CAIRO – 13 February 2018: The term “therapy” is often most followed by ideas of closed rooms, secrecy, medication and civil formality. Group therapy as a possibility is often avoided by patients; the principle of “self-help” tends to bring people shame when it appears to be unfulfilled. What is rarely addressed in such discussions, however, is that “self-help” has never referred to the individual. Rather, self-help is the ability of a community to use its spaces and resources to provide for itself and create its own solutions collectively.
Dr. Jacob Levy Moreno, a Romanian psychiatrist, developed his methodology based on ideas of theater, community self-help, therapy, philosophy and social interactions. Moreno founded psychodrama, a group-action method that involves the full and active contribution of the participants. The participants, much like in group therapy circles, become healing agents for each other, using their own personal experiences and knowledge to create solutions and possibilities.
Moreno explains that psychodrama is “the science which explores the ‘truth’ by dramatic methods,” using different and spontaneous approaches to draw out feelings and responses from the participants. Moreno believed that the lack of spontaneity in the rehearsed theater productions takes away from the value of the story and stage. His method is inspired by improvisation in theater, which allows the “actor” to find different and creative ways to approach a situation.
Let us try to think of “theater” as a community in itself. A single production is comprised of actors in all aspects of the stage – even those who do not appear onstage. Moreno’s ideology stemmed from his belief in the potential contribution of all such actors to different and new possibilities, as well as solutions for group healing.
Caption: Workshop participants – Photo Courtesy of Egyptian Association for Group Therapies and Processes official Facebook Page
Typically, one psychodrama session spans about two hours. In each session, one participant is chosen as the protagonist. Throughout the session, the protagonist's inner feelings, ideas and relationships are explored with the help of the director and fellow participants. The director guides the other participants through the performance to help the protagonist by calling upon them to engage in different activities that help the progress of the performance. The aim of these activities is to create different scenarios and situations for the protagonist to “solve”.
Psychodrama calls upon the use of different acting and theater techniques, and the progress of the session is divided into various stages that employ certain techniques. The stages are “warm up”, “action” and “sharing”. Every session ends with a discussion on their experiences and feelings about the action.
Techniques used in psychodrama include “mirroring”, in which a participant reenacts the protagonist’s scene; “doubling”, in which a participant voices out the thoughts and feelings that they feel the protagonist might be withholding during the performance, acting as a link between the protagonist’s inner world and external environment; “role playing”, in which the participant acts out the role of an object or idea that is significant to them; “soliloquy”, in which the participant voices their thoughts and feelings aloud; and “role reversal”, in which two participants act as each other in a certain scene.
The presence of psychodrama in the Middle East has increased in the 21st century. Egypt is witnessing a rise in the influence of psychodrama initiatives. In Egypt, psychodrama training and programs take place in occasional workshops, or where they may be offered as an option in group therapy solutions. Cairo University and the Egyptian Association for Group Therapies and Processes have both offered programs and workshops in psychodrama, inviting experts from around the world to conduct sessions and provide professional training for workshop participants.
Capacity building programs in Egypt have started to include psychodrama as a method for community participation and development. Studio Emad el-Din and Orient Productions are both examples of Egyptian drama organizations that have incorporated community development goals into their activities, having previously used psychodrama in a three-year training program. Noon Creative Enterprises is another organization that specializes in drama workshops, and it creates plays and performances based on workshop outcomes.
Ben Rivers is a registered drama therapist and an expert in the use of psychodrama and Playback Theater for community development and mobilization and trauma response, and he holds a doctorate in Peace Studies from the University of New England in Australia. He works mainly with communities that suffer structural oppression and violence, conducting workshops and training programs in different countries around the world, including Egypt. In an academic paper titled “Mobilizing Aesthetics in Psychodramatic Group Work” published in 2015, Rivers describes a number of situations and experiences that took place during his work in different Arab countries.
One of the stories Rivers includes in the paper occurred during a workshop in Cairo. The story intends to show the effect of spontaneously “creating” an environment during psychodrama group therapy, and the theory and concepts behind the practice, as well as its potential to address social concerns and issues in a cultural context.
During that workshop, a drama was initiated by a 27-year-old architect named Reem, who wanted to resolve and understand her tendency toward self-sacrifice and perfectionism, which are values imposed on women through socio-cultural ideas and familial norms. When asked to describe her “inner world”, Reem fashioned herself a river and used cloth and material to illustrate her image of self, explaining that she saw her inner, real self as nurturing and peaceful. After she “became” the river, she began to sing and was joined by the other workshop participants.
Later, Reem said that the activity “helped to create an atmosphere arising from [her] own self,” and that “creating the river will have a lasting impact on [her].” She explained that “whenever [she] finds [herself] immersed in a certain negative feeling, [she] will be able to invite again the image, the sounds and the feeling of strength that [she] experienced in that scene.”
Rivers discusses Reem’s account of creating her own environment by explaining that the very idea of an environment is attached to the facets of any given social role, and thus incorporating images of a specific environment allows the qualities of that role to be amplified and emphasized. Using atmosphere to generate an idea or emotion helps the participating group members to all find themselves in a common “place” with which they all have different associations, memories and ideas. At the same time, using a specific environment in the performance helps create an image in the mind of the protagonist of the play that can later be used. In Reem’s case, when she felt overwhelmed by feelings of inadequacy and unfulfillment, she would refer to her inner world and gain a sense of peace and reassurance by imagining the river of nurturance that she created.
Another example of a successful psychodrama program in the Middle East is the Gaza Community Mental Health Program, which created “Psychodrama Without Borders: Gaza”. The program began in 2000, working with fifteen participants originally. In 2006, the participants graduated as psychodrama specialists, equipped with the skills and experience to direct psychodrama programs in different areas. The name of the program, “Psychodrama Without Borders”, was developed by the participants themselves, who wanted to emphasize the potential for psychodrama to “transport” them beyond the artificial borders of Israel’s occupation.
“Psychodrama Without Borders” was created specifically to deal with trauma. When the program branched out with the leadership of the trained psychodramatists, the sessions worked with different traumatized groups in Palestine. Symptoms of PTSD were prevalent among many communities in Gaza, and the program directed its focus to women who suffered severe losses throughout the siege, as well as traumatized children.
The program director, Ursula Hauser, explains that the difficulty and value of psychodrama training lies in the experience of “working [one’s] own subjectivity”. Psychodramatic techniques invite the “protagonist” and participants to use their own experiences in the activities and share their vulnerabilities and feelings in the “co-therapeutic” process. Hauser emphasizes the importance of acknowledging the group-based principle of psychodramatic therapy and the community development aspect of group therapy processes. Palestinian workers in the program underline the community development process as a way of creating psychosocial support in a short documentary of the program.
Psychosocial support refers to the development and creation of solutions for psychological wounds and traumas, in addition to processes that help the community rebuild necessary social structures for group support and active participation.
Another Palestinian initiative based in Ramallah came from the Treatment and Rehabilitation Center for Torture Victims in partnership with the International Association for Group Psychotherapy and Group Processes, developing a three-year training program for psychodrama and group therapy. These Palestinian initiatives and the increased participation in psychodrama programs reflect the underlying need for creative outlet and freedom in third world countries, and especially among marginalized people who are denied options for expressive solutions and are excluded from most discussions on art and drama. Using psychodrama as a tool to help Palestinian torture victims invites consideration of the potential for spontaneous and improvisational drama to allow us to tell our stories and effectively write our true personal and collective histories.
In a different academic article on the effect of group psychotherapy in Egypt, a number of Egyptian lecturers and professors at Minya University emphasized the significance of Egypt’s socio-cultural values and behavior in encouraging healthy bonding and trust among the therapy group. The authors who contributed to the article include psychiatry lecturers at the Faculty of Medicine Mohamed: Taha, Mohamed Abd-El-Hameed, Maha Hassan, Ahmed Kamal and senior professor of psychiatry Refaat Mahfouz.
The article follows a number of arguments on group psychotherapy approaches to make the claim for the Egyptian model’s use of the transformative “power of love” in group therapy. The 2010 article, titled “Power of Love and Love of Power in Group Psychotherapy”, highlights moments in specific cases of Egyptian models of group psychotherapy that show the effect of true involvement and openness of psychotherapy patients. These cases are used to discuss the special dynamics exhibited in specifically Egyptian psychotherapy groups, where the therapist – or, in the case of psychodrama therapy, the director – attempts to draw out or “unblock” patients’ hidden healthy components of their inborn psychological structure, which the article refers to as their “fetra” (nature/instinct). The way this must be done is through means that the patient is unused to, and that correspond with the patients’ need for love, openness and trust. Psychodrama takes on the same approach, requiring a director who is similarly “present, active, encouraging, intimate, compassionate, expressive and transparent.”
Included in the article is a patient’s account of her experience with her psychotherapy group after five years. She says, “The love I feel here is a real emotion, mercy, connectedness and cohesion between people who are not my family or even my relatives. They do not ask for anything, any deal or any money to give me such love...This happens in the same time where some people who live in the same house as family do not listen to each other, do not love each other; on the contrary, they hate each other and need to get rid of each other. This is weird, isn’t it?...I have realized that love is the strongest healing power, much stronger than medicine. I found that being concerned about people, having them in my mind, accepting them and respecting them unconditionally is the best cure for all psychiatric illnesses.”
The Egyptian Association for Group Therapies and Processes held its third international conference and fourth regional African conference in January, inviting psychotherapy expert speakers from around the globe to present the latest discussions and discoveries in the field of psychiatry. The conference also held a pre-conference workshop program that included a number of sessions on group psychotherapy and different approaches to psychodrama.
The variety of topics on psychodrama and group psychotherapy that were discussed throughout the three-day conference emphasize the vastness of the field and its potential to be successfully explored and implemented further in the Egyptian context. Some exciting titles of sessions presented at the conference include “Group Psychotherapy and Dreams: Different Perspectives of Using Dreams in Groups” and “The Way of the Heart – How to Open, Listen, Protect and Heal Our Heart” by German-Spanish psychiatrist Jorge Burmeister, “Religion, Spirituality and the Arabic Culture: Historical and Group Psychotherapy Perspectives” by Saudi Arabian psychiatrist Tariq al-Habib, and “Group Therapy with Children: Play Therapy and Psychodrama” by Egyptian psychiatrists Hanan El-Mazahy and Al-Shefaa Tarek, among many other sessions and workshops offered at the intensive conference.
Although the literature on Egyptian and Middle Eastern psychodrama and group psychotherapy approaches is still somewhat limited, there is a definite increase in public recognition of the need for psychosocial support in traumatized and marginalized communities. Psychodrama works in Egypt mainly through the independent centers and organizations that foresee a future for the practice, and that take on different approaches and venues to encourage openness and invite patient involvement. What is always emphasized, however, is the undeniable need for group cohesion and therapy methods that ultimately form the basis of community healing.
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