“Do I have to be a tree?”

It’s a question Kathy Akers has come to expect when the subject of dramatherapy is raised – but she’s quick to clarify that the answer is ‘no’; well, not necessarily, anyway.

“Dramatherapy can take many forms. We use all kinds of means of communication and creative processes to engage and allow people with a brain injury to express themselves. And if people want to be a tree, then that’s fine, but there is a very wide variety of other ways in which we work,” she explains.

The increasingly popular concept of drama as a therapy, and an important healing practice, is now spreading nationally, and its results are helping to redefine impressions of what drama therapy actually entails.

Far from participants being cast as a tree, dramatherapy can include role play, puppetry, music, image-making, movement or even making films.

As the British Association of Dramatherapists explains, the practice “has as its main focus the intentional use of healing aspects of drama and theatre as the therapeutic process. It is a method of working and playing that uses action methods to facilitate creativity, imagination, learning, insight and growth.”

And statistics show that the use of such therapy can play an important role in brain injury rehabilitation through building interpersonal connections and relationships, helping to rediscover memories and rebuilding confidence and communication skills.

It has also been hailed as helping to build greater connection between right and left hemisphere brain function through connecting the instinctive, emotional right brain reactions with logical, language-based left brain function.

One report, which assessed the impact of dramatherapy on patients recovering from traumatic brain injuries in a neuro-rehab unit, found that it helped psychological adjustment to severe disabilities resulting from neurotrauma, and highlighted four areas in which it empowered participants – it provided them with a sense of personal space; allowed escapism and enjoyment; awakened creativity and a sense of potency; and provided a metaphor to explore personal injuries.

It recommended its further use and development in neuro-rehab. Kathy, a dramatherapist since 2010, specialises in trauma-informed dramatherapy, with a focus on using therapeutic drama to aid neurobiological development.

Since introducing the concept to the charity Headway Nottingham through an eight-week pilot project in 2017, the initiative has delivered impressive results  for its service users, as well as very  favourable feedback. “It was like we were seeing the sparks of ideas in our minds and thinking in a totally new way,” said one.

The concept is now gaining momentum nationwide, with Kathy pointing to the creativity and flexibility dramatherapy allows as being a key factor in its success.

“I think one of the big things is how it engages everyone – I have people in my groups who are in the very early stages of recovery alongside others who have lived with a brain injury for 15 years.

“It accommodates the needs and abilities of everyone, too. We recognise that people one day may be very mobile, but for the next session their movement may be more inhibited, and that’s fine. We work within the boundaries of what people can do,” says Kathy.

“Although statistics say this, we see for ourselves the very positive outlet drama can be for people. We have people with a lot of anger, they’re very frustrated they can’t express themselves as they wish, and it’s hard for them to work in a linear fashion. But through using creativity, we can accommodate this.

“It’s not necessary to have access to lots of language to express yourself and that is where our use of objects, images, songs, whatever it might be, can really help.”

While the content of the sessions themselves is flexible, there is a structure to provide participants with some degree of routine. The group determines the themes and the dramatherapist will suggest drama-based activities and structures to help them explore this from a number of perspectives.

The dramatherapist will help to link the sessions together with reminders so participants can build an ongoing picture and the group can look back on how far they have come and the progress they have made.

Among the many emotions that are expressed via dramatherapy, anger is a very common theme, and the practice is proving  to be an appropriate outlet for people to channel that. Kathy points to the use of creative protest.

“In my groups, the use of creative protest is very popular. There is something really empowering about healthy protest and creating a place for that to happen.

“For people with brain injuries it’s common for them to feel powerless and that they have little choice, and things they used to do for themselves they now rely on others for. I think that is why the creative protests have such power, in that through using creative arts they can get their point across.

“The ability to use music and song to rail against something was very powerful.”

Indeed, music is frequently found to be one of the most popular and engaging outlets – and, in Kathy’s experience, has even led to the creation of a song.

“Music is a key feature in creative work. People can share songs that have an importance for them and share their reasons and associated memories with the group. Discussions about this topic and its associations can throw up some really interesting material which leads to valuable discussions around identification in terms of culture, race, sexuality, gender and class.

“With developing skills of discussion, managing difference and active empathetic listening, people can manage these discussions and challenge assumptions.

“In one of my recent groups, we discussed ways in which the political climate affects our lives, funding, assumptions, perspectives in the media. From these discussions, the group created a story that became a song called Trevor Nobrain, the tale of two friends whose lives took very different turns.

“As a result, we were able to focus on the important themes that came from this songwriting, and the group gained real confidence and skill in this area. It’s also a great reminder of how putting the world to rights can be enormous fun.”