Psychodrama can be a powerful tool in addiction treatment

In some respects, the clinical work Bill Coleman conducts at multiple treatment facilities resembles a task that makes the old new again.

“In the 1980s and the early ’90s, experiential was the thing to do,” says Coleman, LMSW, the resident psychodramatist at Sierra Tucson who also directs psychodrama groups for the intensive outpatient program at the Desert Star Addiction Recovery Center in the same Arizona city. “We’ve drifted away from that, with the press to make one’s treatment fit a medical model.”

While Coleman believes every legitimate addiction treatment program must offer some form of psychodrama as part of its therapeutic services, he adds that it often isn’t easy at first to bring addiction treatment patients into the fold. He generally sees the substance abuse population as the most reluctant group he works with, and he struggles to understand why.

Still, Coleman spreads the message that psychodramatic structures can work well with individuals in early recovery who are experiencing cognitive difficulties. Earlier this month he conducted a psychodrama training session in Tucson for other professionals, teaching them a specific psychodramatic technique that allows patients to identify and practice recovery-affirming actions.

“It makes recovery very concrete,” Coleman says of psychodrama. “You’re not just sitting there getting lectured.”

Dos and don’ts

Coleman, who has been a trainer with Hudson Valley Psychodrama Institute for more than 10 years, holds some strong beliefs about what should and should not take place in a psychodrama session. He wrote in comments to Addiction Professional that he teaches addiction professionals to be knowledgeable about past traumas that have affected their patients.

“Never, never, never re-enact a traumatic event. It does not help,” Coleman wrote. “If possible, identify the defenses or coping strategies created to deal with the trauma and work with those.”

He added in subsequent comments in an interview, “In trauma, we do not address the trauma itself—we cannot change that. Instead, we try to reveal the dysfunctional behaviors that arose because of the trauma.”

He also does not teach or practice what would be considered classical psychodrama for addiction patients, stating that those sessions are too deep and too lengthy for the typical substance use patient.

“I have created what I call Structured Psychodrama,” Coleman wrote. “What makes it different is that each session has a fixed beginning, middle and end. And, it always ends in joy.”

He cites as his primary example a psychodrama that he calls The Relapse Trail. During a group session, a patient describes his/her worst possible relapse, and a sculpture of that is placed at one end of the room. An “all good” state is at the other end, and the patient proceeds down a trail flanked by relapse triggers on one side (such as restlessness or discontent, personified by others participating in the session) and protective actions on the other (such as getting together with one’s sponsor or attending a 12-Step meeting).

When the patient is nearly at the end of the room and approaching relapse, Coleman suggests appealing to the patient’s Higher Power. Not every patient proceeds along the trail during the course of a typical hourlong session, but Coleman says everyone in the room ends up benefiting from the experience.

“Everyone in the room is working,” he says. “They all get caught up in it.”

Psychodrama’s heyday

Coleman recalls that back when he worked at a psychiatric hospital that at the time averaged 30-day lengths of stay, the facility employed three full-time psychodramatists. But it is rare to see that level of commitment to psychodrama in today’s treatment industry.

“They’ve replaced psychodrama with [Dialectical Behavior Therapy] for a two-week admission,” Coleman says of the hospital program where he had worked.