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McAlister, M. (2002). Dramatherapy and Psychosis: Symbol Formation and Dramatic Distance. Free Associations, 9(3):353-370.

(2002). Free Associations, 9(3):353-370

Dramatherapy and Psychosis: Symbol Formation and Dramatic Distance

Maggie McAlister

In This Paper, I would like to share some thoughts and experiences about my work as a dramatherapist in a large regional secure unit where I have worked for five years. What I am particularly interested in is that part of the work which concerns symbolization. Why is the capacity to symbolize important? And what does it mean for the Arts Therapies in Forensic psychiatry, in other words, working with mentally ill offenders who have committed serious, often violent crimes?

Although I am going to focus on dramatherapy I shall be making links with other arts therapies disciplines (art therapy and music therapy) and also psychotherapy, as they all have in common the importance of symbolization. I shall outline some of my thoughts on dramatherapy before exploring how this relates to psychoanalytical understanding of psychosis and symbol formation. I shall then present some clinical vignettes. But before I start on the main body of this paper, I'd first like to say something about the setting in which I work and something about institutional dynamics and thinking space.

I am part of a large Arts Therapies department, in the forensic directorate of a mental health NHS Trust, which offers treatment to approximately four hundred patients who are mainly detained under forensic sections of the mental health act. Once admitted, most of the patients stay in secure wards in the hospital for a number of years and have severe mental illness. A large proportion of the patients have committed their offences as a result of their mental illness and most have a diagnosis of paranoid schizophrenia or schizo-affective disorder. Some patients also have a diagnosis of personality disorder.

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