Psychodrama

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Psychodrama — Evidence & Practitioners | Gyfts

Background

Origin & History

Psychodrama was developed in the 1920s by Jacob L. Moreno, a Romanian-born psychiatrist and playwright who recognized the therapeutic potential of spontaneous dramatic expression. Moreno initially used dramatic techniques in Vienna's therapeutic theater before immigrating to the United States, where he formalized psychodrama as a distinct therapeutic modality. He established the first psychodrama institute in 1942 and developed a comprehensive theory linking spontaneity, creativity, and interpersonal dynamics to psychological healing.

The approach emerged from Moreno's observation that people naturally use role-play and imagination to process experiences, and that structured dramatic enactment could accelerate emotional release and insight. He introduced concepts such as the "protagonist" (the person whose story is being enacted), the "director" (the therapist), and the "auxiliary ego" (group members who play roles), creating a theatrical framework for psychological work. Psychodrama incorporated influences from theater, psychoanalysis, and group dynamics.

Throughout the mid-to-late 20th century, psychodrama gained recognition internationally, with training institutes established across Europe, North America, and beyond. The American Board of Examiners in Psychodrama, Sociometry and Group Psychotherapy was founded to certify practitioners and maintain professional standards. While psychodrama remains less mainstream than talk therapy, it has influenced other action-oriented modalities and continues to be practiced in clinical settings, educational institutions, and organizational development contexts.

The practice

How It Works

Psychodrama unfolds in structured sessions, typically led by a trained director, where participants spontaneously enact scenes from their own lives or psychological concerns. A protagonist (the person exploring an issue) performs key moments with support from auxiliary egos—other group members playing significant people or aspects of self—whilst observers witness the unfolding drama. Through techniques such as role reversal (where the protagonist swaps roles with another character), doubling (where an auxiliary ego mirrors the protagonist's inner experience), and soliloquy (where thoughts are verbalised aloud), participants access emotional material and test new responses in a contained, creative space. The session concludes with sharing and integration, where the protagonist and group members reflect on insights and emotional shifts that emerged during the enactment. This dynamic, embodied approach permits people to move beyond talking about problems to experiencing them differently—often revealing habitual patterns, unprocessed grief, or relational dynamics that remain hidden in conventional conversation-based therapy.

What to Expect in a Session

Initial Consultation

Your first session typically begins with the director (therapist) gathering background information about your concerns, goals, and any previous therapeutic experience. You'll discuss what brings you to psychodrama and what you hope to achieve. The director will explain the process, answer questions about confidentiality and group dynamics (if in a group setting), and assess whether psychodrama is appropriate for your needs. This consultation establishes safety and clarifies expectations.

Treatment

During an active psychodrama session, the director invites you to become the protagonist and enact a scene related to your concern—whether a past event, current conflict, or feared scenario. You may recreate a conversation with a family member, rehearse a difficult conversation, or explore a recurring emotional pattern. Other group members or the director may play roles as "auxiliary egos," taking on the parts of other people in your scenario. You move through the space, speak as if in the moment, and allow spontaneous reactions and emotions to emerge. The director guides the action, encouraging deeper exploration through techniques such as role reversal (where you play the other person's role to gain perspective), doubling (where an auxiliary ego mirrors your emotional state), or soliloquy (where you voice internal thoughts). The session continues until a natural resolution or insight emerges.

After Treatment

Following the enactment, there is typically a structured sharing phase where group members (if applicable) offer observations and connections to their own experiences, without giving advice or analyzing the protagonist's material. This helps normalize experiences and builds community. The director may help you reflect on what emerged, what you learned, and how you might apply these insights. You may feel emotionally tired, relieved, energized, or contemplative—all normal responses. The director provides closure and ensures you feel grounded before leaving.

Follow-up Sessions

Many people continue with regular psychodrama sessions to work through multiple issues, deepen insights, or practice new behaviors. Sessions may revisit earlier themes with greater depth or explore new concerns. Over time, you may notice shifts in how you relate to others, increased emotional awareness, or greater confidence in handling difficult situations. The frequency and duration depend on your goals and the director's recommendations, ranging from weekly sessions to monthly check-ins.

Evidence Assessment

Research on psychodrama is more limited compared to cognitive-behavioral or psychodynamic therapies, but a growing body of evidence supports its effectiveness for several conditions. Most research comes from small-to-moderate sized studies, often conducted in Europe and North America, with varying methodological rigor. Some studies show psychodrama is comparable to other group therapy formats and individual therapy for anxiety, depression, and interpersonal issues; however, large randomized controlled trials are lacking, making it difficult to isolate psychodrama's specific effects from nonspecific therapeutic factors (such as group support, attention, and hope).

Strengths in the evidence base include positive outcomes for trauma processing, social anxiety, self-esteem, and group cohesion, particularly when delivered by trained, certified directors. Some evidence supports its use in educational and organizational settings for team-building and conflict resolution. However, limitations include small sample sizes, difficulty blinding participants and facilitators, lack of standardized psychodrama protocols (since the method is flexible and individualized), and limited long-term follow-up data. Most studies have been conducted in specialized settings (psychodrama institutes) and may not generalize to all contexts.

Overall, psychodrama is best regarded as an emerging therapy with promising evidence for specific applications, particularly in group and relational contexts. It should be integrated with other evidence-based treatments rather than used as a standalone intervention for serious mental health conditions. More rigorous, large-scale research is needed to establish its efficacy relative to other modalities and to identify which populations and issues benefit most.

Evidence varies by condition and individual response. This information is for educational purposes only and does not constitute medical advice.

References

1.Maizes, V., Rakel, D., & Niemiec, C. (2009). Integrative medicine and patient-centered care. Explore, 5(5), 277–289.
2.World Health Organization. (2019). WHO global report on traditional and complementary medicine 2019. WHO Press.
3.Rakel, D. (2017). Integrative medicine (4th ed.). Elsevier.

Questions

Frequently Asked Questions

What happens if I become too emotionally overwhelmed during a session?

The director is trained to manage emotional intensity and can pause, slow down, or shift the enactment as needed. You have agency to set boundaries and can ask for a break. Techniques such as doubling (having an auxiliary ego support you emotionally) or de-roling (stepping out of character) help manage intensity. The goal is therapeutic work, not retraumatization, and skilled directors prioritize your safety and window of tolerance.

How many sessions do I need to see benefits?

This varies widely depending on your goals, the depth of issues being explored, and your engagement. Some people experience insight or shifts after a single session, while others benefit from ongoing work over weeks or months. Many find 8-12 sessions sufficient for a specific issue, though some continue longer for deeper work or multiple concerns. Discuss realistic timelines with your director based on your particular situation.

Is psychodrama the same as role-playing or acting therapy?

While psychodrama uses role-play and dramatic techniques, it is distinct from acting or theater. The focus is on spontaneous, authentic emotional expression and psychological insight, not performance or entertainment. The protagonist is not acting out a script but rather exploring their own material in a structured, therapeutic way guided by a trained clinician.

What if I'm in a group and uncomfortable being the protagonist?

Group psychodrama is voluntary—you are never forced to be the protagonist. You can participate as an auxiliary ego, playing roles in others' enactments, or as an observer and participant in the sharing phase. Many people warm up gradually and may volunteer after observing others. Your comfort and consent are paramount.

Can psychodrama replace individual therapy or medication?

Psychodrama is best used as part of integrated care rather than a replacement for other treatments. If you require medication for a psychiatric condition, continue that treatment and discuss psychodrama with your prescriber. For some issues, psychodrama alone may be sufficient; for others, it works best alongside individual therapy, medication, or other modalities. Your director and other healthcare providers can help determine the right combination of treatments for you.

What is role reversal and why is it used?

Role reversal is a key psychodrama technique where the protagonist switches roles with another character in their enactment, playing the other person while an auxiliary ego plays the protagonist. This builds empathy, provides perspective on the other person's experience, and can resolve conflict or misunderstanding. It's particularly powerful for relationship issues and can shift how someone understands a difficult interaction.

Ask Vidi about Psychodrama

Origin & History

How It Works

What to Expect in a Session

References

Frequently Asked Questions

Who Is This For?

Best for

Not ideal for

Commonly used for

PTSD & Trauma

Social anxiety disorder

Bereavement

Adjustment disorder

Burnout

Generalized anxiety disorder

Symptoms practitioners commonly work with