PAUL HEINRICH WHEN ROLE-PLAY COMES ALIVE A Theory and Practice When role-play comes alive Paul Heinrich When role-play comes alive A Theory and Practice Paul Heinrich Pam McLean Centre University of Sydney St Leonards, NSW, Australia ISBN 978-981-10-5968-1 ISBN 978-981-10-5969-8 (eBook) DOI 10.1007/978-981-10-5969-8 Library of Congress Control Number: 2017952084 © The Editor(s) (if applicable) and The Author(s) 2018 This work is subject to copyright. All rights are solely and exclusively licensed by the Publisher, whether the whole or part of the material is concerned, specifically the rights of translation, reprinting, reuse of illustrations, recitation, broadcasting, reproduction on microfilms or in any other physical way, and trans- mission or information storage and retrieval, electronic adaptation, computer software, or by similar or dissimilar methodology now known or hereafter developed. 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The registered company address is: 152 Beach Road, #21-01/04 Gateway East, Singapore 189721, Singapore I dedicate this book to my wife Chrissie. Foreword I am an academic. So, like all good academics, I begin with a definition. The Oxford English Dictionary defines role-playing as The acting out of the part of a particular person or character, for example as a technique in training or psychotherapy. Most health professionals have experienced role-playing this way at some stage during their training. In the 1990s, the world of healthcare was increasingly assailed by the challenges of effective communication with patients and their families. Communication topped the charts for complaint and litigation, and role-playing seemed a good solution to get- ting a better match between how professionals communicated and what society expected. But it wasn’t working. Sadly, the exercise was often unproductive, and legions of wounded warriors described the experience as disappointing, amusing, boring, pointless, or, occasionally, traumatic. In the world of Psychology, role-playing becomes The unconscious acting out of a particular role in accordance with the perceived expectations of society. (OED) It took me a while to appreciate how doctors, nurses, and other health professionals can play roles that are squeezed (sometimes mercilessly) vii viii Foreword into some sort of perception of societal expectations: but roles that often constrain them personally and professionally—with occasionally disas- trous consequences. It is precisely this conflict between what society expects of us, what health professionals expect of themselves and each other, and who we really are as authentic specimens of humanity that gives role-play its true potential. Effective role-play inhabits the virtual world between who we are, or who we think we are supposed to be, and who we are capable of being. And then came Heinrich. It was Paul Heinrich, a dramatist and thinker, who introduced me to the concept of Lazzi—not in sixteenth- and seventeenth-century Italy, when they first appeared as stock comedic routines traditionally associ- ated with Commedia dell’arte, but a little later in the late twentieth cen- tury in the academic hothouse of a university teaching hospital. Commedia dell’arte translates to “theatre of the professional” and refers to improvised performance based on a set of standardised routines. Performers had stock lazzi (Italian for a “joke” or “witticism”) in their repertoire and would use improvisatory skills to weave them into the plot of dozens of different scenarios. The concept was compelling: that a doctor or nurse might adopt a role characterised by bits of well-rehearsed behaviour woven together through authentic, in-the-moment improvisation to achieve a goal that is right for the moment. To quote from Chap. 13 (“Effective Facilitation”): So how do you make sense of an interaction? You might be tempted simply to compare what the players are doing with what you think they should be doing, based on approved protocols, practice guidelines or on your own professional experience. The approach is quite appropriate for clearly defined procedures that need to be memorized and rehearsed. It directs your attention to shortfalls in performance, that is, to where further work needs to be done. However, that kind of template-based approach is less useful for most open-ended interaction. By directing your attention to mismatch, to what the learner is not doing, it takes your eye away from what is actually happening. Forewor d ix We need to recognize that there is no possibility of scientific certainty at any stage. Instead, you and the group must work your way forward through a shift- ing landscape of rolling hypotheses. It was the beginning of a wonderful experiment in developing a pow- erful mix of clinical medicine, psychological research, and dramatic the- ory and practice that became the multiple award-winning Pam McLean Centre in the Sydney Medical School at Royal North Shore Hospital. In our case, things were very different. Paul, a dramatist, became an integral member of our clinical/research team and that changed the emphasis inexorably. The world of drama had things to offer that could not be supplied by clinical medicine or psychology. Drama didn’t tell us how to communicate, but it did provide effective means to find out and explore. Along the way, we all had to adjust to Paul Heinrich’s unique way of doing things, his exhausting attention to detail, his capacity for absorbing prodigious amounts of clinical and psychological information, and his enormous red glasses. And he had to adjust to the foibles of a team of academic researchers and clinicians in a world that was initially just as foreign to him as his was to us. At this point, any attempt to adhere to scientific inquiry becomes almost irrelevant. Each health professional, in their attempts to maintain authenticity in improvising responses to standard scenarios, constitutes an “n” of 1. We are not in the world of science here. And this book is not an academic survey of evidence for the effectiveness of role-play. Neither is it a description of the programme we developed, or a simple “how to” man- ual for trainers of standardised patients or preparation for OSCEs etc. The book attempts to rectify the imbalance in discussion of role-play and communication skills training by providing a voice for drama itself to describe role-play and, because role-play is a form of drama, it makes sense to talk about it as drama. Role-play is traditionally seen as an edu- cational tool and often its nature as drama is overlooked completely. This book is an explanation of role-play as drama and this explanation is usu- ally lacking. The insights contained in this book have the potential to imbue role- play with a magical quality, sometimes reflected in instant positive changes but, more importantly, leaving participants with the capacity to x Foreword continue to think more deeply about their communication and how they can continue to grow. Professor of Psychological Medicine Stewart Dunn Sydney Medical School—Northern Associate Dean (Admissions) Director | Pam McLean Centre Preface If you are an educator, a trainer in business or one of the professions, a workshop facilitator, a role-play actor, a manager looking for ways to improve the quality of communication in your workforce, or someone interested in role-play as performance, this book is written for you. Research over decades has convincingly demonstrated the superiority of role-play over older, didactic methods in teaching communication and social interaction. So much so that the use of educational role-play has become widespread in professions such as medicine and healthcare, polic- ing, defence, law, and business. However, the experience of role-play is sometimes uneven. If you have ever taken part or been in charge of it, you have probably found that it is not always as effective as it might be. Sometimes we find it hard to lose ourselves in the make believe and just cannot buy into the situation. Sometimes an interaction will grind to a halt, and we are unsure how to proceed. Sometimes an approach that always works well, suddenly fails. This book shows you how to redress many of those shortcomings, rejuve- nate your experience of role-play, and access many more of the resources that it offers. The most important consideration by far for successful role-play is that it comes alive. The interactions need to be so convincing that it is as if they are really happening. Everyone in the room, not only those on stage but also those watching on the sidelines, need to be caught up and xi