This is a short report by Alan Bruce about a Dramatherapy Project at Tiverton Hospital
Dramatherapy Project at the Melrose Unit, Tiverton Hospital, July 2009
Facilitator: Alan Bruce (Dramatherapist and Counsellor)
Client base: Those suffering from varying forms of dementia often with symptoms of mental disorder, eg psychosis, depression etc.
Presentation : Variable, some people exhibiting disinhibition, some seemingly disorientated and upset through a recent admission, others speaking rapidly and excitedly, holding monologues as distinct from conversations. Several appeared to be very keen to have a dialogue with me on a one-to one basis. More than one person suffered from deafness, several suffered from physical problems with consequent impairment or restriction within their mobility, two people suffered from visual impairment. Some presented behavioural problems and would occasionally lash out or grab people.
Physical Health: The majority of clients were physically frail due to old age and environmental factors. One lady had stayed for the bulk of her life within a specialist institution in which she had paced restlessly for much of her time.
A need was identified by the Manager for an approach to the treatment of clients that would emphasise well-being through an activities based group that might encourage participation and communication. A series of Dramatherapy sessions were commissioned, designed with the basic intention of encouraging the participants to have fun; thus increasing the quality of their lived experience on the ward, and directly involving people in a way that they might feel valued.
Session Content: Immediately before the sessions started I spent time talking to each person in the room individually; this served the purpose of providing an introduction for each of us, and therefore an opportunity to gain some trust and a space for people to talk about whatever they chose. (This might include current feelings. concerns over the future or details from the past, perhaps enquiries about myself or the group.)
The sessions initially involved a greeting to the members, then a basic format that had familiar elements each week to provide a sense of continuity :
Hand Dancing: Individual movement to a piece of music selected hopefully as representative of the age group, .participants are encouraged to move however they choose in response to rhythm, their movement is then copied or mirrored by the whole group, movement passed on to person next to you. This exercise was also repeated each week as a familiar element of the session
Soft balls: Extremely soft and lightweight balls were given to group members to throw and catch, thus providing a very direct means of contact with another person, also utilising some physical movement as with the exercise outlined above.
A Main event: This was varied each week, intending to provide a sense of focus and stimulation.
Live music and singing: we sang carefully chosen popular songs from different eras with a guitar accompaniment, sometimes songs that proved popular were repeated on occasion one person would sing to the whole group, again the emphasis was on group involvement, This was also encouraged by the introduction of a fair range of percussion instruments that group members would play.
Closure: A clear ending was offered with a chance for members to comment on the group and make any suggestions.
Themes included within the ‘main event’ of the sessions;
Week One: Extended guitar/singing, including energetic involvement by Claire the Occupational Therapist along with Alby in singing pantomime type songs, Claire suggested men and women sang different parts. Many songs from different periods in time were covered
Week Two: Working together - introduction of a large piece of gold fabric that all the group members could hold on to, and, in this way, make a definite connection with each other, balloons were placed on the fabric the group then tugged at the fabric to keep the balloon supported-the session emphasised observation and how individual action effects the whole group.
Week Three: Exercise- a giant sized lightweight soft football was introduced to encourage an element of play and interaction between group members. The ball could be thrown, passed or kicked to other people, sometimes lifted above the head from floor level encouraging movement connected to a strong visual element
Week Four: Herbs and gardens as a reminiscence theme for the group. Samples of fresh herbs were circulated amongst the group who rubbed them to release their fragrance; in turn stimulating both a ‘here and now’ response to the scents and recall of memories of gardens.
Week Five: The World. An illuminated globe was placed in a central position and people were invited to comment about countries they had visited, or those that held some sort of significance or interest.
Week Six: Significance of May Day. A selection of photos of May customs was circulated amongst the group and individual comments responses or anecdotes were invited. Blossom was bought in to be woven into a hat, as a group exercise, a ‘May Queen’ was then chosen and ‘crowned’.
Right from the beginning the sessions seemed popular and well received by the group, the first session succeeded in holding the group’s attention from start to finish. Group members appeared to respond well to the exercise element and participants seemed to feel safe enough to experiment with different ways of moving. Many of the group chose to sing or become involved in some way. There was a sense that a moderately large group helped rather than hindered individual expression, many people smiled or laughed and there was a sense of fun and freedom in the group.
Subsequent sessions were equally well supported, however not all the people on the ward wanted to be part of a group, in one session a lady clearly found the experience invasive and told me to ‘clear off’. I had a sense that she felt that the group had taken over her private space. Another lady had an unpredictable response to the group, sometimes wishing to be involved and sometimes not. Neither of these responses was unusual, considering both the setting and the nature of people’s illnesses. However, the majority of people clearly seemed to thrive within the welcoming atmosphere of the group. The oldest person chose to sing a song on various occasions to my guitar accompaniment.
A man from Eastern Europe spoke at some length and demonstrated where, on a globe, he had come from and what countries he had lived in. Another lady spoke in some detail and authority about Mayday customs that she remembered, whilst another, an ex-dressmaker fashioned a very presentable hat woven with blossom. Moreover, several people that often seemed quite restless individually appeared to find the group a containing space for their energy and were clearly able to sustain concentration throughout the session.
In summary, I noticed;
The group provided a space for people to express themselves physically and vocally.
• Stimulation and validation of memories and experiences. The group itself serving as a respectful and enthusiastic receptacle for both individual and common experiences.
• Success in finding a balance between being a structured activity and a space for spontaneous communication.
• The group had the effect of focusing people’s attention allowing time for each person to be noticed and appreciated.
• A means to stimulate a sense of interest and identification within other people’s experience (communality), whereas individuals may have experienced a tendency to feel quite separate and cut off from other people.
• A sense that whatever people offered to the group whether it was a small gesture. a smile, a ball caught by frail hands or a lengthy poem or anecdote was welcomed and accepted unconditionally.
It is extremely important that those who facilitated or supported the group shared the same value system, commitment, interest, group familiarity and objectives. In this respect; the collaboration between a Dramatherapist, an Occupational Therapist and an O/T student was very successful.
The creation and maintenance of excellent working relationships between different disciplines cannot be underestimated in contributing to the overall progress of a group or a project.
It was noted that on the same day as there was a staff shortage in the group, a lady who had been admitted in the morning had been advised to stay and attend the afternoon group. In the event, she was distressed and not ready to participate as she had not had time to adjust to her new surroundings. Therefore I spent a lot of time attending to her needs in the group (principally reassurance) which made it harder to facilitate the group-approximately 8-9 people.
It would be better practise to involve people who were more ‘settled’ on the ward, whilst being realistic about how fragile and changeable people’s moods were generally.
Would be helpful to identify nursing staff who would be willing to support the sessions.
That the sessions be continued as they were highly valued and well attended by the participants.