 Good afternoon, Shoshanim. Today we are going to discuss some fascinating techniques borrowed mainly from psychodrama. Psychodrama is a treatment modality, not used very often, but it's very useful when the patient is, for example, too young or when the patient is resilient, resistant to change, not open to insight. Set in his ways, too grandiose, so when the patient is not amenable to a meaningful life-transforming interaction, when the patient is surrounded by defense mechanisms and protections and motes and fortresses and so on and so forth, these techniques come handy. Now we use them in both cognitive behavior therapy, CBT, and in psychodrama, and they are especially useful when it comes to cluster B personality disorders, narcissistic, borderline, histrionic, and antisocial, but also paranoid and schizoate personality disorder, dependent personality disorder. Now, before I proceed, the genders are interchangeable. Wherever I say he, the gender pronouns are interchangeable. Whenever I say he, substitute she. Wherever I say she, which I never do, substitute for he. My name is Sam Vaknin, I'm the author of Malignant Self-Love, Narcissism Revisited, and I'm your black today, professor of psychology, and let's delve right in. Start with doubling. In doubling, doubling is the capital of Ireland, doubling, like being someone's double. In doubling, the therapist or the counselor acts. He becomes an actor. He emulates the client's emotions, cognitions, and behaviors. The therapist becomes the client. If the client is, I don't know, a child abuser, the therapist becomes a child abuser. If the client has anxiety disorder, therapist becomes anxious. If the client is depressed, the therapist acts depressed. So the therapist takes on, imitates the client's identity in every possible sense. He tries to kind of meld or merge with the client's mind, so as to experience the same emotions and cognitions, and he definitely, the therapist, behaves the way the client does. The therapist verbalizes what the client may be thinking, or what they seem to be withholding. As well as the client disavowed and defended against content, mental content, and behaviors. The therapist, in a way, becomes the client's alter ego, doppelganger, twin. Doubling this technique connects the client's internal reality with an external reality, which is essentially the therapist. And in this way, restores reality testing to the client via insight. The client develops insight as he observes the therapist in action. The client then, if the technique works, the client then acknowledges that he sees himself in his double, in the therapist, or in the counselor. So doubling is a very powerful technique whereby the client becomes a passive observer, and the therapist becomes the client. Whatever the client is thinking, it's the therapist who does the thinking. Whatever the client may be emoting or experiencing or feeling, it's the therapist who does the experiencing and the emoting and the feeling. And whichever behavior or misbehavior the client may be engaged in, the therapist appropriates these behaviors and pretends that they are his. In a typical doubling session, the therapist talks most of the time, and the client just observes and at the very end usually confirms. So there's a process of confirmation. The client is likely to say, yes, I am also like this. Yes, I'm also like you. The therapist, yes, I have the same thoughts, the same emotions, the same behaviors. So ultimately, the client owns, takes ownership of his cognitions, emotions, actions and behaviors via the exclusive agency of the therapist. Therapist talks for 45 minutes, and then the client says, yes, I recognize this in myself too. The therapist acts in certain ways or claims to have acted in certain ways. And then the client says, I do the same. I act the same. And this is very good with narcissists, covert narcissists, psychopaths, and to some extent borderlines. They have alloplastic defenses. They tend to blame other people for their own misbehaviors and the consequences of their misbehaviors. They have an external locus of control. So the doubling technique restores ownership and possession to the client. The client then recognizes himself and his contribution to whatever it is that is happening. Doubling is a technique that is very close to mirroring. In mirroring, the client observes other people as they act out scenes, events and conversations for his benefit. It's a bit like observing a theater play or being a spectator in a movie theater. Other people go through the motions. They display certain behaviors. They verbalize certain thoughts. They describe certain emotions. The client just takes it all in, watches the scene intently until at some point he gains perspective. He is able to put some emotional distance between himself and his emotions, for example, and then he better understands his emotions. He is able to put some distance between himself and his cognitions so he recognizes these cognitions for what they are. And having observed behavior and misbehavior in other people in this theater production, the other people could be a therapist, a counselor, a group of therapists, a supervisor of therapists, or a mental health counselor. Never mind. Having observed these other people going through the motions, imitating him to some extent, the client is able to say, wow, that's me. That's the way I think. That's how I usually feel. These are my behaviors typically. Now the next much more famous technique is called role playing. No, not in sex or not only in sex. Role playing in therapy much more boring, much more boring, much less exciting. Role playing in therapy is when the client, not the therapist and not the counselor, but the client assumes the role of a particular person in their life. So the client, I don't know, plays his powers or the client pretends to be his boss or the client even can be his child, his son or his daughter. So the client acts the role of another person in their life. It could be the therapist or the counselor and then there is a kind of switching of roles. In the role reversal, the client is the therapist and the therapist is a client. It's very, very close to doubling. Role reversal is close to doubling, but the difference is that in doubling, the therapist is active 99% of the time and at the very end of the session, the client takes over and says, yes, I recognize myself. I've gained insight. I'm amenable to change and I'm experiencing transformation. In role reversal, it's much more balanced, much more even. It's simply that the therapist becomes a client and the client becomes a therapist, but then they embark on a therapy session with regular exchanges between the analyzed and the analyst, for example. So one possibility for role reversal is between two parties, for example, therapists and clients. And another possibility is that there's a therapist who remains a neutral arbiter. He's just there as a professional authority, able to moderate everything. And the client changes roles with another person, someone else. So this is the second option for role reversal. Now role reversal helps the client to improve empathy and to understand other people's perspective and separateness from him. This is pretty, should be pretty useful with narcissists. These narcissists have no empathy and are not able to tell the difference between themselves and other people. As far as the narcissist is concerned, there are no external objects. Everything is internal. Other people are mere extensions of the narcissist. They're instrumentalized, objectified, and ultimately dehumanized. So the role reversal forces the narcissist to recognize that other people are separate from him, that they have their own needs and dreams and hopes and wishes and fears and emotions and cognitions, that therefore he should relate to other people, not as if there were mere extensions of himself, but as if they were separate from him. The next technique is known as soliloquy. Soliloquy is when the client describes his inner thoughts, his internal feelings, to an audience. And the audience typically is the therapist or the counselor. So the client goes on a stream of consciousness, kind of speech, that's why it's known as soliloquy. And he just deep dives into his own mind, trying to describe the ever-shifting kaleidoscope of his emotions, cognitions, and so on, to the therapist. And this way the client gains greater insight into his feelings and thoughts and experiences, which leads ultimately to catharsis. These are the five basic techniques in psychodrama and in cognitive behavior therapy. I have used doubling quite often with clients where I play the client. I engage in the client's behaviors, however egregious they may be. I describe the client's thoughts, cognitions, and emotions as mine, and I become the client. And then the therapist is totally reversed. I talk for 50 minutes, and at the end the client just says, yeah, I recognize myself. It's basically how the therapy, the doubling technique works. I've also done mirroring, role play, role reversal soliloquy. I've done role reversal with an empty chair, which is borrowed from Gestalt. There's a lot of room for playing this. Play is the key word. It's a bit transactional analysis, kind of thing. Play is the key word here. People assume roles. The role can be a parent or a child or a savior or whatever. They assume roles, and then the roles consume them, subsume them. Nothing is left of the person except the role. And so by externalizing the role, by outsourcing the role, by projecting the role into another person, the therapist in this case, this brings on a lot of new insight. This generates dynamics in the patient, which are very healing and very beneficial. I want to read to you from an article, online article titled, role play in psychotherapy. By the way, in the description you will find detailed bibliography. Role play in psychotherapy, general effects of role play techniques in psychotherapy by Roger Schaller. And this is what he is an eminent authority and scholar on role playing in psychodrama. This is what he has written. Variations in role taking. The therapist can initiate three different forms of role taking through targeted guidance and questions. And he's referring to literature by Gallese, Mignone and Eagle, and to his own writings and to Dampert and Schaller and so on. So he says there are three ways, three variations in role taking. The first one is imitation. When a person tries to play the role of another person, he or she can do this by imitating an observed behavior of the other person. Imitation is a powerful form of learning. Then the second variant is cognitive stimulation. Taking the role of another person is also possible by simulating simulation of what he or she would do in the other's place. So cognitive simulation. He or she does this simulation by representing the way of thinking in the mental states of the other person. And then using own decision making systems to operate on these foreign mental states to predict the behavior feelings and thinking of the other. This cognitive simulation process refers to the concept of theory of mind, one's ability to infer and understand the beliefs desires and intentions of others. So in effect, doubling involves imitation and cognitive simulation. And then there is a embodied simulation. When a person tries to play another role, it may also happen by an embodied simulation. Embodied simulation is a crucial functional mechanism of intersubjectivity by means of which the actions, emotions and sensations of other people are mapped by the same neural mechanisms that are normally activated when we act or experience similar emotions and sensations. In other words, other people can trigger in us the very same emotions and sensations that they are experiencing according to Shalom. While in imitation and cognitive simulation, the process of role taking is conscious. This simulation process is direct and escapes conscious access. Without thinking, the client is instantly able to reproduce bodily position and movements of the other person. In cognitive behavior therapy, usually, role taking is done by a cognitive simulation. In the psychodrama, the therapist activates the patient to take a role by imitation and by embodied simulation. In psychodrama, role taking is usually done by variation. The patient learns to play not only with reality, but also to play with different forms of taking a role. Again, these are powerful techniques intended to penetrate the resistances and defenses of very rigid personalities, not open to change, to insight or to intervention. Thank you for listening.