Using bodily movement in supervision for expressive arts therapy students: A case study

The Arts in Psychotherapy 48 (2016) 8–18

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The Arts in Psychotherapy

Using bodily movement in supervision for expressive arts therapy students: A case study Kyung Soon Ko, PhD, LCPC, BC-DMT, GL-CMA, NCC ∗ 537 Fourth Street, Athens, GA 30601, United States

a r t i c l e

i n f o

Article history: Received 16 June 2015 Received in revised form 29 December 2015 Accepted 29 December 2015 Available online 6 January 2016 Keywords: Movement-based supervision Multiculturalism Dance/movement therapy Expressive arts therapies Creative learning Bodily-felt experiences

a b s t r a c t This qualitative study aimed to explore the experiences of six Korean expressive arts therapy students in Korea in five consecutive clinical supervision sessions integrated with visual art and body movement. Two research questions guided this study: How do Korean expressive arts therapy supervisees describe meaningful moments in supervision? What happens in Korean supervisees’ bodily movements? Three types of data were gathered via a demographic questionnaire, video recording of movement, and individual interviews. Data analysis revealed three themes, each including two categories; (a) knowing through moving and sensing the body (categories: physical touch as a powerful moment, physical sensations from visual art), (b) an emerging need to be alone and together (categories: finding space between the self and others, moving boundaries), and (c) gaining insight from symbolic and artistic exploration (categories: connecting body knowledge, knowing one’s need for self-care). The results of this study support the assertion that using arts media in clinical supervision facilitates students’ artistic journeys, helping them to find insight, awareness, and expression. This study also underscores the importance of educators’ openness to the creative process, as well as the importance of cultural components in teaching with students in Korea. © 2016 Elsevier Ltd. All rights reserved.

Using bodily movement in supervision for expressive arts therapy students In Korea over the past decade, the field of expressive arts therapy has been developed by being incorporated into graduate school programs that require clinical supervision. Clinical supervision is a fundamental element of any type of psychotherapy training, and facilitates students’ growth as mental health professionals by deepening and enriching their knowledge surrounding their clinical experiences (Bernard & Goodyear, 2004, 2009). For instance, Edwards (1993) indicated that the supervisor’s role in supervision is about creating a “space for thinking” (p. 218), to explore and deal with supervisees’ emotional difficulties, such as “anxiety, confusion, uncertainty, vulnerability, and helplessness” (p. 214). Similarly, supervision has to provide a space on the conscious level to process learning, thinking, feeling, and reflection regarding clients’ material (Deaver & Shiflett, 2011; Mollon, 1989). Within that perspective, arts media have been adapted for use in clinical supervision to foster a unique approach in line with expressive therapists’ abilities, as well as to facilitate supervisees’ creative

∗ Corresponding author. Tel.: +82 10 9357 6041. E-mail address: [email protected] http://dx.doi.org/10.1016/j.aip.2015.12.005 0197-4556/© 2016 Elsevier Ltd. All rights reserved.

process of thinking and reflecting. Marshall (2007) described the arts as “an exercise in knowledge construction; [a] process of coming to know” (p. 24), and Payne (2008) stated that use of drawing, writing, or dancing can be used to enrich the clinical supervision process. However, extensive literature has revealed challenges specific to the Korean education system that are not as present in Western culture (Bang & Park, 2009; Kim, 2005, 2007, 2010; Soh, 2011; Sohn, 2005). Bang and Park (2009) interviewed 11 Korean supervisors, and found that Korean supervisors were hesitant to seek feedback from their supervisees and their supervisees preferred to get the right answer from their supervisor. None of the participants in Kim’s (2005) study reported making art in supervision; they perceived a supervisor’s role as instead including guiding treatment plans (27.3%), pointing out mistakes (12%), and helping them to develop self-awareness (1%). Confucianism, which has a strong influence in Korea, tends to encourage a strong power differential and a hierarchal social relationship between Korean supervisors and their supervisees (Bang, 2006; Killian, 2001; Soh, 2011; Sohn, 2005; Yoon & Jepsen, 2008). This in turn creates a lack of space for supervisees to explore, think, and engage in the supervision process. As a result, studies on students in Korea (e.g., Bang & Park, 2009; Soh, 2011) tend to have findings that clash with key Western assumptions, such as Anderson, Rigazio-DiGilio,

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Cochran-Schlossberg, and Meredith (2000) emphasis on “openness” (p. 64) as the most important element in the quality of supervision. Other such Western assumptions include the idea that supervision should provide a space for thinking, feeling (Edwards, 2010; Mollon, 1989), and keeping creativity alive (Gomez & Smart, 2008); and that supervision should allow for playfulness and imagination (Bravesmith, 2008). These cultural differences draw attention to the need to embrace the benefits of using arts media in clinical supervision; however, before attempting such a new way of delivering supervision to this population, a thorough review of the existing literature is necessary.

beneficial for drama therapists (Proctor et al., 2008). Wilkins (1995) suggested a structured approach that involved three steps: exploring relationships with clients through the medium of art, exploring the role of clients through psychodrama, and exploring and investigating relationships further via role play and psychodrama. A creative arts approach to supervision broadens and channels intuitive aspects, because it allows spontaneity and promotes deep personal processes that other approaches may not be able to offer.

Types of arts media in supervision

The crucial role of body movement in clinical supervision and psychotherapy has been emphasized as a way of understanding, knowing (Cooper, 2001; Csordas, 1993; Lewis, 1984; Meekums, 2007; Payne, 2008), and guiding honest sharing (Ko, 2014). Panhofer, Payne, Meekums, and Parke (2011) suggested new ways of self-examination by proposing embodied clinical supervision in five stages: “identifying the presenting problem, warming up, allowing the movement to emerge, composing a final narrative, and evaluating and contemplating” (p. 13). Qualitative data were collected based on a one-day workshop consisting of three phases: a writing exploration based on significant clinical work, creating movement based on the initial narrative, and constructing a movement narrative for further written exploration. The researchers found that embodied practice deepened the connection to personal countertransference material, facilitated their “body knowledge and memory” (p. 15), and helped therapists to see “behind the scenes” (p. 11). Results indicated the importance of using body knowledge, which can be beneficial for integrating and exploring a deeper process. In another study, Meekums (2007) listened to her body during supervision, and described how her “inner eye” and “inner ear” waited for “received” information, rather than rushing to “understanding” (p. 96). The purpose of the study was finding “phenomena associated with spontaneous symbolism within clinical supervision by asking what is really going on here?” (p. 96). Meekums collaborated with a supervisee in a non-led warm-up to enter the wisdom of the body beyond the logical area, and then shared symbols that emerged spontaneously. The results indicated that an embodied approach employing a symbolic process can open unknown areas of body knowledge as wisdom beyond a logical place, based on a narrative self-journal.

Use of art in art therapy There have been numerous studies regarding the benefits of using arts media in clinical supervision (Deaver & Shiflett, 2011; Fish, 2008; McNiff, 1986; Yoo, 2011). Durkin, Perach, Ramseyer, and Sontag (1989) noted that using art in supervision “brought interpersonal richness to [supervisory] relationships, [and] cut through to the core of many issues very quickly” (p. 392). For example, therapists’ intentional use of art media – referred to as response art in clinical supervision – helps therapists to gain new perspectives and knowledge (Fish, 2005, 2012; Jackson, Muro, Lee, & DeOrnellas, 2008). This art-making process also offers tools to improve selfawareness and self-care (Fish, 2008). Deaver and Shiflett (2011) suggested using visual journals to help process and manage countertransference. Other benefits of using art in clinical supervision were found to be more open communication between supervisee and supervisor (Williams, 2000), as well as more empathic supervisory relationships (Yoo, 2011). Using music within music therapy supervision Very little has been written about music making in supervision (Young & Aigen, 2011). Music-making in supervision has been implemented to enhance the supervisee–supervisor relationship (Scheiby, 2001) and to promote group cohesiveness (Austin & Dvorkin, 2001). Nordoff Robbins Music Therapy (NRMT) supervision training uses live music to generate an empathic understanding of clients when the supervisee has blocked feelings. The supervisor gradually adds expressive music elements and identifies repressed emotions to help the supervisee to feel free and to unblock his or her fears (Turry, 2001). The supervisor is asked to play music about the supervisee’s feelings about clients, as well as about the role of the therapist, with a goal of revealing and addressing countertransference. This approach is used to work on supervisees’ awareness indirectly, in an effort not to break down their defenses too openly or aggressively. Using action within drama therapy supervision Theater of the Oppressed (TOTO) training mainly involves using bodies-in-action methods such as sculpture and role-play; incorporating objects placed around the room; and using gestures, sounds, and movements in a symbolic way (Lahad, 2000). Proctor, Perlesz, Moloney, Mcilwaine, and O’Neill (2008) studied the use of TOTO techniques in supervision using participatory action research. Data were gathered via the participants’ journals, reflective body action, case vignettes, and group discussions for eight two-hour sessions over the course of 10 months. Several themes emerged, including “power, invisibility, gender, voice, and normality” (Proctor et al., 2008, p. 47), which revealed that TOTO offered a safe and grounded process in supervision, and that body-oriented supervision can be

Using dance and movement within dance/movement therapy supervision

Summary According to the existing research discussed in this section, it is clear that using the arts in clinical supervision for expressive arts therapists addresses the limitations of traditional models of supervision, which have lacked a deeper understanding of the arts (Marion & Felix, 1979; Wilson, Riley, & Wadeson, 1984). Although using art media could take time away from verbal discussion (Fish, 2008), the majority of Western studies indicated several benefits of integrating arts media (Austin & Dvorkin, 2001; Cooper, 2001; Deaver & Shiflett, 2011; Fish, 2008; Lewis, 1984; Scheiby, 2001; Turry, 2001; Yoo, 2011). Even if the type of arts media could be used differently in clinical supervision, arts media have common strengths. These include movement in TOTO and music in NRMT, both of which help to ensure a safe and indirect guided process (Turry, 2001); action and art can also be used to explore deeper processes (Wilkins, 1995; Yoo, 2011). Integrating several arts media is also a way to deepen supervisees’ exploration within simple structures in different phases, such as combining a mandala with journaling, drawing, and art making (Deaver & Shiflett, 2011), or combining narrative journal and body movement (Meekums, 2007). However, despite evidence of the benefits of using arts media in clinical supervision, arts media have not yet been actively

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integrated in Korea on a large scale. The present study therefore sought to explore how Korean supervisees experience the use of arts media in clinical supervision, in light of their different culture and norms. Method The researcher provided a simple structure, comprising a checkin, movement and art-based exploration, verbal sharing, and a closing ritual called movement-based supervision (MBS) for five consecutive sessions. This MBS approach was based on Panhofer, Payne, Meekums, and Parke’s (2011) embodied clinical supervision concept, which was designed to identify and explore clinical challenges. Employing MBS, the participants were also encouraged to adopt Meekums’s (2007) notion of the body as a container for wisdom and as a way to access symbolic expression in dance/movement therapy (DMT) supervision. Fish’s (2008) idea of using visual art as a way to explore clinical challenges as part of a class was also used. Research purpose and questions The purpose of this qualitative study was to explore how Korean expressive arts therapy students experience the use of arts in clinical supervision. Two specific research questions were addressed in this study. Although visual art and body movement were used in the supervision sessions, the researcher’s area of expertise, bodily movement, was the central modality. (1) How do Korean expressive arts therapy supervisees describe meaningful moments in supervision? (2) What happens in Korean supervisees’ bodily movements?

the research project. The researcher assured participants that all gathered data would be treated anonymously and that they had the right to refuse to participate or to drop out of the study without any penalty; this included having no obligation to review video clips to reflect on their experiences or to participate in individual interviews to process their experiences after MBS. All participants’ names were pseudonyms, their ages ranged from 32 to 54, and the length of their clinical experiences ranged from 4 to 12 years (see Table 1). Six participants (n = 2 DMT major, n = 4 art therapy major) were in their third or fourth semester of a two-and-a-half-year graduate program in expressive arts therapy in Korea. Participants were informed that their internship was not coordinated by their school, nor did they have field supervisors. Five weekly two-hour sessions of MBS were provided in an open studio space. None of the participants missed any scheduled session during the research period. The researcher met the supervisees one week before starting MBS to explain the study, as well as one week after completing MBS to collect post-study data. In sum, this researcher therefore collected data for seven weeks and conducted five weeks of the MBS intervention. Data collection Researcher-designed questionnaire This questionnaire assessed demographic information, as well as supervisees’ perceptions regarding the purpose of supervision, the role of the supervisor, the supervisor–supervisee relationship, their needs with regard to supervision, the use of art media in supervision, the level of self-expression that they felt they had in supervision, and group sharing in supervision (see Table 2). Data from the pre-survey provided information about supervisees’ perceptions before staring MBS, which helped the supervisor to prepare for the supervision class (see Table 1), and the post-survey was designed to note any changes after participating in MBS.

Design The researcher adapted the qualitative case study approach as an appropriate design for this study based on the research purpose and questions. Case study methodologies focuses on “an event, program, an activity, or more than one individual,” and require “multiple sources of data such as interview, observation, documentation, and artifacts” (Creswell, 2013, p.104). Yin (2013) indicated that “case study evaluation can (1) capture the complexity of a case, including relevant changes over time, and (2) attend fully to contextual conditions, including those that potentially interact with the case” (p. 220). Therefore, the present study collected various forms of data – interviews, drawings, documentation, and audiovisual materials – all of which helped to understand participants’ responses. Supervisees were closely observed while in MBS. This study was the second part of a pilot study, which was conducted in partial fulfillment of a doctoral degree in expressive arts therapy at Lesley University. The first part of the pilot study was published in the American Journal of Dance Therapy; this study used two different types of data and had research questions (Ko, 2014).

Interview Interpersonal process recall (IPR) is a qualitative interview approach designed “to access individuals’ conscious yet unspoken experiences as they occurred at the time of the interpersonal interaction under investigation” (Larsen, Flesake, & Stege, 2008, p. 19). Two cameras were used to record each supervision session. The researcher gave five sessions of video clips to the participants after the sessions were completed. The participants were asked to review and find one meaningful moment for themselves in the video clips. The researcher set up a screen so that videos could be watched together with supervisees during the interview process. Each participant identified at least one meaningful scene for herself. She then shared what she experienced physically and emotionally in that moment during the interview. Visual artwork The artworks of participants from all five sessions were gathered together and each participant’s visual art was analyzed in connection with the interview content and notes from observation.

Recruitment of participants

Data analysis

Upon written approval by the Institutional Review Board of Lesley University, Cambridge, Massachusetts, six Korean expressive arts therapy students in Korea were recruited and signed consent forms. All participants were in the same class and the researcher was invited to give a quest lecture for five weeks in this class. All required forms and documents were prepared in Korean to deliver accurate information about this study, and were proofread by two Korean colleagues from the researcher’s academic field. The researcher visited the class one week before staring MBS to explain

Creswell (2013) listed three analysis strategies for qualitative research: analysis of data, including coding; combining codes into themes; and displaying data via charts, graphs, and tables. Data analysis in the present study consisted of the following processes: (a) transcribing individual interviews and organizing the obtained data; (b) reading interview transcriptions and reviewing data multiple times; (c) coding all meaningful statements (horizontalization) and writing memos beside them; (d) Peer-debriefing by sharing original transcriptions with codes with a peer from the field

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Table 1 Participant demographic and basic clinical work data. Pseudonym age

Major/semester arts media used in internship

Population

Previous experience of supervision

Previous media used in supervision

Participant 1 Sang 46 Participant 2 Kim 45 Participant 3 Lee 44 Participant 4 Jung 37 Participant 5 Min 54 Participant 6 Kwan 32

Art therapy/3 Art

Children with developmental delays Mental illness Children Adolescents

Supervision class

Session note Art (client)

10 times over the last two years

Session note, video tape, written note

Dance therapy/3 Art and dance/movement

Chronic mental illness

Supervision class

Session video

Art therapy/4 Art, music, dance/movement

Children Adolescents Senior citizens Seniors with dementia Children Adolescents Children with developmental delays, Chronic mental illness

Supervision class

Session note

12 times over the last 8 months (group); 1(individual) Supervision class

Session note Art (client)

Dance therapy/3 Dance/movement

Art Therapy/3 Art, music, Dance/movement Art Therapy/4 Art/Movement

Session note, Art (Client)

Note. The above demographic information was gathered via a researcher-designed questionnaire.

Table 2 Survey questionnaires.

of expressive arts therapy; (e) reviewing and reflecting on coding based on comments; (f) combining overlapping and repetitive codes and eliminating vague expressions; (g) categorizing similar meaningful statements and units; (h) developing themes for the categories after reviewing the data numerous times; (i) peerdebriefing about the analysis of art data with a peer who is an art therapist; and (j) writing textual descriptions of participant experiences, and finding larger meanings based on the results of data analysis.

Triangulation The trustworthiness of data interpretation in qualitative research depends on the methodological and analytical processes. Several researchers have indicated specific strategies that can

be used to ensure accurate results (Merriam, 2009; Stake, 1995; Peshkin, 1988). Methodological triangulation was adapted to the present study by collecting multiple types of data via interviews, visual artwork, and questionnaires. Peer-debriefing was also conducted by soliciting feedback regarding the analyzed data and codes to increase internal validity. The researcher debriefed her own experiences, thoughts, and reactions with two peers from music therapy and art therapy, respectively, as well as with her research supervisor. This included sharing visual data and triangulating different form of data by reviewing the results of the analysis.

The format and contents of MBS While the researcher provided MBS, there was no agenda; instead, arts-based exploration, moving bodies, and drawing were

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and performed it individually. When the performance came to a close, that supervisee took a final pose; the other supervisees were then asked to reflect on the performer, and to create supportive movement feedback based on her final pose. Later, supervisees gave feedback to each other and shared their experiences regarding their challenges, strengths, or growth. Results Researcher-designed questionnaire results

Fig. 1. Tangled yarn with a needle, by Sang. This figure illustrates a complete family relationship.

spontaneously employed during supervision based on the themes students brought up during the initial check-in. Each session built consensus around a subject that participants agreed to explore through movement and the visual arts. Session 1: “I am so overwhelmed.”: The theme of the first session was “understanding self-care.” This theme emerged after a participant expressed overwhelmed feelings regarding her roles at work and at home. Supervisees were guided to bodily experiences of being supported physically by other group members. Supervisees also experienced lying on the floor to check the status of their mind and body, following verbal guiding to practice attentive self-care. Participants were also helped to learn how to use their bodies as “inner eyes” by pay attention to their bodies, an idea adopted from Meekums (2007). Session 2: “It is difficult to be with clients.”: The theme of the second session was “practicing patience and attunement.” The supervisor provided a simply activity of walking with a partner without verbal interaction, instead noticing one’s emotional and physical awareness of being with someone. Later, this pair walking exercise developed into group walking. After these movement experiences, a group discussion emerged on the differences between therapy and education. Session 3: “Tangled yarn and a needle.”: The theme for third session was “maintaining balance.” This theme emerged from an image shared by Sang (see Fig. 1). The supervisor guided supervisees to embody the image of “tangled yarn and a needle” in their own way. While sharing her bodily experience, Min, a participant, shared the fact that she had undiagnosed pain in her arms, which sometimes turned purple. This unexpected disclosure prompted participants to use symbolical movement by offering a “healing patch” and “wings” to support Min. Each person took turns sharing their needs, both verbally and with a symbolic movement, in the closing ritual. Session 4: “I feel so dirty.”: The theme for the fourth session – “therapist’s body and somatic countertransference” – emerged based on Sang’s sharing during the initial check-in. She reported that “a child spit on my face in session,” which continued to make her feel dirty and upset. The supervisor guided all of the supervisees in a ritual movement of cleansing, as a way to take care of themselves. This ritual involved cleansing the space around one’s self, exploring one’s body parts, and locating one’s self in the most comfortable space and position. These exercises expanded to verbal sharing in relation to self-care and somatic counter-transference. Session 5: “My strength.”: The theme for the fifth session was “finding my strength.” This theme was requested by a supervisee for the purpose of closing the MBS. The supervisor asked the supervisees to think back over their last four sessions, to translate these thoughts into visual art works, and then to expand them into individual performances. Each supervisee created a body movement

The questionnaire results mainly centered on eight areas of participants’ perceptions of clinical supervision that changed over the course of MBS (See Table 2). (a) The purpose of clinical supervision: Before participating in MBS, participants’ perception of the purpose of supervision was mainly indicated as “getting clinical knowledge,” which indicated learning without active exploration. However, these answers changed in the post-survey to include “building competency through empathy,” “being supported through one’s colleagues and supervisor,” and “developing an identity as an art therapist.” (b) Supervisor’s role: Before taking part in MBS, five participants all indicated that a supervisor’s role was “pointing out mistakes,” “providing solutions,” “preventing things from going the wrong way,” and “providing knowledge.” After participating in MBS, participants described the supervisor’s role a little differently, as “providing proper feedback,” “helping with counter-transference issues,” “capacity building,” and “supporting, with a sense of acceptance.” (c) Supervisory relationship: Before MBS, participants described supervisory relationships as like those with “parents,” a “teacher,” or “good mother and bad mother”; they also used images of a “carrot and a lash” and “ship and lighthouse.” However, even before MBS, participants indicated some different perspectives on t he supervisory relationship, as one of a “facilitator” or “cooperator.” In the post-survey, participants indicated that “less critical but supportive” and “feel safe to share weakness” were necessary characteristics of a supervisor. (d) The areas in which participants needed help: Participants reported needing help in diverse areas: professional knowledge, principles, therapeutic intervention, countertransference, treatment goals, ethics, and identity were all mentioned as areas in which participants wanted more clinical supervision, both pre- and post-survey. One participant also mentioned empathetic responses toward clients as another area in which she wanted to work on the post survey. (e) Using media in clinical supervision: None of the participants reported using arts media in clinical supervision in pre-surveys, and instead mainly reported writing reports and studying artwork. In the post-survey, five participants indicated that movement can be utilized for effective supervision. (f) Challenges and benefits of using media: The limitations of writing reports about sessions with clients were that it was “difficult to include clients’ nonverbal expressions” and that “supervisees can defend and selectively share information to avoid being scorned by others.” Some of the benefits of experiential supervision using arts media included embracing therapists’ feelings and thoughts regarding clients, as well as more honest communication. (g) Level of sharing of thoughts and feelings: Before taking part in MBS, only one participant reported that she shared her feelings and thoughts freely in clinical supervision: two participants wrote “sometimes,” two others indicated that they never did

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Fig. 3. Ritual movement of cleansing. This figure captures a moment of exploring one’s body parts after Sang shared that her client spit in her face. Fig. 2. Embodied work of tangled yarn. This figure captures a moment embodying the experience of a complicated relationship.

so, and the last participant said only “I do not know,” because she feared making mistakes and so could not be completely honest in the pre-survey. However, in the post-survey, four participants indicated that they share their feelings and thoughts freely. (h) How to respond when the supervisor had different opinions: On the pre-survey, all participants indicated they would accept the supervisor’s answer as correct because the supervisor had more experience. In the post-survey, however, three wrote that they would “ask questions or try to explain their own thoughts” when they had different opinions from the supervisor. These results indicated that, after arts-based supervision, participants’ perceptions of the supervisory relationship had shifted from an authority-based to a mutual relationship. It seemed that supervisees’ level of comfort related to their sharing of thoughts and feelings was greatly increased, and that participants’ views regarding the purpose of supervision expanded in various ways, incorporating goals such as developing identity, building colleagueship, and creating a supportive environment in which they could address difficulties and gain clinical knowledge. Summary of Individual Interviews Participant 1, “Sang.” Sang recalled “the movement experience with an image of a tangled thread bundle, which was connected with my issues” (see Figs. 1 and 2). She shared a reflected movement experience based on her drawing that provided a bodily sense of closeness with family members. She realized that her family members were not as tightly tangled as she had thought, and that she had her own way to interact with family members. When Sang was preoccupied with needing to escape from a tangled situation, her view was narrow, but when she was able to incorporate rhythm into her movement, she was able to modulate her anxiety. This opened her eyes to see her environment and allowed room for playfulness. Also, in relation to her clinical work, Sang came up with an insight regarding the structure of her sessions at her internship site. “Waiting and standing in the same place could provide rigid structure in a session, but I started to realize how important playfulness is in sessions.” Participant 2, “Kim.” Kim clearly expressed that MBS was an unfamiliar concept that she had never heard of or experienced, which made her curious. Kim strongly felt the therapeutic component in MBS because the movement guided a deep, embodied process that led her to become aware of somatic counter-transference, which made her feel powerless and frustrated (see Fig. 3). Kim pointed to a moment of being apart from the group with some physical distance as a meaningful moment for her. It seemed that she was satisfied with not being part

Fig. 4. Two flowers, by Kim. Two similarly shaped flowers represent the group and an individual. Kim’s need to have her own space was expressed by moving away from the group (i.e., the large flower).

of the group (see Fig. 4). Her movement (embracing herself with her arms via an enclosing shape) indicated a strong need to maintain her personal space. Kim indicated that she was experiencing emotional hardship after the termination of a group she facilitated, so her body needed some distance from others. To create a space away from chaos (see Figs. 1 and 2) – symbolically represented by the bundle of yarn – which was necessary for her work on herself. Kim said that someone in the group mentioned at that moment that “you did not come here when I asked to release the tangled yarn but you came here when asked to play together.” Kim repeated this as an interesting moment for her and shared how much she was burned out. Kim shared that the supervisor and other participants did not forcefully try to approach her or invade her personal space, which made her feel safe and respected in the group. She described her body as being grounded, allowing her to use her own strength after having some distance. She was also able to recognize that emotional self-care is needed for therapists, which can be addressed in clinical supervision. For this participant, a supportive group environment helped to prevent emotional burnout. Participant 3, “Lee.” Lee shared that her most meaningful moment was “walking with a partner,” which provided a way to experience how to be with others. This movement experience personally helped her to reflect on herself as a therapist, which was reflected in her drawing, called “floating with water flow” (see Fig. 5). This experience guided Lee to think about her role as a teacher or therapist in session, as well as her approach toward her clients. She shared that she enhanced her ability to “be with the client” by remembering and embodying the “natural flow of waves” in her body and mind. Participant 4, “Jung.” Jung chose a meaningful moment from Session 5, which she compared with her first class. This session was about the expression

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Fig. 5. Floating with the flow of water, by Lee. This figure illustrates the need for creative flow and inner calmness in her sessions. Fig. 7. A journey of refueling energy and considering the needs of others, by Min. This figure illustrates flexible boundaries and the need for physical touch in Korean culture.

physical contact. Min shared this experience, relating it to her clinical work. Min currently has started to work with cancer patients in a hospital. When Min approaches her clients, she always feels “sadness and pity toward clients, but my experience of today was approaching with hope.” Since she selected a moment of physical connection, she expressed her thoughts regarding boundaries, which need to be flexible depending on the situation (see Fig. 7). The moment of placing her head on someone was “a reset, refueling energy.” Min also discussed the unexpected moment when her chronically painful arm suddenly turned purple, with severe pain, during supervision class; she thanked the group for providing an imaginative healing patch, light wings, and warm physical touch.

Fig. 6. Three essential aspects of a therapist, by Jung. This figure illustrates what Jung found that she needed to grow as a therapist.

of her own private journey through movement. She noticed similarities and differences comparing the beginning and end regarding eye contact, strength, and posture. Her body was tense and she avoided eye contact with the group at the beginning, but she noticed some changes from watching the video. She made her own interpretation regarding this moment from her last pose in the fifth session of MBS. She said that the “group relationship” became more cohesive and strong while still recognizing an “individual’s strengths.” She felt empathy and connection by the end, things that she was not able to find in her body during the first class. She described her individual performance in the fifth session of MBS. Her movement journey started with closing her eyes and moving spontaneously. It was like she was walking in an unknown place, which symbolically represented her first impression of the class. “It looked like a similar movement that I did in the first class but I thought it was completed in this moment [in the fifth class]. [We] stood up with our own strength, not by pushing others. . .I wanted to stay strong like a tree with a wide outlook.” She was very excited and proud of herself that she found two similar movements from the first and last classes and three essential elements for her (see Fig. 6). It seemed to this researcher that Jung was able to embody a clear image of how she wanted to present herself as a therapist in her clinical work. Participant 5, “Min.” Min indicated that her most meaningful moment was when she relied on someone’s body in the last session. Min, in her own last performance, slowly came close to others and experienced light

Participants 6, “Kwan.” Kwan disclosed that she had been very defensive about using her body and art in clinical supervision because she had been uncomfortable about body movements and unknown approaches. However, she was surprised by how using arts media in clinical supervision allowed for honest sharing and group responses during the first class. Kwan identified a meaningful movement scene from the fifth session, when she lay on the floor in the shape of a big X, with core to distal connection. She was able to realize two meaningful things from this movement: “first, this is really comfortable lying here in the moment, and second, I became comfortable and at peace with myself.” She described her bodily sensation while watching the movement video clip: The sensation of pulling her body from group members was an experience of recharging energy. Kwan ended up being extremely engaged in movement and art experiences and gleaned great insight for her own personal and professional growth. Individual interview results The inductive data analysis of interview transcriptions was conducted using the data-organizing program Nvivo 10, which revealed three themes and six categories. Theme 1. Knowing through moving and sensing the body The first theme, knowing though moving and sensing the body, comprised what participants experienced on the bodily level. This theme consists of two categories: (1) physical touch as a powerful moment and (2) physical sensation from visual art. Physical touch as a powerful moment: Three participants (Sang, Jung, Min) pointed to the moment of connecting with others through physical touch as a powerful and meaningful moment. In her own last performance, Min slowly came close to others and laid her head on others. She identified this as being her most meaningful moment, as she shared that while people needs times in their

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me. Then, I could become more firm and solid in the moment of standing up [. . .] I felt that I was getting energy even in each single knuckle. Kwan was surprised to find that she “gradually broke down her defenses” by moving and sharing in group. Kwan said that the group relationship became more cohesive and strong while still recognizing an “individual’s strengths.” She felt empathy and connection by the end of the sessions, things that she was not able to find in her body in the first class.

Fig. 8. Being comfortable and growing together, by Kwan. This figure illustrates Kwan’s experiences in arts-based supervision.

life when they live alone or are more independent, those who have less experience with this need support from those who have more experience. Jung selected moments from the first and last sessions and compared similarities and differences regarding eye contact, strength, and posture. At the beginning her body was tense and she avoided eye contact with the group; however, she noticed some changes during the fifth session from watching the video. “Each person was engaged, [. . .]. It looked like a similar movement to one that I did in the first class, but I thought it was completed in this moment [in the fifth class]. [We] stand up with our own strength, not by pushing others.” Sang shared her embodied experience with the image of tangled yarn. This participant felt burdened with a narrow view and rigid body; however, once she felt a light physical touch from one of the group members, she started to embrace rhythm into her body, which enhanced her ability to see others and the situation with a more broad view. This light physical touch “released emotional burdens.” Physical sensation from visual art: Four participants (Lee, Kwan, Sang, Jung) shared physical sensations related to visual artwork. Lee drew a picture of “floating with the flow of the water” after the movement experience of walking with a partner and relaxing on the floor helped her to be with herself. The visual art image after the movement experience guided her to think about therapeutic relationships and attunement to clients. “If I stay calm, I can be moved by a wave of water naturally and I can be moved with flow; when my mind is comfortable and I keep elements of acceptance and patience, it will help me to be close with clients.” Jung shared her physical sensation and images during a moment on video: I had strength in my legs, and I kept eye contact. Someone who can stay with their own strength is able to see themselves and others. [. . .] I was not uncomfortable making eye-contact and I was able to rid myself of tension easily. I had grown from the first class in these areas. [. . .] I wanted to stay strong like a tree with a wide outlook. Kwan identified a scene from the last session as a meaningful movement. She was lying on the floor with core to distal connection, which was “comfortable physically and emotionally.” She was aware of two meaningful things from the movement: “first, this was really comfortable lying here in the moment, and second, I became comfortable and at peace with myself.” Kwan’s drawing shares her progress of “growing from baby to early adult” (see Fig. 8). Here, she describes her bodily sensation while watching a movement video clip: It was a sensation of pulling in a not hurtful way, pulling me with the appropriate amount of pressure, and fulfilling energy. I felt that I would absorb something that had been supporting

Theme 2. Need for being alone and being together The second theme, need for being alone and being together touched on how participants had experiences in body movement that involved a Korean perspective on interpersonal relationships. This theme consisted of two categories: (1) finding space between self and others and (2) moving boundaries. Finding space between self and others: Three participants (Lee, Sang, Kim) discussed their inner conflict regarding their need for moments alone or with others. Kim described a moment of being apart from the group with some physical distance as a meaningful moment for her, when it felt good to not be a part of the group: “Others were all physically close together, but I moved away from them to a different place. My body was tense and my body was wrapped by my two arms, then later suddenly I unfolded my arms and walked to the group bravely.” Her drawing of this movement experience indicated similarity between herself—represented by a small flower – and a group of people – represented by a large flower. This similarity was conveyed by using similar colors, as well as the same symbolic form (see Fig. 4). Kim wanted to have her own space, but not to be too far from the group. Her movement indicated a strong need to maintain her own personal space, while respecting the needs of others. Later, Kim shared that she experienced emotional hardship after the termination of a group, and that allowing herself to have her own space away from the community or group – symbolically represented by the bundle of yarn – was necessary for her to process her recent termination. Kim indicated that the supervisor and other participants did not try to approach her or invade her personal space, which made her feel safe and respected in the group. Lee’s experience of sharing space together by walking with a partner provided a way to experience how to be with others. It reminded me to think about whether I have been following clients’ needs in session. When I was reaching the corner with my partner, I was anxious and it made my partner anxious too. I realized that I like to teach things to children [Lee’s clients] quickly, and that it can be my own need and it is very difficult to be with. Moving boundaries: Two participants (Min, Sang) shared their different perceptions of boundaries (see Figs. 1 and 7). Sang realized that her family members were not as tightly tangled as she had thought, and that she needed to maintain her personal boundaries to have freedom in her family. Min selected a moment of physical connection as being particularly meaningful, and expressed her thoughts regarding boundaries after watching the video clip: When Min approaches her clients with cancer, she always feels a need for flexibility, as rigid boundaries of not touching a client need to “break down.” Physical touch is a common and very natural intervention in Korean culture for those clients, and conveys “hope.” Theme 3. Gaining insight from symbolic and artistic exploration The third theme, Gaining insight from symbolic and artistic exploration, referred to how participants benefitted from using movement and arts media in clinical supervision. This theme consists of two categories: (1) connecting with body knowledge and (2) knowing one’s need for self-care.

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Connecting with body knowledge: Five participants (Kim, Lee, Sang, Kwan, Min) shared movements, which facilitated their awareness of their emotional state, relating to their needs as therapists. Kim and Jung shared body images that they found through their movement experiences and drawings. Sang had an insight regarding her “rigidity of body” and “narrow view”; these both related to her “inner hurriedness,” which caused a less spontaneous approach to her session structure. She observed that her “rigidity and narrow view also could provide rigid structure in a session, but I started to realize the importance of playfulness in session.” When Sang was able to incorporate musical rhythm into her body, she was able to modulate her anxiety and noticed inner release, which allowed room for playfulness. Jung’s final drawing of “therapist attitude” (see Fig. 6) indicated what her body needed to carry out when she enters her therapy sessions as a clinician. She was proud of herself for finding out what she needs bodily and mentally as a therapist: “sparkling eyes, warm heart, and open arms” (see Fig. 6). Kwan was able to notice her physical need to lie on the floor for a moment as a recuperative strategy after facilitating sessions as a therapist. Min also shared how working on one’s state of mind is important to be a competent therapist; she realized this after engaging in her movement sharing of “approach” and “acceptance.” Knowing one’s need for self-care: Four participants (Lee, Min, Kim, Kwan) shared their new findings regarding the importance of self-care through the arts in clinical supervision. Their comments included how this was an experience of “time of rest and regaining energy” (Min), a “time of nurturing and embracing self” (Kwan), a “feeling of progression within self-care” (Lee), and a “supportive environment [that] helped to prevent emotional burnout” (Kim). Self-care in clinical supervision was indicated as a new experience for most of the participants. Discussion This study posed two research questions relating to emergent themes and categories and to the researcher’s reflection on and interpretation of the literature. The first research question was: How do Korean expressive arts therapy supervisees describe meaningful moments in supervision? Although physical touch is often seen as a boundary violation from the Western perspective on therapy (Bonitz, 2008), four participants (Sang, Kwan, Min, Jung) selected meaningful and memorable moments related to physical touch in group. Sang discussed how a “light touch” from one of the group members became a turning point in a shift in her perception. Kwan discussed how the “sensation of pulling by others” was “like refueling energy.” Jung admired her final body posture, in which she created arm circles with other group members, noting her growth regarding physical engagement, strength, and eye contact as compared to her first class. Min selected a moment of relying on someone’s body as an important moment of being supported and not alone, and emphasized her finding that boundaries could be flexible. However, unlike these four members who reported physical contact as being meaningful, Kim talked about how a moment during the third class when she was apart from the group through physical distance was particularly meaningful. Kim’s movement, which was accompanied by a drawing of big (i.e., the group) and small (i.e., her) flowers, indicated her need to maintain her personal space while respecting the needs of others. These participants’ contradictory experiences raise questions about how Western dance/movement therapy educators or psychotherapists should address boundaries and physical touch when in cultures

with different values, norms, and ideas regarding human relations. Confucianism, a fundamental underpinning of Eastern philosophy, emphasizes uniting with others and being in harmony with others (Kim, 2007). For this reason, the self in Asian cultures needs to be understood within that individual’s socio-cultural context, which can cause a blurring of the boundary between self and society (Chang, 1988; Hsu, 1973; Kim, 2007; Tseng, 2004). Asian cultures tend to have complex concepts of self, which are profoundly related to family, friends, neighbors, and society (Kim, 2007); this is completely different from Western psychoanalytic theory, which is grounded on three layers – the id, the ego, and the superego – of the personal self (Freud, 1923). Sakiyama and Koch (2003) found that different perceptions regarding physical touch impact what are appropriate DMT interventions within a Japanese cultural context. Physical touch is more commonly used in therapy in Asian cultures than it is in the West; this norm of sharing physical space and interpersonal touch needs to be explained in psychotherapy and supervision within Asian cultural contexts. This Asian emphasis on collectiveness tends to encourage cohesive group movement; this was observed in Ko’s (2015) study, which described students’ movement as a “sticky donut dough.” Clearly, it is crucial to be aware of the importance of cultural context when teaching and seeing movement in Asian cultural contexts.

The second question was: What happens in supervisees’ bodily movements? Overall, participants in the present study were able to access experiences of kinesthetic empathy, symbolic use of movement, body and mind connection, and body images. Bodily movement clearly became part of their resources for professional and personal awareness. Theorists in body and movement (Cooper, 2001; Csordas, 1993; Lewis, 1984; Meekums, 2007; Payne, 2008) and art making (Yoo, 2011) have emphasized the epistemological importance of using movement in psychotherapy and clinical supervision. Min’s chronically painful left arm’s response to a symbolic healing patch from group members was mentioned by other participants as a significant experience of kinesthetic empathy and somatic counter-transference. Since empathic attunement involves a somatic component, it may help the supervisee to be aware of the empathic relationship with clients (Cooper, 2001). Drawing on her body experiences, Jung determined that three things were important in being a therapist: “sparkling eyes, open hands, and a warm heart.” Kim was able to recognize her need for personal space around her body. Kwan described how her bodily movement experiences reflected her comfort with her body and in the space for supervision. Sang’s experiences of letting rhythms into her way of moving opened up her view of herself and allowed her to find playfulness in her body. Kwan bodily felt a sense of “pulling and refueling energy,” which further expanded her sense of growing and finding strength to stand up. Min recognized the need to allow a free flow in her body, as represented by her drawing of “waves going in and out.”

Unexpected findings The findings from the two research questions led the researcher to think about fundamental differences in the sense of self, mental health concepts, human relations in Korea. It is clear that cultural perceptions on physical contact, the sense of boundary, group dynamics, and pace of process need to be considered within the specific cultural context when DMT or any psychotherapy-related subjects are delivered from the West to the East or from the East to the West.

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Limitations The researcher in this study was also the supervisor who led this group. Although this researcher tried to encourage mutual relationships with supervisees, Korean culture strongly encourages a hierarchical relationship between a supervisor and supervisees. Although the researcher (a dance/movement therapist) consulted with a board-certified art therapist in analyzing art data, the researcher had more expertise in working with movement data, and may have missed valuable content present in participants’ artworks. All interviews were conducted in Korean and translated into English by the researcher, which may have resulted in some inaccuracies in meaning, especially regarding the details of the English language. Several participants indicated that the five consecutive supervision sessions were not enough, and in their exit interviews they reported being ready for deeper exploration using this new approach. Conclusion Korean expressive arts therapy students benefitted from the creative thinking and feeling processes in clinical supervision offered in the present study. Using bodily felt experiences in clinical supervision facilitated and promoted individual and group artistic journeys, which encouraged insight, awareness, and expression beyond cultural barriers. This study also revealed the importance of expressive art therapy educators’ openness to a creative process that takes into account a cultural perspective when working with students in Korea. Continuous engagement in this creative process supports supervisees benefitting from arts media, and engaging in creative clinical work helps them discover the essence of who they are as expressive arts therapists. References Anderson, S., Rigazio-DiGilio, S., Cochran-Schlossberg, M., & Meredith, S. (2000). Four dimensions deemed essential to quality supervision: Theoretical, personal, and empirical account. In Readings in family therapy supervision: Selected articles from the AAMFT supervision bulletin. pp. 8–11. Washington, DC: American Association of Marriage and Family Therapy. Austin, D., & Dvorkin, J. (2001). Peer supervision in music therapy. In M. Forinash (Ed.), Music therapy supervision (pp. 219–229). Gilsum, NH: Barcelona. Bang, K. (2006). Applying the integrated developmental model to Korean supervisees. Asia Pacific Education Review, 7, 11–18. Bernard, J. M., & Goodyear, R. K. (2009). Fundamentals of clinical supervision (4th ed.). Boston, MA: Merrill. Bernard, J. M., & Goodyear, R. K. (2004). Fundamentals of clinical supervision (3rd ed.). Boston, MA: Allyn & Bacon. Bang, K., & Park, J. (2009). Korean supervisors experiences in clinical supervision. International Forum, 37(8), 1042–1075. http://dx.doi.org/10.1177/ 0011000009339341 Bonitz, V. (2008). Use of physical touch in the “talking cure”: A journey to the outskirts of psychotherapy. Psychotherapy: Theory, Research, Practice, Training, 45(3), 391–404. http://dx.doi.org/10.1037/a0013311 Bravesmith, A. (2008). Supervision and Imagination. Journal of Analytical Psychology, 53, 101–117. http://dx.doi.org/10.1111/j.1468-5922.2007.00704.x Chang, S. C. (1988). The nature of the self: A transcultural view. Transcultural Psychiatric Research Review, 25, 169–203. Cooper, M. (2001). Embodied empathy. In S. Haugh, & T. Merry (Eds.), Empathy. Rosson-Wye: PCCS Books. Creswell, J. W. (2013). Qualitative inquiry and research design: Choosing among five approaches (3rd ed.). Thousand Oaks, CA: Sage. Csordas, T. (1993). Somatic modes of attention. Cultural Anthropology, 8(2), 135–156. Deaver, S. P., & Shiflett, C. (2011). Art-based supervision techniques. The Clinical Supervisor, 30(2), 257–276. http://dx.doi.org/10.1080/07325223.2011.619456 Durkin, J., Perach, D., Ramseyer, J., & Sontag, E. (1989). A model for art therapy supervision enhanced through art making and journal writing. In H. Wadson, J. Durkin, & D. Perach (Eds.), Advances in art therapy (pp. 390–432). New York, NY: Wiley. Edwards, D. (2010). Play and metaphor in clinical supervision: Keeping creativity alive. The Arts in Psychotherapy, 37(3), 248–254. http://dx.doi.org/10.1016/j.aip. 2010.04.011 Edwards, D. (1993). Learning about feelings: the role of supervision in art therapy training. The arts in psychotherapy., 20(3), 213–222. Fish, B. J. (2005). Image-based narrative inquiry of response art in art therapy. In Retrieved from ProQuest dissertation and these database. (304910784, Doctoral dissertation).

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