By Stacey McGinn Hurst, LCPC, BC-DMT, GL-CMA
Re-inhabiting the body, filling it up with the Self, and inviting all parts of the psyche back into the container of its owner are essential to eating disorder recovery. How do therapists invite an individual to create a more harmonious relationship with his or her body, when the body has become a battleground where no truce is in sight? From the work I’ve done with men and women over the years, it appears to me, that eating disordered behavior is a metaphoric crime committed against the Self through the body, where food is used as the weapon to attack or defend against various issues of the psyche. This article will look at the ways an eating disorder manifests on a body level and how dance/movement therapy, a body-based form of psychotherapy, can be used as a viable treatment modality for those struggling with such a disorder. In conjunction with dance/movement therapy, Internal Family Systems model (IFS) created by Richard Schwartz, a primarily verbal therapy approach, can co-facilitate to yield positive changes within the client with an eating disorder.
Separate, Divide and Concur
As Anita Johnson writes in her book, Eating in the Light of the Moon (2000), “…food is not the real issue. It is a smoke screen. It is the red herring.”1 As clinicians, clients, and loved ones, we must not become distracted by the food; instead, we must look deeper towards the root causes and reasons why an individual uses food to self-regulate. Dance/movement therapist, Anne Krantz (1999), writes, “The eating disorder represents a symbolic enactment of a struggle in which the woman’s body has been disconnected from her emotional life. Inhabited by painful conflicts which the eating disorder fails to resolve, her body has become a barrier against feeling and growth.”2
Undeniably, there is disengagement, where emotions are differentiated from the felt sense of the body. Whether an eating disorder manifests as a keeping in, a keeping out, or a keeping separated, a compartmentalization of sorts, is occurring. But how is this possible when neurobiology has now discovered the truth behind the body-mind connection? It is an inseparable and interconnected whole, both intra and interpersonally.3 We can understand this in another metaphor. It is as if the road still exists between the body and mind, but the individual who has an eating disorder, does not travel down that road any more. “Blockades and barriers” have been erected on the road to keep the “disconnect” and compartmentalization in place, in order to manage the emotional content.
The difficult dynamic to understand, is the relationship between the individual’s Self and his/her eating disorder. Originally, the eating disorder began as a way to help the Self cope with life’s stressors and the internal emotional conflicts that often arise. However, over time, this is without a satisfactory resolution, as Krantz (1999) points out above, due to the disconnecting nature of the disorder. The eating disorder’s original, positive intention and way of coping with life, through blockades and barriers, goes painfully awry. It is often at this point when an individual will enter therapy, either on his or her own or with the encouragement of loved ones. These individuals will often appear either shut down or hyper-aroused physically, emotionally, and/or cognitively and may complain about a “war going on in my head”- if they are able to get the words out to explain the inner turmoil.
An example of what “hyper-arousal” looks like on a body level is described in the following vignette of a first session with CW, a now 53-year-old female with anorexia nervosa:
She enters the space appearing exceptionally thin and tired, with a forced smile on her gaunt face. Her upper chest hollowed, sunken, and enclosed. Her eyes are strangely alert, yet not present. Her hands twist as she wrings her wrists. And she speaks with a high-pitched, young-sounding voice marked by a frantic and pressured nature. I can sense the fear she is holding, as evidenced by extreme tension in most every area of her body. Her body-mind is rigid and she appears to hover above the couch, even though she is sitting. I make note of my own body’s response of held breath, discomfort, an uncertainty of where to begin, and the intense rigidity in my musculature. During this first contact with CW, I become aware of her body’s unwillingness to contact the floor/ground. She struggles to be in connection with the environment, her own body, or me. Disconnection is pervasive.
It is often here, where the therapist and client together, begin the journey to create an internal (emotional) and external (behavior) shift. The goals are to identify and remove the blockades, to create a truce between the contending parties (Self and eating disorder), and to develop inner harmony within the client’s body-mind-spirit. If you are a therapist or a client who is familiar with eating disorders, you know this is easier said than done.
Where is the Self?
From Schwartz’s development of the Internal Family Systems model based on his work with hundreds of clients over the years (many of whom struggled with eating disorders), he concludes that everyone has a “Self.” He further described the Self as possessing qualities such as clarity, confidence, connection, and centered-ness. It is experienced and described by his clients as a “state of calm well-being” where one feels free and openhearted and in the present.4 From this concept we can then ask: Where is the Self while all of this “warring” is going on? We can imagine that the Self is being guarded and protected deep within the body – too protected to believe that a change can be created in this powerful storm. The very thing that is the client’s best ally, right now, is perceived as the enemy: the body. To try to rationalize or convince otherwise is a fruitless struggle usually ending in disappointment and not moving any closer to the end goal, that of inner harmony. The Internal Family Systems model would have us understand the individual’s eating disorder as a cluster of parts in the system known as protective “fire fighters” that are used to control the emotional intensity of the body’s/Self experience.5
We can also conceptualize the Self through a Gestalt/relational lens; as an entity that is only known through being in relation to the other and, therefore, exists when it is experienced through the body’s boundary.6 Philippson describes the Self of an individual with anorexia as “…beneath the skin, and alienates the area between the skin and the body identified as self.”7 Therefore, a body-based, relational approach to the development of a strong and vibrant core Self would seem imperative, especially for the individual struggling with an eating disorder.
In order to connect with the Self of the client, the therapist must assist in discovering and dismantling the eating disorder fueled blockades and barriers, which keep the splintered parts in place. These parts function to protect the Self from being overwhelmed in a variety of different ways; most often holding and containing negatively experienced emotions. Simultaneously, the therapist can foster growth and inner resourcing of the client’s Self through various body-based methods used in dance/movement therapy that model to the client and his or her parts that he or she is capable of being with, and connecting to, the emotional content that surfaces.
Dance/Movement Therapy Approach
As a dance/movement therapist, grounded in Schwartz’s Internal Family Systems model and Miller’s Relational-Cultural Theory 8, my observations have shown me that inner harmony can only be experienced when all parts of the Self are residing fully within the body-mind. All parts understand their functional roles in the system leading to compassion and appreciation for one’s inner gifts throughout the intrapersonal system and within relationship to another. The ultimate result: all barriers and blockades are “down” and the system is connected and flowing.
In my experience, even though mental knowledge is power, the progression of reconnecting is incomplete when only processed through the verbal realm. Rather, employing the wisdom of the body is an even greater tool that can be harnessed within the individual to bring forth empathy and healing in the body-mind-spirit. Through the body, the individual can experience connection intra and interpersonally in the corporeal realm, and can develop the ability to hold and accept the emotional content between the Self and the skin.9
According to the American Dance Therapy Association (ADTA) dance/movement therapy (DMT) is the psychotherapeutic use of movement to further the expression of the inner aspects of an individual physically, emotionally, spiritually, and cognitively.10 Its approach is body based, bottom-up and top-down, as described by Bessel van der Kolk in his latest book, The Body Keeps the Score.11 With a high level of what van der Kolk and other scientists call “interoception”12 and dance/movement therapists call “kinesthetic awareness”13 dance/movement therapists are trained to attend to both their own felt sense, as well as to their clients’ emotional, body-based experience. This is known as “kinesthetic empathy.”14
Through the use of these tools and others, the dance/movement therapist can facilitate the increased development of the client’s body felt experience through a range of movement spanning from functional to expressive movement. The development of a felt sense is critical for the person who is attempting to recover from an eating disorder so that he or she can connect to and regulate his or her emotional state more effectively. By gently turning towards the body and its wisdom, the client begins to recover long forgotten and disowned aspects of the Self, leading to less animosity between the Self and the eating diroder and to a greater sense of integration.
How it Works?
Dance/movement therapy seeks to fully integrate all aspects of the psyche and reconnect the body-mind, so often disconnected in the individual with an eating disorder. Through the use of: (1) basic movement tasks (walking, aligning the spine, feeling the feet on the floor); (2) body orientation (awareness in space surrounding the body and orienting to body parts in connection with each other); (3) breath work (various ways to work with the breath to regulate and increase internal awareness); (4) grounding techniques (weight sensing, bouncing, yielding into the earth, imagery); to the more complex (5) full body dance expression (a signature of dance/movement therapy). This 50-year-old approach taps into the individual’s expressive, creative, and healing potential, thus empowering the individual to literally move towards inner harmony.15 As Krantz notes, “The dance therapy process allows a fundamental change in the client’s relationship to her body by active psychophysical expression of experiences connected to the symptoms and thus, provides release from the symptom.”16
One of the most powerful sessions I recall having with CW, occurred when we were mindfully walking around the room. This is simple for most individuals, but for CW, it was a major challenge. As I said earlier, it seemed as if she would hover above the couch to keep her body out of connection. We discovered this was a physical manifestation of her lack of trust that anyone or anything could support her. As we walked, on this particular day, I ask her to really feel her feet on the ground; to sense the bottoms of her feet yield into the earth. I invited her to allow the earth to support her. As we walked, she began to cry tears of joy. She said, “This is the first time I’ve ever experienced connection to anything that feels safe. I know the earth will always be there for me. And now I can actually feel it.”17 This was a transformational moment for CW. She began to really notice herself in relationship and started to increase her ability to trust herself, the environment, and me.
Within the dance/movement therapy session, the therapist and client track the wisdom of the client’s body knowledge trusting that it will ultimately guide the client back to health if nurtured in a safe, trusting, therapeutic movement relationship. Dance/movement therapist Jessica Young defines the therapeutic movement relationship as:
…a shared presence of body, mind, and spirit between the dance/movement therapist and client where healing occurs within the safe containment of a creative collaboration resulting in a resonance. Fundamental to the work of dance/movement therapists and rooted in the tenets of humanism, it is born out of one’s ability to kinesthetically attune and respond to the implicit and explicit movements of another, informed by knowledge of one’s own body sensations and movements as well as continual observation and assessment of the client’s movement.18
In order to engage in such a relationship, dance/movement therapists have training in advanced and codified systems of movement analysis, to understand the body’s movement language in order to meet the client in the non-verbal, corporeal realm. Through the body’s physical expression, the therapist can facilitate increased self-awareness, self-compassion, and self-expression while assisting the client to learn his/her body’s own personal language.
Dance/movement therapy can bring the disowned parts of the Self back into connection and back to its residence in the physical body. The internal contention that formerly took place on the battleground of the body can come to an end as the Self gains strength and brings internal compassion towards the wounded parts once suppressed through eating disordered behavior.
Years later, after many sessions with CW, we now have a connected, safe, trusting, therapeutic relationship. She has also established a much greater connection to her Self and her body. Her posture is more erect, her eyes are open and more engaged, her voice is stronger, and her upper body is more open and relaxed. She is slowly discovering that her body is a safe place in which to dwell, and she has developed ways to decrease the antagonism she feels between her Self and her parts. She is now able to resource strength, stability, and confidence within herself through body-based techniques such as grounding, accessing breath, and increasing her body awareness. She is more apt to listen to her body’s expression with compassion, as she learns how to hold space for herself and her wounded parts, without turning to eating disordered behavior that once formerly disconnected her and perpetuated her inner battle. Today, the war is over and the battleground is cleared of debris. In her words, “I am calm, healthy in mind, body, and spirit. My face is filled out and my eyes are present. I feel so grateful.”19
