DANCE MOVEMENT THERAPY IN THE CONCEPT OF EXPRESSIVE ARTS-THERAPY

Abstract

Dance Movement Therapy is a complementary method which includes using and analyzing of different aspects of body-experience and body-expression such us movement, mimics, pantomime and touch. In Dance Movement Therapy, body is dominant media of therapeutic process. So this kind of therapy may have positive influence on physiological awareness, body expression of emotions, inducing unconscious impulses, and improving new strategies of behaviour through exploring new patterns and qualities of movement, and integration of cognitive, emotional and behavioural aspects in person. In this article, some main aspects of dance movement therapy are described such as historical and theoretical background, observation and assessment elements, as well as methods and therapeutic influence in the frame of individual or group process.

Headnote

Summary: Dance Movement Therapy is a complementary method which includes using and analyzing of different aspects of body-experience and body-expression such us movement, mimics, pantomime, touch...

In Dance Movement Therapy body is dominant media of therapeutic process. So this kind of therapy may have positive influence on physiological awareness, body expression of emotions, inducing unconscious impulses, and improving new strategies of behaviour through exploring new patterns and qualities of movement, and integration of cognitive, emotional and behavioural aspects in person.

In this article some main aspects of dance movement therapy are described such as historical and theoretical background, observation and assessment elements, as well as methods and therapeutic influence in the frame of individual or group process.

Keywords: expressive arts-therapy, dance movement therapy, movement quality assessment, methods of interventions, therapeutic influence

PRIMJENA PLESA I POKRETA U KONCEPTU EKSPRESIVNIH ART-TERAPIJA

Sazetak: Terapija plesom ipokretom predstavlja komplementamu metodu kqja ukljucuje primjenu i analizu razlicitih aspekata tjelesnog iskustva i izrazavanja kao sto supokret, mimika, gesta,pantomima, dodir...

S obzirom da je u okviru ovog pristupa tijelo dominantni medij terapijskog procesa, njezina primjena moze utjecati na osvjescivanje fizioloskih senzacija, tjelesnu ekspresiju emocionalnih stanja, izrazavanje nesvjesnih impulsa, kreiranje novih strategija ponasanja kroz otkrivanje novih obrazaca i kvaliteta kretanja, te integraciju kognitivnih, emocionalnih i bihevioralnih aspekata u osobe.

Uradu suprikazani osnovni aspekti terapijeplesom ipokretom kao sto supovijesna i teorijskapolazista, osnove opservacije i evaluacije, te opis metoda i terapijskog utjecaja u okviru individualnog ili grupnogprocesa.

Kljucne rijeci: ekspresivne art-terapije, terapija plesom ipokretom, procjena kvalitete pokreta, metode intervencija, terapijski utjecaj

EXPRESSIVE ARTS-THERAPY

Expressive therapy, also known as expressive arts therapy or creative arts therapy, is a model of using the expressive arts as a form of thera- py. According to International Expressive Arts Therapy Association (IEATA) the expressive arts combine the visual arts, music, dance/movement, drama, poetry, writing and other creative process- es to foster deep personal growth and community development (figure 1). The European Academyfor Psychosocial Health and Stimulation of Creativity defines creative therapy as an integrative deep psychological and hermeneutic approach which includes verbal and non-verbal forms of communication.

Expressive Arts-therapy is predicated on the assumption that through creative expression and the tapping of the imagination, a person can examine different aspects of Self such as the sen- sory experiences, symbolic expression, emotional expression, life enhancement, cognitive devel- opment and social connectedness (Karkou and Sanderson, 2006). Usually, that kind of therapy is considered as intermodal because facilitate expres- sion in general through using multiple forms of expression with the same client to aid with deeper exploration (Malchiodi, 2003).

At the Department of Motoric Disturbances, Chronic Diseases and Art-therapies at the Faculty of Education and Rehabilitation University of Zagreb a original Croatian model of Ex-gen Creative Therapy was developed with emphasis on discovery of an aesthetic dimension of existential experience, actu- alisation of creative potential and therapy catharsis, as well as on auto-regulation of biodynamic and psy- chosocial processes with regard to self-perception and the application of methods of clinical assess- ment in discovering and supporting adaptive cre- ative potentials of a subject (Prstacic, 2003). Ex-gen Creative Therapy is based on using different aspects of guided imagery, relaxation, body-symbolisation, dance movement therapy, music therapy, bibliother- apy, art therapy, psychodrama etc. to providing psy- chophysical homeostasis. Prstacic (2003) stressed that induction of new symbols system in patient's self-assessment and self-perception mechanisms, can give certain invulnerability to limbic arousal regarding the level on which the patient perceive her/him self to be emotionally and socially sup- ported. In that way expressive arts-therapy could be one of the valuable therapy approach in the different field of education and rehabilitation.

DANCE MOVEMENT THERAPY

Dance Movement Therapy (DMT) is a part of expressive arts-therapy which include using and analyzing of different aspects of body-experience and body-expression such us movement, posture, gesture, mimics, pantomime, touch... Based on the empirically supported premise that the body, mind and spirit are interconnected, the American Dance Therapy Association defines Dance Movement Therapy as the psychotherapeutic use of movement to further the emotional, cognitive, physical and social integration ofthe individual.

In Dance Movement Therapy body is dominant media of therapeutic process. So this kind of ther- apy may have positive influence on physiological awareness, body expression of emotions, inducing unconscious impulses, and improving new strategies of behaviour through exploring new patterns and qualities of movement (Levy, 1988; Payne, 2006).

North explains that: "Movement, as revealed in our gestures, unconscious movements, body carriage and our working actions, is always 'our- selves It always speaks honestly... " (North, 1972). In that way therapy through dance and movement indirectly induce relationship with inner sensations, images, feelings and thoughts.

Pylvänäinen (2010) suggest the following list in that is summarised what Dance Movement Therapy exploration in movement may bring:

* release, relaxation which relates to the calming of the state of the autonomous nervous system

* images, memories, associations

* symbolic expressions of the self

* varying ways of experiencing and encounte- ring the world

* new ways of being and acting in interaction

* activated relationship to oneself: what one discovers in oneself, movement expressions of this, connectedness to the body-self/core-self

* reflections in 'words of these experiences

* being in the body in the present

According to European Association Dance Movement Therapy (EADMT) - DMT could be practiced in mental health; rehabilitation, medi- cal, educational and forensic settings; in nurs- ing homes; day care centres; disease prevention and health promotion programs. Although Dance Movement Therapy is mainly psychotherapeutic approach, specialized treatments also can help cure and aid many types of diseases and disabilities.

Historical and theoretical background

Dance has certainly been an important part of ceremony, rituals, celebrations and entertain- ment since before the birth of the earliest human civilizations. Archaeology delivers traces of dance from prehistoric times such as the 9,000 year old Bhimbetka rock shelters paintings in India and Egyptian tomb paintings depicting dancing figures from 3300 BC (Comte, 2004). Jordania (2011) sug- gested that dance, together with rhythmic music and body painting, was designed by the forces of natural selection at the early stage of hominid evolution as a potent tool to put groups of human ancestors in a battle trance, a specific altered state of consciousness. In other way, dance was used as a precursor to ecstatic trance states in healing rituals, and it is still used for this purpose by many cultures from the Brazilian rainforest to the Kalahari Desert (Guenher, 1975). Dance also played important role in warriors moral support (Pieslak, 2009), in the performance and telling of myths, or in affecting the relationship with human or gods (Comte, 2004).

Although dance has been a method of expression for centuries, it wasn't until the twenty century that it was characterized as a form of therapy, although there are records of dance being used for therapeutic purpose in Britain during nineteenth century. By 1940s a definite Dance Movement Therapy had began by experimenting with psychotherapeutic applications of dance and movement. In the twenty- first century DMT is practised flexibly, either as a primary intervention and therefore as a form of focal psychotherapy, or as a supportive, adjunctive therapy. The more creative, supportive and adjunc- tive function of DMT overlaps in form and function with "therapeutic dance" (Meekums, 2002).

Dance Movement Therapy embrace all three of the major schools of psychotherapeutic thought (psychodynamic, behavioural and humanistic) and, summarized by Levy (1988), rests on certain theo- retical principles which are:

* Body and mind interact, so that a change in movement will affect total functioning

* Movement reflects personality

* The therapeutic relationship is mediated at least to some extent non-verbally for example throu- gh the therapist mirroring the client's movement

* Movement contains a symbolic function and as such can be evidence of unconscious process

* Movement improvisation allows the client to experiment with new ways of being

* DMT allows for the recapitulation of early object relationships by 'virtue of the largely non-verbal mediation of the latter

According to Capello (2009) Dance Movement Therapy is focused on the specific psychosocial categories, and those fundamentals are necessary for effective, meaningful, and creative dance move- ment therapy session. Their relations are shown in the frame of an intra/interactional model of dance movement therapy (figure 2).

Although that model is designed for mentally illness, it is adaptable for use within a wide diag- nostic range and for most age categories. Finally, it attempts to be a true dance movement model, focusing on the limitless creative capacities and aesthetic qualities of the moving body using force/ time/space/flow as a unique and specific funda- mental for therapeutic process.

Basic elements of movement quality observation and evaluation

The important part of the Dance Movement Therapy is the specific system of movement quality observation. One of the mostly used model is Laban Movement Analysis (LMA) which is constructed with the aim to observe, notate, and analyze the dif- ferent substance of movement (Newlove and Dalby, 2005). That model, also called shape - effort, include three categories of observation - a) body shape, b) space {space harmony), and c) efforts {motion fac- tors) - and are descriptive for what could occur dur- ing a dance therapy session. Rudolph Laban (1975) also devised symbols for body parts, spatial designa- tions, and the motion factors - known as kinetogra- phy - used for efficient and quicker observation and notation of movement quality (figure 3).

a) Body shapes

There are four distinct body shapes - narrow, wide, curve, and twist (figure 3) (Maletic, 1983). These shapes can either change or be static (fixed) and can be seen in the torso. The observations of body shape are of particular concern with regard to emotional states, attitudes and energy capacity.

b) Space

There are many ways in which the body can move harmoniously and flowingly through space going from one designated point to another. Main areas are: forward, centre; back, side-to -side; left- right; high-middle-deep; vertical-horizontal-sagital plane. Also it could be observed if person use wide or close space. Important category in space obser- vation s is kinesfere - the space that is used all around the body by the limbs standing still or in motion, ft could be used in "near", "middle" or "far reach" space

c) Effort

The expressive and communicative aspects of bodily movement are discernible and can be notated and codified using the many variables of spatial locations and motion factors, referred to as "Effort" (figure 4). When people begin to move, their bodies go through space in ways that offer significant qualitative differences that yield expres- sions of distinctive styles or personalities. These qualitative or dynamic aspects of movement are described in effort terms. In Effort theory, there are four motion factors: space, -weight, time, and flow, with each factor having two polarities.

Combination of 3 different motion actions is called "effort action" and knowledge of them can be useful in observing nonverbal expression of feelings, drives and intentions (White, 2009). There are 8 "effort actions" such us: float, punch, glide, slash, dab, wring, flick and press.

In the process of observation and evaluation it is also important that following variables are included: posture, gesture, mimics, eye contact, facial expression, physical sensations, interac- tions to other person, dominant body part in action, dynamics and kinaesthetic energy, body-image and body awareness, etc.

Because movement observation can be high- ly subjective, in the field of Dance Movement Therapy hard work was done to validate obser- vations in order to create validity throughout the field in terms of what is seen through the move- ment (Powell, 2008). "Movement information must have a system of observation and notation to be understood and communicated between therapists and for research purposes." (Westbrook and Sing, 1988). So, with the aim of obtaining objective observation and evaluating criteria a number of diagnostic materials are constructed. Some of them are: Movement Psychodiagnostic Inventory (Davis, 1997), Nonverbal Assessment of Family Systems, (Dulicai, 1977), Kestenberg Movement Profile (Hastie, 2006), Psychiatric Movement Assessment Scale, (Westbrook, Sing, 1998), Functional Assessment of Movement and Perception (Berrol etal. 1996), Espenak 's Movement Diagnosis Tests (Espenak, 1989).

Some approaches in Dance Movement Therapy

In Dance Movement Therapy there are number of methods of interventions, but main structure of DMT process include following approaches:

IMITATION - physical imitation (reflexion) of mover's entire shape, form or effort factors in exact synchrony and simultaneity with the purpose that observer (therapist), through kinaesthetic empathy, sense and match mover's movement patterns and feelings (Fischman, 2009).

MIRORRING - in mirroring, the therapist embodies the exact shapes, form and movement qualities of the person's actions, creating a mirror image of the mover by depicting and connecting to the emotional expressivity of person's movement. On the physical level, the observer may to modify, exaggerate or diminish some movement qualities but overall sense and style of the movement is still present (Tortora, 2009). The concept of mirroring is the subject of neuroscience. Studies are reveal- ing that the identical sets of neurons - "mirror neurons" - can be activated in an individual who is simply witnessing another person performing a movement as the observer is actually engaged in the action or the expression of some emotion or behaviour. That domains of that interaction span motoric, psychosocial and cognitive functions, including specific psychosocial issues related to attunement, attachment theory and empathy (Berol, 2006).

BODY-SYMBOLISATION - exploring of the specific posture, gesture, mimics and movement that are characteristic in experiencing and express- ing of specific emotions (Martinec, 1995). Some authors concluded (Merlau-Ponty, 1990; Prstacic et al. 1991; Halsen, 1995; Wengrower, 2009) that using of body-symbolisation, as form of symbolic and kinaesthetic stimulation, could be useful on the body-functional, perceptual, imaginative, and archetypal level. Self-investigation of own move- ments profile connected with some acute or domi- nant emotions could help person's awareness of physical and memory background of some experi- ence, and analogously, developing of new move- ments and dynamics patterns could induced new patterns of psychosocial behaviour.

MOVEMENT EXPLORATION - analyzing how specific movement or set of movement is asso- ciated with own feelings, associations and memo- ries, through meditate staying in one or repetitive position, or through changing shape-effort elements (dynamics, time, space, weight, flow...) (Tortora, 2009).

AUTHENTIC MOVEMENT - using of free movements that are involved and spontaneous. Impulse for authentic movement arises from spe- cific body-parts needs, intrinsic value and symbolic material (Capello, 2009). That kind of movement, based on imagination and improvisation, is useful method of creative liberation and self-expression. Describing the main issues of authentic movement influence, Alperson (1973) stressed: "By becom- ing increasingly sensitized to internal and external stimuli as we move in space, at 'varying rhythms and at different levels of energy, alone or in rela- tion to others, in stillness or in motion; our move- ment responses will begin to merge naturally with other modes of representation (images, memories), and the summation of these experiences will allow us to achieve a new integration or "meaning, " from our experience".

What kind of DMT approach will be used depend on protocol (design) phases, client's needs and proneness, and certainly on therapist's adapta- tion to therapy process. In many therapy sessions some of those approaches are combined, or derived one from other.

Meekums (2002) divided the creative process in four stages, which occur during Dance Movement Therapy:

1. Preparation: the warm-up stage, safety is esta- blished

2. Incubation: relaxed, let go of conscious control, movements become symbolic

3. Illumination: meanings become apparent, can have positive and negative effects

4. Evaluation: discuss significance of the process, prepare to end therapy

Each stage contains a smaller set of goals which correlate to the larger purpose. The stages and goals vary with each individual. Although the stages are progressive, the stages are usually revisited several times throughout the entire DMT process.

REVIEW OF SOME SCIENTIFIC RESEARCES IN THE FIELD OF DANCE MOVEMENT THERAPY

Reviews of the literature suggest that there are growing number of scientific studies in Dance Movement Therapies and related fields. Those studies were carried out in wide range of mental or physical illness in order to gain more profound insight into the efficacy of different treatment options and dimensions they can affect.

In that way, Kiepe et al. (2012) in the system- atic review tried to evaluate the effects of Dance Movement Therapy and ballroom dances as thera- peutic interventions for adults with physical and mental illnesses in comparison to other inter- ventions or care as usual. A systematic review includes 11 randomized controlled trials examin- ing dance therapy and ballroom dances, published between 1995 and 2011. Results showed that Dance Movement Therapy had a positive impact for patients with breast cancer, improving quality of life, shoulder range of motion and body image. In patients with depression psychological distress was reduced by dance therapy. Ballroom dances improved balance and coordination in patients with Parkinson's disease and disease-specific quality of life in patients with heart failure.

Through randomized controlled trial on 162 patients Bräuninger (2012a) compared the effect of a dance movement therapy (DMT) group inter- vention on stress management improvement and stress reduction with a wait-listed control group (WG). Stress management, psychopathology and overall distress were evaluated at baseline, imme- diately after completion of the ten sessions DMT group intervention, and 6 months after the DMT treatment. In DMT group Negative stress manage- ment strategies decreased significantly in the short- term and long-term, Positive Strategy Distraction improved significantly in the short-term (p<.10), as well as Relaxation (p<.10). Significant short- term improvements were observed in the BSI psy- chological distress scales on variables: Obsessive- Compulsive; Interpersonal Sensitivity; Depression; Anxiety; Phobic Anxiety; Psychoticism md Positive Symptom Distress. Significant long-term improve- ment in psychological distress through DMT exist- ed in Interpersonal Sensitivity; Depression; Phobic Anxiety; Paranoid Thinking; Psychoticism and Global Severity Index. Results indicate that DMT group treatment is more effective to improve stress management and reduce psychological distress than non-treatment. DMT effects last overtime.

In the other investigation Bräuninger (2012b) examined the treatment outcome of a ten weeks dance movement therapy intervention on qual- ity of life (QOL). The multicentred study used a subject-design with pre-test, post-test, and six months follow-up test. 162 participants who suf- fered from stress were randomly assigned to the dance movement therapy treatment group (DMT) and the wait-listed control group (WG). The World Health Organization Quality of Life Questionnaire 100 and Munich Life Dimension List were used in both groups at all three measurement points. In the short term, DMT group are significantly improved in the Psychological domain; Social relations/life; Global 'value; Physical health and General life. In the king term, Dance Movement Therapy significantly enhanced the Psychological domain; Spirituality Mid General life. According to the results author conclude that Dance Movement Therapy is effective in the short- and long-term of quality oflife improving.

Also, Dance Movement Therapy is widely prac- ticed as a treatment of choice for depression and other mental illness (Mala et al. 2012). Positive changes of this kind of therapy are obtained at the psychological and physiological level. For example Jeong at al. (2005) assessed the profiles of psycho- logical health and changes in neurohormones of adolescents with mild depression after 12 weeks of dance movement therapy (DMT). Forty middle school seniors were randomly assigned into either a dance movement group (« = 20) or a control group (« = 20). All subscale scores of psychological dis- tress and global scores decreased significantly after the 12 weeks in the DMT group. Plasma serotonin concentration increased and dopamine concentra- tion decreased in the DMT group. These results suggest that DMT may stabilize the sympathetic nervous system. In conclusion, DMT may be effec- tive in beneficially modulating concentrations of serotonin and dopamine, and in improving psycho- logical distress in adolescents with mild depression (Jeong et al. 2005)

In the other study Koch et al. (2007) investi- gated the specific effects of a dance intervention on the decrease of depression and the increase of vitality and positive affect in 31 psychiatric patients with main or additional diagnosis of depression. Patients participated in one of three conditions: a dance group performing a traditional upbeat circle dance, a group that listenedjust to the music of the dance (music only), and a group that moved on a home trainer bike (ergometer). While all three con- ditions alleviated or stabilized the condition of the patients, results suggest that patients in the dance group profited most from the intervention. They showed significantly less depression and more vitality than participants in the music group and in the ergometer group, on post-test self-report scales immediately after the intervention. Stimulating circle dances with jumping movements can thus have a positive effect on patients with depression and may be recommended for use in dance/move- ment therapy and other complementary therapies.

One of the main aims, in the group therapy pro- cess is related to group cohesion especially in the work with the patients those are chaotic and disor- ganised. In that way, Effer and Ziv (2006) describ- ing their results obtained at short-term inpatient psychiatric unit, stressed that group dance move- ment therapy improved impulse control, frustra- tion tolerance, gratification delay, and ability to get along with others.

Improvement in the perceptions of physical and psychological well-being by using Dance Movement Therapy is also proved in the field of chronic fatigue syndrome (Blazquez et al. 2010), eating disorders (Meekums, 2012), oncology (Kaltsatou et al. 2011), geriatrics (Haboush et al. 2006), abusing (Mills and Daniluk, 2002), etc.

At the Department of Motoric Disturbances, Chronic Diseases and Art-therapies at the Faculty of Education and Rehabilitation Sciences University of Zagreb fas Dance Movement Therapy are issue of some scientific investigation, and also subject of some study courses such us "Creative Therapy" or "Creative Therapy Practicum IF. So, at the figure 5 and 6 the results of a study about Dance Movement Therapy influence on the ado- lescent with visually impairments are showed. The program included dance, movement and contact improvisation with some elements of relaxation, guided imagination, and music in 9 therapy session with 8 participants. In the purpose of psychosocial parameters evaluation the following variables are defined: self-experience, body-image, space, physi- cal contact with other person, social interaction. Positive tendency of changes on the controlled vari- ables and qualitative analysis of induced variables showed that program had positive influence on perception, emotion, kinaesthetic empathy, better using of space, body-awareness, thrust, creativity and interpersonal communication (Martinec, 2012).

Results of different scientific research showed that Dance Movement Therapy could have posi- tive influence on different changes in the field of physiological and psychosocial evaluation. Further investigations are needed for developing a more systematic body of scientific evidence that can improve capitalizing what is really known in prac- tice as effective (Mala et al., 2012). Furthermore, as both Karkou (2010) and Meekums (2010) have argued, there is also need of engaging in a dialogue with scientists and form research teams that can generate robust and effective research evidence.

4. CONCLUSION

Dance Movement Therapy is an interdisciplin- ary approach evolved through the synthesis of the art of movement and dance and the science of psy- chology. As such it continues to evolve based on the confluence of knowledge built upon the therapeutic and spiritual use of dance through the ages, cultural anthropology, psychological theories, neuromotor sciences, the psychology of the arts, and the cre- ative process (Chaiklin and Wengrower, 2009). By using body as medium of self-exploring and move- ment as metaphor, Dance Movement Therapy may have influence on different motoric, physiological, psychosocial and cognitive functions.

In Dance Movement Therapy could be consid- ered different variables that are not in the focus in other kinds of therapies, such us change in move- ment qualities; subtle nonverbal communication in terms of shaping, proxemics, rhythms; and kinaes- thetic or somatic cues related to emotional, physi- cal and symbolical experience (Hervey, 2009).

With the purpose of developing the new values, methods, skills and knowledge further investiga- tions are needed (Payne, 2006; Karkou, 2010). They should be oriented to the obtaining such diag- nostic and therapeutic models that have methods of practice established and stabilized, theory clearly articulated and recognized and research method- ologies clinically viable (Meekums, 2002; Hervey, 2009). In that way, and according to results of recent investigation of the therapeutic influence of Dance Movement Therapy, it could be considered that that kind of therapy becomes a common part of interdisciplinary approach in the various fields of rehabilitation and psychotherapeutic practice.

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