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Can Art Save Lives? Questions for Nisha Sajnani on How Drama Therapy Heals

Nisha Sajnani meets with Drama Therapy students Veronica Filson and Lynn Hodeib at the NYU Launch of the Oxford Handbook of Dance and Wellbeing.

Nisha Sajnani meets with Drama Therapy students Veronica Filson and Lynn Hodeib at the NYU Launch of the Oxford Handbook of Dance and Wellbeing.

Nisha Sajnani, PhD, RDT-BCT, is an associate professor at NYU Steinhardt and the director of the Department of Music and Performing Arts Professions’ Drama Therapy Program.

She serves as the research director of the As Performance: Theatre and Health Lab and editor of the Drama Therapy Review.  We interviewed her about the healing power of drama therapy.

I’m interested in the fact that drama therapy combines both theater and mental health principles; art and psychology.  Can you speak to the history of that combination?

Drama therapy combines ideas and practices from psychology and theatre as both involve the study of human emotion, cognition, and behavior. It is a form of therapy for those recuperating from psychological and interpersonal injuries that encourages personal and social change through projective play, dramatic improvisation, role-play, storytelling, fiction, playwriting, and performance.

The use of drama and theatre to heal has a very long history dating back to ritualistic healing performances done by specially authorized persons who were seen as healers in their communities. Ancient performance manuals such as Aristotle’s Poetics and Bharata Muni’s Natyashastra refer to the psychological properties of acting, witnessing, and otherwise participating in theatre. Aristotle, for example, proposed that feelings of fear and pity could be actively aroused and released in audiences to tragic plays resulting in feelings of clarity and renewal. We experience the truth of this insight today every time we find ourselves identifying with the characters of a play, film, or tv serial. Psychologists Green and Brock referred to this phenomenon as ‘narrative transportation.’

Around the fifth century, Caelius Aurelianus translated the ideas of Soranus of Ephesus in On Acute Diseases and On Chronic Diseases in which Soranus prescribes plays best suited to his patients’ needs. Imagine, for example, prescribing a play like Come from Away to help people to grieve 9/11, Sarah Kane’s 4:48 Psychosis to grapple with themes of depression and suicidality, or Richard III for veterans returning from war.

Several developments happen over the 16th-18th centuries that reflect a shift in mental health practice including observations by Sir Francis Bacon about the benefits of ‘stage-playing’ to memory and confidence. William Shakespeare refers to the healing properties of dramatic enactments in King Lear and, later, in The Two Noble Kinsmen. Biagio Miraglia, the first Italian psychiatrist, was amongst the first to formally organize the use of theatre in mental health facilities around the mid-1800s noting that acting gave patients an outlet to express repressed feelings.

Acting “as-if” something is true, as children naturally do in pretend play, was popularized by pioneering psychologist William James and theatre director Konstantin Stanislavski in the late 19th and early 20th century. Being able to make-believe gives people a chance to try out different possibilities and to create new storylines about their lives in a less risky environment. We can, in fact, rehearse the change we wish to be and see.

Perhaps the greatest influence on drama therapy in the U.S was Jacob L. Moreno, a Viennese psychiatrist who, between the 1920s-60s, founded group psychotherapy and two approaches to exploring psychological processes through dramatic action: psychodrama and sociodrama. Both approaches use similar methods and techniques of role-playing based on his relational role-theory of personality and his ideas about the health benefits of spontaneity and creativity.

“Drama therapy” was first used as a term in 1917 but was only formalized as a profession in the U.S. in 1979 through the founding of the North American Drama Therapy Association. I had the pleasure of co-founding the World Alliance of Drama Therapy with member associations representing 22 countries, just last year – 100 years after the first documented use of the term.

The practice of the drama therapy continues to evolve — drawing from new discoveries about the psychology of theatre, trauma, and the role of the body, improvisation, play, social roles and narratives, amongst other factors, in facilitating change.  The Couch and the Stage, written by Dr. Robert Landy, the founder of the NYU Program in Drama Therapy and director of the film Three Approaches to Drama Therapy offers a detailed account of the history of this marriage between psychology and theatre together with examples of innovative techniques and models of practice. I am the Principal Editor of Drama Therapy Review, the primary journal for research in our field where readers can discover how drama therapists promote positive health outcomes with diverse groups and concerns in a variety of contexts.

You are the co-editor of Trauma-Informed Drama Therapy: Transforming Clinics, Classrooms, and Communities, which looks at how drama therapists respond to trauma in communities burdened by historical and current wounds.  Can you tell me how drama therapy can heal trauma?

When we go through highly stressful experiences such as chronic poverty, domestic violence, neglect, racism, or singular events like sexual assault or an unexpected loss, we may experience a disruption in our sense of identity, safety, and connection to others. These ruptures can contribute to anxiety, depression, and emotional dysregulation which may, in turn, prompt helpful or harmful coping strategies such as avoidance and social isolation.

Drama therapy can offer survivors of trauma opportunities to use skills related to acting, such as breath and movement, enrolling and de-rolling, to practice regulating emotional experience and returning to present experience. Through the use of projective techniques such as puppets, texts, and masks, participants can find a language to organize the story of their experience and communicate this to others without becoming too detached or emotionally overwhelmed. The use of relational play can facilitate differentiation and progressive desensitization with children who have experienced trauma. Through theatre games and exercises, participants are able to take creative risks in a less threatening environment and rehearse challenging social situations.

When conducted in a group, drama therapy can offer children, adolescents, and adults opportunities to experience joy, validation, and connection with others again while making meaning of difficult events. For example, this drama therapist writes about a session held with children who survived the Tsunami in Sri Lanka:

I placed a blue cloth in the center and waited to see what would emerge.  The children began to move their arms up and down and we all began to sway. The energy began to build and a section of the circle lunged towards the center and then another section. There was a lot of laughter, and the lunging became more intense. I requested that the translator ask “what is the sound that goes with this movement?” Then it came: “Whoosh!” Others joined in. We were running in and out of the circle, hands linked: “Whoosh!” The energy and the noise built further, bouncing off the temple walls, a sort of contained chaos. “What’s happening?” I shouted above the din. They told my translator. “A Tsunami! Tsunami is coming!” (Jones, 2007)

In ALIVE, an exemplary program that I co-founded in New Haven, CT, drama therapists created and use a myth called The Legend of Miss Kendra to help students, teachers, parents, community leaders speak about the impact of adverse childhood experiences. ALIVE has now spread to four different cities and is featured in the award-winning film Resilience by James Redford.

In yet another example of the potential of theatre in the treatment of trauma, past U.S Army medic and infantry officer turned actor Stephan Wolfert founded DE-CRUIT to support veterans  returning to civilian life. Through “Shakespeare and science” their team, which includes NYU Associate Professor of Applied Psychology Alisha Ali, has been able to demonstrate “significantly improved PTSD, depression and heart rate coherence.” A randomized controlled trial is underway. 

You are the recipient of the Corann Okorodudu Global Women’s Advocacy Award and this year you went to the UN with your students to advocate for drama therapy as a mental health treatment modality. Can you talk about your advocacy for drama therapy and tell us why it is an important tool for resolving conflict?

Creating a theatre ensemble is not unlike creating any group in which members seek to co-exist. There has to be a base of respect, a capacity for listening, an acknowledgment of perspectives other than our own, and a willingness to take personal and creative risks together towards a common goal. This is not possible when one side wishes harm to the other. However, where these elements are in place, drama therapy can make a contribution.

Exercises, where two or more people improvise and mimic each other’s movements or role-play scenarios from another’s point of view, engage the psychological processes that contribute to empathy such as mirroring and mentalization. For example, in the Montreal Life Stories Project, I directed the Living Histories Ensemble, a theatre company that used Playback Theatre to gather and transmit the stories of survivors of war who had resettled in Montreal. Listening to these stories and watching them brought to life through theatre for mixed audiences encouraged empathy, understanding, and a deeper sense of our responsibilities to each other especially as we struggle with the realities of mass displacement.

We continue to create spaces for individuals and communities to use theatre to share their personal stories through our As Performance: Therapeutic Theatre Lab here at NYU. Theatre is the act of seeing through the eyes of someone different than yourself and this is an integral part of working through conflict.

And here’s your wildcard question:  Can art save lives?

Yes, when words fail us, art gives us a vital way to express and communicate inner experience which can make us feel less alone. This is important given that social support is a critical factor in how we manage life’s stressors. Art can also bring visibility to people and concerns that we have neglected as a society. With its ability to engage, connect, and sustain us, art and the arts therapies show great promise in reducing isolation and helping people to recover their creativity, imagine a better future, put ideas into action, and feel alive again.