By: Nicky Morris
Drama Therapy Review
Volume 6 Number 2 - dtr 6 (2) pp. 254–256 Intellect Limited
2020 - 254 Drama Therapy Review
© 2020 Intellect Ltd Book Review.
https://doi.org/10.1386/dtr_00033_5
DRAMATHERAPY FOR BORDERLINE PERSONALITY DISORDER:
EMPOWERING AND NURTURING PEOPLE THROUGH CREATIVITY, NICKY MORRIS
(2018)
Oxford and New York: Routledge, 162 pp., ISBN 978-1-13828-591-0,
p/bk, £27.99
Reviewed by Belinda Sherlock, Independent
Scholar
Those of us working in inpatient mental health settings will
likely be familiar with feelings of confusion, anger, shame or
despair manifesting day to day. Holding onto hope is the key to our
practice, but can feel difficult in the face of
the (often unprocessed) emotional and traumatic content that plays
out both in our work and in the therapeutic, community and
institutional dynamics of which we are part. On discovering Nicky
Morris’ book, in which she explores creative ways to work with and
broaden our perspectives around people diagnosed with borderline
personality disorder (BPD), I felt hopeful. The subtitle,
Empowering and Nurturing People through Creativity, offered an
immediate challenge to the stigma and sense of helplessness that is
often attached to this diagnosis.
From the introduction, Morris addresses this challenge and
stigma, highlighting the importance of compassion and positioning
drama therapy as a medium capable of empowering clients to ‘explore
their inner selves, express themselves freely and interact
playfully – a process that enables positive transformation’ (3).
Morris acknowledges the voices of other professionals and the
clients themselves, and includes her own poetry and lyrics in her
framing of this work. Her introduction sets the tone for the
following chapters – a combination of academic analysis, survey
research with other drama therapists supporting this population,
inclusive discussion and creative exploration.
Morris helpfully divides her work into two key sections.
Chapters 2–4 cover ‘[d]efinitions, history, theory and treatment
options’. Morris guides the reader through the evolution of BPD as
a diagnosis and considers a range of
lenses through which we might understand the disorder. Alongside
current definitions, identified symptoms and co-morbidities, Morris
paints a picture of how BPD sits within and impacts on the United
Kingdom’s population and
mental health system.
Having drawn our attention to the importance of ‘consistent
communication between all members of the [Multidisciplinary Team]’
when working with clients with BPD (29), Morris explores the array
of current treatment options – all psychological and/or
psychosocial. The importance of taking the time to co-create with
the patient a personalized, combined approach to treatment is
emphasized here. Morris then hones in on drama therapy as an
effective intervention for this population. Following a brief
developmental history of the medium, she introduces her particular
approach and the role of drama therapist as ‘a guide, opening the
door to a range of possibilities’ (59).
Having surveyed other drama therapists working with this client
group, she draws on their approaches and
experiences to illustrate the medium’s diversity, flexibility and
evidence-base, as well as touching on techniques for evaluating the
work. She briefly explores the possibility of using drama therapy
for men with BPD, acknowledging the prevalence of this diagnosis
amongst male populations, particularly in forensic settings,
although presentation, co-morbidities and actual diagnosis can
differ. Current research shows men are more likely to be diagnosed
with antisocial personality disorder.
Part 2 (Chapters 5–8) offers ‘[d]ramatherapy clinical case
studies and vignettes’. Morris presents work she delivered with
women in a secure BPD-specific ward and a secure step-down, mixed
diagnosis unit, where her drama therapy is offered in conjunction
with other interventions; for example, combined with DBT, drama
therapy ensures ‘a creative balance to this cognitive, behavioural
approach, nurturing the inner child, rather than focusing solely on
the adult self’ (76). For both settings, Morris’ vignettes and case
studies elicit a more visceral sense of the creative healing
journey, whilst openly acknowledging moments of pain and
difficulty. Most intriguing was her use
of therapeutic performance on the step-down unit, including the
creation of a singing group with subsequent CD recording.
Her analysis also explores the overlap with other treatments her
clients are receiving. The clients’ perspectives and those of her
multidisciplinary colleagues remind us of the importance of
collaboration and co-production. Particularly
moving was the perspective of a mental health nurse, who reported
‘I thought it was just a light, fun group. Quickly I discovered the
therapeutic process and just how important this expression of
conscious and unconscious emotions is’ (109). Morris pulls out
recurring themes emerging for her clients – including ‘to be seen
and heard as a human being rather than a diagnosis’ – and details
some of her key interventions.
Chapter 7, ‘Dancing between life and death’, explores BPD’s
relationship to loss, grief, self-harm and suicide. Particularly
impactful are Morris’ accounts of work with clients before they
take their own lives, and how she supports other staff and service
users to process this loss. Here, too, Morris draws on the voices
of her colleagues and other drama therapists surveyed, highlighting
the roles of strong teamworking and regular clinical supervision in
holding this level of shadow. Through her incorporation of Thich
Nhat Hanh’s teachings, she also turns our attention to the
importance of cultivating our own personal resources when
delivering such challenging work.
Morris pulls few punches when it comes to describing the more
painful, frustrating and devastating aspects of working with this
client group in inpatient settings. She demonstrates awareness of
drama therapy’s limitations
and reveals her own decision-making processes in the face of
challenges. She allows the clients to voice fear and doubt
alongside hope: ‘It was scary, actively expressing my feelings, but
helped reduce the intensity of those [suicidal] thoughts, only
briefly, but any respite from these thoughts was a welcome
breathing space’ (110, client’s words). Morris’ honesty offers me
as a fellow drama therapist some sense of relief and
relatability.
Dramatherapy for Borderline Personality Disorder will prove a
useful and nourishing resource for drama therapists and other
professionals working with this client group. Morris manages to
combine an academic, evidence based
approach with her own creative voice in a way that is likely to
appeal to minds across the scientific/artistic spectrum. I
particularly enjoy the inclusion of her own and her clients’ poetry
and artwork as a regular reminder that,
within the structures and systems of our mental health services, we
are dealing with vitality, creativity and humanity. Morris ends the
book on a hopeful note, bringing our attention back to the
importance of holding ‘hope, courage
and creativity’ for our clients: ‘if [the therapist] can sustain
their belief that healing and change are genuinely possible, the
client is then given the opportunity to believe it too’ (150).
Dramatherapy for Borderline Personality Disorder naturally has
its limitations. Given Morris’ experience working with women in
inpatient settings, she is unable to offer the same in-depth
exploration into men and non-binary people with BPD, outpatient
settings or those outside of the mental health system. Including
the experiences and approaches of other drama therapists adds some
welcome diversity; however, the inclusion of more of the survey
data would have strengthened the breadth and depth of this
text.
Furthermore, ‘letting go’ and self-care are areas that could
have been further explored, given the challenging nature of the
work. I remain curious about how drama therapists answered this
survey prompt: ‘Reflect on […] how easy or difficult you find it to
“let go” at the end of the working day’ (60). Similarly, team
‘splitting’ and other complex dynamics are briefly touched on, but
could have been discussed in more depth, particularly from Morris’
unique perspective as a drama therapist in teams that appear, on
the whole, supportive of her work. She mentions that, ‘[t]he
challenge for the dramatherapists working in these settings may
then be to adapt the way we communicate with other professionals,
without losing their integrity’ (47). It would have been relishing
to read Morris’ reflections on how she approaches this.
Nevertheless, the heartbeat of this book is Morris’ compassion
for this client group and those involved in their care; reading her
book helps us to ‘[remember] the human beings at the heart of the
matter’ (11). Morris’ book is recommended as essential drama
therapy reading and should be recommended also to our psychology,
therapy and medical colleagues as a refreshingexploration of
BPD.
REFERENCES
Hanh, T. N. (2012), Fear: Essential Wisdom for Getting through the
Storm, Kindle ed., London: Ebury Digital.
Morris, N. (2018), Dramatherapy for Borderline Personality
Disorder: Empowering and Nurturing People through Creativity,
Oxford and New York, Routledge.
CONTRIBUTOR DETAILS
Belinda Sherlock is a drama therapist, creative facilitator and
performer based in the United Kingdom. She has worked in forensic
mental health (NHS) for the last five years, alongside her
freelance practice with adults and children who have experienced
trauma. For more on her work, visit www.playfulwellbeing.com.
E-mail: [email protected]
https://orcid.org/0000-0002-7793-0981
