Behavioural Therapy,

UNIT 3 DRAMA AND ART THERAPY IN Cognitive Behaviour Therapy

and Approaches to Counselling
COUNSELING
Structure

3.0 Introduction
3.1 Objectives
3.2 Drama Therapy
3.2.1 Five Stage Theory
3.2.2 Drama Therapy Techniques
3.2.3 Applications of Drama Therapy
3.3 Art Therapy
3.3.1 Basic Approaches
3.3.2 Steps in Art Therapy
3.3.3 Art Therapy Techniques
3.4 Let Us Sum Up
3.5 Unit End Questions
3.6 Suggested Readings

3.0 INTRODUCTION
Counseling is both an art and a science. It is scientific in its development of
theoretical approaches to working with individuals and groups. It is artistic in the
way in which it uses timing and emphasis to implement certain methods with
particular individuals. For effective counseling, art and science must work together
for the welfare of client as well as counselor. Artistic methods and therapies can
be important and useful for the growth of counseling profession because it may
promote new insight. The creative arts have a significant contribution to make to
counseling theory and practice. Creative arts refers to art forms including visual
representations like painting, drawing and sculpture, literary expressions, drama
and music, that help the individuals become more aware of themselves or others.
In counseling, creative arts are defined as arts that are employed in therapeutic
settings to help facilitate relationships between counselors and clients. Various
art forms have been employed in counseling. The most widely used are: Visual
Art, Psychodrama, Poetry, Dance and Music. This unit will discuss art and drama
therapy.

3.1 OBJECTIVES
After completing this unit, you will be able to:
• Discuss the concept of drama therapy;
• Define art therapy;
• Explain the steps involved in the process of art therapy;
• Describe five stage theory; and
• Explain art and drama therapy techniques.

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Counselling: Models and
Approaches 3.2 DRAMA THERAPY
Drama therapy is defined by the National Association for Drama Therapy as “the
systematic and intentional use of drama/theater processes, products, and
associations to achieve the therapeutic goals of symptom relief, emotional and
physical integration and personal growth.”

The word ‘drama’ comes from ancient Greek and means quite literally “things
done” (Harrison, 1913).

Drama therapy uses action techniques, particularly role play, drama games,
improvisation, puppetry, masks, and theatrical performance, in the service of
behaviour change and personal growth.

It is an active approach that helps the client tell his or her story to solve a problem,
achieve a catharsis, extend the depth and breadth of inner experience, understand
the meaning of images, and strengthen the ability to observe personal roles while
increasing flexibility between roles.

The result is an active, experiential process that draws on the person’s capacity
for play, utilising it as a central means of accessing and expressing feelings, gaining
insight, practicing successful approaches to difficult situations. It has its roots in
religion, theatre, education, social action, and mental health/therapy

Early humans began to make art that is, paintings, sculpture, music, dance, and
drama about 45,000 years ago. The origins of the arts and religion seem to be
intertwined because the arts naturally provided effective symbolic ways to express
abstract religious ideas. Dance and drama, in particular, were extremely useful in
rites to create sympathetic and contagious magic as well as to embody myths and
rituals.

The first written theoretical account of drama therapy can be found in connection
with Greek theatre. In his Poetics, Aristotle says the function of tragedy is to
induce catharsis which is a release of deep feelings (specifically pity and fear) to
purge the senses and the souls of the spectators (Aristotle, trans. 1954). According
to Aristotle, the purpose of drama is not primarily for education or entertainment,
but to release harmful emotions in an individual which in turn will lead to harmony
and healing to the individual as well as in the community (Boal, 1985).

Drama therapy applies techniques from theatre to the process of psychotherapeutic

healing. It emerged as a field in the late 1970’s from hospitals and community
programs where it was first used with clients to produce plays and later was
integrated with improvisation and process drama methods. The focus in drama
therapy is on helping individuals grow and heal by taking on and practicing new
roles. While much drama therapy aims at helping people who are in therapy, drama
therapists have extended their applications beyond clinical contexts to enrich the
lives of at risk individuals, to prevent problems, and to enhance wellness of healthy
people. Many of the skills for such extensions require a measure of training
psychological training as well as a strong basis in theatre.

Just as psychotherapy treats people who have difficulties with their thoughts,
emotions and behaviour, drama therapy uses drama processes (games,
improvisation, storytelling, role play) and products (puppets, masks, plays/
34
performances) to help people understand their thoughts and emotions better or to Drama and Art Therapy in
Counselling
improve their behaviour.
The drama therapist is trained in four general areas:
i) drama/theatre,
ii) general and abnormal psychology,
iii) psychotherapy, and
iv) drama therapy.
The drama therapist’s role is to facilitate the client’s experience in a way that
keeps the client emotionally and physically safe while the client benefits from the
dramatic process. Depending on the goals and needs of the client, the drama
therapist chooses a method that will achieve the desired combination of
understanding, emotional release, and learning of new behaviour.
Some methods, such as drama games, improvisation, role play, developmental
transformations, sociodrama and psychodrama are very process oriented and
unscripted. The work is done within the therapy session and not presented to an
audience.
Other methods, such as Playback Theatre, Theatre of the Oppressed, and the
performance of plays are more formal and presentational, involving an audience.
Puppets, masks, and rituals can be used as part of performance or as process
techniques within a therapy session.
Certain techniques like drama games, role play, etc. involve fictional work. The
client pretends to be a character different from him or herself. This can expand
the client’s role repertoire.
Other techniques, such as Psychodrama, Therapeutic Spiral Model, Playback
Theatre, Theatre of the Oppressed and autobiographical performances, allow the
client to explore his or her life directly. Clients need to have good ego strength to
be able to do this kind of non-fiction work because it requires an honest, searching
look at oneself.

3.2.1 Five Stage Theory

Renee Emunah (1994) has identified five stages through which most drama therapy
groups progress. Her five stage theory parallels established wisdom from group
dynamics on how successful groups form and grow.
1) The first stage is Dramatic Play where the group gets to know each other and
the therapist through playing together develop trust, group cohesion, and
basic relationship skills.
2) The second stage is the Scene Work Stage where they continue playing. The
focus remains on developing dramatic skills which they will need as they
continue in treatment. As they grow older and begin school, they are
encouraged to develop their abstract reasoning skills and use them in their
learning.
3) Stage Three focuses on Role Play, exploring issues through fictional means.
Perhaps the group acts out a generic family conflict or a familiar character
from a fairy tale or legend that goes through a crisis or challenge shared by
group members. When the group is ready, they can move on to the next stage. 35
Counselling: Models and 4) Stage Four: Culminating Enactments, where personal issues are acted out
Approaches
directly through psychodrama or autobiographical performance.

5) The final stage is Dramatic Ritual, which usually involves closure to the
work of the group. This might be the sharing of a public performance that
has been created by the group or the sharing of a private ritual within the
group

3.2.2 Drama Therapy Techniques

Drama therapy techniques differ from therapist to therapist or from session to
session, but certain concepts are common to all forms.
1) Use of Metaphor: The first is the use of metaphor through action. Behaviours,
problems, and emotions can be represented metaphorically, allowing for
symbolic understanding. An emotion can be represented with a metaphorical
image: anger displayed as a volcano, an exploding bomb, or a smoldering
fire. These images can be dramatised which allow the client to gain more
insight into the qualities of the emotion and how it functions positively or
negatively in his/her life.
2) Concrete embodiment: This technique allows the abstract to become concrete
through the client’s body. Embodiment allows clients to “experience” or “re-
experience” in order to learn, to practice new behaviours, or to experiment
with how to change old behaviours. Playing a role quite different from oneself
often feels more comfortable than playing oneself directly.

3) Dramatic Projection: This technique is akin to concrete embodiment and

employs metaphor. It is the ability to take an idea or an emotion that is within
the client and project it outside to be shown or acted out in the drama therapy
session.

4) A client’s difficulty asking for help (an internal problem) can be dramatised
in a scene with other members of the group, with puppets, or through masks,
so the problem becomes an external problem which can be seen, played with,
and shared by the therapist and the group.

5) Creation of transitional space: The creation of Transitional Space is an

important component in many therapeutic and learning environments, but it
is essential in drama therapy. Transitional space is the imaginary world that
is created when we play or imagine together in a safe, trusting situation.

6) It is a timeless space in which anything we can imagine can exist. It is created

jointly by the therapist and the clients playing together and believing in the
possibility that anything can happen.

7) Incorporating other Arts: Drama therapy is like a crossroad, where all the
arts come together and are allowed to work together. Drama therapists use
music, movement, song, dance, poetry, writing, drawing, sculpture, mask
making, puppetry, and other arts with their drama therapy activities. Drama
therapists are required to have training in the other creative arts therapies and
why many drama therapists have credentials in one of the other arts therapy
modalities.

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3.2.3 Applications of Drama Therapy Drama and Art Therapy in
Counselling
Drama therapy is primarily conducted in groups, but can be used in individual,
couples, or family counseling. It can be found in a wide variety of settings with
many different kinds of clients. Any kind of therapy group that uses talk therapy
can use drama therapy. For some groups, the action methods of drama therapy are
more effective. Drama therapy ignores the excuses and denial, getting right to the
behaviour.

Other types of groups for instance, nonverbal clients or children who are not good
candidates for verbal therapy can often participate successfully in drama because
they can not verbalize rather show how they feel. It is practiced in clinical settings,
residential settings, correctional facilities, educational situations, corporations and
businesses, community action settings, and social and recreational centers.

3.3 ART THERAPY

Art therapy is a modality emerged from the interacting of art, creativity and
psychotherapy. It uses art media to express internal images, feelings, thoughts
and sensations in a concrete form. It provides the opportunity for non verbal
expression and communication, which can assist in improving the client’s
functional abilities and resolving emotional issues. The use of art as therapy implies
that the creative process can be a means both of reconciling emotional conflicts
and of fostering self awareness and personal growth.

The use of art can be traced all throughout history, from prehistoric eras to the
present, but art therapy first received significant attention due to the theories of
Freud and Jung (Wadeson, 1980). These psychologists believed in the importance
of symbolism, which is very prominent in art forms.

Art therapy has continued to evolve and became a recognised profession in the
1960’s. According to Wadeson (1980), “the creation of the American Journal of
Art Therapy and the establishment of the American Art Therapy Association”
were responsible for art therapy’s rise to a recognised profession and therapeutic
intervention.

Art therapy is based on the idea that the creative process of art making is healing
and life enhancing and is a form of nonverbal communication of thoughts and
feelings (American Art Therapy Association, 1996). It is the therapeutic use of art
making, within a professional relationship, by people who experience illness,
trauma, or challenges in living, and by people who seek personal development.

Through creating art and reflecting on the art products and processes, people can
increase awareness of self and others, cope with symptoms, stress, and traumatic
experiences; enhance cognitive abilities; and enjoy the life affirming pleasures of
making art. It is used to encourage personal growth, increase self understanding,
and to assist in emotional reparation and has been employed in a variety of settings
with children, adults, families and groups.

It is a modality that can help individuals of all ages create meaning and achieve
insight, find relief from overwhelming emotions, resolve conflict and problems,
enrich daily life and achieve an increased sense of well-being (Malchiodi, 1998).

37
Counselling: Models and Art therapy is a mental health profession that uses the creative process of art
Approaches
making to improve and enhance the physical, mental and emotional well being of
individuals of all ages. It is based on the belief that the creative process involved
in artistic self-expression helps people to resolve conflicts and problems, develop
interpersonal skills, manage behaviour, reduce stress, increase self-esteem and
self-awareness, and achieve insight.

Art therapy integrates the fields of human development, visual art (drawing,
painting, sculpture, and other art forms), and the creative process with models of
counseling and psychotherapy. It is used with children, adolescents, adults, groups,
and families to assess and treat anxiety, depression, and other mental and emotional
problems; physical, cognitive, and neurological problems; and psychosocial
difficulties related to medical illness. Art therapy programs are found in a number
of settings including hospitals, clinics, public and community agencies, educational
institutions, businesses, and private practices.

Art therapists are master’s level professionals who hold a degree in art therapy or
a related field. Educational requirements or syllabus include theories of art therapy,
counseling, and psychotherapy, ethics and standards of practice, assessment and
evaluation, individual, group, and family techniques, human and creative
development, multicultural issues research methods, and practicum experiences
in clinical, community, and/or other settings. Art therapists are skilled in the
application of a variety of art modalities (drawing, painting, sculpture, and other
media) for assessment and treatment. Art therapy combines traditional
psychotherapeutic theories and techniques with an understanding of the
psychological aspects of the creative process, especially the affective properties
of the different art materials.

3.3.1 Basic Approaches

There are two basic ways in which an art therapist can approach the idea of art
therapy. The first is to be process intensive. In this approach the art therapist, uses
art as a means to help his/her patient(s) to discover something about him or herself.
Art is used as a catharsis, an emotional journey to which self-actualisation and
discovery are the end result. Edith Kramer was the first person to champion this
school of thought. Kramer emphasised the healing qualities of art making, and
was concerned with artistic quality.

The second approach is not to be so concerned with the process of making the art,
but with what the person is consciously or unconsciously expressing through their
art. Margaret Naumburg believed that this was the best way to utilise art therapy.
In this way, the art therapist uses art as a window into the subconscious of the
patient, and from there can attempt to figure out the underlying problems that the
patient may be suffering from. It can be risky to look into art too closely, but in the
case of children, who may not have the words to express how they are feeling; it
is very beneficial to use art as a mode of expression.

3.3.2 Steps in Art Therapy

1) Assessment: Assessment often comes at the beginning of art therapy, and
usually happens during the first session that the therapist has with the client.
Assessment is used by the therapist to find out what the client is going through,
and to gain any other information that he or she may wish to find out about
38
 the client. It is important to be very up-front at this time with the client, being Drama and Art Therapy in
Counselling
very clear that the session is not treatment oriented, but is for assessment
purposes. Assessment at the beginning of therapy is an important first step
because it is at this point that the therapist will decide if art therapy is a good
option for the client or if it would be a waste of time.

2) Treatment in the Beginning: During the first session, the first thing for the
therapist is to establish a good rapport with the client because it allows for
the development of trust in the relationship. It is also essential for the art
therapist to better grasp the framework from which the client is operating.

After establishing a rapport with the client and getting a grasp on the client’s
vantage point, the art therapist can introduce art therapy to the client by giving
back-round information about art therapy, and answering any questions that
the client may have. At this point, the therapist may suggest doing some
artwork.

This first piece of art that the client creates is a very important one because it
sets the tone for the rest of the session. Because many people have art anxiety
in these beginning sessions, it is important that the therapist makes the client
feel as comfortable as possible. This could be done by saying to the client
that they should not worry about artistic accomplishment, but rather self-
expression. Another important aspect of this first artistic work is the reaction
of the therapist to it.

After this first session, it is important for the art therapist to begin developing
treatment goals, as well as to reflect on what initial reactions the therapist
may have after the first meeting.

3) Mid-phase of treatment: It is hard to know when the treatment has moved

from the beginning portion to the mid phase but there are a couple of key
differences which are given below:

• when the trust between the client and therapist has been established,
and

• the focus of the sessions becomes more goal oriented, that do mark the
mid-phase.

In the mid phase of treatment the therapist first establishes direction and
boundaries, both personal and professional. There are many different
techniques that are used in art therapy and knowing which one to use at what
time is one of the art therapist’s toughest jobs. Because each case is unique
and each client is different, the art therapist must custom fit the art therapy
for each individual client.

4) Termination: The termination of art therapy is initiated abruptly and clearly.

Either the art therapist or the client can initiate the termination of the art
therapy. Termination is generally decided upon when the therapist or the client
realises that the therapy is finite. It is a very important part of the therapy
process. The way in which therapy is brought to a close is crucial to the
outcome of the treatment. If termination is handled incorrectly, the client or
patient may regress as the end of therapy approaches.
39
Counselling: Models and The therapist should prepare the patient well in advance. This can be done by
Approaches
bringing up the issue of termination, focusing on its importance and discussing
and interpreting feelings and behaviours due to the pending ending of the sessions.
This is a difficult tightrope for the therapist to walk because focusing on the end
often brings to mind other separations that client may have suffered.

When nearing the end of the therapy, the client and therapist should begin relooking
at the art that the client has created throughout the sessions and talking about the
progress that the client has made. It is also a good idea to use art in these last few
sessions to help express feeling about the termination of the therapy sessions. The
therapist often will join the client on these works of art.

The termination of the art therapy brings up a very practical question as well,
what should be done with the art that the client created during the course of the
sessions? This is a tricky question, but ultimately it is one that should be answered
by the client. They could keep the art as a form of remembrance to the journey
they went through, or give it to the therapist to show the importance of the
therapeutic bond that they reached.

These are of course not the only two options that the client has, but two of the
most common ones.

3.3.3 Art Therapy Techniques

The following are some techniques that art therapists use:
1) Exploration Tasks: An exploration task can be quite liberating. The goal is
to encourage the patient/client to let go of conscious thoughts and controls,
and to have them express themselves as freely and spontaneously as possible.
In this way, exploration tasks are very much akin to verbal free associations.
Exploration tasks are generally used in the beginning sessions of art therapy.
Some examples of exploration tasks are:

a) Scribble Technique /Automatic Drawing

In this, the patient/client is asked to relax and begin to make draw free lines
or scribbles on paper. In some cases the patient/client will be instructed not
to remove his or her pen from the paper until the exercise is over. Automatic
drawing provides an excellent way for the patient/client to let down their
guards and thus is a good starting point for therapy.

b) Free Drawing
In free drawing all the choices are up to the patient/client. The patient/client
is told to express him or herself freely, and not to worry about planning the
picture. This technique is useful because the images that the patient/client
creates are often mirrors into the person’s present problems, strengths and
weaknesses. Often at the end of free drawing, the patient/client is asked to
share and explain what they drew about.

c) Drawing Completion
In the drawing completion technique, a patient/client is given one or more
pieces of paper that already have a few lines or simple shapes on them. These
shapes or lines act as a starting point for the art therapy artist, and they are to
40
be incorporated into a larger picture. Because of the wide individual responses
 to the same stimuli, this is an excellent technique for a group discussion Drama and Art Therapy in
Counselling
topic. Kinget developed this approach for therapeutic purposes.

2) Rapport-Building: Rapport-building exercises are used in both individual

and group art therapy settings. The basic idea behind rapport building exercises
is to reduce the amount of isolation that the patients/clients may feel while
they are creating their art. This includes isolation from the other patients/
clients in the group, and the distance they feel between themselves and the
therapist. Some examples of Rapport-Building are:

a) Conversational Drawing
In conversational drawing, the group is broken up into pairs. The two people
who are assigned to work together are seated across from one another. The
only way of communication is with shapes, colours and lines. In this way, the
pair is not only communicating, but sharing at the same time. This is a good
way from patients to get to know one another a little better.

b) Painting Completion by the Group

In painting completion by the group, each member of the group is asked to
name one thing, an object, feeling or event, and then depict it. From here,
one or more of the group members begin adding to the collage, trying to
improve upon what is already there. This technique better enables people to
become aware of how it feels when they make something and have someone
else “put upon you anything they want to.” The patients/clients are encouraged
to share what they are feeling about someone else adding to their work.

c) Painting with an Observer

In painting with an observer, one member of a pair tells the other one whatever
comes to into his or her minds as he or she watches the other one paint. The
painter can respond to what the other one is saying as he or she sees fit during
their painting. This exercise promotes discussion of feelings of dependency
and autonomy, as well as acceptance issues.

3) Expression of Inner Feelings: These techniques are designed to help the

patient/client get in touch with inner feelings, desires and fantasies and to
make visual representations of them. This is done in the hope that the patient
will become increasingly aware of him or herself. The therapist will then
attempt to help the patient/client deal with these feelings, and move in a
direction toward a solution. An example of expression of inner feelings
technique is called “three wishes”.

a) Three Wishes
In the three wishes technique, the patient or client is asked to paint or portray
three or more wishes. Responses tend to be of desires for things, personal
security and so on. Responses to this exercise reflect maturity level, degree
of egocentricity and so on. Discussion that follows this exercise focuses on
the strength of the wish and whether or not these goals/wishes are attainable.

4) Self Perception: The self perception technique is aimed at moving a client

toward a more complete awareness of personal needs and body image. Some
examples of this technique are as follows:
41
Counselling: Models and Immediate States -Here the patient/client selects one or more of statements
Approaches
“I am”, “I feel”, “I have”, or “I do” to paint about.

a) Self-Portraits
Self-portraits can vary from being realistic, done with or without a mirror to
abstract. A variation of this technique is to give a time limit to the painter,
such as one minute. In this way, the artist is forced to quickly decide what
important feature about themselves they wish to draw.

b) Draw Yourself as an Animal

Here the patient/client is asked to draw themselves as any kind of animal, or
as the animal that they see themselves as most similar to. This is a good
group building technique because the discussions are usually funny as well
as revealing.

5) Interpersonal Relations: The interpersonal relations technique is designed

to make the patient/client more aware of others, and how others may perceive
him or her. Some examples of this technique are as follows:

a) Portraits of Groups Members

Here group members are asked to depict each other. This exercise helps group
members to more fully clarify their feelings toward each other.

b) Group Mural
Here the group works cooperatively on a large project. The choice in subject
matter and materials may be left to the group or predetermined by the therapist.
This exercise promotes cooperation, group unity, fitting in individually to a
larger whole and self expression in a larger group setting.

6) The Individual’s Place in the World: This technique is designed to help

the patient/client to see where he or she fits into the world, and hopefully
accept and deal with this realisation. Some examples of this technique are as
follows:

a) House-Tree-Person
Here the patient/client is asked to depict a house, tree and a person in one
picture. The patient/client is faced with the task of how to relate the human
figure to the other two common environmental features.

b) Collage and Assemblage

Here the patient/client is allowed to create a personal world out of any
materials that he or she may desire. The therapist may predetermine themes,
or the patient/client may work until themes begin to appear by themselves.

It is important to keep in mind that although there are many techniques available
to the art therapist and all of them are valid, no one technique should dominate.
This is because the techniques discussed here are only loose guidelines that the
art therapist should take into consideration. More important than these guidelines
are that the approaches that the art therapist chooses to take are well designed and
thought out to meet the specific demands and needs of the individual or group.

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 Drama and Art Therapy in
3.4 LET US SUM UP Counselling

Art and Drama therapies have benefited all areas of health care system. According
to the American Art Therapy Association, Inc.’s professional definition of Art
Therapy, Art Therapy is a human service profession that utilises art media, images,
the creative art process and patient/client responses to the created products as
reflections of an individual’s development, abilities, personality, interests, concerns
and conflicts. Defining art therapy is a daunting task because it is an evolving
science, and because it is hard to come up with a definition that fully encompasses
what art therapy is, but it doesn’t mean that it is any less beneficial as a form of
therapy. Art therapy is not just a stepping stone to a verbal exchange, and should
not be treated in this way. The art therapist should be very careful of over or under
reliance on the verbal amplifications of the art by the client or patient.
One of the great advantages of art therapy is it fosters use of both sides of the
brain. The nonverbal art expression is primarily a right brain process; the writing
is coming from the left-brain language centers.
Drama therapy is the systematic and intentional use of drama and theatre processes
to achieve the therapeutic goals of symptom relief and personal growth. It is an
active, experiential approach that facilitates the client’s ability to solve problems,
set goals, express feelings appropriately, achieve catharsis, improve interpersonal
skills and relationships, and strengthen the ability to perform personal life roles.
It increases flexibility between roles. Dance therapy is proving especially beneficial
for the elderly to increase their range of mobility.

3.5 UNIT END QUESTIONS

1) What is art therapy?
2) Define drama therapy.
3) Explain the steps used in art therapy.
4) What is rapport building?
5) Illustrate with examples the exploration technique of art therapy.
6) Discuss Renee Emunah’s stages in drama therapy.
7) What do you mean by Dramatic projection?

3.6 SUGGESTED READINGS

Judith A. Rubin (2001): Approaches to Art Therapy: Theory and Technique.
Publisher: Bruner- Routledge
Dorothy M. Langley (2006): An Introduction to Drama Therapy. SAGE
Publications Ltd.
References
David R. Johnson, Renée E. (2009): Current Approaches in Drama Therapy.
Charles E. Thomas –Publisher Ltd.
Judith A. Rubin (1998): Art Therapy: an Introduction. Publisher: Bruner- Routledge
Sue Jennings (1997): Drama therapy: Theory and Practice 3, Volume 3 Publisher:
Routledge.
Robert J. Landy (1994): Drama Therapy: Concepts, Theories, and Practices. 43