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    1987 Bruscia Improvisational Models of Music Therapy-Compressed

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    IMPROVISATIONAL MODELS OF MUSIC THERAPY By KENNETH E£. BRUSCIA, Pu.D., CMT Profesor of Music Therapy ‘Temple University Philadelphia, Pennspleania CHARLES C THOMAS * PUBLISHER Springfield © Illinois © USA. ‘Pkt et Disibaet Trahod he Wy (CHARLES THOMAS» PUBLISHER 2800 South Fie Stet Springtelé Bnoi 279-9065 “Thin book i proceced by capris No pet oft ‘maybe veprodeced any manner without ersten Permission Vom the pul ber, ©1987 yCHARLES.C THOMAS + PUBLISHER SB 0-398.05272-7 ‘acy of Congress Catalog Card Namber: 86414889 Wik THOMAS BOOKS cf ative spe tl di of menceing oat ig, te Psshs dee rt laa to sifcey ss he satin ed ee obi ead opr fr tay pain nie THOMAS ‘BOOKS sil ot gly te and fd Pil in he Ue Se of rc ORD ira of Cong Cain Pico se Brain, Kennet Timproviationl model frase sheap Includes biographies and inde 1 Mua therapy 8, Improvisation (Music). Tike MLse00.876 1967 GIS SIE BTS ISBN 0386-05272-7 To the loving memory of my mother LENA BARCELONA BRUSCIA And to my beloved father NICK BRUSCIA PREFACE IE PURPOSE of this book isto provide a comprehensive source ofref- erence on the use of musical improvisation in ehecapy. The book contains an introduction tothe fundamentals of improvisational music therapy (Unit One), a detailed synopsis of over twenty-five models of therapy that have been developed over the last thiry years (Unite Two through Nine), and « syethesit ‘ofthe various models into basi principes of clinical practice (Unit Ten). “The models were identified through an exhausive search of che music therapy iterate, including journals, books, and eonference programs. The intent was include all music therapists who have used improvisation asa pri rary method of clinical intervention. ‘Unfortunatly, the licrature on improvisational ruse therapy ia somewhat scattered and fragmentary. Many joureal articles apsear outside of the music therapy literature, and several bocks are out of print. In addition, many music therapists who use improvisstion extensively have not writen or published anything about their work. In these cases, information had to be obsained through questionnaires, personal interviews, tape recordings, and/or notes. Di vailable writings, publications, and material pertaining to each model were used as sources of information. In many cases, this represents the first at empt co bring together and synthesize all ofthe existing literature on a partica Jar model, and to synthesize the ideas ofthe originator at various stages i the formulation of the model. ‘Each model has been described according to the same basic outline. The cutlne was developed bythe author (o provide a uniform way of collecting and tnganizing information about each model, while alm providing a framework for synthesizing different models according to commen topic or variables. The rain topics are; background, salient feates, clinical uses, client prerequi Sites, therapist qualifications, goal, media and voles, session format, cheoreti fal orientations, assessment and evaluation, preparation for a aceon, ‘organization ofa session, procedures, techniques, cient-music dynamics, in- trapersonal dynamic, cient-therapist dynamics, group dynamics, and process (or mages of therapy). i Inprosisational Models of Mae Thay ‘When an entire unit is devoted toa single model, these copics are grouped together into four main chapter, followed by a Unit Summary and Refer- fences, The chapters ate entitled: Introduction, Assessment and Evaluation, ‘Treatment Procedures, Dynamics and Process’ When a single chapter is de ‘voted to:2 model, the topics ofthe outline are used as subheadings within the chapter itself. ‘The chapters and sections within each unit have been sequenced to accom ‘modate the informational needs ofthe reader, which vary considerably accord- ing o the model being described. Consequently, the topies do not always occur jn the same order in every chapter and unit. ‘Summaries are provided for those models that take an entire unit 10 describe. They are not given for those models that are described within a chap- "The reference section always appears at the end of the unit, even when chapters within the unit deal with different models. All citations within the text refer tothe number assigned tothe bibliographical source in the reference lst. ‘That is, any number appearing in parenthesis within the text refers to the cor- responding bibliographical source in the reference list. The bibliographical sources have been numbered using alphabetical and chronological ordering, rather than according to their order of appearance in the tex. Because topics in the basic outline overlap somewhat, sections within the same unit or chapter may cover the same information, but froma different per- spective or with a different emphasis. Some of these overlaps are inherent in the model itself Tn fact, iis interesting to find that each model can be charac: terized according to its own unique overlaps. For example, in one model the sections on goals and musical dynamics may overlap because they are interde- pendent; whereas in another model, goals and asestment are closely linked to gether and therefore have sections that overlapin content. Besides showing which aspects ofthe model re methodologically Linked to- gether, these overlaps between sections can alsoreveal how integrative and log- ieally consistent the model i. Needless to say, the amount of information available on each topic deter rmines the length of each section. Thus, the ength of sections may vary consid: erably from one model to the next. While the obvious reason for a short section is that the originator has simply not written or dealt with the topic, theless ob- vious reason might be thatthe topic is not particularly relevant tothe mode Sometimes the originator has not addressed the topic because itis not esential to an understanding of hisher clinical approach. Here again, completeness of the information on these topics can provide considerable insight into the basic premises underlying the model Proce * Case materia and clinical examples have not been inchuded in the book Aside from not having sufficient space in the book ce do them justice the lusion goes beyond the purpose ofthe book. Ics hoped that the reader will e- turn to the original souree for more detailed clinical information on cach model. Since itis rare for one music therapist to write about the work of another, a major concern throughout the writing ofthis book has been accuracy. Fort reaton, the originators of every major model were asked to review the authors ranuscript and to make any revisions that were deemed necessary. Al of their recommendations for revision were incorporated. Hence, every unit or chapter ‘of the book devoted to a particular model has been scrutinized and approved by its originators) and where appropriate by other therapists who have used jon, to insure organizational elarity and to enhance readability, ‘every section of the book has been critically reviewee by other music therapists and creative arts therapists. Notwithstanding the author's efforts to provide a complete and accurate re- port of his own work and the work of his colleagues, the experience of writing this book has pointed out that, as powerful and valuable as they are, words are only words, Even the most accurate, eloquent description of a model cannot do Justice to the process of improvisational music therapy itself. Most therapists ‘spend their entire careers trying to find the word: to describe their clinical work, just as musicians spend their entire lives trying to capture the essence of ‘musical experience. Therapy and music are both indescribable in their own right, and the art of music therapy is even more elusive to the pen. ACKNOWLEDGMENTS For their personal and professional support, their valued opinions and suggestions, ‘and their editorial advice SANDRA LEVINSON, M.f., CMT CHERYL MARANTO, Pu.D., RMT. PHYLLIS BOONE, RMT. BARBARA WHEELER, PH.D. RMT DAVID READ JOHNSON, Pi.D., ROT. ‘ARLYNNE STARK, M-A., ADTR VICKY ANDERSON WHITELING, M.A. For their personal and administrative support during the writing of this book DEAN HELEN LAIRD DR, JEFFREY CORNELIUS DR. ROGER DBAN For the study leave which made the book possible ‘TEMPLE UNIVERSITY For sharing their work, ideas, and concerns, and for reviewing my description of their work DR. CLIVE ROBBINS, CMT. (MARY PRIESTLEY, LOSM, LGSKC (MT) EVELYN HEIMLICH, 8'5., CPT. BARBARA WHEELER, P#.D., RMT HELEN MANDELGROB, RMT, CPYT LAURA MeDONNELL, M.A. CMT ‘CAROL BITCON, MM, RMT IRMGARD LEHRER. CARLE, CMT CAROL MERLE FISHMAN, M.A CMT SHELLY KATSH, M.A|, CMT PETER SIMPKINS, CMT ANNE RIORDAN, M.ED. LISA SOKOLOY, M.A. CMT GILLIAN STEPHENS, M'A., CMT BARBARA GRINNELL, PH.D. RAST For the illustrations DANIEL A. PARDO Improvisational Models of Mcic Therapy For permission to quote and summarize Musie Therapy in Special Eduction By Paul Nordoff and Clive Robbins MAGNAMUSIC: BATON, INC. For permission ‘o quote and surnmarize Creative Music Therapy By Paul Nordoff and Clive Robbins HARPER AND ROW PUBLISHERS For permission to quote end summarize Therapy in Music for Handicapped Children By Paul Nordoff and Clive Robbins VICTOR GOLLANCZ LTD For permission to quote and summarize Masic Therapy forthe Aatistic Child By Juliette Alvin ‘OXFORD UNIVERSITY PRESS For permission to quote and sure: Music Therapy in Action By Mary Presley MAGNAMUSIC-BATON. INC. CONTENTS Page Aekslekyment xi UNIT ONE: THE FUNDAMENTALS OF IMPROVISATION THERAPY... 5 UNIT TWO: CREATIVE MUSIC THERAPY...... cee 2 ‘The Nordof- Robbins Model (Chapter 1: Introduction cos cetseeseees 28 Ghapter 2: Assessment and Bvaluation 6. ...0002c:ssceesrsere eeeeees SH Chapter 5: Trestmaent Procedures .. coeieee vee AB Chapter 4: Dynamies and Process cosine 96 Unit Summary and References sve 2 7 UNIT THREE: FREE IMPROVISALION THERAPY 1 ‘The Alvin Mode! ‘Chapter 5: Introduction : peeseeseeeesnes IS Chapter 6: Dynamics and Process coe BH Chapter 7: Treatment Procedures fore 96) Chapter 8: Assessment and Evaluation coves 103) Unit Summary and References 2-108 UNIT FOUR: ANALYTICAL MUSIC THERAPY 43 “The Priestley Model Chapter 9: Introduction cocseeeseess 4s Chapter 10: Treatment Procedures -..,.2-.-s2rrsrers 122 Chapter 11: Assetement and Evaluation 140 (Chapter 12: Dynamics and Process 148 Unit Summary and References cocceeseeee AOD xiv Inprosttional Model of Music Dray ‘UNIT FIVE: EXPERIMENTAL IMPROVISATION THERAPY 165, ‘The Riordan-Bruscia Model Chapter 19: Introduction cette cee l7 Chapter 14: Treatment Procedures tee cece ATS (Chapter 15: Dynamics and Process coer eneneee ee ABD ‘Chapter 16: Assessment and Evaluation oe 208 Unit Summary and References we a UNIT SIX: ORFF IMPROVISATION MODELS cece QT (Chapter 17: Introduction. - coe 219 Chapter 18: Treatment Procedures vocseeeeer ee BSL Chapter 19: Dynamics and Process 268 Unit Summary and References 260 UNIT SEVEN: PARAVERBAL THERAPY a 265 ‘The Heimlich Model ‘Chapter 20: Introduction 267 Chapter 21: Treatment Procedures 279 Chapter 22: Assessment and Evaluation we : cee 299 Chapter 23: Dynamics and Process 306 ‘Unit Summary and References .. 313 UNIT EIGHT: MISCELLANEOUS MODELS ai (Chapter 24: Metaphoric Improvisation Therapy 319 ‘The Katth & Merle-Fishman Model (Chapter 25: Adult Improvisational Music Therapy ces B88 ‘The Stephens Model ‘Chapter 26: Musical Peychodama. a ‘The Moreno Model ‘Chapter 27: Vocal Improvisation Therapy cect eeee ee BSB ‘The Sokolov Model ‘Chapter 28: Integrative Improvisation Therapy 360 ‘The Simpkins Model Chapter 29: Developmental Therapeutic Process 375 ‘The Grinnell Model Chapter 30: Other Approaches 383 Unit References 397 Contests w UNIT NINE: IMPROVISATION ASSESSMENT PROFILES, 401 ‘The Bruscia Medel Chapter 31: An Overview 403 ‘Chapter 32: The Profiles 423 (Chapter 33: Peychoanalytie and Existential Perspectives 2. 2.s+esecsene 01450 Appendix: IAP Seales and Criteria 2465 UNIT TEN: SUMMARY AND SYNTHESIS 497 ‘Chapter 34: General Principles of Practice 499 Chapter 35: Principles of Assessment and Evaluation 320 ‘Chapter 36: Methodological Principles 525 Chapter 37: Sixty-Pour Clinical Techniques. seceeeecenen rere BBD Chapter $8: Dynamics and Process 558 Indes. . . 313 IMPROVISATIONAL MODELS OF MUSIC THERAPY UNIT ONE THE FUNDAMENTALS OF IMPROVISATIONAL MUSIC THERAPY DEFINITIONS 'USIC THERAPY is a goal-directed process in which the therapist helps the client to improve, maintain, or restore a state of well-being, Using musical experiences and the relationships that develop through them as ‘dynamic forces of change. The therapist helps the client through assessment, treatment, and evaluation procedures. Aspects of the client's well-being that can be addressed through music therapy inchide a wide variety of mental, physical, emotional, and social problems or needs. In some instances, these problems or needs are approached directly through music; in others, they are addressed through the interpersonal relationships that develop becween client, therapist, and/or group. Musi therapy may involve the dient and therapist ina broad range of mu- sical experiences. The main ones are improvising, performing, composing, no- ‘ating, verbalizing, and listening to music. Methods “which employ improvising asa primary therapeutic experience are referred to as “improvise- tional music therapy” Improvisation is a creative activity which commonly occurs in everyday life, in the performing arts (musie, dance, and drama), and in the respective ans therapies. Accordingly, the term “improvise” has many different defini tions. In everyday language, “improvising” means to make something up as one goes along or as Webster put it “to make, invent, or arrange offhand.” In cer- tain situations, ir can also mean to create or fabricate something from whatever resourees are available. In music, “improvising” is defined as “the art of sponta neously creating music (ex tempore) while playing, rather than performing a composition already written” (1:140). in a music therapy context, improvising encompasses elements of all these efinitions. It is inventive, spontaneous, extemporaneous, resourceful, and it involves creating and playing simnultancousl, Itis not always an “art” however, ‘and it does noe always result in “music" per se, Sometimes it is a “process” “which results in very simple “sound forms” Music therapists strive to improvise ‘music of the highest artic quality and beauty, however, they always accept 5 6 Improvisational Models of Masic Therapy the client's improvising at whatever level itis offered, whether consisting of _musical oF sound forms, and regardless of ite artistic oF aesthetic merit. CLINICAL USES Improvisational music therapy has been practiced in diverse clinical set tings, including psychiatric hospitals, residential institutions, medical hoopi- tals, prisons, out-patient programs, clinics, cegular or special schools, community programs, therapy institutes, ¢raining centers, and private prac: tices, Ithas also been used with numerous client populations including individ- uals with mental retardation, learning disabilities, psychiatric disorders, social and behavioral adjustment problems, sensory impairments, physical and orthopedic handicaps, neurological impairments, bodily injury and pain, med- ical iiness, emotional deprivation, social disadvantage, substance addiction, and the infirmities of aging. In addition, improvisational music therapy has been used to promote psychological growth in normal children, adults, and se nior citizens, to improve marital and love relationships, to assist families in conflict, to assist in relaxation and pain reduction, to treat musical problems, and to train and supervise therapy students and professionals. “Models of therapy are usually designed for a specific linial setting, to meet the needs ofa particular client population or group. It is therefore important to know which models are mote appropriate for which population, and what kinds of clients benefit the most from each model. ‘Many of the differences found between models of improvitational therapy are duc to differenecs in the clinical setting ard population for which they were designed. For example, some models are for children, others are for adults. Some are designed for intellectually normal individuals, others are for intellec: tually impaired individuals. Such differences in elinieal application have pro- found effects on the design of a model, inciuding its goals, assessment and ‘treatment procedures, and prerequisites for client participation. Consequently, ‘most models have to be expanded or adapted before using them in a different clinical situation. Fortunately, because most improvisational models emphasize spontaneity and flexibility, they are relatively eaty to adapt or expand. Improvisational music therapy ean be used with individuals on various levels of development and functioning, however, there are some basic prerequisites that ‘ust be considered in screening clients. Each model has ts own prerequisites for participation, depending upon the clinical setting and the population for-which it was designed. The prerequisites fora model are determined by what che dient will be asked to do. Ifthe model involves singing cr playing an instrument, then the client has to have the physical capabilities required. I the model involves discus- sing the improvisation, thei the client has to have the necessary language skills. ‘Thus, an essential consideration in adapting & model for use with another popula tion is its prerequisites for client participation he Fundamentals of Improvisation Therapy 7 A final consideration in applying a model of therapy is what contraindiea- tions there may be, Certain clients have adverse reactions or abreactions to cer tain kinds of sensory stimulation, motor activity, or psychological experience. ‘Thus, each mode! should be analyzed 10 determine whether it engages the client in anythitig that might cause discomfort or harm to him/her. Obviously, the therapist must have also collected the necessary client information before considering any model GOALS Every model of improvisational music therapy hae its own goals for helping addient to achieve a state of well-being. A goal describes the overall direction of the therapist’ efforts and the desiced outcome of thate efforts with respect 0 the client. The direction of the therapists effors may be to increase, decrease, improve, maintain, or restore some aspect ofthe clien’s being. The outcome ray be a specific feeling, attitude, eait, habit, behavior, relation, ar state of being. ‘Three levels of goals can be identified. “General” goals are thone which re- fect the overall cherapeutic aims of the model itself. They usually indicate the ‘broad kinds of therapeutic problems and needs thatthe approach was designed address “Population-spevific” goals are general goals that have been adapted to ad- dress the specific needs of particular client population or diagnostic group, For example, if sel-awarcacss is a general goal of the model, the population- specific goal may be body awareness with one population and emational aware= ness with another. “Individual? goals are those that focus on the specific problems and symp- toms that a client presents, while alo considering th unique strengths and re- sources thatthe client can bring to bear in resolving them. As such, individual goals address those needs which are most relevant c¢ the client's well-being, be they broad and pervasive, or limited and focused. Most often, individual needs identified and prioritized through assessment procedures “Models vary considerably with regard io the precess of formulating goals. Goals may be established at the very beginning of therapy, or they emerge as therapy progresses. In some models tbe client sets his/her own goals, with vary- ing degrees of guidance from the therapist; in others. the client does not paric~ ipave in the formulation of goals. Goals may be established by the therapist independendy, in consultation with parents, guardicns, or other professionals, or asthe result of @ team process. Tmprovisational music therapy generally address the following goal areas: Awareness of self, physically, emotionally, intellectually, and socially; + Awareness of physical environment; 8 Improvisations! Models of Music Therapy Awareness of others, including significant persons inthe fai, peets, ‘and groups; Attention (0 self, others, and physical environments «Perception and discrimination in sensorimotor areas; -Insight about sef, others, and the environment; Selfexpression; Interpersonal communication; + sIntegration of self (sensorimotor experiences, levels of consciousness, parts of self, time, roles, ete); Incerpersonal relationships with significant others, peers, and groups; - Personal and interpersonal freedom, SALIENT FEATURES Each model of improvisational therapy has certain features which make it unique and different from other models. Often, these features are implied in its ‘name. For instance, “Experimental Improvisation Therapy” was given its name because ofits resemblance to an experiment, and because it uses only imm- provisation. “Creative Music Therapy” was given its name to suggest the im- portance of creativity, and to indieate that it includes musical experiences in Addition to improvisation ‘The salient features of a model can also be gleaned from ite specifi focus or ‘emphasis in the clinical situation. For example, a model may be characterized by its clinical uses and goals, its use of individual or group settings, its theoret- cal orientation, or its procedures and techniques for astestment and treatment. Besides name and clinical emphasis, pethaps the most revealing informa. tion about a model of therapy is the originators basic ideas on the role of musi~ ‘al improvisation in therapy. In fact, the reader will diseover that the “salient features’ of a model most often refer to the originators purpose and rationale for using music, and the ways that s/he uses improvisation in particular. Because improvisation is used in a variety of clinical settings, the first issue that arises is whether the model has goals whith arc educational, recreational, or therapeutic in nature. Educational goals are concerned with helping the client acquire knowledge or skills in music or enother related discipline. Recre- ational goals are concemed with improving the clients use of leisure time ‘Therapeutic goals are concerned with helping the client gain insight about him/herself, work through feelings, problemas, and symptoms, make basic ‘changes in his/her personality, and develop mote effective methods of adapta- tion, Of course, these goal areas overlap frequently. Even when all of the goals are therapeutic in nature, models of music therapy may still have basic philosophical diflerences. A core istue atthe root of these differences is whether music is used a’ therapy or in therapy. ‘The Fundamental of Improvisation Turepy 9 ‘When used as therapy, music serves as the primaty stimulus oF response medium for the clien’s therapeutic change, In such approaches, music is used to influence the clien’s body, senses, feelings, thoughts, or behaviors directly. (Or, music i used a8 a context fr the client ro identi}, explore, andor learn the therapeutic options available to him/her. (The former is often called "Music as Stimulus? and the Inter is called “Music as Response"). In music as therapy, ceamphasis is given to the client relating directly to the music, with the therapist aiding the process or relationship when necessary. Hence, the therapist be- comes a guide, Facilitator, or bridge leading the client into therapeutic contact with the music. Intermusical and interpersonal relationships that develop be- tween the therapist and the client serve to stimulate and support intramusical and intrapersonal relationships that develop within the client. ‘When used é therapy, music is not the primary or sole therapeutic agent but rather is used to facilitate therapeutic change through an interpersonal re- lationship, or within another treatment modality, When the interpersonal rela- is the primary stimulus or medium for therapeutic change, emphasis is given tothe client relating tothe therapist, partner, or group, with music aid- ing the processor relationship(s) a8 necessary. When more than one modality is used co stimulate therapeutic change, emphasis is given to the client working through hia/her problem within the modality that i best-sited atthe time, be it music, art, dance, drama, or verbal discussion. Thus, in music éa therapy, ‘music is used as che guide, facilitator, or bridge leading the cient into thera- peutie contact with a person, a modality, or the client him/herself, In these in- stances, relationships that develop between the dient and music serve to stimulate and support intermusical and interperscnal relationships that de- velop with others. ‘The quality and degree of musical participation by the therapist differs in those models using music ar therapy versus in therapy. When sed as therapy, the therapist is likely to take a more active improvizatory role, whereas when ved in therapy, the miusical role ofthe therapist may vary considerably. ‘The extent to which music is used as or fe therapy affects other basic issues. Improvisational music therapy may be used as a primary treatment modality, as an adjunct co another modality, or as part of a multidisciplinary approach. When used as a primary treatment modality, the improvisational therapist takes overall responsibility for identifying and meeting the main therapeutic needs ofthe client. When uted at an adjunctive modality the therapist works towards the accomplishment of goals established by the primary therapist, and ‘employs consistent methods and procedures. In a multicisciplinary approach, the therapist contributes (o a team process of assessment, treatment, and eval ation, and takes whatever role is decided joinly withthe team, Thus, the im- provitational therapist may work independently, wth a cotherapist, under the supervision of another therapist, or as an equal member of a multiisciplinary 10 Imprectzativasl Model of Marie Therapy Another basic issue in defining a model ithe specific rle given to improvi- sation in the therapeutic process. Improvisation can be used as 2 mcans of assessment, treatment, and evaluation. In some models, improvisation is used ‘exclusively, as the main procedure in al three areas. In others, itis used in only ‘one area, or as one of many procedures that may be employed. Hence, impro- visation may be used as a method in itself, o- asa technique within a broader method, When not used exclusively, improvisation may be used in conjunction with a variety of other activities and modalities. When part of a comprehensive ap- proach to music therapy, it js used in conjunction with activities such as listen ing, performing, composing, notating, and verbalizing about music. When used within a creative arts therapies approach, it can be combined with move: ment, dance, mime, drama, story-telling, play, poctry, and art. When used at 4 form of psychotherapy, it may be combined with any of the foregoing arts ‘modslities plus verbal strategies, and various action methods. The amount of verbalizing that takes place within improvisational music therapy is often a ‘major issue in distinguishing between different models and philosophies. “Models of therapy can also be distinguished by the type of musical improvi- sation used. An improvisation may represen or refer to something outside of itself for meaning, or it may represent or refer only to itelf. When the music is ‘organized in reference to something other then itself, i is called a “referential” or “programmatic” improvisation. Examples inchide improvising to a verbal statement, feling, idea, event, situation, person, image, memory, tie, story, drama, or arowotk. When the music is crested and otganized according to strictly musical considerations, without representing or referring to something outside of tel, it sealed a “nonreferential” improvisation. Examples inchide any instrumental or vocal improvisation that does not rely on a program for its ‘musical organization and meaning. Improvisational procedures can also be dlsinguished according to whether they are active and/or receptive. When the improvisation is active, the client Jmaprovises (with or without another person), and listens to his/her own impro- vising as it unfolds, When it is receptive, the client does not improvise but rather listens to another person improvise. A final dstintion that can be found between models ix musical medium, A ‘model may emphasize vocal, instrumental, body-sound, oF movement impro- visations, oF any combination thereof. THEORETICAL ORIENTATIONS Aside from having a fundamental philosophy regarding the nature of music ‘therapy and the role of improvisation, each model of improvisational therapy is rooted in one or moze treatment theories. T:eatment theovies used in music ‘Tre Bunderenial of Improvisation Therapy ut therapy can come from many different disciplines, including psychotherapy, speech therapy, occupational therapy, physical therapy, music education, or other arts therapies, to name a few. ‘The theories may deal with personality, ‘emotional development, communication, mover aeéon, music, or any other area of human functioning. In iraprovisational music therapy, theories of psychotherapy are most often ‘ited asthe bass for weatment. The most frequently cited theories are those of the peychodynamic, existentiaV/humanistc, and gestalt schools of psychather- apy. Theoriete associated with psychodynamic thinking include Sigmund Freud, Anna Freud, Melanie Klein, Margaret Mailer, Cari Jung, Wilhelm Reich, Alexander Lowen, Eric Erion, and Karer Homey. Theorists asso- Gated with existential and humanistic schools include Ludwig Binswanger, ‘Abraham Maslow, Cas] Rogers, Virginia Axline, and Clarke Moustakas, ‘Theorists associated with the Gestal schoo! are Feta Perls and Joseph Zinker. Other theories that have been used are behavioviom, Transactional Analysis, cognitive developmentaliem, Neurolinguistc Programming, Tavistock, and T- Group models. Some models of improvisational therapy Jean heavily on one theory, other are more ecletic and rely upon construets from different theories. When constructs from different theories are used together, they must be com- patible. Not all theories and constructs fit together to make for a consistent model of therapy. ‘The “theoretical orientations? of a model have profound effects on goals, procedures for assessment and evaluation, the dynamics of intervention, and the process o¢ course of treatment. They also determine how improvisation is ‘used and the rationale for emphasizing certain aspects of improvising over thers. Thus, theoretical orientations are responsBle for many of the dif ferences that can be found between improvisational models of music therapy. THERAPIST QUALIFICATIONS. An important factor in effective therapy is how qualified the therapist is 9 ‘use the procedures and techniques involved in a particular clinical model. With regard to improvisational music therapy, the qualification requirements fall into three main areas: musicianship, clinica expertise, and personal qualities. Improvisational models differ according to which area is emphasized more, sawell as what is specifically equiced within each area, Tn fact, each model can be analyzed by rating the celaive significance of musica, clinical, or personal qualifications, and then examining specific competencies or qualities within each area, ‘An examination of therapist qualifications ofter reveals the basic clinical philosophy of « medel. Those models that advocate ‘musician as therapist are philosophically quite diferent from those that advocate therapist 25 musician?” 2 Imprvizatvnal Medel of Masie Therapy ‘Those that require advanced piano competencies are quite different from those that call for instrumental flexibility. Models that emphasize forbearance and patience are quite different from those that advocate authenticity. SESSION FORMAT Improvisational music therapy is provided in individual, dyadic, family, or svoup settings. In individual sessions, the therapist works with the client alone, ‘whereas in dyadic sestions, the therapist works with two clients at once, The dyad may be 2 child and parent, husband and wife, lovers, work partners, or unrelated peers. In family sessions, the therarise works with an entire family as ‘unit, or focuses on one person as s/he relates to parents and siblings. In group sessions, the therapist works with three or mere clients, most often peers, Each model of therapy sets forth criteria for placing clients in the most ap- propriate seiting, Some models use one setting exclusively (e.g., individual or group) becaure it is indigenous to the treatment approach itself. Other models ‘use different settings at different stages of treatment, and still others place

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