movement therapy faces multiple transitions

The Arts in Psychotherapy, Vol. 24. No. 1, pp. 5964,

1997 Copyright 0 1997 Elsevia Science Ltd Printed in the USA. All tights reserved 0197-4556/97 $17.00 + .OO

Pergamon PI1 SO197-4556(96)00048-2

DANCE/MOVEMENT

THERAPY

PAMELA

FACES MULTIPLE

FAIRWEATHER,

of Reconfiguring

MA, ADTR*

DMT’s Current Developmental

The purpose of this article is to examine Dr. Irma Dosamantes Beaudry’s ideas concerning the field of dance/movement therapy as they are presented in her article entitled “Reconfiguring Identity” (Dosamantes Beaudry, 1997). Additionally, the focus of this commentary is to highlight a vision for the future of dance/movement therapy (DMT) and its collaborative efforts with other creative arts therapies (CAT) and professional disciplines. Before proceeding, I would like to thank Dr. Dosamantes Beaudry for her invitation to write this article, for acting as a mentor and for all her support over the years. Summary

TRANSITIONS

Position

Trends in DMT, Health Care and Strategies for Continued Viability At present, DMT faces several unique developmental challenges pertaining to reassessment of its professional identity and “greater relatedness to an existing complex outside world” (Dosamantes Beaudry, 1997). In the beginning phases of professional development the original creative-movement base aligned with psychological theory served the profession well by sponsoring employment in traditional mental health settings. However, because of economic political and health care shifts DMT must now entertain alternative strategies for continued professional growth and viability. The reasons for this position come into focus when considering that trends in mental health treatment often seem antithetical to DMT’s creative dance, humanistic psychology and psychoanalytic underpinnings. As the medical settings where most DMTs practice usually require them to adopt a medical model perspective that emphasizes diagnostic criteria and demands brief-term treatment, the elusive quality of embodied experience makes the effects produced by this medium difficult to document in terms of rigorous outcome studies demanded by the managed care system. An overriding historical concern in the DMT field has been the need for continued and rigorous outcome studies to “prove” the effectiveness of DMT practices. As one potential coping strategy, some DMTs who are trying to keep their practices

Identity

In her paper, Dosamantes Beaudry traces the development of DMT in this century. This development includes the influences of the ancient role of dance in healing, the modem dance-based pioneers of the field, humanistic psychology, psychodynamic developmental and psychoanalytic theory, the American Dance Therapy Association and the introduction of embodied experience into the medical model treatment equation. She then discusses the current impact of fiscal and managed health care crises on the DMT field and its practitioners that focus on funding cuts for mental health treatment, closure of educational programs and managed care’s move toward a cost-effective/optimal outcome treatment base. Finally, she suggests some possible professional theoretical and educational directions open to DMT in the future and describes potential alliances, CAT licensure, international development, alternative, preventive, social-activist treatment models and educational modifications.

*Pamela Fairweather is a lecturer for the University of California Los Angeles Department of World Arts and Cultures, Graduate Dance/ Movement Therapy Program, and for the California State University Long Beach, Departments of Dance and Educational Psychology. 59

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alive amid these health care shifts have suggested holding outcome seminars to assist dance therapists in quantifying the quality of their treatment in a language that will be accepted by health care management. They also are calling for a DMT definition that operationally defines its competencies and markets the skills unique to DMT (Cort, Kirschenmann & Lawson, 1996; Fraenkel, Armeniox, Kleinman & Kondziolka, 1996). Dosamantes Beaudry points out that the influence of managed care with its focus on short-term treatment with optimal outcome has caused “many practitioners to question their professional future under such a system.” From an optimistic perspective it can be speculated that managed care’s move toward cost effectiveness and, therefore, the hiring of masterslevel providers could augur “well for dance therapists who are licensed as health care providers in their state.” A key point for discussion related to the trend of hiring masters-level providers then focuses on the issue of licensing and certification of DMTs on state and national levels. For many, this concern is directly related to the nature of DMT’s economic survival as DMTs lose their jobs or are prohibited from practicing privately unless licensed. The complexity of this situation is daunting because all states do not require licensure and because of the considerable variation from state to state regarding training, degrees and requirements for licensing. ADTA and NCATA Investigate AjjWation and Licensure

Counseling

An American Dance Therapy Association (ADTA) task force and the National Coalition of the Arts Therapies Association (NCATA) have taken on this problem by investigating possible affiliation with counseling through the American Counseling Association (ACA) and the National Board for Certified Counselors (NBCC) liaisons that would lead to national-level credentialing and recognition as counselors (Armeniox & Benshoff, 1995). Potential benefits of these affiliations are that they would allow DMTs in some states to have greater access to licensure possibilities while allowing DMTs in other states to achieve board-level certification through the development of a nationally recognized standardized examination of competency, both of which are first steps in state-level licensure legislation (Armeniox & Benshoff, 1995; Pallaro, 1996a). This work has caused extreme divergence of opinion among DMTs because it raises fundamental questions regarding the very na-

ture of our professional identity. In considering the outcome of such a collaboration and its long-term consequences, we must be reminded that when we look for security within the auspices of a larger outside organization we run the risk of occluding our unique focus as CATS. Varied opinions have been voiced by DMTs ranging from Siegel (1996, pp. 1314) who states, “There are many reasons why I would regret such a move. . .we would be selling ourselves short. . . [with a] frittering away of our substance on an alliance with another profession,” to Pallaro (1996b, p. 14) who comments, “Collaboration with the NBCC would ensure us more power and status without losing our identity. . .support counseling certification for more opportunities for dance/movement therapists in the health care field.” Other alternatives besides that of alliance with counseling include the choice of some dance therapists pursuing additional graduate training in mainstream professions that are licensed in their states and ADTA’s move to affiliate with other creative arts therapists to “wield greater political influence and to jointly pursue a state-level Creative Art Therapy license” (Dosamantes Beaudry, 1997). Although it is apparent that our combined unique orientation based on a creative artistic approach to therapy would offer the “ideal” license, states such as California, which have stringent and restrictive laws regarding the practice of psychotherapy, are currently legislatively close-minded about creating any new state regulated licenses for masters-level practitioners (Pallaro, 1996a). How long these doors will remain closed is unknown and places CATS in the position of having to work on alternative solutions during the interim. It is important to recognize that other states that are transitioning into greater specification of services and requirements for therapeutic practice are more open to creating a unique CAT license or to include CATS in their by-laws for psychotherapy practice (Armeniox & Benshoff, 1995; Pallaro, 1996a). Because of the eventuality of having a CAT license in some states while not in others, we may see DMTs move to locations that offer such opportunities. Also, it is important to bear in mind that those states that do approve a CAT license will set a precedent for including such a licensing option in other states. Alternative Treatment Models and Potential Applications Clearly the field of DMT is in flux and finding it necessary to open its borders through collaborative

DMT FACES TRANSITIONS affiliations. The resultant “fear and confusion regarding dance therapists’ professional identity” mentioned by Dosamantes Beaudry must be addressed and ongoing support for the power of our work must be nurtured. One way to deal with the anxiety produced by these shifts is to acknowledge what we may be “losing” and then to acknowledge what new “possibilities” might exist. Certainly DMTs will continue practicing in psychiatric settings under a traditional medical model, but the possibility of expanding systems of treatment are exciting to consider. To start, it is reasonable to speculate that the longterm consequences of budgetary cuts will lead to increased funds for other areas of service, such as incarceration and emergency care costs as the system tries to accommodate those who are unable to receive mental health treatment to keep them stabilized. Based on the figures presented by Dosamantes Beaudry, the larger amounts spent on one person for incarceration would provide mental health treatment for several people. Although it is difficult to project an immediate end to this dilemma, in the long run it may very well be that the inflated cost to the criminal justice and prison system plus the increased costs of treating people after a crisis has occurred will cause a reevaluation of how health care funding is being distributed. In the meantime, as more people find their way into the penal system, DMTs may be able to find employment in this area of service. Because much of the fight to maintain and adapt our identity as CATS has been fueled by managed care with its diminished funding for mental health services, quality of care and the curtailed length of treatment provided, it would seem that its costeffective drive “is likely to favor the proliferation of alternative treatment modalities that stress disease prevention over modalities that are aimed at the treatment of illness.” This trend strikes a hopeful note for DMTs who focus on preventive practices rather than illness treatment and it seems only logical that the preventive and alternative medicine models will attract increasing numbers of people. Many DMT practitioners who are philosophically aligned with this model can develop and implement programs for clinics that provide these services. Some potential applications would include a specialized treatment package incorporating basic movement, imagery and relaxation techniques marketed to health management and maintenance corporations. In this instance, DMTs who are also certified as biofeedback clinicians might be in a position to document their results and anticipate greater flexibility in employment opportunities.

Also, those possessing entrepreneurial skills might develop programs for business to reduce employee stress by providing on-site stress reduction sessions or they may find work in fitness facilities that contract their preventive health services to HMOs. Additionally, DMTs currently employed in mental health settings could offer sessions for professional staff in order to maintain staff well-being or other employee assistance programs could be targeted. In keeping with an alternative treatment approach, management of chronic pain through DMT techniques will grow as therapists who understand the relationship between mental, physical and emotional functioning will become increasingly recognized through support from psychoneuorimmunological research. Basically, this means individual DMTs will need to organize and develop employment strategies in areas where DMT currently is not known as a specialty and decide whether a practice in the health care area is acceptable to them. In reference to the “social activist” model that “uses the arts to promote social and political change . . . and . . . [holds] appeal for dance therapists who value a cultural and political activist perspective” several applications can be anticipated (Dosamantes Beaudry, 1997). Continued work with the homeless population will be needed, as will work with AIDS and hospice patients, because each of these areas will need clinicians who possess an intelligent, empathic, body level sensibility in the identification of alienation and loss. It is from this perspective, too, that DMTs wishing to work on a community level for the treatment and prevention of gang involvement and domestic violence might find meaningful employment. To date, DMTs more commonly have provided treatment of this kind in shelters for battered women, through child and foster care services, or in high-risk infant programs and adolescent drug treatment centers. With the ever-increasing problem of violence, the approach of creating a sense of belonging within the community itself interests many therapists because “the expressive arts . . . allow an individual access to the deeper meaning of existence, to a connection to humanity” (Lewis, 1993, p. 4). Concomitantly, government support for community service approaches focused on keeping families together whenever appropriate and on decreasing family and neighborhood violence is increasingly available (S. Biery, personal communication, April 1996). Because of the unique nature of our training as “artists and therapists,” issues of alienation and loss of meaning, which often result in violence, can be addressed

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through proactive family and community-level intervention in collaboration with schools, law enforcement, religious and community centers. Implications for the American Therapy Association Modifications

Dance

in Education

Since the establishment of the ADTA in the early 1960s this association has facilitated DMT employment under the auspices of mental health care and has set criteria for professional development in the mental health area. The evolvement of these theoretical models, however, will require the ADTA to review its educational guidelines especially as DMTs reevaluate their employment options. Trends in the economy and the American health care system will necessitate revisions in curriculum, philosophy and internships. As Dosamantes Beaudry indicates, it will be essential for DMT programs to “retain a core body of knowledge” in order to maintain its distinctive identity as a creative art therapy and improve its chances for pursuing CAT licensure. During the 1996 Annual ADTA Conference, discussions were held by leaders and educators in the field on this issue. These dialogues will help pave the way for needed modifications, which then will face the reality of being implemented by academic bureaucracies. Additionally, Dosamantes Beaudry suggests that training will be extended beyond the traditional university settings and that future training not only will be housed in college and university settings, but also will take place in recognized CAT institutes and DMT regional centers, which will develop in geographical areas where programs do not currently exist. Private schools will expand their alternative training opportunities as they respond to increasing student interest in DMT and CATS thus filling the void left by the closure of long-standing programs. Intriguingly, programs offering a core DMT curriculum, plus areas of specialized application as proposed by Dosamantes Beaudry, will be of great value to students as they can align their particular DMT interest with a compatible educational and employment plan. Modifications

in the ADTA and its Membership

To stay current, changes in various aspects of the ADTA will have to take place. This process has already started, as can be seen in the latest ADTA Ed-

ucational Information Brochure, which includes a revised explanation of dance/movement therapy and lists expanded DMT employment/treatment opportunities (American Dance Therapy Association, 1996). This seemingly simple change advertises to the public a more expansive view of DMTs’ potential impact and effectiveness. Now, it will be challenging to focus on the unique aspects of DMT practice that are still core to its essence and identity and those areas that can be newly embraced. The identified basic tenets of integration of psyche and soma, emotional and communicative movement expressivity, relational movement dynamics reflective of intrapsychic and interactional states, and psychodynamics engendered by movement processes seem vitally alive and relevant today (Dosamantes-Alperson, 1981). We must not abandon hope in the identification of the creative movement process with its intrinsic transformative capacities. These unique tenets of practice can support and guide the field in this era of transition. What we will need to decide, however, is whether our emotionally-based, creative movement foundation can encompass other areas of body knowledge in order to keep ourselves marketable. Conviction of purpose on the part of the ADTA membership will be more important than ever before. The voice of each member must be heard; opinions must be shared; conflicts and resolutions must be worked through. Staying abreast of political and legislative policies impacting our ability to practice are critical activities. The ADTA, in conjunction with the NCATA, has come to recognize the importance of these activities by establishing the Washington-based Advocacy Group (WAG). WAG will benefit all CATS by disseminating information on national policies, providing representation at allied health professional coalitions and by increasing our visibility (Bunney, 1996; Kleinman, 1996). It is the responsibility of each constituent, however, to maintain contact with local and national ADTA and NCATA chapters and to forge relationships with elected state and federal officials. Another area of envisioned modification in the ADTA will be in the registry process. The impact of an extended definition of acceptable employment settings will require that the question of registry be deliberated. Changes would permit dance therapists greater freedom in seeking and maintaining employment opportunities in more varied settings while accruing the needed hours for upper-level registry. Careful consideration will need to be given to the

DMT FACES TRANSITIONS registry process itself as potential licensure becomes a reality (S. Musicant, personal communication, May 1996). A Vision for DMT’s Professional Collaborative Efforts Expansions

Future and

in DMT Internationally

There are several other exciting future progressions that the field of DMT can anticipate. To begin with, we can expect a continued international expansion of the practice. The power of dance, as therapy, to attract international interest is evidenced by recent DMT international conferences and by an everincreasing international membership in the ADTA that now totals 29 countries with 102 international members outside of the United States membership (American Dance Therapy Association, 1995-1996). Because of the ADTA’s professional standards of training and ethical practice, it is natural for practitioners in other countries to look toward the United States and to the ADTA for models of practice. Certainly some of the American DMT doctrines and practices may serve as a basis for development in other countries, but, as Dosamantes Beaudry warns, it is imperative that “all practitioners involved in this hybridization process . . . give due consideration to the world view of the consumers they serve.” The ADTA has responded to the international community be developing panels focused on these issues during its annual national conferences, generating a dialogue between global practitioners with respect to their growth, DMT definition and treatment differences in cultures with varying self and world views. IT will be provocative and stimulating to see how dance as therapy is conceived by various cultural groups. The foundation of American DMT based on the roots of modem dance most likely will not be appropriate nor directly transferable to many cultural orientations whose dance and movement expressions reflect divergent sensibilities in self, communal and emotional expression, artistic aesthetic and spiritual practice. Concurrently, those American DMTs who have studied specific, cultural dance/movement, ritual and healing practices have found ways of synthesizing ’ movement forms into their these “appropriated’ work. Several reasons underlie these appropriations and caution must be taken when a given practitioner’s personal identification with a movement experience leads to an erroneous assumption that a similar effect

would be equally experienced by others. It is no wonder that serious ethical concerns regarding the appropriateness of such practices would emerge and that a larger vision of cultural and societal ethics will have to be considered so that a violation of the “complex psychological and cultural process . . . involved in the acquisition of an individual’s personal and cultural identity” can be avoided (Dosamantes Beaudry, 1997). Via increased contact with the movement healing practices of other cultures and through digital and cyberspace technology, research on the moving body will expand our multicultural awareness of how the body is viewed and what role the moving body plays in healing. As DMT is broadcast over the Internet and Web page, the job market will be viewed intemationally and it will increase our world-wide visibility. With these expansions, it will be curious to see what new contributions to theoretical orientations will develop and whether DMT will be practiced primarily by women as it is in the United States. Expansions in Employment and Collaborations

Opportunities

Next, ongoing fiscal and employment opportunities will emerge within a variety of contexts. Ostensibly, DMT will pursue funding grants for work aimed at specific populations. Developmental centers providing therapeutic services, clinics shifting from residential to outpatient/community services and special education therapeutic schools can all benefit from DMTs who have knowledge pertaining to grant writing and funding sources. Also, collaborative creative arts therapies treatment settings employing several CATS can be marketed and funded to serve specific under-served populations. Mother/infant development and parent education classes can be intelligently devised from a movement observation and developmental movement sequencing base. Creativity centers hosting seminars on the embodied experience can be formed. There are many potential areas where our work can be developed and collaborative models can be created. To encourage success, it will be essential for DMTs to intelligently articulate concepts, methodologies and terminologies as understood by potential affiliates. Conclusion On all levels from education to application dance/ movement therapy faces multiple transitions. In order

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to maintain saliency the long-term implications of implemented coping strategies must be considered. DMT is not, however, starting from scratch as the profession did in the 1960s. In much the same way as the ADTA struggled when developing its original definition of dance therapy, the field now must grapple with its “reconfiguring identity” (Schmais & White, 1996). The potency of the work and the ability to effectively utilize the enormous tension created by this transitional period will lead DMT into new venues for meaningful professional practice. By establishing thoughtfully planned alliances with other professional disciplines, continued arenas of growth will emerge. The individual and collective innovations and intentions of older and younger DMTs should serve the field well in devising a future of productivity and satisfaction. References American Dance Therapy Association (1995-1996). Membership directory. Columbia, MD: ADTA. American Dance Therapy Association (1996).Educational information. Columbia, MD: ADTA. Armeniox, L., & Benshoff, J. (1995). Credentialing in the helping professions. Paper presented at the ADTA National Conference, Rye Brook, NY.

Bunney, J. (1996). Washington-based ADTA, N(3), 9.

advocacy

group

(WAG).

Cart, L., Kirschenmann, A., & Lawson, J. (1996). Members-atlarge: Messages from the vision seminar. ADTA, 30(3), 5. Dosamantes-Alperson, E. (1981). Dunce therapy chuprer in psychiatric manual proposal developed for APA’s Commission on Psychiatric Therapies. Columbia, MD: American Dance Therapy Association. Dosamantes Beaudry, I. (1997). Reconfiguring Psychotherapy.

identity. The Arts in

Fraenkel, D., Armeniox, L., Kleinman, S., & Kondziolka, S. (1996). Report from ADTA’s NBCC task force on credentialing. ADTA, 30(3), 8. Kleinman, S. (1996). National tion. ADTA, N(3), 8-9.

coalition

of arts therapies

associa-

Lewis, P. (1993). Creative transformation: The healing power of the urfs. Wilmette, IL: Chiron Publication. Pallaro, P. (1996a). DMT moving into the future: Licensure possibilities and advocacy opportunities for the creative arts therapists. Paper presented at the meeting of the UCLA Graduate Dance Therapy Association, Los Angeles, CA, May 24. Pallaro, P. (1996b). On certification 30(3), 14.

[Letter to the editor]. ADTA,

Schmais, C., & White, E. Q. (1996). Opening keynote address, 30th annual conference: ADTA: Where, when and how it all began. American Journal of Dance Therapy, IS(l), 5-20. Siegel, S. (1996). On certification 30(3), 13-14.

[Letter to the editor].

ADTA,