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The meaning of change through therapeutic enactment in psychodrama Brooks, Dale Theodore 1999

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THE MEANING OF CHANGE THROUGH THERAPEUTIC ENACTMENT IN PSYCHODRAMA by DALE T. BROOKS B.A. Simon Fraser University, 1986 M.A. University of British Columbia, 1991 A THESIS SUBMITTED IN PARTIAL FULFILLMENT OF THE REQUIREMENTS FOR THE DEGREE OF DOCTOR OF PHILOSOPHY in THE FACULTY OF GRADUATE STUDIES (Department of Counselling Psychology) We accept this thesis as conforming )^ ^ e^jjjulred standard ( THE UNIVERSITY OF BRITISH COLUMBIA December, 1998 © Dale Theodore Brooks, 1998 In presenting this thesis in partial fulfilment of the requirements for an advanced degree at the University of British Columbia, I agree that the Library shall make it freely available for reference and study. I further agree that permission for extensive copying of this thesis for scholarly purposes may be granted by the head of my department or by his or her representatives. It is understood that copying or publication of this thesis for financial gain shall not be allowed without my written permission. D E - 6 (2/88) 11 ABSTRACT The purpose of this study was to understand the meaning of change through therapeutic enactment in psychodrama. Existential and hermeneutic phenomenology conducted from the perspective of a dialectic between storied narrative and thematic analysis was used to investigate the essential meaning of the experience. Eight co-researchers who had experienced significant change through therapeutic enactment in psychodrama were interviewed in depth. Transcripts from these interviews were transposed into narrative form in order to straighten the story of change through enactment in a before, during, and after sequence. These eight individual narratives were validated by the co-researchers. An independent reviewer checked each narrative against the original transcript, video tapes of the enactments, and comments of each co-researcher for trustworthiness. Each validated narrative provided a rich description of the lived experience of change through therapeutic enactment. In addition, fifty-nine (59) essential themes were formulated from the individual narratives: Fourteen (14) in the planning stage, twenty-four (24) in the enactive stage, and twenty-one (21) in the reflective, or integrative stage, of the enactment process. These themes were then woven into a common story representing the pattern and meaning of change through therapeutic enactment for this group of co-researchers. Finally, notations made during the transposing of the transcripts into personal narratives, formulation of the essential themes, and construction of the common story were used to develop a theoretical story of change through therapeutic enactment, as a final level of hermeneutic interpretation. This theoretical story was then presented in summary form as a thematic sequence of multi-modal change processes representing a model of change through therapeutic enactment. Ul The results of this study suggested numerous theoretical and technical implications. Foremost among theoretical implications was the suggestion that Tomkins (1992) script theory of affect may best illuminate the effects and processes of psychodrama and enactment. This study also had implications for interactional theories of development, contemporary psychoanalytic theories of interpersonal functioning, theories of moral development, theories of dream functioning, and ethological theories of myth and ritual. The results of this study also suggested a number of additional qualitative and comparative outcome studies for future research. iv TABLE OF CONTENTS ABSTRACT i i TABLE OF CONTENTS iv ACKNOWLEDGMENTS vi i i CHAPTER ONE: INTRODUCTION 1 Purpose of the Study 1 The Research Problem 1 Background to the Study 3 The Research Problem Situated Practically and Conceptually 3 Enactment as the Clear link Between Theory and Practice 6 The Research Question 8 Rationale 9 The Research Strategy 10 The Research Product 12 CHAPTER TWO: LITERATURE REVIEW 13 Introduction 13 Relevant Psychodramatic Literature 14 Moreno's Views 14 Blatner's Views 21 Goldman and Morrison's Psychodramatic Spiral 32 Hollander's Psychodrama Curve 35 Relevant Psychodrama Research 36 Hofrichter's Study 39 Buell's Study 41 Del Nuovo, Spielberg, & Gillis's Study 42 Marten's Study 44 Baum's Study 47 Articles on Enactment in Psychodrama 52 Battegay's View of Enactment in Psychodrama 52 Holmes View of Enactment in Psychodrama 54 Enactment in Therapies Other than Psychodrama 55 Gilbert's Study 56 Kipper's Behavior Simulation Model 58 Psychoanalytic Literature Relevant to Enactment 61 Freud's Discovery of Remembering Through Action 62 Bowman's Compiled Definitions of Acting Out and Enactment 67 Roughton's Differentiated View of Enactment 70 Eagle's View of Change Through Enactment Without Awareness 73 Weiss & Sampson's View of Enactment as Testing Pathogenic 75 Beliefs Stern on the Dialectic Between Action and Representation in 77 Enactment Stolorow's View of Enactment as Concretization of Organizing 79 Principles Enactment Informed by Tomkin's Theory of Emotion 82 Summary of Tomkin's Relevance 100 Enactment Informed by Burkert's View of Myth and Ritual 100 Conclusion Upon Review of the Literature 110 Approach to the Present Study 111 Existential-Phenomenology 113 Hermeneutic Phenomenology 116 Narrative Research 128 Summary of Approach to the Study 137 CHAPTER THREE: METHODOLOGY 138 Introduction 138 Explication of Presuppositions 140 Co-researcher's in the Study 143 Interview 144 Analysis 153 CHAPTER FOUR: RESULTS 159 Personal Narratives 159 Personal Narrative for Co-researcher One 159 Co-researcher Review 173 Independent Review 173 Personal Narrative for Co-researcher Two 174 Co-researcher Review 179 Independent Review 179 Personal Narrative for Co-researcher Three 181 Co-researcher Review 190 Independent Review 190 vi Personal Narrative for Co-researcher Four 191 Co-researcher Review 198 Independent Review 198 Personal Narrative for Co-researcher Five 199 Co-researcher Review 209 Independent Review 209 Personal Narrative for Co-researcher Six 211 Co-researcher Review 216 Independent Review 216 Personal Narrative for Co-researcher Seven 217 Co-researcher Review 224 Independent Review 224 Personal Narrative for Co-researcher Eight 225 Co-researcher Review 230 Independent Review 230 CHAPTER FIVE: RESULTS 232 Common Themes, Common Story, Theoretical Story 232 Before the Enactment 234 Themes Characteristic ofthe Planning Stage 234 During The Enactment 254 Themes Characteristic of the Enactive Stage 254 After the Enactment 307 Themes Characteristic of the Reflective Stage 307 Context for Viewing the Common Story 353 The Common Story 355 The Desire to Return to Interaction 355 The Active Center 360 The Representational Basis of Change 370 Context for Viewing the Theoretical Story 379 The Theoretical Story 381 Therapeutic Enactment: Core Change Processes 392 CHAPTER SIX: DISCUSSION 393 Introduction 393 Limitations 394 Implications for Theory 395 Implications for Practice 415 Implications for Future Research 417 Summary 419 REFERENCES 421 APPENDIX A 430 Consent Form 431 APPENDIX B 432 Description of Psychodrama as the Research Context. 433 Vlll ACKNOWLEDGMENTS I would like to thank my family for their extraordinary patience and support throughout this project. Particular mention goes to my brother Wayne, who manned the barbecue when I was too busy to feed myself, and to my mother Betty, for her tireless support with my son Gabriel. I would also like to thank Gabriel for his frequent understanding reminder; "Dad shouldn't you be working on your doctor book". I want to thank Dr. Larry Cochran, my research supervisor, for the constant inspiration of his own body of work that has guided me as a standard of excellence for what qualitative research can produce. I also want to thank Dr. Jamie Wallin for agreeing to sit on my supervisory committee and his thoughtful listening, and, I want to thank Dr. Marv Westwood for his years of unfailing support, personal encouragement, and thoughtful guidance. Special appreciation goes to the co-researchers who made this project possible. Their courage and trust in revealing themselves as deeply as they did is something I will always respect and be thankful for. It is an honor to dedicate this document to them and their honest desire to contribute to understanding through the showing, feeling, and telling of their personal struggles with some of the most difficult issues in life. 1 CHAPTER 1 INTRODUCTION Purpose of the Study This study investigated the meaning of change through therapeutic enactment as it occurred in the context of psychodrama, an action based therapy. The study was undertaken in order to illuminate both the theory and practice of psychodrama as well as the nature of enactment itself as a change process. In order to do this eight (8) narratives were produced from interviews of psychodrama participants examining their in-depth experience of change through enactment. From these narratives a common pattern of experience was extracted which has theoretical and clinical implications for both the practice of psychodrama and the development of a model of change through therapeutic enactment grounded in lived experience. The Research Problem Psychodrama is a therapy that emphasizes the utilization of physical action through enactment to achieve therapeutic ends (Fine, 1979). Since its development by Moreno practitioners and participants alike have consistently reported substantial results anecdotally (Blatner & Blatner, 1984; Greenberg, 1974; Kellerman, 1991; Moreno, 1946; Moreno & Moreno, 1969; Westwood & Wilensky, 1997). At the same time a relatively small body of research has supported the ability of enactment-based psychodrama to produce positive outcomes (Baum, 1994; Buell, 1995; Hofrichter, 1973; DelNuovo, 1978; Gilbert, 1992; Kellerman, 1987; Martens, 1990). In addition to outcome studies any therapeutic modality requires a model of change substantiated through research in order to develop credibility and grow in acceptance, use, and 2 areas of application (Goldfried, Castonguay & Safran 1992). No such model of change currently exists in the psychodrama literature rendering discussion, even between practitioners of psychodrama, suspect in terms of wondering if agreed upon constructs, processes and procedures are being referred to. Kipper (1978) has spoken to this point claiming there has been lack of consistent use of definitions in psychodrama research. Kellerman (1987) has stated there is no agreed upon definition of psychodrama itself, leaving consensus about a model of change difficult to approach. This conceptual ambiguity combined with the lack of a clear model of change led D'Amato and Dean (1988) to go so far as to describe psychodrama as "an arrested modality". This particular statement has stood in stark contrast with my own experience of psychodrama over many years as both a participant and practitioner. I have found psychodrama to be anything but arrested in its ability to generate effective and time-efficient change on many levels. I have seen psychodramatic enactments produce immediate behavioral change as well as derivatives of the process which persist for many years with positive utility. For example, dreams derived from enactments often stand as guides for decision and action long past the psychodrama itself, and, memories of significant aspects of enactments are commonly referenced after a psychodrama as strength anchors supporting new behaviors. Above all, it has been this tension between my own experience of enactment-based psychodrama as a potent therapeutic modality, and the literature's admission of its inability to adequately describe this change, that has shaped the research problem addressed here. In response, this study was designed and conducted to understand the meaning and pattern of change through enactment in psychodrama by focusing on the in-depth experience of participants 3 in the process. Background To The Study: The Research Problem Situated Practically and Conceptually As soon as one begins to contemplate researching any human activity issues of praxis immediately arise. Often there is a forced trade-off between the richness of a study and the practicality of conducting it as the research focus increases in complexity (Howard, 1986). This issue is particularly germane to the study of psychodrama because it takes as its inherent focus complex social-emotional states and interactions while insisting that they be in constant dynamic flux. This can create a situation where the more one tries to grab a handful of this river in order to get to know it the more one wonders what they have actually grasped. The suggestion that this complexity can be ovemhelrning is best exemplified in the rather dramatic words of the founder himself. Moreno states that psychodrama intends "to use life as a model, to integrate into the therapeutic setting all the modalities of living - beginning with the universals of time, space, reality, and the cosmos...and moving down to all the details and nuances of life" (Moreno, 1971). This description leaves little for the concerned researcher to disregard while creating some anxiety over what to value as a starting place. In fact, researchers of psychodrama have often been put off as they come to this realization. Both Baum (1994) and Kipper (1978) have offered that the difficulties of researching psychodrama are a function of the complexity of its processes. In my own talks on psychodrama I have described it as utilizing change processes ranging from the sensori-motor to the mythic as a matter of course in a single session (Brooks, 1998). I believe this is in fact the case, and have difficulty thinking of a change process that has not been active in psychodrama. The point is, this 4 is clearly a rich process, but how and where to start practically to study it in a way that would adequately capture this essential richness has been, perhaps, the central research problem in psychodrama. Balancing practicality with complexity in the approach to any problem can only be done through critical conceptualization. If one asks what are the pivotal concepts/events which account for most of the complexity while remaining accessible to inquiry one moves towards situating themselves at a practical and productive research site. This search for a construct/event with enough centrality, inclusiveness and accessibility to serve as a site for investigation of psychodrama has produced several candidates including 'catharsis', 'spontaneity', and 'role' (Gilbert, 1992; Blatner; 1996). The most inclusive and promising of these has been 'role' beginning with Moreno's focus on role theory (Moreno, 1946). Moreno developed psychodrama because he wanted a therapeutic modality that matched the complexity of human life itself. In order to validate psychodrama's ability to do this he moved toward the construct of role, which he believed, had a high enough ordering power to serve as a bridging concept that integrated both objective and subjective aspects of experience. In his words (1946) role "is a unit of synthetic experience into which private, social, and cultural elements have merged". By making role, a unit of psychosocial interaction, the central organizing concept in psychodrama Moreno takes an inherently holistic and integrative position towards the various processes involved in the complexity of human change. Role and role dynamics were seen as up to the task of adequately mirroring the complexity of human change both in life and in psychodrama. This view of role theory as pivotal has become established in the psychodrama literature. 5 Kellerman (1991) for example, views role as the nexus of "covert and overt experience, of interiority and exteriority, of behavioral and existential thinking" and sees it as giving Moreno's theory and technique their potential power not only as a therapeutic modality but also as a theory of integrative psychotherapy. However, he also sees this power as still undeveloped due to haphazard focus on psychodramatic technique at the expense of rigorous theory building. Blatner (1991) similarly views role as a construct adequate to the complexity of human change and calls for theoretical development of Moreno's views on role theory in a direction even wider than that of Kellerman. He proposes a conception of "role dynamics" that serves not only as a theoretical basis for psychodrama "but also for an eclectic approach to...general psychology". Blatner (1991) suggests that "simply stated, role dynamics is a language for general psychology. It describes psychosocial phenomena in terms of the various roles and role components being played, how they are defined, and, most important how they can be redefined, renegotiated, revised, and actively manipulated as a part of interpersonal interaction". So much said, the construct of role has clearly promised much towards understanding the complexity of change processes in psychodrama. However, despite this agreement on the utility of role theory for understanding the complex processes in psychodrama, it is also agreed that there has been a failure to develop the significance of this in terms of research and theory-building. While both Kellerman (1991) and Blatner (1991) explain this lack of fecundity on the basis of inadequate systematization of psychodramatic role theory, Kipper (1991) offers what I think is the more cogent and specific reason, even after the complexity of psychodrama has been taken into account. He suggests that the limited state of development of psychodramatic and related role theory is directly related "to 6 the relative lack of a clear connection between theory and clinical practice". In response, Kipper (1991) calls for studies that "contribute toward narrowing the gap between role theory and practice" rather than further speculations about role dynamics. This may be seen as the starting point ofthe study undertaken here which tries to balance practicality with richness by situating itself on enactment as the critical bridging construct in psychodrama. The underlying premise of this research is that the facet of roles that most practically and inclusively links psychodramatic role theory and clinical practice in an accessible way is the construct of enactment itself. This is worth brief discussion as the basic assumption of this study. Enactment as the Clear Link Between Psychodramatic Theory and Practice Enactment for purposes of this study is defined as the concretization of a role-representation. Any role as "a unit of synthetic experience" in Moreno's words, is comprised in the abstract of cognitive and emotional expectations, self and object images, representations of interpersonal behavioral sequences, and so on, all varying in degrees of situational specificity or generality. In this sense role perse refers to the mental script for a set of psychosocial interactions and meanings, any part of which may or may not be enacted in a particular situation at a particular time (Tomkins, 1962). A role in this description is only a potentiality until it is role-played or enacted. In this way enactment is the bringing into psychosocial reality, or the concretization, of abstract role-representations by a specific person with specific others in a specific situation. In this view every generalized role-representation can have a unique concretization for each existential actor where, for example, the role of student has a generalized meaning for all at the level of an abstract cultural script, but will also have a unique existential 7 reality for each individual who enacts, or concretizes it, in the lived experience of their own situation. There is no necessary one-to-one relationship between a person's conception of a role, or role-representation, and their enactment of that role in a concrete situation. This means that there are as many degrees of freedom as there are people and situations in which to bring roles forward. This is because a situation may not afford all the possibilities encoded in a persons's role-representation; and, role-representations may be inadequate to the reality of the situation. In other words, role dynamics emerge from the fact that one's role-repertoire and reality are never completely matched. In either event, because 'roles' are only concretely present in the actualization of enactment the critical focus of study for understanding how they function and change , whether in the clinical reality of psychodrama or life, becomes the lived experience of psychosocial interactions that comprise enactment; not speculation about abstract contents or processes, which is a different order of investigation equivalent to a metapsychological level of psychodramatic theory. The practical place to start towards a model of change for psychodrama, this study contends, is the domain of experienced actions and meanings associated with the process of enactment understood as the concretization of role-representations. The study is situated in the experience of enactment because it can logically preserve much of the complexity of change through psychodrama as well as move towards clarifying links between theory and clinical practice. For purposes of this study an additional qualification of the construct of enactment is 8 required. This study focuses on investigating the meaning of change through therapeutic enactment. The adjective 'therapeutic' is meant to distinguish the intentional and conscious use of enactment for therapeutic ends from the study of the unintentional and unconscious manifestations of enactments as they arise in the course of therapies. This latter focus is a subject of recent interest in psychodynamic theory and is often considered in the context of understanding complex transference and counter-transference interactions (Ellman & Moskowitz, 1998). Unconscious enactment is not the main focus of this study although it is revealed as an active dimension of therapeutic enactment. The developing literature dealing with unconscious enactment, some of which will be considered in the review below, can shed light on understanding therapeutic enactment but is not the whole story of the same. By making therapeutic enactment the main focus of this study it is assumed that this investigation may be able to extend and complement in a new way the theoretical and clinical understanding of unconscious enactment. This study hopes to develop an understanding the conscious uses of enactment that can be set beside the understanding of its unconscious functioning in order to reveal a more complete phenomenon. (See Appendix B for a description of psychodrama as the research context). Research Question Based on the assumption that the lived experience of therapeutic enactment may be the most pivotal and revealing process to investigate in order to further understanding of how psychodrama produces change a research question was formed. Specifically, 'What is the meaning of change as experienced through therapeutic enactment in psychodrama?' In order to answer this question, participants in psychodrama workshops who felt they had undergone change through their enactments were asked to describe their experience in detail. 9 Rationale There are several significant reasons for investigating the experience of change through enactment in psychodrama. First, as already mentioned, those exposed to psychodrama have tended to regularly find it an effective therapy that facilitates change on many levels. However, definitional ambiguity and lack of a clear model of change have limited its wider acceptance, development and application. In reaction, this study was designed to examine change through therapeutic enactment in psychodrama which was grounded in the experience of those participating in it. This was done in order to develop a more accurate description of the essential processes involved. Therefore, the results of this study will have direct importance for more adequate theory-building related to enactment-based psychodrama. Second, practitioners and participants alike tend to find psychodrama a time-efficient therapy. Results of this study have already suggested that psychodrama is best described as a brief multi-modal therapy (Brooks, 1998). In today's social-economic climate the increasing trend is towards shorter, more cost-efficient and accountable therapies. This study suggests that psychodrama may be particularly able to meet these criteria because it is short and therefore cost-efficient, and, it offers accountability through its built in levels of debriefing and follow-up within a communal setting. Third, as suggested above psychodrama does not own the processes of enactment it simply emphasizes its conscious use. Enactment processes are present in varying degrees in other contexts and therapies (Bowman, 1994). While the findings of a qualitative study cannot be generalized from with reliability, the findings of this study may suggest ways to complement understanding of enactment in other contexts and therapies. 10 Finally, the findings of this study will have direct practical application to the practice of enactment-based psychodrama. Practitioners are continually looking for ways to use psychodrama more effectively and reliably with a wider range of participants (Westwood & Wilensky, 1998). The clinically grounded findings of this study have already provided important suggestions for the refinement and practice of psychodrama. Research Strategy This study was designed to study the in-depth lived experience of individuals who reported change through enactment in psychodrama. Because it is the essential meaning and pattern ofthe experience that is sought a qualitative hermeneutic phenomeno logical method was chosen (Van Manen, 1990). This involved detailed interviews with eight co-researchers who had undergone an experience of change through therapeutic enactment. This method was chosen because it can address complex experience in a fresh and holistic way with the goal of developing a rich description of the experience in question, in this case, the personal meanings participants associated with their enactments (Colaizzi, 1978; Giorgo, 1985, Van Manen, 1990). In Colaizzi's (1978) words the phenomeno logical approach "seeks to explicate the essence, structure, or form of both human experience and human behavior as revealed through essentially descriptive techniques including disciplined reflection." By returning to 'things in themselves' the phenomenological method aims at harvesting the "practical wisdom" that is grounded in lived experience with the phenomenon in question (Van Manen, 1990). This letting "that which shows itself be seen from itself' in Heidegger's (1962) poetic turn, allows one to develop an understanding that is more reflective of the phenomenon than other less grounded conceptions may be. 11 In Van Manen's (1990) words, "human science" based on phenomenological investigation "aims at explicating the meaning of human phenomena and at understanding the lived structures of meanings." For Van Manen (1990) the primary way of doing this is "textual reflection on the lived experiences of everyday life with the intent to increase one's thoughtfulness and practical resourcefulness." Whereas phenomenology proper orientates us to things as they are, 'hermeneutic phenomenology' aims at producing and interpreting the "texts of life" derived from thoughtful reflection on the lived experience with things in themselves. Hermeneutic phenomenology aims at the textual explication of the essence of lived experience (Van Manen, 1990). As such, its product is rigorously thoughtful text, narrative, and story grounded in human experience which attempts to mirror the structure and meaning of that experience as clearly and as free of presupposition as possible; in order to reflect understanding of a lived experience as adequately as possible. More succinctly, in Bakhtin's (1984) words, the texts of human science aim at "speaking being" and should emulate their criterion of knowledge which is "depth of insight" into that which is questioned. In this study, because the phenomenon in question is a process changing over time with a beginning, middle and end, the co-researcher's descriptions were put into narrative form This allowed the detailed descriptions to be organized in a way that more adequately reflected the reality of the time-bound process of enactment. The narrative form also allowed the individual descriptions to be more easily compared to each other in the search for common themes and patterns of experience related to change through therapeutic enactment. Once these common meanings are identified they will be integrated into a condensed and exhaustive description, that tries to capture the essential structure of their interrelation. Previous studies have shown that 12 narratives are a productive way to organize and compare individual descriptions of the same phenomenon (Chusid & Cochran, 1989; Ladd, 1992). Research Product A narrative form of hermeneutic phenomeno logical method was used in this study to produce eight in-depth accounts of change through therapeutic enactment in psychodrama. Each account was organized in narrative form and compared to all others in a search for common themes and patterns of experience. Out of this back and forth comparison the identified recurrent and significant themes were then woven into a common story of change through therapeutic enactment. In addition to the eight narrative accounts, common themes, and common story any meanings that emerged with theoretical implications were noted and collected. These formed the basis for constructing a theoretical story of therapeutic enactment which represents a model of change. The common themes, common story, and theoretical story are then discussed in relation to implications in existing literature. Technical implications for the clinical application of therapeutic enactment are also suggested. 13 CHAPTER TWO LITERATURE REVIEW Introduction The goal of this chapter is to review the literature relevant to this study. The function of a literature review is to serve as a rationale for selecting a research question and approach based on understanding the state of prior knowledge related to the question being investigated. In a hermeneutic study the emphasis in reviewing the literature is not on summarizing all substantive details of pre-existing studies or on auditing their methodological flaws, although both will be done to some extent. Rather, the emphasis is on highhghting important readings and issues that will serve as context and background meanings for later textual analysis (Van Manen, 1990; Wilson & Hutchinson, 1991). In this review literature pertaining to the key concepts of this study; 'change', 'enactment', and 'psychodrama' will be considered. Theoretical, quantitative, and qualitative approaches to these concepts will be discussed in order to justify the research question and approach, as well as establish background meanings for the purpose of creating a sensitized context for hermeneutical analysis of the textual material generated by the study. Because there is such a limited literature dealing specifically with change through enactment in psychodrama the review will be organized in the following way. First, selected literature dealing with change through psychodrama will be addressed. This material will be discussed in terms of its adequacy as an account of change in psychodrama and scmtinized for what it has to reveal about enactment as the pivotal concept of this study. This will include the limited literature dealing directly with enactment in psychodrama. Second, literature based in other therapies that use forms of enactment; for example, role play and social skills rehearsal in 14 cognitive-behavioral therapy, will be considered. Third, psychoanalytic thinking, which has historically supplemented psychodramatic theory, will be reviewed for what it can contribute to an understanding of enactment. Fourth, the work of Silvan Tomkins on script theory will be discussed as a model of emotion for understanding patterns of action in psychodrama and enactment generally. Finally, works on the relationships between ritual and myth will be looked at in terms of what they can suggest about the function of enactment not only in psychodrama, but in life and culture as well. This chapter will then conclude with a summary of the limitations in understanding change through enactment revealed in the reviewed literature, and, a restatement of the purpose of this study in light of those limitations. Relevant Psychodramatic Literature Discussion of the psychodramatic literature will focus on the theoretical work of Moreno (1964), Blatner (1996), Goldman & Morrison (1984), and Hollander (1978) who have offered models of change for psychodrama and by inference enactment. Next, relevant research studies will be considered followed by a look at articles dealing with enactment in psychodrama. Moreno's Views Jacob Moreno is one of the generation of psychological innovators whose work is best understood within the context of his personality and times. He seems to have been a truly integrative thinker by nature. He admits feeling compelled in this direction by his discomfort with approaches to human experience that were more fragmentary. He stated, "I attempted a synthesis, not only for science's sake but also in order to maintain my own mental equilibrium" (Moreno, 1951). This theme of integration is consistent throughout Moreno's work on psychodrama. He saw himself as attempting to "construct a therapeutic setting that uses life as a 15 model, to integrate into the setting all the modalities of living" (Moreno, 1971). After his death his wife, Zerka Moreno (1989), described psychodrama as a "synthesizing process, putting together many elements" where "the enactment was for Moreno...a more lifelike model" of therapy. While this elegant description of enactment has not been given enough attention, the view of psychodrama as essentially integrative persists in practice and theory today. For example, Kellerman (1991) uses the term "integrative psychodrama" to describe the ideal goal of further theoretical development of Moreno's original views. However, it is generally agreed that the promise of psychodrama as an integrative therapy and theory of therapy has not been fulfilled (D'Amato & Dean, 1988). Kellerman (1991) claims this is due to haphazard application of psychodramatic technique at the expense of theory development, while Blatner (1988) sees reasons reaching back to Moreno's personality. Both appear to be true. As well as being integrative Moreno was also flamboyant, often to the point of alienating his more conservative psychiatric colleagues. He chose as his epitaph; "Here lies the man who brought laughter back into psychiatry." This style of self-presentation and way in which he challenged his less integrative contemporaries have sometimes been credited with holding back more general acceptance of psychodrama (Blatner, 1988). It is worth noting as well, that Moreno was producing his ideas in the era of the theories of Freud and Jung; a time when psychology, philosophy, and religion were regularly discussed together. His creation of psychodrama comes out of this tradition where it was developed more as an expression of his philosophical world-view than as a therapeutic response to a circumscribed clinical problem. As a result, Moreno's writings have this grand philosophical and even 16 evangelical flavor, which sometimes obscures the practical elements of his creative contribution to therapeutic practice. This style of theoretical explanation, which often uses broad and general constructs such as creativity, time, space, and the cosmos, stands in stark contrast to what is most refreshing about psychodrama, namely, its concrete and specific use of physical action and direction of interaction. In practice, one is invited to move and play and say without judgements of correctness or appeal to mystical formulae for healing. The point is that a polarization between the productive specifics of action and sweeping metapsychological constructs has created a gap in effective psychodramatic theory development. This originated in Moreno's approach to his own creation as he tried to synthesize religion, philosophy, and psychology in his own unified theory of creative action. Kellerman (1986) agrees that psychodrama theory has suffered because of an incomplete fit between Moreno's manner of theorizing and the clinical observables of psychodramatic practice. Had Moreno, for example, investigated more clinically grounded conceptions such as the notion that enactment is a more lifelike model of therapy, his own theory may have kept up with the practice of his procedures. With this in mind, we move to consideration of what might be regarded as Moreno's framework for therapeutic action. Moreno built his theory on several foundational constructs which include: Creativity, spontaneity, cultural conserves, wanning up, surplus reality, and catharsis. These constructs then justified Moreno's division of any classical psychodrama session into three sequential stages; the warm-up stage, the action or enactive stage, and the sharing or integrative stage. The primary foundational construct is 'creativity'. For Moreno this referred to an 17 existential connection between man and the Godhead. It was in the creative act, Moreno thought, that man and the Godhead were united by the same energy (Moreno, 1964). This view led him to look for ways to understand how the creative moment is brought into being; and how it could be more methodically approached. In this search he arrived at the concept of'spontaneity' and thereafter referred to the theory of'spontaneity-creativity' as the foundation of the psychodramatic method (Moreno, 1964). For Moreno (1964), spontaneity seems to be the psychological ability to receive and respond to the creative ground of being. This casts his theory in Kantian form where creativity as an element of being is never known in-itself. It is only known through the spontaneous act as the manifest action of creativity. In fact, Moreno (1964) coined the term "act hunger" to describe the basic urge for creative action. The degree to which one can "direct" their spontaneous actions in novel and effective ways in a situation becomes the measure of mental health for Moreno. Accordingly, he defined spontaneity as an appropriate response to a novel situation; or, a novel response to an old situation (Kipper, 1986). Moreno believed that spontaneity has two qualities which allow it to be developed and enhanced. First, Spontaneity is 'unconservable', meaning that it belongs to a contextual moment, and cannot be carried over to another. This leads Moreno to emphasize the here-and-now in his therapy. Second, and most importantly for psychodrama, spontaneity can be 'trained'. This is the essential function of psychodramatic techniques; to train people toward more effective "directed spontaneity." While the notion of directed spontaneity seems contradictory, it is not meant that way by Moreno who equates it with the ability to take responsibility for being creative. Blatner (1988) has addressed this best where he says that "developing spontaneity strengthens a 18 person's flexibility of mind for taking responsibility" for new possibilities. The next foundational construct in Moreno's (1964) theory is that of "cultural conserves." This refers to the products of creative and spontaneous actions that are conserved in cultural forms which can be carried over from one context to another. While cultural conserves include all aspects of culture, the most important social-psychological form of conserve focused on in psychodrama is the set of roles people take from one situation to another. Increasing the spontaneous flexibility of roles, as the conserved behavioral patterns of persons, is the primary focus of Moreno's therapy. The next basic construct in Moreno's (1964) model is that of "warming-up." This refers to the continuous but variable state of readiness people have for creative and spontaneous action. It is the preparatory state in which spontaneity is given its directedness based on the interaction between the conserved roles one brings to a situation and factors presented by the situation itself. Moreno (1964) also coined the term "surplus reality." This was meant to confer special status to the realm of imagination as a productive and causal force in human affairs. Moreno (1964) called psychodrama the "theater of truth" where not only real events could be dealt with, but also those that "have never happened, will never happen, or can never happen." These scenes often involve hopes, fears, and losses where psychodrama permits people to use imagination as the source of enactments. In this way imagination is a supplement to reality, or, a surplus reality that is fundamental to creative and adaptive possibilities. When combined with enactment, surplus reality makes possible the rehearsal of adaptive change. Looked at another way, enactment may be seen as trial behaviour in search of novel solutions to felt problems made possible by imaginative variation. 19 Taken together, these five basic elements of Moreno's theory can be seen as describing the dynamics of human action. As human spontaneity responds to the demand of being for creativity, contextualized actions produce cultural conserves, including situated psychosocial roles. Given movement and change as constants cultural conserves including roles, never mirror new situations completely; there is a constant tension between what has been conserved and novel possibilities. The degree to which one is open too imaginatively directing the tension that exists between cultural conserves and the possibility of something new in the present moment is the degree to which one is warmed-up to any situation. At its worst, Moreno (1964) conceived of the withdrawing from this tension of creative possibilities as the basis of human pathology, which he described as "robopathy", the perseverated application of cultural conserves, most particularly roles, to new situations. The view of pathology as fixated role behaviour leads to Moreno's (1964) view of the curative process in psychodrama. The idea of 'spontaneity training' already mentioned as the goal of psychodrama is more a proactive process than a prescriptive cure. Within the process of psychodrama spontaneity training takes the form of "role training'', where one is given the freedom to practice new responses from new role positions. However, more often than not before one can train their spontaneity in new directions, they must break open old conserved roles that constrain movements toward novel actions. This led Moreno to focus on "catharsis" as the major curative process in psychodrama. Therapeutic catharsis in psychodrama takes two forms according to Moreno (1964). The first, he calls "action catharsis." This occurs when the protagonist in the psychodrama becomes active in reliving scenes they have chosen to enact. In this process, catharsis as the release of 20 emotional and physical energy through the completion of interrupted self-expression stands out. The second form of catharsis is referred to as "catharsis of integration." Here, by experiencing new aspects of self and taking other points of view through role reversal there is a release of energy as one identifies with the new expressions and reality of others. There is a kind of 'ah ha' awareness as one integrates a new understanding of self and others. This integrated awareness of how one's role positions are created and often maintained by the role positions of others can then lead to less defensive and rigid role behaviour. Taken together, within the theory of spontaneity-creativity, catharsis of action and integration coupled with role training form a basic outline of Moreno's model of change through enactment. This model of change then supports the division of a psychodrama session into three stages. First, given the group setting it is necessary to warm-up the atmosphere of safety and trust. This stage is critical for setting the tone, building group cohesion, and ensuring the most conducive climate for spontaneity. During this stage protagonists are chosen and enactments are considered. Second, is the action or enactive stage. As the scenes are enacted and relived spontaneity increases and emotion builds often moving toward act completion and catharsis. Old fixated roles are broken open and new ones tried. The third and last stage of a psychodrama session involves the group as a whole focused on sharing and integrating what they experienced in the enactments. Here, both feelings and cognitions are shared, meanings are consolidated, group validation is offered to protagonists, and the significance of the enactments are worked through. There is certainly an internal consistency to this model, and, an intuitive correctness that one can identify with through reflection on managing the tension between habitual roles and novel possibilities in situations. There is even a sense of the genius of Moreno for perceiving the 21 necessity of developing a therapy that involved the person holistically based on a psychology of action. This is a real contribution that foreshadows contemporary constructivist theories of action (Morson, 1994; Bakhtin, 1984; Joas, 1996). As a schematic of change Moreno's model points to the value and necessity of therapy through enactment as a "more lifelike model of therapy." However, for purposes of this study it is also clear that much is left to be filled in. Despite being an existential-phenomenological theory of therapy there is an over reliance on metapsychological discussion of change and little experientially grounded description of the process of change through enactment. For example, apart from catharsis there is no phenomeno logical description of emotional process in enactment. Without such detailed descriptions of the lived experiences involved practitioners and theorists alike are in danger of increasing the gap between theory and practice, limiting the advancement of understanding change through enactment, and psychodrama itself as a cohesive therapy. A more detailed and grounded description of the patterns of change through enactment would allow both theorists and practitioners to move toward Kellerman's goal of an integrative psychodrama and enhance the therapeutic utilization of enactment. In short, the state of Moreno's own theory and style of presentation supports the value and focus of this study on the lived experience of change through enactment. Blatner's Views Adam Blatner is a major contributor to psychodramatic theory (Blatner, 1988). He accepts Moreno's underlying theory of spontaneity-creativity. Moreno is described as attempting to reveal "a class of meta-archetypal processes, basic patterns of creative action...that return afresh not in every generation but rather in every moment (Blatner, 1988)." Blatner though, 22 doesn't content himself with this metapsychological understanding or confuse it with an adequate description of psychological process in the practice of therapy. He directly states that despite Moreno's valid contributions his "system is insufficiently coherent" requiring conceptual refinement and researched effectiveness in order to progress. He goes on to flesh out Moreno's work through more specific development of role theory, catharsis, and identification of change processes and outcomes associated with psychodrama. Each of these aspects of his work will be briefly discussed for what they reveal about change through enactment. In usefully differentiating between Moreno's religious, philosophical, and psychological thinking Blatner denotes the realm of "role dynamics" as the correct psychological domain in which to conceptualize the therapeutic processes of psychodrama. He builds on Moreno's (1946) definition of role as a "unit of synthetic experience into which private, social, and cultural elements have merged." By making a unit of psychosocial interaction the focus of therapeutic work psychodrama is given a holistic and inherently integrative stance toward the various processes involved in the complexity of human change. Blatner (1991) views the holistic and integrative qualities of the role construct as powerful enough to serve not only as a basis for psychodrama but also as "an eclectic approach to...general psychology." In his words: "Simply stated, role dynamics is a language for psychology. It describes psychosocial phenomena in terms of the various roles and role components being played, how they defined, and, most important how they can be redefined, renegotiated, revised, and actively manipulated as part of interpersonal interactions (Blatner, 1991)." While it is not our purpose here to consider the merits of Blatner's nomination of role dynamics as a language for general psychology, it is useful to review the properties of roles he 23 lists, which makes them such good candidates for the job. However, when doing so it is important to keep in mind that the construct of'role' is a heuristic device for referring to a complex set of "components." Strictly speaking, there is no such thing as a 'role'. There are only experiential patterns of behaviour, interaction, thoughts, feelings, images, and sensations which are referred to in conceptual shorthand as 'roles'. It is these experiential role components, nothing more and nothing less, that are changed through enactment; and that comprise the substance of role dynamics at another level of description. Reifying conceptual levels of description and assuming that they adequately reflect experience is always a danger in the development of theory and technique and may well have led to the distance between both in psychodramatic theory. By returning to things in themselves phenomenology and hermeneutical analysis try to reduce the distance between concept and experience. This study attempts to do this by concerning itself with the elements of lived experience encountered in the enactment of roles. This returns us to the definition of enactment as the concretization of a role relationship that is used in this study. Given this semantic relationship between the construct of role and the experience of enacting roles, familiarity with the properties listed by Blatner may facilitate sensitivity to critical factors in the analysis of narratives later in the study; and reciprocally, the revealed themes may lend support through grounded understanding to the conceptual refinement of role dynamics. First, according to Blatner (1991), role dynamics are comprehensive in terms of addressing multiple levels of human organization in both inclusive and flexible ways. In terms of enactment this property suggests multiple levels of meaning may be condensed in different actions. Second, role dynamics are based on a "dramaturgical model" of human experience that is "relatively more understandable" than many other systems of psychological terminology. This 24 suggests that enactment may be usefully informed by existing dramaturgical models of emotion (Tomkins, 1992). Third, the language of role dynamics is relatively neutral as opposed to pathologizing. This suggests that revealed themes in enactment may normalize and destigmatize active responses to trauma and its healing. Fourth, the concept of role and its related dramaturgical model encourages a pluralistic view of human experience allowing a greater openness to a wider range of experience and types of experience that may be neglected in other theories such as play, spirituality, and cultural variations. This suggests that by taking the level of action into account, enactment may contain a wider range of meanings than are usually given value in therapeutics. Fifth, and most significant clinically according to Blatner (1991), the concept of role dynamics encourages the use of "role distance" which may be thought of as the ability to decenter from roles as fixed scripts that one is inevitably embedded in. The ability to reflect on, reevaluate, and redefine the roles one plays in life through role distance breaks down the sense of any one role as inevitable, and, promotes a social constructivistic view of the self which in turn increases a sense of positive interdependence with others. This suggests that enactment can produce critical new experience in role relationships which then serves as the basis for changed behaviour and interaction. Sixth, role dynamics by acknowledging the multi-modal nature of human experience can support the complexity of insights from different theories in an integrative way. This suggests a fuller understanding of enactment may be informative for therapies beyond psychodrama. Finally, another advantage of role dynamics according to Blatner, is that they have the quality of "an associated praxis." By this he means that role playing designed for the purpose of intentional rescription of psychosocial selves and situations holds a practical utility and technical transparency across many different therapeutic issues and concerns. 25 This suggests again, that a better understanding of the patterns of change through enactment may have practical transparency that is applicable to other therapies. In summary, the properties of role dynamics serve to sensitize us to important qualities we may find associated with enactment. If, as Blatner claims, the language of role dynamics is inclusive enough to serve as a general language for psychology then enactment as the actualization of roles may well have equal applicability across theories and therapies. What is clear is that further research would be helpful in supporting and extending the implications of Baltner's role dynamics for enactment. In addition to clarifying and developing role dynamics as the psychological basis of psychodramatic theory Blatner (1985) has also extended Moreno's concept of catharsis. Catharsis as a term was originally coined by Aristotle to describe the release of emotion he observed in audience members of Greek theaters, which seemed to enable them to vicariously purge feelings of "pity and terror" (Scheff & Bushnell, 1984). Since then the meaning of emotional release and purging has remained central to catharsis, and has consistently been used as an explanation for psychological cure in various therapies. The most notable of these were the theories of Breuer and Freud who found that patients under hypnosis who regularly discharged emotion were relieved of symptoms. This led them to term the use of hypnosis to achieve emotional release, or abreaction, the'cathartic method'. Moreno (Fine, 1979) recognized two types of catharsis based on his view that there were two types of memory; one mental and the other somatic. As already discussed, he termed these action catharsis and catharsis of integration. Moreno's view that catharsis includes an element of cognitive integration as well as somatic purging/abreaction has been supported by subsequent experience with psychodrama as well as other theories. In psychoanalytic theory the concept of regression in service of the ego 26 has long acknowledged both aspects of catharsis as necessary to change (Moore & Fine, 1979). Within psychodrama Kellerman (1984) has stated that catharsis "in itself is not curative", claiming that both release and cognitive integration are needed. Davis (1987) has described catharsis as the moment when the "existing structure of roles yields to reform itself' and that attention to integration or re-ihtegration must then necessarily follow. Blatner (1985) accepts the distinction between action catharsis (abreaction) and catharsis of integration and offers further distinctions of his own which, when taken together with Moreno's views, comprise a model of catharsis as curative in psychodrama. He posits four inter-related categories of catharsis: Abreaction, integration, inclusion, and spiritual. Abreaction refers to the release of emotion as commonly associated with catharsis. However, Blatner considers the release of emotion itself to be only a partial explanation of what occurs in the traditional view. He believes it is the emotional release plus the awareness of experiencing new or dissociated feelings that comprise the effective structure of abreaction. In this view there is freedom of release in the service of revealing and regaining new modes of self-experience and expression. In Blatner's view this amounts to an "expansion of the psyche", which he contends is a generic feature of catharsis as abreaction. For purposes of this study, it is useful to keep in mind that the connection between abreaction and enactment is the act of reliving in order to achieve emotional and functional ends such as stress reduction through discharge, mastery, undoing, identification and so on. What the context of psychodrama allows is a conscious and ordered setting for the reliving, as opposed to the less intentional reliving of unresolved issues in life, often referred to as acting-out. Blatner's view of abreaction as expansion of the psyche makes sense then, when release is seen as being in the service of attaining functional 27 ends. Blatner's (1985) next category of catharsis is catharsis of integration as suggested by Moreno. This begins with the psychic expansion encountered in abreaction due to awareness of new and split-off aspects of self-experience. However, a place must be made for this new material within the psyche or in Blatner's words, "it still sticks like an arrow in the soul" rather than becoming a useful and informative part of the self (Buell, 1995). Catharsis of integration then, is related to the experience of enlarging and reorganizing one's self-structure. In line with psychoanalytic thinking, Blatner believes the experience of being able to encounter and contain ambivalent and disparate parts ofthe self strengthens the ego. In terms of this study we are sensitized to the suggestion that through concretization, enactment can facilitate contact with disowned experiences emerging through abreaction, and, provide a means of rehearsal for integrating such experiences into new behaviours and interactions between self and other. Next is the category of catharsis of inclusion. Blatner (1985) defines this as a feeling of belonging. In simple terms this would appear to refer to the positive feeling released when one experiences acceptance and validation within the group context of psychodrama. However, it may be that there is far more significant restructuralization occurring here than might first be suggested. I suspect that catharsis of inclusion involves the reactivation of several developmental dimensions including those of attachment, self-concept, object relations, social and moral cognition (Weiss, 1996). For, within the feeling of belonging there are complex insights, actions, and transformations. For example, negative beliefs about self and other are challenged, normalization occurs, intersubjective patterns of affect are transformed; social attributions, expectations and values may be tested, and reparative selfobject experiences are provided (Kohut, 28 1977). Because psychodrama is also a group therapy which regularly activates deep issues holistically by focusing on behaviour at the level of role organization, the reworking of multiple developmental lines simultaneously is always a potential. From this perspective Blatner's catharsis of inclusion is something of an abbreviated sign which is really pointing to the excitement of continued and reparative development within the intersubjective domain, which is often accepted as the most critical context for personality change (Tomkins, 1992; Stolorow, 1994). In terms of this study, the implications of catharsis through inclusion suggests that a fuller understanding of enactment may reveal it as a primary approach to developmental repair and growth, once the experiential processes involved are teased apart and clarified. Blatner's (1985) final category is spiritual catharsis. This occurs when one experiences a sense of integration with the cosmos, or, the Godhead, in Moreno's words. Here too, according to Blatner, self organization can be lifted to new levels of integration through psychodrama. This level of integration is not unknown in psychological theory. Freud (1930) of course, observed the "oceanic feeling" referring to experiences of merger and expansion of ego boundaries during both disintegrative and positive regression. Jung (1930) discussed the transformative experiences accredited to contact with archetype of the 'self; and Maslow (1968) described "peak experiences" of contentment with oneself and surround. My own experience of having my awareness.reorganized in meta-level ways through psychodrama involves dreams derived from enactments that presented mythical, or, archetypal themes in ways that have personal relevance. For example, after one enactment a dream recast the psychosocial content of my psychodrama in the larger context of the universal themes of war and quest, which provided a new, meta-level integration of emotional, cognitive, and object relational material (Burkert, 1979). This personal 29 experience heightened my awareness of the mythic level as an ever present background form to our experience, and, allowed me to value these critical derivatives of enactments when they were commonly found in the experience of the co-researchers in this study. It also led to consideration of the meaning of enactment in relation to literature on the function of ritual in myth discussed later in this review. In sum, Blatner has extended and differentiated the functions of catharsis as a curative mechanism in psychodrama in ways that are suggestive for understanding the restructuring of experience through enactment. Also indicated is the need for rigorous study of the lived experience of enactment to reveal actual patterns and functions related to the pivotal concept of catharsis. This study was designed in a way that would examine the experience of catharsis as part of the process of enactment. In addition to developing role theory and catharsis Blatner (1988,1996) also lists a set of change processes and outcomes he sees bundled together in psychodrama. It is useful to review this list because, again, it can sensitize us to significant areas of experience that may be pertinent to developing a fuller understanding of change through enactment. Processes related to enactment occurring in a group context include (Blatner, 1988; 1996): 1. Instillation of hope; often related to seeing others grow in psychodrama. 2. Discovering universality of concerns leading to normalization. 3. Experiencing and developing a sense of altruism. 4. Psychoeducational information giving. 5. Corrective emotional experiences related to early interactional dynamics. 30 6. Development of socialization skills. 7. Imitative behaviour. 8. Interpersonal learning around attributions, differences, and social norms. 9. Benefitting from and contributing to group cohesiveness. 10. Catharsis of inclusion. Processes occurring at the ego level in psychodramatic enactment include: 1. Sublimation, where new channels for expressing drives and emotions are created through identification as well observational and imitative behaviour. 2. Reality testing is called into action as perceptions are checked. 3. Judgement is practiced which promotes conscious control of defenses. 4. Decentering and perspective taking skills are exercised. 5. Drive and affect modulation is practiced altering defensive structures. 6. Repatterning of object relational representations is activated through projective identification processes. 7. Cognitive processes such as discrimination, memory, concentration, and attention are practiced in attending to relevant aspects of emotional material. 8. Problem-solving skills are practiced in the collaboration on direction of the enactment. 9. Adaptive regression in service of the ego fosters integration of conscious and unconscious material. Outcomes related to the interpersonal level of role dynamics include: 1. A sense of choice and flexibility in taking adaptive role positions is enhanced as one's role repertoire is increased. 31 2. Differences in others are valued through taking multiple role perspectives. 3. The importance of varied aspects of life are valued through experience with multiple dimensions of expression; such as play, fantasy, physical action, social cooperation, etc. 4. An increased capacity for empathy is developed through identification in role taking. 5. A positive sense of interdependence is developed through group support. 6. A strengthened sense of self is achieved through social validation. 7. Social confidence and mastery is increased. 8. Personal and social vitality is increased which challenges self-doubt and enhances authentic spontaneity and creative self-expression in social contexts. Outcomes at the ego level include: 1. Increased ego strength in terms of perceived self-efficacy, confidence in judgement, and tolerance for ambivalent feelings and thoughts. 2. A clearer sense of reality in terms of reduced dissociation, ego boundary confusion, and better perception checking. 3. Better containment and regulation of drives, impulses, and intense affects. 4. Differentiation of self and other object relational representations. 5. Immature defenses are shifted toward more mature defenses. 6. Stimulus barriers are enhanced in terms of managing inner and outer stresses. 7. Feelings of autonomy and self-control are increased. 8. Synthetic-integrative functioning is developed in terms of adaptively integrating multiple levels of experience. 9. Positive expectations for mastery and competence are increased. 32 Blatner's (1988, 1996) list of change processes and outcomes is comprehensive and ihuminating in terms of the degree of complexity accounted for by considering multiple modes and dimensions of change. This is equally true of what amounts to his model of change through psychodrama when his views on role dynamics and catharsis are combined with his list of processes and outcomes. Once again however, this list is more suggestive than factual without studies grounded in the experience of change. Without such studies it is difficult to imagine what change processes might be associated with which outcome