How Dramatherapy Can Help

 (Early sexual, physical, emotional, mental and/or spiritual* abuses)

Survivors of any of these forms of abuse can be affected throughout their lives by a number of “inner demons” - various forms of PTSD, spontaneous re-traumatisation, overwhelming senses of pain, shame, loss of self-worth, guilt, and a general sense of restlessness that can lead to the development of damaged self-images, to severe difficulties in maintaining wholesome and fulfilling relationships revolving around trust and love. The dependence that children and adolescents in relationships with adults, and their inability to give consent when they are in their safety, is threatened and destroyed can carry over into their adult lives.

The performative narratives, body-based enactments, creative personal rituals, re-writing personal stories, and games afforded by Dramatherapy can provide a very special place where, over time and in a collaborative, therapeutic relationship, the surviving clients/patients can reframe their realities, mend fragmented self-images and work towards healing in the most intimate of physical, mental, emotional and spiritual areas of their lives.

(*Spiritual abuse is the enforcement of a position of power, leadership or attachment in which total unquestioning obedience in thought, word or action is demanded of a child, adolescent or adult under threat of punishment in this life and in an afterlife for themselves, their families, their helpers or others. In this abuse there is no room for the individual to be allowed their own relationship with the Divine as the abusers claim that they are the only link - Sinason and Aduale, “Safeguarding London's Children” Conference - June 2008)

Bruce Howard Bayley, Dramatherapist and BADth Executive Committee Member/Past Chair

Addiction can present as problems at the ‘tip of an iceberg’, manifesting as someone’s visible or hidden relationship to alcohol, drugs, nicotine, caffeine, compulsive eating, exercise, gambling, shopping, sex, pornography and masturbation - to name just a few

But when do any of these behaviours become an actual addiction? Usually, when someone is no longer able to control them, and their use begins to harm their life and the lives of others around them. Promises to give up are sincerely made, but broken over and over, fuelling a sense of shame and failure. Admitting the problem is the first step towards recovery and out of a rock-bottom. But what causes addiction? And how exactly can dramatherapy help recover from it? The answer lies underneath the surface, deep at the core of the iceberg.

For some people, feeling their feelings is overwhelming. They experience intense emotions and feel ‘too much’. Others feel nothing at all and feel ‘dead inside’. Perhaps they create excitement or drama just to feel alive. Perhaps in childhood, they developed strategies to numb out or intensify their feelings to survive or dissociate from the world around them. Their environment might have been dangerous, abusive, dysfunctional or unsafe. As adults, they don’t seem equipped to deal with life, so make their own rules. They search for meaningful connection, but struggle to form intimate relationships. Instead, they form an attachment or dependency to a substance or behaviour to help self-sooth unresolved or unconscious wounds.

Addiction is a coping mechanism and a reaction to this rupture. The rupture has been traumatic, and trauma shatters the human psyche into many fragmented parts. Addiction is a way to anaesthetise the pain that won’t seem to go away. Fragments and parts of the psyche are sent down to the unconscious shadow, where they are less painful to manage. This is what lies at the core of the iceberg, where a very frightened and wounded child is usually hiding.

A dramatherapist can help people find recovery, heal these wounds, reconnect to that lost child and discover a healthier relationship with themselves and others. Dramatherapy works directly with the unconscious through stories, character development, play and embodiment. Less thinking takes place, and more process. The process allows a connection to hidden and buried parts, deep within the iceberg and becomes healthier way to safely ‘act-out’ feelings with creativity and playfulness.

Simon Marks, A Change Of Scene, The Practice, Mount Carmel Rehab, Gay Men’s Group Therapy

Dramatherapy has many benefits for people with a range of mental health conditions such as anxiety, depression, psychosis, borderline personality disorder and bipolar. It can offer a different way of looking at things using a creative platform, rather than only the thinking and discussing method of addressing problems. Not relying on words can help a person who is struggling to express themselves cognitively or for people who have found the talking therapies difficult to engage with.

 

Dramatherapist may use stories, drama, movement, role-play, music, and play in combination or isolation to help meet the goals, aims, needs of an individual and/or group. This creative way of working can help people to share their thoughts and emotions and work through what they are experiencing to help improve their mental well-being.

 

Jane Bourne, Dramatherapist, CNTW NHS Trust, Learning Disability and Mental Health, BADth Vice Chair

If you have ever experienced Anxiety you will know it is a full body experience. When anxious thoughts take over we feel it; our chest might contract, we might feel like we can’t breathe, like we have something stuck in our throat; we might have a dry mouth or shaking, damp hands. We live in the feeling of anxious thinking and it can be extremely distressing and scary. When thought takes hold like this we cannot always identify it as thought in the moment, it becomes our reality and it looks like truth. We can then find that we begin to live in fear of such experiences and there starts a vicious cycle where we feel anxiety about the anxiety, fear of feeling fear.

In Dramatherapy we use the body to heal the body. We welcome the whole self into the therapeutic space rather than just working with the intellect. We call on our intuition to guide and heal. To work through anxiety with Dramatherapy is to explore where experience is coming from and to make space for the part of us that is fearful. We might use movement with touch, enactment, or role to ‘get to know’ the anxiety – what is it frightened of? What is its message? What is it trying to show us? We hold anxiety in gentle compassion and understanding. We call on Dramatherapy techniques such as movement with touch, six-part story work and enactment to be our guides on our journey into the unconscious where we often find gifts of healing. The Dramatherapist will then help the client to create or find symbolic and metaphorical ways to bring the healing into the light of conscious awareness to act as a reminder that we are, always, deeply safe.

Mary Franklin-Smith, Light of Mind & CONNECT, NHS Eating Disorders Service

There are three main ways in which dramatherapy can help with anxiety:

1. Through body work to notice and manage your physical responses to anxiety triggers: this might include breathing, grounding, creating a physical and mental safe space, and releasing emotions through physical expression and movement.
   
   
2. By exploring underlying causes of your anxiety through the safe distance of metaphor. The “as if” can enable experiences and feelings that are difficult to talk about to be expressed and understood, and a new relationship with those experiences to develop.
   
   
3. Through rehearsal. In the safety of the therapy room, practising situations that cause you anxiety can build your confidence in managing them in the future.

A dramatherapy group may help with social anxiety. The structured nature of sessions support greater ease in interacting with others, and the drama action methods can support expression in many different forms that doesn’t have to be talking. Finally, being in a group can offer the opportunity to witness and learn from others’ experiences, and to be witnessed in a safe and compassionate environment held by the Dramatherapist.

Clare Hubbard, Amber Tibbitts and Christine Jiggins, Hertfordshire Partnership University NHS Foundation Trust

Dramatherapy can be a successful therapy for working with clients on the autistic spectrum. A Dramatherapist can work with verbal and nonverbal forms of communication and a range of creative-expressive methods can be used to allow the client to work to their own strengths/interests and pace.

A creative and expressive approach can assist the client in making sense of difficult feelings and emotions - understanding and development is not necessarily expressed by words. The therapeutic relationship is unique in that it is formed by working alongside and with the client – work can be of a collaborative nature.

Dramatherapy can support the expression of feelings in a structured and predictable way that reduces anxiety. The Dramatherapist is sensory aware, moving with and alongside the body they can enable a ‘felt experience’ for the client. Social and communication skills are integral to the work, whether working one to one or in a group. The use of metaphor and symbol can also provide a safe way of working, offering a distance which avoids intensity.

Becky Wilburn and Karen Eastwood, BADth Dramatherapy in Education Subcommittee Convenors

Bereavement is a serious state of loss. Grief hurts. It is physically and emotionally exhausting.

Recently bereaved people may experience sleeplessness, a strange sense of detachment, sudden anger or bitterness, feeling tired, confused, guilty or simply very sad. All of these are normal features of grief and mourning.

Over time these unhappy aspects wane while others emerge, such as a sense of gratitude, acceptance (more often than not) and compassion. Some things make it easier to deal with the death of someone we love, such as having a rewarding relationship with the person who died, how and when they died, the absence of financial worries, having close friends and family, a strong faith or interests, and rewarding work.

Other things may make it much harder, such as poverty or debts, unstable housing, a pre-existing mental health condition, more traumatic or stressful experiences, job-insecurity, or other harsh contexts. When this happens a child’s or adult’s involvement in dramatherapy can ease their tangled knot of troubled feelings and thoughts. This creates space for new energy, an enlivened sense of purpose and the willingness to connect with people, animals, and the natural world.

How? Through the telling and making of new and familiar stories, through expressive movement and sound, through puppetry, play and dramatic improvisation, a healing relationship with the dramatherapist, and through role-play to prepare for challenging situations. The perilous uncertainty that so often follows bereavement can then be transformed into steady resilience.

Alida Gersie PhD, Dramatherapist and Organisation Consultant

It is normal to worry about the destruction of the environment and about the effects of climate change on all that lives. When we acknowledge the numerous threats that the earth’s overheating and environmental degradation pose, resignation and overwhelm are understandable human responses.

However, while it may be reasonable to respond in this way, the embrace of despair or disenchanted indifference is not a great way to live. To the contrary. It cruelly erodes our wellbeing. It also prevents us from doing what we can to put on the brakes or to make things even a bit better. This is where group or individual dramatherapy comes into its own.

The creativity and quality of relationships that can be engendered in dramatherapy help many children and adults who suffer from eco-anxiety. As a result, they become more able to creatively express their feelings, to clarify their stress, and to re-establish meaningful connections to this life now. When the learned helplessness of environmental despair is lifted, it gets easier to envision and to do some productive pro-environmental action, however small.

While generic environmental concerns will probably remain, these concerns are from then on embedded in a revitalising, creative love of people, creatures, and nature. The sense of wonder returns and the overwhelm has given way to empowerment and resilience. This matters a great deal for the individual, their social relations and their and our environment’s health.

Alida Gersie PhD, Dramatherapist and Organisation Consultant

Dramatherapy, as a psychological method that combines dialogue and art form, can offer valuable and multiple support for the individual who is undergoing the experience of cancer through the following ways:

• allows, in a safe way, to process difficult emotions that arise from the diagnosis and later from the treatment.
• encourages the development of a deep care and compassion for the body by embracing the part which is infected by cancer and helping the whole body towards a gradual recovery from surgery and/or from other types of therapy, such as chemotherapy.
• enhances acceptance for the physical changes that take place.
• supports the search of finding meaning in life and bringing quality in daily life.
• creates a container for the psychological shifts that take place during cancer. A container that facilitates reflection for further understanding, acknowledgment, and awareness for oneself.
• offers creativity as a vehicle for psychological relief from physical and emotional pain.
• helps to connect with family and friends, restore old conflicts held within interpersonal relationships.
• helps the individual to find the strength necessary to close pending issues or take life-changing decisions.

Dramatherapy can adapt to any age and all physical and psychological conditions by meeting the individual's needs throughout all stages of cancer.

Maria Polykarpou, Psychologist and Dramatherapist

Dramatherapy for adults with Dementia allows a space for the client to express, create and play in a safe, non judgemental way. The use of creative verbal and non-verbal methods including movement, music, imagery and objects a offers a space to create and experience in the moment freely, where memory can be explored but not relied upon to communicate. Objects, stories and thoughts can be explored in a non linear form allowing confidence, emotional regulation and expression.

Group work encourages further connection and self confidence, with a focus on the positive ability of each member of the group and a shared experience.

Laura Knight, Dramatherapist, Central and North West London NHS Trus

Depression affects about 3% of people in any given week. For some of those it is a seasonal thing (post-natal depression, seasonal affective depression) which will come on and eventually it ease. For others, depression can be chronic and long lasting.

Depression can make it harder to express feelings and can leave people feeling isolated. Dramatherapy can work in verbal and non-verbal ways using images, objects and symbols to show what is hard to describe. Metaphor is the language of dramatherapy, how an image or object can hold something of our experience or inner reality which could include many of the “classic” metaphors used to describe depression such as the black dog, the hole, the glass bell jar, or it could be more unique to you. Dramatherapy uses stories, plays, poems, art or films to explore what others have felt which might be “like me” in some way.

Sometimes, exploring depression creatively or playfully can lead to a feeling of understanding, that your dramatherapist has been alongside you, connecting and understanding your reality. Sometimes it can also lead to “ah-ha” moments where small changes are noted or something shifts or transforms, perhaps revealing something which was hidden.

Amy Willshire, Dramatherapist and BADth Executive Committee Member

People suffering with eating disorders present as having difficulties in their relationship with their thinking about weight, shape and food. What we know is that the disordered eating and subsequent behaviours unconsciously show up as a person’s best attempt to feel better in the moment - as a coping strategy of sorts, a solution to a problem. Patients often describe that the Eating Disorder starts to feel like a friend as much as an enemy. When working therapeutically with someone suffering in this way it is key to help them see the function of their eating disorder. Perhaps the eating disorder makes them feel a sense of control? Perhaps it communicates distress for them in a non-verbal way? Perhaps it allows them to feel better placed to manage difficult and painful feelings and thoughts, or perhaps it plays a role in their interpersonal relationships by drawing people closer. Maybe it allows them to feel a sense of success and achievement? This changes for all individuals but it is key to formulate an understanding of the role the Eating is playing in a person’s life in order to help them see a way out and through. Unlike more traditional talking therapies Dramatherapy proactively works with the distressed body involving the whole self in the session. We understand that there is often a desire or pull to intellectualise the illness and think in a very detail focused and rigid way about solutions, and in Dramatherapy we directly access the social and social emotional mind when we almost bypass the intellect - “you can’t solve a problem from the same thinking that created it”.

Through the use of creative methods such as mask work, movement, story and symbol we can externalise the eating disorder and ‘meet’ it. We can ask - what does this ED say to you? What does it look like? What is the relationship at play here? What does it want? How do you feel when in its arms? What do you want to say to it? We enter a new world of embodied expression and understanding as, together, we journey beneath and before the thoughts that generate and perpetuate the problem. We then work to reintegrate the externalised character of the disorder, helping patients to see the thought created nature of their current reality. We use the body to communicate with the often unconscious and buried intuitive mind of the patient. Slowly and gently we locate where in the body they feel pain, working to tease apart which is psychological and which is a physical symptom of the disordered eating.

Eating disorders isolate individuals and leave them leading lives where they feel compelled to restrict themselves not only from nutrition but also from interaction, feelings, love, compassion and support. The fear is not so much about food as it is about feelings, identity and the unknown. Dramatherapy truly comes into its own as we make proactive and directed use of the imagination to help us envisage a life where we embrace rather than reject change.

Dramatherapy offers a range of ways to express and explore feeling states whilst all the time reaching out to the healthy part of the human that has been temporarily covered up and hidden from view. In dramatherapy we feed the patient with symbolic ways to understand their internal processes and in this feeding we help patients to understand how they can slowly rebuild their relationship with themselves again.

Mary Franklin-Smith, Light of Mind & CONNECT, NHS Eating Disorders Service

There is a strong connection between dramatherapy and learning disabilities; a two-way relationship in which both have learnt and developed from each other. For the clients dramatherapy offers a space in which they can leave their 'disability'; their 'label' at the door and be seen as an individual in order to develop their own sense of self. The nature of dramatherapy is to acknowledge the individual and through offering a safe, client-led space. Clients with learning disabilities are able to explore autonomy, self-expression and creativity. Dramatherapy provides an environment in which a relationship can develop between themselves and the client with learning disabilities. The way a client interacts and plays through the art form reflects and communicates their inner feelings without the need for words, offering a new way for each client to express how they are feeling and have their emotional needs heard and acknowledged.

Dramatherapy supports the individual's emotional development, increases their self-esteem, confidence, and can aid in developing their communication skills. Dramatherapists work to offer this client group a voice, whether this be a verbal or a non-verbal one, in order that they may advocate for their own needs and promote their abilities and skills.

Helen Milward, Dramatherapist and Arts Therapy Service Manager, The Eden Academy Trust

Dramatherapy offers people with personality disorders a creative avenue through which to safely express and process intense emotions, such as inner rage. It is currently used to support both men and women in a wide variety of NHS and Private settings in the UK: Forensic Hospitals, Prisons, Adult and Adolescent Psychiatric Inpatient Units, Outpatient Mental Health Services, MBT and DBT Centred Programmes, Substance Misuse Units and Learning Disability Services.

Complex themes often arise for this client group, including abuse, trauma, negative core beliefs, insecure attachment, relationships difficulties and destructiveness towards self or others. The creative medium provides a vital third dynamic for both the therapy process and the therapeutic relationship, helping to contain the overwhelming chaos that can be experienced.

Dramatherapy techniques also offer the potential for positive transformation, allowing clients to work through difficult feelings and memories indirectly. This is particularly useful for people with personality disorders, who often feel overwhelmed by their emotions and memories. Whilst clear boundaries and containment are paramount, diverse approaches may be used, such as projective methods, distancing, non-verbal techniques, story-work, play, ritual, Sue Jennings’ E-P-R paradigm and N-D-P approach, Phil Jones’ Core Processes and Jungian Concepts, including integration of the shadow and individuation.

Nicky Morris, HCPC MA Dramatherapist and Author, Cygnet Health Care, NHS England.

Having a psychosis or psychotic symptoms; where there is a loss of connection to reality, which may involve seeing or hearing things that others cannot or believing things that are not actually true can be very distressing.

As part of a multidisciplinary approach, Dramatherapy when facilitated for people with a psychosis offers a multifaceted approach and divergent outcomes. People have fed back finding that the therapeutic intervention and exercises offer a distraction from symptoms such as auditory hallucinations.

Secondly the art form with its clear boundaries between the imaginary world and the real world offers a clear distinction which can contain the other world of the psychotic experience. This in turn can alleviate stress and suffering.

Thirdly when a therapeutic relationship is well established there is the possibility of working with a psychotic symptom to achieve some resolution within the art form. The responses are of course dependent on severity of symptoms and as with all interventions are client-led. In addition, secondary symptoms of psychosis can involve isolation and self-neglect. These too can be addressed through the dynamics of interaction and focus on the self.

Kate McCormack, Senior Dramatherapist, The Bethlem Royal Hospital, South London and Maudsley NHS Trust

The symptoms of Post-Traumatic Stress Disorder (PTSD) include physical, relived experiences and psychological reaction to a traumatic event. Dramatherapy calms the physiological experience and somatic responses though stress reduction techniques and focuses on the body and its interaction with its environment - in this case, how it informs our emotions, thoughts, and experiences.

With the level of bodily distress being managed, the story of the traumatic event, both actual and imagined, can be safely explored through story telling techniques in Dramatherapy. Stories are a way of examining painful events in life whilst remaining in control. The Dramatherapist will work with your lived experiences and how any differences are reflected in everyday tasks, activities and relationships supporting well-being.

David Pratt, Dramatherapist and BADth Executive Committee Member

Who and How we are, as sensual, sexual and gendered beings are fundamental to conditions of Health/Wellness, be they physical, mental, emotional, psychic and spiritual. The medicalisation of Sex and Gender together with the binary hegemony within most societal forms have crucial effects on all of us – no matter which sexuality, sexual orientation or gender role we may or may not identify with. Issues to do with the normalisation, compliance/non-compliance to or re-assignation of sexual/gender identification, roles and/or behaviour touch every single one of us. For many of us they can be sources of traumatisation, guilt, fear, self-hatred and many other negative states of mind, feeling and belief that can lead to disastrous and, sometimes, fatal consequences.

Through facilitating creative, imaginative and transformative stories and images, role-play, expressive movement, enhancing hitherto repressed/oppressed aspects of a person's natural and creative potential expression, Dramatherapy offers opportunities for people to reframe prohibitive and oppressive personal mythologies (largely inherited from other people's intolerance and rejection) leading to self-healing, self-acceptance and the establishment and maintenance of a fully healthier, wholesome sense of themselves whatever their sexuality, sexual orientation or gendered/non-binary choices.

Bruce Howard Bayley, Dramatherapist and BADth Executive Committee Member/Past Chair

Dramatherapists are specialists at working with what the body tells us. They are trained to work with the physical discomfort of trauma. When people find it hard to contain their emotions - feeling overwhelmed and anxious - it may mean they are living with the effects of Complex trauma. Unlike Post Traumatic Stress Disorder (PTSD) there is no known event to discuss.

People who have experienced Adverse Childhood Experiences (ACES) find it difficult to manage emotions. Dramatherapists are employed by the Child and Adolescent Mental Health Services (CAMHS) and schools to support children who cannot concentrate in class (disassociate) or lose control without any obvious reason. They cannot explain in words, but their bodies are telling them things are wrong.

Unexplainable problems can occur at any point in our lives. Adults who have encountered sustained unsolvable difficulties in the workplace, or in their personal lives, can begin to experience an unexplained physical overwhelm which has no words. Dramatherapists are trained to work gently, finding and working within the realm of whatever clients feel comfortable with. Rather than direct discussion, dramatherapy involves the use of objects and creative exercises; things that give clients some distance from their internal world.

Dramatherapists are experts at understanding our embodied sense of self (in neuroscience this is called interoception). Some clients are willing to explore their emotions through body work to understand these feelings. In Dramatherapy we can also work on a practical level replaying difficult triggering situations, rehearsing, and embedding coping strategies.

Louise Combes, Dramatherapist and Systemic Practitioner at Aspire, Leeds Early Intervention in Psychosis NHS Service, Trauma Specialist, National Centre for Supervision in Education