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.

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