Drama Therapy and DBT: Role Play as a Game-Changer

In this blog series, we have been exploring how creative arts therapy interventions can be used to teach dialectical behavior therapy (DBT) skills and enhance the therapeutic process. This article will focus on how clinicians can apply the drama therapy conception of role to support clients in practicing mindfulness and developing new insights.

What Is “Role” in Drama Therapy?

Integrating role play in DBT strengthens clients' ability to apply skills in real life.

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Robert Landy (1993), a pioneer in the field of drama therapy, encourages clinicians to view "role" as a psychological construct that represents different aspects of the self. Drama therapists believe that each individual is composed of a system of roles, or role repertoire, that they act from on a daily basis. Each role has its own “personality” and can be associated with a specific set of beliefs, values, behaviors, physical sensations, and emotional states. From a therapeutic perspective, roles provide a structure through which individuals can explore and express their inner experiences.

These roles are not static; they are fluid and can change depending on context. In one moment the client may be in the role of The Student, and in another moment, the client shifts to the role of The Daughter. Often, clients come to therapy when they are stuck in a specific role that is no longer adaptive. In other words, the client continues to play out the same role over and over again, even when this role is not serving them well. For example, a client with anxiety may come to therapy because they are stuck in the role of The Worrier, and are having difficulty accessing other important roles, such as The Friend, The Dreamer, or The Lover.

As expressive art therapists, we utilize creative interventions to help clients expand their role repertoire and support them in moving more fluidly between roles. A rich and flexible role system allows for greater adaptability and resilience in facing life's challenges—the key to well-being.

The Perfect Union: Drama Therapy’s Role and DBT’s Mindfulness

Over the past eight years, I have viewed the concept of role as my secret tool for teaching mindfulness, a core component of DBT. The act of consciously exploring or embodying a role within a therapeutic space helps clients become more mindful of their internal and external worlds.

Here’s why: when a client calls upon a role, whether through discussion, visual art, music, or embodiment, they direct their attention to what it might feel like to be in that role. For example, when exploring the role of The Sick One, they actively observe and describe thoughts, feelings, physical sensations, memories, and images that surface. When the client embodies the role, they are fully participating in this creative process as they become enveloped in the narratives, physicality, and energy of that role.

Case Example: "Sarah"

Sarah is a 28-year-old woman who has been struggling with intense feelings of shame. She has come to therapy for the first time to address a pattern of engaging in ineffective behaviors (i.e., binge eating, isolating, substance abuse), which have led to challenges in her personal and professional life.

While Sarah has difficulty talking about herself in therapy, she has slowly opened up to the therapist over the course of six months. Sarah and her therapist work on DBT skills on a weekly basis; however, she has had a very difficult time applying distress tolerance skills outside of sessions. Though she appears to understand the concept of crisis survival skills, she has reported that she does not implement these strategies because she gets “lost in emotions” and resorts to familiar behaviors.

Using Role and DBT Strategies To Create Change

Sarah explored her role system through numerous modalities, including storytelling, visual art, and role-playing. She recognized that a significant challenge for her is that she gets “stuck” in the role of The Outcast. Identifying this role was a breakthrough in the therapeutic process. Sarah began openly describing vulnerable thoughts and feelings associated with the role. In a mixed-media collage she created of The Outcast, she shared that the role is characterized by the belief that “nobody understands me” and is consumed by feelings of shame and hopelessness. In some ways, the role functioned as a portal to her unconscious, where undiscovered internal processes came to light. Additionally, exploring the role (The Outcast) instead of directly reflecting on herself (Sarah) created a safe enough distance where she was able to comfortably communicate her discoveries with her therapist.

After connecting to The Outcast and becoming mindful of its thoughts, feelings, sensations, memories, and urges, Sarah began to notice what it feels like when she is embodying the role. She realized how quickly she would involuntarily shift into The Outcast after moments of perceived rejection, which directly led to a strong impulse to abuse alcohol, binge eat, or isolate.

After processing this with her therapist, Sarah recognized that when she starts to step into the role of The Outcast, she needs to call on another role, which she identified as The Warrior, to help her implement her distress tolerance skills. When Sarah applied this concept in practice, she was able to disrupt the pattern of maladaptive behaviors. She gained confidence in her ability to apply skills, and was quick to start applying interpersonal effectiveness and emotion regulation skills throughout the remainder of her treatment.

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The case of Sarah illuminates how integrating role into DBT skills training provides a powerful tool for behavioral change.