The Roots of Enactment--the Process in Psychodrama, Family Therapy, and Psychoanalysis

The term enactment is used to describe therapeutic processes in family therapy, psychodrama, and psychoanalysis. An enactment in family therapy involves an encounter between family members in their here-andnow reality, whereas an enactment in psychoanalysis, if it occurs in the transference, is dominated by the intrapsychic reality of the patient, which is, to a large extent, governed by experiences in childhood. In this article, I argue that these two very different types of enactment both occur in psychodrama sessions and that each has a different psychological significance for the participants. I present a clinical example of therapeutic work with a family in mourning in which both of these two types of enactment are involved. THE DRAMA OF HUMAN INTERACTIONS is a feature of all forms of psychotherapy. It may be very apparent, as in treatments such as psychodrama and family therapy, or, as is the case with the more physically static psychoanalytic therapies, the drama may be a subtle but nonetheless powerful quality. Enactment, which is a feature of drama, is considered to be an essential feature of both psychodrama (Blatner 1973, 1988; Kipper, 1985) and family therapy (Guldner, 1983; Minuchin & Fishman, 1981). In these therapies, enactment is a process that uses not only the verbal and nonverbal communications common to all psychotherapy but also, at times, dramatic actions and physical movement. Psychoanalytic therapists, however, tend to be very cautious about using overt action, and especially acting out, in the treatment, seeing it as potentially counterproductive to the therapeutic process (Greenson, 1967; Sandler, Dare, & Holder, 1973). They prefer the therapeutic drama to be in the transference and to be confined to verbal communications between patient and therapist. This theoretical position has resulted in the psychological processes of the active therapies being seen by some as very different from those that occur in psychoanalysis (Williams, 1988). This view tends to miss the point that drama and emotional action are also a feature of individual and group psychoanalytic psychotherapy. Indeed, the British psychoanalyst, Patrick Casement, has used the term enactment to describe the process that occurs in the transference (Casement, 1987). It cannot be denied that there is drama in the psychoanalytic process, albeit more reserved than in some other therapies. The psychoanalyst, S. H. Foulkes, after experimenting with psychodrama in the 1940s, wrote: I find that in the analytic group there is sufficient dramatic action going on between people on deep emotional grounds, and [I] have found "action" unnecessary. (Foulkes, 1975, p. 9) Enactment in Psychodrama A distinction can be made between the enactments in a session of structural family therapy in which, to a large extent, no illusions exist and the illusory enactments in the transference experienced in psychoanalysis. I contend that these two types of enactment can both be observed in a psychodrama session. Each has its roots in a different psychological process that does not have the same significance for the participants. The first type of enactment, which has also been called encounter, is related to the enactment described by family therapists. In an encounter, two people meet in their common shared space in which, as far as is possible, they treat each other as real. Their relationship can be thought of as being symmetrical. When encounters occur within a psychodrama group, the participants' interactions and communications are modulated by tele, which, in Moreno's terms, is a process involving the reciprocity of attraction, rejection, excitation, or indifference (Fox, 1987, p. 4). In such enactments, reality predominates over illusion. The other type of enactment in psychodrama is associated with the, use of role reversals, doubling, and the employment of auxiliary egos. In these circumstances, there is a suspension of reality testing. I believe that these enactments are more akin to the processes that occur in transference in psychoanalysis. Enactment in Family Therapy Salvador Minuchin described enactment thus: [W]hen the therapist gets the family members to interact with each other, transacting some of the problems that they consider dysfunctional and negotiating disagreements, as in trying to establish control over a disobedient child, he unleashes sequences beyond the family's control. The accustomed rules take over, and transactional components manifest themselves with an intensity similar to that manifest in these transactions outside of the therapy session. (Minuchin &: Fishman, 1981, pp. 78-79) This here-and-now interaction of family members in the therapeutic session is a crucial feature of most family therapy processes, in which the emphasis is on the systemic relationships between people. As Minuchin so graphically described, in the process of enactment, the "therapist asks the family to dance in his presence" (Minuchin & Fishman, 1981). Salvador Minuchin's style of structural family therapy has been highly influential (Minuchin, 1967, 1974; Minuchin & Fishman, 1981; Guldner, 1983). However, many other styles and schools of family therapy also employ the same types of enactment in their therapeutic sessions. Enactment in Psychoanalysis: The Transference In psychoanalysis, the relationship between patient and therapist involves both participants in thoughts and feelings and sometimes in actions. To this extent, it is a horizontal relationship in the here-and-now. This relationship, however, is not symmetrical because the emphasis is placed on the patient's reactions and feelings toward the therapist as if he or she were an important figure from childhood. These feelings are experienced in the present. Roles are involved, for example, those of father, mother, or son. Together the therapist and patient are involved in the drama (Greenson, 1967; Sandler, Dare, & Holder, 1973). Psychoanalytic therapists are expected to acknowledge and react to the everyday reality of their patients. During the therapy session, they will obviously have many feelings toward or about their patients. These responses have been called the counter-transference and are considered to be an essential component of modern psychoanalysis (see Greenson, 1967; Sandler, Dare, & Holder, 1973). Some of their reactions will be reality (or tele) based, whereas others will be the result of the therapists' own unconscious inner world and neurotic conflicts (Holmes, 1992; Racker, 1968). The psychoanalytic process involves an enactment in the consulting room in which the patient is involved in reexperiencing a long lost drama from childhood (Casement 1987). Although the process of psychoanalysis is physically fairly static, with the participants either sitting or lying, there is usually tension and drama in the air. Indeed, the psychoanalyst Ralph Greenson states that the transference manifests itself by the patient's "intense emotional reaction to the analyst" that differentiates this response from a relationship based more in reality (Greenson, 1967, p. 157). The psychoanalyst John Klauber describes the transference situation as "therapeutic madness." He wrote: Perhaps illusion would be a more suitable word than madness, especially if you will accept a tentative definition of illusion as a false belief accompanied by uncertainty as to whether to give it credence. An illusion is produced by the breakthrough of unconscious emotion without consciousness surrendering to it completely. An illusion is a waking dream but somewhat less convicting. (Klauber, 1987, p. 6) In the same book, Patrick Casement wrote: [Klauber] says of this horizontal dimension in the analytic relationship: "What had been experienced in the past was also being enacted in a relationship between two people in the present." This enactment, in some measure, involves the analyst as well as the patient. (Casement 1987, p. 80) The patient is experiencing the therapist as if the therapist were his or her father or mother from childhood. This therapeutic illusion involves the externalization or projection of aspects of, or objects from, the patient's inner psychological world onto the therapist (Sandier, 1988). It is the interpretation and resolution of the transference that is a crucial process in the therapeutic power of psychoanalytic therapy The Use of Psychodrama Techniques with Families To further our discussion of these issues, we shall consider the times in psychotherapy when the methods normally associated either with psychodrama or family therapy are used together in the same therapeutic session. The use of family therapy as a method of psychological treatment is often seen as a postwar development, with many of the seminal books on the subject written as recently as the 1970s (Guldner & Tummon, 1983; Will & Wrate, 1985). J. L. Moreno was, however, working with couples and families in New York in the 1930s, using his psychodramatic method (Moreno, 1969). From his published accounts, it appears to me that he was directing psychodramas, using the two different kinds of enactment. As part of the therapeutic process, Moreno staged encounters between people, in which people met and interacted in their own realities. For example, in 1939, he directed a couple, Frank and Ann Mason, in a psychodrama of a marriage. He said to them, "Don't report what happened, don't tell a story of what you said to each other, but relive the situation as it actually occurred" (Moreno, 1969, p. 85). Thus did Moreno direct this couple to enact an aspect of their relationship in the therapeutic session. Together they enacted a scene from their life that had happened a week before in their home. I would suggest that the conversation they had about Mr. Mason's mistress, Ellen, in Moreno's theater was an important encounter or interaction for them in the here-and-now. In Minuchin's terms, they showed Moreno aspects of the tortured dance of their marital relationship. Their session resembled that which might occur these days in the clinical work of any family or marital therapist. The relationship of the couple was symmetrical and occurred in the here-and-now reality of the Masons, Moreno, and his staff.