Description

Drama therapy is one of the creative arts therapies that is increasingly being used in the treatment of mental illness. But it is not yet clear if there are specific indications for this type of intervention compared with other creative therapies such as art and music therapy. When should drama therapy be promoted at the expense of the others? There is also puzzlement about the mechanism by which improvement is made in all these complex interventions and this is a problem when selecting the best outcomes for each form of treatment [1]. Many of the studies suggesting benefit have been in those with relatively minor mental health problems, if any [2,3]. It could therefore be argued that those with severe mental illness should be excluded from this intervention. Large randomised trials of art therapy in schizophrenia and music therapy in autistic spectrum disorder have no shown expected benefits and it is far from clear if there is a dividing line beyond which drama therapy might be regarded as counter-productive [4,5].

One of the common claims about drama therapy and other creative arts is that they, in all their forms, improve self-esteem [6]. If this was true in chronic mental illness it would be a major gain, as in this group self-confidence and self-worth are at a particularly low ebb. In a recent case-control study of drama therapy in chronic mental illness we confirmed that self-esteem, measured by the Rosenberg Self-Esteem Scale was very low at baseline before drama therapy was implemented but improved greatly during drama training [7,8]. This study also recorded personality strengths using a new scale before and after drama training and found marked improvement in strengths that were not found in a control group [9]. The intervention was a relatively short one lasting only a few weeks but the positive findings showed that even short exposure to this intervention can reinforce positive self-worth markedly.

These findings should encourage creative art therapists working in mental health. It may not be most appropriate to treat acutely ill patients with severe problems with drama therapy but for those who with chronic smouldering problems that form a much larger group, drama therapy is a useful therapeutic option. In Mansell, the therapy was linked to the environmental intervention called nidotherapy, the systematic manipulation of the environment to make a better fit for those with mental illness [8,10]. When patients are asked which environmental changes they would like to make in their lives the wish to have more self-confidence and self-reliance feature highly, and drama therapy may be particularly suitable for this group.

The evidence that personality strengths also improved emphasises that one of the common beliefs about personality, that it does not change, is wrong. Personality difficulties can change greatly over the longer term and so the assumption that those with personality disorder could not be helped by drama therapy is almost certainly wrong [11,12]. Where encouragement is necessary, particularly for those who have never had their self-esteem reinforced or have been set back in the COVID pandemic, involvement in drama therapy may involve some persuasion, but it is likely to reap dividends [13].

References

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