Post on 05-Feb-2023
1
Therapeutic Performance: When Private moves into Public Thania Acarón, BC-DMT, LCAT, R-DMP Mayagüez, Puerto Rico & Cardiff, Wales thaniadmt@gmail.com www.thania.info Citation: Acarón, T., 2017. Therapeutic Performance: When Private Moves into Public. In: V. Karkou, S. Oliver and S. Lycouris, eds., The Oxford Handbook for Dance and Wellbeing. New York: Oxford University Press, pp.219–238.
Abstract: This chapter explores whether the use of choreography, dance technique and performance in dance/movement psychotherapy (DMP) hinders or enhances the therapeutic process and how these modes of practice might impact the patient/client’s wellbeing. The inherent cathartic nature of performance proposes a tension between the healing facets of therapeutic material that emerges from dance and questions of ethics around client confidentiality. The therapeutic performance, as developed within a DMP context, is defined and described using examples from the author's practice as an active performer and dance movement psychotherapist. The use of choreographic tools, and specific dance styles in DMP are explored as potential interventions, taking into consideration its benefits and risks to the therapeutic relationship. A case study is presented which makes the connection between the therapeutic performance and patient/client wellbeing. Through making these connections, this chapter aims to explore an underdeveloped area within the field, focusing on the therapeutic potential of public performances of movement created during the sessions, to maintain a clinical balance between the private self within the session, and the public self that others witness. Introduction
Dance movement psychotherapy (DMP)1 developed from the alliance between dance practices and
psychotherapeutic frameworks. The pioneers of DMP came from dance and performance
backgrounds, and their work encouraged the development of an approach that connects body and
mind, and introduces the body as the focus of all experience and the principal agent in the healing
process. Wellbeing encompasses the fulfilment of our own human potential while developing the
resources to cope and transcend adversity (World Health Organization 2014). Movement within
DMP acquires communicative, emotional, symbolic and expressive qualities that take on an 1 The term for the profession in the UK is dance movement psychotherapy, although in the United States the term is dance/movement therapy. The UK version of the term and British spelling will be utilised in this chapter.
2
integrative role within the individual or group. DMP pioneers viewed “mastery or technique as
functional and aesthetic platforms for expression” (Fraenkel 2006, p.1). This included teaching
dance technique to clients to create a basic nonverbal vocabulary. To many dance movement
psychotherapists however, the use of choreography or dance technique within a therapeutic
framework may seem like a contradiction. Duggan (1995) states that some dance movement
psychotherapists argue that conventional dance steps “are inauthentic and keep individuals away
from their feelings” (p.229). Fraenkel (2006) also states that the term ‘dance technique’ elicits a
critical response which echoes the ambivalence of whether structuring a therapeutic process can
thwart a patient/client’s2 own voice. Arnheim (1992) argues that aesthetics are an “indispensable
trait” of human behaviour, and can be useful, even at times necessary within therapeutic contexts.
Choreography and performance, as major elements of dance hence exhibit a controversial role
within DMP, which will be unpacked in this chapter. I will focus on delineating the potential and
limitations of the use of choreographic approaches, movement techniques and performance
opportunities within the DMP setting: how dance performance functions as a therapeutic tool. The
therapeutic performance in DMP will be analysed as an intervention taking into consideration its
benefits and risks to the therapeutic relationship and patient/client wellbeing. I will use examples
from my practice to illustrate certain applications of choreography within DMP and will refer to
debates relating to ethical issues surrounding such applications.
As a dance movement psychotherapist, performer and choreographer who is still creating work for
the stage, my artistic background has offered many new perspectives that promote further
communication between the ramifications of dance/movement as a discipline. However, I have felt
the importance of also illustrating similarities and distinctions between artistic, educational and
therapeutic processes and their application. DMP holds many differences from dance education that
have been a way to demarcate the DMP field from its inception and align it within
psychotherapeutic contexts. Many authors, including Panhofer (2005), Schmais (1970), Duggan
(1995), Meekums (2002) and Hayes (2010) illustrate the fine and precarious line between dance
technique, education and DMP. In order to help my students and workshop participants understand
these differences, I created a working diagram (see figure 1) that encompasses the components of
therapeutic processes in DMP. In summary, it is the focus on the therapeutic relationship between
2 I use the words patient/client in slashes in order to allow for the terminology to be applicable to a variety of settings. In the case of schools and my work with normal neurotic adults, I refer to them as clients, whereas in hospital settings they can be referred to as patients.
3
practitioner and client, and the structures and interventions based on the client's needs and from the
client's movement and verbal contributions that distinguishes DMP from other body-based or
movement-based practices. Using this diagram, a movement-based practice can be distinguished
from DMP. A delicate exception, however, would be body psychotherapy and somatic psychology,
which would also use the body as the main focus of treatment, but may not use dance-based
practices as a mode of intervention, and also may include touch. Considering differences between
DMP on the one hand and somatic psychology and body psychotherapy on the other may require
more of an in-depth theoretical and practical discussion which is outside the scope of this chapter,
since their path and formation are indeed complementary to DMP.
DMP has traditionally been aligned with improvisational processes – the patient/client being in the
moment in movement, the bringing forth of movement as a description of existence, of being. The
objective is to develop awareness of and with the body (Csordas 1993 in Tantia 2012), letting it be a
protagonist within the psychotherapeutic process, allowing expression to occur at a bodily level.
The role of teacher or choreographer is abdicated, making a transition from teaching to therapy:
judgement is suspended, aesthetics become secondary and the patient/client's movement repertoire
becomes the focus (Schmais 1970). This bi-directional process between therapist and patient
initiation and movement dialogue shapes the therapeutic relationship and lays down the foundations
for the therapeutic process, facilitating the delineation of therapeutic objectives in treatment.
The research focus on choreography, performance and the use of dance technique in DMP sessions
was originally introduced by DMP pioneers. However, apart from earlier writings from the pioneers,
there is very little on choreography as a therapeutic tool (Victoria 2012). Duggan (1995) uses
choreography as a flexible structure that both honours the clients', in this case adolescents’
contributions (versus a therapist/choreographer-directed process) and provides a therapeutic
framework. Her work was one of the first mentions of choreographic dance structures as a
therapeutic tool with adolescents. Swami & Harris (2012) and Hayes (2010) conducted their
research on DMP with dancers, Hayes (2010) describing how DMP sessions influenced dancers’
choreographic ability and technique while Swami & Harris (2012) focusing on body image and
body awareness. Jeppe (2006) suggests a model that incorporates music, poetry and DMP with
adults with mental illness, including several final performances that emerged from her work.
Allegranti (2009) uses creative multidisciplinary approaches to DMP that culminated with a film
4
generated by her clients' work. Bacon (2007) discusses the role of Jung's active imagination and
Gendlin's focusing method within performance contexts in DMP, arguing in favour of the
therapeutic processes involved in dance-making. Victoria (2012) proposes a “choreo-therapeutic
model using the psychodynamic concepts of externalisation, transformation, and re-internalisation
in dance choreography to work through and heal inner states” (p. 168). She exposes a process where
choreo-clients, as she terms them, are led through a creative process within sessions, using
performance as a therapeutic tool. Her methodology, which is still in development, indicates why
choreography has a wide potential to be used for therapeutic purposes. Victoria's (2012) model is
perhaps a great starting point for continuing a discussion and developing practice-based models
within DMP.
In terms of the use of specific dance forms, there has been a variety of applications to DMP. Capello
(2007) reviews the American Dance Therapy Association International Panel’s discussion during
their 2007 annual conference. Several DMP delegates from all over the world focused on different
elements of dance performance used both historically and contemporarily within the DMP
profession. Capello's article encapsulates the integration of folkloric forms into DMP contexts as a
way of using familiar and symbolic aspects of dance that are meaningful for the patient/clients'
cultural realm in the service of therapy. Figure 2 shows a summary of the statements provided by
the international panelists invited to this panel to speak on this context, and lists their mentions of
benefits of using their dance forms within DMP sessions. Some panelists offered examples of work
with specific populations, while others selected specific dance forms and their applicability.
Although not all have published research in each individual use of stylised and cultural dance forms
as far as their practice and the specific usage and percentage of application would need to be delved
in further in each country's case, this chapter presents these as possibilities into further research.
The Therapeutic Performance
I define a dance performance as a set of movements, either choreographed and structured in
advance or improvised in the moment, intended to be seen by an audience. The creator(s) of the
movement may develop a piece using material generated from their own internal states, their
therapeutic process, various aesthetic vocabularies, inspiration from the environment (landscapes,
buildings as in site-specific works), images, poems, other visual media, music or any combination
5
of the above. As Bacon (2007) remarks, “performance-makers working with therapeutic tools enter
an imaginal world whenever they begin the creative process” (p.20). There are endless relationships
between the creation of material, the creator and the audience. This is not to leave out the fact that
even in the private sphere, a patient/client may “perform” for the therapist – assuming roles that
they think will please him or her, or may adopt and act out various roles as defences. In many ways
this can be true in reverse, and the therapist may perform roles for the client. The private sphere
within therapy contributes to a sense of mutual construction of reality. Within the arts therapies3,
assuming different roles, acting out symbollically, and embodying metaphor is instrinsic to the work
(Ellis 2001). The concept of performativity, especially in regards to gender, has been much explored
within the social sciences. Butler (1999) claims that every human being performs their own roles
that are inscripted in the body (especially in terms of gender) within social contexts. One may even
question – what is private and what is considered public? Although my intention is not to provoke a
debate around this issue, I highlight this aspect to present that even if, throughout our lives we
manifest infinite types of private and public performances, for the purposes of this chapter, the
therapeutic performance is different – it is a client-led process of creation – the private self, or
private selves that are expressed through the therapeutic relationship make conscious decisions to
create dance/movement material choreographed for an outside audience.
Some dance movement psychotherapists incorporate performance as part of their therapeutic
interventions, while others use dance technique as a way to address the therapeutic objectives
within sessions (some examples are summarised in Figure 2). Within this chapter, I illustrate the key
aspects of the therapeutic performance within DMP as follows:
1. Therapeutic performance is a part of a patient/client/group process of dance
movement psychotherapy.
2. The movement material is generated from patient/client/group work within the
sessions.
3. The process of generation and selection of material is client-led.
4. Concepts from artistic dance-based processes are in dialogue with therapeutic
connotations.
3 Arts therapies is the British and European term that encompasses music therapy, art therapy, dramatherapy and dance movement psychotherapy. Please see the European Consortium for Arts Therapies in Education (www.ecarte.info) for more information. In the United States, this category is termed Creative Arts Therapies and includes psychodrama and poetry therapy. Please see the National Coalition for Creative Arts Therapies Association (www.nccata.org).
6
These aspects correlate to Diagram 1 in that the therapeutic performance4 (and embedded within it
all the movement codes used to create it) remains within the Structures/Interventions, which are
hence generated from the patient/clients, and tied into the therapeutic objectives of the session.
Therapeutic performance is one of many interventions that emerge from the sessions, and serve as a
vehicle to structure and clarify the material the patient/clients bring.
Background
During my work as a dance movement psychotherapist in schools, the question came up often: “Can
I do something for the Holiday Show this year?” The student’s gaze turned to me expecting for
permission to bring the private into the public arena. My role was established as a dance movement
psychotherapist but the school demanded a show for the parents and community, and year after year,
as I remained the only “dance/movement person” within these settings, this performance
expectation started to become a ritual. My initial compromise was to hold ‘performance groups’
separate from those therapeutic in nature. These performance groups had technique classes as part
of their formation, and performed several times a year. I also held different types of sessions:
individual therapy sessions, dyads and group therapy sessions, juggling a myriad of roles within this
setting. The settings' expectations of a performance for the community felt at first as an insult to my
professional career – I felt I had to defend the privacy of DMP and the distinction from dance as a
performing art and communicate this to the school – to administration directly, and then to the staff
through professional development workshops. Additionally, I needed to explain this further to my
young clients, since part of our therapeutic process was defining how movement could benefit them,
and how different our sessions were from a dance class or dance training. This blurring of
boundaries in others enforced an internal boundary in myself: I needed to clarify these different
roles within me in order to create safety and ethical lines within the setting. After transitioning to
work community-based contexts with adults, and teaching DMP in higher education and in South
America and Europe, I realised that therapeutic performances were quite common amongst
practitioners, yet employing this tool needed careful unpacking and analysis.
Therapeutic Rationale and Benefits of Performance 4 Therapeutic performance has also been utilised by psychodrama and dramatherapy4, and within dramatherapy has been termed therapeutic theatre.
7
Developmental psychologists and psychoanalysts, such as D.W. Winnicott (1971), argue that the
existence of an Other shapes us from infancy and ultimately defines our sense of self. The Other is
represented by a multiplicity of roles throughout our lives. In a formal performance situation, the
Other becomes the audience and the situation is taken into a hyper-reality: All eyes descend on the
performer. There is no escape from criticism or approval. There is no stopping or re-doing. An
external view of the performer is immediately injected into what was previously a dual or closed
group process. In the practice of Authentic Movement, awareness of oneself is often developed
through both being witnessed (by the therapist or fellow group therapy members) and witnessing
our own experience (Musicant 1994, 2001; Adler 1996). Therapeutic performances to some extent
can fulfil some of these experiences. The challenge, however, is that the audience-as-witness is not
trained in DMP or familiar with the therapeutic process involved. The audience member will not
necessarily hold the patient/client, sustain and contain the emotional charge spent on what is
presented, might not be willing to manage the intricacies of the patient/client's world. In a public
performance, both therapist and client take a risk plunging into the unknown hands of its audience
members, and need to be prepared for all the configurations of reactions and feedback that are
inherently involved. On the other hand, Jeppe (2006) reports a sense of confidence, and social
affirmation as aftermath of the therapeutic performance which links performance to patient/client
wellbeing. The effects of witnessing a community’s acceptance, and overcoming struggles and
challenges to put up a specific product on stage become instrumental for a patient/client’s personal
growth.
Decision to perform
The process of deciding to get up on 'stage' (whether it is an open community room or a theatre)
involves a unique process of preparation initiated by a self-reflective process and assessment of
readiness and willingness. For many artists, even after decades of training, there is always the
moment of anxiety before a performance. In the case of some patient/clients, where there is little to
no performance background, the decision to purposefully place themselves in an anxiety-ridden
situation may seem controversial and perhaps contraindicated. Pre- and post- performance
assessments can ultimately determine its effects on the patient/client and therapeutic relationship.
8
Duggan suggests that the decision to perform depends upon the establishment of a performance
contract versus a therapeutic contract (personal communication, 27 August 2012). She mentions that
patient/clients (especially in school-based settings) have self-referred solely to participate in a DMP
group for performance purposes. Their desire to perform fuelled their initial contact. She has hence
formed specific performance groups with this output in mind. This is different from the cases in
which the contract is initially a therapeutic one, in which there is a decision to perform that has
emerged from the process. Both cases are included within my definition of therapeutic performance
in DMP.
In my practice, I constantly offered my patient/clients the option of not performing, and had to be
susceptible to possible signs of them feeling overwhelmed, not ready or assess potential
psychological harm as in the case of my children clients that had been previously traumatised. The
work within the sessions needed to provide support and as Winnicott (1971) terms it, a holding
environment and a therapeutic relationship had to be well established before any decisions to
perform were discussed. Many conversations and movement explorations constantly fed the
possibility and intention behind performance and the client's readiness was monitored until the
moment before the performance.
The Therapeutic Material in Movement
The way in which the body is able to express its inner workings through has many pathways in
DMP. Each therapist has their own style of working according to the populations' needs. From my
training in the United States, my approach has encompassed strong elements both from Authentic
Movement and Marian Chace (Lewis 2004), and I have been able to interweave my experience as a
performer and dance educator as well. This section describes some of the choreographic tools I
have employed in my sessions that have culminated in therapeutic performances.
Along with Victoria (2012), I too found extreme validity in DMP Pioneer Trudi Schoop's claim that
structuring unconscious material that had been brought to the conscious into movement phrases was
a useful way of being able to organise thoughts and being able to ground perspectives. “The process
of formulating dance movement sequences served the function of slowing down the expressive
process and in this way allowed more time for the exploration of inner conflicts. Through
9
choreographing conflicts, Schoop believed the individual could gain some control, insight and
mastery over his or her problems.” (Levy, 2005, p. 64). Peggy Hackney (2002) defines phrasing as
“perceivable units of movement which are in some sense meaningful” (p. 239). Hackney (2002)
speaks about 'practicing' new patterns as they are brought to awareness, in an effort to re-train the
body to discover alternatives ways of being. In my work, I use the making of phrases of movement
as a tool in order to bring awareness to an individual's behavioural patterns. These themes of
repetition, patterns or ‘stuckness’ can be explored within the space, with specific movements the
patient/client generates. This tool is often used in dance education frameworks, yet, within the
concept of therapeutic performance in DMP, can be employed as a form of crystallisation of internal
into external states, to aid the identification of intra-psychic conflicts. It can help the client construct
multiple perspectives with which to view a particular issue.
Other choreographic tools that involve explorations of space can be particularly useful. For example,
in the case of one patient/client choreographing for the group, or in group choreography, the use of
spatial formations, or the use of mapping of the space and allocating movement and meaning to
specific locations can be useful. This tool was particularly useful in my work with children in foster
care, in which we explored transitions between the homes of biological parents to the foster homes.
Pathways can be drawn on the map to symbollise a client’s personal events or indicate ways in
which transitions between the events or places took place which the patient/clients can then enact
through movement.
Incorporating dance technique into sessions can also be used to generate therapeutic movement
material and expand the patient/client’s movement repertoire. Maintaining clarity of intention, as
Hackney (2002) suggests, helps structure our world. Through employing dance technique, however,
the focus of sessions may become more “educational”, involving teaching specific steps or
combinations which may then be applied to the choreography. This is not to say that teaching does
not occur at times during therapy. With some clients, psychoeducational tasks may be incredibly
beneficial. The challenge lies in the delicate balance between the patient/client's needs, their
therapeutic process and what elements within the dance technique may address them appropriately.
However, the use of social dances and partner dances may enforce gender stereotypes and need
careful consideration. Duggan (2005) argues that reinforcing traditional gender roles and dynamics
may perpetuate oppressive societal norms. In these cases, the therapist can investigate creative ways
10
in which these traditional dance forms and gender roles can be challenged, providing a safe place
for differences in gender expression and sexual orientation.
The aesthetic value of dance technique is intrinsically linked to dance performance and the
choreographic process. The choreographer employs a specific set of aesthetic values that shapes
their vision of the work. This is a difficult challenge, as the integrity of the patient/client’s material
must not be sacrificed to put on something pleasing to the eye for a performance. It is, nevertheless,
a rich discussion to have with patient/clients around what they consider aesthetically pleasing.
Depending on their therapeutic framework, dance movement psychotherapists may become more
directive in their interventions. Dance movement psychotherapists might also teach choreographic
concepts and structures to form the material as well (i.e. canon, spatial formations, specific
structures such as theme and variation or ABA formats). They may also propose complementary
movements that may support, contrast or expand the patient/client’s movement repertoire (Sandel et
al. 1993). Some dance movement psychotherapists from more of a psychodynamic stance, however,
would adopt a more therapist-as-witness role within session, not moving with clients, but holding
their experience in their bodies and attuning to the client’s movement.
Another device that can facilitate the generation of movement material is the videocamera.
Although videotaping might not be allowed in some settings, and patient/client consent is essential,
it can become a useful tool for self-reflection and documentation of the process. Managing the
anxiety of a “technological eye” is not an easy process when working with a group or individual
client, since enough time has to be allowed in sessions for patient/clients to feel comfortable with its
presence. There is little mention in DMP literature about the use of video with the exception of
Allegranti (2009), who combines film-making as joint part with DMP with self-referred adults. Art
therapist Henley (1992) describes the process and benefits of using videotaping with
developmentally disabled clients within art therapy, adding an embodied way of both patient/client
and therapist assessment during art-making. Henley (1992) states that “video can increase
awareness of self and others through body animation, facial expressivity and interpersonal relating
when taped sequences are played back as a prelude to drawing” (p. 443). Within my practice,
videotaping clients and film-making have been an incredibly useful tool. An example of this was
demonstrated by an adolescent client with selective mutism in my school-based therapy group. As
part of a collective group film project, she was able to speak to the camera and manage her severe
anxiety around adults, whilst providing a creative venue for social interaction and inclusion.
11
The Therapeutic Relationship in Performance
Every element of the creation, development, performance and evaluation of therapeutic
performance material poses both a threat and an opportunity to the therapeutic relationship.
Clarkson & Pokorny (2013) argue that one of the most effective types of therapeutic relationships is
the working alliance relationship, where client and therapist “join forces” to engage in mutual
cooperation (p. 32). The therapeutic relationship is hence negotiated throughout the performance,
ebbing and flowing within a system of unknowns (i.e. audience reaction, client’s perceived ‘success’
of the performance, effect on the relationships with the therapist). Duggan (1995) conveys the
struggle to get her adolescents' choreography to the stage, and how performance impacted the lives
of the youngsters' lives within their school community. As with many of my patient/clients that
chose to perform their therapeutic material, performance day becomes a synopsis about how the
patient/client copes with stressful or difficult situations, which is one of the pillar elements of
wellbeing. Some of my clients were incredibly determined to show their mastery. Some debated
whether to perform almost seconds before going on. Some groups became fragmented due to the
stress, or grew more cohesive. However, all new that they had to make a clear choice to perform
which could be rescinded at any point. As a therapist, these moments when a patient/client(s) were
the most vulnerable became opportunities to offer support without judgment, and model ways of
coping with stressful events.
Debriefing a performance with a client was one of the most fascinating and pivotal moments in our
therapeutic process. They described, drew or moved how they embodied exposure, criticism,
anticipation, self-doubt, pride, anxiety and/or mastery. The therapeutic performance does not end
when the curtain falls or the audience stops clapping; it becomes embedded in the relationship and
therapeutic development of the individual and marks an important point of growth, break or
transition in their life.
Ethics, Benefits and Risks
12
Therapeutic performance in dance, as a process developed within the DMP context carries several
ethical issues. Confidentiality is essential. Within the therapeutic performance process in DMP,
measures need to be taken to protect the confidentiality of the patient's specific history. In this way,
since dance is inherently nonverbal and movement can be interpreted in an infinity of ways, this
brings forth an advantage to the use of this art form. The same may apply to the consideration of the
performance space, which may include from the common treatment room with family and friends,
to the school auditorium, or it may be a general area. The choice of space is important in preserving
a client's confidentiality if he/she belongs to a mental health setting. Videotaping also involves a
heavy component of confidentiality and care as to who has access to the material.
Patient/client safety is also an important consideration – psychological, physical and emotional
safety. In terms of the physical dimension, for example, props decided to be used in performance
should be chosen according to the capabilities of the patient/clients. Patient/clients with sensory
integration problems should be considered, where the extreme noise or over-stimulation can be
potentially detrimental to the client. This was often the case when I worked with children in the
autistic spectrum. If they decided to perform, it was in small group settings or with family members.
In other cases, collaboration with therapeutic assistants was crucial, since they could monitor
specific individuals within a group and be able to leave the premises if needed in order for a child to
have a break from the overstimulation. Additionally, measures of the patient/client's stamina,
condition and bodily abilities must always be monitored, since the adrenaline of performance can
sometimes work against even the most trained of bodies. Emotional and psychological safety should
also be the priority when selecting therapeutic material. This is not to say that movement cannot
betray even the most private of matters. The interpretation of what is seen by the audience cannot be
controlled – but the way in which patient/clients choose their own material can be guided and
discussed. The rationale behind the therapeutic performance is to provide a context of expression.
The patient/client may feel too vulnerable about certain material, so it is important to consider the
potential benefits and risks. Gender and sexuality need also to be considered among the dynamics of
groups and to promote psychological safety amongst members regardless of their gender identity
and sexual orientation within the group.
Snow et al. (2003) reiterated that the drama therapist should not foresake their clients’ needs in
order to prioritise their own artistic ambitions. This also applies to the distinct roles of
13
choreographer and therapist. I must admit there were times in which I noticed during sessions, the
choreographer role emerged in me. It was a moment of internal reflection and I identified my own
countertransferential feelings as an artist being called into question. At times I would find myself
wanting the choreography to ‘look good’ or yearning to adjust or correct a client’s steps, and needed
to hold back. I understood it was my need; the aesthetics wanting to influence the process. Brown
(2008) argues that dance movement psychotherapists must maintaining their own dance practice
alive and consistent in order to address this. Brown (2008), Boris (2001) and Myers et al. (1978)
recommend the maintenance of creative practices as a powerful burnout prevention and professional
development tool for practising creative arts therapists. Brown (2008) states that: “creative arts
therapists must continue to embody the creative spark that first birthed our respective disciplines
and first drew individuals to this creative field” (p. 201). I agree that nurturing our embodied
practices and continuing to create artistic work or developing our movement skills can benefit
ourselves as practitioners and our clients; the fulfilment of our own performance needs are realised
and are kept separate from the patient/client process.
In the next section, I will address a case from my practice in which therapeutic performance was
implemented in order to paint a picture of its application in DMP.
CASE STUDY
Image 1. Body SoxTM (Not actual client)
14
Photo by: Ellen Ríos Padín (Puerto Rico) Dancer: María de Lourdes Biaggi
I had been working at school-based setting as a dance movement psychotherapist where I had
individual and group work for children aged 5-13. Sylvia, a client I had been seeing in individual
sessions, much to my surprise, asked me if she could be in the end of the year performance at an
after-school programme I had been working in. Sylvia was twelve years old, very verbose and
extremely precocious, with incredible responsibilities of taking care of her younger siblings. Sylvia
already at twelve thought of herself as a 'caretaker', and was able to rationalise and justify her
situation in an adult-like manner. She had profound issues with her body image and was very self-
conscious about her body. She had a reputation within her peers as the “tough one”, and it made me
extremely curious that by performing, she was inviting others to see a vulnerable side of herself.
Sylvia had chosen as part of her sessions to use a Body SoxTM (see figure 3), stating she felt safe
inside it. The Body SoxTM is a type of human sized encasing made of lycra in which people can
crawl inside and their body be covered completely, with an option to cover or reveal their face. It
allowed Sylvia a way to cover her body while she moved. Sylvia often used the Body SoxTM with
her head uncovered, finding comfortable ways of moving and exploring the space around her. The
lycra provided proprioceptive feedback and she felt held by this flexible structure, providing her
with the physical boundary she craved from the adult figures in her world, and the nurturance she
lacked everywhere else.
I always had the option of a videocamera available to clients, and Sylvia agreed we videotape5 her
sessions in order to reflect on how she moved through the improvisations. The video footage was
only to be seen by both of us, and her parents consented that if needed, my clinical supervisor
would have access to the material. Selecting the material for the performance was the most difficult
process. Sylvia also had a way of masking her emotions in movement in a similar fashion as she
used her language and adult-like behaviour to create alliances with the adult figures in the
programme and alienate her peers. Some of her improvisations always included the theme of hiding
using external objects such as scarves. She had limited affective range in her facial expressions, and
5 Authorisation for videotaping was obtained from parents and Sylvia since it was an educational setting. Parents
signed consent forms that authorised the use of videos in sessions, for therapeutic purposes and for clinical supervision. At the end of the year, the children were given copies of all the sessions videotaped for them to keep.
15
she used many props to cover her face. One of our therapeutic objectives was to be able to
encourage a deeper involvement with the strong feelings she had about herself, her body, and the
incredible burden of responsibility she carried.
Sylvia decided that she would perform her material with her head inside the Body SoxTM, and I
remember her expressing that this way, she didn't have to worry about her clothes and accidentally
revealing any skin or showing her face, a clear representation of the strong protective measures she
had been applying even throughout the sessions. Sylvia selected a very emotional song that had
come up in our closing movement ritual that expressed the struggle between what was being
demanded of her and what she should do, and that as expressed in the lyrics of the song, the “need
for a pause”, to think for herself. The process of choreographing her piece involved certain shapes
in conjunction to the music, and also included some structured improvisation.
Before the performance, Sylvia remained pretty calm, but at times was a bit ambivalent about her
upcoming performance. When the time came, she decided to perform, much to the surprise of her
community. Her performance brought tears to everyone's eyes. Even though she was covered in the
Body SoxTM, the emotionality and deep connection to her struggles were evident. The audience held
her experience, and the energy felt in the room reaffirmed the power of her movement. When she
finished dancing, she poked her face out of the Body SoxTM and smiled. Her performance marked
the development of our work together – to be able to show vulnerability and emotion through
movement. To her, in the confined boundary inside the Body SoxTM, she didn't have to be a “tough
girl”, or the caretaker – she could just be Sylvia. Some staff members came to me afterwards and
commented on how different Sylvia had portrayed herself versus her usual self within the school.
They were surprised at her expressivity, and glad she had a place where she could explore this
within DMP. As we debriefed the performance, she expressed she was pleased with what she did,
and discussed the possibility of doing other dances without the Body SoxTM in the future. I took this
as a gesture that her therapeutic performance had benefited her therapy in DMP; she was beginning
to be ready to go deeper within herself, and without her “mask”. A beginning of her journey towards
wellbeing.
This case study presents the cathartic aspect of therapeutic performance in dance and its
possibilities for the development of the therapeutic relationship. The patient/client led the process,
chose what she wanted to portray to her audience, what facets of herself she felt comfortable
16
exposing. The Body SoxTM provided a protective barrier in her case, yet the shapes created were
able to transmit much more than she probably anticipated. I interpreted the final detail of peeking
out of the Body SoxTM to take a bow as a sign that she was willing to show a part of herself to the
outside world. My role was not that of a choreographer, looking for the aesthetics of it, but more as
a source of support and offering a contained environment where she could have the independence of
her own voice. The process of selecting the material and shaping it involved asking questions both
verbally and through inviting her to move certain emotions she wanted to portray or offering other
improvisations to develop her movement vocabulary as well, in conjunction to her theme.
Sometimes we used the song she selected, and other times we used different types of music to elicit
other efforts and dynamics. The video provided us with the continuity and external eye, as she was
able to further select movement sequences from her previous sessions she was drawn to. The video
footage also allowed her to view herself, and I guided the process of expressing feedback about
seeing herself on camera, suggesting ways in which she could view herself without the overly
critical eye she had about her body.
The case of Sylvia is only one out of the many powerful stories that came out of the use of
therapeutic performance within my DMP sessions. At times, the experiences were not always
positive, especially with particularly “honest” audience members, whose feedback was not always
censored and at times pretty destructive. However, even the difficult comments or feedback were
useful tools within the context of our sessions. The performances were a hyper-reality of the outside
world, with the exception that this was a world situation I could navigate and process with my
patient/client while being there. I could embody with my client a live mise-en-scene, and I could
incorporate the myriad of aspects within this experience into our therapy. The therapeutic
performance is one of the few ways in which the dance movement psychotherapist and client both
interact with an external audience.
Conclusion
Creativity is “the doing that arises out of being” (Winnicott et al, 1986, p.39). If the therapeutic
relationship is prioritised, choreographic tools and dance forms/styles which are underpinned by
movement techniques, with or without explicit aesthetic objectives can be made available as
therapeutic interventions. The practitioner, however, needs to be aware of how these interventions
17
serve the patient/clients' therapeutic objectives and be also sufficiently familiar with choreographic
principles and dance-based artistic concepts and structures. The dance movement psychotherapist's
previous experience in choreography and performance can be extremely beneficial to the process, if
the tools that are brought forth are used to clarify a patient/clients' artistic vision and are continually
being checked for fulfilment of the patient/clients' needs. At all times, ethical guidelines must be
upheld and the balance between education and therapy need to be maintained. Since a therapeutic
performance can occur or be suggested at any time during the therapeutic process, the challenges
and benefits to the client are intrinsically interwoven. To create something that links to a
patient/client’s life, to witness a client being seen by others, and to have a patient/client witness
themselves being seen by an outside community can have a powerful effect, which can be
incredibly constructive and/or possibly destructive to their process. Although the case study
presented indicates that the therapeutic performance enhanced the client’s wellbeing, this may not
be the case of all therapeutic performances. However, the times when it has been implemented in a
safe way and through the considerations expressed in this chapter, the benefits to the patient/client
have been immense. It is a delicate balance and risk with an enormous amount of potential
therapeutic opportunities which needs to continue to be explored and researched.
(Not actual client) Photo By: Ellen Ríos Padín (Puerto Rico) Dancer: María de Lourdes Biaggi
18
Figure 1. Design by: Claudia Peces This diagram illustrates the therapeutic process interrelations that distinguishes DMP from other dance/movement-based practices
REFERENCES
Adler, J., (1999). The Collective Body. In: P. Pallaro, ed., Authentic movement: moving the body, moving the self, being moved : a collection of essays.. London; Philadelphia: Jessica Kingsley, pp.190–208.
Allegranti, B. (2009). Embodied performances of sexuality and gender: A feminist approach to dance movement psychotherapy and performance practice. Body, Movement and Dance in Psychotherapy, 4(1), 17–31.
Arnheim, R. (1992). Why aesthetics is needed. The Arts in Psychotherapy, 19(3), 149–151.
Boris, R. (2001). The Root of Dance Therapy: A Consideration of Movement, Dancing, and Verbalization vis-à-vis Dance/Movement Therapy. Psychoanalytic Inquiry, 21(3), 356–367. doi:10.1080/07351692109348940
Brown, C. (2008). The importance of making art for the creative arts therapist: An artistic inquiry. The Arts in Psychotherapy, 35(3), 201–208. doi:10.1016/j.aip.2008.04.002
Butler, J. (1999). Bodily Inscriptions, Performative Subversions. In J. Price & M. Shildrick (Eds.), Feminist Theory and the Body: A Reader (pp. 416–422). Edinburgh: Edinburgh University Press.
Capello, P. (2007). Dance as Our Source in Dance/Movement Therapy Education and Practice. American Journal of Dance Therapy, 29(1), 37–50. doi:10.1007/s10465-006-9025-0
Clarkson, P. and Pokorny, M., (2013). The Handbook of Psychotherapy. East Sussex and New York: Routledge.
Dragon, D. A. (2008). Toward Embodied Education, 1850s-2007: Historical, Cultural, Theoretical and Methodological Perspectives Impacting Somatic Education in United States Higher Education Dance (PhD Thesis).
Duggan, D. (1995). The“ 4’s”: A dance therapy program for learning-disabled adolescents. In F. J. . Levy, J. Pines Fried, & F. Leventhal (Eds.), Dance and other expressive art therapies: When words are not enough (pp. 225–240). New York and London: Routledge.
Espenak, L. (1981). Dance therapy: Theory and application. Springfiel, Illinois: Thomas Publishers.
European Consortium for Arts Therapies in Education. (2013). Retrieved from www.ecarte.info
Fraenkel, D. L. (2003). Dance / Movement Therapy: The LivingDance Approach. In S. S. Fehr (Ed.), Introduction to group therapy: a practical guide (pp. 162–166). New York: Haworth Press.
Fraenkel, D. L., & Mehr, J. D. (2006). Valuing the dance teacher and dance technique in dance/movement therapy. In 41st Annual Conference American Dance Therapy Association: Choreographing Collaboration: A Joint Conference with NDEO. American Dance Therapy
Association.
Gilbert, A. G. (1992). Creative Dance for All Ages: A Conceptual Approach. American Alliance for Health, Physical Education, Recreation, and Dance.
Hackney, P. (2002). Making connections : total body integration through Bartenieff fundamentals. New York: Routledge.
Hayes, J. (2010). Dancers in a dance movement therapy group: links between personal process, choreography and performance. Saarbrücken: LAP Lambert Academic Publishing.
Henley, D. R. (1991). Therapeutic and aesthetic application of video with the developmentally disabled. The Arts in Psychotherapy, 18(5), 441–447.
Jeppe, Z. (2006). Dance/movement and music in improvisational concert: A model for psychotherapy. The Arts in Psychotherapy, 33, 371–382.
Levy, F. J. (2005). Dance/Movement Therapy. A Healing Art. (Revised.). AAHPERD Publications. Retrieved from http://eric.ed.gov/?id=ED291746
Lewis, P. (2004). The Use of Marian Chace’s Technique Combined With in the Depth Dance Therapy Derived from the Jungian Model. Musik-, Tanz Und Kunsttherapie, 15(4), 197–203. doi:10.1026/0933-6885.15.4.197
Meekums, B. (2002). Dance movement therapy: A creative psychotherapeutic approach. Sage.
Musicant, S. (1994). Authentic movement and dance therapy. American Journal of Dance Therapy, 16(2), 91–106. doi:10.1007/BF02358569
Musicant, S. (2001). Authentic Movement: Clinical Considerations. American Journal of Dance Therapy, 23(1), 17–28. doi:10.1023/A:1010728322515
Myers, M., Kalish, B. I., Katz, S. S., Schmais, C., & Silberman, L. (1978). Panel discussion: “What’s in a plié: The function and meaning of dance training for the dance therapist’. American Journal of Dance Therapy, 2(2), 32–33. doi:10.1007/BF02593065
National Coalition For Creative Arts Therapies Association. (n.d.). Retrieved December 3, 2014, from www.nccata.org
Panhofer, H. (2005). El cuerpo en psicoterapia: Teoría y práctica de la Danza Movimiento Terapia. Barcelona: Gedisa.
Schmais, C. (1970). What dance therapy teaches us about teaching dance. Journal of Research in Health, Physical Education, 41(1), 34–35.
Shoop, T., & Mitchell, P. (1974). Won’t you join the dance? A dancer’s essay into the treatment of psychosis. Palo Alto, CA: National Press Books.
Snow, S., D’Amico, M., & Tanguay, D. (2003). Therapeutic theatre and well-being. The Arts in Psychotherapy, 30(2), 73–82.
Tantia, J. F. (2012). Mindfulness and Dance/Movement Therapy for Treating Trauma. In Rappaport, L. (Ed.), Mindfulness in the Creative Arts Therapies (pp. 96–107). London: Jessica Kingsley Publishers.
Victoria, H. K. (2012). Creating dances to transform inner states: A choreographic model in Dance/Movement Therapy. Body, Movement and Dance in Psychotherapy, 7(3), 167–183. doi:10.1080/17432979.2011.619577
Winnicott, D. W. (1971). Playing and reality. New York: Basic Books.
Winnicott, D. W., Winnicott, C., Shepherd, R., & Davis, M. (1986). Home is where we start from: essays by a psychoanalyst. New York: Norton.