SPECIFIC DMT GROUPS INTEGRATING FLAMENCO IN TENERIFE, CANARY ISLANDS, SPAIN

Context

The following discussion is based on Dance Movement Therapy workshops carried out in the Canary Islands, specifically the Island’s Plan of Psychosocial Rehabilitation for people with Severe Mental Disorder in Tenerife, Spain. One of the objectives of the DMT workshops was the rehabilitation of psychic functions, physical health, interpersonal relationships, performance of roles, and coexistence in a normalized environment. A set of complementary resources was implemented to cover the needs of the patients and their family members.

Within this context, there are two kinds of housing solutions. The first is protected dwellings, or “sheltered apartments,” that are distributed throughout the territory of the island to facilitate patients’ accessibility and contact with their families. Patients with less deterioration live there and are supervised by a multidisciplinary team. The author worked there with the support of a nongovernmental organization (NGO). The second housing solution is the “miniresidences” where treatment is more personalized. It is in the miniresidences that persons with greater cognitive deterioration live.

DMT was provided to both populations, and during the sessions, flamenco dynamics were used as a socio-affective experience that facilitated body expression.

Patients/Groups

For the intervention integrating DMT and flamenco, there was a total of 42 participants with severe mental disorders who belonged to the Insular Plan of Psychosocial Rehabilitation of Tenerife, Spain. The control group was created with the 37 persons who participated in the workshop of Occupational Therapy for Activities of Daily Living (Al)I.l.

In the DMT workshops, participants were distributed among four groups in the miniresidences and one group in the sheltered apartments. In the latter, patients came to the space where the DMT sessions were held and offered by a town hall. With the other groups, the sessions were held in a structured space created in the same center (the miniresidences) where the patients lived. Participants signed a consent form at the beginning of the intervention.

The members in the DMT workshops presented differences in levels of cognitive deterioration, little autonomy, and little verbal and nonverbal interaction; they also had tendencies to social isolation. The sessions were adapted to the patients’ characteristics. The more independent patients and groups tended to make more use of the space, while the more deteriorated preferred to stay seated and responded better to structured sessions.

We offered those in the miniresidences groups of ten participants, realizing that dropouts could occur at any time, and we also formed an open group in which patients were free to attend or not. On average, each group was comprised of seven to eight participants with the number varying by day.

For the persons coming from the sheltered apartments, a setting of a closed group with an average of seven participants that ran for a three-month period was chosen. After a three-month period, an assessment of the process was made since the DMT offer was in high demand.

All group sessions took place twice a week for a duration of 45 minutes per session. We were clear that the work focused on the person who moved, not the disease or the symptom, but this does not mean that we did not know the characteristics of each individual’s pathology.

METHODOLOGY

The therapeutic objectives were established after evaluating the characteristics of the users. The majority were found to have a lack of body-mind integration, an absence of corporal limits, and a lack of gestural unity (twisted, sporadic, irregular movements, and so on). Once these baselines were established, the therapeutic goals were established. Examples of therapeutic goals include:

  • • To promote the integration of the body and reinforce the real sense of the body image of each participant. That they were able to recognize it, feel it, and differentiate it from the environment.
  • • To promote trying different movement patterns since having more freedom to move could foster autonomy and experience of other ways of being (Wengrower, 2008).
  • • To assist in the control of impulsive behavior and stereotypes.

After several sessions of DMT, a movement profile of each user was generated that gave us information about the body, the movement, the coordination, the use of rhythm, and relational aspects like proximity, visual contact, and presence towards the group, the therapist, and the accessories (see the Appendix).

Development of the Groups

During the development of the sessions, it was very important to create a ritual that would be repeated each time. We started with some rhythmic songs from the collections of Solo Compas, Rumba de los Chichos (“Libre quiero ser”) and Tangos de Camaron (“Como el agua”). The musical activity diminished the patients’ negative symptoms and improved their interpersonal contact, while the compass of flamenco helped them to find structure and stay calm (Lopez, 2014).

Most of the DMT flamenco-based interventions were carried out in the free movement segment within the sessions where there were improvisations of flamenco movements accompanied by the recorded music of Camaron, Solo Compas, and Enrique Morente. On some occasions, after a closing verbalization, the group improvised, moving to various flamenco rhythms, like tangos, solea, rumba, and so on, by forming a “flamenco group” where each individual entered into the center of the group and danced. Reinforcing “jaleos” were used, that is, each person who entered the center of the group received from the other patients a word to bolster their self-esteem, such as “Ole!,” “You are beautiful!,” “How brave you are!,” and “You are so worthy!”

Jaleos are part of the flamenco culture; participants encourage and celebrate the dance of each one in the group’s center. There are infinite expressions in jaleos, which are said following the beat and express respect for the performance. The jaleos were so effective that in one of the groups it was used as a farewell ritual for almost a year of therapy. This was done with the aim of helping the process of internalization and to verbally share moments that had happened in the round of “jaleos.” In these improvisations, the movement patterns were extended. We began to realize how important it was for the identity and self-esteem of the participants that they receive a compliment, a show of affection, admiration, and so on.

The work was progressive, moving from a simpler to an advanced use of space, body, and timing-rhythm. Here is the progression we followed:

  • • Perform exercises to basic flamenco rhythms (clapping, foot tapping on the floor, beat-palm combination, and so on) toward the creation of a common rhythm (group cohesion).
  • • Perform exercises to everyday and easily identifiable rhythms (ticking of the clock, the waves of the sea, a dripping tap, the ring of a telephone, and so on).
  • • Perform improvisation exercises of rhythms with music.
  • • Introduce some flamenco beats and rhythms (tangos, solea, bulerias, and so on).
  • • Move and improvise with these rhythms as a reference.

On some occasions, games were introduced to stimulate expression, communication, and mitigate the patients’ tendency to self-absorption. The most cognitively impaired patients had more problems creating cohesion and recognizing themselves as part of a group. In this case, it was through the game that they managed to stay attentive and focused. They played to reproduce sounds or sang, imitated others, made faces, and so on and thus released tensions. Some of the games offered were change of expression of the face and body, pass the ball between the group members, mirror the movements of a partner and exaggerate them, or even playing pretend, such as pretending that one individual was a sculptor and another a piece of clay.

Other interventions introduced were based on the integration of color and emotion and the clock wheel, which is commonly used in the teaching of flamenco.

Color and Emotion

Colors are able to stimulate joy or sadness, they can make us feel energetic or relaxed, they favor sensations of cold or heat, and they make us perceive order or disorder. Although the perception of color is an individual and subjective process, cultural factors also influence how color affects us. For example, some colors are identified with the masculine and with the feminine, and others with the romantic, but this differs by culture (Heller, 2004). What follows are some associations made about color in the flamenco-based DMT interventions:

  • • Patients were told to associate each emotion with a color (red-passion, blue-loyalty, black-sadness, orange-joy) which is then materially shown through a colored handkerchief or fabric. In this game, everybody would choose a handkerchief according to its color and their personal association with the mood they felt, and then they improvised flamenco steps alone or interacted with one another. At the end of the session there was a verbal sharing of the experience.
  • • In another game, patients were told to associate a color with a flamenco rhythm (palo) (red-passion, blue-loyalty, black-sadness, orange-joy).
  • • A third activity was pretending to “paint colors on the canvas” as a metaphor that involved the creation of choreographies that start from within the group itself.

There were differences between groups and between individuals in the capability to engage in imagination and symbolization. For example, one of the miniresidence groups that worked very well with the rhythm was unable to get out of the everyday, the common, and demanded a rigid structure and containment. For that reason, in the free movement segment of the sessions there was hardly connection or participation. Therefore for them, verbalizing aloud in unison a rhythm by solea or counting the numbers that represented time was much more satisfying than working in free movement.

Clock- Wheelfor Learning the Compass by Solea

The group with the least cognitive impairment learned through this mnemonic rule to recognize the rhythm and measure of the flamenco palos solea and buleria. They first learned

Image 17.2 Clock-Wheel for Learning the Rhythm for Soled by Bulerias through the word, naming in unison each number and time, and progressively added palms with hands and feet. In time, the participants marked with the voice and palms the 12-beat time in soled and were even able to memorize it (Image 17.2).

Process

After a period of approximately six months, users recognized the purpose of the DMT groups and the space where the sessions were held as well as established trust with the therapist and the other participants. In all the groups, the movement patterns were widened and self-absorption diminished, thus increasing group interactions. The group setting allowed each user the opportunity to receive from the other participants a recognition and feedback on their actions.

After six months, the first physical interactions and emotional expressions began to appear: touching hands, hugging, crying. During this time, the patients began to recognize the effects of the disease on themselves and others. They began to have expand movement capacity. This differed from how they had started with rigid bodies and mechanical movements that gave the feeling of being protected by a shield, containing emotions inside. Flamenco requires work on posture, and it is effective when the patient acquires greater body awareness and therefore greater autonomy. The postural change, slow and progressive, made people need more space in the sessions, and in some groups, this was an obstacle in terms of the workplace but it was a reward to be able to observe these bodies “larger” and exhibiting more autonomy.

Using Marian Chace’s DMT model as a reference, we structured the sessions into different phases. It was in the central part of the session where different types of dynamics were carried out. Depending on the group or the circumstances, this middle section was free or guided and based on different creative proposals (plastic, musical, body, moving, and so on). On some occasions, the initial proposal led to other spontaneous actions generated by the participants, and it was therefore very important to observe carefully and assess their interventions and motivate their autonomy.

In this phase, the majority of the flamenco dynamics took place: improvisations, use of castanets, photo visualization of flamenco artists (i.e., Carmen Amaya, Camaron de la Isla, Paco de Lucia) so that patients could know about and learn from these inspirational figures. To know and recognize the flamenco compass, we clapped with our hands, feet stamping against the ground, and used a metronome. Thus, the memory capacity was also enhanced by repeating a sound or a movement proposed by each one of the members of the group and joining them all in a wheel with greater or lesser speed, thus producing an improvement in coordination and perception of space. Using flamenco art at specific times enriched the sessions because of the great variety of resources it has.

Evaluation Study

In the following sections we shall discuss the evaluations carried out to check if the DMT flamenco intervention affected the interaction and cohesion of the groups.

The objective of the study was to verify the effect of a DMT treatment using flamenco on the interaction behaviors of the participants over a two-year duration. More specifically, we compared the level of verbal and nonverbal interaction that occurs spontaneously in the DMT group versus a control group that participated in an occupational workshop. The global level of interaction was compared between both groups.

For the study, a double-blind methodology was used. Videos were recorded in situations of spontaneous interaction before beginning a session of the different therapies in which the patients participated. Patients did not know that they were being observed in their interactions, nor did the observers have information that the people they were observing were mental health patients, much less that they belonged to different treatment groups.

Method and Procedure

A video recording of three minutes was taken with each one of the DMT groups and the control groups while they waited for the beginning of a session. They were unaware they were being filmed and did not receive specific instructions on what to do. The only instruction they received was that they should wait in the space at the beginning of the session. The objective of this instruction was that the possible interactions produced would be spontaneous and not induced by the researchers, and that differences between both groups would not be established. During this time, no researchers, therapists, or center staff were present.

Table 17.1 Register Sheet of Interaction Behaviors During Videos

Behavior Record Sheet—Interaction

Age:_______Gender:_______

Verbal interaction level nothing 0-1-2-3-4-5 a lot

Nonverbal interaction level nothing 0-1-2-3-4-5 a lot

Global interaction level nothing 0-1-2-3-4-5 a lot

One three-minute video of a DMT group and another three-minute video of the control group were chosen at random to be evaluated by observers. In the instructions given, observers were asked to assess the participants’ levels of interaction in each video in three categories: verbal, nonverbal, and global or general interaction. Evaluators indicated their observations on a Likert scale of six levels (0-5) in which the 0 was labeled as “no interaction” and 5 as “a lot of interaction.”

The DMT group in the video consisted of five patients (one woman, four men, ages 35—55), and the video of the control group consisted of eight patients (five women, three men, ages 34—59). Evaluators were either fourth-year psychology students (zz = 35) or sixth-year medicine students (n = 17). The total sample of observers (n = 52) had an average age of 23 years (the age range was from 21 to 56 years), and 77% of the sample were women.

The videos were projected without sound, so that both verbal and nonverbal interaction could be evaluated from exclusively visual information. Each observer filled out the form anonymously, only indicating his/her age and sex. After the sheets were delivered, the purpose of the study was explained as well as what type of patients participated in the research.

The image of the videos was distorted to guarantee the confidentiality of patients’ identities. As previously stated, each participant signed an informed consent document prior to entering the study.

Results

Three analyses of variance (ANOVA) were carried out using IBM’s Statistical Package for the Social Sciences (SPSS). Each of the ANOVAs compared the score assigned by the students on the Likert scale to the DMT group and the control group. The students noticed more interaction in the DMT group than in the control group (Figure 17.1).

For nonverbal interaction, greater interaction was seen in the DMT group than in the control group (see Figure 17.2).

Regarding general interaction, the video of the DMT group was rated higher than the control group (see Figure 17.3).

The Pearson correlations between the categories was significant in all cases (p < 0.001). Within the DMT group, for verbal and nonverbal interaction, the value was 0.45, between verbal and global 0.67, and between global and nonverbal 0.63. In the control group, for verbal and nonverbal interaction the value was 0.63, between verbal and global 0.56, and between global and nonverbal 0.80.

Average of the Verbal Interaction Level Estimates Provided by the Evaluators

Figure 17.1 Average of the Verbal Interaction Level Estimates Provided by the Evaluators

Average of the Nonverbal Interaction Level Estimates Provided by the Evaluators

Figure 17.2 Average of the Nonverbal Interaction Level Estimates Provided by the Evaluators

Average of the Estimates of the Level of global Interaction Provided by the Evaluators

Figure 17.3 Average of the Estimates of the Level of global Interaction Provided by the Evaluators

Discussion

The DMT group was rated by the observers as more interactive than the control group at all levels. We could say that the results of this study support the idea that the treatment developed based on the principles of DMT and the use of flamenco during two years of intervention promoted interaction among users and therefore could be related to a reduction of some of the negative symptoms of their disease, or at least with an increase in group cohesion and reduction of the isolation felt and experienced by this type of patient (see Image 17.3). We should not consider that our results are in any way definitive and significant since there were few patient groups analyzed and we do not have evaluations/measurements of the patients prior to the beginning of the treatment. Additionally, the patients were not randomly assigned to the treatments of the different occupational workshops; they voluntarily enrolled in the groups. Despite these limitations, we can point out that the findings presented in this work are very encouraging.

Image 17.3 Participants experience reaching outwards towards others through their enhanced presence.

Photo courtesy of Keren Yehuda. Photographer: Svetlana Oltzblat Taub.

CONCLUSION

From our experience, we can say that flamenco art enriches DMT sessions clue to its great variety of resources. Following the rhythmic structure requires great attention and the ability to listen in order to perceive the nuances of the accents and to mark the times, the offbeats,3 and the syncopates. Thus, the memory capacity of patients is enhanced by repeating a sound or movement proposed by each of the members of the group and joining them all in a continuous wheel at a higher or lower speed, which thus produces an improvement in coordination and perception of space.

The results of this study showed the intervention appeared to have a good effect on the interpersonal relationships of participants. It allowed the expression of emotions and feelings in a creative way. Flamenco art shares musical, verbal, and gestural language and common signs in the culture of large areas of Spain. Its elements complement, enrich, adapt, and support each other without losing their identity. The common denominator to all of them is the rhythm. Therefore, it is ideal to use as this communicative form for DMT interventions in Spain, for, in addition to the work presented here, flamenco is integrated into working with people in other therapeutic, educational, and social settings.

APPENDIX

Observation Sheet. Based on Laban’s Movement Analysis (White, 2008)

Movement Observation Sheet Date____________________________________

Therapist’s Name___________________________________________________

Date of the Observation______________________________________________

Context of the observation: what is the participant doing, where, with whom . . .

  • 1. The general impression the therapist has from the patients (metaphors, images)
  • 2. Body:
  • 2.1 Posture: rigid or tense, relaxed, curved ... Is there tension tn any part of the body?
  • 2.2 Do all body parts move equally? What body parts are most active? Body parts that lead the movement.
  • 2.3 Physical contact: with himself, with members of the group.
  • 2.4 Breathing (deep, shallow, sighs . . .)
  • 2.5 Sense of one’s own body, grounding.
  • 3. Actions: Frequent movements, tics, touching themself
  • 4. Temporal aspects: Preparations, transitions, accents
  • 5. Spatial aspects: Use of the general space. Personal kinesphere (near, medium, far) Levels preferred (high, low, medium) Planes (table—horizontal, door—vertical, wheel—sagittal)
  • 6. Efforts

Flow: Free—bound

Space: Direct—Indirect

Time: Sudden—sustained

Weight: Firm—light—passive

7. Relational aspects

How the Patient Contacts with the Therapist, Other Participants and Props

Proximity

Eye contact

Grounding, presence

Verbal communication

8. Use of the voice and verbal communication

Voice Volume

Intonation

Vocabulary

Phrase construction

9. Comments regarding coordination and rhythm

NOTES

  • 1. For more information about the Chace approach, see S. Chaiklin & C. Schmais (1993) The Chace approach to dance therapy. In S. Sandel, S. Chaiklin, & A. Lohn (Eds.), Foundations of dance/movement therapy: The life and work of Marian Chace (pp. 75-97). Columbia, MD: Marian Chace Memorial Fund.
  • 2. For more examples on DMT work with persons with severe mental disorders, see Capello (2008, 2016), Wengrower and Bendel-Rozow (in press).
  • 3. An oflbeat is the accent shifted between two times: clapping exactly between two times. That is, the notes played or sung in the weak parts of the measure are preceded by a silence located in the strong part.

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