Dance Therapy: Effective Treatment for Sexually Abused Children

According to child protective service agencies, 906,000 children are abused in the United States each year. Approximately, 10% of cases reported to child protective service agencies were sexual abuse cases (Child Maltreatment, 2007). The Child Abuse Prevention and Treatment Act defines sexual abuse as the employment, use, persuasion, or coercion of any child to be involved in a sexually explicit act (Definitions, 2005). Since sexual abuse affects so many children, it is important that research is conducted on effective therapies for sexual abuse. Research has shown that dance therapy is an effective treatment for sexually abused children.

Importance of Addressing Issue of Sexual Abuse

Children who are sexually abused are more likely to have medical and psychological problems as adults. These include drug abuse, severe obesity, smoking, alcoholism, eating disorders, depression, suicide and sexual promiscuity. Furthermore, abuse during infancy or early childhood can lead to parts of the brain to not develop properly, which causes physical and psychological problems. These children are at an increased risk for sleep disturbances, panic disorder and attention-deficit /hyperactivity disorder (Child Maltreatment, 2007).

In addition, the financial costs of sexual abuse are enormous. Direct costs are about $24 billion annually. The health care system, judicial system, and law enforcement account for the direct costs. The indirect or long-term costs of abuse are about $69 billion each year (Child Maltreatment, 2007). For this reason, it is important to study effective therapies for children who were sexually abused.

Dance Therapy

Often, dance therapy is overlooked as an effective treatment for sexual abuse because there is a preference for verbal therapy (Capello, 2006). However, research has shown that dance therapy is an effective way to help individuals with psychological difficulties (Boughton, 2005).

The American Dance Therapy Association defines dance therapy as the use of movement for therapeutic purposes, which allows the individual to be more connected emotionally, physically and cognitively. Dance therapy promotes the integration of mind, body and emotion and allows the individual to grow emotionally and have a positive sense of self (Mills & Daniluk, 2002). Movement is utilized to encourage social interactions, the expression of emotions and to help individuals gain a sense of self-control (Koshland, Wilson, & Wittaker, 2004). Dance therapists allow individuals to gain a positive self-image, increase communication skills and become emotionally stable (Boughton, 2005).

Since dance therapy allows an individual to express their emotions nonverbally, it is often used with victims of sexual abuse (Boughton, 2005). The body is a "vehicle" for healing, self expression and communication (Capello, 2006). Frequently, victims of sexual abuse have difficulty expressing their feelings with words. Dance therapy focuses on expression of one's emotions and free movement. For victims of sexual abuse, group dance therapy provides emotional support, appropriate physical boundaries and increases communication skills (Boughton, 2005).The main themes that are addressed in therapy with victims of sexual abuse include dissociation, sexuality, shame, guilt, intimacy, boundaries and personal power (Mills & Daniluk, 2002).

However, dance therapy currently is a complicated and diverse form of therapy. Often, the goals of therapy are ill-defined and progress is measured based on the interpretations and judgment of the dance therapist instead of self-reports and behavioral measures. Furthermore, there has been few empirical research studies conducted on the effectiveness of dance therapy. The studies that have been conducted usually involve accounts of client change and decrease of symptoms (Mills & Daniluk, 2002).

Overall, concepts and practical applications of dance therapy are unclear. It is unclear how dance therapy produces change and why specific interventions are utilized under specific conditions. In addition, the subjective experience of the client and their interpretation of how dance therapy leads to change are unclear (Mills & Daniluk, 2002).

Important Contributors to Dance Therapy

Marian Chace.

Dance therapy originated in the 1940s and was developed by Marian Chace. Marian, a modern dancer and teacher, realized that some of her students had more interest in expressing emotions through dance than learning technique. For this reason, she started to encourage them to focus on the freedom of movement. During this time, doctors started to refer patients to Marian. The patients she worked with included

antisocial children, people with movement difficulties and individuals with psychological disorders. She argued that group dance therapy leads to feelings of relaxation, well-being and positive interactions. Dance therapy allows individuals to feel comfortable with their bodies and themselves (Boughton, 2005).

Mary Whitehouse.

Mary Whitehouse, a Jungian analyst, was also an important contributor to the development of dance therapy. She developed a process known as "movement in-depth," which is a combination of movement, dance and depth psychology. She was the founder of authentic movement. Authentic movement is based on Jungian analysis and allows individuals to use dance to express their feelings about an internal image. This helps the individual to understand their current difficulties in life and in the past (Boughton, 2005). Authentic movement causes a decrease in the use of ego defenses and increases spontaneous movement of unconscious parts of the individual's inner world (Mills & Daniluk, 2002).

Theories/Techniques

The main theories dance therapists utilize include Freudian technique, Jungian approach and object relations orientation (Mills & Daniluk, 2002). In Freudian technique, the dance therapist helps the patient discover feelings buried in the unconscious by expressing those feelings consciously through dance. Furthermore, transference is a common technique used (Boughton, 2005).

In Jungian technique, the dance therapist encourages the client to work with recurring images in their thoughts and dreams to obtain meaning from their life. The therapist asks the client to move when they feel the "inner impulse" rather than dancing out their feelings. The client directs the movements and the therapist is the nonjudgmental observer of the movement (Boughton, 2005).

In object relations approach, the therapist instructs the client to assess difficulties in their life by concentrating on the primary relationship with the parents. Clients are encouraged to express their emotions concretely and physically. For example, a client with fears of abandonment would dance close to and dance away from the therapist repeatedly. In addition, dance therapists use drama, art and visualizations. Traditional talk

therapy is also used by discussing the meaning of the movements (Boughton, 2005).

However, there are major themes common among the majority of dance therapy techniques. First, all humans have unconscious feelings, motivations and memories that humans must become aware of and integrate into consciousness. Also, some unconscious material is housed in the body and can be readily accessed through nonverbal ways. This is especially true of memories associated with trauma to the body and during preverbal

stages of development. Furthermore, dance therapy uses a holistic perspective. This means that the connection between mind and body is emphasized (Mills & Daniluk, 2002).

Often, dance therapists mirror the movement of clients as they express important emotions. The therapeutic relationship is the most important component of the healing process. Dance therapists use kinesthetic empathy to meet and understand the client. The therapist mirrors, observes and reflects the nonverbal expression of the client (Gray, 2001). This technique allows the client to feel safe and confirms the client's emotions. The central idea of dance therapy is that the movements the client executes are expressing significant emotions in their lives.

Clients can more easily express frightening and painful emotions through dance therapy compared to traditional talk therapy (Boughton, 2005). The movement portion of dance therapy can include a variety of relaxation and movement exercises, rhythmic dance, unconscious symbolic body movement, spontaneous and creative movement, and thematic improvisational movements (Mills & Daniluk, 2002). Also, dance therapy allows the individual to eventually talk more openly and eliminates the boundaries they have constructed between themselves and others (Boughton, 2005).

Six Common Themes

Mills and Daniluk (2002) assessed how dance therapy causes change in the lives of clients who had a history of child sexual abuse. The purpose of this study was to understand the subjective experience of clients and the meaning of dance therapy for women who felt that this type of therapy led to their healing and personal growth. There were six common themes that emerged from the accounts of each participant's experience of dance therapy.

Reconnection to their Bodies.

The women in this study stated that they selected dance therapy for the purpose of reconnecting with their bodies. Some participants talked about how they had rejected their bodies because it felt fragile or because it had enticed a child abuser. They felt that they were not completely present in their bodies and experienced dissociation. For example, one participant explained that she had spent the majority of her life feeling like

her body walked in front of her. Dance therapy helped them become more aware and comfortable with physical sensations and different parts of their bodies (Mills & Daniluk, 2002).

A reconnection with their bodies increased their sense of safety, control, self-acceptance and care of their bodies. Their increased sense of control and safety helped them remain present in their bodies when painful emotions and sensations emerged about their past sexual abuse. The participants contended that dance therapy helped them learn alternative ways to deal with painful memories. Dance therapy taught them to utilize their bodies as a way to "anchor" them in the present when dealing with painful memories (Mills & Daniluk, 2002).

In addition, dance therapy allowed them to decrease their use of defensive reactions to cope with psychological pain. The women also reported that dance therapy increased their emotional awareness. The women could more easily and accurately discover and identify emotions (Mills & Daniluk, 2002).

Ben-Asher and Koren (2002) used a case of a child who was sexually abused to explore the effectiveness of dance therapy. The researchers discovered that dance therapy allowed the child to feel more connected to her body. In the beginning of therapy, the child's movements were broken and stiff and she did not connect with her body. By the end of therapy, the child felt reconnected with her body.

Permission to Play.

Play was a crucial part of dance therapy and was especially important for those who were not allowed or could not play or have fun as a child. Dance therapy allowed them to experience play that is characteristic of childhood (Mills & Daniluk, 2002).

Sense of Spontaneity.

The participants explained spontaneous body movement as free and natural. As their movements became more spontaneous, it was easier for them to overcome any struggles they came across. The participants explained that dance therapy helped them concentrate on expressing themselves authentically and become less self-conscious about others evaluating them (Mills & Daniluk, 2002).

Sense of Struggle.

At first, the women stated that they struggled with dance therapy because it was an unfamiliar, challenging and nontraditional form of therapy. Some women even felt embarrassed and vulnerable. Also, the participants had anxiety concerning the resurfacing of painful memories and feelings. They discussed how their bodies stored information about past abuse and that shameful memories sometimes emerged during therapy. One woman compared this experience to a minefield because she never knew when a painful memory would surface. Even certain music, movements and activities could set off emotional or physical reactions associated with past abuse. While these women did not want to deal with body memories, they realized that identifying and processing these memories was important for their healing and growth (Mills & Daniluk, 2002).

Sense of Intimate Connection.

The women explained that dance therapy provided emotional connection with others. The emotional connection came out of movements, gestures and dances that communicated trust and caring. Music and synchronized movement also led to feelings of unity. This group connection helped the women to heal and grow through the support of and the emotional acceptance the group provided. Group therapy also allowed them to see others being vulnerable and taking risks. This led to them taking more risks, sharing more about their own struggles and an increase in their self-esteem (Mills & Daniluk, 2002).

Sense of Freedom.

The women explained that they enjoyed the freedom of choice that dance therapy provided. They were free to chose their own activities and participate based on their own needs, goals and level of comfort. Allowing the abuse victims to have control over therapy was important because they had experienced a loss of control emotionally, physically and mentally. Dance therapy helped them feel a sense of empowerment because they were in control of their own body and experiences (Mills & Daniluk, 2002).

Furthermore, the women liked how verbal processing was optional. Since all of the participants had already had traditional therapy, many of them did not want to talk about their pain anymore and they found it safer to express memories of abuse nonverbally (Mills & Daniluk, 2002).

Overall, the majority of women described dance therapy as a cathartic experience. Dance therapy helped them release emotions and physical energy associated with the painful emotions, which allowed them to resolve their pain. In addition, therapy helped them become more connected and aware of deeper emotions. The women recognized, expressed and integrated their strengths with their painful experiences. Dance therapy helped them develop positive feelings about their bodies (Mills & Daniluk, 2002).

Goals for Future Research

First, dance therapy currently is a complicated and diverse form of therapy. Often, the goals of therapy are ill-defined and progress is measured based on the interpretations and judgment of the dance therapist instead of self-reports and behavioral measures (Mills & Daniluk, 2002). For this reason, goals of dance therapy need to be clearly defined and progress in therapy needs to be measured concretely.

Second, there has been few empirical research studies conducted on the effectiveness of dance therapy. The studies that have been conducted usually involve accounts of client change and decrease of symptoms. Overall, concepts and practical applications of dance therapy are unclear. It is unclear how dance therapy produces change and why specific interventions are utilized under specific conditions. In addition, the subjective experience of the client and their interpretation of how dance therapy leads to change are unclear (Mills & Daniluk, 2002). Future research needs to address these issues.

Overall, research has shown that dance therapy is an effective form of treatment for children who were sexually abused. Mills and Daniluk (2002) discovered that dance therapy helped the women reconnect with their bodies. Also, dance therapy gave them permission to play, a sense of spontaneity, struggle, intimate connection, and freedom. Ben-Asher and Koren (2002) found that dance therapy helped a child who was sexually abused reconnect with her body. These studies are important because they show that dance therapy is an effective treatment for sexually abused children. The studies show that the body is an important "vehicle" for healing, self expression and communication (Capello, 2006).

References

Ben-Asher, S., & Koren, B.(2002). Case study of five year-old israeli girl in movement therapy. American Journal of Dance Therapy, 24, 27-43.

Boughton, B.(2005). Dance therapy. Gale Encyclopedia of Alternative Medicine. Retrieved February 2, 2007, from http://www.findarticles.com/p/articles/mi_g2603/is_0003/ai_2603000316

Capello, P. P. (2006). Training dance/movement therapists: The international challenge. American Journal of Dance Therapy, 28, 31-40.

Child maltreatment: Fact sheet (2007). Centers for Disease Control and Prevention. Retrieved March 7, 2007, from http://www.cdc.gov/ncipc/factsheets/cmfacts.htm

Definitions of child abuse and neglect (2005). Child Welfare Information Gateway. Retrieved March 7, 2007, from http://www.childwelfare.gov/systemwide/laws_policies/statutes/define.cfm

Gray, A. E. (2001). The body remembers: Dance/movement therapy with an adult survivor of torture. American Journal of Dance Therapy, 23, 29-43.

Koshland, L., Wilson, J., & Wittaker, B. (2004). Peace through dance/movement: Evaluating a violence prevention program. American Journal of Dance Therapy, 26, 69-90.

Mills, L. J., & Daniluk, J. C. (2002). Her body speaks: The experience of dance therapy for women survivors of child sexual abuse. Journal of Counseling and Development, 80, 77-85.