Behavior Change Through Drama Therapy with Students with Special Needs

A number of years ago I was hired as a drama consultant to conduct ten sessions in a special education classroom at Diamond Elementary School in Gaithersburg, MD, north of Washington, DC. The children were between the ages of 9 and 12. A number had severe learning disabilities and several had various forms of mental retardation. Besides basic reading and math skills, students focused on learning life skills like how to shop, how to make change, how to travel on the bus and subway systems, and other essentials to survival in a large urban area.

When I asked the teacher if there were any educational or social issues I could help with, she immediately said she’d been having trouble with students getting along in the classroom. Certain students would tease others and tears would result. Pencils and other small items got “borrowed” from desks without permission and angry accusations of stealing ensued, along with pushing, shoving, insults, and the inevitable hurt feelings.

I decided to start with identifying emotions and move on to practicing problem-solving social skills through role-playing. We started out simply. We had fun drawing faces and making faces and talking about feelings. Then we started identifying emotions in others by looking at pictures of faces to figure out what these people were feeling. We moved on to show how we felt with our whole bodies and by the way we moved. Then we began to tackle situations of conflict in the classroom.

I wasn’t sure how quickly these children would catch on to that fact that we were just pretending these situations. They’d never had drama before, either in their classroom or as an extracurricular activity. I didn’t want confusion between fantasy and reality to create more bad feelings than already existed. The “worst possible scenario player” in my head created visions of children crying and yelling, “I hate you, I hate you, I hate you,” at each other while the teacher and the principal kicked me out the front door of the school with the admonition never to set foot in Gaithersburg again!

Needless to say, my worst fears were not played out. In fact, each time I set up a dramatic situation in which one student was supposed to create a conflict with another and demonstrate their worst behavior, they insisted on doing the “right thing” and resolving their conflicts peacefully. I started to feel frustrated because I couldn’t get a fight going! Even with direct permission from me to enact an example of “the bad way” or “the wrong way,” they insisted on listening to each other with sensitivity and offering generous win-win solutions.

At the end of class, I shrugged my shoulders and half-seriously said to the teacher, “I’m sorry. I tried. I couldn’t get them to misbehave.” She nodded sagely and said, “Actually, I learned a lot today. Probably more than they did. I learned how much they actually do understand about appropriate behavior. I’m going to have much higher expectations of them now.”

Behavior change. I wish it were simple. I wish, when a student didn’t know how to behave, I could tell him what to do and he’d just do it! Or when a client is not behaving the way I want her to, I could tell her how to change…and she would!

But we all know it’s not that easy. It takes motivation to learn; it takes rehearsal over a period of time; and most of all, it takes patience on the part of the learner and the teacher until the old behavior has been extinguished and the new behavior has come to be second nature.

This is without addressing the issue of learning styles; the fact that each person has a different profile of preferences, both sensory and neurological, for taking in information. Some people are haptic and have to actually kinesthetically experience a new skill, others need to see someone else do it;  others grasp the information best through hearing and reflecting back, and most of us need to do a combination of all three.

Mel Levine, M.D., a pediatrician and expert in the learning and behavior of children, has identified specific neurodevelopmental systems or constructs that each different kind of learning task requires in his book A Mind at a Time (2002). The components within these constructs don’t work alone; they are interconnected and dependent on each other, but the construct framework provide a handy metaphor through which to look at the skills that certain learning tasks require. A block or weakness in a particular system — Levine calls them “breakdown points” – requires pinpointing the exact breakdown through carefully observing the child’s behavior while involved in the learning task, then ascertaining whether this particular individual can heal/improve that breakdown or if it would be more efficient to substitute some other strength from a different process to bypass the “glitch.” To educators and parents who ask, “How can you expect me to invest so much time and expertise in each individual I’m responsible to teach?” and Dr. Levine responds, “Because it’s your job!”

Dr. Levine is one of my ultimate heroes, along with Howard Gardner, Ph.D., who posits that intelligence is multiple and can be accessed, measured, and expressed through the arts, and Daniel Goleman, Ph.D., who speaks eloquently about the necessity of Emotional Intelligence for our social survival. What my three heroes haven’t yet discovered, however, is that the best tool available for implementing their wonderful ideas is drama therapy.

Drama therapy is quite simply the intentional use of drama or (to use the Greek translation of the word) doing to achieve new understanding of oneself and others. Depending on the requirements of the situation and the needs of the students/clients involved, drama therapy can focus purely on discovery through process drama (role-play, creative drama, improvisation, etc.) or can lead to rehearsal and the creation of a formal product (performance). Either way, our most basic human developmental learning strategies are harnessed: imitation and dramatic play which begin universally at about age 3 in most children as well as the use of metaphor for framing and understanding concepts which begins a little later. As drama – watched or participated in – is an embodied, three dimensional, sensory experience, all possible learning styles are encompassed with students listening, speaking, seeing, moving, thinking, feeling, inventing, and replaying by turns or simultaneously. In addition, all the intelligences are accessed at some point in the process. As can be seen in the chart below, all of Aristotle’s elements of drama are reflected in Gardner’s multiple intelligences:

 VERBAL-LINGUISTIC

PLOT, LANGUAGE

Words spoken or signed

LOGICAL-MATHEMATICAL

PLOT,
THOUGHT

Sequence, logical reasoning

VISUAL-SPATIAL

SPECTACLE

Costumes, Sets,
Props, Stage pictures

BODILY-KINESTHETIC

DANCE/CHARACTER

Blocking, Gesture, Dance, Posture, Pose


The connection between drama and multiple intelligences was first identified by the Southeast Institute for Education in Theatre at the University of Tennessee at Chattanooga in their Data Based Theatre Education model (DBTE). What it ultimately means for parents and educators is that when dramatic forms are used to express an idea, the multiple intelligences are naturally all stimulated simultaneously.

What’s most exciting is that while most of us are not pediatricians or neurologists or educational psychologists, we all are expert dramatists. You may not have ever acted in a play, but you have acted out imaginary stories in your backyard or basement while you were growing up, you’ve rehearsed and performed job interviews and presentations, you’ve even occasionally “created dramatic scenes” for good or ill with the other people in your life.

Drama is like riding a bicycle. Once you learn how to do it, you might not “do it” for years, but you always remember how – that inner balance and relationship between your body and mind never leaves you. It comes back naturally, the minute you put it back into practice.

Of course, you can always develop those dramatic skills further – hone them so that they can be used seamlessly in the classroom, at meetings, demonstrations and workshops, and on the job as methods of communication, training, and clarity. The best part is that whether it’s through a formal class, a workshop, or a community play, dramatic skills are not only useful, they’re fun to develop. And the next best part is that the students who you’ll be teaching are also expert dramatists, with perhaps more recent hands-on practice that you!

I discovered in my years of teaching children, adolescents, and adults with and without disabilities that if you, as the leader, are willing to initiate dramatic play, your students will join in. Maybe not with perfect behavior, but gladly! Enthusiastically! Even students with no previous dramatic training in the special education room at Diamond Elementary knew how to role play!

Bibliography:

Bailey, S. (1993). Wings to fly: Bringing theatre arts to students with special needs, Bethesda: Woodbine House.

Bailey, S. & Agogliati, L. (2002) Dreams to sign, Bethesda: Imagination Stage.

Gardner, H. (1993).  Multiple intelligences: The theory in practice, NY: Bantam Books.

Gardner, H. (1999).  Intelligence reframed: Multiple intelligences for the 21st century, NY: Basic Books.

Goleman, D. (1995).  Emotional intelligence: Why it matters more than IQ, NY: Bantam Books.

Levine, S. (2002). A Mind At A Time, NY: Simon & Schuster.

1 Drama comes from the Greek dran, “to do,” hypothetically derived from dra-, “to work” or “deed” and has developed into our modern concept of drama as action through which something of value is accomplished. Webster’s New World Dictionary of the American Language, 2nd ed., 1970.

Self-Advocacy Through Drama for People with Developmental Disabilities

Suppose you were 35 years old and you still lived at home with your parents because they didn’t think you were capable of living by yourself? Or that you had to live in a group home with people you didn’t choose as your housemates and staff you didn’t hire to run the household? Suppose everyone talked down to you as if you were a little child? Or that you worked a 40 hours a week, and only got paid $45 for your entire week of work? What if you weren’t allowed to get married, even though you were in love with someone who wanted to marry you?

Sound impossible in this day and age? It’s not. There are many people in our country, close to 12.4 million, who experience one or a combination of these limiting life situations because they have a physical, mental or emotional condition causing difficulty in learning, remembering, or concentration (U.S. Census, 2000). Some of these citizens have physical or mental illnesses which affect cognition, and many have developmental disabilities, such as mental retardation, autism, cerebral palsy or another neurological condition. (The U.S. Census does not breakdown disability population figures by diagnosis, but by the following categories: sensory disability involving sight or hearing; condition limiting basic physical activities, such as walking, climbing stairs, etc.; physical, mental, or emotional condition causing difficulty in learning, remembering, or concentrating; physical, mental, or emotional condition causing difficulty in activities of daily living such as dressing, bathing, etc; condition that makes it difficult to go outside the home; and condition that affects the ability to work at a job.)

People who have developmental disabilities are not encouraged to live independent lives, even when many of them can. There are many reasons for this: overprotective families; an educational and social service industry that steers clients to be dependent and passive, rather than training them for independence; a social welfare system with built-in work disincentives for people with disabilities; a society that stigmatizes people who have disabilities as “less than equal” to those who don’t have disabilities (Mackelprang & Salsgiver, 1999; Olkin, 1999).

One of the hardest struggles is that last one — against stigmas held cross-culturally about developmental disabilities. Individuals who are “different,” be they of a different race, religion, physical look, or ability level, end up being stigmatized or seen as having a lower, discredited status, being “not quite human,” by the dominant cultural group in any society (Goffman, 1963; Hardaway, 1991). Developmental disabilities are repeatedly rated as one of the most stigmatized on the continuum of possible disabling and/or medical conditions across a wide range of world cultures (Olkin, 1999;Westbrook, Legge, & Pennay, 1993).

In order to address the prevalence of stigma towards disabilities and the necessity of future mental health and education professionals to become aware of and deal with their own stigmatizing attitudes, I have had students in my Drama Therapy with Special Populations class at Kansas State University rate Westbook, Legge, & Pennay’s list of 20 disabilities from least stigmatized to most stigmatized for the past twenty-four semesters (Fall 1999 to Spring 2011). Each semester mental retardation (the closest category on the list to “developmental disabilities”) is in the top three most stigmatized conditions as either number one, two, or three. The only conditions that are ever rated as more stigmatized are AIDS or mental illness. When they compare their class rating with the cultures surveyed in Westbook, Legge & Pennay’s study, my students discover that those cultures also rated those three conditions in their “top” three.

If attitude sampling is not proof enough of the stigma assigned to people with developmental disabilities in our culture, a simple statistic reported in the Kansas City Star says it all. Prenatal genetic tests can determine if a fetus has Down syndrome, a type of developmental disability caused by a chromosomal abnormality. People who have Down syndrome have three copies of Chromosome 21, rather than 2, giving them 47 total chromosomes instead of 46. Down syndrome is not a fatal or painful condition, although there are sometimes medical complications, such as heart conditions. Individuals who have Down syndrome can range in IQ from low to normal. When the prenatal test became common in 1989, 57 percent of fetuses discovered to have Down syndrome were aborted, and since then the percentage has risen (Bell & Stoneman, 2000; Stearns, 2004). Currently, it is estimated that ninety percent of the fetuses determined by prenatal test to have Down syndrome are terminated through abortion (Adler, 2005).

Not only are stigmatized people not accorded the same status as others, seen as inferior, evil, perhaps being punished for their sins or the sins of their fathers (Hardaway, 1991; Pelka, 1994), or as “defective” by medical model standards, many grow up to believe that those who have stigmatized them must be right and internalize a sense of shame and inferiority. Like many oppressed populations, they often become passive and helpless, because they don’t think they deserve better treatment than what they are currently receiving (Goffman, 1963; Mackelprang & Salsgiver, 1999).

Here are a few stories I collected in 1998 from members of STAND Together, a self-advocacy group for adults with developmental disabilities in the Washington, DC Metropolitan area, which illustrate common, every day examples of stigmatizing behavior they have received, in these cases from family members, care-givers, and helping professionals in their lives:

LG: When I was between the ages of 17 and 21, I went to live with my older brother and I was treated as a child and it was totally wrong to do that to me at that age. At that point, it wasn’t right, but I didn’t do anything about it. I didn’t like it, but just took it. I finally just moved away. It feels great to be treated like an adult instead of a child. It’s wrong to treat an adult with a disability like a child. An adult should be treated like an adult. A teenager should be treated like a teenager. A child should be treated like a child.

BH: Sometimes the counselor comes into my apartment to talk to me when I’m having dinner [and wants to meet about life skills and work issues]. I say, “Excuse me, I’m eating.” That’s ignoring my privacy.

MP: I want to tell you about staff who disrespected me at the place I worked, so you won’t ever treat anyone who you work with this way. [The workplace was a sheltered workshop/training center for people with disabilities.] At one point I was in Beginner’s Clerical. I was not feeling good one day and I called in like you would normally do when you’re not feeling good. They asked me to call back later. I did and I said that I still wasn’t feeling good. But my supervisor, she didn’t take no for an answer. She wanted me to come in to work. [MP went back to sleep after hanging up the phone.] I wake up and I’ve got the program specialist on one side of me and the supervisor on the other side of me wanting me to come to work! So to make a long story short on that one – that’s why I’m still afraid to get a job out in the community. I’m afraid someone’s going to come and drag me out of bed and take me back to work!

These three individuals, quoted above, have not remained passive and accepting of the stigmatized way they are treated. As members of STAND Together, one of the oldest self advocacy groups in the state of Maryland, they have learned how to speak up for themselves, protest ill-treatment, and work on changing attitudes and removing barriers to their full inclusion in their community. We’ll talk about their experiences with drama as a tool in their struggle later in the article.

Historically, nondisabled members of society have assumed that people who have disabilities are not able to care for or support themselves. Poorhouses were created in colonial America as a place to warehouse anyone from widows, orphans, or the elderly to people with mental illness, disability, or serious illness (Trattner, 1989). Until recent years people with disabilities, particularly those with developmental disabilities, were committed to institutions for the “mentally deficient.” Doctors would often recommend to families at the birth of a child with disabilities to not even take the child home, but to “send it away” (J. Glenner, personal communication, 1990; Makelprang & Salsgiver, 1999; Morton, 1983). For those who weren’t institutionalized, educational opportunities and jobs were not easy to get.

The terminology chosen to describe this group of citizens (as well as people with physical disabilities) suggests that they are incompetent. Hardaway says it is important to know that the word “handicapped” originated from the phrase “cap in hand,” indicating someone who is a beggar. Begging was one of the only ways that people not segregated in institutions who had disabilities were able to make a living when they couldn’t get a job (Hardaway, 1991). Employers assumed that people who had disabilities couldn’t do the work and often wouldn’t consider them as potential employees.

What does the word “disable” actually mean? According to Webster, disable means “1. to deprive of legal right or qualification: disqualify. 2. to make incapable or ineffective: to incapacitate, especially to deprive of physical, moral or intellectual strength. 3. a. to deprive of what gives value: impair in worth. b. to declare incompetent or invalid.” Impaired, another word sometimes used in place of disabled, means “to make worse, diminish in quality, value, excellence or strength: to do harm to.” (Webster’s Third New International Dictionary of the English Language Unabridged, 1993). None of these words sound very positive used as either a noun to categorize someone or an adjective to describe him. No one wants to be considered an ineffective, incapable, diminished, or invalid human being, especially when the disability condition one has usually only limits one small aspect of one’s life; however, that is what our language suggests happens.

The disability awareness movement which began in the 1960’s helped pass legislation, such as the Rehabilitation Act of 1973, the Equal Education for All Handicapped Children Act of 1975 and the Americans with Disabilities Act of 1990. These laws have helped create more opportunities in education, employment, housing, and access to the community at large for people with disabilities. In the late ‘60s and early 70’s disability advocates and social service workers brought suit in the courts to close state hospitals and release the residents to out-patient services in the community. This, plus spiraling medical costs, caused many institutions in which people had been warehoused to be closed, sending them back in the community to live and work (Anderson, Lakin, Manga, & Prouty, 1998; Mackelprang & Salsgiver, 1999).

However, just because opportunities for independence exist, doesn’t mean the people those opportunities were created for know how to access them or how to succeed once they get them. Statistics have shown that people with disabilities make responsible, hard working, reliable employees. However, statistics also show that a number of employees with disabilities lose their jobs, not because they can not do the tasks required, but because they do not have the social skills to fit into the workplace appropriately (Chadsey-Rusch, Linneman, & Rylance, 1997; J. Gingerich, personal communication, August 17, 1999; Park & Gaylord-Ross, 1989).

Others do not have the self-confidence to go after an educational or employment opportunity in the first place. There are a variety of reasons for this: they might not know how to be assertive; they might not have the support and encouragement they need from significant others; they might see barriers (legal or illegal) in the way that they do not know how to get around. In short, they have problems advocating for themselves.

Here is where drama comes into the picture: drama is the perfect vehicle for teaching assertiveness, problem-solving, and self-advocacy skills and for demonstrating and articulating one’s abilities, opinions, and desires to others. Through acting out a situation in role play, participants can learn how to identify problems, try out different solutions, and practice the solutions they think will work best. They can develop the self-esteem and confidence to believe they can be effective and succeed. Even more important, they can develop the social skills to get their questions answered, their needs met, and their day-to-day on-the-job or in-the-community conflicts worked through in appropriate ways. (Bailey, 1993, 1995; Sternberg & Garcia, 1994).

Why is drama so perfect? It is embodied, experiential, and active. Many people with developmental disabilities have difficulty learning abstract concepts through lecture and other abstract teaching techniques. Many learn better through hands-on, concrete, physical activities. In addition, drama incorporates narrative or story into instruction. Information is easier to remember when linked by narrative than when it is simply memorized by itself as individual facts (Cozolino, 2002; Herman, 2003).  Information is also easier to remember when it is paired with emotions, particularly positive emotions or emotions that are meaningfully appropriate to the material (Jensen, 1998). Drama contains all of those qualities: embodied, experiential, active, concrete, hands-on, narrative, connected to emotions, with the added attraction of being FUN, so that the learning process is interesting and easy to pay attention to! (Bailey, 1993, 1995, 2010).

Young people with developmental disabilities may not understand the subtleties of social situations. Nondisabled children usually pick up many of the social cues and cultural constructs around them through observing interactions of adults and older children, repeatedly seeing the consequences of certain actions (Hall, 1976). Some children with developmental disabilities miss out on these cues and constructs. They might not notice nonverbal behaviors for a variety reasons, including attention deficits, attention overloads, or aural or visual processing difficulties. They might have difficulty with sequencing and, therefore, do not understand the relationship between an action that causes a particular consequence. Having missed observing the behavior in the first place, chances are they probably will not understand theoretical presentations about it. They may not have been given the opportunities to practice appropriate ways to interact socially because no one thought they were capable of learning them and, therefore, never reinforced appropriate behavior.These children need active instruction and practice in order to see, understand, and learn (Bailey, 1993, 2010).

When is the best time to start using drama to train students in social skills and assertiveness? When children are young and in school! Cindy Bowen, a registered drama therapist and transition specialist at Ivymount School, an independent school for multiply handicapped students in Rockville, Maryland, began using drama as a behavior management tool while she was a support counselor in charge of handling discipline problems. She found that when students had negative behaviors in class or on the playground, it was usually because they did not have the words to express their feelings or alternative ways to solve the situation that was frustrating them. She would take them to her office and get them to cool down. Then she would talk to them about what happened and what other options they might have used for dealing with the situation. Once they were able to identify these, she would have them act out the appropriate behavior until they felt they understood it and could use it successfully. Last, she would take them back to the classroom and let them practice the new behavior with the teacher (out in the hallway, not in front of the rest of the class), so that the teacher knew what solutions had been developed and could help reinforce them when the student tried them out instead of reinforcing the old negative behavior.

Cindy realized that this was the beginning of self-advocacy for these children and that its development was crucial to their success, not just in school, but in life. Since her experience as support counselor had proven to her the efficacy of drama as the way to “get through” to students on issues of behavior, she incorporated drama into all her later transition planning work.

In the U.S. students in special education are allowed to stay in school until they are 21. Their educational needs are guided by an Individual Education Plan (IEP) which is devised jointly by their teachers, parents, and, ideally, themselves. The IEP is re-evaluated at least once a year and new goals incorporated into it. As they get older, an Individual Transition Plan (ITP) is included to help them make that major transition from school to work. Cindy saw the IEP/ITP meeting as a place where self-advocacy was needed – allowing both the parents and the student to speak up for their wishes for the future. Did they want to have a specific kind of job? Did they want to live at home, in a group home, or independently in their own apartment? What were the steps that needed to be taken in order to finally achieve those goals? She helped students develop and practice a script so that they could communicate their wishes and desires to their parents and teachers.

Sometimes parents needed skills to work with a child who had unrealistic dreams. For instance, many teenaged boys express a desire to be a professional basketball player.Needless to say, this is not a realistic goal for 99 percent of them, disabled or not! The key to working with this desire, however, is not to discourage the student from having dreams, but to get them to identify what interests they have, what skills they have, what skills they can develop, and from there to think realistically about what kind of job they could get.Cindy found she needed to teach the parents – and did so most effectively through role-play – how to interact with their children about this topic. They practiced how to ask questions to elicit useful information from their child instead of shutting him down by saying, “No, you can’t do that” or “You’ll never be able to do that.”

Job skills from interviewing to personal hygiene to interacting with co-workers could be practiced in Transition Class through drama. Many students not only had difficulty finding words to express themselves, but also in understanding non-verbal cues that others were giving them. To address this, Cindy would set up dramatic situations in which they would practice identifying these through role play. For instance, she might act out different kinds of bosses who might be interviewing students for a job; she might act formal and polite, condescending, or rushed and impatient. A student would interview with her for the job and then have to assess with the rest of the class what she wanted the worker to do in the job and what kind of nonverbal information she was expressing during the interview which might indicate what kind of a boss she might be to work for.

One transition group, called “Express Yourself,” showcased the older students in dramatic presentations as they demonstrated behavior options to the younger students in order to teach social skills through action. “Express Yourself” students would brainstorm different difficult aspects of relationship communication: friend with friend, child with parent, student with teacher, employer with boss. From these, improvisational scenes were created – with both negative and positive behavior choices – and acted out for other classrooms.Cindy would facilitate and lead a discussion. The students watching would respond to what they thought was going on in the scene. Were the actors using a positive way of handling the situation or a negative one? What were some other ways it could be done? Through drama the younger students were able to pick up on the correct behaviors and generalize them to other situations. They would often use some of the words and behaviors they saw enacted in the scenes in their real life situations. They would ask Cindy, “Did I handle this like so-and-so handled it in the play?”

Presenting “Express Yourself” skits served as a wonderful self-esteem builder for the student-actors. They were suddenly “teacher for the day” and were able to share what they had learned with others. Another outgrowth was the “Express Yourself” students became positive role models and mentors for the younger students. Many younger children had never been exposed to the idea of being able to grow up and get a job. Suddenly they realized that “Hey, this older kid has a transition plan. He’s getting a job. I can do that, too!” (C. Bowen, personal communication, January 22, 2005).

Much of my work with young adults with developmental disabilities also took place in suburban Maryland. In my role as Arts Access Director at the Bethesda Academy of Performing Arts (now Imagination Stage), I created programming for children, teens, and adults with a wide variety of disabilities. One acting class, called “Act For Yourself,” was geared along the same lines as the Ivymount “Express Yourself” class, providing practice for young adults with developmental disabilities in assertiveness and social skills. We acted out situations they found difficult in their lives and explored who they were, what they wanted, and how to get their needs met in active, appropriate ways. We also explored how to stay safe in situations in which others might harm them, how to handle anger, and how to behave appropriately in dating situations. “Act For Yourself” was so popular and useful that I was invited to teach it for Montgomery College’s Challenge Program, a division developed to give students with disabilities who had graduated from high school pre-college level experiences on a real college campus.

My favorite experience using drama for social action was with STAND Together in 1998. STAND Together was sponsored by The ARC of Montgomery County (ARC was formerly an acronym for Association for Retarded Citizens, but has formally changed its name to be simply The ARC). They had heard about my drama program from enthusiastic participants and saw a creative, dynamic, and active way to raise staff awareness on privacy issues and basic human rights of residents in their group homes. Twice a month an orientation training (Introduction to Developmental Disabilities) was held for new staff members to address basic information about The ARC’s group homes, developmental disabilities, emergency procedures, health and hygiene and human rights of residents. Trainings had always been done via lecture and handouts. The information was communicated, but most trainees did not really understand the priority The ARC wanted given to respecting the residents as adults with individual needs and preferences. Often in the interests of time and efficiency or out of ignorance, staff would ignore residents’ choices, break confidentiality, or invade their privacy. This problem was exacerbated by the issue of frequent turnover of staff which is a common problem in all areas of the direct support profession serving people with disabilities (Larson, S.A., Hewitt, A.S. & Lakin, K.C., 2004). STAND Together wanted to create a role-play presentation to illustrate ways to handle privacy issues, so that respect and appropriate boundaries could be demonstrated clearly to staff.

My first step in approaching this project was two-pronged. I wanted to let the STAND members train me in what they felt were the most important issues to address – they, after all, were the authorities – and we all needed to know what the law said about current legal standards of individual rights, the procedures for compliance, grievance rights, and what to do in case of violation. We began by looking at the Health-General Article 7-1001 and 7-1002 from the Annotated Code of Maryland COMAR 10.22.07. Then we brainstormed their list of personal and privacy rights.

Identification and articulation are the first steps in self-assertion. Creating an atmosphere of trust and acceptance in which participants can speak honestly and openly about their experience and their pain was paramount. As the group shouted out ideas, I wrote down all suggestions in magic marker on large pieces of paper taped to the wall. I knew all ideas would not end up in the final presentation, but all needed to be acknowledged as part of the pot of material we would pull from. Even though some members of the group could not read, my act of writing down their ideas validated them and communicated the clear message that I respected them and took them seriously. (This list of rights is included at the end of the article.)

The next step was to collect personal stories related to the violation of these rights and to generate ideas of how these negative situations could have been dealt with more kindly, respectfully, and effectively. These stories were then shaped into fictional dramatic situations which we improvised. None of the scenes that ended up in our repertoire for the training were historical re-enactments of anyone’s real-life experiences. On one level this preserved confidentiality, but on another it freed the actors to try out alternative solutions to the conflict instead of sidetracking them into a re-creation of the way events had actually transpired. We could also exaggerate a little to make a point without being untruthful. The purpose of the scenes was, after all, to help create systemic change in the attitude and behavior of employees of an organization, not for the personal therapy of STAND members.

For each scene, we came up with the “wrong” way and a “better” way to handle the situation. The scenes were kept improvisational at all times, so the parts could be taken on by different volunteers. Here’s what one of the situations might have looked like if scripted:

JULIENNE, a staff member at a group home for adults with developmental disabilities, enters the living room and sees a stack of mail on the dining room table. She walks over, leafs through the pile, picks up an envelope, opens it, and takes out a letter and form. Then she gets a pen from the desk, comes back to the table and begins filling out the form, leaving the opened envelope on the table.

EVA, one of the residents, enters the living room and looks through the stack of mail. She sees the opened envelope, which has her name and address on it. She turns to JULIENNE with the envelope in her hand and says, “Who opened my letter?”

JULIENNE: (nonchalantly) Oh, I did.

EVA: Why? My name is on the envelope! See, right here it says, “Eva Jones.”

JULIENNE: I could tell it was that form from the SSI office and I knew you’d need help filling it out, so I opened it for you.

EVA: But it belongs to me. You shouldn’t have opened it.

JULIENNE: It doesn’t matter.

EVA: Yes, it does! It was for me!

JULIENNE: I knew what was in it.

EVA: But what if you didn’t? What if it was something else?

JULIENNE: Well, it wasn’t something else. It was the re-application form.

EVA: It’s my private letter!

JULIENNE: I’m only trying to help!

EVA: But you shouldn’t have opened it! Even my mother knows not to open my mail!

JULIENNE: (throwing the letter at EVA): FINE! Do it yourself!

This scene illustrates behavior a group home staff person might consider “helpful,” but which residents would consider condescending and an invasion of privacy. It was, of course, followed by a replay in which Julienne let Eva open her own letter, asked if it was the form they had been waiting for from SSI, and allowed Eva to ask for help.

A step above and beyond using drama to advocate for yourself and for others is teaching others how to advocate for themselves. In essence, passing on the power. After all, as the old proverb says, “If you give a man a fish, he eats for a day. If you teach a man to fish, he eats for a lifetime.” Deborah J. Zuver, a registered drama therapist in North Carolina, is doing just that through self-advocacy projects she directs through the University of North Carolina Clinical Center for the Study of Development and Learning. The U.S. Administration for Children and Families has designated this site as the University Center for Excellence in Developmental Disabilities in North Carolina.

Deborah has developed a self advocacy training curriculum called Acting for Advocacy (A4A) which is part of Project STIR (Steps Toward Independence and Responsibility).This program explores topics such as Knowing Self, Communicating Effectively, Problem-Solving, Rights and Responsibilities, and Self Advocacy and Self Determination with young adults who have developmental disabilities in the state. Next Generation Acting for Advocacy, an outgrowth of A4A funded by the U.S. Administration on Developmental Disabilities (ADD), targets high school students who are making that important transition from school to work. Through workshops conducted in the schools, students learn those all-important social skills that will help them get a job and then keep it.

Shifting the Power is another program that has developed from A4A and has been funded through ADD. The whole point of Shifting the Power is passing on self-advocacy skills to others in nearby states. The North Carolina training team works with local participants who have developmental disabilities in weeklong training sessions to develop self-advocacy skills. By the end of the residency the North Carolina team has helped the newly trained advocates create a concrete, visual action plan to follow in order to incorporate more self-advocacy into their organization and begin addressing local, regional, and state disability issues.

The A4A advocacy training team consists of 4 trainers, half who have developmental disabilities themselves. They present their information primarily through dramatic enactments. First, they show planned improvised scenes (the lines are not memorized, but the actors have practiced the scenario and know where they are headed with the situation). Then Deborah, as the facilitator, will freeze the scene and engage the audience in a discussion about what happened. Sometimes the actors replay the scene based on audience suggestions. Sometimes audience members are invited up on stage to try out a new solution or re-enact one that they’ve just seen demonstrated.

Deborah says, “This kind of approach is different from trainings in which someone stands up and lectures about skills and then has the students passively listen or imitate.They can try out the skills themselves. Also, watching the enactments is like listening to a story. The information is put into context as well as action. The information is modeled by peers with developmental disabilities which makes it more real and more realistic.” (D.J. Zuver, personal communication, January 5, 2005).

In addition to using her trainers who have disabilities as actors, Deborah involves them in leading the group discussions. She has them present the power point slides which provide visual illustrations to concepts in the training. They also are able to share their personal successes, if they choose. One of the trainers is very proud of the fact that she is the first self-advocate she knows who has bought her own condo and drives her own car! This makes the trainers very viable role models and adds power and validity to the message they bring.

Deborah stresses the importance of including an emotional component in this kind of advocacy training. She says that it is often left out of many social skills and self advocacy trainings. “It’s almost like professionals think members of the DD population can’t handle their emotions, but many can. They just need practice and the opportunity and the support!” She goes on to say, “Brain research shows that emotion and memory are linked. And drama allows emotions to be expressed in a clear, contained manner.” When participants are allowed to explore their ideas and feelings in a safe environment, “They can have insights and come to new understandings.” In fact, Deborah says her favorite moments in workshops are when she “sees the ‘light bulbs’ going off over peoples’ heads when they are understanding a concept for the first time or realizing that they are capable of something that they didn’t think they could do before.” (D.J. Zuver, personal communication, January 5, 2005).

Each of these examples of drama cited above acknowledge Paolo Freire’s pedagogical philosophy of starting with the student, as well as the theatrical spirit, if not the specific methods of Augusto Boal who believed in incorporating the audience as “spectactors” into the exploration of ideas theatrically. As an oppressed minority, people with developmental disabilities lack confidence in themselves. They have been “domesticated” into being passive, dehumanized, and marginalized by the “non-disabled” members of the culture. Instead of lecturing at them and keeping them in the one-down position, through drama we can join them and dialogue with them, raising their awareness and self-esteem, providing them with the skills to break their chains of oppression, so they can see themselves as “normal,” equal, respected citizens in our community, and, as a result, take on those roles. This, then, becomes a real win-win situation. When they begin to have power over their lives, they can contribute to the diversity and strength of the community at large. The community can only be enriched when more of its members are active participants rather than passive “burdens.”

List of Privacy Rights Generated By STAND Together Members, 1998

I have a right to:

  • Choose my own activities.
  • Choose my own job.
  • Choose my own friends.
  • Make my own decisions about purchases.
  • Make my own decisions about life choices and personal style, such as hair cut, clothes and jewelry to wear.
  • Take appropriate medication that helps me function well, but doesn’t over-medicate me.
  • Ask for help and accommodations if I need them.
  • Be accepted for who I am/for myself.
  • Have my parents “let go” and allow me to grow up and become independent.
  • Speak for myself and not have other people speak for me.
  • Be talked to at my level so I can understand and to be able to ask questions without being treated impatiently or as if I’m “stupid.”
  • Be talked to as an adult, and not condescended to or talked to like I’m a baby.
  • Have people talk directly to me and not to a family member or staff person who is with me as if I wasn’t there!
  • Have my confidential information stay confidential.
  • Be disciplined by staff in private, not in front of everyone else.
  • Have privacy on the phone.
  • Not have my mail opened by staff or anyone else.
  • Have my personal space and personal living quarters respected.
  • No one should enter my room without knocking and asking permission.
  • No one should come into my room while I’m not there and rearrange things or change things without asking.
  • Have a private sex life.

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Bailey, S. (2004). Behaviour change through drama therapy. Social Spectrum, 3, 14-17.

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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.

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.

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.