Focusing on Positive Affect in Dance/MovementTherapy: A Qualitative Study

Amanda J. Gordon

� American Dance Therapy Association 2014

Abstract This qualitative study investigated how a small sample (n = 3) of

dance/movement therapists consciously attended to and employed interventions to

address positive affect within adult dance/movement therapy (DMT) groups. While

there is anecdotal evidence of such a focus in the field, limited data regarding

positive affect has emerged in the literature. A semi-structured interview method-

ology was used to collect data that was coded and analyzed, resulting in 13 themes

across the four categories of therapeutic interventions, therapeutic intentions and

goals, client attributes, and therapist attributes. Findings included interventions used

and their apparent effects, as well as identifying therapeutic intentions and goals that

seemed to lay the groundwork for positive affect. Data pointed to a need for

development of positive affect in clients, including tolerance of it. Participants’

rationales for focusing on positive affect, participants’ relationship to positive

affect, and the importance they placed on guarding against their bias toward positive

affect were other themes. Lastly, the results lend support to a focus on positive

affect in DMT and to the utility of a qualitative methodology for building an

understanding of this topic.

Keywords Dance/movement therapy � Positive affect � Positive psychology �Therapist affect � Mind body connection � Therapeutic intentions � Interventions

Psychotherapists, regardless of their approach, are presented with a plethora of

clinical material in a session. They are constantly called to make decisions about

what information or signals to attend to and respond to. Some of the material, and

A. J. Gordon (&)

Somatic Counseling Psychology Program, Graduate School of Psychology, Naropa University,

Boulder, CO, USA

e-mail: agordon@students.naropa.edu

123

Am J Dance Ther

DOI 10.1007/s10465-014-9165-6

arguably all, communicates affect: negative affect, positive affect, or perhaps lack

of affect. When it comes to dance/movement therapy (DMT), should therapists

attend to one more than the other? What might the benefits be of attending to

positive affect, the category of affect that is generally considered more desirable,

versus affect that is more often indicative of pathology?

Questions along these general lines appear to be prevalent currently, as positive

affect has recently received a great deal of attention in certain areas of psychology

and health (Fosha, 2009; Fredrickson, 2001; Hendricks, 2009; Pressman & Cohen,

2005; Schore, 2003; Seligman, 2011). Positive psychology, body psychotherapy,

trauma psychology, psychoneuroimmunology, and other areas of psychology have

produced research and theory that tie the experience of positive affect, including the

use of therapeutic interventions to increase positive affect, to a myriad of variables

including enhanced alleviation of depression, healing from trauma, creative

problem-solving, and resistance to illness (Fosha, 2009; Isen, Daubman, &

Nowicki, 1987; Pressman & Cohen, 2005; Schore, 2003; Seligman, Rashid, &

Parks, 2006). While there is anecdotal evidence of a focus on positive affect in DMT

practice, the subject has not emerged significantly in the research and theory. A few

DMT studies have looked at both positive and negative affect (Devereaux, 2008;

Koch, Morlinghaus, & Fuchs, 2007; Kuettel, 1982). Like much psychology

research, DMT studies have tended to focus on measuring negative states and

emotions, such as depression, anxiety, hostility, and psychological stress (Braun-

inger, 2005; Brooks & Stark, 1989; Mannheim & Weis, 2006).

This research emphasis is a concern for several reasons. First, therapists working

in the field are not just trying to help clients achieve a reduction in symptoms like

depression. Therapists help clients experience lives that include positive states and

affects like joy, satisfaction, love, and pleasure.

Second, while researchers may have been working previously under the

assumption that a decrease in negative affect or symptoms would indicate or result

in an increase in positive affect, research suggests that negative and positive affects

do not generally seem to be part of the same continuum (Bradburn, 1969; Diener &

Emmons, 1985; Watson, 1988). They seem to be only modestly negatively

correlated, although this relative independence is contested by some (Green,

Goldman, & Salovey, 1993; Russell & Carroll, 1999). Therefore, assumptions

cannot necessarily be made about a decrease in symptoms denoting the increase of

positive affect or other signs of health. Along these lines, it has also been discussed

that mental health is not just the absence of mental illness, and that the two are not

poles on a continuum but rather two separate dimensions (Jahoda, 1958; Keyes,

2005). Positive psychology’s Seligman identifies positive emotion as one of the five

pillars of well-being, a term which seems to encapsulate mental health (2011).

These assertions point to a need for additional research that explicitly studies how

positive affect, and ultimately mental health, can be promoted.

This study aimed to make a small contribution to the body of research that

ultimately can assist DMT practitioners in helping clients not just decrease what is

undesirable but increase what is desirable, such as positive affect, in support of

mental health. This qualitative interview study sought to explore the experiences of

a small sample of dance/movement therapists who consciously attended to and

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employed interventions to address positive affects within adult DMT groups.

Specifically, it asked: Amongst dance/movement therapists who consciously use

positive affect in their work with adult groups, how do they do so? What

interventions do they use and in what instances? Why do these dance/movement

therapists work with positive affect and use the interventions they do? For the

purpose of this article, positive affect was equated with positive emotion, and the

operational definition had three parts. First, these were ‘‘feelings that reflect a level

of pleasurable engagement with the environment’’ (Cohen & Pressman, 2006,

p. 122). Second, it included the descriptors within the Basic Positive Emotion scales

from Watson and Clark’s (1994) Positive and Negative Affect Schedule, Expanded

Form (PANAS-X):

1. Joviality: happy, joyful, delighted, cheerful, excited, enthusiastic, lively,

energetic

2. Self-assurance: proud, strong, confident, bold, daring, fearless

3. Attentiveness: alert, attentive, concentrating, determined

Third, the researcher chose to include love, compassion, gratitude, contentment,

pleasure, playfulness, and amusement (may include laughter), based on a review of

the positive affect-related literature and theory.

Review of Literature

While there are many avenues of research regarding positive affect, the trends in

DMT and body psychotherapy literature provide the primary context for this project

and are examined below. Theory and research from a number of other areas, such as

positive psychology, play therapy, laughter therapy, neuropsychiatry, psychoneu-

roimmunology, trauma, and attachment are also included as they contribute to the

understanding of why positive affect should be considered.

DMT Literature

As mentioned above, while dance/movement therapists seem to intuitively support

positive affect in practice, it is not yet reflected well in the research and theory. A

few DMT studies have looked at both positive and negative affect (Devereaux,

2008; Koch, Morlinghaus, & Fuchs, 2007; Kuettel, 1982). Kuettel (1982) conducted

experimental research on affective change in participants of a DMT group and

found increases in the reporting of confidence, including feeling confident, relaxed,

likeable, and accepted, as well as an increase in feelings of affection. Significantly

less reporting of anxiety and inhibition in participants was also found. In another

experimental study, a single dance intervention was found to decrease depression

and increase positive affect and vitality in psychiatric patients with depression

(Koch, Morlinghaus, & Fuchs, 2007). More specifically, motivation, coping,

strength, energy and enjoyment increased, while depression, lifelessness, anxiety,

tension and tiredness decreased. While a single DMT group was a limitation of

these studies, they suggest that DMT interventions may increase positive affect and

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decrease negative affect in participants. Furthermore, Devereaux’s (2008) case

study using DMT with a family who experienced domestic violence noted an

increase in laughing and positive affect in family members over time, which was

described as a significant part of their healing from trauma and a sign of increase in

their capacity for self-regulation.

Much DMT research has focused instead on measuring negative states and

emotions, and sometimes variables such as quality of life and self-esteem. For

instance, lowered depression and anxiety in hospitalized and non-hospitalized

participants were reported following a single DMT group (Brooks & Stark, 1989).

Brauninger’s (2005) experimental study found a reduction in stress and in negative

strategies for managing stress, as well as an improved quality of life in DMT

participants. Another study suggested that DMT with patients with cancer

contributed to improvements in quality of life, reduction of anxiety and depression,

and increased self-esteem (Mannheim & Weis, 2006). A limitation of this study was

that the results could not be attributed to DMT alone due to the multi-treatment

context. Smithson (1997) explored options for addressing Hendricks’ (2009) ‘‘upper

limit problem,’’ or difficulty tolerating positive affect and experiences, in her thesis

case study involving a body- and play-based workshop.

DMT practitioners have, at times, written about positive affect as a component of

their theory and practice. For instance, Trudi Schoop, a pioneer of DMT, privileged

the use of humor, laughter, and playfulness in working with clients (Levy, 2005).

Also, the Kestenberg Movement Profile (KMP), a non-verbal assessment system

used in DMT to understand the psychological significance of movement patterns,

includes Tension-Flow Attributes, which are considered to reflect and convey

feelings related to pleasure and displeasure (Kestenberg Amighi, Loman, Lewis, &

Sossin, 1999). The KMP is also used to assess areas of strength and harmony in

individuals as well as between people. Koch, Morlinghaus, and Fuchs (2007) used

the KMP to inform their DMT intervention, a dance with jumping rhythms.

Body Psychotherapy Literature

Body psychotherapy theory and practice have contributed an understanding of how

the body and positive affect are related and why positive affect is important. Lowen

(1990), founder of bioenergetic analysis, wrote about the phenomenology of health,

stating, ‘‘the subjective feeling of health is one of aliveness and pleasure in the

body, a feeling that increases at times to joyfulness’’ (p. xi). He identified pleasure

and satisfaction as ‘‘the immediate experience of self-expressive activities’’ (p. 49),

and his exercises were designed to enliven the body in order to experience joy and

pleasure. Keleman (1981) described the body’s natural pulsation, or aliveness, as

pleasurable, and Reich (1927/1973), teacher to Keleman and Lowen, equated the

pleasure of orgasm and the pleasure of living. Hendricks (2009) discussed the

‘‘upper limit problem,’’ or the difficulty people have with tolerating positive affects

and experiences, as well as ways of working with this barrier to increase happiness,

intimacy, and success.

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Other Relevant Research

Theory and research from additional areas have contributed to understanding this

topic and providing a context for the project. Positive psychology’s Seligman (2011)

identified positive emotion as one of the five pillars of well-being. Positive

psychotherapy, a branch of positive psychology, departs from many models by

employing interventions that appear to ‘‘increase positive emotion, engagement, and

meaning rather than directly targeting depressive symptoms’’ (Seligman, Rashid, &

Parks, 2006, p. 774). Also within positive psychology, the ‘‘broaden-and-build’’

theory proposes that experiences of positive emotions broaden people’s momentary

thought-action repertoires, which builds their internal resources in the long-term

(Fredrickson, 2001). Dialectical behavior therapy (DBT) asserts the importance of

increasing positive emotions for greater emotion regulation, highlighting the steps

of building positive experiences and being mindful of those experiences (Linehan,

1993). Fosha (2009) has contributed her understanding of the importance of positive

affects in the interpersonal therapeutic process of transforming one’s suffering into

flourishing.

Findings from play and humor research are relevant to this study as well. For

instance, enjoyment was identified as one of the 14 therapeutic elements of play

(Schaefer, 1993) and Csıkszentmihalyi’s (1997) research suggested positive affect

commonly followed states of ‘‘flow.’’ Other research suggested that humor can

alleviate pain, increase immune function, moderate stress, increase positive

emotions, and improve interpersonal processes (Benett & Langacher, 2008;

Chapman, 1976; Gelkopf, Sigal, & Kremer, 1994; Lefcourt, Davidson, Prkachin,

& Mills, 1997; Levenson, 1988; Martin, 2001; Skevington & White, 1998). The

benefits of humor in therapy, and guidelines for its appropriate use, were discussed

by Richman (2003), Sultanoff (2003), and McGuire, Boyd, and James (1992).

Lastly, laughter interventions in the workplace have been shown to increase self-

efficacy in self-regulation, positive emotion, optimism, and social identification

(Beckman, Regier, & Young, 2007).

Much research in neuroscience has pointed to the importance of positive affect in

health. A neuropsychiatry study looked at the disruption of components of affective

processes related to the positive affect systems in cases of depression (Forbes &

Dahl, 2005). Psychoneuroimmunology research has suggested an association of

positive affect with lower morbidity, decreased symptoms and pain, and health

protective responses (Pressman & Cohen, 2005). In the area of trauma and

attachment, Schore (2003) highlighted the role of the positive affective experience

following a negative experience in the healing of trauma and in the development of

healthy attachment.

The present research on positive affect in DMT has several aims. First, it seeks to

help build an understanding of how and why positive affect can be utilized within a

DMT group, adding to previous research that looked at whether positive affect

increased as a result of DMT interventions. In doing so, it aims to bring the

exploration of positive affect to center stage, since, as mentioned above, positive

affect cannot simply be equated with the absence of negative affect. This study

endeavors to make explicit what is intuitively known or assumed by some dance/

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movement therapists about working with positive affect. Finally, the researcher

hopes to spark discussion about how both clients and clinicians might be impacted

by this focus.

Methodology

A purposive and convenience sample of three dance/movement therapists was used

in this study. To recruit participants, the researcher contacted dance/movement

therapists suggested by colleagues and posted a request for participants in the

American Dance Therapy Association (ADTA) online forum. Participants were

registered or board-certified dance/movement therapists who consciously worked

with positive affect in adult DMT groups, such as attending to it, considering

clients’ tolerance for it, or using interventions to support it. They were located in the

greater Denver area and the mid-Atlantic coast, and all were females who appeared

to be Caucasian and without physical disability. Two participants entered the field

within the last 10 years while the third had worked in the field for over 25 years.

They responded about their work with inpatient psychiatric, adult day program, and

eating disorder partial hospitalization program patients.

The semi-structured interviews were conducted for between 60 and 85 minutes,

two in person and one via online video call. Participants received a sheet with the

research question and the operational definition for positive affect for reference

during the interview. The interviews were audio-recorded, while the researcher took

notes to highlight verbal and non-verbal content of interest. The researcher asked

participants approximately the same nine questions, with variations in wording, in

addition to questions informed by the content of the interview and by the previous

interviews. A sample of the interview questions follow: (1) Briefly describe your

theoretical orientation and practice, (2) What does the range of affect in your clients

during a DMT group tend to include? (3) How does positive affect show up? (4)

How do you work with positive affect in your current practice? What interventions

have you found to be most/least effective for working with positive affect with

clients? The researcher used minimal encouragers and summarizing during the

interviews to create contact with the participants and to stimulate further responses.

In order to control for validity and reliability, the interview questions were reviewed

to ensure they were not leading and they were open enough to solicit a wide range of

individual experience, and the researcher practiced self-reflexivity about her own

influence on the interviewee, supported by reflexive memoing during and after the

interviews.

Data analysis was carried out according to established qualitative data analysis

procedures, starting with pre-coding, or reading through transcripts twice and

highlighting passages that appeared significant. The researcher then extracted

in vivo codes, or direct quotation words, phrases, and sentences, from the interview

transcriptions. Process codes, or gerund verbs (‘‘inviting’’), were identified to

capture processes inherent within the codes and sections of narration. Then the

codes for each interview were clumped into categories and reviewed for relevance

to the research question, after which analytic memos were written to summarize

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core messages and impressions from each interview. When the categories and their

contents were compared and contrasted across interviews, four overarching

categories emerged as encompassing the combined interviews’ codes and initial

categories. The researcher pulled out salient themes using the categories, sub-

categories, and analytic memos, and these were combined and distilled into 13

themes.

Results

The following section outlines the results of the study, presenting themes revealed

by the data analysis process under the four categories of Therapeutic Interventions,

Therapeutic Intentions and Goals, Client Attributes, and Therapist Attributes, as

shown in Table 1.

Therapeutic Interventions

Findings within the Therapeutic Interventions category revealed a wide variety of

items pertaining to non-verbal and verbal interventions and their observed results.

These findings mapped onto the ‘‘what interventions did therapists use’’ part of the

research question and contributed to understanding the unasked question of ‘‘what

Table 1 Results categories and themes

Categories Themes

Therapeutic

interventions

Seemed to either encourage PA directly or indirectly

Balance between bodily experience and verbal education and processing

Named or described using their body as an intervention

PA seemed to spread

Positive effects observed and self-reported in response to intervention

Therapeutic intentions

and goals

Intentions seemed to lay groundwork for PA

Emphasized goals of building relationship with the self and experiencing

relationship with others, as well as ways these seemed to lead to PA

Invited full spectrum of affect to be present while also supporting

transformation of affect

Client attributes Benefits of PA focus with clients with depression, anxiety, low vitality,

disconnection from self and others, and self-criticism or self-hatred

Relationship to PA tended to be in need of development and support,

including tolerance for PA

Therapist attributes Articulated their understanding of and rationale for focusing on PA

Strong personal relationship with PA & recognition of its value

Self-reflection, self-knowledge, and frequent assessment of interventions to

guard against ‘‘missing’’ clients due to bias towards PA

PA positive affect

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were the results?’’ One theme was interventions seemed to either encourage positive

affect directly or indirectly. The indirect ways often related to the therapeutic

intentions in the category below, and they included using self-disclosure and voicing

confidence in the therapeutic results to build trust, and normalizing a client’s

experience by asking for input from the group or providing psycho-education and

reframing. Other examples were alleviating clients’ anxiety and creating safety by

responding to clients with acceptance or humor and providing the appropriate level

of structure or options, including the option to not take part.

Many interventions seemed to encourage positive affect directly. Sometimes they

involved humor and play. These were both verbal and non-verbal, including

therapist’s light teasing, verbal quips, ‘‘goofing off’’ facial expressions, or

pretending to fall. Two participants named using ‘‘the fool’’ archetype, including

intentionally making silly movement or being ‘‘goofy.’’ One participant said,

‘‘Humor is really, really curative.’’ Therapists facilitated interactive play with props

and the creation of art. Play also appeared in the attitudes of exploration and

curiosity versus judgment. In a group art example, clients were encouraged to have a

non-judgmental stance and present-moment focus to help them enjoy the process

instead of judging the product and ‘‘trying to make it good.’’ These findings recall

Schoop’s use of humor and playfulness, as well as the literature on the emotional

and behavioral benefits of humor in therapy (Levy, 2005; McGuire, Boyd, & James,

1992; Richman, 2003; Sultanoff, 2003). Other interventions included evoking a

positive movement memory that clients embodied, recalling and sharing their

favorite things or occasions, reframing clients’ intentions in the affirmative, and

enjoying sensory experiences of sights, sounds, smells, touch, and movement. There

was also ongoing group movement to increase vitality and expand clients’

experience of self, including developing integrated movement, broadening the range

of efforts and shapes, and expanding one’s kinesphere.

Interventions that directly encouraged positive affect included those used to

address or increase clients’ tolerance for positive affect, an area of overlap with the

theme about clients’ relationship to positive affect being in need of support,

discussed under Client Attributes. For instance, psycho-education was provided on

the negativity bias and the need to counter it, the dynamics of change, including

gains and backtracking, and the importance of pleasure and joy for health. Also,

‘‘baby steps’’ were used in experiential work that gradually led clients from

exploring negative to neutral to positive stimuli in their bodies and environment.

One participant used humor with a client, calling her ‘‘Teflon lady’’ and talking

about the importance of letting in positive things in recovery. Another gave

homework such as walking outside and noticing ‘‘five things that my eyes are drawn

to, five smells that I find pleasurable, etc.’’ or ‘‘giving permission for play’’ by

assigning a playful activity and reporting back, in order to ‘‘develop the muscle of

positive affect.’’

Another Interventions theme was the balance observed between bodily experi-

ence and verbal education and processing. While bodily experiences of movement,

dance, sensory exploration, and playful interaction seemed to be primary, psycho-

education and verbal processing also seemed to be key to the therapeutic process.

Regarding the first aspect, participants described clients’ bodily experiences of joy,

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pleasure, connection, safety, and gratitude. One said, ‘‘Something got reawakened in

her…she has that sort of joy of life now…we didn’t sit around and talk about it, she

had that experience in her own body.’’ However, therapists clearly used psycho-

education and verbal processing of experiences to support clients’ growth. Two

participants used psycho-education for getting clients’ buy-in, providing a

framework, and normalizing experience. One used psycho-education to clear up

clients’ misunderstanding that ‘‘positive thinking means you’re never supposed to

get mad, and if you get mad, it’s a symptom, and it means you’re a bad person’’ by

normalizing ‘‘the human experience.’’ Two participants described guiding clients’

integration by helping them reflect on their therapeutic experiences, with as little as

a one-word debrief.

Overlapping somewhat with the first theme in this category, therapists named or

described using their body as an intervention, a concept central to DMT theory and

practice. This included many ways of therapists cueing or modeling for clients non-

verbally. For instance, one therapist physically cued clients in a movement circle to

encourage broadening their range of effort and use of space, energizing out their

limbs, and integrating sections of the body. Other examples were breathing deeply,

modeling excitement, using a gesture and posture to communicate confidence, and

modeling playfulness and acceptance of imperfection, sometimes referred to as ‘‘the

fool’’ archetype. One participant noticed, ‘‘I’m really mobilizing my face a lot in

those groups’’ by using ‘‘goofing off facial expressions’’ that patients responded to.

Findings suggested positive affect seemed to spread from the therapist to the

group and within the group. This seemed to point to the value of positive social

interaction and environment, and it seems to be a benefit with implications for group

therapies. Examples included the ‘‘contagion’’ of the therapist’s own love of dance

and enthusiasm for their work, a joke moving through a group causing a positive

affective shift, clients with dementia feeling good because of the positivity in their

environment, and positive memories evoking others’ positive associations in a

fashion described as ‘‘viral.’’ However, one participant mentioned how as energy in

the group rose there was a ‘‘peeling off’’ of clients with lower functioning or lower

tolerance for positive affect.

Lastly, positive effects were observed and self-reported in response to

interventions. These effects spanned the physical, emotional, cognitive, and social

realms. They included smiling, laughing, experiencing their body as a resource, and

feeling hopeful, pleasure, grateful, accepted, strong, and relaxed but alert. Clients

showed self-knowledge, self-acceptance, assurance, and pride. Clients displayed

less facial tension, ‘‘gentle tone’’ in the muscular system, better postural alignment,

rhythmic response to music, integrated movement, and fuller breathing, including

sometimes sighing or audibly exhaling. Clients had greater energy and vitality,

seemed ‘‘lifted up’’ physically and emotionally, were comfortable being themselves,

and had attentiveness in the form of being present in their body. They expressed

emotion and cried. Clients noticed others, leaned in, moved closer to peers, bonded,

made eye contact, collaborated, led, and expressed clearer thoughts. These findings

relate to Kuettel’s (1982) results of increased confidence (feeling likeable, relaxed,

confident, accepted) and less inhibition and anxiety in study participants after a

DMT group. They also recall the increased energy and enjoyment and decreased

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depression, lifelessness, anxiety, tension, and tiredness found by Koch, Morling-

haus, and Fuchs (2007). The findings also relate to the decrease in negative states

and emotions following DMT interventions found in previous research (Brauninger,

2005; Brooks & Stark, 1989; Mannheim & Weis, 2006). There may also be a

connection with Csıkszentmihalyi’s (1997) identification of positive affect

commonly following states of ‘‘flow.’’

Therapeutic Intentions and Goals

It appeared that both therapeutic intentions and interventions had a hand in

supporting positive affect in clients; while intention was not included in the research

question, it would be helpful to include it in future research. This category contained

three themes that seemed to map onto the ‘‘how’’ part of the research question. The

therapeutic intentions therapists described—safety, trust, normalization, acceptance,

connection, resourcing, challenge, playfulness, and exploration—seemed to lay the

groundwork for positive affect, and conceivably, other therapeutic outcomes.

Normalizing experience was very common in the responses. It seemed that

therapists’ normalizing efforts increased the other intentions of safety, acceptance,

and connection with others, which seemed to be precursors for positive affects of

compassion towards oneself, pride, confidence, enthusiasm, and liveliness.

Resourcing was evident in clients finding pleasure in sensory experiments,

physically experiencing the ‘‘joy of life,’’ feeling pleasure in embodying a positive

movement memory that they could go back to when feeling overwhelmed, and

bonding with group members.

The theme emphasized the goals of building relationship with the self and

experiencing relationship with others, as well as ways these seemed to lead to

positive affect were common across participants, although the methods varied.

Relationship with the self included physical integration through movement, sensory

stimulation, tracking sensation and emotion in oneself, staying mentally present to

one’s experience, and building self-knowledge through self-reflection. One

participant said a goal was to ‘‘get the body–mind connection reconnected,’’ as

patients often felt ‘‘broken and fragmented inside’’ upon being admitted and ‘‘frozen

from the neck down.’’ Often her goal was ‘‘the self relationship through the

movement and the body awareness.’’ Increasing clients’ comfort in following their

own movement impulse or expression was mentioned. Two participants emphasized

awareness of the senses and of internal experience in order to give clients a felt

experience of ‘‘body as epicenter and source of wisdom.’’ One also helped clients

develop self-compassion and increase self-knowledge through self-reflection.

Experiencing relationship with others included connecting with others through

movement, verbal sharing, and creative collaboration. One participant said she

aimed to ‘‘foster and encourage contact in as many ways as possible’’ and the group

was partly for ‘‘coming together with others that are having similar life

experiences.’’ Connecting with others through movement was one way of doing

this. Sometimes this meant playing together, such as tossing a ball or swinging a

jump rope. Other ways were sharing with others verbally and collaborating

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creatively, such as co-creating a dance or artwork. Experiencing a safe relationship

with the therapist was also mentioned.

Third, all participants invited the full spectrum of affect to be present while also

supporting transformation of affect. These findings reflected the acceptance and

normalization intentions prevalent in the interviews, as well as the Therapist

Attribute of being cautious to not let their focus on positive affect prevent

attunement. One participant ‘‘let it be okay for…both sides to be there, for the joy

and for the sorrow, and the anger…to have a full plate of emotions that are

welcome.’’ Another said while her groups were joy-oriented, ‘‘there could be a

depressed day where we stay in the sad place and I help them tolerate and be able to

stay in flow even though there’s a lot of heavy sadness.’’ Also, normalization was

used to invite negative affect via discussion and psycho-education about ‘‘the

human experience.’’

In terms of affect transformation, some mechanisms are discussed here, while

interventions are discussed in Therapeutic Interventions. Findings included how

positive and negative affect could combine to make the negative affect safe, and

how forming a relationship with an affect helped shift it. An example was a group

where ‘‘anger mixed with joy,’’ where affect was ‘‘processed and digested in

movement.’’ The anger ‘‘was expressed with great vigor and physical vitality and

humor and playfulness.’’ The therapist said, ‘‘That’s appropriate—if we can be

playful about our hatred and our rage…then we have reflective consciousness.

That’s pretty optimal emotional functioning.’’ Her patients later remarked, ‘‘I was so

mad at this place—now I feel great…I’m going to have a great day today.’’ Another

participant supported clients in experiencing that ‘‘when I don’t try and change it or

force it into positive affect’’ but rather listen to negative affect and give it ‘‘space

and voice and acceptance,’’ it ‘‘transforms it into at least something more neutral.’’

One stated, ‘‘Just speaking of the grief makes them feel better.’’

Client Attributes

In this category, two evident themes mapped onto the ‘‘in what instances’’ (when or

with whom) part of the research question. First, despite their differing populations,

all therapists talked about the benefits of a positive affect focus with clients with

depression, anxiety, low vitality, disconnection from self and others, and self-

criticism or self-hatred. However, the data suggested that the particular form or

level of positive affect needed to be adjusted to the clients’ needs and states, as

some forms could be contraindicated. One participant said that in groups including

patients with hypomania or schizophrenia, interventions needed to be less

activating, more structured, and more focused on containment. These groups were

described as more about the positive affect of contentment versus joyful. While a

‘‘koosh or squishy ball’’ was chosen for warm-up where less activation was desired,

a beach ball was chosen for a more depressed group. Another example was that to

support a client who was very anxious at the end of the day, the therapist would not

use ‘‘excited,’’ but rather happy, reassuring, confident, and at ease affect. One

participant cited clients who are heroin addicts as possible mis-matches for her

DMT groups, as they are often in need of opening up to feelings of grief and

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despair: ‘‘That’s where they need to go therapeutically, not joy, and so my groups

are really not right for them.’’

The other client attributes theme was relationship to positive affect tended to be

in need of development and support, including their tolerance for positive affect.

(See ‘‘Therapeutic Interventions’’ category regarding interventions for tolerating

positive affect). Indicators of difficulty with tolerance included the body language of

blowing off a compliment, looking down, and a shrinking posture. Depressed clients

were described as leaving a DMT group when the ‘‘process moves to…a higher

energy.’’ The experience of positive affect was described as intense and unfamiliar

for clients in two of the three interviews, and two participants described difficulties

with or blocks to experiencing positive affect. Two therapists said that positivity

was often difficult and fear producing for clients, calling it ‘‘disorienting,’’

‘‘uncomfortable,’’ ‘‘different,’’ ‘‘powerful,’’ and ‘‘overwhelming.’’ One said, ‘‘It

feels very weird to feel good! For some people, it’s creepy!…They’ve hardly ever

felt it.’’ Clients who had fun in her group often indicated that this was outside of

their normal experience, saying things like, ‘‘I never dreamed I would ever feel this

good again!’’ One therapist named addiction to heroin and ‘‘masochistic character

dynamics’’ correlating with being ‘‘totally resistant to positive affect.’’ This might

be due to growing up in families where ‘‘excitement is not allowed.’’ These clients

tended to have ‘‘terrible self-hatred,’’ and their difficulty with taking in positive

emotional energy prohibited them from benefiting from a helping relationship.

Another therapist said, ‘‘If you’re stuck in self-loathing and actually believe it, when

you have that spark of self-acceptance…it’s intense!’’ She related tolerance of

positive affect to clients experiencing gains, saying that when clients ‘‘backtrack

and regress’’ after making gains it often ‘‘reveals their threshold for positive affect.’’

She said, ‘‘People need time to get used to change, even if it’s positive.’’ The

therapist who worked with memory-impaired clients talked about re-directing

clients’ attention to the present moment and positive social setting to help clients

access their positive affect, which then tended to ‘‘stick.’’ However, she said,

‘‘When they’re not part of a group, it’s hard to find the positive thoughts.’’ These

findings relate to Hendricks’ (2009) attention to the ‘‘upper limit problem.’’ They

also call to mind the DBT skill of being mindful to positive experiences in order to

take them in and reap the benefits (Linehan, 1993).

Therapist Attributes

The themes within the last category, Therapist Attributes, involved therapists’

rationale for focusing on positive affect, their personal relationship to positive

affect, and their use of self-reflection, self-knowledge, and assessment of

interventions. These findings mapped onto the ‘‘why’’ and ‘‘how’’ parts of the

research question, and they also contributed to understanding the unasked question

of ‘‘who’’: What are the qualities of dance/movement therapists who work with

positive affect? The theme articulated their understanding of and rationale for

focusing on positive affect encapsulated divergent but complementary viewpoints.

These viewpoints included physical vitality as origin of positive affect, positive

affect as foundation for learning and change, and sensory stimulation, bodily

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activation, and social connection as producers of positive affect. The rationales

seemed to be specific to the needs of therapists’ populations, including the level of

care. The therapist on an inpatient psychiatric unit emphasized physical activation,

continuous group movement, being ‘‘in the flow,’’ expanding the kinesphere and the

range of efforts (from Laban Movement Analysis), and rhythmic release. She

asserted that positive affect was ‘‘rooted in physical vitality…it’s getting that

vitality going, it’s where the joy comes from’’ and ‘‘getting people into flow.’’ She

said clients in her groups experienced the ‘‘joy of life’’ bodily, and this ‘‘positive

reinforcement’’ helped motivate clients to stay on medications and attend outpatient

treatment. Her approach supported the goal of getting patients ready to safely leave

the hospital as soon as possible. Furthermore, her humor and ability to roll with a

client’s outrageous remark, for example, helped clients feel safe enough to engage

in an unfamiliar DMT group. The therapist in an adult day program with primarily

older adults with Alzheimer’s and other diseases encouraged positive affect by

helping her clients enjoy the present moment, enjoy interacting with peers, and feel

positive emotions as well as other emotions. Her aim was to ‘‘get people here and

present and feeling good and connecting,’’ for which she emphasized sensory

stimulation, movement, normalizing the clients’ experience, social stimulation, and

interactive exercises to draw clients ‘‘back out into the world’’ so they could access

the positive feelings and support in their environment. The third participant worked

with clients with eating disorders in a partial hospitalization program, and she

stated, ‘‘Positive affect and…the neural soup that that’s associated with…(lay) the

groundwork for positive change, for growth, for self-actualization.’’ She went on to

say, ‘‘When people are relaxed, feel accepted, feel loved, that’s when they will take

risks, try new things, discover new things about themselves.’’ DMT helped her

clients because ‘‘as we move differently, as we expand our movement vocabu-

lary…we’re opening up to new sensations, to new feelings, to new emotions,

and…people have sparks and insight and new ideas on how to change their life for

the better.’’ These findings regarding physical activation and arousal reflect Chace’s

central DMT principles of body action and energy mobilization (Chaiklin &

Schmais, 1993), as well as the increase in positive affect and vitality in DMT

participants found by Koch, Morlinghaus, and Fuchs (2007). The focus on bodily

experience of sensations, including pleasure, and the use of energetic release recall

Lowen’s work (1990).

Participants also exhibited a strong personal relationship with positive affect and

recognition of the value of this in their work. First, two participants either said it was

one of her gifts as a dance/movement therapist or described it as an ‘‘asset’’ and

acknowledged a natural fit between this part of her personality and her client

population. Second, all participants either said they love or enjoy their work, or their

words suggested this. Examples were ‘‘I love my job…that’s part of the joy that I

bring…I’m having a blast, man!’’ and ‘‘I enjoy my work and I enjoy them a lot, and

I try to let them know that.’’ Perhaps participants’ positive affect was a result of

doing work they loved, or perhaps it allowed them to feel positively about their

work. Third, it seemed that having strong positive affect might have helped

therapists to support it in clients. For instance, participants spoke about the

importance of having or consciously modeling positive affects such as excitement,

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appreciation, confidence, fearlessness, acceptance towards oneself, and joy,

including movement efforts one participant associated with joy. One participant

said authentically ‘‘feeling good, I hope, will spread’’ and she noted that it does

seem to. Another participant said, ‘‘I’m very, very confident in the benefits (of

DMT) for them’’ and noted this was a therapeutic factor in psychotherapy. Fourth,

the findings suggested that therapists might need to take steps to develop or maintain

their positive affect. One participant who used a lot of humor noted that she did not

learn to be funny from her family, but from elderly patients she worked with early in

her career. Another participant had a history of depression, shyness, and not feeling

comfortable in her body, but through personal growth she became ready to lead

DMT groups with an emphasis on authentic self and self-acceptance. This area of

the therapist’s relationship with positive affect and using it for therapeutic means is

reflected in Fosha’s work (2009). Use of therapists’ humor in particular recalls

Schoop’s approach with clients as well as Sultanoff’s (2003) suggestions to

therapists for developing humor skills (Levy, 2005).

The theme self-reflection, self-knowledge, and frequent assessment of interven-

tions to guard against ‘‘missing’’ their clients due to their bias towards positive

affect spoke to the best practice of being mindful of how one is influencing the

therapeutic relationship. This theme, emphasized by all three participants, seemed to

answer the ‘‘how’’ part of the research question with ‘‘carefully.’’ One example was

the therapist watching the group’s response to the efforts of her movement cues and

realizing at times ‘‘Oh, whoops, I’m in my groove. That’s not where the group is

today,’’ adding ‘‘it’s always an assessment from moment to moment.’’ Another said

she was careful not to be dismissive of clients’ negative emotions or to seem

‘‘insensitive and not attuned,’’ like by being too ‘‘rah rah rah…too quickly.’’ She

aimed to role model positive affect ‘‘without shoving it in their face.’’ Another

example was trying to make sure that the voices of anger or depression were heard

in the group. This was important because of ‘‘the pressure on seniors to be pleasant

and to not be a bother,’’ requiring that one stay on the lookout for people ‘‘shutting

down their own emotions in order to put on a happy face’’ or making comments like

‘‘there’s no use crying about it.’’

Discussion and Concluding Thoughts

This qualitative study sought to understand how three dance/movement therapists

consciously attended to and employed interventions to address positive affects

within adult DMT groups. What do therapists do when they focus on positive affect,

why do they do so, and in what instances? The researcher’s question was influenced

by reading about positive psychology and learning dialectical behavior therapy,

both of which emphasize not just lessening symptoms like depression and anxiety,

but increasing the emotions and experiences that make life enjoyable and worth

living.

A variety of interesting themes emerged from the interview data and many were

common to all three participants. The themes fell into the categories of therapeutic

interventions, therapeutic intentions and goals, client attributes, and therapist

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attributes. One unanticipated finding under Therapist Attributes contributed to

understanding the unasked questions of ‘‘who,’’ or ‘‘what’’ were the qualities of

dance/movement therapists who work with this focus. The primacy of the role of the

therapist’s relationship to positive affect was of personal interest to the researcher as a

DMT and counseling graduate student exploring how her own personality qualities of

playfulness and humor may fit into this field. It also spiked curiosity as a consumer of

professional training—how might DMT/counseling programs include development

of positive affect in their students, if it does indeed have professional value? How do

students or therapists maintain their own positive affect? What clinical aspects of

focusing on positive affect can be taught? What, if any, are the particular movement

qualities affiliated with positive affect that a therapist may learn to embody or

encourage in a client? It seems that the field would benefit from research on these

topics. It would also be useful to ask about issues of transference and countertrans-

ference, which could influence therapists to stimulate positive affect as a way of

avoiding clients’ negative projections. These issues would be in line with the theme of

self-reflection, self-knowledge, and frequent assessment of interventions.

Another area of interest is the possible expansion of the definition of positive

affect to reflect the embodied experiences woven throughout these results. After the

interview, one participant suggested a modification to include ‘‘feelings that reflect a

level of pleasurable engagement with the self, as well as with the environment.’’ All

the participants spoke to interventions and intentions involving clients’ experiences

of the self in the present moment, often through the body and senses.

Limitations of this study included a small sample size and a lack of diversity in

gender, ethnicity, geographical location, and educational background. Future

research should include a larger and more diverse sample of practitioners to ensure

a more comprehensive understanding of how dance/movement therapists relate to

this topic. Conducting one of the interviews via video call may have influenced the

findings, given that both sides experienced occasional sound and visual interruptions

and the interviewee did not have the research question and operational definition in

hand as the in-person interviewees did. A positive aspect of the video format was

that as the interviewee witnessed her face as she spoke about her groups, she made a

valuable realization about her facial mobility and the use of her face as an

intervention. One study error was that the first interviewee received a positive affect

definition that was slightly more encompassing than the others; the researcher later

removed the PANAS-X’s serenity scale, with descriptors of calm, relaxed, and at

ease, as Watson and Clark (1994) did not identify this scale as core to positive

affect. Future research would benefit from not just articulating a consistent

definition of positive affect within the study but seeking consistency between

studies, in order to increase the validity of results. Also, researcher demand effects

may have influenced participant contributions, and possible expectancy effects may

have influenced the researcher in the interviews or in the data analysis process.

Further qualitative and quantitative research needs to be done both to increase

understanding of what is being done in the field and to measure outcomes. Although

evaluating results was not a goal of the project, the data pointed to a wide array of

benefits to focusing on positive affect in mental health settings, which would be

useful to quantify. Despite its limitations, this study did confirm the researcher’s

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anecdotal evidence of DMT as a natural fit for working with positive affect and it

provided another step for future research to build on towards understanding the area

of positive affect in DMT.

Acknowledgments The author would like to thank Christine Caldwell for her guidance and mentorship.

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Amanda J. GordonMA, R-DMT, is a graduate of Naropa University’s Somatic Counseling Psychology program. Dance/

Movement Therapy and Body Psychotherapy principles are central to her current work as DBT group

facilitator for clients with mental illness and substance abuse at Exempla West Pines in Wheat Ridge, CO.

She is experienced in leading embodied groups with teens and adults in service to social change,

community building, and personal healing. She is delighted to have playfulness as a clinical companion

and personal resource.

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