Performance-based therapeutic approaches — staging scenes, embodying a role, speaking scripted words aloud in front of others — can access something that direct, first-person verbal disclosure often can't for trauma survivors: the protective distance of playing a character can make it safe to access and express genuine emotion that would otherwise feel too exposing to approach directly. This isn't escapism; the emotional work being done through the performance is real, even though it's channeled through someone else's words and story.
The theatrical structure itself — a director's guidance, the presence of a supportive audience or ensemble, a defined beginning and end — provides a contained framework that makes approaching genuinely difficult material safer than it might feel in an open-ended, unstructured conversation, which is part of why this approach has shown real results specifically with populations, like combat veterans, whose trauma is often the hardest to approach directly.
Van der Kolk describes Larry, a fifty-nine-year-old Vietnam veteran with dozens of detox hospitalizations in the prior year, who volunteered to play Brutus in a VA acting workshop — initially so terrified he could barely speak his lines aloud. Guided by a director's repeated, gentle prompts around emotionally loaded words in the script like 'remember' and 'justice,' he gradually learned to stay present with the emotion those words triggered rather than fleeing the scene entirely, and by the program's end he had started his first steady job in seven years. Separately, three of van der Kolk's VA patients recruited a well-known playwright and professional film actors to help stage their own actual war stories and poetry in a Boston production — an experience van der Kolk considers more transformative for them than any conventional therapy he had previously offered.