Thoughts on the relation between Dramatherapy and Psychotherapy

First given at the Dramatherapy/Psychotherapy Debate Day
28th June 1997
at Conway Hall, Red Lion Square, London

As this forum has been linked with the discussion at the AGM concerning personal therapy requirements for students, I find myself asking numerous questions that prevent me from going straight, into the matter of where I stand on the issue of whether Dramatherapy is a form of Psychotherapy or not.

Firstly, why I wonder is this debate still with us after all this time? What, I, perhaps ingenuously, ask myself, is there left to say that has not already been said by numbers of people from various positions on the issue of whether or not Dramatherapy is a form of Psychotherapy? As there are already clearly varying practices of Dramatherapy extant within BADThe by which some dramatherapists consider it a form of psychotherapy and others do not, then what maybe the areas of usefulness of this forum? I am sure there are several but three occur to me at this time:

a) to inform ourselves, perhaps, yet again that there are, indeed, varying practices within what Don Feasey has called a multi-coloured quilt? b) or to seek further clarity, perhaps, in the light of our on-going attempt at joining the HIP Section of the UKCP? c) or to seek more consensual validation of the motions that are in place concerning requirements for personal therapy for students?

I ask these questions at this point because there is another question looming in mind - is this the most helpful debate and, if so, what concerns may it address ?

My position with regard to the personal therapy requirements for students is that I am, largely, convinced that they are the right ones. I'm not at all sure about the three-years' post-qualifying experience requirement for the therapist undertaking work with students. We are not here to debate that point today. However, I would think that if the therapist is a registered therapist and has "substantial experience of working individually and with groups" stipulating "three years" and "post-qualifying" seems like an unnecessary case of "footbinding" to me. However, I am willing to be persuaded should relevant arguments for it be put to me. I say all this is at the outset because I feel that the personal therapy for students issue is really apart from the issue of whether or not Dramatherapy is a form of psychotherapy. I would like to offer a view that goes like this :

Starting with yet another question - What is Health? To me, Health is not a state of permanently acquired freedom from dis-Ease. We are all, therapists and clients, subject at various times in our lives to degrees of dis-Ease from which we seek healing, change or transformation. We all, therapists and clients, have internal processes, unless of course we have ceased to participate in any kind of existance altogether, and come up against our own resistances, life-drama scripts etc. Any therapist, to work as a therapist, needs to have acquired the skills, language and ability to be reflective as far as his/her own internal process may impact on the clients and group members and vice versa before considering the appropriateness of an intervention. It is my strongly held view that this can be acquired not so much by training as by working experientially on "in-depth" work on oneself for a substantial period of time. Whether dramatherapists are eventually going to practise psychodynamically or not - and, yes, there are aspects and settings where we are not called on to work psychodynamically - it still does not alter the need for "in-depth" work on oneself as part of one's acquiring the skills necessary to practise as a therapist.

I would also like to offer this view:

There are two levels at which I see therapy operating, one level is of providing some kind of healing process for dis-Ease in which the therapist facilitates the client to access his/her own self-healing resources that lie within the client from which the client ( and very often the therapist, too) is disconnected - a spiritual resource, if I may use that word without seeming to exoticize or "magicalize" it. The other level is to provide the client, through the therapy-process, with the means to acquire ways of thinking, a language, skill or ability to access this self-healing resource for him/herself throughout the future development of the client's life where possible. This ability, language, skill has something in it of the nature of the ability, way of thinking that has been learned and acquired by the therapist. In a recent conversation I had with Alida Gersie she called this a "redistribution of competencies" and while - yes, we did laughingly acknowledge that the end product of this would ideally be that we worked ourselves out of jobs if all our clients were able to access these competencies, I do believe there is a serious point to this. Students of dramatherapy need to have access to these ways of thinking and much of it is not acquired by training alone but by substantial personal therapy and dramatherapy group experience.

As dramatherapists, I believe we need to weight the "therapy" part of that title. Calling oneself a "therapist" involves claiming to offer some form of "treatment" as part of the healing process that deals from beginning to, hopefully, the end of a problem or situation of dis-Ease present in the life of the client. What is the "treatment" that dramatherapy offers? We need I think to be aware that while drama can have undoubted therapeutic aspects, drama may also have certain anti-therapeutic effects such as encouraging a client's disengagement with an issue or dis-Ease, a degree of distancing that may not produce any insight whatsoever and can distance the client further from her/his own inner self-healing resources through avoidance, flight, or lack of reflection. It is the possible danger of this kind of effect that make me concerned when I hear it said that the drama is the therapy, as if, somehow, the reflection or the bringing to consciousness of transference material, or resistances, or the process-level of interaction within the group or the therapist-client impacting dynamic had less to do with the healing process than the drama. For the therapist not to address this material when it is appropriate to do so and, not to self-reflect on material that may be present in his/her life-drama script or his/her dynamic with a client or group would not only possibly court dangers within the therapist's practice but also, I believe, to render the therapist in a powerful/manipulative position and the client in a vulnerable and possible disempowered position. These are the positions I take in my practice as a dramatherapist and these are the links that I believe dramatherapy or any other arts therapy has with psychotherapy. The fact that drama has therapeutic effects and increases the well-being of people who participate in drama, and I'm sure none of us disagrees with that, does not mean that the drama alone is the therapy.

If I may be imaginative for a moment I would like to consider this : while the play may have been the thing by which Hamlet caught the conscience of the king, I wonder if had the court in Elsinore been part of an on-going dramatherapy process and been afforded the frameworks and structures within which sufficient reflection and opportunity for insight into each individual's or the court's internal processes could have taken place, might there have been less slaughter at the end of that particular cathartic process ?

If there are dramatherapists who feel that is the drama is the therapy, what would be the difference between their position and that of drama-workers or drama-practitioners who are just as professional, just as committed to the well-being of their clients and just as creative as facilitators as dramatherapists. I would maintain, but nothing is ever-fixed in stone and I am willing to be dissuaded, that there is a difference between drama-work increasing the well-being and having therapeutic effects on participants and dramatherapy.

To make my point a bit more personal, perhaps, I wish to go back for a minute to the point at which I made a committed to move from being a drama-worker to being a dramatherapist. Some years ago I worked at a community theatre as a community arts worker and youth theatre director. While the therapeutic effects of the drama on the youths were unquestionable in that they gained confidence, they were empowered with new skills, and they increased self-esteem, they still went home and behaved in self-destructive ways, cutting themselves, attempting suicide, or engaging in anti-social activity. They went back each night to live with their on-going pain. I realized then that drama alone was not enough. Therapeutic though its effects were, they were neither substantial nor deep enough. It was not addressing their significant life problems, it didn't take them through from beginning to end of a problem, it was not necessarily of a substantial duration and I needed some new skills. That was when I embarked on dramatherapy training and in doing so I realized that drama in itself is not therapy. Through my training as a dramatherapist I was confronted with my own processes, my own unfinished business, my own resistances. It was then through my personal therapy and dramatherapy group experience that I began to address my own issues, which I might never have learned had I not undergone my personal therapy. Well, it was not a dramatherapy group anyway and I was not, at that time, a dramatherapist. I went back, some time later and ran a dramatherapy group with other youths at the same community centre who displayed some of the same behaviours. This time it was different. But it wasn't the drama alone that made the difference it was the process of therapy focusing on the "here & now", transference feelings, resistances and the group's interpersonal process whereby the clients were able to access insights and acknowledge them over a substantial period of time, learning new "competencies", as Alida Gersie would say, together with my acquisition of the reflective ability with regard to my own process and supervision that constituted the dramatherapy. And this is the stuff of psychotherapy.

Since then, my clients and client-groups have ranged from gay men with sexuality issues to male prostitutes, some with transexual and gender-role issues to the elderly depressed and people referred to me via Mental Health agencies. Most of my work with individuals or groups so far have been over a year in duration and sometimes two years or so and in all my work, I believe, I am engaged in what John Rowan in his letter to Tone Horwood in the summer of 1992 wrote clarifying the UKCP's position as far as a definition of psychotherapy is concerned: ‘it takes a client through from beginning to end of a problem staying with the client through difficulties & hindrances which may arise in the process of psychotherapy.... a process of some duration sufficient to deal with the problem and to integrate any life decisions which may follow from that. It would involve a process of supervision on that particular relationship, such that problems which arise between therapist & client could be addressed training for which would involve some long-term work on oneself.'

As a dramatherapist who has worked with and does work with dramatherapy students (though in private practice and not as part of a training organization) I am keenly aware of the difficulties encountered by some members in my groups and I would like to think that far from being seen to burden students with what may seem like more and more pressure and higher and higher hurdles to jump over, we may be able to be seen as providing them with frameworks and structures that enhance their experience and future competence as dramatherapists. That I see my practice of dramatherapy as being a form of psychotherapy informs the process of therapy that I offer my clients - be they students or otherwise.

The profile of dramatherapy is increasing in places where there has previously been a somewhat less established culture, knowledge, recognition & acceptance of dramatherapy - such as in adult community education and other community centres and projects not. As this process continues I am sure there will be issues arising about practice within cultures that do not recognize psychotherapeutic language and and work practice. It is very important, therefore, for dramatherapists to be clear about our individual work methodologies and the training we receive and offer students.

At the start I asked if this was the most helpful debate we can have. As there may clearly be more than one approach to dramatherapy amongst members of BADThe, how far is it useful to continue talk in what may seem to be a divisive way or are there other routes to exploring how, we can all be "different" together if, indeed, we can and we wish to be.

© Bruce Howard Bayley, 1997.