Am J Dance Ther (2016) 38:63–80

DOI 10.1007/s10465-016-9212-6

Embodying Self: A Dance/Movement Therapy

Approach to Working with Concealable Stigmas

Nell G. Roberts1

Published online: 4 April 2016

 American Dance Therapy Association 2016

Abstract Concealable stigmas are characteristics, attributes, or identities that can

be hidden from others and are socially devalued and negatively stereotyped. While
research exists on the psychological costs of having a concealable stigma, less exists
on the somatic costs of having a concealable stigma and on clinical approaches with
this population. Drawing on the Kestenberg Movement Profile, Bartenieff Funda-
mentals, and the Five Fundamental Actions, this article proposes how
dance/movement therapy (DMT) can be an additional lens through which to
understand how having a concealable stigma impacts a person, particularly on a
somatic level. This article also outlines specific DMT interventions designed to
increase embodiment and movement repertoire. The goals of these interventions are
to lessen the somatic impact of having a concealable stigma and empower clients to
have choice in the ways in which they present themselves in the world.

Keywords Bartenieff Fundamentals
Concealable stigma
Dance/movement

therapy
Embodiment
Kestenberg Movement Profile

As social animals, humans create community by nature. Community allows

individuals to feel the support of others and experience positive feelings of
belonging. Unfortunately, there are some individuals who may not be embraced
within their communities: individuals who have a socially stigmatized trait. While
these stigmatized traits are often visible to others, there are some that are invisible
and able to be concealed. These individuals’ need for support may go unrecognized

& Nell G. Roberts

nellgroberts@gmail.com
1
Naropa University, Boulder, CO 80301, USA

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particularly around their experiences of oppression, marginalization, and

discrimination.
A stigma is commonly defined as a negative characteristic, attribute, or identity
that an individual either possesses, or is believed to possess, that conveys a social
identity that is devalued or discredited in a social context (Crocker, Major, & Steele,
1998; Goffman, 1963). As a socially derived concept, stigma exists when dynamics
of power and privilege are present (Link & Phelan, 2001; Quinn & Chaudoir, 2009).
Link and Phelan (2001) apply the term stigma when ‘‘elements of labeling,
stereotyping, separation, status loss, and discrimination co-occur in a power
situation that allows the components of stigma to unfold’’ (p. 367). Thus, an
individual is vulnerable to discrimination or prejudice purely on the basis of
negative stereotyping regarding the stigma (Link & Phelan, 2001; Quinn &
Chaudoir, 2009).
A concealable stigma is similar to a visible stigma in that it carries with it social
devaluation; it differs in that it can be kept hidden from others (Crocker et al., 1998;
Frable, Platt, & Hoey, 1998; Quinn & Earnshaw, 2013). Examples of concealable
stigmas include: a positive HIV status, a mental illness diagnosis, many chronic
illnesses, marginalized political or religious beliefs, illiteracy, infertility, unem-
ployment, or being in a minority regarding sexual orientation. It also includes:
histories of abortion, poverty, eating disorders, domestic violence, substance abuse,
or criminal charges (Quinn & Earnshaw, 2013; Sedlovskaya et al., 2013).
Having a concealable stigma can be extremely costly on cognitive, affective, and
self-evaluative levels. However, it can also be costly on a somatic level. While
stigma directly relates to the societal constructs that deem those stigmatized as ‘‘less
than,’’ it also directly relates to the appearance, function, expression, and experience
of the body. Clare (2001) acknowledged this dynamic in writing, ‘‘we must not
forget that our bodies are still part of the equation, that paired with the external
forces of oppression are the incredibly internal, body-centered experiences of who
we are and how we live with oppression’’ (p. 361). For persons who carry a
concealable stigma, part of the body-centered experience can include: not feeling
safe in one’s own body, not feeling self-acceptance, being disconnected from one’s
body, and ‘‘hiding’’ part of one’s identity while in public.
Dance/movement therapy (DMT) can be an effective approach to aid in lowering
these costs as it ‘‘offers a laboratory in which adaptive or maladaptive behaviors are
brought to awareness, in which the demands of the self and those of the dominant
culture are embodied, amplified, nurtured or challenged’’ (Pallaro, 1997, p. 228).
Furthermore, as a psychotherapeutic discipline rooted in the body, DMT has the
potential to work with the somatic effects of the oppression faced within the
concealable stigmatized population.
As mentioned above, there are many different types of concealable stigmas.
Concealable stigmas vary in the level of their salience (the frequency with which
one thinks about the stigma), and centrality (how self-definitional the stigma is to
one’s identity) as well as accompanied negative consequences if revealed
(Pachankis, 2007). The degrees to which these differ will have an impact on how
costly it is to keep a stigma concealed (Quinn & Earnshaw, 2013). For the scope of

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this article, the focus will be on those stigmas that have the most significance to
one’s identity throughout one’s lifespan.
Following a brief review of the literature, this article will present how DMT can
provide an approach to evaluate how a sense of safety manifests in the body and
identify the somatic impact of internalized stigma or shame. A discussion about how
both of these might influence one’s embodiment as well as how one might choose to
present differently in public versus in private will follow. Finally, this article will
address specific clinical interventions DMT can offer this population, given the
various dimensions of living with a concealable stigma.

Literature Review

Costs of Concealing and Revealing a Stigma

Unlike other stigmatized or marginalized populations, individuals with a conceal-

able stigma are in a very particular circumstance—they often know exactly what
others think about the stigma they carry because others might overtly display
prejudiced attitudes and negative stereotypes in their presence (Quinn, 2006; Quinn
& Chaudoir, 2009). Consequently, accompanying the concealable stigma is often
the fear of being ‘‘found out’’ and the desire to stay hidden requires a good deal of
impression management (Sedlovskaya et al., 2013; Smart & Wegner, 1999). Unlike
a visible stigma, a concealable stigma often carries the extra layer of effort and
preoccupation surrounding the decision whether or not to disclose the stigma
(Pachankis, 2007; Quinn, 2006). Keeping a stigma concealed, or ‘‘passing’’
according to Goffman (1963), has some benefits. One advantage to concealable
stigmas as compared to visible stigmas is that by choosing to keep a stigma
concealed, an individual may be able to prevent negative judgments and be accepted
as ‘normal’ (Smart & Wegner, 1999). Furthermore, revealing one’s stigma may
result in more direct discrimination, which has been linked to increased depression
and anxiety (Quinn & Earnshaw, 2013). Additionally, keeping a stigma concealed
can aid in keeping the carrier of the stigma safe as there are tangible risks in
revealing certain stigmas (Crocker et al., 1998; Goffman, 1963; Jones et al., 1984).
The revelation of a concealable stigma can lead to discrimination in education,
housing, medical care, and employment (Pachankis, 2007). It can also result in child
custody loss, loss of job, abandonment by parents, family or community, social
isolation, abuse and violence (Corrigan & Kleinlein, 2005; Herek, 1998; Herek &
Berrill, 1992).
Persson and Richards (2008) discussed the ‘‘tendency to constitute disclosure as
therapeutic, functional and ‘healthy,’ as something that should be encouraged… by
implication, non-disclosure becomes positioned as inherently negative, even
dysfunctional’’ (p. 76). Without pathologizing non-disclosure, or minimizing the
risks of disclosure, it is important for mental health professionals to recognize the
real cognitive, affective, behavioral, self-evaluative, and psychological costs to
keeping a stigma concealed (Frable et al., 1998; Pachankis, 2007; Sedlovskaya,
et al., 2013). Eribon (2004) conceptualizes the effects of passing in this way ‘‘such

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an effort at disguise, such an obligation to lie, even to those to whom one is close, to
one’s relatives, produces an ‘intolerable’ strain, which cannot fail to have profound
effects on an individual personality, on a given subjectivity’’ (p. 99).
The need or desire to manage others’ perceptions requires a great deal of mental
control and adds an additional cognitive burden for those with a concealable stigma
(Quinn, 2006; Smart & Wegner, 1999). A study conducted by Frable, Blackstone,
and Scherbaum (1990) researched how people with a stigma felt when interacting
with someone without a stigma. Their results reported that people with a
concealable stigma were hypervigilant in looking for cues of discrimination and
devaluation when interacting with others. Smart and Wegner (1999) in a study
comprised of qualitative interviews, found concealing a stigma frequently leads to
intrusive thoughts and subsequent attempts at thought suppression, which can result
in greater psychological distress.
The act of concealing is similar to an act of secrecy. Research on secrecy points
to the pervasive preoccupation with what is being kept secret. DePaulo (1992)
references that the hard work of secrecy is due to the behavioral effort it requires.
Lane and Wegner (1995) mention the activeness of secrecy and the deliberate
behavioral and mental work that is required to maintain it and suggest that emotions
may be intensified by the secrecy-produced intrusion of the emotional thoughts.
Thus, if someone is keeping a secret out of fear, this fear, guilt, and anxiety may
become amplified due to the constant awareness of the secret (Lane & Wegner,
1995).
Bosson, Weaver, and Prewitt-Freilino (2012) based their research about
concealable stigmas on self-verification theory, suggesting that people have a
strong need to be seen in a way that acknowledges their ongoing and strongly held
identities, even if these identities are devalued or undesirable. When individuals
conceal their stigmas, they undergo intrapsychic threats to psychological coherence,
feedback that confirms stable self-views (Bosson, et al., 2012). On the other hand,
having a concealable stigma can present an opportunity to build even greater
psychological coherence. Reicherzer (2005) suggested ‘‘to not only identify but to
accept oneself as a [sexual minority], embracing one’s truth, is a major
accomplishment to be lauded. It means that despite all the oppression and cruelty
that is heaped upon [sexual minority] people, the individual holds a deeper value:
honesty of one’s true nature and a willingness to live according to this truth’’ (p.
166). This might suggest that people who have a concealable stigma have an
opportunity to live according to their own truth regardless of whether or not their
sigma is revealed; this might lead to a greater sense of empowerment and self-
esteem.
Another potential consequence of having a concealable stigma is internalizing
the stigma; that is, believing and applying the negative stereotypes about the
concealable stigma directly to the self (Quinn & Earnshaw, 2013). This is likely to
happen due to the fact that people may not be born with their concealable stigma (or
have not yet recognized it) and, thus, have grown up hearing negative beliefs about
the stigma. This might lead to modifying their self-concept to be consistent with the
stigmatizing responses of society (Herek, Gillis, & Cogan, 2009; Quinn &
Earnshaw, 2013). An 11-day experience-sampling study by Frable et al. (1998)

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found that people with concealable stigmas have lower self-esteem than people
whose stigmas are visible. Additionally, unlike those with visible stigmas, it might
be difficult for people with concealable stigmas to find similar others, which might
result in isolation and loneliness (Pachankis, 2007; Quinn, 2006).
Despite the abundance of literature and research on having a concealable stigma,
there has been little discussion around clinical approaches to support these
individuals. Additionally, while accompanying psychological costs have been
addressed, there has not been adequate research on the somatic implications nor the
use of DMT as a clinical intervention.

Dance/Movement Therapy

A fundamental assumption in DMT is that body movement reflects inner emotional

states and that by changing one’s movement behavior, changes in the psyche can
occur (Levanthal & Chang, 1991; Levy, 2005). Body movement is considered
fundamentally expressive and revealing of internal states. Whitehouse (1999)
highlighted, ‘‘the body is not and never will be a machine, no matter how much we
treat it as such, and, therefore, body movement is not and never will be
mechanical—it is always and forever expressive, simply because it is human’’ (p.
52).
Through the action-oriented, nonverbal nature of DMT, an individual’s strength
and natural outlet for expression can be supported (Loman, 2005). Further, within a
trusting therapeutic relationship, DMT can support an individual in identifying
alternative ways to cope with sensations, express emotions, and build relationships
(Milliken, 1990).
There is no specific literature on utilizing DMT as a therapeutic approach with
clients who have concealable stigmas. However, research has addressed the
effectiveness of DMT in alleviating some of the psychological and behavioral
costs—anxiety, depression, and stress—associated with being stigmatized. Studies
by Brooks and Stark (1989), Dosamantes (1990), Jeong et al. (2005), and Koch,
Morlinghaus, and Fuchs (2007) demonstrate that DMT may reduce depression. A
reduction in anxiety and stress through DMT interventions has also been
demonstrated through meta-analyses done by Koch, Kunz, Lykou, and Cruz
(2014) and Ritter and Low (1996).
Dance/movement therapy can also address isolation (Schmais, 1985, 1998;
Thomson, 1997) where ‘‘the client [can] experience being in relationship simply by
moving along with or next to another, without ever having to directly interact,
similar to the parallel play of children. This nonverbal communication enables
feelings of support and relatedness, which are too frightening to achieve on a verbal
level’’ (Thomson, 1997, p. 77). By treating the body as an ally, rather than an
enemy, DMT can support individuals in reclaiming their bodies as a place of self-
fulfillment (Krantz, 1999) and improve self-esteem (Levy, 2005).
Through the creative process, internalized feelings can be externalized, allowing
space and distance that can create safety for clients (Brown, 2009). Malchiodi
(2005) explained, ‘‘as therapist and client work together, self-expression is used as a
container for feelings and perceptions that may deepen into greater self-

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understanding or may be transformed, resulting in emotional reparation, resolution

of conflicts, and a sense of well-being’’ (p. 9). Moreover, DMT rests on the
assumption that by observing a client’s movement through assessment frameworks
such as Laban Movement Analysis (LMA) and the Kestenberg Movement Profile
(KMP), the therapist can gain insight into the client’s experience (Loman, 2005).
Caldwell (2013) makes the argument, however, that body movement observation
and assessment may unconsciously enact a bias against those who have bodies
different from or move contrarily to socio-cultural norms.
While there is no DMT research specifically addressing individuals who have a
concealable stigma, there has been research on the use of DMT with populations
that could be considered stigmatized. Dance/movement therapy pioneers Marian
Chace and Trudi Schoop began their work in psychiatric settings (Levy, 2005);
Romero, Hurwitz, and Carranza (1983) and Silberstein (1987) address using DMT
with individuals with schizophrenia. Milliken (1990) and Thomson (1997) write
about working with clients with substance abuse issues and the themes of shame,
isolation, fear, control, and ambivalence that emerge as well as addressing the
predominant movement characteristics displayed. Krantz (1999) and Padrão and
Coimbra (2011) write about using DMT with people with eating disorders, but do
not explicitly discuss the potential stigmatization of this diagnosis on the clients.
Shame that can lead to secrecy is mentioned in research about various forms of
abuse such as sexual abuse, torture, and domestic violence (Frank, 1997; Gray,
2001; Leventhal & Chang, 1991). Within the abovementioned research, the focus is
on the treatment of the diagnosis or experience rather than the stigmatized nature of
the diagnosis or experience.

Theoretical Framework

The following section will describe the theoretical framework that underlies the
clinical application model that will be presented. Briefly stated, this model posits
that regardless of clients’ attitudes regarding their concealable stigmas, the main
goals of the therapy are to expand clients’ personal level of embodiment, expand
their relational embodiment, and expand their movement repertoires. In order for
this to be done, an understanding of how the concealable stigma manifests on a
physical level, the impact it may have on embodiment, and how it impacts each
client relationally must all be observed and felt by the client and the therapist.

Physical Manifestation

Below is a description of how the Kestenberg Movement Profile (KMP), Bartenieff

Fundamentals, and the Five Fundamental Actions can provide a foundation from
which to look at how the sense of safety, internalized stigma, and shame stemming
from having a concealable stigma, might manifest in the body.

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Kestenberg Movement Profile

The KMP is an instrument used by dance/movement therapists to observe, notate,

and assess nonverbal behavior. It can be used to inform and guide DMT
interventions. The KMP is divided into two major subsystems: System I, which
describes inner needs, feelings and affects, as well as adult patterns that reflect
responses to environmental challenges; and System II, which describes a line of
development for dealing with relationships to things and people (Loman & Merman,
1996). The degree to which individuals feel safe in their body can be experienced
and observed in both systems.
Tension flow attributes, part of System I of the KMP, describe the flow of
muscular tension and reflect core temperament as well as subjective evaluation of
the environment (Kestenberg Amighi, Loman, Lewis, & Sossin, 1999). Free flow
emerges when feelings of safety, pleasure, and ease exist, whereas bound flow tends
to emerge from feelings of anger, fear, or displeasure (Kestenberg Amighi et al.,
1999). Thus, taking note of a client’s propensity towards free or bound flow can
support an understanding of how safe the individual may feel in both body and
environment.
System I of the KMP also includes efforts and pre-efforts. Whereas efforts are
movements that are oriented outwards, pre-efforts are movements that contain a
mixture of inner and outer orientations, as they are ways of attempting to control the
external environment and defend against unwanted impulses. People often use pre-
efforts in the process of learning and defending (Kestenberg Amighi et al., 1999).
According to McCormick (2006), ‘‘Pre-Efforts, thus reveal a degree of inner
connection, but may indicate insufficient confidence in either the inner or outer
environment to support complete expression. In such cases, inner feelings do not
find completion in expressive or relational movement’’ (p. 93). It follows that
individuals with concealable stigmas who believe that the world is not a safe place
might unconsciously prevent their full range of physical expression in order to
defend against potential physical or psychological harm. McCormick (2006) goes
on to state that individuals experiencing internalized homophobia may depend on
just a few movement efforts to affect their environment or may predominately move
with pre-efforts,
Depending on the degree to which an individual feels safe to expand into the
world and connect with the self, Effort qualities may seem to be either
disconnected, effortful acts (as in over-compensation) or as natural, supported
extensions of core feeling states. (McCormick, 2006, p. 96)
Whereas System I can be characterized by movement patterns being shaped by
tension flow, the underlying force behind movement patterns in System II is shape
flow (Kestenberg Amighi et al., 1999). Shape flow is the growing or shrinking of all
three bodily dimensions (horizontal, vertical, and sagittal) and gives structure to
tension flow by providing spatial components (Kestenberg Amighi et al., 1999).
Horizontal shape flow is seen in expansion through widening, which is associated
with feelings of trust in the environment, and through narrowing, which is
associated with distrust in one’s environment (Kestenberg Amighi et al., 1999). In

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the vertical dimension, lengthening can be observed when feelings of comfort, pride
and capability exist, whereas shortening may be observed when one is expressing
pain, anger, or shame (Kestenberg Amighi et al., 1999). Finally, in the sagittal
dimension, bulging emerges with feelings of self-satisfaction while hollowing
emerges with a lack of self-confidence. Thus, for individuals with concealable
stigmas who have learned that the environment is not safe or trustworthy for them,
and/or feel a lack of self-confidence and/or shame, a predominance of narrowing,
shortening, and/or hollowing may be observed.
Importantly, a balance of both movements in all three dimensions is necessary for
healthy emotional expression. According to Kestenberg Amighi et al. (1999):
[S]elf-confidence requires a coming into oneself as well as a going out to the
world. Someone who primarily bulges, looks puffed up, bloated, or full of
himself. He may have much information, but it is hot air, because it has not
been properly digested or processed. Incorporating, digesting, or understand-
ing requires hollowing. Of course, with too much hollowing the information is
too quickly expelled. The person looks depleted. The balance between bulging
and hollowing affords the opportunity to go out into the world and yet return
to find connections with self. (p. 122)

Bartenieff Fundamentals

In addition to the above examples of how specific tension flow and shape flow
patterns, as derived from the KMP, may be associated with feelings of safety in
respect to the external environment, other physical characteristics, as derived from
Bartenieff Fundamentals, may be exhibited—such as a lack of breath support, core
support, and/or limited use of one’s kinesphere. For example, individuals with
concealable stigmas may have predominantly internal orientations due to the
physical and psychological impulses to draw inward when keeping secrets. They
may limit their movement expression, use of kinesphere, and/or breath in order to
limit visibility. McCormick (2006) describes that gay men and lesbians with
internalized homophobia,
…may look as though [they are] pulling up and away from the core of the self,
forcing the breath high into the chest… movements through space may seem
predominantly direct (purposeful) rather than sculpted (relational), and appear
unsupported by the core. They may reflect attempts to control rather than
interact with environments perceived as threatening. (pp. 88-89)
This most likely extends to other such populations with concealable stigmas who
have similarly internalized the outward oppression they face.
On the other hand, individuals with concealable stigmas might be hypervigilant
while in public and have extremely outward orientations due to the perceived need
to scan for external threats. These individuals may appear fidgety with continually
shifting eye movement while lacking breath support, as evidenced by shallow and
rapid breathing (McCormick, 2006).

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In either case, an internal feeling of disempowerment or shame may exist in a

client with a concealable stigma. Drawing on social theorists, Johnson (2009)
articulates how the body is a site of identity; our relationship to our body and our
body language(s) reflects our social status. If having a concealable stigma leads
individuals to perceive themselves as having low social status, this is likely to be
reflected in their bodies. Specifically, it may be observed physically through a lack
of core support. Core support demonstrates confidence and self-esteem. When
clients are impacted by a belief (conscious or not) that they do not have the ability to
affect their situation, they will likely be unable to support themselves through
connection to their core (McCormick, 2006). For example, individuals with a
criminal history may believe that they have no ability to affect their current or future
situation. Consequently, they may lack connection to their core as well as breath
support, and may present with an undeveloped effort life and/or an under use of
their kinesphere.
In addition to a lack of breath support and core support, a lack of head–tail
connection may at times also be observed in a client with a concealable stigma.
Hackney (2002) writes, ‘‘a spine which supports and easily achieves verticality
while also having the potential for fluid grace with flexibility seems to convey an
important message: ‘this person is proud to be the human being s/he is and is
comfortable attending to the world’’’ (p. 85). This verticality is related to having a
strong intention and this might not fully exist in clients who have internalized their
stigma, and have high levels of shame and/or low levels of self-worth (Lovell,
1993).

Five Fundamental Actions

The related field of body psychotherapy can support DMT’s application to this
population through the concept of the Five Fundamental Actions, drawn from Body-
Mind Centering. Having full range and proficiency of these five actions (yield, push,
reach, grasp, and pull) can help people tap into feelings of confidence and capability
(Brook, 2010). The ability to yield, or to ‘‘rest into contact,’’ brings people into
connection with their external world and underlies their basic relationship to their
environment (Aposhyan, 1999). If clients do not feel safe in their world, it follows
that they will have a difficult time yielding. Unlike yield, which focuses on resting
into one’s environment and feeling this support, push entails feeling ourselves,
feeling our boundaries, and supporting ourselves (Aposhyan, 1999; Brook, 2010;
Cohen, 1993). Focusing on push can support individuals in feeling empowered
physically and psychologically. Aposhyan (1999) explains that, ‘‘as adults, the
extent to which we are able to push reflects our internal sense of support,
individuation, confidence, and ability to propel ourselves’’ (p. 69). Developing a
capacity to push may lead to a greater internal sense of worth; with a supporting
push, a healthy reach can become possible. Reaching, on a psychological level,
expresses longing, interest, curiosity, desire, and compassion. When the reach is
well developed, there is willingness for these qualities to be seen by others and this
can serve as a connection between inner and outer worlds (Aposhyan, 1999; Brook,
2010). This ability to reach might be challenging for someone who experiences an

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ever-present threat of losing friends, community, or a job due to a concealable

stigma being disclosed. The final two fundamental actions, grasp and pull, rest on
one’s ability to yield, push, and reach, and are essential to feeling satisfaction
(Aposhyan, 1999; Brook, 2010).
Embodiment is ‘‘the moment to moment process by which human beings allow
awareness to enhance the flow of thoughts, feelings, sensations, and energies
through our bodily selves’’ (Aposhyan, 2004, p. 52). A general lack of embodiment
may be felt and observed in clients who have concealable stigmas as they might lose
their internal connection to themselves in order to stay attuned to the external
environment. Or, as a result from not feeling safe and/or having experiences of
oppression, they might dissociate or disconnect from their physical experience
(Johnson, 2009).
By lacking embodiment, one lacks the resource of listening to the language of
physical sensation that gives individuals access to vital information about their lived
experience (Caldwell, 1996). This, in turn, makes it difficult for individuals to have
trust in their bodily experiences and cultivate the sense of safety in the body. Krantz
(1999) explains, ‘‘reconnecting the body with feeling allows the client to experience
affect and express her inner world, to recognize meaning in her behavior and
relationships, and to develop healthy psychophysical unity’’ (p. 101). Interventions
to expand embodiment, both intrapersonally and interpersonally, will be discussed
in the clinical application model.
The therapeutic container that holds the relationship between clients and
therapists can serve as a mirror of the relationship between clients and the clients’
external world. Clients may choose to conceal their stigmas from their therapists
and/or may choose to disclose them at some point. Regardless, it is likely that the
dynamics of their identity and experiences of their concealable stigmas will be
present in therapy. The following paragraphs address the somatic presentation of
identity and how this may impact the therapeutic relationship.
Identity is comprised of a core, felt sense of self, which joins with core beliefs
about the self, the world, and interconnectedness of the two (Stern, 1985). Within
this, there is often a self that is private and a self that is presented to the public. To a
degree, everyone experiences a difference between these two selves. Caldwell
(1996) explained:
[W]e choreograph a physical persona to relate with the world, while we bury
our essence beneath it. These physical posturings keep the whole system
going. We especially need to administer them to ourselves in times of stress,
or when our act is threatened. (p. 35)
For those with a concealable stigma, the times where individuals might
experience stress or feel threatened could be often; thus, the difference between
public and private selves might be vast.
Caldwell (2013) noted research on the ‘‘nonverbal bilingualism’’ that is likely to
exist amongst those who do not belong to the dominant culture. Citing Henley
(1977), Johnson (2009), and Thomas (1998), Caldwell (2013) describes how people
of color, and people from working class backgrounds or minority sexual orientations
may move and speak differently depending on whom they are around in order to feel

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safe, included, and accepted. It follows that clients with concealable stigmas may
move or speak differently in the presence of the therapist than when at home or
amongst close others. They may feel less embodied in the presence of the therapist
and/or the physical manifestations of the stigma discussed previously may be felt or
observed strongly. Importantly, the therapist may not even know a client has a
concealable stigma due to the effort the client takes to conceal such stigma. This
adds an obvious challenge to the work of therapy.

Application

Based on the theory described above, the following section will describe some
clinical interventions that could be used in working with clients with concealable
stigmas. While these interventions could be used in a group setting, the context for
the purposes of this article is individual therapy. These interventions are designed to
expand a client’s personal embodiment, relational embodiment, and movement
repertoire.

Expanding Personal Embodiment

In working with clients who have become disembodied as a result of their

concealable stigmas, using Focusing, breath awareness practice, bipolar shape flow
exploration, and authentic movement could help reconnect these clients back with
their own bodies. Focusing is a body-oriented and client-directed intervention that
emphasizes the process of listening to one’s body in a gentle, non-judgmental way
(Cornell, 1996). Through this process, one can learn to have a relationship with
strong feelings and/or sensations, acknowledging them and listening to them rather
than pushing them away (Cornell, 1996). This, in turn, can lead to a greater
connection with one’s inner experience and help cultivate inner safety as the body
becomes a resource and ally instead of something to distrust or push away.
Similar to Focusing, cultivating awareness of breath is client-directed and can
also increase embodiment by helping put individuals back in touch with their
internal state as breath is a link to their proprioceptive self (Hackney, 2002). With
gentle guidance from the therapist, clients can explore the rhythm and cadence of
their breathing and where perhaps their breath is held. From this place of awareness,
clients can become attuned to how their breath affects and is reflective of their
feelings and thoughts, and can thus be an ally in the process of change (Hackney,
2002). Breath is also the blueprint for bipolar shape flow (Kestenberg Amighi et al.,
1999). Through developing a greater capacity for bipolar shape flow, clients can
create a stronger container for experiencing strong feelings and sensations, making
embodiment more tolerable.
Authentic movement, originally called ‘‘movement-in-depth,’’ is a form devel-
oped by Mary Starks Whitehouse (Levy, 2005). It is both a contemplative practice
and a DMT intervention used to explore unconscious parts of the self through
movement. Authentic movement helps grow awareness, expand attention to the
present moment and create self-acceptance without judgment by bringing one’s

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somatic, cognitive, and verbal dimensions of self into a more integrated whole
(Pallaro, 1999). This expanded degree of embodiment can support clients to
integrate their various parts, both those that are conscious and/or visible, and those
that are unconscious and/or kept concealed.

Expanding Relational Embodiment

Once clients have developed and integrated their ability to make contact with
themselves through DMT interventions such as breath awareness practice,
developing bipolar shape flow, and/or authentic movement, the clients can use
the therapeutic relationship to begin to develop and integrate their ability to be in
relationship with another. This is particularly important if and when the clients
choose to reveal their stigmas. The therapeutic relationship can serve as a reparative
experience by cultivating internal safety and by serving as an opportunity for public
and private selves to integrate.
Personal embodiment, as discussed above, can serve as the groundwork for
clients to be able to embody their interactions with others and thus support clients’
integration of their public and private selves. As previously mentioned, clients with
concealable stigmas may have the experience of being extremely internally oriented
while out in public, thus, making it difficult to make contact with others. This may
be the case if clients are preoccupied with keeping a part of themselves concealed
and/or managing others’ impression of themselves. On the other hand, clients with
concealable stigmas may have their attention oriented extremely externally. They
may deem it necessary to scan for safety and/or observe and subsequently display
the behavioral norms of the un-stigmatized others. With this outward orientation,
contact can be made but the contact will likely be hollow.
Aposhyan (1999) describes contact as including attention to proximity, touch,
eye contact, speaking, and listening, all of which can be used therapeutically
through DMT interventions to build an embodied relationship. For example,
slowing down clients’ verbal processes in order to include awareness of their
internal experience can be instrumental in creating a bridge between internal and
external or invisible and visible. The dance/movement therapist could prompt
clients to work on staying present with their internal experience while making eye
contact with the therapist, thereby building on the clients’ capacity to feel their
selves while in relationship to another.
Or, the dance/movement therapist could work with physical proximity. Starting
from opposite sides of the room, clients could slowly start approaching the therapist,
pausing intermittently to check in with how the closer proximity was affecting the
clients’ ability to stay in connection to themselves. The dance/movement therapist
could also utilize System II of the KMP, which guides relational embodiment.
Noticing what movements naturally arise from the client, the therapist could attune
to the client’s movements to strengthen the therapeutic relationship and to develop a
mutually empathic relationship (Loman & Merman, 1996). From this relationship,
the therapist could prompt interventions involving bipolar and unipolar shape flow,
and shaping in directions and planes. It is important for these interventions to be

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taken slowly to ensure that integration is occurring and that clients are not losing
their internal experience in lieu of the external one.

Expanding Movement Repertoire

The dance/movement therapist can also use movement-based interventions to

expand ways that a client might be capable of moving in the world. Working with
polarities of movement can be utilized to safely explore the opposite physical
expression of a client’s lived experience (Levy, 2005). Specifically, DMT
interventions rooted in exploring the various polarities that exist within pre-efforts,
efforts, and bipolar shape flow, could be used in working with this population. These
DMT interventions could help facilitate clients’ self-expression while cultivating
broader movement repertoires (Loman & Merman, 1996). For example, a therapist
could draw attention to a client’s propensity towards bipolar shrinking and invite the
verbalization of any accompanying words, images, or emotions (Loman & Merman,
1996). Additionally, if this predominance of shrinking is observed or felt in a client
with a concealable stigma, a dance/movement therapist could prompt the client to
explore what the opposite, growing, would feel like. However, it is important to note
that there is a significant and crucial difference between someone merely trying
something on in order to appear different and someone finding something different
within the self, resulting in an experience that feels different. Consequently, it is
important for the therapist to facilitate this exploration of polarities slowly, inviting
frequent pauses to allow clients to feel how new postures or movements impact
them internally. The goal is not to get clients to appear different for the sake of
appearing different, but rather for the clients to expand their movement repertoires
to support the expansion of choice. It follows that with greater choice, clients will
feel more freedom in expression and less limited by their stigmas.
In addition, the development of a strong sense of self that feels safe and
integrated can be supported through movement interventions designed to cultivate a
client’s proficiency with the Five Fundamental Actions (described previously) and
verticality. Assessing clients’ proficiency with yield, push, reach, grasp, and pull can
help identify ways they relate to their world. If clients with a concealable stigma are
observed to have a difficult time yielding or speaking about feeling unsafe in the
world, the dance/movement therapist could work with them on a physical level. For
example, having clients lay belly down on the ground can give them the experience
of solid, reliable, unconditional support (Aposhyan, 1999). Practicing yielding by
resting into contact with the earth can feel safer than resting into contact with
another person. Additionally, giving clients an opportunity to feel the frontline of
their body through this connection to ground can strengthen their relationship to
breath and encourage a greater degree of breath support. It is important to note that
yielding (like other clinical interventions) may be triggering for certain clients
depending on their specific histories. Therefore, it is important for the therapist to
look for cues about how and when to introduce this process. Continually tracking
their clients’ processes can help ensure the pacing of interventions is clinically
supportive rather than harmful.

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Next, clients could practice pushing away from the ground with various body
parts in order to help them somatically differentiate between what is internal and
what is external (Aposhyan, 1999). Additionally, this practice of push can help
clients progress from feeling just the support of the ground (external) to feeling the
additional support of themselves (internal). From these developed areas of support
from the yield and the push, clients can then begin to practice their reach, grasp and
pull. These more externally oriented actions are the latter half of a cycle that can
bridge their inner and outer worlds, thus facilitating integration of their internal,
concealed self and their external, social self.
Another potentially helpful movement intervention can involve focusing on
clients’ head–tail connection. Exploring areas where clients may feel stuck in their
spinal movement and playing with the many polarities of spinal posturing might
facilitate an expanded range of connectivity and choice. Hackney (2002) describes
how ‘‘the way a person has organized him/herself at the spinal level is giving a
powerful message to others in the society whether the individual is aware of it or
not’’ (p. 86).
For example, if a client with a concealable stigma is observed as having a spine
that slumps over with gravity and a tucked-under tail, the therapist may work with
the client to develop core support and open up the frontline of the body. Practicing
core-distal connectivity can support the client to feel the safety that resides within
the central core (Hackney, 2002). The frontline of the body can be opened up with
active stretching movements designed to open up the chest and belly, and more
passively through the use of props. A therapist could, for example, prompt a client
to lay belly up over pillows positioned under the client’s upper back and neck. As
with all the other interventions, it is important to keep the client tuned into the
internal sensations and feelings that accompany the experience in order to facilitate
integration.

Limitations

This article is purely theoretical and thus is limited by its lack of clinical examples.
By relying on hypotheticals and theory, there is a risk of reinforcing stereotypes.
Consequently, it is important that more research be done regarding this population.
Specifically, the theories presented in this article could be furthered by research that
includes movement analysis of persons with concealable stigmas in order to combat
any possible reinforcement of stereotypes. However, it is the author’s belief that it
may be possible to hide one’s authentic self purposefully through conscious
adaptations to one’s movement behavior. This should be considered in the
movement analysis of such populations. Additionally, any such movement analysis
should take into account any dynamics of power, privilege, and oppression present
in the therapeutic relationship, as well as observational biases on the part of the
therapist or researcher.

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Conclusion

The existence of concealable stigmas, and the experience of having one, is the
existence and experience of social injustice. By deeming certain individuals as ‘‘less
than’’ due to having a stigmatized trait, whether related to their body, beliefs, or
history, we perpetuate oppression. While we can and should work to change the
external, systemic and institutional conditions of oppression, we must also work to
change what we believe about our bodies and our lived experience of who we are.
Through re-embodying our physical selves, we can prevent our physical selves from
becoming the vessel in which oppression lives.
This article presents a theoretical approach, along with some possible DMT
applications for supporting clients with a concealable stigma to become more
embodied both intra- and interpersonally, while cultivating a broader capacity to
move and express. By doing so, DMT might serve as a vehicle to empower clients to
own their experience and exercise choice rather than unduly limit how they feel and
present themselves in the world.
Johnson (2009) described:
Being comfortably anchored in a solid felt experience of the body in relation
to other bodies is so phenomenologically different from the experience of
‘othering’ or being ‘othered’ that it provides a compelling counterpoint to
hierarchical models of social power—a place from which to experience the
world differently even when the social structures through which that
experience is shaped have not yet changed. (p. 28)
Perhaps DMT, a body-based therapeutic discipline, could support clients with
concealable stigmas to anchor themselves to their embodied experience of their
identity.

References

Aposhyan, S. (1999). Natural intelligence: Body-mind integration and human development. Boulder, CO:
NOW Press.
Aposhyan, S. (2004). Body-mind psychotherapy: Principles, techniques, and practical applications. New
York: W. W. Norton & Company.
Bosson, J. K., Weaver, J. R., & Prewitt-Freilino, J. L. (2012). Concealing to belong, revealing to be
known: Classification expectations and self-threats among persons with concealable stigmas. Self
and Identity, 11(1), 114–135. doi:10.1080/15298868.1010.513508.
Brook, A. (2010). From conception to crawling: Foundations for developmental movement. Boulder, CO:
Smart Body Books.
Brooks, D., & Stark, A. (1989). The effect of dance/movement therapy on affect: A pilot study. American
Journal of Dance Therapy, 11(2), 101–112.
Brown, C. (2009). Moving into action: A case study of dance/movement therapy with the dually
diagnosed in a methadone treatment program. In S. L. Brooke (Ed.), The use of the creative
therapies with chemical dependency issues (pp. 187–203). Springfield, IL: Charles C. Thomas.
Caldwell, C. (1996). Getting our bodies back: Recovery, healing, and transformation through body-
centered psychotherapy. Boston, MA: Shambhala Publications Inc.

123
78 Am J Dance Ther (2016) 38:63–80

Caldwell, C. (2013). Diversity issues in movement observation and assessment. American Journal of
Dance Therapy, 35(2), 183–200. doi:10.1007/s10465-013-9159-9.
Clare, E. (2001). Stolen bodies, reclaimed bodies: Disability and queerness. Public Culture, 13(3),
359–365.
Cohen, B. B. (1993). Sensing, feeling, and action: The experiential anatomy of body-mind centering.
Northampton, MA: Contact Editions.
Cornell, A. W. (1996). The power of focusing: A practical guide to emotional self-healing. Oakland, CA:
New Harbinger Publications Inc.
Corrigan, P. W., & Kleinlein, P. (2005). The impact of mental illness stigma. In P. W. Corrigan (Ed.), On
the stigma of mental illness: Practical strategies for research and social change (pp. 11–44).
Washington, DC: American Psychological Association.
Crocker, J., Major, B., & Steele, C. (1998). Social stigma. In D. Gilbert, S. T. Fiske, & G. Lindsey (Eds.),
Handbook of social psychology (4th ed., Vol. 2, pp. 504–553). Boston, MA: McGraw-Hill.
DePaulo, B. M. (1992). Nonverbal behavior and self-presentation. Psychological Bulletin, 111, 203–243.
Dosamantes, E. (1990). Movement and psychodynamic pattern changes in long-term dance/movement
therapy groups. American Journal of Dance Therapy, 12(1), 27–44.
Eribon, D. (2004). Insult and the making of the gay self. (M. Lucey, Trans.). Durham, NC: Duke
University Press.
Frable, D. E. S., Blackstone, T., & Scherbaum, C. (1990). Marginal and mindful: Deviants in social
interactions. Journal of Personality and Social Psychology, 59(1), 140–149.
Frable, D. E. S., Platt, L., & Hoey, S. (1998). Concealable stigmas and positive self-perceptions: Feeling
better around similar others. Journal of Personality and Social Psychology, 74(4), 909–992.
Frank, Z. (1997). Dance and expressive movement therapy: An effective treatment for a sexually abused
man. American Journal of Dance Therapy, 19(1), 45–61.
Goffman, E. (1963). Stigma: Notes on the management of spoiled identity. Englewood Cliffs, NJ: Prentice
Hall.
Gray, A. E. L. (2001). The body remembers: Dance/movement therapy with an adult survivor of torture.
American Journal of Dance Therapy, 21(1), 29–43.
Hackney, P. (2002). Making connections: Total body integration through Bartenieff Fundamentals. New
York: Routledge.
Henley, N. (1977). Body politics: Power, sex and non-verbal communication. Body politics: Power, sex,
and nonverbal communication. Englewood Cliffs, NJ: Prentice-Hall.
Herek, G. M. (1998). Stigma and sexual orientation: Understanding prejudice against lesbians, gay men,
and bisexuals. Newbury Park, CA: Sage.
Herek, G. M., & Berrill, K. T. (1992). Hate crimes: Confronting violence against lesbians and gay men.
Newbury Park, CA: Sage.
Herek, G. M., Gillis, J. R., & Cogan, J. C. (2009). Internalized stigma among sexual minority adults:
Insight from a social psychology perspective. Journal of Counseling Psychology, 56(1), 32–43.
Jeong, Y. J., Hong, S. C., Lee, M., Park, M. C., Kim, Y. K., & Suh, C. M. (2005). Dance/movement
therapy improves emotional responses and modulates neurohormones in adolescents with mild
depression. International Journal of Neuroscience, 115(12), 1711–1720.
Johnson, R. (2009). Oppression embodied: The intersecting dimensions of trauma, oppression, and
somatic psychology. The USA Body Psychotherapy Journal, 8(1), 19–31.
Jones, E. E., Farina, A., Hastorf, A. H., Markus, H., Miller, D. T., & Scott, A. S. (1984). Social stigma:
The psychology of marked relationships. New York, NY: Freeman.
Kestenberg Amighi, J., Loman, S., Lewis, P., & Sossin, K. M. (1999). The meaning of movement:
developmental and clinical perspectives of the Kestenberg Movement Profile. New York, NY:
Brunner-Routledge.
Koch, S., Kunz, T., Lykou, S., & Cruz, R. (2014). Effects of dance/movement therapy and dance on
health-related psychological outcomes: A meta-analysis. The Arts in Psychotherapy, 41(1), 46–64.
doi:10.1016/j.aip.2013.10.004.
Koch, S. C., Morlinghaus, K., & Fuchs, T. (2007). The joy dance: Specific effects of a single dance
intervention on psychiatric patients with depression. The Arts in Psychotherapy, 34(4), 340–349.
Krantz, A. M. (1999). Growing into her body: Dance/movement therapy for women with eating disorders.
American Journal of Dance Therapy, 21(2), 81–103.
Lane, J. D., & Wegner, D. M. (1995). The cognitive consequences of secrecy. Journal of Personality and
Social Psychology, 69(2), 237–253.

123
Am J Dance Ther (2016) 38:63–80 79

Leventhal, F., & Chang, M. (1991). Dance/movement therapy with battered women: A paradigm of
action. American Journal of Dance Therapy, 13(2), 131–145.
Levy, F. (2005). Dance movement therapy: A healing art. Reston, CA: National Dance Association.
Link, B. G., & Phelan, J. C. (2001). Conceptualizing stigma. Annual Review of Sociology, 27, 363–385.
Loman, S. (2005). Dance/movement therapy. In C. A. Malchiodi (Ed.), Expressive therapies (pp. 68–89).
New York: The Guilford Press.
Loman, S., & Merman, H. (1996). The KMP: A tool for dance/movement therapy. American Journal of
Dance Therapy, 18(1), 29–52.
Lovell, S. M. (1993). An interview with Warren Lamb. American Journal of Dance Therapy, 15(1),
19–34.
Malchiodi, C. A. (2005). Expressive therapies: History, theory, and practice. In C. A. Malchiodi (Ed.),
Expressive therapies (pp. 68–89). New York, NY: The Guilford Press.
McCormick, L. A. (2006). Transcending homophobia: Shifting sexual prohibitions in dance/movement
therapy. Unpublished master’s thesis, Naropa University, Boulder, CO.
Milliken, R. (1990). Dance/movement therapy with the substance abuser. The Arts in Psychotherapy,
17(4), 309–317.
Pachankis, J. E. (2007). The psychological implications of concealing a stigma: A cognitive-affective-
behavioral model. Psychological Bulletin, 133(2), 328–345.
Padrão, M. J., & Coimbra, J. L. (2011). The anorectic dance: Towards a new understanding of inner-
experience through psychotherapeutic movement. American Journal of Dance Therapy, 33(2),
131–147.
Pallaro, P. (1997). Culture, self and body-self: Dance/movement therapy with Asian Americans. The Arts
in Psychotherapy, 24(3), 227–241.
Pallaro, P. (1999). Authentic movement: Essays by Mary Starks Whitehouse, Janet Adler and Joan
Chodorow. London: Jessica Kingsley Publishers.
Persson, A., & Richards, W. (2008). From closet to heterotopia: A conceptual exploration of disclosure
and ‘passing’ among heterosexuals living with HIV. Culture, Health & Sexuality, 10(1), 73–86.
Quinn, D. M. (2006). Concealable versus conspicuous stigmatized identities. In S. Levin & C. van Laar
(Eds.), Stigma and group inequality: Social psychological perspectives (pp. 83–103). Mahwah, NJ:
Lawrence Erlbaum Associates Publishers.
Quinn, D. M., & Chaudoir, S. R. (2009). Living with a concealable stigmatized identity: The impact of
anticipated stigma, centrality, salience, and cultural stigma on psychological distress and health.
Journal of Personality and Social Psychology, 97(4), 634–651.
Quinn, D. M., & Earnshaw, V. A. (2013). Concealable stigmatized identities and psychological well-
being. Social and Personality Psychology Compass, 7(1), 40–51. doi:10.1111/spc3.12005.
Reicherzer, S. (2005). Coming out and living out across the life span. In D. Comstock (Ed.), Diversity and
development: Critical contexts that shape our lives and relationships (pp. 161–184). Belmont:
Thomson Brooks/Cole.
Ritter, M., & Low, K. G. (1996). Effects of dance/movement therapy: A meta-analysis. The Arts in
Psychotherapy, 23(3), 249–260.
Romero, E. F., Hurwitz, A. J., & Carranza, V. (1983). Dance therapy on a therapeutic community for
schizophrenic patients. The Arts in Psychotherapy, 10(2), 85–92.
Schmais, C. (1985). Healing processes in group dance therapy. American Journal of Dance Therapy, 8(1),
17–36.
Schmais, C. (1998). Understanding the dance/movement therapy group. American Journal of Dance
Therapy, 20(1), 23–35.
Sedlovskaya, A., Purdie-Vaughns, V., Eibach, R. P., LaFrance, M., Romero-Canyas, R., & Campu, N. P.
(2013). Internalizing the closet: Concealment heightens the cognitive distinction between public and
private selves. Journal of Personality and Social Psychology, 104(4), 695–715. doi:
10.1037/a0031179.
Silberstein, S. (1987). Dance therapy and schizophrenia: Vision of the future. The Arts in Psychotherapy,
14(2), 143–152.
Smart, L., & Wegner, D. M. (1999). Covering up what can’t be seen: Concealable stigma and mental
control. Journal of Personality and Social Psychology, 77(3), 474–486. doi:10.1037/0022-
3514.77.3.474.
Stern, D. N. (1985). The interpersonal world of the infant: A view from psychoanalysis and developmental
psychology. New York: Basic Books Inc.

123
80 Am J Dance Ther (2016) 38:63–80

Thomas, M. (1998). Estranged bodies and Vietnamese identities. Australian Journal of Anthropology,
9(1), 74–88.
Thomson, D. M. (1997). Dance/movement therapy with the dual-diagnosed: A vehicle to the self in the
service of recovery. American Journal of Dance Therapy, 19(1), 63–79.
Whitehouse, M. S. (1999). Physical movement and personality. In P. Pallaro (Ed.), Authentic movement:
Essays by Mary Starks Whitehouse, Janet Adler and Joan Chodorow (pp. 51–57). London: Jessica
Kingsley Publishers.

Nell G. Roberts
completed her Masters of Arts degree from Naropa University in Somatic Counseling Psychology with a
concentration in Dance/Movement Therapy. She currently resides in Boulder, Colorado and is involved in
Boulder’s dance and expressive arts community. She would like to extend thanks to Leslie McCormick
for her guidance and support while writing this article.

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