Applied improvisation for anxiety

1. Introduction

Version followed: the combined "improv plus CBT group" model, as published for Second City's Improv for Anxiety (Chicago, from 2011, co-founded by psychotherapist Mark Pfeffer of the Panic Anxiety Recovery Center with Second City Training Centers) and its written-up form, Comedic Improv Therapy (CIT; Phillips Sheesley, Pfeffer & Barish, 2016). Session-level safety structure (check-in, warm-up, de-roling, closure, distancing) comes from mainstream drama therapy (Bailey, after Emunah). Where a non-clinical improv course is meant, that is said. [source: Columbia Chronicle; Drinko 2019; Fortenbury 2015; Paone 2017; Bailey/Drama Therapy Central]

Applied improvisation for anxiety is not one manualised therapy. It is a family of group programmes that use unscripted comedy-theatre games and scenework as a playful, graduated social exposure, usually alongside cognitive-behavioural processing. Three published delivery formats exist: (a) a therapy phase followed by an improv phase (the original Improv for Anxiety: eight 90-minute sessions with a therapist, then eight 2.5-hour improv sessions with Second City instructors); (b) paired weekly sessions (Krueger's Thera-prov: four weeks, two hours a week, one hour improv and one hour group therapy); (c) improv-only courses, such as Second City's current Improv for Anxiety Level 1 (seven weeks, three-hour sessions) or school programmes like The Improv Project in Detroit. The current Second City course says plainly that it is not a substitute for therapy. [source: Columbia Chronicle; Drinko 2019; Second City IFAX Level 1 page; Felsman 2019 dissertation abstract]

How change is said to happen: each game is a repeated, unavoidable encounter with the unknown in front of others. Partners accept whatever you offer ("Yes, and"), so the expected rejection does not come. Mistakes are made often and meet a positive or neutral response, so fear of judgment weakens. Laughter and play keep arousal tolerable (Pfeffer: "It's hard to be terrified when you're laughing"). The CIT authors name four curative factors: group cohesiveness, play, humour and social exposure. Felsman and colleagues propose, with field data, that a rise in tolerance of uncertainty is one route by which improv lowers social anxiety. [source: Columbia Chronicle; Fortenbury 2015; Paone 2017 summarising Phillips Sheesley et al. 2016; Felsman et al. 2022 abstract; Drinko 2019 quoting Felsman]

Main target: social anxiety, shyness and public-speaking fear. Other anxiety presentations and depression have been included in community programmes (Thera-prov; Atlanta's Curtain Up! Anxiety Down!, 12-week workshops). [source: Drinko 2019] The CIT paper itself is not drawn on directly; its content is known here only through two secondary summaries. [uncertain]

Professional frame. No regulated profession or credential exists for "applied improvisation". In the published clinical versions the therapy component is run by licensed mental health professionals, and the improv component by trained improv teachers. The CIT authors' advice, as summarised, is that the therapist need not be a comedian but should take improv classes before leading a group and must be skilled at pausing to process. [source: Fortenbury 2015; Drinko 2019; Paone 2017] If you use improv as treatment, rather than referring to a course, work within your own licence (for example as a CBT-trained psychologist, counsellor or social worker). Drama therapists bring a regulated route: HCPC registration with BADth membership in the UK, NADTA's RDT in North America. [uncertain: registration details] Do not run deep autobiographical enactments, such as replaying a client's own humiliation or trauma scenes, without drama therapy or psychodrama training. [synthesis]

2. Framework

No source opened gives a session-by-session manual. The phase structure below combines the published formats. Session counts are as published; criteria for moving on are my own synthesis.

Phase 0: Referral, screening and preparation (1–2 individual contacts). Goals: confirm social or performance anxiety is the main target; screen out people for whom group exposure is unsafe now; agree personal goals; explain that the group is graduated and opt-out is allowed. The CIT summary advises pre-screening, as for any group. [source: Paone 2017] Screening content [synthesis]: current suicide risk; active psychosis or mania; recent trauma, or PTSD where shame or social-humiliation memories are easily triggered; severe depression; substance intoxication at sessions; severe social anxiety with near-total avoidance. In that last case, start individual CBT first. Fortenbury reports that some severely anxious participants drop out believing they need more therapy first. [source: Fortenbury 2015 for the dropout point; rest synthesis] Move on when: the person has consented, has a personal goal, and has at least one coping skill to use if overwhelmed.

Phase 1: Therapy and psychoeducation (in format (a), 8 × 90 minutes in a group). Goals: CBT model of social anxiety; spotting negative predictions; the exposure rationale; preparing for the improv phase. The original programme used this as a run-up to the improv debut; later descriptions call the therapy part CBT and exposure groups. [source: Columbia Chronicle; Drinko 2019] The specific CBT content of Pfeffer's sessions was not found. [uncertain]

Phase 2: Improv practice (in format (a), 8 × 2.5 hours; in format (b), 1 hour a week, paired with 1 hour of processing). Goals: graduated exposure through games, from non-verbal ensemble games, to short verbal games, to two-person scenes, to longer group narratives. The original improv content was reportedly nearly the same as Second City's ordinary beginner curriculum, relabelled with a therapy focus. [source: Columbia Chronicle quoting S. Elam; Fortenbury 2015 for non-verbal-first progression] Move on to harder formats [synthesis] when most members join the current level with manageable anxiety, can recover from a "mistake" within the session, and report fewer anticipatory safety behaviours.

Phase 3: Culmination (optional). Goals: a low-stakes sharing, such as a showcase for invited guests or the group itself, or a closing ritual. Drama therapy describes final phases as a shared performance, a private ritual or an evaluation and goodbye, and notes that not every group reaches the later phases. That is not failure. [source: Bailey/Drama Therapy Central] Make any performance optional and graded. [synthesis]

Standard session shape (every session). Check-in (lets you read readiness and resistance), then warm-up, one or more main activities each followed by discussion, then de-roling, then closure (a game, ritual, review or song). [source: Bailey/Drama Therapy Central] In combined models, the processing segment ties in CBT: predictions before a game, what happened, what the person learned. [source: Paone 2017 (merging improv with cognitive-behavioural processing); details synthesis]

Format. Closed groups of roughly 8–14 [synthesis; group sizes were not given in sources]. Weekly. 90 minutes to 3 hours. A room with clear floor space.

Materials and physical safety [synthesis]: clear the floor of trip hazards; take care with fast tag or "zip" games, running and chair-based games; offer seated alternatives for mobility limits; keep a quiet space or chair just outside the circle as a sanctioned break spot; agree that no touch is required in any game, and ask before any contact game.

3. Guiding principles

Yes, and. Accept a partner's offer and add to it. Practical meaning: model and reward acceptance of members' contributions. This acceptance is what makes exposure feel safe. [source: Fortenbury 2015; Bermant 2013; Drinko 2019 citing Krueger]
Unconditional support of the partner. In Bermant's account, each player's only obligation is to their partner, which creates a safety "net". Practical meaning: coach people to attend to their partner, not themselves. This turns attention away from self-monitoring. [source: Bermant 2013; Second City IFAX page ("others-focused")]
Failure is safe and expected. Practical meaning: celebrate mistakes publicly (for example with the failure bow) so that feared outcomes are repeatedly disconfirmed. [source: Fortenbury 2015; Bermant 2013]
Graduated exposure. Practical meaning: let people start with non-verbal or ensemble games and step up at their own pace. Progress, not immediate full participation, is the aim. [source: Fortenbury 2015 (Arjet example); Second City IFAX ("low-pressure")]
Embrace uncertainty. Practical meaning: name tolerance of not knowing as a skill. Debrief what it was like not to plan. [source: Felsman et al. 2022; Felsman 2019]
Play and humour as active ingredients. Practical meaning: keep the tone light and laughter shared, never at a member's expense. [source: Paone 2017; Columbia Chronicle; "never at a member's expense" synthesis]
Combine with therapy. Pfeffer reports that improv alone or therapy alone has worked less well than the two together. Practical meaning: always link games to cognitive processing, or refer to a therapist alongside the course. [source: Fortenbury 2015; Drinko 2019]
Pause and process. Practical meaning: stop a game when a learning moment or distress appears. You may gently push past comfort zones, but processing comes first. [source: Paone 2017]
Form is rehearsed, content is not. Practical meaning: drill game structures repeatedly so the only uncertainty left is the content. Predictable structure contains the anxiety. [source: Bermant 2013]
Not a substitute for therapy. Practical meaning: improv courses run by theatres are adjuncts. Severe or trauma-related anxiety needs a clinician. [source: Second City IFAX page; Fortenbury 2015 quoting D. Wendler]
Distancing. Fictional roles create more distance; autobiographical roles create less. Practical meaning: keep scenes fictional by default for anxious members, and move closer to real situations only when the person chooses. [source: Bailey/Drama Therapy Central; application synthesis]
Consent and opt-out at every step. Practical meaning: "pass" is always allowed and is never commented on as failure. Watch that passing does not become long-term avoidance (see Section 5). [synthesis]

4. Intervention inventory

The sources name only a few specific games. Each item below is marked: sourced items carry a [source]; the common improv-teaching games that were not found in the anxiety-programme sources are marked [synthesis] and are not attributed to any programme. All example language is illustrative.

4.1 Screening and goal-setting interview

Purpose: select members for whom group exposure is safe now; set one personal social goal; give informed consent. Pre-screening is advised for CIT groups. [source: Paone 2017; content synthesis]
Steps: (1) assess the anxiety profile with your usual social-anxiety measure and interview; (2) assess risk (suicidality, self-harm), trauma history (especially humiliation, bullying or assault memories), psychosis or mania, substance use, and medical or mobility limits; (3) describe the format honestly: games in front of others, laughter, mistakes are expected, and "pass" is allowed; (4) agree a personal goal, such as "speak first in a meeting"; (5) agree a personal overwhelm plan: a signal, a break spot, a grounding skill; (6) if near-total avoidance, uncontained trauma or acute risk is present, offer individual CBT or trauma treatment first and revisit the group later. [synthesis]
Example language (illustrative): "Every week you'll be doing short games where nobody knows what happens next, including me. You choose how far to go. Passing is allowed, and we'll talk about what passing does for you."
Watch for: agreeing in order to please (a social-anxiety safety behaviour); hidden trauma linked to being laughed at. Working means the client can name a goal and an exit plan in their own words.

4.2 Check-in

Purpose: gauge readiness and resistance at the start of each session. [source: Bailey/Drama Therapy Central]
Steps: circle; each person gives a one-word or 0–10 rating of anxiety right now, plus one thing they did this week toward their goal. Passing is allowed. [synthesis on format]
Example language (illustrative): "One word for how you're arriving, and a number for your anxiety right now."
Watch for: very high ratings. Offer that person a lower-demand role today, such as side-coaching or watching first.

4.3 Warm-up

Purpose: focus the group on each other and the present; prepare body and imagination. [source: Bailey/Drama Therapy Central]
Steps: start with whole-group, simultaneous, low-exposure activity, where everyone moves or speaks at once so nobody is watched; then pass-the-focus games; keep it to about 10–20 minutes. [synthesis]
Example language (illustrative): "Everyone at once, nobody's watching: walk the room, and when I clap, freeze and make a shape."
Watch for: rising energy with laughter means it is working; withdrawal to the edge means slow down.

4.4 Non-verbal ensemble games (graduated entry)

Purpose: the lowest exposure rung. Lets very anxious members take part without speaking. One improv teacher describes a shy teenager who joined only non-verbal exercises in his first term and all games by his second. [source: Fortenbury 2015 quoting J. Arjet]
Steps: offer games where the group moves together or passes a gesture or sound around the circle; allow a member to stay at this rung across sessions; invite (never push) one small verbal step when ready. [synthesis on specifics]
Example language (illustrative): "You can do this whole game without a word. If you want to add a sound later, that's your call."
Watch for: a member stuck at this rung for many weeks. Review it with them as possible avoidance (see 5.2).

4.5 Mirror [synthesis: common improv and drama exercise]

Purpose: attention on a partner, synchrony, low verbal demand.
Steps: pairs face each other; one leads slow movements and the other mirrors; switch; then "nobody leads", where the pair tries to move together with no leader.
Example language (illustrative): "Make it slow enough that your partner can't fail."
Watch for: eye-contact distress. Allow mirroring hands or shoulders instead of the face.

4.6 Mind Meld

Purpose: build "group mind" and partner focus. Described by Bermant as two players exchanging free associations until they say the same word at once. [source: Bermant 2013]
Steps: two players count to three and each says any word; on the next count both say a word that connects the two previous words; repeat until both say the same word; the group celebrates. [procedure detail beyond Bermant's one-line description: synthesis]
Example language (illustrative): "There's no right word. You're only trying to meet your partner."
Watch for: freezing because the person is searching for a clever word. Coach "first word, not best word".

4.7 Yes, And exercise

Purpose: the core principle. Partners accept and build on each offer, which removes the rejection social anxiety predicts. [source: Fortenbury 2015; Bermant 2013; Second City IFAX page]
Steps: (1) pairs plan something imaginary, such as a party, with each line starting "Yes, and..."; (2) contrast round: each line starts "Yes, but..." or "No...", then compare how each felt; (3) debrief what being accepted did to anxiety and to self-focus. [the contrast round is synthesis]
Example language (illustrative): "Whatever your partner says is now true. Your only job is to add one thing."
Watch for: Bermant notes that players can find it hard to tell denying an offer apart from accepting a conflict. Clarify that a character can disagree while the player still accepts the reality offered. [source: Bermant 2013]

4.8 Word-at-a-time story [synthesis: common improv exercise]

Purpose: tolerate not controlling the outcome; speech in tiny units.
Steps: pairs or a circle build a story one word each; the facilitator keeps it going regardless of sense; then debrief planning versus not planning.
Example language (illustrative): "If you've already planned your word, let it go and take whatever comes."
Watch for: rehearsing ahead (a safety behaviour). Name it kindly, as a link to tolerating uncertainty.

4.9 One long improvised narrative (group story)

Purpose: sustained shared uncertainty; each member contributes in turn to one story. Reported as a format used in improv-for-anxiety classes. [source: Fortenbury 2015; procedure synthesis]
Steps: the group sits or stands in a line; the facilitator gives a title; the facilitator points to members to continue the story mid-sentence; vary the pace; end with a group bow.
Example language (illustrative): "When I point at you, pick up mid-sentence. If you blank, say 'and then' and look at me. I'll move on."
Watch for: freezing. A built-in rescue ("and then", or pointing on) keeps blanks safe.

4.10 Questions only

Purpose: reported as a format used in improv-for-anxiety classes. Players may only speak in questions, which trains quick responding and listening. [source: Fortenbury 2015; procedure synthesis]
Steps: two players are in a given scene; every line must be a question; a player who makes a statement, hesitates or repeats a question swaps out, cheered by the group; rotate quickly.
Example language (illustrative): "Getting out is the fun part. We cheer every time someone gets swapped."
Watch for: "getting out" producing shame. Pair it with the failure bow (4.11) and debrief.

4.11 Failure bow

Purpose: make failure safe. Reported from intro improv classes: a student who thinks they failed a scene takes a bow and announces the failure while classmates cheer. [source: Fortenbury 2015]
Steps: (1) teach it early, as a group, before anyone has failed; (2) whole group practises bowing together and announcing "I failed!" with arms up while everyone cheers; (3) use it after any mistake in any game; (4) debrief what happened to the feared consequence. [steps beyond the description: synthesis]
Example language (illustrative): "Arms up, big smile, 'I failed!', and we all cheer. Then notice: what did the room actually do?"
Watch for: anyone for whom being looked at and cheered is itself overwhelming, or trauma linked to public humiliation. Offer a small private version, such as a thumbs-up to the facilitator.

4.12 Zip-Zap-Zop and other pass-the-focus circle games [synthesis: common improv warm-up]

Purpose: fast, brief moments of being the focus, repeated many times. A gentle step up from simultaneous warm-ups.
Steps: in a circle, players pass a clap and word to someone else with eye contact; the sequence runs zip, zap, zop; speed it up; mistakes get the failure bow and play restarts at once.
Example language (illustrative): "Speed beats accuracy. If it breaks, we bow and go again."
Watch for: one person being repeatedly targeted. Ask players to spread the passes around.

4.13 Two-person scenework within fiction ("magic if")

Purpose: the main exposure step up. Short unscripted scenes in front of the group, protected by fictional distance. Improv relies on fully accepting the imagined premise (Bermant's "magic if"). Fictional roles give more distance than autobiographical ones. [source: Bermant 2013; Bailey/Drama Therapy Central; application synthesis]
Steps: (1) the group suggests a place or relationship; (2) two volunteers play 1–2 minutes, aiming to accept offers and look after their partner; (3) the facilitator side-coaches lightly and ends the scene on a high point; (4) applause, then the players say one thing their partner did well; (5) gradually lengthen scenes and reduce side-coaching. [steps synthesis]
Example language (illustrative): "Your only job is to make your partner look good. I'll end it before it gets long."
Watch for: scenes drifting into a member's real distress, such as a job interview that mirrors a recent humiliation. Steer back into fiction or end the scene (see 5.3).

4.14 Bridging scenes: rehearsing target real-life situations [synthesis]

Purpose: transfer to the member's own feared situations. This reduces distance step by step, and only at the member's choice. Real-life rehearsal of this kind is not described in the improv-for-anxiety sources.
Steps: (1) the member names a situation from their goal (small talk, speaking up at work); (2) first play it as a fictional, exaggerated version (an absurd office); (3) then play a realistic version with a group member as the other person; (4) before the scene, the member writes or states their prediction; afterwards, compare it with what happened; (5) assign a matching real-world exposure for the week.
Example language (illustrative): "What do you predict will happen if you blank? Let's see what actually happens here."
Watch for: shifting from fiction into personal trauma material. That belongs to drama therapy or psychodrama training, not to this group.

4.15 Pause-and-process: CBT processing of games

Purpose: turn play into learning. CIT merges improv activities with cognitive-behavioural processing, and the therapist must be skilled at pausing and processing at the right moments. [source: Paone 2017; Drinko 2019 (CBT and exposure groups in Improv for Anxiety)]
Steps: before a game, ask for one feared outcome and a 0–100 belief rating; after it, ask what happened, re-rate the belief, and name what was learned; link the lesson to safety behaviours (rehearsing lines, avoiding eye contact) and to tolerating uncertainty; record learning in a log. [procedure synthesis; the CIT paper's own processing protocol is not drawn on, uncertain]
Example language (illustrative): "You predicted people would stare at you in silence after a mistake. What did you see?"
Watch for: self-critical processing ("I was terrible"). Redirect to observed facts and to the group's responses.

4.16 Grounding and body awareness

Purpose: settle arousal before or after exposure. Bermant links improv's bodily awareness to mindfulness practices such as the body scan. He describes this as a parallel, not as part of an anxiety protocol. [source: Bermant 2013; clinical use synthesis]
Steps: 2–3 minutes of a brief, non-judging scan of feet, breath and hands; or feet-on-floor grounding, naming three things seen in the room.
Example language (illustrative): "Feel your feet. Notice three things you can see. You're here, in this room."
Watch for: grounding used as a safety behaviour mid-game. Keep it to transitions.

4.17 De-roling

Purpose: leave the role and reconnect with yourself after role-play. [source: Bailey/Drama Therapy Central]
Steps: after any character work, each player (1) physically shakes off or steps out of the playing space; (2) states their own name and one way they differ from the character; (3) the group uses their real name in feedback. [specific steps synthesis; sources describe the purpose, not a procedure]
Example language (illustrative): "Shake out the character. Tell us your name and one thing about you that's nothing like them."
Watch for: a member still in a role's emotion. Give extra time and check in individually.

4.18 Closure

Purpose: contain the session and mark its end. Done by a game, ritual, session review or song; at the end of a group, by a shared performance, private ritual, or evaluation and goodbye. [source: Bailey/Drama Therapy Central]
Steps: a quiet group game; each person names one risk they took; set the week's real-world exposure; ask everyone for a 0–10 rating before leaving. [synthesis] Do not let anyone leave above the level agreed in their overwhelm plan without checking in.
Example language (illustrative): "One risk you took tonight, and one you'll take this week."
Watch for: a quiet member leaving quickly. Follow up before the next session.

4.19 Optional culminating showcase

Purpose: a final, larger exposure and celebration. Drama therapy recognises a shared performance as one possible culmination. Second City's original programme prepared participants for their "improv debuts". [source: Bailey/Drama Therapy Central; Columbia Chronicle; format synthesis]
Steps: let the group decide the audience (only the group, invited friends, or public); rehearse game structures, not content; give everyone a role, including non-performing roles such as host or lighting; debrief afterwards.
Example language (illustrative): "Performing is optional. Every role in the show counts as taking part."
Watch for: pressure to perform from peers or from family in the audience.

5. Handling problems

The sources say little about problem handling. Except where a source is cited, everything below is my own synthesis. [synthesis]

5.1 Dropout before or early in the programme

Sources report that some participants with more severe social anxiety drop out because they believe they cannot manage the class or need more therapy first. Felsman's school data suggest social anxiety did not prevent participation in a school improv course. [source: Fortenbury 2015; Felsman 2019 abstract]
Response: phone or meet each new member before session 1; let them watch part of the first session; offer a stepped start through non-verbal games only (4.4); if needed, provide individual CBT first and then a second try. [synthesis]

5.2 "Passing" that becomes avoidance

Response: keep "pass" always allowed, but review it privately. Ask what the person predicted would happen. Agree a next small step, such as one sound or one word. Make passing visible as a choice, not a failure. Track it against the member's goal. [synthesis]

5.3 Overwhelm and panic mid-game

Signs: freezing, shaking, crying, leaving the room, dissociation (a blank stare, not responding).
Response: (1) end the game lightly for everyone, or let the scene continue around the person, so they are not the focus; (2) a co-facilitator goes with them to the break spot and uses their agreed overwhelm plan and grounding (4.16); (3) do not insist they return to the scene immediately; offer a low-demand role later; (4) process afterwards, privately or with the group only if the person consents, framing it as data rather than failure; (5) check in before the next session. Two facilitators are strongly preferable. [synthesis]

5.4 Retraumatisation: humiliation, bullying and trauma triggers

Risk: laughter, being watched, sudden "failure" and being cheered can echo past bullying, ridicule or abuse. A scene suggestion can land on real trauma, such as an assault or a family fight.
Prevention: screen for these at intake (4.1); default to fictional, distanced scenes (principle of distancing); set ground rules that we laugh with, never at, and that no real personal stories are put in scenes without the owner's choice; ban suggestions about sexual violence, self-harm and named group members; give the facilitator a veto on any audience suggestion. [source for distancing: Bailey/Drama Therapy Central; rest synthesis]
If it happens: stop the scene; de-role everyone involved (4.17); attend to the affected person as in 5.3; do not process trauma content in the group; arrange individual follow-up and, if needed, a trauma-focused referral; review with the group what changes to the rules are needed. [synthesis]

5.5 Ruptures: hurtful humour, dominant members, peer laughter that stings

Response: name the norm (acceptance, making your partner look good); privately coach dominant players to give their partners more space; repair openly where a member was hurt ("That joke landed on you, not on the scene. Let's reset."); use "Yes, and" as the shared rule both of you can point to. [source for norm: Bermant 2013; response synthesis]

5.6 Stuck clients: plateau, no transfer to real life

Response: increase exposure difficulty step by step (longer scenes, solo turns, a showcase); add bridging scenes (4.14) and weekly real-world exposure with predictions; check for hidden safety behaviours in games (planning lines, playing only "safe" characters); consider individual CBT alongside. Pfeffer reports that combining improv with therapy works better than either alone. [source: Fortenbury 2015 for combination; rest synthesis]

5.7 Non-adherence to between-session exposure

Response: make tasks small and specific; set them in closure (4.18); review them at check-in without shaming; link each task to an in-session game experience ("you survived blanking in Questions Only, so the meeting is the same skill"). [synthesis]

5.8 Risk disclosure in session

Response: if a member discloses suicidal thoughts, self-harm or abuse, the clinician leads; follow your service's standard risk-assessment and safeguarding procedures; improv teachers in a theatre-run course must have a clear route to a clinician, or be told before the course to signpost to emergency and clinical services. [synthesis]

5.9 Children and adolescents

School and youth improv programmes exist (Detroit's The Improv Project, grades 8–12), but the sources do not describe their safeguarding procedures. [source: Felsman et al. 2022 abstract; Felsman 2019] [uncertain]
Response: get parent or carer consent plus the young person's own assent; follow local safeguarding and mandatory-reporting duties for disclosures; use age-appropriate games and topics; never require performance in front of peers who may bully; liaise with school staff on known bullying dynamics; give carers a short explanation of the exposure rationale. [synthesis]

5.10 Touch, body and cultural sensitivity

Response: no game requires touch; ask explicitly before any contact game and offer a no-touch version; never any sexual or genital touch; give eye-contact and gender-mixing alternatives; respect cultural and religious norms about physical contact, gender and humour; avoid accents, ethnic or disability caricature in scenes. [synthesis]

5.11 Theatre-run course versus therapy: boundary problems

Second City states its course is not therapy, and an improv coach quoted by Fortenbury says severe or trauma-related anxiety belongs with a mental health professional. [source: Second City IFAX page; Fortenbury 2015]
Response: if you refer a client to a theatre course, keep your own treatment going; agree with the client what to bring back to therapy; do not expect the improv instructor to manage risk or overwhelm. [synthesis]

5.12 Facilitator inexperience

The CIT summary advises therapists to experience improv classes themselves before leading a group; comedy expertise is not required. [source: Paone 2017]
Response: take a beginner improv course; co-lead with an improv teacher; for any autobiographical enactment, seek drama therapy or psychodrama training (see Introduction). [synthesis]

Sources

Sources:

Further reading, cited from these pages (not drawn on in full):

Phillips Sheesley, A., Pfeffer, M., & Barish, B. (2016). Comedic improv therapy for the treatment of social anxiety disorder. Journal of Creativity in Mental Health, 11(2), 157–169. doi:10.1080/15401383.2016.1182880 (as given by Paone 2017). [uncertain]
Krueger, K. R., Murphy, J. W., & Bink, A. B. (2019). Thera-prov: a pilot study of improv used to treat anxiety and depression. Journal of Mental Health, 28(6), 621–626 (authors as given by Drinko 2019; volume and pages from the Rush record). [uncertain]
Felsman, P., Seifert, C. M., & Himle, J. A. (2019). The Arts in Psychotherapy, 63, 111–117 (as given by Drinko 2019; full title not confirmed). [uncertain]
Emunah, R. (1994, 2020). Five Phase Model of drama therapy, as cited by Bailey; book details not confirmed. [uncertain]
Wiener, D. J. (1995). Rehearsals for Growth: Theater Improvisation for Psychotherapists. W. W. Norton. Background only; its contents are not drawn on. [uncertain]

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