“The goal of therapy is not to therapise the ADHD away”
Summary:
This article critiques current approaches to psychomotor interventions for ADHD and autism, arguing that they focus on behaviour and deficits at the expense of inner experience.
It highlights risks of harm in attempts to define and assess "normal" movement, drawing on personal experience to call for more reflective and inclusive therapeutic practice and training.
“The goal of therapy is not to therapise the ADHD away” … thus began the lecture on ‘psychomotor interventions for ADHD’ at the university where I was studying.
So why, I wondered, were the interventions proposed appear to be doing the exact opposite?
Why did study materials present pathologised, deficit-oriented conceptions of autism and ADHD?
Why were goals framed uniquely in terms of externalised behaviour (“restraining impulsivity”, “teaching social skills”, “promoting rule adherence” and so on)?
Why was there no focus on the inner world and experience of children and young people?
Why was no-one commenting on the privilege and ableism inherent in normative motor function tests and skills interventions premised on the concept of a ‘normal’ and ‘correct’ body?
Why was no-one talking about the fact that a focus on acquiring specific, pre-defined movement competencies could unintentionally reinforce harmful inner narratives about defective bodies rather than achieving the stated aim of increasing agency?
Why did the training, with its focus on group projects, exclude ongoing experiential groups for trainee therapists to reflect upon their own lived experience and requirements for personal therapy?
And why was there no requirement to examine the historical roots of Psychomotor Therapy in German gymnastics that ultimately supported the emergence of fascism?
Experience of movement therapy education as a neurodivergent therapist
In session after session, I was told that people like me needed to just learn to be — well, be different. Change. Control ourselves better. Not disturb others. Consider the needs of other people. Read some books about self-control.
With my statement of reasonable accommodations in my back pocket, I felt completely othered.
No research co-authored by neurodivergent researchers. No lecturers sharing lived experience with students.
I felt like a science project.
With these questions percolating in my head, I was also experiencing, for the first time, pronounced social exclusion- and this, in a school of ‘special needs’ education no less.
The course was my 6th higher education degree. It was my very first course of study as an “out” neurodivergent student and the first time I had sought reasonable accommodations.
Therapy training is never easy, existing in neuro-normative society is never easy and studying in a second (or fourth) language is challenging too.
To be neurodivergent, whether ADHD, autistic, PTSD, dyslexic, TBI or anything else, is to have an experience of feeling constantly different. And often, to be treated as such too.
Yet, never had I experienced such acutely distressing experiences of marginalisation and social exclusion in a higher education setting. Not in dance therapy training. Not in a law degree. Not in a languages degree.
It was (is) painful to name and talk about although, arguably, given the research on the prevalence of bullying in higher education, it should not have been surprising.
Was this an indication of what the practice of psychomotor therapy would look like in schools? How far did my experiences in training mirror the experiences of children and young people with ‘special needs’?
Picasso once said … all children are born artists.
The problem is to remain an artist as we grow up.
And the consequence is that many highly talented, brilliant, creative people think they're not, because the thing they were good at at school wasn't valued, or was actually stigmatized.
And I think we can't afford to go on that way.
Ken Robinson, How schools kill creativity
What is ‘Psychomotor therapy’?
Psychomotor Therapy is commonly described as a form of ‘educational-therapy’ and is offered in schools in many German-speaking/Northern European countries as well as in Portugal. It is mostly unknown and unheard of in other countries, including the UK.
Its roots lie largely in sport/gymnastics as this was taught in German schools in the 1950s, not in therapy and not in art/dance; although some practitioners in Switzerland synthesized dance therapy approaches into their approaches.
Acknowledging this sporting heritage is, I would argue, critical, given the relationship between the development of ‘gymnastics’ in German schools, militarism and the viewing of disabled bodies as inferior, illegitimate and worthless.
The ableism that lies at the heart of Psychomotor Therapy has not received nearly enough critical examination yet can be traced back to the development of ideals around normative bodies emerging from the German tradition of Gymnastik and Turnen from the late 1700/early 1800s on. Here, from the Prussian empire, through to the first Weimar Republic and the rise of Hitler and national socialism, concepts of good posture, strength, resilience and speed were inextricably linked with the push for political and military dominance that reached its full, catastrophic expression under Nazism with the adoption of the Aryan body culture ideology.
Movement therapy in contemporary educational settings in Switzerland
Today, Psychomotor Therapy in Switzerland and Germany continues to have a small research base and remains largely practice-oriented.
In Switzerland, for now, psychomotor therapy is the only thing on offer for therapeutic movement work in primary schools and kindergardens.
Here, the right of disabled people to access education was only entrenched in law in the 1960s. At this time, three offers were defined for children and young people with disabilities; psychomotor therapy, speech therapy and ‘special needs/curative’ education. Psychomotor Therapy is heavily subsidised and funded by the government. Thus, support on offer to children and young people is called ‘therapy’ yet conceived of as, at least in part, pedagogy or teaching.
The creative arts psychotherapies available in many school settings in Europe and in the USA have not yet been formally integrated into educational settings in Switzerland. In the UK for example, dance movement psychotherapists and art psychotherapists are regularly employed in schools (funds permitting). The Swiss creative arts therapies association, Ode Artecura, is trying to change this but has not yet succeeded.
Contemporary expressions of ableism in Psychomotor Therapy?
In 2023, Whalley Hammel published a “call to resist occupational therapy’s promotion of ableism”. According to Whalley Hammel, the very professional identity of occupational therapy is rooted in ableist neuro-normative deficit-oriented notions and disabling practices.
In my view, her critique of occupational therapy (or ‘Ergotherapie’ as it is known in Switzerland) applies to contemporary psychomotor therapy too, most particularly in its focus on work with autistic and ADHD children and young people. This is for three main reasons:
Firstly, as described above, any attempt to apply sport-based concepts to a therapeutic setting will result in a therapist bringing attendant notions of “functional” and “non-functional” bodies into the room.
Secondly, a focus on (allegedly) observable motor skills through the lens of ‘motor deficits’ will come at the expense of focus on lived/subjective body experience, and the a client’s own sovereignty and authority, particularly if the therapist has not done their own work in therapy to inquire into their own biases. Part of this obsession with motor tests may have to do with attempts at professionalisation. The desire for the profession as a whole to justify itself as ‘scientific’ and to prove credibility and worth is often expressed by means of language which is distancing and formulaic, such as that used within test settings.
Lastly, the context in which psychomotor therapy arose means that it is presented (at least in Switzerland) as a synthesised “therapy/pedagogy”. Although ABA is not practiced in Swiss schools, and although we are told that the goals of therapy are not to “therapise away the ADHD/autism”, psychomotor therapy training thus often emphasises the importance of teaching a child or young person to change, to acquire something (for example “social skills”) and this implicitly leads to unconscious reinforcement of the child not being ok as they are.
All this creates fertile ground for dehumanization and implicit and explicit objectification of both body and self.
Is dance movement therapy any better?
I do believe that dance movement therapy has the potential to be a particularly affirming vehicle for neuroaffirmative therapy due to its inherent nature as a modality that values all forms of experience and communication and its focus on lived body experience.
That said, it is not possible to say that dance movement therapy/psychotherapy does not have ableism in its foundation either. There is research (particularly older research) that supports the notion of targeting particular traits of autistic and ADHD people.
Dance itself also has an uncomfortable heritage of supremacy and privilege which many practitioners are starting to critically examine in work and in training.
white hearts superimposed on a blurred background
Can we distinguish between an ableist worldview and how we practice as individual therapists?
Beyond interrogating whether any movement therapy training is non-ableist, empancipatory and liberating, the wider question for me is, is it possible to distinguish between a particular therapy modality’s ableist worldview and how we ourselves practice as individual therapists?
Certainly, all the psychomotor therapists I had seen and worked alongside on placement worked in respectful, creative and curious ways from which there was much to learn. Also, the psychomotor therapy rooms in schools that I had seen were playgrounds. The focus seemed to be agency, and I knew from my own research that the promotion of agency is a critical component of trauma recovery. And - there was funding and resources. Trampolines, climbing frames, hammocks, bouncy cushions. Sensory materials. Art materials. Music materials. Games. Toys. These rooms looked like paradise spaces in which to facilitate the language of therapy with younger children; play.
I am not sure that I can come up with a definitive answer to this question. It is certainly possible to set an intention not to commit harm and to take actions to ensure this. It is my fervent hope and desire that, should I ever practice in school settings once again, I will be able to do so in a way that is affirming of autistic autonomy and does not commit harm.
There are many things that therapists can do to try and ensure that they work in affirming ways, for a start:
doing our own deep embodied inquiry into our own internalised ableism and oppression
staying abreast of critical disability studies as applied to therapy
making connections with other therapists seeking to work in non-harmful and affirming ways (for example the Therapist Neurodiversity Collective)
working with our trauma responses so that, when in institutional settings like schools, we are less likely to fall into old patterns such as appeasement when relating to school structures that may lead us to harm clients
making conscious choices about modelling self-acceptance
making conscious choices about where we work, to the degree that this is possible, including where we feel it may be safer and more healthy to working in an alternative setting over modelling adaptation to an unhealthy environment.
I will continue to read the work of autistic researchers and other critical disability theorists, while wrestling with these questions and exploring them through the lens of my own dance work and choreography.
Further reading:
Naul, R. (2002). History of sport and physical education in Germany 1800-1945. In: Sport and physical education in Germany. Eds. Naul, R. & Hardman, K.
