Posted: May 19, 2022
Author: Madison Magness, MSW Student

Description of Intervention

Dance/Movement Therapy (DMT) is the psychotherapeutic use of movement and dance to promote social, cognitive, and physical wellbeing (Feniger-Schaal et al., 2018). DMT emphasizes the importance of non-verbal communication and bodily- movement as our first form of communication. Movement can soothe and regulate individuals; reconnecting with the body and staying present are pillars of DMT (Dieterich-Hartwell, 2017). DMT also utilizes talk therapy throughout the movement sessions. DMT can benefit many mental health disorders, including anxiety, depression, PTSD, and autism, among many others. Because DMT focuses heavily on non-verbal interventions, it is a valuable modality for people who are non-verbal or who have communication barriers (physically, mentally, or culturally). A common technique used in DMT is called mirroring.  

Mirroring in Dance/Movement Therapy (as well as drama therapy), otherwise known as the Mirror Game, is a practice used to gain a greater sense of empathy and understanding between a clinician and a client or members of a group through imitating or "mirroring" each other's movements (Feniger-Schaal et al., 2018). These movements should be slow and easy for the participants to follow with their partners / or within a group. Eye contact is also suggested to promote a stronger connection between the individuals. It is common in the mirror game between two individuals to start with one person designated as the leader while the other person follows their movements. Generally, they will each have five minutes to act as the session's leader, and during the third turn, there is no designated leader. Other types of mirroring in DMT involve imitating a client's movements, emotions, or intentions while in session (McGarry and Russo, 2011).

There are currently very few randomized controlled studies on mirroring precisely in Dance/Movement Therapy; there is an apparent gap between practice and research on the effectiveness of mirroring (McGarry and Russo, 2011). Still, it is noted in several studies that the technique is valuable within Dance/Movement Therapy in that it fosters a greater sense of empathy and understanding of togetherness in those who participate.

Historical and Cultural Origins

Although there are no exact origins for the specific DMT technique of mirroring, it is essential to understand the beginnings of DMT and dance in a historical/cultural context. Marian Chace (1896 1970) was the founder of Dance/Movement Therapy. She attended the Denishawn School of Dance in New York City and continued with a career in professional dancing. She then transitioned to working in institutions and focusing more on the unique form of movement/dance instead of rigid techniques classically trained dancers tend to focus on. The emphasis shifted to the client's movements and ultimately meeting the client where they were at and working within the context of those parameters. In 1942, Marian began working at St. Elizabeth's Hospital in Washington, DC (Bunney, 2013, p.6). During this time, individuals struggling psychologically from the aftermath of World War II who were now in psychiatric hospitals were the first to experience "Dance for Communication," later known as Dance/Movement Therapy (Sandel, 1993).  Dance/ movement has been used for centuries in many cultures to heal and communicate through cultural rituals. It is essential to acknowledge that Dance/Movement Therapy is a young form of therapy. It is rooted in ancient dancing rituals ranging from Africa to Australia to Native American Tribes in North America.

Philosophical and Theoretical Foundations

Although the research lacks how mirroring movements brings a sense of togetherness, it has been used in Dance/Movement Therapy for decades. Researchers are currently studying mirror neurons in the brain and how mirroring can activate them, but further studies must be conducted to explain the complex processes (Karkou et al., 2019). The purpose of mirroring is to create a deeper bond between two individuals or members of a group. Through imitating movements non-verbally, a greater understanding between a client and worker can be established. This is an especially valuable technique when working with clients who are non-verbal and may use movement to communicate their thoughts and feelings. Mirroring also helps the therapist gain insight into the client's experience by imitating their movements (Shafir, 2016).

Literature Review of Intervention

For people diagnosed with schizophrenia, social interaction and social connectedness can be one of the most prominent and debilitating aspects of the disorder (Salesse et al., 2021). Synchrony is a crucial factor to have a successful connection with another person. A study by Salesse et al. used the mirror game to investigate improvisation between stable schizophrenic patients and healthy controls (Salesse et al., 2021). Participants included 30 patients diagnosed with schizophrenia who were stable outpatients and 30 participants who were deemed healthy and matched the participant's age with schizophrenia (Salesse et al., 2021). Participants would take turns playing the mirror game, taking the role of leader, follower, and no designated role (improvising together). Results showed that those with schizophrenia improvised less than the control sample; however, participants with schizophrenia were more successful at synchronizing when leading rather than following (Salesse et al., 2021). It is noted in the study that it is rare to observe the level of synchronization in schizophrenic patients in the rest of the studies conducted with this population. In conclusion, the study indicated a negative correlation in schizophrenic participants between socio-motor improvisation and synchronization, suggesting that synchronization enhances social skills (improvisation) and flexibility in a clinical setting (Salesse et al., 2021). Limitations of the study mentioned were the use of outdated scales and participants with schizophrenia were lacking symptom severity (Salesse et al., 2021).

Another study by Slowinski et al. used the mirror game in patients with schizophrenia to propose a plausible intervention to determine potential biomarkers of schizophrenia by playing the mirror game. Slowinski et al. mention the lack of research on biomarkers for people diagnosed with schizophrenia and how motor movement impairments are associated with the diagnosis. They propose that the mirror game could help clinicians recognize early symptoms of schizophrenia through motor abnormalities that would be present during the game (Slowinski et al., 2017). This study used computerized avatars and an iCub robot to act as the leaders in the mirror game and measured participants' coordination with them. They found that clinicians could use their methods when they are uncertain about a diagnosis of schizophrenia as a potential screening tool. It is also mentioned in the study that clinical trials would have to be conducted with at-risk populations, and follow-ups would have to be administered over time; all of the patients were medicated, which could affect their movement abilities, and the sample size of the individual experiments was small (Slowinski et al., 2017).

Training Necessary

Mirroring is a technique used in Dance/Movement Therapy. To use mirroring in the context of DMT, a person would have to graduate from an American Dance Therapy Association (ADTA) approved graduate program, or it is possible to take an alternate route by obtaining a master's degree in dance/movement therapy training from those who are qualified DMT teachers (Hoyt, 2020). Taking the alternate route, psychology coursework, fieldwork, internship, and dance experience are additional requirements for becoming a certified dance movement therapist (Hoyt, 2020). There are different credentials awarded based on certain circumstances. For instance, after graduating from an ADTA approved graduate program or completing the alternate route requirements, the Registered Dance/Movement Therapy (R-DMT) certificate is given. It is also possible to obtain the Board Certified Dance/Movement Therapist (BC-DMT) credential with experience and additional requirements (Hoyt, 2020). This is an advanced credential where dance movement therapists can provide therapy in a private practice setting (Hoyt, 2020). It is also acceptable to practice mirroring in other mental health disciplines, such as social work and counseling, as long as the practitioner is competent in the technique and does not claim to be a dance movement therapist.

Self-care

Mirroring could be a valuable form of self-care for social workers in session with a patient because it offers the chance to connect more meaningfully with their client and gives the social worker time and space to regulate their own emotions before initiating more verbal/cognitive work with a client if they are in a therapeutic setting. It could also be beneficial for social workers to practice mirroring with someone they are close with to decompress and connect with loved ones in a non-verbal manner. Barriers to using mirroring as a form of self-care are that mirroring requires at least one other person to imitate movements. A solution to this barrier could be watching a YouTube video of someone looking into the camera and making mirrorable gestures while the person follows along. Mirroring may not be the most suitable technique for self-care.

Application in Practice

When exploring the practice of mirroring with a client, it would be beneficial to give a brief overview of the practice and the intentions of the practice, which is to foster the therapeutic relationship and promote a greater sense of empathy. A strong relationship between the client and worker can benefit the client in their therapeutic process and create a greater probability of change (Karkou et al., 2019). Non-verbal communication and non-verbal synchrony are vital for social connection; it would be essential to emphasize this with clients, especially those who may be non-verbal and feel as though they cannot connect with those who rely more on verbal communication to form connections (Feniger-Schaal, 2020). Mirroring can benefit various patients, from those with affective disorders, anxiety disorders, trauma, burnout, and personality disorders, to those with mental/ physical disabilities and geriatric patients with dementia. According to Koch 2020, there are no contraindications for any disorder. However, I could see mirroring being challenging to participate with someone who has full-body paralysis.

I am pursuing a career in social work research; I could see mirroring used as a group activity to promote group cohesion and stronger connections between management and coworkers. Mirroring could be an excellent activity to engage in when a new hire or a significant transition occurs. An example could be transitioning from working remotely to working in person; doing simple group mirroring techniques could foster a greater sense of togetherness and trust throughout the team. Mirroring aligns with the NASW Code of Ethics because it promotes the importance of human relationships. As social workers, we understand the importance and power of forming relationships with the people we serve and mirroring compliments this value by creating an environment where empathy and understanding are cultivated. Mirroring also reflects the dignity and worth of a person by meeting our clients where they are and working with them in whatever capacity they can (NASW, 2017). Competency is also essential when practicing mirroring, ensuring that we are not claiming to be dance/movement therapists unless we are board-certified while using this practice.

Conclusion

Although more research is needed to understand the inner workings of mirroring fully, there is no denying the potential to build stronger connections and a greater sense of empathy through this technique.