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Looking backward, dancing forward: A student's encounter with the practice of dance movement therapy
The Arts in Psychotherapy 34 (2007) 249–255
Looking backward, dancing forward: A student’s encounter with the practice of dance movement therapy Rob Baum, Ph.D. ∗ Centre for Drama and Theatre Studies, Monash University, Wellington Road, Victoria, Australia
Abstract Early clinical placements in dance movement therapy are students’ first encounters with the discipline as practiced. Clinical placement accentuates differences between class work, study and movement experientials (somatic learning) with other “normal urban neurotics,” and the actual needs and expressions of clinical populations. A student’s remembered perspective produces a less complicated view of the medical and ethical issues faced by a therapeutic team. The author frankly reflects on her student work – and emotional confrontation – with developmentally delayed children and their caregivers in a day programme. She explores the revelations and paradoxes of therapeutic provision, including counter-transference, family structures, and local regulations. © 2007 Elsevier Inc. All rights reserved. Keywords: Dance therapy; Developmental theory; Student practitioner
Perspective Fieldwork necessitates a substantial leap from acquaintance with literature to the expectations of practice. This article derives from notes made as a dance movement therapy (henceforth DMT) student in clinical placement, tempered by the reflective stance of a professional handling her own populations. The central issue is the DMT student’s first encounter with the actual embodied contexts, prescriptions and problems of professional DMT practice, and the ongoing development required for the work. I have sought to retain the novice’s original perspective on our discipline while infusing this article with the benefits of continuing engagement and experience. Although these observations occurred during my placement with Ms. Susan Maling, a very experienced RDMT based in Melbourne, the issues addressed remain my own. I am fortunate to have had the opportunity of a placement in a well-designed and expertly run program, and to have been nurtured through my first startling discoveries of DMT practice by so generous a practitioner: Maling’s guidance continues to inflect my work. Structure “Noah’s Ark” is a community facility that began as a toy library; 20 years later, the lending library is still in operation and a wealth of programmes for children take place in the two-storey Victorian residence. The programs are government-funded but run by a private organization, and the therapeutic team has the ability and autonomy to ∗
Tel.: +61 3 9905 2961; fax: +61 3 9905 3241. E-mail address: [email protected].
0197-4556/$ – see front matter © 2007 Elsevier Inc. All rights reserved. doi:10.1016/j.aip.2007.02.004
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make decisions and policies centred on humanitarian and practical issues rather than the government’s economical and political concerns. Like its sister programmes from the 1980s, Noah’s Ark is a “family-based” operation that strives to support the unity of family. This may sometimes be at odds with the leanings of the therapists employed there. For instance, all the therapists with whom I worked on the Noah’s Ark team were child-based: they placed the needs of children in our care before those of their parents or the family unit. This dichotomy in focus becomes critical when making treatment decisions or determining duty of care, as I will show. Unlike my student peers in other programmes and facilities, I worked directly with children and their caregivers in weekly group-therapy sessions, and I was involved in the work of three distinct groups within the programme. The therapist (the DMT or an Occupational Therapist) would work directly with a child who was sitting either on the therapist’s or mother’s lap, while explaining to the entire group the somatic protocol she was following. In any single session there were 8–12 children accompanied by their caregivers, generally birth-mothers, as well as the 3–5 members of the therapeutic team. A group of 20 people was common. Some mothers had two or three children present, and children would be carefully distributed among the team members to provide optimum results both in terms of the current treatment and later follow-up. The most severely affected children were handled first by therapists modelling treatment, and then handed to their caregivers; the therapists would observe the caregivers’ understanding and continuance of the movement. As I would discover, having caregivers present did not make the work easier. On the contrary, the caregivers had their own needs, which they also (perhaps unconsciously) sought to meet during the children’s work. Sometimes the caregivers’ own issues overshadowed those of the children. Over an 8-week period of placement I observed and participated in three distinct groups made up from a population of developmentally delayed children, ranging in age from infant-in-arms to 4 years. Sessions are called “movement therapy,” acknowledging DMT as an active and successful modality. As the DMT trainee I had the benefit of working with a therapeutic team made up of many modalities – occupational therapy, speech therapy, physiotherapy, dance therapy, and play therapy – all adhering to a humanistic psychotherapeutic approach of ample patient/client interaction, wellness, and transparent process. All participants – children, caregivers, and therapists – share a need for recognition, growth, and personal acceptance, and the circle is a meeting ground for all those present, showing that no one is more important than another. The circle also provides the basic structure for using the techniques of Dance Therapist Marian Chace, whose early work in circular patterns proved the simple effectiveness of this form for therapeutic work. The “good enough” mother The programme’s tendency to reinforce mothers’ desires (unless signalling a clear case of present harm) aligns with the notions of early developmental theorist Donald Winnicott that the “good enough” or “ordinary devoted” mother instinctively and compassionately knows what is best for her child (Winnicott, 1988: 3). Obviously Winnicott deals with special populations elsewhere; I wish here to identify “good enough” with “normalcy”: We often talk about difficult children, and we try to describe and classify their difficulties; we also talk of normality, or health, but it is much harder to describe a normal child. [. . .] But a child with a healthy body, and a normal or even supra-normal intellect, can still be very far from normal as a whole personality. [. . .] (Winnicott, 1964: 124). In the combined population of my group’s weekly session at Noah’s Ark there were female caregivers with post-natal depression, chronic depression, failure to thrive, eating disorders, employment difficulties (such as lack of, desire to return to, problems with employment), genetic abnormalities, chronic illness, and marital problems, to name only a few of the issues. There were additionally problems with husbands or partners, families, and other children (outside the group) whom the team had not met (Kelly, 1992). The type and degree of principal caregivers’ problems and issues can be problematic, requiring their own lengthy, detailed assessments, discussions, and resolutions. I found Winnicott’s great body of knowledge, particularly his notion of the child/mother dyad, extremely helpful: Winnicott (1965) believed that there was no such thing as an infant alone, but only an infant-mother unit. By this he meant that whatever the infant becomes as a social being is mutually created within the merged space molded by both the infant and its mother (Dosamantes, 1992, p. 261).
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Thus working directly with the mother–child dyad as a single unit provides an optimum opportunity for intervention, modelling and progress.1 Several mothers in the group exemplified the significance of taking the caregiver’s own health into consideration in this work. Like many of the women, O.’s mother suffered from post-natal depression, but her situation was complicated by a history of psychosis. She was unable to be psychologically or emotionally present for her twin boys for the first 2 or 3 years after their births. The fact that she bore twins essentially doubled the trauma of birth, as there was thus twice the demand upon her as a mother. Both boys were afflicted (although they received different assessments), but the therapeutic team made the decision for the mother to work with O. alone in this group, due to his gross muscle motor delays, tendency to use impulsive speech as a distraction, and dire attention deficits. I asked whether the other boy were receiving care in another group, perhaps later in the week, and discovered that he was not—because the team felt that the mother would be unable to cope with an additional diagnosis, let alone the second child’s treatment schedule. As a result of the caregiver’s own mental condition, therefore, one of her children did not receive vital care. I was privately cautioned about my (privately expressed) lack of sympathy for the mother. Subsequently I moderated my impression of what constitutes appropriate care, as opposed to what comprises desirable treatment. Caregivers’ health concerns may be identical to their children’s, particularly when genetic. Social attitudes expressed as a mother’s “culpability” for the deformity of her child only add to the guilt and grief the mother is already experiencing in seeing and handling her “abnormal” child (Hannaford, 1985; Morris, 1991). In a facility that aims to care for both child and mother in a single group – thereby presenting a model for a working mother-child dyad – the mother’s experience must also be consistently “good enough” (Winnicott, 1964). Without consistent modelling and reinforcement of appropriate dyadic responses, the caregiver may cease to attend the group – removing the child from regular treatment. But the consequences of genetic predisposition need not always be unhappy. In the post-play morning tea time one week I discovered that one of the mothers with two children in the group has passed down a genetic deformity resulting in physical shortening of the arm ligaments in both of her children. In the infant’s body it was most severe. Within a few minutes of gentle questioning I was able to determine the extent of the abnormality in the mother’s own body and a measure of its psychological effects upon her. When I suggested simple activities that she might consider doing with her children, in which the physical problem would not painfully surface, she was thrilled. I realised that the team treatment protocol, while emphasising the interaction between parent and child, does not include any physical assessments of – or interventions for – the parent. Fearing that I had overstepped my authority in the situation, I debriefed later with the DMT. Maling encouraged me to draw from my own training (years in dance, sport, anatomy, and kinesiology) while carefully noting the methods of the therapeutic team: I was always in the company of four or five other trained professionals.2 Further, Maling reinforced my work with the mother, acknowledging her long-held desire to run movement classes dedicated to caregivers’ bodies. Unfortunately, these classes never commenced, due to the lack of funding for parental therapy (which might at least provide for child care during “the women’s” hour). Most of the mothers experienced great difficulty in taking or finding time to care for themselves, given the needs of their children; they expressed guilt over this, as well. These are some of the problems intrinsic to treatment of developmental delay even in a family-based paradigm. It is challenging enough for a caregiver to find and follow a relevant and progressive course of treatment for the child with developmental delay, let alone provide an outlet for self expression or therapy. In the following example of a sensory integration exercise, I show the importance of recognising children’s special needs and the difference between an adequate and an appropriate response. In this regard, the dance therapy novice may represent a “good enough” mother. The experienced and knowledgeable DMT, however, can intervene to create a more constructive and supportive mother–child dyad.
1
See also Leventhal (1980) and Stern (1977). The issue of responsibility is a significant one, based on a number of variables, including: the DMT trainer’s preferences, experience and contractual responsibilities; the DMT trainee’s abilities, background, and credentials; the institution’s duty-of-care; and local statutes. Australian protocols are markedly different from those in, for instance, the US, where states set their own codes: my experience in the US is that states with more remote populations grant broader authority to individuals with a lesser degree of training, under the rubric of “para-professional” standing. Soon after the occurrence described, I visited the Victorian offices for children services to enquire about local codes for duty-of-care. I was sent from room to room without getting a substantive answer to my questions, and I was made to feel unwelcome for asking. 2
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Sensory integration One method used to accustom children to physical contact is firm brushing with hair-, cosmetic-, watercolor-, and other brushes, chosen by the children themselves from a basket. During this exercise, caregivers may devote themselves to their own child or children, brush themselves, or (as the therapists often do) brush other children. Most of our caregivers enjoy the sensation of a soft and undemanding touch, and this exercise can be sadly revealing of their domestic situations. Many children revel in this exercise of “body brushing,” some in the process of choice alone: the permission to choose, play with or be touched by a particular object.3 Yet one child gently turned away from me during my brushing of his body. Despite his gentleness I was mortified. I did not understand the deep grief N.’s rejection awakened in me. From my studies I knew enough of “attunement” – the partly intuitive synergy between the dance therapist and her client, through which the therapist “feels” her client – to recognise its absence in my actions; I reprimanded myself for not noticing the small boy’s unspoken wishes. The experienced therapist sensibly avoids the path of self-punishment, which does not benefit client or therapist. In fact, making a poor choice is also part of a therapeutic course, in which some interventions prove more productive than others; every choice provides useful information, when the therapist is attentive. And I was paying attention—but at this point more to myself than to the children. Maling intervened: being able to read somatic signals appropriately as they happen is key to progressive treatment. Although a moment before N. had been enjoying the contact, he had “suddenly” reached the limits of his sensory participation and was “overloaded.” (In fact it was not sudden at all, but I did not then recognise N.’s progression towards overload.) Suffering from post-natal depression, his mother could not alert me to this, herself lacking the stamina to continually follow his movements. N. did not intend to shun my attention: what I initially perceived as egotistic recalcitrance was actually the physical response of his skin to the touch of the brush. As a principal organ of the body with its own intricate system of response, the skin reveals the physical and psychic reality of the individual (Pines, 1993) and is of special significance in early development due to its function as a boundary between child and environment (Bick, 1968). As DMT Susan Stockley writes: Sensory stimulation provokes a response kinaesthetically which helps balance spatial orientation, so that a person feels more grounded in the here and now, and more self-aware. Emotionally, sensory stimulation provides contact, warmth, and closeness, and decreases a person’s sense of isolation and despair. The need to experience warm, loving contact continues throughout life . . . (Stockley, 1992: 89–90). N.’s ability to reject and end the brushing was actually a positive reaction, in accordance with Ostrov’s (1981) finding that children should take the lead in the mother–child “conversation, which may appear as non-verbal reciprocity.4 There were two children with sensory integration problems, and I had fixated upon one of them. I felt each of N.’s responses as a knife to my own skin; my scalp prickled with his difficulties – I felt raw – but did not think to mention any of this to the therapeutic team. My peers had already heard my stories of how hard the work was (I was the first to “go into population”); when they went out on placements I expected to hear of similar disturbances. But none were forthcoming. Each student loved her population (as did I), and although some expressed nervousness no one expressed emotional difficulty. I alone seemed to be unsuited to the work, and it was in the context of a confession that I at last said something to one of my DMT teachers. By this time several weeks had passed; I continued to work with the groups; each week I de-briefed for an hour or more with the DMT. (I have already noted Maling’s generosity.) But then, and for hours afterwards, I would walk the city streets; going in and out of shops, touching cloth or paper or wood without feeling its texture; unable to eat, drink, sit, meet with a friend, work, or even read. Four or more hours would pass in this way, until night was falling, and I made myself go home, because I had a cat to feed. So I asked my teacher: how is dance movement therapy bearable, if one must be useless for the remainder of the day, if not two days? And I described my “zombie-like” state following the 3 h morning sessions. My teacher instantly recognized these reactions as my counter-transference – not a personal failure but part of the therapeutic process –
3
For an explanation of sensory integration problems, see Bick (1968). The experience of the skin in early object-relations, International Journal of Psychoanalysis, 49, 114–118. See also connections between disabilities (more broadly defined) and child abuse, in Kelly (1992). The connections between disability and child abuse: a review of the research evidence, Child Abuse Review, 1, 157–167. 4 Compare Schaffer’s (1977) description of “pseudo-dialogue” as the equivalent of a reciprocating movement interaction.
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and a topic we would be studying shortly. At this time I understood “counter-transference” as something related to transference, but I did not really know what that meant. I assumed it pertained to the population at large, meaning that I would never be able to work with developmental delay. In subsequent coursework I became the peer “expert” on counter-transference, as I was the only one of my training group to have experienced it. I came to understand that through N.’s aversions to touch I was re-experiencing my own childhood sensitivities. Counter-transference is, in part, an inability to provide an interpretation of the client, and substitution of the therapist in his place. That is, instead of understanding N.’s reaction I had also reacted, focusing upon my own feelings, hurt, and memories. Dance therapist Penny Bernstein describes counter-transference as the “interchange of energy flow from somatic unconscious to somatic unconscious [with] the quality of an embodied vision . . .” (Bernstein, 1984: 182–3). In my body I felt the “polarized aspect of the complex” of the child’s behaviours—in my interpretation the reason for N. pulling away from me became the reason I had pulled away from adults as a child. This may be useful processing for the therapist in her work, but not for the client in the moment: my history has nothing to do with N.’s movement patterns or therapeutic process. The irony is that, by feeling the counter-transference – by setting off my own childhood memories – I was attuning. But I did not recognise it because I was so engrossed in my interpretation of these events, lost in my own narrative. My response was later addressed in supervision, and I began to come to terms of my own counter-transference: as Mary Whitehouse put it, “I discovered that I worked directly with the unconscious when I worked with the body” (1977: 4). This would prove a recurrent theme in my encounters with developmentally delayed children.5 Creating the holding environment Behaviour and intention differs among developmentally delayed children. In one session, 3 out of 10 children were on their feet and running around the room while the group and therapists sat in the circle. To the untrained eye, though physically dissimilar the three boys were behaviourally similar; in a mainstream class, group, or cr`eche all three boys would have been escorted kindly (or roughly) back to the central activity and invited (or made) to rejoin. In this group, however, O., J., and G. were seen to exhibit diverse movement qualities, and were treated quite differently. I will describe the habitual and specific movement behaviour of each boy, then explain the DMT’s intervention. O. habitually exhibited physical aggression (primarily kicking), precocious speech (using speech to avoid physical action of most kinds) and aggressive behaviours (for instance, an incident of self-poisoning). Without apparent movement difficulties, O. walked directly to the door and tried to leave the room, loudly twisting the knob and kicking the locked door. O. was a boy whose large size was daunting for the other children; such aggression, though ostensibly directed at the door, was frightening for the group. Conversely, J., a very small boy and chronically malnourished, habitually ran rather than walked, his body light, rigid, and erect as he lacked the balance to lean frontally into the run. Born prematurely, he exhibited associated attention deficits, ineffective or delayed growth, and failure to thrive. These factors were, in his case, more an indication of his mother’s depressed state than of his own early birth. His running took him erratically from place to place in the room without lasting preference, in accordance with a marked attention disorder. Lastly, G.’s movement was marked by its rarity: he was customarily content to sit in his mother’s lap, passively responding to movements externally initiated by his mother or a therapist. He was clingy and, apart from his mother-fixation, lacking in attention. On this occasion, however, G. ran directly and steadily around the room, occasionally yelping, distracting everyone in the circle. O.’s activity was perceived as wilfully distracting and a means of avoiding movement instruction and group interaction. The DMT’s response was to immediately return O. to the group and instruct him that if he were outside the group he would cause other children to leave the group. J.’s running was perceived as impulse-driven and, given his small size, a marker of his motor difficulties: although he was superficially strong and well-coordinated, on his feet and in nearly continual movement, he was actually unable to stop or control his movements, meaning that he could not simply walk. The team therefore permitted him to run aimlessly for about 5 min, and then his mother was asked to scoop him up onto her lap.
5 I have since found Penny Bernstein’s acknowledgement of counter-transference very helpful; see Bernstein (1986) and Lewis (1992). I feel that this area requires more investigation, and as a result have made personal encounters with counter-transference an ongoing discussion in my own peer tutorials.
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This left G., the only boy allowed to run around the group as we sat together in our play circle. I found this inequity in the therapists’ response puzzling; the team seemed to be playing favourites. Although I managed to suppress my questions they emerged during our debriefing that afternoon. Maling then explained what the therapeutic team had detected: while G. appeared to be running outside the group he was actually running around the group—exhibiting a normal child’s developing relationship to space by defining the physical parameters of the group. The sophistication of this distinction was difficult for me to absorb, but I later understood it in the context of Marcia Leventhal’s work with early development. Leventhal asserts that space is critical in: helping a child build towards autonomy over non-conflictual objects, dealing with primitive separation . . .. Space in all its ramifications is used as a container in order to facilitate individuation (Mahler, 1968), a first step leading to both integration of the multitude of stimuli-forming personality and preceding socialization . . . (Leventhal, 1979: 176). From this incident I also learned that a child’s return to the circle was not, after all, punishment, but the point of the session. The modelling that goes on between the therapeutic team and the care-givers, through the medium of the infants’ bodies, is a restoration, or in some cases initiation, of the mother–child dyad in the context of nearness, warmth, and touch. These are also issues of space, the space shared by mother and child in the holding environment. For some of these infants, being held silently, firmly, or lovingly was the outcome of Noah’s Ark programs. Winnicott perceived the dyad as a solitary unit, with emphasis upon the “nursing couple” rather than a baby and its mother; Judith Kestenberg’s work with childhood development extended Winnicott’s “good enough mother” into the realm of movement, noting the mirroring of the mother by the child: Kestenberg has found that infants and mothers engage in reciprocal “holding” patterns, in which not only does the mother hold the child, but the child “holds” the mother as well, by its weight distribution, its effort flow, and its shaping patterns. Through mutual accommodation, mother and child learn to trust each other. Says Kestenberg: “The trustworthy baby does not lean on the mother so heavily that she cannot breath in comfort, nor does the trustworthy mother hold him in a rigid embrace which interferes with his respiration. The same is true of shape-flow rhythms” (Feder and Feder, 1981, p.163). Kestenberg’s work is useful in the Noah’s Ark population, where babies and mothers are seen and treated together (despite the greater emphasis upon the children). Because of their own serious problems, the mothers are likely to transmit what kinesic researchers view as “double messages,” patterns, postures, and movements that lack psychic synchrony, and encourage responsive dyssynchronous movements in their infants. This is particularly prevalent among schizophrenic mothers; as Kestenberg notes: It becomes very apparent to the observer of infants that early positions and directions imposed upon the infant can become embedded in individual body attitudes. The significance of such study seems to lie in the potential the findings offer for preventive as well as for therapeutic work (Kestenberg and Buelte, 1977, p. 349). The holding environment of the dance circle is a space from which to venture, and to which to return, like the ideal concept of “home”: knowing that it is a constant in the space, the session, and the adults’ bodies (mothers and therapists), children may leave the circle, run its circumference, and be sure of finding and coming back to their mothers afterwards. This also a form of mirroring, the physical and mental reflection of a concept, created by bodies seated in a circle and the adults’ mindfulness of the children’s place among them. Even in this example of unplanned activity, the children’s movements herald the temporal dimension of space, recognition of time continuance, and boundaries between body and environment—the place where “I” stop and the object begins. As Mahler, Pine, and Bergman (1975) discovered in their research on children’s movement within the mother–child dyad, They observed the growing motility patterns as evidence of ‘separation’—the distancing and coming close again to mother that the child must go through in order to achieve the task of becoming a person (Loughlin, 1992: 1). The activity of moving into another activity therefore carries its own accomplishment of establishing the child’s personality as discrete from the mother. And it was plain that at times the caregivers forgot the children – gratefully forgot, confusedly forgot, or shamefully forgot – as they watched others interacting with the children, sometimes in
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ways they could not bring themselves to do. I see that in my student notebook, among ideas for exercises (wriggling, patting, shrugging, rocking, stamping, squirming—as well as running, shrieking, flying), I wrote: At Noah’s Ark we work with the parent as if they’re perfect, and it is their children who are delayed . . . when often the children are hampered, and will continue to be so, because the parents are so locked in denial . . . But my anger at the caregivers has long since been tempered. From my conversations with Maling, as well as my ongoing DMT supervisor, I came to understand and eventually forgive those periods of respite, of escape, from the reality they faced. What confusion, what terror, they visited daily. There was one young woman, the mother of a child with Downs Syndrome, who expressed alarm upon realising that hers was the only child in the group without metal leg braces. I was the one to explain to her how fortunate she was, that her little girl’s limbs were so strong and flexible and able that she did not require prosthetics in order to stand. Another mother could not stay a minute after the scheduled time, but would hastily pack up her plastic lunch boxes, tiny blankets, and pram, and scurry down the ramp with her two children. One day the two of us were in conversation when her cell phone rang, and she went white. It was her husband, and she was out of time. Looking backward, I recognize that those brief moments when the care-givers could give over, relinquish the constant demand of mindfulness (let alone the physical challenges), were a part of what we offered, and a vital aspect of the holding environment itself. Within this circle, the caregivers could experience the support they desperately needed in order to raise their children. That support was comprised of the comfort of finding others like themselves, others like their children, and professionals cognizant of and sympathetic to the grief they felt when they looked at their children. Where a single caregiver could not bear the task, the circle could generate a collectively “good enough” mother—giving all of us, children, caregivers, and team alike, a time to dance, and a place to hold each other. References Bernstein, P.L. (1986). The somatic countertransference: The inner pas de deux. Paper presented at the American Dance Therapy Association Conference in Chicago. Bick, E. (1968). The experience of the skin in early object-relations. International Journal of Psychoanalysis, 49, 114–118. Dosamantes, I. (1992). Body-image: repository for cultural idealizations and denigrations of the self. The Arts in Psychotherapy, 19, 257–267. Feder, E., & Feder, B. (1981). The expressive arts therapies: Art, music & dance as psychotherapy. New Jersey: Prentice-Hall, Inc.. Hannaford, S. (1985). Living outside inside. Berkeley, California: Canterbury Press. Kelly, L. (1992). The connections between disability and child abuse: a review of the research evidence. Child Abuse Review, 1, 157–167. Kestenberg, J., & Buelte, A. (1977). Prevention, infant therapy and the treatment of adults. International Journal of Psychoanalytic Psychotherapy, 6, 347–349. Leventhal, M. B. (1979). Structure in dance therapy: A model for personality integration. Dance Research Annual, 10, 173–182. Leventhal, M. B. (Ed.). (1980). Movement and growth: dance therapy for the special child. In Symposium on dance therapy for the special child (New York City 1979). Lewis, P. (1992). The Creative arts in transference/countertransference relationships. Arts in Psychotherapy, 19, 317–323. Loughlin, E. (1992). Becoming a separate person. Dance Therapy Collections, 1, 1–3. Mahler, M. S., Pine, F., & Bergman, A. (1975). The psychological birth of the human infant: Symbiosis and individuation. New York: Basic Books. Morris, J. (1991). Pride against prejudice: Transforming attitudes to disability. Philadelphia, Pennsylvania: New Society. Ostrov, K. (1981). A movement approach to the study of caregiver communication during infant psychotherapy. American Journal of Dance Therapy, 4(1), 25–41. Pines, D. (1993). A woman’s unconscious use of her body: A psychoanalytical perspective. London: Virago Press. Schaffer, R. (1977). Mothering. London: Open Books. Stern, D. (1977). The first relationship: Infant and mother. Boston, Massachusetts: Harvard University Press. Stockley, S. (1992). Older lives, older dances: Dance movement therapy with older people. In H. Payne (Ed.), Dance movement therapy: Theory and practice (pp. 81–99). London: Routledge. Winnicott, D. W. (1988). Babies and their mothers. London: Free Association Books. Winnicott, D. W. (1964). The child, the family, and the outside world. New York: Penguin Books.
Looking backward, dancing forward: A student’s encounter with the practice of dance movement therapy Rob Baum, Ph.D. ∗ Centre for Drama and Theatre Studies, Monash University, Wellington Road, Victoria, Australia
Abstract Early clinical placements in dance movement therapy are students’ first encounters with the discipline as practiced. Clinical placement accentuates differences between class work, study and movement experientials (somatic learning) with other “normal urban neurotics,” and the actual needs and expressions of clinical populations. A student’s remembered perspective produces a less complicated view of the medical and ethical issues faced by a therapeutic team. The author frankly reflects on her student work – and emotional confrontation – with developmentally delayed children and their caregivers in a day programme. She explores the revelations and paradoxes of therapeutic provision, including counter-transference, family structures, and local regulations. © 2007 Elsevier Inc. All rights reserved. Keywords: Dance therapy; Developmental theory; Student practitioner
Perspective Fieldwork necessitates a substantial leap from acquaintance with literature to the expectations of practice. This article derives from notes made as a dance movement therapy (henceforth DMT) student in clinical placement, tempered by the reflective stance of a professional handling her own populations. The central issue is the DMT student’s first encounter with the actual embodied contexts, prescriptions and problems of professional DMT practice, and the ongoing development required for the work. I have sought to retain the novice’s original perspective on our discipline while infusing this article with the benefits of continuing engagement and experience. Although these observations occurred during my placement with Ms. Susan Maling, a very experienced RDMT based in Melbourne, the issues addressed remain my own. I am fortunate to have had the opportunity of a placement in a well-designed and expertly run program, and to have been nurtured through my first startling discoveries of DMT practice by so generous a practitioner: Maling’s guidance continues to inflect my work. Structure “Noah’s Ark” is a community facility that began as a toy library; 20 years later, the lending library is still in operation and a wealth of programmes for children take place in the two-storey Victorian residence. The programs are government-funded but run by a private organization, and the therapeutic team has the ability and autonomy to ∗
Tel.: +61 3 9905 2961; fax: +61 3 9905 3241. E-mail address: [email protected].
0197-4556/$ – see front matter © 2007 Elsevier Inc. All rights reserved. doi:10.1016/j.aip.2007.02.004
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make decisions and policies centred on humanitarian and practical issues rather than the government’s economical and political concerns. Like its sister programmes from the 1980s, Noah’s Ark is a “family-based” operation that strives to support the unity of family. This may sometimes be at odds with the leanings of the therapists employed there. For instance, all the therapists with whom I worked on the Noah’s Ark team were child-based: they placed the needs of children in our care before those of their parents or the family unit. This dichotomy in focus becomes critical when making treatment decisions or determining duty of care, as I will show. Unlike my student peers in other programmes and facilities, I worked directly with children and their caregivers in weekly group-therapy sessions, and I was involved in the work of three distinct groups within the programme. The therapist (the DMT or an Occupational Therapist) would work directly with a child who was sitting either on the therapist’s or mother’s lap, while explaining to the entire group the somatic protocol she was following. In any single session there were 8–12 children accompanied by their caregivers, generally birth-mothers, as well as the 3–5 members of the therapeutic team. A group of 20 people was common. Some mothers had two or three children present, and children would be carefully distributed among the team members to provide optimum results both in terms of the current treatment and later follow-up. The most severely affected children were handled first by therapists modelling treatment, and then handed to their caregivers; the therapists would observe the caregivers’ understanding and continuance of the movement. As I would discover, having caregivers present did not make the work easier. On the contrary, the caregivers had their own needs, which they also (perhaps unconsciously) sought to meet during the children’s work. Sometimes the caregivers’ own issues overshadowed those of the children. Over an 8-week period of placement I observed and participated in three distinct groups made up from a population of developmentally delayed children, ranging in age from infant-in-arms to 4 years. Sessions are called “movement therapy,” acknowledging DMT as an active and successful modality. As the DMT trainee I had the benefit of working with a therapeutic team made up of many modalities – occupational therapy, speech therapy, physiotherapy, dance therapy, and play therapy – all adhering to a humanistic psychotherapeutic approach of ample patient/client interaction, wellness, and transparent process. All participants – children, caregivers, and therapists – share a need for recognition, growth, and personal acceptance, and the circle is a meeting ground for all those present, showing that no one is more important than another. The circle also provides the basic structure for using the techniques of Dance Therapist Marian Chace, whose early work in circular patterns proved the simple effectiveness of this form for therapeutic work. The “good enough” mother The programme’s tendency to reinforce mothers’ desires (unless signalling a clear case of present harm) aligns with the notions of early developmental theorist Donald Winnicott that the “good enough” or “ordinary devoted” mother instinctively and compassionately knows what is best for her child (Winnicott, 1988: 3). Obviously Winnicott deals with special populations elsewhere; I wish here to identify “good enough” with “normalcy”: We often talk about difficult children, and we try to describe and classify their difficulties; we also talk of normality, or health, but it is much harder to describe a normal child. [. . .] But a child with a healthy body, and a normal or even supra-normal intellect, can still be very far from normal as a whole personality. [. . .] (Winnicott, 1964: 124). In the combined population of my group’s weekly session at Noah’s Ark there were female caregivers with post-natal depression, chronic depression, failure to thrive, eating disorders, employment difficulties (such as lack of, desire to return to, problems with employment), genetic abnormalities, chronic illness, and marital problems, to name only a few of the issues. There were additionally problems with husbands or partners, families, and other children (outside the group) whom the team had not met (Kelly, 1992). The type and degree of principal caregivers’ problems and issues can be problematic, requiring their own lengthy, detailed assessments, discussions, and resolutions. I found Winnicott’s great body of knowledge, particularly his notion of the child/mother dyad, extremely helpful: Winnicott (1965) believed that there was no such thing as an infant alone, but only an infant-mother unit. By this he meant that whatever the infant becomes as a social being is mutually created within the merged space molded by both the infant and its mother (Dosamantes, 1992, p. 261).
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Thus working directly with the mother–child dyad as a single unit provides an optimum opportunity for intervention, modelling and progress.1 Several mothers in the group exemplified the significance of taking the caregiver’s own health into consideration in this work. Like many of the women, O.’s mother suffered from post-natal depression, but her situation was complicated by a history of psychosis. She was unable to be psychologically or emotionally present for her twin boys for the first 2 or 3 years after their births. The fact that she bore twins essentially doubled the trauma of birth, as there was thus twice the demand upon her as a mother. Both boys were afflicted (although they received different assessments), but the therapeutic team made the decision for the mother to work with O. alone in this group, due to his gross muscle motor delays, tendency to use impulsive speech as a distraction, and dire attention deficits. I asked whether the other boy were receiving care in another group, perhaps later in the week, and discovered that he was not—because the team felt that the mother would be unable to cope with an additional diagnosis, let alone the second child’s treatment schedule. As a result of the caregiver’s own mental condition, therefore, one of her children did not receive vital care. I was privately cautioned about my (privately expressed) lack of sympathy for the mother. Subsequently I moderated my impression of what constitutes appropriate care, as opposed to what comprises desirable treatment. Caregivers’ health concerns may be identical to their children’s, particularly when genetic. Social attitudes expressed as a mother’s “culpability” for the deformity of her child only add to the guilt and grief the mother is already experiencing in seeing and handling her “abnormal” child (Hannaford, 1985; Morris, 1991). In a facility that aims to care for both child and mother in a single group – thereby presenting a model for a working mother-child dyad – the mother’s experience must also be consistently “good enough” (Winnicott, 1964). Without consistent modelling and reinforcement of appropriate dyadic responses, the caregiver may cease to attend the group – removing the child from regular treatment. But the consequences of genetic predisposition need not always be unhappy. In the post-play morning tea time one week I discovered that one of the mothers with two children in the group has passed down a genetic deformity resulting in physical shortening of the arm ligaments in both of her children. In the infant’s body it was most severe. Within a few minutes of gentle questioning I was able to determine the extent of the abnormality in the mother’s own body and a measure of its psychological effects upon her. When I suggested simple activities that she might consider doing with her children, in which the physical problem would not painfully surface, she was thrilled. I realised that the team treatment protocol, while emphasising the interaction between parent and child, does not include any physical assessments of – or interventions for – the parent. Fearing that I had overstepped my authority in the situation, I debriefed later with the DMT. Maling encouraged me to draw from my own training (years in dance, sport, anatomy, and kinesiology) while carefully noting the methods of the therapeutic team: I was always in the company of four or five other trained professionals.2 Further, Maling reinforced my work with the mother, acknowledging her long-held desire to run movement classes dedicated to caregivers’ bodies. Unfortunately, these classes never commenced, due to the lack of funding for parental therapy (which might at least provide for child care during “the women’s” hour). Most of the mothers experienced great difficulty in taking or finding time to care for themselves, given the needs of their children; they expressed guilt over this, as well. These are some of the problems intrinsic to treatment of developmental delay even in a family-based paradigm. It is challenging enough for a caregiver to find and follow a relevant and progressive course of treatment for the child with developmental delay, let alone provide an outlet for self expression or therapy. In the following example of a sensory integration exercise, I show the importance of recognising children’s special needs and the difference between an adequate and an appropriate response. In this regard, the dance therapy novice may represent a “good enough” mother. The experienced and knowledgeable DMT, however, can intervene to create a more constructive and supportive mother–child dyad.
1
See also Leventhal (1980) and Stern (1977). The issue of responsibility is a significant one, based on a number of variables, including: the DMT trainer’s preferences, experience and contractual responsibilities; the DMT trainee’s abilities, background, and credentials; the institution’s duty-of-care; and local statutes. Australian protocols are markedly different from those in, for instance, the US, where states set their own codes: my experience in the US is that states with more remote populations grant broader authority to individuals with a lesser degree of training, under the rubric of “para-professional” standing. Soon after the occurrence described, I visited the Victorian offices for children services to enquire about local codes for duty-of-care. I was sent from room to room without getting a substantive answer to my questions, and I was made to feel unwelcome for asking. 2
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Sensory integration One method used to accustom children to physical contact is firm brushing with hair-, cosmetic-, watercolor-, and other brushes, chosen by the children themselves from a basket. During this exercise, caregivers may devote themselves to their own child or children, brush themselves, or (as the therapists often do) brush other children. Most of our caregivers enjoy the sensation of a soft and undemanding touch, and this exercise can be sadly revealing of their domestic situations. Many children revel in this exercise of “body brushing,” some in the process of choice alone: the permission to choose, play with or be touched by a particular object.3 Yet one child gently turned away from me during my brushing of his body. Despite his gentleness I was mortified. I did not understand the deep grief N.’s rejection awakened in me. From my studies I knew enough of “attunement” – the partly intuitive synergy between the dance therapist and her client, through which the therapist “feels” her client – to recognise its absence in my actions; I reprimanded myself for not noticing the small boy’s unspoken wishes. The experienced therapist sensibly avoids the path of self-punishment, which does not benefit client or therapist. In fact, making a poor choice is also part of a therapeutic course, in which some interventions prove more productive than others; every choice provides useful information, when the therapist is attentive. And I was paying attention—but at this point more to myself than to the children. Maling intervened: being able to read somatic signals appropriately as they happen is key to progressive treatment. Although a moment before N. had been enjoying the contact, he had “suddenly” reached the limits of his sensory participation and was “overloaded.” (In fact it was not sudden at all, but I did not then recognise N.’s progression towards overload.) Suffering from post-natal depression, his mother could not alert me to this, herself lacking the stamina to continually follow his movements. N. did not intend to shun my attention: what I initially perceived as egotistic recalcitrance was actually the physical response of his skin to the touch of the brush. As a principal organ of the body with its own intricate system of response, the skin reveals the physical and psychic reality of the individual (Pines, 1993) and is of special significance in early development due to its function as a boundary between child and environment (Bick, 1968). As DMT Susan Stockley writes: Sensory stimulation provokes a response kinaesthetically which helps balance spatial orientation, so that a person feels more grounded in the here and now, and more self-aware. Emotionally, sensory stimulation provides contact, warmth, and closeness, and decreases a person’s sense of isolation and despair. The need to experience warm, loving contact continues throughout life . . . (Stockley, 1992: 89–90). N.’s ability to reject and end the brushing was actually a positive reaction, in accordance with Ostrov’s (1981) finding that children should take the lead in the mother–child “conversation, which may appear as non-verbal reciprocity.4 There were two children with sensory integration problems, and I had fixated upon one of them. I felt each of N.’s responses as a knife to my own skin; my scalp prickled with his difficulties – I felt raw – but did not think to mention any of this to the therapeutic team. My peers had already heard my stories of how hard the work was (I was the first to “go into population”); when they went out on placements I expected to hear of similar disturbances. But none were forthcoming. Each student loved her population (as did I), and although some expressed nervousness no one expressed emotional difficulty. I alone seemed to be unsuited to the work, and it was in the context of a confession that I at last said something to one of my DMT teachers. By this time several weeks had passed; I continued to work with the groups; each week I de-briefed for an hour or more with the DMT. (I have already noted Maling’s generosity.) But then, and for hours afterwards, I would walk the city streets; going in and out of shops, touching cloth or paper or wood without feeling its texture; unable to eat, drink, sit, meet with a friend, work, or even read. Four or more hours would pass in this way, until night was falling, and I made myself go home, because I had a cat to feed. So I asked my teacher: how is dance movement therapy bearable, if one must be useless for the remainder of the day, if not two days? And I described my “zombie-like” state following the 3 h morning sessions. My teacher instantly recognized these reactions as my counter-transference – not a personal failure but part of the therapeutic process –
3
For an explanation of sensory integration problems, see Bick (1968). The experience of the skin in early object-relations, International Journal of Psychoanalysis, 49, 114–118. See also connections between disabilities (more broadly defined) and child abuse, in Kelly (1992). The connections between disability and child abuse: a review of the research evidence, Child Abuse Review, 1, 157–167. 4 Compare Schaffer’s (1977) description of “pseudo-dialogue” as the equivalent of a reciprocating movement interaction.
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and a topic we would be studying shortly. At this time I understood “counter-transference” as something related to transference, but I did not really know what that meant. I assumed it pertained to the population at large, meaning that I would never be able to work with developmental delay. In subsequent coursework I became the peer “expert” on counter-transference, as I was the only one of my training group to have experienced it. I came to understand that through N.’s aversions to touch I was re-experiencing my own childhood sensitivities. Counter-transference is, in part, an inability to provide an interpretation of the client, and substitution of the therapist in his place. That is, instead of understanding N.’s reaction I had also reacted, focusing upon my own feelings, hurt, and memories. Dance therapist Penny Bernstein describes counter-transference as the “interchange of energy flow from somatic unconscious to somatic unconscious [with] the quality of an embodied vision . . .” (Bernstein, 1984: 182–3). In my body I felt the “polarized aspect of the complex” of the child’s behaviours—in my interpretation the reason for N. pulling away from me became the reason I had pulled away from adults as a child. This may be useful processing for the therapist in her work, but not for the client in the moment: my history has nothing to do with N.’s movement patterns or therapeutic process. The irony is that, by feeling the counter-transference – by setting off my own childhood memories – I was attuning. But I did not recognise it because I was so engrossed in my interpretation of these events, lost in my own narrative. My response was later addressed in supervision, and I began to come to terms of my own counter-transference: as Mary Whitehouse put it, “I discovered that I worked directly with the unconscious when I worked with the body” (1977: 4). This would prove a recurrent theme in my encounters with developmentally delayed children.5 Creating the holding environment Behaviour and intention differs among developmentally delayed children. In one session, 3 out of 10 children were on their feet and running around the room while the group and therapists sat in the circle. To the untrained eye, though physically dissimilar the three boys were behaviourally similar; in a mainstream class, group, or cr`eche all three boys would have been escorted kindly (or roughly) back to the central activity and invited (or made) to rejoin. In this group, however, O., J., and G. were seen to exhibit diverse movement qualities, and were treated quite differently. I will describe the habitual and specific movement behaviour of each boy, then explain the DMT’s intervention. O. habitually exhibited physical aggression (primarily kicking), precocious speech (using speech to avoid physical action of most kinds) and aggressive behaviours (for instance, an incident of self-poisoning). Without apparent movement difficulties, O. walked directly to the door and tried to leave the room, loudly twisting the knob and kicking the locked door. O. was a boy whose large size was daunting for the other children; such aggression, though ostensibly directed at the door, was frightening for the group. Conversely, J., a very small boy and chronically malnourished, habitually ran rather than walked, his body light, rigid, and erect as he lacked the balance to lean frontally into the run. Born prematurely, he exhibited associated attention deficits, ineffective or delayed growth, and failure to thrive. These factors were, in his case, more an indication of his mother’s depressed state than of his own early birth. His running took him erratically from place to place in the room without lasting preference, in accordance with a marked attention disorder. Lastly, G.’s movement was marked by its rarity: he was customarily content to sit in his mother’s lap, passively responding to movements externally initiated by his mother or a therapist. He was clingy and, apart from his mother-fixation, lacking in attention. On this occasion, however, G. ran directly and steadily around the room, occasionally yelping, distracting everyone in the circle. O.’s activity was perceived as wilfully distracting and a means of avoiding movement instruction and group interaction. The DMT’s response was to immediately return O. to the group and instruct him that if he were outside the group he would cause other children to leave the group. J.’s running was perceived as impulse-driven and, given his small size, a marker of his motor difficulties: although he was superficially strong and well-coordinated, on his feet and in nearly continual movement, he was actually unable to stop or control his movements, meaning that he could not simply walk. The team therefore permitted him to run aimlessly for about 5 min, and then his mother was asked to scoop him up onto her lap.
5 I have since found Penny Bernstein’s acknowledgement of counter-transference very helpful; see Bernstein (1986) and Lewis (1992). I feel that this area requires more investigation, and as a result have made personal encounters with counter-transference an ongoing discussion in my own peer tutorials.
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This left G., the only boy allowed to run around the group as we sat together in our play circle. I found this inequity in the therapists’ response puzzling; the team seemed to be playing favourites. Although I managed to suppress my questions they emerged during our debriefing that afternoon. Maling then explained what the therapeutic team had detected: while G. appeared to be running outside the group he was actually running around the group—exhibiting a normal child’s developing relationship to space by defining the physical parameters of the group. The sophistication of this distinction was difficult for me to absorb, but I later understood it in the context of Marcia Leventhal’s work with early development. Leventhal asserts that space is critical in: helping a child build towards autonomy over non-conflictual objects, dealing with primitive separation . . .. Space in all its ramifications is used as a container in order to facilitate individuation (Mahler, 1968), a first step leading to both integration of the multitude of stimuli-forming personality and preceding socialization . . . (Leventhal, 1979: 176). From this incident I also learned that a child’s return to the circle was not, after all, punishment, but the point of the session. The modelling that goes on between the therapeutic team and the care-givers, through the medium of the infants’ bodies, is a restoration, or in some cases initiation, of the mother–child dyad in the context of nearness, warmth, and touch. These are also issues of space, the space shared by mother and child in the holding environment. For some of these infants, being held silently, firmly, or lovingly was the outcome of Noah’s Ark programs. Winnicott perceived the dyad as a solitary unit, with emphasis upon the “nursing couple” rather than a baby and its mother; Judith Kestenberg’s work with childhood development extended Winnicott’s “good enough mother” into the realm of movement, noting the mirroring of the mother by the child: Kestenberg has found that infants and mothers engage in reciprocal “holding” patterns, in which not only does the mother hold the child, but the child “holds” the mother as well, by its weight distribution, its effort flow, and its shaping patterns. Through mutual accommodation, mother and child learn to trust each other. Says Kestenberg: “The trustworthy baby does not lean on the mother so heavily that she cannot breath in comfort, nor does the trustworthy mother hold him in a rigid embrace which interferes with his respiration. The same is true of shape-flow rhythms” (Feder and Feder, 1981, p.163). Kestenberg’s work is useful in the Noah’s Ark population, where babies and mothers are seen and treated together (despite the greater emphasis upon the children). Because of their own serious problems, the mothers are likely to transmit what kinesic researchers view as “double messages,” patterns, postures, and movements that lack psychic synchrony, and encourage responsive dyssynchronous movements in their infants. This is particularly prevalent among schizophrenic mothers; as Kestenberg notes: It becomes very apparent to the observer of infants that early positions and directions imposed upon the infant can become embedded in individual body attitudes. The significance of such study seems to lie in the potential the findings offer for preventive as well as for therapeutic work (Kestenberg and Buelte, 1977, p. 349). The holding environment of the dance circle is a space from which to venture, and to which to return, like the ideal concept of “home”: knowing that it is a constant in the space, the session, and the adults’ bodies (mothers and therapists), children may leave the circle, run its circumference, and be sure of finding and coming back to their mothers afterwards. This also a form of mirroring, the physical and mental reflection of a concept, created by bodies seated in a circle and the adults’ mindfulness of the children’s place among them. Even in this example of unplanned activity, the children’s movements herald the temporal dimension of space, recognition of time continuance, and boundaries between body and environment—the place where “I” stop and the object begins. As Mahler, Pine, and Bergman (1975) discovered in their research on children’s movement within the mother–child dyad, They observed the growing motility patterns as evidence of ‘separation’—the distancing and coming close again to mother that the child must go through in order to achieve the task of becoming a person (Loughlin, 1992: 1). The activity of moving into another activity therefore carries its own accomplishment of establishing the child’s personality as discrete from the mother. And it was plain that at times the caregivers forgot the children – gratefully forgot, confusedly forgot, or shamefully forgot – as they watched others interacting with the children, sometimes in
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ways they could not bring themselves to do. I see that in my student notebook, among ideas for exercises (wriggling, patting, shrugging, rocking, stamping, squirming—as well as running, shrieking, flying), I wrote: At Noah’s Ark we work with the parent as if they’re perfect, and it is their children who are delayed . . . when often the children are hampered, and will continue to be so, because the parents are so locked in denial . . . But my anger at the caregivers has long since been tempered. From my conversations with Maling, as well as my ongoing DMT supervisor, I came to understand and eventually forgive those periods of respite, of escape, from the reality they faced. What confusion, what terror, they visited daily. There was one young woman, the mother of a child with Downs Syndrome, who expressed alarm upon realising that hers was the only child in the group without metal leg braces. I was the one to explain to her how fortunate she was, that her little girl’s limbs were so strong and flexible and able that she did not require prosthetics in order to stand. Another mother could not stay a minute after the scheduled time, but would hastily pack up her plastic lunch boxes, tiny blankets, and pram, and scurry down the ramp with her two children. One day the two of us were in conversation when her cell phone rang, and she went white. It was her husband, and she was out of time. Looking backward, I recognize that those brief moments when the care-givers could give over, relinquish the constant demand of mindfulness (let alone the physical challenges), were a part of what we offered, and a vital aspect of the holding environment itself. Within this circle, the caregivers could experience the support they desperately needed in order to raise their children. That support was comprised of the comfort of finding others like themselves, others like their children, and professionals cognizant of and sympathetic to the grief they felt when they looked at their children. Where a single caregiver could not bear the task, the circle could generate a collectively “good enough” mother—giving all of us, children, caregivers, and team alike, a time to dance, and a place to hold each other. References Bernstein, P.L. (1986). The somatic countertransference: The inner pas de deux. Paper presented at the American Dance Therapy Association Conference in Chicago. Bick, E. (1968). The experience of the skin in early object-relations. International Journal of Psychoanalysis, 49, 114–118. Dosamantes, I. (1992). Body-image: repository for cultural idealizations and denigrations of the self. The Arts in Psychotherapy, 19, 257–267. Feder, E., & Feder, B. (1981). The expressive arts therapies: Art, music & dance as psychotherapy. New Jersey: Prentice-Hall, Inc.. Hannaford, S. (1985). Living outside inside. Berkeley, California: Canterbury Press. Kelly, L. (1992). The connections between disability and child abuse: a review of the research evidence. Child Abuse Review, 1, 157–167. Kestenberg, J., & Buelte, A. (1977). Prevention, infant therapy and the treatment of adults. International Journal of Psychoanalytic Psychotherapy, 6, 347–349. Leventhal, M. B. (1979). Structure in dance therapy: A model for personality integration. Dance Research Annual, 10, 173–182. Leventhal, M. B. (Ed.). (1980). Movement and growth: dance therapy for the special child. In Symposium on dance therapy for the special child (New York City 1979). Lewis, P. (1992). The Creative arts in transference/countertransference relationships. Arts in Psychotherapy, 19, 317–323. Loughlin, E. (1992). Becoming a separate person. Dance Therapy Collections, 1, 1–3. Mahler, M. S., Pine, F., & Bergman, A. (1975). The psychological birth of the human infant: Symbiosis and individuation. New York: Basic Books. Morris, J. (1991). Pride against prejudice: Transforming attitudes to disability. Philadelphia, Pennsylvania: New Society. Ostrov, K. (1981). A movement approach to the study of caregiver communication during infant psychotherapy. American Journal of Dance Therapy, 4(1), 25–41. Pines, D. (1993). A woman’s unconscious use of her body: A psychoanalytical perspective. London: Virago Press. Schaffer, R. (1977). Mothering. London: Open Books. Stern, D. (1977). The first relationship: Infant and mother. Boston, Massachusetts: Harvard University Press. Stockley, S. (1992). Older lives, older dances: Dance movement therapy with older people. In H. Payne (Ed.), Dance movement therapy: Theory and practice (pp. 81–99). London: Routledge. Winnicott, D. W. (1988). Babies and their mothers. London: Free Association Books. Winnicott, D. W. (1964). The child, the family, and the outside world. New York: Penguin Books.