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   <front>
      <journal-meta>
         <journal-id journal-id-type="DOAJ">15041611</journal-id>
         <journal-title-group>
            <journal-title>Voices: A World Forum for Music Therapy</journal-title>
         </journal-title-group>
         <issn>1504-1611</issn>
         <publisher>
            <publisher-name>Grieg Academy Music Therapy Research Centre, Uni Research
               Health</publisher-name>
         </publisher>
      </journal-meta>
      <article-meta>
         <article-id pub-id-type="doi">https://dx.doi.org/10.15845/voices.v17i3.924</article-id>
         <article-categories>
            <subj-group subj-group-type="heading">
               <subject>Invited Submission - Special Issue</subject>
            </subj-group>
         </article-categories>
         <title-group>
            <article-title>Rendering <italic>beyond_words</italic> in transitioning to motherhood
               through visual and dramatic arts</article-title>
         </title-group>
         <contrib-group>
            <contrib contrib-type="author">
               <name>
                  <surname>Scotti</surname>
                  <given-names>Victoria</given-names>
               </name>
               <xref ref-type="aff" rid="aff1"/>
               <address>
                  <email>victoriascotti@gmail.com</email>
               </address>
            </contrib>
            <contrib contrib-type="author">
               <name>
                  <surname>Gerber</surname>
                  <given-names>Nancy</given-names>
               </name>
               <xref ref-type="aff" rid="aff2"/>
            </contrib>
         </contrib-group>
         <aff id="aff1"><label>1</label>Independent Scholar and Author, Art Therapist</aff>
         <aff id="aff2"><label>2</label>Program in Creative Arts Therapies, Drexel University.</aff>
         <contrib-group>
            <contrib contrib-type="editor">
               <name>
                  <surname>Viega</surname>
                  <given-names>Michael</given-names>
               </name>
            </contrib>
         </contrib-group>
         <contrib-group>
            <contrib contrib-type="reviewer">
               <name>
                  <surname>Kenny</surname>
                  <given-names>Carolin</given-names>
               </name>
            </contrib>
         </contrib-group>
         <pub-date pub-type="pub">
            <day>1</day>
            <month>11</month>
            <year>2017</year>
         </pub-date>
         <volume>17</volume>
         <issue>3</issue>
         <history>
            <date date-type="received">
               <day>23</day>
               <month>5</month>
               <year>2017</year>
            </date>
            <date date-type="accepted">
               <day>29</day>
               <month>9</month>
               <year>2017</year>
            </date>
         </history>
         <permissions>
            <copyright-statement>Copyright: 2017 The Author(s)</copyright-statement>
            <copyright-year>2017</copyright-year>
         </permissions>
         <abstract>
            <p>The purpose of this doctoral dissertation research study was to use arts-based
               research methods to explore the beyond_words phenomena of first-time mothers who were
               in the process of transitioning to motherhood. The multidimensional embodied,
                  emotional, and sensory experiences that accompany new motherhood can be overwhelming,
               be difficult to articulate verbally, and impact the perceptions of the new mother’s
               relationship to herself and her child (<xref ref-type="bibr" rid="C2009">Crossley,
                  2009</xref>; <xref ref-type="bibr" rid="LSS2011">Lintott &amp; Sander-Staudt,
                  2011</xref>; <xref ref-type="bibr" rid="PHMB2014">Prinds et al., 2014</xref>).</p>
            <p>In order to honor and capture the emergent, vital, and multi-dimensional nature of
               beyond_words in transitioning to motherhood, in this study, arts-based research
               methods were used to explore and represent these phenomena, otherwise inexpressible
               in words. The arts-based results are presented as five portrait syntheses and a final
               synthesis play in four acts that bring to life and invite the viewer to live the
               mothers’ beyond_words experiences, while simultaneously positioning them within the
               wider context of current medical and health sciences research perspectives.</p>
            <p>The final synthesis, which is the featured dramatic play, aspires to give voice and
               aesthetic power to these mothers’ beyond_words transitioning to motherhood
               experiences. In the philosophical tradition of ABR (<xref ref-type="bibr" rid="L2009"
                  >Leavy, 2009</xref>, <xref ref-type="bibr" rid="L2015">2015</xref>), this study
               marries the rigor of research with the aesthetic power of the visual and dramatic
               arts challenging existing assumptions, beliefs, and cultural stereotypes about
               motherhood and disseminating the results to relevant stakeholders.</p>
         </abstract>
         <kwd-group kwd-group-type="author-generated">
            <kwd>art therapy</kwd>
            <kwd>transitioning to motherhood</kwd>
            <kwd>arts-based research</kwd>
            <kwd>portraiture</kwd>
         </kwd-group>
      </article-meta>
   </front>
   <body>
      <fig id="fig1">
         <label>Figure 1</label>
         <caption/>
         <graphic id="graphic1" xlink:href="Pictures/10000000000014000000068ADF5F0ED472059C43.jpg"/>
      </fig>
      <!-- sec lvl 2 begin -->
      <sec>
         <title>Introduction</title>
         <p>This arts-based research study explored the <italic>beyond_words</italic> phenomena for
            women transitioning to motherhood. <italic>Beyond_words</italic> is defined as the
            aesthetic pre-verbal and pre-conscious phenomenon including sensory, embodied,
            emotional, and imaginal ways of knowing that women encounter when they become mothers.
            These multi-sensory, embodied, and emotional experiences permeate and powerfully
            influence the mother’s body and mind, impacting her perceptions of and relationships
            with her child and family. In addition to the implosion of intrinsic bodily and
            emotional stimuli, new mothers are also exposed to stereotypic images and narratives
            about motherhood in the media that can conflict with those <italic>beyond_words</italic>
            experiences in the emerging self-image of the new mother (<xref ref-type="bibr"
               rid="CKM2005">Cowdery &amp; Knudson‐Martin, 2005</xref>; <xref ref-type="bibr"
               rid="DSF2010">Darvill et al., 2010</xref>; <xref ref-type="bibr" rid="FS2013"
               >Fahey &amp; Shenassa 2013</xref>; <xref ref-type="bibr" rid="RBSDIE2011">Razurel
               et al., 2011</xref>).</p>
         <p>Due to the epistemic nature of the <italic>beyond_words</italic> phenomena, their
            under-representation in the dominant culture, and, their incompatibility with more
            traditional methods of research, we decided to use an arts-based research approach by
            which to represent and authenticate the <italic>beyond_words</italic> phenomena
            experienced by new mothers. The arts-based interpretations and representations of these
            phenomena provide a venue by which new mothers can understand and affirm their own
            experiences as well as to communicate and disseminate these insights to a larger social
            context to increase cultural empathy and understanding.</p>
         <p>The purpose of this article, therefore, is to present the arts-based results of this
            research project and its message for new mothers and beyond. Traditionally the
            arts-based representation of results in ABR studies, such as the play presented in this
            article, is intended to stand alone as a work of art. However, for purposes of
            contextualization and in the service of the advancement of knowledge about ABR, a
            contextual description of the topic and a textual description of the investigational
            methods and procedures resulting the final synthesis performance are also included in
            this article. In addition to demonstrating the topical rationale and rigor of the
            methods, the contextual and procedural descriptions simultaneously act as a map to guide
            reader engagement with the arts-based results. To that end in the text we: 1) provide a
            concise contextual description about the <italic>beyond_words</italic> phenomena in
            transitioning to motherhood, 2) briefly introduce montage portraiture, the ABR method
            that was specifically designed for this study, 3) provide the reader a guide to
            engagement with the arts-based results of this study.</p>
         <!-- sec lvl 3 begin -->
         <sec>
            <title>Contextual Description</title>
            <p>The focus of this study was on the <italic>beyond_words</italic> phenomena in
               transitioning to motherhood<italic>. Beyond_words</italic> for the purpose of this
               study was conceptualized and operationally defined as the pre-verbal and unconscious
               sensory-embodied, relational, and imaginal phenomena that are inherent in all
               dimensions of transitioning to motherhood. The problem that this study addressed was
               twofold. First, because of the sense-based and embodied epistemic of
                  <italic>beyond_words</italic> experiences are unconscious; they pose a challenge
               in translation to verbal expression and thus remain generally unarticulated by the
               mother (<xref ref-type="bibr" rid="C2009">Crossley, 2009, 1991</xref>; <xref ref-type="bibr" rid="LSS2011"
                  >Lintott, 2011</xref>; <xref ref-type="bibr" rid="PHMB2014">Prinds et al.,
                  2014</xref>). When becoming a mother, a woman encounters multiple dynamic
               rewarding, challenging, and transformative experiences that exist within interactive
               physiological, psychological, social, and spiritual domains. The
                  <italic>beyond_</italic>words phenomena are embedded within these domains and are
               representative expressions of the multidimensional experience of transitioning to
               motherhood. Based upon the contextual and conceptual evidence that these
               transitioning to motherhood phenomena can potentially exert a strong, insidious
               influence on the woman’s self-image, affecting her relationship with her child and
               family across multiple domains; further investigation, articulation, and
               dissemination is warranted (<xref ref-type="bibr" rid="ASL2013">Afoakwah et al.,
                  2013</xref>; <xref ref-type="bibr" rid="N2006">Nelson, 2006</xref>; <xref
                  ref-type="bibr" rid="O2010">Or, 2010</xref>; <xref ref-type="bibr" rid="SL2001"
                  >Schmied &amp; Lupton, 2001</xref>; <xref ref-type="bibr" rid="PHMB2014">Prinds et
                  al., 2014</xref>).</p>
            <p>The second aspect of the problem was related to the selection of a research
               philosophy and methodology that would capture the <italic>beyond_words</italic>
               phenomena while addressing the under-representation of these phenomena in the
               dominant research literature and culture. Due to the aesthetic epistemic of
                  <italic>beyond_words</italic>, using traditional quantitative or text-based
               research methods was determined to be ill-aligned epistemologically, thus making it
               prohibitive. Therefore, the decision was made to use an arts-based and art therapy
               informed research approach. Using an art therapy and arts-based research informed
               philosophy and method, we aspired to explore ways in which the new mother could
               identify, express, and make meaning of her <italic>beyond_words</italic> experiences
               while simultaneously creating an emotional, visual, and verbal language to represent
               these experiences. Ultimately we hope to contribute to the conversation and
               accessibility of resources for new mothers, their families, and the general public by
               offering resonant transformative visual and dramatic representations of the
               multifaceted and <italic>beyond_words</italic> experience of transitioning to
               motherhood.</p>
            <p>To this end the intention is to disseminate the arts-based, descriptive written, and
               performative results representing women’s <italic>beyond_words</italic> of
               transitioning to motherhood experiences to the following groups: 1) the
               mothers-participants, new mothers, and mothers-to-be to contribute to their awareness
               and validation of <italic>beyond_words</italic> experiences in transitioning to
               motherhood; and 2) to art therapists and other clinicians who work with new mothers
               and couples. For art therapists and other clinicians, the aim of the results of the
               study was to increase awareness of the <italic>beyond_words</italic> experiences
               during the mother’s transition, foster empathy with new mothers during this
               transition, and provide a practical clinical paradigm that might be used in their
               work with new mothers.</p>
            <p>The research question for this study was two fold: 1) How do first-time mothers
               express and make meaning of their <italic>beyond_words</italic> experiences, and 2)
               how are these experiences represented using montage portraiture?</p>
         </sec>
         <!-- sec lvl 3 end -->
         <!-- sec lvl 3 begin -->
         <sec>
            <title>Situating the researcher- personal stance</title>
            <p>The worldview of this study is influenced by the first author´s (Scotti) lived
               experience as a mother, art therapist, and a visual artist. Becoming a mother 9 years
               ago was a life changing experience for me. Particularly the first year of
               transitioning to motherhood prompted me to wonder about the boundaries between the
               self and the other, my identity as a person and a mother, and the complexity of the
               maternal experiences. It occurred to me that some of these maternal experiences were
                  <italic>beyond_words</italic>: they were embodied, relational, not fully
               conscious, fluctuated on the continuum of pleasure and pain, and were very difficult
               to articulate and make meaning of verbally. As an art therapist, I use art making and
               verbal follow-up to explore human experiences with my clients. As an emerging
               arts-based researcher, I designed an independent pilot study where I used
               self-portraiture to explore my own embodied experiences as a mother and journaled
               about my thoughts and feelings that came up during the process. This exploration
               opened a door to explore <italic>beyond_words</italic> experiences in transitioning
               to motherhood, which resulted in greater self-awareness, creative growth, and a clear
               direction for my research.</p>
         </sec>
         <!-- sec lvl 3 end -->
      </sec>
      <!-- sec lvl 2 end -->
      <!-- sec lvl 2 begin -->
      <sec>
         <title>The Design and Method</title>
         <!-- sec lvl 3 begin -->
         <sec>
            <title>Design</title>
            <p>The design of this study was arts-based research. Arts-based research or ABR has been
               defined as "an effort to extend beyond the limiting constraints of discursive
               communication in order to express meanings that otherwise would be ineffable" (<xref
                  ref-type="bibr" rid="BE2012">Barone &amp; Eisner, 2012, p. 1</xref>). ABR provides a framework for the rigor
               and systematic inquiry of research while honoring the ontological and epistemological
               foundations of the phenomena under investigation. The methods of ABR, in keeping with
               these philosophical traditions, embrace and prioritize the use of artistic practice
               in all phases of the research (<xref ref-type="bibr" rid="MN2008">McNiff,
               2008</xref>). In this study visual and dramatic arts practices were used to examine
               and represent the <italic>beyond_words</italic> phenomena in transitioning to
               motherhood.</p>
            <p>To honor and capture the emergent phenomenon of <italic>beyond_words</italic> in
               transitioning to motherhood, this study has been situated within the art therapy
               informed, arts-based research paradigm (<xref ref-type="bibr" rid="CGS2015">Chilton,
                  Gerber, &amp; Scotti, 2015</xref>). The arts-based research paradigm is one that
               embraces a pluralistic, intersubjective ontology wherein intersections between
               individual realities yield a co-constructed human narrative. This human narrative is
               often comprised of knowledge that is pre-verbal or unconscious. This form of
               knowledge, as referenced previously, includes sensory, embodied, emotional, and
               imaginal cognitions, which together form what we call an aesthetic epistemology. The
               pluralistic intersubjective ontology and the aesthetic epistemology define the nature
               of the <italic>beyond_words</italic> phenomena that is the subject of this
               investigation.</p>
            <p>This arts-based research study aspired to assist the research participants to express
               and make meaning of their <italic>beyond_words</italic> experiences of transitioning
               to motherhood using both artistic means as well as verbal reflection that are the
               basis of both art therapy and arts based research practices (<xref ref-type="bibr"
                  rid="K2010">Kapitan, 2010</xref>; <xref ref-type="bibr" rid="L2009">Leavy,
                  2009</xref>). The study was approved by the Institutional Review Board of Drexel
               University.</p>
         </sec>
         <!-- sec lvl 3 end -->
         <!-- sec lvl 3 begin -->
         <sec>
            <title>Methods</title>
            <p>The arts were central to the investigation, interpretation, and representation of the
                  <italic>beyond_words</italic> phenomena of transitioning to motherhood. Therefore,
               data generation and analysis required engagement in the arts from the participants
               and the researcher during every phase of the research. Five women who met the
               criteria of transitioning to motherhood volunteered to participate in this study. A
               special method for data generation and analysis called Montage Portraiture was
               designed specifically for this study by the primary author. The method builds on the
               concept of portraiture, a genre that is used both in the fine arts (<xref
                  ref-type="bibr" rid="B2002">Brilliant, 2002</xref>; <xref ref-type="bibr"
                  rid="F2010">Freeland, 2010</xref>; <xref ref-type="bibr" rid="W2004">West,
                  2004</xref>) as well as qualitative research (<xref ref-type="bibr" rid="LL2005"
                  >Lawrence-Lightfoot, 2005</xref>; <xref ref-type="bibr" rid="LLD1997"
                  >Lawrence-Lightfoot &amp; Davis, 1997</xref>) and art therapy practice (<xref
                  ref-type="bibr" rid="AM2007">Alter-Muri, 2007</xref>; <xref ref-type="bibr"
                  rid="CDB1989">Costello-Du Bois, 1989</xref>; <xref ref-type="bibr" rid="H2003"
                  >Halifax, 2003</xref>; <xref ref-type="bibr" rid="F2012">Fish, 2012</xref>;
                  <xref ref-type="bibr" rid="H2007">Hanes, 2007</xref>; <xref ref-type="bibr"
                  rid="MG2006">McGann, 2006</xref>)</p>
            <p>In Montage Portraiture, the data generated included textual interview data,
               participant generated artwork, researcher generated arts based memos, researcher
               generated in depth arts-based analysis, and participant feedback. In the Montage
               Portraiture is a visual/textual interview in which the participants were asked to
               create a self-portrait by tracing photographs of themselves and their child. During
               the interview they added drawings to their portrait as they verbally described and
               reflected on the artwork while exploring their <italic>beyond_words</italic>
               experiences in transitioning to motherhood. Data generation also included artistic
               and written reflexivity from the researcher in response to the visual and textual
               data generated in the Montage Portraiture interview. In the data analysis phase, the
               researcher used her personal artistic practice to create montage portraits of the
               individual participants based on careful content analysis of the textual and visual
               data to authentically capture, reflect, and represent their experiences. The
               portraits were shared with the participants to obtain their feedback. Finally, the
               Final Synthesis was created by creating an aggregate group portrait and a cross case
               analysis. The Portrait Syntheses and the Final Synthesis were exhibited and performed
               on the premises of Drexel University in Philadelphia. External input was collected
               from the audience to obtain feedback and to evaluate the credibility of the arts
               based results.</p>
         </sec>
         <!-- sec lvl 3 end -->
      </sec>
      <!-- sec lvl 2 end -->
      <!-- sec lvl 2 begin -->
      <sec>
         <title>The Arts-based Results</title>
         <p>In this study there were two major arts-based results—the Portrait Synthesis and the
            Final Dramatic Synthesis. In the Portrait Synthesis, the visual arts were used to
            construct portraits of each woman using her words, her self-generated montage portrait,
            the researcher’s memos, and the researcher’s visual art interpretation, participant
            feedback, synthesis, and representation of these data.</p>
         <p>The Final Dramatic Synthesis is the arts-based result of the study in dramatic play
            form. This play which is the focus of this article, represents the aggregate of the
            arts-based and narrative data from five participants individual Portrait Syntheses in a
            group interactive dramatic portrayal. Even though the final synthesis is the focus of
            this article, it is essential to also describe and include the individual portrait
            syntheses. We cannot reproduce these 5 portrait syntheses here in full so we will
            present one case in order for the reader to understand how the research data and
            analysis from each case were synthesized and represented in the final synthesis.</p>
         <!-- sec lvl 3 begin -->
         <sec>
            <title>Portrait Synthesis</title>
            <p>In order for the reader to quickly grasp how the artistic images in Portrait
               Synthesis emerged from the original data, it is useful to juxtapose the images that
               the participants and the researcher created during data generation, and the final
               image of the Portrait Synthesis, as seen in the case example of one of the five
               participants, Gabriela. The first of the set of the three images represent the
               initial artistic data collected from the participant, Gabriela. The second image
               features arts based memoing responses by the researcher. The third image is the final
               image of the Portrait Synthesis that demonstrates how the researcher systematically
               synthesized the textual and image based data to create the Portrait Synthesis for
               Gabriela.</p>
            <fig id="fig2">
               <label>Figure 2. The creation of Gabriela’s Portrait Synthesis</label>
               <caption/>
               <graphic id="graphic2"
                  xlink:href="Pictures/10000000000007F8000003520BB73A3BEB205440.png"/>
            </fig>
            <p>In order to represent the investigative and representative integrity of arts-based
               research in this project, we share an example here of one Portrait Synthesis from one
               participant (Gabriela). The Portrait Synthesis is presented as if it were a journal
               of Gabriela´s experiences as a new mother aligning the visual representation with the
               narrative description from the visual and verbal interview data. The captions that
               appear in red mark the verbatim quotes from the participant.</p>
         </sec>
         <!-- sec lvl 3 end -->
         <!-- sec lvl 3 begin -->
         <sec>
            <title>Portrait Synthesis</title>
            <!-- sec lvl 4 begin -->
            <sec>
               <title>Participant 2: Gabriela</title>
               <p>August 2<sup>nd</sup>
               </p>
               <p>Next month is Alison’s first birthday. I can’t believe it’s been a year already!
                  She’s grown to be a <styled-content style="color:red">happy, chubby</styled-content>, thriving baby. We are planning to celebrate at
                  home with family and a few of for her little friends. As we are getting closer to
                  the date, I want our home to be neat and clean for the party so I’m clearing the
                  house of newborn onesies and toys that she has outgrown. The bassinet has to go,
                  too! I’ve been a bit sentimental about it but rationally I understand that it’s
                  just taking up too much space and she won’t fit in it any more. Wow, it feels like
                  yesterday that she was sleeping in it, and now she’s almost a year old. The first
                  year is a milestone, and <styled-content style="color:red">it all happens so fast from the time you deliver to now</styled-content>.
                  I am glad that I can take this time to look back at my experience of becoming a
                  mom.</p>
                  <fig id="fig3">
                  <label>Figure 3</label>
                  <caption/>
                  <graphic id="graphic3"
                     xlink:href="Pictures/10000000000009B100000DB3E4E7A09DBEB325DF.jpg"/>
                     </fig>
                  <p>Today at
                  work, looking at some cell samples through the microscope, I realized that in the
                  beginning Alison, too, was just a <styled-content style="color:red">cluster of cells</styled-content>. How incredible is that!</p>
              <fig id="fig4">
                  <label>Figure 4</label>
                  <caption/>
                  <graphic id="graphic4"
                     xlink:href="Pictures/10000000000009B100000DB31EEE50E30F212C28.jpg"/>
                 </fig>
                 <p>It’s really
                    <styled-content style="color:red">fascinating</styled-content> how tiny cells and biological processes can produce a living,
                  breathing tangible human being … 
               </p>
               <fig id="fig5">   
               <label>Figure 5</label>
                  <caption/>
                  <graphic id="graphic5"
                     xlink:href="Pictures/10000000000009B100000DB35CB0C8761864460F.jpg"/>
               </fig>
               <p>I remember the day she was born. When I held her for the first time, I held her
                  gently like <styled-content style="color:red">an egg</styled-content>, because I was <styled-content style="color:red">afraid she might just break</styled-content>.</p>
               <fig id="fig6">   
               <label>Figure 6</label>
                  <caption/>
                  <graphic id="graphic6"
                     xlink:href="Pictures/10000000000009B100000DB3BD0C7CD27BA04A07.jpg"/>
               </fig>
               <p>But then again, she <styled-content style="color:red">was fragile but not that fragile. Babies are like animals</styled-content>, they are
                  very resilient, <styled-content style="color:red">they are just trying to survive</styled-content>. And I am responsible for her
                  survival, for her to thrive.</p>
               <fig id="fig7">
                  <label>Figure 7</label>
                  <caption/>
                  <graphic id="graphic7"
                     xlink:href="Pictures/10000000000009B100000DB34B5B2637784F5F47.jpg"/>
               </fig>
               <p> And she
                  thrived on being breastfed. Ever since she was a newborn, Alison had a great
                  appetite, I always breast fed her and am still breast feeding.</p>
               <fig id="fig8">
                  <label>Figure 8</label>
                  <caption/>
                  <graphic id="graphic8"
                     xlink:href="Pictures/10000000000009B100000DB312908A6A85D31F8D.jpg"/>
               </fig>
                  <p>In the
                     beginning, my whole life revolved around breastfeeding. My body became <styled-content style="color:red">a feeding
                  machine</styled-content>, I can almost envision the wheels and bolts and little mechanical parts to
                     make milk every couple of hours. <styled-content style="color:red">I was feeding and feeding and feeding…</styled-content></p>
               <fig id="fig9">
                  <label>Figure 9</label>
                  <caption/>
                      <graphic id="graphic9"
                     xlink:href="Pictures/10000000000009B100000DB3661443970F7F4DB9.jpg"/></fig>
                  <p>I usually
                  cope pretty well with adversity but this was one of the hardest times in my life.
                  I felt drained, truly. <styled-content style="color:red">Words cannot even begin to describe how tired I felt</styled-content>.</p>
               <fig id="fig10">
                  <label>Figure 10</label>
                  <caption/>
                      <graphic id="graphic10"
                     xlink:href="Pictures/10000000000009B100000DB32B4A55DB374CA235.jpg"/></fig>
                  <p>Plus, I had
                     no life any more: I could not go out, and do what I wanted to do any more. <styled-content style="color:red">I think
                  that emotionally and physically probably breast feeding is one of the hardest
                  things I’ve ever done</styled-content>. This time for me was all <styled-content style="color:red">red and black</styled-content>.</p>
               <fig id="fig11">
                  <label>Figure 11</label>
                  <caption/>
                  <graphic id="graphic11"
                     xlink:href="Pictures/10000000000009B100000DB39674CC8AD0BE2274.jpg"/>
               </fig>
               <p>But then again, <styled-content style="color:red">at some point you don’t complain about it either because … it’s
                  just a part of it</styled-content>.</p>
               <p>I am a pretty rational person who keeps emotions at bay and does not fantasize too
                  much but…</p>
               <fig id="fig12">
                  <label>Figure 12</label>
                  <caption/>
                  <graphic id="graphic12"
                     xlink:href="Pictures/10000000000009B100000DB3CEA8E6817989994B.jpg"/>
               </fig>
                  <p>…I remember
                     that sometimes after another sleepless night I had <styled-content style="color:red">this fantasy of opening the
                  door and going back to the life that I had: I imagined I could do ANYTHING: go to
                  the gym, go out, go for a run…but I knew that it was not possible. Now that she is
                  sleeping better, things are becoming easier and easier but the beginning was
                  hard</styled-content>.</p>
               <fig id="fig13">
                  <label>Figure 13</label>
                  <caption/>
                  <graphic id="graphic13"
                     xlink:href="Pictures/10000000000009B100000DB3FFBE2C9DB9739CEA.jpg"/>
               </fig>
                  <p>I really
                  don’t know how I would have gotten through this without my husband. I am so
                  grateful to Eric who was so supportive and did everything he could to help. Just
                  his arm around me at that time made feel supported and understood…</p>
               <fig id="fig14">
                  <label>Figure 14</label>
                  <caption/>
                  <graphic id="graphic14"
                     xlink:href="Pictures/10000000000009B100000DB3C03AC54A4EF1B509.jpg"/>
               </fig>
               <p>Now that Alison is almost a year old, I wonder if it’s time to start weaning her.
                  Breastfeeding has been so central in our relationship both physiologically and
                  emotionally. At first, it definitely was a <styled-content style="color:red">one-way relationship</styled-content>. I think I was
                  <styled-content style="color:red">just a source of food</styled-content> for her. Her brain was just wired for survival and the brain
                  cells and instinctual processes were telling her what to do to get fed and get her
                  needs met.</p>
               <p>I’m holding this little baby that is just like a <styled-content style="color:red">little animal trying to survive</styled-content>
                  and I feel that I am exhausted but I have the <styled-content style="color:red">obligation</styled-content> to feed her. <styled-content style="color:red">You give and
                  you give and you don’t know if you get anything back … but at some point you think
                  it’s worth it, it’s working. I´m just feeding and feeding but she’s thriving</styled-content>.</p>
               <p/>
               <fig id="fig15">
                  <label>Figure 15</label>
                  <caption/>
                  <graphic id="graphic15"
                     xlink:href="Pictures/10000000000009B100000DB3B8946B318177AE50.jpg"/>
               </fig>
                  <p>As she
                     grows older, our relationship is evolving and getting more complex. Because <styled-content style="color:red">she is
                  developing more into someone who recognizes me as a person more than a source of
                  food</styled-content>, I make a connection to her heart. <styled-content style="color:red">She has a brain, hopefully she’ll develop
                  more of an attachment to the person more than the physiological need. Which is
                  what matters. At the end</styled-content>.</p>
               <fig id="fig16">
                  <label>Figure 16</label>
                  <caption/>
                  <graphic id="graphic16"
                     xlink:href="Pictures/10000000000009B100000DB368E43F1FB30F6F74.jpg"/>
               </fig>
               <p><styled-content specific-use="fig"></styled-content>As she is developing and becoming more of a person of her own, I feel that I, too,
                  am developing and growing as a mother and a person. I am confident as a mother, I
                  know what I want and how to get things done. Happiness is the key word to sum up
                  my experience of becoming a mom. I am happy with my relationship to Alison, and I
                  think that I have coped well with adversity. I am so pleased that she is a
                  thriving, happy baby.</p>
               <p>As I am reading what I just wrote, I realize that the first weeks and months of
                  transitioning to motherhood feel more and more distant, almost like looking at
                  someone else’s experience. With Alison’s first birthday, we are celebrating the
                  closing of a very important chapter in our lives. Now, it’s time to move on: <styled-content style="color:red">we’re
                  entering a different phase</styled-content>.</p>
               <hr/>
               <p>The example above of Gabriela was one of the five cases that were created as part
                  of this research study. Based on synthesis of all five cases, the final synthesis,
                  the play, was created.</p>
            </sec>
            <!-- sec lvl 4 end -->
         </sec>
         <!-- sec lvl 3 end -->
         <!-- sec lvl 3 begin -->
         <sec>
            <title>Creating the Final Synthesis</title>
            <p>In order for the reader to understand how the final synthesis was created, a brief
               description is provided below. The final synthesis, which is in the form of a
               dramatic play, (see
                  <uri>https://voices.no/index.php/voices/article/downloadSuppFile/924/290</uri> )
               came into being as I was immersed in the data and developing each individual Portrait
               Synthesis relative to the data collected from each participant. In order to analyze
               and synthesize the data across cases, and represent the findings, I decided to create
               a play based on the analysis.</p>
            <p>The first step in the final synthesis included a content analysis (<xref
                  ref-type="bibr" rid="S2012">Schreier, 2012</xref>), which used the combination of
               concept-driven and data-driven strategies. As described above, the data consisted of
               the montage portraiture interview visual and textual data, the researcher’s memoing
               and iterative artistic responses, and participant feedback resulting in the creation
               of the portrait syntheses and then the aggregate final synthesis. During the draft
               phase of the play, I outlined the structure and sequence of the play. The following
               concept-driven main categories became the first three acts of the play: Act I
               sensory-embodied experiences, Act II: relational experiences, and Act III: imaginal
               experiences. Each act was divided into scenes that correspond to the data-driven
               themes that emerged during the final synthesis.</p>
            <p>Below is the division of acts and scenes.</p>
            <list>
               <list-item>
                  <p><bold>Act I: sensory-embodied experiences</bold></p>
               </list-item>
               <list-item>
                  <p>Scene 1: Introduction</p>
               </list-item>
               <list-item>
                  <p>Scene 2: Holding</p>
               </list-item>
               <list-item>
                  <p>Scene 3: Breast feeding</p>
               </list-item>
               <list-item>
                  <p>Scene 4: Connected as one organism</p>
               </list-item>
               <list-item>
                  <p>Scene 5: Pregnancy</p>
               </list-item>
               <list-item>
                  <p>Scene 6: The baby is an ocean</p>
               </list-item>
               <list-item>
                  <p><bold>Act II: Relational experiences</bold></p>
               </list-item>
               <list-item>
                  <p>Scene 1: Introduction</p>
               </list-item>
               <list-item>
                  <p>Scene 2: Breast-feeding tied in with the relationship</p>
               </list-item>
               <list-item>
                  <p>Scene 3: One-way relationship vs reciprocated relationship</p>
               </list-item>
               <list-item>
                  <p>Scene 4: Connection with the baby</p>
               </list-item>
               <list-item>
                  <p>Scene 5: Relationship evolves over time</p>
               </list-item>
               <list-item>
                  <p>Scene 6: Coping with stressors of adjustment</p>
               </list-item>
               <list-item>
                  <p>Scene 7: Joy in the relationship</p>
               </list-item>
               <list-item>
                  <p><bold>Act III: Imaginal experiences</bold></p>
               </list-item>
               <list-item>
                  <p>Scene 1: Introduction</p>
               </list-item>
               <list-item>
                  <p>Scene 2: Fantasy of returning to a former life</p>
               </list-item>
               <list-item>
                  <p>Scene 3: Awareness of darker fantasies</p>
               </list-item>
               <list-item>
                  <p>Scene 4: Positive fantasies for the future</p>
               </list-item>
            </list>
            <p>
               <bold>Participant Feedback</bold>. Another aspect of the research data that
               contributed to the formation and interpretation of the final synthesis was the
               participant feedback. As described earlier, after creating each Portrait Synthesis, I
               shared it with the participants and asked them for feedback. The participants
               provided in depth and insightful feedback that added to the existing data. The
               feedback was synthesized and added to the play as the 4th act.</p>
            <p>
               <bold>Visual component of the play</bold>. The Final Synthesis also included a visual
               component. As described previously, five individual Portrait Syntheses had been
               created. As part of the final synthesis I decided to aggregate the five Portrait
               Syntheses illustrating the across case comparison and evolving group portrait
               narrative. Based on the scenes in the draft play, I revisited the scanned images of
               the individual portrait syntheses in order to locate the visual representations that
               pertained to the categories and evolving dialogue in these scenes for each
               participant and between the participants. These group portrait syntheses were aligned
               with and positioned within the categorical scenes and were then assembled into a
               slideshow to be shown during the actual reading of the play.</p>
            <p>
               <bold>Setting of the play</bold>. After I had drafted the play and planned the
               sequence of the slideshow, the question of the setting of the play emerged. Because
               this is an arts-based research study, the findings are represented artistically. The
               participants, of course, never met in real life but in the play they appear to be
               talking to each other. This raised the need to create a setting in which these five
               women could come together, and several options were considered. At this point, I
               asked for and received valuable guidance from my dissertation advisor. After a
               fruitful discussion with her, I decided that the play be set in an artist´s studio.
               The main argument in favor of this setting was the fact that the researcher, not the
               actual participants, created the featured artwork. It then became apparent that the
               researcher, too, should be a participant in the play, acting as the portraitist.</p>
            <p>
               <bold>The portraitist’s voice</bold>. Another question that arose was that of the
               portraitist’s voice. In keeping with the pluralistic intersubjective ontological
               perspective for this study, the data generated and the interpretation of the data,
               and the formulation of the results were all co-constructed. Therefore the
               portraitist’s voice is integral to all phases of the study. As part of the data
               generation, I had created artistic responses and written memos and observations in
               response to the participants’ data and data generation process. These artistic
               responses had helped me create each individual Portrait Synthesis. For the Final
               Synthesis, as the artistic components of the individual portraits were incorporated,
               it seemed inevitable that the researcher’s voice should also be present in the Final
               Synthesis. Interacting with the research participants, and later creating artwork
               made me personally present with the participants and the research process. In my
               presence, the participants were exploring and making meaning of their experiences,
               exposing their doubts and insecurities. In response, those meetings evoked memories,
               associations, and countertransference in me that I recorded in written memos (<xref
                  ref-type="bibr" rid="G2011">Gemignani, 2011</xref>). And thus, I could not be just
               a quiet observer but that my voice should also be heard, therefore, I added myself as
               a character in the final synthesis and based on my reflexive memos, shared some of my
               own thoughts, reactions, and observations.</p>
            <p>The portrait syntheses as well as the final dramatic synthesis were presented to an
               audience of graduate students and staff at Drexel University. The portrait syntheses
               were presented in the form of an exhibition, and volunteer members of the audience
               read the final dramatic synthesis, the play. It is important for the reader to
               understand how the mother’s <italic>beyond_words</italic> experiences were
               represented, staying true to the data, yet holistically and engagingly representing
               their experiences so that the viewer can LIVE the meaning of the
                  <italic>beyond_words</italic> phenomena. Typical, textual, linear description
               alone cannot do justice to the <italic>beyond_words</italic> phenomena that are
               non-discursive, multidimensional, and poetic. The arts-based representations require
               that the viewer experientially engages with the artwork that is essential
               comprehending the full impact of the <italic>beyond_words</italic> phenomena. In
               order to guide the reader to reflect on and engage with the play, the reader might
               consider the following questions that were also presented to the audience members for
               their feedback:</p>
            <list list-type="order">
               <list-item>
                  <p>What did you learn about the <italic>beyond_words</italic> phenomena that
                     mothers experience in their transition to motherhood?</p>
               </list-item>
               <list-item>
                  <p>How has this research impacted your attitude and empathy towards first-time
                     mothers?</p>
               </list-item>
               <list-item>
                  <p>In what way might accessing the results from this research be useful to
                     first-time mothers, mothers-to be and/or art therapists or other clinicians who
                     work with new mothers?</p>
               </list-item>
               <list-item>
                  <p>Did you experience any emotional responses? Which feelings did this research
                     evoke in you?</p>
               </list-item>
               <list-item>
                  <p>Were there any particular parts in the play that evoked emotions or
                     sensations?</p>
               </list-item>
               <list-item>
                  <p>What personal images or experiences did this research evoke in you? Please
                     reminiscence on any personal memories that came to mind.</p>
               </list-item>
            </list>
            <p>If you would like to share your own responses to these questions with us, we would
               appreciate it! You may contact the corresponding author, Victoria Scotti, by e-mail:
                  <email>victoriascotti@gmail.com</email>
            </p>
            <p>
               <bold>Audience feedback. </bold>Audience feedback was the final step in the research.
               In arts-based research, the presentation of the results often is in the form of
               exhibitions or performance of the artistic results in a public forum as a method for
               further assessing the authenticity and credibility of the results. For that purpose,
               collecting and analyzing audience feedback in this study was implemented as a
               credibility and authenticity measure. After witnessing the Portrait Synthesis and the
               reading of the play, the audience members were asked to fill out anonymous feedback
               questionnaires.</p>
            <p>The objectives of the questionnaire were to assess 1) usefulness of research, and 2)
               aesthetic power of the research which are among two most often used constructs used
               to evaluate the authenticity and credibility of arts based research (<xref
                  ref-type="bibr" rid="CL2014">Chilton &amp; Leavy, 2014</xref>; <xref
                  ref-type="bibr" rid="CK2008">Cole &amp; Knowles, 2008</xref>; <xref
                  ref-type="bibr" rid="L2015">Leavy, 2015</xref>).</p>
            <p>The audience members described that the arts-based experience was useful in
               communicating a dynamic and interactive expression conveying the simultaneity of
               emotional, physiological, social, and spiritual dimensions of transitioning to
               motherhood. This experience, they said, could be useful for healthcare providers,
               family members, and friends to increase empathy, communication, and preparation for
               motherhood. The aesthetic power of the performance and the art referred to the
               engagement with audience through the authentic evocation of visceral experiences,
               memories, emotions, and personal associations, which contributed to understanding and
               usefulness. One audience member described “the sense of blending, overlapping of a
               myriad of emotions and sensations. I really felt that I was witnessing/experiencing
               the intersubjective relationship between mother, child, and father.” Another audience
               member reported that the experience was “Very powerful. The artwork made me feel, at
               once, light and heavy at the same time.” Overall, the audience feedback was a
               testament to the aesthetic power of the arts based results relative to its
               contribution to insight, empathy, emotional resonance, and transferability to real
               life situations.</p>
         </sec>
         <!-- sec lvl 3 end -->
      </sec>
      <!-- sec lvl 2 end -->
      <!-- sec lvl 2 begin -->
      <sec>
         <title>Conclusion</title>
         <p>In summary, this arts-based research study engaged new mothers in a process of
            expressing and conveying their <italic>beyond_words</italic> experiences of
            transitioning to motherhood through their textual and artistic expressions. These
            textual and artistic expressions were then systematically and rigorously analyzed using
            the researcher’s intentional arts based processes that incorporated data from
            participants’ interviews, arts processes, researcher arts based and textual memos,
            participant feedback, arts based responses, constructions, and synthesis. Arts based
            research was selected for this study because of both its alignment with
               <italic>beyond_words</italic> phenomena and its disseminative impact. By hearing each
            amplified voice in the associated narratives, and experiencing their interactive
            dialogue in the play, the viewer can relate to the holistic existential beingness and
            experience of these mothers which otherwise may not have been conveyed through more
            traditional research or text.</p>
      </sec>
      <!-- sec lvl 2 end -->
   </body>
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