Dance therapy

Dance/movement therapy (DMT) in USA^[1]/ Australia^[2] or dance movement psychotherapy (DMP) in the UK^[3] is the psychotherapeutic use of movement and dance to support intellectual, emotional, and motor functions of the body.^[4] As a form of expressive therapy, DMT looks at the correlation between movement and emotion.^[5] A typical DMT session has four main stages: preparation, incubation, illumination, and evaluation.^[6] Organizations such as the American Dance Therapy Association and the Association for Dance Movement Psychotherapy UK, maintain standards of professional courtesy and high levels of educational standards within the field. DMT is practiced in various clinical settings and is used for psychotherapy purposes and physical therapy.

History

Dance has been used therapeutically for thousands of years. It has been used as a healing ritual in the influence of fertility, birth, sickness, and death since early human history. Over the period from 1840 to 1930, a new philosophy of dance developed in Europe and the United States, defined by the idea that movement could have an effect on the mover vis-a-vis that dance was not simply an expressive art.^[7] The actual establishment of dance as a therapy and as a profession occurred in the 1950s, beginning with future American Dance Therapy Association founder Marian Chace.^[8]

Although dance has been a method of expression for centuries, it wasn’t until the past half century that it was characterized as a form of therapy. The development of DMT can be split into two waves throughout history.

First wave

Marian Chace, spearheaded the movement of dance in the medical community as a form of therapy. She is considered the principal founder of what is now dance therapy in the United States.^[9] In 1942, through her work, dance was first introduced to western medicine. Chace was originally a dancer, choreographer, and performer. After opening her own dance school in Washington, D.C., Chace began to realize the effects dance and movement had on her students.^[10] The reported feelings of wellbeing from her students began to attract the attention of the medical community, and some local doctors began sending patients to her classes. She was soon asked to work at St. Elizabeth’s Hospital in Washington, D.C. once psychiatrists too realized the benefits their patients were receiving from attending Chace’s dance classes.^[11] In 1966 Chace became the first president of the American Dance Therapy Association, an organization which she and several other DMT pioneers founded.^[10] According to the ADTA, dance is "the psychotherapeutic use of movement as a process which furthers the emotional, social, cognitive, and physical integration of the individual."

Second wave

The second wave of Dance Movement Therapy came around the 1970s to the 1980s and it sparked much interest from American therapists. During this time, therapists began to experiment with the psychotherapeutic applications of dance and movement. As a result of the therapists' experiments, DMT was then categorized as a form of psychotherapy. It was from this second wave that today’s Dance Movement Therapy evolved.^[10]

Principles

The theory of DMT is based mainly upon the belief that body and mind interact. Both conscious and unconscious movement of the person, based on the dualist mind body premise, affects total functioning, and also reflects the individual’s personality. Therefore, the therapist-client relationship is partly based on non-verbal cues such as body language. Movement is believed to have a symbolic function and as such can aid in understanding the self. Movement improvisation allows the client to experiment with new ways of being and DMT provides a manner or channel in which the client can consciously understand early relationships with negative stimuli through non-verbal mediation by the therapist.^[10]

Through the unity of the body, mind, and spirit, DMT provides a sense of wholeness to all individuals. The body refers to the "discharging of energy through muscular-skeletal responses to stimuli received by the brain." The mind refers to "mental activities...such as memory, imagery, perception, attention, evaluation, reasoning and decision making." The spirit refers to the "subjectively experienced state of feeling in engaging in or empathically observing dancing."^[12]

Dance therapy works to improve the social skills, as well as relational dynamics among the clients that choose to participate in it to better improve their quality of life. Through this form of therapy clients will gain a deeper sense of self-awareness through a meditative process that involves movement, motion, and realization of one's body. Dance therapy is different from other forms of rehabilitative treatments because it allows creative expression and is more holistic, meaning it treats the full person: mind, body, and spirit.^[13]

The therapy process

The therapy process has four stages, which occur during DMT and can be a creative time for both the therapist and patient(s). Each stage contains a smaller set of goals which correlate to the larger purpose of DMT. The stages and goals of DMT vary with each individual. Although the stages are progressive, the stages are usually revisited several times throughout the entire DMT process. The four stages are:

Preparation: the warm-up stage, a safe space is established without obstacles nor distractions, a supportive relationship with a witness is formed, comfort for participants to be familiar with moving with their eyes closed.

Incubation: leader verbally prompts participant to go into subconscious, open-ended imagery used to create an internal environment that is catered to the participant, relaxed atmosphere, symbolic movements.

Illumination: process which is integrated through conscious awareness via dialogue with witness, self-reflection in which the participant uncovers and resolves subconscious motivations, increased self awareness, can have positive and negative effects.

Evaluation: discuss insights and significance of the process, prepare to end therapy^[13]

Dance styles used

A variety of dance styles are used in DMT depending on the needs to the client. These include: Modern Dance with its emphasis on the pure elements of movement, Authentic Movement, Turkish dance, ballroom dance, tango, waltz, foxtrot, aerobic dance, line dancing and body psychotherapy.^[14]

Research

Proposed mechanisms

Various hypothesis have been proposed for mechanisms by which dance therapy may benefit participants. There is a social component to dance therapy, which can be valuable for psychological functioning through human interaction. Another possible mechanism is the music that is used during the session, which may be able to reduce pain, decrease anxiety, and increase relaxation. Since dance requires learning and involves becoming active and discovering capacities for movement, there is also the physical training that could provide benefits as well. Dancing may be considered more uplifting and enjoyable than other types of exercise. Dance therapy can also involve nonverbal communication, "which enables participants to express their feelings without words. This might be helpful when normal communication is absent or has broken down (eg, for patients with dementia)."^[15]

Studies

A Cochrane review entitled Dance therapy for schizophrenia in 2013^[16] concluded:

"Overall, because of the small number of participants, the findings are limited. There is little evidence to support or refute the use of dance therapy. Larger studies and trials are needed that focus on important outcomes (such as rates of relapse, quality of life, admission to hospital, leaving the study early, cost of care and satisfaction with treatment). Further research would help clarify whether dance therapy is an effective and holistic treatment for people with schizophrenia, especially in terms of helping people cope with negative symptoms that do not respond so well to antipsychotic drugs."

A review by the Cochrane Collaboration entitled Dance/movement therapy for cancer patients was updated in January 2015^[17] to say:

"The three studies included a total of 207 participants, which were women with breast cancer. The studies were small in size. We found no evidence of an effect for depression, stress, anxiety, fatigue, and body image. The findings of individual studies suggest that dance/movement therapy may have a beneficial effect on the quality of life, somatization (i.e. distress arising from perceptions of bodily dysfunction) and vigor of women with breast cancer. No adverse effects of dance/movement therapy interventions were reported."

The most recent Cochrane review for DMT was in February 2015 entitled Is dance movement therapy an effective treatment for depression? A review of the evidence.^[18] The findings stated:

"Due to the low number of studies and low quality of evidence, it was not possible to draw firm conclusions about the effectiveness of DMT for depression. It was not possible to compare DMT with medication, talking therapies, physical treatments or to compare types of DMT due to lack of available evidence. Key findings were:

Overall, there is no evidence for or against DMT as a treatment for depression. There is some evidence to suggest DMT is more effective than standard care for adults, but this was not clinically significant. DMT is no more effective than standard care for young people.
Evidence from just one study of low methodological quality suggested that drop-out rates from the DMT group were not significant, and there is no reliable effect in either direction for quality of life or self esteem. A large positive effect was observed for social functioning, but since this was from one study of low methodological quality the result is imprecise."

One review of the effect of DMT on Parkinson's disease noted that there have been few studies in this area. DMT appears to meet most requirements for exercise programs for patient's with Parkinson's. Benefits in gait function, balance, and quality of life were found in short-term studies, though further studies need to be done to see if any of these benefits are seen long-term.^[19]

Benefits

Research has found that using dance movements as a form of therapy activates several brain functions at once: kinesthetic, rational, musical, and emotional. This type of movement requires mental, physical, and emotional strength to work simultaneously, causing a full body and soul workout.^[20] In one research study, senior citizens were placed in a 21-year study to see if any physical or cognitive recreational activity influenced mental acuity. Researchers monitored rates of dementia in the elderly participants. The study included cognitive activities such as reading books, doing crossword puzzles, and playing musical instruments and physical activities such as golf, walking for exercise, and dancing. Results showed that almost none of the physical activities appeared to offer any defense against dementia. The activity with the highest percentage of protection against dementia was dancing frequently (76%). It was the greatest risk reduction of any activity studied, cognitive or physical. This is because dance therapy combines multiple areas of the brain to work together at once rather than just stimulating one area at a time.

Dance therapy is found to have beneficial results on children who have been abused. Research has found that this therapy is a useful form of support and intervention for these children.^[21] Through a case study with a sexually abused female, the researcher stated that the individual felt a sense of empowerment after the dance therapy sessions and reported greater success in school. The individual also felt a stronger sense of self-confidence and a higher view of self-esteem. The study states that using dance therapy would be a beneficial experience in a multi-disciplinary treatment for abused and neglected children.

Another researcher studied the effects of dance therapy with children at risk of abuse and their relationship with their mothers. During this study, mothers and their children were surveyed on their relationship prior to the session, asking questions regarding their communication, physical touch, and sense of security felt by the child. After the dance therapy session, the participants were surveyed again with the same measure. The results reported a stronger bond between mother and child.^[22] The participants reported a stronger sense of belonging in the pair and felt more openness in terms of communication. Through dance therapy practices, these mother and daughter pairs were able to develop a starting point in rebuilding their relationship.

The effects of dance intervention were also found to be therapeutic to psychiatric participants and those who are emotional disturbed. In one research study, psychiatric patients were randomly assigned to one of three conditions: a dance group in a traditional dance circle, a group that just listened to the music, and another group that rode stationary bikes without music but same time duration as the dance circle. While all three conditions lessened or stabilized the condition of the patients, the results found that the dance group benefitted the most from the dance intervention.^[23] The dance circle group reported less depression and more vitality than the other groups. This study shows that not just physical activity or listening to music is enough; the combining of the two into dance is the most beneficial for achieving a positive impact.

Another research study completed with children in psychiatry also showed a positive relationship with this type of therapy. The ending result was a newfound cohesion among children who were previously labeled disorderly and misbehaved.^[24] The participants reported an increase in self-confidence and a positive body image after the dance intervention. The children had stronger communication and social skills, such as team work, after the dance intervention.

Adverse effects

Most trials studying dance therapy did not specifically comment on whether or not adverse effects occurred, though one noted a broken finger, thought to be related to dancing.^[15]

Locations

DMT is practiced in a large variety of locations. Such locations include:^[8]

• Physical medicine
• Rehabilitation centers
• Medical settings
• Education settings
• Nursing Homes
• Day care facilities
• Disease prevention centers
• Health promotion programs
• Hospitals
• Mental health settings

Organizations

Organizations such as the American Dance Therapy Association were created in order to uphold high standards in the field of DMT. Such organizations help connect individuals to therapists and DMT.^[25]

American Dance Therapy Association

American Dance Therapy Association (ADTA) was founded in 1966 in order to uphold high standards throughout dance therapy. The ADTA was created by Marian Chace, the first president of the ADTA, and other pioneers in dance movement. Along with setting standards for which therapists must attain to become licensed therapists, ADTA keeps an updated registry of all movement/dance therapists who have met ADTA’s standards. In addition, ADTA also publishes the American Journal of Dance Therapy and sponsors annual professional conferences.^[25]

Association for Dance Movement Psychotherapy, United Kingdom

The Association for Dance Movement Psychotherapy, United Kingdom (ADMP UK) was one of the first organizations established to regulate the field of dance therapy. ADMP UK accredits therapists and oversees that all regulations are followed.^[26]

Allied professions

Allied professions are areas that a person could do, special studies, short courses, or eventually become trained in the area of DMT.^[27]

• Dance
• Physical education
• Occupational therapy
• Physiotherapy
• Psychology
• Art therapy

Therapist qualifications

ADTA is the main regulator of the required education and training in order to become a dance/movement therapist in the USA.^[25] A master's degree is required to become a dance/movement therapist. "Registered Dance/Movement Therapist" (R-DMT) is the title given to entry-level dance/movement therapists who have completed requisite education and a minimum 700-hour supervised clinical internship. Those who have completed over 3,640 hours of supervised professional clinical work may hold the advanced credential "Board Certified Dance/Movement Therapist (BC-DMT).^[11]

Education

Because becoming a dance therapist requires a graduate degree of at least a Master's level, the undergraduate track that a student chooses to take is very important, as well. There is no specific undergraduate degree that a student is required to obtain. However, it is highly recommended that they choose a degree in a behavioral science, like Psychology, or in something related to dance, such as Performing Arts.^[28]

There are only 6 ADTA approved master's programs from which to earn Registered Dance/Movement Therapist (R-DMT) credentials: Antioch University New England in New Hampshire, Columbia College Chicago in Illinois, Drexel University in Pennsylvania, Lesley University in Massachusetts, Naropa University in Colorado, and Pratt Institute in New York.^[29] Each of these programs require two to three years of study. Students are expected to complete sixty to sixty-two credit hours, along with an internship/practicum of two to four semesters.^[30]

Those with a master's or doctoral degree in a human services-related field may have the option to become an R-DMT via alternate route^[31]

In addition to the R-DMT, which stands for Registered Dance Movement Therapist, there is the BC-DMT, which stands for Board Certified Dance Movement Therapist. The R-DMT requires a master's degree with 700 hours of supervised clinical work, while the BC-DMT is the "advanced" qualification requiring a master's degree of 3,640 hours of supervised clinical work and passing a grueling exam.^[32]

There are five universities in the United Kingdom that offer graduate programs in Dance Movement Psychotherapy and have been approved by the ADMP UK: Dance Voice Therapy and Education Centre, Bristol, Edge Hill University, Goldsmiths University of London, University of Derby and University of Roehampton.

All five universities offer an MA degree in Dance Movement Psychotherapy, typically 2 years full-time or 3 years part-time. University of Roehampton also offers a PhD course, either 3 years full-time or up to 6 years part-time.^[33] Along with clinical placements, experiential groups and movement analysis, students are required to undergo personal psychotherapy while in training.^[34]

See also

• Expressive therapy
• Process art
• Rudolf Laban

Further reading

• Meekums, B. (2002). Dance Movement Therapy: a Creative Psychotherapeutic Approach. London: Sage.
• Chodorow, J. (1991). Dance Therapy and Depth Psychology. London.
• Lewis, P. (1984; 1986). Theoretical Approaches in Dance Movement Therapy. Vols I & II, USA: Kendall/Hunt.
• Payne, H. (ed). (2006). Dance Movement Therapy: Theory, Research and Practice (2nd edn). Tavistock / Routledge.
• Siegel, E. (1984). Dance Movement Therapy: Mirror of Ourselves: The Psychoanalytic Approach. New York: Human Science Press.
• Stanton-Jones, K. (1992). An Introduction to Dance Movement Therapy in Psychiatry. London: Tavistock/Routledge.
• North, M. (1990). Personality Assessment Through Movement. Northcote House.
• Payne, H.L. (2000). Creative Movement and Dance in Groupwork. Oxon: Speechmark.
• McCormack, D. (2003) An event of geographical ethics in spaces of affect. Transactions of the Institute of British Geographers, 28, (4), 488–507.

External links

• The Association for Dance Movement Therapy in UK
• American Dance Therapy Association
• Coalition of Creative Arts Therapy Associations