Mémoire de dramathérapie: comment les neurosciences soutiennent l'efficacité de l'impact thérapeutique de la dramathérapie, Master II Dramathérapie, Université Concordia, Montréal, 2006
Voilà un résumé de mon mémoire de dramathérapie que vous pouvez également lire en entier. Ce mémoire est le premier écrit (2006) où j'ai commencé à tisser des liens entre les connaissances en neurosciences et les expériences cliniques avec les approches corporelles et créatives. Depuis j'approfondis ces thématiques: trauma psychique, mémoire affectives, thérapies avec engagement du corps et de l'imaginaire.
Usefulness of embodiment in psychotherapy: Dramatherapy applies neurosciences's knowledge about somatic memories
Making links between embodied pains and their psychological roots has raised passionate debates which have rightly remained unsolved. The link between psychological issues and somatic expression is of actuality from a long time ago and researchers have been many to write on psychosomatic diseases. For instance, Groddeck (1985) finds a psychosomatic root to any organic disease. It is demonstrated that a large part of memories is stored into somatic/emotional memories and therefore not accessible in verbal therapy. Following such theories, numerous therapeutic approaches have been invented to help treat those psychosomatic diseases. Somatic psychotherapists intuitively facilitate therapeutic changes with physical, embodied methods. To cite few names, Reich (1949, one of Freud's student) followed by his own disciple, Lowen, created the bioenergetic approach that combines body and verbal work: paying first attention to ancient physical sensations and making them conscious, an analytical work completes to make links between the physical sensations and the personal history. In traumatherapy especially, body approaches appear necessary: Rothshild (2000) advises bringing the client to self awareness of expressions and sensations.Other approaches such as the Pesso method or Susan Aaron's Psychodramatic Bodywork involve body work for psychotherapeutic purposes. Dramatherapy and Psychodrama are specific embodied approaches using stories, projection or metaphors additionaly to embodiment to facilitate healing. All these therapies are used and developed worldwide, but how can we explain their usefulness and efficacy? Neuroscience has been making discoveries about the neuronal systems that help explain and guide these intuitive approaches. This paper presents the current knowledge to explain what makes such psychotherapeutic interventions efficient.
The need for embodied psychotherapies
When one comes to psychotherapy, it is many times because s/he could't find the personal resources to bypass a life difficulty, to get over some pain that impairs the ability to enjoy life. Psychotherapists have been working to propose all kinds of approaches allowing the person to deal with his/her issues, to change one point of view, see a situation as less threatening, find new and more adapted ways to react to some circumstances. Verbal therapies are useful in many instances because what the person seeks is to be listened to, to see his/her issues being recognized, decrease the feeling of loneliness and also have another's point of view on his issues that helps see new perspectives and solutions. At times however, talking about an issue isn't enough and one may have fully understood where the issue comes from without being able to change his feelings or be overwhelmed by situations without knowing what is happening and why. Indeed, while we are an intelligent being and try to find explanations for everything, we also remain a being of flesh and blood; this is to say a big part of what we are and feel isn't accessible to our understanding and we need to take this part into consideration to treat the being in its whole. A person describes a Psychodrama experience: “ Sometimes I wanted so badly to BE in the situation, but a life-time habit of being very self-conscious kept me from it. Sometimes, I suppose, I got caught up in the movement of the moment and was really there. I think having a lot of movement helped: walking and talking, not just standing ”
What I have just described may appear obvious to most of us because we experience it everyday. This article proposes to explain the neurobiological reasons why we cannot intellectually access the world of emotions, and most importantly, why creative art therapies are solutions to permit changes at this non-verbal level.
Splitting of the verbal and emotional experience
In the case of traumatic situations, the body needs to react quickly to survive. It was discovered that the physiological reaction actually precedes the intellectual perception of the danger (Ramachandran, 2003). The sensory context retrieves the memory trace of this physiological reation through a "somatic marker" (ref to the somatic marker hypothesis, Bechara, Damasio, 1997). This conditioned reaction spares time and analyse before one can react. The whole reaction happens by itself, without us being able to control anything. Alas, in traumatic repetition, this is also what is relived. The traumatic response is triggered beyond conscious will and there is no intellectual control of the reaction. There is a dissociation between the sensory and the conscious processes. This has for consequence that one may have created a perfect explanation for his reactions but the emotional reaction remains unaccessible to cognitive treatment...it is where sensory approaches are necessary. Gazzaniga (2002) demonstrates how the right hemisphere of the brain treats the event in a factual, sensory way while the left hemisphere acts as an interpreter. This implicit memory is different from a repressed memory and the lack of words is not in that case a need to forget (Schachter, 1987). For Ledoux (1996), this is the “ true emotional memory ”. Dramatherapist Penny Lewis uses guesses at the counter-transferences issues that can be worked with through embodiment (Lewis and Johnson, 2000) as others work on understanding conuter-transference throuhj words.
The body has learned a specific reaction to a situation, so it is the body that needs to experiment a new way to react. Embodied therapies apply this principle. To understand, we may relate to conditioning theories: at the time of trauma, we create embodied memories that associate a situation to a reaction through our amygdala-based fear-memory system connected to our emotional system (the amygdala is necessary for the integration of emotional components and specifically in coupling emotional reactions of fear with learned sensory stimuli, Ledoux (1996)). The impact of emotional arousal on encoding is mediated by stress hormones through a pathway involving the amygdala and other areas like the hippocampus (involved in contextual memories). Under stress, the level of the hormone adrenaline increases and hypo-activates the hippocampus while hyper-activating the amygdala. Ledoux (1996) explains how this results in a memory being stored without capturing the experience into a context of words or symbols. The amygdala stores "free floating feelings of significance to sensory input" (Van der Kolk, 1994) that provoke strong emotional reactions in contexts beyond intellectual treatment. All those neurobiological actions happen in regions located in the ancestral parts of our brain that were used before we could interpret and try to control our reactions. For ecological reasons those conditioned reactions are quite resistant to change over time even if not always the most appropriate. Therefore, when a child powerless in front of a dangerous situation developed a defensive reaction, this reaction might remain as an adult even though he is now intellectually capable to face the event.
Embodied therapies enable the body to experience new physical reactions to contexts that were perceived as threatening; little by little these reactions become more appropriate. Psychodrama (Moreno, 1987, Blatner, 2000) is the perfect example of an embodied situation when one relives a past traumatic experience in a new and safe context. The person is given the opportunity to transform the reactions to the old experience, it is a "corrective emotional experience" (Alexander, 1946, Hartman & Zimberoff, 2004) where the principle is to "re-expose the patient, under more favorable circumstances , to emotional situations which he could not handle in the past" (Alexander, 1946).
Jennings (1999) explains how Dramatherapy allows the individual to re-experience each developmental stage and therefore "repair" past experiences that may have remained negatively remembered. A client describes: “ At first I was nervous. I thought about controlling what would happen. As I started to play I couldn't think of any defenses anymore (like controlling the situation) because I got emotionally involved right away. (...). So there was anxiety in the beginning, then my actually feelings came out: shame, confusion, anger, sadness, feeling powerful and independent. After that, emptiness, calm, self-love.” In Developmental transformation (Read Johnson in Jennings, 1998), the client enters a playing space and encounters representations of one's life but is able to manipulate his/her responses to the situation: the therapist adapts so as to comply to the client's will and act the situation the way the client would like...hence the new feeling is really experienced: “ I suddenly stood up in the role of the father and defended my daughter. I hadn't learned to do it in my own life (...); it gave me a practice. I don't feel I was completely changed about how I am in a conflict but it surely took part in a long and subtle change that emerges in me (...). ”
Psychodrama adds to this physical transformation an intellectual analysis by the "talking period" after the playing time, during which the physical transformations can be integrated through discussions with the therapist (and other clients) in an intellectual process that completes the treatment (Hug, 2007). “ This helped me to gain a better understanding of my response patterns, fear of confrontation, and opportunity to change my attitudes, and ultimately my behaviours in a particular situation. I think back to my experience in Psychodrama often, I felt a real shift in my attitude towards my relationship after I participated and played out scenes from my life. The areas where I was blocked or stuck in my relationship became clear as they were externalized ”. In terms of treatment of the information, the right hemisphere is mostly involved in the intuitive process and the left hemisphere in the analytical treatment. In a normal functioning brain, there is integration of those left and right cognitive treatments (Gazzaniga, Ivry, and Mangun, 2002). If it could not happen in the traumatic situation, this integration can be done in the therapeutic space. Then the new reactions and thoughts can be transferred to real life.
The need for projection
Dramatherapy uses this principle of transformation of a situation but adds to it a distance that is sometimes necessary to permit the process to happen. Indeed, one can understand that reliving traumatic situations so as to transform them may be too hard for clients (children but also adults). Playing “ in the skin ” of the traumatized person may trigger such strong reactions that s/he is unable to change them. What Dramatherapy proposes is to work at a projectional distance. The use of puppets, stories, masks allows to be physically experiencing a situation without having to be at the center of the action. This is less threatening. At a neurological level, mirror neurons intervene (Ramachandran, 2006). Indeed, it was observed that when one watches an action, these types of neurons get activated so as to imitate what happens in the action being observed (these neurons may be the ones needed for empathy). So, there is a real neurological transformation without having to reexperience the traumatic action.
In my work with a client confronting issues of fear of death, masculinity and her relationship to religion, it was with small puppets representing God and herself that she could tackle this difficult relationship. For example, by interchanging the two puppets, she could experience powerfulness and freedom in a projected manner but with real feelings.
The use of metaphors
We discussed the therapeutic action of associating a new reaction to a past traumatizing experience. However, humans cannot be considered as such simple associative machines. It is not only the reaction but the meaning attributed to a situation that is the cause of pain and the target of psychotherapeutic work. The use of metaphors is a natural way to express feelings by poets (that we all are at times) and the natural bridge humans have found between emotions, physical sensations and ideas. When one expresses his/her reality through metaphors, the body actually gets transformed at a neurological level. The phenomenon of synesthesia demonstrates how two physical modes of perception can be associated by a neurological connection. For example, the famous writer Nabokov would perceive colors in the shape of letters, each letter having an appropriate color. The neurobiological basis for metaphors is supposed to be related to the angular gyrus that connects touch, hearing and vision (Ramachandran, 2005). It is that same principle that may associate a feeling and a word. By this natural way, new metaphors create new associations between a word or a concept, and a sensation. Siegel (1999) specifies that it is the right hemisphere that is involved in the non-verbal polysemantic meaning of words and understanding of metaphors, paradox and humor. A Psychodrama actor describes: " I was asked to play myself as a little girl and sit on my father's laps. I did it (...) but I felt so uncomfortable, as if I didn't want to release my weight on him. (...) I realized the metaphor that I was “ a weight for him ”." The patient described earlier (with the issue of religion) was suffering from psychosomatic symptoms keeping her hair from coming out her scalp. In Dramatherapy sessions, she intuitively used the symbol of cutting her hair in search for freedom and power. Creating the two puppets, she showed pleasure and care in making the hair of both characters. We can hypothesize that this sensory experience helped her get in touch with the emotional memories symbolically associated with hair.
This paper demonstrates how embodied therapeutic experiences impact individuals and change their cognitive, emotional and meaning-making ways to perceive the world. I hope it is an example of how neurobiology give the most importance to each individual unique experience and help understand the extraordinary human coping with life.
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