Drama as Therapy Volume 2

Clinical Work and Research into Practice

Phil Jones

• Publisher: Routledge
• Year: 2010
• ISBN:
  9781135164515
• Edition: 1
• Topic: Psychologie
• Subtopic: Psychotherapie

How is dramatherapy practised? What does research reveal about how dramatherapy offers therapeutic change? This book examines the many ways clients and therapists explore the therapeutic possibilities of drama. Whilst the first volume combined theory, practice and research in the field, this second volume concentrates on clinical material from a range of contexts, with thorough description and analysis of therapeutic work.

Bringing together international contributors, chapters explore work with various client groups in an array of contexts, including:

• work with clients with learning disabilities, dementia, HIV and cancer
• work with children, adults, older adults, families and women's groups
• contexts including the justice system, education, family therapy and neurorehabilitation.

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Drama as Therapy Volume 2: Clinical Work and Research into Practice is not only a welcome companion to the first volume, but also is an important stand alone work which will be of great interest to all those studying, practicing or with an interest in dramatherapy.

Part 1
Clinical practice: contexts, research and dialogues

1
The nature of practice and practitioner research

Phil Jones

Introduction: the emergence of the dramatherapy practitioner

Dramatherapy practice has emerged from a history of discoveries made by individuals and groups in many different contexts, as described in Volume 1. These included ideas and experiments in many countries prior to the established health systems of the twentieth century (Casson 1999; Jennings 1994; Jones 1996, 2007; Landy 2001). The term ‘dramatherapy’ developed as practices became more coherent: as individuals discovered each other’s work occurring within health and care services, ranging from early psychiatric hospitals to special schools and units. From these early steps onwards, access to the therapeutic benefits of drama has expanded to meet an enormous range of client experiences, challenges, creativity and needs. The development of dramatherapy has been one of discovery within its own emergent methods and ideas, alongside dialogue and engagement with related disciplines from psychotherapy to Forum Theatre, from dance to neuroscience (Andersen-Warren and Grainger 2000; Langley 2006; Mitchell 1996; Pearson 1996). Volume 2 illustrates the ways in which this discovery and dialogue is still alive in contemporary dramatherapy. This chapter offers a context for the edited chapters, which cover a range of practice. It introduces the nature of enquiry in dramatherapy, and the frameworks within which dramatherapy occurs. The chapter will feature references to the chapters in Part 2, helping readers relate the issues it raises to the clinical practice and research contained in that section of the book.

In many countries, the way in which dramatherapy is practised is now framed by regulation and structures set in place by professional associations, recognised qualifications and by national or international health care systems or policies. The hard work undertaken by individuals and groups has created structures which aim to guarantee safety and assurance for the client entering into therapy concerning issues such as the level of training of their therapist, ethical procedures and the overseeing of the quality of the dramatherapy practice they experience. These systems also ensure the quality of training for those wishing to qualify in the field, and subsequent opportunities for them to follow a career which is structured within mainstream health care provision and to pursue career routes within different professional contexts. Though details vary, a standard approach is similar in many countries. This infrastructure consists of four interrelated components:

1 professional associations

2 trainings offered within agreed standards – usually set through a combination of the association with the education and health care systems

3 supervision and continuous professional development

4 research.

The role of the professional associations has been to bring practitioners together, to develop the field, to establish and carry a vision for the development of dramatherapy and to negotiate, and represent, its members in relation to standards, training and employment. The associations have also advanced the frontiers of research and enquiry. The pattern for most trainings to qualify as a dramatherapist is that they are set at postgraduate exit levels, with those entering study holding a relevant first degree in the art form or in a health-related subject such as psychology, nursing or social work. The trainings combine theoretical study with practical skills-based sessions, placement with training supervision and a sustained experience of dramatherapy as a training client. Supervision is seen as both an element of training, and as a process that supports, sustains and builds the professionalism of the practicing therapist. This process, distinct from managerial supervision, involves the dramatherapist meeting with a qualified professional to reflect on the processes at work within their practice. Some systems make supervision mandatory in practising as a professional within a period of time after qualification. Within recent UK research the experience of supervision was seen as essential to the continuous development of the therapist as a reflective practitioner and to understanding the nature and impact of dramatherapy (Tselikas-Portmann 1999; Jones and Dokter 2008).

The practice of research: researching practice

The fourth component of the infrastructure, research into dramatherapy practice and theory, involves developing insight into the field. It is engaged with by practitioners within the context of their work and also within the framework of academic institutions and health care providers. There are different perspectives on research, which reflect different directions in enquiry. Kellett (2005) has summarised three key values which are relevant to consider in relation to dramatherapy. She asserts that research is important because:

• its innovatory and exploratory character can bring about beneficial change

• its skeptical enquiry can result in poor or unethical practices being questioned

• its rigorous and systematic nature extends knowledge and promotes rigorous problem solving.

(Kellett 2005: 9)

She sees the broad canvas of research in a way that is useful for dramatherapy to work from:

Research sets out … to establish the ‘truth’ of something through a systematic and rigorous process of critical enquiry where even the most commonplace assumption is not readily accepted until it has been validated. Kerlinger (1986) refers to this skeptical form of enquiry as checking subjective belief against objective reality. Furthermore any ‘truth’ established by research also has a self-correcting process at work in the ongoing public scrutiny to which it is subjected (Cohen et al. 2000) and any research inaccuracies will ultimately be discovered and either corrected or discarded.

(Kellett 2005: 9)

Here Kellett draws together research’s relationship to truth, skeptical enquiry, validity and its connection to both subjective and objective perspectives. In any research within the field of health and medical enquiry, particular elements of this relationship are drawn to the fore. These relate to the values Kellett identifies, concerning concepts of truth, validity and the relation between notions of the ‘subjective’ and ‘objective’. As a discipline drawing both on the arts and on systems of health, dramatherapy engages with various, and often opposing, ideas about the validity of what is called subjective or objective, for example. In arts or theatre practice-based research, processes such as creativity, originality, innovation and the value of personal expression and richness of data are often foregrounded. Medical and health practice-related research is often concerned with a need to validate experiences and outcomes from a framework that values quantitative, objective or scientific criteria. These need not be oppositional, but can often be experienced as such within spaces that dramatherapy is practised in: for example, in hospitals or other health provision. Robson refers to a divide which reflects cultural and research traditions, and one which arts therapist practitioners and researchers will recognise:

Differences fall within two main traditions which engage in sporadic warfare. One is labeled as positivistic, natural-science based, hypothetic-deductive, quantitative or even simply ‘scientific’; the other as interpretive, ethnographic or qualitative – among several other labels…

(Robson 2002: 7)

Within many areas of contemporary cultural enquiry the fields of health and medicine and those of the arts are encountered in ways that emphasise their difference, even irreconcilability. The arts therapies enquirer can often experience this tension when it comes to research or concepts such as truth and validity. As I have said elsewhere (Jones 2005), the field of the arts therapies is responding to this cultural divide through a variety of responses:

As the disciplines develop further, and as clients and therapists work together to discover more about both the potentials and ways of describing the methods and approaches, the nature and value of change in the arts therapies will become ever more established and articulate. This will not, and should not, happen by the arts therapies using one approach or framework: rather, as Grainger (1999: 143) says, ‘we need to have several different languages at our command.’

(Jones 2005: 246)

Practitioner research

The focus of recent work has reflected this variety in its approach to understanding dramatherapy practice. This book reflects the diversity of practitioner research: work within its chapters draws on qualitative and quantitative methods and is connected to systems that operate within medical care such as the notion of ‘evidence based practice’, whilst also engaging with other frameworks such as social models of health, and theatrical or sociological perspectives on change. The nature of enquiry is a broad one within the field and, as such, fits the different needs of an emergent discipline and a variety of contexts. One way of looking at this is in terms of a necessary diversity: from formal large scale research to informal research undertaken within day-to-day practice (Mahrer 1997). At one end of a scale is substantive, resourced formal research. An example of this would be an examination of efficacy within a national health service drawing on work undertaken in many settings, using models derived from a quantitative approach to evidence-based research often utilised within such a system. Another example of substantive research would be doctoral or postdoctoral enquiry drawing on extensive in-depth casework using qualitative methods in order to gain rich data and insight into the process and impact of the therapy. At the other end of this scale would be work which is not undertaken within such an intensive, resourced and supported framework. An example of this arena of research is that engaged with by a dramatherapist and client together within their everyday practice, as understood within what is often referred to as a ‘practitioner researcher’ framework. This acknowledges the ‘correspondences between the reflective processes of qualitative analysis and the reflective processes’ of the therapy itself (Clarkson and Angelo 1998: 20). Here the enquiry is undertaken by the therapist within their normal caseload, in reflection and supervision, as they explore the practice and develop insight within a structured framework of analysis.

This spectrum relates to the impetus and need behind the research into dramatherapy practice. A national health service’s needs and those of a day centre, of a PhD student and a therapist and client working together in private practice are all related, but are also different. The design, goals and outcomes need to be fitted to the framework and available resources within which the research operates. This is not to say that the kinds of research tools and methods are necessarily different. Similar ways of examining efficacy, for example, might be used in the larger scale and the smaller scale work – the main difference can lie in the scope and extent of the enterprise and its claims. All are valid, but in different ways. Hence the formal large-scale framework may fit research within a national health service’s resources and needs, whilst a practitioner researcher approach will fit the needs and resources of everyday work with clients. Dadds’ descriptions of practitioner research fit the framework of many of the chapters in Part 2:

Practitioner research … is not seeking generalisations in the way some large-scale forms of research attempt to do. Rather, it is seeking new understandings that will enable us to create the most intelligent and informed approach we can to improving our provision for those in our care. Stenhouse claimed that ‘we are concerned with the development of a sensitive and self-critical subjective perspective and not with the aspiration to unattainable objectivity’ (1975: 157). In accepting the mantle, as researchers, of professional communicators in a more public arena, therefore, we seek to share our research stories with others so that colleagues can, if appropriate, engage with them and relate them to their own work … This is how the influence of the small-scale, particular project, shared across the profession, can work its way into the larger fabric.

(Dadds 2008: 3)

This definition is one that many in the field might find of use, and it is a fitting definition for the enquiry and practice contained in Part 2. Within this book the research undertaken by the contributors reflects the different needs and possibilities within such a practitioner researcher framework.

A key aspect of many of the chapters concerns how to gain client perspectives on their experience of the therapy. This includes quantitative and qualitative methods, narrative approaches to research, work with clients as co-researchers, the use of dramatic and other arts based methods as evaluation, questionnaires, structured and semi-structured interviews, focus groups, video and non-participant observation. The following excerpts from Part 2 give a sense of this range.

Novy, for example, in Chapter 4 uses narrative approaches to research in dramatherapy within vignette analysis of work involving clients as co-researchers:

… Solange, Louise and Carole were interviewed all together about their experience during the project. I was curious to hear their evaluation of the methods that we worked with and, more specifically, their understanding of whether and how these were helpful. To begin the intervie...

Table of contents

• Contents
• Illustrations
• Contributors
• Preface
• Acknowledgements
• Part 1 Clinical practice: contexts, research and dialogues
• Part 2 Clinical practice and practitioner research
• References
• Contacts
• Index