an idealized rather than a real self unconsciously look for the ideal job, the ideal mater and an ideal family, rather than real people and professions. They become bonded wit the fantasy of who they are rather than the reality of who they are and feel incapacitated when confronted with real-life situations and relationships.

Part of the process of therapy for these people s a process of dismantling this idealized self so that the hidden core self can emerge. It is generally full of rage and tears. And when they finally come into contact with it, they may not recognize what they are seeing; they may be angry at the therapist who has put them in this vulnerable, defenseless position. They will have to take the time it will take to rebuild a self.

Often in alcoholic families, bonding among members is distorted. Instead of bonding with the real parent, a child may bond to what they wish their parent was: a fantasy bond. Siblings may form bonds based not on friendship and mutuality, but on the need for comfort and safety in the face of danger or the playing out of painful family dynamics: a traumatic bond. Children who have formed such bonds actively seek them out as adults. Therefore, when treating the AcoA in therapy, it is necessary to understand both the intrapsychic system of the child who grew up in an alcoholic home and the alcoholic system itself. According to P Steinglass:

In recent years a more empathetic view of families with alcoholic members has been emerging. Family-oriented clinicians and researchers have drawn on the finding from family interaction research to suggest that families with alcoholic members constitute highly complex behavioral systems with remarkable tolerance for stress as well as occasional bursts of adaptive behavioral inventiveness that provoke wonder and admiration in observers.

AcoAs carry this "intolerance for stress and adaptive behavioral "inventiveness" into adulthood. Steinglass also found that the stress attendant on alcoholism is spread uniformly throughout the family rather than being restricted either to the person who is drinking or the nonalcoholic spouse. Such holistic thinking which is central to a system perspective, is expounded by Michael Patton:

A system is a whole that is both greater than and different from its parts. Indeed, a system cannot validly be divided into independent parts as discrete entities of inquiry because the effects of the behavior of the parts on the whole depend on what is happening to the other parts. Te parts are so interconnected and interdependent that any simple cause-effect analysis distorts more than it illuminates. Changes in one part lead to changes among all parts and the system itself. Nor can one simply add the parts in some linear fashion and get a useful sense of the whole.

Moreno, one of the earliest system thinkers, left us with the science of sociometry: tools to study and measure dynamics within a given system. We can use the social atom in innumerable ways to examine many aspects of multigenerational systems and to provide a firm anchor for concretizing one's position in the family or personal network. We tend to take our status in our original family into other areas of our life — work, school, relationships, and marriage — living it out over and over again.

Children from alcoholic families grow up keeping secrets. The biggest secret that they keep is that they hurt inside. AcoAs often suffer silently. Claudia Black tells us.

They weren't always the ones who had adjustment problems, nor were they the angry ones. The majority of these people indicated instead, that they had strong tendencies to appear "normal" and to be from "typical" American families. They do not exhibit problematic behavior, and they rarely or never talked about the alcoholism in their primary family...

Karen Horney has said,

Through a variety of adverse influences, a child may not be permitted to grow according to his individual needs and possibilities. ... The people in the environment were too wrapped up in their own neuroses to be able to love the child, or even to conceive of him as the particular individual he is; their attitudes toward him are determined by their own neurotic needs and responses.

As a result, the child goes not develop a feeling of belonging, of "we" but instead a profound insecurity and vague apprehensiveness, for which I use the term basic anxiety ... The cramping pressure of his basic anxiety prevents the child from relating himself to others with the spontaneity of his real feelings, and forces him to find ways to cope with them. He must (unconsciously) deal with them in ways, which do not arouse, or increase, but rather allay his basic anxiety.

In a healthy human relationship the moves toward, against or away from others are not mutually exclusive ... But in the child who feels himself on precarious ground because of his basic anxiety, these moves become extreme and rigid. Affection, for instance, becomes clinging; compliance becomes appeasement. Similarly, he is driven ... keep aloof, without reference to his real feelings ... The degree of blindness and rigidity in his attitudes is in proportion to the intensity of the basic anxiety lurking within him.

In time, he tries to solve it by making one of these moves consistently predominant — tries to make his prevailing attitude one of compliance or aggressiveness or aloofness.

THE EFFECTS OF GROWING UP WITH CHAOS

Children from alcohol homes have little sense of certainty about what the day with bring. Family members walk gingerly, tip-toeing around anything that they fear might become explosive, while at the same time waiting hyper-vigilantly for the bottom to fall out the situation and the yelling, insults, shouting of orders and general abuse begin. Talking things out in a constructive manner is not possible under either of these circumstances, and so people tend to:

  • hold feelings until they become numb
  • act feelings out — do inappropriate things to get rid of the feeling rather than identify and experience it
  • disappear within themselves, yet remain physically present leave the situation and isolate themselves in an attempt to gain safety

During early childhood years, this turbulent emotional environment sets up fear of feeling. As children the only things AcoAs had any control over was themselves, and many discovered that shutting down their own feelings was the most effective way to control their inner experience of chaos. Unfortunately, life is full of ups and downs and real relationships and families are seldom the way they looked on the Dona Reed show. When AcoAs attempt to have families and relationships in adulthood, they over react to the vicissitudes of daily living, not so much because they feel strongly about a given situation, but because they are afraid of the potential strength of their own feelings. Feeling their own feelings put them into a state of fear in which they see chaos, out-of-control behaviors and abuse looming around the corner — because this was their early childhood experience. They are so convinced that distress is at hand that they experience mistrust and suspicion if problems are solved smoothly. Often they will push a situation in a convoluted self-protective attempt to ferret out potential danger until, through their relentless efforts to avoid it, they actually create it. As so the pattern of strong feelings to chaos, rage and tears is once again reinforced.

While the AcoA is well defended and may present as tough or inaccessible, he is covering up deep wounds; the reason the defenses are so strong is that he is protecting and shoring up so much vulnerability. The AcoA has never really had the opportunity to get to know himself in a supportive family environment. Letting down his guard would mean deep connection and love one day and emotional annihilation another, for inconsistency is the hallmark of a family where addiction is present. Because the AcoA has not been able to develop self safely he has trouble inwardly locating or describing a self when asked to be self-examing in therapy. Psychodrama, by putting the inner reality of the protagonist on stage over and over again in a safe way, where it is not attacked, allows a self to emerge. The it can be examined after it is seen and observed by the protagonist himself. Seeing the self in action affirms the self for the client and opens the door for the process of rebuilding the self.

Breaking destructive patterns is one of therapy's treatment tasks. Groups, because they mobilize feelings or become the surrogate family, are ideal vehicles both to bring these patterns forward and to create the opportunity to heal them. Psychodrama, because it allows the original cast to be present through role-play, presents the client with the opportunity to resolve transference by working them through in a controlled environment. The child who could not speak says what she needs to say; the adolescent who hid in his room comes out and talks to the people he ran from; and the wife who silently poured bottles of liquor down the sink confronts her alcoholic husband.

Being part of group therapy sessions over a prolonged period of time helps the addict or AcoA learn to "sit with" painful feelings or anxiety provoking situations without running from them or acting out in inappropriate ways. When the person can consciously acknowledge and feel his feelings — when he can own them — then he can make informed choices as to what to o with them.

Low self-esteem is a core issue of addicts and many AcoAs who have internalized confusing messages about themselves from their home environments. Following is an overview of some of the factors that contribute to low self-esteem and some of the common feelings and issues addicts and AcoAs share.

  • shame
  • isolation
  • unresolved grief and mourning
  • development distortion
  • Post Traumatic Stress Reaction
  • sober vs. non-sober thinking and behavior
  • emotional numbness
  • disorganized thinking
  • distorted internalized family system
  • distorted parental role models
  • difficulty in forming empathetic bonds
  • incomplete separation from parents
  • parentified children
  • internalized marital dysfunction
  • inflexible ego structure
  • physical and sexual abuse in childhood
  • dissociation
  • grandiosity
  • difficulty clarifying needs

SHAME

For the addict or the person in an addicted environment, shame becomes not so much a feeling that is experienced in relation to an incident or situation, but rather a basic attitude toward and about the self. It can be difficult to identify because it is so pervasive, a part of the very fabric of the personality. It is experienced as a lack of energy for life, an inability to accept love and caring on a consistent basis or a hesitancy to move into self-affirming roles. It may play out as impulsive decision-making or an inability to make decisions at all.

Shame can keep people stuck at an early stage of development, and it can also be the fuel behind compulsions and obsessions. Some will never feel they can achieve enough to offset their deep sense of shame, and some will use alcohol, drugs. food, sex or work compulsively to medicate emotional pain and shame.

How Can Psychodrama Help?

One of the most important steps in relieving shame is to break the lock that imprisons the secret behind the shame and bring it to the attention of others. The group acts as a powerful witness to the material being shamed. The person who role-plays a situation with which shame is associated has the chance to give back to the perpetrator the shame that she has internalized as her own. In psychodrama this can happen spontaneously, in just the way the protagonist needs it to take place.

Unconscious feelings of shame will exert a powerful control over the psyche until they are made conscious and felt in the present moment: when shame arises, an effort is made to allay it — by controlling the self or others, by acting out behaviorally or by ingesting substances. Psychodrama offers the opportunity both to mobilize shame through direct enactment and to watch the enactment of others, so that shame can be brought from the inner depths to the surface of the mind where it can be seen and felt in the present; its origins can be understood and insight can come. Psychodrama provides previously hidden pieces of the puzzle so that the whole picture can be seen.

ISOLATION

In the addicted family, where real feelings and issues are being denied, children who are in pain have nowhere to go for understanding, comfort or reality confirmation. They feel crazy — as if they are overdramatizing the situation or creating unnecessary trouble. To make matters worse, family members who are steeped in denial will confirm their distorted self-perceptions, because the reality is too painful for the family to live with and denial feels safer. The child's opportunity for genuine connection within the family system decrease because the system itself is living a lie, silently committed to maintaining the status quo.

In such a closed system, no one tells the truth about how he feels, and no one escapes from his pain. The inability to talk safely about reality forces everyone to go "under" with his real feelings — which means there can be little support and empathy. The result is that everyone feels insulated in his own pain.

How Can Psychodrama Help?

Our status within a group rises when we make a sincere self-disclosure. Our sense of isolation diminishes, and our altered status brings new and meaningful connections with other individuals in the group.

Psychodrama calls on people to work together toward the common goal of role-playing the protagonist's drama or their own. Group members are asked to play important roles in the protagonist's life and, through this, have an opportunity to experience themselves in different roles. They also feel important to the action because they come to see how helpful they are to the catharsis and resolution of the protagonist's work.

All these factors draw people from their isolated positions toward interaction, which continues to diminish their sense of isolation. In the group sharing, the director can bring in isolates simply by asking how they experienced the psychodrama and what it touched for them in their own lives.

UNRESOLVED GRIEF AND MOURNING

Addicted families suffer profound losses. There is the loss of the addict to his substance and the enabler to her co-dependency. For children there is the loss of parents to rely on, the loss of a free and untroubled childhood, the loss of a feeling of safety, the loss of the secure family unit, the loss of trust, the loss of a stable and smooth early development. There are the losses of comfortable family events, rituals and holidays, and for children the loss of the security of knowing that their parents are in a position to parent them and meet their changing needs.

Many members of addicted families experience a sort of inner death or psychic numbing as a way to cope with an overload of fear, pain and anxiety — and one task of therapy is to provide a safe arena in which they can undergo a process of mourning in a supportive, emotionally connected group.

How Does Psychodrama Help?

Psychodrama, unlike other methods, offers an opportunity to speak what needs to be spoken and done what was left undone. We can finish old business in the context of an enactment. The final goodbye, the things we never had a chance to say, the love that went unspoken the tears that were never shared, the anger that was held in quivering silence — all can be role-played psychodramatically so that we can work through the unresolved loss, bring it to satisfactory closure and move on with our lives.

DEVELOPMENTAL DISTORTION

Parents who are more preoccupied with their own problems than with parenting cannot adequately meet their children's needs. The child's sense of basic trust and security is threatened, which makes it difficult to build self-esteem and move through developmental stages freely and with the necessary support. If a child, for instance, needs to move away from the parents and the parent is not secure enough to allow that, or interprets it as a personal rejection, the child's strivings for autonomy will be blocked — and later developmental stages will be affected as well. A teenager especially needs to believe that separation from home will not mean banishment. If, instead of putting his energy toward becoming his own person, he constantly uses his energy to make sure his home is still intact, separation will be seriously hampered.

How Does Psychodrama Help?

When a scene or situation has been locked within a person's psyche is placed upon the psychodrama stage to be lived out again, unhealthy behaviors that surface in action are often seen and identified as "crazy" or "sick" — both by the protagonist and by the group. Distorted behavior that one has lived with for so long that it came to feel normal becomes easier to see for what it is when it is fully enacted. Later, with the sharing and processing within the group, nuances of the internalized distortions can be examined and replaced with new awareness and insight can occur. Long-term therapy allows the client to move slowly through and rework the stages of development that he missed.

POST TRAUMATIC STRESS REACTION

Children who grew up in addicted homes are survivors of a wide range of early childhood trauma. Their traumas were often sustained over a long period of time, and they were helpless in the face of them, never knowing when to expect abuse, what caused it or how to prevent it from continuing. As adults they may bear many of the symptoms of Post Traumatic Stress Syndrome experienced by combat soldiers.

AcoAs have a tendency to over-react, over-manage, or withdraw and hide. They learned as children to become hyper-vigilant for any signs of distress — and would swing into action to placate, manage, avoid or rake on the abuser in order to protect themselves. So it is no wonder that many of them court crisis and choose high-stress professions and partners. They have come to gain a certain sense of self-worth from managing the unmanageable. Even when there is nothing particularly Threatening to take care of, they will perceive that there is. According to Claudia Blackburn,

AcoAs with Post Traumatic Stress Reaction (1) have a hard time setting emotional boundaries (2) are very well defended (3) have numbed out and avoided pain for so long that they feel "something is missing," (4) experience other people setting limits and boundaries as rejection or even abuse; and (5) may report that they "have had a trauma but moved through it quickly and are just fine now."

How Does Psychodrama Help?

The action component of psychodrama accesses the same areas of the brain that are accessed through everyday behavior. In other words, if trauma happens through action, it can be healed through action. Old traumas such as growing up with an alcoholic parent and a painful family system are carried into adulthood. Normal lie provokes anxiety because the traumatized self waits for the crisis to come. AcoAs who have bonded with crisis rather than normalcy hesitate to bond with what feels good as a way of protecting themselves against the pain of their original loss. Unfortunately, this way of living does not protect them but keeps them in a constant state of free-floating inner tension.

When hurts and pains are brought out of hiding (through sharing, role-playing, journaling, art or whatever will reach into the shadowy depths and bring out the truth), the story can be told and witnessed. And the person is enabled to find meaning in the pain. Psychodrama is particularly well suited to reach past the defenses and activate, both through identification with others and through one's own drama, the material that needs to be self-disclosed.

SOBER VERSUS NON-SOBER THINKING AND BEHAVIOR

Addicted homes function with two alternating realities, one sober and one substance affected by the addict's substance abuse. When a substance is being used, its use has to be protected by the person using it. This requires minimizing and denying the impact the user has on the system. Whether the substance is alcohol, drugs, food or sex, its compulsive/addicted use will alter family dynamics. The addict will put energy into preserving the supply of the substance, often in secrecy, and the family will put energy into preserving the normal look of the family.

The system organized itself differently when the addict is using and when he is not, differing realities that live on within children and are triggered throughout their adult lives. Normalcy triggers mistrust, and pain triggers early fears of abandonment and/or dependency that can bring the past into the present in the form of defensive, passive-aggressive or aggressive behavior.

How Does Psychodrama Help?

People can play out both sober and non-sober realities in psychodrama. Through psychodrama they can raise the level of awareness about each and bring what has been confused and colluded in the unconscious to the conscious level, where it can be separated into two distinct atmospheres. They can come to see where the sober inner world may be polluting their current lives.

Psychodrama can also help clarify what comes from the past and what belongs o the present. For instance, if a wife is screaming at her husband and saying things that she unconsciously wishes she could have said to her alcoholic father, the director can ask her to chose her father and speak directly to him. Doing so can make her aware in actuality of how feelings carried over from her addictive family are where her past is overwhelming her present, and where habits developed in a relationship where addiction was present are playing out in a relationship where addictions may not be present.

EMOTIONAL NUMBNESS

Children who grow up in painful situation learn how to numb themselves emotionally in order not to hurt. They can accomplish this numbness through compulsive behavior, distracting the hurt into an activity, repressing or dissociating from the painful feelings, using a substance to bury hurt or learning how to shut down emotionally. Shutting down can effectively stop pain, but it also stops other feelings. It puts the person using numbness out of touch with his real feelings and inhibits his ability to make meaningful connections between circumstances and his emotional response to them. Feelings of isolation and disconnection result.

How Can Psychodrama Help?

Thawing out these frozen feelings during therapy can feel very disorienting, frightening and confusing — but ultimately it gives the person back to himself. Psychodrama models the opposite of emotional numbness by encouraging engagement in emotionally charged activity. Watching other people's dramas and identifying with them gives the person an opportunity to lower defenses and warm up his own feelings. Through the process of identification with the psycho dramatic action, feelings that have been buried rise to the surface. Often memories that were previously out of reach come into the foreground. It is difficult to remain completely shut down in a psychodrama environment without having the shutdown become obvious. Over a period of time, psychodrama will gradually help a person store the ability to feel and behave in a spontaneous manner.

DISORGANIZED THINKING

One of the survival tactics of dysfunctional families is to look good, and because the emotional undercurrent can differ radically from the surface image, children experience their inner reality as out of sync with their outer lo reality. Their feelings are not corroborated or validated, and so they feel disconnected and confused. Addicted people do not think clearly. Children who try to speak rationally with their non-sober or dysfunctional parents do not arrive at rational understandings. They are made to feel that their perceptions are inaccurate and consequently they come to doubt their ability to reason. When feelings and thinking are at odds with what is acceptable, thinking can become disorganized. And so children in addicted families eventually experience thinking and feeling as detached both from each other and from the children's internal reality, which comes to seem meaningless and irrelevant. Deep, unresolved pain and anxiety are carried at the expense of the inner person.

How Does Psychodrama Help?

Emotion and thoughts are connected. Often we organize thinking around strong emotions to in some way accommodate, manage, validate or rationalize them. When emotional pain has nowhere to go, it builds pressure and distorts the way we experience ourselves and our worlds. We organize our thinking around erroneous perceptions because the emotions that come to the surface in present-day living are not about present-day circumstances. Many are historical emotions looking for a place to go for release, but we do not identify them as such, rather, we think the pain we are experiencing is about whatever circumstances triggered it. When emotional loads are held in silence and secrecy within the psyche as deep, untouchable wounds, a network of false reasoning grows up around them to protect them and keep them from being known, seen and felt. When they are released in psychodrama, they no longer have that effect on thinking.

DISTORTED INTERNALIZED FAMILY SYSTEM

The addicted family system is built around denial, delusion, repression and distortion. The principles upon which the family is organized are based on living with addiction or dysfunction. When the dysfunctional family is internalized early in life by the growing child, he carries the system internally into adulthood which means that ACoA's "inner family" is also dysfunctional. In adult life this system is lived out and become an organizing principle in relationships and families where addiction and trauma may or may not be present. ACoAs and addicts tend to be hyper-vigilant in relationships — waiting for trouble even when trouble is not there. The closed-system rule — "Don't trust, don't talk, don't feel — are triggered and the adult uses these ways of behaving and surviving in the new family.

How Does Psychodrama Help?

In a psychodrama group, family dynamics and transferences become felt and acted out. Resolving these transferences is the road to healing. The group sociometry brings the internalized family of each group member to the surface. Social atoms and action sociograms offer each participant endless opportunity to examine and re-examine the family from his own position, as well as from the positions of others. Role reversal allows the participant not only to see another person's point of view within the system but also to experience it.

Over and over again in the group, through dramas and in sociometric exercises, family roles and family system are examined and explored, Making the unconscious dynamics of the family system conscious is the first step toward evaluating and sorting out the distortions from the point of view of the protagonist, as it is the protagonist's truth that is being told. This process helps to reduce the cognitive dissonance within the self by bringing reality and distorted perception and expectation into greater balance.

DISTORTED PARENTAL ROLE MODELS

In dysfunctional homes the child's normal developmental needs are often neglected in favor of coping with addiction and compulsion. What the child sees are parents who are lost to him and unable to be fully present as parents. Later in life, when he becomes a parent himself, he does not have healthy parental roles to use as models.

Modeling is one of the deepest forms of learning. Our own parents teach us more about how to parent than anyone or anything else. We tend to parent either in the style that we were parented or in a style that is in some form a reaction to that. Therapy offers an opportunity to relive the pain of inadequate parenting and to be re-parented in healthier ways.

How Does Psychodrama Help?

In psychodrama the person can play out the introjected parents both from his point of view and from theirs. Spending time in the role of the parents helps to bring the personality of the parent that lives within the protagonist to a conscious level. Then the director can use the technique of interviewing the protagonist in the role of his parents, both to keep him in that role and to elicit information. Spending time in the role of the parents allows for playing out the introject in a safe clinical environment where destructive internalized roles can be examined, experienced and released. Spending time in the role of the protagonist helps that person to give back to the parent such feelings of shame, anger and even love, which he has carried in silence within him because the empathic bond between the parent and child was not sufficiently intact to contain these emotions.

DIFFICULTY IN FORMING EMPATHIC BONDS

Children learn whether or not the world can be trusted by the way they are treated by their primary caretakers. If caretakers perceive their needs with reasonable accuracy and respond to them, children come to see the world as a friendly place that can meet their needs. When children have not had that empathic caretaker, when their development of self is incomplete and there is a sense within them that they have not gotten enough of what they need it becomes difficult for them to give from what feels like an empty place. A person who was unable to separate emotionally from the parent will find it difficult to have a sense of other because, to some extent, she is still incorporated within the parent.

Empathy is present when we are able to reverse roles with another person, seeing and feeling things as the other person might see them. The person who has not had enough development and satisfaction in the self finds it difficult to let go of the self and reverse roles. According to Robert Siroka, "There is a sense that the self is not intact enough to leave in favor of empathy with another, that some part of the self might be lost or compromised if it is not constantly guarded or even withheld." In this climate of a lack of self-trust, it becomes difficult to extend outwardly toward another.

How Can Psychodrama Help?

Psychodrama has the power to access early pain and rejection, and opens the protagonist up to very raw emotion. At those moments the protagonist can work through the pain that has blocked him and the defenses that numb the pain. Once they are out of the way, the protagonist is able to let people in, in a more positive manner. New bonding experiences can occur, and the self can be lived in and rebuilt. Once the self is intact, an awareness of the other is possible; once empathy is incorporated into the self, it can be extended to someone else.

INCOMPLETE INDIVIDUATION / SEPARATION FROM PARENTS

The stages of separation and individuation from the parent allow an eventual rapprochement or return to take place. Some parents view separation as rejection and withdraw their love and break their connection with a child who they feel is moving away from them. In this case separation comes to mean loss of the parent, which often feels like too high a price to pay. For example, the adolescent girl who brings friends home rather than going out with them, so that she does not leave her mother alone too much, will not be able to move through the developmental task of separating; she feels she must take care of her parent's needs before exploring her own.

One of the tragedies of this situation is that the child confuses separation with incorporation. The lesson is, "When I feel a need to move away, I have to move toward instead — I have to incorporate within me that which I wish to leave and lie about my wish to leave it, even to myself, because it is intolerable to my parent. My parent would die without me." The developmental task of individuation becomes too frightening and painful to undertake. And as a result, the child learns to meet her needs through a kind of emotional and psychic fusion: "I meet my needs through meeting yours, and I allow you to meet my needs through meeting mine."

How Can Psychodrama Help?

We must first successfully bond before we can successfully individuate. Psychodrama helps protagonists experientially to "get with they never got." After concretizing, for instance, the feeling of aloneness, it moves in to fill the void by using surrogates to provide a feeling of love, acceptance and support. Because psychodrama can mobilize deep feeling, the protagonist can come to be fully in touch with areas of unmet need or open wounds, letting down defenses against feeling pain. Once the pain is felt, it can be healed.

For individuation to take place, we not only have to locate the parent, but we also have to locate the parent within ourselves. For this to happen, we need to work through and resolve the parent-child relationship. When the parent is intact within the child, the child can move out into the world with an inner point of reference — a sense of being loved and held; he can learn to love and hold himself and recognize other people and experiences that provide that same feeling. But if this deep feeling is not intact, he is condemned to a lifelong search for the love and acceptance that he never got. Sadly, with actually experiencing and learning that feeling, we do not know what we are looking for and confuse love and acceptance with just about anything that feels good.

PARENTIFIED CHILDREN

Dysfunctional homes do not just happen. They are created by parents who themselves were not adequately taken care of and nurtured. These parents tend to look toward their own children to meet their unmet emotional needs for security and safety.

When children are called upon to meet an excess of their parents needs and their parents are not able to reach out in larger ways, they become little adults too soon. Little adults in dysfunctional homes tend to (1) try to be perfect to make their parents look good; (2) think of what would be best for their parents before what they would like; (3) consider their parents' needs before their own; (4) gain their self-worth from being good rather than feeling good; (5) put their own needs aside so regularly that they lose their ability to identify them; (6) feel inadequate because they cannot make their parents happy; (7) are called upon to supply their families with self-worth; and (8) internalize an over-whelming sense of failure at not being able to fix their parents and families.

While meeting another's need is natural and healthy, it becomes dysfunctional when neither parent has an awareness of whose needs are being met and neither parent can identify his own needs. In such cases people may feel their own needs and feelings through identifying them in someone else, and they miss or even deny them within themselves. Depending on someone else's needs to gain one's own emotional relief creates a co-dependent relationship.

How Can Psychodrama Help?

Some of the wounds of being a parentified child are (1) the loss of childhood; (2) assuming adult roles beyond one's capability and the resulting sense of failure; (3) the loss of the parent as a person by whom to be nurtured and mentored; (4) the day-to-day learning to fill someone else's needs before one's own and the lesson that the way to get love and approval is by caretaking another person; and (5) the loss of time to wonder, struggle and focus on one's own developing self. Through psychodrama the adult children act out desires and unfinished business so that they can become conscious and be resolved, and through the sociometry of the group he can resolves transferences and practice new behaviors.

INTERNALIZED MARITAL DYSFUNCTION

Into extra familial personal relationships AcoAs inevitably bring the internalized marital dysfunction of their parents. For most the model is a marriage in which partners were unable to talk things out honestly and openly, to reach resolution and to move on. Or they may have had parents who used the children to play out unresolved hurt and competitive issues, actually pitting their children against the spouse to gain power in the relationship. They take in, at a deep level, the reality of two people who were disappointed in one another and hurt each other profoundly.

With such a model, marriage may not only look dangerous but actually become dangerous; with the relationship skills that AcoAs have learned, they may continually recreate the pain and misunderstanding that they grew up with. Learning to be in a functioning relationship means revisiting that pain and bringing it into the present to be seen, felt and released, and then forging new and constructive relationship skills.

How Can Psychodrama Help?

The atmosphere of a marriage is a primary force in the atmosphere of a home, and psychodrama offers an opportunity to recreate that atmosphere on the stage so that it can be entered and experienced from the point of view of the child who lived it, of the parent who lived it and of the adult who can now see it as it really was. Bringing out through role-playing the way in which one's parents related, and re-experiencing it in the present, can help the protagonist to see how he may be unconsciously living out his parents' script. Psychodrama helps to illuminate destructive patterns and aid in understanding them.

INFLEXIBLE EGO STRUCTURE

ACoAs learn not to share their real feelings or discuss what is really going on within them. They come to understand that it they let their guard down, they leave themselves vulnerable to possible hurt. They also learn not to tell the truth about what they see going on around them, because if they do, they risk being attacked and put down by those in the family who are in denial about the family illness and invested in "looking good" as a survival strategy.

When people who use denial to survive are challenged, they experience the challenge as life threatening. As a consequence ACoAs and addicts come t lead a double life. All of the members of the family system are leading double lives, either consciously or unconsciously, because their inner and outer worlds are not in sync. They become frightened and self-protective. They learn that they need to be on guard at all times, either to avoid abuse or maintain a momentary safe edge.

In an environment where "the best defense is a good offense," being spontaneous, vulnerable or even casually interactive feels unsafe, and often is. Rigid and inflexible roles are developed, Even fun and humor have an unnatural intensity about them because they are used as much to release painful feelings or to control through sarcasm masquerading as humor as they are for enjoyment. People take their positions and guard them; behavioral roles become survival roles. Then roles learned in the system become the internal organization of the self-system and are played out in group situations throughout life.

How Can Psychodrama Help?

The therapeutic group is a safe place for people to learn new roles and practice new behavior. The sociometry of the group allows for transferences and projections to be resolved through making them conscious and working them through. Flexibility of mind is an important component of mental health, and psychodrama offers direct experience in a variety of role — strengthening roles that one feels insecure in, discarding or reworking roles that are no longer serving the self-system well and spending time in and practicing new roles and/or new behavior. Examining old and new roles from a variety of perspectives — directly in the role, in role reversal, as an auxiliary, as part of the audience or as an observer — is a concrete way to alter internal organization.

PHYSICAL AND SEXUAL ABUSE

Because of the reduced inhibitions that result from alcohol and drug use and the poor impulse control of the addict, children of addicts run a high risk of being violated physically and/or sexually. A deeply internalized sense of helplessness, defeat and terror results from being subjugated in such ways by an authority figure or parent. When the abuser is a parent, confusion at the core of the personality about boundaries and proper behavior in intimate relationships results. Trusting other people feels foolish, compromising or dangerous. And trusting the self is equally difficult because the victim may feel a deep sense of guilt or complicity: "What was my part in this? Why did I want/deserve for it to happen?"

Part of healing is accepting that one was truly an innocent victim. Unfortunately, along with this comes the tragic realization that the parent or authority figure was the perpetrator, that he really did put the child at a terrible risk with apparently no thoughts of the child's welfare or future well-being.

No child really wishes to know this about a parent or elder. This may account for why these memories so often do not surface until the victim feels independent enough to survive on her own. The disease concept is helpful because it is more acceptable and forgivable to think that a parent did this because he had a disease — that his disease had taken him over and he was "out of his mind" — than to feel that he deliberately inflicted pain.

How Can Psychodrama Help?

The brain, when traumatized, does not work normally; it generates frozenness rather than a context. Consequently, traumatic memories are stored in an unfinished, unresolved state. Each time a memory stored in this way is called to the surface (because something has triggered it, such as an intimate relationship, loud anger, sexual interaction and so forth) it emerges in this unfinished, frozen sate and blocks normal participation in the experience at hand.

By using psychodrama to bring traumatic memories to the surface, and then enacting a metaphor of the situation with safe surrogates and clinical control, a context for the event can be supplied. The story can be told and the frozenness can be walked, spoken, acted, cried, raged and worked through. All the emotions that were arrested can surface and be experienced in the body so that they can be integrated and viewed while they are actually being felt. In this way the natural paring down and discarding of irrelevant brain cells and the inclusion of new ones can occur; the trauma memory will be restored in a new cell assembly, with some information discarded and new information added, and new awareness can foster a move from helplessness to empowerment. Thus traumatized people can begin to see that they were actually a victim of their size and situation; that they need not feel responsible for what happened as if they caused it; and that they can take care of themselves in a way they could not as children, so that living and loving and risking is again possible.

DISSOCIATION

When it becomes too frightening or painful, one possible reaction to that trauma is to dissociate from it — to physically move away. People often recall trauma, such as physical and sexual abuse, as an out-of-body experience, as if they were watching themselves from another location.

The most extreme form of dissociation is Multiple Personality Disorder — when the person generates one or more alternate personalities who are assigned to deal with the pain. In a lesser form of dissociation the person simply drifts, mentally, far away, not to any particular place, but away from the present moment. This habit of never being fully present is a defense against feeling, only here there is no substance, just a sort of psychic absence. Dissociation also serves as a defense during trauma, allowing some individuals to experience painful events as though they had happened to a different "self." This defense trades awareness of immediate physical helplessness during trauma for a subsequent sense of psychological helplessness, with intrusive recollection of the events (absorption), the loss of pleasure in usually enjoyable activities (dissociation), and extreme sensitivity to stimuli reminiscent of the trauma (suggestibility or absence of criticism).

People who dissociate regularly can feel "fake" or inappropriate because their actions in the present are not connected to real feelings. They "think" their feelings instead of feeling them, making a mental effort to come up with what looks to them to be the right response to a situation because thy lack access to the information that would inform and guide appropriate responses.

How Can Psychodrama Help?

To heal dissociation a person has to re-enter the self to make a real connection with his inner life. And to affect the return, he has to feel, experience and reintegrate all the feelings that lay unfelt during the flight from the self. Psychodrama warm-ups and viewing of or participating in another person's drama are useful in putting him in touch with repressed feelings. The enactment phase, whether he is a protagonist, auxiliary role-player or audience member, offers him the opportunity to experience frightening feelings in a safe setting. Once they are felt and reviewed by the inner observer, they can be integrated in a new way. Then the sharing phase allows him to see that he is not alone in having sought a way out of feeling more pain than he could tolerate.

Psychodrama's emphasis on spontaneity training is useful because it helps to retrain people to live inside of their own minds and bodies and to learn to tolerate strong feelings with dissociating.

GRANDIOSITY

Because of the magical thinking of childhood, coupled with the child's fervent wish to bring peace and harmony to her unhappy family, she comes to feel that she knows how to cure if family — if only everyone in their family would listen to her. Later in life this kind of magical can translate into grandiosity — the feeling that she alone really saw and understood what was going on in her family.

A different kind of grandiosity develops as a defense against feelings of helplessness, inadequacy and despair. Because the reality of the situation is too overwhelmingly painful for a child to live with, he constructs a false reality full of special reasons and rationalizations for his family's differences from others. Rather than feel like an underdog, he tells himself that his is a special lot — he is misunderstood by outsiders. All the while, beneath this illusion of being exceptional, lives a wounded little person, terrified to let himself know that which he suspects he already knows, that this family is slowly falling apart.

The parentified child also has an exaggerated sense of his own importance. He truly feels that within him the family would not operate. He carries this illusion into adulthood, where he believes that it is he and he alone "who keeps it all together" and understands what is really needed. It is difficult for him to become comfortable with his rightful size.

How Can Psychodrama Help?

Psycho dramatic enactment allows an authentic self to emerge. The wounded, frightened child can come out of hiding and connect, through his pain, with others. Connecting with other and moving out of isolation reduces the need for a grandiose defense system. Through identification with others who have also been hurt and who have felt different from other people, he learns that he is not alone in having survived painful, often mortifying, childhood experiences: others have been abused and made to feel bad about themselves. This identification with others helps to depersonalize the feelings of being somehow defective and encourages the acceptance of a more real self. When the shame is reduced, the need to compensate with grandiosity lessens.

DIFFICULTY IN CLARIFYING NEEDS

A person whose needs are continually unmet in childhood can become frightened of asking for what she needs. First, she becomes unable to tolerate her own neediness, Being needy feels weak, stupid or dangerous, and so she hides the feeling from herself by denying it or projecting it onto another person.

Next, the idea of being clear about needs and asking for something on behalf of the self creates a paradoxical dilemma. On the one hand, the fear of asking and not receiving brings up the pain of the childhood disappointment of needing and not getting and then feeling humiliated for feeling needy. On the other hand, if a need is requested and met, the satisfying of the need brings up the pain of separation because the met need is by nature finite, and because while she is asking to have a specific need met, her real hunger is far deeper and more difficult to define.

The ACoA learned in childhood to depend on no one. She met or did not meet her own needs in painful isolation, never taking the risk of asking. Consequently, the deep, irrational position is, "I will not ask for anything that will prove to me what I already know, that my parent is not there. This is how I will stay connected, by suffering my neediness in silence. If I were to make my needs known and out in the open, I would risk being cut off for being too needy and then I would be all alone." Because of this inner dynamic, ACoAs seldom risk being up front about needs, as it brings up fears of abandonment and separation.

How Can Psychodrama Help?

Group interaction mobilizes feelings of neediness because it recreates the original family dynamics; it can induce a person to feel isolated, threatened, unheard, unseen, rejected, competitive and so on. Over time, being able to tolerate the feeling of neediness, to own this feeling, to express it and to process the discomfort associated with it will help make the behavior and dynamics resulting from it conscious. Once these elements are conscious, they can be worked with and understood.


For more information, contact Mark Felber.


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