This month I started seeing a new client. People often ask me “what happens in a dramatherapy session” – a tricky question for a therapy where every session is as unique as the client and current situation. But in that first session, actually there are some essential building blocks which get slotted together.
- It is important to explain what dramatherapy is
- to begin to build the therapeutic relationship.
- It is also important for the client and therapist to agree the “rules” or “contract” for dramatherapy.
- Depending on how you arrive at dramatherapy (referral or self referral) there may also be some assessments or goal setting to find out more about what you hope to get out of therapy and what might be useful.
In this post I want to think a bit more about that contract
What goes into a dramatherapy contract?
There are some practical things to agree.
- Who: Name of therapist and client. Or if it is a group session who is in the group? Is it open or closed to new members?
- What: What is dramatherapy? In order to give informed consent the client needs to understand what dramatherapy is.
- Where will the session take place? The venue and the room. There may even be a specific area in the room where the sessions start each week.
- When are the sessions? What day and time? How long? How often? How many sessions will there be?
- How are the sessions financed? Does the client pay? Does someone or another organisation pay for them? What about cancelled sessions or sessions where the client does not turn up?
There are things about relationship within the session
- What are the boundaries of physical touch? In some styles of therapy this will be a total no-no, but in dramatherapy sometimes a hand massage, an arm wrestle or leaning against each other back to back may be offered as therapeutic interventions. This is always negotiated with the client and checked at the time to ensure there is full consent.
- If in a group, how can the time and resources be shared?
- If a client is overwhelmed in a session how can the activity be stopped or slowed right down so the client can stay in the room without feeling out of control? Can the client feel supported to state their needs?
- Can clients own their own feelings rather than speaking on behalf of the group? “I think” rather than “we think” or “you think”.
Some things about client safety
- Where are the limits of client confidentiality? e.g. if the client is in danger, are there any cases where the therapist would break the confidentiality to ensure the client receive the specialist support they may need, e.g from their GP or a social worker. There will always be some limits to confidentiality – there are some crimes which must legally be reported and sometimes child clients need the support of their parent or carer. It is important that the client understands that most of what happens in a session is private and confidential, but also understands when this does not apply.
- If a client is angry how can this be expressed safely with in session? As drama may be used sometimes a client may act out anger during a scene but it is important to have boundaries to protect the people, space and resources – sometimes having a cushion to hit can be useful.
- How can communication between sessions be managed? Is it ok to phone or text between sessions? Can you leave messages? Are there times when this is not ok? This question takes into account that sometimes there needs to be communication but there also need to be boundaries and a respect of confidentiality.
- Respect – whenever I ask a group what the rules are this is almost always one of the first suggestions. Part of contracting is to help the group to unpick this and think about how specifically they want to show and receive that respect.
Sometimes clients ask about specific rules to stop themselves being overwhelmed or re-traumatised, such as “no-go” areas which they do not want to explore. In this case it is about negotiating what is and is not acceptable but also leaving open the possibility that the client can change this boundary in future if, or when, they need to.
How does the contract look?
Although the contracts often contain similar information, the way they look can be very different. Here are three examples or in some cases there may be both a formal contract and a group agreement.
Sometimes they are a blank sheet where a group writes the rules they agree for themselves, like the example at the top. It is important to discuss these rules before they go on the paper to make sure everyone agrees and interprets them the same way.
Sometimes they are a typed document where the client signs on the dotted line.
When working with young children or adults with profound and multiple learning disabilities, sometimes the agreement will be mostly pictures rather than words. The images are usually then selected by the client; perhaps a bee will represent how to protect yourself or a clock might show the session start and finish times.