Dancing away mental illness

25/1/2017

Back in 2015, the Alchemy Project piloted a 4 week scheme to take 12 people with mental health problems from dance novices to performing a choreographed routine in front of an audience.

The results they achieved were remarkable,

Participant’s wellbeing improved undoubtedly, but we also have the numbers to back it up [...] interventions in the NHS settings were seeing +1.2 points improvements. The pilot study saw an increase of 6.7 points, so very significant numbers, and in the Alchemy Project it was up 7.9 points.

Source Oxford University Press blog

So what's the catch?

As the author, Carly Annabele-Coop, makes clear, the purpose of the article is to attract funding. And of course funding bodies like the NHS want measurable results.

However, this can have an unfortunate side effect, because the 'treatment' can get thought of as you might a pill.

Thinking about a 'treatment' like a pill goes something like this...

Depression causes a chemical imbalance in the brain, which the pill restores and 'treats' the depression.

And just as pills are combined to treat particular symptoms, so talking therapies
can be formulated to treat particular problems. This has happened in CBT which has become increasingly 'manualised', such as on p68 of this guide, where inaccurate thinking is 'treated' by the application of the correct technique.

Manualisation all too frequently relegates warmth, empathy, genuiness and rapport to being merely a means to an end. Rather than being seen as therapy in themselves, we discover on p19 these qualities are instead just a way to, "improve response and motivation to engage in therapy."

One of the issues of something just being a means to an end is that it is difficult to engage with. And compliance is a significant problem in mental health treatments.

In 2002 Pampallona and his team performed an analysis of adherence in depression treatment and found that around 1 in 3 patients do not complete their course of treatment.

While more recently, the effectiveness of cCBT (computerised CBT) has been questioned on the grounds of poor compliance.

What does this have to do with dance?

If you wanted to replicate the Alchemy Project, and you wanted to distill out the magic ingredients so you could manualise it, how might you see it?

Perhaps it's about having a competent teacher who can instill the correct dance techniques?
Or maybe it's just a form of exercise?
Or it could be that what people with mental health problems need is to have a challenging end goal, like putting on a show?

So what did Lauren Gavaghan from the Alchemy Project think were the magic ingredients?

"[Carly, Ellen, and Delene] lead the group with strength and a confidence that immediately fosters trust and creates a safe, containing and nourishing space."

"The typical hierarchical structure that often dominates medical environments is done away with as we enter the doors of the community centre - here we are all equals."

"by bringing people, quite physically and literally back into the light, whilst being 'seen' by others. It is this sense of being seen and heard which is incredibly powerful."

Source The Alchemy Project blog on RPpsych

Which do you think would be more therapeutic? The manualised version or Lauren's? Which would you be most likely to want to stick at?

In Lauren's description the relational aspects such as safety, containment, equality, being heard, are not merely a means to an end, they are an end in themselves. They are by themselves therapeutic - the technique or the exercise in which they appear is nothing more than the wrapper which holds these magic ingredients together.

What does all this mean for you?

If you are feeling depressed, one of the things your therapist is likely to recommend is to take up exercise.

Which is one of those means to an end kind of things - you're taking exercise to help you feel less depressed. And of course it's a whole lot easier for your therapist to suggest it, than it is for you to do it, especially as one of the things depression strips you of is motivation.

What if you looked at this from a different angle?

In the counselling room the conversation often goes something like this,

Me People often find exercise helpful with depression.

Jake Well, I used to like going to the gym.

Me What was it you liked?

Jake Feeling fitter. I felt better about myself when I felt more toned... more confident really, like I could I tackle anything... and I think people saw me differently... I used to have a gym buddy. Me and this other guy went there at the same time each week, and we used to help each other out. We'd push each other. I like the feeling of being in a bit of a competition... Against myself really. Pushing myself a bit harder each time, to see if I could do another rep, or add some more weight.

Me How would it be to go to the gym again?

Notice how Jake's description is much more like Lauren's, and this leaves us with a question.

Is the benefit of exercise to do with chemical changes in the body?

Or is it more to do with things like feeling more confident, being encouraged, having shared goals, and bettering yourself? Are they in themselves therapeutic, and exercise is just the wrapper they come in?

I have lots of conversations similar to the imaginary one with Jake, and I am much more interested in the place people want to get to, than the means they get there, because this is where the real magic is. This is where therapy happens.

main photo by Pexels

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