We wanted to place our skills in a new environment to challenge and question our practice and reflect on how we as artists can adapt and develop our work. We have rarely had the opportunity to engage with participants in a clinical environment such as the NHS where there are issues relating to space, access and treatment.
The residency, which ran for four months, carried two main aims:
- To develop the role of dance within the NHS Trust and explore the further potential of dance and movement- related work in the context of health and therapeutic services;
- To raise understanding amongst staff, clients and carers of the potential role of a dance artist and their real value in such a context.
Crucially, it was to be the role of a dance artist and their 'real value' which became the basis for our exploration because ultimately a person undergoing treatment within any NHS Trust is receiving and requires the highest level of care. As visitors we have no priority over medical treatment and should never place ourselves in a position that may distract from or negate the purpose of such treatment.
Staff-related illness was to affect the number of areas that we could access and the amount of practical work we were able to engage in. We therefore redirected our focus to research and consultation and the participants we did encounter were drawn from a wide range of patient services from across the NHS. Some had issues relating to mental health, others had learning difficulties, which required long-term care programmes, there were elderly patients being treated for dementia whilst several had physical mobility considerations.
The residency highlighted many areas that warrant a great deal of in-depth attention but ultimately we gained the greatest insight from talking to staff, trainers, occupational therapists and members of the Clinical Governance team. So at this juncture, I will focus on exploring the purpose and reason attached to delivery of workshops rather than the actual content of these sessions.
From the outset, we decided to engage in a high level of training and induction just as a new member of staff would. We hoped to be able to understand the NHS environment better and therefore have a stronger basis upon which to build. Training also included making ourselves familiar with the medical and professional vocabulary that exists within the NHS. We were socialising and communicating with staff from diverse backgrounds and life experience. Many were interested in the benefits that our work could potentially bring to their specialist area such as physiotherapy and long-term units. They thought it was great that there were artists that could deliver an alternative activity into environments that seldom experienced arts-based work.
As a dance company we have always strived to deliver open, accessible, though technically based work that concentrates on the dynamics and expression of movement in its own right. We play with rhythms, space and awareness of others and we play with our facility and capability to move. The term 'play' cannot be over-emphasised in the context of our dancemaking. We endeavour to engage with people through the form of dance. Within one space, we can communicate, interact, stimulate and evaluate. We are thinking, feeling and doing, enabling the chance to learn about oneself, others and one's surroundings.
We had been invited to undertake this residency because feedback from previous work had often talked of the therapeutic value of our work and how the outcomes within our various programmes relate to 'dance therapy'. People often talk of dance in general as stimulating and having emotional and physical benefits. I have never experienced 'dance therapy' training and know little about the practice. I was once told that to deliver therapy was to endeavour to locate a problem and treat it accordingly. That statement, if accurate, is at the opposite end of the spectrum from where we work, however our paths will always inextricably cross and are linked possibly in more ways than are initially perceived.
As we meet a group in the workshop space, we are immediately assessing the level of delivery required. We need to be adaptable to the individual person on an individual day where 1001 factors will have formed a person's mood, emotional state, level of energy and willingness to be an active participant. From simple observations, we make judgements based upon our previous experience. We do, in our heads, form a sort of prescription of the content and style required for the following one hour workshop which, for example, will most benefit the participants in terms of goals and outcomes and is not restrictive or lacking in progression. Therein lies similarity between a dance therapist and practitioner but as a practitioner, my outcomes are movement-led and focus on enjoyment, understanding and expression. I have not identified a 'problem' or a specific area that requires treatment, yet the session may make an individual feel confident, empowered or relaxed, all feelings that can be termed as therapeutic. I should make it clear that I am not suggesting that dance therapy is an activity that does not incorporate enjoyment, understanding and expression. I actually believe it to be a wholly positive experience as well as vital but I am sure that we have different agendas that therefore form contrasting styles of delivery.
Again, throughout a session, the content is changeable and flexible dependent upon participants' responses and input. Within a therapy ideal, as with any form of treatment, you are required to re-evaluate and sometimes change direction where appropriate and to be adaptable to ensure that the participants receive the maximum benefit from the work.
So our style and ethos is certainly strong in therapeutic value if the notion detailed above is true. To put the participants' needs and desires at the forefront of any planning and delivery is, however, to develop the role of dance in the community.
The fact that patients within the NHS Trust are members of the community should always be remembered and valued. To take dance or any other artform into the NHS to engage with others is to include a vital part of our community, not to see the environment as separated or that the surroundings imply that the patients have no need for leisure and activity.
Dance is an important artform that can thrive upon innovative creation and dynamic or moving performance but it is also an essential (if not optional) ingredient in the recipe of leisure. The right to be involved and included in an activity of our own choice is to partake in leisure. Fundamentally this is how most people access dance from the community.
So, is it important how we perceive leisure? Possibly, because the word leisure is synonymous with 'Leisure Centres' where you can access gymnasiums, swimming pools, group and individual sports facilities but rarely dance activities - we therefore do not automatically match dance with the 'L' word. But the notion of leisure is inherent to any activity that is inclusive and an individual's choice.
Leisure has been described as:
'...time left over from (occupation or) work when a person involves themselves in activity or non-activity, of their own free will, for pleasure and not for remuneration, and enjoys a feeling of well-being, relaxation or stimulation.' (1)
Occupation, in contrast to work, has been described as any activity that a person sees as being purposeful or non-purposeful which has taken up time of his and/or her day. The balance between leisure and occupation can be overlooked. Both areas along with self-care will satisfy most of a human's fundamental need - contributing to self worth, independence, competence and confidence. Leisure importantly incorporates the notion of play. It is often heard in general conversation that young people no longer know how to play, but do we? Just because we are no longer young does not mean that we might not wish to experience enjoyment, relaxation, fun as well as developing our curiosity, imagination and cognitive development.
In the NHS, leisure is a part of many areas that range from sports activity relating to health and fitness benefits to assessment and review within a Care Coordination Programme. When a patient is first admitted into the NHS they receive an assessment programme designed to highlight and implement the best form of treatment for that patient. The assessment involves carers, GP's, care coordinators, occupational therapists as well as other specialist staff. What form the assessment takes is based on the individual and can include leisure as a method of identifying certain needs within the programme. Leisure activities that take place in the company of others can aid relationships, improve understanding of capabilities or communication and illustrate possible future activity. A care coordination programme also includes any family or relative carers attached to the patient and their participation in leisure can offer them social support, provide a new pursuit or empower the carer to understand their relatives capabilities and needs.
All the above point to several important issues. The NHS recognizes and actively employs the principals of leisure. Here is an environment that is open to all forms of leisure and therefore dance can and is being embraced and nourished. For us as artists to understand more about the NHS would mean an opportunity to be able to have an increased input into our co-development. By creating a pathway of communication between the Trust and artists there can be fantastic opportunities to extend our range of practice and learn in a new, inspiring environment. The one present drawback in my area of the country is a lack of artists who are willing and experienced enough to work within the NHS Trust. I understand why artists may not wish to follow this path of delivery as it is a unique place within which there are complications and difficulties and maybe deep down what I am attempting to say is try it, get involved. We have just experienced an incredible eye opening, educative research-based process that enabled us to analyse what we do as artists and how we see what we term the community. It may do the same for you.
We can be sure that in the context of leisure any participant does not want activity that is confusing, stressful, restrictive, and meaningless or under- stimulating. Through proper communication and development between the artists, and in this case the NHS Trust, and by having a clearer understanding of the notion of leisure we can create an environment that allows people to be self-selective, undertake an activity for its own sake and develop play and enjoyment.
Martin Wilson, co-director, TIN Productions. Contact +44 (0)1429 820556. Email tin.productions@talk21.com
Funded by Northern Arts Board, County Durham & Darlington NHS Trust.
Reference
1. Ravetz, C., Occupational Therapy in short -term psychiatry, Churchill Livingstone, Edinburgh, 1984