People on the autistic spectrum have been described by Frith (1989) as having ‘literal minds’, meaning specific deficits in emotional intelligence, theory of mind and the use of metaphor. As a result, their behaviour can be seen as inappropriate or immature and considerable difficulties are encountered with peers because of an impaired ability to understand what other people are thinking and feeling. Children and young people with ASD are therefore at risk of suffering from anxiety and depression as they mature and become more aware of their social impairments and limited life opportunities (Godfrey & Haythorne 21).
Dramatherapy is particularly appropriate for this client group (National Autistic Society, 2012, http://www.nas.org.uk) as it develops social skills and supports the expression of feelings through structured work that helps reduce anxiety. The dramatherapist can model clear, expressive communication, as well as facilitate the development of relationships with others, which gives participants numerous opportunities to rehearse and replay social skills until they are learned and integrated into behaviour (Godfrey & Haythorne 21).
There is a lack of published research assessing dramatherapy for clients on the autism spectrum, with much previous work employing single-case study designs (Dunn, 1988). One study used a pre-post design to evaluate a social skills programme consisting of art and group therapy for children on the autistic spec- trum (Epp 2008). This showed significant improvement in assertion scores, and decreased internalizing behaviours, hyperactivity scores, and problem behaviour scores in the students aged 11–18. However, although this intervention included art therapy, it used a cognitive behavioural approach and therefore cannot be used as evidence for the effectiveness of dramatherapy-based treatment (Godfrey & Haythorne 21).
There has recently been research published suggesting that social skills train- ing is a successful intervention for children and adolescents 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 inter- vention, to improve social skills via in vivo practice. They found encouraging improvements in assertion and the ability to detect emotions in adult voices and less parent reported social problems after an intensive six-week summer inter- vention. This study included 17 participants aged 11–17 years and was well designed, employing manualised interventions and standardised measures from multiple informants. Nevertheless, it was conducted in the United States, and did not use dramatherapy or trained dramatherapists, so the findings are not necessarily generalisable to other contexts or practitioners (Godfrey & Haythorne 21-22).
Because of its appeal, immediacy and flexible approach, Dramatherapy is particularly effective, irrespective of age, ability and background (Godfrey & Haythorne 22).
The combination of dramatherapists and clients has many variables e.g. two therapists to one child/adult, one therapist to a group. In a group setting each ses- sion may provide space for up to three or four clients, where individual and group aims would be addressed through the creative process of dramatherapy (Godfrey & Haythorne 22).
The basic structure of a session remains the same every week in order to increase confidence and reduce anxiety related to change. However within the basic strucure the main theme for each week will change in response to feedback from the group in the sessions and the issues that arise over the course of the project (Godfrey & Haythorne 23).
The issues associated with ASD create difficulties in forging strong and supportive relationships. The anxieties the condition often generates can make familiar situations challenging, and make new situations an ordeal. Children and young people with ASD struggle to work with the national curriculum, and need a high level of support and expertise if they are to progress or thrive at school (Godfrey & Haythorne 23).
Dramatherapy sessions offer permission people with ASD to express and be themselves. The sessions also offer clearly defined boundaries and structures that help build trust and familiarity in the sessions and with each other. In this therapeutic environment, people with ASD are able to explore communicating their needs, feelings and interests and have attention paid to these needs and to workwith them in a creative way (Godfrey & Haythorne 24).