Psychodrama

Moreno and the early twentieth century

Psychodrama is credited to Jacob Levy Moreno, a Romanian-born psychiatrist. Reviews in the research literature date its origin to 1921 and describe it as inspired by improvisational theater and as an early form of group psychotherapy. A scientometric review places its formal conceptualization, together with Moreno's study of interpersonal connections known as sociometry, at the turn of the 1920s in the aftermath of World War I. These dates are the ones used by later researchers; the reviews do not reproduce Moreno's own accounts, and the sources reviewed here do not describe his emigration or later career.

Adaptation and divergence since the 1980s

A 2018 systematic review reports that several authors departed from Moreno's original theory from the early 1980s, which it links to a proliferation of techniques with unclear definitions. The review also reports that psychodrama is widely used in Europe, including in hospitals and mental health services, and that more than 60 training schools in 26 European countries are overseen mostly by one federation of training organizations. Its authors judged that contemporary practice differs between schools, so findings about one school's methods may not describe another's.

Research on psychodrama has grown unevenly. One review of controlled trials observes that most clinical trials were published in the twenty-first century, despite the method's long history, and another describes intervention research as relatively scarce compared with research on other psychotherapies.

Names and related terms

The literature uses several labels: Morenian psychodrama for work that follows Moreno's theory, classic psychodrama for the group format studied in controlled trials, and psychodrama psychotherapy or psychodrama group therapy in clinical reports. Professional bodies also refer to sociodrama, an action method that the British Psychodrama Association lists alongside psychodrama. A European training standard distinguishes the title psychodrama psychotherapist from titles used in other fields, such as psychodrama leader, sociodramatist or creative therapist. The sources reviewed do not set out a single agreed definition of sociodrama.

Roles and techniques

Within Moreno's framework, a session has five instruments: the protagonist, whose material is enacted; the director, who guides the session; the auxiliary ego, a person who plays other roles in the scene; the audience, made up of other group members; and the stage. A 2018 review reduced 56 techniques found in 21 papers to 11 core techniques: soliloquy, double, mirror, role reversal, resistance interpolation, sculpture, social atom, intermediate objects, games, sociometry and role training. That list was checked with an expert and then discussed with a network of 22 European psychodramatists.

In the same review, the double is a person who voices the protagonist's unspoken thoughts and feelings, the mirror lets the protagonist watch others reproduce his or her posture and words, and role reversal asks the protagonist to take another person's perspective. Moreno proposed spontaneity and creativity as distinguishing features, and the term surplus reality refers to an externalized version of a person's subjective reality that is created on stage. These are concepts of the tradition and not measured biomedical constructs.

Phases of a session

Reviews describe a classic session in three phases. In warm-up, the director establishes contact with the group and uses exercises intended to increase spontaneity and reduce inhibition about sharing. In the action phase, the protagonist acts out a real or symbolic scene, and further scenes may show past events, present concerns or future possibilities. In the sharing phase, group members respond. The core techniques are used mainly in the action phase, and clients speak in the first person to the people in the scene, who are usually played by group members or represented by an empty chair.

Format and dose in studies

A 2025 systematic review of 27 studies published from 2018 to 2022 found that psychodrama was usually delivered in a group, mostly to adolescents and adults, weekly for 8 to 13 sessions of about two hours. Role reversal, doubling and mirroring were the techniques most often used. None of the studies reported using a treatment manual, and the review notes that the method's reliance on spontaneity makes manualization difficult.

Trials of other kinds of delivery exist. One randomized trial of social anxiety compared psychodrama with cognitive behavioral group therapy and a combined format, and a trial of excoriation disorder compared psychodrama group therapy with a support group. These designs are protocols from research, not standard practice, and the sources do not describe what typical private sessions cost or how long they last.

Populations and problems in the literature

Reports describe psychodrama in many settings. The 2025 systematic review lists results for post-traumatic stress, the empowerment of women in vulnerable situations, symptoms of people with schizophrenia and antisocial behavior in adolescents. The 2019 integrative review found more than 20 different outcomes, mostly in adults, with two studies involving children. Controlled trials have been run in Turkey, the United States, Finland, Canada, Brazil, Italy and Iran, among other settings. These are uses that researchers have studied and not an endorsement of any of them.

Examples from specific studies

Individual studies have addressed social anxiety in adults, skin picking in adults, and PTSD symptoms in an inpatient addiction treatment center. In that inpatient study, two trauma-focused psychodrama models were used, and the authors reported patient satisfaction survey data that they said highlighted tolerability, emotional safety and group cohesion. These are the claims of the study authors, and each applies to the population and setting studied.

Practice descriptions of role training, one of the core techniques, say it lets a person rehearse a role in a protected setting, such as a difficult conversation. That is a stated purpose of the technique and not a tested outcome.

Systematic reviews

A 2021 systematic review identified 14 randomized controlled trials and one quasi-randomized trial of group psychodrama, with 642 participants in total. The authors concluded that psychodrama improved symptoms across a range of problems and called for further research. They rated the studies as strong or moderate on a quality tool, although the paper gives different counts in two places, and the trials often did not state whether outcome assessors were blinded. Comparators included waiting lists and other treatments, so the findings are not a single estimate for one comparison.

The 2025 review of 27 studies found that only three used a randomized design, 48 percent were quasi-experimental and 40 percent were single-group designs. Effect sizes were reported in 40 percent of studies and were typically medium or large, but the authors judged sample sizes too small for solid conclusions, and about a fifth of studies found no significant change in any dimension. A 2019 integrative review concluded that results were promising but that methodological and reporting quality needed to improve.

Randomized trials and a meta-analysis

A 2024 meta-analysis of seven randomized trials from mainland China (332 participants, 25 effect sizes) reported an overall standardized mean difference of 0.768 (95 percent confidence interval 0.591 to 0.946) in favor of psychodrama. It was based on the abstract only for this page, covers trials in one country, and combines varied outcomes and comparators, so the pooled figure should not be applied to a particular condition.

Two trials compared psychodrama with active treatments. In a trial of 144 people with social anxiety disorder, psychodrama, cognitive behavioral group therapy and their combination were each better than a waiting list at reducing social anxiety complaints, with no significant differences between the active treatments after treatment or at six-month follow-up and no difference in dropout. In a trial of 53 adults with excoriation disorder, psychodrama group therapy was not more effective than a support group, although both groups improved.

What the evidence does not show

A single-group study of trauma-focused psychodrama in an inpatient addiction center reported reductions of more than 25 percent in PTSD symptoms, but its authors state that effects cannot be isolated because there was no control group and participants received other treatment. The sources reviewed did not identify trials showing that psychodrama is superior to other established group therapies, and they provide little long-term follow-up: the 2025 review found follow-up assessment in 26 percent of studies. A PubMed search for systematic reviews and trials was run, but other databases were not searched.

What the reviews report about harms

The 2025 systematic review reported that no included study found iatrogenic effects, meaning harm caused by the intervention. This should be read with caution, because most of the reviewed studies were small, many were not randomized, and the review did not assess whether harms were systematically recorded. Absence of reported harm in these studies does not show that distress or negative reactions do not occur. The other reviews used here concentrate on benefit outcomes, and none of the sources reviewed provides rates of adverse events.

Care boundaries and suitability

Psychodrama involves enacting emotionally significant scenes in front of other people, and a 2018 review notes that the mirror technique can feel exposing and recommends a professional in the auxiliary ego role. The reviews do not give contraindications. In the reviewed trials, the studied groups included people with diagnosed conditions treated in clinics, so the findings do not apply to every person or to any individual. The method is a psychotherapy and is not a substitute for assessment of a mental health condition, medical care or crisis support. A person who is in crisis or at risk of harming themselves should seek urgent professional help.

Training and professional standards

In the UK, the British Psychodrama Association describes itself as the accrediting body for psychodrama and sociodrama training schools and is accredited by the UK Council for Psychotherapy. It says its practitioners, trainers and trainees follow a code of practice and a code of ethics, that psychodramatists are required to have regular supervision, and that UK practitioners who finish a recognized psychodrama psychotherapy training must be individually registered on the UKCP register. These statements are the organizations' own and were not independently audited.

A European federation's minimum training standard describes a program of 880 hours over at least four years in a training organization, including 200 hours of personal experience in a psychodrama group and 80 hours of supervision, with admission requiring a bachelor's degree in a relevant field. No statutory regulation or training standard applying outside these professional bodies was sought or found for this page, and requirements differ by country.