Musings of a Dance/Movement Therapist

The Dance of Interaction: Embodied Relationships in Dementia Care

The Dance of Interaction: Embodied Relationships in Dementia Care

Donna Newman-Bluestein and Meg Chang

Mar 9 2013 - Mar 10 2013

9:00AM--5:30PM

California Institute of Integral Studies

San Francisco, CA

This workshop focuses specifically on nonverbal communication skills for caregivers of people with dementia (PWD). This experiential and interactional program utilizes creative movement and dance therapy techniques to teach participants to create a psychologically safe and supportive social-emotional environment for PWD. People with language deficits may not have the ability to understand verbal language, but they do understand the nonverbal language of movement. Training methods piloted at a Memory Unit in Assisted Living will be demonstrated, and basic elements of nonverbal communication identified. Discussion and role plays will enrich applications to working or relating to people with dementia. Students, caregivers, or family members will come away equipped to communicate better and improve their relationships with people with dementia. Dance/movement therapists with significant experience working with people with dementia will have the tools to teach this training module in nonverbal communication to caregivers of PWD.

Find out more and register here.

Dance Movement Therapist Linni Deihl Remembers Daniel Stern

The following was posted on the American Dance Therapy Association's Facebook page. On learning of the death of Daniel Stern, Linni Deihl wrote:

"I worked with Dan at Psychiatric Institute at Columbia Presbyterian where he was a resident in Psychiatry. He was fascinated with Effort/Shape Movement Analysis and it informed his seeing. We formed a movement analysis team with Al Schflen,MD Murray ShaneMD, Peter BorcheltPHd and myself and toured college campus' and eventually Europe ....the highlight, presenting at the Bielefeldt, Germany, Movement Analysis conference on behavior and non verbal communication. Dan's work is significant. He was a charming and brilliant person and I will miss him dearly."

Linni clarified that she "was at PI, Psychiatric Institute, 1966 - 1970 when Dan was a resident and later chief resident in psychiatry. Our tour of college campus' was in '69 and the European tour and conference in Germany was in 1972 - 73."

Dance movement therapist Heidi Ehrenreich adds this, "His work in attunement was a bridge in languaging dance therapy to other professions."

There are many psychiatrists, psychologists, and others whose work has been influenced by dance movement therapists and certified movement analysts. Unfortunately, the dance movement therapists'  and certified movement analysts' contributions are rarely credited.

Waiting for the Next Peak Experience

Just back from the Texas Culture Change Coalition which was informative and exciting, my presentation Enhancing Quality of Life through the Dance of Interaction well received. Most inspiring was the presentation by psychologist Dr. Richard Taylor, who has been living with the diagnosis of dementia, probably of the Alzheimer's type, for the past 10 years. In his his words, Richard "dedicates his remaining consciousness toward breaking down the stigmas of dementia". His speech was fiery, powerful in his charge to diminish the stigma of dementia with many examples of the ways that even we, caregivers who truly care, continue to unwittingly foster the stigma. I highly recommend Dr. Taylor as a highly articulate and cogent speaker, transmitting his message through humor and authenticity. As he said, "It's hard to stumble when you're talking from your heart because the words just pour right out." Some additional quotations from his presentation:

"Culture Change begins in your heart... You're here to enable, not disable me."

A stragegy for people with dementia ~ "MSU" or Make Stuff Up.

According to Taylor, imagining what it feels like to be a person with dementia through strategies such as  glasses being smeared with Vaseline, earplugs to muffle sound, binding one arm to your body, etc. is simply pretending, not empathizing.

"You're pretending by empathizing with a different processor. It can't start with the brain. It has to start in your heart, go through your feelings and up to to the brain."

The end result is, people with dementia "get a lot of pity and not much empathy."

In the presentation that I led and the nonverbal communication trainings that I lead, I do not have people imagine what it feels like to be a person with dementia. I ask participants to experience their own feelings when they experience a mismatch in pacing or are ignored. I ask them to feel their own discomfort with intimacy during experientials. Why do I want people to feel uncomfortable? So that they feel the feelings they are discharging through chatter or giggling. There's nothing wrong with those; it's simply that if we do not experience our feelings, we have no opportunity to reflect and change them and they will be perceived by and affect highly emotionally sensitive people with dementia.

Taylor also spoke of the vast financial resources that are being spent. "Instead of spending research on pills that don't help, spend it on social science research that encourages intimacy among people. . .  People need to learn to communicate better".

This one really got me. Taylor said that while it's great that dementia programs are bringing in better quality arts professionals these days, "What happens after that hour? You leave people waiting for the next peak experience". When told that staff never see a resident nearly as expressive as they are in my groups, I am often struck that what that means is that the self of the person with dementia is there inside all the time, with no one to help them come out. That is the reason I teach people to communicate nonverbally and to bring dance to people with dementia. I want others to know what I know that is so very clearly effective. I regularly have the experience as I know other dance movement therapists do of reducing the agitation and improving the mood of people with dementia. Having embodied, aware and self-reflective practitioners on the staff of dementia programs ought to be best practice. I believe that it is grossly neglectful not to utilize the strategies which can be proven effective. However, there needs to be funding to provide such research.

Taylor also spoke about how staff/caregivers will often hug people, often without asking. That is confusing for the person with dementia who may not remember the person hugging. He suggested that caregivers "Learn not to invade their space." "We don't take the time. Just sitting with someone and eventually putting your hand near their hand - works better than asking what's bothering you." These are all skills that are not simply spoken about but practiced in the comprehensive nonverbal communication trainings that I lead.

And finally, Taylor asks:

"What about the person with dementia's higher level needs? Ask what is his purpose today? How is his self-esteem, his sense of belonging today. Then ask about his vital signs."

Favorite Dance Movement Therapy Quotes from Laurel Bridges

The following quotations are from: Bridges, L. (2006). Application of dance/movement therapy principles to nursing care for people with a dementia: a non-verbal approach. In L. Bridges.  & C. Le Navenec,  (Eds.), Creating connections between nursing care and the creative arts therapies, expanding the concept of holistic care (pp. 305-329). , IL: Charles C. Thomas.

Susan Sandel and M. Kelleher in Waiting at the Gate: Creativity and Hope in the Nursing Home: "Movement activites are not the goal of the group experience, but rather the tool for creating a therapeutic environment. (Sandel & Kelleher, 1987, p.27).”

“Dance/movement therapy’s basic premise is that ‘body movement reflects inner emotional states and that changes in movement behavior can lead to changes in the psyche, thus promoting health and growth’" Fran Levy in Dance/Movement Therapy: A Healing Art.1988, p. 1).

Dancing with People with Dementia Improves The Culture of Care

At the Pionneer Network a couple of weeks ago, I had the opportunity to meet lots of wonderful, like-souled people, passionate as I am about improving the culture of care for people with dementia.If you are not familiar with the PN, here is a little from their Vision statement.

"The Pioneer Network supports models where elders live in open, diverse, caring communities. Pioneers are working for deep system change by both evolutionary and revolutionary means, using Pioneer values and principles as the foundations for change. In-depth change in systems requires change in . . . the individual's and society's attitudes toward aging and elders; change in elders' attitudes towards themselves and their aging; and change in the attitudes and behavior of caregivers toward those for whom they care. We refer to this work as culture change. Our aim is nothing less than transforming the culture of aging in America."

My primary focus is to change the attitudes and behavior of caregivers by increasing awareness of how they communicate nonverbally with people with dementia. My style is to do that playfully, through dance and the dance of interaction.I was astonished at how many people signed up for my workshop entitled Enlivening Elders and People with Dementia through Dance/ Expressive Movement and who were afraid to dance or move expressively. Over half of them - probably 25 people. I had to threaten not to begin until the inner circle of concentric circles was filled before I would start just to get people to take the risk of being seen. In short order, people understood that there would be no judgments; they need not be graceful, then only needed to move and to consider their choices in movement. That as long as they were judging themselves, they would be judging others, and I wouldn't have any of that.

From there we proceeded to have a frolicking great time, all the while learning about how we communicate to others through movement. I played some of my favorite music to play in my dance movement therapy groups with people with dementia: If I Knew You Were Coming I'd Have Baked a Cake, You Must Have Been A Beautiful Baby, and introduced them to some of the props that I use and how I use them. Often, people get stuck wanting to know what props to use. What makes a group great is not so much about WHAT we do, it's about HOW we do it. And that is WHAT DANCE IS ALL ABOUT. And, dance movement therapy is not only about what and how we do what we do, it's about WHO WE DO IT WITH. It's about our relationship to others.

Every person present was engaged and excited about bringing dance to people with dementia and let me know how much they enjoyed it afterwards. And all of this reminds me of a conversation I have been having with @Exisdance on Twitter - about how when we make things look easy, it seems to make it seem less substantial, less worthy. And yet, that is not the case with the Olympics.

So next time you see someone doing something wonderful and it looks easy, reconsider. Imagine what might go into their provision of that experience - or ask them. That is how we inspire one another.

This photo is from a workshop I led at the American Dance Therapy Association Conference where we are using the Octaband.

I'll be leading a workshop at the 2012 ADTA conference in Albuquerque, NM on Saturday, Oct. 13. I hope to see you there.

Benefits of an Embodied Approach to Being a Self-Reflective Practioner

At the Pioneer Network Conference earlier this week, CEO Peter Reed stressed the importance of self-evaluation. As I self-evaluate ....

Meg Chang and I are in the process of revising and self-publishing a training manual to accompany our Nonverbal Comunication Training for Caregivers of People with Dementia: An Embodied Approach.

As I re-read the manual, I am struck that this concept below does not seem to be well understood.

When trainees reflect on their experiences within the training and their

"self-reflections are accepted, they learn to value and respect their somatic experience and the subtleties of how their inner attitudes manifest in their nonverbal communication. This builds confidence in themselves and ultimately in their ability to respond intuitively to [persons with dementia] in moments of crisis."

'In care work at all levels, the proper aim is to promote the formation of a 'reflective practitioner' (Schon 1983) - one whose work is flexible, assured and full of understanding. A mechanized approach, which merely deals with acquiring 'competencies', does not go nearly far enough. The training of staff, if well designed, will set up a process of experiential learning, involving a cycle of action, refection, and consolidation of better practice (Kolb 1992) . . . . The content of training should never be merely theoretical as has often happened with dementia. It should stimulate staff to subject their practice to continuing reflection (Kitwood, 2008 pp. 110-111).

and,

"Confidence in one's actual in-the-body knowing is a foundational source from which to spontaneously respond and problem solve when people with dementia are distressed."

Contact me for information on how your staff can be trained to be self-reflective practioners regarding their nonverbal communication with people with dementia.

Dance Charter School for Kids with Kinesthetic Learning Styles

I awoke from a dream earlier this morning in which I was being interviewed about dance movement therapy pioneer Norma Canner's influence on me. In the dream I was talking about feeling validated within the dance therapy training program for expressing myself gesturally with my hands. In the dream, while I began expressing myself with my hands, I moved easily to expressing myself with my whole body.

I awoke thinking about how the monoculture I grew up and was educated within did not validate my values as expressed through movement. I was so relieved to find the profession of dance movement therapy and to find like-hearted-minded-embodied-ensouled people who also value the importance of self-expression. As long as our educational system continues neglecting education about the value of our whole selves and our emotional connection to one another, we will continue to have shootings because some child is bullied and made to feel marginal. In fact, I would imagine that the majority of the people within the U.S. are marginalized due to the undervaluing of movement, dance, emotional expression and cultural richness.

So, imagine my surprise when I just received the link to this program. I was moved to tears watching this video of children getting to learn through the strength of their learning styles, rather than having to adapt from a young age to more singular and restrictive methods of teaching.

 

"A unique approach grounded in academic rigor and high expectations infused with dance has shown incredible results for Gabriella Charter School, which was honored with the Hart Vision Award for Charter School of the Year. Gabriella Charter School is located in Los Angeles, California."

Karyn Edison, Director of Dancing Arts Center and the Massachusetts Dance Festival is calling for a similar academic program in Massachusetts for K-8 kids with kinesthetic learning styles. What a phenomenal idea.

Norma Canner's early dance teacher was Barbara Mettler, who encouraged Norma to go out and teach dance when she moved to Ohio, I think. Mettler's curriculum for Creative Dance is accessible to people of all ages and abilities and builds upon our natural movement language.

Veteran teachers Mary Ann Brehm and Nancy Lob will be teaching in Newton, Massachusetts this summer.

Mettler Studios' Summer Dance Improvisation
and
Teacher Training Workshop
August 6-10, 2012

This is a course for anyone who:
- loves to move freely, paying attention to the sensations of their movement
- enjoys dancing with in groups
- wants to be able to share/teach improvisation or creative dance
 
No previous experience necessary
Course content:
- Movement exploration based on Mettler's core principles of dance
- Progressions for developing craftsmanship in individual and group dance improvisation
- Discussions on how to present Mettler-based material to any group

For more information contact Mary Ann Brehm mabdance@aol.com, 814-670-9214.

The more ways that we can bring dance to children, and to people of all ages for that matter, the healthier our society will be.

 

Expressing Appreciation Build Higher-Performing & More Sustainable Team

Tony Schwartz has written an excellent article, "Why Appreciation Matters So Much", in the Harvard Business Review blog.

"Whatever else each of us derives from our work, there may be nothing more precious than the feeling that we truly matter — that we contribute unique value to the whole, and that we're recognized for it.

The single highest driver of engagement, according to a worldwide study conducted by Towers Watson, is whether or not workers feel their managers are genuinely interested in their wellbeing. Less than 40 percent of workers felt so engaged.

Feeling genuinely appreciated lifts people up. At the most basic level, it makes us feel safe, which is what frees us to do our best work. It's also energizing. When our value feels at risk, as it so often does, that worry becomes preoccupying, which drains and diverts our energy from creating value."

Encouragement and words of praise are much better motivators than negative criticisms. That does not mean that everything we do is great, but that positivity to encourage people to address one's growing edge is more likely to drive results than negativity.

The same is true for people with dementia. Words of praise and recognition of value go a long way toward encouraging people with moderate to advanced dementia to continue to engage in life.

Quality of Staff Communication with People with Dementia Has a Major Impact on Their Quality of Life

Improving Communication Skills in Care of People with Dementia, an article in the Nursing Times.Net,reported the results of a study in the UK. (CSCI, 2008). While this report is about the quality of life for people in long term care in the UK, suffice it to say that in the UK these studies are being done. I have not yet seen similar research undertaken in the U.S. Following are excerpts from the article.

"This study, based on findings from 100 inspections of care homes, used the new Short Observational Framework for Inspection (SOFI) to examine the experiences of 424 people with moderate to advanced stages of dementia."

"Communication issues

While the report recognises that offering the appropriate level of support to people with dementia can be a difficult balancing act, it found 22% of people spent time in a withdrawn mood state at a time of day when people were generally engaged in activities. Those least engaged were those with the most severe communication problems and disabilities.

The investigation did find excellent examples of care, offered with warmth, understanding and tolerance. The data in the investigation report shows a ‘significant relationship’ between people being in a happy and relaxed state and being engaged in the world around them.

Issues surrounding maintaining privacy and dignity were highlighted in 18 out of 100 care homes. The report argues that impersonal assistance and a task-oriented approach undermine people’s sense of dignity and can lead to them being passive and silent. It adds that the quality of communication – both verbal and non-verbal – has a great bearing on how people with dementia feel."

"The CSCI emphasises that it is not just negative forms of communication that leave people feeling distressed; ‘neutral’ styles of communication can also have this effect. A neutral style of communication is defined as staff focusing on a task that needs to be completed, and lacking empathy and warmth.

The report also highlights the importance of promoting communication between people with dementia and family carers, the wider community and other residents."

"The report states that the quality of staff communication with people with dementia has a major impact on their quality of life. It concludes that a significant finding is the negative effect of neutral communication on the feelings of people with dementia, and stresses the importance of well trained and supported staff."

Dr. Meg Chang and I recently completed Nonverbal Communication Training for Caregivers of People with Dementia: An Embodied Approach, the training manual to accompany our trainings. Why an embodied approach. This approach is comprehensive, providing caregivers with the tools to be aware of their own communication style as well as what the person with dementia may be communicating. This is a how-to training program that empowers the caregiver/ staff / trainee to continually evaluate their communication, rather than 10 Easy Steps. After just completing the most recent 120 hour course in Laban Movement Analysis, I can assure you, there are NO easy steps. Every one of us is unique, which means that our communication styles are unique as well.

Contact me for information about our training programs.

2011 Year in Review ~ Dance for Connection

2011 has been an extraordinary year for me and my newly reorganized business, Dance for Connection. Hopefully we will have our new website, Dance for Connection, up and running in 2012. Dance for Connection has a number of aspects, which include:

Dancing with Elders and People with Dementia

Continues to be my favorite part of the work. Playing and bringing joy to elders which continues to bring great joy to me. You can hear about what motivated me to do this work and some of my early experiences at 60 minutes 

Listen to internet radio with Alzheimers Speaks Radio Show on Blog Talk Radio

 

 

 Octaband

See the 4 minute video of the Octaband being used with children and elders. Thanks once again to videographer Sherry Moore and Expressive Therapist Adam Riccio and the children and adults who participated in the video.

Check out our Facebook page and "Like" us. Maybe it will make it easier for you to communicate with us.

You can also see the Octaband video that Music Together created.

We met lots of wonderful folks at the American Therapeutic Recreation Association conference where I led a 2.5 hour workshop. We also exhibited at the New England Region American Music Therapy Association on Cape Cod, Map through the Maze Massachusetts/NH Alzheimer's Association conference, Society for the Arts in Healthcare (SAH) conference in San Francisco in June, Pioneer Network conference in St. Charles, MO in August, American Dance Therapy Association conference in Minneapolis in October.

In 2012 we look forward to seeing the protocol for using the Octaband with the elderly and people with dementia which will be published in Karen Grote's next edition of Behavioral Health Protocols for Recreational Therapy.

Relationship-Centered Nonverbal Communication Training for Caregivers of People with Dementia: An Embodied Approach

Dr. Meg Chang and I have self-published the manual to accompany the train-the-trainers for this course.

I led a 20 hour training for a wonderful group of dance movement therapists and others at Kinections in Rochester, NY this past June.

Meg Chang and I and a panel of 3 of our original trainees at Friends Village, NJ ~ Patience Oakes, Tabitha Gifford and Linda Price ~ presented on the trainings at the Pioneer Network conference. Our work was well received and we had a lot of fun.

Meg and I also delivered our evaluation research findings in poster presentations at the ADTA and SAH conferences.

Back Pocket Dancers

Back Pocket Dancers, an intergenerational dance company of which I am a member, performed for the West Medford Community Center and the Somerville Council on Aging. We're available for bookings in the greater Boston area as of Spring 2012. Check out our video by going to joangreendance.com on YouTube. Click on Back Pocket Dancers to see excerpts of DANCE ME A STORY.

Module II of the Laban/Bartenieff Movement and Somatic Studies was an amazingly wonderful experience at Lesley University. It has helped me as a dancer, dance therapist, dance therapy educator, and trainer in nonverbal communication (to say nothing of myself as a human being). I'll be taking the next Module in January. Lesley will be offering another such certification program in May, 2012.

Woohoo! What a year! What to expect in 2012?  More blogging I'm sure. More dancing, hopefully lots of it with people with dementia. Am looking into setting up some trainings in nonverbal communication on both coasts, presenting at conferences in NJ and Albuquerque I hope. And the Octaband? May it continue to provide people with a sense of belonging. That may be the most important thing of all.