Pamela, a young woman, looks much older than her years. She is
pale with dulled eyes and dark circles beneath them and she looks
as though she has not slept in many days. Her rounded shoulders
give her the appearance of being burdened. Her chest appears hollow
and collapsed. She holds her muscles rigidly. Her breathing is
so shallow that it is barely visible. She sits on the couch in
my office in heavy stillness with the exception of the restless
movements of her hands and feet. Little energy is available for
eye contact, for facial expression, for relationship. Pamela is
depressed. We have all seen people such as Pamela in our clinical
and the Body
From a movement perspective, depression equals suppression; suppression
of the life force, suppression of self-awareness, suppression
of emotion. This bodily defense whether situational or chronic
is very limiting in terms of total functioning. Yet, it serves
to protect the depressed person from feared aspects of inner experience.
Suppression is accomplished automatically and unconsciously in
the body by decreasing respiration, by holding the muscles tensely,
and by limiting movement. Hence, movement is the enemy of depression.
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
As I inquire of patients what depression-related symptoms they
might be experiencing bodily, such as disturbances in eating,
sleeping, sexual functioning, etc., I also inquire about any changes
in their movement habits. Of course, it is not unusual to hear
that there has either been a decrease in their usual movement
activities or amount of movement generally. It is also not uncommon
to hear that movement has never been of particular interest to
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.
Getting Started: Using Movement as Intervention in Your
First, there are questions for the clinician. How comfortable
are you with body movement? Would you be comfortable to use simple
movement in your sessions with depressed patients? If you have
answered that you are reasonably comfortable with movement and
the idea of using it as intervention in your sessions, this section
applies to you. If not, the good news is that the sections below
entitled Supplements and Alternatives to Movement in Your Sessions
and Help! My Patient Won’t Budge will support your efforts
to add movement into the treatment process.
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.
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.
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.
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.
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.
Stretching. Beginning from the feet, guide your client
to slowly stretch each body part or body area, proceeding sequentially.
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
Using the interview information regarding receptivity to movement
and movement interests and experiences, refer your clients to
suitable movement experiences and classes. Possibilities include
stretch class, dance class, yoga, t’ai chi, playing a sport,
walking, running, etc. Remember to think incrementally, as the
defense to movement in depression is powerful. For example, putting
on music at home, visualizing dance, watching a dance performance,
moving to music at home, signing up for the dance class, observing
a class may all be precursors to actually attending a class as
a participant. Again, your patient’s reactions regarding
the possibilities for movement, as well as his or her experiences
of participating in it provide you with opportunities for therapeutic
What to Do When Your Client Won’t Budge
As is often the case, the nature of the depression/resistance
to overcoming depression is such that self-generated movement
does not seem feasible. If this is the case, I suggest less active
ways to get started, for example massage, other forms of body
work, or acupuncture. These methods allow a person to remain still,
to receive passively and to feel relationship with and nurtured
by the practitioner. At the same time, these forms of treatment
are very powerful and, because they address symptoms of depression
physically/physiologically, from a holistic perspective, they
also can have positive psychological effects. As with any referral,
it is essential that the body work professional be suitable for
the particular patient in mind, and that the professional is interested
in working together with the clinician in support of the patient.
If you do not have personal experience with these methods of treatment,
it is very likely that therapists you know can provide informed
referrals. One caution is that body work may not be suitable for
patients who have experienced body-related traumas, at least until
their psychotherapy has progressed sufficiently.
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.
Throughout the course of treatment, it is also very important
to consider “the basics,” for example, sleep disturbances,
poor nutrition, and the use of substances, such as alcohol, caffeine,
nicotine, and other drugs can seriously affect mood. Resistance
to making changes in these areas must be addressed and explored
over and over again in the therapy, as a stable physiological
baseline is a crucial support for ameliorating depression.
Working with depressed patients can be frustrating and challenging.
Additionally, projected states by the patient into the therapist
can leave the therapist feeling helpless, hopeless, angry, sad,
isolated, etc. Hence, the therapist should be aware of the effects
of working with the depressed state on his or her state of being.
Support and a combined team approach can make the work more bearable.
Many of the practices suggested above can also be of value for
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
private pCEU Continuing Education for
Social Worker CEUs, Psychology CEUs, Counselor CEUs, MFT CEUsractice involving the long-term treatment of adults individually
and in couples in psychodynamically-based treatment using verbal
and nonverbal techniques. She has also provided supervision to
many student and professional psychotherapists.
For many years, Dr. Fisher was Assistant Professor in the Dance/Movement
Therapy Graduate Program at Goucher College in which she taught
courses related to dance/movement therapy theory, practice and
research. She also served as Thesis Coordinator for the Program
and was responsible for overseeing research for and writing of
the master’s thesis. Most recently (2000-2003), Dr. Fisher
was Co-Editor of The American Journal of Dance Therapy, the official
publication of The American Dance Therapy Association.
The article above contains foundational information. Articles below contain optional updates.
Reflection Exercise Explanation
Goal of this Home Study Course is to create a learning experience that enhances
your clinical skills. We encourage you to discuss the Personal Reflection
Journaling Activities, found at the end of each Section, with your colleagues.
Thus, you are provided with an opportunity for a Group Discussion experience.
Case Study examples might include: family background, socio-economic status, education,
occupation, social/emotional issues, legal/financial issues, death/dying/health,
home management, parenting, etc. as you deem appropriate. A Case Study is to be
approximately 300 words in length. However, since the content of these Personal
Reflection Journaling Exercises is intended for your future reference, they
may contain confidential information and are to be applied as a work in
progress. You will not
be required to provide us with these Journaling Activities.
Reflection Exercise #1
The preceding section was about Movement as Intervention in the
Treatment of Depression. Write three case study examples regarding
how you might use the content of this section of the Manual or
the “Positive Reinforcement” section of the audio
tape in your practice.
Online Continuing Education QUESTION
What is the enemy of depression?