Running head: THE BOOK OF ME

The Book of Me Dermot Connolly Stenberg College

THE BOOK OF ME Abstract This paper explores the importance of the application of psychodrama in psychiatric nursing. In particular, this paper focuses on the importance of using specific written psychodrama techniques such as letter writing, reflective journaling and drama scene creation. The implementation of these three techniques in the field of psychiatric nursing is explored with specific examples for each of their uses being discussed. This paper also explores the self reflective interpretation of each technique and concludes that each technique has demonstrated the ability to increase empathy, self awareness and cathartic response from members of the psychiatric nursing field. The paper also concludes that if implemented correctly, all three techniques can greatly enhance the therapeutic experience for the psychiatric patient and increasing the quality of nursing care afforded to them. Keywords: letter writing, reflective journaling, drama scene creation, empathy.

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Psychodrama is a form of group therapy created by J.L. Moreno in which the interactions and actions of humans are studied on the life stage of a protagonist. Psychodrama allows the protagonist to view their world from the outside looking in and reenact portions of their life through the eyes of others. It has being described as a form of expression rich in gestures and interactive language, a process described as show us, dont tell us Dayton, T. (2005) p xix. In terms of my own personal experience, I was really unsure about how I felt when I first began reading about psychodrama. The concept was new to me and I struggled to fully understand how acting out a scene from ones life could truly give a cathartic experience. Through the development and understanding of the techniques created and adapted by Moreno however I have being able to gain a much greater insight into the values associated with psychodrama. Moreno developed these techniques to aid in his process of expression on the psychodrama stage. He believed that human behavior was such that painful and disturbing experiences are pushed from our memories but not necessarily from our conscious. As a consequence, these events may still influence our human behavior without us being aware of it. Each technique developed by Moreno is designed to help the protagonist identify that traumatic event and the behavior that it drives. If successful, the protagonist is able to identify their behaviors that control their unconscious mind and if needs be, change it. Some of these techniques can be used on the psychodrama stage such as doubling, role reversal, soliloquy and the mirror technique. Dayton, T. (2005) p 36-42. The role of psychodrama has far reaching benefits in the field of psychiatric nursing where the application of Morenos techniques can drive not only a change in the protagonist but also enables the psychiatric nurse to gain a greater insight into their own values and believes through the development of an empathetic and self awareness response.

THE BOOK OF ME From the range of psychodramatic tools developed by Moreno, the techniques of letter writing, reflective journaling and drama scene creation offer the most benefit to a psychiatric nurse The use of letter writing in psychodrama was a powerful experience for me, I wrote a letter to my mother who died last year from lung cancer. In my letter I apologized to her for not

making it home in time to say goodbye. I felt a deep connection with that letter as it was my first opportunity to tell her all the things I never could over the phone. Dayton describes the letter writing technique as a near psychodramatic technique Dayton, T. (2005) p180, in that no enactment is required. The process allowed me the freedom to be as expressive as I wished in the privacy of my own thoughts. I remember being surprised about how long it took me to write the letter. I had expected it to take me just a few minutes, but instead took me several hours. The outpouring of emotion that accompanied that experience will stay with me as it was my first cathartic experience from psychodrama. The experience allowed me to truly understand the value of the written word and the effect it can have in helping its writer indentify and express their feelings. I see the application of the letter writing technique in the clinical setting of the psychiatric nurse as being very important. As we continue with our first clinical of the older adult, I can see its application being used as a form of communication to the resident and their families. As psychiatric nurses, the role of communication, empathy and self awareness are important aspects of our practice and I believe the application of letter writing is an excellent opportunity for those aspects to be expressed. From reflecting on my own clinical experience, I see great value in writing a letter to my assigned resident thanking her for giving me the opportunity to learn through her experiences and grow as a result. The same approach could also be adapted for the family of my resident where I would thank the family for allowing me the opportunity to meet such a wonderful woman. The benefits of this approach are twofold,

THE BOOK OF ME according Kirkhorn & Airth Kindree, who experimented with this method, the families who received the letters felt more informed about the role the nursing student played in the care of their loved one. One family even took the time to respond, sharing additional information about the patient and giving additional insight into her life. Kirkhorn & Airth Kindree (2010). A second application for the letter writing technique allows the patient to write a letter either themselves or to the trauma they are currently experiencing. I can see this technique being

particularly useful for a patient who is struggling with addiction, a patient who wants to stop but cant. By asking the patient to write a letter to his addiction or to himself, the patient is afforded the opportunity to identify the barriers preventing them from combating their addiction. The letter may evoke a cathartic response from the patient where those barriers can be broken down. The process of removing barriers can also manifest itself through the action of a drama scene. For me the experience of writing a drama scene was one where I got to create a conversation with my manager at work. In my written scene, I used two of Morenos techniques; doubling and role reversal. While I did not enact my drama scene onto my personal stage, I did transfer the stage into my written words. Through the process of doubling I was able to add a voice to my inner struggles with my manager and my job. Dayton describes the process of doubling as a process where the protagonist explores deeper layers of expression that a traditionally kept locked away or expressed only in the privacy of ones own room. Dayton, T. (2005) p 37. Doubling enabled me to express my anger and despair at the policies being adapted by our company. I felt I had the freedom to express my discomfort at adopting these same policies into my own position and that of my department. As I wrote my drama scene, I felt I switched from the doubling role to that of role reversal where began to view the scene I had created through the eyes of my manager. I found this to be an interesting experience, as for the

THE BOOK OF ME first time, I saw my trauma through the eyes of another and I began to develop feeling of empathy towards him. These feelings of empathy are important when discussing the importance of the practical uses of writing a drama scene. An important application of the drama scene

would involve a patient who is struggling to take their medications. The application of the drama scene would involve requesting the patient to write out a scene in which he confronts his medication in an attempt to gain a better understanding as to why he struggles to take them. The drama scene may evoke a powerful response from the patient where his reasons are finally drawn out and explored. Switching the scene to one of role reversal will also give the patient the opportunity to view the trauma through the eyes of his medication. Viewing and dealing with ones trauma in a manner that is effective highlights another important aspect of psychodrama, journaling through reflection. The application and use of reflective journaling in the clinical setting can play an important role in the nurse / patient relationship. From my experience, I have found the process to be very fulfilling. Through reflection, I have found that I have gained a much greater insight into my performance as a psychiatric nurse. The process has helped me develop my critical thinking skills and become more aware of my values and beliefs while at the same time allowing me to develop an understanding into my own self awareness. Reflective journaling has also helped highlight areas where I need to improve which in turn is reflected back into my leaning plans. I have found that through reflective journaling, I have grown in my confidence in my abilities as a psychiatric nurse. This increased level of confidence is reflected in the quality of nursing care I deliver to my patients which highlights for me the importance of reflective journaling in the clinical setting. My reflections towards journaling are also echoed in many studies carried out on the subject. In one such study, Williams et al, reported that four themes emerged from the analysis of students

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reflective journal entries. These four themes were; 1) becoming more self aware, 2) the feeling of emotional pain, 3) what I learned and 4) personal growth. Williams et al (2009) p 38. The analysis showed that as a student progressed through their psychiatric mental health clinical, they developed a greater awareness of their own preconceived notions of the mentally ill and how they interacted with them. Through reflective journaling, the students were able to see how much they had grown over time and their role as psychiatric nurses. Other studies on the value of reflective journals in clinical settings outline the importance of the method used to record reflective journals. While methods vary, research has shown that students and nurses tend to benefit more from a more structured and guided approach to reflective journaling. Lasater & Nielsen (2009). Structured approaches to reflective journals such as the Lasater clinical judgment rubric have shown to improve the level of critical thinking and evaluation performed by the writer. Lasater & Nielsen (2009). I too found this approach to be the best in my clinical applications. A more structured approach to reflective journaling allows me to categorize by emotions more clearly and in a manner that allows me to see my progress develop over time. The role of psychodrama in the field of psychiatric nursing is an important one. Through the implementation of the psychodrama stage, both the patient and the psychiatric nurse are afforded the opportunity to explore the depths of their subconscious and to unveil their own traumas. Once that trauma and the behavior it drives have being identified, the correct psychodrama technique can be applied. This in turn enables the protagonist to confront that trauma and attempt to proceed through life without it. The written techniques of the psychodrama stage are the most effective in psychiatric nursing. Each of the written techniques I have demonstrated all support the development of empathy, self awareness and a cathartic response from the psychiatric nurse. These techniques include letter writing, reflective journaling

THE BOOK OF ME and drama scene creation and all three benefit the patient directly as their successful implementation results in an improved quality of nurse care for all.

THE BOOK OF ME References. Dayton, T. (2005). The Living Stage: A step-by-step guide to psychodrama, sociometry, and experiential group therapy. Deerfield Beach. Health Communications Inc. Kirkhorn, L., C. & Airth Kindree, N., M., (2010). Letter writing as an expression of nursing care. Nursing Education Perspectives. 31 (2). 116-117.

Lasater, K., & Nielsen, A. (2009). Reflective journaling for clinical judgment development and evaluation. Journal of Nursing Education, 48(1), 40-44. doi:10.3928/0148483420090101-06 Williams, G., B., Gerardi, M., B., Gill, S., L., Soucy, M., D. & Taliaferro, D., H., (2009). Reflective journaling: Innovative strategy for self-awareness for graduate nursing students. International Journal for Human Caring. 13 (3). 36-43.