Chapter Three

A Psychosocial Approach
to Dance-Movement Therapy
Susan L. Sandel
Maryellen Kelleher

In our mechanized society, with its emphasis on leisure time, peo-

ple become less and less active with advancing age. This is often en-
couraged by well-meaning friends and relatives, who urge the elder-
ly to take it easy and not to strain themselves when participating in
sports or performing household chores. For those confined to a con-
valescent home these problems are intensified. There, the older per-
son's role is typically that of a passive recipient of nursing care.
Often the staff is too busy providing basic medical care to focus on
the residents' other physical and psychosocial needs. An atmosphere
in which motionlessness prevails is not unusual in many nursing
homes. The severely restricted capabilities of the patients them-
selves and the confining nature of the institution tend to reinforce
this inactivity.

INACTIVITY AND AGING

Many disabilities commonly associated with old age are accepted

as an inevitable consequence of growing old. Recently, researchers
and clinicians have begun to challenge this longstanding belief.
They are learning that many of the health problems of older people
are not the inevitable consequence of old age but the result of a sed-
entary life style (Bortz, 1981; deVries, 1974; Kraus, 1956).
For example, one of the most common conditions of old age, ar-
teriosclerosis, is characterizcd by accumulation of fatty deposits in

Originally published ns "'DanceiMovcment Thempy" (Chnptcr 8). in Pl~piculFinless

und the Older Person (1984). edited by Lonard Biegel. Copyright 1984. Rcprintcd by per-
mission o f Aspen Publishers. Inc.
25
26 WAITING AT THE GATE

the arteries of the heart, brain, extremities, and kidneys. Arterio-

sclerosis contributes to heart disease, stroke, walking disabilities,
and poor organ function and accounts for approximately half of all
deaths in the United States. Commonly thought to be an inevitable
consequence of old age, arteriosclerosis is actually the result of de-
creased activity (Keelor, 1976). As one ages and becomes less ac-
tive, muscle mass is replaced by fat tissue. Conversely, increasing
the amount of muscle mass can help to counteract fatty tissue
replacement; muscle mass can be increased, regardless of age,
through physical activity.
Inactivity also contributes to a host of other symptoms associated
with old age. Inactivity facilitates accumulation of free-floating ten-
sion, manifested in such symptoms as insomnia, irritableness, and
restlessness (Gulton, 1975). This is especially so for those confined
to bed or wheelchair, who get very little exercise. Restlessness and
insomnia are often treated with drug therapy or physical restraint
rather than with activities designed to reduce tension. .
Depression is another condition prevalent among the institutional-
ized elderly. Loss of societal role, material deprivation, physical de-
cline, or loss of a spouse can trigger depression. One of the prime
signs of depression is inactivity. A vicious cycle can easily develop
in which depression and inactivity reinforce each other, and it can
become increasingly difficult for the individual to interrupt this de-
bilitating pattern.
Physical activity stimulates functioning of the respiratory, circu-
latory, and skeletal systems. Exercise also promotes and maintains
muscle tone, balance and coordination, and spatial orientation. The
old adage, "use it or lose it," applies not only to physical vigor, but
to memory, orientation, social skills, and the ability to give and
receive affection.

TREATMENT MODALITIES

Movement is a part of many different treatment modalities for the

aged. Physical therapy (including exercise programs) as well as cre-
ative movement and dancelmovement therapy all utilize physical ac-
tivity. Fitness programs offer exercises of varying levels of difficulty.
depending upon the stamina and overall health of the participants.
Goals of such programs might include increased mobility, improved
circulation and breathing, and relaxation and release of tension;
 Healing Elements of Movement and D r a m lherapy 27

emotional well-being is a byproduct of better physical functioning.

Although exercise programs are usually performed in a group, the
emphasis is on the individual's experience and improvement.

Dance Movement Therapy

Creative movement, as a therapy for the aged, has been widely

used in nursing homes and senior centers recently. Goals of creative
movement programs include the same ones that characterize fitness
programs (with the additional aims of increasing self-esteem and
social interaction) (Herman & Renzurri, 1978). Classes include a
variety of movement activities, often accompanied by music,
designed to encourage creativity, spontaneity, and bodily awareness
within a social setting.
Dancelmovement therapy integrates physiological, psychologi-
cal, and sociological aspects and attemps to give meaning to move-
ment through the development of images within the movement inter-
action. While encouraging emotional reactions and processing of
affective responses (both positive and negative), dancelmove-
ment therapy also facilitates social interaction. Movement activities
are not the goal of the group experience, but rather the tool for cre-
ating a therapeutic environment. This approach distinguishes dance/
movement therapy from other physical movement therapies and of-
fers a comprehensive treatment method for the elderly.

DancelMovement Distinctions

The American Dance Therapy Association defines dance/move-

ment therapy as " the psychotherapeutic use of movement as a pro-
cess which furthers the emotional and physical integration of the in-
dividual." It is distinguished from other uses of dance (i.e., purely
social) by its focus on the nonverbal communicative aspects of
behavior and the use of movement as the mode of intervention in the
therapeutic relationship. Dance/movement therapy includes a varic-
ty of approaches in which the therapist and client use movement as a
medium for communication (Chaiklin & Schmais, 1975). Ap-
proaches usually do not rely on structured exercises but rather on
the spontaneous unfolding of interaction among participants.
Presently, the terms "dance" and "movement" therapy are used
interchangeably. Although the American Dance ~ h e r a p yAssocia-
tion recognizes a Registered Dance Therapist as the qualified practi-
28 WAITING AT THE GATE

tioner, "movement" is used by therapists who wish to convey a

broader meaning to their work. Particularly in geriatric settings, the
term movement therapy is more widely used because "dance" is
easily misunderstood by people who feel that their physical capabili-
ties are limited. Even the term movement therapy may require ex-
planation, because it can be confused with physical or occupational
therapy.

ist thy of Dance/Movement Therapy

Dancelmovement therapy was introduced into geriatric patient
programs as early as 1942, when Marian Chace, a pioneer of group
dance therapy for hospitalized psychiatric patients, began working
with elderly patients at St. Elizabeth's Hospital in Washington,
D.C. Since then, several therapists have been refining and adapting
dance/movement therapy techniques for use with convalescent
home patients (Fersh, 1980; Garnet, 1972; Samuels, 1973). The
model program created by senior author Susan L. Sandel at the
Sound View Specialized Care Center, West Haven, Connecticut,
utilizes a group-oriented, interactional approach focusing on the
psychosocial benefits to the participants. Action is a vehicle for in-
teraction; physical movement is used to foster social interaction and
expression of feelings. Patients also derive physiological benefits
from the activity, including improvement in cognitive functioning,
which, in turn, affects the ability to interact with others.
Dancelmovement therapy seems to have the potential for reaching
a wide range of people. Whereas other movement approaches may
require task completion, exercise mastery, fine motor coordination,
or mental alertness, dance/movement therapy in its most basic form
requires participation on a sensory-motor level, thereby tapping into
the natural response to rhythm and touch. Patients who might other-
wise be excluded from activities can function in a dancelmovement
therapy group.

Dance/Movement Therapy Techniques

A typical session begins with the patients sitting in a circle (in

many convalescent homes, the majority of patients are in wheel-
chairs). Basic warm-up exercises, which the patients then~selves
may direct, help to stimulate muscles and nerves. Music initially
provides a rhythmic framework, although it need not be used for the
 Healing Elements of Movement arzd D r a m 7herapy 29

entire session. The warm-up movements suggest images that may be

related to past life experiences or current concerns. The images pro-
vide a focus for meaningful interaction among group members and
often stimulate discussion. Sessions always end with a sound and
movement ritual that has been created by the group.
Specific techniques that have proved most useful in the authors'
model dancelmovement therapy program include:
Circle Formation. The circle formation is the primary spatial
structure for unison action. It contributes to the feeling of group uni-
ty and increases the opportunity for eye contact. Because the
therapist and patients are visible to everyone, those with hearing dif-
ficulties may participate in group movements by following others.
Patients with visual impairments may be seated next to the therapist
or other patients, who can describe the activity to them. Although
ambulatory participants may move into other spatial formations
such as lines, spirals, or a scatter around the room, the circle is still
desirable for beginning and ending groups. The circle is particularly
desirable for physically disabled and disoriented patients, for it
facilitates touch and communication.
Mutual Touch. Mutual touch (such as patting, holding hands, and
massage) is an extremely important element of dancelmovement
therapy sessions. This type of touching differs from the passive
touch that convalescent home patients experience when they are
bathed, fed, and dressed. Instead of being the passive recipient of
physical contact, patients are encouraged to reach out to others to
hold hands or pat someone's shoulder. In order to promote an at-
mosphere of mutuality, the therapist does not manipulate patients'
limbs when they are having difficulty performing the movements.
The attitude that patients "participate at their own level" is consis-
tent with a nonmanipulative approach.
Music. Music often provides a useful stimulus for beginning a
session, because it taps into the natural inclination to respond to
rhythm. Music with a clear rhythmic beat is the most useful kind for
dancelrnovement therapy sessions. This can include older music
(from the patients' past) or more current music. Music should be
playing as the group warms up; however, when recorded or in-
strumental music interferes with patients making their own sounds,
singing songs, or engaging in discussion, the music should be
discontinued. The therapist, if seated near the phonograph or tape
recorder controls, can fade the music in and out as desired.
Vocalization. Whenever possible, patients should make sounds
30 WAITING AT WE GAZE

while moving. Sounding, even a "hum" or an "ah," stimulates

breathing, circulation, and central body involvement. This tech-
nique is particularly useful for stroke or severely disabled patients
whose speech is impaired; they may participate in making group
sounds even if they cannot form words or participate in a variety of
actions. Any sound that a patient offers is accepted and incorporated
into the group experience. As people become more comfortable
with vocalization, the therapist might encourage sounds that are ex-
pressive of particular feelings by asking, "What kind of sounds do
we make when we're happy? sad? angry?" This, in combination
with movements, can increase the range of expressive and com-
municative behavior.
Props. Certain objects are particularly useful for stimulating ac-
tivity and encouraging interaction among convalescent home pa-
tients. Some favorite props are foam "Nerf" balls, colored scarves,
and various legnths of stretch material (Lindner et al., 1979). These
objects may be used initially to motivate movements such as squeez-
ing, punching, tugging, and throwing, which may develop into par-
ticipatory games. Props may be used to provide increased sensory
stimulation and to link group members together to increase interper-
sonal awareness.
In groups with disoriented or confused patients, props may be the
external focus or support that keeps the group together. In sessions
with more alert patients, props may serve as the initial stimuli for in-
teraction but may not be necessary later on (as group members begin
to interact freely with one another).
Empathic Movement. One of the major distinguishing characteris-
tics of dance/movement therapy from other body disciplines is the
therapist's reliance on empathic movement as the basis for group in-
teraction. Developed by pioneer dance therapist Marian Chace, em-
pathic movement is a technique in which the therapist guides and de-
velops group interaction as it unfolds during the session. Most
dancelmovement therapists who use this technique do not come to a
session with a preconceived plan of activities but rely on verbal and
nonverbal cues from the participants, coupled with their own intui-
tive responses, for the contents of the session. Suggestions, rather
than commands, characterize this approach, so that the therapist is
cast in the role of catalyst, not teacher.
When using the empathic movement approach, the therapist first
creates an atmosphere that encourages self-expression through
 Healing Elements of Movement and Drama Therapy 31

movement. The dancelmovement therapist then responds to the feel-

ings and thoughts being expressed, rather than imposing specific
muscle movements to condition postural changes or evoke certain
emotions (Chace, 1975). This technique challenges the therapist's
skill in dealing with spontaneous movement expressions and group
process.
Imagery. The development of group images is another technique
of dancelmovement therapy distinguishing it from other physical
movement therapies. The use of imagery shifts the experience from
that of a simple action to a symbolic, shared act. A basic guideline
for this technique is to begin with the movement and allow the image
to develop from the action. For example, if the group movement in-
volves stamping feet, the therapist might ask, "What can we stamp
on?" or "Have you ever stamped on something?" This approach
encourages participants to express ideas and associations without
binding the group to the therapist's own imagination.
Imagery can be useful in identifying feelings, relating movements
to real situations, and facilitating reminiscing; thus, the developing
of images gives meaning to the movements. Many patients in con-
valescent homes arc not motivated to exercise for the physical
benefits they might derive. The use of group images switches the
focus from the action to the feelings, thoughts, and memories being
expressed; this provides the motivation for movement.
Reminiscing. Dancelmovement therapy sessions with the elderly
provide an opportunity for reminiscing in a social context. Remi-
niscing by the aged can be an adaptive behavior and should be en-
couraged in the appropriate circumstances (Butler, 1963; Fallot,
1976; McMahon & Rhudick, 1967). In group dancelmovement
therapy, reminiscing may aid in developing interaction among the
participants. For example, rhythmic actions done in unison can un-
cover forgotten memories and feelings. These memories may be
pleasant or painful or of past mastery experiences.
The same guideline that applies to introducing imagery applies
here: always begin with the movement and allow the image (andlor
reminiscence) to develop from the action. ~ r o ~ r e s s i ofrom
n the sen-
sory experience (movement) to a symbolic one (image or associa-
tion) permits spontaneous unfolding of material during the session.
The therapist need not introduce a topic for the group arbitrarily, but
can pick on the issue or concern suggested by the actual movements
and images.
32 WAITING AT THE GATE

Benejts to Different Patients

The various goals of dance/movement therapy are appropriate for

-
the needs of most convalescent home uatients. Increasing activitv.
bridging isolation, and encouraging emotional expression and
..
socialization can be helpful to all institutionalized people. Different
types of patients within the convalescent home, however, have
specific needs, which require variations in therapists' techniques.
Cognitively Impaired. People who suffer from recent memory
loss, disorientation, confusion, and other signs of organic brain syn-
drome can benefit from a consistent and predictable group ex-
perience. Consistency in time, place, leadership, and activities helps
patients remember or relate to aspects of the group. For example,
one very confused woman does not remember the dance/movement
therapy session outside of the room where it takes place. Once she
enters the room, she knows what to expect and often begins doing
warm-up exercises.
Reality orientation techniques may easily be incorporated into the
dancelmovement therapy session and can be included in the opening
and closing rituals. A favorite activity in one of our groups is pass-
ing a foam ball and asking participants to say their name when they
have the ball. This kind of structured interaction is reassuring when
it happens at the beginning of each group; the activity itself becomes
an orienting factor for the participants.
When participating in movements that recall past mastery ex-
periences, confused patients often appear more alert and organized.
Reminiscing often seems to stimulate immediate, if short-lived,
cognitive reorganization.

One day as I was walking down the hallway gathering people

for a group, I heard Ms. B's perseverative wails several doors
from her room. The nurse's aide who was attempting to quiet
her was relieved when I wheeled Ms. B. to the small room
where the group meets. Gradually Ms. B. stopped her wailing,
slumped down in her chair, and lapsed into an apparent stupor.
"Well," I thought, "at least she's not screaming. Perhaps she
feels comfortable here." As group members began their
warm-up exerciscs, which led to reminiscing and conversa-
tion, Ms. B. remained unresponsive. Then Mr J. initiated
some vigorous swinging arm movements and bell-like sounds.
Soon everyone (except Ms. B.) was swinging their arms
 Healing Elements of Movement and Dram Therapy 33

rhythmically, chanting "bong, bong, bong." Suddenly Ms. B.

lifted her head, opened her eyes. and said "Big Ben." For
several minutes she.talked lucidly about her travels to London
and responded to questions from others. Then her eyes closed
and she again lapsed into her sleep-like state for the remainder
of the group session.

This kind of experience can change the group's perception of in-

dividuals, making it possible to tolerate periodic lapses in their par-
ticipation or attention.
Physical actions that evoke images of concrete activities such as
rowing a boat, washing clothes, or kneading dough usually reawak-
en memories of past experiences. These provide an excellent vehicle
for discussion and sharing even among very confused people.
Direct physical contact also has a dramatic organizing effect on
patients who drift in and out of reality. Sometimes people who
usually appear disoriented can carry on a lucid conversation when
they are holding hands with another person. Movement experiences
involving physical contact (holding hands and swaying from side to
side or patting other people's hands or faces, for example) are ex-
tremely effective in engaging confused patients.
Physically Disabled. Many nursing home patients have severely
disabling conditions such as strokes, arthritis, or other degenerative
illnesses. Physical limitations need not prevent patients from par-
ticipating in movement therapy. An accepting, nonjudgmental at-
mosphere in which people feel free to function within the limits of
their own capabilities is most useful for patients with severe physical
handicaps. When the focus is on the psychosocial values of the
group, rather than on the activity, even the most physically disabled
persons can feel that they have something to offer. In such an en-
vironment, activities such as making sounds, singing, telling stories,
or simply touching one another are especially important. In one
group at the Sound View Specialized Care Center, a woman who is
paralyzed on one side said, "We get together to be together. Then
we do as much as we can do. It's okay."
A critical factor in creating an accepting atmosphere is the lan-
guage that the therapist uses in guiding the group. For example, if
the therapist were to say, "Everyone lift your right arm; now your
left arm; now both arms," there might be several people who could
not successfully do at least one of those activities. A person who
feels obliged to do everything, in order to participate in the group.
34 WAITNG AT 7HE GATE

will probably drop out or otherwise resist. If directions are offered

as suggestions, in a nonauthoritarian style, it is less likely that peo-
ple will feel excluded. For example. the therapist might say, "Can
we lift one arm? How about the other arm? If you can only lift one
arm, that's okay. Can anyone lift both arms? If not, lift one arm as
high as you can. If you can't lift your arms, how about your
fingers?" This approach makes it possible for participants to say,
"No, I can't do this, but I can do. . . " As group norms develop, the
patients themselves might come up with suggestions for including
someone with a specific physical limitation.
Implicit in dance/movement therapy is the expectation that par-
ticipants will attempt to move-an expectation that stimulates pa-
tients' feelings about their bodies and their physical limitations. The
authors have observed that sometimes patients feel stupid or humili-
ated when they cannot do a movement "well." By creating a safe
environment and not avoiding patients' difficulties, the therapist
learns to tolerate patients' feelings about their disabilities, thus
establishing a model for the group; people subsequently begin to talk
about Lheir limitations and be more supportive toward one another.
Emorionally Disturbed. More and more nursing homes are
receiving patients diagnosed as psychologically disturbed. This is
due partially to deinstitutionalization trends, which are emptying
large state mental hospitals, and partially to physicians and families
who are becoming increasingly aware of emotional disturbances in
older people. Significant differences exist between the elderly per-
son who is clinically depressed because of the sudden onset of a
traumatic illness or the loss of a spouse and the older person with a
long history of psychiatric disturbance. In the former case, the
dance/movement therapy group can provide an opportunity for the
patient to mobilize feelings of anger and frustration, express them
through acceptable group activities, and gain support and validation
through the sharing of these feelings. In the latter case, a person
with chronic psychological problems can benefit from a dance1
movement therapy program that offers a consistent, orienting en-
vironment within a social atmosphere.
Patients with longstanding emotional disturbances are often re-
ceiving antipsychotic or antidepressant medications. Proper medica-
tion management-combined with a structured interpersonal envi-
ronment--often helps such patients maintain adaptive functioning
and prevents further social withdrawal and regression. Dancelmove-
ment therapy has traditionally proven to be effective treatment for
 Healing Elements of Movement and Drama 7herapy 35

long-term psychiatric patients because of the opportunities it affords

for unison rhythmic movement, channeled expressions of emotions,
and socialization (Chaiklin & Schmais, 1979; Samuels, 1973).
Mentally Alerr. Many residents of nursing homes are mentally
alert but require nursing care for physical illnesses or injuries. Some
do not require total care but live in an intermediate care facility or a
skilled nursing facility because they are unable to find other suitable
living arrangements. Often the traditional passive entertainment and
recreational activities do not adequately stiinulate the mentally alert
person struggling to maintain functioning. Dancelmovement thera-
py sessions that activate the body and mind through creative and
expressive involvement can provide the necessary stimulation. Ap-
proaches that encourage patient autonomy and leadership are espe-
cially appropriate for such people (e.g., helping one another get to
the group, taking turns leading exercises, choosing a name for the
group, and involvement in group decision-making).
After patients learn a repertoire of movements, they can exert
more leadership in the group's activities. The therapist, by assuming
a non-directive but warm stance, becomes a resource person for the
group rather than the sole authority. The therapist may suggest new
movements or creative activities but should be responsive to
patient's offerings, both verbal and nonverbal. In dancelmovement
therapy sessions with very alert people, movement images often
stimulate lengthy discussions about the past and/or present. There
may be just as much talking as there is moving in such groups; this is
to be expected (and even encouraged).

Contraindications

Although most people confined to a convalescent home could de-

rive mental and physical benefits from dancelmovement therapy,
not all are willing or able to participate in a group experience. Some
patients who are not clinically depressed and who have many visi-
tors and adequate family support build a life for themselves in the in-
stitution within their own rooms. They are reluctant to attend most
recreational or therapeutic activities yet do not appear withdrawn or
isolated. Staff generally hesitate to interfere with their routine
because they appear content and do not present a management prob-
lem. Such patients could benefit from an individualized exercise
program to prevent muscle atrophy and maintain mobility.
Another class of patients who may not be able to benefit from
36 WAITING AT THE GATE

group dancelmovement therapy are those with paranoia. Such pa-

tients usually exhibit suspicious and guarded behavior and require
very structured environments. They may be upset by imagery or ex-
pressions of emotion and may become more paranoid in a group.
Sometimes very elderly people use guarded behavior as a defense a-
gainst fears about their declining mental andlor physical health; at-
tempts to disrupt their routine or involve them in new activities may
be disorienting. Such patients might be able to benefit from individ-
ually administered exercise programs if the reasons for treatment
were clearly communicated.

Motivarion

Programs that focus exclusively on physical exercise tend to fail

when presented to convalescent home patients if the exercise has no
meaning for the patients and thus offers little to motivate them to ac-
tivity. Many people in this situation have no motivation to improve
their range of motion, stamina, breathing, or flexibility. Comments
such as "We're too old to do this" or "I've exercised enough in my
lifetime" are common. A rationale for activity based solely on its
physiological benefits is quickly rejected by those who no longer
believe that their physical health will improve.
A strong group identity-with an emphasis on addressing inter-
personal needs-is a motivating factor for attending dancelmove-
ment therapy sessions. The notion that "we are a group" is a
powerful force in helping people get to the sessions even when they
are not feeling particularly well. Once patients enter the room, see
each other, perhaps hear music, it is difficult to resist involvement.
Motivation is an issue not only for patients but also for the ther-
apist who works in long-term care facilities. It is one thing to work
at a senior center or adult education program with 50-or 60-year-
olds who might prolong their independence through movement and
creative expression therapy. It is quite another experience to sit in a
room with 75- to 100-year-olds who can't see, hear, or speak intelli-
gibly. In order not to be overwhelmed by feelings of pessimism and
despair, it is essential in such a situation for the therapist to abandon
traditional notions of cure. With rare exceptions, people are not go-
ing to get better. Often the therapist's role is not to promote cure by
usual standards but to facilitate a supportive, humanizing environ-
ment in which people can express and share their fears, pleasures,
and memories. Dancelmovement therapy cannot cure paralysis or
 Healing Elements of Movement and Drama 7heropy 37

blindness, but it can provide a bridge for the isolation that people ex-
perience as a result of such limitations.

Establishing a Program

Until recently, there has been little demand for dancelmovement

therapy programs in convalescent homes. In both private and non-
profit facilities, priority has been given to providing basic medical
services. The combination of (1) public consciousness-raising re-
garding institutional care of the elderly, (2) recent legislation con-
cerning quality of treatment in long-term care facilities, and (3) in-
creasing interest in the relationship between activity and health has
evoked great interest in movement therapy for the elderly.
Administrative Support. Adequate administrative support is es-
sential for the success of any new program. Administrative support
can be clearly demonstrated by the hiring of qualified personnel at
appropriate salaries, the acquisition of adequate supplies, and the al-
location of suitable space. This will concretely demonstrate to staff,
patients, and families, perhaps more effectively than any rhetoric,
the administration's support of the dancelmovement therapy pro-
gram.
The administrator should differentiate the dancelmovement ther-
apy program from other recreational and leisure activities. Although
these other activities are very important in the lives of many institu-
tionalized patients, attendance is voluntary and may be sporadic.
Dancelmovement therapy sessions can be viewed as part of the pa-
tient's treatment and should be presented accordingly. The staff's
attitude toward the sessions influences the patients' own attitudes; if
the staff considers the sessions valuable, patients are more likely to
attend.
Nursing Involvement. Nursing staff cooperation is absolutely es-
sential to the survival of any program in a convalescent facility.
Nursing personnel are responsible for the minute-to-minute care and
management of all patients. They, to a great extent, control whether
or not someone is dressed and ready to participate in therapeutic
programs. Therefore, the therapist should encourage nursing staff
involvement in the dancelmovement therapy sessions. Ideally, all
participating staff should attend sessions regularly; however,
changes in the nursing staffs' schedules are common and often make
regular attendance difficult. Whenever possible, a nurse or nurse's
aide should attend sessions and be encouraged to pass on any obser-
38 WAITING AT THE GATE

vations to other nursing staff. If nursing personnel can participate

regularly, they should be invited to do so.
The dancelmovement therapist must spend time with the nursing
staff, in in-service programs and informal exchanges of patient data.
If occasionally a patient is not ready for a session, the therapist
should find out why but be sympathetic to nursing personnel's
stresses. Posting a list of the dancelmovement therapy groups at
each nurse's station, including the day, time, place, and participants
facilitates cooperation.
Personnel. Dancelmovement therapy sessions should be conduct-
ed by a qualified therapist. Ideally, an assistant should participate
regularly in each group, especially in groups with confused or phys-
ically disabled people. In addition to providing logistical support
(transporting patients, setting up the room, etc.), a co-leader or as-
sistant can facilitate contact with patients who have difficulty panici-
pating. Any motivated staff members or students can assist in these
groups if they (1) are able to attend regularly; (2) are receptive to
supervision and guidance from the dance therapist; and (3) feel
comfortable moving and enjoy spontaneous interaction with pa-
tients.
At the Sound View Specialized Care Center, for example, the
therapeutic recreation director, physical therapists, social workers,
and college students have, at various times, assisted in the dance1
movement therapy groups. In-service training and staff meetings
after each session clarify the assistants' role and provide an oppor-
tunity for teaching new skills.
Size of Groups. The potential for therapeutic benefit is maximized
in groups of 8 to 12 people. Certainly, creative movement activities
can be beneficial to patients in large group settings; small groups,
however, are more conducive to reminiscing, self-disclosure, and
sharing. A comprehensive group program in a convalescent home
should offer both small and large group experiences as they provide
very different social environments.
Referral Criteria. Referral criteria based on cognitive functioning
seem to be more important that those based on physical capabilities.
For example, it is possible to have ambulatory and nonambulatory
patients in the same dancelmovement therapy group, but very alert
people are often intolerant of confused people. In a group of less
mentally alert patients, it is helpful to have people at varying levels
of confusion and responsiveness. If a group comprises only ex-
tremely withdrawn, non-verbal, or nonresponsive members, the
 Healing Elements of Movement and Drama Therapy 39

therapist will work hard, see no results, and eventually feel quite
frustrated. If, however, a few people-who, despite moderate con-
fusion--can respond to music or touch, their energy will help others
become involved. In a sense, patients act as catalysts or co-thera-
pists by creating multiple lines of communication with other pa-
tients.
Space. A private, uncluttered room that can accomodate 12 to 15
chairs and1 or wheelchairs is preferable for dancelmovement ther-
apy sessions. Recreational movement activities are often held in
open lounges, but small groups are best conducted in a more pro-
tected space. This creates a safe atmosphere in which people feel
free to express themselves.

CONCLUSION

An interactional approach to dancelmovement therapy with the

elderly can facilitate emotional expression, spontaneity, and peer in-
teraction as well as increased bodily awareness and range of move-
ment. Socialization is a primary goal of group approaches with con-
valescent home patients, along with the expression of feelings and
the development of independent behavior. The isolation so prevalent
in institutional settings can be alleviated by participation in group
rhythmic movement activities, which lead to the sharing of feelings
and memories.
Therapy facilitates recall of feelings and memories through in-
volvement at the body level. When practiced within a setting in
which group interaction and cohesion are fostered, it can provide an
arena for very elderly people to express themselves and engage in
social relationships. In addition to the obvious physical advantages
of a regular program of activity, the psychosocial approach to
dancelmovement therapy offers a wide range of emotional and so-
cial benefits.