What Is Drama Therapy? How It Differs From Psychodrama and How a Session Flows

What is drama therapy and how does it differ from psychodrama? The logic of working with role, story and improvisation, how a session flows and the evidence.

Picture a woman in her forties. When she is asked to talk about her relationship with her mother, her throat tightens and after a few sentences she changes the subject. But in a group session, while acting out the story of a lighthouse keeper on a deserted island, the words the keeper speaks as he waits for a ship that never comes pour out of her of their own accord. She is not telling her own story; yet everything she says belongs to her in some way. The answer to the question "what is drama therapy" is hidden in this scene: fiction makes it possible to express, from a safe distance, what cannot be told directly. In this article we look at what drama therapy is, how it differs from psychodrama, with which it is often confused, how a session unfolds, who it may suit, and what research says about this method.

What Is Drama Therapy?

Drama therapy is an approach in which theatrical tools such as role-taking, improvisation, storytelling, enactment, masks, puppets and play are used for psychological support, within a planned and safe framework. The aim is not to put on a good performance; it is to make room for a person to notice and express their feelings and to look at their life from different angles.

Behind this approach lies a simple but powerful idea: throughout their lives, people take on many roles. Child, parent, spouse, employee, friend... Sometimes we get stuck in one of these roles; sometimes a role inside us that has never found a place is waiting. Drama work offers the chance to try out, change and expand these roles on stage.

The main tools used in drama therapy are:

• Improvisation: Acting out a scene that emerges in the moment, without a pre-written script.
• Story and myth work: Working through fairy tales, legends or stories made up together.
• Role-taking: The person taking on a character, an object or an emotion different from themselves.
• Masks and puppets: Making expression easier by placing an object in between, especially when speaking directly is difficult.
• Body and movement: Showing feelings with the body before words; freezing like a statue or exaggerating a movement.

Let us add an important note here: taking part in a school play or going to a theatre course can also do a person good. But these are not therapy. Drama therapy is a process with specific goals, carried out within a safe relationship, in which feelings are handled with care.

The Roots of Drama Therapy: Catharsis and Theatre

Reflection on the effect of theatre on the human soul goes back a very long way. According to Aristotle, tragedy provides a kind of purification, "catharsis", by arousing pity and fear in the audience. This concept is frequently mentioned in the history of the relationship between drama and psychology. If you are curious about the details of the idea of catharsis, you can read our article on what catharsis is.

However, today's drama therapy is not built solely on "releasing emotion". Understanding a feeling, gaining a new perspective and trying out small changes that can be carried into daily life are as important as expressing the feeling. Venting anger by shouting on stage may be a start; but the real work is being able to talk afterwards about what that anger is protecting.

What Is Drama Therapy, and How Does It Differ From Psychodrama?

Drama therapy and psychodrama are often thought to be the same thing. Both use the stage, roles and the group; both draw on theatre. But there are clear differences between their approaches.

Psychodrama was developed by Jacob Levy Moreno. Moreno gave 1 April 1921, the session he held at the Komödienhaus in Vienna, as psychodrama's birthday. In psychodrama there is usually a "protagonist", that is, a lead player, and what is brought to the stage is mostly a memory, a relationship or a conflict from their own life. Techniques such as role reversal, mirroring and doubling form the basis of this work. It is accepted that Prof. Dr. Abdülkadir Özbek played an important role in the institutionalisation of psychodrama in Turkey. For the details of psychodrama, you can read our article on what psychodrama is.

Drama therapy, on the other hand, uses a wider range of tools and does not always require a person to stage their own life directly. Work is often done through fiction, metaphor, fairy tales or imaginary characters. As in the lighthouse keeper example at the start of this article, a person can approach their own story from behind a character.

We can summarise this difference as follows:

• In psychodrama the person often goes on stage "as themselves"; in drama therapy they frequently go on stage "as someone else".
• Psychodrama is usually shaped around the story of one protagonist; drama therapy can also work with stories the group builds together.
• In drama therapy, the distance provided by fiction can offer a gentler way in when speaking directly is difficult.

Let us make this concrete with an example. Someone who constantly takes on too much work and cannot say "no" would, in psychodrama, most likely bring a real conversation with their manager to the stage; a group member plays the manager, and at some point the person reverses roles and takes the manager's place. In drama therapy, the same person might play, for example, a village postman who carries everyone's burdens, or a giant trying to carry all the bridges on his own. Both paths touch the same issue; but one enters through a direct door and the other through an indirect one.

These differences are not sharp boundaries; the two approaches feed each other and some techniques are shared. What matters is which one suits the person's needs and readiness.

How Does a Drama Therapy Session Go? The Flow of a Session

Drama therapy sessions can be individual or in a group. Although practice varies, a session usually proceeds in four stages.

1. Warm-up

The session begins with simple activities that prepare the body and mind for work. Walking around the room, name games, showing an emotion only with facial expression, or passing an object from hand to hand and giving it a new meaning. The warm-up reduces participants' anxiety and helps trust develop within the group. Many people come to the first session saying "I know nothing about acting"; the warm-up stage lets them experience for themselves that this does not matter at all.

2. Main work

In this stage the work that is the focus of the session takes place. A fairy tale may be enacted, a character created, a scene improvised, or a mask made and spoken through. For example, in a group each participant creates a character setting out on a long journey and chooses three things that character will take along. The choices often carry clues about what the person is holding on to in their own life; but these clues are not interpreted by force.

3. Stepping out of role

This is a very important stage in drama therapy, but one that is little known from the outside. A person who has taken on a role must leave that role on the stage. To do this, the person may say their name out loud, take off the role's costume or prop and put it aside, or say a few sentences about their own real life. This step is necessary so that people, especially those who have played a difficult character, do not carry that feeling home.

4. Sharing and closing

At the end of the session participants share their experience. Here, rather than interpreting, giving advice or criticising anyone, people talk around the question "What did this scene remind me of?" The closing aims for the person to leave the session feeling safe.

Fiction is a mask; but sometimes a person can only show their face from behind a mask.

Who May Drama Therapy Suit?

Drama-based work is used across very different age groups and settings. It may open a new door for a person in the following situations:

• People who find it hard to put feelings into words: When telling something in conversation feels hard, speaking through a character may be easier.
• Children and adolescents: Play and enactment are close to children's natural way of expressing themselves. The basic logic of working with children rests on the idea that play is the child's language.
• People with social anxiety: Rehearsing a difficult conversation or a job interview in a safe environment can give a person courage.
• People who want to notice recurring patterns in their relationships: Replaying a scene from different roles can make habitual reactions visible.
• People experiencing grief or loss: Symbolically staging a farewell that could not be said can be meaningful for some people.

That said, drama work is not suitable for everyone or for every period. During a severe crisis, at times when intense trauma symptoms persist, or when the connection with reality has weakened, more structured and individual support may be needed first. Making this decision is the job of a professional who assesses the person.

What Does Research Say About Drama Therapy?

Although drama therapy is an intriguing method, its scientific evidence base is still limited. For example, the Cochrane review of drama therapy for schizophrenia and similar conditions (Ruddy and Dent-Brown, 2007) stated that the reporting of studies was inadequate and that the benefit or harm of the method remained unclear.

The limitations seen across arts-based approaches in general also apply to drama therapy: studies are mostly carried out with small samples, blinding is not possible because participants know what they are taking part in, measurements often rely on self-report, and follow-up periods are short. It is therefore more accurate to think of drama therapy not as a method that replaces medical treatment or structured psychotherapy, but as an approach that can accompany them where appropriate.

The situation in Turkey

In Turkey there does not appear to be a separate, legally defined professional title of "drama therapist"; legislation in this area should be followed for updates. Psychodrama training, meanwhile, has long been provided through associations and institutes. Drama-based work should be carried out by people who are competent and trained in the field of mental health, together with psychotherapy where necessary. Educational drama, which is common in schools and courses, is a separate field; we cover this in our article on what creative drama is.

Using Role and Story in Everyday Life

Drama therapy is a process carried out with a professional; but you can also draw on the power of role and story in small ways in everyday life. The suggestions below are not therapy but creative exercises for getting to know yourself:

• Rehearse a difficult conversation. If a situation makes you tense, such as asking your boss for leave, talking to a neighbour about noise in the apartment block or setting a boundary during a bayram (religious holiday) visit, first try saying what you want to say out loud in front of a mirror or with someone you trust. There is a surprising difference between thinking something through on paper and saying it aloud.
• Look at yourself in the third person. Write a day you have lived as a short paragraph, as if it were the day of a novel's protagonist: "That morning, running to catch the shuttle bus..." This small distance can make it easier to look at events with a little more compassion.
• Play with puppets with your child. A child who will not say what happened at school sometimes answers a puppet's question more easily. The aim here is not to interrogate, but to stay within the play and listen with curiosity.
• Rewrite a fairy tale. Change the ending of a fairy tale you knew as a child. Which character you rescue and which one you give a voice to may make you think about something in yourself.

If these exercises feel hard or stir up feelings of unexpected intensity, do not force them; it is better to talk about this with a professional.

When Should You Seek Professional Support?

Attending a drama workshop can be an enjoyable way of expressing yourself. But it is wise to speak to a mental health professional in the following situations:

• If after a workshop or session you experience intense distress, nightmares or restlessness lasting for days,
• If a difficult event from your past often comes to mind and is affecting your daily life,
• If recurring problems in your relationships are wearing you out,
• If you are having thoughts of harming yourself or ending your life. In that situation, do not wait; in an emergency, call 112 (emergency services).

Psychotherapy can also make use of role work, enactments or imagery exercises from time to time. In cognitive behavioural therapy (CBT), for example, a difficult conversation can be rehearsed within the session. You can find general information about this process with adults on the individual therapy page.

Frequently Asked Questions

What happens if I cry or become very emotional in a drama therapy session?

Being moved is a natural part of this work and is usually not a problem. The person leading the session slows the pace when intense feelings arise, pauses the work if necessary, and takes care at the close that the person feels safe.

Is drama therapy also used with children?

Yes. Because play and enactment are close to children's natural way of expressing themselves, drama-based work is also used with children. Depending on the child's age and needs, puppets, fairy tales or short scenes may be preferred.

Can drama therapy be done online?

Some drama-based work can be adapted to an online setting, especially in individual sessions and using stories or objects. However, work involving the body and a group is carried out more comfortably face to face; which format is appropriate is assessed according to the person's needs.

• #drama therapy
• #psychodrama
• #role work
• #creative methods

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Eda Erkan Alapala

Klinik Psikolog. İstanbul Kent Üniversitesi Klinik Psikoloji Tezli Yüksek Lisans mezunu; bilişsel davranışçı terapi, çocuk merkezli oyun terapisi ve çocuk-ergen psikoterapisi alanlarında eğitimlerini tamamlamıştır.

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