After her mastectomy, Jennifer LaFleur found herself lying on the hardwood floor in her kitchen. The firm surface seemed to loosen up her tense back muscles, which were sore from the maddening stillness her recovery required.
LaFleur was first diagnosed with breast cancer in July 2011. Six rounds of chemotherapy, a lumpectomy, a second surgery, and six weeks of radiation drove the cancer into remission—only for it to return in September 2014. This time, she underwent the mastectomy and reconstruction, and after one final surgery, she was cancer-free. But the invasive treatments left her feeling that her body no longer quite belonged to her. “I realized recovering from this trauma was going to be a complicated process,” she says.
On the floor, LaFleur’s mind drifted to, of all things, belly dance. Before her diagnosis, she had danced with Fata Morgana, a belly-dance troupe in Charlottesville, where she’s working toward a Ph.D. in ancient Greek and Latin historiography at the University of Virginia. The slew of medical treatments had driven LaFleur into a sedentary life, disconnected from the activities she once enjoyed. She wondered, could returning to belly dance help her find a way back to the life she had known before cancer?
LaFleur knew that belly dance couldn’t treat, let alone cure, cancer. But the practice incorporates a mix of gentle movements and intense focus that she realized was the perfect balance of physical activity, play, and meditation for her recovery. In fact, maybe it could be the perfect activity for other people recovering from cancer, too. Soon, she was thinking through how she could design a belly-dance class.
Beyond Charlottesville, LaFleur’s inclination to connect healing with play aligns with a growing sector of therapists in the United States. The field, known as recreational therapy, uses games and other leisurely pursuits, including activities as mundane as bean-bag tosses and art projects, to help patients regain fine motor skills and reduce anxiety or depression. Like its better-known relatives—such as physical or occupational therapy—recreational therapy relies on measurable outcomes, but aims for fun and socialization outside of the medical office.
The field isn’t widely known—and it’s controversial. Because most states don’t license recreational therapists, it’s difficult to determine whether a practitioner is offering legitimate therapy or promising unrealistic results. Music therapy, a subset of recreational therapy, has also come under scrutiny in recent years as some people insist that it helps children with developmental disorders and others worry the impact is irresponsibly exaggerated.
According to the Bureau of Labor Statistics, employment opportunities for recreational therapists are predicted to grow by 12 percent between 2014 and 2024, a rate faster than average across all occupations, due in part to America’s aging of population as baby boomers retire. Currently licensed in Utah, North Carolina, Oklahoma, and New Hampshire, with bills pending in several other states, recreational therapists must earn a four-year college degree, complete a 560-hour internship, and pass a national-certification exam. Since its formation in 1984, the American Therapeutic Recreation Association—the largest national membership organization for recreational therapists—has grown from 60 to more than 2,200 practitioners.
Vincent Bonadies has practiced recreational therapy for nearly 38 years and currently serves on ATRA’s board. In reflecting on his career, he recalled one of his first patients, a young man who had been in a motorcycle wreck that left him almost completely paralyzed. The man spent hours every day sitting in bed with little to break up the monotony. “He had the ability to move his head, and he loved painting,” Bonadies says. So Bonadies helped the patient learn to hold a paintbrush in his mouth.
Like many other patients whose cancer has come back after remission, LaFleur remains afflicted by the nagging doubt that the cancer is ever truly gone. “Cancer is, at its core, your body turning against itself,” she says. “You have a hard time trusting your immune system. It’s very alienating, and it can be frustrating to not have the stamina you’ve had your whole life.”
LaFleur liked that belly dance can promote body positivity and isn’t too difficult to pick up. The dance can also be modified to accommodate students who might need to sit or lie down due to weakened health. She decided to limit her class to other cancer survivors with the goal of connecting over the shared experience. She named the project My Body Raqs, in reference to a classic Egyptian style of belly dance, and began offering free classes.
While the notion that exercise and community involvement has a positive impact on health isn’t controversial, some do question the legitimacy of recreational therapy. With few states licensing recreational therapists, regulation is nonexistent and purported recreational therapists may not be qualified to practice. The petition website Change.org is littered with appeals for licensing from people in states that don’t currently recognize recreational therapists. Unlike LaFleur’s free, casual classes, an unlicensed recreational therapist could potentially charge steep out-of-pocket fees while promising impossible results.
Bonadies, the recreational therapist, believes that the lack of public familiarity with his profession is the key issue holding licensing back. “[Recreational therapy] is not a household name like physical therapy,” he says. Recently, there are some signs that this will change. In 2016, the Veterans’ Health Administration endorsed recreational therapy as a valuable treatment option for veterans, noting that the practice has been in use since the Civil War.
Christiana Brenin, a University of Virginia oncologist who specializes in breast and colorectal cancer, would not readily recommend recreational therapy to her patients. “The short answer is no,” she says. During treatments, she works closely with a team of clinical psychologists who help her patients address the anxiety and fear that can accompany a diagnosis. Additional layers of therapy could be unnecessary, if not harmful, for patients already dealing with time-consuming and exhausting treatments, she says. And in cases of breast cancer like LaFleur’s, she points out, most patients continue to work and do recreational things throughout their treatment anyway. Why introduce unnecessary approaches?
Still, Brenin won’t stop patients from pursuing recreational therapy if they think it will help. “I definitely believe in placebo effect,” she says. She has noticed that patients who embrace placebo treatments regain a sense of control over their care and tend to be less stressed. Moreover, she encourages any activity that can help patients shore up their support networks. “I’ve had some patients decide to volunteer in support groups to help others who are having a hard time,” she says. “They find a meaning in life. It’s really good way to reintegrate into society.”
This was true of LaFleur. She planned her first belly-dance class with no idea whether she would spend the session teaching or waiting in an empty room. To her relief, a small group of women arrived, curious to see what she would offer. Over the course of eight weeks, nearly all of the students returned. Away from doctors and caretakers, the group found relief in speaking frankly about their shared cancer experiences. “We make all these morbid jokes,” LaFleur says. When the class ended, she shared everyone’s contact information and has occasionally organized meet-ups.
Cancer still affects LaFleur’s daily life. The illness has left her with chronic fatigue syndrome, a constellation of symptoms that makes her search for words that used to come easily and forces her to take naps during the day. She’s had to put her belly dance classes on pause while completing a teaching assignment for her Ph.D. in Lynchburg, Virginia, but hopes to return with a new round of My Body Raqs class offerings this summer.
No one has determined a perfect formula for helping cancer patients heal. As Brenin points out, each cancer patient is unique, and treatment that works with some patients may not work for others. Regardless, LaFleur is convinced that a little belly dance doesn’t hurt.