HERStory: development and process evaluation of a manualized drama therapy intervention for women with breast cancer

Abstract Despite increasing recognition of creative arts therapies within psycho-oncology, manualized drama therapy interventions remain scarce. This article introduces HERStory, a six-session drama therapy group intervention for women with breast cancer, combining the Heroine’s Journey with role work, dramatic enactment, embodiment-oriented techniques, and resource-oriented approaches, and presents an initial process evaluation. The HERStory study was conducted as a prospective, non-randomized study with a pre–post–post design. Process evaluation used the newly developed Drama Therapy Process Observation Instrument (SK-BTP), a 43-item observer-rated instrument assessing eight dimensions of drama therapy group processes. Ratings were completed by an independent drama therapist. Descriptive analyses included 14 participants completing the intervention. Overall process quality demonstrated a positive trajectory. Mean scores increased from M = 3.56 to M = 4.31 in Group 1 and from M = 3.63 to M = 4.51 in Group 3, whereas Group 2 maintained consistently high scores (M = 4.19–4.30). Process openness reached relatively high levels early, whereas role flexibility, thematic development, and symbolic depth increased across sessions. The findings provide preliminary insights into the implementation of HERStory and the development of core drama therapy processes across the six sessions. The manual offers a transparent and reproducible intervention for future research and clinical practice. Further studies with larger samples and controlled designs are warranted to evaluate its effectiveness and applicability in other populations. Trial registration : German Clinical Trials Register (DRKS), DRKS00036673, registered 15 April 2025.