Drama Therapy

Antecedents in theater and education

A practitioner-written article hosted by the child mental health charity ACAMH traces the use of drama as therapy to 18th-century Europe, notes that dance, rhythm, storytelling and ritual came earlier, and names Stanislavski, Brecht, Artaud and Grotowski as theater influences. The same article credits the actor Peter Slade with first using the term in the United Kingdom in the 1930s. This is one practitioner's summary posted in 2018, and the dates it gives were not checked against primary sources for this page.

The British Association of Dramatherapists

The British Association of Dramatherapists (BADth) says it was established in 1977, after practitioners in mental health, special education and social care had begun using drama and other creative methods. Its history page names Sue Jennings and Gordon Wiseman among the founders and lists Peter Slade as vice-president. It gives the association three tasks: protecting the interests of people receiving dramatherapy, upholding practitioners' interests, and setting standards for practice, training, research and continuing professional development.

The same page says that Marian Lindkvist set up the Sesame trainings in the 1970s and that graduates joined BADth in growing numbers during the 1980s. It describes UK training as growing from weekend workshops and short courses at colleges of further education to master's degrees at several universities. This account comes from the professional body itself and is not an independent history.

North America and the research field

The North American Drama Therapy Association (NADTA) states that it was incorporated in 1979 to set and uphold standards of professional competence for drama therapists, and that it belongs to the National Coalition of Creative Arts Therapies Associations. A bibliometric analysis of 395 articles indexed in Scopus found that the work of the field's early figures is still widely cited, that older adults and mental health are a current research focus, and that large amounts of research remain unpublished.

Drama therapy and dramatherapy

Professional bodies in North America use the two-word form drama therapy, while the British association and the UK research literature use the single word dramatherapy. NADTA defines the practice as the intentional use of drama and theater processes to achieve therapeutic goals. The bibliometric analysis reports that the diversity of terminology across the literature is itself an obstacle to surveying the field.

Titles, credentials and related labels

NADTA grants the Registered Drama Therapist (RDT) credential, which it describes as master's level. BADth's history page states that the title Dramatherapist became protected after the Health and Care Professions Council sought powers to regulate art, drama and music therapists; it gives no date. Named approaches include the Sesame approach in Britain and Playback Theater, an improvised form based on personal stories, which was the format of one trial with older adults.

PubMed indexes records on this subject under the heading Psychodrama, so database searches for drama therapy also return psychodrama studies. The sources reviewed do not define how the two practices relate, and findings about one should not be carried over to the other.

Processes, settings and facilitators

NADTA describes drama therapy as an embodied, active and experiential practice that draws on play, embodiment, projection, role, story, metaphor, empathy, distancing, witnessing, performance and improvisation. Common forms include improvisation, theater games, storytelling and enactment, and some practitioners also use text, performance or ritual. NADTA says acting skill is not needed. It lists clinics, schools, hospitals, substance use centers, correctional facilities, shelters, nursing homes and private practices as settings.

A practitioner article adds small objects, arts materials, music, fabrics, masks and puppetry to the methods used, and says that drama therapy is sometimes chosen when verbal communication is hard.

Formats described in studies

A systematic review of 15 papers on dramatherapy for ages 8 to 18 found that it was most often delivered in schools (46 percent) and clinical settings (20 percent), and more often to adolescents than to children. A scoping review of school-based drama therapy for young children identified metaphor, distance and links between the drama and the participant's life as recurring practice features. A trial with older adults used 12-week groups in the Playback Theater format combined with life review.

Uses stated by professional bodies and practitioners

NADTA says drama therapy is open to people across the lifespan and names people in addiction recovery, abuse survivors, people with developmental disabilities, people who are incarcerated or homeless, older adults and at-risk youth among those with whom drama therapists work. A practitioner article lists autism, anxiety, anorexia, bereavement and trauma among the presentations seen in UK health services and schools. These are statements of use and not evidence of effect.

Uses that have been reviewed

Systematic or scoping reviews exist for emotional distress in children and adolescents, psychosocial problems in children and adolescents, adults with psychosis, and socio-emotional skills in early childhood in schools. A bibliometric analysis also identifies older adults and mental health as a growing area. The reviews described under Research and Evidence below cover only these groups.

Children and adolescents

Keiller and colleagues searched seven databases and included 15 papers on dramatherapy for emotional distress at ages 8 to 18. Seven reported quantitative data, only three of those studies were controlled, and none was blinded. Pre-to-post effect sizes ranged from 0.17 to above 2, samples were small, and response was not consistent. The authors concluded that the results were promising but that the evidence base is small and methodologically flawed.

Berghs and colleagues included 10 of 3,742 screened studies: four randomized controlled trials, three non-controlled trials and three pre-post designs. They report positive effects on overall psychosocial problems, internalizing and externalizing problems, social functioning and coping, but note that study quality varied substantially, some samples were small, and no direct relation was found between the therapeutic means used and the proposed mechanisms of change.

Adults with psychosis

A systematic review screened 8,541 papers and included 11 studies of dramatherapy for adults with psychosis, synthesizing them narratively and thematically. The authors report positive effects including reduced psychotic symptoms, improved relationships and reduced anxiety about making choices, and say quantitative data supported the qualitative findings. They call for methodologically sound research. Only the abstract was available for this page, so study designs and risk of bias were not checked.

Early childhood and older adults

A scoping review identified 16 articles on school-based drama therapy for young children and described the evidence base as emerging, with notable limitations in the searched literature. For older adults, one publication reports two case studies from within a randomized study of 12-week groups: one participant had a clinically significant change in depressive symptoms and well-being, and the other in self-esteem and relationship satisfaction at the end of the intervention but not at follow-up. Two case studies cannot show the effect of the group program.

The sources reviewed for this page did not include a clinical guideline or a Cochrane review of drama therapy. They do not cover dementia, post-traumatic stress in adults, autism or substance use, so no evidence statement is made for those uses.

Study design and bias

In the review of work with ages 8 to 18, no study was free of risk of bias; the randomized trials had weaknesses around blinding of outcome assessors, and case studies carried the highest risk. The review of school-based work for young children noted that in several studies the researchers delivered the intervention themselves, and in one the facilitator had minimal drama therapy credentials by NADTA's parameters. The authors advise that the person delivering therapy should not also act as the researcher.

Independence and measurement

The first author of the 2023 review is a volunteer member of the BADth research subcommittee, a role the author declared in the conflict-of-interest statement. A practitioner article argues that standardized outcome measures do not fit the arts therapies well because of their quantitative background, and the bibliometric analysis points to unpublished research and varied terminology. These points do not show bias, but they mean the evidence is not wholly independent of the profession and is difficult to compare across studies.

What the reviewed sources say about negative effects

The drama therapy reviews examined for this page do not describe how adverse events or negative effects were recorded, and the abstracts of the others do not either. A systematic review of instruments for assessing negative effects of psychotherapy in general found that such research is comparatively rare, identified 17 domains of negative effects that the nine instruments assessed inconsistently, and found psychometric properties usually unsatisfactory. That review is not specific to drama therapy, and an absence of reports in drama therapy studies does not show that harms do not occur.

Suitability and care boundaries

The psychosis review describes dramatherapy as used within services where psychiatric treatment often combines therapy and medication, and with people who find talking therapies hard to engage with. The sources do not support using drama therapy in place of assessment or other necessary care for mental health conditions. Anyone in crisis, or at risk of harming themselves or others, needs urgent help from emergency or crisis services. Because sessions can involve enactment of personal material, a person can ask a therapist about the approach and about pausing or stopping an activity.

Training and registers

NADTA describes the RDT as a master's-level credential requiring psychology and drama therapy coursework, theater experience, a supervised internship and work experience, and adherence to its Code of Ethics, reached either through an accredited master's program or through training mentored by a Board Certified Trainer. In the UK, a practitioner article from 2018 reports that drama therapy is taught at master's level at four institutions and that practitioners are registered with the Health and Care Professions Council, while noting that registration standards were still under discussion. These are professional bodies' own descriptions, and requirements differ by country; statutory regulation is not covered on this page.