Theater Processes Therapeutic in Drama Therapy

by Barbara Trainin Blank

The ancient Greeks used drama for catharsis. As anyone who has acted knows, theater can tap into emotions, build self esteem, and reduce feelings of isolation.

But drama therapy takes those emotional gains to another level. It uses drama and theater processes intentionally to achieve therapeutic goals. These can include symptom relief, emotional and physical integration, improvement of interpersonal skills and relationships, and personal growth.

According to the National Association of Drama Therapy (NADT), the modality is active and experiential. It provides a context for participants to tell their stories, set goals, solve problems, express feelings, or achieve catharsis. The NADT was incorporated in 1979 to establish and uphold standards of professional competence for drama therapists and set requirements for qualifying as a Registered Drama Therapist (RDT).

With older adults, for example, drama therapy can maximize cognitive and communication skills, build community, and strengthen self-esteem. With addicted clients, this creative arts modality helps them express emotions more openly and envision a drug-free future. Because it’s active, drama therapy allows clients to act out negative behaviors—without consequence—while facing them directly and truthfully.

Often using puppets and dolls, drama therapy with children and adolescents taps into the appeal that play has for young people—assisting them to overcome feelings of isolation and gain mastery over conflicts and anxieties.

Among the processes and techniques drama therapy employs are improvisation, theater games, storytelling, and enactment. Many drama therapists use text, performance, or ritual to enhance the therapy.

Drama therapy has been used in a wide array of settings, including mental health facilities, schools, hospitals, substance abuse treatment centers, correctional facilities, adolescent group homes, nursing homes, housing projects, and theaters, among others.

In what may be a first, Western State Hospital in Lakewood, Washington State, uses drama therapy with forensic patients at the psychiatric hospital, with people who have been deemed criminally insane or incompetent to stand trial.

As described in the Seattle Times on October 28, 2009, the program focuses on working toward recovery by having the patients create an original piece of theater together to practice their people skills in a safe place.

Valerie Miller, an RDT with an MSW, no longer works in a traditional field but in a program called Art and Social Change. The program provides struggling high-school students in alternative education with opportunities in the arts, so they can “engage with and respond to professional works of art to develop their ‘voice’ and create work that reflects their views in different disciplines, including theater, and exhibit and showcase it.”

After attending an arts school and studying psychology in college, Miller heard of the Brazilian activist Augusto Boal, and his work with drama therapy. She came to drama therapy through an alternative track at Kansas State University.

“My work is therapeutic, not therapy,” Miller says. “But I definitely draw on the techniques and tools of drama therapy. The students are incredibly transient, and it’s hard to sustain. But we do a play in a day. Some have a depth of experience to bring to the table.”

Founder of the drama therapy program at KSU attended by Miller is Norman Fedder, a playwright and trained drama therapist. Fedder became interested in drama therapy when doing creative drama with developmentally disabled students and finding the work to be “therapeutic.” “Creative drama morphed into drama therapy,” he says. “The difference between therapy and therapeutic is that therapy is intentional and systematic, with goals and a plan; therapeutic is whatever you do that works.”

When drama therapy is done in groups, essentially these are “group experiences that emphasize creativity and release, humor and playfulness, imagination and joy,” Fedder explains. “Rather than discussing and analyzing personal problems with a therapist, you’re guided through the embodiment of them. You have the opportunity not only to play yourself in relationship to the threatening figures in your life and mind, but also to rehearse more effective ways of dealing with them—and to gain insight from observing others playing you.”

What makes drama, or any arts, therapy so effective? According to Fedder, it’s that art is “holistic,” not analytical. But drama therapy isn’t formal theater. With kids, memorizing lines may seem “dictatorial,” whereas disabled kids may not be able to memorize. “But they can develop a scenario,” Fedder says. “Most drama therapy is improvisational.”

Despite the differences, Fedder feels drama therapy and formal theater are moving closer together. “The field of drama therapy was founded and is practiced mostly by theater/creative drama folk with (initially) theater degrees,” he says. “That’s in contrast to psychodrama, which was developed by psychiatrist Jacob Moreno—and whose practitioners derive largely from the psychiatric/psychological/social work/family therapy/counseling community.”

Still, Fedder would like to see more theater departments recognize drama therapy as a concentration in their curricula and more theater companies incorporate therapeutic processes in their work.

Katherine Amsden, an LCSW and clinical social worker for the past 30 years, works privately in psychotherapy, psychodrama, and group therapy. Feeling that talking therapy “wasn’t that effective,” she went for training in psychodrama at the American Society for Group Psychodrama and Psychotherapy and was certified in 2005.

“Drama therapy is a more indirect approach that allows the person to deal with issues from a distance and helps manage defenses,” says Amsden. “He or she might write a play with other characters—working through them or using them to deal with personal issues or using puppets and other theater approaches.”

“Psychodrama, on the other hand, is more about the person’s story but does use theater concepts and ideas. It’s more about people enacting their own stories and trying on new roles,” Amsden adds.

Amsden met Fedder at a drama conference after 9/11. She had begun to spontaneously write music and had it produced as an album called “Awakening.” The music related to her own trauma and also to working with trauma survivors. The two agreed to develop a play based on the album through a process entitled “Playwriting for Re-Writing Your Story.”

“I found that through psychodrama you could explore your actual story in the safety of a group, and in drama therapy, or more specifically, playwriting, you could rewrite it,’ Amsden says.

Since then, she has added music and dance to the mix. “The difference between talk therapy and creative arts therapies is that the latter involve the whole person, which is a social work approach, and the body. That evokes creativity and self-determination.”

Sally Bailey is a registered drama therapist and social worker, as well as an associate professor at KSU. After discovering drama therapy, she worked in Washington, D.C. for 12 years with recovering addicts at a long-term residential facility and later at the Bethesda Academy of Performing Arts to facilitate kids with disabilities.

Bailey also discovered that intake interviews are related to the kind of research actors do about their characters in plays and their motivations. Working currently with private clients—adults with disabilities—she creates an original play with them every year based on the idea of their choosing. The play is then presented publicly.

“It’s not about deep personal issues, but working on social skills and the ability to communicate,” Bailey says. “When people come to see the shows, they say they had no idea stigmatized people thought this way.”

Role playing, rather than just following scripts, is the key to drama therapy. “The first time we do anything, it feels foreign,” Bailey points out. “But with practice, you can tweak it and learn to feel comfortable adapting. Through role playing, we try out different roles.”

Drama therapy also gives people the opportunity to change their life’s narratives. “You can’t rationalize with it the way you can so easily with talk therapy,” she explains. “I think drama therapy should be the therapy of choice for people in recovery. It’s also very effective with Asperger’s patients to rehearse social skills and with the developmentally disabled. Creativity is the birthright of every human being.’”

Another strength is that drama therapy potentially uses many other modalities, including the visual arts, music, dance, poetry, and movement.

Also a KSU graduate is Karen Knappenberger. Beginning with a theater degree, she later became a drama therapist and chose an MSW degree for the alternative track.

Knappenberger works with adolescents in an inpatient setting, using experiential drama therapy and role playing to teach emotions and body language. “A lot of the girls have been in and out of hospitals,” she says. “They have pretty severe problems—bipolar, family estrangement, drug abuse. They have a limited realm of emotions. We try to teach them, so when they’re hit with anger, they don’t go from one to 100—so they can be in control of their emotions. As in theater class, we train them how to act in certain situations--what emotions look like. This is a safer place for them to experiment.”

Knappenberger also does drama therapy with outpatients 65 and older, many with mobility or gait problems. Positive experiences through arts and drama can “open up their world a little and help with anxiety” in people who feel life has passed them by. “We’ll read a scene, or do deep breathing exercises,” she says.

One thing that makes drama therapy different is that it allows the entire body to experience emotion. “Drama connects the mind, body, and expression in a way that almost trains the body how to act,” Knappenberger says.

Cinema Therapy, a Newer Modality

Everyone knows how powerful movies can be. How many times does someone who says he or she “never” cries burst into tears at an ending, or laugh hysterically?

Cinema therapy, like drama therapy, treats films in therapeutic fashion.

In Woody Allen’s film The Purple Rose of Cairo, the protagonist seeks an escape from her dreary life and abusive husband by going to the movies. The on-screen hero seeks an escape from his predetermined celluloid existence by jumping off-screen.

Cinema therapy can offer people alternative scenarios to their lives and help them work through problems and blocks, while setting more positive and realistic goals.

Cinema therapy analyzes films and psychological dynamics based on the concept that the film viewer is conditioned by his or her own life, which makes that viewer’s perception unique and his or her interpretation highly subjective.

Like dream work, inquiries into emotional responses to movies “open a window to the soul and the unconscious,” says Birgit Wolz, an Oakland, California-based psychotherapist and leader in the field who started the first-of-its-kind program for people to obtain certification in cinema therapy.

The program teaches the power of movies in the therapeutic process for adults, children, and adolescents. Students learn the transformational effects of films through Positive Cinema Therapy.

The program includes three online courses, a 20-minute interview with Birgit Wolz, and an extensive listing of therapeutic themes and relevant movies.

Like drama, film isn’t just about one creative art form. “Movies affect us powerfully because the combined impact of music, dialogue, lighting, camera angles, and sound effects enables a film to bypass ordinary defensive censors in us,” Wolz writes in an online newsletter at http://www.cinematherapy.com. “They draw us into the viewing experience, but at the same time--often more easily than in real life—afford a unique opportunity to retain a perspective outside the experience, the observer's view.”

According to Wolz, the field built on the ages-old modality of drama therapy, but it began formally the 1980s. It “really took off since 2001,” especially with the accessibility of films through DVDs and television. Still, despite the proliferation of movies in people’s homes, cinema therapy as a modality is more common in bigger cities.

“Some therapists say they’ve been doing this all along, but what I’ve done is put it in a structure and teach an orientation,” she says.

In the “prescriptive” aspect of cinema therapy, the practitioner asks the client to watch a particular movie at home or in a group workshop. In the “evocative” aspect, the client may bring discussion of any movie into a therapeutic session.

In real life, a person may have trouble seeing projections of his or her own anger or other emotions on other people. In movies, it’s much easier to see. “Also, some people can cry about others more easily than about themselves,” Wolz says.

Michael Kahn is a former attorney who in 1994 obtained a master’s in counseling, working at an agency and later on his own. After reading an article written by Wolz, Kahn became drawn to cinema therapy.

“I was already using movies in workshop presentations,” says the Charlotte, North Carolina, counselor. “And my clients often came in and talked to me about films and characters.”

Kahn created a cinema therapy group seven years ago and does a few a year. The groups include anywhere from 4-10 people and focus on personal growth for higher-functioning people, generally young middle-aged.

“They don’t have one particular issue, but are drawn by the use of movies,” Kahn says. “They have relationship concerns, mild depression. They’re unhappy with work, or feel isolated, not having a support system. Films can make clients more approachable than regular group therapy. It opens connections faster.”

Kahn calls his approach “Reel to Real” and targets it to individuals who “want to create radical transformation in their life and work.” Participants receive individual coaching to define goals and further progress—using metaphors, plots, and characters from certain movies to promote increased self-awareness. They identify goals and obstacles, making a plan to “continue the momentum after the work” of the group is completed.

Kahn selects a movie and gives participants copies to watch at home, asking them to pay attention to aspects that affect them emotionally, making them angry, sad, or happy—or to characters they hate or love. During the next session. the group will discuss a scene or two that particularly had an impact on them and watch those scenes. And in the final session, participants watch a movie together to elicit “an immediate response.”

“We try to choose a movie with a number of characters and story lines and universal themes that could apply to the group,” says the counselor. “A few I’ve used have included Dead Poets’ Society, Chocolat, and To Kill a Mockingbird.”

“Movies have a way of getting past logical defenses,” Kahn says. In therapy, clients can pick and choose what they talk about. “But a movie can bring stuff up without our knowing it. We can’t analyze until after the emotions come up.”

Still, a therapist has to be careful in the selection of the films and timing so as not to “re-traumatize” a person after a loss or painful experience. He or she also has to know a film well, to be aware of what parts might be too “rattling.” “And you wouldn’t use movies with clients who don’t like movies,” Kahn says.

Wolz sees limitations to cinema therapy. She would not try this modality, for example, with seriously mentally ill people, whose reactions would need to be monitored over time. She does prescribe it for those with mild depression, anxiety, or grief. In appropriate circumstances,” Wolz says, cinema therapy can “open the therapeutic process.”

Becoming a drama therapist

Three schools in North America offer NADT-approved drama therapy master’s or doctoral degree programs—New York University, California Institute of Integral Studies in San Francisco, and Concordia University in Montreal.

There are also programs that offer graduate degrees in fields related to drama therapy, such as drama, theater, or social work, plus completion of alternative track education requirements under the supervision of an RDT and an internship.

For more information, see http://www.nadt.org/rdtrequirements.htm.

For Your Information

National Association for Drama Therapy—http://www.nadt.org

Cinema Therapy—http://www.cinematherapy.com and http://www.cinematherapy.com/professionaldirectory.html

American Society of Group Psychodrama and Psychotherapy—http://www.asgpp and http://www.asgpp.org./html/executive.html

Drama Therapy Central—http://www.dramatherapycentral.com/

Kansas State University—http://catalog.k-state.edu/preview_program.php?poid=2918&catoid=2

NYU—http://steinhardt.nyu.edu/music/dramatherapy

California Institute—http://www.ciis.edu/academics/pdt.html

Concordia—http://art-therapy.concordia.ca

Barbara Trainin Blank is a freelance writer in Harrisburg, PA.