Therapy & Theater

Using playwriting to support narrative language and emotional wellbeing

Children need stories. In fact, we all do. Stories help us make sense of our world and our place in it. But what if you struggle to organize yours? Or you ramble through ideas leaving out important details? What if the only feedback from recounting your day is a disinterested listener cutting you off mid-sentence and changing the subject, or a bad grade, if asked to write a narrative? Telling a story can be challenging, but if your narrative language skills are lacking, writing a story may be even more difficult. 

Narrative language skills - like describing and linking events causally and using decontextualized language - support children's stories in both the personal and academic realm. When children share ideas and recount events with their friends, they are often practicing narratives. Later, teachers begin to ask children to write their stories. And in fourth grade, narratives become a part of high-stakes testing for many states. SLPs are accustomed to scaffolding narrative skills for children diagnosed with expressive and/or receptive language delays; yet, because narrative language proficiency is closely linked to academic success, programs that emphasize narrative language development could benefit a broader spectrum of students.

Supported by the Mind, Brain and Education (MBE) master's program at the University of Texas at Arlington (UTA), I have developed an intervention that uses the narrative form of playwriting to attempt to improve narrative language skills and emotional wellbeing in children. Cook Children's Hospital in Fort Worth, Texas is partnering with UTA to pilot this intervention with a variety of children who frequent the hospital on an outpatient basis. The Child Life team at Cook Children's has helped us realize that children with long-term diagnoses may have the greatest need. These children are often only able to attend school sporadically - if at all - secondary to health issues and outpatient treatments. Limited school attendance and fragile physical health take its toll on academic progress, peer relations and emotional wellbeing. Learning to tell better stories could help these children build language skills that would yield both academic and emotional gains.

What Is MBE?

Mind, Brain and Education is an interdisciplinary approach that seeks to use knowledge from the fields of psychology and cognitive neuroscience to inform educational practices. But MBE is not just a framework for schools.1 Learning takes place in many environments, and though the specific needs of the population may change, the MBE framework translates across contexts. Children's hospitals are an important and unique context, and understanding the learning process allows educators to adapt to the unique challenges these children face and design curricula profiting from speech-language therapy.

Theoretical Framework
SLPs are well-versed in designing therapy hierarchically according to developmental norms and scaffolding learning for our clients. However, two theories from MBE are bringing new meaning to these ideas: Perceptual Control Theory and Skill Theory.2,3 These theories offer a deeper understanding of creating effective goals and designing lessons in hierarchical fashion to match the developmental trajectory of learning as individuals mature over a lifetime - and, very importantly, how learners profit from this framework in the more immediate contexts where learning happens.4 Achieving both empowers students to achieve outcomes that are important to them. Lessons that require students to actively construct their own meanings are more effective than traditional lessons where teachers or therapists supply the answers. Building feedback into activities is also instrumental to the success of students. The act of solving a problem helps students evaluate and determine whether to continue or modify their actions until the goal is reached.5 These kinds of ideas are at the heart of my playwriting intervention.

Plays and Narrative Language

Playwriting is appealing as a curricular vehicle in three important ways. First, writing a play is a form of storytelling, and may be an effective tool for building narrative language skills.6 Second, it combines drama with writing, which is an academic skill sorely lacking among school-aged children. Drama techniques are well linked to improved language development in children, and oral language skills in particular. As an SLP I am drawn to using stories and role-play in therapy, using puppets, story enactments and reader's theater whenever possible. If creative drama can affect oral language skills, perhaps creative drama in its written form - playwriting - can affect written narrative language skills.

Plays and Emotional Wellbeing
Stress, anxiety, missed schoolwork and social isolation can take their toll on an already physically compromised child. The playwriting intervention at Cook Children's could translate to salutary effects on physical health that reflect improvements in the emotional wellbeing of the child. Narrative writing has in fact been linked with improvements in both mental and physical health.7 Developing stories through playwriting allows children to share their experiences, connect with peers and build situational understanding.

The Program

One of the most exciting parts of the program is that it moves playwriting from a solitary experience to a group one. With the first trial currently underway, the group dynamic has already proven powerful. Theater games redesigned using MBE models have pulled even the most reluctant students into the process. One student was motivated to write five pages of dialogue after just one session, and has gone on to start four plays. Key to the experience has been guiding students through personal narratives rather than learning story elements (plot, characterization, conflict, etc.) from fictional narratives. Students are developing plot lines and characters built from personal experiences, giving their work greater meaning.

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Oral readings of plays in progress have offered rich feedback, as students are listening to each other's scenes and raising thoughtful questions like, "I don't understand why your character, George, says this after Amber's line." Questions like this indicate that students are understanding the importance of linking events causally in a narrative and learning to craft dialogue that moves the story forward. This is vastly different from sequencing events from a book they've read for a grade. The rewards here are intrinsic and real because the stories are their own. Surprisingly, most students are choosing not to write about their illnesses. Rather, subjects common to adolescent angst prevail: bullying, fights with friends, embarrassing mishaps and dating. Exploring common ground beyond their diagnoses is fostering a healthy sense of collaboration, support and often laughter.

The initiative is not without its challenges. Interruptions abound in the hospital setting where medical needs take necessary priority over academic or language goals. Flexible planning has been key. At times it is sheer fatigue that trumps all, and normally engaged and motivated students really just need to sleep. Staying positive and working with students individually when needed has helped the program keep pace.

The formal success of the program will be determined by measuring narrative language skills, narrative writing, and student confidence in writing. Data is being collected and will be ready for report in Spring 2014. Informally, however, the students' success will be measured by completing the plays they are writing. This will be celebrated, formal studies aside, in a live performance of the collection. Seeing their stories performed on stage will give these children a sense of accomplishment and an often much-needed voice.

Rebekah Carlile is a speech-language pathologist and a theater teacher in Fort Worth, Texas. She is currently pursuing a second master's degree in Mind, Brain, and Education at the University of Texas at Arlington. Marc Schwartz is professor of Education at UTA and director of the Southwest Center for Mind, Brain and Education at UTA. Schwartz is a charter member of the International Mind, Brain and Education Society (IMBES), past vice president, and current president. The mission of IMBES is to facilitate cross-cultural collaboration in biology, education and the cognitive and developmental sciences.

1. Schwartz MS, Gerlach J. Guiding principles for a research schools network: Successes and challenges. Mind, Brain and Education. 2011; 5(4):172-179.
2. Forssell Dag, ed. Perceptual Control Theory: Science and applications- a book of readings. Hayward, CA: Living Control Systems Publishing; 2009.
3. Fischer KW, Mascolo MF. Dynamic development of thinking, feeling, and acting from infancy through adolescence. In: Damon W, Molenaar PCM, Overton WF, eds, Handbook of child psychology and developmental science. 7th ed. New York: Wiley; 2014, in press.
4. Schwartz MS. Cognitive development and learning: Analyzing the building of skills in classrooms. Mind, Brain and Education. 2009; 3(4): 198-208.
5. Schwartz MS. Khan Academy: The illusion of understanding. In Press. Asynchronous Learning Networks.
6. Reilly MA, Gangi JM, Cohen R. Teaching - Learning Indigenous, Intercultural Worldviews: International Perspectives on Social Justice and Human Rights: Deepening literacy learning: Art and literature engagements in K-8 classrooms. Charlotte, NC: IAP; 2010.
7. Pennebaker JW, Seagal JD. Forming a story: The health benefits of narrative. Journal of Clinical Psychology. 1999; 55(10): 1243-125.

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