Watsu (Dull) and Waterdance

1. Introduction

Version followed: Watsu as developed by Harold Dull and taught through the Worldwide Aquatic Bodywork Association (WABA), as described in Dull's biography, interviews and course materials and in the 2020 systematic review by Schitter and colleagues; WaterDance (WATA, German WasserTanzen) as attributed to Peter Aman Schröter and Arjana Claudia Brunschwiler (1987). Dull's own manual (Watsu: Freeing the Body in Water, 4th ed., 2008) is cited by title only; its procedures are not reproduced here [uncertain]. For WaterDance and the combined European form, this guide also follows the Swiss method identification for aquatic bodywork (OdA KT, 2021).

What it is. Watsu ("water" + "shiatsu") is a passive form of aquatic bodywork. The practitioner stands in warm, chest-deep water and holds the receiver, who lies face up and floats. The practitioner then moves, sways and stretches them in slow sequences, adding gentle traction, joint mobilisation, massage and pressure on shiatsu points [source: Schitter et al. 2020; Orsi and Mather 2007 course handout]. Dull, a poet and Zen Shiatsu practitioner, worked in the lineage of Shizuto Masunaga. In 1980 he found that Zen Shiatsu could work well in water, and he developed Watsu in the warm pool at Harbin Hot Springs, California, where he was teaching Zen Shiatsu; Harbin dates the invention to 1980. Dull died on 31 July 2019 [source: ABMP 2018; Harbin Hot Springs 2019; OdA KT METID 2021]. WATSU is a registered trademark, and only authorised practitioners may use the name [source: Bionity lexicon, Harold Dull].

WaterDance (WATA / WasserTanzen) builds on Watsu. Its development is attributed to Peter Aman Schröter and Arjana Claudia Brunschwiler in 1987 [source: Bionity lexicon; Watsu India modalities page]. The receiver wears a nose clip and is taken both above and below the surface. The practitioner follows the receiver's breath and gives a manual signal before each submersion [source: Watsu India]. One course handout describes it as introduced after several Watsu sessions, with breath synchronised with the practitioner [source: Orsi and Mather 2007]. The Swiss method identification states that the psychologist Peter Schröter began underwater work around 1980 and developed it with Arjana Brunschwiler from 1987, that it has been taught since 1993, and that Brunschwiler, who trained in Watsu in the US and taught both forms in Switzerland, combined them into what German-speaking countries call aquatic bodywork (Aquatische Körperarbeit); in that combined method Watsu keeps the nose and mouth above water, while WATA is partly underwater with a nose clip [source: OdA KT METID 2021].

How change is thought to happen. Practitioners and the related literature describe several mechanisms:

Warm water reduces gravity and joint load, so the spine and joints can move in ways that are impossible on land [source: Orsi and Mather 2007; Schitter et al. 2020].
Breath connection between giver and receiver is central to the method [source: Orsi and Mather 2007; ABMP 2018].
Being held with unconditional support can let emotions surface. The grey literature describes emotional growth, altered states and, in WaterDance, regression and the processing of "past wounds" [source: Schitter et al. 2020; Watsu India].
Dull framed the method's purpose as answering a need for physical intimacy, empathy and compassion offered without threat [source: ABMP 2018].

These are practitioner accounts, not established mechanisms.

Who delivers it. Watsu and WaterDance are delivered by aquatic bodyworkers trained and registered through WABA or national aquatic-bodywork institutes. In some clinical settings they are delivered by physiotherapists and aquatic therapists [source: ABMP 2018; Schitter et al. 2020]. This is hands-on work in water. A psychotherapist's usual role is to assess, refer, prepare, collaborate and integrate. The psychotherapist does not deliver it unless their own code allows hands-on work and they hold the aquatic training (see section 3) [source: USABP Code of Ethics; EABP Ethics Guidelines 2020].

Evidence status. A 2020 systematic review and meta-analysis found effects favouring Watsu for pain, physical function and mental-health measures. Its authors rated the evidence low to moderate at best, based on small samples and poorly reported studies. They recommended Watsu for wellness and only cautiously for clinical use [source: Schitter et al. 2020]. Neither Watsu nor WaterDance is a treatment for cancer or any other physical disease. One course handout lists cancer and recovery from sexual abuse among its "recommended" uses. That listing is the handout's own claim and has no evidence base [source: Orsi and Mather 2007]. The 2020 review covers Watsu only; this guide cites no controlled study of WaterDance [uncertain].

2. Framework

Watsu is not a phased psychotherapy. It is a series of individual bodywork sessions, and the psychotherapist's work around those sessions has its own natural phases. Session structure below follows the published descriptions. The psychotherapist's phases are [synthesis].

The Watsu session as published.

The practitioner opens by establishing breath connection in the Water Breath Dance: the receiver sinks a little on the exhale and rises on the inhale, in time with the practitioner's breath. This is repeated early so the connection carries through the session [source: Orsi and Mather 2007].
Next come moves such as the "Accordion" (gently folding and opening the floating body), stretches, rotations, joint mobilisation and point work [source: Orsi and Mather 2007; Schitter et al. 2020].
Phases of movement alternate with phases of stillness and integration [source: Sonnenpark spa page].
Beginners learn fixed sequences. Experienced practitioners work in an individualised "free flow" [source: Schitter et al. 2020].
Session length is reported in the literature but is not given here as a recommendation.
WABA offers Watsu certification and trainings internationally; therapists may use Watsu-type movements, but may not advertise as Watsu practitioners unless WABA has registered them, and certification alone does not authorise hands-on health care [source: Salzman 2008, Aquatics International]. The Worldwide Aquatic Bodywork Registry, begun by Dull, lists classes and practitioners and stores practice and teaching authorisations [source: Harbin Hot Springs 2019]. In Switzerland, aquatic bodywork (Watsu and WATA) has a published competence profile for professional practitioners, covering assessment, treatment and accompaniment, work with a client's support person, continuing education with regular water-safety courses, and practice administration [source: OdA KT METID 2021]. WABA's specific levels and hour requirements are not given in these sources [uncertain]. Ask the practitioner, WABA or the national aquatic-bodywork association which courses they have completed and whether they are registered.

The WaterDance session as published. It is described as an advanced form of Watsu that adds dance-like underwater movement. The practitioner gives a manual signal before each submersion, and the receiver wears a nose clip [source: Bionity; Watsu India]. Seven basic movements are named: Snake, Aikido, Roll, Somersault, Inversion, Release and Embrace [source: Bionity]. This guide does not give a procedure for submersion work.

The psychotherapist's phases [synthesis].

Consider and screen. Decide whether aquatic bodywork fits the client's goals. Screen for psychological contraindications. Confirm that medical screening by a doctor or the practitioner is under way. Move on when the client wants it, the medical screen is clear, and the psychological risks are manageable.
Refer and coordinate. Help the client choose a registered practitioner and agree, with the client's consent, what information may be shared. Move on when a practitioner has been identified and the client's consent and boundary plan is written down.
Prepare. Rehearse the stop signals, agree trauma-informed adaptations, and practise noticing and naming body states. Move on when the client can describe their own stop signal and adaptations without prompting.
Integrate (after each session). Debrief bodily, emotional and relational material, and screen for adverse effects. Move on to a further session only when the previous one has been processed.
Review. After a few sessions, review the benefit, any harm and the client's continued consent, and decide whether to continue, adapt or stop.

The typical number of sessions is not standardised in the sources cited here; studies used varying numbers [source: Schitter et al. 2020].

3. Guiding principles

Consent before and during touch. Touch is agreed in advance and checked as the session goes on, because initial consent may not reveal reactions the client is not yet aware of. In practice: get explicit agreement from the client for each element (being held, face near the water, submersion) and check it again before each element [source: USABP Code VIII.2–4].
The right to stop at any moment. The client may refuse or end any touch at any time. In practice: agree a signal that works with the ears underwater and the eyes closed, such as a firm tap or squeeze, and agree that the practitioner stops at once and returns the client to standing [source: USABP Code VIII.5; signal design is synthesis].
Never sexual. Genital or other sexual touch is always inappropriate, including when the client proposes it. In practice: tell clients plainly that any sexualised touch or remark is misconduct, and that they can leave and report it [source: USABP Code; EABP 5.b.1].
Touch serves the client only. Touch is used only when it is expected to benefit the client, never to meet the practitioner's needs. In practice: in collaboration, ask the practitioner how they decide on closeness and holding [source: USABP Code VIII.6].
Stay within your competence. Offer only what you are trained in. In practice: a psychotherapist does not get into the pool and practise Watsu unless trained and permitted by their code. Mainstream codes (UKCP, BACP, APA, AAMFT, BPS) contain no explicit touch provision but require working within competence and referring on. Body-psychotherapy codes (USABP, EABP) set specific conditions for using touch [source: UKCP Code items 23–24; BACP 2018 para 13; APA code 2.01; EABP Principle 7].
Medical safety first. Water and heat carry contraindications. In practice: never recommend a session before medical screening (see section 5) [source: WPhLAG 2016; Orsi and Mather 2007].
Be trauma-informed about passivity. Being held, floated and moved, with loss of control, closed eyes, the face near water and, in WaterDance, being taken under, can trigger survivors of abuse, near-drowning or restraint. In practice: agree beforehand which elements to leave out [synthesis].
Emotions may arise and are allowed. Emotions may surface as part of the flow [source: Orsi and Mather 2007]. In practice: prepare the client to expect this, and debrief it in therapy rather than leaving it unprocessed [synthesis].
Name the evidence honestly. The evidence is low to moderate, and no disease is treated. In practice: present the work as a possible support for relaxation, body awareness and the felt experience of being held, never as a cure [source: Schitter et al. 2020].
Avoid role confusion when services run in parallel. When a client receives similar services from another professional, consider the implications and discuss them with the client. In practice: agree with the client who handles what, and keep the psychotherapy separate from the bodywork [source: EABP 6.b].

4. Intervention inventory

Part A describes the method's components as their developers and trainers publish them. These are carried out by the aquatic bodyworker, and they are described here so the psychotherapist can prepare and debrief clients. They are not instructions for delivering the work. Part B gives the psychotherapist's own interventions, which are mostly [synthesis] built on the touch codes and safety sources cited.

Part A. Components of the method (delivered by the aquatic bodyworker)

A1. Water Breath Dance (Watsu)

Purpose: to establish breath connection between giver and receiver at the start. Repeated early, the connection is meant to carry through the session [source: Orsi and Mather 2007].
What the client experiences: the client floats face up, supported by the practitioner. On each exhale they sink slightly, and on each inhale they rise, in time with the practitioner's breathing [source: Orsi and Mather 2007]. The practitioner supports the head, not the neck, and keeps the ears in the water [source: Orsi and Mather 2007].
Example language (preparing the client, illustrative): "At the start you'll be floated on your back and you'll gently sink and rise with your breathing. Your ears will be underwater, so sounds will be muffled. That's expected, and you can open your eyes or stop at any point."
Watch for: muffled hearing and sinking can feel like losing control or drowning. Breath-focused attention can trigger panic in clients with panic disorder. Signs it is working: the client later reports settling, slower breathing and a sense of being held without fear [synthesis].

A2. Moves, stretches, mobilisation and point work (Watsu)

Purpose: gentle, gradual stretching, spinal movement that is not possible on land, joint mobilisation and myofascial stretching, plus stimulation of shiatsu points [source: Orsi and Mather 2007; Schitter et al. 2020].
What the client experiences: slow, circular sequences while held by the hands, forearms or shoulders. Named moves include the "Accordion" (folding and opening the floating body) [source: Orsi and Mather 2007; Schitter et al. 2020]. The practitioner supports the sacrum and knees to avoid overarching the lower back, and flexes the body after each extension or turn [source: Orsi and Mather 2007].
Example language (illustrative): "You'll be gently folded, turned and stretched, close to the practitioner's body. If any hold feels too close, too tight or too exposed, give your signal and they will change it or stop."
Watch for: the closeness of the holds. The receiver is often cradled against the practitioner's body, and for some clients this evokes earlier unwanted contact. Watch also for joint pain, hypermobility and dizziness after rotations [synthesis]. Report any pain or swelling to the practitioner. One rehabilitation case recorded knee swelling after a session [source: Schitter et al. 2020].

A3. Stillness and integration phases

Purpose: to let the receiver absorb the movement. Phases of silence and integration alternate with movement [source: Sonnenpark spa page].
What the client experiences: being held still, or floated with minimal movement.
Example language (illustrative): "There will be quiet pauses. If thoughts or feelings come up in the stillness, you don't need to do anything with them. We'll talk about them here afterwards."
Watch for: stillness with the eyes closed can open the way to dissociation or intrusive memories. Clients sometimes report distorted time perception [source: Schitter et al. 2020]. Agree beforehand whether the client wants the practitioner to check in during stillness [synthesis].

A4. Fixed sequence versus free flow

Purpose: beginners learn fixed motion sequences, while experienced practitioners adapt the work to the individual in "free flow" [source: Schitter et al. 2020].
Relevance for the psychotherapist: free flow is less predictable, so a client who needs predictability can ask the practitioner to describe what they will do, or to keep to a familiar sequence [synthesis].
Example language (illustrative): "You're allowed to ask the practitioner for predictability, for example, 'Please tell me before you turn me.'"
Watch for: a client who feels unable to ask for changes. Rehearse the request in session first [synthesis].

A5. WaterDance (WATA / WasserTanzen) submersion work

Purpose: described as an advanced form of Watsu with dance-like movement both above and below the surface. Practitioners attribute effects to the dive reflex slowing breath and heart rate, and describe possible regression and the processing of past wounds [source: Bionity; Watsu India]. These are practitioner claims, not established findings.
What the client experiences: the client wears a nose clip. The practitioner follows the client's breath and gives a manual signal before each submersion. The client is then moved underwater in extensions, stretches and dolphin- or snake-like rhythms, and brought back to the surface for breath [source: Watsu India; uncertain: the movement descriptions are secondary, unverified]. The seven basic movements are named Snake, Aikido, Roll, Somersault, Inversion, Release and Embrace [source: Bionity]. One course handout places WaterDance after several Watsu sessions [source: Orsi and Mather 2007]. This guide gives no submersion procedure or breath timings.
Example language (illustrative): "WaterDance includes being taken underwater with a nose clip after a signal. It's an optional extra, not a step you have to take. You can agree to Watsu only, and you can withdraw consent for going under at any moment, even mid-session."
Watch for: panic, water inhalation, coughing or choking, ear pain, and disorientation after somersaults or inversions. Watch also for re-experiencing in clients with a history of near-drowning, waterboarding, suffocation or immersion abuse. Treat any loss of consciousness, confusion, breathing difficulty or persistent cough after a session as a medical matter [synthesis]. Epilepsy and perforated eardrums are listed cautions for warm-water bodywork generally [source: Orsi and Mather 2007]. Submersion should not be considered without explicit, specific, revocable consent and medical clearance [synthesis].

Part B. The psychotherapist's interventions

B1. Suitability and psychological screening

Purpose: to decide whether to suggest aquatic bodywork at all, and in which form (Watsu only, or with submersion) [synthesis].
Steps:
1. Clarify the client's goal, for example relaxation, body awareness, a felt sense of safe holding, or pain-related stress.
2. Ask about fear of water, swimming ability and any history of near-drowning.
3. Ask about trauma involving being held down, restraint, sexual abuse, medical restraint or water.
4. Ask about panic, dissociation, psychosis, eating disorders and body-image distress (being seen in swimwear), and about current alcohol or substance use.
5. Decide: proceed, proceed with adaptations, defer until stabilised, or do not suggest it.
Example language (illustrative): "Before we think about this further, I'd like to ask some questions about water, touch and being held, because the experience is very physical and close. You can skip any question."
Watch for: idealisation ("this will heal me"), compliance with the therapist's suggestion, and avoidance of disclosure. It is a good sign when the client can say what they would not want.

B2. Medical clearance and physical-safety screening

Purpose: warm-water work carries medical contraindications [source: WPhLAG 2016; Orsi and Mather 2007].
Steps:
1. Explain that the client needs medical clearance from their doctor, and that the practitioner should complete their own health intake.
2. Flag conditions the sources name. Absolute contraindications in NHS hydrotherapy guidance include fever or systemic illness, acute vomiting or diarrhoea, medical instability, chlorine or bromine allergy, angina or breathlessness at rest, uncontrolled heart failure, and open infected wounds [source: WPhLAG 2016]. Relative contraindications and precautions include poorly controlled epilepsy, unstable diabetes, known aneurysm, open wounds, incontinence, hypotension, renal failure, impaired thermoregulation, pregnancy in very warm water, fear of water and unpredictable behaviour [source: WPhLAG 2016]. A Watsu course handout adds serious heart problems, abnormal blood pressure, severe urinary infections, kidney disease affecting fluid balance, multiple sclerosis (heat sensitivity), contagious illness, recent brain haemorrhage and perforated eardrum [source: Orsi and Mather 2007]. The Swiss aquatic-bodywork method identification also names inflammatory and contagious conditions (including fungal infections), recent injuries and scars, irritated skin, perforated eardrum, recent head injury, epilepsy, acute psychosis, some vestibular disorders, frequent shoulder dislocation and some spinal conditions (medical advice or flotation aids), heart, circulatory and lung conditions, high-risk pregnancy and the weeks after giving birth, and severe inflamed varicose veins [source: OdA KT METID 2021].
3. Ask about medicines that affect alertness, blood pressure or seizure threshold, and advise against attending after alcohol [synthesis].
4. Children: aquatic bodywork for minors needs parental consent, the child's own assent, and a practitioner trained for paediatric work. Safeguarding applies [synthesis].
Example language (illustrative): "Warm-water bodywork isn't suitable for everyone medically. Please check with your doctor, and tell the practitioner about your health, medicines and any seizures or heart problems before your first session."
Watch for: clients who minimise their symptoms. Never give or endorse water temperatures, session lengths or schedules.

B3. Choosing and checking a practitioner

Purpose: to make sure the client sees someone trained and accountable [synthesis].
Steps:
1. WABA keeps a registry of authorised Watsu practitioners and classes [source: ABMP 2018; Harbin Hot Springs 2019]. The WATSU name is trademarked for authorised practitioners [source: Bionity], and only WABA-registered practitioners may advertise as Watsu practitioners [source: Salzman 2008]. Advise the client to check the registry or the relevant national aquatic-bodywork association.
2. Ask whether the practitioner also holds a regulated health registration, such as physiotherapist, and what insurance and complaints route they have.
3. Ask whether the venue has lifeguard or emergency cover and supervision. Ask how the practitioner handles stop signals, consent, chaperones and adaptations for trauma survivors.
4. For submersion work, ask about WaterDance-specific training. In the Swiss aquatic-bodywork profile, WATA is taught as part of the combined method and practitioners are expected to keep up regular water-safety courses [source: OdA KT METID 2021]; WaterDance-specific hour requirements are [uncertain]. Ask the practitioner which WaterDance courses they have completed and when they last did water-safety training.
Example language (illustrative): "It's fine to ask a practitioner about their training, how they handle consent, and what happens if you want to stop. A good practitioner will welcome those questions."
Watch for: practitioners who dismiss consent questions, discourage the client from talking to their therapist, offer sessions in unsupervised private pools with no emergency plan, or make cure claims [synthesis].

B4. Written consent and boundary plan

Purpose: to make consent before and during touch concrete. This follows the body-psychotherapy codes' requirements of informed consent, ongoing monitoring and the right to end touch [source: USABP Code VIII.2–5; EABP Principle 7].
Steps:
1. With the client, list each element: being held close, the head cradled, the face near the water, the ears submerged, the eyes closed, specific holds, stillness, and submersion (WaterDance).
2. Mark each element yes, no or "ask me first".
3. Note areas of the body that are off-limits. Note that genital or sexual touch is never part of the work.
4. Note whether the client wants a chaperone or companion present poolside, and whether they want a same-gender practitioner.
5. The client gives the plan to the practitioner, or authorises you to share it.
Example language (illustrative): "Let's go through what you're happy with, what's a firm no, and what you'd want to be asked about at the time. You can change any of it, before or during the session."
Watch for: a client who marks everything "yes" quickly. Slow down and explore it. Consent is ongoing, not a one-off signature [source: USABP Code VIII.3–4].

B5. Stop-signal rehearsal

Purpose: the right to stop at any moment, adapted to water, where the ears may be underwater and speech impossible [source: USABP Code VIII.5; adaptation is synthesis].
Steps:
1. Agree with the client a stop signal, such as a firm double tap on the practitioner's arm or standing up, and a "pause" or "change" signal.
2. Rehearse in session. Ask the client to imagine being floated and to practise giving the signal.
3. Ask the client to confirm the signals with the practitioner at the start of the session, on land.
4. Agree what happens on stopping: the client returns to standing with their feet on the floor and their face out of the water.
Example language (illustrative): "Show me the signal you'd use if you wanted to stop right now. Good. And if you only wanted a change, not a full stop?"
Watch for: freeze responses, where a client may be unable to signal. Ask the practitioner to watch for stillness that looks frozen rather than relaxed, and to check in regularly [synthesis].

B6. Trauma-informed adaptations

Purpose: to reduce the risk of re-traumatisation from passivity, closeness, loss of control and water [synthesis].
Steps:
1. Identify the specific triggers: being held from behind, the head held, being face-up and exposed, closed eyes, water near the face, submersion.
2. Agree adaptations, for example eyes open, the feet touching the pool floor at times, shorter holds, the practitioner describing each move before making it, a familiar fixed sequence rather than free flow, and no submersion.
3. Suggest a first session limited to simple floating and breath work, with the option to stop early.
4. Plan grounding steps for after the session: feet on the poolside, naming five things seen, and an agreed contact with a support person.
Example language (illustrative): "Given what happened to you, being held and unable to see could be hard. What would help you feel more in charge in the water?"
Watch for: the client's sense of obligation to tolerate discomfort. Make clear that stopping is a good outcome, not a failure.

B7. Land-based preparation of body awareness

Purpose: to build the ability to notice and name sensations and emotions before and after aquatic sessions, without the therapist touching the client [synthesis].
Steps:
1. In session, invite brief noticing of the breath, contact with the chair and areas of tension or ease. Give no breathing instructions or timings.
2. Practise a simple vocabulary for states (calm, floaty, tight, numb, far away, scared).
3. Agree a scale (0–10) for distress, to be used afterwards.
Example language (illustrative): "Just notice where your body is touching the chair. What word fits how you feel right now?"
Watch for: rising dissociation or panic with interoceptive attention. Stop and orient to the room if this happens.

B8. Post-session debrief and integration

Purpose: emotions may surface during and after sessions [source: Orsi and Mather 2007]. The grey literature reports emotional growth, altered states and distorted time perception [source: Schitter et al. 2020]. Integration helps the client make use of what came up [synthesis].
Steps:
1. At the next psychotherapy session, ask about body, emotion, images, memories and the relationship with the practitioner, in that order.
2. Ask about any moment the client wanted to stop and whether they did. Validate either outcome.
3. Link the experiences, such as being held or trusting, to therapy themes like attachment and safety, without forcing meaning onto them.
4. Decide jointly whether to continue, adapt the plan or stop.
Example language (illustrative): "What do you remember most from the session, in your body first? Was there any point you felt unsure or wanted to stop?"
Watch for: a lingering altered state, sleep disturbance, new intrusive memories, shame about crying, or strong attachment to the practitioner. Signs it is working: the client feels more settled, has a clearer sense of their body, and reports a positive experience of being held with their consent respected.

B9. Working with emotional release and regression material

Purpose: WaterDance practitioners describe possible regression and the processing of past wounds [source: Watsu India]. Material that surfaces needs a therapeutic container [synthesis].
Steps:
1. Treat memories that surface as material to be explored, not as verified fact. Avoid suggestive interpretation.
2. Use your usual trauma-processing approach at a pace the client can tolerate.
3. If material is overwhelming, pause the aquatic sessions and stabilise first.
Example language (illustrative): "Something powerful came up in the water. Let's take it slowly and see what it means to you, without deciding anything yet."
Watch for: destabilisation after sessions, and pressure from the practitioner or the client to "go deeper". A sign it is working is that the material becomes speakable and less overwhelming.

B10. Adverse-effect screening and passing it on

Purpose: adverse events are under-studied. In one review only six studies reported on side effects, and the authors call for systematic monitoring [source: Schitter et al. 2020].
Steps:
1. After each session, ask about physical effects (pain, swelling, dizziness, nausea, ear problems, coughing, headache, fatigue, skin irritation) and psychological ones (panic, intrusions, dissociation, low mood).
2. With the client's consent, pass physical concerns on to the practitioner and the client's doctor. Urgent symptoms, such as breathing difficulty, chest pain, confusion or a persistent cough after water exposure, need prompt medical assessment.
3. Record what happened and the action taken.
Example language (illustrative): "Did you notice anything unpleasant afterwards, physically or emotionally? Would you like me to let the practitioner know?"
Watch for: clients who downplay symptoms to protect the practitioner relationship [synthesis].

B11. Collaboration and role clarity

Purpose: to coordinate parallel services without role confusion [source: EABP 6.b; UKCP Code item 24].
Steps:
1. Get written consent for contact with the practitioner and agree the scope of what is shared.
2. Share only what is needed: the consent plan, the stop signals and agreed adaptations. Do not share trauma details unless the client asks you to.
3. Agree how the practitioner will tell you, through the client, about distress in a session.
4. Keep the roles separate. The psychotherapist does not join or deliver the aquatic session unless trained and permitted by their code [source: EABP Principle 7; UKCP Code item 23].
Example language (illustrative): "I'd suggest I send the practitioner just your stop signal and your no-go list. Is that all right with you?"
Watch for: splitting, where the client tells one professional things they hide from the other, and a practitioner who begins to act as a therapist.

B12. Review and ending

Purpose: to decide, after a few sessions, whether the aquatic work is still helping [synthesis].
Steps:
1. Compare the client's goals with their experience and with any adverse effects.
2. Re-check consent, including whether the client feels free to stop.
3. Decide to continue, adapt (for example drop submersion) or end, and process the ending of the relationship with the practitioner.
Example language (illustrative): "Looking back over these sessions, what's helped, what hasn't, and do you still want to carry on?"
Watch for: dependence on sessions for regulation. Keep therapy as the main place for skill-building.

5. Handling problems

The sources say little about problem-handling. Except where cited, the guidance below is [synthesis].

Fear of water or of being held. Do not push. Offer graded options agreed in advance: land-based Tantsu (Dull's land form of Watsu holding) [source: Watsu India], a session of standing in the water only, or no aquatic work. Fear of water is a listed precaution in NHS hydrotherapy guidance [source: WPhLAG 2016].
Panic in the water. The practitioner stops, brings the client to standing with their face clear of the water, and gives space. Afterwards, review the triggers and decide whether to continue. If submersion triggered the panic, drop it. Panic during or after submersion, coughing, or any breathing difficulty is a reason for medical assessment, not for pushing on.
Freeze or dissociation ("I couldn't signal"). This is a consent problem, not a client failure. Revise the plan: eyes open, more frequent verbal check-ins, a simpler sequence, shorter holds. Consider pausing until the client can reliably signal in rehearsal [source for ongoing consent: USABP Code VIII.3–5].
Overwhelming emotional release or new memories. Pause the aquatic sessions, stabilise and process the material in therapy before resuming (see B9). Avoid treating surfacing images as confirmed history.
Stuck or flat responses ("nothing happened"). Accept this. Not every client finds the work meaningful. Explore what the client hoped for, and do not escalate to submersion to produce an effect.
Non-attendance or ambivalence. Explore whether the client agreed to please you or the practitioner. Make it clear that stopping is an acceptable choice.
Rupture with the practitioner (felt unheard, a boundary crossed). Validate it, clarify what happened, and help the client decide whether to raise it with the practitioner, change practitioner or stop. Help the client name what a better experience would need.
Rupture with the psychotherapist (the client feels you pushed them into it). Own your part, repair, and re-open the decision.
Idealisation or strong attachment to the practitioner. Being held and floated can evoke caregiver transference. Explore it in therapy, and watch for blurred boundaries such as social contact, gifts or private sessions outside the usual setting.
Sexualised touch or other misconduct disclosed. Genital or sexual touch is always inappropriate [source: USABP Code]. Believe and support the client. Explain the routes: the practitioner's professional association or registry, the regulator if the practitioner is registered (for example as a physiotherapist or a regulated massage therapist), the venue, and the police. Help them seek medical or sexual-assault services if relevant. Follow your own safeguarding and confidentiality duties. No reliable reports of misconduct specific to Watsu or WaterDance practitioners are cited in this guide [uncertain: not verified].
Physical adverse effects (pain, swelling, dizziness, nausea, ear problems, skin irritation, symptoms after water inhalation). Advise contact with the practitioner and the client's doctor. Urgent breathing, chest or neurological symptoms need emergency care. A knee swelling after one session is the only adverse effect recorded in a 2020 review, which highlights how little adverse events have been studied [source: Schitter et al. 2020].
Claims that the method cures disease or "heals trauma". Correct them calmly. The evidence is low to moderate and does not support Watsu or WaterDance as treatment for physical disease, or as a substitute for trauma therapy [source: Schitter et al. 2020].
Practitioner in a remote or unsupervised setting. Advise against submersion work where no emergency cover exists.
Psychotherapist asked to join the client in the pool. Decline unless your code permits hands-on work and you are trained in aquatic bodywork. Mainstream codes require working within competence and referring on, and body-psychotherapy codes set explicit conditions for touch [source: UKCP Code items 23–24; APA code 2.01; EABP Principle 7; USABP Code VIII].
Children and young people. Get parental consent and the child's own assent, and use a practitioner trained in paediatric aquatic work under supervision. Apply safeguarding procedures. Do not suggest submersion work for children without specialist and medical input.

Sources

Web sources:

Books cited by title only (contents not reproduced here; details [uncertain]):

Dull, H. (2008). Watsu: Freeing the Body in Water (4th ed.). Watsu Publishing.
Dull, H. (2010). Watsu: Basic and Explorer Paths. Watsu Publishing.
Dull, H. (2008). Tantsu: Yoga of the Heart. Watsu Publishing.

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