A Blended Group Model

Thomas Treadwell E.D., TEP, CGP

integrating Cognitive Behavioral Therapy with Psychodrama

A model for clinical and college counseling settings

                        Cognitive Behavioral Therapy (CBT) was established by Aaron T. Beck (1967, 1979), and involves several techniques to challenge negative thought patterns and increase engagement in positive and success-based experiences. Psychodrama group therapy was created based on work by Jacob. L. Moreno (1953), and involves experiential, interpersonal exercises to raise awareness and reduction of internal conflicts in order to change negative relational patterns. The CBT model is sometimes criticized for being overly structured and intellectually oriented (Young & Klosko, 1994; 1996; Woolfolk, 2000).  As a result, some group therapists today use an approach based upon CBT or identify with a less structured approach called eclectic (Kellerman, 1992) that typically employs techniques that come from cognitive behavioral therapy and its related research. CBT is a robust, proven, and highly effective treatment approach for many mental disorders, including the big ones like depression and anxiety.  Beck reports “My employment of enactive, emotive strategies was influenced, no doubt, by psychodrama and Gestalt therapy” (A. Beck, 1991, p.196). Psychodrama is an eclectic tool to enhance the cognitive and behavioral change. Several practitioners have worked to integrate CBT into the Psychodramatic model by highlighting the ways CBT enhances psychodrama exercises (Boury, Treadwell, & Kumar, 2001, Treadwell, Kumar, & Wright 2004), adapting psychodrama to include the exploration of irrational beliefs (Kipper, 2002), and considering the way in which psychodrama could be considered a form of CBT (Baim, 2007; Fisher, 2007; Treadwell, Travaglini, Reisch, & Kumar, 2011; Wilson, 2009). The blending of the two models yields a complementary approach to multiple problem-solving strategies (Treadwell, Kumar, & Wright 2004):

Cognitive Experiential Group Therapy (CEGT) is an effective model for working with a variety of clinical and nonclinical populations. The model incorporates cognitive behavioral and psychodrama interventions, allowing group members to identify and modify negative thinking, behavior, and interpersonal patterns while increasing engagement in positive and success-based experiences (Treadwell, Dartnell, Travaglini, Staats & Devinney, 2016, Treadwell, Dartnell, Travaglini, Abeditehrani, 2021. The CPGT environment creates a safe and supportive climate where clients can practice new thinking and behaviors and share their concerns freely with group members (Treadwell, Kumar, & Wright, 2004).

Initially, all members are assessed using various instruments to establish the nature and severity of presenting issues and to uncover other relevant information. The first one or two sessions are devoted to establishing group norms, explaining Cognitive Behavior Therapy (CBT) and schemas, and describing the session format. The initial didactic sessions are intended to explain the group format as a problem-solving approach for working through various interpersonal, occupational, educational, psychological, and health-related conflicts. The sessions include information about the nature of the structured activities so participants have realistic expectations about how the group will run.  Each group member signs informed consent and audiovisual recording consent forms. The audiovisual recordings create an ongoing record of group activities and serve as a source for feedback when needed. Here’s how the model looks the action model is introduced. In session one, the director/facilitator, introduces the Beck Depression Inventory-II (BDI), Beck Anxiety Inventory (BAI), and Beck Hopelessness Scale (BHS) (Beck, 1988; Beck& Steer, 1993; Beck, Steer, & Brown, 1996), and explains the importance of completing each scale on a weekly basis. The instruments are administered before the start of each session and are stored in personal folders to serve as an ongoing gauge of participants’ progress within the group (Treadwell, Kumar, & Wright, 2008).

In the second session, additional data on early maladaptive and dysfunctional schemas/core beliefs are obtained when group members complete Young’s (Young, Klosko, & Weishaar, 2003; Young & Klosko, 1994; Young, 1999) schema questionnaire. A list and the definitions of dysfunctional schemas and core beliefs are given to participants during the initial session (Treadwell, Kumar, & Wright, 2008).  Additionally, we administer the Therapeutic Factors Inventory (TFI) to identify four dimensions of group progress (Joyce, MacNair-Semands, Tasca,  & Ogrodniczuk, (2011) during this week, week 8, and week 16.

Each group session in CEGT is divided into three sections typically found in psychodramatic interventions: warm-up; action; and sharing (Moreno, 1934). Many CBT techniques (Beck, 2011) are utilized in the warm-up, including: identifying upsetting situations, automatic negative thoughts and triggered moods; writing balanced thoughts to counter negative automatic thoughts; and recognizing distortions in thinking and imprecise interpretations of difficult situations. The second portion, action, employs psychodramatic techniques such as role-playing, role-reversal, and mirroring, which facilitate the examination of various conflicting situations individuals experience within the group context. This enables group members to better understand the nature of negative thoughts triggered by situations and their effects on moods. The last stage, sharing, allows auxiliaries and group members to share their experiences with the protagonist. At this stage, the director may provide additional guidance to the protagonist regarding ways to begin resolving the actual situation in real life. Normally, the protagonist will be asked to complete a homework assignment that will be reviewed at the next session.


The Automatic Thought Record (ATR) (Greenberger& Padaskey, 1995/2015) is explained and shown how to complete on a white board during warm-up.  A group member volunteers his/her situation and facilitators walk the person through the seven columns.  This individual is then referred to as the protagonist.


The protagonist selects a group member, to be her double.  The double communicates thoughts and feelings the protagonist is having but cannot express. Since the protagonist is rather agitated, one may have some difficulty getting into the psychodrama; in this case, the soliloquy technique would be helpful.  Implementing soliloquy technique, the protagonist walks around the room, thinking aloud, expressing concerns, discomfort, and hopes, allowing protagonist to relax, focus, and prepare for the psychodrama. This is also useful in helping other group members focus on the upcoming action phase. The double walks with her, expressing thoughts he assumes she is thinking but not expressing.  To operationalize these unexpressed thoughts the director/facilitator brings another group member to mirror the protagonist’s role and has the protagonist watch the interaction. This technique, called modeling, occurs when a group member demonstrates to the protagonist how he or she would handle the situation. Doubling, modeling, and role-training are crucial in learning how to get unstuck from repeated behavioral patterns. Many protagonists are anxious when learning a new role; therefore, it is important to support them as they try it in session.


At the end of the psychodrama, group members share and discuss what occurred, commenting on their experience playing a particular role or on how the situation affected them.  Sharing is critical both for the protagonist and for each of the group members as they reflect, share, and learn from each other. Sharing is a fundamental component in enhancing group cohesion.  During the sharing stage, assigning homework to the protagonist is essential, as it encourages the continuation of work on the new role explored in the session.  Role development needs practice for habituation to take place and to move the protagonist to feel safe in her new role.


Utilizing principles of CBT and psychodrama created a powerful and effective group process, enabling participants to address problematic situations with the support of group members. Clients find CBT helpful in becoming aware of their habitual dysfunctional thought patterns and belief systems that play an important role in mood regulation; the action component allows them to actually see and feel the dysfunction.


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