Professional Documents
Culture Documents
Dance/Movement Therapy
with an Adult Survivor of Torture
Introduction
Torture Sequelae
Torture creates physical and psychological sequelae that affect survivors
to the extent that their personalities become deconstructed (Callaghan,
1993; Genefke, 1992; Doerr-Zegers, Hartmann, Lina, & Weinstein,
1992). The ever-growing literature on torture emphasizes that the survi-
vor’s body is both the site of wounding and healing. Torture is always a
heinous assault to the body. Practices of torture include: electric shock
to body parts, and frequently to the genitalia; severe beatings and whip-
pings; bondage; isolation; light and sensory deprivation; mock execu-
tions; sexual abuse and rape; and starvation, among other things (Gene-
feke, 1992). In the training manual of the International Rehabilitation
The Body Remembers 31
Council for Victims of Torture (IRCT), the authors divide symptoms into
somatic, psychological, and psychosomatic categories that are thought
to be lasting effects of extreme trauma (Vesti, Finn, & Kastrup, 1992).
According to the IRCT, many of the somatic symptoms that torture sur-
vivors experience appear to be related to the psychological distress they
endure. While musculoskeletal injury is not uncommon, the IRCT re-
ports relatively few medical findings compared to somatic complaints in
their large population of clients. The IRCT manual addresses the impor-
tance of providing interventions that target both body and mind, stating
that psychosomatic symptoms are perhaps the most crucial to address.
Zeeburg (1998) discusses the identification and diagnosis of torture
survivors, and proposes that while Post Traumatic Stress Disorder
(PTSD) is a common and accurate diagnosis for survivors of torture, it
may not be comprehensive enough. Serious medical and psychiatric disa-
bilities can result from torture, and rehabilitation can be a complex en-
deavor, as physical and psychological symptoms are interlaced. Common
symptoms include shame and guilt, self-destructive behavior, psychoso-
matic symptoms, somatic disorders, somatic pain disorders, heightened
startle reflex, and nightmares. Zeeburg describes the importance of non-
verbal therapy for torture survivors. He cites a clinical model of treat-
ment used in Hungary, where a nonverbal therapist, using art, move-
ment, and creative writing, is part of every client’s rehabilitation team.
Zeeburg writes, “The idea is to move the deeper parts of the soul of se-
verely tortured persons” (p. 37).
Allodi (1999) discusses the complexity of torture sequelae from a psy-
choanalytic perspective and describes the body as physical and meta-
physical, anatomy and experience. “In torture the body becomes the key
to the soul” (p. 101). Therefore, both the intention and effect of torture
“are based on the properties of the natural body, mostly its tendency to
unity with the experienced body and thereafter with the spirit or con-
sciousness” (p. 102). Going on to describe the effects of torture on con-
sciousness, Allodi states, “we begin to find the limits of words and the
failure of all metaphors and other tropes of the language” (p. 102).
From a different perspective, Callaghan (1993) describes the impor-
tance of the body-mind continuum in both the wounding and healing of
torture survivors. She characterizes torture as an experience that cannot
easily be separated into physical or psychological categories. Describing
the mental anguish of prolonged solitary confinement, Callaghan asks,
“Is there a clearly defined boundary between physical and mental tor-
ture? Given that torture exists on a body-mind continuum, if the contin-
uum runs from body to mind it must also run from mind to body” (p. 4).
Torture violently disrupts the sequential organization of experience
that occurs naturally within the human organism (Minton, 1997). If sen-
sation is too unbearable, the physical experience can be shut down and
32 Amber Elizabeth Lynn Gray
self-image onto the victim (Salter, 1995). In non-sadistic abuse, the per-
petrator denies the victim’s pain, because perpetrators must deny their
own pain. This denies the victim’s true experience. The victim often dis-
sociates from the experience, appearing “invisible.” This invisibility ap-
pears as withdrawal and isolation. In therapy, the victim may appear
“absent” to the therapist. Survivors of this type of torture have reported
in sessions that they feel like they live in an empty shell. Sometimes,
survivors will dissociate specific areas of the body from the whole body,
because the pain in these areas is unbearable. The author has heard
many survivors refer to the arm, or say it feels ugly. Such statements
are made to describe an arm that is no longer part of the victim’s body
image.
Regardless of whether the torture is sadistic or non-sadistic, the victim
is systematically and purposefully stripped of dignity and respect, and
finds living in the body-home a painful challenge. The body, used by
the torturer, becomes the physical and psychological site of destruction
(Callaghan, 1993). A survivor’s ability to relate to others is severely al-
tered by the experience of torture. Intimacy, companionship, and com-
munity can feel threatening. The relational nature of torture-induced
trauma creates a need for therapeutic safety and therapeutic relation-
ship in the healing process.
the client. These concepts are particularly useful in the treatment of tor-
ture survivors. However, they are challenged by the relational and often
sadistic nature of the torture. Therefore, the therapist must be especially
careful to attune and empathize with a client in a nonthreatening fash-
ion, while keeping in mind that the use of empathy was the abuser’s tool
for knowing best how to inflict pain and suffering (Salter, 1995).
Salter (1995) suggests that intense anxiety and decompensation are
possible as the victim becomes better understood in the therapy, as “be-
ing seen” can trigger feelings the victim had in the presence of the perpe-
trator. It is the work of the dance movement therapist to see what the
body reveals, and what the client may want to hide, and to gently and
respectfully nurture the awareness in the client that his or her body is
home, a relatively safe place to which to return. Relative safety refers to
the idea that we are as safe as we can be in a world where danger,
including torture, can happen to anyone (St. Just, 1999; Forrest, 1996).
Therapists must also keep in mind that the work with the body is
likely to stimulate memories more quickly than if words alone are used
(Callaghan, 1993). Given the body’s direct involvement in torture, care
should be taken, so that the client is not overwhelmed.
To facilitate the healing process, DMT can be modified through the
use of resources and titration. Resources are defined as anything that
helps a person maintain a sense of self and inner integrity in the face of
disruption (St. Just, 1999; Heller & Levine, 1998). Resources can include:
positive imagery; memories; past or present social contacts; interests;
and personal and work experiences that enhance the torture survivor’s
sense of integrity and strength. Titration requires that the stimulus or
energetic charge be broken into smaller pieces, so that the pace of the
work is more manageable and the traumatic experience can be inte-
grated (Heller & Levine, 1998). The use of props such as therapy balls,
stretch bands, and scarves facilitate titration and pacing.
Also, titration is relevant in the expansion of the use of breath in the
therapy of torture victims. It is important to remember that traumatized
people often hold their breath, breathe shallowly, breathe rapidly, or
sometimes, appear not to breathe at all, as a protection to experiencing
increased bodily sensation and emotion. Therefore, the introduction and
the expansion of the use of breath must be carefully managed, so as not
to introduce uncomfortable or overwhelming sensation too quickly.
Case Study
due to her brother’s political beliefs. Her brother was shot and killed in
front of her. His brutal murder was also witnessed by both his and her
children. She was then dragged down the street in front of the children,
thrown into a truck, and taken to what she described as a “barracks.”
She remained there for one month, until a co-worker in a crafts coopera-
tive negotiated her temporary release, helping her to flee the country.
She was repeatedly raped, beaten, kicked with heavy boots, and dragged
across rocks while in prison. She had no access to food, water, or sanita-
tion, and was left to lie on a cold rock floor without clothes or coverings.
When she arrived in the United States, she reunited with her husband
who had also fled political violence. She came to see me a year later.
Rita’s therapy took place almost weekly over a period of six months,
for a total of nineteen sessions. At her initial intake session, she de-
scribed herself as extremely depressed. There were indications of a col-
lapsed posture in the initial assessment. This was evident in her down-
ward gaze, and her body tension. She held her pelvis, upper torso, and
shoulders forward. There was a lack of support in her pelvis that re-
sulted in an inability to push through her spine, one of the earliest devel-
opmental movements. Rita moved tightly and awkwardly and did not
extend herself into the space. Her kinesphere was small and fragmented.
She looked unsure of her own mobility, and made minimal eye contact.
She reported an exaggerated startle response, nightmares, insomnia,
and constant fear. She experienced unbearable pain in her left shoulder,
arm and neck, and could not work for more than a few hours a day due
to this. Her breath was barely visible. Describing herself as “formerly a
strong woman,” she also described moments of intense fear when she
was home alone. She was afraid someone would beat the door down and
“come to get her.” She described feeling helpless, and in our initial ses-
sions, she had difficulty making decisions. She shared that her husband
felt like he hardly knew her. She had left their two children behind with
her aging, frail mother, and she was concerned for their well-being. In
this initial intake session, Rita communicated this information with flat
affect and frequent dissociation.
I was assigned to Rita initially as a therapist, but our first sessions
consisted of a combination of case management and DMT. Rita was so
focused on her childrens’ well-being that it was necessary for us to work
on this problem before we could begin to work with her experience. After
discussing possibilities for contact with her children, and beginning the
long process to secure her political asylum so she could bring them to
the United States, we began our work.
In her first therapy session, which followed a mental health evaluation
for her asylum case and took place two weeks after her intake, Rita dis-
cussed her children with more emotion. Weeping occasionally, Rita spoke
The Body Remembers 37
of the pain she felt at leaving her children. I asked her to describe her
pain, and she responded with “a pain outside my body.” As she said this,
she made frequent gestures to her heart with her left hand. When I
pointed out that she was gesturing towards her heart, she seemed
stunned. She simply said “there is a pain in there.” I asked her to specify
in more detail where she felt the pain, and she replied, “It’s like the pain
I feel in the left arm and shoulder.” She described this area of her body
as disconnected and broken. Recalling that in her intake she had often
pointed to this same area when describing her beatings, I suspected a
connection between her physical abuse and her “broken heart” for having
left her children.
I invited Rita to locate her pain even more specifically, hoping to facili-
tate her awareness of sensation. She pointed to the same area. I asked
her to take a moment with this pain and describe the quality of it, or
explore any movement, images, or information that might be there. She
said “A rock.” I asked for clarification, and she said “Pressure. There’s
pressure there, and I feel like I want more, like someone pushing into
it.” This felt like a crossroads to me; the rock could represent an internal-
ized image of her torture, and it could also be a resource. I remembered
that warm rocks are often applied to the body in many traditional heal-
ing practices.
To titrate our work and avoid re-traumatizing her, I left the image of
the rock momentarily, and asked if there was a specific movement sug-
gested by her preference for pressure. She attempted to roll her shoul-
ders backwards, which opened her chest and created a more erect pos-
ture. It also echoed a traditional African dance movement. She was
unable to complete this movement sequence. She described a point where
it “got stuck.” This seemed to be a frozen movement impulse, perhaps
related to her sensation of pressure and perception of a rock. At this
point, her breathing became more labored and she reported increased
pain. I suggested she imagine the movement instead, and she closed her
eyes and seemed to attend inside. She placed her finger on her heart
area and pushed. The push required effort from her shoulders, and she
stated that it hurt her arms to do this, although the pressure felt good.
Suspecting she might be accessing a healing resource, I offered to place
my hand there and apply light pressure. I maintained pressure while
she explored arm movements. Two things happened. The pain moved
farther down her arm, “as if it wants to leave,” and she rolled her shoul-
ders backward, completing the movement sequence of the formerly fro-
zen impulse and bringing herself to a more erect and supported posture.
She was able to move sequentially and fully through her torso. A slight
smile emerged as she said “I can breathe better.”
The following week, she canceled her session, due to a relapse of the
38 Amber Elizabeth Lynn Gray
asthma she developed following her torture. She recognized that the
work we had done had “opened something up,” and expressed a desire to
rest. We agreed she should remain at home.
When she returned to therapy two weeks later for her second session,
her posture was slightly more erect. Her spinal push was better sup-
ported by a more integrated and energetically active pelvic floor. Her
head was held higher, which enabled her to make more eye contact. She
shared a dream she had about a village healer from her childhood, a
medicine man who pressed hot leaves and earth into villagers’ flesh to
ease illness and pain. It was possible the rock image had become a re-
source, a healing image from past memory. Some psychological theories
posit that dreams are reflections of both our unconscious minds and the
collective unconscious. In many African cultures, dreams are believed to
be the voice of God (Hickson & Kreiger, 1996). This dream, a potential
connection to the transpersonal, created a possibility to rebuild the in-
tegrity of her body through the resource of healing memories. We worked
with this image in our next three sessions.
I asked Rita to scan her body, with awareness on her chest and arm.
She said “the pain is almost gone, but it’s deeper in my heart. My arm
feels very heavy.” These statements reflected increased bodily integra-
tion through a more physical and emotional integration. I suggested she
imagine the healer working with her arm. As she did this, she reported
sensations of increasing lightness in her arm, noting that the longer she
imagined a hot leaf compress against her skin, the lighter she felt. She
also reported feeling more awareness of her skin. The image of an angel
emerged, so I suggested she allow her arms to be angel wings. We cre-
ated “angel exercises” which were her “homework” assignments for the
next several weeks. Using stretch bands, and the image of feathery
arms, she began by lying on the ground to feel the earth’s support, as
she did when treated by the village healer. After three weeks of practice
in her weekly sessions and at home, she performed the exercises while
standing. By this point, Rita felt only a very diffuse pain in the middle
and upper positions of her arm, and reported she was able to work for
longer periods of time with less pain and exhaustion. She reported a
decrease in nightmares and startle response, and said keeping the image
of the angel with her helped her to feel safer. Her affect range and move-
ment repertoire were increasing simultaneously. As the available range
of motion in her arms increased, she was expressing more laughter and
tears.
In sessions occurring throughout the third and fourth months of ther-
apy, Rita began to demonstrate even greater range of movement, a more
erect posture, and increased eye contact. In one session in particular (her
ninth), I introduced a therapy ball to facilitate grounding her pelvic floor
energy in a non-threatening way. Sitting on the ball, she expressed a
The Body Remembers 39
deeper relaxation in her upper body than she had experienced since her
torture. Along with the release in her chest, she began to talk about the
emotions in her heart. She described her heart as broken, and attributed
this to two traumas. The first was the rape and beatings she suffered
from “the young boys who hurt her.” The second trauma was leaving
her children. This statement reflected a more physical, emotional and
cognitive integration. She described her wounded heart as full of “poison-
ous pus,” and that she wanted to be rid of it. As she shared this image
with me, she also shared that she had recently spoken with her children
for the first time since leaving them. In previous phone calls, she had
been unable to speak because of her intense grief. Expressing a desire to
“push the pus away,” she named it “shame,” and through visualization
and movement, we created a movement sequence to “push” it out of her
heart. At the end of this session, she expressed gratitude for her exer-
cises, saying, “they allow me to touch the pain in my heart.” Rita was
integrating her bodily experience, emotions and beliefs, verbally and
nonverbally, about her choice to flee home without her children. Her
body and mind were becoming more congruent and integrated, as she
began to work sequentially through her traumatic experience, which had
become somaticized.
For the next two months, we continued to work through the body with
emergent gestures and images. Rita broke down and wept deeply in sev-
eral sessions that occurred in the fifth month, and began to show more
agitated movement and affect. She once moved so quickly through an
“angry arm swing” that she lost her breath and almost fell over. At
times, her enthusiasm to heal led to hyperarousal and flooding. When
this occurred, we began a practice of slowing every movement that
emerged to half-time, then quarter-time; what we soon called “dream-
time.” This titration enabled her to access her past resources and inner
body experience with increased awareness of their meaning in her pres-
ent life, and to integrate the experience of torture into her present body-
mind by reclaiming the experience sequentially. We worked in this way
throughout the sixth and final month of her therapy.
In her second to last session, Rita entered the room exuberantly,
throwing her arms above her head and proclaiming, “I came here to tell
you I’m not going to die anymore. I’m going to live!” Her gait and posture
were more normal; she was sleeping better, and her eyes were brighter
as she made direct and steady eye contact with me. Our therapeutic
relationship had strengthened in the safety of the therapeutic container
that was created in our sessions. Her freer movements and extended
range of motion communicated a state of relative safety and comfort in
her body. She expressed how much she liked coming to the center, an
indication of a holding environment that felt safe. She recalled several
traditional village dances she had been practicing and asked if I would
40 Amber Elizabeth Lynn Gray
dance with her. This was our first truly interactive activity. Rita had
assumed a role of greater equanimity in the relationship, and, for the
first time, we moved together. I followed and mirrored her movements,
finally able to reflect my experience of her directly back to herself. In
this session, she thanked me for helping her to “find her body again.”
She also reported that she and her husband had decided to have another
child, and that she was pregnant. She felt good about the possibility of
creating new life in her body. She came to see me only one more time,
two weeks later. As her pregnancy progressed, she experienced some
complications, and was forced to spend more time at home. We agreed
to discontinue therapy until the baby was born and she was more com-
fortable to travel. We agreed she had made enough progress to continue
her work at home.
Discussion
The progress Rita made was relatively quick, and this is probably indica-
tive of the fact that she had resources to utilize. She had the support of
her husband, but the loss of her children was devastating. That we en-
gaged in a dual relationship initially (therapist and case manager) is
noteworthy. This dual relationship can be a challenging one, but it can
support the healing process as much as therapeutic work itself. The frag-
mented nature of torture requires that the healing process be integrated.
Referral to a separate caseworker might have fostered continued frag-
mentation.
Rita’s initial presentation was fragmented and dissociated. Her refer-
ence to the pain outside of her body, the arm and the heart, reflected
disintegration in her relationship to physical, emotional, and cognitive
aspects of herself. She had separated individual body parts from the
whole, and did not connect her physical experience of torture to her emo-
tional pain. To descrease her emotional pain, she separated body from
mind. She experienced difficulty relating to others, as evidenced by her
husband’s statement that he didn’t know her, her isolated behavior, and
her inability to make eye contact. Her initial posture lacked support, and
may have expressed subservience in our relationship.
Through various DMT interventions, Rita began the process of reinteg-
rating physically, emotionally, cognitively, and spiritually, and infusing
her past experience with present meaning. When we first began to work
with her pain, I chose a fairly standard DMT intervention specification
of sensation to one area of the body. Another common intervention is the
generalization of sensation to a larger area of the body, or to the entire
The Body Remembers 41
Acknowledgments
The author would like to acknowledge the following people for their edi-
torial assistance, patience, and support: Carlos Gonsalves of the Insti-
tute for the Study of Psychopolitical Trauma; and Robyn Flaum Cruz,
Anne C. Fisher, Sarah J. Kaye, Ryan Kennedy, and Joan Lewin of the
American Dance Therapy Association. She would also like to thank the
entire staff of the Rocky Mountain Survivors Center (RMSC), who are
present in all the work of the Center, and the clients of RMSC, who
are the real teachers of this work. Finally, the author would like to thank
Rita for her willingness to explore her healing so creatively and so coura-
geously.
References
Abram, D. (1996). The spell of the sensuous. New York: Random House.
Allodi, F. (1999). The body in political violence. Torture, 9 (4), 100–105.
American Psychiatric Association. (1994). Diagnostic and statistical manual of mental dis-
orders (4th ed.). Washington, DC: Author.
The Body Remembers 43