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Role of Drama Therapy in HD Patients

Drama therapy has been used as a form of psychotherapy for those who view the more conventional “talking therapies” as less beneficial. Such groups have included people with dementia and long-standing schizophrenic illnesses. Dementia refers to neurodegeneration that results in loss of mental abilities. While Huntington’s disease (HD) is commonly thought of as a motor disorder, cognitive symptoms can be present, which can be progress to dementia. In addition, paranoid schizophrenia-like symptoms occur in 6% to 25% of HD cases.

Why Drama Therapy?

The reasoning for the use of drama therapy in HD patients is that as an action-oriented therapy, it has helpful features not present in the purely talking therapies. For HD patients, thoughts and emotions may be disordered and hard to contain. Thus, conventional psychotherapy can be problematic because it presumes at least some ability to self-regulate thoughts and feelings and to undertake basic reality checking. According to a theory (Bielańska, Cechnicki, & Budzyna-Dawidowski, 1991), the more formal structure of drama therapy and its separation between the world of the drama and the world of the group, may offer a degree of environmental regulation.

Another concept is that of aesthetic distancing (Jones, 1991). Here, the ‘make-believe’ element of the drama allows participants to work with material, which is sensitive to them. Such sensitive issues could relate to murderous or persecutory fantasies that might be so alarming that a patient would chose to deny or minimize them, rather than talk them through in therapy. The distancing effect of drama by playing the fantasy out in a metaphorical or symbolic way allows the material to be worked with, with an underlying safety net that this is, after all, ‘only a story.”

Approaches to Drama Therapy

Drama therapy has a developmental model, with increasing demands being placed on participants with greater resilience, insight and interpersonal abilities. A creative-expressive approach to drama therapy may consist of activities such as drama games and improvisational exercises to encourage spontaneity and creativity within a safe framework (Jennings 1990). No exploration of the images and material created is necessary.

Another approach to drama therapy encourages participants to recognize their own projects in the work they produce, or modify and experiment with the roles they play (Jenkyns 1996). Existing texts may be used to allow participants to explore roles that are new or challenging to them.

Finally, a third approach to drama therapy uses the archetypal myths, fairy tales and folk tales from various cultures to allow participants to engage with these socially evolved stories with dark topics and undergo emotional growth. (Bettelheim 1976).

Case Studies

There has been no research to date on the role of drama therapy on HD patients. However, case studies on the role of drama therapy on patients with complex neurological disabilities and psychiatric illnesses suggest the potential it has on improving the wellbeing of HD patients.

For example, a study on interactive drama in complex neurological disability management suggests that the majority of participants were able to engage with interactive drama therapy and that it offered residents opportunities for enjoyment achievement, challenge and experiencing meaningful experiences (Fenech, 2009).

In addition, a study analyzed five randomized controlled trials that compared drama therapy, psychodrama and related approaches with standard care or other psychosocial interventions for patients showing psychiatric schizophrenic like symptoms (Ruddy & Dent-Brown, 2007). One study had drama therapy as the intervention, one had role-playing, one had a social drama group and two used psychodrama. Two of the included studies were Chinese and it is difficult to know whether psychodrama and inpatient psychiatric care in China is comparable with the drama interventions and inpatient care in other studies.

Resources

North American Drama Therapy Association was incorporated in 1979 to establish and uphold rigorous standards of professional competence for drama therapists. The organization maintains requirements that must be met to qualify as a registered drama therapist. It also promotes drama therapy through information and advocacy. For more information, please check out its website: http://www.nadta.org/

The Living Arts Counseling Center provides high quality psychotherapy services provided by interns, trainees and fully licensed therapists on affordable basis. Its focus is on drama and expressive arts therapy. It is affiliated with Living Arts Playback Theater and Healing the Wounds of History. For more information, please check out its website: http://www.livingartscounseling.org/

 

Citations:

Bielańska, A., Cechnicki, A., & Budzyna-Dawidowski, P. (1991). Drama therapy as a means of rehabilitation for schizophrenic patients: our impressions. American Journal of Psychotherapy, 45(4), 566–575.

Fenech, M. A. (2009). Interactive drama in complex neurological disability management. Disability and Rehabilitation, 31(2), 118–130. https://doi.org/10.1080/09638280701850900

Jones, P. (1991). Dramatherapy: Five Core Processes. Dramatherapy, 14(1), 8–15. https://doi.org/10.1080/02630672.1991.9689804

Ruddy, R., & Dent-Brown, K. (2007). Drama therapy for schizophrenia or schizophrenia-like illnesses. In Cochrane Database of Systematic Reviews. John Wiley & Sons, Ltd. Retrieved from http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD005378.pub2/abstract

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