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