Working with reluctant clients
Implementing elements of psychodrama for successful psychotherapy with traffic offenders
by Roger Schaller
First published in German: Schaller, R. (2020). Wenn die Behandlungsmotivation gleich Null ist. Zeitschrift für Psychodrama und Soziometrie, 1. doi: 10.1007/s11620-020-00535-3
Successful psychotherapy is often assumed to depend on a client’s willingness to participate and his or her motivation to change. In traffic therapy, however, therapists are confronted with resistant clients who only attend therapy in order to get their license reinstated. In this article, I describe how elements of psychodrama can be used to get even such unmotivated clients to actively participate in the therapeutic process and reflect on their situation, attitudes and behavior and formulate intentions to change.
Psychotherapy with traffic offenders
Traffic offenders – who are primarily male – often display a number of abnormal and sometimes even pathological attitudes, behaviors, and/or personality characteristics that limit their ability and willingness to adhere to traffic regulations (cf. Raithel & Widmer 2012, p.8). Traffic psychotherapists aim to address such dysfunctional tendencies in order to increase the probability that clients will drive more safely in the future. One of the biggest challenges of traffic therapy is overcoming clients’ resistance. Indeed, successful psychotherapy is often assumed to depend on a client’s willingness to participate and his or her motivation to change. Clients of traffic therapy, however, typically perceive therapy as an unnecessary form of punishment; they see themselves as perfectly capable drivers and attend therapy only as a means of regaining their driving license. Moreover, clients of traffic therapy often perceive themselves as victims; they believe their situation is the result of arbitrarily applied and excessively strict traffic laws. Much of traffic therapy therefore entails encouraging clients to view their traffic offence(s) and potentially other problematic aspects of their lives from different perspectives, critically reflect on their experiences, and acknowledge their role as perpetrator as opposed to victim. In this article, I describe how traffic therapists can use short psychodramaticsequences to get even reluctant clients to actively participate in therapy, re-evaluate their past behavior and develop intentions to change (see also Lamberger 2016), which ultimately establish the foundation for safer driving behavior. The psychodramatic elements enable clients to experience a model of resilience during the therapy sessions.
Men are much more apt to commit serious traffic violations than women; traffic therapy is thus mostly geared toward treating male clients. In my own practice in Switzerland, many of the traffic offenders I work with are men who have been faced with multiple challenges such as migration, poverty, mentally- or physically-ill parents, psychological or physical violence within the family, parental separation or ongoing conflict, problematic educational experiences or dropout, unemployment, or alcohol and drug abuse. When faced with difficult experiences, they have learned to “grit their teeth and get on with it.” Their psychological/psychiatric characteristics are usually inconspicuous in everyday life and they would have never initiated psychotherapy voluntarily. Their therapy-averse attitudes make for a difficult starting point. In this article I discuss a case example involving a male therapist (like myself) and a young, multiply-burdened male client typical of the clients I see. I detail how I implement various psychodramatic methods across 10 sessions of therapy with the case client. The session excerpts demonstrate how scenic methods can encourage even reluctant clients to reflect upon their own thought processes and behaviors.
The client is 21 years old. He was born and spent much of his childhood in a southern European country. His childhood was exceptionally difficult. He states that his father “was fortunately almost never around.” He grew up mostly under the care of his grandmother because his mother was often working abroad and his father had begun serving a long-term prison sentence for a violent crime when the client was 2 years old. After several changes in guardianship, at age 12 the client was sent to his older half-sister in Switzerland. He learned German relatively quickly and finished school on schedule. He began an apprenticeship in the automotive industry but quit before he had completed his training. At age 19, he obtained his driving license. His driving license had been revoked after two major traffic violations (excessive speeding). In such a case, Swiss law prescribes that a new license can only be issued after at least one year and after the person has passed a traffic-related psychological assessment. The client had failed a previous assessment due to his striking tendency to downplay his offenses and his failure to critically reflect on the motivational and emotional reasons for his behavior. The examiner therefore concluded that, given the opportunity, it was highly likely that the client would continue to drive recklessly. She believed that his driving behavior was related to his biography and personality; she hence concluded that his driving behavior was unlikely to change unless he critically confronted elements of his past. She recommended that he complete a minimum of 10 one-on-one traffic therapy sessions, after which a new assessment would be conducted.
Overview of the therapeutic sessions
The client’s therapy was based on the psychological and philosophical model of psychodrama complemented by elements of talk therapy and cognitive behavioral therapy. Table 1 displays the themes addressed in each phase of the client’s therapy and the method(s) used to address each theme. The psychodramatic methods are in italics. In this article I describe only the psychodramatic elements. For the other sequences I refer to Raithel & Widmer (2012).
As I have detailed elsewhere (Dumpert & Schaller 2017, Schaller 2017, 2019), in the one-on-one setting I implement only very brief psychodramatic sequences which I then discuss with the client. In the following, I describe how such short psychodramatic sequences enabled the case client to re-evaluate his driving-related thoughts and behavior as well as develop an intention to behave differently in the future.
Table 1. Overview of the therapeutic sessions
Much of traffic therapy revolves around addressing problematic elements of a client’s biography and personality. In the first or second therapy session, I typically conduct a verbal anamnesis to get an overview of the client’s current life situation and biography. At this stage, clients often tend to normalize and downplay their experiences. New information often surfaces during the course of therapy. At some point during the initial phase, I almost always implement three psychodramatic exercises: a figurative depiction of the assessment situation on the table stage, a physical simulation of stopping distances, and a role play of the assessment. In my experience, these three exercises have proven highly effective for establishing a therapeutic alliance as well as getting clients to actively participate in the therapeutic process and confront problematic aspects of their behavior.
Session 1: Figurative depiction of the assessment on the table stage
During the first session, I almost always have clients conduct a short figurative exercise on the table stage. This exercise establishes the basis for a therapeutic alliance. The exercise lends clients some insight into the complexity of the assessment situation and makes it possible for the client and therapist to formulate a therapeutic goal.
- Therapist: In her report, the examiner recommended that you complete at least 10 sessions of traffic therapy. Do you understand why?
- Client: No, I don’t get it. This is such a scam!
- Therapist: I’m going to try to explain how it got to this point. I am going to use these two figures (therapist takes out a box full of play figures, see Figure 1). The queen here is the examiner. Her job is to find out whether a person is going to follow the rules and obey the speed limit in the future. (Therapist puts the queen figure on the table.) The figure here, the caveman with the club, this is you as the offender: you do what you think is right, even when you are driving much too fast. You think you have everything under control. (The therapist puts the caveman figure on the table.) And this is you in another role. (The therapist puts a figure of a man in a suit on the table.) You showed the examiner your best side, and said what people in such a situation are supposed to say: “I won’t ever do it again! It was just a stupid mistake!” or maybe, “I don’t know what happened, it’s not like me at all! You can forget about that caveman back there!”
- Therapist: What do you think, does the examiner believe the gentleman?
- Client: Pugh, how should I know…
- Therapist: I don’t think she does. She’s heard the same excuses, the same promises a thousand timesbefore. No, that’s not what she wants to hear. (Therapist places the two client figures side-by-side.) The examiner doesn’t want to just see this gentleman here. She also wants to see the caveman. She wants to hear how this fine young gentleman, with all his skills and positive qualities, could sometimes turn into a driving caveman. Do you get what I am trying to say?
- Client (smirking): You’re right, it was just like that, I thought I was showing her my best side. Therapist: And now I come on the scene. (Therapist places a fourth figure on the table, see Figure 2). This is me as the therapist. My job is to get you to think about your driving behavior and get you to see things from a different perspective.
The therapist can use this figurative exercise to delve into whatever themes are most relevant for the particular client. One highly relevant theme for this particular client was his perception that he was being unfairly punished, as illustrated by assertions such as “Other people drive much more dangerously than me!” or “I’m being treated like a criminal!
- Therapist: Yes, you might be right. (Points to the therapist figure.) But what do you expect the therapist to do? Should he give the traffic offender a pat on the back? (Points to the caveman figure.) Should he say, “Oh poor you! It’s so unfair! The laws are ridiculous!” (Points to the suited figure.) Would that help him to pass the next assessment?
- Client: No, that’s not what I meant …no, that wouldn’t do any good.
- Therapist: Exactly, you got it, it wouldn’t help. (Points to the therapist figure.) The job of this fellow here is to offer a counter position, ask cheeky questions, provoke, get the offender thinking. The goal of traffic therapy is to have both the caveman and the gentleman present at the next assessment, and to have this fine young man here tell the examiner why the caveman was able to take over the wheel, and how he’ll make sure that he manages himself better in the future.
- Session 2: Physical simulation of stopping distances
One of the goals of therapy with this particular client was to get him to appreciate the risks associated with driving even slightly over the speed limit. The following simulation exercise encouraged the client to actively confront and reflect upon the potential consequences of his behavior.
The therapist leads the client to the sidewalk outside the practice. On the way, the therapist asks the client about any children or young people in his social network. The client reveals that he has a five-year old niece (his sister’s daughter).
- Therapist: Let’s imagine that the sidewalk is the road. You are in your car – what kind of car do you drive?
- Client: An Audi 5.
- Therapist: Great, then let’s imagine you are here in your Audi. You’re driving through a town; the speed limit is 50 km/h. Now we are going to simulate a risky situation: suddenly a child appears in the street. Let’s say it’s a five-year-old girl, like your niece. What’s her name?
- Client: Aurelia.
- Therapist: Let’s imagine that Aurelia unexpectedly runs out onto the street. You are driving at the speed limit: 50 km/h. Your reaction time – that is, the time between you seeing the girl and you stepping on the brake—is at least 1 second. Do you know how much distance you cover in one second, travelling at a speed of 50 km/h?
- Client: 10 meters?
- Therapist: Not bad – if the street is dry and your tires are good, you would go about 14 meters. I have a tape measurer here – let me measure out those 14 meters. (Therapist measures out 14 meters and calls the client over.) We started at that post. This distance here – we’ll call it the reaction distance – is the distance you in your car would cover in 1 second travelling at 50 km/h. Where we are standing now is where you begin to brake. What do you think, how long is the braking distance at 50 km/h, that is, how much distance you would cover before your car came to a complete stop?
- Client: Maybe 5 to 6 meters?
- Therapist: On a dry street it’s 11. Let’s use my tape measurer to measure out the braking distance, too. (Therapist walks out 11 meters and calls the client over). Where we are standing now is where your car comes to a complete stop. We’ll call the whole distance the stopping distance. That’s the reaction distance plus the braking distance. At 50 km/h the stopping distance is 25 meters. And this time we get lucky: let’s imagine that Aurelia is standing exactly here (Therapist places an object on the sidewalk to mark her position) and your car stops just in time. Aurelia doesn’t get hurt. Lucky break, huh?
- Client: Yeah, nothing bad happened this time either.
- Therapist: And now let’s do the same thing for a speed of 60 km/h.
The therapist and client go back to the starting position and follow the same procedure assuming a speed of 60 km/h. The exercise demonstrates that, at 60 km/h, the car would hit Aurelia at a speed of about 40 km/h. (For reaction and-braking distances at different speeds, see e.g., https://www.qld.gov.au/transport/safety/road-safety/driving-safely/stopping-distances
- Therapist: You would hit Aurelia at a speed of 40 kmh. How do react to that?
- Client: I didn’t realize what a difference 10 km/h would make …I’m shocked.
- Therapist: You’re not the only one …few drivers really have a good understanding of stopping distances, not even Aurelia’s uncle. Let’s imagine that you, as Aurelia’s uncle, now have to explain to your sister that you just didn’t realize that 10 km/h would make such a big difference…
The therapist gives the client an information sheet about stopping distances at different speeds. A discussion of the risks associated with different degrees of speeding ensues.
Physically simulating stopping distances is especially effective when the imagined victim is someone close to the client. How other dangerous driving behaviors (e.g. driving while intoxicated) affect stopping distances can also besimulated as part of the same exercise. I typically first have the client map out the actual, one-to-one reaction and braking distances outside; later on, I may ask the client to repeat the simulation on the table stage using play cars and figures. It is also possible just to conduct the exercise on the table stage in settings where mapping out the actual distances would be impossible.
Session 3: Role play of the assessment
The third session focuses on the legal basis for revoking a person’s driving license. First, I present clients with information sheets that clearly differentiate between minor, moderate, and severe traffic violations and the legal ramifications associated with each level of offense. Clients should expand their knowledge of traffic regulations and acknowledge that losing their license was part of a transparent and clearly-defined rule system. In a second step, clients are asked to apply their new knowledge during a role play of the assessment situation. The exercise constitutes a corrective emotional experience: in the role play, clients are able to experience the assessment in waysthat contradict their previous, negative understanding.
- Therapist: (Therapist positions two chairs.) I’m going to set up two chairs: this here is the examiner’s chair, and this here is the traffic offender’s chair. Of course, there are other things in the room – a table, a computer – but let’s just forget about the rest for now. Now we have a situation more or less like what you experienced.
- Client: Yes.
- Therapist: Now I would like you to stand up and position yourself behind the offender’s chair. (Therapist and client stand behind the chair.) Would you tell me what this person here is thinking? What is he feeling? What does he want?
- Client: I want my license back.
- Therapist: Sure, he wants his license back. And what is he thinking, what is he feeling?
- Client: This is bullshit. I don’t have a mental problem. This is…it’s just completely ridiculous.
- Therapist: Very good, thank you. Now let’s go and stand behind the other chair. (Therapist und client position themselves behind the examiner’s chair.) The examiner reads in the file: got license in June 2017 – first major offense in July 2018 resulting in a three-month suspension – September 2018 another major offense, license revoked. What does the examiner think when she reads this? What does she expect the offender to do?
- Client: No clue.
- Therapist: Yes, it’s hard to imagine. Let me help you. Maybe the examiner is thinking: Is this one of those people who’s never going to change, no matter what?
- Client: From the outside it might seem like that (briefly pauses) …but it’s not like it was dangerous…I didn’t cause an accident.
- Therapist: Great, that’s enough. Let’s go back to our discussion chairs.
During the ensuing discussion, the therapist refers to the stopping distance simulation exercise from the second session. The therapist encourages the client to develop a new awareness of risk and safety. During the discussion, the role play chairs remain where they are. The therapist refers to them as needed, for example:
- Therapist: (Points to the empty chair of the offender.) That person is saying “But I didn’t cause an accident!” Can you imagine what the examiner is thinking when she hears that? (Therapist points to the empty chair of the examiner.)
- Client: Maybe she is thinking: it’s fine, he’s got everything under control.
- Therapist: And does she believe that he’s got everything under control? Or does she maybe think that hedoesn’t really appreciate the dangers and risks involved? In your assessment report it says: “Tendency to downplay and normalize behavior.”
- Client: That’s rubbish…I’ve never had an accident!
- Therapist: So, in your mind the examiner (points toward the empty chair of the examiner) should just wave through anyone who has never had an accident?
The therapist now engages the client in a confrontational discussion. The aim of the conversation is to reveal the client’s dysfunctional cognitions and encourage the client to re-evaluate how he perceives himself and the situation. By referring to the two empty chairs and speaking in the third-person, the therapist is able to assertively confront the client while leaving room for playful provocation and humor, and without endangering the therapeutic alliance.
The procedure of the individual phase of traffic therapy differs greatly from client to client. Generally, the sessions revolve around therapeutic discussion with elements of traffic-related psychoeducation and encouraging the client to re-evaluate his or her understanding of the offence (see Raithel & Widmer 2012). Encouraging safer driving behavior often necessitates addressing aspects of the client’s biography and personality which may at least initially seem peripheral to the offense. To ensure adherence to the therapist-client agreement, it is imperative that therapists make it explicitly clear how each addressed topic is related to the client’s driving behavior, at the end of the session at the latest.
I generally begin the individual phase of traffic therapy by asking clients questions about what it was like growing up, their educational experiences, family, and social setting. In my work with the case client, I implemented two psychodramatic exercises: role play of a scene from the client’s past, and role play of finding out that his driver’s license had been revoked. The goal of the exercises was to help the client be able to relate his experiences andmotivation to his physical body, values, biography and current life circumstances.
In response to the therapist’s questions, the case client explains how and why he came to Switzerland when he was 12 years old, and how he coped with this major life change. The therapist asks the client to describe a scene, a vivid memory from this period. The client describes being in the schoolyard of his new school. There he was primarily on his own. He didn’t understand the other kids and he didn’t want anyone to tease or to feel sorry for him. The therapist invites the client to act out the scene in a short role play.
Session 5: Role play of a scene from the client’s past
- Therapist: Please stand up and show me what it looked like. Show me exactly how this young man, theyoung Boris, was standing. Let’s imagine that this is the schoolyard. (Therapist points to a corner of the room). Where is Boris standing?
- Client: (Points to a particular spot.) Here.
- Therapist: Then please go over and stand there as 12-year-old Boris. You are now young Boris in the schoolyard. Now position your body just as you remember – just like how the young Boris was standing in the schoolyard.
- Client adjusts his position; his chin is slightly uplifted, his gaze is straight ahead, his left hand is flat against his chest, his right hand is by his side, balled into a fist.
- Therapist: That’s perfect, thank you. Now step out of the scene, you are here again and not in the schoolyard anymore. Come over to me and let’s take another look at this scene.
The therapist and client now stand at the edge of the room stage and discuss the role play. The therapist questions the client about the meaning of the hand on the chest, and what feelings he associates with it. The therapist then asks about the meaning of the fist. To help the client trace the meanings and feelings associated with each gesture, he has the client briefly step back into the role several times throughout the discussion. The client does not associate the hand on the chest with any special meaning; to him, the fist represents his assertiveness. The therapist offers asomewhat different interpretation of the two gestures. The therapist and client then return to the discussion chairs and discuss the relevance of the scene for healthy personality development. The themes of stress, burden and resilienceare addressed. The therapist refers to the schoolyard scene throughout the discussion.
Session 6: Role play of finding out that license had been revoked
During the sixth session, the client often plays the role of a victim and reiterates how losing his license was the worst thing that had ever happened to him. The therapist expresses his wonder:
- Therapist: Do I understand correctly that losing your license was worse than your parents’ absence, moving to Switzerland, having to start school in a foreign country and everything else you have experienced?
- Client: Yes, it’s completely demeaning. My car means everything to me. It’s my life. I lost my job because I have no license. And I can barely go out with my girlfriend anymore. I just can’t understand why they would do this to me.
- Therapist: Oh…I’m surprised to hear that, after everything we observed and talked about in the lastsession. Help me to understand: I need to be able to picture it. Can you show me what it was like when you found out that you had lost your license?
- Client: What do you mean?
- Therapist: Where were you when you read the letter telling you that your license had been revoked?
- Client: At home.
- Therapist: Where exactly?
- Client: At the kitchen table. In the kitchen, sitting at the table, the letter is on the table.
- Therapist: That’s what I want to see. Let’s imagine that this here is the kitchen (therapist positions a chair) and here you are sitting in this moment, the letter is on the table in front of you. Please take a seat on this chair and show me what this moment looks like: the moment you realize that you are no longer allowed to drive.
The therapist recognizes a number of similarities between this role and the role of the young man in the schoolyard from Session 5. The therapist asks the client to step out of the role and come back to his discussion chair.
The goal of the conclusion phase of therapy is to review and reinforce what the client has learned. In my work with the case client, I used two psychodramatic sequences — a figurative depiction and a short role play — to reinforce his adapted understanding of his driving behavior.
Session 9: Figurative depiction of the assessment with focus on the examiner and interest groups
The goal of the figurative exercise was to help the client to better recognize the logic of traffic laws as well as some of his own dysfunctional thoughts and behaviors by considering them from multiple perspectives.
- Therapist: Today I would like to come back to the assessment, but this time we are going to focus on the examiner’s role. What pressures, what demands and expectations does he or she face? Evaluating someone one-on-one is no easy situation — lots of people have a stake in the outcome and want to have a say in how things proceed. I want to use figures to demonstrate what I mean here on the table. (Therapist takes out a box with play figures.) I’m going to use the same examiner figure and the two figures of the traffic offender that we used in our first session together. (Therapist puts the three figures on the table and takes out a jar filled with spools of thread.) And now I am going to use these spools of thread to represent the authorities and all of the other groups of people that have specific expectations about the assessment process.
In cooperation with the client, the therapist places a number of spools of thread behind and next to the examiner-figure to symbolize all of the different authorities, organizations and groups with a stake in the outcome and quality of the assessment process. In a first step, the therapist plays the roles of the interested parties, verbalizing their particular demands and expectations. Later on, the client takes over.
Sessions 9 and 10: Role play of the upcoming assessment
As a final step in the therapeutic process, clients once again simulate the assessment as in Session 3. The exercise offers clients the opportunity to recognize how they may have changed during the course of therapy and also practice for the upcoming assessment. The exercise thus constitutes a sort of role training. Clients should adequately recognize and evaluate their own mental state (e.g., mood, intentions, goals), articulate their new functionalcognitions, and appreciate the examiner’s perspective. Typically, role training exercises are used to help clients improve their social competencies by modelling appropriate behavior (see e.g., Dumpert & Schaller 2017 and Schaller 2019 for details on role training methods). The aim of this role training exercise, however, is to help clients authentically describe their therapeutic process to the examiner in their own words. Therapists should therefore refrain from actively performing the roles themselves.
- Therapist: (positioning two chairs.) I am going to place two chairs here again. Would you please stand up and sit on the examiner’s chair?
- Client takes a seat on the examiner’s chair.
- Therapist: You are the examiner. You already know the offender from the first assessment. Let’s imaginethat he is sitting there. He has completed 10 hours of traffic therapy with Mr. Schaller. What do you, the examiner, want to ask him? How can you find out whether he has really reflected about what happened?
- Client: I would ask him what he had learned.
- Therapist: Yes, very good, just ask him straight-out. He’s sitting on this chair, go ahead and ask him.
- Client: You’ve had 10 hours of traffic therapy, what have you learned?
- Therapist: Perfect! Now please come over to this chair. Now you’re the one being assessed. You are playing yourself in this future situation.
- Client moves to the other chair.
- Therapist: Please answer the examiner’s question: What have you learned?
- Client: I’ve learned that speeding is dangerous.
- Therapist: Oh…step out of the role and come over to me. Let’s look at this from the perspective of both chairs. (Client joins the therapist at the edge of the stage.) Let’s imagine this dialogue: “What have you learned?” and the answer: “Speeding is dangerous.” That doesn’t seem very convincing to me. Too good to be true, like something learned by rote at school, don’t you think?
The client plays the roles of the offender and examiner again and again. The therapist interrupts and asks the client to examine the scene from the director’s perspective at the edge of the stage as necessary. The therapist and client can also interrupt the exercise in order to return to the discussion chairs, discuss the training process and potentially adapt the role play.
Psychodramatic methods can be highly effective for getting not only traffic offenders, but also other kinds of reluctant clients, to actively participate in therapy, critically reflect on their experiences, and develop functional cognitions and behaviors. The course of traffic therapy described in this article began after the client committed a major traffic violation as a requirement for getting his license reinstated. At the beginning of the therapy, the client’s only goal was to get his license back; he had no explicit intention of following traffic regulations in the future. During the course of the therapeutic process, he made an important step: he recognized the sense of traffic laws and formed an intention to adhere to them.
- Dumpert, H.D. & Schaller, R. (2017): Rollenspiel – Techniken der Verhaltenstherapie [Role Play: Techniques from Behavioral Therapy]. Weinheim: Beltz
- Lamberger, A. (2016). Psychodrama-Techniken in verkehrspsychologischen Nachschulungskursen [Using Psychodramatic Techniques in Driver Re-training Courses]. Saarbrücken: AV Akademikerverlag
- Raithel, J. & Widmer, A. (2012). Deviantes Verkehrsverhalten – Grundlagen, Diagnostik und verkehrspsychologische Therapie [Deviant Driving Behavior: Fundamentals, Diagnosis, and Traffic Therapy]. Göttingen: Hogrefe
- Schaller, R. (2017). Regiegespräch – die zentrale Technik für das Psychodrama im Einzelsetting [Director’s Talk: the central technique in individual psychodrama]. Zeitschrift für Psychodrama und Soziometrie, 2: 223-233. doi: 10.1007/s11620–017–0393–x
- Schaller, R. (2019). Imagine You Are… Role Play in Individual Therapy, Counselling and Coaching. Lulu.