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Classroom Drama Therapy Program for Immigrant and Refugee Adolescents: A Pilot Study

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This evaluative study assesses the effects of a school drama therapy program for immigrant and refugee adolescents designed to prevent emotional and behavioral problems and to enhance school performance. The 9-week program involved 136 newcomers, aged 12 to 18, attending integration classes in a multiethnic school. Pretest and posttest data were collected from the students and their teachers. The self-report and teacher's forms of the Strengths and Difficulties Questionnaire were used to assess emotional and behavioral symptoms. At the end of the program, although there were no reported improvement in self-esteem or emotional and behavioral symptoms, the adolescents in the experimental group reported lower mean levels of impairment by symptoms than those in the control group, when baseline data were controlled for. Their performance in mathematics also increased significantly compared to that of their control peers. The findings suggest that the workshops may have an impact on social adjustment of recently arrived immigrants and refugees. This drama therapy program appears to be a promising way of working preventively and in a nonstigmatizing manner with adolescents who have been exposed to diverse forms of adversity, among which are war and violence.
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Psychiatry
Clinical Child Psychology and
http://ccp.sagepub.com/content/12/3/451
The online version of this article can be found at:
DOI: 10.1177/1359104507078477
2007 12: 451Clin Child Psychol Psychiatry
Viger Rojas, Alejandro Moran and Dominique Bourassa
Cécile Rousseau, Maryse Benoit, Marie-France Gauthier, Louise Lacroix, Néomée Alain, Musuk
Pilot Study
Classroom Drama Therapy Program for Immigrant and Refugee Adolescents: A
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Classroom Drama Therapy Program for
Immigrant and Refugee Adolescents:
A Pilot Study
CÉCILE ROUSSEAU
McGill University and Montreal Children’s Hospital, Canada
MARYSE BENOIT, MARIE-FRANCE GAUTHIER, LOUISE
LACROIX, NÉOMÉE ALAIN, MUSUK VIGER ROJAS,
ALEJANDRO MORAN, & DOMINIQUE BOURASSA
Montreal Children’s Hospital, Canada
ABSTRACT
This evaluative study assesses the effects of a school drama therapy program for
immigrant and refugee adolescents designed to prevent emotional and behavioral
problems and to enhance school performance. The 9-week program involved 136
newcomers, aged 12 to 18, attending integration classes in a multiethnic school.
Pretest and posttest data were collected from the students and their teachers. The
self-report and teacher’s forms of the Strengths and Difficulties Questionnaire
were used to assess emotional and behavioral symptoms. At the end of the
program, although there were no reported improvement in self-esteem or
emotional and behavioral symptoms, the adolescents in the experimental group
reported lower mean levels of impairment by symptoms than those in the control
group, when baseline data were controlled for. Their performance in mathematics
also increased significantly compared to that of their control peers. The findings
suggest that the workshops may have an impact on social adjustment of recently
arrived immigrants and refugees. This drama therapy program appears to be a
promising way of working preventively and in a nonstigmatizing manner with
adolescents who have been exposed to diverse forms of adversity, among which
are war and violence.
KEYWORDS
adolescents, adjustment, drama therapy, immigrant, prevention, refugee
IN THE PAST few decades, emigration has become a way to flee countries where
organized violence prevails, whether in the form of internal armed conflict or a repres-
sive regime responsible for major social upheaval. As a result, many newly arrived
children and adolescents, immigrants and refugees alike, have been exposed to violent
Clinical Child Psychology and Psychiatry Copyright © 2007 SAGE Publications
Vol 12(3): 451–465. DOI: 10.1177/1359104507078477 www.sagepublications.com
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events in their homelands and, being socially disadvantaged, may remain in violent
neighborhoods even after migration (Jaycox et al., 2002; Rousseau & Drapeau, 2004).
Schools, which are the main point of contact between these adolescents and the host
society, are in a key position to implement prevention programs based on ecological
CLINICAL CHILD PSYCHOLOGY AND PSYCHIATRY 12(3)
452
ACKNOWLEDGEMENTS: This research was supported by a grant from the Fonds Québécois
de la Recherché sur la Santé et la Culture (FQRSC). Statistical expert: Maryse Benoit. The
authors have no financial relationships to disclose.
CÉCILE ROUSSEAU, PHD is an associate professor of psychiatry at McGill University
and directs the Transcultural Child Psychiatry Research Team at the Montreal Children’s
Hospital. Her clinical work is with refugee and immigrant children, mainly in the area of
trauma and psychosis, and she consults for health institutions and school boards. Her
current research involves evaluation of programs for refugee children and adolescents in
schools.
CONTACT: Cécile Rousseau, Director, Child Transcultural Psychiatry Team, Montreal
Children’s Hospital, 4018 Ste-Catherine Street West, K-107, Montreal (Quebec), H3Z 1P2
Canada. [E-mail: cecile.rousseau@muhc.mcgill.ca]
MARYSE BENOIT has been associated for 3 years with Cécile Rousseau’s Transcultural
Psychiatry Team at the Montreal Children’s Hospital. She completed her PhD at Quebec
University in Montreal. Interested in trauma and posttraumatic adjustment, she has co-
ordinated research projects on posttraumatic stress at the National Center for PTSD in
Menlo Park (California). She is pursuing her postdoctorate studies at McGill University.
MARIE-FRANCE GAUTHIER has a Masters degree in arts therapy from Concordia
University in Montreal and has been working for many years with Cécile Rousseau in the
transcultural psychiatry team of the Montreal Children’s Hospital. Interested in prevention
interventions, she is highly involved in the development of the theater activity. She is the
director of the Pluriel team and is in charge of the clinical part of the drama therapy projects
in high schools.
LOUISE LACROIX is art therapist and assistant professor in the Creative Arts Therapies at
Concordia University, and clinician in a Transcultural Psychiatric Clinic. Her research
interests are in the transcultural domain with immigrants and refugee children and
adolescents. Her implications are to develop and implement creative expression workshops
in multiethnic schools.
NÉOMÉE ALAIN is an art therapist and a social worker.
MUSUK VIGER ROJAS is a Peruvian-Canadian psychologist. He holds a Masters degree in
clinical psychology from University of Montreal. Also interested in anthropology, he has been
working for many years in ethnopsychiatry with immigrant families. He is part of the Pluriel
team as a comedian and musician.
ALEJANDRO MORAN achieved his drama studies at the drama school of Fine Arts in
Mexico City, and at Jacques Lecoq’s movement, mime and mask school in Paris. He works as
an actor and as a drama teacher in Mexico, France and Canada. He works with Pluriel at the
Children’s Hospital in Montreal and he is the artistic director of the Ollín Teatro Transfor-
mación, playback in Montreal.
DOMINIQUE BOURASSA is a comedian.
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principles to enhance young people’s ability to adapt to their new lives (Bolloten &
Spafford, 1998; Rasco & Miller, 2004; Tolfree, 1996).
Building on the literature describing the usefulness of creative expression programs
for immigrant and refugee children in clinical and community settings (Danev, 1998;
Lopez & Saenz, 1992; Miller & Billings, 1994), a Montreal team composed of schools,
community organizations and health professionals developed a set of prevention
programs. Their aim is to help newly arrived children and adolescents bridge the gap
between home and school, past and present, as well as to work through experiences of
loss and trauma (Rousseau, Bagilishya, Heusch, & Lacroix, 1999; Rousseau, Drapeau,
Lacroix, Bagilishya, & Heusch, 2005; Rousseau & Heusch, 2000; Rousseau, Lacroix,
Bagilishya, & Heusch, 2003; Rousseau, Singh, Lacroix, Bagilishya, & Measham, 2004).
Through repeated qualitative evaluations, four key elements associated with the
effects of the workshops were identified: Constructing a safe space, acknowledging and
valuing multiplicity, establishing continuity, and transforming adversity (Rousseau et al.,
2004). A quantitative evaluation of the elementary school program showed that it signifi-
cantly increased children’s self-esteem and decreased their level of emotional and
behavioral symptoms (Rousseau, Drapeau, et al., 2005).
As part of this set of prevention programs, the program offered to adolescents in high
schools is based on drama expression. Drama has a number of advantages over group
discussion therapy for adolescents (Novy, 2003; Slusky, 2004) and this is particularly true
for immigrant and refugee adolescents (Couroucli-Robertson, 2001): First, it facilitates
the nonverbal expression that is so important to young people who have verbal limi-
tations; second, it allows conflicts expression and an exploration of a variety of avenues
that might lead to solutions to be acted out in a safe environment (Shuttleworth, 1981).
For teenagers, theater is also a place where they can play with metaphors, and through
them, step back from personal, family, and group experiences and make them their own
(MacCormack, 1997). In a school setting, drama promotes social growth through
noncompetitive activities that emphasize shared responsibilities and teamwork
(McCaslin, 1981). Although most of these interventions have not been systematically
evaluated, a randomized trial comparing an intervention using drama-group therapy to
a curriculum-studies control and to a waiting list control suggests that the drama inter-
vention is more efficient than the other modalities and that the effects sustained over a
year-long follow-up period (McArdle et al., 2002).
Drama is a very specifically human experience. The ability to represent others, to
transform oneself, to alter one’s state of consciousness, are common features of
otherwise quite different types of theater (Schechner, 1985). The opportunity to play
with different or ambivalent identities is one of the keys to the transformative power of
theater. This transformation of consciousness takes place within a ritual framework that
ensures safety for all participants (Myerhoff, 1990) making it possible to hold the stories,
images and emotions evoked. Ritual thus becomes at once a form of knowledge, a
method of learning, and a way of acquiring a sense of agency (Brockett, 1977).
Playback theater is a type of improvisational theater whose goal is to achieve personal
and social transformation through sharing experiences within a ritual space (Fox, 2000a,
2000b). By transforming the framework of time and space it introduces a distance from
reality which facilitates the work around a shared intention based on the participant’s
awareness of a social and ethical responsibility. This may take place around a specific
theme (i.e. racism, migration, inequality), or more broadly, a commitment to social
justice. Playback theater is used in over 30 countries with different age groups in a
variety of settings (schools, hospitals, workplaces, community centers). It borrows from
Moreno’s Forum Theater (Moreno, 1947) the desire to reach out to the silenced, the
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isolated, those who define themselves, or are perceived, as different. It is also inspired
by Boal’s (1979) and Freire’s (1970) wish to promote a position of subject for the margin-
alized and excluded, which can empower them to transform themselves and their
environment. Thus, Playback theater, by acting out personal stories from contemporary
society, shakes up or temporarily abolishes the established social structures in order to
enable new relationships to emerge within the group (Fox, Muennich Cowell, & Mont-
gomery, 1994).
This article presents the results of the quantitative evaluation of high-school drama
therapy workshops for newly arrived immigrant and refugee adolescents that aimed to
facilitate social adjustment, reduce emotional and behavioral symptoms, and improve
self-esteem and school performance.
Description of the program
The program is based on Augusto Boal’s forum and Jonathan Fox’s playback theater.
It was developed gradually over a period of 3 years by the Transcultural Psychiatry Team
at the Montreal Children’s Hospital, in partnership with the creative arts therapies
program at Concordia University and the French-language St. Luc High School in Notre
Dame de Grâce, a multiethnic district in Montreal with a high proportion of recently
arrived immigrants and refugees.
The goal of the drama therapy program was to give young immigrants and refugees a
chance to reappropriate and share group stories, in order to support the construction of
meaning and identity in their personal stories and establish a bridge between the past
and present.
The drama project team, called Pluriel, is composed of two men and four women aged
20 to 55 from a variety of cultural backgrounds. They have training in psychology and/or
creative arts therapies, as well as in the arts (music, visual arts, theater). All had prior
experience of working with children and teens and were familiar with theater techniques,
improvisation and therapy involving difficult psychosocial issues.
The workshop is part of the regular school day. The teachers are present and partici-
pate at will, by commenting or contributing a personal story for example. The students
take part in nine weekly 75-minute sessions.
Within a safe and respectful atmosphere, a play director co-ordinates and contains the
story told by an adolescent as it unfolds, while actors and musicians gather the infor-
mation in order to play the story back to the teller and the group, sometimes as early as
Week 2. Adolescents join in to play with the team. The stories told can be transformed
and replayed through alternative scenarios developed by the group of adolescents. The
idea is to alter the situation to empower the storyteller and the others, either by changing
the meaning, building a relationship, or creating an opening or dialogue with others that
was missing from the original story. This part of the workshop becomes a collective effort,
focusing on cocreating a story or situation where the adolescents look for alternatives to
their first reactions and strategies.
All the workshops are organized along the same lines over the 10 weeks, although
student involvement and topic complexity often gradually increase as participants
become more comfortable with the medium. Each week, the Pluriel team members
introduce a topic by each relating a brief personal experience. The students are then
invited to express their experiences or concerns on the topic using fluid sculptures, rants,
pairs and other reflective techniques, which have been refined by playback and Boal’s
forum theater. Using sound, movement, and a few words, they rely mostly on images and
work with metaphor to reflect the point of view and the feelings of the teller. For
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example, the pairs technique is used to reflect a person’s contradictory feelings, and the
rants simultaneously reflect different points of view of the same situation or experience.
They can help broaden the perception of a situation by representing a plurality of
internal and external voices. The topics are broad and are presented in an open-ended
way to prompt the exploration of ideas and feelings associated with key experiences,
such as migration, families, moving from one culture to another, belonging, and not
belonging. For example, participants are encouraged to talk about a situation that makes
them feel good or in which prejudice or racism plays a role. Some topics lead to an
exploration of power relationships, expectations, and other common constraints on
young people. The last workshop deals with expectations of the future, hopes and
dreams, and the worries that go along with them. A number of youth stories evoke
experiences of adversity. Some speak, directly or indirectly, of the insecurity in the
country of origin.
A youth from Sri Lanka recounted a story about his childhood:
He was 6 years old and had been left alone at home by his parents who warned him not
to open the door. Someone knocked on the door. He did not want to open to the man he
could see through the window. He tried to phone his father but did not succeed. He was
terrified because of the stories he had heard about criminals entering the houses to steal
and kill. He threw a chair in the window and hid under the covers in his bed. In the
morning he heard his parents talking with the man he had been afraid of, who turned out
to be a Canadian friend. ‘He was not dangerous and gave me chocolate, but I had been so
afraid’.
For this youth the most important feature of this story is the feeling of helplessness
when he could not reach his father. In his memory, Sri Lanka is associated with terror
and feelings of abandonment, while Canada evokes a more benign environment. For
him, the storytelling and acting were associated with the sharing of strong emotions and
subsequent relief. It appeared to be a form of working through premigratory and family
issues. Other youth stories highlighted adversity in the host country.
A teenage girl from the Middle East shares with the class that she is afraid of her ex-
boyfriend. After a brief period of dating, she broke off the relationship because she
realized he was ‘doing bad things’. He subsequently called her mother and even her
brothers in the country of origin, accusing her of bad conduct. Her mother was worried
and the rest of her family upset and angry with her. Her best friend seems not to take her
seriously. She became quite sad during the storytelling and acting. The boys in the group
showed solidarity and proposed to help, even if sometimes in inappropriate ways (suggest-
ing to ‘beat up’ the ex-boyfriend). The teacher also was concerned and suggested different
solutions. The girl felt supported and somehow protected. The intervention gave her story
legitimacy and provided her both with a solidarity network and with a feeling of agency
because the group believed in her capacity to defend herself and stand up in front of
intimidation.
Once or twice during the program, or when participants seemed to be stuck or reticent
to share stories spontaneously, sometimes because of the sensitivity of the topics, the
team used a tool called a ‘story house’, developed by one of its members to address
specific themes, such as violence or migration. Each participant writes a three-sentence
story on a sheet of paper. The stories may stem from their own experiences, or things
they have heard about; they may be either very close to or seemingly quite far removed
from what they have experienced themselves. The stories are then posted around the
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room and the participants vote on the ones they wish to see acted out. All of the stories
remain posted throughout the session and it is emphasized that those not selected are
just as important and meaningful as those that are.
One of the team’s goals is to convey the story through the use of images and
metaphors. The use of verbal language is limited in order to emphasize sound,
movement, and rhythm. Youth rapidly become familiar with this means of expression
and use the simple means available (colorful fabrics and music instruments) very
effectively in their improvisations. For example, they may use a piece of red cloth to
represent fire or blood as well as to dress up for a ball. To alleviate slightly the constraints
of expressing oneself in host-country language students are encouraged to use their
native language and the group follows the musicality and intonation of the voice, while
translation is provided whenever peers or team members can help by interpreting. It is
interesting, however, to note that while some emotions have to be expressed through
their mother tongue, the teens often prefer to use a foreign language to create a distance
from the emotional experience and decrease its intensity.
Qualitative evaluation suggests that the ritual nature of the drama therapy workshops
provides a safe environment for the adolescents to express themselves. Witnessing the
reenactment of their traumatic stories as well as their hopeful stories of resilience allows
the adolescents to transform adversity directly, indirectly (by witnessing others) or
metaphorically. The workshops empower the adolescents by emphasizing the strengths
that stem from adversity and provide them with an opportunity, through the playback
of their stories, to construct meaning and grieve some of the losses associated with their
migration and premigration experiences (Rousseau, Gauthier, et al., 2005).
Method
Overview
Data collection occurred during the school year of 2003–2004. The drama workshops
were held in five integration classes in a multiethnic high school in Montreal. Inte-
gration classes are attended by newly arrived refugee and immigrant youth to help them
to learn French, the mainstream language in Quebec.
As opposed to other high-school classes, the integration classes have two main
teachers, a French teacher with which the students spend most of their time and a
mathematics teacher. The French teachers attached to these classes by the school at the
beginning of the year were randomly assigned to the experimental versus control group.
There were no exclusion criteria and all the students in the randomized classes were
included in the pool of potential participants. Youth under the age of 18 gave written
assent for participation as well as one of their parents or legal guardians. The ethical
review committee of the Montreal Children’s hospital approved all the procedures.
Some 79.2% of the adolescents and their parents who were asked consented to the
research and 8% of the participants in the initial sample dropped out during the course
of the study because they changed classes or school. A total of 123 adolescents aged 12
to 18 took part in the whole study; 66 in the experimental group and 57 in the control
group. Adolescents in the experimental group who did not consent attended the
workshops, but no data were collected on them. Adolescents did not receive a monetary
compensation for their participation.
Pre and postassessment
Data were collected before and after the program. Project staff, composed of four
research assistants from different cultural background and languages, distributed the
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assessment questionnaires (described later) to the participants in the experimental and
control groups. Participants sat apart from each other and were instructed to keep their
response confidential. Project staff remained available to answer questions and assist
with reading and comprehension difficulties. When the 9-week workshops were done,
the participants in both groups were invited to repeat the assessment questionnaires.
Teachers were also asked to complete the questionnaires at pre and postassessment.
Assessment questionnaires
Emotional and behavioral symptoms were assessed with the Strengths and Difficulties
Questionnaire (SDQ; Goodman, 1999) completed by the adolescents and by the
teachers. This 25-item Likert scale was completed by the teachers and adolescents. The
psychometric properties of the SDQ are good (Goodman, 2001). The SDQ has been
translated into more than 20 languages and has been widely used in culturally diverse
settings (Bourdon, Goodman, Rae, Simpson, & Koretz, 2005; Goodman, Renfrew, &
Mullick, 2000). A choice of the French or English version was offered to the adolescents,
but a version in their native tongue was available on request. The teachers received a
French version. The SDQ also includes an impact supplement that enquires about
symptoms in terms of chronicity, distress, social impairment, and burden for others. In
our study, internal consistency of the self-report version was satisfactory, although not
high, with Cronbach’s alphas ranging from .53 for the total SDQ score at T1 and .73 at
T2. The internal consistency of the self-report Impairment Impact Supplement was
excellent (α = .96). Internal consistency of the teacher’s version was also high (α = 0.91
at T1 and 0.90 at T2).
Self-esteem was assessed with the self-esteem scale (SES), a 10-item Likert scale
(Rosenberg, 1965) (α = .90).
School performance was assessed on the basis of the first and the last report cards of
the school year. The first report was issued in November, before the beginning of the
program, and the last one was issued in June. We considered the grade point average
(GPA) in mathematics and French, the two compulsory subjects in integration classes.
It is to be noted that all the teachers were blind to the fact that school performance was
part of the study assessment and that the mathematics teachers, who did not participate
in the intervention, were also blind to the experimental versus control status of their
students.
Statistical analysis
The effects of the drama workshops on the young people’s emotional and behavioral
symptoms were assessed with univariate generalized linear models (GLMs). The statisti-
cal significance of the program was assessed with t-tests for the experimental status
coefficient adjusted for the baseline measure of the outcome under study to control for
the initial difference between the experimental and control groups. To gain a better
understanding of gender differences, independent GLMs were also conducted for each
gender. The fit of each model was checked by residual analysis.
Results
Table 1 summarizes gender distribution, age and continent of origin of the adolescents.
Most were from Asia, Eastern Europe, and South America. Continent of birth did not
significantly influence the effect of the program and thus was not controlled for in the
statistical analysis. The gender ratio was roughly equal in the control group, but there
were more boys (60%) than girls (40%) in the experimental group. The mean age was
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similar in both groups. At the moment of the study, 75% of the participants had been in
Canada for less than a year, 15% for between one and two years, and 10% for more than
two years. Regarding the immigration status at preassessment, 60% of the participants
were permanent residents, 15% were refugees or waiting for a status, and 25% had no
idea of their parents’ status. The majority of the refugee participants were from Asia
(53%) or South America (33%), while the majority of the permanent residents were
from Eastern Europe (42%). At preassessment, the majority of the participants reported
to understand well or very well French (68%) and/or English (56%).
To compare the emotional and behavioral symptoms of the two groups at baseline,
independent t-tests were performed on the SDQ self-report and teachers’ report scores.
The t-tests showed that the mean self-report score was significantly higher at baseline in
the experimental group than in the control group (t = 2.312, df = 121, p = 0.022). No
significant group differences were found in the teachers’ reports at baseline.
Paired sample t-tests measuring the differences between baseline and postinterven-
tion (Table 2) and regression analysis controlling for group differences at baseline did
not show significant differences at posttest between the experimental group and the
control group with regard to emotional and behavioral symptoms reported either by the
adolescents or their teachers.
However, paired sample t-tests (Table 2) and regression analysis controlling for group
differences at baseline (Table 3) performed on the distress and impairment perception,
as measured by the SDQ Impact Supplement, showed a significant effect of the inter-
vention on the adolescents’ perception of the impact of their symptoms on different
aspects of their lives (general distress, home life, friendships, classroom learning, leisure
activities, and total impact score). The participants in the experimental group reported
less impact in all categories except learning at posttest, whereas those in the control
group reported more impact on distress (t = –2.353, df = 56, p = 0.022) and friendships
(t = –2.191, df = 56, p = 0.033), and a higher total impact score (t = –2.159, df = 56,
p = 0.035). No significant group differences were found in the teachers’ reports.
Independent t-test analysis showed significant differences between the groups at
baseline. Participants in the experimental group reported a greater impact than those in
the control group for all categories. Thus, regression analysis controlling for the group
differences at baseline (Table 3) showed that the therapy had significant effects on the
CLINICAL CHILD PSYCHOLOGY AND PSYCHIATRY 12(3)
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Table 1. Demographic characteristics
Experimental Control
——————— ——————–——
n = 66 n = 57
Gender
Boys (%) 60 53
Girls (%) 40 47
Age
Mean 15 14
SD 1.4 1.4
Origin (%)
Asia 31 58
Eastern Europe 38 23
South America 22 14
Middle East 7.5 5
Africa 1.5 0
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perception of distress (β = –.183); on the perception of impairment of home life
(β = –.183), friendships (β = –.187), and leisure activities (β = –.172); and on the total
impact score (β = –.194).
Additional statistical analyses considering immigration status and length of time since
the participants’ arrival showed no differential effect on the symptoms at baseline or on
the response to the intervention. However, paired sample t-test analysis revealed a
ROUSSEAU ET AL.: CLASSROOM DRAMA THERAPY PROGRAM
459
Table 2. Mean pre- and posttest SDQ scores for emotional and behavioral symptoms and
impairment perception – paired sample t-tests
Experimental Control
———————————— ————————————–
N = 123 Before After Paired t-test Before After Paired t-test
Emotional and behavioral symptoms
Self-report 13.30 13.23 .126 11.46 11.89 –.701
Teacher’s report 6.38 6.05 .682 5.63 5.07 1.163
Impairment perception (Impact Supp.)
Self-report
Difficulties upset or distress me 1.15 .82 2.462* .58 .93 –2.353*
Interfere with home life 1.08 .68 3.089* .53 .82 –1.839
Interfere with friendships 1.26 .80 3.363** .53 .84 –2.191*
Interfere with classroom learning 1.12 .83 1.754 .61 .91 –1.720
Interfere with leisure activities 1.00 .65 2.789* .51 .82 –1.818
Total impact score 5.61 3.79 3.085* 2.75 4.33 –2.159*
Teacher’s report
Difficulties upset or distress
adolescent 1.29 1.27 .116 1.09 1.18 –.697
Interfere with friendships 1.21 1.21 .000 1.12 1.25 –.828
Interfere with classroom learning 1.45 1.44 1.21 1.39 1.44 –.394
Total impact score 3.95 3.92 0.093 3.60 3.86 –.718
Self-esteem 28.77 28.68 0.173 28.72 28.68 0.075
* p < 0.05; ** p < 0.01.
Table 3. Effects of drama therapy program on distress and impairment perception
a
N = 123 Beta t-test
b
Self-report
Difficulties distress me –.183 –2.289 (.024)
Interfere with home life –.183 –2.192 (.030)
Interfere with friendships –.187 –2.310 (.023)
Interfere with classroom learning –.120 –1.404 (.163)
Interfere with leisure activities –.172 –1.988 (.049)
Total impact score –.194 –2.378 (0.019)
Teacher’s report
Difficulties
Distress adolescent .009 .113 (.91)
Interfere with friendships –.038 –.472 (.637)
Interfere with classroom learning –.017 –.257 (.798)
Total impact score –.021 –.276 (.783)
ª Regression coefficient for experimental status (exp. = 1; cont. = 0) after controlling for baseline value of
outcome.
b
t statistic (p value in parentheses) for test of significance of regression coefficient.
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gender effect on the perception of impairment and distress: Girls in the experimental
group showed a significant decrease on the total impact score (t = 3.781, df = 25,
p = 0.001), whereas boys in the control group showed a significant increase on the total
impact score (t = –2.309, df = 29, p = 0.028) (Figure 1). No age effect was observed.
With regard to self-esteem, paired t-test analysis did not show significant differences
within groups between pre and post assessment. Independent t-test analysis did not show
between group differences at baseline.
With regard to school performance (Table 4), paired sample t-test analysis comparing
the first and last report cards of the school year showed a significant difference in oral
expression for both groups (experimental group: t = –4.022, df = 62, p = 0.000; control
group: t = –3.607, df = 55, p = 0.001) and a significant improvement in mathematics for
the experimental group (t = –2.890, df = 62, p = 0.005). Although independent t-tests did
not show significant group differences at baseline, the GPAs in French (including oral
expression) and mathematics were higher in the experimental group than in the control
group at baseline. Regression analysis controlling for group differences at baseline
confirmed significant posttest differences in mathematics GPAs between the experi-
mental and the control group (β = –.167). No significant improvement was reported in
either group between the first and the last report cards with regard to overall French
results.
Further paired sample t-test analysis showed a gender effect on improvement in
the GPAs for French and mathematics. Figure 2 illustrates a bigger improvement on
both measures for the boys in the experimental group than for those in the control
group. Specifically, the boys in the experimental group showed a significant improvement
in their French (t = –2.708, df = 36, p = 0.01) and mathematics results (t = –2.836,
df = 36, p = 0.007) between the first and the last report cards, while the boys in the control
group did not (French: t = –.420, df = 27, p = 0.678; mathematics: t = –0.938, df = 26,
p = 0.357). Regression analyses controlling for group differences at baseline were not
significant.
CLINICAL CHILD PSYCHOLOGY AND PSYCHIATRY 12(3)
460
0
1
2
3
4
5
6
7
Pretest Posttest
Mean SDQ Impairment Scores
Girls intervention Girls control
Boys intervention Boys control
Figure 1. Gender differences on mean pre and posttest SDQ total impact scores.
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Discussion
Although the drama workshops do not have a direct effect on symptoms reported by
adolescents or teachers, they do significantly decrease the adolescents’ overall per-
ception of impairment by symptoms and decrease the symptoms’ interference with
friendships, home life, and leisure activities.
Impairment is an inherent component of most childhood diagnoses, and in particular
of posttraumatic stress disorder (American Psychiatric Association [APA], 1994).
However, in the field of trauma studies, researchers have frequently focused more on
the number of symptoms than on how these affect everyday life (Eyber & Ager, 2004).
In the literature on refugees, a noticeable gap between symptoms and social adjustment
in traumatized and yet well functioning adolescents is often reported, indicating that in
spite of adversity, they are able to adapt to their new lives (Mollica, Poole, Son, Murray,
& Tor, 1997; Sack, 1999; Tousignant et al., 1999). The decrease in impairment observed
suggests that the drama workshops may consolidate the adolescents’ adaptation to
their new milieu and may be a good strategy to help them cope with the challenges of
ROUSSEAU ET AL.: CLASSROOM DRAMA THERAPY PROGRAM
461
Table 4. School performance as measured by GPAs on first (November) and last (June) report
cards of school year – paired sample t-tests
Experimental Control
———————————— ————————————–
First Last Paired t-test First Last Paired t-test
Oral expression 4.27 5.21 –4.022* 3.77 4.82 –3.607*
French (total results) 16.98 17.81 –1.482 15.73 16.70 –1.281
Mathematics 4.35 4.94 –2.890* 3.96 3.91 .185
* p < 0.05.
Figure 2. Differences in boys’ French and mathematics GPAs between first and last report cards.
3.7
3.9
4.1
4.3
4.5
4.7
4.9
First Second
Mean scores in French and Maths
Control boys – French
Intervention boys – French
Control boys – maths
Intervention boys – maths
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reconstruction, even though there is still some emotional turmoil associated with this
adjustment period.
It is to be noted that, in this study, refugee children did not report more symptoms that
their migrant counterparts. A recent study in Montreal (Rousseau & Drapeau, 2004)
shows that premigratory traumatic experiences are as common and are associated with
as much symptoms in migrant and refugee families in Quebec in the last decade. This shift
in profile of immigrant, from economic migrant to political migrant, may be responsible
for this absence of difference observed.
The workshops also improved school performance, especially in mathematics, indi-
cating that the subjective self-reported perception of decreased impairment is also
associated with an objective improvement in functioning in some domains. As expected
in a welcoming class, oral French expression also improved significantly in both experi-
mental and control groups during the year. The improvement seemed more important
in the experimental group, although it was not statistically significant, probably because
of the limited sample size.
Interestingly, this positive change was not reflected in the teachers’ reports. In focus
groups, teachers from the experimental group (and their colleagues in the qualitative
assessment) (Rousseau, Gauthier, et al., 2005) spoke of the perceived benefits of the
therapy and the fact that the workshops made them realize the past experiences and the
present distress of many of their students. It is possible that the progress they emphasized
in the focus groups was not reflected in their posttest SDQ reports because their increased
awareness of the adolescents’ emotional state made them more conscious of symptoms
and their impact.
The therapy appears to act differently in boys and girls: It is associated with a decrease
in impairment for girls, while it appears to prevent its increase in boys. The effect on
academic performance, however, is more significant in boys in the experimental group,
who improved both in mathematics and in French. These differences in effects, which
were also observed in the evaluation of the elementary program (Rousseau, Drapeau,
et al., 2005), are a good reminder of the necessity to consider the specific needs of both
genders when developing such programs and assessing them with a variety of indicators.
Surprisingly the intervention had no measurable effect on self-esteem, in spite of the
subjective evaluation of the youth documented through the qualitative evaluation in
which the youth underlined that the intervention helped them to know more about
themselves and to feel better. This absence of effect may be a sign of limited transcultural
validity of the self-esteem scale or an indication that the youth subjective evaluation
could have been dictated by the desire to please the interviewers and the intervention
team.
This study has a number of limitations. First, the evaluation was limited to short-term
effects and did not include a longer-term impact measure because of the difficulty of
following the participants after they had moved to another class or school. Second,
teachers were not blind to experimental versus control status. Third, the relatively low
Cronbach’s alpha of the SDQ raises some concerns about the need to further validate
its transcultural use. Because it is applied to a limited number of units (classrooms),
randomization in this study did result in significant differences among groups, with the
experimental group displaying significantly more symptoms and impairment than the
control group. In spite of these differences, the directionality of change supported the
hypothesis of program effectiveness.
When these limitations are taken into account, our results provide preliminary
evidence that drama workshops may help adolescent newcomers through their adjust-
ment process. The program appears to be a promising way of working preventively and
CLINICAL CHILD PSYCHOLOGY AND PSYCHIATRY 12(3)
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in a nonstigmatizing manner with young people who have been exposed to war and
violence, by providing a metaphorical space where trauma and loss can be expressed and
transformed.
More research is needed to replicate these results, evaluate the medium- and long-
term impact of the workshops, determine the optimal moment for this type of pre-
ventive intervention and envision their potential usefulness in the regular curriculum
of schools that receive newly arrived immigrants and refugees.
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This program, designed for a multiethnic classroom setting, uses drawing and storytelling to help immigrant and refugee children build bridges between the past and the future by attaching meaning to experience. Three main themes—family, friends, and myths— run through the children's work. The family represents continuity of attachments and values, friends make up the human environment of the host country, and myths of the homeland seem to provide a framework for experiences and emotions. Expression of these themes appears to indicate not only that these factors can protect against psychological distress, but also the children's ability to adjust to existence in a bicultural world. On the other hand, the time sequence analysis of the stories suggests that an absence of solid ties to the past prevents children from imagining a future for themselves.
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The field of performance studies embraces performance behaviour of all kinds and in all contexts, from everyday life to high ceremony. This volume investigates a wide range of performance behaviour - dance, ritual, conflict situation, sports, storytelling and display behaviour - in a variety of circumstances and cultures. It considers such issues as the relationship between training and the finished performance; whether performance behaviour is universal or culturally specific; and the relationships between ritual aesthetics, popular entertainment and religion, and sports and theatre and dance. The volume brings together essays from leading anthropologists, artists and performance theorists to provide a definitive introduction to the burgeoning field of performance studies. It will be of value to scholars, teachers and students of anthropology, theatre, folklore, semiotics and performance studies.