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Models for understanding the nonverbal process in relationships
The Arts in Psychotherapy, Vol. 23, No. 4, pp.341-350, 1996 Copyright 0 1996 Elsevier Science Ltd
Pergamon
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MODELS FOR UNDERSTANDING
THE NONVERBAL
PROCESS
IN RELATIONSHIPS
SUSAN LOMAN, MA, ADTR with LISA FOLEY, MA*
The spirit of this paper embraces the notion of a work in progress modeled after the Stone Center Working Papers Series. It is an attempt to weave together core beliefs drawn from the field of dance/ movement therapy, the Kestenberg Movement Profile (Kestenberg & Sossin, 1979) system of movement analysis and the Relational Model. Movement patterns evolve and change as the individual matures. A predictable sequence of movement development that parallels psychological development can be observed. When traumatic events or obstacles impede the normal growth process, maladaptive experiences get stored in the body and are reflected in body movement. Through movement observation and intervention techniques, the dance/ movement therapist can assess what developmental and/or relational issues the client may be struggling with, while subsequently engaging in work on the movement level to promote expansion of expression and growth.
Recent studies in women’s psychological growth and development (Jordan, Kaplan, Miller, Stiver & Surrey, 1991) have stressed the importance of the quality of relationship across the life span. Jordan, Surrey and Kaplan (1991) re-examined empathy and questioned the emphasis by traditional object relations and self-psychological thinking on separateness, objectivity and autonomy. In the self-in-relation model, the self develops within the context of relationships. This viewpoint offers an alternative to the separationindividuation model (Mahler, Pine & Bergman, 1975) that Surrey called, “relationship-differentiation” (1991a) and her colleagues described as, . . a dynamic process that encompasses increasing levels of complexity, structure and articulation within the context of human bonds and attachments. Such a process needs to be traced from the origins in early childhood relationships through its extensions into all later growth and development. (p. 36)
The Kestenberg Relational development encompasses the goal of deepening the capacity for relationship and relational competence alongside other lines of development, such as creativity, autonomy and assertion. The challenge for those in the relationship is to “maintain connection and to foster, adapt to, and change with the growth of the other” (Surrey, 1991b, p. 60).
Movement
Profile (KMP)
The developmental progression inherent in the framework of the Kestenberg Movement Profile (Loman, 1990) can provide the nonverbal foundations of relational development. The KMP offers movement descriptions beginning with early infant-caregiver interactions, evolving into more multidimensional and
*Susan Loman is Director, Masters Program in Dance/Movement Therapy with a minor in Counseling Psychology and Associate Chair, Antioch New England Graduate School Department of Applied Psychology, Keene, NH. She is the Chair of the Education Committee of the American Dance Therapy Association and provides training in the KMP nationally and abroad. Lisa Foley is an expressive therapist at Jackson Brook Institute, South Portland, ME. 341
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complex interactions. Through a system of movement observation, notation, scoring and analysis the dance/ movement therapist employing the KMP may ascertain specific developmental conflicts as well as strengths present in the client. The KMP can be divided into two major subsystems called the Tension-flow-Effort system (left side of the profile), and the Shape-flow-Shaping system (right side of the profile). The left side of the profile documents a line of development beginning with movement patterns available to the fetus and newborn describing inner needs and affects and evolving to more adult patterns reflecting responses to environmental challenges. The right side of the profile documents a line of development dealing with relationships to people and things (Loman, 1990). For the purposes of this exploration the right side of the profile with be focused upon. The right side of the KMP (Kestenberg & Sossin, 1979) depicts a progression of relational developmental movement patterns as follows: Bipolar ShapeFlow, Unipolar Shape-Flow, Shaping in Directions and Shaping in Planes (See Figure I). For a full description of the KMP, see Kestenberg and Sossin, 1979. Shape-flow Shape-flow expresses plasticity of living tissue. In its simplest form, Shape-flow can be seen in the continuous changing shapes of the body during respiration. It also exists in fetal movement patterns as the fetus expands and contracts. Breathing and other shape-flow rhythms provide structure for increasing and decreasing contact with the environment. Through these rhythms, we express self-feelings and mood through expanded or contracted body shapes and facial expressions. Shape-flow patterns provide a means to express and structure internal feelings about relationships. When we feel trust, for example, we tend to grow and enlarge our body boundaries. On the other hand, growing while in an unpredictable environment may produce dissonance between internal feelings and their outward expression. When there is a disturbance in the balance between feeling and expression, individuals may move in conflicting movement patterns and have difficulty communicating their needs and feelings effectively in relationships. Babies begin to develop self-confidence in trustworthy and predictable environments. As self-trust is built, the foundation for interaction with others is pro-
vided. Shape-flow categories in the KMP can trace the early development of relational patterns. The newborn relates with the external environment, such as air temperature, noise and light, by expanding (growing) and contracting (shrinking) movements in horizontal, vertical and sagittal dimensions. These Bipolarshape-flow (symmetrical) patterns serve the expression of self-feelings, providing the nonverbal medium for demonstrating feelings and moods related to pleasure and displeasure. When infants and caregivers share shape-flow patterns through adjusting to each others’ breathing rhythms and embraces, they tend to develop relationships based on empathy and mutual support. Trust develops out of the predictability inherent in compatible breathing rhythms and supportive holding patterns. Unipolar shape-flow (asymmetrical) patterns form a basis for communication, interactional rhythms and the core of attraction and repulsion. These patterns also exist in utero and continue throughout the life span, providing the source for approaching people and attractive stimuli and withdrawing from unpleasant interactions and noxious stimuli. The body reaches and grows toward stimuli or shrinks away from it. The stimuli may be within the body or outside of it. We grow when we desire contact and satisfaction. When we shrink, we withdraw as the body responds to painful and/or unpleasant feelings. A rhythm of growing and shrinking helps to form nonverbal interaction styles. Through Unipolar shape-flow patterns infants can grow and shrink asymmetrically in response to specific stimuli and people in the environment. Infants can now reveal, through expanding and contracting shapes, which interactions are attracting (growing) and which are repelling (shrinking). Unipolar shape flow patterns provide the structure for discriminating between and responding to feelings of safety and danger. Shaping in Directions The bridging of body boundaries between oneself and another can be articulated through Shaping in directions. These spoke-like and arc-like movements are used to localize people and things in space, such as pointing to someone, and to form protective boundaries used in defending oneself. The ability to erect clear boundaries for self-protection is considered a more developmentally advanced step than Unipolar shape-flow. In Unipolar shrinking, for example, the
THE NONVERBAL Dwcriptionof the Kestenbq Movement ProfIle
The K&&erg Movement profile (I&IF’) is s ~~erbsl sssessment tool which can be used to tiuatc individusls of all sges including the fetus. It :oatsins nine cstcgories of movement psttems cprcsenting two lines of development, s description of he body attitie (the individual’s habitual msnner of aisning the bcdy and including infmmstion not notsted n tbc KMI-‘)and qusnti&ingnumerical data. The ystem for record@ movement includes fiecbsnd racing of muscle tension, snd the USCof symb& &ted from L&an and Lawence (1947) and Lamb 1965). Tbc profiler w&&es nstuml, evexydsy novcmcnt fkm video or live obsuvstion. To notate ldult movement animated conversation is ususlly ~&i&at but notating children rquires observing them luring both sctive snd quiet sctivitics. TbeKMpcsnbedividedint0twomsjorsubsystems alled the Tension-flow-Effort System (Systmn I) snd he Sbspe-flow-Sbspin~ System (System II). System I ncludes 1111 the disgrsms on the I& side of the KMP diagrams l-4) and Systun II includes all of the lisgrsms on the ri&t side of the KM? (diagrams S-9). System I documents s line of development beginning vith movement p&terns svsilsblc to the fehu snd suborn and continuing tbmugbout life. Tension-flow &ytbms and Tension-flow Attributes describe inner acds, foelii snd s&cts. The mOvclnmt psttcms in iystem I wbicb evolve to more sdult psttems reflect esponses to eiwimmnultal chsllcngcs. Tbcy 8.x called ‘recumots of Effmts and Efforts. System II documents s lie of development dealing vitb relstimlsbips to people end things. Tbc top lisgrams, Bipolar snd Unipolar Sbspe-flow, repruent nwement psttems available to the fetus and newborn nd continuica tbrougb~ut life. They describe ymmebicsl and ssymmehicsl dimensional body xpansion and contmctio~ respectively. The next &gay is Sbspe-flow Design which rcpmsmts novement psthwsys towards snd sway fkom the body. ;hspillSin Diiect.ionsrepresents psuems wbicb form ineal vectors. The most sdvrln,xd p&terns are shaping n Planes wlkb represent elliptical designs within one cr more spatial planes (Lomsn & Mermsn, 19%).
1
PROCESS
IN RELATIONSHIPS
BODY ATTl’NDN
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Figure I. KMP of a 13.month-old boy (some statistics not included). From Sossin, K. M. & Loman, S. (1992). Clinical applications of the Kestenberg Movement Profile. In S. Loman with R. Brandt (Eds.), The body mind connection in human tmvement analysis (p, 24). Keene, NH: Antioch New England Graduate School. Copyright (c) 1992 by Susan Loman. Reprinted with permission.
individual can only become smaller and shrink away from a dangerous environment or an attacker. When using Shaping in directions though, the individual is able to better project the body. The creation of linear vectors in space can shield the body from an attacker, such as raising the arm to ward off a blow from above. Shaping in Planes The most advanced level of interpersonal relationships occurs through Shaping in planes. The mover
carves space by creating concave and convex multidimensional forms. Space is carved in combinations of horizontal, vertical and sagittal planes. Differing from spoke-like and arc-like movements, Shaping in planes form elliptical movements that create trace forms, outlining a volume of space. They can represent three dimensional aspects of interaction and are often seen in animated conversation when participants are fully engaged. The implication of using Shaping in planes movement patterns parallels the Relational Model’s criteria
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for mutually enhancing relationships. Similar to Jordan’s description of the “intersubjective, mutual quality of sexual involvement,” Shaping in planes allows for the full expression of oneself (199 1, p. 89). Movement qualities that form and hold space infer a sense of creativity and potential. Movers are engaged in the freedom of fully representing themselves in relationship, while responding to and being moved by each other. The deepening of interaction through Shaping in planes reflects the ever-deepening levels of relational connectedness, with its foundation in authentic self-representation. As Jordan (199 1) has stated, In the interplay of bodies and heightened feelings, in finding interest in the response of the other, in coming to know the impact of one’s own action on the other and opening to the other’s affecting us, there is opportunity for such intensity, pleasure, and growth. (p. 90) The possibility for experiencing the Relational Model’s “Five Good Things” (Miller & Stiver, 1991) is heightened through shaping in planes movement expression. The ability to shape, create and contain the embodied environment, through affective engagement with oneself, the other and the bi-personal space generates feelings of connectedness and empathy (Lewis, 1993).
Stages in Relational
Development
There are many ways that people may choose to move using Bipolar, Unipolar, Shaping in directions and Shaping in planes movement patterns. Movement repertoires are influenced by individual preferences, stage of development, cultural (Amighi, 1990), gender (Lamb, 1992) and environmental factors. To illustrate the developmental differences inherent in these four categories of movement, the example of an embrace will be used. The same goal of initiating contact with another person through a hug will be demonstrated. The hug (embrace) will be traced through the following KMP developmental sequence: Bipolar shape-flow, Unipolar shape-flow, Shaping in directions, and finally Shaping in planes. In the earliest stage, using Bipolar shape flow, the embracers can only grow and shrink symmetrically, which has a stable and self-contained effect. There is
no way to reach beyond themselves, toward each other, while using only Bipolar shape-flow. While already in an embrace, movers can share breathing rhythms by inhaling and exhaling in coordination with one another. While using the next category, Unipolar shapeflow, the embracers can grow toward each other through snuggling into comfortable body parts. This approach might signal the desire for a hug or contact with each other, but no actual embrace would be possible using only Unipolar shape-flow movements. The arc-like or spoke-like qualities available in Shaping in directions tend to have a distancing effect, as lines or boundaries are created between people. It would be possible for the embracers to point to one another, touch body parts, as in meeting elbows or fingers, or even create a stiff hug, but a true enclosing relationship could not be formed. It is when the embracers can use their arms to encircle each other with Shaping in the horizontal plane (enclosing) that the most effective approach for hugging is attained. In this category the embracers can wholeheartedly hug by creating a mutual relational space for intimate contact. If breath support through Shape-flow is used during hugging, the interaction is even more connected. The embracers can breathe synchronously by breathing into each other while inhaling and breathing away from each other on the exhale (Kestenberg, 1978). This breathing rhythm provides a model for a balance between coming together and separating. While maintaining a synchronous breathing pattern, the embracers experience connectedness without losing their unique experience of self (Stiver, 1991). In contrast, reciprocal breathing never allows for coming back to the self. In reciprocal breathing the breathers would always be in contact (one is inhaling into the other’s exhale). Although reciprocal breathing is enjoyable at times, the breathers would tend to lose their connectedness to the self and have difficulty maintaining boundaries. Certain Shape-flow qualities can have a conflicting effect on forming relationships when combined with certain Shaping in planes qualities. For example, a gesture of invitation that spreads out in the arm can impart a mixed signal when the shoulder shrinks up at the same time. The arm suggests a welcoming impression, but the addition of the contracting shoulder suggests holding back. Such conflicting movement patterns are representational of the “paradox” as defined within the Relational Model. As Miller and Stiver, (199 1) outlined,
THE NONVERBAL
PROCESS
In the face of repeated experiences of disconnection, we believe people yearn even more for relationships to help with the confused mixture of feelings. However, they also become so afraid of engaging with others about their experience, that they keep important parts of themselves out of relationship, i.e., they develop techniques for staying out of connection ... Precisely in the face of so needing connection, we develop a repertoire of methods, which we believe we must maintain, to keep us out of real engagement. (p. 2) As described earlier, this “repertoire of methods” for staying out of connection can be observed through inconsistent, conflicting movement patterns. A gesture of spreading (toward connection) may well be combined with the element of shrinking (away from connection) illustrating the conflict in this mixture of movement qualities. As described in the “paradox,” memories of disconnection maintain their stronghold alongside intense longing for connection. Patterns of growing toward and shrinking away from others, the formation of trustworthy and untrustworthy relationships, and early patterns of physical support and holding have a lasting impact on relationships. The development of response patterns to childhood abuse and/ or trauma, illness, unpredictable caretakers and environments and over- or under-stimulation also affect relationships. The following sections on movement empathy and trust illustrate some relevant nonverbal therapeutic interventions. Movement
Empathy
Attunement in Tension-jlow in Shape-flow
and Trust
and Adjustment
At the central core of movement work is the concept of “attunement” or kinesthetic identification, involving a sense of harmony and recognition between attunement” (Kestenberg, the movers. “Complete 1975) is based on mutual empathy, similarity between partners, and a synchronization in rhythms. Attunement requires the process of identification with another’s body movement. Muscular tensions, called “tension-flow,” felt in one person, are also experienced by the other. It is not necessary to directly duplicate the shape the movement assumes in order to empathize. During attunement, physical needs and feelings are responded to. “Visual attunement’ ’ is accomplished while looking at, but not touching the
IN RELATIONSHIPS
mover. For example, if babies kick their legs vigorously, attuning to them involves identifying how their kicking movement feels. The attuner would match the kicking by moving his or her own body (or body part) in rhythm with the baby. The attuner would not have to use the same body part as the baby (Loman, 1980). “Touch attunement” is a similar process to “visual attunement” but includes the component of touch. To illustrate, the attuner would hold hands or touch the mover, matching any tension changes felt in the hand or body. The attuner would move in the same rhythm and use the same degree of tension exerted by the mover. There may be only slight movement, such as small changes in the contraction or stretch in the muscles. While attuning, movement may be felt in the hand alone or throughout the whole body. The numerous variables and sensory combinations inherent in empathic attunement are described by attunement.” As he Stern (1985) as “intermodal stated, There are some qualities or properties that are held in common by most or all of the modalities of perception. These include intensity, shape, time, and number. Such qualities of perception can be abstracted by any sensory mode from the invariant properties of the stimulus world and then translated into other modalities of perception. For example a rhythm such as “long ) can be delivered in or abshort” (-stracted from sight, audition, smell, touch, or taste. (p. 152) Responding to a child or adult who is upset using visual, touch or auditory/vocal/verbal attunement can lead to soothing and mutual understanding. The degree of tension exhibited by a child or adult can be initially matched and then developed into less intense, more soothing patterns (Loman, 1980). Crying infants respond well if their rhythms and intensity levels are matched, rather than met with polar opposite qualities, such as low key gentleness. The matching of intensity created through the engagement in “intermodal attunement” conveys a kinesthetic experience of mutuality to both therapist and client. As Jordan emphasized, Mutual relationships in which seen, understood, and known, ing, seeing, understanding, available, are vitally important
one feels heard, as well as listenand emotionally to most people’s
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psychological well-being. In many know ourselves through relationship. 96)
LOMAN WITH FOLEY ways we (1991, p.
Jordan’s use of sensory components to describe mutual empathy, and the expanded capacity to “be with” one another, would be further enhanced with the inclusion of touch and movement. The deepening through relationship’ ’ inof our ‘ ‘self-knowledge vokes an embodied experience. Although, perhaps speaking metaphorically, the Relational Model consistently refers to embodied methods of attunement and mutuality. Elaborating on relational empowerment and empathy Surrey (1991a) stated, The capacity to engage in an open, mutually empathic relational process rests on the maintenance of fluid “ego boundaries” and the capacity to be responsive and “moved” by the thoughts, perceptions, and feeling states of the other person. Each feels “heard” and “responded to” and able to “hear,” “validate,” and “respond to” the other. . . . The capacity to be “moved,” and to respond, and to “move” the other represents the fundamental core of relational empowerment. (pp. 167-168) Adjustment is based on mutual trust where the shape-flow changes or movement patterns regulating the breathing rhythm are responsively duplicated. Distinguishing which qualities are being responded to, in a more specific way, can enhance the therapeutic process. The interpersonal matching of tensionflow and shape-flow patterns exemplify the nonverbal components of empathy and trust respectively (Kestenberg, 1985). Attunement and adjustment are applicable in a wide range of human interactions including: fetus-mother, parent-infant/child, therapistclient, teacher-student, family interaction, adultadult, child-child, or human-animal. Dance/movement therapists familiar with their own shape and tension-flow movement preferences are able to enter into the therapeutic relational process with greater clarity. Ideally they match whatever feeling state their clients present (Lewis & Loman, 1992). As Stiver (1992) has articulated, both the therapist and the client are continually involved in the “paradox of connection and disconnection” (p. 6). At times such struggle may lead to perceived therapeutic impasse. As it remains the “therapist’s major responsibility
and task to help move the relationship back into connection from periods of disconnection” (Stiver, 1992, p. 6), it is of benefit for therapists to have an indepth understanding of their personal movement preferences as well as inhibitions. This conscious awareness toward self-empathy and an embodied relationship serves as the vessel for both the creation and expression of often ambiguous and conflictual feeling states (Lewis, 1993). As Stiver (1992), stated, “When patient and therapist can move with the rhythm of connection and disconnection and come to understand together what triggers disconnection and how these problems can be resolved, the therapeutic alliance becomes strengthened” (p. 6). The creation of a consistent “holding environment” (Winnicott, 1965) is of great importance for both the therapist and client. A sense of continuity can be created in therapy by maintaining a predictable environment over time, both in the physical layout of the room and by the consistent presence of the therapist. Empathy and attunement can be further developed within the containment of “holding” vessels available within the therapeutic partnership (Lewis, 1993). KMP movement observation skills can help to determine whether the interaction is emphasizing empathy (shared tension-flow) or trust (shared shape-flow). In healthy relationships there is an affinity (good fit) between the shape-flow and tension-flow patterns that are used to support and enhance each other. The following related KMP concepts can be used to further understand the movement components underlying empathy and trust in relationship. Attunement without adjustment-the sharing of tension-flow patterns with another person without the corresponding shape-flow patterns. This interaction illustrates the nonverbal components of empathy and understanding, but lacks the outward expression conducive to support and structure. Adjustment without attunement-the sharing of shape-flow patterns with another person without the corresponding tension-flow patterns, demonstrating the appearance of emotion without the associated internal sensation. The structure for feelings is matched but not the feelings themselves. Clashing-interacting with the opposite extreme movement qualities, such as one person using high intensity boundflow while the partner uses low intensityfreeflow. This example illustrates trying to soothe an enraged child in the midst of a temper tantrum
THE NONVERBAL
PROCESS
(high intensity) by gently stroking (low intensity) the child’s back. Using affinities rather than identical movement qualities-interacting with another person using related or similar qualities that can promote a supportive but non-synchronous interaction. An example of using affined qualities occurs when the therapist responds to a client’s hesitant approach into the dance/ movement therapy session with accommodating, flexible movements. Hesitation and jlexibility are both indulgent Precursors of Effort in the KMP (Merman, 1990). As will be seen in the following clinical case example, Loman described how she attuned to the client’s movements, which provided her empathic support through shared muscle tension. She also adjusted to the shape of her body, promoting trustworthy and reliable interactions that allowed the client to develop a nonverbal relationship at her own pace. Clinical
Case Example
The client, Brunhilda, is an adolescent developmentally delayed girl who also has cerebral palsy. She has little verbal language, speaking only a few words, but is able to understand language and to respond appropriately. She attends a non-residential school for developmentally delayed children and adolescents. She was referred to dance/movement therapy to work on the following goals: to nonverbally communicate needs, to decrease tactile defensiveness, to improve her ability to relax, to work on increasing attention span, eye contact and babbling and to redirect inappropriate behavior, such as excessive giggling. Brunhilda was seen once a week for half-hour individual sessions over a period of nine months. The sessions were held in a large all-purpose room that contained exercise equipment, mats and other props, such as scarves, large therapy balls and instruments. During the first several meetings, Brunhilda was quite distractible, often giggling uncontrollably and unable to maintain eye contact. She could not stay with any activity (using scarves, the large ball, tambourine or balloon, for example) for very long. At times she ran around the room wanting to be chased. Other times she kicked her legs while lying on the mat as if having a temper tantrum. The therapist’s initial goals were to try to develop a beginning relationship and to establish mutual trust. In the KMP model, predictability in the relationship provides the safety for trust to flourish and for cre-
IN RELATIONSHIPS
ativity, spontaneity and dynamics to be contained within the consistent structure (Loman, 1994). The KMP informed the therapist about how Brunhilda moved and expressed herself nonverbally as well as where she was in terms of movement development. She seemed to respond to simple patting rhythms typical of a child in the biting phase of development. When the therapist began to give simple commands, such as “Let’s hold hands down the hall,” she began to respond. As the weeks passed, she initiated sitting in the therapist’s lap. The giggling began to decrease, but her behavior was often erratic and at times she reverted to running around the room, kicking and giggling. A breakthrough occurred when the therapist tried using her preferred patting rhythm as a modified massage. The therapist incorporated the crucial KMP concepts of attunement, based on a sharing of qualities of muscle tension, and shape-flow adjustment, based on a similarity of breathing patterns and the shape of the body, the nonverbal counterparts to empathy and trust. Brunhilda was able to accept this kind of touch and allowed the therapist to pat her back, head, arms and shoulders. When the therapist attempted to change the pattern to the next developmental level using the twisting rhythm, like a kneading movement, Brunhilda clearly indicated, by moving away, that she didn’t like the change. Then the therapist attempted rocking with the patting. Brunhilda played with the therapist’s feet, then assumed the fetal position and allowed the therapist to closely hold and rock her for a long time. After a while, the therapist introduced a large circular band of stretch material and a peek-a-boo game developed that is typical for the twisting phase of development. While under the stretch band, they looked at each other and then looked away. Brunhilda was able to come to the therapist when she wanted to be held. A shift occurred when she began to push the therapist away using the straining rhythm, the next stage in the KMP developmental framework. At first the therapist allowed Brunhilda to have an effect on her bodily positioning and responded by collapsing. Remembering that, during the straining phase, twoyear-olds like to test limits, the therapist wondered if Brunhilda might be asking her, through this pushing movement, if she were strong enough to be there for her. The therapist changed her position and resisted being moved. As the session time was ending, the therapist told her it was time to go and she put on her shoes when the therapist asked her to. While they
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walked to her class there were none of the usual giggles. The KMP approach can further an understanding of the sequence of movement phases typical in development (Loman, 1995). The KMP trained therapist can identify themes that pertain to a specific phase of movement development outlined in the KMP, and then support the client’s exploration of them within the safety of the therapeutic environment. When Brunhilda indicated, through changes in movement patterns, that she was ready to explore the next phase of development (the straining phase), the therapist provided suitable phase-appropriate interventions. The therapist altered her approach to accord with Brunhilda’s needs, especially important in this transition to a more mature phase of development. During the next few sessions, Brunhilda was able to relax more and to maintain more eye contact. A theme of pushing the therapist away and wanting to be held became clear. She also started babbling. Sessions often began with the therapist patting her back. She began to say Mama, make sucking noises, look at the therapist and hide under the parachute. During one session, she switched positions and came closer to the therapist after first hiding under the parachute and pushing her away. She appeared relaxed and trusting of the therapist. She tried pushing the therapist down, but the therapist remained seated and began rubbing Brunhilda’s back and head; Brunhilda assumed a fetal position and climbed on to the therapist’s lap. During the middle of the session, Brunhilda went over to a beach ball, after displaying a mischievous look on her face and lying down on her back, totally extending her body. She seemed to enjoy falling back and repeated this sequence. She then pushed the ball away with her feet and tried lying on it like on a pillow. Soon she began to kick the therapist away and then lie down on her side with her back to the therapist who let her stay there alone for a while and then patted and stroked her back while she lay still with her eyes open. She remained in that position until the end of the session when the therapist patted her softly and told her it was time to go. She calmly walked back to her class, holding hands with the therapist. In a later session, Brunhilda appeared pleased to see the therapist and smiled widely when asked to come for their session. In the therapy room she immediately made it clear that she wanted to be patted on her back. She was extremely calm for 10 minutes. Later she went for a beach ball, covered herself with it and then hit the ball and pushed it away. Her shoul-
ders were very protracted and tense. The therapist said, “It’s hard to look at someone, isn’t it? Try to relax.” She looked at the therapist, but giggled in the process. Brunhilda was able to be direct about wanting to be touched, but was also mischievous about wanting to play and test the therapist. At one point she gently pushed the therapist who responded by retuming the gesture. For a while they struggled, as though wrestling. Brunhilda pushed the therapist over and the therapist pushed her. Later, she initiated rubbing the therapist’s back, which she did for a few seconds, and then pushed her away again. Brunhilda began giggling on the way back to the room, but midway when the therapist took her hand firmly, she was able to stop. In later sessions, some new behaviors included pounding the mat and, with the same rhythm, playing the tambourine and the drum. She would beat the drum while the therapist played the tambourine. Then they switched instruments. They spent much time playing the instruments, hitting the mats and making vocal sounds. The therapist followed Brunhilda’s drumming rhythms. They also played with a rope that developed into a keep-away game and then a tug of war that seemed to be typical of the approach-avoidance theme that had developed. At one point, the therapist pantomimed that she was looking for the rope, which Brunhilda had, and then Brunhilda showed recognition by laughing and hiding the rope from the therapist. With the background of knowing how to help a client channel aggression into phase-specific, creative outlets, the therapist helped Brunhilda express intense feelings through movement expression within the safety of the therapeutic container. In terms of verbal expression, Brunhilda began to “Mama,” babble, and the therapist responded, “Baba.” When Brunhilda said “Baba,” the therapist said “Mama.” Brunhilda appeared to want to take a mother role toward the therapist and hugged and then pushed her away (perhaps what her own mother did). Once the therapist responded by pretending to cry when she was pushed away by Brunhilda, who laughed and put her finger near the therapist’s eye. They were very close most of the session. When they walked back to the room, they held hands and swung their arms. Brunhilda was able to wave goodbye to the therapist and then wave hello to her class, a sign that she was beginning to make additional relationships. As the sessions drew to a close, Brunhilda made progress in maintaining eye contact, taking turns, re-
THE NONVERBAL
PROCESS
laxing, babbling, cooperating and staying with activities for longer periods. The push-pull dynamics became subsumed into games, such as mutual sit ups where Brunhilda and the therapist took turns pulling each other up from a lying position. Discussion Relational
Themes
The therapist’s responses of rhythm duplication via “intermodal attunement” (Stern, 1985) instead of simple imitation, enabled Brunhilda to respond to the therapist more creatively. It is evident in this interaction that the therapist’s ability to attune on an embodied level helped lay the foundations for the development of a mutually empathic relationship. The therapist clearly physically conveyed her ability to be “moved” by Brunhilda, who was able to indulge in the increased sense of relational empowerment inherent in having an impact on others as well as the environment. Through exceptionally simple, yet effective interventions and responses, the therapeutic dyad embodied Miller’s definition of power, as the i‘ . . . capacity to produce change” (1991, p. 198). Both Brunhilda and the therapist experienced a deepened level of connection synonymous with being truly seen and heard (Miller & Stiver, 1991). Another important aspect evident in this vignette is that of relational “resistance” and tolerance for intimacy. Gilligan, Rogers and Tolman (1991) have reframed the clinical understanding of resistance “as a health sustaining process” (p. 1). Their definition parallels the theories underlying the Relation Model’s “paradox” (Miller & Stiver, 1991). Through the therapist’s conscious attunement with Brunhilda’s developmental rhythms, she enabled her to establish contact in a way that is not only safe and trust building, but also enticing. Their interactions highlight Brunhilda’s willingness for further relational engagement, created in an environment of mutual exploration. Developmental
Sequencing
Having the knowledge of the KMP sequential phases helped inform the therapist in which developmental stage Brunhilda was functioning and which behaviors were expected for that stage. The therapist was better able to provide more specific ways of attuning in keeping with Brunhilda’s developmental
IN RELATIONSHIPS
level. During vulnerable transitional periods when Brunhilda was entering a new phase of development, it was essential for the therapist to support Brunhilda’s practicing of the newly emerging movement patterns. The therapist helped facilitate Brunhilda’s working through unresolved developmental issues. Through observation and interaction, the therapist identified that Brunhilda lacked certain indulgent movement patterns and showed an excess of fighting movement qualities. Prone to disorganize readily and having poor communication skills, Brunhilda through a developmentally based form of intervention was provided the opportunity to express herself at her own level while developing less mature qualities in more mature patterns. Over time she was able to improve her impulse control, coping skills and social skills. Her movement repertoire evolved over the course of treatment to reveal patterns reflecting growth and integration. Conclusions The Kestenberg Movement Profile can provide a tool for enhancing the understanding of the subtle and intricate possibilities for nonverbal relationships. KMP provides a vocabulary and a well-developed system of notation to clearly describe the nonverbal aspects continually occurring within relationships. An increased knowledge of the complexities involved in nonverbal communication serves to punctuate clinical understanding and intervention methods with an increased facility toward mutually conscious responses to connection and disconnection. Movement observation and interaction encourages empathy and relational embodiedness, both of self and other. As Kaplan stated, “Empathy in therapy is essential to the successful facilitation of the patient’s growth. It is not, however, some mysterious quality that some people ‘just somehow’ seem to have more than others” (199 1, p. 50). Empathy is an embodied response to the relational and environmental landscape in which we move. References Amighi, J. K. (1990). The application of the KMP cross-culturally. In P. Lewis & S. Loman (Ed%), The Kestenberg Movement Profile: Itspast,present applications, andfuture directions (pp. 114-125). Keene, NH: Antioch New England Graduate School. Gilligan, C., Rogers, A. G., & Tolman, D. L. (Eds.). (1991). Women, girls & psychotherapy: Reframing resistance. New York: Harrington Park Press.
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Jordan, J. V. (1991). The meaning of mutuality. In J. V. Jordan, A. G. Kaplan, J. B. Miller, I. P. Stiver &J. L. Surrey. Women’s growth in connecrion: Wrirings from the Stone Center (pp. 8 l96) New York: Guilford Press. Jordan J. V., Kaplan A. G., Miller J. B., Stiver I. P. & Surrey J. L. Women’s growth in connection: Writings from rhe Stone Center. New York: Guilford Press. Jordan, J. V., Surrey, J. L., & Kaplan, A. G. (1991). Women and empathy: Implications for psychological development and psychotherapy. In J. V. Jordan, A. G. Kaplan, J. B. Miller, I. P. Stiver & J. L. Surrey, Women’s growth in connection: Writings from the Stone Center (pp. 27-50). New York: Guilford Press. Kaplan, A. J. (1991). Empathic communication in the psychotherapy relationship. In J. V. Jordan, A. G. Kaplan, J. B. Miller, 1. P. Stiver & J. L. Surrey. Women’s growth in connection: Writingsfrom the Stone Center (pp. 44-50). New York: Guilford Press. Kestenberg, J. S. (1975). Children and parents. New York: Jason Aronson. Kestenberg, J. S. (1978). Transsensus-outgoingness and Winnicott’s intermediate zone. In S. A. Grolnick & L. Barkin (Eds.), Between reality and fantasy: Transitional objects and phenomena (pp. 63-73). New York: Jason Aronson. Kestenberg, J. S. (1985). The flow of empathy and trust between mother and child. In E. J. Anthony & G. H. Pollack (Eds.), Parental influences: In health and disease (pp. 137-163). Boston, MA: Little Brown. Kestenberg, J. S., & Sossin, K. M. (1979). The role of movement patterns in development Vol. II. New York: Dance Notation Bureau Press. Laban, R., & Lawrence, F. C. (1947). Efsort. London: MacDonald & Evans. Lamb, W. (1965). Posture and gesture. London: Gerald Duckworth. Lamb, W. (1992). The essence of gender in movement. In S. Loman & R. Brandt (Ed%), The body mind connection in human movement analysis (pp. 135-151). Keene, NH: Antioch New England Graduate School. Lewis, P. (1993). Creative transformation: The healing power of the arts. Wilmette, IL: Chiron Publications. Lewis, P., & Loman, S. (1992). Movement components of affect: Tension-flow attributes within the Kestenberg Movement Profile (KMP). American Dance Therapy Association 27th Annual Conference Proceedings. Columbia, MD: American Dance Therapy Association. Loman, S. (I 980). Attunement. Child Development Research News, 2, 3. Loman, S. (1990). Introduction to the Kestenberg Movement Profile. In P. Lewis & S. Loman (Eds.), The Kestenberg Movement Profile: Its past, present applications, andfuture directions (pp. 52-64). Keene, NH: Antioch New England Graduate School.
WITH FOLEY Loman, S. (1994). Attuning to the fetus and young child: Approaches from dance/movement therapy. ZERO TO THREE Bulletin of rhe National Center for Clinical Infant Programs, f5( I), 20-26. Loman, S. (1995). The case study of Warren: A KMP approach to autism. In F. J. Levy (Ed.), Dance and orher expressive art therapies (pp. 213-223). New York: Routledge. Loman, S., & Merman, H. (in press). The KMP: A tool for dance/ movement therapy. American Journal of Dance Therapy. Mahler, M., Pine, F., & Bergman, A. (1975). The psychological birth of the human infant: Symbiosis and individuation. New York: Basic Books. Merman, H. (1990). The use of precursors of effort in dance/ movement therapy. In P. Lewis & S. Loman (Eds.), The Kestenberg Movement Profile: I& Past, Present Applicarions and Future Directions (pp. 85-100). Keene, NH: Antioch New England Graduate School. Miller, J. B. (1991). Women and power. In J. V. Jordan, A. G. Kaplan, J. B. Miller, I. P. Stiver & J. L. Surrey. Women’s growth in connection: Writings from the Stone Center (pp. 197205). New York: Guilford Press. Miller, J. B., & Stiver, I. P. (1991). A relational reframing of therapy (Work in Progress, No. 52). Wellesley, MA: Stone Center Working Paper Series. Sossin, K., & Loman, S. (1992). Clinical applications of the Kestenberg Movement Profile. In S. Loman & R. Brandt (Ed%), The body mind connection in human movement analysis (pp. 21-55). Keene, NH: Antioch New England Graduate School. Stem, D. N. (1985). The interpersonal world of the infant: A view from psychoanalysis and developmenral psychology. New York: Basic Books. Stiver, I. P. (1991). The meanings of “dependency” in femalemale relationships. In J. V. Jordan, A. G. Kaplan, J. B. Miller, I. P. Stiver & J. L. Surrey. Women’s growth in connection: Writings,from the Stone Center (pp. 143-161). New York: Guilford Press. Stiver, I. P. (1992). A relational approach to therapeutic impasses (Work in Progress No. 58). Wellesley, MA: Stone Center Working Paper Series. Surrey, J. L. (1991a). Relationship and empowerment. In J. V. Jordan, A. G. Kaplan, J. B. Miller, I. P. Stiver, & J. L. Surrey. Women’s growth in connecrion: Writings from the Stone Center (pp. 162-180). New York: Guilford Press. Surrey, J. L. (199 lb). The relational self in women: Clinical implications. In J. V. Jordan, A. G. Kaplan, J. B. Miller, I. P. Stiver & J. L. Surrey. Women’s growth in connection: Writings from the Stone Center (pp. 35-43). New York: Guilford Press. Winnicott, D. W. (1965). The maturational processes and the facilitating environment. New York: International Universities Press.
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MODELS FOR UNDERSTANDING
THE NONVERBAL
PROCESS
IN RELATIONSHIPS
SUSAN LOMAN, MA, ADTR with LISA FOLEY, MA*
The spirit of this paper embraces the notion of a work in progress modeled after the Stone Center Working Papers Series. It is an attempt to weave together core beliefs drawn from the field of dance/ movement therapy, the Kestenberg Movement Profile (Kestenberg & Sossin, 1979) system of movement analysis and the Relational Model. Movement patterns evolve and change as the individual matures. A predictable sequence of movement development that parallels psychological development can be observed. When traumatic events or obstacles impede the normal growth process, maladaptive experiences get stored in the body and are reflected in body movement. Through movement observation and intervention techniques, the dance/ movement therapist can assess what developmental and/or relational issues the client may be struggling with, while subsequently engaging in work on the movement level to promote expansion of expression and growth.
Recent studies in women’s psychological growth and development (Jordan, Kaplan, Miller, Stiver & Surrey, 1991) have stressed the importance of the quality of relationship across the life span. Jordan, Surrey and Kaplan (1991) re-examined empathy and questioned the emphasis by traditional object relations and self-psychological thinking on separateness, objectivity and autonomy. In the self-in-relation model, the self develops within the context of relationships. This viewpoint offers an alternative to the separationindividuation model (Mahler, Pine & Bergman, 1975) that Surrey called, “relationship-differentiation” (1991a) and her colleagues described as, . . a dynamic process that encompasses increasing levels of complexity, structure and articulation within the context of human bonds and attachments. Such a process needs to be traced from the origins in early childhood relationships through its extensions into all later growth and development. (p. 36)
The Kestenberg Relational development encompasses the goal of deepening the capacity for relationship and relational competence alongside other lines of development, such as creativity, autonomy and assertion. The challenge for those in the relationship is to “maintain connection and to foster, adapt to, and change with the growth of the other” (Surrey, 1991b, p. 60).
Movement
Profile (KMP)
The developmental progression inherent in the framework of the Kestenberg Movement Profile (Loman, 1990) can provide the nonverbal foundations of relational development. The KMP offers movement descriptions beginning with early infant-caregiver interactions, evolving into more multidimensional and
*Susan Loman is Director, Masters Program in Dance/Movement Therapy with a minor in Counseling Psychology and Associate Chair, Antioch New England Graduate School Department of Applied Psychology, Keene, NH. She is the Chair of the Education Committee of the American Dance Therapy Association and provides training in the KMP nationally and abroad. Lisa Foley is an expressive therapist at Jackson Brook Institute, South Portland, ME. 341
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LOMAN WITH FOLEY
complex interactions. Through a system of movement observation, notation, scoring and analysis the dance/ movement therapist employing the KMP may ascertain specific developmental conflicts as well as strengths present in the client. The KMP can be divided into two major subsystems called the Tension-flow-Effort system (left side of the profile), and the Shape-flow-Shaping system (right side of the profile). The left side of the profile documents a line of development beginning with movement patterns available to the fetus and newborn describing inner needs and affects and evolving to more adult patterns reflecting responses to environmental challenges. The right side of the profile documents a line of development dealing with relationships to people and things (Loman, 1990). For the purposes of this exploration the right side of the profile with be focused upon. The right side of the KMP (Kestenberg & Sossin, 1979) depicts a progression of relational developmental movement patterns as follows: Bipolar ShapeFlow, Unipolar Shape-Flow, Shaping in Directions and Shaping in Planes (See Figure I). For a full description of the KMP, see Kestenberg and Sossin, 1979. Shape-flow Shape-flow expresses plasticity of living tissue. In its simplest form, Shape-flow can be seen in the continuous changing shapes of the body during respiration. It also exists in fetal movement patterns as the fetus expands and contracts. Breathing and other shape-flow rhythms provide structure for increasing and decreasing contact with the environment. Through these rhythms, we express self-feelings and mood through expanded or contracted body shapes and facial expressions. Shape-flow patterns provide a means to express and structure internal feelings about relationships. When we feel trust, for example, we tend to grow and enlarge our body boundaries. On the other hand, growing while in an unpredictable environment may produce dissonance between internal feelings and their outward expression. When there is a disturbance in the balance between feeling and expression, individuals may move in conflicting movement patterns and have difficulty communicating their needs and feelings effectively in relationships. Babies begin to develop self-confidence in trustworthy and predictable environments. As self-trust is built, the foundation for interaction with others is pro-
vided. Shape-flow categories in the KMP can trace the early development of relational patterns. The newborn relates with the external environment, such as air temperature, noise and light, by expanding (growing) and contracting (shrinking) movements in horizontal, vertical and sagittal dimensions. These Bipolarshape-flow (symmetrical) patterns serve the expression of self-feelings, providing the nonverbal medium for demonstrating feelings and moods related to pleasure and displeasure. When infants and caregivers share shape-flow patterns through adjusting to each others’ breathing rhythms and embraces, they tend to develop relationships based on empathy and mutual support. Trust develops out of the predictability inherent in compatible breathing rhythms and supportive holding patterns. Unipolar shape-flow (asymmetrical) patterns form a basis for communication, interactional rhythms and the core of attraction and repulsion. These patterns also exist in utero and continue throughout the life span, providing the source for approaching people and attractive stimuli and withdrawing from unpleasant interactions and noxious stimuli. The body reaches and grows toward stimuli or shrinks away from it. The stimuli may be within the body or outside of it. We grow when we desire contact and satisfaction. When we shrink, we withdraw as the body responds to painful and/or unpleasant feelings. A rhythm of growing and shrinking helps to form nonverbal interaction styles. Through Unipolar shape-flow patterns infants can grow and shrink asymmetrically in response to specific stimuli and people in the environment. Infants can now reveal, through expanding and contracting shapes, which interactions are attracting (growing) and which are repelling (shrinking). Unipolar shape flow patterns provide the structure for discriminating between and responding to feelings of safety and danger. Shaping in Directions The bridging of body boundaries between oneself and another can be articulated through Shaping in directions. These spoke-like and arc-like movements are used to localize people and things in space, such as pointing to someone, and to form protective boundaries used in defending oneself. The ability to erect clear boundaries for self-protection is considered a more developmentally advanced step than Unipolar shape-flow. In Unipolar shrinking, for example, the
THE NONVERBAL Dwcriptionof the Kestenbq Movement ProfIle
The K&&erg Movement profile (I&IF’) is s ~~erbsl sssessment tool which can be used to tiuatc individusls of all sges including the fetus. It :oatsins nine cstcgories of movement psttems cprcsenting two lines of development, s description of he body attitie (the individual’s habitual msnner of aisning the bcdy and including infmmstion not notsted n tbc KMI-‘)and qusnti&ingnumerical data. The ystem for record@ movement includes fiecbsnd racing of muscle tension, snd the USCof symb& &ted from L&an and Lawence (1947) and Lamb 1965). Tbc profiler w&&es nstuml, evexydsy novcmcnt fkm video or live obsuvstion. To notate ldult movement animated conversation is ususlly ~&i&at but notating children rquires observing them luring both sctive snd quiet sctivitics. TbeKMpcsnbedividedint0twomsjorsubsystems alled the Tension-flow-Effort System (Systmn I) snd he Sbspe-flow-Sbspin~ System (System II). System I ncludes 1111 the disgrsms on the I& side of the KMP diagrams l-4) and Systun II includes all of the lisgrsms on the ri&t side of the KM? (diagrams S-9). System I documents s line of development beginning vith movement p&terns svsilsblc to the fehu snd suborn and continuing tbmugbout life. Tension-flow &ytbms and Tension-flow Attributes describe inner acds, foelii snd s&cts. The mOvclnmt psttcms in iystem I wbicb evolve to more sdult psttems reflect esponses to eiwimmnultal chsllcngcs. Tbcy 8.x called ‘recumots of Effmts and Efforts. System II documents s lie of development dealing vitb relstimlsbips to people end things. Tbc top lisgrams, Bipolar snd Unipolar Sbspe-flow, repruent nwement psttems available to the fetus and newborn nd continuica tbrougb~ut life. They describe ymmebicsl and ssymmehicsl dimensional body xpansion and contmctio~ respectively. The next &gay is Sbspe-flow Design which rcpmsmts novement psthwsys towards snd sway fkom the body. ;hspillSin Diiect.ionsrepresents psuems wbicb form ineal vectors. The most sdvrln,xd p&terns are shaping n Planes wlkb represent elliptical designs within one cr more spatial planes (Lomsn & Mermsn, 19%).
1
PROCESS
IN RELATIONSHIPS
BODY ATTl’NDN
1. lmNsIoN-PLow D + _UM-:
_:_:_:_p
-:
_:_:_:_r
_:_:_:_:_M
-T
LSfPl-_:_ L:slMb_:_ M.R. ltstz
. _ ::::::
small au@itude :::::: muudedm ::::::
:::::: :::::: ::::::
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angular menal
3. Plflxmmorn or EFFORT GE=_ AC=-_ L.F= 37 _l:L=flextbUtty
lndlrect
Figure I. KMP of a 13.month-old boy (some statistics not included). From Sossin, K. M. & Loman, S. (1992). Clinical applications of the Kestenberg Movement Profile. In S. Loman with R. Brandt (Eds.), The body mind connection in human tmvement analysis (p, 24). Keene, NH: Antioch New England Graduate School. Copyright (c) 1992 by Susan Loman. Reprinted with permission.
individual can only become smaller and shrink away from a dangerous environment or an attacker. When using Shaping in directions though, the individual is able to better project the body. The creation of linear vectors in space can shield the body from an attacker, such as raising the arm to ward off a blow from above. Shaping in Planes The most advanced level of interpersonal relationships occurs through Shaping in planes. The mover
carves space by creating concave and convex multidimensional forms. Space is carved in combinations of horizontal, vertical and sagittal planes. Differing from spoke-like and arc-like movements, Shaping in planes form elliptical movements that create trace forms, outlining a volume of space. They can represent three dimensional aspects of interaction and are often seen in animated conversation when participants are fully engaged. The implication of using Shaping in planes movement patterns parallels the Relational Model’s criteria
LOMAN WITH FOLEY
344
for mutually enhancing relationships. Similar to Jordan’s description of the “intersubjective, mutual quality of sexual involvement,” Shaping in planes allows for the full expression of oneself (199 1, p. 89). Movement qualities that form and hold space infer a sense of creativity and potential. Movers are engaged in the freedom of fully representing themselves in relationship, while responding to and being moved by each other. The deepening of interaction through Shaping in planes reflects the ever-deepening levels of relational connectedness, with its foundation in authentic self-representation. As Jordan (199 1) has stated, In the interplay of bodies and heightened feelings, in finding interest in the response of the other, in coming to know the impact of one’s own action on the other and opening to the other’s affecting us, there is opportunity for such intensity, pleasure, and growth. (p. 90) The possibility for experiencing the Relational Model’s “Five Good Things” (Miller & Stiver, 1991) is heightened through shaping in planes movement expression. The ability to shape, create and contain the embodied environment, through affective engagement with oneself, the other and the bi-personal space generates feelings of connectedness and empathy (Lewis, 1993).
Stages in Relational
Development
There are many ways that people may choose to move using Bipolar, Unipolar, Shaping in directions and Shaping in planes movement patterns. Movement repertoires are influenced by individual preferences, stage of development, cultural (Amighi, 1990), gender (Lamb, 1992) and environmental factors. To illustrate the developmental differences inherent in these four categories of movement, the example of an embrace will be used. The same goal of initiating contact with another person through a hug will be demonstrated. The hug (embrace) will be traced through the following KMP developmental sequence: Bipolar shape-flow, Unipolar shape-flow, Shaping in directions, and finally Shaping in planes. In the earliest stage, using Bipolar shape flow, the embracers can only grow and shrink symmetrically, which has a stable and self-contained effect. There is
no way to reach beyond themselves, toward each other, while using only Bipolar shape-flow. While already in an embrace, movers can share breathing rhythms by inhaling and exhaling in coordination with one another. While using the next category, Unipolar shapeflow, the embracers can grow toward each other through snuggling into comfortable body parts. This approach might signal the desire for a hug or contact with each other, but no actual embrace would be possible using only Unipolar shape-flow movements. The arc-like or spoke-like qualities available in Shaping in directions tend to have a distancing effect, as lines or boundaries are created between people. It would be possible for the embracers to point to one another, touch body parts, as in meeting elbows or fingers, or even create a stiff hug, but a true enclosing relationship could not be formed. It is when the embracers can use their arms to encircle each other with Shaping in the horizontal plane (enclosing) that the most effective approach for hugging is attained. In this category the embracers can wholeheartedly hug by creating a mutual relational space for intimate contact. If breath support through Shape-flow is used during hugging, the interaction is even more connected. The embracers can breathe synchronously by breathing into each other while inhaling and breathing away from each other on the exhale (Kestenberg, 1978). This breathing rhythm provides a model for a balance between coming together and separating. While maintaining a synchronous breathing pattern, the embracers experience connectedness without losing their unique experience of self (Stiver, 1991). In contrast, reciprocal breathing never allows for coming back to the self. In reciprocal breathing the breathers would always be in contact (one is inhaling into the other’s exhale). Although reciprocal breathing is enjoyable at times, the breathers would tend to lose their connectedness to the self and have difficulty maintaining boundaries. Certain Shape-flow qualities can have a conflicting effect on forming relationships when combined with certain Shaping in planes qualities. For example, a gesture of invitation that spreads out in the arm can impart a mixed signal when the shoulder shrinks up at the same time. The arm suggests a welcoming impression, but the addition of the contracting shoulder suggests holding back. Such conflicting movement patterns are representational of the “paradox” as defined within the Relational Model. As Miller and Stiver, (199 1) outlined,
THE NONVERBAL
PROCESS
In the face of repeated experiences of disconnection, we believe people yearn even more for relationships to help with the confused mixture of feelings. However, they also become so afraid of engaging with others about their experience, that they keep important parts of themselves out of relationship, i.e., they develop techniques for staying out of connection ... Precisely in the face of so needing connection, we develop a repertoire of methods, which we believe we must maintain, to keep us out of real engagement. (p. 2) As described earlier, this “repertoire of methods” for staying out of connection can be observed through inconsistent, conflicting movement patterns. A gesture of spreading (toward connection) may well be combined with the element of shrinking (away from connection) illustrating the conflict in this mixture of movement qualities. As described in the “paradox,” memories of disconnection maintain their stronghold alongside intense longing for connection. Patterns of growing toward and shrinking away from others, the formation of trustworthy and untrustworthy relationships, and early patterns of physical support and holding have a lasting impact on relationships. The development of response patterns to childhood abuse and/ or trauma, illness, unpredictable caretakers and environments and over- or under-stimulation also affect relationships. The following sections on movement empathy and trust illustrate some relevant nonverbal therapeutic interventions. Movement
Empathy
Attunement in Tension-jlow in Shape-flow
and Trust
and Adjustment
At the central core of movement work is the concept of “attunement” or kinesthetic identification, involving a sense of harmony and recognition between attunement” (Kestenberg, the movers. “Complete 1975) is based on mutual empathy, similarity between partners, and a synchronization in rhythms. Attunement requires the process of identification with another’s body movement. Muscular tensions, called “tension-flow,” felt in one person, are also experienced by the other. It is not necessary to directly duplicate the shape the movement assumes in order to empathize. During attunement, physical needs and feelings are responded to. “Visual attunement’ ’ is accomplished while looking at, but not touching the
IN RELATIONSHIPS
mover. For example, if babies kick their legs vigorously, attuning to them involves identifying how their kicking movement feels. The attuner would match the kicking by moving his or her own body (or body part) in rhythm with the baby. The attuner would not have to use the same body part as the baby (Loman, 1980). “Touch attunement” is a similar process to “visual attunement” but includes the component of touch. To illustrate, the attuner would hold hands or touch the mover, matching any tension changes felt in the hand or body. The attuner would move in the same rhythm and use the same degree of tension exerted by the mover. There may be only slight movement, such as small changes in the contraction or stretch in the muscles. While attuning, movement may be felt in the hand alone or throughout the whole body. The numerous variables and sensory combinations inherent in empathic attunement are described by attunement.” As he Stern (1985) as “intermodal stated, There are some qualities or properties that are held in common by most or all of the modalities of perception. These include intensity, shape, time, and number. Such qualities of perception can be abstracted by any sensory mode from the invariant properties of the stimulus world and then translated into other modalities of perception. For example a rhythm such as “long ) can be delivered in or abshort” (-stracted from sight, audition, smell, touch, or taste. (p. 152) Responding to a child or adult who is upset using visual, touch or auditory/vocal/verbal attunement can lead to soothing and mutual understanding. The degree of tension exhibited by a child or adult can be initially matched and then developed into less intense, more soothing patterns (Loman, 1980). Crying infants respond well if their rhythms and intensity levels are matched, rather than met with polar opposite qualities, such as low key gentleness. The matching of intensity created through the engagement in “intermodal attunement” conveys a kinesthetic experience of mutuality to both therapist and client. As Jordan emphasized, Mutual relationships in which seen, understood, and known, ing, seeing, understanding, available, are vitally important
one feels heard, as well as listenand emotionally to most people’s
346
psychological well-being. In many know ourselves through relationship. 96)
LOMAN WITH FOLEY ways we (1991, p.
Jordan’s use of sensory components to describe mutual empathy, and the expanded capacity to “be with” one another, would be further enhanced with the inclusion of touch and movement. The deepening through relationship’ ’ inof our ‘ ‘self-knowledge vokes an embodied experience. Although, perhaps speaking metaphorically, the Relational Model consistently refers to embodied methods of attunement and mutuality. Elaborating on relational empowerment and empathy Surrey (1991a) stated, The capacity to engage in an open, mutually empathic relational process rests on the maintenance of fluid “ego boundaries” and the capacity to be responsive and “moved” by the thoughts, perceptions, and feeling states of the other person. Each feels “heard” and “responded to” and able to “hear,” “validate,” and “respond to” the other. . . . The capacity to be “moved,” and to respond, and to “move” the other represents the fundamental core of relational empowerment. (pp. 167-168) Adjustment is based on mutual trust where the shape-flow changes or movement patterns regulating the breathing rhythm are responsively duplicated. Distinguishing which qualities are being responded to, in a more specific way, can enhance the therapeutic process. The interpersonal matching of tensionflow and shape-flow patterns exemplify the nonverbal components of empathy and trust respectively (Kestenberg, 1985). Attunement and adjustment are applicable in a wide range of human interactions including: fetus-mother, parent-infant/child, therapistclient, teacher-student, family interaction, adultadult, child-child, or human-animal. Dance/movement therapists familiar with their own shape and tension-flow movement preferences are able to enter into the therapeutic relational process with greater clarity. Ideally they match whatever feeling state their clients present (Lewis & Loman, 1992). As Stiver (1992) has articulated, both the therapist and the client are continually involved in the “paradox of connection and disconnection” (p. 6). At times such struggle may lead to perceived therapeutic impasse. As it remains the “therapist’s major responsibility
and task to help move the relationship back into connection from periods of disconnection” (Stiver, 1992, p. 6), it is of benefit for therapists to have an indepth understanding of their personal movement preferences as well as inhibitions. This conscious awareness toward self-empathy and an embodied relationship serves as the vessel for both the creation and expression of often ambiguous and conflictual feeling states (Lewis, 1993). As Stiver (1992), stated, “When patient and therapist can move with the rhythm of connection and disconnection and come to understand together what triggers disconnection and how these problems can be resolved, the therapeutic alliance becomes strengthened” (p. 6). The creation of a consistent “holding environment” (Winnicott, 1965) is of great importance for both the therapist and client. A sense of continuity can be created in therapy by maintaining a predictable environment over time, both in the physical layout of the room and by the consistent presence of the therapist. Empathy and attunement can be further developed within the containment of “holding” vessels available within the therapeutic partnership (Lewis, 1993). KMP movement observation skills can help to determine whether the interaction is emphasizing empathy (shared tension-flow) or trust (shared shape-flow). In healthy relationships there is an affinity (good fit) between the shape-flow and tension-flow patterns that are used to support and enhance each other. The following related KMP concepts can be used to further understand the movement components underlying empathy and trust in relationship. Attunement without adjustment-the sharing of tension-flow patterns with another person without the corresponding shape-flow patterns. This interaction illustrates the nonverbal components of empathy and understanding, but lacks the outward expression conducive to support and structure. Adjustment without attunement-the sharing of shape-flow patterns with another person without the corresponding tension-flow patterns, demonstrating the appearance of emotion without the associated internal sensation. The structure for feelings is matched but not the feelings themselves. Clashing-interacting with the opposite extreme movement qualities, such as one person using high intensity boundflow while the partner uses low intensityfreeflow. This example illustrates trying to soothe an enraged child in the midst of a temper tantrum
THE NONVERBAL
PROCESS
(high intensity) by gently stroking (low intensity) the child’s back. Using affinities rather than identical movement qualities-interacting with another person using related or similar qualities that can promote a supportive but non-synchronous interaction. An example of using affined qualities occurs when the therapist responds to a client’s hesitant approach into the dance/ movement therapy session with accommodating, flexible movements. Hesitation and jlexibility are both indulgent Precursors of Effort in the KMP (Merman, 1990). As will be seen in the following clinical case example, Loman described how she attuned to the client’s movements, which provided her empathic support through shared muscle tension. She also adjusted to the shape of her body, promoting trustworthy and reliable interactions that allowed the client to develop a nonverbal relationship at her own pace. Clinical
Case Example
The client, Brunhilda, is an adolescent developmentally delayed girl who also has cerebral palsy. She has little verbal language, speaking only a few words, but is able to understand language and to respond appropriately. She attends a non-residential school for developmentally delayed children and adolescents. She was referred to dance/movement therapy to work on the following goals: to nonverbally communicate needs, to decrease tactile defensiveness, to improve her ability to relax, to work on increasing attention span, eye contact and babbling and to redirect inappropriate behavior, such as excessive giggling. Brunhilda was seen once a week for half-hour individual sessions over a period of nine months. The sessions were held in a large all-purpose room that contained exercise equipment, mats and other props, such as scarves, large therapy balls and instruments. During the first several meetings, Brunhilda was quite distractible, often giggling uncontrollably and unable to maintain eye contact. She could not stay with any activity (using scarves, the large ball, tambourine or balloon, for example) for very long. At times she ran around the room wanting to be chased. Other times she kicked her legs while lying on the mat as if having a temper tantrum. The therapist’s initial goals were to try to develop a beginning relationship and to establish mutual trust. In the KMP model, predictability in the relationship provides the safety for trust to flourish and for cre-
IN RELATIONSHIPS
ativity, spontaneity and dynamics to be contained within the consistent structure (Loman, 1994). The KMP informed the therapist about how Brunhilda moved and expressed herself nonverbally as well as where she was in terms of movement development. She seemed to respond to simple patting rhythms typical of a child in the biting phase of development. When the therapist began to give simple commands, such as “Let’s hold hands down the hall,” she began to respond. As the weeks passed, she initiated sitting in the therapist’s lap. The giggling began to decrease, but her behavior was often erratic and at times she reverted to running around the room, kicking and giggling. A breakthrough occurred when the therapist tried using her preferred patting rhythm as a modified massage. The therapist incorporated the crucial KMP concepts of attunement, based on a sharing of qualities of muscle tension, and shape-flow adjustment, based on a similarity of breathing patterns and the shape of the body, the nonverbal counterparts to empathy and trust. Brunhilda was able to accept this kind of touch and allowed the therapist to pat her back, head, arms and shoulders. When the therapist attempted to change the pattern to the next developmental level using the twisting rhythm, like a kneading movement, Brunhilda clearly indicated, by moving away, that she didn’t like the change. Then the therapist attempted rocking with the patting. Brunhilda played with the therapist’s feet, then assumed the fetal position and allowed the therapist to closely hold and rock her for a long time. After a while, the therapist introduced a large circular band of stretch material and a peek-a-boo game developed that is typical for the twisting phase of development. While under the stretch band, they looked at each other and then looked away. Brunhilda was able to come to the therapist when she wanted to be held. A shift occurred when she began to push the therapist away using the straining rhythm, the next stage in the KMP developmental framework. At first the therapist allowed Brunhilda to have an effect on her bodily positioning and responded by collapsing. Remembering that, during the straining phase, twoyear-olds like to test limits, the therapist wondered if Brunhilda might be asking her, through this pushing movement, if she were strong enough to be there for her. The therapist changed her position and resisted being moved. As the session time was ending, the therapist told her it was time to go and she put on her shoes when the therapist asked her to. While they
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walked to her class there were none of the usual giggles. The KMP approach can further an understanding of the sequence of movement phases typical in development (Loman, 1995). The KMP trained therapist can identify themes that pertain to a specific phase of movement development outlined in the KMP, and then support the client’s exploration of them within the safety of the therapeutic environment. When Brunhilda indicated, through changes in movement patterns, that she was ready to explore the next phase of development (the straining phase), the therapist provided suitable phase-appropriate interventions. The therapist altered her approach to accord with Brunhilda’s needs, especially important in this transition to a more mature phase of development. During the next few sessions, Brunhilda was able to relax more and to maintain more eye contact. A theme of pushing the therapist away and wanting to be held became clear. She also started babbling. Sessions often began with the therapist patting her back. She began to say Mama, make sucking noises, look at the therapist and hide under the parachute. During one session, she switched positions and came closer to the therapist after first hiding under the parachute and pushing her away. She appeared relaxed and trusting of the therapist. She tried pushing the therapist down, but the therapist remained seated and began rubbing Brunhilda’s back and head; Brunhilda assumed a fetal position and climbed on to the therapist’s lap. During the middle of the session, Brunhilda went over to a beach ball, after displaying a mischievous look on her face and lying down on her back, totally extending her body. She seemed to enjoy falling back and repeated this sequence. She then pushed the ball away with her feet and tried lying on it like on a pillow. Soon she began to kick the therapist away and then lie down on her side with her back to the therapist who let her stay there alone for a while and then patted and stroked her back while she lay still with her eyes open. She remained in that position until the end of the session when the therapist patted her softly and told her it was time to go. She calmly walked back to her class, holding hands with the therapist. In a later session, Brunhilda appeared pleased to see the therapist and smiled widely when asked to come for their session. In the therapy room she immediately made it clear that she wanted to be patted on her back. She was extremely calm for 10 minutes. Later she went for a beach ball, covered herself with it and then hit the ball and pushed it away. Her shoul-
ders were very protracted and tense. The therapist said, “It’s hard to look at someone, isn’t it? Try to relax.” She looked at the therapist, but giggled in the process. Brunhilda was able to be direct about wanting to be touched, but was also mischievous about wanting to play and test the therapist. At one point she gently pushed the therapist who responded by retuming the gesture. For a while they struggled, as though wrestling. Brunhilda pushed the therapist over and the therapist pushed her. Later, she initiated rubbing the therapist’s back, which she did for a few seconds, and then pushed her away again. Brunhilda began giggling on the way back to the room, but midway when the therapist took her hand firmly, she was able to stop. In later sessions, some new behaviors included pounding the mat and, with the same rhythm, playing the tambourine and the drum. She would beat the drum while the therapist played the tambourine. Then they switched instruments. They spent much time playing the instruments, hitting the mats and making vocal sounds. The therapist followed Brunhilda’s drumming rhythms. They also played with a rope that developed into a keep-away game and then a tug of war that seemed to be typical of the approach-avoidance theme that had developed. At one point, the therapist pantomimed that she was looking for the rope, which Brunhilda had, and then Brunhilda showed recognition by laughing and hiding the rope from the therapist. With the background of knowing how to help a client channel aggression into phase-specific, creative outlets, the therapist helped Brunhilda express intense feelings through movement expression within the safety of the therapeutic container. In terms of verbal expression, Brunhilda began to “Mama,” babble, and the therapist responded, “Baba.” When Brunhilda said “Baba,” the therapist said “Mama.” Brunhilda appeared to want to take a mother role toward the therapist and hugged and then pushed her away (perhaps what her own mother did). Once the therapist responded by pretending to cry when she was pushed away by Brunhilda, who laughed and put her finger near the therapist’s eye. They were very close most of the session. When they walked back to the room, they held hands and swung their arms. Brunhilda was able to wave goodbye to the therapist and then wave hello to her class, a sign that she was beginning to make additional relationships. As the sessions drew to a close, Brunhilda made progress in maintaining eye contact, taking turns, re-
THE NONVERBAL
PROCESS
laxing, babbling, cooperating and staying with activities for longer periods. The push-pull dynamics became subsumed into games, such as mutual sit ups where Brunhilda and the therapist took turns pulling each other up from a lying position. Discussion Relational
Themes
The therapist’s responses of rhythm duplication via “intermodal attunement” (Stern, 1985) instead of simple imitation, enabled Brunhilda to respond to the therapist more creatively. It is evident in this interaction that the therapist’s ability to attune on an embodied level helped lay the foundations for the development of a mutually empathic relationship. The therapist clearly physically conveyed her ability to be “moved” by Brunhilda, who was able to indulge in the increased sense of relational empowerment inherent in having an impact on others as well as the environment. Through exceptionally simple, yet effective interventions and responses, the therapeutic dyad embodied Miller’s definition of power, as the i‘ . . . capacity to produce change” (1991, p. 198). Both Brunhilda and the therapist experienced a deepened level of connection synonymous with being truly seen and heard (Miller & Stiver, 1991). Another important aspect evident in this vignette is that of relational “resistance” and tolerance for intimacy. Gilligan, Rogers and Tolman (1991) have reframed the clinical understanding of resistance “as a health sustaining process” (p. 1). Their definition parallels the theories underlying the Relation Model’s “paradox” (Miller & Stiver, 1991). Through the therapist’s conscious attunement with Brunhilda’s developmental rhythms, she enabled her to establish contact in a way that is not only safe and trust building, but also enticing. Their interactions highlight Brunhilda’s willingness for further relational engagement, created in an environment of mutual exploration. Developmental
Sequencing
Having the knowledge of the KMP sequential phases helped inform the therapist in which developmental stage Brunhilda was functioning and which behaviors were expected for that stage. The therapist was better able to provide more specific ways of attuning in keeping with Brunhilda’s developmental
IN RELATIONSHIPS
level. During vulnerable transitional periods when Brunhilda was entering a new phase of development, it was essential for the therapist to support Brunhilda’s practicing of the newly emerging movement patterns. The therapist helped facilitate Brunhilda’s working through unresolved developmental issues. Through observation and interaction, the therapist identified that Brunhilda lacked certain indulgent movement patterns and showed an excess of fighting movement qualities. Prone to disorganize readily and having poor communication skills, Brunhilda through a developmentally based form of intervention was provided the opportunity to express herself at her own level while developing less mature qualities in more mature patterns. Over time she was able to improve her impulse control, coping skills and social skills. Her movement repertoire evolved over the course of treatment to reveal patterns reflecting growth and integration. Conclusions The Kestenberg Movement Profile can provide a tool for enhancing the understanding of the subtle and intricate possibilities for nonverbal relationships. KMP provides a vocabulary and a well-developed system of notation to clearly describe the nonverbal aspects continually occurring within relationships. An increased knowledge of the complexities involved in nonverbal communication serves to punctuate clinical understanding and intervention methods with an increased facility toward mutually conscious responses to connection and disconnection. Movement observation and interaction encourages empathy and relational embodiedness, both of self and other. As Kaplan stated, “Empathy in therapy is essential to the successful facilitation of the patient’s growth. It is not, however, some mysterious quality that some people ‘just somehow’ seem to have more than others” (199 1, p. 50). Empathy is an embodied response to the relational and environmental landscape in which we move. References Amighi, J. K. (1990). The application of the KMP cross-culturally. In P. Lewis & S. Loman (Ed%), The Kestenberg Movement Profile: Itspast,present applications, andfuture directions (pp. 114-125). Keene, NH: Antioch New England Graduate School. Gilligan, C., Rogers, A. G., & Tolman, D. L. (Eds.). (1991). Women, girls & psychotherapy: Reframing resistance. New York: Harrington Park Press.
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Jordan, J. V. (1991). The meaning of mutuality. In J. V. Jordan, A. G. Kaplan, J. B. Miller, I. P. Stiver &J. L. Surrey. Women’s growth in connecrion: Wrirings from the Stone Center (pp. 8 l96) New York: Guilford Press. Jordan J. V., Kaplan A. G., Miller J. B., Stiver I. P. & Surrey J. L. Women’s growth in connection: Writings from rhe Stone Center. New York: Guilford Press. Jordan, J. V., Surrey, J. L., & Kaplan, A. G. (1991). Women and empathy: Implications for psychological development and psychotherapy. In J. V. Jordan, A. G. Kaplan, J. B. Miller, I. P. Stiver & J. L. Surrey, Women’s growth in connection: Writings from the Stone Center (pp. 27-50). New York: Guilford Press. Kaplan, A. J. (1991). Empathic communication in the psychotherapy relationship. In J. V. Jordan, A. G. Kaplan, J. B. Miller, 1. P. Stiver & J. L. Surrey. Women’s growth in connection: Writingsfrom the Stone Center (pp. 44-50). New York: Guilford Press. Kestenberg, J. S. (1975). Children and parents. New York: Jason Aronson. Kestenberg, J. S. (1978). Transsensus-outgoingness and Winnicott’s intermediate zone. In S. A. Grolnick & L. Barkin (Eds.), Between reality and fantasy: Transitional objects and phenomena (pp. 63-73). New York: Jason Aronson. Kestenberg, J. S. (1985). The flow of empathy and trust between mother and child. In E. J. Anthony & G. H. Pollack (Eds.), Parental influences: In health and disease (pp. 137-163). Boston, MA: Little Brown. Kestenberg, J. S., & Sossin, K. M. (1979). The role of movement patterns in development Vol. II. New York: Dance Notation Bureau Press. Laban, R., & Lawrence, F. C. (1947). Efsort. London: MacDonald & Evans. Lamb, W. (1965). Posture and gesture. London: Gerald Duckworth. Lamb, W. (1992). The essence of gender in movement. In S. Loman & R. Brandt (Ed%), The body mind connection in human movement analysis (pp. 135-151). Keene, NH: Antioch New England Graduate School. Lewis, P. (1993). Creative transformation: The healing power of the arts. Wilmette, IL: Chiron Publications. Lewis, P., & Loman, S. (1992). Movement components of affect: Tension-flow attributes within the Kestenberg Movement Profile (KMP). American Dance Therapy Association 27th Annual Conference Proceedings. Columbia, MD: American Dance Therapy Association. Loman, S. (I 980). Attunement. Child Development Research News, 2, 3. Loman, S. (1990). Introduction to the Kestenberg Movement Profile. In P. Lewis & S. Loman (Eds.), The Kestenberg Movement Profile: Its past, present applications, andfuture directions (pp. 52-64). Keene, NH: Antioch New England Graduate School.
WITH FOLEY Loman, S. (1994). Attuning to the fetus and young child: Approaches from dance/movement therapy. ZERO TO THREE Bulletin of rhe National Center for Clinical Infant Programs, f5( I), 20-26. Loman, S. (1995). The case study of Warren: A KMP approach to autism. In F. J. Levy (Ed.), Dance and orher expressive art therapies (pp. 213-223). New York: Routledge. Loman, S., & Merman, H. (in press). The KMP: A tool for dance/ movement therapy. American Journal of Dance Therapy. Mahler, M., Pine, F., & Bergman, A. (1975). The psychological birth of the human infant: Symbiosis and individuation. New York: Basic Books. Merman, H. (1990). The use of precursors of effort in dance/ movement therapy. In P. Lewis & S. Loman (Eds.), The Kestenberg Movement Profile: I& Past, Present Applicarions and Future Directions (pp. 85-100). Keene, NH: Antioch New England Graduate School. Miller, J. B. (1991). Women and power. In J. V. Jordan, A. G. Kaplan, J. B. Miller, I. P. Stiver & J. L. Surrey. Women’s growth in connection: Writings from the Stone Center (pp. 197205). New York: Guilford Press. Miller, J. B., & Stiver, I. P. (1991). A relational reframing of therapy (Work in Progress, No. 52). Wellesley, MA: Stone Center Working Paper Series. Sossin, K., & Loman, S. (1992). Clinical applications of the Kestenberg Movement Profile. In S. Loman & R. Brandt (Ed%), The body mind connection in human movement analysis (pp. 21-55). Keene, NH: Antioch New England Graduate School. Stem, D. N. (1985). The interpersonal world of the infant: A view from psychoanalysis and developmenral psychology. New York: Basic Books. Stiver, I. P. (1991). The meanings of “dependency” in femalemale relationships. In J. V. Jordan, A. G. Kaplan, J. B. Miller, I. P. Stiver & J. L. Surrey. Women’s growth in connection: Writings,from the Stone Center (pp. 143-161). New York: Guilford Press. Stiver, I. P. (1992). A relational approach to therapeutic impasses (Work in Progress No. 58). Wellesley, MA: Stone Center Working Paper Series. Surrey, J. L. (1991a). Relationship and empowerment. In J. V. Jordan, A. G. Kaplan, J. B. Miller, I. P. Stiver, & J. L. Surrey. Women’s growth in connecrion: Writings from the Stone Center (pp. 162-180). New York: Guilford Press. Surrey, J. L. (199 lb). The relational self in women: Clinical implications. In J. V. Jordan, A. G. Kaplan, J. B. Miller, I. P. Stiver & J. L. Surrey. Women’s growth in connection: Writings from the Stone Center (pp. 35-43). New York: Guilford Press. Winnicott, D. W. (1965). The maturational processes and the facilitating environment. New York: International Universities Press.