The Inner World Outside

Object Relations Theory and Psychodrama

Paul Holmes

• Publisher: Routledge
• Year: 2015
• ISBN:
  9781317543084
• Edition: 2
• Topic: Psychology
• Subtopic: Psychotherapy
• Index: Psychology

First published in 1993, The Inner World Outside has become a classic in its field. Paul Holmes walks the reader through the 'inner world' of object relationships and the corresponding 'outside world' shared by others in which real relationships exist. Trained as a psychotherapist in both psychoanalytical and psychodramatic methods, Paul Holmes has written a well informed, clear introduction to Object Relations Theory and its relation to psychodrama. He explores the links between the theories of J.L. Moreno, the founder of psychodrama, and Sigmund Freud, the founder of psychoanalysis, and presents a stimulating synthesis. Each chapter opens with an account of part of a psychodrama session which focus on particular aspects of psychodrama or object relations theory illuminating the concepts or techniques using the clinical material from the group to illustrate basic psychoanalytic concepts in action.

Published here with a new introduction from the author that links the book's content to concepts of attachment theory, the book weaves together the very different concepts in an inspiring and comprehensive way that will ensure the book continues to be used by mental health and arts therapies professional, whether in training or practice.

Chapter 1
Introduction

Psychodrama and psychoanalytic theory

The group

George arrived late, out of breath and rather red in the face. The group was due to start in a couple of minutes. Thelma gave him a cup of coffee which he accepted gratefully.

‘You’ll be late for your own funeral one day,’ said Joyce, adding, ‘but at least this week you’re on time for the start of the group.’

Maggie interrupted, ‘Oh leave him alone, he tries to get here on time.’

‘Well he might try harder. I don’t like it when people come after we’ve started.’

The rest of the group looked on. Tussles such as this were becoming an all too regular start to the group sessions.

Paul, the group leader, came into the coffee room from his office where he’d been having an animated, and rather tense, argument, unconnected with the psychodrama group, with Tom, a social work colleague.

Paul suggested that they move up to the ‘theatre’, the largest room in the Victorian house in which his clinic was based. Coffee cups were quickly drained and the group trailed up the stairs. Debby rushed to the lavatory. She knew that it was going to be a long evening.

The group had been meeting every week for eight months. People had joined for various reasons. Joyce, an attractive middle-aged woman, had become depressed after the collapse of yet another relationship. As she got older she was having to come to terms with the reality of never becoming a mother. Her family doctor had suggested therapy. Joan had heard about psychodrama through a friend. David, a successful lawyer, had joined the group to work on problems related to difficulties in close personal relationships. Debby on the other hand joined to learn more about psychodrama. Her children were growing up and leaving home and she wondered about becoming a psychodramatist. All the members of the group hoped that their lives could be improved by joining the group, but not all were clear in what way.

The group was ‘semi-closed’, members agreeing to join for a contractual period of a term of twelve sessions. New members joined at the start of the term. Initially there were ten in the group, but Roy, an anxious unemployed young man, had left after three sessions saying: ‘Psychodrama is not for me. It scares me.’ Jane, a single parent, left after the first term because of difficulties in finding baby sitters for her young children. For a term the group had eight members, and at the start of the third term George had joined. He wanted to work on his difficulties both at work and in his marriage. He made others in the group angry at times and his arrival had a marked effect on the group dynamics.

The group sat around in the ‘theatre’, a comfortable room with many cushions. The chairs had been removed before the session, but some of the toys that related to Paul’s work as a child psychiatrist remained. While they waited for Debby to finish in the lavatory there was a rather subdued discussion during which Thelma was asked how her week had been after her psychodrama in the last session. Debby arrived and Paul looked around the group.

He was aware of the rather quiet and reserved mood pervading the room. This fitted with his mood after the row with Tom. People were tired, the evenings were drawing in, and the weather outside was awful. The group lacked energy, no one was making it obvious that they needed to ‘work’. Paul himself felt tired and lacking in creativity (it had been a long week so far). He checked his impression that no one felt ready to become the evening’s protagonist.

More energy was needed so Paul decided on a playful warm-up. He asked the group to think of a toy from their childhood and to start moving around the room being that toy. Thelma at once began to suck her thumb and look floppy, while Peter walked around moving his arms like the pistons of a toy train, hooting his horn every now and then, ‘Toot!’.

Debby was jumping around the room saying, ‘I’m Tigger! I’m Tigger!’

For a time neither David nor George would join in, standing together in a corner. Paul then asked the ‘toys’ to interact at which point Tigger went over to the two men and began to push them gently. David then became a toy car, rushing round the room hooting, braking suddenly, and having near ‘accidents’ with the other toys. George remained still and tense, but began slowly to rock on his heels. It became apparent to Paul that he was now in the role of a toy. After a few minutes the whole group seemed more alive; there was laughter in the room as the toys interacted and people’s impersonations became more relaxed and extravagant.

Paul said, ‘Let’s stop now.’

The group sat around in a circle.

‘Anyone like to tell us about their toy?’

Debby started: ‘Yes, I was Tigger from the Winnie the Pooh books. I was given him by my parents when I was about four. I’ve still got him, but he’s very tatty now.’

Thelma added: ‘I was a rag doll that I used to sleep with, I’ve no idea what happened to her. I think my mother threw her out when she became too dirty.’

One by one people said a little about their toys. Questions were asked:

‘Did you miss the doll?’ and answered:

‘Yes. I was much more careful of my children’s toys.’

Even George, who was still tense and quiet, talked a little about his wooden toy soldier: ‘With his smart red tunic, he looked so proud and strong.’

‘Well, does anyone wish to explore their toy and the memories it stirred up in you?’

No response. A psychodrama director’s nightmare. A session and no one ready or willing to become a protagonist.

Continued on page 14

(Note: To make it easier to read this account of a psychodrama session at one sitting, the number of the first page of the next chapter is given at the end of each section.)

The Outer World Inside and the Inner World Outside

These words, the original but over-long title of this book, sum up the ideas I present in the following chapters. The psychoanalytic model of object relations theory is used to explain how the inner world of the individual derives from experience of the outer world, while an account of a single psychodrama session is used to demonstrate how this inner world may be externalised both in life and in psychotherapy.

A Personal Introduction

This book is the result of my attempt to understand and to integrate my experience (as both patient and therapist) of two apparently very different forms of psychotherapy: psychodrama and psychoanalytic psychotherapy.

My first encounter with psychoanalytic therapy occurred long before I trained as a psychiatrist or psychotherapist. While an undergraduate, I went to see the doctor in the student health service. He referred me to a psychoanalytic group in an attempt to help me resolve certain personality conflicts and the resulting depression. My experience of analytic groups and individual psychoanalysis continued (on and off) for the next fifteen years. And some things never changed!

I later trained as an analytic psychotherapist, in part as a result of my own positive experiences of the therapeutic process. This is not an uncommon route into the profession of psychotherapy.

On the other hand, my first direct contact with psychodrama was almost accidental, as is perhaps appropriate for a therapy which so values spontaneity. I was looking for somewhere to go for a week’s holiday when I saw a poster for a psychodrama course at the Holwell Centre in Devon, run by Marcia Karp (who subsequently became my trainer).

I remembered that some years previously I’d bought (by post) a copy of an early version of Adam Blatner’s first book Acting-In. (At that time it was a duplicated document published privately and entitled ‘Psychodrama, role playing and action methods’ [Blatner 1970].) I had found its contents interesting but I had done nothing more about psychodrama.

So it was with a degree of trepidation and excitement that I went down to Holwell Centre, which is based in a farmhouse high on the moors of north Devon. It was there that I had my first taste of real psychodrama.

The week was a revelation. I enjoyed the atmosphere of the centre and the humour and warmth of the sessions. I liked psychodrama’s lack of interest in diagnosis and labelling, and its theatricality reminded me of the years I had spent directing drama in the students’ union when I should have been doing research in my laboratory on the functions of the cerebral cortex of rabbits. In fact, it was my enjoyment of my theatrical activities, with all the associated complexities of human relationships, that had encouraged me, a few years previously, to leave the neurophysiology laboratory and continue my medical studies.

I was trained first as an individual psychoanalytic psychotherapist while I was also working as a psychiatrist at the Maudsley Hospital in London. I subsequently trained as a psychodramatist. These two forms of psychotherapy appeared to me to exist in very different philosophical, theoretical, and practical camps and for several years I practised these methods of treatment in isolation from each other. I think that I found it easier and more appropriate to follow the advice and instructions of my different supervisors and mentors.

Analytic psychotherapy abhors certain actions, such as touching each other during a session or friendships developing between a patient and his therapist. Such behaviour is called ‘acting out’ and is considered to be counter-productive to the therapeutic process (see Sandler et al. 1973).

As a young professional I valued the safety provided by the rules about the patient-therapist relationship: rules and expectations which also fitted with my training as a doctor and psychiatrist. Psychoanalysis also offered me a well-developed psychology of the mind and of emotional disturbance whose clarity and logic appealed to my background in neurophysiology.

Psychodrama on the other hand is, by its very nature, dramatic. Action and movement are encouraged. Indeed, a static psychodrama session, dominated by talking, might be considered to be a failure. I enjoyed the excitement of the drama. Relationships are allowed to grow between group members. I found this openness very rewarding and supportive.

Perhaps it is no wonder that I tried to keep these two powerful therapies separate in my clinical practice.

I continued to see myself mainly as a psychiatrist and as an analytic psychotherapist. Psychodrama provided me with a forum for my personal development and therapy, although I also ran groups for adolescents in a hospital (Holmes 1984, 1987). In time, however, I decided to train as a psychodramatist with Marcia Karp and her husband Ken Sprague. Marcia followed the theories and practice of her trainers, J.L. Moreno and Zerka Moreno (with perhaps some additional influences from Carl Rogers).

At the Holwell Centre there was little talk of the theories of the psychoanalysts. Indeed, J.L. Moreno had a deep-seated antagonism to Sigmund Freud, his followers, and most of his theories, an attitude that I initially felt was shared by many of Moreno’s students and trainees.

While I was a psychodramatist in training I developed an increasing conviction about the techniques and methods of psychodrama. However, I continued to have little real understanding or appreciation of the metapsychological theories of Moreno. I was a psychoanalytic therapist who happened to run psychodrama groups.

In time I discovered how much of my psychoanalytic training and knowledge I was using in my clinical practice as a psychodrama director. I also found that I had made significant philosophical shifts towards a more humanistic (and less medical) approach to my clinical work. It was increasingly necessary therefore to develop my own integration of psychodrama and psychoanalysis.

To my delight, and perhaps surprise, I found my trainers, colleagues, and friends in the psychodrama movement most supportive. I now see myself as committed to the theories and clinical practice of both therapeutic camps, and I still work, when opportunities present themselves, both as an individual psychoanalytic therapist and as a psychodramatist.

This book is one consequence of my personal journey.

PS

The reader may be surprised to find a postscript so near the start of a book. However, the very nature of psychodrama allows for the unexpected.

This book was written in Mexico during a period of my life when I was cut off from regular contact with British psychodrama. On my return to Britain, and after reading the final draft, I became aware once more that the theories I present explain only part of the richness of the psychodramatic process.

The book reflects my rather concrete, and perhaps at times over-rational, approach to an understanding of the ...

Table of contents

• Cover
• Title
• Copyright
• Dedication
• Contents
• Acknowledgements to the first edition
• Introduction to the classic edition
• 1 Introduction: psychodrama and psychoanalytic theory
• 2 The director’s assessment: systems within systems
• 3 Repetitions and the transference
• 4 The inner object world
• 5 Relationships and roles
• 6 The inner world and the drama of psychotherapy
• 7 The countertransference
• 8 Psychological defence mechanisms
• 9 Conflicts and anxiety: holding and containment
• 10 Playing and reality
• 11 The dynamics of the group
• Coda How does psycho drama change people?
• Bibliography
• Psychodrama bibliography
• Name index
• Subject index