Psychodrama and the elderly: how does psychodramatic therapy work?

Care for the elderly has not been one of the traditional areas of intervention in psychology. It has been gaining prominence in recent decades as scientific advances have led to a considerable increase in life expectancy. In addition to this, low birth rates in the so-called developed countries have led to an increase in the population of elderly people, both relatively and in absolute terms.

Focusing on psychodramatic work with this type of population, we can see how the cognitive state of the participants affects the effectiveness of the techniques implemented and the efficiency of the method.

What are the stages of psychodrama?

Psychodrama uses a wide range of cognitive resources. The stages proposed by Rojas-Bermudez (1984) can be differentiated:

  1. Warm-up: this is the first part of the session, where the group interacts with each other verbally or bodily and a protagonist-theme emerges. The purpose is to define what and who will dramatize in the next stage.

In verbal warm-up, the cognitive resources used would be more associated with attention-working memory (maintaining a conversation); long-term, semantic or episodic memory (participants narrate personal experiences, beliefs, ideas, …) and expressive and comprehensive language. In other words, processes of a symbolic nature.

On the other hand, in a bodily warm-up, the participants’ executive abilities come into play, in which they must transform an internal-emotional state into motor behaviors. Often, objects such as fabrics are also used in this type of warm-ups. In other words, subsymbolic processing mechanisms.

  1. Dramatization: at this stage, the emerging protagonist works the content on stage, carrying out the director’s instructions that respond to technical criteria. At first, these instructions must be understood by the person (comprehensible language), in order to then carry out the technique in question. The techniques are grouped into dramatization, image construction and psychodance.
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The technique called dramatization requires abstract thinking. The protagonist proceeds to the construction of the scene (selected by the director) and assumes each of the other roles involved in it, so he must act according to it and the other elements involved (role reversal). This task involves behaving according to the behavior patterns of that role, i.e., acting on the basis of abstract and non-tangible elements.

In the construction of images, abstract thinking is also stimulated. The psychodramatic context is “as if”: the protagonist must physically and spatially materialize the different elements that make up the content in question, so as to reflect it faithfully.

Finally, as far as psychodrama is concerned, the cognitive processes that are stimulated are the executive skills. Similar to what happens in body warm-up, there must be a translation of an emotional experience into motor behaviors.

At a technical level, it goes from the more symbolic – cortical (dramatizations) to the more subsymbolic – subcortical (psychodance), finding the construction of images halfway between the two. It could be said that the construction of images favors the integration between the two types of processing.

  1. Comments: this last stage consists of a synthesis (personal and group) of what has been worked on during the session.

The function of this stage is that the members of the group expose some personal experiences related to the previously worked content (called group resonance), which is shared in the group by means of linguistic processes (specifically, expressive language). To achieve this, mechanisms of episodic long-term memory have to be set in motion. In this way, the narrator reaches personal conclusions through abstract thinking.

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How does psychodramatic intervention help us?

Once the psychodrama session is over, the group members return to their social context. Like any psychological intervention, the objective is that the person introduces changes and modifications in this context, depending on what has been worked on in the sessions. For this, the cognitive substrate of the learning processes is necessary.

Traditionally, work with the elderly population is based on the paradigm of cognitive stimulation, either to prevent its appearance or to attenuate the symptomatology if it has already appeared. This type of intervention has a structured nature, designed by the specialist in psychology who carries it out. It is usually made up of exercises that set in motion different cognitive processes: memory, language, praxias, perception, attention, executive functions (problem solving, planning, reasoning).

In contrast, psychodramatic intervention makes a difference by focusing on the body and emotion. Although the psychodrama director implements techniques following theoretical criteria (based on Rojas-Bermudez’s core self theory), the sessions are guided by the patients according to the natural ways they express themselves. The director must make an adequate reading of them, and thus apply techniques on stage that confirm or reject their therapeutic hypotheses.

The fundamental mediating instrument to work with is music. The psychodramatic method takes the anthropological value that music has in the human being. In our framework, music has a communicative and emotional function, since it facilitates the expression of emotional states. Recent research has shown the effects of music on the brain, which is none other than the modification of emotional states or arousal (Salimpoor et al., 2009).