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ABSTRACT. In this article, the author reviews the historical interface between behavior therapies and psychodrame, noting their mutually enhancing elements. She proposes an integration of those elements as a vehicle for providing brief, yet intensive therapy for difficult-to-treat clients, such as those with personality disorders. With a review of relevant principles of psychodramatic practice, she clarifies the compatibility of the 2 types of therapy with basic learning theory concepts. The author provides an overview of schema-focused cognitive therapy, including findings on the validity of Young's schema questionnaire. She also presents and discusses a model for the presentation of schema-focused cognitive therapy through the medium of psychodrama.
Key words: cognitive therapy, psychodrama and cognitive therapy, schema-focused therapy, treating personality disorders
IN THIS ERA OF MANAGED CARE AND LIMITED RESOURCES FOR BEHAVIORAL HEALTH TREATMENT, brief therapy approaches are receiving significant attention. The notion that briefer is better, or at a minimum, cheaper, appears to be a driving force. Many cognitive and cognitive-behavioral approaches are brief therapies, and there is empirical evidence of their efficacy. With difficult or personality-disordered clients, however, brief therapy does not address pervasive underlying factors that contribute to poor functioning. In a review of recent practice in cognitive-behavioral approaches, I found indications of significant use of psychodramatic techniques (Linehan, 1993; Mahoney, 1991b; Young, 1999). Linehan (1993) advocates role playing and behavioral rehearsal in her Dialectical Behavior Therapy for borderline personality disorders. Mahoney (1991b) lists psychodrama and role playing as useful techniques in the cognitive therapists repertoire. Young (1991) suggests the use of role reversal in his point-counterpoint technique. In the model described in this article, I suggest that the cognitive integration of schema principles be used through psychodramatic techniques in a group therapy format.
A model for brief, intensive intervention emerges when the therapist uses cognitive-behavioral concepts that were developed for use with personalitydisordered clients, and implements those through psychodramatic and experiential techniques. Young's (1999) schema-focused cognitive therapy (SFCT) is a working theory that is comprehensible to clients and that addresses deeper constructs that underlie their behavior. The schemas are the lenses through which humans see and construe their worlds. Clients who identify and examine their schemas can choose and develop the skills to maintain more adaptive schemas. The treatment approach works...