The Locus of Therapy – Moreno

When I was a social worker in the early ’80s and a person was waiting in the waiting room to see me, the receptionist would ring me and jokingly say your client system is here to see you.

Social Work has had a strong sense for a long time that the individual is always part of a system. This same systems theory was taught to me as being central to Psychodrama, specifically through an article by Lynette Clayton.

Recently I have read some good material in Imago Relationship Therapy : Perspectives on Theory, particularly by Randall C. Mason, Ph.D. who talks about the Relational Paradigm, and sees it as distinct from systems thinking.

I have been wanting to tie all this together, and Moreno’s contribution is significant. I love the way he sees the origin of our thinking of individual psyche ties in with the body as being the locus of treatment in medicine. What a fallacy it has been to continue to think like that in psychotherapy!

The opening of the Chapter on Sociometry in Psychodrama Volume one follows.

I’ve also added more notes on Sunday, 29 November 2015

315

SCIENTIFIC FOUNDATIONS OF GROUP PSYCHOTHERAPY

The late arrival of group psychiatry and group psychotherapy has a plausible explanation when we consider the development of modern psychiatry out of somatic medicine. The premise of scientific medicine has been since its origin that the locus of physical ailment is an individual organism. Therefore treatment is applied to the locus of the ailment as designated by diagnosis. The physical disease with which an individual A is afflicted does not require the collateral treatment of A’s wife, his children and friends. If A suffers from an appendicitis and an appendectomy is indicated, the appendix only of A is removed, no one thinks of the removal of the appendix of A’s wife and children too. When in budding psychiatry scientific methods began to be used, axioms gained from physical diagnosis and treatment were automatically applied to mental disorders as well. Extra-individual influence as animal magnetism and hypnotism was pushed aside as mythical superstition and folklore. In psychoanalysis—at the beginning of this century the most advanced development of psychological psychiatry—the idea of a specific individual organism as the locus of psychic ailment attained its most triumphant confirmation. The “group” was implicitly considered by Freud as an epiphenomenon of the individual psyche. The implication was that if one hundred individuals of both sexes were psychoanalyzed, each by a different analyst with satisfactory results, and were to be put together into a group, a smooth social organization would result; the sexual, social, economic, political and cultural relations evolving would offer no unsurmountable obstacle to them. The premise prevailed that there is no locus of ailment beyond the individual, that there is, for instance, no group situation which requires special diagnosis and treatment. The alternative, however, is that one hundred cured psychoanalysands might produce a societal bedlam together.

Although, during the first quarter of our century, there was occasional disapproval of this exclusive, individualistic point of view, it was more silent than vocal, coming from anthropologists and sociologists particularly. But they had nothing to offer in contrast with the specific and tangible demon-

316 PSYCHODRAMA

strations of psychoanalysis, except large generalities like culture, class and societal hierarchy. The decisive turn came with the development of sociometric and psychodramatic methodology.*

The change in locus of therapy which the latter initiated means literally a revolution in what was always considered appropriate medical practice. Husband and wife, mother and child, are treated as a combine, often facing one another and not separate (because separate from one another they may not have any tangible mental ailment). But that facing one another deprives them of that elusive thing which is commonly called “privacy.” What remains “private” between husband and wife, mother and daughter, is the abode where some of the trouble between them may blossom, secrets, deceit, suspicion and delusion. Therefore the loss of personal privacy means loss of face and that is why people, intimately bound up in a situation fear to see one another in the light of face to face analysis. (They prefer individual treatment.) It is obvious that once privacy is lifted (as a postulate of individual psyche) for one person involved in the situation, it is a matter of degree for how many persons the curtain should go up. In a psychodramatic session therefore, Mr. A, the husband, may permit that besides his wife, his partner in the sickness, the other man (her lover) is present, later his daughter and son, and some day perhaps, they would not object (in fact they would invite it), that other husbands and wives who have a similar problem, sit in the audience and look on as their predicaments are enacted and learn from the latter how to treat or prevent their own. It is clear that the Hippocratic oath will have to be reformulated to protect a group of subjects involved in the same therapeutic situation. The stigma coming from unpleasant ailment and treatment is far harder to control if a group of persons are treated than if it were only one person.

But the change of locus of therapy has other unpleasant consequences. It revolutionizes also the agent of therapy. The agent of therapy has usually been a single person, a doctor, a healer. Faith in him, rapport (Mesmer), transference (Freud) towards him, is usually considered as indispensable to the patient-physician relation. But sociometric methods have radically changed this situation. In a particular group a subject may be used as an instrument to diagnose and as a therapeutic agent to treat the other subjects. The doctor and healer as the final source of mental therapeusis has fallen.

______

*Sociatry is applied sociometry. The group psychotherapies are subfields of soci3,_1173′ as the latter comprises also the application of sociometric knowledge to groups distance”, to inter-group relations and to mankind as a total unit.

SOCIODRAMA 317
Sociometric methods have demonstrated that therapeutic values (tele) are scattered throughout the membership of the group, one patient can treat the other. The role of the healer has changed from the owner and actor of therapy to its assigner and trustee.

But as long as the agent of psychotherapy was a particular, special individual, a doctor or a priest, besides being considered the source or the catalyzer of healing power—because of his personal magnetism, his skill as a hypnotist or as a psychoanalyst—the consequence was that he himself was also the medium of therapy, the stimulus from which all psychotherapeutic effect emanated, or at least, by which they were stimulated. It was always his actions, the elegance of his logic, the brilliancy of his lecture, the depth of his emotions, the power of his hypnosis, the lucidity of his analytic interpretation, in other words, he, the psychiatrist was always the medium to which the subject responded and who in the last analysis, determined the mental status which the patient had attained. It was, therefore, quite a revolutionary change, after disrobing the therapist of his uniqueness, showing for instance that in a group of 100 individuals every individual participant can be made a therapeutic agent of one or the other in the group and even to the therapist himself, to go one step further and to disrobe all the group therapeutic agents themselves of being the media through which the therapeutic effects are attained. By means of a production on the stage a third element is introduced besides the healer and the patient-members of the group; it becomes the medium through which therapeutic measures are channelized. (This is the point where I went with psychodramatic methods beyond the methods I had used previously in group psychotherapy, even in its most systematic form—the group psychotherapies based on sociometric procedures and sociometric analysis.) In psychodramatic methods the medium is to a degree separated from the agent. The medium may be as simple and amorphous as a still or moving light, a single sound repeated, or more complex, a puppet or a doll, a still or a motion picture, a dance or music production, finally reaching out to the most elaborated forms of psychodrama by means of a staff consisting of a director and auxiliary egos, calling to their command all the arts and
all the means of production. The staff of egos on the stage are usually not patients themselves, but only the medium through which the treatment is directed. The psychiatrist as well as the audience of patients are often left outside of the medium.

318 PSYCHODRAMA

When the locus of therapy changed from the individual to the group, the group became the new subject (first step). When the group vvt” broken up into its individual little therapists and they became the agents of therapy, the chief therapist became a part of the group (second step) and finally, the medium of therapy was separated from the healer as well as the group therapeutic agents (third step). Due to the transition from individual psychotherapy to group psychotherapy, group psychotherapy includes individual psychotherapy; due to the transition from group psychotherapy to psychodrama, psychodrama includes and envelops group Psychotherapy as well as individual psychotherapy.

The three principles, subject, agent and medium of therapy can be used as points of reference for constructing a table of polar categories of group psychotherapies. I have differentiated here eight pairs Of categories: amorphous vs. structured, loco nascendi vs. secondary situations, causal vs. symptomatic, therapist vs. group centered, spontaneous vs. rehearsed, lectura] vs. dramatic, conserved vs. creative, and face to face vs. from a distance. With these eight sets of pairs, a classification of every type of group psychotherapy can be made.

(pages 318 – 319 Illustrate such a table)


Later Sunday, 29 November 2015

What are the implications for this on training?

Husband and wife, mother and child, are treated as a combine, often facing one another and not separate (because separate from one another they may not have any tangible mental ailment). But that facing one another deprives them of that elusive thing which is commonly called “privacy.” What remains “private” between husband and wife, mother and daughter, is the abode where some of the trouble between them may blossom, secrets, deceit, suspicion and delusion. Therefore the loss of personal privacy means loss of face and that is why people, intimately bound up in a situation fear to see one another in the light of face to face analysis. (They prefer individual treatment.) It is obvious that once privacy is lifted (as a postulate of individual psyche) for one person involved in the situation, it is a matter of degree for how many persons the curtain should go up.

It is clear that the Hippocratic oath will have to be reformulated to protect a group of subjects involved in the same therapeutic situation. The stigma coming from unpleasant ailment and treatment is far harder to control if a group of persons are treated than if it were only one person.

The hippocratic oath needs revision, also the codes of practice in how we frame training in psychodrama and related methods. How does the intimacy, and significance of the group change the balance of significance and intimacy in the marriage?

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