Dance therapy

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Dance/movement therapy
MeSH D003614

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 modality of the creative arts therapies, DMT looks at the correlation between movement and emotion. [5]

Contents

History

The American Dance Therapy Association was founded in 1966 as an organization to support the emerging profession of dance/movement therapy and is the only U.S. organization dedicated to the profession of dance/movement therapy.

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. [6] There is a general opinion that Dance/movement as active imagination was originated by Jung in 1916, [7] developed in the 1960s by dance therapy pioneer Mary Whitehouse. Tina Keller-Jenny and other therapists started practicing the therapy in 1940. [8] 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. [9]

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. [10] 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. [11] 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. [12] In 1966 Chace became the first president of the American Dance Therapy Association, an organization which she and several other DMT pioneers founded. [11] 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. [11]

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 control, 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 experiences through non-verbal mediation by the therapist. [11]

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 feeling of engaging in or empathically observing dancing." [13]

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 holistic creative expression, meaning it treats the full person: mind, body, and spirit. [14]

Methodology

DMT/P methodology is fairly heterogenous and practitioners draw on a variety of psychotherapeutic and kinetic principles. Most trainings in Dance Therapy will have an established theoretical base which they work from – for example Psychodynamic theory, Humanistic psychology, Integrative therapy, Cognitive behavioral therapy, Existential therapy etc. Depending on the approach or combinations of approaches practitioners work from very different processes and aims will be worked towards.

Additionally to the psychotherapeutic basis of their work, different approaches to movement and dance may be employed.

Whilst some dance therapists work with codified dance movement and styles – such as ballet, folk dance, contemporary dance etc. – most work within a kinetic framework of creative and expressive movement practices, usually with a significant element of structured improvisation.

Commonly requirements on mosts DMT/P graduate programmes are Movement Analysis and Profiling (often based in Laban movement analysis and the Kestenberg Movement Profile), experiential anatomy, human development and Developmental psychology, Authentic Movement and supplementary body-mind integration practices, such as Body-Mind Centering®, Bartenieff Fundamentals, Feldenkrais Method or Alexander Technique. [15]

Additionally since a variety of populations may be encountered in DMT/P, methods are adapted to meet the needs of the circumstances and clients and this further reduces standardisation.

Bonnie Meekums, a second wave dance therapist, described four stages of the therapy process, based on her experience in the field:

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 [14]

Research

Dance therapy is not an established field of medical practice and has varying acceptance and recognition in different countries. In countries where a Master level of education is required, dance therapists often work within medical psychiatric settings alongside other healthcare professionals, whereas in other countries the practice of dance therapy is fringe and mainly occurs in private and independent settings.

For this reason, scientific research into the mechanisms and efficacy of dance therapy is still in its infancy. Additionally, since the practice of dance therapy is heterogenous and the scope and methodology varies greatly, this makes it even harder to create medically rigorous evidence bases. However, studies exist which suggest positive outcomes of dance therapy. [16] [11]

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)." [17]

Studies

A Cochrane review entitled Dance therapy for schizophrenia in 2013 [18] 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 [19] 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. [20] 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. [21]

The latest Cochrane review entitled Dance Movement Therapy for Dementia published in 2017 concluded that there we no high quality trials to assess the effect of DMT on behavioural, social, cognitive and emotional symptoms in people with dementia. [22]

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. [23] In one research study[ specify ], 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. [24] [ non-primary source needed ] 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.[ non-primary source needed ] 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. [25] 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. [26] [ non-primary source needed ] 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. [27] [ non-primary source needed ] 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.It also acts as an intervention between treatments for depression. [17]

Locations

DMT is practiced in a large variety of locations. Such locations include: [9]

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. [28]

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. [28]

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. [16]

European Association of Dance Movement Therapy

The European Association of Dance Movement Therapy is an umbrella association which represents national professional bodies for Dance Movement Therapy in Europe. It represents members in Germany, Greece, Hungary, Italy, Latvia, Netherlands, Poland, Russia, Spain and the UK; with partial members in Austria, Czech Republic, Finland, France, Switzerland, Ukraine and associate members in Croatia, Cyprus, Denmark, Israel, Portugal, Romania and Sweden.

Allied professions

Allied professions are areas that a person could do, special studies, short courses, or eventually become trained in the area of DMT. [29]

Therapist qualifications

ADTA is the main regulator of the required education and training in order to become a dance/movement therapist in the USA. [28] 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). [12]

Education

Typically becoming a dance therapist requires a graduate degree of at least a Master's level. There is no specific undergraduate degree, however many practitioners hold undergraduate degrees fields in, or related to, psychology or dance. [30]

All master's degrees in the UK and the USA require clinical placements, personal therapy and supervision, as well as experiential and theoretical learning, and typically require between 2 and 3 years to complete. Upon completion of a Masters graduates are eligible to register as Dance Movement Therapists/Psychotherapists with their professional associations. In the UK graduates may also register with the UK Council of Psychotherapists(UKCP).

It is also possible to register as a Dance Movement Therapist/Psychotherapist without a DMT/DMP Masters. This usually requires equilvilant psychotherapeutic training and substantial experience of applying dance into therapeutic settings.

See also

Related Research Articles

Cognitive behavioral therapy Therapy to improve mental health

Cognitive behavioral therapy (CBT) is a psycho-social intervention that aims to improve mental health. CBT focuses on challenging and changing cognitive distortions and behaviors, improving emotional regulation, and the development of personal coping strategies that target solving current problems. Originally, it was designed to treat depression, but its uses have been expanded to include treatment of a number of mental health conditions, including anxiety, alcohol and drug use problems, marital problems, and eating disorders. CBT includes a number of cognitive or behavior psychotherapies that treat defined psychopathologies using evidence-based techniques and strategies.

Psychotherapy is the use of psychological methods, particularly when based on regular personal interaction with adults, to help a person change behavior and overcome problems in desired ways. Psychotherapy aims to improve an individual's well-being and mental health, to resolve or mitigate troublesome behaviors, beliefs, compulsions, thoughts, or emotions, and to improve relationships and social skills. There are also numerous types of psychotherapy designed for children and adolescents, such as play therapy. Certain psychotherapies are considered evidence-based for treating some diagnosed mental disorders. Others have been criticized as pseudoscience.

Group psychotherapy or group therapy is a form of psychotherapy in which one or more therapists treat a small group of clients together as a group. The term can legitimately refer to any form of psychotherapy when delivered in a group format, including Art therapy, cognitive behavioral therapy or interpersonal therapy, but it is usually applied to psychodynamic group therapy where the group context and group process is explicitly utilized as a mechanism of change by developing, exploring and examining interpersonal relationships within the group.

Music therapy

Music therapy, an allied health profession, "is the clinical and evidence-based use of music interventions to accomplish individualized goals within a therapeutic relationship by a credentialed professional who has completed an approved music therapy program."

Psychedelic therapy refers to therapeutic practices involving psychedelic drugs such as LSD, psilocybin, DMT, mescaline, 2C-B, and MDMA. In psychedelic therapy, in contrast to the use of conventional psychiatric medication which is taken by the patient regularly or as-needed, patients remain in an extended psychotherapy session during the acute activity of the drug and spend the night at the facility. In the sessions with the drug, therapists are nondirective and support the patient in exploring their inner experience. Patients participate in psychotherapy before the drug psychotherapy sessions to prepare them and after the drug psychotherapy to help them integrate their experiences with the drug.

The expressive therapies are the use of the creative arts as a form of therapy, including the distinct disciplines expressive arts therapy and the creative arts therapies. Unlike traditional arts expression, the process of creation is emphasized rather than the final product. The expressive therapies are based on the assumption that people can heal through the various forms of creative expression. Expressive therapists share the belief that through creative expression and the tapping of the imagination, people can examine their body, feelings, emotions, and thought process.

Art therapy

Art therapy is a distinct discipline that incorporates creative methods of expression through visual art media. Art therapy, as a creative arts therapy profession, originated in the fields of art and psychotherapy and may vary in definition.

Mindfulness-based cognitive therapy (MBCT) is an approach to psychotherapy that uses cognitive behavioral therapy (CBT) methods in collaboration with mindfulness meditative practices and similar psychological strategies. It was originally created to be a relapse-prevention treatment for individuals with major depressive disorder (MDD). A focus on MDD and cognitive processes distinguishes MBCT from other mindfulness-based therapies. Mindfulness-based stress reduction (MBSR), for example, is a more generalized program that also utilizes the practice of mindfulness. MBSR is a group-intervention program, like MBCT, that uses mindfulness to help improve the life of individuals with chronic clinical ailments and high-stress lives.

Cognitive therapy (CT) is a type of psychotherapy developed by American psychiatrist Aaron T. Beck. CT is one of the therapeutic approaches within the larger group of cognitive behavioral therapies (CBT) and was first expounded by Beck in the 1960s. Cognitive therapy is based on the cognitive model, which states that thoughts, feelings and behavior are all connected, and that individuals can move toward overcoming difficulties and meeting their goals by identifying and changing unhelpful or inaccurate thinking, problematic behavior, and distressing emotional responses. This involves the individual working collaboratively with the therapist to develop skills for testing and modifying beliefs, identifying distorted thinking, relating to others in different ways, and changing behaviors. A tailored cognitive case conceptualization is developed by the cognitive therapist as a roadmap to understand the individual's internal reality, select appropriate interventions and identify areas of distress.

Child psychotherapy, or mental health interventions for children have developed varied approaches over the last century. Two distinct historic pathways can be identified for present-day provision in Western Europe and in the United States: one through the Child Guidance Movement, the other stemming from Adult psychiatry or Psychological Medicine, which evolved a separate Child psychiatry specialism.

Psychoeducation is an evidence-based therapeutic intervention for patients and their loved ones that provides information and support to better understand and cope with illness. Psychoeducation is most often associated with serious mental illness, including dementia, schizophrenia, clinical depression, anxiety disorders, psychotic illnesses, eating disorders, personality disorders and autism, although the term has also been used for programs that address physical illnesses, such as cancer.

Reminiscence therapy Intervention technique with brain-injured patients

Reminiscence therapy is used to counsel and support older people, and is an intervention technique with brain-injured patients and those who appear to have "Alzheimer's and other forms of cognitive disease."

Psychological therapies for dementia are starting to gain some momentum. Improved clinical assessment in early stages of Alzheimer's disease and other forms of dementia, increased cognitive stimulation of the elderly, and the prescription of drugs to slow cognitive decline have resulted in increased detection in the early stages. Although the opinions of the medical community are still apprehensive to support cognitive therapies in dementia patients, recent international studies have started to create optimism.

Supportive psychotherapy is a psychotherapeutic approach that integrates various therapeutic schools such as psychodynamic and cognitive-behavioral, as well as interpersonal conceptual models and techniques.

Exposure to trauma induces an intense amount of stress as a result of an individual directly or indirectly experiencing some type of threat, also referred to as a Potentially Traumatic Experience (PTE). PTEs can include—but are not limited to—sexual violence, physical abuse, unexpected death of a loved one, witnessing another person badly hurt, exposure to natural disaster, being a victim of a serious crime, car accident, combat, interpersonal violence and many other stressful experiences. PTEs can also include learning that a traumatic event occurred to another person or witnessing the traumatic event; an individual does not have to experience the event themselves to develop Posttraumatic Stress Disorder (PTSD). PTEs are labeled as such because not everyone who experiences one or more of the events listed will develop PTSD. However, PTSD is estimated to develop in about 4% of individuals who experience some type of traumatic experience. Approximately 8% of adults the United States population will have PTSD at some point in their lives. That means about 8 million U.S. adults have PTSD during a given year, which is only a small portion of individuals who experience traumatic events. Biological stress responses can be adaptive at the time of the traumatic event, but prolonged biological stress responses can lead to impairing symptoms known as PTSD.

Compassion focused therapy (CFT) is a system of psychotherapy developed by Paul Gilbert that integrates techniques from cognitive behavioral therapy with concepts from evolutionary psychology, social psychology, developmental psychology, Buddhist psychology, and neuroscience. According to Gilbert, "One of its key concerns is to use compassionate mind training to help people develop and work with experiences of inner warmth, safeness and soothing, via compassion and self-compassion."

Homework in psychotherapy is sometimes assigned to patients as part of their treatment. In this context, homework assignments are introduced to practice skills taught in therapy, encourage patients to apply the skills they learned in therapy to real life situations, and to improve on specific problems encountered in treatment. For example, a patient with deficits in social skills may learn and rehearse proper social skills in one treatment session, then be asked to complete homework assignments before the next session that apply those newly learned skills.

Audio therapy is the clinical use of recorded sound, music, or spoken words, or a combination thereof, recorded on a physical medium such as a compact disc (CD), or a digital file, including those formatted as MP3, which patients or participants play on a suitable device, and to which they listen with intent to experience a subsequent beneficial physiological, psychological, or social effect.

Accelerated experiential dynamic psychotherapy (AEDP) is a mind-body psychotherapy that is informed by research in the areas of attachment theory, emotion theory, and neuroscience of change. This model of psychotherapy incorporates techniques from experiential therapies and ISTDP.

Sexual trauma therapy is medical and psychological interventions provided to survivors of sexual violence aiming to treat their physical injuries and cope with mental trauma caused by the event. Examples of sexual violence include any acts of unwanted sexual actions like sexual harassment, groping, rape, and circulation of sexual content without consent.

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Further reading