The occupational therapy literature was reviewed to determine how drama was used as a clinical modality in the 1920s and 1930s. It appears that the emergence of the Little Theater Movement in the early 1900s, which enabled amateurs to perform publicly, provided the impetus for occupational therapists to use drama as purposeful activity. The theatrical modes most frequently used were pageantry, puppetry, and comedic plays. Additionally, the collective nature of drama facilitated group-centered treatment. Noble, a psychiatrist at Sheppard and Enoch Pratt in Maryland, used drama for insight-oriented therapy and recommended that occupational therapists use drama for treatment of persons with mental illness. Drama in occupational therapy still exists in some psychiatric settings, although a new discipline known as drama therapy, which is a division of the creative arts therapies, has arisen. Although drama therapy addresses psychodynamic goals, drama also can be used in occupational therapy to promote competence, enhance self-concept, and improve socialization.