Healing trauma through theatre: A therapeutic vignette from the DE-CRUIT Veterans’ theatre program

Abstract

As the use of arts-based approaches to support Veterans’ mental health continues to expand, there is growing interest in the mechanisms underlying their delivery. This article describes the DE-CRUIT group treatment program that uses theatre to support Veterans in their transition to civilian life and in coping with mental health struggles. Components of the DE-CRUIT program are outlined, in particular, the use of Shakespeare in addressing Veterans’ trauma. In the program, Veterans immerse themselves in Shakespeare’s verse with an emphasis on the many Veteran and military characters throughout Shakespeare’s plays. They examine the Shakespearean monologue form and subsequently compose their own personal trauma monologues. Here, the experience of the program is illustrated through the case vignette of an African American woman Veteran who experienced military sexual trauma. After completing the program, she was able to disclose her abuse to family members for the first time. She also continued to write about her experiences and has now performed her spoken-word work publicly on stage. The article includes recommendations for expanding the DE-CRUIT program, as well as for including family members in the DE-CRUIT treatment process.

Lay Summary

DE-CRUIT is a drama-based trauma-focused treatment program for military Veterans. The goal of the program is to help Veterans with the psychological effects of trauma and aid them in transitioning to civilian life. The core of the DE-CRUIT program is studying Shakespeare’s work. In this article, the experience of the program is illustrated through the case vignette of an African American woman Veteran who experienced military sexual trauma. After completing the program, she was able to disclose her abuse to family members for the first time. The article concludes with recommendations for expanding the DE-CRUIT program and including family members in the DE-CRUIT treatment process.

Introduction

Scientific findings from recent decades have consistently shown military Veterans are significantly more likely than civilians to experience a host of social and psychological problems, including depression, posttraumatic stress, addiction, suicidality, homelessness, and incarceration.^1–5 These persistent problems reported among U.S. Veterans are due, in large part, to the failure of various systems to meet the challenge of responding to the psychosocial needs of Veterans who are facing transition to civilian life.^6–9 It is imperative that interventions are developed and evaluated to help with that challenge. Researchers examining such interventions found engaging in the arts can be central to psychological recovery and community transformation.^10–12 While much of the focus on creative arts therapies for Veterans and service members has involved art therapy, music therapy, and dance/movement therapy,¹³ treatment programs based in theatre and drama are rapidly gaining traction in this realm, as the evidence base for such work continues to grow.^14–16 One such program is the DE-CRUIT program, which used theatre to treat Veterans’ trauma for over a decade.

The purpose of this article is to delineate some of the therapeutic benefits of the DE-CRUIT program through the illustrative case of an African American woman Veteran who experienced military sexual trauma (MST) during her time in the military and who completed the DE-CRUIT program in 2022. In keeping with the DE-CRUIT philosophy, and with the ethical and scientific tenets of Veteran-led research,¹⁷ the Veteran featured in this clinical vignette, Zina Dawson, is an author of this article.

The DE-CRUIT Program

DE-CRUIT is a drama-based, trauma-focused treatment program for military Veterans. The program uses a group modality across six to eight weekly sessions held in-person or remotely for up to three hours per session. The goal of the program is to help Veterans with the psychological effects of trauma and to assist in the transition to civilian life (i.e., to provide support to “de-cruit” from the military in a similar way to how service members had individuals and services available to recruit them into the military). Veterans from any era and of any discharge status are welcome to participate. The core of the DE-CRUIT program is Shakespeare. The program uses principles from classical actor training (e.g., experiential analysis, breathwork, symbolic representation) as well as verses and characters from Shakespeare’s plays to allow Veterans to better understand themselves and the Veteran experience. Participating Veterans immerse themselves in Shakespeare’s plays and learn that many of the characters are military Veterans or loved ones of Veterans. They come to understand the timelessness of Veterans’ suffering through analyzing texts from centuries ago, which represent that suffering through a precise, elevated language that serves to both capture and honour the Veteran experience. Participants then write their own first-person monologues in any format they choose, using the Shakespearean monologue form as a guide. Monologues are shared to an invited audience of family members and friends at the final program session, thereby expanding Veterans’ communities of support.

The DE-CRUIT program was developed by U.S. Army Veteran Stephan Wolfert based on his own experience of applying Shakespeare to his recovery from trauma. Using Shakespeare’s verse, the program provides a controlled mechanism for Veterans to access and examine emotionally charged memories in a supportive, peer-based environment. The program guides Veterans through a routine set of techniques that equips them with essential social, emotional, psychological, and practical skills that will help them in working toward life goals. A key component of the routine involves therapeutic embodiment. Specifically, the iambic pentameter that characterizes much of Shakespeare’s verse mimics the rhythm of the human heartbeat. Accordingly, it is possible to use this rhythm and verse to regulate breathing patterns of participating Veterans, countering the psychophysiological dysregulation that often characterizes a trauma response.¹⁸ The DE-CRUIT program uses routine breathing techniques from actor training to allow participating Veterans to inhabit their written words and immerse themselves in presenting first-person monologues more fully.

In addition to writing a first-person trauma monologue, each of the Veterans is assigned a monologue from one of Shakespeare’s plays, selected using an algorithm developed by DE-CRUIT to match the dominant theme of each first-person monologue. Veterans rehearse and ultimately recite the selected monologues at the end of the program in addition to their own monologues. The algorithm used is thematically matched, rather than based on the gender or background of Veterans. This process is in keeping with various gender-related components of DE-CRUIT that parallel both the military world and the world of Shakespeare. One such component is the fact that both worlds transcend certain aspects of gender, with female characters being played by male actors in Shakespeare’s day, and the notion of the military label GI (i.e., government issue) branding everyone as a soldier, rather than being defined through their gender, race, and so on.

Additionally, the world of Shakespeare parallels the military world in that the Elizabethan Great Chain of Being is about rank, not gender, and very closely matches the rank structure of the U.S. military. Lastly, Shakespeare wrote strong women soldier and Veteran characters into his plays. Shakespeare scholar Tina Packer’s book Women of Will¹⁹ dedicates the entire first section to an analysis of women soldiers and Veterans in Shakespeare’s plays. In that section, entitled “The Warrior Women,” Packer discusses the ways gender is reflected within the plays through such characters as Margaret of Anjou and Joan of Arc who, like women in today’s military, find themselves in a world assumed to be primarily a world of men. It is against such a backdrop that Dawson’s story takes place.

Therapeutic Vignette

The content of this vignette was developed through a semi-structured qualitative interview between the lead author and Dawson. The goal of the interview was to understand the key themes and reactions Dawson experienced in going through the DE-CRUIT program and expressed while writing her first-person monologue. Dawson served in the U.S. Army full time as a combat medic and armourer and as an active duty reserve service member across the continental United States. She was honourably discharged from the military after a combined eight years of service.

Dawson was recruited via email invitation from one of the DE-CRUIT founders. As there were no inclusion or exclusion criteria that needed to be screened for prior to requesting the interview with Dawson outside of confirming past participation in the DE-CRUIT program, a screening process was not implemented. As Dawson previously participated in the DE-CRUIT program and was deemed suitable for the group intervention through the program’s screening process, no assessment of her trauma nor of her suitability or fit for the intervention was relevant to this post-hoc qualitative interview. Dr. Alisha Ali presented to Dawson the goals of the interview and the interview protocol for review prior to Dawson providing verbal consent to the interview. The interview was approximately one hour long and conducted via Zoom.

The interview protocol consisted of 14 open-ended questions (see Appendix 1) developed in coordination with the study team based on knowledge of the principles of the DE-CRUIT program, knowledge of the participant’s military experiences, and review of the participant’s monologue. Dawson’s first-person monologue and Shakespearean monologue were transcribed and reviewed prior to the interview for reference. Interview questions were worded to gather information about the participant’s general background, previous experience in the arts, DE-CRUIT experience, DE-CRUIT program effects on well-being, pivotal moments within the program, specific skills/coping strategies learned from the program, use of Shakespeare, monologue construction, program structure, and potential program revisions. Follow-up questions outside the interview protocol were used as needed. The interview was audio and video recorded via Zoom, with Dawson’s consent, and the Zoom recording was transcribed by the lead author. The transcript was analyzed by the co-authors using thematic analysis methods to discover thematic categories related to Dawson’s experiences in the DE-CRUIT program. Open-coding techniques were used to identify differing types of therapeutic process themes, and axial coding was used to identify the properties of each theme, including critical moments, emotional responses, impact on well-being, and effects of different aspects of the program. The co-authors actively engaged in peer/expert debriefing within the group of co-authors to discuss interpretations, findings, and potential biases to maximize the validity and reliability of the themes gleaned and to ensure multiple perspectives were considered. The co-authors also presented findings from the thematic analyses to Dawson as a member-check to confirm her lived experiences of the program were accurately represented through the unearthed themes before all the authors, including Dawson, began the writing process.

Therapeutic cohesion

The foundation of the therapeutic process in the DE-CRUIT program is the bond of camaraderie formed among group members by virtue of all participants being Veterans. This process hinges on the phenomenon of union cohesion, a term Freud²⁰ used to describe connection among members of a military unit as they work toward a common goal — in this case, the goal of collective processing and healing. DE-CRUIT’s collective element was crucial for Dawson, who never openly described her experience of MST or the aftermath of filing a claim following the abuse. In her discussion with the lead author, Dawson described how DE-CRUIT created a secure, Veteran-only space in which she felt able to share her experience. She stated, “For the first time in my life I was able to say out loud what I was living for 30 years, and that was powerful.” Dawson chose to conclude her first-person monologue by emphasizing the potential for healing with the line “Perhaps I will begin to breathe, find healing … begin to live,” highlighting the empowering impact and strength she gained through opening up about her trauma to those she now trusted. In reflecting on the transformative power of sharing, she stated the DE-CRUIT program was “a revelation” that demonstrated “you can’t heal what we don’t reveal.” She described how the sense of camaraderie extended beyond the end of the group, saying, “I used to be an alone sufferer” but now “I have new battle buddies, a tribe with a common thread.”

Transformation through Shakespeare’s verse

As with all Veterans in the program, a Shakespearean monologue was selected for Dawson using the DE-CRUIT algorithm based on the dominant theme in her first-person monologue. In Dawson’s case, the dominant theme was anger pertaining to her MST experience. In her first-person monologue, she wrote about her anger around the incident itself:

The incident that most affected me is still MST. It violates my days. I don’t have nightmares anymore. I have daymares. I think of doing harm to only one being who may not even be alive anymore.

She also wrote about her anger around the necessity of having to expose herself to scrutiny in filing a claim about the incident:

Now, a bunch of strangers will see me naked, violated, traumatized again and again and again. They will make judgment without ever meeting me.

The Shakespearean monologue that was matched to Dawson’s theme of anger was a speech from Coriolanus that represents the disdain and anger the banished military Veteran Coriolanus felt toward those in the civilian world who were indifferent to the suffering of Veterans. Dawson specifically connected to the line “He that depends upon ye favors swims with fins of lead,” which conveys sentiments that closely parallel the hopelessness and anger she held toward those who hurt her. In discussion with the lead author, Dawson described how Shakespeare’s verse allowed her to verbalize her anger in the words of a character, thereby providing a distance through which she could observe her own physiological reaction and breathing to the release provided through the speech. This process ultimately scaffolded her own expression of anger using her own words in her first-person monologue: “Shakespeare has already felt these feels for me and I just get to spit it.”

Moving beyond therapy

The DE-CRUIT program is designed, in part, to support Veterans in strengthening their relationships with family members and community members as they move forward with their lives after the group ends. In discussion with the lead author, Dawson emphasized two key ways this support had a significant impact on her life. First, having already shared and described her experience in group sessions, she was then able to tell family members about her experience of MST for the first time. Before DE-CRUIT, Dawson was “disconnected,” but DE-CRUIT gave her the language to finally tell her family members what had happened to her. She stated, “It has affected all of my family relationships … healing and revealing with family.” Second, she highlighted in her interview the benefits of healing through creative self-expression. She reflected that, while she felt connected to the arts all her life, “it … took until the last four years that I was able to say, ‘I am an artist.’” Her prior connection to the arts helped her readily embrace theatre as a means to heal. She further described the ways writing and reciting her first-hand monologue in DE-CRUIT ultimately led her to create new, additional first-person writing. This resulted in performing her own spoken word writing publicly on stage in New York City. Dawson felt that, through these extensions of her monologue, she was able to create “transmutations of energy, to make something beautiful from something painful.”

Conclusion

Dawson’s experiences highlight some of the essential aspects of the DE-CRUIT program that supported her growth and well-being. These experiences also provided insight into the underlying processes behind the program components, including breathing techniques, emotional expression through the written word, and the group format. In discussion with the lead author, Dawson also described ways the program could be strengthened. In particular, she emphasized the benefits of continuing to offer the program remotely, allowing Veterans to participate in DE-CRUIT from a sanctuary of safety in their own personal spaces. In her own experience with the program, Dawson found the online modality fostered a sense of comfort. She stated, “People are in their safe spaces when talking about something so vulnerable.”

There are certain challenges concerning the delivery of the DE-CRUIT program that should be noted. For instance, not all Veterans are comfortable taking part in a group-based program, and arts-based programs — whether in-person or online — are not the right fit for all Veterans. Similarly, it cannot be assumed home is always a safe space for taking part in online sessions, particularly in the context of violence or abuse. Additionally, no one program can meet all the mental health needs of Veterans. DE-CRUIT is but one program in an array of programs, including sports-based programs, that support Veterans in dealing with trauma and the transition to civilian life by using models that vary from typical medical approaches. One example is the groundbreaking work of the Contact! Unload project that uses Veterans’ real-life stories and theatre to connect civilian audiences to the realities of Veterans’ experiences.¹⁵ Parallels between that work, and the work of DE-CRUIT, are discussed in other writing.^21,22 It should also be noted that arts-based interventions can successfully be used in combination with more typical interventions when working with Veterans, and this integration is strongly recommended. Lastly, it is worth mentioning some women Veterans who experienced MST may prefer to take part in all-women groups, as opposed to mixed-gender groups. While the authors found most women Veterans in DE-CRUIT with a history of MST prefer mixed-gender groups, for reasons described in detail elsewhere,²³ they continue to offer women-only DE-CRUIT groups.

In her reflections about the program, Dawson recommended DE-CRUIT offerings be expanded in terms of who is served. The program is already in the process of adding programming for family members of Veterans, as well as programming that brings Veterans and their families together in sessions. Through further expansion of DE-CRUIT, the program will be able to reach more Veterans who, like Dawson, can continue to move forward in their lives after the military through collective healing and the power of the arts.

Biographies

Michelle Jeffers, MA (michelle.jeffers@nyu.edu), is a second-year doctoral student in New York University’s counseling psychology PhD program under Drs. Alisha Ali and Lisa Suzuki. Her research and clinical interests surround trauma and its consequences within vulnerable and at-risk populations. Jeffers’s previous scholarship investigated processes through which individuals differentially react to traumatic stress and anxiety, specifically posttraumatic stress disorder. Jeffers received her BA in psychology from Cornell University and her MA in psychology from Teachers College, Columbia University.

Alisha Ali, PhD (alisha.ali@nyu.edu), is an associate professor of applied psychology at New York University. She specializes in the use of theatre and other arts-based forms in the treatment of the psychological effects of trauma.

Stephan Wolfert, MFA (stephan@decruit.org), is a U.S. Army Veteran and founder/director of the DE-CRUIT program. He is also a classically trained Shakespearean actor. His award-winning autobiographical play Cry Havoc documented his military experience and forms the basis of the DE-CRUIT program.

Zina Bethea Dawson (zinadawson@msn.com), was a U.S. Army combat medic from 1984 to 1992 and is now a military Veteran and textile artist. She served as a medic with the 7th Infantry Division and the 320th Evacuation Hospital.

Annie Farnsworth, MA (af3229@nyu.edu), works with a research team in the Computational Psychiatry division at New York University Langone. Her research interests are in stress and trauma. Her current research focuses on identifying biomarkers associated with posttraumatic stress disorder and suicide risk. Farnsworth received both her BA in interdisciplinary studies and MA in psychology from New York University.

Shakira Thompson, BA (skt9885@nyu.edu/ skthompson870@gmail.com), is a case management administrator for Suffolk County Mental Health and Hygiene Adult Single Point of Access in Hauppauge, New York. She is interested in increasing mental health awareness and using creative means to foster meaningful change. Thompson received her BA in global public health and psychology at New York University.

Appendix

Interview Protocol

DE-CRUIT monologue interview protocol

Would you allow me to audio record our interview today for transcription and data purposes? This will be kept confidential within the study team and deleted upon your request.

1. Can you tell me a little bit about yourself in terms of your background and why you decided to take part in the DE-CRUIT program?

2. Did you have any experience with the arts (e.g., visual arts, writing, performing) before taking part in the DE-CRUIT program?

3. What were your overall impressions of DE-CRUIT during your participation in the program?

4. How did the program impact your emotional well-being?

5. In what ways did you benefit from taking part in DE-CRUIT? Were there specific pivotal moments in the program that were especially powerful for you (e.g., “breakthrough moments”)?

6. Are there specific skills or ways of coping that you learned from the DE-CRUIT program that have helped you during times of crisis or stress (e.g., the breathing and grounding techniques)?

7. Were there things you discussed, disclosed, or wrote about in the DE-CRUIT program that you had not shared with people before? If so, what was that like for you?

8. How did Shakespeare’s verse itself impact you as you went through the program?

9. Tell me about the monologue you wrote. I found it to be very powerful and moving. How did you decide to write about those experiences? Can we discuss some of the Shakespeare lines in the monologue so that you can tell me about how and why you used them in your monologue?

10. How important was it to you that the program was led by a veteran?

11. What are some advantages of DE-CRUIT being delivered in a group format (as opposed to an individual format)? Are there any disadvantages of the group format?

12. Are there any changes you would recommend to improve the DE-CRUIT program?

13. Is there anything else you would like to share regarding your participation in the DE-CRUIT program?

14. Lastly, do you have any questions for me?

Funding Statement

No funding was received for this article.