Edith Z. Baum, M.A, AD.T.R., is a movement therapist at
the Dissociative Disorders Program at The Institute of
Pennsylvania Hospital.
For reprints write Edith Z. Baum, M.A, AD.T.R., Activities
Therapy Department, The Institute ofPennsylvania Hospital,
III N. 49th Street, Philadelphia, PA 19139.
ABSTRACT
Group movement therapy with multiple personality disorder (MPD)
patients can provide a useful healing experience, though the treat-
ment of homogenous MPD group can be a challenging endeavor.
Four pervasive themes emerged in the movement sessions: establish-
ing trust through kinesthetic empathy, negotiating social interac-
tion, eliciting expressive movement and traumatic material, and
integrating a more coherent sense of self. These themes were con-
gruent with parallel developments in individualpsychotherapy. The
interdisciplinary collaboration ofverbaland movement therapy works
well together. Often work in one modatity helps to negotiate impass-
es in the other. The evocativepower ofmovement and the therapeutic
principles thatflow from it, i. e., that one can move across the dimen-
sions of behavior, affect, sensation and knowledge (BASK), serves
to reconnect the sequestered aspects of the traumatic past, encour-
aging integration.
INTRODUCTION
Movement (alternativelycalled dance) therapy is based
on the assumptions that the body and the mind are insepa-
rable, and that human body movement embodies and
expresses inner psychic states.
There is so close an interrelation between the muscu-
lar sequence and the psychic attitude that not only does the
psychic sequence connect up with the muscular states, but
also every sequence of tensions and relaxations provokes a
specific attitude. When there is a specific motor sequence it
changes the inner situation and attitudes and even provokes
a phantasy situation which fits the muscular sequence.
(Shilder, 1950, p. 208).
Thus, not only do specific movements reflect certain
inner psychic realities, but the movements may call forth
images, moods, and memories. One can understand the way
one feels from body movement as well as change the way
one feels by changing movement behavior. To regain a sense
ofwholeness by experiencing the fundamental unity ofbody,
mind, and spirit is the ultimate goal of movement therapy
(Chaiklin, 1974; Levy, 1988).
Since the days of neolithic man, dance has served as
an expression oftribal unity and strength, and has been used
to mediate with external forces; e.g., fertility dances, war
dances, etc. Ithas provided individualswith a means to express
themselves and to communicate with others. The dances of
the medicine man, priest or shaman belong to the oldest
forms ofhealing, in which the release oftensions transformed
physical and mental conflicts into healthier attitudes. At the
dawn ofcivilization, dancing, religion, music, and medicine
were inseparable (Meerloo, 1960).
In modern times, psychoanalysts and movement ther-
apists encouraged the expression of inner turmoil for ther-
apeutic purposes, and recognized the relationship between
body expression and inner feelings. Freud himself acknowl-
edged the connection between the body and the emotions
in his oft quoted statement, "He that has eyes to see and ears
to hear may convince himself that no mortal can keep a
secret. If the lips are silent, he chatters with his finger tips,
betrayal oozes out of him at every pore. And thus the task
of making conscious the most hidden recesses of the mind
is one which it is quite possible to accomplish" (Freud,
1905/1948, p 94). Wilhelm Reich (1944) believed that phys-
iological behavior is fundamentally identical with psychic
behavior. He postulates that "character armor" consists not
only of psychological defenses, but also of muscular defens-
es, both ofwhich serve to protect the individual againstpainful
and threatening emotional experiences. While psychoana-
lysts and dance therapists have agreed about the intercon-
nectedness of mind and body, psychoanalysts and psycho-
analytically-oriented psychotherapists primarilyencouraged
verbal expression ofthe unconscious, while dance therapists
used body movements as the vehicle for expression (Levy,
1988).
The early dance therapy pioneers were interested pri-
marilyin "spontaneity, authenticity ofindividual expression,
awareness of the body, themes that stressed a whole range
offeelings and relationships" (Bartenieff, 1975, p.246). Marion
Chase, influenced by neo-Freudian and interpersonal the-
orists Harry Stack Sullivan and Freida Fromm-Reichman,
used rhythm and synchrony to draw out patients from iso-
lation and withdrawal. She perceived the role of the thera-
pist as one who created opportunities for interrelatedness
among patients as well as with the therapist. Expression, com-
munication, and relatedness was the essence of her thera-
peutic work. This enabled her patients gradually to build a
sense of self through interactions with others (Chaiklin H.,
99
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DISSOCIATIO:'I, Vol. IV. :'10. 2,June \99\
MOVEMENT THERAPY WITH MPD
1975).Whitehouse (1979), influenced byJung, utilized move-
ment as a key to reaching unconscious material. Her goal
was to encourage individuals to let go of conscious control
in order to move more freely and expressively.
According to Dyrud this release ofmuscle tension "may
very well have been of particular value, because it occurred
in a context of beginning dialog, re-establishing patterns of
motility which could then logically extend from motor, to
affective and cognitive sequences ... in the dialog between
patient and therapist" (1963, p 151). Current literature on
child development suggests that the sequence of motor to
affective to cognitive growth is seen in early childhood devel-
opment (Mahler & McDevitt, 1982). It is now recognized
that the psychomotor development of the child provides the
action which is subsequently internalized as thought and
feeling. The movement therapy experience replicates this
natural developmental process. Movement therapy can serve
as a catalyst for the patient to relieve tension, allow expres-
sive behavior, and create meaningful insights.
MOVEMENT THERAPY WITH
MULTIPLE PERSONALITY DISORDER PATIENTS
Multiple personality disorder (MPD) nearly always
occurs in the aftermath of severe and sustained child abuse
(Putnam, Guroff, Silberman, Barban, & Post, 1986; Ross, et
aI., 1991; Schultz, Braun, & Kluft, 1989).
Because ofthe overwhelming trauma, MPD patients dis-
sociate much of their painful experience, gradually creat-
ing alter personalities and with them alternative "realities"
more tolerable than the onerous one in which they live. From
the perspective ofthe movement therapist, they may be under-
stood to cut themselves off from their own feelings, armor
their bodies, and separate their physical and psychological
selves. The trauma creates feelings ofpowerlessness and betray-
al, along with denial, shame, guilt, anger, rage, loss of con-
trol, and depression. Re-experiencing the trauma is equal-
ly overwhelming, and further characterized by intrusive
feelings, denial, and emotional numbing (Horowitz, 1980).
MPD patients are often reluctant to move freely for fear
ofarousing material that will lead to loss ofcontrol. Instead,
they keep a cautious watch against the triggering of materi-
al that eventually must be recalled. It is as if they intuitively
appreciate both the evocative power of movement and the
nature of Braun's BASK model of dissociation and the ther-
apeutic principles that flow from them (Braun, 1988a,
1988b); i.e., that one can move across the dimensions of
behavior, affect, sensation, and knowledge to reconnect the
defensively sequestered aspects of their traumatic past.
Since MPD patients often cut themselves off from their
traumatic experiences, verbal psychotherapy, the tradition-
al treatment of choice, seems to progress more effectively
in conjunction with non-verbal modalities (Kluft, 1984). In
an oral presentation Baum, Kluft, and Reed (1984) described
the therapeutic process and techniques involved in an inter-
disciplinary collaboration, such as the use of one modality
to negotiate impasses in another. Art and movement were
reported to facilitate the uncovering ofmaterial, to enhance
100
the integrative process, and to afford the patientan enhanced
opportunity to participate in the milieu. By working with
both verbal and movement therapies, individual and with
groups, the growth of MPD patients' sense of self is encour-
aged by their learning to express feelings verbally and non-
verbally, weaving together both physical and psychological
aspects. The two work well together because while verbal
therapy concentrates on the individual and the resolution
of internal conflicts, a small therapy group is most useful;
"multiple personality patients rarely have had the opportu-
nity or the ability to understand the concepts of self and self
in the world. Group therapy presents an opportunity for the
MPD patient to participate in a sense of togetherness, with
other humans in a social context" (Caul, Sachs, & Braun,
1986, p. 147).
In the context of movement therapy the painful mem-
ories which must surface and be worked through if healing
is to take place may be triggered by the lyrics of a song, a
movement, or the music, and then further explored in indi-
vidual psychotherapy. It is not uncommon for the sensory
motor aspects ofa painful memory to be triggered in a move-
ment session. Simply moving and focusing inwardly can bring
to awareness a trauma that needs to be identified, expressed,
and worked through. Thoughts and feelings first identified
in a verbal session can be further explored in movement.
Conversely, what is generated in a movement session can be
elaborated upon and explored in verbal sessions. Such syn-
ergy facilitates increased connections across the BASKdimen-
sions, encouraging aspects of integration. The reader will
note that although the patients the author has treated have
been involved in many other concurrent treatment modal-
ities (such as art group therapy, music therapy, cognitive
group therapy, verbal group therapy, occupational therapy,
activities therapy, etc.) for the sake of exposition, only the
synergy of movement and verbal therapy is discussed here.
ASPECTS OF GROUP MOVEMENT THERAPY
WITH MPD PATIENTS
The author has conducted movement therapy group
for MPD patients over a five-year period at The Institute of
Pennsylvania Hospital. The treatmentofhomogeneous MPD
groups can be a challenging endeavor, but, with adequate
structure and judicious patient selection, it can provide a
useful healing experience for this group of patients, who so
often do poorly in groups with a diverse patient population
(Caul, 1984; Caul, Sachs, & Braun, 1986; Coons & Bradley,
1985; Kluft, 1984).
The Institute's MPD movement therapy groups grew
out of a need to decrease isolation and to encourage inter-
relatedness and support among MPD patients, who were com-
ing to The Institute in increasing numbers and often hav-
ing difficulty in conventional movement group settings.
Patients were referred by Richard Kluft, M.D., and the group
wasco-lead by Cathy McCoubrey, C.MA, M.CAT.,A.D.T.R.,
and the author. The first group consisted offive female mem-
bers who met for one hour twice a week. All participants
began as inpatients; two became outpatients. Attendance
DISSOW.TIO:\. \'0l.1\'. :\0. 2.June 1991
was consistent with the exception of one member, who was
hospitalized briefly in another facility. The group members
were all in individual intensive psychotherapy. Over the course
of treatment four themes emerged which were congruent
with issues in the patients' individual work: establishing trust
through kinesthetic empathy, negotiating social interaction,
eliciting expressive movement and traumatic material, and
integrating a more coherent sense of self.
,
Establishing Trust Through Kinesthetic Empathy
As a session begins, the group sits in a circle of chairs.
The leaders check with each member, both verbally and non-
verbally, to appreciate their mood and concerns. Then the
group decides on the music to be played. Mter an initial
warm-up, the group stands. One of the two leaders begins
to move, picking up cues from one of the patients. At times,
synchrony develops and members move rhythmically togeth-
er. At other times, one patient might respond to inner stim-
uli, so the leader will pick up that person's movement to imi-
tate and follow. The therapist's movement reflects what the
patient is expressing, consciouslyorunconsciously. Replicating
the patient's movement allows the therapist to share the
patient's experience in the moment. The patient in turn
experienc'es the therapist's acceptance. This empathic
response from the therapist furthers the development of
trust and the formation of a therapeutic relationship
(Brumfield, 1981) .With the deepeningoftrust, patients bring
forth repressed images and feelings. When they can safely
experience this material, their movements embody the per-
sonal truth of their histories.
Negotiating Social Interaction
Within the group setting, members learn how their move-
ment affects others as well as how they react to others' move-
ments. Patients can begin to identify dysfunctional styles of
interaction and to practice alternate behaviors. For exam-
ple, one patient was moving only minimally and avoiding
eye contact, distancing herself from the group. During the
processing, she was confronted by another member about
this behavior. Much to her chagrin, she had been unaware
of her behavior and her impact on the others. In the next
session, she took a more active role, moving with more con-
viction and engaging activelywith others. This more assertive
behavior was supported by the therapist's replication ofher
new movement qualities. In this way the movement therapy
provided opportunities to develop important social aware-
ness and skills.
Members also learn to recognize the inner sources of
their intense reactions to others. One patient came to a ses-
sion wearing a long-sleeved shirt. Another patient guessed
that her sleeves were covering self-inflicted wounds. This
realization stimulated the observing patient to initiate punch-
ing movements. Mter just releasing the anger she first felt
toward the injured patient, she was able to verbalize the inten-
sity of her reaction and to recognize her own self-destruc-
tive impulses.
Group cohesiveness developsgradually as members come
to appreciate the common bonds of their disorder. Trust
initially placed in the therapeutic relationship is extended
among group members by moving together in a safe envi-
ronment. When, in the middle ofasession, one patientbegins
to respond to inner stimuli, or an alter suddenly initiates a
new movement pattern, group members pick up the spe-
cific dynamic qualities. During processing, patients receive
and often welcome feedback about how they moved and
what affects were conveyed. The MPD patients can serve as
auxiliary observing egos for each other even when their own
fragmentation, amnesia, and distorted perceptions of self
and others make it difficult for them to exercise this func-
tion for themselves on a reliable and consistent basis. Their
experience in giving others such feedback often makes it
possible for them to tolerate feedback both in movement
therapy and in other settings.
Eliciting Expressive Movement and Traumatic Material
Authentic movement emerges when the mover follows
an inner impulse generated by sensations or images. The
mover learns to allow this unfolding, which is often enabled
by closing the eyes. 'The release may be cathartic in nature ...
or it may be a quietly gentle experience of centering, ofdis-
covering a condition ofharmony (congruence) between inner
feelings and outer expression. Whether it is intense or gen-
tle ... authentic movement ultimately leads toward integra-
tion of the personality." (Smallwood, 1974, p. 26). An exam-
ple of this occurred when a patient expressed the internal
conflict of two personalities during a period ofdissociation.
The right side of the body physically struggled with the left
side, as the right hand reached toward the throat and the
left hand pulled it away. A self-destructive alter was strug-
gling with an internal self helper.
Integrating a More Coherent Sense ofSelf
Movement therapystimulates the sensory motor aspects
of repressed memories (the sensation and behavior dimen-'
sions ofBASK) .The accompanying affects are re-experienced
through the innate structure of movement in a safe inter-
personal environment. This structure is determined by the
organization of the body in space: i.e., the relationship of
the body parts to the whole, the patterns of body tension,
the initiation and flow of movement through the body, as
well as the mover's inner attitude toward sensing and assert-
ing herself with strength or lightness, intuiting and reflect-
ing with suddenness or sustainment, attending with direct-
ness or multifocus, and expressing feelings with restraint or
freedom (Laban, 1960). The increasing awareness of one's
body and moving self supports the mastery of overwhelm-
ing affect. The fluid nature of movement stimulates both
fear ofdisorganization and loss ofcontrol as well as the poten-
tial for integration of feeling, thought, and action. Alters
emerge, making themselves known by movement patterns
that tell pieces of their story. The validation received from
the group's replication ofthese patterns empowers the mover
regardless ofwhich alter is out. Associated images and mem-
ories combined with a sense of personal agency instruct the
mover's perception of her autonomy.
As one patient remarked, 'This group is helpful because
101
D1SS0CIATIO:-l. rol.l\'. :-10. 2.June 1991
MOVEMENT THERAPY WITH MPD
as I am able to re-experience the feelings that have been
buried, I am able to begin to feel whole, rather than frac-
tured into many pieces."
An example of an integration in a movement session
occurred when Ella (a pseudonym) arrived and asked that
"Memories" (Webber, 1974) be played. She was being dis-
charged within a week and she was eager to master what she
could before leaving. With eyes closed she slowly began to
move, using the near reach kinesphere (i.e., the space near
her) with gestural movements. Gradually this grew into full
body movement with greater use of the space around her.
The intensity of her movement built gradually as she
stretched her arms up, fists clenched. Suddenly she pulled
her body down bringing her arms in close to her body. Her
head slowly curled down to her knees. Herwhole bodybegan
to tremble. She began bending andwrithingwith great strain.
Gradually the movement became rhythmic with more orga-
nized phrasing. When the song ended she recomposed her-
self and opened her eyes. "I'm sorry," she said, apparently
referring to several previous sessions when she had lost con-
trol, dropping to the floor, kicking and screaming, while
reliving earlier traumas. This time, however, her abreaction
had remained under control. She stated that she was exhaust-
ed and needed to rest. The palms of her hands were wet.
Though tired, she appeared relaxed and stated that she felt
that an integration had taken place. Thiswas later confirmed
by her individual psychotherapist. While Ella was moving
most of the others in the group attempted to replicate her
intense expression. One patient stood immobilized, watch-
ing in awe. When Ella apologized, one member said that
there was no need to apologize, that indeed her deeply felt
reliving of traumatic material was impressive. Others nod-
ded their heads in agreement.
CASE ILLUSTRATION
The case of Bea (a pseudonym) illustrates the themes
discussed above over the course of her involvement with a
long-term movement group for MPD patients.
Bea had a massive history of childhood sexual abuse,
towhich she had responcfed by elaborating dissociative defens-
es and the formation of alter personalities. Although she
lived in personal anguish, she had functioned competently
in a professional position for over a decade: When she arrived
to her first movement session, her body appeared rigid, her
movement patterns were restricted, and her use of the kine-
sphere was limited. There was little eye contact, with only
an occasional glance at the therapist. She was frightened
and insisted that the window in the door be covered so that
no one would be able to look in. Unable to look at others
or to tolerate others looking at her, she was withdrawn social-
ly, hypervigilant, and rigidly armored to protect herselffrom
others and her own repressed memories.
Creating a safe environment in which feelings could
be expressed in an empathic nonjudgmental, caring envi-
ronment was essential. To overcome her timidity, she need-
ed and elicited continual support and reassurance. The ini-
tial movement therapy goal was to arouse responsiveness to
102
the kinesthetic stimulation of rhythm and movement. By
replicating and developing the intent of the patient's move-
ment initiative, use ofspace and body articulation, the ther-
apist helped her to modulate the dyna!Uic qualities of her
actions. As she developed trust with the therapist and the
group members, she began to move more freely, using a
wider range of movement parameters, indicating growth in
her coping mechanisms. At first, she would freeze and go
into a trance-like statewhen traumatic materialwas triggered,
or she would move tentatively, struggling to remain present.
She shared feelings of isolation, difficulty with loss of time,
and fear of how sharing her traumatic history might affect
others. Gradually, she was able to take risks by improvising
movements that triggered painful memories. While moving,
Bea remembered a recent dream. Someone was watching
and making negative comments. She was angry with me,
associating me with the critical watcher. She came to real-
ize that I reminded her of her mother, who had sold Bea's
sexual favors to men in order to get money for drugs.
On another occasion Bea arrived wearing dark glass-
es, which she usuallywore when she had a migraine headache.
Not surprisingly, her body was rigid and her use of the kine-
sphere was limited. Mter the group warm-up, she removed
her glasses and began stretching outwardly, using more of
the space around her. The group was encouraged to join
her in these slow movements as she stretched from side to
side. Suddenlyshe quickened the pace. The movements were
strong and directed outwardly, then just as suddenly she
turned them on herselfand began striking her body. Another
personality had emerged, beating the body, and shouting
in a deep masculine voice, "I'll kill you ifyou tell!" It appeared
that she was recalling either a memory ofan altercation with
her abusive father or a fearful fantasy of one, in which one
personality was an obedient masochistic daughter, another
condemned her father angrily, and a third sadistically
defended the father and was identified with him. In that
movement sequence Bea was remembering important trau-
matic material for the first time. She went on to explore this
material further in individual psychotherapy and art thera-
py (Baum, et aI., 1984).
In another session, Bea arrived angry and silent. She
had trouble staying with the group and was switching rapid-
ly. Later in the session, Beastarted to move with angry clenched
fists which she released into light, quick fluid movements of
her arms. Her eyes closed, perhaps indicating her fear of
her anger. Then her fists clenched and flared open, tensing
and releasing repetitively. With the therapist's cue, the group
took hands around the circle and swayed together to create
a safe container for these feelings. Bea shared her realiza-
tion that although the material she was enacting had been
uncovered in her verbal psychotherapy sessions, the feelings
had, until now, remained isolated from the traumatic mate-
rial. Through the movement her feelings had emerged and
found expression.
Bea's progress from immobilization to a willingness to
take risks, allowing authentic movement to emerge served
as a role model for the other group members. As of this writ-
ing, she is nearing complete integration, has been out of the
D1SS0CI.U10\". Yol. IY. \"0. 2.JlIne 1991
~.,' BAUM
. .
hospital for nearly two years, and has begun volunteer work
in preparation for return to full employment.
CONCLUSION
Group movement therapy with MPDs can be a useful
modality in conjunction with verbal psychotherapyand other
therapeutic interventions. Establishing trust is an ongoing
issue with MPD patients, and is maintained through kines-
thetic empathy throughout the therapeutic process. Expressive
movement elicits affect and memories related to earlier trau-
mas, which can then be further explored in individual psy-
chotherapy. Interdisciplinary collaboration enhances the inte-
grative process by negotiating impasses between the physical
and psychological aspects and working toward congruence
between the two.
Negotiating social interaction is an important goal for
patients who are isolative. Movement therapy provides an
arenawhere members learn not only to move synchronously
with others, but to explore ways to modulate their own dys-
functional styles of interaction.
Since MPD patients' bodies were often abused, they feel
splintered and have formed many alters. By playing out these
alters and their experiences in movement, they help bring
shape and form to the various alters' self-expressions, thus
facilitating integration of disowned aspects of themselves.
•
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ACKNOWLEDGEMENTS
My appreciation to my daughter, Shelley Baum-Brunner,
Ph.D., for her sensitive reading and many valuable sugges-
tions with this article. My thanks to Catherine McCoubrey,
C.M.A., M.C.AT., A.DT.R., my friend and co-leader over a
two and one-halfyear period, for her support and assistance
in bringing this paper to fruition.
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I