Surveys from all over the world show that people who have medical conditions are especially likely to have sleep problems. A medical condition can lead to a sleep problem, and a sleep problem can lead to a medical condition. Each can exacerbate the other. There is a particularly strong link between chronic pain and sleep difficulty. Most people with chronic pain have insomnia. Research shows that cognitive behavioral therapy for insomnia improves the sleep of people who have heart disease and insomnia. People with lung cancer and women with breast cancer are especially likely to experience sleep difficulty. People who experience seasonal allergies are more likely than other people to have insomnia, to snore and to have sleep related breathing problems. The chapter also summarizes some of the findings about sleep when a person has Alzheimer’s disease, Parkinson’s disease, or multiple sclerosis.
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This chapter comes up with two numbers that are essential for Sleep Therapy. Sleep Therapy combines the most effective components of Cognitive Behavioral Therapy for Insomnia (
CBT-I); it involves tailoring bedtime and rise time for sleep needs, and associating bed with great sleep. Knowing the numbers will allow one to tailor their sleep improvement procedures. The first number is one’s “total sleep time”, which is how much sleep they are getting now. The second number is “sleep efficiency”, which is how solid their sleep is. One can use their baseline sleep diary to estimate fairly accurately their baseline values for total sleep time and sleep efficiency. The chapter shows how to estimate one’s baseline sleep duration, based on a night from their sleep diary.
This chapter summarizes the strategies of sleep therapy in 6 specific steps. The steps of sleep therapy appear to be simple, but they require some time and effort. The most important factor that determines whether their sleep will improve is the consistency with which one follows the steps. The chapter discusses fifth and sixth steps. Fifth step is if sleepiness is overwhelming, one may take a short nap (set aside no longer than 45 minutes) in the afternoon, between 1:00 and 4:00 p.m. Many programs recommend that one avoid daytime naps entirely because naps may make it harder to sleep at night. While this is partially true, one also knows that humans are biologically predisposed to have a nap in the afternoon if circumstances permit. Sixth step is maintaining a sleep diary. Keeping a sleep diary will show how one’s sleep improves as a result of their actions.
There are several helpful strategies for calming active thoughts. To begin with, it is helpful to take an observer’s stance, and notice where exactly one’s mind is going. The chapter discusses the thoughts or worries about the effects of not sleeping, and the worries about things going on in one’s life. It is very common to have worries about work, school, relationships, family, or health issues. If this is true for one, write these issues down. Then consider which are productive worries and which are nonproductive. Nonproductive thoughts and worries are things that can be released and let go of at night. This is more easily said than done. Another approach to get out of problem-solving mode, or overactive-thinking mode, is by training one’s mind with meditation. There are many types of meditation and one can choose the type that suits them best.
Often people who are starting to improve their sleep worry that their progress is only temporary and that poor sleep will return. If a person had insomnia for several years, he/she may be especially prone to this fear of relapse. Maintenance starts with reminding oneself that they have acquired new knowledge about their sleep and mastered the strategies that improve it. This is very important to remember; it means that one will never be back at square one. This chapter provides some very practical steps to anticipate what could happen. Once a person knows the strategies for improving sleep he/she can use them as needed.
Sleep Therapy is the term used for the specific program, which combines the most powerful and effective components of cognitive behavioral therapy for insomnia. The first part of the program, called FIRST THINGS FIRST, involves recording one’s sleep using sleep diaries to assess the nature of their insomnia. This chapter focuses on how to uncover, or rediscover, the biological processes that allow one to sleep. It shows how to tailor one’s bedtime and rise time in order to get solid sleep, and how to associate one’s bed with great sleep. The procedures will be summarized in Six Steps to Solid Sleep, the main techniques of Sleep Therapy. With some practice of these relaxation and “cognitive therapy” techniques, one knows how to move their mind into a state that is more conducive to having sleep arrive, to having the velvet hammer descend.
One’s sleep diary provides good information about their sleep timing, quality, and quantity, and is the best way to measure sleep if a person has insomnia. For more in-depth examination of sleep by scientists, or sleep medicine clinicians, special equipment is used to track sleep stages and cycles through the night. To determine sleep stages, three main measurements are used: brain waves, eye movements, and muscle tone. These are measured using electrodes that are attached to the scalp, the face near the eyes, and under the chin, respectively. Polysomnography is measurement of sleep overnight in the sleep lab, with electrodes that are attached to the scalp, face, and chin, to determine sleep stages. Actigraphy is another way that sleep can be measured, but only roughly.
Sleep is increasingly being recognized as the third pillar of health, along with nutrition and exercise. All three health behaviors (yes, sleep can be considered a behavior) interact with one another. If our sleep is good, we are more likely to eat well, to exercise and to be healthy. This chapter shares some fascinating new research findings about these interrelationships. Sex has rarely been discussed in relationship to sleep. The chapter examines what we know, or don’t know, about this relationship. Men with these sleep disorders have high rates of erectile dysfunction. A recent online survey revealed that worse sexual functioning was linked with worse sleep. Looking from a positive perspective, this also means that those with better sexual functioning experienced better sleep. Just as with nutrition and exercise, sexual functioning is related to sleep bidirectionally: each influences the other.
The most useful and efficient way of starting one’s sleep program is by understanding their current sleep–wake patterns. The standard measurement tool for insomnia is the “sleep diary”. Sleep diaries are not really diaries, but simple logs, based on one’s recollection of their last night’s sleep. Because they are the expert on their insomnia, they are the best person to report on each night’s sleep in order to measure their sleep problem. In fact, people with insomnia who go to sleep labs usually have trouble sleeping in the lab, which simply confirms their insomnia. Although the sleep information obtained from consumer wearable devices is appealing, at the time of writing this, these trackers are not yet ready for use in Sleep Therapy. This chapter provides a note about personal electronic sleep trackers and discusses logging your sleep with a sleep diary.
Hygiene means “principles of maintaining health; the practice of these”. In the strict sense “sleep hygiene rules” are tips for maintaining good sleep health. They include things that our grandmother may have told us, such as don’t eat a big meal before we go to bed. The research concurs: Sleep hygiene alone is not effective for reversing chronic insomnia. This chapter offers the recommendations or the top tips for better sleep. They can be helpful for people who usually sleep well but who have occasional or situational sleep problems in order to prevent further problems. By following them, one can certainly eliminate some of the factors that can interfere with sleep.
Women are more likely than men to have insomnia. A family history of insomnia increases the likelihood of developing insomnia, especially if one’s mother had sleep difficulty. Some girls and women experience worse sleep in the 3–4 days before their menstrual period than at other times in their cycle. This is especially likely if they have premenstrual symptoms like depressed mood, irritability, appetite changes, and feeling tense. Pregnancy increases the risk of developing some other sleep disorders. Childbirth is a time when your sleep is bound to be totally disrupted. Women who develop persistent insomnia sometimes identify childbirth as the starting point of their poor sleep. Effective treatments are available for most sleep disorders. For insomnia, women make up the majority of volunteer participants in treatment studies. Cognitive behavioral therapy for insomnia works to reverse insomnia during most stages of life including young adulthood, midlife, and old age.
This chapter guides one forward after the third week of sleep therapy. It presents a chart called Calculating Your Week 3 Sleep Efficiency. By entering the sleep diary answers for Questions 1 to 7 in the top section of the chart one can calculate the sleep efficiency. The chapter also presents Six Steps to Solid Sleep for week 4: go to bed only when sleepy and not before your threshold bedtime; maintain a regular threshold rise time in the morning; use the bed only for sleeping; leave the bed if one can’t fall asleep or go back to sleep within 10–15 minutes, return when sleepy, and repeat this step as often as necessary during the night; if sleepiness is overwhelming, one may take a short nap (set aside no longer than 45 minutes) in the afternoon, between 1:00 and 4:00 p.m; and maintain a sleep diary.
Although women tend to report insomnia in greater numbers, men have their share of sleep problems. Testosterone, a hormone that occurs in much higher levels in men than in women, influences the development and maintenance of male sexual characteristics, including reproductive organs, body structure, beard growth, strength, sex drive, aggression, and mood. There are important connections between testosterone and sleep. Research shows that the more the father is involved in caring for the infant—both during the day and at night—the better the mother’s sleep and the fewer times the infant wakes at night. There are two sleep disorders that occur more frequently in men than in women. These are “sleep related breathing disorders” and “
REMsleep behavior disorder”. This chapter outlines both. With age, men’s sleep, like women’s, becomes shorter and more broken up by awakenings. As with women, men experiencing stress at work are at high risk of insomnia.
This chapter provides information on some substances that are not exactly “pills” but they are often marketed as sleep aids. They include over-the-counter products, natural health products including herbal remedies, and cannabis. Over-the-counter sleep aids do not require a prescription and they are quite widely available through pharmacies. If a person has seasonal allergies, these medications may help them sleep on those nights when their allergy symptoms would otherwise disturb their sleep. Natural health products may help induce sleepiness and help some people who have mild difficulty falling asleep, and who are otherwise healthy (having no medical or mental health problems). There are several downsides of using recreational cannabis for sleep. Regular use of any form of cannabis can lead to dependence and difficult withdrawal symptoms including irritability, insomnia, depression and anxiety. Importantly, it can impair brain function, especially in people under age 21, whose brains are still developing.
This chapter explains two essential elements form Sleep Therapy, which are based on sleep science and psychology principles. Many people find this background intriguing. What’s more, it is always easier to carry out techniques when one understands how they work. The elements of Sleep Therapy are: uncovering one’s natural sleep processes and associating one’s bed with sleep. By understanding how sleep comes and goes in the natural state one can see more clearly how to restore healthy sleep. Good sleep comes when our biological sleep processes can operate without interference. Associating one’s bed with sleep element of Sleep Therapy is based on something called “conditioning” or “learned associations”. These are connections one make in their mind (automatically) between two things that occur together on several occasions.
As insomnia develops, one may start to worry about not sleeping. One of author’s friends had a stressful management position over which she started to lose sleep. She then feared that the lack of sleep would negatively affect her work performance. This made it even more difficult for her to sleep because the thought of underperforming increased her anxiety. One can see how this can become a cycle of worry and sleeplessness. This chapter discusses some of the common worries that are linked to insomnia. By examining these topics in the light of day, rather than ruminating during a sleepless night, we achieve a more balanced view of our sleep problem and its effects. Stressful thoughts at night have a way of expanding to fill the dark spaces around us. The chapter provides information that will help to bring one’s sleep-related worries down to earth.
After Week 4 of Sleep Therapy, it is recommended that one should check to see if they are now free from insomnia. One can do this by looking at the same things in their current sleep diary, before they started Sleep Therapy. This chapter provides suggestions to find out the experiences of initial insomnia, multiple awakenings, middle insomnia, and terminal insomnia. If a person takes longer than 30 minutes to fall asleep, he/she is experiencing “initial insomnia”. If a person has more than 3 awakenings per night, he/she can describe it as having “multiple awakenings”. If a person awakes each night, (3 nights or more) for greater than 30 minutes, he/she is experiencing “middle insomnia”. If a person wakes up for more than 30 minutes too early on at least 3 mornings, then he/she has “terminal” or “end-of-night” insomnia.
Insomnia is a complaint of difficulty falling asleep or staying asleep that impairs the functioning or causes distress. So, compared to a bout of poor sleep, insomnia is a sleep problem that takes on a life of its own. Basically, it is persistent, unsatisfactory sleep that has daytime consequences. When insomnia occurs at least three nights per week and lasts for three months or longer, it is technically called “chronic” insomnia. People with insomnia report low mood, irritability, poor concentration and memory, reduced physical well-being, and some difficulties interacting with other people. They also report having more fatigue-related car crashes than people without insomnia. People with insomnia seem to be able to perform mundane tasks of daily living but they tend to have less enjoyment of their activities and show less “cognitive flexibility”—they tend to think more narrowly and less creatively—than people who sleep well.
This chapter provides methods to overcome the negative self-talk, by replacing it with balanced thinking that includes some realistic optimism. We humans have problem-solving, thinking brains that are always trying to make sense of our world. Sometimes sleep-related thoughts persist and this is when we need to face them head-on, evaluate them and respond to them in a new way so they are not so alerting and troubling. The chapter introduces us to the “cognitive therapy” component of cognitive behavioral therapy for insomnia (
CBT-I). Feelings are basic and instinctive and easier to identify than thoughts. Therefore, the chapter presents an exercise that starts with asking one about their feelings, and then asks them to identify their associated automatic sleep-related thoughts. It provides an example, based on a real person with insomnia.
The completed sleep diaries will provide very interesting and useful information. This chapter helps the reader to go through their baseline sleep diary and see what it tells us. One will be looking at certain rows of their sleep diary now. The chapter guides us through the sleep diary, pointing out what to look for. It follows the same sequence that the author uses when he examines people’s sleep diaries in the clinic, which is not necessarily the same order in which we filled out the sleep diary. The first mission is to identify what type of insomnia we have. One has just looked at their baseline sleep diary for initial insomnia, multiple awakenings, middle insomnia, and terminal insomnia. It is quite common for people to have more than one type of insomnia problem. Our impression of how we are sleeping is, of course, one of the most important measurements.
Sadness and anxiety are normal human emotions and stress is a normal occurrence in our lives. When we’re feeling somewhat down, anxious or stressed, we can benefit from exercise, relaxation, recreation, eating nutritious foods, allowing time for sleep, and talking to a friend. Clinical depression and anxiety are very common conditions. This chapter looks at what they are, what happens to sleep, and what helps recovery of mood and sleep. It outlines what is known about treating insomnia in three forms of clinical depression: major depression, Seasonal Affective Disorder, and Bipolar Disorder. Research on how people respond to natural disasters has told us that within the first months of disaster, many people develop signs of anxiety, depression and posttraumatic stress. With respect to sleep, people with posttraumatic stress disorder tend to get somewhat less deep sleep, longer periods of being awake during the night, and an overall shorter sleep duration.
Years of research have revealed that certain techniques reliably lead to improved quality and quantity of sleep and increased satisfaction with sleep. Together these techniques can be called “cognitive behavioral therapy for insomnia” (
CBT-I). In the mid-1990s two important reports were published on these techniques. These reports were based on meta-analyses. In a meta-analysis, the research data from many studies of a given treatment are carefully combined to provide the overall story on the treatment’s usefulness. In these particular meta-analyses, the authors reviewed studies that had compared CBT-Itechniques with no treatment or with a placebo treatment. Research shows that CBT-Iis useful even if one have some mild to moderate symptoms of anxiety or depression, or some long-lasting medical problem like chronic pain or cancer. This book shows how to deal with and overcome insomnia if one has insomnia that has lasted longer than 4 weeks.
There are things over which one have direct control. So, if they are contributing to poor sleep, they can be addressed right away. One will now be perusing their sleep diary for three things: naps, alcohol, and sleep medication. Not that any of these things is bad, one just wants to make sure that they are not interfering with their nighttime sleep. If they are interfering, it is much easier to deal with them now, before one goes further. If one did nap, were the naps inadvertent or intentional? If they were inadvertent, this can be a sign of “excessive daytime sleepiness”. If the naps were intentional, then look at the timing of each nap. If one is taking sleep medication, it is dangerous to also drink alcohol. So, if one takes sleep medication, be sure to read and follow the instructions on the medication label.
This chapter guides one forward after the second week of sleep therapy. It presents a chart called Calculating Your Week 2 Sleep Efficiency. By copying one’s sleep diary answers to Questions 1 to 7 for the typical night into the top section of this chart one can calculate the sleep efficiency for week 2. The chapter also presents a chart that helps to adjust one’s threshold bedtime, and Six Steps to Solid Sleep for week 3. The six steps are: go to bed only when sleepy and not before your threshold bedtime; maintain a regular threshold rise time in the morning; use the bed only for sleeping; leave the bed if you can’t fall asleep or go back to sleep within 10–15 minutes; if sleepiness is overwhelming, one may take a short nap (set aside no longer than 45 minutes) in the afternoon; and maintain a sleep diary.
This chapter discusses the advantages and disadvantages of the current medications that are used for sleep. If a doctor prescribes a medication to help one sleep, it is most likely to be a benzodiazepine receptor agonist (
BzRA). If one needs sleep immediately, BzRAswill most likely help. Sometimes, instead of prescribing a BzRAfor sleep, physicians prescribe a low dose of an antidepressant or antipsychotic medication. For people who are depressed, the sedating antidepressants can improve sleep, more so than some other classes of antidepressants. Standard (immediate-release) melatonin can sometimes be useful for prevention of east-bound jet lag and for certain shift work schedules, and it may be helpful in the short term (up to 1–2 weeks) for sleep difficulty. Orexin is a neuropeptide that is involved in the regulation of wakefulness and sleep as well as other functions such as appetite regulation.
This chapter guides one forward after the first week of sleep therapy. It presents a chart called Calculating Your Week 1 Sleep Efficiency. By entering the Sleep Diary answers to Questions 1 to 7 for one’s typical night into this chart one can calculate the sleep efficiency for Week 1 of Sleep Therapy. If at any point one realizes that the night chosen is not really representative of the week, then one can try another night and see how close the sleep efficiencies are. If the nights are not consistent, then one may want to calculate all 7 sleep efficiencies and take the average for the week. The chapter also presents a chart that helps to adjust one’s threshold bedtime, and Six Steps to Solid Sleep.
Sociometry, a relatively new science developed gradually since the World War of 1914-1918, aims to determine objectively the basic structure of human societies. The field work of sociometry was started with small sections of human society, spontaneous groupings of people, groups of individuals at different age levels, groups of one sex, groups of both sexes, institutional and industrial communities. From the point of view of a descriptive sociometry, the social atom is a fact, not a concept, just as in anatomy the blood vessel system, for instance, is first of all a descriptive fact It attained conceptual significance as soon as the study of the development of social atoms suggested that they have an important function in the formation of human society. The introduction of sociornetric procedure, even to a very small community, is an extremely delicate psychological problem.
A simple illustration of sociornetric technique is the grouping of children in a dining room. The technique of letting girls place themselves works out to be impracticable. It brings forth difficulties which enforce arbitrary, authoritative interference with their wishes, the opposite principle from the one which was intended a free, democratic, individualistic process. The best possible relationship available within the structure of interrelations defines the optimum of placement. This is the highest reciprocated choice from the point of view of the girl. The factors entering into sociometric assignment are numerous the psychological organization of every cottage, the sociometric saturation point for minority groups within them, the social history of the new girl, to mention a few. The greater the original affinity between the newcomer and the prominent members of the group the better will the newcomer be accepted by the whole group.
The psychodramatic realizations of suicidal or homicidal fantasies may give courage and prepare a patient to carry out the suicide in life itself. Such a patient may be already warmed up to the near action point when the treatment begins. The psychodramatist has to have, besides telic sensitivity, knowledge of the codes of alcoholics and drug addicts, as well as of prisoners in prison, in order to approach them effectively. Psychodrama and group psychotherapy are two independent developments. Contrary to unsophisticated opinion, psychodrama is the broader classification. Individual, “a deux", psychodrama is possible; it is an accepted and valuable form of psychotherapy, but obviously “individual” group psychotherapy is a contradiction. Individual psychodrama may be combined with psychodramatic group treatment in such cases where certain types of problems are not suitable for group revelation or when the patient feels the level of acceptance is not compatible.
One of the greatest of the methodological difficulties which the social sciences have had to face has been the discrepancy between verbalized behavior and behavior in life situations. The more fundamental and central a situation or relationship may be in family and marriage relationships for the individuals concerned, the greater is the social tension if such discrepancy arises. Psychodramatic procedure establishes a number of typical situations which are standardized for use in the various relationships which come under observation. These situations, of course, are based upon actual psychodramatic experience with many married couples. Psychodramatic treatment of marriage problems has emphasized the importance of the part played by hidden roles in the personalities of the two partners. Many cases of failure have been noted in which the cause could be traced to the emergence of the role, at a time which may be even years after the wedding.
This chapter discusses psychodrama to sociometry. The psychodramatic method uses mainly five instruments the stage, the subject or actor, the director, the staff of therapeutic aides or auxiliary egos, and the audience. Reality and fantasy are not in conflict, but both are functions within a wider sphere the psychodramatic world of objects, persons, and events. Delusions and hallucinations are given flesh and an equality of status with normal sensory perceptions. The architectural design of the stage is made in accord with operational requirements. The locus of a psychodrama, if necessary, may be designated anywhere, wherever the subjects are, the field of battle, the classroom, or the private home, but the ultimate resolution of deep mental conflicts requires an objective setting, the psychodramatic theatre. The psychodramatic approach deals with personal problems principally and aims at personal catharsis; the sociodramatic approach deals with social problems and aims at social catharsis.
The new era is one of multiple innovations which have set the pace for the developments in psychiatry. The theories of interpersonal relations, micrasociology, and sociometry and the theories of the encounter, spontaneity, and creativity have opened up vast areas of research in psychiatry, social psychology, and social anthropology. New methods of therapy group psychotherapy, psychodrarna, sociodrama, psychosomatic medicine, and psychopharmacology have been introduced. The ideas of the therapeutic society, therapeutic community, and the “open door” of prisons and mental hospitals are beginning to replace the older coercive methods of the management of prisoners and mental patients. A new body of theory has developed in the last thirty years which aims to establish a bridge between psychiatry and the social sciences; it tries to transcend the limitations of psychoanalysis and behaviorism by a systematic investigation of social phenomena. One of the most significant concepts in this new theoretical framework is the role concept.
Spontaneity is a readiness of the subject to respond as required. It is a condition a conditioning of the subject, a preparation of the subject for free action. Thus freedom of a subject cannot be attained by an act of will. It grows by degrees as the result of training in spontaneity. Spontaneity is a biological value as well as a social value. Historically there have been two avenues which led to the psychodramatic view of catharsis. The one avenue led from the Greek drama to the conventional drama of today, and with it went the universal acceptance of the Aristotelian concept of catharsis. The other avenue led from the religions of the East and the Near East. In the Greek situation the process of mental catharsis was conceived as being localized in the spectator a passive catharsis.
This chapter provides general introduction to Moreno’s ideas, designed for the newcomer to the field. The objective of psychodrama was, from its inception, to construct a therapeutic setting which uses life as a model, to integrate into it all the modalities of living, beginning with the universals time, space, reality, and cosmos down to all the details and nuances of life. Man lives in time past, present, and future. He may suffer from a pathology rekted to each. The problem is how to integrate all three dimensions into significant therapeutic operations. It is not sufficient that they figure as “abstract” references; they must be made alive within treatment modalities. The psychological aspect of time must reappear in toto. Freud, an exponent of genetic psychology and psychobiology, found going back and trying to find the causes of things of particular interest.
This chapter illustrates how the psychodramatist uses action techniques for diagnosis. It also discusses three techniques which are used today in psychodramatic work: the double technique, the mirror technique, and the reversal technique. These techniques in psychodrama can be significantly compared to three stages in the development of the infant: the stage of identity; the stage of the recognition of the self; stage of the recognition of the other. The double is a trained person, trained to produce the same patterns of activity, the same patterns of feeling, the same patterns of thought, the same patterns of verbal communication which the patient produces. Identification presupposes that there is an established self trying to find identity with another established self. Now, identification cannot take place until long after the child is grown and has developed an ability to separate itself, to set itself apart from another person.
The patient, Martin Stone, earne to Beacon for treatment, at times together with his wife, once a week during the summer of 1941. Two days after his second treatment session this dream took place. Its psychodramatic production was recorded by means of a recorder, and an observer in the audience recorded the actions and interactions between the dream characters. The objective of psychodramatic techniques is to stir up the dreamer to produce the dream instead of analyzing it for him. The first stage of the production was the dream which Martin actually had on the reality level on a specific date; then Martin was unconsciously his own producer. The stage of production was in the mind of the sleeper; the dreamer hallucinates all his auxiliary egos and auxiliary objects. The second stage of production takes place in a theatre of psychodrama; it is here that therapy beings.
The sociometric test requires an individual to choose his associates for any group of which he is or might become a member. The sociometric test is an instrument which examines social structures through the measurement of the attractions and repulsions which take place between the individuals within a group. In the area of interpersonal relations people often use more narrow designations, as “choice” and “rejection". Sociometry in communities and the psychodrama in experimental situations make a deliberate attempt to bring the subjects into an experimental state which will make them sensitive to the realization of their own experiences and action patterns. This conditioning of the subjects for a more total knowledge of their social situation is accomplished by means of the processes of warming up and by learning to summon the degree of spontaneity necessary for a given situation.
Psychoses can be treated by means of the psychodraina, but questions have been raised as to just how this treatment can be accomplished and what effect the psychodramatic treatment has upon the psychotic and his disorder. Freud distinguished between those mental disorders in which a transference from the patient to the physician can take place and those of such narcissistic character that no transference is possible. He declared persistently that psychoanalytic treatment can be applied only to patients who can produce a transference to the analyst. Consequently, as soon as he discovered that a patient was suffering from a schizophrenia or similar narcissistic disorder, he declined to treat the patient further stating that psychoanalytic treatment would do no good. The psychodrama actually functions as a milieu which will reflect that patient’s psychosis in such a way and on such a level that he can see his psychotic experiences objectified.
This chapter discusses autobiographical fragments. It also presents examples from Moreno’s own cases containing verbatim transcripts that illustrate the give-and-take between Moreno, his patients, and the audience observers. The chapter reviews Moreno’s life and ideas in the context of his time and in the field of psychotherapy. When he was very young the idea of death, his own death, never entered his mind. He was in direct communication with God. If love or comradeship should arise, it should be fulfilled and retained in the moment without calculating the possible returns and without expecting any compensation. It was in his work with the children that his theories of spontaneity and creativity crystallized. The two factors, spontaneity and creativity, went together. Also he found that whenever a child repeated himself in the playing out of an idea of a dramatic sketch, his portrayals became more and more rigid.
This book presents the best and most important writings of J. L. Moreno in one concise and accessible place. This unique collection explores Moreno’s thought in developing psychodrama and sociometry, with his strong emphasis on spontaneity and creativity. The book discusses both basic and advanced concepts and techniques of psychodramatic treatment. Jonathan Fox introduces the book with a brief overview of Moreno’s life and ideas and places him in the context of his time and in the field of psychotherapy. Fox’s notes throughout underscore significant aspects of the selections for the practitioner and student. The essence of sociometry lies in the idea that groups have an internal life of their own and that this life can best be understood by examining the choices members make at any given moment with regard to each other. The book consists entirely of protocols that show Moreno at work directing psychodrama and sododrama, and contains autobiographical fragments. One of the basic instruments in constructing a patient’s psychodramatic world is that of the auxiliary ego, which is the representation of absentee individuals, delusions, hallucinations, symbols, ideals, animals, and objects. The psychodramatic method uses mainly five instruments—the stage, the subject or actor, the director, the staff of therapeutic aides or auxiliary egos, and the audience. All group methods have in common the need for a frame of reference for assessing the validity of their findings and applications. Spontaneity is often erroneously thought of as being more closely allied to emotion and actions than to thought and rest. The sociometric test is an instrument which examines social structures through the measurement of the attractions and repulsions which take place between the individuals within a group.
As long as the nature of eugenic affinities is not established by biogenetic research, we shall assume two practical rules: that psychological nearness or distance is indicative of eugenic nearness or distance and that clinical studies of crossings lead to a preliminary classification of eugenic affinity. We may have to consider not only changes in the genes but changes between the genes whatever mutation may have taken place in a gene and for whatever reason, mechanical and chemical. If this mutation should be favorable the genes must be attractive to one another, that is, must correspond to changes in some other genes. In other words, the genes must be able to produce a functional relation; morphological affinities and disaffinities between them may exist. A definite relation may exist between gene effect, the reflection of one gene upon another and upon the individual characters, and tele effect.
The problems of industry are not merely those of machines, of technological processes, or of scientific engineering. An industrial conflict of various sorts is to be found merely in the definition of the dichotomous interests. The problem is one of human relationships the focus of attention must be on interpersonal relationships. It is for this reason that sociometry, which has grown out of clinical practice on human relationships, is so well adapted to needs of the scientists and clinicians working in the industrial situation. The interest in human relationships in industry on a large scale is rather recent. While economists wrote on the problem generations ago, while industrial psychologists have claimed a discipline for a generation, and while sociologists have been interested in group structure for half a century, the focus of attention by many disciplines in any concerted way has come about only in the last seventeen years.
The late arrival of group psychiatry and group psychotherapy has a plausible explanation when we consider the development of modern psychiatry out of somatic medicine. In a particular group a subject may be used as an instrument to diagnose and as a therapeutic agent to treat the other subjects. The doctor as the final source of mental therapeusis has failed. Sociometric methods have demonstrated that therapeutic values are scattered throughout the membership of the group. One patient can treat the other. The role of the healer has changed from the owner and actor of therapy to its assigner and trustee. But as long as the agent of psychotherapy was a particular, special individual, a doctor or a priest, the consequence was that he was also the medium of therapy as well as the catalyzer of healing power.
Psychodrama projects actual processes, situations, roles, and conflicts into an experimental milieu, the therapeutic theatre a milieu which can be as broad as the wings of imagination can make it, yet inclusive of every particle of our real worlds. Applied to the marriage problem, it opens up new vistas for research and treatment. By far the most conspicuous marriage conflict brought to the attention of the psychodrarnatic consultant is the triangle, or better, the psychological triangle of husband, wife, and a third party, man or woman. The training of an auxiliary ego, especially in marriage problems, is of great importance. The auxiliary ego must learn to detach himself entirely from anything in his own private life which might bias him toward one or the other of the marriage partners. Elaborate spontaneity training may be necessary before his own private conflicts cease to affect his function as an auxiliary in marriage problems.