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The Royal College of Psychiatrists Improving the lives of people with mental illness

The Alchemy Project: Dance as part of an Integrated Recovery Model in Early Intervention in Psychosis

Dr Lauren Gavaghan, ST5 Psychiatrist
South London and Maudsley NHS Foundation Trust

The Alchemy Project

Photographs by Pari Naderi

The Alchemy Project is taking forward the work of Dance United, who have a proven award-winning methodology, which evolved over many years of working within the criminal justice sector. A dance intervention 'Seabreeze,' directed by Carly Annabel-Coop, was piloted in 2013 with young adults from the Early Intervention in Psychosis teams within the South London and Maudsley NHS Trust. Sixteen young people, alongside 6 peer mentors took part in an intensive dance-led intervention, over the course of four weeks, culminating in participants showing a final dance performance to an audience. This led to a clinically significant increase in the wellbeing of participants and remarkably high levels of attendance were noted.

 

The Alchemy Project 2015 is the follow-on from this pilot. This action research project is again co-produced with SLAM Early Intervention in Psychosis Services. The mission is for it to be a catalyst for radical change, realising the potential of individuals. The teaching methodology is to engage and inspire people struggling in their lives and it is innovative, holistic and focuses on wellbeing rather than deficits.


"There is a strong focus on community, teamwork and growth, and there seems to be an exquisite sensitivity towards each person's uniqueness and potential."


Below is Dr Gavaghan's blog recounting her experience with the project during its first phase in 2015. A further phase is planned and there will be the opportunity to watch the second performance in July 2015.

 

 

Monday 23 February

I am invited to join the team induction. I arrive at Stockwell Community Centre, where The Alchemy Project will be working from for the next month or so. Carly, the Project Director introduces me to the other members of the team and we sit together in the dance studio, discussing the finer details of the project. I immediately feel a part of the team, having been met with smiles and warmth and I am struck by the positive, curious and non-judgemental attitude that fills the room. We are introduced to one another by doing what dancers do best - moving! We work through some physical trust-building exercises, and review the underlying principles of The Alchemy Project, that will guide the team and participants during the next 4 weeks. I imagine myself taking part in this intensive dance intervention if I were in my recovery from a first episode of mental illness. It is clear that every person participating will have their voice heard, each will be respected and there will be a focus on the here and now, rather than on histories and people's pasts. There is also a strong focus on community, teamwork and growth, and there seems to be an exquisite sensitivity towards each person's uniqueness and potential.

 

During the week, I have the opportunity to take part in the recruitment phase of the project. I join Carly in meeting with a client from the OASIS team. She is thrilled with the idea and very keen to join. Meanwhile Elisa, the Support Manager for The Alchemy Project and Jide, a vocational support worker from LEO (another Early Intervention team) are busy recruiting the last of the participants in the other teams.

 

Monday 2 March

Taster sessions began last week and all participants have now been recruited. They have all seemingly enjoyed their first day. I join the team for a morning planning meeting. Participants will come in at 10 am, to allow time for those who struggle with getting up early to arrive. Psychotic illness can lead to negative symptoms, which often interfere with a person's ability to self-motivate. The team are sensitive to this and plan for it, with Elisa enthusiastically calling participants to encourage them to attend if they are having problems getting in.

 

Breakfast is ready and waiting for the participants, with the welcoming smell of toast, and the sound of chatter filling the space. The project is as much about inclusion and community as it is dance, and much of the healing happens in the spaces outside of the dance studio. One might expect an environment like this to be daunting for young people who may have been isolated as a result of their mental distress, but again the team plans for this. Amma, an incredibly friendly member of the team, seems to dance, sing and smile no end, such that even the quietest of participants relaxes quickly and all feel ‘allowed’ to simply be themselves. 

 

There are 12 dancers in this cohort, with males outnumbering females. This is important, as it knocks on the head the gender stereotype of dance. Along with the new participants, there are also 6 peer mentors. They are recruited specifically for this role, and have dance backgrounds, an interest in mental health or community dance. Their presence and example is encouraging and inspiring for the newcomers to be witness to, many of whom have not danced before. One of the male peer mentors took part in the initial pilot intervention and now acts as an ambassador to the project, participating alongside the others.

 

Jide the support worker from the LEO team is an awesome presence in many ways. He is well liked and respected by participants, many of whom know him already. He brings lightness and a sincerity to his own practice, which others look up to, particularly the males. The typical hierarchical structure that often dominates medical environments is done away with as we enter the doors of the community centre - here we are all equals. The Alchemy Project has a very clear principle that as soon as participants enter the project, they become dancers, each part of a professional working dance company, with a shared goal to work towards. For young people who may have already been labelled and given diagnoses to describe their experiences, it is an important transition. Here, all labels and past is left outside the door of the dance studio, which leads to an incredibly powerful 'here and now' present experience, which I believe adds to the successful outcomes of this project.

 

I am immediately awed by just how quickly participants pick up the choreographed dance movements. Despite being someone who totally believes in dance as a therapeutic medium, I am surprised at my own surprise, at the capacity of the participants to learn and process information with such apparent ease.

 

In the studio, Carly, Ellen and Delene come into their own. Trained as dancers and very used to working in this way, they lead the group with strength and a confidence that immediately fosters trust and creates a safe, containing and nourishing space. Many participants have never danced before, yet in the studio it seems that parts of themselves are shown that perhaps they did not even realise existed. Ellen is powerful, active and loud, and with a wonderful drummer accompanying the dancers, she raises the energy levels and warms participants up quickly! Delene is an equal force, yet there is something deeply spiritual and empowering in the way in which she dances and in what she expects from others. Her warm-up contains many metaphors for life in general and she often asks participants to relate their movement to their life, particularly to their personal hopes and futures. It is an inspiration to dance with her. Carly exudes warmth and often contrasts and complements the other dancers, ensuring that there is a rhythm and routine to each day. The choreography is clever, thoughtful and sensitive.

 

OASIS Dance Warm-up


"The principles and long-term benefits of an intervention like the Alchemy Project are more far-reaching than simple physical activity"


This is not just teaching a few dance moves, but instead, moving participants from a place of no experience to a high-end artistic professional performance. The dance sections require memory, focus and attention, spatial awareness and an awareness of oneself in relation to others. I am fascinated by dance being able to challenge ‘what is me and what is you’ and continually test one’s own boundaries, particularly in relation to others. In psychotic illness, there is understandably much confusion related to this issue, and I see dance as a way of making the implicit explicit, in a powerful and embodied physical way. Stamina and a real enthusiasm are also required, and through the way the dance is led, participants seem to keep up. Again, physical trust-building exercises are a large part of this stage of the project. We are introduced to the name of the final piece, 'El Camino' ('The Way' in Spanish) and participants begin early on to take ownership over the performance they will finally be in, on stage, in front of a keen public audience.

I am once again reminded of the importance of having a physical aspect to our treatment approaches. As someone who regularly dances, I cannot imagine not having this in my life - the joy it brings, the community and the impact upon my own personal life, is immense. Yet how is it that within mental health services, there is so little attention paid to the body? We live in an era where physical health is now a priority in mental health and the medications we prescribe have potentially long-lasting effects on people's physical health. Diabetes, obesity and cardiovascular effects are commonplace. Yet, unlike GP's, we as psychiatrists do not routinely ensure that people have access to physical activity and monitor this adequately. Having said this, the principles and long-term benefits of an intervention like the Alchemy Project are more far-reaching than simple physical activity, which I believe is why it works so well.

 

Participants eat together and socialise outside of the studio. It is in this time, that bonds are forged between participants and the team members. People have the opportunity to feel as though they belong to something, as though their part of this whole is an integral one, and through this they start to take responsibility of themselves and others. There is already a real care being shown between participants and a community of validation is being nurtured in this space.  

 

Following the morning session, I join with Andrew Coggins, to discuss the documentary that shall be made about the project. The hope is that this service might become commissioned as part of the mental health service, and as an integral part of SLAM's inclusion and recovery policy in the future.

 

Monday 9 March

Joining the team for the morning meeting, I hear that the previous week has gone very well. Participants have mostly attended every day and have managed the increased levels of physical activity without any major issues. One participant was noted to have initially struggled with low mood in the mornings, but once in the studio and focused on the dance, this transitioned quickly into an attention to the movement that resulted in a marked change of perspective and outlook. 

 

Breakfast is very different to last week, with more chatter and laughter. I hear stories of weekends, of aching muscles and of excitement at the thought of returning each day. I move with the team into the studio and we begin to feel grounded in our bodies again.

 

Up on the wall of the studio are schematic drawings of the different pieces that will make up the final dance performance. Here, the dancers can see where they might end up in solo performances and where they will all be working together. There is now a sense of real pride and ownership of their dance, and the dancers are keen to show me their progression.

 

Dave the brilliant drummer accompanies our dancing in the dynamic morning warm-up and the live music and rhythm adds a very different and natural dimension to the movement. As a psychiatrist working within a system that relies heavily on words and language to communicate difficult and traumatic experiences, I think of the importance of the embodied experience. So often the most challenging experiences cannot be verbally communicated and so paying attention to the embodied experience can be invaluable. Dance has after all, been practised for millennia, yet we as humans have increasingly moved away from our bodies and into our minds, which necessitates complex communication. Often in psychosis, communication becomes interrupted, as ones thoughts and perception change. Language is often impaired, particularly in acute illness. I wonder what movement might provide in terms of a means to express oneself when other methods of communication fail, and why this is not utilised more often. 

 

I note a marked change in the dancers. Their posture has changed - they are now standing with their heads up, shoulders back, and with a confidence that wasn't this visible a week ago. Delene leads the company though a section named 'Corridors of Light' which involves participants walking in a mindful and focused fashion, and making a choice to engage in different movements at various points in time. Half of the company act as witness to their fellow dancers, standing in complete stillness, their full attention on their peers. The dancers are asked to imagine that they are walking into a corridor of light, and are asked to reach for something they truly want in their life. It is a humbling experience to see these young people standing upright, feeling proud and comfortable in their own bodies, in the spotlight, witnessed by others. Mental illness so often takes people out of the spotlight, and this process seems to do the opposite - by bringing people, quite physically and literally back into the light, whilst being 'seen' by others. It is this sense of being seen and heard which is incredibly powerful.

 

Dynamic Dance Movements

 


"What it must feel like to be believed in fully, when so often once someone is diagnosed with mental illness, the way others treat one is different, with the label often causing profound changes in the way in which a person is viewed and on the expectations of the person by others."


 

 

 

For me, these kinds of exercises represent the healing of the less easily explainable aspects of mental illness, which cannot be improved by medication alone. It is about allowing participants to physically 'become' and grow towards something new, reaching their full potential, akin to the caterpillar emerging from the chrysalis as the beautiful colourful butterfly.

 

The afternoon is spent with half the company working hard on pieces that began to take shape in the previous week. Dancers work in pairs and trios with trust and partnership as on-going themes. Trust in oneself, trust in others and trust in the process itself. This unfaltering belief comes first from those in the dance team, who never stray from their determination and belief in each individual. I think about just how powerful this method is, to focus on possibility and potential rather than deficit. What it must feel like to be believed in fully, when so often once someone is diagnosed with mental illness, the way others treat one is different, with the label often causing profound changes in the way in which a person is viewed and on the expectations of the person by others.

 

Dance is a complex activity and requires a plethora of different brain regions to work simultaneously. I consider this in the context of negative symptoms of psychosis, well known to not respond to most biological treatments. I wonder about the potential for movement and dance as a treatment strategy, or at least as a means of perhaps improving these particular symptoms and what changes in brain chemistry and function an intensive intervention such as this might result in.

 

Stigma continues to be a huge problem as far as mental illness is concerned and this project challenges the many prejudices that abound. The notion that people with mental illness perhaps might not 'be able' to succeed in such an intensive project is knocked on it's head straightaway. This project screams from the rooftops 'Who can't?' There is something very human and humanising about the whole experience. Here, all dance, all perform and all have a place and a voice that is listened to and heard. Participants are taken seriously; they take themselves seriously, and regard themselves as part of a professional dance company right from the offset, which sets up a truly impressive professional quality to the work. 

 

Over lunch, we find out more about one another. I discover that one lady is a proud mother, another loves music and singing, a male participant has a passion and real skill in rapping and has performed at venues across London. It is a normalising every-day experience and no longer do I see these people around me as 'patients,' but instead, interesting individuals, with their own stories to tell, their ways of doing things, and most beautifully, their own individual dances. 

 

Monday 16 March

The last week is reflected upon with smiles in the morning team meeting. Nearly all of the original participants are regularly attending the project. They have now begun to work on the final piece, and many of the dance 'phrases' and 'fragments' are being developed.

 

The group has gelled and the relationships between the young people have solidified even more. Everyone seems to have somehow come through their initial anxieties. I also note that the group are more familiar with one another bodily, that is to say, they hug one another more, and are generally more tactile. It strikes me that whilst we as doctors experiment with hormones such as Oxytocin to try and encourage similar kinds of increased social behaviour and bonding, a project such as this is allowing this experience in a much more natural way. I am reminded of how powerful it is to be part of a trusting, validating community and what this in itself allows in terms of bonding and recovery. ‘Symptoms' do not seem to dominate the days on the project and it would be evident if they started to, with the team working so closely together. Though I am aware of a couple of dancers who have had minor wobbles during the weeks so far, it seems that for many, the symptoms abate once the dancing starts and an intense focus is required.

Connecting in Space

The group steams ahead in the warm-up and I can’t keep up this week! They really are a dance company now, each strongly connected with one another in the space.

It is important for me to note that this dancing, in my opinion as someone who dances fairly regularly (albeit it in an improvised fashion), is not simple stuff. The dance company are taught specific and challenging choreographed contemporary dance sequences. These are taught in sections, so that later on, these can be knitted together as 'phrases' of the final piece. At times smaller groups of dancers separate off to practice their own 'fragments.' Here, they are given the opportunity to choose creatively what they wish to bring to the piece. It is a brilliant mix of led work and creativity that will make up their final performance and again, different areas of the brain are challenged when dancers are working together to create different pieces for themselves.

 

There are 18 'phrases' making up the whole of El Camino, and by the end of today the company have moved through 11 of these. I am astounded. I cannot believe the progress they have made in such a short time.  

 

Monday 23 March

Today is my final day with the dancers before their big day later this week. I spend the morning with a film crew, being interviewed for the documentary that is being made of the project and then join the team in the studio. 

 

I watch, for the first time, the dance company perform the entire piece to music and whilst there is still work to do, the fine-tuning and timing of their movements has taken on a new feel. They are now looking professional and this continues to show not only in their movements inside the studio, but also in the confidence with which they conduct themselves outside.  

 

Though some are nervous about the performance in just a few days time, most seem to be greatly looking forward to getting on stage and have invited family and friends along to watch. I think about what this might mean for the dancers, to extend an invitation to others to witness them on stage, in a theatre. To have the tables turned in a sense.  For once, for it is them in control up there on stage, it is their dance, their expression, when so often the locus of control is taken away from people with mental illness. I think about the effects of just this act in itself, in terms of increased confidence and self-esteem.

 

Thursday 26 March

Today is the dancers big day. They have spent the last two days rehearsing on stage at the Shaw Theatre, where they will perform tonight. They have all had their costumes fitted, thought about carefully by the costume designer, to reflect each of their unique characters and dance styles.

 

I meet the team back stage in the dressing rooms, getting themselves ready. There is an incredible buzz in the air and a palpable and audible excitement. The males have had haircuts and they all look fine in their wonderful earthy colours that will soon be under the spotlight on stage. The females are all busily paying attention to the finer details of their costumes and looks. Smiles and grins meet smiles. 

 

The back-stage team usher us all to prepare to move upstairs and wait in the wings. Carly gathers the team together in a circle holding hands and inspiring last words are exchanged. Each participant is hugged before they move silently upstairs. Their families, friends and many important others are now in their seats in the audience, anticipating the show. The families, many of whom who have never witnessed their son or daughter, their mother or brother on any stage before. Never witnessed them under a spotlight, dancing, moving, expressing themselves with confidence. The audience is probably about 150 in total and this is the first time that a formal theatre space and stage has been utilised. It was felt in the pilot that this environment may lead to excess stress and so a smaller venue was chosen. This time, Carly and the team opted to take things to a new level, believing that it was entirely possible- and it was indeed. 

 

I experience something of what the dancers will in just a few moments, as Carly and I welcome the audience from the brightly lit stage. We take our seats, the lights come up and El Camino starts. I sit on the edge of my seat throughout the 20 minutes of the performance. I am inspired, amazed, moved and humbled and feel utterly privileged to be a part of this team. I look around to see people in the audience with tears in their eyes. It really is something to see. With the lights up, the vibrant colours of the costumes, and the pride and precision shown in the dance, it is a dynamic and impressive piece.

OASIS Solo Parts


"People with vast experience in dance are sincerely impressed by the high-end artistic quality of the performance."


The audience is stunned. I meet many of them in the foyer afterwards and hear only comments of amazement and interest in more of such work. I speak to commissioners, professional dancers, a politician, families of participants and others interested in dance as therapy. People with vast experience in dance are sincerely impressed by the high-end artistic quality of the performance. Mental health professionals state that they have had their own preconceptions challenged, and cannot believe the quality of the dancing and final performance. A mother of a male dancer states over and over in disbelief 'My son, he dances. My son, he dances.' She has never seen this before and cannot believe her eyes, crying with happiness, desperate for the video to take back to show her family, who she says, would never believe this.

 

A Panel discussion follows the performance and Carly, Ellen, myself and Jide enter into dialogue with audience members, along with some of the dancers. It is useful to engage in this discussion and there is much interest in further projects like this. The wider benefits and practicalities of integrating such work into mental health services are considered on political and practical levels.

 

Everyone leaves energised and inspired. It has been a great success. But the work does not stop here, for now, equally as important, is the on-going follow-up. The dance company will all meet tomorrow where each will be given their own individualised testimony from one of their dance teachers, which will be read out in front of their peers. This is a powerful and often emotional exercise, which encourages further reflection, now key to the on-going personal work of the individuals involved.

OASIS Dance Performance


"Jide leads a session looking in more detail at how the work done in the last 4 weeks may now be used and integrated into the dancers own lives."


 

Monday 30 March 

I meet with the team for a debrief meeting. I listen and contribute, as all aspects of the project are discussed, from beginning to end. We reflect upon what has gone well, the particular challenges this time around and what could be changed next time. It is a fascinating meeting, and again, I am surprised by the vast amount of thought and hard work that has gone into this project. 

 

The afternoon is spent with the dancers, and Jide leads a session looking in more detail at how the work done in the last 4 weeks may now be used and integrated into the dancers own lives. He focuses on their personal goals and thinks about how they may work to achieve their goals, utilising some of the skills they have learnt in the preceding weeks. 

 

The team will meet again tomorrow for further movement practice and are also all invited to join a weekly dance practice session at Morley College in South London. This shall be known as the Performance Company, and will lead into the next phase of the project in 2015. Dancers will also have the opportunity to become ambassadors in the next intervention and be involved with the recruitment phase alongside Elisa. This role will develop their own leadership and teamwork skills and provide them with first-hand experience of mentoring.

 

There is much focus now on this follow-up work, as it is recognised that after such an intensive 4-week period, there is a need to continue to contain those who have participated. The dancers will also all meet for reunions at regular intervals and shall watch the film of their performance together.

 

Outcome questionnaires are also collected from participants, to complement those filled out at the start of the project. Research data is being collected so that an evidence-base may be built up for this work, which is necessary in order for the intervention to be considered as an integrated part of mental health services in the future.

 

I am sad to leave the team at the end of the day, though thrilled to be a part of this and know that I shall continue to act as an advocate/ ambassador for this project. To move to a more embodied treatment model of mental illness in my view is important and I hope that services will consider incorporating such projects into mental health services routinely in the future.

 

Dr Lauren Gavaghan

 

Funders and Co-Production Partnerships:

This co-production project was made possible with funding from Guy’s & St Thomas’ Charity, Maudsley Charity and Arts Council England and with the support of South London and Maudsley NHS Foundation Trust Early Intervention in Psychosis Services and SLAM Arts Strategy. Optimity Matrix has led independent evaluation of the project and Dr Matthew Taylor of King’s College, London has acted as expert consultant.

 

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Re: The Alchemy Project: Dance
I wish to invite you and/or Gwen to speak at a symposium we are organising at Canterbury Christ Church University on 19th April at 12.30-4.30pm.
My e-mail is angela.pickard@canterbury.ac.uk
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  Dr Lauren Gavaghan
 


Dr Lauren Gavaghan is an ST5 Psychiatrist, currently working with OASIS, an Early Intervention in Psychosis Team, within South London and Maudsley NHS Foundation Trust.

She has a passion for movement and dance, and more recently, she has become interested in the value dance and movement have in mental health services, and how we may begin working in more embodied environments.

She is fascinated in the benefits movement may have for people experiencing mental health difficulties, particularly psychosis.

She has begun training in the Open Dialogue approach and is keen to explore different ways of treating mental illness. These interests led her to join The Alchemy Project 2015 for one day each week, where she has participated alongside clients and the team and acts as an enthusiastic advocate of the work.

If you would like to contribute to the Blog Zone series, please email an outline of your blog to: jburnside@rcpsych.ac.uk