Dance/Movement Therapy.] INSTITUTION Zero to Three/National Center for Clinical Infant Programs, Arlington, VA

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AUTHOR Fenichel, Emily, Ed. TITLE [Dance/Movement Therapy.] INSTITUTION Zero to Three/National Center for Clinical Infant Programs, Arlington, VA. SPONS AGENCY American Express Foundation, New York, NY. REPORT NO ISSN-0736-8083 PUB DATE Sep 94 NOTE 38p. AVAILABLE FROMZero to Three/National Center for Clinical Infant Programs, P.O. Box 25494, Richmond, VA 23260-5494 ($37 per year). PUB TYPE Collected Works Serials (022) JOURNAL CIT Zero to Three; v15 nl -Sep 1994

EDRS PRICE MFOI/PCO2 Plus Postage. DESCRIPTORS *Dance Therapy; *Disabilities; Early Intervention; Infants; *Movement Education; *Play Therapy; Preschool Education; *Therapy; Toddlers

ABSTRACT This newsletter theme issue focuses on dance, play, and movement therapy for infants and toddlers with disabilities. Individual articles are: "Join My Dance: The Unique Movement Style of Each Infant and Toddler Can Invite Communication, Expression and Intervention" (Suzi Tortora); "Dynamic Play Therapy: An Integrated Expressive Arts Approach to the Family Treatment of Infants and Toddlers" (Steve Harvey); "Attuning to the Fetus and the Young Child: Approaches from Dance/Movement Therapy" (Susan Loman); "Hopping, Jumping, Leaping, Skipping, and Loping: Savoring the Possibilities of Locomotion" (Lois Barclay Murphy); "Do Baby Boys Naturally Lead with the Left Foot?: Research on the Asymmetries of Movement Patterns in Newborns and Infants" (Mary P. Grattan and others). Additionally, the newsletter provides reviews of books and videotapes, letters to the editor, highlighted sections containing valuable information, and calls for conference papers and proposals. (DB)

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[Dance /Movement Therapy]

Zero to Three/National Center for Clinical Infant Programs 2000 14th St. North Suite 380 Arlington, VA 22201-2500

"PERMISSION TO REPRODUCE THIS MATERIAL HAS BEEN GRANTED BY di-nLeAs2--L,

TO THE EDUCATIONAL RESOURCES INFORMATION CENTER (ERIC).- 9111

It National Center kir Clinical Infant Programs

Volume 15\o. IAugust / September 1994 ISSN one-me; Join My Dance: The Unique Movement Style of Each Infant and Toddler Can Invite Communication, Expression and Intervention

remember that childhood feeling of sheer joy and freedom in moving. Children explore so much of their world through movement. Their non-verbal expressions tell us about them- %./ selves, their needs, their feelings. We can learn so much about them by watching them. Before a child develops verbal skills, we must obtain much of our knowledge about a young child's needs and wants by lis- tening to his or her cry and watching how he or she responds to the world. During the early vears, children make - sense of the world through their sensorimotor experiences. From the beginning, each baby develops his or her own personal communicative dance to express how he or she perceives and experiences his or her surroundings. Becoming attentive to the Suzi Tortora qualities of a young child's non-verbal cues provides a window into that child's ex Suzi Torture, A.D.T.R., C.M.A., Cold Spring, New perience, expression and development of his sense of York self. These qualities include the rhythm, tempo, mus Quick quick running, running GO! GO! GO! Here I come! Back-up, forward around and around Contents: wiggly, leaping BLIMP! OOPS falling down, down to the ground STOP shhh! S-1-o-w4-y...s-l-o-w-l- Join My Dance 1 y...one hand at a time...creeming...cr-awl-ing...quietly Dynamic Play Therapy 11 gently intoaball makingself What Is Dance/Movement Therapy? 18 small...waiting waiting holding breath stillness Attuning to the Fetus and the Young Child 20 building cues widening suddenlu 8000! Here Savoring the Possibilities of Locomotion 27 I am the body exclaims arms reaching up and out to the Asymmetries of Movement Patterns in Newborns sky legs jumping 1-2-3 ! and Infants 28 Publications 32 Observing an energetic toddler completely en- Videotapes 33 gaged in a spontaneous game of chasing hide- Letters to the editor 34 and-seek can he contagious.It can draw us in, Conference Call 35 make us eager to join in the exuberance, to touch and 3 2000 14th St. North, Suite 380, Arlington, VA 22201-2500TEL: (703) 528-4300Publications orders: 1-800-899-4301 cular tension, spatial pathway and amount of strength used to perform the movement sequence. Each Zero to Three Staff individual's personal movement style is made up of a EditorEmily Fenichel unique organization of these different qualities. Consulting Editors Jeree Pawl and Jack Shonkoff One of the key therapeutic techniques in the field Assistant Editor, Videotapes -- Margie Wagner Assistant Editor, Publications Julia Bromley ofdance movement therapyisobservingthe Zero to Three is the bi-monthly bulletin of ZERO TO THREE/ expressivity of the body's movement qualities. By fo- National Center for Clinical Infant Programs. Unless otherwise cusing on the essences of the body in motion, we can noted, materials published in Zero to Three may be reproduced by health professionals or employees, officers or board membersof listen to its tune. gaining insight into how that indi- non-profit education and social services organizations for non-com- vidual organizes his or her experience of the world. mercial use, provided they acknowledge ZERO TO THREE/ Na- Originally this field developed from dancers' own ex- tional Center for Clinical Infant Programs as the source and copy- periences with using the power and universality of right owner of this material. dance to communicate. The drive to know oneself and ZERO TO THREE/National Center for Clinical Infant Programs to express the deepest feeling of self through the body Board of Directors Kathryn BarnardUniversity of Washington T. Berry BrazeltonChildren's Hospital Medical Center, Boston Since dancers mid young children share an Maria Chavez -- Department of Children, Youth and Families, State affinity for non-verbal expression, it seems natural of New Mexico Robert N. EmdeUniversity of Colorado School of Medicine fin the dance and the young child to meet. Linda GilkersonThe Evanston Hospital and Erikson Institute, Chicago by using dance and movement is primal, enabling the Stanley I. GreenspanGeorge Washington University School of Medicine mover to cross the barrier of language. In this way the Robert J. HarmonUniversity of Colorado School of Medicine dancer's world relates very much to that of the infant Irving B. HarrisPittway Corporation, Chicago and toddler's. In the young child's world, the body is Asa Grant Hilliard, III Georgia State University, Atlanta Gloria Johnson-PowellHarvard Medical School his or her first tool for containing and processing indi- Sheila B. KamermanColumbia University School of Social Work vidual experiences. Through movement the infant first Anneliese KornerStanford University Medical Center attempts to communicate these experiences. J. Ronald LallyFar West Laboratory, San Francisco Bernard LevyNew York City Since dancers and young children share an affin- Alicia F. LiebermanUniversity of California, San Francisco ity for non-verbal expression, it seems natural for the Samuel MeiselsUniversity of Michigan dance and the young child to meet. Dance transforms Dolores NortonUniversity of Chicago Robert Nover Ceorge Washington University School of Medicine movement.Because dance is not task-oriented, as Joy OsofskyLouisiana State Univ. Medical Center, New Orleans some movement is, it is the ultimate form of self-ex- Jeree PawlUniversity of California, San Francisco pression.Ideally, its only purpose is to enable the Deborah Phillips - -- University of Virginia Kyle PruettYale University School of Medicine mover to fully engage in experiencing herself moving. Arnold SameroffUniversity of Michigan As a dancer, Ifirst brought the dance to children Marilyn M. SegalNova University, Ft. Lauderdale, Florida through teaching creative movement classes.It soon Rebecca Shahmoon ShanokJewish Board of Familyand Children's Sernices, NYC become evident to the me that as the children enhanced Jack ShonkoffUniversity of Massachusetts Medical School their physical skills and improved coordination, a Lynn StrausMamaroneck, NY deeper confidence and expressivity of self developed Ann P. TurnbullBeach Center on Families and Disability, Lawrence, Kansas as well. As I encouraged children to repeat and elabo- Bernice WeissbourdFamily Focus, Inc., Chicago rate their individual stylistic movement preferences Serena WiederClinical Psychologist, Silver Spring, Maryland into dance phrases, each child's personal choreography G. Gordon WilliamsonJFK Medical Center, Edison New Jersey became an expression which seemed to describe his or Barry ZuckermanBoston University School of Medicine her past and present experiences. Life Members Experience is another element key to dance Mary a Salter-AinsworthUniversity of Virginia Peter Blos, Jr.Ann Arbor, Michigan therapy technique. The dance therapist aims to help Peter B. NeubauerNew York City the children use their bodies through dance and move- Arthur H. ParmeleeUniversity of California Medical Center, Los ment, to express their experiences of relating and de- Angeles Julius B. RichmondHarvard University Medical School veloping within their surroundings.The postural Mary RobinsonBaltimore, Maryland qualities of a person's movements reflect the mover's Pearl RosserSilver Spring, Maryland sense of self on an intrapersonal level. The way the Albert SolnitNew Haven, Connecticut Edward ZiglerYale University mover interacts with hisor her environment isobserv- able in how the mover then moves within that body posturing through the spatial environment. During in- Associate Director: Carol Berman tervention, the therapist always looks at the child Associate Director: Emily Fenichel within this context of expression of self (body move- This publication was made possible in part by a grant from the ment) in relationship to interaction with others (space). American Express Foundation The dance therapist looks to see how the child has co- OZERO TO THREE/National Center for Clinical Infant Programs 1994

August / September, 1994 Zero to Three ordinated all aspects of self motoric, sensorial, verbal/communicative, emotional, cognitive to com- Editor's note: municate with and to interact with the surroundings. Suzi Tortora, who inspired, conceptualized, These observations are crucialeven if the movement and organized this issue of Zero to Threeobserves pattern that the child displays is not synergisticor effi- that "from the beginning, each baby developshis or cient for that child's total functioning,or if it is influ- her own personal communicative danceto express enced by an organic developmental difficulty. how he or she perceives and experiences hisor her The therapist strives to understandhow the surroundings." We all know thatyoung children hild's way of relating and moving colors thatchild's use movement to explore much of their world. But experience. The first question I ask when observinga we must also be aware that young children alsouse child in session is, ''What does it feel liketo experience movement to tell the world what they need and how the world through that child's particularstructuring of they feel. And, particularly in the earliestyears of his movements?". The second question thenbecomes, life, it is through body movement thatcaregivers "Flow can I structure an environment that enablesthe communicate their attunement tovery young chil- child to experience his or herown way of relating and dren and create what Susan Loman callsa "shared functioningwhilesimultaneouslyenabling him movement dialogue." through that experience to explorenew ways of inter- Since non-verbal communicationsare the raw acting with that environment?" materials of the field of dance /movementtherapy, As the practitioners of this field watchedyoung this field has much to offeranyone who works with ch i Id reitgrow through this way of -sceinc,,," we felt we infants, toddlers, and their families. Indance/move- had much to share with otherprofessionals. The work ment therapy, body movement simultaneously of several theorists and practitioners pro- in the field of vides the means of assessment and the modeof in- child development have especially createda lively ex- tervention. Observing and analyzing the qualitiesof change. Winnicott (1987) best reinforcesmy experi- a young child's movement suggests ways to help in- ences as a dance therapist with infants andyoung chil- fants, toddlers, their parents, and other d ren: caregivers enter into a physical dialogue not with the goal The basis of all theories about humanpersonality of helping children accomplisha task (although development is continuity, the line of life, which through this process skills will often beachieved), presumably starts before the baby's actualbirth; but rather to developa socially, emotionally sup- continuity which carries with it the ideathat portive relationship as a way to hear whatthe child nothing that has been part ofan individual's ex- wants and needs to say about hisor her experience perience is lost or can ever he lost to thatindi- in the world and what is problematic aboutthis ex- vidual, even if in various complexways it should perience. and does become unavailableto consciousness... In this issue of Zero to Three, dance/movement some kind of communication takes placepower- therapists Suzi Tortora, Susan Loman,and Steve fullyfrom the beginningof each human Harvey discuss the theoretical foundations oftheir individual's life, and whatever the "potential"the work; their methods of observation; andinterven- "actual experiential" build-up that becomesa per- tion approaches that can be used ina variety of set- son is precarious; development can be heldup or tings in work with parents, caregivers, andyoung distorted at any point... It will be observed that I children from pregnancy onward. MaryP. Grattan am taking you to a place where verbalization has and her multidisciplinary group of colleaguesde- no meaning (p.90-91). scribe their fascinating and thought-provokingre- This place where "verbalization hasno meaning" search on newborns' movement is n here dance therapists patterns, which are may enter, especially when the building blocks for voluntary actionsof infants, working with the youngest children. Forthe raw ma- children, and adults. And Lois BarclayMurphy, terials of our trade are non-verbal communications. finding, as always, precisely the right wordsto ar- The first technique toolwe use is observation; the sec- ticulate her keen observations, showsus how tod- ond, sensory awareness and stimulation.Through the dlers and young children "savor thepossibilities" of honed ability to observe non-verbalexpression, the locomotion. dance therapist can geta sense of the infant's experience. From these observations, she creates a therapeu- The dance therapy environment provides tic environment based on the infant's a sooth movement reper- ng, consistent, and emotionally warm and accepting toire and developmental capacity. Overtime, she en- holding environment which allows the childto be di couragesdevelopment by providing experienceswhich enable the child to explore rective about his or her activities and socialengage more varied movement ment. We use the term "holding" qualities which expand hisor her movement repertoire. as Brazelton did in 1974, to describe the mother's ability to holdthe infant through her touch, hereves, her voice, and her smile 5 Zero to Three August / September, 14'44 as the baby's attention waxes and wanes according to looks to see how infants may be holding memories of his or her physiological demands and social capabili- those experiences within their bodies, affecting their ties.The initial goal in a session is to broaden the movement.In particular, the therapist looks to see child's social and communicative base by first helping how the child may be expressing these experiences the child experience his or her movements as commu- nonverbally and how they may be affecting the child's nications, enabling exchange and interaction with oth- physical, emotional and social development. ers. Embedded in this process are sensory integration Parent/infant attachment difficulties are also a activities which enable the child to experience and frequent cause of referral.In these cases, the dance learn about regulating and organizing his or her sen- therapist analyzes both the parent's and the infant's sory system. movement style as well as their nonverbal interactive By initially attempting organization on a symbolic style.The therapist will include the parent in the preverbal level, the child begins to develop a body dance-play sessions, encouraging the parent to explore schema. Through this physical experiencing the child new qualitative movement interactions with the child, gains information about where his or her body is in as the child's movement story unfolds. space. The therapist and child explore proprioceptive, As part of prenatal care, obstetricians often refer vestibular and auditory processing through physical pregnant women with psychiatric difficulties such as activities that enable the child to practice putting his or depression or hypertension, and physical problems in- her joints in a position useful for a movement task. The cluding low energy or back pain. The focus for these therapist provides emotional, tactile and verbal sup- women is to learn relaxation techniques, to improve port. Through this process the child learns kinestheti- their physical and emotional awareness of their chang- cally to organize sensations, as they relate to external, ing bodies and postural mechanics, and to prepare environmental stimuli. The child thus learns about and them for the labor and birth. A dance therapist would becomes comfortable with variability and versatility also help them begin to become attuned and attached within the environment. to their developing unborn babies. After birth, a par- Although this process may seem similar to occu- ent/infant activity class can help the participants to pational and physical therapy, the major difference is better understand their baby's unique nonverbal cues. the intent of dance therapy. We enter into a physical Dance therapy sessions occur in both individual dialogue with children not to help them accomplish a and group settings. As one participant said, "These are task (although through this process tasks will often be dance classes with a difference." That difference is the achieved), but rather to develop a socially, emotionally dance therapist's attention and intention. In a session supportive relationship as a way to hear what the in- led by a dance therapist, the participants will feel good tent wants and needs to say about his or her experience about themselves not only from the enjoyment of sim- in the world and what is problematic about this expe- ply moving their bodies, but also from their enhanced rience. self-awareness and expression. Populations and treatment setting for dance The improvisational atmosphere of each dance therapy therapy session supports the participant's free expres- Dance therapists work in a wide variety of set- sions while encouraging more social relatedness. As tings, including private practice; early intervention fa- the child begins to experience his or her movements as cilities; the NICU, pre- and perinatal, psychiatric, rec- a rich source, facilitating self-expression, language ac- reational and rehabilitation departments in hospitals; quisition and social engagement, he or she also learns day care; schools; and early parent education classes. how to regulate his or her sensory system through Our roles in these settings vary from primary therapist, body awareness and the stimulation of physical devel- to teacher, to a member of an interdisciplinary team. opment. The knowledge a dance therapist brings from Our approach in each of these settings also varies. her understanding of the universally expressive quali- In the one-to-one setting described. below, the ties of dance provides crucial access to a child's body children were referred to my private practice due to de- and mind. Thus, dance therapists help children expe- velopmental delays. Often a very young child is re- rience their full social/communicative potential. ferred by a pediatrician when the child exhibits diffi- Observational approach culties but no definiive diagnosis has been made. When I begin to work with an infant, 1 often feel Young children showing signs of, or diagnosed with, as if the infant is taking me on a very personal journey Failure to Thrive, Autism, and Pervasive Developmen- into the wilderness, on which the infant shares with me tal Disorders often respond well to this form of early what he or she has experienced. Along the way we intervention. Dance therapy has also been helpful for make stops, try new pathways, sometimes get lost, and children and infants who have undergone continuous make discoveries. All the while, my role as therapist is or complicated medical treatment such as surgery, to share, support and decode the child's expressions treatment of feeding difficulties, or prematurity inter- through this exploration. During the decoding process, ventions and NICU experiences. The dance therapist verbalizations become important also. This brings cog-

4 6August / September, 1994 Zero to Three In work with the birth-through-three population, Guidelines for observing emotional states a foundational belief must be that, as Winnicott (ibid) reflected in posture and personal movement states, from the very beginning infants are having ex- styles periences and collecting memories about those experiences, perhaps not on a mature cognitive level, butcer- Based on the Urban Movement Analysis system, pre- tainlyon an impression-based, sensorial level. sented bySlidTortora In his 1985 work, Daniel Stern describes how children enter the world with an emerging sense of self Structure of body: that acts as the primary organizing principle in the development of self and social relating: Placement/movement of limbs in relation to Infants are not "lost at sea" in a wash of torso abstractable qualities of experience.They are Proximal-distal initiation gradually and systematically ordering these ele- Upper-lower body relationship ments of experience to identify self-invariant and Left to right body relationship other-invariant constellations and whenever any Contra lateral body relationship constellation is formed the infant experiences the Pattern of breath flow emergence of organization ...It operates out of Particular parts/areas of body individual awareness as the experiential matrix from which seems to be aware of thought and perceived forms and identifiable acts Particular parts/areas of body which attract and verbalized feeling will later arise (p. 671. your attention I have found the image that the infant is "not 'lost Most used parts of body during movement at sea' in a wash" extremely useful as a way to ac- Least used parts of body during movement knowledge and respect the infant when I first approach Use of body as a whole, vs. in parts him or her during the initial stages of treatment. Symmetry/asymmetry To begin this journey with a baby, the first impor- Place of initiation of movement tant task is to wait...watch...listen...and quiet down within oneself. In this way one can become a clear re- Overall sense of connection, fluidity vs. ceptor, open to spontaneously receiving information disconnection, holding throughout body in from the infant's movement repertoire. In my practice, stillness and in motion I strive to perceive the child through his or her experience, rather than through my own bias.It is essential Spatial/movement qualities: to try not to judge or evaluate what the child is doing, but rather, to observe openly so a relationship with the Use of space large/small, near, mid, far baby can develop without expectations. By paying at- reach of limbs tention to repeated movements and even to my own Enclosing/opening movements verbal comments and expressions to the child, themes Weight shifting and patterns will emerge. Level changes in space Often I first observe the infant without reviewing Rhythm of movement phrase exertion/ his or her history.I listen and watch to see what un- recuperation sequencing folds during the sessions. Once I've established some Sense of propulsion, locomotion, mobility, ideas, I review the charts to get an understanding of stillness, energy how the child has been perceived and diagnosed in his Intention, motivation to move or her environment, to see if and how our movement communications and the emerging themes compare and reveal this information as well. nitive awareness to the child's nonverbal expressions A child's movement repertoire includes both ob- and supports the acquisition of language as the pri jective and subjective aspects. The objective aspect mare communicative tool, integrating verbal and non concerns appropriate behavior for that child's develop- verbal expression most effectively. The physical expe- mental level: attention span, motoric, social, and cog- rience of combining different movements, such as step- nitive abilities based on age. Observations are done ping, stamping, kicking, and running, into one se- within this context. quence acts as a kinesthetic precursor to the child's The subjective aspect involves the child's interac- ability to combine thoughts and sounds to produce lan- tion with his or her environment: room, objects in the guage. Verbal prompting, which connects to the prop- room; peers; caregivers; relationship with mother and rioceptive input of the movement experiences, en- father; and the particular qualitative movement ele- hances the young child's understanding and use of lan- ments used during these interactions. guage.

Zero to Three August / September. 1944 5 Questions I ask when first observing a child are: ing her left arm against her body. The nurses had attended to this action by wrapping her left hand with 1. What feeling am I receiving through the child's a cloth, and had tried to restrain her left arm when movements? they saw her reaching toward her mouth. This inter- 2. What do I think the child's needs are, based on vention did not prevent Nancy from attempting this these movements? gesture; it only seemed to stress her more. 3. How specifically does the child express his or As I watched this gesture the qualities that her needs through these movements? stood out to me were the strength and emphasis that 4. What are the parent/physician concerns about she employed to begin this sequence as she swept her the child? right arm across her body, followed by the intensity 5. What are the parents' attitudes about the child? of her biting of her left hand, which drew all her at- 6. How are 4 and 5 being expressed nonverbally tention inward to her hand. My experience, when I through interactions with the baby? tried this action on, matching these qualities, created a sense of enclosure, as if I was closing myself off Asanswer these questions, patterns, elements, from the world surrounding me. Although this ac- and qualities of the movements within the actual situation is primarily self-oriented, the gestural arcing did tion will become apparent. I am especially looking for cause her to move through her surrounding space, unique stylistic patterns that occur and recur. Often, which hinted at a potential for social interaction. seemingly random actions, when observed more I began my intervention by sitting behind closely, turn out to be coping responses.I look beyond Nancy and placing her between my straddled legs. I the immediate context of the situation to see how these wanted to support her expression of enclosure elements may express deeper feelings. These recur- through the tactile sense of my body against hers. At ring, stylized, emotionally expressive patterns are the same time I did not want to create a sense of clos- called movement metaphors. The therapist tries these ing off the surrounding space completely, which may movements on, matching the qualities of the action have occurred ifI had wrapped my legs totally both physically and empathetically, as much as pos- around her.I then placed my arms next to hers, fol- sible. This technique is called mirroring. It enables the lowing their pathway as they swept through the air, therapist to experience what these actions feel like. The enclosing her. But this time when she enclosed her- dance therapist then uses these patterns to create an in- self, she also experienced herself enclosed within an- teractional movement experience between herself and other enclosure, which was my arms around her. An the child.So the therapist enters the child's world interaction with someone outside of self had begun. through actions the child is familiar and comfortable As I repeated this action with Nancy, I noted with. that the strongest accent of her movement phrase was Mirroring, which uses the child's movement se- on the first beat of the right arm swing. This beat quence as a baseline choreography from which to im- seemed to create the momentum of the enclosing feel- proviseandbuildtherelationship,relatesto ing. I followed this initial emphasis but added a sec- Greenspan's (1992) technique of establishing reciproc- ond accented beat at the end of the movement phrase. ity and a two-way communication circle. This can be So rather than holding her right hand on her left illustrated by the following vignettes of my work with shoulder before the left arm came up for the next several young children. These composite descriptions phase of the phrase, I initiated an accented opening are designed to maintain client anonymity. and spreading of her right arm reaching out into the Nancy was born with an unidentifiable chromo- space in front of her. This change in emphasis from somal abnormality. She was 19 months old when she enclosing and holding to opening and accented con- was admitted to a major city hospital to be observed: tinuous movement immediately got her attention. It recently, she had regressed from developmental mile- enabled her to feel an alternative to her gesture while stones and had developed a chronic, idiosyncratic still keeping within its parameters. The physical ex- gesture. Nancy had begun to crawl at 13 months but perience of the opening sweeping gesture also natu- had stopped by 16 months. When I examined her, she rally encouraged Nancy to gaze outside, beyond her had been remaining in whatever position she was immediate kinesphere (a movement term describing placed, and would not adjust her body or attend to a the space surrounding the body within reachable dis- stimulus not within her immediate gaze. The gesture tance without moving away from center). As her arm she continually repeated further limited her interac- reached out and around so did her head and visual fo- tions with her surroundings. While sitting upright cus. She twisted her body to look at me, creating a she would briskly swing her right arm across her diagonal shift into her right side. She began to ex- chest over to her left shoulder. When it reached her periment with shifting her body weight from side to shoulder she would hold it there while she quickly side and diagonally from her lower left to her upper and tensely brought her left hand up in a tight fist to right body parts. As I supported her with my hands her mouth, biting it in a short quick beat, and press-

6 August / September. 1994 Zero to Three to explore her body transitioning through space in this way she became more attentive to her surroundings and the people within them. Her movements became more energized and she became more animated. During the course of the next few sessions this opening action developed into other socially and physically engaging activities.As Nancy experi- mented with shifting and twisting her body to her right she reached behind herself onto all fours and began to crawl. The world around her now became available for her to explore again. I was now able to sit in front of her to engage in more direct eye contact during expanded movement activities. This vignette displays how Iintervened by attending to the baby's movement phrasing rhythm. the dance therapist thinks about movement phrases and rhythms as if they are the phrases and rhythms of a musical score. All movement occurs within some type of phrasing sequence involving accents, pauses, in- t reas in g and d cc was i ng inoinentton and emphasis. and a beginning, middle and end of the phrase. Ob- servation of the spatial pathways the body makes through movement phrasing reveals how and when an individual initiates and terminate:. interactions and re- movement involves the arcing or spoke-like pathways lationships within his or her surroundings. the body makes to execute the actions; and shaping re- Laban movement analysis fers to the body's molding by adapting or shaping it- Observing movement from this framework is part self in relation to objects, people or surrounding space. of a larger movement observation system all dance The following vignette will further illustrate how the observational concepts of Laban Movement Analysis therapists study in their training program: Laban are integrated in the intervention technique. Movement Analysis. Laban Analysis is a system and a ocabular for describing qualitative aspects of move- Stacy was 9 months iid when I first saw her in ment, based on four interrelated components: body, ef- the day care setting where I was teaching creative fort, space, and shape. movement. It was a full care facility servicing chil- On a body level, the therapist looks to see what dren from 6 months to five years. The children came combination of body parts. whole body actions and from a middle to upper-middle class urban popula- breath, the client uses to perform the movement. Spe- tion of working parents. None of the children was cifically, the therapist notes relationships between the known to have or have been diagnosed with any dif- central body or torso and the periphery or limbs, in the ficulties.However, as is common with this age context of movement coordination and developmental group, some of the children were beginning to cause milestones. the caregivers some concern. Stacy was one of these Effort refers to the qualitative changes of move- children. She showed little interest in exploring her ment exertion, which create a feeling tone to the move- surroundings sociat.y, visually or physically. When ment within four motion factors. Each motion factor she was placed sitting up on a blanket on the floor has two opposing elements: flow (bound/free); exer- she did not attempt to watch any of the activities of tion of weight (strong/light); spatial focus (direct/in- the children nearby or to move her body beyond her direct); and time (quick/sustained). personal kinesphere.She only manipulated toys Space refers to how individuals move their bod- within her arms' reach and did not transition her ies in their surroundings. The therapist observes the body through different levels of space to explore her body pathways within the mover's personal space body moving. Her vocalizations were a high-pitched ( kinesphere) and the public or general space.Floor screech without any tonal variation or babbling. On patterns and transitions through levels of space thigh, a body level, Stacy's muscular tone fluctuated from middle and low) are noted. hyper- to hypotonic and her breathing rhythm was Shape refers to the forms or shapes the body extremely tense. These physical characteristics and makes in space. These forms vary depending on they her lack of social curiosity resulted in her not attract- body, effort, and space combinations. Three elements ing much favorableattention from either the comprise this component: shape-flow refers to changes caregivers or other children. Most often she ended up that occur only between the body parts; directional sitting by herself for extended periods of time.

Zero to Three August / September, 1994 0 7 Because Stacy made so little movement through of their breath capacity, from shallow to deep, and its space, reflecting her lack of social engagement, I be- different rhythms, from slow to rapid, has been espe- gan to work with her first by attending on a body cially useful with children with Attention Deficit and level to her breathing rhythm. Sitting close in front Hyperactive Disorder. of her, I placed my hands on her rib cage to provide Other props which encourage multisensory and tactile support as I followed the tense manner in physical exploration include: music of all styles and which she held her breath as she inhaled and barely tempos; musical instruments; colorful sheer scarves; as- relaxed her muscles as she exhaled.I then added a sorted sized pillows and bIls; tunnels; blankets; bean free flowing release (the opposite of the tense exhala- bags; a fabric-covered circular rope; a parachute; art tion she was exhibiting) with a sense of sustainment materials such as clay, sand, paper, and crayons; and on the exhale. Simultaneously I vocalized this freer dolls and stuffed animals. Older toddlers begin to in- breath, making a soft sound as I blew the air out of tegrate play and dance as these props are used within my mouth. My proximity and tactile and verbal the action of the developing narrative.I use the term stimulation drew her attention. Slowly, as I repeated dance-play to describe this type of session,. as a way to this gentler breathing, Stacy's body tension began to emphasize the personal choreographic element of the decrease as she began to kinesthetically experience a child's play, which the dance therapist looks for and softer breathing approach. Her vocalizations began analyzes. For example, when dolls are used in the to have more variation, with a more melodic tone. dance-play narrative, the therapist watches how the Her breath flow slowed and she began to focus her toddler plays with the doll. Does she rock it tenderly gaze on me. She seemed to be coming out of her in- close to her body? Or is she tense, pulsing back and ner focus to look beyond her self. forward, almost throwing the doll off her lap with each Oyer time Stacy's tonicity had become more re- rock? Where in the treatment room does the child tend laxed. I was able then to begin to address her lack of to play most and how much space does she or he use movement initiation and spatial exploration. I played to play? Does the dance -play story take the child trav- a recording of Pachelbel's Canon in D as I placed eling freely throughout the room or does the child tend Stacy on my pelvis while I lay down on my back. As to surround him- or herself with the chosen toys within the gentle flowing tones of this music filled the air, I a confined space? These variables all demonstrate dif- rocked her from side to side, enabling her to sense ferent ways a child reacts to and interacts with his or her body shifting weight. When Stacy was comfort- her surroundings. When the therapist considers these able with the rocking I increased the distance of the questions within the context of the child's total emo- rock so she began to feel her body transitioning in tional social profile she may glean pertinent informa- multiple spatial directions (forward, left, back, right). tion about how the child organizes his or her ex ri- I gave her verbal directions, and a big smile when she ences. came forward toward me. Moving fluidly through Z and his mother: Movement interactions as a these new spacial orientations created a more legato reflection of a relationship tempo which opened her spatial interactional field. This posturing and movet..ent exploration oriented I have included the final vignette because it was one of the first studies that got me excited about study- her to physically sensing and visually focusing on her surroundings. ing parent-child nonverbal interactions. It clearly dem- onstrates how the quality, tempo and spatial aspects of After our weekly sessions, Stacy's mother and a parent's and child's separate movement styles reflect caregivers reported that.she seemed more physically their bonding relationship and can influence the child's active and attentive. In turn, her caregivers and peers began to pay more attention to her. As they were style of relating with others. This abridged version of drawn in to the music, coming closer to watch us, the movement profile of each member of the dyad and the Intervention in dance therapy clinical terms should Stacy eagerly vocalized and reached toward them. give readers a taste of a more detailed movement Stacy had acquired a greater ability to physically in- analysis.I hope it will stimulate you to try this new teract with her surroundings; a new socialization pro- way of seeing with your own cases. The descriptive cess had begun. analysis of this child's and mother's movement reper- Use of props toire was observed on videotape and in live movement The above vignettes demnstrate -everal of the interactions when the child was 2 I /2 - 3 years old. props dance therapists use to facilitate the experiential My participation in this case was as a caregiver in aspect of their approach. The primary tool, of course, a multi-aged group care setting. My colleagues and I is the body. During dance therapy, the child physically de.cribed our work in detail at ZERO TO THREE/Na- experiences new ways to use his or her botde to gain tional Center for Clinical [rib! 1 Programs' 5th Biennial more body awareness, self-expression and enhanced National Training Institute 112/871 under the title Peer social engagement. Breath awareness is an important relations as one of several interventions fir a failure to thrive therapeutic tool. Helping children sense the toll range nf:issues and implications for practice. This excerpt

8 r-t August / September,Itttn Zero to Three describes my work with this child in the group care set- Thus Z. exhibited a movement dance character- ting. The following year, this child and his mother con- ized by moving toward and then breaking away from tinued to work with me in private therapy. physical contact with his environment. Such phrases were marked by sudden bursts into space via an exten- Early history sion of his left arm or an ejection of his whole body as Z. was diagnosed as failure to thrive at age b he darted across the room. At some point a spin might months. He was horn full-term through a breech de- emerge within the action, or thc action would stop be- livery with a birth weight of 5 lbs. 3 oz. From birth, cause Z. came in contact with a wall (a peripheral sur- reeding wc-s always a problem due to colic, and low face). There was often a resilience to his phrasing qual- muscle tone created difficulty swallowing. An allergy ity; it was characterized bY pulsing accented, quick to milk products was suspected. However, the organic lively movements, which merged into "timeless" and/or nonorganic contributions to this failure to pauses during which he held his body very still as he thrive condition were not clearly delineated. Nine to gazed off to a mysterious, private place.His move- twelve-month delays in motoric, language and social ments appeared to he directed by an inner tune filled development were found. with surprise reversals in mood and tone. Z's movement pattern When I started to observe his mother, S., during Z. was able to move his body in homologous (an drop-off and pick-up times, Z.'s movement style began upper to lower body orientationhomolateral (a left to make sense. body half to right body half orientation), and contralat- Mother's movement patterns eral an upper left to lower right and vise-versa criss- During the particular interaction to be described. cross orientation) coordinations. However, his move- S. was bringing Z. into the classroom and giving him ments most often exhibited an alternating use of his left food. To begin, S. initially attempted to carry Z. over to right side, emphasizing homolatet al body connec- the low door. Z. refused, making his body limp. S. left tions.Z. displayed this tendency by continually ma- him at the door, turned away from him and climbed nipulating objects, switching them from his left to right over herself. She walked away from Z., placing some hand. In momentary pauses, he would extend his left items on a shelf behind the table. She then returned to arm up and out into space while dangling his right arm Z., opening the door to encourage him to come in. Z. or holding it down at his side.This pose often pre- entered while S. was acknowledging other children. ceded a frequent spinning action, which he performed She redirected her attention toward Z. by picking him by swinging his left arm and leg around his body, cre- up and placing him in the high chair. She then turned ating a vertical axis from which he rotated in a com- away again and returned shortly, placing food items plete circle. Z. use-he right side of his body as stabi- near Z. She began to crack an egg and empty it into lizer, the left as mobilizer. This spin always occurred Z.'s howl, but stopped to turn around and get a spoon. in a clockwise direction. She went back to the egg, which Z. had begun to eat, Z.'s movement tendencies stressed the upward and then changed her focus again by walking away to aspect of the vertical dimension without a downward throw out the shell. She momentarily returned, strok- counterpull. Thus, on a body level Z. often appeared ing Z.'s head, and then turned away again to get juice. to he "floating in space," which was exaggerated by his Z. continued to eat the egg while staring out into space tendency to toe-walk. Such a posture accentuated Z.'s during this interaction. There was little eye contact be- orientation to the upper areas of space. Contact with tween them throughout this time. lower areas of space occurred only when Z. would spi- S.'s movements were all characterized by a ral his whole body down through space, curling and nonmetric start and pause pulse, featuring many initia- rolling himself on the floor. This transition would oc- tions of contact without always a complete conclusion cur in seconds, followed by an equally quick transition to the phrase before a new beginning was initiated. back up and running. Her sweeping gestures often had momentary to ex- Without a postural kinesthetic connection to the tended pauses in midspace. The emphasis of these ges- group, Z.'s movements in space at first glance often ap- tures occurred during the initial movement exertion. peared to lack a sense of direction or spatial intent. She concluded these actions by releasing the pause and However, by observing Z.'s pathways and his phrasing either dropping the hand in abandonment or redirect- in space qualities, I noted a definite pattern. Often, Z. ing it in an opposite direction, beginning the cycle would retrace pathways to certain areas of the room again.Therefore. a clear complete ending to each several times within the hour.I noted that Z. took phrase did not exit. these same pathways each day. The salient character- At first glance the above description of their in- istic of these pathways was that they alternated from teraction appears not to involve reciprocal dyadic dia- movement toward the center of the room or a person, logue. However, careful analysis of their movement to movement toward the periphery. away from the cen- styles did reveal an established system of relating. The ter or a person. communicative dance between Z. and his mother was

Zero to Three Allgtlq / Paki 11 about coming and going, connecting and unconnecting, ments within the large general space, rather than re- attending and withdrawing. However, their manner of sponding to his personalized body-oriented movement relating did not provide Z. with the ability to learn how qualities. As stated earlier, these body level qualities to self-organize (Brazelton, 1974) that would facilitate reveal one's internal orientations and sense of self. By his ability to relate to his environment in a universally responding to his manner of moving in the surround- understood manner. ing space, I could affirm his external relationships, pro- Given the movement characteristics of Z.'s viding him with respect and the freedom to control his mother, one can conjecture that her holding framework intrapersona I self. did not act as a "container" for attention and with- During our initial movement experiences to- drawal patterns.During a verbal interview, para- gether, Z. would send us sailing through the room with phrased here, S. did reveal to me that she had difficulty speed and agility as we'd quickly change positions in attracting Z.'s attention as an infant: space, floating high up on our toes as if weightless and I never knew what to do with him...he did not re- airborne, to rolling on the ground, sensing the hardness spond to me much...he used to stare off into space a lot of the floor against the surfaces of our bodies. Soon the and he didn't move much...Ifeltstupid with running became a game of Follow- the-leader-catch- him...when I fed him he seemed so uncomfortable...he me-YES-you-can! Z. would run to a place across the would contract his chest muscles pulling his shoulders room and wait with anticipation, smiling and hopping up and tense his neck.... on his toes as I ran toward him following the path he It is important to note here that this inability to had made.I would create a clear ending to this se- provide a holding framework reflects not poor moth- quence by giving him a hug when we met. The firm ering but perhaps mismatched temperaments i,Tronick, tactile stimulation provided a support as well as a I986). This mismatch is perhaps further complicated sense of boundaries through a distinct movement by Z.'s sensitive homeostasis (Greenspan, 1981). Given phrase ending, as he gained a new kind of kinesthetic this information, one begins to wonder what Z.'s early awareness about self and other. Physical and mirrored experiences felt like to him. interactions stressed Z.'s vertical homolateral move- Z.'s process of organizing his experiences, which ment patterns. At the same time, we stimulated,Z.'s involved stressful contacts during eating, long periods awareness of the downward vertical pull through such of no contact, and/or abrupt stop-and-go contact, activities as jumping, and using strength to push his seemed to create a tension build-up into a release. Z. feet against my hands while lying supine, alternating needed to recuperate into himself after these powerful feet as we counted to ten and then held this pose for a interactions with others. This is exactly what his move- beat or two. We experienced running, rolling, jump- ment profile shows.His interactions with his sur- ing, and spinning within the confines of Z.'s spatial roundings are characterized by cyclical approaches and phrasing patterns requiring us to continually make withdrawals of closeness to activities (or people), and break contact. However, even during lapses of ac- marked by momentary extended periods of self-ori- tual contact, I provided Z. with a holding framework ented stimulation through spinning around his center, through my verbal recognition of Z.'s whereabouts; eye rolling on the floor, bumping into walls, or staring out contact; putting on music that I knew he liked; ormir- into space as he stands on his toes.All these tech- raring the movements he was performing from a place niques are significant in their full body physicality. parallel to him (which could be across the room). Z.'s upward vertical orientation to space did not pro- This created an environment which constantly in- vide a kinesthetic sense of weighted presence; thus, Z. vited interaction within an orientation familiar to him. needed to learn to use his whole body to create a physi- Once our relationship was established, I began to in- cal sense of self. volve Z.'s peers in our interactions. As Atkins (1983) These movement tendencies display the nonver- discussed in his article about peer relatedness in the bal manner in which Z. had internalized defensive cop- first year of life, peer interactions may very well signifi- ing strategies (Tronick, ibid). These defensive patterns cantly help stabilize a child's sense of self-representa- are observed in Z.'s tendency to accelerate his tempo, tion. Although Z. continued his intermittent involve- often spinning and darting around the room after con- ment, with the presence of a trusted adult who could tact or the suggestion of contact with others is pre- act as a catalyst for his communications his expressions sented to him.It is this quality of his movements were integrated into the group activity, facilitating Z.'s which reveals Z.'s true character: this is the nonverbal participation.I lis characteristic rhythms were added method he has developed to communicate with his sur- to group dances and songs and his movements were roundings.Z.'s communicative style seemed to he followed during turn-taking sequences with others. based on the interactive system established between Z. By following and responding to Z.'s cues through and his mother. our movement exchanges, we demonstrated a respect Intervention strategies fur an interactive regulation of his internal processes. Over a period of nine months, this approach enabled Z. I first approached Z. by responding to his move-

9 It) August / September, 1994 Zero to Three to experience synchrony, reciprocity and the repair of 1. New Hampshire:Antioch/ New England Graduate mismatches (Tronick, ibid). This intervention encour- School. aged Z. to develop positive coping strategies as he be- BrazcIton, TB. et al. (1974) "The origins of reciprocity" in gan to experience more rewarding social interactions I.ewis, M. and Bosenblum, L. (Eds.; The Effects of the infant with peers and adults. These interactions seem to en- on Its CanNiver. New York: Wiley. 1974. Dell, C. (1970) A Primerjiff Movement Description. New York: able the formation of new emerging organizational ex- Dance Notation Bureau, Inc. periences. As Stern suggests 11989, because such ma- Greenacre, I'. (1960) "Considerations regarding the parent trices catalyze ongoing affective appraisal of events, infant relationship' in The international Journal or Psi', ho- these new experiences played an important role in Z's Analysis Vol XLI Part 6. sense of self as he related to others in his environment. 4 Greenspan, S. (1981) Psychopathology and Adaptation in In- References fancy and Early Childhood. New York: International Univer- sities Press, Inc. Atkins. R. (1983) "Peer relatedness in the first Year of life: the Greenspan. S. (1992) Intence and Early Childhood, Nladison, birth of a new world" in 141Psycnoananists Vol It pgs. 227 - Conn.: international Universities Press, Inc. 244. Laban. R. (174)The Language of Movement: A Guide co Axtmann, A., Kessler, 0., Tortora, 5. (1987).Peer relations Choreutics. Boston, MA.: Plays, Inc. as one of several interventions for a failure to thrive infant: Levy, F. (1988) Dance Movement Therapy: A Healing Art. Vir- issues and implications for practice.In "Frontiers and ginia: National Dance Association: The American Alliance (runt lines" cth Biennial National Training Institute, National for Health, Physical Education, Recreation, and Dance. Center for Clinical Infant Programs. Stern, D. (1985) The Interpersonal World of the Intent. New Bartenierf. I. (19801 Bode Movement. Coreig with the Enviren- York: Basic Books, Inc. newt. New York: Gordon and Breach Science Publishers. Tronick. E. (1986) "Interactive mismatch and repair:chal- Inc. lenges to the coping infant'" in ZERO TO THREE/NCCIP Vol Bernstein. P. and Singer, D. (Ris.) 11982). The Choreograph& VI #3, February. of Object Nelations: Advanas in ()aim' Morelnelif rherOpy VOL

Dynamic Play Therapy: An IntegratedExpressive Arts Approach to the Family Treatment of Infants and Toddlers ties, sound- and music-making, and video-making. Its Steve Harvey, Ph.D., ADTR, RDT, RPT/S Colorado goal is to help parents and children experience more Springs, Colorado creativity and flexible expressiveness in their daily life, and to develop meaningful metaphors that reflect dif- The father of a very securely attached little boy ficult issues (particularly those concerning intimacy recently told me about the jumping game that he and and attachment) and emotions in their relationships. his son developed and extended during the boy's first two years. During the boy's third and fourth months, the father would begin bouncing his son as the boy bent his knees to the baby's great delight. Throughout the next several months, the boy began regularly to "ask" for this game by crawling over to his father and placing himself in the "jumping" body position. Later he would place his father's hands on his own waist, and during his second year, the boy would gesture and babble to indicate his desire to start the game. When, as a toddler, the boy would run away from his father during chase games, he would raise his arms when he was ready to be "caught" and lifted. The father, of course, played along, and both father and son thoroughly enjoyed what became a re- joining or reuniting "dance" when the father returned from work. Through repetition and development over the years, the jumping/lifting game was full of meaning, even though no words were used. It was a way for father and son to generate, express, and ec remember their positive feelings for each other. a Dynamic Play Therapy is an intervention style a which encourages parents and children to engage in mutual expressive activities.This approach involves m an integration of movement, dramatic games, art activi-

Zero to Three August / September, 1994 Q 11 BEST COPY AVAILABLE Dynamic Play therapy techniques are helpful not only Some of the theoretical models and intervention in work with birth parents and their children, but also techniques involved in the expressive arts therapies are with infants and toddlers who have been abused and similar to those of other parent-infant therapies that in- are now in foster care or adoptive families. volve coaching, generating playful experience, video Dynamic Play Therapy builds on Bow lbw's (1982) review, enactment. and encouraging reciprocity. How- onceptualization of attachment as the psycholog ever, Dynamic Play Therapy differs from other ap- and emotional relationship that develops between a proaches in two significant dimensions: parent and child and is characterized by parents' abil- a much enlarged use of physical engagement ity to provide a sense of security for their young chil- for both parents and children; and dren. Parents foster secure attachment in part by meet- an emphasis on spontaneous creativity in mo- ing their children's nonverbal expressions of distress in ment-to-moment playful expression. a sensitive, attuned, and contingent manner often While most, if not all, parent-infant intervention throughnonverbal, emotionallyandphysically utilizes the concept of a parent being able to follow or matched interactions. The successful practice of Dy- mirror the young child's nonverbal gestures and ex- namic Play Therapy also incorporates concepts of inter- pressions, the expressive arts approach emphasizes the active mismatch and repair (Tronick, 1987), affective use of a parent or child's whole body expression, attunement (Stern. 1985), mirroring (Kohut, 1971), and whether in following or in turn-taking activities. previewing arad 19921. The Dynamic Play approach emphasizes the play- Techniques of observation and intervention ful interaction between parents and children.It as- In order to encourage large-scale physical interac- :times that healthy. secure parents and children will tion, Dynamic Play Therapy is usually carried out in a generate dances, drawings, turn-taking dramatic large room furnished with attractive large props. This games, and videotapes easily and with pleasure.Ex- context encourages a much wider range of interactive pression builds from the interaction, and small interac- movement possibilities, including the use of all limbs, tive problems are solved easily through creative and large locomotive movements (such as running, crawl- imaginative negotiation.For example, a young child ing, climbing, and movement through space), as well who playfully runs off, distancing herself from her par- as movement on all levels from crawling on the floor ent, might spontaneously become a bird in search of a to jumping and swinging in the air.With these re- nest who, returning to her parent's lap or "nest", ex- sources, a movement interaction between, for example, presses joy with her entire body. As early as the sec- a very withdrawn toddler and his parent might cover ond year of life, children attentively watch videos of the range from matching finger games, to the parent themselves and their parents playing with pillows, and child rolling together across a large expanse of gymnastic balls, and scarves; then they repeat and floor, to crawling together underneath large para- elaborate on their past enactments with pleasure. chutes. As atherapeuticapproach, DynamicPlay Large foam pillows in various shapes are espe- Therapy uses movement, art, and interactive games to cially helpful in organizing mutual movement. Rect- identify expressive mismatches between parents and angles, squares and cylinders are used to build houses children who have difficulties with intimacy, attach- (which are sometimes knocked down), walls (to be ment, and emotional expression. As suggested by at- crawled over or under), and "lands." Heart-shaped tachment theory, the goal of Dynamic Play Therapy is pillows five feet across can he used to represent Mom's to help parents generate security; to help children pro- or Dad's Land or Heartland. The pillows' softness duce organized behavior which shows both explora- helps to channel even children's most energetic move- tion and return, related to their own internal needs; ments into activity which is potentially more interac- and to help both parents and children experience trust, tive. The large hearts and other pillows can also be leading to pleasure in their relationship. used to rock and soothe children towards the end of Dynamic Play Therapy uses various expressive sessions. forms to help parents and children generate positive Parents and children use large gymnastic balls, behavior during the actual experience of play, so that stretch ropes, and stretch blankets to pull towards and they discover their own natural creativity in a context away from each other. Large brightly-colored scarves that encourages the enjoyment of mutual, spontaneous, and life-sized stuffed animals also stimulate creativity uninhibited expression within their relationship.l'ar- and dramatic play with children, especially with chil- ents and children create new experiences together. d ren over two. From these new experiences, which generate signifi- The large scope of Dynamic Play Therapy also fa- cant, positive feelings between parents and children, cilitates dramatic enaction (any interaction which in- families begin to understand what positive change, volves turn-taking or the use of role, even in nonverbal leading toward increased attachment, might feel like activity).For example, a young toddler dealing with for them. issues of object constancy might run across the space and hide from her parent under several large pillows,

12 14 August / September. 1994 Zero to Three Li

while the parent takes on the role of finder.Enlargement of the scope of such games helps in the identification of difficulties in role examples in interaction, as well as in finding new role possibilities. An example of mis- matching roles occurred in dramatic play between an adoptive mother and her two-and-a-half-year-old boy. The boy had experienced significant physical abuse prior to entering his adoptive placement.In a play epi- sode,thhis boy would repetitively crawl on top of a large dog and fall

off, playing that he was hurt. Me 1 adoptive mother kept encouraging .Ellibmw him to continue his initial story, with- - out acknowledging his fall.Clearly the boy was taking a role of "being hurt," v. bile the mother's actii it 01 watching and urging him to continue his story didn't swinging, hiding, falling, and rolling over pillows are match. the mother was then coached to catch and help common activities. Drawing activities (scribbling on the boy "rider," first "nursing" him back to health and newsprint, drawing outlines of body parts or full bod- then "teaching" him how to ride safely. ies) and dramatic play (especially with stuffed animals) It is extremely helpful to have a video camera and also produce interaction. monitor available to capture interaction and immedi- Natural creativity and "breaks" ately feed this back to both parents and children.I Natural creativity in interaction can serve as an have found children as young as 18 months to be ex- ongoing resource to help build or rebuild relationships tremely interested in such visual feedback of their in- between parents and children.It is useful to think of teractive play. certain aspects of a parent-child relationship as an im- The expressive arts therapies emphasize creativ- provisational dance or drama, in which one partner's ity in interaction.In people of any age, creativity in- nonverbal expressions stimulates the other partner's volves a curious engagement with the environment, in- expressi 3ns, by eliciting a creative response. In healthy trinsic enjoyment in expression, and pleasure in at- relationships, the natural creativity within a parent and tempts at mastery. Such curiosity can occur in interac- child keeps their "dances" moving from gesture to ges- tions as well. The creativity of young children is easily ture, facial expression to facial expression, etc. One recognizable: toddlers begin to dance or sing and en- partner's expression stimulates and moves the other, in gage in scribbling or mark making; two- and three- a pleasurable, problem-solving flow that generates year-olds engage in imaginative role play.But even good feeling. This natural creativity can be thought of young infants can he creative in their playful use of as the magical "it" of a relationship, in which parents variation in interactive games with their parents. Em- and children fill out and continue their emotional ex- phasizing creativity, the Dynamic Play therapist at- pressive experience with each other from moment to tempts to go beyond simple face-to-face activity or mir- moment. roring of body parts. From this perspective, children and parents with In Dynamic Play Therapy, parent-child activities problems in their attachment might be thought of as include both therapist-directed games, to help promote experiencing breaks in this ongoing creativity. The coordinated interaction, and free play. All activities are gaps created by their mismatched expressions become designed to produce interaction in which parents and so great that mutual creativity stops. Expressive arts children match each other in complementary ways. intervention, then, helps parents and children become Therapist-directed activities include games, such as aware of and use their natural curiosity within creative lace-to-lace play; swinging the child, sometimes to pro- responses to each other as they occur in the moment, duce an excited state between children and parents, during mismatches. This style of intervention attempts sometimes for soothing and calming down; playing to help parents and children engage or re-engage with peek-a-boo with the large scarves; and playing hide- each other in activities which generate creative mutual and-seek using the large pillows. In free play, parents responsiveness. The goal, in other words, is to help re- are coached to help set the structure of the activity, and start an ongoing improvisation that has stalled. then to follow the child's lead throughout the room

Zero to Three August / September, P+'+4 Ii The following case vignette illustrates the use of that the more energetic he became, the more lethargic enlarged physical engagement and emphasis on natu- she felt and less motivated to protect and contain him. ral interactive creativity. Clearly, this mother and son showed several significant Renee and Sam mismatches in their nonverbal interactive style and Renee was a 22- year -old woman who had been emotional communication with each other. Mon diagnosed with schizophrenia at the age of16. this situation was producing a potentially dangerous Throughout her voung-adult years she had complained situation in the home as Sam negotiated his environ- of hearing voices that told her to kill herself or her boy- ment with little adult protection and/or interaction. friend. By the time Renee was 22, she was able, with Intervention proper medications and support, to work part-time and In her individual sessions, Renee and the thera- was living with a constant male companion. During pist began with activities in which she could instruct this period she gave birth to Sam. Sam was seven him verbally where to move in space, then show him months old when Renee began creative arts therapy. with gestures involving her hands and then arms, and She was also in ongoing follow-up treatment with a then use full body movement. Next Renee and the psychiatrist at a local mental health center. therapist began to move in the room together. Renee Renee was seen initially in individual dance/ used both verbal and nonverbal communication to con- movement-oriented sessions. She would begin her ses- trol the therapist's distance from her. As sessions con- sions by describing some of the events of her life and tinued, Renee became quite animated and began using then, together with the therapist, would design physi- her arms and torso actively and spontaneously. The cally-oriented activities to address the conflicts in a therapist responded in a complementary fashion. As metaphoric way. During these sessions, Renee reported sessions progressed, Renee began to enjoy these activi- that throughout her early and mid-adolescence, she ties, especially moving simultaneously with the thera- had been repeatedly assaulted sexually by an uncle. pist.Mutual dances began to continue for 20 or 30 This information was important, as body boundaries, minutes, as Renee became quite creative in using her feelings of trust, and feelings of overwhelming fear in body to influence the interaction between herself and relationships with others became major issues ad- the therapist. The goal of spontaneous dance-making dressed in individual sessions through movement im- was to increase Renee's movement initiation, while the provisation involving physical play metaphors. therapist matched his response to hers.

After approximately two months of individual Interactions were extended with props. Renee. treatment, Renee asked if she and Sam could be seen and the therapist placed large pillows between them, together, as she was having some difficulty caring for moving the pillows across large spaces at different him. Sam had begun to crawl and was becoming quite speeds and body levels while leaning into the pillows difficult for her to manage. When Sam was eight and with their weight. The pillows represented various is- one-half months old, he and his mother began several sues in Renee's life, finally coming to represent coop- months of weekly sessions. Renee continued weekly eration between Renee and the therapist in raising Sam. individual movement-oriented sessions as well. In these activities, Renee needed to actively en- When Renee had first begun dance/movement gage her weight, spine, and all of her major joints, re- therapy, she was a slightly overweight, lethargic young sponding creatively, spontaneously, and in an ongoing woman who showed very little animation in her facial way to the therapist. This was important because Renee or gestural expression.During initial sessions, she was now feeling her body rather than exhibiting the rarely moved her hands or arms away from her body. protective, defensive, non-moving response that may Because she showed very little rotational movement in have been a result of earlier boundary violations and her shoulders, hips, or spine, her movement had a very molestation. The pillows may have been a metaphor one-dimensional quality. for a buffer between Renee's self and the outside When Renee was first seen with Sam, she held world, which helped her to move more easily, and with him awkwardly. Because of her rigidity, Renee could full body weight, through space. The therapist, for his not mold or adjust her shoulders, arms, or spine to of- part, followed Renee's physical initiations sensitively fer Sam a comfortable place for his body to be in her and contingently. For example, when she would ini- arms or lap as she picked him up. Mother and son tiate a light use of weight by leaning on the pillow, he showed little face-to-face activity. Sam presented as a would merely match it; when she began to initiate quite energetic and reckless little boy who used loco- more joint movement, he would respond to that in the motive behavior (crawling, and later walking) to move moment. rapidly away from his mother, rarely returning to her. When Renee first brought Sam to sessions, he Because of his quickness, he was constantly bumping would crawl away from her quickly, and Renee would into furniture and walls and falling down stairs with simply sit watching him, apparently exhausted. Renee much greater frequency than other infants. Renee described this exhaustionas coming from her many ef- talked about her difficulties caring for Sam. She said torts to hold or "contain" Sam. Sam, for his part, be-

14 inAugust / September, 1994 Zero to Three gan crawling away from Renee as soon as he could caretakers, and excess aggression and /or withdrawal. wiggle his body down to the floor. Once away from Jen brought her adopted son, Johnny, for parent- his mother, Sam moved away quickly, without looking child treatment when the child was 10 months old. Ac- for Renee at all. The therapist and Renee then decided cording to social service records, Johnny's birth mother together to pile pillows in a circle ap ,roximately six had attempted to abort him by taking an overdose of feet in diameter, so that Renee could keep Sam ina cocaine. Johnny was born two months prematurely, range where she might actively try to engage him. As showing signs of cocaine addiction.He was taken Sam would approach the pillows, Renee could follow from his birth mother at the hospital and placed in two behind him. Renee and Sam spent several sessions fall- foster placements before tinnily arriving at his adoptive ing into the pillows. The interaction was now clearly a home. game of chase and catch (as Sam may well have At 10 months, Johnny was extremely clingy and wanted all along). Both mother and son began to laugh continually distressed. Jen reported that she was ex- together. sharing positive emotional exchange for the hausted; she could go nowhere by herself without first time. lohnny holding onto her leg. He could not tolerate any Gradually, the game enlarged.Sam began to separation and would let only Jen hold him. However, climb over the pillows, but Renee was able to catch and even being held did not soothe Johnny or calm him hold him while rolling down one side or another of the down. pile. like the initial chase and catch game, the rolling During their initial session, len sat primarily in produced much enjoyment, mutual laughter, and one position, without bending or shifting her shoul- many aria tions o. et. time. Interestingly, in the rolling, ders, face, or back to match Johnny's movement in any Renee xax able to adjust her torso, arms, and weight way. She seemed to be physically very uncomfortable o hold Sam much different from the awkward hold- and very tense even being on the floor with her infant. ing observed earlier. lohnny was actively crawling around her.At one Indic i d ua I and parent infant treatment continued point, the therapist asked len to move approximately for approximately 10 months. At that time Renee and 10 feet away from Johnny, who then became extremely Sam began to engage in long periods of interrupted disoriented and unable to locate his mother. At this pleasurable play together, including spontaneous im- point, he began to crawl in the opposite direction, got provised games of chase and following each other lost, and became extremely distressed. Although Jen throughout the room.In such activity, when Renee was able finally to calm him down by holding and would stop, fall, or change direction, Sam would fol- rocking, this effort took quite some time, and Johnny low or initiate his own movement ideas to which Renee and Jen were not able to generate any further interac- would then respond. Such give and take generated tive play. laughter and other expressions of joy between mother Clearly,the breaksininteractionincluded and child.Sam became far more interested in his Johnny's inability to tolerate any separation without mother and Renee found her time with her sun more becoming extremely disorganized and anxious. Such relaxing and energized.In her individual therapy, anxiety interrupted active search behavior. Jen, mean- Renee developed more ease in her improvised move- while, was not using energetic interactive play to help ment play as well, as she no longer introduced themes Johnny remember or orient to her position in the room. related to her past molestation and victimizations. The therapist used a large balloon, which Johnny Rather, in both individual and parent/child therapy, could activate with very little effort, as a prop to cap- Renee introduced play which was responsive to the ture his attention. As Johnny reached for and touched present moment, freely developing movement play re- the colorful balloon, it would move immediately, cap- lated to the props in the room, her present "in the mo- turing Johnny's interest in a physical way. Gradually, ment" body feelings, or her son's interests.Signifi- as the balloon play between the therapist and Johnny cantly, this style of play began to offer both Renee and became more coordinated, Jen was encouraged toex- Sam opportunities to express emotions in response to tend and enlarge the scope of the play by reaching out, each other in a spontaneous way. and such spontane- changing levels, and leaving her basic sitting position. ity provided the energy to keep them engaged with At first, Jen found this exhausting rather than relaxed each other in a natural, easy manner. and easy. But as she began to extend herself more with len and fohnnt the balloon play, Jen was able to accept Johnny's efforts Much of the author's longtime practice has in- with more enjoyment..1 parachute was used to rock volved helping foster and foster-adoptive families cre- Johnny so that he could maintain eye contact with Jen. ate attachment relationships with young children with At first, Johnny had difficulty relaxing in this activity, histories of neglect. abuse, and multiple separations but when peek-a-boo was added to the rocking, hewas and placements. Many of these children are referred able to laugh and seek out his mother's face while be- because of problems with emotional constriction, ing soothed at the same time. As Jen's and Johnny's nightmares, inability to accept soothing from foster repertoire of activities grew and became more self-sus-

Zero to Three August / September, 1994 7 15 taining, Jen reported that Johnny was able to separate Bill,Gail, and Ben more easily from her and was becoming far less anx- Bill and Gail, the foster-adoptive parents of Ben, ious and clingy. His sleeping also improved. brought this 26-month-old boy for treatment because he was being excessively aggressive toward other chil- Susan and Alice dren in the home. Aggressive outbursts included bit- Susan brought her adopted two-year-old daugh- ing and pinching. Ben had difficulties being soothed ter, Alice, for treatment because the little girl could not and in sleeping. During the intervention period, Ben he soothed, was showing aggression towards other was supposed to he seeing his birth father weekly. children in the house, and had difficulty separating the fatherwasextremelyinconsistent, and from her mother. At the same time, however, Alice However, after a missed visit, Ben's aggression and moodiness openly rejected Susan's physical advances and efforts would increase significantly for several days. to hold her, arching her back when she was held. In Ben was seen with Gail and Bill on alternating initial sessions, Alice showed extreme tantrum behav- weeks to accommodate their work and child care re- ior when Susan attempted to leave the room. Alice did sponsibilities. Interestingly, the initial breakthrough in not speak but was extremely controlling throughout play came in a session when Bill was instructed merely the interactive play, grasping and screaming at Susan. to follow Ben through the large playroom. Ben moved While Susan was generally patient, she clearly was from wall towall, but assoon as he realizedhis frustrated. quickly adoptive father was following him, he initiated several The therapist and Susan began together to rock games, such as crawling through the pillows. Coach- Alice on the large, soft heart-shaped pillow. The thera- ing helped Bill turn this game into hide-and-seek and pist chose this activity to help Alice experience physi- a version of peek-a-boo, much to Ben's enjoyment. cal softness close to her body while being.rocked gen- These games developed over several sessions. For ex- tly. Alice initially resisted this, and showed some tan- ample, the therapist would make a house for Ben and trum behavior. Then the therapist and Susan began to roll Alice gently back and forth between the two of a house for his father out of pillows. Both father and also them, until Alice was able to roll from the therapist's son would go in and out ofeach house easily and arms across a lifted pillow into her adoptive mother's knock them over in their play. arms. Although Alice could tolerate this activity for These play episodes were videotaped, and Ben and Bill were instructed to watch the tapes throughout only brief amounts of time in early sessions, she soon Ben became extremely interested in the came to enjoy it and asked for it eagerly with gestures the week. tapes and would ask repeatedly for "his movie," which and babbles during her sessions. Alice and Susan also he would watch attentively for episodes of several min- began scribbling together, with Susan matching Alice's style and energy level in drawing. A final activity in- utes over many hours. Ben's increasing curiosity and volved Alice moving freely throughout the room with engagement in play sessions suggested that the tapes may have helped him to focus. The tapes were particu- Susan following as closely as she could. Alice then began to fall on the pillows, enjoying it when Susan larly useful when Ben's birth father had missed a would fall next to her. As had happened with Renee scheduled visit.When the foster-adoptive parents played the videos for Ben, he was able to watch with and Sam, this activity became a game of "chase and be interest and then begin to engage in positive play with caught." Over a six-month period, Alice became much them, rather than exhibit his previously typical tantrum behavior. more open to Susan's holding overtures and began to seek out holding at home. She was also able to be com- Several years aftertreatment, Ben has been forted, and her tantrum behavior decreased signifi- adopted by Gail and Bill, and his aggressive behaviors toward other children have become almost non-exis- cantly as her language increased. Alice's increasing curiosity and creative, fun-filled exploration and enlarge- tent. Ben still enjoys watching his movies occasionally. ment of activities in therapy sessions were accompa- Summary nied by growing enjoyment of relationships at home. Healthy parent-child interactions can be thought More specifically, Alice began to show active and spon- of as improvisational dances and dramas. These inter- taneous use of shaping behavior, adjusting her body to actions produce a motivated flow of active expression, match Susan's holding gestures in a soft way, match- which rises and falls to match internally felt emotional ing the rhythms of gestural movement to Susan's ex- impulses. Dance/ movement, art, drama, music, and pression, eye contact, and relaxed, responsive partici- video techniques can help parents engage creatively pation in game - playing with her adoptive mother. and positively with their young children. Creative arts rwo years after the beginning of treatment, this adop- therapists observe how interactive play emerges be- tion is proceeding positively and without incident, de- tween parents and children and notice breaks and despite its having been viewed as at high risk for disrup- viations within it. Therapeutic intervention then works tion because of Alice's earlier behaviors and inability to to re-engage family members in game-like activities form relationships. which generate curious, plavtul, creative interaction.

16 August / September, 1994 Zero to Three Li

While many parent-infant intervention styles Harvey, S. A. (in press In Dynamic play therapy: An ex- make use of activities and video, the creative/expres- pressive arts approach to family intervention. In 01Conner. sive arts therapies offer two unique contributions to the K., and Schaefer, C. (eds)., Handbook of play therapy, Vol IL field of parent-infant psychotherapy. First, when par- New York, NY: John Wiley and Sons. ents and children make use of their whole bodies to Harvey, S. 11991). Creating a family: An integrated expres- move through space, using multiple levels of locomo- sive an is approach to adoption. me Art in Psychotherapy, IS, 213-222. tion and an enlarged movement repertoire, their physi- Harvey, S. (1990). Dynamic play therapy: An integrated ex- cal, artistic, or dramatic interactions seem to generate pressix e arts approach to the family therapy of young chil- an "expressive momentum" which creates new, posi- dren. The Arts in Psychotherapy, 17. 239-246. tive experiences. Second, building on naturally occur- Harvey, S., and Kelly, E. C. (1993). Evaluation of the quality ring motivation, curiosity, and mutual enjoyment helps of parent-child relationships: A longitudinal case study. The parents and children who are experiencing difficulties Arts in Psychotherapy, 20, 387-395. in their relationship create engaged, playful exchanges lernberg, A. M., and Booth, D. (1921.1 Clinical research mid in the therapeutic setting. As these are repeated and teaching uses of the Mwaschak Interaction Method (MIMI: Ob- elaborated upon at home, the style of playful give-and- -.erring mid eihiating can trolled iuteret lions bet fPeen WWII I'S and take of these parents and children comes to resemble children. Chicago, IL: The Theraplav Institute/Worthington the spontaneous, joyful interaction of healthy parents Trust and Associates. and children. Kohut, H. (14711. The analysis of self.The Psticluimollutft 4 study of the Chad Monograph No. 4. New York, NY: Univer- References and bibliography sity Press, Inc. Bowibv. j.I982)..1:tachnint and Vo/. 1:Attach:neut. Stern, D. N.1985). Ike ruterpersoua/ ,nwld of the Wald. New 2nd ed. New Yoi k, NY: Basic Books. ork, NY: Basic Books. liar:es', S. A. tin press at The development of attachment: Trad, D. V. (1992). interventions with infants and parents:the Long-term family intervention with the adoption of a sexu- theory and practice of preziierving. New York, NY: John Wiley ally abused child.In F. Levy led.), Dane therapy:.1 heal* and Sons. art. Vol II.Reston, VA: The American Alliance for I lea Ith. Tronick, E. 7.. (1989). Emotions and emotional communica- Physical Education, and Dance. tions in infants. Amerman Psychologist, 44, 112-120,

Plan To Attend Now ZERO TO THREE's Ninth National Training Institute "Frontiers and Front Lines in Infant/Family Practice, Policy, Research, and Training" December 1-4, 1994 Hotel Regency Dallas at Reunion Dallas, Texas

For registration information, call(703) 356-8300, fax: (703) 790-7237

Zero to Three August / September, 1994 19 17 LI

What is Dance/Movement therapy? What does D.T.R. (Dance/Therapist Registered) Dance is the most fundamental of the arts, involv- mean? ing a direct expression of one's self through one's body. It signifies to the public and professional commu- It is an especially intimate and powerful medium for nities that an individual is prepared to practice dance/ therapy. Based on the assumption that body and mind movement therapy in a clinical, educational, or reha- are interrelated, dance/movement therapy is defined bilitative setting. by the American Dance Therapy Association as "the Can one receive a D.T.R. with a Master's degree psychotherapeutic use of movement as a process which from a related field plus Dance/Movement Therapy furthers the emotional, cognitive and physical integra- coursework? tion of the individual." Thus, dance/movement ther- Yes, there is an alternate route which requires apy effects changes in feelings, cognition, physical a functioning and behavior. master's degree, specific dance/movement therapy The dance/movement therapist focuses on the courses and supervised internships. For further infor- movement behavior as it emerges in the therapeutic re- mation write to A.D.T.A., 2000 Century Plaza, Suite 108, Columbia, Maryland 21044, for materialson the lationship. Expressive, communicative and adaptive alternate route D.T.R. requirements. behaviors are all considered for both group and individual treatment.Body movement simultaneously What does A.D.T.R. (Academy of Dance/ provides the means of assessment and the mode of in- Therapist Registered) mean? tervention. This is the advanced level of registry, signifying What do-Dance/Movement Therapists do? that an individual has the education and experience to They work in hospitals, clinics, rehabilitation fa- teach dance/movement therapy and to supervise in- terns. cilities, nursing homes, senior centers, and special schools with a wide variety of clients; they conduct in- Approved ADTA graduate programs in Dance/ dividual and group sessions and collaborate with Movement Therapy members of the professional staff; they use movement ADTA approves programs that meet the require- observation skills as part of a research team; they train ments stated in the ADTA standards for Graduate other professionals to understand movementas com- Dance/Movement Therapy Programs. Graduates from munication and expression; and they consult withcom- approved Dance/Movement Programs meet all profes- munity leaders in recreation, education, and mental sional requirements for Registry (DTR Level). health. For further information about financial assistance, What kinds of work experience would be prerequisites, housing, etc., please write to each college helpful for a future Dance Movement Therapist? or university. Dance teaching of all kinds with all agegroups, Antioch/New England Graduate School. 103 Roxbury Street, performing, choreographing, and working in human Keene, NH 03431. Telephone:(603) 357-3122, Ext. 222. Masters Program in Dance/Movement Therapy, Department service professions such as recreation, teaching andso- cial work. of Applied Psychology. Susan Loman, M.A., A.D.T.R, Direc- tor. What undergraduate preparation shouldone Columbia College, Chicago. 600 South Michigan, Chicago, IL have? 60605.Telephone:(312) 663-1600, Ext. 669.Graduate Extensive dance experience and a liberal arts Dance/Movement Therapy Program.Jane Genet Sigel, background with coursework in psychology. Forspe- MA., A.D.T.R., Coordinator. cific prerequisites contact each graduateprogram. Hahnemann University. M.S. 906, Broad and Vine Streets, Philadelphia, PA 19102-1192. Telephone: (215) 762-6924, What degree do Dance/Movement Therapists 762-6926. Department of Mental Health Services, Dance/ receive? Movement Therapy Graduate Program. Sharon W. Goodin, Professional training is on thii graduate level. M.C.A.T., A.D.T.R., Director. Graduates receive a master's degree in dance/move- Hunter College CUNY. 425 E. 25th Street, New York, NY ment therapy. Graduates from an "approved" dance/ 10010. Telephone: (212) 481-4347. Graduate Dance/Move- movement therapy program are eligible for a D.T.R. ment Therapy Program. Nana S. Koch, Ed.D., A.D.T.R., Co- (Dance Therapist Registered). ordinator. Naropa institute.2130 Arapahoe Avenue, Boulder, CO What does approval of graduate programs 80302. Telephone: (303) 444-0202, Ext. 558. Somatic Psychol- mean? ogy Department. Christine Caldwell, A.D.T.R., L.P.C., Direc- An approved program has met the basic educator. tional standards of the American Dance Therapy Asso- University of California, Los Angeles. 405 Hilgard Avenue, ciation. Los Angeles, CA 90024. Telephone: (310) 825-3951. Credo-

18 011 August / September. 1994 Zero to Three ate Dance/Movement Therapy Program, Department of 4000 or (516) 653-8750. Dance/Movement Therapy Intensive, Dance. Irma Dosamantes, Ph.D., A.D.T.R., Director. Two Week Institute, Fine Arts Department. Linni Deihl, M.F.C., A.D.T.R. Other graduate programs and graduate State University of New York at Brockport. Department of coursework in Dance/Movement Therapy Dance, Brockport, NY 14420. Telephone: (716) 395-2153. Jacqueline Davis, M.A., C.M.A. Recognizing that many regions of the country do Wesleyan University. Middletown, CT 06457. Telephone: not have an integrated comprehensive sequentially or- (212) 420-0899. Graduate Liberal Studies Program. Jane Wil- dered program in dance /movement therapy, the son Dowries, A.D.T.R., C.M.A. ADTA recognizes an alternate route to registry. The al- Undergraduate Dance/Movement Therapy ternate route is designed for individuals with extensive coursework dance/movement background wishing to pursue a These courses help students evaluate their inter- master's level degree in dance/movement therapy est in dance/movement therapy and may serve as pre- education and training in combination with study in a requisites for graduate study. related field (i.e., social work, psychology, counseling, special education). For spe:ific information about at- Barn College. 700 Westleigh Road, Lake Forest, IL 60045. taining the alternate route DTR, write to ADTA-Cre- Telephone: (708) 461-9826. Dance Department with major emphasis in Dance Therapy. Gina Demos, A.D.T.R. dentials Committee. Brookdale Community College. Newman Springs Road, Courses in the following colleges and universities Lincroft, NJ 07738. Telephone: (908) 842-1900. Creative may meet requirements toward registry. Arts Therapies. Dr. Nina Garcia. Arizona State University. Arizona State University, Depart- Gaudier College.Dulaney Valley Road, Baltimore, MD ment of Dance PEBE 107-B, Tempe, AZ 85287-0304. Tele- 21204.Telephone:(410) 337-6387.Dance Department. phone: (602) 965-5029, Beth Lessard. Crystelle Trump Bond, M.S.A. California Institute of Integral Studies. 765 Ashbury, San Hope College. Dow Center, Holland, MI 49423. Telephone: Francisco, CA 94111 Telephone: (415) 753-6109. Drama (616) 394-7700. Dance Department. Maxine DeBruyn, Chair Therapy Master's Program. Renee Emunah, R.D.T., M.A. of Dance. California State University, Hayward. Department of Kine - Hunter College. 425 E. 25th Street, New York, NY 10010. siology and Physical Education, Hayward, CA 94542-3062. Telephone: (212) 4814347. Dance Therapy Program. Nana Special Graduate Major in Dance/Movement Therapy. Tele- Koch, Ed.D., A.D.T.R. phone: (510) 881-3108. Cynthia F. Berrol, Ph.D., A.D.T.R. Loyola Marymount University. 7101 W. 80th, Westchester, Laban Centre for Movement and Dance. Laurie Grove, New CA 90045. Telephone: (310) 338-5160. Department of The- Cross, London, UK SE14 6NH. Telephone: 44-81-692 4070, ater and Dance. Judy Scalin, Chair of Dance. Ext. 37.Diploma & Masters Dance Movement Therapy, Marymount College. Tarrytown, NY 10591. Telephone: MPhil & PhD Dance Research. Jacqueline Blatt, M.C.A.T., (914) 631-3200. Department of Dance. Janice Cronin. A.D.T.R. Metropolitan State University. 121 Seventh Place E., Suite Lesley College. 20 Everett Street, Cambridge, MA 02138. 121, Metro Square, St. Paul, MN 55101-2189. Psychology De- Telephone: (617) 868-9600. Counseling Psychology/Expres- partment. Telephone: (612)332-0278. Marylee sive Arts Therapies. Vivien Marcow-Speiser, Ph.D., Hardenbergh, A.D.T.R, C.M.A. A.D.T.R., Acting Coordinator. The American Dance Therapy Association Mary:burst College. P.O. Box 201, Marylhurst, OR 97036. Since its founding in 1966, ADTA has worked to Telephone: (503) 636-8141, Ext. 381 or 403. Dance Therapy establish and maintain high standards of professional Certification Program/Art Therapy Department. Christine Turner, M S., A.T.R. education and competence in the field. Melbourne University.4 Madden Grove, Kew, Victoria, ADTA stimulates communication among dance/ Australia 3101. School of Early Childhood Studies, Gradu- movement therapists and members of allied profes- ate Diploma in Movement and Dance. Telephone: (03) 860- sions through publication of the ADTA Newsletter, the 3333, 3374. Karen Bond. American Journal of Dance Therapy, monographs, bibli- New York University. School of Education, Health & Arts ographies, and conference proceedings. Professions, 35 West 4th Street, New York, NY 10003. Tele- ADTA holds an annual conference and supports phone: (212) 998-5406. Dance Professions/Department of formation of regional groups, conferences, seminars, Communication and Culture. Miriam Roskin Berger, workshops and meetings throughout the year. A.D.T.R. For further information, contact the American Northwest Institute for Creative Arts Therapies. 33 E. 20th Dance Therapy Association, 2000 Century Plaza, Suite, Street, Eugene, OR 97405.Telephone:(503) 683-4483. Counselor Education Department. Leigh Files, M.A., A.T.R., 108, Columbia, Maryland 21044. L.P.C. Southampton College. Long Island University, Southampton Campus, Southampton, NY 11968. Telephone:(516) 283-

BEST COPY AVAILABLE Zero to Three August / Septembet. 1404 21 Pi Attuning to the Fetus and the YoungChild: Approaches from Dance/ Movement Therapy Susan Loman,M.A.. A.D.T.R..littioch Neu.England monious relationships between family members, using Graduate Schim1. Keene. New Hampshire both nonverbal and verbal methods of communication, flies paper is an erilanydperston of it chapter publishedin and to promote community spirit and an extended 1992. Fetal movement notation: a method ofattuning fe fhe family environment during the sometimes challenging tries. in S. Lama:: & R. Brandt (Eels.), The body mind and often isolating process of parenting. connection in human movement analysis t kerne. New Part of the Center's prevention philosophy was Ilainpshire: Antioch YewEngland Graduate School). based on the concept of providing an optimal environment for growth in each developmental phase.Plea- Children often tell us how they feel by the way surable creative art activities were offered which en- they move. Adults can learn to better understand and hanced and supported the child's mastery of develop- relate to children through body movement. For ex- mental tasks. When special problems, such as sleep ampla mother attunes to her one-and-a-half-year-old disturbances, weaning, separation, or anxiety, arose, son by moving in his rhythm while they are sitting to- the multidisciplinary staff worked with individual gether. As he ventures out on his own, she continues families using movement, music, or art interventions. to move as he does. Through their shared movement The staff was informed of families' progress through dialogue, she tells him that she supports his creative weekly journals, written by the mother or father.If a expression. igni licant event was occurring in the family, such as a When parents understand the various stages in hospitalization, the birth of a new baby, or a long busi- movement development that their children are experi- ness trip of a parent, a special book was written and il- encing, they begin to be able to predict the changes as lustrated to help the child understand and prepare for their children grow. rather than be taken by surprise each time the child enters a new stage of development. Parents and caregivers can learn to meet the child's de- Tension-flow Rhythms velopmental needs through pleasurable creative art Tension-flow rhythms are patterns of tension modalities, especially dance, art and music; channeling changes which occur in regular or irregular inter- aggressive impulses into appropriate and interesting vals and serve need satisfaction. Rhythms of ten- motor avenues; and creating and maintaining a consis- sion-flow are used to express various ranges of tent "holding environment" (Winnicott, 19b5), which pleasure and displeasure and are observable in 10 establishes a basic trusting relationship. developmentally-based patterns: Understanding normal movement and psychological functioning, as well as the key concept of Sucking a ttunement, or nonverbal empathy, can help parents, Biting caregivers, and professionals working with very young 3. Twisting children to avoid stress at vulnerable periods of devel- 4. Straining opment and to prevent emotional disorders. My own 5. Running work as a dance/movement therapist is grounded in 6. Run-stop-go the Kestenberg Movement Profile (KMP) system of 7. Undulating movement analysis, which describes predictable move- 8. Swaying ment phases of development through variations in 9. Jumping muscle tension and changes in bodily shapes which can 10. Leaping. he notated and catalogued. the KMP provides dance/ movement therapists with a comprehensive tool for the Although they are developmentally based, all 10 assessment of clinical populations of all ages as well as rhythms are potentially available to the fetus and imparting a framework for understanding the progres- are present at birth.As the child matures, sion of motoric development. rhythms associated with various phases in devel- MV initial dance /movement therapy work with opment come to the fore. infants and their parents took place at the Center for In interpretation, specific tension-flow rhythms Parents and Children, which operated from 1972-1440 are connected with particular modes of drive dis- under the direction of Judith Kestenberg and Arnhilt charge and need satisfaction. An individual's Buelte. Through the use of nonverbal methods, such as preferred manner of dealing with drives and attunement, mutual holding patterns, breath support, needs is reflected in his or her predominant ten- andcreativearts,staffattheCenter applied sion-flow rhythms. When two or more individu- Kestenberg's movement studies to helping parents and als share similar tension-flow rhythms, the core their children to communicate more effectively to- of empathic communication is present. gether. The Center was also designed to facilitate har-

20 22 August / September. 1994 Zero to Three the event.In addition, the Center's Prenatal Project trained prospective parents to become aware of the Tension-Flow Attributes preferred rhythms of the fetus and newborn and to re- Tension-flowattributesdescribetension-flow spond in a similar rhythm in order to facilitate early changes in terms of six qualities of intensity, which mother-child bonding (Kestenberg, 1975). Expectant determine the expression of affect. They also reflect mothers learned how to record fetal movement to fur- an individual's temperament and characteristics of ther enhance early empathy. arousal or quiescence (Sossin & Loman, 1992). Since 1988, a Creative Movement Group for Par- ents and Children, modeled after the Center, has been 1. Even flow: Tension is stabilized at thesame an integral part of the Masters Program offered to level; indicates ease, resting, steadiness, stead- ;;raduatedance/movement therapystudentsat fastness, and an even temperament. Antioch New England Graduate School. As director of this program, I feel that it is essential to train creative 2. Flow adjustment: Tension adjusts itself and art therapists to work with a normal population as a adapts to meet new situations; indicatesan ac- foundation for their future therapeutic work. Thus commodating temperament. since 1988, the Creative Movement Group at Antioch New England has been open to local children from 3. High intensity: Tension reaches extreme three months to four years of age who are accompanied bound or free flow; reflects intense feelings, by a parent, grandparent, or caretaker. Offered for 12 such as joy or anger, and an excitable tempera- one-hour sessions per semester, the group provides ment. parents and caretakers with a chance to relate to and understand their children's movement development 4. Low intensity: Tension remains moderately and also serves as a fieldwork course for threeor four bound or free; reflects low-key reactionsor de- dance/movement therapy students, who learn to lead creased excitement, and a mild temperament. the group under my supervision. Students have the

opportunity to observe normal movement develop- 5. Abrupt: Tension increases or decreases ata ment in the children and to work with families, devel- rapid rate; reflects impulsivity, impatience,or oping their own styles in working with thisage group. alertness. I also offer workshops for parents and professionals working with young children. 6. Gradual: Tension increases or decreases ata This article will describe some of the basiccon- slow, leisurely rate; reflects patience, endur- cepts and techniques used at the Center for Parents and ance, and taking the time to feel intensely. Children and in the Creative Movement Group for Par- ents and Children as training for dance/movement tween mother and child, between adults, between chil- therapy. An accompanying overviewofthe dren, or among groups Kestenberg Movement Profile's needs and feelings are re- (Kestenberg and sponsively duplicated on the level of physical Sossin, 1979) core ideas of tension-flow movement pat- sensa- tion.In complete attunement of tension-flow, which terns is presented as the foundation of this approach to can be found between mother and nursing child, there understanding underlying motoric factors in children's growth. is a kinesthetic identification in which the muscular tensions of one are simultaneously felt in the other's Attunement: The basic premise and its body (see page 23 for a discussion of tension-flow variations rhythms during the first five years of life). However, Attunement, or nonverbal empathy, is the bimisof this duplication of the flow of muscular tension does the early parent-child bonding process. One form of not necessarily require duplication of body shape attunement is complete attunement, which can be (Loman, 1988). found in the mother-infant relationship. Kestenberg Visual attunement and touch attunement in- explains that "complete attunement is basedon mutual volve the same principle of duplicationresponse, but empathy...a sameness of needs and responses, but also are perceived and expressed through different forms of a synchronizationinrhythms"(1975,p.161). contact. Visual attunement is accomplished by observ- Kestenberg postulates that needs and feelingsare re- ing the level and rhythm of tension in another person's flected in changes in muscular tension (tension- flow). moving body, and then matching that tension-rhythm In normal development, Kestenberg emphasizes,par- in one's own body. Again, the muscular tension alone ents and children do not only attune together. Periods is duplicated, not the shape of the body. For example, of clashing, especially when the child is transitioning to attune to an infant who is vigorously kicking its legs, into a new developmental phase, are essential for let- one cod t move in rhythm with the kicking with any ting the parent know that developmental needsare body part, matching the muscular tension, rhythmicity, changing. In tension flow attunement whether be- and speed of the baby's movements.

Zero to Three August / September, Nti-i 23 21 Li

Touch attunement is similar to visual attunement. for changing an activity. The children soon become but based on touch contact:for example, hold hands able to predict the sequence of activities during the ses- and respond to any changes in, hand movements sion. They feel comfortable within this repetitive struc- (touching). As in other forms of attunement, the re- ture, and their creativity and self-expression begin to sponses occur without (John,. simultaneously with the flourish. perception ot movement. Even the smallest changes, The holding environment creates the space in such as the contraction or stretch ofiuscles, will he which children can fully explore an activity.It also duplicated. I iivever, the size of the attuning response provides support and enlists the trust of parents. Over does not have to reflect the size of the original move- the twelve-session course of the group, the parents in- ment; the response to a tiny muscular stretch could be crease their comfort, responsiveness, and involvement. felt in the responder's whole hand or throughout the The consistent presence of the group leaders is ex- responder's entire body. tremely important for the children as they become Attunement is t cry similar to the approach used more and more comfortably with each other. by Marian Chace, a founder of dance therapy, in work- Props to encourage creativity ing with psychiatric patients. Chace describes her tech- We use props, such as scarves, parachutes, foam nique of making initial contact with a patient: halls, hoops, and stretch material, which we consider the movements used in establishing initial con- "neutral" objects. The children can use these materials tact tith a patient may be qualitatively snnilar to in their own svays to help them express their moods those or the patient (not an exact mimicking, since and feelings.For example. if a child conies to the this is oriel) construed by the patient a mocking)... group in an angry mood. "he can wave a scart vigor- I he toll( 'wing is an example of how the patient ously up and down or throw it, which helps the child muscular tensions are picked up by the therapist express her feelings creatively.If. on a different day, and carried into dance action. One patient stands the child is sad, she might wave the scarf slowly and hunched forward, contracted through the abdo- delicately. The group leader can reflect these expres- men. his whole posture that of a person in terror. sive movements with her own scarf and begin to cre- The therapist feels the tension within her own ab- ate a group movement theme, which promotes mutual domen, and using this as a center of action, she understanding within the group. Sharing movement develops a tension relaxation dance sequence communicates support and recognition and builds a (1975, p. 73). sense of self-confidence in the children. Touch attunement is the mechanism first used to At other times, a scarf may become a bridge be- teach expectant parents to perceive fetal movement. In tween people. A parent and child may move together one exercise. the expectant mother's partner gives her as they hold different ends of the scarf. When the child a back massage with a variety of tension-flow patterns or parent ends the interaction, the child can carry the )see page 201.(his rhythmic massage pro ides sensa- imige of this interaction in the realm of the imagina- tions similar to the flutters and pushes of the fetus, and tion. helps mothers learn to become sensitive to movement Parachutes can be used to encourage group activ- changes (such as intrauterine fetal movements) which ity even when individual group members move in dif- they can feel but cannot see. The mother attunes to ferent ways. For example, as several three- and -a -half- these sensations by duplicating them with hand move- 'ear -old girls jump on top of a large parachute, parents ments, simultaneously tensing and relaxing her arms and students on the periphery attune to their move- and hands. After learning these exercises, she is taught men' rhythms by making jumping-type vocalizations tension-flow notation to record her perceptions of fetal and tapping on the ground. A one-and-a-hall-rear -old tension changes. boy, who cannot jump yet, joins the girls by bouncing The holding environment up and down. Children of different age groups can The Center for Parents and Children translated tune into each other and cooperate by sharing a simi- Winnicott's concept of the -holding environment" into lar rhythm. the physical surroundings of the Center, which were Intervention strategies designed to create an atmosphere ot safety and trust. Numerous intervention strategies were created at In the Creative Movement Group, we continue the pro- the Center for Parents and Children to help parents un- cess of translation, creating safety and trust through derstand the developmental movement needs of their consistency and continuity in group membership and children. For example, parents are encouraged to use routines, as well as in the physical environment. We holding and supporting methods which promote keep the structure of the group consistent and stable. proper alignment.Placing a four-to-six-month-old The room is arranged the same way each week, and the child on the belly aids the child's pre-crawling move- same group leaders come each time We sing a hello ments. Picking up a child by holding her at the waist, and a goodbye song to begin and end the sessions. We rather than under the arms, encourages the child to also sing to begin transitions, as we prepare the group support her own weight rather than to hang limply.

August / September. 1994 Zero to Three 22 1) Li

Rhythms of the first year learn to run (although without yet being able to stop). It is Sucking rhythm: This rhythm is observed at birth during reflexive sucking, which later is controlled voluntarily. a phase of free-flowing fluidity and wandering with no It specific aim. is best observed during nursing in the infant's oral zone It marks the transition from being stable in the vertical plane to becoming mobile in the sagittal plane and can also be found in the fingers and toes. The rhythm (moving back and forth). The rhythm originates in the ure- typically has a smooth, rocking quality of tension and re- thral sphincter muscle initiating the flow of urine. Typical lease in short, regular intervals. This rhythm promotes activities in this phase include chasing and catching games. symbiosis and attunement, self-soothing, and nurturing. The primary plane in which movement takes place is the Run-stop-go rhythm: The rhythm is typified by sharp horizontal, or table plane Children in this phase enjoy put- transitions of muscle tension changes, often occurring ting objects in their mouths and sucking on them. Pacifi- abruptly but also capable of changing gradually. During ers, fingers, toys, and blankets all serve as pleasurable objects for this purpose. the second half of the third year of life, children leant to initiate and stop the flow of urine as well as to stop themselves, without falling, while running. Movement qualities Biting rhythm: This rhythm emerges with the onset of develop an abrupt sharpness, which has an urgent or im- teething and typically has a "snap and bite" quality.It is recognized by sharp transitions in tensed, then released, patient sense of time. Favorite activities include squirting water and stop-start games such as musical chairs and red- muscle contraction, and when used to chew, the quality of light/green-light. holding on or even flow is added. These rhythms serve the practical function of cutting through solid food as well as the developmental function Rhythms of the fourth year of separation and boundary formation. The child enjoys Wavy rhythm, undulating: The rhythm is characterized by patting and tapping, shaking rattles, clapping games, and gradually rising and falling waves of low intensity muscle banging on any convenient surface. tension and release, emerging in the pelvic region. The specific zone of origin is the inner portion of vagina or the Rhythms of the second year tunica dartos of the scrotum. The inner-genital phase is the developmental stage beginning in the fourth year of life, Twisting rhythm: Beginning at the end of the first year and the task is to integrate past and present needs. Chil- and continuing into the beginning of the second year, the child becomes flexible at the waist and pelvis in the service dren are interested in babies and playing with dolls in a of crawling and adjusting to spatial demands. "Anal twist- nurturing fashion. Typically they alternate between mature ing" rhythms appear in spinal motions which originate in behavior and regression to earlier, more disorganized pat- the anal sphincter and spread throughout the body. The terns. Both girls and boys begin nagging and are unclear child is playful, teasing, and coy and begins to practice about what they require to satisfy their needs. more locomotor skills.Later, the child enjoys smearing food and such creative messiness as finger painting. Swaying rhythm: This rhythm is characterized by gradually rising and falling waves of high intensity muscle tension and release. Most predominantly observed during Straining rhythm: This rhythm is characterized by evenly- childbirth contractions in labor and delivery or menstrual held intensity of muscle tension, usually maintained in high cramping, it is rarely seen in children in its pure form. intensity.Toddlers pull themselves up, climb, and let themselves down with caution in rhythms like these. Typi- cal of an 1S-month-old child, tasks in this phase are: the be- Rhythms of the fifth year ginnings of bowel control, climbing skills, autonomy, sta- Jumping rhythm: The rhythm is characterized by an bility, organization, confrontation, verticality, intentional- abrupt rise and fall of muscle tension with smooth inter- ity, presentation of self and the adaptive approach to the vening transitions. The rhythm frequently reaches high in- force of gravity. tensity.In children, it can be observed during periods of In this phase the child makes the transition into the vertical excitement, showing off, jumping, playing shooting games, plane, becoming upright to fact the world. Children enjoy and bubbling over with ideas. The outer-genital phase is making things with clay, throwing objects into containers, the developmental stage between the fifth and seventh and asserting themselves by saying "no" with great inten- years of life. The task is to become outwardly directed, sity. This is also the age of the start of temper tantrums. with increased needs for gross motor activity and intensi- fied relationships. Movements in this phase are intense, Rhythms of the third year percussive, and abrupt and originate in the outer genitals. Running/drifting rhythm: This rhythm is characterized Leaping rhythm: by smooth transitions and small, gradual changes in ten- The rhythm is characterized by an abrupt rise and fall of tension with sharp intervening tran- sion, as seen in urinating passively with a lack of control. sitions. A young toddler may begin running by touching the front The rhythm frequently .- =aches high intensity. Children use this rhythm for aggressive butting, pushing, of the body and end by touching an object that bars further progression. punching, broad-jumping, and leaping.In comparison This developmental stage begins in the third year of life. with the "jumpi; ;" rhythm it is more focused and controlled aggression Tasks are o master locomotion, carry out operations, and sharper, more directed and coordinated.

Zero to Three 1ugust / September. lin; 23 2 5 BEST COPY AVAILABLE Children are provided the opportunity to fully ex- children to explore it. The children squeezed it into plore each movement milestone, such as standing un- balls, put it on their heads, tore it, and threw it. At first supported. At times, adults prematurely stimulate a the hair-pulling boy was delicate with the tissue paper, child to advance to the next stage for example, by but after seeing what the other children were doing, he helping the newly standing child to walk.If children began to experiment. He especially enjoyed an inter- are not rushed into walking, they practice stooping and action with the group leader which involved a "tug of standing and eventually walk sideways while holding war" with the tissue paper that used the same move- onto objects like furniture. When they do begin to ment pattern as hair pulling. A little later in the ses- walk forward, they have a good feeling of stability and sion, when the boy again attempted to pull the younger balance. Later, children in the running phase are en- child's hair, the leader intervened immediately, offer- couraged to run and stop to music. The running is con- ing him the tissue paper and saying, "We can't pull tained within an activity, but this motoric outlet is not children's hair, but we can pull the tissue paper." The prohibited. boy ts as provided with tissue paper after each attempt The creative arts encourage acknowledgment of at hair-pulling. By the next week, he had completely the full range of feelings. For example, when a three- stopped pulling the younger child's hair. vear-old child was angry during the group and would Developing movement themes not participate in the activity, singing the song "When The development of age-appropriate movement you're angry and you know it" prompted her to show themes, such as encouraging four -year -olds who love us three or four dances about feeling angry. Role plays to jump to pretend to he popping popcorn, allows chil- with a doll can be used when children hurt themselves dren to express their own creativity as well as their during the group and don't know what happened. need to jump. In this game, children can determine When two children bumped into each other, I8-month- how small they will be as kernels of popcorn and how old Peter began to cry. The scene was reenacted with big they will be when they are ready to jump up and two dolls, and the story was retold emphatically: "The down as popping popcorn.Finally, they will decide doll was running and bumped right into this doll. Her when the popcorn is ready, and if they will have a pop- head bumped right here on that doll's head. The doll's corn party. A popular theme for three-year-olds is the head hurt so much, she cried. Poor doll, and poor Pe- creation of big and small ocean waves with the para- ter." By this time, the child usually turns his attention chute. The children can swim in the ocean on top of to the doll and stops crying. The scenario ends with the waves, or go underneath it and swim underwater. the song, "Feel better, Peter, we hope you feel better Images of fish swimming, finding their fish houses, soon." and avoiding fish monsters help to keep the activity in- Understanding that children have their own teresting.Children remember themes from earlier movement styles and preferences teaches us how to ap- weeks and begin to make requests for creative play ac- proach children individually.In a recent group, one tivities based on previous groups. These suggestions child who liked to be cajoled into interaction pretended reflect various developmental stages and contribute to to hide.The group leader played along with her. the group's cohesion. When the leader exclaimed, "Where is Lilla' Where could she have gone?I don't see her anywhere, do Working with expectant parents you?"the child began to smile and then appeared. AttheCenterforParents and Children, Other children may like to be approached with hesita- Kestenberg and her colleagues designed the Prenatal tion, coyness, or directness. Project to help expectant parents prepare for the arrival of the new baby. These "Preparation for the Child" Children's aggression classes differ from other pregnancy classes in that they In the Center model, aggressive movement quali- prepare the parents not only for the birth process but ties are seen as part of the normal progression of move- also for the initial development of the relationship be- ment phases and are not prohibited. The group leader tween parent and child (Kestenberg, 1980).In this does, however, help children channel aggression into a class, parents are given the opportunity to re-discover similar, but more acceptable, form of the same move- the movement patterns of babies, which differ a great ment quality. For example, a two-year-old boy began deal from adult movement patterns. They are encour- to pull the hair of a one-vear-old child. In an effort to ,ed to develop an image of how the unborn child prevent this behavior, the father pulled his con away moves, and are taught to notate the tension changes in and said, "No, don't pull her hair." This intervention fetal movement. Kestenberg describes the results of was not effective.The boy continued toI ull the this training process: younger child's hair.In response, the father continu- This (training) not only brought them into a type ally shadowed his son, and the atmosphere in the of communication with the fetus, but it taught group became tense. them to consider the fetus as a partner, an idea Then the leader brought a large box of varicol- which then pervaded their deliveries. They were ored tissue paper into the room and encouraged the aware of the fetal movement during labor and

24 26 August / September, 1444 Zero to Three LI had a feeling of continuity from inside to the out- responses (music too loud or unpleasant to the baby side by observing the movement of the baby a from positive responses Imusic enjoyed by the baby). soon as it was horn. The expectation that one can Another kind of musical expression is also used recognize the baby by the way it had moved in- in the class the expectant mother is taught to sing side of the mother strengthened the feeling of be- deep tones to accompany labor and pushing contrac- longing mothers develop after the initial estrange- tions. These vocalizations are practiced throughout the ment from the infant (1980, p. =191. pregnancy. They have been shown to he effective in in- In these classes. the expectant mother is encour- creasing the dilation of the cervix during the transition aged to keep a journal of her fetal movement notations, phase of delivery, and in enabling the expectant physical sensations, feelings, and dreams. Kestenberg mother to actively engage during labor, instead of dis- believes that many dreams during pregnancy are re- tracting herself from the pain. lated to fetal movement (1982), with specific themes ac- In several instances, Kestenberg has attended de- cording to the state of pregnancy {1976). For example, liveries as a coach, and videotaped the birth process. dreams in the third trimester often have mobile themes These videotapes reveal how mothers utilize the con- involving flowing water or riding in vehicles such as cepts learned in the "Preparation for the Child" classes. sleds and watermobiles. As one mother writes: Special exercises help the expectant mother's ...I notated my child's fetal movements and drew body actively stretch and adjust to the fetus. These ex- pictures of what I thought it looked like inside.I ercises emphasize the growing movements of widen- put headphones on my stomach and played rock ing, lengthening, and bulging, helping to make room music to this baby.I even talked to this unborn for the fetus and to avoid pain tram pressure on the child of mind, and so did my son, Keith bladder or back. The mother is taught to breathe into "Hello, baby!" he would scream into my stom- painful spots, which also encourages stretching to ac- ach... Dr. Kestenberg's presence during my labor commodate the baby's expansion. :\ modified form of and delivery was a wonderful and extremely belly dancing is taught, to increase flexibility and coor- helpful experience. (She) moaned, groaned, dination, aiding in a smooth delivers,. This process of pushed and es-en screamed with me (Amoruso, adjusting the expectant mother's alignment to accom- 1982, p. 4) modate the additional weight of pregnancy helps to Fetal movement notation give her the feeling that she is actively carrying the Fetal movement patterns vary greatly.All the baby, instead of being pulled down by it (Loman, tension-flow rhythms, attributes, and combinations of 1980). rhythms and attributes (see sidebars) can occur in the Another benefit for expectant mothers is an im- womb. Each fetus has its own movement repertoire. proved body image, at a time when many women may Furthermore, fetal movement appears to progress and be feeling awkward about their growing size. One par- develop over the course of the pregnancy. The early ticipant describes this aspect of the program: movements feel like small bubbles of low intensity and (The exercises) helped us to stay in shape and are fairly repetitive.As the pregnancy progresses, cope with the increase in body weight... Common more variety of movement develops, and over time, re- problems such as heartburn and excessive urinary peated movement phrases can be recognized. Some frequency were helped with posture changes so typical fetal movement patterns are shown in Figure 1. that the weight was shifted from the bladder or Expectant parents begin their training in fetal stomach. Simple things like How do you get movement notation with tension-flow touch up off the floor or chair?... what is the best way to attunement exercises. For example, in one exercise the rest with your legs elevated? proved to be very expectant father presses his palms against the mother's helpful (Jordan, 1981). back for a few seconds, then rhythmically releases and The prenatal classes have been experimenting repeats the pressure every few seconds. To attune with with introducing the fetus to music, through head- these sensations, the mother tenses and relaxes her fists phones placed on the mother's abdomen (Kestenberg, in the same rhythm as the pressure. As she becomes 1982). The idea of this exercise is that music which fe- adept at responding to these tension changes, she be- tuses hear in the womb may be especially soothing to gins to isolate her responses to her hands and fingers. them after birth. Results so far indicate that the fetus The expectant mother traces the fetal movement responds to the music either by becoming more still notation on paper by hand. She can begin her fetal (perhaps sleeping) or by moving more actively and movement journal as early as the fourth or fifth month some mothers are reporting that after birth their babies of pregnancy, and can eithe. notate the movement as it continue to respond to the music which was played to occurs or from memory. The notation records the them in the womb. It should be noted, however, that variations in muscle tension and release seen in a wide the fetus has no choice in the selection of the music, variety of rhythms and attributes. The tension changes and more research is needed to differentiate negative are recorded by drawing variations in tension level, in-

Zero to Three August / September, l94-1 9 7 25 tensity and rate along a horizontal time am. This ten- also he a powerful diagnostic tool to identify expectant sion-flow writing tracks the rhythm of the fetus' mus- mothers who have difficulty relating nonverbally to cular contractions and releases along a time axis, pro- their fetus and who might benefit from extra support ducing tracings which look like EKG recordings. We and training. For adoptive parents, touch attunement have found that pregnant women learn the technique exercises could help them recognize and respond to of notation very easily. their children's needs and to enhance early communi- Some expectant mothers will feel a familiarity or cation. compatibility with their unborn child's movement, In conclusion while others will feel estranged from it.In either case, Normal movement and psychological functioning attunement to her fetus' movement can help the in the earliest years of life begins with the first flutters mother get to know her child and begin the process of and pushes of the fetus and develops into the varied mother-child bonding. On a family level, the indi- repertoire of the pre-schooler, able to express the full range of emotions through movement. Adults who un- Figure 1: Fetal movement notation derstand the various stages in movement development and who are attuned to the unique movement patterns Free flow Neutral line of the young children in their care are better able to SI% ern& NIP tut support these children's creative, self-expressive mas- Bubbles Bound flow ter of developmental tasks. 4 Bibliography Amoruso, l..1982. A -pecial thankon.Child Di:Moment Resiarch News. 3 (1). Chace. M. 1975. Dance as an adjunctive therapy wit hospi- talized mental patients.In IL Chaikin, (Ed.), Alorion Chace: Flutters (kr papers. Columbia, MD: American Dance Therapy Asso- ciation. Jordan, S. 1981. The prenatal program. Child Development Re- search News..3 (1). Kestenherg. JS. 1976.Regression and reintegration in pregnancy. Journal of the American Psychoanalytic Association, 24, 213 -25(1. Kestenberg, JS. 1980. Pregnancy as a developmental phase. Twisting or changing position laurnal of Biological Experience: Studies in the Life of the Body. 3, 58. Kestenherg, IS 1982.Parenthood A changing lifestyle. Child Dezielopment Research Notes, 4, (2). Kestenberg, JS. 1985. The role of movement patterns in diagnosis and prevention. In DA Shoskan & WL Roller (lids.), Paul Slinkier: Mind explorer. New York: Human Sciences licks Press, Inc. Kestenberg, JS & Sossin, M. 1979. The Role of Movement Pat- terns in Development (Vol. 2). New York: Dance Notation Bu- reau Press. V V v Leman, S. 1980. The Prenatal Project. Child Development Re- search News, 2 (1). Loman, S, Aigen, K, & Leevwenburgh, E. 1988, October. Non-verbal empathy with infants and toddlers through Pressing orNip movement, music and art.Paper presented at the Kids in pushing Crisis Conference sponsored by the Center for Creative Arts Therapies, Cambridge, MA. r Loman, S & Amighi, J.1990.Origins of the Kestenherg vidual tension-flow attribute diagrams of the fetus and Movement Profile.In P Lewis & S Loman (Eds.), Tire other family members will show their characteristic Kestenberg Movement Profile:Its past, present applications, and patterns of temperament and affective expression. future dinvttout, (pp. 9-32).Keene, NI isAntioch New En- These individual tension-flow diagrams can be used to gland Graduate School. improve understanding of potential areas of harmony Sossin, K & Loman, S. 1992.Clinical applications of the and conflict within the family, and to assist the family Kestenherg Movement Profile.In S Loman & R Brandt (Eds.), The body mind connection in human movement analysis. system in adapting to the new baby. Keene, NH: Antioch New England Graduate School. So far, fetal movement notation has been used Winnicott, DW. 1965. The Maturational Processes and the Fa- with relatively high-functioning families, but it may tilitating Environment. New York: International Universities Press.

26 J rjr August / September, 1994 Zero toThree Hopping, Jumping, Leaping, Skipping, and Loping: Savoring the Possibilities of Locomotion Lois Barclay Murphy, Washingt;;;I, O.C. first steps. The timing varies from child to child.At a As I sat on a bench at the side of the road in the party for little children, I saw one eight-month-old boy /00, watching the children brought M. their mothers or running around easily, while the twelve-month-old fathers, I rarely saw a little boy walking quietly beside host sat by himself, thumbing througha magazine! Ius parent. One was hopping, anotherwas jumping. Usuallv ti'e see children in the secondyear of life Others were leaping, or skipping,or loping, raising toddling around with uncertain balance and gait. This each foot higher than it needed to he lifted for ordinary gradually smooths out over the next twoor three years, walking. Some children waved theirarms. Each one so that by four, children can walk as adults do. But seemed to savor the feeling of the moment, wanting to most of the time, they don't even after they have discover the possibilities of locomotion. achieved a "real" walk, until schoolage children this curiosity seemed to disappear by theage of mostly run, or stretch, stride, or bounce. Walking isnot tour or five, when the little boys now walked quietly taken for granted at first it is an achievement to be along with mother or father. used and explored. Little children like to explore the possiblities in walking walking on curbs and other special areas, They climb out of their strollers and jaasi sten push them for awhile. Only when theyare tired do -44-1cial they climb back in, ready to be pushed. What leads the child to go through thesestages? From early infancy, an alert and active baby watches the people around him. He probably identifies with them, internalizing what he sees and developing the wish and intention to do what they do.(A "wild" child raised by animals does not develop the abilityto stand up and walk and run, but gets aroundon all fours, like the animals he sees.) When I heardthe en- thusiastic yelp of a one-year-old who had managedto stand up alone, I realized how he had longedto he able to do that.He had watched the big people going around on their own two feet, and he wantedto do that too:t

When does locomotion begin? One mightsay that locomotion begins at about four months, whena baby first succeeds in turningover on his stomach. He has to be able to do that before he beginsto creep and crawl, which he succeeds in doing in severalweeks. Some babies, however, do notcreep or crawl. They want to be able to see everything, so they have to discover a way to manage locomotion while retaininga large visual area.I was told as a child that I managed locomotion by maintaining a sitting position, extending one leg, and hitching along.I couldn't move as fast as a crawling baby moves, but I could see much more As an adult, 1 have seen other babies using the samesys- tem. It is some time after creeping and crawling(or hitching) before a baby is able to standup and take his

Zero to Three August / September, RN 29 27 Do Baby Boys Naturally Lead with the Left Foot? Researchon the Asymmetries of Movement Patterns in Newborns and Infants Mary P. Grattan, Ph.D., PT, Graduate Pediatrics and of normal individual differences in behavior develop- Perinatal Programs. Universitu of Illinois; Eric DeVos, ment, as well as the etiology of developmental disor- Ph.D., Psychology Ocilartment, Saginaze University; Tern' ders. Letni, Ph.D., PSI/Chatakty Department, 'The University of Coordination of asymmetric movements Chicago; Martha A IJOintoek. Ph.D., Psychology Depart- Various sensory and motor asymmetries (eve, ea r, ment. The University of Chicav hand, foot dominance) do not appear to become corre- Acknowledgments: Fie pre niraHon of this manuscript and lated over developmental time. In adults, these asym- much of the research desc bed ve been supported, hi part. metries not only favor the right half of the body but are Ini,c,rant #12-02-190 4oit the March of Dimes Foundation. also positively, though quite imperfectly, correlated Dance is to move the body in rhythm, ordinarily with each other.' Among 7-year-olds, handedness cor- to music. The baby first "dances" to the rhythm and relates with the direction of spontaneous head turns as- sounds of the mother's voice, heart beat, breathing, and sociated with reflex adjustments of the trunk and limbs digestion as the fetus first moves at approximately 12 in infancy.'" Among 19-week-old babies" and 2 -year- weeks gestational (tee.. At birth, the infant brings to the olds', handedness correlates with their rotational pos- dance movement abilities that include his or her posture du ring delivery. tural response to being held or moved, rhythmicity of This correlation of asymmetries among a wide va- movements, and a repertoire of movement patterns riety of movements could reflect control either by a which are building blocks for voluntary actions. single lateralized system (e.g. cortical or subcortical The reflexes and spontaneous movements Of most structures) or by the integrated action of multiple sub- newborns are asymmetric that k, they are stronger systems. Multiple subsystems, if they exist, may be and more coordinated on the right than on the left side less tightly integrated at birth.123314 Because most stud- of the body, although both sides min? normally.' Dur- ies of motor asymmetry have examined only a single ing delivery most newborns emerge with a right rota- movement behavior, little is known about the coordi- tional posture (i.e., the infant's face rotated towards the nation of different asymmetric movements in either mother's right thigh)) When the walking reflex is elic- newborns or infants. Our research was designed to ex- ited, they lead with the right foot.'" Infants have a plore this uncharted territory. stronger grasp with the right hand than with the left' Examining coordination among different and hold the right hand in a fisted posture more often asymmetric movements in newborns than the left.' This is a normal asymmetry believed to To examine the coordination among different bea buildingblockforlaterhandedness and asymmetric movements. we needed to look at a battery footedness.Among adults, 88.2 percent are right- of movement behaviors in the same baby. We selected handed, using the left hand to stabilize objects and the 4 areas of the body (i.e., upper, lower, proximal, distal) right for many voluntary movement behaviors.' and 10 movement behaviors. The four body regions Newborn reflex asymmetry, in which certain be- differ in stages of movement development at birth. De- haviors are normally somewhat stronger, more coordi- velopment proceeds simultaneously from the upper to nated, or more frequently exhibited on one side of the the lower body and from the proximal regions to the body than on the other3 can serve as a sensitive behav- distal.' ' °' Moreover, these movements may be inner- ioral index of indh idual differences in underlying neu- vated by different movement subsystems.' ral organization. tWe do not refer here to gross asym- In newborns, the different movement control sys- metry, such as hemiplegia, which would indicate se- tems in the midbrain, hindbrain, and spinal cord are vere neurological abnormality.) Studying newborn re- likely to be functionally isolated in other words, dif- flex asymmetry is particularly helpful in trying to un- ferent subsystems control such newborn behaviorsas derstand how perinatal factors may disrupt normal de- spontaneous fisting and automatic walking. So we did velopment and how prenatal hormones may affect in- not expect to find a correlation among asymmetries of dividual differences in central nervous system organi- movement behaviors controlled by different sub- zation controlling movement patterns. systems at different levels of the neuraxis. On the other This article:Ill present our team's research on hand, a single motor pool can regulate several behav- the asymmetries of movement patterns with which iors (for example, spontaneous fisting and the palmar newborn infants begin their "dance." We are discov- grasp reflex). We did expect the asymmetries of these ering how infants' asymmetric movement patterns are behavior.: to covary. coordinated within and across body regions, how male Our research results showed that, indeed, new- and female newborns differ in the asymmetric organi- borns' control systems for behavior asymmetry in 4 zation of their foot and leg movements, and what im- quadrants of the body (i.e., proximal upper-body, dis- plications this finding has for understanding the causes tal upper-body, proximal lower-body, and distal lower-

28 )') August / September, 1994 Zero to Three body) appear to be functionally isolated. As we ex- overall rate of development. More specifically, this pected, in newborns the asymmetry of spontaneous suggests that within 4-6 weeks, the movements of male fisting did not predict asymmetry of the automatic babies will become as right biased as female babies' walking reflex. The lack of correlation among quad- movements are at birth. rants suggests that in newborns, multiple subsystems, However, the sex difference in distal lower-body rather than a single asymmetric system, control asym- reflexes among newborns parallels a sex difference in metric action in different body regions. adults. Men are more likely than women to be left-bi- How, then. to explain the significant (although ased, particularly in the lower extremities". This paral- imperfect)correlationDetweenhandedness and lel is consistent with the hypothesis that it is permanent footedness in adults?" The absence of a similar correla- changes in central nervous system organization which tion in newborns suggest that development involves are producing sex differences in asymmetry of neona- some integration of separate asymmetric subsystems. tal reflexes. And neonatal reflexes form the basis for Behaviors dependent on a common pool of adult voluntary behavior. According to this hypoth- spinal motor neurons esis, the leftward bias among males could he a fixed Although, in newborns, multiple subsystems ap- male characteristic resulting from the effect of sex ste- pear to control asymmetric action of different body re- roids on the organization of the subcortex and spinal gionsi single neural subsystem appears to control cord. (In animals and humans, the left cortex is smaller asymmetries in behavior that depend on a common and functionally less developed in males than fe- pool of spinal motor neurons. We found three pairs of males:L=3, suggesting that testosterone slows the de- movements that shared a motor neuron pool: velopment of the left cortex.) Sex differences persist I. Spontaneous fisting and palmar grasp reflex, To determine whether the sex differences in dis- both of which involve finger flexion; tal lower-body reflexes of newborns are transient or 2. Automatic walking reflex and asymmetric permanent, we kept on watching babies as they devel- tonic neck reflex, both of which involve move- oped. To our knowledge, no one else has examined ments of the lower limbs, in which flexion of one newborns and followed their asymmetric motor devel- limb is coordinated with extension of the other; opment month by month. And certainly no one has and looked for sex differences in asymmetric movement 3. Babinski reflex and plantar grasp, both of patterns at this young an age, despite ample documen- tation that sex hormones are high both during fetal de- which involve movements of the toes, although velopment andforthefirstfew months after one is an extension and the other a flexion. birth.'" "21.'27 All three pairs of movements that shared a motor We found that the sex difference in lower-distal neuron pool showed positive association of asymme- reflexes isnottransient? Male infants' movements tries.For example, newborns with right-biased spon- within 4-6 weeks didnotbecome as right-biased as the taneous fisting also had a right-biased palmar grasp re- females' had been at birth. This finding suggests that flex. whatever perinatal factors affect the organization of Sex differences in asymmetries among newborn behavior may also have long-term conse- newborns quences for the development of adult lateralized be- Although the majority of newborns we studied havior, including voluntary movements such as dance. had elicited reflexes and spontaneous movements that Perinatal complications, left-handedness, and were generally stronger and more coordinated on the perinatal sex hormones right side than on the left side, most newborn males (61 Other researchers have found that perinatal com- percent) were left biased in their foot and leg move- plications, such as hypoxia, are associated with abnor- ments (i.e., distal lower-body reflexes:plantar grasp, mal asymmetry among infants,'" as well as with left- Babinski, and placing reflexes).'This sex difference handedness among adults.'132 And although the asso- could indicate either a temporary or a permanent sex ciation has not always been replicated"-'4, researchers difference in central nervous system organization. have nonetheless continued to propose that left-handed At birth, male babies lag 4-6 weeks behind fe- behavioral asymmetry is the abnormal, even pathologi- males in neuro-motor development. As noted cal result of perinatal complications:: " Since left-hand- above, neurological maturation of movement behavior edness is a behavioral asymmetry which is more com- proceeds from the upper to the lower body and from mon among males than females" and is also associated the proximal regions to the distal." We observed left- with perinatal complicationsc, researchers typically in- bias only in the least mature movement behaviors (i.e., terpret males' tendency toward left-handedness in lower-distal) of newborn boys. This suggests that the terms of male vulnerability during development.' left bias of the least mature movement behavior in We also found an association between labor com- males is transient, reflecting only a sex difference in plications and left-biased asymmetry among male new-

Zero to Three August r September, 1994 Q 29 horns.Specifically, left-biased asymmetry among ings suggest that the same steroid hormones could males was associated with a prolonged active phase of cause both behavioral asymmetry in the fetus and dis- labor. there are alternative explanations for this asso- rupted labor in the mother.Variations in levels of ciation. rho traditional interpretation proposes that la- these hormones could account for both group differ- bor complications are associated with fetal hypoxia. ences in behavioral asymmetry between the sexes and which niav damage the neural mechanisms underlying individual differences among males and among fe- asymmetric action, especially in males, vv ho may he at males. greater risk tor disrupted neural development.4. )ur We are currently measuring the fetoplacental and work, however, strongly suggests an alternative expla- maternal sex hormones that are likely mechanisms for nation. Prenatal sex steroids of the fetus may atfect the the sex difference in behavioral asymmetry and may sexual differentiation of neural mechanisms underlying also be the causal factors underlying the association be- behavioral asymmetry of the infant and in addition. tween behavioral asymmetry and labor complications. disrupt uten TIC function during labor.I rum this per- Summary spective. atypical behavior found more commonly in In trying to learn more about the movement pat- males isuch as lett-handedness or reading disability) terns of newborns which are the building blocks for may represent extremes of normal hormonally-medi- all the volunlur actions of infants, children, and adults ated development, rather than birth aiphyia or we have observed fascinating asymmetries in new- trauma.this view has broad iinplica lions tor Our un- borns' movement patterns. Most newborns had elic- derstanding of both the causes of normal individual ited reflexes and spontaneous movements that were dinerenties in behavioralLe%C.lpment and the etioltig% stronger and more coordinated on the right side than ot deit elopmental disorders. on the left side.Multiple subsystems, rather than a Our data simply do not support the conclusion single asymmetric system, appeared to control asym- that prolonged labor disrupts behavioral development metric action of different body regions in the newborn. to produce left-biased behavior.It lett-biases among There were sex differences in asymmetry of the distal males represent disrupted behavior, we would have to lower-body movement behaviors that parallel the adult conclude that 61 percent of the newborn males we pattern. These sex differences persisted over the first sampled were abnormal, and we have no reason to be- three months of life, suggesting that the asymmetric lieve that this would be the case in a normal newborn bias with which an infant is born persists and is prob- nursery. In addition, we did not find an association be- ably incorporated into voluntary movement asymme- tween fetal hypoxia (which would presumably mediate tries.The left-biased movement asymmetry among the effects of prolonged labor) and behavioral asymme- males was associated with prolonged and difficult la- try. bor. However, we have reason to believe that this sex Since there are sex differences in the incidence of difference in behavior was not the result of birth lett-biased behavior, both in our neonatal data and in trauma, but rather the result of hormones which orga- the literature on adults, we feel that a more reasonable nized sex differences in neural mechanisms of behav- interpretation of the correlation between labor compli- ioral asymmetry and also disrupted uterine function cations and behavioral asymmetry focuses on the influ- during labor. Our current research is designed to ex- ence of perinatal sex hormones. We suggest that plore this hypothesis.6 perinatal sex hormones of the fetus produce sex differences in behavioral development prenatally and, in ad- References dition, disrupt uterine function during labor.Indi- 1. Humphrey, T.1969. Postnatal repetition of human prenatal activity sequences with some suggestions of their neu- vidual differences among males' asymmetry could also roanatomical basis. In R. Robinson (Ed.), Brain and early be- be explained by variation in sex hormones. havior (pp. 43-71). New York: Academic Press. Support for the hormonal hypothesis 2. Turkewitz, G. 1977. The development of lateral differences Two bodies of literature support our hormonal in the human infant. In S. Hamad, R.W. Doty, L. Goldstein. hypothesis. First, many animal studies clearly demon- J. Jaynes, & G. Krauthamer (Editors), Latralization in the Ner- strate that steroid hormones orgarize the central nervous System (pp. 251-259). New York: Academic Press. vous system during critical or sensitive periods of de- 3. Grattan, M.P., DeVos, E., Levy, J., McClintock, M.K. 1992. Asymmetric action in the human newborn: sex differences in velopment.'" Therefore, some researchers suggest patterns of organization. Child Den, 63, 273-289. that sex differences in steroid hormones produce sex 4. Churchill, J., Ig,na, E., & 5enf, R. 1962. The association of differences in neuroanatomical asymmetry of human position at birth and handedness. Pediatrics, 29, 307-309. fetuses and functional asymmetry in later develop- 5. Kamptner, L.N., Cornwell, KS., Fitzgerald, H.E., & Harris, ment."""2 L.J. 1985. Motor asymmetries of the human infant: stepping Second, the sex steroid hormones Ma' affect CNS movements infant Mental Health Journal, 6, 145-157. development in the fetus also affect uterine function in el. Peters, M. & Petrie, B.F. 1979. Functional asymmetries in the mother.44"A6Given the correlation between behav- the stepping reflex of human newborns. Canadian Journal of ioral asymmetry and labor complications, these find- Psychology/Review of Canadian Psychology, 33 (3), 198-200.

30 32 August / September, 1994 Zero to Three 7. Petrie, B.F. & Peters, M. 1980. Handedness: left/right dif- in neonatal tail posture in the rat.Developmental Brain Re- ferences in intensity of grasp response and duration of rattle search, 9, 99-101. holding in infants.Infant Behavior and Development. 3, 215- 27. Rosenfield, R.. Lucky. A., & Allen, T. (1980). Hormonal 221. determinands of sexual differentiation. In The diagnosis and 8. Cobb, K., Goodwin, R., Sr Sae lens, E. 1966. Spontaneous management of intersex. Current Problems in Pediatrics, 10, 1, hand positions of newborn infants., me Journal of Genetic May, 8 -12. Psychology, 108, 225-237, 28. Grattan, M.P. 1993. Sex differences in asymmetric action 9. Porac, C., & Coren, S. 1981. Lateral preWrences and human of infants. Unpublished doctoral dissertation, University of behavior. New 1 ork: Springer-Verlag. Michigan. 10. Viviani, J., Turkewitz, C., & Karp, E. 1978. A relationship 29. Liederman, J. Sr Coryell, J. 1982. The origin1 left hand between Literality of functioning at 2 days and at 7 years of preference: pathological and non-pathological influences. age. Bulletin of the Psuclwnomic Society, 12(3), 189-192. Neuropsychologia, 20, 721-725. 11. Goodwin, RS., & Michel, G. 1981. Head orientation po- 30. Turkewitz, G., Moreau, T., & Birch. H.G. 1968. Relation sition during birth and in infant neonatal period, and hand between birth condition and ileum behavioral organization preference at nineteen weeks. Child Development, 52, 819-826. in the neonate. Pediatr Res, 2, 243-249. 12. Kelso, S., Skala, K., & Thelen, E. 1987. The dynamic na- 31. Bakan, I'. 1977.Left-handedness and birth order revis- ture of early coordination: evidence from bilateral leg move- ited. Nettropsychologia, 15, 837-839. ments in young infants. Developmental Psychohwy, 23(2), 179- 32. Coren, S., Searlman, A., & Porac, C. 1982. The effects of 186. specific birth stressors on four indexes of lateral preference. 13. Kelson, S., & fuller, 13. 1481. Toward a theory of apractic Canadian Journal of Psychology, .36, 478-487. syndromes. Brain and Language, 12, 224-245. 33. Hicks, R.A., Pellegrini, R.J.. & Evans, E. 1978. Handed- 14. Ihelen, E. 1984. Developmental origins of motor coordi- ness and birth risk. Neuropsychotogla, In, 243. nation: leg movement in human infants. Derchipmenta/ Psi/- 34. McManus, I.C. 1981.Handedness and birth stress. J /0140/(''i. 18(11, 1-22. Psycho/ Med. /1, 485-496, 15. Gesell, A. 1954. The ontogenesis of infant behavior.In 35. Satz, P., Orsini, aL., Saslow, E., & Henry, R.R. 1985. The Leonard Carmichael (Ed.), Manual ofhill psychology (2nd pathological left-handedness syndrome. Bram Cogn, 4, 27-46. ed.) (pp. 335-3731. New York: John Wiley and Sons. 36. DeVos, E., Levy, J. & McClintock, M. 1994. Labor com- 16. Langworthv, 0. 1933. Development of behavior patterns plications and left-biased behavior in newborn boys:alter- and myelinization of the nervous system in the human fetus native causal hypotheses. Submitted to Child Development. and infant. In the Carnegie Institute's Contributions to embry- 37. Erzurumlu, R.H., & Killackev, H.P. 1982.Critical and ology: 24(139), (pp. 1-57, publication No. 443). Washington. sensitive periods in neurobiology. Curr Top Dezi Bio1, 17, 207- 17. Smoll, F. 1982. Developmental kinesiology: toward a 240. subdiscipline focusing on motor development. In S. Kelso & 38. MacLusky, N.J., & Naftolin, F. 1981. Sexual differentia- J. Clark (Eds.), The development of movement control and co-or- tion of the central nervous system. Science, 20, 1294-1303. dination (pp. 319-325). New York: John Wiley and Sons LTD. 39. Baum, M.J. 1987. Hormonal control of sex differences in 18. Kuypers, H.G. 1982. A new look at the organization of the brain and behavior of mammals. In D. 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Zero to Three AugustSeptember. 1494 33 31 Coping in Young Children: Early Intervention Publications: Practices to Enhance Adaptive Behavior and Resil- ience (19941Shirley Zeitlin and G. Gordon William- A Welcome for Every Child: Care, Education son (Paul H. Brookes Publishing Company, P.O. Box and Family Support for Infants and Toddlers in Eu 10624, Baltimore, MD 21285) $36.00. rope (1994) - Sheila B. Kamerman and Alfred J. Kahn The more effectively a child copes, the more effec- (ZERO TO THREE/National Center for Clinical Infant tively a child learns. The more effectively families are Programs, 2000 14th Street North, Suite 380, Arlington, able to cope with the demands of daily living, the more VA 22201) $10.00 plus $4.00 shipping and handling. able they are to provide support and nurturance and to This report describes exemplars and cutting-edge achieve a sense of well-being.These research-sup- policies and programs in child care and family support ported assumptions underlie Coping in Young Children, in Denmark, France, Italy, Finland, and England. The which presents a validated frame of reference for plan- materials derive from a broader research project by ning and implementing early intervention services that Professor Kamerman and Professor Emeritus Kahn, was developed during the COPING Project, a model who are co-directors of the Cross-National Studies Re- demonstration and later outreach training program search Program at the Columbia University School of funded by the U.S. Department of Education. From Social Work. this perspective, the primary goals of intervention are Kamerman and Kahn note that child care and to enhance the child's developmental capabilities and family support services directed at children under age coping behaviors and to promote a good fit or congru- 1 are increasing and changing character in Europe. ence between the child's coping resources and environ- These changes represent societal responses to the in- mental demands and expectations. creasing number of mothers of very young children in This book describes adaptive functioning in the work force; the growing social isolation of families young children and the transactional coping process as with infants and toddlers; and public awareness of the it occurs throughout the lifespan (see Zero to Three, importance of offering even the very youngest children June /July, 1994) in individuals and in family systems. cognitive stimulation and socialization with peers and Zeitlin and Williamson then offer a collaborative deci- adults, whether or not there is a parent at home during sion-making model for assessment and planning, and the clay. intervention options designed to expand coping re- Where a consensus has developed in European sources and support effective transactions in daily liv- countries about what very young children and their ing. Three intervention options, typically addressed si- parents need, the vision goes beyond child care for the multaneously, are: 1) modifying demands so that they children of working parents or "deficit model" pro- are congruent with the child's capabilities to manage grams designed for children or families "at risk." The them; 2) enhancing internal and external coping re- policy goal, rather, is to respond to a broader (and uni- sources; and 3) providing appropriate, contingent feed- versal) set of cognitive, social, physical, and psycho- back to the child's coping efforts. logical needs, and so to move toward a more holistic The book describes specific intervention strategies "policy for the under-3s." In this context, child care and activities; offers guidelines for developing "an and family support services are emerging as a compre- IFSP with a coping perspective"; discusses factors that hensive and integrated service system for young chil- contribute to staff coping; describes the experiences of dren and their families. four families in the COPING Project and the experience In considering the implications of the European of a parent support group; and discusses the develop- experience for United States policy and practice, mental process of the COPING Project itself. Kamerman and Kahn observe that paid and job-pro- tected maternity/parental leaves are universal and Eu- Pathways to Independence:Orientation and rope. They also note that European child care is expen- Mobility Skills for Your Infant and Toddler (1989)- sive but heavily subsidized; parent fees for child care Barbara O'Mara (The Lighthouse, National Center for constitute less than 10 percent of the average income of Vision and Child Development, 111 East 59th Street, families with children in the study countries. New York, NY 10022) $2.50 Bulk discounts available. In addition to reporting on the supply, quality, Also available in Spanish. costs, financing, staffing, and curriculum of child care Addressed to parents, this publication offers and family support programs for infants, toddlers, and games and activities that can be integrated into daily their families in Europe, A Welcome liter Every Child of- routines to help visually impaired children develop fers detailed descriptions of daily activities in exem- some basic orientation and mobility skills as early as plary programs in Denmark, France, Italy, and En- the first year. Topics addressed include: encouraging gland. the child's desire to reach out and explore; helping the child develop the senses available to her; developing a sense of body image; gross motor development; experiences to foster the development of concepts of space;

32 34 August / September, l)94 Zero to Three environmental landmarks and cues; and encouraging ward self-sufficiency (most of the 50 young mothers independent mobility at home, including teaching were still receiving public assistance when interviewed "protective techniques." 30 months after leaving New Chance), and the salience of their interpersonal issues and needs. Economic and Young, Poor, and Pregnant: The Psychology of psychological support (or the lack thereof) from family Teenage Motherhood (1993) Judith S. Musick. (Yale members and partners played a crucial role in the University Press, P.O. Box 209040, New Haven, CT young women's lives. Growing up in an especially dis 06520-9040)527.50. organized family had lasting negative consequences for "Mother love: you can't give it if vou need to get an number of young women and for their young it yourself." This observation might be the "sound bite children. summary" of a book which focuses primarily on the In discussing implications and recommendations psychology of adolescent motherhood but also empha- for strengthening programs for young mothers, the au- sizes the social and economic roots of that problem. thors note the crucial importance of: skilled and trained As a "practitioner-scholar," Musick draws on data staff; preparing young people for the culture of the from large-scale research studies and on qualitative workplace (and for discrimination); providing addi- sources, including interviews with adolescent mothers tional supports to college attenders; ongoing contracep- and community-based service providers, videotapes tive counseling; testing the benefits of providing coun- and observations,diaries and journals of an ethnically seling and continued assistance as young people make diverse group of adolescent mothers. critical decisions; testing alternative approaches to help Observing repeatedly the phenomenon of "failure more disadvantaged, less successful participants; and at the moment of potential growth" (often expressed by high-quality, low-cost child care and back-up child a new pregnancy) among adolescent mothers, Musick care. notes that: For poor adolescents, like all adolescents, positive change comes about only when developmental readi- Videotapes: ness meshes with realistic opportunities to succeed in personally valued roles and areas of competence... Normal Development of Walking. Produced by Positive change takes place where adolescents can mas- anet L. Hale, B.Sc.(PT), M.Sc. for IMS Creative Com ter new knowledge and skills within the context of munications. Distributed by Therapy Skill Builders, strong, repeated, emotionally salient experiences with 3830 E. Bellevue/P.O. Box 42050, Tucson, AZ 85733, tel: people they trust and admire...(who) have strong ex- (602) 323-7500. 13 minutes. Viewer's guide included pectations as well (p. 233). $79. Musick calls for community-based programs in During the first two years of life, the child which skilled, self-aware staff are prepared to address progresses from an infant unable to maintain the head all the domains of adolescent mothers lives includ- in a controlled position to an adventurous toddler able ing sexual behavior and values, sexual exploitation, re- to get into everything and go anywhere. This video lationships with men, childrearing practices, and fam- program, with extensive footage of infants and young ily violence. children, shows the many complex stages in early de- Lives of Promise, Lives of Pain: Young Mothers velopment of the motor skills that comprise walking. after New Chance (1994) - Janet C. Quint and Judith S. This tape is designed to assist the viewer in com- Musick, with Joyce A. Ladner (Manpower Demonstra- paring an individual child's gait to normal develop- tion Research Corporation, Three Park Avenue, New mental stages; educate parents about the developmen- York, NV 10016) $12.00 plus $3.00 shipping and han- tal stages necessary to walking; and give students a vi- dling sual understanding of locomotion development. This monograph reports the findings of a study This program highlights the qualitative and quan- based on interviews with 50 young mothers who par- titative changes which occur during the maturation of ticipated in a national research and demonstration pro- walking. In learning to walk, the child develops muscle gram called New Chance which aims to increase the strength, control, coordination, and balance, which employment, economic self-sufficiency, and general form the basis for all subsequent motor achievements. well-being of young women on AFDC who are high Although the exact chronological age at which each school dropouts, and to enhance the learning and de- stage is achieved varies widely among normally devel- velopment of their children as well.During the oping children, the process is the same. The tape dem- program's demonstration phase, which began in /089 onstrates and analyzes features of walking at various and concluded in 1992, New Chance was operated by stages of development; these features include speed, community-based organizations, schools, a community length of step and stride, pelvic span to ankle spread college, and municipal agencies at 16 locations in 10 ratio, flexibility at the knee, the ratio of stance-to-swing states across the country and enrolled over 1,550 young phases, arm motion, hip motion, and the function of women. feet. This analysis of normal development is presented The key findings of this study concern the hetero- as a basis for understanding problems of locomotion in geneity of the young women, their slow progress to- children, both congenital and acquired.

Zero to Three August t September, 6494 33 LI

Preschool Diagnostic Team is that the child wouldbenefit Letters to the editor from more time with his primary caregivers and reduced hours in alternative child care settings because ofthe de- $ I read Sharon Kagan and Peter Neville's article mands being made on the child duringan 8-hour day. 'Parent Choice in Early Care and Education: Myth or Re Yet we are forced to accept that this is notan option for Ate" in Zero to Three, February/ March 1994, with a Brea the majority of today's parents. For most, part-timework enthusiasm for their attempt to address the complexityin is either not available or involves lesserpay with neither olyed in determining what constitutes parents'"choice' job security nor health care benefits. when selecting child care arrangements. Iagree with their By quitting a job, the family may forfeit crucial ben- conclusion that most parents are presented with a very efits, such as health insurance or income the familyde- limited range of child care options to choose from. How- pends on to meet monthly bills, particularly iftheir child ever. I was disappointed that they did not address the role needs special services such as speech andlanguage .9 then ork place in limiting those options. In the section therapy, occupational therapy, mental healthservices. on system reform I hoped to see an examination of why Equally important, the paid work may hea source of sup- we allow the needs of the employer to take precedence port, personal satisfaction, and intellectual challenge, all over the needs of the child.I am atraid that too often par- factors which may contribute to a parent's mentalhealth, ents' child care arrangements are determined not by the adult development, and relationship with theirchild and, parent's sensitivity to their child's needs but rather by the in turn. their child's development. However. withthe demands placed on them by their employer,among them current lack of options, suggesting a reduced work load optimal produt th itc. a goal which may be at odds with is interpreted by most mothers as meaning thatmaternal the developmental needs of the young child and her ta m- employment is had for infants and preschool children.In i Iv. the face of this, 1 believe that we must placemore direct Ihave repeated Itobserved an industry being pressure On industry and employers to provide praised by professionals involved parents in the care of young with work options which are attentive to thechildren's children for its efforts to provide quality childcare set- developing needs. tings for its employees. The recipient talks about invest- In summary, I believe that it is not sufficientto look ing in child care as a benefit for industry because it allows at the ways in which parents can becomemore involved mothers to return to the paid %cork place sooner, miss in the early care and educationalprograms they choose fewer work days due to child care complications, and be- for their child without examining theways in which the cause it fosters a sense of loyalty in the employee. Not work place fosters or penalizes theseparents for making mentioned are the changes needed in the parents work child oriented decisions. If we are to believe thatfamilies schedules so that the children may utilize these resources must he the primary constituency and y rice (or earlycare to meet their individual needs. For example, infants may and education, as Kagan and Nevilleso strongly suggest, do best it their parents t% orked a 20-hour week, preschool then we must also take a more active role in demanding children may do well with their parents working a 30- work and child care options at leastas sensitive to the hour work week, and parents of school age children a 35- needs children as those of industry.if not, I fear that we hour work week. will have lust sight of many of our children'sindividual As a mental health professional, I have spent the needs with potentially very high cost toour society's fu- past ten years examining the ways in which children'sre- ture productivity and mental health. lationships at home are related to their relationships in the child care setting and the parents' work.Numerous stud- Laurie Leventhal-Belfer, Ph.D.,The Children'sHealth Council; Palo Alto, California ies have demonstrated the relationship betweenparen satisfaction with their child care decisions, their mother's References mental health ILeyenthal-Belfer, Cowan, & Cowan,1992: Silverstein, 1991), and the child's development(Scarr, Leventhal-Beller, L., Cowan, P., & Cowan L. (April,19421 1991). Satisfaction with child care arrangements: Effectson adap- As an infant mental health consultant to The Child tation to parenthood. American Journal of Orthopsythiatry,h2 (2), 165-177 Care Outreach Program and a Therapist in the Therapeu- Scarr, S., Phillips, a & McCartney, D. (November. tic Parent-Preschool Child Program at the 19891. Children's Working mothers and their families. AmericanPsychologist, Health Council, I am frequently consultedabout the di- 44, (111, 1402-1409. lemma which parents, especially mothers, facewhen Silverstein, L. (October, 19911.Transforming the debate forced to choose between their paid job andmore desir- about child care and maternal employment. AmericanPsy- able child care alternatives. A significantnumber of the etiologist, 46, (10), 1025-1032. children under age six thatwe see at the Children's 4I am writing this letter per Linda Gilkerson'srequest Health Council are referred foran evaluation due to the for a follow-up to her article "Supporting Parentsin Lead- child's poor adaptation to their childcare arrangements. ership Roles" in the February/March 1994 issue One of our frequent recommendations from of Zero to the Infant- Three. It is important to recognize that Linda'sarticle was

34 August / September. i994 Zero to Three the end product of a collaborative activity of Illinois State service delivery system is family-centered. Continuation Interagency Council on Early Intervention's Family Sup- of the traditional medical-model/child-centered system is port Committee. Last winter, she wrote a short position a major stressor for families, one that drains their energy paper "On Preventing Parental Exhaustion" and submit- and lessens their availability for leadership and policy- ted it to participants in the Family Support Committee for making activities. review and feedback.I submitted a written response, Linda Gilkerson's openness to seeking out parental which was discussed at a committee meeting and which collaboration serves as a powerful role model for us all. helped to shape Linda's response. The process of what We need to emulate her example in our own matrices of transpired isa valuable example and an easily service delivery, policy-making and professional develop- replicable model of parent-professional partnership in ment activities. We seem to be functioning pretty well in policymaking. this regard at the national level, so we need now to shift Due to the fact that I am a professional who was our focus to regional and local involvement. A great chal- trained in the "child-centered" old days and had worked lenge and a great opportunity await each of us. Our as a special educator, counselor and administrator before children's future car, only be optimized by the quality of becoming the parent of a child with special needs, I have our family-professional collaboration in service delivery, a somewhat unique perspective on parent-professional re- administration, policymaking, and advocacy. lations. Since giving birth to my daughter, moreover, I Faye Manaster Eldar; Skokie, Illinois have never ceased to be amazed by the professionals who allude to the fact that my graduate degree in special edu- Conference Call: cation somehow qualifies me to be a superlative parent of a child with multiple disabilities, one who could not pos- December, 1994 sibly need any type of family support services but is al- December 1-4: ZERO TO THREE/National Center for ways available for volunteer assignments. My twelve Clinical Infant Programs will hold its Ninth National years of parenting experience have shown me that virtu- Training Institute in Dallas, Texas, with the theme ally the only overlap with my graduate schooling is the "Frontiers and Front Lines in Infant/Family Practice, ability to do extensive library research related to my Policy, Research, and Training." Plenary speakers will daughter's special needs. include IsamuBarrera,ElizabethBates,Sonya I am greatly encouraged that the policy-making arm Bemporad, T. Berry Brazelton, Tiffany Field, Stanley of our service delivery systems has finally made great Greenspan, Marshall Haith, Marva Lewis, Beverly strides in the inclusion of family members and consumers Roberson Jackson, Dolores Norton, Joy Osofsky, Jeree in their activities although certainly not to the greatest ex- Pawl, Deborah Phillips, Kyle Pruett, Arnold Sameroff, tent possible. Unfortunately, in all too many cases, the and Jack Shonkoff. For information contact ZERO TO system that delivers the services still has not become fam- THREE-NTI, tel: (703) 356-8300, fax: (703) 790-7237. ily-centered to any significant degree.It is exceedingly January, 1995 difficult to expect families to make themselves more avail- January 11: The Hawail Early Intervention Coordinating able for leadership and policy-making roles, when the Council will present the sixth annual early intervention very configuration of the service delivery is the antithesis conference in Honolulu, Hawai'i on the theme, "Chart- oftheprogram's avowedphilosophy. Family- ing Our Course into the 21st Century." Family-profes- centeredness must exist in deed as well as in word. To sional presentations will be featured. Contact Dr. Jean my dismay, I still frequently confront barriers erected by Johnson or Kris Takekawa, ZERO-TO-THREE HAWAII service providers (in early intervention as well as in other PROJECT, 1600 Kapi'olani Blvd, #1401, Honolulu, HI areas) in terms of services that continue to be center-based 96814, tel: (808) 957-0066, fax: (808) 946-5222. during weekday business hours only, with no transporta- tion or childcare supports. Call for proposals: This state of affairs really hit home when a "fortysomething" colleague of mine, recently remarried, Abstract submissions are invited for poster pre- gave birth to a son with Down syndrome. Despite her sentation at Child Health 2000, World Congress and residence in a major metropolitan center and her many Exposition on Child Health, to be held in Vancouver, years of involvement and advocacy on behalf of her adult Canada, May 30 to June 3, 1995, co-sponsored by the son with a developmental disability, she was forced to Global Child Health society and the University of Brit- quit her job in order for her family to access needed ser- ish Columbia. Poster topic categories include global vices for their newborn son. In 1994 Chicago, she could child health, major children's issues, health care, ma- find absolutely no appropriate homebound services nor ternal health, and science and technology. The dead- services available on evenings or weekends which would line for receipt of abstracts is November 30, 1994. For have permitted her to continue her employment. an abstract form, contact CHILD HEALTH 2000, 113- In order for us to fulfill our commitment to shared 990 Beach Avenue, Vancouver, B.C., Canada V6E 4M2, leadership with families, we must first make sure that our tel: (604) 682-6008, fax: (604) 682-6771.

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BOARD OF DIRECTORS Kathryn Barnard T. Berry Brezelton Man. Chew: Robert N. Emde Linda Gilkenon Stanley I. Greenspan Robert L Harmon Inong B. Hams An CL Hilliard. IR Glona Johnson-Powell Sheila B. Kamemon Anneliese Kamer 53277 I Ronald LAIN JANET DRILL Berard Levy ACQUISITIONS DIRECTOR Alicia F. Lieberman ERIC CLEARINGHOUSE-CEC Samuel Meisel! Dolores Norton 1920 ASSOCIATON OR Robed Plover RESTON, VA 22091 Joy Dworsky term Pawl !aural' Phillips Kyle Pruett Arnold Semeroll Marilyn LA Segal Rebecca Shshmoon Shenok lack Shonkoll Lynn Straus Ann P Turnbull Bern we Wroshourd Servos Weeder G Cordon Williamson Barn Zuckerman MOVING? gg Be sure to notify Zero to Three of your new address. Third class mail is not ADDRESS CORRECTION REQUESTED automatically forwarded.