Using drama therapy as an effective intervention for bullying among siblings

Prahbhjot Malhi; Bhavneet Bharti

doi:10.4103/ipcares.ipcares_295_21

CASE SERIES

Year : 2021 | Volume : 1 | Issue : 4 | Page : 228-230

Using drama therapy as an effective intervention for bullying among siblings

Prahbhjot Malhi¹, Bhavneet Bharti²
¹ Department of Pediatrics, Post Graduate Institute of Medical Education and Research, Chandigarh, Punjab, India
² Dr. BR Ambedkar State Institute of Medical Sciences, Sahibzada Ajit Singh Nagar, Punjab, India

Date of Submission	27-Sep-2021
Date of Decision	14-Oct-2021
Date of Acceptance	30-Oct-2021
Date of Web Publication	29-Nov-2021

Correspondence Address:
Prahbhjot Malhi
Department of Pediatrics, Post Graduate Institute of Medical Education and Research, Sector 12, Chandigarh - 160 012
India

Source of Support: None, Conflict of Interest: None

DOI: 10.4103/ipcares.ipcares_295_21

Abstract

Background: Sibling bullying is repetitive aggressive behavior that is motivated by the desire to dominate and incite distress on the victims. It is a hidden epidemic, with nearly 50% of children being victimized sometime in their lives. Since this is associated with adverse consequences for victims and abusers, it requires prompt recognition, evaluation, and management. Clinical Description: We present three families of sibling bullying. Comprehensive individual in-depth interviews (individual and group) were conducted by a team of professionals. The goal was to understand the psychological impact on the children, the family dynamics, and underlying psychosocial issues. Common factors identified were inadvertent positive reinforcement of bullying by parental inability to set limits to the abuser's aggression, failure to model respectful communication, and lack of using appropriate conflict resolution strategies. Management and Outcome: Drama therapy was used as the primary modality of intervention. This involved putting families in hypothetical situations in which they reenacted a bullying incident. Family members played various roles interchangeably in multiple sessions. The role-plays and ensuing discussions created awareness of the adverse effects of sibling bullying on the entire family. This coupled with instruction on positive disciplining and use of conflict resolution and anger management strategies resulted in a gradual decline in bullying. Conclusions: Sibling bullying can be effectively managed by strategies that promote positive interpersonal relationships. Pediatricians need to recognize cases of sibling bullying and consider referral to mental health professionals for evaluation and appropriate management.

Keywords: Creative therapies, drama therapy, intrafamilial aggression, sibling bullying

How to cite this article:
Malhi P, Bharti B. Using drama therapy as an effective intervention for bullying among siblings. Indian Pediatr Case Rep 2021;1:228-30

How to cite this URL:
Malhi P, Bharti B. Using drama therapy as an effective intervention for bullying among siblings. Indian Pediatr Case Rep [serial online] 2021 [cited 2023 Apr 1];1:228-30. Available from: http://www.ipcares.org/text.asp?2021/1/4/228/331378

Sibling bullying is a common, repetitive, and extremely harmful form of intrafamilial aggression. Given its covert nature, it can be considered a hidden epidemic, especially since 40%–50% of all children are victimized at some time in their lives.^[1] Despite the high prevalence, both the general public and professionals fail to recognize it as deviant behavior, or confuse it with sibling rivalry. These terms are often used interchangeably, but it is important to realize that both have different constructs and outcomes. Sibling relationships naturally involve conflict. Instances of minor hostility, competition or aggression, unwillingness to share and cooperate can be classified as sibling rivalry. In contrast, aggressive behaviors that are severe, repetitive, and predominantly motivated by the desire to dominate and incite fear or distress in the victims are referred to as bullying. Ineffective parental disciplining such as lack of consequences for the abuser may worsen the problem.^[2]

Sibling abuse is often observed in dysfunctional families with multiple stressors, such as marital conflict, maternal depression, economic stress, substance abuse, and family disorganization.^[2] Other risk factors for victimization include belonging to a large family, being younger, and having male siblings. Research has ascertained that sibling bullying victims experience higher rates of mental health problems such as depression, anxiety, trauma-related symptoms, and self-harm behaviors.^[2] Evidence indicates that perpetrators of sibling bullying use aggression to attract attention, gain material resources, and establish social dominance within the family.^[2] Involvement in bullying at home significantly increases the likelihood of participation in school bullying.^[1] Sibling bullying has not been widely researched in the Indian setting, despite its prevalence and serious negative consequences for both victim and perpetrator.

Strategies to help parents manage sibling aggression include improving their children's social skills and teaching them mediation techniques for resolving conflicts. Recent research has highlighted the use of creative therapy like drama therapy in managing peer aggression, but its usefulness in sibling conflict is yet to be established. Drama therapy involves using various theatrical techniques (i.e. puppetry, masks, improvisation, and role-play) to facilitate the exploration of interpersonal problems within the context of social learning to achieve psychotherapeutic goals in an imaginative, controlled, and safe way. This is recognized as a powerful intervention tool to achieve psychological growth by exploring underlying emotions and increasing the awareness of the perspectives of affected individuals.^[3] No script is provided to the players/performers, and children are neither named nor blamed. Role-play provides a unique opportunity to share experiences and revisit them within the boundaries of fantasy and safety of the therapeutic setting.^[3]

In this paper, we share the creative use of dramatic role-play to effectively manage three families with children exhibiting sibling bullying, and how we used it to promote empathy and cooperation among them.

Clinical Descriptions

Family 1

A middle-class nuclear family sought help for their daughters, RK and MK, aged 9 and 13 years, respectively, due to concerns regarding their behavior. Both repeatedly engaged in aggressive and hostile acts such as physical violence, name-calling, and belittling each other for the last 2 years. The girls were evaluated by the child psychology team, first individually, and then together along with their parents, over three sessions each lasting about an hour. Each of them and the parents were invited to put themselves in a hypothetical hostile situation, and play the role of the other person to appreciate the “other” person's perspective. They were told that it was a collaborative pretend exercise, wherein they had the freedom to make up their own storyline, provided it revolved around sibling conflict and did not exceed 15 min.

This role reversal and the ensuing discussion helped in gaining insight into each other's perspectives and feelings, regarding the effects of the bullying on each other. The reasons for the elder girl's desire to dominate and control were explored, and she was counseled to develop her interests in sports and channelize her energy in outdoor activities, i.e., cycling. The parents reported a substantial decline in sibling aggression and improvement in their interpersonal relationships (increased sharing and cooperation) over the next 6 months.

Family 2

AB, an 11-year-old boy, studying in class five in a government school was referred to us by his class teacher who was worried about the significant deterioration in his school performance over the previous 3 months. History revealed that AB was a timid boy with an elder 15-year-old brother, SC, who teased him mercilessly, called him names like “stinky” and “filthy,” and would often physically abuse him. AB's parents were indifferent to these aggressive acts, considered them normal, and thus, failed to intervene despite AB's evident distress. Further probing also revealed that the father had a “drinking problem” which the family was struggling to cope with.

During the interview with our team, AB talked about his desire to be loved and accepted by his family, particularly his older brother, whom he admired for his physical prowess, muscular body, and academic excellence. The siblings were asked to enact a recent incident of bullying with role reversal, and the family members were given time to elaborate upon on how they felt during the scene. Constructive strategies for handling anger (e.g., deep breathing, etc.,) and alternatives for conflict resolution (i.e., amicably negotiating a solution) were discussed. Follow-up after 3 months revealed a marked decline in the bullying episodes and improvement in the academic grades of AB.

Family 3

M, a 13-year-old boy presently studying in class 7 of a private school, was diagnosed with a specific learning disability in class 5. He has been struggling with his academic work despite classroom accommodations and special education. this led to him being ridiculed by his schoolmates. His 16-year-older brother, V, was ashamed of his brother's scholastic backwardness and actively avoided him at school. At home, he used disparaging language to humiliate M that often escalated to physical abuse. The parents were unable to manage V's misbehavior and usually resorted to harsh discipline in their attempts to control the conflicts.

Drama therapy was initiated to help parents to appreciate the thoughts and feelings of their sons and understand what they were each going through. They were counseled regarding the need for creating an emotionally supportive home environment, fostering bonding, and preempting V's attempts to intimidate M. Follow-up after 6 months revealed that, except for occasional episodes of conflict, there was an overall decline in the sibling bullying.

Discussion

In recent years, sibling bullying has been recognized as a serious problem that can negatively impact functioning in children. Failure to recognize and support the victim's emotional distress can exacerbate the expression of negative emotions and/or externalizing problems (i.e., aggression) to other settings beyond the home.^[2] Behavioral problems are entrenched in dysfunctional parenting marked by a lack of insight into their children's need for a supportive home environment. Inappropriate parenting styles of intervening inadvertently result in the development of toxic sibling relationships. Parental indifference has been known to exacerbate dysfunctional interactions and sibling conflicts well into adulthood.^[4] Techniques that improve parental insight and strengthen their skills in nurturing harmonious sibling relationships can greatly reduce the family's psychosocial burden and increase sibling well-being.^[4],[5]

These cases [Table 1] were presented to illustrate the urgent need to address sibling bullying, and also demonstrate the feasibility and effectiveness of drama therapy to reduce sibling bullying. There is emerging evidence to indicate that theatrical techniques help in achieving psychological growth for all participants and trigger parental reflection and introspection that lead to positive interpersonal relationships within the family.^[3],[6] The utility of school-based drama therapy in alleviating peer victimization in the classroom has been scientifically demonstrated.^[5] An intervention program started in a primary school in Finland reported a decrease of 21% in bullying.^[7] However, not all studies have found role-playing to be successful in reducing victimization, particularly if the intervention is brief.^[8],[9] Reductions in peer aggression tend to be more marked when the interventions are intensive and sustained over time.

Table 1: Summary table of specific issues and management techniques used for sibling bullying

Click here to view

There is scientific evidence that links sibling and peer bullying. A recent study suggested that adolescents victimized by both their siblings and peers were most likely to develop clinical depression and suicidal ideation in adulthood.^[10] It is important to recognize that perpetrators of bullying also suffer adverse consequences, are likely to remain aggressive beyond childhood, and engage in high-risk and anti-social behaviors as adults.^[2],[9] Timely addressal of intrafamilial aggression attenuates the effect of early-life toxic stress and has long-term implications, i.e. promoting subjective well-being in adulthood. When encountering cases of sibling bullying in their practice, pediatricians should never disregard them lightly or give false reassurances, but consider referring the family to mental health professionals for comprehensive evaluation and holistic management.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form, legal guardians have given their consent for images and other clinical information to be reported in the journal. The guardians understand that names and initials will not be published and due efforts will be made to conceal patient identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

References

1.	Tippett N, Wolke D. Aggression between siblings: Associations with the home environment and peer bullying. Aggress Behav 2015;41:14-24.
2.	Dantchev S, Wolke D. Sibling bullying at 12 years and high-risk behavior in early adulthood: A prospective cohort study. Aggress Behav 2019;45:18-32.
3.	Mayer C, Frydman JS. Understanding school-based drama therapy through the core processes: An analysis of intervention vignettes. Arts Psychother 2021;73:101766.
4.	Tucker CJ, Finkelhor D. The state of interventions for sibling conflict and aggression: A systematic review. Trauma Violence Abuse 2017;18:396-406.
5.	Wang Q. Association of childhood intrafamilial aggression and childhood peer bullying with adult depressive symptoms in China. JAMA Netw Open 2020;3:e2012557.
6.	Mavroudis N, Bournelli P. The role of drama in education in counteracting bullying in schools. Cogent Educ 2016;3:1233843.
7.	Dirks MA, Persram R, Recchia HE, et al. Sibling relationships as sources of risk and resilience in the development and maintenance of internalizing and externalizing problems during childhood and adolescence. Clin Psychol Rev 2015;42:145-55.
8.	Joronen K, Konu A, Rankin HS, et al. An evaluation of a drama program to enhance social relationships and anti-bullying at elementary school: A controlled study. Health Promot Int 2012;27:5-14.
9.	Agley J, Jun M, Eldridge L, et al. Effects of ACT Out! social issue theater on social-emotional competence and bullying in youth and adolescents: Cluster randomized controlled trial. JMIR Ment Health 2021;8:e25860.
10.	Dantchev S, Hickman M, Heron J, et al. The independent and cumulative effects of sibling and peer bullying in childhood on depression, anxiety, suicidal ideation, and self-harm in adulthood. Front Psychiatry 2019;10:651.