Monday 3rd December 2012
A unique six-week programme is helping people with brain tumours express themselves through creativity.
Dramatherapy is a psychological therapy that adopts principles and techniques common to drama, theatre and psychotherapy. The aim is to promote personal insight, growth and healing.
In August 2010, the neuro-oncology service at King’s College Hospital, London piloted a six-week dramatherapy programme with funding from Macmillan.
Dramatherapy had produced positive outcomes in palliative care and mental health settings,1,2,3 and due to commonalities between these patients and neuro-oncology patients, the service felt that it was worth further exploration.
The pilot programme was developed by the three dramatherapists from Beam Dramatherapy Group, who had been researching the use of dramatherapy in palliative care. They were supported by their clinical supervisor Anna Chesner.
The aim of the pilot was to provide a safe, structured, six-week journey in which the patients could explore and identify their personal qualities, strengths and inner resources and apply these to manageable aims or goals.
The groups ranged from three to six participants and were recruited by the neuro-oncology nurse specialists. The small numbers allowed for additional support to be given to those with the most severe neurological deficits. For example, one group member was almost completely deaf as a result of his tumour, and could only participate with one-to-one attention from a dramatherapist.
The group members had a range of diagnoses from low to high grade primary brain tumours, and were at different stages of their treatment. The first intake focused on newly diagnosed patients. When this proved difficult to recruit to, it was opened up to people at any stage. This proved to be a positive change as it offered people who were further into their treatment the chance to prepare themselves for the uncertain future they were facing - something they didn’t feel they would have been able to do at an earlier stage.
The model was influenced and inspired by The call to adventure: Bringing the Hero’s Journey to Daily Life4 by actor, director and teacher Paul Rebillot, and dramatherapist Roger Grainger’s, Into and out of chaos: dramatherapy and the symbolization of life changes.5 The structure of each session was consistent and included:
- an open circle for group members to share thoughts and feelings
- a main activity
- a sharing circle to finish.
The first session focused on group boundaries, cohesion, connections and symbols of hope. The second session looked at establishing an actual and metaphorical safe space for group members, prior to entering more explorative material. Session three identified ‘hero’ qualities (personal qualities that group members admire) and internal/external resources and strengths.
Sessions four and five allowed the clients to look at the challenges ahead and find ways to apply strengths and inner resources to these challenges with the support of the group. The final session reflected on the individual and group process.
Before and after each session, members were invited to place themselves on or indicate one of three coloured squares representing their anxiety levels - (low) yellow, (medium) orange or red (high). This showed that overall the anxiety levels of the group stayed the same or decreased.
Findings and recommendations
Dramatherapy offered a positive intervention for the group, however the quantitative measurement tool used in this pilot did not accurately reflect the benefit that patients derived.
In future, one-to-one interviews will be used to evaluate the benefit of this intervention. A pre-course interview could have been conducted as part of the recruitment process.
The main benefits were not easily measured but the qualitative feedback gathered by phone provided much greater insight into people’s experiences. The group valued and needed ongoing support and assistance to adjust to living with a long-term condition. The creative approach was popular as a gentler way of accessing emotions without feeling over exposed. It was also suitable for people with neurological deficits. Through this creative process, group members could get in touch with aspects of themselves that may have been forgotten due to trauma of diagnoses and treatment.
At the beginning of the six weeks even naming their diagnosis was a challenge as some struggled to come to terms with their condition. For the highest grade tumour, members strongly related the name to a death sentence. By the end of the process members allowed themselves to share the reality of their individual situations and identified their needs and aims.
They were also able to seek help rather than feel alone and isolated. The people who attended the dramatherapy courses commonly did not attend a brain tumour support group prior to the intervention. This was due to not understanding what was involved in a support group. They had also not placed value on peer support until this time. Attending the course led to increased interest in attending a support group once it finished.
Four groups were run in total. There is demand for further courses but there is no funding for this at present. People with brain tumours are surviving longer and neurooncology services need to adapt the support offered to patients to reflect this. If funding can be sourced, dramatherapy would be a beneficial psychological intervention for this patient group as part of the holistic support provided through neurooncology teams.
You can watch videos about dramatherapy and the Beam Dramatherapy Group on their Vimeo page.
Email Vicky Hurwitz and Jamie Logan, Neuro-oncology Clinical Nurse Specialists King's College Hospital, London
Visit the King's College Hospital Neuro-oncology Service website.
Dramatherapists Sarah Kokkinos, Alison Singleton and Rebecca Blake.
1. Diane Waller. Arts Therapies and Progressive Illness. 2002. Routledge.
2. Hartley N and M Payne. Eds. The Creative Arts in Palliative Care. 2008. Jessica Kingsley, London.
3. Eileen Haste, Pat McKenna. Clinical Effectiveness of Dramatherapy in the Recovery from Severe Neuro-trauma. 2010.
4. Rebillot P. The Call to Adventure: Bringing the Hero’s Journey to Daily Life. 1993. Harper, San Francisco.
5. Roger Grainger. ‘Into and out of chaos: dramatherapy and the symbolization of life changes’ in Practical approaches to dramatherapy. The Shield of Perseus. 2000. Jessica Kingsley, London.