Schizophrenia is a psychotic condition, associated with a loss of boundaries between the self and non-self, and is often described as a state of dreaming while awake. Symptoms including hallucinations, hearing voices, and a blunting of emotions, which can leave you feeling cut off and extremely agitated. The National Institute for Health and Care Excellence (NICE) recommends that drama therapy is one of the most effective psychological treatments for managing the symptoms of schizophrenia. We asked drama therapist Nicola Barron to explain what drama therapy is, and how it can be used as a treatment for schizophrenia.
Drama therapy is a way for you to explore your experiences, come to terms with your difficulties, and work with challenging situations that happen to you, through using your own creativity in a way that's guided and supported by your therapist.
Drama therapy works by allowing you to acknowledge and work with feared stimuli (e.g. hallucinations), which are accepted by the therapist as real experiences. The therapist provides a companion and a safe space, in which you can interact with your experience, rather than try to avoid it, thus gaining familiarity and confidence when dealing with your symptoms. Drama therapy can work with any scenario or role or story that you bring to it, and drama therapists aren't too attached to what's real and what's not real. Your therapist will work with your experience, and not tend to challenge those experiences, so you can bring hallucinations or delusions to a therapeutic situation and explore them. Drama therapists won't say "this is how you can overcome it", but will work directly with your situation to find out what those experiences mean to you, and how you can in some way gain mastery over the experience, rather than the experience being the master of you. Drama therapy can be used to aid you in exploring your childhood difficulties, and coming to terms with traumatic events that may have been triggers for episodes of your condition.
For schizophrenia it would ideally be individual sessions, but I'd assess it on a case-by-case basis. In a group situation I would have no more than a maximum of probably four or five. I certainly wouldn't recommend more than that, although there are people who have worked with larger groups in hospital situations.
NICE recommends that drama therapy for schizophrenia typically lasts for at least 16 sessions.
Drama therapy is suitable for anybody really, because of the fact we can use such a variety of different formats. For instance, within one session there might be a talking part, where members of the group can talk about the challenges of life, their hopes and dreams, or themselves as people; there might be a part where the group is engaged in discussion between themselves, in smaller groups; they might do art; they might work with music and sound or movement; or they might create roles and stories, and work directly with drama. The drama therapist will be guided by what each person in the group feels comfortable doing, or they might also offer a challenge as well - so if you are very verbal and like to just talk about things, your drama therapist might occasionally say "ok, let's put this into movement", or "let's put this into sound", to introduce the idea of being creative.
However, during periods when you are experiencing high levels of distressing psychotic symptoms, drama therapy should be used with caution, and should never be seen as a 'cure' but rather as an aid to coming to terms with the illness and finding ways to live with the symptoms. If you're feeling very out of control with your experiences, and feeling very anxious, or requiring quite heavy doses of medication, then it wouldn't be appropriate, but drama therapy can be effective at a time when you're functioning on a day-to-day basis, to help you feel stronger and more able to respond to what you're experiencing.
It has been found that drama therapy can be helpful for the negative symptoms of schizophrenia. The outcome hopefully would be a reduced anxiety around your symptoms, which may lead to a reduction in symptoms, and an increased ability to tolerate or respond to the symptoms when they arise.
Drama therapists are registered as arts therapists by the Health and Care Professions Council (HCPC).