By Eva Marie Chadwick, Dramatherapist and Clinical Supervisor at Thornford Park Hospital
The development of trauma-informed dramatherapy in a forensic hospital has evolved through working with forensic patients who have mental health diagnoses, challenging and difficult behaviours, and a background history of trauma, complex trauma and/or PTSD. Dramatherapy is a creative psychological therapy regulated by the Health and Care Professions Council (HCPC) and is a recommended modality for rehabilitation (www.evidence.nhs.uk).
Trauma-informed dramatherapy maintains the clinical perspective ‘what happened to you?’ as opposed to ‘what’s wrong with you?’, whilst symptoms and behaviours are recognised as strategies to cope with trauma (www.samhsa.gov). The approach includes working within Herman’s three-phase model: Stabilisation, Processing and Integration; and provides patients with tools, methods and techniques appropriate during each phase of their therapeutic journey.
Becoming trauma-informed within the dramatherapy practice has meant drawing on theories and trauma-treatment methods outside of dramatherapy and integrating them into the creative approach. Developing an understanding of the physiological and psychological effects of trauma is a key aspect of this work, in providing an understanding of the aetiology of a patient’s presentation; enabling them to stabilise; self-regulate; and process trauma without re-traumatising.
‘I work with the understanding that trauma is held in the physical body (Fisher 1999; Ogden et al. 2006; Rothchild 2000; van der Kolk 2014). In accessing unprocessed trauma, I [continue to be] mindful of the potential for flooding or dissociation, resulting in the risk of retraumatising in the process. Stephen Porges’s Polyvagal Theory (2011) provides an understanding of the physical processes a person undergoes during trauma, from the inability to move/freeze during the incident, to the ability to unlock and process these in therapy (Dana, 2018).’ (Chadwick, E. 2021).
Psychoeducation is a key component within trauma-informed therapy and aims to empower and support the patient’s understanding of what is happening for them on a physiological level (as above). In addition, somatically-driven approaches that support the patient’s capacity to re-organise their experiences as past and alleviate activating triggers continue to be adapted and integrated into the dramatherapy interventions, including the Lifespan Integration (Pace, 2015); Sensorimotor practices (Ogden et al. 2006); and EMDR exercises (Shapiro, 2012), complementing the physical nature of the dramatherapy modality.
Psychological fragmentation, the sense of stuckness and arrested development is a well-documented effect of trauma (Fisher 2017), and Richard Schwartz’s ‘Internal Family Systems’ has offered as a way of empowering the patient in managing their personality construct, and the development of coping styles that protects and defends against wounding and shame. Trauma-informed dramatherapy continues to be developed in the hospital and this integrative approach offers forensic patients the ability to manage their emotions; explore their life narrative; process trauma; and reduce the conflicts and negative coping strategies that developed in the attempt to manage past trauma.