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Animated Edition - Summer 2005
Awakened by touch
Follow Katy Dymoke's journey from dance therapist to creator of special training courses for dance artists and activity nurses in mental health settings
My first experience of therapeutic dance came whilst working with deaf blind people in Denmark in 1989. Steve Paxton and Anne Kilcoyne, founders of Touchdown Dance, were invited to deliver workshops for three weeks. We did face massage, hand and arm holding leading from the periphery of the body and following from the spine, and became disorientated by Aikido rolls and gymnastics, lifting and rolling. All of this merged into dance improvisation.

One member of the group was subject to chronic depression. This touch-based experience called contact improvisation changed his life and fed his personality. Through dance he could reach out to others and into his surroundings. Touch and movement enabled him to have physical contact with his environment, to feel and move freely and openly through it (with the intimate support of a partner). He possessed taste and smell and the deeper, more intuitive perceptions that we all share, along with the primitive reflexive responses which enable us to sense, relate and communicate with the world around us. Without sight and hearing, however, he was forced into isolation. Sighted and hearing people like me had to learn other languages, such as touch and signing, in order for him to be included.

Thanks to this man I became aware of the many visible and invisible languages of communication. I learned that touch revealed so much more than eye contact or vocal tone. I had to read his signed responses and facial expressions. I could hear his breath, and sense his emotional state through the quality of his movement. Through the tactile receptors in every cell in his skin I could sense retraction, hesitation, inhibition. I also realised, as Irene Dowd says in her article Intentional Touch, that 'you can't touch someone without changing them.'

Had I not heard and seen his joy in moving, I wouldn't be where I am today - determined to enable people suffering from a sense of loss, deprivation, personal breakdown or exclusion to regain a sense of self, well-being and inclusion through movement.

The sensory/motor response cycle is continual and complex. It sets up expectations. The wrong kind of touch can be as hurtful as the wrong kind of look, or an insult. The right kind enables response, if you keep the intention of listening and waiting rather than forcing or grabbing. You can feel another's response moving towards or away from you. In this delicate moment you can engage with a person, dialogue with them, allow them to move and you to follow, and establish a trust in which they feel mutual support. This is a therapeutic relationship, as by literally and metaphorically holding them, you attentively reflect back their sense of being in the world.

Through a dance form I was re-patterning my ways of communicating with people. I couldn't use convention. I had to work hard in the dark and unknown to understand how to relate without spoken words. I had to touch people not only to say words, but to reassure, support and guide. Sensitising an awareness of the body as a reflection of the mind, is an experiential learning process called embodiment.

This was the beginning of a change of direction. I became dedicated to facilitating a joy and ease in people for whom movement was a huge challenge. The causes are varied: inhibition, institutionalisation and fear, inaccessible spaces or teaching methods, a sense of exclusion, a separation from the body, an alienated notion of dance or simply a lack of opportunity. These barriers, although numerous, are surmountable.

On returning to the UK I accepted an offer to assume the artistic direction of Touchdown Dance from Steve and Anne. When Performance Research Associates contacted me about the Connected Body Conference in Amsterdam, I agreed to attend and document the workshop in exchange for a bursary place. Following five days of Body Mind Centering® I decided to pursue practitioner training. In 1999 I was qualified, but within the first two of the four-year training I was already working with and sharing the methods in projects with disabled and non-disabled people in dance.

Body Mind Centering® has various therapeutic approaches for the (re-)integration of the body-mind (embodiment) in people who have suffered from physical or psychological illness, injury, trauma and so on. BMC works from the principle that support precedes movement, however subtle or general the notion of support may be. I found myself truly at home in the training because of the wealth of communication and relationship skills in hands-on, touch-based work. The therapy comes from finding the core from which disintegration began, whether in tissue or bone, nerve cell or synapse or the chemical balance of the hormones. The hands 'listen' to the sensations that the client is expressing, tuning in and waiting for the state to shift, to change. It's at this moment of body-mind integration and embodied awareness that healing begins.

Taking CARE
After many years of working in health and special education I created CARE, or Communication And Relationship Embodiment. Using BMC principles of developmental movement material and the perception cycle, I evolved a working process with soft balls. After an initial assessment I adjust the content to the needs of the group I'm working with, and run a series of sessions applying the principles in a clinical or therapeutic setting. The key to the process is touch, direct or indirect but generally with a ball. Touch brings us directly into relationship with sensation and our inner being. Fundamentally it's a form of inward communication. I started to develop the work with patients, confirming that touch initiates movement and inspires parts of the mind that have been subsumed by illness, e.g,. the imagination or reminiscence, recent or distant. Regenerating new or past layers of being and understanding, the process re-establishes a sense of self.

Through these experiences I've acquired a sense of what to avoid and what to affirm. I know that touch can arouse inappropriate behaviour if the intention is unclear. I know that intentional touch works at many different layers of consciousness and presence which talk and sight can't reach in such an authentic, supportive and immediate way. I know that too much touch can overload and inhibit, as I know that the wrong sort of touch can traumatise.

With all of this to consider, a typical session is loaded with material to observe and witness. It's always full of surprises and wonderful challenges. It's important to acknowledge the richness beneath the apparent simplicity and realise that this is essential to the healing process.

Used as an interface between hand and body to prevent direct contact, the balls have the softness of skin and work well for self-massage. Moving with the balls enables the mover to connect both arms or legs with ease and provides a focal point to keep them engaged. Group work is also possible, stimulating the reflexes, a sense of play and an interaction that establishes friendships, relationships and the feel-good factor.

Mindfully trained
Having worked for three years on mental health wards for the hospital arts organisation LIME, we discussed CPDT (continued professional development training) for the activity nurses so they could continue to run the sessions when my funding stopped. This was initially due to positive feedback from staff and patients. My aim was, and still is, to ensure that the dance/movement approach I developed in CARE can be applied in care settings by non-dance trained professionals (e.g., activity nurses) as well as dance practitioners interested in the health field. I cannot provide for all needs, and there are so many settings where dance movement can transform and support the day to day lives of people suffering from mental illness. LIME offered the Open College Network accreditation framework and I offered a range of training experience, as a National Vocational Qualification assessor, RDMT (registered dance movement therapist) and BMC Practitioner.

On the basis of this collaboration the Primary Care Trust accepted the Dance in the Community level 3 module as a suitable training for nurses in Bolton, Salford and Trafford. The training involved three weekends over four months, with weekly sessions in between that were established on the wards by the dancers and nurses - five of each. They worked together, planning and delivering therapeutic dance to groups of patients. This involved trying different styles appropriate to the group, selecting music both recorded and live. It also entailed session reports and evaluations, as well as gathering feedback from participants.

Hospital settings include dementia, continuing care, mental health, psychiatric and secure wards. In mental health people are experiencing a wide range of illness as victims of trauma or, more clinically, such conditions as paranoia, phobia, schizophrenia or psychosis. The nurses know about the medical needs, while the dancers can bring in movement ideas and develop them. Together they analyse and assess the group response, sharing insights and expertise from both sides of the fence.

Peer learning was the most valid part of the course. Together the trainees learned how to provide and sustain a process that is both educational and therapeutic. For example, the opening and closure of the session is of vital importance, as are agreed ground rules to create a common understanding of its purpose. This enables the patients to feel safe and open, supported and enthusiastic. Their weakened sense of self is given time to feel renewed, refreshed and welcome. The nurses are convinced from an early stage that this will benefit the patients, an intuitive feeling that sustains their work. The dancers experience the complexity of the group's needs, the necessity of a person-centred approach and the value of dance in a new, intensive context.

Responses
An eighty-six year old man on a continuing care ward overcame his fears for one hour a day, appreciating his own ability to move the ball and catch it and feeling better from the massage he gets moving it over his body. The atmosphere on the ward changed, too. Post-session the nurses dropped the top-up medication for most of the patients, who were calmed. The reactions of patients elsewhere ranged from 'This is the most therapeutic experience I've had in seven years of mental health treatment' to 'It's great! I forgot about everything and had a chance to relax and enjoy myself.'

'I'm doing this to benefit the clients,' said Deborah, a nurse at Hope Hospital, Salford, 'to see them smile and socialise and come out of their skin. It's an effective distraction treatment for people hearing voices.' Jean, a nurse in Trafford, told of a Mr B: 'He was a professional ballroom dancer. When he joined the ward he'd lost 90% of his sense of being. During the dance we put on ballroom music. He took me up and down the ward in a moment of bliss, my feet keeping pace with his. He's been known to be aggressive to staff. He was never aggressive on our ward, and was discharged after three weeks.'

'I've enjoyed working with [dance teachers] Val and Mike,' said Jessica, an activity nurse in Salford. 'They've educated us on dance, and us them on the mental health side. Hopefully this is productive for us to use long-term. It gives patients a sense of purpose, motivating them to get up in the morning. We don't do the same things every week. That keeps the interest of the group and brings them back together. I've noticed how they bring their own movements in, doing their own thing and going into their own world. It's all about creativity at the end of the day. They don't need instruction all the time, but need to work with their own ideas. Other members of staff who don't know about dance therapy don't understand the value.'

For her part, retired dance teacher and former dance officer Val Smith wrote, 'The course has built my confidence, and taught me how to adapt to a new client group. Collaborating with mental health staff was an invaluable experience. I gained insight into settings, illnesses, client behaviour and working as a team in this environment. I have long known that dance can have positive effects on the mind and mental health, but now I'm able to put it into a language others can understand.'

Amongst the questions I have are, is an activity nurse a qualified dance artist after completing a level 3 Dance in the Community course? I believe that they've studied, worked with and delivered a range of dance styles appropriate to their groups within a therapeutic model of supporting different needs. They will, however, need to continue to be inspired and keep dancing! Clearly nurses can train in dance and work successfully with it as a beneficial activity. In May 2005 three of the five nurses on the course received an award from the NHS for the success of the groups they've run.

Is a dance artist qualified to work on mental health wards after completing a level 3 in this setting? They've all proven that they're in a good place from which to develop further. We can't be totally successful as health practitioners without experience. I'd recommend that dancers interested in working in health pursue post-graduate training in dance movement therapy, or BMC certification. Alternatively, to cover legalities, they should always have insurance and a nurse or health practitioner in attendance who has risk assessment and other formalities in place. Once in a field such as the NHS, there are many mandatory training opportunities and other voluntary ones to take.

At the closing stages of the current training, it's plain that the partnerships established between dancers and nurses will continue along with the work. The underlying purpose has been for the nurses to start up the ladder towards a greater understanding of the healing potential of dance movement therapy, so that it can be integrated into the range of arts activities with which they work. For dancers it opens up new possibilities for a wider application of their skills, demystifies the arts in health scene and shows the incredible satisfaction to be gained from working in this setting.

Katy will run the dance in mental health settings course again in the autumn and, for the first time in the UK, BMC school courses. For further information contact K Dymoke RDMT, BMC Practitioner, 180 Stamford St, Old Trafford, Manchester M16 9LU. 0161 868 0509 or touchkate@aol.com For Touchdown Dance contact Waterside Arts Centre, Sale, Manchester M33 7ZF. 0161 912 5760 or info@touchdowndance.co.uk

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Animated: Summer 2005