TERAPIA PSICODRAMÁTICA: EL ROL DE LOS PADRES EN UN CASO DE LENGUAJE CON TRASTORNO EXPRESIVO

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TERAPIA PSICODRAMÁTICA: EL ROL DE LOS PADRES EN UN CASO DE LENGUAJE CON TRASTORNO EXPRESIVO

Thalia Adriana Rocha Vazquez

Alumna de la:
Maestría en Psicología Educativa
Universidad Bancaria de México

INTRODUCCIÓN

El apoyo psicoterapéutico, tiene como finalidad mejorar la calidad de vida del paciente incrementando su bienestar mental y potenciando sus habilidades (Sabaté, 1994).
Ahora bien la terapia psicodramática, es una de las estrategias terapéuticas y a su vez se concibe como una herramienta que de acuerdo con Moreno (Moreno, Psicoterqapia de Grupo y Psicodrama , 1978) se puede entender como "un método para sondear a fondo la verdad del alma a través de la acción".
Desde esta perspectiva en el presente documento se plantea una propuesta de intervención psicodramática para que los padres de familia de la paciente puedan comprender la situación de su hija y a su vez asuman la responsabilidad y compromiso que implica el apoyo que debe recibir por su parte.
Para la mayor comprensión del contenido el trabajo se encuentra organizado como sigue: Se presenta el marco teórico que apoya el desarrollo de la intervención psicodramática, se realiza la presentación del caso (historia clínica y datos generales), le sigue luego la planeación de la intervención psicopedagógica, y finalmente se presentan las fuentes bibliográficas que apoyaron la construcción del proyecto.
MARCO TEÓRICO
Psicodrama
El Psicodrama es una herramienta de intervención que permite inmiscuirnos en nuestro propio pensamiento y a su vez proyectar situaciones que no tenemos del todo conscientes (Moreno, Psicoterqapia de Grupo y Psicodrama , 1978).
Fue creado por Jacobo Levy Moreno partiendo de los conceptos griegos psique (alma) y drama (movimiento), y lo que pretende es poner la mente de las personas en movimiento. Es un método de trabajo grupal e individual, en el que por medio del empleo de técnicas de acción se logra la exploración de la situación vital y existencial de la persona (Bezanilla 1, 2009).
A diferencia de las psicoterapias con encuadres verbales, el psicodrama hace intervenir el cuerpo en sus variadas expresiones e interacciones con otros cuerpos. Esta intervención corporal involucra el compromiso total con los temas o situaciones sobre las que se trabaja; compromiso que resulta fundamental para la terapia y, por ello, para el individuo y el desarrollo de mejores y mas completos medios de comunicación con sus semejantes (Forselledo, 2008).
En el psicodrama no se deja de lado lo verbal sino que, por el contrario, se lo jerarquiza para incorporarlo a un contexto mas amplio como lo es el de los actos. De esta forma, como dice Rojas Bermúdez (1997), el individuo "se hace cargo de lo que dice y responde con su hacer"
El psicodrama es, además, una técnica de psicoterapia directa, es decir, que en ella el proceso terapéutico se realiza en el "aquí y ahora", con todos los elementos emocionales constitutivos de la situación patológica expresados a través de personajes y circunstancias concurrentes y por tanto se centra en el sujeto protagonista o en el grupo de terapia. Los participantes tienen que representar sus experiencias espontáneamente. Se pasa de un relato longitudinal al relato tridimensional de la escena representada; de una sintaxis de la palabra a una sintaxis de la acción (García, 2010).
El psicodrama constituirá, pues, una técnica dirigida a que un sujeto, transforme en acción, (interprete sus roles) (Bezanilla, 2011), lo más amplia posible, los hechos vivenciales propios de un modo espontáneo, según se sienta impulsado a hacerlo sobre la marcha. El sujeto puede actuar solo, en cuyo caso se hablara de Autodrama (Moreno, Psicodrama , 1961). Pero por lo general el sujeto protagonista o sujeto paciente se ve guiado por un experto en la aplicación del método psicodramático denominado psicodramatista o director que habrá de ser una persona cualificada, formada psicológicamente y conocedora de la teoría, la metodología y las técnicas psicodramáticas, siendo su función poner su bagaje de conocimientos al servicio de los individuos y grupos, para darles la posibilidad de que actúen en el nivel de espontaneidad que les permita conocer las raíces de sus problemas y conflictos; buscar soluciones y desarrollar al máximo su espontaneidad, su sensibilidad y sus roles, en beneficio de una posibilidad vital gratificante. Desde este punto de vista el director o psicodramatista, es el coordinador natural de un grupo de psicodrama (Rojas, 1997).
El sujeto paciente o protagonista es el actor principal de la dramatización, el que provee el material de la dramatización y al mismo tiempo la interpreta. Es, pues, de forma simultanea, actor y autor principal. En ocasiones, puede haber más de un protagonista. En relación a la actuación de este sujeto protagonista hemos de advertir que debe estar dirigida por cuatro principios de acuerdo con García (2010):
1º. – Liberación de la espontaneidad: Ofertándole todas las posibilidades para que exprese su espontaneidad con toda libertad.
2º. - Puesta en escena: El sujeto protagonista y paciente dramatiza sus conflictos en lugar de hablar de ellos, representando sus experiencias, superando el nivel verbal. El mismo sujeto elegirá el lugar el tiempo y la escena.
3º. - Participación y entrega: El sujeto protagonista y paciente deberá quedar comprometidamente inmerso en la acción. Es imprescindible su compromiso afectivo y emocional.
4º. - Realización simbólica o concretización en actos o imágenes: Se facilitará al sujeto protagonista o paciente el encuentro con las partes de su yo o con todas las personas que tienen relación con su mundo interno y externo. El protagonista proyecta sobre el escenario cada una de las cosas que están en su mente, en su fantasía, en su memoria sensorio-corporal.
Psicodrama Pedagógico
El psicodrama pedagógico es, en primer término, un método derivado del psicodrama. Como método, implica un camino, que persigue un fin, mediante ciertas técnicas, apoyado en un determinado encuadre.
El psicodrama pedagógico es una metodología educativa que utiliza el juego dramático como factor esencial para integrar los diversos aspectos involucrados en la temática o situación de aprendizaje. Para ello, se apoya en el encuadre clásico del psicodrama (contextos, etapas, instrumentos) (Forselledo, 2008). Utiliza un variado despliegue de técnicas, siendo las fundamentales el juego de roles y las imágenes reales y simbólicas.
Para el encare pedagógico, se basa fundamentalmente en la dinámica de la comunicación. Comunicación que va a ser facilitada y dirigida hacia los objetivos educativos preestablecidos.
De esta manera, utiliza distintas técnicas grupales de integración e intercambio, algunas de ellas para tareas pedagógicas específicas, otras para el caldeamiento grupal para trabajos dramáticos, otras, mediante juegos reglados estructurados para los objetivos pedagógicos.
El psicodrama pedagógico utiliza al máximo la capacidad espontánea de las personas. El concepto de “espontaneidad” – utilizado en el sentido moreniano - es la capacidad de un organismo de adaptarse adecuadamente a nuevas situaciones (Rojas, 1997).

¿Cuáles son las etapas?

En el Psicodrama Pedagógico, la sesión transcurre por tres etapas. Ellas están claramente diferenciadas, en razón de que los límites de cada una están dados por los cambios de contexto.

a) Caldeamiento: Es este un momento de entrada en calor y de generación de un clima que posibilite el trabajo posterior. Momentos de conexión con el cuerpo, con la respiración, con las contracturas y con las zonas fluidas del cuerpo, los apoyos, la energía. Diferentes juegos en libertad a partir de diversos ritmos musicales. Es un momento de entrada y preparación para el juego expresivo y psicodramático.
- Caldeamiento específico-visualizació Se propone al grupo conectarse con diversas imágenes que fluyan de su historia educativa – escolar, como educador y educando, como docente o como alumno. Circulando por varias imágenes, sin detenerse en principio en ninguna. Es un momento de investigación personal, de buceo interno

b) Dramatización:
- La construcción de los personajes; De esas imágenes surgidas, ir eligiendo algunas con las que deseen trabajar. Del conjunto de esas imágenes, o de alguna en particular, extraer elementos para ir construyendo 2 personajes: Docente y alumno. Pueden ser personajes que los representen a sí mismos o a otras personas significativas de su historia. Van adoptando vestimentas, posturas corporales, gestos, modos de caminar, de actuar, de sentir (este trabajo se potencia mucho si pueden utilizarse máscaras, vestimentas y objetos para encarnar a los personajes, pero puede hacerse también sin esos elementos). En esta preparación ya se va instalando un potente campo escénico.
- Inversión del rol en la dramatización: Luego de un determinado tiempo, se detiene la escena y se les pide que inviertan el rol: Los que hicieron de docentes pasan a ser alumnos y viceversa. Es este un momento especial. El efecto psicodramático se instala a pleno cuando uno es inducido a encarnar a su personaje complementario en la relación pedagógica. Los personajes vuelven a interactuar luego del cambio. Puede ser con palabras o en silencio. Se pueden ir dando micro-escenas grupales, duales o individuales. Aparecen emociones, parálisis, extrañamientos. También alegría, sorpresas. Sentimientos encontrados y ambiguos frente a lo que emerge de lo latente en
c) Cierre del trabajo-reflexión: Muchos cierres son posibles para este trabajo: Escenas grupales a partir de lo que apareció, esculturas, presentación de los rasgos de los personajes a modo de escenario, trabajo corporal produciendo un movimiento expresivo grupal, etc.. Es el momento de cierre del trabajo dramático y el paso a la reflexión sobre lo que apareció en las vivencias. ¿Qué nos pasó cuando encarnamos a los 2 personajes, qué apareció de nuestra historia y tomó cuerpo en la escena, qué interrogantes se abrieron? Es aquí donde la reflexión y el debate convoca la ayuda de lo teórico. Es aquí donde la transformación de la vivencia en reflexión teórica va constituyendo un aprendizaje en que se integran el sentir, el pensar y el actuar (Medina, 2007).
Técnica de la silla Vacía
Ésta técnica se concibe como un recurso terapéutico de las proyecciones y a su vez facilita a la persona el descubrimiento y la reintegración de sus propias proyecciones.
A su vez se puede encontrar un importante recurso para el trabajo terapéutico de las proyecciones y al mismo tiempo facilitar a la persona el descubrimiento y la reintegración de sus propias proyecciones. La forma como se desarrolla este procedimiento cambia dependiendo de lo que se proyecte en la silla. Cuando se trabaja con un acontecimiento la experiencia es más narrativa y descriptiva de la situación. Se hace énfasis en el sentimiento o emoción que acompaña al instante. Cuando se trabaja un aspecto de la personalidad la experiencia se vuelve más interactiva y dialogal. El terapeuta dirige la intervención hacia el momento más intenso emocionalmente que contribuye a que ocurre la concientización (Martin, 2000).
Cuando se trabaja con una persona significativa que no puede estar presente por varias razones (fallecimiento, abandono, etc.) el paciente utiliza la imaginación para rellenar la silla con la persona ausente y se entabla un “dialogo”, el terapeuta lo alienta a expresar sus emociones para que se fortalezca su conciencia.
Para trabajar la sesión de silla vacía se siguen los siguientes pasos (Torres, 2009):
1) Inicio de la sesión (Caldeamiento)
2) Observaciones iniciales: Se observa el estado general del paciente
3) Se identifica la figura
4) Observación fenomenológica: El terapeuta presta mayor atención al como, y al que es lo que indica el paciente (Sentimiento, emoción, voz, tono muscular...)
5) Silla vacía: dialogo, retroalimentación...
6) Cierre de la experiencia

Trastornos del lenguaje
Generalmente, bajo el encabezamiento de trastornos del habla, en su más amplio sentido, se sitúa todo problema que surge de un daño de las funciones motoras de los órganos vocales –trastornos en la anatomía, fisiología o neurología de los sistemas relacionados.
Esta categoría incluye anormalidades estructurales congénitas o adquiridas (por ejemplo, fisura palatina, paladar ojival, labio leporino, frenillo labial superior, frenillo lingual, malformaciones linguales, atresia mandibular etc.), trastornos neuromotores (por ejemplo, las disartrias o parálisis de la lengua, parálisis facial…) y enfermedades que temporalmente afectan el aparato del habla (por ejemplo, la laringitis o la disfonía). Incluye lo que algunos llaman disglosias (alteraciones en la articulación producida por anomalías en los órganos articulatorios de causa orgánica o adquirida) y las disartrias (Romero, 2010).
La disartria se refiere a una serie de trastornos motores del habla que surge como resultado de un daño del sistema nervioso y que se manifiesta por alteraciones en el control muscular de los mecanismos del habla. Se asocia a debilidad, espasticidad o incoordinación de la musculatura del habla. Puede incluir, además de la articulación, los elementos supra segmentales del habla (entonación, ritmo, acentuación..) y pueden alterarse otras actividades en las que intervienen los órganos vocales, como mascar, tragar, sonreír, toser, o estornudar. Puede, por lo tanto, verse afectado cualquier aspecto de la producción, dependiendo de donde ocurra la lesión. Puede encontrarse asociada a cuadros de parálisis cerebral y también en la enfermedad de Parkisón (Martínez, 2008). La disfonía hace referencia a alteraciones de la voz, en cualquiera de sus cualidades - tono, timbre, intensidad - debido a alteraciones orgánicas o funcionales.
A menos que existan otros déficits asociados, este grupo de trastornos afectan solamente a la articulación del habla y/o a su transmisión a través del sonido; puede incluir, por tanto, trastornos de articulación, de fluidez y de la producción de la voz.
Algunos autores (Ver por ejemplo la clasificación de Cl. Chevrie-Muller y J. Narbona) integran este grupo de déficits dentro de la categoría Déficit de los “instrumentos de base” en las que incluyen los déficit anatómicos, los trastornos neuromotores que afectan al orden y control de la motricidad faringobucal y los déficit sensoriales-auditivos (Rosales, 2005).

Presentación del caso:
Luego de realizar las evaluaciones pertinentes, se llego a la conclusión de que la paciente tiene un C.I. normal debido que en el dibujo de la figura humana obtuvo un promedio de es de 133.66, y su puntaje global es de 108, al ubicarlo en la tabla encontramos que su desarrollo se encuentra de acuerdo a la media. Ahora de acuerdo con lo argumentado por la madre de la paciente en la entrevista, la paciente comprende las instrucciones y las pone en practica según su condición anímica y disposición hacia le trabajo; por tanto se detectó un posible problema de lenguaje expresivo, debido a las dificultades en la articulación de su lenguaje oral.
Ahora bien, en la presente intervención se pretende involucrar a los padres de familia de la paciente a razón de que la intervención familiar es un factor que coadyuva o entorpece los avances que se pudieran tener en las intervenciones pedagógica, por lo que al comprometerse realmente potenciaran la habilidades de su hija no solo en referencia a su trastorno de lenguaje expresivo, sino también en habilidades sociales y emocionales que son la base para su pronta recuperación.
Propuesta de intervención:
Se plantea trabajar con los padres de familia de la paciente por separado para trabajar la técnica de la silla vacía, en la que se pretende que ellos proyecten cómo vive sus hija día a día su trastorno de lenguaje a fin de que puedan entender el nivel de apoyo y compromiso que necesita la paciente para subsanar esta vulnerabilidad y finalmente vencerla.
Estrategia Propósito de Desarrollo Preguntas clave
Silla Vacía Comprendan y concienticen el apoyo y la forma de trato que debe recibir su hija a fin de potenciar un mejor desarrollo de sus habilidades lingüísticas Caldeamiento:
Imaginar uno de los momentos que evoque mayor alegría al momento de ser padres.
Realizar una carta dirigida a su hija diciendo lo que sintieron cuando la vieron por primera vez.
Compartir la carta con su pareja respectivamente.
Elaborar un dibujo, proyectando ahora lo que sienten por su hija, y cómo quisieran que fuera al ser mayor ¿Qué sintió cuando tuvo a su hija en sus brazos?
¿Qué es lo que más recuerdan?
Elaboración de la carta 10 minutos
¿Cuáles fueron los sentimientos que compartieron?¿los sentimientos han cambiado?
Cómo es que afecta la condición de su hija en referencia a su trastorno del leguaje expresivo su visión de ella en el futuro
Dramatización
Trabajar la técnica de la silla vacía: pedir a uno de los padres se coloque frente a la silla e indicarle que concentre toda su atención y evoque a su hija, y que indique todas sus características (Física, emocional, conductual, en su forma de hablar).
Pedirle que ahora tome asiento en la silla y que ahora representen a su hija tal cual es, iniciar cuestionamientos, sobre ¿quién es, cómo se llama, si va a la escuela, …?
Realizar poco a poco intercambios según sea necesario
Para cerrar, solicitar que cierre sus ojos y que piensen muy fuertemente en la imagen de su hija, y que la depositen en un lugar de su cuerpo, que no sea su cabeza, que se despida de ella y que poco a poco abra los ojos, respire lentamente hasta incorporarse.

Cierre
Invitar a los padres que indiquen lo que sintieron, como vislumbran ahora la imagen de su hija.

Conclusiones
La experiencia psicoterapéutica en el campo del psicodrama, apoya a que el la persona que la vivencia, se conozca, comprenda y reconstruya su propio ser, por ello es importante que esta experiencia sea única.
El proceso en la intervención psicodramática debe aportar elementos al individuo para que reconstruya su ser y le permitan afrontar el día a día potenciando sus habilidades y brindando salud mental y emocional.
Nunca se debe olvidar lo siguiente:
• El papel del psicodramatista solo será de guía
• El valor real de la terapia solo se dará si es una experiencia real, genuina y espontanea
• En todo el evento debe existir respeto
• El cierre debe permitir la recuperación del paciente a un estado de bienestar y calma.
Finalmente en el psicodrama cada experiencia es única y por tanto espontanea pero siempre ayudar [a al paciente a rencontrarse...
Un encuentro de dos:
Ojo a ojo, cara a cara,
y cuando estés cerca
yo te arrancaré tus ojos
y los pondré en el lugar de los míos,
y tú me arrancarás mis ojos
y los pondrás en el lugar de los tuyos.
Entonces, yo te miraré con tus ojos
y tú me mirarás con los míos.
Y nos encontraremos...
Moreno, 1914

Bibliografía

• Bezanilla 1, S. H. (2009). La aplicación del método psicodramáticopa la orientación familiar. México D. F.: Instituto de Enlaces Educativos A. C. (ENLACE).
• Bezanilla, S. H. (2011). SOCIOMETRÍA: Un método de investigación psicosocial. México : PEI.
• Forselledo, J. G. (2008). El psicodrama Pedagógico. Montevideo: UNESU.
• García, J. J. (2010). La teoría noverbal en la terapia Psicodramática . Madrid : Universidad Complutense de Madrid.
• Martin, A. (2000). Manual practico de psicoterapia Gestalt. Francia : Desclée De Brouwer.
• Martínez, S. J. (2008). Neurolingüística: patologías y trastornos del lenguaje. Revista Digital Universitaria , 1-18.
• Medina, J. (2007). Psicodrama, Juego y Creativida . Mexico: UNAM.
• Moreno, J. L. (1961). Psicodrama . Buenos Aires: Hormé .
• Moreno, J. L. (1978). Psicoterqapia de Grupo y Psicodrama. Barcelona: FCE.
• Rojas, B. J. (1997). Teoría y Técnica Psicodramáticas. Barcelona: Paidos.
• Romero, R. A. (2010). Trastornos del Lenguaje . Valencia: Alicante.
• Rosales, D. R. (2005). Trastornos del Lenguaje . Los Andes: Universidad de los Andes.
• Sabaté, N. (1994). Familianova-shol . Recuperado el 20 de Julio de 2012, de Familianova-shola: http://www.familianova-schola.com/files/Psicoterapia_psicodinamica.pdf
• Torres, P. (2009). Tecnica de la silla vacia. Mexico: Centro de Orientacion y Desarrollo Humano.

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