Am J Dance Ther DOI 10.1007/s10465-017-9257-1
The Art of Reaching Out Rebekka Dieterich-Hartwell1
American Dance Therapy Association 2017
Abstract This paper examines the intersubjective processes encountered in a 10-week creative arts studio class. The objective was to explore how transference and countertransference, along with metaphor and symbolism, fostered meaning, which in turn could contribute to an understanding of the therapeutic process. While several themes emerged through the data analysis, the main theme extracted was the phenomenon of reaching out. Two vignettes were highlighted to indicate a connection between this theme and transference, countertransference, metaphor, and symbolism. An arts based method using improvisational movement illuminates and adds to the understanding of what it means to reach out. The paper closes with applications and suggestions for the field of dance/movement therapy based on the findings and personal clinical experiences. Keywords Arts based research Dance/movement therapy Intersubjectivity Reaching out Somatic countertransference
Introduction What makes individuals do what they do when they are in the company of others? What holds them back one moment and pushes them forward the next? The choices we make mostly originate in our unconsciousness. As we share an intersubjective space, we enter into each other’s lived experiences and unknowingly re-create old relationships that affect our behaviors. In other words, we encounter the phenomena Sigmund Freud coined transference and countertransference. In this paper, the & Rebekka Dieterich-Hartwell
[email protected] 1
College of Nursing and Health Professions, Drexel University, 1601 Cherry Street, Philadelphia, PA 19102, USA
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reader is invited on a journey into a simulated creative arts studio class. Two vignettes describe how transference was experienced, what factors contributed to both meaning making and transformation, and how this data could inform the psychological understanding of a creative arts process in therapy. The main theme that emerged from the studio class was reaching out. This phenomenon can be defined as an extension of the self to another person or the lack thereof, both of which may take place internally, in form of an attitude, as well as externally, through shifts in body language. Improvisational movement and personal connections to clinical experiences allow this theme to take further shape and develop an understanding of its relevance to the field of dance/movement therapy.
Research Position This paper is situated within arts based research, an approach that utilizes the artistic process to understand and explore experiences by both researchers and people involved in the study (Knowles & Cole, 2008). Arts based research is founded on the belief that some human experiences cannot be adequately communicated through conventional language but can be conveyed through art in a unique, preverbal manner (Hervey, 2000; McNiff, 2011). The researcher thus engages in art making, using visual arts, music, dance, and other art forms to gather data (Hervey, 2000). The process of analysis is iterative—gradually the experience is put into words through reflecting and continued art making (Kapitan, 2010). For the purpose of this paper, movement and ensuing narrative were utilized to gain a better understanding for the theme of exploration.
Setting As part of a PhD program in creative arts therapy (CAT), a studio class took place over the course of ten weeks. For seven weeks, five students and two instructors engaged in discussions of literature, an hour of art making within their modalities of music and dance/movement, followed by personal reflections through journaling and, lastly, a sharing of impressions with one another. The remaining three weeks were devoted to an overview of transference and countertransference, a re-watching of some of the recorded art making experiences, and student presentations.
Objective The purpose of this paper was to get a better understanding of the meaning making processes that occurred in the intersubjective space and explore how these could contribute to the work of creative arts therapists.
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Method of Inquiry The first step was to read through all the personal journal entries in one sitting with a fresh mind. Multiple renditions of sifting through the texts ensued, as well as a conscientious act of remembering and visualizing the experiences that were described in the entries. Although this was a slow and indecisive process that included breaks and impasses, gradually recurring phrases and scenarios became noticeable. These were highlighted in different colors and entered into a matrix that included following headings: Artistic Expression, Personal Journal Entries, Discussion Summary, Intersubjectivity, and Literature (N. Gerber, personal communication, September 21, 2015). Furthermore, discussion notes and readings that corresponded to the highlighted phrases were added. The main themes that emerged were: (a) feeling something new, (b) peace through music making, (c) inhibition vs. freedom, (d) impulse vs. grounding, and (e) reaching out. For the purpose of this paper, the last theme, reaching out, was selected for further investigation, with the plan to revisit and examine the other themes at a later time. Before communicating some of the happenings in the studio class and in order to get a fuller understanding, a brief description of the phenomena closely connected to the chosen theme, intersubjectivity, transference, and countertransference is offered in the next section.
Intersubjectivity, Transference and Countertransference Intersubjectivity can be defined as a quickly engaging, unspoken, and dynamic process in which people enter into each other’s lived subjective experience (Brown, 2011; Schwartz, 2012; Stern, 2005). In the creative arts therapies, intersubjectivity is displayed through a sharing of both fantasies and realities and the creating of expressive art that is filled with meaning (Gerber et al., 2012). While the mind is involved, the body, too, is a crucial factor in this process: ‘‘Through the bodily self’s resonance, others become second selves, or second persons and this is a vivid experience of intersubjectivity’’ (Gallese, 2014, p. 2). Tanaka (2015) proposed that ‘‘we use embodied interactions to understand the other person…,’’ which ‘‘does not assure a precise understanding of the mental states of the other’’ (p. 460), but does allow us some access. Intersubjectivity is closely related to transference and countertransference; in fact, the interplay between the latter two can be conceptualized as an intersubjective process (Stolorow as cited in Schwartz, 2012):’’If transference and countertransference are present, then intersubjectivity is as well’’ (Schwartz, 2012, p. 93). Transference is the unconscious transfer of feelings or thoughts about people in the client’s past to the analyst, often due to unresolved issues within these former relationships (Freud, 1912). Erotic or affectionate and negative, hostile transference are both possible, however, the degree of transference can vary from superficial to deep and emotional constructions (Symington, 1997). While the initial, classical view regarded transference as a repetition of wishes and fantasies, the current,
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broader, totalistic (Gabbard, 2001) view sees transference as an attempt to re-enact and resolve conflict in order to heal (Freud, 1912). It is a naturally occurring process, present in therapeutic settings as well as in our daily social lives (Andersen & Burk, 1998). Transference manifests itself through behaviors, response patterns, and affect (Kauff, 2009). According to Kauff (2009), through connection making between internal process and external reality, the client is able to make positive changes. Countertransference can be defined as the therapist’s own transference, unconscious emotional reactions in response to the client’s transference. Initially regarded as damaging and interfering with treatment (Kernberg, 1977), a broader perspective of this phenomenon established by Heimann (1960) came to view the emotional responses of the therapist, both unconscious and conscious feelings towards the patient, as actually useful in recognizing the latter’s conflicts and defenses: ‘‘The analyst’s countertransference is an instrument of research into the patient’s unconscious’’ (Heimann, 1960, p. 81). Different from individual therapy, countertransference in a group setting needs to be considered in terms of resonance and mirroring (Hopper, 2006).
Reaching Out Class Vignettes In this section, two separate stories from the studio class are described. Both entail the act of reaching out in different ways. Encountered incidents of transference, countertransference imagery, metaphors, and symbols are highlighted. The vignettes are kept in a simple, narrative style that gives voice to the authenticity of the moment. Reaching Out From a Distance This particular studio was initially filled with turmoil for me. I had just returned from an intense conference the day prior and felt the repercussions—my confidence was low and I felt small, restless, and overwhelmed. I was generally aware of my surroundings but mostly focused internally. Nevertheless, I somehow noticed my peer standing by herself with an ocean drum. Something in her demeanor, in her aloneness, made me approach her. She did not seem to mind, but she also did not seem to encourage it. We connected minimally through my egg shaker mirroring the movements of her ocean drum. It was actually sort of endearing because the instruments were obviously mismatched but still connected. After a while we both moved our separate ways. Later, at this time three of us were humming in modal harmonies, this same peer became visibly upset. In the following discussion, she shared that our harmonies had reminded her of Buddhist chants and brought up the memory of the recent loss of a family member in a visceral way. She put down the ocean drum and moved to the far side of the room. I had the impulse to take the ocean drum and continue playing
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it for her, but something held me back. It didn’t seem right. I felt helpless, wanting to reach out to her, yet sensing that she needed space. She appeared closed off and recoiled in her body language. There was no entry to her. So, I just stood where I was, facing her, with my hands on my heart. I stood like this for a long time, rocking from side to side, sending loving thoughts and peace all the way over to her side of the room. Then I opened my arms as if I were to give her a hug. I didn’t know if she was able to sense it or receive it. She reminded me of a bird with a broken wing, hurt, but unapproachable. My heart ached for her because I could feel her distress, but all I was able to do was stand there with open arms. During the discussion, she said that she felt my dance (my rocking back and forth, my hands on my heart, and my outstretched arms) as ‘‘support and holding her space’’. This comment showed me the power of the arts in the intersubjective space. What I had initially wanted to do was exactly that—allow her to take time to grieve and not feel that she had to continue playing the ocean drum because I could just do that for her, which then I shied away from. Her sensing my intention and feeling the support, even from what seemed miles away, was a compelling reminder of the unspoken shared experience in the room. In this example, I venture a guess at the transference my peer was having towards me. She might have seen me as a caring acquaintance or peer, but not necessarily as someone whose shoulder she could cry at. Then again, her slightly reserved personality might also be an indicator that she would rather handle sadness on her own. My countertransference towards her was one of respect and care, almost like how you might treat an elder. I realized that I could not overwhelm her with physical closeness but needed to show her in a ‘‘small way’’ that I cared. The imagery of the bird and the metaphor of the ‘‘broken wing’’ spoke to the notion of fragility and vulnerability that was present. Reaching Out in Proximity At the onset of this studio class I was slightly uninspired yet open minded. One of my peers had shared with us over lunch that her mother was in the hospital. She seemed worried about her. I remember feeling compelled to reach out to her during our art making time. She was sitting on the floor and I slowly approached her from the side, just sensing her presence, but not yet engaging with her. Later, when she was standing again, I moved slowly next to her, shuffling my feet towards her once. She shuffled them towards me, so I shuffled mine closer. It was an intricate moment where our feet told the story. Her responding to my somewhat playful shuffle gave me the permission to move closer. We stood next to one another in silence. I put my arm around her, somehow knowing that this would be acceptable. She did the same thing. We stood in solidarity, moving slightly to the soft brush strokes in the background that sounded like gentle waves. Then, slowly emerging, came the urge to move behind her and lend her my support that way, free her to be who she needed to be. I put my arms to the side, just standing behind my peer who was dancing freely, uninhibitedly. All of these decisions were seamless in that I didn’t reflect over them but just acted in the moment, trusting my intuition. Even though this was only pointed out later during our discussion, unconsciously I must have felt like a mother, ‘‘having
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her child’s back,’’ ready to fight if any threats emerged, because it made much sense to me when I heard the comment. Congruent with this countertransference and metaphor, my peer later stated that during the time I stood behind her she had been transported to a place ‘‘that feels, not thinks, an internal place where nothing else exists, enveloped in goodness and grounded.’’ Again, I was amazed at the ability of the arts to make meaning and transform us in our shared experience. In regards to transference and countertransference, I believe that my peer trusted me fully while she was dancing. It appeared that she saw someone in me who would be there no matter what. I, on the other hand, felt grounded and secure in my place. I felt caring towards her, wanting her to feel comfortable and be her authentic self. The metaphor—holding someone’s back—and image—mother and child—spoke of support and care.
Artistic Movement Improvisation Response I chose to investigate the concept of reaching out further through movement improvisation. I initially depicted an open stance, arms contracted, palms up. I then extended my arms forward with a clear invitation to someone. Next I opened my arms to both sides and reached out to left and right. Lastly, I fully reached forward to the point where I almost lost my grounding. I ended by coming back to myself. Narrative My first reaching out was quite minimal, just holding my hands open. It was very doable, but it almost felt too limited to actually matter. However, maybe this is exactly the right way to reach out to some people. It is not intrusive and not overwhelming, just a small sign of ‘‘I see you and I am here for you!’’ What I perceive as minimal may be perceived by someone else as ‘‘just right.’’ When I actually extended my arms, I realized that I was getting more involved. I was clearly aware of some need and engaged in giving my support. This kind of reaching out was comfortable. It still felt doable yet I was more invested and not just half-heartedly engaged. I became aware of my unilateral focus and turned to both sides. The opening movements felt good—round and organic. It seemed as if I was spreading goodness and distributing my means. This movement invitation was satisfying, possibly because it was fluid rather than static and wholesome, as if I were providing nourishment and life sustaining resources. Another attribute that made it attractive was that it was not single focused. I didn’t have to get lost in the minutia or get pulled into just one person’s life, but was able to attend to a wide range of experiences and keep an open perspective for what was needed all around me. Then… a crisis. I felt like I had to rescue. This was demanding my all. Reaching forward to the point of exhaustion, wondering whether I could actually do it. Was it too much? Was I overextending myself? I noticed that my torso followed my arms, that I was losing my balance and that the ground beneath me was no longer steady. After reaching unsuccessfully for what seemed like an eternity, I saw the need to
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retreat. It was too much. I closed my eyes and found my ground, reaching out to myself, my own heart. The Opposite—Reaching Out For Help I quickly realized that my focus throughout the studio class and also within my improvisational movement response had been on reaching out to help or support someone. However, reaching out can have other motives as well. For this reason, I decided to explore, through movement, how reaching out for help differed from reaching out to help. One of the things I noticed was that rather than holding my ground and merely extending my upper body I was leaning into whatever direction I hoped to receive support from. My weight tipped towards an unknown source to the point where, without someone else’s support, I could no longer stand on my own. It felt dependent and ungrounded, needy and uncomfortable. Metaphors and Symbols Noted in the Process The metaphors and symbols that arose during the movement improvisation response were limited, half-hearted, fluid, static, organic, wholesome, nourishment, rescue, get sucked into, overextending, losing ground, retreat. Several spoke to the image of nutrition, which bring into question whether the act of reaching out is necessary to sustain life. Also, within the improvisation, there was a transition from one extreme (limited) to the other (overextending), showing the wide range of possibilities and how they manifest in the body as well as metaphorically.
Discussion and Relevance to Dance/Movement Therapy The concept of reaching out, explored both through the studio class vignettes as well as through an artistic movement improvisation response, raises several issues and questions that appear relevant to the field of DMT. For example, going along with reaching out comes the issue of touch. When is touch appropriate and when is it contraindicated? Furthermore, how much should therapists reach out? What is too much? When are they not to reach out? What are appropriate boundaries? Touch is an important topic for DMT because the focus of this type of therapy is the relational engagement between the bodies and movements of therapists and clients, so it occurs more frequently than in traditional, verbal therapy sessions (Popa & Best, 2010; Willis, 1987). However, while touch has been shown to be beneficial with certain client groups theoretical guidelines for its use are missing and there is a call for specific research into both the positive and less positive aspects of touch (Popa & Best, 2010). Popa and Best (2010) described how touch could have varying effects, ranging from an increased sense of inclusion, support, restoration, and containment to a heightened feeling of sexual discomfort and invasion. Therapists need to remember that they are the ‘‘foreigners, visiting the world of [the] clients, trying to learn their languages, their gestures, their sense of meaning-making and their relationship to touch’’ (Popa & Best, 2010, p. 41).
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Having gained an understanding of how uncomfortable it can be to be on ‘‘the other side,’’ to be the one reaching out for help, raises the question whether some clients may have a tendency to hold back and minimize their hardship. As dance/movement therapists then, it is important to be aware of this potential tendency and read subtle cues of acute need, responding in similarly subtle fashion. At times, it might be necessary to hold on and wait to understand the context of reaching out or eliciting reaching out. This waiting may in fact be an important piece of the story that plays out between therapist and client. Certainly, the opposite extreme can occur as well, as indicated in personal clinical work, when clients lack boundaries and reach out for help at a degree that surpasses the therapist’s ability. At the end of my improvisational movement response, when I was losing my grounding to give more than I was capable of, I had a particular client in mind. The movement brought me back to the time she shared her trauma with me, not having ever revealed it to anyone else before. This disclosure and my holding her secret appeared to unleash an intense focus on me. At the same time, her post-traumatic stress disorder symptoms were getting worse— she experienced multiple flashbacks, nightmares, and dissociative episodes every day. I recognized that I was experiencing a deep disturbance within myself. I could not shake the images of the trauma she had shared with me, I felt helpless, exhausted, and I dreaded going to work. I remember holding constant tension in my body and feeling relief when I finally came to the realization that my role of rescuer in her life was not helpful. I had to set boundaries to protect myself and help her be less dependent. She, on the other hand, needed to learn to reach out to others and not merely rely on one person. Hervey (2015) defined boundaries as ‘‘where I can go and where I can’t. Where I am and where I’m not. What I do and what I don’t do. Or what I do and what you do. Who I am and you who are’’ (p. 10). Boundaries thus speak about unique identities and about how individuals distinguish themselves from others. The physical body gives important cues and shows when boundaries are overstepped, whether it be through a sense of discomfort, increased tension, or an instinctive recoiling. Not only is the setting of appropriate boundaries important in regards to therapists’ psychological health, it is also essential for the clients we work with. According to Dosamantes-Beaudry (2007), if therapists resist a limit setting but instead feel compelled to satisfy clients’ particular types of gratification, ‘‘the result is that the [clients] are comfortable, the therapists feel loved and unchallenged, but the potential for psychotherapeutic movement is also effectively blocked’’ (p. 213). An important aspect to consider is the difference between experiencing the urge to reach out and how to use this urge to help someone understand their own message or life story. The impulse, in fact, reflects the transference and countertransference that occurs in the relationship. Transference and countertransference feelings and reactions can be a helpful source of information about the inner world of both patient and therapist. Therapists need to reflect over this urge and make wise decisions based on what they feel coming from the patient and what their responses to these behaviors are (Prasko et al., 2010). Depending on the client’s state, it may be helpful to convey the presence of an urge to reach out.
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What about clients who are problematic to connect with because they reject help? Should a continued effort to reach out be made? In general, therapists ought to be open and accepting, no matter what their client is experiencing. If individuals do not seem receptive to support, this can be acknowledged, but a safe space needs to be patiently and continuously provided. Bloom (2006) calls on dance/movement therapists to be anchored in their own bodies and read the clients’ bodily experience through their own so they can then ‘‘introject [clients’] anxiety rather than react to it’’ (p. 66). Sitting with help-rejecting clients in their discomfort and sharing their struggles merely by being with them might provide just enough support and acceptance. This kind of environment may instill trust, which in turn is necessary to summon the courage to reach out. Therapists are bound to come across clients who fall on all sides of the spectrum. Reaching out is a risk. Therapists may be taken advantage of or rejected. However, they may also be able to provide sustaining and life-saving support and assist individuals who are in desperate need of connection and understanding. Through somatic countertransference reactions therapists can determine the situation at hand and assess what kinds of movement experiences may be needed to facilitate emotional growth (Dosamantes-Beaudry, 2007).
Summary This paper examined how transference and countertransference were experienced in the context of a creative arts studio class, specifically through the selected theme of reaching out. One of the findings, based on metaphors, seemed to indicate that reaching out is life sustaining. Another observation was the range that reaching out could occur at, spanning from an open presence to a rescuing act. A third intriguing outcome from an improvisational movement response was the question about the motive behind reaching out. It appears that, depending on whether one reaches out to help or for help, the body shifts from increased grounding to a lack of grounding. No matter what type of reaching out occurs, however, it seems to require initiative and therefore implies risk. Dance/movement therapy with its focus on nonverbal, unconscious material, is particularly suited to address this phenomenon. Therapists are called to be familiar with their own movement repertoire so that they can freely engage with clients, be aware of the manifestations of transference and countertransference, and make healthy and appropriate choices in regards to reaching out to clients.
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Rebekka Dieterich-Hartwell MA, BC-DMT is a dance/movement therapist and PhD candidate in Creative Arts Therapies at Drexel University. She has 15 years of clinical experience with adults with acute and chronic mental illnesses, substance abuse issues, eating disorders, and psychological trauma. Thanks to a background in biology, she is interested in connecting science and art, specifically neuroscience and dance/movement. Her other main clinical and research interest is dance/movement therapy with refugees or traumatized immigrants. She serves on the Board of the Pennsylvania Chapter of the ADTA in public relations and as Adjunct Faculty at Drexel University.
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