Episode 40: Dance Therapy for PD

Dan Keller 0:08
Welcome to this episode of Substantial Matters: Life and Science of Parkinson's. I'm your host, Dan Keller. At the Parkinson's Foundation, we want all people with Parkinson's and their families to get the care and support they need. Better care starts with better research and leads to better lives. In this podcast series, we highlight the fruits of that research, the treatments and techniques that can help you live a better life now, as well as research that can bring a better tomorrow. Parkinson's disease is a movement disorder, but its effects reach deeper than just problems with motor control. It can affect people's minds, emotions, and spirit. Various health professionals can help providing physical occupational speech, art, music and medical therapy in their areas. One form of therapy, employing dance and movement, can cut across these traditional lines and improve several aspects of life. It focuses on balance, coordination, gait and mobility, but through movement, it also addresses depression, digestive complications, anxiety and fatigue. Dance movement therapy is provided by highly trained, board certified therapists, and may be covered by some private health insurance. I spoke with therapist Erica Hornthal of Chicago Dance Therapy, who describes what dance movement therapy is, what a therapy session is like, and how one can find a therapist or program.

Dan Keller 1:48
What is dance therapy and how does it differ just from dance?

Erica Hornthal 1:54
Sure, so dance movement therapy is the psychotherapeutic use of movement and all that entails. So it can be something like dance, or it could be something as far as our gesturing, our the way we posture, the way we run, walk, jump, talk with our bodies, the way we use our hands, the movement in all of its glory and all of its forms. It's the use of that to contribute to social, emotional, physical, cognitive and even spiritual well being. So it's a way of using the body and the mind to enhance mental health and to help people from the perspective of mental as well as physical integration. How it differs from dance is that it's not based on a skill level or a technique. People don't have to have any ability or previous exposure to the field of dance to participate in dance movement therapy. It really just goes off of the premise that we're breathing, which means we are moving, our eyes are blinking, our heart is beating. And you know, when we are diagnosed with a movement disorder, it totally changes how we relate and move in our own bodies. And even though dance is a wonderful way to engage the body and exercise and stay mobile, it's not always tapping into the psychological things that are happening as our body movement changes. So as a dance movement therapist, I can be present to the therapeutic, the emotional, the psychological aspects of the movement disorder in addition to the physical.

Dan Keller 3:39
So it sounds like it's not only for people with Parkinson's disease, but various movement disorders.

Erica Hornthal 3:44
Correct. In my field of practice and in my company in general, I mean, we see all ages, and we see all cognitive abilities, movement abilities, you know, we work with really any mental health diagnosis, like suffering from depression, anxiety, could be something like an adjustment disorder. Somebody lost their job, any way that there's a psychological occurrence, right? Something changed in our mental health functioning. Somebody can use dance movement therapy. We just see a lot of people requesting movement therapy that happen to be living with.

Dan Keller 4:18
So this is not Arthur Murray. How do you become a dance therapist?

Erica Hornthal 4:23
I wouldn't be upset if people called me Arthur Murray. So I'm a dance movement therapist. You know, they maybe start three or four years old. That was certainly my story. I was a dancer my whole life, and it was my form of expression, my form of release and self care. Ultimately, I decided that I really wanted to be in a helping profession, but I didn't want to let go of that side of myself. And early on, a professor of mine told me about the field of dance movement therapy, and it married the two things that I was passionate about, psychology and dance. And it's very similar to art therapy, music therapy, drama therapy. So I got my bachelor's in psychology and dance, and then dance movement therapy is studied on the master's level. So it's a graduate program, and there are very few programs in the United States that offer it, but it's about a two to three year program, give or take. There's a couple internships required. Some of the programs require a thesis and a practicum as well. It's a little different than a training. It's not just certification. And then to actually become board certified as a movement therapist requires two years of full time work after you've graduated from an accredited program.

Dan Keller 5:38
Does one become licensed or credentialed? What qualifies you, or how does one separate out the people who think they know what they're doing from those who really are highly trained like you?

Erica Hornthal 5:53
Well, thank you. So yes, it's really state to state, though there is an overarching registry where we mention board certification, which is national. But each state is different. And so if you want to become a private practitioner, like I'm from Chicago. I live in Illinois. In order to be a dance movement therapist practicing privately, it's required by my state that I'm either a psychologist, a licensed clinical professional counselor, or a licensed clinical social worker. And the program that I graduated from actually gave me all the credits necessary to be a licensed clinical professional counselor. So I just have to make sure I'm getting supervised, I get all of my hours, and then I sit for an examination, and I have to keep up with continuing education credits every year. It just depends on the state that you practice in. I always tell people, depending on where you're living, if you're looking for a dance therapist, the best way to see if they're legitimate is to go to the American Dance Therapy Association website, which is www.adta.org, and it has a list of all of the registered and board certified dance movement therapists in the country.

Dan Keller 6:58
How do you fit into the care team, and how does someone invoke your services?

Erica Hornthal 7:04
I feel like, personally, I kind of reside somewhere in between social services and activities. You know, we're connected to the mental health side of things, so we are capable of making assessments and referrals. We know the lingo and how to talk to psychiatrists, how to talk to the PCP, the neurologist in the medical field, but we also know how to come at it from an expressive, creative standpoint, where we can come at it from the dance, the music, the really joyful side, if you will. That then allows people to kind of open up and start the work that can be really difficult to talk about. You know, we have this side where it's a little bit more therapeutic and, quote, fun and joyful, and then we have the side that's work and it's challenging, and it's really sitting with people in their disease and in their emotions around that. We kind of can mold ourselves depending on where we need to be, to align more with the neurologist. Do we need to align more with the physical therapist or the occupational therapist and really find that common language that allows them to understand what our purpose is?

Dan Keller 8:17
What is a typical session like? How long does it last? How many times a week does it happen?

Erica Hornthal 8:25
That's the age old question. What does it look like? Because it is a controlled confidential therapy, it's very hard to see it in person if you are participating in it, or maybe a family member is participating in it. We don't get to film it very often. We really don't take pictures of it again because of that HIPAA violation. So that being said, it's hard to see what it looks like. And I always tell people it looks different for every individual. But typically, if we're talking about a movement disorder like Parkinson's, if we're doing a group atmosphere, it can look like a body warm up. We do some guided stretching, and we just always allow people to move from their comfort level, right? Like you're not copying my movement. If anything, I might be using yours as an example. We allow people to be empowered by what they can do, not what they can't do. So we do a little bit of what we call body warm up, a head to toe light movement. It might entail going across the floor. We might be working in a studio where we can play with different rhythms and timing and space, and sometimes we'll bring in like a slice of game, or we'll bring in a scene. Today we're talking about independence. What does that look like in our bodies? How do you move independently? One on one is always different as well. Sometimes it's a little bit more talking and just resourcing the body as it comes into a therapeutic relationship, noticing your posture shifted, your eyes drop to the floor. Tell me what's going on as we're talking. What are you feeling? I've done work with couples where we do adaptive movement lessons, so an individual is, as their movement capabilities are changing and the relationship with their care partner is changing, we can use dance to actually build the relationship back up, or find another way to find compassion or communication through the body, so that we're not just relying on what that person used to say or how they used to move, but how they currently are today, in the moment, within those realms. It can look different every single time we meet, but the goals are always the same. We always want to enhance connection to the self, bring awareness to the body, work on any agitation that might be coming up, decreasing depressive symptoms for an individual be having a really hard time with their diagnosis. So we're always focused on those goals, and then we support and use movement to help achieve those.

Dan Keller 10:50
Is there research on how it affects physical symptoms and mental health?

Erica Hornthal 10:55
So there's a lot of research on dance with Parkinson's disease. There's not a lot specifically on dance therapy, but we're hoping to change that. There is some research that is available on the internet. Some things have been written specifically in the Journal of American Dance Movement Therapy, which people can again find at the American Dance Therapy Association's website. We had the fortune of actually working with Northwestern University this summer, and we did a pilot study with one of their med students, and we looked specifically at how dance movement therapy affected fatigue in Parkinson's disease. And what made it really different was that wasn't your standard dance class, it was a dance therapy session. So not only are we moving and dancing in each session, but we're addressing themes each week and really talking about how the movement makes us feel and how our disease makes us feel, and almost marrying dance with a support group and allowing for a safe environment for people to talk about what's really going on.

Dan Keller 11:58
What kind of feedback do you get from participants?

Erica Hornthal 12:02
Wonderful feedback. I feel lighter, I feel more coordinated, I feel more connected. I forgot that I had this disease. I finally feel comfortable in my body again. I stopped trembling. I relaxed. And oftentimes it comes with this look of shock, like, wow, I didn't think I could feel this way. You know, I always say dance and movement isn't for everybody. Talk therapy isn't for everybody. That's why people need to know they have options. So, you know, if the movement isn't necessarily working, we might refer somebody to an art therapist, or to a music therapist, or some other non traditional forms of therapy. But for the most part, it's seeing the potential in each person and having them understand that this isn't a life sentence. I can actually learn to live a quality of life with this illness and learn to accommodate and be comfortable in this ever changing body.

Dan Keller 13:00
Do you think there's an aspect of rhythm adding to someone's abilities, as opposed to just making a volitional movement? It's almost sort of an automatic movement, I'm thinking of like people who stutter singing.

Erica Hornthal 13:16
Absolutely. So we use rhythm a lot. People don't have to be able to keep a beat or stay in rhythm. People say, oh, it's two left feet. That's okay. Two left feet are always welcome in this room. So it's not about being able to keep a rhythm, but there is something in movement therapy we call rhythmic group activity. There's something about everybody participating in the same action, same rhythm, if you will, that creates a sense of validation, support, camaraderie. There's a physical validation that happens, as well as a psychological validation of being seen and felt. There are people that come because of the music. As soon as you put music on, my toe starts tapping, and that's the in for some of the other work to happen. You know, we have other individuals that maybe prefer not to use music, and we really are just talking and kind of using the body as a guide for relaxation or stress management or symptom management. But absolutely, I think a lot of people come because of the rhythm that comes with the music that we often use.

Dan Keller 14:20
Have we missed anything or anything else interesting to add?

Erica Hornthal 14:24
You asked all the really important questions. You know, the only thing I just always like to leave people with is that everybody has the ability to try therapy. We work with individuals that are mobile, and we work with people that are in wheelchairs. I've worked with people at their bedside, so we have to kind of take out stigma that comes with the word dance and just see it more as all the abilities that our bodies have to move, period, how we walk, how we gesture, how we posture, how we even breathe, and just knowing that until we take our last breath, we're always moving. That's the first way we learn to communicate, and it'll be the last form of communication we have, which is allowing people to kind of change the way they look at what movement means, not just exercise. It's actually a way of being and a way of communication.

Dan Keller 15:13
Excellent. I appreciate it. Thanks.

Dan Keller 15:26
You can get a good summary of dance movement therapy at parkinson.org/dance therapy. For more in depth information, go to the website of the American Dance Therapy Association at adta.org. And of course, you can call our toll free helpline to speak with our PD information specialists. They can answer questions and provide information about this topic or anything else having to do with Parkinson's. You can reach them toll free at 1-800-4PD-INFO. If you have any questions about the topics discussed today, or if you want to leave feedback on this podcast or any other subject, you can do it at parkinson.org/feedback. At the Parkinson's Foundation, our mission is to help every person diagnosed with Parkinson's live the best possible life today. To that end, we'll be bringing you a new episode in this podcast series every other week. Till then, for more information and resources, visit parkinson.org or call our toll free helpline at 1-800-4PD-INFO, that's 1-800-473-4636. Thank you for listening.

Erica Hornthal, LCPC, BC-DMT, is CEO of Chicago Dance Therapy. She is a clinical counselor and board-certified dance therapist who specializes in working with individuals living with movement and cognitive disorders. Additionally, Erica works with people of all ages and abilities to connect the mind and body to promote self-awareness, self-expression, healthy attachments, compassion and improved quality of life.