Healing attachment wounds: Drama therapy within an interpersonal theoretical frame as a group treatment modality

Drama Therapy is an active and experiential form of psychotherapy that is useful for group and individual therapy with a variety of populations (Dintino & Johnston, 1996; Emunah, 1999; Johnson, 2009; Landy, 1996, 2009; Sajnani, 2010). Often, there is ample work within the therapy process on understanding and shifting interpersonal patterns. Interpersonal Reconstructive Therapy (Benjamin, 2006; 2018) offers a set of organizing principles emphasizing how early relationship patterns are copied in present relationships with self and other in order to conceptualize and guide treatment, focusing on in-session processes (Critchfield & Benjamin, 2006). The potential for integrating Drama Therapy and interpersonal modalities such as Interpersonal Reconstructive Therapy is rich, as experiential interventions invite clients to engage through creativity and embodiment, reaching the “primitive brain” (Benjamin, 2018) where relational learning can take place. This mixed-methods study investigated a group protocol that integrates these approaches, evaluating the group processes and subsequent changes in participants’ interpersonal patterns and distress levels. The analysis of this group indicated that adaptive change occurred through factors of group connectedness and cohesion, experiential processes, validating experiences, identifying barriers and red patterns, finding new ways of being and desired future states, and integrating new ways of being within group sessions and in outside experiences. The adaptive change included measurable symptom reduction, particularly in areas most targeted by the group including lessening of functional (relationship) difficulties, as well as adaptive changes in self-treatment

The Case of Sharon Considered from the Vantage Point of Interpersonal Reconstructive Therapy

In Interpersonal Reconstructive Therapy (IRT: Benjamin, 2003/2006; 2018) a case formulation is used to tailor interventions to each patient’s unique patterns. Using the IRT lens, psychopathology is understood as reflecting attempts to adapt to current environments using maladaptive rules and values that were learned and internalized in the context of close attachment relationships. IRT identifies precise ways in which early learning shapes present experience. Additionally, the "gift of love" (GOL) hypothesis posits that motivation to repeat maladaptive ways is linked to the wish to receive love and acceptance from specific internalized attachment figures by repeating their ways and values for the patient. The IRT case formulation has been shown to be reliable and valid (Critchfield, Benjamin, & Levenick, 2015). The therapy adherence measure is also reliable (Critchfield, Davis, Gunn, & Benjamin, 2008) and correlates well with retention as well as reduced symptoms and rehospitalization rates (Karpiak, Critchfield, & Benjamin, 2011) among "difficult to treat" patients characterized as having high levels of personality disorder, chronic and severe problems, and prior failed treatment attempts. To illustrate the case formulation process, an IRT formulation is applied to the case of a 28-year-old female patient for whom a poor outcome was documented

Interpersonal Wishes and Fears with Regard to Internalized Attachment Figures: Differing Focus of Two Case Formulation Methods that use SASB

This commentary is organized in parallel with Westerman’s (2021b) comparison to include focus on (1) the formulation methods used by IRT and Interpersonal Defense Theory, and then (2) their treatment implications. In each major section, comments center first on comparison of the approaches in general, and then turn to a focus on the details of Sharon’s case. In sum, we wish to underscore the need for continued empirical work in both IRT and Interpersonal Defense Theory traditions as ways to advance our field. We see each method as offering a different scope and focal areas of concern. With a mind toward the advancement of research and application along both lines of thought, our commentary provides an overview of how we see areas of alignment, divergence, and their potential meaning for theory and practice. The two methods share a great deal in terms of assumptive worldviews, prioritization of relational material, and even specific measurement methodology (SASB). Where the methods diverge, we believe it is primarily because they seek answers to different kinds of questions