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Enhancing Your Therapy with Gestalt Approaches
Gestalt Therapy continuing education counselor CEUs

Section 25
Gestalt Techniques in Dance Therapy

CEU Question 25 | CEU Answer Booklet | Table of Contents | Gestalt
Social Worker CEUs, Counselor CEUs, Psychologist CEs, MFT CEUs

Theories in psychology that have been most influential in the field of dance therapy include Reichian, psychoanalytic, Gestalt, object relations, humanistic, family systems, and Adlerian. Levy (1988) noted a trend toward increasing theoretical eclecticism and integration in the field of dance therapy. However, there are some key conceptual themes that are common to most dance therapy approaches. Human beings are assumed to have unconscious memories, feelings, and motivations that need to be introduced and integrated into individuals' conscious awareness (P. L. Bernstein, 1986). Furthermore, it is assumed that some unconscious material, especially memories formed during preverbal stages of development and bodily trauma, are stored in the body and are more easily accessed through physical expression (Levy, 1988). Within the holistic conception of the individual conscious intellect, the emotions, the unconscious, and the body are considered interconnected, with the experiencing and processing of physical experiences believed to positively affect emotional and cognitive growth and functioning (P. L. Bernstein, 1986; Espenak, 1981).

We undertook this qualitative study in an attempt to begin to understand how dance therapy effects change in clients' lives. The purpose of this phenomenological exploration was to explore the lived experience and meaning of dance therapy for women who found that this form of therapy contributed to their personal growth and healing. The question that guided this research was, “What is the lived experience and meaning of dance therapy for individuals who found it to be facilitative of their personal growth and healing?”

Participants were required to have been involved in individual or group dance therapy that was facilitated by a certified dance therapist. Individuals were screened through telephone conversations, and the first 6 women who met the inclusion criteria were included in the study. However, when it became apparent during the data collection that 5 of the 6 participants had histories of child sexual abuse, we decided to limit our analysis to the 5 abuse survivors.

Six themes that were common to the participants emerged from the data analysis. The words of the participants are used in the following descriptions of the themes and subthemes to more accurately capture the essence and meaning of their dance therapy experiences. To enhance reporting, each subtheme is italicized within the thematic descriptions.

Theme 1: Reconnection to Their Bodies
All of the women in this study mentioned having felt disconnected to varying degrees from their bodies. Some spoke about a rejecting attitude they had toward their bodies, either because it seemed fragile or because it had attracted a child abuser. As one participant put it, “I thought of my body as this unfortunate accessory … it has just caused me trouble … it always felt like the enemy.” Others talked about a general sense of not having been present in their bodies. At the extreme were various descriptions of dissociation, which seemed to be related to experiences of childhood sexual abuse. For example, one participant reflected on her sense of having been a collection of pieces: “I always felt sort of fractured, fragmented, like parts of my body are on different planes and they're not connected to me personally.” In fact, having experienced various other forms of more traditional “talk” therapies, these women specifically sought dance therapy as a means to help them reconnect to their bodies. It is not surprising, then, that a sense of bodily reconnection was an extremely prominent theme running through the transcriptions of each of the participants. All of the women talked about how dance therapy involved a process of getting back into their bodies. By becoming more connected to their bodies, the women were able to become more “present” in and more comfortable with the range of energetic and emotional sensations in their bodies. In reestablishing a connection with their bodies, the participants reported feeling an increased sense of acceptance and care of their bodies.

The participants also talked about their previous tendencies to cope with physical and psychological discomfort by “going into their heads” through intellectualizing, minimizing, and denying. The participants reported that, unlike traditional talk therapies, dance therapy offered them a way to bypass this defensive reaction to discomfort, because this therapeutic process was rooted in bodily expression. As one participant observed, “I think the moving repeatedly helps you to stay in your body, and not go back into your head.”

Theme 2: Permission to Play
The women in the study had experienced talk-based therapies as sometimes serious and hard work and were surprised that play was encouraged as an integral part of the dance therapy process. One woman found that, contrary to her expectations, she really enjoyed the dance therapy sessions. She remarked, “I thought, aren't we supposed to be crying and upset and angry?” The women described the playful element of this therapy as “delightful” and “exciting.” They experienced it as a means of recapturing a sense of carefree youth that had been lost to them over the years. This aspect was particularly significant for some women who remembered childhood years in which play and fun were lacking or forbidden. Through dance therapy, these women were able to experience, as adults, a sense of the type of playfulness that is characteristic of childhood. The participants noted especially, how the playfulness of dance therapy provided a balance to and a relief from some of the emotionally heavier aspects of therapeutic work. As one participant said, “There was at least one moment every time I went where I just had a good time. And that was a neat thing to learn, that I could do some healing work and it didn't have to be totally serious and really hard all the time.” Indeed, that play and work could coexist and, in fact, that both together could lead to healing and growth was considered a significant new insight by the women in this study.

Theme 3: Sense of Spontaneity
Spontaneous movement was mentioned as an important aspect of the dance therapy experience by the women in the study. When they spoke about spontaneous body movement, the participants described movement that was free, self-determined, natural, and uncontrived. They spoke about a progression during their dance therapy experiences toward increased spontaneity in their body movements and toward overcoming the various obstacles they encountered along the way. One obstacle that emerged from the women's stories of their group dance therapy experiences was what one participant referred to as having an “outer focus.” They reflected on how, at times, their concern with “what others might think” about they way they moved led to self-conscious and constrained body movement.

Theme 4: Sense of Struggle
All of the women in this study reported that their experience of dance therapy was infused with a sense of struggle. Initially this involved the unfamiliarity of this type of therapy. Many found dance therapy to be new and strange and used words like “challenging,” “difficult,” and “uncomfortable” to describe their experiences. Some felt inhibited and embarrassed at the idea of dance itself, whereas others felt apprehensive because this approach to therapy was non-traditional and represented uncharted territory. As discussed previously, the women struggled with the discomfort of being seen by others. They felt self-conscious and worried about looking foolish. For some, the experience went beyond embarrassment to a more acute sense of vulnerability and exposure. One woman's metaphor poignantly conveyed this feeling: “Moving is like opening the book … it wasn't just like opening the book, it was like ripping the book open. It was really difficult.” Some of the women also reported that they struggled with how to deal with painful memories and feelings that arose during their dance therapy sessions. Many talked about how their bodies contained information about past traumas and about how that powerful and sometimes shameful material surfaced while they were engaged in the therapeutic movements. Anticipating the emergence of new and potentially painful material contributed to the women's sense of apprehension. This was dramatically captured in one woman's metaphor: “Being in my body always feels like walking through a minefield … you know that there's danger out there, you just don't know where … you're waiting for the inevitable.” The women also reported their struggle to cope with the fact that particular aspects of the dance therapy process (e.g. music, certain movements, structured activities) could trigger physical and emotional responses associated with past trauma. Certain kinds of music triggered in one woman a deluge of emotion and frightening mental images related to the ritual abuse she had experienced as a child. An exercise that involved holding still reminded another woman of being bound and confined as a small child, and these memories resulted in considerable emotional and physical distress during the session. Although these women struggled to keep from being overwhelmed by body memories and emotional triggers, they were also aware that this material was necessary “grist for the therapy mill,” the identification and working through of which was critical to their own growth and healing. As such, these women considered it essential to develop a sense of safety in the group. They reported that the therapist and other group members helped create a safe environment in which they were able to challenge themselves to explore difficult and painful issues.
Despite these struggles, the women said they continued in dance therapy because they saw their hard work actually helping them to grow and heal.

Theme 5: Sense of Intimate Connection
The women in this study reflected on their experience of a unique kind of emotional connection with others while engaging in dance therapy. They remarked on how this intimacy was created without words, simply by moving together and at times, physically connecting with each other. The women talked about how the sense of intimacy they experienced with other participants during dance therapy was uncontrived. It seemed to emerge spontaneously through the wonder of simple gestures, playful moments, and dances that conveyed trust and caring. The women also spoke about factors like music and synchronized movement that contributed to a feeling of unity in the group. The participants believed that this connection and intimacy added greatly to their growth and healing through dance therapy, because they felt supported by others and accepted both physically and emotionally within the group.

The participants in this study remarked that observing another person being vulnerable while dancing was also a meaningful aspect of their dance therapy experience. They called this observation “witnessing” and said it was important for them in several ways. Seeing others taking risks and being vulnerable made them more willing to risk and to open up and share more of themselves and their struggles. The women also felt “honored” to receive the gift of another's dance and said this contributed greatly to their own sense of self-worth. The women also discovered that during group sessions, they gained insights about themselves and were engaged in their own work, even when bearing witness to the struggles of other members or when others were working individually with the therapist. As one participant said, “My experience was that things always came up for me. It never stayed feeling like it was the other person's time; it was always my time as well.”

Theme 6: Sense of Freedom
The word freedom appeared repeatedly in all of the women's stories in many different contexts. The participants reflected on how they appreciated the freedom of choice that characterized dance therapy. They talked about having their choice of the activities that were presented and about feeling free to adjust their participation according to their own needs, agendas, and comfort levels. One woman explained, “It was clear to me that I could choose not to do any exercise, which was very important, or I could choose to do it in my own way.” For one woman, this freedom of choice and control over the therapeutic process was especially significant and meaningful in light of her past abuse experiences:” For most people that have been sexually abused, that's one thing that was taken away from them, their ability to move, emotionally, physically, mentally, everything. So you've got this freedom that is so important.” This woman described the sense of personal freedom as entitlement—reclaiming her right to be in charge of her body and her experience. All of the women told stories of emotional release, which they experienced to some degree in more traditional forms of therapy. What the women believed was unique to dance therapy, however, was the opportunity to discharge some of the physical energy that accompanied these powerful emotions. As one woman put it, “When stuff comes up in dance therapy you've got some way to expend the energy that's involved … to deal with it in terms of your body, and to get the energy out of your body, not just out of your mouth.”
- Mills, Letty J.; Daniluk, Judith C.; Her Body Speaks: The Experience of Dance Therapy for Women Survivors of Child Sexual Abuse;  Journal of Counseling & Development, Winter2002, Vol. 80 Issue 1
The article above contains foundational information. Articles below contain optional updates.

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Personal Reflection Exercise #11
The preceding section contained information about Gestalt techniques in dance therapy.  Write three case study examples regarding how you might use the content of this section in your practice.

Online Continuing Education QUESTION 25
What were six themes regarding dance therapy discussed by sexual abuse survivors? Record the letter of the correct answer the CEU Answer Booklet.

 
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The article above contains foundational information. Articles below contain optional updates.
Enhancing psychotherapy process with common factors feedback: A randomized, clinical trial.
In this study, we developed and tested a common factors feedback (CFF) system. The CFF system was designed to provide ongoing feedback to clients and therapists about client ratings of three common factors: (a) outcome expectations, (b) empathy, and (c) the therapeutic alliance. We evaluated the CFF system using randomized, clinical trial (RCT) methodology. Participants: Clients were 79 undergraduates who reported mild, moderate, or severe depressive symptoms at screening and pretreatment assessments. These clients were randomized to either: (a) treatment as usual (TAU) or (b) treatment as usual plus the CFF system (TAU + CFF). Both conditions entailed 5 weekly sessions of evidence-based therapy delivered by doctoral students in clinical psychology. Clients completed measures of common factors (i.e., outcome expectations, empathy, therapeutic alliance) and outcome at each session. Clients and therapists in TAU + CFF received feedback on client ratings of common factors at the beginning of Sessions 2 through 5. When surveyed, clients and therapists indicated that that they were satisfied with the CFF system and found it useful. Multilevel modeling revealed that TAU + CFF clients reported larger gains in perceived empathy and alliance over the course of treatment compared with TAU clients. No between-groups effects were found for outcome expectations or treatment outcome. These results imply that our CFF system was well received and has the potential to improve therapy process for clients with depressive symptoms. (PsycINFO Database Record (c) 2017 APA, all rights reserved)
Can reflecting on personal values online increase positive beliefs about counseling?
This research developed and tested an online values-affirmation exercise to attenuate threat and enhance positive beliefs about counseling among individuals struggling with mental health concerns. There is evidence that reflecting on personal values (values-affirmation) is an effective approach to eliciting self-affirmation—a psychological process that temporarily bolsters self-worth in order to forestall maladaptive, self-protective responses to counseling information. The present study utilized a randomized 2-group between-subjects design to test the effectiveness of a values-affirmation exercise with an online sample (N = 186) of adults who reported struggling with a mental health concern. It was predicted that values-affirmation would reduce threat related to reading mental health information and increase positive beliefs about counseling. Results indicated that those in the values-affirmation condition reported fewer negative emotions such as feeling upset, irritable, hostile, and scared after reading mental health information, indicating that the information was perceived as less threatening. There was also evidence that engaging in values-affirmation was associated with greater anticipated growth in counseling and greater intent to seek counseling, reflecting greater positive beliefs about counseling. Overall, the results suggest that reflecting on personal values may have the potential to enhance the positive effects of online psychoeducation. (PsycINFO Database Record (c) 2017 APA, all rights reserved)
Depression symptoms moderate the association between emotion and communal behavior.
Depression is associated with emotion regulation deficits which manifest as elevated negative affect and greater continuation of negative affect over time. The present study examined a possible emotion regulatory deficit, whether depression symptoms attenuate the association between communal (i.e., agreeable, quarrelsome) behavior and affect. A community sample reported on depression and anxiety symptoms before recording their affect and behavior following naturally occurring interpersonal interactions over 21 days. Participants’ behaviors were measured using items selected to represent the Interpersonal Circumplex Model of behavior. Results indicated an association between affect and communal behavior, which was stronger for negative than positive affect. Depression symptoms moderated this association; elevated depression symptoms were associated with decreased association of affect and interpersonal behavior. Comorbid anxiety symptoms did not moderate this association. Results suggest that elevated depression symptoms are associated with a diminished ability to adapt communal behavior to emotion cues. Given prior evidence of elevated overall quarrelsome behavior among individuals with elevated depression symptoms, this may demonstrate an interpersonal mechanism by which emotion regulation deficits impact the generation of interpersonal problems. (PsycINFO Database Record (c) 2017 APA, all rights reserved)
Thwarted belongingness, perceived burdensomeness, and depression among asian americans: A longitudinal study of interpersonal shame as a mediator and perfectionistic family discrepancy as a moderator.
This short-term longitudinal study applied Joiner’s (2005) Interpersonal-Psychological Theory of Suicide to Asian Americans’ experiences with depression. Interpersonal shame (i.e., the experience of inadequacy arising from interpersonal concerns) was hypothesized to mediate the effects of (a) thwarted belongingness and (b) perceived burdensomeness on future depression. Furthermore, the positive associations between (a) thwarted belongingness and (b) perceived burdensomeness on future depression were hypothesized to vary depending on students’ experiences with perfectionistic family discrepancy (PFD; their perceived gap between their actual performance and what their parents expect of them). A total of 605 Asian Americans attending predominantly White, Midwestern universities completed 3 online surveys. Conditional process modeling via Hayes’s (2013) PROCESS was used to analyze the data. Results demonstrated that (a) thwarted belongingness and (b) perceived burdensomeness contributed to higher interpersonal shame, which influenced students’ future depression. Furthermore, the effect of thwarted belongingness on future depression was significantly positive for those with PFD levels greater than the 12th percentile, after taking into account students’ initial level of depression. The effect of perceived burdensomeness on future depression was not significant for those with PFD levels greater than the 3.5th percentile. This study identified that students with perfectionistic family discrepancy may be at higher risk for depression while experiencing thwarted belongingness. Overall, findings supported using Joiner’s (2005) theory to understand Asian American students’ risk for future depression. Future studies may gather data across Asian American students’ years in college. Counselors can apply these findings to increase students’ awareness about possible risk factors for depression. (PsycINFO Database Record (c) 2017 APA, all rights reserved)
Distress disclosure and psychological functioning among Taiwanese nationals and European Americans: The moderating roles of mindfulness and nationality.
Research using Western samples shows that talking about unpleasant emotions—distress disclosure—is associated with fewer psychological symptoms and higher well-being. These benefits of distress disclosure may or may not be observed in East Asia where emotional control is valued. Instead, mindfulness may be more relevant to emotion regulation in East Asia (e.g., Taiwan). In the present study, cultural context (Taiwanese nationals vs. European Americans) and mindfulness were examined as moderators of the relation between distress disclosure and both depression symptoms and life satisfaction. A sample of 256 Taiwanese college students and a sample of 209 European American college students completed self-report measures in their native language. Moderated multiple regression analyses revealed significant interaction effects of mindfulness and distress disclosure on both depression symptoms and life satisfaction for Taiwanese participants but not for European Americans. Specifically, distress disclosure was negatively associated with depression symptoms and positively associated with life satisfaction for Taiwanese low in mindfulness but not for Taiwanese high in mindfulness. For European Americans, distress disclosure was not associated with depression symptoms but was associated with higher life satisfaction, regardless of one’s level of mindfulness. These findings suggest that the potential benefits of disclosing distress are a function of one’s cultural context as well as, for those from Taiwan, one’s mindfulness. (PsycINFO Database Record (c) 2017 APA, all rights reserved)

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