Integrating Dance Therapy Into Treatment SUSAN L. S1INDEL, MA., Dance Therapist Yale Psychiatric Institute New Haven, Connecticut
D.T.R.
chizophrenics skills. The patients groups
For several years after dance therapy was introduced at Yale Psychiatric lnstltute in 1967, patients perceived It as an activity totally separate 5mm theIr fresitment program. The author describes changes in hospital procedure and in the structure of the dance groups that helped alter that perception. They include involving the patient’s treatment team In the selection of activities; establishIng groups In which membership is fairly constant, thus increasing the likelihood of interpersonal interaction; and setting aside ten or .15 minutes at the end of each dance session for discussion of the feelings evoked. The author says the changes have clarified values and goals within the dance therapy groups. SIn
1967
Psychiatric
dance Institute,
therapy
was a
46-bed
initiated
at
the
Yale
psychoanalytically
oriented residential treatment facility. As a dance therapist entering such a setting, I was faced with the problem of introducing a nonverbal group therapy into a milieu in which verbal psychotherapy was the primary treatment. Dance therapy has been defined by the American Dance Therapy Association as “the psychotherapeutic use of movement as a process which furthers the emotional and physical integration of the individual.’ The first dance therapy groups at the hospital were composed of six to ten adolescents and young adults who selected dance therapy as part of their activities schedule. At that time the activities program was in its infancy, and patients regarded the activities as a diversion from the “business” of therapy in the hospital or an intrusion into preferred solitude or Inactivity. My focus in the groups was on developing individual body awareness, group interaction and cooperation, and sharing of feelings in movement. The dance therapy sessions were especially useful for regressed Ms. SandeFs address at the instituteIs 33 Cedar Stjeet, Connecticut 06510.
New
Haven,
with sessions
a minimum provided
who had difficulty in the hospital. Dance
the nonverbal patient’s hospital community. In the sessions, which emphasized maintaining stant flow of movement identify the affect being group
was
of social structured
and verbal contact for
participating
therapy first mode
in
sessions of entry
verbal
are often into the
ran for 45 minutes to an hour, I a steady rhythm and a coninteraction. I used imagery to
expressed. For example, if the in stamping their feet, I would ask,
engaged
“What can we stamp?” When a patient offered an image, I developed it into a group movement improvisation in which objects or people associated with painful feelings could be named and the feelings toward them explored. Thus some feelings were shared during the sessions,
mostly
at my
initiation.
Beyond that, there was no discussion about what we did or how people felt about it. Any attempts on my part to initiate more discussion were met with strong resistance. Most patients did not consider their movement experiences connected to the rest of their treatment. In fact, the mind-body dichotomy that dance therapy seeks to bridge was being intensified. The general feeling seemed to be, “In dance therapy we move, in psychotherapy we talk.” Patients seemed to regard the dance therapy sessions as
an
opportunity
to
move
around,
to
engage
in
physical contact, and to express a variety of often undifferentiated feelings with minimal demands upon them to discuss or label those feelings. They rarely mentioned their experiences in dance therapy during their psychotherapy sessions. It became evident that several changes, both in the hospital community and within the dance therapy groups, would be necessary if the patients were to regard dance therapy as an integral part of their treatment in the hospital. CHANGES
IN PROCEDURE
The integration process has been helped by a newer procedure for assigning patients to activities. Formerly the patients selected their own activity schedule with minimal guidance from an activities therapist. The only requirements were that a patient participate in two ac-
VOLUME
26 NUMBER
7 JULY
1975
439
A basic assumption in dance therapy is that participation in a group movement experience constitutes a shared emotional experience that forms the basis for relationships with others. tivities
a day
exercise
a week.
within
the
devised with
and
last
have
at least
Under
the
three
years,
by the patient’s the
new
said,
has
adopted
therapy
team
plan
is
in consultation
me to clarify
the
of dance therapy and to communicate at the time of referral. Consequently
patients
entering
now
the
groups
in a corner
wish
Cindy
with
some
record.
the
corner
she
responded;
finally
of physical
therapeutic goals them to patients are
“I
favorite
hours
forced
been working together refused to participate
had
patient
of the
room,
head
for
and
down,
rock-
would
join
us.”
The
group
spent
the next 20 minutes working with her to engage her in movement. One patient changed the music to Cindy’s
to a particular therapy is planning meeting. That
planning
that
One
ing on her heels forward and back. She met my invitation to join us with silent refusal. I decided to proceed with the session and see what happened. The other patients began to get involved in a lively movement interaction when one of them stopped and
patient.
of treatment
a group
months.
sat crouched
procedure,
treatment
with
three
an activities
The rationale for referral made explicit in a treatment kind
three
sion
idea
of
Another
and
joined
patient
sat
joined
her in the
several
people
the group,
close
talked
and
to Cindy
rocking
motion
to her
in
until
quietly.
She
they
all moved together in rhythmic stamping and jumping and then relaxed. In the discussion that followed, several group members told Cindy that the group was better when she joined it. They acknowledged that Cindy had been very disturbed, although she couldn’t fully explain why, and told her that she showed courage in joining the group when she was feeling so badly. Another patient said she also liked to be pulled into the group and sometimes did things to make others prove that they wanted her. The sharing of powerful feelings through movement
how dance therapy relates to their treatment plan. I also initiated changes in the group structure that have affected the patients’ view of dance therapy.
is constantly
stressed
tion
participation
Within
forms the basis for relationships with others. The use of imagery leading to the identification of feelings is regarded as an important part of the sharing process. However, the movements often may be so compelling or the energy level so high that it is impossible to identify all the feelings that are being expressed at the moment they occur. Certainly individual patients perceive and react to those emotions in a variety of ways. For those reasons I decided to set aside time for discussion at the end of each session. It seemed to me that such
the
past
year,
I have
attempted
to establish
groups in which there are minimal changes in membership. A weekly session on the locked ward is open to all patients; usually between ten and 12 participate. evaluation
the
About the same session in the
evaluation
group
for
group
six to eight
number also gym. Patients
upon
admission
weeks,
after
attend a weekly are admitted to
and which
stay they
in the may
be
transferred to another group or discontinue dance therapy if it is contraindicated. They may also remain in the group for several more weeks to work on basic movement
interaction
There them at preparation.
members
the every
each;
appropriate Each group six
groups when the maximum benefit discharge-related
ongoing
to
weekly
I can
refer
time and can absorb
eight
weeks.
groups new
of about patients
with about
plans
motivate
Patients
them
to
leave
the
received or other
to focus
outside
the
facilitated
the
clarification
has been to set aside the last session for group discussion. that period not only has enof feelings, but also has of values
and
goals
in the
group. Minimizing the open structure of the group increases the likelihood that its members will take more responsibility for dealing with the resistance some patients show in the sessions rather than depending solely on my intervention. That advantage was illustrated in a ses-
440
HOSPITAL
verbal
would
& COMMUNITY
PSYCHIATRY
and in the
of
in
A basic
the
therapy
the
that
participants’
nonverbal
ex-
session.
was strong. silence
ex-
experience
facilitate
of
assump-
movement
emotional
integration
dance
resistance sitting
therapy.
in a group
a shared
sharing
Initially sions
in dance
constitutes
periences
adequate one new
therapist feels they have or when job-hunting
hospital. A second major change ten or 15 minutes of each The verbal sharing during couraged the expression
perience
understanding
socialization.
are two other
six to eight
patient
and
is that
But
for
ten
after
several
minutes,
ses-
patients
began to talk. I tried to facilitate discussion by asking direct questions about people’s reactions to the movements we had done. I subsequently found that the verbal sharing following the movement is particularly useful for helping patients deal with some of the unresolved feelings evoked in the group. Its value is illustrated by an incident that occurred shortly after I had initiated the discussion period. A young woman with religious delusions was offended by other patients’ use of obscene language and sexual gestures in the dance sessions. That was consistent with in psychotherapy,
within ings.
herself Several
her
attitude toward in which she
of any hostile, times
she
tried
life on the denied the
aggressive, to
avoid
ward and existence
or sexual attending
dance sessions by scheduling conflicting appointments. In a subsequent session the young woman refused
feelthe
to
participate
in
patients
any
aggressive
commented
mobile
during
movements.
on the fact that
a movement
sequence
in which
She they
said she didn’t were against
were “arguing” nonverbally. negative feelings because religious beliefs. Patients were quick flict was not necessarily
could
have
patient
positive
remained
to share negative,
results. in
group
that
interchange
and
was
im-
people
like her
their feelings that and that sometimes
After
the
Other
she had stood
conit
the
more
open
about her dislike of some activities. The other patients learned more about her interpersonal difficulties and were very supportive of her. Neither the patient’s
A Survey of Treatment Modalities Used by Mental Health Clinicians and Activity Therapists
behavior nor beliefs changed as a result of this interaction, but all the participants gained some understanding of the patient’s behavior. I think the open
acknowledgment in the
of her difficulties
group
even
if she
could
enabled
not
her to stay
participate
in every
exercise. VALUES
CLARIFYING
AND
GOALS
In the primarily nonverbal dance therapy sessions, values were imparted by my actions and the behavior of long-term group members. A new patient entering the group would pick up the values and limits implied in the participants’ behavior. That process continues as the focus remains on the movement interaction; however, the closing discussions have made the values more explicit and open to examination. For example, the implied value that In this group we are permitted to touch each other” has been extended to include “and we can talk about the feelings we experience when we touch.” The verbal clarification of the implicit value has enabled patients to share their problems related to touching others and being touched. “
Similarly,
verbalizing
the
goal
of group
cooperation
has
stimulated examination of why and how the group members do or don’t work together. As values and goals are crystallized, patients have a clearer understanding of what they can gain from dance therapy and how it relates to the rest of their treatment. The discussions seem to have enabled patients to more freely share with their
psychotherapists
Material
related
to appear
The within
mind-body
the
in psychotherapists’
changes the
groups
feelings
to movement in assigning themselves
evoked
experiences reports
patients have
in the
of therapy
to the groups helped
group.
has begun
bridge
hours.
GWEN L. GIBSON, Art Therapist Baltimore City (Md.)
M.L.A.,
A.T.R.
Psychiatric
Day
Center
An art therapist conducted a survey of 150 mental health clinicians and activity therapists to find which of ten treatment modalities they preferred to use with ten types of psychiatric patients. Thefinal sample consisted of 68 respondents: 34 clInicians, 1 7 activity therapists, and 1 7 art therapists. The three respondent groups agreed on the same optimum treatment modality for jive patient groups. Art therapists felt art therapy was most effective in treating the youthful drug abuser, the child with educational problems, and the moderately depressed patient. Clinicians and activity therapists agreed on other treatment modailtiesfor those patients.
and the
dichotomy that formerly existed. The clarification of values and goals within the groups is contributing to the patients’ view of dance therapy as part of their treatment program.S
SArt
therapists
chiatric clinics,
work
hospitals, and schools.
in many
settings
children’s centers, Some self-employed
including
psy-
community art therapists
work in private practice with referrals from psychiatrists, psychologists, social workers, and marriage counselors. The therapists are talented in the fields of painting, graphics, ceramics, or sculpture, and usually have studied clinical psychology, projective techMs. Gibson’s
mailing
address
Maryland
is
21204. This paper is based meeting of the American Art Therapy 1974, in New York City.
VOLUME
26 NUMBER
7 JULY
Overlook, Box 6815, Baltimore, on a presentation at the annual Association held October 25,
1975
441
D.T.R.
chizophrenics skills. The patients groups
For several years after dance therapy was introduced at Yale Psychiatric lnstltute in 1967, patients perceived It as an activity totally separate 5mm theIr fresitment program. The author describes changes in hospital procedure and in the structure of the dance groups that helped alter that perception. They include involving the patient’s treatment team In the selection of activities; establishIng groups In which membership is fairly constant, thus increasing the likelihood of interpersonal interaction; and setting aside ten or .15 minutes at the end of each dance session for discussion of the feelings evoked. The author says the changes have clarified values and goals within the dance therapy groups. SIn
1967
Psychiatric
dance Institute,
therapy
was a
46-bed
initiated
at
the
Yale
psychoanalytically
oriented residential treatment facility. As a dance therapist entering such a setting, I was faced with the problem of introducing a nonverbal group therapy into a milieu in which verbal psychotherapy was the primary treatment. Dance therapy has been defined by the American Dance Therapy Association as “the psychotherapeutic use of movement as a process which furthers the emotional and physical integration of the individual.’ The first dance therapy groups at the hospital were composed of six to ten adolescents and young adults who selected dance therapy as part of their activities schedule. At that time the activities program was in its infancy, and patients regarded the activities as a diversion from the “business” of therapy in the hospital or an intrusion into preferred solitude or Inactivity. My focus in the groups was on developing individual body awareness, group interaction and cooperation, and sharing of feelings in movement. The dance therapy sessions were especially useful for regressed Ms. SandeFs address at the instituteIs 33 Cedar Stjeet, Connecticut 06510.
New
Haven,
with sessions
a minimum provided
who had difficulty in the hospital. Dance
the nonverbal patient’s hospital community. In the sessions, which emphasized maintaining stant flow of movement identify the affect being group
was
of social structured
and verbal contact for
participating
therapy first mode
in
sessions of entry
verbal
are often into the
ran for 45 minutes to an hour, I a steady rhythm and a coninteraction. I used imagery to
expressed. For example, if the in stamping their feet, I would ask,
engaged
“What can we stamp?” When a patient offered an image, I developed it into a group movement improvisation in which objects or people associated with painful feelings could be named and the feelings toward them explored. Thus some feelings were shared during the sessions,
mostly
at my
initiation.
Beyond that, there was no discussion about what we did or how people felt about it. Any attempts on my part to initiate more discussion were met with strong resistance. Most patients did not consider their movement experiences connected to the rest of their treatment. In fact, the mind-body dichotomy that dance therapy seeks to bridge was being intensified. The general feeling seemed to be, “In dance therapy we move, in psychotherapy we talk.” Patients seemed to regard the dance therapy sessions as
an
opportunity
to
move
around,
to
engage
in
physical contact, and to express a variety of often undifferentiated feelings with minimal demands upon them to discuss or label those feelings. They rarely mentioned their experiences in dance therapy during their psychotherapy sessions. It became evident that several changes, both in the hospital community and within the dance therapy groups, would be necessary if the patients were to regard dance therapy as an integral part of their treatment in the hospital. CHANGES
IN PROCEDURE
The integration process has been helped by a newer procedure for assigning patients to activities. Formerly the patients selected their own activity schedule with minimal guidance from an activities therapist. The only requirements were that a patient participate in two ac-
VOLUME
26 NUMBER
7 JULY
1975
439
A basic assumption in dance therapy is that participation in a group movement experience constitutes a shared emotional experience that forms the basis for relationships with others. tivities
a day
exercise
a week.
within
the
devised with
and
last
have
at least
Under
the
three
years,
by the patient’s the
new
said,
has
adopted
therapy
team
plan
is
in consultation
me to clarify
the
of dance therapy and to communicate at the time of referral. Consequently
patients
entering
now
the
groups
in a corner
wish
Cindy
with
some
record.
the
corner
she
responded;
finally
of physical
therapeutic goals them to patients are
“I
favorite
hours
forced
been working together refused to participate
had
patient
of the
room,
head
for
and
down,
rock-
would
join
us.”
The
group
spent
the next 20 minutes working with her to engage her in movement. One patient changed the music to Cindy’s
to a particular therapy is planning meeting. That
planning
that
One
ing on her heels forward and back. She met my invitation to join us with silent refusal. I decided to proceed with the session and see what happened. The other patients began to get involved in a lively movement interaction when one of them stopped and
patient.
of treatment
a group
months.
sat crouched
procedure,
treatment
with
three
an activities
The rationale for referral made explicit in a treatment kind
three
sion
idea
of
Another
and
joined
patient
sat
joined
her in the
several
people
the group,
close
talked
and
to Cindy
rocking
motion
to her
in
until
quietly.
She
they
all moved together in rhythmic stamping and jumping and then relaxed. In the discussion that followed, several group members told Cindy that the group was better when she joined it. They acknowledged that Cindy had been very disturbed, although she couldn’t fully explain why, and told her that she showed courage in joining the group when she was feeling so badly. Another patient said she also liked to be pulled into the group and sometimes did things to make others prove that they wanted her. The sharing of powerful feelings through movement
how dance therapy relates to their treatment plan. I also initiated changes in the group structure that have affected the patients’ view of dance therapy.
is constantly
stressed
tion
participation
Within
forms the basis for relationships with others. The use of imagery leading to the identification of feelings is regarded as an important part of the sharing process. However, the movements often may be so compelling or the energy level so high that it is impossible to identify all the feelings that are being expressed at the moment they occur. Certainly individual patients perceive and react to those emotions in a variety of ways. For those reasons I decided to set aside time for discussion at the end of each session. It seemed to me that such
the
past
year,
I have
attempted
to establish
groups in which there are minimal changes in membership. A weekly session on the locked ward is open to all patients; usually between ten and 12 participate. evaluation
the
About the same session in the
evaluation
group
for
group
six to eight
number also gym. Patients
upon
admission
weeks,
after
attend a weekly are admitted to
and which
stay they
in the may
be
transferred to another group or discontinue dance therapy if it is contraindicated. They may also remain in the group for several more weeks to work on basic movement
interaction
There them at preparation.
members
the every
each;
appropriate Each group six
groups when the maximum benefit discharge-related
ongoing
to
weekly
I can
refer
time and can absorb
eight
weeks.
groups new
of about patients
with about
plans
motivate
Patients
them
to
leave
the
received or other
to focus
outside
the
facilitated
the
clarification
has been to set aside the last session for group discussion. that period not only has enof feelings, but also has of values
and
goals
in the
group. Minimizing the open structure of the group increases the likelihood that its members will take more responsibility for dealing with the resistance some patients show in the sessions rather than depending solely on my intervention. That advantage was illustrated in a ses-
440
HOSPITAL
verbal
would
& COMMUNITY
PSYCHIATRY
and in the
of
in
A basic
the
therapy
the
that
participants’
nonverbal
ex-
session.
was strong. silence
ex-
experience
facilitate
of
assump-
movement
emotional
integration
dance
resistance sitting
therapy.
in a group
a shared
sharing
Initially sions
in dance
constitutes
periences
adequate one new
therapist feels they have or when job-hunting
hospital. A second major change ten or 15 minutes of each The verbal sharing during couraged the expression
perience
understanding
socialization.
are two other
six to eight
patient
and
is that
But
for
ten
after
several
minutes,
ses-
patients
began to talk. I tried to facilitate discussion by asking direct questions about people’s reactions to the movements we had done. I subsequently found that the verbal sharing following the movement is particularly useful for helping patients deal with some of the unresolved feelings evoked in the group. Its value is illustrated by an incident that occurred shortly after I had initiated the discussion period. A young woman with religious delusions was offended by other patients’ use of obscene language and sexual gestures in the dance sessions. That was consistent with in psychotherapy,
within ings.
herself Several
her
attitude toward in which she
of any hostile, times
she
tried
life on the denied the
aggressive, to
avoid
ward and existence
or sexual attending
dance sessions by scheduling conflicting appointments. In a subsequent session the young woman refused
feelthe
to
participate
in
patients
any
aggressive
commented
mobile
during
movements.
on the fact that
a movement
sequence
in which
She they
said she didn’t were against
were “arguing” nonverbally. negative feelings because religious beliefs. Patients were quick flict was not necessarily
could
have
patient
positive
remained
to share negative,
results. in
group
that
interchange
and
was
im-
people
like her
their feelings that and that sometimes
After
the
Other
she had stood
conit
the
more
open
about her dislike of some activities. The other patients learned more about her interpersonal difficulties and were very supportive of her. Neither the patient’s
A Survey of Treatment Modalities Used by Mental Health Clinicians and Activity Therapists
behavior nor beliefs changed as a result of this interaction, but all the participants gained some understanding of the patient’s behavior. I think the open
acknowledgment in the
of her difficulties
group
even
if she
could
enabled
not
her to stay
participate
in every
exercise. VALUES
CLARIFYING
AND
GOALS
In the primarily nonverbal dance therapy sessions, values were imparted by my actions and the behavior of long-term group members. A new patient entering the group would pick up the values and limits implied in the participants’ behavior. That process continues as the focus remains on the movement interaction; however, the closing discussions have made the values more explicit and open to examination. For example, the implied value that In this group we are permitted to touch each other” has been extended to include “and we can talk about the feelings we experience when we touch.” The verbal clarification of the implicit value has enabled patients to share their problems related to touching others and being touched. “
Similarly,
verbalizing
the
goal
of group
cooperation
has
stimulated examination of why and how the group members do or don’t work together. As values and goals are crystallized, patients have a clearer understanding of what they can gain from dance therapy and how it relates to the rest of their treatment. The discussions seem to have enabled patients to more freely share with their
psychotherapists
Material
related
to appear
The within
mind-body
the
in psychotherapists’
changes the
groups
feelings
to movement in assigning themselves
evoked
experiences reports
patients have
in the
of therapy
to the groups helped
group.
has begun
bridge
hours.
GWEN L. GIBSON, Art Therapist Baltimore City (Md.)
M.L.A.,
A.T.R.
Psychiatric
Day
Center
An art therapist conducted a survey of 150 mental health clinicians and activity therapists to find which of ten treatment modalities they preferred to use with ten types of psychiatric patients. Thefinal sample consisted of 68 respondents: 34 clInicians, 1 7 activity therapists, and 1 7 art therapists. The three respondent groups agreed on the same optimum treatment modality for jive patient groups. Art therapists felt art therapy was most effective in treating the youthful drug abuser, the child with educational problems, and the moderately depressed patient. Clinicians and activity therapists agreed on other treatment modailtiesfor those patients.
and the
dichotomy that formerly existed. The clarification of values and goals within the groups is contributing to the patients’ view of dance therapy as part of their treatment program.S
SArt
therapists
chiatric clinics,
work
hospitals, and schools.
in many
settings
children’s centers, Some self-employed
including
psy-
community art therapists
work in private practice with referrals from psychiatrists, psychologists, social workers, and marriage counselors. The therapists are talented in the fields of painting, graphics, ceramics, or sculpture, and usually have studied clinical psychology, projective techMs. Gibson’s
mailing
address
Maryland
is
21204. This paper is based meeting of the American Art Therapy 1974, in New York City.
VOLUME
26 NUMBER
7 JULY
Overlook, Box 6815, Baltimore, on a presentation at the annual Association held October 25,
1975
441
