Madelaine and Rebecca

Madelaine is a graduate of our MA Dramatherapy degree. During the course, she attended a placement under the mentorship of Rebecca at London Disability Network and now works as a registered Dramatherapist.

Tell us a little about who you are and your roles on the placement

Rebecca: I am a manager of two supported living services in Camden in London. Supported Living is a placement for clients with learning disabilities, and it's basically care being provided within a home setting with the aim of making them independent people with very fulfilled lives.

Madelaine: I'm a recent graduate from ARU on the Dramatherapy Masters and a registered dramatherapist. My placement lasted a few months - I started working here in September 2021 and finished around April 2022, doing hour-long therapy sessions with each of the clients from both the services Rebecca works at.

Madelaine, what were you hoping to do when you finished your course?

M: Initially I was going to look for jobs within the NHS as a Dramatherapist, but even before I finished, Rebecca said that one of the clients that I worked with, their parents were really impressed with the work that we had done together, and that she wanted me to continue working with her. I was pleased - that was something I also wanted to do, because I really wanted to work privately within an organisation. So I took on that opportunity, and I’ve been working with that client since September this year. It’s been really good, and I’ve enjoyed it so much. I came in today to work with another client as well, and hopefully there’ll be other opportunities as well.

R: I just keep borrowing her for various therapy opportunities. Whenever I think something’s wrong I just get Madelaine in!

How did it feel settling in to the placement Madelaine, and were you well supported by LDN to do this?

M: A week before I started, Rebecca invited me in to have a chat with the clients and staff, so I got to know everybody and where things were before the start date, so I wasn’t going in blindfolded. It was the first time I’d ever worked in a therapy setting with people with learning disabilities and physical disabilities, so it was very important to me to know where I was going to be and who I was working with so I could try to adapt myself, rather than just coming in and planning a whole session with someone that it didn’t apply to.

Any time I was reading through the files and thinking ‘What does this condition mean? How does that client cope or communicate with this kind of condition?’ and Rebecca would say, ‘Well, this is the things that we’ve learned to do with them, so maybe you could add this to the session, or that to the session.’ It was really informative and very helpful for me, not just at the start - I felt very settled throughout the whole time.

How much support did you receive from ARU to find your placement and while you were on it?

M: Stavroulla Demetriou (MA Dramatherapy Lead) supplied the placement for me, and I had supervision for an hour with her each week, which was really lovely. If something big happened within a session I was able to go to her and unpack what happened, what my feelings were within the session, and think therapeutically about that as a practitioner, but also as a person, and how to address it in the next session. But I was also able to tell her “Oh my Gosh! I was able to do this in a session! I’m so proud of myself!”

R: Stavroulla understands the setting really well. She has a really in-depth experience of learning disability settings, but also specifically the service that Madelaine has been working in, and I think that’s quite a unique perspective to have. So, from an outsider’s perspective, I can see that she was able to give quite unique guidance to Madelaine as well. Stavroulla has worked with us before, and she currently works with one of our clients separate to ARU. I think she has an understanding of how wonderful the placements are, but equally how emotionally draining they can be. So it was a good combo, the three of us.

What are the kind of qualities you look for in a placement student, Rebecca?

R: Openness to anything. Not being scared off by a lot of things. A lot of the clients that Madelaine came into contact with and supported don’t have any of the usual neurotypical markers that you think they would need to take part in therapy. One of our clients is completely non-verbal, you often have no real idea of how much information she’s able to process. Her learning disability is incredibly profound, but she was as in need of therapy as anyone else, and we worked it out together, how to communicate with her.

Flexibility is a big one as well. As much as I would like to plan the day, I’m running round like a headless chicken all the time. so Madelaine was very good at saying ‘Ok, this is my authority, this is the space and the time that I’ve asked for, but equally that person’s had a seizure, let’s give them five minutes and then they’ll be able to engage more,’ or ‘Ok, things haven’t gone great this morning, how can I accommodate your needs?’ But also I think Madelaine pushed us to be a bit more time-savvy and respectful of that therapeutic space as well. She added a lot.

What benefits does your organisation gain from offering work placements to students?

R: There’s a massive inequality in health in general with clients who have a learning disability. Mental health isn’t even on the roster when it comes to people’s entitlement for that. There’s such a misconception about what mental health means, and actually whether it’s a worthwhile thing to even be addressing. So I think a huge benefit for us was to be able to access that, and be a case study for me to say ‘look what we’ve achieved’, and we only achieved it out of the goodness of Roulla suggesting Madelaine come in.

I think Madelaine taught us a lot about what is possible, and what we should be aiming for going forward – that actually there’s no excuse to not address mental health, because overall we see an improvement in engagement, we see an improvement in mood. When mental health is better then physical health is better as well. We’ve seen an improvement in seizure activity and self-harming behaviours that were going on prior to Madelaine coming. If we’re here to advocate for the clients, then we’re advocating for their entire health, that’s the whole point, so I think it’s allowed us to do our jobs better than we were doing before, which is really important.

How did you keep track of Madelaine’s progress on the placement?

M: I had two separate journals, one for all the work I’d done with the clients: what happened; how did I address this?; what have I learned from this? Then another journal for my own emotional feelings and experiences. Because as Rebecca says it can be emotionally draining, and sometimes physically draining depending on which client you’re working with. I needed to lay everything out onto paper, then look back on it in a couple of weeks or days, and assess how I’d grown, or things I’d done differently, things that I’d been able to work through from the beginning. And that also made me think about whether this was the kind of setting I could work in my professionally qualified career, and be capable of taking all the tools that I’d learned on the journey to other places.

R: We caught up fairly often, and a lot of those chats were quite frank and honest about how difficult things can be.  I think Madelaine is a breath of fresh air in the sense that she’s just very open, lays everything bare, and says ‘Actually today was really difficult for x, y, and z reasons’.  This was my first experience of being a mentor, so I had to try to understand Madelaine’s point of view, because I know care is difficult, but also coming into this setting from outside and trying to reach into the mental health elements of care is a big undertaking. So I hope I contributed to her reflection and gave her some tools from my perspective as well. I said early on to Madelaine that I expected her to be part of the team, and wanted her to have some authority in this space, and understand the diagnoses and how the team functions, and she did that amazingly, so it made that element of my job a lot easier.

What techniques did you use to deal with the pressures of the role, Madelaine?

M: I start off with time boundaries. For me, as a professional, I think ‘Ok, this is the time that I’m dedicating therefore it should be honoured’, but this is also the time for the client, and if it’s a time that we’ve scheduled for every week, that should be honoured for the client, so they know that this is their time to do what they need to do before the pressures of the world come to them. If something happens, I have to give leeway. That’s what is needed, especially for the therapy to work.

And taking it step by step - I have to give 50, and the client would give 50, and if the client doesn’t give 50, I’m not giving that. Communication doesn’t work. Things like the use of touch, and especially around consent. If the client can't verbalise consent to me, how do I go about that? If the client were to pull away, I would take that as ‘That's not acceptable’. So I'm finding what yes or no means through eye contact or how they're feeling, if they're breathing shallow, in terms of the emotional support I need to give them that day.

It was very much easier for me to have sessions with the client from January, but really rough between September and December - just trial and error of different interventions, storytelling, drawing, paintings and then trying to figure out ‘what does this actually mean?’

R: I think Madelaine had to, quite early on, shift the parameters of success. I think in her learning at uni there’s quite a clear ‘OK, you're getting somewhere with this client because XYZ is in place,’ or ‘This is a breakthrough’. But with a lot of the work she’s doing, even the client she now supports privately, success a lot of the time is just any engagement, because any engagement is an improvement on what we've had before.

Engagement can equal better mental health because they’re able to put everything else aside mentally and focus on that space. I don't think we’re ever going to get to a point with our clients where it's like ‘OK, I can almost diagnose this person with this mental health issue, and I know that I'm fixing it.’ A lot of the time it’s identifying that ‘on this day at this time, this person felt this emotion and I was able to identify it and able to relieve them to some degree of what was going on’, or ‘I managed to engage this client in storytelling and they've never opened up to me before in that capacity.’ That actually gives us the tools as care staff that we can use these kind of communication techniques and therapy techniques in our work as well.

What do you feel was the biggest breakthrough that you had with a client?

M: I was working with one client who is non-verbal, and we were able to create two poems. That session was round about 45 minutes to an hour long, whereas usually after ten minutes he’s pointing at the door, which means the session’s over. But that particular session we were able to create these two poems that he was happy about.

Initially I typed up some things I already knew about him, then went through some poems on the theme of change, and took out sentences from them and cut them into strips. Then I would pick up sentences and read them out, and with the small mobility he has, I would ask him to choose which ones he wanted, sometimes swapping them round and asking again to make sure he was fully engaged. Then I laid them out on a table until it was finished, and read through it again to see if he’d like it, and if there were any changes he would either make a sound or nod.

R: It quite profoundly described how he was feeling. This is a client that is non-verbal but is very able to communicate non-verbally in a very general sense. You can tell that he’s sad, or in pain, or he’s very, very happy, but we’ve never got to the real crux of where these feelings come from, or how it feels to be him as a person. And I sobbed the first time I read this poem. When you read a poem by someone who’s non-verbal but you can see and hear them in the words, you think ‘That’s a breakthrough, because I understand him better.’ And it was a way that he was able to reflect on his life, and how it feels to be him, and be cared for and be reliant on others. There was a bit in it about wanting to be free, and how freedom feels to him, that got me really choked me up.

It’s not just the end product, but the whole idea that he was engaging enough to make choices like that, and think it a good use of his time. It gave him purpose, he was engaged, he was involved, and he made choices for himself, and what else can you ask for? We displayed it in the main corridor of the service, and submitted it to the magazine of the charity that we work for. I think it was a real source of pride for him as well.

What’s the most valuable thing that you took away from the placement, Madelaine?

M: Everything in general has been very important to me. I can’t really point out one specific thing because, throughout training, working with learning disabilities has opened my eyes to what is possible, and the creativity that I have within myself to be able to work around and figure things out, and then take that away and build on something. I feel like I’m definitely more flexible in every aspect.

R: Definitely more confident. From what I saw at the beginning, Madelaine was so accommodating, but she just grew into her own, and realised that she’s very capable of making change, and that what she’s doing is important.

Is there any advice you’d give to other students considering a placement?

M: To be confident in the abilities that you have currently, because they will definitely grow as you go on, and don’t be afraid to ask for advice. To call out if you’re feeling overwhelmed or going through burnout, because if you don’t say then nobody’s ever going to know. It only impacts you, and it impacts the client, so you can’t really do the job that you need to do properly.

And just have fun! You have your times where it is mentally or physically draining, but therapy doesn’t necessarily have to be so serious or downhearted. Sometimes it can be joyous. With one of the clients, for the first ten minutes we listened to Amy Winehouse and danced and sung. So it’s not always just about all the hard-hitting stuff. Sometimes there are positive things that clients want to share with you, and you just need to reciprocate that back, and enjoy it with them.