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Couples Therapy: Communication Strategies that work!
Couples Communication continuing education psychology CEUs

Section 17
An Introduction to Action Methods in Couples/Family Therapy

CEU Question 17 | CEU Test | Table of Contents | Couples
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Action Methods (AM) are therapist-initiated tasks that engage clients in physical activity or in taking on dramatic roles. Although there are psychotherapeutic approaches that make use of action methods as central techniques in clinical treatment, such as psychodrama, play therapy, and drama therapy, their use therapy has been more peripheral, with mainstream approaches typically using action methods only as a supplement to verbal discourse. Nonetheless, there exist numerous action methods that contribute to therapy praxis.

Advantages of Action Methods
The advantages to the inclusion of Action Methods in therapy are many. Contemporary therapy is rooted in Family Systems Theory (Nichols & Schwartz, 2001, p.104), according to which problems or symptoms manifested in individuals are best understood in the context of those larger social systems dynamics (most important, families) in which those individuals participate. Accordingly, practitioners work to alter patterns of interaction and attend to observable social behavior in families more than to reports of internal experiences. Wiener and Oxford (2003, pp. 5–6) enumerate 10 advantages of Action Methods in comparison with exclusively verbal techniques, nine of which apply particularly well to conjoint therapy. Action Methods (1) better engage clients who process in visual and kinesthetic modes; (2) equalize participation for children and adults; (3) heighten awareness outside of prior verbal representations; (4) create new experiences that go beyond verbal description; (5) illustrate abstractions concretely; (6) dramatize familial role relationships; (7) effect relationship changes through role expansion; (8) offer safe ways to explore and practice new behaviors; and (9) facilitate life transitions.

Scope of This Review
The Action Methods of psychodrama and sociodrama, which include role play, role reversal, mirroring, doubling, auxiliary ego, and multiple ego techniques (Blatner, 2000), are well known to the majority of readers of this journal and will not be described further. What is relevant about those Action Methods is that, collectively, they have contributed significantly to the underlying rationale of using action techniques and constitute a proportion of Action Methods that have been adapted by others to therapy praxis. In this review, we describe Action Methods used in psychodrama influenced therapy approaches and Action Methods used in approaches that differ from psychodrama in their underlying premises, structure, design, and implementation. Except for citing Moreno’s contribution, we give little attention to who influenced whom or first devised any particular Action Methods.

The majority of Action Methods included are intended primarily for purposes of assessment rather than as interventions. It should be noted, however, that assessment and intervention are often reciprocal; each purpose may be advanced by, or even comprise the process of, the other.

Action Methods can be usefully classified as either dramatic or nondramatic. Johnson (1992) has coined the term "play space" to denote "an interpersonal space within an imaginal realm, consciously set off from the real world by the participants, in which any image, interaction and physical manifestation has a meaning within the drama" (pp. 112–113). Enactments are dramatic when they occur in the play space; note that psychodramatic Action Methods are inherently dramatic. In general, evoking the play space in therapy facilitates role expansion, because in a dramatic situation, clients are often freer to explore uncharacteristic and new behaviors and reactions than in nondramatic enactment. Action Methods classified as dramatic are marked with an asterisk when first cited.

In light of the sheer number of Action Methods that have been used in therapy and their still more numerous variations, we aim in this review to present a wide range of important and representative Action Methods, occasionally offering brief descriptions of how they are implemented. We include specific techniques (in which explicit instructions are available) and broader classes of a technique (in which a principle or example is given). Where named as distinct techniques, Action Methods are italicized in the text. The reader is referred to the sources cited for more detailed information about the rationale and pragmatics of their application.

The Contributions of J. L. Moreno
Many of the Action Methods in contemporary therapy praxis are derived from the techniques of psychodrama, a psychotherapeutic method developed by J. L. Moreno between 1936 and the early 1940s (Blatner, 2000). Moreno was one of the first psychiatrists to venture beyond individual psychotherapy to contribute to the foundations of interpersonal therapy. In a number of his writings, Moreno noted that intergroup and interindividual processes are at the core of all social phenomena and that mental illness can exist solely within a system rather than within any one individual (Blatner, 2000; Moreno, 1934). Not only did his work influence many subsequent approaches that use Action Methods, Moreno himself made significant early contributions to the theory and application of couple and family therapy (Compernolle, 1981), documenting his relational work with couples and families and the beginnings of a systems theory. Williams (1998) similarly points out that Moreno’s concepts and techniques integrate well with contemporary therapy praxis. Blatner (1999) suggests how psychodramatic concepts contribute to furthering the aims of family therapy.

Considerations for Using AM in Systemic Couple and Family Therapy
The format and techniques of classical psychodrama, modified in application to accommodate differences in group sociometry, have been used to conduct individual family therapy (Guldner, 1990; Hollander, 1983; Leveton, 1991; Oxford & Wiener, 2004; Perrott, 1986) and multiple family therapy (Guldner, 1982). Several authors (Guldner, 1983; Kipper, 1986; Seeman & Wiener, 1985; Wiener & Oxford, 2003) have noted important limitations of and differences in applying psychodrama (which was primarily developed for groups of nonaffiliated persons) to affiliated groups such as couples and families. For example, instead of full [psychodramatic] role reversal, a therapist working with a conflictual couple might use double-bonding role reversal* (Hale, 1985), in which the husband takes the wife’s role from the position of her chair, addressing a projection of himself in the facing empty chair that he just vacated. At the same time, the wife stands at the side of and slightly behind her own chair, thus doubling for herself.

- Wiener, D. J., & Pels-Roulier, L. (Summer 2005) Action Methods in Marriage and Family Therapy: A Review. Journal of Group Psychotherapy, Psychodrama, & Sociometry, 58(2).

Peer-Reviewed Journal Article References:
Barry, R. A., Barden, E. P., & Dubac, C. (Apr 2019). Pulling away: Links among disengaged couple communication, relationship distress, and depressive symptoms. Journal of Family Psychology, 33(3), 280-293.

Li, P. & Johnson, L. N. (2018). Couples' depression and relationship satisfaction: Examining the moderating effects of demand/withdraw communication patterns. Journal of Family Therapy, Supplement, 40, 63-85.

Miller, K., & Kelly, A. (2020). Is self-compassion contagious? An examination of whether hearing a display of self-compassion impacts self-compassion in the listener. Canadian Journal of Behavioural Science / Revue canadienne des sciences du comportement, 52(2), 159–170.

Online Continuing Education QUESTION 17
According to Wiener and Oxford, what are the 9 advantages of Action Methods in comparison with exclusively verbal techniques that apply particularly well to conjoint therapy? Record the letter of the correct answer the CEU Test.

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