- Email: [email protected]
movement therapy with field-dependent alcoholic women
The Arts in Psychotherapy,
Vol. 17, pp. 349-W.
A PRELIMINARY
Q Pergamon Press plc, 1990. Printed in the U.S.A.
STUDY OF DANCE/MOVEMENT DEPENDENT
ALCOHOLIC
JANET DORAN REILAND,
THERAPY
0197-4556/90 $3.00 + .OCI
WITH FIELD-
WOMEN* MA, ADTRt
than do mothers of more meld-dependent children (Witkin, Dyk, Faterson, Goodenough, & Karp, 1962). The more a family or culture emphasizes the separation of self from nonself, with encouragement for autonomous functioning, the more field independent its members will become (Oltman, 1986, p. 89). Thus, the measure of field dependence-independence is related to the emotional contexts of separation and individuation in human interactions and to the nonverbal aspect of the interaction between child and motherlenvironment-the context in normal attachment and separation-individuation processes. Witkin (1965) and his associates developed several perceptual tests for evaluating a person’s field dependence-independence. The BodyAdjustment Test, the Rod-and-Frame Test, and the Embedded-Figures Test are the three most well-known of these measures. They also found, not surprisingly, that measures of body articulation are related to the concept of field dependence-independence. Witkin states that:
Witkin (1965) reported that people show consistent, characteristic ways of perceiving and intellectual functioning, called “cognitive styles,” that can be measured with objective experimental tests and procedures. He identified cognitive style in the area of perception, where it is called ‘field dependence-independence,” finding that scores of large numbers of people show an even distribution along a continuum from field dependence to field independence. With a more field-dependent style, one tends to perceive in a more global fashion, perceiving the whole with more distinction than the individual parts, and experiencing the field as “fused.” With a more field-independent mode of perception, one experiences more of the parts of the field as discrete from the organized background, with parts relating both to each other and to the whole. There appears to be both a developmental and cultural element to the perceptive qualities of functioning and these qualities appear to relate to how one experiences oneself and one’s relationship to others. Field dependence is the natural state of young children who are unable to distinguish between self and other, and who experience the world without clear de~nition of boundaries. As they grow older, their perception naturally becomes more field independent (Witkin et al., 1954), as they learn to distinguish between self and other as well as being better able to distinguish and perceive relationships. It has also been found that mothers of field-independent children give them greater opportunity to develop a separate identity in their interactions
There is now considerable evidence that children and adults who show an a~iculated cognitive style in their performance in perceptual and intellectual tasks . . . are also likely to have an articulated body concept-that is to say, they
experience their bodies as having definite limits or boundaries and parts as discrete yet correlated and formed into a definite structure. (P. 319) Witkin
et al. (1962) developed
a Spoint rating
*Research was conducted at Sheppard Pratt Hospital, Towson, MD in 1982 as part of author’s master’s thesis. *Janet Doran Reiland, formerly creative arts therapist at Western Psychiatric Institute and Clinic, Pittsburgh, private practice. 349
PA, is now in
350
JANET
DORAN
scale, reflecting sophistication-of-the-body concept, to be used with the Drawing-of-theHuman-Figure Test (Machover. 1949). The scale’s purpose is to determine articulation of body concept. The person to be tested draws a human figure on a blank sheet of paper, and then, on a second sheet, draws a person of the opposite sex. The scale, called the Articulation-of-theBody-Concept Rating Scale (ABC), looks at three aspects of the drawings: (a) form level (the shape, placement, and size of the body and its parts); (b) identity and sex differentiation (degree of role assignment to figures via clothes, stance, representation of secondary sexual characteristics, etc.); and (c) level of detailing (degree of organization of stance and presence or absence of features, clothing, etc.). A single rating is assigned to each figure drawn, taking into account combinations of the above three aspects. A rating of 5 being the most primitive or inarticulated body reproduction, and a rating of 1 being the most sophisticated or articulated, the 5-point rating scale is used. This rating scale has been tested and found to have both good reliability and good stability (Witkin et al., 1962) as well as to relate significantly to measures of cognitive style (Witkin, 1965). Research shows that certain psychiatric diagnoses tend toward either marked field dependence or marked field independence. Psychiatric diagnoses that tend toward field dependence include hallucinating psychotics, ulcer patients, obese persons, asthmatic children, patients with functional cardiac disorders, and character disorders (Witkin, 1965) as well as heroin addicts (Arnon, Kleinman, & Kissin, 1974), anorexic women (Basseches & Karp, 1984), and adult depressed women (Kingsland & Greene, 1984). These diagnoses are often associated with an inability to separate or distinguish perceptually and emotionally between various aspects of the environment and the self-a blurring of boundaries. Common major psychiatric diagnoses that tend to be very field independent include delusional psychotics, paranoids, obsessive-compulsive disorders, and schizophrenics with a welldeveloped structure of defenses (Witkin, 1965) as well as heavy cannabis (marijuana) users (Weckowicz, Collier, & Spreng, 1977). Persons with these diagnoses are often characterized by rigidity of boundaries and have difficulty forming
REILAND close attachment to others. Alcoholics have been found to be significantly and consistently field dependent (Karp & Konstadt, 1965; Karp, Witkin, & Goodenough, 1965; Witkin, 1965; Witkin & Goodenough, 1965). Also, alcoholic women have been found to be significantly more field dependent than both alcoholic men and nonalcoholic matched female controls (Jacobson, Van Dyke, Sternbach, & Brethauer, 1976; Karp, Poster, & Goodman, 1963). This marked inability of the female alcoholic to separate and articulate is clearly evident in alcohol usage itself and can be a strong obstacle to recovery. Alcohol, a depressant, creates a sensation of “blurriness” as it dulls sensation both physically and emotionally. The distinctions of cause and effect of problem drinking become diffuse as one’s reason for drinking (pain of losing one’s job, for example) leads to more drinking, which leads to a greater potential for more loss (one is less able to function in a work setting). One is less able to organize, control, and utilize one’s body efficiently and to react to the environment. Distinctions among events in one’s life and in significant relationships with others begin to dim in perception as the “alcoholic persurfaces-the alcoholic relates to sonality” others more and more exclusively in terms of the alcohol. Thus, the use of alcohol itself can be seen as contributing to a more field-dependent mode of experiencing the world, one that the alcoholic may experience as familiar and comfortable as well as limiting. This field-dependent mode of perception also contributes to the difftculty of recovery from alcoholism, as the alcoholic is less able to see clearly and distinctly the effects of the use of alcohol on her own body, her perceptions, and her interactions with others, and, thus, is able to deny difficulties that are obvious to others. She is also less able to perceive the viability of alternative methods of dealing with specific issues, problems, or feelings. She may feel overwhelmed by her experience of unresolved past losses and conflicts, experiencing them as merged with current difficulties, and being less able to recognize the distinctions. Dance/movement therapy is a form of psychotherapy that may be able to facilitate the developmental process of moving from a more
DANCE/MOVEMENT
THERAPY
WITH FIELD-DEPENDENT
field-dependent mode of perception toward more field independency, as it deals directly with the nonverbal aspects of interaction. In a movement therapy medium, the early preverbal patterns of mother/child can be directly and quickly accessed and can be worked with in a concrete and immediate way. In verbal therapy, focusing on words can confuse or mask early preverbal leamings or perceptions for the patient or the therapist. The use of dance therapy techniques such as mirroring can help the therapist and client to relatively quickly recreate the early feelings of attachment and merging with a specific other-the context in which humans are most able to develop their perceptive abilities. Once such a therapeutic attachment is formed, and within its context, a trained dance/movement therapist can help the field-dependent person to begin the process of separating and individuating, reflecting the support and guidance that a mother gives to her developing child. The client can be helped to expand her movement vocabulary, to gain a sense of mastery and control over her own body, to develop a more accurate body image, to experience her own internal perceptions and feelings, and, thus, to develop a more articulated sense of body boundary, all within the context of relating to a specific other to whom the client feels attached. Inasmuch as very little or no work has been conducted on the relationship between field dependence-independence and dance-movement therapy, this piece of research is considered preliminary. The variables measured were scores obtained on the ABC Rating Scale. It was hypothesized that each of the subjects would initially show a high score on the ABC rating scale, reflecting relatively poor articulation of body concept as well as a strong tendency toward field dependence. It was also hypothesized that dance/movement therapy would improve the field-dependent alcoholic woman’s score on the ABC Scale, reflecting a change toward greater articulation in her perception of her self, her body, and her environment. Subjects The subjects of this study were four women, all inpatients of a short-term (four to six weeks) alcoholic unit of a private psychiatric hospital. Each woman had a primary diagnosis of alco-
ALCOHOLIC
WOMEN
351
holism and no other known psychiatric disorder. Each responded to a request to participate, knowing that she could withdraw at any time without reprisal. The women, aged 30, 51, 65, and 66, all had serious difficulties with alcohol, including medical difficulties (chronic liver disease, hepatitis, an arm sprain-the result of an automobile accident). Three of the four women had previous admissions for alcoholic treatment.
Procedure Each subject met individually with this author, then a dance/movement therapy intern, for six one-hour sessions (two times per week for three weeks). Prior to the first, third, and sixth sessions, the subject was given the first half of the Drawing-of-the-Human-Figure Test. At the end of the first, third, and sixth sessions, she was given the second half of the test. (Inasmuch as no control group was used in this preliminary study, splitting the test into two parts gave an opportunity to determine if measurable change occurred as a direct result of the dance/movement therapy sessions.) The movement sessions with each subject began with a movement warm-up, generally initiated by the therapist. The tone of the sessions was one of accepting warmth, as each subject was helped to make a positive attachment to the therapist and to experience her own sense of physical and emotional self as centered, distinct, and whole. The therapist did this by initiating movements that facilitate attachment, such as mirroring of movements and use of props (balls, scarves, stretch band) that can symbolize attachment; by initiating movements that facilitate body boundary awareness (such as patting of various body parts, isolating and stretching body parts and the body as a whole); and by encouraging the patient to experience movements as originating within her body and her self. The latter was accomplished by verbally expressing that she should not do any movement that was uncomfortable in any way; by nonverbally and verbally supporting her when she initiated her own movement responses, and incorporating her movement qualities into the movement; by often structuring movement in such a way that it was not necessary to be in visual contact with each
352
JANET DORAN REILAND
other and then gently encouraging not looking; and by asking her to stay with a particular movement for an extended period of time, to do it at her own speed and in a way that was comfortable for her, and, tinally, to initiate the next movement herself. Verbal material in early sessions often centered around topics of attachment to significant others, usually accompanied by much anxiety and fear of loss. One woman spoke of an old boyfriend, and then a dog, both of whom had died suddenly, and another told that she was currently having marital difficulties. Although verbal material was noted and acknowledged verbally by the therapist, active therapeutic intervention was made on a movement level. Each woman presented with a very different movement style. The first session warm-up for one very wealthy woman took the guise of grandly painting and exquisitely decorating the barren room in which sessions were held, using large, sweeping, controlled arm and upper body movements. Another subject preferred fast dancing to the music of Donna Summers, and a third subject was most comfortable making initial contact through small, quiet movements with her feet. The fourth subject’s movement was very light, very quick, with a racing and ungrounded quality. All subjects tended to be inactive in the central portions of their bodies and had difficulty engaging their trunks in the movement; movement of more peripheral body parts was somewhat easier to facilitate. There was a strong tendency in the women to be very watchful of the therapist’s movement, often commenting that they wanted to do it “right,” despite reassurances and encouragement from the therapist to focus on their own physical sensations. Some anxiety or ambivalence about attending sessions was apparent in all subjects prior to the first session, but it was not noted at all in either verbalization or behavior after the first session. Strong attachments to the therapist became apparent by the second, third, or fourth sessions, and was most apparent when the therapist adapted her own movement to reflect the movement qualities exhibited by the subjects. For example, in the third session with one subject, mirroring movements with scarves were being done. The subject willingly led for the first time
and began a series of very quick, agile, “tricky” movements, speaking about magic tricks as she did so. At the end of this session, she expressed obvious delight that the therapist had been willing to try to mirror and follow her even when she was being tricky. After this, the quality of this subject’s movement displayed less anxiety, her verbalizations were less superficial, and she spoke directly of her alcohol addiction for the first time. In the second session, another subject began to speak at length, as she had in the first session, about difficulties with her job, her failing marriage, the death of a close relative, and a miscarriage. During the first session the therapist had rocked to the rhythm of the subject’s voice as she spoke (an anxious rhythm). During the second session, the therapist asked the subject to “walk” the rhythm with her. As this continued, the therapist put a stool in the center of the room and the two took imaginary items from the stool. The subject said she was taking “understanding.” She was very attentive to the therapist throughout this activity and was reluctant to end the session. As the therapist helped to both facilitate and expand the quick, light, indirect movements of one subject by making movements larger, smaller, lighter, and stronger, it became apparent through the verbal material that the patient had suffered many significant losses and was currently having marital difficulties. She said that her nickname was the “flying flea” and that she moved quickly so that no one would notice her limp-the result of a childhood accident. As the movement expanded to include more than “flying,” but also the steady, even tempos of rocking, the quick rhythm of Scottish dance-steps, or the gentle gliding of ice skating, the memories and accompanying sadness, loss, pain, and insecurities began to surface-the patient said she felt everyone would blame her if she expressed unhappiness over her many losses. In the last session she spoke for the first time about the problems she was having in her marriage and how difficult it was for her to talk with other people about these problems. Later sessions for all subjects included many more references to mothers, to early losses in life and to current losses, with a tone less of anxiety and more of sadness. All subjects were much
DANCE/MOVEMENT
THERAPY
WITH FIELD-DEPENDENT
more comfortable with standing, balancing, and push/pull sequences in later sessions-all requiring more ability to deal with separation issues on a body level-and much more movement was initiated by subjects. Subjects all appeared to be more focused on their own movement sensations and less on the therapist’s movement. However, saying good-bye to the therapist was very difficult for all subjects, and resistance to moving was evident with three of the four subjects in the final session. Each expressed verbal appreciation to the therapist at the end of the six sessions. Scoring Tests Drawing-of-the-Human-Figure The were scored by three independent raters, using the ABC Rating Scale. One rater was a bachelor’s level counselor, a second an artist, and the third a graduate student in art therapy. Each knew that the drawings had been done by alcoholic women, but had no prior knowledge of the actual subjects and did not know which drawings had been done at which points in the treatment. Final score for each drawing was found by averaging the scores from each of the three raters. All raters had been familiarized with the rating scale and had tested at least 84% agreement with criterion scores provided by the test developers. Results Three of the four subjects of this study received initially-high scores on the ABC Rating Scale, reflecting a field dependent perception; initial scores were 5, 4.34, and 3.67. The fourth subject’s initial score was 2. (Table 1). (Interrater agreement was 87.5% for all scores.) A paired t-test against one-sided alternatives for small samples was done on the initial scores (first session only) and the final scores (last session only) of all four subjects. Although a change in scores in the predicted direction of high to low (less articulated to more articulated) did occur, it was not to a significant degree (p < .15). A paired t-test was also done using the same scores for only the three subjects whose initial scores were the predicted high scores. The changes in these scores were in the predicted direction and were found to be highly statistically significant (p < .0075).
ALCOHOLIC
WOMEN
353
Table 1 Raw Scores* on the Drawing-of-the-Human-Figure Articulation-of-Body-Concept (ABC) Rating Scale First Session
Third Session
Test
Sixth Session
Subject 1 before session after session
5 5
4 4
4 4
Subject 2 before session after session
4.34 4.34
4.34 4
4 3.34
Subject 3 before session after session
3.67 3.34
3.34 3
3 3
Subject 4 before session after session
2 2
3 3
2.67 2.61
*Average
score
of three
independent
raters
Finally, similar analyses compared scores on all drawings done prior to sessions with all scores on drawings done at the conclusion of sessions for the purpose of determining if significant change occurred during the sessions. When the scores of all four subjects (p < .026) and the three initially high-scoring subjects (p < .025) were compared, change was found to be statistically significant. Discussion/Implications
for Future Research
Considering the preliminary nature of this study and the difficulty of obtaining statistically significant results with such a small sample, these are surprising and exciting findings. Despite the obvious limitations of the study (small sample, no control group, absence of long-term follow-up, one therapist, etc.), the results indicate that the nonverbal dance/movement therapy medium may enable the more field-dependent person to move, at least temporarily, to a state of greater articulation, as reflected in the drawing of the human figure. There is a difference of opinion as to the degree of change possible in one’s style of perception once adulthood has been reached, with some researchers finding that the more markedly field-dependent person has a tendency to “merge” and thus feel better early in therapy
354
JANET
DORAN
without long-term change (Witkin, Lewis, & Weil, 1968). However, these results are not a reflection of the merging or attachment aspect of the therapeutic relationship, but of the ability to articulate or distinguish, to feel separate and distinct. They also suggest that change in perception is possible in adulthood, again at least temporarily, and with adults of advanced years. It would be helpful to attempt to replicate these findings with alcoholic and other typically field-dependent populations, adding a variety of variables and including a more exact measure of field dependency-independency, such as the Embedded-Figures Test. An examination of the differences that occur as a result of group dance/movement sessions versus individual sessions may help to clarify the question of the value of interpersonal relationship to the facilitation of this kind of change. Obviously, long-term follow-up of subjects to determine if changes are permanent would be very helpful. If these findings can be replicated in more sophisticated studies, and especially if changes are found to be long-lasting, new areas of consideration would be exposed for understanding the unique value of the therapeutic use of dance/ in the process of separationmovement individuation as it relates to existing psychological theory of cognitive style. This would not only be clinically helpful to the dance/movement therapist, but would help to present the unique value of this creative art to the mental health community and to society at large. References Amon, M. D., Kleinman, M. S., & Kissin, M. D. (1974). Psychological differentiation in heroin addicts. Intunarional Journal of the Addictions. 9. 15 I-159.
REILAND Basseches, H. I., & Karp, S. A. (1984). Field dependence in young anorectic and obese women. Psychotherupy and Psychosomatics, 41, 33-37. Jacobson, G. R., Van Dyke, A., Sternbach, T. G., & Brethauer, R. (1976). Field dependence among male and female alcoholics: Norms for the rod-and-frame test. Perc,eptual and Motor Skills, 43. 399-402. Karp, S. A., & Konstadt, N. L. (1965). Alcoholism and psychological differentiation: Long range effect of heavy drinking on field dependence. Journal of’ Nervous and Mental Disease, 40, 412-416. Karp, S. A., Poster, D. C., & Goodman, A. (1963). Differentiation in alcoholic women. Journal of‘Persona/iry. 31, 386-393. Karp, S. A., Witkin, H. A., & Goodenough, D. R. (1965). Alcoholism and psychological differentiation: Effect of alcohol on field dependence. Journal of Abnormal Psychology, 70. 262-265. Kingsland, R. C., & Greene, L. R. (1984). Psychological differentiation and clinical depression. Cognitive Therapy and Research, 8(6), 59%605. Machover, K. (1949). Personality prc?iection in the drawing on the human jigure. Springfield, IL: C C Thomas. Oltman, P. K. (1986). Psvchological differentiation theory in social and cross-cultural p&hology. In N. Bertini: L. Pizzamiglio, & S. Wapner (Eds.), Field dependence in psychological theory. research and application (p. 85-91). Hillsdale, NJ: Erlbaum. Weckowicz, T. E., Collier, G., & Spreng, L. (1977). Field dependence, cognitive functions, personality traits, and social values in heavy cannabis users and nonuser controls. Psychological Reports, 41, 291-302. Witkin, H. A. (1965). Psychological differentiation and forms of pathology. Journal of Abnormal Psychology, 70, 317336. Witkin, H. A., Dyk, R. B., Faterson, H. F., Goodenough, D. R., & Karp, S. A. (1962). Psychological d~ferentiation. New York: Wiley. Witkin, H. A., Lewis, H. B.. Hertzman, M., Machover, K., Meissner, P. B., & Wapner, S. (1954). Personality through perception. New York: Harper. Witkin, H. A., Lewis, H. B., & Weil, E. (1968). Affective reactions and patient interactions among more differentiated and less differentiated patients early in therapy. Journal of’N<~rvous and Mentul Disease, 146, 193-208.
Vol. 17, pp. 349-W.
A PRELIMINARY
Q Pergamon Press plc, 1990. Printed in the U.S.A.
STUDY OF DANCE/MOVEMENT DEPENDENT
ALCOHOLIC
JANET DORAN REILAND,
THERAPY
0197-4556/90 $3.00 + .OCI
WITH FIELD-
WOMEN* MA, ADTRt
than do mothers of more meld-dependent children (Witkin, Dyk, Faterson, Goodenough, & Karp, 1962). The more a family or culture emphasizes the separation of self from nonself, with encouragement for autonomous functioning, the more field independent its members will become (Oltman, 1986, p. 89). Thus, the measure of field dependence-independence is related to the emotional contexts of separation and individuation in human interactions and to the nonverbal aspect of the interaction between child and motherlenvironment-the context in normal attachment and separation-individuation processes. Witkin (1965) and his associates developed several perceptual tests for evaluating a person’s field dependence-independence. The BodyAdjustment Test, the Rod-and-Frame Test, and the Embedded-Figures Test are the three most well-known of these measures. They also found, not surprisingly, that measures of body articulation are related to the concept of field dependence-independence. Witkin states that:
Witkin (1965) reported that people show consistent, characteristic ways of perceiving and intellectual functioning, called “cognitive styles,” that can be measured with objective experimental tests and procedures. He identified cognitive style in the area of perception, where it is called ‘field dependence-independence,” finding that scores of large numbers of people show an even distribution along a continuum from field dependence to field independence. With a more field-dependent style, one tends to perceive in a more global fashion, perceiving the whole with more distinction than the individual parts, and experiencing the field as “fused.” With a more field-independent mode of perception, one experiences more of the parts of the field as discrete from the organized background, with parts relating both to each other and to the whole. There appears to be both a developmental and cultural element to the perceptive qualities of functioning and these qualities appear to relate to how one experiences oneself and one’s relationship to others. Field dependence is the natural state of young children who are unable to distinguish between self and other, and who experience the world without clear de~nition of boundaries. As they grow older, their perception naturally becomes more field independent (Witkin et al., 1954), as they learn to distinguish between self and other as well as being better able to distinguish and perceive relationships. It has also been found that mothers of field-independent children give them greater opportunity to develop a separate identity in their interactions
There is now considerable evidence that children and adults who show an a~iculated cognitive style in their performance in perceptual and intellectual tasks . . . are also likely to have an articulated body concept-that is to say, they
experience their bodies as having definite limits or boundaries and parts as discrete yet correlated and formed into a definite structure. (P. 319) Witkin
et al. (1962) developed
a Spoint rating
*Research was conducted at Sheppard Pratt Hospital, Towson, MD in 1982 as part of author’s master’s thesis. *Janet Doran Reiland, formerly creative arts therapist at Western Psychiatric Institute and Clinic, Pittsburgh, private practice. 349
PA, is now in
350
JANET
DORAN
scale, reflecting sophistication-of-the-body concept, to be used with the Drawing-of-theHuman-Figure Test (Machover. 1949). The scale’s purpose is to determine articulation of body concept. The person to be tested draws a human figure on a blank sheet of paper, and then, on a second sheet, draws a person of the opposite sex. The scale, called the Articulation-of-theBody-Concept Rating Scale (ABC), looks at three aspects of the drawings: (a) form level (the shape, placement, and size of the body and its parts); (b) identity and sex differentiation (degree of role assignment to figures via clothes, stance, representation of secondary sexual characteristics, etc.); and (c) level of detailing (degree of organization of stance and presence or absence of features, clothing, etc.). A single rating is assigned to each figure drawn, taking into account combinations of the above three aspects. A rating of 5 being the most primitive or inarticulated body reproduction, and a rating of 1 being the most sophisticated or articulated, the 5-point rating scale is used. This rating scale has been tested and found to have both good reliability and good stability (Witkin et al., 1962) as well as to relate significantly to measures of cognitive style (Witkin, 1965). Research shows that certain psychiatric diagnoses tend toward either marked field dependence or marked field independence. Psychiatric diagnoses that tend toward field dependence include hallucinating psychotics, ulcer patients, obese persons, asthmatic children, patients with functional cardiac disorders, and character disorders (Witkin, 1965) as well as heroin addicts (Arnon, Kleinman, & Kissin, 1974), anorexic women (Basseches & Karp, 1984), and adult depressed women (Kingsland & Greene, 1984). These diagnoses are often associated with an inability to separate or distinguish perceptually and emotionally between various aspects of the environment and the self-a blurring of boundaries. Common major psychiatric diagnoses that tend to be very field independent include delusional psychotics, paranoids, obsessive-compulsive disorders, and schizophrenics with a welldeveloped structure of defenses (Witkin, 1965) as well as heavy cannabis (marijuana) users (Weckowicz, Collier, & Spreng, 1977). Persons with these diagnoses are often characterized by rigidity of boundaries and have difficulty forming
REILAND close attachment to others. Alcoholics have been found to be significantly and consistently field dependent (Karp & Konstadt, 1965; Karp, Witkin, & Goodenough, 1965; Witkin, 1965; Witkin & Goodenough, 1965). Also, alcoholic women have been found to be significantly more field dependent than both alcoholic men and nonalcoholic matched female controls (Jacobson, Van Dyke, Sternbach, & Brethauer, 1976; Karp, Poster, & Goodman, 1963). This marked inability of the female alcoholic to separate and articulate is clearly evident in alcohol usage itself and can be a strong obstacle to recovery. Alcohol, a depressant, creates a sensation of “blurriness” as it dulls sensation both physically and emotionally. The distinctions of cause and effect of problem drinking become diffuse as one’s reason for drinking (pain of losing one’s job, for example) leads to more drinking, which leads to a greater potential for more loss (one is less able to function in a work setting). One is less able to organize, control, and utilize one’s body efficiently and to react to the environment. Distinctions among events in one’s life and in significant relationships with others begin to dim in perception as the “alcoholic persurfaces-the alcoholic relates to sonality” others more and more exclusively in terms of the alcohol. Thus, the use of alcohol itself can be seen as contributing to a more field-dependent mode of experiencing the world, one that the alcoholic may experience as familiar and comfortable as well as limiting. This field-dependent mode of perception also contributes to the difftculty of recovery from alcoholism, as the alcoholic is less able to see clearly and distinctly the effects of the use of alcohol on her own body, her perceptions, and her interactions with others, and, thus, is able to deny difficulties that are obvious to others. She is also less able to perceive the viability of alternative methods of dealing with specific issues, problems, or feelings. She may feel overwhelmed by her experience of unresolved past losses and conflicts, experiencing them as merged with current difficulties, and being less able to recognize the distinctions. Dance/movement therapy is a form of psychotherapy that may be able to facilitate the developmental process of moving from a more
DANCE/MOVEMENT
THERAPY
WITH FIELD-DEPENDENT
field-dependent mode of perception toward more field independency, as it deals directly with the nonverbal aspects of interaction. In a movement therapy medium, the early preverbal patterns of mother/child can be directly and quickly accessed and can be worked with in a concrete and immediate way. In verbal therapy, focusing on words can confuse or mask early preverbal leamings or perceptions for the patient or the therapist. The use of dance therapy techniques such as mirroring can help the therapist and client to relatively quickly recreate the early feelings of attachment and merging with a specific other-the context in which humans are most able to develop their perceptive abilities. Once such a therapeutic attachment is formed, and within its context, a trained dance/movement therapist can help the field-dependent person to begin the process of separating and individuating, reflecting the support and guidance that a mother gives to her developing child. The client can be helped to expand her movement vocabulary, to gain a sense of mastery and control over her own body, to develop a more accurate body image, to experience her own internal perceptions and feelings, and, thus, to develop a more articulated sense of body boundary, all within the context of relating to a specific other to whom the client feels attached. Inasmuch as very little or no work has been conducted on the relationship between field dependence-independence and dance-movement therapy, this piece of research is considered preliminary. The variables measured were scores obtained on the ABC Rating Scale. It was hypothesized that each of the subjects would initially show a high score on the ABC rating scale, reflecting relatively poor articulation of body concept as well as a strong tendency toward field dependence. It was also hypothesized that dance/movement therapy would improve the field-dependent alcoholic woman’s score on the ABC Scale, reflecting a change toward greater articulation in her perception of her self, her body, and her environment. Subjects The subjects of this study were four women, all inpatients of a short-term (four to six weeks) alcoholic unit of a private psychiatric hospital. Each woman had a primary diagnosis of alco-
ALCOHOLIC
WOMEN
351
holism and no other known psychiatric disorder. Each responded to a request to participate, knowing that she could withdraw at any time without reprisal. The women, aged 30, 51, 65, and 66, all had serious difficulties with alcohol, including medical difficulties (chronic liver disease, hepatitis, an arm sprain-the result of an automobile accident). Three of the four women had previous admissions for alcoholic treatment.
Procedure Each subject met individually with this author, then a dance/movement therapy intern, for six one-hour sessions (two times per week for three weeks). Prior to the first, third, and sixth sessions, the subject was given the first half of the Drawing-of-the-Human-Figure Test. At the end of the first, third, and sixth sessions, she was given the second half of the test. (Inasmuch as no control group was used in this preliminary study, splitting the test into two parts gave an opportunity to determine if measurable change occurred as a direct result of the dance/movement therapy sessions.) The movement sessions with each subject began with a movement warm-up, generally initiated by the therapist. The tone of the sessions was one of accepting warmth, as each subject was helped to make a positive attachment to the therapist and to experience her own sense of physical and emotional self as centered, distinct, and whole. The therapist did this by initiating movements that facilitate attachment, such as mirroring of movements and use of props (balls, scarves, stretch band) that can symbolize attachment; by initiating movements that facilitate body boundary awareness (such as patting of various body parts, isolating and stretching body parts and the body as a whole); and by encouraging the patient to experience movements as originating within her body and her self. The latter was accomplished by verbally expressing that she should not do any movement that was uncomfortable in any way; by nonverbally and verbally supporting her when she initiated her own movement responses, and incorporating her movement qualities into the movement; by often structuring movement in such a way that it was not necessary to be in visual contact with each
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other and then gently encouraging not looking; and by asking her to stay with a particular movement for an extended period of time, to do it at her own speed and in a way that was comfortable for her, and, tinally, to initiate the next movement herself. Verbal material in early sessions often centered around topics of attachment to significant others, usually accompanied by much anxiety and fear of loss. One woman spoke of an old boyfriend, and then a dog, both of whom had died suddenly, and another told that she was currently having marital difficulties. Although verbal material was noted and acknowledged verbally by the therapist, active therapeutic intervention was made on a movement level. Each woman presented with a very different movement style. The first session warm-up for one very wealthy woman took the guise of grandly painting and exquisitely decorating the barren room in which sessions were held, using large, sweeping, controlled arm and upper body movements. Another subject preferred fast dancing to the music of Donna Summers, and a third subject was most comfortable making initial contact through small, quiet movements with her feet. The fourth subject’s movement was very light, very quick, with a racing and ungrounded quality. All subjects tended to be inactive in the central portions of their bodies and had difficulty engaging their trunks in the movement; movement of more peripheral body parts was somewhat easier to facilitate. There was a strong tendency in the women to be very watchful of the therapist’s movement, often commenting that they wanted to do it “right,” despite reassurances and encouragement from the therapist to focus on their own physical sensations. Some anxiety or ambivalence about attending sessions was apparent in all subjects prior to the first session, but it was not noted at all in either verbalization or behavior after the first session. Strong attachments to the therapist became apparent by the second, third, or fourth sessions, and was most apparent when the therapist adapted her own movement to reflect the movement qualities exhibited by the subjects. For example, in the third session with one subject, mirroring movements with scarves were being done. The subject willingly led for the first time
and began a series of very quick, agile, “tricky” movements, speaking about magic tricks as she did so. At the end of this session, she expressed obvious delight that the therapist had been willing to try to mirror and follow her even when she was being tricky. After this, the quality of this subject’s movement displayed less anxiety, her verbalizations were less superficial, and she spoke directly of her alcohol addiction for the first time. In the second session, another subject began to speak at length, as she had in the first session, about difficulties with her job, her failing marriage, the death of a close relative, and a miscarriage. During the first session the therapist had rocked to the rhythm of the subject’s voice as she spoke (an anxious rhythm). During the second session, the therapist asked the subject to “walk” the rhythm with her. As this continued, the therapist put a stool in the center of the room and the two took imaginary items from the stool. The subject said she was taking “understanding.” She was very attentive to the therapist throughout this activity and was reluctant to end the session. As the therapist helped to both facilitate and expand the quick, light, indirect movements of one subject by making movements larger, smaller, lighter, and stronger, it became apparent through the verbal material that the patient had suffered many significant losses and was currently having marital difficulties. She said that her nickname was the “flying flea” and that she moved quickly so that no one would notice her limp-the result of a childhood accident. As the movement expanded to include more than “flying,” but also the steady, even tempos of rocking, the quick rhythm of Scottish dance-steps, or the gentle gliding of ice skating, the memories and accompanying sadness, loss, pain, and insecurities began to surface-the patient said she felt everyone would blame her if she expressed unhappiness over her many losses. In the last session she spoke for the first time about the problems she was having in her marriage and how difficult it was for her to talk with other people about these problems. Later sessions for all subjects included many more references to mothers, to early losses in life and to current losses, with a tone less of anxiety and more of sadness. All subjects were much
DANCE/MOVEMENT
THERAPY
WITH FIELD-DEPENDENT
more comfortable with standing, balancing, and push/pull sequences in later sessions-all requiring more ability to deal with separation issues on a body level-and much more movement was initiated by subjects. Subjects all appeared to be more focused on their own movement sensations and less on the therapist’s movement. However, saying good-bye to the therapist was very difficult for all subjects, and resistance to moving was evident with three of the four subjects in the final session. Each expressed verbal appreciation to the therapist at the end of the six sessions. Scoring Tests Drawing-of-the-Human-Figure The were scored by three independent raters, using the ABC Rating Scale. One rater was a bachelor’s level counselor, a second an artist, and the third a graduate student in art therapy. Each knew that the drawings had been done by alcoholic women, but had no prior knowledge of the actual subjects and did not know which drawings had been done at which points in the treatment. Final score for each drawing was found by averaging the scores from each of the three raters. All raters had been familiarized with the rating scale and had tested at least 84% agreement with criterion scores provided by the test developers. Results Three of the four subjects of this study received initially-high scores on the ABC Rating Scale, reflecting a field dependent perception; initial scores were 5, 4.34, and 3.67. The fourth subject’s initial score was 2. (Table 1). (Interrater agreement was 87.5% for all scores.) A paired t-test against one-sided alternatives for small samples was done on the initial scores (first session only) and the final scores (last session only) of all four subjects. Although a change in scores in the predicted direction of high to low (less articulated to more articulated) did occur, it was not to a significant degree (p < .15). A paired t-test was also done using the same scores for only the three subjects whose initial scores were the predicted high scores. The changes in these scores were in the predicted direction and were found to be highly statistically significant (p < .0075).
ALCOHOLIC
WOMEN
353
Table 1 Raw Scores* on the Drawing-of-the-Human-Figure Articulation-of-Body-Concept (ABC) Rating Scale First Session
Third Session
Test
Sixth Session
Subject 1 before session after session
5 5
4 4
4 4
Subject 2 before session after session
4.34 4.34
4.34 4
4 3.34
Subject 3 before session after session
3.67 3.34
3.34 3
3 3
Subject 4 before session after session
2 2
3 3
2.67 2.61
*Average
score
of three
independent
raters
Finally, similar analyses compared scores on all drawings done prior to sessions with all scores on drawings done at the conclusion of sessions for the purpose of determining if significant change occurred during the sessions. When the scores of all four subjects (p < .026) and the three initially high-scoring subjects (p < .025) were compared, change was found to be statistically significant. Discussion/Implications
for Future Research
Considering the preliminary nature of this study and the difficulty of obtaining statistically significant results with such a small sample, these are surprising and exciting findings. Despite the obvious limitations of the study (small sample, no control group, absence of long-term follow-up, one therapist, etc.), the results indicate that the nonverbal dance/movement therapy medium may enable the more field-dependent person to move, at least temporarily, to a state of greater articulation, as reflected in the drawing of the human figure. There is a difference of opinion as to the degree of change possible in one’s style of perception once adulthood has been reached, with some researchers finding that the more markedly field-dependent person has a tendency to “merge” and thus feel better early in therapy
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DORAN
without long-term change (Witkin, Lewis, & Weil, 1968). However, these results are not a reflection of the merging or attachment aspect of the therapeutic relationship, but of the ability to articulate or distinguish, to feel separate and distinct. They also suggest that change in perception is possible in adulthood, again at least temporarily, and with adults of advanced years. It would be helpful to attempt to replicate these findings with alcoholic and other typically field-dependent populations, adding a variety of variables and including a more exact measure of field dependency-independency, such as the Embedded-Figures Test. An examination of the differences that occur as a result of group dance/movement sessions versus individual sessions may help to clarify the question of the value of interpersonal relationship to the facilitation of this kind of change. Obviously, long-term follow-up of subjects to determine if changes are permanent would be very helpful. If these findings can be replicated in more sophisticated studies, and especially if changes are found to be long-lasting, new areas of consideration would be exposed for understanding the unique value of the therapeutic use of dance/ in the process of separationmovement individuation as it relates to existing psychological theory of cognitive style. This would not only be clinically helpful to the dance/movement therapist, but would help to present the unique value of this creative art to the mental health community and to society at large. References Amon, M. D., Kleinman, M. S., & Kissin, M. D. (1974). Psychological differentiation in heroin addicts. Intunarional Journal of the Addictions. 9. 15 I-159.
REILAND Basseches, H. I., & Karp, S. A. (1984). Field dependence in young anorectic and obese women. Psychotherupy and Psychosomatics, 41, 33-37. Jacobson, G. R., Van Dyke, A., Sternbach, T. G., & Brethauer, R. (1976). Field dependence among male and female alcoholics: Norms for the rod-and-frame test. Perc,eptual and Motor Skills, 43. 399-402. Karp, S. A., & Konstadt, N. L. (1965). Alcoholism and psychological differentiation: Long range effect of heavy drinking on field dependence. Journal of’ Nervous and Mental Disease, 40, 412-416. Karp, S. A., Poster, D. C., & Goodman, A. (1963). Differentiation in alcoholic women. Journal of‘Persona/iry. 31, 386-393. Karp, S. A., Witkin, H. A., & Goodenough, D. R. (1965). Alcoholism and psychological differentiation: Effect of alcohol on field dependence. Journal of Abnormal Psychology, 70. 262-265. Kingsland, R. C., & Greene, L. R. (1984). Psychological differentiation and clinical depression. Cognitive Therapy and Research, 8(6), 59%605. Machover, K. (1949). Personality prc?iection in the drawing on the human jigure. Springfield, IL: C C Thomas. Oltman, P. K. (1986). Psvchological differentiation theory in social and cross-cultural p&hology. In N. Bertini: L. Pizzamiglio, & S. Wapner (Eds.), Field dependence in psychological theory. research and application (p. 85-91). Hillsdale, NJ: Erlbaum. Weckowicz, T. E., Collier, G., & Spreng, L. (1977). Field dependence, cognitive functions, personality traits, and social values in heavy cannabis users and nonuser controls. Psychological Reports, 41, 291-302. Witkin, H. A. (1965). Psychological differentiation and forms of pathology. Journal of Abnormal Psychology, 70, 317336. Witkin, H. A., Dyk, R. B., Faterson, H. F., Goodenough, D. R., & Karp, S. A. (1962). Psychological d~ferentiation. New York: Wiley. Witkin, H. A., Lewis, H. B.. Hertzman, M., Machover, K., Meissner, P. B., & Wapner, S. (1954). Personality through perception. New York: Harper. Witkin, H. A., Lewis, H. B., & Weil, E. (1968). Affective reactions and patient interactions among more differentiated and less differentiated patients early in therapy. Journal of’N<~rvous and Mentul Disease, 146, 193-208.