A detailed look at the therapeutic process

Faye was a young lady who was referred for Dramatherapy when she had just turned 16 years old.  She had been unsuccessful in engaging with the Child and Adolescent Mental Health Service, had been excluded from mainstream school and had involvement with the Youth Offending Service due to a series of physical assaults.  She was a looked after child and had been in many care homes and foster placements that unfortunately had broken down due to her behaviour. There was a history of mental health, abuse and alcoholism within her family and due to this she suffered significant family disruption and trauma.

When the therapist first met Faye she presented with a very infantile anger/rage, she was violent verbally and physically.  She easily drifted off into a trance like state and would block people out in a variety of ways.  She was pre-verbal at times and very dissociated. Her obsessive or need for control would result in her being very argumentative with issues around food/eating disorder.

The therapist observed her attempts to turn the care home into what she knew.  She would play out the same thing she did in her family home in the hope that it would be different this time.  However, this induced the care home to bring her what she was used to….terror! Staff would despair with her behaviour and she was regularly restrained.  In meetings the therapist watched as she pressed buttons, got angry, would lose her temper and then get frightened/terrified and run off.  She blocked people out by being in a trance like state, having verbal diarrhea, playing on her phone, ignoring and rejecting all around her.  These things stopped her feeling by deflection.  Another way she stopped herself feeling was by being obsessed with food.

In therapy Faye displayed all the above behaviours, often arriving to sessions in a good mood where she would then become quickly rejecting, blocking and fiercely angry, where the therapist could do nothing right.  The therapist worked with her inner child, the infant who lived inside her who was very hurt indeed. The therapist validated her anger and to allow her to speak about who got angry at her in order to explore her experiences.  Faye was clearly expressing anger rather than hurt and so it was the therapists aim to help her understand this and to encourage her to be vulnerable safely within the therapeutic relationship.  After a while Faye began to open up more and was honest about her lack of trust for men and women and the reasons behind this.  She was very sensitive to any sense of inauthenticity, she believed all staff were just doing a job and that no one really cared about her.  This was her transferential material, seeing and experiencing staff and the therapist at times as if members of her family.  When she was in a very rejecting mood, the therapist would talk through what she was seeing rather than react to it.  She would say ‘I think you are trying to push me away because its easier that way.  You can then say, see know body loves me’.  This is known as a self-fulfilling prophecy and her internal unconscious thought process might have gone something like this:

“I’m going to be rejected because that is my experience, this is what happens so I will make sure it happens and therefore I am in control of it and am in a familiar and comfortable place.  If I thought someone did actually care, that might make me be in touch with my hurt and my anger protects me from that and I don’t want to feel my hurt”.

When the therapist voiced these processes she would agree that these were her thoughts but that she was unaware at the time and did not know how to stop it or why she did it.  This was explored further on in therapy.

The therapist worked in consultation with staff so that they would understand Faye’s behaviour and ways they could help her healing process.  The therapist asked them to stop and listen to her, accept and not get angry with her.  They needed to be truthful with her about her food or anything else but not shame her.  Notice and justify her ager, validate her experiences.

After some time in therapy Faye would allow herself to become little and vulnerable and liked nothing more than to be nurtured.  This was the reparative work she so very much needed.  She would ask about whether her previous family experiences were normal or right and enjoyed hearing the therapist feel strongly about them not being good enough.  The therapist shared her feelings safely with Faye, which then justified some of her own emotions.  Faye would engage with the therapist intensely when she was trying to assess whether she did actually really care about her.  There would be no point in the therapist not being authentic as Faye would be scrutinizing her for this.

At present Faye is preparing to leave care and live independently.  She is also preparing to end therapy in the near future.  She has stopped being physically violent and her anger is often expressed in much healthier ways.  She has maintained a place at college and is doing well.  She is learning about relationships with peers and though still finds this very challenging she works hard at getting it right.  She has no current eating disorder, though does wish to eat very healthily.  Maybe most importantly she has engaged in and maintained a healthy therapeutic relationship of which the impact has been very noticeable.

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