Action Oriented Techniques in Adolescent Group Therapy: Does Action Make a Difference?

Joseph Kastner, PhD, and Christine Sheffer, MS

This article examines the use of psychodrama techniques in an adolescent psychotherapy group. This research was presented in part at a symposium entitled “Current Research in Group Psychotherapy,” at the 1999 meeting of the American Group Psychotherapy Association. 

The pioneer of the field of psychodrama was J. L. Moreno, who wrote prolifically about the use of psychodrama as a therapeutic method (J. Moreno, 1947, 1951, 1959, & 1978). Moreno was convinced that there exists, at the very core of human nature, spontaneity and creativity. For Moreno, human suffering and psychopathology were the result of the suppression of these natural human tendencies. Psychodrama, or the assumption of the psychodramatic role, was the vehicle or medium to allow individuals to separate from their social roles and thus open their reservoir for real and meaningful human experience (J. Moreno, 1966). 

Psychodramatic techniques have a long and fruitful history of use in group psychotherapy (Blake & McCanse, 1989; Kipper, 1996; J. Moreno, 1947, 1964; Z. Moreno, 1965, 1989; Strum, 1965; Treadwell, Stein, & Kumar, 1990), and have been applied across a wide variety of patient populations, including adolescents (Knittel, 1990; Ozbay, Goka, Ozturk, Gungor, & Hincal, 1993; Sasson, 1990). Unlike more traditional forms of psychotherapy, the focus of psychodrama is in the “here and now” and on “doing or showing” rather than telling (Blatner & Blatner, 1991; Kellerman, 1992; Kipper, 1996). The group leader’s roles are multifaceted, and one functions as an empathizer, director, agent of change, and manager within the group process. 

In the seven decades since Moreno formulated and articulated the therapeutic method of psychodrama, hundreds of psychodramatic techniques have been developed and applied in a wide variety of group settings and by therapists from a wide variety of differing orientations (Blatner & Blatner, 1991; Kipper, 1996; Treadwell et al., 1990). While there is ample anecdotal and theoretical information supporting the use of psychodramatic or action-oriented techniques with adolescents in group therapy (Knittel, 1990; Sasson, 1990), there is little, if any, empirical support for these techniques (Azima, 1996; Azima & Richmond, 1989; Dagley, Gazda, Eppinger, & Stewart, 1994; Hoag & Burlingame, 1997; Sugar, 1993). This, however, is the unfortunate status with adolescent group work as a whole.

In an attempt to rectify this empirical problem, we evaluated the effects of action-oriented techniques on adolescent behavior and group climate in an adolescent therapy group (Kastner & Sheffer, 1999). Examples of action-oriented techniques used in this investigation included the double, role-reversal, psychodramatic and behavioral role-playing, and the empty-chair technique. 

We used an alternating treatments design to evaluate two conditions (Kazdin, 1982). The two conditions were (a) group therapy without action-oriented techniques, and (b) group therapy with action-oriented techniques. The two conditions were assigned randomly, but were limited to a maximum of three continuous occurrences of any particular condition (Barlow, Hayes, & Nelson, 1984). The group met for 16 sessions (nine sessions with action-oriented techniques and seven sessions without action-oriented techniques) throughout the course of the school year.

Participants included seven middle school students who were referred to a school-based group by their teachers, school counselor, and parents due to behavioral and emotional problems. Three participants had previous psychiatric histories, and two were living in foster care and group home settings during the course of the group. The mean age of the students was 14 years. Four students were African American, and three were Caucasian; four were females and three were males.

The Group Climate Questionnaire-Short Form (GCQ-SF) was used to measure group process and to evaluate the interaction patterns between group members (MacKenzie, 1983; MacKenzie, 1994). The GCQ-SF is a 12-item questionnaire containing three factors—engaged, avoiding, and conflict. The GCQ-SF is easy to use, provides a group therapist with a “group as a whole” rating, and has evidence of factor structure.

There were several other dependent measures used in this investigation, including aggressive behavior, verbally aggressive behavior, dyad/triad out of group discussions, and redirection’s from the group therapist. These four behavioral measures were therapist ratings of in-group behavior and were recorded as frequency counts (i.e., number of occurrences). 

The current study did not definitely suggest that action-oriented techniques positively affect adolescent behavior or group climate in an adolescent therapy group. There were no statistically significant differences between the two conditions. However, there was a clear ??trend?? in the data, indicating that action-oriented techniques positively affect group climate, primarily enhancing engagement between group members and decreasing group member avoidance. Time-series analyses also revealed that the GGQ-SF is sensitive in assessing developmental changes in the climate of the group over time (scores indicated greater engagement and reduced avoidance over the course of the group).

There are several possible explanations for the lack of statistical significance between the two conditions, aside from the small sample. The one most worthy of discussion here concerns possible multiple treatment interference effects. Alternating treatment designs are especially sensitive to these effects, which occur when the effects of one treatment condition interact with another treatment condition, thus causing an overall treatment effect. Interference effects make it difficult to determine whether there are real differences between treatment conditions across dependent measures. Because psychotherapy groups develop and mature over time, interdependency between sessions is a natural part of group process, thus interference effects are likely to occur to some degree. In spite of this design limitation and the small sample, it is impressive that several analyses approached the level of statistical significance, again lending evidence that action-oriented techniques may enhance group climate.

The purpose of this study was to examine the effects of action-oriented techniques on adolescent behavior and group climate in an adolescent therapy group. Action-oriented techniques did not appear to affect behavioral measures, but there was a trend toward improved group climate. Action-oriented techniques generally led to increases in engagement and decreases in avoidance between group members. 

Further research in this area, though, is clearly needed. The first author is in the initial planning stages of such a project. Methodological improvements will include the utilization of a between-groups approach with random assignment (instead of a within-groups approach), the inclusion of multiple measures of group climate and group process, the assessment of therapeutic factors, and the administration of objective personality measures to assess treatment outcome. If additional studies are consistent with our current findings, clinicians might consider the value of action-oriented techniques in enhancing group process for adolescents. 

In their review of the child and adolescent group therapy literature, Hoag and Burlingame (1997) succinctly and eloquently write that “the clarion call of narrative reviews of the literature typically includes a compelling petition for further research. The literature in child and adolescent group psychotherapy is clearly in need of such an admonition.” There is no area of the adolescent literature that has been more woefully neglected than that of psychodramatic or action-oriented techniques. The current study (Kastner & Sheffer, 1999) investigated a hitherto empirically unknown area of this literature. We hope that others will join us.

Joseph Kastner, PhD, corresponding author, is with the Department of Pediatrics, University of Mississippi Medical Center, 2500 North State Street, Jackson, MS 39216; phone: 601-984-5236; jkastner@ped.umsmed.edu. Christine Sheffer, MS, is with Jackson State University.

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This article was published in the April/May 2000 issue of The Group Circle.