Author: Anna Chessner

First published: 18 November 2024 © Springer Fachmedien Wiesbaden GmbH, ein Teil von Springer Nature 2024

Abstract

The article, published in the Zeitschrift für Psychodrama und Soziometrie (ZPS), reflects upon the backstage thinking during a therapist process. If one-to-one psychodrama psychotherapy can be seen as a kind of performance à deux, what happens in the backstage domain of therapist awareness? How do we balance being and doing in the therapy room, and what informs the choice and timing of action methods offered? Examples from practice illustrate key issues and highlight the less visible domain of therapist process.

Note that all clinical vignettes have been fictionalised and are composite versions of sessions, drawing on many years of practice.

Keywords Being and doing · Therapy as performance · Backstage thinking · Role analysis · Somatic being-with · Working with transference · Creative intuition · Awareness

1 Introduction

Thinking about thinking about action New psychodrama trainees learning about one-to-one practice tend to assume initially that all sessions are based in doing action methods. Given their background experience in psychodrama as a group psychotherapy it might seem logical that sessions would follow a similar path to classical group psychodrama—a theme is chosen, a scene or scenes constructed, enacted, de-roled and reflected upon. While such an action rich approach might on occasion be helpful and appropriate, I notice that my own practice does not conform to this pattern. This discrepancy between their expectations and my experience gave me cause to reflect. I certainly think in psychodramatic terms, noticing role, role relationship and role conflicts. I also consistently reflect in terms of role analysis, using the London Centre for Psychodrama five factor approach to make sense of the various narratives that emerge in the sessions; not only the narratives that are told about the client’s present and earlier life, but also the narrative that emerges in our here and now relationship (Chesner and Zografou 2014, p. 49). To a greater or lesser extent with different clients, and at different times I offer psychodramatic action methods as part of the sessions. This article is about what informs the choice of these offers. Why might I choose to initiate a psychodramatic piece of work? What informs the timing and complexity of such interventions? In responding to these questions to self I take as a starting point the notion that a therapy session is a kind of performance à deux. There is in true Aristotelian style a beginning, middle and end to a session, as well as an arrival and a departure from the therapy space. (Aristotle 1996, p. 13). This arc is similar to the arrival at and departure from a theatre performance. The journey there is a warmup to the particular shared reality of a show or therapy session. The journey back is a time for reflection on what has been and to some degree a time for integration, a settling back into the world of regular reality. Indeed, during and since the Covid pandemic I have felt that something was lost as I moved so much of my therapy practice online. Clients may arrive at Zoom sessions straight from a whole series of other Zoom meetings during the day. The liminal space between everyday life and the therapy session provided by a physical journey has been compromised by the current online therapy culture, convenient though it may be. If a therapy session is seen as a performance à deux, the action might, in its simplest variety, take the form of a conversation. This would be the familiar cultural conserve that most members of the public would associate with psychotherapy. Psychodrama and other experiential therapies include explorations beyond the verbal conversation, activities that require a certain level of stage management.

2 Being and doing

A therapy session, bounded by the temporal and spatial frame of the session, provides a special opportunity for the client to be, to be in the presence of an interested and relatively neutral other, and to attend to their own process and reflections. This frame, recurring in a regular and predictable way can in itself be transformative. Those of us who tend to prioritise the action component of psychodramatic psychotherapy should remind ourselves of the value of being, and being with. It is the foundation of the therapeutic relationship. On the other hand, there might be a danger that, in waiting too long to introduce the language of creative action into sessions we conspire to create a cultural conserve that keeps the therapy sessions going round in circles, revisiting familiar narratives and complaints, but not necessarily moving towards change. Even when there is a natural hiatus in the need to talk, not moving into action might still be the creative choice.

Clinical vignette 1

The anxious client—prioritising being over doing Bob is a young man suffering from anxiety and panic attacks. During the assessment period I introduced creative techniques to unpack his life story and the chronology of his issues with anxiety and panic. Subsequently most of the session time is dedicated to his ruminating about his daily life, all through the perspective of anxiety, potential panic attacks and the things he is doing to stay alive and well. There seems little depth to these accounts, and I get the feeling that he sees himself as a faulty machine, that needs constant vigilance in order not to go wrong at any moment. Eventually, after a couple of months there is a silence in the room and the statement “I don’t seem to have anything to talk about”. The statement feels like an anxious and rather embarrassed request for me to offer up a fix. I smile and say “Good! Tell me what that’s like”. What ensues is, in both our opinions, a turning point in the therapy. We explore how alien it is for him to just be, to be with himself, alone or in the presence of another, and to become aware of the moment-to-moment sensations that are coming up without any attempt to change something. I could have offered a piece of psychodramatic work, but my judgment was at that point that I would be in danger of colluding with his constant doing as an unhelpful attempt to avoid ‘just being’. Instead, I suggested we just sit quietly for a couple of minutes and then share what the experience was like. Arguably the framing of this exploration of ‘just being’ can be considered an action intervention in its own right, or perhaps something of a creative experiment. It certainly lacks the familiar psychodramatic markers of using concretisation, getting on our feet, or exploring role. Nonetheless it was spontaneous, an adequate and transformative response to a new situation. The therapeutic relationship changed, as did the way he used the sessions, and the theme of anxiety receded as his experience of being himself deepened.

3 Backstage

Thinking and role analysis What informs the decision to offer an action intervention? There is a lot of activity that goes on in the mind of the therapist that is not visible to the client. I call this backstage thinking. When we go to the theatre there is a degree of magic in the experience of the performance of a production, and the uninformed audience member may lack curiosity about the backstage elements of the show—the directing decisions that have been made, the stage management, lighting and sound effects. Such backstage elements deeply affect the aesthetic quality of the production, subtly directing the attention of the audience towards certain phenomena and meanings, and away from others. In the therapy session as in the theatre key moments can be spotlighted or allowed to rest gently in a diffuse light of free-floating attention. The kind of backstage thinking that takes place in the therapy room is both left brain and right brain thinking. I use these terms as a short-hand for different kinds of thinking. Both sides of the brain are actually involved with both creativity and logic. In terms of more ‘left brain thinking’ I may consciously and intentionally sift through the narratives I am hearing and my client’s way of being in the moment and apply a role analysis to these.

Clinical vignette 2

The selecting therapist—role analysis as a guide to formulating patterns and options Sara, a woman in her late thirties is struggling with depression. In her first few sessions she tells the story of a job she has recently started, in which she finds herself feeling on the outside, sensing that she has not made a good start, is not integrating with the team. She is concerned that this will impact her future journey in this role, and that it will be a repetition of an experience she has had in a number of previous jobs, where she found herself on the outside, feeling misunderstood, under-appreciated, and held back from career progression. Even with this small amount of information I can make a tentative role analysis, a formulation, initially for myself. This formulation is intentional, a conscious left-brain application of the London Centre for Psychodrama’s five factor approach to role analysis, namely Context, Behaviour, Feelings, Beliefs, Consequences. (Chesner and Zografou, loc cit) The first factor to consider is the context, ie what Sara is facing or what is it that the other is doing to which she has a role response? Consideration of the context of role is a useful reminder of the relational nature of role as a way of being. We are not a closed system but exist in relationship with others and the world. In a situation where Sara faces the task of integrating as a new person into an established group and finding a sense of belonging. The second factor to consider is her behaviour, ie what she actually does in response to the context. I like to subdivide this into external behaviours in relation to the other/s and internal behaviours, what she does to herself. Externally, she shows up, but is on the lookout for small signs of rejection or judgment in the others. Internally, there appears to be a degree of negative and diminishing self-talk that undermines her confidence and spontaneity and that mirrors her sense of the external response of others. The third factor to consider are her feelings. She feels anxious, trapped in a repeating loop and shame. The fourth factor in creating a role analysis is the implicit beliefs that create the assumptive world of the client. I like to consider these from three different angles, belief about self, other and the world. In Sara’s case she believes about herself that she is doomed to be unappreciated, and that she doesn’t have the social skills to convey confidence or to belong. About others she believes that they see her and judge her as different, not one of them, as inferior. About the world she believes that people from her cultural background (ethnicity and class) are at a disadvantage that cannot be overcome and that attempts to challenge the status quo are futile and likely to lead to shameful consequences. The fifth factor in role analysis are the consequences. These are usually synonymous with the presenting issue under discussion. In this case the consequence for her is that even as she seems to have a new chance with a new job, she feels depressed and stuck. This way of methodically formulating how Sara presents and experiences her world can guide me to consider where the therapeutic focus may usefully be placed, where to put the therapeutic spotlight in terms of her overdeveloped, underdeveloped and adequate roles, and potentially what psychodramatic interventions might be offered. To unpack this a little, there is an overdeveloped role of ‘wronged outsider’ or ‘unappreciated team member’. There is an underdeveloped role of ‘optimistic joiner of a group’ or ‘open-minded and determined team member’. In terms of adequate roles, the mere fact of coming to therapy for help suggests the role of ‘aware self-reflector’ and ‘honest contemplator of potential change.’ It might be used for speculative consideration of the origins of her issues. In Sara’s case, the biographical fact of having been in care and then adopted, and of needing to change schools twice in her early years as the adoptive family moved home are held in mind as potential factors in the locus of role, which may influence forward thinking as the therapy progresses. All of this therapeutic reflection remains backstage for the moment but offers a supportive framework for the therapist’s presence in the room.

4 Somatic being-with as backstage thinking

What about the less conscious right-brain backstage thinking that goes on? As two embodied human beings in the room there is a plethora of communication that passes between us body to body. For example, Sara’s physical presentation conveys something of her depressed affect in terms of her posture, which is subtly collapsed, the downwards direction of her eye gaze conveying something of her tendency towards shame. The quality of her breath and its impact on her voice tone all have an impact on me, which I may not articulate clearly to myself in words, but which I sense with my body, and which may require more time to travel into conscious knowing. In the backstage arena of my own mind, I pay attention to both kinds of thinking, and part of my attention is always directed towards my own process, my sensing, and my countertransference. The verbal language of analytical thinking and the somatic language of the relational field dance together and contribute to the experience of attentive therapeutic presence. The combination of active backstage thinking and here and now mindful presence support the moment-to-moment attunement that is paramount in the therapy process. When to go into action? Bradford Keeney, the American creative systemic therapist and author of The Creative Therapist (Keeney 2015) uses the concept of a three act play as he considers the question of how and when to intervene to interrupt the habitual “complaint” of the client. By framing his reflections in terms of three acts he too uses a theatrical metaphor to make sense of this question. What he describes as the First Act, the phase of the complaint or lament relates to the kind of narratives accounted above with Bob and with Sara. A client could spend weeks,months or years in the First Act, dwelling on current troubles. Keeney looks for the opportunity to move into what he calls Act Two, an intervention, perhaps through reframing, that opens a door into the possibility of a different perception, of creativity. As psychodrama psychotherapists, the opportunity of moving into Act Two often presents itself as a sense that doing something in action might be helpful, informed by conscious and less conscious backstage thinking. The use of action is inevitably an opportunity for a change of perspective, and a change of perspective is what opens up the possibility of change. There are numerous possibilities of action intervention. We have a whole repertoire of them, some of which are listed below and all of which may have something to offer. The more difficult question might be when to offer one of these. Too soon and there is a risk that the process of therapy drifts into a cultural conserve whereby there is an expectation in both therapist and client that the therapist is there to fix, and to come up with doing-type solutions, which are privileged over the more subtle and slower paced process of being together in the client’s challenges. Too late and moving into action might come across as strange, and interruptive of an ongoing verbal and reflective process that in itself has become a cultural conserve.

• So, what are the options for action?
  Sara might work projectively with small objects, e.g. using a three-dimensionalcommunicube to concretise the system at work that she is currently facing (Casson2007). The role relationships are configured in miniature and there may be somespeaking from r ole with the finger placed on the objects representing differentteam members. At the same time, because the small world stage is in miniature,a part of her is very much in mirror position, able to take in the whole picture andreflect upon both self and group dynamics that have been represented.
• This sculpted image might be taken as a starting point to also represent previousteams or groups she has tried to be part of and to look at the patterns that haverepeated over time within a work context. The aesthetic distance provided by con-cretisation and by the scale of working in miniature is especially supportive ofreflective function and the making of links.
• The same sculpt could be used as a starting point to mark the overlap betweenthe current dynamics she is experiencing and earlier family or school experiences.Just as we might find in a psychodramatic vignette directed within a group context,figures from the past can be made visible on the small stage simultaneously withthe current dramatis personae. This reveals the underlying structure and patternof role relationships and enables the client to gain some distance on transferentialphenomena—how the challenge of learning to belong in the present context hasevoked an old role response to a similar challenge in the past.
• We might work with role. Sara might encounter her new boss in role, or rolereverse with her and with different teammates. Through this process she mightbe able to reality check her assumptions about the judgments they are making o rexplore how she herself is contributing to how she is being seen and treated by theothers.
• A different kind of role work, of a more internal nature, could also be used. Shemight go into role as the part of herself that believes she will never belong; and should not even expect to. She might find another internal role that wants to chal-lenge that outdated belief, leading to an encounter or role dialogue between thesetwo roles.
• Deepening the work, we might unpack the early experiences that have led to h erseeing herself and the world in this way. Perhaps a concretised timeline depictingmoments along the way that have contributed to her way of being in the worldcould be a starting point for this more archaeological approach.
• This psychodynamic approach might lead to the representation projectively orthrough role work of the family-of-origin messages that have been introjected.Such an approach could strengthen the possibility of developing new, more up-to-date messages to support herself.
• Given the cultural dimensions of her belief about ‘people like her’ this explorationcould become transgenerational, concretising the experiences and the messagesacross the generations that have contributed to her current way of being.

5 A balancing act

All these possibilities (and many more) can become part of the onstage dimension of a therapy session. They belong to the dimension of doing, of facilitation and the performance of therapy. They open up the doorway to new perceptions and ways of being which can move the therapy forward. How is the decision made to offer an action intervention, which one to offer, why, and why now? The therapist needs to balance the instinctive or intuitive creative impulse which seems to just arise with their more conscious reflective and analytic judgment. It is this balancing of internal backstage processes within the therapist that gives a true sense of creativity rather than impulsivity. The suggestion then comes into the therapist-client relational field—sometimes I offer a menu of possibilities and the client chooses which one resonates or interests them most at this moment, in a sense choosing their own spotlight. At other times I might myself suggest the focus and method, bearing in mind the time available in the session to work something through and the likely emotional intensity of different foci. In this instance I am directing the spotlight.

6 When the transference comes into the spotlight

There are moments in one-to-one therapy sessions where the transference relationship becomes figural, even whilst engaging in psychodramatic action work. I give a couple of examples here as an opportunity to highlight the importance of such moments as well as the challenges they may present in terms of spontaneous backstage thinking.

Clinical vignette 3: working with the transference—the angry therapist

Brian is a new client, coming up to his first break in therapy as the Christmas holidays approach. He had originally started therapy in order to explore his ambivalence in his relationship with his partner. Today, on entering the consulting room, he notices some masks on the wall and remarks, “I’ve never seen that before, is it new?” As we sit down, I ask him what he sees in the mask, which is not new, and he replies, “it’s angry, maybe scornful.” At this moment my backstage thinking is fairly active. I am wondering who he might be angry with or who may have been angry with him in the past week. It is unusual for him to notice the props in the room so I am also considering suggesting we explore creatively using the mask as a starting point to unpack the layers of meaning and associations that may be behind it. It is always interesting when clients notice things in the room as if for the first time. I am also aware of it being our last session before the break, so I ask how he has been since we last met. The reply comes, “I’ve felt bad all week, as soon as I left here last week, I was thinking that you must be angry with me for what I said about therapy just as I was leaving. I was really dismissive, saying I wasn’t sure it was helping. And then I thought, that was a stupid thing to say, and you must be really angry. That thought has been with me all week.”

Backstage thinking
At this point I recognise that he is presenting the therapeutic relationship as what needs to be worked with, that the mask represents me, at least his mental image of me as it has accompanied him during the week. There is the real question of whether we are a good fit therapeutically. It is a new piece of work. Of course, he has a right to choose to end the therapy relationship, find a different therapist, or give up on therapy altogether. I also recognise that his ambivalence about the therapy beautifully mirrors the ambivalence in his intimate relationship that originally brought him to seek help. There is also the timing of the statement he had made. I know that breaks, especially in the early stages of therapy can be challenging. Was his statement the previous week a way of projecting some of his feelings of uncertainty into me? It was unsettling, and I wondered to myself if the feeling I had was similar to his partner’s response to his ambivalence in their relationship. Was I about to be ‘dumped’? Did his partner also feel how precarious the continuity of their relationship was? Was it a test to see if I would let him go too easily, or fight to keep the therapeutic relationship and potentially contribute to his feeling trapped? How much of this should we explore today? And how? All of these reflections are going on internally and it is not a linear process. As if I am considering an internal communicube with all its multiple layers filled with possibilities, it is my job to select the way of being or doing most appropriate to that moment. What I actually choose to do is firstly to make a link back to the mask, acknowledging it represents me or his idea of me during the week. We explore his mentalisation of my process in response to his statement on leaving the previous week. I choose to do this verbally rather than in action, with the internal rationale of not wanting to fan the flames of his fantasy or create too emotional a response in our last session before the break. I also decide to take seriously the question as to whether he wishes to work towards an ending, to respect any doubts he may wish to voice and to be as neutral as possible as to the outcome of our conversation, in order to underline his agency in the decision. I prioritise the frame and the question of ‘in or out’ over the more intricate questions of the transference and the link to his presenting issue for therapy. Such questions can be explored in depth at a later point if he is ‘in’, and if he is deciding to end then the priority must be on co-creating a good enough ending. In the event, the conversation led to a deepening of trust, and a commitment to continue the therapy after the Christmas break. This may not have been the most exciting use of psychodramatic action methods, but it was thoughtful and containing at a time when that was the most important factor.

Clinical vignette 4: working with the transference—the angry client

Maria has been in therapy for over a year. She suffers from various somatic complaints that loosely link to a history of childhood trauma. She comes from a middle-class family but where emotional neglect has left its mark. She presents as pleasing, polite and grateful for the space to explore a more authentic sense and expression of self. On this occasion she starts by sharing that she had had a powerful dream that was still on her mind and that she begins by describing. My initial intervention is to ask her to tell the story of the dream in the present tense as if witnessing or experiencing it right now. This is a simple action intervention which brings the experience of the dream into the here and now and activates the ‘as if’ of the dream in the therapy space. She is upstairs in a large old house, looking out of a window onto the garden and grounds of the property. There is a driveway, a moat filled with water and a gated bridge over the moat. She watches as the defences of the property are attacked by a group of zombie-like workers who are doing the bidding of a foreman, who himself is impersonal and only there to fulfil the orders of a higher authority. She sweeps downstairs and attempts to intervene with the foreman to protect her property. She struggles to get the foreman to hear her and wakes before there is a resolution. My sense is that we could usefully explore the dream from different perspectives, and so I make a further action intervention. I begin by asking her to draw the significant features of the dream from her point of view. This functions as a kind of scene setting as well as helping her to remember some details of the garden and the spatial relationships of the setting and the people. It helps me see what she sees and brings the dream a little nearer. It also maintains some aesthetic distance compared to the more immersive classical psychodramatic technique of re-dreaming the dream and re-enacting it physically. I then introduce the idea that there is a school of thought that considers all elements of a dream in some sense expressive of self, parts of self or unlived potential roles. With this in mind I ask her to role reverse with various roles within the dream and to retell the dream from their perspective. She begins by recounting the experience from the role of the large house, and then of the bridge, the moat, the foreman and the zombie-like workers. It is at this point that something occurs between us in the room. Maria struggles to narrate the dream from the perspective of the attacking workers. I suggest it might be useful to try anyway, since it might throw light onto aspects of her own way of being that are self-attacking, particularly somatically, not a new theme in the therapy work. She is visibly impacted by my comment and manages to say that she is having a strong reaction to me. We pause the focus on the dream and I ask her to say more about what is happening between us. It seems that I am pushing her too hard, or too far and that identifying through role reversal with the attacking figures in the dream is a step too far. I suggest she stay with her current state and express herself directly to me. She tells me with authentic emotion to “Back off” and then to “Fuck off!” The dynamic of the dream has come into the room. While within the dream she wakes before dealing with those who are attacking her property/her Self, here in the therapy room I have unintentionally become the intrusive and persistent breacher of defences that the dream presented her with. By pushing back and allowing the expression of her anger she has in effect completed the dream. In my backstage thinking I recognise this as a key moment in our relational process and that it is the first time that she has expressed raw emotion towards me. It also marks the development of an underdeveloped or repressed role in Maria: the assertive defender of her limits. We spend some time reflecting together on how energising it felt to push back so strongly, and to see that I had survived the attack, and indeed that our relationship had survived. For me it was also a reminder that what I might judge as a mistake (being a too pushy therapist) can be an opportunity for growth if the dynamic is explored authentically and in a moment-to-moment way, with a readiness to hold in mind both the story that is emerging in the room and the story that has been brought to the room.

7 Conclusion

I have shed some light on the processes that go on in the mind of the therapist, that inform some of the decisions that are made within a therapy session, decisions that may lead to apparently doing nothing (perhaps prioritising ‘just being’) or moving into psychodramatic action interventions. I have given examples of psychodramatic thinking, particularly through the device of role analysis, and moments where the transference relationship comes to the fore in the therapy room. I have called the tracking of both conscious thinking and creative intuitions backstage thinking. I offer these reflections as an invitation to the therapist or trainee therapist to recognise the importance of the complex processes of the therapist in the conducting of a session as well as the importance of moment-to-moment awareness in the therapy room. In doing this I offer the concept of backstage thinking as a factor in the performance of one-to-one psychotherapy that is worthy of as much attention as the application of technique in helping a client work through their issues.

References

Aristotle (1996). Penguin Classics.

Casson, J. (2007). Psychodrama in Miniature. In C. Baim, J.Burmeister & M. Maciel (Eds.), Psychodrama Advances in Theory and Practice. Routledge.

Chesner, A., & Zografou, L. (Eds.). (2014). Creative supervision across modalities. Jessica Kingsley. Keeney, B. (2015).

The creative therapist. Routledge. Publisher’s Note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Information about Anna Chesner

MA, Co-director London Centre for Psychodrama Group and Individual Psychotherapy, BPA Senior Trainer and Supervisor, UKCP integrative Psychotherapist and Training Supervisor, BPA representative of FEPTO. Anna works as a supervisor and psychotherapist in private practice in London. She leads the London Centre for Psychodrama Creative Supervision training programme and co-runs the Psychodrama Psychotherapy programme. She is widely published in the field of psychodrama, dramatherapy, trauma work and supervision.