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.

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.

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
Happy Feeling in love Excitement	Angry Sad Jealous Nervous

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.

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...

Dementia
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.