In this Papers Podcast, Eleanor Keiller discusses her JCPP Advances Special Issue paper ‘A systematic review of dramatherapy interventions used to alleviate emotional distress and support the well-being of children and young people aged 8–18 years old’ (https://doi.org/10.1002/jcv2.12145).
There is an overview of the paper, methodology, key findings, and implications for practice.
Discussion points include:
- What is ‘Dramatherapy’ and why it is well suited for children and young people.
- Why dramatherapy has ‘slipped under the radar’ when it comes to research.
- Recommendations for how dramatherapy can be best used to support children and young people.
- Implications of the findings from the paper for child and adolescent mental health professionals.
- Recommendations for those considering future research in dramatherapy.
In this series, we speak to authors of papers published in one of ACAMH’s three journals. These are The Journal of Child Psychology and Psychiatry (JCPP); The Child and Adolescent Mental Health (CAMH) journal; and JCPP Advances.
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I am a dramatherapist and first year PhD doctoral researcher based in the Youth Resilience Research Unit. Although in its infancy, my research explores the role of dramatherapy as means of developing resilience for adolescents experiencing anxiety and/or depression. Outside of this role, I am also an active member of the British Association of Dramatherapists’ Research Subcommittee where I strive to develop the evidence base of the field. (Bio and image from Queen Mary, University of London).
- Featured paper ‘Research Review: A systematic review of dramatherapy interventions used to alleviate emotional distress and support the well-being of children and young people aged 8–18 years old’, (2023). Eleanor Keiller, Megan Tjasink, Jane Bourne, Dennis Ougrin, Catherine Elizabeth Carr, Jennifer Y. F. Lau
- Full list of papers published in the JCPP Advances 2023 Special Issue ‘Evidence-based Synthesis Studies for Child and Adolescent Mental Health Conditions’
[00:00:01.390] Jo Carlowe: Hello, welcome to the Papers Podcast series for the Association for Child and Adolescent Mental Health, or ACAMH for short. I’m Jo Carlowe, a Freelance Journalist with a specialism in Psychology. In this series, we speak to authors of papers published in one of ACAMH’s three journals. These are the Journal of Child Psychology and Psychiatry, commonly known as JCPP, the Child and Adolescent Mental Health, known as CAMH, and JCPP Advances.
Today, I’m interviewing Eleanor Keiller, Doctoral Researcher based in the Youth Resilience Research Unit at Queen Mary University of London. Eleanor is the first author of the paper, “A Systematic Review of Dramatherapy Interventions Used to Alleviate Emotional Distress and Support the Wellbeing of Children and Young People, Aged 8 to 18 years old,” recently published in JCPP Advances. This paper will be the focus of today’s podcast.
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Eleanor, thanks for joining me. Can you start with an introduction about who you are and what you do?
[00:01:14.840] Eleanor Keiller: Hi, yes, of course. But, first of all, thanks for having me today. I really appreciate being given the time to speak. So, my name is Eleanor Keiller and I am a PhD Student or Doctoral Researcher at the Youth Resilience Unit at Queen Mary. I’m also a Dramatherapist by training. So, a Drama Psychotherapist, and I’m researching dramatherapy as part of my PhD.
[00:01:33.720] Jo Carlowe: Thank you. We’re going to look at your paper today. This is “A Systematic Review of dramatherapy Interventions Used to Alleviate Emotional Distress and Support the Wellbeing of Children and Young people, Aged 8 to 18 years old,” recently published in JCPP Advances. Eleanor, before we go into the detail, can you tell us a little about dramatherapy, and why it’s so well suited to children and young people?
[00:01:58.500] Eleanor Keiller: dramatherapy is one of four creative psychotherapies, and typically, practiced in the UK. So, it sits alongside art therapy, music therapy and dance movement psychotherapy, and dramatherapy is the fourth there. And these creative therapies, really, they are psychotherapies, but they’re psychotherapies wherein the, sort of, mode through which the therapy is delivered is creativity, it’s one of those four art forms. So, I like to say much like the talking therapies use talking, dramatherapy uses various aspects of drama for that therapeutic process, and it does use talking as well. And then why is it so useful for children and young people?
Well, I suppose many of the reasons are similar to why it’s useful for adults. Sometimes it can be very difficult to, kind of, put your emotional experience into words, especially if you’ve had a traumatic experience and it’ll be hard to translate in a verbal way. And dramatherapy allows you to have these amazing, wonderful and the, kind of, numerous different languages through which to communicate. So, you can communicate through the body, you might work with images, you might work with puppets, you might work with sounds.
You might do performances. I think some people often think that dramatherapy is performances. But I would say it’s very, very rare, kind of, do any performance and especially if the client you’re working with, adult or child, doesn’t want to go there. That it’s absolutely, kind of, not a prerequisite of dramatherapy.
So, yeah, kind of, a creative therapy that uses various aspects of drama and I probably will say that dramatherapy borrows a lot from art, music and dance as well.
[00:03:24.380] Jo Carlowe: Let’s get into some of the details of the paper. So, what did you look at and why?
[00:03:29.000] Eleanor Keiller: So, we looked at dramatherapy with children and young people, and that’s primarily, because some reviews of dramatherapy had taken place already. And when we started this process, this was the first review that looked specifically at dramatherapy with children and young people. But I think there was one review that came before that looked at children with autism, but this is – it does have a slightly different focus. So, lots of dramatherapy is happening with children and young people. So that’s another reason why, kind of, our efforts were, kind of, focused on this client group.
And we looked at children aged 8 to 18 because at 8 children typically, go through a process where they’re more able to self-report on various aspects of their lived experience. And then we chose that upper band of 18 because that’s typically when children and young people move to adult services as well. So, we had a really nice range in that age group.
And then emotional distress or mental distress, we looked at. So that in this paper is anxiety, depression, and trauma, and that’s either as a diagnosis or just symptomatically. And we looked at those because this is – you know, those experiences are being felt by a lot of children and young people. Especially after COVID, anxiety and depression are the leading causes of illness and disability in, kind of, all age groups. But it’s especially so in young people. And again, it’s just partly because dramatherapy might be really useful in this area. So, it was worth reviewing what’s out there.
[00:04:42.660] Jo Carlowe: And can you say a little about the methodology used for this review?
[00:04:46.490] Eleanor Keiller: We used a systematic review methodology. So, that meant that we did an extensive literature search and looked for all of the papers that were available on this topic. We found a number that were available, and included those in our review. We then treated every paper identically and extracted as much data as possible from them, conducted a bias checking or a quality assessment of those to, kind of, see how robust what they were telling us and really was. And then they fed various things with data and graphs and tables, which you can see more in the paper, but tried to, kind of, overall see what did all of these papers together, tell us about dramatherapy?
[00:05:22.630] Jo Carlowe: And what did it tell you? What were the key findings that you would like to highlight?
[00:05:26.430] Eleanor Keiller: Well, it told us that dramatherapy is happening in a lot of different settings, and Dramatherapists are working quite flexibly with various different client groups. So, we found out lots about the kind of research that’s being done by Dramatherapists. You know, dramatherapy, the evidence base is developing, whilst the practice is really quite well developed. It’s happening in schools, and hospitals, and NHS settings, and warzones, and crisis settings. The evidence base is, kind of, developing more into, sort of, empirical research at the moment.
So, we found out a lot about the kind of research that’s going on. There’s a question in there about the effects of dramatherapy and we found out that dramatherapy might be quite effective for, like, high level clinical symptoms of emotional distress. So, maybe where children and young people have experienced a significant trauma. And also that there are quite ranging effects of dramatherapy in schools and this is, sort of, where our interest has really gone following the review. dramatherapy, in an early intervention space in school settings, might be really useful for the, sort of, low level anxiety and depression and trauma, which could really help with, kind of, the later stages of treatment as well.
[00:06:31.319] Jo Carlowe: You, kind of, alluded to this earlier, but your review reveals that dramatherapy research is in its relative infancy. So, although you say it’s actually well used, and in place, but in your view, why has dramatherapy slipped under the radar when it comes to research?
[00:06:47.949] Eleanor Keiller: Hmmm. That’s a really good and quite complex question, thank you. I’ll do my best to answer here, but I’m sure there are many more voices that could contribute. So, I suppose in terms of research, I think dramatherapy has not necessarily slipped under the radar because there is data and there are papers out there, but there is a lot more work to do, I think, for Dramatherapists in the field. And I think part of it is the confidence and the skill of Dramatherapists to conduct research and that’s something that – I’m a member of the Research Subcommittee of the British Association of Dramatherapists, and, kind of, our ethos is to develop research skills in the, kind of, body of Dramatherapists in the UK.
So, I think we do need to build confidence of Dramatherapists to do research. And, you know, those Dramatherapists, who are working in isolation in schools, have a really, really valuable voice to add to our evidence base, and probably have a lot of valuable data to add as well that they could really be supported to translate into publishable work.
And then the other thing I think is that dramatherapy is creative, it is embodied, it is client-led. It’s almost quite difficult to tie down into a quantitative paper that is respected in the medical model where we’re searching for those numbers. So, I think what dramatherapy needs to do, and maybe what the medical model and the people looking for evidence need to do is respect the, kind of, variety of voices that can come through in dramatherapy research. And I think Dramatherapists and dramatherapy Researchers can really utilize both methods. You know, there’s qualitative and quantitative methods of research.
[00:08:16.900] Jo Carlowe: I appreciate that it’s difficult to draw conclusions, given the relatively small sample sizes, but your review does suggest there is clinical potential for dramatherapy. From the review, and your experience as a Dramatherapist, what are your recommendations for how dramatherapy could be best used to support children and younger people?
[00:08:37.360] Eleanor Keiller: Again, another great question. Thank you, and I’m really pleased that you, kind of, allowed the – and your experience as a Dramatherapist, because I think the review does suggest there’s clinical potential. But I would also say there is clinical work happening all over the country that confirms clinical potential as well. But in terms of how it can be used to best support children and young people, I think use it with children and young people. You know, we need to be building and, kind of, getting more Dramatherapists out there, more Dramatherapists who are training, more dramatherapy work to be funded.
And then I come back to what I mentioned about it being client-led. The real beauty of drama therapies, how flexible Dramatherapists can be in their practice, and it can be really led by children and young people. It’s just a real asset of dramatherapy that we can work in that way.
[00:09:20.959] Jo Carlowe: But what are the implications of your findings for CAMH professionals and those working in education?
[00:09:26.700] Eleanor Keiller: So, I think that, you know, we can use these findings to really direct practice of dramatherapy. You know, if we’re thinking of we have a child – thinking of CAMHS’ professionals, if they have a child who has maybe gone through CBT, but they’ve experienced a high trauma, maybe something like dramatherapy is the, kind of, next port of call of treatments, that is, you know, it can be very difficult to work with trauma, as I mentioned. But what dramatherapy offers is the, kind of, metaphor, and the creativity, and the containment in creativity that sometimes people who have mental distress do need.
And then in terms of those working in education, I think supporting spaces and making spaces for Dramatherapists in schools. And the more we learn about dramatherapy, I think the more possible it will be to make more spaces for work in those areas.
[00:10:10.630] Jo Carlowe: You touched on resources earlier, and I’m wondering what your message is then to policymakers and those that hold the purse strings?
[00:10:19.730] Eleanor Keiller: Hmmm, I think I would say, you know, as a Researcher and as a Clinician, we cannot sit on the arts therapies for any longer without really using them to their full, full potential. You know, we know there’s a crisis in mental health services right now, and we know there’s a crisis in youth mental health. These Art Therapists and Dramatherapists are a huge, huge asset to the workforce, and if we really empower them and if we fund these practices and get Dramatherapists into your settings, you will see a huge difference.
[00:10:50.709] Jo Carlowe: What recommendations do you have for those who are thinking of conducting future research in this area?
[00:10:56.889] Eleanor Keiller: Gosh. The first recommendation is just do it. Just please, please do it. If you’re thinking of conducting research in dramatherapy, you know, probably have a really, really valuable insight to share. So, please do it and feel confident enough to do that.
I think second to that it would be to use a robust methodology. You know, what came through in the review is that, you know, we’ve got lots of single case studies and lots of, kind of, methodologies are being applied quite loosely, but the more we use those methodologies as a guidance, and I say this whilst also holding in mind that space for creativity, and that space for metaphor, and that space for what dramatherapy brings, but do use these methodologies because they – they’ll make our research more robust and we’d then be able to translate and use those messages similar.
[00:11:39.670] Jo Carlowe: Eleanor, is there anything else in the paper that you’d like to highlight?
[00:11:43.020] Eleanor Keiller: So, I think something that is worth mentioning is the setting that dramatherapy is taking place. And we know it’s taking place in mental health settings and in hospitals, inpatient and outpatient. But around 46% of Dramatherapists in the UK are working in schools, and that came through very clearly in our data as well. I think it was around 45% of the studies that we looked at were also taking place in school settings.
So, again, it’s a really huge resource that we can tap into both as Researchers. We can be researching this, but also as professionals and, like you said, people who hold the purse strings. Schools are a really, really important place for this work. You know, it’s where children and young people are. It’s often where they feel safe. It’s where there’s a body of professionals who support them, and yeah, so we should do more research and also more practice in those settings.
[00:12:30.560] Jo Carlowe: So, reading onto more research, and are you planning any follow-up research or is there anything else in the pipeline that you would like to share with us?
[00:12:37.980] Eleanor Keiller: Yes, I’ll certainly be researching this for at least the next couple of years and hopefully much longer. There’s a lot of space in dramatherapy to do research. There are a lot of questions that we could be asking of our practice that would just be really useful to know. And I think lots of the questions we can ask, we know as Clinicians, but we really do need to translate into research, if we can.
So, yeah, I’m planning – our follow-up research as a qualitative study coming out of this review, and then there’s various studies. I’m speaking to Dramatherapists about their work at the moment to understand more and looking at particularly in that area of schools and then hopefully, sort of, a slightly bigger study that involves young people as well because their voice is so important. You know, we’re client learning dramatherapy. Let’s be child-led in our research of dramatherapy as well, if we can.
[00:13:23.130] Jo Carlowe: Finally, Eleanor, what is your take home message for our listeners?
[00:13:25.149] Eleanor Keiller: It would be that dramatherapy has a lot of potential. You know, it’s being realised in some settings, that potential is being really, really, kind of, realised to the full in some settings, but there are others where we can really strengthen that and hopefully through research like this where we can, kind of, learn about what the literature is saying, but also by exploring our practice more. There’s a lot of potential that we could really be tapping into.
[00:13:48.230] Jo Carlowe: Fantastic. Eleanor, thank you so much. For more details on, Eleanor Keiller, please visit the ACAMH website, www.acamh.org, and Twitter @acamh. ACAMH is spelt A-C-A-M-H, and don’t forget to follow us on your preferred streaming platform, let us know if you enjoyed the podcast, with a rating or review, and do share with friends and colleagues.