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.

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.