Psychomotor Therapy

Concept and Definition of Psychomotor Therapy – Kinesiotherapy

Hátlová (2003) used the term kinesiotherapy in the Czech Republic to describe a newly emerging field of therapy carried out through actively performed, intentional movement, leading to a somato-psychological influence on the individual—their mental processes and states, personality, and relationships. Since 2007, the Czech Republic has been a member of the European association “Physiotherapy in Psychiatry and Mental Health” and adopted the term psychomotor therapy for kinesiotherapy. This somatotherapeutic activity works with structured, purposefully targeted movement programs that use elements of physical exercises, sports, and movement games. The aim is to contribute to the reduction or elimination of psychological and psychosomatic difficulties, or their causes.

Psychomotor therapy seeks to gain access to the patient through movement and, via personal experience, influence their psyche in the sense of becoming aware of their own psychosomatic “self” and its possibilities. The purpose is to lead the individual to work on themselves, help them discover ways of approaching their problems, and give them space to find these pathways on their own. In this way, the individual’s activity is stimulated. Nonverbal elements are emphasized, and the need for verbal communication is gradually evoked (Hátlová, 2003).

Psychomotor-therapeutic programs model situations in which the patient tests and develops abilities that can later be transferred to other areas of life. Depending on the patient’s difficulties, the programs focus on self-perception, awareness of one’s functions, and the possibility of regulating them. In this way, they contribute to changes in the patient’s experience and behavior and, through gaining a new perspective on the experienced problem, shape the awareness that it is possible to cope with it. The aim is to help the patient regain awareness of their “own mobility,” psychosomatic unity, restore positive self-acceptance, integrity, emotional spontaneity, creativity, bodily symbolism, and communication skills (Hátlová, 2003). At the beginning, modeled situations may be perceived as unmanageable. Under the therapist’s guidance, the patient is led to overcome fears of failure, gradually tests their possibilities and competence, and learns to use—and later develop—internal and external coping resources, thereby increasing self-regulation. In this way, through testing and growing trust in their own abilities, patients’ self-confidence can be developed, as well as mutual trust and communication with others in modeled situations whose solutions require cooperation and communication.

Psychomotor therapy is inspired by psychotherapeutic approaches based on learning and behavioral therapies.

Effects of Psychomotor Therapy

Psychomotor therapy is a somatotherapeutic activity that helps patients rediscover awareness of mobility, psychosomatic unity (the unity of body and mind), renewal of positive self-acceptance and integrity, bodily symbolism, emotional spontaneity, creativity, sociability, and communication.

Awareness of Mobility

This involves awareness of one’s own body, its possibilities, and subsequently the possibility of controlling one’s own body. It deepens the positive experience of actively perceiving body parts in positions and in movement and perceiving one’s own contribution to change.

Psychosomatic Unity

Movement is one of the connecting links between the inner and outer world. Intentional, actively performed movement is simultaneously a physical and psychological activity and a means through which both body and psyche are expressed.

Restoration of Positive Self-Acceptance

An objective body image and its expression often differ from a person’s subjective body image. The subjective image is formed on the basis of one’s own experience with the internal and external environment, including interpersonal relationships, which may not be realistic in mental disorders. To restructure self-image toward more positive acceptance, it is necessary to choose exercises of appropriate difficulty that enable the patient to experience bodily changes caused by their own will. Excessively difficult exercises could activate defensive mechanisms.

Self-Acceptance and Integrity

During physical exercises, the patient is guided to become aware of their own body, its positions, the course of movement, the effect of their own movement expression, and its meaning. (The process of building autonomy is especially important in psychotic patients.)

Bodily Symbolism

Movement and body postures have symbolic meaning. Therefore, it is possible to express oneself through movement (used especially in dance therapy).

Emotional Spontaneity

Due to life circumstances, patients are often forced to suppress the expression of emotions connected to the need to express their needs and wishes. Movement programs initiate the release of emotional expression and behavioral spontaneity. The aim is to experience release and a positive experience of one’s own relaxation. Therefore, during movement, the patient is not restricted, and in many programs emotional expression is initiated and understood as an appropriate part of self-expression.

Creativity

Movement activities, through their course, intentionally initiate spontaneity and creativity.

Sociability

The patient is guided to become aware of their own movements, the movements of others, and how they themselves are perceived. Perceiving one’s own movements and those of others enables not only confrontation but also stimulates intentional self-regulation of one’s own movements.

Communication

We start from the assumption that contact is more easily established through nonverbal communication. Movement serves as the means of communication. Nonverbal communication creates situations for the emergence of verbal communication.

Forms of Psychomotor Therapy in the Treatment of Psychiatric Patients

Supportive therapies, among which psychomotor therapy belongs, lead patients to gain greater self-confidence. Psychomotor therapy creates programs that model situations in which the patient tests and develops abilities that are subsequently transferred to other areas of life. Depending on the patient’s difficulties, movement programs focus on self-perception, awareness of one’s functions and the possibility of regulating them, on developing self-confidence by testing one’s own strength (exercises involving overcoming non-traditional obstacles; exercises can be modeled in natural environments as well as indoors), and on developing mutual trust and communication (modeling situations whose solutions require cooperation and communication).

Psychomotor therapy always maintains conditions for establishing a trustworthy relationship with the therapist, a non-threatening environment, and an appropriate physical and psychological load that gradually increases toward the upper limit of manageability. This approach stimulates the patient’s active attitude: they test their own strength and shift the boundaries of their perceived possibilities and competence. These forms of psychomotor therapy are created and modeled with regard to the patient’s impairment and current psychosomatic state. The possibilities of psychomotor therapy are designed to influence pre-selected components of personality.

Approaches in Psychomotor Therapy

The forms of psychomotor therapy used by us are based on the following approaches: integratively oriented psychomotor therapy, activating programs, actively relaxing programs, concentratively oriented psychomotor therapy, programs increasing self-confidence and trust in others, communicative programs, and the therapeutic use of sports exercises.

Integratively Oriented Psychomotor Therapy

Integratively oriented psychomotor therapy works with healthy parts of the personality so that, through experiencing one’s own body schema as an indivisible unity, it becomes possible to anchor the self in the external world. It uses simple gymnastic movements and postures. The patient is guided to continual awareness of their body, its wholeness and its parts, and the position of body parts relative to each other and in space. It requires active cooperation from the patient. Emphasis is placed on the quality of execution and self-control. The most significant aspect is considered to be the experience of wholeness. Later, emphasis is placed on feeling individual body parts at rest and in motion, the ability to choose and control body parts, and later the whole body. Awareness of one’s body schema can reduce the degree of disintegration.

Activating Programs

Activating programs of psychomotor therapy focus on initiating cognitive processes and motor skills. The programs use manipulative exercises, elements of sports, and dance elements that restore and develop patients’ movement capacities. Emphasis is placed on precision in performing the movement structure and on a positive experience of mastering the motor skill.

Actively Relaxing Programs

Actively relaxing programs of psychomotor therapy focus on initiating cognitive and emotional processes. The programs use gymnastic exercises, dance and expressive sequences, and elements of sports. The exercises are easily manageable and do not demand performance. The aim is to induce a positive experience of oneself and the release of tension (in a psychoanalytic approach, which can be used in a certain period of treatment in neurotic patients, people with addictions, and patients with behavioral disorders, tension may also increase). Healthy parts of the personality are supported so that self-esteem and trust in the environment and in the possibility of experiencing pleasant and joyful feelings are encouraged and strengthened. Emphasis is placed on positive emotional experience; precision of the movement structure is not essential.

Concentratively Oriented Psychomotor Therapy

Concentratively oriented psychomotor therapy leads to conscious monitoring of the performed movement and its effects and regulates breathing and muscle tone. It is based on findings about the existence of mutual relationships between psychological and motor activity and the possibility of mutual influence. It uses gymnastic exercises, relaxation and breathing exercises, and elements of hatha yoga. It requires active cooperation from the patient. Emphasis is placed on the quality of execution, experiencing one’s own movement, and self-control.

Programs Increasing Self-Confidence and Trust in Others

These programs focus on initiating cognitive and volitional processes. By performing modeled exercises using elements of sports and games, individuals test their abilities and possibilities. The exercises take place in small groups and are modeled with regard to the patient’s physical and psychological possibilities. Their difficulty gradually increases. The content is modeled according to the needs of testing or training skills. Emphasis is placed on completing the task.

Communicative Programs

Communicative programs are based on the assumption that contact is more easily established through nonverbal communication. They focus on the social dimension, the perception of participation and cooperation, and the initiation of cognitive and communicative processes. They use elements of games and outdoor activities. Emphasis is placed on experiencing participation and accepting the surroundings.

Therapeutic Use of Sports Exercises

The therapeutic use of sports exercises includes sports games, gymnastic and dance exercises, martial arts, and strength-training routines. Sport-oriented exercises use rules that must be followed during performance. Emphasis is placed on precise adherence to commands and prohibitions in order to become aware of order as a source of certainty. The patient is also guided toward possibilities for their own creative approach in solving game situations and movement tasks. These programs are especially suitable for long-term hospitalizations. For men, we recommend performance-motivated sports activities; for women, exercises with music, dance forms, and also performance-motivated sports activities.

Principles of Leading Psychomotor Therapy for People with Mental Illness

The purpose of psychomotor therapy is to lead a person to work on themselves, help them discover ways of approaching their problems, and leave them space to find these pathways on their own. When creating a positive, cooperation-based relationship, the therapist should pay attention to what the patient expects from therapy, what their previous experience with therapy has been, and should familiarize the patient with the course of the therapy. Another aspect is the therapist’s ability to take an empathic stance toward the patient’s experiences. The therapist’s style is considered a significant factor. The therapist’s approach can be decisive in whether the client chooses resistance or change; Rogers (1971) concluded that the helping person is a central factor that determines whether the relationship will support or inhibit.

Working with people with mental illness places increased demands on the therapist. It requires careful preparation, both theoretical and practical. The therapist must be prepared to cope with an unusual environment, learn to manage their own reactions to unusual ways of thinking and behavior caused by illness, appropriately choose methods and aids so they can be used in the given environment, and ensure that possibilities of adverse influence are excluded. It is necessary to be prepared for the likelihood of unexpected situations and to be able to address them appropriately.

The task of psychomotor therapy is to ensure a targeted, safe, and comprehensible movement program corresponding to the patient’s current psychosomatic state and developing their psychological capacities in the desired direction. All other therapeutic activities are left to other professionals. When creating movement programs, we pay particular attention to building on previous positive experience with movement activity, ensuring appropriate psychological and physical demands, and considering the possibilities of the environment in which the exercises take place. Assigning a patient to individual psychomotor therapies must respect the patient’s personality, current mental state, previous experience, and motivation to exercise.

References

Hátlová, B. Kinesiotherapy: Movement Exercises in the Treatment of Mental Disorders. Prague: Karolinum, 2003. ISBN 80-246-0420-5.
Hátlová, B., Adámková, M. Psychomotor therapy. In: Kolář, P. et al. Rehabilitation in Clinical Practice. Galén, 2010. ISBN 978-80-7262-657-1.
Rogers, C. R. On Becoming a Person. Constable, London, 1971.