Drama therapy is increasingly used to help people suffering from dementia. However, far from a fad, drama therapy has been around for a while.

Origins of drama therapy

Drama therapy was developed in the 1960s as an approach for dealing with clients who didn’t have the verbal capacity required when coming under psychoanalytic scrutiny.

It then became more widely used in rehabilitation centres, psychiatric hospitals, special schools, disability services, prisons, and elderly care homes throughout Europe and the USA.

Drama therapy has since evolved into a useful approach in helping people with dementia. Drama therapists Bas van der Hoeven and Linda French recently produced a paper showing the positive effects drama therapy has on dementia sufferers, including improved concentration, memory, and activity. Its techniques also enable family members and carers to get involved in the therapy, helping them to better engage with the individual.

What is drama therapy?

Using alternative means of communication, such as psychodrama, gestalt, and creative therapeutic method, drama therapy aims to help the client address their issues. With drama and play as the medium, the client can experiment with emotions and situations in a safe situation. For instance, a client playing the part of a school teacher might explore the feeling of being angry, but they are distanced from the emotion as they are only pretending.

Drama therapy can take many forms including improvisations, role play, puppetry, working with masks, playing games, using real life stories, or working with scripts, myths, and fables.

The imaginative play paradoxically helps orient the client: to utilise the imagination, the individual needs to generate neuronal activity in the brain stimulating both implicit and explicit memory systems. Drama therapy is a means for improving neuroplasticity of the brain.

The drama therapist assists the client by playing the other roles, verbalising the thought processes, and acting as a sounding board onto which the clients can project their emotions.

Sessions generally take one hour and are held once a week in either individual or group sessions, depending on the needs of the client. French says it is important sessions are held regularly to maintain momentum and build on progress from earlier sessions.

Drama therapy helps the therapist to analyse the client’s behaviour, assess the issues confronting them, and put appropriate processes in place to address these issues.

Drama therapy in dementia

French and van der Hoeven have developed a programme aimed to help better manage dementia using the well-established therapeutic method of drama therapy to achieve cognitive enhancement.

The first component of this programme is ‘Regain’, a 12-week course of sessions provided by a team of experienced practitioners to raise participants’ skill level of communication, improve motor skills and cognition, and resolve psychosocial issues. This is supplemented by the second component, ‘Sustain’, which is provided by trained carers and designed to maintain the skills level that participants gained during the Regain part of the programme. Then there is ongoing training and support for carers as needed.

The ‘Regain and Sustain’ approach is shown to improve the quality of life of people living with dementia and is cost-effective, demonstrable, measurable, and practical. French and van der Hoeven believe it has the potential to be developed into a national delivery model.

The programme, which is claimed to be the only one of its kind currently available in New Zealand, has received international acclaim. Robert Sarison of the Irene Swindells Alzheimer’s Residential Care Program in California says it is an integral part of their approach to working with dementia clients and has vastly improved their quality of life.

French says that drama therapy helps people with dementia become less withdrawn and more positive, communicate more, and start to interact at a much higher and more complex level than they were before.

French says that at the beginning of the drama therapy sessions for one particular group, many people were slumped in chairs, made little eye contact, and often did not communicate at all.

“The staff worked very hard at providing a supportive and comfortable environment and all clients were well cared for, but not engaging much with anyone. Occasionally, there were outbursts of animosity. There were factions in the group and some physical and verbal aggression between members. By the last session, group members were interacting, taking charge of the dramas they created, debating outcomes, and suggesting plot developments and roles. They remembered the sessions from week to week. We learned from the staff that they were talking more at lunchtime, showing less aggression, and were more lively in general.”

French says it is truly wonderful to witness those suffering from dementia respond to drama therapy by gaining confidence and taking a keen interest in what is happening around them.

Drama in dementia: success stories

The Queen of Sheba

Mrs A was a lady in her seventies. A true Cockney, she had grown up in the East End of London and came to New Zealand in her twenties. She was bright, cheeky, and loved her work as a nurse in a hospital for many years. She married but didn’t have a family.

Mrs A came to drama therapy sessions regularly. In the earlier sessions, she sat quietly and rarely took part. Staff tried really hard to involve her but felt that her deafness was isolating her more and more.

As the sessions progressed, Mrs A started to become much more involved. When the chance came to play a role, she took it. She was thrilled when she decided she would play the Queen of Sheba and demanded a crown to wear. Once she put the crown on, her whole demeanour changed. She truly became regal in posture and speech. Another person took the role of train driver so she decided to go on her “royal train”. The man sitting next to her had tried to talk to her without much success many times. He suggested he could be her assistant but she said he had to be her servant. She told him to go and get her a ticket. When he asked for some money she said, “Don’t be daft. I don’t carry money. I’m the f**king Queen of Sheba”. The group loved it.

The Haka

Mr B was a Pasifika man and had worked in the public service for many years. He had considerable difficulty walking and leaned heavily on a stick, often with someone supporting him. He also had some memory issues but had many interesting ideas and stories of his work life. He was a leader in his community, cared for by his family.

He had made friends with a couple of group members – men of similar age, intelligence, and experience – but liked to sit back and observe.

He took part in drama therapy sessions but only in a very quiet way. He always seemed interested, and when he did take part, he displayed a wonderful creative streak and sense of fun.

After some sessions where he gradually took more of a lead role, things came to an amazing climax. At the end of a story he had created about him being a doctor saving the life of a mother and baby in a storm, he announced he wanted to celebrate what we were all doing. He rose to his feet, and without his stick or any other help, performed a haka learned in his island childhood. The power and the emotion in the delivery moved everyone. He sat down to loud applause and yells of appreciation.

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