The Arfs in Psychotherapy, Vol. 9 pp. 49-53, Ankho International Inc., 1982. Printed in the U.S.A.

MOVEMENT NEGOTIATIONS WITH AN AUTISTIC CHILD

IVY LEE COLE, PhD, DTR*

In the summer of 1976 I participated in a dance therapy program of eight weeks with an autistic child for the purpose of documenting the thera- peutic process. Data were collected by videotap- ing one session in each of the eight weeks, and the results of that study were included in my dis- sertation (Cole, 1979). Descriptions of interac- tions between client and therapist, taken from my dissertation, are used in this paper to illus- trate a point of view regarding the therapist’s needs in a therapeutic relationship. Dance ther- apy sessions occurred at the Center for Behav- ioral Studies, North Texas State University, Denton, Texas. The child, Peter, was a day stu- dent at the Center. At that time I was a doctoral candidate and a registered dance therapist.

Peter was selected for dance therapy on the basis of four criteria: (1) he was autistic; (2) he was nonverbal; (3) he was small enough in size for me to carry; and (4) he had parental permis- sion. Peter was seven years old and had been at the Center for three years. He lived at home with his parents and three older siblings. He was slightly built, weighed 45 pounds and stood 46 inches high. His medical history was essentially negative, with emotional and behavioral prob- lems being the exceptions. He appeared hyper- active and seemed tired most of the time. This was explained somewhat by his mother who told me of Peter’s moving around, alone, in his room at night until midnight or later. I chose to work with this nonverbal, autistic child because any communication between us would be, of neces- sity, nonverbal and through movement.

As a dance therapist I have a sustained inter- est in therapeutic relationships established

through and in movement. Following this interest I began recently to study myself as the therapist. My interest led me to focus on my needs, expressed in movement, as they affected the therapeutic relationship. Never before had I de- liberately studied myself as the therapist. My focus had always been on the client. This paral- lels research in psychotherapy where, until the 1950s and again in the 197Os, little consideration was given to the therapist’s use of self in the treatment situation (Bandura, 1956; Issacharoff, 1976). Before these periods of interest in thera- pists there was considerable investment in ther- apists’ ability to detach “. . . themselves from personal feelings and needs in the service of the analytic task” (Epstein, 1977, p. 446).

Therapists’ feelings and needs enjoy consider- ably more positive prominence in recent litera- ture on countertransference. Giovacchini (1975) noted that the shift in focus from the patient to interaction between patient and analyst brought the analyst’s participation to the fore (p. x). Thus, therapy became a highly interpersonal af- fair. Issacharoff (1976) defined countertransfer- ence as “. . . the living response to the patient’s emotional situation at a given moment” (p. 410); while Cahn in 1980 defined therapy as “. . . a process of human involvement between subjec- tive, valuing beings” (p. 2). Bettelheim (1975) declared the therapist’s emotional preoccupa- tions to be the main incentive for him to help psychiatric patients (p. 266). Epstein and Feiner (1979) viewed countertransference as a normal, natural interpersonal event. They believed that the data of countertransference have potential value in understanding the patient, in under-

*Dr. Cole is on the faculty of the Department of Physical Education and Dance, University of Wisconsin-Madison, Madison, Wisconsin.

0197-4556/82/010049-05$03.00/O Copyright 0 1982 Ankho International Inc.

50 IVY LEE COLE

standing the therapeutic relationship and in for- mulating interventions (p. SOS). It would appear from the literature cited that successful therapy is dependent upon the understanding and use of countertransference.

In 1955 Colm applied the field theory of phys- ics to human events. The field theory states that it is not the characteristics of individual bodies but what happens between them that determines their behavior. From this theory Colm thought it evident:

. . . that therapy cannot be a one-sided opening up-a relationship which for the one person is spontaneous and open; and for the other controlled and withholding

There must be an inner contact of two human beings who turn to each other with their fields of experience-past and present, conscious and uncon- scious-and meet, interact, relate (p. 341).

This theory of psychotherapy allows a partner- ship to exist between therapist and client, a give and take on both parts, with healing occurring in the field common to both where each has access to and contact with the unconscious areas of his field and of the other (p. 341). Colm’s theoretical point of view is most acceptable to me as I re- searched into my needs as therapist.

Before the dance therapy program with Peter began I anticipated my needs: (1) to help, not harm him by supporting and caring for him; and (2) not to be physically hurt or uncomfortable. I also identified what I thought were Peter’s needs: (1) to be allowed choices in his activities; (2) to be supported by me in his choices; and (3) to re- ceive affection-approval on a body level from me.

When I began to re-analyze, via the video- tapes, Peter’s and my reciprocal interactions with reference to both our needs, it was immedi- ately apparent that our needs were sometimes harmonious and sometimes conflicting. When our needs were harmonious, I felt that I had been a “good” therapist. However, I was ashamed initially to realize that my needs sometimes con- flicted with Peter’s. As a client-oriented therapist, it had been my intention to build interactions by following and supporting Peter’s movement cues. Yet, a favorite activity of Peter’s, the chair activity, had its beginning in conflicting needs. In the first session Peter often moved to the video camera and poked its lens. Aside from his possi-

ble damage to the lens, Peter was too close to videotape and I physically removed him from the camera area each time he got too close. Once I pulled him away from the camera as he sat in a chair. He responded by pushing the chair back- ward with his feet against the floor; then he stood in a crouched position, reached behind him, took hold of the chair seat, and pulled the chair for- ward toward the camera and sat in it. I pulled him backwards away from the camera and then pushed him forward as he sat in the chair. Thus, the chair activity, consisting of Peter’s being pushed from behind as he sat in the chair, had its beginning. My not supporting his movement cue of poking the camera led to the chair activity.

For the first twenty-two sessions the chair ac- tivity was the dominant activity. Peter seemed to want to be pushed in the chair most of the time. We were not in direct physical contact during this activity, but our relationship was maintained through the mutuality of the chair.

In those twenty-two sessions the chair activity was never as continuous as Peter wished because at times several of my needs influenced the ac- tivity. He wanted to ride in his chair all the time; I did not want to push all the time. In our early sessions I was determined to “relate” to Peter by facing him directly. However, face-to-face inter- action with Peter was not possible from my push- ing position behind the chair. Often I stopped pushing and tried to relate face-to-face, but this was not very effective. Another need of mine, that of proving that dance therapy works by get- ting Peter to talk, also interfered with the chair activity. From time to time I stopped pushing, faced him, and tried to get him to name parts of his body. On one occasion he spontaneously named parts of his face as he touched them. I wanted Peter to do it again. He didn’t. He toler- ated these needs of mine, but repeatedly demon- strated his need to ride in the chair. When I stopped to talk, relate, or rest, Peter pulled the chair a short distance, sat, waited, pulled again and waited until I pushed him in the chair. He also cued me to push him by placing my hands on the chair’s back. If I didn’t push, he cued me again and again until I did push. If I pushed in the wrong direction or at the wrong speed, he redi- rected me with a variety of movement cues to fulfill his need to ride in his chair.

By the fourteenth session the chair activity

MOVEMENT NEGOTIATIONS WITH AN AUTISTIC CHILD

was a well established routine. Having discov- ered that a lighter chair made pushing easier for me, I tested two chairs at the beginning of this session for ease in pushing. Peter stood waiting, and sat in the chair of my choice. I pushed a short distance and quickly reconsidered chairs. We both switched to a second chair and off we went in our usual pattern of circling the room. His tol- erance for waiting for my need to be satisfied and his assistance in my fulfilling that need seemed remarkable to me.

By this time I had given up some of my earlier needs. I did not need to relate face-to-face with Peter because I understood we were in a rela- tionship that was important to me as it was. I gave up trying to get Peter to talk because it re- quired a lot of my energy and took time away from activities he wanted to do. Besides, it didn’t work and it seemed to interfere with our process. I pushed him in his chair, to my tolerance level of pushing because I understood that being pushed in the chair as he liked was important. Peter, labeled hyperactive, sat quietly in his chair as it circled and circled and circled the room digging permanent, deep ruts in the floor. This activity was very reminiscent to me of an infant being pushed in a stroller. As such, it may have repre- sented a need for regression on Peter’s part, which was certainly supported by me. Thus, the chair activity represented harmonious needs as well.

Peter’s interactions with other objects in his environment may have resulted from my inability to tolerate pushing him in the chair for thirty un- interrupted minutes. My need for physical and mental relief caused me to push Peter to a variety of objects in the room. It was my hope that he would choose to interact with them and allow me to rest. The piano activity was an example of this. When I tired of circling the room, I pushed Peter to the piano. If he wished (needed) to inter- act with the piano, he did so. If he did not wish, he redirected the chair by pushing with his feet away from the piano. I honored his need to ride in his chair by continuing to push. When Peter chose to interact with the piano, his activity was rich and varied. He played the keys with his fin- gers, toes, feet, fists, palms, elbows, chin, head, lower arms, and my fingers. He walked and sat on the keys, climbed on top of the piano from the front and back of the piano, moved the pedals

and lifted the front of the piano to watch the ac- tion of the beaters against the strings. He stood on the keys and lifted the top of the piano to peer inside, hit the piano with a block of wood and his palms, and stroked the keys without depressing them.

All the different actions comprising the piano activity were initiated by Peter and supported by me. Sometimes I joined in to satisfy my need to do something. Often he tolerated my participa- tion; sometimes he removed my hands from the keys. I tolerated that for awhile. When I needed to, I joined the playing again. I was careful not to make my actions intolerable for him. We seemed to have developed considerable give and take with reference to our needs.

Peter’s interactions with the piano were of a very different nature from those with the chair. He sat quietly and passively in the chair, but he actively manipulated the piano as he explored it inside and out, caressed and hit it. These inter- actions appeared to me to indicate his need to test his control of himself and of his environ- ment. He seemed to use play, as normal children do, as the medium for self-discovery. I believed his need to interact with the piano using such a broad range of movements to be therapeutically significant; therefore, I supported all his interac- tions with the piano.

I loved the piano activity for myself. It al- lowed me to rest and still facilitate and participate in Peter’s interactions with the piano. The piano activity allowed me a greater variety of move- ment than had the chair activity. I could play the keys, help Peter stand on the piano, lift and hold the top of the piano, and I could sit. In the six- teenth session I sat in Peter’s chair for the first time as he stood to play the piano. I needed to rest. He soon sat on my lap and did so for much of the piano time. Thus, an intimate, sustained physical contact began because of my need to rest. I enjoyed his sitting on my lap and leaning back against me as he played the piano. This sat- isfied my need for closeness with him. Since it was also his choice over and over again, I pre- sume a similar need of his was satisfied.

Peter was very skilled in getting me to comply with his needs. At one point during the four- teenth session I told him that I was tired (of push- ing) and sat down on the mattress to rest. He said, “Push in chair,” as he left his chair and

52 IVY LEE COLE

climbed onto a table. I got up to protect him from the possibility of falling by walking along beside him as he walked on top of the table. This was my usual movement behavior when he was on the table. He seemed to have anticipated this movement behavior of mine. When I got to the table, he immediately jumped down and sat in his chair. As I resumed pushing him, I realized that I had been maneuvered from my resting. I so commented to Peter. He made no response as he continued riding in his chair.

Only once in the eight weeks were our needs in such conflict as to cause Peter great frustra- tion. In the fourteenth session I stopped pushing and stood behind the chair resting. He reached for my watch in my hand. I refused to let him have it and moved the watch out of his reach. He sat in his chair and whined. I stood. I did not push. He stood and hit his head against the phonograph. He sat in his chair and whined. Still I didn’t push. My insides were churning because he was in distress and I didn’t know what to do for him. He ran to the wall and rammed his head against it. He ran back to his chair and sat. His distress cry was louder. He was in obvious pain. In shock, I automatically began to push him in his chair. I realized that he had been very frus- trated by not getting the watch and by not being pushed in his chair. It was most distressing to me to know that he had turned his anger at me onto himself to give it expression.

During the fourth week in the sixteenth ses- sion, our needs clashed more gently as we sat at the piano. Peter got up from my lap and indicated that he wanted to be pushed in his chair. His movement cue on this occasion was to pull me up and place my hands on the chair. I wanted to continue sitting. I “played dumb” and ignored his wish to be pushed by sitting back down in the chair. He said, “Chair, chair, oh, oh,” and sat on my lap. He graciously let me continue resting.

During session twenty-two in the fifth week Peter transformed his need to be pushed in his chair into a need to be pushed in his chair on top of the table. As I pushed him behind the table, he got up, touched the table and tried to lift the chair up onto the table. I was taken aback and refused to put the chair on the table. I had a need to keep him safe. Since it was a familiar activity, I of- fered to put him on the table. He accepted and indicated that he wanted the chair on the table as

well. I responded with a head shake no and a verbal, “No,” followed by a short pause and a, “Well, maybe.” I put the chair on the table. My quick switch from an emphatic “No” to compli- ance was amusing. I was not as flexible as I had wished. None of Peter’s earlier movements had indicated that this new experiment with the envi- ronment was about to emerge. After we set the limits of the chair/table activity, this activity led to Peter’s falling into my arms from the chair as it rested on the edge of the table.

The chair activity and its transformation, the chair/table activity, ceased after this session, number twenty-two. They were replaced by Pe- ter’s wish to be carried in my arms as I circled the room. His favorite position in my arms was one of facing outward. This facing was inter- preted as his need to be involved with the exter- nal environment from a solid, secure base of support, me. As I carried him around and around the room, just as I had pushed him around and around the room, I paused frequently at some object. To rest my arms and shoulders, I put some of Peter’s weight on the object. He did not tolerate my stopping to rest for long periods. If I were in one place too long, he would wiggle down and out of my arms. I liked carrying him and I still needed to rest; therefore, I paused for short periods frequently. Thus, satisfying our various needs.

Peter used several movement cues to com- municate his need to be carried. He fell or leaned into my arms from a chair, table, or piano. When both of us were standing on the floor, he backed up to me and waited to be picked up.

Carrying Peter around the room was reminis- cent of pushing him around the room. When pro- longed, both activities were tiring. The primary difference between the two activities was the close physical contact required by the act of car- rying. This physical intimacy between Peter and me was interpreted to mean that we were in a meaningful relationship which was satisfying to both. Our needs were harmonious.

In the seventh week, session thirty-five, a new activity of great intimacy, the No game, invented by both of us, came into existence. This game was a result of my changed attitude toward Pe- ter’s hitting his head. Although I never liked his hitting himself, I had never interfered previously. While I carried Peter in this session, he hit me on

MOVEMENT NEGOTIATIONS WITH AN AUTISTIC CHILD 53

the head with a drumstick. I responded, “No, don’t hit Lee.” I did not like that. A moment later he hit himself. The juxtaposition of the two hits helped me decide that neither of us needed to be hit. I told Peter, “No, don’t hit Peter, love Peter.” He responded with a threatening gesture to hit himself, “‘No,” and a giggle. I followed with another, “No.” He threatened to hit himself several times until I lay him on the mattress and began to stroke, tickle, hug, touch, and cuddle him. When I paused, he reached toward me, said, “No,” giggled and threatened to hit him- self. In this manner Peter controlled the intensity and length of the cuddling. We played this game in each of the Iive remaining sessions. Our long- est sustained contact, over nine minutes, oc- curred in the fortieth and final session. The No game reminded me of cuddling with normal in- fants and young children. This game allowed each of us to express our need for closeness. Since the game was never begun until Peter gave the movement cue, he controlled the onset of the game. My need for closeness never overrode his need for any other activity.

I did have the need for Peter to move toward self-ful~llment, to get better. I believe I ex- pressed this need in our movement interactions. I believe Peter expressed the same need in his in- teractions with me and with his environment. This need we shared was paramount in the therapy.

This re-search into my needs as the therapist has been an impo~ant personal journey for me. Early in my study I stopped feeling anxious about my needs. They were there and seemed respectable. They did not seem to interfere with the therapeutic process. In fact they seemed in- fluential and important to the process. I began to think of this particular therapeutic relationship as a blend of Peter’s and my harmonious and con- flicting needs. It occurred to me that this blend of our expressed needs may have been the positive force in the relationship that carried the thera- peutic process forward. But for this blend, I sug- gest that Peter might not have left his chair to interact increasingly with other objects in his environment. Without my need for closeness and warmth from Peter, his need for human contact might not have been realized. At one level of analysis I further suggest that all that happened

between us in the common field of dance therapy sessions resulted from the blending of our ex- pressed movement needs.

This point of view about needs and their role in the therapeutic relationship and process repre- sents a new way of looking at my work and re- flects Hollander’s (1980) view that the role of therapist fully represents the individual’s range of possible responses to others and the world (p. 46). Examining the interrelationship between Peter’s and my needs has enriched my under- standing of the therapeutic process as I experi- ence it. I am convinced that as a therapist I must be sensitive to and willing to examine my needs in terms of their positive or negative influence on the therapeutic relationship and process. In ret- rospect I find a very human “me” to have been involved in the dance therapy sessions with Pe- ter. And that is fine.

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ISSACHAROFF, A. (1976) Barriers to knowing in psycho- analysis. Contemporary Psychoanulysis, 12, 4, 407-422.