Bailamos! An Evaluation of Cuban Salsa in A Psychiatric Hospital Unit 1

Bailamos!
An Evaluation of Cuban Salsa in a Psychiatric Hospital Unit
Bailamos!AnEvaluationofCubanSalsaasaMeansofTransformingStaffPatient
RelationsinaPsychiatricHospitalUnit
AThesisSubmittedby:
AMANDAS.GILL
Forthedegreeof
MasterofArtsinExpressiveTherapies
LESLEYUNIVERSITY
GRADUATESCHOOLOFARTS&SOCIALSCIENCES
MAY21,2011
Bailamos! An Evaluation of Cuban Salsa in a Psychiatric Hospital Unit
ACKNOWLEDGEMENTS
Iwouldliketothankthefollowingpeoplewhohaveinspiredmealongtheway:
EllenLandis,forexposingmetonewliteratureandprofoundinnerlisteningskills,
JoanKovach,fordefendingmyideasandsearchingforsolutions,
AbbyZane,forbelievinginmeandofferingconstantsupport,
LourdesBracheTabar,foralwaysremindingmetoreturntothedance,
NancyBeardall,forpushingmeoutofstuckplacestoseetheoptions,
samsmiley,forpositiveencouragementandinspiration,
LindaCassensStoian,forofferingconstructivecriticism,
LaineShakerdge,forbeingmynumberonefan!
Mydearfriendsandfamily,foracceptingmydisappearingactintheprocess,
AlloftheMSEstaff,forvolunteeringtoparticipateandofferfeedbackontheprogram,
DCCasinerosandRuedadeCotorrodancers,foragreeingtobeinterviewedanddiscuss
theiropinionsonRuedaandtherapy,
DavidGabel,forprovidinghelpfulresearchcriticism,
YousefAlAjarma,forreviewingmydataanalysis,
GonzaloGrau,forinspiringmusicalchoicesfortheprogram,
ZitaandMyra,forbeingmythesispartnersincrime,
andmymother,forplantingthehealingdancerinme.
Thankyouall.
TABLEOFCONTENTS
LISTOFTABLES.............................................................................................................5
LISTOFFIGURES.................................................................................................,.........6
1.
INTRODUCTION....................................................................................................
.....8
2.
LITERATURE
REVIEW..............................................................................................14
Dance/Movement Group Therapy Interventions ..............................................................15

Relational cultural theory ............................................................................................15
DMT in psychiatric settings ........................................................................................16
Neuroscience and DMT ..............................................................................................17
Ballroom or social dance in therapy ...........................................................................18
Staff-Patient Relations in Inpatient Psychiatric Care ......................................................19
Types of nursing interventions ....................................................................................20
DMT with patients and staff .......................................................................................22
Harm in inpatient settings ...........................................................................................22
Staff Well-being and Burnout ..........................................................................................23
Burnout ......................................................................................................................24
Emotional exhaustion in the nursing profession ........................................................24
Staff well-being ..........................................................................................................24
3.
METHOD ..................................................................................................................26
Theoretical Orientation ..................................................................................................26
Ethical Considerations ...................................................................................................27
Participants .....................................................................................................................28
Data Analysis and Interpretation ....................................................................................29
Data sources ...............................................................................................................29
Analysis and interpretation .........................................................................................31
4.
RESULTS ..................................................................................................................32
PartOne:AnalysisofSeparateInterviews....................................................................32
Interviewee1:Heather...............................................................................................32
Interviewee2:Sandy..................................................................................................33
PartTwo:AnalysisAcrossInterviews...........................................................................35
Positiverelationalbehaviors.......................................................................................35
Empatheticunderstanding...........................................................................................37
Hopeineffectivenessoftreatment.............................................................................39
QuestionnaireResults....................................................................................................43
MyObservations............................................................................................................62
5.
DISCUSSION.............................................................................................................66
APPENDIXA:InformedConsent....................................................................................73
APPENDIXB:
Advertisement..........................................................................................76
APPENDIXC:PostRuedaDanceTherapySessionQuestionnaire.................................78
APPENDIXD:InterviewGuide.......................................................................................80
APPENDIXE:RuedaDanceTherapyProgramEvaluationQuestionnaire.....................83
REFERENCES.................................................................................................................86
LISTOFTABLES
TABLE1,ParticipantsResponsestoHowtheProgramImpactedtheUnit...............45
TABLE2,ParticipantsResponsestoHowtheProgramAffectedRelationships
withPatients.................................................................................................................47
TABLE3,ParticipantsResponsestoHowtheProgramAffectedPatientsand
StaffWellbeing...........................................................................................................50
TABLE4,ParticipantsResponsestoHowtheProgramBenefittedPatients.............52
TABLE5,ParticipantsResponsestoHowtheProgramBenefitsStaff.....................54
TABLE6,ParticipantsResponsesAbouttheValueofanOngoingProgram...........57
LISTOFILLUSTRATIONS
Figure
1. Didparticipatinginthesessionimpactstaffwellbeing?.......................................44
2. Howhastheprogramaffectedtheunit?.................................................................46
3. Howhastheprogramaffectedstaffsrelationshipswithpatients?........................48
4. Howdostaffperceivetheprogramhasaffectedpatientsmoodsandtheir
ownwellbeing?......................................................................................................51
5. Howmightthisprogrambenefitpatients?..............................................................53
6. Howmightthisprogrambenefitstaffontheunit?.................................................55
7. Howmightanongoingprogrambevaluablefortheunit?....................................58
8. WouldstaffparticipateinanongoingRuedatherapyprogramwithpatients?......60
ABSTRACT
Bailamos!AnEvaluationofCubanSalsaasaMeansofTransformingStaffPatient
RelationsinaPsychiatricHospitalUnit
AmandaGill
ThisthesisexamineshowafivemonthRueda(CubanSalsa)dancetherapy
programforstaffandpatientsaffectsstaffwellbeingandstaffpatientrelationsonan
inpatientpsychiatricunit.ThirteenMcLeanSoutheaststaffparticipantswereinvolvedin
thestudy;twowereinterviewedandtherestcompletedwrittenquestionnaires.Iused
qualitativeanalysis,informedbynaturalisticinquiryandprogramevaluationtheory,to
interprettheirsubjectiveexperiencesoftheprogram.Resultsshowedthatthestaffwho
participatedinthedancetherapysessionswithpatientsbenefittedfromstressreduction
andstrongerrelationshipswithpatients.Thestaffwhodidnotparticipateinsessionsand
observedtheprogramreportedreducedpatientagitationontheunitandanincreasein
positiveinteractionsbetweenpatients,andpatientsandstaff.Thedatasuggestsfurther
researchshouldexplorehowdancetherapyprogramswhichincludepatientsandstaffcan
improvestaffpatientrelationsandtheimpactonpatientssymptomotologyandrelational
behaviorintheworkplace.
KEYWORDS:dance/movementtherapy,Rueda,inpatientpsychiatric,staffpatient
relations,staffwellbeing,programevaluation,burnout,emotionalexhaustion
CHAPTER1
INTRODUCTION
Rueda and Salsa has helped me to feel connected to people
who come from different backgrounds than myself. It helps me
feel more broadly connected to the world.
~David Gabel, Washington, DC
Yes, dancing Rueda de Casino has a positive impact on the
community. For example, people that have lower social abilities,
when they enter a Rueda and dance they leave behind their
bad habits or customs and they develop a better relationship to
society.
~Jairma, Havana, Cuba
I have been pursuing an artistic passion and career path with the Cuban salsa
circle dance Rueda de Casino since 2004. As a foreigner studying five months abroad
in Havana, Cuba, I made sound friendships quickly with fellow dancers in the Rueda
de Casino dance troupe from the National Arts Institute, Instituto Superior de
Arte, and the local neighborhood. I observed how this circular, synchronous, rhythmic
dance promoted trust, joy, and respect among the participants. Being a member of this
dance group gave me an instantaneous sense of belonging to a community; the
experience also provided a non-threatening space to develop connection and practice
cooperation with others. Years later, I witnessed divided students in high school
classrooms, groups of strangers at neighborhood festivals, and anxious individuals in my
dance company DC Casineros have similar positive behavioral responses while dancing
Rueda de Casino. As a dance/movement therapy (DMT) intern at McLean Southeast
Hospital (MSE), I wonder if these positive behavioral changes might occur in an inpatient
psychiatric hospital setting.
Based on Relational Cultural Theory (RCT), this study will consider how the
Rueda dance therapy program has affected clinical staff working with patients in an
inpatient hospital unit. Recovering from mental illness is not an individual, or solely
medically-induced process. The dominant culture in the United States urges people to
focus on self-development and care, and relationships are viewed as background supports
to individual development (Beardall, Bergman & Surrey, 2007). However, studies show
that ones social environment and support have a significant impact on recovery (Sharac,
McCrone, Sabes-Figuera, Csipke, Wood & Wykes, 2010). In other words, the relational
climate in a hospital has a direct effect on patients ability to concentrate and adapt. Based
on the Stone Centers Relational Cultural Theory, central to healthy human growth is
relational development (Beardall et al., 2007). Healthy human relationships lead to
increased levels of zest and empathy. Studies show that greater staff-patient interaction,
10
such as participation in therapeutic or social activities, in inpatient wards improves

patients clinical outcomes (Duignan, Hedley & Milverton, 2009; Sharac, et al., 2010).
The main goal of my research is to gain a better understanding of the healthcare
staffs perceptions of the Rueda dance therapy program at the MSE Adult Psychiatric
Program. Through a Relational Cultural lens, I am evaluating how this dance experience
affects staffs perceptions of their relationships with patients and their well-being in the
workplace. I have informal evidence that it promotes social interaction and an improved
sense of well-being. As an intern at MSE, I have the opportunity to format the dance for a
psychiatric setting, where touch is prohibited, yet a need for more social connection
exists.
This recreational group Salsa dance maintains some of its traditional aspects, such
as: call-and-response format, the repetitive 1-2-3-hold 4 basic step, and the circle
structure. For the psychiatric setting at MSE, I utilize DMT methods like empathetic
reflection and movement metaphor to incorporate content of participants treatmentrelated goals. From the start of the program in September 2010, staff have been invited to
join the group. Over the last five months I have had an average of 8-10 patients attend
each of the two weekly DMT groups, and occasionally a staff member will participate.
DMT can provide a non-threatening avenue for people to develop new
relationships with others and oneself (Levy, 2005). It can also be an outlet where staff and
patients shift their focus from their negative preoccupations to present moment-tomoment connections with one another. In Havana, Cuba and Washington, DC, Rueda
de Casino dancers have reported this circle dance to be a supportive escape from stress,
as well a way to promote positive relational behaviors, provide tension release, and
11
increase self-esteem and worth (O. Lopez-Ayon, K. Zalan, V. Cuello, L. Betancourt,

personal communication, January 2010). As director of DC Casineros, I have observed
my dancers attitudes shift from stressful, anxious and reserved to more relaxed, trusting,
sociable moods, and I am interested in whether or not Rueda dance therapy is an
effective DMT method in health care settings.
With the advent of managed care over the last 15 years, the typical lengths of stay
for psychiatric patients has been greatly reduced to between four and seven days (Jones,
2005). The short-term nature of treatment creates more pressure on clinicians to work
harder and faster, and often with patients facing more severe symptoms. Patients have
little time to adjust to the new hospital environment, a foreign place where they are
expected to heal and follow the advice of a team of strangers. Therefore staff members
have to deal with more resistance. Prior studies show this leads to higher rates of
employee burnout (Jourdain & Chnevert, 2010). Dance therapy may be an appropriate
tool for reducing mental healthcare staffs emotional exhaustion and, ultimately, job
turnover.
Research shows that staff rapport with patients has a huge impact on clinical
outcome (Pitknen, Htnen, Kuosmanen & Vlimki, 2008; Sharac, et al., 2010).
Burnout, which may be provoked by hostile patients and/or other stressors, is a
detrimental factor impairing staff performance, along with patients treatment (Jourdain
& Chnevert, 2010). Finding ways to build relationships with the patients and staff might
lead to a more productive culture, more meaningful work in the workplace, and greater
patient satisfaction.
12
Through anonymous written program evaluation questionnaires and semistructured interviews with two workers, staff will share their opinions on the effects of
the Rueda dance therapy program. Two staff who participated in at least two Rueda
therapy sessions will be interviewed and asked to share more in depth their views of their
experience moving with patients. The research will supplement the literature on the
impact of dance therapy on inpatient staffs well-being, staff relations with patients, and
their perceptions of how dance therapy affects an inpatient unit.
There are several limitations to this study. First, the staff responding to the written
evaluations have had different amounts of exposure to the program. Any staff who has
worked at the time a dance therapy group took place was invited to complete a
questionnaire; therefore some staff have witnessed the program one day vs. twenty days
over the five-month period. Also, due to the current nature of short stays in inpatient
units, there is a high patient turnover. The staffs experience will be dependent on the
clinical profiles of patients. It is probable that each DMT session will consist of different
patients. The DMT sessions will be highly influenced by the severity of symptoms and
resulting behavior of the patients. My own assumptions and biases around the therapeutic
benefits of Rueda de Casino will also play a role in the study. I will address these
potential biases by using triangulation and peer checking methods.
There are few studies exploring how DMT affects staffs perceptions of wellbeing and relations with patients in psychiatric settings. There is evidence of how the arts
can improve the healthcare environment of hospitals and may alleviate patients and
staffs emotional and physical responses to illness (Hume, 2010). One pertinent study
focused on staff and dementia patients engaging in the dance Wu Tao, and the authors
13
concluded that patients agitation levels were reduced, while positive interactions and
staff empathy for patients increased (Duignan et al., 2009). The significance of this study
shows that a non-Western dance form can have therapeutic effects on patients and staff in
a Western health care setting. DMT has proven effective since Marion Chaces work at
St. Elizabeths Hospital in the 1940s, and this study will explore its effectiveness in
enhancing staff well-being and relations with patients.
There is a need to develop psychiatric inpatient interventions that promote
patients sense of safety, belonging, and empowerment to adhere to treatment. Staffs
interactions with patients contribute to the quality of treatment provided. I will be
inquiring from a variety of staff members whether they gain empathy and a healthier
connection to patients after participating in Rueda therapy. Is there any impact on staff
who simply work during the hours of the program? I will explore how staff members
working on the unit observe the impact of dance therapy on patients moods. Do they
sense the Rueda dance therapy program impacts their relationships with patients, and
their own well-being? And lastly, do they find this program valuable for an inpatient
psychiatric unit and its staff?
14
CHAPTER 2
LITERATURE REVIEW
It has been said that research creates new understanding by building on what
exists (Chaiklin & Chaiklin, 2004). In this naturalistic inquiry study, I have considered
the questions of how do staff experience participating in Rueda dance therapy sessions
with patients and what is the impact of the program on their experience working with
adult psychiatric patients? There is a lack of investigation in the existing literature on
DMT interventions with staff and patients in psychiatric settings. However, in turning to
the existing body of knowledge in related areas of study, I will explore the foundation of
past research that supports the need for this intervention and the gap in knowledge it may
fill.
In this literature review I have synthesized and compiled results of previous
studies related to dance therapy and inpatient staff-patient relations. I will situate my
study into the context of three different categories of literature:
15
I. Dance/Movement Group Therapy Interventions

II. Staff-Patient Relations in Inpatient Psychiatric Care
III.
Staff Well-being and Burnout
In each of these subdivisions, I will explore the major themes in the literature and
relate their strengths and limitations and pertinence to my study. In order to begin to
consider the impact of DMT sessions with staff, it is important to identify the history of
what has been done. Furthermore, examination of patients and hospital staffs
descriptions of in-patient psychiatric unit environments along with staff well-being may
reveal how dance therapy will impact staff-patient relations. By highlighting dances
therapeutic effects on mental health and interpersonal relations, I may deduce that this
method of intervention would be plausible with support from existing literature.
Dance/Movement Group Therapy Interventions
As a dance therapy student using Cuban Salsa in the study, I have found no
previous peer-reviewed published research on Salsa dance in therapy. It has been a
challenging venture to find studies on the effects of social or recreational dance in
therapy. My literature review led me into new territory that explores relational
connections and the neuroscientific evidence for DMT.
Relational Cultural Theory. The conceptual framework for this study is
Relational Cultural Theory (RCT), an alternative to the traditional theories of
psychological development. This theory will provide me a way of looking at the world,
the basis for making an interpretation (Chaiklin & Chaiklin, 2004). Independence and
self-sufficiency have been considered the goal-markers of human psychological
development in the West (Miller & Stiver, 1997). Developed by Jean Baker Miller
16
(1997), RCT supports the belief that maturity involves growth toward connection and
relationship throughout the life span.
RCT plays a major role in DMT interventions because it reinforces the relational
skills that can be gained in non-verbal therapy (Beardall et al., 2007). This theory is the
basis of a secondary school curriculum called Making Connections, Building
Community and Gender Dialogue in Secondary Schools, and this DMT
method has been proven to increase healthy connections in the school environment
(Beardall et al., 2007). A connection is an interaction where mutual empathy and mutual
empowerment exist. A few strategies for fostering connections include: getting to know
each others strengths, and conveying attentiveness to others through nonverbal gestures.
To consider whether you are experiencing a connection, you can ask yourself: Does this
interaction lead to a greater sense of connection with the person(s) directly involved-- and
does it lead to the motivation for more connection in general? (Miller & Stiver, 1997, p.
34). In Beardalls DMT work with middle schoolers, participants practice and gain
relational skills and observational skills to identify and promote connecting behaviors.
Two of the personal outcomes of emotionally healthy relationships are increased
zest and empathy. Miller & Stiver (1997) write how zest feels like an increase in vitality,
aliveness, energy; it does not mean you feel less sad or fearful, however it is to say that
what matters is to be in connection with others, and with the feelings, whatever they
are, that arise out of an experience (p. 30). Empathy is explained as having a more
accurate picture of the other, and gaining awareness of your own feeling with the other
(Miller & Stiver, 1997). Action is the feeling of empowerment to impact the other and
create change and it is significant in psychological development because through
17
interaction we learn to augment and diminish others. These aspects of relational

connection are essential to growth-fostering relationships.
DMT in psychiatric settings. Clinicians began to use therapeutic movement
in psychiatric settings following Marion Chaces effective work with psychiatric adults in
the early 1940s (Levy, 2005). The populations treated in the dance therapy literature
range from developmentally disabled, normal neurotics, the elderly, and mentally ill.
Specific goals of group DMT with psychiatric populations include: improve body image,
improve mood, increase treatment adherence in the medically ill, help schizophrenic
patients to build inner structure, increase social functioning, and utilize a space where
participants can confirm some of their beliefs of the other and environment (Levy, 2005;
Goodill, 2005; Leahy, 2004; Duignan et al., 2009).
A study by Leahy (2004) explored the effects of movement therapy on
schizophrenic patients, and found patients had stronger ego function, social functioning,
and increased mindfulness. Although this study looked specifically at effects on patients,
it implies that patients will reduce their hostility and interact more easily with staff.
Duignan, et al. (2009) showed that after four weeks of weekly Wu Tao dance therapy
with staff and patients with dementia, there was increased therapeutic bond and a
reduction in patients agitation. Staff in the study reported relaxing, mood-lifting benefits,
higher job satisfaction, and increased interaction and sense of togetherness.
Neuroscience and DMT. One of the fundamental concepts in DMT work is
empathetic reflection. In this method, the therapist faces and mirrors the actions of the
patient. Berrols research (2006) discusses the role of mirror neurons in empathetic
understanding and attunement. Neuroscientists have revealed that the same sets of motor
18
neurons are activated in an observer as in the individuals actually engaged in the

expression of some emotion or behavior. This mirror matching mechanism allows
humans to identify empathetically with others and experience a shared s-identity (social).
The research supports the idea that humans are neurologically endowed with the capacity
for mutual knowing, understanding and feeling (Berrol, 2006; Siegel, 2010).
Physician and writer Dan Siegel integrates brain science into the practice of
psychotherapy and elaborates on the mirror neuron system. Human beings have the
potential to embed the mind of another into our own brains firing patterns (Siegel, 2010).
Our developmental and attachment patterns impact how solid or distorted our own
sequencing circuits are. For example, if we see straightforward behavioral patterns in our
caretakers, we map sequences with security and the intentions of kindness and care
(Siegel, 2010). Through intentional movement and mirroring others, we embody their
emotional states and emotional energy underlying their behavior. The act of intentionally
sharing behaviors helps bind people together. This literature defends dance therapy as a
tool for relational skills development.
Ballroom or social dance in therapy. Judith Lynne Hannas seminal book
Dancing for Health addresses historical and non-Western dance-stress relations, and
defines the link of dance and exercise to neurogenesis (2006). Dance offers both sensory
and symbolic meaning, and stimulates creative cognitive patterning. Hanna writes how
the key purpose of social dance is to provide the opportunity for people to get together
and interact (2006, p. 53). There are limited studies however implementing social dance
into dance therapy with psychiatric populations.
19
Two noteworthy studies investigating the therapeutic value of ballroom dance

take place with geriatric populations. Haboush & Floyd (2006) conducted a pilot study to
examine how dance lessons affect levels of depression. Their findings reveal that
recreational dance, with its physical activity and social benefits, will likely become an
activity that the participant will engage in outside of therapy. It is common for
recreational dance to become a hobby for life (Haboush & Floyd, 2006). Even without
physical contact, this is an experience that could facilitate positive social interaction,
which is lacking in those affected by mental illness.
Another key study found that ballroom dance had therapeutic effects on a group
of 60 elderly Brazilians in a residential setting (Lima & Vieira, 2007). The therapeutic
meaning came from a sense of fun, opportunities to socialize, mental challenge (staying
with the rhythm, executing choreographed steps), and benefits on self-esteem. Lima &
Vieira (2007) found that ballroom dance classes helped to create a culture of inclusion
fortifying both understanding and acceptance among senior citizens. This argument
supports my views that Rueda dance, a structured group dance with choreographed
elements like ballroom, will have therapeutic effects on participants.
Lastly, a conference paper called Choreographing Inner City At-Risk and
Conduct Disordered Youth: Salsa in Dance/Movement Therapy, written by Duggin and
Mercado (2005), addresses how salsa dance can be a tool for exploring therapeutic issues.
Duggin & Mercado report how dancing salsa in groups promotes collaboration and
communication, as well as opportunities to learn to cope with anxiety. Their preliminary
research on effects of salsa dancing provide informal evidence of this recreational dance
to be a beneficial therapeutic intervention.
20
Staff-Patient Relations in Inpatient Psychiatric Care

Providers in psychiatric settings face a double-edged sword in simultaneously
caring for and protecting the patients (Bjorkdahl, Palmstierna & Hansebo, 2010;
Gildberg, Elverdam & Hounsgaard, 2010). Staff are challenged to develop interventions
that support the quality of life for patients with varieties of disorders. Previous studies
show how the arts have improved the well-being of patients and staff in hospitals and
residential facilities (Duignan et al., 2009; Hume, 2010). The increased interest in the
relationship between medicine and the arts addresses the reality of isolation, confusion,
and loss of control patients face in hospitals (Hume, 2010; Rodin, 1989; Taylor, 1979).
The arts may have a unique way of alleviating the emotional and physical responses to
illness and to the environments in which people are ill (Hume, 2010).
There is a lack of studies on the effects of group DMT on staff-patient relations.
However I was surprised to find ample research on how patients in Western health care
systems criticize the social environments of psychiatric units (Pitknen, Htnen,
Kuosmanen & Vlimki, 2008; Robins, Sauvageot, Cusack, Suffoletta-Maierle & Frueh,
2005). I am hoping that dance therapy with staff and patients will increase participants
relational behaviors and promote more connection in the hospital setting.
Types of nursing interventions. In a Swedish study by Bjorkdahl, et al.
(2010), research revealed how nurses in acute psychiatric care units use different caring
approaches with patients. Nurses face the challenge of keeping units ordered and safe,
meanwhile initiating relationships with patients. Another study conducted in Denmark
also reviewed existing literature for themes characterizing mental health staff and
inpatients relations in forensic psychiatric nursing settings between 1997 and 2009
21
(Gildberg et al., 2010). Two overriding themes were identified: parentalistic/behaviorchanging care and relational/personal quality-dependent care. These studies observed the
conflicting expectations of mental health staff in Western health care systems, and these
descriptions are relevant to psychiatric care and interventions in the U.S.
A mental health intervention called Open Dialogue uses a dialogical approach and
the patients social network to treat psychiatric crises (Seikkula, 2006). The founder of
the practice, Jaakko Seikkula, is a Finnish psychologist who explored how involving the
patient and his family in all treatment team meetings would have an impact on clinical
and social dialogue and the patients ability to utilize his coping resources. The relational
theory underlying this practice supports those involved in treatment to co-create a new
dialogue and jointly develop treatment plans. The findings show that by sharing emotions
and collaborating, rather than searching for monological answers, more effective
treatment can be provided to the mentally ill patient.
Gildberg, et al. (2010) elaborates on relational behaviors that support interactions
with patients and can render the clinical outcome positive. They specifically identify
empathy as useful because it can deescalate patient aggression. Meehan, McIntosh &
Bergen (2006) interview patients in a high-secure forensic facility in Australia and
confirm that staffs lack of empathy can become the reason for violence towards staff.
Two of the potential strategies identified by patients to reduce aggressive behavior
included providing meaningful activities to reduce boredom and improving staff attitudes.
This implies a need for investigation on interventions targeting staff and patients in
psychiatric settings.
22
Pitknen, et al. (2008) call to attention patients descriptions of nursing

interventions supporting quality of life for patients with schizophrenia, schizotypal
disorder, or delusional disorder. The authors, all professors or researchers at hospitals in
Finland, are investigating how a more holistic model of psychiatric nursing can improve
quality of life for patients. One key nursing behavior is activating intervention, which
promotes social relationships and patients performance of daily activities. Patients
descriptions also reveal that giving information and encouraging hope are two important
nursing interventions. If staff engage in dance therapy sessions, they may develop these
skills in a structured way.
DMT with patients and staff. The only peer-reviewed study I have found
involving dance therapy with patients and staff took place in a dementia care unit with six
clients and nursing staff (Duignan et al., 2009). Dance therapy was selected as the
intervention due to its power to decrease feelings of loneliness, boredom, and sensory
deprivation. Over four weeks of weekly sessions of Wu Tao dance therapy, 92% of staff
felt it increased their job satisfaction, and 100% of staff claimed the dance reduced
patients agitation and improved staff well-being.
In Ravelin, Kylm & Korhonens study (2006), the authors conduct focus group
interviews with nurses who have danced in a nursing context. Researchers are examining
different kinds of nursing interventions to reach mentally ill patients with a limited
capability of expressing themselves. This study highlights how dance promotes
psychiatric patients capability to communicate and express themselves. An important
finding is that dance may foster self-reflection and interaction with other people,
23
promoting mental health. This study supports my view that dance offers new possibilities
for patients and staff to develop closeness and interaction with one another.
Harm in inpatient settings. In a study by Robins, et al. (2005), U.S.
consumers perceptions of harmful inpatient experiences were explored. Two sets of
themes emerged from the interviews with 27 participants; one set described themes of
staff members not knowing the consumers as individuals, a perceived lack of fairness,
and consumers experiencing embarrassment in the hospital. The results suggest that
inpatient settings are often perceived as volatile, threatening environments. The findings
suggest that consumers have perceived inpatient hospital stays as humiliating,
dehumanizing, and distressing (Robins et al., 2005). Evidence from this research
introduces questions of how do staff cope with the stressors of mental illness and at the
same time work towards improving the safety and dignity of psychiatric care? There is no
doubt that interactive interventions which target patients symptoms along with staff wellbeing will address some of these harmful perceptions of inpatient care.
Staff Well-being and Burnout
There is a plethora of research on staff burnout and suggestions for how to
prevent burnout in the workplace. Mental healthcare staff are more susceptible to burnout
related to physical, mental and social burdens (Angermeyer, Bull, Bernert, Dietrich, &
Kopf, 2006). The primary job of mental healthcare staff is to care for and protect ill
patients; therefore, their mental and physical health is a huge factor in their ability to
perform their job well. Dance therapy and its impact on physical, emotional, mental, and
spiritual well-being may address aspects of burnout, such as emotional exhaustion and
24
depersonalization, which threaten the capacity of staff to provide quality treatment for
patients.
Burnout. In prior studies, emotional exhaustion emerges as a key component of
burnout (Halbesleben & Bowler, 2007; Iglesias, Vallejo, & Fuentes, 2010). Burnout
consists of three parts: emotional exhaustion, depersonalization, and reduced perceptions
of personal accomplishment. Nurses are particularly susceptible to burnout due to their
heavy workloads, responsibility for urgent matters, and limited authority (Iglesias et al.,
2010). The research concludes that programs to reduce emotional exhaustion, and
improve physical and emotional health in health care providers, will improve productivity
and address the burnout syndrome.
Emotional exhaustion in the nursing profession. Jourdain &
Chnevert (2010) investigate how hostility from patients leads to emotional exhaustion in
nurses. The research defends that nurses tasks and roles should be restructured to reduce
work overload and increase meaning in their work. This study also looks at the energetic
process, and how exhaustion of personal energies inhibits access to social support, which
can lead to burnout. Nurses are more likely to decrease their engagement and leave the
profession when experiencing depersonalization and emotional exhaustion. These
findings suggest that burnout among mental healthcare workers could be reduced if more
meaningful activities are integrated into their work.
Staff well-being. Throughout the existing literature, an emphasis on building
employee relationships and increasing meaningful activities in the workplace are linked
to stress reduction and staff well-being (Halbesleben, 2010; Halbesleben & Bowler, 2007;
Jourdain & Chnevert, 2010). Halbesleben (2010) looks at frameworks in the work
25
environment and targets his defense at administrations. He determines that building

relationships will stimulate meaningful employee involvement. Also, sustaining
opportunities for stress reduction practices is crucial to ensure a burnout-free work
environment. Dance therapy has been effective in promoting social interaction, reducing
stress, and may address these factors to increase well-being.
26
CHAPTER 3
METHOD
Theoretical Orientation
This thesis is theoretically oriented towards naturalistic inquiry along with
program evaluation design. When I began the Rueda dance therapy program in
September 2010, I was already anticipating investigating its effects on the unit using
qualitative research. Aigen (2005) writes in regards to the naturalistic inquiry approach,
the findings and structure of a given research project will unfold spontaneously as a
result of the unique interaction between the researcher and the setting at a particular time
(p. 356). My interactions with the Nursing Director, the McLean IRB Board, and staff on
the unit over the past five months have inspired the emerging naturalistic inquiry
evaluation design.
The results of this study will be based on participants subjective responses to the
experience as well as my observations as participant/observer. According to Aigen
(2005), in naturalistic inquiry the source of the study is the natural setting, and the
researcher hopes to understand the native knowledge of the research participants, who are
considered the experts. As researcher, and human instrument, I have had to adapt to the
unknown situation and become familiar with the people and setting. In efforts to create a
triangulated case study, data was collected through multiple methods, including two
semi-structured interviews, written questionnaires, and observation.
Evaluation research is used to assess the effectiveness of programs in achieving
program goals as well as to collect information on the perceived benefits (if any) of the
program to participants (Cruz, 2004). My evaluation research will explore how MSE staff
27
perceive the Rueda dance therapy program to have affected their own well-being, their
relationships with patients, and the unit as a whole. The programs initial goals were to
reduce patients depressive symptoms, especially mobilize their energy and and increase
their ability to socialize. This summative evaluation will consider only staff perceptions
on the overall effectiveness of the program to improve patients moods as well as benefit
well-being in the workplace.
In my attempt to combine naturalistic inquiry with evaluation theory, I
acknowledge the limitations of the study. In studying this particular dance therapy
program, I am not warranted to extrapolate my findings to another dance therapy group in
an unqualified way. The results of this study must be carefully generalized and grounded
in the commonalities between the original context and the specific group to which I
would like to apply the findings (Aigen, 2005).
Ethical Considerations
This method of research was approved by Lesley Universitys Institutional
Review Board; it was not required to have McLean Hospitals Institutional Review Board
approval because it constitutes a Program Evaluation. To ensure this study was conducted
in an ethical manner, the two interview participants signed the Letter of Informed
Consent (See Appendix A). The staff who completed written questionnaires were
informed of the purpose of the research, my name and affiliation, time required for
participation, an anonymity statement, and the researchers contact info. For these
participants, documentation of informed consent was not required because all MSE staff
are at least 18 years of age, and they received the required information to engage ethically
in the study. The files of the audio recordings from the interviews were saved on my
28
personal laptop and deleted from the recording device. I deleted them from my laptop
only after fully transcribing them and I then destroyed them so that so that the voices of
participants can no longer be used to identify the individual. The transcriptions were
saved in my personal laptop, which is password protected, and the anonymous written
questionnaires were kept in a locked file cabinet in my home office.
Participants
In naturalistic inquiry the goal of the researcher is to maximize discovery of the
varied patterns that occur in the particular context being studied (Erlandson, Harris,
Skipper, & Allen, 1993). Since the purpose of my research was to investigate the staffs
insight around the dance therapy program, I used purposive sampling to select two
participants to interview who would provide information-rich cases. After consulting with
the nurse manager, I interviewed one Mental Health Specialist and one nurse; both staff
had worked on the unit over 5 years. These staff had participated in at least two Rueda
dance therapy sessions and expressed interest in sharing their impressions of the
experience.
Any staff on the in-patient unit who had worked during the time Rueda dance
therapy occurred was made aware of the study by advertisement on the staff lounges (See
Appendix B), as well as by announcement in nursing staff meetings. Participation in
completing a written evaluation questionnaire was open to all staff employees fluent in
English. No group of persons were excluded from the research. This study population is
representative of the population that stands to potentially benefit from this research
because they represent the staff who are highly involved in patients treatment, and
therefore susceptible to burnout.
29
Data Collection and Analysis

This study evaluated the Rueda dance therapy intervention from September 20,
2010 to March 11, 2011. The 30-minute sessions occurred twice weekly, Mondays and
Thursdays from 10:15-10:45am, and anywhere from 4 to 15 patients and 0-3 staff
attended each session. The group dance therapy format was designed to employ elements
of Rueda de Casino (Cuban Salsa dance) along with methods described in previous
studies and texts (Leahy, 2004; Levy, 2005). The Rueda dance session is divided into
three parts:
- Breathing awareness and stretching
- Sculpt (where participants non-verbally show their emotional state)
- Salsa dance in a circle with mirroring and creative movement metaphor
The participants are in a circle for the duration of the session. The circle promotes
inclusion and allows participants to be witnessed and reflect one another (Levy, 2005).
The progression of each session varied according to patients energy levels, psychological
and physical needs, and cognitive abilities.
Data Sources. Using three sources of data: interview (See Appendix D),
questionnaires (See Appendices C and E), and observations, I have tried to capture MSE
staffs experience of the Rueda dance therapy program in ways that are consistent and
compatible with their insights. I gathered data from a variety of sources and in a variety
of ways, in order to explicate the constructed realities of the participants. The
naturalistic researcher seeks and collects data about human activity that will enable him
or her to break the barriers of separate constructed realities (Erlandson et al., 1993, p.
80).
30
The two semi-structured interviews lasted approximately forty five minutes each
and were conducted face to face in the hospital. Interviews were held at a time when staff
were available at the discretion of the nurse manager and they did not have an impact on
delivery of care. There were no missed breaks for staff or overtime incurred. The written
questionnaires were available in staff lounges and staff returned them over a 2-week
period to a marked box in the mailroom. The written questionnaires took staff 5-15
minutes to complete. In interviews and written questionnaires, participants were asked
about 1) their experience of participating in the sessions, 2) the impact of the program on
their well-being and their relationships with patients, 3) the impact of the program on the
patients, and 4) the impact of the program on the unit.
Thequestionnaireaskedatotaloffivebackgroundquestions,codedAE,and12
Evaluationquestions,codednumerically.Thepurposeofthequestionnairewastoglean
insightfromabroadbackgroundofstaffonhowtheyhaveperceivedthedancetherapy
programtoaffecttheunit.Ifstaffhadparticipatedinoneormoredancetherapysessions,
theywereaskedtocommentontheirexperienceandwhethertheirlevelsofzestand
empathytowardsotherswereaffected.AllEvaluationquestionswereopenendedanda
spaceforadditionalcommentswasincludedattheend.
Due to my dual role as participant and observer, my subjective experience is
recorded and included in the data analysis. Aigen (2005) writes, there is an inseparable
and interactive relationship between the knower and the known (p. 354). My
observations are based on prolonged engagement and persistent observation. I have been
facilitating the morning Rueda dance therapy sessions for five months, and I
occasionally process the group with a staff member who attended. I record a group note
31
after each session, documenting the activities of the group, individual movements and
metaphors through gesture, and my clinical observations. My field notes describe
interactions with other staff and their direct statements about the impact of the dance
therapy program on the unit.
Analysis and Interpretation. The data collected will be analyzed along the
general form of deconstruction, generation of meaning units or themes, and
reconstruction (Forinash, 2004). The audio recordings of the two interviews will be
transcribed to document commentary in written format. Using the data analysis software
HyperRESEARCH, I will perform multiple analyses, uncover emerging themes, and
describe the data that emerges. At the completion of data analysis, I will perform peerchecking with two colleagues to confirm interpretations of their information. The
Program Evaluation questionnaires and observation data will be used to consider
subjective trends for individuals as well as the group as a whole. These findings will be
checked for trustworthiness through peer debriefing with two colleagues who are
professors and PhD researchers in the Expressive Therapies field. These results may
serve to further identify any effects the program had on staff perceptions.
CHAPTER4
RESULTS
Inanalyzingmydata,Ihavedeconstructedandreconstructedtheinformation
frominterviewsandwrittenquestionnairesusingcodedthemes.Ihavealsoassembled
myobservationsoverthepastfivemonthsrelatedtosuccessesanddrawbacksofthe
32
Ruedadancetherapyprogram.ThroughcapturingthevoicesofthestaffparticipantsI
hopetoprovideamorecompletepictureofthereactionoftheunittodancetherapy.
PartOne:AnalysisofSeparateInterviews
Interviewee1:Heather.Thefirstsubject,Heather,whoallowedmetoidentify
herbyherrealname,hasbeenworkingasaMentalHealthSpecialist(MHS)and
phlebotomistatMSEfortwelveyears.Shedidnotdescribehavinganydanceinher
background,andthiswasherfirsttimeparticipatinginanysortofdancegroup.Heather
isthemostseniorMHSontheunitandsheattendedfourdancetherapysessionspriorto
theinterview.IaskedhertodiscusshermostrecentexperienceintheRuedasessionwith
13patients,onestaffmember,andthreenursingstudents.
AsHeatherdiscussedherexperienceinthefirstsession,shedescribedhavinga
verystressfulmorning.Herchildwashomesick,shewasreceivingpersonalcalls,
crying,feelingverytenseandshorttempered;participatinginthegroupimprovedher
moodandincreasedherenergy.Basedonherpositiveexperience,sheinvitedtwoMHSs
tojointhefollowingtwosessionswithher.Shehopedthegroupwouldenergizeone
malecolleaguewhowastiredafterworkingadoubleshift.Shereportedheendedthe
groupsmiling,feelingbetter,andstayedworkingontheunitforafewextrahours.She
invitedanotherstaffwhowassadafterputtingherdogtosleepthatmorning;andshe
reportedfeelingbetterafterparticipating.Whenaskedhowherexperiencewasaffected
byhavingotherstaffinthegroup,shesaiditdidntmatter,andthatsheenjoyeditthe
sameamount.
33
Havingworkedontheunitfor12years,Heatherdescribeshavingstrong
relationshipswithmanyofthepatientsthatreturntoMcLean.AsanMHS,everyshift
shemanagesfourpatients,checkingonthemevery515minutes,torecordwherethey
areontheunit.Shesitsdownwitheachofthefourpatientsonceashiftfor1530
minutes,tocompleteaNursingAssessmentFlowsheetconsistingof9questionsrelated
tothepatientsphysicalfunctioning,6questionsrelatedtocognitive/perceptualpatterns,
2questionsrelatedtorole/relationships,anareatolisttheirlearningneeds,andanareato
describestressors.Herfrequentinteractionsandexposuretopatientsmakesherfeelvery
closetosomeofthem.ShecommentedthatafterparticipatingintheRuedatherapy
sessionwithpatients,theirrelationshipsfeltstronger,inpartbecausesheheardthem
expressverypersonalneedsinthesession.Shealsothoughtthesharedgroupinteraction
benefitedpatientsandthestaffpatientrelationshipbecausepatientsseestaffashaving
somethingincommonwiththem.
HeatherfoundvaluablethattheRuedasessionattractedhighnumbersofpatients
frombothAandBtracks.Whenmostpatientsareinoneroom,itiseasierforMHSsto
dotheirjob.Theyfindtheirpatientsmoreeasilyanditiseasiertocareforthem.She
mentionedseveraltimeshowthesessionssetafocused,calmertoneontheunit.She
noticedanoverallreductionofagitationafterthegroupandstatedseveraltimesthegroup
createsagoodstarttotheday.
Interviewee2:Sandy.Thesecondsubject,Sandy,alsoallowedmetoidentify
herbyherrealname.SheisafemaleRNstaffnurseandhasbeenworkingontheunitfor
fiveyears.Onherwrittenpostsessionquestionnaire,shedescribesherdancebackground
34
asconsistingofballetandtaplessons,alongwiththetwist,around1013yearsold.This
washerfirsttimeparticipatinginadancegroupsincechildhood.Beforeinterviewing
Sandyforthisstudy,wehadtalkedtwotimescasuallyoverlunchorinthenursesstation
aboutherobservationsofpatientsduringdancetherapy.Shejoinedthedancesessiona
totalofsixtimesovertheyearandwasaskedtoreflectonhermostrecentRuedadance
therapysessionwith12patientsandoneotherstaffmember.
Inherinterview,Sandyhighlightedherownkinestheticreactionswhile
participatinginthesession.Shecommentedonherbodyexperiencesduringthegroup:
takingdeeperbreaths,feelingtaller,feelinglooserinherupperbody,andfreerinher
bodymovement.Shedescribesherbodyawarenesscontributingtoasenseof
empowermentandincreasedselfefficacyinaccomplishingthestep.Sandyalso
discussedhavinganewfoundrhythmwhiledoingthesalsastepthathelpedherhandle
hertasksafterthegroup.Afterthegroupshefeltmoreincontrolofhertasksandwas
betterabletoprioritizehertasks.
ThroughouttheinterviewsheemphasizedthecontrastingexperienceoftheRueda
dancetherapysessiontoherregularworkplacebehaviors.Theprocessesofinterpretation
andexpression(turningfeelingsintomotionsandwitnessingotherscreative
expressions)energizedherandprovidedavariationtoherdailyconcreteroutinesof
handlingmedicationsandfollowingrigidcareplans.Theexperienceprovidedabreak
fromstressfultasks.Sheenjoyedrelatingtopatientsinnewwaysandobservingtheir
increasedpatternsofinteraction.Beinginthegroupprovidedabreakfromworkplace
stressandledtoherfeelingmoreinvigorated.
35
SandydiscussesherinitialdiscomfortintheRuedasession;itwasintimidatingto
beseenonapersonallevelbypatients.Instandinginacirclewithagroupofpatients,
shefeltthatshewasonfullview,ratherthanbehindthecounterorsittingdownone
ononewithapatient.Shefeltintimidatedatthebeginningwhilepresentingherselfina
group;thisfeelingincreasedherempathyforpatientswhomayfeeltheyareconstantly
beingwatchedorevaluatedwhileontheunit.Shealsotalkedabouthavingadiagnostic
perspectivewhilemovingwiththem,andanincreasedunderstandingofhowdifficultthe
patientslivesmustbewhentheirmovementisuncoordinated.
PartTwo:AnalysisAcrossInterviews
Tobegintoanalyzetheinterviewdata,Ilookedathowtheycommentedontheir
ownbehaviorsandreactionsversusotherstafforpatientsbehaviors.Usingthedata
analysisprogramHyperRESEARCH,Iidentifiedoverfiftythemesinthetranscriptions.
Afterrereadingthedatamultipletimes,andpeercheckingwithtwocolleagueswhoare
PhDlicensedExpressiveTherapists,Icategorizedtheinformationusingthreethemes:1)
Positiverelationalinteractions,2)Empatheticunderstanding,and3)Hopeinthe
effectivenessofthetreatment.EachthemeisbrokendownintosubthemesofSelfand
Other.Selflabelswhentheintervieweeistalkingaboutherownexperience;Other
signifiestheintervieweeisobservingapatientoranotherstaffperson.
PositiveRelationalInteractions
Self.ParticipatingintheRuedadancetherapyaffectedthetwoMSEstaffin
uniqueways.Heatherexperiencedimprovedmoodandlessstressafterparticipating;this
empoweredhertoinvitetwostaff(whowerefeelingtiredand/orsad)toparticipatein
36
futuresessions.Sheshowedinterestinthewellbeingofotherstaffmembersand
encouragedthemtoengageinthedancetherapysession.Likewise,Sandydescribed
encouragingpatientstojointhesessions:whenpatientswouldsay,Icantdoit...she
respondedwithYesyoucan,youcandoit!Bothstaffdemonstratednewpositive
relationalinteractionswithothersasaresultofparticipatingindancetherapy.
Bothstaffdiscussedasenseoffuninteractioninthegroup.Sandytalkedabout
herpleasureinfocusingoncreativemovementexpression,sharingpositiveaffirmations,
andstayingawareofwhotoincludethroughoutthegroup.Thecreativityprovidedanew
structureforinteractingwithpatients.Sandyfeltempoweredtointroduceherselftoanew
patientwhowassmilingafterthegroup.Sandyfeltlessintrusiveconnectingwiththe
smilingpatientattheendoftheRuedasession.
Other.Bothstaffnoticedpatientsexhibitingincreasedrelationalbehaviorsonthe
daysRuedadancetherapytookplace.Heathercommentedthatpatientswouldaskherif
thedancewashappeningthatdayandtheywouldencourageeachothertogo.While
participating,Heatherobservedpatientsmakingmoreeyecontact,laughing,andsharing
honest,difficultfeelings.Aftergroupsheadmittedpatientswerelessanxiousand
demandingwithher;sheobservedpatientsthatnormallyisolatedthemselvessittingand
engagingwithothersatlunch:Youmightseeadifferentsideofhimatlunchtime,when
hellgetinagroupandsitwithpeopleinsteadofbyhimself.SoIthinkitsanopening
doorforthem.
DuringthesessionSandywassurprisedtoobservepatientsbehavinginnew
ways:participantsincludedpatientsthatdidnthaveachancetospeak,manicswaited
37
theirturn,demandingpatientswerenonjudgmental,andpatientsrespondedtothegroup
processwithlaughter.Shereported:
...someoneelsecouldnudgesomeoneandsay,trythis,trythisposition
orwhatever,Ithinkthattheyhelpedeachother,andIthinkthatfeels
goodforpeople...thewaytheyhad[afemalepatient]participate,I
thinkthatmakespeoplefeelgood.Thewaytheyopenedthecircleup,
andenlargedit,simplething,butIthinkthatthatmakesthemmore
opentoinclusiveness...
Sherecognizedindividualandgroupreactionsthroughoutthesessionthatdemonstrated
positiverelationalinteractions.
EmpatheticUnderstanding
Self.BothMSEstaffexperiencedsomediscomfortatthebeginningoftheirfirst
sessionwithpatients.Theyexperiencedselfdoubtandintimidationmovinginfrontof
patientsandacquiringanewdancestep.Bothstaffwerechallengedbythecontrolled
rhythmicshiftingofweightinthesalsastep.Heatherdescribedfeelingstuckinusing
herrightfoottorockback;sherelatedthedifficultchallengetohowothersmightfeel
whentrappedinapatterntheycantbreak.
Onasimilarnote,Sandygainedunderstandingofhowpatientsmightfeelin
doubtingtheirabilitytoaccomplishthestep;shealsoempathizedwithpatientsfeeling
liketheyreunderobservation.Thepressuresofstandinginacircle,rememberingothers
names,andperforminganewdancestepprovidedahelpfulpracticetimefordealingwith
perfectionisticthinking:
ButevenIhadmessedupsometimes,butitsokay...andIthinkits
perfectionism,andIseethisespeciallyinalotofyoungwomenwho
feelthattheyneedtobeperfect.Theirparents,evenmyselfstruggle
withthat,youknow,tryingtodoagoodjob.Andyet,itsokayto
makeamisstep.Itsokay,youreoutthere,youretryingit,and
38
youreenjoyingit.And,Ithinkithasmademefeelclosertothem,
moreempathyforthem,alittlebitmoreinsightintohowdifficultitis
forthemtowalkintoagroup,howdifficultitistoperformfor
someoneelse,toremembernames,tobecalledon,tohavetheball
cometoyou,tohavetothinkonyourfeetlikewhodoIthrowthis
backto?
Sandyexpressesfeelingclosertopatients,andgainingimmediateinsightintotheir
commonstrugglesdespitethestaffpatientpowerdifferentialinthehospitalsetting.This
groupprovidedaplacetopracticecompassionwithherself;asaresult,shegained
empathyforthepatientsexperience.Inobservingtheminagroupsetting,ratherthan
oneonone,sheempathizedwiththeperformanceanxietysheandotherswere
experiencing.
Eachrespondentsharedthevaluableinsighttheygainedthroughparticipating.
Heathergainedadeeperunderstandingoftheintensesufferinganddangerpatientsfeel.
Sandyenjoyedobservingpatientsstrengthsandremindingherselfthatstaffarenot
supposedtobebetterthanpatientsineverything.Bothstafffeltcomfortableinthismore
levelcontextwithpatients,andenjoyedfeelingthesenseofpeersupportandequal
standingwithpatients.
Other.Thereisevidencethatbothstafffeltthestaffpatientrelationshipgrow
strongerinthegroup.Heatherperceivedthatpatientsjoinedbecauseshewasinthereand
theysenseditwasasafesetting.Shealsosensedpatientslookedatherasbeingona
moreequallevel:
Weallhavehardshipsanditsnoteasy,soIthinkthat,whenIwould
participatetheywouldsay,wellshesintheretoo,maybeIllgoin,
itsokay.Itssafe...andIfeellikemaybetheyviewedmetobelike
them,orImnodifferent,wereallhuman.
39
Onasimilarnote,Sandyhadasensethatpatientslettheirguarddownduringthe
group,andthisresultedinthemacceptingtheirownmistakesandnotjudging
othersformakingmistakes.Sheobservedpatientsencouragingoneanotherin
learningthestepandshowingempatheticsupportintheprocessofacquiringnew
movementexpression.
HopeintheEffectivenessoftheTreatmentintheMSEUnit
Self.Bothstafffeltasenseofempowermentandstressreliefafterparticipatingin
thesession.Sandytalkedaboutthestressful,fastpacednatureofherwork,which
includesdischargingpatients,distributingmedications,gettingpatientsbloodpressures
andpulse,writingmedicalsheets,attendingrounds,etc.ShedescribestheRuedagroup
asabreakfromthepressureandnamestheemotional,kinesthetic,andbehavioral
impactsithadonher:
IthinkthatmymindwasclearerwhenIgotthrough.Iwasableto
prioritizebetter.IwascalmersothatIcouldsayokayImgonnado
thisnow.AndthenImgonnadothat.AlmosttherhythmIdidnthave
beforeIdidthegroup.BecausemymuscleswouldtenseandIwas
thinkingIgottadothis,Igottadothis,Igottadothis.Mymindwas
clearer...therewasarhythm.Iwasgonnadothisdischarge,thenI
wouldbedoingthis,andthenIwoulddothat.
Sheattributesthecreativemovementexpression,physicalexercise,andfocusrequiredin
thegroupworktohercalmermood.Shealsomentionsasenseofempowermentin
masteringthebasicsalsastepandfeelinglooserinherbody.Thecombinationofmental,
physical,andemotionalprocessesledtostressrelief.
Sandyfeltarenewedsenseaboutwhyshedoesthiswork.TheRuedasession
providedheraglimpseoftheirstrengthsandremindedhertherearetimeswhentheywill
40
dobetter.ShesaidparticipatinginRuedasessionsconfirmedherbeliefthatsmall
incrementsofbriefpositivemomentswilladdup.Sheadmittedshelearnedalotabout
herpatientsbyobservingtheminteractinagroup,e.g.theleveloftheirdepression,their
levelofconcentration,theirabilitytoselfregulate.Shewassurprisedtoobservepatients
demonstratinglesssymptomaticbehavior.
Heathertalkedaboutasimilarresponseoffeelingcalmerandlessoverwhelmed
withtheworkloadafterparticipating.Themorningshejoinedshestatedherhomelife
wasstressfulandthegrouphelpedherbecomemoreoptimisticandfeelempoweredto
handlejobstress.HerautomaticthoughtsshiftedfromWhyarewetakingthispatient?
Whattheheckarewedoing?toImhere,itsgonnagetdone.Imnotgonnaworry
aboutit.Icandoit.Shealsodiscussedhowpatientsimprovedmoodsmadethemless
anxiousanddemanding,thereforemakingherjobeasierandlessstressful.
Other.Sandydescribesthatnursinginapsychiatricunitisparticularly
challengingbecausewhenpatientsreturntotheunitthereisasenseoffailurethatthe
previousworkdonewiththemdidnothelp.Nursesfaceasenseofhopelessnesswhen
patientscomebacktobehospitalized.Asanurse,oneofSandysmainjobsisto
distributemedicationstopatients.Theseencountersrevealthepatientssick,needyside.
Shediscusseshowthegroupbringsouttheirstrengths:Wealwaysseemtoseethemat
theirworst.Itsnicetoseethemwhentheyrehavingthesemomentsofdoingreally
well...Becausetheywontputonthatfacewithus,behindthemedwindow.For
example,shefelthopefulinobservingcertainpatientsincludewithdrawnorshypatients
41
andshowawarenessofwhohasnothadachancetospeak.Shealsoenjoyedobserving
patientssmiling,actingmorerelaxed,andenjoyingthemoment.
Sandycommentedonhowthistherapytargetsthepatientsisolatingsymptoms
andtendenciestodwellonnegativethoughtsinthehospital.Shedescribeswhythegroup
benefitspatientsontheunit:
Itwasasenseofaccomplishment...Ijustthinkitscalming,its
soothing,andinthisenvironmentitsverymuchneeded,anditsa
waytoteachmindfulnessinawaythatreallyoccupiesyourmind,so
thatitsnotdistractedbythenegativethingsoftheunitallthetime.In
awaythatevenwalkscantdo,forthosethatisolate.
ShebelievestheRuedasessionrefocusespatientsfromtheirnegativethinkingandthe
environmentalremindersofillness,toacomforting,mindfulgroupactivity.
Bothstaffdescribehowtheyseetheprogramempoweringpatientsintreatment
andincreasingtheirrelationalbehaviors.Heathercommentedonhowpatients
demonstratemoresocialandrelationalbehaviorsafterengaginginthedancetherapy
session.Shecommented:
Thismightbeapersonthatsbeenintheirroomforthreedays,andto
seethemupandmoving,andactuallyparticipating,andlikekindof
joking,sayingwellicantdothisverywell...itslikesowhat?
yourehere,youreapartofthis,so...Ithinkitsgreattoseethemin
there.Youmightseeadifferentsideofhimatlunchtime,whenhell
getinagroupandsitwithpeopleinsteadofbyhimself.SoIthinkits
anopeningdoorforthem.
Inthesessionsheattended,Heatherwasinspiredbypatientswordsand
expressions.Whenoneveryanxiousanddisorganizedpatientdescribedhermoodas
empowered,Heatherwassurprisedandpleasedwiththepatientsnewfoundstrength.
Asastaffwhoisconstantlyexaminingpatientstoassuretheirsafetyandappropriate
42
behaviorontheirunit,theseglimpsesofpatientsstrengthsareuplifting.Sandy
commentsontheaccomplishmentpatientsfeelafterlearningastep,remembering
somebodysname,throwingaballandencouragingothers.Thisempowersthemoutside
ofgroup.HeatherobservedovertimethathighernumbersofpatientsintheRueda
sessionsmeanthighernumbersofpatientsintalktherapygroups.
AfterHeatherinvitedtwostafftojointheRuedasessions,shefoundtheyboth
reportedfeelingmoreenergizedandinabettermood.Alongwithotherstafffeelingmore
effectiveintheworkplace,HeatherhasnoticedtheRuedasessionspromoteanoverall
calmermoodontheunitthatlaststhroughouttheday.
QuestionnaireResults
Atotalofelevenquestionnaireswerecompleted,andtherespondentsconsistedof
aclosegenderratio,fivefemalesandsixmales.Therespondentsincludedone
psychiatrist,onesocialworker,onerehabgroupcounselor,twonurses,fivementalhealth
specialists,andthenursingdirector.ThelengthoftimerespondentshaveworkedatMSE
rangedfrom3yearsto11years,withtheaveragetime5.7years.Sevenpeoplenotedthat
dancewaspartoftheirculturalbackground;theotherfourreporteditwasnot.Threeout
ofelevenhadparticipatedinatleastoneRuedadancetherapysessionanddisclose
perceptionsoftheirdancingexperiences.
Fortheeffectivenessofdisplayingmyresults,Ihavecarefullyextractedportions
ofparticipantsoriginalwordstohighlightthesignificantunitsofmeaningintheir
responses.Ihavealsocorrectedsimplegrammaticalimperfectionsinresponses,to
protecttheintegrityoftherespondents.
43
Staffsexperiencedancingwithpatients.Thethreestaffwhoparticipatedinone
ormoreRuedadancetherapysessionsreportedanoverallimprovementintheirwell
being.Allfeltincreasedzest,andtwooutofthreewroteaboutgainingempathyfor
patients(SeeFigure1).Tworespondentsexperiencedachangeintheirrelationshipswith
patients,basedon1)engaginginalivelieractivitywiththem,and2)havingtolearna
newdancestep,whichcreatedasenseofequalityintheirrelationship.ThemaleMHS
whorespondedfeltanincreaseinempathyafterobservingpatientsstrugglingto
coordinatetheirsteps.Seeingtheirdifficultyinphysicalcoordinationincreasedhis
awarenessoftheimpactoftheirillness.
44
45
Figure1.Didparticipatinginthesessionimpactstaffwellbeing?
46
Impactoftheprogramontheunit.AsIexaminedtheseresults,fourthemesemerged
inthedata(SeeTable1).Theresultsshowthatthemostcommonimpactwasobserving
patientslesssymptomatic(SeeFigure2).Staffobservedloweranxietylevelsandlatent
strengthsinpatients.Staffobservedmorecohesionontheunitbecausetheprogram
broughtpatientsfromseparatetracksintoabiweeklyDMTgroupbasedonexpressive
skills,wherepatientscouldmeeteachotherinaplayfulway.
Table1.ParticipantsResponsestoHowtheProgramImpactedtheUnit.
ThemesSamplesofParticipantsStatements
EnergizestheUnitPatientslookforwardtoit
Givespatientsanopportunitytoexpressthemselves
withmovementsinsteadofwithwords.
Itissomethingdifferenttolookforwardto.Exciting
forthepatientsandstaff.
Addedphysicaljumpstartindayandgoodprepfor
laterdiscussiongroups.
Energized
CohesivenessonUnitItgives[patients]consistencywithinthe
group.
Mostbasiclevelitfilledinthreegroupsnormally
usedtoairvideossogreaterunitcohesion/value
DecreasesPatientsSymptomsDecreasedoverallstresslevelofpatients
Openedeyestosomepatientssharinghidden
strengths
Particularlyactivatingforthosewithneurovegetative
symptoms
[Patientswere]flattosmiling,allowedtheirbodies
tobeexpressive.
...bringsabigimpactontheunitfloor:relaxation,
moodchanges,lessinappropriatebehavior,interact
withothers.
...decreasingpatientsanxietylevel
ValuedbyPatients...waswellattendedandappreciatedby
patients
47
Frompatientfeedback,ithasbeenenormously
helpful,wellreceived.
Ihaveheardpositivefeedbackfrompatients
meaningthedancetherapygroupishavinganimpact
ontheirwellness(treatment).
Figure2.Howhastheprogramaffectedtheunit?
48
Programsimpactonstaffpatientrelationships.Questionthreerevealedthatallstaff
whoparticipatedinsessionsexperiencedachangeintheirrelationshipwithpatients(See
Figure3).Thesestaffreportedbenefitingfromhavinganotherperspectivefromwhichto
observeandengageintreatmentwithpatients;onestaffobservedapositiveimpacton
patientscommunicationandtheircomfortwithhim.Staffappreciatedhavinganon
threateningspaceinwhichtobuildrelationshipswithpatients.Oneobserverfeltashiftin
therelationship,becauseofthepatientsabilitytocopebetter,whereastherestadmitted
nochangeintherelationship.Threestaffleftthisquestionblank.InTable2,Idisplaythe
staffsresponses.
Table2.ParticipantsResponsestoHowtheProgramAffectedStaffsRelationships
withPatients
QualityofChangeRoleSamplesofParticipantsStatements
PositivelyParticipantIhaveanotherleveltoobservepatients
PositivelyParticipantSomepatientsthatsawmeattendbecame
morerelaxedandopenwithme.
PositivelyParticipantPatientsandstaffareabletoparticipateina
nonthreateningatmosphere.
PositivelyObserver[theprogram]hashelpedmyrelationships
withpatientsbygivingthemacopingskill
thathelpsthemincrisis.
49
NoChangeObserverWithoutchange
NoChange
ObserverUnaffected
NotSureObserverNotsureitdidbutIhavelimitedinteraction
asanadministrator
NotSureObserverUncertain
Figure3.Howhastheprogramaffectedstaffsrelationshipswithpatients?
50
Programsimpactonpatientsmoods.Staffdescribedhowtheyhaveseentheprogram
impactpatientsmoods,andwhetherthishashadanimpactonthem(SeeTable3).
Resultsshowallrespondentsnoticedtheprogramhadapositiveimpactonpatients
moods,andfourstaffreportedthisimprovedtheirmoodaswell(SeeFigure4).Threeout
ofelevenstaffobservedpatientswerelessanxiousafterparticipatinginaRuedasession.
Twostaff,oneobserverandoneparticipant,reportedhavingimprovedcommunication
withpatientsthathadparticipated.Anurserespondentnoticedatrendthatfeweranti
anxietyPRNswererequestedaftertheRuedasessions.Whilemoststaffnoticed
beneficialeffects,threestaffdidnotreportanypersonalimpactbytheprogram.
Questionfiveinquiredintohowstaffhaveheardpatientscommentonthe
program.Thewordfunappearedthemost,infivedifferentquestionnaires.The
primarythemesemergingfromstaffsreportsofpatientscommentsare:enjoyable,
moodelevating,andincreasedbodyawareness.OneMHSreportedpatientscommenting
thatitwouldmakeagoodcopingtooloncetheyleavetheunit.
51
Table3.ParticipantsResponsestoHowtheProgramAffectedPatientsandStaff
Wellbeing
StaffTitleObservationsofChangeinPatientsImpactonSelf
MHSBrightandexcitedInteractionswithpatients
moreengaging
MHS...seepatientssmile,happy,
talkingtoeachother
MHSitmadequiteafewmoreEasiertocommunicatewith
relaxedandateasewithstaffpatientsaboutsensitive
topics
MHSincreasedenergy,moreapttostayItsajoytoseepatientsafter
outofbedandattendfurthergroupsoutthisgroup
MHSwhenyouseeapatientsmiling,Notdirectly,butindirectly;it
somethingpositiveishappeninghaspositiveeffectson
patientstreatment
Nursesawseveralpatientsusuallyvery
flatanddepressed,abletosmileand
52
showsignsofenjoyment
Nursesomewereverypositiveaboutityes,whenpatientsare
happy,Imbetteroff
NurselessofnecessaryPRNantianxietyafeelingofpleasure
medicationswererequestedbecauselessmeds
Psychiatristimprovedmoodpleasedpatientshaving
positiveexperience
RehabTherapistuplifting,funwaytofocusonIintendtoincludemore
movementincombinationwithmusicmovementinmygroups
musicandpeers
SocialWorkerpatientsreportmoodimprovement,no
lessdepressedandesp.lessanxious
53
Figure4.Howdostaffperceivetheprogramhasaffectedpatientsmoods
andtheirownwellbeing?
54
Benefitsofprogramonpatients.AfterrereadingtheresponsesIhavedrawnoutfour
majorthemesaroundhowtheprogramhasbenefittedpatients(SeeTable4).Ihave
recordedthenumberoftimeseachthemeisreferencedinallelevenquestionnaires(See
Figure5).Theexamplesarecategorizedbythemesbelow.
Table4.ParticipantsResponsestoHowtheProgramBenefittedPatients
IncreasesPatientsInteractionsincreaseawarenessofnonsexualbodymovements,
andExpressiveSkillsofpeers,areminderofwhatbeingplayfulis
...givesthemawaytointeractwithpeers,especially
iftheyareshyinnature
Differentinteraction
Nonverbalexpressionofthoughtsandaffect
Improvepatient/patientandpatient/staff
communicationthroughfamiliarity
Providesfun,interactiveactivity
benefitsthembykeepingthemawake,visible,and
busydoingsomethingingroupwithothers
IncreasesPatientsEnergyLevelsIncreaseexercise
Moreenergy
Boostenergylevel
IntegratestheUnitconsistencywithgroups,combinesAandB
track,
integratesfemale/maleandallmentalillnesses
ReducesPatientsSymptomsDecreasesmedications
Ahealthywaytoreleasetension
Discoverstrengths
Tensionreduction,funactivity
Benefitfromtherelaxationresponse
Willelevatetheirmood,increaseheartrate,boost
mood,increaseflexibility
55
Theseresultsshowthatstafffindthemostbeneficialimpactonpatientstobean
increasedabilitytosocialize.Theyalsorecognizetheprogramsenergizingandstress
relievingeffects.
Figure5.Howmightthisprogrambenefitpatients?
56
Increases patients
interactions and
expressive skills
Reduces patients
symptoms
Integrates the unit

BenefitsofprogramonMSE
thisquestionblank.However
Increases patients
energy levels
staff.Tworespondentsleft
fromthenineresponses,
threeoverallthemesemerged(SeeFigure6).Tworesponsesclearlyrevealedthatasthe
programbenefitedpatients,therewasadirectpositiveimpact(stressrelief)onstaff(See
Table5).Nursingstaffallreportedthisprogramhelpsreducestaffstress,supportedby
observationsofpatientsrequestingfewerPRNsafterRuedatherapysessions.Thestaff
whohadparticipatedinasessionreportedanincreaseinempathyandeaseof
communicationwithpatients.Theseresponseswereuniquetostaffwhoparticipatedin
thesessions.
Table5.ParticipantsResponsestoHowtheProgramBenefitsStaff
57
LowersStaffStress...abreakawayfromdutiesisalways
refreshing
decreasetensionofpatients,decreasingstaffsstress
tensionreduction
lightenmood;helpdecreasestress/blowoffsteam
patientshaveanoverallimprovedexperience
samewayitbenefitspatients:elevatemood,increase
heartrate,boostenergylevel
itgivesthemtimetodosomethingelse
increaseinactivepeopletoactivitymayintroduce
anotherstressreductionexerciseforcopingskills,
lessenPRNmedications
providefuninteractiveactivity
HelpsImproveCommunicationenhancecommunicationwithpatientsthat
attendthewithPatientssession
IncreasesEmpathyinStaffachancetorelaxandworkwiththepatientsin
PatientRelationship
nonthreateningway.Staff/patientsIfeelwouldget
alongbetterandhavemoreofanunderstandingthat
wearehumans.
chancetoseepatientsdifferently
58
Increases empathy in
staff-patient relationship
Helps improve
communication
with patients
Lowers staff
stress
Figure6.Howmightthisprogrambenefitstaffontheunit?
59
Thevalueofanongoingprogram.Allrespondentswereinfavorofanongoing
programandstatedreasonstheyfounditvaluable.Fourthemesemergedfromthe
responses(SeeFigure7)andIhavecolorcodedtheoccupationalcategoriesof
respondents.Afterreviewingrespondentsanswers,themostcommonvaluetoemerge
waspatientsimproveintheirrecovery.Basedonresponses,improvementsignifies
decreasedstress,increasedcontrolovernegativebehaviors,andhigherselfesteem.Two
ofthestaffwhoparticipatedindancetherapysessionsdescribedhowtheprogram
increasedcohesion,amongmembersinthesessionaswellasamongthetwotracksof
patientsontheunit.Staffofeveryjobtitlenoticedimprovementinpatientssymptoms,
andexpressedhowtheprogramwouldbenefitpatientsphysical,mentalandsocial
functioning.
60
Table6.ParticipantsResponsesAbouttheValueofanOngoingProgram
IncreasedUnitCohesion...cohesivenessingroupdynamicexperience
especiallywhenincorporatinggesturesfromgroup.
Thisoffersagroupforeverybodyinsteadof
separatingthepatientsintoseparategroups.
PatientsImproveintheirpatientscapacitytomoveingroupimproved
along
Recovery
withtheirrecovery.
Dancingisbeneficialtothebody,mind,mood...
Definitelyvaluableforpatients
Increaseexercise
Discoverstrengths
Improvespatientsmood
Decreasesoverallstresslevelofpatients
Tensionreduction
Yourprogramisachanceforpatientstoexert
controloversymptomsandhavesomefunaswell.
ImprovesStaffWellbeingIthelpspatientsandstaffinmanywayssince
it
affectedthemoodofthepatients.
Patientshavinganoverallimprovedexperience.
Ithinkitmotivatesstaffandpatientsandstartsthe
dayofftoagoodstartaddingenergy.
Tensionreduction
PromotesStaffPatientDifferentinteraction
Interactions...itgivesawayforstaffandpatientstointeractwith
oneanother,otherthanjustnormal1to1.
Itoffersthepatientsandstaffsomethingdifferent
fromthenormaltherapeuticsessionsthatsometimes
becomeroutine.
BuildsPatientsExpressivePatientsareabletoexpressthemselvesinany
waySkillstheywant.
Nonverbalexpressionofthoughtsandaffect.
61
Figure7.Howmightanongoingprogrambevaluablefortheunit?
62
Staffparticipationintheprogram.Outofthe11respondents,tworeportedtheywould
notparticipateinanongoingprogram,duetotimeconstraintsintheirdailyscheduleand
feelingtooklutzy(SeeFigure8).ThepsychiatristsresponsewascodedasNotsure
becauseitstateditwouldbeappropriatewithsomepatientsandnotothers.Twonurses
respondedyes,becauseitisalevelerandhelpspatientsseethemasmoreequaland
lessauthoritative.AllMentalHealthSpecialistsrespondedyes,andtheirexplanations
includedfeelingasenseofenjoymentwhenpatientsarehavingfun,andstatingthatthe
programprovidesagoodwaytoacclimatepatientstotheunit.
63
Figure8.WouldstaffparticipateinanongoingRuedatherapyprogram
withpatients?
64
Commentary.AttheendofthequestionnaireIprovidedroomforrespondentstowrite
additionalfeedbackontheprogram.Sevenrespondentssharedinsightthatincluded
positiveremarksandfuturehopesfortheprogram.Thenursingdirectorrequesteda
formattoreproducesimilarmovementgroups.Amentalhealthspecialistreflectedonher
ownactionsofencouragingpatientstoattendbecausesheobservedthebeneficialimpact
onpatients.ShecommentedIhaveneverheardsuchpositivefeedbackfromanygroup
ontheMSEunit.Onenursewrotehowthetherapywouldbeespeciallygoodforsexual
abusevictims.Anothermentalhealthspecialistwhohaddancedinthesessionnoticeda
patientthatdidnotattendorparticipateinothertherapygroupsactivelyparticipatedin
theRuedasession.OnestaffstatedtheRuedadancehelpsthepatienttoavoidsomekind
ofbehaviordyscontrol,lessfrustration(maintaininggoodbehaviorcontrol).Allofthe
responsesweresupportiveoftheprogramandsomerevealedstaffmotivationtokeepthe
programrunning.
65
MyObservations.
OverthepastfivemonthsIhaveperceivedarangeofbenefitsanddrawbacksin
theRuedadancetherapyprogram.Therehavebeensingleinstancesthatraiseapertinent
question,aswellasrecurringphenomenathatperplexme.Ihaveobservedsomepatients
patternsofresistanceinresponsetousingasocialdancefromLatinAmerica.Onthe
otherhand,patientshavetoldmehowexcitedtheyaretolearnthisdance.Occasionally
patientshavesharedsexualexpressionsinthecontextofthegroup.Iwilldiscussthe
drawbacksandsuccessesasafacilitatorandparticipantintheprogram.
DevelopingadancetherapygroupatMSEwasinitiallysupportedbyjustmy
supervisorandmyself.Inoticedthetermdancealoneprovokedvariousnegative
reactionsfromstaffandpatients:immediateheadshakingandohno,Imnotadancer,
scoffinglaughter,andquickglancesdownwardandwalkingoffinanotherdirection.
Approachingschizophrenicandschizoaffectivepatientswithaninvitationtojoina
movementgroupwasoftenineffective.Aspatientsshowedincreasedabilitytoregulate
theirbehaviorandsocializeingroups,Iobservedstaffsreactions.Inthefirstmonthof
theprogram,onenurseusedaRickyMartincdandattemptedtoleadthegroupinSalsa
danceonemorningwhenIwasnotthere.Inthe2ndmonth,staffbegantoverbally
66
encouragepatientsinthehallstoattendthegroup.Also,Istartedannouncingthe
movementgroupattheCommunityMeetings,asitdownmorningmeetingwhere
patientssetgoalsfortheday.Staffleadingthemeetingswouldoftenpromotethegroup
andhighlighthowithelpedotherpatientsreducetheiranxiety.
Onanestimatedsixdifferentmorningsontheunit,Ifacedresistancefrom12
malepatientswhodidnotwanttoparticipateinSalsadance.ThetermSalsamadeone
middleagedCaucasianpatientrespondwithIdontwanttodoaLatinodance...were
notLatino!Ilearnedthatusingaculturalsocialdancewillimmediatelyrepelsome
people.Inthiscase,themanstayedinthegroup,occasionallyaddingvulgarcomments,
andcontinuedtoattendduringhistwoweekhospitalization.Herefrainedfromsaying
negativecommentsinthefollowinggroupsandshowedincreasedcoordinationand
positiveaffectovertime.
Onasimilarnote,Ihaveobservedyoungmalepatientsshowembarrassment
duringtheRuedaportionofthegroupandchoosetositdown.One19yearoldCaucasian
malediagnosedwithschizophreniajoinedthegrouponhisfirstdayandremained
standing,engaged,inthecircleforthewholesession.Iwasconcernedwhenhemade
unpleasantfacialexpressionsduringtheSalsa,andhisnonverbalbehavior(looking
down,uncoordinatedstepping,occasionallystoppinginplacewithagrimacewhile
othersweremoving)demonstratedhewasuncomfortable.Infuturegroupshe
participateduptothepointofRuedadance,thenhewouldsitandwatch.Thismakesme
wonderifachoreographedstepisbeneficialforallpsychiatricpatients.However,inhis
third,andlastgroup,hespokeupfromhischairandaddedamovementtotheRueda
67
dance.Thegesturerelatedtoapologizingtohismotherforhisharmfulbehavior.Though
hestayedseated,hecontributedtothegroupdanceinapoignant,expressiveway.
Afterobservingpatientssitdown,oroptoutforjustthatportion,Iwonderif
becausethereisanexpectation,acorrectwaytodothedance,patientsmaygeteasily
frustratedintheprocessandfeeldefeatediftheyhavedifficultysteppingonthebeatsand
repeatingthepattern.PatientswouldoftensayIcantgetitandwouldsometimes
choosetositandobserve.Theshort,patterned,rhythmicstepscanbedauntingfor
someonewhomaybedizzyfromheavymedications,andconfusedfromracing,
disorganizedthoughts.However,atthesametimeIoftenheardpatientsremark,Iam
onlyfocusedonthisstep;itreallyhelpsdistractmefromallofthenegativethoughts.Its
agoodcopingtool.Ihaveobservedpatientswithrigid,hunchedposturesdancesalsa
andtransformintolifted,gracefulbodiesmovingwithincreasedcontrolandfocus.When
patientswereunabletostandduetophysicalproblems,Iencouragedthemtomarkthe
rhythmonthefloor.Manypatientsshowedfulleraffectandincreasedrangeofmotion
whileswingingtheirarmsinaseatedposition.
Astheonlydancetherapyworkerintheunit,Ifelttheneedtoprovetheprogram
waseffectiveandgetotherstaffonmyside.Iinvitedstafftoparticipateingroupsfrom
thestartoftheprogram,andoccasionallyarehabtherapist,nurse,ormentalhealth
specialistwouldjoin.Inoticedpatientswouldfollowdirectivesandselfregulatewell,
contributingtoamorecoherentflow,whenotherstaffjoinedthegroup.Perhapsthe
authoritypresencekeptthemmorefocused.Ialsonoticedpatientseyesopenwiderand
theirfacialexpressionsincreaseasstaffrevealedtheiremotionsinbodymovement.As
68
thegroupsgrewto12or15patients,Ifounditdifficulttocompletethegroupin30
minutes.Thesizeofthegroup,aswellaspatientsphysicaland/ormentalabilities,
wouldaffecttheflowofthegroup.Whenpatientsweremoredisorganizedor
unregulated,ittooklongertoteachthebasicsalsastep.This,inturn,shortenedthetime
forsharingtheirgesturesrelatedtotreatmentgoals.
Overtheextentoftheprogram,Inoticedrareinstanceswhenpatientswould
expresssexualstatementsduringorattheendoftheRuedadancing.Inonesession,a
severelydepressed40yearoldCaucasianwomansharedshefeltsexy,andIhaventfelt
thiswayinalongtimeattheendofthegroup.Hermovementsthroughoutthegroup
werecontrolled,smoothlycoordinated,andaccompaniedbyslightsmiling.Onemanic
Latinafemalepatientinhermid20s,whowasfamiliarwithSalsadancing,addeda
gesturethathadaseductiveconnotation.Sheperformedaloweringlungewithoneknee
pointingforward,onehandraisedwithafingercurling,andasoftgrin,andwithasultry
tonecalleditComesalsawithme.Thequestionofsalsabeingaseductivedancecame
intoplay.Thestaffmemberwhoparticipatedinthissessionsaidsheenjoyedwatching
thepatientshowconfidenceandinthepatientswords,feelmoreempowered.As
facilitatorIrealizedthatwithinthecontainerofthegroup,patientsexpressionswillbe
interpreteddifferently.Inthiscase,Iwasconcernedaboutherintention,whereasanother
clinicanwasdelighted.
Asthefacilitatorandresearcher,Iwasconstantlyawareofstaffandpatients
remarksaboutthegroup.MysitesupervisoroncecommentedthemorningDMTgroup
wasfun,anditwasintheafternoonDMTgroupsthatdeepworkhappened.After
69
repeatedlyhearingotherparticipantsreactionsofitwasfunandrelaxing,Ibeganto
questiontheroleofthegroupinpatientstreatment.Didtheunitneedthisspaceforpure
connectionandcommunitybuilding?Didthesenseoffunoverridemorepressing
needspatientsfaced?Ipersonallyfeltmorerelaxedaftermovingwithpatientsandstaff;
theyoftenreportedthesamereaction.Thisbroughtintoquestionthetimepressuretoget
asmuchsubstantialinformationintothepatientstreatmentand,inmyopinion,the
missingspaceforbuildingconnectionandrelationshipsontheunit.
CHAPTER5
DISCUSSION
Iwillreturntotheoriginalguidingquestionofthestudy:Howdothestaff
perceivetheirwellbeingandtheirrelationshipswithpatientstobeaffectedbytheRueda
dancetherapyprogram?Theevaluativeaspectoftheresearchaddresseshowwellthe
programimprovedpatientsfunctioningandrelationalconnectionsontheunitthrough
theeyesofstaff.Cruz(2004)writes,evaluationresearchoffersapragmaticwayof
examiningDMTprogramsandextendingpracticethroughcreatingopportunitiesfor
dance/movementtherapists...itprovidesameansbywhichdance/movementtherapists
canusetheirworktopositivelyguidetheprofession(p.180).Aftersummarizingthe
findings,Iwillstatetheimplicationsthisresearchhasforthefieldofexpressivetherapies
andmakerecommendationsforfurtherinquiry.
70
Staffoninpatientpsychiatricunitsfacerelentlesspressuretotreattheirpatientsin
aspeedyfashion.Theliteratureshowsthatthepressured,demandinginpatientpsychiatric
environmentleadstohighstaffturnoveraswellasdissatisfiedpatients(Jourdain &
Chnevert, 2010; Robins et al., 2005).Thisstudyshows,alongwithpriorstudies,thatthe
artsplayasignificantroleinimprovinghealthcareenvironments(Hume,2010).The
findingsrevealthatMSEstafffoundthefivemonthRuedadancetherapyprogram
valuableintermsofstressreduction,improvementinpatientsrecovery,andincreased
staffstaff,staffpatient,andpatientpatientconnectionsontheunit.
Accordingtotheliterature,hostilityfrompatientscontributestostaffburnoutin
psychiatricsettings(Jourdain&Chnevert, 2010);inaddition,patientsreportthat
improvedstaffattitudesandstaffempathydeescalatetheiraggression (Gildbergetal.,
2010;Meehanetal.,2006).Sincestaffsbehaviorwithpatientshasadirectimpacton
theirpatientsmoodsandrecovery,interventionsthatassiststaffinfosteringhealthy
relationshipswithpatientsarebeneficial.BothSandyandHeatherdisclosedthatthey
werelesstense,gainedabetterunderstandingofpatientsneeds,andexperienced
strongerrelationshipswithpatientsafterparticipatinginthedancegroup.Thisimplies
thatthestaffgainedgreatersensitivitytowardspatientsandthepatientsreceivedgreater
empatheticgroupsupport.AllstaffparticipantsagreedtheRuedatherapyprogram
improvedpatientsmoodsandmoststatedithadapositiveimpactontheirownwell
being.
LiteratureonRelationalCulturalTheoryissupportedbyfindingsinthisstudy.
Staffreportedfeelingempoweredaftertryingnewbehaviorsandobservingpatients
71
strengths.Mutuality,orsharedparticipationinarelationship...energeticresponsiveness
onbehalfofallparticipants,occurredinthegroup,andthisisaqualityofahealthy
connection(Beardalletal.,2007).Intervieweesdisclosedtheirdiscomfortaroundbeing
observedinthedancegroup;thisfeelingevokedempathyforpatientsbeingunder
observation.Also,severalstaffcommentedonhavingmoreempathyforpatientsafter
observingtheiruncoordinatedstepsandrealizingtheeffectsoftheirillness.Staffnoticed
patientsdemonstratedhealthyrelationalqualities,includingrespect,engagement,zest,
empathy,andempowermentduringandafterRuedatherapysessions.Manystaff
witnessedpatientssocializingmore,attendingmoregroups,encouragingoneanother
throughouttheday.Also,myresultsshowcommonconclusionswithDuignan,etal.
(2009),inthatstaffbenefitfromfeelingmorerelaxed,experiencingimprovedmood,and
engaginginnewinteractionswithantagonisticorwithdrawnpatients.Staffcommented
onhavingmorezestafterparticipating,aswellasbringingthatpositiveenergybackto
theunit.Inotherwords,therewasapositivecollectiveresponsetotheprogram.
EmpatheticreflectioninDMTmethodsengagesourmirrorneurons(Berrol,2006;
Siegel,2010).Thesefindingsrevealthatnursingstaff,socialworkers,psychiatristsand
mentalhealthspecialists,whotypicallyengageinonlystructuredoneononeinteractions
withpatients,enjoyedwitnessingpatientsperformstrengths,spontaneity,andhelping
actionsingroups.Theinterneuronalconnectivitybetweenstaffandpatientsmayreflecta
sharedsenseofincreasedhopeandenjoymentinsocializing(Berrol,2006).
StaffwhoparticipatedinRuedasessionsexperiencedanincreaseinpositive
moodandmotivationtodealwithstressorsintheworkplace.Theseeffectsseemtoresult
72
fromtheirexperienceofpersonalgrowth;thegroupprovidedastructuretotapinto
intrinsicmotivation(accomplishment,stimulation,andlearning)(Jourdain&Chnevert,
2010).Myfindingsrevealthatstaffhadimprovedworkdaysafterengaginginand/or
observingpatentsparticipationandmeaningfulinteractionsthroughouttheday.Offering
healthcarestaffacreativegroupexperiencewithpatientswouldincreasemeaningintheir
work,whichwouldlikelystimulatetheiremotionalenergyandinvestmentintheirwork.
Accordingtotheliterature,staffburnoutisinfluencedbydifferentfactors,
includingreduced perceptions of personal accomplishment, lack of motivational
resources to deal with emotional exhaustion, depersonalization, role stress, and hostility
from patients (Halbesleben & Bowler, 2007; Jourdain&Chnevert, 2010). In my
findings, themes of staff engagement and empathy for others are supported. Both Sandy
and Heather reported feeling closer to patients, reduced somatic tension, and more aware
of positive relational patterns in the group and in patients. If sustained, the Rueda dance
therapy program may address staff burnout, by increasing staffs self-efficacy, their
motivational resources, their sensitivity to patients needs, and the strength of their
relationships in the workplace. These findings contribute to the research on preventing
burnout in the healthcare workplace.
Myfindingssupporttheliteratureonthetherapeuticeffectsofsocialdanceand
providenewinsightforthefield(Haboush & Floyd, 2006; Hanna, 2006; Lima & Vieira,
2007). Staff noted the program promoted new interactions, increased socialization, and
improved moods.Lima&Vieira(2007)discusshowparticipantsshiftintheir
conventionalrolesaspassiveresidentswhentheypartakeinsocialdanceevents.My
findings,accordingtostaffreports,showthatpatientsatMSEexperiencedchangefrom
73
isolated,depressedindividualstostronger,interactivecitizensofthecommunitywhile
engaginginRuedasessions.Ravelinetal.(2006)notethatinmentalhealthworkitis
importanttofacilitatepatientsexperiencesofpleasure.MyfindingsshowthatRueda
dancetherapyencouragesplayfulinteractions.Priorstudiesdonotdemonstratehowsalsa
andRuedadanceaffectstaffworkingwithadultswithpsychiatricillness.Staffresponses
confirmedDuggin&Mercadosfindingsthatexecutingthesalsasteprequiresconscious
impulsecontrol.Myfindingsexhibitthestaffsinitialresistanceandintimidation,which
overtimetransformedintoamoremindful,empowering,andenergizingopportunityfor
personalgrowthandinteraction.
OccasionalpatientresistancetoengagingintheRuedaportioninvitesthe
question:dosomepatientsresistdoingthesocialdancebecausetheyfindithardtogive
themselvespermissiontohavefunwhilehospitalized?Dosocialdancesposeathreat
topatientsthatmaybedealingwithfeelingsofshame,e.g.notforgivingoneselffortheir
actions,ornotfeelingdeservingtoengageinasocialdance?Ontheonehand,many
patientsrespondedwithenthusiasmandexcitementinlearningsalsadance.Iobserved
manicpatientsfocusonthesalsastep,whichhelpedtocontaintheirunfocusedenergy.
YetothersoptedoutoftheRuedaportion.Thestaffreportedthatpatientscommentedon
thedanceasacopingtoolforagitation.Furtherstudiesneedtobeconductedtoglean
patientsperceptionsregardingtheirexperiencesoftheRuedasessions.
My findings support Humes research (2010) that the arts contribute to patients
recovery in hospitals because they provide an opportunity for patients to practice exerting
control over their emotional and physical symptoms. According to the staffs responses,
the group provided a fun outlet on the tension-filled unit. The staff often observed
74
patients smiling, interacting in new ways, and enlarging the circle to include others
during the group; these results verify an increase in participants levels of zest and
engagement, or sustained involvement in the group activity. The groups produced
increased connections and inclusiveness amongst participants.
Introducing creative, non-threatening interventions that increase the relational
connections in healthcare settings is not only appreciated by staff, but also visible in
patients positive responses. Aiming at improving staff well-being from a patientcentered, therapeutic approach benefits clients treatment and the quality of staff
interactions with patients. This suggests a need for DMT interventions that promote
calmer, positive workplace environments for staff and patient well-being.
Due to the limited time and number of participants, my research findings do not
statistically prove changes in empathy and well-being, but qualify the subjective
experience of these staff participating in Rueda therapy sessions. Another limitation is
due to my status as an intern, I did not have baseline knowledge of the staff-patient
relations on the unit. Also, participants comments may be skewed, due to 1) trying to
please the researcher and/or 2) hesitancy to share certain opinions with an intern.
My findings are limited to this particular unit and these thirteen participants,
however the findings provide a springboard for further inquiry into interventions that
support healthier mental healthcare environments. Given the short length of the
intervention and the findings that staffs hopefulness increased, further studies to
investigate the long term impact of this program are called for. Future research should
also investigate understanding the nature of non-threatening, arts-based interventions in
75
psychiatric settings, and how DMT interventions affect staff-staff, staff-patient, patientpatient relations.
Future studies of DMT for staff and patients in psychiatric units should adopt
validated assessment scales, compare control and experimental groups, and be
implemented with longitudinal design. In future studies investigating staff-patient
relations, researchers should gather baseline data so that comparisons can be made before
interventions and at the end of the program. Evaluation studies should evaluate whether
or not DMT programs can improve patients experiences of psychiatric hospital care.
The implication of this study is that short term interventions using Rueda has a
positive impact on staff-patient interactions and staff well-being. Healthy relationships
support zest, empathy, and motivation; in mental health care settings staff need sustained
support to nurture these qualities, both personally and professionally. Given the increase
of evidence supporting DMT interventions with psychiatric populations, more attention
should be given to combined patient-staff programming. Programs that address both staff
and patient wellness are needed. Staff should receive proper organizational support to
maintain physical and emotional well-being; patients will, in turn, benefit from more
energetic and empathetic hospital staff. Designing movement-based programs that
promote more non-threatening, creative, empathetic relationships can decrease patients
symptoms and improve staff well-being. Psychiatric units would benefit from programs
that contribute to both the healing of patients and a supportive workplace environment.
Appendix A
Informed Consent
76
77
29 Everett St., Cambridge, MA 02138
ThesisResearchInformedConsent
YouareinvitedtoparticipateintheresearchprojecttitledBailamos!AnEvaluationof
CubanSalsaasaMeansofTransformingStaffPatientRelationsinaPsychiatricHospital
Unit.Theintentofthisresearchistoexplorehowstaffperceivethepresenceofa
dancetherapyprogramatMSE.Thisstudymayrevealhowadancetherapyprogram
canincreaseoursenseofwellbeingandaffectourrelationshipswithpatientsinthe
workplace.
Yourparticipationwillentailattendingtwo30minuteRuedadancetherapysessions,
completingawrittensurvey,andsharingyourreactionsinasemistructuredinterview
lasting45minutes1hour.Theinterviewwillbeaudiorecorded.Intheinterview,you
willbeinvitedtosharehowparticipationinthesessionsaffectedyoursenseofwell
beingandhowyouimaginganongoingRuedadancetherapyprogramwouldaffectthe
unit.Aftertheinterviewistranscribed,youwillbeinvitedtomeetwithmeagainfor15
minutes,eitherinpersonoroverthephone,sowecandiscussandclarifywhatwas
learnedbyyouandgiveyoutheopportunitytoaskanyquestionsyoumighthave.
78
Inaddition
Formerexperiencewithdanceisnotnecessary.
Youarefreetochoosenottoparticipateintheresearchandtodiscontinueyour
participationintheresearchatanytime.
Identifyingdetailswillbekeptconfidentialbytheresearcher.Datacollectedwill
becodedwithapseudonym,theparticipantsidentitywillneverberevealedby
theresearcher,andonlytheresearcherwillhaveaccesstothedatacollected.
Anyandallofyourquestionswillbeansweredatanytimeandyouarefreeto
consultwithanyone(i.e.,friend,family)aboutyourdecisiontoparticipateinthe
researchand/ortodiscontinueyourparticipation.
Participationinthisresearchmayposesomeemotionalorphysicalreaction,either
positiveornegativefromthemovementtherapyexperienceandfromyour
associationtolifeexperience.Itisimportantthatyoureporttotheresearcherany
medicalconditions,particularlyphysicalailments,asthedancingmayexacerbate
these.Theprobabilityandmagnitudeofharmordiscomfortanticipatedinthe
researcharenogreaterinandofthemselvesthanthoseordinarilyencounteredin
dailylife.
Ifanyproblemintheresearcharises,youcancontacttheresearcher,AmandaGill
at(571)2248572,andbyemailatagill2@lesley.eduorLesleyUniversity
sponsoringfacultyDr.LourdesBracheTabarat(315)2143436.
Theresearchermaypresenttheoutcomesofthisstudyforacademicpurposes
(i.e.,articles,teaching,conferencepresentations,supervisionetc.)
MyagreementtoparticipatehasbeengivenofmyownfreewillandthatIunderstandall
ofthestatedabove.Inaddition,Iwillreceiveacopyofthisconsentform.
____________________________________________________________________
ParticipantssignatureDateResearcherssignature
Date
Appendix B
79
80
Advertisements
How do you think the

Dance Therapy program
is affecting MSE?
81
THEY WILL
CONTRIBUTE
PLEASE TAKE 715 MINUTES AND
TO MSES
FILL OUT A
PROGRAM
PROGRAM
EVALUATION
EVALUATION!!
AND THE
COMPLETION
OF A MASTERS THESIS
PLEASE RETURN IN THE
MAILROOM BY THURSDAY, 3/10
82
AppendixC
PostRuedaDanceTherapySessionQuestionnaire
PostRuedaDanceTherapySessionQuestionnaire
Backgroundquestions
A.Circlethecategorythatbestdescribesyoursex:Male/Female/Other:__________
B.Whatisyourcurrentjobtitleatthissite?___________________________________
C.HowlonghaveyouhaveworkedatMSEinpatientunit?______________________
83
D.Isdanceapartofyourculturalbackground?Pleasedescribe:
E.Isthisyourfirsttimeparticipatinginadancegroup?
IfNO,pleasedescribeyourpriorexperience:
YES/NO
Experiencequestions
1. HowdidparticipatinginthisRuedadancetherapysessionwithpatientsaffectyou?
1A.Didyounoticeanychangeinyourlevelofzest(yoursenseofvitality,
aliveness,energy)?Pleasedescribe:
1B.Didyounoticeanychangeinyourlevelofempathytowardsothers?Please
describe:
2. HowwouldyousayparticipatinginthisRuedadancetherapysessionaffectedyour
relationshipwithpatients?
3. Ifitwereavailable,wouldyouparticipateinRuedadancetherapyagainafter
experiencingthissession?Why?
Feelfreetoshareanyothercommentsorfeedbackonyourexperienceparticipating
inthisRuedadancetherapysession:
84
Appendix D
Interview Guide
Interview Guide
RuedaDanceTherapyProgramEvaluation
ThankyouforagreeingtobeinterviewedaspartoftheMastersthesisBailamos!An
EvaluationofCubanSalsaasaMeansofTransformingStaffPatientRelationsina
PsychiatricHospitalUnit.
Youarebeingaskedtoanswerthefollowingquestionsaspartofanevaluationofhow
Rueda(CubanSalsa)dancetherapyhasimpactedtheinpatientunitoverthepast5
85
months.Theinterviewmayfeelmorelikeaconversation,andpleaseanswerashonestly
asyoucan.
Questions
1. Id like you to go back to when you
were moving with patients last Friday
in the group. Can you tell me about
your experience participating in the
Rueda dance therapy sessions with
1A. More specifically, did you notice
any change in your level of zest (your
sense of vitality, aliveness, energy)
while participating in the group? After
the group?
1B. Did you notice any change in your
level of empathy towards others?
2. Based on your experience working

at MSE, how do you feel the weekly
Rueda dance therapy program has
affected the unit?
3. How would you say the presence of
the Rueda dance therapy program
has affected your relationships with
patients?
4. Through observation or
participation, have you noticed the
Rueda dance therapy program has
impacted the patients moods
4A. Has this in turn affected you in any
way?
Observations
Questions
5. How have you heard patients
describe Rueda dance therapy?
86
Observations
6. How might Rueda dance therapy

benefit patients on this unit?
7. How might Rueda dance therapy

benefit staff on this unit?
8. Do you think an on-going Rueda

dance therapy program would be
valuable for patients and staff? How
come?
9. If it were available, would you
participate in Rueda dance therapy
with patients? Why?
10. Do you have any questions or
anything youd like to bring up that I
havent asked you?
AppendixE
RuedaDanceTherapyProgramEvaluationQuestionnaire
87
RuedaDanceTherapyProgramEvaluationQuestionnaire
Youarebeingaskedtoanswerthefollowingquestionsaspartofanevaluationofhow
Rueda(CubanSalsa)dancetherapyhasimpactedtheinpatientunitoverthepast5
months.Pleaseanswerashonestlyasyoucan.Thisinformationwillbeusedtoprovide
valuableinsightonwhethertoconsiderimplementingfutureprogramsontheunit.Itwill
alsosupportthecompletionoftheMastersthesisBailamos!ACaseStudyEmploying
88
CubanSalsaasaMeansofTransformingStaffPatientRelationsinaPsychiatricHospital
Unit.
Backgroundquestions
A.Circlethecategorythatbestdescribesyoursex:Male/Female/Other:__________
B.Whatisyourcurrentjobtitleatthissite?___________________________________
C.Howlonghaveyouhaveworkedontheinpatientunit?________________________
D.Isdanceapartofyourculturalbackground?Pleasedescribe:
E.DidyouparticipateinanyoftheRuedadancetherapysessions?Yes/No
IfYes,howmanysessionsdidyouattend?______
Evaluationquestions
IfyouhaveparticipatedinoneormoreRuedadancetherapysessions,answerquestions
1,1Aand1B.Ifyouhavenot,skipquestion1andstartatquestion2.
1.HowdidparticipatingintheRuedadancetherapysession(s)withpatientsaffectyou?
1A.Didyounoticeanychangeinyourlevelofzest(yoursenseofvitality,
aliveness,energy)?Pleasedescribe:
1B.Didyounoticeanychangeinyourlevelofempathytowardsothers?Please
describe:
2.HowdoyouthinktheweeklyRuedadancetherapyprogramhasaffectedtheunit?
3.HowwouldyousaythepresenceoftheRuedadancetherapyprogramhasaffected
yourrelationshipswithpatients?
4.Throughobservationorparticipation,haveyounoticedtheRuedadancetherapy
programhasimpactedthepatientsmoods?Pleasedescribe:
4A.Hasthisinturnaffectedyouinanyway?
5.HowhaveyouheardpatientsdescribeRuedadancetherapy?
89
6.HowmightRuedadancetherapybenefitpatientsonthisunit?
7. HowmightRuedadancetherapybenefitstaffonthisunit?
8.DoyouthinkanongoingRuedadancetherapyprogramwouldbevaluableforpatients
andstaff?Why?
9.Ifitwereavailable,wouldyouparticipateinRuedadancetherapywithpatients?Why?
FeelfreetoshareanyothercommentsorfeedbackontheRuedadancetherapy
program:
90
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Bailamos!

An Evaluation of Cuban Salsa in a Psychiatric Hospital Unit

Bailamos! An Evaluation of Cuban Salsa in a Psychiatric Hospital Unit

Bailamos! An Evaluation of Cuban Salsa in a Psychiatric Hospital Unit

Dance/Movement Group Therapy Interventions ..............................................................15

Bailamos! An Evaluation of Cuban Salsa in a Psychiatric Hospital Unit

Bailamos! An Evaluation of Cuban Salsa in a Psychiatric Hospital Unit

Bailamos! An Evaluation of Cuban Salsa in a Psychiatric Hospital Unit

Bailamos! An Evaluation of Cuban Salsa in a Psychiatric Hospital Unit

Bailamos! An Evaluation of Cuban Salsa in a Psychiatric Hospital Unit

Bailamos! An Evaluation of Cuban Salsa in a Psychiatric Hospital Unit

Bailamos! An Evaluation of Cuban Salsa in a Psychiatric Hospital Unit

such as participation in therapeutic or social activities, in inpatient wards improves

Bailamos! An Evaluation of Cuban Salsa in a Psychiatric Hospital Unit

increase self-esteem and worth (O. Lopez-Ayon, K. Zalan, V. Cuello, L. Betancourt,

Bailamos! An Evaluation of Cuban Salsa in a Psychiatric Hospital Unit

Bailamos! An Evaluation of Cuban Salsa in a Psychiatric Hospital Unit

Bailamos! An Evaluation of Cuban Salsa in a Psychiatric Hospital Unit

Bailamos! An Evaluation of Cuban Salsa in a Psychiatric Hospital Unit

I. Dance/Movement Group Therapy Interventions

Staff Well-being and Burnout

Bailamos! An Evaluation of Cuban Salsa in a Psychiatric Hospital Unit

Bailamos! An Evaluation of Cuban Salsa in a Psychiatric Hospital Unit

interaction we learn to augment and diminish others. These aspects of relational

Bailamos! An Evaluation of Cuban Salsa in a Psychiatric Hospital Unit

neurons are activated in an observer as in the individuals actually engaged in the

Bailamos! An Evaluation of Cuban Salsa in a Psychiatric Hospital Unit

Two noteworthy studies investigating the therapeutic value of ballroom dance

Bailamos! An Evaluation of Cuban Salsa in a Psychiatric Hospital Unit

Staff-Patient Relations in Inpatient Psychiatric Care

Bailamos! An Evaluation of Cuban Salsa in a Psychiatric Hospital Unit

Bailamos! An Evaluation of Cuban Salsa in a Psychiatric Hospital Unit

Pitknen, et al. (2008) call to attention patients descriptions of nursing

Bailamos! An Evaluation of Cuban Salsa in a Psychiatric Hospital Unit

Bailamos! An Evaluation of Cuban Salsa in a Psychiatric Hospital Unit

Bailamos! An Evaluation of Cuban Salsa in a Psychiatric Hospital Unit

environment and targets his defense at administrations. He determines that building

Bailamos! An Evaluation of Cuban Salsa in a Psychiatric Hospital Unit

Bailamos! An Evaluation of Cuban Salsa in a Psychiatric Hospital Unit

Bailamos! An Evaluation of Cuban Salsa in a Psychiatric Hospital Unit

Bailamos! An Evaluation of Cuban Salsa in a Psychiatric Hospital Unit

Data Collection and Analysis

Bailamos! An Evaluation of Cuban Salsa in a Psychiatric Hospital Unit

Bailamos! An Evaluation of Cuban Salsa in a Psychiatric Hospital Unit

Bailamos! An Evaluation of Cuban Salsa in a Psychiatric Hospital Unit

Bailamos! An Evaluation of Cuban Salsa in a Psychiatric Hospital Unit

Bailamos! An Evaluation of Cuban Salsa in a Psychiatric Hospital Unit

Bailamos! An Evaluation of Cuban Salsa in a Psychiatric Hospital Unit

Bailamos! An Evaluation of Cuban Salsa in a Psychiatric Hospital Unit

Bailamos! An Evaluation of Cuban Salsa in a Psychiatric Hospital Unit

Bailamos! An Evaluation of Cuban Salsa in a Psychiatric Hospital Unit

Bailamos! An Evaluation of Cuban Salsa in a Psychiatric Hospital Unit

Bailamos! An Evaluation of Cuban Salsa in a Psychiatric Hospital Unit

Bailamos! An Evaluation of Cuban Salsa in a Psychiatric Hospital Unit

Bailamos! An Evaluation of Cuban Salsa in a Psychiatric Hospital Unit

Bailamos! An Evaluation of Cuban Salsa in a Psychiatric Hospital Unit

Bailamos! An Evaluation of Cuban Salsa in a Psychiatric Hospital Unit

Bailamos! An Evaluation of Cuban Salsa in a Psychiatric Hospital Unit

Bailamos! An Evaluation of Cuban Salsa in a Psychiatric Hospital Unit

Bailamos! An Evaluation of Cuban Salsa in a Psychiatric Hospital Unit

Bailamos! An Evaluation of Cuban Salsa in a Psychiatric Hospital Unit

Bailamos! An Evaluation of Cuban Salsa in a Psychiatric Hospital Unit