Dance Movement Therapy used with a group of homeless men suffering form Schizophrenia
Maria Sangiorgi 2005
This paper describe the movement characteristics and life challenges that may be faced by a group of homeless men suffering from Schizophrenia. It discusses the special contribution that dance therapy makes and the methods can be used and theoretical framework that support my ideas.
This work aims to explore the relationship between a number of theoretical frame works and their application to the sessions I was involved in with during my eight week placement. The frameworks applied were firstly Humanistic, as this framework gave the group essential care and a place to “be”, the use of creativity and the opportunity to experience their greater potential. The Phenomenological framework which places emphasis on cultivating awareness of who they are as a whole person by creating awareness of direct moment experiences, giving real feed back and encouragement. Object Relations helped them to come out of their isolation and gave them a sense of familiarity and safety enabling them to share experiences and open them selves to the Dance Movement Therapy (DMT) sessions.
I spent my placement in a hostel for homeless schizophrenic men called Prague House situated in the leafy green suburb of Kew, Melbourne with Dance Movement Therapist Elizabeth McKenzie. It provides personal care and assistance for men who are over fifty. It is run by an order of nuns, the Sisters of Charity. Their mission is to provide a secure and peaceful environment, holistic care and to enhance the dignity of each person. Some of the men also have alcoholic acquired brain disorders, dementia, depression and bipolar disorder.
Schizophrenia is a mental illness of the brain, which manifests as a disorganisation of brain function. The brain makes inappropriate connections and misinterpretations, which creates hallucinations. Those suffering from schizophrenia think other people are communicating with them. They hear voices and are divorced from reality. Because they are constantly preoccupied with their own mental and emotional worlds they suffer from chronic isolation, loss of motivation, lack of organization and depression. They lack insight and self-awareness, have a poor sense of body parts and sometimes lack self-confidence.
As a rule their behaviour is very introspective, they are not very physically active, communicative or social. I was often greeted by a row of men slumped in armchairs, who may or may not look up to see who had walked into their space. They generally would not greet me or engage in communication unless I initiated it. ‘The head bowed down’ was an indication of how chronic their condition was and that they were preoccupied with their own inner dialogue.
Because of their inability to socialise or communicate there were very few attendants at the DMT sessions. Out of the 35 men who live at Prague House we had an average of 2 who attended the sessions. I was able to work with the larger population on the rock’n’roll days, of which there were 2 during my visit. The Rock’n’Roll days are held in a public area, a large out door veranda contained by rows of armchairs. This is where the majority of communal activities take place and also where many of the men who are chronic smokers sit all day. The DMT session are held in the TV and recreation room that is a more private area. The sessions were held on Thursday afternoons.
During the first session of DMT I participated in, Elizabeth took me to the room and introduced me to a man named Quentin. He was sitting in an armchair against the far wall with his head bowed down. Elizabeth went to find the men who had said would come to the session. The numbers would have dwindled to two. The problem with the inconsistency was that it was difficult to create a group bond making the kind of spontaneity that allows for group movement that can flow from one week to the next almost impossible. There were two other factors that influenced the number of men at the sessions. One was that a Nun ran a bingo session at the same time and the other was illness. One of the regulars was hospitalised twice during my time there.
The two men Elizabeth returned with were Michael and Frank. All of the DMT sessions began seated and in a circle. Elizabeth would always invite Quentin who remained seated in the armchair to join us. He would always decline and resume his head bowed down pose. Elizabeth later told me that he used to leave the room during the sessions but now stayed for the duration.
In each session Elizabeth would ask the men to become aware of their breathing by introducing some kind of breath awareness exercises. She also constantly referred to the Sacrum, and the use of their abdomen. The feeling of their feet and legs on the floor. In one warm up and release she asked the men to bounce a ball to each other using a lot of strength and making a” ha” sound. The focus on the breath and the sacrum related to the work of Liljan Espanak. (Levy,1988)
“Breathing as the most natural rhythm in ones life . . . Breathing is closely interconnected with both physiological and emotional changes in the body . . . In normal locomotion the sacrum performs a small wheel-like movement which allows a smooth and relaxed change of weight form one feet to another. In case of disturbance this wheel-like-action will be hampered and the execution will be jerky or rigidly inactive “
This exemplified disturbed function of the Sacrum because they had very restricted movement qualities and coordination and they also had difficulty engaging in steady rhythmic deep breathing. By engaging with their breath and becoming more aware of their breath they had the opportunity to disengage with the preoccupation of what was going on in their minds. Their attention moved to the activity and they then became more present and aware of their physical bodies, which also created a greater self-awareness.
In another warm up and release the men were asked to imagine that they were moving sand with their feet by brushing the side of the foot one way and then the other alternating legs. This apparently simple exercise was very difficult for them and their interpretation was indicative of all their very restricted movement qualities. They moved very slowly often unable to move through the whole movement range of the lower leg and foot and became very fatigued in a very short time. In Laban terms they move with bound Flow, using a light Weight and little sense of centre. Their movements in Time are slow and sustained with no acceleration and their relationship to Space is indirect and multi focused.
In another session the men were each asked to initiate a movement from a different body part. The aim of all these activities was for them to focus on finding strength in their bodies, create body awareness to increase a sense of presence and feel gravity creating a relationship to the earth. This would allow them to have sense of themselves, making things more concrete and giving them the opportunity to move away from their preoccupation with their minds. It would bring them to the reality of the here and now.
The imagination was used but with concrete ideas. Elizabeth used suggestive and affirming language. Every time they did something she would validate their choice or discuss how the movement felt or what it did. This is supported by the humanistic theory. (Halprin, 2003)
“Exploring human potential meant identifying optimal conditions which foster creativity and growth, developing models for exploring what a fully functioning human being might be, and generating methods for investigating the whole-parts dynamic”
She always explained things clearly and concisely using simple ideas and metaphors. Elizabeth’s use of weight also corresponds to the vertical axis, which corresponds to the sense of “I”, representing the power of upright self which for men who spent so much time slumped, sleated and looking down was very important.
After talking to Elizabeth I brought some percussive recorded music to the sessions. For one of the themes we used the music to stomp to the drumbeat moving in a circle. This promoted a sense of strength in the men’s bodies. To continue this theme we then used sticks. One person would hold their stick horizontally and assume a strong supporting pose, while the other held the stick vertically and pushed against the first persons stick. Again Elizabeth asked the men to use their whole body and to feel the strength through their torso, feet and legs. This was a very focussed activity that required a lot of concentration and use of sustained strong weight. Next the men again assumed a strong supportive pose while another person pushed against the others sacrum, using their body weight. The men were encouraged to feel the strength that is needed to resist being pushed.
In another theme session Elizabeth asked the men to position themselves any where in the room. The men had the choice of floor, or chair, or table. Elizabeth then asked everyone what they could see from where they were positioned. Then they were asked to change positions.
Throughout the sessions I observed the men often pausing and reiterating the instructions before attempting any given activity, as if they had to compute the instructions before attempting the activity and that every instruction or event outside of their immediate personal world was so far away from their internal reality they had to really work to understand it. This characteristic exemplifies to me their great sense of aloneness, (2002, Jason Stuart Ratcliff)
Ratcliff’s study suggests that “They do not share a belief system with others, but are the sole inhabitants of their own belief system . . . they lose the ability to comprehend how others see them, comprehend their place in a social system, and in consequence build a personal belief system to replace this only increases their loneliness.”
The use of a Phenomenological therapeutic framework with the emphasis on direct experience, giving real feed back and encouragement – what and how does it feel? Bringing the body to the here and now. Creating interactions and experiences that enhance a physical, spiritual, social, evolutionary and moral growing which validates the sense self. An opportunity for time to develop a sense of relationship to others, and to engage in a communal activity, that physically expands their bodies and also their minds and eases the sense of aloneness. (Halprin 2003)
“Phenomenological approaches call for immersion in actual experience, defined not as “reality as such,” but as how the person actually experiences reality – what she thinks, feels, senses, and imagines in the moment. For the humanists, the shaping of the felt experience through full expressiveness to be shared with others became another important step in the therapeutic process.”
It was very important to communicate to each person individually so as to help him or her become a part of the community. Even Quentin in the armchair who did not directly participate other than being in the room was always asked if he enjoyed the sessions. (Halprin 2003)
“the therapist must create a relationship with the client based on warmth, unconditional positive regard, and caring”
One of my favourite centring and closures was sitting in a row in chairs and giving one another a shoulder massage. Elizabeth then placed 3 sticks on the floor and asked the men to jump over the sticks and run out of the room. This closure helped to establish awareness between the transition from here to there and was also a very direct, strong and purposeful way to end the whole session. It was also a very simple and playful ending and it was a way to bring play into the lives of men who are not very playful, small leaps out of the room. It was also a way to insight “felt sense”; if it was a felt experience it will become a pure experience that is embodied in their soul memory, a moment of pure being. This is be another example of the use of Phenomenology, the value of a lived experience
Michael and Frank attended The first session I facilitated. I began the warm up by getting the men to roll a soft therapy ball about 20 cm in diameter, with small protruding knobs around their bodies. They moved this up and down their arms and across their shoulders. I did this to promote upper body mobility and to develop feeling the sensation from the softness and knobbiness of the balls. Frank found this very challenging and strenuous. He found it very difficult to raise his arms even slightly over his head but never the less he did it. I then gave them small dense soft balls, the size of tennis balls and asked them to roll the ball under one foot at a time. Frank wouldn’t take his shoes off so he felt no new sensation. Michael said that his feet felt different. I did this to increase the mobility in the bottom of the men’s feet. I then asked them to come forward on their chairs, so that they could bend forward to roll the therapy balls to each other between their legs. I did this to mobilise their hips and spines. Frank did it for short while then began to kick the ball.
I then asked them to roll their shoulders. Michael was slouching back in his chair and I suggested he move forward or he would not be able to do the movement. Elizabeth later said it was good that I affirmed everything that the men did and that I got Michael to sit up out of his slouch. She suggested that when Frank began to kick the ball, perhaps I could have changed the activity, but that it was still ok because we did not loose the flow.
During both theme sessions I facilitated rhythm and percussion were involved. (Lumsden 2002)
According to Lumsden “Rhythm can influence body rhythms such as heart beat and breathing. Different rhythms also arouse different emotional reactions”
“Boas emphasized that by playing percussive instruments, the therapist could help to direct the flow of the emotional expression through the use of crescendos, accelerandos, ritardando, and diminuendos” (Levy 1988)
The first session, which was a continuation of the above, I introduced them to finger cymbals. They were delighted with this exercise, and both became quite animated especially Frank who was the most disengaged of the two. I gave them 2 cymbals each, one for each hand. I showed them how to hit the cymbals to get the best sound. Frank really responded to this and was very concerned when his did not sound right and he really tried to make a better sound. They both had a good sense of rhythm but very different styles. We then tried 2 fingers on each hand, which is the way they are traditionally played. This was very challenging for both the men, particularly Frank as he had the shakes. Nevertheless focusing on the cymbals helped Frank to stabilise his hands. I suggested he go back to 2 cymbals, which he could manage better. We took it in turns to lead a rhythm. Frank became more and more animated asking me where I got them. Quentin also enjoyed the cymbals and he kept looking up and smiling.
The next session I facilitated was with John G and John O. This was a very short session. John G’s response to each of the warm up activities was to recall something from his memory. He gets lost in the associations and in-between he would slump back. The activity that stood out was when I gave each one a set of ankle bells to put on their arm. We all tapped out a rhythm or took it in turns to instigate a pattern. The rhythmic pattern and sound of the bells made John G remember a Nursery rhyme “Sing a song of sixpence”. We then all began to piece together the words of the song and sang it together a number of times. John G then slumped back into his chair and became introverted, gave his apologises, said that he had to go and left. Elizabeth said he probably became self-conscious; John G normally doesn’t join groups so it was a great thing that he came. .
John O, who also has dementia and is very slow and forgetful. He was only at my session because I walked him to the room. John O’s experience in that session was very moving for both Elizabeth and myself. He talked about and lamented the loss of his amputated finger and told us that it was “a stupid accident” that happened when he worked on an assembly line. Because of the focus of his hand with the bells and singing the nursery rhyme he was able to recall his hand and to bring the experience to the here and now. The Humanistic framework again supports this experience, what Carl Rogers call the “empathetic listener” (Halpin 2003)
“the therapist must create a relationship with the client based on warmth, unconditional
positive regard, and caring.”
Through all the kinds of listening that took place. Listening rhythmically, so as to be able to copy and to take turns all playing. Listening to the nursery rhyme, listening to Johns story about his lost finger, we were able to bring about this very special moment that gave John a voice to be heard. (Fran J Levy 1988)
“Even severely withdrawn patients could be mobilised by the contagious aspect of rhythm, with safe and simple rhythmic sequences providing a medium for the externalisation of otherwise chaotic and confusing emotions”
What also struck a chord with me particularly to do with this session was a something Maslow said, (Maslow 1993)
“Self improvement is partly a consequence of criticising the experience that one has allowed to come into consciousness. Schizophrenic people experience many insights and yet don’t make therapeutic use of them because they are to much “totally experiencing and not enough “self observation and criticising”
Here the therapist is the catalyst that brings the internal world and insight into the reality of now this is where that humanistic statement links to the object relations theory.
“schizophrenia is distinctively characterized by a withdrawal from object relatedness . . . The person who as a result of unfortunate learning experiences fails to develop such techniques, experiences an inordinate amount of anxiety in his interactions with people and is likely to protect himself by withdrawing from the human environment . . . there is little question that withdrawal and disturbed object relationships are salient features of schizophrenia”.
John sharing his story with us was a poignant moment because he felt safe enough to tell us this moving and meaningful personal story from his past.
Maslow’s Hierarchy of Needs is also one of the most essential theoretical frame works that supports this group. If this group were still homeless they would be completely out of reach and inaccessible to the dance therapist. They are provided with the most basic physiological needs, food, shelter, clean clothes and body cleanliness and they a given a placed to “be”. They then have the opportunity to participate in real and rewarding life activities such as DMT.
The other important sessions that Elizabeth organized were the Rock’n’Roll days. These sessions allowed the men who chose to physically participate to partner dance with us and other members of the staff. This was important because it was a way for the men to experience physical contact in a safe controlled environment that is something that is lacking in their lives. This again relate to Maslow hierarchy of needs. It was also an opportunity for us to relate to them one on one and to be involved with the larger population. I developed relationships with a couple of the men who were the chronic smoker that I had mentioned earlier in this piece. I spoke to them on each visit, during the Rock’n’roll sessions I would always invite them to dance and they always declined. This became a jovial banter. Again Object Relations comes into play here. As they got to know me, see me, talk to me, they began responding with more familiarity and trust. Another one of the therapeutic framework that emerged in these sessions was Mirroring. During the partner dancing I was able to mirror their movements and alter the quality of the movement to be less erratic and more rhythmic and in time with the music being. Often the dances also involved a lot of swaying, which was soothing and calms the central nervous system. The effect that these sessions had on the men and the staff was that it made everyone happy. The intentions and the skills of the Dance Therapist also created a container that embraced everyone there, even if they weren’t dancing they were still participating and being included. (Bernstein, P. & Singer, D. 1982)
“When initiating a therapeutic contact, it is necessary to traverse the defeat-strewn pathways of the individual’s psyche with a sense of faith in the human spirit and the personas ability to exist in that moment . . . attuning to the being who is to be engaged in a therapeutic dialogue. This provides the “holding container necessary to sprout the seed of trust”.
I conclude that the most essential therapeutic framework is the Humanistic framework, beinging with Maslows Hierarchy Of Needs; without shelter food clothing and basic care there would be no platform to even begin to work with these men. With these basic needs taken care of we then have the opportunity to enter their mentally and emotionally preoccupied worlds and meet them where they are at. This gives them the opportunity to expand there body moments and in turn their minds in a safe and creative space we. This if followed by Object Relations; by offering them constant supportive and safe relationship we become familiar and trustworthy. This opens the door to a trusting environment that we can then enter together. The Phenomological framework is also important. This is evident In the DMT session where we are constantly wanting them to tell us how what they were experiencing felt in that moment, to help bring them to the hear and now.
My time at Prague house was very rich, rewarding, and challenging. The inconstancies of this group were a very important lesson for me. I came to learn and to acknowledge that, even though the therapist may not be dancing she is always holding the therapeutic space. This skill produces a container that holds all of those that the therapist comes in contact with. This space can be developed on a deep and subtle level and have a constant and healing affect on the population, without being obvious to the untrained person, except through the end result. Through the experience of DMT the world of those suffering from Schizophrenia can be made more concrete and immediate which then affects all other interactions in their daily lives.
Fran J. Levy 1988, Dance/Movement Therapy A Healing Art, Liljan Espenak ,P 57
Daria Halprin 2003, The Expressive Body in Life, Art & Therapy, Chapter 4, P 49
Jason Stuart Ratcliff 2002 The Egocentric world of the Schizophrenic, The Angelhaunt Library Schizophrenia and Human Nature
website www.anglehaut.net/schizophreina/sandhust. 25/11/05
Daria Halprin 2003, The Expressive Body in Life, Art & Therapy, Chapter 4, P 45,
Daria Halprin 2003, The Expressive Body in Life, Art & Therapy, Chapter 4, P 49
Malvern Lumsden, Ph.D Moving Together in Transitinal Space: Dance Therapy Rehabilitation, Oslo, July 2002, PDF file Web 17/4/06
Fran J Levy 1988, Dance/Movement Therapy a Healing Art. Marion Chase, Page 29
Daria Halprin 2003, The Expressive Body in Life, Art & Therapy, Chapter 4, P 49
Fran J Levy 1988, Dance/Movement Therapy a Healing Art. Marion Chase, pioneering Lituery Contributions to Dance Therapy, Franziska Boaz, Page 114
Bretha G. Maslow 1993, Abraham Maslow’s The Farther Reaches of Human Nature Author, p 21 The Creative attitude
Irving B. Weiner 1997 Psychodiagnosis in Schizophrenia. Page 149
Bernstein, P. & Singer, D. (1982). The choreography of object relations. Thoughtful theoretical overviews and examples of clinical applications.