Therapeutic Puppetry 
Empowering - Transformative - Healing

Healing Puppetry – Puppets in Service of the Therapist                  (150725)

 A sunny summer afternoon in between grey skies a group of people came together from Greece, Denmark and Sweden to talk about the therapeutic use of puppetry. The setting was Pegasus International, a puppet festival in ecological environments in South of Sweden.

Special guest was child psychiatrist and psychotherapist Dimitris Karagiorgas from Greece, earlier working in Sweden. He generously shared his work and views and answered the moderator´s as well as the participants´ questions. Topics raised were target groups, theory, method, structure, cultural aspects, the therapy room and puppets / props, relation to therapist and other important people, closure, rituals, goal attainment / compliance and evaluation.

Our journey started with a 10-minute video clip from a child therapy where Dimitris used puppet drama with a young school aged boy with neuropsychiatric, high functioning diagnose. The case became a red line throughout the conversation, enforced by experiences and examples from the morning workshop led by Dimitris. As shown in the video puppets have a potential to catch attention even when clients have difficulties with focusing. As Dimitris say, usually children take the initiative to bring out the puppets from his cupboard. Therapeutic puppetry are also inclusive, it is possible to include other objects or art in an ongoing role play. Sometimes being excluded again on therapists initiatives when needed, however with both a lot of structure and flexibility. To create a safe space for the client in this way is of course crucial.

Dimitris uses techniques mainly from psychodrama and therapeutic puppet play, inspired from different schools such as the child /client centred, Jungian one developed in Switzerland and Germany. Also some Cognitive Behavioural Therapy (CBT). He has made an interesting fusion of his own where observation, following the child and working in the symbolic frame has a prominent role. He uses the method with children, parents, families and adults, not very much with teenagers. Here matching is important, but also probably dependent on what puppets and props you use. Including masks, making your own puppet, shadowplay etc could make a difference for the older children. Also having a wide range of material can be helpful. Gudrun Gauda in Germany for example offers many puppets of the same archetype such as kings, queens, witches, Death, crocodiles and more, and symbolic props such as treasure boxes, food and swords. There you can find the good and bad mother for example, which can help in creating your own story and feel connected with the puppets. Another thing common in that tradition fascilitating closeness is using fingers as puppet hands and sometimes arms, as well helping in getting grip and sensations. The collective experience is working within us all. On the contrary the puppets in the German-speaking countries tend to appear quite similar, often made with in same way, can be a limitation.     

Much more is left to say on the topic and our talk, for example getting information through making observations, such as the ability to symbolize, but the conversations will continue. For all mortal - as well as therapies - there is closure and endings. Helped by ritual we can continue our journey. Bon Voyage.

Text: Åsa Viklund, July 2015 


 Therapeutic Puppetry – An Expressive Arts approach

Course Leader: Matthew G. Bernier, mcat, atr–bc, Eastern Virginia Medical School, USA

On the 31´st of July 2014 a group of therapists met to learn more about therapeutic puppetry. A parallel group of puppeteers met as well, joining up in one group some hours every of the four course days. The beautiful spot for the event was Inartes Institute in Helsinki, therefore naturally using expressive arts as a springboard.

Therapeutic puppetry is an interdisciplinary therapy form that gives a lot of possibilities. A crucial thing, apart from the making of a puppet, is exploring it, getting in touch with its essence. This is initially done through movement in the non-verbal dimesion. Except for the puppet has to be convincing; in appearance, moves, words and sounds. This includes observing what is its advantages and weaknesses, making changes if needed depending on the puppet´s unique purpose.

So what is convincing? Can waste be convincing? Broken things, damaged goods? Again it all depends on purpose. Matthew states that these things should be a part of every puppet therapist´s collection offered, among many other things. Parts of ourselves can be – and probably always is – torn or damaged somehow. To make belive is to make that imperfect hand suit in that imperfect puppet glove. There is no way we can reach our clients if not. Also, not using perfect, new material means it is possible to throw around; a gain in every therapy.

Rather similar and yet unknown - at least for nordic people term-wise - is Eco Art Therapy or Eco Psychology, using things from nature in therapeutic work. This can help us with grounding and connect us to Mother Earth. Using rituals this work can be reinforced, for example when dealing with transitions such as birth and death (actual or symbolic). A question raised by Matthew was: is Eco Therapeutic Puppetry (or Therapeutic Eco Puppetry? writer´s comment) a useful term? It could – and would - of course include existing work in the field today.    

In addition; it is a winning concept to offer a wide range of puppets in therapy. Even better – almost essential – is offering a wide range of materials so that the client can make a puppet of his/ her own. Puppethands can easily be made and personalized by drawing the outlines of the client´s own hand on fabric or paper and cut out. Finally Matthews words in new context: puppets can be both evocative and provocative – so look out! And of course even more important: look in. Meaning that the outside is only a mirror of the inside, and the puppet an extension of the self.

Text: Åsa Viklund 

The Little Angels Theatre Applied Puppetry Symposium, 2013                                    

An interesting text (and more) by Joanna Hruby: 

Hand-out from a Conference in USA summer of 2009 (Respect the copywright!):

Creating & Using Healing Stories in Education & Therapy                                

Presented By: Joanne F. Vizzini, Ph.D., LCPC, NCC

Dissertation Abstract: To date there has been little controlled research on use of puppet therapy to facilitate psychotherapy in general and alcoholism treatment in particular. This study established a foundation for quantitative puppet therapy research. The contribution of three puppet therapy sessions compared to three sessions of regular therapy in a 12-Step inpatient chemical dependency facility on evaluation of treatment, anxiety levels, and spiritual coping were investigated. Respondents (N = 71) were patients at Hanley-Hazelden chemical dependency facility,  West Palm Beach,  Florida. Participants completed the Client Satisfaction Questionnaire (CSQ-8), the State and Trait Anxiety Scale, the Religious Problem-solving Scale,  and some demographic questions. Days in treatment was used as a covariate and units: women, men, and older adults were used as a stratifying variable. Results indicate that puppet therapy was evaluated significantly higher by all groups compared to regular therapy. For women and men ages 55 and below, state and trait anxiety was lower in puppet therapy groups compared to regular therapy groups and higher for state and trait anxiety for older adults, women and men ages 56 and above. Spiritual coping scores were non-significant except for the men’s unit. The self-directing style was used in both therapy groups on the men’s unit significantly more than the older adult unit. The alexithymia variable was non-significant across therapy groups and only about 30% of the sample was truly alexithymic, scores > 61. ANCOVA was used to evaluate therapy, unit and therapy x unit for each of the seven dependent variables. Further research duplicating this study as well as use of this model with clientele who have obtained longer sobriety is recommended.

An Overview of Puppet Use

Puppet Therapy:

“For the purpose of this (presentation), puppet therapy is defined as puppet use by a trained therapist in a therapeutic setting for the purposes of psychotherapy.” (Vizzini, 2003, p. 9)

W. M. Pfeiffer wrote, “Whereas it matters little if only a few readers of this annual publication   . . .  are interested in the treatment of mental disturbances, all puppeteers should know what an effective means of treatment they hold in their hands . . . . A veritable ‘hygiene of the soul’ for normal people, both children and adults” (1977, p. 30). 

Medical Use of Puppets:

These accounts are generally not puppet therapy.  See Zahr, 1998, puppets in play used to lower stressful responses to surgery for preschool children in  Lebanon.

Two accounts of puppet therapy: Linn, Beardslee and Patenuade (1985) reported on children having a bone marrow transplant, and Cassell (1965) designed an experiment for children before an operation.  In both studies puppet therapy was considered successful.

Educational Use of Puppets:

Sesame Street (Children’s Television Network, 1968) provided formative and summative research.

Kids on The Block (Snart & Maguire, 1986; 1987) provided empirical evidence for increase knowledge and positive attitudes toward children with disabilities.

Theoretical Development of the Use of Puppets in Therapy


“In play we may move below the level of the serious, as the child does; but we can also move above it – in the realm of the beautiful and the sacred” (Huizinga, 1950, p.19).

“A word search in various cultural contexts to tease out the meaning of “play” took Huizinga to the word aardigkeit (from the word aard for “art”) from the Dutch language and the German word wesen meaning “essence” or “state of being.”” (Vizzini, 2003, p. 25)

“Play and humor are multidimensional, adaptable, and associated with ingenuity and the promotion of mental health (Witmer, 1985).” (Vizzini, 2003, p. 26)

Adult Play:

“Thus, play is engaged in by both children and adults because it relieves the stress of living in reality and the frustration of basic conscious and unconscious needs; it provides a mechanism for confronting a challenge and overcoming it in a gratifying manner” (Colarusso, 1993, p. 226).

“Through the arts, we try to transform not only our joys, but also our tears and anguish, paralysis and fear, and the unexplained and mysterious into images of strength, clarity, and control” (Steinhardt, 1994, p. 217).

Transitional Phenomenon:

“… Donald Winnicott, proposed the idea of “transitional space” to define the experience of the psyche which supports play. Fraser (2000) discusses object relations theory and cites Winnicott as suggesting that human psychological development is based primarily upon relationships, beginning with one’s relationship with his or her mother.” (Vizzini, 2003, p. 28)

“Adults desire objective acceptance of their subjective phenomenon. Normal adults do so in culturally acceptable means through art, religion, and philosophy (Meissner, 1984).” (Vizzini, 2003, p. 28)

Puppets as Transitional Objects:

“Dolls are probably the oldest toy in human history and have existed for thousands of years. Based on human or animal figures, they may be play objects or serve religious or ritual uses, thus becoming a transitional object between people and their Gods or between people and their emotions” (Steinhardt, 1994, p. 205).

“Puppets serve as transitional objects (Winnicott, 1951).” (Vizzini, 2003, p. 29)

God and Object Relations Theory:

“The transitional space is no longer just a meeting of the minds but a place where creativity is rediscovered by both patient and therapist working very deeply and closely with one another . . . . For instance, some patients are more effectively contacted through a . . . spiritual approach” (Robbins, 1992, p. 183).

“Beginning with Rizzuto, psychotherapists have considered the object representation of God as something that does not need to be overcome, rather as something that can support and aid in the psyche’s integration as a healthy adult.” (Vizzini, 2003, p. 32)

“The language of the heart that includes relational stories about God, self, and others, is essential … (Kurtz & Ketcham, 1992).” (Vizzini, 2003, p. 35)

Rationale for the Study’s Hypothesis

Group as Transitional Space:

“The idea of puppets as transitional objects is supported by the sense that within the context of a group transitional space, a space of safety is possible.” (Vizzini, 2003, p. 36)

“In puppet therapy, the universality of the group allows the members to bond and to regress together.” (Vizzini, 2003, p. 36)

Narrative Meaning and Spiritual Stories:

“Puppet play allows children, with relative safety, to tell their story” (Bromfield, 1995, p 438).

“Entering into the mystery of persons’ stories is the basic art of psychotherapy.” (Vizzini, 2003, p. 40)

“Narrative theory offers another way of understanding selfhood and unique identity. “Research in narrative theory, both in psychology and theology, has confirmed that human personality is storied. Human beings do not simply tell stories, or illustrate their lives with storytelling. We construct our sense of identity out of stories, both conscious stories and those we suppress” (Lester, 1995, p. 29).” (Vizzini, 2003, p. 38)

As persons we are constituted by our social interactions; we have a history, and what happens to us can be and should be integrated in our life story. As adults our sicknesses have a context and a life story (Richard, 1992, p. 105).

Twelve-Step Groups:

“…spirituality is conveyed by stories, which use words in ways that go beyond words to speak the language of the heart. Especially in a spirituality of imperfection, a spirituality of not having all the answers, stories convey the mystery and the miracle - the adventure - of being alive.” (Kurtz & Ketcham, 1992, pp. 8-9)

“In a study by Winzelberg and Humphreys (1999) that predicted substance abuse outcomes at follow-up, 12-Step meeting attendance was significantly associated with the positive outcomes of abstinence and absence of substance abuse problems in the last three months.” (Vizzini, 2003, p. 40)   


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