What if one key could unlock expression in a child with autism, turn a young woman away from substance abuse, or stop a hardened criminal from reoffending? There is perhaps not one key, but there may be one set of keys: drama therapy.

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Drama therapy can help people of all ages to express themselves.

In the 1920s, a Romanian psychologist, Jacob Moreno, observed how role play and experimental theater freed people to reveal their thoughts and feelings. He began to incorporate drama into psychotherapy.

Psychodrama continues to be practiced as a technique to help individuals achieve resolutions to specific issues by discovering how the past impacts the present.

In the 1960s, a radical Brazilian theater director, Augusto Boal, was working on the concept of community theater, from which would emerge "the theater of the oppressed."

Boal envisaged a theater where the audience could express themselves through becoming actors, presenting and solving the problems of their own lives. His work provided new direction for drama therapy.

Today drama therapy helps people in a wide range of contexts to achieve change, be it through shedding old habits, learning new skills or accepting a difficult past.

What is drama therapy?

The North American Drama Therapy Association (NADTA), based in New York, was set up in 1979 to oversee and maintain standards in drama therapy practice.

NADTA's Doug Ronning told Medical News Today: "Drama therapy is practiced in so many places: hospitals, recovery programs, community mental health clinics, schools, dating and career coaching, elderly care, private practice mental health, just to name a few."

New York University (NYU) Steinhardt defines drama therapy as: "The intentional use of theater techniques to facilitate personal growth and promote health, thus treating individuals with a range of mental health, cognitive and developmental disorders."

Louise Croombs, of Dramatherapy.net in the UK, draws parallels with music therapy, which Medical News Today have previously reported on, and dance therapy. She explains that as humans are creative beings, drama therapy takes them step by step through creative means to find solutions to their problems.

Based on the theoretical teachings of drama, theater, psychology, psychotherapy, anthropology, play and interactive and creative processes, any aspect of the performance arts can be involved in the therapeutic relationship.

Drama therapists are trained in both performance art and as clinicians. Through their skills and training in theater and therapy, they help clients to achieve psychological, emotional and social change.

Role plays, stories and improvisation

Activities aim to bring together the body and the mind. They vary according to the context, but include stories, myths, play, puppetry, masks, improvisation, role play and rituals.

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Role play can help people to see themselves and others in a new way.

Doug Ronning told MNT that a closing ritual might consist of "a hand squeeze or thumb hug along with an evocation of confidentiality and self-care."

Stories may be real, fantastical or based on the client's own experience, providing an indirect approach to help participants explore difficult and painful life experiences.

A performance-oriented approach can involve participants working with a theme to create and perform their own plays, choral readings or poetry. Scripted plays are sometimes produced to present to an audience.

Role plays and improvisations can encourage participants to understand negative behaviors and to practice new ways of reacting and of being.

Sally Bailey, an associate professor at Kansa State University (KSU), who previously worked with recovering addicts, says:

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

One-to-one sessions can benefit people with autism or those who are socially withdrawn. Croombs explains that private performance gives a confidential space for the person to use their own time and own way to express themselves without being put on the spot.

On the question of feedback, Ronning told us that, while this depends on the style of drama therapy and the facilitator, "most forms would invite verbal processing if there was sharing of personal stories or culminating enactments, with the guidelines not to critique or comment on performance, but to share what feelings, memories, associations emerged for them through the drama."

Releasing the power

Drama therapy allows for catharsis, defined by the Merriam-Webster online dictionary as "purification or purgation of the emotions (as pity and fear) primarily through art." It can help people tap into their emotions in their search for solutions to emotional and mental health problems.

Practitioners say it can empower people who struggle with communication to express their needs and feelings. It can help to forge relationships by enhancing confidence or bringing people together. It can provide chances to experience positive self-esteem and self-worth, and it can help people gain control over conflicts and anxieties.

Participants can develop new ways of coping with difficult situations in a safe and supportive explorative environment. They can process past events and explore painful issues and feelings without feeling threatened.

Acting out also gives practice in new ways of facing events through alternative choices, choices which may be socially unacceptable in the participant's normal environment, without having to worry about the consequences.

People who face difficulty trusting or connecting with others in everyday life or conventional therapy may also benefit from the space that drama therapy provides.

Drama therapy has been described as "therapeutic rather than therapy." Activities do not necessarily focus on people's problems, but the process enables them to move to a new level of self-understanding and ability to cope.

A new lease of life for seniors

Among seniors, drama therapy encourages physical and mental activity and stimulates communication and cognitive skills. Coming together in a community can add to a sense of purpose and self-worth.

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Acting out stories can benefit seniors in many ways.

On a deeper level, NADTA explain that as people age, events such as retirement, the death of a spouse or reduced mobility can lead to a loss of identity.

Drama therapy can enable individuals to "redefine themselves" through learning new skills, developing a new interest or creatively sharing their stories.

Sessions can become a space for reminiscing, reviewing, acknowledging life's achievements and envisaging the future.

Role play can offer practical help for people who are anxious about facing situations that they may find daunting, such as dealing with doctors or making complaints.

Those whose ability to speak is diminished, perhaps after a stroke, can explore movement as a new channel of expression. For people with dementia, puppets, costumes, photos or sounds can be used to stimulate memories.

Addressing addiction

Drama therapy, NADTA explain, can provide an environment where people struggling with addictions can express emotions, explore future possibilities, develop skills, make personal connections and practice honesty.

It can provide a platform for acting out and exploring negative behaviors without consequences. Through role playing themselves or others, participants can gain insight about the effect of their behaviors and choices on others.

Playwright Norman Fedder, who founded the drama therapy program at KSU, says:

"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."

Long-term addiction can cause people to identify strongly with the labels attached to them by their family, society and friends; but playing new roles can help them to visualize a new identity and a new, drug-free future.

As a cathartic experience, those who have experienced abuse or other trauma may use the space to express feelings of past loss and suffering.

NADTA explain that long-term substance abuse can lead to emotional stagnation; drama therapy can help people to get back in touch with their feelings and explore positive ways of developing relationships with others.

NADTA further note that people with problems of addiction are often "sensitive and creative" and benefit from expressing themselves through the media of movement, art, words, music and drama. Drama can provide excitement without drugs and offer a new interest and skills.

Practical activities enable participants to rehearse new behaviors and skills needed to apply for jobs, to refuse drugs and to relate to their families.

Ultimately, drama therapy can enhance positive self-image, self-esteem and self-discipline among people struggling with addictions.

New ways of expression for people with autism

The non-verbal form of communication offered by drama therapy is thought to make it accessible to people with autism spectrum disorders (ASD). Research Autism say that the approach includes storytelling, role play, enactment and mime, voice production and the use of props.

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Movement can offer people with autism new ways of self-expression.

Croombs explains how drama's use of metaphor can help people to express themselves and relate to others in indirect ways.

Through the use of movement as metaphor, especially with touch and sound, participants can interact physically with the world and "explore how they fit in with the environment."

This offers a platform for people to "get a better sense of themselves," build relationships, express feelings and discover new ways of being.

While pointing out that there is still little research to support the benefits of dramatherapy for people with autism, Research Autism are of the opinion that "used skillfully, it can provide a tool to explore a number of issues that are either experienced by people with autism or are relevant to the individual's current life experience."

Drama behind bars: exploring new solutions

Augusto Boal described prisoners as "restricted in space, but free in time." Interactive theater, he said, creates free space for people can imagine and think about the past and the present, and invent the future instead of having to wait for it. Theater in prison, he believed, could lead to "a healthier and more creative lifestyle."

Boal's concept of theater involved raising issues that demand solutions, and it called on the audience to participate in finding them. "We are all theater," said Boal.

Research has suggested that drama therapy in prisons can have a positive impact on anger management. MNT previously reported that increasing emotional awareness among young offenders can reduce the risk of them reoffending.

Alternatives to anger

In a prison in Los Angeles, CA, actor Tim Robbins worked with a group of men in a project called "The Actors' Gang." The work, which focused on their emotions, and anger in particular, has been documented by the BBC.

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Anger management classes involve trying out new emotions.

Activities provided the opportunity to respond to a range of scenarios with different emotions in a safe environment. Participants developed new ways to react when confronted with hostility and anger.

Feedback from participants said the program helped them change their lives and taught them that they can control their anger rather than their anger controlling them. In the words of one man, it "allowed my past to empower me rather than define me."

Robbins was impressed at the "level of truth" about emotions that participants revealed.

While not definitive, studies have suggested a fall in the number of infractions committed by inmates, and a potential drop in the rate of recidivism among those who took the course.

The Geese Theater Company

In the UK, the traveling Geese Theater Company give workshops in custodial institutions, with the aim of preventing crime through rehabilitation.

Fast facts about mental health in prisons
  • In 2006, 61% of people in state prisons for violent offenses had a mental health problem
  • 74% of prisoners with substance abuse issues had mental health problems
  • 58% had violated rules while inside the prison.

Learn more about mental health

The Company delivered training for 12 mentally disordered patients in one of the UK's four maximum security hospitals. The men, aged on average 25 years, had all committed major violence in the past.

Productions by the actors included the use of masks to emphasize the gap between the outer image and the reality of inner feelings.

Following these came a chance for participants to examine and work through examples of offending behavior, uncovering the underlying cognitive processes and practicing alternative behaviors.

Self-reported data revealed that levels of anger fell immediately after the workshop and remained low 3 months later. The men also reported more frequent attempts to control their anger.

Feedback from participants indicated that the experience was "positive and beneficial."

Comments said it showed that they had anger "deep down," that no-one needs violence, and that there are other ways to cope.

Encouraging participation

The UK prison study mentions that people with severe problems of anger and violence can be reticent about joining any kind of therapy.

However, they speculate that drama therapy may offer a more suitable space than conventional psychotherapy, potentially leading to more successful results.

MNT asked Ronning whether people are generally keen to join in. He told us that it depends on the context, whether they are there by choice, or compulsorily, as is likely in schools or addiction centers.

He shared some of the techniques used to encourage more reticent members:

"Someone who doesn't want to join in play may be invited to witness, perhaps even participate from the sidelines by offering alternative courses for a character or scene. In more improvisational forms like developmental transformations, an imaginary wall or curtain may be drawn between the active and non-active participants, with an open invitation to come through a portal into the play.

I often begin with poetry or drawing comics, an internal solitary process that can then become embodied work, body sculpts or scenes. This is a way to invite more introverted, shy or anxious clients to participate without performing."

Empirical research into the effects of drama therapy is not extensive, but anecdotal evidence and participant feedback suggests it is a cathartic and positive learning experience for a wide range of people with different needs.