Researching directiveness and structure in drama therapeutic substance abuse treatment in a Czech psychiatric setting

While drama therapy (DT) is used in substance abuse treatment (SAT), little is known about how therapists navigate the clinical tension between client-centred, process-oriented principles and the directive protocols of psychiatric settings. This qualitative study explores this dynamic within a specific SAT program in a Czech psychiatric hospital. Semi-structured group interviews were conducted with six drama therapists experienced in addiction treatment, and data were analysed using inductive content analysis to identify core practitioner strategies. The findings indicate that in response to the directive environment, therapists consistently prioritize the therapeutic relationship, using this alliance as the primary means to foster safety and support client autonomy. This study concludes that in such demanding clinical contexts, the strength of the therapeutic alliance is the most critical factor for effective DT practice, representing a key professional adaptation for navigating directive settings.