Therapist perceived active ingredients of school-based dramatherapy for children and young people with emotional distress

Dramatherapy, a creative form of psychotherapy, is used as a treatment for children and young people (CYPs) who have common mental disorders including anxiety, depression and trauma. Although widely used, particularly in schools, little is known about the active ingredients of this intervention. A qualitative approach, triangulating both semi-structured interviews (N = 11) and a focus group (N = 5), was taken to elicit dramatherapists’ perspectives on the active ingredients of school-based dramatherapy. 11 active ingredients were identified. That dramatherapy fosters autonomy, freedom and agency (1), that experiences are processed creatively (2), that CYPs experience and express emotions (3) in dramatherapy, were found; dramatherapy’s person-centredness (4) and the use of structure (5) were also found. The creation of safety, in the therapeutic relationship (6) and space (7) and, the ability to develop meaningful social connections (8) via dramatherapy, were also identified as active ingredients, as were, dramatherapists’ use of theory (9), the importance of a systemic approach (10) and that therapeutic experiences are integrated into life beyond dramatherapy (11). This study is the first to explore the active ingredients of school-based dramatherapy for CYPs with emotional distress. The findings presented may inform further research, measuring mediators of change, and practice, which enhances symptom reduction. •The active ingredients of dramatherapy with children have not been investigated.•Many dramatherapists work in schools and setting affects psychotherapeutic process.•11 active ingredients were found via interviews with school-based dramatherapists.•Amongst others, offering client agency and a safe therapeutic relationship were found.•Understanding active ingredients can help us to deliver effective dramatherapy.