"Why Was I Born Among

Mirrors?" Therapeutic Dance

for Teenage Girls and Women
with Turner Syndrome

Elizabeth E. Loughlin

Por qud nacf entre espejos?

Why was I born among mirrors?

Federico Garcia Lorca

From ~Song of the Barren Orange Tree"

A woman's psychology is defined to a very large extent

by her designated social role as a mother.

Eichenbaum and Orbach, 1987, p. 52

A therapeutic dance program was offered to teenage girls and

women with the chromosomal disorder Turner Syndrome whose main
clinical features are short stature, failure of pubertal development
and infertility. The program aimed to improve the participants' self
esteem and confidence and to provide a medium in which to address
specific psycho-social issues raised by the clients and informed by the
research literature. The dance project was held within the context of
social work practice in a hospital paediatric endocrinology depart-
ment. It was shown to be a useful medium to observe significant
habitual physical behaviour which was not always observable in the

American Journal of Dance Therapy © 1993 American Dance

Vol. 15, No. 2, Fall/Winter 1993 1 07 Therapy Association
108 Elizabeth E. Loughlin

clinical consultation. Video recordings were made. Difficulties in par-

ticipant assertiveness and decision making in group dance and some
difficulties in reading the body movement cues of others were ob-
served, suggesting a starting point for future research. The paper
considers societal attitudes which may affect these girls and women
achieving the status of the confident woman.

omen with a chromosomal karyotype that is different from the usual

W female count of 46 XX generally have incomplete development of
female sexual organs and may face psychological difficulties about de-
layed pubertal development and infertility. Achievement of a satisfying
social identity should be seen as a routine component of the medical treat-
ment accompanying the necessary physiological management.
This paper describes a dance therapy program with girls and women
with Turner Syndrome, the most common female chromosomal disorder.
The program was developed as one way to address some of the psychologi-
cal and social distress that may arise from the condition. The paper
reviews the medical and psychological literature on Turner Syndrome. It
identifies how dance highlighted the dilemmas in the participants' physi-
cal expression and communication patterns and how dance offered a
medium for personal awareness and for therapeutic change. It examines
two psychodynamic frameworks which offer some understandings how
societal attitudes may contribute to the uncertainties experienced by the
participants.

Literature Review
Since Turner Syndrome was first identified as a phenotype by Turner at
Oklahoma in 1938, studies have examined the physiological and cogni-
tive effects of the syndrome. Turner Syndrome has an incidence of about
one in 2,500 girls born (Hall, Sybert, Williams, Fisher and Reid, 1982).
Total or partial loss of the second sex chromosome means that in most
girls the ovaries will fail to develop, they will not have a natural puberty,
and will be infertile. In some cases a range of physical features m a y
include skin folds at the neck, moles, oedema of feet or hands, cardio-
vascular or hearing problems. The chromosome condition also leads to
short stature with an average height of 142.2cm (approx. 4'8") (Lippe,
1991). Intelligence is within the normal range, but with higher scores on
verbal comprehension and lower scores on perceptual organisation (Shaf-
fer, 1962), with a demonstrable ability to use verbal skills over perfor-
mance skills involving spatial visualisation and orientation (Silbert,
Wolff and Lilienthal, 1975).
Medical treatment includes hormone replacement therapy to establish
secondary sexual characteristics (Hall et al, 1982). Growth hormone ther-
 "Why Was I Born Among Mirrors?" 109

apy has been available for girls with Turner Syndrome in Australia since
1988.
The literature has also examined the psychological and social outcomes
of the syndrome for girls, and more recently for adult women. Research
studies suggest positive outcomes in school and employment performance
(Nielsen and Stradiot, 1987) but report common social relationship diffi-
culties. Money and Mittenthal (1970) note a tendency for adolescents to
feel social isolates and to be unassertive. McCauley, Ito and Kay (1986)
found that girls with Turner Syndrome were consistently depicted by
teachers and parents as having more difficulties in peer relationships
than the short statured controls. McCauley, Kay, Ito and Treder (1987)
suggest that difficulties in social adjustment may be due to difficulties in
discriminating facial cues. More specific social difficulties are reported in
adults. Adult women related their feelings of social inadequacy to infer-
tility (Downey, Erhardt, Gruen, Bell and Morishima, 1989), and had a
considerably impaired sense of self esteem, with limited heterosexual
contact (McCauley, Sybert and Erhardt, 1986). Some of the literature
comments on the low dating and marriage rates (McCauley, Sybert and
Erhardt, 1986), while a recent Swedish study (Sylven, Hagenfeld,
Brondum-Nielsen and von Schoultz, 1991), reported higher rates, finding
63% of the total subject population over 35 years had been married.
Approximately one third of girls are diagnosed in the new born period,
one third in childhood, and one third in their teens when they fail to
develop (Hall et al., 1982). Although childhood and adolescent medical
needs are well cared for by paediatricians, in young adult life when social
differences can become more pronounced, there is usually no defined
organization or medical specialty to meet their problems (Sylven et al.,
1991), or to offer psychological counselling for their feelings about infer-
tility.
Studies recommend anticipatory guidance and advocacy within the
nursing context (Williams, 1992), and supportive strategic information
sharing in the interdisciplinary clinical team (Mullins, Lynch, Orten and
Youll, 1991), and also note the value of peer support in the Turner
Syndrome support groups (Nielsen and Stradiot, 1987). No published
accounts of using dance therapy with clients with Turner Syndrome have
been found.

Two Contributing Psychodynamic Frameworks

Some women with Turner Syndrome feel their life style is affected mini-
mally by the syndrome, while others feel strongly that they have been
affected by the syndrome's anomalies and by the concomitant social
attitudes the syndrome engenders in others. Clinicians and adult women
110 Elizabeth E. Loughlin

with Turner Syndrome question why some with the syndrome lack confi-
dence in themselves and in their identity as women and some do not.
The psychodynamic approaches of D. W. Winnicott and the Womens'
Therapy Centre, London, offer two frameworks in which to understand
and interpret some of the behavior and experiences of women with
Turner Syndrome.
D. W. Winnicott, pediatrician and psychoanalyst, offers some under-
standings through his work on the interactions of infants and parents.
Winnicott's theory of the mirror role of the mother in the infant's early
life explains a process, which if incomplete, could account for the deep
uncertainties about the self expressed by some women with Turner Syn-
drome. Winnicott describes how the first reflection for an infant girl
comes from the mirror of the mother's face (Winnicott, 1967). The new
mother is absorbed in her baby and her identification with her baby
means that her face with its adoring gaze becomes a mirror for the baby
to see himself or herself. "The mother is looking at the baby and what she
looks like is related to what she sees there" (Winnicott, 1974, p. 131).
Expressed in another way, what the baby sees when the baby looks at the
face of the mother is him or herself. Through this mechanism, doubts and
misgivings about a daughter's feminine outcome may be communicated
to the young child and create a break in the essential mirroring process of
approval. This could possibly threaten the development of later secure
feminine identifications.
The second psychodynamic approach is concerned with the mirroring in
the wider societal context that m a y affect those diagnosed after infancy.
Recent contributions to the understanding of women's psychology in the
feminist psychotherapy literature offer further explanation for the diffi-
culties infertile women may have in developing a satisfying feminine
identity. Ernst and Maguire, (1987) from the Women's Therapy Centre
London, look at the way the problems of all women are enmeshed in a
patriarchal context. More particularly, Eichenbaum and Orbach (1987)
ask what are the ramifications of socialisation to the feminine role. They
suggest that "a woman's psychology is defined to a very large extent by
her designated social role as a mother" (p. 52). Their argument goes some
way to explain the difficulties experienced by women who are infertile,
when societal attitudes link female sex to mothering. They identify the
hallmarks of femininity:

Mothering . . . . not in the biological sense of the capacity to give birth,

but in the sense of the socially established notions of what goes along
with being a mothering person, is a key feature of femininity. (p. 54)
Fundamental to the uptake of femininity is the taboo on dependency
and the taboo on initiating. That is to say her actions, large and small,
which proclaim her own existence and attempt to define her bound-
aries are constrained by the responses she receives. (p. 59) The stress
 "Why Was I Born Among Mirrors?" 111

on giving and attending to the needs of others inevitably thwarts the

daughter's development towards differentiation and autonomy.
Awareness of the other is ever present. She initiates within the
context of behaviours that are sanctioned. She restricts initiatives on
behalf of self which seem to threaten connections in relationships.
Gradually she loses the facility to clearly identify needs and desires
that arise internally. (Eichenbaum and Orbach, 1987, p. 60)

For a young woman whose hormonal abnormalities already create a

social vulnerability, it m a y be more difficult to develop an autonomous
feminine self within the patriarchal context described. Family and soci-
ety attitudes may be acting as mirrors reflecting "difference" in girls and
women with Turner Syndrome rather than supporting their individual
identity.

Background to Intervention
The dance therapy program was conducted within a large pediatric teach-
ing hospital which is the state's main treatment centre for girls with
Turner Syndrome. The work of the Endocrine unit with this population is
clinical, research and community outreach. The clinics are staffed by
pediatric endocrinologists, a nurse educator for growth hormone and a
social worker who is allocated from the Social Work Department to the
Endocrine Unit. The hospital social work practice includes counselling
and group work with both clinic patients with Turner Syndrome and
their families, and with members of the Victorian Turner's Syndrome
Association support group in Australia. There are about seventy girls
with Turner Syndrome treated in the Endocrine Clinic. The social worker
is referred the families of newly diagnosed infants and older children and
sees many of the other girls with Turner Syndrome and their parents,
when they attend the clinic. She also attends the committee meetings of
the Turner's Syndrome Association and is available for counselling for
their adult members.
Parents have expressed persistent worry about their daughters' physi-
cal difference from other girls and w o m e n - t h e short stature and the
inability to have children. The older adolescents and young adults have
found that their height led to practical problems at work, and that it often
made them appear young and immature in social relationships. But their
main reported concern was that infertility set them apart from other
women and they felt they were denied any "choice" to become or not
become a mother. Some adult women in the Association reported diffi-
culties in developing relationships.
112 Elizabeth E. Loughlin

It was considered that the dance therapy approach, with its emphasis
on the body and its meaning, might be a helpful medium to offer as a
social work intervention. The social worker attached to the unit is also a
creative dance teacher, with training in dance therapy.
Following discussion with the committee of the Turner's Syndrome
Association, a written proposal for the dance therapy program was dis-
cussed with the Director of Endocrinology and advertised in the Associa-
tion's newsletter. The newsletter reaches about 105 with Turner Syn-
drome, two thirds in the age range, infant to 21 years and one third over
21 years. Selected clinic patients were also informed.
At the planning stage, it was expected that the dance therapy program
might uncover feelings about failure of the body that were not emo-
tionally accessible in verbal discussion. It was also seen to enlarge the
opportunities for expressiveness for these particular clients, who were on
a whole considered less confident and assertive than others of the same
age.

Framework for Intervention

Traditional assumptions underlying dance therapy practice, creative
dance and notions from phenomenological frameworks were used.
The program assumed the basic premise of dance therapy that visible
movement behaviour of individuals is analogous to their intra psychic
processes (Schmais, 1974) and can reflect the way the body experienced
earlier relationships.
The method of intervention in the first series followed the approach of
pioneer dance therapist, Blanche Evan, who called her work ~'creative
dance as therapy" (Evan, 1959). Evan used words, and objects such as
scarves to elicit different qualities in the client's movement improvisa-
tions. She felt the aim of dance therapy was to help her client work
towards expressive action and ~%arn to feel again, feel meaningfully"
(Evan 1974, in Rifkin-Gainer, Bernstein and Melson, 1984, p. 11).
The dance therapy program described in this paper used the imagery
found in classical and ethnic music, visual objects, and in spatial dimen-
sions in order to help participants enjoy their body for expressive action,
and to begin to engage with it in a movement and verbal dialogue.
The program initially considered the dance and movement expression
within a Jungian framework (Woodman, 1980) and examined the emerg-
ing dance themes for their symbolic content. The program increasingly
used the concepts of phenomenology to observe the dance expression in
the sessions and on the video records. ~'Phenomenology focuses on the
subject's experience and involves the process of intuition, reflection, and
 '~Nhy Was I Born Among Mirrors?" 113

description in order to elucidate the meaning for the subject of that

experience" (Giorgi, Fischer and von Eckartsberg, 1971, p. 10). '~By analy-
sing meaning, the significance and relevance of an experience for the
whole person becomes intelligible" (Giorgi et al, 1971, p. 10). Writers in
the expressive therapies find that the phenomenology framework is
suited to elucidate the meaning of the clients' experience (Betensky,
1984). Levin considers that for the purpose of understanding dance, the
phenomenological approach is the only one that acknowledges the body
as it is actually lived (Levin, 1977, p. 92). As the participants in the
program became more confident in the dance medium they began to
reflect on their dance to discover more about their own personal and
group themes.

Aims of Dance Therapy Program

1. To help participants enjoy moving their bodies expressively.
2. To overcome lack of confidence about their short stature.
3. To bring to awareness painful feelings about the body, especially
feelings about infertility.

Development of the Program

The first year was an experiment for the participants to try this new type
of dance therapy intervention in medical social work. The program was
offered over ten weeks; a verbal introductory discussion, five dance ses-
sions, two video observation and feedback sessions and two follow up
sessions for those who wished to work on personal themes. A video made
in the first year showed that the dance therapy medium may help partici-
pants to develop new understandings about their self image and confi-
dence and to begin to try new patterns of physical expression and commu-
nication. The dance therapy program was offered again over the next
three years. It developed to be approximately fourteen weeks each year.
The dance component was expanded to eight weeks with extra follow up
sessions for a selection of the participants to work more intensely on their
own personal themes. There were also group discussion sessions based on
observation of the videos.
Each year was considered a new series. Most participants chose to
attend several series. In the first and second year there were six partici-
pants, in the third year, eleven and in the fourth year, there were eight.
By the third series, three women over forty had joined the program. The
1 14 Elizabeth E. Loughlin

total number of individual participants was fourteen, and all but two
finished the sessions in their series.
The majority of the participants were employed, although two had
difficulties in finding and maintaining work. Three participants were at
school. Two of the older women were married with adopted children and
worked in home duties and voluntary work. The stature of the partici-
pants varied. The shortest participant was 4'4" and the next in height
was 4'6". The tallest participant was 5'1". The other participants ap-
peared very short, but not unusually short. Prior to the program, five of
the 14 participants expressed difficulties with body image or social rela-
tionships, a further five reported personal or physical concerns about
themselves as women with Turner Syndrome, and four of the younger
participants seemed to feel they coped reasonably well with their syn-
drome.
At the start of the program participants were keen to improve their
confidence about their physical self and to find a new way to work on
their problems. Some said they also hoped to widen their experience and
their imaginative ability, and some wanted to relax and ~%osen up
things." The younger ones came for enjoyment and to learn a skill. All
expressed interest in being with a group of others with Turner Syndrome.
The program offered opportunities for participants to enter a new ex-
pressive medium, to widen their range of movement qualities, to feel
more courageous in shaping the body and to learn to move through space
and be %een" by others. Some of the dance sessions explored their own
personal themes-difficulties in finding energy, difficulties in receiving
support, doubts about independence and the need for protection.
The dance and discussion was always conducted with therapeutic aims.
The therapist acted as witness to both the expression and changes in each
participant and facilitated their further movement and verbal explora-
tion of their own dance.

Documentation

Observations were recorded in writing for all sessions. Video tape record-
ings were made of each year's series, one in the first year, and three video
recordings in the other three years. The video recordings provided veri-
fication for the therapist's observations and validation for the partici-
pants of their movement experience. They also enabled a selection of the
dance therapy program to be edited into an educational film.
Participants completed open-ended questionnaires or self-reports at the
end of each session. The questionnaires were designed to encourage
participants' perception of their own physical and emotional response.
 "Why Was I Born Among Mirrors?" 11 5

Questions covered the expectations of the program, responses to given

movement themes, feelings that emerged in improvisation, attitudes to
the body and responses to watching their own movement on video:

What do you expect from the program?

What would you like for yourself?.
In which dance or movement activity were you most aware of your
feelings today?
How did it feel in the body when you worked with the sticks?
What movement did you like doing? What is its opposite?
When I move in the dance / when I am at home alone / when I am at
school or work, the image of my body is . . . . .
What image or picture came to you when you were moving today?
What feelings or thoughts came to you when you were moving today?

Participants completed a body satisfaction scale and body image draw-

ing outline as well as Laban observation charts about the movement
efforts and directional body shaping they preferred.
Answers and reports seemed perfunctory and concrete at first, but later
in the program, the answers became fuller, descriptive and a new form of
dialogue with the body, its behaviour and its meanings began to emerge.
Participants wrote two reports about their responses to the program in
the Association newsletter. Transcripts were made of three participants'
comments in three individual audio taped interviews in year two about
the usefulness of the sessions. An audio tape of evaluative comments was
made after the final series in year four. An edited video of the second
year, "Just Go," was made and shown at the International Turner Syn-
drome Contact Group Meeting, Spain, 1991 and in many local medical
and educational venues. An edited video of the fourth year is in produc-
tion.

Observations

Most participants found using their body daunting, especially in the

beginning. At times painful awareness about fears and misgivings about
the physical self emerged, but at other times participants were delighted
to discover their own dynamic expression that unexpectedly developed. In
the planning stage it was expected, that themes of loss related to infer-
tility and themes about lack of confidence related to being very short
would emerge. However other themes emerged: variation in the ability to
engage the body, difficulty in maintaining a physical presence, difficulty
for some in reading the body cues of others, and the reliance on the group
1 16 Elizabeth E. Loughlin

context. The themes are illustrated by quotations from the written re-
cords of sessions, the audio tape and video tape records, and the partici-
pant questionnaires and self reports.

Themes

I. Engagement of the Body

Engagement of the body seemed paradoxical. In the first two series,
participants found it easier to engage the body in strong, formed shapes.
The participants were given bamboo sticks, blankets or cushions as
objects and used them in assertive shapes in their dance. Music that
suggested form and strength such as Beethoven's Symphony No. 5 in C
minor, was introduced and used by participants to dance in the group
with force and confidence. However without the support of the music it
was observed that the participants often could not sustain strength or
physical presence. The reluctance to engage the body was also noticeable
in dances with a theme that touched on loss. In a dance about an empty
basket, most found it hard to respond to the image and to begin to move.
One went and sat in the corner with her basket. Most of the others
appeared mystified. Only one of the participants, an older woman, ap-
peared to want to respond to the image. She gently danced with the
basket, looking inside it as she moved. Later, she reported that the dance
had brought up many feelings for her. (Video record, year two)
In spite of the difficulty in engagement in the less structured segments,
in the energetic dances participants showed they could almost always re-
engage the body. In one dance to Stravinsky's ~Rite of Spring," the
dancers took a long bamboo pole and struck a ~'claim" in a section of the
room with gusto, and then powerfully strode to another place "claiming"
it with their whole physical selves. (Video record, year three). However in
spite of their repeated energetic expression in many sessions, the partici-
pants' verbal feedback showed that they still felt a sense of powerless-
ness. Participants said they could not dare display such vitality in their
everyday life. '~There's no opportunity for expression of our feeling," ~It's
not often we can be crazy . . . . If you're short, you don't want to look like a
child" (Written record, year two).
In year three and four, when the participants began to develop impro-
vised group dances, difficulties about allowing the body to be engaged
reappeared. Issues about decision making and assertiveness emerged. In
year three in one movement activity, three dancers were sensing the
strength and direction of the rope thrown to the ground by one of the
 "Why Was I Born Among Mirrors?" 117

dancers. As one of them threw it to the ground, they all moved to make a
strong group shape beside the rope. Then they waited. No one moved. The
tension waiting for someone to move increased, and then evaporated. It
was as if their energy leaked away. They repeated the activity many
times. Again no-one found they could take the initiative to pick up the
rope and throw it again unless I named a person. Later in the discussion,
the dancers said: '~We generally wait," ~'I'm much more comfortable sit-
ting back," '~We're loath to push each other, we've experienced being
shoved aside" (Video record, year three). They felt the response in the
dance was similar to everyday life where they found it hard to take the
initiative because they were afraid of the damage they may cause to
others. In year four in a similar rope sequence, difficulties emerged
again. The seven participants were divided into three groups. One group
improvised with the rope while two groups watched the dance sequence.
The first group of participants made strong, imaginative shapes but
repeatedly became immobilized in them. They found it hard to take the
initiative to make the first move in order to continue the dance. The
dancers and observers discussed the rope sequence of each group and
commented when the action was frozen and when someone had the
confidence to make a move. When the therapist asked the first group why
they had stopped in their shapes, why they let the energy drop, they
laughed at themselves in recognition: '~We're taking it in turns!" again
seemingly fearing to impinge their presence on others (Video record, year
four). Later the participants said they felt the rope sequence demon-
strated that their major problem was their difficulty in being assertive
and taking the initiative with others (Written record, year four).

2. Invisibility
Invisibility as a metaphor recurred in the dance activity and in discus-
sion about the dance. In the less structured, more improvised segments,
participants sometimes gave an impression of not being emotionally and
physically present. It was as if they were unable to command a presence
through their individual expression. They also talked about being over-
looked, not noticed, not being seen by others as real adult women. Invisi-
bility generally means something is hidden, not revealed, and in some
ways the dance was like the substance which makes the invisible mes-
sage visible. The dance as an enactment began to reveal a physical person
whose physical presence had to some measure been hard to see and
recognize.
In the first two years, the therapist observed a tendency for some
participants to hug the floor, or hug the wall, %o die" as we termed it. It
was as if some participants wished to reduce their presence, to almost
118 Elizabeth E. Loughlin

give a physical part of themselves away. At times we verbally reflected

on this behaviour. One participant described herself as switching off from
the body while trying to keep up with a group moving across the room:

It's like lead in your shoes, you can't move. Frozen, functioning in a
vacuum, suspended. I realised I was lagging behind . . . . . . but I real-
ised the more I tried, that it would not work. Instead of the energy
flowing, you feel your whole physical self and your energy just shut-
ting down (Audio tape record, year two).

However at other times, when an object or a piece of music suggested

energy and presence, this dancer found her fiery expression. She said
when the group was dancing with bamboo sticks to modern Japanese
music that she felt she was trying to unblock her energy. ~I was begin-
ning to flow again and because it was with sticks and something a bit
fiery and direct, I could sort of harness my energy" (Audio tape record,
year two). Summing up her experience, this participant commented she
felt more physically present. "I'm definitely more aware of what's from
the neck down. That is just so helpful in presenting yourself as a person,
becoming sort of co-ordinated with the energy. I've noticed gradually it's
becoming easier and easier" (Audio tape record, year two). When asked
how she had gained by the dance experience she said: '~An awareness that
I can move, that I can be connected" (Audio tape record, year two).
In the fourth series this participant still experienced some difficulty in
pair work. In the middle of a pair dance, as she walked down the room
trying to make an arch with her partner, her partner commented: "You're
not there!" The psychic effort of working in a balanced dyad still was
exhausting. However immediate discussion of her physical response after
her partner's comment enabled her to be more aware of her %anishing"
mechanism and she was more able than in previous series to take courage
and complete the dance, giving and receiving from her partner. In pre-
vious series she had tended to opt out, shaking her head, sitting on the
floor saying %he couldn't do this one." This participant attended all the
series each year and really developed her own presence through forceful
shapes and an ability to flow through the space, sensitive to the others
around. Within the Turner's Association she took a more consistently
active and positive role and also successfully managed a decisive career
change in her professional life.
Laban analysis of movement efforts in selected video clips and during
some of the sessions supported the observations about the difficulties in
establishing ~'presence." The video excerpts highlighted the difficulties
the participants found in using weight or force of any kind, either light or
heavy. In the Laban framework, this movement characteristic suggested
a reluctance to use intention (Laban 1950). This reflected the partici-
 "Why Was I Born Among Mirrors?" 119

pants' comments of being overlooked, diminished, invisible, and unable to

make their views known to others.

3. Interpreting the Intention of Others

Body cues of the others were not always perceived or understood. It was
noticeable on video that some participants did not "read" the body or
spatial cues of the other participants. A few dancers commented after
some of the sessions that several of the dancers did not seem to take
account of other people's movement and what was happening in the room.
In the stronger formed dances there was always a sense of tuning into the
movement shapes of others. But in the more flowing movement, there
seemed almost a time lag with most of the participants before they tuned
into a partner or to a small group. In the fourth year, we practised this
skill over and over again. To Telemann's vivace from the Concerto for
oboe in A major, the dancers strode around the room in pairs. One partner
changed direction and the other had to read the movement cues and
adjust smoothly. At first, many found it difficult to quickly anticipate the
other person's change. However with focus, practice and discussion over
several weeks, the 'treading" of the body cues improved.

4. Reliance on the Turner Group

Dances which involved the group were seen to be more important than
ones which asked that the individual dance in her own space. Most
participants said they preferred to dance in a group. ~'We've got a common
goal in the group, there's just a bond between us. No-one's going to point
the finger. There's a real feeling of support even though there's such a
wide range" (Audio tape record, year two). There seemed a reluctance to
try out individual expression. In year four, six out of seven participants
reported feeling more comfortable dancing in a group (Questionnaires,
year four). Participants commented on the acceptance of the group, and
the protection of the group: "It didn't make you stand out" (Written
record, year two). The video, ~Just Go" (1990), demonstrated how the
participants really connected with each other in the group dances. In one
dance, the group is looking through a green chiffon curtain hanging in
the room. To the music of Greig's Peer Gynt, '~Solvejg's Song," the dancers
slowly put their hands out as one connected group to push through the
curtain and flow through, lifting their arms and stretching up with a
breath and a smile. One participant said later on looking at the video:
~You had the support of the others' energy, so it's almost as if you're
floating through on their energy!" (Audio tape record, year two). In fact,
120 Elizabeth E. Loughlin

the dancers seemed to need the group participation to maintain the

energetic flow and a sense of presence of "I am."
These themes suggested a habitual reluctance to engage the body to
make its presence felt and seen in the space by others. Once they experi-
enced support, and permission was given to find the right level of engage-
ment, participants danced with vigor and form and enjoyment, and by the
fourth series, with flow and expressive feeling. When participants felt
less containment, the video excerpts showed their enlivened dance fal-
tered and a majority of participants still used a stopping mechanism that
suggested deep complex feelings about the engagement of the physical
self.
At these times when it had been difficult to engage the body, for some,
the focus on the body in the movement and dance seemed to enable the
verbal expression of loss, anger and despair about their physical selves: "I
am nothing." "We're not really women" (Written record, year one).

Group Evaluation Comments

The participants recorded their reflections about the dance therapy pro-
gram in four audio taped evaluation sessions. Their comments indicated
that they had become more aware of their physical body and had begun to
appreciate their body for its expressive abilities. One participant, age 45,
said after her first year, "I was expressing it through my body and what I
was feeling was coming through. That's probably a valuable lesson to
learn, that in all aspects I can express how I feel and I don't have to hold it
in and worry about it" (Audio tape record, year two). Later, she said, "I am
learning each time to appreciate myself more, most definitely that's
coming out" (Audio tape record, year four). In the same evaluation ses-
sion, another older participant said that for her the dance program was
%he beginning of the process, accepting your own feelings and needs and
being able to express them in a body language." In year three, in the
video feedback session, most commented that they were surprised how
much they liked their physical image. After the next series, one partici-
pant said "It's surprising to think that I have the ability to express myself
so well. I didn't think that I could" (Audio tape record, year four).
In the final evaluation session in year four, comments placed value on
the dance as a safe medium for expressing feelings particularly feelings
of anger. "You can practice assertion and aggression, it's a safe environ-
ment to try it." Another type of comment referred to the opportunity to
develop physical presence "I couldn't get off the floor, there was no
energy, but then I just felt, well OK, I'm going to show you that I am
here." The same person reiterated ~I have become a bit more vertical-
 "Why Was I Born Among Mirrors?" 121

that's very different for me." Another comment referred to the increased
ability to communicate through the body. One participant said how the
group helped everyone %0 tune in to themselves, become aware of their
body and body language, and then to be able to tune in to others." A
further comment related to the participants' sense of individuality in the
dance, ~You can access your own natural rhythm, who you are as a
person." The group of participants concluded their discussion in this
session with comments that suggested they were ready to hold both parts
of their paradox: "In most ways we face a lot of the same issues as other
women do" and '~It is time to accept that we can be different" (Audio tape
record, year four).

Discussion

The dance therapy program began to explore how women who generally
do not have a reproductive capacity may begin to be aware how society
attitudes have affected their confidence in their physicality, their ability
to assert themselves and communicate with others, and the way they
experience themselves as women.
Winnicott's 1967 theory of the mirror process between mother and
daughter in early life may have relevance. It can explain how a mother's
uncertainties about her baby girl's reproductive abilities may have a
lasting effect on her daughter's uncertainties about aspects of her femi-
nine s e l f - s u c h as those expressed by the women in the dance g r o u p -
especially if early counselling opportunities for parents are not available.
The hesitancy in ~being seen" and the reluctance to move as an individual
in the space may link with an earlier anxious reflection from the parent
child interaction. The dance movement demonstrated for most partici-
pants persistent uncertainties of the body that may relate to early non
verbal tensions that have been held in the body for many years.
The w a y society links the female sex to mothering, referred to by
Eichenbaum and Orbach (1987) also suggests why some of the women
were reluctant to be seen as an individual and to engage in expressive
action. In improvisations like the rope sequence, the taboo on initiating
and the feeling of being restrained by the likely judgments of others
referred to by Eichenbaum and Orbach (1987), was in evidence. Following
some of the sessions, participants talked in a way that echoed the femi-
nist argument. They felt they had failed society's prevailing attitudes to
women's bodies as mothering instruments. ~'We're nothing," '~We're the
XO club" (Written record, year one, year four). The personal feeling of
failure from not achieving womanhood was seen as sociologically rein-
forced. As women for whom mothering has never been a real option, this
122 Elizabeth E. Loughlin

societal attitude seemed to threaten their efforts at integrating the femi-

nine self into their identity.
Comments by the dance participants suggest that the reluctance to
take the initiative, alongside the feelings of being overlooked, is perva-
sive and long standing. Money and Mittenthal (1970) have described the
personality of those with Turner Syndrome as characterized by ~inertia"
or "compliance." Difficulties in developing an assertive presence could
suggest rather that some of these women develop a depressive response to
their lives.
The preference for group dancing over individual expression indicated
there was safety in belonging to a group of like individuals. This prefer-
ence demonstrated the continued need for acceptance from peers who
provide a safe environment separate from the demanding world which
elevates motherhood as the achievement of women.

Conclusion
Dance was a valuable medium in which to highlight the dilemmas experi-
enced by women who sometimes feel unsure of their role in society. The
themes that emerged in the dance clarified the suggestions in the medical
literature that many adult women with Turner Syndrome felt not alto-
gether happy with their lives. The dance therapy program revealed a
measure of ambivalence about bodily expression and communication in
most participants. The dance activity increased the participants' aware-
ness of their own emotional response, and in most cases, modified their
perception of their physical selves. By trying out new patterns of expres-
sion and daring old fears, the participants began to challenge the judge-
ment they experienced from a society which evaluates women in repro-
ductive terms.
Further work in therapeutic dance could focus on the specific diffi-
culties in decision-making and in reading facial and movement cues of
others, as well as the opportunity for exploration of personal concerns.
More individual work in dance therapy could focus on the feelings of loss
and depression about the fertility status.
The dance themes in the program call attention to the importance for
medical practice to address the emotional issues that arise from the
physiological status of girls and women with Turner Syndrome. This
particular program has revealed that the response to the condition is not
solely to be found in the individual's physiological or psychological make-
up, but in the way that early mirrors of childhood and the often judge-
mental mirrors of a patriarchal society reflect the individual who has a
physiological vulnerability. If consideration is given to how society atti-
 "Why Was I Born Among Mirrors?" 123

tudes, values and gender prescriptions contribute to the way the body is
perceived and experienced in a person with Turner Syndrome, then these
women may have more opportunity to find their own identities and
physical presence.

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