Real-Life Role Play: A Cognitive Therapy Case Study with Two Young Sex-Abuse Survivors
Jacobs, Julie E., Journal of Group Psychotherapy, Psychodrama & Sociometry
ABSTRACT. The author of this case study describes the use of an adaptation of role-playing in cognitive therapy with two adolescent sex-abuse survivors who were treated in individual and conjoint sessions. Each girl had been sexually abused by a male caregiver. Both men committed suicide after the girls disclosed the abuse. Both girls benefited from sharing insights in the conjoint sessions, with the older girl enacting the role of teacher and the younger girl that of learner. Both were able to challenge and change beliefs about their trauma histories and emerged with different beliefs about themselves, others, and the future, and consequently were able to react differently to their pasts.
Key words: real-life role play, role play in cognitive therapy, treating sex-abuse survivors
RESEARCHERS HAVE DOCUMENTED THE USE OF ROLE PLAY in a variety of therapeutic contexts, including its use as one technique among many in cognitive therapy (cf. Beck, 1995) and as a separate mode of therapy in psychodrama (cf. Moreno, 1964, cited in Kipper, 1996). In this case study, I present an adaptation of the role-playing process, which I used in cognitive therapy with two children who survived similar traumata. I describe details of the case and offer a brief discussion of the various aspects of role playing in different therapeutic contexts.
In its broadest context, as Kipper (1996) outlined in a historical overview, role playing has been used for thousands of years, in religious ceremonies, among children practicing for adulthood, and, since the 1930s, in a variety of systems of therapy. As he writes, "Role-playing has been associated with the alleviation of feelings of helplessness and uncertainty; with reducing the discomfort caused by fears; with instilling hope; with forming a coherent sense of self-identity; with healing; and with efforts to enhance understanding among people" (p. 101). In psychodrama, role-playing has been seen as creating a "therapeutic culture in miniature" (Moreno, 1964, p. xxii), in which an "unsatisfactory natural habitat" (Moreno, 1964, p. xxii) can be replaced or extended to allow healing to take place. In that context, therapists use group role playing as a strategy when working with abused children (cf. Bannister, 1997), building from the observation that once the safety of the therapeutic context is established, the interactions among a group of children can be as powerful a healing mechanism as those between the therapist and client.
Among cognitive behavioral therapists, role playing is one of many written, artistic, and play-based techniques used in treating children who have been sexually abused, with goals that are parallel but differently defined. Role playing is seen as one way to help decrease children's blame of themselves for the abuse and, more accurately, to attribute blame to the perpetrator (Celano, Hazzard, Campbell, & Lang, 2002). As in other forms of therapy, a sound alliance between the child and the therapist is necessary before the shift in attribution can take place.
In the present case, I treated two girls in the same small community who had each experienced prolonged sexual abuse by a male caregiver. When girls disclosed the abuse, the perpetrators committed suicide. That left each girl devastated; each felt responsible not only for the sexual abuse but also for the additional trauma of having "caused" the adult perpetrator's death. The two girls, who did not know each other, disclosed the sexual abuse at age 10. One girl is now 15 and has undergone additional traumata in the subsequent 4 years. The younger girl was brought into treatment at age 10, right after the perpetrator's suicide. The current intervention involves bringing the two girls together for several conjoint sessions. In essence, each girl provided a real-life role-playing experience for the other, which allowed both to progress in their healing. The older girl was able to make meaning of her trauma by experiencing the new role of teacher and helping the younger child avoid some of the pain that she had experienced. …