Psychodrama and Cognitive Behavioral Therapy

Dr. Corby’s work in the field of cognitive behavioral therapy (CBT) has greatly influenced her work as a psychodramatist. Cognitive therapy and psychodrama can be done in the individual session setting or in group therapy. Cognitive therapy is based on the cognitive model, which sets forth that thoughts generate behaviors and physiological responses, and that all are interconnected.

Furthermore, the cognitive model stipulates that automatic thoughts (i.e., thoughts that “pop up” into a person’s conscious awareness) are connected to the deeper “core beliefs” (beliefs that are fixed and entrenched from childhood) of either “inadequacy” or “unlovability.” CBT theory believes that these beliefs are generally irrational in the here and now, but are a product of early unsuccessful or traumatic childhood experiences that molded together in the child’s psyche to form a “schema.” A schema is a template that includes the amalgamation of the maladaptive thoughts, beliefs and behaviors that can crystalized and replayed throughout our lives. These are 18 basic problematic schemas identified by cognitive therapists (e.g., with themes such as abandonment, entitlement, defectiveness/shame, for example), and clients in treatment identify and address these schemas through work that focuses upon identifying and changing unhelpful or inaccurate thinking, problematic behavior, or distressing emotional responses.

The behavioral aspect of CBT includes the physical aspect of treatment, such as role playing/training, exposure therapy (e.g., the client practices facing fear in graduated steps while simultaneously learning then practicing relaxation exercises, until the fear is extinguished), guided imagery, journal writing and social skills training, to name a few. The behavioral aspect of CBT is usually started after the cognitive portion is deeply explored together in therapy and well-understood by the client. The client and therapist together develop a very good handle on understanding the belief elements, as well as the fear and avoidance components involved in the presenting problems or symptoms. Much rapport and tele (the deep, mutual, accurate awareness of the self and other) is developed between therapist and client, and much safety is established via empathic attunement, before behavioral rehearsal takes place. Cognitive behavioral therapies are the most empirically supported form of psychotherapy and have shown excellent outcomes in addressing a wide range or psychological and behavioral difficulties.

Dr. Corby has found that CBT and psychodrama can fully enrich each other. Both CBT and psychodrama recognize the need to balance objectivity with subjectivity before entering into the client’s world. Cognitive therapy and psychodrama both emphasize that we humans actively construct our personal realities, as well as our own representations of our inner worlds. Dr. Corby often uses psychodrama to demonstrate the fluidity of the intrapsychic pieces that might be in conflict for a client. For example, a woman might be wrestling with the fear that she is going to be rejected if she tries to make friends. She may realize from her cognitive work initially that her belief stems from her abandonment and defectiveness/shame schemas.

It is possible to then put this cognitive distortion to the test by using psychodrama action methods: The client can experience in action an “encounter” (i.e., reversing of roles and places with a person or part of self or object) with the “rejected/defective” self, to see what she experiences in the role or in the mirror position if another group member were to assume the role (mirror position is when the client is removed from the action into a place of distance to observe the self and action from a distance). Often the client will gain empathy for the split off part of self (in this case, the “rejected/defective” self), and can see that the experience is in the past, and that she can influence in the here-and-now the role she has been playing (e.g., move from the role of “abandoned self who is defective” to the “active, included self”). The woman might generate compassion for herself in the action work, and develop a new internal representation of herself that is more self-caring and self-supportive.

 There are many other similarities between CBT and psychodrama. Both work in the here-and-now and offer people sometimes immediate and profound relief or insights that might have taken much longer to obtain during time in traditional talk therapy. Both cognitive therapy and psychodrama do not see people as “pathological” – only stuck in a schema or maladaptive role configuration, which has become fixed in their minds and bodies, since early childhood. Both methods teach tools that empower clients to keep their minds and bodies centered. Both techniques are wonderfully adaptive to a variety of people, problems, and settings.

Many people in CBT and psychodrama circles are misinformed about the other technique, and believe that the two theories are incompatible. This is true between various factions in much of psychology, unfortunately. Aside from some minor points of emphasis of different language and different techniques, Dr. Corby has learned over the years of practicing both that they are wonderfully complementary! The hope is that the general public, psychodramatists, CBT therapists and other practitioners learn of, and take advantage of, the healing power and beauty of both methods.