Bristol-based dramatherapist Rosie Strain blogs on the challenges and benefits of creative dramatherapy groups with LD clients & staff. For further information about Rosie’s work, or to contact her, please see www.rosiestrain.co.uk
The following examples of Therapeutic Storymaking Groups began in August 2007 at a Residential School for young people with learning difficulties and challenging behaviour. It proved to be a valued opportunity for communal activity, which encouraged playful interaction between staff and clients, developed personal confidence (particularly in non-English speaking staff) and fostered essential team-building skills.
During the first few weeks of undirected dramatic play, I began to notice between some staff and clients a disconnect in relationship. This could be seen mostly in increased difficult behaviour by the client when with that staff member and on the latter’s part a discontentment and sometimes fear of working with that client. So I began to explore the possibility of supporting this area and encouraging a better, more meaningful and engaging relationship between the two. I felt that the sphere of the creative arts suited this by providing a tool for expressive and alternative ways of connecting where communication had essentially broken down.
This also came during the time as several, high profile and disturbing cases emerged of serious failings within the institutional care system. It was my feeling that much of these situations were born out of ignorance and misunderstanding of the ‘human’ levels needed in the areas of LD care. Too often it is assumed that a job is done by meeting the client’s basic needs, without an understanding of the very complex and demanding nature of working with ‘difficult individuals’ and the impact this has on the staff as well as the client. Often, this area is only covered by basic or standard training and therapeutic activities are solely for the client and merely the staff’s responsibility to make sure they attend and participate.
The aim of the groups is to encourage meaningful and appropriate relationship between staff and client that goes beyond the former meeting only the basic needs. A more healthy relationship is formed where there is a greater awareness of the client’s emotional needs and therefore the benefits of the care are greater. The creative element of the group also allows for other potential benefits:
- For staff to learn to new skills of play and interaction with the clients
- To be able to integrate learning into everyday life and to encourage enthusiastic and creative aspects of care rather than ‘the requirement of the job’
- To gain a greater awareness of the client’s experience and how they perceive the world.
- To strengthen the ‘bond’ between the staff & client
- To simulate the Imaginative/Creative side of the brain (for both)
- To activate the language processing part of the brain
- To captivates and expands imaginative capacities
- To develop Listening skills
- To encourage stillness (& therefore improve attention span and focus)
- To develop emotional language
- To helps the brain to process experience
- Also, the Physical bond is strengthened via eye contact, vocal volume, facial expressions & gestures
On a basic level, the sessions are a form of Intensive Interaction, creative communication that enables the clients to explore and expand their imaginative and sensory development. Through play, staff are encouraged to enter into the client’s world and interact in their ‘language’, communicating with their sounds and gestures and so gaining a better understanding of their experience.
Sessions start with a practice we call ‘check-in’. This serves to allow each person to share any current feelings (physical or emotional), concerns, reservations and any important or difficult events they may have recently experienced. Non verbal clients are encouraged equally to express themselves in their own way and the group witnesses this behaviour. The ritual serves as a marker for the clients to know that the session has begun.
Importance is placed on both staff and client checking in. This adds to a sense of “we are equal” in this shared experience. A ‘check-out’ at the end provided the same benefits, allowing the group to have a conclusion and creates a helpful transition boundary for the next activity.
In the first months we focus on establishing a sense of safety and trust by exploring boundaries, becoming familiar with each other, being honest and open and sharing our experiences. Time is invested in simply playing creatively together through imagination and improvisation, games and exercises and learning how to play in a more uninhibited way. This contributes to everyone feeling ‘equal’ in the shared space.
The time is then given to everyone to play together, allowing any images, characters or ideas to emerge (which can be used in the story later on). This is done by exploring articles from assorted sensory materials (fabrics/costumes, wool, tubes and rattles etc) using our imagination to share with the others what we have chosen for the story. e.g. A piece of wool becomes a cloud or a sheep, a tube transforms into a pirate’s telescope or an umbrella.
This has various purposes including introducing an element of imagination, providing a starting point for the story’s narrative and creating a shared investment in the costumes or characters.
Using the chosen materials, we then create story narratives and journeys, speaking them aloud with everyone having an opportunity to be the narrator. We bring the story to life, improvised as its spoken using voice, facial expression and MAKATON (and other appropriate communication aids) as much as possible. The story starts by asking questions alongside our ‘props & costumes’;
- What we can see around us?
- What is the client doing?
- What can the materials in the room become?
- What ideas are popping into our heads?
The story will then become formed around these questions and what the clients are doing at that moment:
- What are the client’s actions, movements and sounds?
- If there’s a lot of jumping, can they be a frog in the story?
- If they are enthusiastically rifling through drawers or looking around the room, could they be a curious explorer?
- What sort of character could we be if we joined them?
- What’s the weather like outside & how are they affected by it?
- Does the client like particular places? Forests and Jungles or Train Stations and Cafe’s?
- What might capture their interest?
We are never looking for elaborate, complex or detailed fairytales. Neither do our stories need to be ‘narratively correct’ with clear beginnings and endings. The object is not to create something fantastical that could be published but to play creatively with the impulse of each person and see what emerges.
I rarely direct the sessions. Rather I facilitate a space in which there is a non-judgmental acceptance to whatever emotion or action emerges and what issues and energies are current on the day. By being ‘in the moment’ the group can then address anything present and support each member to overcome any insecurity, embarrassment or lack of confidence. If at times there is conflict in the group I will facilitate more directly to allow the story to focus on members finding alternative ways to relate to each other and in such instances, the group’s cohesion and trust can support each person, bringing a deeper investment and involvement in the session.
Growing confidence and familiarity with the sessions has means staff are increasingly able to challenge themselves, develop their learning and connect with the clients emotionally. They also become increasingly able to articulate what theirs and their client’s needs are from the group.
Every effort is made to have the same staff attend the group to provide continuity and the benefits to both client and staff this would offer. This was not always possible and is reliant on senior staff communicating effectively the time, place and ‘what to expect’. This in turn allows the new staff member to have an open mind when attending the group and help them to be receptive to the process. Regular sustained attendance greatly improved this and the success of the group’s therapy depends on a good system of communication as a result.
There is also the issue of disinterest or refusal by a staff member to join in with the group. This occasionally appears in the form of critical commentary or rude language or behaviour. I usually see this as a sign of anxieties born out of misplaced assumptions of what is expected of the staff (“Do I have to perform? Have a good imagination” etc) which are often laid to rest once that person has participated in the group. If such negative responses continue, I discuss it directly in private with the staff member, or bring it to their manager where necessary.
Resistance or disinterest is rarely shown by the client as their carers/managers are usually astute in whether joining such a group would be something they would enjoy. There is never a pressure to have to stay in the room and they are able to leave if it becomes too much. They are also encouraged to return where possible to see the process through.
Risk Assessments are created for the group as a whole as well as for each individual client. If difficult behaviour occurs it is discussed first with the staff on how the group might adjust to help the client manage better. This is usually the effective way of meeting challenging behaviour, however if it persists it is discussed with wider management and with the question in mind whether the group is the right place for the client. Usually the safety and trust created by the group and the lack of pressure to remain if not managing means that difficult behaviour is rarely an issue.
The effectiveness of these groups has so far been evidenced via verbal testimonial from the staff or a change in behaviour by a client. I have measured the evidence on the following:
- Visible enjoyment by client and/or staff
- Regular attendance by client and/or staff
- Regular feedback/comments opportunities, both verbal and written
- Visible confidence changes in client and/or staff, observed via language, gesture, facial expressions and general demeanour
- Ongoing Personal Supervision where issues are discussed and resolved
- Mentoring & Observations by Therapy Students on Clinical Placements
- Annual or Process Reports/Reviews on a regular basis
Having honest and creative communication gives the client’s and their staff a much more fruitful, productive and happy relationship. Working with both client and staff can combat some potential conflict and so bring about a healthier relationship and therefore a much higher standard of care.
However as far as I understand it there is not much in this field beyond mandatory training. I have not found anything that works therapeutically with the difficulties arising between client and staff.
Therefore, it is my intention to conduct a 2 year research project in the future, examining in more detail what I have outlined in this blog. This would follow a Qualitative Research Storymaking Group across a 2 year time period with the aim of examining aspects including cultural, social & emotional aspects of group members and the organisation, physical & mental limitations, historic & academic research of the use of story as a therapeutic method.
The groups continue to grow in strength and with individual a gradual sense of ownership in their creative development, increasing confidence and connection with one another. As each member becomes more confident and at ease within the group, they will also in turn continue to grow and develop into a strong and solid community.
For Further Information:
- Rosie Strain: rosiestrain.co.uk
- The British Association of Dramatherapy: http://www.badth.org.uk
- Intensive Interaction: http://www.intensiveinteraction.co.uk
- Makaton: http://www.makaton.org
- Person-Centered Psychotherapy: http://www.pce-world.org
 *Intensive Interaction “is an approach to teaching the pre-speech fundamentals of communication to children and adults who have severe learning difficulties and/or autism and who are still at an early stage of communication development.” http://www.intensiveinteraction.co.uk