Encyclopedia
Please note this is a comparison between Version 1 by Marij Berghs and Version 2 by Jason Zhu.
Drama therapy is applied to children and adolescents with psychosocial problems. Drama therapy is an experiential form of treatment which methodologically uses drama and theatre processes to achieve psychological growth. Positive effects were found on overall psychosocial problems, internalizing and externalizing problems, social functioning, coping and regulation processes, social identity, and cognitive development. An adaptive approach was mentioned as the therapeutic attitude. The means established contribute to a dramatic reality, which triggers the mechanisms of change. These are processes that arise during treatment and which facilitate therapeutic change.
- drama therapy
- children
- adolescents
- youth
- psychosocial problems
- mechanisms of change
- review
1. Introduction
Psychosocial problems consist of a combination of emotional, behavioral, and social problems [1][2][1,2]. One out of five children and one out of seven adolescents suffer from psychosocial problems, including mental disorders [3][4][5][6][3,4,5,6]. The mean global coverage of prevalence for mental disorders in children aged 5–17 years was 6.7% in 2016, subdivided into conduct disorder (5.0%), attention deficit/hyperactivity disorder (5.5%), autism spectrum disorders (16.1%), eating disorders (4.4%), depression (6.2%), and anxiety (3.2%) [7]. As an expression of dysfunction related to psychosocial problems, a distinction can be made between internalizing and externalizing problems. Internalizing problems concern emotional problems that focus inward, such as depression, (social) fears, withdrawn behavior, and psychosomatic complaints. Externalizing problems concern behaviors that are more outwardly directed, such as hyperactivity, aggressive behavior, and attention problems [8][9][8,9]. Children and adolescents who suffer from psychosocial problems are more likely to be a victim or a bullying perpetrator [10][11][12][10,11,12], experience lower academic performance [13][14][13,14], and have an increased risk of suicide [3][13][15][16][3,13,15,16]. Failure to identify and treat psychosocial problems in time increases the risk of problems in the future [17], for example, of physical disorders [18]. These problems have economic consequences which create additional costs for the society [19][20][19,20]. Many psychosocial problems in children and adolescents are not recognized and treated in time [21]. Addressing these problems at early age is necessary to prevent them from getting worse [22].
The most common treatment for children and adolescents with psychosocial problems are cognitive behavior therapy focusing on cognitive behavior, psycho-education, emotion regulation, communication, interpersonal skills, or parent training [23][24][25][26][27][23,24,25,26,27]. Some studies suggest that cognitive-behavioral therapy is less appropriate for young children and for children and adolescents who have difficulty expressing themselves verbally [28][29][30][31][32][33][28,29,30,31,32,33]. Activating strategies, such as role-playing, are emphasized as effective elements in treatment for these children and adolescents. In particular, role play is seen as important for modeling behavior, to expose fears, and as an opportunity to develop coping skills [27]. Activating strategies, and role play, in particular, are important elements in drama therapy to treat psychosocial problems in children and adolescents [31][34][35][31,34,35].
Drama therapy is an experiential form of psychotherapy which methodologically consists of drama and theatre processes, fictional reality created by a wide range of verbal and non-verbal dramatic techniques aimed to achieve psychological growth and change within a therapeutic relationship [36][37][38][36,37,38]. Drama therapy is one of the creative arts therapies (together with psychodrama, art therapy, dance and movement therapy, music therapy, and bibliotherapy). In drama therapy, drama and theater processes are influenced by and based on different psychological perspectives such as psychodynamic, cognitive behavioral therapy, attachment theory, and developmental psychology, client-centered therapy, or narrative theory [30][39][40][41][42][43][30,39,40,41,42,43]. Drama therapy is considered suitable for children because of the underlying play. Dramatic play is seen as one of the core processes in drama therapy [39][44][45][46][47][39,44,45,46,47]. Dramatic play gives children the opportunity to express (non-)verbally, gain control of their thoughts and feelings, and understand others. A variety of means, i.e., forms and techniques, are used in drama therapy, such as role-play, storytelling, puppet play, and theater games. These are aimed at creating a playspace where children can play in a fictional world. Although playing takes place in a dramatic (“as if”) reality, behavior, thoughts and feelings can be real at the same time. Hence, there is both a distance and a connection between play and daily life [39][46][47][48][39,46,47,48].
Attunement within the therapeutic relationships is important. The drama therapist adaptively matches the drama therapeutic means (e.g., drama role, themes) to the needs, expression, and wishes of the client [49][50][51][49,50,51].
In clinical practice, drama therapy is successfully applied by drama therapists using a variety of drama therapeutic approaches and theories based on good practice, theoretical insights, and intuition [30][49][52][30,49,52]. In a qualitative study, drama therapists reported several effects of drama therapy in children and adolescents, such as improvement of social skills, regulation of emotions, better child and adult relationship, increased assertiveness and self-expression, and more resilient responses to bereavement, separation, and loss [53]. These outcomes are important effects that may promote self-esteem that buffers the negative effect of stressful life events in adolescence [54]. Drama therapy experts assume that drama therapy is used to promote understanding of one’s own and others’ behavior in terms of mental states (mentalization) [55][56][57][55,56,57], executive functions [58][59][58,59], working memory [60][61][60,61], and resilience [39][62][63][39,62,63]. Most studies on the effects of drama therapy in children and adolescents are based on expert opinions reflecting on their clinical work. An overview of effects based on empirical studies using cohort studies and (randomized) controlled trials is still lacking.
Besides the effects of drama therapy on children and adolescents, little is known about what and how drama therapy leads to a positive change in psychosocial problems of children and adolescents [27][34][64][27,34,64]. There is a growing interest in insights into the effectiveness of drama therapy works and which processes contribute to changes of the client’s wellbeing. These processes are called mechanisms of change, referring to processes that arise during the treatment that facilitates the therapeutic change [65][66][65,66]. A few mechanisms of change are described in drama therapy. For example, drama therapists and adult clients describe the importance of a positive therapeutic relationship, working within a safe distance, being actively involved in the therapy, and having physical experiences that facilitate the development of new awareness and language skills through which clients can communicate to themselves and others [67].
