The Arts in Psychotherapy 80 (2022) 101951

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The Arts in Psychotherapy

journal homepage: www.elsevier.com/locate/artspsycho

Dance movement therapy processes and interventions in the treatment of

children with anxiety disorders derived from therapy logs
Ayala Bresler Nardi 1, Michal Bat Or, Einat Shuper Engelhard
Uniberstiy of Haifa, The School of Creative Arts Therapies, Israel

A R T I C L E I N F O A B S T R A C T

Keywords: Dance movement therapy (DMT) offers children a space to encounter strengths and experience a sense of vitality
Therapy logs to increase their sense of confidence and self-awareness, thereby easing their anxiety and/or helping them
Dance movement therapy with children achieve more adaptive emotion regulation. While previous studies indicate that DMT effectively reduces anxiety
Treatment of children with anxiety disorders
symptoms, such as stress, scant research focuses on the nature of the therapeutic interventions and how they
Therapeutic interventions in dance and
movement therapy
assist in treating anxiety. This study is a qualitative assessment that examined DMT techniques and interventions
Somatic mirroring of one therapist’s work through their documentation in therapy logs tracking eight long-term treatments of
The paper chase intervention model children aged 8–11 coping with anxiety symptoms. Four intervention axes were identified: (1) action-promoting
interventions (2) separation-promoting interventions; (3) interventions for strengthening the sense of self; and
(4) integration-promoting interventions. Based on the findings, a therapeutic model is proposed drawing on
various “mirroring” interventions as the basis for forming the therapeutic relationship and additional therapeutic
interventions involving movement. The model enables the child to explore their experience of the relationship,
understand themselves in a new way, and create meaning.

Introduction documented in eight therapy logs during 2013–2018. The therapy logs
were analyzed based on the Milner Method (Halton-Hernandez, 2020)
Anxiety disorders affect one-quarter of the population. Childhood is for subjective autobiographical writing and psychoanalytical
a critical period for developing general and social anxiety disorders self-exploration. This was done through inductive analysis of movement
(Essau et al., 2014) that disrupt the child’s social, emotional, and aca­ and verbal content, defining domain content and identifying core ideas
demic development (Taylor et al., 2019). In addition to cognitive, under the phenomenological hermeneutics qualitative paradigm, which
behavioral, psychodynamic therapy methods, and creative arts thera­ relates to written text, dance, and art as expressing the wealth of human
pies, including dance movement therapy, invite the child to encounter experience (Tzabar-Ben Yehoshua, 2016) and is based on phenomeno­
vital forces and emotions designed to enhance their confidence and logical elements from multiple case studies (Yin, 2013). Data analysis in
self-awareness, thereby relieving the sense of anxiety. Although previ­ the current study is based on the consensual qualitative research (CQR)
ous findings do indicate the effectiveness of dance movement therapy method (Hill et al., 1997).
for reducing symptoms of anxiety (e.g., stress reduction), there is a The study findings shed light on how the therapeutic process mani­
dearth of focused research on the nature of therapeutic interventions fests in the body of children with anxiety disorders and how various
and how they help treat anxiety. types of physical interventions facilitate the process for the body and
This study examines therapeutic techniques and interventions used psyche. Four intervention axes were identified: (1) action-promoting
in dance movement therapy, as documented in the therapy logs of eight interventions; (2) separation-promoting interventions; (3) in­
children aged 8–11 who received long-term therapy for dealing with terventions for strengthening the sense of self; and (4) integration-
symptoms of anxiety. promoting actions.
The current study is a participant observation study (Aronson, 1995), Somatic mirroring was found to lie at the heart of the interventions
this study examined actions taken by the therapist and her patients as and seven different types of mirroring were identified. The various types
well as reciprocal actions that took place within the shared space, as of mirroring allow the patient to have different experiences throughout

E-mail address: [email protected] (A. Bresler Nardi).

1
University of Haifa Israel.

https://doi.org/10.1016/j.aip.2022.101951
Received 12 March 2022; Received in revised form 6 July 2022; Accepted 9 July 2022
Available online 16 July 2022
0197-4556/© 2022 Elsevier Ltd. All rights reserved.
A. Bresler Nardi et al. The Arts in Psychotherapy 80 (2022) 101951

the course of therapy and serve as a foundation for deepening the in­ humor, and creativity to help the child gain control of their emotional
terventions as the timeline progresses. Through the prism of child experience and experience some relief. The therapist reflects the content
development, these findings serve to expand our understanding of that emerges as they play, thus expanding the child’s experience of being
therapeutic processes in children coping with anxiety in order to seen and validated and allowing for self-expression that leads to a sense
establish a therapeutic intervention model. of self-efficacy (Schaefer & Drewes, 2009).
In play, the child moves from passivity to activity. Thus, the expe­
Methods of treating children with anxiety disorders rience of having no control, which is typical of anxiety-ridden situations,
is reduced and in its stead, feelings of helplessness, along with the need
Cognitive behavioral therapy for children with anxiety disorders for control and rigidity, are expressed (Kra-Oz & Shorer, 2017). One of
the main roles of play is to transform raw and overwhelming emotions
Anxiety disorders affect a quarter of the population, with general that arise in children when they experience anxiety and provide a way
anxiety disorder and social anxiety disorder being among the most for these to be expressed (Weitkamp et al., 2018). Within the therapeutic
common in the United Kingdom (Taylor et al., 2019). Childhood is a process, the therapist serves as an object that can help the child’s ego
critical period for developing general and social anxiety disorders (Essau expand and gain control by accepting and joining the child’s inner world
et al., 2014), which disrupt the child’s social, emotional, and academic and gradually advancing the process by verbally articulating the child’s
development (Taylor et al., 2019). They are the most difficult emotional emotional experiences (Chethik, 2000). A large-scale study conducted
disorders experienced by children and adolescents (Halldorsson et al., among children and adolescents aged 4–21 (n = 86) found that the
2019); untreated, they often affect functioning in adulthood (Taylor dynamic therapeutic space allowed children to verbally and physically
et al., 2019). express internal situations of stress, aggression, and conflicting emotions
The most common way of treating childhood anxiety disorders is that may be experienced as unbearable, without feeling that they are
cognitive behavioral therapy (CBT) (Taylor et al., 2019), which has been threatening a significant other or the relationship. The researchers found
found effective in 60% of cases, mainly among children under the age of that anxiety symptoms had significantly decreased by the end of the
15. This therapy technique emphasizes the patient’s behavior, thoughts, course of therapy and had remained low a year after it ended (Weitkamp
and beliefs. Incorporating positive and calming talk in response to et al., 2018). Another study found that when parents (n = 392) of
anxiety-provoking thoughts, role playing as part of the therapeutic children with somatic complaints focused on their child’s emotional
process (Craske et al., 2014), and gradual interoceptive exposure to experience, validated and gave it meaning, there was a significant
anxiety-provoking situations while creating new and positive experi­ decrease in the scope of complaints (Kehoe et al., 2014). It appears that
ences, by among other things, using humor and positive reinforcement children require an adult to validate and give meaning to their bodily
(Abramowitz et al., 2012; Craske et al., 2014), have been found effec­ sensations and emotional experiences without being perceived as
tive. Another significant factor in the treatment’s success is the rela­ intrusive or frightening. When a child’s physical symptoms are treated
tionship between the therapist and the patient, formed within a while their emotions are ignored, or when their bodily sensations are
protective and empathic environment (Hoffman, 2019). interpreted in a biased way, expressions of anxiety increase.
While CBT has been proven effective, about 40% of children
continue to experience significant levels of anxiety post-treatment Dance movement therapy for anxiety disorders
(Alkozei et al.,2014). Studies show that CBT has low effectiveness in
cases of social anxiety (Warwick et al., 2017) and that the technique of Dance movement therapy (DMT) combines movement and attention
generating competing thoughts in response to negative thinking only to physical sensations using a dynamic approach (Chaiklin & Wen­
partially helps to reduce physical symptoms (Alkozei et al., 2015). In grower, 2015) in order to improve emotional and social functioning by
this context, researchers found that combining arousal reduction tech­ integrating body movements, emotional responses, and self-expression
niques, such as relaxation, with cognitive therapy techniques that help (Pylvanainen, 2010). In DMT for children, the therapist uses guided or
organize, normalize, and explain physical arousal symptoms as part of spontaneous relaxation, imagery, play, and dance, using their body to
stress-related phenomena, significantly contribute to the reduction of reflect the patient’s movements and adapt themselves to the child (e.g.,
symptoms (Alkozei et al., 2015). One of the techniques combining a by referring to the child’s facial expressions, muscle tension, posture,
cognitive approach with physical intervention is the Unified Protocol for breathing, and voice) (Weitz & Opre, 2019). For the child still devel­
Transdiagnostic Treatment of Emotional Disorders (Barlow, 2016), oping secondary thinking processes, it is difficult to express emotions
which combines relaxation and self-relaxation techniques, including verbally; their natural inclination is to physically discharge feelings of
observing and focusing on the body, accepting physical sensations stress and discomfort (Chethik, 2000).
without judging them, and talking about the experiences, emotions, and DMT is based on the assumptions that primary object relationships
sensations. are internalized in the body and imprinted as a somatic memory
(Garavito, 2013; Michalak et al., 2009) and that various experiences of
Dynamic therapy for children with anxiety disorders movement may assist in learning new ways of forming relationships
(Chaiklin & Wengrower, 2015). The therapist is in a state of psychoso­
Dynamic therapy examines the underlying causes for anxiety in matic awareness; that is, they are constantly listening to physical sen­
children, which it considers linked to developmental conflicts related, sations and body-related emotions, thoughts, and images as they arise
among other things, to phallic and oedipal urges (Curits, 1979). The (Pvinle & Parteli, 2014). Awareness of somatic transference and coun­
purpose of therapy, among other things, is to enable the child to bring tertransference processes forms the basis of the therapeutic process as a
their latent impulses to the surface and get to know and accept them tool for understanding the therapeutic relationship and the patient’s
without feeling guilty, thereby easing their anxiety. The object relations inner world. Thus, the therapist’s body becomes a transformative space
dynamic is recreated within the therapeutic relationship. Therefore, in the therapeutic processes (Vulcan, 2009). Concurrently, nonverbal
identifying the content arising in transference and countertransference interventions that relate to the actions of the body as analytical material
processes is significant for building a treatment and intervention plan. promote a direct and unmediated encounter with parts of the self that
As children express their emotions through action (Chethik, 2000), dy­ have been wounded as a result of failures in primary object
namic therapy for children is generally conducted through play therapy relationships.
(Baggerly & Jenkins, 2009). In order to enable the child to express Authentic Movement (AM) is a DMT technique that invites the pa­
thoughts and emotions they cannot express directly or speak about in the tient to listen to their bodily sensations and notice how these are
presence of the therapist, the therapist encourages using imagination, expressed in movement. It is based on the assumption that creating a

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space in which repressed emotions can be expressed through movement Data collection procedure
can allow parts of the self that have been stunted by avoidance or denial
mechanisms to be expressed (García-Díaz, 2018). A study examining the For the purpose of the study, eight logs of completed clinical pro­
effect of AM on mitigating anxiety disorders in adults (n = 57) found cesses were examined to analyze the treatment of children aged 8–11
that in the therapeutic processes, the repressed emotions that arose were coping with typical symptoms of anxiety: night and day terrors; avoiding
mainly those perceived as negative, such as anger, and that the level of social gatherings and various experiences; distorted perceptions of re­
anxiety decreased (García-Díaz, 2018). Another study that investigated ality; irritability; rage attacks; rigidity; and being overly critical. At the
the effect of DMT on adolescent girls (n = 162) found that following recommendation of the school psychologist, the children (three boys
treatment, the girls were more aware of the connection between their and five girls) were referred to and treated by the first author during
physical and emotional sensations and that anxiety levels had decreased 2013–2018 for a minimum of 25 therapeutic sessions, with the average
(Bräuninger, 2012). course of treatment lasting 25–40 sessions. In four of the cases, the
In a study examining DMT’s contribution in the treatment of children symptoms had passed by the end of the treatment. In the four other cases
aged 6–7 with aggression and anxiety disorders (n = 30) researchers symptoms had partially improved. At the time of the study, the
found that symptoms of anxiety and aggression had decreased after 10 researcher, a certified DMT therapist, had over ten years of experience
sessions, compared to the control group that did not undergo treatment and was being guided by a senior instructor with over 30 years of
(Khodabakhshi et al., 2014). In a systematic review of 23 studies, re­ experience as a DMT therapist and psychotherapist. The therapeutic
searchers found DMT to be effective in reducing anxiety symptoms for processes documented included 45-minute one-on-one sessions with the
children and adults (Koch, Kunz, Lykou, & Cruz, 2014). The nature of children and parent training once a month. The sessions took place in a
the interventions in these studies included a combination of ballroom space in an Israeli elementary school that was adapted for DMT, with
dancing (Hackney and Earhart, 2009), Creative Movement (Noreau mattresses, balls of different sizes and textures, fabrics, veils, elastic
et al.,1995), spatial orientation (Röhricht & Priebe, 2006), and AM bands, hoops, sticks, and balancing beams.
(Dibbell-Hope, 2000).
In addition, a study that examined the effectiveness of combining Research tools
DMT with CBT for children (n = 99) found that providing psychological-
educational explanations while focusing on the patient’s bodily sensa­ The therapy logs were analyzed based on the Milner Method (Hal­
tions and the physical expression of their emotions and thoughts ton-Hernandez, 2020) for subjective autobiographical writing and psy­
contributed to the treatment’s success (Weitz & Opre, 2019). Other choanalytical self-exploration. In her log, among other things, Milner
studies found that encouraging patients to use their physical strengths documented four decades of children’s case studies and her training
and vitality gave them a sense of confidence and promoted sessions with Melanie Klein (Haughton, 2014). With the help of Win­
self-awareness (Khodabakhshi Koolaee et al., 2014), qualities that are nicott, Milner established the study of personal logs as a reflective tool
diminished in children dealing with anxiety disorders (Schaefer & that assists in methodical construction (Halton-Hernandez, 2020). A
Drewes, 2009). DMT, then, is unique in integrating the body’s move­ large-scale study (n = 120) found that writing a log enhanced the
ments and sensations, emotions, and thoughts. It creates a space for self-reflection process (Yu & Chiu, 2019). In addition, it has been found
expression, regulation, and empowerment, thus assisting patients in that self-reflection processes and treatment log analysis, together with
situations of anxiety. This study’s goal is to identify and map DMT self-reflection and peer dialogues help the therapeutic community
processes and interventions for children with anxiety disorders upon develop critical thinking and expand their professional knowledge (Chiu
which to propose an initial model for using DMT in treating children et al., 2013; Yu & Chiu, 2019). This reflective process examines the
coping with anxiety disorders. significance of the action taken and its implications for the various
people involved (Shlesky, 2006) in order to produce methodological
Method knowledge that supports and improves the clinical work (Yin, 2013).
Specifically, the therapy logs contain a documentation of events
The research paradigm unfolding from the moment the patient enters the room until the session
ends, with reference to the patient’s behavior, including how they treat
DMT combines various therapeutic disciplines and makes use of the therapist, the setting, and the main interventions the therapist per­
multiple therapeutic techniques and interventions throughout the forms. The therapy logs contain thoughts, questions, and insights that
therapeutic process. This calls for qualitative research based on a arise and form as they are being written regarding the processes that
methodology that facilitates a broad and holistic perspective of the na­ took place in the treatment room. These represent the therapist’s sub­
ture of these interventions and their effects (Koch et al., 2014). The jective thoughts, attempting to reflect the objective reality that existed
current study is a participant observation study (Aronson, 1995) in in the room as closely as possible. The therapy logs document verbal and
which the therapist is also one of the researchers. The study examined physical dialogues, the patient’s physical expressions and how they
actions taken by the therapist and her patients as well as reciprocal moved, as well as the therapist’s primal sensations, emotions, and
actions that took place within the shared space, as documented in eight physical sensations emerging during the sessions as part of transference
therapy logs during 2013–2018. This was done through inductive and countertransference processes. The materials appearing in the
analysis of movement and verbal content, defining domain content and therapy logs were written immediately after the sessions and were
identifying core ideas under the phenomenological hermeneutics qual­ expanded upon throughout the week, as part of the reflective processes
itative paradigm, which relates to written text, dance, and art as of observing the sessions.
expressing the wealth of human experience (Tzabar-Ben Yehoshua,
2016). This method is commonly used in studies dealing with consulting Data processing
psychology and psychotherapy (Hill & Hess, 2012) and is based on
phenomenological elements from multiple case studies (Yin, 2013). To analyze the data, a sequence of sessions were used, all taken from
Data analysis in the current study is based on the consensual qualitative each log from three points in time throughout the courses of treatment
research (CQR) method (Hill et al., 1997). consisting of 25 sessions: sessions 1–6 from the start of treatment, ses­
sions 10–15 from the middle of treatment, and sessions 18–25 from the

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end of treatment. Sessions were selected from different stages of the Findings
treatment in order to gain a perspective on the therapeutic process in
relation to the timeline. In total, one hundred of the treatment sessions In the current study, which focused on therapeutic interventions,
were analyzed. In accordance with the CQR method (Hill et al., 1997), four main axes were identified: (1) interventions that encourage the
the analysis process was conducted by three researchers who are also patient to take action (n = 8), designed to help the patient move from
experienced therapists (two DMT therapists and one art therapist). In the avoidance patterns toward self-efficacy; (2) separation promoting in­
first stage of content analysis, the content chosen for analysis was coded terventions (n = 7) to encourage the construction of an identity and the
by each researcher separately to identify domains under which the data establishment of the self around content related to closeness/distance
could be clustered. The researchers then discussed their results and relations and dependency patterns; (3) interventions to strengthen the
reached agreement on the appropriate domains (Hill et al., 2005). In the sense of self (n = 7), intended to build a sense of confidence and au­
second stage, the core ideas common to the therapeutic interventions tonomy; and (4) interventions that promote integration (n = 7), which
were discussed, identified, and formulated using systematic comparison emphasize the connection between various aspects of the self. For each
and generalization while taking measures to ensure these reflected the of these axes the following four clinical interventions were identified:
data as accurately as possible (Befani, 2013; Hill et al., 2005). At this “mirroring”; “witnessing”; “movement sequences between poles”; and
stage, the units of meaning were labeled based on the content that “focusing to heighten awareness.”
emerged from the data. In the third stage, the final themes, referred to as The interventions identified were classified in reference to the
cross-analysis, were produced. The therapeutic axes unique to DMT therapeutic axes. Seven types of “mirroring” interventions were identi­
were identified, along which the therapeutic interventions used at fied: (1) synchronized somatic mirroring; (2) sustained somatic mir­
various stages of the therapy shifted. The research team met several roring; (3) interpretive somatic mirroring; (4) mirroring to encourage
times throughout the study. In addition to writing together and agreeing initiative; (5) mirroring to bear witness; (6) mirroring to join an ille­
on the codes and categories, the research team also discussed dis­ gitimate expression of the psyche; and (7) mirroring to encourage
agreements regarding the analysis process through peer discourse (Hill powerful movement (see Diagram 1).
et al., 2005). The second author, an experienced DMT therapist and Eight types of interventions were identified that included “move­
academic researcher, served as auditor. Her role included ensuring that ment sequences between poles” enabling the patient to try, experience,
the raw material had been classified under the appropriate categories, and practice relationship patterns and encounter their psychological
that all the material was represented in a reliable way in the core ideas, mechanisms in a safe environment: (1) from parts to a whole; (2) se­
that the core ideas had been conceptualized in a manner that retained quences between poles using imagery; (3) from the edges to the center of
the essence of the raw data, and that the cross analysis reliably repre­ the body; (4) avoidance and presence; (5) closeness and distance; (6)
sented the data. She performed this auditing function at each stage of the holding and letting go; (7) controlling and yielding; and (8) exper­
analysis and writing. imenting with balance. The choice of using any one of these depends on
identifying the content the patient brings to the session and their needs
Professional ethics and confidentiality (see Diagram 2).
Three types of “focusing to heighten awareness” interventions were
To protect the children’s privacy, their names, along with any other identified: (1) joining the emotional experience by listening to the body
identifying details have been changed. The parents consented to the use and focusing on its needs and available resources; (2) verbal mirroring;
of the treatment logs for research purposes after it had been made clear and (3) returning to movement content of the patient’s choosing (see
to them that there would be no consequences if they refused to consent. Diagram 3).
The study was approved by the Faculty Ethics Committee of the Uni­
versity of Haifa.

Diagram 1. Mirroring.

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Diagram 2. Movmement sequences between poles.

Diagram 3. Focusing to heighten awareness.

Some interventions appeared in all the axes and some appeared only Separation-promoting interventions
in one.
Regarding merging patterns, seven main interventions appeared in
Action-promoting interventions the therapy logs (n = 6): (1) witnessing; (2) mirroring to bear witness;
(3) interpretive somatic mirroring; (4) mirroring to encourage initiative;
Three main action-promoting interventions appeared in the therapy (5) expression of movement sequences between the poles of closeness
logs in response to avoidance patterns exhibited by patients (n = 3): (a) and distance; and (6) focusing to increase awareness using verbal mir­
mirroring to encourage powerful movement; (b) encouraging movement roring. The interventions are characterized by an emphasis on
sequences between the poles of avoidance and presence; and (c) strengthening the patient’s connection to themselves and their ability to
focusing to increase awareness by listening to the body’s needs and have a sense of themselves in the presence of another. Table 2 describes
sensations. Table 1 presents a definition of each intervention together the intervention, the way it is performed, and examples in reference to
with an example. The findings indicate that in some of the interventions, the timeline from the findings. “Mirroring to encourage initiative”
other arts were combined, and changes took place along the timeline. appeared only in the early stage of treatment while “focusing to increase
Table 1.1. awareness” appeared in the later stages of treatment. Table 2.1.

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Table 1
Action-Promoting Interventions.
Intervention Description Example

Resonating mirroring to help the patient The therapist mirrors the patient’s expressions as accurately as Yael’s log: “I emphasize the powerful movement beginning to flow
experience powerful movement and possible as soon as the patient completes the movement. When a from her to make more room for a sense of power and self-efficacy”
express strength and vitality powerful movement emerges, the therapist expands it by enlarging (log 3, Session 15). The initiative can come from the therapist, as
it or emphasizing it with sound. She also expands it through was the case with Aviv: “I invite Aviv to the center of the room, we
“interpretive movement mirroring,” which can involve stomping, stand opposite each other. I lead with invigorating movements
clapping, jumping, pushing, making sounds, throwing a ball, and/ that promote presence, such as massaging, kneading, drumming,
or pounding. Appeared in all treatment therapy logs (n = 8). and he’s with me.” (log 5, Session 23)
Movement sequences between the poles A movement and verbal dialogue to help the patient experience Verbal processing deepens the experience. For example, when
of avoidance and presence transitioning from avoidance and invisibility to being present and playing gazing games with 10-year-old Yael: “How does it feel
being seen through movement, verbal mirroring, and with your head inside? She says: ‘I feel alone, and when I come out
conversation. This intervention can evoke up emotional content and meet your eyes it’s nice, someone’s waiting for me and wants
related to experiences of loneliness versus togetherness. Appeared me.’ I say: And when my eyes don’t meet yours? She says:’ I feel
in most of the treatment therapy logs (n = 6). alone. And continues: It’s like that in life, not only in movement.’”
(log 3, Session 3)
Focusing to increase awareness Joining the patient’s emotional experience while listening to the “After Yael shares some painful emotional content I suggest
body’s needs and resources. focusing on her needs and inner resources… I work with her using
guided imagery… to notice which part of the body is asking for
attention and to breathe into it… After the experience Yael says: ‘I
actually felt that it was the uninjured leg that needed some
attention, because no one was paying attention to it now…’” (log
3, Session 6)

Table 1.1 the poles of holding and letting go; (4) movement sequences between the
Additional Findings, Interventions in reference to the Timeline. poles of controlling and yielding; (5) movement sequences from parts to
a whole; (6) experimenting with balance; and (7) focusing to bring
Focusing to raise In the final stages of treatment, patients had internalized the
awareness connection between movement and emotions modeled awareness to emotional and sensory content of the patient’s choosing.
during treatment. Thus, after experiencing a movement, Yair Table 3 describes the following interventions: “synchronized somatic
said: “I listened to myself and not to the bad thoughts. I was mirroring,” “somatic mirroring to join an illegitimate expression of the
with my body.” (log 6, Session 33)
psyche,” “movement sequences between the poles of holding and letting
go,” and “experimenting with balance,” along with examples. The
findings indicate that other art modalities were used only in “mirroring
to join an illegitimate expression of the psyche.” In addition, three in­
Clinical interventions for strengthening the sense of self terventions appeared in the early stage of the treatment: “movement
sequences between the poles of controlling and yielding,” “movement
For the purpose of building build a sense of confidence and auton­ sequences from parts to a whole,” and “focusing to bring awareness to
omy, seven therapeutic interventions were identified (n = 7). These emotional content of the patient’s choosing.” Examples are presented in
were: (1) synchronized somatic mirroring; (2) mirroring to join an Table 3.1.
illegitimate expression of the psyche; (3) movement sequences between

Table 2
Separation-Promoting Interventions.
Intervention Description Example

Witnessing Serving as an observing presence. Being with the patient and allowing Aviv: “‘Don’t move,’ he says to the ball, goes inside the tunnel and
them to move in the space. Appeared in most of the therapy logs (n = 7). pushes it with his head. As if he were reenacting the story of his birth.”
This intervention can connect the patient to primal experiences. It (log 5, Session 3)
promotes the development and growth of movement and initiative.
Mirroring to bear witness Joining the patient, moving simultaneously with them, and then Na’ama: “We start moving together, and after a few movements I switch
transitioning to being a witness. This is done to allow space for the to being an observer. Na’ama crawls, rolls around, gets up, and
patient’s independent movement to develop. As the treatment develops, occasionally asks me to join her.” (log 1, Session 2)
the patient moves more freely on their own. This interventions appeared
in most of the therapy logs (n = 7) in various stages of treatment.
Interpretive movement Movement mirroring that is not simultaneous; the patient moves and the A question and answer movement dialogue, emphasizing movements
mirroring therapist identifies certain elements, suggesting new possibilities based that express selfhood and independence: “We start moving together as
on what is present or absent. she leads the movement… I emphasize a powerful movement and
expand it to make more room for a sense of power and self-efficacy.” (log
3, Session 15)
Sivan: The therapist identifies Sivan’s difficulty with decision-making,
endings, and goodbyes. The expansion offered the patient a chance to
connect to her ability to choose and notice the transitions using verbal
and movement strategies: “She starts walking with crossed legs, she
seems embraced… I join her… I identify the difficulty and invite her to
choose a place in the room… She chooses a different spot each time and
I’m with her.” (log 8, Session 2)
Mirroring to encourage Encouraging the patient to take initiative, explore and act within the The encouragement can be verbal, e.g., “You can do it,” “Whatever you
initiative space, or try different ways of moving. This intervention appeared in want,” and “You can continue,” (log 4, Session 2) “It’s okay” (log 3,
most of the therapy logs (n = 7). Session 1) or nonverbal: “She turns to the tunnel and looks inside, looks
at me and silently asks for permission to enter. I give it to her with a
look.” (log 1, Session 2)
(continued on next page)

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Table 2 (continued )
Intervention Description Example

Movement sequences between Movement on the axis between closeness and distance followed by Na’ama: “… we both stand at opposite ends of the room and move closer
the poles of closeness and talking about the sensations that came up during the experience. This to one another. She stops when it’s right for her, setting the pace as we
distance intervention appeared in most of the therapy logs (n = 7). This get closer and move away.” (log 1, Session 4)
intervention allows patients to experience how close they can get and
when to move away, and to verbally process the movement of the psyche
as it shifts between the desire to merge and the need to separate.

Integration-promoting movement interventions

Table 3
As the treatment progresses, the interventions and relationship with Clinical Intervention to Strengthen the Sense of Self.
the patient grows deeper, creating new possibilities for connecting and
Intervention Description Example
integrating aspects of the self (see Table 4). Table 4 describes inter­
Synchronized movement Moving in sync with the Aviv: “He starts walking
vention methods and presents examples. The therapy logs describe
mirroring patient’s movement. This around the room. I join
seven therapeutic interventions that address the children’s detachment intervention appeared in him and we play with
mechanism: (1) sustained somatic mirroring; (2) interpretive somatic most of the diaries walking and stopping as
mirroring; (3) witnessing based on resonating mirroring; (4) movement (n = 6). In situations he sets the pace. We
sequences from parts to a whole; (5) movement sequences from the where the patient begins a switch to jumping and he
movement, stops, and stops every time right
edges to the center of the body; (6) movement sequences between poles
withdraws, the therapist before we reach the
using imagery; and (7) focusing to increase awareness. The findings joins the patient’s peak.” (Diary 5, Session
indicate that in some of the interventions additional art modalities were movement as accurately 25)
used and that changes took place in relation to the timeline. Table 4.1. as possible to give them a
sense of controlling the
movement and help them
Table 2.1. feel supported and
Additional Findings in Reference to the Timeline. confident.
Mirroring to join an Joining expressions of Alon: “… and he shows
Intervention In reference to the timeline illegitimate expression anger, aggression/ me and I mirror it back
Witnessing “She wraps herself up in a cocoon of fabric. I of the psyche gentleness that cannot be without words… My
lie opposite her. There’s a sense of calm and legitimately expressed in response seems to give
intimacy… we lie like this for a while and then the patient’s world. This him permission to
she comes out of the fabric and goes to the intervention appeared in continue… I mirror the
board and draws the space and her all the diaries (n = 8) and faces he makes… the
experience.” (log 2, Session 23) encouraged expansion of vitality increases and
Mirroring to bear witness As the treatment progresses, the patient moves movement. suddenly a very scary face
more freely on their own, as in the case of comes out of him…”
Aviv: “He walks in the room and starts (Diary 4, Session 2)
walking around. (log 5, Session 28) Experiencing movement This intervention Alon: “He asks that we
Interpretive movement mirroring Suggesting an opposite mirroring movement sequences between the appeared in most of the play together with a ball
allows that patient to experience likeness and poles of holding and diaries (n = 5). and then takes a blanket
variance in relation to another. E.g., in the letting go Sometimes choosing a and wraps himself up in it.
case of Gali: ”… I suggest moving the opposite game that requires control In a stream of
way – when she spreads her arms, I close mine can serve as a defense consciousness he speaks
and vice versa. She finds it hard to move like mechanism shielding the about losses in his life,
this and quickly returns to the simultaneous patient against feelings of ending with the
movement.” (log 7, Session 32) sadness and pain. Joining understanding that there
Movement sequences between the At advanced stages of therapy, new insights the patient where they are are some things I can look
poles of closeness and distance are born, as in the case of Aviv: “Aviv enters is another way of moving after and some things I
the room and starts moving. The question from holding to letting go, can’t.” (Diary 4, Session
arises within me: Is he asking me to join him? while making room for the 9)
It’s so subtle I prefer to let it go. I understand spectrum of sensations
this sensation is related to content that arises and emotions that emerge.
in transference relationships and decide to Experimenting with Experimenting with Na’ama: “She stands on
verbally mirror the movement in the room. balance balance in various ways the physio ball and tries to
Alone, together, I direct his attention to the allows the patient to find balance. She uses me
sensations he feels in regard to what’s experience movement for help. I wrap my arm
happening in the body, and to the act of sequences between the around her and she does it
choosing. Following the movement, Aviv says poles of control and lack again.” (Diary 1, Session
of himself that he easily gives up and switches of control. This can help 3)
to waiting mode.” (log 5, Session 40) the patient regain the
Focusing to raise awareness Na’ama erased her name and gave herself experience of having his
through verbal mirroring another name. “My name is Ayelet [giving body serve as an anchor
herself a name that sounds close to the for feelings of confidence
therapist’s name] and your name is Tsetcham. and autonomy. The
I say: ‘You gave us new names and you gave therapist can serve as an
yourself a name that sounds similar to mine.’” additional anchor. This
(log 1, Session 34). Na’ama is expressing a intervention appeared in
hidden desire to become the therapist. The most of the diaries
therapist makes room for this desire and (n = 5).
mirrors the patient’s expression, creating a
potential space for Na’ama to touch an aspect
of self-seeking to be filled with the name of
another, that of the therapist.

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Table 3.1.
Clinical Interventions to Strengthen the Sense of Self Combining Other Art Modalities, in Reference to the Timeline.
Intervention Description Example

Synchronized movement Moving in sync with the patient’s movement. This intervention Ella: “… I join her movement, throwing the handkerchief up in the air
mirroring appeared in most of the diaries (n = 6). In situations where the and letting it fall down. I gradually move aside and become the
patient begins a movement, stops, and withdraws, the therapist joins observer. The mask of a smile comes off her face and she starts
the patient’s movement as accurately as possible to give them a sense meditatively working with the handkerchiefs…” (Diary 2, Session 24)
of controlling the movement and help them feel supported and
confident.
Movement sequences between Experiencing movement with eyes closed initiated by the patient or Na’ama: “She fills parts spread out on the floor with color and I fill
the poles of control and the therapist. This intervention appeared in half the diaries at late shapes that connect to each other. She gives me a smearable green, I
surrender stages of treatment (n = 4). In response to the patient’s request to gently color and she oozes her body down from the chair to the floor. I
experience a lack of control in the treatment room, this intervention ask her to do it again. She oozes, lies down, crawls into the tunnel and
allows them to experience both control and surrender along with the starts moving with the tunnel toward the paper ball I threw. She picks it
lack of control. up and brings it to me. I spread it out on the floor and straighten out the
folds.” (Diary 1, Session 34)
Focusing to bring awareness to A suggestion at the end of a treatment session to focus on significant Ella after experiencing movement with handkerchiefs: “Ella says with a
emotional content of the movement content of the patient’s choosing that arose in the session. smile: I felt I became a handkerchief.” (Diary 2, Session 24). “Ella
patient’s choosing This intervention helps patients experience a sense of control, chooses to draw the feeling of letting go” (Diary 2, Session 37). From a
autonomy, and collectedness. In all the diaries, the patient’s choice session with Na’ama: “She chooses to go back to walking with her eyes
was to focus and go back to pleasant experiences of relaxation, closed as I watch over her” (Diary 1, Session 24). In focusing on the
release, or empowerment (n = 8). sensations of the body and transitioning to a verbal dialogue, as in
Gali’s session, the therapist noticed a stop and directed Gali to listen to
her body: “I say: Can you notice what’s happening in your body right
now? She says:’ It’s like a mountain with a wheel on it and it’s stuck on
a little stone.’ I echo what she says, noting a sense of suffocation in my
chest and belly…” (Diary 7, Session 30)

Table 4
Integration Promoting Clinical Interventions.
Intervention Example

Sustained somatic mirroring, i.e. joining the patient’s movement and sustaining their E.g. in the case of eight-year-old Ella: “… I recognize that her main movement pattern is
movement qualities, while emphasizing key elements, patiently waiting for a new to end a movement phrase by collapsing her chest inward. I repeat her no movement /
movement to be born out of the patient’s body. This intervention appeared in all the movement… until a new movement is born out of her.” (Log 2, Session 3)
therapy logs at the start of treatment (n = 8). Sustained somatic mirroring allows the patient to experience connection in areas where a
disconnect was created as the movement of her body is mirrored by that of the therapist.
Interpretive somatic mirroring, i.e. somatic mirroring that is not simultaneous. The E.g. in the case of Ella: “I expand her movement content by repeating the movement of
patient moves and the therapist identifies certain elements, suggesting new possibilities collapsing and straightening up. She joins me… the chest straightening up and
based on what is present or absent. This intervention appeared in all the logs at various collapsing, repeating the movement in various paces.” (Log 2, Session 3). By introducing
stages of treatment (n = 8). various paces to the movement that exists in the patient’s body, the therapist offered a
somatic interpretation of what may have been occurring within Ella without being
expressed.
Movement sequences from the edges of the body to the center. This refers to the invitation E.g. in the case of Yair: “Yair and I move, simultaneously mirroring each other. The
to connect the movement of the limbs to the center of the body through a process of transitions between the movements are sharp… slowly the hands come near the body. His
focusing to increase awareness using movement or words. This intervention appeared in listening to himself and to me changes, his hands slide over his body from top to bottom,
half the logs (n = 4) at the start and middle of treatment. listening deeply.” (Log 6, Session 1)
Focusing to bring awareness, i.e. repeating significant movement content of the patient’s In early stages of treatment the intervention is geared toward connecting the movement
choosing or using verbal mirroring. This intervention appeared many times throughout with the experience: “I suggest that he show this to me with his body” (Log 4, Session 9)
all stages of treatment in all the logs (n = 7). Focusing on the physical experience and observing the movement experience: “I ask her to repeat a movement that was
facilitates connection and a renewed understanding of the detachment mechanism. meaningful to her” (Log 1, Session 1)

Table 4.1
Integration Promoting Clinical Interventions Additional Findings Combining Props or Other Art Modalities in Reference to the Timeline.
Intervention Movement combined with other art modalities Intervention with reference to the timeline

Interpretive movement mirroring In a session with Gali: “Gali’s movement goes out and in Movement interpretation can accompany concrete verbal
with no ending. To reinforce the separation between the or emotional interpretation: “Aviv sits and rolls a ball
start and ending and the border between them I suggest toward me. I send the ball back to him and add words that
incorporating sounds into the experience… I make a sound mirror the way the ball meets various parts of Aviv’s
and she walks up to where the sound ends… I suggest body… he detaches and connects intermittently… He tells
drawing the sound… I suggest moving in a way that me about a detached princess doll who doesn’t know who
expresses the picture she drew… she takes steps, her she is. I say: That’s scary. He says: It’s more sad than
presence grows stronger…” (Log 7, Session 13) scary.” (Log 5, Session 20)
Witnessing based on resonating mirroring. By the later “Yair shifts his weight from one leg to the other. I join him
stages of treatment, mirroring becomes established as a and gradually transition to observing him as he continues
therapeutic language and thus deepens the patient’s to move and express himself… the transitions flow and he
connection to their body and their independent is immersed in the movement.” (Log 6, Session 32). The
movement in the therapist’s presence. The therapist mirroring echoes the patient’s movement in a non-
echoes the patient’s movement as accurately as simultaneous way, according to the therapist’s choice of
content to be echoed. Contrast this with simultaneous or
(continued on next page)

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Table 4.1 (continued )

Intervention Movement combined with other art modalities Intervention with reference to the timeline

possible as soon as the patient completes the movement interpretive mirroring, which creates a variation on the
and transitions to the role of witness. theme.
Movement sequences from parts to a whole, i.e. E.g. in the case of nine-year-old Ella. The therapist invites E.g. in the case of 10-year-old Aviv: “Aviv enters the room
identifying, joining, and expanding themes using Ella to focus her attention on the parts of her body and crawling… I suggest that he continue crawling to the huge
movement, voice, words, or other artistic modalities. then on the body as a whole using drawing and movement. sheets of paper with a color in each hand. The color leaves
This intervention appeared in most of the logs at the “I suggest drawing body parts on each of the pieces of traces of his movement on the paper… Aviv identifies
end stages of treatment (n = 5). paper… I suggest choosing some of the body parts and shapes in the traces… I encourage him to keep going…
connecting them into a movement sequence… I repeat Aviv continues and creates a story, as he puts it – a self-
each of her movements… she connects the movement portrait.” (log 5, Session 35)
sequences she has created into one whole sequence and
repeats it several times” (Log 2, Session 35)
Movement sequences between poles using imagery. This Experiencing opposing qualities of movement of holding Movement and verbal expressions of the experience of
is an invitation to experience qualities of movement, and letting go creates a physical-emotional change, e.g. in being present and masking following their appearance in
images, or emotions on opposite poles, in an aim to the case of Ella: “I suggest switching to squeezing and transference relationship appeared in late stages of
strengthen the patient’s sense of being connected to releasing the ball… slowly her movement opens up, she treatment in half of the logs (n = 4). E.g. in the case of
their center. This intervention appeared in most of the becomes more attentive and spontaneous…” (Log 2, Na’ama: “… I suggest playing with being and not being…
logs (n = 6). Session 34) in ‘being’ she decides to stomp her foot loudly. When she is
‘not being’ she hides.” (Log 1, Session 24)
Focusing to increase awareness This intervention appears in most of the logs in later stages
of the sessions. It involves verbally mirroring detachment
in the body, focusing on physical sensations, focusing
attention on unconscious movements and asking focusing
questions (n = 5). E.g.: “What just happened? Can you
repeat the movement you just did? Is there an image or
something that comes up for you? Why did you stop, How
did it feel?” (Log 7, Session 33) Or: “Where is this
strangeness in the body?. pointing to the center of the
body… What is it doing?. demonstrating a drumming
movement near the ear… Why is it bothering you?.
Because it wants me to listen to it… What do you do?. look
for ways to ignore it, like eat or do something to distract
me.” (Log 7, Session 32)

Discussion movement and implied emotional intention in the closest way possible,
depicts as exploring intrapsychic and intersubjective connections within
The goal of the current research was to identify and map methods of the patient’s world (Shuper Engelhard, 2018).
DMT intervention for treating children with anxiety disorders and ulti­ This can be thought of in terms of creating a new physical experience
mate identify a therapeutic model, based on the analysis of therapy logs within the therapeutic relationship marking the soma. Mirroring
tracking the treatment of eight children aged 8–11 coping with various involving looks, facial expressions, and physical gestures, serves as a
symptoms of anxiety. The children had been given long-term therapy, central function in transforming the body’s concrete experience into a
consisting of at least 25 sessions. The study findings shed light on how symbolic one that can be represented in the child’s developmental
the therapeutic process manifests in the body of children with anxiety process (Bowlby, 1951). This process is contingent on a parent providing
disorders and how various types of physical interventions facilitate the a supportive environment throughout the child’s development (Winni­
process for the body and psyche. Four intervention axes were identified: cott, 1950). In his later works, Winnicott delves deeper into the idea that
(1) action-promoting interventions (2) separation-promoting in­ a unified soma is essential for creating a coherent experience of the self.
terventions; (3) interventions for strengthening the sense of self; and (4) According to Winnicott, “The mother has the ability to hold the baby so
integration-promoting actions. he does not have to know about being made up of a collection of parts.
Somatic mirroring was found to lie at the heart of the interventions; The baby is a belly joined on to a chest and has loose limbs and
recent research has validated the presence of connections between the particularly a loose head: all these parts are gathered together by the
expression of movement in mirroring games and the elements of mother who is holding the child, and in her hands, they add up to one. In
attachment (Feniger-Schaal, 2017). failed holding the parts add up to more than one.” (Winnicott, 1989). To
Seven different types of mirroring were identified here. The various “add up to one” is essential for integrating the self and is the foundation
types of mirroring allow the patient to have different experiences for what gradually becomes the baby’s experience of self (Winnicott,
throughout the course of therapy and serve as a foundation for deep­ 1987). Winnicott refers to the mother’s physical holding of the child as
ening the interventions as the timeline progresses. Through the prism of critical to the developmental process. Essentially, this holding is what
child development, these findings serve to expand our understanding of creates the experience of “adding up to one” body that delineates the
therapeutic processes in children coping with anxiety in order to psyche’s boundaries. In the absence of this experience, extinction anx­
establish a therapeutic intervention model. iety arises, as the self requires the body’s boundaries, created before
consciousness is formed, in order to sense its own being. Winnicott refers
to this process, which takes place in the therapeutic space, as part of the
“Somatic mirroring” as a “somatic holding function”
“holding function” of therapy (Winnicott, 1987).
To expand on this, this study proposes examining the novel concept
The study findings indicate that “synchronized somatic mirroring,” i.
of the “somatic holding function” in DMT. “Sustained somatic mirror­
e., joining the patient’s movements, can make patients feel they are in
ing” refers to joining the patient’s movement and sustaining its qualities
control of the movement, giving them a sense of support and confidence.
while emphasizing central elements, patiently waiting for a new
This finding corresponds with previous research finding that when the
movement to be born out of the patient’s body. For example, in the case
mother’s contribution to the movement interaction is high, the child
of eight-year-old Ella, the therapist noticed that there was no movement
exhibits fewer problems of depressions (Shuper Engelhard et al., 2021).
in the chest area. Ella’s main movement pattern was to end a movement
in addition “somatic mirroring,” i.e., joining the patient in their

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phrase by collapsing her chest and staring at the therapist. The therapist within the soma. This kind of intervention can lead to an emotional
repeated Ella’s movement/no-movement, sitting in front her, leaning on connection in places where there was a disconnect from the emotional
one hand with her chest collapsed. By repeating the patient’s body experience.
movement, even the slightest, the therapist stays with the patient in her In his later works, Winnicott speaks out against the accepted thera­
kinesthetic experience until a new movement is born from within her. peutic approaches that focus on interpretation and awareness. He claims
Staying in the no-movement can allow the patient to feel areas that may that the body loses touch with its needs and finds shelter in mental
have been discarded by the soma, parts devoid of movement or aware­ functioning in response to an environmental failure. That is, the body
ness, thereby serving as a “somatic holding function.” “Sustained so­ develops as a separate entity, detached from its physical and emotional
matic mirroring” allows the patient to be alone in the presence of roots. The psyche settles itself in the mind and is governed by it instead
another and thus have the experience of their own presence in their of integrating into the psychosoma as a distinct function (Winnicott,
soma. This sustaining action can be thought of as corresponding to the 1987). In this context, interpretive somatic mirroring can serve as a
way silence is understood in psychoanalytic therapy as a means of bridge between movement and interpretation and support the psyche as
gauging the development of the patient’s ability to be alone, signaling it settles into the soma. In this way, interpretive somatic mirroring
the level of matured emotional development (Berman, 2009). Sustained supports patients’ connection sensations, emotions, and physical senses
somatic mirroring is necessary in order to strengthen the patient’s sense in an integrative way.
of self and their ability to separate. It is analogous to an important stage With respect to avoidance and merging patterns, interpretive so­
of child development, which, paradoxically, is that of being alone in the matic mirroring serves as the foundation for “mirroring to encourage
presence of the mother (Winnicott, 1965). That is, the shared lingering vitality and imitative” and can promote action, initiative, vitality, a
inherent in “sustained somatic mirroring” may constitutes a “somatic sense of separateness, self-efficacy, and power. The interpretation refers
holding function” that establishes the experience of the self. to the therapist’s choice of movement content to stress, for example
The findings demonstrate that “mirroring to bear witness” in­ through a questions-and-answers movement dialogue in which move­
terventions can also assist in separation processes and strengthening the ment qualities of selfhood and independence are emphasized. It can be
sense of self, as was the case with eight-year-old Na’ama. Here, the accomplished by mirroring the patient’s angry face or amplifying vital
therapist made sure that Na’ama led the movement as the therapist movements, such as clapping and stomping. The therapist recognizes
gradually moved out of her way. In this case, the “somatic holding burgeoning signs of vitality in the patient’s movement and effectively
function” was performed as the therapist witnessed the patient’s legitimizes them and gives them presence by “mirroring to encourage
movement, which shifted from being alone to being alone in the pres­ vitality and imitative.” This corresponds with other studies that found
ence of another. “Witnessing” is derived from AM, which, as mentioned that encouraging patients to use their physical strengths and vitality
above, is a DMT technique based on the assumption that creating a space gave them a sense of confidence and promoted self-awareness (Khoda­
for expressing repressed emotions through movement can help express bakhshi Koolaee et al., 2014), qualities that are diminished in children
parts of the self that have been stunted by avoidance or denial mecha­ dealing with anxiety disorders (Schaefer & Drewes, 2009).
nisms. The patient moves in the presence of the therapist, who positions Regarding control patterns, it was found that “synchronized somatic
themselves as a witness to what unfolds (Mason, 2009; Pallaro et al., mirroring” and “mirroring to join an illegitimate expression of the
2007 in García-Díaz, 2018). psyche” could provide patients with a sense of support and the confi­
The current study findings expand other work on the possibility of dence to express aggression/gentleness that could not be legitimately
using authentic movement for therapy with children by gradually expressed in their environment or world. These interventions enabled
transitioning from the mirroring intervention for the purpose of simply patients to express feelings of sadness and loneliness and discover new
observing, or “witness bearing.” The “witness bearing” presence may qualities, such as flow, tenderness, and spontaneity. For example, Ella,
facilitate a quiet space for the child to listen to themselves and express nine-years-old, was throwing silk handkerchiefs up in the air. The
difficult experiences, sensations, and emotions. The findings further therapist joined her while emphasizing the soft quality of the fabric,
indicate that the therapist’s position as witness bearer encourages in­ gradually moving aside so Ella could continue on her own. Ella adopted
dependent movement, action, and initiative of the patient in the thera­ the softness of the fabric, a very different quality from the rigid move­
pist’s presence. Perhaps attentive nonjudgmental observation allows ment she had usually displayed, finishing the session by saying, “I felt I
children to listen to themselves and express themselves spontaneously became a handkerchief.”
and creatively. Such emotional expression may help lower anxiety, a In conclusion, the holding function is central in assisting the psyche
possibility that corresponds with findings from a previous study inves­ to settle into the soma. The study findings demonstrate how various
tigating the effect of AM on easing anxiety disorders in adults (n = 57) types of mirroring can serve a “somatic holding function” to support the
that indicate that the repressed emotions that arose during the thera­ psyche as it settles into the body, embracing parts of it that have been
peutic process were mainly those that were perceived as negative, such discarded, rejected, or invalidated. The various types of mirroring allow
as anger, and that the level of anxiety had decreased (García-Díaz, for new connections to be created within the self and form the founda­
2018). tion for different therapy processes.
The findings of the study show that the process of settling the soma in
The process of settling the psyche within the soma the body can strengthen the connection to physical and emotional
feelings and can affect the level of anxiety. This finding is consistent with
“Interpretive somatic mirroring” can also assist in strengthening the another study that investigated the effect of DMT on adolescent girls
ability to separate and integrate the physical and emotional experience, (n = 162) found that following treatment, the girls were more aware of
as seen in the case of Aviv. Here the therapist joined Aviv in playing with the connection between their physical and emotional sensations and
a ball while verbally mirroring the encounter between the ball and that anxiety levels had decreased (Bräuninger, 2012). Symptoms of
various parts of Aviv’s body: “leg,” “hand,” “belly,” “head,” and later by anxiety and aggression had decreased. In other studies examining DMT’s
mirroring the representation of the whole body and the relationship contribution in the treatment of children aged 6–7 with aggression and
between their bodies in the space by saying “to me,” “to you.” Aviv anxiety disorders (n = 30) and in studies in which the nature of the
associated the experience with that of a doll who does not know who she interventions included a combination of ballroom dancing (Hackney &
is and the association developed into a conversation about emotions and Earhart, 2009), Creative Movement (Noreau et al., 1995), spatial
connection to a sense of fear related to the experience of detachment. orientation (Röhricht & Priebe, 2006), and AM (Dibbell-Hope, 2000),
The movement interpretation created movement along the axis moving the results found that symptoms of anxiety had decreased.
from parts to a whole and strengthened the psyche’s ability to reside

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These findings expand our understanding of how mirroring con­ information she received by somatically listening to the patient’s
tributes to raising self-awareness (Sandel et al., 2005), promotes movement and the emerging emotional content. She then processed it on
empathic processes in therapy (Mcgarry & Russo, 2011), and serves as a behalf of the patient and returned it to her as a verbal suggestion to
tool for understanding the patient’s world through the therapist’s explore a psychological pattern through movement. The possibility of
awareness of sensations arising in their body through somatic trans­ using the body to explore movement sequences between holding and
ference processes (Vulcan, 2009 in Mcgarry & Russo, 2011). It may be letting go in the presence of the therapist can allow the patient to
that the therapist’s attitude when mirroring the patient’s movements, embark on an associative movement sequence, one that is somatically
joining and enabling them, is what helps reduce the sense of held by the therapist and echoed by her both physically and verbally.
self-criticism characteristic of children with anxiety disorders (Hall­ This intervention can allow a new somatic quality to emerge out of the
dorsson et al., 2019). These findings are congruent with the findings of a body and become part of the patient’s psychophysical lexicon.
previous study indicating that when family CBT was used to reduce In “movement sequences from parts to a whole” interventions the
parental rejection and criticism rather than their granting children au­ therapist also joins the patient’s movement through an associative
tonomy (n = 128), anxiety levels were lowered (Van der Giessen et al., stream of consciousness. For example, a patient enters the room crawl­
2019). ing on his belly; in response, the association of a caterpillar arises within
the therapist and she returns it to the patient by inviting him to crawl on
Analytical processes in movement big sheets of paper holding a crayon in each hand. The color leaves
traces on the paper, just as the caterpillar leaves traces in the sand. Based
In more later stages of therapy, different types of mirroring served as on the traces of the movement on the paper, an associative stream of
an infrastructure for interventions that included “movement sequences consciousness arises within the patient, which he expresses verbally. Out
between poles,” enabling the patient to try, experience, and practice of the medley of lines, he recognizes shapes, and the therapist encour­
relationship patterns and encounter their psychological mechanisms in a ages him to use them to create a narrative, which he titles “Self-Portrait.”
safe environment. Eight “movement sequences between poles” were In his article, “On Not Being Able to Dream,” Ogden (2011) describes a
identified (see Diagram 2). The choice of using any one of them depends sudden turnaround that took place three years into the treatment of a
on the content the patient brings to the session and what they require. patient, when the latter approached him in a way that created inap­
These findings will serve us in deepening our understanding of DMT propriate physical proximity. Ogden surrendered to the flow of associ­
interventions and the way the psyche and body’s movement are inter­ ations arising within him, leading him to a significant understanding of
twined within the therapeutic relationship. the patient and bringing about a new interpretation that effected change
The study findings give rise to the assumption that when dealing (Ogden, 2011). Similarly, in the intervention of “movement sequences
with the need to control, movement sequences between the poles of from parts to a whole” described above, the patient was expressing
“holding and letting go,” “controlling and yielding,” and “experimenting himself through his body. The experience was sensory and primal
with balance” can encourage exploration of movement along this axis. In crawling on his belly. The therapist facilitated the patient as he moved
addition, these types of interventions can strengthen the patient’s ability from an associative movement to associative thoughts, allowing him to
to trust their body as an anchor connecting them to a sense of confidence go from a sensory experience to the level of symbolization and
and autonomy. For example, Na’ama, hiding her eyes, wrapped herself conceptualization. It is possible to view the movement in the room as a
in fabric and started walking. The therapist was present as a self-object flow of beta particles collected through an alpha function represented by
(Kohut, 2011) and served as a physical and emotional anchor for the therapist, who surrenders to the associations arising within her,
Na’ama, as she protected her from the sides to make sure she would not giving them presence as an interpretive action in the space. Thus, by
bump into anything. The biopsychosocial model refers to feelings as a deepening the representation of the caterpillar using the paper and
process of mutual interaction between the limbic areas of the brain and colors, the beta particles were able to turn into alpha particles through a
body. Accordingly, the body gathers information about its surroundings process of symbolization and conceptualization (Bion, 1962). Previous
through its senses. Humans have the ability to expand their emotional studies that examined the effectiveness of combining DMT with CBT for
processing beyond the activation of primary motor schemes by creating children (n = 99) found that providing psychological-educational ex­
representations of those schemes in the psyche (Allen et al., 2008). Thus, planations while focusing on the patient’s bodily sensations and the
when experimenting with balance, the patient can explore her physical physical expression of their emotions and thoughts contributed to the
stability while relying on the therapist, who provides a transformative treatment’s success of (Weitz & Opre, 2019). This is consistent with the
space for the patient’s self-exploration. The encounter between the two findings of the present study that show that the movement between the
bodies and the two psyches can help the patient reestablish the experi­ body and the word may contribute to the success of the treatment and a
ence of control and autonomy within the space. decrease in the levels of anxiety.
Creating space for exploration in therapy when dealing with patterns A type of intervention similar to the “movement sequences between
of rigidity and holding appears also in regard to “movement sequences poles” technique appears in other expressive therapies, such as music
between holding and letting go.” This refers to inviting patients to ex­ therapy, where the therapist creates music to mirror the patient’s
press emotional content by moving along the axis between holding and emotional stance, by either anchoring or contrasting the patient’s mel­
letting go. For example, in a later stage of treatment, a patient entered ody. In addition, the therapist joins the content the patient brings to the
the room with squirming body movements. The content that arose session and improvises on its themes or improvises together with the
within the therapist in response was softness as opposed to holding. She patient (Stern, 2010). Improvisation is an open-ended and ongoing
suggested working on this pattern through movement – pushing various process that includes, among other things, emotional expressions of
organs into the floor and letting go onto the floor in various rhythms – laughter, struggle, disagreement, and misunderstanding. There is no
movement that created a collapse as opposed to a letting go. Using words fixed method regarding the structure of the intervention (Stensaeth,
and movement, the therapist mirrored the differences and various ways 2017). Similar to the findings of the current study, the therapist must be
the patient moved, emphasizing the pushing, letting go, and collapsing. open to what unfolds and respond creatively according to the patient’s
At the end of the experience, the patient calmly lay down on the floor, needs.
gently moving her hand, marking the birth of a new quality of move­
ment. Listening to the association that emerged allowed a movement Applied implications
space to open up offering the possibility of returning to primary, pre­
verbal, regressive areas in which the psyche had not yet settled into the The study was conducted based on the qualitative paradigm of her­
soma. As the patient entered the room, the therapist translated the meneutic phenomenology for multiple case studies using participant

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A. Bresler Nardi et al. The Arts in Psychotherapy 80 (2022) 101951

observation. It involved shifting between the personal and professional two main approaches to treating anxiety in children, dynamic play
by reflectively observing the action during and after its occurrence and therapy (Baggerly, 2009) and CBT, which includes gradual exposure to
documenting the process in therapy logs. These served as a basis for the anxiety-inducing situations and sensations (Matweychuk, 2014). This
methodical construction of clinical diagnosis and intervention pro­ indicates that DMT combines various therapeutic disciplines, as it in­
cesses. The methodological foundation of this study can serve other volves thinking about anxiety patterns and motivations, leading the
clinicians seeking to investigate and conceptualize the therapeutic therapist to use symbolic and play-related interventions characteristic of
processes that take place in the treatment room. This research process the dynamic approach, in addition to focusing on the unfolding expe­
promotes the connection between clinical work and research and con­ rience and the therapeutic relationship as change agents that promote
tributes to professional development and improvement. awareness. In addition, DMT interventions allow patients to experience
The possibility of encountering and experiencing the emotional anxiety-inducing content in a safe environment, which is a type of
patterns described in the study corresponds with the principle of intervention characteristic of CBT.
immediacy, which encourages a focus on the experience as it occurs Based on an examination of the study findings in reference to the
during the therapeutic encounter, allowing the patient and therapist to timeline, this study designed an intervention model that can serve as a
experience and explore patterns that arise in the relationship (Clemence referential anchor for the therapeutic process. At the core of the in­
et al., 2012). Theories of self refer to sensations and experiences as terventions are identification, joining the content brought by the patient
change agents in the therapeutic process. These include attention to through various types of mirroring, expanding it through “witnessing”
physical sensations, visual imagery, the choice of words used in con­ or by using “movement sequences between poles,” and by using colors,
versation during the session, and nonverbal aspects of the relationship, sounds, and conversation to promote “focusing to increase awareness.”
based on the assumption that the creation of a new experience within a All of these are used and adapted based on the patient’s needs and stage
relationship is a therapeutic process (Curtis, 2012). In this sense, the of treatment. In the early stages of treatment, various types of mirroring
“movement sequences between poles” technique appears to combine the are required in order to establish the relationship and the language of

Diagram 4. Intervention terapotic model.

12
A. Bresler Nardi et al. The Arts in Psychotherapy 80 (2022) 101951

movement as a therapeutic language used in the room. These constitute Barlow, D. H., Allen, L. B., & Choate, M. L. (2016). Toward a unified treatment for
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the basis for deepening the therapeutic interventions though “movement
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therapy training at Kibbutzim college (2013–2017). She is a psychotherapist and a dance-
Protocol for a randomised controlled feasibility study examining the efficacy of brief
movement therapist (supervisor). She worked as a therapist with Holocaust survivors and
cognitive therapy for the treatment of anxiety disorders in adolescents (TAD-A.
in various kindergartens and high-schools in Israel, with children who suffer from
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emotional difficulties and developmental problems

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