Sunday, 4 December 2011

The Silent Epidemic

Some of you may have heard a recent visitor from the UK – Graham Stokes, a Neurologist. He spoke to many groups about the huge increase world wide in dementia that is going to happen oveer the next 40 years.
He cited many factors amongst them an increasingly long lived population, the “Baby Boomers” population bulge and better methods of diagnosis. It is not that rates of incodence of the condition are increasing, just that there will be a larger group from which people will develop the disease.
He made it very clear that this is not a psychiatric condition but a neuorolgical condition, something that we are not always clear about even now.
The points he made were very clear. There will not be enough beds to cope with the level of need.
There will need to be better supports for families and carers in the community. It will not be possible to rely on “The Family” to automatically take on the very real burden of care because our society is changing so much. Women tend to marry men older than themselves and if a marriage is not providing what they want many are now divorcing in their 50's and 60's. Second relationships do not have the same level of establishment so if a partner becomes ill there is not the same commitment to taking on caring for them.
We have another change in that children are economically dependent on their families for much longer. A combination of student debt, economic conditions in general and a much later date for settling down compared to previous generations.
We are already seeing calls for the retirement age to be raised. A result from this will be that in some cases people who might have taken on care will still be at work.
None of this paints a pretty picture but there are things that can be done. And we need to start now before the full force of this epidemic hits.
Dramatherapy can help both the person diagnosed and their families and care givers. It is much easier to cope with the memory loss if the person is not depressed withdrawn or angry, if they communicate although not from the past. Using this therapuetic approach benefits the individuals,and their families and enables them to stay in their community for longer whether it be home or the retirement village they have chosen.
We can do something that is positive in all directions, personally, socially and economically.
But we need to act before we get overwhelmed.
All those people who paid for the infrastructure we have now deserve better.
Today's teenagers will not be thinking about this yet but when they do get old – and they are likely to live even longer, they might just be grateful for having good standards of care well established.

Friday, 18 November 2011

Speaking the same language

One of the most important challenges any therapist faces is communicating effectively with their client.. We work hard to understand their context, their philosophy, their world view so that our interaction is effective. This is important when people are from similar settings, sharing the same cultural context. It pays not to make any assumptions as always. Oscar Wilde commented that England and The United States of America were two countries divided by a single language.
What makes dramatherapy so effective is that it isn't tied to language or complex cultural norms.
It's about being creative, working with the clients' imagination, working with them through the way they play. Play and fun a pretty much universal. Imagination is not a cultural specific although true respect for anyone mandates respect for their culture.
We saw this today wonderfully illustarted by two Samoan ladies who do not speak a lot of English. We were greatly helped by having someone to go over what we were discussing with the group in Samoan but the actions that followed were a tonic for every one.
The story created was about a trip to Samoa on a Sunday - so off to church for a blessing and then to the picnic. One lady stood and danced a beautiful slow hula and then the other sang. Everyone in the group loved it.
In another story, a Maori lady who has severe cognitive impairment and only uses a few words of Te Reo dressed up, followed all the movements, and sat with a beaming smile.
Of course culture is enormously important and we look forward to a time when we have enough drama therapists who are fluent in Te Reo, Samoan or whatever languages we need but until then it is so heartening to know that we can connect through creative thinking and action.

Friday, 11 November 2011

A few thoughts...

I just got back from our first session with a new group, using drama therapy for people living with dementia.
It was incredible. When you practice drama therapy, you have your own expectations and goals but you can never exactly predict what will happen.
Today was beyond my expectations ... to see someone with very limited motor skills (this person had two carers stabilising her when she arrived), be able to get out of her chair and cross the room by herself, to be part of a story being acted out was inspiring. The power and persistence that was shown was simply amazing.
Roll on next week to be blown away again! If there was ever a need at times to motivate us to do what we do, sessions like today’s was all the reason necessary.

Friday, 28 October 2011

Gibberish or Double Dutch?

Communication is the key to working through personal issues and interacting with society.

If we no longer can communicate, we become depressed and isolated. But often our feelings are misunderstood or unacknowledged. Are we simply speaking gibberish? Do we expect too much of others in requiring them to read between the lines?

The difficulties with communication are compounded where a person has a disability (eg Autism, ID) or an illness (eg Dementia). In these instances, difficulties arise as a result of some type of barrier (intellectual or physical) between the person trying to communicate, and the person on the receiving end trying to understand the message being given.

Drama therapy helps remove barriers and allows people to express (or communicate) their issues and feelings, and give them form - often indirectly. A drama therapist is trained to read between those lines and help the client interpret what they express in therapy.

A person might create a story about an angry boss, firing an employee. This could represent a feeling of needing control, or being allowed to vent frustration and anger.

For those that are non-verbal, drama therapy provides the opportunity to use mime and gesture to convey their needs. The therapist’s response validates those actions and empowers the person. A growling lion will scare the duck (representing in a different way the same feelings as the angry boss firing an employee in the example above). Purring noises being an indication of needing to be accepted and loved.

Through positive reinforcement (e.g. responding to the person’s particular way of communicating (and teaching others how to similarly respond)), a person will start to become more interested in trying to communicate. For example, those with Dementia come out of their state of isolation, and start to get interested once again in the world around them - starting with forming sounds, they move on to seeking to initiate contact, and often begin to use words again.

By making an effort to understand apparent gibberish (in some cases, be it growling, shushing, or tapping) and seeking to remove barriers to communication, we might open up a whole new and rewarding world for all involved.

Monday, 24 October 2011

Happy Families

This is a quick reflection on how families cope when a beloved member gets dementia. It takes a while to work out what is happening. When we are close to people we often don't notice changes for a long time. Eventually we realise that things are not as they should be. Diagnosis is not always easy or clear cut. We can get aggravated by behaviours that we think are unnecessary or could be controlled with a little effort. It is all too easy to get into a pattern of being irritated, angry and resentful. We forget who the person was for most of their life and see them only as how they are now.

Sometimes when someone has a terminal illness people feel it is almost easier to behave as though that person was already dead and gone from their lives. This can also happen with dementia.
And yet how much time and pleasure in that person's company is stolen from families if this happens?
We need to be supporting families who struggle to care for a dementia sufferer. At least in a hopsital setting, staff work in shifts, have a life outside and however poorly paid at times have the choice of being there. Likewise the amazing community groups who offer respite care at day centres. They still have the opportunity to be elsewhere.
Families have no such choice. Regardless of the relationships that existed before – good, bad or indifferent, there is an expectation that the family will provide.
It is much more likely that a family will find the energy and willpower to do this if they can interact with their relative with dementia in a meaningful way, a way that gives them something positive not just frustration and grief.
Dramatherapy can give that positive contact. Of course it isn't going to bring back the original person but they will see someone interesting with something to say, original ideas and thoughts and a person in their own right.
We hope that in time this method will be available to family members to enhance their relationship or even build a new one.
Everyone deserves the right to make the best of a really tough situation, not just have to keep coping with what must seem a hopeless situation.
There is a better way.

Saturday, 15 October 2011

Drama Therapy and Intellectual Disability

Drama therapy is one of the few therapy forms that is beneficial for people with an intellectual
disability (ID).

Here in New Zealand, people with an ID diagnosis often miss out on receiving therapeutic
interventions. Frequently, they are told that their ‘psychological’ issues are disability related, and therefore, no funding is made available for therapeutic assistance.

If depression, Post Traumatic Stress Disorder (e.g. sexual abuse) or anxiety is diagnosed, no suitable therapies are provided by the Mental Health Services that hold the funding. Clients that I work with, have been offered CBT (Cognitive Behaviour Therapy), only to be told after a few sessions that due to their disability, they were unable to follow this therapy. Instead of being offered suitable ‘non-verbal’ therapies, they were sent away.

Drama therapy is a form of therapy that works on the sub-conscious layer of the thought processes. This means that changes are made and established while working in the creative therapeutic module (drama, music, art or dance). By creating a safe environment, the clients are encouraged to experience and experiment with feelings, thoughts, and issues to change their perspective and integrate new coping mechanisms.

I have listed below some of the goals drama therapy is able to achieve for people who have an ID.

  • Expression and regulation of emotions

  • Expansion of frustration tolerance

  • Diminishing impulsive behaviour

  • Improvement of reality orientation

  • Improvement of social interaction and interpersonal skills

  • The ability to set boundaries

  • Expansion of behavioural skills

  • Improvement of self esteem

  • Change and expansion of self view

  • Diminishing the fear of failure

  • Developing control mechanisms

  • Exploring new thoughts and feelings

  • Self-actualisation (development of self)

  • Development of self reflection

  • Dealing with bereavement

  • Dealing with grief

  • Dealing with change

Friday, 30 September 2011

Take two laughs and call me in the morning

Laughter Good Medicine for Dementia Patients and for those around them.
Nice to see this therapy from Australian humour therapist Jean-Paul Bell bringing life and living to those, too often, written off by society.

The ripple effect

As with any therapy form, drama therapy also has a ripple effect. You treat the person, and automatically family, school, work, and the wider community will benefit from the effects drama therapy offers.

System theory explains it all. Change one element, and the rest automatically has to change as well.

It is great to hear the stories from families, and the people involved in their lives, of the benefits that drama therapy has brought for all of them.

A while back, Linda and I ran a drama therapy program at a dementia day centre. The effects of the therapy were not only noted in relation to the clients. We also received feedback of the changes for the caregivers and the clients’ families. As a result of breaking the isolation felt by the clients, they started to re-engage with the people around them - newly established communication skills (expression, empathy and in some cases, speech) allowed for positive communication and reciprocity. Families got to see and reconnect with their loved ones again, aggressive behaviours diminished and mobility skills improved, allowing for meaningful participation in the community.

By way of another example, a previous client with Autism diagnosis, through drama therapy was able to become engaged in meaningful employment. The client went from being unable to participate in the community, due to fear and depression, to being a productive member of society.

Sometimes it is possible to become so focussed with a client that you tend to forget (or not realise) the changes that drama therapy makes to many people lives, over and above the client that you are directly working with. Whenever a difficulty is encountered in a client’s progress, it is often inspiring to look at the bigger picture and recognise this ripple effect, to appreciate that any short term challenges are just a step on the way to bringing changes for the better in many people’s lives.

Friday, 23 September 2011

The difference between work and play

I use action methods to improve communication and reduce conflict in the workplace. Using play methodology can often move past barriers that have appeared to be set in concrete. But these methods still rely on a shared understanding of why we are at work and how adults at work behave. It is an interesting paradox that whilst asking people to relax and enjoy being playful this is to improve performance at work. An increasing number of employees either do not know the boundaries between work and personal life or just ignore them.
When we go to work we are exchanging our time and skills usually for money. It isn't slavery largely thanks to some serious work put in over the years by various unions and supporting legislation. This does mean we are answerable to others and have to abide by rules around attendance, behaviour and dress as well as what we achieve.
This may well sound like stating – as Basil Fawlty says “The bleedin' obvious”, but recently I have dealt with people who have said how bad the workplace was. On talking with them it becomes clear that the badness was “Not sitting where I want”, “Not getting to do the bits of my job I like”, “Having to arrive at the same time every day”, “Interrupting my face book updates”,and “Having to wear something other than a stained track suit just because I'm a receptionist”.
All the people concerned had applied for their jobs, read the relevant policies and agreed to them but all had suffered a catastrophic memory failure almost immediately. All felt they could do things as they wished.The idea that someone might have the responsibility for their work and therefore the right to question them about it was unacceptable to all. They all either owned the role outright or felt that any discussion of performance was intrusive and cruel.
At this point I realised that my default state was becoming increasingly grumpy.
I want us all to achieve at work and enjoy it as much as possible. I work at shifting barriers and building effective working relationships. This is based on everyone being a grown-up for most of the time. The methodology is based in play not childishness. We can be adult and use play techniques at work. What we can't do is go to work and only do what we want.

Friday, 9 September 2011

Practice makes perfect

Acting out different situations and ‘what ifs’ helps the brain to store the different feelings
of these experiences. So next time the person is in a similar situation the brain can use this
stored knowledge to make a more appropriate/educated response.

Practising new situations can be scary, so often we change the characters and environment.
So it is the witch in the forest who needs to tell the garden gnomes to stop misbehaving.
This is a lot safer than the person telling classmates/colleagues to stop teasing him/her.
It allows the client to practice being assertive, allows him/her to be angry (letting go of pent
up emotions associated to this trauma), and be in control.

It is always a delight to see people act out different sides of their personalities. When the
executive/ professionals allow themselves to be mischievous, or vulnerable, or if a person
with a disability lets people trip over, or be in total control.

Giving your brain experiences helps improve the brain’s ability to make sense of what is
happening around you. Often when people get isolated, the world around them becomes a
scary place. Disassociating oneself from society is an all too common phenomenon. People
can become ‘narrow-minded’ and set in their ways of communicating, in some cases they
stop communicating all together, and this in turn leads to isolation.

Keep practising... it’s a lot easier than Sudoku.

Saturday, 3 September 2011

Live in the moment

Following on from thinking about saying “Yes” more and taking more risks, I started to think about how dementia sufferes have to live in the moment. Memory loss ensures this. We seem to interpret this as a huge negative – and for others it may well be. But for the person concerned, if we can learn to value this and respond positively to it, how much better would their lives be?
Most of us are mindful of consequences – it's a good way to ensure survival – but have we moved past this to letting ourselves be inhibited in the present by always thinking ahead?
I was told possibly the most positive thing I have ever heard around dementia from the son of a lady with considerable memory loss. He said that, at first, visiting her in the safe home had been a huge trial. He and his wife had cared for mum for as long as they could but work and young children made this an impossibility. They felt guilty at “Giving up” but exhaustion was damaging them, their children and their relationship. The first visits were a nightmare of trying to talk, trying to keep a mother and son relationship alive. Then he realised, that was gone. It hurt but the next time he saw his Mum he just went with whatever she said. She was so much more relaxed and he began to see a lovely woman, not his Mum but a lovely person. A couple of visits later she told him it was great to talk to him because he was a good listener. She said that another man used to come but he was always thinking about other things and was never really interested in her. He did check with the carers but as he guessed, he was the only man visiting.
He said that learning from his Mum to stay with what is in front of you was a huge gift. It works for him as a father and as a manager.
We have to analyse and plan ahead but unless that is the purpose of our being with others, let's stay focused on the real people.
It all comes down to being with the living person you are with rather than the imaginary outcomes in your head.  

Thursday, 1 September 2011

Taking a chance

I’m a cautious person by nature and experience. Much of my my training is about making progress slowly and carefully although it is also about going with the moment, working with “now” but sometimes that can get overlooked.
People living with dementia don’t have a lot of time to make slow, ordered progress. They can’t take time to build trust. Their world is immediate and often short lived in terms of memory. yet they are a shining example of willingness to take risks when there is some fun attached. I am continually amazed and impressed by their willingness to try anything imaginative with little knowledge of where it may go or what it might involve. There is some initial caution from some - quite right too -but all of them quickly get involved, share ideas and get stuck in. They embrace play in a way most of us take time to get to.
We can argue that their sense of self is different, they are less embarrassed by others’ potential opinion, but that is not always so.They say yes when they could say no.
This week the news featured an item on those whose memory it total. They forget nothing and have complete and instant recall. The impressive thing about them was that they approached every day thinking “I must make this count because it will always be with me.
At both ends of the memory spectrum there are people willing to take chances because that is where the true quality of their life is for them.
The action methods we use are such fun. The impact on me that working with people with dementia has had is totally positive. They have taught me that saying yes and taking a chance is so much more rewarding than standing in my own way. I haven’t seen the Jim Carey movie about saying yes yet but can I encourage all of us to say yes rather than no if at all possible?
Of course we shouldn’t take foolish risks. Most of us learn to assess risks once we make it through adolescence and realise we aren’t invincible. But then we stop a lot of our play.
using Improv, puppets and drama takes a long time with other groups because they have to get past their inner fogey saying “Don’t make a fool of yourself”.
The most fun I’ve had at work has come from doing just that. And when we do get groups past that barrier they grow and progress so fast.
So, don’t start climbing mountains, bungy jumping or going on the stage- unless you want to, but say yes to as many things as you can and see where it takes you.

Friday, 19 August 2011

The King is dead... Long live the King

Isn’t it great how children can use imagination and play to give form to their experiences? Children still surprise us in the way they interpret the world around us. Sometimes it matches our interpretation, often not.
When asked to pretend to be thirsty, some children will drop dead from thirst immediately, others beg for a drink bottle, and some enjoy the process of just crawling on the floor in search of water.
An invitation to act out being a King or Queen can be met by having your head chopped off in the first 10 seconds, having to be their servant, or to having a chat about how great they are. There are fewer inhibitions, and children tend to act the bits they want to act, rather than being worried what others might think or do.
Some adults need a bit of time to adjust to the fact they can be ‘silly’ or allow themselves to enjoy play. Boundaries we place on ourselves might need to be overcome. (Why are they there?) Giving form to events in your life is important to maintain a sense of sanity and control. Finding a way to do this is very personal. Drama therapy can be a form which meets those needs, when talking, simply isn’t doing the trick.


Photo: Phil Reid/The Dominion Post
Residents from five Wellington rest homes gathered at Fergusson Rest Home in Upper Hutt on Wednesday for the third annual Wellington Care Homes Wearable Arts show. see Dominion Post 19 Aug 2011

Sunday, 14 August 2011

When words can’t do the job

Most of my current focus with Drama therapy is around working with those with dementia and related conditions. Their withdrawal or diminished communication skills as well as memory loss are a huge factor in the grief anxiety and frustration friends and relatives can feel. It is an even bigger factor for the people themselves.  But it is not just they who have trouble with words.
In the modern world we make huge judgements based on language and how those around us use it to communicate. We haven’t moved far from Professor Higgins and Eliza Doolittle in some respects.  Fail to express yourself in a smooth, articulate way and this will not enhance your job or promotion prospects.
We do seem able to cope with a wider range of accents than in Edwardian times but style really does matter in the spoken word particularly in the professional world.
Recently I have been working with two people from very different settings. In the past we would have talked about whatever they brought and used a variety of models to try and best address their issues. But these two, both intelligent and sensitive had some barriers to their verbal communication.
The first is highly educated, doing well in a high pressure setting but with a gentle, low key style. Their speaking voice is low, their approach polite. Some perceive this as weak. They have been challenged in an entirely inappropriate way but because they did not respond with volume or rudeness, this was seen as a failure. The initial brief was to change how they spoke but on meeting them it quickly became obvious that there was no major problem. Less explaining, short sentences and no apologising for doing the job dealt with that. This was a mature, courteous professional.
Once we stopped relying only on the verbal side of behaviour  we could start to play around with their style non verbally. And play is the important approach. Acting out the fears and then  fun preparing, laid the foundations. They discovered that they had many ways to deal with situations within themselves that did not compromise their ethics.The pleasure in their voice when they described stopping a takeover of a meeting without yelling was a treat. They had enjoyed the practice, gained confidence and above all made a change that was fun with no harm to anyone. The rest of the group were stunned by the quiet but effective methods employed. And they all loved seeing a bully shut down - politely.
The second person is an immigrant of high intelligence but a limited grasp of professional English. They are fine with conversation and can make themselves clear. This is someone who speaks three other languages fluently. But his aspirations get crushed when he comes up against a language barrier. He has felt too shy and ashamed to find a way past this barrier. He became so overcome that I was struggling to get to what he wishes to say and then we moved to playing it out. He came alive. His grief at having his great coaching skills overlooked because he “Didn’t sound right” was powerful. I felt his quiet pleasure in outdoing the team he wasn’t allowed to coach was more than justified. Natural justice does rule sometimes.
We could argue that an interpreter would have dealt with this situation but I think it would have reinforced his feelings of inadequacy. As it was he took charge and showed what was happening for him and what he wanted. There is a lot of hard work ahead and no guarantee of a happy ending but he is in charge.
Talking is not always the best way when there are marked differences in language skills or style. I am realising more and more that not only do actions speak louder than words but they can be so much more direct. When you put the two together, it’s formidable.

Sunday, 7 August 2011

Directors Cut

(and finding a Drama Therapist)
The Directors Cut drama therapeutic activity has its roots in both Gestalt and Creative therapeutic methods. Both the final product and the process of getting there are hugely important.

The client becomes the director, directing the other person (therapist), projecting their own fears and feelings, as well as being in control of what the end product looks like. The drama therapist can make suggestions and steer the process into ‘difficult’ territory. The client can accept or reject these inputs, or even criticise the ‘actor’ for doing things wrong (a high - low status mechanism). As with many other drama therapy techniques, this technique can help the client to reach the point of catharsis (having a strong emotional response / aha moment or epiphany).

Suffice to say that when practising drama therapy, you need to know what you are doing. During my time working as a drama therapist, I have met people who claim to be providing drama therapy. When I ask about qualifications, and practice methods, sometimes the answers are surprising. Some think that teaching drama is the same as therapy. Sometimes therapists think that working towards catharsis is the main responsibility of a therapist and the end goal. In my opinion, all good therapists and counsellors know (or should know) that this is not the end goal. Often the work only just starts at this point.

If you are looking for a drama therapist or counsellor, please ask for their credentials and experience. Where did they train and for how long? How much supervised therapeutic practice have they undertaken? What therapeutic methods are they trained in and what do they actually use? How long they have been practising? What client groups or issues do they work with/have experience in working with?

As anyone reading this will appreciate - a person not knowing what they are doing can cause more harm than good.

I invite other Drama Therapists to leave a comment setting out their experiences – wherever you are – Linda and I are pleased to see that our blogs are reaching a truly worldwide audience.

Until next time…

Friday, 29 July 2011

Dignity – who needs it?

One of the many reasons I like drama therapy is that it is fun. There's no sense of therapist superiority. The person doing the work controls all aspects.
The license to be the child they want to be, to access play, ideas, fantasy is their choice.
Children do not have the constraints that adults learn to place on themselves but when adults attempt to play they can often trip themselves up. What do I look like? Will people think I'm silly?
A colleague told me of some relatives who were distressed that someone, an older person, was allowed to leave still wearing tiger facepaint. The person was very happy being a powerful tiger but for the family it was not dignified.
As adults we live every day with the judgements we place on ourselves as well as those others may make. They do have a place in life in the sense that knowing of such judgements may well influence our choices such as not drinking and driving, avoiding theft or violence not just because they are morally wrong but because people will not value us. Sadly this doesn't work for some. But these judgements can also stop us from simpler, harmless pleasures and things that may improve our whole lives.
When someone older loses their original sense of self it is bewildering and scary for them and their family and friends. Part of the individual's anxiety is a response to that shown to them by the people around them. If they find a medium that gives them joy and confidence surely we can accept this and not keep referring back to the dignity and style of someone who sadly no longer exists despite their physical presence. Of course this is hard but with people who see the benefits of drama therapy the transition is much easier.
We mourn the loss of the person we knew but at least can see the existing person is happy and having some fun.
If the way for this is by accessing play, so be it. What is wrong in something that all children embrace. We all have those memories. Just because the outward appearance is of a mature adult does not mean we should be denied ways that are effective and give happiness.
There is not a lot of dignity in misery. There is much more in the look of pleasure when the pirate chief takes the treasure galleon and sails into the sunset.
So heave ho me hearties – I may look daft to you but its' my ship and I've got the gold, jewels and a crew ready to make you walk the plank if you don't join in. And there are sharks in my ocean.
Still want your dignity?

Saturday, 16 July 2011

Marching to the same beat

This week was hugely exciting. Research undertaken with people with Parkinson’s Disease was published showing that with active methods, improvements to their lives in several areas can be made. The researchers at Roehampton University in the UK showed that when dancers worked with those having Parkinson’s, they grew in confidence, in their actual ability to move more and with more control over those movements. The dancers worked with the group to teach them ballet steps and movement to music. The fact that the dancers were from the English National Ballet was the icing on the cake.
There is much to be considered here. Even moving more and in positions that allow the lungs better movement will always help. More oxygen to our bodies can only be a plus when we make that increase through our own efforts. But this work goes a long way past this. The rhythm, the music and the imagination that goes into dance is stimulating many different parts of the brain.
The results that have been found here bear a close resemblance to those achieved using dramatherapy with the disabled, autism and those with dementia. The increase in confidence, in feeling less anxious and in the ability to interact are rapid and make a huge difference to the lives of those affected by such conditions - not to mention their families and friends.
One of my many happy memories is of a man who started out re-enacting gangster or cowboy movies. He ended by doing the haka for us. For non kiwis that’s the challenge given to important guests as they arrive, a mark of respect but intimidating. To see someone who had only sat in a chair do this, unable to walk except with a stick very slowly, on his feet unaided at full volume was uplifting. And he told us after that this was his gift to us.
We have the opportunity to do that research here, before the arrival of, what the current Minister of Health, Tony Ryall, has described as, the next major threat to our health system. That is the huge increase in those diagnosed with Alzheimers and dementia that will come with our aging population. It is already starting and in a small country like ours we do not have the resources to deal with this.
Let’s invest in some work that does offer positive results. So many people who are affected directly or have family or friends affected by illness that affects memory ,movement or interaction have indicated that they give up in despair because they lost hope. Here is a way that is safe, fun and rapidly beneficial and we haven’t even begun to explore its’ full potential.
Whoever you are, dance, sing, make up stories this week. Do it for yourself, for fun and take a moment to reflect on how much it could help so many.

Friday, 8 July 2011

Creating New Behaviours

Isn’t it amazing how people behave? There are so many ways in which we respond to
different stimuli. We have varying responses depending on where we are, or who we
interact with. (Even though this is often influenced by the way we feel).

We behave differently when we purchase our bus ticket, to when we are called into our
children’s school principal’s office. Our expectations/ previous experiences program our
body to such an extent that it almost automatically takes over.

For example; most people don’t enjoy going to the dentist. Our muscles tense up, our
breathing changes and most of us experience a sense of fear. Research has shown that
dentists are the least liked people to visit. (Is it also a coincidence that dentists have
amongst the highest rates of suicide and depression?)

How we subconsciously behave has an effect on our environment. It also has an effect on

Sometimes, it is easy to change the way we feel. When we leave the dentist, we feel
instantly happy/ relieved. However, when we are subject to a certain feeling for a long
period of time, it is harder to shift this feeling. And we might identify with this feeling to
such an extent that it takes over our rational thinking.

Taking our dentist example again, it is possible that the dentist feels it is he or she that is
not liked, and begins to feel that he or she does not deserve to be liked – our poor dentist
(not a phrase you are likely to hear very often!) might believe he or she is a horrible person,
and then take disproportionate or inappropriate action. An otherwise cognitively intelligent
person may make a cognitively disastrous decision.

Practising different feelings, and changing feelings, is an important part of drama therapy.
The people we work with are often stuck in a feeling. People with a disability or dementia,
or those working in management, often experience feelings of isolation or feelings of
depression. When a person feels isolated for some time, they become reclusive and
withdrawn. It needs some serious intervention to break this habit.

An important part of drama therapy is the interaction between people. You do something,
you get a response:
The cowboy shoots the therapist, the therapist dies.
An aunty gives you an elephant as a birthday present, and you become the envy of the
A robber steals the Queen’s crown jewels and the robber gets chased by police.

By practising different emotional responses and behaviours in drama therapy, a person
becomes more resilient and adaptable to situations outside the therapy room. The brain
stores all experiences, and doesn’t discriminate between reality and non-reality. The body
uses all we experience to form a response.

It makes sense that a person who feels worthless needs a lot of positive experiences - where
they are in charge (the boss), being cared for, happy, funny, etc. This counter balancing
helps the brain to have a wider range of experiences to pick from.

Returning to our dentist example again, if you are (or know) a dentist, you may wish to
pass on that the happiest dentist I have ever met always wore a facemask with bunnies
on it during treatment. Creating this non-threatening character by using a prop, made
his patients feel at ease, and his great sense of humour allowed him to deal with negative
feelings head on (and consequently he felt unafraid and not marginalised).

If you are going to the dentist soon, good luck, and remember that your dentist may be
feeling ill at ease too!

Monday, 4 July 2011

The Past is Another Country

One of the hardest things any person or family faces when someone they love has dementia is that the person they love is physically there but the personality is gone. Many struggle with this. They believe “If only” the person tried hard enough or was reminded enough memories would return. It can become an agonising struggle for all. There is no chance of any outcome other than frustration on both sides and increased anxiety for all.
It is understandable that often people walk away or find contact very difficult.
One of the most positive aspects of drama therapy in these circumstances is that it offers a relaxed, fun way to reconnect. Often we base our knowledge of older people on who they are right now, forgetting that they have lived long, full lives. The recent upsurge in interest in genealogy shows that many of us are interested in the past yet how many of us really know our parents and older relations? We may think we do because they may well have repeated many stories but it is often amazing to find out just what they have achieved.
Last year the community based group we worked with had a huge and varied history. Fortunately the people working with the group knew them well and had recorded their individual histories.
It is these earlier memories that are clear and thus accessible. These are the memories that people share when we are developing stories with them. It is so much more powerful if we know what these memories relate to.
It is almost miraculous to watch someone engage who has been totally detached and uncommunicative. When we enter their world, even if it is one from many years ago, we are there with them. It is familiar to them so not a source of worry. It puts them in control at a time when the world may feel very confusing and scary. I loved the quiet man who got asked to do a song in one of the plays and produced not just a pop song but a stunning operatic aria. His family knew of this but felt it might be painful for him to remember as he now no longer sang. The smile on his face as we all applauded said this was an area to talk about with joy. Each person had huge talents and their own fascinating experiences.
An additional bonus is that when families get involved they can continue a relationship that is positive and not a burden. They sometimes learn new things about a person they thought held no surprises. They get to enjoy being with the person again. Being relaxed and happy is something we all benefit from.
Making it easier for them to stay at home for as long as possible can only be an advantage. A more positive relationship is good for the individual but think what it could do for loving but currently exhausted care-giving families.
This is one of the areas we are keen to do more research in. This method is non invasive, does no harm and is fun. And it improves daily life for all using it.
There is nothing to lose for any of us and everything to gain.
We hope to offer a programme for people and their families in the community soon so keep watching – get to know your family and have as much fun as you can.

Sunday, 12 June 2011

All work and no play ...

Work is a very serious thing at any time. It's how most of us support the other areas of our life.

With the job market tight and pressure on to make more with less , the workplace is a demanding environment.

We all spend a large chunk of our week at work so how can we make it a happier place to be?

This is just as important for the organisation as it is for the staff. A happy workplace is more productive, loses less time to sickness, is more likely to solve problems quickly.

A lot of unhappiness centres on communication. All of us have times when we can't say what we want. We put barriers in our own way and at times that's a very good thing. That little brake in our head that stops us saying what we are thinking at that second has probably saved lives as well as jobs and relationships.

But at work we sometimes have to say things that may not be well received no matter how diplomatic we are. We don't always distinguish clearly between the fact that lovely though we are, we are at work, paid to do a job. Not everything is personal or about us. Yet because we take ownership of our role for most of us our work is extremely personal. Any comment on what we do is a comment about us.

Organisations spend a lot of time money and effort on promoting good communication. This is a very serious matter indeed. But does the way we do this have to be so serious?

I'm always amazed that teams go away to try and build relationships. They won't be working at a resort in a room at a high level of intensity, or on an assault course.

Why not use the surroundings they will have to work in but make that more fun?

The methods taken from Drama Therapy are just as effective in the corporate and government fields

The puppets in the picture have been an amazing resource for getting people to talk. Someone who is uneasy speaking in a group turns into a lead orator with one of the puppets as his or her mouthpiece. The puppets get away with saying outrageous things and give everyone a laugh.

People who have enjoyed each others' company, not felt threatened will form much more effective working relationships. They will be more comfortable knowing that any impressions their colleagues have of them were at least partially formed in a happy, relaxed place.

No matter how this is approached, having fun is important for us all.

Watching a team that can barely talk to one another except via e mail learn to enjoy and respect each other is a great experience. Watching a new team come together having fun and building positive links is even better.

Whatever you are doing, have a think about having more fun at work. Being a professional, being a high achiever doesn't mean being a misery. So many people feel that some one is pulling their strings.

When in doubt, let a puppet do the talking for you.

Friday, 10 June 2011

Expressing Emotion – Clients with an ASD, ID, Alzheimer’s Diagnosis

Expressing emotions in therapy is one of the hardest things to do for many people. We are taught from a young age to keep our emotions in check. This is certainly true in New Zealand. We have the attitude that we can fix it all ourselves (the No.8 wire mentality). Allowing clients to act out their feelings in play using characters, helps them express pent up emotions. Using the hierarchy of needs method – allowing people to express what is on top, allows them to explore what is underneath.

Often conventional therapies (like classic CBT, psycho-analysis, etc) are not suitable for our client group, as you need a certain level of cognitive ability to participate in these therapies. The clients we work with often can’t describe the feelings they have, process the information the therapist/counsellor gives them, or integrate this and form meaningful responses. Using drama therapy, people can show what they feel, experiment and adjust feelings they have, and reflect upon those feelings from a safe distance. (After all it is the police officer that is angry, not me...) It is internationally proven that drama therapeutic methods are successful when working with people having cognitive disabilities (ASD, ID, Dementia, Alzheimer’s, and head injuries).

Autism, Asperger’s & ID

I found that people with an ASD or ID diagnosis are often confused by the emotions they see in others. It is difficult for them to understand what other people feel because they are confused by the emotions they feel themselves. What often happens is that they categorise feelings into good and bad ones. This might look like this:

Good feelings

Bad feelings


Feeling in love






They then respond with a planned response. These planned responses are a safety mechanism which happens automatically. A planned response for bad feelings might be putting your hands over your ears and rocking, swearing, punching someone/something, isolating yourself. A good feeling might be to hug a person.

As feeling annoyed is a negative feeling, it will have the same response as being scared. This is very confusing for the community they live in, as it is for them.

In drama therapy, I use many games to practise different emotions, and different intensities of emotion. For example, anger ranges from slightly annoyed to extremely aggressive. Practising these different levels of anger helps people understand the feeling. It also makes it a valid and useful emotion and is no longer just bad. Practising different emotions also allows the client to practice different outcomes. Having alternative responses will help people be more appropriate in their responses.

Dementia & Alzheimer’s

When Linda and I worked with people suffering dementia, we noticed that expressing emotions was difficult for many of the participants - however, it was very important for those clients to let their emotions out. By validating every emotion/action expressed by the participants in drama and giving an immediate response, people came out of their state of isolation. Once the participants allowed themselves to express emotions, it often had a very strong and profound effect. Some people expressed their fear of dying, others found closure of previous experiences. For example, one person revealed the abuse and fear he suffered. Finding peace with his past allowed him to relax more and be less anxious.

We look forward to hearing your experiences in working on emotions with clients with cognitive disabilities in your practices.

Monday, 6 June 2011

Playing has no rules

People with memory loss can rapidly become isolated from those around them. They don't communicate the way they used to.

I keep coming back to how much we all rely on talking to stay connected to each other. And how difficult that is for many of us as we get older. We place so much judgement on how someone speaks. Get a word wrong, mispronounce something or just muck up your grammar and a lot of negative judgements may come in to play. Heaven help you if you stumble a bit. If your memory is not working the way you want it to, so the right words don't come, that can be very frightening. That is even harder on family and friends who struggle with this loss of contact with the person they love and care for.

But playing has no rules. We can make them up as we go along. There is no way we can fail or feel anxious about being second rate, not up to standard. If something doesn't work, we just change it with no baggage, no regrets or worries that it wasn't right. “It's just a story” - how safe does that make whatever we do?

Using play works so well because it just takes away any anxiety. People relax , have some fun and start communicating any way they wish. They use their early memories and the rest of start get a glimpse of amazing lives and achievements. With time this could take many people so much further or at least make daily life a less unhappy and worrying thing.

That's what I have come to love about the action methods of Drama Therapy. It allows us to act out what we want, how we want. No one can query our choice of words. If we don't use words at all just gestures, we are still communicating. If we're communicating, we can be in touch.

It is wonderful for me to see how people respond and reconnect when they get the chance to rediscover memories through Drama Therapy.

Friday, 3 June 2011

Using puppets in drama therapy.

We sometimes use puppets when we work with our client groups. As the photograph shows, our
puppets are quite big, and very human-like.

Linda having a serious get together with some of the puppets...

When working with a lady who suffered from dementia, and had lost her speech, using the puppets,
allowed her to re-engage with her environment. I put the puppets on the floor, and looked away
from the lady, pretending to be busy doing something else. With her walking stick she brought
the puppet closer to her. Casually I put the puppet in her lap. She started cradling the puppet, and
when she discovered how to operate the mouth, she started singing to the puppet. Everyone was in
awe, as this lady had not spoken for quite some time, only making grunting noises. As the sessions
progressed the lady started to use her voice more and more. The puppets allowed her to re-engage
with her environment.

Autism – Aspergers
I found that people with an ASD diagnosis sometimes have difficulties understanding the world
they live in. They are often frustrated, as they miss social cues, and unwritten rules. They feel often
isolated. Using puppets they can create social situations in which they can let the puppets practice
different social reactions to problems. For example, what can a puppet do if it wants to play with
another puppet? How do you ask? How do you react when they say no, or do not want to play what
you want to? Having experienced different responses and outcomes, people with ASD diagnosis
can recall these memories when they come into similar situations. Having already practised how to
interact will help them connect with their environment.

Cognitive Impairments (e.g. intellectual disabilities, brain injuries, Cerebral Palsy)
Being able to show people what happened to them, without having to rely on oral language allows
people to look at their issues from a safe distance and express their feelings in a safe environment (it
is the puppet who is frightened...not me...). To see people finding closure to traumatic experiences
using puppets is very rewarding.

Wednesday, 1 June 2011

Introducing Drama Therapy

Welcome to our new weekly updated blog about drama therapy.
As drama therapy is relatively unknown in New Zealand we decided to make our blog , so drama therapists and people with an interest in using its techniques in New Zealand, and overseas can contribute and share ideas.
As a quick introduction: We are from Wellington, New Zealand, where we work as drama therapists.
We have experience in a diversity of fields, using drama therapeutic and action methods. They include the disability sector (intellectual disabilities, physical disabilities, Aspergers, Autism, brain injury), elderly sector (Alzheimer’s, Dementia, Age Care), mental health sector (post traumatic stress, Depression, Psychosis and Neurosis) and we also use our skills in clinical supervision, management training and team building.
In our weekly updates we will talk about different techniques we use in the different settings/sectors. For example, projective techniques (like masks and puppets) psychodrama with people who have cognitive difficulties, slowing down the deterioration in people suffering dementia, and which techniques we found most successful.
We would also love to hear about your experiences in using drama processes when working with your client-base.

Drama Therapy and Dementia

Hi anyone reading this. Drama Therapy was something I'd used a little – and enjoyed hugely but it wasn't until I had the chance last year to work with Bas that I saw the enormous potential it has in the care of those with dementia.
We worked with a group of elderly – and not so elderly -people with varying degrees of dementia and Alzheimers. When I first met them, some were completely withdrawn or very limited in their communication. It was truly wonderful to see them respond, gain in confidence and start taking a keen interest in what was going on. Those working with them were doing a great job. They really got involved and valued the positive changes. Participants started to remember the sessions and interact more. Aggression decreased considerably.
This all happened just as a report from the Minister of Health was published. This showed the
impact of an ageing population and increased rates of dementia were going to pose an enormous
challenge to the Health sector over the next years.
There is little detailed research in NZ on using Drama Therapy but some very useful information
from the USA on the positive impact on behaviour and the potential reduced need for drugs.
We'll keep you posted as we try to introduce these methods, find some funding for research and
This is one problem we all face potentially as we live longer. I'd like to think there was some fun
ahead for me, whatever the state of my memory. How about you?