Behavioral Health Types Of Therapy
Drama therapy
Drama therapy is the use of techniques typically utilized in theater in order to reach therapeutic goals. It is an expressive and experiential therapy similar to art or music therapy. It is effective with a wide range of individuals and disorders who may struggle with general talk or cognitive therapy.
Development of drama therapy
While drama has been used as recreation and a form of expression for much of human history, it wasn’t until the 18th century that drama was recognized as helpful for patients struggling with mental health needs. Hospitals began to allow patients to utilize drama recreationally, and professionals began to recognize that this method was effective therapeutically for some patients.
The term drama therapy was coined as a phrase in mental health treatment by Peter Slade in the 1930s. For 60 years, he would dedicate his professional career to demonstrating how important drama can be for mental health.
Since that time, drama therapy has flourished and has become widely accepted as an effective style of treatment across the world. The North American Drama Therapy Association (NADTA) was founded in 1979 as an outgrowth of the National Coalition of Creative Arts Therapies Associations (NCCATA). and began credentialing drama therapists in North America as well as assisting in the growth, development, and recognition of the field in the mental health world.
Drama therapy settings
Drama therapy can take place anywhere that has the space needed for the process. This may be a therapy office that is set up with room for movement, a community center, in schools, or actually in theaters.
The setting required will depend on the method being used. Some individuals may express themselves with mask work, puppetry, or story-telling while others may act out scenarios. The process is individualized and the setting or space needed is individualized as well.
Drama therapy may take place in a group therapy setting, which allows individuals to interact with others and act out various conflicts or it may also take place in an individual setting with a therapist. Individual therapy may be more appropriate for sensitive subjects or self conscious clients. As with all forms of therapy, the focus should be on what methods most help the client resolve their concerns.
Drama therapy techniques
The process of therapy should always begin with an assessment of the client’s strengths and needs and the creation of a plan for treatment. Drama therapy is no exception.
After the creation of the plan, the therapist and client will use different drama techniques, activities, and exercises to help the person explore their emotions and process the mental health concerns that led them to treatment.
These creative methods may include:
- Various games and writing exercises
- Story telling or developing
- Role-playing or play-acting
- Puppetry or mask work
- Guided imagery
- Improvisation
Drama therapists may also use other expressive media as prescribed to address specific needs of their clients. These may include music and dance or other movement exercises.
The therapist acts as a guide for the clients and offers reflections as well as guidance as the client learns to process through their specific concerns. As with most therapies, the therapist-client rapport and relationship is an essential component of the treatment process as well. It is especially important that the client feels safe and secure in the drama therapy environment.
Effectiveness
Because of the relative newness of drama therapy as a modality, few larger scale studies exist.
However, there are a number of studies that show the effectiveness of drama therapy for a wide range of conditions such as:
- Mood disorders
- Trauma
- Anxiety
- Addiction
- Relationship and interaction problems
- Personal growth
NADTA publishes a peer-reviewed journal, the Drama Therapy Review, which discusses the latest research into drama therapy methods and effectiveness. The goal of this journal is to improve scholarship in the field of drama therapy and encourage effective growth of practitioners and their clients.
Downsides
The lack of larger scale studies as of yet may be seen as a limitation by some as this may cause some hesitation or lack of belief in the effectiveness of drama therapy techniques. However, the research in the field is growing and continues to show effectiveness in the treatment of a range of mental health disorders.
Additionally, while individuals do not need high levels of creative talent or ability to benefit from any form of expressive therapy, including drama therapy or psychodrama, this belief often holds some people back. Individuals may be self-conscious about their skills or be so focused on perceived criticism that they are unable to focus on the therapeutic process. If this lack of confidence is due to therapy currently being group oriented, then perhaps a shift to individual therapy is needed to build the self-efficacy necessary to participate in group or family related drama therapy.
It is important that prospective clients and therapists work together to develop a trusting relationship especially if this kind of reluctance or resistance occurs. Additionally, because therapy is never a one-size-fits-all process, the client and therapist should have a conversation about a number of important details including the therapist’s experience with your specific mental health disorder or concern, what options are available, and if the client is comfortable with those, as well as what to expect.
Billing for drama therapy
Drama therapy doesn’t have a specific CPT code for use. However, since these methods could be considered similar to other ‘tools’ that therapists use, similar to games utilized in play or family therapy, then some therapists bill under regular coding 90837/34/32 for individual sessions and 90853 for group sessions.
Other therapists report the use of code 90899 Other Psychiatric Services or Procedures to report psychiatric services or procedures that do not have a specific code. In the notes, therapists should indicate information referring to specific techniques used and the client's response to the treatment as a best practice and to increase the likelihood of insurance approving the claim.
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Some specific insurance companies do have their own billing codes to designate expressive therapies, including drama therapy. Always consult information received upon credentialing with specific insurance boards for best billing practices.
If used in medical settings such as occupational therapy, G0176 is a valid 2022 HCPCS code for Activity therapy, such as music, dance, art, or play therapies that are not recreational in nature but are related to the treatment of a patient’s mental health diagnosis. Sessions must be a minimum of 45 minutes to qualify for this.
Special training for the drama therapist
Typically drama therapists earn their bachelor’s degree in a combination of art and psychology or something similar as this provides them with the necessary background for undertaking a Master’s degree program in drama therapy. NADTA credentials drama therapists as Registered Drama Therapists (RDT) and Board Certified Trainers (BCT). Therapists will need to refer to their state licensing board for the requirements of mental health licensure in order to practice independently.
NADTA offers an alternative program for licensed therapists to obtain certification when they attended a Master’s program that was not an accredited drama therapy program. This includes work as both a therapist and experience in drama or theater. This doesn’t necessarily require acting roles as work in improv or directing can be counted as well.
Individuals become provisionally licensed when working with a supervisor towards the drama therapist certification. Upon completion of the required hours and activities, including required graduate courses, an individual becomes a Registered Drama Therapist. For the full list of requirements and forms see the NADTA website on certification.
Who can benefit from drama therapy?
Drama therapy can be helpful for a wide range of people ranging from childhood to older adulthood. The healing process of creatively expressing oneself has no age limit. This modality has been shown to be especially beneficial for improving general mental health, addiction disorders, recovering from abuse or trauma, as well as family or social related struggles.
However, drama therapy may not be appropriate for everyone. This modality brings forward a wide range of emotions including difficult ones. It is important for individuals embarking on the journey of drama therapy to be comfortable exploring all emotions and to have a solid support system in place outside of therapy. As with all forms of therapy, the individual must be willing to work on themselves and explore outside of their comfort zone in order to benefit.
How does it compare to psychodrama?
While psychodrama and drama therapy have many similarities since they are both expressive therapies, there is one major difference. Drama therapy allows for the exploration of stories that may be fictional, these may or may not directly relate to the client’s personal life, psychodrama focuses on the exploration of the individual’s lived experiences.
Because of this emphasis, individuals who are ready to directly address certain events and traumas from their lives may want to try psychodrama; however, it is important to note that drama therapy can also address these concerns in its own manner.
Resources
- NADTA Mentorship program
- National Coalition of Creative Arts Therapies Associations has a wealth of information available on all expressive therapies.
Therapists using tools such as drama in their practices can utilize EMRs and practice management software to help with scheduling and billing for these services. TheraPlatform is an intuitive, all-in-one platform that offers a 30-day trial without entering a credit card. Cancel anytime.
More resources
- Art therapy
- Animal-assisted therapy
- Therapy resources and worksheets
- Therapy private practice courses
- Ultimate teletherapy ebook
- The Ultimate Insurance Billing Guide for Therapists
- The Ultimate Guide to Starting a Private Therapy Practice
