Dance Therapy

Marian Chace and the founding of the profession

A Dance Teacher profile by Rachel Straus, first printed in August 2010, says Marian Chace was born in Rhode Island in 1896, trained with the Denishawn company and toured vaudeville before opening her own school in Washington, DC. It dates her work as the first government-paid dance therapist to 1942 at St. Elizabeths Hospital and describes her method as empathetic reflection, in which the therapist mirrors the emotional quality of a patient's movement and does not simply copy it. The profile is a trade-magazine account, not an archival biography.

The American Dance Therapy Association (ADTA) says dance/movement therapy emerged in the 1940s, when accomplished dancers saw therapeutic potential in movement, and that the association was established in 1966. Straus names Claire Schmais, Sharon Chaiklin and Elissa White as students who joined Chace in founding it, and gives her death as 1970.

Mary Whitehouse and depth psychology

Marisa Farah's 2016 article in Psicologia USP examines the writings of Mary Starks Whitehouse and describes her as applying Jung's technique of active imagination to dance. In Farah's account, Whitehouse held that the body is the physical aspect of the personality and movement is the personality made visible, with movement lying between spontaneous impulse and ego control. The practice that grew from this is commonly called Authentic Movement.

Schoop, Evan and Espenak

The Historical Dictionary of Switzerland describes Trudi Schoop as a Zurich-born dancer, choreographer and dance educator who lived from 1903 to 1999. It says she moved to California in 1952 and from 1957 worked with psychiatric patients at Camarillo State Hospital. The entry is brief and does not describe her method.

Andrea Harris's 2022 article on Blanche Evan's 1935 film reports that Evan danced and choreographed from 1927 to 1947 and taught creative dance in a New York studio from 1934 to 1958. After psychology training at the Adler Institute, which Harris dates to 1959, she formalized her approach as dance therapy, building on an anatomy-based system she called Functional Technique. The article centers on the film, so its account of the therapy work is short.

Liljan Espenak published 'The role of dance therapy in Adlerian psychology' in The Individual Psychologist in 1966; the archive record consulted gives citation details only. Sabine Koch's 2020 survey article cites a 1985 textbook by Espenak as the first by a dance movement therapist to name contraindications for specific patient groups.

Limits of the historical record

The sources reviewed here are secondary: a magazine profile, a dictionary entry, two journal articles on individual figures and association statements. None settles who first used the term dance therapy, so dates and details for Schoop, Evan and Espenak should be read as provisional.

Names and definitions in use

The ADTA defines dance/movement therapy as the psychotherapeutic use of movement to promote emotional, social, cognitive and physical integration. The European Association of Dance Movement Therapy (EADMT) defines it as the therapeutic use of movement to further emotional, cognitive, physical, spiritual and social integration, and states that dance as body movement, creative expression and communication is its core component. The UK association uses the title dance movement psychotherapy for its registered practitioners.

The Cochrane reviews use dance therapy and dance movement therapy interchangeably, and a German randomized trial of negative symptoms in schizophrenia combined body psychotherapy with dance/movement therapy under the heading movement therapy. Movement therapy is therefore not a single standardized term, and results from combined programs should not be assigned to dance/movement therapy alone.

Therapy compared with dance as activity

The Cochrane depression review counted a trial as dance movement therapy only when participatory movement had clear psychotherapeutic intent and was led by someone with a level of training reasonably expected in that country. Koch and colleagues' 2019 meta-analysis analyzed dance movement therapy and recreational or preventive dance interventions as separate groups and found different patterns of effect.

Named methods

In Koch's 2020 survey of 54 practitioners, respondents named the Chace method, Authentic Movement, body image work, mirroring, circle dances and Laban movement analysis among the approaches they use. These are method labels used by practitioners, and the survey did not test them against one another.

Formats and session content

ADTA says dance/movement therapy is offered in individual, couple, family and group formats and treats movement as a primary means of communication. Practitioners in Koch's survey described the Chace method as mirroring, minimizing and maximizing movement, with process-oriented work on group topics and empathic reflection at its center, and described circle dances as giving security, structure and solidarity.

Programs in trials vary. A German trial used 20 manualized sessions of body psychotherapy and dance/movement therapy, and the Hong Kong dementia trial reviewed by Cochrane used a 12-week group program. These are trial protocols and not standard practice.

Consent, touch and assessment

The EADMT ethical code asks therapists to work from informed consent covering the modality, scope and likely duration, goals, fees, setting, confidentiality and conditions for ending therapy. It says decisions about touch should be intentional and informed, weighing diagnosis, developmental level, transference, history, cultural context and group dynamics, and that a client may decline touch even if it was agreed earlier.

The same code describes assessment as ongoing, not a single observation, and says therapists must not make or publish misleading claims about the likely outcome of treatment or treat clients whose needs lie outside their competence.

Training and registers

ADTA describes two routes: an ADTA-approved graduate program, typically two to three years full-time, or an alternate route of a master's degree plus dance/movement therapy coursework, fieldwork and internship. The R-DMT credential marks entry level, and the BC-DMT credential, available after R-DMT, is described as qualifying a therapist to supervise, train and enter private practice. ADTA states no specific undergraduate degree is required.

The UK association keeps a Professional Register and a Student Register, requires at least 25 hours of continuing professional development a year, and reports master's-level training at three universities. Post-qualification clinical hours are supervised at a minimum of one supervision hour per eight clinical hours. EADMT adopted common training standards on 2 October 2017, with member associations expected to apply them to new intakes from 2020; its web page does not state hours or program length.

Settings and groups named in the literature

The Cochrane review on schizophrenia says dance therapy may be of value for people with developmental, medical, social, physical or psychological impairments and can be practiced in mental health rehabilitation units, nursing homes and day care centers, as well as in prevention and health promotion programs. The cancer review says patients use it to accept and reconnect with their bodies, build self-confidence, express feelings and address isolation, depression, anger and fear.

The dementia review describes it as an embodied psychological intervention that may address the physical, emotional, social and cognitive processes involved. Koch and colleagues' 2019 meta-analysis found controlled studies in depression, anxiety, schizophrenia, autism, older adults, oncology, neurology and heart disease. These are the purposes reviewers and practitioners describe, and they are not findings of effect.

Practitioner views on suitable approaches

In the 2020 practitioner survey, respondents most often described the Chace method as suitable across patient populations, and described structured work such as circle dances and body image work as broadly indicated. Improvisation and Authentic Movement were described as often suited only to higher-functioning participants. This is opinion gathered by questionnaire in 2010, not trial evidence.

Cochrane reviews of depression and cancer

The 2015 Cochrane review of dance movement therapy for depression (Meekums, Karkou and Nelson; searches to October 2014) found three small randomized trials with 147 participants, 107 adults and 40 adolescents. It reported no reliable effect on depression (standardized mean difference -0.67, 95% confidence interval -1.40 to 0.05; very low quality evidence) and concluded that the low-quality evidence did not allow firm conclusions.

The 2015 Cochrane review for people with cancer (Bradt, Shim and Goodill) rested on three studies with 207 participants. It found no evidence of an effect on depression, stress, anxiety, fatigue or body image in women with breast cancer. One study of 37 participants at moderate risk of bias suggested a large benefit for quality of life (standardized mean difference 0.89, 95% confidence interval 0.21 to 1.57). The reviewers rated overall quality very low and drew no conclusions.

Cochrane reviews of schizophrenia and dementia

The 2013 review for schizophrenia (Ren and Xia; searches to July 2012) included one single-blind trial of 45 people comparing dance therapy plus routine care with routine care alone. Nearly 40 percent were lost from both groups by four months, total symptom scores were similar, and negative symptom scores were lower in the dance therapy group (mean difference -4.40, 95% confidence interval -8.15 to -0.65; moderate quality). The reviewers found no evidence to support or refute its use.

The 2023 dementia review (Karkou and colleagues; searches to December 2022) found one trial of 204 adults in Hong Kong with mild neurocognitive disorder or dementia. Dance movement therapy may have made little or no difference to neuropsychiatric symptoms or cognition, and may have reduced depression slightly on a four-item scale (mean difference -0.60 against waiting list). All outcomes were rated low or very low certainty.

Broader reviews and a single trial

Karkou and colleagues' 2019 review included eight studies of 351 adults with depression, pooling randomized and non-randomized designs. Depression scores favored dance movement therapy plus usual treatment over usual treatment in all included studies, and the authors concluded it is effective, while noting a paucity of high-quality studies. Its conclusion is more favorable than the earlier Cochrane review, partly because it accepted wider designs.

Koch and colleagues' 2019 meta-analysis of 41 controlled studies (2,374 participants, 2012 to 2018) found a medium overall effect with high heterogeneity, and a smaller effect of about 0.30 that was consistent when only dance movement therapy studies were considered. Larger effects came from observational measures, possibly indicating bias.

A multicenter trial of 68 outpatients with schizophrenia spectrum disorders (44 in 20 sessions of body psychotherapy and dance/movement therapy, 24 on usual treatment) reported lower negative symptom scores, with moderate effect sizes. The authors called the therapy highly effective; one trial combining two approaches does not by itself settle the question.

Contraindications reported by practitioners

Koch's 2020 questionnaire study of 54 dance movement therapists in several countries, collected in 2010, asked about indications and contraindications. Respondents named Authentic Movement and free improvisation as most often contraindicated, citing psychosis and schizophrenia, eating disorders, affective disorders, trauma and anxiety disorders. For trauma they described avoiding confrontational techniques, closed-eye exercises and touch because of the risk of re-traumatization, and for eating disorders they described avoiding inner-focus work.

Respondents also named overstrain, performance pressure and under- or over-structuring as general problems. The authors link inappropriate technique to frustration, drop-out or worsening of symptoms. The study has a small sample, relies on subjective answers and used an inductive method, so the authors describe its results as initial descriptions needing larger validation.

Touch, boundaries and what trial reports show

The EADMT code notes that the common use of touch in dance movement therapy may carry sexual connotations for a client, and requires therapists to watch the client's reaction, clarify boundaries and take responsibility for the safety of the setting. The UK association's code states that the welfare and safety of clients is at the forefront of professional practice.

The Cochrane abstracts reviewed report drop-out data for the depression and schizophrenia trials, with no significant difference for depression (odds ratio 1.82, 95% confidence interval 0.35 to 9.45; low quality), but do not summarize adverse events. Absence of reporting is not evidence of absence of harm.

Care boundaries

Karkou and colleagues note that current clinical guidelines for depression do not include dance movement therapy, mainly because of perceived insufficient evidence. Dance/movement therapy should not delay or replace necessary medical or psychiatric care, and a person can ask a prospective therapist about training, registration, the use of touch and supervision.