Shall We Dance?
Using Creative Arts Therapies to Promote Play,
Social-relatedness and Self-Expression in ASD:
Meet Evan a 17-year old dancer, musician and
artist and his mother
Suzi Tortora Ed.D.
BC-DMT, CMA, LCAT, LMHC
www.dancingdialogue.com
Profectum: The
Power of Play
“It is through original, real,
imaginative, and self-generated
exploration that a child explores ways
to understand and integrate
experiences, and to create new
images that support new ways of
developing her sense of self.
Creativity fosters inner expression.”
Dr. Suzi Tortora
(The Dancing Dialogue, 2006)
John Jay College, NYC
October 18, 2015
Most Important Message From A Creative
Arts Therapeutic Perspective
What distinguishes creative arts therapists from
dance, art, and music teachers?
• trained and licensed psychotherapists
• primary goal: create a psychotherapeutic healing
environment that supports emotional and psychosocial
development
• use creative arts mediums as primary tool for expression
• The process of art making is the essential core of the
experience • Goal is to create experiences for the ASD child to tell
you who s/he is • Each child’s view and contribution has a place and
value
• Experience of art making is a journey of discovery
and expression leading to a deeper sense of self
• Emphasis on individual creative aspect of art making
rather a final product that they must follow, copy,
mirror
Ways of Seeing
Observe with a dance-like frame of reference:
Ways of Seeing
WHEN OBSERVING THE CHILD
1. What isolated actions is the child doing
– how can I link them together like a dance?
Theoretical Principles &
Methods
WHEN OBSERVING INTERACTIONS
2. What is the dance of interaction - the dancing
dialogue - observable between the child and adult?
This dancing dialogue portrays patterns of
communication between self and other.
Tortora, 2006
Interactions– spontaneous choreographies
Key Developmental Factors to Consider
• Role of Body Experience in Development
•Multisensory Development
•Development of Attachment
•Language Development
Tortora, 2006
Developing Relationships/Interactions
• Quality of mother-infant relationship affects infant’s
physiology, neurophysiology & psychology (Hofer, 1981,
When I look,
I am seen,
so I exist
2003)
• (Porges, 2004)
Neurological regulation - developmental process
contingent on social -emotional interactions
- Winnicott (1971/1991)
• “Neuroceptive” sense of safety, established through
nonverbal and vocal cues is necessary to support
infant’s [improvisational] social engagement
Parent - Child Attachment Relationship
Beebe (2004)
• Exchange between mother and infant unfolds
during each interaction & is CO-CONSTRUCTED
at the NONVERBAL LEVEL involving a. SELF-REGULATION = how each person is
affected by own behavior b. INTERACTIVE or CO-REGULATION = how
each member is affected by the behavior of the
other
Language Development as it Relates to
Relationships (Bucci, 1994; Appelman, 2000)
• Nonverbal experiences between infant &
caregiver play a significant role
• Transformation
• Organization of experience
• Language
Seven Sensory Systems
• Control of attention & cognition
– think flexibly
– ignore distractions
– resist impulses
– maintain focus
– hold information in mind
• Arousal level
• attentive, alert
• over - arousal
• under - arousal
• Regulation: Develop self -control
• Regulation
• Physiological
• Emotional
•
Executive Functioning Skills
– mind
– body
– emotion
Body-based Regulation of
Attention
3 Phases
– Monitoring self- regulation - attuning to
“sensational” voice – Expressing Intersubjective awareness =
awareness of others thoughts & feelings
- creating a“shared psychological
field”(Stern)
– Successfully engaging in joint activities
Tortora, 2006
Autistic Spectrum Disorder (ASD)
through the
Ways of Seeing
Lens
Characteristics of ASD
• severe language, communication and developmental
delays in all areas of development
• avoidance and detachment
• caused by extreme sensory sensitivities, disregulations, and atypical neurological functioning
Ways of Seeing Thoughts about ASD
• What if children in the autistic spectrum are stuck in this
stage of communication and attachment before
verbalization where nonverbal experiences reign?
• They are driven by severe sensory integration
sensitivities & the inability to regulate nonverbal input timing, space, arousal, affect, proprioception.
• Perhaps children with severe communication disorders
become driven by bodily sensations. • approaches the world from a place of self-protection
and evasion
• extremely perseverative, filled with unusual and
intricate gestures and full body actions
• Regarding nonverbal behaviors as communications, acts
as a precursor to symbolic representation and meaning
making.
Tortora, 2006
Ways of Seeing Conclusions
FOR THE AUTISTIC SPECTRUM CHILD PERHAPS
BODY & BODY SENSATIONS
ARE THE REFERENCE
POINT
FROM WHICH THEY
DECODE EXPERIENCES
Tortora, 2006
• the discharge and regulatory function of the
nonverbal stress behaviors supports their use
as a communicative element
• nonverbal behaviors can be used to initially
interact along the journey towards more
adaptive functioning and increased relating
Tortora, 2006
Ways of Seeing Conclusions
• Intervention focus:
• create a “neuroceptive” (Porges,2004) environment
of safety to ensure comfort level
• use multisensory sensitivity needs as
starting point of communication
• enhance/explore physical developmental
coordination (Dynamic Process III)
• create environment for free creative selfexpressive spirit
Tortora, 2006
Movement Qualities in ASD that affect SOCIAL
RELATING Movement Qualities in ASD that affect
SENSE OF [emotional] SELF
• Affect sense of physical self which in turn affects
emotional self
• Little torso differentiation
• Personal idiosyncratic actions
• Sense of limbs as disconnected/ unrelated to
torso
• Lack of fluid coordination/connectedness
between body parts
• Difficulty making fluid, sequential actions
• Lack of full extension of body parts – stiffness –
not reaching out into space – into environment
or even fully with in own kinespheric space
• Toe walking
Tortora, 2006
.
Movement-based DIFFICULTIES underlying all
(SOCIAL) ACTIVITIES
(Tortora, 2006)
• Lack of eye contact
• Modulation- rhythmicity, timing & using gradation
• Darting, turning away with body part
– Shoulder
– torso
• Darting, turning away with full body
• Running through room
• Isolating self in space
Tortora, 2006
• Body, movement & emotional regulation from
active to calm
• KEY GOAL
Learn to regulate/moving up & down a
movement spectrum from more active to less
active
Tortora, 2006
Ways of Seeing Goal with ASD
Ways of Seeing Goal with ASD
• Develop socially engaging interactions by
creating a “neuroceptive” sense of safety
• Regulate/moving up & down a movement
spectrum from more active to less active
• Leads to inter-personal regulation &
connection
• Leads to possibility of developing
intersubjectivity
• Establish internal regulation
• Develop a positive sense of self
Tortora, 2006
Tortora, 2006
KEY PRINCIPLES THAT GUIDE EACH SESSION
~ All activities in the session give the mover the opportunity
to show the therapist who she/he is.
Principles that guide Ways of
Seeing sessions
~ Start where the child is at -- child directed
~ Nonverbal behaviors are expressions of self
~ Observing nonverbal actions tell us important information
about how the mover is experiencing, exploring, and
learning, about the surroundings
Tortora, 2006
KEY PREMISE:
5 Key points to Nonverbal Observation
ALL NONVERBAL ACTS HAVE THE POTENTIAL TO BE
COMMUNICATIVE
Go beyond the behavioral
aspect of action and ask:
1. A dictionary type of interpretation should not be
used to understand nonverbal actions
2. No nonverbal action or quality is good or bad. 3. Determine if the nonverbal behaviors are
motivated by a need to satisfy a sensory related
reaction, a social or emotional drive, or both.
IF THIS BEHAVIOR/ ACTION IS A
COMMUNICATIVE ACT, WHAT MIGHT THIS
Tortora, 2006
Tortora, 2006
CHILD BE SAYING?
3 questions when observing a child:
5 Key points to Nonverbal Observation
4. Determine if body actions, vocalizations,
verbalizations, or a combination or all of these
elements are influencing your perceptions of the
mover’s behavior. 5. Notice if the nonverbal body action occurs
facially, gesturally, posturally, or a combination
of all of these expressive modes.
Tortora, 2006
1. How does relating and moving in that child’s unique
way color their experience?
2. What does it feel like to experience the world through
that child’s particular expressive movement repertoire?
3. How can a therapeutic environment be structured to
enable the child to experience their way of relating and
functioning as a communicative tool, while
simultaneously enabling the child, to use that
experience to explore new ways of interacting with the
environment?
Tortora, 2006
WAYS OF SEEING : Four part procedure in therapeutic
process:
1. Match - feel quality through attunement or mirroring.
2. Dialogue through use of these movements.
3. Explore/ expand develop these movements.
4. Verbalize - Move communication from nonverbal to
verbal exchange.
Tortora, 2006
Early Detection of ASD related to
nonverbal expression:
• Self & other
18-24 months
– by 6 month deviants in attention to objects
vs other - sharing in “games” with other
– lack of understanding of gestures
• Early movement issues
– muscle tone
– no protodeclarative pointing
– gait peculiarities - toe walking
– balance
– postural weakness
Tortora, 2006
– delay in motor milestones
Early Detection of ASD related to
nonverbal expression:
18-24 months
• Timing & phrasing:
– lack of rhythmic exchange in joint attention built
from mutual regulation/co-regulation
– lack of cooperative purpose, shared awareness
• Facial expression & eye contact:
– lack of cyclic reciprocal expressions (Stern’s
mutual reciprocity)
– no build up of emotional arousal
– not mirroring expressions of others
Tortora, 2006
– no or fleeting eye contact
Ways of Seeing: Early Dance/Movement
based Intervention for ASD: 18-24 months
• Timing, phrasing & use of space:
– slow down actions
– transform wandering by connecting through
mobile space
– avoid rote play by keeping activities fluid
– play with rhythmic emphasis to different parts of
movement phrasing - 2 beat accent to
impactive & explosive
Tortora, 2006
Ways of Seeing: Early Dance/Movement
based Intervention for ASD: 18-24 months
Ways of Seeing: Early Dance/Movement
based Intervention for ASD: 18-24 months
• Facial expression & eye contact:
– exaggerate facial expressions
– provide eye contact from different angles,
levels and distances in space
• Early movement issues
– activities that provide tactile, proprioceptive, &
vestibular awareness
– core strength and full body activities
Tortora, 2006
Where Floortime and Ways of Seeing DMT
meet
• Relationship-based — focus on “affect sharing” to relate
• Following child’s lead - supporting optimum engagement
• Follow fragments of child’s engagement as way in —
expanding social-emotional relating from here
• Extend “circles of communication”
• Goal is to expand range of interactive experiences and
emotional expressivity
• Engage in and encourage spontaneous play, building
upon child’s natural interests
• Developmentally focused
• Self & other
– primary caregiver is still key attachment
figure even if not obvious
– mirror, attune, transform child’s activity,
object attention into social engagement
– model ways to engage encouraging primary
caregiver to try
Tortora, 2006
Tortora References
• Tortora, S. (2015). Mindfulness and movement. In Willard, C. &
Saltzman, A. (Editors). Mindfulness with youth: From the clinic to
the classroom. New York: Guildford Press.
• Tortora, S. (2015). The importance of being seen – Winnicott,
Dance Movement Psychotherapy and the embodied experience.
In Spelman, M. & Thomson-Salo, F. (Editors). The Winnicott
tradition: Lines of development – Evolution of theory and practice
over the decades. London, UK: Karnac.
• Tortora, S. (2013). The essential role of the body in the parentinfant relationship: Nonverbal analysis of attachment . In
Bettmann, J. & Friedman, D. (Co-Editors). Attachment-based
clinical social work with children and adolescents. New York:
Springer.
Tortora References
• Tortora, S. (2012). Beyond the face and words. In Beebe, B.,
Cohen, P., Sossin, K.M., Markese, S. (Editors), Mothers, Infants
and Young Children of September 11, 2001: A Primary Prevention
Project. New York: Routledge.
• Tortora,S. (2010). From the Dance Studio to the Classroom. In
Karkou, Vassiliki (Ed.), Arts therapies in schools: Research and
practice. London, England: Jessica Kingsley.
• Tortora, S. (2009). Dance Movement Psychotherapy in Early
Childhood Treatment. In Chaiklin, S. & Wengrower, H. (Eds.), The
Art and Science of Dance/Movement Therapy: Life is
Dance. Routledge: New York.
• Tortora, S. (2006) The Dancing Dialogue: Using the
Communicative Power of Movement with Young Children.
Baltimore, MD: Paul H. Brookes Publishing Company.
SUZI TORTORA ED.D., BC-DMT, LCAT CMA
Dancing Dialogue PLLC
www.suzitortora.com
[email protected]
80 East 11th Street, NYC, NY 10014
26 Main Street, Cold Spring, NY 10516
Tortora, S. (2006) The Dancing Dialogue: Using the
Communicative Power of Movement with Young Children
www.brookespublishing.com/store/books/tortora-8345-index.htm
Other References
• Appelman, E. (2000, April). Attachment experiences transformed into
language. In American Journal of Orthopsychiatry, 70, 2, 192 – 202
• Beebe, B. (2004). Co-constructing mother-infant distress in face-to-face
interactions: Contributions of microanalysis. In Zero to Three, 24(5), 40
- 48.
• Bucci, W. (1994). The multiple code theory and the psychoanalytic
process: A Framework for research. In Annual of Psychoanalysis, 22, 239
–259.
• Hofer, M. A. (1981). The roots of human behavior: An introduction to the
psychobiology of early development. San Francisco: W.H. Freeman
and Company.
• Porges, S. (2004, May). Neuroception: A subconscious system for
detecting threats and safety. In Zero to Three, 24 (5), 19 – 24.
• Winnicott, D.W. (1991). Playing and reality. London: Routledge/Tavistock.
(Original work published 1971).