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and the Body
In combination with other therapies, such as verbal psychotherapy and medication, movement is a critical, but often overlooked, aspect of the treatment of depression. The usefulness and effectiveness of working with the physical/physiological suppression in the body cannot be underestimated. Because the mind and body function as an integrated whole, bodily activation positively affects total functioning- physiologically/physically, emotionally, cognitively, and relationally. Yet, how do we get our patients moving when certainly our patients are hesitant to go beyond suppression? And, how do we begin to use movement as intervention, especially when we may be working in non-movement-oriented clinical practice or when we may not accustomed to considering movement as part of the treatment protocol for depression?
Including Movement in Your Assessment
If the person has or has had preferred
movement activities, such as walking, playing a sport, dancing,
etc., I note that information to use in considering and shaping
movement interventions. If there doesn’t seem to be interest
in movement-oriented activity, I will inquire about movement activities
the person did or liked to do as a child. Children are developmentally
more movement-oriented, so I can usually gather some information
by asking this question. As in any client-centered treatment,
the goal is to start where the person is, no matter how disinterested
in movement he or she seems to be and build from any available
starting point. The way a client responds to the movement-related
questions also gives me a gauge regarding how receptive he or
she may be to movement interventions.
The following are suggested interventions for working with depressed patients. All can be done while seated. Use the information gathered in your assessment combined with your clinical intuition to gauge how receptive your patient might be to movement, and to choose which technique(s) to use. The techniques are generally ordered from least to most challenging in terms of the extent of movement involved. It is recommended that you teach clients these techniques during sessions and suggest their subsequent practice at home. After completing an exercise, remember to engage the patient in exploring his or her reactions to it. What thoughts and affect emerged? Use this material as a springboard for further psychotherapeutic interaction.
1. Visualization/Ideokinetic Facilitation. Ask your client to close his or her eyes and visualize a scene involving others moving and have him or her describe it to you. Next, ask your client to include himself or herself in the scene and describe it to you. Visualization/Ideokinetic facilitation can enhance motivation to move.
2. Progressive Relaxation. Ask your client to close his or her eyes. Guide him or her to tense body parts as fully as possible, holding the tension in that part for 10 seconds and then releasing. Start with the feet and guide him or her to work toward the head part by part, in a sequential fashion.
3. Body Awareness. With your client’s eyes closed, guide him or her focus on different body parts sequentially, beginning with the feet. Ask him or her to notice the sensations experienced while attending to each part.
4. Breathing. With eyes closed, ask your client to notice his or her breathing. Encourage him or her toward slightly deeper breathing. Or, ask your client to take a breath and hold it until he or she reflexively exhales. Repeat.
5. Stretching. Beginning from the feet, guide your client to slowly stretch each body part or body area, proceeding sequentially.
6. Rhythmic Movement. Ask your client to bring in some favorite music to play. While seated or standing, guide him or her to move to the music by moving different body areas- hands and arms, feet and legs, head and shoulders, hips, and finally the whole body.
or Alternatives to Movement in Your Sessions
What to Do When Your Client Won’t Budge
If your patients won’t go to body work, and are not self-motivated, I suggest that, if they like music, that they listen to music. If they like dance, that they watch dance. If they like sports, that they watch sports. The vicarious experience of movement can enhance the motivation to begin to move.
Anne C. Fisher, PhD ADTR is a licensed clinical psychologist and
a registered dance/movement therapist in private practice in Washington,
DC. For the past 20 years, she has had a general psychotherapy
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