An Introduction to Medical Dance/Movement Therapy

Health Care in Motion

Sharon W. Goodill

• Publisher: Jessica Kingsley Publishers
• Year: 2005
• Print ISBN: 9781843107859
• eBook ISBN: 9781846421037
• Topic: Psychology
• Subtopic: Psychotherapy
• Index: Psychology

Presenting dance/movement therapy (DMT) as a viable and valuable psychosocial support service for those with a medical illness, Sharon W. Goodill shows how working creatively with the mind/body connection can encourage and enhance the healing process. This book represents the first attempt to compile, synthesize, and publish the work that has been done over recent years in medical DMT.

The emerging application of medical DMT is grounded within the context of established viewpoints and theories, such as arts therapies, health psychology and scientific perspectives. As well as examining its theoretical foundations, the author offers real-life examples of medical DMT working with people of different ages with different medical conditions.

This comprehensive book provides a firm foundation for exploration and practice in medical DMT, including recommendations for professional preparation, research and program development. Interviews with dance/movement therapists bring fresh and exciting perspectives to the field and these and the author's testimonies point to the possible future applications of medical DMT. With an increasing number of professional dance/movement therapists working with the medically ill and their families, this is a timely and well-grounded look at an exciting new discipline. It is recommended reading for DMT students and professionals, complementary therapists, and all those with an interest in the healing potential of working innovatively with the mind and body.

Part I

Overview

CHAPTER 1

Introduction

So embrace your chance
And join our Dance
Our dance of alchemy

Where dreams and fears
And pain and years
Dissolve in synergy

From “Dance of Alchemy” by R.A. Lippin¹

Purpose and scope of the book

The aim of this volume is to describe the emerging application of dance/ movement therapy, a creative arts therapy, to the needs of those with a primary medical illness. There are three main objectives for this text:

1.to define the subspecialty of medical dance/movement therapy

2.to ground the clinical application in theoretical and scientific discoveries from related fields of health psychology and the medical sciences, and

3.to encourage research on and increased utilization of medical dance/movement therapy in general health care systems.

To date, this book represents the first known attempt to compile, synthesize and publish the work that has been done with medical populations by dance/ movement therapists.

I hope that this book will interest dance/movement therapy professionals and students as well as health care professionals who collaborate with, supervise, or initiate dance/movement therapy programming. Others who are interested in mind/body approaches to health and healing will also find the book of interest.

Dance/movement therapy (DMT) is formally defined as “the psychotherapeutic use of movement as a process which furthers the emotional, cognitive, social and physical integration of the individual” (American Dance Therapy Association n.d.). DMT is a specialty discipline in the mental health field, along with the other creative arts therapies (art, music, drama, poetry and psychodrama therapies). Academically, the field combines and synthesizes the study of psychological and social processes with other theoretical constructs from both the art of movement and kinesiological/biological principles of movement. Clinically, the work comprises a mind/body integrated approach to psychotherapy. Both the client(s) and the therapist attend to and address the sensed, kinesthetic and motoric connections between cognitive processes (including the creative process), emotional responses, interactional patterns and the issues relevant to the therapy. Common objectives of this therapy are, in part:

•increased integration of cognitive, affective and physical experience

•expressive competence

•increased self-awareness.

Assessment and clinical techniques are both sophisticated and flexible, so the therapy is adapted to the needs of a broad range of populations. Dance/movement therapists emphasize the congruence and connections between the verbal and nonverbal modes of expression. However, assessment and therapy can proceed entirely in the nonverbal realm of movement, touch, rhythm and spatial interactions, and so the approach is well suited to the needs of people who cannot participate in verbally oriented forms of psychotherapy. In addition, principles and techniques borrowed from this form of clinical interaction can also inform and enhance the work of other health care professionals by increasing sensitivity to these subjective, sensed components of the patient’s condition, and by improving the patient–caregiver relationship through better communication skills in the nonverbal dimension.

Since the establishment of DMT as a professional discipline in the United States in 1966, most of the work of dance/movement therapists has taken place in mental health and special education settings. Nonetheless, there is a longstanding interest among dance/movement therapists in working with those who are primarily medically ill, with theoretical and clinical explorations dating back to the 1970s. Evidence of this interest and emerging expertise is abundant. For example, several articles have been written in peer-reviewed academic journals over the last decade, and a handful of funded research projects on medical applications of DMT have been conducted (including one by this author). Dozens of Master’s theses have explored concepts and applications of DMT with medical populations and numerous professional conference presentations have been given on these topics (Ascheim et al. 1992; Cannon et al. 1997). Recent scientific advances from various branches of basic and clinical medical science provide explanatory models for the processes underlying DMT, and the DMT community has been increasingly engaged in discussion and collaborations with this information. This work has yet to be presented in a comprehensive manner, nor has it been framed in relation to the current prevailing psychological and scientific models.

For the purposes of this text, medical DMT is defined as the application of DMT services for people with primary medical illness, their caregivers and family members. It also includes the theoretical constructs that inform this specialization and the research approaches that support it. This book reflects the author’s perspective that, in the medical realm, DMT functions primarily as a psychosocial support intervention, complementary to conventional and standard medical treatments.

The first challenge in describing a new specialty is to define its boundaries. This task is especially difficult in relation to medical DMT. The medicalization of mental health in the U.S., marked by a shift during the 1980s and 1990s towards more pharmacological intervention and less psychotherapeutic intervention, has blurred the distinction between medical and non-medical disorders. The Diagnostic and Statistical Manual of Mental Disorders (4th edition) of the American Psychiatric Association (or APA) (1994) notes that “there is much ‘physical’ in ‘mental’ disorders and much ‘mental’ in ‘physical’ disorders” and that the distinction is in fact “a reductionistic anachronism of the mind/body dualism” (p.xxi).

However, the following limits have been placed on this book, if only to bring a potentially vast subject into a manageable scope. The book does not cover the treatment of those disorders traditionally identified as primarily psychiatric or behavioral in nature. In the same way, developmental disorders, such as mental retardation, those on the autism–PDD spectrum, and ADD/ADHD, are not included. Despite the obvious and strong neurological component in these conditions, DMT in these areas has been well described elsewhere in the literature and does not represent an emerging specialty within DMT. The book will include review of work in three areas that could be considered in either category: neurorehabilitation, such as recovery from stroke or traumatic brain injury, work with psychogenic somatic disorders, and medically fragile, seriously neurologically impaired children.

The book is organized into three main parts. Part I provides theoretical and scientific underpinnings to medical DMT. Part II describes examples of work to date in the field, with an emphasis on work by dance/movement therapists in the U.S. The book is by no means exhaustive; there are many dance/movement therapists in the U.S. and abroad providing services to medically involved populations. The material presented in this book is simply representative, and, in this author’s judgment, of sound quality. Clinical case examples are incorporated throughout the text, with pseudonyms for all patients and DMT participants.

Part III proposes areas for future development of the specialty with foci on research, education of our colleagues in health care, and professional preparation. Suggestions for clinical tasks and training exercises will be included where appropriate. Sources for the book include published literature, doctoral dissertations, Master’s theses, and the author’s own experiences providing, researching and teaching medical DMT. The book also includes new material obtained in telephone interviews with medical DMT practitioners from across the U.S. These specialists, Judith R. Bunney, Linni Deihl, Susan Imus, Nicholas Kasovac and Pat Mowry Rutter, generously contributed their time, experience, opinions and wisdom so that this text could include information about their valuable and groundbreaking work. Interviews were conducted in 2002, and are referenced herein as personal communication. Biographies of interviewees can be found in Appendix B.

Foundational concepts for medical dance/movement therapy

This section presents several concepts germane to medical DMT. Together they form the scaffolding of a theoretical foundation for this specialization.

The biopsychosocial model

Engel (1977), in a seminal article that inspired some of the most important research in mind/body medicine, proposed a biopsychosocial model for health care. He envisioned a model that “includes the patient as well as the illness” (p.133) and where the “doctor’s task is to account for the dysphoria and the dysfunction which lead individuals to seek medical help, adopt the sick role, and accept the status of patienthood. He must weight the relative contributions of social and psychological as well as of biological factors…” (p.133). Engel argued against what he called the reductionistic, mind–body dualism of the biomedical model, identifying an origin of this thinking in the European Christian church of the fifteenth century. In the years following Engel’s publication, there would be a host of leaders and researchers developing and adapting theories toward more wholistic, interdisciplinary health care. DMT and other mental health specialties have benefited from the introduction of the biopsychosocial model into modern medical arenas (Blumenthal, Matthews and Weiss 1993).

Along with the articulation of the biopsychosocial model, the idea of wholism, and the tenets of systems theory have found their way into mainstream health care discussions. Multidisciplinarity and interdisciplinarity are considered essential in any efforts to actualize these ideals in practice. What follows is a brief review of these concepts as might be applicable to the provision of DMT in medical settings.

Tapp and Warner (1985), writing from the perspective of behavioral medicine, considered the philosophy of science and described that worldview as mechanistic and monocausal, concerned with “objectifiable matter-energy and space-time phenomena” (p.6). They observed that behavioral medicine and a multisystems perspective heralded:

…a partial shift in these basic assumptions to a paradigm that has been labeled “holistic”. According to this view, the world is seen from a hierarchical perspective within which matter, energy, space, time, life, and nonlife are transformations within the same ordered unity. The metaphysics of the holistic paradigm is thus monistic, stressing the unity of the phenomena of the universe. For the holistic paradigm, truth is to be found in the interaction between the knower and the external world and involves both inner experience and external verification. (1985, p.6)

Schwartz (1982) drew on Pepper’s categories of “world hypotheses” to examine various views of health and illness. They are:

1.Formistic – binary and categorical, “either–or” thinking.

2.Mechanistic – single-cause/single-effect thinking, also of an “either–or” nature.

3.Contextual – an essentially relational style necessary to systems thinking, in which all is multi-caused.

4.Organistic – interactive, context-sensitive thinking.

Schwartz explains that organistic thinking is “and” thinking in which “combinations of causes are believed to lead to the emergence of new phenomenon and hence, new ‘wholes’ ”(p.1042). It is oriented to patterns, wholistic in nature, and the essence of a systems perspective. According to Schwartz, Western medical science has emphasized a combination of formistic and mechanistic perspectives, but several Eastern approaches have used contextual thinking. The biopsychosocial approach reflects Pepper’s second two ways of approaching the world: contextual and organistic. Theoretical contributions in DMT also reflect contextual and organistic perspectives (Kestenberg 1975; Lewis 1979/1994, 2002; Pallaro 1993).

Systems theory

Systems theory is familiar to most mental health professionals because it is the bedrock of family therapy. However, systems theory is a transdisciplinary concept originating with the sciences, particularly physics and biology (von Bertalanffy 1968), and employed in fields as diverse as immunology and computer technology. Systems theory views groups, families, biological, social and individual processes as interacting networks, wholes being more than the sum of parts; each “whole” with active homeostasis (or interaction between equilibrium and disequilibrium); with rules, permeable boundaries and relationships with other systems (Scheflen with Scheflen1972). The concepts have enabled dance/movement therapists to understand, for example, that movement behavior takes on meaning at multiple levels simultaneously (Davis 1990) and that clinical assessment through movement must consider interactional, cultural, developmental, anatomical and psychological aspects (Dulicai 1995). Systems theory undergirds the biopsychosocial model and informs DMT practice in medical contexts. A brief review of the characteristics of systems can highlight how.

Tapp and Warner (1985) outline six properties of systems: wholeness, hierarchical organization, interdependence, self-maintenance, activity and self-transformation. Three of these lead directly to a rationale for dance/movement therapy’s role in general health care. First, an understanding of self-maintenance equips one for appreciating the physiological dynamics in human health and illness:

Most control systems operate on the basis of negative feedback. It is to be assumed that within every system there is an internal sensing device whose function is to monitor the state of the internal environment. When deviations occur outside the range of “normal” the control mechanism is initiated. The detector system continues to test the state of the environment and when balance is restored the control mechanism is shut off. (Tapp and Warner 1985, p.9)

Self-transformation refers to:

the capacity of systems to transform their properties, including their form and structure, over time. Such changes can occur at the same or at higher or lower hierarchical levels. Alterations in the structure of systems thus become an essential component to system survival… Overlapping and alternating feedback loops allow the system to transform itself (i.e., to learn, within any given level of the hierarchy). (Tapp and Warner 1985, p.8)

Third, activity is:

a property of systems that emphasizes the process of transformations that constitute the continual interaction among system elements. Systems are neither static nor reactive. The feedback loops that interrelate system elements insure activity as a constant condition of the system within and between hierarchies. (Tapp and Warner 1985, p.8)

One might consider these properties – self-maintenance (control systems within systems), activity as a constant condition, and a system’s capacity for self-transformation – in terms of a distressed or ill individual. It is also possible to conceive of DMT operating on these same principles. The basic DMT techniques of reflecting the patient’s movement initiations and guiding the patient through improvisational processes imply a confidence on the therapist’s part that something within the patient is going to effect the desired changes. The basic premise that changes occurring on the movement level will generalize to other areas of functioning (Schmais 1974) manifests the systems theory understanding of self-t...

Table of contents

• Cover Page
• Of Related Interest
• Title Page
• Copyright
• Contents
• List of figures
• Foreword by John Graham-Pole, MD
• Preface
• Acknowledgments
• Part I: Overview
• Part II: Applications of Medical Dance/Movement Therapy
• Part III: Research and Education
• Appendix A: Additional Resources for Medical Dance/Movement Therapists
• Appendix B: Biographies of Foreword Writer and Medical Dance/Movement Therapy Interviewees
• References
• Subject Index
• Author Index