Psychodrama as a Tool of Ethics

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Author: Roger Schaller

Abstract

Psychodrama in the professional field of offence-oriented therapy is first a tool of applied ethics: the scenic action is an attempt to recognise, evaluate and contextualise problematic behaviour and thinking. In order to achieve this goals, some major challenges must be overcome, especially in the individual setting: prejudices, hermeneutic injustice, imbalance of power and lack of autonomy. This article shows how the methods of psychodramatic play and director’s commentary are effective in overcoming these hurdles and promote a shared moral understanding of the behaviours concerned.

Keywords

Ethics, Moral Judgment, Testimonial Injustice, Hermeneutic Injustice, Social Intuitionism, Director’s Commentary, Autonomy, Psychodrama, Monodrama

Introduction

How do I deal with a client who I know has committed an immoral act and is not coming to therapy voluntarily?

Case vignette part 1

A psychotherapist is waiting for his client: it is the first appointment with Adel, a 19-year-old man who grew up in Syria and came to Switzerland 7 years ago. The therapist had initial contact with him by email and then by phone: he learnt that the social welfare authorities had urged him to attend this therapy. He arrives late and apologises for being late: “a lot of traffic”. What does the therapist think about this client?

Could it be that I have prejudices that affect the credibility of the client? In my psychotherapeutic practice, I primarily see male 1 adolescents and young adults who have difficulties in various areas of their lives due to their non-conformist behaviour. Based on my professional experience, I have some stereotypical prejudices about the credibility (1) of my clients. And the therapeutic encounter in the context of offence-oriented therapy presents us with further fundamental ethical questions:

(2) Is there a hermeneutic injustice in the therapist-patient relationship in the sense that clients in offence-oriented therapy often had rather limited access to education and therefore have few cognitive resources to interpret and communicate their life experiences?

(3) Is there a power problem with regard to the evaluation of the offence? Who decides what is “right” and what is “wrong” / what is “good” and what is “bad”?

(4) What about the client’s autonomy in an arranged therapy? The client has the right to decide which aspects of his personality and mental state he does not want to bring into the treatment. How can the therapist guarantee this autonomy and still explore the personal background of an offence?

Psychodrama as a tool of applied ethics

In this article I will address the four ethical issues mentioned above, using a case study from my practice in an individual setting. I want to show how psychodrama can become an effective tool of applied ethics in individual setting. By way of introduction, I would like to describe what I understand by applied ethics.

The seriousness of a moral problem does not take place in theory, but in concrete everyday life with all its complexity. Even if we cannot avoid defining moral principles (such as “Thou shalt not kill” or “Human dignity is inviolable”), the most important thing in questions of morality is not their clear formulation but the analysis and discussion of the application of moral principles in concrete actions. As the german philosophers Gabriel & Scobel (2021) write, ethics does not take place in seclusion. Only by analysing and discussing with other people who think differently, it can be recognised that one could have acted differently. Applied ethics is the analysis and argumentative transformation of action-relevant differences in moral thinking. Suddenly we realise: “Oh, my counterpart sees things very differently from me and would act very differently in this situation” A specific action in a specific situation can be judged very differently by different people. This is not surprising, as we do not live in a vacuum but in communities with their respective moral concepts, norms, customs, history and traditions. An ethic that consists of distanced, rational reflection and is only orientated towards the abstract other remains largely inefficient. For the Alsatian tropical doctor and philosopher Albert Schweitzer, “abstraction is the death of ethics”. Schweitzer understood ethics as a relationship, as a “living relationship to living life” (quoted from Theobald 2015). The task of ethics is not to leave people alone with their difficulties, but to bring them together with others and those who think differently in order to broaden their perspective on the problem situation and thereby learn more about their own needs, values and goals. It is important to understand the problem in its context: It is not abstraction that leads to moral action but concretisation. And this is exactly what we do in psychodrama: the scenic representation of a problem in its context. In the case study from the field of offense-oriented therapy, I will show how effective psychodrama can be for ethical reappraisal.

(1) Prejudices in credibility

For many years I have been working with clients who do not come to therapy of their own free will, but out of pressure or coercion. In the process, I may have developed negative identity-prejudicial stereotypes, what the british philosopher Miranda Fricker calls testimonial injustice. These are general associations between a particular client group and some disparaging characteristics, whereby this attribution is a generalisation and shows a certain resistance to evidence to the contrary. When these clients turn up late (or don’t turn up at all for their appointments) I tend to find their reasons less credible. This probably has an effect on my relationship with the client. I therefore address this in the first therapy session – after the greeting, getting to know each other, information about the aim and purpose of the therapy and a brief anamnestic discussion.

Case vignette part 2

T: (stands up and places two stools on the stage) “The boss of a restaurant is sitting on this stool. He is waiting for a job applicant. He was referred to him by the social services. The applicant has probably had some difficult years. And now he hasn’t turned up at the agreed time.” (sits down on the stool) “And now I’m sitting here as an employer waiting for the job applicant. It’s already 5 minutes late. As an employer, why do I think this delay is? Is it more for external reasons – such as traffic jams, accidents, train delays – or internal reasons – such as motivation, reliability, self-discipline, etc.?”

In the further course of this first role play, the therapist also refers to the current therapy situation and the associated possible prejudices of the therapist and the client. The field of discussion can also be extended, for example to prejudices against foreigners. Only the therapist is active in this first role play and he shows various examples of possible prejudices. In the subsequent discussion, the significance of prejudices is discussed: We cannot constantly fall back on a thorough clarification regarding a person or a situation and go through life like that. That would be far too complicated and it would severely restrict our ability to act. In this discussion about the advantages and risks of prejudices, the client is also invited to report on his prejudices about the therapy. The role play was a kind of door opener for this discussion.

(2) Hermeneutic injustice

Case vignette part 3

Adel entered Switzerland as a 12-year-old accompanied by his uncle’s family and was recognised as a refugee. His parents and siblings remained in their home country. Adel experienced war and flight during his childhood. In Switzerland, Adel was able to learn the language and obtain a school-leaving certificate. After a few detours, he was also able to find an apprenticeship and is now in his final year of training. During these years, he repeatedly exhibited behavioral problems: Threats, violence, alcohol abuse. After a massive conflict with his supervisor (threat of violence), his apprenticeship is now on the brink of collapse. Through the mediation of a job coach, therapy was arranged to deal with the incident.

People and animals that grow up under difficult living conditions have different bio-psycho-social preconditions than creatures that have grown up under favourable conditions. A threatening environment stimulates the brain in an unfavourable way and leads to complicated social behavior. Animals and humans that are socialised in this way undergo a development in which every encounter can trigger an alarm reaction (van der Kolk 2015, Panksepp 1989, 2007). The French neuropsychiatrist Boris Cyrulnik (2023) sees the roots of juvenile delinquency, which mainly affects boys, in the early acquisition of risk factors in a difficult environment in which children have never learnt to manage their emotions. Neuroimaging indicates significant changes in brain function in young adults who have grown up in a dysfunctional environment. Empathy developed incorrectly because there were hardly any caring adults in this difficult environment. The two prefrontal lobes appear less active. The amygdala, which is not slowed down by the prefrontal lobes, reacts violently and makes every encounter explosive. The brain concentrates and intensifies painful information from the body and from relationships. A lack of empathy and a lack of guilt have their neurological roots in a brain that has developed in a difficult environment.

If we want to meet these difficult conditions, we need to create a framework for an open, critical and respectful setting in the offence-orientated therapy. This process was started with a role play in which the client’s credibility was discussed. Now comes a second step: the narration of the offence from the client’s perspective.

Case vignette part 4

T: “Please tell me what happened.”

C: “A work colleague walked past me and made a stupid remark, so I told him to……” (C describes how it came to an argument with his colleague, to insults and finally the other person also insulted his mother, so he shouted at him and grabbed him and at that moment the supervisor came in and wanted to settle the dispute. At that moment, the client made threats to his superior.)

T: “I want to be able to get an accurate picture of what happened – I’ll do it here with these figures” (makes a line-up with human figures on a small table between T and C, see Fig. 1) “This figure here with the lance is the attacker. This man here with the stick is you, if I understood correctly, you wanted to protect yourself. This figure here is the superior who has joined you. And there’s another figure that seems important to me, even if she wasn’t directly involved: the mother – I’ll take this figure here, the queen.”

In a first step, I let the client tell me how he sees this problem situation. I ask several questions to clarify the description. In a second step, I show the client how I have understood his description. I use this as a model to show the client how communication works: You say something and I get a picture of it. In a further step, the client is given the opportunity to correct, expand or add to my picture. With this small constellation work, I try to show the client that I want to understand his statements better and that the emotional parts are also becoming recognisable. In this phase of therapy, I will not question or contradict the client’s statements, the client has probably already experienced this enough: I assume he has the feeling that he is the only one who sees himself as the victim of an unjustified attack. The people around him are probably disappointed that another incident of violence has occurred. Persons living a situation where there is a big discrepancy between how they see the world and how others see the world, may loose their confidence in being able to make sense of what is happening around them. The philosopher Miranda Fricker calls this a loss of epistemic self-confidence. This can lead the person feeling alone and misunderstood. It can also severely limit the ability to acquire new knowledge, as the courage to look at things from a different perspective is lacking. By sharing the attention on the scene on the table stage, the client is given the opportunity to share his point of view with another person. As a therapist, I do not intervene in a corrective or moralising way during this phase. I merely try to better understand the problem situation and provide new tools for interpretation, such as emotional components.

(3) What is the good?

In his magnificent book A Spirit of Trust. A Reading of Hegel’s Phenomenology, the US philosopher Robert Brandom tries to explain Hegel to us. Brandom explains that we can only achieve an appropriate awareness and a sense of self-efficacy if we learn to understand ourselves as members of a social community based on mutual recognition. Only when I meet other people who recognise me and cause me to recognise them reciprocally do I experience that I exist in a world that I can help to shape. And this is only possible through the process of carrying out a deliberate, intentional action with which I enter into an exchange with others.

Therefore, the subject is “the series of its actions” and the individuality “the circle of its actions”: “The individual can therefore not know what it is before it has brought itself to reality through its actions”. (Hegel, quoted from Brandom 2021, p.649)

And this is exactly what we do in psychodrama: the client presents a problematic life experience in a scenic way and, through this fiction, enables a confrontation with other perspectives, attitudes, norms, values and goals. This brings us to a centrepiece of Hegelian philosophy: dialectics. It describes a process of dialogue-based reflection in which negation is of the utmost importance: existing knowledge and attitudes are put to the test in order to gain a more precise understanding of the subject in question. The world is complex and contradictory and our sensory perception and ability to think is challenged. Here is a simple example: I am walking through the autumn forest with a friend and say how beautiful I find this red-brown carpet of leaves. “Yes”, replies my friend, “and those wonderful porcini mushrooms there!”. Marvellous porcini mushrooms? I only see leaves, but then I suddenly realise my mistake. Negation is the positive moment of recognising and learning. But it doesn’t mean that all the leaves on the forest floor will now turn into porcini mushrooms. Recognising and learning consists of a permanent interplay between determination and negation. For all judgements about the world, this means that they are never final and we can never be absolutely sure of anything. And because mistakes happen again and again in life, wicked actions take place, false reasons are given and insane truth claims are declared. A good life requires the ability to admit what is wrong and the willingness to forgive. And here, too, psychodrama offers a practical stage.

Case vignette part 5

T: “I suggest we do a little experiment. I would like to better understand what exactly happened at that moment when you threatened your superior. Where exactly did this take place? On what day? At what time?”

This is followed by scenic work in which the client takes on various roles. The core of this work consists of a technique I call director’s commentary: at the edge of the room stage, T and C discuss what they have seen and felt in the scenic play and how they judge and evaluate this. It is a repeated in-and-out of the roles and the therapist can also take on a role if necessary. And again and again T and C meet at the edge of the stage and comment on what they have seen and experienced. A different scene can also be played here, for example the same emotional or social experience in a different context (former workplace, school, family, childhood, etc.).

I have described the procedure with director’s commentary in previous articles (Schaller 2022, 2020, 2019). In this therapy phase, it is a repeated back and forth from the director’s commentary to the play scene. Only very short role plays are performed, which are immediately commented on again by T and C, standing at the edge of the stage. When the therapist takes on a role, he tries to free himself from explanations, assumptions, theories and hypotheses. This requires an open attitude on the part of the therapist:

  • The basic approach is not primarily solution-oriented, but process-oriented: the therapist responds to the client’s suggestions and interpretations and tries to verbalise the client’s thoughts and feelings
  • The therapist behaves receptively and tries to put him/herself in the client’s shoes: at times he/she physically imitates the client’s behaviour.
  • The therapist repeatedly checks the extent to which his own perception and judgement matches the client’s perception and judgement and contradicts the client when differences appear.

A therapeutic principle of offense-oriented therapy is that we firmly condemn the act, but not the perpetrator. And even if the client agrees with our judgement, it remains uncertain whether their moral thinking has actually changed. Often this only happens out of adaptation to the power relations in therapy. In our case study, it would probably be possible to convince Adel that this act was bad. People with a complex history like Adel have a high ability to adapt: he would want to go along with the therapist’s arguments – at least for the duration of the therapy session. The social psychologist Jonathan Haidt compares verbal moral disputes to shadow boxing: every boxer hits the opponent’s shadow hard with his arguments and wonders why the opponent doesn’t fall over. I don’t think Adel would fall over. He would just pretend to fall over. His basic moral stance is based on a very complex personal development. You can’t knock someone down that easily. Haidt sees role-taking as an alternative to shadow boxing: you can generate new moral judgements by putting yourself in another person’s shoes. “According to Piaget, Kohlberg and other developmental psychologists, this is one of the essential paths of moral reflection. One experiences multiple competing intuitions by looking at a problem or dilemma from more than one side. The final judgement is made either by following the strongest intuition or by choosing between the alternatives through reason by consciously applying a rule or principle.” (Haidt 2020, p.92)

A moral judgement is an evaluation of an action according to the criterion of good vs. bad. This judgement is made in relation to virtues that are considered obligatory by a culture or subculture in a certain context. Context sensitivity is an outstanding quality of psychodrama. In the case study, it is important to assess how the verbal threat is to be categorised in this context. But let’s take a closer look: How do moral judgements come about?

Following the philosophers Baruch Spinoza, Georg W.F. Hegel and David Hume and more recent research in the field of moral psychology, Jonathan Haidt sees emotions as the decisive authority for moral judgements. The thinking process only comes afterwards to provide a verbally conclusive justification for judgements that have already been made intuitively. Haidt speaks of the social-intuitionist model of moral judgement. The social-intuitionist model assumes that the majority of moral thinking takes place intuitively and outside of consciousness, so that we only look for reasons for our judgement in retrospect – but the decision has already been made before conscious thought. As the evolutionary biologists Carel van Schaik and Kai Michel write, moral judgements are about ensuring the functioning of social units such as couples, friends, groups and societies by enforcing rules of behaviour. The aim is to ensure the stability and security of a social arrangement. As this is a very complex matter, we humans are reliant on quick decisions. “We cannot simply register actions or even observed scenes. We always judge them by dividing them into good (in the sense of praiseworthy and admirable) and bad (in the sense of blameworthy, reprehensible or even repulsive). The reason for this is obvious: we are a hypersocial species, and our survival has always depended on our ability to distinguish reliable from unreliable fellow travellers. (..) Our intuitive morality has evolved as an adaptation to our Stone Age hunter-gatherer existence. We have a set of moral preferences that are part and parcel of our first nature. (..) The sense of fairness is deeply ingrained in us. We expect to be treated fairly and to receive something in return for our good deeds.” (Van Schaik & Michel, p.148/149)

Psychodrama offers the client a stage for examining his moral judgements. The first step is the narration of the problematic situation and the associated explanations, theories and emotions. The second step is a context-sensitive scenic representation. And the third step is the argumentative debate in the director’s position. The therapist and client then sit back down on the meeting chairs and evaluate the process so far and plan further work. This process is repeated several times during a therapy session.

(4) Ethical client involvement: a question of autonomy

I have shown how important it is for offense-oriented therapy to move away from the image of the “bad client” and to make room for the client’s point of view: the psychodramatic fiction makes it possible to recognise how the client interprets and judges events in the real world. The German philosopher Markus Gabriel describes how fiction helps us to understand events in real life. He is saying that we can only make judgements about things and events from a safe distance. Gabriel (p.63) gives the example of the unexpected encounter with a lion. One does not form the concept of the lion when it is close enough to be dangerous, but under the existentially secure conditions of a meeting in the cave. Gabriel understands fiction to be the representation of an event, for example a drawing of a lion or a story about a lion. However, fictions are not primarily artistic contributions, but are found above all in our daily conversations and thoughts about something. Fiction is a means to facilitate communication and get more clarity about things. Almost every statement has a fictional element. The practical and beautiful thing about fiction is the fact that fiction expands our perception. Our direct sensory perception only ever perceives one aspect of a thing, namely the aspect that is accessible to us due to our temporal-spatial location. In addition, the perception may be limited against the background of a threatening situation: I can’t see how beautiful the lion’s mane is. In my imagination, however, I can even stroke the lion’s mane. Fiction means transcendence: “Man as a free spiritual being does not cling to the sensory given, but is at a distance from what is presented to him and can modify it on the basis of this minimal transcendence” (Gabriel, p.116).

The fictional exploration on the psychodrama stage can provide important information about the client’s resources and possible solutions. Gerger et.al. (2020) emphasise how important it is to understand the client’s perspective and to make the client a partner in the therapeutic work: “In particular, patients themselves as active agents within psychotherapy need more attention, including their idiosyncratic experiences with psychotherapy, as well as their perspectives on health and illness (i.e. their illness and health narratives), their moral and normative values.” (p.5). If the client is not only to be an object of treatment, but is to be involved as an active co-creator of the therapy process, he must also be able to take on a corresponding role. In psychodrama in the individual setting, this happens mainly in the directing position. The client becomes a co-director of the psychodramatic fiction on stage.

Case vignette part 6

(Therapist and client stand at the edge of the stage):

T: “You know that feeling of being unfairly accused? From other situations? Or from your school days, from your childhood?”

C: “I was always to blame when there were arguments between us children. My cousin cried loudly, then my uncle joined in and so I was always blamed by my uncle.”

T: “Can you think of a specific situation? Do you have a concrete memory of such an incident?”

C: “Yes, there are many.”

T: “Can you tell me one?”

C: “Once my cousin hurt his hand. We were in the room when the doorbell rang and we both wanted to jump to the door to open it…. but my cousin fell over and hurt his hand. He shouted that I had pushed him and that’s why he fell over.”

T: “And then?”

C: “Then my uncle came and shouted at me and hit me.”

T: “Was that in the room or in the corridor?”

C: “In the corridor.”

T: (T asks a few more questions about the place, time and space of the situation and then makes a suggestion for further work) “Let’s imagine here is the place where this situation took place…here is the front door…here is the door to the kitchen where your uncle is and here I put a cushion on the floor – that’s you as a child…how old were you then?”

C: “I don’t know exactly…about 9.”

T: “So this cushion here is for you as a 9-year-old boy and this second cushion is for your cousin. Let’s imagine this situation… do you want to try to put yourself in this 9-year-old boy’s shoes? I suggest you just stand where this cushion is and try to feel what’s going on inside this boy…Okay”

C: (In the role of the child) “Oh that’s shit, I was always blamed, I was always the bad boy.”

T: (Stands behind C to whisper) “Yes, always me, I feel…..?”

C: “That’s not fair. Sure, they treated me well, but….”

T: (Stands at the edge of the stage again) “Well, why don’t you come out of your role and join me here. We want to watch it again. 9-year-old Adel is lonely, that’s what I felt watching him.”

C: “Well, not really lonely….it is more this feeling of injustice.”

T: “But I felt also anger….may be anger against the parents who are not here to protect?”

(A short conversation develops at the edge of the stage about the emotions that arise when playing and observing the scene. Then T and C sit back down on the meeting chairs for feedback on the role play and sharing and assessment of the scenic play).

T: “How did you feel in the role of the 9-year-old child?”

C: “That wasn’t nice.”

T: “Yes, I felt that too. And as I said earlier: sadness and loneliness too. Did you realise that you didn’t really take on the role of the child?”

C: “Yes…not rally…..”

T: “You talked about the child, you talked about how it used to be, but you didn’t speak from the child’s heart, with the child’s voice, but you spoke as an adult.”

In this dialogue on the meeting chairs, the client now enters a meta-position: he will explore with the therapist why it did not come to a real role-taking. The therapist’s assumption is that the client is afraid of being flooded with emotions. The therapy process here becomes a psychoeducational model regarding autonomy. The client should experience that he has the possibility of co-determining the emotional depth of the therapeutic process. The client learns that he can decide whether or not to take on a role. This is facilitated by three positions in the therapy room:

  1. Discussion room: the place for the therapeutic dialogue. This is where we sit at the beginning and end of the therapy session and where we develop ideas for the play. This is where we spend most of our time during a therapy session.
  2. Stage: An unfurnished part of the therapy room. This is where the scenic play takes place. An alternative to the room stage is the table stage – see Case vignette part 4.
  3. Director’s position: is located between the stage and the discussion room. This is where the dialogue between therapist and client takes place about thoughts and feelings that arise from watching the scene and where ideas about possible changes to the scene are discussed.

Fiction allows us to see new aspects of something from a safe distance. In our case study, Adel finds two safe places: the meeting position and the director’s position. In the course of the therapy, Adel will learn that strong emotions can be activated on the theatre stage, but that he has the option of dropping the acting role at any time and returning to the directing position. And in this position, he will experience himself as a co-director in partnership who can co-decide which themes and roles are brought onto the stage. The directing position is also the place where the client will experience that other people often think differently.

The dialogue about the therapy process and about attitudes, norms, values, needs and goals then takes place again in the meeting position. With Adel, a dialogue about justice, fairness, proportionality, care, happiness and other important things in life can develop here. The meeting position is the most important position in the dimension of time. I spend around 45 minutes in this position during a 60-minute session. We need about 5 minutes for the scenic play on the stage in the room. The directing position takes about 10 minutes in total. During a therapy session, there are several rounds through these positions and the changes from playing position to directing position are very quick. From the clients’ feedback, I repeatedly learn how central the scenic presentation was to their cognitive process. The short play actions and the exchange in the directing position activate the client, which has a positive effect on the meeting position. The client’s point of view, needs, attitudes and objectives become visible and can be worked on.

Conclusion

Psychotherapy is not a value-free endeavour. Each of us brings what we are as individuals to our professional role, including our personal values. This can become particularly complex in the case of offence-oriented therapy, where we encounter people who experience the world very differently from us and have done things that we condemn. Using a case study, I have tried to show how helpful psychodramatic action methods can be in this complex therapy constellation. The three positions (discussion, role play and directing) create an intersubjective mental space that enables the experience of thirdness. Thirdness means adopting a perspective that goes beyond personal views and attempts to recognise the situational context and the motives behind an action through identification and empathy. The more abstract our approach to the experiences of others is, the greater the danger of simple moralising and pre-judgement. For the therapist, thirdness means stepping out of a position of knowing and doing into a space of not-knowing. The psychoanalyst Jessica Benjamin says “that the Third is that to which we surrender, and thirdness is the intersubjective mental space that facilitates or results from surrender. In my thinking, the term surrender refers to a certain letting go of the self, and thus, also implies the ability to take in the other’s point of view or reality. Thus surrender refers us to recognition – being able to sustain connectedness to the other’s mind while accepting his separateness and difference. Surrender implies freedom from any intent to control or coerce. (Bemjamin, p.23/24)” Thirdness makes possible that the client feels recognised and respected as a human being, opening a window to emerge from a world of shame, guilt or denial and enter a world of recognition and responsibility. Psychodrama offers a wonderful stage for this form of applied ethics.

 

1 Remark: I almost exclusively treat male adolescents and adults in the field of offence-oriented therapy. I therefore use the masculine form in this article.

Bibliography

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Brandom, R.B. (2021). Im Geiste des Vertrauens – Eine Lektüre der Phänomenologie des Geistes. Berlin: Suhrkamp

Brandom, R.B. (2019). A Spirit of Trust – A Reading of Hegel’s Phenomenology. Harvard: University Press

Cyrulnik, B. (2023). Quarante voleurs en carence affective. Paris: Odile Jacob

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Schaller, R. (2020). Director’s Commentary. https://psychodrama.world/practice/directors-commentary/

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Author

Roger Schaller, 1955, grew up in Bern (Switzerland), studied psychology there and completed the psychodrama training at the Moreno Institute Überlingen. He is a federally recognised psychotherapist, a specialist psychologist for traffic psychology FSP, president of the Swiss Psychodrama Association PDH and he heads the Institute for Psychodrama and Action Methods IPDA. He is the author of specialist books and articles on role play and psychodrama.

Roger Schaller
Burgerweg 7, 2532 Magglingen, Switzerland
E-Mail: schaller@ipda.ch