POLYPHONYJournal of the Irish Association of Creative Arts Therapists
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Drama Therapy During COVID-19: A Call to Digital Adventure

Published on May 12, 2020 by Monique Alexandra Hill

In the time of COVID-19, many drama therapists have found themselves forced to start work online, adapting in-person techniques to the digital space. This article challenges the notion that online therapy is simply drama therapy taking place online, with the idea that the online drama therapy space is uniquely creative, and can be seen as a digital call to adventure and to explore new methodologies and techniques. Mask work is briefly explored, as well as the idea of text-based drama therapy and avatar therapy.

In a strange way, COVID-19 gave me a community. I have been working as an online drama therapist since the beginning of 2019. Many of the reactions that I received from practitioners, and even potential clients, up until this point have been characterised by bafflement: how would a form that focuses so much on embodiment work in a digital space?

But as therapists and clients have been forced into the online therapy space, many of them are discovering what I have been convinced of all along: the online space is creative, imaginative, and full of possibility for connection.

I honestly believe, however, that to properly access the online therapy space, we need to do more than simply move our practices online. When we know what apps and software are available to us, often more easily accessed than we expect, then we can truly hear the digital call to adventure that online work offers. In this article I would like to briefly show the possibilities of online work, focusing on a few of the apps and techniques that I have found useful so far.

I am no expert in online therapy, but it is my hope that my love for the medium can help therapists who may feel overwhelmed by the digital space. Where many have had an online practice thrust upon them, I have chosen this work as my normal, and I hope that my learning can remove some of the fears around this new mode of working.

Masks and Costumes in the Digital Space

As a projective technique, mask work is a staple of in-person drama therapy work. As Jennings states, “some feelings can only be expressed through masks-feelings that are too anti-social, dangerous or depressing to be shown in other ways. Masks can contain the feelings that could not otherwise be expressed” (1990, ch.6, para.33). It is my belief that the online drama therapy space presents us with unique opportunities to not only work with masks, but to allow the client to see themselves in role with an immediacy that does not often happen in-person.

Many theorists have documented the use of video in sessions to provide an opportunity for clients to see themselves in role and reflect on their embodied experience. Landy describes the work as providing “a means of instant feedback, self-perception, and self-analysis” (1994, p.151). Likewise, Emunah describes exercises involving the client confronting themselves on video as “an intense and intimate encounter with oneself” (1994, p.227). Previously, this technique would need to be accessed through the use of a video camera or recording device set up in the session. However, on video calls we are presented with a constant video stream, allowing the client to see themselves at all times during the therapy session.

In this way, the entire drama therapy session is played out through video, with the client being both themselves in their physical location, as well as in their role as client, seen in the video feed reflected back to them. Likewise, the therapist has an opportunity to see themselves in the therapist role, as seen by the client, which presents interesting opportunities for reflection in-session.

If we then add masks and costumes, through a lens app such as Snap Camera®, the client can access the benefits of seeing themselves reflected back in role in real time. Snap Camera® is a free to use app that allows users to add lenses to their videos. For our purposes, we can think of a lens as a digital mask or costume. Snap Camera® can link to many popular video conferencing platforms such as Zoom® to provide a method of wearing masks during a video call.

Snap Camera® thus allows us, in theory, to create a shared costume box with our clients, and we can use these in role work, narradrama (the combination of narrative therapy and drama therapy), or play, much in the same way we might do so in-person.

There are of course dangers to this kind of work, as both the seeing of oneself on camera and the use of realistic or immersive masks can be underdistanced (Landy 1994, p.153). I personally experienced this when using Snap Camera® masks with my supervisor. As I had chosen a mask that covered my face completely, it took just a few short minutes for me to feel the effects, and I was left feeling silenced, overwhelmed, and overcome with emotion. Although the mask undeniably represented the role I was working with, the act of seeing myself in that mask was under distance, and it derailed the role work that we were doing. Figure 1 shows an example of an immersive mask in Snap Camera®, one that would need to be used with caution in the therapy space.

Figure 1_1

Hill, M. A. (2020), Immersive mask example, Photograph of a Snap Camera Lens. Chalong, Phuket: Private Collection.

With this in mind, I commissioned a set of masks on Snap Camera® that are less realistic, and more two dimensional, giving more distance and enabling the client to withstand seeing themselves in the mask for prolonged periods. The Drama Therapy Online masks (or simply DTO) are freely available for drama therapists to use, and the set is slowly building to include archetypal roles that would be useful in therapy work. Figure 2 is an example of one of the DTO masks, which leaves the face relatively unobstructed, and gives less of an immersive experience for the client.

Figure 2 a

Hill, M. A. (2020), Distanced mask example, Photograph of a Snap Camera Lens. Chalong, Phuket: Private Collection.

It is vital to focus on ways to create safety for the client entering digital mask work, especially as the therapist is not physically alongside them to ground and contain the work. As such, my work with masks is always preceded with ample practice of gestures that take the mask off the face. The filter technology relies on facial recognition, and as such, placing a hand in front of the face effectively removes the mask while allowing the client to feel like they can stay on camera and in visual contact with the therapist. This gesture is the online equivalent of taking a step back out of the play.

There is always a chance that a client will see one of the immersive masks available on Snap Camera® and become adamant that it is their chosen representation of the role in question. In this instance, it is perhaps not conducive to the therapeutic relationship to block their wishes, but rather to find ways to make the experience less intense. Time is of the essence here, as the longer the client spends enrolled, seeing themselves in the mask, the more intense the experience potentially becomes.

One option is to invite the client to take a picture or video of themselves in the mask (both options easily accessible in Snap Camera®) so that they may then take off the mask and reflect on the role by looking at the video or photograph separately. This is essentially a direct representation of what Landy refers to as “the paradox of the me and not-me” (1994, p.149), allowing the client to both be the self and reflect on the enrolled self at the same time.

As with all online drama therapy techniques, there absolutely is value in using masks and costumes in a ‘low-tech’ way. We can invite the client to bring scarves or hats to the session, or whatever they may have on hand.

Afterall, especially as we respond in crisis mode to clients who may never have wished to move to online therapy, it is important not to lose focus on the most important goal of therapy: meeting the client where they are. However, if you and your client find yourselves curious about the online world, and able to access apps and software together, I truly believe the experience can lead to new ways of working that are real and full of connection, and the opportunity to create new spaces of imaginative projective work.

Text-Based Drama Therapy

In my home country, South Africa, the emergency lockdown measures due to COVID-19 have thrown up even more challenges for therapists trying to maintain a therapeutic space for clients digitally. How can we provide online therapy when our clients have limited access to the internet, and certainly do not have the data required to access video calls? In this instance, I would argue for the use of text-based drama therapy, either synchronously through instant messaging, or asynchronously through email.

For the therapist newly navigating the digital space, removing even the view of the body may seem like an insurmountable task. However, text-based therapy has been a staple of talk therapists for some time, and this can provide us with a solid grounding for where to start the work. As Anthony (2004), one of the pioneers of online talk therapy, states, “[t]he rapport between therapist and client in cyberspace is developed not by reacting to another person’s physical presence and spoken word to interpret a person’s state of mind, but by entering the client’s mental constructs via the written word and responding in a like manner” (p.135).

It is my belief that text-based drama therapy is an interesting new field of work, that opens up possibilities in storymaking, narrated play, role work and beyond. My experience echoes that of Anthony, who suggests that in “removing the physical aspect of the therapy, the ‘pure expression of mind and soul’ may be communicated effectively, bypassing the defences of therapist and client” (2004, p. 134).

Text-based work also offers an alternative for clients who cannot access video calls in a confidential space. Where the whole family is in lockdown at home, and the client cannot have a room to themselves, there is something to be said of therapy that can be accessed without the threat of being overheard, and not having to find a space that is suitable for video calls.

Text-based drama therapy may also be of interest to those clients to whom the spoken word represents a difficulty, or for example, clients on the autism spectrum, who find their safety in the written word rather than the embodied space. Here is an opportunity to access the ‘body of the mind’, and bring creativity and imagination into areas where movement and physical embodiment may not be possible.

Text-based work can take many forms, depending on the needs of your client. With email work, writing prompts are used to help the client enter the narrative space. These prompts can be imaginative, or rooted in the client’s real-life experience, depending on the distancing required. The simple prompt of, ‘tell me a story about…’ is a good place to start for most clients. Once the client’s email is received, the therapist spends time entering into the narrative, and may write in a different colour in between the client’s words, noticing themes, asking clarifying questions, or inviting reflection. This form of working is referred to by Anthony and Nagel as a ‘living document’, essentially a journal that responds back to you (2010, p.54).

Instant messaging therapy provides even more opportunities to enter into storymaking and play. Just as we consider how to invite clients into the in-person play space, so we should spend time crafting a way of entering the text-based play space, and making the boundaries of that space clear. Figure 3 gives a simulated example of an invitation into play during an instant messaging therapy session, although the exact methods of initiating entering into an imaginative space will differ depending on your client and your own personal style. Instant messaging therapy also goes beyond text, and can incorporate photographs, emoticons, and even voice notes, allowing the therapist to guide the client through an embodied check-in, for example.

Figure 3 a

Hill, M. A. (2020), A simulated call to adventure in text-based drama therapy, Photograph of a Signal Conversation. Chalong, Phuket: Private Collection.

Avatar Therapy: Embodiment in the Digital Space

The last call to digital adventure that I would like to invite you to hear, is the amazing world of avatar therapy. In this context, avatar refers to a representation of the self, or a digital human form.

Where in-person drama therapy makes wonderful use of the body to create meaningful image work, or psychodrama, avatar therapy gives us space to take this work into a digital space. 

The software that I am referring to is called ProReal®, and it has been building up a solid body of research of its use in a variety of situations (ProReal 2020). Essentially, avatar therapy is a projective technique, allowing the client to project their inner world and conflicts onto the avatars. The software can be thought of in terms of psychodrama, where we can use concretisation, “giving concrete form to situations or dynamics that would otherwise be expressed abstractly, in words” (Chesner 2019, p.31). The client can digitally place their avatars in a world full of metaphors: mountains, waterfalls, bridges, castles, and ravines. The avatar can change in size and position, gesturing in a way that is congruent with the expression the client is trying to embody. Figure 4 gives an example of my own reflections on being a therapist unable to contact my in-person clients during lockdown.

Figure 4 a

Hill, M. A. (2020), A therapist explores the disconnection with her clients under lockdown, Photograph of a ProReal World. Chalong, Phuket: Private Collection.

Although this image represents disconnection, as the client and I are separated by a broken bridge, there is potential for change, and worlds can be revisited as often as necessary. This concretised image can be “viewed from different perspectives (literally and metaphorically) by moving it or moving around. It can be described as is, or transformed into a future possibility…” (Chesner 2019, p.31). Figure 5 shows how this psychodramatic transformation can take place in ProReal®, as my previously shown disconnection is transformed into connection by adding the bridge of online therapy.

Figure 5 a

Hill, M.A. (2020), A therapist transforms her disconnection by way of building a bridge, Photograph of a ProReal World. Chalong, Phuket: Private Collection.

Where psychodrama is enriched by group work, allowing clients to utilise other bodies in the space, ProReal® allows the individual client to benefit from multiple bodies, even though they are accessing the world alone with their therapist. Perhaps most excitingly, ProReal® has a roaming camera option, which means that we can actively facilitate distance for the client to see their problem from further away, or to zoom into areas where they may feel disconnected.

The client may also choose to give voice to their avatar, providing a phrase for them, and even adding ‘inner voices’, smaller heads that literally sit on the avatar’s shoulder. Figure 6 gives an example from a ProReal world I created, showing my feelings around online drama therapy work, and my inner thoughts around taking space as a potential pioneer.

Figure 6 a

Hill, M. A. (2020), A therapist looks to the future of online drama therapy, Photograph of a ProReal World. Chalong, Phuket: Private Collection.

It is perhaps this avatar therapy that truly embodies what I believe to be the current state of online drama therapy. There are apps and platforms that already utilise our language and techniques, and we are curious explorers, just starting to discover their potential.

Online Drama Therapy: Challenges and Opportunities

The online space is filled with challenges that may seem insurmountable. Technology is fallible, and it is scary to think about the number of things that can go wrong during a session just from a hardware point of view. There are certainly huge questions to be thought of in terms of ethics and confidentiality, and these cannot be ignored. Although a full breakdown of the ethics of online work is beyond the scope of this article, an informed therapist would do well to access the work of Anthony and Nagle (2010) as they begin to outline the limits of online confidentiality, and the importance of choosing secure platforms when working with clients. They succinctly sum up the problem by saying, “where there were previously four walls, a ceiling and floor, and two chairs within which to contain the therapeutic relationship, there is now an ephemeral space with no physical limits and many unknown technological factors…to contend with” (p.58).

There is also the very human fear that we are not ready for this work, that we have not had enough training, or maybe even that we cannot do it at all because of some perceived personal digital inability. For those therapists who consider themselves less than ‘tech-ready’ or even ‘tech-phobic’, I challenge you to step out of that role with all its anxieties and heaviness. Just like in our therapeutic work, it is the role of curious co-traveller that may be most useful when navigating the online space. Certainly, many of our clients feel just as ill-prepared to take on online therapy. Perhaps it is our empathy with those feelings that can be harnessed to deepen the therapeutic relationship, and create authentic connections, even when the digital connection falters or the wrong buttons get pushed.

As someone who loves all things technological, I can say with confidence that this world is waiting for us and is worth the risks. If we can push past our own perceived inadequacies and fears, and dare to enter the digital space, the opportunities are near-infinite.

Not only can we access new techniques and avenues of creativity, but we can also, perhaps most importantly, create increased access to our therapy spaces. And whether in times of COVID-19 lockdown or beyond, creating access to our therapeutic spaces is vital.

Think of the single parent with a sick child at home from school who does not have to cancel therapy because therapy is available wherever they are online. Think of the person who has no means to get themselves to in-person therapy, that could potentially access a therapist from home, even if they are hundreds of kilometres away.

In this era of disconnection and disempowerment, let us choose to connect with our clients in meaningful ways, whether that sees us in the same physical space or something a little more digital. Let us hear this strange call to digital adventure, which we may never have asked for or wanted, and let us respond as always with empathy, curiosity, and imagination, meeting our clients wherever in cyberspace they are.

References

Anthony, K. (2004), ‘Therapy online: The therapeutic relationship in typed text’, in Bolton, G., Howlett, S., Lago, C. and Wright, J. K., eds., Writing cures, New York: Brunner-Routledge, 132-140.

Anthony, K. and Nagel, D. M. (2010), Therapy online: A practical guide, London: Sage.

Chesner, A. (2019), ‘Concretisation and playing with perspective’ in Chesner, A., ed., One-to-one psychodrama psychotherapy: Applications and technique, London: Routledge, 30-49.

Emunah, R. (1994), Acting for real, New York: Brunner Mazel.

Jennings, S. (1990), Dramatherapy with families, groups and individuals: Waiting in the wings [Kindle], London: Jessica Kingsley.

Landy, R. J. (1994), Drama therapy: Concepts, theories and practices, 2nd ed., Springfield: Charles C. Thomas.

ProReal (2020), Research, available: proreal.world/research/ [accessed 6 May 2020].

Monique Alexandra Hill

Monique Hill Author Photo

Monique trained and registered as a drama therapist at the University of the Witwatersrand in Johannesburg, South Africa. For the past three years, she has been travelling in Asia with her husband. It was this travelling that pushed her to pursue online drama therapy. She is a Certified Cyber Therapist, trained by the Online Therapy Institute in the UK. She is currently based in Phuket, Thailand, and runs a private practice: Drama Therapy Online. She offers therapy via video chat, email, or text, and also runs webinars to train drama therapists in online techniques and ethical issues. She can be contacted at moniqueh@dramatherapyonline.com.