Introduction
Drama therapy uses all of the processes and products of drama and theatre to help clients get to know themselves better, make peace with their pasts, envision their futures, and develop the skills to get along better with others in their present (NADT Brochure, 1997). This provides a drama therapist a wide array of tools for guiding clients toward their goals.These goals could include self-acceptance, self-empowerment, learning clear communication skills, improving social interaction abilities, or resolving on-going conflicts in their lives.
From 1988 through 1999, I worked as a drama therapist at Second Genesis, a non-profit mental health organization that ran six long term residential substance abuse treatment facilities in the Washington, DC area. For a long time, I was the itinerant drama therapist, traveling from house to house to run a weekly two hour drama therapy group. Later, I became a full time substance abuse counselor at Melwood House, a facility that focused on treatment for women addicts and their children.
Second Genesis’s program was based on the Daytop model of Therapeutic Communities (TC), using confrontation, structure, and tough-love to teach the skills needed to live a sober, drug-free life. In a TC group relations theory is applied to the whole treatment milieu, not just therapy groups, to ensure that every interaction in the environment is safe and therapeutic (Winship in Waller & Mahony, 1999). The three Cardinal Rules at all Second Genesis facilities were: No Drugs, No Sex, and No Violence. Breaking a Cardinal Rule was grounds for immediate termination. If a minor rule was broken or a direction given by a staff member or a resident with authority was not followed, the disobedient resident received what was called a “consequence” or “learning experience.” This could include losing a privilege, wearing a sign that advertised what you were at fault for or listed what you were not working on in treatment, wearing a stocking cap (symbolic of the “old days” in TCs when people’s heads were permitted to be literally shaved), sitting on the bench by the front door (reminding the resident that they were one step away from being kicked out), or having to do some kind of unpleasant cleaning task in the facility (like cleaning the grease trap in the kitchen or scrubbing the floor with a toothbrush). If the infringement was serious, the resident could be put “on contract,” which meant that he lost all privileges and had a number of tasks to complete before he got them back. Behavior was also dealt with in weekly encounter groups in which residents were expected to confront each other verbally on their negative behaviors.
Besides the structure of a traditional TC, Second Genesis utilized the treatment philosophy of the Twelve Steps of Alcoholics Anonymous (AA, 1976) and Narcotics Anonymous (NA,1988) and, like both self-help organizations, put emphasis on the role of group support for recovery. Residents worked through three phases that related to specific recovery tasks, the AA/NA Steps, re-entry into the workforce, and re-unification with their families and the community. Anyone who did not have a high school diploma was eligible for classes preparing them for their GED (General Education Diploma). For example, the primary goal of Phase One, Level One – Orientation and Accepting the Need to Change – was based on the first step of AA and NA: We admitted we were powerless over alcohol (our addiction) – that our lives had become unmanageable (Alcoholics Anonymous, 1976, p.59; Narcotics Anonymous, 1988, p.19). AA and NA meetings were brought into the facility and once residents had earned the privilege of a “pass” to the outside, they were required to attend AA or NA meetings while out “on pass.” Shortly after I began working there, Second Genesis began incorporating Relapse Prevention Training as articulated by Terrence Gorski into required groups (Gorski & Miller, 1986).
Substances that had been abused by residents ran the gamut: alcohol, cocaine, heroin, inhalants, prescription drugs, stimulants – you name it, they had done it. Most people were addicted to more than one substance and everyone was a practicing nicotine addict. Many of the clients were remanded from prison for treatment or sentenced to treatment by drug court. They lived at the facility for 6 months to a year and learned how to live without drugs and alcohol, eventually transitioning back to their jobs and families in the community.
A great many addicts – both male and female – were survivors of childhood sexual, physical, and/or emotional abuse and neglect. Some were children of alcoholics or addicts. They had experienced so much trauma and upheaval while young that the only way to cope with the pain, shame, self-hatred, and blame was to numb out their feelings with drugs. Getting high was the only way they could function – to get on with life – until, as inevitably happens with addictive substances, the substances overpowered their lives and led them into prostitution, dope dealing, theft, and robbery in order to feed their habit. Their families fell apart. Their health failed. Most people arrived for treatment so thin they looked like concentration camp survivors.
Emotional Implications of Addiction
Whenever one starts doing drugs, emotional development stops. Someone who starts getting high at fourteen will not mature socially or emotionally beyond that age because the drugs allow the addict to avoid working through problems whether they be personal, interpersonal, financial, or educational. When the addict stops doing drugs, he is emotionally right back where he was when he started doing drugs; he returns to his previous developmental level of emotional maturity and progresses from there (Gorski & Miller, 1988).
One new drama therapy intern turned to me after her first session with a newly formed drama therapy group and asked, “How old are these women?” I said, “Between 20 and 45 – most of them are in their 30’s.” “Really?” was her response, “They act like teenagers!” And sure enough, when I asked them at the beginning of the next group to share how old they were when they first started getting high, the answers ranged from 6 to 16. The behavior of recovering addicts in treatment resembles that of rude, unruly, insecure teenagers complete with an unending series of nasty putdowns, snide remarks, and games of one-upmanship. Before any therapeutic progress can be made on either an individual or group level, the drama therapist has to teach basic group skills and how to interact respectfully.
Establishing a Drama Therapy Group
I found the best way to create an environment of respect was through theatre games. Games had to be challenging and fun, but not competitive. Some groups could handle cooperative games at the beginning, but most had not yet reached the stage of cooperative play. Most groups had to start with parallel or associative games (Garvey, 1990). Examples of successful early associative games are “The Winds Are Blowing,” “Magic Tube,” or “Making an Entrance” (see List of Drama Games at end of chapter for descriptions of these and other games.)
Once a basic respect was established, I could move on to games where two people had to work together like “Mirroring,” “Balances and Leans,” or “Open Scenes,” working slowly toward more complex cooperative games like “Environments,” “Transportation” or “Trust Circles.” Group interaction skills slowly improved and group members began to develop trust in the group and respect for each other while they were also developing their basic drama skills. As a result, when we moved into improvisation and role play, they understood how to create dialogue, how to listen to their acting partner, and how to build a dramatic scene through give and take. This parallels Renee Emunah’s Integrative Five Phase Model of Drama Therapy in which the group proceeds progressively through more difficult sets of activities over time as they are ready. The Five Phases are Dramatic Play, Scene Work, Role Play, Culminating Enactment, and Dramatic Ritual (Emunah, 1994).
Addicts come into a drama group with many highly developed acting skills: they were acting in order to survive all the way through their addiction. Each time I began an orientation on the first day of a new group, I would tell them that the purpose of drama therapy was not to make them into actors or to put on a play, but to take the negative skills they had developed for manipulating and conning others and transform them into positive skills for living a clean and sober life. I would say, “If you think back to when you were out on the street getting high, you were doing a lot of acting!” and they would laugh in recognition.
Using the Process Communications Model
Introducing drama therapy this way made a big difference in whether I was met with resistance or willingness. In addition, I always made sure that in the first several sessions we had lots of fun. This is easy to do when you are playing drama games. Quickly, I realized that the fun aspect was very important for the “buy in” and later, I discovered why: drug addicts are all Rebels!
There is a wonderful interaction assessment and training tool called Process Communications Model or PCM developed by Taibi Kahler, a clinical psychologist (Pauley, Bradley, & Pauley, 2002). It focuses on how people send and receive messages. If you want someone to understand you, you should communicate to them in their preferred communication style, not yours. In other words, you need to learn to speak their language. Another important concept is that before someone will listen to you, they need to have their psychological needs met. In PCM terms, they need to be “stroked.”
One of the six communication styles in PCM is Rebel. How are rebels stroked? Rebels need to play! If you can engage a rebel in play, he will then be willing to listen to whatever message you have to share because he has had his “fun-quotient” met. If you do not play with a rebel, you will be met with resistance and sometimes outright rebellion. Through theatre games, I bypassed all the resistance that other therapists faced in their groups and individual sessions. No matter what phase of drama therapy we were in, I always included a warm-up game at the beginning of the session to let everyone release “steam” and have fun.
Identifying Feelings and Trusting Oneself
Drama therapy group was often the first time that many residents explored their feelings or even learned to identify the names of the emotions that they experienced. Because addiction involves numbing out feelings, residents were in the habit of being disconnected from their bodies and intellectualizing their experiences (Browne-Miller, 1993; Gorski & Miller, 1988; Waller & Mahony, 1999). When I would ask during our check-in at the beginning of group what people were feeling, I would get generalities like “OK,” “Good,” or “Bad;” none of which are feelings. I started requiring group members to identify a specific feeling. I even brought in cards with names of emotions and acted them out for them. (They really enjoyed my dramatic performances.) Or I asked them to express their feelings through a metaphor like a color, an animal, or a weather report which gave them some distance from admitting to the feeling, but also allowed them to be creative and explore the multiple layers of complexity available through the connotations attached to a metaphorical image.
I had to get group members to start to trust their bodies and feel their feelings again. To help with this, we followed each check-in with a physical warm-up where we shook out tension, stretched, bounced, and breathed slowly and deeply. Often I would ask them to report how they felt after the warm-up in contrast with before. This facilitated learning that both physical and emotional sensations can be transformed after a short intervention. This focus on developing awareness of the individual’s physical presence was introduced to me by my drama therapy mentor Jan Goodrich, RDT, who had created the drama therapy program at Second Genesis, and was reinforced by my subsequent mentor Rudy Bauer, Ph.D. at the Washington Gestalt Therapy Training Center.
Once we got “into” our bodies and acknowledged our emotions, pleasant and unpleasant, we moved on to playing a warm-up game. This was another good way to begin to practice experiencing feelings in a non-threatening way. In the course of playing games, most of the emotions that were generated were pleasant, but sometimes unpleasant ones cropped up because someone was not playing fairly or was in a bad mood. We learned how to name and work with all of these emotions, because they are all part of life.
Case Example: Althea, Part One
One day Althea, a very intense, intimidating resident, came into group in a very belligerent mood. Her infant was sick and she wanted to stay with him down in the nursery; however, staff had said she needed to attend her groups. Althea had a lot of trust issues and felt that no one other than herself could take adequate care of her baby. Like most addicts she only wanted to do what she wanted to do when she wanted to do it; she did not like to follow directions from authority figures. Yes, she was a Rebel. She came into drama group and announced that she did not want to be there and she was not going to stay.
I said, “Listen, I can tell that you are really upset and worried and you want to be with your baby, but if you go down to the nursery the way you are acting right now, you are going to get in trouble and there will be serious consequences.”
“I don’t care,” she said.
“Well, I do,” I said. “I’ll tell you what – I’ll make a deal with you. [Drug addicts also tend to be Promoters – another PCM communication style – and Promoters like to make deals!] You stay for check-in and warm up and play the first game I have planned for today, and then, if you still want to, I’ll let you go back downstairs to check on the baby.”
She agreed. We did our check-in: we went around the circle and everyone said how she felt (Needless to say, Althea was “angry, worried, and stressed out”). We did our physical warm-up to get everyone alert, relaxed, and connected with their bodies. Then we played Machines. First we made Imaginary Machines where one person started with a sound and a movement and another person added on another sound and movement and then another and another until everyone was involved in a gigantic Rube Goldberg contraption. Next we segued into Emotion Machines. In this version every part of the Machine (and, therefore, every person) has to express the same emotion with their sound and movement. This version of Machines is very cathartic. There’s nothing like a good Anger Machine to get your frustration out. And there’s nothing like a Tenderness Machine to get you in touch with your gentle, loving side.
When we finished, I turned to Althea and said, “OK, we’re done with our warm-up game. If you want, you can go back down to the nursery.”
By that time, she was completely calm and in a state of emotional balance. “No,” she said, “I don’t have to go now. I’m fine. And staff was right. They will take care of my baby. I should be here in group.” Then she pointed her finger at me and said, “You! You did this on purpose! Oh, you’re so smart, Miss Sally. You knew I wouldn’t want to leave group after I played that game because you knew I wouldn’t be angry anymore!”
“Well,” I said, “I didn’t know that would happen, but I hoped it would.”
“I understand now,” she said, “You are teaching us about life in this group! I’m going to pay close attention to what you have us do from now on!” She had discovered what I love all my clients to discover: that I don’t just play games to have fun. I also play games to teach impulse control, flexibility, spontaneity, and all the other many skills that they need to live their lives successfully.
Moving into More Serious Therapeutic Work
Once a drama group developed the necessary level of respect and group interaction skills, we could start moving into more serious therapeutic work: using sociodrama to practice the skills they would need to stay clean and sober, using psychodrama to explore painful personal issues in an honest but playful way, and creating and performing short original plays that metaphorically allowed them to rehearse actions they wanted to take or envision goals they wanted to achieve.
Art was often a very effective intervention because it pre-empted the verbal rationalizing that addicts so skillfully use as a defense mechanism by funneling their ideas into non-verbal images first (Bailey, 2007). Maps to Recovery, drawn to show the obstacles and the supports on each individual’s life journey, were perfect jumping off points for dramatic enactments.Social atoms, which symbolically depict relationships with family, friends, and (sometimes) enemies, also served as excellent segues into scenes of personal exploration.
One of the most effective exercises I used with many groups was the creation of masks from plaster of Paris bandages. We painted the masks to depict the metaphorical behavioral masks they put on to hide their true feelings. Sometimes we made half masks and performed in them. Other times we made full face masks which were painted on the outside and the inside. When each mask was finished, the maker sat in front of it and imagined what the mask would say to him or her if it could come alive and speak. The maker would write down what the outside of the mask said and what the inside said in whatever form the words came to him: poetry, story, or monologue. These therapeutic products were extremely important to each individual because they expressed what they had come to understand were “the games they played as an addict” and “the real person they hid underneath.” We talked in group about the necessity of taking off the Mask of Addiction (or of The Victim or of Shame or of whatever it was that they habitually wore) in order to live and breathe and grow out in the open.
Case Example: Althea, Part Two
By the time Althea made her mask she had humbled herself, accepted the need to change her behaviors, given up intimidation, learned how to work with others flexibly, and allowed the vulnerable person she really was inside out into the world. When she sat down to paint the outside of her mask, at first she hesitated because “The Mask of the Bully,” the mask she wore when I first met her, was not one she wore anymore. But, she said, if she were ever to relapse, she knew it was the mask she would put back on. She decided she needed to memorialize that behavior, so she would never forget her addiction and, consequently, never go back to it. The outside of her mask was truly frightening. This is what it said to her:
Anger is my name.
Bullying is my game.
Don’t put me in a corner,
For I will spit fire.
I don’t care what you think,
Because I just want to get higher.
If you look into my eyes,
They will lead you the wrong way.
Because I don’t give a fuck
What you may say.
So if my game don’t make you jump,
I’ll just move on until I find another punk.
“I DON’T NEED YOU!!”
She cried every time she looked at it.
Inside was “The Real Me”:
I have this huge concern about being neglected.
I am afraid you won’t like me or just care for me the way I like.
I am scared you will use me and my body –
Say you love me, but you don’t really care.
This side of me I am very happy, very affectionate, and soft,
Very giving, loving, and caring.
I love to laugh and feel secure,
But am afraid of being abused.
I am very vulnerable and will believe your words,
Because I long for my dreams –
A dream that may never come true.
So please don’t lie to me.
I would appreciate it if you just let me be.
After graduating from the program, Althea got a job in the main administrative office of Second Genesis. I often saw her at various functions and she would come back to the facility to talk to new residents. Every time I saw her she said, “Miss Sally, I still have my mask. It’s sitting on the table in my living room on the stand you gave me. Every time I get angry or frustrated and think about “picking up” [getting high] again, I go over, look at it, take it in my hands, and I cry because I remember what it was like before I found my recovery. It’s kept me honest and it’s kept me sober more than once. Nothing is worth going back to that life. Nothing.”
Conclusion
Until the advent of Alcoholics Anonymous in the 1930’s, most experts believed that addiction was untreatable (Alcoholics Anonymous, 1976; Cantopher in Waller & Mahony, 1999; Diamond, 2000). Once the 12 Step self-help process was accepted as the treatment of choice, experts believed that only intervention by other addicts was useful in addressing the problem. In the late 50’s, Therapeutic Communities came into acceptance as a treatment of choice for a certain set of entrenched addicts (Winship in Waller & Mahony, 1999). Not until the 1960’s did the Medical Model gain general acceptance (Gorski & Miller, 1998). This was followed in the late 1980’s and early 90’s with belief that addiction could be treated through psychotherapy or counseling (Diamond, 2000; Gorski & Miller, 1998; Groterath in Waller & Mahony, 1999).
Each of these treatment paradigms sees addiction through a different lens: as a spiritual disconnection, a social disorder, a biological disease, or a psychological condition. In the case of systems therapists, like social workers and marriage and family therapists, it is seen as a biopsychosocial condition. Drama therapy and the other creative arts therapies come out of the biopsychosocial tradition, but bring in addition a holistic approach to the treatment of addiction that emphasizes creativity and health. Jacob Moreno, the founder of psychodrama, saw every human being as creative and capable of discovering their creative resources through interaction with others (Groterath in Waller & Mahony, 1999). Other founders and developers of creative arts therapy methods subscribe to similar beliefs. By focusing first on what is healthy within all the group members, nurturing that health through creative interactions within the group, and using these creative abilities to work through internal and external problems, clients begin to recover not only their sobriety, but also their sense of self, their power to act for positive goals as the protagonists in their own lives, and their ability to make a difference in the lives of others. Because of this unique strength-based and health-based approach which incorporates reparative interventions to heal the trauma and disconnects created by family of origin and addiction issues, it is my belief that the creative arts therapies should be offered as the first line of treatment offered to addicts.
References
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