A Different Kind of Movement Therapy
Dr. Rivi Har-El is a physical therapist with a doctorate in physical therapy and pathokinesiology in private practice in Manhattan. She has also studied psychology extensively. She estimates that 50 to 60 percent of her patients have fibromyalgia. In her private practice, Dr. Har-El often utilizes a special movement therapy program, in conjunction with music and guided imagery, to treat her patients. She recently took some time to answer questions about her unique treatment methodology.
Q. How did you develop your movement therapy program?
A. When I entered the New York University doctoral program, I did two pilot studies. They were unsuccessful because they didn’t lead me where I wanted to be. But then I did a third pilot study, leading me to where I actually did my Ph.D. about: how to treat chronic pain using physical therapy and movement therapy. I took many subjects who had chronic neck pain and let them participate in physical therapy versus movement therapy.
Q. How do you start out treating a patient?
A. What I think I’m doing very different than many, many other physical therapists is when I’m putting my hands on the person, it’s not for five to 10 minutes. I spend a lot of time with hands-on techniques with the FM patient. They have pain all over the body, so I really spend time trying to go from one area to another. I really concentrate on the entire body, and it takes time. I can’t spend just five minutes with them. They lie down and I’ll treat them. It’s more conventional physical therapy—even though it’s not so conventional.
Q. How do patients respond to that?
A. Many of them are telling me, "You are my psychologist. I prefer to talk to you when you’re treating me, because you’re not so intrusive; if I want to be quiet, I’m quiet, if I want to spill something out, I do so." I listen to the body; listening is really being sensitive to the soft tissue in the joint. At the same time I’m looking at the body language, the facial expressions. It’s very, very holistic in nature.
Q. And how do your sessions continue?
A. The second part is movement therapy, a form of intervention that uses movement rather than words as the primary medium for assessment, insight, and change. I try to incorporate looking at them in the session—how they move, what are their physical movement patterns. That tells me a little bit about them—why a person holds their neck in that particular way, for instance. I put music on if they respond well to music. We start doing very, very basic things just to warm them up. As the session develops, we really start to connect between events, traumas, motion, frustration, and their body. We have to find a way of closure. We can talk about it, or we can move. A person may cry and we have to talk about it. It’s very, very individual.
Q. How do patients respond to the movement therapy?
A. Some people respond really well to music; they’re moving, they’re enjoying themselves. One of the wonderful things in movement therapy is you allow them to have a sense of pleasure in a painful body. It really brings a sense of indulgence that they are liking because they’re oftentimes in so much pain.
I’ve had some people who could not really breathe—could not expend their ribcage and chest, had no movement in the neck, suffered from chronic neck pain. Something is deeper there. They cannot really feel the sense of themselves. Something is choking them from inside. My task was to be able to go to this core of the pain that choked them from inside, to feel their presence, to feel that they are there.
As treatment progressed, one patient revealed a lot of deep stuff about the relationship of the father and the mother; the father left the family when the children were really young. She felt nobody really wanted her and tried to make herself disappear. We were able to connect between external stimulus and what’s happening in her body. There was a connection between the therapy and how the body responded.
Q. How do you suggest people who don’t live in Manhattan find a practitioner who offers a treatment similar to yours?
A. Look for somebody who can touch and talk. You have to ask around and look around. Movement therapy in groups is being done in some settings in hospitals and psychiatric places.
