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Indications and contraindications in dance movement therapy: learning from practitioners' experience on indications and contraindications of dance movement therapy (DMT) cific patient populations. Fifty-four practitioners from ten different countries worldwide indicated the "dos and don'ts" for their main pop

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  • Alanus University Alfter, RIArT / SRH University Heidelberg

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Dance movement therapy is increasingly established as an evidence-based treatment modality in health care. However, systematic knowledge on indications and contraindications of dance movement therapy (DMT) are widely lacking. In this study, we developed a questionnaire to learn from practitioners’ experience with DMT intervention methods for specific patient populations. Fifty-four practitioners from ten different countries worldwide indicated the “dos and don’ts” for their main populations. These inductively and experientially gained indications and contraindications for DMT, and their justifications, fell into 22 clinical categories such as psychiatry, psychosomatics, neurology, trauma, eating disorder, pain, oncology, and treatment of specific groups such as children, adolescents, families, pregnant women or prisoners. Extensive materials resulted for each disorder. Results suggest that for clinical populations the Chace method, body image work, and movement rituals, such as circle dances, are indicated without contraindications; relaxation and inner focus are differentially indicated (e.g. inner focus is contraindicated for eating disorder and schizophrenia), whereas Authentic Movement and free improvisation are are often only indicated with high functioning participants, and contraindicated with low functioning participants (level of functioning moderated the results). Possibilities and limitations of this inductive participatory approach to investigating indications are discussed. The study contributes to defining differential disorder-specific DMT interventions, therapeutic factors of DMT, as well as new methods. Future studies should increasingly investigate indications and contraindications of DMT with diverse methods and populations.
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Indications and contraindications in dance movement
therapy. Learning from practitioners’ experience
Abstract
Dance movement therapy is increasingly established as an evidence-
based treatment modality in health care. However, systematic knowledge Sabine C. Koch1,2
on indications and contraindications of dance movement therapy (DMT) 1 Research Institute for
Creative Arts Therapies
are widely lacking. In this study, we developed a questionnaire to learn
from practitioners’ experience with DMT intervention methods for spe- (RIArT), Alanus University
Alfter, Germany
cific patient populations. Fifty-four practitioners from ten different
countries worldwide indicated the “dos and don’ts” for their main pop- 2 School of Therapy Sciences,
SRH University Heidelberg,
Heidelberg, Germany
ulations. These inductively and experientially gained indications and
contraindications for DMT, and their justifications, fell into 22 clinical
categories such as psychiatry, psychosomatics, neurology, trauma,
eating disorder, pain, oncology, and treatment of specific groups such
as children, adolescents, families, pregnant women or prisoners. Extens-
ive materials resulted for each disorder. Results suggestthat for clinical
populations the Chace method, body image work, and movement rituals,
such as circle dances, are indicated without contraindications; relaxation
and inner focus are differentially indicated (e.g. inner focus is contrain-
dicated for eating disorder and schizophrenia), whereas Authentic
Movement and free improvisation are are often only indicated with high
functioning participants, and contraindicated with low functioning par-
ticipants (level of functioning moderated the results). Possibilities and
limitations of this inductive participatory approach to investigating indic-
ations are discussed. The study contributes to defining differential dis-
order-specific DMT interventions, therapeutic factors of DMT, as well
as new methods. Future studies should increasingly investigate indica-
tions and contraindications of DMT with diverse methods and popula-
tions.
Keywords: dance movement therapy, indications, contraindications,
clinical experience, inductive method, therapeutic factors, clinical
disorders, dance movement therapy intervention methods
Introduction
The necessity to explicate indications
Dance movement therapy (DMT) has its roots in the
modern expressive dance of the 1920s in Europe and
the USA. It was taken abroad by artists that emigrated
from Second World War Europe in the 1930s, and de-
veloped and blossomed in the US in the course of the
Humanist Movement in the 1960s, from where it returned
to Europe in the 1980s [1], [2]. DMT’s focus is the
therapeutic use of movement in the sense of a process
that promotes the physical, psychological, individual and
social integration of the individual [3], [4]. Today dance
movement therapy is increasingly anchored in medical
and health science evidence-based models (partly due
to the high pressure of legitimation). In these contexts,
DMT must prove which disorders it is suitable for and
which of its specific intervention methods or techniques
are indicated or contraindicated in specific contexts, fol-
lowing the criteria of evidence-based medicine (EBM) [5].
Meta-analyses of the efficiency of DMT show that there
are medium effect sizes for many populations for the
clinical outcome variables of anxiety reduction, depression
reduction and increase in quality of life and well-being
[6], [7], but relatively little is known about specific thera-
peutic factors or mechanisms of change [8], [9], [10].
Despite many studies on the effectiveness of DMT for
specific populations (e.g., [11], [12], [13]), little knowledge
exists regarding specific active factors and differential
indications. Moreover, evidence-based studies often fail
to sufficiently consider the specific effectiveness of the
actual intervention components.
Current state of knowledge
Theoretical derivations of indications
In a seminal article of 2003, Trautmann-Voigt pointed
out that literature on indications and contraindications
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Research Article
OPEN ACCESS
Dance Movement Therapy
in the field of DMT is largely lacking, and emphasized that
“systematically posing the indication question would be
one of the most important research concerns in Germany
for the further establishment of this method” [1]. While
there is some theory on the topic (e.g., [14]), there is often
a lack of systematization or corresponding empirical and
statistical validation.
An early explicit mention of DMT indications and contrain-
dications can be found in Lilian Espenak’s textbook on
dance therapy from 1985 [15]. In a paragraph entitled
“Contraindications”, Espenak writes:
“The (dance) therapy [...] is contraindicated in exhibitionist
and voyeuristic patients who could use the physical side
of the therapy to strengthen their neurosis. Such a result
would possibly be unavoidable; therefore, other non-
verbal therapies would not only be much more effective,
but would also achieve much faster results [15].”
With this paragraph, she was the first person DMT to ex-
plicitly mention contraindications for specific patient
populations. Today we would no longer agree with Es-
panak’s views as to the unsuitability of dance movement
therapy for severely impaired psychotic patients. Nonethe-
less, she did lay the foundation for the more systematic
investigation of contraindications. More recent work on
indications and contraindications can be found in Eber-
hard-Kaechele [16], [17], Hoelter [18], Klein [19], Quinten
[10], [20], Roehricht [21], Lausberg [2], and Trautmann-
Voigt and Voigt [14].
In his book “Körperorientierte Psychotherapie psychischer
Störungen” (body-oriented psychotherapy for mental
disorders), Frank Roehricht [21] systematizes successful
body therapy interventions for depression, anxiety, per-
sonality disorders, and schizophrenia. In the German lit-
erature, Gerd Hoelter [18] covers the spectrum of indica-
tions from schizophrenia to affective disorders, personality
disorders, eating disorders, addiction, and psychiatric
diseases of children and adolescents and in old age.
Marianne Eberhard-Kaechele [16], [17] describes patient-
related factors and contributes differentiated indications
and contraindications for oncology (see also [22]) and
trauma (see also [23], [24]). Eberhard-Kaechele [25]
gives a detailed overview of indications for personality
disorders, developing interventions for individual person-
ality disorders from diagnostics with the Kestenberg
Movement Profile (KMP); Degener [26] does the same
for borderline personality disorder and Bertolaso [27] for
narcissistic personality disorder. Quinten [10], [20]
defines the field of dance movement therapy for chronic
pain as disorder-specific and thus contributes significantly
towards the integration of dance movement therapy in
health sciences. Trautmann-Voigt & Voigt [14] differenti-
ate the indications in parent-child interactions, anxiety,
addiction, and trauma. In addition, Bender [28] contrib-
utes to indications in systemic family therapy, Bräuninger
[29] to anxiety and addiction, and Schmitt and Frölich
[30] to dementia. Lausberg [31] lists indications for eating
disorders and other psychosomatic diseases and places
them in the context of the debate as to the differential
diagnostic possibilities of dance movement therapy.
Arnim and Joraschky [32], for example, have developed
their own tests for somatoform disorders and pain pa-
tients. Most of this literature, however, is in German and
thus hardly reaches beyond national boundaries, why it
is important to include it here.
Overall, the state of knowledge on indications and con-
traindications in DMT remains incomplete and in need
of improvement. Due to the low level of differentiation in
the literature, it is often assumed that there are hardly
any contraindications for dance movement therapy, and
that the indication is comprehensive. A lack of knowledge
about indications and contraindications in dance move-
ment therapy can lead to the use of contraindicated
methods, which risk triggering frustration in the patient,
by overstrain or underload, or leading to therapy drop-
outs or worsening of symptoms. Specific diagnostic
knowledge can expand or focus in on the range of possib-
ilities for indicated methods. Thus, it is of eminent theor-
etical and practical importance for DMT to differentiate
between, and specify knowledge about, indications.
Empirical derivation of indications
Within the framework of care guidelines (e.g., [33], [34]),
quantitative empirical evidence for arts therapies is in-
creasingly requested in the context of political decisions
in the health sector. Care guidelines form the evidence
basis for the recommendation of therapeutic interventions
and are thus decisive in the health care system. In Ger-
man medical care guidelines, dance movement therapy
was – together with the other creative arts therapies
(mainly art therapy and music therapy) – included as a
recommended treatment in the S3 guideline for breast
cancer patients ([12], [35], [36], [37]); in the guideline
for trauma treatment ([38], [39], [40]); the guideline for
schizophrenia and severe psychiatric disorders ([41],
[42], [43], [44]); and in the guideline for Parkinson pa-
tients ([45], [46], [47]) among others.
A meta-analysis by Koch, Kunz, Lykou, and Cruz [17]
compiled all evidence-based control group studies in the
field of dance movement therapy between 1996 and
2012. Empirical evidence for dance movement therapy
existed in the areas of schizophrenia [41], [44], depres-
sion [48], [49], [50], anxiety [6], [51], stress [11], eating
disorders [52], autism [53], [54], children and adoles-
cents [55], [56], somatoform disorders [57], neurological
disorders [58], cystic fibrosis [59], pain [60], Parkinson’s
disease [14], [61], [62], [63], and dementia (e.g., [64],
[65], [66]).
The problem, however, is that the intervention methods
used in these studies were usually not sufficiently well
documented, impairing replicability of the studies [7]. In
seven out of 23 cases, the interventions were somewhat
specified and in only two cases was there a specified
treatment manual [44], [54]. The interventions were
generally very heterogeneous and only a few were ori-
ented towards classical dance movement therapy meth-
ods. However, Bräuninger found homogeneous effects
of dance therapy in eleven different DMT groups in pre-
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ventive contexts, all of which used different methods.
This may speak for an additional general therapeutic
factor of DMT [67].
Although the systematic testing of specific DMT factors
is only just beginning, the data on the efficiency of dance
movement therapy provides important clues as to areas
of action and enables hypotheses to be made about
general active factors [50], [68], [69], [70]. It is indeed
conspicuous that in the evidence-based research work
of the 12 years that entered into the meta-analysis [7],
dance movement therapy interventions were only spe-
cified in seven out of 23 studies and assumptions about
specific therapeutic factors were only made in three out
of 23 studies [7].
For the aforementioned reasons, the idea of this study
was to execute an inductive survey among international
practitioners as to methods and techniques which are,
on the one hand, effective and recommendable in the
respective populations and, on the other, ineffective and
could even cause harm. The aim was to obtain a differen-
tiated overview of indications and contraindications in
dance movement therapy from a participatory angle. To
this end, the participating practitioners were asked to
state their professional experience and to describe the
Do’s and Dont’s for their specific population in detail (see
Attachment 1).
Methods
Sample
The sample consisted of 54 dance therapists. The mean
age was 44.5 years, SD=11.72 (range=29–71 years).
Three of the participants were men. The nationalities of
the therapists were as follows (data on nationalities ob-
tained for 40 participants): Australia (1), UK (2), Belgium
(2), Greece (2), Netherlands (2), USA (3), Switzerland (4),
Latvia (5), Austria (6), and Germany (13).
The data collection was carried out inductively based on
a questionnaire specifically developed for this purpose.
It was available in two versions; as an online question-
naire and an identical paper-and-pencil version (see At-
tachment 1). The experiences with dance therapy meth-
ods that have proven effective in certain disorders or
populations (dos) or as potentially harmful (don’ts) were
based upon the experiences of national and international
practitioners of dance movement therapy.
Procedure
Completing the questionnaire “Indications and contrain-
dications in dance movement therapy” took about 30
minutes. Thirty-eight questionnaires were completed on-
line and 16 were completed in paper and pencil versions.
The paper and pencil versions had been distributed to
national and international participants in Spring 2010 at
a three-day international conference (organized by S.
Bender in Freising near Munich), “Moving from Within II”,
and at the international “Summer School of Arts Ther-
apies” in Dundaga, Latvia in Summer 2010. Some parti-
cipants completed questionnaires on site, others took
them home and sent meticulously-completed question-
naires back to the researcher. At the Freising conference,
with about 200 participants, about 150 of which were
dance movement therapists, seven questionnaires were
returned; in Dundaga, with about 120 creative arts ther-
apists taking part in the summer school, of which about
30 were dance movement therapists, five participants
handed in the completed questionnaire. Voluntary parti-
cipation was guaranteed, no reward was given. The parti-
cipants were informed about the purpose of the study
when the questionnaires were distributed; in addition,
the purpose of the study was also explained on the first
page of the questionnaire. A total of 38 completed online
questionnaires reached the researcher. The link to the
online version was sent mainly by email to the German
listserv of the Professional Association of Dance Therap-
ists in Germany (BTD), the listserv of the European Net-
work for Dance Movement Therapy (in the meantime the
European Association for Dance Movement Therapy
EADMT emerged from this), the Australian listserv and
the forum of American Dance Therapy Association’s
(ADTA) homepage. All mailing lists, except the Australian,
had an original call and a later reminder.
Evaluation
The disorders and patient populations mentioned by the
therapists were clustered by two master’s students of
psychology within their research internship (see supple-
mentary material in Attachment 2). They listed the men-
tioned indicated and contraindicated dance movement
therapy methods for the disorders in order to provide an
overview (see Table 1, Table 2, and Table 3). In this listing,
multiple responses for the single disorders were possible.
Results
Overview
The therapists named a total of 23 different patient
groups and areas of application. With seven mentions
each, “eating disorders” and “children and adolescents”
were the most common. Then came the groups “trauma”,
“schizophrenia and psychosis”, “neurosis”, “affective
disorders” with six mentions each, “mentally and physic-
ally disabled persons” with five mentions each and
“burnout” as well as “anxiety disorders” with four men-
tions each. The groups “unspecified general psychoso-
matics”, “geriatric psychiatry”, “dementia”, “addiction”
and “adults” were named three times. The groups
“forensics”, “personality disorders”, “autism” and “seni-
ors” were each mentioned twice and the groups “neuro-
logy”, “pregnant women”, “orthopedics”, “family” and
“unspecified psychiatric diseases” were each mentioned
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Table 1: Tabular overview of indications (sorted by population, institution, age)
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(Continued)
Table 1: Tabular overview of indications (sorted by population, institution, age)
once. The bar chart shows the absolute frequencies of
the mentions of the treated disorders (see Figure 1).
Professional experience of the therapists
In order to better assess the quality of the individual
therapist’s statements, the therapist’s professional exper-
ience in dance movement therapy as well as the treat-
ment setting were requested. This revealed problems of
understanding: some participants understood “treatment
setting” to mean the institution in which they work (e.g.,
clinic or private practice) while others indicated type of
therapy sessions (individual or group), frequency of ses-
sions or size of the therapy group.
In terms of work experience (data for 48 participants),
the participants differed as follows: six were beginners,
24 had worked one to ten years and 18 had worked in
the field for eleven years or more (see Figure 2).
Indications
Across disorders, there were only small differences in the
recommended dance therapy methods. Often the Chace
method (24), dance techniques (circle dances 3; others),
mirroring (7), body image work (14), Laban (14),
Kestenberg (7) and Sherborne (1) (the latter three also
diagnostic methods) and relaxation methods (25) were
mentioned as indications. Techniques of improvisation
(10) and creation (5) were often only given with precise
structural specifications.
The most widely used method for diagnosis is motion
analysis according to Laban (14) and Kestenberg (7). As
independent theories, these offer not only methodological
access as movement diagnosis instruments, but also
enable the derivation of a wide range of clinical hypo-
theses that can be used directly for intervention planning.
In order to promote the development of body awareness
of a realistic body image, the therapists suggest body
image work, perception of body boundaries and exercises
on closeness and distance and perception of one’s own
needs. In body image work, the body image is, for ex-
ample, drawn, shaped in clay, or outlined in contour. In
severely impaired patients, body image can be distant
from reality and fragmented (e.g., in schizophrenic or
anorectic patients). The aim of body image work is
therefore the integration, autonomy and support of
identity formation starting on the body level.
The processing of emotional content is most frequently
realized through imitation and reflection and additionally
through verbal processing and reflection. Relaxation ex-
ercises, yoga, and exercises from modern dance (contract-
release exercises) are used to reduce tension. Active
creation (such as in improvisation), in which patients have
more control over and distance to the inner experience,
is also mentioned as a method of emotional expression.
The dance techniques are fixed forms of movement. They
provide structure, cultural references, possibilities for
ritualized use, offer references to metaphor and body
memory and emphasize individual movement qualities
and forms. In this context, circle dances are most fre-
quently mentioned across all disorders (3). These provide
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Table 2: Tabular overview of contraindications (sorted by malfunction, institution, age)
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Table 3: Tabular overview of indications and contraindications of DMT methods for different populations
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(Continued)
Table 3: Tabular overview of indications and contraindications of DMT methods for different populations
security and structure, lead to the experience of solidarity
with other people, bring fun, promote exuberance and
activity, and establish relationships between mood and
movement as well as movement and meaning. Improvisa-
tion and Authentic Movement are used to promote au-
thentic expression and to integrate the unconscious, al-
though this is usually only recommended for higher
functioning patients with precise structural requirements
or in advanced therapy. Table 1 provides an overview of
the indications mentioned.
Contraindications
Free improvisation (2) and Authentic Movement (AM)
were often mentioned as contraindications (36 times,
especially in psychoses, dementia, and autism, i.e. the
most severe mental health disorders). On the other hand,
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Figure 1: Absolute frequencies of the treated populations
Multiple responses were possible; x-axis: number of therapists reporting on the according population
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Figure 2: Participating therapists within the different work experience clusters (n=48)
y-axis: number of participating therapists
Authentic Movement was listed five times as an indica-
tion: for neuroses, personality disorders, trauma, autism
and pregnant women. The contradictory data for autism
can be resolved by separating the lower functioning per-
sons on the autism spectrum (formerly early childhood
autism where AM is contraindicated) from the higher
functioning persons on the autism spectrum (Asperger
autism). More structured forms of free improvisation,
such as the Baum-circle, have proven particularly effective
for high functioning persons on the autism spectrum [71].
In Authentic Movement, the patient moves with closed
eyes and without music following only his/her inner im-
pulses and images and is observed and supported by a
witness. Since it can be difficult and frightening for pa-
tients, and since they can feel overwhelmed and insecure
by the sudden freedom in acting and moving, improvisa-
tion and Authentic Movement are often listed as contrain-
dications. However, introduced stepwise and in structured
forms, AM can be helpful even for lower functioning pa-
tients. By switching off self-control and intellect, access
to emotions, unconscious material, and one’s own pro-
cesses can occur, which is helpful for many patients.
General contraindications are achievement-oriented
overstrain (emotional and physical) and pressure to per-
form, for example through competitive games and situ-
ations. Dance movement therapy distances itself from
these aspects, which are overemphasized in Western as
well as Asian societies, and provides an opposite pole of
physical sensation, kinesthetic answers, individual and
social competence experience, joy, enjoyment, hedonism
and play. Under-structuring (e.g., leaving the patient
without sufficient guidance) is regarded as a contraindic-
ation, as is strongly directive behavior and over-structur-
ing. Here it seems important to find an appropriate bal-
ance. In general, the participating therapists recommend
a respectful and empathetic attitude, providing security
and structure, while remaining flexible and responsive.
An overview of all contraindications mentioned is provided
in Table 2.
Disorder-specific interventions
In the following section, methodological peculiarities of
the different populations are summarized. The parti-
cipants state that it is important not to work directly on
the unconscious in a number of disorders; they mention
psychotic, dementia, and trauma patients, but also
forensic patients, and patients with neurological injuries.
The integration of the unconscious requires a clear and
stable ego-structure. Attachment 3 provides an overview
of major DMT interventions commonly and internationally
used.
Methodical specificities for individual disorders are
1. The emphasis in the treatment of depression and
burnout is on promoting body awareness, relaxation,
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activation and expansion of the movement reper-
toire.
2. For patients with anxiety disorders, the focus should
be on emotional expression and relaxation. In this
context, creation and well-structured improvisation
to express one’s own feelings are often recommen-
ded.
3. For trauma patients, techniques that provide security
and structure (e.g., circle dances or other dance
techniques in the group) as well as body awareness
exercises are indicated as the method of choice.
Confrontation should be avoided (e.g., Authentic
Movement, as well as other exercises with closed
eyes, touching each other) as there is a risk of re-
traumatization.
4. In patients with psychosis, exercises can be used to
strengthen the ego structure, such as body percep-
tion exercises or closeness and distance exercises.
Direct work on the subconscious should be avoided.
5. With eating disorder patients, the focus is on body
awareness and the emotional experience of the
physical. No exercises should be performed that in-
crease the pressure to perform, instead emphasis
should be placed on sensing and finding an emotion-
al connection with the body. Relaxation exercises
are recommended with specific reservations (no
prolonged closing of the eyes).
6. For addiction, it is recommended to avoid procedures
that may be associated with loss of concentration.
7. In intellectually disabled patients, verbal reflection
of movement is usually quite limited. For this work,
it is advisable to remain on the non-verbal level and
to use different media.
8. Patients with dementia and patients in geriatric
psychiatry benefit from exercises that provide
structure and security (e.g., circle dances). The focus
is on long-term memory and the updating of positive
body memory contents. This can be achieved, for
example, by using familiar music. It is also important
to offer rituals.
9. For the patient group of children and adolescents,
the focus is on promoting body awareness, emotional
expression, relationships and communication. Circle
dances and group movements are recommended.
Often, creation and well-structured improvisation
are used to express one’s own feelings. It is neces-
sary to provide clear structure, but strongly directive
behavior should be avoided. Instead, it is important
to awaken the interest of children and adolescents
and to avoid boredom.
10. For the elderly patient group, increased work with
aids and materials is important. Physical overload
should be avoided and (adapted) circle dances are
a well-tested method.
Only a few of the other disorders are mentioned in
Table 2 but they do not allow reliable statements to be
made about indications.
Scope and limitations of individual
therapy methods
If one focuses on the particularities of individual therapy
methods and deductively analyses their indications and
contraindications, the following picture emerges (due to
the large number of mentions, only methods with multiple
mentions were considered in Table 3):
According to the participants, Laban movement analysis
application (in the sense of the use of Laban’s system of
movement analysis for intervention planning and therapy;
[75]) is indicated for patients with eating disorders (2),
schizophrenia and psychoses (2), neuroses (2), addiction
(1), and anxiety disorders (1). Laban’s movement analysis
application is also beneficial for children and adolescents
(1), people with mental and physical disabilities (1), gen-
eral psychosomatics (1), geriatric psychiatry and patients
with dementia (1), and orthopedics (1). Laban’s move-
ment work focuses on the expansion of the movement
repertoire and the functional use of movement qualities,
both individually and inter-bodily. Laban is not mentioned
as a contraindication for any disorder.
The Chace method is indicated for patients with eating
disorders (3), schizophrenia and psychoses (2), neuroses
(2), traumata (1), affective disorders (1), burnout (1),
anxiety disorders (1), and addiction (1), as well as for
psychiatric disorders (1) that are not specified in more
detail. The Chace method ([72]) works with mirroring,
minimizing and maximizing movement and process-ori-
ented work on group topics. The process of empathic re-
flection is at the center of therapeutic action in the initial
phase. The Chace method is also mentioned as an applic-
ation in general psychosomatics (2), in geriatric psychiatry
and in patients with dementia (1), in forensics (1), and
in work with pregnant women (1), children and adoles-
cents (2), seniors (1), and patients with autism (1). The
Chace method is not mentioned as contraindicated by
any of the sources of this study. It is a generic method
that works with any patient population.
Interventions according to Kestenberg [73], [74] are
mentioned in relation to patients with eating disorders
(1), autism (1), as well as in work in general psychosomat-
ics (2). Movement work expands the movement repertoire
and works on missed or inappropriately established de-
velopmental steps by providing the patient with a space
to practice or relearn them. According to the participants,
Kestenberg Movement Analysis has no contraindications.
Work with the body image or body perception exercises
[75] are mentioned as indications in patients with anxiety
disorders (6), eating disorders (5; reference is also made
here to work with individual body parts (1)), burnout (5),
schizophrenia and psychoses (4), trauma (3), neuroses
(3), affective disorders, in particular depression (4), ad-
dictions (1), and personality disorders (1). Body image
work is also suitable in general psychosomatic medicine
(2), neurology (1), orthopedics (1), geriatric psychiatry
and in work with patients with dementia (1), people with
mental and physical disabilities (1), children and adoles-
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cents (1), and pregnant women (1). In neuroses, physical
proximity and sensitive touch (1) are listed as contraindic-
ations. In general psychosomatics it is important not to
start with the focus on the body (1). Body image work
seems to be generally contraindicated in patients with
autism (1).
Authentic Movement [76], [77] is recommended for
pregnant women (1), neuroses (1) and autism (1) as well
as for patients with personality disorders (1). Authentic
Movement in persons with psychoses and schizophrenia
(6), affective disorders (5), trauma (5), eating disorders
(4), burnout (4), anxiety disorders (3), addiction (2), and
neuroses (2) are mentioned as contraindications. Authen-
tic Movement is also considered contraindicated in per-
sons with mental or physical disabilities (3), in general
psychosomatics (1), forensics (1), geriatric psychiatry and
work with dementia patients (1), as well as in seniors (1)
and children/adolescents (1).
Mirroring [72] is regarded as indicated in patients with
affective disorders (3), anxiety disorders (1), trauma (1),
burnout (1), and personality disorders (1). It is also recom-
mended in work with patients with mental or physical
disability (1), in geriatric psychiatry or in patients with
dementia (1). Mirroring is not mentioned as contraindic-
ated in any disorder.
The Baum-circle [78] seems to be suitable for patients
with trauma (1), neuroses (1), affective disorders (1), and
autism (1); in the case of autism, however, it is also
mentioned by one person as a contraindication. With the
Baum-circle, the patients bring their own music, meaning-
ful for them, into the session and improvise in an authen-
tic way to that piece of music. The task of the group is to
mirror the person in their improvisation in order to feel
with them. After three to six persons have initiated the
movement, a verbal part follows in which group members
give each other feedback on how it was for them to move
with the initiating persons. Initially, it is surprising how
effective this simple technique can be. The Baum-circle
is resource-, support- and solution-oriented.
Tension and relaxation techniques are mentioned as in-
dicated for affective disorders (4), addiction (3), burnout
(3), eating disorders (2), trauma (2), schizophrenia and
psychoses (2), anxiety disorders (2), and personality dis-
orders (2). In the case of mental and physical disabilities
(2), orthopedics (1) and work with children and adoles-
cents (2), adults (1) and seniors (1), tension and relaxa-
tion work is also recommended. In the case of eating
disorders (2), psychoses and schizophrenia (1), and
mental or physical disability (1), prolonged relaxation
should be avoided. Relaxation is contraindicated in geri-
atric psychiatry and in work with dementia patients (1).
Discussion
The present work represents a step towards a more de-
tailed recording and differentiation of indications and
contraindications in dance movement therapy and en-
riches the knowledge of disorder-specific interventions
in the field.
The main results of the study speak for a broad spectrum
of indications for dance techniques, mirroring, body image
work, movement analysis applications, and relaxation
methods (as general indications across disorders). Impro-
visation techniques are usually only recommended in
connection with a higher degree of structure of the inter-
ventions. Free improvisation and Authentic Movement
are most often mentioned as contraindications. As a rule,
Authentic Movement and free improvisation are almost
exclusively recommended for high functional patients,
unless strongly structured variations such as the Baum-
circle are used [78]. According to the results of our study,
the disorder specificity of individual DMT methods is
rather low, conversely the generalizability is high [67].
This is partly due to a concentration on general therapeut-
ic factors of DMT. Specific therapeutic factors such as,
for example, the vertical movement of jumping, causing
a decline of depression [50], the role of the experienced
unity with the music or the partner when dancing [69],
the experienced freedom of choice or empowerment [79],
or the non-goal-orientation of dance movement [70] have
only recently become the subject of DMT research [8].
One of the limitations of the present work is that it was
not always possible to clearly assign the stated disorder
to the clusters (cluster formation; see also supplementary
material Attachment 2). In addition, some therapists did
not provide information on certain questions (missing
data). Further, direct comparisons and frequency data of
indications and contraindications were difficult to interpret
due to the therapists’ different contents- and language-
related interpretations and conventions, and finally the
small sample size in single clusters. Therefore, this
overview cannot be regarded as an exhaustive description
and should therefore be read critically and interpreted
with caution. Furthermore, the collection of indications
and contraindications concentrates exclusively on thera-
peutic techniques or methods and does not explicitly
consider patient-related aspects. For intervention plan-
ning, this material can be an orientation, but patient- and
case-specific aspects need to be considered in addition.
Furthermore, it is likely that we have missed literature on
indications in our search, since often indications are not
explicitly named as such.
The inductive method of data acquisition, on which we
based this paper, proved to be generally fruitful. Due to
the small number of cases and the small number of
multiple answers in many cases, however, it only yields
first descriptions, still relatively subjectively bound to the
participating therapists, as can be seen from reading the
overview in Table 1, Table 2, and the supplementary
material (Attachment 2). An increase in the number of
cases would be necessary in order to achieve a valid
systematic gain of knowledge with this method. Due to
the limited sample size of the study, there is a continuing
need for research in this area.
Despite all limitations, the present study makes a fertile
contribution to the initial systematization of indications
12/16GMS Journal of Arts Therapies 2019, Vol. 1, ISSN 2629-3366
Koch: Indications and contraindications in dance movement ...
and contraindications, as well as to the development of
disorder-specific knowledge and treatment approaches
in DMT. The study can be both an orientation for interven-
tion planning in practice, and a stimulus for future invest-
igations of disorder-specific indications and therapeutic
factors in dance movement therapy.
Notes
The questionnaire data of this article was first reported
in Koch SC, Kolter A, Kunz T. Indikationen und Kon-
traindikationen in der Tanz- und Bewegungstherapie Eine
induktive Bestandsaufnahme. Musik-, Tanz- und Kunst-
therapie. 2012:23(2):87-105. Because the information
has been requested to be put forth in English from col-
leagues worldwide, the present article provides access
to the updated results in English and provides extensive
formerly unpublished materials (<75%) in German and
English suited to guide practitioners in DMT intervention
planning with regard to indications and contraindications
for their specific populations.
Competing interests
The authors declare that they have no competing in-
terests.
Attachments
Available from
https://www.egms.de/en/journals/jat/2019-1/jat000005.shtml
1. Attachment1_jat000005.docx (32 KB)
Attachment 1
2. Attachment2_jat000005.docx (193 KB)
Attachment 2
3. Attachment3_jat000005.docx (30 KB)
Attachment 3
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Corresponding author:
Prof. Dr. phil. habil. Sabine C. Koch
Department for Therapy Sciences, SRH University
Heidelberg, Maria-Probst-Str. 3, 69123 Heidelberg,
Germany
sabine.koch@hochschule-heidelberg.de
Please cite as
Koch SC. Indications and contraindications in dance movement therapy.
Learning from practitioners’ experience. GMS J Art Ther. 2019;1:Doc05.
DOI: 10.3205/jat000005, URN: urn:nbn:de:0183-jat0000052
This article is freely available from
https://www.egms.de/en/journals/jat/2019-1/jat000005.shtml
Published:
2019-10-28
Copyright
©2019 Koch. This is an Open Access article distributed under the terms
of the Creative Commons Attribution 4.0 License. See license
information at http://creativecommons.org/licenses/by/4.0/.
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Koch: Indications and contraindications in dance movement ...
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