The Therapeutic Dance

April 2021

This is a term I first saw a few years ago on a list serv for speech language pathologists interested in stuttering. It was used to describe the effective speech therapist in action with a client as they move toward a goal, comparing the process to a dance. I wish I could remember the name of the clinician who posted. But what she said resonated with me and caused me to think about what it is we actually do when we provide speech therapy.

First, what does the therapist need to dance effectively? Bruce Wampold and others have said an effective therapist has a well-developed set of interpersonal skills; knows how to form alliances; is an effective communicator; is flexible; offers hope; relies on best research and best practice evidence; and continues to improve through professional development (Wampold, 2011; Mosak & Rasmussen, 2002). Carl Rogers (1957) famously said the effective therapist sees the client with an accepting, validating, unconditional positive regard. I believe the effective therapist must also be willing to be vulnerable and to be grateful, for the gifts she has been given to do this work and for the courage the client shows in coming to her.

And so the dance begins. Effective speech therapy is movement between partners and movement toward a goal. Sometimes we lead, giving direct instruction. Sometimes we follow. Sometimes we lead by gliding backwards, so we can observe the client as we both move forward. Sometimes it feels like we are dragging the client and sometimes we have to run to keep up, dodging and weaving to stay out of the way because change is happening so fast. Always we listen, sometimes smiling in amazement at the truth the client has just voiced, and sometimes wincing internally as an unproductive thought or behavior resurfaces. Effective therapy is individual. It DOES NOT, CANNOT, and NEVER WILL exactly follow programmed steps. It is not prefabricated or canned or one size fits all. The dance must be open and malleable and flexible so it can be adjusted. And as much as we would like, there is no instruction manual for working with the unique individual in front of us.

Some days this process is effortless. We are dancing on air and in the zone. Everything is going right. And, at other times, nothing is working, and we wonder why we chose this profession and how we could have possibly fooled so many people for all these years. We don’t feel like dancing at all. That’s when it is most important to listen to the music, the internal melody of our best hopes for the client coupled with the rhythm of our own experience. At first it may be only us who hear the music.

The success of the dance depends on relationship. The client needs to trust her partner as they dance. For her part, the therapist is an excellent but not distanced observer, able to spot something that is clearly not working and change it in real time or use that information to change the next visit. She is constantly watching for clues from the client. The therapist must be able to sense momentum, that slight and elusive indication that things are progressing. The therapist must be nimble, creating and recreating as the dance progresses. She is always encouraging and supporting and validating, and in that way continually moving even though she is sitting still.

The therapeutic dance includes presenting a task, watching the response, evaluating how effective the response was at moving the client toward the goals, and then changing the next instruction as needed. It is multitasking and yet constantly maintaining presence with the client. The process takes genuine listening as well as a thorough knowledge of possible approaches at one’s disposal. When she models speech tools, the therapist is constantly judging how well the approach fits by how the client responds, by his body language and, perhaps, even, by what he says. It demands a focused awareness on the part of the clinician and when successful, is exhilarating and exhausting. The dance demands everything we have. Watching an experienced clinician execute the therapeutic dance is eye opening and inspiring and overwhelming because the therapist makes it look so easy and you know it is not easy. It is an art as much as a science. An art as much as a science.

© 2021 Glenn Weybright. All rights reserved.

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Mosak, H.H. &Rasmussen, P. (2002). Dance as a metaphor of the psychotherapeutic encounter. Journal of Individual Psychology, 58, (2).

Rogers, C.R. (1957). The necessary and sufficient conditions of therapeutic personality change. Journal of Consulting Psychology, 21 (2).

Wampold, B. (2011). Psychotherapy effectiveness: what makes it work? Address to the 2011 American Psychological Association Convention Symposium.