817296

research-article2019
DRT0010.1177/0263067218817296DramatherapyMillbrook

Original Article

Dramatherapy

Digital storymaking: 2019, Vol. 40(1) 28­–40

© The Author(s) 2019
Article reuse guidelines:
Dramatherapy with sagepub.com/journals-permissions
DOI: 10.1177/0263067218817296
https://doi.org/10.1177/0263067218817296
young people online journals.sagepub.com/home/drt

Alyssa Millbrook
Cambridge, UK

Abstract
The Internet has become thoroughly embedded into most aspects of modern life, and no one is
more plugged-in than the youngest generations. With the aim of utilising the omnipresence of
the digital space to therapeutic ends, this article examines the application of online storymaking
interventions with adolescents. The young people discussed are quite isolated and high-need;
they have self-excluded from mainstream school and are now pursuing education in an alternative
online provision, where they also have access to therapy. Following an overview of the current
literature on web-based therapies, this article offers two illustrative case studies in which a story-
based dramatherapy intervention was delivered online. This will include an evaluation of the
therapeutic work from the case studies using the BASIC Ph assessment method, as well as a
broader discussion on the experience of working as a therapist online.

Keywords
Adolescent mental health, bullying, dramatherapy, online therapy, story

Introduction
The realm of online therapy is nebulous and largely uncharted. The increasingly ubiqui-
tous reach and accessibility of technology has created an opportunity to engage therapeu-
tically with individuals who may have previously fallen through the cracks. The purpose
of this article is to illustrate a practical application of dramatherapy techniques, story-
making in particular, in an online setting. This article offers two case examples of a digi-
tal storymaking project with vulnerable, isolated adolescents unable to engage in
face-to-face therapy and evaluates the work within the context of Lahad’s BASIC Ph
mode of assessment (Lahad and Dent-Brown, 2012).
The work I will be discussing takes place within an alternative education provision;
the organisation primarily takes on secondary-aged students who have self-excluded
from mainstream school due to bullying or other trauma, but also provides for students
who have difficulty accessing traditional education due to other mental or physical health

Corresponding author:
Alyssa Millbrook, 25 Beaulands Close Cambridge, CB4 1JA Cambridge, UK.
Email: alyssamillbrook@gmail.com
Millbrook 29

needs. Many of the students accessing this provision are at a stage of anxiety where they
rarely leave their homes and sometimes even their bedrooms. In order to accommodate
the complex needs of these young people, learning and therapy are conducted entirely
online with some community engagement taking place in person. The online work is
often entirely text-based, so the teacher or therapist and the student may never see the
other’s face or hear the other’s voice. The organisation is based in the East of England,
but due to the remote nature of the work, it is able to provide for students across the
country; the number of students accessing this provision is continuously growing, but at
the time of writing stands at around 80. The length of time students spend with this provi-
sion varies widely depending on individual circumstances and can range from half a
school term to several years. The nature of the needs of these young people limits their
access to face-to-face therapies, so online interventions may be the first, or only, choice
available to them.

Methodology and rationale

The background for the work I will be discussing is an approach that I developed as part
of a dissertation for an MA in Intercultural Communication (Martin, 2015). For this
project, I applied my dramatherapy training to the field of intercultural communication
in order to design a programme which utilised the therapeutic nature of story to facili-
tate cultural competence training within organisations. The objective of the project,
which I titled ‘Transcultural Narrative’, was not therapeutic in nature, but the results
from the pilot study I conducted demonstrated therapeutic potential. This project offered
inspiration and insight which enabled me to translate the approach into a clinical
intervention.
As I began working in the online education setting, important differences in the cul-
ture of online therapy versus traditional face-to-face therapy emerged. Notably, I found
that there was a need for a way of communicating which allowed for a greater breadth
of expression than could be conveyed through text alone. In the online space, therapeu-
tic interactions were typically less spontaneous than when working face-to-face. This is
likely due in part to the needs of the clients typical of this setting. Due to their state of
mental ill health and lack of rich social environments, spontaneous play is often a dif-
ficult task; in addition, many have had negative experiences with therapists and other
professionals, thereby making the establishment of adequate trust for spontaneity to
thrive a longer and slower process. However, even accounting for the specific needs of
these young people, online therapy appears to place some limitations on spontaneity.
Without the conventions of the consulting room, there are fewer subtle client ‘leads’ to
follow, for example, idly fiddling with objects or showing interest in art media. Dix
(2012) describes this process in a case study taking place within a face-to-face educa-
tion setting; she details how her young male client spent several weeks energetically
exploring all of the toys on offer and how he was finally able to maintain a sustained,
coherent engagement with an object (a cardboard box) he had spotted on the way to the
therapy room. Providing offerings of this quantity with such comprehensive sensory
stimulation is impossible to accomplish with only text and digital media at one’s dis-
posal. It takes significant preparation in order to create any level of suitable electronic
30 Dramatherapy 40(1)

facsimile of typical offline therapy resources. Even something as simple as drawing a

picture requires in-session administration, such as creating and appropriately sharing
electronic documents.
In my journey to find suitable creative interventions, I drew inspiration from the
approach I had developed as Transcultural Narrative. The method was intended to be a
flexible groupwork structure, but could be easily adapted for individuals. I had care-
fully designed the framework of the technique to follow a trajectory that began with
telling existing stories and ended with creating new stories; this sequence of activities
could be used for individual online work, prepared in advance, and the stories them-
selves would provide, if not physical objects, imaginative ones that could be explored
in innumerable ways.
A key element of Mitchell’s (2012) ritual theatre approach is the application of narra-
tive fiction to offer a ‘safe dramatic parallel to work with in pursuit of [the client’s] thera-
peutic objectives’ (p. 249). Mitchell (2012) also states that the role of the therapist is to
enable clients to create their own rituals and rites of passage, and emphasises the need for
the therapist to offer an ‘organised pathway’ for this creative action to take place (p. 244).
I chose three basic components to organise the pathway of this intervention; I applied
this trajectory in both the Transcultural Narrative pilot and the case studies described in
this article with only minor modifications. These steps and their modifications are as
follows1:

1. Recounting a story that the teller feels a strong connection to, usually from
childhood
In order to assist the participants with getting in touch with meaningful stories, I
begin this stage with an invitation to create a life map which illustrates important
moments or events; the maps are then embellished with stories that were impor-
tant in each of these stages of life. I define ‘story’ broadly, including books, films,
television shows, myths, fables, folktales, songs, or any other narrative that feels
like a significant piece of their personal culture. This is followed by participants
selecting one story that stands out to them and telling a short version. Recalling
Mitchell, the life map provides an artistic means of identifying key rites of pas-
sage that may need addressing, and the corresponding stories offer a metaphori-
cal means with which to begin addressing them in a way that is safe and
appropriate for the individual.
2. Listening to (if face-to-face) or reading (if online) the beginning of a story
and creating one’s own ending
This step is intended to aid participants in transitioning from telling existing sto-
ries to creating them. Each time I have applied this intervention, the story I chose
to tell has been a Pacific Islander story adapted by Dr Sue Jennings (2010), ‘The
Story of a Child of Fire’. I will tell the story up to the point when the protagonist,
due to the objections of the other villagers, is sent away from home by her mother
for continuing to light her magical fires.
3. Creating a new story
In this step, I utilise the Six-Part Storymaking Method (Lahad and Dent-Brown,
2012) to help guide participants through the process of creating an original story.
Millbrook 31

In a group setting, this exercise creates a space in which participants work col-
laboratively to create their own collective piece of group culture and have a sense
of ownership of the outcome. When working with individuals, this provides a
useful assessment of coping mechanisms using Lahad’s BASIC Ph and thus aids
in guiding the work towards (re)building the individual’s resilience.

The case studies discussed in this piece apply this three-step outline to individual
online therapy with young people. Implementing this intervention in individual work ena-
bles the participant to fully engage in the elements of self-discovery and identity construc-
tion that narrative offers, providing opportunities for empowerment and a deepened sense
of self. This, with a particular focus on identifying coping mechanisms using BASIC Ph,
was the key aim of the work detailed in the case studies. Practically speaking, the prede-
termined sequence of activities also provides a structure to the sessions for the duration of
the storytelling project. Establishing these parameters offers a well-boundaried space for
safely engaging with creativity; it also serves the purpose of relieving some uncertainty in
the sessions for both client and therapist. This thereby aids in developing trust in the thera-
peutic relationship, which is critical for the efficacy of the intervention.

Literature review
As may be expected in such a new and unconventional sphere of therapeutic engage-
ment, the existing literature is limited. Documented successes of online therapy tend to
lie within Cognitive Behavioural Therapy (CBT); Spence et al. (2008), suggest that CBT
is particularly suitable for online work due to its structured and systematic format (p.
412). However, it is worth noting that the limited number of quantitative studies con-
ducted about online therapy is weighted towards CBT interventions. As much as possi-
ble, I drew from publications across the spectrum of counselling and therapy modalities,
including manuals and guides for online clinicians, quantitative studies and qualitative
case studies. I primarily focused on three areas: developing the therapeutic relationship,
working digitally with the arts and working therapeutically with young people online.
These highlighted areas provide a theoretical foundation for working online, an over-
view of the way digital interventions are presently being employed and a context for how
my clinical work fits into the existing body of research.

The online therapeutic relationship

One of the chief clinical concerns that accompanies online therapy is the ability to ade-
quately develop the therapeutic relationship. Particularly in a setting where the work is
text-based (i.e. with no voice or video component to the communication between client
and therapist, as was the case with the clinical work I conducted), the types of nonverbal
cues typically present in therapy are not available. However, research suggests that a lack
of face-to-face contact does not necessarily inhibit the therapeutic relationship. Cook and
Doyle (2002) cite evidence that indicates strong and long-lasting relationships are being
formed online. They conducted their own study into the development of the working
alliance in online therapy using the Working Alliance Inventory (WAI) as a measuring
32 Dramatherapy 40(1)

tool. The WAI assesses three components of the therapeutic alliance: (a) agreement on
the tasks of therapy, (b) agreement on the goals of therapy and (c) development of an
affective bond; the results of this study showed better scores in all three subsections for
online therapy when compared to the face-to-face sample group. With only a small sam-
ple size of self-selected participants, these results must be generalised with caution. I
would posit that no therapy is one-size-fits-all, and the authors indicate online therapy is
not appropriate for everyone; however, this is promising evidence that strong, positive
relationships can be developed between therapists and clients working online.
The current research points to online interventions being especially successful for
certain cohorts of clients. Cook and Doyle (2002) cite those with introverted personali-
ties and conditions such as panic disorder and agoraphobia as examples of clients who
may prefer the perceived anonymity and sense of control offered by online interactions.
Fenichel et al. (2002) reiterate the examples of introverted clients and those with social
anxiety or phobias and add those with physical disabilities and clients concerned with
social stigma. They suggest that for individuals who are deeply affected by issues of
isolation, secrecy, shame, hypervigilance, vulnerability, sexuality and intimacy, citing
abuse survivors and LGBT+ (lesbian, gay, bisexual and transgender) individuals as
common examples, the option of online therapy can make it more likely that they will
access therapeutic support. There are those who would argue that this way of working
(i.e. without face-to-face interaction) would increase feelings of isolation; however,
McKenna’s (1998) research disputes that claim, stating that quite the opposite is true.
Those who are lonely and socially anxious are able to use the Internet as an outlet to con-
nect with others in a safe and controlled environment. Those who have difficulty forming
‘real life’ friendships can benefit from the perceived anonymity of the Internet, as the
fear of rejection that inhibits self-disclosure can be bypassed. These lowered inhibitions
lead indirectly to a greater intimacy, decreasing social anxiety and enhancing social
skills. Ceranoglu (2010) also corroborates these claims, stating that the Internet and the
transition to personal computers have created ‘a medium for human intimacy to an extent
never before imagined’ (p. 141) and that meeting children and adolescents in particular
on this level can aid in the development of the therapist–client relationship.

The arts in online therapy

Carlton discusses a 2005 symposium she attended for the utilisation of tablet computers
and smartphones in the arts and play therapies; one of the speakers, artist Sarah Ezekiel,
shared her experiences using eye-tracking technology to create digital art after the debili-
tating effects of Motor Neurone Disease rendered her unable to engage with other art
media. These tools were not only vital to her ability to express herself as an artist but also
to heal emotionally as the use of her physical body became more limited. Carlton (2017)
states that no one in attendance of this presentation would have questioned the artistic
legitimacy of Ezekiel’s drawings and paintings or that the act of creating them had been
therapeutic for her. While this is an exceptional illustration as well as a case of therapeu-
tic art rather than art therapy, it raises the important point that the spectrum for creativity
lies beyond material art forms and demonstrates the need for a wider offering of sensory
experiences.
Millbrook 33

Orr (2011) posits that online tools should not be seen as outside the scope of tradi-
tional art therapy practice, but instead digital media exists within the spectrum of all
media (p. 90). She goes on to say that digital-based media has become such a central part
of Western society that it is not only something to be consumed but indeed helps shape
culture. Thus, digital influences can contribute to identity formation. With the line
between art creator and art consumer blurred and the inherent participatory nature of
digital media, using these tools in art therapy can provide a sense of empowerment when
other forms of art may feel too removed from the client’s experience. Orr emphasises the
need for the therapist to understand their client’s world, which, particularly for those
working with youth, is likely to include a great deal of digital input. The therapist’s role
is not to eschew this peculiar way of working in favour of more ‘traditional’ artistic inter-
ventions, but rather to engage with it and help the client make sense of themselves within
their image-saturated world.

Working creatively with young people online

Much of the existing literature that addresses online therapy with children and adoles-
cents centres heavily around gaming. This may include using existing commercial video
games the way one might use toys or objects in a therapy session (Ceranoglu, 2010),
conducting therapy in an avatar-based virtual reality platform, such as Second Life (Merz
Nagel and Anthony, 2011; Wilson, 2010), or the creation of a purpose-built therapeutic
gaming application, such as the work conducted on the Games4Therapy project by
KenVaK Research Centre for Arts Therapies (Ferri et al., 2016). Interestingly, Lahad
(2017a) makes the case that gaming, for all its merits, should not be a person’s sole
source of playfulness as game algorithms offer a series of pre-set outcomes that ulti-
mately inhibits creative, out-of-the-box problem solving (p. 58).
In terms of the arts, current research is largely focused on the incorporation of digital
media into face-to-face art therapy sessions. For instance, Choe (2017) offers clinical
examples of successful integration of an iPad into her work with adolescents and its
usefulness in building rapport. Perhaps understandably, there is very little work around
exclusively using online interventions in the arts therapies. The manuals and guides
available indicate that online therapeutic engagement tends to fall into three basic cate-
gories: video chat (e.g. by Skype), asynchronous text (e.g. by email) and synchronous
text (e.g. real-time online chat). The case work I will be discussing falls into the third
column; vignette examples of synchronous text therapy sessions that capture the nature
of this work can be found in Merz Nagel and Anthony (2010: 100–109) and Adlington
(2009: 186–196). In addition to text chat, I also employed other applications in Google’s
‘G Suite’ such as Google Docs and Google Slides. These allow for more artistic input
into the work than chat alone, as clients can draw pictures, copy and paste images from
elsewhere online, and write/edit stories, and I am able to view this work being created in
real time. Fenichel et al. (2002) refer to this kind of supplementary material as ‘grist for
the mill’ in the therapeutic relationship, helping to create a robust and all-encompassing
therapeutic experience (p. 486).
It is worth noting, particularly as this article is dramatherapy-centred, the bias towards
the visual arts within therapeutic digital media over the performing arts. This is of course
34 Dramatherapy 40(1)

a product of the considerable difficulty of facilitating remote, online, text-based per-

formative activities. Skype offers some limited performative capacity, but is not used
within the organisation discussed in this article primarily because it would be far too
exposing for the highly anxious service users to tolerate. The online work that I do by
necessity draws more heavily from visual art in order to offer creative interventions that
are accessible within the G Suite platform. Perhaps with time, as more sophisticated
virtual reality technology becomes widely available, there will be more space to bring in
greater performative elements to online therapy.

Clinical discussion
Case study 1: ‘Sam’
Sam is aged 15 and identifies as gender non-binary. They came out as non-binary during
the course of the digital storymaking project, which included a name change from a
strongly gendered name to the more neutral ‘Sam’ and the request to be known by neutral
they/them pronouns. They were bullied at primary school for long periods of time and
are affected by depression, severe anxiety and OCD (obsessive–compulsive disorder).
They were having regular debilitating panic attacks at the time they left mainstream
school. The entire process of the story project took several months, and we began the
project after working together for around 4 months.
We first visited the ‘Story of a Child of Fire’ the last session before a week-long
school break. At this time, Sam was still using their previous given name. The ending
they developed for the story concluded that the logical next step was that the fire set by
the protagonist would consume the village, but the girl would survive as she had already
been sent away. In this version, the girl was on her own when she left, the home she left
behind destroyed.
Upon resuming after the break, Sam had come out to the students and staff of the
provision as non-binary and changed their name. We revisited the fire story, and Sam
decided to make some changes. In the updated version, the girl was not alone, as her
friends had left the village with her. The tone of the story shifted to one of hope. Sam
described the group of friends as feeling ‘free, but anxious’. They felt a newfound free-
dom from their families and the restrictions of home, but with some sense of loss over
leaving their home behind. To help keep the memories of their families close to them, the
friends carry trinkets as reminders. The ending was ambiguous and it remains unknown
whether the friends find a new place to live or perish. While the future is uncertain, they
leave the village with a sense of hope and freedom to be themselves.
Sam’s six-part story took place in a zombie apocalypse. The unnamed protagonist is
described as ‘genderfluid, cold, awkward, loner, reader, terrible with direction, disabled,
depressed, and with some kind of addiction, something like smoking or drinking’. The
character’s mission is to survive as best they can, keep their friends safe, and find an area
with food and shelter. The obstacles they will face will be, of course, zombies and also
extremist factions of people such as racists and Nazis. These adversaries, who believe
they are better than other people, will take advantage of the situation to oppress and
inflict cruelty on others and try to take control. Along their journey, the protagonist forms
Millbrook 35

a ‘found family’ with 5–6 other people. Sam decided that it probably was not realistic for
all of the obstacles to truly be overcome in the long term. The group finds somewhere to
live, but ‘everyone’s got issues, due to the apocalypse or not’. Some, perhaps all, of the
party members will die, but Sam hints at a hopeful afterlife where they will all be together
because ‘dying sucks’.

Case study 2: ‘Alfie’

Alfie, aged 15, contracted a serious illness as an infant which has left disabling physical
effects; he has limited mobility and is easily tired. He experiences anxiety around educa-
tion, which is linked to serious gaps in learning due to difficulty in accessing school. He
is also affected by a sense of isolation and lack of belonging in groups. The process of
the story project took place over 7 weeks and we commenced the project after working
together for around 1 month.
In Alfie’s version of the fire story, the girl flees to the forest after her initial banish-
ment. Unfortunately, she accidentally burns the forest down with one of her fires. She
then returns to her home village, hoping to be able to live there again; she felt ‘spooked’
living on her own. The people of her village allow her to stay but she must promise that
she won’t light any more fires. She makes this promise, but Alfie expressed that she
probably wouldn’t be able to keep it; eventually she would get bored and light fires
again. When she is caught, she is unfortunately sent away forever. The girl is sad and
alone again for a while, but later finds a new village. The people there take her in and
give her a new home. These villagers don’t mind her setting fires as long as she does
it safely.
Using the 6PSM method, Alfie created an original story about a farmer. He is 60 years
old, lives in an English village and grows oranges. Growing oranges is what he likes to
do and that is his immediate goal. However, this is disrupted when a flood hits where he
lives. Luckily, a helicopter arrives. An air ambulance person rescues him from danger.
Once he is safe and things have settled again, another person comes to the farm to help
the farmer build a drain to get rid of all the extra water and dry out the fields. This effort
is successful, and the story ends with the oranges being fine and everything being okay.

Evaluation
In response to critiques that text alone is inadequate to convey the human experience,
Fenichel et al. (2002), state that ‘the whole body of human literature from Homer to hip-
hop renders this frequently stated myth absurd. It is widely believed that Shakespeare
saw as deeply into the human heart as Freud’ (p. 486). They go on to explain that even
Freud himself saw some patients exclusively through written correspondence. Adlington
discusses that with the removal of body language and tonality, text-based communica-
tion relies 100% on the actual written words. He goes on to say that it is the role of the
therapist to use these written words to uncover the client’s values, which may not even
be within their conscious awareness (Adlington, 2009: 27–28). This links fluidly with
Lahad’s BASIC Ph mode of assessing coping mechanisms through storymaking, which
is how I will evaluate the work conducted in this project. As the theme of resilience is at
36 Dramatherapy 40(1)

the heart of Lahad’s work, this method of interpreting the data is particularly apt; foster-
ing resilience is a core aim of the professionals working with the young people dis-
cussed, ergo uncovering their individual modes of resilience can offer insight into the
best ways of supporting them (Lahad and Leykin, 2013).
Applying BASIC Ph to Sam’s stories, we can identify Belief (B) and Social (S) as
their primary coping languages. The B is present in the prevailing messages of hope and
self-belief even under the most trying circumstances, and the S comes through clearly in
the themes of friendship and found family. Lahad (2017b) indicates that the BS configu-
ration identifies a social-oriented belief system, emphasising human rights and social
justice. This closely aligns with the story they told in the earlier phases of the project;
they chose a trilogy of supernatural novels which centres around two factions of witches,
one which fancies themselves as superior and paints the others as ‘evil’. The reality is
more nuanced, and the (bisexual) main character joins the resistance to fight for equality,
as the ostensibly ‘good’ White witches are killing and oppressing everyone else. Justice,
acceptance and the freedom to be oneself are the crux of the material Sam brought to the
sessions.
It is also useful to note Sam’s offline experiences during this process and how they
began to parallel their characters’ journeys of acceptance. As discussed previously, they
came out as non-binary to the educational community in the middle of the project, and
there was a corresponding shift in the tone of their stories. They were not, however, out
everywhere else at this time, including to some members of their immediate family. The
day after completing the project, the organisation was informed by Sam’s mother that
they were now fully ‘Sam’ at home. They had also begun engaging with face-to-face
community activities with their peers for the first time since joining the organisation
nearly a year before as well as developing offline friendships with other students. In this
case, the story (and perhaps our therapeutic relationship) served as a ‘test run’ for expe-
riencing acceptance and the freedom to be oneself which Sam then felt able to carry over
into their life offline.
Alfie’s dominant languages are somewhat less clear-cut, but the most prominent
appear to be Social (S) and Physical (Ph). The S is demonstrated in the fire story with the
girl’s desire to be a part of a society and feeling sad and scared when on her own; it is
also visible in the farmer’s need of outside help and his readiness to accept it. Ph is evi-
dent in the girl’s impulse for the physical act of lighting fires, as well as the active and
tangible problem-solving methods employed by the characters in the orange farmer’s
story. The SPh configuration communicates that social participation and informing or
instructing others are an individual’s way of making sense of the world (Lahad, 2017b).
The story Alfie brought at the beginning of the project, an anime series, complements
this configuration. The protagonist is a member of a warrior race who defends Earth from
forces of destruction. This warrior legacy is central to their group culture and knowledge
is passed down through many generations. Physicality is crucial, as the characters are
engaging in combat in each episode. The particular vignette of this series that we focused
on involved the main character gaining an ability that enabled him to fight instinctively,
bypassing his thinking brain. This allowed him to be extremely successful, as his oppo-
nents were unable to anticipate his next move. Alfie expressed particular interest in this
trait and ‘how cool it would be to be able to not have to think’. C (Cognition) may be an
Millbrook 37

adjacent language for Alfie, as his stories were quite logical and realistic, but his affinity
for the ability to act without thinking indicates that it is not the channel he is most deeply
engaged with. Reflecting on his personal circumstances, this stands to reason as he has
likely never been able to use his body without considerable conscious thought due to his
disability.
Working with this story also brought our therapeutic relationship and rapport to a
deeper level and his engagement in the work markedly increased. His previous tentative-
ness gave way to great enthusiasm as he explained the characters, history and conven-
tions of the world of the anime; this zeal for teaching me something he was knowledgeable
about and the positive effect it had on our work together matches the parameters of the
SPh configuration.

Reflections
A key lesson learned from this project was how slow therapeutic progress can be. I
regularly cite not underestimating the potentially languid pace of the work as the most
crucial message I can convey about online therapy; this is particularly the case with
this cohort of clients who often need a significant amount of time to build trust. Even
with my knowledge of the tempo of the work in general, I still neglected to anticipate
how this would affect the digital storymaking project. Due to the delicate nature of the
work, as well as the realities of working within school terms, the project had the poten-
tial to be disrupted for weeks at a time. Therapy, and indeed engagement of any kind,
would be put on hold during school holidays; issues would arise during the time away
that took precedence in the sessions when we resumed, further lengthening the dura-
tion of the project. In her model of dramatherapy support in mainstream schools,
Meldrum (2012) flags this issue and indicates that work in such contexts is best con-
tained within academic terms with the opportunity to make an ending, review and cre-
ate a new contract if appropriate. However, in contrast to mainstream education, the
setting discussed in this article is designed as a therapeutic community and thus oper-
ates with an open-ended style of therapeutic engagement. Factoring in the breaks was
not only unavoidable but also proved useful by slowing the work to a manageable pace
for the clients to tolerate.
Alfie was able to engage in some element of the storymaking project for several con-
secutive sessions. Sam, particularly in the early stages of the work, would more regularly
have more pressing issues come up during the holidays, or even week to week, that
needed addressing. An unintended benefit of conducting the sessions online was that the
material would always remain held in ‘the cloud’ for whenever the client was ready to
re-engage with it. We glided in and out of the story world as needed and the clients were
able to gradually increase their tolerance of engaging, however obliquely, with the emo-
tions raised by the stories as well as sharing them with me.
Another challenge that arose during the project was the varying levels of difficulty the
clients had with the process itself. For example, Sam quite easily and concisely com-
pleted the life map step without much need for prompting; Alfie, however, found this
task to be a struggle. His experiences with his disabling illness dominated the narrative,
even though he was in actuality too young to have conscious memories of these events.
38 Dramatherapy 40(1)

As such, we had to find different ways identifying his important stories. We focused on
thinking of memories individually rather than plotting a timeline, and we found the
anime series working in this way. The storymaking framework was designed to be flex-
ible, and that component was tested during this project. In this instance, the journey of
the project was completed and its aims fulfilled even if the path was slightly varied in
shape. Taking note of these variations also informs the work; for example, Alfie’s chal-
lenges with this particular exercise signalled for me to explore and build on themes of
developing a sense of self that is not overridden by the labels of his disability.
The extreme anxieties that both of these young people experienced around leaving
their homes coupled with their fluency in digital communication suggest that perhaps the
online nature of the therapy was a vital component to their therapeutic journeys. Rather
than being an acceptable stand-in for conventional therapy, I suggest that the online
engagement was necessary for the therapeutic journeys they took, and the creation of
these poignant stories would not have been possible face-to-face. This possibility is ech-
oed in the research of Cook and Doyle (2002); many participants in their study com-
mented at length about the stress they felt in face-to-face therapy and how working
online enabled them to be completely open and honest with a therapist for the first time
(p. 101).
The young people discussed in this article unquestionably fall under the descriptor of
extremely vulnerable and isolated; however, it is crucial to note that being of compulsory
education age but out of school ideally means that they are ‘on the radar’ so to speak of
the local authority and are thus more likely to have access to support services. Adults
with difficulty accessing conventional face-to-face therapy due to physical or mental
health needs will likely not have as much structural support, and as a result may be even
more vulnerable and isolated. While the focus of this article is working online with
young people, this should not dissuade wider exploration of digital interventions with
other client groups. Undoubtedly, a large cohort of adults could benefit from such con-
tinued research and innovation.

Conclusion
Working therapeutically online presents a host of novel challenges. This emergent and
experimental way of working has made therapy accessible for the young people
described in this study, who may not have otherwise been able to access therapeutic
input; however, while nuances do come through the text as the relationship develops,
the lack of visual contact makes it difficult to assess progress, engage creatively beyond
the written word and navigate the direction of the work. Using this storymaking tech-
nique provides structure to the sessions, which I found helpful as both Sam and Alfie
struggled with spontaneous ‘play’. It also introduces creativity in a safe and controlled
way and, when paired with the BASIC Ph configurations, provides an excellent assess-
ment tool for unpicking how the client meets the world and therefore informing future
work with that client.
Orr (2011) states that digital media is a mediator in the same way that a paintbrush is
a mediator, and it is not the mediator itself that determines therapeutic success but rather
how that mediator is used by the therapist. For all its challenges, we cannot discount the
Millbrook 39

role of digital media in dramatherapy, but rather forge ahead and find new ways of bring-
ing the tools of dramatherapy online.

Acknowledgements
With thanks to Dr Ditty Dokter for your support and guidance in this project. To ‘Sam’ and ‘Alfie’,
thank you for your stories.

Declaration of Conflicting Interests

The author(s) declared no potential conflicts of interest with respect to the research, authorship,
and/or publication of this article.

Funding
The author(s) received no financial support for the research, authorship and/or publication of this
article.

Note
1. See also Sajnani and Dokter (2017) for an illustration of ritual theatre principles in clinical
practice.

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Author biography
Alyssa Millbrook is a UK-based American dramatherapist who graduated from Anglia Ruskin
University in 2013. The majority of her current work is in supporting vulnerable adolescents from
a variety of backgrounds. She holds particular research interests in the areas of trauma, migration
and the use of narrative.