Drama therapy and psychodrama are perhaps the least well-known of the creative arts therapies offered in schizophrenia care, partly because the word "drama" can sound off-putting. The reality is gentler than the name suggests. Both are structured psychological therapies that use roleplay, scene work, and embodied story to help people explore feelings, rehearse difficult situations, and recover a sense of agency.
Drama therapy and psychodrama use embodied story and roleplay, led by a credentialed therapist, to support emotional processing, social skills, and recovery in schizophrenia — included in NICE's recommendation of arts therapies.
The two traditions
Drama therapy uses scripted scenes, improvisation, masks, puppets, and storytelling, typically without requiring the person to play themselves. The protective distance of working through a character can let people approach difficult material safely. In the US, drama therapists are credentialed by the North American Drama Therapy Association. In the UK, dramatherapists are registered with the Health and Care Professions Council and represented by the British Association of Dramatherapists.
Psychodrama, developed by J.L. Moreno in the early 20th century, is more direct. The person ("the protagonist") plays out scenes from their own life, supported by group members in roles ("auxiliaries") and guided by a trained psychodramatist. The American Board of Examiners in Psychodrama credentials practitioners in the US; the British Psychodrama Association oversees UK training.
Why use drama in schizophrenia care?
Several features of drama-based work fit the recovery needs of schizophrenia:
- Embodied work bypasses the verbal blocks that often follow psychosis or accompany prominent negative symptoms.
- Roleplay creates a low-stakes way to rehearse social situations — appointments, family conversations, returning to work — that pure talking may not prepare the body for.
- Working through a character provides protective distance for processing trauma or shame.
- Group format builds social engagement and the experience of being witnessed by peers.
What the evidence shows
NICE recommends arts therapies — including dramatherapy — as an option for all people with schizophrenia, particularly to alleviate negative symptoms. The evidence base is smaller and more mixed than for music therapy. A Cochrane review of drama therapy for schizophrenia identified only a handful of small randomised trials and concluded that the available evidence was insufficient to draw firm conclusions, though small studies have suggested benefits for social functioning and engagement.
This does not mean the work is ineffective; it means that high-quality randomised trials are difficult to run for embodied group therapies, and the existing evidence is suggestive rather than definitive. Qualitative reports from patients are consistently positive.
What a drama therapy session looks like
Sessions typically last 60 to 90 minutes and are run in groups of 6 to 12. A typical structure includes a warm-up (a movement game, a name circle, a check-in), a main activity (improvising a scene, working with masks, building a story together), and a cool-down to bring participants out of role and back to their everyday selves. The cool-down ("de-roling") is taken seriously — leaving role cleanly is part of safe practice.
Therapists working in psychosis services are trained to pace the work carefully. Asking someone in early recovery to play a highly emotional scene without preparation would be poor practice. Most early sessions stay light: warm-ups, group games, simple shared stories.
What a psychodrama session looks like
Psychodrama is structured around three phases: warm-up, action, and sharing. The warm-up identifies a protagonist with a scene they want to explore. The action phase enacts the scene, with group members playing supporting roles assigned by the protagonist. Techniques like role reversal (briefly stepping into the role of another person in the scene) and the "double" (a group member voicing the protagonist's inner experience) deepen the work. The sharing phase brings the group back together, with members reflecting on what the scene evoked in their own lives — never offering interpretation or advice.
In schizophrenia services, psychodrama is usually offered to people in stable recovery rather than acute psychosis. Acute paranoia or active hallucinations make the high-stimulation format less safe.
Roleplay or scene work consistently triggers worsening voices, dissociation, or distress lasting beyond the session. Pacing and approach can be adjusted.
Who tends to do well
- People in stable recovery looking for a richer group therapy
- People with prominent negative symptoms wanting embodied engagement
- People rehearsing social or vocational re-entry — interviews, family conversations
- People who like physical, story-based work
Who may find it less useful
- People in active acute psychosis
- People with severe trauma histories where embodied work may feel unsafe (individual trauma-focused therapy may be a better entry point first)
- People who actively dislike performance or roleplay
Cost and access
Drama therapy is offered in some NHS mental health services in the UK and in selected community programmes, day hospitals, and forensic settings in both the UK and US. Access is uneven. In the US, the NADTA find-a-therapist directory and the BADth directory in the UK list credentialed practitioners.
How drama therapy fits with CBTp and medication
Drama therapy does not replace antipsychotic medication or CBTp. It sits alongside them. Some CBTp interventions actually overlap with drama techniques — behavioural experiments, role rehearsal of difficult social situations, voice work using avatar therapy. The boundary is more about training tradition than technique.
The bigger picture
Drama therapy and psychodrama are quieter members of the schizophrenia treatment family. The evidence base is smaller than for music therapy, but the clinical experience and patient feedback are consistent. For people who find embodied, story-based work resonant, they offer a different kind of recovery space — one where the body, the imagination, and the group are part of the medicine.
This article is for educational purposes only and is not medical advice, diagnosis, or treatment. Always consult a qualified mental health professional. If you or someone you know is in crisis, call or text 988 in the US, or your local emergency number.