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Winston Churchill Memorial Trust Report 2010
“Developing embodied communications in dementia care”
Dr Richard Coaten
Dance Movement Psychotherapist & Churchill Fellow 2010
Experiential Workshop at the Reitman Centre, Toronto
20th September 2010
“We must all be willing to redefine our role in society, seeking new structures and not clinging to the past, but recognizing that the artist is part visionary, part
showman, part educator and part trouble-maker” Adrian Noble, Artistic Director, Royal Shakespeare Company (Observer, 2/1/2000)
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Introduction This report details the main aspects of a month long trip to Canada between September 11th and October 10th, in both Toronto and Vancouver, and a trip to a major arts and health conference in Penticton in the Rockies. It covers what took place and why, some of the people met, the organisations visited including benefits/recommendations for my own community on return. I would like to give everyone I met a mention here however that is not feasible unfortunately. The purpose was to enable me to better understand the use of movement, dance and embodied practices in the care and treatment of people with dementia and their ‘care-givers’ in Canada, bringing lessons learnt back here. This involved a strategy of meeting and shadowing key players in the field in both Toronto and Vancouver and using their connections and local knowledge to extend my original plans. This quest for skills and knowledge was coupled with my intention to disseminate my recently completed doctoral researches through talks and workshops. In brief I work for the South West Yorkshire Partnership NHS Foundation Trust as a Dance Movement Psychotherapist running a Dance Movement Psychotherapy Service in Calderdale. The role involves using movement, dance, music, song and reminiscence techniques to help older people with mental health problems maintain their skills and abilities for as long as possible. The work also helps foster relationships and aims to enable people to continue to live as independently as possible in their own homes.
I would like to thank all those at the WCMT and my colleagues at SWYPFT for giving me an extraordinarily rich opportunity to further develop my work and researches; building new friendships in Canada: extending my knowledge and understanding of the importance of international dialogue, and opening up new career development opportunities. Since returning I have had some very affirming emails, asking if people I met and worked with can come and train with me here in the UK. Surprisingly, during the trip I gradually discovered that through the meetings and 11 workshop/presentations I gave (sharing my work with over 210 participants) what I brought was very new, and I could find little evidence* of movement and dance work happening in Canada with people living with dementia. This meant that the purpose of the Fellowship shifted while there to a focus on dissemination of my own work and researches, which attracted real interest, in part I think, because of its innovative nature.
* This does not mean that it is not happening in Canada, just that I could find little evidence of it unfortunately.
“The multimodal work you shared with us at the conference in Penticton has ignited a desire in us to study your work on a deeper level. Your research and its outcomes resonated with us to our core. We find it imperative to study your research and practices on a deeper level before we can begin to integrate these processes into the broader culture here. Your work resulted in improved well-being, more meaningful and emotionally congruent relationships that were built non-verbally by way of the body, and this is something we want to understand, witness and internalize under your mentoring”. Marti, Pat & Geoff (Portland, Oregon)
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Itinerary
The actual timetable is included below because it contains the details of all that I did, that may in future prove useful to Fellows planning their own travels in relation to the same or similar subject area.
Dr R Coaten Actual Timetable Winston Churchill Fellowship
2010
Date Day AM PM Travel Mode 11th Sept 2010
Saturday Travel Huddersfield to Manchester 11.16am (arr. 12.12pm) to Toronto Dep.; 15:45
Arrive 18:30 settle in accomm in ‘Annex Guest House’ Annex neighbourhood/downtown
Thomas Cook Airlines
12th Sept Sunday Settling-‐in recovery from jet lag etc
13th Sept Monday Getting bearings etc 14th Sept Tuesday 12pm Meet Music
Therapist Amy Cortes @ Baycrest Care Facility
Visit Toronto Museum – View Photographic Exhibition by Dr Mark Nowaczynski founder of ‘House Calls’ Project 1998
Bicycle Hire
15th Sept Wednesday 12.15pm to 1.30pm Meet Amy Cortes @ Baycrest Care Facility
2pm to 3pm Meet Neuroscientist Dr Takako Fujioka @ Rotman Brain Research Centre/Baycrest
Bicycle Hire
16th Sept
Thursday 9am-‐10am Meet Team & tour centre.10.15am Meet Molyn Leszcz, Chief Psychiatrist/Toronto City 11am Further Meets with Team till 12pm Cyril & Joel Reitman Centre/ Mt Sinai Hospital Meet Julia Gray/Catlin Agla
2.30pm Meet Prof Stephen Katz in café downtown. 416-‐493-‐5838 (remember to call him)
Bicycle Hire
17th Sept
Friday Visiting Bay Crest Day Care Facility – Meet Faith Malach Day Care Director & tour centre
18th Sept
Saturday Day Off
19th Sept Sunday Day off/sightseeing in Toronto
20th Sept Monday
3hr Presentation at Reitman Centre (Mt Sinai Hospital, 60 Murray Street, Room L1-‐012) 1-‐4pm
Educational/community focus, talk to include carers. Nos =15
21st Sept Tuesday 3hr Presentation at Reitman Centre (Mt Sinai Hospital) 9am to 12pm
1pm to 3.30pm Attend Reitman Centre Caregiver support session. Staff = Jenny Carr OT & Christina
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Staff professional development focus inc. academic/clinical staff . Nos =8
Dashko Chaplain (I contribute to session practically)
22nd Sept Wednesday (Eileen depart 07.49am)
1pm Meet Dr Pia kontos, Research Scientist at Toronto Rehab Institute (lunch together & meeting)
Toronto Rehabilitation Institute 3-‐4pm talk (Clinical/research staff focus) Lecture Theatre-‐University Centre, 550 University Ave. Nos = 20
23rd Sept Thursday 10.30am to 12pm Shadowing Pia Kontos at Toronto Rehab Institute
3pm to 4pm Attend staff meet at Reitman Centre to discuss my work & approach in more detail.
End of Bicycle Hire
24th Sept* (Amy Birthday)
Friday Trip to Niagara Falls/’Maid of the Mist’ boat trip
Day off today Hire Car
25th Sept Saturday Travel to Vancouver 12:00hrs
Arrive Vancouver: 14:02hrs Settle in accommodation Vintage Executive Hotel, Howe Street
AIR
26th Sept Sunday Settling in Vancouver day Sightseeing. Visit Vancouver Aquarium
27th Sept Monday ‘Round table discussion’-‐ Doug Durand etc. Scotiabank Dance Centre Meet Jill Marcuse etc (Nos 25) 09.30am to 12.30pm (Board Room) 677 Davie Street, Vancouver Nos= 17
28th Sept Tuesday 10am Meet Dr Alison Phinney & staff at Centre for Research on Personhood in Dementia. 1.30pm Meet Jeff Small also from CRPD
4-‐5.30pm Centre for Research on Personhood in Dementia 45/50 mins talk good mix of people. Talk – knowledge translation talk. Nos = 18
29th Sept Wednesday 10am Meet Claudia Jacova Neuroscientist –University of British Columbia Brain Research Centre – researching use of (f)MRI scanning on music therapy & dementia patients
Travel to Okanagan Valley Stay Penticton (Venue & Accomm: Lakeside Resort Hotel)
Avis Car Hire Pick-‐up 12pm
30th Sept Thursday Attend Pre-‐Conference CECD Conf. CAR
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Workshops (Songwriting Wksop all morning Judith Kate-‐Friedman
David Barnet / Drama & Storytelling Wkshop all afternoon (Venue & Accomm: Lakeside Resort Hotel)
1st Oct Friday Attend CECD Conference Penticton (present researches/
CAR
2nd Oct Saturday Attend CECD Conference Present researches etc RC presenting today 4.10pm to 5pm Member of expert panel to take questions
3rd Oct Sunday Visit Kelowna with Kay Wells another Churchill Fellow
Sightseeing Kelowna & walk (Accomm: Lakeside Resort Hotel last night)
CAR
4th Oct Monday Travel to Kamloops (3hrs)
Meet Wendy Hulko & Gwen McArthur Aboriginal Cultural Education Co-‐ordinator. 3-‐4.30pm Exp. Wkshop Nos =14
CARAccommodated Thompson Rivers University
5th Oct Tuesday Return to Vancouver Follow up links made at conference
Car Hire return 1.30pm
6th Oct Wednesday Visit Granville Island 1pm Afternoon spent with Alison Phinney at UBC Dinner at her house
7th Oct Thursday Visit Vancouver Anthropology Museum (all day)
8th Oct Friday Morning spent with Alison Phinney meeting at the Roundhouse and looking at her researches/powerpoint presentation
As follow-‐up to Scotiabank Dance Centre Round-‐Table Discussion (27th Sept) I gave a further experiential workshop. Nos=12 1.30-‐4.30pm
9th Oct Saturday Dept Vancouver 17:25hrs AIR 10th Oct Sunday Arrive Manchester
10:45hrs
Highlights in Toronto
I discovered a new and more fully rounded approach to support for carers of people living with dementia
in the form of the ‘Cyril & Dorothy, Joel & Jill Reitman Centre for Alzheimer’s Support and
Training’ (www.caregiverMSH.com) based at Mt Sinai Hospital. A privately funded service for
caregivers it includes a fully integrated, comprehensive dementia care program that introduces the
innovative use of standardised patients - actors trained to simulate real-life situations - so that caregivers,
guided by expert clinical coaches, learn how to deal with common challenging situations. The goal is to
enable family caregivers to support their loved ones' ability to successfully age at home as they cope with
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the condition. The staff team ably led by Director Dr Joel Sadavoy, were so generous with their time in
sharing their work and approach, and Catlin Agla arranged a really valuable timetable for my visit. I was
particularly interested in their use of drama techniques, including the use of Video Tape Recording of
sessions with caregivers taking a good look at their coping strategies, and learning in the process how to
develop new ones. I gave several workshops, one with a community focus and the other for clinicians
and left inspired to bring what I had learnt back to the UK. I hope that in future the team builds on their
innovative approaches using the arts, extending the scope and range of their use; which would make their
work quite unique and eminently researchable. I acknowledge their kindness, their generosity and team
spirit and wish them well in their future endeavours with caregivers, currently a high-priority here in the
UK. Their service was much more psychotherapeutically oriented to any I have previously seen in the
UK, and on return I have been disseminating these findings at talks and conference presentations, and
also in meetings with senior staff at my NHS Trust. In response to all the meetings and discussions I had
with my Canadian colleagues I have set-up a database and send articles, relevant papers and information
about the UK dance and dementia community to them all on a regular basis which they can opt-out of at
any time; this helps keep open channels of communication maintaining international relationships with
new friends and colleagues there.
The dream team (some of) at the Reitman Centre 16/9/10. From l-R. Marci, LJ, Ann-Marie, Teshome, Jenny, Catlin & Joel
Note the biscuits…superb!
Other highlights –
I have become personally and professionally more confident by way of giving presentations, talks and
workshops to different groups in different settings, becoming more imaginative and creative in style,
content and delivery; a real breakthrough for me. I also learnt to present my work more sensorially,
adapting my material on the basis that embodied practices are best understood through presentation in
experiential and embodied ways; otherwise these can remain as cognitive experiences only, and thus not
as long-lasting and interesting as they might otherwise be.
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The Fellowship has given me a better working knowledge and understanding of where Canada sits in
relation to the development of embodied practices. The two main experts I met (Dr Pia Kontos (Toronto)
& Dr Alison Phinney (Vancouver)) were most helpful in sharing their insights and knowledge and in
facilitating the development of my Fellowship; the third, Professor Katz from Toronto, has inspired
further academic development for me in relation to a whole genre of critical gerontology in the social
sciences, about which I was unaware. I was really pleased to meet staff at the Baycrest Facility
particularly music therapist Amy Clements-Cortes and Faith Malach, Director of the social based day
care programme. The facility is an all encompassing approach to living independently, coupled with
provision of incremental support as care needs increase, including access to on-site hospital care if
needed; similar in concept to one’s in the UK run, for example, by Extra-Care Charitable Trust in
Birmingham. Baycrest also houses the Rotman Brain Research Centre, where quite fortuitously I was
able to meet Dr Takako Fujioka a brain researcher doing remarkable work on music and the brain that
was very relevant to my own researches. I consider that the purpose of the Fellowship has been fully
achieved, in relation to my own personal and professional development; in relation to what it gave to
colleagues in Canada and the US (Portland): and in relation to its potential for making a difference to my
life and on-going work in the UK.
Highlights in Vancouver & the Rockies
Meeting and dancing with artists, dancers and creative practitioner’s from the arts and health field in British Columbia was a real highlight. In Toronto area I had met a range of social scientists, academics and clinicians while in Vancouver and the Rockies this was counter-balanced for me with a great deal more contact with artists and dancers, which was very different and valuable. Thanks to much co-ordination on the part of BC Cultural Planner Doug Durand, who was able to bring together a wide cross-section of artists, dancer’s, administrator’s; we had a really fruitful Round-Table discussion at Scotiabank Dance Centre concerning, amongst many other things, how to improve the care of seniors using arts based activities. Following this, a suggestion was made by my wife Mary to try and offer a
Dear Richard, We sincerely thank you for all the knowledge, technique and joy you have brought to the Reitman Centre, our clients, and the larger Mount Sinai Hospital Community. Your dedication, and passion are inspiring and we have so appreciated the opportunity to learn and share with you…and please keep in touch. The Reitman Team
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practical and experiential session for this community and anyone else interested. Mirna Zagar, Director of the Vancouver Dance Centre thought this a great idea and was instrumental, not only in setting this up at short notice, but also in helping us find accommodation for the latter part of our stay in Vancouver having returned from the Penticton Conference. Meeting staff at the Centre for Research on Personhood and Dementia at the University of British Columbia was also a highlight, as was giving a talk there, that resulted in more very affirming and moving feedback from a participant who came and emailed me this later:
“Firstly, I enjoyed your ease with people, finding your way very welcoming and immediately engaging.
I loved the way you demonstrated how to enroll people of all ages with the simple movements of hands
or ankles. You made everyone feel ‘at home’ with your topic and one another. I am not a student at
the University (of BC)…So I don’t come with an academic interest purely a compassionate one out of
an avid interest in my mother’s Alzheimer condition…Movement is one way to connect with those
struggling to be seen and heard as unique and special even in their differences. The short film clip you
chose demonstrated how responsive some are to simple felt connections. I liked the way you led us to
experience how the senses of hearing, smell and taste illicit memory. As I recalled my mother helping
me clean a basket of dried rosemary, I could feel her wellbeing in remembering a childhood holiday
spot and the warmth of the summer sunshine. For me it was important to check how I am
communicating and create spaciousness for my mother to feel valued and seen…Thanks for your time
here and for responding to my requests to Rodin’s hands. All the best to you, Barb Quinn”.
I took every opportunity to meet with people who came recommended by those I was meeting or working with at the time, and to offer opportunities to slot in additional experiential movement and dance based workshops, at the Vancouver Dance Centre for example (see pic below).
Workshop Vancouver Dance Center 8/10/10
This very successful workshop was more experiential and embodied, keeping it in the realm from which it evolved. This was one of my main learning points in relation to understanding the impact of my
Experiential workshop for dancers, and those interested in using movement and dance with people with dementia. Vancouver Dance Centre 8/10/10
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travels. When disseminating the nature of embodied practices, endeavour to stay as close as possible to the embodied realm (experiential and practical) rather than the disembodied (chalk and talk/powerpoint).
Penticton Conference (30/9 to 2/10) Meeting so many arts and health practitioner’s with a special interest in dementia was very special indeed
and the presentation I gave at the conference was very well received.
“Richard Coaten’s dedication to his craft and the engaging way he conveys his message makes the performance arts accessible to all. Richard’s workshop and comments during the 5th International Conference on Health, Aging and the Creative Arts in Penticton Canada, gave practical demonstration of the limitless possibilities of dance and movement for those living with dementia and further indicates the value and application of a person-centred approach to dementia care”. Julie Gross McAdam MAC.ART Program Director (www.macart.com.au)
Following a presentation of the work of visual artist Jeff Nachtigall, he kindly sent me a copy of the
DVD of his work by the National Film Board of Canada as artist-in-residence at Sherbrooke
Community Centre, a long-term care facility in Saskatoon. The film documents the importance of the
arts and of a care-culture called the ‘Eden Alternative’, or ‘Human-Habitat Model’, which is attracting
significant interest in the care home sector in the UK, where several are already using it. My intention is
to show this 56 minute film in May/June to a specially convened arts and health audience in Stoke-on-
Trent, introducing it and the artist’s work; this followed with an audience discussion about the
implications for care practice in the UK (date TBA). I am also looking at ways of making and singing
newly composed songs in my sessions, in addition to one’s older people are familiar with, as a result of
innovative singing workshops in Penticton with vocalist/songwriter Judith-Kate Friedman
(www.songwritingworks.org).
(Halifax Courier 29/10/10) Travelling on from Penticton to Kamloops to meet Dr Wendy Hulko of Thompson Rivers University and
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Gwen McArthur, Aboriginal Cultural Educational Co-ordinator at Kamloops Hospital was a real treat.
Both are experts in working with traditionally marginalised groups and First Nations elders with
dementia in particular. Of special note I have just found out that in April 2011, Wendy and colleague
Elisabeth Antifeau have been awarded a significant grant to research the experience of First Nations
elders in relation to dementia and how they experience it; this is excellent news. Wendy had organised a
workshop for me at the University and on arrival my family and I were drummed and sung onto the
territory by a Secwepemc family. This was unforgettable for us, as was learning from the elders
afterwards, that dementia for them is about ‘soul-loss’; in response they help to enable ‘soul-return’ by
traditional means using singing, chanting and drumming, invoking spiritual power in the process. Both
Wendy and Gwen are experts in working with aboriginal communities and in learning from them their
traditional ways of life and sustaining values and beliefs. Gwen’s work in the hospital setting helps
mediate the experience of First Nations people when they come into hospital for treatment. This has
value for us in the UK in learning how best, for example, to support BME communities and asylum
seekers in navigating the increasingly complex bureaucracy surrounding the benefits system.
Gwen McArthur in front of 1860 pic of several chiefs from the interior at New Westminster BC
Kamloops Hospital 4/10/10
Dissemination and development
Press releases and blog A number of press releases have been produced and published, one of which appeared above in our local
Halifax Courier and another in the Newsletter ‘Emotion’ Winter 2010 (VolXX No4 p5-6) of the
Association of Dance Movement Psychotherapy UK (http://www.admt.org.uk/). WCMT press office and
my own NHS Trust worked collaboratively to issue a joint press release, which was published in my
Trust’s in-house staff newsletters. I managed to set up a blog for the purposes of people being able to
view what was taking place during my trip. This can still be viewed on
http://dancingdoctorstrip.blogspot.com
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Conferences
I have been able to present my findings briefly at the ‘5th UK Dementia Congress in Bournemouth’
(9th/11th November), where I was responsible for chairing two different sessions: one on ‘Dance and
Movement’ and the other on ‘Creativity and the Arts’. It was a big national and international conference
with over 800 delegates from all sectors of the dementia care field. I have also helped organise
‘Memory: 1st National Conference on Dance & Dementia’ at the Bluecoat Arts Centre in Liverpool
(10th and 11th December), where I was also a keynote speaker on Day 1. As a direct result of attending
the Penticton Conference I realised that in helping organise Liverpool we needed to invite Dr Julia Clark,
a Clinical Neuropsychologist from Scotland (who also came to Penticton), to give her presentation to the
dance and dementia community here in the UK. Dr Clark’s talk was a keynote at the Conference on Day
2 and came as a direct result of meeting her in Penticton.
Key-note at Liverpool 10th December
Publications Robert Mundle, a priest at the Toronto Rehabilitation Institute, (Mount Sinai Hospital) attended my
talk there on 22nd Sept and got in touch via email on my return. Having been introduced to my work and
researches in Toronto, and following my talk, he downloaded a copy of my thesis and via email asked if
he could use examples of my work in relation to his own up-and-coming publication (“The spiritual
strength story in end of life care: two case studies in Palliative and Supportive Care Journal, Dec. 9(4), in
press). I am delighted about this development and have circulated his proposed paper to my UK based
colleagues, currently working spiritually with people with dementia. I am also working up another paper
with a newly qualified Dance Movement Psychotherapist (who attended the Liverpool Conference) about
enabling knowledge and skills transfer from our own profession, to the important dementia care sector,
‘I found Richard particularly memorable, because of his willingness to be completely open in a forum where people would expect people to communicate from behind a paper and lectern’ Conference Delegate
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where our embodied skills and knowledge could really help make a positive difference to people living
with the condition. I have had published in April 2011 a 2 page article in ‘Animated, the Community
Dance Magazine’, called ‘Going by way of the body in dementia care…’. It details important aspects of
what was achieved at the Liverpool Conference and follows developments in my own thinking and
practice following my Canadian experience.
Finally…
And most significantly, the Fellowship has given me the drive and commitment to pursue setting up a
‘Centre of Excellence for Movement, Dance & Dementia’ (title to be confirmed), here in West
Yorkshire and in partnership with my NHS Trust. This proposal has now (April 2011) passed a crucial
first hurdle, and with good support for it locally, I am quietly confident that this idea will convince senior
managers that the business case is sound, and it can move forward to become a reality. From an
international perspective it would aim to attract Canadian, US and others from around the world, all
interested in improving the quality of life for people with dementia and their carers (professional and
lay); using music, movement, song, dance and reminiscence. This is in part a response to the moving
comments by Marti, Pat & Geoff on p.2 of this report that they would travel from Portland, Oregon to
train with me over here in the settings where I work. Initially it was their idea to invite me to Portland to
train them, however this plan has changed to them being invited to come to West Yorkshire. This
followed much debate with my colleagues, as the training is best located and ‘embodied’ here in the
settings where it is best understood in this UK context. It would be up to international visitors to do the
transposing back to their own settings and cultures. The plan would also aim to meet the need for dancers
and artists based here, to have a place for specialist training in this most rewarding of work. The
Fellowship has given me the impetus to pursue this idea and I am really looking forward to developing
what promises to be a significant career development, and an important contribution to improving quality
of life for those living with dementia and their carers here in the UK and abroad.
I await with interest to learn from Dr Phinney, how her researches go into the uses a local care-home has
made of the ‘Portrait of a Life’ multi-media pack which supports individuals, family carers and care staff
to undertake Life-Story work. I took this to her as an example of good practice asking her to review it.
A mask at the Vancouver Museum of Anthropology (http://www.moa.ubc.ca/collection-online/search) and a
special reminder of the extraordinary trip I had…