7%~Arts in t’~_xktht%ip?;, Vol. 14 pp. 215-221. Q Pergamon Journals Ltd., 1987. Printed in the U.S.A.Q197-4556187 $3.00 + .
oO
MUSIC THERAPY WITH THE OVERCONTR~LLED OFFENDER:
THEORY AND PRACTICE
JANICE M. COHEN,
The violent criminal typically is characterized
as displaying little control over aggressive im-
pulses. A less-considered overcontrolled type of
offender has been described as introverted
(Blackburn, 1971), helpless, insecure (Weiss,
Lamberti, & Blackman, 1960), submissive, pas-
sive, and extremely dependent (Schultz, 1960).
Blackburn (1968) found that overcontrolled of-
fenders admitted to fewer hostile feelings and
denied undesirable traits in themselves and
others, thus appearing more socialized and ex-
hibiting less psychopathology than their impul-
sive counterparts. Yet Megargee (1965) found
that this outward conformity is coupled with re-
pressed inner alienation.
The violent crime committed by the overcon-
trolled offender has been described as excessive
or even psychotic given the apparent catalyst to
that crime (Megargee, 1966). Kahn (1959) found
that overcontrolled offenders had fewer socially
acceptable emotional outlets. Weiss, Lamberti,
and Blackman (1940) speculated that these indi-
viduals learned that they must suppress hostile
and aggressive impulses in order to satisfy their
mothers’ demands for conformity and thus insure
her love, and Schultz (1960) added that they
would continue to control these impulses only as
long as their dependency needs were gratified.
Megargee suggested that the intensity of the vio-
lent act was in response to a generalized buildup
of anger related to minor provocations over time.
*Janice Cohen, co-founder of the Pennsylvania Coalition for Creative Arts Therapists, is on the faculty of Hahnemann University
where she is conducting research on “Rhythm and Tempo in Mania.” She has been a fu~~~tirnemusic therapist in the psychiatric
unit of the Philadelphia Prisons since 1983.
215
MM, CMT-BC”
Blackburn (1972) described two subgroups,
both with strong impulse control, but one deny-
ing all anxiety and hostility, and the other admit-
ting to some of each. This author speculates that
the former subgroup is at greater risk of psycho-
logical disturbance, especially when faced with
the reality of the violent act. Laufer, Johnson,
and Hogan (198 I) preferred the construct of ego
control, that is, the ability to moderate impulse
control plus a wiI~ingness to admit primary proc-
ess thought into consciousness. They found that
extremely violent offenders often display high
ego control, preferring familiarity, structure, and
order. They borrowed this construct from Block
and Block (1980) who considered the two-way
interplay of ego-control and ego-resiliency in im-
pulsive behavior.
Rothenberg (1971) explored anger and its as-
sociation with violence. Anger is arousal directed
toward an object serving as an alerting, that is,
communicative phenomenon. Anxiety results
from undirected arousal; therefore, suppression
of anger over time can result in shaking, dis-
rupted thought, and, ultimately, violence. Fur-
thermore, increased anxiety from nonexpression
of anger results in increased potential for vio-
lence. Thus, the violent act results from this
buildup of anxiety associated with the angry state
regardless of the specific situation. Rothenberg
found that most violent people have difficulty
dealing with angry feelings. He conjectured that
216 JANICE
anger is suppressed primarily because it indicates
need and secondarily because of fear of its de-
structive potential.
Alcohol intoxication has been considered as a
catalyst to the violent crime in those who ordi-
narily may not have acted violently (Holcomb &
Adams, 1985). The intoxicated violent offender is
often a passive, nonpsychopathic individual from
a rigid and ethically strict upbringing. Holcomb
and Adams further suggested that alcohol con-
sumption increases the potential for violence by
distorting perception and cognitive interpreta-
tion, especially regarding perceived threats. The
present literature search did not discover links
between the construct of Overcontrolled-Hostil-
ity (Megargee, 1966) or high ego control (Laufer,
Johnson, & Hogan, 1981) and intoxication as a
catalyst to violent behavior, although this author
speculates that there is a relationship.
The unpredictable nature of the overcon-
trolled offender’s violent act generally means
that treatment is rarely received until incarcera-
tion (Megargee, 1966). In prison the overcon-
trolled offender may appear relatively well-
adjusted to the environment and so may not be
referred for psychiatric services. Furthermore,
the punitive penal system promotes passivity by
rewarding control and punishing even mild ex-
pressions of aggression (Adler, 1975). The
prison, as a closed system, creates a holding en-
vironment of sorts that fosters dependency (Mil-
ler & Rice, 1967). However, prison relationships
are not dependable due to the unpredictability of
transfer to another institution (Blatt, 1983). Even
though Megargee f 1966) promoted psycho-
therapy as more effective than incarceration for
the overcontrolled offender, the more serious na-
ture of the offense is likely to rule out this alter-
native.
Megargee (1966) suggested that the goal in
therapy be to decrease excessive inhibitions so
that the overcontrolled offender can acknowl-
edge and accept hostility in the self and in others.
The therapist must use the constructive, com-
municative potential in anger to encourage the
expression of rage related to need and fear
(Rothenberg, 1971). Kernberg (1975) emphasized
the importance of a safe therapeutic environment
where the client can express rage and survive
without hurting anyone. This can be particularly
threatening for the client who in reality has acted
M. COHEN
on an unacceptable fantasy and so has a real
precedent for the fear of losing control. Thus
there is the risk in therapy of acting out or even
psychotic break as the client comes close to
acknowledging repressed aggression (Megargee,
1966).
Although the literature lacks a diagnostic for-
mulation linked to the overcontrolled phenom-
enon, this author speculates that there is a rela-
tionship between the overcontrolled offender and
primitive (borderline and narcissistic) personality
disorders. Theorists have associated primitive
personality disorders with rage that can lead to
destructive acts (Adler, 1979). Campbell (1982)
recommended a flexible therapeutic relationship,
and Adler (1979) added that the therapist must
balance support with encouragement to increase
the capacity to bear frustration. Some theorists
have emphasized the importance of the primitive
nonverbal relationship that evolves with these
individuals, including prememory phenomena
that defies verbal description and so is elusive to
the verbal therapist (Balint, 1968; Blanck &
Blanck, 1979).
Music therapy offers the language of creative
musical expression as a vehicle for therapeutic
growth and change. The work of therapy can
take place in the actual process of playing music.
through associations to the music, or in the rela-
tionships that develop as a result of the music
(Bruscia, 1987). The music therapist can be flex-
ible in meeting the client at the appropriate de-
fensive level. Stein and Thompson (1971) showed
that aesthetic considerations in music without a
referent outside of itself can serve as a motiva-
tion for behavioral change in mentally-ill clients.
Of improvisational music therapy Bruscia stated
that “the playful aspects of improvisa-
tion . . . bring the pleasure of gratifying one’s
impulses, and the safety of controlling some as-
pect of the external world . . .”
A therapeutic relationship can be expediently
formed with the more active, less-verbal prisoner
through shared music making (Zwerling, 1979).
Literature applying music therapy to prisoners
and criminals, however, is limited to the descrip-
tion of music applied as a therapeutic activity
rather than as a vehicle for psychotherapy. The
purpose of this article is to describe the use of
music psychotherapy in the treatment of over-
controlled offenders. Case examples will be used
 MUSIC THERAPY WITH THE OVERCONTROLLED
to illustrate this application, and directions for
research will be suggested. “Overcontrolled of-
fenders” was chosen based on this author’s ob-
servation that inhibition of hostility is related to
inhibition of other emotions.
CASE EXAMPLE: R
R was a ‘26-year-old single Black male. He had
completed high school and had served in the
Army for two years before being honorably dis-
charged due to unspecified psychiatric problems.
He was raised by his natural mother and father
until his father’s death and had lived with his
mother, stepfather, and brother prior t.o his in-
carceration. He described his upbringing as
strict. R’s mother made frequent contact with the
clinical staff during his imprisonment and treat-
ment. R was described by his mother as bright,
industrious, and responsible until, after gradua-
tion from high school, he began to withdraw. He
was charged with simple assault and attempted
rape, and this was his first incarceration. He was
believed to have been intoxicated and acutely
psychotic while committing the crimes.
R began music therapy during recovery from
an acute psychotic episode on the inpatient ward
of the prison psychiatric unit. His initial music
was limited in expressive range. He held rigidly
onto repetitive rhythmic motifs, and displayed
limited ability to adjust to changes around him.
His movements across the xylophone keys were
more horizontal than vertical so that his playing
was quiet and unarticulated; he was easily
drowned out by others. Additionally, horizontal
movements suggest dependency as they are re-
miniscent of the oral-dependent stage of devel-
opment (Kestenberg, 1965).
R was unable to make boundaries in his own
music through phrasing, between musical pieces
by ending, with others’ music by differentiating
from the musical background, and physically by
staking his claim to a chosen instrument. His
music was only loosely organized when he did
not receive external rhythmic support. His musi-
cal behavior thus confirmed the passivity,
helplessness, and dependency characteristic of
the overcontrolled offender.
R was un~omfo~ab~e with and withdrew from
loud music that he associated with negativity. He
spoke of his psychosis and criminal behavior as a
OFFENDER 217
frightening loss of control. His limited expressive
and physical range seemed a way of concretely
maintaining control in the sessions. He denied
responsibility for his musical actions by avoiding
defining his experience verbally, thus splitting
thought from action. This author speculated that,
as Megargee (1966) suggested, the psychosis re-
sulted from an inability to continue repressing
the unacceptable aggressive impulses. Not sur-
prisingly, images of good and bad permeated R’s
delusional material.
R was referred to the prison creative arts
therapy program by his psychiatrist and chose to
be involved in music therapy; he participated for
five months while incarcerated. The goal in
therapy was to strengthen his ability to organize
his music so that he would be able to increase his
expressive range, and to strengthen his musical
boundaries, decrease his passivity, and improve
his interactional skills. He attended weekly indi-
vidual sessions with a student intern and weekly
group sessions with the author (hereafter re-
ferred to as therapist).
In the initial individual sessions R was permit-
ted to indulge his dependency needs in a musical
holding environment in which he played on and
on accompanied by the clear structure of the
intern’s rocking, accepting rhythms. The holding
environment has been indicated in the treatment
of primitive personality disorders (Kernberg,
1973, and Priestley (1975) described the use of
holding as a musical intervention. The musical
context made this dependent relationship possi-
ble because it was not necessary to consciously
define the relationship as such. Approximately
two months into therapy, R offered to initiate the
group music and did so with a clear, articulated
beat that was easy to follow.
At first, synchronizing with, syncopating to,
and imitating R’s rhythms helped to reinforce his
emerging musical self. During subsequent group
and individual sessions, as R began to develop
trusting musical relationships, the therapist in-
troduced musical exercises designed to assist R
in expanding his dynamic and melodic range.
Musical interventions were then aimed at reflect-
ing and intensifying (Bruscia, 1987) the affective
elements in R’s music. The therapist began to
encourage verbal association to the musical
material to prepare R for more conscious use of
the expressive qualities in his music. She used
 JANICE
exercises requiring contrasting opposite musical
qualities, and games and storytelling that re-
quired creating verbal images to match the
music. Taped feedback during exercises requir-
ing R to create music to fit verbal images inspired
him to further increase the expressive range of
his own music. With these exercises, he in-
creased his interactional options and more fully
projected his musical self into the group.
R offered his first unsolicited ext~musi~a~
association to a musical experience approx-
imately four months into therapy. This occurred
irr an exorcise that explored each individuaf’s
dynamic range in the context of the group. As he
played louder and the group followed him he re-
ported feeling “charged up,” adding that “I
haven’t felt that way in a long time.” Again, the
nondesignated meaning of such a musical task
permitted R to safely explore what he had ini-
tially defined as a negative impulse. During this
time R was transferred from the inpatient unit to
the general prison population. He continued to
attend music therapy and psychiatric sessions.
Up to this point R’s musical and verbal in-
teraction was primarily with the therapist rather
than with other group members, With increased
experience of expressing himself within safe lim-
its in a group context, R began asserting himself
in the group. He freely initiated more music, of-
fered extramusical references to the music, and
refused to switch instruments with others.
Without warning, R was transferred to another
institution where he could not continue in music
therapy. The therapist visited him once to make
closure and reinforce the work they had begun.
Within a month, R was djscharged and returned
to live with his parents. He called the psychiatric
unit to report that he was doing well and continu-
ing on meditation and in treatment.
CASE EXAMPLE: J
J was a 30-year-old single Black male who had
completed high school and two years of college
and had worked as a legal assistant prior to in-
carceration. He also had lived with his fiancee in
an apartment rented from his mother. He was the
youngest of five siblings, all of whom had been
moved to two separate foster homes after their
parents’ divorce. J was 18 months old at this
time. The parents visited the children regularly
M. COHEN
for 13 years, at which time the father took cus-
tody of the boys and the mother took custody of
the girls. J described his foster home as strict and
restrictive. He described his natural mother as
loving and caring and his natural father as harsh
and abusive. His mother was also in frequent
contact with clinical stat?’ during his incarcera-
tion. She described him as bright and industrious
until he began experimenting with drugs and
alcohol in college. He reported that this was lim-
ited to marijuana and beer. He was charged with
rape and attempted rape, and this was his first
incarceration. He claimed to have been inebri-
ated while committing the crimes.
J’s initial musical behavior was similar to R’s
in its horizontal movements on the instruments,
quiet, limited range, and lack of boundaries
within his own music, between musical pieces,
and with others’ music. J differed from R in his
ability to organize his music without rhythmic
support from others. This ability to use con-
scious processes to rigidly control his musical
impulses suggests that J had more ego strength
than R. This was confirmed in that J maintained
his rigid control after commission of the violent
act rather than regressing into psychosis.
Whereas R exhibited a thought disturbance. J
exhibited an object disturbance, projecting his
good and bad onto objects in his world. Both R
and J had used alcohol, which lowered their in-
hibitions and resulted in the aggressive action.
J voluntarily initiated contact with the psy-
chiatric unit because he was bored and needed
something to do. His case worker described him
as “petulant and dema~djng.” J chose to be in-
volved in music therapy and a relaxation class,
and remained in therapy for 10 months while in-
carcerated. He attended weekly group and. later,
individual music therapy sessions. The goal for J
in music therapy was to increase his tolerance for
an expanded range of musical expression, im-
prove his ability to interact, and generalize this
behavior to the extramusical realm.
Within the first four sessions J established a
preference for verbal rather than musical inter-
action. He used intellectualization to avoid re-
sponsibility for his musical behavior. In group
sessions his music was quiet and self-involved.
and he requested individual sessions, reporting
that he felt generally uncomfortable in groups. J
stated that he felt superior to yet alienated from
 MUSIC THERAPY WITH THE OVER~ONTROLLED
other inmates and shared his feelings of loneli-
ness and isolation in the individual sessions. He
believed, however, that he must suffer through
these groups to earn the coveted attention of the
individual sessions.
J offered associations to the instruments, stat-
ing that the xylophone mallets reminded him of
phalluses and the bongos were like his safe teddy
bear through which he could hide from the pres-
sures of the group experience. J “fell in love”
with the therapist’s guitar. These object transfer-
ences were to become the basis for J’s work in
therapy.
Early in individual treatment, J began creative
writing. In keeping with the conceptual frame-
work of music therapy, the therapist considered
J’s writing as his voice unprojected into the
world. His initial prose writings were rhythmi-
cally unarticulated like his music. After three
weeks of prose writing, at the therapist’s sugges-
tion J began to create rhythmic and formal
shapes in poetry; parallel forms did not occur in
his music. Writing seemed to be another inroad
to therapeutic change. J titled his poetry collec-
tion “Inside/Outside,” which became a meta-
phor for his work in therapy encompassing inside
and outside of both the jail and the self.
As with R, the nondesignated meaning of mu-
sical experience allowed J to safely explore new
options for expression. By repositioning instru-
ments alternately close to and farther apart and
away from him, J compared the effects of open
and closed postures on his experience of his own
and the group’s music. The immediate auditory
feedback inherent in music enhanced J’s aware-
ness of the contrast and facilitated the group’s
ability to respond to the change. His subsequent
poetry revealed a new awareness of the separa-
tion and interrelatedness of his inner world and
his environment. Images of a concrete and steel
jail in his poetry became metaphors for the cold
exterior he presented, while the longing within
the walls of jail were longings he became aware
of within himself.
In the first four months of therapy, group ses-
sions had combined music and verbal activity
whereas individual sessions were exclusively
verbal. In the fifth month, as J became more will-
ing to share verbal associations to the music in
the group sessions, music was introduced into
the individual sessions. J was angry and reiuc-
OFFENDER 219
tant. He likened an exercise in which he and the
therapist sat on opposite sides of the same
xylophone to a sexual interaction and shared his
fear of not being good enough to satisfy women,
all of whom he viewed as insatiable. In the next
individual sessions the therapist sat on the same
side of the xylophone as J to foster a sense of
support and empathy rather than confrontation.
She taught him the basics of scale and melody
construction to lessen his fear of the more active
musical experience by engaging his preference
for cognitive processing. In this exercise she
used musical holding to establish unconditional
acceptance of J’s musical expression.
This was to be a turning point in therapy with
J. During this session he increased his range of
notes and use of melodic form, thus increasing
his potential for using the music as a conscious
projection of himself. In the next group session J
chose and played anger on the bongos, which had
represented dependency, in an exercise requiring
pairs of group members to communicate emo-
tions musically to the rest of the group. His beats
were loud with very little rhythmic organization,
yet he was able to stop playing and describe his
experience including his fear of losing control in
anger. He also shared that the anger turned to
happiness during the piece in that he was finally
able to “let it out.” In subsequent individual
sessions he began to find conscious objects for
his anger including the therapist and his mother
who “didn’t understand me either.”
In J’s final group session the therapist chose a
songwriting task, combining poetry and music
making to bring together and concretize early
and late group and individual experiences. J was
lively in his interaction, both encouraging others
and asking for their support. He even offered to
and did sing the song. Furthermore, independent
of the group task, J had written a song, which he
sang for the final individual session. With J’s
permission, an excerpt from a poem sent to the
therapist from the drug and alcohol program to
which he was transferred after incarceration is
included here:
In leaving,
I’ve realized that there can be warmth
Behind the barren coldness
Of concrete and steel walls,
That kindness does escape momentarily
220 JANlCE
From the hardened souls who call this hell
home;
That they, like you, are also human;
And all are good and bad
At one time or place or another . . .
I lost a part of my life inside,
But I found that WC should all
Spend some time inside
And maybe then
We could more accuratery
Judge our brother.
DISCUSSION
This article has presented two models for
using music therapy with overcontrolled offend-
ers in prison. The clients in both case examples
had committed uncharacteristically violent
crimes that they associated with a loss of control
attributed to alcohol and psychosis in one case
and alcohol alone in the other. Their initial musi-
cal productions were similar, that is, passive and
dependent yet retaining internal and interactional
organization.
The main differences between the two clients
were their level of defensive functioning and
their ability to establish ego boundaries. R, who
had been psychotic, used very primitive defense
mechanisms, preferring the more primitive musi-
cal world of rhythms and melodies. He exhibited
a loose sense of his own boundaries so that it was
necessary to define and delimit his relationship to
the rest of the group before encouraging him to
expand his expressive range and develop a con-
scious awareness of and ability to control his be-
havior. J, who had never been psychotic, used
more conscious, verbal defenses and was more at
ease in verbally defined interaction. He dis-
played rigidly constricted boundaries and was
encouraged in therapy to expand his limited
range of expression.
In both cases, music seemed to provide a con-
text uniquely conducive to the treatment of the
overcontrolled offender. The primitive nature of
musical rhythms (Hudson, 1973; Meerloo, 1961)
provided the nonverbal, prememory relationship
suggested for work with this population. Once a
sense of safety was established, music allowed
the flexibility to introduce challenge while sus-
taining support. This could be achieved within a
single musical piece, alternating between steady
consonance and syncopated dissonance. Intense
M. COHEN
musical expression was associated by the clients
with a positive cathartic experience without the
need for designated emotional content. When
emotional interpretation was available, the ac-
tion was more permissible because of the aes-
thetic considerations of the music. This expres-
sion was experienced as creative rather than de-
structive and communicative rather than with-
drawn.
The prison environment provided the therapist
with additional chatlenges that were addressed in
sessions through musical interaction. Defenses
were bolstered at the end of sessions with music
that emphasized individual instrumental roles to
prepare clients for reentry into the nonsupportive
cellblock environment or the possibility of unex-
pected transfer. Emphasis on music with clear
beginnings and endings helped to reinforce these
boundaries. The active nature of music provided
the opportunity to practice assertive behavior
that might be discouraged on the cellblock, and
music provided a safe container for the expres-
sion of intense emotions.
As suggested by Megargee (1966) related to
diagnostic scales, overcontrolled offenders might
change their behavior just to please the therapist.
The difficulty with which the clients expanded
even their musical expression suggests that this
was not the case. Another problem in consider-
ing the effectiveness of any treatment with of-
fenders is the standard by which that success is
measured. The prison staff looks for prison ad-
justment based on behavior; the mental health
system prefers life adjustment based on person-
ality measures; and the court system considers
society adjustment based on recidivism. The
scope of the present article does not permit an
exploration of this dilemma.
There are many directions for research related
to the use of music therapy in the treatment of
the overcontrolled offender in prison. The effec-
tiveness of music therapy might be compared to
that of other treatment modalities. Musical rating
scales might be developed and correlated with
other scales to determine whether passive or
rigidly controlled behavior is really reflected in
musical production. Additionally, a IongitudinaI
study might reveal whether changes in musical
behavior generalize to other settings. In short,
the use of music therapy with this client popula-
tion warrants continued application and study.
 MUSIC THERAPY WITH THE ~VERCONTROLLED OFFENDER 221

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