INTEGRATING MORENIAN ROLE THEORY

AND COGNITIVE BEHAVIOUR THERAPY

WITH BABUSHKA DOLLS: AN EXAMPLE OF
HEALTHY ROLE DEVELOPMENT IN
INDIVIDUAL COUNSELLING

JO-ANNE COLWELL
2010

A thesis presented to the Board of Examiners of the Australian and New Zealand
Psychodrama Association in partial fulfilment of the requirements towards
certification as a Psychodramatist.
 Copyright Statement

This thesis has been completed in partial fulfillment of the requirements toward
certification as a practitioner by the Board of Examiners of the Australia and New
Zealand Psychodrama Association Incorporated. It represents a considerable body of
work undertaken with extensive supervision. This knowledge and insight has been gained
through hundreds of hours of experience study and reflection.

© Australia and New Zealand Psychodrama Association Incorporated. 2010

Copyright is held by the author. The Australia and New Zealand Psychodrama
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recording or otherwise save with written permission of Australia and New Zealand
Psychodrama Association Incorporated and/or the author.

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great care. However, the publisher is not responsible for any errors contained herein or
for consequences that may ensue from use of materials or information contained in this
work.

Enquiries:
PO Box 232, Daw Park, South Australia 5041, Australia
Contents

Abstract ............................................................................................................................... ii
Preface................................................................................................................................ iii
Acknowledgements ............................................................................................................ iv
Chapter 1: Introduction ....................................................................................................... 1
Babushka Dolls ................................................................................................................... 2
Structure .............................................................................................................................. 2
Chapter 2: A Theoretical Framework ................................................................................. 4
Overview ............................................................................................................................. 4
Cognitive Behavior Therapy ............................................................................................... 5
Relaxation CD..................................................................................................................... 7
Morenian Role Theory ........................................................................................................ 8
Development of Roles......................................................................................................... 9
Role Analysis: Progressive, Fragmenting and Coping Roles ........................................... 10
Central Organizing Factor................................................................................................. 11
Doubling and Mirroring .................................................................................................... 12
Doubling ........................................................................................................................... 12
Mirroring ........................................................................................................................... 13
Psychodrama and Projection onto Inanimate Objects ...................................................... 14
Summary ........................................................................................................................... 15
Chapter 3: An Illustration of the use of Cognitive Behavior Therapy and Psychodramatic
Role Theory in Individual Practice ................................................................................... 16
Shane ................................................................................................................................. 16
Setting the scene ............................................................................................................... 17
Background to Session One .............................................................................................. 17
Session 1 ........................................................................................................................... 17
Insights gained from Session 1 ......................................................................................... 18
Role Discussion ................................................................................................................ 19
Background for Session 2 ................................................................................................. 21
Session 2 ........................................................................................................................... 21
Discussion of Session 2 .................................................................................................... 22
Therapeutic Reflection ...................................................................................................... 23
Role Descriptors................................................................................................................ 24
Background to Session 3 ................................................................................................... 25
Session 3 ........................................................................................................................... 25
Discussion of Session 3 .................................................................................................... 36
Tracing the Progressive Role Development ..................................................................... 36
Next Steps for Shane ......................................................................................................... 37
Chapter 4: Implications For Psychodramatists ................................................................. 39
Role Dynamics .................................................................................................................. 40
The Significance of Doubling ........................................................................................... 40
The Mirror Position........................................................................................................... 41
Chapter 5: Conclusion....................................................................................................... 43
References ......................................................................................................................... 44

Diagrams
Diagram 1: Identifying the progressive element within the coping gestalt ...................... 20
Diagram 2: Fragmenting roles ......................................................................................... 20
Diagram 3: Identified emerging elements within coping gestalts .................................... 24

Figures
Figure 1: The Cognitive Behavioural Model ...................................................................... 5

Photographs
Photograph 1: The Babushka doll unpacked to represent Shane‟s internal roles ............ 35
 ABSTRACT

This paper explores an application of Morenian role theory and CBT to healthy role
development in individual counselling where Babushka dolls act as auxiliaries. A
theoretical framework exploring CBT, role theory and development, projective
techniques, and the techniques of doubling and mirroring provides a background to work
with a client. This work highlights the use of Babushkas as a projective device in a re-
storying of the clients early functioning. In this process the client is coached in
developing new perspectives on their role development. Recommendations for therapist
use are followed by a conclusion.

ii
 PREFACE

Throughout my years at university studying psychology and the scientific approach, I

have always felt that something was missing. People are more than just rational/
irrational cognitions and behaviors. We are all imaginative, playful, creative beings that
have the potential to alter the way we operate in the world. My work in the field of
disability highlighted the „creative genius within‟.

When working at RMIT University, Melbourne I had frequent conversations about the
use of psychodrama in the disability field. Faculty staff within the disability department
believed that cognitive behavioral techniques were the only effective techniques. After
repeatedly witnessing the link between awareness and new role development in children
toilet training, my intelligent creative genius enabled me to meld psychodrama and CBT.

When I entered into private practice, I developed ways of working psychodramatically.

In the beginning, I had a container of small animals, some dolls, crayons and paper. One
day there was a need to explain role development, I reached for my battered Babushka
and from there my use of role theory and Babushka dolls has expanded.

In essence, I have followed along the lines of this quote attributed to Jung:

“Learn your theories as best you can, but lay them aside when you touch the miracle of
the human soul.” (Schaefer 2003: 10)

iii
 ACKNOWLEDGEMENTS

Elizabeth Hastings introduced me to psychodrama in 1989. My passion for psychodrama

grew out of our work. My goal has been to become as good a Psychodramatist.

My husband and family have sacrificed many a weekend to my goal of becoming a

Psychodramatist and I wish to thank them for their patience and understanding. I owe my
writing supervisor Rollo Browne a debt of gratitude. I also wish to thank Ari Badaines
and Kate Hill for their supervision and Jean Mehrtens for being such an excellent coach.

iv
Chapter 1

INTRODUCTION

This thesis focuses on the combined use of Cognitive Behavior Therapy (CBT) and
Morenian role theory in individual therapy using Babushka dolls. Babushka dolls are
auxiliaries to the client and tools for the therapist/director. The question I aim to answer
is „What is an effective way to assist clients in developing an awareness of healthy new
roles?”

The Babushkas aid demonstrating role theory in an experiential manner: placed on a table
(stage) and moved around as needed. The client projects aspects of self onto the dolls.
New perspectives arise based on ideas drawn from CBT and Morenian Role Theory.
This is particularly helpful in my work with traumatized clients. Frequently adult
survivors are distrustful of the new and different; they will not engage readily at the
beginning of therapy.

Combining CBT and role theory adds an extra depth to both therapies. There is
flexibility within psychodrama that is lacking in more structured approaches. I have
found that melding CBT with role theory increases spontaneity and supports role
changes. For me there is a symbolism connecting the dolls to the healing work I do.
Sometimes when working with clients there is a need to peel back the layers, akin to
unpacking a doll.

The work with the Babushka's relies heavily on my belief of the creative potential within.
I believe strongly that we all have the capacity to develop healthier functioning. Often
the difficulties clients are experiencing arise from the roles they developed as children.
At the time the roles were often of assistance in the functioning of the child; however as
adults these roles may interfere with healthy functioning. We all posses the creative
potential to develop new roles and it is this potential that is the focus of my work. The
following quote reflects my approach;

1
 “A more realistic therapeutic procedure would be seen to be one which in accord
with Moreno, would leave clients “on a level which is as near as possible to the
level of their natural growth;” and one in which the counselor‟s role, in addition
to being permissive, activates the client and “stimulates his spontaneability” to
immediate production on action as well as on verbal levels”
(Hass; cited in Anderson & Anderson, 1951: 672)

Babushka Dolls

Babushka dolls are traditionally known as Russian Nesting dolls. The dolls are often
brightly colored and on average contain 6-8 smaller dolls. One can start with the surface,
which may be symbolic of the client‟s current role, and then unpack the dolls. When
explaining role theory for the first time I prefer to use the babushka with 12 dolls, the
smallest is like the tiniest embryonic role.

Structure

This thesis is structured with an Introduction followed by a Theoretical Framework, a

detailed Illustration of Client Work, Implications for Psychodramatists and a Conclusion.

The theoretical framework provides an understanding for the use of Babushka dolls, CBT
and Psychodrama. There is a brief explanation of; CBT and Benson's relaxation
technique, Morenian role theory, including descriptions of role analysis and role
dynamics, and an explanation of the techniques of doubling and mirroring. The chapter
concludes with a brief exploration of psychodrama and inanimate objects.

An illustration of my work is presented to assist the reader in visualizing the combination

of CBT and role theory using Babushka dolls. Shane is a father dealing with a number of
crises in his life. Chapter 3 contains a presentation of two summarized sessions and a

2
third detailed single session. The implications for future work are followed by a brief
conclusion.

3
Chapter 2

A THEORETICAL FRAMEWORK

Overview

Cognitive behavior therapy (CBT) is currently one of the preferred evidence-based

clinical approaches for funded therapy within Australia. Modern CBT has expanded
since its conception in the sixties to include behavioral rehearsal, relaxation techniques
and exercise. CBT has been evaluated in individual and group settings across a wide
range of mental health issues. The goals of CBT are to assist the client in altering their
thinking processes and behaviors in an attempt to alter their feelings.

Dr J.L. Moreno developed Role Theory as an integral underpinning of his

psychodramatic approach. Psychodrama is, in essence, a projective method using
dramatic techniques that allows clients to look at their functioning and develop a new
way of acting in the world. The client views their actions from a perspective of „roles‟
which are oriented toward healthy functioning and development.

Psychodrama and cognitive therapy are similar in that they view human nature as
essentially free and open-ended with regards to the future. Both are based on respect for
the power of human beings to choose beliefs and actions. Both Psychodrama and CBT
involve restructuring reality. CBT targets thought patterns while Psychodrama focuses
on generating new experiences and roles. In becoming aware of our thinking, we can
start responding from a new role rather than reacting from the old role. CBT is an easily
accessible way for people to start the process of becoming aware of their thinking and
hence a gateway to developing healthier functioning. Both therapies focus on identifying
the issue, exploring alternatives, either in action or verbally and reinforcing new skills.

Following is a brief outline of CBT and a relaxation technique. The key elements of Role
Theory, doubling and mirroring are reviewed. A brief section on the use of inanimate

4
objects for therapeutic purposes and a summary concludes the chapter.

Cognitive Behavior Therapy

Aaron Beck (1976) introduced the model from which Cognitive Behavior Therapy (CBT)
has evolved. Beck proposed that emotional problems could be alleviated by changing
thinking processes. Since then the cognitive model has expanded to include the roles of
physiology, behavior, environment, motivation and therapeutic processes (Simmons &
Griffiths, 2009). The basic CBT model focuses on four key elements of psychological
distress - thoughts, feelings, physical sensations and behavior - and the relationship
between them ( Figure 1).

Figure 1: The Cognitive Behavioral Model

Thoughts

Feelings Behaviours
(emotions)
Feelings
(physical
sensations)

The CBT model hypothesizes that situations in themselves do not cause psychological
distress; rather it is the way people interpret, make sense of and react to the situation.
People will experience distress if they construe a situation negatively, or react to it in a
negative way. CBT therefore aims to correct negative biases in thinking processes and
behavioral reactions (Simmons & Griffiths, 2009).

Psychological distress is often manifested physically. Anxiety usually produces marked

physiological changes, such as increased heart rate or shortness of breath. Another
element of psychological distress is behavior. This can include changes in activity levels
and avoidance, as well as coping strategies such as drug and alcohol use or self-harm.

5
The CBT model suggests that all these elements are related. A negative change in one
element can start a 'negative spiral' or 'vicious cycle', through the impact it has on the
other elements of psychological distress (Simmons & Griffiths, 2009). Cognitive
behavioral interventions aim at breaking this vicious cycle by creating positive changes in
one or more elements of psychological distress. Cognitive interventions aim to produce
changes in thoughts and beliefs, behavioral interventions to change behaviors, and
interventions such as breathing retraining and relaxation produce changes in physical
feelings. All of these interventions affect emotions indirectly. Cognitive work can be
helpful to challenge negative beliefs about emotions. Coping strategies for dealing with
overwhelming emotions are developed through behavioral interventions.

For CBT to be effective it is important that the client has a good understanding of the
CBT model and treatment rationale. Everyday examples from the client's life are useful.
The important point is that different thoughts can arise from the same situation, resulting
in different maintenance cycles. Illustration of 'helpful/positive' maintenance cycles as
well as 'unhelpful/negative' cycles assists the client in understanding that it is the
interpretation and meaning of a situation that makes the difference.

CBT can be the first step in assisting people to develop healthier ways of functioning. In
CBT terms, the thinking aspect can provide one 'way in' for changes to feeling or
behavior. For example; these things I am thinking are contributing to the way I am
feeling. If I change the way I am thinking, that will affect the way I'm feeling. If I
change, the way I'm feeling then that will affect the way I'm behaving. At the beginning
of therapy, the client may not have developed the capacity for objective self-reflection.
Part of the therapist's job is to assist with this development. Drawing attention to a
person's thinking styles, untangling them, viewing them from a different perspective can
spark the awareness necessary for change. CBT is accessible to a client often the
language is familiar. There are often no new concepts involved at this stage of therapy.
This assists with reducing client anxiety and increasing their ownership of ability.
Talking in terms of thoughts, feelings, and behaviors assists with developing a sense of
familiarity, safety, containment and can decrease client anxiety around their sense of

6
ability. The idea in the initial sessions is to help the client feel capable, heard, and
understood. In times of stress people forget that they can affect their thinking, they revert
to „old roles‟ and can often become stuck.

To assist the process I frequently provide clients with a relaxation CD, accompanied by a
homework sheet and instructions to note down comments about the day, exercise, and
listen to the CD. This approach to therapy is CBT oriented; focused on behavioral
change. The task serves three purposes; the client gains a sense of empowerment, a
reduction in depression/anxiety levels and I gain a sense of their commitment to the
work.

Relaxation CD

The relaxation CD includes a variation of Benson's breathing and thought stopping.

Listening to this CD assists with skill development in utilizing CBT. Clients are often
very anxious and reducing levels of anxiety assists them in being more open to
developing healthier functioning. Benson's relaxation technique based on Transcendental
Meditation; is a form of relaxation which has shown to improve physical and mental
health and reduce stress (Benson, 1977; 1984; Casey et al., 2004; Nystul, 1987). The
technique increases an individual's ability to make a 'relaxation response' in the face of a
stressor. Some of the psychotherapeutic value of the relaxation response is derived from
an increase in self-efficacy and a sense of control evoked by the proficiency obtained in
relation to physiological self-regulation (Carter & Cheeseman, 1988; Nako et al., 2001)

Mastering a relaxation response can result in an enhanced sense of 'mental calmness', a

sense of control and a reduction in negative thoughts (Benson, 1984). The thought
stopping component of the CD comes from the work of Albert Ellis (1970). The goal is
to have the client stop the worrying thoughts, relax, and replace the thought with a more
helpful one. Setting the task of listening to the CD daily achieves two things; the client is
building the required 100 minutes of practice to develop the ability to relax within three
seconds as well as increasing their awareness that they can affect their thoughts.

7
Morenian Role Theory

Role theory is one of the core theories Moreno developed to support his psychodramatic
method. His fundamental propositions include;
• “Role can be defined as the actual and tangible forms which the self takes… the
functioning form the individual assumes in reacting to a specific situation in
which other persons or objects are involved.” (Moreno, 1964:153)
Moreno believed that the individual consisted of roles that developed in response
to our relationship with the other.
• Each person is a Creative Genius. Role development involves people bringing their
spontaneity to areas of life in which growth occurs. Moreno‟s Theory of
Creativity-Spontaneity (Moreno, 1953) expands the concept of spontaneity, its
nature and place in human creativity.
• “Roles do not emerge from the self, but the self emerges from the roles” (Moreno,
1964:II). The many roles that a person experiments with and adapts, over time,
will coalesce into a set of roles with which they most identify.
• Roles emerge in relationship to people and objects. They are a dynamic interactive
expression of the person.
• A role has three components: thinking, feeling and action. When these components
align, the role is congruent. Often therapeutic work involves bringing out the
under-developed part of the role.
• The therapeutic techniques of doubling, mirroring and role reversal significantly aid
role development. These techniques are fundamental to Moreno‟s Spontaneity
Theory of Child Development (Moreno, 1964) which outlines the Stages of the
Double, the Mirror and Role Reversal and emphasizes the role of spontaneity in
human development.

For our purposes, the aspects of role theory that are most relevant to my work are:
• the development of roles in early life, particularly when a role emerges for the first
time,

8
• role analysis, progressive, coping and fragmenting roles,
• the central organizing factor in a person‟s role system (Reekie, 2007), and
• the techniques of doubling and mirroring.
These are expanded below. Readers wishing to explore Moreno‟s Theory of
Spontaneity-Creativity and The Spontaneity Theory of Child Development further please
refer to Moreno, 1953 and 1964 respectively.

One of the powerful aspects of Moreno‟s concept of role is that it is practical, aimed at
assisting people to reflect on and change their own beliefs about themselves and their
behavior. Primarily this is done through dramatic enactment on a stage where a client
can experience the roles they take and practice new roles. This idea is mirrored in the use
of the Babushka dolls. The client is able to reflect on and change their own behavior and
beliefs about themselves.

Development of Roles

Roles develop at different stages in a person‟s life, in response to different situations,

environments and the people that surround them. The psychodramatic theory of roles
takes into account three types of roles: the Psychosomatic, the Social and the
Psychodramatic.

Role development begins in the preverbal stages of development and continues

throughout the individuals‟ lifespan. Every role from conception onwards is interactive
and develops in a particular context. "Every human act or performance has a primary
action-pattern, a status nascendi" (Moreno & Moreno, 1977:58).

Moreno proposed that every role has a moment of creation (the locus of role). The
person manifests a specific response to the stimuli present (the matrix of the role) and
there is a specific moment when the response emerges (the status nascendi of the role)
(Jefferies, 1998: 197).

9
These concepts are reflected in Bustos' approach to the psychodramatic method;
• A clear, specific determination about what is wrong and what has to be put right
• An investigation of the locus or group of conditioning factors where this something was
created.
• An investigation of the specific determining response that the person made to the
stimuli that were present, ie. the matrix.
• An investigation of the specific moment when this response emerged, i.e. the status
nascendi
(Bustos, 1994: 66)

Role Analysis: Progressive, Fragmenting and Coping Roles

First, Lynette Clayton, and subsequently, Max Clayton, significantly contributed to

Moreno‟s role analysis. Moreno‟s original role categories (well developed, under
developed, developing, conflicted and absent) were superseded by an analysis of roles as
„progressive‟, „coping‟ and fragmenting ' (L. Clayton 1982; M. Clayton 1994).

Lynette Clayton expanded the concept of roles to include role clusters hypothesizing that
roles clustered into three gestalts, „neurotic‟, „coping‟ and „individuated‟. Each gestalt
has a central identity or autotele that acts as the integrating force for the role cluster. The
neurotic gestalt represents the unresolved pathological aspects of the parent's personality
combined with the role responses of the child. The coping gestalt represents the best
means of coping the person has learned in the family system. Drawing on the work of
Karen Horney (1950), Lynette identified three different types of coping strategies:
moving towards, moving away and moving against. The roles are modeled after the
problem and crisis solutions demonstrated by parents and significant others. The third
gestalt, the individuated, consists of the roles, which draw together themes in the person's
life. These roles provide solutions to the paradoxical polarities i.e., good/bad,
power/weakness, action/contemplation etc. (Clayton, L. 1982: 113).

Max Clayton (1994) based his approach to role analysis on these three gestalts adding

10
subcategories. The progressive functional gestalt which includes subcategories for well
developed and developing roles is an expanded view of the individuated gestalt The
coping gestalt, following Lynette Clayton's work (1982) includes sub categories of
moving towards, moving away and moving against. The fragmenting dysfunctional
gestalt is the equivalent of the neurotic gestalt and includes subcategories for diminishing
and unchanging roles. This expanded system for role analysis encourages an
understanding of the flexibility of roles and their fluid manifestation. For example, a
person who relies on only one means of coping tends to develop a narrower range of
personality functioning as compared to a person who can move either toward or away or
against. This framework allows the therapist to see the appropriateness, creativity and
effectiveness of role changes over time.

An example of the fluidity of roles is that of a child growing up with unpleasant or

defining experiences. All experiences involved in growing up influence the roles an
individual develops. When children experience stressors, a number of the roles they
develop are orientated toward protection of the self. These well-developed protective
roles at the time may be considered progressive; that is, they were the desired roles for
healthy functioning of the child. However as the child grows and their environment and
situation changes these roles are no longer useful and often become detrimental to the
person‟s functioning. These roles may now be considered fragmenting. Fragmenting
roles are developed for survival, typically in the family of origin.

Central Organizing Factor

Role theory allows us to work with a person in the moment. We can describe a person
systematically, observe and analyze the person‟s responses in a thoughtful manner. In his
approach to role dynamics Don Reekie (2007) suggests that if we focus only on the

presenting behavior, we can reduce our awareness of the uniqueness of the person. In

particular, we may limit our appreciation of the progressive element at the heart of a
coping role system. If we identify the central organizing factor behind a person‟s

11
functioning then we gain a deeper appreciation of the „whole person‟ and can work with
the embryonic progressive elements. The environment in which the role is developed
needs to be considered whenever examining a role. Missing the progressive aspect in the
situation in which a particular role developed can lead to a limited perception of a client.
Working with role dynamics goes beyond naming the role and supports the therapist to
expand their perception to include the where and how of role development. This assists
with working in a nonjudgmental way. The therapist works with the health rather than
the dysfunction of the client. Role dynamics searches within a role for the healthy
response that was the origin of that role. This grants access to the 'creative genius' of the
individual. When working with the spectrum of presenting roles always look for the
progressive elements, or embryonic roles that will contribute to the repair of
psychological social atom (Reekie, 2007).

These embryonic roles contribute to the central organizing factor of the individual. The
central organizing factor of an individual is informed by their core values, ethical
imperatives, personal goals, and commitment to relationships and community. This
uniqueness of being is encapsulated in each individual. In times of stress, this essence is
hidden within coping gestalts or buried by fragmenting gestalts. It is extremely helpful
for the therapist to generate working hypotheses about the client‟s central organizing
factor to guide the development towards progressive functioning.

Doubling and Mirroring

Doubling and mirroring are extremely powerful psychodramatic techniques. Both

techniques evolve from mother infant interactions where the mother attunes and responds
to the infant. The ability of the therapist to double enhances the client‟s expression of
their inner world. The use of mirroring assists the client to develop self-awareness, a
critical part of the therapeutic process.

Doubling
The technique of doubling gives expression to the protagonist's unexpressed

12
thoughts/feelings. Doubling consists of the therapist (or auxiliary in a group setting)
playing the part of the inner self of the protagonist, for example, Sam. In a psychodrama
enactment, the double becomes a second Sam, taking on the thoughts, feelings and
behaviors' of Sam. What you see on stage are two people who represent one person. The
double echoes the physical position of the person and tries to speak out the internal
reality of the protagonist (Karp et al., 1998). The double becomes a voice that ensures
expression of the protagonist's inner feelings. The double assists the protagonist to the
threshold of his own experience (Dayton, 1994). In the case of revisiting traumatic
material, the double can assist the protagonist in having a voice in a situation where
previously the protagonist may have been powerless. The double can assist the
protagonist to stay „in his body‟ if they have previously dissociated (Dayton, 2005). An
accurate double feels like an inner ally supporting the protagonist through her presence
and understanding. This assists the protagonist to feel and integrate emotions that may
have been split out of consciousness because, at the time, they were too difficult to deal
with (Dayton, 2005).

Doubling enables the therapist to stay 'in touch' with the client, assisting them to
understand how they may have developed particular roles, adjusting the explanation to
more accurately reflect the client's experiences. The impact of doubling (whether done
on a stage or not) is to deepen a person‟s sense of self worth (Clayton 2003 workshop
notes).

Mirroring
The technique of mirroring allows the protagonist to view himself „as if in a mirror‟.
This involves the use of objects/auxiliaries to represent aspects of their internal world in a

concrete or tangible form and having the client step away and look at it . The protagonist

is in the mirror position where they can view the scene from the outside. As a result,
mirroring develops self awareness in the client, a significant step in the therapeutic
process.

The mirror technique is useful when working with someone who has become role-bound

13
or glued, as it were, into an emotional or psychological position from which they cannot
get loose (Dayton, 2005). The distance provided by this technique is particularly useful
when working with trauma survivors. The mirror allows for emotional safety and is used
extensively in the Therapeutic Spiral (Hudgins, 2002). Working with puppets, soft toys
and babushka dolls also allows the protagonist in a one-one setting to work from the
mirror position to see their inner world represented externally. This involves a projective
process.

Psychodrama and Projection onto Inanimate Objects

Projection is an accepted therapeutic process used in many expressive therapies, such as

Play Therapy, Drama Therapy, and Art Therapy. For this paper, projection is the process
of imbuing objects with meaning. This is distinct from the psychoanalytic process of
projection, which involves splitting off unwanted parts of the self and projecting them
onto others.

In this first sense, psychodrama is fundamentally a projective method. As such it

explicitly invites the client to create their world on the stage. The point of projection is to
release these aspects from the client‟s internal world so that the client can see, interact
with, examine, rearrange, and alter them as part of the therapeutic process. Moreno in
part based his methods on the observation that making concrete and interacting with
one‟s inner world was fundamentally cathartic (Marineau, 1989).

Working one-to-one, dolls, puppets, cushions and other inanimate objects are used

instead of auxiliaries. The protagonist projects aspects, roles, onto inanimate objects.

The inanimate object is treated as if it is taking on the role.

Children usually have no difficulty playing many roles and in changing roles frequently
(Bannister, 1998; Crane, 2000; Hoey, 1997). Adults can be more self-conscious about
changing roles. Many adults may be hesitant to step onto a stage and to ease this tension,

14
both Bannister (1998) and Raimundo (2002) use small figures on a table. Karp describes
using Babushka dolls to focus on developmental blocks that prohibit spontaneous
expression (Holmes et al., 1994). In all cases, the therapist helps the work progress by
suggesting role-reversals and by eliciting the feelings behind the words and actions
(Bannister, 1998). The therapist remains fully sensitive to the person‟s needs, just as a
director in a classical group psychodrama must do.

Summary

The theoretical framework provided is to support the reader with a background that
complements the following illustration of work with a client. This framework is by no
means the complete story; however, the scope of this paper is limited. The aspects of
cognitive behavior therapy, role theory, role analysis and role dynamics, doubling and
mirroring described above will assist the reader in understanding how Babushka dolls,
CBT and role theory are combined to develop awareness in the client of healthier roles.

15
Chapter 3

An Illustration of the use of Cognitive Behavior Therapy and

Psychodramatic Role Theory in Individual Practice

Shane

This chapter consists of information relating to three sessions with a client, Shane. The
descriptions of the first two sessions are brief; they form the backdrop to the third
session, which is the focus of this chapter. There is an introduction to three sessions,
followed by brief descriptions and reflections. A detailed discussion follows the third
session.

The Australian Medicare Better Access Scheme gives Australians access to a government
rebate for up to 12 psychology sessions (18 in exceptional circumstances) per year. The
psychologist is expected to work with Focused Psychological Strategies (evidence based
therapies), such as CBT. Shane attended under this scheme.

When working with clients I develop a hypothesis about their central organizing factor.
For Shane I start with the roles that have brought him into the therapy room. Here is a
man highly distressed, on the verge of giving up on life yet he manages to find his way to
the psychologist. Here is a man orientated toward survival. As Shane's story emerges,
we glimpse aspects of his functioning. Shane is orientated toward; living a more
meaningful life, understanding his functioning and altering the way he is in the world and
interacting with his children in a meaningful manner, being the best father he can. I
begin to sense that Shane's central organizing factor might be: a man determined to make
the most of his life, provide the best role modeling for his children, to live a fuller more
meaningful life.

16
Setting the scene

Background to Session One

The first session determines whether a client returns to therapy. Rapport building and
history gathering are the cornerstones of this session. I need to gain a sense of what is
happening with the client. This forms the beginnings of a treatment plan. In the
background of my mind is the 12 session Medicare limit. CBT and role theory meld to
form the basis of my therapeutic approach. The questions that I hold stem from this
mixed approach.

What can the client achieve in 12 sessions that will have maximum healthy impact?
What thinking styles are involved here? (A CBT question)
What is the central organizing factor within this person‟s role system? (A Morenian
question, after Reekie, 2007)

Session 1

Shane is very anxious about being in the room. He wants to know if I am "up to the job".
The doctor has mentioned "this CBT stuff" and Shane is so desperate he is willing to try a
psychologist. Shane states the he does not really believe that talking will have an effect
but here he is. He does not have much time or money to waste and he wants his problem
fixed as quickly as possible. Shane then proceeds to fire questions at me. I feel as if I am
being interrogated, not just interviewed for the position! Shane is perched on the edge of
the couch, his body held very tightly. He looks as if he will flee the room at any moment.
I answer Shane‟s questions calmly and honestly and he relaxes slightly, sitting back on
the couch. Very gently, I start asking Shane questions. Initially Shane is very guarded
and provides limited responses to my probing. As the session progresses Shane‟s guard
slowly drops.

Shane is 52 years old and has recently; lost his job, contracted a debilitating infection
whilst in Bali and his wife of 30 years is leaving him. Shane says "I feel like a failure;

17
everything is fucked”. Shane worked in the transport industry and spent most of his
married life away from the family home. Shane reports that he was often tired and
irritable due to the shift work nature of his job. Shane has three children, 10, 12, and 15.
Toward the end of the session, Shane reveals that he has been having suicidal thoughts.
Shane has a suicide plan but has put it on hold to see if this "talking stuff" can help.
Shane verbally agrees to stay alive until the next session and commence walking on a
daily basis.

Insights gained from Session 1

Shane's presents as highly distressed and anxious, he is not safe in the world and seems
unsure of how to cope. I pay attention to his role functioning. At the beginning of the
session, Shane appears strongly oriented to thinking. He seems unaware of his own
anxieties and is determined on interviewing me for the position of 'fix it' person. My
initial warm up is to Shane's body language which is not congruent with his words. He is
very anxious, desperate, tense, his body is „perched‟ on the chair, and is ready to flee at
any moment. Combined with Shane's words this is an indication to me that he is not
connected with his feelings. Shane has demonstrated this in his aggressive interrogation
approach, “What can you offer me?” Shane is scientifically orientated and not open to
'those touchy feely therapies'. I tentatively conclude that Shane is using the interrogative
questioning to protect himself from the inner torment he is feeling. He is unsure of his
place in the world and terrified of his feelings. Shane is unable to trust his instinct or
'inner guide'. He is full of self-doubt and self-loathing.

Shane's presentation and expectations influence my decision regarding therapeutic

approach. I am thinking in role terms and CBT. Due to Shane's need for a quick fix, his
high levels of distress and his factual approach to life I decide to commence with CBT. I
believe that if I were to mirror or double Shane's level of apparent distress it would
potentially alienate him. Shane has made it very clear that he is not open to feelings. .
Shane is operating from a coping gestalt organized around thinking. To assist with
increasing Shane's spontaneity, I model calm whilst questioning him and explaining

18
CBT. The CBT is what his GP suggested trying. I agree with Shane about using CBT
and also inform him that I use other modalities as well. Shane is not interested in hearing
them and I do not expand. I am aware that engaging this man where he is in the moment
will increase the likelihood of his returning for a second session.

Shane responds to this approach, his anxiety has reduced enough for him to sit back on
the couch and answer my questions. Shane's levels of spontaneity are increasing.
Engaging Shane in this manner enables him to reveal his suicidal thinking. Shane is
exceptionally distressed; he is talking about taking his own life. Shane talks about the
suicidal thoughts; he does not mention feelings at all. There is a shift in Shane's body
language at this point; it is as if he has let out a huge sigh without the noise. This is the
real reason he is here in the room and it terrifies him. He does not expand on this
extreme distress however, I am aware that it needs to be reduced as quickly as possible. I
value Shane's disclosure and do not probe for further information; we are at the end of the
session. I am aware that the distress involves pain and fear and that the fear is severely
reducing Shane's level of spontaneity

By the end, the session Shane's level of distress has decreased and his level of
spontaneity has increased to a point where he is willing to undertake the set tasks.
Shane's agreement to walk and stay alive is an indication that Shane is orientated to
survival. What becomes clear to me during this session is that within Shane is an
embryonic role orientated toward changing his approach to life, determined survivor.
When Shane relaxes and answers questions, I glimpse his progressive roles. Working
with the focus on healthy role development, I gain some insight into Shane‟s central
organizing factor.

Role Discussion

To assist with forming a therapeutic hypothesis I hold in mind Shane's role development.
What roles are present here in the therapy room? What might they imply about his
functioning in the wider world? What roles are missing, under or over developed? These

19
therapeutic hypotheses are very fluid and alter as more information is gained over time. I
constantly strive to recognize the progressive elements within the apparently
dysfunctional „now‟. I have observed that embedded in fragmenting or coping roles there
are progressive elements.

Diagram 1 illustrates some of what I observed in the first session with Shane. In the first
column, I present coping gestalts, or ways of being, I observe in the therapy room. In the
second column are the motivational aspirations that I think Shane is trying to achieve in
each coping gestalt and, lastly, the progressive embryonic elements embedded within
these gestalts. From these progressive elements, I can begin to clarify the central
organizing factor around which his behavior is organized.

Diagram 1: Identifying the progressive element within the coping gestalt

Coping Gestalt Motivational Progressive Embryonic

Aspiration Elements

scientific yearner for a

understanding different way of
precise to find relief
interrogator living/ determined
from torment survivor

determined need to find seeker of a

problem healthier healthier
solver solutions life

I also identify two fragmenting roles, Diagram 2, that overshadow Shane‟s coping
gestalts. This role analysis is tentative, I have just met Shane but these observations
influence my choice in how I work with him.

Diagram 2: Fragmenting roles

suicidal terrified hider

despairer from internal
turmoil
20
I do not share these insights with Shane, to do so would cut across his warm-up. I store
this information away and during the ongoing sessions, I add to and refine this
information. I will share with Shane when the moment presents itself. Shane's
presenting fragmenting roles have affirmed to me that CBT is the starting point in this
case. This is reaffirmed when Shane starts to relax and agrees to walk. At the end of this
session, I am aware that Shane's central organizing factor is orientated around living in a
different manner. Currently I lack enough information to expand on this hypothesis.

Background for Session 2

When working with clients I hold in mind a general goal; for Shane reducing his levels of
depression and anxiety. I also respond to what is occurring in the present. This is part of
my psychodramatic thinking. Clients are more responsive if they can work with what is
occurring „right now‟ in their lives. I am constantly reassessing where the client is in the
therapeutic process and responding to those needs.

The second session with Shane will commence with a review of his week. In this
session, I am looking for indications of his willingness to change, and awareness of his
own self-talk. At the same time I am building up my experience of Shane and his CBT
cycle of functioning (the causal loop of thought/ feeling/ behavior, see Figure 1) to assist
with unlocking his thought patterns. I also seek changes in spontaneity and role. This
means paying attention to the nuances of his body as well as his words.

Session 2

Shane has arrived early for his appointment and appears eager to commence. I assist in
developing Shane's ability to reflect by asking about his week. Shane replies; he has
commenced walking daily. He claims that this has helped, he feels less suicidal but still
feels like his life „is fucked‟. Shane expresses that everything is his fault. He tells me

21
that he cannot stop thinking this. Shane is quite agitated at this stage and is firmly
convinced that he is a total failure at life. I explain a simplified version of CBT (refer
Figure 1). Responding to Shane's need for a scientific approach I start with the
possibility of Shane changing his self-talk. This line of action appeals to the role of
determined problem solver, identified in the previous session. I relate back the positives
about Shane‟s situation, he owns his house, he has previously provided for his family, he
is exploring his employment networks and he is working on recovering his health. I am
mirroring the positive elements in Shane's life; speaking to the embryonic role of
determined survivor. I am developing Shane's ability to reflect on his current
circumstances in a healthier manner. I suggest we listen to the relaxation technique 1.
Shane agrees to do this if it will help. Shane is far more relaxed after listening to the CD.
Shane‟s tasks for the week are to listen to the CD and walk daily.

Discussion of Session 2

I was surprised at Shane's early arrival; he had been so critical in session one. Perhaps
this is an indication that there has been a role shift. A therapeutic rapport is being
developed and the possibility of change has been strengthened. Hearing that Shane has
taken up the recommended exercise heartens me. Shane is committing to his recovery
and willing to put into action the suggested activities: another clue relating to a role shift.
However Shane‟s thought patterns worry me: if he continues to think everything is his
fault his recovery will be impeded. This is an indicator for continuing with CBT.
Shane's underlying terror, relating to his feelings assists in my reassessment of where to
start. I am aware of a need to tread gently yet proceed with haste. Using the most
familiar terms will assist in settling Shane's anxieties. Shane has pushed his feeling
world away because it is too difficult for him to cope with therefore it is safer and more
familiar for Shane to commence the work with thoughts; thus CBT.

1
In 1996 as part of my Graduate Diploma I made a relaxation CD for children with uncontrolled epilepsy.
The CD consists of Benson’s Breathing, a visualization involving dolphins and a thought stopping
technique.

22
Reflecting the positives in Shane‟s life helps him see that things are not as bad as he
thought. This assists with further developing the embryonic role of determined survivor.
I am valuing Shane's progress. I hope that Shane‟s thinking will shift from, „I‟m stuffed,
it‟s my entire fault‟ to „things are not as bad as I thought‟. Mirroring Shane‟s skills and
abilities will assist with the progressive role development. The seeds for the new role of
determined survivor have been uncovered and growth has begun.

Therapeutic Reflection

Shane's eagerness to enter the therapy room is evidence of a reduction of his anxiety and
an increase in his levels of spontaneity. The change in Shane's presentation is amazing. I
am conscious that last week this man was suicidal. Gently I reflect back these changes,
and wait for what emerges. Shane's suicidal ideation has reduced. There is a possibility
of change and perhaps death is not the only way out of this terrifying situation. These are
fantastic role shifts and help support my hypothesis regarding his central organizing
factor. To meet Shane's requests for ongoing progress we listen to the relaxation CD.

The relaxation technique is very useful. Frequently clients think thoughts are outside
their control. The idea that they can change the thoughts is often foreign. Clients receive
a „homework‟ sheet at this point. The sheet has a Likert scale of 1-5 for mood; 1 is very
sad and 5 is very happy. This is for tracking compliance with listening to the CD,
exercise, reflection and general mood state. This sheet can provide a wealth of
information. If the client completes the sheet then information about progress, coping
roles, antecedents etc. is gained. Recording is part of CBT; it is the equivalent of data
collection. Shane brings back (Session 3) information about his mood state as well as his
exercise.

Session 2 has been rich, full of insights about Shane‟s role system as well as meeting
needs to be productive and „not waste time‟.

23
Role Descriptors

Throughout the session, I have been adding to my awareness of Shane's role system. I
have not shared this with Shane. The session focus is on the relaxation technique and
Shane's issues. I am conscious that rapport is still fragile and Shane's need to work in a
structured manner is honored. I file my observations strengthening my new belief that
part of Shane's central organizing factor is orientated toward healthy living. I have
presented the emerging roles that assist with building my therapeutic hypothesis about
Shane (Diagram 3). These roles are added to my internal image of Shane. I am able to
double Shane and mirror his achievements from a place of genuine support. This in turn
encourages Shane to reflect on his successes in life rather than focusing on all that has
gone wrong.

Diagram 3: Identified emerging elements within coping gestalts

Coping Gestalt Motivational Progressive Embryonic

Aspiration Elements

Eager desire for believer in

seeker of improvement a new
support in life reality
turmoil believer in
a new
reality
turmoil
reluctant strong reality believer in
reflector of checker ability to
achievement protecting self succeed
from failure turmoil
turmoil

These emergent progressive elements support my hypothesis about Shane's central

organizing factor. Shane desires to live differently in the world. He does not want to
remain self-critical; he wants to derive pleasure from his life. I continue to build a rich
picture of Shane's functioning. He is engaging more deeply in the therapeutic
relationship. I am conscious that working with his thoughts, relaxation and exercise, to

24
mobilize his body, allows reduction in his nervous tension. I am hoping to work with an
increased level of feeling however; I am conscious that this will need to done in a
structured way.

Background to Session 3

Shane left the previous session with two new skills to develop, the relaxation technique
and thought stopping. I am hoping that Shane has listened to the relaxation CD and he is
becoming more conscious of his thinking patterns. The thought stopping component on
the CD helps increase client‟s awareness of their thoughts. Combining this with the
exercise may decrease Shane's level of suicidal ideation. The relaxation technique and
exercise will reduce his levels of nervous tension, in turn allowing for an increase in
spontaneity and connection with his feelings.

Session 3 is presented with client-therapist dialogue. This session highlights the shift
from CBT to a Psychodramatic approach. The dialogue is broken by reflective therapist
comments in italics.

Session 3

Shane practically bounced out of the chair when I came into the waiting room. He smiled
at me, his posture was stronger than before and there was a spring in his step as he moved
toward me. There is a significant shift in Shane's levels of spontaneity. I am amazed at
the changes however, I still hold in mind that last week Shane was struggling with
suicidal thoughts. Shane starts the session with good news about the infection and is
“cautiously optimistic” about his recovery process. He also talks about an insight he
experienced that morning. Shane is warmed up to relating this insight.

Shane: “I was walking my two small dogs when up ahead I could see a large dog
behind a fence. I thought „Oh, no here we go, the dogs will bark and there
will be problems getting past‟. I then became anxious about walking past the

25
 dog but continued and my two small dogs went past the large dog. To my
surprise there was no barking, in fact my dogs just continued walking past
and the large dog took no notice of my little dogs. Once I was past the dog I
realized that it had not gone as I had imagined. I thought about this and my
feelings of anxiety and wondered how often I have done something similar.
That is; predicted a negative outcome regarding a particular situation”.

This was the first time Shane had become aware of his negative thought patterns. This
awareness can be the first step in developing a new way of responding in the world. For
me this is part of new role development, he is responding from the new role rather than
reacting from the old role. I am very excited about Shane's insight but contain my joy
and remain the intrigued attentive therapist. Shane is very surprised about his thinking
style.

Shane: “Where do the thoughts come from, where did I learn to think this way?” ......
.....“ I have been doing this forever.”
Therapist: “Well, not forever, it is something you have learnt, an old role.”

This is the first introduction of an unfamiliar term, 'an old role'. Shane is unsure of my
response and I am aware of a need to keep his levels of spontaneity up and engaged with
the shift in therapeutic approaches. Shane does not know it yet but we are about to enter
into a world where feelings are included.

Shane looks at me. We have not previously talked about psychodramatic concepts. The
previous two sessions were focused on reducing Shane‟s anxiety, suicidal ideation and
strengthening his belief that he can cope.

Shane: “This question is very important to me. How long have I been thinking this
way? I need to know!”

26
I sit and think for a moment. Shane has expressed his thoughts with deep feeling; there
has been a dramatic role shift towards progressive functioning. He is no longer
operating from a coping gestalt that is organized around defensive thinking. Here is a
man that so intent on productively using every second of each session: he does not want
to „waste his time‟. In fact, in the first session he practically interviewed me for the job!
What is the most concise way to explain this to him?

For me Shane's warm-up to his insight is an action cue for using psychodramatic
methods. Shane wants answers. Yes, he is warmed up however I am conscious that he
wants answers fast. I am hoping to educate Shane in a manner that provides solid
foundations for continuing development. Psycho-education is the goal now. For me in
the therapy room this is the first step toward future dramas. I choose to use guided
restorying as a warm up. This is a gentle way of engaging very distressed clients in the
work. They are in control; they are operating within safe parameters. This allows for
their spontaneity to remain high and role development to continue.

I look at him and as I reach for a Babushka doll, asking …“A male or female one?”
Shane: “Male”
I proceed to unpack the doll until I am down to the smallest one inside.
Therapist: “That‟s the problem with these one‟s they never go down small enough. I
prefer unpacking to the tiniest baby size when explaining role theory for the
first time.”
Shane: “Well, if we are going to do this we may as well do it right, which one is it?”
Therapist: “The red one on the far left.”

I have consciously chosen to proceed in this manner. I am being slightly cheeky and
lighthearted. I am instilling a sense of playfulness into the situation to help ease Shane
into 'playing' with dolls. I am also increasing his awareness that I am explaining role
theory and that it is important to start at the beginning of life. I have learnt that doing it
this way helps increase the warm-up of the client and they become fully engaged in
projecting onto the dolls; working from the mirror position. This is a significant

27
departure from traditional psychodrama; I make the selection of dolls. I have found that
doing so provides a safe transitional step. My motivations are multipurpose; I am not
fully aware of the client‟s history and I wish to avoid triggering the person, particularly if
they have a trauma history. Often people with extreme anxiety have difficulties making
decisions and at this stage asking them to make choices around the dolls may; increase
their anxiety and unhelpful self thought, as well as decreasing their levels of spontaneity
and thus involvement in the therapeutic process. I am also conscious that Shane has a
suicide plan, that it is early days in the therapeutic process and I do not wish to alienate
him. During this interaction, there has been an increase in Shane's curiosity as well as a
lessening of his tension. He is now leaning forward eager to engage in this process; his
spontaneity is high, Shane is warmed up sufficiently to maintain the shift from thoughts to
feelings.

Shane leans over and picks up the red doll.

Whilst unpacking the dolls I launch into a client tailored version of role theory.

Therapist: “Roles are developed in response to situations. In children, in particular,

some roles are orientated to keeping them safe and may be healthy roles.
However as we grow into adults some of these roles are no longer so healthy,
sometimes they get in the way and interfere with relationships. It is important
to remember not to judge roles, they develop in response to situations. We
are always developing new roles. There are three kinds of roles; the
psychosomatic, which is expressed in the body, the social, for example the
police officer and the psychodramatic, that‟s the individual expression of the
social role, for example a mother acting as if she was an angry policeman.
There are three components to a role as well, thinking, feeling and action. If
these are not congruent then you can feel slightly anxious, not too sure of
what you are doing. When you are fully in role then the thinking, feeling and
action are congruent. We develop roles right from the beginning.”

28
Therapist: “Imagine this is the baby you, you have the potential to be anything, do
anything.” I say as I pick up the smallest doll in the set.
Shane: Looking slightly skeptical at first then nodding his head, “Yes in that moment
of birth we do, then things happen.”

This comment is a marker for me that I store away; there has been a definite shift in
Shane. He is aware that 'things happen'. Now however is not the time to enter into this
branch, or scene, we are answering Shane's initial question and I am conscious that
working with the somatic preverbal roles of the infant can be very challenging work.
This work is often left for a later stage in therapy when the client is more robust, well
placed in their new roles, rather than at the beginning of the therapeutic journey.

Therapist: Nodding: “Yes they do. For instance if you have a mum who has postnatal
depression you develop a certain cluster of roles. Mum might be able to meet
your physical needs, but she might not be able to meet your emotional needs.
You miss out on the emotion interaction.”
Shane: Looks at me quizzically.
Therapist: “A cluster is a group of roles that act together. In this instance, mum cannot
meet your emotional needs, she can feed you and change you, but babies need
emotional interaction as well. If mum can‟t provide that then baby may miss
out and as an adult this can cause problems in expressing, feeling emotions,
and staying connected in relationships.”

I am building a story with feelings involved, that we are not just thinking beings; we are
emotional beings.

I look at Shane to see if he is following my thoughts, he is intently focused on the dolls.

Therapist: “The first roles that develop are the psychosomatic roles; they are in the body,
e.g., the baby expressing hunger. Then as the baby interacts more roles
develop.” I move the second smallest doll out in front of the baby. “When
we go off to kinder we develop a range of roles dependent on how we are and

29
 our experiences. You may have been very social or perhaps you were
bullied.” I move the third smallest doll out.
I look at Shane to check for a response.
Shane: Flicks a hand as if to say, “continue”.

Shane is yet to enter the story as his own. He is watching to see if it has enough truth.

Therapist: “At kindergarten children learn how to interact with one another and their
experiences, the situation, contributes to the roles they develop. Some
children are very sociable while others hang on the fringes. Their behavior is
influenced by what has come before. The roles they have developed in
relationship to their immediate family.” I shift another doll out to the front.
“We go off to school and our responses are affected by our previous
experiences and we develop more roles, e.g., the studious student or if you
were shy, perhaps the reluctant socializer. The roles we develop are
dependent on our experiences.”
Shane: “I was shy at school.”
I look at Shane and smile whilst moving a slightly larger doll out.

Shane has started to enter into the story, he is projecting himself onto the dolls. His
voice is full of reflective feeling.

Therapist: “Then we go off to high school. Entire role clusters develop dependent on
the situation. For example if you are bullied you develop a range of roles in
response. If you are very social a different cluster of roles are developed.
These roles are influenced by the roles developed earlier. We keep building
on our experiences and our experiences influence how we act in the world,
the roles we are in.” I look at Shane to see if he is following.
Shane: “I went to an all boys‟ school. I was shy and didn‟t know how to talk to
girls.” Leaning back into the chair with a look of recall on his face “I just
remembered when I was at school my dad decided I would go to the

30
 community dance. He set me up with a girl and organized everything. I was
so scared about going that I deliberately got into trouble with the science
teacher so I would not have to go home. I was late but my dad made me go
anyway. I was so nervous I was nearly sick.”

Shane has entered fully into the story, the dolls are no longer just dolls they are receivers
of the projected images of Shane's youth. He is fully in role in the mirror position
watching his drama unfold.

Therapist: “What were you nervous about?”

Shane: “We lived in a rural community and were very isolated. I didn't know how to
talk to girls and I didn‟t know how to dance. I didn‟t want to go but I
couldn‟t tell my dad that.”
I look at Shane hoping he will expand his comments.
Shane: “You never said no or questioned my dad. You just did as he told you. In
fact, I remember another thing. I was only sixteen and he was determined I
would learn how to public speak. He took me along to the local Masonic
Lodge. I had to deliver a paper on history. I was so scared I threw up before
hand. I knew I wasn‟t ready to do it but my dad had made up his mind. I had
to stand up there in front of a room full of men and deliver this speech. I kept
hoping something would happen so I wouldn‟t have to.”
Therapist: “Sounds like you really didn‟t want to do it. You weren‟t able to let your dad
know how you were feeling.”

I am doubling Shane to deepen the feeling component of his experience.

Shane: “No, it never occurred to me to talk to him. We just did as dad said”
Therapist: “Were you scared of what he would do?”
Shane: Shakes his head: “No, he didn‟t hit me or anything, I think he was just a very
powerful man and mum always did what he said, without question, and so did
I.”

31
Therapist: “I can imagine that night must have been very difficult for you. Having to
stand up in front of a room full of men and do a speech.”
I continue to double Shane

Shane: Shakes his head to correct me: “No, it was ok. They were an older group of
men, quite influential in the community, powerful men. I think they realized
how nervous I felt and perhaps felt a bit sorry for me. I stumbled through
without too many mistakes and then they clapped. I think the clapping
helped, I felt ok about myself at the end of it. Though I wasn‟t very happy
about doing it and my dad and I never spoke about it.”
Therapist: “You and your dad never spoke about it?”
Shane: Shakes his head in the negative.
Therapist: “It‟s great that the men clapped and were supportive, that sort of support can
make a big difference. It‟s hard enough being an adolescent at times without
having to perform under pressure like that.”
Shane: Shakes his head in agreement. There is a faraway look in his eyes as if he is
recalling other events.

When I doubled Shane the second time I was wrong, however it was successful as it drew
a deeper response from Shane, he went on to recall other instances from his past. I allow
him the space to reflect without interruption. We are only part of the way through the
telling and I am conscious of the benefits for Shane in finishing the story. I am still
working in the role of the producer whilst doubling Shane.

Shane: Straightens in his chair and points to the dolls “What‟s next?”
Therapist: “Well you keep growing and developing new roles in response to different
situations. For example; you went on to become a logistics manager, then
married, and had children, so you would have developed the role of the
father.” Moving two more dolls out.
Shane: Looks sad and shakes his head in the negative: “I don‟t think I developed

32
 the role of the father, I was away so much and when I was home I was always
tired and grumpy. The kids were always so noisy, mostly I yelled at them.”

Shane is still fully warmed up to the drama unfolding on the table, he uses the word role
for the first time. Shane is expressing his feelings. He is not operating from the previous
coping gestalt. This is very significant. Shane is fully in role when previously he was
taking a role. Experiencing feelings in this safe, contained way will assist Shane in
coping with his feelings outside the therapy room. We are strengthening the new roles
Shane is developing.

Therapist: “I can imagine that you would be tired coming home after long shifts and
children are noisy and if you were trying to sleep during the day….” I
become silent for a moment then go on to say, “You are still a father and you
can develop new ways of being with your children, new roles. Remember
that roles are developed in response to a situation, we don‟t judge them, they
just are. Then you were tired and needed to sleep so you could go back to
work, now things are different so now you can interact differently.”
Shane: Looks at me hopefully: “It‟s not too late?”
Therapist: “No it‟s not too late, you are there and they are still growing, you have an
opportunity to do it differently, build healthy relationships with them.”
Shane: “How do I do it differently? Julie‟s there and the kids listen to her more than
they do me.”
Therapist: “You can praise them for the good things they do, you can spend time playing
with them, Nintendo, watching TV etc., or you can take them to a park.
What‟s important is that you are spending time interacting with them in a
positive manner.”

I model the role of positive encourager that he can use with his children.

Shane: “Ok, I‟ll try and spend quality time with them; it won‟t be easy though…”

33
Therapist: “Give it a go; I don‟t think it will be that difficult, it may feel uncomfortable
or strange to start with. Don‟t expect them to react positively to start with;
they‟ll probably be wondering „hey, what‟s going on with dad, he‟s being
nice to us?‟” I say this in a lighthearted manner looking directly at Shane.

I remind Shane that living differently may require conscious thought to start with, a
choice to respond from the new, and although things are shifting for him, his children are
not aware of the changes he is experiencing.

Shane: Smiles and nods his head. He then looks down at the dolls, his expression
changing. (Refer Photograph 1)
Shane: “What do I do about this other stuff? How do I change the way I think?”

We have journeyed to the end of the drama. Shane has shifted from, 'where do these
thoughts come from' to 'how do I change this'. For me this is an indication that the work
has been successful, Shane is in a new role, he is relaxed and questioning with feeling.
He is no longer operating form a thought based coping gestalt. He is more orientated to
central organizing factor of living differently.

Therapist: “Well, you are now aware of the way you have been thinking. This is the
first stage; you need to be aware of what is happening before you can change
it. Now that you are conscious of the way, you are thinking you can do
something about it. You can breathe and think of the dolphins and use the
stop on the CD. Then put in place a more helpful thought. For example
instead of thinking the dogs are going to be a problem you can think we‟ll go
straight past this dog, no problem, my dogs know how to behave themselves.”
I look at Shane to make sure he is following this. “The trick is not to give
yourself a hard time if you miss the thought to start with. You are developing
a new role, a new way of being. It takes practice. It‟s ok if you miss an
opportunity and then realize later on. You can think of how you can do it

34
 differently next time. Over time with practice you will start to catch yourself
in the moment.”

In answer to Shane's question, I bring us back to the familiar, the CBT. I have found that
working this way encourages progress with stability. I am helping Shane build the
foundations for stable change. Shane can now be in control of his progress, he can
consciously alter his thinking patterns which in turn will affect the roles he operates
from. This empowers the client; they keep working on change outside the therapy room.

Shane: Nods thoughtfully: “We‟ll we better make another time for next week.”

Shane is taking charge of his progress, it's his idea to return next week, he is committed
to change.

Therapist: “First we need to pack up the dolls. You can let me know how you go with
your children next week. Remember all this takes time, you are developing
new roles.”
Shane: Nods in agreement and then places the doll back on the shelf.

I am the producer, conscious that the drama is finished and we need to clear the stage.

35
Photograph 1: The Babushka doll unpacked to represent Shane‟s internal roles.

Discussion of Session 3

In this session I decided to extend and deepen our work to focus on role development.
Shane presented with an insight into his thinking patterns and was highly motivated to
learn how this developed and how to change it. Shane commenced working on
developing a new role when he became aware of his thinking processes. The “where did
I learn to think this way?” question I viewed as an opportunity to use Morenian role
theory and the Babushka dolls. To me this is wonderful, Shane has taken on board our
discussion; he has been consciously working on improving his situation. I become very
excited when clients actively assist themselves, and I noticed Shane respond to this.

Tracing the Progressive Role Development

Throughout these three sessions Shane has been actively engaged in the process of
developing progressive roles. When he first commenced therapy he was suicidal. Now
in session three he is interested in how his thinking style developed and how to be a

36
better father. The focus of his thoughts has changed and he is becoming actively engaged
in his life. The progressive embryonic elements hypothesized at the end of session one,
yearner for a different way of living/ determined survivor (Diagram 1) are now more
evident within Shane's functioning. They are reflected in his questioning of how his
thoughts came to be, his engagement around his children and most importantly his
commitment to continue his work. The fragmenting roles of terrified hider from internal
turmoil and suicidal despairer (Diagram 2) are no longer evident instead we see the
progressive roles of concerned father and conscious thinker of helpful thoughts. Shane is
orientated toward living in a healthier more meaningful manner; this is evidence of
Shane's central organizing factor. Shane wants to connect with his children in a more
meaningful manner and be the best father he can. This is observed when Shane questions
"It's not too late?" (Session 3). There is a strong desire in Shane to alter the relationships
with his children. Shane's central organizing factor may be expressed as; a man
determined to make the most of his life and provide the best role modelling for his
children.

For me these role shifts in Shane are wonderful. Shane has been able to tap into the
embryonic progressive elements within his functioning. These developments are an
indication that using the babushka dolls with a combined role theory/CBT approach can
be an effective way to assist clients in developing an awareness of the possibility of
healthy new roles.

Next Steps for Shane

The first three sessions for Shane have focused on decreasing his suicidal ideation and
building his belief that he can alter his circumstances. I have deliberately guided Shane
into distancing himself from his crippling anxiety through a director-directed re-storying
of his developmental experiences. In this way he witnesses a non-judgemental
description of how he came to be, without experiencing overwhelming anxiety.
Experiencing himself this way Shane can reclaim some feelings without becoming

37
distressed. This is a safe transitional step towards Shane integrating some of his feelings
with his thoughts.

Shane has expanded the progressive elements within his coping gestalt and hopefully he
will continue to build on what has commenced. Shane will need continued support to
strengthen and expand the new roles he has developed. Shane may need guidance on
how to broaden his interactions with his children and specific role development in
relation to his fathering. There would be benefit in Shane further exploring and doing
some interactive repair work on his relationship with his father. This may assist Shane in
valuing his father's strengths and developing an awareness of how to do it differently
with his own children.

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Chapter 4

IMPLICATIONS FOR PSYCHODRAMATISTS

Working in an individual setting with highly traumatized naive protagonists can be a

challenging task. Frequently adult survivors are distrustful of the new and different; they
will not engage readily at the beginning of therapy. I have found they do engage with
role theory and Babushka dolls. The dolls are a talking point, safe and minimal risk to
the client. The dolls engage the client and they are then able to safely project onto the
dolls parts of themselves that might otherwise not be exposed. Using the dolls enables
the client to work from a safe distance, the mirror position. This makes the dolls an
invaluable tool for working with trauma.

The Babushka dolls may represent the client‟s internal role system or demonstrate the
story of development. The dolls can be set out to represent family or friends. The
smaller dolls can concretize the inner child and the client often feels a sense of safety and
reassurance. Relationships can be explored using different dolls. The restrictions we
place on our own creative genius limits the dolls‟ application.

Psychodramatists and therapists alike will benefit from considering this combined
approach of CBT and role theory and playing with a Babushka doll or two. There is no
set format to be remembered when working with the dolls. Retention of the value of
Morenian role theory will assist the therapist in maintaining an objective overview of the
client‟s roles and their development.

Working from the framework of Moreno‟s role theory assists the clinician in gaining a
deeper understanding of their clients. Explaining role theory and the development of
roles frequently, helps remove shame, blame and other unhelpful emotions surrounding
childhood events. The client no longer stays trapped in the guilt/blame cycle but can step
out of this cycle and work on developing new roles. New ways of being in the world and
increasing a sense of safety are often the most healing aspects of working with the
Babushka dolls.

39
Adding the role theory to CBT appears to deepen clients learning and assists them to
better integrate their feelings. They develop new roles in the therapy room and often
these roles are rehearsed, tested, and strengthened in their world before they finish
therapy.

Role Dynamics

Don Reekie's (2007) approach to role theory expands on the work of J. L. Moreno
(1953), Lynette Clayton (1982) and Max Clayton (1994). Role dynamics adds a further
dimension to our understanding of role. Being aware of the situation in which a role has
developed aids us in understanding the progressive elements of the role. In session 3,
when Shane questioned “where did I learn to think like this?” he was considering his own
development. It is not necessary for the therapist to know the details of where and when
a role was first developed, what is necessary is that the therapist holds in mind that the
functioning was orientated toward health. Doing so will allow the therapist to work with
the client in a nonjudgmental way.

Focusing on the embryonic progressive elements within a role allows us to work with the
central organizing factor behind the client‟s functioning. Holding in mind, the need to
search out the progressive elements within coping or fragmenting roles increases our
understanding of the client's developmental process. This understanding in turn allows us
to assist the client in developing healthier responses in the present. This approach allows
the therapist to work with the whole person rather than just the presenting symptoms.
Role dynamics assists the therapist in working with the creative genius: their own and the
clients.

The Significance of Doubling

Throughout the drama in my role as director, I frequently double the client. Becoming

40
attuned to their world as a double enables me to build the protagonist‟s story with
authenticity. I link into how the protagonist is feeling; the shifts in their emotions are a
guide to how accurate the story telling is. In the role of the director, I am also
introducing an alternative narrative and asking Shane to project himself onto the
story/dolls. The client sees this story enacted symbolically. The support the protagonist
feels via the doubling enables them to engage fully in the story unfolding on the stage.
The protagonist is reliving their past from a safe distance. This new view resonates with
the client‟s inner experience allowing them to integrate this different perspective.

The significance of doubling allows me to refine my intervention with the protagonist.

Firstly, it enables me to name what the protagonist feels; they test it and this increases
their awareness of their emotions. This gives an expression to those feelings and
permission to feel that way. In the process, it becomes understandable that the
protagonist has these feelings; they become normalized. The protagonist is not alone;
others would feel the same given those circumstances. Once this has occurred, an
awareness that it is ok to change follows: the protagonist becomes aware of his or her
own capacity for change.

Secondly doubling informs my ability as a therapeutic guide on how to match the story to
the protagonist. Entering into the drama with the protagonist, whilst doubling from the
position of producer, allows for continual adjustments in the narrative. The refinement of
the story and careful attunement by the director alongside him sustains a sense of safety
in the protagonist to do this work. The work is facilitated using the mirror position.

The Mirror Position

The protagonist from the mirror position engages in the drama and projects onto the
Babushkas. Being in the mirror position means the protagonist is one step removed from
what is occurring on the stage. This avoids the protagonist re-experiencing the past,
important in trauma work (Hudgins, 2002). Safety is also increased when the protagonist
is in the mirror position; the protagonist feels more in control of the situation. Using the

41
Babushka dolls means the work is on the stage and the protagonist is safely in their seat
projecting onto the dolls. The protagonist also feels held in this position. They are able
to take in what is occurring on the stage and develop a different perspective on what has
happened. The protagonist is supported in sustaining the illusion it is not him on the
stage. Instead, it is the Babushka dolls. The power of projection means that we are not
merely using them for play therapy; they have taken on aspects of auxiliaries in a drama.
Ownership is evident when, for example, Shane had a faraway look in his eye and
recalled an event from his childhood. The protagonist is safely contained within the
therapy environment and able to step outside himself and experience a new way of being:
one of the purposes of a drama.

The use of dolls alongside role theory is a powerful way to slow the story down so that
the protagonist sees the value of this framework. It also allows him time to warm up to
the depth of what role theory offers him in understanding how he has come to be the way
he is and in recreating his story.

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Chapter 5

CONCLUSION

This paper has explored an effective way of developing healthy new roles in clients. A
brief explanation of Cognitive Behavior Therapy, Morenian role theory, role dynamics
and analysis along with the techniques of doubling and mirroring were presented to
enable the reader to link the melding of CBT and role theory with Babushka dolls in an
individual setting.

The illustration of Shane's work was provided to enable the reader access to the
therapeutic value embedded within the combination of role theory, CBT and Babushka
dolls. Working with this combination has proven to be an effective way of assisting
clients in developing an awareness of healthy new roles. I hope that other therapists will
add Babushka doll or two to their tool kits.

43
 REFERENCES

Anderson, H. & Anderson, G. (Eds.) (1951) Projective techniques & other devices for
understanding the dynamics of human behavior. Eaglewood Cliffs, USA: Prentice
Hill Inc.

Bannister, A. (Ed.) (1998) From hearing to healing. Working with the aftermath of child
sexual abuse. West Sussex, England: John Wiley & Sons Inc.

Beck, A.T. (1976) Cognitive therapy and the emotional disorders. New York:
International University Press.

Benson, H. (1977) The Relaxation response. New York: Avon.

Benson, H. (1984) The relaxation response and stress. In Matarazzo, J.D., Weiss, S.M.,
Herd, J.A. , Miller, N.E. & Weiss, S.M. (Eds.) Behavioral health: A handbook of
health enhancement and disease prevention. (325-350) New York: Wiley.

Bustos, D. M. (1994) Wings and roots. In Holmes, P. Karp, M. & Watson, M. (Eds.)
Innovations in theory and practice Psychodrama since Moreno. London:
Routledge. 63-76.

Carter, F. & Cheeseman, P. (1988) Anxiety in childhood and adolescence encouraging

self-help through relaxation training. USA: Croom Helm.

Casey, A., Benson, H. & MacDonald, A. (2004) A mind/body approach to stress

management, exercise, and nutrition for heart health. New York: Free Press.

44
Clayton, L. (1982) The use of the cultural atom to record personality change in individual
psychotherapy. Journal of group psychotherapy, psychodrama and sociometry.
35:3 111-117.

Clayton, M. (1994) Role theory and its application in clinical practice. In Holmes, P.
Karp, M. & Watson, M. (Eds.) Innovations in theory and practice Psychodrama
since Moreno. London: Routledge. 121-144.

Clayton, M. (2003) Workshop notes October, Stanwell Tops; NSW

Crane, S. (2000) Spontaneity with children: Applications of psychodrama which enable

children to express their creativity. Thesis submitted to Board of Examiners of the
Australian and New Zealand Psychodrama Association Inc (ANZPA). This thesis
was excerpted under the same title in ANZPA Journal No 12, Dec 2003

Dayton, T. (1994) The drama within. Psychodrama and Experiential therapy. Florida:
Health Communications, Inc.

Dayton, T. (2005) The living stage. Florida: Health Communications, Inc.

Ellis, A. (1970) The essence of rational psychotherapy: A comprehensive approach to

treatment. New York: Institute for Rational Living.

Hoey, B. (1997) Who calls the tune? A psychodramatic approach to child therapy.
London: Routledge.

Holmes, P., Karp, M. & Watson, M (1994) Psychodrama since Moreno.

London:Routledge.

Horney, K. (1950) Neurosis and human growth. New York: Norton.

45
Hudgins, M.K. (2002) Experiential treatment for PTSD. The therapeutic spiral. New
York NY: Springer Publishing Company.

Jefferies, J. (1998) The processing. In Karp, M., Holmes, P., Bradshaw Tauvon, K.
(Eds.) The handbook of psychodrama. NewYork: Routledge. 189-201.

Karp, M., Holmes, P. & Tauvon, K.B. (1998) The handbook of Psychodrama. Routledge:
London.

Marineau, R.F. (1989) Jacob Levy Moreno 1889-1974. London: Routledge.

Moreno, J.L. (1953) Who shall survive? New York: Beacon House.

Moreno, J.L. (1964) Psychodrama First Volume. 3rd Edition, Beacon, N.Y.: Beacon
House Inc.

Moreno, J.L. & Moreno, Z.T. (1977) Psychodrama, Vol 1. 4th Edn. Newyork: Beacon
House.

Nako, P., Myers, P., Friccohione, G., Zuttermeister, P.C., Barksy, A.J. & Benson, H.
(2001) Somatization and symptom reduction through a behavioral medicine
intervention in a mind/body medicine clinic. Behavioral Medicine 26(4) Winter
169-176.

Nystul, M.S. (1987) Transcendental meditation. In Corsini, R.J. (Ed.) Concise

encyclopedia of psychology. New York: Wiley.

Raimundo, C.A. (2002) The play of life - A biological view of its impact on behavioral
change. Australia & New Zealand Psychodrama Association Inc Journal. 11: 48-
58.

46
Reekie, D. (2007) Becoming Jane: Appreciating her being and becoming through
explorations of role. Australia & New Zealand Psychodrama Association Inc
Journal. 16: 4-54..

Schaefer, C.E. (Ed.) (2003) Play therapy with adults. USA: John Wiley & Sons Inc.

Simmons, J. & Griffiths, R. (2009) CBT for beginners. London: Sage

47