Gestalt therapy, dramatherapy and psychodrama are currently the most widespread theatre-based therapy methods. The latter two referring to the Aristotelian notion of catharsis, they claim to grant clients relief through playful reenactment of biographic scenes (psychodrama) or through the acting of dramatic scenes, sometimes based on a dramatic text (dramatherapy). But since live events cannot be fully planned, these therapeutic methods entail risks: it is not possible to foresee how the audience will react to the actors’ performances and how these reactions may, in turn, affect the actors’ play. Once the process begins, it can easily run out of control. Theatre as therapy, then, faces an ethical dilemma: how can performances be integrated into therapeutic or even clinical contexts in spite of their ephemerality and unpredictability? And what kinds of special demands must the therapist as director face? This project engages these questions through a comparison of theatre-based therapy practices in the USA, the UK, and Germany, and it considers how these three different healthcare systems influence both the status and practice of psychodrama and dramatherapy.