Notes on Dramatherapy & Autism (Emmett)

Note: This book is actually a compilation of many journals. Each journal will be cited separately.

Using extensive examples from practice with a range of client groups, Dramatherapy and Autism confronts the assumption that people with autism are not able to function within the metaphorical realms of the imagination and creativity. It demonstrates not only that people who function along the spectrum are capable of engaging in creative exploration, but also that, through encountering these processes in the clinical context of dramatherapy, people with autism can make changes that are life enhancing (Haythorne & Seymour).

We provide evidence for the effectivity of dramatherapy as a clinical interven- tion with people with autism and also as a way of conceiving the performative aspects of dramatherapy as ongoing metaphors that improve and support daily life for people living with the challenges of being autistic, in an often unsympathetic world (Haythorne & Seymour 1).

The book is dedicated to dramatherapy praxis rather than attempting to embrace the other creative arts therapies or discuss joint work. This deliberate choice acknowledges that more needs to be published across the arts therapies and respects the work that colleagues are doing in related fields (Haythorne & Seymour 1).

Drama and theatre arts are practised in a whole range of settings, from drama classes in schools, to putting on plays, and in forms variously titled Applied Theatre, (Nicholson, 2005; Prendergast and Saxton, 2009), Arts in Health (Brodzinski, 2010) or Social Theatre (Seymour, 2009, pp.27–37). Activities take place in theatres, community, educational and health settings, with the intention of improving well-being and sometimes encouraging behavioural change (Haythorne & Seymour 4).

Dramatherapy grew out of a movement that began in the late 1970s, which, responding to the changing political climate, sought to explore new possibilities in the theatre by taking it out of theatre buildings and into communities (Haythorne & Seymour 4).

The core principle emerging from this work was that theatre can be used to deepen our understanding of the human condition and that the skills and means of making theatre can be flexible, mobile and inestimable in their scope. This also coincided with an expanded, liberatory view of whose story could be told in the theatre, valuing voices that had not been heard before (Haythorne & Seymour 5).

In dramatherapy the client learns that their ‘voice’ is respected and valued and the therapist is the kindly audi- ence or ‘witness’ to what they want to show. Many of our clients have suffered vilification for their incapacities, so the straightforward acceptance of who they are, in the present moment, can of itself be reparative. The theme of empowerment runs through all of the work described in this book, so that dramatherapy as a clinical practice may be justifiably associated with a tradition of theatre for change (Haythorne & Seymour 5).

In summary, we are actors in our lives with the potential to form early primary attachment, to separate and operate independently, to negotiate space and relation- ship to an objective and relational universe, and to form independent attachments of different orders. We propose that, even though the capacity to achieve these goals is impaired for many people with autism, dramatherapy works on the principle of discovering and building the power of the creative self in whatever form that is manifest, in the knowledge that this process has the capacity for healing and change (Haythorne & Seymour 6).

A delicate balance is required, where firm containing structures need to be in place to establish safety and trust and, at the same time, to allow the client to explore and enact chaotic and difficult feelings (Haythorne & Seymour 6).

Dramatherapists have continued to be drawn to this client group, believing that dramatherapy has real relevance for people on the autistic spectrum. Practitioners have begun to build an evidence base of the impact and outcomes of dramatherapy interventions (Haythorne & Seymour 7).

Dramatherapy is seen as a positive intervention that facilitated emotional development, peer relationships and social skills, reducing anxiety through its structure and clear boundaries, and also helping to support the wider family and social system around the child (Haythorne & Seymour 7).

We suggest that dramatherapy can reach out to people on the autistic spectrum by recognising difference and individuality, and through a broad range of techniques it can support people to express their feelings and imagination and to develop their communication and social skills. It might seem that the creative medium of drama is inaccessible and perhaps confrontational to people who are struggling with the triad of social impairments (Haythorne & Seymour 9).

People with autism, and parents, carers, professionals and researchers, are increasingly questioning and reframing the ‘deficits’ presented in diagnostic criteria and the impact this has on the lives and possibilities for people with autism (Haythorne & Seymour 9).

There is a strong precedence for this premise, as Hans Asperger created an educational pro- gramme for the boys he was treating that actually involved drama alongside speech therapy and physical education (Haythorne & Seymour 10).

Gallo-Lopez (2012) sends out a strong argument in favour of dramatic play through dramatherapy intervention as a catalyst for moving from the self, a solitary state, a reference to autos, the Greek root of the word autism, to a world of connectivity (Haythorne & Seymour 11).

Beginning with sensory play, the autistic child may move on to symbolic play and then to projective play, with the aim of moving finally into sociodramatic play. This is where there is movement from ‘monologue’, with the child absorbed in solitary play expressing little interest in others, to ‘dialogue’, as the child builds relationships and chooses to interact (Haythorne & Seymour 11).

Many writers on autism talk about the autistic mind being ‘unable’ to work in metaphor and symbol: ‘Although a few pupils with autism will acquire the rudiments of sym- bolic or pretend play . . . it is very often stereotyped and fails to develop in any creative way’ (Jordan & Powell, 1995, p.124). However, I have found that autistic clients can engage with metaphor and symbol (Davidson 16).

Swanepoel (2011) explains that the dramatherapist may engage with metaphor and symbol in a number of ways, through verbal expression, projective exercises (drawings, images and stories) or through expression in the body (gesture, sound and actions, in improvisations and enactments). This allows for a somatic response and an experience of feelings that can break habitual or repetitive behaviours. Symbolic representations are particularly important as they allow the autistic child an oppor- tunity to practise the ‘switching of gears’ necessary to take them between the polar- ised concepts of the literal to the metaphorical (Davidson 16).

As dramatherapy supports the exploration of complex feelings through the use of character and role, when the client enters into role they can examine their own struggles through embodying a character: ‘Role-reversal can be employed as a technique to help individuals recognise another point of view’ (Davidson 17).

In this chapter I explore whether this creative practice and experience of relationship dynamics allows the autistic child to address their struggles with ‘mindblindness’ (Davidson 17).

Recent research has confirmed what I experienced in my own work, that ‘71% of children with autism have at least one co-occurring mental health problem, while 40% have two or more’ (Madders, 2010, p.7). I questioned whether autistic children experiencing emotional trauma may not have the expressive tools with which to manage these experiences. Could dramatherapy practices help these children express difficult feelings through metaphor and symbol (Davidson 17)?

In order to build confidence and lessen anxiety for my two clients, I held ses- sions at the same time and place each week in a room always set up in the same manner. Every session began with the client checking in with a heart-shaped cush- ion and a drum. Whilst holding the cushion, they could talk about anything ‘good’ or ‘not so good’ that had been happening in their lives. The drum provided an opportunity for non-verbal expression of emotions, as the client was encouraged to play out their feelings (Davidson 18).

When preparing to enter the ‘creative space’, the clients crossed a metaphori- cal threshold, which they imagined and created for themselves each week. During the work in the ‘creative space’, they accessed a number of transitional objects. As they engaged with them, I followed their lead, making additional offers and initiat- ing dialogue. When the work was finished, the clients returned over an imagined threshold – which may be different to the one originally crossed (Davidson 18).

Joey had created an entire world and a story with many characters. Up to this point I had been placed by Joey in the role of ‘active witness’. I use this term as, whilst he would engage in dramatic projection with the objects and take on all the characters, it was still an isolated play. I would participate by asking him questions in character, but I was not invited to engage in his story as an active participant. For many sessions Joey seemed com- fortable with this and it was important I went at his pace. My role as active witness seemed to have two reasons. First, Joey did not naturally know how to play with others, and I was quite literally ‘bearing witness’ to his struggles. Second, I was to remain in this role until Joey trusted our relationship enough to invite me to fully interact and engage in his world (Davidson 19).

I reviewed these episodes in detail in supervision, confirming my sense that Joey was exploring the client/therapist relationship through his enactment with Sir Stretchyman and Butterfree. Their relationship seemed to mirror ‘our’ relationship and he seemed to be exploring and expressing his deep desire to be understood and accepted. ‘The drama engaged then is both healing and set within a context of healing, within a triple boundary of metaphor, client therapist relationship, and dramatherapy space’ (Davidson 20).

The ‘power objects’ seemed to symbolise the ‘power’ that Joey believed he held and other people tried to destroy. He often referred to having ‘something inside me that no one can touch’. These objects appeared to represent Joey’s autism and how that made him both different and special. They all had different functions and effects upon the characters, which represented both the positive aspects of Joey’s ASD and the shadow elements (Davidson 20).

The lack of development of a Theory of Mind is often referred to in ‘explaining’ the behaviour of autistic children; it results in what Baron-Cohen (1997) refers to as ‘mindblindness’. Dramatherapy allows for emotional reciprocity, an opportunity to relate to the feelings of another person. I wanted to investigate whether this opportunity to ‘rehearse’ ‘mindreading’ could allow the autistic child the time and space through which to develop a theory of mind (Davidson 20-21).

Agro, a 10-year-old boy with a diagnosis of ASD and the second client in this piece of work, clearly had difficulty with understanding the perspectives and actions of those around him. Agro was referred due to difficult family issues, having become more tearful and having threatened to kill himself. He had been school refusing and there were serious concerns over his mental health. Agro was unable to recognise and express his own emotions. This was apparent from the initial assessment session and from his referral. Agro was on the surface a very placid boy, but he was prone to angry outbursts, when he would smash windows and hit out (he later described this as feeling like the Incredible Hulk) He appeared to have no control over his outbursts. He could not anticipate their eruption by reading his own feelings, as there were no signifiers he could recognise (Davidson 21).

Working in small and achievable stages towards recognising and contextualising emotions seemed to give Agro confidence. Attitudes towards autism often describe a ‘lack’ of emotions. However, this may derive from a struggle to reference and express what is being felt and therefore be able to recognise and empathise with these feelings in others. ‘People with autism may not show emotions in a traditional way, but this does not mean they have no emotions’ (Davidson 22).

Through building emotional vocabulary an autistic child may enter into the developmental stage of theory of mind, which may have been delayed or not developed in childhood (Davidson 22).

Meeting the client on their own terms presents an opportunity for the therapist to be invited to experience ‘their world’. One of the defining characteristics of autism is ‘rigid ritualistic interests’. Many people with autism have obsessions or detailed knowledge of narrow fields of interest. Allowing these interests to have voice, and exploring them in the dramatherapy session, enables communication. The princi- ple is to acknowledge and support what the clients bring to sessions (Davidson 22).

I invited Agro to create his own Pokémon character. He enthusiastically drew a character called ‘Voltage’, which he then described. Voltage held great strength and power and was able to motivate change. Agro created a sculpt of Voltage and then walked around the room in character. He then created a ‘Six-part Story’ (Lahad, 1992), with Voltage as the main character. In his story Agro drew an identical twin Voltage, who assisted Voltage in carrying out his task. This metaphor carried across much of the work with Agro. He showed a need and desire for friendship with someone ‘like him’, and he wished to be supported and understood by some- one who experienced the world as he did (Davidson 23).

I used Agro’s fixation with Pokémon as a means to communicate on a level and in a context that he would understand: ‘it is possible to use a child’s particular obses- sion or stereotyped actions as a legitimate starting point . . . one has to engage with whatever is engaging the child whatever that may be’ (Jordan & Powell, 1995, p.23). By encouraging him to create his own characters, he was able to work with his own unconscious material and begin to look at the world through the eyes of the characters (Davidson 24).

The dramatic metaphors in Joey’s Colourland story appeared to be symbolic of his real-life experiences: they worked as a container, giving Joey a distance through which he could safely explore and express these experiences. As the process of therapy continued, some of Joey’s feelings began to move from the unconscious to the conscious and the story itself became more literal as he started to make con- nections between what was taking place in the creative space and his reality. The language of reality began to creep into the metaphor and reflected his movement into a more conscious way of working (Davidson 24).

Both Joey’s school and his mum reported a shift in his behaviour and his ability to express himself – and the threat of exclusion from school was removed. Joey’s ability to work in metaphor and symbol challenges the common conception that autistic children cannot engage in this way. I believe that dramatherapy demonstrates huge possibilities for high-functioning autistic children at risk of mental health issues: ‘Dramatherapy using stories presents a real and exciting set of possibilities for engaging young people with ASD in a positive therapy, likely to benefit their emotional, psychological and social development’ (Davidson 26).

Part of Agro’s referral was that he was frequently refusing school, causing serious concerns and risk of exclusion. Agro responded well to the regularity and structure of the sessions, turning up early for sessions eager to enter the space, even attend- ing on days when he had refused to go to school. By session 10, Agro told me that he had received a certificate from school celebrating his consistent attendance over two weeks. Both the school and Agro’s mum reflected that the only difference at this time was his attending dramatherapy sessions. Whilst we never worked directly with his school refusal, the child-led dramatherapy had achieved this improvement indirectly (Davidson 26).

This chapter demonstrates that dramatherapy sessions enable the autistic child to engage with their issues through dramatic metaphor. The containment and ritual within the session structure creates a secure environment in which the client can begin to explore and make connections. The development of a trusting and holding client/therapist relationship supports exploration through mutuality and respect (Davidson 27).

The word drama means ‘action’. Therapy means ‘change’. The action is what we do and the change is what we are hoping for. The process of using dramatherapy can be healing in and of itself for those taking part. Using the imagination can be key to bring- ing about change. The dramatherapist is witness, actor, audience, and most importantly the midwife of the participant’s process (Treves 81).

Dramatherapists offer the unspoken a voice. This can lead to insight, awareness, and potential for change (Treves 81).

The tools I use have changed over almost thirty years of practice and teaching. At present, the physical props I take into sessions are puppets, objects such as mythical figures, stones, buttons and action figures, story-making cards, and plenty of art materials. There are also the skills carried in my head, the unseen resources, that can be found in a moment should they be needed: fairy tales and myths, role-play ideas, improvisation games, and not least the ability and awareness to intervene when needed and to know when this might be (Treves 81-82).

These two disciplines appear to have quite different methodologies for the ther- apist. Dramatherapy is a ‘doing’, action-based therapy, in which the client and therapist can be active and expressive (Treves 82).

As part of my ‘doing’ role I provide dramatherapy tools, and appropriate verbal or non-verbal interventions. The young people are able to use the materials to explore and respond as they wish to the interventions. My ‘being’ role involves quietly listening and watching with full attention and without judgement. This is part of the practice of ‘mindfulness’, which enables me to be aware of my own process, thoughts, feelings and reactions. It helps me monitor how my own process may influence the session (Treves 82).

My preferred style of working is also reflected in how I refer to the people with whom I work. Yalom suggests that, rather than calling people clients, patients or analysands, we use more equal terminology. He says, ‘I prefer to think of my patients and myself as “fellow travelers”, a term that abolishes distinction between “them”, the afflicted, and “us” the “healers”’ (Yalom, 2002, p.8). For the purpose of this chapter and in the spirit of Yalom’s thoughts, I will use the term ‘young people with autism (Treves 82).

Recent research into autism and introversion suggests that there may be a connec- tion between the two. Some of the traits of each appear to have similar qualities, such as the need for time alone, being over-stimulated by too many people or too much noise, enjoying one’s own thoughts and feelings, and perhaps having less of a need to be in relationship than typical extroverted people (Treves 83).

A young person with autism and traits of introversion attends dramatherapy sessions on a one-to-one basis. He presents in the school environment as quiet, withdrawn and depressed, as reported by those working with him. He rarely speaks and has good receptive understanding. He enters the room, and sits down. The room is small and almost empty apart from beanbags, two chairs and a small table. Dramatherapy resources are on display. I notice that his energy seems depleted; he chooses to sit with his body hunched and caving inwards, as though he is carrying a heavy load. I let him know that puppets and materials are available, should he wish to use them. There follows a silence last- ing five or six minutes. He is not moving and neither am I. I model his physical position and we wait. He then leans down and chooses a puppet, a squirrel. He chooses a koala puppet and offers this to me. He places his hand inside the squirrel puppet and begins to move it, then makes a noise. It sounds like crying and I name this. He nods a ‘yes’ and spends a further six or seven minutes making this sound, which I in turn mirror, back to him. Then comes a change. He leans forward and moves my hand with the koala puppet on it, and tells the koala to hug the squirrel. This carries on and he begins to smile, then chooses to leave the room and finish his session. His shoulders are down, and no longer hunched (Treves 84).

The combination of dramatherapy and mindfulness appeared to work well in this session. There was no demand upon the young person. In choosing what he needed in an atmosphere of non-judgement, he used dramatherapy tools to express himself and have his expression witnessed (Treves 84).

I now offer feedback from young people with autism and traits that I identified as introverted. This is a small sample only, and the young people are from differing socio-economic backgrounds (Treves 85).

Mark found the regular space and quiet of the sessions healing. His artwork began in the literal, where he drew guitars in pencil. This moved on to drawing how he felt in challenging situations in school. The final drawings were in vibrant colour and from his imagination. This suggested to me that by the end of the intervention Mark felt more able and free to move away from the literal to the imaginative (Treves 86).

This chapter builds on a study of written feedback post dramatherapy intervention for children and young people with Autistic Spectrum Disorder (ASD) provided by parent/carers and teachers (Godfrey and Haythorne, 2013). The study revealed five key themes, with no negative comments being recorded (Godfrey & Haythorne 156).

Dramatherapy is particularly suitable for this client group (National Autistic Society, 2012) because it develops social skills and supports the expression of feelings using structured work that helps reduce anxiety. The dramatherapist can model clear expressive communication, as well as facilitate developing relationships with others, by giv- ing participants opportunities to rehearse and replay social skills until they are learned and integrated into behaviour (Godfrey & Haythorne 156-157).

Recent research suggests that social skills training can help children and adoles- cents with Asperger’s syndrome and high-functioning autism. Lerner et al. (2011) used a ‘socio-dramatic affective–relational intervention’, a type of drama-based social interaction intervention, to improve social skills. They found clients demon- strated encouraging improvements in assertion and their ability to detect emotions in adult voices, and subsequently parents reported fewer social problems (Godfrey & Haythorne 157).

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