Kansas State University graduate receives Rotary scholarship to research drama therapy for women with post-traumatic stress disorder

Friday, Oct. 30, 2015

Jessica D Muñoz

Jessica D. Muñoz, August 2015 master’s degree graduate in theatre. | Download this photo.

 

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MANHATTAN — A Kansas State University graduate will use drama therapy to help internally displaced women in Colombia with post-traumatic stress disorder.

Jessica D. Muñoz, August 2015 master’s degree graduate in theatre with an emphasis in drama therapy, Albuquerque, New Mexico, received a $30,000 Rotary International Global Grant Scholarship to evaluate the effectiveness of trauma-centered group drama therapy with displaced women in Colombia.

Internally displaced people are similar to refugees in that they are forced to flee their home but they remain in the same country. According Muñoz, Colombia has the second largest population of internally displaced people in the world and about 60 percent are women and children.

“The emotional impact of displacement creates many challenges, such as the paralyzing effects of post-traumatic stress disorder, preventing people from rebuilding their lives,” Muñoz said. “While few studies have measured the rates of PTSD in internally displaced people, recent clinical studies demonstrate that rates of PTSD among refugees range from 39-100 percent — compared to 1 percent in the general population.”

Muñoz will work with Sally Bailey, professor and director of Kansas State University’s drama therapy program, and Jorge Palacio Sañudo at the La Universidad del Norte in Colombia. The goal of the project is to help participants build a community of trust and empathy in a safe environment so they can share stories and heal. As the project progresses, researchers will measure the overall improvement in mental health, including the severity and frequency of PTSD symptoms.

“There is not enough research published yet on the effectiveness of drama therapy,” Bailey said. “Yet, we know from our experiences — anecdotal though they may be — that drama therapy works extremely well for clients who have experienced trauma. I am so excited that Jessica will have the opportunity to research the efficacy of drama therapy with displaced women in Columbia.”

The Global Grant Scholarship is awarded for graduate level academic studies and/or research, which must occur in a foreign country. The scholar completes classes, conducts research or a substantial project that aligns with one of Rotary’s areas of focus.

“The interview and selection process for the scholarship is rigorous,” said Rebecca Gould, co-chair of the scholarship committee for the Konza and Manhattan Rotary clubs and director of the university’s Information Technology Assistance Center. “Jessica’s research is unique and includes four of Rotary’s six areas of focus — peace and conflict prevention/resolution, maternal and child health, basic education and literacy, and economic and community development — by providing training to professionals using her skills as a drama therapist.”

Muñoz is a member of the North American Association of Drama Therapy. She worked as a refugee advocate for the Refugee Well-being Project at the University of New Mexico and was a student delegate for the United Nations Commission on the Status of Women in New York. She completed a residency at the Post Traumatic Stress Center in New Haven, Connecticut, was a site leader for the Manhattan chapter of Hollaback! and a facilitator for Kansas State University’s Center for Advocacy Response and Education. She will start the research in February 2016 in Barranquilla, Colombia.

“It is critical that innovative ways to address the trauma of displacement are developed and integrated into systems of crisis intervention,” Muñoz said. “The development of trauma-centered group drama therapy holds the potential to improve the collective and personal psyches of female internally displaced people in Colombia and across the globe.”

Muñoz is the daughter of Edward and Kellie Northam, Omaha, Nebraska.

Student’s research project looks at how de-roling may help actors shed intense roles

Thursday, June 5, 2014

MANHATTAN – Actors and actresses have learned many methods of becoming their characters, but how do they leave their character — or de-role — when the role is over?

“I asked myself that question,” said Daijah Porchia, a Kansas State University freshman in theatre, Kansas City, Missouri. “How do actors handle intense parts without becoming depressed or negatively harmed?”

Porchia used this question as the basis of her research project for the university’s Developing Scholars Program, which provides underrepresented students opportunities to conduct research projects with a faculty mentor.

Sally Bailey is a professor and director of Kansas State University’s drama therapy program. She is Porchia’s faculty mentor and has been involved with de-roling techniques for actors and drama therapy clients for the last 20 years. She wrote a chapter about de-roling in the book “Safe Enough Spaces,” which explores methods of teaching theatre. De-roling is described as taking roles off after rehearsals so that actors and actresses can come back to themselves when their performance is finished.

Examples of de-roling techniques include shaking limbs and body to literally shake the character off, or ritualistically stepping out of a performance by handing back a character’s specific prop or costume piece to a director.

“De-roling is not a common practice in acting, but it’s used all the time in drama therapy because you’re working with clients who are very vulnerable,” Bailey said. “But actors are very vulnerable, too. They spend many, many years learning how to get into role, but they’re never taught techniques about getting out of it.”

Bailey said she has known many actors — and read about others — who have been bothered by playing really intense roles. Those roles have led to changes in their personality, including depression, acting out or heavy drinking because they didn’t leave their characters behind at the end of the day.

Porchia’s interest in method acting and de-roling came from the death of actor Heath Ledger, who played the Joker in the movie “The Dark Knight” in 2008.

“Heath Ledger became completely immersed in his role so that he was unable to separate the character from himself,” Porchia said. “He seemed to become the Joker and died shortly after performing the intense role.”

In fall 2013, Kansas State University’s theatre program performed “columbinus,” a play based on the Columbine High School shooting in 1999. Director Jennifer Vellenga invited Bailey to teach the cast de-roling techniques. Vellenga’s concern was that the student actors were close in age to the characters in the play and, as in the play, they may have experienced similar situations of bullying and stereotyping in real life.

Vellenga believes that the de-roling techniques, along with cast members consciously providing support for each other, helped them handle the intensity in “columbinus” better than if they had not had some way to consciously leave the play in the theatre each night.

For her research project, Porchia interviewed six of the eight “columbinus” cast members about their experiences with the show and how de-roling assisted them. She also asked how they personally were able to come out of their character and if they would do such an intense show again.

Porchia and Bailey will analyze the themes of the students’ answers as well as answers from actors and actresses who have not used de-roling techniques in similar intense productions. They want to see how much of an effect de-roling has.

Using empirical data, Bailey and Porchia want to see how valuable de-roling is for all actors. They hope to show that de-roling should be incorporated into all actors’ training, no matter the size of the stage on which they are performing.

Drama Therapy Improves Mood, Reduces Pain During Hemodialysis

Tuesday, May 14, 2013

MANHATTAN — For patients with kidney failure, getting creative may provide some relief.

Kansas State University researchers are exploring the effects of drama therapy on patients undergoing chronic hemodialysis and are the first in the world to study the topic.

The research is part of a master’s thesis by Jamie Ansley, a spring 2013 graduate in theatre with a concentration in drama therapy. Ansley, a former professional hospital clown, has a family member who will soon be receiving dialysis treatments. The treatment for kidney failure uses a machine that removes wastes and fluid from blood, and then returns clean blood to the body.

Preliminary results of the study show trends in improving mood and reducing pain after using drama therapy, which is the use of drama and theater to achieve healing outcomes. The research, supported by Manhattan-based nonprofit The Drama Therapy Fund, won the poster contest at the 2013 Heartland Kidney Conference in Overland Park.

Hemodialysis patients must follow a strict treatment schedule and typically visit a clinic two or three times a week for up to four hours per visit. Ansley worked with patients at a Manhattan dialysis clinic during treatment sessions in the fall and spring semesters.

“Patients are sitting there with a lot of time on their hands,” she said. “Some choose to watch TV, read or fall asleep. Others inevitably start to think about their worries in life.”

Patients could not move during treatment, so Ansley brought prompts like pictures, games, guided imagery and music. She asked questions to help patients verbally improvise a scene, story or character. Some patients created a detective character, and story themes included death, loneliness and friendship.

“Drama therapy creates a wonderful metaphor and distancing effect for people so that they can talk about their problems,” said Sally Bailey, professor and director of the drama therapy program at the university. “They can create characters who are dealing with similar issues and succeed, which gives them hope for themselves. It’s empowering and helps them feel more in control of their lives.”

Patients completed surveys before and after each session, and a 65-item Profile of Mood States assessment before and after the study. They reported that drama therapy was an enjoyable way to pass the time during treatment and took their mind off of their worries. They also perceived that the therapy reduced their pain and improved their mood.

Ansley gave patients a personalized book of their stories, along with recordings of some of their creative work.

She previously worked for Los Angeles-based Starlight Children’s Foundation for its New York City and Midwest chapters as a hospital clown in pediatric intensive care units in New York City and Milwaukee, WI Ansley wants to work as a drama therapist with patients undergoing hemodialysis at a hospital or clinic in Wisconsin.

“Having something to look forward to, discovering a new talent and finding a passion for creativity can change a person’s perception of his or her life,” Ansley said. “Drama therapy is an invitation to have some fun and discover new possibilities.”

She is a 1996 graduate of Belleville Township High School West in Belleville, Ill., and a 2000 graduate of Webster University in St. Louis.

K-State Drama Professors Create Curriculum to Help Kansas Teachers Use “Romeo and Juliet” to Talk with Students about Violence

News release prepared by: Erinn Barcomb-Peterson, 785-532-6415, ebarcomb@k-state.edu

Tuesday, Aug. 11, 2009

MANHATTAN — William Shakespeare’s “Romeo and Juliet” opens with a brawl between the feuding Montagues and Capulets until the Prince of Verona steps in and threatens them with death if they don’t stop fighting.

But what if Romeo’s cousin Benvolio Montague had talked with Juliet’s cousin Tybalt Capulet and agreed that they would try to convince their respective families to disarm, making themselves look like heroes in the process?

This is just one of the ways that Kansas State University theater professors have re-imagined the famous play and are using it to get teenage readers and audiences to talk about alternatives to violence.

“Romeo and Juliet is a perfect example of everything you would not want to do with people who are depressed and potentially suicidal and people who are really angry and potentially violent,” said Sally Bailey, associate professor of drama and director of K-State’s drama therapy program. “The way Shakespeare has structured the play, at every decision point instead of making a positive choice the characters are making a classically negative choice.”

Although high school teachers are sometimes leery of teaching the play to students who might view the young characters as role models, Bailey and collaborator R. Michael Gros, assistant professor of theater at K-State, saw an opportunity.

“Understanding how violence works and how conflict resolution works, you can see ‘Romeo and Juliet’ as a primer to teach about what to do and what not to do,” Bailey said. “It’s often very hard to get teenagers to see that something that was written 400 years ago has any relevance to them. In this play the relevance is palpably felt by the students.”

Bailey and Gros got a grant from K-State’s Center for Engagement and Community Development to develop a curriculum that can help teachers introduce these themes to students.

Bailey and Gros took the curriculum to Topeka High School and to a K-State women’s studies class. Now they are looking for as many as 10 Kansas teachers to pilot the program. With feedback from the early adopters, they hope to revise the curriculum and take it to broader audiences.

The project also involves faculty from K-State’s School of Family Studies and Human Services, who helped with the curriculum from a psychological standpoint. They include: Tony Jurich, an expert on adolescents; Terrie McCants, a conflict specialist; and Sandra Stith, who specializes in family violence.

“Juliet turns 14 in this play, and Romeo is probably all of 16,” Gros said. “It really is at the heart of adolescence. As we’ve been learning from our partners, the psychological wiring in teenagers is very, very different in how they respond to a sense of time, a sense of death, a sense of responsibility and permanence.”

The curriculum includes a written portion and a video of a panel discussion with the experts. It also includes a DVD pairing original scenes with re-imagined versions. K-State students, faculty and alumni put on “Romeo and Juliet” — set in the late Edwardian period — as part of the theater department’s spring series. The same actors performed modern versions of some scenes with re-imagined outcomes: Instead of killing Paris at Juliet’s tomb, Romeo and his rival talk it out.

Gros said that the play presents an opportunity to talk not just about teen violence but also about family communication and violence. One scene involves Juliet’s father threatening her with violence if she doesn’t obey. In some productions, the father beats her.

At the same time, Gros said that the play offers hopeful messages. Although Romeo is dead set on wooing another girl at the beginning of the play, his cousin encourages him to keep looking. Gros said that the lesson there is to keep your eyes open and to be open to possibilities.

“Students can see themselves, but there’s also a certain safety in that we are separated from these characters by 400 years,” Gros said. “This is a variation of the ‘I have a friend in trouble’ speech. But the resonance is there, and they open up.”

Shakespeare’s sense of the human condition also makes “Romeo and Juliet” an ideal vehicle to talk about issues like violence, Bailey said.

“Teachers often think of it as just a tragedy,” Bailey said. “They may not realize all of the psychological underpinnings, but it’s so clinically accurate. Teachers know Shakespeare understands the human heart and soul, but they may not realize how incredibly crystal clearly he does.”

Video available: http://www.youtube.com/kstate#play/user/3C37FA11F9E68548/0/qL9tppn2Rw4
Note to editor: More information about what K-State is doing to help Kansans is available at http://www.k-state.edu/media/webzine/engagement/index.html

Accommodations for Autism Spectrum Disorder

ASD Behavior/Symptom General Accommodation Drama Accommodation
Easily over-stimulated by too much sensory input.

Result: can shut down, self-stimulate, or melt-down/ tantrum.

Keep clutter in room to a minimum.

Do not design a “busy” environment with lots of colors, movement, etc.

Provide information through one sensory learning channel at a time (verbal or visual or kinesthetic).

Provide a quiet spot in the room with few visual and auditory distractions for student to go to for a break, when necessary.

Keep games simple at first, building complexity as you get to know your students.

Avoid games with lots of simultaneous
movement from all group members.

Avoid games with lots of simultaneous
vocalizations from all group members.

To refocus, try hand pattern games with one other partner.

Aversive to loud, sudden noises. Find a quiet location for your classroom. Avoid games with balloons.

Avoid games with sudden loud sounds.

May have difficulties with boundaries, such as where his physical body ends or where the socio-emotional and physical boundaries are between self and others. Provide clearly designated spaces for sitting
(i.e., chairs, carpet squares, X’s on rug). 

Create clear classroom rules, particularly regarding hands and legs to self, and post rules in a place where all can see them.

Play movement games which teach boundaries
(for example, hula-hoop space walk; play with stretchy bands, cooperabands,
parachutes). 

Delineate acting and audience areas clearly and keep them the same each class.

Tactile Defensiveness (Does not like light touch). Use deep touch.

Give high-fives for praise.

Provide heavy/weighted blanket, mat, bean-bag chair, or heavy pillows
for student to wrap self in or burrow under.

Do not play games that involve touching or tagging.

Use isometric exercises in warm-ups (student presses against self, wall, object, or another person).

Typically does not easily handle changes in routine. Stay in the same space from week to week.

Follow the same order of activities in each lesson plan.

Post lesson plan where it is easy to see.

Try to stick to the scheduled lesson plan.

When playing a game, remind students several rounds before the end of a game so they are prepared to stop.

Keep arrangement of the room the same from week to week: audience area and stage always in the same place, circles always in the same place, etc.

Open and close class with the same ritual drama activity.

Typically are concrete, literal, and visual thinkers versus abstract thinkers. Avoid using figures of speech:  “It’s raining cats and dogs.”

Be concise and concrete with instructions.

Say what you want students to do instead of what not to do: instead of saying, “Stop fooling around!” say “Come over here and sit down.”)

Use lots of props and costumes.

At first, play games that involve concrete objects and later move to abstract, “invisible,” pantomimed objects.

Remind students that drama class is where we use our imaginations and anything can happen: we are not bound by the laws of physics when we pretend.

Might have sensitivity to certain smells. Do not wear perfume, after-shave lotion, scented lotion when teaching.

Ask if janitor can use scent-free cleaning materials.

Avoid room deodorizers and incense.

Avoid using fog machines in productions.
Difficulty making eye contact. Do not force eye contact, but do encourage students to turn towards each other while communicating. Avoid playing games where eye contact is necessary, such as mirroring.

If two actors must look at each other in a scene, suggest they look at the other’s nose or another part of the other’s face instead of directly in the eyes.

Can obsess about certain topics and not want to talk about or work on others. Set clear guidelines about what is OK and not OK to talk about.

Set limits (perhaps use a timer) for the amount of time to discuss any one subject.

Insist that everyone must have the opportunity to share their own ideas and listen to/respect others’ ideas.

When sharing in a circle, use an object like a feather or fake microphone to designate the “official speaker.”

Try to incorporate your students’ interests
into improvs and stories, while encouraging them to branch out to new areas.Add small changes into repetitive routines or stories to create variety and encourage flexibility.

Stress the need for an actor to “be in the moment” and respond to all offers with “Yes, and….” Practice this.

Has a tendency to be rigidly honest and, therefore, may say inappropriate or impolite things to other people. Discuss the importance of demonstrating
respect to others.Define constructive criticism and why it is important.
Role play “constructive” and “destructive” criticism before anyone needs to be critiqued.

Role play “appropriate” and “inappropriate” topics of conversation or comments to others.

Barrier-Free Theater book published

Wednesday, Dec. 22, 2010

DRAMA THERAPIST’S NEW BOOK PROMOTES BARRIER-FREE THEATER

MANHATTAN — Sally Bailey, associate professor and director of the drama therapy program at Kansas State University, recently had her third book, “Barrier-Free Theatre,” published by Idyll Arbor. In the book Bailey shares her ideas, tips and anecdotes about making theater accessible to children and adults with disabilities. “If you do theater, but know nothing about disabilities, you’ll learn about them,” Bailey said. “If you know about disabilities, but not about how to facilitate drama, you’ll learn about that. I wanted to give all the building blocks so that people can take what they need. If you have no building blocks, with this book you have a whole kit.”

Bailey was first exposed to drama therapy and learned about accommodating people with disabilities when she worked for various arts programs in Washington, D.C. After becoming a registered drama therapist, she used her skills while working with recovering drug addicts at the rehabilitation facility Second Genesis, and with people with disabilities at Imagination Stage, a nonprofit arts center. She moved to Manhattan to head up K-State’s drama therapy master’s program in 1999. She also is the director of the Manhattan Parks and Recreation’s barrier-free theater. “By chance, one of the families whose children I had worked with in the D.C. area had moved to Manhattan and had talked the parks and rec department into creating a barrier-free program,” Bailey said. “They believed it was so important that every town should have one.”

Bailey’s new book is nearly a decade in the making. She said publishers could not understand who the audience was, but she knows that since 20 percent of people have some kind of disability, the audience is definitely there. “Drama can really level the playing field and allow many different people to work together,” Bailey said. “In the theater all people can express themselves and be creative as equals. Drama can be a part of more people’s lives if directors and teachers know how to include everyone.”

Ancient and Modern Roots of Drama Therapy

INTRODUCTION

The word drama comes from ancient Greek and means quite literally “things done” (Harrison, 1913). Drama therapy is, in simplest terms, the use of action techniques, particularly role play, drama games, improvisation, puppetry, masks, and theatrical performance, in the service of behavior change and personal growth. It has its roots in religion, theatre, education, social action, and mental health/therapy. The North American Drama Therapy Association, created for promoting the field of drama therapy in the United States, was organized  in 1979, but drama therapy has been around much longer than that!

ANCIENT ROOTS: RELIGION AND THEATRE

Evidence in archeological records suggests that early humans began to make art – paintings, sculpture, music, dance, and drama – during the Upper Paleolithic period about 45,000-35,000 years ago. Experts marvel at the suddenness with which the arts burst onto the human scene and tie it to the beginnings of symbolic, metaphoric thought (Pfeiffer, 1982; Mithen, 1996; Lewis-Williams, 2002). Simultaneous with this creative explosion, shamans and priests began utilizing the arts in their healing and religious practices. The origins of the arts and religion seem to be intertwined because the arts naturally provided effective symbolic ways to express abstract religious ideas. Dance and drama, in particular, were extremely useful in rites to create sympathetic and contagious magic as well as to embody myths and rituals. Details about these ancient origins are sketchy, but many scholars have hypothesized about those origins, based on surviving cave paintings, artifacts, myths, and even on extrapolating from contemporary shamanistic practices (Pfeiffer, 1982; Lewis-Williams, 2002).

Greek scholar and cultural anthropologist Jane Ellen Harrison, for instance, theorizes that early art developed directly out of ritual from mimesis or imitation of an experience and became an abstract representation or metaphor which was then available for magical use (Harrison, 1913). However, without a written record providing direct testimony, we cannot know exactly what those ancient practices entailed and how those ancient humans understood their ceremonies.

Eventually, the art form of theatre developed out of religious rites and rituals. Western theatre history usually begins its formal accounts with ancient Greek theatre. Religious festivals dedicated to Dionysus, god of fertility and revelry, featured theatrical competitions in which plays brought mythology to life for the community. The Great Dionysia, held in Athens in early spring, featured tragedies, comedies, and satyr plays written by citizen-poets and performed by citizen-actors for the entire populace. During a choral presentation at one of these festivals around 560 B.C. Thespis, the first actor, stepped away from the chorus to take on an individual character for the first time and theatre, as we know it, was born (Brockett, 1968).

The first written theoretical account of drama therapy can be found in connection with Greek theatre. In Poetics, Aristotle says the function of tragedy is to induce catharsis – a release of deep feelings (specifically pity and fear) to purge the senses and the souls of the spectators (Aristotle, trans. 1954). These cathartic feelings are experienced empathically for the characters in the play by the individuals watching the performance and they share that theatrical/cathartic experience with others in the audience magnifying the release and allowing for an adjustment in the community’s attitude as a whole. According to Aristotle, drama’s purpose is not primarily for education or entertainment, but to release harmful emotions which will lead to harmony and healing in the community (Boal, 1985).

In his analysis of Aristotle’s work, Brazilian director Augusto Boal (1985) suggests that this cathartic release helped preserve the status quo in Greek society, for a populace that is content and at peace will not rebel against the rulers in power. Aristotle’s ideas about catharsis have influenced many psychotherapy models from Freudian psychoanalysis onward by focusing psychotherapeutic work on the idea that insight into troubling emotional issues and healing occurs only after the patient has achieved catharsis. This process is disputed as unrealistic and unnecessary by cognitive-behavioral therapists, rational-emotive therapists, and others who feel that catharsis and insight are not enough to induce healing or change, that new thoughts and behaviors must be learned to replace the old, and that change doesn’t automatically follow emotional release and understanding.

MENTAL HEALTH ROOTS

Ancient physicians recognized the value of drama as a therapeutic tool. Soranus, a second century Roman, believed that the way to cure mentally ill patients was to put them into peaceful surroundings and have them read, discuss, and participate in the production of plays in order to create order in their thinking and offset their depression (Cockerham, 1991). In the fifth century, another Roman Caelius Aurelius took this a step farther. He states in his treatise On Acute Diseases and on Chronic Diseases that in order to achieve emotional balance, patients should go to the theatre and watch a performance that expresses the emotion opposite to their condition. For depression, see a comedy; for mania or hysteria, see a tragedy (Jones, 1996).

For the most part, however, people with mental illness were not treated by taking trips to the theatre or by reading and performing plays; they were locked away in horrible prisons and asylums where they were either forgotten or attempts were made to cure them through exorcisms and treatments which could only be described as torture. Not until the late18th century, with the beginning of the “Moral Treatment” movement, did some mental institutions provide occupational, horticultural, and artistic activities as part of their treatment regimen (Cockerham, 1991; Whitaker, 2001). This approach to treatment continued in enlightened institutions in Europe and America into the 20th century and opened the door to the practice of drama therapy.

The groundwork for inclusion of the art therapies into psychiatric hospitals in the U.S. was laid after World War I. Talk therapy and medical interventions did not help veterans recover from what at the time was called “shell-shock” (now called Post-Traumatic Stress Disorder), the emotional response to traumatic combat experience. However, the arts did help. In the early 20’s and 30’s, inclusion of the arts in hospital programming was expanded. Occupational therapists at many psychiatric hospitals began involving patients in the rehearsal and performance of plays, pageants, and puppet shows. Interestingly, the genre of plays performed was limited to comedy, so as not to upset the patients (Phillips, 1994).

T. D. Noble, a psychiatrist at Sheppard-Pratt Hospital in the Baltimore, MD area, noticed that patients in his psychotherapy sessions who had acted in the hospital plays were able to understand and identify emotions better than other patients, could link their present emotional state and behavior to their earlier trauma more easily, and were able to experiment with alternative modes of behavior with more flexibility (Phillips, 1994). He wrote in a 1933 issue of Occupational Therapy and Rehabilitation that he found drama was a vehicle for the discovery and expression of conscious and unconscious conflicts. Playing other characters in the plays, he noted, helped patients release repressed emotions so that they could later deal with them directly in therapy. He also observed that drama was a useful diversion and encouraged socialization among patients (Phillips, 1994).

SOCIAL ROOTS OF DRAMA THERAPY

The social action root of drama therapy can be traced to Hull House and other sites of the settlement movement. Jane Addams opened Hull House in 1889 to serve as a socializing, civilizing, connective, and reforming force for the immigrant, working-class neighborhood of the Nineteenth Ward of Chicago’s West Side (Jackson, 2001). She set up a series of what she termed “Lines of Activity:” courses, lectures, and group experiences which would bring culture, education, social connection, and change to the community living in proximity to the settlement house. The most popular activities were the drama clubs which provided socialization, a creative outlet, and an exciting group experience which led to a product shared with others (Jackson, 2001). Young people would join drama clubs at the age of seven or eight and found so much meaning in their work together that they would remain in them until they were in their 30’s and 40’s. The Little Theatre or community theatre movement grew, in part, out of the enthusiasm for amateur performance that the Hull House drama clubs created (Hecht, 1991).

Movement and recreational groups were run for children at Hull House by Neva Boyd (Jackson, 2001). She used games and improvisation to teach language skills, problem-solving, self-confidence and social skills. Boyd became a sociology and theatre professor at the University of Chicago and is one of the founders of the Recreational Therapy and Educational Drama movements in the U.S. Her student Viola Spolin, learned Boyd’s techniques and developed them further, writing the widely-studied Improvisation for the Theatre, from which many theatre games and improvisation techniques used in American theatre training and in drama therapy originate (Spolin, 1963).

AMERICAN FORE-RUNNERS IN THE FIELD OF DRAMA THERAPY

The surge in the growth of educational theatre in the U.S. can be traced to this source and to the educational theatre program at Northwestern University in Chicago which was helmed by Winifred Ward. Many founders of the National Association for Drama Therapy began as creative drama teachers. Drama therapists like Eleanor Irwin, Rosilyn Wilder, Naida Weisberg, Rose Pavlow, Jan Goodrich, and Patricia Sternberg discovered the therapeutic benefits of process drama through their work with young children and extended it to other populations in an intentional manner.

Lewis Barbato is credited with first using the term drama therapy in print in an article he wrote in 1945 for the Journal of Psychodrama and Group Psychotherapy, and Florsheim published a book in which she discussed utilizing the enactment of scripted plays as therapy in 1945 (Casson, 2004). However, Gertrud Schattner, a Viennese actress, is credited with popularizing the term drama therapy and providing the impetus to create a national organization in the U.S (Reiter, 1996). In order to avoid Hitler’s invasion of Austria, Gertrud fled to Switzerland for safety during the Second World War on a temporary visa. When it expired, she used her acting skills to have herself admitted to a mental hospital as a patient, convincing the doctors that she was suicidal. She learned a great deal about mental illness from “hiding out” in the hospital (Reiter, 1996).

Gertrud ended up marrying Edward Schattner, a psychiatrist working with refugees and survivors of Nazi concentration camps in a Swiss tuberculosis sanitarium. While he was able to make his patients’ bodies healthier, he had little success healing their utter desperation, depression, and despair. Edward asked Gertrud to come in to the sanitarium to do drama, storytelling, and poetry with the patients in a recreational vein. Through their participation in drama, they began to come back to life. Gertrud recognized what she was doing was something special and out of the ordinary – she called it drama therapy (Schattner, 1981; Reiter, 1996).

After the war the Schattners moved to the U.S. and Gertrud practiced drama therapy in a number of social service organizations and psychiatric hospitals in the New York City area. She taught the first drama therapy courses at Turtle Bay Music Center on Long Island (Reiter, 1996). In the early 1970’s, she and drama educator Richard Courtney began approaching other people who were doing similar work to collaborate on a publication which became Drama In Therapy, Volume One: Children and Volume Two: Adults, the first books in print about drama therapy (Schattner & Courtney, 1981). She and a number of those other pioneers, including David Read Johnson, Eleanor Irwin, Marilyn Richman, Rosilyn Wilder, Naida Weisberg, Ramon Gordon, Jan Goodrich, Barbara Sandberg, and others formed the National Association for Drama Therapy (now the North American Drama Therapy Association) in 1979 in order to promote the training and education of drama therapists, to establish standards for registry, and to promote the field (Finneran, 1999).

EUROPEAN ROOTS OF DRAMA THERAPY

At the same time as drama therapy was developing in Great Britain. The British put the two words together: dramatherapy. Sue Jennings reports that because psychotherapy is one word, British dramatherapists felt their modality should also be expressed in one word. Peter Slade, who as early as 1939 addressed the British Medical Association on the new modality, said he felt it had more force that way. (Jones, 1996).

British origins can be connected to the educational drama work of Peter Slade in the 1930’s in an arts center in Worchester. He wrote Child Drama in 1954, the first book to connect drama with helping children develop emotional and physical control, confidence, observation skills, and abilities to be tolerant and considerate of others. In 1959, Slade began calling what he and others were doing dramatherapy in a pamphlet entitled “Dramatherapy as an Aid to Becoming a Person.” (Jones, 1996).

Brian Way developed similar ideas about the essential growth drama offers participants in his classic book  Development through Drama, which collected ideas and methods from his work in educational drama from the 40’s through the mid-60’s (Way, 1967). Dorothy Heathcote used drama in education for teaching purposes, but also as a way for children to develop insight, understanding, and empathy. In 1964 Marian Lindkvist created the first dramatherapy training program, the Sesame Institute, which focused on drama and movement as forms of learning and expression, particularly in work with children with special needs. Peter Slade worked with her to deepen their method through psychological training.

Another early pioneer was Sue Jennings who began doing drama at a psychiatric hospital when she was a young drama student and called the work she was doing “remedial drama” (Jones, 1996). In the 1970’s, she completed a Ph.D. in anthropology which focused on ritual and started referring to her work as “dramatherapy.” (Jones, 1996). The British Association for Dramatherapists (BADth) was created in 1976 to promote the education and credentialing of dramatherapists in the UK (Jones, 1996). It is interesting to note that this is just three years before the NADT was formed in the U.S. While the British and the American forms of drama therapy developed separately and have different theoretical emphases, they truly did develop along parallel lines and in a similar pattern.

Drama therapy also has a history in Russia and the Netherlands. Phil Jones, in Drama as Therapy: Theatre as Living talks about two Russian drama therapists who were influenced strongly by the work of Stanislavky (Jones, 1996). Nicholai Evreinov, a Russian director, created a method he called Theatrotherapy which focused on the internal and psychological processes involved in acting to create healing and well-being in participants and help them re-frame or re-imagine their difficulties into a new way of life. Vladimir Iljine also created a Therapeutic Theatre in the years before the Russian Revolution (1908-1917) using theatre games and improvisational training to encourage flexibility, spontaneity, expressiveness, and communication abilities. He used his methods with individuals and groups in many situations and locations: psychiatric patients, people with emotional problems, and actors in the theatre (Jones, 1996).

After the Revolution there were others who carried on this work. One, Nikolai Sergevich Govorov, developed a theatrical storytelling technique, which he used to help psychiatric patients and others develop social connections, self-confidence, and socially appropriate behavior (A. Martin, personal communication, June 2, 2004). He felt that much of mental health depended on people having the ability to socialize and support each other morally and humanly. Govorov was very aware of Evreinov’s work and consciously built on it and other Western therapeutic theatre work (A. Martin, personal communication, June 2, 2004). His work developed between the 1950’s and the 1970’s.

One other country in which drama therapy currently thrives is The Netherlands. In the late 40’s, Activity Leaders involved with social welfare and youth care in community and residential care centers began using the arts and play for self-expression and social interaction (Jones, 1996). This gave rise to The Netherlands Society for Creative Expressive Therapy in the 1960s; a branch for dramatherapists was formed in 1981. There are, perhaps, more drama therapists per capita in the Netherlands than anywhere else in the world!

OTHER INFLUENCES

Two other individuals should be mentioned as important influences on drama therapy. The first is Constantin Stanislavky. Before Stanislavsky, theatre was not considered a psychological art. His work at the Moscow Art Theatre (1900-1938) set the stage, not just for actor training in the 20th century, but also for the use of his methods as tools for connecting with the emotional mind by other educators and psychotherapy professionals (Blair, 2002). His intuitive utilization of the imagination (the brain’s natural ability to create imagery and metaphor), the unconscious (as a gateway to connecting with true emotion), and given circumstances (embodying the actor in the physical and psychological details of the moment in which the character is) mesh with research that has been done on neurology and brain processes in the past fifteen years. The body-mind is essentially one, as Antonio Damasio explains in Descartes’ Error and The Feeling of What Happens, and as Stanislavsky’s methods demonstrate (Blair, 2002). Stanislavsky’s methods deeply influenced not just the Russian drama therapists, but also theatre artists from the West, most notably in our case, Viola Spolin and the American theatre educators who developed into the first drama therapists.

The other critical individual who must be mentioned is Jacob Levy Moreno, the father of sociometry, sociodrama, and psychodrama (Johnson in Lewis & Johnson, 2000). Moreno, born in Bucharest in 1889, grew up and studied medicine in Vienna. There, as an attending physician at a refugee camp at Mitterndorf at the end of World War I, he developed sociometry, a method of assessing of the social choices made within a group by its members and then intervening in a systemic way to create social change (Garcia & Buchanan in Johnson & Lewis, 2000). He applied these new measurements and intervention tools to create order and improve living conditions in the displaced residents’ lives. It worked! Later he started what amounted to a support group for Viennese prostitutes, using role play and improvisation to help them find solutions to social problems with which they were faced.

From 1920-24 Moreno led The Theatre of Spontaneity, an improvisational theatre in which professional actors created spontaneous drama based on current events. This work developed into sociodrama and later psychodrama as the focus changed from the community and social issues to personal and psychological issues of individuals. Moreno emigrated to the U.S. in 1925 where he continued developing his methods with the general public through the Impromptu Theatre at Carnegie Hall and by consulting at prisons, psychiatric hospitals, and residential treatment centers. In these latter institutions, he helped individuals who had serious personal, emotional or social problems learn how to function better (Blatner, 2000). The American Society for Group Psychotherapy and Psychodrama (ASGPP) was founded in 1942. Many of the pioneers of creative arts therapy movements, experiential therapy, and traditional talk therapy came to his sessions and were influenced by his work, including Marion Chase, Eric Berne, Arthur Janov, and Fritz Perls (Blatner, 2000; Johnson in Lewis & Johnson, 2000).

Psychodrama and drama therapy purists would argue that Moreno’s work is not a subset of drama therapy, but there is some truth to the idea that Moreno was the “first drama therapist,” as he identified role and social relationships as important therapeutic issues through his writing and work with clients long before American or British drama therapists became organized or began publishing (Johnson in Lewis & Johnson, 2000). My view of psychodrama is that it is part of the drama therapy toolbox, and, therefore, its story rightfully belongs as part of drama therapy history.

CURRENT AND FUTURE DIRECTIONS

Currently, there are four Master degree programs in the U.S. and one in Canada approved by NADTA for training drama therapists: New York University in New York City, California Institute for Integral Studies in San Francisco, Lesley University in Cambridge, MA, Antioch University in Seattle, WA, and Concordia University in Montreal, Quebec. NADTA has also developed an alternative training program that allows students to work with a Board Certified Trainer/Mentor to create an individualized program of study in drama therapy in conjunction with a Masters degree in theatre, social work, counseling, special education, or another related discipline. Kansas State University functions as the only university with a drama therapy program under Alternative Training.

Being an interdisciplinary field, training in drama therapy requires courses in psychology/therapy, drama therapy, and other creative arts therapy as well as internships in which students practice their skills and receive supervision from experienced professional drama therapists and other credentialed mental health professionals.

The professional credential for drama therapists in the U.S. and Canada is the R.D.T. (Registered Drama Therapist) which can be applied for after one has finished an appropriate Masters degree, the approved drama therapy and psychology coursework, an 800 hour drama therapy internship, a minimum of 500 hours of theatre experience and a minimum of 1,500 hours of professional hours working as a drama therapist. Most registered drama therapists have much more than a minimum of 500 hours of

Most registered drama therapists have much more than a minimum of 500 hours of theatre when they discover drama therapy since most begin as theatre artists or educators who discover the healing aspects of drama through their theatre training and work. However, more and more social workers, counselors, and special educators are discovering that talk therapy is not enough; that there is a need for “things done” in therapy for insight and change to be effective for clients. As this happens, drama therapists with theatre origins are being joined by drama therapists with clinical mental health backgrounds who have discovered the magic and intrinsic healing value of drama. Among the ranks of drama therapy students, there are also ministers, priests, and rabbis who have discovered the healing power of drama therapy. Perhaps this is an indication that we are rounding the bend to complete the circle to the place where our drama therapy roots began.

DRAMA THERAPY TIMELINE

 43,000 BC – 33,000 BC Homo sapiens sapiens begin thinking symbolically and creating arts (painting, sculpting, dance, drama).

 

TIME

EUROPE RUSSIA

NORTH AMERICA

400-500 BCE     GreeceOrigins of Greek Theatre    
534 BCE             GreecePrize for Best Tragedy established at City Dionysia Festival.    
c. 560 BCE Greece:  Thespus steps out of Greek Chorus to become first actor.    
c. 335-323 BCE Greece:  Aristotle writes Poetics.
     
c. 100-200 ACE  Rome Soranus has mentally ill patients reading and performing plays.    
c. 500 ACE     Rome:  Caelius Aurelius writes On Acute Diseases and on Chronic Diseases.    
 1789 Paris: Moral Therapy reforms begun by Phillippe Pinel and continued by others in Europe.   Moral Therapy continued by others in America.
1889-1900     Hull House, ChicagoTheatre and theatre games with immigrants by Edith de Nancrede and Neva Boyd.
1900-1930 Moscow: Constantin Stanislavski develops his psychological acting method at the Moscow Art Theatre. Hull House, ChicagoTheatre and theatre games with immigrants by Edith de Nancrede and Neva Boyd.
1908-1917  Vienna:  Jacob Moreno develops sociometry. (1917) Kiev: Vladimir Iljine develops Therapeutic Theatre.  
1920-24 Vienna:  Moreno creates the Theatre of Spontaneity. St. Petersburg: Nicholai Evreinov develops   Theatrotheatre.  
1925     Chicago:  Winifred Ward begins educational drama movement; Neva Boyd begins therapeutic recreation movement.
1926-40        New York:  Jacob Moreno developing psychodrama in prisons/hospitals.
1930’s UK:  Peter Slade begins working with children. Occupational therapists using drama with residents in psychiatric hospitals.

Chicago: Viola Spolin is developing her improvisation methods.

1940– 47               Switzerland:  Gertrud Schattner works with refugees in Swiss sanitarium.    
1942     New York:  Moreno founds American Society for Group Psychotherapy & Psychodrama                                                (ASGPP).
1947     New York:  Schattner and Moreno work in schools and hospitals.
1950-70 UK:  Peter Slade writes Child Drama (1954).

UK:  Peter Slade writes Dramatherapy as an Aid to becoming a Person (1959).

UK:  Sue Jennings begins doing “remedial drama” (1960).

The Netherlands: The Netherlands Society for Expressive Therapy formed (1960).

St. Petersburg: Nikolai Govorov develops his drama therapy techniques. New York:  Schattner and Moreno work in schools and hospitals.

 

 

                                                  

1964 UK:  Marian Lindkvist opens The Sesame Institute (1964).   New York: Schattner teaches 1st DT training program at Turtle Bay Music Institute.
1975     Chicago: Marilyn “Toddy” Richman founds The Institute for Therapy Through the Arts.
1976 UK: British Association for Dramatherapy (BADth) founded.    
1979     National Association for Drama Therapy  (NADT) founded.

National Coalition for Creative Arts Therapies (NCCATA) founded.

1981 The NetherlandsDrama Therapy Branch formed in The Netherlands Society for Creative Expressive Therapy   Drama In Therapy, Vols. I and II, published, edited by Gertrud Schattner and Richard Courtney.
1982     Pittsburgh, PA: First Registered Drama Therapist: Eleanor Irwin.

New York: 1st DT MA Program approved at  NYU.

1983     California: 2nd DT MA Program approved at Antioch-Sacremento, later moved to California Institute of Integral Studies in San Francisco.
1999     Montreal: 3rd DT MA Program approved at Concordia University.
2012     NADT changes its name to North American Drama Therapy Association (NADTA) to better represent membership, which includes many Canadian members,
2014     Cambridge, MA: 4th DT MA Program approved at Lesley University.
2015     Seattle, WA: 5th DT MA Program approved at Antioch University.

Drama Therapy Review: First issue of the first journal devoted solely to drama therapy. DTR documents and disseminates research on the relationship between drama, theatre, and wellness.

 

Bibliography

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Brockett, O. (1968). History of the theatre. Boston: Allyn and Bacon, Inc.

Boal, A. (1985). Theatre of the oppressed. NY: Theatre Communications Group.

Casson, J. (June 30, 2004). “Tribute to Peter Slade,” read at Peter Slade’s funeral.

Cockerham, W. C. (2000). Sociology of mental disorder. Englewood Cliffs, NJ: Prentice Hall.

Damasio, A. (1994). Descartes’ error: Emotion, reason, and the human brain. New York: Avon Books.

Damasio, A. (1999). The feeling of what happens: Body and emotion in the making of consciousness. San Diego: Harcourt, Inc.

Finneran, L. (1999). Beginnings: Letters to and from Gert. (Dramascope. (19) 2, 1, 18-20.

Gordon, R. (1999). Beginnings: Cell Block Theatre. Dramascope. (19) 1, 1, 13, 26.

Harrison, J. E. (1913). Ancient art and ritual. Bath, England: Moonraker Press.

Hecht, S. J. (1991). Edith de Nancrede at Hull House: Theatre programs for youth.Youth Theatre Journal. (6)1, 3-10.

Jackson, S. (2001). Lines of activity: Performance, historiography, Hull-House domesticity. Ann Arbor, MI: University of Michigan.

Jones, P. (1996). Drama as therapy: Theatre as living. London: Routledge.

Landy, R. (1997). Drama therapy – The state of the art. The Arts in Psychotherapy. (24)1, 5-15.

Lewis P. & Johnson D. R. (Eds.). (2000). Current approaches in drama therapy. Springfield, IL: Charles C. Thomas Publisher.

Lewis-Williams, D. (2002). The mind in the cave: Consciousness and the origins of art. London: Thames & Hudson.

Mithen, S. (1996). The prehistory of the mind: The cognitive origins of art, religion and science. London: Thames and Hudson, Ltd.

Pfeiffer, J.E. (1982). The creative explosion: An inquiry into the origins of art and religion. New York: Harper & Row.

Philips, M. E. (1996). The use of drama and puppetry in occupational therapy during the 1920’s and 1930’s. The American Journal of Occupational Therapy (50)3, 229- 233.

Reiter, S. (1996). Honoring Gert Schattner. Dramascope (14)1, 1, 3.

Schattner, G. & Courtney, R. (1981). Drama in therapy, Volume One: Children, NY: Drama Book Specialists.

Slade, P. (1954). Child drama. London: Hodder and Stoughton.

Slade, P. (1959). Dramatherapy as an aid to becoming a person. Pamphlet, Guild of Pastoral Psychology.

Spolin, V. (1963). Improvisation for the theatre. Evanston, IL: Northwestern University.

Stanislavsky, C. (1936). An actor prepares. New York: Theatre Arts Books.

Way, B. (1967). Development through drama. Atlantic Highlands, NJ: Humanities Press.

Whitaker, R. (2001). Mad in America: Bad science, bad medicine, and the enduring mistreatment of the mentally ill. Cambridge, MA: Perseus Publishing.

Art as an Initial Approach to the Treatment of Sexual Trauma for Creative Therapies for Sexual Abuse Survivors

SEXUAL TRAUMA AND THE BRAIN

I am a drama therapist who could not function properly without art, music, movement, and poetry. All of the other art modalities intersect with drama, prepare for it, enhance it, empower it, develop it, and release it. I have found this to be particularly true when working with clients who are recovering from sexual trauma.

Because sexual trauma runs so deep and creates so much overwhelming shame and confusion within the survivor, addressing the emotional wounds caused by the manifestations of sexual abuse requires the choice of therapeutic methods which can create emotional distance and a safe container. Survivors of sexual trauma are not just “resisting” when they avoid dealing with their issues or when say they can’t access their emotions because they feel numb. They are not just “overreacting” when they lash out in anger, experience flashbacks, or display other emotional outbursts in or outside of the therapy session. Their behavior is a direct result of the biological changes that have occurred in their brains in response to their traumatic experience.

Studies reveal that trauma material is not encoded in the brain’s long-term memory system in meaningful narrative form as non-traumatic experiences are, but is dissociated into somatic sensations, undifferentiated, free floating affective states, and visual images that can break through to consciousness in nightmares and flashbacks (van der Kolk et al, 1996; van der Kolk, 2002). This is experienced as threatening and overwhelming as if the trauma were happening all over again in the present moment, not as a past event (van der Kolk et al, 1996; van der Kolk, 2002). An immediate lack of emotional distance is created the minute the survivor starts accessing the past trauma, whether triggered by chance in everyday life or on purpose in therapy.

Words are inaccessible when the brain is in a traumatized state. Brain scans reveal that while remembering trauma, survivors’ right hemispheres, where negative emotions are processed, become active and Broca’s area in the left hemisphere, where words are processed, shuts down (van der Kolk, 2002). This literally leaves trauma survivors in a speechless condition. Bessel van der Kolk, one of the world’s foremost authorities on traumatic stress reactions, says, “When people get close to reexperiencing their trauma, they get so upset that they can no longer speak….Fundamentally, words can’t integrate the disorganized sensations and action patterns that form the core imprint of the trauma.” (Wylie, 2004, 34-35). As a result, he currently advocates nonverbal therapeutic approaches to trauma material (Wylie, 2004; van der Kolk, 2002).

VISUAL IMAGES TO ART TO WORDS

If clients do not have access to words, it makes sense that the subject of the trauma is best broached through images. Likewise, if clients feel mentally, physically, and emotionally overwhelmed when approaching traumatic memories, it makes sense that a less embodied, more distanced therapeutic modality be used. Art therapy is often a better initial approach to identify and express an experience that was horrific beyond words and somatic in origin. The visual images have been preserved in unconscious, nonverbal memory and can serve as the tools to bring the unconscious to light. The resulting art work acts as a safe, distanced container that can hold the feeling and the memory of the experience for the client.

Putting the trauma into words so it can be understood, translating those words into metaphors, and integrating the meaning that is created back into one’s life history is necessary for healing. Humans are narrative-making creatures and we cannot integrate an experience into our mental schema and emotional make-up until we can make sense of it for ourselves within a worded story of our life (Dayton, 1994, 1997, 2000; Herman, 1992; van der Kolk et al, 1997). The art work, because it physically exists, can capture the essence of the image and feeling in a way that does not feel overwhelming. It can then be returned to in future therapy sessions as a resource for putting the experience into words and creating metaphors. The therapist can say, “Tell me about this,” or “Tell me more.” What often begins as a description of the object turns into an explanation of what it means at a symbolic level or a narrative of the traumatic experience itself. Therapeutic work can move into the other distancing containers of movement, music, drama, or poetry later when the client has been able to get past the hurdle of acknowledging the traumatic experience to the self and to witnesses (therapist alone or therapist and group) and has moved a little further into the healing process. At all points the client can feel in control because she made the image herself, she is able to step back from it to observe it, and she uses her own words to describe what it means to her.

SEXUAL TRAUMA AND ADDICTION

While I was working with recovering drug addicts at Second Genesis in Washington, DC, a long-term residential substance abuse treatment center, I found that the vast majority of my clients, both male and female, had experienced multiple sexual traumas. Van der Kolk states that about one-third of traumatized people eventually turn to alcohol or drugs to relieve themselves from the emotional symptoms caused by their trauma (van der Kolk, 2002, 38). I discovered as I listened to my clients’ stories that many were survivors of childhood/adolescent incest or rape and almost all of them had prostituted themselves during their addiction in order to procure drugs. If you needed to get high and you didn’t have any money, sooner or later you ended up prostituting yourself formally for money or informally as a barter for drugs. It was hardest for the men to admit to this, since most of them identified as heterosexuals but had engaged in homosexual acts. The vast majority of potential customers interested in buying sex on the street were men who were looking for either heterosexual encounters or homosexual encounters. While everyone felt shame about their street behavior after they got sober, the heterosexual men had real difficulty coming to terms with their prostitution experiences, as it was cognitively dissonant with their life-long internalized beliefs about their sexual preference. African-American males had the most problem as their community is traditionally macho and homophobic.

Additionally, addicts who ended up imprisoned had often endured rape while incarcerated, sometimes gang rapes by other inmates or sexual alliances forged with one particular inmate to gain protection from gang rapes and abuse at the hands of prison staff. This set up existed in male and female prisons. Although protection through sexual alliances was a practical matter of survival behind bars, it was still experienced as extremely shameful and traumatizing, particularly for males. The Bureau of Justice Statistics did its first survey of sexual violence in prisons in 2004. The statistics reveal that proportionally more male prisoners than female experienced and reported nonconsensual sex acts and that 42 percent involved staff-on-prisoner violence. Actual figures identified only 2,090 incidents in the six-month period of the survey, but as the survey was completed by prison officials in relation to reported sexual violence and not gathered directly or anonymously from inmates, the true figures of all cases of rape, sodomy, and harassment are undoubtedly higher (BJS, 2006).

On one hand, if residents did not admit to their past sexual traumas, especially those incurred while they were active addicts, treatment staff did not feel they were fully addressing the goal of Phase 1 of the program (Accepting the Need to Change) or Steps 4 and 5 of the 12 Steps of AA/NA (Narcotics Anonymous, 1988):

Step 4: We made a searching and fearless moral inventory of ourselves.

Step 5: We admitted to God, to ourselves, and to another human being the exact nature of our wrongs.

On the other hand, residents were not supposed to focus on healing from their sexual traumas while in drug treatment because the philosophy of the therapeutic model required that they focus on recovery from their drug addictions first. The idea behind this focus makes sense at first glance. Residents were in treatment primarily for their addiction, so that was what the therapeutic contract identified and prioritized. Overseeing government agencies and managed care organizations that pay for treatment like to see very specifically identified goals and objectives on treatment plans that refer directly back to the identified treatment issue they are funding. Many staff members were recovering addicts themselves who had earned their certification in addictions counseling, but were not trained in dealing with sexual trauma. Many of them were still young in their own recovery from substance abuse and had not yet addressed their own sexual trauma issues. When I brought up the need to deal with abuse issues in our treatment team meetings, I was told focusing on them would take away from addiction issues and we hardly had enough time to work through them. The official word from above was that healing from sexual traumas or any other traumatic experiences prior to or concurrent with addiction were supposed to wait until the recovering addicts had been clean and sober for a minimum of a year, otherwise their sobriety was at risk.

However, this caused a very big Catch-22. One of the major reasons these clients had become addicts in the first place was to numb the emotional pain caused by their sexual (and other) traumas. Stopping the drugs meant not just struggling with the symptoms of withdrawal and the cravings created by their physical and psychological addiction; it also meant that with sobriety the old feelings from the trauma that had been numbed away for so long started to come back.

Many residents were not able to handle learning to live without drugs, developing the social and emotional skills they had not practiced for years while “on the street,” holding at bay all the feelings of guilt and shame for their addictive behavior (cheating, lying, stealing, neglecting children and spouses, betraying friends and family) while doing drugs, and handling the feelings generated by their unresolved traumas. It was too overwhelming. Second Genesis had a very high success rate as far as drug treatment programs went (33%), but many people absconded and relapsed before they ever finished the program, and I have always believed that some of them left in order to medicate their trauma symptoms, not because they couldn’t resist drug cravings.

CASE EXAMPLE: THE BOX SELF-PORTRAIT WITH CAMILLE

For the first eight years I worked at Second Genesis, I was the itinerant drama therapist who traveled between the six residential facilities running a weekly drama therapy group in each. Later I worked full time as a primary therapist and drama therapist at Melwood House, the facility for women addicts and their children. Throughout these years other primary therapists came to me to share that they had difficulty getting their clients to deal with essential issues in individual sessions. Some clients resisted talking in group sessions about anything beyond the obvious (“I had a drug problem.”). I didn’t have difficulty getting drama group members to open up about issues or to talk in my drama group because through basic games and improvisations they began to feel very safe with each other and with me. Usually about the fifth or sixth session, I would bring in an art exercise which we used to facilitate NA Steps 4 and 5, the “searching and fearless moral inventory.” I called this the Box Self-Portrait. This exercise creates a literal and metaphorical container for clients’ issues in concrete three-dimensions. It illuminates for them the emotional dichotomy that exists for them as addicts and survivors: projecting a false identity to the world on the outside while hiding their real thoughts and feelings inside. Denial is a big issue in addiction and must be addressed before addicts can begin to “get honest” and “deal openly” with their issues. Dissociation is a big issue in trauma and must be broken through before the trauma can be consciously accessed and addressed. Exploring their feelings through the Box Self-Portrait helped reveal what was happening on the inside while also validating the existence of their outside defenses. In a sense, they could have their cake and eat it, too, because they were able to acknowledge their defenses and what those defenses were protecting.

I bought three different sizes/shapes of boxes from a local bakery supply store and brought in an array of art supplies: Magic Markers, crayons, construction paper, tissue paper, pipe cleaners, colored cellophane, scissors, tape, and glue. Each person picked a box that best represented them (a big rectangular box, a flat pie box, or a medium square box). They were to decorate the outside with colors, shapes, pictures, and symbols (no words unless they were involved in a symbol – like a STOP sign) to express all the qualities, emotions, behaviors, and personality traits – good and bad – that they show to others. They decorated the inside with colors, shapes, pictures, and symbols to express all the qualities, emotions, behaviors, and personality traits – good and bad – that they experience on the inside, but which they may or may not show to others. I always had to say “good and bad” or I would only get one or the other, depending on how the person was feeling about himself that day. A talent for drawing was not necessary in order to make the box very effective and striking because there were the options of cutting out paper, coloring designs, making three-dimensional objects to put inside or outside, or even cutting the box itself.

Drama group was two hours long. After a check in and a physical warm-up, the group members typically spent an hour creating their Box Self-Portraits. Then we went around the circle and shared them. Each person got to describe what the symbols on the box and inside the box meant.

What was inside the box was hidden from view as long as the box was closed, but when the box was opened, it became visible for the whole group to see. This often caused some anxiety for people who were willing to express what was happening on the inside as long as nobody ever saw it. My response to their questions about this while they were working was, “The rule for this exercise is you have to show us whatever you put in the box, but then you can close the box back up after you show us. If you don’t want to show us something, don’t put it in the box.” This was enough of a reassurance of safety for group members to move forward. I never had anyone refuse to open their box and share it with the group, partly because there was a great deal of pride generated in making this kind of self-portrait and partly because of the level of trust we had generated by that time in the series of sessions. While I’m sure there were plenty of unhappy experiences and ugly feelings that did not get put in boxes, no one avoided including at least some of their uncomfortable inside parts. If nothing else, I could always count on getting a depiction of the person’s drug of choice!

The sharing time was often the first time many had ever expressed either their abuse or the emotions they felt about it. One of the most dramatic examples of this was Camille, whose earliest memory at the age of 3 was of her older brother sexually abusing her, a practice he kept up the entire time they were growing up. When, as a teenager, Camille finally disclosed the abuse to her mother, she was not believed. Camille had to wait until her brother graduated high school and went out on his own for the daily abuse to stop. By that time she had such a low self-concept and lack of physical and emotional boundaries that she continued to allow herself to be used sexually by every man who came her way. In groups and individual sessions at the beginning of her treatment, she insisted that she wasn’t angry about anything, that she was, on the contrary, very happy and optimistic. Her rationale for this happy state of mind was that she had made it into treatment and was in the process of turning her life around.

It wasn’t until she made her Box Self-Portrait that she felt safe enough to express the truth. The outside of her box had a bright happy sun on it with flowers growing and birds flying in the air, but the inside of the box she had filled with a three dimensional sculpture of red, orange, and black tissue paper in the form of an erupting volcano. And underneath the volcano, drawn very small in faint crayon was a little girl, hidden, helpless, and trapped beneath it all.

Color is an important element in art therapy as it symbolizes emotions. Some color symbolism is culturally derived. For example, in Western countries white symbolizes purity which is why brides wear white, but in many Asian countries, white symbolizes death and is the color worn by mourners. Some use of color is based on nature: fire is red, grass is green. Other uses are very personal emotional symbols, such as a client associating lavender with love because her loving mother always wore that color. Due to different associative experiences, one person may associate a color with one quality or emotion, while another associates the same color with something very contrasting. For example, someone who loves being near and in water might associate blue with relaxation and happiness while another might associate it with sadness, and another might connect it with fear. Some art therapists subscribe to the belief that certain colors always represent certain emotions, but I was trained in the psychocybernetic model of art therapy (Nucho, 1987), so I believe in asking clients to interpret their work to me, rather than putting my own symbolism on their images. This, I think, works well with trauma survivors because a large part of their therapeutic task in recovery is to make meaning of their own experience (Dayton, 1997, 2000; Herman, 1992; van der Kolk et al, 1997).

Camille reported that the red, orange, and black symbolized a volcano, its molten lava, and fire which, in turn, symbolized her rage. She was relieved to finally be able to express what she was feeling in (what she considered) an indirect way. In her mind she hadn’t actually said, “I’m angry,” but she was able to acknowledge the unacceptable emotion. Anger had not been an emotion that was allowed expression in her home at any time in her past or present.

Anger, like all emotions, is a survival signal that tells us when we are in potential danger and we need take action to protect ourselves from being violated (Bilodeau, 1992; Tavris, 1982.) However, anger is usually not expressed openly by survivors to their abusers or to their families, sometimes not even to themselves. Expression of it during or after the trauma could have put them in danger at the hands of their abuser. In case of incest, where there are family bonds and emotional connection at stake, expressing anger could put the survivor at risk of losing the love of the abuser to whom she still feels a loving connection. Instead survivor anger tends to be turned inward against the self, leading to depression, self-harm, or suicide attempts (Dayton, 1997, 2000; Herman, 1992). If trauma occurs repeatedly over a long period of time, the survivor can develop learned helplessness, a belief that action is useless and the only choice is to accept the abuse passively (Dayton, 2000).

Whenever Camille had expressed her anger in the years after she revealed her brother’s abuse, her mother and father had accused her of trying to hurt them and rejected her. After Camille made the volcano, she began to be able to talk about her family dynamics and to understand how her parents had been implicitly involved in the abuse by turning a blind eye to her situation. She began to acknowledge all the emotions – positive and negative – that she was experiencing on a daily basis. She went back to working through The Courage to Heal (Bass & Davis, 1988), a self-help book for survivors of sexual trauma, which she had tried unsuccessfully to work on during her addiction. Later in treatment, I had her write a fairy tale about the little girl under the volcano and explore how she got there and how she finally got out. Camille also began attending a weekly sexual survivors’ support group outside of the facility.

I was called on the carpet for allowing Camille to work on her sexual abuse issues so directly. The facility director said, “Residents aren’t ready to deal with sexual trauma while they are in treatment.” But I knew that if I didn’t help her deal with it while she was in a residential facility where there was lots of support – staff members and other residents to whom she could go to 24 hours a day – that once she moved out and the old feelings of guilt and shame returned, she would start smoking crack again in order to deal with the feelings.

Other residents also used the Box Self-Portrait to symbolize traumatic experiences in acceptable and safe ways. Using images instead of words, they felt as if they were being extremely honest and direct, while also being covert and indirect. They enjoyed being able to feel proud and sneaky at the same time. As addicts they put a great deal of energy into rationalizing, hiding behind words, and manipulating meaning for others and themselves through language. Graphic images bypassed their practiced verbal abilities and gave them an “out” for being honest since it was a wordless medium. It was simultaneously less real and more real, in part because it was an unfamiliar way of communicating, but also because it created a safe distance and communicated viscerally, as opposed to intellectually, through color, shape, and image. Great pride was taken in sharing images and then revealing their meaning through words. For many, it was their first truly honest attempt at a moral inventory they had undertaken.

CASE EXAMPLE TWO: DRAWING AND MASK MAKING WITH GENA

At the time I was working at Melwood House, the entire residential treatment program lasted six months, and each drama therapy group was about three months long. Phase 1: Accepting the Need to Change was 1 month. Phase 2: Working on Recovery and Relapse Prevention was three months. Residents were usually assigned to drama therapy group in this second phase. Phase 3: Re-entry was two months. Then the women returned for after-care meetings one evening a week for several months.

Gena, one client on my caseload, waited until she was in her sixth month before she revealed that she had been incested as a teenager. Throughout her time in treatment, she had been compliant, but evasive. I knew there was something going on inside, but she wouldn’t let anyone in. She was what Second Genesis staff called a “people pleaser,” willing to work hard and do anything asked of her, to the point of denying her own needs in hopes that others would like her. She had difficulty disciplining her children because that meant confronting them and saying, “No!” She agreed with whatever others said and never put forth her own opinion to avoid confrontation and controversy. In essence, she compromised her own needs, wants, and desires in order to fulfil those of others; however, what happened instead was that she was used by them and then abandoned. She would not set limits on the negative behaviors that others performed in her presence and would “go along” in order not to make waves. This had the potential of jeopardizing her recovery, because if she got involved with the wrong crowd once she was out on her own, she could end up relapsing because she couldn’t say no. “People pleasing” is a survival behavior that develops in chemically dependent and abusive families. It works but at great cost to the self-efficacy of the “people pleaser.”

In the early months, Gena would do anything to avoid individual sessions with me, because – as it turned out – she was afraid she would reveal her traumatic secret and I would not like her anymore. She would always say, “I’m OK. I don’t want to bother you,” and would go on an errand or work down in the child care center. I would have to seek her out and tell her again and again that she was not bothering me; she deserved her individual session; furthermore, she was required to have one. Finally, the week before she was ready to move out, in her individual session she was talking about how even though she was getting ready to leave, she did not feel ready because she still felt uncomfortable. She said she could not describe it in words, but she felt it in her body. I asked her where this uncomfortable feeling was and she pointed to her chest. Then, I asked if she could maybe draw for me what it felt like. She quickly drew a little round ball with many spikes sticking out of it. It looked to me like an explosive mine. I asked her to tell me about it and suddenly she was telling me the story about how her mother and father had died when she was about eleven and she had to go live with her grandmother and grandfather. A year or so later her grandmother died. Her grandfather started “using her for his sexual needs.” And her uncle who lived with them found out. Instead of rescuing her, he demanded that his father share her with him. She seriously considered running away, but she did not know how she would survive on her own, so she stayed. And began hating herself. And doing drugs to numb the pain. None of this history was in her intake interview, nor had she breathed a word of it in any groups she had participated in the last six months.

When I asked, “Why didn’t you tell me about this before?” her response was, “I have never told anyone before, and I thought if I told you, you would think badly of me.” I immediately reassured her that it was not her fault, that she did nothing to deserve this treatment, and, of course, I did not think badly of her! She was immensely relieved.

I knew that having just revealed this horrible secret, leaving treatment would be experienced by her as a rejection. In truth, her revelation was quite literally a cry for help. I told her I thought we needed to bring this information to the attention of the director and the rest of the therapeutic team because maybe now was not the right time for her to move out, maybe she needed some more time in the facility to work on this important issue. She agreed. I requested that she be demoted to Phase 1 so she could start treatment over. My reasoning to staff was that she was only now finally able to be honest and could begin addressing her addiction issues. The rest of the staff agreed with me and she was able to stay for another six months.

Never a verbal person, art remained the best way for Gena to express how she felt, how she thought, and how she could change. One of the most powerful pieces she made during that time was a plaster of Paris life mask that expressed exactly how her history of abuse fueled her people-pleasing behavior. Again, the outside/inside metaphor helped her express the conflict between her feelings and her behavior. The outside of the mask was painted with images of love – a large heart covering her mouth showed she only said loving and pleasant words to others and another heart on her forehead showed how she only thought positive thoughts about others. But on the inside of the mask, the heart over her forehead was broken and the whole bottom of her face was covered with prison bars which held back the words she really wanted to say: No! No! No! No! No!

When asked what the two faces would say if the mask could come alive, she wrote:

Outside Mask depicting "The People Pleaser"
Outside Mask of “The People Pleaser”


FRONT
I’m looked on as
The one who’s always happy,
Smiling,
Always caring,
Always sharing,
Always willing to do whatever
For whoever.

Inside Mask, “No!”

BACK
But what I’m really feeling is
Frustration,
Angry,  Guilty,
Because what I really want to say is
“NO, NO, NO,
PLEASE NOT NOW!”
But I’m afraid I might hurt your feelings.


Six months later Gena was truly ready to move out with her children and begin to try to live life on life’s terms. She had matured a great deal, and while she still struggled with “people pleasing,” she had begun to be able to hold herself and others accountable for their actions.

Conclusion
My experience suggests that traversing the bridge of healing involves careful movement from unspeakable wound to image to languaged story in order to unlock and release the trauma trapped in the heart and mind of a survivor. A journey that happens too quickly or which covers too much distance at once can cause re-traumatization or can scare the client into being unwilling to make the journey at all. Art, as a more primal expression than language, but a less embodied one than movement, can be a valuable tool, particularly in allowing the client an initial way of expressing what seems to be inexpressible.

WORKS CITED

Bass, E. & Davis, L. (1988). The courage to heal. New York: HarperCollins Publisher, Inc.

Beck, A.J. & Hughes, T.A. (July 2005). “Sexual violence reported by correctional authorities, 2004.” U.S. Department of Justice, Bureau of Justice Statistics Special Report. Retrieved January 30, 2006, from http://www.ojp.usdoj.gov/bjs/pub/pdf/svrcao4.pdf

Bilodeau, L. (1992). The anger workbook. Minneapolis, MN: CompCare Publishers.

Dayton, T. (1994). The drama within: Psychodrama and experiential therapy. Deerfield Beach, FL: Health Communications, Inc.

Dayton, T. (1997). Heartwounds: The impact of unresolved trauma and grief on relationships. Deerfield Beach, FL: Health Communications, Inc.

Dayton, T. (2000). Trauma and addiction: Ending the cycle of pain through emotional literacy. Deerfield Beach, FL: Health Communications, Inc.

Herman, J. (1992). Trauma and recovery. NY: Basic Books.

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

Nucho, A. (1987). The psychocybernetic model of art therapy. Springfield, IL: Charles C. Thomas Publisher.

Rizzo, T. (January 23, 2006). “New study sheds light on prisons’ sexual predators.” Kansas City Star, A1, A4.

Tavris, C. (1982). Anger: The misunderstood emotion. New York: Simon & Schuster.

van der Kolk, B. (2002). “In terror’s grip: Healing the ravages of trauma.” Cerebrum, 4(1), 34-50.

van der Kolk, B., McFarlane, A.C., & Weisaeth, L., eds. (1996). Traumatic stress: The effects of overwhelming experience on mind, body, and society. New York: Guilford Press.

Wylie, M.S. (2004). “The limits of talk.” Psychotherapy Networker. 6(1), 30-41, 67.


APPENDIX
Sample of Therapy Plans for Drama Therapy Group at Melwood House

Session One: Introduction
Physical Warm-up
Name Game
Individual introductions to group and pantomime something you like to do
Mirrors

Session Two: Games
Check in (Identify an emotion)
Physical Warm-up
The Winds are Blowing
Partner Pantomimes
What Are You Doing?

Session Three: Nonverbal Communication
Mind-Reading
Physical Warm-up
Come-Go-Stay
Identify Personal Space
Making an Entrance
Tone of voice/Open Scenes

Session Four: Personal Inventory
Check in (What color are you?)
Stretch and write your names in the air
Make Self-Portrait boxes and share

Session Five: Setting Goals
Check in (What animal do you feel like?)
Pass the imaginary object and change it
Emotion statues (drama game)
Past-Present-Future Self Portrait Statues (drama game)

Session Six: Mask Making
Check in
Physical Warm-up
Make plaster of Paris Life Masks

Session Seven: Mask Making
Check in
Physical Warm-up
Design and begin painting masks

Session Eight: Mask Making and Exploration
Check in
Physical Warm-up
Finish painting masks
Writing: Imagine what the inside and the outside of the mask would say to you if it came alive. Write it down.

Session Nine: Performance and Closure
Check in
Physical Warm-up
Practice performing mask pieces
Perform mask pieces for invited audience
Graduation from Drama Group

Ideas for Inclusive Playwriting

Think in terms of the strengths and talents of your actors – what do they do best?

INCORPORATE THEIR STRENGTHS AND INTERESTS INTO THE SCRIPT.

Think of ways to SIDE-STEP the WEAKNESSES of your actors.

  • You can do this by not giving actors action or lines that you know would be difficult for them.
  • Incorporate other actors into the scene who can help them (see ideas below).

    CAST the play before you begin to write so you can pair up people who can help each other in different ways during the course of the play.

    INCORPORATE SPECIAL TALENTS:
  • Playing an instrument,
  • Dancing,
  • Singing,
  • Pantomime,
  • Juggling,
  • Magic Tricks,
  • Telling jokes,
  • Howling like a werewolf,
  • Puppetry,
  • Pratfalls, etc.

    INCORPORATE wheelchairs and other devices into the play so there is a reason for the devices to be onstage:
  • Thrones,
  • Carriages,
  • Royal litters,
  • Haywagons,
  • Ambulances,
  • Trucks,
  • Cabs, etc.

    • On the other hand, you don’t HAVE to have a rationale or excuse for a character to be in a wheelchair or to have another obvious disability – you can have that just be part of that character that is not even remarked upon in the play.

• Don’t let a device or a disability stop a character from doing what he or she needs to do in the play. Where there’s a will, there’s a way.

IF A LINE IS DIFFICULT TO SAY, rewrite it:

  • Use different words
  • Change the order of the phrases
  • Shorten the line


USING MEMORIZATION STRENGTHS:

• Use the natural speaking rhythms, phrasing, and vocabulary of your actors, especially if the script is based on their improvisations. If the lines are already in their words, speech, and thought patterns, they will be easier for actors to speak and remember.

• If you have an actor who is a good memorizer, have him or her ask questions in a scene to an actor who is not as good at memorization. It is easier to remember the answer to a question (especially since you know the answer from the script) than it is to remember a question.

• However, don’t have characters answer just “yes” or “no,” as they may become confused about which answer to say. Have answers be with specific Who, What, Where, and When information that relates clearly to the story and which can be more easily remembered.

• An actor who is a good memorizer can also handle the part of someone in authority, who gives orders.

• If an actor has a joke – make sure he/she understands the humor/meaning behind it, or he won’t be able to remember it.

• Incorporate reminders for actions and lines into the dialogue of actors who can memorize – make sure those reminders are phrased in positive terms. An actor with a cognitive disability will do what he or she is told to do, but can become confused if the hint is phrased in a negative way (For example, if you want an actor to go into a cave, a hint from another actor like, “Don’t go in there!” probably will be taken as a direction to not go in!).

If a line is phrased indirectly (“I wonder where we should go next?”) the actor being cued won’t be helped…because there is no hint in the line.

• Use a live or recorded narrator to structure the scene.

• Use music and/or sound effects to remind characters about entrances or exits or cue changes in the action within a scene.

• Incorporate video or film into your play. These scenes won’t have to be memorized. And they can be filmed as many times as you need in rehearsal until they are just right.


SIDESTEPPING problems with MEMORIZATION:

• A character like a TV interviewer, talk show host, doctor, or detective can have a clipboard of notes that can be referred to for the questions they might have to ask other characters. It looks realistic to incorporate the lines written on those props.

• Create groups of characters who work together onstage with at least one actor involved who has a good sense of direction and memorization. Everyone else can follow along and do their appropriate lines and actions if they have someone reliable to follow.

• In rehearsals encourage actors to improvise if they forget a line and to help fellow actors remember lines through asking them appropriate questions in character. Let them practice so they will be ready if it happens in performance.


SIDESTEPPING problems with actors who are NOT CLEAR SPEAKERS:

• Have another character repeat the line incredulously, pretending they understood what was said.
“I didn’t do it!”
“You didn’t do it? How do you expect me to believe that?”


or…more subtly…


“You expect me to believe that you didn’t do it?”
“I went to the store”
“Yes, I know you went to the store, but what did you buy there?”

• Have the actor who does not speak clearly play a foreign character who nobody in the play understands or play someone who always mutters under their breath. (Example: Swen Swenson, the Swedish cinematographer, has been hired because of his movie making talents, but he speaks no English. That’s ok because all he needs to understand to do his job is “Action” and “Cut.”)

There could be a legitimate reason why a character can’t speak. For instance:

  • She is a professional mime,
  • He has laryngitis because he yelled too loudly at the football game,
  • She’s taken a vow of silence for religious reasons,
  • He is refusing to speak because he is angry,
  • Her voice was stolen by an evil wizard.

SIDESTEPPING problems with actors who CAN’T REMEMBER BLOCKING:

• Have the character teamed with a duo or trio of others who can remember blocking.

• Cast the actor a character who is a ruler or rich person who needs a personal assistant to be at his beck and call. (The personal assistant can be an actor who knows what to do and where to go and will be the one who is really in control, but will not look like it).