Healing World Trauma with the Therapeutic Spiral Model. Группа авторов

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      Stress Hormones

      If the amygdala is always hypervigilant and sending out signals, the brain, then, is always producing stress hormones to try to calm the situation. Unfortunately, this causes two problems by intensifying the right-brain–left-brain split. The stress hormones cut off the connection between the right-brain, which is receiving the input of sensory information and danger signals, and the left-brain where the hippocampus has information stored on what to do in an emergency. The brain then also eventually runs out of stress hormones, leaving itself and the body depleted and unable to tolerate even normal amounts of stress in daily living.

      The Hippocampus

      The hippocampus is the part of the left-brain that contributes to the storage of language, memory, and decision-making processes. We describe it as a file cabinet since it holds short- and long-term memory that includes past solutions to problems. As noted above, when the stress hormones flood the brain the meaningful flow of information to the hippocampus is cut off. So, to continue the metaphor, it is as if someone is standing at the file cabinet, not being able to access its contents, and frantically throwing out random files/answers to solve a problem, when they don’t even know what the problem is. What becomes clear from this neurobiological information is the reason why someone with PTSD has difficulty with here-and-now decision-making.

      Similarities between Classical Psychodrama and the Therapeutic Spiral Model

      While many people immediately notice the differences between TSM and classical psychodrama, we want to start with their similar foundations. There are two theories at the core of psychodrama that TSM fully shares:

      1.Spontaneity and Creativity (Moreno 1973)

      2.Role Theory (Blatner 2000).

      Another allegiance is the belief in the “godhead” (Moreno 1921), which is a connection to spiritual awareness as the true curative agent of healing. As part of its structure, TSM uses a team of trained auxiliary egos—a concept that was a core part of fundamental psychodrama for decades at the original theater at Beacon, NY. Finally, both modalities use the same basic psychodrama techniques (Moreno and Moreno 1969) with clinical modifications by TSM for safety and containment (Toscani and Hudgins 1993; Hudgins 2002).

      Spontaneity and Creativity Theories

      In his original book, Theatre of Spontaneity (1973), Moreno defined the Canon of Creativity showing how the warm-up process is crucial for spontaneity to develop, so that creativity can burst forth from the “well of spontaneity” that is within us all. He describes spontaneity as the function necessary to make an adequate response to a novel situation and a new response to a repetitive situation.

      Moreno also names this well of spontaneity the “godhead” and brings to the definition a spiritual quality that goes beyond mere psychological language. In Words of the Father (Moreno 1921), which he first wrote in red paint on the walls of a castle in Vienna, Moreno speaks about the “god within.” Blasphemous at that time in psychological circles, his definition of the God within humans, defining humans as co-creator of their own lives, is now widely accepted in philosophical, psychological, and spiritual communities.

      In this vein, a thread of spirituality runs through TSM, both conceptually and in action. TSM has delineated the Prescriptive Roles—roles that are needed and prescribed in the drama to establish a state of spontaneous learning (Toscani and Hudgins 1993; Hudgins 2002, 2008). When TSM Prescriptive Roles are identified and fully enacted on the stage, the protagonist is then in a state of spontaneity, ready to find creative solutions to face their past trauma in new ways. This allows a clinical template for the director to assess spontaneity in the moment. The Prescriptive Roles add what has long been called for in psychodrama—a pure, operational definition of spontaneity that is measurable both in action and for the purpose of research.

      Role Theory

      One of the true gifts of classical psychodrama is the use of role theory to make abstract psychological concepts understandable both to laypeople and to patients. Role theory uses everyday language to explain often confusing and complicated behaviors in a way that everyone can grasp, based on observable behavior. There are three role categories in psychodrama that conform to standard developmental psychology, as described by Zerka in Chapter 1:

      1.psychosomatic or body-based roles, e.g. the eater, the sleeper

      2.the psychosocial—the interpersonal or interactive roles, such as mommy, teacher, shopkeeper

      3.the psychodramatic or fantasy roles, such as an animal, a tree, a Buddha.

      A basic classical psychodrama concept is that the self develops through the roles we enact and with which we interact.

      While this is a simple way to describe personality development, it is also a way that most people can relate to and understand. In classical psychodrama, role theory describes interpersonal relationships; however, in TSM we use it to describe internal or intrapsychic personality roles as well, as we illustrate in the next chapter.

      Clinically Modified TSM Psychodrama Techniques

      TSM changes to classical psychodrama were based on clinical experiences. For example, we saw protagonists who would end up doing the same drama over and over again, never showing any lasting change even though they would appear to get relief from the drama itself. Below is a list of what we learned in action and incorporated into TSM, showing clearly the reasons for modifying classical psychodrama to work with people with PTSD.

      •Trauma survivors need a more resilient intrapsychic personality structure before they are able to benefit from classical interpersonal psychodrama.

      •Classical psychodrama, with its emphasis on catharsis with intense emotions, can re-traumatize trauma survivors, causing even further damage to the neurobiological structures of the brain.

      •Protagonists who are trauma survivors unconsciously use the defense of dissociation to guard against being overwhelmed with intense emotion. This was one of the main reasons protagonists would repeat the same drama: since they were “not present” for the drama where there was too much emotion, it did not produce lasting change.

      •The group is not only an audience to the drama but is part of the protagonist’s intrapsychic world, which coexists with their own worlds. What we have is not one solar system, but a universe of many solar systems interacting simultaneously.

      •A team is needed to address the multiple concurrent worlds safely.

      The basic techniques of psychodrama are used in TSM and here we show where they are retained and when they are clinically modified to focus more on containment than on expansion.

      Soliloquy

      Most people know of Hamlet’s pondering soliloquy, while in psychodrama this action technique is often described as “free association in action.” Rather than talking uncensored on the Freudian couch, the protagonist or group member is asked to walk around the stage or room and talk out loud in an uncensored manner, while also using their bodies to gain extra information. Soliloquy is often used as a warm-up or summary action structure in both classical and TSM psychodramas.

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