Psychoanalytic dance therapy

1. Introduction

Version followed: Elaine V. Siegel's psychoanalytic dance-movement therapy (USA, 1960s–1990s; Siegel 1973, 1984, 1995; German editions 1986/1988 and Siegel, Trautmann-Voigt & Voigt 1997). I reconstructed it mainly from her six treatment guidelines (Siegel 1988, p. 77, as reproduced by Willke 2005, p. 26) and from her 1995 description of three treatment settings. Where I use the later German development taught at DITAT (Bonn), I say so. That development is Trautmann-Voigt's "rhythmisch-dynamischer Handlungsdialog" (rhythmic-dynamic action dialogue) and Siegel's "Motilitätskonzept" (motility concept). Her procedures are known here only through secondary reproductions and abstracts, so the step-level detail below is largely [synthesis]. [uncertain]

Name note: the founder is sometimes written "von Siegel". Every catalogue and journal record gives the founder as Elaine V. Siegel ("E. V. Siegel"). The "V." is a middle initial, not the nobiliary "von". [source: TUM catalogue record; PEP record of Siegel 1973] [uncertain: inferred misreading]

What it is. Siegel trained as both a dance therapist and a psychoanalyst. She belongs to the US "second generation" of dance therapy, after Chace, Schoop, Espenak and Whitehouse. She integrated classical psychoanalytic concepts into dance-movement therapy and treated movement as a psychotherapeutic tool in its own right. Her 1973 paper in the Journal of the American Psychoanalytic Association is titled "Movement therapy as a psychotherapeutic tool". It is an approach and a body of clinical writing, not a manualised protocol. [source: Willke 2005, pp. 25–27; Bender 2020 table of contents §4.5; PEP record] Her dates are given as 1928–2013 (Bender 2020) and as 1928–2014 (Devereaux & Loman 2014). [uncertain]

How change happens (Siegel's model). Siegel saw both psychoanalysis and dance therapy as developmental. Their shared aim is to help the patient grow out of inefficient or infantile ways of existing toward an ordinary adult existence. The transference relationship is decisive for that growth, and resistance (defence) plays a central role. Movement improvisation runs parallel to verbal free association. The movement work lets the patient regress to the fixation point, where unresolved conflicts can be re-experienced and worked through. Careful movement work rebuilds a harmonious unity of body and psyche and an adequate body image. What the patient discovers through her own movement and self-observation must then also be worked through in words. Siegel held that movement and verbal processes follow the same laws, so she analysed movement in the vocabulary of classical psychoanalysis. [source: Willke 2005, pp. 25–27, citing Siegel 1986, 1988]

Where it is used. Siegel described the approach in three formats:

experiential groups;
"dance-therapeutic psychoanalysis" with individuals;
Chace-style groups in institutions.

She adjusted her technique to each format. [source: Siegel 1995 abstract] She also wrote about children with affective disorders and about incest (Siegel 1991, and a German book titled Inzest); neither book is drawn on here. [uncertain] In Germany, DITAT (Deutsches Institut für tiefenpsychologische Tanztherapie und Ausdruckstherapie, Bonn) bases its training on Siegel's concept. [source: Willke 2005, pp. 35–36; Trautmann-Voigt 2006 abstract]

2. Framework

No published phase model was found. None of the sources gives a numbered phase sequence, session count or progression criteria for Siegel's method. [uncertain] The framework below arranges her six guidelines and her psychoanalytic process concepts (transference, resistance, regression to the fixation point, working through) into a usable sequence. Its ordering and the criteria are [synthesis].

Settings and format [source: Siegel 1995 abstract; Willke 2005]

Individual "dance-therapeutic psychoanalysis". Movement and words alternate within a psychoanalytic treatment. Siegel's frequency and duration were not found. Psychoanalytic treatments are typically open-ended and long-term, often more than once a week. [uncertain]
Experiential group. Used for self-experience and training. Size and length were not found.
Chace-style group in an institution. A circle-based group, following Marian Chace's model, adapted by Siegel for inpatients.
Practical defaults [synthesis]: individual sessions of 50–60 minutes, once or twice weekly, open-ended or 25+ sessions for conflict-oriented work. Groups of 6–10 for 60–90 minutes. A brief, structure-focused course of 10–20 sessions is possible in clinic settings, in line with DITAT's "Strukturierung" dimension (see 4.18).
Room [synthesis]: clear floor, mats, chairs for the verbal part, optional music and percussion.

Phases [synthesis, built from Siegel's guidelines]

Phase A: assessment and alliance.

Goals: observe the patient's preferred movement patterns, tensions, use of space and rhythm. Gauge her developmental level. Establish the frame (time, place, how movement and talk alternate). Agree what touch, if any, is acceptable.
Typical length: 1–4 sessions.
Move on when there is a working alliance, a provisional formulation (developmental level, main defences, central conflict) and enough body safety to explore.

Phase B: structuring, body image and motor capacity.

Goals: "careful movement work" that builds motor skill, an adequate body image and a felt body–psyche unity. Breathing work, developmental movement and, where indicated, holding belong here. [source: guideline 1; Willke 2005, p. 25]
This phase may be most of the treatment for fragile, psychotic or developmentally early patients.
Move on when the patient can sense and name body states, tolerate moving in your presence and return to a steady state after arousal.

Phase C: improvisation, regression, emergence of transference and resistance.

Goals: free improvisation used as free association. Allow controlled regression toward the fixation point. Notice how transference and defence show up in movement and in the movement relationship. [source: Willke 2005, pp. 25–26]
Move on when recurrent themes, transference patterns and bodily defences (muscular holding) are visible and can be spoken about.

Phase D: working through.

Goals: interpret transference and resistance and connect movement to history. Use catharsis only where it serves recall of dramatic events. Every movement insight is also worked through verbally. [source: guidelines 2, 3, 6]
Move on when insights generalise outside sessions, defences soften without collapse and the patient initiates movement and meaning.

Phase E: consolidation and ending.

Goals: build choreographed dances from the patient's own preferred patterns. Strengthen autonomy through self-directed improvisation. Work through separation from the therapist. [source: guidelines 4, 5; the separation work is synthesis]
End when the goals agreed in Phase A are met and the ending has been talked through and danced through.

Phases repeat. In practice they recur in cycles. A patient may return to Phase B after a regressive crisis. [synthesis]

Typical session arc [synthesis]

Brief verbal check-in.
Warm-up or structuring movement.
Main movement work: improvisation, dialogue or theme.
Return to a steady state.
Verbal working-through, then close.

3. Guiding principles

Each principle is followed by its practical meaning.

Developmental orientation. Place the patient's movement and conflicts on a developmental level and pitch interventions there. Holding and rhythm suit early levels; structured dance and interpretation suit later ones. [source: Willke 2005, p. 25; Siegel 1995 "several developmental levels"]
The transference relationship is the vehicle of growth. Track how the patient moves toward, away from, with or against you. That is the transference in action. [source: Willke 2005, p. 26]
Resistance and defence are central and show up in the body. Treat avoidance, rigidity or performing for the therapist as material to understand, not as non-compliance. [source: Willke 2005, p. 26]
Muscular inhibition and cramping are an unconscious attempt to express aggression and suppress it at the same time. When you see chronic holding, wonder with the patient about anger. Do not force it loose. [source: guideline 6, Siegel 1988 via Willke 2005, p. 26]
Improvisation is free association. Give minimal instruction and follow the sequence of movements as you would a chain of associations. [source: Willke 2005, p. 25]
Regression is allowed in order to work through, never for its own sake. Let the patient return to early modes only inside a firm frame, and bring her back before the session ends. [source: Willke 2005, pp. 25–26; the frame and return are synthesis]
Body–psyche unity and body image are rebuilt through careful movement work. Prefer slow, precise, skill-building work over intensity. [source: guideline 1]
Catharsis serves recall, not discharge. Use strong expressive movement only when it can bring back and contain memories of dramatic events, then process them. [source: guideline 2]
What is found in movement must also be worked through verbally. Leave time in every session to put the experience into words. [source: guideline 3]
Start from the patient's own preferred movement patterns. Build exercises and dances from what she already does, not from your repertoire. [source: guideline 4]
Foster autonomy through improvisation. Over time, hand the lead to the patient. [source: guideline 5]
Movement and words follow the same laws. Use transference, resistance, fixation and defence to understand movement, and expect the same patterns in both channels. [source: Willke 2005, p. 27] Willke criticises this position for neglecting dance as its own symbolic form, "präsentative Symbole" (presentational symbols) after Langer. Practical meaning: also respect what the dance says without translating it. [source: Willke 2005, fn. 10; the practical meaning is synthesis]
Adapt technique to the setting. The same conflict is handled differently in an experiential group, in individual analysis and in an institutional Chace group. [source: Siegel 1995 abstract]
Rhythm and the nonverbal action dialogue come first (DITAT version). Attend to the shared rhythm and dynamics between you and the patient as the basis of contact. [source: Trautmann-Voigt 2006 abstract]
Dose the method: structure, experience activation or conflict orientation (DITAT version). Choose how much structure versus evocation versus conflict work a patient can use today. [source: Trautmann-Voigt 2006 abstract; how to choose is synthesis]
Abstinence and safety in a body-based analysis. Your own movement and any touch serve the patient's process only. Keep sexual boundaries absolute and analyse wishes rather than gratify them. [synthesis, from general psychoanalytic abstinence]

4. Intervention inventory

How complete this inventory is. It lists every intervention named for Siegel's approach in the sources:

her six guidelines;
the components Willke attributes to her: holding, breathing exercises and motor-developmental exercises;
her three settings (Siegel 1995);
the DITAT additions.

It also includes two related procedures (mirroring, and the therapist's body countertransference), which are marked as such. Step-level instructions and wording are [synthesis] unless cited. Her book-length case technique is not drawn on here, so further named techniques may exist in Siegel 1984 and 1986. [uncertain]

Training and touch. Psychoanalytic dance therapy assumes training in dance-movement therapy and in psychodynamic or psychoanalytic therapy, plus supervision. Any touch (4.8, and touch inside 4.6 and 4.7) needs specific training and supervision. Check first what your licence and jurisdiction allow. Sexual or genital touch is never part of any technique. [synthesis]

General screening before vigorous, cathartic or regressive work (4.6, 4.10, 4.11) [synthesis; the sources give no contraindications]. Screen for:

pregnancy;
cardiovascular or respiratory illness, including asthma;
epilepsy;
recent injury or surgery;
acute psychosis or a recent psychotic episode;
severe dissociation;
active suicidality or recent self-harm;
recent or ongoing trauma without stabilisation;
current substance intoxication.

This work also needs medical clearance where relevant. In these cases stay with structuring work (4.5, 4.7, 4.18 "Strukturierung").

4.1 Movement observation and developmental formulation

Purpose / when. At intake and continuously throughout. Identifies:
- the patient's preferred movement patterns, which are the starting point for later choreography (guideline 4);
- muscular holding, a possible defence against aggression (guideline 6);
- her developmental level.
Siegel described patients and process in classical psychoanalytic vocabulary. [source: Willke 2005, pp. 25–27] Kestenberg's Laban-based system links movement qualities to developmental phases and object relations. Siegel's own use of it is not confirmed. If you are trained in it, it can sharpen this step. [source: Willke 2005, pp. 28–29] [uncertain]
Steps.
1. Invite the patient to move freely to neutral or no music for 5–10 minutes, or simply to walk the room.
2. Note:
  - posture and breathing;
  - which body parts are active and which held or "left out";
  - tempo and rhythm (smooth, abrupt, repetitive);
  - use of space (near or far, centre or edges);
  - closeness to and orientation toward you;
  - recurrent motifs.
3. Afterwards ask what she noticed and felt.
4. After the session, write a formulation: developmental level, dominant defences, central conflict, transference expectations, preferred patterns. [synthesis]
Example language (illustrative). "For the next few minutes just move in whatever way your body wants. There is no right way. I'll watch, and afterwards we'll talk about what it was like."
Watch for / working.
- Avoid interpreting too early: hold impressions as hypotheses.
- Watch for patients who perform to please you, itself a transference datum.
- It is working when patterns recur across sessions and the patient begins to recognise them herself.

4.2 Mirroring and empathic movement reflection (related technique; Siegel's use partly inferred)

Purpose / when. Mirroring comes from Chace, Siegel's predecessor. The therapist reflects the patient's movement, in movement and/or words, to convey understanding and acceptance. Use it early to make contact, and with patients at early developmental levels. [source: Willke 2005, pp. 21–22] Siegel titled her main book Dance-Movement Therapy: Mirror of Our Selves. Her exact procedure is not drawn on. [uncertain] Willke criticises the isolated and undifferentiated use of mirroring in practice. Use it selectively and with a clear aim. [source: Willke 2005, p. 21]
Steps [synthesis].
1. Ask permission to move with the patient.
2. Stand facing her or beside her at a distance she chooses.
3. Take on the quality of her movement (rhythm, effort, shape) rather than copying it exactly. Exact copying can feel mocking.
4. Hold it for 1–3 minutes, then let her lead changes.
5. Stop, return to chairs and ask how it felt to be followed.
Example language (illustrative). "I'd like to move along with you, picking up how you move rather than copying you. Tell me or simply stop if it feels uncomfortable."
Watch for / working.
- Patients with fragile ego boundaries may feel merged, intruded on or mocked. Then increase distance, mirror only the rhythm, or use words instead.
- It is working when the patient relaxes, makes eye contact or starts to vary her movement in response to you.

4.3 Rhythmic-dynamic action dialogue (DITAT development)

Purpose / when. Trautmann-Voigt developed this from Siegel's motility concept, drawing on infant research and brain research. It is a nonverbal dialogue of rhythm and dynamics between therapist and patient, the basis of contact and of nonverbal communication. [source: Trautmann-Voigt 2006 abstract] Use it with patients whose words are unavailable or defensive. Procedure details are not drawn on. [uncertain]
Steps [synthesis].
1. Start with a simple rhythmic element from the patient: stepping, clapping, swaying or tapping.
2. Answer it, matching tempo and intensity, then slightly varying one quality (faster or slower, stronger or lighter) as a turn in the conversation.
3. Let the patient answer.
4. Alternate turns for several minutes. Allow pauses.
5. Close by slowing together to stillness.
6. Talk about who led, who followed and what it was like to be answered or not.
Example language (illustrative). "Let's have a conversation without words. You make a rhythm, I'll answer, then it's your turn again."
Watch for / working.
- Watch for compliance (always following) or control (never letting you change anything). Both are transference material.
- It is working when the turn-taking becomes mutual and the patient risks variations.

4.4 Free movement improvisation as free association

Purpose / when. The core analytic technique. Improvisation is treated as parallel to verbal free association, giving access to unconscious material and enabling regression. [source: Willke 2005, p. 25] Use it from Phase C onward, once there is enough structure.
Steps [synthesis].
1. Agree the time (5–20 minutes) and a stop signal.
2. Give a minimal starting point: a felt body sensation, a word from the verbal part, or nothing at all.
3. The patient moves, eyes open or lowered as she prefers. You watch attentively from a fixed place, without directing.
4. Note sequences, breaks, repetitions and moments of hesitation: these are the movement equivalents of associations and resistance.
5. Signal the end a minute ahead. Let her find a resting position.
6. Move to verbal working-through (4.13).
Example language (illustrative). "Start from whatever you notice in your body right now and let one movement lead to the next, the way thoughts follow each other. If something feels too much, you can stop or slow down."
Watch for / working.
- Watch for abrupt stops, freezing, looping repetitions or dissociation (glazed eyes, loss of contact). Respond by naming what you see and offering grounding (4.5).
- It is working when the movement brings up images, memories or affect that link to the patient's history.

4.5 Careful body-image and motor-skill work ("sorgfältige Bewegungsarbeit")

Purpose / when. Rebuilds a harmonious body–psyche unity by fostering motor abilities and an adequate body image. Siegel stated this as her first guideline. [source: guideline 1, Siegel 1988 via Willke 2005, p. 26] Use it first with fragile, psychosomatic or developmentally early patients, and at any time to restabilise.
Steps [synthesis].
1. Choose a small, achievable movement task. Examples: feel the feet, shift weight, find the spine, reach into space and return, or move one body part while the rest stays still.
2. Demonstrate, or let the patient find her own version.
3. Repeat slowly with attention to precision and sensation, about 5–10 repetitions.
4. Name the body parts and qualities involved.
5. Add complexity only once the step is mastered.
6. Close with a brief verbal check: what she now notices about her body.
Example language (illustrative). "Let's take time to really feel where your feet meet the floor. Shift your weight slowly forward and back. What do you notice?"
Watch for / working.
- Body-image distress, shame or critical self-talk, especially in eating disorders. Keep the focus on sensation and function, never on shape or weight.
- It is working when the patient describes her body more fully and realistically and moves with more ease and range.

4.6 Breathing exercises ("Atemübungen")

Purpose / when. Willke lists breathing exercises among the components of Siegel's work, one reason "dance" gave way to "movement therapy". [source: Willke 2005, p. 25] Siegel's exact exercises are not drawn on. [uncertain] Use breath for self-perception, grounding and regulation, not for intensification.
Steps [synthesis].
1. Seated or lying, the patient notices her breath without changing it for 1–2 minutes.
2. She places her own hand on her belly or chest (self-touch, no therapist touch) and notices movement.
3. Optionally she lengthens the exhalation gently for 5–10 breaths, or links breath with a simple arm movement (opening on the inhalation, closing on the exhalation).
4. She returns to natural breathing.
5. Talk about what changed.
Example language (illustrative). "Just notice your breath as it is. You don't need to change it. Where do you feel it most?"
Watch for / working.
- Do not use rapid or forced breathing. Stop at dizziness, tingling, panic or dissociation, and return to normal breathing with eyes open and feet on the floor.
- Screen as above, especially for respiratory or cardiac illness, panic disorder and pregnancy. [synthesis]
- It is working when the patient can use the breath to settle herself.

4.7 Motor-developmental exercises ("motorische Entwicklungsübungen")

Purpose / when. Willke lists these among the components of Siegel's work. [source: Willke 2005, p. 25] Siegel's exact sequences are not drawn on. [uncertain] They fit her developmental model: revisiting early movement stages to build motor and body-image foundations and to reach early material. Use them in Phase B, or for patients fixated at early levels.
Steps [synthesis].
1. On mats, offer a sequence in the order motor development follows: lying on the back with small movements of the limbs; rolling to the side and back; lying on the belly and pushing up; crawling; kneeling; standing; walking.
2. Let the patient choose her pace and stay at stages that feel significant.
3. You may demonstrate or move alongside.
4. Close in sitting or standing with an orienting look around the room.
5. Talk through what each stage evoked.
Example language (illustrative). "We'll go through the ways a body learns to move, from lying to standing. Take as long as you like at each stage and notice which feel familiar and which feel difficult."
Watch for / working.
- Regressive pull, shame at "baby" movements, or physical limits (joint problems, recent injury: adapt or skip).
- It is working when stages that were avoided become possible and the patient links them to feelings or memories.

4.8 Holding ("Halten der Patientin") – touch

Purpose / when. Willke names holding the patient as a component of Siegel's movement therapy. [source: Willke 2005, p. 25] Siegel's procedure, indications and consent steps are not drawn on. [uncertain] Within a developmental-psychoanalytic frame, holding offers containment and body-boundary experience to patients at early levels or in regressive states. [synthesis]
Consent and safety [synthesis; the sources give none]:
1. Explain beforehand, outside a regressive moment, what holding would involve and why.
2. Ask explicitly. Accept no, or not now, without pressure.
3. Always offer a no-touch alternative: a blanket or cushion the patient holds herself, self-holding (arms around herself, hand on chest), or the therapist sitting close without contact.
4. Agree a verbal and a nonverbal stop signal, such as "stop" or a tap.
5. Check in during the hold ("Is this still all right?") and afterwards.
6. Record consent in the notes.
7. Never hold during intoxication or acute psychosis, with a patient who cannot give consent, or where erotic transference is active and unanalysed.
Steps [synthesis].
1. The patient sits on a mat.
2. With consent, place a hand on the upper back or shoulder blade, or sit back-to-back, or hold the patient's hands. No touch to chest, buttocks, thighs or genitals.
3. Keep still and breathe calmly for 1–3 minutes.
4. Release slowly, announcing it.
5. Move apart and talk about what it was like.
Example language (illustrative). "Some people find it steadying to feel a hand on their back. Would you like to try that, or would you prefer to hold this cushion yourself? Either is fine, and you can stop at any time."
Watch for / working.
- Holding can evoke longing, dependency, erotic wishes, or trauma memories of being held down. Interpret the wish rather than extend the gratification.
- It is working when the patient settles, then becomes able to self-soothe and needs less holding.

4.9 Working with muscular inhibition and tension as defence

Purpose / when. Siegel regarded muscular inhibition and cramping as an unconscious attempt to express aggression and suppress it at the same time. [source: guideline 6, Siegel 1988 via Willke 2005, p. 26] Use this when chronic tension, stiffness or blocked movement appears.
Steps [synthesis].
1. Name what you see without judgement.
2. Invite the patient to exaggerate the tension slightly for 3–5 breaths, then release by about half.
3. Ask what the tension seems to want to do (push, hold back, strike, protect).
4. Let her try a small, controlled version of that movement, such as pushing against a wall or a cushion she holds. Keep it slow, not explosive.
5. Explore verbally: whom or what it is directed at, and what makes it dangerous.
6. Link it to the transference if the anger seems aimed at you.
Example language (illustrative). "I notice your shoulders are up and your fists are tight. If that tension could do something, what would it do?"
Watch for / working.
- Premature release can flood patients who fear their aggression. Go step by step.
- It is working when the patient can feel and name anger, and tension softens as aggression becomes thinkable rather than acted out.

4.10 Cathartic movement in the service of recall

Purpose / when. Siegel understood catharsis as a route to recalling dramatic events. [source: guideline 2, Siegel 1988 via Willke 2005, p. 26] Use it only in Phase D, with stabilised patients, when a specific memory or affect is near the surface. Discharge is not a goal in itself.
Screening. Apply the general screening above. In addition, exclude unprocessed recent trauma, severe dissociation, a history of violence toward others, and current suicidality or self-harm. [synthesis] The sources name no contraindications. [uncertain]
Steps [synthesis].
1. Agree the purpose, the time limit (a few minutes), the stop signal and the safe objects (a large cushion, a mat, the floor). Never a person, and never the therapist's body.
2. Build intensity gradually from the movement already present: stamping, pushing, a stronger rhythm, voice if it arises.
3. Keep eye contact or verbal contact. Name what is happening.
4. At the peak or at the signal, slow down together. Return to breathing (4.6) and grounding (4.5).
5. Sit and ask what came to mind: images, people, scenes.
6. Spend at least as long on verbal working-through (4.13) as on the movement.
Example language (illustrative). "Let that movement get a bit stronger, only as far as feels right. I'm here. When I say 'slow down', or you tap the floor, we come back to stillness together."
Watch for / working.
- Watch for loss of orientation, re-living without awareness of the present, self-injury or escalation. Stop immediately and ground the patient: eyes open, name five things in the room, feet on the floor, slow exhalation.
- It is working when affect is followed by recall and the patient can reflect on it in the same session.

4.11 Facilitating and containing regression to the fixation point

Purpose / when. Movement therapy lets the patient regress to the fixation point so that unresolved conflicts there can be worked through. [source: Willke 2005, pp. 25–26] Use it in Phase C/D with patients whose ego strength allows a return to adult functioning.
Steps [synthesis].
1. Choose movement forms associated with the relevant developmental level. Examples: rocking, curling and holding for early levels; push–pull and holding on and letting go for autonomy themes; display and competition for later themes.
2. Let the patient stay in the regressive form while you hold the frame: time, space, your steady presence.
3. Watch for the moment the conflict appears, such as wanting and refusing, or approaching and withdrawing.
4. Bring her back before the end: standing, orienting, an adult conversation.
5. Interpret the conflict (4.12) and work through (4.13).
Example language (illustrative). "You've been rocking and curling up for a while. Let's slowly come back to sitting and look around the room. What was that place like?"
Watch for / working.
- Malignant regression shows as loss of the observing ego, refusal to return, or demands for gratification. Shift to structure (4.5, 4.18) and shorten the movement time.
- It is working when regressive experience yields new understanding and the patient leaves the session oriented.

4.12 Interpreting transference and resistance in and about movement

Purpose / when. Transference and resistance are central. Siegel analysed process in classical psychoanalytic terms. [source: Willke 2005, pp. 25–27] Use interpretation once a pattern has repeated and the patient can reflect.
Steps [synthesis].
1. Collect the evidence: how she moves near you, waits for instructions, performs, stops when you watch, competes, imitates.
2. First describe the movement fact.
3. Then link it to her feelings in the room.
4. Then, tentatively, link it to an earlier relationship or to her history.
5. Watch her body's response to the interpretation (softening, stiffening, turning away) as confirmation or resistance.
6. Optionally test the interpretation in movement, such as trying the opposite pattern.
Example language (illustrative). "Each time I look up, you stop moving. I wonder whether being watched feels like being judged, the way you described it at home."
Watch for / working.
- Intellectual agreement without bodily change suggests compliance.
- It is working when the patient brings the pattern up herself and her movement in the relationship changes.

4.13 Verbal working-through

Purpose / when. Insight gained through one's own activity and self-observation must also be worked through verbally. [source: guideline 3, Siegel 1988 via Willke 2005, p. 26] Use it at the end of every movement segment and in its own right in the analytic setting.
Steps [synthesis].
1. Return to chairs or sitting on the floor.
2. Ask open questions: sensation first, then feeling, image or memory, then meaning.
3. Help the patient find words for nonverbal experience.
4. Connect to earlier sessions and life outside.
5. Return to the theme over following sessions until it is integrated (working through).
6. Close with a summary sentence by the patient.
Example language (illustrative). "Let's put some words to what happened. What did you notice in your body? What feeling or picture went with it? Does it remind you of anything?"
Watch for / working.
- Watch for verbal flight into explanation, and for inability to find words (alexithymia). Then go slower: name the sensation first, offer choices of words.
- Respect Willke's caution that dance has its own symbolic form. Not everything must be translated. [source: Willke 2005, fn. 10]
- It is working when movement and words begin to say the same thing.

4.14 Choreographed dance built from preferred movement patterns

Purpose / when. The patient's preferred movement patterns serve as the starting point for specially choreographed dances. [source: guideline 4, Siegel 1988 via Willke 2005, p. 26] Use it to consolidate (Phase E), to give form to themes, and to widen the repertoire.
Steps [synthesis].
1. Choose 2–4 of the patient's recurring movements, identified in 4.1 and 4.4.
2. Together, put them into a sequence with a beginning and an end.
3. Add one new element that expands the repertoire, such as a missing direction, quality or level.
4. Rehearse it over several sessions, optionally with chosen music.
5. The patient performs it for you, or for the group in group settings.
6. Talk about what the dance expresses and what the new element meant.
Example language (illustrative). "These three movements keep coming back for you. Shall we build them into a short dance of your own, and see what one new movement might add?"
Watch for / working.
- Perfectionism or performance anxiety: keep it private if needed.
- It is working when the patient owns the dance, varies it freely and links it to her current life.

4.15 Self-directed improvisation to foster autonomy

Purpose / when. Independence is promoted through improvisation. [source: guideline 5, Siegel 1988 via Willke 2005, p. 26] Use it increasingly in later phases, and in preparing for the ending.
Steps [synthesis].
1. The patient chooses the theme, music, space and length herself.
2. You take a witnessing role with minimal input.
3. Gradually reduce your structuring over sessions.
4. Afterwards ask her to describe and evaluate her own process before you comment.
Example language (illustrative). "Today you decide: what to work on, what music, how long. I'll watch, and afterwards you tell me first what you noticed."
Watch for / working.
- Watch for helplessness or waiting for you to lead: dependency transference to interpret.
- It is working when the patient initiates and reflects without prompting.

4.16 Chace-style group adapted psychoanalytically (institutional setting)

Purpose / when. Siegel worked with a Chace group in an institution and adapted her approach to that setting. [source: Siegel 1995 abstract] Chace's first aim is effective, empathic interaction among patient, therapist and group, using mirroring in movement and words. [source: Willke 2005, pp. 21–22] Use it for inpatient or day-clinic groups, including more disturbed patients.
Steps [synthesis; Siegel's specific adaptations are [uncertain]].
1. Form a circle.
2. Warm up with each member contributing a movement that the group takes up and reflects.
3. Develop a shared rhythm or theme from what emerges.
4. The therapist reflects individual movements and names group themes.
5. Close the circle with a slower shared movement.
6. Hold a brief verbal round.
7. Interpret group-level themes rather than deep individual transference, given the setting.
Example language (illustrative). "Let's start in a circle. Anna, show us a movement for how you're arriving today, and we'll all try it with you."
Watch for / working.
- Watch for withdrawal, members overstimulating each other, and psychotic loosening.
- It is working when members begin to respond to each other's movements and verbal contact increases.

4.17 Experiential group

Purpose / when. Siegel also described the approach in an experiential group, with technique adjusted to it. [source: Siegel 1995 abstract] Use it for training, self-experience or higher-functioning clients. Its structure was not found. [uncertain]
Steps [synthesis].
1. Agree a contract: confidentiality, the right to sit out, stop signals.
2. Warm up together.
3. Hold improvisation rounds, alone, in pairs (4.3) or as a whole group.
4. Do verbal working-through in pairs, then in plenary.
5. The leader interprets themes shared across the group, such as fantasies that recur among members.
Example language (illustrative). "We'll work in movement first and then talk. You can always choose to watch instead of move."
Watch for / working.
- Members exposing more than they can hold in front of peers.
- It is working when shared themes become visible and can be discussed.

4.18 Dosing the method: structuring, experience activation, conflict orientation (DITAT development)

Purpose / when. Trautmann-Voigt names three methodical dimensions:
- "Strukturierung" (structuring);
- "Erlebnisaktivierung" (experience activation);
- "Konfliktorientierung" (conflict orientation).
She illustrates them with cases from a psychosomatic clinic and an outpatient practice. [source: Trautmann-Voigt 2006 abstract] Her criteria are not drawn on. [uncertain] Use the three dimensions to choose the level of work in each session.
Steps [synthesis].
1. Assess today's capacity: arousal, orientation, ego strength.
2. If low, work with structure: clear tasks, rhythm, body boundaries (4.5, 4.7).
3. If moderate, use experience activation: improvisation and dialogue that evoke feeling (4.3, 4.4).
4. If high, use conflict orientation: regression, interpretation, catharsis (4.10–4.12).
5. Move between dimensions within a session as needed.
Example language (illustrative). "Today seems a day for something steady. Let's start with your feet and the rhythm, and see where it goes."
Watch for / working.
- Watch for over-activation in fragile patients, or under-challenge that keeps the work superficial.
- It is working when the patient can increasingly tolerate the next level.

4.19 Using the therapist's body: kinesthetic empathy and countertransference (related; not Siegel-specific)

Purpose / when. Dance therapists experience patients partly through their own bodies. Skove (1986), interviewing dance therapists working with schizophrenic patients, documents kinesthetic empathy and weakened ego boundaries in the therapist. Therapists used preparatory and recuperative measures for this. [source: Skove 1986 abstract] Psychoanalytically, this is the countertransference. [synthesis] Use it in every session.
Steps [synthesis].
1. Before the session, ground yourself: feel your feet, breathe, set your intention.
2. During, notice tension, fatigue, impulses or images in your own body as data about the patient.
3. Do not act them out. Use them to inform interpretation or a change of intervention.
4. After the session, shake out and reorient, then note your bodily countertransference in your records.
5. Take it to supervision.
Example language (illustrative), for your own notes or a careful disclosure. "While you were moving I noticed a heaviness myself. I wonder if there's something heavy here we haven't put into words."
Watch for / working.
- Merging, exhaustion, or erotic or aggressive countertransference.
- It is working when your bodily reactions help you anticipate themes the patient later confirms.

5. Handling problems

The sources address problem handling only through Siegel's general stance: resistance and defence as central material, muscular holding as warded-off aggression, and technique adapted to setting. Everything below is [synthesis] unless a source is given.

Resistance in the body (stiffness, refusal to move, "I can't dance").

Treat it as defence, not failure. [source: Willke 2005, p. 26]
Lower the threshold: sit and move only the hands, or walk instead of dance.
Name the resistance kindly: "Something in you says no to moving here; let's be curious about that no."
With chronic muscular holding, explore the hidden aggression step by step (4.9). Never force release.

Performing for the therapist or compliance.

Interpret it as transference (wishing to please, fearing judgement) (4.12).
Reduce your visibility: look slightly away, or move alongside rather than watch.
Move toward self-directed improvisation (4.15).

Stuck: repetitive movement or the same theme without change.

Treat the repetition as the fixation point showing itself. Ask what it protects.
Introduce one small variation in rhythm, space or quality (4.3), or have the patient shape it into a choreography (4.14).
If intellectualising, return to sensation. If acting out, return to words.

Persistent reality-distorting fantasy. Siegel's 1995 paper treats one widespread, reality-distorting fantasy that the patient experiences as alien to herself. She traced it across developmental levels and handled it differently in group, individual and institutional settings. [source: Siegel 1995 abstract] Her specific technique is not drawn on. [uncertain] Practical approach:

Locate the fantasy's developmental level (4.1).
Let it appear in movement.
Interpret it at the patient's level.
In institutional groups, stay with shared and reality-oriented movement rather than deep interpretation.

Overwhelm, flooding or dissociation during improvisation, regression or catharsis.

Stop the exercise.
Speak in a calm voice. Ask her to open her eyes, put her feet on the floor and slow her exhalation (4.6). Orient her to the room by naming objects.
Offer self-holding or a cushion. Offer touch only if previously agreed (4.8).
Shift to structuring work (4.18) for the rest of the session and the next sessions.
Review the screening.

Malignant regression or loss of the observing ego.

Shorten movement segments and lengthen verbal time.
Avoid early-level forms such as curling and rocking.
Strengthen the frame.
Consider whether more support is needed (more sessions, a psychiatric review, a less regressive setting).

Psychotic patients and fragile ego boundaries.

Close mirroring and holding can feel merging or intrusive. Use more distance, rhythm-based contact and group structure (4.16).
Watch your own ego boundaries (4.19). [source: Skove 1986 abstract, on therapists' weakened ego boundaries with schizophrenic patients]

Ruptures.

Typical causes: mirroring felt as mockery, touch felt as intrusion, an interpretation felt as an attack, or the therapist moving in a way the patient experiences as dominant.
Response:
- Acknowledge your part.
- Ask what she experienced.
- Repair verbally before any further movement.
- Offer to return control of distance and pace to her.
- Explore the rupture as transference only after repair.

Erotic transference and boundary pressure in body work.

Analyse the wishes. Do not gratify them.
Suspend touch and close-contact exercises while the transference is active.
Keep sessions in the usual room and time.
Seek supervision early.
Sexual contact with a patient is unethical and in many jurisdictions criminal.

Non-adherence (missed sessions, refusing the verbal part, leaving early).

Interpret it in the transference: lateness or absence as resistance.
Keep the frame consistent.
If the patient avoids talking afterwards, shorten movement time so verbal working-through (4.13) is protected.

Shame about the body, body-image disturbance, eating disorders.

Stay with function and sensation. Avoid mirrors and comments on shape, weight or appearance.
Avoid exercise that could feed compulsive activity. Coordinate with the medical team.

Trauma history.

Stabilise first with structuring work (4.5, 4.7, 4.18).
Avoid catharsis and deep regression until the patient can stay oriented.
Give her control of space, exits and touch.
Single sessions suit people who cannot yet manage groups. [source: Obrecht, Kepler Universitätsklinikum leaflet, on individual therapy for trauma-affected patients]

Physical safety.

Clear the floor.
Respect pain and injury.
Adapt for limited mobility (seated versions of 4.5–4.7).
Stop any exercise that causes pain.

Suicidality or self-harm emerging.

Pause the movement work.
Do a structured risk assessment in line with current standard practice: ideation, intent, plan, history, protective factors.
Make a safety plan, including counselling on limiting access to lethal means (safe storage or removal).
Involve the treating team or emergency services as indicated.
Defer regressive or cathartic work until the risk is stable.

Therapist depletion or bodily countertransference overload.

Use preparatory and recuperative routines (4.19). [source: Skove 1986 abstract]
Take bodily countertransference to supervision.
Limit consecutive high-intensity sessions.

Children (Siegel also wrote on the treatment of children with affective disorders; [uncertain]).

Use play-based versions of 4.3, 4.5 and 4.7.
Keep sessions shorter.
Involve parents or carers with consent.
Follow safeguarding duties strictly, especially around touch.

Sources

Sources: