Drama Therapy and Treating Trauma

Course of treatment as a trauma counselor dealing with family crisis

Introduction

When it comes to providing counseling for clients dealing with a family crisis, such as domestic violence, sexual assault, substance abuse, personal loss or disaster, it is important for counselors to understand the role that trauma-centered treatment can play. Trauma can prevent clients from processing their problems in a positive way. So it is helpful if a counselor can empower the client to address the trauma so as to be able to move past it. This paper provides an explanation of a course of treatment as a trauma counselor dealing with family crisis.

Trauma

Trauma affects different people in different ways. Some people who are traumatized by an event try to self-medicate and end up abusing drugs or alcohol. Others may not realize they are traumatized at all but may engage in the same traumatizing behavior that led them to be traumatized in the first place—such as sexual abuse (Groth & Burgess, 1979). Trauma is an underlying problem that affects the cognition and emotions of the individual. For a counselor to help in a family crisis, understanding how to treat trauma is crucial.

To address trauma, one of the most important steps a counselor can take is to promote mindfulness with the client (Scott, 2014). Mindfulness is a common concept found in meditation and contemplation through various cultures. Mindfulness promotes self-awareness, understanding, self-discovery, self-control, and the ability of the individual to come to terms with trauma (Shim, Goodill & Bradt, 2019).

It is also important to realize that there is no one-size-fits-all course of treatment when it comes to healing trauma. Every client may respond differently so the counselor must see what course is most likely to work with the client, based on the client’s own willingness to work within a certain kind of treatment. Cognitive behavioral therapy (CBT) is a common course of treatment for trauma clients. Prolonged Exposure Therapy (PET) is another common course. Some new courses of treatment that are being used now include drama and body motion trauma treatment (such as dance and yoga). The key to implementing trauma-focused treatment is to remember that these courses work because they are “treatment approaches fostering safety, trustworthiness, choice, collaboration and empowerment” (Giordano et al., 2016, p. 61). They help the clients to learn how to better manage their thoughts and feelings, identify triggers, process emotions, process traumatic memories, create positive conceptualizations of themselves (Giordano et al., 2016, p. 62).

Course of Treatment

Treating trauma does not have to be confined to one course of treatment. On the contrary, it is often helpful to combine treatments. For instance, dance or yoga therapy could be combined with CBT or PET or both. As long as mindfulness and resiliency are promoted, the course of treatment can be creatively approached as the counselor and client work together on a treatment that is appropriate. In most cases, beginning with CBT and PET and facilitating these primary treatments with a supplemental treatment like yoga or dance therapy can be all that is needed (Sajnani et al., 2019).

CBT is not about focusing the attention of the client on the past but rather on the current situation, the current environment and the current triggers that the client can identify. In this respect, it is more a treatment oriented toward controlling for the trauma rather than towarad getting the client to address the trauma directly. The reasons for the trauma are irrelevant in CBT. Psychoanalysis might be used to address the trauma and bring it to the consciousness—but in CBT the main goal is to identify what thoughts, feelings, environments and situations trigger something in the client to lose control. The goal is to identify these triggers and implement behaviors and thinking habits that allow the client to overcome or combat the triggering situations when they arise. CBT also involves identifying some good habits or goals that the client would like to develop or reach and setting about implementing a course of action that will facilitate that goal. It is a very goal-oriented course of treatment. The point of it is to enable the client to take back control and ownership of his life, little by little, step by step. It works because its underlying purpose is to get the client to address “automatic thoughts and core beliefs” that affect behavior (Beck et al., 2004, p. 265). By getting the client to develop a habit of cultivating positive thoughts and feelings and rejecting negative or triggering thoughts and feelings, the course of treatment provides the client with a way to overcome the trauma (Robertson, 2010).

To facilitate the process of CBT, it is also helpful to augment the course of treatment by pairing it with another approach, such as PET. Like CBT, PET also assists the client in addressing unwanted thoughts and feelings—but the goal of PET is to help the client re-engage with life in a meaningful way. Instead of focusing on overcoming triggering thoughts and feelings, the client is encouraged to talk about the trauma that he has experienced. By talking about it and sharing it, the trauma is processed and the person is no longer fearful of it. By getting it out into the open, the person is able to step out from under its shadow where he might have been living in fear. This can be especially helpful for people who feel that there is a stigma related to trauma or to something like PTSD. They may feel ashamed of requiring counseling or treatment in the first place. They should not feel ashamed, however, and the counselor who applies PET to the course of treatment can help the client to get those feelings out in the open where they can be properly addressed.

Both approaches are important to a trauma-focused course of treatment. CBT enables the client to reshape his life in terms of developing new, positive habits and ways of thinking so that the old negative behaviors and thoughts are overcome. The client is enabled to develop a new habit of being. PET enables the client to tell his own story, to share his own experience—and this can be eye-opening for the client and for others, particularly if it is done in a family counseling session (but it does not need to be done in such a setting for it to work). The point with PET is that by going over the trauma in a controlled environment allows the client to process it without risk of being overcome by it.

To supplement this course of treatment in which CBT and PET are used to help the client heal from trauma, some dance or yoga therapy can be used. This is helpful because they promote mindfulness, self-control, contemplation and self-acceptance. It is often the case in trauma that the person feels he is to blame for something, and the acquisition of self-acceptance can help such feelings to go away (Sajnani et al., 2019). The reason dance or body movement therapy supports CBT and PET is that in the course of treatment, the client can experience bouts of anxiety, stress and depression—and the physical activities of dance, drama, yoga or meditation are ways that get the client re-engaged with life in a physical way. In other words, the client is not trapped inside his head or inside his heart over the course of the treatment but is actually given something physical to do to maintain mindfulness and awareness.

Body movement therapy reduces stress and anxiety by giving the body and mind a sense of purpose, place, rhythm, balance and presence that slows the heart rate and facilitates breathing, both of which have a calming effect and can still an aggravated mind (Smith, Esat & Kanojia, 2020). For instance, a person who is dealing with the trauma of substance abuse may find it impossible to sit still because it is this stillness that makes him want to jump back into the addiction. So to counter that trigger, the movement of the body in dance can create an invigorating flow and rhythmic movement of the blood that keeps the client from wanting to go back to the easy way out and abuse drugs or alcohol. By keeping him in the right mindset, body movement therapy makes it more possible for CBT and PET to have their effect and work correctly. If CBT and PET are to be promoted, there should be some supplementary course of treatment that acts as a prop to keep the doors open to these treatments while the client is out of the office. Dance or body movement therapy can be just that prop.

There is also an aspect of self-discovery involved in dance and drama therapy that facilitates the process of self-discovery and self-awareness raised in PET. This is especially the case if the client uses drama therapy to support his course of treatment. Drama therapy allows the client to disappear into the role of another character and engage in the cathartic processing of thoughts and feelings that the character goes through. For instance, a client might find it very helpful to take up the role of Hamlet and to act out scenes at home because Hamlet goes through so much in his own life that a person of trauma might understand and identify with. It has a purgative and cathartic effect over all and this helps in the process of overcoming the traumatic effect that has built up in the person over time.

CBT, PET and body movement, drama, dance, yoga or meditation therapy can all be combined in one course of treatment for the client dealing with trauma in a family crisis. Whether the family is involved in the course of treatment or not should be up to the client and the family. If the client wants one-on-one treatment, family therapy should not be imposed on him. However, the counselor may want to stress the benefits of engaging in group or family counseling just because of how it helps to hear and share stories that oneself or others have gone through in dealing with their trauma. But in any case supplemental treatment should be used, such as dance, drama or yoga therapy. Some counselors will recommend a pharmacological treatment if they think it is necessary, but such a course is not always necessary or even wanted and the client should be made aware of options and potential side effects.