Introduction
This essay, in eight chapters, is a report on how I used scenes from Shakespeare’s Romeo and Juliet with a Dialectical-Behavioral Therapy (DBT) group in a mental health residential facility. The residents all suffered from severe and persistent mental illnesses, such as schizophrenia and bipolar illness with psychotic features. I am writing about the period Feb. 2004 to Feb. 2005. The group met weekly but with many weeks when, for one reason or another, the group had to be postponed.
For 20 or 25 weeks, I had been using the DBT skills workbook Don’t Let Your Emotions Run Your Life , by Scott E. Spradlin (2003, New Harbinger Publications) with a group of residents at the facility. They were almost all seriously afflicted with impulsiveness around anger or depression, such that they were a danger to themselves or others. They were at various levels of intellectual functioning, from high to moderately low. Most had little or no insight into themselves; many had delusions of one kind or another and often were responding to internal stimuli.
The book and its exercises engaged the participants and kept their interest, although I had to be selective in what topics we covered and the exercises to do, because of the difficulty of some for lower-functioning individuals. Each session was about 30 minutes. Attendance was part of the treatment plan for some individuals, although participation was voluntary. They got free caffeine-free soda pop at the end of each session.
When we reached the end of the book, people were still interested in continuing. At the same time, I had not seen the progress in their behavior that I had hoped. The exercises had helped them to think in DBT terms, but there wasn’t much change in their lives.
One aspect of DBT skills training I had not used (nor was it in the book) was role-playing to practice DBT skills. If I were to use typical situations in their lives, I felt that they would likely get defensive and feel attacked, or identify other people’s issues but not their own, or just get stuck. Role-playing seemed just too charged, especially in the evening, the only time I could do the group. Also, I didn't have any experience using role-playing with clients. I wanted something fun and non-threatening for all of us.
I had always loved Shakespeare’s Romeo and Juliet. There were a number of situations in that play around the core emotions that our workbook covered: sadness, love, anger, joy, fear, and difficult relationships, especially with family. The situations bore some similarity to the clients’ own circumstances. Moreover, when a character was stuck in an emotion, other characters used DBT-like strategies to get them unstuck, I decided to give the play a try.
First I had to edit the scenes so that unfamiliar words and allusions wouldn’t slow them down. Mostly this was by deleting sentences; this is common practice in putting on the play anyway. There were two instances where I did not want to delete the sentence, so I changed the obscure word to a modern equivalent using the same pun (e.g. "dung" in the last speech of Unit I, Part A, below). I picked some selections to appeal to the particular people I hoped would read them. Also, I wanted them to be able to read a scene in 15 minutes or so, leaving 15 minutes for discussion.
To make the discussion part easier for them, I prepared passages in the manual that related to each scene, and gave them to the participants as a handout. Finally, I formulated questions that would require them to make connections. I posed them orally to the participants as a way of starting discussion. Sometimes I got through them all, sometimes I didn’t. Sometimes the answers were superficial, and I didn't press them for better ones.
Were I to do the group again, there are a couple of places (Romeo and his friends with Tybalt, Juliet with her parents) where residents might have had fun role-playing how the characters could behave differently, using DBT skills.
Participants seemed to enjoy this new wrinkle. They were able, most of them, to connect the scenes with the workbook meaningfully. Moreover, some of them were more engaged and at a higher level then than I usually saw them. Most importantly, I started to see changes in their behavior that accorded with DBT principles. I am not saying that there was a direct causal relationship. There were other factors. But the clients’ lives did change in ways that fit DBT principles that the play brought out, and they themselves talked about those particular features of the play outside of class to myself and others. Many of the participants quickly made a stable transition to less intensive care environments.
In the nextseven chapters, I give what we did, session by session. It may take longer than one session to do each piece. Participants may have to do part of one and part of another in a few sessions. So I have called them units instead of sessions.
For 20 or 25 weeks, I had been using the DBT skills workbook Don’t Let Your Emotions Run Your Life , by Scott E. Spradlin (2003, New Harbinger Publications) with a group of residents at the facility. They were almost all seriously afflicted with impulsiveness around anger or depression, such that they were a danger to themselves or others. They were at various levels of intellectual functioning, from high to moderately low. Most had little or no insight into themselves; many had delusions of one kind or another and often were responding to internal stimuli.
The book and its exercises engaged the participants and kept their interest, although I had to be selective in what topics we covered and the exercises to do, because of the difficulty of some for lower-functioning individuals. Each session was about 30 minutes. Attendance was part of the treatment plan for some individuals, although participation was voluntary. They got free caffeine-free soda pop at the end of each session.
When we reached the end of the book, people were still interested in continuing. At the same time, I had not seen the progress in their behavior that I had hoped. The exercises had helped them to think in DBT terms, but there wasn’t much change in their lives.
One aspect of DBT skills training I had not used (nor was it in the book) was role-playing to practice DBT skills. If I were to use typical situations in their lives, I felt that they would likely get defensive and feel attacked, or identify other people’s issues but not their own, or just get stuck. Role-playing seemed just too charged, especially in the evening, the only time I could do the group. Also, I didn't have any experience using role-playing with clients. I wanted something fun and non-threatening for all of us.
I had always loved Shakespeare’s Romeo and Juliet. There were a number of situations in that play around the core emotions that our workbook covered: sadness, love, anger, joy, fear, and difficult relationships, especially with family. The situations bore some similarity to the clients’ own circumstances. Moreover, when a character was stuck in an emotion, other characters used DBT-like strategies to get them unstuck, I decided to give the play a try.
First I had to edit the scenes so that unfamiliar words and allusions wouldn’t slow them down. Mostly this was by deleting sentences; this is common practice in putting on the play anyway. There were two instances where I did not want to delete the sentence, so I changed the obscure word to a modern equivalent using the same pun (e.g. "dung" in the last speech of Unit I, Part A, below). I picked some selections to appeal to the particular people I hoped would read them. Also, I wanted them to be able to read a scene in 15 minutes or so, leaving 15 minutes for discussion.
To make the discussion part easier for them, I prepared passages in the manual that related to each scene, and gave them to the participants as a handout. Finally, I formulated questions that would require them to make connections. I posed them orally to the participants as a way of starting discussion. Sometimes I got through them all, sometimes I didn’t. Sometimes the answers were superficial, and I didn't press them for better ones.
Were I to do the group again, there are a couple of places (Romeo and his friends with Tybalt, Juliet with her parents) where residents might have had fun role-playing how the characters could behave differently, using DBT skills.
Participants seemed to enjoy this new wrinkle. They were able, most of them, to connect the scenes with the workbook meaningfully. Moreover, some of them were more engaged and at a higher level then than I usually saw them. Most importantly, I started to see changes in their behavior that accorded with DBT principles. I am not saying that there was a direct causal relationship. There were other factors. But the clients’ lives did change in ways that fit DBT principles that the play brought out, and they themselves talked about those particular features of the play outside of class to myself and others. Many of the participants quickly made a stable transition to less intensive care environments.
In the nextseven chapters, I give what we did, session by session. It may take longer than one session to do each piece. Participants may have to do part of one and part of another in a few sessions. So I have called them units instead of sessions.
posted by Michael S Howard at 7:01 PM
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