גיליון טיפול בתנועה -בין המילים
Abstract
גיליון 12 של כתב העת בין המילים. הגיליון דן בהיבטים שונים בטיפול בתנועה, והוא מכנס יחד מאמרים והרצאות משלושת ימי העיון שנערכו בתואר השני לטיפול בתנועה ומחול במכללת סמינר הקיבוצים בשנים 2015 – 2017 .הגיליון ערוך בשלושה שערים: דימוי גוף, מיניות, אהבה וטראומה. בכל אחד מן השערים ישנה התייחסות להיבטים שונים, תאורטיים וקליניים, בטיפול בתנועה. עורכות הגיליון: ד"ר נעמה לב ארי וד"ר עינת שופר אנגלהרד.
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This research explores a new Integrative Trauma Therapy Model, which is comprised of two methods: Dance-Movement therapy and Somatic Experiencing, in a Group setting for traumatized patients. The aims of the research were: (1) Exploring how, if and in what ways the model as embodied and enacted in a therapeutic programme developed by the therapist and experienced by the participants of this research is effective in healing those subjects, who are traumatized women suffering from spouse abuse. (2) Exploring and defining the healing indicators which indicate and provide evidence of any progression among the participants from being 'victims' of the traumatic effects of spouse abuse to their becoming 'successful survivors'. (3) Inquiring, exploring and defining which aspects of the model could be said to enable the healing process. The conceptual framework combined theories of trauma, Neuro-physiology and survival, body-mind connection, emphasizing use of resources and Positive Psychology. As a piece of applied research it is focused on practice and on practical implications. The participants were 14 older women ages 60-83, victims of long lasting spouse abuse. They were all clients of a centre for domestic violence in Israel where the researcher is a practitioner. This research study accompanies and is focused on the characteristics and effectiveness for the research participants and subjects of the practice of the programme, which is underpinned by theories, and the therapeutic model developed by the researcher practitioner.
This paper presents a model of treating women with eating disorders through dance/movement therapy based on the methods of Blanche Evan. Evan's theoretical viewpoint and methods of treatment are described with specific applications to working with women with eating disorders. Finally, a summary of an individual dance therapy treatment of a 24 year old bulimic woman is presented, illustrating the potential of this approach to promote therapeutic change. The symptoms of eating disorders serve to disconnect affect from the body, particularly as sexuality, trauma, and cultural influences contribute to conflicts in the woman's developmental struggle toward self-identity. Reconnecting the body with feeling allows the client to experience affect and express her inner world, to recognize meaning in her behavior and relationships, and to develop healthy psychophysical unity.
In this paper we attempt to explore the unique meaning of the body for the bulimic patient. In contrast with Selvini-Palazzlis's view of the body as a persecutory object in anorexia nervosa, we suggest that a more primitive meaning or function underlies the role of the body in bulimia. Specifically the body becomes a transitional object, a vehicle for the representing of the maternal object and then the repudiation of her. A synthesis of the cognitive and object relations lines of development is presented to elucidate this role.
Traditional psychotherapy addresses the cognitive and emotional elements of trauma, but lacks techniques that work directly with the physiological elements, despite the fact that trauma profoundly affects the body and many symptoms of traumatized individuals are somatically based. Altered relationships among cognitive, emotional, and sensorimotor (body) levels of information processing are also found to be implicated in trauma symptoms. Sensorimotor Psychotherapy is a method that integrates sensorimotor processing with cognitive and emotional processing in the treatment of trauma. Unassimilated somatic responses evoked in trauma involving both arousal and defensive responses are shown to contribute to many PTSD symptoms and to be critical elements in the use of Sensorimotor Psychotherapy. By using the body (rather than cognition or emotion) as a primary entry point in processing trauma, Sensorimotor Psychotherapy directly treats the effects of trauma on the body, which in turn facilitates emotional and cognitive processing. This method is especially beneficial for clinicians working with dissociation, emotional reactivity or flat affect, frozen states or hyperarousal and other PTSD symptoms. In this article, we discuss Sensorimotor Psychotherapy, emphasizing sensorimotor processing techniques which can be integrated with traditional approaches that treat these symptoms. Because the therapist’s ability to interactively regulate clients’ dysregulated states and also to cultivate clients’ self-of inner body sensations is crucial to this approach, three sessions are described illustrating the clinical application of this method.
Present awareness through mindfulness creates a foundation for embodiment, an enlivened sense of oneself in the world. Dance/movement Therapy can facilitate the movement from mindfulness to embodiment by animating a client’s images, emotions and memories, leading to improved physical, mental and emotional wellbeing. However, for clients who have experienced on-going trauma throughout their lifetime, the body is perceived as unsafe, and requires a more subtle approach to mindfulness.
This chapter explains how mindfulness is used as a pathway toward embodiment, as it is applied in an inter-disciplinary somatic psychotherapy and dance/movement therapy session with a client, “Hanna,” who had been sexually assaulted the previous summer. That trauma triggered repressed memories of a lifetime of physical and sexual abuse, and the vignette illustrates how I help Hanna safely track her awareness from a dissociative state back into her body. By engaging in mindfulness, Hanna shifts from intellectualization to identification with herself and finally is able to express herself as an enlivened, embodied woman. Using creativity and imagination through images, body awareness and movement, Hanna emerges from a frozen dissociated state to an enlivened place of embodied action.
Baer's review (2003; this issue) suggests that mindf ulness-based interventions are clinically efficacious, but that better designed studies are now needed to substantiate the field and place it on a firm foundation for future growth. Her review, coupled with other lines of evidence, suggests that interest in incorporating mindfulness into clinical interventions in medicine and psychology is growing. It is thus important that professionals coming to this field understand some of the unique factors associated with the delivery of mindfulness-based interventions and the potential conceptual and practical pitfalls of not recognizing the features of this broadly unfamiliar landscape. This commentary highlights and contextualizes (1) what exactly mindfulness is, (2) where it came from, (3) how it came to be introduced into medicine and health care, (4) issues of cross-cultural sensitivity and understanding in the study of meditative practices stemming from other cultures and in applications of them in novel settings, (5) why it is important for people who are teaching mind-fulness to practice themselves, (6) results from 3 recent studies from the Center for Mindfulness in Medicine, Health Care, and Society not reviewed by Baer but which raise a number of key questions about clinical applicability, study design, and mechanism of action, and (7) current opportunities for professional training and development in mindfulness and its clinical applications.
Ever since people's responses to overwhelming experiences have been systematically explored, researchers have noted that a trauma is stored in somatic memory and expressed as changes in the biological stress response. Intense emotions at the time of the trauma initiate the long-term conditional responses to reminders of the event, which are associated both with chronic alterations in the physiological stress response and with the amnesias and hypermnesias characteristic of posttraumatic stress disorder (PTSD). Continued physiological hyperarousal and altered stress hormone secretion affect the ongoing evaluation of sensory stimuli as well. Although memory is ordinarily an active and constructive process, in PTSD failure of declarative memory may lead to organization of the trauma on a somatosensory level (as visual images or physical sensations) that is relatively impervious to change. The inability of people with PTSD to integrate traumatic experiences and their tendency, instead, to continuously relieve the past are mirrored physiologically and hormonally in the misinterpretation of innocuous stimuli as potential threats. Animal research suggests that intense emotional memories are processed outside of the hippocampally mediated memory system and are difficult to extinguish. Cortical activity can inhibit the expression of these subcortically based emotional memories. The effectiveness of this inhibition depends, in part, on physiological arousal and neurohormonal activity. These formulations have implications for both the psychotherapy and the pharmacotherapy of PTSD.
The present review addresses the outcome of anorexia nervosa and whether it changed over the second half of the 20th century.
A total of 119 study series covering 5,590 patients suffering from anorexia nervosa that were published in the English and German literature were analyzed with regard to mortality, global outcome, and other psychiatric disorders at follow-up.
There were large variations in the outcome parameters across studies. Mortality estimated on the basis of both crude and standardized rates was significantly high. Among the surviving patients, less than one-half recovered on average, whereas one-third improved, and 20% remained chronically ill. The normalization of the core symptoms, involving weight, menstruation, and eating behaviors, was slightly better when each symptom was analyzed in isolation. The presence of other psychiatric disorders at follow-up was very common. Longer duration of follow-up and, less strongly, younger age at onset of illness were associated with better outcome. There was no convincing evidence that the outcome of anorexia nervosa improved over the second half of the last century. Several prognostic features were isolated, but there is conflicting evidence. Most clearly, vomiting, bulimia, and purgative abuse, chronicity of illness, and obsessive-compulsive personality symptoms are unfavorable prognostic features.
Anorexia nervosa did not lose its relatively poor prognosis in the 20th century. Advances in etiology and treatment may improve the course of patients with anorexia nervosa in the future.
This study evaluated the clinical significance as well as predictors of outcome for adolescents with severe anorexia nervosa (AN) treated in an inpatient setting. Body mass index (BMI), eating disorder (ED) symptoms [Eating Disorder Inventory-2 (EDI-2)], general psychopathology and depression were assessed in 238 patients at admission and discharge. BMI increased from 14.8 + 1.2 to 17.3 + 1.4 kg/m(2) . Almost a fourth (23.6%) of the patients showed reliable changes, and 44.7% showed clinically significant changes (EDI-2). BMI change did not significantly differ between those with reliable or clinically significant change or no reliable change in EDI-2. Length of stay, depression and body dissatisfaction were negative predictors of a clinically significant change. Inpatient treatment is effective in about two thirds of adolescents with AN and should be considered when outpatient treatment fails. About one third of patients showed significant weight gain, but did not improve regarding overall ED symptomatology. Future studies should focus on treatment strategies for non-responders. Copyright © 2015 John Wiley & Sons, Ltd and Eating Disorders Association.
This article explores the issue of dance/movement therapists’ professional identity which, it is argued, is still overshadowed by the somatic–verbal divide. The discussion was generated by a small-scale research project, initially designed to examine therapists’ somatic awareness and awareness of somatic countertransference. The results of this study, briefly presented in the first part of the article, pointed to a prevalent preference for verbal training, supervision, and session processing, and to a surprising absence of awareness of and engagement with the therapist's own bodily response to the therapeutic encounter.Moving on from the findings of the initial research project, the article focuses on the troubled issue of DMTs professional identity through a contextualization of these findings and further elaboration of their symptomatic relevance. While some of the issues of professional identity are “external”, having to do with funding, status, institutional frameworks and training programmes, it is argued that the underlying sources of the problem are fundamentally related to the still unbridged somatic–semiotic divide, and the deep-rooted ambivalence of DMTs in relation to their own approaches and practices. It is proposed that the resolution of this ambivalence will be conducive to the development of a more robust DMT professional identity.
Presents an integrative framework for understanding the interface of the brain and the social environment through childhood, adolescence, and adulthood. The author addresses fundamental questions about mental health and dysfunction as he explores the ways that interpersonal relationships influence the genetically programmed unfolding of the human mind.
The volume synthesizes current knowledge from independent, usually isolated areas of research, including attachment, memory, emotion, neuroscience, genetics, and psychopathology. The chapters focus on how specific mental processes and cognitive abilities are fueled by emotional relationships throughout life. When attachment to caregivers is hindered or disrupted specific problems with memory, self-organization, and emotional regulation may result. Implications for adult states of mind, emotional competence, and relationship skills are considered, as well as links to such clinical problems as dissociation and depression. The book is intended to serve as a text for courses in psychiatry, clinical and developmental psychology, neuropsychology, and cognitive science. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
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