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

This article examines how drama therapists navigate the clinical tension between client-centred, process-oriented principles of drama therapy (DT) and the directive, structured protocols typical of substance abuse treatment (SAT) within a Czech psychiatric hospital (PH) setting. Through qualitative analysis of semi-structured group interviews with six experienced drama therapists, the study identifies that therapists prioritize the therapeutic relationship as the key strategy to foster safety and support client autonomy amid institutional demands for directiveness. Findings reveal that directiveness and structure in DT are interrelated but distinct concepts, with directiveness providing necessary boundaries and energy early in therapy, which decreases as trust in the therapeutic alliance grows. The research highlights the influence of the PH's regime treatment model on therapy practice and underscores the importance of therapist adaptability to balance institutional requirements with the humanistic, indirect methods of drama therapy in addiction treatment.