What is music, dance, and theater therapy?

Introduction

Music, dance, and theater therapies employ a wide range of methods to accomplish the goal of successful psychotherapy. “Psychotherapy” is a general term for the wide variety of methods psychologists and psychiatrists use to treat behavioral, emotional, or cognitive disorders. Music, dance, and theater therapies are not only helpful in the observation and interpretation of mental and emotional illness but also useful in the treatment process. Many hospitals, clinics, and psychiatrists or therapists include these types of therapy in their programs. They are not limited to hospital and clinical settings, however; they also play important roles in a wide variety of settings, such as community mental health programs, special schools, prisons, rehabilitation centers, nursing homes, and other settings.

Music, dance, and theater therapies share a number of basic characteristics. The therapies are generally designed to encourage expression. Feelings that may be too overwhelming for a person to express verbally can be expressed through movement, music, or the acting of a role. Loneliness, anxiety, and shame are typical of the kinds of feelings that can be expressed effectively through music, dance, or theater therapy. These therapies share a developmental framework. Each therapeutic process can be adapted to start at the patient’s physical and emotional level and progress from that point onward.

Music, dance, and theater therapies are physically integrative. Each can involve the body in some way and thus help develop an individual’s sense of identity. Each therapy is inclusive and can deal with either individuals or groups and with verbal or nonverbal patients in different settings. Each is applicable to different age groups (children, adolescents, adults, the elderly) and to different diagnostic categories, ranging from mild to severe. Although music, dance, and theater therapies share these common characteristics, however, they also differ in important respects.

Dance Therapy

Dance therapy does not use a standard dance form or movement technique. Any genre, from ritual dances to improvisation, may be employed. The reason for such variety lies in the broad spectrum of persons who undergo dance therapy: Neurotics, psychotics, schizophrenics, the physically disabled, and geriatric populations can all benefit from different types of dance therapy. Dance therapy may be based on various philosophical models. Three of the most common are the human potential model, the holistic health model, and the medical model. The humanistic and holistic health models have in common the belief that individuals share responsibility for their therapeutic progress and relationships with others. By contrast, the medical model assumes that the therapist is responsible for the treatment and cure.

Dance therapy is not a derivative of any particular verbal psychotherapy. It has its own origin in dance, and certain aspects of both dance and choreography are important. There are basic principles involving the transformation of the motor urge and its expression into a useful, conscious form. The techniques used in dance therapy can allow many different processes to take place. During dance therapy, the use of movement results in a total sensing of submerged states of feeling that can serve to eliminate inappropriate behavior. Bodily integration is another process that can take place in dance therapy. The patient may gain a feeling of how parts of the body are connected and how movement in one part of the body affects the total body. The therapist can also help the patient become more aware of how movement behavior reflects the emotional state of the moment or help the patient recall earlier emotions or experiences. Dance therapy produces social interaction through the nonverbal relationships that can occur during dance therapy sessions.

Music Therapy

Music therapy is useful in facilitating psychotherapy because it stimulates the awareness and expression of emotions and ideas on an immediate and experiential level. When a person interacts musically with others, he or she may experience (separately or simultaneously) the overall musical gestalt of the group, the act of relating to and interacting with others, and his or her own feelings and thoughts about self, music, and the interactions that have occurred. The nonverbal, structured medium allows individuals to maintain variable levels of distance from intrapsychic (within self) and interpersonal (between people) processes. The abstract nature of music provides flexibility in how people relate to or take responsibility for their own musical expressions. The nonverbal expression may be a purely musical idea, or it may be part of a personal expression to the self or to others.

After the activity, the typical follow-through is to have each client share what was seen, heard, or felt during the musical experience. Patients use their musical experiences to examine their cognitive and affective reactions to them. It is then the responsibility of the music therapist to process with the individual the reactions and observations derived from the musical experience and to help the person generalize them—that is, determine how they might be applied to everyday life outside the music therapy session. Group musical experiences seem to stimulate verbal processing, possibly because of the various levels of interaction available to the group members.

Theater Therapy

Theater therapy, or drama therapy, uses either role-playing or improvisation to reach goals similar to those of music and dance therapy. The aims of the drama therapy process are to recognize experience, to increase one’s role repertoire, and to learn how to play roles more spontaneously and competently.

The key concepts of drama therapy are the self and roles. Through role taking, the processes of imitation, identification, projection, and transference take place. Projection centers on the concept that inner thoughts, feelings, and conflicts will be projected onto a relatively ambiguous or neutral role. Transference is the tendency of an individual to transfer his or her feelings and perceptions of a dominant childhood figure—usually a parent—to the role being played.

Uses and Goals of Psychotherapies

New approaches and applications of music, dance, and theater therapies have been and are being developed as these fields grow and experiment. The goal of theater or drama therapy is to use the universal medium of theater as a setting for psychotherapeutic goals. Opportunities for potential participants include forms of self-help, enjoyment, challenge, personal fulfillment, friendship, and support. The theater setting helps each individual work with issues of control, reality testing, and stress reduction.

David Johnson and Donald Quinlan conducted substantial research into the effects of drama therapy on populations of schizophrenics. Their research addressed the problem of the loss of the self and the potential of drama therapy in recovering it. They found that paranoid schizophrenics create more rigid boundaries in their role-playing, while nonparanoid schizophrenics create more fluid ones. They concluded that improvisational role-playing is an effective means to assess boundary behaviors and differentiate one diagnostic group of schizophrenics from another. Subtypes of schizophrenia diagnosis, however, are no longer included in the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders, which was published in its fifth addition in 2013.

Drama therapy has also been used in prison environments to institute change and develop what has been termed a therapeutic community. The Geese Theatre Company, founded in the United States in 1980, works to change the institutional thinking, metaphors, responses, and actions unique to the prison environment, to allow both staff and prisoners to change and convert prisoner images and metaphors. The therapists found that drama therapy, or role-play, intensifies the affect necessary to challenge beliefs. The method requires strong support from the staff and the institution. Drama therapy, they point out, provides an unexpected format, action-based, and driven by people in relationship with one another. Their work in prison settings in both Australia and Romania helped in continuing development of process and principles for transforming prison cultures into effective therapeutic communities.

Dance therapy has been found to be extremely useful in work with autistic children as well as with children with minimal brain dysfunction (MBD). The symptoms of a child with MBD may range from a behavioral disorder to a learning disability. Though the symptoms vary, and some seem to vanish as the child matures, the most basic single characteristic seems to be an inability to organize internal and external stimuli effectively. By helping the child with MBD to reexperience, rebuild, or experience for the first time those elements on which a healthy body image and body scheme are built, change can be made in the areas of control, visual-motor coordination, motor development, and self-concept.

The goals of dance therapy with a child with MBD are to help the child identify and experience his or her body boundaries, to help each child master the dynamics of moving and expressing feelings with an unencumbered body, to focus the hyperactive child, to lessen anxiety and heighten the ability to socialize, and to strengthen the self-concept.

Music therapy has been used successfully with patients who have
anorexia nervosa, an eating disorder that has been called self-starvation. Anorexia nervosa represents an attempt to solve the psychological or concrete issues of life through direct, concrete manipulation of body size and weight. Regardless of the type or nature of the issues involved, which vary greatly among anorectic clients, learning to resolve conflicts and face psychological challenges effectively without the use of weight control is the essence of therapy for these clients. To accomplish this, anorectics must learn to divorce their eating from their other difficulties, stop using food as a tool for problem solving, face their problems, and believe in themselves as the best source for solving those problems. Music therapy has provided a means of persuading clients to accept themselves and their ability to control their lives, without the obsessive use of weight control, and to interact effectively and fearlessly with others.

Many health professionals have acknowledged the difficulty of engaging the person with anorexia in therapy, and music has been found to work well. Because of its nonverbal, nonthreatening, creative characteristics, music can provide a unique, experiential way to help clients acknowledge psychological and physical problems and resolve personal issues.

Music and dance therapies are being used to improve quality of life for older victims of dementias, including Alzheimer’s disease. The number of cases of Alzheimer’s is expected to increase as the population ages. It has been found that both music and movement can be used to reach these patients when other methods fail. The keys to this therapy include song preference of the client and the use of music specific to the client’s life and youth. This music has been most effective if presented live, using the same rhythms and syncopations as the original music. Such therapy can be used to support and encourage behaviors that allow patients with dementia access to a higher quality of life, and to the expression of feelings and enjoyment.

Dynamic play therapy is another approach that combines concepts and techniques of drama and dance improvisation. It has been used in clinical settings involving foster, adoptive, and birth families with troubled children. This type of family play therapy emerged from sessions that often included adult caretakers of foster children and addressed specific problems concerning abuse and family-related expressive activities.

Interdisciplinary Relationships

The interdisciplinary sources of dance, music, and drama therapies bring a wide range of appropriate research methodologies and strategies to the discipline of psychology. These therapies tend to defy conventional quantification. Attempts to construct theoretical models of these therapies draw on the disciplines of psychology, sociology, medicine, and the arts. There is no unified approach to the study and the practice of these therapies.

Dance therapy has its roots in ancient times, when dance was an integral part of life. It is likely that people danced and used body movement to communicate long before language developed. Dance could express and reinforce the most important aspects of a culture. Societal values and norms were passed down from one generation to another through dance, reinforcing the survival mechanism of the culture.

The direct experience of shared emotions on a preverbal and physical level in dance is one of the key influences in the development of dance or movement therapy. The feelings of unity and harmony that emerge in group dance rituals provide the basis of empathetic understanding between people. Dance, in making use of natural joy, energy, and rhythm, fosters a consciousness of self. As movement occurs, body sensations are often felt more clearly and sharply. Physical sensations provide the basis from which feelings emerge and become expressed. Through movement and dance, preverbal and unconscious material often crystallizes into feeling states of personal imagery. It was the recognition of these elements, inherent in dance, that led to the eventual use of dance or movement in psychotherapy.

Wilhelm Reich
was one of the first physicians to become aware of and use body posturing and movement in psychotherapy. He coined the term “character armor” to describe the physical manifestation of the way an individual deals with anxiety, fear, anger, and similar feelings. The development of dance into a therapeutic modality, however, is most often credited to Marian Chace, a former dance teacher and performer. She began her work in the early 1940s with children and adolescents in special schools and clinics. In the 1950s and 1960s, other modern dancers began to explore the use of dance as a therapeutic agent in the treatment of emotional disturbances.

There is a much earlier history of music therapy; the use of music in the therapeutic setting dates back to the 1700s. The various effects of different types of music on emotions were recognized. Music could be used to restrain or inflame passions, as in examples of martial, joyful, or melancholic music. It was therefore concluded that music could also have positive healing effects, although these would vary from person to person. Early research showed music therapy to be useful in helping mental patients; people with physical disabilities; children with emotional, learning, or behavioral problems; and people with a variety of other difficulties. Music could be used to soothe and to lift the spirits, but it required experimentation and observation.

Although its theatrical roots are ancient, drama or theater therapy is still in early stages of professional development. The field developed out of clinical experience in the 1920s, and its use and its value as a psychotherapeutic tool is well documented. As a profession, drama therapy now requires the articulation and documentation of theories and methods as well as intensive case studies as support. Four challenges have been identified for the field: to develop new university programs and to increase the supply of students, to expand opportunities for advanced learning and to use mentors to help internalize a professional identity, to produce books and texts to attract new students and to establish the field academically, and to participate with other creative arts therapy organizations to protect legislatively professional interests and the needs of clients. All these forms of therapy can thus be best understood in terms of their backgrounds, relationships, and individual contributions to therapeutic applications in both mental and physical healing.

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