Blending Psychodrama and Cognitive Behavioral Therapy to Treat Addiction

A new twist on cognitive behavioral therapy is gaining traction in the treatment of drug and alcohol addiction. It uses techniques from psychodrama, an experiential role play therapy, layered over the research-based favorite, cognitive behavioral therapy. Although this combination is not officially recognized as a distinct form of therapy, it’s being used by some leading-edge therapists to successfully treat addiction and mental health disorders. Jennifer Maguire, clinical director at Park Bench drug rehab in New Jersey, discovered this combined approach, which she calls “experiential CBT psychodrama,” in 2013. It started as an experiment in group therapy, but has since become its own entity and is used on a daily basis as part of outpatient drug rehab treatment. “We’re using psychodrama and experiential techniques to bring CBT to life,” says Maguire. “Instead of talking about thoughts, feelings and behaviors, we do role plays. It helps clients get to the heart of the issues in a more creative, active way.”

Two Complementary Approaches

Cognitive behavioral therapy is a staple in mental health and drug rehab treatment. It helps people spot negative thoughts that drive addictive disorders and use specific skills to develop healthier patterns. By changing their thoughts, patients are empowered to change their feelings and behaviors. Patients learn how to cope with drug cravings and triggers and avoid relapse even when faced with high-risk situations. CBT is considered an evidence-based therapy, meaning research has shown its effectiveness in treating substance abuse and other mental health issues. It is a practical, collaborative and goal-oriented approach that can be immediately applied to solve problems in everyday life. CBT is often combined with medication and other behavioral therapies for maximum benefit. But even classics can be adapted and improved upon. “I’ve always been CBT-focused. It’s the way I intuitively understand people – through the thoughts, feelings and behaviors that make up the human experience,” says Maguire. “But a lot of people have trouble identifying their thoughts, behaviors and feelings, not to mention talking about them in a meaningful way. Role plays are a great way for them to get in touch with their inner world in a different way.” Psychodrama can most easily be understood as a type of therapeutic role play. Patients may act out scenes about relationships, past situations or plans for the future, among other topics, with guidance from a therapist. Other patients are strategically chosen to play the roles of family members, the audience or other key figures to help bring issues to the surface and offer support and encouragement. As a hands-on, experiential therapy, psychodrama can be a powerful complement to traditional therapies for addiction. Through acting out scenes and taking different points of view, patients are able to express difficult feelings, gain new insights, develop healthy communication skills, rebuild their confidence, practice recovery skills, and resolve issues that drive substance abuse.

‘Never Had an Experience Like This’

Cognitive behavioral therapy works in many types of role plays. For example, Maguire might use it to have a client talk to another client who represents their inner voice. Or she may select three different people to personify a client’s thoughts, feelings and emotions so they can act out the dynamics of their inner world. Experiential CBT psychodrama can be effective for people with a variety of issues and backgrounds, but Maguire says it’s particularly useful for clients who don’t like the idea of therapy. “Some people are skeptical of therapy,” she explains. “They might be scared, or maybe they feel they’ve ‘been there, done that’ in rehab before and assume it won’t work.” Maguire describes it as a “back-door therapy technique” because people get immersed in the experience and forget they’re doing therapy. Suddenly, they realize they learned something useful or gained an insight into their pain. “Clients often tell us ‘I’ve been to 20 rehabs and never had an experience like this before,’” says Maguire, whose goal is to provide truly client-centered therapy that reaches people in just the right ways to help them get better. “The way it looks is different from group to group. We choose participants strategically based on who can help bring up issues for someone else. We meet every day to plan what we’ll do the next day, pulling in issues that just came up in the group.” Although it isn’t widely known about or used, others have found the combination of CBT and psychodrama to be effective as well. In a paper titled “Enriching Psychodrama Through the Use of Cognitive Behavioral Therapy Techniques,” the authors describe the combination of therapies as an ideal balance between the creative emotional exploration of psychodrama and the problem-solving, data-based approach of CBT. “The blending of the two models yields a complementary eclectic approach to multiple problem-solving strategies,” they wrote. The freedom to explore new approaches and truly personalize treatment to her client’s needs has kept Maguire at Park Bench Group for the past two years. “This is the first place I’ve worked where I get to try really cool things with a supportive group of clinicians,” she says. “Other centers usually say, ‘We don’t do it that way here,’ and continue on with the status quo.” At Park Bench, trying new things to help people who struggle with addiction and chronic relapse is the norm. “It’s all about human connection,” says Maguire. “We’re always looking beyond the symptoms being presented to get to the deeper layers that no one has looked at before.” And, for some patients, experiential CBT psychodrama plays an important part in digging into the core issues and being freed from addiction. By Meghan Vivo

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