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The Boy who Lost his Heart – Attachment and Dramatherapy

Ricky was five when he was referred for a dramatherapy assessment. He was a child of dual heritage who had been with his adopted parents since he was three. Ricky had experienced difficult attachment experiences with his birth mum, who had a mental health diagnosis and who had experienced severe domestic violence. His birth father had been diagnosed with a personality disorder and had been dependent on Class A drugs. Ricky’s start in life had been characterised by unpredictable, chaotic and frightening relationships and experiences. When moved into foster care at 10 months of age he was already exhibiting fearful behaviours, screaming, demonstrating clawing movements, tears. His adoptive parents noticed that Ricky still presented with some unusual behaviours and wondered if therapy could support him and them in understanding and responding to him.

heartRicky entered the therapy room with his adopted mum. He wanted to tell me a story he said. He set a home where a black mummy doll lived with her son; Ricky told me that ‘there was no daddy’. Every now and again a knight visited the little boy and his mum. Using the little knight puppet Ricky showed me how it would attack the little boy’s heart with a great sword, Ricky told me how much this hurt the little boy’s heart.

Ricky fetched the doctor’s kit from the side of my room; taking on the role of doctor he tried to mend the little boy’s heart. When the doctor looked closely at the place where the little boys heart should have been he declared that ‘it was gone!’ I wondered where the little boy’s heart had gone. Ricky knew the answer, ‘it’s at the bottom of a deep ocean, and only a diver can get it.’ We looked around my room for a toy that could become a diver and reclaim the lost heart. To each suggestion I made Ricky gave an empathic ‘No’, there was nothing and no one who could help.

Going back to the doll’s house he showed me again and again how the knight would come and attack the space where the little boy’s heart should have been. The mummy puppet asked why the knight was so angry. The knight told her that as a baby he had cried and cried and no one had come and now he was cross.

Ricky was telling me that it was not safe to have a heart that just got hurt over and over again, better to hide it at the bottom of a deep ocean where no one could harm it. Of course Ricky could not find a diver in my room to retrieve his heart, he did not know me well enough, he did not know if he could trust me and so he needed to stay in charge and keep his heart hidden and protected. He had also not experienced a safe and trusting adult in infancy and so had not internalised a representation of a ‘good enough other’ who could help Ricky know about feeling safe, loved , protected from harm and cared for.

Over the following sessions Ricky and I continued to engage with dramatic play in the therapy room. This theory understands that in all play there is a process of dramatic projection; that in the process of play the child engages in the placing of themselves, parts of themselves and their feelings onto objects that are then engaged with in play. The dramatherapist supports the child in the process of play and in the encouraging of the telling of a metaphorical story through the use of symbolic objects which hold projected meaning for the child. This process enables the child to engage in difficult, themes, feelings at an emotional distance that feels safe enough to encourage engagement and exploration.

Dramatic Play was a natural language for Ricky; it gave him words and actions to convey the meaning of his experiences. Over the following sessions Ricky and I played lots of games together in which themes of significance were explored; power versus powerlessness, the lack of a safe and trusted helper, hyper arousal and fear, the potential of gaze to contaminate and turn someone ‘bad’. Ricky’s play was focused on what Bion (In Symington 1996) terms the nameless dread, it was attachment related and focused on the trauma of his experiences at a time when he was powerless to protect himself in anyway other than through psychological defence.

Overtime his metaphorical narratives worked on in therapy developed more coherence, he became less hyper aroused, his stories developed with an emotional narrative, he overcame difficulties, his play was populated with friends and helpers, he became more robust. Some way into his therapy Ricky came into the room with his mum. ‘Tell Sarah what you told me’ said mum. ‘Sarah’ said Ricky, ‘I have got a heart now.’  ‘That’s great’ I said, ‘and how is that?’ ‘Good’ he said ‘I have a heart because I have someone to love,’   Ricky pointed at his adopted mum.

Ricky had reclaimed his heart and he knew how to use it. Dramatherapy and psychotherapy are powerful therapeutic interventions, that with Ricky, supported the development of a good enough attachment. How great is that!

Sarah Mann Shaw

November 2016.



Bion W. In Symington J (1996) The Clinical thinking of Wilfred Bion ( Makers of Modern Psychotherapy) Routledge London



Dramatherapy – An Exploration in Trust

Felix is five, he is now adopted. He has experienced early childhood trauma, he had a mother who was unable to attach to him in a secure and loving way, as both she and Felix had lived with perpetual domestic violence.

The impact of such an experience on the developing infant’s body and brain is profound. We know that when the primary care giver is unable to provide a warm safe and loving bond with the infant then these children grow up with real difficulties in trusting others to help make their world safe. They are unable to regulate what they feel inside, often feeling anxious and on the alert for any possible real or imagined signs of danger. Their brains are wired to decode anything which might trigger a threat. Sometimes these triggers are external, as in noises, movements, facial expressions, sometimes they are internal, a raise in body heat, feeling anxious or excited. Without the experience of a safe and loving other the child has little capacity to make sense of these stimuli and to soothe himself. Without the feeling of being understood, of knowing that trauma induced terror can be managed with the help of a regulating other these children often remain, anxious or aggressive or controlling, their brains and body’s operate from a sense of fear rather than a sense of hope… the hope that there is someone else who can help.

Such was the case with Felix, he had a traumatised brain and really needed to know that his new mum and dad were resourced and robust and could help him figure things out and feel safe in the world.

Felix and his new mum came for dramatherapy. Felix liked to play and he was good at it. His mum was good at watching and joining in when Felix needed her to. Felix loved to play with action figures; he told me that their job was to save the world from the bad man figure. He told me that the bad man was scary, he wanted to attack people all the time, and that he wanted all the action figures to feel as angry as him.

castleFelix built a castle and filled it with toys, play food and dolls house beds. He told me that this is where the action figures would learn not to be angry. ‘How long would that take?’ I wondered, his answer ‘two weeks!’ They would be helped by a superhero who had already worked out not to be angry.

It was a really hard job for the action figures to learn to have other feelings, they learnt how to be sad when the ‘bad man’ attacked their safe castle, they learnt to trust the superhero figure to protect them when the bad man attacked, eventually they learnt that having friends made them feel happy. They learnt to choose which friends might be the best ones to help.

One session Felix asked me to pick up the bad man figure and chase the two action figures that he would hold around the therapy room. We played chase for about thirty seconds. At first Felix looked delighted with the game but then quickly realised that this wasn’t so good, throwing his action figures to the floor he ran into his mum’s lap.


  1. She held him tight and told the bad man to ‘clear off, there was no way’ he ‘was having her son’. Felix snuggled into his mums lap and gazed at her. She gazed back lovingly. ‘Can we go home now?’ Felix said.

We cleared up the space together, and I commented on how well at playing Felix was and how good his mum was at sorting out bad men in the play. Felix grinned at me ‘See you next week Sarah’ he said as he left, hand in hand with his mum.

Felix had just had a reparative experience of accessing other to help; he had found other and had trusted that she could help. That trust had been beautifully responded to by his new mum.

Felix continues to enjoy his dramatherapy sessions.


Playing with Release Dramatherapy, pooing and weeing

Welcome to my first blog as a dramatherapist and child and adolescent psychotherapist. I really love what I do so that’s what I am going to write about, interesting then that my first blog is addressing Encopresis and Dramatherapy!

food allergy This is because I had a recent enquiry from a parent who was dismayed to find small rounded stools in her child’s bedroom, she felt that they looked as if they had been ‘played with’, and as she explored her child’s room found other evidence of smearing. Another parent has recently expressed horror at finding containers in her child’s room which had been used to hold wee and poo.

‘Why are they doing this?’ both parents exclaimed,

 ‘Is it just defiance?’

Encopresis is the soiling of underwear with stool by children who are past the age of toilet training. Because each child achieves bowel control at his or her own rate, medical professionals do not consider stool soiling to be a medical condition unless the child is at least 4 years old. Both these children were older, they knew how and when to use the toilet but they weren’t.

My response was to think about how to help the parents tackle this issue and to look at it in the child’s therapy session  

We do have to think about the practical issue how to help our children manage their relationships with their bodies; do they need the loo?, is it hard to go to the loo?,  are they constipated, going to the toilet too late? etc.

Secondly is to think about it as an expression of worry or anxiety rather than defiance or a layer of ‘horrible’ behaviour. I remember when I was small that just outside the bathroom we had a poster of a tiger in long grass, the kind of poster where the eyes follow you. I was terrified. I had a very active imagination and was convinced that the tiger knew all my misdemeanours and one evening would get me! I used to wake my sister in the middle of the night to go to the toilet with me; if she refused I would crawl on my belly under the picture trying to avoid the tiger’s gaze! This went on for weeks until my mum realised that there was a problem and I plucked up courage to tell her and the poster was moved. That night I went to the toilet without any problems.

Be curious, what might your child be worried about?

Your child may also like the texture so what could you substitute poo with.  Can they play with clay, use finger paints at home, find other ways to get the same texture and feel?

Although it may look and feel revolting to you I am sure you know that it is important not to show this to your child but to think with them about what might help and to reassure them.

In dramatherapy one of these children was playing with dinosaurs and had created a world in which the smallest dinosaur was king, everyone was very gracious to this King and he was gracious back. This is nice, I thought, lots of positive reflections between the dinosaur characters, and then the little King was placed on the head of a much taller dinosaur by the boy in therapy. The little boy started to make thumping and whooshing noises. I wondered what was happening.

‘He is pooing and weeing all over the dinosaur’s head,’ he said.

We made the noises of pooing and weeing together and laughed at the skill of each other’s trumpy sounds. Then I asked what had caused the little dinosaur to poo and wee on the big dinosaur’s head.

‘Oh’, the little boy said, ‘he’s really scared and when he’s scared he can’t hold it in anymore. Commenting on the world the dinosaur lived in I asked if there was anyone who could help the little dinosaur with this dilemma.

baby-dinosaur-clipart-black-and-white-1194985539997768686dino_architetto_francesc_07.svg.hiThe little boy nodded and manipulated a long necked Dinosaur to bring the little dinosaur back down to the ground. Then he used other dinosaurs to come up to the little King, one by one each said

‘I do that too sometimes when I am scared.’

In recognising, naming and normalising both fear and response the little dinosaur was able to reunited with his community without shame..


The little boy left the session laughing and was greeted with a big hug from his mum.

Next week his mum told me that there had been no more problems ‘in that area’.

Next time: Dramatherapy and Release – Enuresis within a trauma frame of reference.


Comments really welcome.