Haguit Ehrenfreund
Dance Movement Psychotherapy (DMP) was institutionalized as a therapeutic discipline in 1966 in the USA. Its particularity is in the focus on body movement as a way of enlarging the emotional repertory, treating the body and the mind simultaneously. Movement patterns give the therapist the possibility of learning the patient’s history, and the way he expresses himself in the world (Chaiklin, 1975a; Chaiklin and Wengrower, 2009; Schoop and Mitchell, 1974).
In DMP it is considered that physical behavior reflects emotional states (Fuchs and Koch, 2014; Shahar-Levy, 2004). Changing the patterns of movement can lead to the mobilization of psychic forces. For that reason, the focus is on returning to somatic reality, and awakening the initial source of the psychic experiences. Emotional-movement is employed, also named dance-movement, aiming to harmonize the body and mind relationship when disturbed by mental disorders (Bartenieff and Lewis, 1980; Chace, 1953; Fischman, 2009; Schoop, 1978).
This chapter aims to theorize (meta-theory) the disturbance of the psychosomatic unity as a disorder of the body-mind relation. Medicine uses the term psychosomatic to designate psychic disorders manifesting in the body, when there is no organic cause. In the last years the term ‘psychosomatic’ was replaced with ‘medically unexplained symptoms’ and more recently with ‘somatic symptom disorder’ in DSM-5. However, the conception of that term relies on the interrelation between psychic processes and somatic processes. The word ‘psychosomatic’ is engaged in this chapter to remind readers of its psychodynamic orientation. When the concept of imbalance of the psychosomatic identity is used in this chapter, always to be heard as a disturbance of the body-mind relation, the author arises to it as an emotional disorder.
This pathological state means that as long as the correlation (cause and effect) between the body and the thinking process is not invested by an emotion (an affect), the patient cannot form a representation of their own psychosomatic self (Chemouni, 2000; Marty, M’Uzan, and David, 1963; Sami-Ali, 1977; Stora, 1999). In fact, it is through the action of the body, movement and the emotions that this process arises, and that it becomes possible for the patient to recognize the connection between body, emotion and speech. Once this process is accomplished, the patient is capable of naming and feeling, which in the absence of words, was kept out of consciousness (McDougall, 1989). For certain patients the transition via the body and its movement is a necessary step, in order to reach a conscious psychological organization of their life experiences.
We have observed the disturbance of the psychosomatic balance in our practice with different patients, suffering from diverse psychopathologies. In this chapter the pathology will be analyzed relying on psychoanalytical theories of mental pathologies, using Freudian concepts to build a hypothesis of psychosomatic disorder. The discourse of patients suffering from eating disorders will be exposed to enlighten the clinical consequences, because the disturbance of their psychosomatic identity is particularly clear.
This procedure should enable us to theorize as to the disturbance of psychosomatic balance as a pathology of the body-mind relation, and to conceptualize dance-movement psychotherapy as a psychosomatically informed discipline. The chapter will start by presenting the uniqueness of the DMP discipline and its therapeutic use of movement, to follow with a meta-psychological description of body expression that will serve to ground the concept of psychosomatic identity. The consequences of psychosomatic imbalance will be discussed, illustrated by the discourse of patients suffering from eating disorders. Finally, the author will outline her therapeutic approach and a technique for body-mind awareness: body cartography.
‘It is not gymnastics, it is an awareness process’ (Bejart, 2001, p. 20). At the beginning of the twentieth century a revolution took place in the art of dance. The emphasis was turned from the technical performance of movement as a form of emotional expression (Bartenieff and Lewis, 1980; Chaiklin and Wengrower, 2009; De Mille, 1963). Dancers participate in the revolution. The message that those artists bring to the world relates to the importance of body expression, to the freedom of emotional expression, and the place of the individual in society. The leading dancers of this period are Isadora Duncan (1878–1927) in the USA; Mary Wigman (1886–1973) in Germany, one of the pioneers of expressive dance; Rudolf Laban (1879–1957) the initiator of the Labanotation system (Laban, 1956, 1960; Laban and Laurence, 1974); Maurice Bejart (1927–2007) in Europe whose writings speak of philosophy through the interpretation of the dancer’s place in society (Bejart, 1982, 1994, 1998, 2001); and Martha Graham (1894–1991) in the USA, whose choreographies and teachings remain relevant today (Graham, 1973, 1992). It is in that historical, artistic and social context that dance-movement therapy emerges. The pioneers of DMT in the USA, Marian Chace (1898–1970), Mary Whitehouse (1911–1979), Trudi Schoop (1903–1999), Blanche Evan (1909–1982) and Irmgard Bartenieff (1900–1981), were all accomplished dancers.
The body-mind relation, the role of emotions, the need for expression and the place of dance in society were the impulses for those dancers to use movement as a psychotherapeutic tool (Levy, 1992). Each of them developed their therapeutic approach and working tools, which form the base of dance-movement psychotherapy today. The dancers that followed have developed training programmes in order to teach and systematize this new form of therapy. (Chaiklin, 1975b; Chodorow, 1991; Adler, 2002; Lewis, 1986; Shahar-Levy, 2004). This has led to the publication of clinical cases and exchanges among practitioners that raised new questions. And so, it was left to the third generation, to which this author belongs, to conceptualize the meta-theory. This chapter belongs to that effort of theorizing.
In a dance movement therapy session, speech is not the privileged tool, which does not mean that it is not present. Movement allows the patient’s memories to rise from the unconscious and join the present (Adler, 1999; Chodorow, 1999; Whitehouse, 1970, 1999). Dance-movement is a process of free emotional association on the psychosomatic level, in the sense of a body-mind process. The transference occurs on the body-movement level between the patient and the therapist (Gallagher and Payne, 2015; Whitehouse, 1999). At a certain point of the session, in order for the free emotional association to pass from sensual-gesture energy to speech, a process of mental consciousness is needed (Adler, 2002; Chodorow, 1991). This transition structures the physical experience in verbal language and permits the appropriation and elaboration of the contents experienced. When the physical expression is broadened, the gestural expression and the verbal expression integrate and complete each other (Modlingere, 1997).
This psychotherapeutic approach is especially precious when we work with patients suffering from mental or psychosomatic disorders. In these kinds of pathologies, the body becomes the speaker for the psychological apparatus, and sometimes the principle form of expression, communication and learning (Stora, 1999). The physical-gestural language operates as the moderator between body, emotion and thought, allowing the patient to find a body-mind balance (Fischman, 2009; Payne, 2009). This method requires the therapist have knowledge of the body, of movement and of psychopathology. It also requires the capacity to stay tuned to the body-mind relation through movement. Furthermore, it is recommended that the therapist is trained to employ other body disciplines such as yoga, dance styles, relaxation, etc. These conditions restrict the number of persons qualified to practice this discipline. For dancers drawn by the understanding of the psyche and the desire to be a therapist, this method presents unique possibilities.
The body is a physical-emotional-psyche space. Movement actively expresses the needs and drives of the person. Thus, creating a dialogue with the environment. Cognitive science has started to recognize the importance of the interaction brain-body-environment. The principal idea of embodying meaning is that mental process is embodied in physical activity and embedded in the environment (Lakoff and Johnson, 1999; Thompson and Varela, 2001). In DMP we consider that every exchange between two persons implicates an embodied process, through posture, gesture, facial expression or any other physical expression and reaction (Fuchs and Koch, 2014; Gallagher and Payne, 2015). As described by Freud in his early work, every psychic state and every mental process has an affective component and are all accompanied by a physical manifestation and the capacity to modify the somatic process (Freud, 1980).
Our body is a moving body, whose language is structured by physiological rules (nature) and psychological representations. Movement is a repertoire, a language that tells us how the individual apprehends the world, and the way he manages his internal forces (Bartenieff and Lewis, 1980; Dychtwald, 1986). One of the principal advantages of working with the body is the possibility of expanding the repertoire of physical and emotional expression (Chace, 1953; Chaiklin, 1975a). The ability to release muscular tensions while conserving the body forces softens the physical and psychological efforts that life requires (Bartenieff and Lewis, 1980; Shahar-Levy, 2004).
When body and speech is approached through danced-movement, the capacity of the individual to express himself in harmony is exploited: body-emotion-mind (Chodorow, 1991; Ne’eman and Bartal, 1992). This reconciliation meets the patient’s need for holistic expression, engaging her/his entire being, and offers her/him a tool for acting by, and in her/himself. The body is then conceived of as not only an extraordinary machine, or a way of communicating with others, but also as a way of enabling the patient to recover his or her psychosomatic balance.
Sigmund Freud proposed speech as the method of treatment because of its capacity to provoke psychological modifications (Freud, 1980). The psychoanalytic method concentrates on delivering repressed psychological content to consciousness through speech and the process of free association (Freud, 1920/1981). Helping the patient create the link between her/his memories and her/his present relations and behaviors helps her/him redraw his history and prepares her/ him for new life choices which are more conscious and more adaptive (Freud, 1937/1985; Hoffmann, 2008).
DMP proposes movement as a method of treatment because of its capacity to restore balance on the psychosomatic level. It concentrates on investing body action, and the patient’s communication with emotion (Chace, 1953; Fischman, 2009; Schoop, 1978). Helping the patient restore her/his psychosomatic identity, considered to be the body-mind balance, gives an emotional color to her/his gestural choices and reinforces her/his self-esteem and body image. The transition from an improvised unconscious movement to conscious movement invested with affect improves her/his kinesthetic sense and her/his capacity for making the link between movement, emotion and thinking.
Body movement is conceived of as an emotional process, therefore it is possible for us to discuss it in terms of a meta-psychology. It is proposed that it is possible to equate Freudian meta-psychology, meaning the dynamic, the topic, and the economics of psychological process (Freud, 1915/2008b), with this conception of movement. Body movement can be discussed on the levels of: gesture, organization, and flow. A meta-psychological presentation of movement would mean describing the flow of movement, to put it differently: the physical patterns, in terms of emotional fluidity and complexity. Discussing movement as a psychological act in that perspective would mean observing body movement as an organized flow system, with non-movement indicating unconscious repressed conflicted content, while fluidity indicates free expression of the emotional self.
Free movement is created by a harmonious coordination of the limbs, in their variety of action, toward a rhythm of contraction and relaxation (Graham, 1992). Such a movement is fluid and peaceful, does not suffer from any obstruction, and is economical in terms of energy. It also allows gathering forces operating with speed and precision when such are needed (Humphrey, 1959/1992). Through such knowledge of the body and its movement, the person acquires a sensation of self and space control. They can recognize the possibilities of change directly or indirectly, feel comfortable with that sensation and use it openly for meeting needs and self-expression. This physical coordination is based on the perception of the body structure, of its weight, of space and time. It enables one to choose the best support points to keep one’s balance: a balance that is the key to body management (Graham, 1992). In fact, an imbalanced movement creates muscular tension and discomfort resulting from effort, psychical as well as physical. As a consequence, the capacity to liberate the limbs that do not participate in the action, to be able to choose the best considered movement for the task, avoiding surplus effort and conserving the body forces, softens the psychic effort that physical expression requires. Moreover, it allows for an adjustment of movement to the emotional rhythm of the personality.
An obstruction in movement signifies a blockage in the body action fluidity, or a blockage of emotional expression. This interception is an indication of an unexpressed conflict that prevents movement from accomplishing the act of discharge, followed by relaxation (Schoop and Mitchell, 1974; Shahar-Levy, 2004). Around each obstruction muscular-emotional tension is created that accompanies the contraction of the physical zone. This constant contraction creates pain that the person will try to avoid by repressing the emotion, and by establishing diverted gestural courses that will become movement habits (Shahar-Levy, 2004). The result of this defense mechanism, psychic as well as physical, is the development of what we name a ‘dead zone’. This part of the body, which is not integrated into the gestural vocabulary of the person, is a landmark on the map of the body. The uncomfortable or painful sensation felt by the patient, when one of these obstructions is evoked during a DMP session, reconnects the emotion to the body, awakens the memory, and offers the patient the possibility of perceiving his needs and emotions through movement and speech (Fischman, 2009).
When Freud (1915/2008b) presented his hypothesis of the unconscious, modern psychotherapy was born, and a treatment method for some mental disorders became possible. Freud postulated that psychic processes are all unconscious. The representations, the affects and the drives of the psyche are only partially known by the individual. In order for a representation to become the object of consciousness, it needs to be invested by the word that represents it. Hence, a conscious knowledge is formed in the mind, to put it differently: a thinking process is constituted. The link between the conscious representation invested by words and unconscious memories is activated during psychoanalytical therapy by the discourse of the patient (Freud, 1915/2008b).
In dance movement psychotherapy, we use the term subjective link (Chodorow, 1999) after to refer to the perception of our own body formed by the sensation of movement. Subjective link is formed and is used to form the identity of the patient affected by pathology.
Freud enlightened us as to the development of identity, beginning with the perception of the difference between external and internal via muscular activity (Freud, 1915/2008b). When this separation (external and internal body) is not affected by pathological reasons, the difference between physiological stimulations and drive stimulations does not exist. The consequence of that interrupted process is the disturbance of the patient’s identity on the psychosomatic level (Marty, M’Uzan, and David, 1963; Sami-Ali, 1987). In those cases, introducing movement in the therapeutic process enables this separation, and begins to construct the psychosomatic unity. In order for the process of separation and unification to take place, the subjective link between the body and the psychic process (the mind) has to be perceived, so it can become an object of consciousness. The perception of ‘my body’ needs to be attached to a representation and a sensation for it to become an identity. Because dance-movement psychotherapy uses body movement and the emotions this process awakens, it is the most direct method to restore psychosomatic balance and treat psychosomatic identity disorder.
The hypothesis of the unconscious developed by Freud brings an additional element to the understanding of the psychosomatic imbalance. The destiny of affect after repression can take one of three courses: being repressed without leaving any trace, manifesting as another emotion, or transforming into anxiety (Freud, 1915/2008a; Marty, M’Uzan, and David, 1963; McDougall, 1989). The body movement awakens the unconscious content and gives it the drive strength to become conscious.
Through the use of movement the representation is reinvested with an emotion and the somatic force due to the movement impulse. The body action allows the affect (the emotion) to develop, while the subjective link between the body movement and the revealed emotion brings the memory back to the surface. When the source of the experience was not verbalized, because of the pathology or because the event happened in an early stage, the transition through the body becomes necessary in order to be transformed into words.
The key function of the psychic apparatus, using its specific mechanisms, is to keep the individual at the lowest level of tension. Pleasure, through this psychic logic, is the satisfaction resulting from the reduction of inner tension. Displeasure corresponds to the increase of the level of tension, which usually indicates the possibility of danger (Freud, 1920/1981). In certain pathological conditions, pleasure is obtained by the sensation of body contraction (high tension) (Chemouni, 2000; Sami-Ali, 1977; Stora, 1999). In this case, this contraction that we can also call pain, connects the person to his body. Keeping the tension high and increasing the contraction becomes the emotional and physical structure of the psychopathology. The scene of psychic conflict is transferred to the body, which becomes the enemy. Examples of this psychic functioning in patients suffering from unexplained headache, back pain, non-cardiac chest pain or severe eating disorders (Chemouni, 2000; Payne, 2009; Stora, 1999). Working with movement, reconnecting the body to an emotional reality, liberating the tension due to the restricted movement, are all part of dance-movement psychotherapy tools. Bringing sensations back to the body allows the patient to restart the psychosomatic balancing. The emotional experience of the body in movement helps patients to restructure their body image, and revives the psychosomatic identity.
In the case of eating disorders (anorexia, bulimia), it can be observed how the psychosomatic identity can cause an emotional split between the body and the mind. Words of the patients, when asked to complete the sentence ‘I am a body. . .’ at the beginning of a dance-movement psychotherapy session include: ‘I am a mute body’, ‘I am a body without space, a body that doesn’t belong’, ‘I am a body ball (and chain), heavy, captive’, ‘I am a miserable body, we should split’, ‘I am a body unfortunately’, ‘I am not a body’, ‘I am a tormented spirit’, ‘I have suffered too much, and it makes the persons close to me suffer’, ‘Why won’t it die, this body?’.
When asked about the body and mind relationship they answer: ‘In me it’s the mind criticizing the body instead of them supporting each other’, ‘I would like to be able to make the connection between the cause, the feeling of stress and my eating behavior, but it has been so long, so it is necessary to go back at the beginning, go untie the knots and find the source’, ‘I am a very sensible person, and I have difficulty holding it all back and feeling, that is why I digress and cut out the emotions’, ‘The body is intelligent, but in daily life I don’t let it talk, I don’t let it act’, ‘Most of the time I feel like the body does not exist’ and ‘I am a mind without body’.
By working with movement with this population the aim is to reinvest each part of the body with sensation and emotion, in order to reach the psychosomatic balance that was disturbed by the absence of emotional mediators. Through the emotional-movement experience, patients can find again the affective level of speech, and the capacity of expression and sensation of the body. When they are asked at the end of the session to complete the same sentence ‘I am a body. . .’, the answers are the following: ‘I am a calmed body’; ‘I am a living body’; ‘I am a body that needs sun’; ‘I am a wise body’; ‘I am a good body’; ‘I am a present body’; ‘I am an extended body’; ‘I am a moving body’.
With such patients in order to reconnect with the psychosomatic self and wake the power of healing, they need to develop a representation of the body-mind relationship and restart the capacity to hear the body messages. Experiencing pleasure in their contracted body, being able to recognize different emotional states, and not fearing the felt body sensations, can transform the perception of the body. Contrary to what is often assumed, working with the body in movement does not bring the patient into an overexcited emotional state, nor does it risk driving them into a psychologically decompensated state. On the contrary, it allows them to reach a calmer state due to the discharge of exaggerated tension, and to the expression of the repressed emotions. The clinical illustration confirms that for certain patients the transition via the body and its movement is necessary in order to find an emotional continuity between body sensations and thoughts processes.
There follows a description of the author’s therapeutic approach to the body-mind awareness process. Mapping the body is a procedure aiming to guide the patient into an intermediary state between relaxation and tension. The objective of this process is to eliminate excessive tension, in order to open the channel to a physical sensational-emotional receptiveness, and active expression (meaning emotional movement). The body cartography is an adaptation of warm-up exercise in dance practice, to guide a process of body-mind awareness. This will include: placing the body in space, naming the limbs, bringing movement to each part of the body, thus establishing a body cartography that will later be set in motion.
The term ‘body cartography’ refers to both a physical and cognitive process. All parts of the body are invested by the sensation of movement and perceived by the knowledge of the body organization. Thus, the body map is laid out, not just as a static image but as a moving body that the patient can use for expression. By helping the patient clarify and enlarge movement, identification with his body and involvement in the expression of feelings can be unified (Chace, 1953). The body becomes a known place that the patient can signify as their own, while movement becomes their personal expression.
For every person, in particular those suffering from diverse pathologies, it is useful that the different parts of the body be named, and for patients, to be reminded how they are structured in order to make them present in their consciousness. This warm-up phase is for an isolated sensitization of the body (only the shoulders, or only the pelvis, etc.), in order to focus attention on areas of tension and contraction. In fact, it is impossible to start moving without first preparing the body.
If the patient wishes, music of their choice can accompany this phase. It is desirable to let the patient lead the body cartography for three reasons: in an instructive approach teaching how to release muscular tension, or encouraging them to take charge, or for the affirmation of the ‘self’. In a group session, the ‘Chace circle’ protocol is followed, adding to it the body cartography. The body mapping process promotes interaction, every participant proposing a movement that will be integrated in a collective choreography, as Marian Chace illustrated (Chaiklin, 1975a; Chaiklin and Wengrower, 2009). Before ending this part of the session, every participant is asked how they feel, and if there is any part of their body that needs additional attention. This sequence is frequently used to work separately on each part of the body, giving specific attention to areas of tension and to the mechanical function of the limbs. This procedure aims to prepare the patient for a fluid physical-emotional expression, where all the parts of the body participate.
During this process, the therapist uses their body as a mirror for the patient, helping them to elaborate their own body perception. Words accompany these moments, naming each limb and guiding the form of movement (circle, undulation, right/left, etc.). As mentioned before, with time some patients guide the process themselves. The use of the body as a mirror for the patient’s movement is unique to dance-movement psychotherapy. The initial movement of the patient is employed by the therapist to establish the therapeutic relationship, and to transmit a message of acceptance (Chace, 1953). For her, mirroring is not about imitating the patient’s movement, but rather embodying its sense, so that the therapist can accompany the patient.
For the psychoanalyst Jaqcues Lacan (1996), the mirror stage is a crucial moment in the relationship that a person will develop with his body, and with the others that resemble him. The infant identifies with his image reflected in the mirror. In order for that to happen, the mother has to be present and confirm that it is indeed the infant’s own reflection. The mirror stage allows the child to establish a relationship with reality, through the capture of his spatial body. This process will mark the mental development of the child, and later it will shape the social bond.
When the therapist’s body is used as a mirror for the creation of the body cartography, the physical form from space (the gestalt) needs to be outlined, in order to establish a conscious balanced center. When the body map is posed and centered, movement can occur in space, the impulse arriving from the body toward the outside world.
The perception of the body is structured through what the patient sees and imitates in the therapist, but also by the internal sensation that her/his own movement creates. After the body cartography has been posed and the limbs invested with a feeling, the patient can express her/his movement in space and deliver her/his emotional experiences.
Dance movement psychotherapy is practiced in diverse settings, and if there are differences in its conceptualization, which can modify the style or the techniques, the basic theories of movement stay the same. In order to understand the physical expression of the patient, the therapist needs a real knowledge of the body and movement and she must be familiar with the art of expressive and improvisational dance. Movement patterns, the fluidity of expression, the range of movement, are all of essential importance to the psychotherapeutic use of dance movement (Gallagher and Payne, 2015).
The basics of dance are employed in order to understand the patient’s movement, in order to join them, to enable transference, and to propose new movements. As Sharon Chaiklin insisted, the simple fact of being able to move does not constitute the ability to use movement as a therapeutic tool (Chaiklin, 1975b).
The author has presented and proposed a tool, body cartography, which it is hoped will add to the reservoir of therapeutic techniques used to awaken body-mind awareness. Grounding the emotions in the body sets the healing forces in motion.
The particularity of dance movement psychotherapy is the approach centered on the integration of psychic contents with psychosomatic manifestations; we can also call it the psychotherapeutic awareness of the body-mind relation.
This chapter has attempted to theorize the imbalance of this relation, and the effect that it can have on the patient’s mental health. This psychosomatic imbalance, which can be defined as the shortage of emotional mediators between the body and the mind, can be the pathology itself, or it can accompany another psychopathology. In both situations the psychosomatic identity is essential for the apprehension and the treatment of the patient. One of the objectives of the dance-movement psychotherapists is to help the patient recover and develop the flow of information between the body and the psychic level. This process will support the healing forces, helping the patient to improve his emotional awareness and his message to the environment (Bartenieff and Lewis, 1980).
It is time to define dance movement therapy practice more precisely as a psychosomatic psychotherapy, based on the understanding of the body-mind relation, and the place of emotions in the balance of this unity. This will allow us to further develop the practice and theory of our unique discipline, and to find our place in the discussion concerning psychopathologies, what causes them and what can heal them.
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