I*CARE Roundtable with Rebecca Walters Video Transcript

Interpersonal Communication And Relationship Enhancement (I*CARE)
Roundtable with Rebecca Walters
A Conversation with Walter Baile, M.D. and Rebecca Walters
Date: May 26, 2011
Time: 26:23

Rebecca Walters, MS, LMHC, TEP
Hudson Valley Psychodrama Institute
New Paltz, NY


Dr. Baile: Hello I'm Dr. Walter Baile, Director of the MD Anderson program on Interpersonal Communication and Relationship Enhancement, or I*CARE. We're very pleased to have Rebecca Walters here today for our I*CARE roundtable discussion. Rebecca is a Licensed Mental Health Counselor and a trained Psychodramatist who is certified as a trainer, educator, and a practitioner in Psychodrama, Sociometry and Group Psychotherapy. In this capacity she directs the Hudson Valley Psychodrama Institute in New Paltz, New York. She's also been on the faculty of the Trial Lawyer College teaching plaintiff attorneys to use psychodrama methods in conducting litigation. For many years she was Director of Psychodrama Services at Four Winds Psychiatric Hospital in New York. For the past year Rebecca has worked with our I*CARE program at MD Anderson to adapt the action techniques which are used in psychodrama and sociodrama to teach communication skills to clinicians and other faculty and staff. She has pioneered the use of these interactive methods in teaching such topics as dealing with emotions in cancer patients and family members resolving interpersonal conflicts and its supervision and mentoring. Her workshops on these and other topics have received stellar evaluations from those participating. Welcome, Rebecca.

Rebecca Walters: Thank you Dr. Baile.

Dr. Baile: Thank you for being here today.

Rebecca Walters: It's a pleasure.

Dr. Baile: So tell us a little bit about psychodrama and sociodrama. I know people have heard these words but probably don't have a really good understanding of what they're about.

Rebecca Walters: Okay. Well psychodrama and sociodrama were developed by a Viennese-born psychiatrist named Jacob Levy Moreno in the early part of the 20th century. And he came to the United States around 1926. So it's been mostly developed here in this country. Psychodrama is a form of working with groups where people reenact scenes from their lives with the goal being to reverse roles with the other significant people in our lives so we can be more effective in dealing with them. Psychodrama is the individual's story where sociodrama looks at the role. So for example, a nurse is having conflict with one of the other nurses. And let's say her name is Mary. In psychodrama it would be Mary's story of the conflict she's having with this other nurse and she would invite someone from the group to play the role of the other nurse. And she would reverse roles and show that person how to play the role of this other nurse because it's Mary's story. Well that's great in psychotherapy and its great in an ongoing peer group who get to know and trust each other very deeply. But it's not terribly appropriate to be doing in a work setting where people don't know each other very well. Or where there's no commitment to continued working with each other. So sociodrama is looking at the role, so instead of it being about Mary it's about the role of a nurse. It's about the role of two nurses in conflict. And the group creates the story. So it's not so personal and yet we can still learn the skills that are needed to deal with conflict through sociodramatic enactment.

Dr. Baile: Tell me about these components of a sociodrama, you mentioned role reversal. Can you say more about role reversal and what it does and why it's important?

Rebecca Walters: Sure will let me--let me take a step back; both psychodrama and sociodrama always begin with a warmup. Anytime we go into a group we do some exercises usually fun light hearted structures that allow people to get to know each other in a playful, relaxed sort of manner because we find without doing that people's anxiety is too high in order to step into the enactments. Once we start the enactments we use a variety of techniques both in psychodrama and in sociodrama. And the first is role reversal which is stepping into the shoes of the other person. We ask a series of questions that help deepen the immersion into the role such as, what's your name, how old are you, what are you wearing today, why are you here, how are you feeling about being here today. Questions like that help the participant immerse themselves fully in the role, and that's what role reversal is about.

Dr. Baile: Let me step back for a second because I want to get back to role reversal. But what would an example of some of these warm ups be because I know that you mentioned that sort of structured exercise so--what would a warm up look like?

Rebecca Walters: Well, we might just invite people to consider how many years have they worked at MD Anderson and line up on an imaginary line between--I just started here yesterday to 25 or 30 years. It gets them talking to each other. They have to find out where they are in relationship to each other. To get on that--in the right place on that line. Another one might be what we call polarities, which is just going to stand in either side of a room on a list of topics such as ice cream-cake, cowboy boots-dancing slippers, nighttime person-morning person. It gives people a chance to sort of know who's in the room with them. Sometimes we get a little more to the point for example if we're talking about dealing with difficult emotions after we do some playful warm ups like that we might invite people to think about which feeling do they have the most difficult time with when somebody else is angry, sad, anxious or other. And we put a chair in each of those positions and people go and stand by those chairs and then talk to each other.

Dr. Baile: I see.

Rebecca Walters: They get to see who shares with them a common concern?

Dr. Baile: Yeah. So folks get to know one another both on a more superficial level such as whether you are morning person or an evening person.

Rebecca Walters: Right.

Dr. Baile: But on a bit of a deeper level so that they might know if someone else has a problem with dealing with anger just as they do.

Rebecca Walters: That's a challenge.

Dr. Baile: Yeah. And so by the time you get to action--what is--the goal of the warmups is to warm people up.

Rebecca Walters: Warm people up to be comfortable with each other enough to begin talking more fully about what conversations they personally find challenging. And then we move them into action. We don't move them into action psychodramatically so for example if a group member named Joe is having--one of the challenges for Joe is how to tell somebody that there's no more treatment for them. And Joe finds that very, very hard to do. We're not going to have Joe be Joe. We're going to have the group create a character who has trouble talking about end of life issues like this.

Dr. Baile: So you want in the warm ups to get people comfortable enough to be able to participate in creating Joe for example.

Rebecca Walters: Yes absolutely.

Dr. Baile: So if I volunteer to be Joe I would sit in the chair and--

Rebecca Walters: You want to know what we would do?

Dr. Baile: Yeah, how would that be created?

Rebecca Walters: Oh okay. I would ask the group, okay somebody give this man a name. So someone says, Charlie and somebody else you tell me how old he is, and somebody else what's he wearing today and somebody else why is he sitting here, what's going on for him and somebody else tell me, how old--I said how old he is? Tell me does he have a family?

Dr. Baile: So you kind of create the character.

Rebecca Walters: We create, the group creates the character.

Dr. Baile: And so the group creates the character. So people have sort of ownership.

Rebecca Walters: Yes.

Dr. Baile: And once you create the character then what happens?

Rebecca Walters: Well, many different things can happen. We might have two characters. One is the patient and one is the care provider and the group can do the same thing for the care provider. And then we begin to see how they can--how they interact. One of the things that we're very interested in helping people understand is what's going on underneath. So we use a technique called doubling. Now, this is used in psychodrama but it's also used in sociodrama. So here's Charlie and he's sitting here and he's waiting to meet with his doctor. And we might invite the group to think what's Charlie feeling?

Dr. Baile: Charlie or Joe in my case, right?

Rebecca Walters: No Joe is the actual person in the group. You're Joe playing Charlie.

Dr. Baile: Ah, I got it okay.

Rebecca Walters: It can get a little confusing. So here's Charlie. He's a patient, right? The person playing Charlie knows what the group has said about him, right? I might invite group members--what do you imagine is going on inside Charlie that he is not saying? And they stand behind and they put that into words, many, many different possibilities. They're all right. There is no wrong answer.

Dr. Baile: So the group gets involved with the creation not only of Charlie, right? But gets involved also with trying to sort of articulate what Charlie might be feeling in a particular situation, for example if he's going to have a conversation with the doctor about the results of an important test that came through.

Rebecca Walters: Exactly.

Dr. Baile: And how is that--what does that do? How does that help?

Rebecca Walters: Well, if we understand what's going on inside of Charlie, Charlie may look, for example, Charlie may seem very sure of himself and he may be very angry when the doctor tells him that the results of the tests were not very good. He may look really angry. Group members will say, "What do I do if he's angry? I don't know what to do?" Well if you can stand behind Charlie and figure out what's going on inside you may have--get some clues that will help you become more effective. For example, very likely Charlie's feeling very scared and a little helpless. So if the medical personnel, if the care provider can tune into that they may be able to approach Charlie in a way that's more helpful to the conversation.

Dr. Baile: So even though Charlie may be angry the group has doubled Charlie and sort of got their fingers underneath the surface of the feelings and articulated them so that the person in the other chair now has some idea of what other emotions might be under the anger.

Rebecca Walters: Right, which will help them figure out a more effective way of approaching Charlie. Now there's another piece to it, which is we do the same thing with the person in the care provider's role. What's going on with them? And one of the things that we've learned here--in the year and a half that I've been coming to MD Anderson, one of things that we've learned is how common it is for people to not feel that they know how to effectively deal with these difficult situations but nobody talks to each other about it. So it's quite a relief for people to be able to find out that they're in a group of 15-25 people and it's a very common experience, and that's a relief. So then we can help them find--we actually help teach them the techniques to approach the Charlies in our lives.

Dr. Baile: So there's the sharing element which is very powerful because people don't feel that they are alone with their own anxieties or everything else.

Rebecca Walters: Right.

Dr. Baile: Right there's the kind of opening up a new window into what's going on with the other person so you might be able to respond more effectively. And then what do people do with that?

Rebecca Walters: Well they practice. In our workshops we give them a chance to sit down with each other often in dyads or in small groups and actually practice in small little role plays what they've just learned. Because after we do the figuring out what's going on underneath the characters. We actually give them steps to be more effective. And they get to try it out. Now, how do you know if you're being effective? We say reverse roles. So if Joan decides she wants to practice being effective with Charlie after a few minutes of her talking to Charlie we say reverse roles. And then Joan is Charlie. And the person playing Charlie takes on Joan's role.

Dr. Baile: So, so Joan gets to experience as Charlie in her own words.

Rebecca Walters: Yes exactly.

Dr. Baile: Well that's very--it's a little complicated but it sounds like it might be valuable to be able to step into the shoes of another person and have them repeat to you what you repeated to them.

Rebecca Walters: Well then you can hear how you sounded.

Dr. Baile: You can hear how you sounded and most of all I think one thing you can probably feel how they felt.

Rebecca Walters: Well yes of course, absolutely. They can hear how they sounded and how does that live inside of them emotionally in the role of this other person. So they can know whether or not they're being effective or not. That's what this is all about, effective communication.

Dr. Baile: Right.

Rebecca Walters: The other thing that's interesting about this way of working with people that I'd like to mention is once you learn how to role reverse you can do it with anybody. So the skills that people learn from these workshops they can generalize to other situations.

Dr. Baile: Well give me an example how that might happen?

Rebecca Walters: Okay. So if you learned for example how to step into the role--Joan is a person in the group, right? And she is--let's say she's a doctor. So she practices with Charlie, this made up character named Charlie. The skills that she develops by learning how to reverse roles with Charlie, the next time she has a challenging patient she can in her own office do the same thing for her self. So she can literally learn to step into someone else's shoes and figure out, "Okay so if I'm this other patient and this is what I'm presenting, this is what's really going on inside me," and how can Joan be most effective.

Dr. Baile: So she kind of--so once you've experienced this process that it's easier to think when you're in a like situation later on, intuit what the other person might be feeling because you've gone through that in the role reversal already.

Rebecca Walters: Right, right.

Dr. Baile: Yeah.

Rebecca Walters: And you've learned some skills for how to reverse roles, yeah.

Dr. Baile: That's very, very powerful. So, I wanted to ask you of course most of your work was done with kids.

Rebecca Walters: Teenagers and children.

Dr. Baile: With teenagers and children and that would seem to be somewhat of a different scenario and does this technique work just as well with teenage kids?

Rebecca Walters: Well with younger children I mean role play is children's natural way of learning anyway. And with teenagers it was--they loved psychodrama. First of all, when I'm doing psychodrama or even when I'm doing sociodrama with the kids, one of the steps is letting them vent a little bit and getting to say all the things that they would get in trouble for saying in their real lives. I do that with the staff here too. I let them say the politically incorrect things and everybody gets a good laugh out of it. And that's--it breaks down the anxiety also.

Dr. Baile: Yeah, yeah.

Rebecca Walters: But with the teenagers it was a very powerful work and a lot of times they got to practice being more effective in their communication with their parents, getting to say behind their, you know in a psychiatric hospital you have a lot of kids who are very angry, and so being able to step behind their own anger and express the deep vulnerabilities and the deep hurt that they have is really an important opening for a conversation with some parents. I remember one boy in particular who--he was so obnoxious to his father, he could not--"I want to come home and you're not taking me home," and he'd curse his father out. He came in one day and said I want to work on this because I want to be able to go home and live with my father. And I couldn't get him to figure out how to communicate effectively with his dad without getting a major attitude. So I had him reverse roles.

Dr. Baile: With his father?

Rebecca Walters: With his father. Now his father wasn't in the room. This was done in the psychodrama group.

Dr. Baile: Right.

Rebecca Walters: I had him reverse roles then I had him stand behind his chair and see his father's inside feelings. And I said, "Dad, tell me the story about the night your son was born, or the day your son was born?" And this young man who was about 15 in dad's role talked about how proud he was to have a son. I knew this boy was an only boy in the family with three sisters, so I'm making a guess. He talked about how proud he was to have a son. And then I said to this boy in his father's role, "What are you most afraid of?" And the young man said in his dad's role, "I'm afraid he's going to die if he keeps on behaving this way." So tell him. So this young man told the kid that was in the other chair, "I'm afraid you're going to die," and then I had them reverse roles. And I had this young man now in his own role listen to the person playing his dad say I' m afraid your going to die. And I said now you stand behind your chair and tell your dad what you're really afraid of. He said, "I'm afraid that you don't want me home again." And then we were able to begin a conversation.

Dr. Baile: Wow, that's pretty powerful.

Rebecca Walters: Yeah. And the result of it which was the boy was able to go home--not home go into a family session and tell his dad what his fear was.

Dr. Baile: Wow.

Rebecca Walters: That's a big break through.

Dr. Baile: Big break through.

Rebecca Walters: Yeah.

Dr. Baile: So these techniques sound to me to be very sophisticated because you not only have to know how to work with the group but you have to know how to work with an individual and their issues. And even if you work with medical people you have to know something about well what's behind the people's anger, you know fear of the unknown, uncertainty about the future, et cetera. So what kind of training does it take for people to be able to do your kind of work?

Rebecca Walters: Well, in order to be certified by the American Board of Examiners in Psychodrama and Group Psychotherapy and Sociodrama you need to have a master's degree or higher. And you need to have 680 hours of training which is a lot of training. You need to have supervised experience where somebody who is at my level provides supervision for you as you are doing your work. And then you need to sit for your boards. So it's a lot of training and a lot of practice to become certified as a Psychodramatist and to become--we don't have a sociodrama certification in this country. They do in Great Britain and in Australia and New Zealand.

Dr. Baile: So if for example, you know doctors wanted to use some of these techniques maybe you know not to delve into people's personal life or you know their childhood and things of that sort they wanted to learn how to role reverse people and do doubling, could someone do that? Is it possible for example for someone who is working in the education field of medical professionals who wanted to teach people how to improve their communication or deal with conflict and that to learn some of these techniques without getting certified and--

Rebecca Walters: Sure, sure. I want to point something out. Most of us remember elementary school. And if you think back to elementary school probably most the very most wonderful teachers you ever had, used sociodrama in teaching whether it was putting literature into action whether it was exploring historical situations in action.

Dr. Baile: Oh you mean someone you be George Washington and you be the King of England and talk to one another.

Rebecca Walters: That's right, that's right absolutely.

Dr. Baile: That's sociodrama.

Rebecca Walters: That's sociodrama. It's not made up. It's characters that are from history or from literature but it's the same thing. We don't know what they really said, do we?

Dr. Baile: Right, no we don't.

Rebecca Walters: So they make it up. And we did one years and years ago when I was an undergraduate just beginning to learn this stuff. We did the burning of Kingston, New York and they had a meeting of the town's people to discuss what they should do and different 10 and 12 year olds sat down and they new enough about--they were given a character and they knew what the issues were and they had a discussion. And these 10 to 12 year olds were very sophisticated in their way of looking at this. I took the little--the 5 and 6 year olds. We were the fire. But what I--I'm thinking also about teaching science in action, right? I mean I remember right when my daughter was in 3rd grade her teacher taught the children about gas, solids and liquids by having them become molecules. And she had then move closer together to be solid and further away to become gas and they remember that. Well the same thing is true when we go into teaching communication skills you don't need to be a certified Psychodramatist to learn how--when to say role reverse or to learn to use some of these basic role playing techniques that deepen the experience for people.

Dr. Baile: You know it seems to me that it was very interesting for me to hear you say that you know the children are actually much better and more spontaneous at this than the adults. And it seems like somewhere along the line of growing up we lose our ability to pretend?

Rebecca Walters: We get self conscious.

Dr. Baile: And so you know this form of getting people comfortable enough to pretend seems very powerful and I was just thinking when you mentioned this kind of group here that it's even possible to get people together for example to simulate a family meeting, and for--just people in the group to take various roles of different family members that the group might construct.

Rebecca Walters: Yes.

Dr. Baile: And then kind of turn them loose to interact with each other to see kind what their issues were.

Rebecca Walters: One of the very first times I came to MD Anderson, we were looking at difficult communication in healthcare and the group created a family. And there were some--a four year old; a four year old wasn't in the scene it was his father, his mother, his stepmother. The patient advocate, the social worker, the doctors, the nurse--I think I covered them all. And they began to interact but what was most interesting to me was that the mother and step mother bonded. And kind of both of them chastised the father. They kind of ganged up against the father, which I didn't expect but it was very creative and people really got into it. We also had--they had a chance to take different roles too. They weren't stuck in the same role the entire sociodrama.

Dr. Baile: They could switch.

Rebecca Walters: They could switch roles. Sure?

Dr. Baile: To kind of experience what it would be like. In fact it sounds like this switching is really a key element in getting people to empathize what the feelings and troubles and problems with someone else.

Rebecca Walters: Right. In that particular sociodrama what I remember is that there was an actual MD playing a nurse and an actual nurse playing the doctor and so they both were able to understand the difficulties that the person in the other role had, and that was very wonderful.

Dr. Baile: Yeah it sounds like once you're able to get into the role of someone else it actually is pretty compelling to actually experience what it might be for them in a particularly challenging conversation.

Rebecca Walters: Yes, yes.

Dr. Baile: Well thank you very much that's very enlightening and I hope there might be opportunities for more clinicians to train in some of these methods since they sound like they're very powerful and would be very powerful in medical education.

Rebecca Walters: Well I hope so too. And thank you so much for having me.

Dr. Baile: Thank you. Today, we've been talking with Rebecca Walters from Hudson Valley Psychodrama Institute about her training programs here at MD Anderson in communication skills for oncology professionals. Thank you again.