Review: Trauma-Informed Drama Therapy

“The boundary between therapy and ethics collapses in trauma treatment. Due to the nature of trauma, treatment will benefit from ethical principals of transparency, consent, and restraint on self interest.” p.13

Trauma-Informed Drama Therapy: Transforming Clinics, Classrooms, and Communities, initially published in 2014, has been updated in 2024 to reflect the profound changes brought about by the COVID-19 pandemic. This edition was conceived against the backdrop of George Floyd's murder (Dreyer et al., 2020) and the ensuing global protests against racial and social injustice. It provides a focused examination of trauma within marginalised communities and explores both the potential and the challenges of dramatherapy in addressing such trauma.

The book is written through the crucial lens of intersectionality. Intersectionality is a framework for understanding how various aspects of a person's social and political identities (such as gender, race, class, sexuality, ability, etc.) combine to create unique modes of discrimination and privilege (Crenshaw, 1989). Employing this framework, "The text consistently analyses and reflects on the therapist's position and role, particularly emphasising the idea that 'members of a dominant majority hold power over those who are not, regardless of the state of interaction, and regardless of their intention or desire'" (p.39). Aimed at experienced dramatherapists, clinicians, and educators, it is also accessible to those interested in understanding the complexities of trauma.

It is organised into three sections: Clinical Settings, Educational Settings, and Performance Settings, comprising twelve chapters, each addressing trauma from different perspectives. In the Clinical Settings section, David Read Johnson and Rebecca Davis explore the power dynamics that arise when white therapists work in racially diverse settings, using developmental transformation (DvT) theory (Johnson & Pitre, 2020) as their analytical framework. They introduce a key concept within DvT known as "varielation" or "shaking the tree," which involves the intentional use of play to “disrupt, destabilize, and create openings in the clients’ defensive positions” (p.31). As a specialised area of Dramatherapy, DvT demands rigorous training and expertise. While this chapter offers a valuable introduction for novice practitioners, it is crucial to emphasise that practicing these concepts without proper training and a comprehensive understanding of their application and implications would be unethical.

Shelly Bockstead and Mathieu van der Straeten build on Ogden and Fisher's (2015) sensorimotor approach, Porges' (2017) Polyvagal theory, and Levine's (2010) somatic experience theory, offering a multifaceted perspective on trauma therapy. They particularly emphasise the critical role of the therapist’s response in helping the client regulate their nervous system. This approach illustrates how, “when passive responses are changed by active responses, the client experiences a natural process of shaking and trembling and the breathing changes from the surface to a deep relaxed state” (p.64).

Craig Haen, Maria Hodermarska, and Lucy McLellan explore the role of dissociation in white therapists’ experiences of racialisation and prejudice, providing for consideration of the unconscious biases that affect therapeutic relationships. One case study, in particular, resonated with me deeply. It described a racial misstep by the therapist, which ultimately opened the door to a healing dialogue. By acknowledging their mistake and sitting with the resulting shame and discomfort, the therapist was able to confront and understand their blind spot (pp. 93-94).

In exploring the diverse and complex experiences of trauma across different cultural contexts, the book considers the effects of societal and political issues on individual and collective well-being.Anshuma Kshetrapal highlights the impact of misogyny on Indian women's freedom of expression and identity, illuminating the intersections of gender and cultural oppression. Ravindra Ranasinha discusses the role of dramatherapy in addressing the impact of terrorism, specifically the Easter Sunday suicide bombing in Colombo in 2019, and the resulting trauma within affected communities (Seale, 2023).

The Educational Settings section explores various applications of Dramatherapy in educational contexts, David Read Johnson, Nisha Sajnani, Cat Davis, and Hadar Lubin review the efficacy and barriers of the Miss Kendra Program (Miss Kendra Programs, n.d.), highlighting innovative approaches to trauma-informed education. Their insightful chapter highlights the role of the Miss Kendra program in addressing toxic stress within school settings through a social justice lens. By fostering open conversations and bearing witness to students' lived experiences, the program offers a meaningful approach
to healing (p. 160).

Heidi Landis examines the role of dramatherapy in mitigating stress among immigrant and refugee students through the Creative Alternatives of New York’s (CANY) model, addressing the unique challenges faced by those populations, She notes that “Psychotherapy with traumatized individuals is challenging when their basic needs are not being met, language is an ongoing barrier, and their sense of safety has been shattered” (p181). The chapter also examines the role of embedded counselling (Mcleod, 2022) in educational settings, highlighting its importance in supporting immigrant and refugee students (p. 191).

In a related exploration of education through a therapeutic lens, Susana Pendzik, Ingrid Lutz, and Jutta Heppekausen focus on contemporary German youths' understanding of the Holocaust. They explore how dramatherapy can be employed as a powerful tool to facilitate historical learning. These chapters collectively highlight the transformative potential of dramatherapy in both addressing immediate trauma and fostering deeper educational engagement.

Maitri Gopalakrishna, Padmalatha Ravi, and Pallavi Chander discuss the emotional impact of the closure of a progressive, trauma-informed school in rural India, demonstrating the importance of supportive educational environments for children. They highlight the effectiveness of this approach, stating, “by entering the space with a desire to learn a language rather than impart knowledge, acknowledging and negotiating power dynamics, falling in step with the rhythm of the space, and responding to the emergent needs with adaptiveness and curiosity, we were able to identify, amplifyand concretize the resources and expertise of the students” (p.256).

In the section on Performance Settings, Gary Raucher, Renee Emunah, and Aileen Cho update their work on self-revelatory performance in trauma treatment (Emunah, 2015), demonstrating the power of performance in personal healing. Bonnie Harnden reports on using autoethnography to address systemic oppression through her films You Arrive and We Arrive (Concordia University, 2022), illustrating the role of creative expression in social justice. Margie Pankhurst explores gender-based violence in South Africa through the experiences of three women of colour within a racialised context, offering a compelling look at the intersection of race, gender, and trauma.

Each chapter provides a thorough and thoughtful investigation of its subject matter, with a cohesive thread that allows readers to easily cross-reference and reflect on the text's relevance. That said, while the breadth of chapters is impressive, some readers might find themselves wishing for a deeper exploration of a select number of stories. The writing is accessible and appealing to a broad audience. As an experienced dramatherapist, I do find myself wondering whether dramatherapy is still fully finding its voice in textbook form. Given its inherently embodied nature, writing about dramatherapy through a clinical lens presents unique challenges. Despite its recognised significance and efficacy in trauma treatment, dramatherapy often remains on the fringes within the clinical field (Lea-Weston, 2017). There is still a need for greater awareness among healthcare providers and administrators about its benefits and methodologies. This brings me back to my earlier point about the volume of case studies in this edition. A more focused collection, highlighting the rigorous methodology and clinical expertise of dramatherapists, might more effectively underscore the discipline's value in mental health and trauma care.

This textbook includes excellent and up-to-date references to current clinical guidelines and research, making it an invaluable resource for researchers, clinicians, and anyone interested in trauma-informed therapy. One of its most vital points is its dedicated focus on intersectionality and white privilege, examining how both impact the therapeutic relationship. While the text does not include specific pedagogical tools, it certainly provides food for thought. The case studies offer insight, provoke reflexivity, and invite critical inquiry into one's practice.

As a Dramatherapist working with marginalised Irish communities, I found this textbook a necessary call to awakening within my practice. Ireland's population has grown significantly in recent years with global conflict, economic pressure, climate change and human rights concerns leading to a rise in people seeking refuge from a diverse range of countries. This change in demographics has led to a significant rise in racial discrimination and attacks. In this context, this book has forced me to interrogate my position as a white, middle-class therapist working within marginalised communities.

One of the most valuable questions during my training was, "Why be a helper?" This book asks, "How are you helping?", and in doing so, it not only invites but implores therapists to consider their methods, the impact of their position, and the implication of their role in clients' experiences of trauma.

This new edition of Trauma-Informed Drama Therapy: Transforming Clinics, Classrooms, and Communities is a welcome addition to dramatherapy. Experienced clinicians will benefit from the case studies, and newcomers will have their curiosity piqued. Working therapeutically with individuals who have experienced trauma requires a sensitive, informed, and multifaceted approach. Given the profound and lasting effects of trauma on an individual's well-being, therapists should be adequately trained and continuously educate themselves on the latest trauma-informed practices. Healing emerges from the bravery, confidence, courage, love, kindness, creativity, determination, past experiences, and knowledge shared by both the therapist and the client (p. 200).

References

Crenshaw, K. (2021). Demarginalizing the intersection of race and sex: A black feminist critique of antidiscrimination doctrine, feminist theory and antiracist politics. Droit et société, 108, 465.

Dreyer, B. P., Trent, M., Anderson, A. T., Askew, G. L., Boyd, R., Coker, T. R., ... & Stein, F. (2020). The death of George Floyd: Bending the arc of history toward justice for generations of children. Pediatrics, 146(3).

Johnson,D.R., & Pitre, R. (2022). Developmental transformations. In D.R. Johnson, & R. Emunah, Current Approaches in Drama Therapy (pp. 123-161). Springfield, IL: Charles C Thomas, Publisher.

Lea-Weston, L. (2017). On the edge – from the margins to the mainstream: Developing dramatherapy as a practice and a profession. Dramatherapy, 38(1), 59–65. 

Levine, P. A., & MD, G. M. (2010). In an Unspoken Voice: How the Body Releases Trauma and Restores Goodness (Illustrated edition). North Atlantic Books, U.S.

Mcleod, J. M., Julia. (2022). Embedded Counselling in the Helping Professions - A Practical Guide. Open University Press.

Ogden, P., & Fisher, J. (2015). Sensorimotor Psychotherapy: Interventions for Trauma and Attachment (First edition). W.W. Norton & Company.

Porges, S. (2017). The Pocket Guide to the Polyvagal Theory: The Transformative Power of Feeling Safe (Norton Series on Interpersonal Neurobiology) (Illustrated edition). W. W. Norton & Company.

Nicola Kealy

Nicola trained as an actor and has worked in arts and disability for twenty-five years. Nicola's interest in the power of the arts as a therapeutic tool led her to a Masters in Dramatherapy, qualifying as a dramatherapist in 2012. She works in private practice, where she specialises in anxiety and depression and with First Fortnight in adult and children's services. Nicola is a guest lecturer in the School of Nursing, Psychotherapy and Community Health at DCU and the School of Education at Maynooth University. In addition, she teaches a module on inclusive creative practice for social care students with The Open Training College. Nicola is in the final stages of a psychotherapy doctorate, where she is researching women's experiences of perimenopause.