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An introduction to music psychotherapy

Article · January 1998

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Kenneth E. Bruscia
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 Chapter 1
AN INTRODUCTION TO MUSIC PSYCHOTHERAPY
Kenneth E. Bruscia

The purpose of this chapter is to provide a context for examining transference and countertransference in music
psychotherapy. For this to be possible, three basic questions must be examined: What is psychotherapy? How is
music used for psychotherapeutic purposes? What characterizes a psychodynamic orientation to music therapy?
Given the difficulty of defining both music and psychotherapy and the enormous diversity of opinion on these
subjects, these questions cannot be answered with any finality. What follows, instead, is an attempt to address
the issues underlying these questions in a way that will help the reader to understand the specific contents of
this book.

PSYCHOTHERAPY AND MUSIC

The term psychotherapy, when broken down into its two main components, means a form of treatment for the
psyche. It is essentially concerned with helping a person make those psychological changes deemed necessary or
desirable to achieve well-being. The goals of psychotherapy may vary according to what the therapist and client
deem to be necessary or desirable changes to be made. Characteristic goals are greater self-awareness,
resolution of inner conflicts, emotional release, self-expression, changes in emotions and attitudes, improved
interpersonal skills, resolution of interpersonal problems, development of healthy relationships, healing of
emotional traumas, deeper insight, reality orientation, cognitive restructuring, behavior change, greater
meaning and fulfillment in life, or spiritual development.
Aside from a focus on problems of a psychological nature, what makes psychotherapy different from other
therapies is its reliance on the relationship that develops between therapist and client as the most essential
condition for treatment. Psychotherapy is essentially an interpersonal process. Treatment takes place within and
through the client-therapist relationship. In fact, it is this relationship that enables the client to make the
necessary psychological changes, many of which can be quite difficult.
As originally conceived and traditionally practiced, psychotherapy is essentially a verbal experience. That is,
therapist and client use verbal discourse as the primary means of communicating, developing a relationship, and
working toward agreed-on goals. In contrast, music psychotherapy is defined by the use of music experiences in
addition to or in lieu of the traditional types of verbal discourse. Specifically, therapist and client create and
listen to music as a primary means of communicating, relating to one another, and working toward goals,
supplementing these experiences with verbal discourse as necessary. In short, music psychotherapy is the use of
music experiences to facilitate the interpersonal process of therapist and client as well as the therapeutic change
process itself.
The relative emphasis given to music experiences versus verbal experiences can vary considerably, depending on
the clinical situation and the therapist’s orientation. Essentially, there are four levels of engagement used in
music psychotherapy, ranging on a continuum from exclusively musical to exclusively verbal. Each level can be
part of a single session or it can comprise an entire session, period of therapy, or methodological approach in
itself. The four levels are as follows.
Music as psychotherapy: The therapeutic issue is accessed, worked through, and resolved through
creating or listening to music, with no need for or use of verbal discourse.
Music-centered psychotherapy: The therapeutic issue is accessed, worked through, and resolved through
creating or listening to music; verbal discourse is used to guide, interpret, or enhance the music
 experience and its relevance to the client and therapeutic process.
Music in psychotherapy: The therapeutic issue is accessed, worked through, and resolved through both
musical and verbal experiences, occurring either alternately or simultaneously. Music is used for its
specific and unique qualities and is germane to the therapeutic issue and its treatment; words are used
to identify and consolidate insights gained during the process.
Verbal psychotherapy with music: The therapeutic issue is accessed, worked through, and resolved
primarily through verbal discourse. Music experiences may be used in tandem, to facilitate or enrich the
discussion, but are not considered germane to the therapeutic issue or treatment of it.

A further distinction can also be made between experiential forms of therapy and those that rely solely on
verbal discussion. Experiential therapies are those that use specially designed activities or experiences (other
than verbal discussion) to help the client relive and work through his or her problems. In addition, the activities
and experiences provide an important medium through which the client and therapist express and shape their
relationship. Examples include the first three levels of music psychotherapy listed above, along with
corresponding forms of art, dance, poetry, and drama therapies. These contrast with verbal forms of therapy,
which rely solely on verbal discussion to analyze and reflect on the client’s problems and the client-therapist
relationship.
An even finer distinction can also be made between those forms of music psychotherapy that aim at experiential
change, which I call transformative therapy, and those that aim at verbally mediated awareness, which I call
insight therapy. This is an important distinction because the process and outcomes of these forms of therapies
are different, and these differences have significance for understanding the essential nature and therapeutic
potential of music.
In transformative music psychotherapy, it is the music experience itself that leads to change. This characterizes
the first and second levels of engagement above (music as psychotherapy and music-centered psychotherapy),
in which the music experience is therapeutically transformative and complete in and of itself. The premises for
this are that the musical process is in fact the client’s personal process when interacting within the world, that
the musical outcome is the desired therapeutic outcome, and that the process and outcome are inseparable.
In contrast, in insight therapy, the client may or may not “experience” and “work through” problems in a
medium other than words, and in either case, the aim is always verbally mediated insight. This aim characterizes
the third and fourth levels above (music in psychotherapy and verbal psychotherapy with music). Notice that
although the first and second levels of engagement rely heavily on the nonverbal experience of music, with little
need for verbal consolidation, the third and fourth levels depend on the verbal extension and consolidation of
the nonverbal experience of music. The difference is whether therapeutic or life changes result from the
experience or from the insight, from the spontaneous living through or reliving of the problem in the present
(verbally and/or nonverbally), or from a verbal reflection on the problem in the present as it was experienced in
the past.

METHODOLOGY
The next crucial question is, What is the nature of music experiences used in psychotherapy? This book features
three general approaches to music psychotherapy, each involving the client in a different type of music
experience: improvisation, songs, and music imaging. These are certainly not the only approaches. There are
many other kinds of music experiences that can be used, and there are endless variations of the ways that these
three types of music experience can be implemented. Improvisation, songs, and music imaging are featured in
this book only because they seem to be the ones most frequently employed within a psychodynamic orientation
to therapy.
What follows is a brief description of how each type of music experience is used in psychotherapy. Greater detail
can be found in individual chapters by each author.
 Improvisation

When psychotherapy involves improvising, the client “makes up” music spontaneously while playing an
instrument or singing, extemporaneously creating sound forms, melodies, rhythms, or entire pieces. The client
may select any musical medium within her capabilities (such as voice, body sounds, percussion, strings,
keyboard, wind instruments) and then, with the necessary instructions or demonstrations from the therapist,
learns to make sounds extemporaneously. As the sounds emerge, the client follows them up with more sounds
and gradually shapes them into something meaningful, such as a beat, rhythm, melody, timbre, or harmony. This
process of spontaneous music-making taps into every human being’s natural propensity to create and respond
to sounds expressively and aesthetically. No musical training is required. Improvising is simply playing around
with sounds until they form whatever patterns, shapes, or textures one wants them to have, or until they mean
whatever one wants them to mean. As such, it is a way of free-associating with or projecting oneself onto
sounds.
Three variables are considered in designing the client’s improvisation experience: the interpersonal setting, the
musical media used, and the point of reference. Each variable influences how transference and
countertransference are manifested, and each provides its own way of using music projectively.
INTERPERSONAL SETTING. The first variable to consider in setting up an improvisation is whether the client should
improvise alone, with the therapist, or in a group. This determines the interpersonal context for the client’s
music-making. When improvising alone, the client has to deal with only whether the sounds are what she wants
them to be, without having to worry about anyone else’s sounds; on the other hand, the challenge is to take on
all the responsibilities and risks that go with such freedom, accomplishing one’s own goals without the support
and assistance, musically or emotionally, of others. In contrast, when improvising with the therapist or group,
the client shares all the responsibilities and risks of music-making with others while also enjoying their musical
and emotional support and assistance; the challenge in this setting is to retain one’s own identity while still
being in relationship—to be oneself with others.
Needless to say, these differences in settings have considerable implications for transference and
countertransference. For examples in this book of how transference and countertransference are manifested in
solo and duet improvisations, see the chapters by Alan Turry, Benedikte B. Scheiby, Louise Montello, and Diane
S. Austin; for examples of group work, see the chapter by Janice M. Dvorkin and the Riordan-Bruscia model
(Bruscia, 1987).
MEDIA. The second variable is whether the client uses voice, a musical instrument, or body sounds. Each has its
own projective significance, and each provides a different medium for expressing transference and
countertransference:

In vocal media, one’s body is the sound-producing object. The body creates the vibration, resonates, and gives sensory feedback to itself. Unlike other
media, the voice requires using the invisible parts of the self. The body mobilizes the unseen physical self—to sound its inner self—according to
feedback from the observing self. As the individual instrument of the body, the voice extends the physical self and projects a sound identity of the
inner self (Bruscia, 1987, p. 516).
Unlike the voice, instruments require using the external, visible parts of the body to produce the sound. Since instruments are touched, held, and
manipulated through various body postures and movements, they serve as visible extensions of the body in both form and function. Since the
instruments also replace the voice as the resonating object, they receive the vibrations instead of the self. Since the instruments have greater material
variety than the body, they also extend its sound capabilities. Thus, instruments extend the visible self, displace the feeling self, and extend the
audible self. They project the self into the outer world, displace the inner self onto non-self, and extend the inner self (voice) to project other sound
identities. When manipulating an instrument, the body extends its outer self—to displace feelings onto objects—and project its inner self through
various sound identities (p. 517).
Similar to instrumental media, the body uses external parts of the self to produce sound; however, similar to vocal media, the body resonates and
receives the vibrations instead of an external object. Thus, the body extends and replaces itself (p. 517).

For examples in this book of vocal improvisation, see the chapter by Diane S. Austin; for examples of
instrumental improvisation see the chapters by Alan Turry, Benedikte B. Scheiby, Louise Montello, and Janice M.
Dvorkin; for examples of body sound improvisations, see Bruscia (1987).
POINT OF REFERENCE. The third variable is whether the musical improvisation is referential or nonreferential. A
referential improvisation is one that portrays or represents something nonmusical, such as an idea, feeling,
image, or story. Because the sounds are created in reference to something other than themselves, the meaning
of the improvisation is derived from relationships between the sounds and whatever they portray. In most
cases, referential improvisations are verbally mediated. The thing being portrayed in sound is presented and
conceived verbally, in the form of words, phrases, or statements around which the improvisation is built. Thus,
referential improvisations are usually sound projections onto an experience that has been verbalized.
In contrast, a nonreferential improvisation is one that is organized and created according to strictly musical
considerations; it represents, refers to, and derives its meaning from only relationships within the music itself.
The improvisation is built purely around the sounds themselves, without any attempt to portray anything else.
Thus, nonreferential improvisations have the potential for being a purely nonverbal experience: they do not
have to be based on an experience that has been verbalized (even though they may be influenced by verbal
discussions that precede them) and they do not have to be analyzed verbally to be therapeutic (although they
may be discussed afterward).

Referential and nonreferential improvisations provide different opportunities for projection. When a client improvises with reference to feelings that
have already been verbalized [referential improvisation], the improvisation enables him/ her to project the feelings underlying the words onto the
music. The music helps to turn frozen emotions or verbally consolidated experiences into dynamic forms that live in time. The client relives the
feelings nonverbally and reexperiences the process by which they unfold. By examining the dynamics and processes of a feeling, the content of
feelings can be verbally clarified.
When a client improvises without reference to verbalized feelings, the improvisation is content-free. As such, it represents an emotionally ambiguous
or open-ended situation that allows the client to organize the music according to his/her own preferences and needs at the time. In this case, the
improvisation is a nonverbal projection of the client’s personality, with the dynamics and processes of the music reflecting the dynamics and
processes of his/her thoughts and feelings at the time. A non-referential improvisation then enables the client to nonverbally explore him-/herself and
the materials without specific reference to any verbalized feelings or emotions, and to examine the dynamics and processes of his ongoing
experience. This in turn helps to clarify the content of his/her feelings.
When an improvisation is discussed afterwards, the reverse kinds of projections take place. The discussion enables the improviser to project the
feelings expressed musically onto the words and to consolidate them into more clear-cut and manageable forms (Bruscia, 1987, pp. 561–562).

The distinctions made here between referential and nonreferential improvisations are not meant to imply that
they can be categorized neatly as verbal and nonverbal and as insight-oriented and transformative, respectively.
Although it may seem as though nonreferential work relies more on music and is essentially transformative, this
not always the case: a therapist can use a nonreferential improvisation to prepare the client for a verbal
discussion that will be transformative or he can use a nonreferential improvisation to promote verbal insight.
Conversely, although it may seem that referential work relies more on words and is essentially insight oriented,
this is not always the case: a therapist can use a verbal title to evoke an improvisation that is transformative in
itself or he can help the client gain verbal insight about a transformative musical improvisation.
Perhaps the best way of understanding how referential and nonreferential improvisations work in tandem is to
conceive of them as vehicles along the same continuum, connecting nonverbal and verbal channels of
therapeutic experience.

Music can provide a nonverbal means of self-expression and communication or serve as a bridge connecting nonverbal and verbal channels of
communication. When used nonverbally, musical improvisation can replace the need for words and thereby provide a safe, acceptable way of
expressing conflicts and feelings that are difficult to express otherwise. When both nonverbal and verbal channels are employed, the improvisation
serves to intensify, elaborate, or stimulate verbal communication, whereas the verbal communication serves to define, consolidate, and clarify the
musical improvisation (Bruscia, 1987, p. 561).

For examples in this book of nonreferential improvisations, see the chapters by Alan Turry, Janice M. Dvorkin,
and Louise Montello; for examples of referential improvisations, see the chapter by Benedikte B. Scheiby.

Songs

Songs are ways that human beings explore emotions. They express who we are and how we feel, they bring us
closer to others, they keep us company when we are alone. They articulate our beliefs and values. As the years
pass, songs bear witness to our lives. They allow us to relive the past, to examine the present, and to voice our
dreams for the future. Songs weave tales of our joys and sorrows, they reveal our innermost secrets, and they
express our hopes and disappointments, our fears and triumphs. They are our musical diaries, our life stories.
They are the sounds of our personal development.
Because of these myriad connections, songs provide easy access to a person’s emotional world and to the
thoughts, attitudes, values, and behaviors that emanate from it. Given the aims of psychotherapy, songs can
greatly facilitate the process and provide a very effective vehicle for emotional change. Several different
methods can be used to introduce songs into the psychotherapy session. The main ones include
Song performance: The client or therapist or both sing precomposed songs as a means of experiencing,
expressing, and exploring the feelings and ideas contained within them. For examples, see chapters in
this book by Janice M. Dvorkin, Diane S. Austin, and Louise Montello.
Song improvisation: The client or therapist or both extemporize songs or melodies with lyrics that
portray what the client is feeling or experiencing or what issues are emerging in the therapeutic process.
For examples, see the chapter in this book by Diane S. Austin.
Induced song recall: Cora L. Díaz de Chumaceiro (Chapters 15 and 16 in this book) differentiates between
consciously and unconsciously induced song recall. In consciously induced song recall, the therapist asks
the client what song comes to mind in reference to a particular topic or issue occurring in the therapeutic
process. In unconsciously induced song recall, a song unexpectedly comes into the therapist’s or client’s
awareness in response to a particular topic or issue arising in the therapeutic process.
Song communication: The therapist asks the client to select or bring in a recorded song that expresses
something that the client wants to communicate about herself, or the therapist brings in a recorded song
that relates to what the client is working on in therapy. Then both parties listen to the song and
afterward explore what the song communicates about the client and the therapeutic process. Note that
there are three components: song selection, the music listening experience, and the processing
afterward. The song selection process may involve induced song recall, as described by Díaz de
Chumaceiro, or it may involve an active searching for new songs that the client and therapist do not
already know (and therefore are not recalling). The second component, the listening experience, is
central to this method and differentiates it further from induced song recall. Listening to the song
provides the client with an opportunity to live through and reexperience the issues and feelings
presented in the song, rather than to reflect on them verbally without experiencing them. The third
component, processing the song experience afterward, also differs from induced song recall in that it
goes beyond interpreting verbal components of the song to include analysis of specific features of the
performance selected and of the music itself. It should be noted that “song communication” also goes
beyond and includes the technique commonly called song or lyric discussion, in which the emphasis is
usually on what the lyrics mean to the client, with less attention given to the feelings evoked by the
listening experience itself.
Song writing: The therapist helps the client to compose a song that pertains to a therapeutic issue.
Depending on the client’s abilities and the kind of assistance provided by the therapist, the client may
take responsibility for writing the lyrics and/or improvising or composing the musical accompaniment.
For an example in this book, see the chapter by Paul Nolan.

Music Imaging

Music imaging, as used here, is a broad term for any experience that involves listening to music and allowing
oneself to respond imaginally—that is, through free associations, projective stories, images, feelings, body
sensations, memories, and so forth. Music imaging experiences can be designed in many different ways: with
music of many different styles and characteristics; with music in the foreground or background; with the client in
an altered, relaxed state of consciousness or in an ordinary alert state; with or without the therapist’s providing
specific directions or images for the client to follow; and with or without the client’s dialoguing with the
therapist during the experience.
A very specific approach to music imaging, called Guided Imagery and Music (GEM), is featured in this book. GIM
is a model of psychotherapy, developed by Helen Bonny (1978a), that involves the client in imaging to specially
designed music programs while in an altered state of consciousness and also dialoguing with the therapist. Every
GIM session has five main components.
PRELUDE. In the prelude, the therapist helps the client to identify and examine issues, feelings, or events that are
of concern to the client or significance to therapeutic process. This can be done through verbal discussion,
mandalas (colored circle drawings), musical improvisation, or any appropriate therapeutic technique. On the
basis of what emerges in the prelude, the therapist then selects a music program to be used to guide the client’s
imaging. Each program consists of various pieces from the classical literature, specially selected and sequenced
to explore a particular emotional theme or process (Bonny, 1978b). The programs vary in length from 20 to 45
minutes and may be extended or shortened, depending on the client’s needs.
INDUCTION. In the induction, the therapist helps the client enter into an altered or nonordinary state of
consciousness by using various relaxation techniques. The therapist then gives the client a focus for the imaging
experience. The focus may be an image, feeling, or symbol that arose from the prelude and also fits with the
mood and character of the music program selected.
MUSIC IMAGING. In the music imaging part of the session, the client images to the music and reports to the
therapist at regular intervals on what she is experiencing. The therapist tries to support and deepen the client’s
experience of the music and the image, without leading or directing it in any way. Within the GIM context,
images may consist of body sensations, visions, feelings, memories, fantasies, allegories, metaphors, symbols, or
any variety of internal experiences. This part of the session continues until the client comes to some sense of
closure with the experience.
RETURN. In the return, the therapist helps the client move out of the imagery experience and into an alert,
ordinary state of consciousness in the here and now.
POSTLUDE. In the postlude, the client and therapist reflect on the entire experience and explore its significance for
the client and the therapeutic process. Any technique used in the prelude may also be employed in the postlude.
For examples of GIM in this book, see the chapters by Kenneth E. Bruscia, Lisa Summer, and Connie Isenberg-
Grzeda.

A PSYCHODYNAMIC ORIENTATION
For purposes of this book, a psychoanalytic or psychodynamic orientation to music therapy is characterized by
any or all of the following basic premises:
The psyche manifests at various levels of consciousness, ranging from the unconscious (that layer
containing material completely out of awareness) to the preconscious (that layer containing material that
is out of awareness but that could be in awareness) to the conscious (that layer containing material in
awareness).
The unconscious layer contains all memories and instincts of the individual and species and exerts
considerable influence over the individual.
The past influences the present. Individuals learn from every experience they have and generalize what
they learn from past situations to present ones.
The conscious mind mitigates between the demands of the unconscious, the demands of reality, the
need for personal safety and gratification, and standards of morality.
The psyche places limits on the unconscious realm and its influences through repression. Repression is
any effort the psyche makes to prevent unacceptable or threatening material in the unconscious from
becoming or remaining conscious.
 Defense mechanisms are characteristic ways of coping that a person uses whenever an experience
threatens to destroy the delicate balance between what is repressed and what is in awareness. As such,
defenses are efforts to ward off the anxiety that repression might fail and that the conscious mind will
have to deal with the disturbing contents of the unconscious. Typical defense mechanisms include
Resistance: Any attempt that the client makes to avoid or impede the therapeutic process for
fear that repressed material will be brought into consciousness is called resistance. This is usually
accomplished through defense mechanisms. Note the difference: whereas defense mechanisms
are used frequently and characteristically in ordinary life situations, resistance is the specific
application of those defenses to the therapeutic situation.
Transference: The reliving of significant relationships from the client’s past within the therapeutic
setting is called transference; countertransference is a corresponding dynamic enacted by the
therapist.

Considering these premises all together, the two primary aims of psychodynamic therapy can now be stated: (1)
to bring into the client’s conscious experience material from the past that has been repressed and kept in the
unconscious through defenses and resistances and that exerts adverse psychological effects on the present and
(2) to work through that material by using transference and countertransference to engage the client in
corrective emotional experiences.

REFERENCES
Bonny H (1978a). Facilitating GIM sessions (GIM monograph 1). Salina, KS: The Bonny Foundation.

Bonny H (1978b). The role of taped music programs in the GIM process (GIM monograph 2). Salina, KS: The
Bonny Foundation.

Bruscia KE (1987). Improvisational models of music therapy. Springfield IL: Charles C Thomas Publishers.

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