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‘The space between’: Role-play as a tool in the treatment of child sexual abuse

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Abstract

Child sexual abuse is a traumatic experience which may have a negative impact on a child’s attachment processes and sense of safety. A dramatherapy model that has been proposed for the treatment of child sexual abuse is the regenerative model. The regenerative model utilises role-play as a form of treatment and allows children to experiment with different roles in order to gain control of their experience and feel safe again. This article discusses a dramatherapy approach to the treatment of child sexual abuse on the basis of the regenerative model. It first introduces the model, and more specifically the concept of ‘the space between’ the therapist and the child. It then describes a case example and the use of role-play as a vehicle to explore emotions and thoughts and to process the traumatic experience symbolically. It concludes with the contention that dramatherapy, grounded on the regenerative model, may provide a safe space to work through the trauma relevant to child sexual abuse, in order to help a child heal and be able to form new, healthy attachment relationships.
https://doi.org/10.1177/0263067219899044
Dramatherapy
2019, Vol. 40(3) 134 –141
© The Author(s) 2020
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DOI: 10.1177/0263067219899044
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‘The space between’: Role-play
as a tool in the treatment of
child sexual abuse
Christiana Iordanou
University of Kent, UK
Abstract
Child sexual abuse is a traumatic experience which may have a negative impact on a child’s
attachment processes and sense of safety. A dramatherapy model that has been proposed for the
treatment of child sexual abuse is the regenerative model. The regenerative model utilises role-
play as a form of treatment and allows children to experiment with different roles in order to gain
control of their experience and feel safe again. This article discusses a dramatherapy approach
to the treatment of child sexual abuse on the basis of the regenerative model. It first introduces
the model, and more specifically the concept of ‘the space between’ the therapist and the child.
It then describes a case example and the use of role-play as a vehicle to explore emotions and
thoughts and to process the traumatic experience symbolically. It concludes with the contention
that dramatherapy, grounded on the regenerative model, may provide a safe space to work
through the trauma relevant to child sexual abuse, in order to help a child heal and be able to
form new, healthy attachment relationships.
Keywords
Child sexual abuse, dramatherapy, regenerative model, role-play, space between
Child sexual abuse is defined as ‘any use of a child for sexual gratification by another
person’ who could be a ‘an adult, an older or more developmentally advanced child, or
even a child of the same age if coercion is present’ (Olafson, 2011: 8). It is a traumatic
experience which negatively affects a child’s attachment processes (Alexander, 1992).
Prevalence rates range between 8% and 31% for girls and 3% and 17% for boys world-
wide (Barth et al., 2013; Lewis et al., 2016). Creative therapies such as dramatherapy can
have a remedial effect on children who have experienced sexual abuse because they can
offer the opportunity to play an active role in one’s own healing (Bannister, 1998). This
is achieved by incorporating in the therapeutic process a number of tools such as one’s
Corresponding author:
Christiana Iordanou, School of Psychology, Keynes College, University of Kent, Canterbury, Kent CT2 7NP,
UK.
Email: c.iordanou@kent.ac.uk
899044DRT0010.1177/0263067219899044DramatherapyIordanou
research-article2020
Clinical Comment
Iordanou 135
own body, non-verbal communication and dramatic methods such as role-play.
Dramatherapy, in particular, is an effective form of treatment of child sexual abuse, as it
can provide a safe space for children to process their experience symbolically and allows
for a new healthy attachment relationship between therapist and child to form (Bannister,
1998, 2003).
From a theoretical perspective, child sexual abuse can be addressed through the
regenerative model (Bannister, 2003). The regenerative model is grounded on the prem-
ise that young children who are victims of abuse can regenerate their capabilities by
processing their emotions and experiences in a creative manner. The model involves
three phases: assessment, action and resolution. In the assessment phase, the child’s
development, and more specifically their attachment behaviour, sense of safety and cop-
ing skills are assessed. Assessment of development is achieved through various forms of
play, such as embodiment play, projected play and role-play. Assessment of attachment
behaviour involves observation of the interaction between children and their caregivers.
Assessment of coping strategies involves determining children’s locus of internal and
external control and observing any signs of dysfunctional behaviour, such as dissocia-
tion. This can be accomplished through direct observation of the child’s behaviour, as
well as information provided by caregivers and/or psychometric tests. The last part of
this phase involves investigating children’s sense of safety, both within their home envi-
ronment and within themselves (Bannister, 2003).
The next phase, action, involves building a trusting therapeutic relationship with chil-
dren and producing interactive therapeutic work through creative methods (Bannister,
2003). For a sound therapeutic relationship to form, the therapist is expected to accept
children as they are, all the while setting clear boundaries for herself/himself and the
child regarding the process of therapy. These steps can promote the development of a
healthy attachment between them. The main goal here is to create a space in which chil-
dren feel free to express their emotions and for the therapist to accept and validate these
emotions. This process takes place in ‘the space between’. Processing emotions crea-
tively at this stage is achieved through interactive play that is relevant to the child’s
developmental stage. Play mainly involves dramatic activities, specifically role-play and
rehearsal, as well as other creative activities, such as dance, story work, music and draw-
ing. Here, the therapist can also utilise psychodramatic methods, such as ‘doubling’,
‘mirroring’ and ‘role-reversal’, which are characteristic of developmental processes that
take place between children and their caregivers (Bannister, 2003). Through such meth-
ods, children can begin to actively work through their experience in the safe space cre-
ated within the therapeutic relationship.
In the resolution phase, children learn to regulate their emotions. Specifically, chil-
dren learn to acknowledge and express their emotions as well as acquire the ability to
form healthy relationships and either maintain or terminate them as the circumstances
require. This latter aspect involves an understanding that the therapeutic relationship
will at some point terminate. At this stage, the therapist is expected to evaluate
whether children will need further therapy. The therapist may also be required to sup-
port caregivers in helping children sustain the changes achieved during therapy while
welcoming the various changes that they will go through as they develop (Bannister,
2003).
136 Dramatherapy 40(3)
The space between
A central concept of the regenerative model is ‘the space between’, which is the space
where a healthy attachment process can begin to develop for the child and is an important
element of the action phase. It involves the space between a child and their caregiver, or
a child and the therapist, where children can play safely and learn to express their emo-
tions freely, in order to process their experience and come to terms with it (Bannister,
2003). It can be compared to Winnicott’s (1971) ‘potential space’ and Vygotsky’s (1978)
zone of proximal development (ZDP). The ZDP involves a space in which activities take
place between a child and a more experienced individual which facilitate the former’s
cognitive development, mainly their learning and problem-solving skills (Leman and
Bremner, 2019). According to Bannister (2003), these two concepts are similar in many
respects; they both involve the ‘playing space’ all children are familiar with, which helps
them mobilise their fantasy during play. Furthermore, they both entail creative interac-
tions between two or more individuals, during which participants can experiment with
new concepts and ideas, and through trial and error come to a new understanding or
receive answers to their problems. Accordingly, in ‘the space between’, the child can
experiment with and learn new ways of relating to other people, which involve trust, safe
boundaries and exploration of all emotion that may emerge.
Role and child sexual abuse
In ‘the space between’, children can experiment with various roles, real or imagined. The
concept of ‘role’ is inherent in dramatherapy practice, with a number of theoretical
approaches having been developed with respect to its application (Jennings, 1992; Landy,
1993; Meldrum, 1994). According to Landy (1993), role is ‘the container of all the
thoughts and feelings we have about ourselves and others in our social and imaginary
worlds’ (p. 7). Jones (1995) argues that when role is used in dramatherapy, the client
adopts a fictional identity which is different than her or his own, engages with this new
identity through play and isolates specific aspects of this identity which forms the basis
of the role. Such actions happen in role-play, which involves engaging in pretence/
impersonation of other people, animals and imaginary companions (Harris, 2000;
Langley, 2006). When individuals experiment with a new role in dramatherapy, they are
acquainted with its numerous qualities. By re-enacting different behaviours of the role
and reflecting on them, one can gain an understanding of the various possibilities that
exist for change. It is this understanding that dramatherapy targets to help clients reach
desired outcomes (Langley, 2006). Similarly, when abused children engage in role-play,
they can approach their experience from a dramatic distance (Jennings, 1992). This
involves processing the traumatic event symbolically, from a safe distance, which can
enable them to recreate it and accept it. It is this actual process, during which the child as
protagonist steps out of her or his reality and recreates her or his experience in a novel
way, that is at the heart of healing (Jennings, 1992).
During role-play, children can use metaphors, symbols, as well as their body as tools
in the therapeutic process (Jennings, 1992; Jones, 1995; Landy, 2008). Integrating the
body in, in particular, is vital, given that in sexual abuse cases the child’s body has been
Iordanou 137
attacked or violated. In role-play, children can use their body to move freely and express
themselves physically. This helps them feel that they have control over their body and
allows them to set physical boundaries in a healthy and safe manner, which can enhance
the healing process (Bannister, 2003). In this sense, engaging with role-play can help
children strengthen their sense of (physical) self.
Case study
With the aforementioned theoretical perspectives in mind, in this article I will discuss the
use of role-play as a therapy tool in the treatment of a child sexual abuse case. Although
I worked with this child throughout the course of several months in my private practice
in Greece, I will present the course of two sessions. My therapeutic approach to this
particular case was theoretically grounded on the regenerative model (Bannister, 2003),
and the two sessions I will outline involve the action phase of the model. More specifi-
cally, I will describe how this child used role-play in ‘the space between’ to process her
experience symbolically. I was given written permission by the child’s mother to write
this article, and in order to protect her confidentiality, names and other significant case
information have been disguised.
Sophia
Sophia was 6 years old when her mother informed me that there were serious implica-
tions that she had been sexually abused by her father, whom she usually stayed with
during her school holidays. Sophia’s parents were divorced, and she was living with her
mother. I had worked with Sophia therapeutically in the past, thus rapport had been
established between us. When she came back to my practice, she presented a number of
clinical symptoms, such as fear and anxiety, anger and psychosomatic symptoms with no
biological aetiology. Every time she entered my office she went straight to the room
where I kept the toys and my dramatherapy material and started playing. Sophia was
always free to choose the type of play she wanted to engage in. Being very creative and
expressive, she mainly chose to engage in role-play with or without props and was proac-
tive in allocating the roles she wanted us to re-enact. Her play was disorganised, with no
beginning or end. She chose to re-enact scenes that involved violence and aggression, in
which she mainly played the role of the victim (e.g. wounded and chased child, wounded
animal). In her play, she expressed her emotions powerfully by shouting and screaming.
In the two sessions, I will proceed to describe how she expressed strong emotions of
anger and frustration.
Session 1
Sophia entered the playroom, opened the closet in which I kept several theatrical cos-
tumes and suggested we both dress up. She chose a colourful ballerina costume for her-
self and a black garment for me. She came up with roles and a scenario for our
improvisation, which she called ‘the battle game’. She explained that she would be ‘the
princess of Africa, a beautiful little butterfly’ and I would be ‘the bad witch, who wants
138 Dramatherapy 40(3)
to kill the princess’. She also gave each one of us a (toy) sword, clarified that she would
be ‘the good one’ and I ‘the bad one’ and proposed we have a sword fight. During the
battle, her movements were violent and forceful, and she kept trying to injure me. In role,
she kept referring to ‘a bad dad’ and repeating that she was protected by ‘a protector-
queen’. While in role, she exclaimed that her mother (the protector-queen) was the source
of her strength. After some time into the battle, she stopped what she was doing abruptly,
picked up a toy mobile phone and pretended to talk on the phone with her father. During
the ‘phone call’, her father asked her to meet with her, at which point she looked at me
with frustration and fear. She told me with despair that her father was speaking in a lan-
guage she could not understand. She then shouted angrily at him to leave her alone, at
which point she put away the phone and stopped her play. Before finishing the session, I
made sure we both de-roled (Landy, 1993), so that we could step out of our roles, and
Sophia could feel safe and secure back in my office.
Session 2
In a following session, Sophia suggested we play ‘the battle game’ again. She allocated
the same costumes and roles. We started the battle, and this time, referring to me as ‘the
bad witch’ she asked me to kill her (the princess of Africa) with my sword. She suddenly,
looked angrily at me and shouted ‘you are a bad father!’. She then ran and hid behind a
chair. She looked at me again with fear and, referring to herself, said, ‘the girl is help-
less’. Then, referring to me as ‘the bad witch’, she again asked me to kill her. Hesitantly,
I did as she requested; I approached her and lifted my sword up, ready for the attack. At
this point, Sophia changed the scenario completely: out of nowhere, the mother of ‘the
princess of Africa’ appeared (Sophia played the role of the mother) and killed ‘the bad
witch’ (me), who again Sophia addressed as ‘the bad father’. At this point, Sophia
announced that the game was over and that she was pleased with the outcome. Once
again I invited her to de-role to ascertain that she felt safe in the room.
Reflections
My work with Sophia was spontaneous and centred around her own needs and pace. The
aims of my work with her were multiple; to provide a safe space for her to express herself
freely and creatively; to develop a trusting relationship with her; to give voice to her
emotions; to give her the opportunity to engage her body in the therapeutic process; to
allow an attachment relationship to form between us, by being physically and mentally
present in her play and empathetically validating her thoughts and emotions; to enable
her to process her experience symbolically and through metaphor, in order to take the
distance she needed to heal.
A common theme that emerged in Sophia’s play throughout all our sessions, not just
the two I presented, was the she experimented the roles of the victim, the rescuer and the
persecutor. This pattern is evident in cases that involve abuse, sexual, physical or emo-
tional, and highlights the dysfunctional dynamics that can be transferred from one’s real
life to the dramatherapy setting (L’Abate, 2009; Newman, 2017). By bringing such
dynamics in ‘the space between’ and working through them, the child can begin to
Iordanou 139
internalise a sense of safety and trust again. Sophia chose to re-enact characters who
were helpless, wounded or abandoned. I believe that identification with such characters
helped her process her own sense of powerlessness towards the traumatic experience. I
could feel her anger and frustration during these sessions, which were evidenced in
Sophia’s disorganised play. Sophia transitioned from one role to the next (princess of
Africa to that of her mother; princess of Africa to that of herself on the phone with her
father) rapidly and abruptly. This did not come as a surprise, given that Sophia had expe-
rienced a traumatic event and was confused about what had happened. The fact that she
addressed me as either ‘a bad witch’ or ‘a bad father’ simultaneously, shifting uncon-
sciously from a fictitious character (witch) to a real one (dad), is also suggestive of how
flooded she felt by strong emotions relevant to her experience. I felt that these rapid
shifts formed her attempt to process a real experience through fantasy and play, in order
to safely express her anger, sense of victimisation and need to take control over the situ-
ation. This was also evident in the fact that when she pretended to speak to her father on
the phone, he spoke in a language she could not understand. It may be that Sophia could
not really understand how a person she trusted so much betrayed her trust, or that she did
not want to talk to her father. What is important here is that Sophia was able to verbalise
that she did not understand and express her despair regarding the situation.
Furthermore, when she requested that ‘the bad witch’ kills ‘the princess of Africa’, I
felt scared and hesitant. She wanted me to physically attack her and threaten her with my
sword. I wondered whether she was trying to re-enact in a safe environment the sense of
physical threat she had experienced and I wanted to ascertain that she did not feel trau-
matised anew. Thus, I accepted her request and verbally stated my every move (e.g. ‘now
I will come closer’, ‘now I will lift my sword’), so that she was aware of every action in
advance and could stop me anytime she wished to. This approach seemed to have a reme-
dial effect. Sophia immediately adopted the role of the rescuer, the ‘princess’ mother
who saved ‘the princess’ from ‘the bad father’ (again she addressed me as ‘the father’ and
not ‘the witch’, which was my role up to that point). This active shift in the role-play
shows that Sophia was aware that she could reach out to her mother for protection.
Throughout our work together, Sophia’s therapy sessions followed a particular sequence
which she set herself: she started each session by first giving me directions about the type
of role-play we would engage in. She chose when the role-play would be over and then
spent the rest of the session talking about her relationship with her father. As there was an
ongoing legal case taking place, Sophia expressed her concerns regarding seeing him
again. I felt that engaging with role-play helped her to first take control of her experience
and recreate it in ‘the space between’. She was then able to process her thoughts and emo-
tions regarding the event from a place of safety. Finally, she acknowledged that she could
rely on her mother for protection, which offered her a sense of security.
Conclusion
Dramatherapy can create a space in which a traumatic experience can be reconstructed,
challenged and finally accepted (Newman, 2017). This is the space between therapist
and client (Bannister, 2003). In Sophia’s case, role-play allowed her to externalise and
explore her emotions and capability to cope with the event. Her ability to give a more
140 Dramatherapy 40(3)
positive ending to her dramatisation, by bringing in the role of the mother as a rescuer,
gave her a new perspective of the event and allowed her to explore a new sense of inner
strength. This is in line with Landy’s (1993) argument that the use of role enables clients
to experiment with their actual roles as well as those they desire to have, in order to gain
a better understanding of themselves and their identity. Gradually, over the course of
therapy, Sophia’s clinical symptoms started to dissipate. The fact that Sophia had a lead-
ing role in each dramatherapy session, through choosing each improvisation and then
freely discussing her concerns, suggests that she felt safe to express her thoughts and
feelings and that she was able to start trusting again.
In this article, I only described the action phase of the regenerative model in my work
with Sophia. Nonetheless, my overall approach involved all the phases of the model. The
action phase is an active process which helps the child create a new, healthier attachment
relationship with the therapist and feel safe to express herself/himself fully and freely.
The fact that Sophia was able to voice her concerns every time she completed her role-
play suggests that through the use of this method, she was able to face reality and openly
address it. By taking a distance from her experience, she was able to approach it from a
space of safety and resilience. Overall, using the regenerative model as a theoretical
starting point helped Sophia turn her feelings of powerlessness to feelings of strength.
Here, I presented my dramatherapy approach to one child sexual abuse case. Future
research could potentially test the use of the regenerative model in the treatment of simi-
lar cases as well as other types of child abuse. Such an empirical exploration will allow
us to have a better understanding of the use of the regenerative model in dramatherapy
sessions with abused children.
Acknowledgements
I am grateful to Sophia and her mother for giving me permission to write this article. In addition,
thanks to Dr Ioanna Iordanou for her insightful comments.
Funding
The author(s) received no financial support for the research, authorship, and/or publication of this
article.
ORCID iD
Christiana Iordanou https://orcid.org/0000-0002-6288-8995
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Author biography
Christiana Iordanou is a lecturer in Developmental Psychology at the University of Kent. She is
also a dramatherepist with extensive experience in a number of settings in Greece where she also
practised privately before moving to the United Kingdom. She is particularly interested in the use
of drawing and dramatisation in children’s eyewitness testimony and dramatherapy in the treat-
ment of child abuse.
... However, the automatic desire for revenge when being unjustly insulted or hurt seems to be neglected in treating children who experienced sexual abuse (Davidson et al., 2013;Goldberg, 2004). The desire for revenge followed by revenge fantasies (Berger, 2014) is defined as a natural human impulse in response to harm to oneself, aims to undo the injustice and acquire back the victim's self-dignity and self-respect (Field & Chhim, 2008;Iordanou, 2019). Although retaliating against the transgressor is often considered harmful because it may be involving in property damage or physical harm (Mulvey et al., 2020;Van Denderen et al., 2014), numerous studies reported the empowering benefits of the desire for revenge and revenge fantasies, such as feeling satisfaction (Crombag et al., 2003), reducing aggression (Gollwitzer & Denzler, 2009), enhancing victims' feelings of empowerment (Strelan et al., 2020;Twardawski et al., 2021) and sense of justice (Funk et al., 2014). ...
... The findings seem to broaden our understanding of the psychological meaning of living with a history of CSA who may desire revenge and reverse their state as victims to step out of it (Goldner et al., 2019;Iordanou, 2019). Additionally, findings shed light on how the desire for revenge and revenge fantasies can serve via drawings and narratives as a coping strategy and a way to express complicated feelings (Lev-Wiesel et al., 2020). ...
... In addition, it directs survivors' destructive anger outwardly towards the attacker instead of inwards (Berger, 2014;Gollwitzer & Denzler, 2009), providing the survivors with some degree of emotional closure (Haen & Weber, 2009) and, above all, draw the line between what is right and what is wrong, who is responsible and should carry the blame and who should not. In the latter sense, a desire for revenge is self-protective, stabilizing the psyche and transforming the victim's behaviour from passive to active, thus, regaining a sense of control and self-esteem which is required for recovering (Iordanou, 2019;Strelan et al., 2020). Creative tools such as drawings are useful techniques for expressing socially unacceptable desires such as the desire for revenge, encouraging verbalization and enriching the narratives, which may promote recovery (Lev-Wiesel et al., 2020;McInnes, 2019). ...
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Whereas the desire for revenge for an unjust deed is considered natural, its use within the therapeutic setting is scarce, specifically in sexually victimized children. The study aimed to find how experiencing sexual molestation during childhood and the revenge fantasy is reflected in drawings and narratives of sexually victimized children. Following ethical approval and signing a consent form, 14 children who experienced sexual abuse and were psychologically treated (ages 11–18) were recruited. They were asked to draw two drawings: “draw an unjust event that had happened to you” and “draw what you would have liked to happen to the person that unjustly treated you.” At completion, participants were asked to give a narrative to each drawing. Phenomenological analysis of the drawings and narratives indicated that most participants refrained from using more than two colours, did not draw the perpetrator and drew schematic figures. The main themes that emerged in the drawings and the narratives were feeling of loneliness, aloneness, and the desire for role reversal.
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