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DTR 9 (2) pp. 273–315 Intellect Limited 2023
Drama Therapy Review
Volume 9 Number 2
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© 2023 The Author(s). Published by Intellect Ltd. Article. English language.
Open Access under the CC BY-NC licence. https://doi.org/10.1386/dtr_00133_1
Received 1 February 2023; Accepted 15 July 2023
NISHASAJNANI
New York University
MARCWILLEMSEN
HU University of Applied Sciences Utrecht
JASON D.BUTLER
Lesley University
A scoping review of observed
benefits of Developmental
Transformations (DvT)
ABSTRACT
Developmental Transformations (DvT), a practice involving interactive, improvi-
sational play in pairs or groups, has gained international appeal as a therapeutic
intervention for different populations in a variety of health, care and recreational
contexts. However, a rigorous review of the benefits of DvT has not been conducted.
The purpose of this study was to review extant literature for the observed benefits
of DvT, identify gaps in the literature and make recommendations concerning
future research including identifying possible areas for outcome measurement for
preliminary studies. The authors, who each completed training in this approach,
conducted a scoping review of English-language, published, peer-reviewed and
grey DvT literature through 2021. From an initial 745 records retrieved through
databases and a manual search, 51 publications met criteria, which, when analysed
using in-vivo and pattern coding, resulted in a total of seventeen categories of
observed benefits ascribed to DvT. These included six general categories – rela-
tional, emotional, social, cognitive, behavioural and physical benefits – and eleven
complex categories of benefits to participants across the lifespan. In addition to
KEYWORDS
Developmental
Transformations
(DvT)
health
improvisation
play
scoping review
benefits
drama therapy
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274 Drama Therapy Review
benefits for participants, benefits of DvT were also observed and reported for
facilitators, therapists, teachers and supervisors engaged in this practice. This
review revealed inconsistencies regarding the reporting of practitioner training,
frequency, format, population, intended goals, assessment measures and outcomes.
Future studies with increased experimental rigor, standardized outcome measures
and consistent reporting are recommended.
RESUMEN
Las Transformaciones del Desarrollo (DvT), una práctica que involucra juegos
interactivos e improvisados en parejas o grupos, han ganado atractivo internac-
ional como una intervención terapéutica para diferentes poblaciones en una varie-
dad de contextos de salud, cuidado y recreación. Sin embargo, no se ha realizado
una revisión rigurosa de los beneficios de la aplicación de la DvT. El propósito
de este estudio fue revisar la literatura existente sobre los beneficios observados
de la DvT, identificar las lagunas presentes en la literatura y hacer recomenda-
ciones para las investigaciones futuras, incluyendo la identificación de posibles
áreas para la medición de resultados para estudios preliminares. Los autores,
cada uno de los cuales completó la capacitación en este enfoque, realizaron una
revisión de alcance, de la literatura gris y revisada por pares, publicada sobre la
DvT, en inglés hasta 2021. De los 745 registros iniciales recuperados a través
de bases de datos y una búsqueda manual, 51 publicaciones cumplieron con los
criterios que, cuando se analizó mediante codificación in vivo y de patrones, dio
como resultado un total de 17 categorías de beneficios observados atribuidos a la
DvT. Estos incluían seis categorías generales: beneficios relacionales, emocion-
ales, sociales, cognitivos, conductuales y físicos; y 11 categorías complejas de
beneficios para los participantes a lo largo de la vida. Además de los beneficios
para los participantes, también se observaron e informaron los beneficios de la
DvT en los facilitadores, terapeutas, maestros y supervisores involucrados en
esta práctica. Esta revisión reveló inconsistencias con respecto al informe de la
capacitación de los profesionales, la frecuencia, el formato, la población, las metas
previstas, las medidas de evaluación y los resultados. Se recomiendan estudios
futuros con mayor rigor experimental, medidas de resultado estandarizadas e
informes consistentes.
RÉSUMÉ
Les transformations développementales (DvT) – une pratique impliquant un jeu
interactif et improvisé en paires ou en groupes – ont acquis un attrait interna-
tional en tant qu’intervention thérapeutique pour différentes populations dans une
variété de contextes de santé, de soins et de loisirs. Cependant, on n’a pas effectué
d’examen rigoureux des avantages des DvT. Le but de cette étude était d’examiner
les avantages observés des DvT, d’identifier les lacunes dans la littérature à ce
sujet, et de faire des recommandations concernant les recherches futures, y compris
l’identification des domaines possibles de mesure des résultats pour les études
préliminaires. Les auteurs, qui ont chacun suivi une formation sur cette approche,
ont examiné la portée de la littérature DvT en anglais, publiée, évaluée par des
pairs et grise jusqu’en 2021. Sur les 745 premiers enregistrements récupérés via
des bases de données et une recherche manuelle, 51 publications répondaient aux
critères qui, lorsqu’ils ont été analysés à l’aide d’un codage in vivo et de modèles,
PALABRAS CLAVE
Transformaciones del
Desarrollo
DvT
salud
improvisación
juego
revisión de alcance
beneficios
drama
MOTS-CLÉS
transformations
développementales
DvT
santé
improvisation
jeu
examen de la portée
avantages
théâtre
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ont abouti à un total de 17 catégories d’avantages observés attribués aux DvT.
Celles-ci comprenaient six catégories générales: avantages relationnels, émotion-
nels, sociaux, cognitifs, comportementaux et physiques, ainsi que 11 catégories
complexes d’avantages pour les participants tout au long de la vie. Les avan-
tages des DvT ont été observés et signalés par des animateurs, des thérapeutes,
des enseignants et des superviseurs engagés dans cette pratique. Cet examen a,
en outre, révélé des incohérences concernant les rapports sur la formation des
praticiens, la fréquence, le format, la population, les objectifs visés, les mesures
d’évaluation et les résultats. On recommande que de futures études soient menées
avec une rigueur expérimentale accrue, des mesures de résultats standardisées, et
des rapports cohérents.
INTRODUCTION
Developmental Transformations (DvT), originally conceived by David Read
Johnson, is an improvisation-based practice with a recognizable indi-
vidual and group protocol, involving an entrance structure, unison sound
and movement, structured and unstructured role play and an exit structure
throughout
which the client, called a player, spontaneously enacts how they are
feeling and what they are thinking with a therapist, called a playor, and
other players if in a group format. This practice can occur in any arts
modality, and any social frame (e.g., therapy, performance, education,
public health), though DvT was created within a drama therapy context.
(Johnson and Pitre 2021: 123)
It has been discussed and used in the context of other creative arts therapies
such as dance therapy (Johnson 1993) and art therapy (Rosen et al. 2016) and
used to promote health and well-being as well as manage and treat clini-
cal symptoms (Johnson and Pitre 2021; Landers 2012a, 2012b). Despite the
fact that DvT is widely taught in drama therapy and postgraduate training
programs around the world and used in a variety of clinical and community-
based care programs, a systematic investigation of the benefits ascribed to
the practice has not been undertaken. Such appraisals are necessary to ethi-
cal practice, training and useful to the development or selection of suitable
outcome measures to further investigate the impact of DvT. Therefore, the
purpose of this scoping review was to identify and analyse literature docu-
menting observed benefits of DvT towards identifying patterns, gaps in the
literature and making recommendations concerning future research.
A chronological review of benefits attributed to DvT
This review of literature tracks the chronological evolution of DvT with a focus
on the benefits that have been theorized and proposed by people trained in
this approach in order to establish the context for this study. The theoretical
frameworks, settings and proposed goals of DvT have changed over time and
oscillated between a focus on representing internal experience in the closed
context of a psychiatric unit or residential care facility and an exploration
of the external conditions that influence interpersonal experience in open,
community and public contexts. As Johnson writes:
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276 Drama Therapy Review
DvT was originally conceived as a form of therapeutic free play (Johnson
1982, 1991, 1993, 2007), and then it transformed into an exploration of
intimacy (Johnson 2009; Johnson, Forrester, Dintino, James, & Schnee
et al. 1996; Porter 2000), and then an encounter with presence (Johnson
2013). Now DvT is being framed as a means of questioning and disrupt-
ing discourses of power.
(Johnson and Pitre 2021: 124)
The earliest publication by Johnson on what he then referred to as the
Developmental Method stressed its value in ‘increasing [one’s] range of expres-
sion, so that the person has access to, and flexibility to move among, all
developmental levels […] [and an] ability to adapt flexibly to changing circum-
stances’ (1982: 185). In the early 1980s, the Developmental Method united
aspects of dance movement and drama therapy which, according to Johnson,
seemed ‘to be associated with an increased access to and flow of images and
words’ (1984: 313). His observations, while providing group drama therapy in
an elder care facility, led to insights about how this approach might improve
the overall milieu of care while also instilling hope, enhancing vitality and
deepening meaningful relationships. In the latter half of the 1980s, Johnson
began to stress the value of DvT in reducing rigidity, anxiety and promoting
greater psychological flexibility in addition to aforementioned benefits of free-
ing up and expanding one’s range of expression and adaptability to change
(Johnson 1985, 1986).
In the 1990s, those writing about DvT appeared to place a greater empha-
sis on how this approach might lead to increased self-acceptance and a sense
of meaning. Johnson wrote that ‘the benefits it provides include a sense of
inner calm, acceptance of oneself and one’s painful history, a sense of fullness
and an increased range of experiencing, deepened by the stirrings of an inner
life, moving upward from below’ (1991: 299). Referring then to the practice
as Transformations, Johnson wrote that this approach to drama therapy could
increase ‘the client’s access to and tolerance of internal states that have for
various reasons been cast aside, labeled as unacceptable, or seen as threaten-
ing’ (1992: 128).
From the mid-1990s onwards, we see assertions of the benefits of this
approach in publications written by other practitioners or co-authored with
Johnson (Forrester and Johnson 1996; Dintino and Johnson 1997; Schnee
1996). The Developmental Method and Transformations merged into its current
form, Developmental Transformations (DvT), in an article written by Johnson
et al. in which they emphasized the potential of DvT to reduce ‘existential
discomfort and achieve greater intimacy’ (1996: 296). In an article exploring
the benefits of DvT in the treatment of combat-related post-traumatic stress
disorder, there was an explicit differentiation between the aims of DvT from
other approaches in drama therapy:
The major focus on DvT is not the re-living or problem solving of life
experiences, nor achieving catharsis, but rather embracing an attitude
of acceptance and tolerance of the multifaceted aspects of self, good
and bad, profound and superficial. The goal becomes to expand the
freedom that the individual has in moving from one level of experi-
ence to another, rather than the ability to work out one particular
conflict.
(James and Johnson 1996: 138)
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The moral benefits of DvT emerged as a focus during the end of the 1990s
and early 2000s. In work with Vietnam veterans, Johnson and Dintino (1997)
asserted the benefits of self-acceptance and psychological flexibility but also
highlighted how the representational properties of the playspace enabled
clients to ‘acknowledge their past actions and future potential for violent
behavior as they choose to behave differently […] each moment in the play-
space is a choice not to act in violence’ (1997: 220). Landers (2002), in an arti-
cle about the use of DvT to deconstruct toxic masculinity, also asserted that it
may contribute to a reduction in violent behaviour.
Articles published in the 2000s reinforced earlier assertions about the
benefits of DvT. In an article focusing on the benefits of DvT with older
adults, Smith (2000) emphasized the potential of DvT to reduce existen-
tial fear. Johnson et al. (2003) revisited the contributions of DvT to a sense
of vitality, meaning and self-acceptance while also contributing to a positive
cultural change within care institutions. Galway et al. (2003) and Glaser (2004)
explored the role of DvT in promoting greater flexibility, spontaneity and a
means of disrupting limiting self-narratives. James et al. (2005) articulated the
value of DvT in desensitizing memories of past sexual abuse in their work
with children.
As we approached the 2010s and entered into the next decade, we saw
the emergence of writing about DvT in languages other than English (see
Dočkal 2009, 2010; Hannagan and Lau 2019; Louis 2021; Willemsen 2014).
We also observed a critical turn in how the practice was being written about
in that the benefits of DvT began to be discussed in terms of agentic potential
and disruptions to the status quo. No longer was DvT solely located within
a private, clinical context but situated as a public practice capable of decon-
structing stereotypes and enabling a greater sense of responsiveness and free-
dom amidst restrictive social conditions. For example, Mayor (2012) discussed
DvT as a means of playing with race as a social construct. Landers (2012a)
introduced Urban Play as an expression of DvT designed for public spaces
and as a response to neo-liberalism in which participants might be awakened
‘to the opportunities for action that are everywhere among us’ (2012a: 205).
Sajnani et al. (2014) presented the value of DvT in school-based settings, and
Sajnani and Johnson (2016) discussed DvT in relation to social change.
Previous assertions remained, though they were, at times, directed at
related fields outside of drama therapy. Domikles (2012) discussed the poten-
tial of DvT to provide relief and greater self-acceptance of unpreferred feelings.
Reynolds (2011), in a journal for group social work, described the benefits of
DvT in relation to increased ‘flexibility and capacity for creative expression’
in an inpatient psychiatric unit for children. Like several publications within
this period, he emphasized the benefits of DvT for individual participants as
well as facilitators and the social and cultural milieu in which the practice was
taking place.
Alongside these developments was a more rigorous engagement with
how DvT could contribute to a reduction of symptoms of post-traumatic stress
in children, adolescents and adults. In what could be described as a trauma-
informed turn in the literature, Johnson proposed Trauma-Centred DvT (2014)
in which he situated the practice as a form of imaginal exposure therapy. In
keeping with DvT as a response to trauma, Pitre (2014), Pitre et al. (2015,
2016), Frydman and Pitre (2019), Webb (2019) and Willemsen (2020) demon-
strated the potential of DvT to offer emotional release and relief from stressful
memories. Further, McAdam and Johnson (2018) wrote about the potential of
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278 Drama Therapy Review
DvT in addressing symptoms of depression amongst adolescents. While not
specific yet still relevant to trauma treatment, Frydman (2017) theorized how
an embodied understanding of cognition might contribute to DvT practice.
The technological turn is the most recent lens through which the benefits
of DvT have been explored. Regula (2020) asserted the possibility of experi-
encing the benefits of interpersonal presence in DvT online. Marshall (2020)
raised ethical and practical questions about the relationship between DvT and
developing technologies with a particular focus on similarities between the
DvT practitioner’s capacities to notice micro movements and differences in
interpersonal, embodied play and the mass deployment of artificial intelli-
gence (AI) to gather granular human data. Buckley (2020) called attention to
how DvT online may both amplify and reduce isolation.
This chronological review reveals an evolution of how this approach has
been theorized. This is evident in the writing of its progenitor, David Read
Johnson, whose publications reflect the same commitment to transforma-
tion as the method itself. When taken up by other authors, DvT theory was
brought into conversation with their unique interests and world-views such
as Buddhism (Legari 2019), cognitive neuropsychology (Frydman 2017), neo-
liberalism (Landers 2012a), gender studies (Dintino 1997; Dintino et al. 2015;
Landers 2002), critical race and performance theory (Mayor 2012), attachment
theory (Pitre 2014), family systems (Domikles 2012) and group work theory
(Reynolds 2011) that likely influenced how they understood the value and
purpose of DvT.
In summary, there have been many psychological, physical, relational,
social (including cultural) and moral benefits attributed to the practice of DvT
inspired by the theory and practice of its founder and people who trained in
this approach. Amongst these are an expanded range of expression, greater
psychological flexibility, adaptability, tolerance of uncertainty, a reduction of
fear and violent impulses and an increased sense of vitality and intimacy in
interpersonal relationships and various spheres of social organization.
METHOD
The purpose of this scoping review was to systematically identify which bene-
fits have been observed in DvT practice, identify gaps in the literature and
make recommendations concerning future research. The primary research
question for this study was ‘What are the observed benefits of DvT?’. As
authors, each of us had completed training in DvT, used it in clinical prac-
tice and trained students in this approach at our respective institutions.
We chose to conduct a scoping review as it is an approach that can facili-
tate a broad investigation of the breadth and depth of what has been writ-
ten about in a field of practice and highlight directions for further research
(Arksey and O’Malley 2005; Peters et al. 2015, 2020). A scoping review is a
‘form of knowledge synthesis that addresses an exploratory research ques-
tion aimed at mapping key concepts, types of evidence, and gaps in research
related to a defined area or field by systematically searching, selecting, and
synthesizing existing knowledge’ (Colquhoun 2014: 1292–94). We used the
Preferred Reporting Items for Systematic reviews and Meta-Analyses exten-
sion for Scoping Reviews (PRISMA-ScR) checklist to facilitate complete and
transparent reporting (Tricco et al. 2018). Consistent with guidelines concern-
ing scoping reviews, the protocol for the search was registered,1 and more
than two researchers were involved in the selection and screening process. In
1. The protocol for
this scoping review
was registered with
the Open Science
Framework: https://osf.
io/8zrtq/?view_only.
Accessed 1 July 2023.
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accordance with the purpose of scoping reviews, we did not appraise the qual-
ity of the study extracted before inclusion, but rather provided an overview to
map the variety of research, identify gaps and make recommendations (see
Appendix 1).
Eligibility criteria
On average, we met online biweekly and used an iterative process to define
inclusion and exclusion criteria prior to the selection phase. We agreed that
literature had to include statements about benefits directly or indirectly
observed as a result of the DvT intervention. Direct observations involved
documented practitioner accounts of the benefits of DvT intervention. Indirect
observations were the practitioner accounts of what clients or involved staff
shared with the practitioner about the benefits of DvT intervention as well as
observations recorded by researchers. We agreed that the literature had to be
published in English, as this was the language common to the co-authors, in a
peer-reviewed publication before 2021. Consistent with best practice concern-
ing reviews, we included grey literature in order to further ‘reduce publica-
tion bias, increase reviews’ comprehensiveness and timeliness, and foster a
balanced picture of available evidence’ (Paez 2017: 233). Grey literature may
be divided into sources of varying trustworthiness relating to degrees of edito-
rial oversight and peer review. We included first-level grey literature consisting
of literature published in books and periodicals (e.g. articles published in the
Chest of Broken Toys), but excluded second- and third-level grey literature such
as theses and opinion pieces (Higgins et al. 2019; Pollock et al. 2021).
Information sources
We searched the following databases for English peer-reviewed literature:
PsycINFO, Academic Search Complete, Web of Science and Sage. In addition,
we asked the directors of DvT training institutes around the world to send DvT
publications in English that they have used in their training. Contributions to
peer-reviewed and grey literature came from Belgium, Canada, China, Czech
Republic, France, Hong Kong, Israel, the Netherlands and the United States.
Finally, we completed a manual search through the references listed on the
online DvT library.2
Search
The search protocol was developed from December 2020 to January 2021 in
consultation with two research librarians at our affiliated universities. The list
of search terms was organized in search strings adjusted to the underlying
structure, syntax and capabilities of each specific database used.3
Selection of publications
In the different databases, 643 records were identified and 95 duplicate records
were removed. The remaining 548 publications were imported into the web
tool Rayyan (Ouzzani et al. 2016). We screened the title and abstracts for every
entry independently from each other. In case of doubt or disagreement, we
examined the full text and came to consensus. Although entries were filtered
for English language, several publications were excluded because they were in
another language (n = 7). We also excluded publications that did not have direct
2. The online DvT library
is accessible here:
http://developmental
transformations.com.
Accessed 1 July 2023.
3. The databases, date of
search, search strings
and identified records
may be found in the
registered protocol
on Open Science
Framework: https://osf.
io/8zrtq/?view_only=.
Accessed 1 July 2023.
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Figure 1: PRISMA flow chart.
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or indirect observations about the benefits of the practice of DvT (n = 508). The
materials received from the DvT training directors and found through a manual
search were read and discussed individually (n = 102). Reasons for exclusion
included ‘not relevant’, ‘wrong publication type’, ‘background article’ (n = 46).
After a full-text reading of the remaining 58 relevant entries, seven publications
were excluded from the scoping review because they did not contain direct or
indirect observations about the benefits of the practice of DvT, leaving a total of
51 (Figure 1). For example, Frydman (2017) was purely theoretical.
Data extraction
The 51 publications were divided between each of us, and we rotated the
publications through a process of extracting and charting information on a
shared Google Excel document. During this process, the chart was refined
several times. To best meet the objectives of the scoping review, we extracted
and charted the following information from each of the included publica-
tions: year of publication; authors; title including title in language of origin;
type of source (i.e. chapter, book, article); abstract; age of the target group;
characteristics of population; intended benefits; DvT concepts; settings (i.e.
private practice, outpatient care, school, public space); frequency; format (i.e.
individual, group); country where DvT took place; method of research if any;
DvT primary intervention or not; training of the first author; full APA citation;
the authors’ assumptions about the theoretical benefits of DvT with quotes;
observed benefits of the practice of DvT with indicative quotes.
Data analysis
We used in vivo coding to identify the observed benefits of the practice of DvT
(Saldaña 2014). To stay as close to the intended meaning of the author(s) as
possible, we bolded words and phrases within each excerpt in the chart that
stood out as indicative of what the author(s) documented as benefits. In total,
615 codes were identified and transferred to the computer-assisted qualita-
tive data analysis software (CAQDAS) Dedoose. Using Dedoose, we grouped
these initial 615 codes into 102 unique codes and then, upon further examina-
tion, reduced this to 95 unique codes.
We further categorized these 95 unique codes according to their similari-
ties. As a result of this pattern coding (Saldaña 2014), a hierarchically organ-
ized outline was developed. Fifty of the 95 coded benefits were categorized
into six general categories: cognitive, behavioural, relational, social, emotional
and behavioural. The remaining 45 coded benefits were grouped into eleven
additional ‘complex categories’ as they were observed to have a complex
mixture of the general categories (i.e. both emotional and cognitive). After
pattern coding, we went back to the excerpts of the observed benefits to check
if any possible benefits were not identified. This did not lead to new codes.
From Dedoose, the results were brought to a shared Google document and,
in accordance with the last step of the coding process (Saldaña 2014), a cross-
case analysis was conducted to come to a final layout (Table 2) of the observed
benefits of DvT and findings written below (Onwuegbuzie et al. 2016).
FINDINGS
Fifty-one publications met the inclusion criteria in that they presented direct
or indirect observations of benefits ascribed to DvT (Table 1). Only one of the
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Table 1: Included publications.
Full APA citation
Population
age Clinical focus Setting
DvT
frequency
Group vs.
individual Identified benefits
Johnson (1982). Developmental
approaches in drama ther-
apy. Arts in Psychotherapy,
9(3), 183–189. https://doi.
org/10.1016/0197-4556
(82)90035-1
Mixed Young adults with
schizophrenia;
20-year-old mute
man with cata-
tonic schizophre-
nia. Patients in a
nursing home;
12-year-old boy with
autistic behaviour,
fragmented move-
ment, impulsivity,
fits of rage, somatic
delusions
Private
practice
Partially
indicated
Both Increased flexibility, adaptability,
security, attachment, intimacy, self-
expression, social engagement
Johnson, D. (1984). The repre-
sentation of the internal world
in catatonic schizophrenia.
Psychiatry, 47, 299–314.
Adults Catatonic
schizophrenia
Inpatient
hospital
Twice/
week
Group Initiate movement, active engage-
ment, feeling hopeful (therapist),
explore aspects of self, bounda-
ries, clarification, differentiation,
increased quality of life, vocaliza-
tion, self-acceptance, self-aware-
ness, self-regulation, collaboration,
tolerance of emotions, authen-
tic emotions, optimism, changes
relationship to self and others,
self-expression, reduced violence,
psychological symptom reduction
Johnson, D. (1985). Expressive
group psychotherapy with the
elderly. International Journal of
Group Psychotherapy, 35, 109–127.
Older adults 64–96-year-olds
in residential care
facility
Aged care
facility
Once/
week
Group Active engagement, interpersonal
investment, social engagement
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Full APA citation
Population
age Clinical focus Setting
DvT
frequency
Group vs.
individual Identified benefits
Johnson, D. R. (1986). The devel-
opmental method in drama
therapy: Group treatment with
the elderly. Arts in Psychotherapy,
13(1), 17–33. https://doi.org/
http://dx.doi.org/10.1016/0197-
4556(86)90005-5
Older adults Individuals in wheel-
chairs, 80–94 years
old
Aged care
facility
Once/
week
Group Meaning-making, increased
playfulness, increased flexibility,
optimism, changes relationship to
self and others, forgiveness of self,
increased self-awareness, integra-
tion of self, social engagement,
tolerance of emotions
Johnson, D. R. (1992). The dram-
atherapist ‘in-role’. In S. Jennings
(Ed.), Dramatherapy: Theory and
practice, vol. 2 (pp. 112–136).
Routledge.
Adults Depression, overeat-
ing, low libido, past
sexual abuse
Private
practice
Not
indicated
Individual Increased agency, increased
dimensionalization, increased
self-awareness, increased
self-acceptance
Johnson, D. R. (1993). Marian
Chace’s influence on drama ther-
apy. In S. Sandel, S. Chaiklin & A.
Lohn (Eds.), Foundations of dance/
movement therapy (pp. 176–189).
Marian Chace Memorial Fund.
Adults Veterans Inpatient
hospital
Not
indicated
Group Mourning, emotional release,
self-expression, physical release,
acknowledging shame, increased
self-awareness
Forrester, A. M. & Johnson, D. R.
(1996). The role of dramatherapy
in an extremely short-term inpa-
tient psychiatric unit. In A. Gersie
(Ed.), Dramatic approaches to brief
therapy (pp. 125–138). Jessica
Kingsley.
Adults Psychosis, suicidality,
substance abuse
Inpatient
hospital
Once/
week
Group Empowerment, therapy adherence,
humour, aliveness, support, social
engagement, transform shame
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284 Drama Therapy Review
Full APA citation
Population
age Clinical focus Setting
DvT
frequency
Group vs.
individual Identified benefits
James, M. & Johnson, D. R.
(1996). Drama therapy in the
treatment of combat-related
post-traumatic stress disorder.
Arts in Psychotherapy, 23(5),
383–395.
Adults Veterans with PTSD Inpatient
hospital
Once/
week
Group Mourning, intimacy, increased
self-acceptance, forgiveness of
self, support, acceptance of others,
transform shame, tolerance of
emotions, tolerance of others
James, M. & Johnson, D. (1996).
Drama therapy for the treatment
of affective expression in post-
traumatic stress disorder. In D.
Nathanson (Ed.), Knowing feeling:
Affect, script, and psychotherapy
(pp. 303–326). Norton.
Adults Veterans Inpatient
hospital
Once/
week
Group Mastery, positive behavioural
change, active engagement,
explore aspects of self, revision,
clarification, increased playful-
ness, fun, humour, spontaneity,
role flexibility, increased quality of
life, mourning, authentic emotions,
stress relief, optimism, aliveness,
reduce fear, increased presence,
increased attention, changes
relationship to self and others,
intimacy, self-expression, embod-
ied, experiencing, stress relief,
increased self-acceptance, forgive-
ness of self, vulnerability, integra-
tion of self/experience, increased
self-regulation, collaboration,
tolerance of emotions, tolerance of
uncertainty, desensitization
Johnson, D. R., Forrester, A. M.,
Dintino, C., James, M. & Schnee,
G. (1996). Towards a poor drama
therapy. Arts in Psychotherapy,
23(4), 293–306.
Adults General wellness Private
practice
Once/
week
Individual Increased presence, self-expres-
sion, social engagement
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Full APA citation
Population
age Clinical focus Setting
DvT
frequency
Group vs.
individual Identified benefits
Schnee, G. (1996). Drama therapy
in the treatment of the home-
less mentally ill: Treating inter-
personal disengagement. Arts
in Psychotherapy, 23(1), 53–60.
https://doi.org/10.1016/0197-
4556(95)00041-0
Adults Homelessness,
mental illness
Inpatient
hospital
Twice/
week
Group Fun, self-expression, social
engagement
Dintino, C. & Johnson, D. R.
(1997). Playing with the perpe-
trator: Gender dynamics in
developmental drama therapy.
In S. Jennings (Ed.), Drama
therapy: Theory and practice 3 (pp.
205–220). Routledge.
Adults Veterans Outpatient
care
Not
indicated
Group Increased agency, role flexibility,
reduce fear, increased self-aware-
ness, reduce violence, morality,
desensitization
Johnson, D. R. (1998). On
the therapeutic action of the
creative arts therapies: The
psychodynamic model. Arts in
Psychotherapy, 25(2), 85–99.
Children 7–9-year-old boys
with acting out
behaviour, interper-
sonal violence and
distress
Outpatient
care
Not
indicated
Group Increased agency, active engage-
ment, fun, role flexibility, increased
quality of life, changes relation-
ship to self and others, calm down,
reduce violence
Johnson, D. R. & Lewis, P. (2000).
Developmental Transformations:
Toward the body as presence.
In Current Approaches in Drama
Therapy (1st ed., pp. 87–110).
Charles C Thomas.
Adults 32-year-old woman
with depression,
overeating, low
libido, past sexual
abuse. 36-year-old
woman concerned
about intimacy
Private
practice
Partially
indicated
Individual Therapy adherence, perspective,
pleasure, healthy relationships,
intimacy, self-expression, increased
self-acceptance, psychological
symptom reduction, tolerance of
emotions
Table 1: Continued.
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286 Drama Therapy Review
Full APA citation
Population
age Clinical focus Setting
DvT
frequency
Group vs.
individual Identified benefits
Porter, L. (2000). The bifur-
cated gift: Love and intimacy
in drama psychotherapy.
Arts in Psychotherapy, 27(5),
309–320. https://doi.org/10.1016/
s0197-4556(00)00070-8
Adults Desire for romantic
connection and a
sense of meaning
Private
practice
Not
indicated
Individual Freedom, explore aspects of self,
increased flexibility, emotional
release, healthy relationships, inti-
macy, physical release, increased
self-awareness, integration of self/
experience, social engagement,
tolerance of uncertainty
Smith, A. G. (2000). Exploring
death anxiety with older
adults through Developmental
Transformations. Arts in
Psychotherapy, 27(5), 321–331.
https://doi.org/10.1016/
s0197-4556(00)00074-5
Older adults Older adults with
existential concerns
Aged care
facility
Once/
week
Group Aliveness, existential fear, changes
relationship to self and others,
intimacy, ownership, reduced isola-
tion, tolerance of emotions
Landers, F. (2002). Dismantling
violent forms of masculin-
ity through Developmental
Transformations. Arts in
Psychotherapy, 29(1), 19–29.
https://doi.org/10.1016/
S0197-4556(01)00132-0
Adults Veterans Outpatient
care
Variable Individual Increased sense of safety, increased
self-acceptance, reduce violence
Galway, K., Hurd, K. & Johnson,
D. R. (2003). Developmental
Transformations in group therapy
with homeless people who are
mentally ill. In D. J. Wiener & L. K.
Oxford (Eds.), Action therapy with
families and groups using creative
arts improvisation in clinical prac-
tice, vol. 1 (pp. 135–162). American
Psychological Association.
Adults Homelessness,
mental illness
Outpatient
care
Once/
week
Group Explore aspects of self, humour,
increased flexibility, interpersonal
investment, increased self-aware-
ness, deconstruct stereotypes,
social engagement
Table 1: Continued.
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Full APA citation
Population
age Clinical focus Setting
DvT
frequency
Group vs.
individual Identified benefits
Johnson, D. R., Smith, A. G. &
James, M. (2003). Developmental
Transformations in group therapy
with the elderly. In C. E. Schaefer
(Ed.), Play therapy with adults (pp.
78–103). John Wiley.
Older adults Physical immobility,
dementia
Aged care
facility
Once/
week
Group Increased self-acceptance, trans-
form shame
Porter, L. (2003). Death in
transformation: The importance
of impasse in drama therapy.
Arts in Psychotherapy, 30(2),
101–107. https://doi.org/10.1016/
S0197-4556(03)00025-X
Older adults General wellness Aged care
facility
Once/
week
Group Explore aspects of self, mean-
ing-making, fun, reduce fear,
self-expression, increased self-
acceptance, vulnerability, social
engagement, increased tolerance,
tolerance of contradictions
Glaser, B. (2004). Ancient tradi-
tions within a new drama
therapy method: Shamanism and
Developmental Transformations.
Arts in Psychotherapy, 31(2),
77–88.
Adults General wellness Private
practice
Not
indicated
Group Emotional release, stress relief,
changes relationship to self and
others, intimacy, physical release,
social engagement, somatic symp-
tom reduction
James, M., Forrester, A. M. &
Kim, K. C. (2005). Developmental
Transformations in the treat-
ment of sexually abused chil-
dren. In A. M. Weber & C.
Haen (Eds.), Clinical applications
of drama therapy in child and
adolescent treatment (pp. 67–86).
Brunner-Routledge.
Children Sexual abuse Private
practice
Not
indicated
Individual Increased agency, reduce fear,
increased sense of safety, trust in
caring adult, embodied, reduce
violence, somatic symptom reduc-
tion, desensitization
Table 1: Continued.
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288 Drama Therapy Review
Full APA citation
Population
age Clinical focus Setting
DvT
frequency
Group vs.
individual Identified benefits
Johnson, D. R. (2007). British
influences on Developmental
Transformations. Dramatherapy,
29(2), 3–9. https://doi.org/10.1080
/02630672.2007.9689719
Adults Unclear Private
practice
Not
indicated
Both Role flexibility
Parkinson, E. (2008).
Developmental Transformations
with Alzheimer’s patients in a
residential care facility. Arts in
Psychotherapy, 35(3), 209–216.
Older adults Alzheimer’s Aged care
facility
Not
indicated
Group Humour, reduce fear, self-expres-
sion, increased self-acceptance,
transform shame, increased
tolerance
Johnson, D. R. (2009).
Developmental Transformations:
Towards the body as presence.
In D. R. Johnson & R. Emunah
(Eds.), Current approaches in
drama therapy (pp. 89–116).
Charles C Thomas.
Adults 32-year-old woman
with depression,
overeating, low
libido, past sexual
abuse. 36-year-old
woman concerned
about intimacy
Private
practice
Once/
week
Individual Increased playfulness, increased
quality of life, improved mood,
increased self-acceptance,
forgiveness of self, increased
self-awareness
Mayor, C. (2010). Contact zones:
The ethics of playing with ‘The
Other’. Poiesis: A Journal of the
Arts and Communication, 12,
82–90.
Children Psychiatric Inpatient
hospital
Not
indicated
Group Freedom, perspective, increased
playfulness, humour, movement
repertoire, social engagement
Reynolds, A. (2011).
Developmental Transformations:
Improvisational drama therapy
with children in acute inpa-
tient psychiatry. Social Work with
Groups: A Journal of Community
and Clinical Practice, 34, 296–309.
Children Acute psychiatric
symptoms including
aggression and signs
of traumatic stress
Inpatient
hospital
Weekly Group Explore aspects of self, intimacy,
experiencing, increased self-aware-
ness, participation, tolerance of
others
Table 1: Continued.
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Full APA citation
Population
age Clinical focus Setting
DvT
frequency
Group vs.
individual Identified benefits
Butler, J. (2012). Playing with
madness: Developmental
Transformations and the treat-
ment of schizophrenia. Arts in
Psychotherapy, 39, 87–94.
Adults Schizophrenia Outpatient
care
Not
indicated
Group Increased agency, empowerment,
explore aspects of self, revision,
differentiation, meaning-making,
pleasure, increased flexibility,
increased quality of life, increased
presence, integration of self/expe-
rience, increased self-regulation,
symptom reduction
Domikles, D. (2012). Violence
and laughter: How school-based
dramatherapy can go beyond
behaviour management for
boys at risk of exclusion from
school. In L. Leigh, I. Gersch,
A. Dix & D. Haythorne (Eds.),
Dramatherapy with children
young people and schools: Enabling
creativity, sociability, communi-
cation and learning (pp. 71–82).
Taylor & Francis. https://doi.
org/10.4324/9780203138830
Children School children
with behavioural
difficulties
School Once/
week
Individual Mastery, positive behavioural
change, improved academic
performance, low drop-out rate,
increased quality of life, emotional
release, aliveness, self-expression,
physical release, increased self-
regulation, reduced violence, social
engagement
Landers, F. (2012). Urban play:
Imaginatively responsible behav-
ior as an alternative to neo-liber-
alism. Arts in Psychotherapy, 39,
201–205.
Adults General wellness Public
space
Variable Group Self-expression, vulnerability,
social engagement, tolerance of
uncertainty
Table 1: Continued.
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290 Drama Therapy Review
Full APA citation
Population
age Clinical focus Setting
DvT
frequency
Group vs.
individual Identified benefits
Landers, F. (2012). Occupy wall
street, urban play and the affir-
mation of crisis. Journal of Urban
Culture Research, 4, 40–55.
Adults General wellness Public
space
Variable Group Increased playfulness, increased
tolerance
Mayor, C. (2012). Playing with
race: A theoretical framework
and approach for creative arts
therapists: The creative arts
therapies and social justice. Arts
in Psychotherapy, 39, 214–219.
Adults General wellness College/
university
Single
session
Individual Empowerment, revision, mourning,
emotional release, changes rela-
tionship to self and others, physical
release, deconstruct stereotypes
Sajnani, N. (2012). Improvisation
and art-based research. Journal of
Applied Arts & Health, 79–86.
Adults Secondary traumatic
stress with drama
therapists working in
trauma centre
Private
practice
Variable Group Increased playfulness, humour,
increased self-awareness, reduced
isolation
Johnson, D. (2014). Trauma-
centered Developmental
Transformations. In N. Sajnani
& D. Johnson (Eds.), Trauma-
informed drama therapy:
Transforming clinics, class-rooms,
and communities (pp. 68–92).
Charles C Thomas.
Mixed Trauma Private
practice
Not
indicated
Individual Positive behavioural change,
low drop-out rate, benefits to
therapist, explore aspects of self,
differentiation, increased playful-
ness, spontaneity, improved mood,
stress relief, optimism, reduce fear,
increased attention, stress relief,
reduce violence, conforming to
social norms, symptom reduction,
psychological symptom reduction,
tolerance of emotions, tolerance of
others, tolerance of uncertainty
Table 1: Continued.
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Population
age Clinical focus Setting
DvT
frequency
Group vs.
individual Identified benefits
Omens, S. (2014). Body as
impasse: Drama therapy with
medically compromised chil-
dren. In N. Sajnani & D. Johnson
(Eds.), Trauma- informed drama
therapy: Transforming clinics, class-
rooms, and communities. Charles
CThomas.
Children Medically compro-
mised children and
grieving parents
Inpatient
hospital
Variable Individual Active part of client lives, thera-
pist flexibility, optimism, aliveness,
reduce fear, increased presence,
embodied, increased tolerance
Pitre, R. (2014). Extracting
the perpetrator: Fostering
parent/child attachment with
Developmental Transformations.
In N. Sajnani & D. Johnson
(Eds.), Trauma-informed drama
therapy: Transforming clinics,
classrooms, and communities (pp.
243–269). Charles C Thomas.
Children Trauma and attach-
ment concerns
Outpatient
care
Not
indicated
Individual Positive behavioural change,
benefits to parents and carers,
boundaries, positive cognitive
change, differentiation, perspec-
tive, pleasure, cognitive flexibility,
adaptability, increased quality of
life, mourning, stress relief, reduce
fear, attachment, changes relation-
ship to self and others, self-expres-
sion, trust in caring adult, sensory
integration, stress relief, vulnerabil-
ity, reduce violence, tolerance of
emotions, tolerance of uncertainty,
desensitization
Sajnani, N., Jewers-Dailley, K.,
Brillante, A., Puglisi, J. & Johnson,
D. (2014). Animating learning by
integrating and validating experi-
ence. In N. Sajnani & D. Johnson
(Eds.), Trauma-informed drama
therapy: Transforming clinics,
classrooms, and communities (pp.
206–242). Charles C Thomas.
Mixed Students and teach-
ers in primary school
School Variable Both Positive behavioural change, bene-
fits to teachers, improved mood,
stress relief, increased atten-
tion, self-expression, stress relief,
increased self-awareness, calm
down, improved atmosphere
Table 1: Continued.
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Full APA citation
Population
age Clinical focus Setting
DvT
frequency
Group vs.
individual Identified benefits
Dintino, C., Steiner, N., Smith,
A. & Carlucci Galway, K. (2015).
Developmental Transformations
and playing with the unplayable.
A Chest of Broken Toys: A Journal
of Developmental Transformations,
12–31.
Adults Veteran with
violent history.
HIV+ transgender
young adult with
feelings of humili-
ation, shame and
rage. Older adults
in a nursing home.
Homeless man with
schizophrenia
Multiple Not
indicated
Both Active engagement, explore
aspects of self, positive cogni-
tive change, clarification, differ-
entiation, meaning-making, fun,
cognitive flexibility, role flexibility,
mourning, authentic emotions,
optimism, aliveness, increased
presence, changes relationship
to self and others, experiencing,
deconstruct stereotypes, social
engagement, tolerance of contra-
dictions, tolerance of emotions
Miller, R., Vgenopoulou, S. &
Johnson, D. (2015). Tending
to the supervisory relation-
ship through Developmental
Transformations. A Chest
of Broken Toys: A Journal of
Developmental Transformations,
35–52.
Adults Graduate student
and DvT trainee
– general well-
ness in supervisory
relationship
DvT train-
ing (post-
graduate)
Once/
week
Individual Benefits to supervisory rela-
tionship, healthy relationships,
changes relationship to self and
others, self-expression, increased
self-awareness
Pitre, R., Sajnani, N. & Johnson,
D. (2015). Trauma-centred devel-
opmental transformations as
exposure treatment for young
children. Drama Therapy Review,
1, 41–54.
Children Children with
trauma
Private
practice
Once/
week
Individual Mastery, therapy adherence,
benefits to parents and carers,
differentiation, pleasure, increased
flexibility, role flexibility, inter-
personal investment, attachment,
vulnerability, increased self-regu-
lation, reduced violence, social
engagement, symptom reduc-
tion, somatic symptom reduction,
increased tolerance, desensitization
Table 1: Continued.
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Population
age Clinical focus Setting
DvT
frequency
Group vs.
individual Identified benefits
Armstrong, C. R., Rozenberg,
M., Powell, M. A., Honce, J.,
Bronstein, L., Gingras, G. & Han,
E. (2016). A step toward empiri-
cal evidence: Operationalizing
and uncovering drama ther-
apy change processes. Arts in
Psychotherapy, 49, 27–33. https://
doi.org/10.1016/j.aip.2016.05.007
Adults One Black adult
male – general
wellness
College/
university
Single
session
Individual Experiencing, increased self-
acceptance, psychological symp-
tom reduction
Domikles, D. (2016). Stop kick-
ing: The story of Lucy and Tracey.
A Chest of Broken Toys: A Journal
of Developmental Transformations,
129–138.
Children Abuse and neglect Outpatient
care
Not
indicated
Both Benefits to parents and carers,
differentiation, pleasure, increased
quality of life, attachment, changes
relationship to self and others, feel
witnessed, reduce violence
Pitre, R., Mayor, C. and Johnson,
D. R. (2016). Developmental
Transformations short-form as a
stress reduction method for chil-
dren. Drama Therapy Review, 2(2),
167–181. https://doi.org/10.1386/
dtr.2.2.167_1
Children 11-year-old student
with violent history
and stress
School Variable Individual Pleasure, role flexibility, emotional
release, stress relief, increased
presence, intimacy, trust in caring
adult, physical release, stress relief,
vulnerability, desensitization
Reisman, M. D. (2016). Drama
therapy to empower patients
with schizophrenia: Is justice
possible? Arts in Psychotherapy,
50, 91–100. https://doi.
org/10.1016/j.aip.2016.06.001
Adults Schizophrenia Multiple Once/
week
Individual Empowerment, explore aspects of
self, perspective
Table 1: Continued.
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294 Drama Therapy Review
Full APA citation
Population
age Clinical focus Setting
DvT
frequency
Group vs.
individual Identified benefits
Rosen, M., Pitre, R. & Johnson,
D. R. (2016). Developmental
Transformations art therapy:
An embodied, interactional
approach. Art Therapy, 33(4),
195–202. https://doi.org/10.1080/
07421656.2016.1229514
Adolescents 12-year-old male
with history of
violence
Private
practice
Not
indicated
Individual Self-expression, increased
self-awareness
McAdam, L. & Johnson, D.
(2018). Reducing depressive
symptoms in adolescents with
post-traumatic stress disor-
der using drama therapy. In A.
Zubala & V. Karkou (Eds.), Arts
therapies in the treatment of depres-
sion (pp. 48–67). Routledge.
Adolescents 15-year-old male
and 16-year-old
female with depres-
sive and PTSD
symptoms
School Once/
week
Individual Empowerment, positive behav-
ioural change, improved academic
performance, active engagement,
perspective, improved mood,
emotional release, optimism, phys-
ical release, increased self-aware-
ness, increased self-regulation,
psychological symptom reduction
Frydman, J. S. & Pitre, R. (2019).
Utilizing an embodied, play-
based intervention to reduce
occupational stress for teach-
ers. Drama Therapy Review, 5(1),
139–55. https://doi.org/10.1386/
dtr.5.1.139_1
Adults Teachers – stress
reduction
School Variable Individual Increased quality of life, stress
relief, increased presence, changes
relationship to self and others,
integration of self/experience,
increased self-regulation, calm
down
Legari, S. (2019). The direct trans-
mission of DvT. A Chest of Broken
Toys: A Journal of Developmental
Transformations, 141–158.
Adult DvT trainee DvT
Training
(postgradu-
ate)
Not
indicated
Both Benefits to supervisory relation-
ship, increased self-acceptance,
increased self-awareness
Table 1: Continued.
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Population
age Clinical focus Setting
DvT
frequency
Group vs.
individual Identified benefits
Pitre, R. & Johnson, D. (2019).
400 seconds. A Chest of Broken
Toys: A Journal of Developmental
Transformations, 182–227.
Children 8-year-old girl with
trauma, shock and
non-verbal
Private
practice
Once/
week
Individual Revision, emotional release, stress
relief, reduce fear, existential fear,
increased presence, attachment,
self-expression, embodied, physical
release, increased self-regulation,
increased tolerance, tolerance of
others, desensitization
Webb, E. (2019). Pocket play:
Playful persona as an approach
to stress-reduction in an elemen-
tary school program. Drama
Therapy Review, 5, 267–277.
Children Stress reduction School Variable Both Increased playfulness, stress
relief, self-expression, stress relief,
increased tolerance
Willemsen, M. (2020). Reclaiming
the body and restoring a bodily
self in drama therapy: A case
study of sensory-focused
trauma-centred developmental
transformations for survivors
of father–daughter incest.
Drama Therapy Review, 6(2),
203–219, https://doi.org/10.1386/
dtr_00028_1
Adults 26-year-old incest
survivor with PTSD
Private
practice
Once/
week
Individual Increased agency, empowerment,
mastery, initiate movements, active
engagement, explore aspects of
self, boundaries, positive cogni-
tive change, revision, clarifica-
tion, differentiation, perspective,
imagination, cognitive flexibility,
role flexibility, increased quality of
life, increased presence, healthy
relationships, changes relationship
to self and others, intimacy, self-
expression, embodied, experienc-
ing, sensory integration, increased
self-acceptance, vulnerability,
increased self-awareness, increased
self-regulation, transform shame,
transform guilt, desensitization
Table 1: Continued.
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296 Drama Therapy Review
included publications constituted a formal study; it involved process research.
The rest included observations made by the authors about the benefits of DvT
as demonstrated through case vignettes and, in one case, descriptive statistics.
Of the included publications, the majority (47/51) were from authors located
in the United States. Also represented were contributions from Canada (1),
the Netherlands (1) and the United Kingdom (2). Thirty-one (31) publications
were from peer-reviewed sources, and twenty entries consisted of grey litera-
ture, including book chapters and non-peer-reviewed articles.4
Authorship of the included publications was limited to David Read
Johnson, the originator of DvT, from 1982 to 1995 after which co-authored
publications began to emerge (Figure 2). There was variation and incon-
sistency with regard to whether and how details such as age group, clini-
cal focus, setting, frequency and format were reported. Included publications
presented work with children (twelve), adolescents (two), adults (28), older
adults (six), and the remaining publications included work with mixed age
groups (three). The majority of sessions took place within a private practice
(fifteen), followed by inpatient hospitals (nine), outpatient care (seven), aged
care centers (six), schools (six), training institutes (two), universities (two),
public spaces (two) and mixed settings (two). An examination of age in rela-
tion to setting, in the included publications, revealed that adults partici-
pated in DvT across settings; children were seen in outpatient and inpatient
settings as well as in schools; older adults were seen uniquely in aged care
facilities; and adolescents were minimally represented in schools and public
spaces (Figure 3).
The majority of reported sessions took place once a week (twenty); other
intervals reported were variable (nine), twice per week (three), single session
4. Amongst the included
publications were five
involving one or more
of the co-authors of
this study.
Figure 2: Authorship of included literature.
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(two), and seventeen did not indicate frequency. An equal number of reported
sessions took place within a group format (22) vs. individual format (22), while
the remaining publications referred to both individual and group sessions
(seven). When examined in relation to age, the majority of included publica-
tions involved adults in group DvT (Figure 4).
Figure 3: Age and setting.
Figure 4: Reported format by age.
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298 Drama Therapy Review
Categories of benefits
Through an analysis of the coded segments, we grouped observed bene-
fits into six general categories and an additional eleven complex categories
of benefits (Table 2). The six general categories are positive relational change,
positive cognitive change, positive emotional change, positive social change, posi-
tive physical change, positive behavioural change. The eleven complex categories
are increased tolerance, increased playfulness, increased self-acceptance, increased
self-regulation, increased agency, increased flexibility, increased dimensionalisa-
tion, symptom reduction, increased presence, increased quality of life and benefits
to others.
DISCUSSION
Before moving into a discussion of the categories of benefits observed, it is
important to note that, with the exception of one study, all the observations
were made in the context of case vignettes rather than intentional research
studies. Therefore, confidence in these findings must be calibrated accordingly.
This review also revealed several inconsistencies regarding the reporting of
practitioner training, frequency, format, population, intended goals, assess-
ment measures and outcomes, which are further discussed in the context
of recommendations. Finally, it is important to remember that the language
used to describe categories of benefits arose from a combination of in vivo and
pattern coding in combination with our own interpretations as co-researchers.
This is further discussed in the context of limitations.
Categories of observed benefits of DvT
The 95 unique coded benefits found in the selected 51 publications, distrib-
uted across six general and the additional eleven complex categories, show
a wide variety of observed benefits. While we did not conduct a comparative
analysis of theoretical versus identified benefits, it would appear that the find-
ings resemble the benefits presented in the chronological review of theoretical
benefits ascribed to DvT. The exception to this was the ‘moral benefits’ of DvT,
which were theorized to be a possible benefit of DvT in the review of literature
but were not identified explicitly in the included publications.
Discussing each of the codes in depth is beyond the scope of this arti-
cle; however, we have chosen to highlight some of our observations. The
general category of positive relational change had the largest number of coded
segments, with representation in 36 different publications, related to interper-
sonal engagement. This is consistent with Johnson and Pitre’s (2021) articula-
tion that DvT theory went through periods focusing on intimacy, encountering
others and power, all dynamics that are centred around relationships and
engagement with the ‘other’. For example, in early writing, Johnson theorized
the impact of DvT on relationships, noting that groups, in particular, could
lead to ‘increasing the sense of spontaneity, hopefulness, and life, through the
development of meaningful interpersonal relationships’ (Johnson 1985: 125).
The complex categories, however, included a mixture of the general
categories. The complex category with the highest number of representative
publications was increased tolerance (23). This is also resonant with the exist-
ing theoretical literature where it has been theorized that benefits include
the tolerance of internal states (Johnson 1991, 1992, 2013), the tolerance of
multifaceted aspects of experience (James and Johnson 1996) and, as the focus
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Table 2: Results.
Benefit (number of distinct
publications where benefit
was observed)
Sub-categories (number of distinct publica-
tions per code) Sample segments
Positive relational change (36) • Self-expression (18)
• Changes relationship to self and others (13)
• Intimacy (11)
• Attachment (6)
‘The group had been able to tolerate intimacy and find support
and forgiveness’ (James and Johnson 1996: 391).
• Healthy relationships (5)
• Trust in a caring adult (3)
• Interpersonal investment (2)
• Support (2)
‘He has been increasingly open with Claire at home about
memories of his early experiences, and there seem to be a few
barriers in their attachment with each other’ (Pitre 2014: 267).
Positive cognitive change (30) • Self-awareness (16)
• Differentiation (8)
• Perspective (6)
• Integration of self/experience
‘The therapy also helped to bring deep subconscious fears and
behavior patterns to the forefront so that they could be recog-
nized, assimilated and released’ (Porter 2000: 318).
• Revision (5)
• Clarification (4)
• Meaning making (4)
• Positive cognitive change (3)
• Imagination (1)
‘The themes of power and powerlessness permeated the session,
with the patients exploring the role of doctor and temporarily
experiencing the feeling of being one-up over a staff member,
thus gaining a new perspective on their usually second-class
status’ (Reisman 2016: 96).
Positive emotional change (28) • Stress relief (9)
• Reduce fear (9)
◦ Existential fear
◦ Security
◦ Increased sense of safety
‘Many students return to class much calmer and in an almost
introspective mood […] Students’ level of self-perceived stress
was rapidly and statistically significantly decreased by these indi-
vidual drama therapy sessions’ (Sajnani et al. 2014: 233).
• Emotional release (8)
• Optimism (7)
• Mourning (6)
‘As I double for her and Derick in response, she begins to thaw
and withdraw from that frozen, fearful place’ (Omens 2014: 278).
• Aliveness (6)
• Improved mood (4)
• Authentic emotions (3)
‘During the time of this treatment, Jamal’s depressive symp-
toms and mood dramatically improved’ (McAdam and Johnson
2019:63).
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Benefit (number of distinct
publications where benefit
was observed)
Sub-categories (number of distinct publica-
tions per code) Sample segments
Positive social change (25) • Social engagement (15)
◦ Participation (1)
• Deconstruct stereotypes (3)
‘The group began in the shame phase but advanced to the empa-
thy phase by transforming shame play into enactments of mutual
support and grieving’ (James and Johnson 1996a: 393).
• Support (2)
◦ Collaboration (2)
◦ Reduce Isolation (2)
◦ Acceptance of others (1)
‘Overall, the group members were able to practice positive inter-
personal skills and be recognized as human beings with unique
attributes’ (Galway et al. 2003: 160).
• Improved atmosphere (1)
• Morality (1)
• Conforming to social norms (1)
‘In this way, our collective improvisation was also generative in
that it disrupted the isolation that often comes with vicarious
traumatization’ (Sajnani 2012: 86).
Positive physical change (23) • Stress relief (9)
• Physical release (8)
• Experiencing (6)
‘Engaged in developmental transformations, Jamaar slowly rein-
habited his body and regained a felt sense of safety and control’
(James et al. 2005: 84).
• Embodied (5)
• Sensory integration (2)
• Increased vocalization (1)
• Movement repertoire (1)
‘Neomi starts to feel more embodied and present in and outside
of therapy […] says that she better knows where she is and more
aware of what is going on for her […] This process shows that
her bodily self is developing and her inner compass based on
sensory information and integration is evolving’ (Willemsen 2022:
212–13).
‘Jamal demonstrated evidence of physical release through tears
orbodily relaxation’ (McAdam and Johnson 2019: 63).
Increased tolerance (23) • Tolerance of emotions (9)
• Desensitization (8)
• Increased tolerance (7)
• Tolerance of others (5)
• Tolerance of uncertainty (5)
• Tolerance of contradictions (2)
‘Where the group had been depressed, fearful, hostile, the
physio -affective expression was now playful, light, spontaneous,
and more tolerant of emotional complexity and ambiguity’ (James
and Johnson 1996b: 320).
‘By the 20th session, Frankie had achieved a successful desensiti-
zation of his traumatic memory, and was able to play freely with
references to it’ (Pitre, Sajnani, Johnson 2015: 47).
Table 2: Continued.
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Benefit (number of distinct
publications where benefit
was observed)
Sub-categories (number of distinct publica-
tions per code) Sample segments
Increased playfulness (21) • Playfulness (8)
• Pleasure (8)
• Humour (6)
• Fun (5)
• Spontaneity (2)
‘His defensive posturing, when incorporated into the group,
became less rigid. His awareness of this guardedness became
more pronounced, and he was able to laugh about this with the
group’ (Galway et al. 2003: 159).
‘This play allowed for humour to be injected into serious topics,
provided a mutual and discrepant space where real differences
like age, race and therapist-patient dynamics could be explored,
and allow us to see each other in new ways’ (Mayor 2010: 87).
‘Unlike the beginning, his play was much more spontaneous,
open-ended, and relaxed, even with the direct references to his
traumatic experiences’ (Johnson 2014: 87).
Increased self-acceptance (21) • Self-acceptance (12)
• Vulnerability (7)
• Forgiveness of self (4)
• Acknowledging shame (2)
• Feel witnessed (1)
• Ownership (1)
‘They as well as the therapist benefited greatly from this group,
through which they held firmly to an appreciation for life and
learned to forgive themselves for some of their own faults’
(Johnson 1986: 31)
‘In facing death in this way, the group has chosen life, and in this
role play they have taken responsibility for the choices they made
and continue to make in life’ (Smith 2000: 328–29).
‘Elaine used this and other sessions to acknowledge her feelings
about not having children, about her fears that such a decision
would be a rejection of her mother and grandmother, and about
her doubts whether her career was the right one for her’ (Johnson
2009: 32).
Increased self-regulation (17) • Self-regulation (10)
• Reduce violence (10)
• Calm down (2)
‘The shift in play occurred simultaneously with a reduction in
their acting out behavior, interpersonal violence and distress
outside the session’ (Johnson 1998: 95).
Table 2: Continued.
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Benefit (number of distinct
publications where benefit
was observed)
Sub-categories (number of distinct publica-
tions per code) Sample segments
‘They can play at being all-powerful, and vent their destructive-
ness on the world, without really hurting anyone […] she noted
that Lucy’s aggression towards her had diminished since the
session’ (Domikles 2016: 134-135)
‘Many students return to class much calmer and in an almost
introspective mood’ (Sajnani et al. 2014: 233).
Increased agency (15) • Agency (6)
• Empowerment (6)
• Mastery (4)
• Freedom (2)
‘Neomi is developing a sense of agency and a sense of being able
to actively defend and protect herself in her daily life instead of
constantly being overwhelmed’ (Willemsen 2022: 215).
‘His playful exuberance speaks to his achievement of a state of
mastery over his past’ (Pitre, Sajnani, Johnson 2015: 51).
Positive behavioural
change(14)
• Active engagement (7)
• Behavioural change (6)
• Therapy adherence (3)
‘[P]roblem behaviors in the entire school had collapsed, includ-
ing office referrals, suspensions, and lost days due to disciplinary
actions’ (Sajnani et al. 2014: 235).
• Initiate movements (2)
• Low drop-out rate (2)
• Improved academic performance (1)
‘As Jeremy has progressed through treatment, his sexual acting-
out behaviors have disappeared. He no longer gorges on food’
(Pitre 2014: 267).
Increased flexibility (14) • Role flexibility (8)
• Flexibility (5)
• Cognitive flexibility (3)
• Adaptability (2)
‘However, during his 2 years with the group, he began to show
more flexibility in this area. Although he still did the same move-
ments, he took in the other members of the group while he
did this. He allowed other members to ‘borrow’ his movement,
something that previously upset him a great deal’ (Galway et al.
2003:159).
‘The client transcends the rigidity and stereotypical behav-
iors common to his diagnosis in these moments’ (Dintino et al.
2015:29).
Table 2: Continued.
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Benefit (number of distinct
publications where benefit
was observed)
Sub-categories (number of distinct publica-
tions per code) Sample segments
Increased dimensionaliza-
tion (13)
• Explore aspects of self (11)
• Boundaries (3)
‘Switching back and forth between punishing figure and victim
was helpful in delimiting the extent of destructive power main-
tained in his fantasy’ (Johnson 1985: 307).
Symptom reduction (12) • Psychological symptom reduction (5)
◦ Transform shame (5)
◦ Transform guilt (1)
‘He did not fight at school anymore, he had stopped urinating in
his bed at night, he was no longer afraid of monsters’ (James et al.
2005: 82).
• Symptom reduction (5)
• Somatic symptom reduction (3)
‘[B]oth students experienced dramatic reductions in their scores
on the Beck Depression Inventory’ (McAdam and Johnson
2019:64).
Increased presence (11) • Presence (9)
• Increased attention (3)
‘Neomi starts to feel more embodied and present in and outside
of therapy’ (Willemsen 2022: 212).
‘For S to allow herself to experience the moment freed of the
control of her schema is indeed an act of great courage, achieved
not through an act of strength, but of letting go’ (Pitre and
Johnson 2019: 224).
Increased quality of life
(transfer to everyday life) (11)
• Quality of life (11) ‘Jake’s quality of life at least at school was significantly better’
(Domikles 2012: 79).
Benefits to others (9) • Benefits to parents and carers (3)
• Benefits to supervisory relationship (2)
‘As a practitioner of DvT, this method has allowed me to be more
available and more successfully tolerate unplayable aspects of the
medical condition and to be an active part of the lives of the chil-
dren I encounter’ (Omens 2014: 272).
• Benefits to therapist (1)
◦ Active part of client lives (1)
◦ Feeling hopeful about participant (1)
• Benefits to teachers (1)
‘[B]etter understanding of her daughter, and their relationship
had significantly improved’ (Domikles 2016: 138).
Note: Greyed items indicate six general categories.
Table 2: Continued.
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turned towards trauma-informed DvT with its emphasis on desensitization,
a greater tolerance for anxiety and uncertainty (James et al. 2005; Johnson
2014; Pitre 2014; Webb 2019; Willemsen 2020). Rather than being firmly in
one general category, our analysis highlighted both the emotional and cogni-
tive components of tolerance, informing the creation of this complex category.
The benefits observed in the earliest selected literature (Johnson 1982,
1984, 1985, 1986) continued to recur in the literature that followed. An excep-
tion to this is that increased agency and increased presence were not observed
in those first four publications by Johnson. This relative consistency remained
despite the fact that the included literature covered a wide variety of target
groups and, over time, reflected a wider authorship beyond the originator
of the method. This may be due to the fact the categories are quite broad.
Benefits of DvT were also observed and reported not only for clients but also
for facilitators, therapists, teachers and supervisors engaged in this prac-
tice who reported feeling more hopeful and/or emotionally able to tolerate
unplayable material in encounters with students and clients, depending on
the context.
Although a majority of the DvT sessions referred to in the selected publi-
cations took place within a mental health care setting, the benefits were, on
the whole, not linked to specific symptoms or diagnoses but appeared to
refer to transdiagnostic factors – factors that cut across different mental disor-
ders like negative affectivity (Böhnke et al. 2014) related to positive emotional
change, intolerance of uncertainty (Khakpoor et al. 2019) related to increased
tolerance, repetitive negative thinking (Ehring et al. 2008) related to positive
cognitive change, emotion regulation difficulties (Cludius et al. 2020) related
to increased self-regulation and experiential avoidance (Khakpoor et al. 2019)
related to increased tolerance.
Lastly, the observed benefits were unevenly balanced across age groups.
The majority of included publications were about individual and group DvT
with adults. DvT with children and adolescents was mostly presented in
the context of individual care, while older adults were only discussed in the
context of group work. This raises questions about whether the provision of
DvT was determined by the format of care available to these age groups in
specific settings or by what clinicians considered to be most effective.
Limitations
The primary limitations of the review process itself are tied to critiques of
scoping reviews. Namely, the limitations of a scoping review are typically
associated with the lack of critical appraisal that limits its capacity to iden-
tify gaps in literature or offer recommendations concerning policy or practice
(Pham et al. 2014).
The primary limitation of the literature included in this review is that
observations were not made within the context of intentional research studies,
with the exception of one publication (see Armstrong et al. 2016). The majority
of included publications did not state a research question and were based on
case vignettes and therapist observations without a defined methodological
approach. Given the inconsistencies in reporting, it was often necessary for us
to make interpretations about the authors and their observations. For exam-
ple, in cases where the author’s training was not indicated, we relied on our
knowledge of the author. In addition, this review did not include publications
written in languages other than English.
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We also acknowledge our own biases as practitioners versed in the theory
and practice of this approach as well as the biases present in the publications
included in this review. For the most part, the benefits ascribed to the practice
of DvT were documented from the perspective of practitioners rather than
participants and, in nearly half of the included publications, were authored
or co-authored by the founder of the approach. Additionally, most of the case
vignettes were used to illustrate a DvT concept; thus, they may not be repre-
sentative of general DvT practice and likely highlight positive outcomes. It was
not possible to determine whether the articulated benefits were actually due
to DvT or external factors, or whether the benefits observed and reported by
practitioners occurred at all for the participants.
Consistent with confirmation bias, our tendency to interpret evidence in
ways that confirm existing beliefs, explanatory models used to describe DvT
influenced the kinds of benefits that contributing authors were inclined to
notice, document and report (Mynatt et al. 1977). Of course, given that we
were analysing observations reported as case illustrations of theory, this is not
surprising. For example, in Willemsen’s (2020) case study of a woman working
through the impact of incest through weekly DvT in an individual format, he
used ‘parental embodied mentalization’ with its emphasis on the development
of the bodily self as an explanatory model and, consequently, described the
benefits of DvT in similar terms such as the integration of exteroceptive and
interoceptive body sensations or sensory integration. However, this tendency
may have obscured or minimized attention to information that appeared to
fall outside of an author’s original theoretical frame.
Implications for practice and training
Notwithstanding these limitations, there remain several insights and implica-
tions arising from this review that may be beneficial for students and practi-
tioners of DvT. Considering possible benefits associated with the practice may
facilitate making more informed decisions about the suitability of DvT as an
intervention. For example, documentation about the relational benefits of DvT
may offer insights to practitioners working with clients who struggle with inti-
macy about the potential ways in which DvT may support treatment goals.
The categorization of the observed benefits may support students and
practitioners in setting treatment goals as well as identifying and document-
ing possible positive impacts of their practice. It may also aid trainees and
practitioners in finding a language to communicate observations made within
the context of their DvT practice to others involved. As revealed by this review,
such communication should include salient details such as the setting, diag-
nosis, format, frequency and outcomes of practice.
Recommendations for future research
This review revealed a need for research about the impact of DvT across age
groups, diagnoses, formats and settings. For example, there were very few
publications about DvT with adolescents, and those that existed were focused
uniquely on individual DvT. While there were multiple publications about
working with older adults, these were all in group-based format and in aged
care settings. It was not possible to determine whether this was reflective of
what is happening in practice or only an indication of what was being written
about. Future research might also focus on the intersections of age and other
aspects of identity or social determinants of health such as socio-economic
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status, access to healthcare and housing and availability of social support
networks.
Given the inconsistency of reporting, our overall recommendation to those
interested in documenting and/or researching the practice of DvT is to include
standardized information such as intended goals, frequency (e.g. once a week
for 45 minutes over six weeks), format (individual or group), the context of
intervention (i.e. school, hospital, etc.), any measures used to evaluate impact
including participant feedback, and outcomes. Documented accounts of prac-
tice should also include demographic information including the age, gender
identity, race and ethnicity and referring concern or diagnosis.
DvT practitioners are trained to facilitate using a recognizable protocol
for individual and group intervention. Manualizing this protocol, including
the operationalization of key terms (e.g. dimensionalization), would enable
research of DvT’s effectiveness and impact to be conducted by both DvT and
non-DvT researchers and further reduce the risk of bias. Further research
might also focus on specific adaptations of this protocol such as Trauma-
Centred DvT (Johnson 2014), short-form DvT (Pitre et al. 2016), urban play
(Landers 2012a) and sensory-focused Trauma-Centred DvT (Willemsen 2020).
It is necessary to organize well-designed qualitative, quantitative and
mixed-method studies with identified research questions and clearly artic-
ulated procedures towards increasingly rigorous quasi-experimental and
experimental research. Future qualitative research would benefit from a rigor-
ous analysis of the voices and perspectives of participants of individual and
group DvT in a variety of settings. Future quantitative and mixed-method
research would benefit from the use of validated measures to evaluate the
effectiveness of this approach in addressing the benefits observed in this
scoping review. Given the findings of this review with regard to the poten-
tial of DvT to increase one’s tolerance of uncertainty or facilitate positive
emotional and cognitive change, such instruments might include Dalbert’s
Uncertainty Tolerance Scale (1996), the Profile of Mood States Scale (POMS)
(McNair et al. 2003) and/or the Alternative Uses Task (AUT) (Felsman et al.
2020; Guilford 1967; Lewis and Lovatt 2013) to measure divergent thinking
as possible pre and post measures. As intolerance of uncertainty has been
correlated with both anxiety and depression (Carlton et al. 2012), this may be
a unique area where DvT may be able to offer relief and therefore should be
studied further.
Finally, future research might also examine therapeutic factors theorized
and demonstrated to contribute to the benefits observed in DvT in connec-
tion with observations made about the therapeutic factors in the creative arts
therapies (see de Witte et al. 2021), improvised dramatic interaction (Felsman
et al. 2019) and non-scripted and semi-scripted drama (Zeisel et al. 2018).
CONCLUSION
Given the interest in DvT and its use across several populations, systematic
appraisals of impact and efficacy are necessary to ethical practice. This scop-
ing review revealed six general and eleven complex categories of observed
DvT benefits in the included publications as well as significant inconsisten-
cies in documentation. These findings may support students and practition-
ers of DvT in making more informed decisions about the suitability of DvT as
an intervention and to document and communicate their observations about
the benefits of this practice to others. Findings from this review also offer us
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useful starting points from which to design focused studies on the impact of
DvT with specific age groups, settings and concerns. Finally, this review has
revealed the need for a standardized approach to documenting the impact of
DvT and increasingly rigorous methods of evaluation, which include partici-
pant voices, towards increasing confidence in and accessibility to this compel-
ling and creative approach to care.
ACKNOWLEDGEMENTS
We thank information specialists Dorine Korsten and Simone Oostendorp
of the HU University of Applied Sciences Utrecht for their supervision and
support during the development of the search protocol. We also thank Akhila
Khanna, research assistant in the Theater and Health Lab within the NYU
Program in Drama Therapy, for support with charting supplemental data.
CONFLICT OF INTEREST
The authors have no conflicts of interest to disclose.
AUTHOR CONTRIBUTIONS
All authors mutually developed the research question and aim of the article,
assessed all the publications, extracted and analysed the data, formulated the
results and contributed to the content of this article.
ETHICS STATEMENT
No ethical approval was sought to pursue this scoping review.
FUNDING
Funding was received from NYU Steinhardt Theatre and Health Lab in the
NYU Program in Drama Therapy to support the open-access publication of
this research.
APPENDIX 1: PRISMA CHECKLIST WITH APPLICABLE ITEMS
RELEVANT TO THIS SCOPING REVIEW
Checklist items Status
Title: identify as scoping review Completed
Abstract Completed
Introduction
Rationale Completed
Objectives Completed
Methods
Eligibility criteria with rationale Completed
Information sources: all databases including the dates of
the last search
Completed
Search strategy: present the full search strategies Completed
Selection of evidence: how we chose Completed
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Checklist items Status
Data collection process: specify the methods used to decide
whether a study met the inclusion criteria
Completed
Data items: list and define all outcomes for which data
were sought
Completed
Data items: list and define all other variables for which
data were sought
Completed
Study risk of bias assessment: specify the methods used to
assess risk of bias in the included studies
Completed
Synthesis: describe the process used to decide which stud-
ies were eligible for each synthesis
Completed
Results
Selection of sources using flow diagram Completed
Cite studies that might appear to meet the inclusion crite-
ria, but which were excluded and explain why
Completed
Characteristics of the evidence Completed
Results of individual sources Completed
Discussion
Summary Completed
Limitations Completed
Conclusions Completed
Other information
Registration and protocol: provide information for the
review, including register name and registration number
Completed
Indicate where the review protocol can be accessed Completed
Describe and explain any amendments to information
provided at registration or in the protocol
Completed
Support: describe sources of financial or non-financial
support for the review
Completed
Declare any competing interests of review authors Completed
Report which of the following are publicly available and
where they can be found: template data collection forms;
data extracted from included studies; data used for all anal-
yses; analytic code; any other material used in the review
Completed
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SUGGESTED CITATION
Sajnani, Nisha, Willemsen, Marc and Butler, Jason D. (2023), ‘A scoping review
of observed benefits of Developmental Transformations (DvT)’, Drama
Therapy Review, 9:2, pp. 273–315, https://doi.org/10.1386/dtr_00133_1
CONTRIBUTOR DETAILS
Nisha Sajnani, Ph.D., RDT-BCT, is the director of the Program in Drama
Therapy and Theatre and Health Lab at New York University (NYU). She
is a graduate of the Institute of Developmental Transformations, princi-
pal editor of Drama Therapy Review (DTR), past president of the North
American Drama Therapy Association (NADTA), and founding member
of the World Alliance of Drama therapy. Dr Sajnani is the co-founding,
co-director of the Jameel Arts & Health Lab established in collaboration
with the WHO.
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Contact: New York University, 35 W. 4th Street, New York, NY 10012, USA.
E-mail: nls4@nyu.edu
https://orcid.org/0000-0001-5805-6179
Marc Willemsen, MA, is a registered drama therapist and a senior lecturer
at the HU University of Applied Sciences in the Netherlands. He is a Ph.D.
candidate at the Open University, connected to the HU research centre for
youth and the collective research centre for arts therapies, KenVaK. He initi-
ated the shared practice Het Speelvlak and joined 1nP. He is a graduate of
the Institute for Developmental Transformations, a registered psychodrama
therapist, a supervisor and a group therapist. He is an EFD board member and
co-training director of DvT Netherlands.
Contact: HU University of Applied Sciences Utrecht, De Nieuwe Poort 21 in
Amersfoort, the Netherlands.
E-mail: marc.willemsen@hu.nl
https://orcid.org/0000-0002-6318-8907
Jason D. Butler, Ph.D., RDT-BCT, LCAT, is a professor and chair in the
Expressive Therapies Department at Lesley University and the editor-in-
chief for The Arts in Psychotherapy. He is a former president of the North
American Drama Therapy Association and the previous training director for
DvT Montreal.
Contact: Lesley University, 29 Everett St, Cambridge, MA 02138, USA.
E-mail: jbutler8@lesley.edu
https://orcid.org/0000-0003-4509-7558
Nisha Sajnani, Marc Willemsen and Jason D. Butler have asserted their right
under the Copyright, Designs and Patents Act, 1988, to be identified as the
authors of this work in the format that was submitted to Intellect Ltd.
