As the Dance Winds Down: Coping with Aging as a Dance Therapist

Jane Wilson Cathcart

In dance/movement therapy, the role of dance is both central and unique. Central to our psychotherapeutic form is the dance, with all inherent expressive possibilities. The uniqueness of our work is how we use our whole selves always with dance as the starting place. It is our creative and physical home base. Most theoretical models offer the sequential phase of development, on one or two axes, similar to a series of still snapshots. However our way of knowing happens both sequentially and simultaneously. It is more similar to a hologram where you walk around and peruse with greater depth, larger surface and wider context. We see in space, time, weight and flow; in the personal kinesphere, the interactional space and the physical holding environment. Additionally, because of the dance our model is neither static nor flat.

There is no dance without the body: not the mind, not the spirit, not the words, and not even the pure body: the dancing body. This embodiment is our vehicle and instrument of sensing, observing, responding, interacting and healing. In our field we often refer to Freud’s well-known statement in that the ego is first and foremost a bodily ego (1961). This is true for all humans. And dance/movement therapists value this particular definition of self in our schema of identity. Winnicott furthers this tenet when discussing the ongoing “basis for self in body” (1972). We realize, as van der Kolk (1996) states, the body keeps score. We know this within our profession and within our personal embodied selves. And if the body keeps the score of trauma and hurt, might it not also keep the score of masterful and pleasurable experience? This positive transitional phenomena can provide strength in times of injury and lessening of capacities due to aging.

While we develop and gain life experience intellectually, emotionally and physically our bodies remember . . . how it felt to skip, climb a tree, ride a bicycle, and dance on pointe. When we work with others we are invited to sense the other, to meet that separate self in a mutual space. We use our well-honed skills of mirroring and reflection to attune with others. This demonstrates our connection, empathy and understanding while offering a creative framework for perceiving a direct access to another’s mental and emotional states (Damasio, 1999).

This is all well and good when we work at full physical and expressive capacities. But what of injury and aging? Perowsky (1991) helpfully reminds us that “Unlike professional dancers, dance/ movement therapists are not required to gracefully retire when the aging process takes its toll and increases vulnerability to injury. Therefore, they must consider how to function despite impairments due to age or injury” (p. 50). Both sides of the therapeutic relationship are affected. It used to be that I would extend or refine a patient’s movement repertoire by offering my own. What happens now that my repertoire is diminished? How does the “call and response” shift? While I would “pick up” on the other’s movement, now I have to modulate and regulate my response and offer dance that extends or refines without being able to necessarily physically offer my former full range of ways to cope with the internal and external environments (Bartenieff & Lewis, 1980). As a consequence the patientmay not feel as strong a bond, as safe a holding environment, as rich a facilitating climate as before. The therapist may feel at the ver}' least limited, possibly incompetent, maybe fraudulent, perhaps even as an invalid. There are many feelings and many challenges.

We as healers meet each person where they are and the excitement for this existential moment has not changed for me (Moustakas, 1966). But now what happens after that has changed dramatically. While moving together still elicits the dance elements, I can no longer offer the same expanded or focused ways to move the individual’s “dance” along solely by my own physical expression. What happens subsequently has shifted and is more charged with probable limitations. I realized too much was changing much too fast when I worked with preschoolers into my early sixties.

Throughout my career, in sessions with individual children and groups I always utilized highly energetic, rhythmic and richly interactional dance. We would change levels: stand, squat, spiral, sink to the floor, rise again and so on. One day I was quite puzzled by the way the preschoolers were descending and ascending hesitantly and cautiously, as if elderly. I asked the staff for their thoughts. They pointed at me and gently said the children were mirroring me. The children could express fully all elements of the dance, while more often I could only suggest the intended movement.

At the same time in my private practice I was also unable to dance as fully as I once had been able. I began to utilize more of what I refer to as “mumbling”. This is a way of reflecting in a more muted way the elements of movement. The name is derived from mumbling verbally, where there is a sense of what is being stated but also a lack of clarity in the expressed thought. I had begun using it decades earlier to purposefully reflect a diminished sense of what patients were presenting, but in a way where their greater abilities could be expressed as they showed me more fully what they were “saying” when I got it not quite right. Correcting me succeeded in eliciting from them what had been in them all along. Fischer and Chaiklin (1993) note this was a lesson learned from Marian Chace who “chose interventions which might elicit healing responses from each person” (p. 137). Our use of this Socratic model of health is one of our strengths, we are midwives to the strengths within those with whom we work (Cathcart, 2014).

Earlier in my private practice I devised the following technique with a particular patient while I was still able to dance fully. She was a young adult who was motivated to pursue dance therapy previously experienced in an inpatient facility. However, she would only talk and not dance in any way, shape or form. She finally agreed to walk around the dance therapy room. During one of these walks she said an image of a ladder would be helpful in our sessions. Ready to latch on to anything that might make me feel more effective as a dance therapist, I found one in a neighboring office. She directed me as to how to move with the ladder as a prop laid on the floor, and she remained unwilling to do anything but give directions and correct me verbally. I moved so badly (on purpose at the time) so that she was forced to embody her own experience while correcting me—this is always empowering for a patient. We continued this back and forth with her finally joining fully as a participant in her own healing dance.

I employ a mechanism I refer to as “mini-choreography”. This usually involves my demonstrating in a reduced way the salient contrast under consideration in our clinical work. Sometimes it will be polar opposites: moving from the stuck feeling or emotion versus the desired expression, action, release as a healthier way of coping. One example of a common theme is the giving all and dispersal of self until there is nothing left to maintain uprightness. No “legs” if you will, to “under stand”, or stand under and support. This uses a pun of

“understanding” when the ability to support the self is depleted. It is contrasted with giving, reaching only so far as you are able to return to the stability of the self. At the very least, this dance expands ways of thinking and experiencing the patient’s conflict; more often it widens their repertoire. The frequent result is a broadened expression to illuminate the “how” of that individual’s experience in danced form. Here I am the mover, many times in a “call and response” with the patient in a subsequently embodied refinement or expansion. This structure supports their needs, and I am capable within my gesture and muted movement to offer and model these options. .And they are able to try them on, make adjustments, and own what really has been their own dance all along. They may be experienced internally and invisibly, but felt nonetheless.

A useful pathway for these later years was also created well before injury, aging and the loss of mobility arrived and moved in. I decided that in order for mutual clarity about goals in private practice I would need to set the therapeutic goals with the client and to arrive at a structure that translated movement into words at the outset. This is in contrast to my agency work where treatment plans were the guide to goals, at the ver}' least a starting point dictated by the institution rather than patient input. This simple innovative structure enabled me to suggest form for the individual’s content and goal setting both verbally and nonverbally.

Most patients were desiring to dance and move within sessions. After all, they came into treatment with me precisely because I am a dance therapist. However, they also wanted to talk. The goal of dance therapy is not to make patients elegant beautifully moving expressive mutes. It is instead to enable their full expression, including and not incidentally verbal communication.

The structure of this exercise was simple enough. Once we introduced ourselves, I invited the patient to experiment. Would they go outside the room, close the door and when ready come back into the therapy room? There were two re-entries required using no words. I asked that I be shown first of all, how they felt coming into the room, into therapy and so on at this very moment. The second entrance would present how they thought they might feel entering the room for the last time when we were in agreement our work was satisfactorily finished. These demonstrations of before and after were then put into their own words. Bodily expression preceding the intellectual offered a glimpse of the parameters that would guide us in our therapeutic contract. This became a reference throughout our work as well as concrete transitional phenomena for the patient to take away between sessions. An additional, and major goal, was to facilitate understanding about how the body speaks, remembers and is present in all our living moments. Everyone who agreed to experiment with this structure completed both parts—except one woman.

She took a bit longer than most to prepare. As usual I was standing fairly close to the door. When the door opened I looked and saw nothing. No one was down the hall. But there she was, on her belly on the floor, crawling into the room. She stopped as soon as she was clear enough for the door to shut again. I joined her, face down on the floor on my belly. And so we spent our first session. Now, I would be unable to join her so quickly, move so readily and maintain that position due to old injuries, joint replacements and my aging body. I certainly could respond therapeutically, but at this point in my life it would be vastly different in energy, shape and level. For example, I now use gesture to shape what I once would have expressed in my whole body. Hands can replicate so many elements with dimension and dynamics. In sessions we are able to increase or decrease our expressive movement in shape, speed, height, force and flow. The hand is a universal communication tool that I now combine with my torso, limbs and whatever else is needed and able to engage in the dance. However, no matter how transformed, the intent for healing remains.

There is nothing permanent except change.

—Heraclitus (2018)

When we change, the dance changes. And the opposite is true. As my dance has changed, I have had to reset expectations about my abilities. I have reworked the definition of myself and my identity while looking for other constants. There are many stages in life. Stages of learning, developing a relationship and of development of our physical, emotional and thinking selves. In our work we are trained to apply our craft to the different life stages of our patients. But what of the different stages we clinicians traverse as we continue dancing through our own life cycles? Looking at the stages of the life cycle has been an extremely useful schema both clinically and personally.

Erikson (1959) provides a context of challenges for each phase. While his system describes a progression, it can also remind us how we revisit the issues over and over each time we face a similar situation There are eight psychosocial stages offered, of which I have found the first and the last two most enlightening for the purposes of this topic.

The earliest stage of development is trust versus mistrust, the latter of which I now experience predominantly on a body level. Is my “new normal” dance movement safe enough for me on a physical level, and adequate for my patients in a reflective, healing context? When referring to Terese Benedek’s correlating trust with confidence, Erikson understandably negates confidence as a useful descriptor of an infant (p. 63). However, I see it as a useful naming of what I am personally revisiting in this time of waning ability. Indeed, I feel a mistrust, and am therefore far less confident in my dance movement repertoire. Often my struggles parry between embracing and overcoming the attendant mistrust. Yet trusting my instincts, intuition and current body response all lead to a revised, albeit abridged, sense of confidence.

Generativity versus stagnation is the next to last stage. And while he meant generativity mainly in a genital reproductive sense, he allowed a far wider definition:

Generativity is primarily the interest in establishing and guiding the next generation, although there are people who, from misfortune or because of special and genuine gifts in other directions, do not apply this drive to offspring but to other forms of altruistic concern and of creativity, which may absorb their kind of parental responsibility.

(Erikson 1959, p. 103)

This defines how I classify myself. I plan to continue my work life for the rest of my days.

Concomitantly, I am squarely in the integrity versus despair stage. For me, despair is largely absent as an issue. Rarely in my life has it been present, even in moderation. Part of that is due to temperament. Another part must be clearly attributed to the transformative nature of dancing itself. We dance among the possibilities of response to life not only with our patients but within our own psyches, minds and creative bodies. Now is the time to renew our acquaintance with that source within us as we address our own needs. We have solved some of the very same crises we might personally face at times when treating others. This is a reverse treatment of the projected self: we remember how the challenge was resolved for another with our help, and we reach into that repository and now try it on as a possible solution to a current personal situation. Always we employ the elements of the dance to reintegrate this newfound sense of self.

Can you, can’t you, can you, can’t you, can you join the dance?

—L. Carroll (1865), The Lobster-Quadrille (paraphrased)

Decades ago I sustained a knee injury from singly breaking up a fight among four adolescent boys yielding large pieces of wood as weapons. This marked the end of my ability to dance on pointe. I had always felt so fully engaged in my body and in space when dancing on pointe for my own pleasure. It was also as recuperation and self-care from my clinical work life. However, this loss was certainly not the end of being in the world as a dancer—not by a long shot! Edited? Perhaps. Nevertheless, I had no idea that this particular lesson in reduction would be in the service of my ego for this current stage of life.

Here we continue to talk about ability. Not desire. Not even will. The reality, however, is that the full-out physical response as a dance therapist is diminished. Sandel and Hollander (1995) might include aging dance movement therapists when they state: “Implicit in a dance/movement therapy session with the physically challenged is the expectation that people will attempt to move and that movement stimulates their feelings about their bodies and their physical limitations” (Levy, 2005, p. 115). Some aging dance therapists would dance and move less. Less is experienced as loss. Vigilance is needed to view the loss—to experience and move both with and through the attendant sadness. The emotional aspect of the work likely remains unchanged, with the patient remaining the central focus. The content of the goals and goodwill towards the patient has not shifted, but the emphasis in the “how” has. The physical reaction in the clinical setting might appear to be more offhanded rather than hands on. Perhaps one becomes more witnessing or directive than participator}' in body. Perhaps the full-out dance has become the art of gesture and more muted expression. There are many possible responses for individual therapists facing their increasing years.

Does this new iteration of the aging clinician still have validity? If not, it would become invalid. Turn the adjective “invalid” into a noun, pronounce it with different emphasis and it defines one as “not strong” (from Latin, invalidus, from tn-‘not’ + validus ‘strong’.) No one wants to be negated, and yet the ancient Greeks saw old age as a form of unconsciousness. They posited if you were infirm in your body the rest of you followed into a demise of the self. This is juxtaposed against the concomitant reverence of elders and their wisdom. If both of these notions, seemingly opposite, can be contained in the thinking of a great civilization, who are we to argue? We can be both diminished in physical capacity and wise and valued for our lived years. Our field assesses people from a strengths perspective. Turn this mirror on our aging selves to rediscover our capacity for being as vital and present as possible. Is there an inverse relationship to knowing in ways other than the physical abilities? Does the inability to move as freely as I once did force my antennae to tune in differently? Is my new type of full presence now also redistributed in a new way?

The privilege of a lifetime is being who you are.

—Joseph Campbell, A Joseph Campbell Companion: Reflections on the Art of Living

Many currently aging dance therapists were most fortunate to learn from the founders of Dance Therapy as a modern profession. Those women were also in their older years when they taught us what they had gleaned over their lifetimes. As I write these words, I realize that Marian Chace was only a couple of years older than I am now when I was in her last class at Bellevue. Similarly, Irmgard Bartenieff was around my current age when she taught my two-year certification program at the Dance Notation Bureau. I reflect on some of the differences of these particular dance therapists at the end. What now do I incorporate of them at that stage in their lives?

The work of Chace and Whitehouse was not mutually exclusive; rather it overlapped, forming a continuum of style and technique with healing expression at the core.

When I studied with Chace in the final months of her life, I was struck by how little dancing occurred as opposed to a concentration on meaningful gestural dance movement. Much of what I learned about adaptation was demonstrated by her clinical work just weeks before her life ended. She healed mainly from her seated position.

While I did not study with Mary Whitehouse, she was highly regarded and well known in the field. Her techniques were so different than those of Chace. I wondered how leading from a seated position due to her MS compared with Chace. Hendricks (2010) provides a window into the presence of Whitehouse, sensing “her trying on the movements in her body.” She notes about Whitehouse teaching from her wheelchair “that consciousness communicates even when the physical realm has diminished” (P 65).

As I reflect on my trajectory, I cannot help but think of these innovators as unwitting role models for this very moment in my life just by having been in their individual situations and stages of their lives. They have passed on. As I have incorporated what they offered to me I wonder what of our shared past experiences will have meaning for those with whom I have worked. I occasionally hear, but for the most part it remains a mystery. And I truly have no way to ascertain any part of it once my life ends. Earlier in my private work I had an unusual portend of what it might be like.

A woman in her early thirties was referred to me by a clinical psychologist specializing in eating disorders. While this therapist felt it was time to terminate work with this patient, she also recognized the need for the body to heal. I knew from the referral that there was a history of sexual abuse by her father. However, I was struck upon seeing her that her mother had also abused her. Nothing in the referral or our preliminary chat to set up an appointment had revealed this. I do not know how to explain this knowing. Perhaps it is because we dance therapists gather information on many levels simultaneously. Often we form impressions from visual, emotional expression and kinesthetic data more immediately than when we focus on one aspect of the interaction at a time.

One of the main challenges a patient may face is the intimacy of moving one to one with a therapist. Because there often can be a sense of intimacy with bodies moving, rather than sitting, feelings of discomfort can arise. Since there is only one other person in the room, and therefore no one else to rely on, a patient may fear for her safety. This can be intensely triggering when the perpetrator of the one to one traumatic event was the same gender as the therapist. The fear of doing something wrong, of not being perfect, of not meeting expectations, much less being violated, can contribute further to the anxiety already present just in seeking help from a therapist and bringing in the body, psyche and sense of self that has been so wounded.

We worked together with more space between our moving bodies than usual. Comfort and safety were paramount. This became even more explicitly understood when she eventually told me of the additional abuse by her mother. After more than a year of weekly sessions we mutually agreed that our work was coming to a satisfying conclusion. Our last session was unlike any other in my entire career. She declared she had a final dance of healing. I was delighted to hear this. What she said next was a huge surprise. She asked that I sit in the waiting area outside the dance therapy room while she did the dance.

I quickly assessed her mental state to assure myself she would not hurl herself out of the third floor window. She said she would lock the door. Oh dear, can I handle being shut out? Trust works both ways. So does feeling safe. And so it came to be. I sat in my waiting area, which was shared with other offices. Minutes ticked by. I waited. After what seemed like an interminable amount of time she unlocked the door and invited me into the space she had just blessed with her healing dance. We ended our work together on this note of empowerment and ownership of the health she needed only to witness herself. This now gives me a sense of what it is to be held present internally, while absent in the physical environment (Winnicott, 1958). This was an experience of mutual object constancy. And a preparation for my final absence.

Older women are like aging strudels—the crust may not be so lovely, but the filling has come at last into its own.

—Robert Farrar Capon (n.d.), Brainy Quotes

As an older therapist, you revisit the spiral of the stages of life many times over as they occur for you and in other people’s lives. So you have kept gaining internal, emotional and intellectual experience even as your body responses are lessening. The balance shifts: you have less of one thing and more of another. But they still add up to the same percentage of you being a whole clinician. Now when people ask me how I m doing, I usually quip: "I’m doing my best with what I have left.” However, on reflection, I am doing just fine. Truly.