Tag: Drama Therapy

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Drama with Older Adults for Life Enhancement

Warm-up at Drama Workshop at Aging Conference -- people are throwing away their stress.
Warm-up at Drama Workshop at Aging Conference

Drama has been used as an activity in senior centers, day programs, assisted living facilities, and nursing homes for years as a way of bringing creativity and joy into participants’ lives and creating a more connected community. This is true whether the drama group participants have normal cognition or if they have begun to develop dementia.

In fact, because drama engages the imagination and stimulates the senses through embodied, concrete activities, it can bring adults struggling with Alzheimer’s Disease lucidly into the present moment and connect them clearly with memories of their past for the duration of the drama group.

Why Drama?

Drama involves the whole person in an active manner. Scenes can be done with dialogue or in silence (as pantomime), making it adaptable to the verbal abilities of the group. Lots of movement can be incorporated or drama can be successfully done from a stationary position. Memorization is not required as most drama sessions are made up as they go along. The major ingredient necessary for a successful enactment is imagination.

Acting out a memory makes it more real than just talking about it. Through action an abstract thought is given form and movement in an improvised scene. That memory comes alive in the moment and can be re-experienced, shared, and celebrated.

Even without using words, participants become aware of the others around them and start to connect and create social relationships. And best of all, drama is fun!

Typically a drama group begins with a warm-up activity which introduces a dramatic theme to be explored. The group might sing a song, look at a picture, or touch an object that brings up memories, engages their senses, and begins to connect them to each other. Then group members take the memories into action, replaying parts of their past or trying out new adventures they have just imagined.

Aging Workshop with actors about to unveil a "new product" that will enhance ageing.
Aging Workshop with actors about to unveil a “new product” that will enhance ageing.

Expensive equipment is not necessary for a successful drama group. Found props and simple costumes like hats or colorful scarves can be used in dramatizing a story. These inexpensive additions enhance the imagination, help participants get into character, and add more sensory stimulation to the experience.

A drama group usually incorporates all the other arts. A session may move from brainstorming an idea to acting out a scene to singing a song to playing a game to drawing a picture on the same theme. This provides an outlet for individual strengths and allows group members to focus on expressing themselves freely and creatively, rather than on perfecting a final product or performance. A trained drama therapist or drama facilitator can tailor activities to each specific group of participants’ abilities, interests, and attention spans.

Resistances/Concerns:

Beginning participants sometimes worry that they will have to “perform” in a drama group or that they will need special “talents.” In actuality, every one of us is able to do drama from the time we are quite young. Around the age of three all children naturally begin to imitate the people around them and engage in dramatic play. It’s one of the ways we are “hard-wired” to learn about ourselves and our world. Parents usually encourage this exploration by “playing along,” which develops the child’s imagination and cognitive abilities. This means everyone has experienced drama at least once as a young child, and anyone who has raised children, has participated in the process again from the parent perspective.

Drama is like riding a bicycle – once you learn how, you never forget it! What group leaders need to address initially are group members’ fears of failure and being put on the spot in front of a lot of people. This can be gently handled in the beginning by doing activities in which everyone participates simultaneously, while allowing participants to take the spotlight whenever they are ready and providing support and praise when they do.

Most participants, even those who may be confused in general, understand when they are pretending in a drama group and when they aren’t. As far as I know there has been no research to explain how or why this phenomenon happens; however, I suspect that since the ability to use the imagination and to pretend begins early in development, we retain this ability even when certain parts of the brain later in life begin to decline. Since dementia seems to erase skills and abilities backwards, from newest to oldest, the concept of “pretend,” developed at 3, remains when other cognitive functions start to go. As a result, individuals who have been out of touch with themselves or with their surroundings will often become very alert, energized, and cognizant during a drama group.

The Arts and Mental Health

Current research indicates that the Arts have powerful positive intervention effects for health promotion and disease prevention as well as positive impacts on maintaining independence, reducing dependency, and promoting a sense of well-being (Cohen, 2006). Dr. Gene Cohen, director of The Center on Aging, Health and Humanities at the George Washington Medical Center in Washington, DC is in the process of an ongoing research study, begun in 2001, which indicates that older persons who participate in creative arts programs conducted by professional artists show significant improvements in health compared with individuals initially matched by age and health who do not participate in the arts. At the beginning of the study the average age of participants was 80.

Over time those involved in weekly guided arts activities, such as drama, poetry, music, painting, pottery, dance, and storytelling, have had fewer doctor’s visits, less need for medication, fewer falls and less hip damage, more positive reports on mental health measures (the Geriatric Depression Scale, the UCLA Loneliness Scale, and the Philadelphia Geriatric Center Morale Scale), and have been more involved in overall life activities.

Previous research indicates that when older adults experience a sense of control or mastery, they have better health outcomes. Meaningful social engagement with others promotes better health as well. Researchers believe that at a physiological level these types of experience promote stronger immune systems, reduced blood pressure, lower stress hormones, and more growth of dendrites and synapses in the brain (Cohen, 2006). Group participation in the Arts, particularly drama which is a positive interactive group process, provides both a sense of control and meaningful social engagement.

Of particular note: normally a study that indicates less decline of one group over the other would be considered a successful intervention. In this Creativity and Aging Study, the arts group showed an increase in health over time while those who did not participate in the arts showed a decline in physical and mental health as well as in their involvement in other activities.

How to Start a Drama Group

There is probably more written on how to do drama activities with older adults than about any other art form. The books are clearly organized and written in non-technical, user-friendly language. See suggestions of excellent resources below.

The key to a successful group is finding a drama leader who has energy, confidence, and a willingness to play. She can’t be afraid to use her imagination, connect with group members, and even be silly, because the drama group leader is the model for how to take on and play out a role or a dramatic situation. An enthusiastic, empathetic person with background in creative drama or improvisation could learn how to run a drama group.

The best choice for a drama group leader, however, is a drama therapist. Drama therapists are trained to plan and run drama groups with the added skills of understanding the social-emotional, developmental, and health issues faced by participants. They can optimize the dramatic activities to facilitate life review, social connections, conflict resolution, and community building in your organization.

Actors demonstrate a "new product" that will enhance ageing!
Actors demonstrate a “new product” that will enhance ageing!

Small groups of six to eight participants work well for a drama group with older adults. This size allows everyone to participate and interact in a comfortable manner. A quiet, open space where group members can clearly see and hear each other without being interrupted is needed. Most drama group sessions last between 45 and 60 minutes, depending on the attention spans of the group members. If group members have mobility, sensory, or cognitive difficulties, the drama group leader needs to have staff assistance so that everyone can be optimally involved.

Recommended Resources:

Clements, C.B. (1994). The Arts/Fitness Quality of Life Activities Program. Baltimore: Health Professions Press.

King, K. (2014). Engage! 28 Enrichment Experiences for Older Adults, Portland, OR: ArtAge Publications.

Sandel, S. & Johnson, D.R. (1987). Waiting at the Gate: Creativity and Hope in the Nursing Home. NY: Haworth Press.

Telander & Quinlan (1982). Acting Up! Chicago: Coachhouse Books.

Thurman A.H. & Piggins, C.A. (1982). Drama Activities with Older Adults: A Handbook for Leaders. NY: Haworth Press.

Weisberg, N. & Wilder, R. (2001). Expressive Arts with Older Adults: A Sourcebook. London: Jessica Kingsley Publishers.

For more on the Creativity and Aging Study:

http://www.gwumc.edu/cahh/

Cohen, G. D. (2006). The Creativity and Aging Study: The Impact of Professionally Conducted Cultural Programs on Older Adults. Final Report: April 2006 downloaded December 25, 2006 from http://www.gwumc.edu/cahh/pdf/Creativity%20&%20Aging%20Study-Final%20Report.pdf

Cohen, G. D. (2006). Research on Creativity and Aging: The Positive Impact of the Arts on Health and Illness. Generations, San Francisco: The American Society on Aging, 30 (1), 7-15.

Cohen, G.D. (2005). The Mature Mind: The Positive Power of the Aging Brain. New York: Basic Books.

Cohen, G.D. (2004). MindAlert Lecture: Uniting the Heart and Mind: Human Development in the Second Half of Life. San Francisco: The American Society on Aging.

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Drama Therapy with Recovering Addicts

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

Alcoholics Anonymous. (1976). Alcoholics Anonymous: The story of how many thousands of men and women have recovered from alcoholism. New York: Alcoholics Anonymous World Services, Inc.

Bailey, S.D. (2007). Art as an initial approach to the treatment of sexual trauma. In S.L. Brooke (Ed.). Creative arts therapies in the treatment of sexual abuse. Springfield, IL: Charles C. Thomas Publisher.

Bailey, S.D. (in press). Playwriting with the Group in Drama Therapy. In R. Emunah & D.L. Johnson (Eds.). Current approaches to drama therapy, 2nd ed. Springfield, IL: Charles C. Thomas Publisher.

Browne-Miller, A. (1993). Gestalting addiction: The addiction-focused group psychotherapy of Dr. Richard Louis Miller. Norwood, New Jersey: Ablex Publishing Company.

Diamond, J. (2000). Narrative means to sober ends: Treating addiction and its aftermath. New York: Guilford Press.

Emunah, R. (1994). Acting for real: Drama therapy process, technique, and performance. NY: Brunner/Mazel.

Fox, J. (Ed.). (1987). The essential Moreno: Writings on psychodrama, group method, and spontaneity by J.L. Moreno, M.D. NY: Springer Publishing.

Garvey, C. (1990). Play. Cambridge, MA: Harvard University Press.

Gorski, T.T. & Miller, M. (1986). Staying sober: A guide for relapse prevention. Independence, Missouri: Herald House/Independence Press.

Landy, R. (1996). The use of distancing in drama therapy. Essays in drama therapy: The double life. London: Jessica Kingsley Publishers.

Narcotics Anonymous (1988). Narcotics Anonymous, 5th ed. Van Nuys, California: World Service Office, Inc.

Pauley, J.A., Bradley, D.F., & Pauley, J.F. (2002). Here’s how to reach me: Matching instruction to personality types in your classroom. Baltimore: Paul H. Brookes Publishing.

Sternberg, P. & Garcia, A. (2000). Sociodrama: Who’s in your shoes?, 2nd ed. Westport,

CT: Praeger.

Waller, D. & Mahony, J. (1999). Treatment of addiction: Current issues for arts therapies. London: Routledge.

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Key Principles

The Structure of Drama Therapy Sessions

A typical drama therapy session begins with a “Check-in” in which clients share how they are currently feeling. This provides important information to the drama therapist about how to lead the group that day, what issues are ready to be worked on, and what resistances will need to be worked past to get the group to function openly and smoothly. Next, the “Warm-up” gets everyone focused on each other and on being in the “here and now.” A warm-up also prepares muscles that may be used in activities later in the session so no one gets hurt and prepares imaginations so everyone is ready to work together creatively and safely. Each session usually has at least one major drama therapy activity that is participated in and then discussed by the group. Those who have taken on a role need to “de-role” afterwards in order to reconnect with themselves. The group ends with a closure activity: a game, a ritual, a review of the session, or a song.

The Structure of a Drama Therapy Series of Sessions

Renee Emunah (1994, 2020) has identified five phases through which most drama therapy groups progress. Her Five Phase Model parallels established wisdom from group dynamics on how successful groups form and grow. The first phase is Dramatic Play where the group gets to know each other and the therapist through playing together to develop trust, group cohesion, and basic relationship skills.

Then the group moves on to the Scenework phase where they begin focusing on developing the dramatic skills they will need as they continue in treatment. All humans develop basic dramatic skills at the ages of 3-5, a time when they naturally begin learning about the world around them through imitation and dramatic play. As they grow older and begin school, children are encouraged to develop their abstract reasoning skills and use them to the exclusion of hands-on forms of learning. However, drama is like riding a bike. You never forget how to do it. The Dramatic Play and Scenework phases allow clients to get back in touch with those skills and feel competent and confident using them again.

Phase Three focuses on Role Play, exploring issues through fictional means. Perhaps the group acts out a generic, fictionalize family conflict or familiar characters from a fairy tale or legend that goes through a crisis or challenge shared by group members. When the group is ready, they can move on to Phase Four: Culminating Enactments, where personal issues are acted out directly through psychodrama or autobiographical performance.

The final phase, Dramatic Ritual, involves closure to the work of the group. This might be the sharing of a public performance that has been created by the group, the sharing of a private ritual within the group, or an evaluation session where clients can review what they’ve learned, how they’ve changed, and where they can say goodbye and thank the people in the group who have helped them and to whom they have become close.

Not every drama therapy group works its way through all five phases. Some groups aren’t together long enough to develop the skills and trust to reach the Culminating Enactment phase. This is especially true in this day of limited reimbursement by health insurance for mental health services which are often limited to 6-8 sessions.

Age and developmental level make a difference, too. Children often get the full benefit of emotional healing through play and fictional work alone, so there is no need to move into some of the later stages. Some adult groups dealing with severe trauma, anger, or who are extremely immature may not work through their trust issues enough to move on to Phase Four. That doesn’t mean that they have “failed” as a drama therapy group; it means they needed more time to heal at an earlier emotional developmental level, perhaps because their wounds in that area were very deep.

As mentioned earlier, metaphorically, the Five Phase Model is the plate on which the Drama Therapy Pie rests. Different slices of the pie are used in different phases. Typically, Phase One incorporates drama games and improvisation. Phase Two moves into improvisation and role play. Phase Three involves more structured role play methods, such as Role Method or Sociodrama. Phase Four includes techniques such as performance, Psychodrama, and Theatre of the Oppressed forums or deeper explorations of Role Method or Developmental Transformations. Phase Five might end with rituals, games, and techniques which help bring the group to closure.

Concepts Common to All Drama Therapy Approaches

While drama therapy techniques may differ from therapist to therapist or from session to session, there are concepts that are common to all forms.  Dramatic Reality is an important component in many therapeutic and learning environments, but it is essential in drama therapy. Dramatic Reality is the imaginary world that is created when we play or imagine together in a safe, trusting situation. It is a timeless space in which anything we can imagine can exist: dragons can be vanquished, castles can be built, raging rivers can be crossed, acceptance and love can be experienced. Dramatic Reality is the place where change and healing can happen because it is potential space, a magic play space, Stanislavksy’s “Magic If.” It is created jointly by the therapist and the clients playing together and believing in the possible.

Another crucial concept is using metaphor through action or Dramatic Metaphor. Behaviors, problems, and emotions can be represented metaphorically, allowing for symbolic understanding. A certain set of behaviors can be looked at as a “role,” such as the role of mother, victim, student, or hero. These roles can be played out in a dramatic situation, leading to a greater understanding of the role as helpful or harmful, safe or dangerous. An emotion can be represented with a metaphorical image: anger displayed as a volcano, an exploding bomb, or a smoldering fire. Dramatized, these images allow the client deeper insight into the qualities of the emotion and how it functions positively or negatively in his/her life.

Embodiment allows the abstract to become concrete through the client’s body. We all experience life first through our senses and our bodies, and only later, at older ages, through language and abstract thoughts. Acting out an idea or an experience allows it to become “more real.” This allows it to be dealt with in form rather than in the abstract, through feeling rather than only through thought, in the moment rather than through past memory or future projection. Embodiment allows clients to “experience” or “re-experience” in order to learn, practice new behaviors, or experiment with how to change old behaviors. This is particularly important for clients who are kinesthetic or visual learners (estimated to be at least two-thirds of the population).

Distancing allows the therapist to change the degree to which the role being played is like you symbolically or like you actually. Children intuitively use distancing to protect themselves from shame and guilt in play by acting out characters similar to them, but not them. Pretending to be Gretel, abandoned in the forest by her mother and father, allows a child to explore her feelings of being punished by her parents or a significant adult.

Playing a role quite different from oneself often feels more comfortable than playing oneself directly. In some cases, an experience is too “close” to us for us to see our part in it. We need to take a step back (metaphorically speaking) and see the experience in a wider context: to see the forest in order to see the tree.

Sometimes a situation is too emotional or intense for a client to encounter in therapy without becoming overwhelmed emotionally. More distance, through fictionalizing a situation, using a metaphor to represent the problem, or using a technique like puppets, removes the situation a step from flesh and blood reality.

On the other hand, some clients will create so much intellectual distance from an issue that they can’t get in touch with their feelings (see the story of Henry under Residential Settings in Applications). They need less fiction and more emotional involvement to be able to face the issue honestly and directly.

Certain drama therapy techniques tend to create more distance, and others tend to create less distance. For example, Psychodrama, which deals directly with the personal, nonfiction history of the client, is less distanced. Puppets, theatre games, and improvising fictional characters are more distanced. Some techniques can go either way, depending on how they are used. The performance of an autobiographical or self-revelatory play is less distanced than the performance of a play about fictional characters. Role play can be very close to oneself or distanced, depending on the role being portrayed. (A note here: as every actor knows, the emotions in any role can feel very real while the role is being portrayed!)

Dramatic Projection is akin to concrete embodiment and employs metaphor. It is the ability to take an idea or an emotion that is within the client and project it outside to be shown or acted out in the drama therapy session. A client’s difficulty asking for help (an internal problem) can be dramatized in a scene with other members of the group, with puppets, or through masks, so the problem becomes an external problem that can be seen, played with, and shared by the therapist and the group.

Incorporating the other Arts. Drama therapists use music, movement, song, dance, poetry, writing, drawing, sculpture, mask making, puppetry, and other arts with their drama therapy activities. Just as the theatre is a crossroads where all the arts come together, drama therapy allows all the arts to meet and work together, too. Starting with writing and then enacting the story or poem, or beginning with drawing and then embodying the art through movement, body sculpting, or drama is a natural way to progress. This is one reason drama therapists are required to have training in the other creative arts therapies, and why many drama therapists have credentials in one of the other creative arts therapy modalities.

© Copyright Sally D. Bailey, Registered Drama Therapist. All Rights Reserved.

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What is Drama Therapy?

Drama therapy applies techniques from theatre to the process of psychotherapeutic healing. Beginning in the early 20th-century drama was used by occupational therapists in hospitals and by social workers in community programs to teach clients social and emotional skills through performing in plays.  Later in the 70s, these techniques were integrated with improvisation and process drama methods as the field emerged as a separate profession.

The focus in drama therapy is on helping individuals grow and heal by taking on and practicing new roles, creating new stories, and rehearsing new behaviors which can later be implemented in real life. Drama therapists have extended their applications beyond clinical contexts to enrich the lives of at-risk individuals, prevent problems, and enhance wellness of healthy people. 

Drama and therapy have been natural partners for at least the last 350 centuries. Archeological evidence suggests that early humans began to make art – paintings, sculpture, music, dance, and drama – between 45,000 and 35,000 years ago at the same time they became capable of symbolic, metaphoric thought. From those early times, drama was incorporated into healing, religion, and the communication of culture from one generation to the next. That the arts have been connected to healing and meaning-making since their origins, shows how vitally important they are to health and civilization. In fact, research by Gene Cohen et al. (2005), James Pennebaker (1995), Helga and Tony Noice et al. (1999, 2004, 2008), and others are proving that participation in drama and the other arts enhances physical and mental health.

Drama and psychology are both the study of human behavior: you could say they are two sides of the same coin. Psychologist Philip Zimbardo, author of The Lucifer Effect, acknowledges this when he says, “Drama, psychology, and therapy share a basic goal of trying to find what is essential about human nature and try to use that knowledge to improve the quality of individual and collective life.  When drama is good, it transmits knowledge about what is essential about people and between people” (Zimbardo, 1986).  Psychology studies thoughts, emotions, and behavior; drama actively analyzes and presents the thoughts, emotions and behavior of characters for an audience to see and understand. Much of dramatic literature addresses the psychological, social, and cultural conditions of humanity and, thus, serves as a natural vehicle for actually helping real people more consciously address their problems.

Just as psychotherapy uses talking to treat clients who have difficulties with their thoughts, emotions and behavior, drama therapy uses informal drama processes (games, improvisation, storytelling, role play) and products (puppets, masks, plays/performances) to help clients understand their thoughts and emotions better or to improve their behavior. However, unlike most types of therapy which rely purely on talking, drama therapy relies on taking action. This creates for the client an embodied, concrete experience of the issues being explored, making them easier to understand and change.

Because there are so many forms that drama, drama therapy is a very broad field, including many different approaches and techniques. This allows the drama therapist to intentionally adjust to the right emotional distance needed by the client, based on the client’s goals and needs in the moment. The metaphor I like to use is to say there is a big “Drama Therapy Pie,” which can be cut into many smaller slices. The slices of the pie below represent only a few of the more well-known drama therapy approaches in order to provide a general idea of the variety available; it is not exhaustive.

Within the pie are two different directional continuums. The up to down continuum ranges from fictional enactments to ones which are more true-to-life. Fictional work (drama games, improvisation, role play, Sociodrama, Developmental Transformations, rituals, masks, puppets, and some types of performance) allows clients to pretend to be characters different from themselves. This can expand their role repertoires (the number of types of roles that can be accessed for use in real life) or can allow clients to explore a similar role to those they usually play under the guise of “not-me-but-someone-like-me.” Non-fictional work (Psychodrama, Playback Theatre, Theatre of the Oppressed, ethnodrama, and autobiographical performance) allow clients to explore their lives directly. Clients need to have good ego strength to be able to do non-fiction work.

The left to right continuum ranges from presentational enactments (presented for an audience) to process-oriented ones (done just for the group). Methods like Playback Theatre, Theatre of the Oppressed, and the performance of plays are presentation, while methods like drama games, improvisation, role play, Developmental Transformations, Sociodrama, and Psychodrama are process-oriented. Other methods, such as puppets, masks, rituals, can be used as part of performance or as process techniques within a therapy session.

Imagine that underneath the pie is a plate. That plate represents Renee Emunah’s Five Phase Model of Drama Therapy (1994), which guides the growth and process of a drama group from the time they start as complete strangers to the time they end their work together. Different phases pull activities from different slices of the pie.

Drama therapy is primarily conducted in groups, although there are practitioners who use it in individual, couples, or family practice. Drama therapy can be found in a wide variety of settings, used with many kinds of clients. Most clients who benefit from talk therapy can benefit from drama therapy and some populations who have difficulty verbalizing, like individuals with autistic spectrum disorders or people recovering from trauma respond well to drama therapy, too.

For some populations, the action methods of drama therapy are more effective. Recovering substance abusers are notorious for being disconnected from their feelings, for making up endless excuses (called rationalizations) for their behavior, and for “being in denial” about their addiction and addictive behaviors. Drama therapy bypasses the excuses and denial, getting right to the maladaptive behavior. Other types of groups — for instance, nonverbal clients or children – who aren’t good candidates for verbal therapy – can often participate successfully in drama, because they can show, rather than tell, how they feel.

Depending on the goals and needs of the client, the drama therapist chooses a method (or several) that will achieve the desired combination of understanding, emotional release, and learning of new behavior. 

See Key Principles and Applications for more.

© Copyright Sally D. Bailey, Registered Drama Therapist. All Rights Reserved.

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Social & Recreational Settings

Campers and Drama Therapy students play with a parachute at Super Summer Camp, Kansas State University.
Campers and Drama Therapy students play with a parachute at Super Summer Camp, Kansas State University.

One of my first drama therapy jobs was to create an arts access program for children with special needs at a non-profit community arts center in suburban Maryland. I integrated students with disabilities into regular drama classes and productions by helping teachers identify ways to make adaptations and accommodations that leveled the playing field. I created programming in special education classrooms for teaching social skills, self-expression, or an aspect of the curriculum. Theatre companies comprised of adolescent actors with and without disabilities created original plays dramatizing their own ideas. Some of this work could be categorized as educational drama, some as therapeutic drama, some as drama therapy, some mixed them all together.

The performing troupes were originally designed to be venues for disabled actors to explore issues of difference and to provide awareness education to non-disabled audiences. However, my actors had different ideas. They told me right off that they were sick of thinking about their disabilities because they had to deal with them “24-7.” They wanted to explore issues that were universal to adolescents like rebellion, responsibility, growing up, falling in love, being rejected, friendship and family. We created many plays together through improvisation. Each play became a metaphor for exploring their struggles, allowing them to fictionally explore and express their concerns, hopes, and dreams. Each rehearsal process became a laboratory for the development of better social skills, flexibility, responsibility, self-discipline, communication abilities, and the development of higher self-esteem.

Making Connections, a play about a video dating service, provided opportunities to explore appropriate dating behavior, first impressions, and unfair assumptions. During our improvisations, we explored all the WRONG ways to behave on a date and all the right ways. We practiced what information is appropriate to reveal to someone you just met and what is inappropriate. We role-played anxious, overprotective parents waiting for their daughter to come home from a date and laid-back, gentle ones. In the play that resulted, one couple arranges to go on a date based on viewing each other’s video interviews, but the girl doesn’t reveal that she uses a wheelchair until they meet outside the restaurant. She wants to be chosen for her personality, not rejected on the basis of her disability. Her date has to get past his expectations of what he thought she would be like. Another girl chooses a guy who, unbeknownst to her, turns out to be a foot shorter than she is. At first, she is horrified, but later learns that he’s a wonderful person, no matter what his height.

Making Connections was later turned into an educational video for the purpose of modeling social and dating behavior to young people with disabilities and their parents. It won Honorable Mention in several video/film competitions, was shown on WETA, the PBS station in Washington, DC, and for many years was marketed by Choices, Inc., a non-profit that sponsors educational videos for people with developmental disabilities. In the course of this adventure, the actors got to “film on location” and learned about acting “in the movies.” They had a chance to share their ideas and what they learned during our rehearsal process with a much larger audience. Self-esteem sky-rocketed when people who saw them on TV came up to tell them how wonderful their “movie” was and to ask for their autographs!

Parents report that the dramatic experiences their young people had in our performing companies helped them develop a greater level of independence, responsibility, and self-discipline than their peers who didn’t participate in drama. Most of my former actors are now middle-aged adults holding down full-time jobs and living independently in apartments. One job coach at a school-to-work transition program confided he could always tell which of his clients had been actors of mine: they had more self-confidence, better communication skills, and the self-discipline necessary for succeeding in the world of work.

© Copyright Sally D. Bailey, Registered Drama Therapist. All Rights Reserved.

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Residential Settings

Years ago, recovering substance abusers stayed in treatment for one to three years in order to learn how to live without drugs and alcohol; today three months is considered long-term treatment and 28-day programs are the norm. A drama therapist is lucky to get one session per week with clients.

I worked thirteen years in a long-term residential treatment program with recovering substance users in the Washington, DC area. A drama group of 12-14 residents ran between three and six months. In the beginning weeks, we focused on drama games and improvisation to build group trust, social skills, drama skills (although recovering substance users are already excellent actors – skills honed during their addiction), communication, and understanding, and the idea that we can learn life lessons through metaphor and action.

Later we worked on deeper psychological issues through Psychodrama and Gestalt therapy. One of my favorite success stories involves Henry, an older recovering alcoholic, who revealed during our check-in one day that he was on the verge of being kicked out of the program for “lack of motivation.” He had always participated fully and enthusiastically in drama, so I was surprised. He reported that he never talked in other groups, and he wouldn’t work on issues in individual therapy sessions with his primary therapist. When I asked him why, he said, “Well, I hardly know what my feelings are! How can I talk about them?”

“Maybe you can’t talk about them,” I offered, “because you’ve ignored them for so many years that they feel like strangers to you. How would you like to meet them?”

“Sure!” he said, “That would be great!”

He picked four group members to represent four of his feelings and sculpted them in chairs. “Fear” hunched over in his chair looking at the floor, his arms across his chest, protecting himself. “Pain” looked away, afraid to make eye contact. “Sadness” bent over into her lap and covered her face with her hands, as if crying. “Rejection” sat defiantly with his back to Henry.

Henry introduced himself to each Emotion one by one and asked them questions so he could get to know them. As he did, each Emotion came alive and spoke about how much they missed being part of his life. They expressed how deeply they cared for him and that they wanted to help him complete treatment.

It was a turning point. Henry began to talk in his other groups and in his individual sessions. He started to acknowledge his feelings, to identify and understand how they related to his behavior. He also began to take more risks in revealing secrets and shames he was carrying inside. And because he was now able to reveal them, he could let the negative ones go.

The exercise worked for him on a metaphoric level, a practical level, and a relational level. On a metaphoric level, he was able to reconnect with emotions he had “cut off” during his addiction; on a practical level, he was able to practice talking “with feeling” to another person; on a relational level, he made a deep connection with the group members he chose to play parts in his psychodrama. This then made it easier for him to trust and open up to them and fellow residents in other groups and interactions. The group members learned about their own relationships to the emotions they portrayed, as they gave voice and body to them. They felt more connected to Henry, more connected to themselves, and more connected to each other.

Henry graduated from the program six months later. He proudly and successfully made it through treatment, and members of his family were there to see him “walk across the stage.”

Members of a Drama Therapy Group at Second Genesis perform wearing half masks.
Members of a Drama  Therapy Group at                Second Genesis perform wearing half masks.

Mask work was an extremely powerful technique for these clients.           Sometimes we made half-masks, painted them with designs                       representing their behaviors or issues, and performed a poem or               created a play about “wearing masks” and “being dishonest” in life.

Sometimes we would make full, life masks, paint the outside to                  represent one of the metaphorical, behavioral masks they wore in life, and paint the inside to reveal what they were really feeling. Then they would imagine that the outside mask and the inside mask could come to life and speak. They wrote down the monologue or poem that came from each, and we shared them in a dramatic reading for family and friends. Often it was the most honest, revealing work they did their entire time in treatment.


The Mask of the Bully

One woman, who created an outside mask of bullying and intimidation, told me that after she graduated she still kept her mask on display in her home, and whenever she felt threatened and became threatening to others, she meditated on her mask to remind herself that she doesn’t need to make negative behavior choices, and, in fact, can’t if she is to remain healthy and sober.

© Copyright Sally D. Bailey, Registered Drama Therapist. All Rights Reserved.

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Psycho-Educational Settings

Medical and mental health professionals often find they need to provide basic self-care information to clients and their families. When this information is delivered through traditional lecture methods, a lot of information goes “in one ear and out the other,” but when presented through drama with human stories and emotions attached to the facts, the information makes sense.

Kaiser Permanente, a major HMO, for many years had professional theatre troupes in different regions of the country toured original plays on HIV/AIDS, violence prevention, and other issues to schools and community groups. Stop-Gap Theatre of Orange County, California, also tours plays that deal with important issues and involves students in workshops and discussions afterward.

SafeHome, a prevention and intervention non-profit in Kansas City, has a teen acting troupe, which each year tours a play on dating violence and sexually responsible behavior to high schools. These are but a few of the many examples of troupes making medical and mental health issues accessible in a live, dynamic format.

One of the most interesting projects in this vein came out of the Psychosocial and Behavioural Research Unit at Toronto Sunnybrook Regional Cancer Centre in Toronto, Canada. Doctors, researchers, writers, and actors came together to create a new kind of research report: a dramatized one (called an ethnodrama). They ran focus groups with women who had metastatic breast cancer, and separate focus groups made up of their family members and of their medical caregivers. The focus groups were recorded, transcribed, and used as a basis for improvisations about the experience of living with metastatic breast cancer. The resulting play Handle with Care? and a later project on prostate cancer No Big Deal? toured throughout Canada for several years. Both plays capture the confusion, frustration, and fears generated by these diseases and offer supportive suggestions of “do’s and don’ts” for patients, family, friends, and medical personnel alike.

Monica Phinney, RDT, a drama therapist in Kansas City, worked with filmmaker Robert Greene as he filmed the documentary Procession (2021). The film follows six men who experienced abuse childhood abuse perpetrated by powerful figures within the Catholic Church. Guided behind the scenes by Monica, the men write and enact scenes to explore and reframe their experiences. In one scene a man replayed a meeting with a church board, which had dismissed his claims as unrealistic lies, and was given his opportunity to say exactly what he wished he could have said to each of them. Procession is available on Netflix. The film is not an example of drama therapy, but more an example of how a drama therapist can help direct and contain an exploration of an experience safely and ethically.

© Copyright Sally D. Bailey, Registered Drama Therapist. All Rights Reserved.

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Older Adults

Senior Day Programs, Retirement Communities and Nursing Homes

Actors demonstrate a "new product" that will enhance ageing!
Actors demonstrate a “new product” that will enhance ageing!

Older adults have a variety of needs that can be addressed through drama therapy. Isolation and loss are big issues: some older adults have experienced physical losses due to medical conditions, cognitive losses from Alzheimer’s disease, or social losses through the deaths of friends and family members and losses from retirement from their life’s employment. The developmental issue of old age is life review as the individual looks back and evaluates what has been accomplished and learned over the course of the years (Erikson, 1997). Drama therapy can help older adults make new social connections, assist with reminiscence and meaning-making, and bring enjoyment of the present moment back to participants, even those who are losing touch with the world around them due to dementia.

Judy Holstein, RDT/BCT, was the Program Manager for a senior day program for elders in Evanston, Illinois. In her drama therapy groups, she created dramatic opportunities to re-visit enjoyable times from past and to celebrate the present. A session might involve creating humorous commercials for “products that help with an age-related issue,” or making up an original radio drama based on a favorite radio show like “The Shadow” or “Fibber McGee and Molly,” or re-enacting an important story from Jewish history, such as the Purim Story or the Passover Story.

But drama therapy is not just about the past; it can help process current events. Judy recalls when a drama group was scheduled on the day after a gunman shot and killed a number of people at a Jewish Community Center in Los Angeles. The group members were very upset at the news reports and needed to process their anger, frustration, and helplessness. A number were survivors of the Holocaust or had relatives who had died in Hitler’s concentration camps, so this example of violence was very upsetting to them. Judy and her assistant Deb Mier, RDT, led the group in brainstorming the creation of a new and improved society, which they dubbed “Earth 2 – Dreamland.” In this place, children with potential emotional problems would be identified and helped when they were young, so they wouldn’t grow up to become adults who hurt others. A council of young and old called The Care-Givers would work together to make sure that justice was served and needs were met for all. The group nominated their choices for this council, including two group members who were highly admired and respected, the Reverend Jesse Jackson, Sammy Sosa, Michael Jordan, and – to her great honor and surprise — Judy. Then they all stood together, held hands, and chanted “Let us begin!” This drama therapy ritual brought closure and relief to the group as they struggled to find meaning in an upsetting event and allowed them to continue to act as problem-solvers and care-givers.

Quality of life, an important concept in serving the needs of older adults, relates to “an individual’s personal sense of satisfaction with areas of life such as physical comfort, emotional well-being, and interpersonal connections.” (Kuhn, Origara, & Kasayka, 2000). Quality of life is particularly important in the lives of those who live in nursing homes or who are dealing with varying degrees of dementia. Drama therapy, with its emphasis on being “here and now,” on connecting with others, communicating, and making meaning together, has proven to contribute to quality of life. In 2001 a study using Dementia Care Mapping was conducted at the day program Judy Holstein managed. Six clients were observed doing a variety of activities on two different days. Residents had a “significant spike on a subscale of ‘Pleasure’ on the Affect Rating Scale and recorded the highest level of individual well-being scores during the 75-minute drama session. There was nothing to compare to these scores…except for the 30-minute music/dance session” (Kuhn, 2001).

Aging Workshop with actors about to unveil a "new product" that will enhance ageing.
Aging Workshop with actors about to unveil a “new product” that will enhance ageing.

Drama therapy is also useful with independent older adults who want to continue to grow, enhance their talents, and give back to the community. Acting has been shown to enhance the memories and cognitive abilities of older adults (Noice, Noice, Perrig-Chiello & Perrig, 1999; Noice, Noice, & Staines, 2004; Noice & Noice, 2008). Mental and physical health improvements result when participants are immersed in drama because it involves the challenging tasks of analysis, empathy, emotional integration, physical expression, and socialization, all of which jumpstart the growth of new neurons in the brain as well as growth in the number of synapses on older neurons (Cohen, 2006; Cohen, 2009; Noice, Noice, & Kramer, 2013). The physical, mental, emotional, and relational tasks involved while acting out a character encourage connections to be formed and exercises across the brain from the left to the right hemisphere and from top to bottom of the brain, providing better overall brain functioning (Cohen, 2009).

All of this can be done without requiring older actors to memorize lines. Drama can be created in a purely process, improvisational basis or plays can be devised without a script, or actors practice storytelling skills to share their experiences with younger generations.

© Copyright Sally D. Bailey, Registered Drama Therapist. All Rights Reserved.

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Educational Settings

Juliet and her mother Lady Capulet (from Shakespeare's "Romeo and Juliet" demonstrate better choices through role play in Conflict Resolution Workshop.
Juliet and her mother Lady Capulet role play better choices in Conflict Resolution Workshop.

Drama therapists work within the school system as counselors, using drama therapy as their treatment method with children and adolescents. In Casper, Wyoming, Linda Nelson, RDT used drama therapy to help high school students formulate and reach academic and personal goals. In elementary schools in Michigan and Illinois, Mary Fahrner, RDT, a counselor, and Linda Sheehan, RDT, a social worker,  used drama therapy with elementary school children to teach social skills, explore diversity issues, and improve personal coping skills.

Drama therapists work as teachers in public schools as well. Mary Reid, RDT, created a peer conflict resolution program in a California middle school using drama to teach communication, empathy, and problem-solving skills. Over 100 peer mediations were successfully conducted each year of the program and detentions went down twenty percent. She also brought narrative drama therapy techniques into her counseling groups so students could address their personal life challenges by acting out turning points in their lives.

Conflict Resolution Workshop with Martin Luther King Quote written on the blackboard.
Conflict Resolution Workshop with MLK Quote on board.

Lanell Finneran, RDT/BCT worked in the Therapeutic Classroom in Lawrence, Kansas for close to 20 years, first as the classroom therapist and then as the lead teacher. Her students were adolescents with emotional disorders, such as school phobia, depression, schizophrenia, bi-polar disorder, and Asperger’s syndrome who couldn’t function in a regular public school classroom. Many had learning disabilities and/or medical conditions. In her classroom, however, students were able to work through their problems while keeping up with their academics. Lanell incorporated the arts and socio-emotional education into her lesson plans. She encouraged self-expression by example: reading Harry Potter books out loud in costume with detailed character voices and props, then encouraging students to join her in acting out scenes from the books.

Even social issues were addressed through drama. One boy in the Therapeutic Classroom was being scapegoated and tormented by other students on bus trips to and from school. Lanell discussed the problems and potential solutions in individual therapy sessions with all the students, stressing each person’s responsibility in solving the situation. Then she set up a sociodrama in the classroom: the bus was created using chairs and each student sat in their assigned seat. Lanell took each student out of the bus on a “walk and talk” to verbalize what they were thinking and feeling, how they played into the problem, and at least one alternative they could take to make it better. Once everyone had contributed, they acted out a bus ride using the brainstormed solutions. After this intervention, problems on the bus stopped; everyone made an effort to be more flexible and understanding with each other for the rest of the school year.

© Copyright Sally D. Bailey, Registered Drama Therapist. All Rights Reserved.

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Clinical Settings

The groundwork for inclusion of the creative art therapies into psychiatric hospitals in the U.S. was laid after World War I. Talk therapy and medical interventions were not very successful in helping veterans recover from what at the time was called “shell shock” (now called Post Traumatic Stress Disorder). However, the arts brought unresponsive patients back to life. In the early 20’s and 30’s inclusion of the arts in hospital programming was expanded. (Phillips, 1994).

Today drama therapists working in a psychiatric hospital or an outpatient mental health clinic might work with patients who have a wide variety of clinical diagnoses, including eating disorders, depression, schizophrenia, bi-polar disorder, addictions, or Alzheimer’s disease. Previous to our current era of short hospital stays, in-hospital drama therapy groups would often work together over long periods of time, several times a week, and could develop original plays or do long-term in-depth work. Today with shorter stays and less coverage for psychotherapeutic services, groups tend to be short-term or a single session. Drama therapists might need to utilize process-oriented interventions in which the drama work is contained within one hour. Developmental transformations can be used in this fashion. Playback Theatre can be used for one-time therapeutic interventions in some hospitals, where a trained troupe of playback actors re-enacts stories told by the patients who comprise the audience.

Anne Curtis, RDT, and Paula Patterson, RDT, two drama therapists in Florida, have worked with acutely and chronically ill patients of all ages in medical hospitals. Puppets, guided fantasies to safe healing places, music, movement, clowning,  and fairy tales help children and adults stimulate their immune systems, get back in touch with their healthy selves, and feel hope. One of Anne’s favorite parts of her visits is the Healing Parade: All the mobile patients dress up in costume and parade throughout the unit past the rooms of those who are too sick to get out of bed, spreading songs, “healing energy,” and good humor. Even staff members ask for drama therapy sessions to help them deal with their stresses, frustrations, and disappointments.

© Copyright Sally D. Bailey, Registered Drama Therapist. All Rights Reserved.