Experiential Therapy for PTSD: The Therapeutic Spiral Model by M. Katherine Hudgins. 2002. New York: Springer Publishing Company.

Years ago, when I was introduced to experiential psychotherapy, I worked with family members of chemically dependent persons at a treatment center in Pennsylvania. Although I was initially enchanted by the creative possibilities of action methods and their power in comparison to traditional talk therapy, I became increasingly concerned about their limitations as my learning and practice progressed.

Our unit worked primarily with adults who came from alcoholic homes, and it seemed to me that focus was placed on the "inner child" and the necessity of the adult's accepting that part of the self for full recovery. Too often, however, dramatic vignettes didn't go according to script — the patient rejected the symbolic inner child and the early pain this invisible child carried. Or the patient accepted the "childlike" part of herself or himself and brought a stuffed animal to a session. Nevertheless, the patient continued to struggle with activities of daily living and was still haunted by symptoms typical to trauma survivors.

When I discovered the model of change known as the Therapeutic Spiral Model, it seemed to me that the originator must have traveled a parallel path. Using her experiences in practice and teaching, Hudgins has created a model that speaks to the complexity of trauma while making the best use of the special features of psychodrama.

In this step-by-step guide for using experiential methods safely, Hudgins presents the theoretical foundations of her model, research on trauma, and the case for experiential psychotherapy as the treatment of choice for survivors. With the Therapeutic Spiral Model, Hudgins modifies classical psychodrama and integrates its use with advances in current trauma treatment and the real-life tendency for protagonists and group members to dissociate when on-stage action becomes threatening. She has expanded on the image of the spiral by relating her theories to Zerka Moreno's oft-repeated description of a complete psychodrama session as one that moves "from the periphery to the core" — which Goldman and Morrison delineated in their book, Psychodrama: Experience and Process. The Therapeutic Spiral Model, however, views the spiral not as two dimensional but rather as three dimensional, which gives the image depth as well as shape.

Here, the image of the spiral is separated into three strands: experiencing, energy, and meaning. Its dimensional quality refers to the awareness of the debilitating and chaotic reality of violent experience with a reasoned approach to integrating that experience in ways that re-establish social ties and reassert non-violent values. Survivors often speak of spiraling down into memories of pain and losing their abilities to reason and take intelligent and conscious action. The model suggests that a survivor who tumbles into the whirlpool tendencies of traumatic memory must learn to spiral up and out as well as in, taking steps to think and communicate rationally.

The model's centerpiece is the Trauma Survivor?s Intrapsychic Role Atom, or TSIRA. It shows the internalization of traumatic experience within the survivor as defined by role theory and serves as a clinical map for treatment. It defines the essential internal roles in the self-organization and personality structure of a trauma survivor and identifies roles that must be firmly integrated within the personality of the survivor before the trauma can be addressed in a deep and healing way.

Hudgins divides the TSIRA into three sets of roles: prescriptive roles, trauma-based roles and transformative roles. That basic structure serves as a guide to propel the survivor ever deeper into unprocessed trauma material, only to surface repeatedly to make new meaning of experience. The prescriptive roles are intended to build strength within the survivor who may feel depleted of resources. Two important prescriptive roles are the Observing Ego — which in classic psychodrama is the mirror technique — and a unique modification of the classic double, known as the Containing Double. The classic double, which supports the protagonist in expanding his or her awareness and emotional states, is often not helpful when the survivor's fear expands into panic and panic into dissociation. The Containing Double role, using statements that support the narrative by labeling feelings and anchoring them in the here-and-now, prevents regression and dissociation with the protagonist. Assisting team members also can employ the Containing Double intervention to support group members to stay emotionally and cognitively present when a protagonist is active during a vignette.

The model also names additional roles that support the building of ego strength within trauma survivors, taking advantage of our natural multiplicity. The roles are developed as treatment proceeds, and the survivor is able to grasp their usefulness and dynamics: the Body Double, the Client, the Keeper of Defenses, the Manager of Healthy Functioning, the Sleeping-Awakening Child, and others. In all, the book names six clinical action structures and 14 intervention modules employing art, role play, and other experiential methods.

The author argues effectively for the use of experiential methods, anchored in clinical theory and practice, to be the treatment of choice for trauma survivors. Citing research on the neurobiology of trauma, she suggests that experiential methods increase treatment effectiveness and decrease treatment time because flashbacks and other trauma symptoms activate the emotional parts of the brain that do not respond easily to cognitive interventions.

With her model, Hudgins breaks beyond the cultural conserve while amplifying some of J.L. Moreno's early ideas, including that of using a team of professionals with a group, rather than a single director. The model is adaptable for individual sessions and groups in which there is a single director.

The action segments focus on sociometric warm-ups and enactment of the constellation of roles, and contain less information about the art projects that are frequently parallel to sessions of enactment. Art interventions and other adaptations of the model for use with specialty populations such as offenders, patients with eating disorders, at-risk adolescents and those involved with community education are ideal circumstances for further documentation and development of this model.

KAREN CARNABUCCI
Racine, WI