Empowering

Therapeutic Practice
Integrating Psychodrama
Into Other Therapies

Edited by
Paul Holmes, Mark Farrall and Kate Kirk
Foreword by Marcia Karp

Jessica Kingsley Publishers

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First published in 2014

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 Contents

Foreword: Integrating Therapies? 7

Marcia Karp, group and individual psychotherapist and
trainer, educator and practitioner in psychodrama

Glossary: An Introduction to Psychodrama

Concepts and Terms 9
Marcia Karp and Mark Farrall, forensic psychologist
and psychodramatist, director of Ignition

Chapter 1  Introduction: The Integration of

Psychodrama and Other Modalities 23
Paul Holmes, child and adolescent psychiatrist, adult psychoanalytic
psychotherapist and psychodrama psychotherapist, Kate Kirk,
psychodrama psychotherapist, researcher and trainer, and Mark Farrall

Chapter 2  Psychodrama and Mentalization:

Loosening the Illusion of a Fixed Reality 35
Anna Napier, clinical specialist occupational therapist
and psychodrama psychotherapist, and Anna Chesner,
psychodrama and group analytic psychotherapist

Chapter 3  Psychodrama and Group Analysis 61

Mary Levens, group analyst, Institute of Group Analysis

Chapter 4  Passion in Action: Family Systems Therapy

and Psychodrama 83
Chip Chimera, psychodramatist and systemic family
psychotherapist, director of Centre for Child Studies,
The Institute of Family Therapy, London
Chapter 5  Cognitive Behavioural Therapy and
Psychodrama 109
Bernadette Hammond, high-intensity therapist
and psychodrama psychotherapist

Chapter 6  Integrating Psychodrama with Attachment

Theory: Implications for Practice 125
Clark Baim, senior trainer in psychodrama psychotherapy and co-
director of the Birmingham Institute for Psychodrama, UK

Chapter 7  Hypnotherapy, Altered States of

Consciousness and Psychodrama 155
Eberhard Scheiffele, theatre artist, psychotherapist and psychodramatist

Chapter 8  Scenes from a Distance: Psychodrama and

Dramatherapy 179
John Casson, dramatherapist and psychodrama psychotherapist

Chapter 9  Psychodrama Informed by Adaptive

Information Processing (AIP): The Theory
Underpinning Eye Movement Desensitization
Reprocessing (EMDR) 201
Kate Bradshaw-Tauvon, psychotherapist and co-founder of Stockholm
Institute for Psychodrama, Sociometry and Group Psychotherapy

Chapter 10  The Owl and the Pussycat: Psychodrama,

Other Therapies and Young People 225
Kate Kirk and Carl Dutton, psychodrama
psychotherapist and mental health nurse

Chapter 11  Psychoanalysis and Psychodrama 249

Teresa M. Brown

Contributors 271

Subject Index xxx

Author Index xxx

 CHAPTER 6

Integrating Psychodrama
with Attachment Theory
Implications for Practice

Clark Baim

Psychodrama uses enactment to help people better understand

themselves and their history, resolve loss and trauma, overcome fears,
improve their relationships, express and integrate blocked thoughts
and emotions, practise new roles and prepare for the future. The
scenes enacted in a psychodrama may be based on specific events in a
person’s life, their current or past relationships, unfinished situations,
desired roles or inner thoughts and conflicts (Casson 2004; Dayton
2005; Karp, Holmes and Bradshaw Tauvon 1998).
Since its origin, psychodrama has been used to treat people with a
wide array of psycho-social problems (Moreno 1985; Weiser 2007).
In order to work safely and effectively with the broadest range of
people and their presenting symptoms, psychodramatists must draw
from sound developmental theory and adapt their interventions to suit
each client (known in psychodrama as the protagonist).
Having a well-evidenced theory of psychological functioning
and development across the lifespan is crucial; it provides a reliable
framework for understanding the developmental roots of the client’s
difficulties and a rationale for the director’s selection of techniques to
address specific psychological problems.
While psychodramatists have a wide range of well-established
techniques and procedures, current psychodramatic theory does not
necessarily provide a sufficiently uniform or comprehensive rationale

125
126 EMPOWERING THERAPEUTIC PRACTICE

for adapting the techniques in a purposeful way to address specific

psychological problems and their developmental roots.
Integration of psychodrama theory with related theories is called
for, with the aim of moving towards a comprehensive and integrated
theory of psychodrama (Broom 2010; Holmes 1992; Kellermann
1992). This chapter explains how attachment theory, and particularly
the Dynamic-Maturational Model of Attachment and Adaptation
(Crittenden and Landini 2011), can assist this integration.

Attachment theory
Attachment theory focuses on how we adapt to the dangers in our
environment in order to increase our chances of survival – in other
words, how we stay alive as individuals. It is also a theory about
how we form and sustain close relationships, including sexual
relationships, and how parents ensure the survival of their children
– in other words, how we stay alive as a species.
While focusing on the core issues of survival, attachment theory
also incorporates a systemic and cross-species view. John Bowlby,
the originator of attachment theory, drew on evolutionary theory,
biology, ethology, systems theory and developmental psychology,
and saw attachment theory as a way of explaining and exploring
the survival strategies of many species (Bowlby 1971, 1995, 2000).
Subsequent authors have built on Bowlby’s work. Contemporary
attachment theory takes into account the biological, cognitive,
affective, social, psychological, epigenetic and neurological aspects
of human development, and considers these factors in age-specific
ways, across the entire lifespan (Cicchetti and Valentino 2006;
Farnfield et al. 2010; Howe 2011; Karen 1998).
Attachment theory is also particularly strong in the way that
it takes into account cross-cultural factors and the large variation
in human cultural practices around parenting, relationships and
sexuality. For example, in order to understand why a particular
culture tends to raise their children in a certain way, one must
fully consider that culture’s history of war, famine, disease,
natural disaster, oppression, social-economic or gender inequality,
occupation, migration, civil and religious conflict and displacement
(Crittenden and Claussen 2000).
Integrating Psychodrama with Attachment Theory 127

Attachment theory acknowledges in rather profound ways

the human impact of these social conditions and upheavals. This
impact can, of course, last generations, affecting the underlying
currents of human relationships, sexuality, child-rearing and
emotional well-being for many decades, even centuries (Meaney
2009; Schutzenberger 1998; Trickett, Nolla and Putnam 2011).
This holistic view, understanding the psychology of individual
human beings as being intricately bound up within broader
cultural, political and demographic contexts, accords well with
the systemic, integrative, existential and humanistic philosophy
underpinning psychodrama (Moreno 1972). This is just one of
many ways in which attachment theory and Morenian philosophy
complement each other.

Attachment and human development

Attachment theory is sometimes mistaken as applying only to
infancy. The early empirical research did indeed focus on infancy,
and most particularly on the mother–infant bond (Ainsworth et al.
1978). In the past several decades, however, scores of empirical
studies and theoretical developments have shown that attachment
theory applies to every stage of life (Dallos and Vetere 2009; Howe
2011; Thompson and Raikes 2003).
Attachment theory is increasingly accepted as a foundation
theory within the field of developmental psychology because it
provides a well-evidenced model explaining the development of
self-protective mental strategies across the lifespan, and a model
for understanding how early experiences of care influence our
development. It also offers a framework that can be applied to
diverse therapies (Steele and Steele 2008; Wallin 2007).
From birth, human infants – and, incidentally, all primates and
most other mammals – can activate a range of instinctive behaviours
to signal their distress and maximise their chances of survival. This
attachment-seeking behaviour helps the infant to achieve closeness
with and comfort from a protective person, particularly when the
infant is feeling afraid, in pain or otherwise unsettled.
When distressed, the infant will instinctively display signals
such as crying, clinging and reaching out towards the protective
128 EMPOWERING THERAPEUTIC PRACTICE

person, i.e. an attachment figure. These signals are attempts to meet

four basic survival needs:
1. Faced with perceived danger, we seek safety.
2. Faced with perceived distress, we seek comfort.
3. Faced with perceived isolation, we seek proximity to our
attachment figure(s).
4. Faced with perceived chaos – including internal chaos – we
seek predictability, e.g. what is familiar to us.
Thus, the term attachment refers to a number of related processes:
staying safe, seeking comfort, regulating proximity in relation to
attachment figures, and seeking predictability (Crittenden 2007).
It is important to note that each of these strategies has both an
internal and an inter-personal component. For example, we can
seek safety through internal psychological processes (e.g. recalling
a positive attachment figure; blocking out toxic memories; denial,
dissociation) or we can seek safety through external behaviour
and inter-personal means (e.g. seeking out a reliable and protective
person; fight or flight). The same internal and inter-personal
variations apply to seeking comfort, proximity and predictability.
This concept will be familiar to psychodramatists who draw on
role theory, which also distinguishes internal and inter-personal
roles (Blatner 2007; Daniel 2007; Moreno 1985). While attachment
theory refers to strategies, psychodrama theory typically speaks in
terms of roles. These concepts complement each other well and can
be integrated in the director’s thinking and decision-making.

The roots of psychological disturbance:

strategies out of context
Whether and how the caregiver responds to the infant’s distress will
create the early template for how the infant learns to recognise and
regulate their emotions and interact with their attachment figures
(Howe 2005). These early experiences, particularly powerful or
repeated experiences early in life, often become deeply embedded
within the neural pathways of the brain (Hudgins and Toscani
Integrating Psychodrama with Attachment Theory 129

2013; Siegel 1999). A related notion is that of schema, or implicit

ways of seeing, understanding and being in the world (Erikson
1997; Vygotsky 1978; Young, Klosko and Weishaar 2003).
Attachment theory offers insights into how and why
psychological and emotional problems develop. People who suffer
with developmentally rooted psychological problems have often
faced early-life disrupted attachment, separation, maltreatment,
abuse, neglect, loss or trauma – all of which can pose life-threatening
dangers which impact brain development, the organisation
of memory systems, and mental and inter-personal processes
(Cozolino 2002; Fonagy 2001; Holmes 2002; Panksepp 2005;
Perry 2008). Depending on circumstances, children and young
people facing such threats will develop starkly different strategies
for organising their mind and their behaviour around threat and
danger (Crittenden and Landini 2011; Schore 2003; de Zulueta
1993).
At the time these mental and behavioural strategies are
developed, they should be seen as the best response that the child
can generate to adapt to the threats they are facing. Later in life, if
these same strategies are used out of context, only then may they
be thought of as maladaptive. This is crucial to our understanding
of psychological disturbance: the very same strategy that is adaptive
in infancy or childhood may be maladaptive later in life.

Attachment and adaptation: the

development of the A, B and C patterns
Readers may be familiar with attachment terminology such as
dismissing/distancing, balanced/secure and preoccupied/ambivalent
to describe attachment strategies. Rather than using these terms,
which are described in contradictory ways by different authors, this
chapter instead offers the more user-friendly A, B and C patterns.
These are the original letter names given by Mary Ainsworth, with
the advice of Bowlby (Crittenden and Claussen 2000).
Ainsworth, an American psychologist who worked closely with
John Bowlby, was the first to identify the A, B and C patterns in
babies and infants. She did this through her field work in Uganda
130 EMPOWERING THERAPEUTIC PRACTICE

and also through her experimentation with the Strange Situation

procedure, the first empirical measure of attachment in humans.
This procedure and Ainsworth’s meticulous recordings of her
observations enabled the attachment patterns as we now know
them to be identified.
In the procedure, which involves a series of timed separations
and reunions between caregiver and baby, Ainsworth observed
three patterns of response (in the original study, the babies were
observed with their mothers, so the following list refers to mothers):
A. Some infants, when their mothers departed and returned,
did not display distress.
B. Some infants became upset when their mother left the
room, and when she returned they settled down when she
comforted them.
C. Some infants became highly distressed when their mother
left the room and also found it very difficult to settle when
she returned, despite their mother’s efforts to comfort them.
The following three sections explain the early life experiences
that influence the development of the A, B and C strategies, and
how the childhood strategies may further develop in adulthood.
This explanation draws significantly from Crittenden and Landini
(2011). We will consider them in the order B, A and C. First is the
B strategy, which balances thoughts and feelings.

Development of the B strategy –

predictability and attunement
Two critical factors have a decisive influence on the development
of a baby’s mind and his/her attachments with other people:
predictability and attunement of care. Predictability is important
because it allows the baby to learn basic routines by making cause-
and-effect links, e.g. ‘If I cry, someone helps me to feel better’.
Attunement is important because an attuned response is an accurate
response; it will tend to lessen the baby’s distress and make him/
her feel safe, comfortable, fed, rested, etc.
If, when the baby cries out, he/she receives predictable and
attuned care, his/her mind will have an optimum environment in
Integrating Psychodrama with Attachment Theory 131

which to develop (Gerhardt 2004). He/she learns that his/her

thoughts (e.g. linking causes and effects in their predictable world)
and his/her feelings (e.g. of distress, fear, anger, sadness, need for
comfort) have equal self-protective value. This will typically lead to
the development of a B or ‘balanced’ attachment strategy in close
relationships, i.e. a strategy that balances thoughts and feelings.
As this person approaches adulthood, he/she will be well
prepared to give and receive care in an integrated way that satisfies
both him/her and other people, including his/her children, if he/
she has children. This person is able to reflect on and balance his/
her own thoughts, feelings, abilities and goals with those of other
people and adjust his/her behaviour accordingly, trusting that
other people can respond to his/her expressed needs.

Development of the A strategy –

predictability with lack of attunement
If, however, the baby’s care is predictable but not attuned, he/she
is likely to develop a markedly different attachment strategy –
the A strategy. When he/she cries, this baby may be consistently
ignored, chided, rebuffed or handled coldly or roughly. In severe
cases of maltreatment, the baby may be screamed at or physically
harmed when he/she cries.
In such circumstances where the danger is predictable, the baby
will soon learn to limit his/her tears, anger or clinginess, because
such displays consistently increase his/her distress. He/she learns,
‘When I feel bad, no one helps, and when I cry, I feel worse’.
As they grow, the child learns that thinking – in particular,
thinking about cause and effect – is critical to survival. This child
becomes cognitively organised, meaning they trust and rely on their
thoughts more than their feelings. He/she knows that thinking is
what protects him/her, and to display fear, anger, sadness or the need
for comfort puts him/her in danger or makes him/her feel worse.
The emphasis on cause-and-effect consequences may lead this
child to develop ways of thinking and behaving that prioritise the
outer world and discount his/her inner experience. At the milder
end of the continuum, which is normative in safe contexts, the A
strategy may take the form of people-pleasing (being a ‘good boy’
132 EMPOWERING THERAPEUTIC PRACTICE

or a ‘good girl’), an emotional ‘stiff upper lip,’ or high academic

and professional achievement. Indeed, a large proportion of high-
achievers are likely to use the A strategy.
Moving to the more concerning part of the continuum, a
person developing an A strategy may also develop compulsive
caretaking behaviours, putting the other person first. As an adult,
if he/she has children and/or forms relationships, he/she may
become intolerant or abusive when faced with negative displays
of affect in their own children or partner, because such displays
have proved to have such negative consequences for him/her in
the past. Further still along the continuum, he/she may become
highly controlling and even punishingly dominant, as a way of
regulating relationships to stay at the correct emotional distance.
Alternatively, he/she may become socially isolated, because
human contact has proved to be so troubling and predictably
damaging. In some circumstances, this can translate into a
superficial social promiscuity, where the person seems to have a
wide circle of social contacts, but these contacts are kept superficial
for reasons of self-protection.
In other people, this social promiscuity can translate into sexual
promiscuity, again following the pattern of achieving some level of
human contact but at an emotional distance, where inner feelings
are protected by the superficiality of the encounter.
In the context of psychological therapy, this person is likely to
find it difficult at first to engage with a nurturing and empathic
therapeutic process or to express difficult or painful emotions.
People with extreme A strategies are sometimes also given diagnoses
of neuroticism, schizophrenia or obsessive-compulsive disorder.
They may also experience acute psychotic breaks (e.g. delusions
or hallucinations that are either highly critical of them or which
provide comfort and predictability) or affective breaks, sometimes
known as ‘intrusions of “forbidden” negative affect’ (panic attacks;
violence; convulsive and inconsolable sobbing) when the A strategy
fractures (Crittenden and Landini 2011).
Integrating Psychodrama with Attachment Theory 133

Development of the C strategy –

unpredictability with variable attunement
The C pattern develops when the baby has a carer who is unpredictable
and inconsistently attuned. Her/his carer sometimes responds well,
and sometimes not, sometimes too soon and sometimes too late.
There are many reasons why a carer may be unpredictable, from
mild distractibility to serious substance misuse, domestic violence,
unresolved trauma or mental illness.
The inconsistency is very confusing for the baby. Her/his
crying, anger or clinginess sometimes gets him/her the care he/
she needs and sometimes does not. The problem is that the baby
can’t predict when and how his/her carer will respond. This
baby is likely to learn that his/her emotions of fear, anger or
sadness, when exaggerated, get more predictable results, because the
exaggerated affect is difficult to ignore and is more likely to focus
the caregiver’s mind on the baby. Consequently, the baby’s tears
may become exaggerated, his/her anger may become a temper
tantrum, his/her sadness, inconsolable. He/she may become fussy,
complaining or ‘helpless’. As the child grows older, he/she may
act out in any way that gets his/her unpredictable carer’s attention.
This behaviour confuses the carer, who may be unaware that his/
her inconsistency worsens the child’s distressed behaviour. When
the C pattern is firmly established, typically by toddlerhood, both
carer and child gradually descend into misery together.
The child developing a C strategy learns it is pointless to try
to ‘perspective-take’, because other peoples’ minds cannot be
predicted. He/she stays firmly in his/her own perspective. He/
she also learns that cause-and-effect contingencies have little value.
Again, this is because he/she has grown up in an unpredictable
environment, where cause and effect cannot be predicted in the
normal way (without the added ingredient of heightened emotional
expression).
Moreover, the child learns that to truly get his/her needs met
and the attention he/she needs, he/she must not only get their
caregiver’s attention, he/she must hold it. When the carer finally
does respond, the child must continually change direction and
create problem after problem in order to keep their attachment
134 EMPOWERING THERAPEUTIC PRACTICE

figure engaged and enmeshed in an ongoing, everlasting sequence

of unsolvable problems. This is the essence of the C pattern, which
is twofold: first, exaggerate my feelings of sadness, fear, anger or needing
comfort, and secondly, keep changing the problem.
In therapy, a person using a prominent C strategy may have a wide
range of presenting problems. In the mild part of the continuum, this
person may appear overwhelmed by their feelings of sadness, fear,
helplessness or anger. Where the C pattern is in a more extreme
form, the person may feel either intimidating or menacing to the
therapist or, with their expression of vulnerability, invite rescue
from the therapist. This person may also have previously been given
one or more diagnoses of personality disorder, such as borderline,
emotionally unstable or anti-social personality disorder. In the most
extreme cases, where his/her emotions of anger and fear are running
rampant and unchecked, an individual may develop delusional
beliefs about him-/herself as being all-powerful (i.e. to wreak angry
revenge on people who have done him/her wrong) or relentlessly
persecuted (i.e. to have paranoid and fear-driven beliefs such as ‘They
are all out to get me/There is danger everywhere’).
A particularly challenging aspect of working with a person
who uses the C strategy is that it is often very difficult to get to
‘the real issue’ because this person has, from the earliest age, used
a sophisticated strategy for making their problems irresolvable.
One problem is presented after another, perhaps with glimmers of
progress, and then relapse.
Because of their deep-rooted fear of abandonment, this person
may likewise fear the implications of ‘getting better’ (i.e. ending
therapy, which can activate old feelings of abandonment). Effective
therapy would need to explicitly address this dilemma (Baim and
Morrison 2011).

The Dynamic-Maturational Model

of Attachment and Adaptation
Since Ainsworth’s experiments with the Strange Situation,
subsequent researchers have expanded her work and developed
further empirical measures of attachment. For example, Patricia
Integrating Psychodrama with Attachment Theory 135

Crittenden, who was a doctoral student of Ainsworth’s, has

developed a range of attachment assessments that apply across
the lifespan. This has led to her development of the Dynamic-
Maturational Model of Attachment and Adaptation (DMM), a name
that reflects the dynamic and developing potential of adaptive
strategies within each person, across his/her lifespan (Crittenden
and Landini 2011; Farnfield et al. 2010).
The DMM deliberately avoids using clinical categories or labels.
Instead, the DMM considers strategies as serving a function in their
time and context, and considers these strategies on a continuum of
attachment security. The DMM stresses that the strategies, when first
developed in childhood, were adaptive to that individual’s survival at
that time. It is only later that the use of these strategies may become
maladaptive, i.e. used out of their original context, and associated
with what might be described as ‘psychopathology’. For example,
aggression may be one way of meeting one’s basic needs in childhood,
but may, later in life, prove self-defeating or dangerous to others.
This way of conceptualising the development of psychopathology
contains a powerful reminder of the need for compassion for people
showing behaviour and mental distortions at the extremes; the roots
of such distorted thinking, feelings and acting can usually be traced
to childhood neglect, abuse, loss, trauma, shaming, separation and
maltreatment.
Therefore, a crucial job for the psychodramatist is to work with
the client to help him/her understand how his/her mind has had to
adapt to the dangers he/she experienced and how those adaptations
may still be operating in the present in helpful or unhelpful ways.
For the interest of the reader, Figure 6.1 shows the complete
version of the Dynamic-Maturational Model of Attachment and
Adaptation. The model shows how the A, B and C patterns each
have a number of sub-patterns.
As a general rule, the further down the model one goes, the
more danger a person has faced in their early years. In the upper
third of the model, in the low-numbered A and C parts of the
circle, people may have been under-comforted as children, but did
not face chronic, deceptive or life-threatening dangers from their
caregivers. Alternatively, they may have faced great dangers or
losses early in life, but these are now largely resolved.
136 EMPOWERING THERAPEUTIC PRACTICE

Towards the middle of the circle, on the A and C sides of the

model, people will have faced dangers, perhaps chronic dangers and/
or neglect, compounded by a lack of comfort. Towards the bottom
of the model, these dangers will have been complicated by deception
(e.g. the parent smiles and beckons the child, before striking them).
At the very bottom of the model we find extreme forms of
psychological survival strategies, including delusions and various
distortions of reality and bodily sensation. People who function with
these strategies have usually faced extreme forms of danger, neglect,
abuse or psychological treachery, often from attachment figures and
often with deception (Crittenden 2007; Jefferies 1991; de Zulueta
1993). This typically leads to severe psychological disturbance and
impaired brain development (Gerhardt 2004; Perry 2008).

Integrated true
information
True True negative
cognition affect
B3
Comfortable
B1–2 B4–5
Reserved Reactive Distorted
Distorted negative
cognition affect
A1–2 C1–2
Socially facile/ Threatening/
Inhibited Disarming

A3–4 A/C C3–4

False Compulsively False
positive Aggressive/
affect
Caregiving/ Feigned Helpless cognition
Compliant

A5–6 C5–6
Compulsively Punitive/
Promiscuous/ Seducitve
Denied Self-Reliant A7–8 Denied
negative true
Delusional C7–8
affect Idealisation/ cognition
Menacing/
Externally Paranoid
Assembled AC
Self Psychopathy
Delusional Delusional
cognition affect
Integrated
transformed
information
Figure 6.1: Crittenden’s Dynamic-Maturational Model of Attachment and
Adaptation (courtesy of Dr Crittenden)
Integrating Psychodrama with Attachment Theory 137

Space does not allow a full account of the DMM in this chapter.
See Crittenden and Landini (2011) for a detailed explanation
of the DMM.

Measuring attachment beyond childhood:

the adult attachment interview
There are a range of validated tools for the assessment of attachment
for different age groups. The Adult Attachment Interview (AAI)
is the most relevant for psychodramatists working with adults
(Crittenden and Landini 2011; George, Kaplan and Main 1996;
Steele and Steele 2008).
The aim of the AAI is to determine the subject’s present state
of mind with regard to significant past relationships and dangers.
This has a strong influence on his/her expectations about current
relationships and dangers. The AAI reveals the strategies the person
uses to stay safe when he/she is under threat. In the interview,
the person is asked to describe their early relationships with their
parent(s) or primary carers.
The interviewee is also asked about other important memories
related to attachment, such as losses, separations, traumas and
abuse, as well as comforting behaviour. Unresolved losses and
traumas may be revealed in this way, and must be listened to with
care and professional compassion.
The interview typically takes about 90 minutes and is audio-
recorded. It is then transcribed and analysed according to both
the content of the person’s reported experiences and his/her
narrative style – the way he/she tells his/her story. It is not only
what subjects say, but how they say it which reveals their attachment
strategies. Interviews by people with severe adverse childhood
experiences may still be classified as secure (B) if they tell their
stories in a coherent, reflective and integrated way.
138 EMPOWERING THERAPEUTIC PRACTICE

Implications for the psychodrama director:

the relevance of the DMM Model
Role analysis during the presenting scene
In psychodrama, role analysis (Williams 1989) serves a similar
function to the analysis of the Adult Attachment Interview. Role
analysis is the process of gathering information and formulating a
hypothesis about the protagonist’s response in a given situation.
Role analysis typically happens in the first scene of the drama,
which is known as the presenting scene.
During the presenting scene of the drama, which typically
portrays a recent situation where the protagonist has faced a
difficulty or suffered in some way, the director observes in the here-
and-now behaviours that reflect the protagonist’s role response in
the there-and-then. In attachment terms, the director is working
towards an understanding of how and why the protagonist employs
his/her self-protective strategy – i.e. their attachment strategy – in a
given context. The director notes four kinds of communication
from the protagonist:
• semantic information: what is said
• syntactic information: how it is said
• affective information: what feelings are displayed or inhibited,
and how well the displayed affect matches what is said
• somatic information: the actions, physical clues and non-verbal
signals given by the protagonist.
Using this information, the director and the protagonist consider
where the role response (in attachment terms, the strategy)
originates, where it has been used in the past, what function it
serves, and what internal and inter-personal influences maintain
the response. When the director and the protagonist feel that they
have identified and named the role response/strategy, the director
can guide interventions that help to ‘track back’ the role response
to its source in order to promote insight, emotional catharsis and/
or working through (Bustos 1994; Goldman and Morrison 1984).
Tracking back will often lead to early childhood scenes,
where the protagonist may have the chance to experience what
Integrating Psychodrama with Attachment Theory 139

was missing but needed at that time. The drama may also track
back several or more generations in order to ‘hand back’ or resolve
hidden legacies in the family tree (Schutzenberger 1998).
As this takes place, the director helps the protagonist to identify
effective self-protective strategies (i.e. attachment strategies) and
develop new strategies aimed at integration and balance. In
attachment terms, the director is helping the protagonist to develop
his/her B responses – choosing the best response from the wide
array of human responses – to meet the challenge of the situation.
In psychodrama terms, this might also be called role expansion, role
training or spontaneity training.
To clarify the link further: what in psychodrama we call
the ‘locus’ scene, i.e. the location, time and place where the
protagonist’s role response first developed, in attachment terms,
we would describe as the scene where the attachment strategy first
developed to protect the self from some combination of dangers,
real or perceived, in relation to their attachment figure(s).

Adaptation of psychodrama,
based on DMM principles
Psychodrama is just as much a method for encouraging emotional
containment as it is a method for emotional expression. It is
sometimes misinterpreted as a method that focuses solely on
emotional catharsis (which may be very useful for people using
an A pattern), neglecting the very important function of emotional
containment – which may be useful for people using a C pattern.
Crittenden (2007) and others have supported the notion of
‘purposeful eclecticism’ in psychotherapy; that is, the adaptation
and combination of psychotherapeutic interventions to best meet
the needs of each client. Psychodrama is a notably adaptable form
of therapy, capable of addressing any human theme and as broad
as nature itself. Indeed, the essence of the method is to recreate as
closely as possible the conditions and circumstances of life on the
psychodrama stage.
As such, psychodrama can, at different times, function with an
overtly cognitive bias, encouraging the protagonist to ‘think’, or with
140 EMPOWERING THERAPEUTIC PRACTICE

an emotion-elevating focus, encouraging the protagonist to ‘feel’

and express emotion. Directors will be more effective if they make
purposeful adjustments to psychodrama techniques and processes.
The following section offers some ideas about how
psychodramatists can apply their skills and techniques in strategic
ways with people who use A or C strategies or some combination
of the two. Further research and empirical testing will be needed
to test the validity of this theoretical outline.

Working with a person who uses the A strategy

CENTRAL DILEMMA
This person will have an exterior presentation that inhibits
negative affect. A key dilemma in relationships for a person using
the A pattern is trying to strike a balance between his/her fear of
intimacy versus his/her fear of emotional loneliness.

PRESENTING SCENE AND ANALYSIS OF ROLE RESPONSE

See Table 6.1 (left-hand column) for a summary of the A strategy
role responses protagonists may display in the presenting scene or
other scenes. These behavioural responses may be understood as
ways of gaining comfort and safety by inhibiting the ‘forbidden’
or ‘shadow’ emotions, particularly anger, fear, sadness or the desire
for comfort.
Directors should focus on the function of the behaviour/role
response rather than the behaviour itself, both in the ‘here and
now’ and in the ‘there and then’ of the psychodrama. Directors
should also emphasise emotional and cognitive integration and
new responses that help the protagonists to perceive, interpret and
express their authentic feelings.
The A strategy person may be the last person to put him-/
herself forward as protagonist. He/she may be the ‘invisible’ group
member, or the group member who takes care of the others but
rarely seeks help. He/she may also be dismissive of the process and
how it focuses on feelings.
 Table 6.1 A and C strategies reflected in the
protagonist’s role response during the psychodrama
– particularly in the presenting scene
(reading down the columns, the strategies go from mild to
severe in terms of potential risks and treatment need).[AQ]
A strategy responses C strategy responses
Socially immature or too- Threatening or angry response.
simplistic response (e.g. ‘being
good’ or ‘not making a fuss’).

Mild
Inhibited response (can include Disarming/coy/appeasing
‘frozen’ non-response and self- response, to appease or disarm
blaming). the other person’s anger.
Compulsively caregiving to other Aggressive response. Typically,

Concerning
people, to the detriment of the complaining about perceived
self. injustices, sometimes decades ago
in the past.
Compliant, or over- Feigned helpless response: ‘I
intellectualised response. can’t help myself ’.
Promiscuous response – socially Punitive response: ‘I will get back
or sexually promiscuous, or both at you’.
– where there may be pseudo-

intimacy but lack of real intimacy.
Self-reliant response, detached
from other person. Includes
withdrawal. Can appear highly
able and independent, but lacks
intimacy.
Idealising the other person,
sometimes to the point of
delusional idealising.
The response of an externally
Endangering
Seductive response (the strategy
is to become entangled with the
other person by seducing him/
her into rescue).
Menacing response (including
deception): ‘I am all-powerful
and I will have my revenge!’
Paranoid response: ‘I see danger
Delusional

assembled ‘false’ self, generated everywhere’. Can be highly

in the presence of a more dangerous and include deception
powerful person such as an as the person strives to protect
authority figure or an attachment him-/herself, possibly by striking
figure, and focused entirely on the first blow against a perceived
protecting self with no trust for enemy.
or genuine interaction with other
person.
Note: These strategies can also be played out in the relationship with
the director and the group members, i.e. in parallel process.
142 EMPOWERING THERAPEUTIC PRACTICE

The protagonist may give careful attention to ‘impression

management’ to preserve a particular impression of him-/herself
or his/her attachment figure. Related to this, he/she may continue
to blame him-/herself or excuse their parents for early life
maltreatment, or he/she may idealise them.
In relation to the director, he/she may try to soothe and comfort
the director or try to perform well. He/she may attribute too much
power to the director or become analytical or over-intellectual
with the director.

Working with a person who uses the C strategy

CENTRAL DILEMMA
A person using a C attachment strategy has developed a pattern
where he/she exaggerates genuinely felt fear/desire for comfort
and alternates it with genuinely felt anger (with varying degrees
of one presentation being dominant) in order to coerce the
attachment figure into an ongoing, irresolvable struggle that keeps
the relationship going. He/she is stuck in a dilemma, where he/
she fears both abandonment and the loss of autonomy.
A key aim with such a person is to help him/her arrive at a
more adequate understanding of him-/herself from previously
uncontained emotion, unboundaried interpersonal relationships
and unstructured narrative.

PRESENTING SCENE AND ANALYSIS OF ROLE RESPONSE

See Table 6.1 (right-hand column) for a summary of the C strategy
role responses protagonists may display in the presenting scene or
other scenes.
These behavioural responses may be understood as ways of
gaining comfort and safety by maximising affective displays
and attempting to entangle the other person in an ongoing,
irresolvable struggle. This struggle may extend to an interpersonal
entanglement with the director and the group. Where appropriate,
the role response can be traced to the locus scene, where the focus
would be on a new cognitive response and understanding.
Integrating Psychodrama with Attachment Theory 143

Table 6.2 provides an overview of suggested adaptations for

psychodramatists who use a DMM understanding to inform their
purposeful selection of techniques.

Conclusion
This chapter has provided an overview of the developmental
pathways for attachment patterns and has suggested some
adaptations for psychodramatists working with people who suffer
from psychological and emotional problems. It offers further
theoretical support to what is, for many psychodramatists, already
common practice. As a consequence, the chapter helps practitioners
to underpin sound practice and the informed use of particular
techniques to address particular problems.
The use of attachment theory as a theoretical framework
provides the psychodramatist with several advantages. Attachment
theory is foremost an interpersonal and systems-oriented theory.
This integrates well with psychodrama’s approach and Moreno’s
original conception of psychodrama as a form of interpersonal
therapy, emphasising ‘tele’ and the encounter between individuals
(Moreno 1985; Moreno, Blomkvist and Rützel 2000). An
understanding of attachment theory also usefully complements
role theory, one of psychodrama’s underpinning theories (Blatner
2000; Moreno 1993).
The A and C strategies suggest quite different treatment
approaches and goals. Attachment theory provides further
understanding of why some psychodrama techniques may be
beneficial for some people and not for others.
Psychodramatists – indeed, therapists of all disciplines – who are
informed about attachment theory will be better able to generate
useful and accurate functional formulations and tailor treatment to
the individual. We will also be better able to engage with, motivate
and establish useful goals with clients to help them develop a more
adequate interpretation of their inner world and to give meaning
to their lives, symptoms and hopes for the future.
 Table 6.2 Suggested adaptations and considerations for psychodramatists based on the DMM:
purposeful adaptation for working with protagonists who use A and/or C strategies
Clients who use a prominent A strategy for self- Clients who use a prominent C strategy for self-
protection. protection.
Group- The psychodramatist should emphasise safety, warmth, The psychodramatist should emphasise structure,
building and acceptance and how it is OK to express feelings. boundaries and empathic awareness of other people.
warm-up
Protagonist The person who uses the A strategy may have difficulty The person who uses the C strategy may have a
selection showing need or offering to be a protagonist. profusion of issues, and/or display distress if not
selected, or may punish the group or the director if not
chosen. The switch from victim to persecutor can be
rapid.
Group The person who uses the A strategy may find it difficult The person who uses the C strategy may be a ‘difficult’
process to connect with other people in the group, or may member of the group, or may become a scapegoat for
present as invulnerable or arrogant as a way of hiding the group, becoming bullied or bullying.
their vulnerability.
Interpersonal The person who uses the A strategy may ‘perform well’
process with for the director or attribute too much power to the
the director director. He/she may laugh off, minimise or dismiss the
importance of difficult or painful events.
Beginning/ The psychodramatist should build trust to overcome
contracting suspicion of the therapist (and the group); identify
strengths and build self-esteem.
The psychodramatist should beware of the ‘quick fix’
(the protagonist is likely to minimise his/her problems),
and build trust to overcome suspicion and enable the
protagonist to make a full conscious choice to trust
rather than be led.
Act The psychodramatist should encourage expression of
hunger/act previously ‘forbidden’ emotions such as anger, fear,
gratification sadness, need for comfort and intimacy, and be cautious
about encouraging an act hunger that may reinforce
the problematic strategies, e.g. looking after others and
negating the self.
The person who uses the C strategy may become
entangled with the director in a power struggle, or
seduce the director or the group into rescuing him/
her. Multiple problems may be presented in a jumble,
making the problems ‘unsolvable’ and keeping the
director engaged while also off-balance.
The psychodramatist should anchor the start of the
drama in the here and now of the group room, and
emphasise being direct, clear and authentic. He/she
should create structures and clear boundaries, make
eye contact, make physical contact (e.g. shake hands),
if appropriate. Where needed, the psychodramatist
should find an ally in the room who can be a steady
companion (‘someone who can be a close comfort to
you’) so that the director is less likely to be enmeshed
with the protagonist’s C strategy.
The psychodramatist should encourage self-talk
through the use of the ‘aside’ technique, and use role
reversal to ‘get outside one’s own perspective’. He/she
should ecourage the protagonist to understand his/her
own role in situations and his/her own responsibility
for their actions and decisions.
cont.
 Table 6.2 cont.
Clients who use a prominent A strategy for self-
protection.
Presenting The psychodramatist should encourage the protagonist’s
scenes and understanding of how he/she learned to inhibit
‘tracking feelings of anger, sadness, desire for comfort, or fear
back’ (locus) in order to gain sufficient safety and proximity from
scenes attachment figure(s) in early life. Early-life scenes may
lead to self-forgiveness and appropriate attribution of
responsibility and also to appropriate expression of
emotion. Encourage the client to appraise self from his/
her own rather than his/her parents’ perspective and to
gain an accurate distribution of responsibility, especially
in relation to experiences of abuse from attachment
figures.
The psychodramatist should honour the story while
eliciting more balanced stories, including painful and
difficult emotions.
The psychodramatist should not ‘attack’ the idealised
attachment figure, but instead allow gradual reappraisal
of episodes and relationships.
Clients who use a prominent C strategy for self-
protection.
The psychodramatist should encourage completed and
clear episodes which provide an antidote to the ‘stream of
consciousness’ speaking that is typical of the person using
the C strategy.
He/she should encourage accurate distribution of
responsibility, including self-responsibility, which may
be all too easily avoided with the C strategy, and the
revisiting of avoided areas of life or ‘unspeakable’
emotions. The technique of doubling may be useful
here. He/she should encourage the protagonist’s
understanding of how he/she learned to focus on his/
her own difficult or painful feelings and to exaggerate
their display in order to gain safety, comfort, proximity
and predictability from his/her unpredictable attachment
figure(s) in early life. He/she should work to help the
protagonist create a coherent story from uncontained
emotion and unstructured narrative. He/she should
encourage an accurate and full, factual account of
episodes.
He/she should encourage the identification of
exceptions, for example when Mother was caring/
uncaring.
Role reversal The protagonist may gain no benefit from role
reversal with his/her attachment figure because he/
she instinctively reverses roles all the time and this
is part of his/her problem. In a psychodrama, if he/
she does reverse roles with significant figures in his/
her life, this should only be done after he/she has
acknowledged and expressed his/her own difficult or
painful feelings and authentic point of view. If role
reversal is used before this emotional expression, it
should be for the purpose of helping the protagonist to
identify the authentic intent of an oppressive person.
Back in his/her own role, the protagonist may then feel
more warmed up to express anger, sadness or needing
protection and comfort.
The double The psychodramatist should encourage ‘I’ statements,
i.e. about the protagonist’s own feelings. The
protagonist may benefit from a ‘feelings’ double, an
amplifying or a paradoxical double. Possibly also
multiple doubles with different views, or a containing
double (Hudgins and Toscani 2013) to promote
emotional expression. Perhaps most beneficial will
be the protagonist doubling for him-/herself, i.e.
expressing his/her own inner feelings.
The psychodramatist should help the protagonist
to develop skills of accurate perspective-taking, and
use role reversal to encourage perspective-taking
and promote fair distribution of responsibility for
events upon self and other people. It may be useful
to keep the protagonist in role reversal with his/
her attachment figure (or other significant figure)
for a considerable time, to encourage awareness of
that person’s perspective. Then, back in his/her own
role, the protagonist may be better able to accept a
fair distribution of responsibility, and perhaps enact
a surplus reality scene of predictable comfort or
protection from a reformed auxiliary (an auxilary who
offers comfort or care that the real-life person is not or
was not able to offer).
The protagonist may benefit from a double that helps
move him/her beyond feelings and self-referencing
into thinking mode and considering new possibilities.
Example: ‘Why does this keep happening? What
can I do to try to change things?’ May also benefit
from containing double to encourage cognitive and
emotional integration and growth.
cont.
 Table 6.2 cont.
Clients who use a prominent A strategy for self-
protection.
The mirror The protagonist may benefit from seeing him-/herself
at a distance, which may help him/her to see what
is there and what is missing, i.e. what he/she needed
to happen that did not happen. Additionally, the
protagonist may benefit from seeing an example of
someone expressing their authentic feelings of anger,
fear, sadness or need for comfort. This may serve as a
way into taking on that role.
Other (To aid emotional expression): empty chair; goodbye
techniques scenes; soliloquy; aside; monologue; monodrama;
judgement scene; sculpting (especially working in
silence, if words are getting in the way); surplus reality
(e.g. a reformed auxiliary offering comfort, protection
or containment); psychodramatic ‘surgery’ (e.g. to
metaphorically remove or ‘relieve from duty’ whatever
blocks the psychological growth and freedom of the
protagonist); dividing the attachment figure into good
and bad parts (to allow for expression of emotion
without the protagonist worrying about destroying the
‘good’ parts).
Clients who use a prominent C strategy for self-
protection.
Using the mirror technique may help the protagonist
to see him-/herself more objectively. This may be
particularly useful for the people using a C strategy,
who are typically often overwhelmed by their feelings
of anger, fear, sadness or need for comfort.
(To promote objectivity, cognitive integration,
perspective-taking and regulated emotional expression):
empty chair; goodbye scenes; psychodramatic ‘surgery’
(e.g. to ‘add connections’ that will help integrate the
emotions and the thoughts); dividing attachment figure
into good and bad parts (to allow the protagonist to
express negative emotions about the attachment figure,
but to also see that there were other parts to this
person, e.g. a part that cared). Externalisation: using
objects, chairs, writing, drawing and any of a variety of
methods to concretise and ‘make real’ what can often
seem chaotic and overwhelming.
Emotional The psychodramatist should encourage the expression
expression of authentic feelings, especially fear, sadness, disgust,
shame, guilt, anger, and give permission for ‘shadow’
side to be given a voice and developed, e.g. allow
‘forbidden’ or ‘unacceptable’ emotions or roles.
Somatic The psychodramatist should be aware that the protagonist
symptoms may be holding a great deal of emotion in their body, and
that his/her body may be offering clues. For example,
he/she may have stomach pain, a headache, tension in
the jaw, palpitations or nervous ‘tics’. Use doubles and
possibly auxiliaries in the role of the symptom or painful
body part, to encourage understanding, working through
and integration, or try to move feelings in the body (for
example, anger shown by clenched fists into speech, or
sadness in the heart into tears in the eyes).
The psychodramatist should emphasise separating
one’s own feelings from those of other people, and be
cautious about encouraging emotional expression that
reinforces the problematic strategy – beating a cushion
or crying may simply be ‘spinning the wheels’, i.e. part
of the problematic response pattern.
The psychodramatist should encourage the protagonist
to stay grounded and centred, with control of his/her
breath, and help him/her to regulate their emotions.
He/she should encourage the protagonist to gain a
more objective view of how his/her bodily process is
working. For example, what is his/her body telling the
protagonist? What is causing the fear, anger, sadness
or feeling of needing to be comforted? Can he/she
name the cause-and-effect sequence of events that has
occurred to generate such feelings?
cont.
 Table 6.2 cont.
Clients who use a prominent A strategy for self-
protection.
Encouraging Techniques that may be useful: parts of self; future
integration, projection; auxiliary work (to free up different modes of
goals expression); role training to practise skills of attunement
and new and emotional expressiveness, intimacy skills and
roles[AQ] asking for care/comfort/reciprocity in relationships.
Developing intimacy skills such as communication,
talking about emotions, asking for care/comfort.
Sharing The psychodramatist should encourage personal
connections, sharing of emotions and realistic
distribution of responsibility.
Clients who use a prominent C strategy for self-
protection.
The psychodramatist should emphasise cognitive
integration and new responses that reflect awareness of
self and other. Parts of self (to encourage integration
of the cognitive and affective parts of self, and also the
self-focused and other-focused parts of self ); future
projection (for reality testing and practical goal-setting);
auxiliary work (to experience other points of view);
role training to practise skills of problem-solving,
perspective-taking and attunement and contingency (i.e.
learning that other people have different perceptions).
The psychodramatist should encourage sharing
that is not enmeshed, and moves beyond blame
and resentment of attachment figures towards
understanding.
For both A The psychodramatist should:
and C 1. develop and strengthen the ‘earned’ B roles. These include any roles tending towards improving internal
strength, self-awareness, social integration, trusting others, communicating thoughts and feelings, body
awareness, meta-cognition, reflective functioning, emotional intelligence, and other integrative roles
(Hudgins and Toscani 2013; Blatner 2007; Daniel 2007). ‘Earned B’ roles should help the protagonist to:
• reflect on his/her thoughts, feelings, physical sensations and memories, and reconsider and re-evaluate
these where needed
• experience and connect with difficult or painful feelings, and contain and express these emotions
appropriately
• give meaning to his/her symptoms
• become more integrated around danger, i.e. develop a more realistic understanding of safety and danger
• understand that many events in life have complex causes
• distribute responsibility accurately for events in his/her life
• express mature emotions
• develop the role of the ‘internal investigator’
• develop empathy for all, including the self
• develop flexibility of mind and varied strategies
• accept the negative effects of events
• accept that some information is ambiguous/uncertain/incomplete
• arrive at difficult conclusions
cont.
 Table 6.2 cont.
For both A • find the good in others and develop a balanced view of people and events
and C cont. • find the good even in difficult or painful life experiences
• develop enough optimism to maintain resilience when under stress
• develop a sense of self-efficacy, self-compassion and self-leadership.
2. encourage the repetition of training in and rehearsal of new roles, behaviours, strategies and situation-
specific responses. Note the importance of repetition in neurobiological growth. Role training can help
participants develop B strategies in appropriate situations.
3. use careful summarising to help increase the likelihood that new learning is understood and integrated.
4. stay predictable and attuned.
5. add to the role repertoire, rather than taking away roles.
6. integrate the use of the Adult Attachment Interview. For example, where training and resources allow,
the AAI can be delivered to new clients and the episodes from within the AAI can serve as the basis for
exploration in the psychodramas. This would be particularly useful when clinicians become aware that
there are significant discrepancies, omissions, distortions, denial, or self-deceptions at play in the episodes
recalled in the AAI.
7. encourage the protagonist to understand his/her attachment history, and how his/her history can be
activated in the present day – in both positive and negative ways.
8. be willing to become a transitional attachment figure for the protagonist. The group as a whole or
member(s) of the group may also serve this role for the protagonist.
Integrating Psychodrama with Attachment Theory 153

Acknowledgments
The author wishes to thank Chip Chimera and Dr. Paul Holmes
for their collaboration and assistance with this chapter. Thanks
also to Dr. Patricia Crittenden for permission to use the image of
the Dynamic-Maturational Model of Attachment and Adaptation.

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