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.

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.

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 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.

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.

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.

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.

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.

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.