Techniques     Overview Articles    Sexual Trauma    Reviews    Trauma    Staff Issues

SUPPORTIVE ROLE PLAYING IN THE TREATMENT OF DENIAL, RESISTANCE, AND SHAME

This excerpt was taken from an article which originally appeared in the Mental Health Aspects of Developmental Vol. 2, number 4 pp 141-149.

A variety of role-playing techniques are described for working with individuals who are unwilling, unmotivated, or unable to engage in a therapeutic process. Drawn from the field of psychodrama, these procedures have been modified for use with people with mental retardation and developmental disabilities (MR/DD). They include representational dramas, doubling, the use of auxiliaries, process of intervention, and the empty chair.

INTRODUCTION

Ms. A. was new to the survivors group. Head down, eyes covered with both hands, she mumbled her words. Others watched. They knew what she was feeling: Shame.

Sometimes the trauma, problems, or stress become so profound that a natural protective shield prevents participants from taking part in psychotherapy. Practitioners working with people who have mental retardation and developmental disabilities (MR/DD) will notice an array of symptoms that evolve from a participants reluctance to engage in a therapeutic process. At their core, these symptoms spring from a central theme of disengagement. The pain of awareness activates a protective reaction fashioned to rescue the individual and deliver him or her to a safer place. Ironically, such reactions are paradoxical in nature. While hey protect the person, they simultaneously isolate him or her and worsen the prospect of gaining support. Whatever protects also inhibits. In the effort to be safe, the individual dons a shield of armor. It works momentarily to provide protection from the distressing pangs of consciousness. But as this shield is worn, it prevents the person from participating in the very thing which can help liberate him or her from the nightmare: therapeutic contact with others.

Many researchers working with people who are intellectually normal have argued for experiential role playing as the treatment of choice for survivors of trauma. Indeed one of the leaders in the field of trauma, Bessel van der Kolk, wrote:

Prone to action, and deficient in words, these patients can often express their internal states more acticulately in physical movements or in pictures than in words. Utilizing drawings and psychodrama may help them develop a language that is essential for effective communication and for the symbolic transformation that can occur in psychotherapy.

Psychodrama, the clinical use of role playing as played a significant part in the treatment process of trauma survivors. Nevertheless, with notable exceptions, relatively little has been written about treatment for survivors of trauma with MR/DD, and only recently have role playing and other action methods been described for use with these individuals at all. This lack is mentioned because, even in the most promising area for their use, role playing is underused. Three possible explanations may be because providers:

. May feel competent to deliver treatment to intellectually normal patients but uncertain about how to modify their therapy for cognitively challenged individuals.

. May have competency with people with MR/DD but feel uncertain about how to approach the specific issues associated with surviving trauma.

. May be unfamiliar with role playing or uncertain about use of various role playing techniques.

Alcohol Treatment Comparisons

This table appeared as part of the article DRUG ABUSE TREATMENT FOR PEOPLE WITH MENTAL RETARDATION: WHO WILL DO IT? by Daniel J. Tomasulo, Ph.D. in the Mental Health Aspects of Developmental Disabilities journal in 1998 and is reprinted with permission of the publisher.

COMPARISON OF TREATMENT APPROACHES FOR ALCOHOL ABUSE & ADDICTION

Traditional Substance Abuse Treatment

-Genrally Self Referred
-Generally Self Motivated
-Usually Required to go through traditional detoxification before admission to other forms of treatment
-A patient's denial is seen as the root cause of their problems. Traditional treatment uses intense confrontation methods to attack this denial
-Patients usually hit bottom before treatment becomes effective
-Aimed at tearing down the defense structure

Culture in Action: Diversity Training with a Cultural Double