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Under the Skin: Barriers and Opportunities for Dance Movement Therapy & Art Psychotherapy with LGBT+ Clients



This chapter provides an introduction to collaborative creative arts therapies practice with clients who identify as gender and sexually diverse identities. Its objective is to examine gender identity and sexual orientation in the context of interdisciplinary therapeutic work in a community-based setting in Scotland. The authors will particularly focus on art and movement interventions, contributing relevant themes in working with clients who are lesbian, gay, bisexual, transgender or related identities (LGBT+). The chapter reviews current research on art therapy and dance movement therapy with LGBT+ clients, identifying gaps and opportunities for further research. It follows with an exploration of the external/internal self, LGBT+ visibility and identity as key thematic areas for creative work in relation to mental health. Finally, the authors examine a case example of collaborative creative arts workshops focusing on skin as a barrier, which serves to protect, expose and transform internal and external aspects of our identity. The authors explore interdisciplinary arts practice with a client group that has been historically marginalised and has limited representation in creative arts therapy research. It presents an affirmative stance in creating constructive experiences of therapy for LGBT+ clients, and the opportunities offered by an integration of movement and art.
Under the Skin: Barriers and Opportunities for Dance Movement Therapy & Art
Psychotherapy with LGBT+ Clients
Thania Acarón and Alison Wren
Acarón, Thania, and Alison Wren. 2019. “Under the Skin: Barriers and Opportunities for
Dance Movement Therapy & Art Psychotherapy with LGBT+ Clients.” In Gender and
Difference in the Arts Therapies: Inscribed on the Body, edited by Susan Hogan, 24–35.
London and New York: Routledge.
This chapter provides an introduction to collaborative creative arts therapies practice with clients
who identify as gender and sexually diverse identities. Its objective is to examine gender identity
and sexual orientation in the context of interdisciplinary therapeutic work in a community-based
setting in Scotland. The authors will particularly focus on art and movement interventions,
contributing relevant themes in working with clients who are lesbian, gay, bisexual, transgender
or related identities (LGBT+).
The chapter reviews current research on art therapy and dance movement therapy with LGBT+
clients, identifying gaps and opportunities for further research. It follows with an exploration of the
external/internal self, LGBT+ visibility and identity as key thematic areas for creative work in
relation to mental health. Finally, the authors examine a case example of collaborative creative
arts workshops focusing on skin as a barrier, which serves to protect, expose and transform
internal and external aspects of our identity.
The authors explore interdisciplinary arts practice with a client group that has been historically
marginalised and has limited representation in creative arts therapy research. It presents an
affirmative stance in creating constructive experiences of therapy for LGBT+ clients, and the
opportunities offered by an integration of movement and art.
This chapter provides an introduction to collaborative creative arts therapies practice with
clients who identify as lesbian, gay, bisexual, transgender or related identities (LGBT+).
Its objective is to analyse how gender identity and sexual orientation are manifested
through felt experience, and attest to the potential of art therapy (AT) and dance
movement therapy (DMT) to foster their expression in a group setting. We aim to expand
the repertoire of relevant themes for therapeutic work with gender and sexually diverse
identities, thus contributing to an underdeveloped area in creative arts therapies research.
This chapter represents an affirmative stance in creating constructive experiences of
therapy for LGBT+ clients, and the opportunities offered by an integration of movement
and art.
Gender and sexuality are universal to all human beings. They have an early influence in
how our sense of identity develops and how we build relationships with others. Identity
comprises the facets of human development that determine who we are and what make
us unique, which stem from a combination of biological, psychological, social and cultural
factors. Gender identity refers to an individual’s identification with societal denominations
of female, male, a combination or neither binary gender. Sexual orientation regards the
degree of attraction, including non-attraction,
towards a person of particular gender(s)
which is felt emotionally, sexually and/or romantically (HGSE QueerEd 2010; Amnesty
International 2014), and may remain dynamic or stable throughout a person’s life. Gender
identity and sexual orientation are aspects that contribute to an individual’s sense of self,
lived experience, and ultimately to physical and mental health; thus it is an issue needing
attention by the therapeutic community and within therapeutic spaces.
This chapter presents an example of interdisciplinary arts therapies practice with a client
group which has been historically marginalised and which has had limited representation
in creative arts therapy research. We will first review the literature in the fields of DMT
and AT relevant to LGBT+ clients. Then we will explore key themes based on our work,
which highlight the opportunities art and movement-based creative work offers to
improving participants’ mental health. We will particularly focus on exploring the themes
of the internal/external selves, LGBT+ visibility and identity that emerged from our
workshops. We will examine these themes through a case example of a collaborative
creative arts workshop focusing on the theme of skin, as a barrier that serves to protect,
expose and transform internal and external aspects of our identity.
The Community Setting
We deliver workshops and therapeutic sessions as part of a nonprofit, community-based
LGBT+ organisation in Edinburgh, Scotland. Alison Wren is a Scottish art therapist who
works as a Mental Health Development Worker, and Dr. Thania Acarón is a Puerto Rican
dance movement therapist working as a sessional workshop facilitator and professional
development consultant. The organisation offers counselling services, social events,
mental health courses (including AT), arts workshops, helpline support and information
sessions. Creative arts therapy workshops are offered within their mental health
programme, which includes individual and group sessions. Adults self-refer to the
services, which can be accessed flexibly through regular or drop-in sessions. Those who
access the mental health program vary in age, gender, sexual orientation, ethnicity, faith,
socioeconomic status, (dis)ability and familiarity with the creative arts therapies. People
who refer do not need to have experienced mental ill health, though a significant amount
of people who do refer have lived experience of mental illness. This is in keeping with the
recorded higher rates of mental ill health for LGBT+ people compared to the general
population (Fish and UK Department of Health 2007; National Alliance for Mental Illness
2017; The Shaw Mind Foundation 2016).
After introducing our key concepts and setting, the next sections present a review of DMT
and AT research pertinent to work with LGBT+ clients.
DMT and work with LGBT+ Clients
DMT and the creative arts therapies have much research work to do on sexual minorities,
an area that music therapist Hadley (2013) reiterates holds great promise. Allegranti
(2009; 2011) argues for an embodied approach to addressing gender and sexuality within
dance and DMT, exploring gender perspectives, feminist frameworks and sexuality as
expressed in performance (dance and film) and therapeutic work. Her integration of body
politics and gender theory with therapeutic approaches, and the inclusion of sexually
diverse narratives in her case analysis of a performance lab, brings to light issues of
LGBT+ visibility and heteronormativity within group work (2011). Currently the only case
study explicitly working with LGBT+ clients, Hanan’s (2010) master’s thesis focuses on
body image through DMT sessions with six transgender clients, exposing emergent
themes of self-acceptance, isolation, bodily discrimination and societal norms regarding
body and identity, which we have also encountered as salient themes in our work.
There is an emerging interest in the LGBT+ community, which has sparked a focus on
therapist competencies. For example, a questionnaire specifically directed towards dance
movement therapists’ knowledge of best practices with LGBT+ clients is currently in its
analysis stages (Robyn Flaum Cruz, e-mail message to author, 10 October, 2016).
Additionally, Acarón led a webinar for the American Dance Therapy Association (2015),
addressing key ‘body questions’ regarding gender identity and sexual orientation, with an
aim for more professional development training opportunities in this area. However, new
research needs to be developed on therapeutic competencies, and non-verbal aspects
of gender identity and sexual orientation.
Art Therapy with LGBT+ Clients
Art therapy literature reinforces there is a lack of research in the field in relation to gender
and sexuality, and the impact of AT interventions on LGBT+ clients (Addison 2003, Hogan
2003, Pelton-Sweet and Sherry 2008). Pelton-Sweet and Sherry’s review of current art
therapy LGBT+ research addresses some common themes: the coming out process,
client feelings of safety, the need for training in therapist competencies and explorations
of identity. Pelton-Sweet and Sherry (2008) claim that AT interventions are well placed
for exploring identity issues and contribute to the development of an evidence base for
the value of creative arts therapies with this client group. Ellis (2007) argues from a
phenomenological perspective that the subjectivity of sexuality can be embodied in the
AT experience and the possibilities of expression that a range of art media can provide
are of value when communicating conscious and unconscious lived experiences of
sexuality. This provides a rationale for examining interventions that integrate movement
experientials with visual art.
One of the challenging areas found in the literature with LGBT+ clients is the developing
nature of the appropriate terms and concepts. Addison (2003) attempted an introduction
to working with LGBT+ clients specifically in AT settings, however, due to the nature of
the evolution of the language LGBT+ communities are using to self-identify, some of the
language in her chapter now appears dated or inaccurate. Pelton-Sweet and Sherry
(2008) also found there is consistent need for culturally competent effective care for this
community, which sustains the claim for current training for therapists in this area. They
specifically recommend that art therapists require “knowledge of the social, cultural and
health issues facing this population, a non judgemental attitude and skill in counselling
LGBT clients” (Pelton-Sweet and Sherry 2008, 175). While Whitehead-Pleaux et al.
(2012, 2013) have compiled a best practice survey for music therapists supporting LGBT
clients, no AT (and DMT) specific guidelines for best practice exist.
Although there have been some advances in the way creative arts therapies address
sexual orientation and gender identity, AT and DMT interventions need to be analysed
according to current changes in LGBT+ legislation, policies, treatment options and remain
current within the evolving nature of the community. The next sections will describe the
context of our work and present our case example.
Case Example: The Skin and Boundaries Workshop
We have provided collaborative creative arts therapy workshops for two consecutive
years as part of the Scottish Mental Health Arts and Film Festival
, which we chose as a
case example. Our case example is a highlighted feature of our work with the LGBT+
community which has transpired for over six years. The twenty participants of this group
comprised of cisgender
and transgender
women, aged 20-50, identifying with a range
of sexual orientations. Three quarters of the participants were from the UK with an
international make up of people from Ireland, Nigeria, Poland, Spain and United States.
One of the participants was seeking asylum in the UK on the grounds of being LGBT+. In
this intensive workshop, we used a combination of movement and art-based interventions
on the topic of the skin as the boundary of the body, and also as protector. Here we will
provide a selection of key interventions in this workshop to elucidate our themes: the ‘skin
layer’ art/movement activity and the use of the folktale The Selkie Bride as a platform to
work on the theme of internal/external selves. Movement-based warm-up interventions
included sensory play, visualisations, structured improvisations, tableau
work and group
devising. Somatic attention to the body and with the body (Csordas 1993, Tantia 2012)
was exemplified by body scanning, body tracing and movement exploration of
interpersonal spatial boundaries. These exercises encouraged participants to engage
with their own rituals of renewal and cleansing after the workshop:
I still do some of the exercises, especially the one we run our hands over our body
without actually touching it to feel the energy then pushing out all negative energy.
Actually makes me feel like I'm cleansing myself (Anonymous participant, personal
communication, 2016).
The sensory play provided the participants with an encounter with the workshop space
and the art materials, in order to cultivate client's presence at a somatic level and
providing a multidimensional experience integrating all senses. We chose materials that
had drastically differing perceptual qualities in terms of size, texture, weight and
malleability (i.e. rolls of aluminium wire, soft modeling materials, marbles, large rolls of
paper, feathers, among other objects chosen for representational capacity). Another
consideration of our choices of materials related to the immediacy of their qualities,
therefore not requiring drying time or more complex construction.
Interdisciplinary working
A key aspect of the work is the embodied articulation of AT, and the visual, tangible aspect
of DMT. Incorporating somatic techniques in art making and laying out objects across the
space allowed an active engagement with the materials and deeper body awareness. The
interventions alternated between art and movement to suit the objectives and needs of
the participants, and aid in the flow of the workshop, which is key to collaborative work.
The workshop took place in a dance studio, away from a more traditional AT room setting
(Case and Dalley 2014), which encouraged participants to move more and to actively
engage with the art materials distributed around the room. There were no tables or chairs,
as objects were laid out on the floor as an art-making surface, a shift from the ‘sitting
down’, chair and table-focused traditional setup of AT, which invites new possibilities. This
is an atypical set-up for AT, but an ideal layout for collaborative art and movement
sessions. The participants crawled, rolled on the floor, and used their whole bodies in
their art-making.
Alternatively, having movement interventions represented visually
aided in the reflection and revisiting of the workshop themes, which we will address more
in depth in subsequent sections. Art-making allows a material representation of one’s felt
experience which is a useful tool to make connections between DMT sessions, helping
to visually record therapeutic material, as a point of reference for in-depth exploration.
There was a dynamic flow between art-making and movement, and dual interventions
proposed which did not suggest a segregation of each art form.
The next sections will outline the key interventions and themes that arose from this
Skin Layer Activity
Projective work is at the heart of creative arts therapies. ‘In projective art groups, themes
are introduced to provide a common framework to which each individual in the group
relates his or her own personal meaning’ (Dalley 2008, xvii). This was the case with one
of the main movement interventions, which involved the participants in outlining an
imagined layer (1-2 inches) external to the skin. This was described as an imaginary
‘covering’ of the whole body.
Fraenkel (2010) theorizes that imagining and sensing this body boundary, and ascribing
a metaphoric visualisation can aid in the understanding of one’s own personal and spatial
awareness, and the spatial relationships established with others. The participants could
choose any material to symbolise this boundary, which led to many different types of
ideas of materials the skin boundary
could be composed of, some
examples being: cork, foam, plastic,
rubber, tar, dishwashing sponge,
plush, velvet and more. This
materiality, as creative arts
therapists, gave us not only some
indications as to the type of
boundaries that were emerging
during the workshop, but also
suggested a materiality of the
boundaries they engaged with in their
everyday life. This echoes Moon’s
(2010) reflections on a social
constructivist theory of materiality in
art therapy, whereby personal artistic
Illustration: Suzi Dorey
expressions are rooted in social schemas, here examined in terms of gender and
sexuality. In the case of LGBT+ clients, materials might be used to celebrate self-
acceptance, in addition to constructing creative means to be resilient against societal
oppression. In the workshop, we expanded on the skin layer exercise by asking
participants to move around the space in closer proximity to others, noticing if there were
potential changes in their skin layer visualisations. This exercise was offered to stimulate
a shift from individual experience to fostering group awareness and interaction. In post-
activity discussions, some participants struggled with visualising and maintaining body
boundaries while engaging with others in the space.
For several participants, their imagined skin layer became more solid when encountering
others in space, while others reported their visualised body boundary disappearing or
melding with others. One of the participants said she felt surrounded by rubber, and
connected it to her inability to adapt to social situations or in relationships with others.
She stated things seemed to “bounce off of her”. In Newman’s (2010) case study
exhibiting installation art in response to the needs of young LGBT+ people within an AT
group, she describes one piece, ‘I’m Rubber’, which explores the resilience required to
experience life as part of a stigmatised population. The workshop participants’ feeling of
being surrounded by rubber can be hence analysed not as a barrier to connection, but as
a source of strength to survive situations perceived as unsafe. Another participant
reiterated the connection between material and experience:
The art activities were particularly poignant for me as they helped me to realise
that the 'skin' I was enveloping myself in, saying I was fine when I wasn't, was
stopping me from really processing my emotions and asking for help from those
close to me. (Anonymous participant, personal communication, 2016).
In this participant’s case, representing this boundary evoked an awareness of guarding
and masking difficult feelings, and the challenge in trusting others and welcoming support.
Art-making offered an opportunity to take the movement interventions into a visual,
tangible form, and we proposed a visual representation of an imagined dissected ‘slice’
of their skin boundary using art materials. We encouraged participants to consider colour,
Illustration: Suzi Dorey
texture and scale when art making. Once people had created their individual slice they
were invited to bring their artwork into the centre of the room into a type of circle museum
to reconnect with the other participants. We asked them to circle around each of the art
objects, being mindful of their presence, and to observe others’ artwork and reflect on
their own reactions, sensations and perceptions. The museum exercise was designed to
not require verbal explanation in the sharing of the art work and its associated meanings,
encouraging nonverbal reflection.
In both workshop interventions participants connected their own ‘skin boundary material’
to specific moments where they needed more strength or protection, and described
instances where they had felt more vulnerable, which holds relevance to LGBT+ clients
and the anticipatory anxiety of coming out, fear of stigmatisation, discrimination and
rejection that can result in increased social isolation (Haplin and Allen 2004). Herein lies
the strength of metaphoric work, as the layers of visual art and movement served as a
dual vehicle for alternating modes of somatic experience with projective techniques,
adjudicating strength to expressing vulnerability.
The Selkie Bride
Another key aspect of the workshop linked movement and art interventions to the folk tale
of the Selkie Bride (Breslin and Keiper 2012), a popular story in fishing communities in
Scotland, Ireland, Portugal, and Scandinavia. The Scottish version of this story (in
simplified form) centres around a selkie, a transformative creature that fluctuates between
woman and seal by shedding her sealskin, who gets entrapped by a fisherman when she
leaves her sealskin unguarded. The fisherman falls in love with the selkie and hides the
skin. After many years, her children find her sealskin and she has to choose between her
essence, the sea, and her role as mother and wife. Despite the heartbreak inflicted upon
her family, she chooses to return to the sea and her true home, thus abdicating her role
on land.
As our group was formed by women, this conflict between inner self and outer self, and
each of the responsibilities and consequences these entail formed the basis for the design
of the interventions. We used the story of the Selkie Bride as inspiration for art-making,
bringing in clear latex-free gloves and a wide variety of materials (feathers, buttons,
markers, metal, glitter, sequins, etc.) that the participants used to represent their inner
self (internal essence) and outer self (external demands). The participants were asked to
move their gloves in an exploratory journey through the space. They also created an art-
movement dialogue between the boundary slice of skin layer they had created and their
glove, fostering connections between interventions. The participants were asked to create
short representations of these explorations in group tableaus in a group sharing and
With these key interventions in mind, we will analyse the symbolic exchange created
between external/internal selves and their relationship to work with LGBT+ clients in the
following section.
Illustration: Suzi Dorey
Exploring External and Internal Selves with LGBT+ Clients
Creative arts practice aims to provide an external output to what transpires in an
individual’s internal world. Inner conflict and transformation are conveyed by making an
experience visible, tangible and present, enabled by the therapeutic relationship.
Although not specifically aimed at LGBT+ clients, art therapist Makin (2000) explored
themes of ‘inside/outside’ through self-portraiture interventions. Self portraiture
techniques in AT offer creative opportunity for feelings to be externalised that can be too
exposing, frightening or shameful to express verbally (Addison 1996, Brody 1996, Fraser
and Waldman 2004). We chose to portray these by creating the skin boundary
visualisation and movement exploration as symbolic internal self portraits which elicited
associations with LGBT+ identity and visibility.
Lasser and Wicker (2008) argue that nonverbal behaviour is a key factor in managing
visibility with LGBT+ clients. Many LGBT+ client's’ internal world will have aspects of
negative external messages about how it is not ok to be LGBT+. Some examples of these
messages include: historical pathologisation in mental health diagnosis, criminalisation,
lack of equal rights, societal stigma, oversexualised identities, lack of positive
representation in mainstream media. The internalisation of these powerful messages may
result in internalised homophobia/biphobia/transphobia, ultimately impacting on the self-
worth of the person and their capacity to live a fulfilling life with flourishing mental health
(Fraser and Waldman 2003). This is something unique to LGBT+ clients, as heterosexual
and cisgender clients are not usually rejected for their sexual orientation or gender
Since our workshop space was explicitly inclusive of all sexual orientations and gender
identities, participants made use of movement and art as tools for visibility of their own
personal themes. For example, one of the participants related the weight of external
demands being extremely difficult at this particular time when she was seeking asylum in
the UK on the grounds of their LGBT identity. Her glove boasted vibrant colours which
she related to the strength she was gaining in uncovering her own identity, despite the
painful memories of her hiding this from her family in her home country and her current
lack of acceptance from the United Kingdom Home Office, who she was having to ‘prove’
her sexuality to. She repeatedly referred to herself as finding freedom in her artistic
expression, and hope in the rebuilding of her true identity. Another LGBT+ participant
chose to use more stereotypically associated symbols such as rainbow flag colours to
externally represent their inner self. This participant chose not to move around the space
as much as some others, quietly and carefully making a relatively small piece of artwork,
suggesting a connection between notions of safety and visibility within the group. The
symbolisation of the rainbow communicated something celebratory about their identity
that could have been potentially overlooked. This is consistent with Addison’s (2003) and
Pelton-Sweet and Sherry’s (2008) recommendations that there is symbolisation unique
to the LGBT+ community can be visually expressed but won’t necessarily be verbally
communicated. However, in contrast to Addison’s (2003) descriptions of potential LGBT+
symbols, it is important in our practice to keep current on LGBT+ content but withhold
assumptions of associations until disclosed or identified by the client. Not all LGBT+
clients will symbolise their identities in their artwork/movement in this way. This colludes
with unhelpful dominant beliefs of societal stigma and stereotypes that LGBT+ people
already contend with, which can considerably hinder the therapeutic relationship.
In the final group showings and discussions, the external/internal theme generated a
construction of new shared meaning amongst participants akin to Moon’s (2010)
description of a social constructivist stance on the correlation between materiality and
shared experience. Some chose to represent their family or close circles and the
challenges presented by their external demands. Others chose to focus on the
importance of cultivating and nurturing their inner self (expressed as passions, drives,
goals). The transformative elements from the story of The Selkie Bride and the precarious
balance between internal and external demands resonated with the participants in deep
personal aspects, with opportunities for deconstruction and alternative meanings.
This chapter described the collaborative process between art and dance movement
psychotherapists in an intensive workshop format within a mental health festival in
Scotland. We claim that a focus on sexual orientation and gender identity, as a
fundamental aspect of human life, needs careful attention. The creative arts therapies
have a limited trajectory of research in this area, and while there is emerging research in
both DMT and AT, further research on relevant themes for this client group are needed.
We chose to focus on our work with LGBT+ clients for this chapter, but recommend further
research on therapist competencies and current training on terminology and affirmative,
inclusive interventions.
The art/movement interventions all related to the theme of internal versus external selves
and were rooted in the folk tale of the Selkie Bride. Sensory play with a wide range of art
materials, movement experientials and the visual representation of a protective skin
boundary helped ground these experiences, enabling inner listening and awareness of
self and others in the space. We applied projective techniques through the creation of a
skin boundary ‘slice’ and a glove that represented either external demands or their
internal essence, which were shared and discussed.
In terms of our theme, external demands were linked to social pressures, which elicited
discussions surrounding the difficulty of LGBT+ visibility amongst family members, and in
one strong case, allowed one of the participants to process her current status as someone
seeking political asylum. The exploration of internal essence helped participants identify
current experiences that seemed to be at a liminal stage: stuck between a crystallisation
and identification of the experience, but not able to be externalised and expressed.
Visibility, in some respects, may represent a cost, loss or an opportunity to some LGBT+
clients. For some, though not all clients, being who they are might provoke a loss of their
family, loved ones, interfere with work opportunities or put them at risk of violence. There
are also many positives to being visible as an LGBT+ person: affirmation of identity, self
acceptance, experiences of love and support from family/loved ones/work colleagues,
which offer positive themes to address through creative arts therapies. Thus the battle
and assuagement between the internal and external worlds, especially in terms of LGBT+
identity was both pertinent and important to this group.
The focus of our work is to allow the somatic experience to become integral to art making,
and also explore visual, tangible manifestations of movement. A group that included
heterosexual, LGBT+, cisgender and transgender women in a community-focussed
workshop fostered an inclusive environment, which allowed deep individual exploration
and safe group interactions without pressure of disclosure. The collaborative dialogue
between dance/movement and art-making allowed metaphoric connections between
materiality and felt experience. Collaborative work between creative arts therapists and
integrated movement and art-making interventions can offer multidimensional
explorations, perspective-making, and an embodied approach to working with gender and
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Please note that people who identify as asexual are not sexually attracted to any gender and are part of
the continuum of sexual orientation.
The term gender(s) is used to reflect the full spectrum of gender, including people who identify as male,
female, non-binary, non-gender or any combination of male and female.
For more information on the festival, see
Cisgender definition: a person whose gender identity corresponds with their sex assigned at birth
Transgender definition: a person whose gender identity does not correspond with their sex assigned at
A tableau is a drama-based group exercise, which portrays still shapes (or repetitive movements in
some variations) with a common theme, to create what can be described as a live version of a painting.
Chairs were available for participants with limited mobility.
Dr Thania Acarón, PhD, BC-DMT, R-DMP, FHEA
Thania is a lecturer, performer, choreographer and dance movement therapist from Puerto Rico,
currently based in Wales. She obtained her PhD on the role of dance in violence prevention at
the University of Aberdeen and holds a master’s degree in Dance Education from New York
University. She is certified as a clinical supervisor and dance movement psychotherapist in the
UK and US. Thania currently works as a lecturer at the Dance Programme at the University of
South Wales in Cardiff. She currently co-directs two artistic companies and is touring her own
work. Thania offers international workshops on movement and wellbeing, decision-making
through movement and interdisciplinary practice.;
Alison Wren, MSc, HCPC, BAAT
Alison Wren is an integrative Art Psychotherapist and supervisor based in Scotland. She primarily
works in the voluntary sector and in private practice, specialising in working affirmatively with
clients around issues of sexuality, gender and relationship diversities. She is the professional
officer for Scotland for The British Association of Art Therapists and a tutor on The University of
Glasgow’s Art Psychotherapy introduction course. She regularly teaches Arts Therapy trainees
and other mental health professionals on issues of cultural competence with LGBT+ clients. She
has developed an award-winning mental health and wellbeing service for LGBT+ people,
produced two educational films and published a creative writing anthology co-created with LGBT+
people with lived experience of mental ill health.
Illustrator: Suzi Dorey
Transgender and nonbinary people, whose gender identity differs from their sex assigned at birth, experience substantial mental health disparities. Guidelines for care of transgender and nonbinary people include psychotherapy to affirm one’s gender, to explore a new gender identity or expression, and to cope with the effects of stigma and resulting psychological distress. Drawing on theory to inform practice, this paper explores the basis for dance movement therapy with transgender and nonbinary people by considering minority stress (coping with stigma and enhancing resilience), gender affirmation (adapting to physical changes and improving body image), and identity development (exploring new movements and integrating sense of self). This paper discusses how dance movement therapy is applicable from each of these three theoretical perspectives and how it may be put into practice to support the mental health and well-being of transgender and nonbinary people. Dance movement therapy interventions for this population should be theory-informed and developed in collaboration with transgender and nonbinary clients as well as transgender and nonbinary dance movement therapists. Recommendations include additional training for dance movement therapists to increase cultural awareness of transgender and nonbinary populations, to explore their understanding of their own gender, and to identify biases and assumptions around gender identity and expression.
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This article explores the embodied decision making model, an innovative method of skill-building and fostering sustainable practice in professional development and workplace wellbeing. Embodied decision making features a non-linear, dynamic process is used to identify body-based stressors, assess environmental factors and clarify needs and priorities in order to map potential courses of action/non-action. This article extends the original model developed by Warren Lamb & Rudolph Laban and their collaborators. Perspectives from individual differences research on decision making are examined providing a rationale for utilizing movement for supporting crucial transitions in professional identity. An original contribution is the connection between decision making and embodied self-reflexivity, suggesting future applications for practitioner training and higher education. The article concludes that dynamic individual differences models that maintain an integrated view of body-mind can challenge the notion of decision making as a standardized and cognitive-focused process, while maintaining an inclusive and diverse client-centered stance.
Given the increasing numbers of openly lesbian, gay, bisexual, transgendered, and questioning (LGBTQ) people, music therapists are more likely to be in contact with LGBTQ individuals in their daily routines. LGBTQ people are coming out at earlier ages, staying out into their senior years, participating in marriage, and raising children. Expanding media coverage has focused on civil rights, marriage equality, bullying in the schools, and respect and pride in the community. Even though the AMTA Code of Ethics and Standards of Clinical Practice define a non-biased approach to working with LGBTQ individuals, the profession is still in need of best practice guidelines that will assist music therapists with tools to ensure that they are informed and sensitized to the needs of the LGBTQ community. The purpose of this paper is to propose a set of best practice guidelines and make recommendations for its implementation.
The special strength of art therapy is that it encourages us to envision, on our own terms, our definitions of self and reality. Since it provides an opportunity to make oneself seen, art therapy has a special resonance for lesbians because of their historical invisibility and isolation. This paper discusses the imagery and process of an art therapy support group for low-income isolated lesbians, through five related “lenses”: (1) women's relational dynamics and the centrality of relationships in lesbians' lives; (2) trauma; (3) socioeconomic class; (4) lesbian identity, visibility, culture, and gender; and (5) transference. An intertwined constellation of themes—safety, danger, gender, aggression, sexuality, power, intimacy, isolation, autonomy, and family—is traced through the progress of the group's interactions and visual productions.
We live in societies in which we are shaped and positioned by dominant/subjugating narratives including patriarchy, Eurocentricism, heterosexism, capitalism, psychiatry/psychology, and medical science. This paper explores the ways in which our understandings of ourselves and others are fundamentally shaped by such narratives. These narratives shape how creative arts therapists understand concepts such as therapy, health and wellness, and issues of identity such as gender, race, ability, and sexuality. The author contends that it is imperative that creative arts therapists examine all aspects of identity in therapy, not only aspects of the client's identity, but also those of the therapist, and how these aspects of identity impact, structure, and mediate the therapeutic relationship. That is, as therapists we are not above the fray of complex identity formation shaped by dominant/subjugating narratives. The author discusses the need for creative arts therapists to examine how dominant/subjugating narratives are communicated through the art forms that we engage in within the therapeutic process. Also explored are the ways in which creative arts therapists are complicit with these dominant/subjugating narratives through our educational and research practices. Finally, the author discusses the need for constant vigilance against such dominant/subjugating narratives in order to work toward anti-oppressive practice and social justice.
The purpose of this study was to describe the subjective experience and expression of body image for 6 transgender adults while they participated in a series of dance/movement therapy (DMT) sessions. Participants included 4 transgender women and 2 transgender men, ranging in age from 39 to 63 years old, all of whom identified as in the process of transitioning to living as their desired gender. Data were collected through the observations of the researcher during 4 DMT sessions that she led for participants, movement phrases created by participants during the sessions, and exit interviews with each participant. Data were reported in a written narrative, which integrates major themes and variant themes of body image as they emerged from the data. The study found 6 group themes: (a) the importance of expressing one‟s true and unique self, (b) supporting one another‟s efforts to express the true self, (c) the body‟s experience of violence and discrimination, (d) studying and practicing gendered movements, (e) actively working to shape the body as a vehicle of self expression, and (f) joy, relief and celebration in the gender transition. The study found 4 variant themes: (a) active engagement in the transgender community, (b) physical limitations caused by medical conditions, (c) struggling with the decision whether to transition, and (d) controlling the body‟s expression of sexuality. These findings may be applicable to health care providers serving transgender clients by increasing their awareness of the subjective experience of transitioning to living full-time as a man or a woman.
The authors employed grounded theory to explore the high school experiences of gay, lesbian, and bisexual students in Central Texas. The central phenomenon that emerged from the study was Visibility Management, or decisions made regarding the disclosure of invisible traits. This article reviews the results of this research with an emphasis on the ways in which gay, lesbian, and bisexual participants used nonverbal strategies to manage their visibility. Results indicate that GLB youth use a wide range of nonverbal behaviors to regulate the degree to which their sexual identity is made known to others. Implications for clinical applications and further research are discussed.
This paper examines sexual identity development and the integration of art therapy in counseling with lesbian, gay, bisexual, and transgendered (LGBT) clients. Especially during the coming out process for LGBT clients, research has shown that levels of emotional and physical well-being decrease considerably. However, there is growing evidence in support of a relationship between personal creative expression and sexual identity, as well as between expressiveness and physical and emotional health. This paper argues that the use of art therapy during the coming out process increases wellbeing in the LGBT population.