Readings On Music Therapy Theory (Bruscia, Kenneth)

READINGS ON
MUSIC THERAPY
THEORY
EDITED BY
KENNETH E. BRUSCIA
READINGS ON
MUSIC THERAPY
THEORY
EDITED BY
KENNETH E. BRUSCIA
Readings in Music Therapy Theory
Edited by
Kenneth E. Bruscia
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CONTRIBUTORS
Brian Abrams, PhD, MT-BC
Fellow of the Association for Music and Imagery
Associate Professor of Music Therapy
Montclair State University
Montclair, NJ: USA
Kenneth Aigen, DA, MT-BC

Nordoff-Robbins Music Therapist
Associate Professor of Music Therapy
Temple University
Philadelphia, PA: USA
Jennifer K. Adrienne, M.A., M.M.T.

Social Studies Teacher
Agora Cyber Charter School
Emmaus, PA, USA
Gary Ansdell, PhD

Nordoff-Robbins Music Therapist
Director of Education
Nordoff-Robbins Music Therapy Center
London, England
Kenneth E. Bruscia, PhD, MT-BC

Professor Emeritus of Music Therapy
Temple University
Philadelphia, PA: USA
Roberto Cicinelli, Dr
Fellow: Association for Music and Imagery. Associated Fellow: RET Institute
Assistant Director and Professor of Integrated Cognitive Psychotherapy
School of Psychotherapy and Integrated Music Therapy
Rome, Italy
Sandi Curtis, PhD, MT-BC, MTA

Professor and Graduate Music Therapy Program Coordinator
Concordia University
Montreal, Quebec, Canada
Jane Edwards, PhD, RMT

Director: Music and Health Research Group
University of Limerick
Republic of Ireland
Susan Gardstrom, PhD, MT-BC
Associate Professor and Director of Music Therapy
University of Dayton
Dayton, OH: USA
Rudy Garred, PhD

Head of department, Early Childhood Education
University of Stavanger
Norway
Kate E. Gfeller, PhD

Russell B. and Florence D. Day Chair of Liberal Arts and Sciences
School of Music: Department of Communication Sciences and Disorders
The University of Iowa
Iowa City, IA: USA
Frances Smith Goldberg, MA, MT-BC

Director and Primary Trainer
Therapeutic Arts Institute
Indianapolis, IN: USA
Susan Hadley, PhD, MT-BC

Professor of Music Therapy
Slipper Rock University
Slippery Rock, PA: USA
James Hiller, PhD, MT-BC

Lecturer and Clinical Supervisor of Music Therapy
University of Dayton
Dayton, OH: USA
Carolyn Kenny, PhD, MT-BC

Professor of Human Development and Indigenous Studies
Antioch University PhD in Leadership and Change
Santa Barbara, CA: USA
Däg Korlin, PhD

General Psychiatrist, Certified Psychotherapist
Fellow and Trainer of Association for Music and Imagery
Stockholm, Sweden
Colin Andrew Lee, PhD, MTA

Professor and Director of Music Therapy
Wilfred Laurier University
Waterloo, Ontario: Canada
John Pellitteri, Ph.D. LCAT
New York State Licensed Psychologist
Associate Professor & Counseling Program Director
Queens College, City University of New York
Flushing, NY: USA
Gabriella Giordanella Perilli, PhD

Primary Trainer and Fellow of the Association for Music and Imagery
Director and Professor of Integrated Cognitive Psychotherapy
School of Psychotherapy and Integrated Music Therapy
Rome, Italy
Randi Rolvsjord, PhD

Associate Professor in Music Therapy
The Grieg Academy, University of Bergen
Bergen, Norway
Even Ruud, PhD,

Professor of Musicology: University of Oslo
Adjunct Professor of Music Therapy: Norwegian Academy
Head: Center for Music and Health
Oslo, Norway
Mary Scovel, MM, MT-BC

Professor Emeritus of Music
Western Michigan University
Kalamazoo, MI: USA
Margaret Sears, MME in Music Therapy

Honorary Life Member
American Association for Music Therapy
Santa Fe, NM: USA
William W. Sears, PhD, RMT (1922–1980)

Professor of Music Therapy
University of Kansas
Lawrence, KS: USA
Chava Sekeles, PhD, RMTI/OTR

The Israeli Association of Creative & Expressive Therapies (ICET)
Initiator, Manager & Teacher (1980-2002) First MT Program in Israel
David Yellin Academic College
Jerusalem, Israel
Sue A. Shuttleworth, EdD, MT-BC

Retired Professor of Music Therapy
Slippery Rock University
Slippery Rock PA: USA
Henk Smeijsters, PhD

Professor Emeritus of the Arts Therapies
KenVaK Research Center for the Arts Therapies
Universities of Applied Sciences Zuyd, Utrecht, ArtEZ and Stenden
Heerlen, The Netherlands
Brynjulf Stige, PhD

Professor of Music Therapy and Head of Research
The Grieg Academy, University of Bergen, and GAMUT
Uni Health Uni Research
Bergen, Norway
Michael H Thaut PhD

Director, RF Unkefer Academy of Neurologic Music Therapy
Professor of Music - Professor of Neuroscience
Colorado State University
Fort Collins, CO: USA
TABLE OF CONTENTS
CONTRIBUTORS
TABLE OF CONTENTS
INTRODUCTION
READING 1
Bruscia, K. (2005). Developing Theory. In B. Wheeler (Ed.) (2005). Music
Therapy Research (Second Edition), pp. 540–551. Gilsum NH: Barcelona
Publishers.
READING 2
Aigen, K. (2005). Philosophical Inquiry. In B. Wheeler (Ed.) (2005). Music
Therapy Research (Second Edition), pp. 526–539. Gilsum NH: Barcelona
Publishers.
READING 3
Abrams, B. (2011). A Relationship-Based Theory of Music Therapy:
Understanding Processes and Goals as Being-Together-Musically.
READING 4
Adrienne, J. (2006). A Feminist Sociology of Professional Issues in Music
Therapy. In S. Hadley (Ed.), Feminist Perspectives in Music Therapy, pp. 41–62.
Gilsum NH: Barcelona Publishers.
READING 5
Aigen, K. (1998). Two Excerpts: Paths of Development in Nordoff-Robbins Music
Therapy. Gilsum NH: Barcelona Publishers.
o The Music (Chapter Fourteen) pp. 249–282.
o The Clinical Process: Work, the Will, Creating a Self (Chapter Fifteen),
pp. 283–298.
o References
READING 6
Aigen, K. (2005). Three Excerpts: Music-Centered Music Therapy. Gilsum NH:
o Origins and Foundations of Music-Centered Music Therapy (Chapter
Three) pp. 47–75.
o Values Central to Musicing in Music-Centered Music Therapy (Chapter
Four) pp. 77–90.
o Rationales, Practices, and Implications of Music-Centered Music
Therapy (Chapter Five), pp. 91–128.
o References
READING 7
Ansdell, G. (2011). Steps Toward an Ecology of Music Therapy: A Guide to
Theoretical Wanderings 1989–2011.
READING 8
Bruscia, K. (1992). Musical Origins: Developmental Foundations of Music
Therapy. Proceedings of the Annual Conference of the Canadian Association for
Music Therapy.
READING 9
Bruscia, K. (1998). Four Excerpts: Defining Music Therapy (Second Edition).
o A Working Definition (Chapter Three), pp. 18–25.
o Types of Music Experiences: The Four Main Methods of Music Therapy
(Chapter Thirteen), pp. 113–125.
o Dynamic Forces (Chapter Fifteen), pp. 131-151.
o Defining Areas and Levels of Practice (Chapter Seventeen), pp. 157–173.
o References
READING 10
Bruscia, K. (2002). Foreword. In B. Stige, Culture-Centered Music Therapy, pp.
xv–xviii. Gilsum NH: Barcelona Publishers.
READING 11
Bruscia, K. (2012). Theoretical Notes on the Practice of Guided Imagery and
Music (GIM).
READING 12
Bruscia, K. (2002). A Psychodynamic Orientation to the Bonny Method. In K.
Bruscia & D. Grocke (Eds.), Guided Imagery and Music: The Bonny Method and
Beyond, pp. 225–243. Gilsum NH: Barcelona Publishers.
READING 13
Bruscia, K. (2012). Helen Bonny’s Foundational Theories of Guided Imagery and
Music (GIM).
READING 14
Curtis, S. (2006). Feminist Music Therapy: Transforming Theory, Transforming
Lives. In S. Hadley (Ed.), Feminist Perspectives in Music Therapy, pp. 227–244.
READING 15
Edwards, J. (2006). A Reflection on the Role of Informants from Feminist Theory
in the Field of Music Therapy. In S. Hadley (Ed.), Feminist Perspectives in Music
Therapy, pp. 367–392. Gilsum NH: Barcelona Publishers.
READING 16
Garred, R. (2006). Four Excerpts: Music as Therapy: A Dialogical Perspective.
o Frame and Picture (Chapter One) pp. 1–38.
o The Music Therapy Triad (Chapter Three) pp. 67–88.
o Relational Knowing (Chapter Four) pp. 102–126.
o Relating to Music (Chapter Five), pp. 127–147.
o References
READING 17
Gfeller, K (2005). Music as Communication. In R. Unkefer & M. Thaut (Eds.),
Music Therapy in the Treatment of Adults with Mental Disorders: Theoretical
Bases and Clinical Interventions, pp. 42–59. Gilsum NH: Barcelona Publishers.
READING 18
Gfleller, K (2005). Music as a Therapeutic Agent: Sociocultural Perspectives. In
R. Unkefer & M. Thaut (Eds.), Music Therapy in the Treatment of Adults with
Mental Disorders: Theoretical Bases and Clinical Interventions, pp. 60–67.
READING 19
Gfeller, K. (2005). The Function of Aesthetic Stimuli in the Therapeutic Process.
In R. Unkefer & M. Thaut (Eds.), Music Therapy in the Treatment of Adults with
Mental Disorders: Theoretical Bases and Clinical Interventions, pp. 68–84.
READING 20
Goldberg, F. (2002). A Holographic Field Theory of the Bonny Method of Guided
Imagery and Music (BMGIM). In K. Bruscia & D. Grocke (Eds.). Guided Imagery
and Music: The Bonny Method and Beyond, pp. 359–377. Gilsum NH: Barcelona
Publishers.
READING 21
Hadley, S. (2012). Embracing Feminism in Music Therapy.
READING 22
Hiller, J. (2012). Implications of Embodied Cognition and Schema Theory for
Discerning Potential Meanings of Improvised Rhythm.
READING 23
Kenny, C. (2006). Seven Excerpts: Music and Life in the Field of Play: An
Anthology. Gilsum NH: Barcelona Publishers.
o The Death-Rebirth Myth as the Healing Agent in Music (Chapter One), pp.
5–9.
o The Mythic Artery (Chapter Two), pp. 10–59.
o Music and Spirit: Acknowledging a Greater Reality (Chapter Three), pp.
60–61.
o The Magic of Music Therapy (Chapter Four), pp. 62–65.
o The Field of Play (Chapter Seven), pp. 80–122.
o Beautifying the World (Chapter Sixteen), pp. 178–181.
o The Earth is our Mother: Reflections on the Ecology of Music Therapy
from a Native Perspective (Chapter Twenty-Five), pp. 236–244.
Kenny, C. (2011, May). Time for Integration: Journey to the Heartland. Paper
presented at the meeting of the Canadian Association for Music Therapy,
Winnipeg, Manitoba, Canada.
READING 24
Körlin, D. (2002). A Neuropsychological Theory of Traumatic Imagery in the
Bonny Method of Guided Imagery and Music (BMGIM). In K. Bruscia & D.
Grocke (Eds.). Guided Imagery and Music: The Bonny Method and Beyond, pp.
379–415. Gilsum NH: Barcelona Publishers.
READING 25
Lee, C. A. (2012). Theoretical Notes on The Architecture of Aesthetic Music
Therapy.
Lee, C. A. (2003). Five Excerpts: The Architecture of Aesthetic Music Therapy.
o Beginnings: On Music (Chapter One), pp. 1–38.
o Tone, Form, and Architecture (Chapter Four), pp. 69–86.
o Clinical Listening (Chapter Five), pp. 87–100.
o Musical Form and Clinical Form (Chapter Nine), pp. 147–158.
o Reflections and New Directions (Chapter Fifteen), pp.233–244.
o References
READING 26
Pellitteri, J. (2012). Theoretical Notes on Emotional Processes in Music Therapy.
Pellitteri, J. (2009). Three Excerpts: Emotional Processes in Music Therapy.
o Emotions and Music in Personality Development (Chapter Six), pp.
119–144.
o The Isomorphism of Music and Emotion (Chapter Eight), pp. 172–
189.
o Emotional Intelligence and Music Therapy (Chapter Nine), pp.
190–209.
o References
READING 27
Perilli, G., & Cicinelli, R. (2012). From Tacit Knowledge to Narrative Re-
Description Through Music Psychotherapy: A Perspective from Second-
Generation Cognitive Science.
READING 28
Rolvsjord, R. (2006). Gender Politics in Music Therapy Discourse. In S. Hadley
(Ed.), Feminist Perspectives in Music Therapy, pp. 311–327. Gilsum NH:
READING 29
Rolvsjord, R. (2010). Four Excerpts: Resource Oriented Music Therapy in
Mental Health Care. Gilsum NH: Barcelona Publishers.
o Music Therapy and the Politics of Mental Health Care (Chapter One),
pp. 18–37.
o Paths Toward A Conceptualization of Therapy (Chapter Two), pp. 38–
58.
o Paths Toward A Concept of Music (Chapter Three), pp. 59–72.
o Toward A Concept of Resource-Oriented Music Therapy (Chapter
Four), pp. 73–88.
o References
READING 30
Ruud, E. (2012). Overview of My Writings.
Ruud, E. (1978). One Excerpt: Music Therapy and its Relationship to Current
Treatment Theories. Gilsum NH: Barcelona Publishers.
o The Humanistic/Existential Trend in Psychology (Chapter Four)
pp. 43–60.
Ruud, E. (1998). Two Excerpts: Music Therapy: Improvisation, Communication,
and Culture. Gilsum NH: Barcelona Publishers.
o The Individual as Improviser: The Concept of the Individual in
Music Therapy (Chapter Two), pp. 19–30.
o Music and Identity (Chapter Three), pp. 31–48.
Ruud, E. (2010). Two Excerpts: Music Therapy: A Perspective from the
Humanities. Gilsum NH: Barcelona Publishers.
o Musical Meaning in Music Therapy (Chapter Four), pp. 54–72.
o Musicking as Self-Care (Chapter Ten), pp. 157–179.
Combined References for Ruud Writings
READING 31
Scovel, M., & Gardstrom, S. (2005). Music Therapy within the Context of
Psychotherapeutic Models. In R. Unkefer & M. Thaut (Eds.), Music Therapy in
the Treatment of Adults with Mental Disorders: Theoretical Bases and Clinical
Interventions, pp. 117–132. Gilsum NH: Barcelona Publishers.
READING 32
Sears. M. (Ed.) (2007). Three Excerpts: Music—The Therapeutic Edge: Readings
from William W. Sears. Gilsum NH: Barcelona Publishers.
o Processes in Music Therapy, pp. 1–15.
o A Re-Vision and Expansion of Processes in Music Therapy, pp.
16–41.
o Time, The Servant of Music, pp. 125–148.
READING 33
Sekeles, C. (1996). Two Excerpts: Music: Motion and Emotion: The
Developmental-Integrative Model in Music Therapy. Gilsum NH: Barcelona
Publishers.
o The roots of music therapy in traditional healing rituals
(Chapter One), pp. 1–24.
o Notes
o The Developmental-Integrative Model in Music Therapy
(Chapter Two), pp. 25–62.
o Notes
o References
READING 34
Shuttleworth, S. (2006). Viewing Music Therapy Assessment through a Feminist
Therapy Lens. In S. Hadley (Ed.), Feminist Perspectives in Music Therapy, pp.
READING 35
Smeijsters, H. (2005). Three Excerpts: Sounding the Self: Analogy in
Improvisational Music Therapy. Gilsum NH: Barcelona Publishers.
o Analogy: A Core Category in the Writings of Music Therapists
(Chapter Five), pp. 55–64.
o Forms of Feeling and Forms of Perception (Chapter Six), pp. 65–
86.
o Defining and Re-defining the Core Category of Analogy (Chapter
Seven), pp. 87–110.
o References
Smeijsters, H. (2012). Analogy and Metaphor in Music Therapy: Theory and
Practice. (This reading is a version of an article first published in the Nordic
Journal of Music Therapy, (2012), Volume 21. Available online through
http:///www/tandfonline.com/rnjm. Reprinted by permission of Routledge and
Taylor & Francis Journals.
READING 36
Stige, B. (2012). Notes on Culture-Centered Music Therapy: Evolution,
Emerging Practices, and Embodied Meanings.
Stige, B. (2002). Four Edited Excerpts (2012): Culture-Centered Music Therapy.
o Why Culture (Chapter One), pp. 13–46.
o The Power of Musicking (Chapter Three), pp. 79–110.
o Redefining Music Therapy (Chapter Seven), pp. 179–206.
o A Model of the Music Therapy Process (Chapter Eight), 207–230.
o References
o Notes
READING 37
Thaut, M. (2005). Neuropsychological Processes in Music Perception and their
Relevance in Music Therapy. In R. Unkefer & M. Thaut (Eds.), Music Therapy in
the Treatment of Adults with Mental Disorders: Theoretical Bases and Clinical
Interventions, pp. 2–32. Gilsum NH: Barcelona Publishers.
READING 38
Thaut, M. (2005). Toward a Cognition-Affect Model in Neuropsychiatric Music
Therapy. In R. Unkefer & M. Thaut (Eds.), Music Therapy in the Treatment of
Adults with Mental Disorders: Theoretical Bases and Clinical Interventions, pp.
INTRODUCTION
Kenneth E. Bruscia
The notion that music has healing or therapeutic powers is certainly not new in
the history of ideas. In fact, questions about what makes music healing, and what
aspects of the universe can be healed by music have fascinated thinkers, musicians, and
healers in most civilizations past. In a critical review of historical evidence on the
powers attributed to music in earlier cultures, West (2000) points out how diverse the
theories have been. He gives several examples: In pre-scientific societies, musical
instruments made from a person’s bones were believed to contain the person’s spirit,
and as a result, these instruments had magical powers that enabled the shaman to
access and influence the spirit world. In contrast, Pythagoras proposed that the
mathematical relationships inherent in every musical tone provided a rationale for using
the vibrations of tones to harmonize the soul, as well as the universe. Damon, an
associate of Socrates, claimed that each mode and rhythm used in Greek music had its
own ethos, and that this link made it possible to influence the ethical qualities of the
listener’s soul, as well as emotions. This in turn led to the notion that the state should
regulate which musical modes the population should be allowed to hear, especially
during childhood, so as to ensure public morality and propriety. Equally diverse theories
on the powers of music can be found in historical writings from Africa, India, China, and
the Middle East, attesting further to the widespread and long-lasting hypothesis that
somehow music and health are integrally related.
As these theories have evolved through the centuries, the profession responsible
for applying them has shifted from shaman and priest, to philosopher and
mathematician, to physician, psychiatrist, musician, music teacher, and various
combinations thereof. It was not until the middle of the 20th century that the profession
of music therapy was formed for the sole purpose of advancing knowledge and practice
related to the use of music for therapeutic or healing purposes.
Gaston (1968), often called the father of music therapy, divided the first twenty-
five years of the profession in the USA into three stages, the first emphasizing the role of
music over the role of the therapist, the second emphasizing the therapist’s relationship
with the client over the music, and the third trying to find a balance between the two.
Gaston’s observation of the past was quite a prophetic one, as these three emphases
have continued to define and divide orientations to music therapy practice since his
time. Gaston also recognized that, given these differences in orientations, the music
therapy profession would need a strong foundation, built upon the interdependence of
practice, research, and theory. He said: “Without practice and research, theory is
impotent and unproven; without theory and research, practice is blind; and without
theory and practice, research is inapplicable” (p. 408).
Gaston’s book (1968) was one of the earliest attempts to review practice, theory,
and research in music therapy in the USA. It offered the first two modern theories that
are still quoted often today. Gaston’s theory articulated the significance of music in
individual development (psychology), health (medicine), society (sociology), culture
(anthropology), and religion (theology). Sears’ theory (1968) concentrated on how
music provides opportunities for experiencing structured behavior, organized self-
expression, and relationships with other.
Since these two book chapters were published, theory has evolved in music
therapy through various kinds of writings, illustrating the interdependence of practice,
theory, and research. Some writings are fully developed theories, some are clinical
articles that present theoretical constructs or treatment orientations for practice, and
others are research articles that build upon or advance theory. In a recent survey of
literature in the English language, the author identified over 150 such writings. Other
than a brief overview of some of these writings (Bruscia, 2005), these theoretical
contributions to the field have not been examined and compared on any large scale, and
despite their significance for practice and research, there is no single source where the
ideas put forth in these theories have been presented for scholarly or practical scrutiny.
The purpose of this book is to provide a panoramic view of music therapy theory,
and in so doing, to entice students and practitioners in the field to seek out new or
different ways of thinking about music therapy. Toward this end, the book has been
designed as a large and diverse compendium of original writings on music therapy
theory—a compendium of different voices, presenting general and specialized theories,
both basic and advanced conceptualizations of music therapy, in many different
orientations and writing styles, on various topics, geared to students and professionals,
at different levels and with different interests and specializations.
The writings have been drawn from books published by Barcelona with the intent
of providing a representative and comprehensive sample of the most significant music
therapy theories, written by major authors of theory in the field. To supplement the
collection, authors of theoretical writings not published by Barcelona were also invited
to contribute something new (e.g., Abrams, Ansdell, Bruscia, Hadley, Hiller, Kenny,
Perilli & Cicinelli, Pavlicevic, and Smeijsters).
The actual selection of writings to be included was a joint effort of the editor and
the authors. The editor selected which authors would be included in the volume, and the
authors selected which writings or book chapters they wanted to present. Then based on
that selection, each author had an opportunity to write an introduction or addendum to
the writings selected. Thus, each “reading” may include one or more “writings” of a
particular author, some new and some previously published. And to the extent possible,
each “reading” is devoted to one main topic or theoretical stream. Thus, the same
author may have one reading that contains several writings on the same topic, or the
author may have several readings that cover different topics.
After much thought about the pros and cons of different ways of organizing and
sequencing the readings, the editor decided to present them by author, and to simply
sequence them alphabetically. To organize them in any other way (e.g., by type of
theory, philosophical foundations, epistemology, or treatment theory) would have
required the editor either: 1) to interpret and categorize each theory accordingly, or 2) to
create and impose a meta-theory of his own that would accommodate the various
theoretical points of view presented. Another concern was that if presented by any of
these organizing principles, the reader may simply seek out those readings that are most
consistent with their way of thinking, and then ignore those that are not. While this is
certainly one way any book of readings can be used, it is clearly not the intent of
presenting such a diverse collection of theoretical readings. The aim of this book of
readings is to open rather than close minds about what music therapy is and what it can
be.
Ideally the reader will approach this book the way a musician approaches a new
collection of songs in different styles and idioms, by different composers and lyricists.
Having the songs appear in alphabetical order does not present a problem, as the most
enjoyable way to explore the collection is to scan through and actually sight-read many
different songs, and then select the ones for further study. So the recommended
approach for delving into this book is to first look at the Table of Contents, then scan
and spot-read the book, and then decide what to read or study more carefully. And if
that is not possible or expedient, readers can use the “find” or “search” function on the
e-reader to locate a particular theoretical author, orientation, theory, or construct. This
function serves as an index.
Readings 1 and 2 of the book serve as an introduction to the entire series of
readings. Reading 1 by the editor provides an introduction to theory and theorizing in
music therapy and offers a brief overview of existing theories in the field, many of which
are included in the book. Reading 2 by Aigen outlines the basic questions and
procedures of philosophical inquiry, which in terms of the present book, can give the
reader a basic framework for reading, understanding, and evaluating theory.
Most of the theoretical writings included here were originally published in the
last 12 years, however a few date back to the 1990s, and some go back even further. It is
important to note that some of the writings appearing in recently published anthologies
were actually published much earlier. The original publication date of the writing is
noteworthy, not because newer theoretical ideas are better than older ones, but because
the original date gives a historical context for what the author was envisioning at the
time. In fact, most of the older writings presented in this volume provide evidence of
how visionary many of the pioneering theorists in music therapy have been.
The question that inevitably arises is how might the reader evaluate these
theoretical writings? Which are the most insightful or visionary? One must start with
the notion that a theory is a “way of thinking” that the theorist “constructs” about what
we do or what we know. As such, it may or may not be a statement of fact, it may or may
not be completely true, and it may or may not be verifiable. Thus, it should not be
surprising to discover that theorists in this book disagree with one another, and that one
theory or parts thereof may contradict another theory or parts thereof. This is exactly as
it should be. A book of theoretical readings is bound to contain disagreements and
contradictions. It is the very nature of theorizing.
So then, what criteria might one use to evaluate a theory? The reader may want to
consider the following:
1) Coherence: How well organized is the theory? Are the ideas sequenced in an
understandable way? Are parts of the theory logically related to one another?
Is there a hierarchy of ideas?
2) Clarity: Are basic premises of the theory stated in the simplest possible way,
and are all important terms and concepts clearly defined? How well-written is
the theory?
3) Comprehensiveness: Does the theory deal thoroughly with the topic or
question under scrutiny? Does it address all issues related to the main topic or
question?
4) Relevance: Does the theory provide pertinent and relevant answers to the
most important topics or questions under scrutiny?
5) Usefulness: Does the theory provide any new and valuable insights? Can the
theory guide one in decision-making? Does this “way of thinking” actually
facilitate practice and research?
A final recommendation: it is hoped that the reader can approach each writing
and author with an open mind—that is, without assuming that there is only one “right”
way of thinking about music therapy. These writings demonstrate that our evolution as a
discipline shows otherwise. As a health profession, music therapy cannot embrace only
one way of thinking, it must take into serious consideration all ways of thinking that will
enable us to best meet the needs of our clients through music. Our theorizing must
therefore reflect not how we music therapists prefer to think but rather how our clients
need us to think.
References
Bruscia, K. (2005). Developing Theory. In B. Wheeler (Ed.), Music Therapy Research

(Second Edition), pp. 54—551. Gilsum NH: Barcelona Publishers.
Gaston, E. (Ed.) (1968). Music in Therapy. New York NY: MacMillan Publishing.
West, M. (2000). Music Therapy in Antiquity. In P. Horden (Ed.), Music as Medicine

(pp. 51–68). Burlington, VT: Ashgate Publishing.
READINGS ON
MUSIC THERAPY
THEORY
READING 1
Taken from: Wheeler, B. (Ed.) (2005). Music Therapy Research (Second

Edition), pp. 540–541. Gilsum NH: Barcelona Publishers.
Developing Theory
Kenneth E. Bruscia
A theory is way of thinking about what we do or what we know. It usually consists of

propositions, theorems, or constructs that give the theorist’s conceptualization about phenomena
within a particular domain. A proposition or theorem is a fundamental assertion that the theorist
makes about the topic, whereas a construct is usually a single-standing idea or metaphor that
the theorist uses to describe a particular aspect of the topic. In a complete, formal theory, the
theorist generally presents a set of propositions and theorems that are logically related to one
another so that, when considered together, they provide an integrated and comprehensive way of
thinking about the target phenomena. In less formal theoretical writings, the theorist usually
presents a construct or two or informally discusses theoretical ideas and relationships in a more
limited way.
A theory is always created. The propositions or constructs are always constructed by the
theorist based on how that theorist views what we do or what we know. Thus, a theory may be
both descriptive and interpretive, empirical and speculative, depending upon how much the
theorist adds his or her own perspective.
The purposes of theory may be: (a) to define or delimit practice or knowledge so as to gain
greater clarity on boundaries; (b) to describe practice or knowledge in a way that changes
perspectives on them; (c) to explicate patterns or structures that underpin practice or knowledge,
so as to gain new insights; (d) to identify cause-effect relationships in practice or knowledge in a
way that allows prediction and control of the phenomenon; or (d) to evaluate practice or
knowledge so as to establish priorities.
A theory is always concerned with phenomena within a particular domain. In music
therapy, the theories may be concerned with the disciplinary domain (music therapy assessment,
treatment, and evaluation), the professional domain (phenomena related to music therapists,
their training, credentialing, employment, characteristics, socio-economic and cultural aspects of
music therapy, and so forth), and the foundational domain (phenomena pertaining to music,
health, therapy, other health professions). This chapter focuses only on disciplinary theories.
The Place of Theory

Theory has a central place in music therapy—it shapes and is shaped by practice and research.
Regardless of whether the theory has been clearly articulated by the therapist or theorist, theory
provides a foundational structure for all clinical work. Conversely, practice is often the basis
upon which a theory is developed. Similarly, research may be the foundation for theory, or it may
be the result of theory. Theory in music therapy is also closely related to practice and knowledge
in other disciplines. Often ideas from other disciplines are imported into music therapy and then
expanded to accommodate the unique character of music therapy. For example, Ansdell (1997)
proposed that the latest developments in musicology have important ramifications for music
therapists, and at the same time, the new musicologists could learn much from music therapists.
Similarly, importing the constructs of transference and countertransference from psychology has
been influential in shaping how music therapists describe the client-music and therapist-music
relationships in music psychotherapy (Bruscia, 1998b), and conversely, the myriad ways that
music therapists have expanded these constructs to include musical phenomena have very
important implications for psychology.
One might say that all the disciplines related to music therapy provide a way of thinking
about practice and knowledge in music therapy, and conversely, that music therapy provides the
Developing Theory 541
same for these disciplines. Thus, for example, psychology provides a way of thinking about and
knowing human beings, and this epistemology can be useful to how music therapists understand
what they do and what they want to know. At the same time, music therapy has its own way of
thinking and knowing about human beings, or its own epistemology, that can be useful to
psychology. The same can be said about music, medicine, the social sciences, education,
communications, humanities, the other arts, and all of their subdisciplines. In short, every
discipline has its own epistemology, its own culture and focus of knowing, and this epistemology
can be fruitfully applied to theory in other disciplines.
Theories in music therapy are also closely related to philosophy. Philosophy lays the
foundation for all forms of knowledge.1 It is the discipline of disciplines. Every theory, regardless
of domain or discipline, has its deepest roots in an entire philosophy of life, knowledge, reason,
values, and ethics. Philosophy deals with fundamental questions about what exists, how we come
to know what is and what is not, how we go about determining what is right and wrong, and
what has value and beauty. It is not concerned with particularized areas of knowledge unless
they relate in some way to these fundamental questions. In contrast, a theory deals with a
particular topic, domain, or discipline like physics, mathematics, or music.
Of course, philosophy and theory also have many similarities. They both have the same
aim: understanding. In that, they relate to practice and research in the same way. Philosophy
and theory focus on what practice and knowledge mean rather than on what constitutes effective
action (practice), and on what is known or unknown (research). Philosophy and theory are also
alike in that they both involve thinking activities, such as reflection, reasoning, criticism,
speculation, and intuition. In a sense, philosophizing is theorizing, and theorizing is
philosophizing.
Every theory has a metatheory. A metatheory is a theory of theories. For example, this
chapter is a metatheory because it presents the author’s constructions of what theories are, what
they do, and so forth; and because there as many conceptions of theory as there are theorists,
there is no one truth about the nature of theory. Often, a metatheory is a philosophical or
theoretical perspective that underpins or overlays a theory. For example, every theory makes
certain philosophical assumptions about the nature of existence, knowledge, and human values.
Thus, this deeper layer of a theory is a metatheory or a reflection upon the theory. Similarly, if a
theory in one discipline, say physics, is applied to a theory in another discipline such as music
therapy, a metatheory is being developed. Or if an epistemology of another discipline, such as
psychology, is applied to music therapy, it yields what might be called a psychological metatheory
on a music therapy theory.
Methods of Developing Theory

One can create a theory in many different ways, depending upon the objective. The following
sections describe some of the main methods of developing theory. Each method can be used alone;
however, often they are used in combination. Thus, the examples given below may belong in more
than one category.
Explication
A theory is developed by identifying, differentiating, defining, classifying, organizing, and
naming concepts, practices, and terms found in music therapy. The focus may be on what
clinicians, researchers, and theorists do, how they conceptualize what they do, and what
terminology they use to describe their work. Explication requires a clearly delimited focus on a
particular aspect of music therapy and what is already known or done in relation to it. As
suggested by the name for this method, the theorist makes explicit what is implicit; or the
theorist describes what is, or what is done, based on his or her perceptions and perspectives.
An example of this method of theory building is the inventory of 64 clinical techniques
used in improvisational music therapy (Bruscia, 1987, pp. 533–558). After surveying several
models of improvisational music therapy, the author identified, compared, and named all
1
For additional information on philosophy and philosophical inquiry, see Chapter 39, Philosophical
Inquiry.
542 Developing Theory
techniques used by the originators of these models. For purposes of this inventory, a technique
was defined as “an operation or interaction initiated by the therapist to elicit and immediate
response from the client, or to shape his/her immediate experience” (p. 533). The techniques were
classified according to: (a) their focus (what aspect of the client was addressed); (b) their objective
(what the therapist was trying to do with regard to the focus); and (c) their implementation (how
the therapist went about achieving the objective). The techniques were then named and put into
the following categories: empathy, structuring, intimacy, elicitation, redirection, procedural,
emotional exploration, referential, and discussion.
Other examples include Aigen (1998), Bruscia (1995, 1998a, 2002a), Maranto (1993,
1991), and Wheeler (1983).
Integration
A theory is developed by relating concepts or practices in music therapy to those in another field.
Most often this is done by importing theory, research, and practice from an outside field into
music therapy, then using the joint processes of accommodation and assimilation. In the
accommodation process, phenomena in music therapy are fit into theories or constructs imported
from other fields. In the process, some aspect of music therapy is expanded, limited, revised, or
modified to accommodate the other field. In the assimilation process, theories or constructs
outside the field are modified to fit into music therapy. Here the external model is expanded,
limited, revised, or modified to accommodate music therapy phenomena. Theories that integrate
music therapy with other fields can vary greatly according to the relative emphasis given to
accommodation and assimilation; however, in all cases, the outcome is a mutual fertilization of
both fields. Ideas in music therapy are fertilized and expanded by the other field, and ideas in the
other field are fertilized and expanded by music therapy.
Integration theories, then, are intrinsically interdisciplinary—they invariably deal with
topics of shared interest among different disciplines, and through the process of accommodation
and assimilation, they invariably integrate different disciplinary perspectives on the same topic.
It is not surprising, then, that integration theories are most prominent in those fields of
knowledge that are interdisciplinary by nature—like music therapy.
In surveying the literature, one finds that integration theories in music therapy cover a
variety of topics and are drawn from many different but related disciplines. A distinction can be
made between integration theories that apply the broad perspective of another discipline to
music therapy and those that borrow specific constructs from another discipline around a topic of
common interest. A few of the many integration theories that draw upon the broad perspective of
another discipline includes Hadsell’s (1974) theory of music therapy based on sociology, Eagle’s
(1991) theory of music therapy based on physics, and Thaut’s (2000) scientific theory of music
therapy based on the integrated perspectives of the psychology, physiology, and neurology of
music, along with experimental aesthetics.
In addition to these more broadly based theories are those that borrow specific ideas
about a shared topic. Curiously, these theories seem to cluster around four main interdisciplinary
topics: health and pathology, human development, therapy, and music.
Health and Pathology. Music therapy theories that import ideas about health and
pathology usually offer a model of practice based on ideas in other fields about what constitutes
health or pathology. For example, the present author drew upon ideas about health from
Antonovsky (1987), a medical sociologist, and Wilber (1995), a philosopher, to develop a definition
of health for specific use in music therapy. As a result, health was defined as “the process of
becoming one’s fullest potential for individual and ecological wholeness” (Bruscia, 1998a, p. 84),
and the fundamental aim of music therapy was defined as promoting this process. There are also
integration theories that import knowledge about a specific pathology to further inform music
therapy practice. For example, models of music therapy practice have been formulated based on
outside theories on learning disability (Gfeller, 1994), anorexia (Smeijsters, 1996), pain (Eagle &
Harsh, 1988), and problems in sensory integration (James, 1984), to name a few.
Human Development. Ideas about human development have been imported into
music therapy from many sources, including the work of Piaget (Lehtonen, 1993, 1995; Rider,
1977; Robb, 1999), Erikson (Robb), Freud (Lehtonen, 1993), Wilber (Rugenstein, 1996), Winnicott
(Barclay, 1987; Nolan, 1989; Summer, 1992; Tyler, 1998), Stern (Lehtonen, 1995; Wigram,
Pedersen, & Bonde, 2002), and Basch-Kahre (Erkkilä, 1997; Lehtonen, 1995). In these theories,
isomorphic aspects of nonmusical and musical development are identified, and information about
how the human being develops in essentially nonmusical domains is used as a template for
understanding developmental phenomena in music therapy.
Proceeding from the opposite direction, Briggs (1991) and Bruscia (1991) began with
research on stages of musical development and linked them to stages of psychological
development as outlined by Piaget, Freud, Mahler, and Wilber. These links then were used to
build a foundation for the developmental assessment, treatment, and evaluation of clients in
music therapy. Similarly, Loewy (1995) identified the musical stages of speech development and
related these to simultaneous stages of development in cognitive, physical, and emotional
domains.
Nature of Therapy. Ideas about the nature of therapy have been imported into music
therapy from many different schools of clinical practice (Ruud, 1980; Wheeler, 1981), such as
psychodynamic theory (Priestley, 1994; Bruscia, 1998b, 2002b), Jungian theory (Priestley, 1987;
Ward, 2002), and humanistic theory (Bonny, 2002; Broucek, 1987), to name a few.
Notice that the theories in this category start from the question: What is the nature of
therapy that leads us to think that it can be accomplished effectively through music? One might
say that the main purpose is to identify isomorphic aspects between therapy and music, starting
from what defines or characterizes the therapy.
Nature of Music. In the next category, the question about what is isomorphic between
therapy and music is posed from the opposite direction than in the previous section; that is,
rather than starting from what defines or characterizes therapy and applying it to music, here
the starting point is what defines or characterizes music. Specifically, what is the nature of music
that leads us to think that it can be used therapeutically? Here the theorist looks at music with
therapy in mind.
The music therapy literature abounds in theoretical papers that identify the therapeutic
potentials of music and then describe how these potentials can be or have been utilized within
the music therapy process. Ideas about what makes music therapeutic emanate from many
disciplines and particularly those hybrid disciplines that combine music with another field, such
as psychology of music, sociology of music, anthropology of music, biology of music, neurology of
music, physics of music (acoustics), and philosophy of music. Examples include the following
theoretical writings:
· In a series of articles, Noy (1966, 1967) reviewed the psychoanalytic literature on
music to identify issues in formulating a psychodynamic understanding of music—
what it is, what properties it has, and what it does. Implicit in presenting such a
review was the need to clarify the psychological and psychotherapeutic
foundations of music therapy.
· Aigen (1991a) examined shamanic conceptions of music, and used these
conceptions to define wellness and to articulate the role of music and music
therapy in promoting and maintaining health.
· Deschênes (1995) examined the symbolic and semantic components of music and
then related these to music therapy.
· Bruscia (1998a) defined and classified clinical practices in music therapy
according to six models of music experience. The models are based on the extent to
which the therapist focuses the client’s experience on the (a) objective, (b)
subjective, (c) collective, (d) universal, (e) aesthetic, and/or (f) transpersonal
properties of music.
· Weisethaunet (1999) evaluated theoretical ideas about the nature of improvisation
in terms of their relevance to clinical practice in music therapy.
· Weyman (2000) considered multi-faceted aspects of the experience of improvising,
and implicitly suggested its therapeutic values.
· Grinde (2000) used a biological, evolutionary perspective to understand how music
serves as a form of human adaptation, which in turn implies its therapeutic value.
· Trevarthen and Malloch (2000) identified and contextualized the therapeutic
properties of music in terms of the therapeutic needs of human beings.
· Daveson and Skewes (2002) examined theoretical ideas about the nature of
rhythm in terms of how it is used and conceptualized in music therapy.
· Marshman (2003) examined Jung’s theory of artistic creation and its inherent
aesthetic implications for music and, based on this, offered a theoretical
explanation for why music is so powerful as a therapy.
Philosophical Analysis
A theory is developed by relating fundamental concerns of philosophy (ontology, epistemology,
logic, ethics, aesthetics) to music therapy practice, theory, or research. There are two approaches,
one that starts from philosophy and one that starts from music therapy.
The first approach is to import a philosophical theory or construct into music therapy and
then apply it to a particular theory, practice, or research. In most cases, the aim is to enlarge
upon or expand existing notions in music therapy. For example, Salas (1990) drew upon the
philosophical notions of Gregory Bateson regarding aesthetic experience, and within that
experience, the meaning of beauty. She then proposed that aesthetic experience, and the beauty
that is derived within it, is an affirmation of ontological meaning, that is, the very meaning of
one’s existence. The value of music therapy, then, is that by providing aesthetic experiences
through music, clients are able to explore and find beauty and meaning in their lives. Mereni
(1996, 1997) sketched out the African philosophy of music and how music relates to the African
causal theory of ailments. The close relationship between music and medicine and healing in
Africa, and the rationale for this relationship, was then compared to modern music therapy in
Western cultures. Other philosophical theories and constructs that have been applied to music
therapy include: Dewey’s aesthetic theory (Aigen, 1995), Heidegger’s concept of lifeworld (Nagler,
1995), Buber’s I-Thou ontology (Garred, 1996), Wittgenstein’s language games (Stige, 2002), and
Wilber’s spectrum model (Bonde, 2001).
Notice there is some overlap between theories built upon philosophical analysis of the
nature of music and earlier integration theories based on the nature of music. The main
distinction is whether the nature of music is being analyzed philosophically or according to
another discipline, such as sociology or psychology.
The second approach is to analyze existing music therapy theory, research, or practice so
as to identify or further clarify its philosophical underpinnings. For example, Aigen (1991b)
uncovered and evaluated the philosophical assumptions underlying the predominant view of
music therapy at the time and provided arguments for a change in paradigm. Hadley (1999)
analyzed the philosophical premises underlying Creative Music Therapy and Analytical Music
Therapy and compared them with regard to what constitutes health versus pathology and how
the relational dynamics of therapy are configured.
Empirical Analysis
A theory is developed based on the analysis of research data of some kind. The data may exist
already, or they may be gathered through any form of empirical research. This method varies
according to whether the research used to build the theory is quantitative or qualitative.
In quantitative research, an empirical theory is an attempt to evaluate or explain a body
of existing research findings, so that deductions can be made from them. A method of increasing
relevance to music therapy is meta-analysis (see Chapter 23 of this book). Typically, a meta-
analysis in music therapy shows whether the effect of music or music therapy found in many
different studies can be considered significant. This is done by statistically analyzing the size of
the effect found in all of the studies examined, taking into consideration differences in dependent
and independent variables. For example, Standley (1986, 1992, 1996, 2000; Standley & Whipple,
2003) has used meta-analytic procedures to examine the effectiveness of music and music
therapy in medical and dental treatment. Other meta-analyses have been conducted by Koger,
Chapin, and Brotons (1999), Silverman (2003), and Dileo and Bradt (in press).
In qualitative research, an empirical theory is an attempt to conceptualize a phenomenon
based on some form of systematic observation, inquiry, or research investigation. Unlike in
quantitative research where empirical theory comes from previous research, empirical theory in
qualitative research comes from data specifically gathered for the purpose of theory building. A
common method used is grounded theory, as developed by Strauss and Corbin (1990), and as
described in Chapter 29 of this book. In this method, the theory is developed incrementally, while
gathering and analyzing the data. Initial theoretical formulations are constantly compared with
incoming data, and then meticulously elaborated, modified, and reinterpreted until the theory is
fully grounded in the data. Data sources may include interviews, field observations, and various
kinds of arts works or documents. An example is Amir’s (1996a) study of meaningful moments in
music therapy.
Another method of theory building through empirical analysis employs the RepGrid
technique, a computerized program for analyzing the constructs of individuals (see Chapter 37 of
this book). An example in music therapy is the study by Abrams (2002), who interviewed
practitioners of Guided Imagery and Music (GIM) about their own GIM experiences as clients,
and based on their construct systems, developed a theory on the nature of transpersonal
experiences.
Reflective Synthesis
A theory is developed by reflecting on one’s own experiences with a phenomenon, relating these
reflections to existing ideas or perspectives of other theorists, looking at research, and intuitively
synthesizing all these sources of insight into an original theory or vision. The theory may start
from any of the sources.
Gaston (1968) and Sears (1968) were probably the first Americans to present general
theories of music therapy, that is, ones that might account for most, if not all, music therapy
practices. Gaston based his theory on an interdisciplinary analysis of music and what contributes
to its universality. Bringing in biology, genetics, anthropology, and the behavioral sciences, he
identified several basic premises regarding the therapeutic potential of music. Sears’ (1968)
theory delved into what he called the processes of music therapy, focusing on three kinds of
experiences that music affords the client: experience within structure, experience with self-
organization, and experience in relating to others.
Carolyn Kenny has devoted much of her career to the development of music therapy
theory. In her first book, The Mythic Artery, Kenny (1982) built connections between music,
myth, and nature, and then showed how the death-rebirth cycle is indigenous to them all. In her
1985 article, Kenny expanded and further organized her ideas by exploring the relevance of
systems theory and proposing that the whole system is made up of different fields within fields
and spaces within the fields, where the quest for wholeness (healing) unfolds and is reenacted
through their dynamic interplay. These notions then provide the foundation for examining how
music is a model of the whole system, as well as a field and space within it. The Field of Play
(1989) can be seen as the culmination of many of Kenny’s previous ideas, as well as the beginning
of a newly organized direction for her theorizing. So far, she had identified the regenerative
experience as a core process in music and nature, with wholeness and healing as the ultimate
quest, and through her lens of systems theory, she had begun to identify many of the
interdependent elements, fields, and spaces that interact in the ongoing process of reconnecting
to this quest. Now, she was to organize these ideas into a formal theory and find a language that
was closer to her understanding of the music therapy process. Briefly, Kenny’s field of play
theory proposed that there are seven fields essential to music therapy.
1. The aesthetic: A field or environment containing the conditions of beauty,
including the human being. This is the loving and supportive field that resources
all others.
2. The musical space: The contained space that arises out of the aesthetic when
therapist and client relate to one another through music.
3. The field of play: The open field that arises out of the aesthetic field and the
musical space, and that expands into a field of experimentation, play, and
modeling. The field of play contains four interactive fields, as in the following
points.
4. Ritual: Any repeatable form created through the conditions present at the time.
5. A particular state of consciousness: A field of relaxation, concentration, and
playfulness.
6. Power: The field of energy that motivates receptivity and induces action
7. Creative process: The process and field that results from the interplay and
overlaps of the previous fields.
These fields are environments that have varying conditions, each of which operates in an
organic ecology according to certain principles. When the fields overlap, or when elements or
conditions interact, a relationship emerges and a new field is created. In 1996, Kenny introduced
a new element in her theory by identifying various qualities of the seven fields. The qualities are
helpful in recognizing and distinguishing the fields, without operationally defining or limiting
them.
There are many more theories built through reflective synthesis. Examples include Amir
(1996b), Bruscia (2000), Goldberg (2002), and Perilli (2002).
The Nature of Theory

Theories vary in nature according to several dimensions. The first dimension is its objective or
aim. A theory that aims at explaining cause-effect relationships in practice or research is quite
different from a theory that aims at enlarging the way practice or research is construed. Thus,
theories may vary according to how explanatory and how constructive they are, with the former
emanating from positivistic paradigms, and the latter from nonpositivistic ones. Along with this,
explanatory theories focus on what is or what was in order to predict what will be; whereas
constructive theories focus on how the past and present can be re-visioned, in order to create yet
unknown possibilities for the future. Thus, the objective or aim of a theory provides three
different but related continua for describing a theory: (a) from explanatory to constructive aims,
(b) from positivistic to nonpositivistic paradigms, and (c) from predictive versus visionary foci.
The second important dimension of theory is method. As discussed above, there are many
different ways of creating a theory, and each theorist finds his or her own way of using and
combining these methods, depending upon his or her own metatheory and epistemology. Method
has an important impact on the nature of the theory created because it determines the kind of
foundation that is laid for the theory. Thus, those who want a factual foundation for theory will
gravitate toward theories based on empirical analysis, whereas those who want reason as the
foundation for theory will gravitate toward philosophical analysis and those who want intuition
combined with reason and experience will gravitate toward reflective synthesis, and so forth. In
short, the method of theory building establishes its trustworthiness in combination with the
epistemology of the person reading or using the theory. In the end, the creator of a theory and the
user of a theory have to be on the same wavelength with regard to both metatheory and
epistemology. Essentially, the method of developing a theory influences the extent to which the
theory has objective or subjective foundations.
The third important dimension is outcome. If the theory is useful in guiding actions or
decision-making, it can be described as practical. The practical theory helps people to do research
or to do practice. If the theory is useful in understanding something or if it can help to gain
insight about something, without immediately obvious implications for what to do, the theory can
be described as more reflective. Thus, theories may be described along a continuum from
practical to reflective.
The fourth important dimension is form, which involves completeness and coherence. A
complete theory is one that has as many propositions as needed to deal with the all of the most
important aspects of the target phenomenon, whereas an incomplete theory has one or more
constructs that deal with only a few aspects. For example, consider the difference between a
theory that covers the entire relationship between developmental theory and music therapy, and
one that looks only at a particular period of development (0–2 years) or a particular
developmental phenomenon, such as transitional objects. Thus, theories vary according to
whether they are complete in their treatment of a topic, or whether they consist of only a few
constructs.
Theories that have the most coherence describe the relationships between all parts and
levels of the theory, for example propositions and corollaries, whereas theories with less
coherence relate only some, if any, part of the theory. Thus, theories vary along a continuum
ranging from less to more coherent.
The fifth dimension is disciplinary scope, that is, whether the theory was created to deal
with the entire discipline or to only a part or dimension of it. For example, the theories of Sears
(1968), Kenny (1989), and Amir (1996b) were meant to apply to all of music therapy and are thus
more general in disciplinary scope. In contrast, the theories of Perilli (2002), Goldberg (2002), and
Körlin (2002) were intended to apply to only Guided Imagery and Music, just as theories by
Aigen (1996, 1998) and Robbins and Forinash (1991) were intended to apply to only Nordoff-
Robbins Music Therapy. In these cases, the theory is specific to a particular approach within
music therapy but not all of the discipline (which of course does not mean that the theories have
no implications or value for the entire discipline). A theory can also be specific to a particular
orientation. For example, a developmental theory or a behavioral theory of music therapy is
specific in that it applies to only one orientation within the field and has less applicability than a
theory that is orientation free. Thus, theories may be general or specific, depending upon
whether their scope covers larger or smaller areas of music therapy, as differentiated by both
method and clinical orientation.
Notice that disciplinary scope is different from completeness. A theory examining the
significance of metaphor in GIM, for example, may be quite complete in its coverage of the topic;
however, it cannot be considered a general theory because it is not applicable to all practices
within the discipline of music therapy. In this case, then, the theory is complete but specific.
Conversely, the iso principle is a construct rather than a complete theory, but since it was meant
to apply to the entire discipline, it would be considered incomplete as a theory but general in its
scope.
Closely linked to the generality and completeness of a theory is the dimension of
relevance. Here the question is how well the theory covers the most significant aspects of the
target phenomenon or domain, regardless of whether the theory is general or specific in scope
and regardless of how completely developed the theory is. Is the theory pertinent? Does it deal
with the topics and issues that are essential to consider in understanding or explaining the
phenomenon or domain? For example, compare the relevance of a theory on the role of metaphors
in GIM with a theory on the role of contingent reinforcement in GIM. Both theories are specific in
scope and both could be equally complete, but obviously, the theory on metaphor is more relevant
to the intrinsic nature of GIM than a theory on reinforcement. Thus, in addition to generality and
completeness, theories vary along a continuum from less to more relevant.
The problem with relevance is that it is a matter of opinion. What is relevant to one
person may not be so to another. This is usually not so much of a problem in determining the
relevance of specific theories where the phenomenon or domain are clearly defined and delimited
by the theorist. In these kinds of theories, the boundaries are more carefully delineated, and this
makes relevance easier to evaluate. In general theories, however, this is not the case. The reason
is that it is more difficult to draw the boundaries for an entire discipline. One person’s idea of
what the full scope of music therapy is may be different from another person’s. Thus, for someone
who defines music therapy as only this method, or only this approach, or only this orientation,
relevance is limited to only his or her definition of the discipline. Thus, people with narrower
views of music therapy will tend to see more theories as irrelevant than relevant, and those with
broader views will tend to see more theories as relevant than irrelevant.
Certainly, a major factor in sketching out the full scope of music therapy is its
interdisciplinary nature. As soon as there are two disciplines to balance or integrate, differences
of opinion arise. If, for example, we simply say that music therapy is an amalgam of music
disciplines and therapy disciplines, at least two polarities are already implicit. One camp will say
that music therapy is a music-centered discipline, and therefore, for theory to be relevant, it must
be music-centered; while the other camp will say that it is therapy-centered, and that for theory
to be relevant, it must be therapy-centered. And then, there is what lies in the middle of these
two polarities—the true integration and equal balance of music disciplines and therapy
disciplines to form a new discipline that has its own unique identity, which is intrinsically
different from either the music or therapy side or any of their subsidiary disciplines. For this
camp, a theory is relevant only if it is centered on music therapy itself. A metaphor may be
helpful. A cake is not flour-centered or egg-centered, based on relative proportions used; it is a
cake—a unique combination of ingredients that undergoes a metamorphosis that leads to a new
entity altogether. This in no way undermines the importance of understanding the flour or the
egg; it only emphasizes that understanding either the flour or the egg or both is not sufficient for
understanding the cake.
For purposes of our discussion, then, theories can be music-centered, therapy-centered, or
music therapy-centered. The music-centered theory gives greater emphasis to understanding the
nature of music and its role in therapy; the therapy-centered theory gives greater emphasis to
understanding the nature of therapy and how music can contribute to it; a music therapy-
centered theory gives greater emphasis to how music therapy itself works—how both music and
therapist work equally and in tandem, how the client-music and the client-therapist
relationships are used equally and integratively, how music and therapy processes unfold
together, and so forth.
This entire discussion leads us to the last dimension that defines the nature of any
theory: whether it is indigenous or imported. Based on the above distinctions and definitions, an
imported theory is a theory that emanates from or gives precedence to music (and any of its
subdisciplines) or therapy (and any of its subdisciplines). An imported theory is one of the two
polarities: it is either music-centered or therapy-centered. A music-centered theory tends to
describe and explain music therapy in musical terms; a therapy-centered theory tends to describe
or explain music therapy in therapy terms. Both are imported views, with neither being more
indigenous to music therapy than the other. Imported theories make sense to people in outside
disciplines, because they often use their language.
An indigenous theory is music therapy-centered. It deals with phenomena as they appear
in music therapy settings, as they unfold through music therapy intervention, as they change
through music therapy processes, as they make sense within a music therapy context, as they are
perceived and languaged by music therapists, and as they can be understood by other music
therapists. Indigenous theories describe and explain what music therapists do and think through
their theory, research, and practice. Because of this, indigenous theories make sense to people
inside the field because they have first-hand knowledge of the experiences being described. Thus,
the final dimension to be considered in understanding the nature of any theory is the extent to
which the information is imported from music or therapy disciplines or is indigenous to music
therapy.
It is hoped that these descriptions of the various dimensions of theory, and the
distinctions that have been made, will enable readers to be more discerning when reading a
theory and evaluating its integrity or usefulness.
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READING 2
Taken from: Wheeler, B. (Ed.) (2005). Music Therapy Research (Second
Edition), pp. 526–539. Gilsum NH: Barcelona Publishers.
Philosophical Inquiry
Kenneth Aigen
The fierce controversies between contending philosophies disturb not a single

leaf and cast not a troubling shadow over the world as we live in it as
cognitive beings. As we shall see over and over again. . . philosophical
differences seem at once momentous and negligible.
Danto1
What comes to mind when you hear the word philosophy? Perhaps you have some of the
following images: dusty medieval texts being pored over by socially isolated beings known as
philosophers; disputes over seemingly inconsequential questions such as whether a tree falling in
the woods makes a sound if no one is there to hear it; Plato’s account of Socrates’ passion about
virtue, truth, and beauty, a passion so great that he was willing to die for it; the famous dictum of
Descartes, Cogito Ergo Sum, I think therefore I am; or, a discipline which has been described by
philosophers themselves as both the queen of all sciences and completely irrelevant to science
and the acquisition of human knowledge. In short, whether you consider philosophy to be
essential to a morally, spiritually, and intellectually meaningful life or irrelevant to such a life,
you will find yourself with ample company.
Why does the discipline of philosophy engender such differences of opinion regarding its
nature? One answer can be seen in Arthur Danto’s (1989) observation that “the issues of
philosophy must be settled on some basis other than that of possible cognitions” (p. 13). This
means that the traditional problems of philosophy cannot be solved by a particular discovery or
experience. If the issue is solvable in this manner, then the question is not a truly philosophical
one but rightly belongs to another discipline, such as history or science.
For example, the implementation of certain medical procedures—such as abortion or the
sustaining of life through mechanical means—can bring up questions that are philosophical in
nature. In the former procedure, the question relates to when life begins; the latter stimulates us
to consider when life ends. We have much of the relevant scientific knowledge needed to answer
such questions. That is, we can ascertain things like the viability of the fetus outside of the
mother and the brain activity of the comatose individual, yet these facts do not answer the
questions of when human life begins and when it ceases. In principle, no increase in our
knowledge of physiology will provide an answer to the ethical dilemmas posed by these two
medical situations. Instead, we are required to make value judgments in answering them. Hence,
these questions of utmost importance in contemporary society are inherently philosophical, and
philosophical thinking can be useful in helping us to identify the problems and to clarify the
ethical dilemmas they represent.
I am a strong believer in the importance and usefulness of having a philosophical
understanding of things, even in an applied discipline such as music therapy. Philosophy
provides the foundation for all forms of knowledge. Using the metaphor of a tree, Carolyn Kenny
(1998) suggests that philosophy provides the roots, theory the trunk, method the branches, and
data the leaves, which eventually return to the ground, nourishing and influencing the roots.
Even among philosophers, there is no agreement on exactly what philosophy is. In fact,
any definition of philosophy involves taking a particular position in philosophy. Similarly, there
is no general agreement among philosophers on the nature of philosophical method. However,
the notion that “in philosophy speculation is controlled by critical discussion” (Passmore, 1967, p.
218) provides a good starting point, not because it provides a definition but because it reminds us
1 This quotation is from Danto (1989), p. xv.

Philosophical Inquiry 527
that all forms of critical inquiry—including scientific research—grew out of philosophy. Thus,
becoming acquainted with philosophical modes of thinking and areas of inquiry can provide a
foundation for intellectual explorations of all types.
Although it may not be possible to define philosophy, it nonetheless remains important to
be able to provide a working, pragmatic definition of philosophical inquiry for the purpose of the
present book, which is to demonstrate how different types of systematic inquiry can be applied to
music therapy. Philosophical inquiry involves the use of philosophical procedures to “analyze and
contextualize theory, research, and practice within the history of ideas” (K. E. Bruscia, personal
communication, March 4, 2003).2
Jorgensen (1992) distinguishes three characteristic procedures that philosophers follow
in accomplishing their aims: clarifying terms, exposing and evaluating underlying assumptions of
other philosophical and theoretical stances, and relating ideas as a systematic theory and
showing their connection to other conceptual and theoretical systems. I would add a fourth
characteristic: using argument as a primary mode of inquiry and a presentational device. The
contexts in which philosophizing arises include presenting a philosophy; evaluating and
comparing theories, theoretical systems, and comprehensive philosophical systems of thought;
and addressing typically philosophical questions.
Characteristic Procedures of Philosophy

Clarifying Terms
Verbal language has connotative and denotative meanings. The former term refers to the
implications and images stimulated by a word and the latter refers to its literal referent. While
connotative uses are relevant for poetry, literature, and certain types of qualitative research, the
activity of philosophy requires the precision of denotative meanings. Unless one can be precise
about the meanings of words and the ideas they express, it is “difficult to compare ideas and
systems of thought because one is uncertain of what is being compared” (Jorgensen, 1992, p. 91).
Clarifying terms is of primary importance for two reasons: First, although our everyday use of
the language of ideas tends to be good enough for most practical problems we encounter, it is
inadequate when applied to philosophical problems. Second, some problems in philosophy result
from an imprecise or improper use of language.
A music therapy study where the clarification of terms was the central purpose and
procedure is Defining Music Therapy (2nd Edition) by Kenneth Bruscia (1998). The text is devoted
to clarifying the term music therapy, defining areas and levels of music therapy, and
distinguishing among the various types of clinical practice. The author provides a rationale for
the practical benefits of addressing definitional concerns:
Every definition sets boundaries for the field. Having such boundaries is
crucial, for without them, it is impossible to know which types of clients and
problems are best served by music therapy, which goals and methods are
legitimately part of clinical practice, which topics are relevant for theory and
research, and what kinds of ethical standards must be upheld. Furthermore,
without these boundaries, it is impossible to design curricula and field
training programs for preparing music therapists, and to establish
meaningful requirements for earning credentials in the field. (p. 3)
2 Editor’s note: In Chapter 40, Developing Theory, Bruscia provides further information as he clarifies
the relationship of theories in music therapy to philosophy. He says:
Theories in music therapy are also closely related to philosophy. Philosophy lays the
foundation for all forms of knowledge. It is the discipline of disciplines. Every theory,
regardless of domain or discipline, has its deepest roots in an entire philosophy of life,
knowledge, reason, values, and ethics. Philosophy deals with fundamental questions about
what exists, how we come to know what is and what is not, how we go about determining
what is right and wrong, and what has value and beauty. It is not concerned with
particularized areas of knowledge unless they relate in some way to these fundamental
questions. In contrast, a theory deals with a particular topic, or domain, or discipline like
physics, or mathematics, or music. (p. 541)
528 Philosophical Inquiry
At first glance, it may not be apparent why creating definitions is an example of

philosophizing. Is not the applying of labels to entities a mechanical operation undertaken in all
uses of language? In actuality, as Bruscia (1998) explains, “definitions are always more than
factual statements or objective descriptions,” something that is particularly true when the term
being explained has no obvious logical or formal boundary. In studying definitions of music
therapy drawn from all over the world, Bruscia observed how each definition reflected different
“philosophies about music, therapy, health, illness, and even life” (p. 3). When we realize how
much variation there is in the terms we encounter in our professional activities—and that these
differences reflect of deeply held worldviews, value systems, and philosophies—it gives us a
newfound respect for the various definitions we encounter and the work that goes into crafting
them.
Exposing and Evaluating Underlying Assumptions

Understanding this type of philosophical inquiry is to understand why philosophy is relevant to
the concrete world of human actions. As Jorgensen (1992) avers:
Assumptions predicate and underlie action. They consist of beliefs held to be
true, taken for granted and acted on. . . . The philosopher makes explicit that
which otherwise may remain implicit, and clarifies aspects that are prior to
and deeper than the actions to which they give rise.” (p. 93)
Because all human actions stem from the implementation of an implicit philosophy or
belief system, it is necessary to articulate and understand the philosophy in order to understand
the actions. Critical and analytical thinking are used in drawing inferences regarding belief
systems:
Critical thinking involves the capacity to judge the relative worth of actions
and ideas. Analytical thinking entails the ability to take a situation or an
idea apart. . . . One separates its constituent elements, makes judgments
about the significance of those elements, and speculates about the various
causes that might have led to a particular thing. (Jorgensen, 1992, p. 93)
Once underlying beliefs are made apparent, the music therapist can choose a treatment,
training, or research approach based on the values and beliefs that he or she would like to
implement.
An important study by Even Ruud (1980) fits into this category of inquiry. He observed
that clinical theories in music therapy have traditionally been built upon theories drawn from
psychology. Hence, the focus of his study was to
clarify the relation between music therapy and different approaches within the
field of mental health, to see how different procedures in music therapy are
related to general trends in treatment thought, and to see how these trends
correspond to various philosophical orientations. (p. i)
This was done by considering the primary psychological orientations—psychoanalytic,
behavioral, and humanistic-existential—and the music therapy theories derived from each,
examining their underlying foundations, and comparing them to one another. The clinical
procedures, goals, and rationales of various music therapists are compared to those typical of the
various psychological orientations in order to draw parallels between them.
So, for example, Ruud (1980) describes psychoanalytic theory as including the following
characteristics: (a) increased insight, (b) the resolution of disabling conflicts, (c) increased self-
acceptance, (d) more efficient techniques for coping with problems, and (e) the general
strengthening of the ego structure of the patient (pp. 21–22). Ruud then describes and analyzes
the techniques of music therapists Wright and Priestley (1972) to show their relationship to
psychoanalytic thought:
The patient who has been avoiding unconscious conflicts and painful
emotions is now allowed to express these conflicts and emotions. . . .
Following this emotional expression (catharsis), the body is relaxed and it is
easier for the patient to examine the causes of the anger and to find out other
possible ways of dealing with the situation. This . . . could be considered as a
general strengthening of the ego structure of the patient along lines of

adequacy and security. (Ruud, pp. 22–23)
In another type of analysis, Freudian thought is revealed as deterministic as a
consequence of its biological emphasis. This characteristic is considered by Ruud (1980) to place
limitations on psychoanalytic investigations that look at humans in relation to their own selves
and to others; it only accounts well for humans in relation to their biological environments. Ruud
completes the analysis by saying that the overreliance on determinism leads to a restricted view
of the human ego that is incompatible with music therapy practice. Yet, it is observed, modifying
this view too much means leaving the familiar frame of reference of psychoanalysis and
establishing a new one (Ruud, p. 25).
Relating Ideas as Systematic Theory

A body of philosophic thought should be coherent, consistent, systematically organized, and have
explanatory value. It connects to other systems of thought as well as to human practices and
beliefs. Evidence used in assessing the value of philosophies includes “logical argument, appeals
to authority, precedent, example, or analogy” (Jorgensen, 1992, p. 94). Jorgensen notes that
philosophy can be differentiated from science because in science “empirical data constitute the
most persuasive evidence. In the philosophical worldview, however, other nonscientific ways of
knowing may be equally or more persuasive” (p. 94). As a result of this epistemological tolerance,
philosophy can connect the “various ways of knowing, be they scientific, artistic, religious,
philosophical, or otherwise” (p. 94).
Kenny (1985) presents a philosophy in her introduction of systems theory as consisting of
a holistic methodology, a view of nature as unified, and a humanistic perspective on the
responsibilities of science. She uses this philosophy to create a larger context in which to
understand music and healing, thus expanding the consciousness of the reader regarding what
music therapy is and what it can be. In fact, she presents an entire world view based on music
and connects this to processes that support health and human development:
Music is no longer merely a metaphor to help us describe a phenomenon.
Music, according to many physicists and systems theorists, is the way things
are. . . . Music is what happens when things are created, when things become
what they are, and particularly when things change. Music helps us to come
home to the natural rhythms and patterns of our being, so that we can
change. (p. 5)
She then connects this view to the clinical reality of the music therapist through understanding
musical improvisation as a form of ritual that allows access to experiences that facilitate growth
and transformation.
Using Argument as a Primary Mode of Inquiry

Of all the characteristics of philosophical inquiry, the use of argument is quite possibly the most
important. This is because philosophical thinking appeals to our capacity for deductive,
inductive, and retroductive reasoning. Our ability to evaluate philosophical claims is based on the
evidence and chain of reasoning provided by the philosopher. In this sense, argument performs
the same function in philosophy as method does in quantitative research and an inquiry audit
does in qualitative research.
An argument consists of a premise whose truth value is assumed, a series of assertions
deduced or inferred by this premise, and conclusions whose truth value is determined by how
well the rules of logic were followed throughout the chain of the argument. In philosophic
writing, a good argument will consider alternative points of view to the one promoted by the
author and offer various forms of evidence to dispute them, often in the form of counterexamples.
It is common in philosophy for authors to sketch out the form of the argument before
delving deeply into it. This prepares the readers for what follows, and they are in a better
position to follow the argument. Because this type of analysis can be complex, it is helpful to see
it in its most bare form before plunging in. There is also a rhetorical function to encountering the
argument initially, meeting it again in a more developed form, and reviewing it one final time in
conclusion. We can compare this to the aesthetic function of a sonata form with an exposition,
development, and recapitulation of a theme. Both the aesthetic and the rhetorical forms have
evolved because they help us to better assimilate information.
In order to understand how philosophical arguments are constructed we will examine in
detail a study by the present author (Aigen, 1991) in the final section of this chapter.
Contexts in Which Philosophizing Arises

Presenting a Philosophy
Philosophy was discussed earlier as a coherent system of beliefs to guide human action.
Philosophical systems can be presented directly by their authors, or they can be inferred from the
observation and gathering of data.
As an example of the former approach, Barbara Hesser (1985) presents a philosophy for
music therapy training, a rationale for having a philosophy, and a means for its promulgation.3
She believes that the skills of a music therapist cannot be taught in an ethical vacuum, and that
the attitudes held by instructors, whether implicit or explicit, will be transmitted to students and
internalized as part of their training. She says: “The essential attitudes communicated to
students during training are fundamental to the effectiveness of any course work or clinical
training. These attitudes must be considered the core of the program” (p. 67). There is a variety of
essential components to her philosophy: the process of becoming a music therapist is an in-depth,
lifelong process; academic training should contain opportunities for the student’s personal
growth; participating in shared music-making is an important component of the teaching
community; the training should be noncompetitive; and, each student’s unique skills and
interests should be emphasized. Because the training involves self-exploration on the part of
students, establishing a safe and supportive atmosphere is essential.
The entire community—students, academic staff, and internship and fieldwork
supervisors—“works together to be a reflection of the basic attitudes and values which are
fundamental” to clinical work (p. 67). The student-teacher relationship characterizing the
program parallels the client-therapist relationship in that members are considered to be learning
from one another. Hence, the treatment philosophy taught is intimately tied to the educational
procedures and human relationships comprising the program. Education, therapy, and a model
for human relationships in general are integrated within this philosophy.
Evaluating and Comparing Theories, Theoretical Systems, and

Comprehensive Philosophical Systems of Thought
This type of endeavor can have a number of different rationales: (a) facilitating communication
between individuals from different theoretical traditions, (b) evaluating the theoretical
development of a discipline, (c) stimulating the development of sophisticated theory, (d)
remediating practical problems, and (e) organizing disparate theoretical elements into a unified
whole.
When we consider the diversity of theoretical orientations within the music therapy
profession and between music therapy and related professions, it becomes apparent that
philosophic efforts at comparing different systems can translate concepts and facilitate
communication, both among music therapists and between music therapists and other
professionals. This enables adherents of one tradition to understand the ideas of others and to
3 Editor’s note: Since Hesser’s philosophy of music therapy relates to the discipline of music therapy, it
is an illustration of a theory rather than a philosophy, using Bruscia’s distinction between a
philosophy and a theory. In this chapter, however, Aigen uses it as an example of a philosophy. Thus,
this appears to be an illustration of Aigen’s statement in this chapter, “Even among philosophers,
there is no agreement on exactly what philosophy is. In fact, any definition of philosophy involves
taking a particular position in philosophy. Similarly, there is no general agreement among
philosophers on the nature of philosophical method” (p. 526).
become less bound to one way of looking at things. This interchange of ideas stimulates the
theoretical development of music therapy, since theoretical constructs that are relevant across
different traditions tend to be more sophisticated and useful because their application is that
much broader.
Moreover, this type of analysis can also show if the type of translation to which I am
referring is even possible to do in an integral way. For example, there are traditions of both
psychoanalytic and transpersonal orientations in music therapy. A possible philosophical inquiry
would be to examine the theories from these traditions to see if they share similar underlying
mechanisms or constructs, even though their surface languages may be quite different from one
another. A positive finding would facilitate the convergence of theory, something that is
characteristic of more developed disciplines. On the other hand, such an analysis might just as
easily have the opposite result, showing that the underlying premises from the different systems
are so different that it is impossible to translate concepts from one orientation to the other
without sacrificing something essential.
An historically important publication of this type in music therapy is by William Sears
(1968), as it illustrates the function of organizing disparate theoretical elements into a unified
whole. His strategy was to organize, classify, and describe processes in music therapy so that a
complete system would emerge that would enhance the scientific status of music therapy. Sears‘s
intent was to express his system in a language which was theoretically neutral regarding
particular personality theories or theories of psychotherapy, so that it could be applied by
individuals working within a variety of orientations.
This system was presented in terms of three realms of experience in music: experience
within structure, experience in self-organization, and experience in relating to others. As an
example of experience within structure, consider how music “demands time-ordered behavior”
and “permits ability-ordered behavior” (Sears, 1968, p. 33). As experience in self-organization,
“music provides for self-expression” and “for the enhancement of pride in self” (p. 33). Last, as
experience in relating to others, music “provides means by which self-expression is socially
acceptable” (p. 33) and “enhances verbal and nonverbal social interaction and communication” (p.
34).
Sears saw his own work as constituting a working theory that summarized in “one
system the best knowledge and thought presently available concerning the function of music in
therapy” (p. 44). Interestingly, the tone he strikes appears to straddle different dichotomies on
contemporary theoretical issues in music therapy. For example, he discusses his preference for
expressing his system free of connections to any one school of thought, and yet frequently refers
to music therapy as a behavioral science, seemingly not realizing the theoretical commitment
that this implies. Also, at the beginning of his article, Sears avers that he is taking this strategy
specifically not “to claim any special status for music therapy” (p. 31), yet he concludes that
“processes in music therapy take place by uniquely involving the individual” (p. 44) in the three
realms of experience mentioned above. In this light, Sears can be seen as an important
transitional figure, someone whose writings reflected the underlying contradictions inherent in
pioneering theoretical developments indigenous to music therapy while remaining within
existing systems of thought.
Addressing Typically Philosophical Questions

Jorgensen divides the questions created into the subdisciplines of philosophy: ontology, the study
of the nature of existence; epistemology, the study of knowledge; axiology, or matters of value;
ethics; and aesthetics, the study of beauty and art. Music therapists who discuss questions such
as the following are focusing on the typically philosophic: What is music therapy and what
conditions must be present for a given activity to be a bona fide example of music therapy
practice? What constitutes ethical music therapy practice? And, are aesthetic considerations
relevant to clinical practice?
Ontological Issues. Ontological questions deal with ultimate issues of existence and
essence. The following types of questions are considered to be ontological ones: What is the
nature of reality? What, if anything, exists independently of human consciousness? Is the
ultimate reality material? What is space and time? What is the nature of a cause-effect
relationship?
In music therapy, ontological concerns can be formulated more specifically: What is

music? Where does the impetus for harmonic or melodic motion originate? What is music
therapy? What is the nature of the world in which the music therapist practices? We will look at
two studies in this vein that illustrate contrasting approaches.
First is Charles Eagle’s (1991) “Steps to a Theory of Quantum Therapy,” in which he uses
the procedure of relating his ideas as a systematized theory in relation to other theoretical
systems. In this case, he presents a conception of clinical music therapy practice based upon four
principles from quantum physics. His premise is that the universe is based upon quantum
principles, and that music therapists who consider these aspects of their working reality will be
more effective clinicians. Eagle’s view is that quantum physics represents the highest, most well-
verified achievement of modern science, and that music therapists should follow the lead of
physiologists and psychologists in formulating theories based on these principles.
Here are two examples: For Eagle, the concept of complementarity, which holds that
matter exhibits properties of both particle and wave phenomena and cannot be comprehensively
described by either one, manifests in music therapy in the duality of process and product. Also,
an implication of Heisenberg’s uncertainty principle is that the observer unavoidably affects
what is observed through the act of observation. The duality of observer and observed breaks
down here and the traditional scientific notion of objective observation is thereby challenged.
Eagle takes this to mean that “what we know about our universe is due to the observations made
by us; we participate in creating our observed universes” (p. 58). For the music therapist, the
connection is that we change a client merely by our presence in a therapy session. We do not
merely observe our clinical reality, but we help create it through our presence in it.
While Eagle’s purpose was to increase the awareness of music therapists through
presenting an alternative way of considering music therapy, David Aldridge (1989) pursues a
contrasting strategy. In “Music as Identity: A Phenomenological Comparison of the Organization
of Music and the Self,” he seeks to establish a conception of the individual person and of
biological health based upon music. Aldridge sees a strong connection between form in music and
form in biology:
By regarding the identity of a person as a musical form that is continually
being composed in the world, a surface appears on which to project our
understanding of a person as a physiological and psychological whole being.
The thrust of this endeavor is to view people as “symphonic” rather than
“mechanic.” (p. 1)
Aldridge reverses the traditional notion of basing the contribution of music to health on
conceptions gleaned from a medical frame of reference, instead seeking to establish a sense of
individual identity and health from considerations of the nature of music. This also contrasts
with Eagle, who begins with conceptions from another discipline and attempts to develop music
therapy correlates. Instead, Aldridge begins with musical phenomena and seeks to build the
bridge in the other direction.
Aldridge establishes the connection between music and individual identity when he
observes that “the perception of music requires an holistic strategy where the play of patterned
frequencies is recognized within a matrix of time. People may be described in similar terms as
beings in the world who are patterned frequencies in time” (p. 7). His perspective is that through
improvised music we perceive a direct expression of a person that requires no verbal translation
in order to be grasped. Because “musical form and biological form are isomorphic” (p. 7),
improvised music can reveal the individual’s state of health, and well-being can be directly
assessed.
Epistemological Issues. Epistemological issues relate to questions of what it is
possible to know. Do we have knowledge of the external world or only of the contents of our own
minds? Can we gain knowledge with certainty or just probability? What does it mean to know
that something is true? Are there different types of knowledge? These are traditional
epistemological questions. Although not commonly addressed in the music therapy literature, we
can conceive of some important questions for music therapy in this area. One concern of the
study discussed in the final section of the present chapter (Aigen, 1991) is to support the
articulation of an epistemology, or theory of knowledge, for music therapy. The rationale is as
follows:
Musical interaction is a unique way of gaining information about ourselves,
other people, and our physical, social, and psychological environment.
Through music therapy techniques like clinical improvisation, a therapist can

engage in a musical interaction with a client and help to create music which
facilitates a fundamental transformation in the inner being of the client. In
some way, the inner world of the client becomes manifest to the therapist;
clinical results render this judgment undeniable. Rather than [force] the
knowledge gained in this manner into categories derived from purely verbal
modes of thought. . . we [should] allow the musically obtained knowledge to
suggest its own epistemology. (p. 374)
The thrust of this argument is that, because musical thought and interaction may be
fundamentally different from verbal modes of thought, music therapists should create a theory of
knowledge based upon what is suggested by what they experience as clinicians.
Clive Robbins and Michele Forinash (1991) utilize this strategy in presenting a
multilevel theory of time that is stimulated by and illustrated through experiences in music
therapy. They present four levels of time experience: physical time or clock time, characterized by
sameness and fixity; growth time, “perceived in the process of growth or development of any
living organism as it occurs over a period of time” (p. 51) and characterized by stability; emotional
time, “the personal time of feeling” (p. 53), characterized by impulsiveness and mobility; and
creative time or now time, “the moment of intuition” (p. 53), characterized by spontaneity and
newness. These concepts are offered to music therapists in order to provide them with concepts
within which they can understand their clinical experiences. The authors believe that “a clinician
can gain security from a supportive conceptual perspective, one that provides a realistic
framework for the artistic processes. . . and that can differentiate and elucidate the ongoing
phenomena of creative music therapy” (p. 56). Thus the various concepts of time provide an
orientation point for clinicians in therapy and also open new possibilities to consider how time is
experienced in the clinical as well as the nonclinical milieu.
Axiological Issues. Axiological issues relate to questions of value: What is the role of
music therapy in society? Who should receive services? What level or type of work is most
appropriate for various populations? Should the type of music therapy—rehabilitative,
psychotherapeutic, medical, or educational—offered to an individual be determined by that
individual’s condition or inherent need or by the specific training of the treating music therapist?
What type of music therapy is more appropriate for what type of client and is this even the right
way of approaching the question? Indeed, what is the purpose and ultimate significance of music
therapy for the lives of individuals as well as for society as whole?
In a study of this type, “Beyond Healing to ‘Whole-ing’: A Voice for the
Deinstitutionalization of Music Therapy,” Marcia Broucek (1987) argues for an expanded concept
of the nature and role of music therapy practice. While traditional concepts of music therapy
have regarded it as an institutional service for individuals in exacerbated states of need, Broucek
would like to see music therapy deinstitutionalized and its benefits offered to the population at
large and to music therapists themselves.
Further, she offers the concept of the life spirit and articulates a conception of clients and
types of therapeutic work in terms of it:
Our tasks as therapists vary in light of our clients’ life positions. For persons
who are against life, our challenge is to revive the life spirit, to tap into each
person’s health and restore belief in the value of life. For clients who are
indifferent to life, our challenge is to sustain the life spirit, to feed and
encourage a suppressed or dormant belief in the creative potential of life. For
those who embrace life, our challenge is to nurture the life spirit, to offer
avenues for expansion, learning, and growth. (p. 51)
For each of these three categories of individuals, Broucek offers four types of personal
need that music therapy can specifically address. She also challenges music therapists to
determine where they stand on this continuum and to decide how their view of the profession
relates to it. This translates to the question: “What roles do we see for music therapy in the larger
world’s struggle for life?” (p. 58). This type of value-laden question challenges music therapists to
expand their conception of the profession and its possibilities for application outside the realm of
pathology and disability.
Ethical Issues. In traditional philosophy, ethics is a prime area of concern. It deals
with the following types of questions: What is good? What is moral? How should human beings
relate to one another? What do we owe each other, if anything? What constitutes moral actions,
and how are they determined? Who is entitled to make such judgments?
In music therapy, it has fallen primarily to professional associations to establish
standards for ethical practice; indeed, establishing such standards for the protection of clients is
one of the prime motivations for professionals to organize. In addition to providing guidelines for
equitable and ethical relationships between clients and therapists, associations also address
questions of ethical research, training, and publication practices.
Important questions for music therapists to address in this area include the following:
What values underlie different treatment or research approaches? Are these values consistent
with professional standards as well as those espoused by the practitioners of such approaches?
What happens when client need conflicts with articulated standards? What obligations do
practitioners have to articulate their value systems?
Cheryl Dileo Maranto and Madelaine Ventre (1985) discuss the ethical dimension of the
principle of confidentiality, considered as the “client’s right to privacy [which has] both ethical
and legal implications” (p. 62). This proscription against revealing information regarding the
client’s treatment is seen as having clinical importance as well as reflecting a legal right. In order
to benefit from therapy, a client must reveal him- or herself, something that would be unlikely
without the guarantee that what is expressed in the therapy session remains between client and
therapist. The establishment of trust, essential to therapy, is dependent upon the principle of
confidentiality.
Client rights in this regard are not absolute and can come into conflict with both the
rights of others and considerations of what is in the client’s own best interests. For example,
when a client is considered to present “an immediate danger to himself or others” (p. 62), the
music therapist must act to protect the endangered party, regardless of whether or not this
violates confidentiality. Certainly there is much that philosophical analysis can provide in
helping to determine the proper course of action and ethical guidelines when aspects of an ethics
code conflict. Another important study in this area is by Maranto (1987).
Aesthetic Issues. Aesthetic questions relate to issues of beauty, art, and the nature of
aesthetic experience: What is the essence of art? Are aesthetic judgments objective? Are these
judgments universal or culturally relative? What is beauty and what is its relationship to art?
This is perhaps the one area of philosophy that is most obviously relevant to music
therapy. We can conceive of the following questions regarding aesthetic issues that are relevant
to clinical practice: Are aesthetic considerations relevant in determining either clinical
interventions or client outcome? How and when do they come into play? Which conceptions of
aesthetics are consonant with clinical music therapy practice or clinical theory? What are the
healing properties of aesthetic experiences? Are they essential or incidental to clinical music
therapy process?
Considering that music is an aesthetic medium, it is surprising that music therapists
have not pursued this area of inquiry extensively. In one of the earliest studies of aesthetics and
music therapy, E. Thayer Gaston (1964) notes that “research in aesthetics is difficult, and there
appears to be not much interest in it” (p. 2). For Gaston, the desire for aesthetic experience is
universally present, a defining characteristic of human nature, and has a physiological basis.
Moving through a long argument based upon mammalian biology, the need for early sensory
stimulation, and the development of the uniquely human capacities of the brain, Gaston
concludes that aesthetic experience is necessary for “health and normality” because it
encompasses “the whole realm of feelings, values, [and] sentiments” (p. 5), essentially human
qualities. His attitude is that “the significance of the aesthetic experience of music for the
individual is, that without it, he would be less complete as a human being” (p. 5).
In a study applying the aesthetic thought of the philosopher John Dewey to music
therapy (Aigen, 1995), I speculate that the dearth of published studies on the relevance of
aesthetics to music therapy may be due to the fact that music therapists have traditionally based
their clinical theories on medical and psychological models which, as Gaston noted, tend not to
place much emphasis on the remedial properties of aesthetic experience. This tendency is
exacerbated by the common feeling that aesthetic judgments are subjective, arbitrary, and not
relevant in determining clinical interventions or outcome. I correlate Dewey’s aesthetic thought
with aspects of the creative music therapy approach of Nordoff and Robbins (1977). Also
presented is the notion of improvised music as a clinical-aesthetic object whose clinical
importance is aesthetically perceived by the therapist, much in the way a trained eye or ear can
perceive the aesthetic properties of a nonclinical work of art. If music therapists can perceive the
clinical significance of a client’s music based upon properties of the music itself, rather than upon
their own subjective preferences, this exploration can have implications for creating an
epistemology for music therapy, as described above.
A Detailed Examination of One Philosophical Study

In order to understand how philosophical arguments are constructed, we will examine in detail
the present author's study, The Roots of Music Therapy: Towards an Indigenous Research
Paradigm (Aigen, 1991). It is a detailed analysis of the philosophy of science that had
traditionally guided much of the research in music therapy from its origins until the time the
study was conducted. It evaluates the philosophy for its suitability in guiding research on
creative and improvisational clinical approaches in music therapy.
Because of its focus and structure, this study illustrates many of the procedures and
topics constituting philosophical inquiry, and it demonstrates how these facets are integrated to
further the purposes behind this type of inquiry: First, the study includes a detailed philosophical
clarification of terms such as paradigm and theory; second, the primary focus is to expose and
evaluate underlying the assumptions of a philosophical stance; third, a new philosophy of science
is related in a systematic way; fourth, the entire study takes the form of an extended argument;
fifth, the analysis includes the evaluation of a comprehensive philosophical system of thought;
sixth, some typically philosophical questions are considered in the area of epistemology, the
theory of knowledge.
The Argument
The argument of this study includes the following steps typical of this type of inquiry: defining
the problem, considering possible explanations, presenting the argument, and operationalizing
the argument.
Problem. The focus of this study originated in a concern regarding the schism between
research and clinical practice in music therapy. Empirical evidence was presented to document
that clinicians have continually observed that the research base of the field has been of limited
applicability and relevance to clinical work.
Possible Explanations. After noting the problem, the first step was to articulate
possible explanations for this state of affairs. Philosophical inquiry demands that we consider
alternatives to our own points of view and establish that they are not viable. One could say that
the philosopher has an ethical responsibility to make these alternatives clear, represent them in
a fair light, and present convincing and uncontrived evidence regarding their deficiencies. I
formulated five logically plausible alternatives: (a) The evidence documenting clinicians’ opinions
was either not valid or not representative of the profession as a whole; (b) the research actually
was useful, but clinicians lacked the interest or expertise to apply it; (c) the research had value,
but researchers failed to make the applications evident; (d) the philosophy of research guiding
the work was sound, but its realization had serious flaws; and (e) the philosophy of research was
fundamentally flawed, and a new research approach would need to be articulated.
Prior to beginning this study, I was convinced that the fifth reason (e) was correct, and
that music therapy would benefit from a new research approach or paradigm. This is one
important way in which philosophizing differs from empirical inquiry or research. Here, it is
permissible to know the conclusion we want to reach rather than discovering it through our
inquiry.
I discounted the first possible explanation (a) because my evidence for the dissatisfaction
with research included surveys of music therapists and statements by prominent authors and
theorists. The second explanation (b) was discounted because I presented evidence that clinicians
were predisposed toward favorably receiving and applying research reports if the reports related
to the issues and problems that they faced in their functioning as music therapists. I did not
address the third possible explanation (c) directly, instead focusing my efforts on the fourth (d).
My reasoning was that, if I could show that the basic research approach was flawed on a
conceptual level, I would not need to address the researchers’ inability to make the applications
clear.
This strategy illustrates another important aspect of philosophical argument: It is not

necessary to counter each and every point of an opposing position. At times, it is more economical
to aggregate certain points and show that they are dependent upon a more fundamental notion.
Then, if the fundamental notion can be discredited, all of the points resting on this notion are
similarly discredited.
Form of the Argument. The argument comprising the inquiry was as follows:
1. Research in music therapy theory has been traditionally guided by the paradigm of
medical and behavioral research as employed in psychology and the medical
professions;
2. This research theory was devised to investigate other types of phenomena and has
conceptual roots antithetical to those underlying the salient aspects of music therapy
practice utilizing creative and improvisational methods;
3. Continuing to utilize this research paradigm limits the applicability of research
theory and findings and inhibits the overall development of the profession;
4. Music therapy will become more theoretically developed when theory is drawn from
concerns indigenous to the discipline;
5. It is necessary to develop a new research paradigm for music therapy, the conceptual
bases of which should be congruent with clinical practice and allow for the
development of indigenous theory.
Tasks. Once the basic argument was delineated, it was necessary to operationalize the
argument in terms of specific tasks whose sequence reflected the logical form of what I was
attempting to demonstrate. The goal of offering conceptual support for a new research paradigm
was approached through answering the following questions:
1. What are the theoretical and methodological constraints, as well as the pragmatic
professional considerations, that have guided traditional research in music therapy?
2. What are the indigenous elements of creative music therapy practice and the
metatheoretical implications of these elements for research?
3. Are the guidelines that come to light in Task 1 congruent with the implications that
arise in Task 2? If not, what is the nature of the conflict between them?
4. What are the elements of a conceptual framework or paradigm that will reflect the
aspects of creative and improvisational music therapy practice iterated in Task 2?
We can look at each of these four tasks in terms of the characteristic procedures of
philosophical inquiry: (a) Task 1 involves exposing the underlying assumptions of traditional
research; (b) Task 2 is akin to the creation of a philosophy whose parts comprise a systematized
whole based solely upon the author’s experience; (c) Task 3 involves evaluating the underlying
assumptions of Task 1; and (d) Task 4 is the creation of a philosophy based upon the analysis
arising in Task 3.
This last task brings us full circle. The problem that stimulated the study is that research
is music therapy has not been applicable to clinical practice. The solution, reached in Task 4, is to
create an approach to research that reflects the principles underlying clinical practice.
The Findings
The findings of the study were developed in four areas sequentially: characterizing the nature of
traditional research in music therapy; distilling the conceptual foundations of creative and
improvisational music therapy practice; demonstrating the incompatibility of traditional research
for examining this latter type of music therapy practice; and, developing a more suitable research
philosophy.
Traditional Research in Music Therapy. Three primary components were focused
on in this section. These included (a) collecting statements by important theoreticians regarding
of what they considered legitimate research to consist; (b) inferring or deducing the underlying
philosophy of science from which their advocacy of specific procedures was derived; and (c)
determining the social, political, or methodological reasons behind their advocacy of these
positions.
The investigation showed that the philosophy of science traditionally adhered to in music
therapy consists of the following elements:
1. Belief in the doctrine of the unity of science that holds that there is a single scientific
method whose components do not vary according to subject matter—the psychologist
should be held to the same standards as the physicist;
2. Scientific data is objectively determined, theory neutral, and publicly observable.
One’s prior beliefs should not influence how one perceives data and cognitions of any
kind; thoughts, feelings, intuitions, and so forth, must be operationalized in terms of
observable behaviors to figure in scientific activity;
3. The focus of research in music therapy should be on generating scientific laws to
account for musical behavior;
4. Progress in science requires adherence to the reductionist program of explanation
which holds that terms in the softer sciences should be translated or reduced to
explanations in the more fundamental ones; that is, psychological explanations
should not invoke constructs, for example, superego or self-esteem, that are not
explainable based upon purely biological ones;
5. The purpose of science is to allow for prediction and control over phenomena, and
music therapy research should be oriented to giving experimenters and clinicians the
ability to predict and control client behaviors based on specific interventions.
Indigenous Elements of Music Therapy: Implications for Research. The
next step was to present the salient aspects of creative and improvisational music therapy
practice through a set of principles whose function was to provide “a meta-theoretical perspective
from which models, theories, criteria for explanation and research designs” could be derived
(Aigen, 1991, p. 201). I described the portrait as “a constellation of mutually supportive beliefs,
adherence to which. . . will generate a meaningful, clinically-relevant research program” (p. 277).
All of the principles were examined in great detail, related to one another, and defended
against criticism. For example, I discussed how the music therapist can, at times, abandon
conscious and deliberate action and place trust in the external, creative process of musical
creation. I then anticipated three possible objections to this statement: (a) that it implied an
abrogation of professional responsibility, (b) that it would discredit the practice of music therapy
as a legitimate treatment form, and (c) that it might lessen the importance of theory and training
in music therapy practice.
These anticipated objections were directly answered. First, I asserted that the use of
music therapy treatment is validated by client outcome, not by having a step-by-step, rule-based
model for how treatment proceeds. Second, even if the inner processes of accomplished therapists
are not formally determined according to verbalizable guidelines, there is still an important role
for theory in training in the same way that all artists and creative professionals learn their craft
through studying the work of more proficient practitioners.
In philosophical inquiry, one must anticipate possible objections and answer them in
order to keep the reader engaged. If a reader comes up with an objection that you do not answer,
he or she has a lessened motivation to follow your argument to its end conclusion.
Clash of Paradigms: The Nature of the Conflict. My analysis—that is, the
evaluation of the appropriateness of the philosophy of science comprising traditional research in
music therapy for investigating the indigenous elements of practice—demonstrated in what ways
the five elements of the traditional research approach were not conceptually congruent with
creative and improvisational music therapy practice.
The Elements of a New Research Approach. The final step of the study was to
“provide a conceptual framework for studying aspects of music therapy process that lie outside
the domain of traditional research.” Because “the limitations of traditional methods stem from
their philosophical bases,” I felt that it was “apparent that new methods will require a new
philosophical justification.” The intent was to offer standards for observation and explanation
that would “preserve the structure and salient elements of scientific practice” and yet formulate a
research program that would maintain a high degree of clinical relevance (Aigen, 1991, p. 382).
The following areas of research activity were discussed with a focus on the
considerations that would enhance the ability to create indigenous theory: (a) the use of
language, (b) theory building, (c) the use of models, and (d) research design and methods.
In the area of the use of language, I discussed how a new paradigm for music therapy
must recognize that translating clinical music to verbal language necessarily alters the salient
content, treat music as a bona fide medium for the acquisition and communication of knowledge,
and expand the traditional use of verbal language in science to allow it to carry the meaning and
expressive value of music.
In the area of model building, two perspectives on the use of models in science were
articulated. In the fictionalist view, the model is merely a calculating device, much as describing
an automobile’s power in terms of horsepower allows for measuring and comparing the capacities
of different cars. This position contrasts with the position of realism, which holds that models
reflect actual processes or entities and that scientists want their models to reflect reality.
I argued that by using medical, behavioral, or psychoanalytic models for treatment and
clinical process, music therapists unwittingly adopted fictionalist criteria for models. While
“these models can adequately represent music therapy phenomena in the language and
constructs of their respective systems,” they may only incidentally represent the salient
properties of musical processes (Aigen, 1991, p. 416). Imported models are evaluated based upon
their adequacy to the imported conceptual context, not to the actual musical phenomena. In
contrast, the realist approach holds that models should be evaluated according to how well they
represent the actual phenomena, independent of preexisting theoretical constraints. The realist
view of models is thus more conducive to building indigenous theory.
The last set of suggestions in this study related to issues of research design and methods.
The conclusion was that designs should be patterned after procedures of clinical practice. For
example, some experimental researchers comparing music therapy to other treatment forms may
feel compelled to predetermine the techniques or activities comprising the sessions. Yet if this
does not reflect actual practice, there will be a serious question regarding the applicability of a
research study so constructed. Moreover, one of the axioms of creative clinical practice presented
in the study held that the therapeutic “relationship is the context from which the meaning of the
events in a music therapy session is derived” (Aigen, 1991, p. 437). Therefore, to apply to clinical
practice, research designs must allow for and account for the establishment of such a relationship
and explore its manifestations and effects upon treatment outcome.
Conclusion
In sum, I would like to reiterate some of the concrete tasks that philosophical inquiry can help
accomplish in music therapy:
1. Provide a suitable epistemology and value system for practice, training, and
research;
2. Evaluate current theories and paradigms by distilling them into their underlying
assumptions;
3. Allow for interdisciplinary dialogue by comparing concepts and theories;
4. Contribute to the general communal wisdom of humankind by drawing the
implications of music therapy practice for areas such as epistemology, aesthetics,
and education;
5. Diagnose the reasons for practical problems in music therapy and suggest
solutions when these problems are of a conceptual nature;
6. Analyze and discuss the relationship between the artistic and scientific aspects of
music therapy.
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Kenny, C. (1985). Music: A whole systems approach. Music Therapy, 5, 3–11.
Kenny, C. (1998). Embracing complexity: The creation of a comprehensive research culture in
music therapy. Journal of Music Therapy, 35, 201–217.
Maranto, C. D. (1987). Continuing concerns in music therapy ethics. Music Therapy, 6, 59–63.
Maranto, C. D., & Ventre, M. (1985). Confidentiality and the music therapist: Ethical
considerations. Music Therapy, 5, 61–65.
Nordoff, P., & Robbins, C. (1977). Creative music therapy. New York: John Day.
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pp. 216–226). New York: Macmillan.
Robbins, C., & Forinash, M. (1991) A time paradigm: Time as a multilevel phenomenon in
Ruud, E. (1980). Music therapy and its relationship to current treatment theories. St. Louis,
MO: MMB Music.
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30–44). New York: Macmillan.
Wright, P., & Priestley, M. (1972). Analytical Music Therapy. British Journal of Music
Therapy, 3(2), 20–25.
READING 3
A Relationship-Based Theory of Music Therapy:
Understanding Processes and Goals as Being-Together-Musically.
Brian Abrams
Background
Therapy is the professional practice of employing various processes to help

promote health. Ways of understanding health, and the processes promoting it, vary
among different therapy disciplines. One important distinction in these ways of
understanding therapy consists of the science perspective vs. the humanities perspective.
From the science perspective, health consists of specific physiological,
behavioral, and psychosocial variables, with intrinsic value based upon general standards
of health across particular dimensions of functioning. These variables, while applicable to
human beings, are not uniquely indigenous to human beings, per se. Rather, they are part
of a common framework and continuum of the natural phenomena, addressed by such
sciences as physics, chemistry, biology, neurophysiology, behavioral psychology, and
social psychology. From this perspective, processes that promote health are based upon
the mechanisms of deterministic causality found in all of nature, in any and all of its
manifestations, and are subject to predictability, via inferential statistics rooted in natural
scientific laws (even when natural phenomena are too complex to predict statistically, as
is postulated in the fields of complexity science and chaos theory, the premise of causality
remains). The scientific perspective on health and health promotion is concerned with the
“what” of living things (including humans) and with the question of how well “it” works
(the operation of a causal mechanism) in promoting health, with “evidence” manifesting
from within a positivist (or post-positivist) paradigm (based upon a single, central reality
that is discerned objectively).
From the humanities perspective, health consists of uniquely human ways of
being, with value based not upon any general standards, but rather upon the personal and
interpersonal contexts of the person or persons in question. These ways of being are
meaningful only within a framework uniquely indigenous to persons. Physical, chemical,
biological, neurophysiological, behavioral, and social phenomena hold no intrinsic value
of their own, but are meaningful only to the extent that they are part of a whole human
context. From this perspective, processes that promote health are based upon the principle
of human agency, which can never be subject to the predictability of natural scientific
laws (not because they are too complex to predict, but because the principle of agency is
itself incompatible with any form of determinism, simple or complex). The humanities
perspective on health and health promotion is concerned with the “who” strictly of
persons, and with the question of how well “I” or “we” work (the human acts of a person
or persons) in promoting health, with “evidence” manifesting from within a constructivist
paradigm (based upon multiple realities that are negotiated, intersubjectively).
The present essay explores a general theory of music therapy specifically from a
humanities perspective, in which the practice of music therapy is considered indigenous
to the being of persons and the human agency intrinsic to the art of music, beyond any
natural, deterministic phenomena. More specifically, the theory represents a framework,
for any practice of music therapy, in which the processes (means) and goals (ends) of the
practice are rooted fundamentally in musical relationship—or ways of being-together-
musically. The argument for this relationship-based theory of music therapy is
constructed upon the following premises and respective corollaries:
The Proposed Theory
An argument for a relationship-based theory of music therapy is built upon these

fundamental premises and corollaries:
Premise 1. Being-as-persons ontologically means being-in-relationship.
Corollary 1a. Health, insofar as it specifically concerns health on a level

unique to humanity, must be understood as healthful ways of being-in-
relationship.
Corollary 1b. Any human therapy must be understood as a practice of

promoting healthful ways of being-in-relationship.
Premise 2. Music is a temporal-aesthetic phenomenon, ontologically rooted in

humanity and being-as-persons.
Corollary 2. Music essentially comprises temporal-aesthetic ways of being-in-

relationship.
Premise 3. Based upon Premise 1 and 2, music therapy, insofar as it is a strictly

human therapy, distinguished by its foundation upon the ontologically
human phenomenon of music, must be understood as a practice of promoting
healthful, temporal-aesthetic ways of being-in-relationship.
Each of the above points will be explicated in the sections that follow. The third point,
concerning an understanding of music therapy, will include a working definition. In
addition, a model locating music therapy as a relationship-based practice will be
proposed. Finally, several implications of this theory will be considered.
Premise 1: Being-as-Persons Ontologically Means Being-in-Relationship.
The existential philosopher Martin Heidegger (1962), in Being and Time,

elaborates upon the nature of Da-sein (literally, “being there”), the ontological foundation
of existence as a person. In this work, he does not attempt to construct a metaphysical
philosophy illuminating “what” persons are (e.g., in terms of a theory of mind, nature,
etc.); rather, he strives to capture the nature of being in terms of the strictly human
question of “who” persons are. Being, for Heidegger, is not a “thing”—it is a “way,” in
the sense of a very real and everyday existence.
In examining the “who” of being, Heidegger explains how being is
simultaneously being-with (Mit-sein or Mit-da-sein) humanity within the world or, for the
purposes of the present theory, being-in-relationship. From this point of view, being-in-
relationship is a primordial principle of humanity and is inextricable from any form of
existence as a person. While this relational principle manifests as specific associations or
encounters with others, and in particular physical or social spaces, it precedes and
transcends any specific or particular social parameters. Thus, it is not a special condition
or event, nor it is not bound to any particular sets of physiological characteristics,
psychological contents, or states of consciousness. Anyone, by virtue of being a person,
is always, already, being-in-relationship, within the world. Heidegger elaborates upon
this point by asserting Mit-sein’s continuity, even in the face circumstantial “aloneness”:
Being-with existentially determines Da-sein even when an other is not factically

present and perceived …. This Being-With and the facticity of Being-With-One-
Another are not based on the fact that several “subjects” are physically there
together (p. 113). … Being-With is an existential characteristic of Da-sein even
when factically no Other is present-at-hand or perceived. Even Da-sein’s Being-
Alone is Being-With in the world (pp. 156–157).
The “who” of a person’s being-in-relationship is therefore unconstrained by “factical”

realities and is neither located within the concrete physicality of one’s body nor within
the psychological content of one’s moment-to-moment experience—rather, it is located
in one’s human relational context. In this sense, a person, at her or his existential root, is
an embodiment of humanity itself, at a uniquely particular and relative “position.” Thus,
a person’s individual agency as a person does not exist in isolation.
This relational principle of human existence does not, per se, deny a person’s
private, internal reality; rather, it acknowledges that any internal reality exists in a
relational context with others. Neither does it necessarily imply that one’s existence is
passively “determined” by contextual, social factors. Individual expressions of humanity
maintain their agency and autonomy, but do so within a context that one co-constructs in
relationship with others.
Various others since Heidegger have affirmed this principle of human being-in-
relationship. For example, Buber (1971) extends the existential principle of being-in-
relationship in his treatise on the uniquely human dynamic of the I-Thou encounter.
Buber argues along similar lines as Heidegger, advocating for the primacy of human
interrelationship as the foundation for being a person. In Being Singular Plural (2000),
Nancy (2000) offers as a premise of his title essay that there is no being without being-
with, that “I” does not come before “we” (i.e., Da-sein does not precede Mit-sein), and
that there is no existence without coexistence. In addressing issues such as freedom,
community, and the sense of the world, he posits that being-with (i.e., being-in-
relationship) is a phenomenon in which the agency of the individual person is preserved,
carrying the implication that community is not subject to an exterior or pre-existent
definition. For Nancy, meaning is itself the sharing of being. For Nancy, being is always
“being with,” “I” is not prior to “we,” and existence is essentially coexistence.
Corollary 1a: Health, insofar as it specifically concerns health on a level unique to
humanity, must be understood as healthful ways of being-in-
relationship.
Given the human primacy of being-in-relationship, it follows that human health

fundamentally concerns healthful modes of being-in-relationship, insofar as “humans”
are understood as persons with identities beyond the concrete attributes of their bodies,
brains, psychological contents, and so forth. Thus, the relevance of any health concern on
a truly human level must be understood with respect to its human, relational value. For
example, a physically injured arm has fully human health significance only on the level
of its impact on the “who” of being—specifically, the meaning of restricted mobility,
pain, concerns about further injury, etc., as these pertain to one’s capacity to be with
other persons, in the world. Thus, one’s health, as a person, cannot be defined by any
categorical set of physiological or psychosocial conditions (as may be the case from a
natural/social science perspective), but rather by the constitution of the various facets of
the person’s human, relational context.
Health, in the sense of being-in-relationship, transcends any concrete, tangible
dimensions of organismic or behavioral functioning. Interactions among persons that are
contextually considered humane or inhumane can hold implications for one’s humanity
(or, for humanity itself). Consider, for example, bioethical matters such as the treatment
of persons in “vegetative” states of consciousness, human embryos/fetuses, persons at the
end of life, and so on. Interestingly, it has been argued (Aristotle, 2011; Feinberg, 1977;
Nagel, 1971) that even the deceased continue to exist by virtue of their human, relational
contexts, and thus humanity maintains an enduring interest in their humanity (hence the
reverent treatment of memorial sites holds very real implications for humanity, beyond a
strictly symbolic act for the benefit of the deceased loved ones).
Corollary 1b: Any human therapy must be understood as a practice of

promoting healthful ways of being-in-relationship.
Given the corollary above that one’s health on a strictly human level (i.e., as a
person) is the healthfulness of one’s being-in-relationship within humanity as a whole, it
likewise follows that any therapy that primarily addresses the health of persons as
persons must be understood as a practice of promoting healthful ways of being-in-
relationship.
From the point of view of the humanities (wherein the present theory is situated)
the promotion of relational health via therapy is not a deterministic process. Rather, it is
one in which the therapist helps by affording the client opportunities for promoting
health. As Frankl (1984) has written in the context of describing his existential model of
psychotherapy known as logotherapy, “A human being is not one thing among others;
things determine each other, but man is ultimately self-determining” (p. 135). Again,
because being-in-relationship is not dependent upon specific conditions or levels of
human functioning, “opportunities” are existential in nature and can be “used” in ways
beyond acts on a conscious, cognitive level. For example, the simple act of a therapist
being present with a client who has a severe disability, in subtle, thoughtful, dignifying
ways as a person, can qualitatively shift the client’s context in ways that afford that client
new ways of expressing her or his agency and humanity. In this sense, any therapy
strictly for persons (rooted strictly in the humanities) is a relationship-based therapy,
consisting of therapeutic ways of being together with clients in order to help them be-
with-others-in-the-world more healthfully.
This notion of relationship-based helping as relational opportunity is supported in
the philosophy and therapy literature. Heidegger (1962) identified a particular mode of
Mit-sein called Fürsorge (meaning “caring for”), the fundamental expression of concern
for others’ humanity. More specifically, he described a way of helping called “leaping
ahead,” in which one acts on behalf of another in the interest of affording the other
opportunities to cultivate their own human resources and to actualize their own human
potentials authentically (i.e., in ways that they themselves can “own,” as opposed to
being “fixed” or “rescued”). Models of psychotherapy reflecting this principle of being
together as “leaping ahead” in various ways include those articulated by Rogers (1980),
Maslow (1998), May (1983), and Yalom (1980). Moreover, in support of the
relationship-based nature of therapies for persons, Nancy (2000) has specifically applied
his relational-existential concepts of personhood to practices of psychotherapy.
It is worthy of note here that, because the processes in relationship-based
therapies integrally involve the therapist in the act of being together, the matter of who
the therapist is (i.e., identity) supersedes the matter of what the therapist does (i.e.,
technique). As Corey (2009) states with respect to the practice of counseling and
psychotherapy, “You are your own very best technique” (p. 6). While there is value to
therapy method and technique, assigning them value beyond helpful anchors or guides in
particular ways of working together with clients, the therapy ceases to be a truly human
one and is in peril of becoming a manifestation of clinical methodolatry. As Frankl
(1967) has written,
The crucial agency in psychotherapy is not so much the method but rather the
relationship between the patient and his doctor, or … the “encounter” between the
therapist and the patient. This relationship between two persons seems to be the
most significant aspect of the therapeutic process, a more important factor than
any method or technique. (p. 144)
Thus, from within the current perspective, the therapist is never a health technician, but a
skillful “Thou” in the presence of the client’s “I.” Moreover, technique, no matter how
advanced, cannot substitute for the therapist’s own personal development and
actualization of human potential; likewise, any so-called altruistic acts of “putting the
client first” at the expense of the therapist’s own well-being are inauthentic, ineffective,
and even potentially unethical (factors relevant to the therapist’s humanity can include
her/his sense of professional self-esteem, her/his perceived value of services, her/his
experience of working conditions, etc.).
Premise 2: Music is a temporal-aesthetic phenomenon, ontologically rooted in

humanity and being-as-persons.
The meaningfulness and identity of art, as art, is not located in any of its material,
concrete properties, or components, nor can it be reduced to the medium through which it
may be conveyed. For example, art paintings as certain patterns of pigment on canvas,
poetry as arranged words on a page, drama as certain sequences of behaviors on a stage,
and so forth. Likewise, it is not located in the perceptual processes of neurological
systems. The human act of creating and/or participating in art exists fundamentally as a
whole that transcends its parts, located uniquely within the realm of being-as-persons. Put
another way, art can be considered an aesthetic way of being. From this perspective, art
can never be treated as a natural science phenomenon subject to determinism and
prediction, but rather must be treated as a humanity and as a resource encountered by and
through human agency.
As Abrams (2011) contends, music, as a form of art, can likewise be understood
as a particular aesthetic way of being. An important implication of understanding music
in this way is, as is the case for any form of being, that it cannot be reified as an object or
“thing” to use solely for ulterior motives. In fact, it can be argued on ethical and moral
grounds that, to the extent that one objectifies music, one objectifies humanity. Yet, as a
way of being, it does afford opportunities for development in that way of being.
Supporting the assertion that the value of music is not found in its utility, Santayana
(1905, Vol. 4, chap. 4) has written, “Music is essentially useless, as life is: But both have
an ideal extension which lends utility to its conditions.”
Because music as an aesthetic form fundamentally unfolds in time, Abrams
(2011) suggests an understanding of music as an aesthetic way of being that is
specifically temporal in nature—hence, a temporal-aesthetic way of being. However, he
further argues that just as no art form is bound to any concrete, physical medium, music
is not bound to sound. For example, because the phenomenon of silence (e.g., rests or
long periods of no-sound, purposefully employed by a composer) can only be understood
as musically meaningful as a temporal event in a larger artistic context (i.e., without
which it would simply be the absence of sound), the music itself must be located
somewhere “beyond” the sound, on some whole, contextually human level.
Zuckerkandl’s (1956) perspectives have helped to provide a foundation for this position
on the nonconcrete “location” of music.
Here, it is important to clarify the significance of time specifically as applicable to
the present theory. The Ancient Greeks conceptualized two distinctly different forms of
time: Chronos and Kairos. According to these concepts, Chronos is the objective passing
of “clock” time, unfolding independently in its own right, as an absolute reference point
for the passing of events. Kairos is the subjective (and intersubjective) passing of
phenomenological, human time, unfolding in context (and, in some cases, narratively) as
a relative expression of events-as-meanings. Whereas Chronos is the “what” of time,
pertinent to the sciences, Kairos is the “who” of time, pertinent to the humanities.
According to Smith (1969), Chronos is quantitative time, whereas Kairos is qualitative
time. Musical time, which must be embodied in way that is artistically relevant, unfolds
in Kairos. Examples of how Kairos manifests in music include qualitative tempo
markings (adagio, andante, allegro, etc.), aesthetic organization of the pulse into meters
and measures, aesthetic “time-play” (e.g., rubato and fermata), and temporal “units” of
musical meaning such as phrases. While time-ordered musical sound can be “clocked,”
chronologic measurements of musical time hold no intrinsic artistic relevance, any more
than do the physical lengths of figures on a canvas of paint or the number of words on a
page of poetry. Even precise, metronomic tempo markings or mathematically patterned,
chronologic features in musical compositions are meaningful only to the extent that they
ultimately inform the aesthetic value of the work, as heard (or otherwise encountered) in
artistic, human, Kairos time.
As to the question of where, specifically, music is located, Abrams (2011) cites
the medieval philosopher Boëthius’s (1989) distinction between the constructs Musica
Instrumentalis (expression of music in sound) and Musica Humana (the underlying,
musicality of human existence itself) and how relatively concrete Musica Instrumentalis
derives its very essence from the far more primordial Musica Humana. This principle
extends to any human act or expression of art that may manifest through, but is not bound
to, particular, concrete media (Abrams, 2011). Of clinical significance is that Musica
Humana is an expression of one’s general, human health, construed musically. The extent
to which one, as a person, feels, thinks, talks, moves, etc., in aesthetically integrated
ways, through time (temporally) are all dimensions of human music. Thus, Musica
Humana is a dimension of health, on the level of being-as-a-person. Moreover, it can be
considered a dimension of health that does not stand alone but rather is embodied in and
manifests across all other human health domains (Abrams, 2011).
Corollary 2: Music essentially comprises temporal-aesthetic ways of being-in-

relationship.
Given that being-as-a-person means being-in-relationship, it follows that music,

as a uniquely human, temporal-aesthetic way of being (again, temporal in the sense of
Kairos, as described above), is also intrinsically a relational way of being. In this sense,
music is not merely a medium through which relationship might occur—it is itself
relationship, of a temporal-aesthetic kind. From this perspective, health understood
musically consists of the healthfulness of one’s temporal-aesthetic-relational being,
embodied in, and manifesting across, all other human health domains.
Just as Heidegger (1962) has asserted that Mit-sein does not depend upon being
with others circumstantially, music-as-relationship does not depend upon being with
others in musical sound, in any circumstantial sense. For example, music that someone
composes privately, yet never shares, remains meaningful by virtue of its foundation in
relational being. Likewise, in listening to classical masterworks, one can be with its
composer (whether living or deceased), as well as with humanity as a whole, in various
ways.
Premise 3: Based upon Premises 1 and 2, music therapy, insofar as it is a strictly

human therapy distinguished by its foundation upon the ontologically
human phenomenon of music, must be understood as a practice of promoting
healthful, temporal-aesthetic ways of being-in-relationship.
Given that music therapy is a therapy based upon music, and that music is
intrinsically relational, it follows that music therapy is based upon relationship. As a
relationship-based therapy, it regards clients as relational beings and therefore employs
particular ways of being together as the basis for its processes. Likewise, it regards client
health (as described previously here) as ways of being together (relationship). As has
been articulated by Heidegger, this aspect of relationship and being together is not
restricted to immediate physical or social presence—it extends to relationship by virtue of
the therapeutic roles, even when there are phases during the therapeutic process wherein
client and therapist are not immediately present to one another.
That which distinguishes music therapy among other relationship-based therapies
is its musical way of construing both therapeutic processes (means) and health goals
(ends). In other words, it is a practice of promoting healthful, temporal-aesthetic ways of
being-in-relationship (“promoting” extending both to the processes within therapy and to
the goals/outcomes extending beyond therapy). Expanding this statement into a working
definition of music therapy, specifically incorporating the principles of the general theory
being formulated here, may also be useful. Although the aspect of relationship has been
included in a number of recent definitions of music therapy (e.g., American Music
Therapy Association, 2010; Bruscia, 1998), none of these definitions specifically
“locates” relationship in/as the music itself, across various practices of music therapy.
Interestingly, an older definition by Bruscia (1984) does frame the practice as an
interpersonal process, manifesting in music experiences, which closely captures several
core ideas presented here. For addressing the totality of elements in the present theory
(including the concept of music beyond sound, as well as the concept of both processes
and goals being both musical and relational), however, the following working definition
is offered:
Music therapy consists of the client and therapist working together relationally
and aesthetically in time to promote the client’s relational, temporal-aesthetic
health.
Or, stated more succinctly (given an understanding of music as a temporal-aesthetic-

relational phenomenon):
Music therapy consists of the client and therapist working together musically to
promote the client’s musical health.
This general understanding of music therapy locates relationship in the musicality

of the work itself. This is a principle not restricted to any particular clinical method or
model, as each could be understood as a particular way of being-together-musically, for
and as health. The irreducibly human foundation of music therapy would remain intact,
across different ways of working. Even in relatively technical applications of music
therapy—for example, music therapy in the rehabilitation of a person with neurological
damage—that which “matters” about the therapy can still be understood as relational
humanity, or the person’s capacity to be-in-relationship, aesthetically, in time
(manifesting through the dynamic form and flow of the therapeutic process, the
“phrasing” of verbal communication, the “contours” of movement, etc.). Only when one
treats client and/or music as object (i.e., an “it”) would the musicality and humanity of
the work be abandoned—the sine qua non of music therapy as understood here—in favor
of a technical intervention that utilizes certain sound features to effect certain change in
organisms.
A number of sources in the literature support the ideas comprising the present
perspective on music therapy. Although none of these sources addresses the idea of music
beyond sound, each provides important points that strengthen the arguments for a
relationship-based concept of music therapy.
Ansdell (1995) presents a model of therapeutic relationship in music therapy,
consisting of progressive steps of interpersonal intimacy in musical engagement, ranging
from contacting to musical meeting. Bruscia (1995, 1998) presents findings from an
exploration of the phenomenon he calls “being there” for/with the client in music therapy,
including a consideration about how this and other dimensions of relationship comprise
dynamic forces of therapeutic change in music therapy. Aigen (2005) asserts that the
clinical relationship in music therapy is the musical relationship between or among the
participants-as-musicians. Garred (2006) applies Buber’s construct of the I-Thou to the
interrelationships among client, therapist, and music. Muller (2008) presents findings
from a study exploring the phenomenon of presence in music therapy, indicating how this
phenomenon manifests along the axes of being and time, reflecting not only the nature of
the way music works in sound but also the generally musical nature of what it means to
be together clinically in music therapy. In support of the foregoing perspectives and
findings, Ruud (2010) describes the musical client-therapist relationship in music therapy
as being together, in time.
Others further elaborate upon the basis of music as therapeutic relationship. These
include arguments for a view of music as relationship itself (e.g., Aigen, 2005; Ansdell,
1995; Lee, 1996; Nordoff & Robbins, 2007), as a relational, “third” force within the
client-therapist relationship (e.g., Garred, 2006; Ruud, 2010), as a field of relational
interaction (Kenny, 2007), or as embodying relationship on sociocultural levels (Stige,
2002).
A Relationship-Based Model for Understanding Music Therapy
As part of a foundation for a general theory of music therapy, a model that

“locates” the practice of music therapy in accordance with the perspective offered here is
presented below. The model is illustrated as an intersecting circle diagram, with
explanations provided for each of the constructs (i.e., the circles and their various
intersections) represented within the diagram (refer to Figure 1 for the diagram). Each of
the constructs within the model is based upon the premises and corollaries already
articulated here.
The model is related to Bruscia’s (1998) diagram that identifies the discipline of
music therapy as a hybrid of music and therapy. In the present model, music is
specifically defined as a temporal-aesthetic-relational phenomenon that manifests in ways
beyond sound. Likewise, although the diagram resembles Kenny’s (2007) diagram
illustrating a field theory of music therapy, the present model is not an explanation for
how music therapy works; rather, it illustrates where the practice of music therapy is
located, according to certain defining features.
The main components in the model are represented in the diagram as the large and
concentric circles, while the various domains of practice are represented by the various
intersections among the main components. The domains are not necessarily names for
established disciplines or professions—only the practices that may fall within or outside
of the boundaries of the practice of music therapy, according to the present theoretical
constructs. The model is not meant to imply that music therapists must practice only that
which falls within “music therapy,” nor that they must not practice that which falls
outside of “music therapy.” Professional boundary lines may be among the implications
of this model, but this matter is beyond the scope of the present essay.
Figure 1. Diagram of Relationship-Based Model for Understanding Music Therapy
Primary Components of the Model
The primary components of the model (i.e., the circles in the diagram) consist of (and are
defined by) the general “spheres” defined in the descriptions that follow.
· Sound
Here, sound is defined as aurally perceptible pressure waves in physical medium. That is,
the physical wave phenomenon that the human ear can experience as some form of sonic
sensation, whether embodied in the air or in some other medium (such as water) that can
also conduct sonic wave energy patterns.
Note that, according to the foregoing theoretical constructs, sound is not an essential
component in what defines music. However, due to popular, conventional ideas about
music, it is important to include sound among the primary components, so that its
nonessential role in locating music therapy can be illuminated.
· Therapy
Here, therapy is defined as a health promotion process—that is, the professional practice
of implementing a particular set of systematic interventions or other purposeful actions
designed to promote health, according to any of its accepted definitions. Please note that,
in the present model, “professional” does not pertain exclusively to practices that have
been codified under specific titles and can, for example, include certain practices that
occur on a community or sociocultural level (provided that they are professional in
nature).
Note how the dimension of human relationship, while part of what defines certain
practices of therapy, is not necessarily a component in all forms of therapy. Therapy can
consist simply of an effective, health-promoting intervention on the level of an organism,
a neurological system, a pattern of behavior, and so forth. The therapeutic administration
of biochemical medication is such an example. While a human encounter may occur in
the context of medical consulting, diagnosis, and treatment, the encounter itself is
essential neither to the process nor to the purpose of the primarily biomedical, science-
based (as opposed to humanities-based) intervention.
· Being-in-Relationship
Here, being-in-relationship signifies the relational dimension of being a person

(essentially, Heidegger’s Mit-sein). It can also be understood as being together—not
limited to the circumstantial, social presence of two or more persons, but rather extending
to the general relational nature of being-as-a-person.
Importantly, while persons as persons are always beings-in-relationship, in the present

model, this sphere pertains only to phenomena for which the relational dimension of
being holds essential relevance, or is intrinsic to what defines the discipline. For
example, while human physicists practice the science of physics, the relational dimension
of humanity holds no essential relevance with respect to the discipline of physics itself.
This holds for any of the natural science disciplines (or for any disciplines outside of the
humanities), including the practice of medicine and other health sciences.1
· Art (within the sphere of Being-in-Relationship)

Here, art is defined as specifically comprising the aesthetic dimensions of being-in-
relationship—that is, those aspects of being together that essentially concern qualitative
matters of creativity, meaningfulness, balance, integration, and so forth. Because art is
defined as a particular way of being here (specifically, of being together), it is an
existential mode, restricted neither by expression via any particular medium nor by
perception via any particular sense modality.
· Music (within the sphere of Art)
Here, music is defined as specifically comprising the temporal dimensions of art—that is,
the temporal-aesthetic dimensions of being-in-relationship. Again, “temporal” here refers
to the unfolding of time as phenomenological, human meaningfulness (Kairos) vs. as
“clock” time (Chronos). As is the case for art, as defined here, music is considered a
particular way of being together as an existential mode, neither expressed exclusively via
the physical medium of sound nor perceived exclusively via the aural sense modality.
This concept of music is, essentially, the Boëthian concept of Musica Humana, as
described by Abrams (2011)—that is, an expression of one’s fundamental humanity and
of health, as embodied in and manifesting across all other human health domains.2
Intersecting Components of the Model: Specific Domains of Practice
The various ways in which the primary components of the model (i.e., the circles in the
diagram) intersect represent a distinct set of specific domains of practice. Each of these is
explained in the descriptions that follow.
Primary Intersection One

Sound and Therapy: Sound Therapies
Sound therapies consist of those professional practices designed to promote health,

through or as various forms of sound phenomena. Sound therapies may be relationship-
based or non-relationship-based.
· Sound and Therapy, inside of Being-in-Relationship: Relationship-Based Sound

Therapies
Relationship-based sound therapies consist of sound therapies that integrally involve

both processes (means) and goals (end) concerning ways of being-in-relationship.
Relationship-based sound therapies may be arts-based or non-arts-based.
· Sound and Therapy, inside of Art: Arts-Based Sound Therapies
Arts-based sound therapies consist of relationship-based sound therapies that integrally

involve aesthetic dimensions. Arts-based sound therapies may be music-based or non-
music-based.
· Sound and Therapy, inside of Music: Music-Based Sound Therapies

Music-based sound therapies consist of arts-based, relationship-based sound therapies
that integrally involve temporal dimensions.
An example is when client and therapist improvise together in musical sound (i.e.,
through instruments and voice), within the context of a music-based, therapeutic
relationship, for the purposes of promoting new possibilities for the client’s healthful,
temporal-aesthetic, being-in-relationship within the world (in thought, feeling, speech,
action, etc.). These new possibilities can include (but are not limited to) ways of engaging
in sound-based music experiences outside of therapy. Another example would be the
phenomenon of musicking (Elliott, 1995) or the act of engaging in the human experience
of music—in this case, specifically in the context of the professionally informed or
guided act of engaging in musical sound experiences expressly for health-promoting
purposes (including when the musical sound experiences themselves are considered
health), known as health musicking (Stige, 2002). Within the framework of the present
model, this is one manifestation of music therapy.
· Sound and Therapy, inside of Art but outside of Music: Non-Music-Based, Arts-
Based Sound Therapies
Non-music-based, arts-based sound therapies consist of arts-based, relationship-based

sound therapies that do not integrally involve temporal dimensions.
An example is a when client and therapist engage in uses of sound within the context of
an arts-based, therapeutic relationship, for the purposes of promoting new possibilities for
the client’s healthful, aesthetic, being-in-relationship within the world. Neither the
artistic dimensions of the sound experiences nor the therapeutic outcomes are based upon
the way the experiences and/or ways of being unfold (or are ordered) in time—for
example, sound effects derived in relation to certain visual elements of a client’s painting
or an ambient sound of some form accompanying a client’s recitation of a poem (the
expression of which, while spanning the length of time of the poem, and while intended
to enhance the poem’s aesthetic depth, would not be temporally relevant to the poem’s
aesthetic essence).
· Sound and Therapy, inside of Being-in-Relationship, but outside of Art: Non-Arts-

Based, Relationship-Based Sound Therapies
Non-arts-based, relationship-based sound therapies consist of relationship-based sound

therapies that do not integrally involve aesthetic dimensions.
An example is sound-based psychotherapy, in which sound is employed as a medium

through which the therapeutic relationship can develop and through which the client can
develop her or his potential on a uniquely human, relational level. In this instance, neither
the aesthetic qualities of the sound itself nor the aesthetics of the context in which it is
employed are relevant in the processes or goals of the therapy.
· Sound and Therapy, outside of Being-in-Relationship: Non-Relationship-Based
Sound Therapies
Non-relationship-based sound therapies consist of sound therapies that are not integrally
relational.
An example is the prescriptive use of sound vibration to treat pain, based scientifically
upon the biophysical interactions of vibratory stimulation and living tissue.
Interestingly, while one may classify this as “sound medicine,” the term “music
medicine” would not apply meaningfully here, as music is situated exclusively within the
spheres of art and of being-in-relationship. On the other hand, the practice of “medical
music therapy” (relationship-based/arts-based/music-based practices of therapy that
primarily serve persons with medical conditions and/or who are encountered in medical
settings) could apply to the categories music-based sound therapies (already explained
above) or non-music based, non-sound-based therapies (to be explained subsequently),
both constituting music therapy.
Primary Intersection Two

Sound and Being-in-Relationship: Being Together in Sound
Being together in sound consists of practices (not necessarily professional) that integrally
involve being-in-relationship through various forms of sound phenomena. Being together
in sound may be in the form of therapy or nontherapy.
Note that the intersections comprising each of the levels of Relationship-Based Sound
Therapies have already been described here, under the primary intersection of Sound and
Therapy; thus, only those domains of being together in sound located at the intersections
that fall outside of the sphere of Therapy will be described here.
· Sound and Being-in-Relationship, outside of Therapy: Nontherapy Ways of Being

Together in Sound
Nontherapy ways of being together in sound consist of being together in sound in

contexts not based upon the professional promotion of health. Nontherapy ways of being
together in sound may be arts-based or non-arts-based.
· Sound and Art, outside of Therapy: Arts-Based, Nontherapy Ways of Being Together
in Sound
Arts-based, nontherapy ways of being together in sound consist of being together

aesthetically in sound in contexts not based upon the professional promotion of health.
Arts-based, nontherapy ways of being together in sound may be music-based or non-
music-based.
· Sound and Music, outside of Therapy: Music-Based, Nontherapy Ways of Being
Together in Sound
Music-based, nontherapy ways of being together in sound consist of being together

temporally and aesthetically in sound in contexts not based upon the professional
promotion of health.
Examples include many conventional, everyday forms of engaging in music experiences

(alone or with others), such as listening to a recording of music, attending a music
concert, or making musical sound in some form. They also include the practice of
musicking, when not specifically doing so within a professional, health-promotion
context.
· Sound and Art, outside of Music and outside of Therapy: Non-Music-Based, Arts-
Based, Nontherapy Ways of Being Together in Sound
Non-music-based, arts-based, nontherapy ways of being together in sound consist of

being together aesthetically in sound, in ways that do not integrally involve temporal
dimensions and in contexts not based upon the professional promotion of health.
An example is engagement in a sound art experience (alone or with others), in which

sound is utilized artistically, without any particular temporal sequence, order, form, or
flow, such as tones or sound effects that serve as a necessary (but not expressly temporal)
part of a particular artwork, exhibit, or installation of some form.
· Sound and Being-in-Relationship, outside of Art and outside of Therapy: Non-Arts-

Based, Nontherapy Ways of Being Together in Sound
Non-arts-based, nontherapy ways of being together in sound consist of being together in

sound in ways that are not integrally aesthetic and in contexts not based upon the
professional promotion of health.
An example is the everyday sound and noise tied specifically to the expressions of
humanity-in-action (e.g., street noise). Another example could be communicating in
sound, such as verbal conversation, or communing in sound, such as chanting or toning
(alone or with others), insofar as these do not involve artistic processes or professional,
health-promotion purposes.
Primary Intersection Three

Therapy and Being-in-Relationship: Relationship-Based Therapies
Relationship-based therapies consist of professional practices designed to promote health

that integrally involve both processes (means) and goals (end) concerning ways of being-
in-relationship. Relationship-based therapies may be sound-based or non-sound-based.
Note that the intersections comprising each of the levels of Relationship-Based Sound
Therapies have already been described here, under the primary intersection of Sound and
Therapy; thus, only those domains of relationship-based therapy located at the
intersections that fall outside of the sphere of Sound will be described here.
· Therapy and Being-in-Relationship, outside of Sound: Relationship-Based, Non-

Sound-Based Therapies
Relationship-based, non-sound-based therapies consist of relationship-based therapy

practices that do not integrally involve sound. Relationship-based, non-sound-based
therapies may be arts-based or non-arts-based.
· Therapy and Art, outside of Sound: Arts-Based, Non-Sound-Based Therapies
Arts-based, non-sound-based therapies consist of relationship-based therapy practices

that integrally involve aesthetic dimensions but do not integrally involve sound. Arts-
based, non-sound-based therapies may be music-based or non-music-based.
· Therapy and Music, outside of Sound: Music-Based, Non-Sound-Based Therapies
Music-based, non-sound-based therapies consist of relationship-based therapy practices

that integrally involve temporal-aesthetic dimensions but do not integrally involve sound.
An example is a therapy process in which a session involving no conventional sound-

based music experiences is construed and treated musically, including the tempo and
dynamic form/flow of verbal conversation (including pitches and tones), the formal
treatment of thematic material as it unfolds in time (e.g., theme and variation), the
treatment of interpersonal dynamics in a manner parallel to that of
melody/accompaniment, etc. Any expressions of sound are incidental, and nonessential to
the musicality of the temporal-aesthetic-relational therapy process and to the temporal-
aesthetic-relational therapy goals. Within the framework of the present model, this is
another manifestation of music therapy.
Of the two ways in which music therapy can manifest within the present model, this one
is the more general, pervasive way. It underscores how the essential, defining property of
music therapy can be understood as temporal-aesthetic being-in-relationship, within the
professional context of health promotion. It further underscores how music therapy can
be understood in a way that transcends concrete, physical sound as its only medium.
· Therapy and Art, outside of Music and outside of Sound: Non-Music-Based, Arts-
Based, Non-Sound-Based Therapies
Non-music-based, arts-based, non-sound-based therapies consist of relationship-based

therapy practices that integrally involve aesthetic dimensions but do not integrally
involve temporal dimensions or sound.
An example is a practice of visual art therapy (e.g., painting) wherein the therapy process
and outcomes target health according to aesthetic being-in-relationship that is not
essentially defined by the manner in which it dynamically unfolds through time, per se.
· Therapy and Being-in-Relationship, outside of Art and outside of Sound: Non-Arts-

Based, Relationship-Based, Non-Sound-Based Therapies
Non-arts-based, relationship-based, non-sound-based therapies consist of relationship-

based therapy practices that do not integrally involve aesthetic dimensions or sound.
Examples include most conventional forms of verbal psychotherapy, wherein the therapy
processes and goals are rooted in healthful ways of being together, yet in which neither
the processes nor the goals depend upon aesthetic dimensions of any kind; nor is sound
integrally relevant to the therapy processes or outcomes (consider interaction that occurs
in silence, via sign language).
Reflections, Implications, and Conclusions
The present theory suggests a way of understanding the defining essence of music
therapy as the capacity to be with the client in temporal-aesthetic (i.e., musical) ways, in
order to help afford the client opportunities to develop capacities for temporal-aesthetic
ways of being together in life. According to this theoretical perspective, music therapy
would be indicated to the extent that the referring (or assessed) “problem,” “issue,” or
“need” can be construed relevantly as a particular matter of being-in-relationship,
aesthetically in time (i.e., a musical problem or need)—and to the extent that the
“solution,” “response,” or “intervention,” can be meaningfully addressed through the
affordance of opportunities for development of temporal-aesthetic-relational being (i.e.,
through music), within one or more particular other health domains. Thus, to the extent
that the problem or its potential solution cannot be construed musically with sufficient
meaningfulness, music therapy would not be indicated.
This theory has a truly humanistic core, not due to the employment of
traditionally humanistic constructs in therapy (such as unconditional positive regard, self-
actualization, etc.), but rather because it considers persons and music to be irreducibly
human. From this particular perspective, the components of music therapy are never
technical, material “things,” subject to deterministic forces; rather, they are always
aspects of humanity itself, built upon a foundation of individual and shared human
agency capable of utilizing opportunities. In this sense, music therapy would not be
considered a health science, but a health humanity. An understanding of music therapy as
a health humanity is generally considered a departure from the more popular
understanding of the practice as a health science and carries certain social and economic
implications.
Health sciences are often valued highly (both socially and economically) because
of their capacity to predict outcomes based upon deterministic forces. In the health
humanities, evidence-based practice cannot be meaningfully informed by the objective
rigors of scientific research informing biomedical practices, but rather by the very
different (yet no less valid or intensive) intersubjective rigors and standards of
accountability appropriate for humanities research (Abrams, 2010). Patience and care is
undoubtedly required to compel stakeholders (including clients and others), who invest
resources in their care, to acknowledge the equal but different value of a practice based
upon nonpredictable, humanistic agency. This is not to say that the outcomes of music
therapy cannot be, or should not be, evaluated; however, evaluation from the present
perspective frames outcomes as possibilities, as opposed to probabilities. Thus, in this
context, evaluation means intersubjectively appraising the extent to which the
opportunities of therapy afford the client valuable possibilities.
Articulating a general, theoretical perspective on music therapy’s defining essence
(as has been the purpose of this essay) can help to clarify, ground, and anchor the
indigenous expertise belonging uniquely to music therapists, in relation to an array of
related but different practices. It can further help bring to light the ways in which music
therapy makes a special contribution to the community of allied health practices—one
that no other practice can address in quite the same way or for quite the same set of
purposes. At the same time, articulating this perspective identifies a common ground
underlying all practices of music therapy without being bound by specific methods or
techniques. As an important part of developing and articulating this general theory of
music therapy, a detailed taxonomy of health-as-musical-relationship, including
applications across multiple clinical methods, is indicated. The present essay represents
an important, initial stage that establishes the foundations for any future development of
the theory.
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Endnotes
1
For those who would argue that the quality of the patient-physician relationship has an
impact on health outcomes, it is important to acknowledge that such an argument is based
upon the determinism of science, wherein “relationship” is treated as yet another causal
factor in a chain of events obeying natural law, resulting in an outcome of “health”
defined in an objective way. In other words, it would be that the “what” of “relationship”
is of relevance in this scientific context, as opposed to the “who,” where the existential
phenomenon of being-in-relationship is located.
2
Note that, based upon this definition of music, certain areas of art (each understood as
particular aesthetic ways of being-in-relationship) such as dance (corporal-temporal-
aesthetic being-in-relationship), drama (narrative-temporal-aesthetic being-in-
relationship), and animation/film (visual-temporal-aesthetic being-in-relationship) would
each be considered specific forms of music (or, put another way, being musical). The
intent of this classification is not to “co-opt” these other art modalities in any hierarchical
sense, but rather to establish the connections and distinctions among art modalities
according to relative levels of specificity within the general sphere of art, which is, in
turn, situated within the more general sphere of being-in-relationship.
READING 4
Taken from: Hadley, S. (Ed.) (2006). Feminist Perspectives in Music
Therapy, pp. 41–62. Gilsum NH: Barcelona Publishers.
A FEMINIST SOCIOLOGY OF PROFESSIONAL ISSUES IN

MUSIC THERAPY
Jennifer K. Adrienne
I began this chapter with the question posed by Sue Hadley: Could I imagine a music therapy in
which, as a feminist, as a sociologist, as a musician, and as a former music therapist, I could
work and feel true to my sociologically minded ethics? Answering this question was personally
as well as professionally and academically interesting and difficult. At the completion of the
chapter, I had not worked in music therapy for five years. I had since begun a career as a
sociologist, working primarily in domestic violence shelters and teaching. I consciously left the
music therapy field for specifically feminist and sociological reasons. This article is
undoubtedly guided by my ideals. I have worked in environments where feminist ideals were
addressed in daily operations, so I believe this imagining is worth the effort.
The structure of this chapter is succinct. In the first section, I introduce and apply some
ideas of founding sociologists as well as feminist sociologists to training and professional issues
in music therapy. I include some reflections on my personal work experience as well. In the
second section, I propose four principles for a feminist music therapy.
I. SOCIOLOGICAL FOUNDATIONS
Feminist sociologists, like feminists in most disciplines, have many diverse voices. Janet S.
Chafetz (1988) defines four criteria for feminist sociological theory that are helpful in analyzing
music therapy theory and practices. These are summarized by Sara Delamont as: “1) that gender
is a central focus, 2) that gender is systematically related to social contradiction, inequalities and
pressure points, 3) that the theory accepts that gender relations are mutable, have changed and
will change, 4) that it can be used to challenge, counteract, or change a situation in which
women are devalued or disadvantaged” (2003, p.18). These are underlying guidelines
throughout this chapter.
I propose that a feminist music therapist must be competently trained in basic

sociological theories as well as sociological theories of gender. The
42 Jennifer Adrienne
psychoanalytic and general counseling psychology orientation of music therapy,

whether formally or inadvertently learned, is lacking in education about the
political context in which clients are engaged. The field of sociology has
contributed a breadth of research on the intersections of race, class and gender.
A clinical perspective that is informed by the pervasiveness of these social
structures would more justly serve clients.
Charles Horton Cooley theorized that we see ourselves as society reflected
back to us—known as the “looking-glass self” (Cooley, 1964). Socialization
research states that our personality is constructed and formed by our relation-
ships, experiences, and social problems (Erikson, 1976; Shibutani, 1961). For
this analysis, the question must be asked: what is the music therapy experience
reflecting back to our clients about gender?
Clients are essentially in a social position in which they are perceived as
having difficulty managing social forces, whether drug addiction, illness, or
family issues. Music therapists’ insight into these social forces shapes the course
that these social forces take. Peter Berger and Thomas Luckmann (1966) assert
that we are socially constructing our reality, communally. In other words, we are
together—music therapists and clients—building our knowledge and our reality
of the present and the future, through our daily interactions. We must understand
the impact of our professional social position in this reality construction. We are
socially constructing race, class, and gender together with our clients.
The artifacts of culture are the very items of evolving culture. In music
therapy, the basic artifacts are the instruments, the printed music, the therapy
room, the case notes. A sociological dramaturgical analysis (Goffman, 1959)
would examine the music therapy session and institutional surroundings as if it
were a drama. Who are the actors? Who plays the leading role? Who are the
supporting actors? What are the costumes? What are the props? What is
happening upstage . . . downstage . . . backstage? What is the script? What does
all this communicate about the values and norms of the culture of music therapy
or the culture of the particular institution? In the examination of daily life, we
can observe how culture in constructed.
Music therapy is part of the evolution of cultural values, including gender
norms and values. It is not an oasis from cultural construction. My feminist per-
spective asserts that we are accountable and responsible because of our social
position. If we do not actively work toward systemic change, represented in our
own interactions as well as in our institutional policies and procedures, clients
will be offered a small helping of the human potential for change. If we keep in
mind the concept of the looking-glass self, we note that inner cognitive and
inner emotional adjustment to social forces would only help a client adapt to a
difficult societal environment. This would alter the personality toward this end
only, and ultimately.
A Feminist Sociology 43
Gender Research in Sociology

Female clients are raised in a cultural context in which domestic violence, rape,
sexual abuse as children, and sexual harassment lead to cumulative experiences
and consequences that create gendered differences (Kelly, 1999, p.121–125).
Women restrict their movements and involvements in public life far more than
men (Stanko, 1990). The prevalence of violence against women affects
“personal safety, routine decision-making to long-term mental health problems”
(Kelly, 1999, p.125). This prevalence makes it a “citizenship issue” (Kelly,
1999, p.125). In a feminist sociological perspective, the personal consequences
of this violence are not individual therapeutic issues.
“That sexual violence is so pervasive supports the view that the locus of
violence rests squarely in the middle of what our culture defines as ‘normal’
interaction between men and women” (Johnson, 1980, p.146). For women, the
most significant predictor of psychiatric treatment, suicide attempts, criminal
convictions and involvement in the sex industry is prior victimization (Kelly,
1999, p.132). As therapists, our manifest societal function is to help normalize
clients to society to the best of their abilities. In essence, we are helping clients
adjust to these realities, rather than demanding new realities. Music therapists
work in institutions that sociologists refer to as “total institutions.” The societal
function of total institutions is to completely resocialize the personality, to
reconstruct the intellect, the emotions, and behavior patterns to make one a
successful social being in the present state of society. If “normal” is so violently
gendered, feminist music therapists need to create a different role with different
job responsibilities; otherwise we are participating in and approving of the
current violent gender norms.
As awareness of the extent of sexual violence has developed, so have

professional responses to it. In many Western societies this response
has become increasingly therapeutic and individualized, (Dobash &
Dobash, 1992) displac-ing feminist frameworks, which stress collect-
ive support and response through self-help groups and political
activism. The last decade could be described as the “decade of
disorders” . . . and personal healing has eclipsed the stress on social
justice and collective action. (Kelly, 1999, p.138)
Unfortunately, from a feminist perspective, the profession of music therapy

has followed this trend. However, the possibilities for a social justice, collective
action music therapy still exists if we find and follow the examples of music that
have historically accomplished such goals, rather than music which has
supported social institutions that upheld unequal and violent race, class, and
gender ideologies.
Liz Kelly states: “The barriers which are created for black and migrant
women, disabled women, young and elderly women, women in the sex industry,
and women with mental health problems must be explored and addressed at all
levels” (Kelly, 1999, p.138). For our profession, we first must examine the
position and the role in the social systems in which we work and ultimately, we
must examine the layers of the music that we trustingly apply. These barriers are
embedded in the music as well.
As well-trained music therapists, we continue our professional, ethical-as-
trained role as part of the bureaucratic structure of our therapeutic institutions.
We believe that if we are professionally ethical that gender oppression or any
form of socially constructing gender is minimized. In contrast, feminist
sociology illuminates systemic, institutional gender oppression.
Dorothy Smith (1987) is a feminist sociologist who defines her sociology
as “explaining sociology to people,” “sociology beginning in the actualities of
people’s lives and exploring the actual social relations and organizations in
which they participate.” For example, our social class shapes how we think, feel
and behave, yet social class is rarely examined or challenged in the therapeutic
environment. Social class influences, if not determines, where or if we work,
what we wear to work, what schools we went to, how much school we finished
and what careers we considered, how professionally or academically we are able
to communicate, what cars we drive, whether or not we take the bus or subway,
where we buy groceries, what food we eat, what religion we practice, how we
raise children or who raises our children for us, what we think of people who
have more or less wealth than ourselves, who we know and how we know them,
our mannerisms, how we relate to authority, and how we arrange our living
environment, to name a few examples. Our social class guides our gender
construction, including our values, norms, and perceptions of events related to
gender roles. In Feminist Theory: From margin to center, bell hooks (1984)
describes the complex social realities of class and race applied to feminist issues
such as the nature of work, childcare and the (false) idea of a common
oppression among women.
Woman on the Edge of Time, by Marge Piercy, is a story defined by
feminist ideologies, about a woman who is institutionalized and labeled insane,
yet throughout the book she is sanely tuned into the future and alternative ways
of life. Piercy explores equal and peaceful gender relations in her characters’
lives. As I read this book, I began to imagine clients on the edge of bureaucratic
time, with music therapy placating, soothing, and softening the edges of
overmedication, ritualization, and institutional rules. Music therapy relaxes the
urge to question diagnoses and other issues considered not relevant to the
defined therapeutic goals. As feminist therapists, we ought to continue to ask
who is doing the problem defining.
The formal systems for problem defining in therapeutic institutions for

mental health—namely the DSM and related pharmaceutical companies—have
remained unchallenged by the profession of music therapy, yet these systems
structure the focus and direction of much of our work. Sociologists and
anthropologists have compiled quite a bit of evidence about the relativity of the
DSM. The social construction of mental illnesses as symptom-based disease
entities is a new system of classifying behavior and human conditions tied to
“specific social and historical circumstances and from the interests of particular
groups that benefit from classifying psychological conditions as states of illness”
(Horowitz, 2002, p.208). Third-party funding, the desire to acknowledge
psychiatrists and social workers (and allied mental health workers) as legitimate
medical professionals, and corporate pharmaceutical interests required a
“rational, quantitative system of thought about mental disorders” (p.209). Many
new jobs, professions, and medications have been created as a result.
This system provides health care professionals with a sense of objectivity,
reason, and truth (music therapists often ‘apply’ music with this sense as well),
yet close examination reveals categories with egregious logical flaws and a
system of knowledge lacking research validity. This perspective of pathology
has only been firmly in place since 1980, yet it is the standard. It is not seen as
one possible view of human distress, but the truth of human dysfunction. More
recently, the President’s New Freedom Commission on Mental Health, begun in
2002, serves to benefit pharmaceutical companies and mental health professions
far more than people with so-called mental illnesses. Allan Horowitz (2002)
concludes that we ought to “consider when restoring normality is best
accomplished by changing individuals and when it is best done by transforming
social conditions” (p.229). Remember, of course, that violent gendered relations
are considered normal, so we have one more layer to consider.
The DSM does indeed point to what we consider deviant in our particular
society. But, the medicalization of deviance creates social problems including
the individualization of social issues and the depoliticization of deviance
(Conrad & Schneider, 1992). Within the ideals of corporate patriarchy, the
female gender is a category defined as deviant. Diagnoses, psychiatrically,
psychologically, and medically, explain more about our fears as a society than
about the individuals themselves. Medical diagnoses often serve to silence
explanations that point to social problems. Feminist music therapists cannot
accept this.
One of the most striking examples I personally witnessed occurred
throughout the time I managed programs in a domestic violence shelter. I was
deeply saddened to see the quantity and types of psychotropic medications
regularly prescribed to survivors of domestic violence. Accompanying the
medications were the usual personal statements about their diagnoses,
contributing to their disempowered self-concept. In medical environments in
which these surviving women seek assistance, they are considered “needy,”
typically requiring a little more time in their appointments.
We must take this reality painstakingly further into the analysis of the
music that we are using with clients. We need to facilitate an understanding of
the sociology of music to our clients, at least the social relations and gendered
organization of the music itself. If this task is not accessible or difficult to
accomplish with clients, the gendering continues unexamined, particularly due
to our status in the institutional hierarchy.
Are we using music to help people adapt, and make sense of how the world
sees them, rather than “explaining society,” specifically in terms of gender
stratification and interrelated socioeconomic stratifications? As I will discuss
further, music, unanalyzed for gender in form, is doing just that: reconfirming
the position of the client in society, and perhaps resocializing her to be better at
it.
In university, I was enrolled in a course in disability rights. Introducing
myself on the first day, I proudly said I was studying music therapy and the
professor responded, “Isn’t that interesting, if I’m normal it’s called listening to
or engaging in music, if I’m defined by society as not normal, it’s called music
therapy.” This began my search for an understanding of how helping
professions, in their usual form, actually perpetuate social inequalities.
I believe our intentions as music therapists are hopeful and sincere, as I
also believe music can help transcend and confront social problems. At the same
time, I also believe that music can be an integral part of gendering, especially in
the therapeutic relationship where the client has a label and thus a stigma.
According to labeling theory, people become what we socially imagine them to
become, particularly when one is labeled deviant (Becker, 1963) (see, for
example, Herman, 1993). What do we imagine for our clients? What relation-
ships, professions, skills, ambitions, loves, do we imagine are possible? A part
of music therapy training is to learn to minimize the unequal power relationship
of the therapeutic dyad, or to use the interpersonal dynamics of this to the
client’s advantage. Although this is a good start, this does not change the
institutional hierarchy of power, also paralleled and experienced in the music.
Thus, social construction of violent gendered relations persists.
Bureaucracy, feminism, and music therapy

We work in industrialized societies where bureaucracies are the ideal models of
providing care. One characteristic of bureaucracy is specialization of professions
(Blau & Meyer, 1987) for the purpose of rational institutional functioning. In my
work as a music therapist, I was always struck by a sense of over-specialization.
Specialization is prone to missing the big picture. Even if we have the big
picture, within an institution it is theoretically not our position to think about

this. In bureaucratic structures, we do not hold the authority to have legitimate
knowledge of functioning beyond music.
Smith (previously mentioned) studies issues in the sociology of knowledge
and the social construction of reality from a feminist perspective. Sociologists
examining the construction of knowledge, such as Smith, are interested in how
we arrive at knowledge socially. I suggest that therapy is a form of knowledge
production, the production of knowledge about one’s life. It is that particular
therapist/client dyad, that particular music, that particular institution that
produces a specific knowledge about oneself. A different institution, a different
dyad, a different music thus equals different knowledge about oneself. Gender
hierarchy and subsequent oppression are part of our health bureaucracy. Being
an unaware part of the bureaucracy contributes to the construction in everyday
life and activities of gender oppression. Gendering in music recreates gendering
in the therapeutic experience.
Another characteristic of bureaucracy is the significant effort spent
defining job descriptions (Blau & Meyer, 1987). The professionalization of
music therapy may actually be part of the reason it cannot be feminist in model.
Professionalization has included aligning ourselves to similar adjunct mental/
social health professions, as we create acceptance for our work. Our therapeutic
processes, models, and daily activities closely resemble recreational therapy, art
therapy, social work, counseling, etc. Is this really how music works when used
as a part of healing?
The construction of assessments, goals, objectives, evaluations, clinical
notes, and insurance diagnoses, are all how we socially create what is necessary
in order to legitimate our profession and to legitimate the need for our job.
Professionally, we must also construct the body of knowledge, including our
journals and research venues, to legitimate the likelihood of pay. If we were just
helping someone on our instinct, our intuition, our biased care, we would not be
granted the authority within the bureaucratic hierarchy. So, there are experiences
in music that we have cut out of sessions because what remains must be able to
be written in case notes and thus remunerated. Our beloved music is being used
to maintain client status.
Sociological thought and research (Marx, 1844, Simmel, 1902–1903,
Weber, 1905) provides evidence that industrialization and globalization have
brought about increases in alienation and weak social bonds. Under patriarchal
systems, which are the only systems that currently exist, where power, prestige,
and privilege are part of any social construction of reality, women as a gender
category, and women/girls as mental health clients, are alienated to a greater
degree from power, prestige, and privilege (Stefan, 1996, pp.195–218).
As we write our case notes and plans, we are part of the “practices of
ruling” in our kind of society (Smith, 1990, p.24). We are “rewriting the other’s
world and imposing upon it a conceptual framework that extracts from it what
fits with ours” (p.25). Smith is critiquing the sociology of knowledge and
sociological inquiry. I find parallels relevant to our jobs as therapists.
As professionals we know how to practice and preserve the rupture

between the actual, local and historically situated experience of
subjects and a systematically developed consciousness of society . . . .
We must be competent performers of this severance. (Smith, p.52)
Smith examines the texts of the relations of ruling, such as the reports of
ceremonies, task forces, and ad hoc committees. I find similarities to case notes,
session plans, and reports for health insurance.
The immediate and concrete features of experience become a

resource for the expression of the conceptual version; the
particularities fall away and only what can be grasped and interpreted,
divested of its material basis remains. (Smith, 1990, p.52)
The presence and actualities of our clients’ daily activities are subsumed into our
professional schema of interpreting. Our theories produce knowledge for
organizational relevance and purposes (p.145). “Setting up categories, develop-
ment of methods, filling categories . . . these are integral to the organization of
the state . . . and the relations of ruling” (p.144). Importantly, Smith finds that
the results of this are damaging: detaching mood and feelings from “lived
actualities disconnects them from possibilities of change, action and of power”
(p.137).
Smith (1990), in distinguishing between feminist sociology of knowledge
and traditional sociology of knowledge, believes that as women, we inquire into
the particulars of knowledge, the social organization of knowledge. She offers
an alternative: knowledge is not transcendent of local and particular worlds;
instead, “knowledge can be investigated as the ongoing coordinated practice of
actual people” (p.62).
Music has become a text in the “relations of ruling.”

“Objectified forms of knowledge structure the relation between knower and
known” (Smith, 1990, p.63). In our profession, an objectified form of know-
ledge, a text of ruling, is our music. The music and the production of knowledge
about the music is a “virtual” reality. We are trained how to read our “texts,” our
music. We know our clients through a “textually” mediated reality. They
become an “objectified form of knowledge constituent to the contemporary

organization of ruling” (p.63).
Thus, music becomes a text of relations of ruling. The technical knowledge
we have of the music is not accessible to the majority of clients. They are on the
receiving end and we seek to understand them through the lens of music, as we
know it. As music therapists, our knowledge of the client outside the “textual
presence” is not relevant to our specific job in the institution. We apply our
schema. Clients have some response—sometimes profound. Even if we claim
that we don’t interpret, we still must place our knowledge somewhere within the
institutional structure above them. We begin to produce an account of their
behavior from our viewpoint. Often, we don’t offer assistance with a client’s
social situation, only with the emotions.
As we translate music therapy sessions to our colleagues or multi-
disciplinary teams, our knowledge of the client becomes dislocated from the
lived actuality with the music. The music experience has a situation-specific
quality that is also dislocated from the situational specifics of a person’s actual
life. Yet, our music therapy assumption and ideology are that these are related.
Music has become a “bureaucratically controlled text” (Smith, 1990, p.65).
Our professional procedures legislate a reality rather than discover one.
The objectified forms, the rational procedures, the abstracted

conceptual organization create an appearance of neutrality and
impersonality that conceals class, gender, and racial subtexts.
Institutionally differentiated spheres of bureaucratic, managerial, and
professional control manage the local situations that people
experience as a totality . . . the domestic situation of women is
parceled out into issues of housing, mental illness, child neglect,
poverty, welfare, and family violence. The actualities of class,
gender, and race are dispersed over a range of sites within the
institutions of ruling. (p.65)
II. PRINCIPLES FOR A FEMINIST MUSIC THERAPY

Drawing on the work of feminist musicologist Susan McClary, feminist
sociologist Dorothy Smith, and feminist linguist, Genevieve Vaughn, I argue for
these introductory principles:
1. A feminist music therapist is well trained in the social premises of

music and challenges the social functions of music that unconsciously
perpetuate gender oppression.
2. A feminist music therapist practices friendship in music.
3. A feminist music therapist understands that music out of a bonded

community context is dissociative and disembodied.
4. A feminist music therapist works to make music free from the
capitalist patriarchal paradigm of economic exchange.
Principle: Be well-trained in the social premises of music.

Conventional Wisdom by Susan McClary and Music and Society edited by
Richard Leppert and Susan McClary are recommended reading for those
interested in beginning to listen to music in a sociologically minded manner.
McClary summarizes the focus of her own work as exploring “the social
premises of music.” As she demonstrates throughout her music analyses,
“gender-related issues have intersected with music at different historical
moments” (2000, p.1).
As a graduate student in music therapy, I surveyed all available recorded
music by women composers in an attempt to find suitable pieces for Guided
Imagery and Music programs. In the process, I was trying to discern what
qualities make good music for GIM. Although there were hundreds of
recordings by women from which to choose, the musical canon of GIM was
following the musical canon of the performance world of Western “art” music.
GIM was culturally wedded to the masterpieces, which historically were all by
male composers. Some questions that I grappled with were: what did this mean
for clients when the gender of all the music was male-composed? I knew from
my classical music studies that gender relations for the specific historical period,
as well as the gender construct of the individual composer, are indeed embedded
in the form of the music, but how does this translate to the therapeutic
experience and how do people begin to reinterpret their lives through this
process?
Historically, women did not have the same access to compositional
opportunities as men and the gendered social history of the classical music
canon cannot be changed, so I did not have as much accomplished material to
consider, although I made some recommendations. If therapy is resocializing a
client to society, what was this unarguably gendered music resocializing her to?
These are particularly important questions for GIM because the method lends
itself to trusting in the music on the part of the therapist and the client. Trust the
masterpieces.
This project led me into the sociology of music. McClary always does a
brilliant job of arguing against the claim that there is anything “purely musical”
about any piece of music. Traditionally trained music therapists, like our music
performance colleagues, have been taught that the structure of music is just
“forms, chords, and pitch-sets” (2000, p.2), not gender, not narratives, and not
politics. Music therapists have extended the idea to imagine and perceive the
possible psychotherapeutic connections to musical structures—without much
solid research underpinning the nuanced ideas we have of particular pieces, or
passages or even instruments—which calls upon the question, what is ethical in
the professional “ruling-relations” (Smith, 1990) in which we work?
Imagination, well-educated ideas, and intuition are all wonderful if we were
helping a friend in an equally powerful situation. But, this is not the case. Music
therapists work in hierarchical bureaucratic structures in which our
interpretations become record, add evidence to diagnoses, to treatment plans, to
medication prescriptions. Ultimately, we influence the life course of our clients
and the social construction of their particular illness. We influence their path to
wellness, which really goes against the motivation of bureaucratic institutions.
We need ongoing, chronic illness in order to keep our institutions and our
professions running.
Describing her standpoint, McClary writes, “I have found it impossible to
accept any kind of bedrock certainty, anything natural or purely formal in the
realm of human constructs” (2000, p.2). Music, gender, and therapy are the
human constructs for our consideration. Since the nineteenth century, Western
art music has striven to go beyond convention, toward the purely musical. My
experience as a music therapy student, and thus part of my orientation to my
practice, was that these purely musical moments were somehow related to the
healing potential in music. In GIM training this applied very specifically to
music that is believed to be non-representational. My perception was that we
were to prepare sessions that could create maximum interface for clients with
these moments in music. From my feminist orientation, I felt that I could not be
certain that these definitely palpable moments of validation, insight, and
intuition occurring in the relationship trio—client, therapist, music—were purely
helpful. What if this experience was not really change for the better? Who was
defining better? Even if a client is defining change as better—what are we
socialized to believe is better? Of course, much of our socialized beliefs are for
the betterment of human progress. However, looking at the socioeconomic status
and quality of life indicators for women, our socialized beliefs about gender are
not serving us well. Thus, gender analysis of music is required for feminist work
in this field.
Within our clinical dialogue, some of us are able to be sensitive in our
speech and are situationally open-minded, trying to avoid socializing our clients
back into unhealthy gender norms. But, can we do that with the music that we
choose, create, or listen to in therapy? Are necessary situational issues not
changing because these moments in music are in effect recreating the bond to
society with all of its gender hierarchies? Rather, therapeutic goals ought to
analyze to what type of society we are re-bonding and how we are constructing
everyday life. Having studied the prolific sociological data about the lives of
women, I have come to the conclusion that reorganizing ourselves and clients
back into these norms is actively anti-feminist.
Principle: Challenge the social functions of music that

unconsciously perpetuate gender oppression.
A significant image was passed on to me in the course of my music therapy
training: the belief that male therapists and female therapists are different in
essentialist ways. I do see sociological evidence for some essential differences
between the genders but the current understandings of the differences are the
ones I disagree with. We construct reality in everyday interactions. We can
change gendered realities in every interaction. The conventional differences are
the oppressive forms. Based on an analogy of the male or female in sexual
intercourse, homosexual or heterosexual, it was suggested that male therapists
know how to help clients push through issues, to pierce through, penetrate, etc.
and female therapists know how to surround, to hold, etc. It was also suggested
that you could identify these properties in music—male or female qualities,
mother or father qualities. It may be that gendered qualities describing these
exist representationally in the music (McClary would probably support exactly
that), but is this the engendering that we want to continue—has this helped us?
Is this then the music that is healing? Using music that is unconsciously
gendered in the same oppressive forms with which we have been gendered is
powerfully (because we know the encompassing effect of music on the
organism) resocializing a person to the same thing all over again. It is
dissociative to think that music has separate qualities from those in society.
Having just birthed a baby one year prior to the completion of this chapter,
I have birth analogies running parallel in my mind. This belief system I
mentioned is also suggestive of the crisis related to our divorce from natural
birth. If you know natural birth, you know that the power of women to birth the
divine into physical form takes quite a bit more intensity, strength, focus, and
love than the pacified, receptive, holding qualities we associate with the
feminine. Not to mention that this original idea of women in sexual intercourse
is a false understanding of the anatomy and physiology of female sexual
experiences. I don’t fault the person for passing on this analogy, but rather, I
point to the sickened gendered state of humanity. This is just one example of
how cultural practices, values, and beliefs intersect with therapy decisions and
musical perceptions.
Music performs social functions. What are these functions? What dominant
cultures are upheld? What dominant gender ideologies are upheld? If these
questions are unexamined, music therapists can’t deny our role in perpetuating
these social functions.
I return to the problem of analyzing the social function of music for use by
therapists. In the GIM canon example, it is easy to assume that Western
“classical” music belies interpretation of cultural constructedness because of its
supposed non-representational qualities. However, I quote McClary (2000) at
length as she introduces her feminist musicology and highlights the functions we
need to be interested in as well.
I want to explore in music history the kinds of processes Raymond

Williams calls “structures of feeling,” Fredric Jameson the “ political
unconscious,” Roland Barhes “mythologies,” Thomas Kuhn
“paradigms,” Kaja Silverman “dominant functions,” or Ross
Chambers simply the “social contracts” that establish the conditions
for the production and reception of artworks. Whatever we label these
structures, they are intensely ideological formations: whether noticed
or not, they are the assumptions that allow cultural activities to “make
sense.” Indeed, they succeed best when least apparent, least
deliberate, most automatic [italics, mine]. Although musicologists
and theorists often grant these kinds of formations the status of the
“purely musical,” I will treat them as conventions—albeit
conventions that so permeate human transactions that we usually fail
to notice their influence. And I want to examine the values they
represent, the interests they reinforce, the activities they enable, the
possibilities they exclude, and their histories within the contested
field that music inevitably is. (p.4)
Conventions in music—the songs we take for granted, the phrases we

assume to signify certain feelings, the rhythms we believe represent certain
states of experience—McClary says are “nothing less than the premises of an
age, the cultural arrangements that enable communication, co-existence and self-
awareness” (2000, p.6). Masterfully describing the argument and complexities
of form versus content in music analysis, she encourages us to move beyond just
methods for skepticism and to “consider how music actually operates as a
cultural practice” (2000, p.8).
She asks the questions I believe we need to ask about gender. “What social
needs did musical conventions satisfy, what functions did they serve, what kinds
of cultural work did they perform?” (2000, p.65). She goes on to discuss the
convention of tonality, on which much of our work is based, as constructing the
ideals of rationality, individualism, progress, and centered subjectivity. She
argues that music is not just reflecting the times, but also that “these musical
procedures participated actively in shaping habits of thought on which the
modern era depended” (2000, p.65).
Our tonal and timbral system of music helped construct the values required
to build an industrialized, corporate, patriarchal society. John Shepard concludes
that the “vast majority of music consumed in the Western world is concerned
with articulating, in a variety of different ways, male hegemonic processes”
(1987, p.171). He documents how classical music through its “insistence on
standardized purity . . . gives expression to the closed, finite and infinitely
repeatable nature of capitalist social relations (p.161),” including our
constructions of gender. Classical music is not neutral, safe, harmless, or
innocent, but alienating to all but the bureaucratized norm. He examines the
parameters of timbre, pitch, and rhythm in classical and popular music and finds
male hegemonic processes dominating and recreating the traditional ideas of
gender, despite the conventional associations. He claims that the “technical
characteristics of music represent little more than sites over and through which
power may be mediated textually” (p.172).
Principle: A feminist music therapist is to practice friendship in

music.
I remember one client I was going to visit in the AIDS unit of a nursing home. I
was properly trained and knew my professional role well; I was to walk in the
room with my goals, objectives, and empathies squarely ready for the session. I
walked in and found the client distressed that her long hair was severely matted,
from roots to ends . . . her room and body neglected by family and staff. Was I
to facilitate or support her in expressing her distress toward this situation—how
might that be handled by staff and psychiatrists? To help her relax, be
comforted? Would this physical neglect be continued then? What did I do? I
gently combed her hair for an hour and chatted. This, I know, is not
reimbursable music therapy.
I argue that we have taken a wrong turn in the professionalization of our
field. Our human species has survived difficulties up to this point, through
kinship relationships, friendship relationships, and shared community concern,
not through time slots, goals and objectives, and specialized people for
specialized purposes. Friendship in music is the only humane, musically moral
option. We have taken preindustrial practices of music, that of music for
community bonding and physical healing by a known community member, and
tried to fit this into the systems of industrial/postindustrial “health” institutions.
Therapeutic relationships, and the necessary codes of ethics, have been designed
as just a blip in time, a substitute relationship, typical for industrialized societies
that have lost community, generational, and familial roots and ties.
In the movement against domestic violence, the empowerment model of
counseling is espoused. This model is a good place to start in finding a way to
practice friendship within social service settings. A basic tenet of this model is
that a counselor does not need a certification or professional license to help
another woman find safety and make choices. In my experience, counselors
adopted the following nuanced assumptions as part of this model:
1) The woman is the authority on her own life, not just

ideologically, but as a matter of life and death. Only she knows
what is and is not possible for her own individual situation of
surviving violence. Following the advice of a “professional” can
put a woman in danger because she does not follow her own
instincts.
2) Advocates minimized their own personal details that might
otherwise intimidate a woman or indicate to her that the
advocate knows better. Generally, education and socioeconomic
differences were deemphasized.
3) Advocates fought to maintain as much privacy for the woman as
possible, from the state and from other helpful people. The
details of conversations were not shared among staff, casually or
formally, and the absolute minimum was recorded in a file.
4) The advocate clearly indicated the optional nature of the
relationship. There were no requirements. In other words, the
message was not: “we will give you shelter but you must meet
with a counselor once a day. . . .”
To generalize these ideas to the practice of friendship, I suggest these

qualities that are found in the literature on the sociology of friendship:
1) The relationship is personal in the sense that it is one individual

to another individual. It is not the individual to the group
(hospital, nursing home, school, etc.). Non-kin relationships
form on a one-to-one basis not a one-to-group, or a one-to-place
relationship. Often the client is asked to form a trusting
relationship with the group of people providing care, and each
individual that provides care represents the group. The therapist
should not use the power of the group or institution as an
assumed basis for a therapeutic relationship. How would you
converse or interact with this woman if she was in your
community of relationships?
2) The therapist should seek to protect the privacy of sessions as
you would an important conversation with a friend. I always
personally felt that I was betraying the confidence of a client
when I wrote case notes and shared information with treatment
teams. Certainly there is a short-list of information that ought to

be passed on; we can work toward that short list.
3) The relationship must be voluntary.
4) The relationship should be non-exploitive. The relationship
should not serve any instrumental purpose for the therapist.
(This is a whole article topic in itself.)
5) The relationship should be equal in status.
6) Recognize that in many cultures if you have truly helped her, in
her eyes, you have surpassed friend status to one of kin. Honor
this.
7) The relationship should have some reciprocity. As therapists we
like to imagine that we don’t seek to gain anything from a client,
that the relationship cannot be mutual. But, bottom line, it is. It
pays our salary; that is a reciprocal relationship. In a more subtle
line, a woman will feel embarrassed for always being helped or
receiving services without feeling that she can repay. For
example, regarding the practice of not accepting gifts—although
I certainly know the pitfalls—there needs to be some method
that a client can feel that she is giving back. Otherwise, the “we
can’t accept gifts” serves to indicate to the woman that she is in
the helped status and the therapist is in the helper, thus the status
difference (Allan, 1979, pp.35–47).
Historically, feminism has sought to equalize power relations or radically

shift institutional conventions. Unfortunately, the more the movement against
domestic violence has become bureaucratized, the less this model has been
accepted, and violence against women and their children is still raging in
increasingly severe methods.
I worked in domestic violence shelters for years, and of course, we had
ethical guidelines for behavior and wonderfully professional staff. However, our
allegiance to our job, the administration, the funding streams in non-profit work,
and our field undoubtedly resulted in times where we had to choose against the
truly ethical (versus the professionally ethical—most of the time they are the
same, but there is a distinction), in service of preserving our place in the
professional hierarchy. As the course of professionalization goes, we have all
mastered the ways of interpreting events and of explaining knowledge of an
experience to rationalize why we could not follow a certain course of action
over another. Again, in a feminist orientation, the humanely, truly ethical and
the professionally ethical are not always the same. In a friendship model, the
client supersedes the bureaucracy or the institution in importance.
I don’t think combing this client’s hair was the bureaucratically or
professionally ethical decision—I don’t properly recommend this to music
therapy students. However, what does it say about the role of music in
institutions? It is applied at ordained, efficient times. It is routinized, it is
gendered. Statistically, we the female support staff serve to legitimate the
authority of psychiatry. (Personally, I don’t have experience in health
institutions where psychiatry was not a key component of the team; so, extend
my ideas only to this type). A staff member saw me doing this and the next time
I came to visit this client her hair was shaven.
Principle: Music out of a bonded community context is

dissociative and disembodied.
Experiences of dissociation and disembodiment are qualities of everyday life
documented throughout the ethnographic record of patriarchal society. Music
outside of a mutually bonded community is artificial. It is mechanized.
Returning to the birth analogy, consider what we have done to birth in this
culture . . . mechanized it, medicalized it, theorized it, diagnosed it, disintegrated
the flow into sections, parts, different rooms, different locations, taken it out of
the natural, lived setting, introduced different professionals for different
purposes throughout the process, and made it “The Norm.” We have done the
same to music in institutions. I ask the feminist reader this: Is this the music that
inspired you to become a therapist?! Entrenching ourselves in professionalizing
and legitimizing our field is in my opinion not feminist and not the potential of
musical intelligence for our species. It is trapping it. It only serves to maintain
the status quo.
In my understanding, a feminist music therapy seeks to transform, relating
at all levels of society. Music should be restored to its flow in natural time and
in its natural communities. Music that socially acknowledges life passages,
facilitates community bonding and personal wellness can only wield its power
under these conditions. I ask myself, after examining gendered emotional
barriers, if I were instinctively creating a social ritual using music to facilitate
healing, would it really require, for example, ongoing, scheduled sessions of 50
minutes, with assessments, evaluations, goals and objectives, with a suggested
length of 6 months or more? Sometimes one embodying experience is all that it
takes to move on. However, this in not the basis for a job, and thus my point of
caution. Be alert to how clients are becoming part of the construction of our job.
However, we should be embracing the essential, authentic community-supported
path toward the client’s own true healing and confronting/changing systematic
oppression.
If music could be researched and proven to help heal the neurological
damage done to each individual in this culture of violence (beginning with our
culture of violent birth and the template this creates for the rest of our lives, see,
for example, the works of Joseph Chilton Pearce); if music could work toward a
culture of connection and mutual bonds; if music could reverse the social
damage from this past Century of Violence, and be done in a way in which the
music relationship was not unequally powered through money, or status, or
authority, or engendered to current gender relations; if music could strengthen
common bonds between women and allies of women and decrease the alienation
that is symptomatic of patriarchal institutions (the family, education, religion,
politics), then we might have a feminist music therapy.
Principle: A feminist music therapist works to make music free

from a capitalist patriarchal system of exchange.
Through the work of her foundation and her writing, linguist Genevieve Vaughn
has identified and described two economies that operate in capitalist patriarchal
economies. One is the known economy based on exchange and the other is the
hidden economy based on gift-giving. In industrialized countries, the volunteer
work, social bonding work, mothering, and household work of women is the
hidden economy. In developing countries, the unpaid work of women supports
the economies of industrialized countries. Feminist political scientists have
analyzed the sacrifices made by women in this hidden economy (see, for
example, the works of Maria Mies). Usually, this is presented as a problem to be
corrected. Vaughn, however, theorizes that this may be one of the ways out of
capitalist patriarchal systems and all of the accompanying violence and
oppressions. She labels this model the “gift paradigm.” “It is a way of
constructing and interpreting reality that derives from the practice of mothering
and is therefore woman-based (at least as long as women are the ones who are
doing most of the mothering)” (1997, p.30). She starts from the premise of gift-
giving in language, extending this to the values of mothering, making
suggestions for a new, valued economy.
Vaughn demonstrates how the patriarchal exchange economy is a parasitic
system. “Those above are nurtured by the free gifts of their ‘hosts’ below. Profit
is a free gift given to the exchanger by the other participants in the market and
those who nurture them. Scarcity is necessary for the functioning of the system
of exchange and is not just an unfortunate result of human inadequacy and
natural calamity” (1997, p.34). Similarly, therapists and policy makers have
made sanity a scarcity (see Presidential Commission on Mental Health) in order
to make a profit. I was recently in a conversation with a counselor in private
practice and noted the language as she described the challenges of “growing her
practice.” Clients give therapists free gifts in the form of their difficulties, and
therapists are nurtured; although in our exchange economy it looks as though the
flow goes in the other direction.
The more we quantify, evaluate, and analyze music and musical responses
by clients for institutional purposes, the more we participate in the exchange
economy. A gift-paradigm of music would be need-based, and given without
needing an equal return, or a “fair” exchange. Therapists’ fair exchanges are our
texts in the “relations of ruling” (Smith, 1990). As Vaughn eloquently explains,
the exchange paradigm is really more about the gift-giver than about the one
supposedly receiving the gift. In other words, we give only to get something
back. In capitalist thinking, we are trying to find the parts of music, the
phenomena of music that occur in relationships with clients that can be captured
and replicated easily and cheaply for profit, if not for ourselves, for our
institutions.
This does not rule out the possibility of work in music therapy. I believe it
just requires that we offer a different paradigm for the functioning of music to
the places in which we see a true, not just professional, need. In trying to
imagine how this might exist in the world today, I envision a cross between the
role of a hospital chaplain and the role of the facilitator in earth-based traditions.
A chaplain role maintains flexibility in the timing of meetings, no-bureaucratic-
strings-attached (ideally), and a voluntary nature of the relationship. The space
of a chapel would be a better model for a music therapy room: honoring life
passages, facilitating community bonds, and encouraging personal wellness as
understood in a broader social context beyond the institution providing care.
Earth-based traditions encompass indigenous traditions, pagan, goddess, and
wicca spiritualities. The life cycle of birth, death, and regeneration is celebrated.
The divine feminine is still a part of the ceremonies or rituals. Typically there
are non-hierarchical forms of shared leadership. The interdependent nature of
our existence is honored. These traditions are often community- and/or location-
dependent, and not viewed as universal to all human beings. The traditions are
flexible, creative, and dependent on the needs and desires of particular
communities. Starhawk and Hilary Valentine (2000) provide a model for
facilitating reclaiming rituals. In facilitating rituals, the psychological privacy of
the participants is respected and protected, sharing one’s process is optional but
still deeply transforming. The facilitator is well trained in setting up the space
and flow of the ritual, yet there is no observer status that will be documenting
progress or level of connection to the event or material. Starhawk and Valentine
do not separate the spiritual, or psychological from the political, and participants
have power as a group.
In this type of role, music therapists could question the efficacy of
insurance systems, the nature and hierarchy of treatment teams, and the standard
concepts of mental health, with a focus on unhealthy gender norms. If the APA,
as a group, can challenge and even politically encourage the legalizing of gay
marriage, then music therapists and allied expressive art therapists can certainly
challenge the hegemonic sterilization of creativity as it is expressed within

health care institutions.
CONCLUSION
In conclusion, I hope this chapter encourages a sociologically-inspired interpret-
ation of gender in the professional context of music therapy, and in the larger
institutions in which we work. I hope the principles for a feminist music therapy
are a strong enough foundation on which to begin building a new paradigm of
music therapy. Thank you, Sue Hadley, and the reader, for offering me the
opportunity to imagine this possibility.
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READING 5
Aigen, K. (2005). Two Excerpts: Paths of Development in Nordoff-
Robbins Music Therapy, pp. 249-282, 283-298. Gilsum NH: Barcelona
CHAPTER 14 Publishers.
Excerpt One
The Music
Kenneth Aigen
MUSIC AS THE AGENT OF CHANGE
In considering psychotherapeutic applications of music, other models of music

therapy can stress its cathartic value, its value as a projective device, its ability
to circumvent defenses, its ability to reach preverbal areas of intrapsychic
conflict, its transpersonal or healing qualities, its capacity to facilitate
emotional expression, its ability to function as transitional object, or its
symbolic value, among others. The Nordoff-Robbins approach is perhaps
unique in emphasizing the objectivity of music and the therapeutic value of
this quality as it becomes aesthetically realized.
This emphasis can stimulate questions in the psychotherapeutically-
informed music therapist who comes into contact with this work: What is the
nature of the music in this therapy, whether that of the therapist, client, or that
which is created together? Is the music accurately considered to be personal
expression for either the client or therapist, or is the focus on the music as
more of an objective entity? What is the real agent of change in this therapy?
Is it the music, the therapist's personality, the therapeutic relationship, or some
inner capacity within the client? What is the role of personal expression and
relationship dynamics in this work?
As both the individual client studies and the following analyses show,
music was often used because of its ability to objectify a situation, elevating
it out of the dynamics of the therapeutic relationship. Consider Paul singing
to Loren, "Here is a drum, here is a boy. What is the boy, going to do, on the
drum?" With Loren, there were relatively complex relationship dynamics
occurring which influenced the course of the therapy, yet these were not
acknowledged or worked with by the therapists. Instead, the music was used
as a third entity (not client and not therapist) in order to help Loren make
cognitive and emotional gains that would be prevented by becoming embroiled
in relationship dynamics.
This illustrates an important recurring function of music in this work: that
is to help the client engage in emotional experiences and challenges without
the personalization of experience which mobilizes defenses, resistiveness, and
250 Paths ofDevelopment
resiStance. 61 The music, as a third clement. carries <at least) two levels of
communication in this regard: because of the forces present in tonal and
hannonic motion and in rhythmic impetus, music as an autonomous,
traDspersoDaI entity carries its own oommunications, demands, invitations, and
gratifICations. Additionally, it can provide a field for expression of the
therapist's will-filled communications and invitations to the client without
evoking the natw'al resistances to a more direct expression of these personal
desires and intentions. Thus it is not that the music merely provides a
camouflage, masking the therapist's willful intentions, and it is not only that
music is a conveyor of impersonal communications. Both of these levels of
communication happen simultaneously.
The music becomes, and is used as, another personality in the session.
Rccall with Martha how it was observed that her musical experiences became
more meaningful and enjoyable when she learned "to trust music itself." In
some ways, this coming into relationship with music itself could be seen as the
ultimate goal of the courses of therapy comprising this study.
THE USE OF IDIOMS, STYLES, AND SCALES
All forms and models of music therapy, by virtue of using music, can have
their interventions described through the language of idioms, styles, and
scales. This is true even for those therapists whose primary vehicle might be
atonal improvisation, because this music also has tonal, rhythmic, and
harmonic relationships regardless of to what extent these relationships are
consciously employed. This observation, however, is not so interesting in and
ofitselfunless we also consider the following two questions: 1) Is the musical
description a salient one in considering clinical process? By this I mean that
just because we can describe an intervention in terms of its formal musical
characteristics, e.g., melodic contour, key, style, or idiom, etc., this does not
necessarily mean that we are providing important information regarding
clinical process. This can only be determined empirically. The distinction
61 In their writings. Nordoff and Robbins employed the term "resistiveness" rather
than "resistance." This choice was probably guided by a desire to refer to all of the
elements of the therapy and music that the client resisted being affected by. and not
just by the unconscious elements which would be implied by the latter term. Moreover
"resistiveness" takes on a positive valence when the client begins to resist regressive
and avoidant tendencies.
The Music 251
being drawn here is between an intervention occurring through or in a
particular scale, key, <r idiom, as opposed to the particular scale, key, <r idiom
beingpart ofttY: interveoticn 2) lfthe musical description does have clinical
relevance, can we fUrther specifY if the relevance holds for the theory
guiding the therapist's interventions, or for the client's experience of the
intervention, or for the actual clinical outcome? Thus even if the theory
underlying a particular model of music therapy supports the use of interven-
tions amprised of specific mllsical elements, it is not necessarily the case that
this aspect of the model either has an effect on the client or is a crucial factor
affecting clinical outrome. This does not mean that it is an unimportant factor
for the model as a whole, just that it is more important in understanding the
therapist's interventions than in understanding the processes that mediate the
client's growth or development
The fact that a particular musical intervention occurred within a Dorian
mode, for example, might be due either to A) random or nonclinical factors,
e.g., therapist preference, or B) it might have been chosen either deliberately
or intuitively (but without cooscious intmt) by the therapist. In (A), the formal
musical description will not tell us anything about the therapist's treatment
model because the interventioo takes place within the mode; in (8) the musical
descriptioo would give us important infonnation about the treatment form as
the mode is the intervention (along with the way that it is realized).
Also, it may be that the tonal and hannonic relatiooships of the Dorian had
a unique, identifiable impact on the client's experience in which case the
musical descriptioo is relevant, thus providing an answer in the afTumative to
question (1); on the other hand, the client may report that other factors were
more important in determining his/her experience, e.g., the choice of
instruments, the absence or presence of melody, the therapist's touch on the
piano, etc., in which case the formal musical description in terms of key and
mode would not tell us anything relevant to understanding the intervention in
terms of the client's experience.
Last, there are times when the client's experience or self-report may not
be an adequate indicant of clinical outcome. This can occur when the self-
report is distorted, either due to conscious or unconscious factors, or when
self-report is not possible because of disability or medical condition. In these
cases, it will be difficult if not impossible to determine the relative clinical
importance of the tonal relationships comprising the clinical music.
One of the defining characteristics of the Nordoff-Robbins approach is an
unambiguous position on the two questions posed above: The musical
description is always important clinically, both from the standpoint of gaining
Paths ofDevelopment
insight into the client's experience and for understanding the therapist's
intervention. It is a foundational belief of the Nordoff-Robbins approach that
things such as the direction and shape of a melody, the voicings of a given
chord, and the tonal relationships of a particular scale, will directly affect the
client's experience and hence, clinical outcome. Thus, if we want to understand
what elements in the therapy situation helped accomplish clinical goals, then
we look to the melodic, harmonic, and rhythmic construction of the music.
Because the therapist thinks, feels, and acts musically, endeavoring to
draw the client into an ever-expanding world of musical choices and experi-
ences, one can also always gain insight into the therapist's interventions
(again, either on a conscious or intuitive level) by looking at the formal
musical descriptions. This is because it is believed that the experiences of joy,
satisfaction, intentionality, exhilaration, introspection, etc., which the therapist
seeks to create are determined by the keys, scales, intervals, rhythms, tempi,
modes, etc., that give rise to these experiences and opportunities. In short, the
same factors which render the musical description relevant to understanding
the client's process also render this description relevant to understanding the
therapist's process. Thus, using one's knowledge of the various tonal and
hannonic relationships characteristic of the various forms of music as a guide
to clinical intervention is more than a useful heuristic strategy, as can be the
case with many psychodynamic psychotherapy theories. Instead, this
knowledge is believed to represent the objective reality of music and its
archetypal impact on human beings.
Before proceeding in this discussion, it may be helpful to review the
various types of music employed with the eight clients studied here. Keep in
mind that this list will not include all of the music used with each child, only
that music which can be clearly categorized. Moreover, I have not included
music that may have been used only once or twice in an explorative way, but
have kept the list to that music which was an important, recurring part of the
therapy process, or that which may have only been used once or twice but was
a salient part of the clinical process. Last, all of the clients except Mike and
Indu were also exposed to song forms utilizing traditional western harmonies
and melodic structures in addition to the types of music listed with each
individual client:
The Music 253
Audrey Traditional Classical Styles (waltz, opera), Eurythrny Exercises

Martha SongFonns
Loren March, Waltz, Symphonic Improvisations
Terry Middle Eastern, Dissonant Clusters, Ascending Sequences of
Dominant-Tonic Chords, Waltz
Walker Pentatonic
Indu Dorian Mode, Phrygian Mode, Contrary Motion Scales (with
major scale in the ascending hand), Phrygian Improvisations,
Pentatonic, Major-Minor Chord Alternations, Whole-tone, Orga-
num, Romantic, Chromaticism, Tritone, Spanish, Minor Keys (as
a recurring element)
Mike Chromatic Waltz, Chromaticism, Spanish, Pentatonic, Whole-
tone
Anna Pentatonic, Middle Eastern, Mixolydian Mode, Waltz
11te relative placement and frequency of the different scales and idioms in
Mike's therapy illustrate some of the important principles underlying the work
in this study. We will briefly examine the musical elements within each of his
sessions and discuss how their presence reflected beliefs over the nature and
use of styles, idioms, and scales:
Mike's Sessions and Accompanyinl: Music

1) Pentatonic 9) Spanish
2) Whole-tone 10) Chromatic Waltz
Pentatonic 11) Chromatic Waltz
Chromatic 12) Chromatic Waltz
Spanish Spanish
3) Chromatic 13) Chromatic Waltz
4) Chromatic Spanish
5) Chromatic 14) Spanish
Chromatic Waltz Chromatic Waltz
6) Chromatic Waltz Whole-tone
Pentatonic 15) Chromatic Waltz
Spanish Spanish
7) Fifths 16) Chromatic Waltz
Chromatic Waltz Spanish
Spanish 17) Chromatic Waltz
8) Spanish Whole-tone
Chromatic Waltz Spanish
frequency of Occurrence for Each Styielldiom in Mike's Sessions

Pentatonic - 3 sessions
Whole-tone - 3 sessions
Spanish - 13 Sessions
Chromatic (non-waltz) - 4 sessions
Chromatic Waltz - 14 sessions
Fifths - 1 session
First, it seems typical that the pentatonic is used in the first session.
Because of the absence of tension in its constituent scale steps, the pentatonic
does not make as powerful a musical statement as some of the other idioms.
Because it can easily be developed into other musical forms through the
addition of tones, it is an idiom that would lend itself to being used when the
therapist is getting to know a client, exploring areas of ability and need. The
fact that it was subsequently used sparingly-appearing in Sessions 2, 6, and
9-and not at all in the second half of Mike's therapy, shows that this was not
a particularly important idiom for Mike. Thus, just as simple intervals and
ambiguous tonal statements opened up the sessions with Indu, the pentatonic
as a less committed musical idiom can be seen as appropriate for beginning a
course of therapy with such a client as Mike.
The frequency with which the Spanish idiom and the chromatic waltz were
employed, together with the way they were employed as described in Chapter
10, reinforce the judgment that these were the two essential musical elements
of Mike's therapy. Typical is the way that both came in relatively early in the
course of therapy, the Spanish in Session 2 and the chromatic waltz in Session
5. Frequently, the fonns that were to become important parts of the courses of
therapy are revealed early in treatment. In fact, the non-waltz chromatic
playing also first was introduced in session two, showing the way that Paul
came relatively quickly to the musical elements which would become the
important recurring constituents of the sessions. This was also seen with Terry
where the Middle Eastern idiom was fIrSt introduced in Session 2.
Last, it is also of note that once Paul determined that chromatic music and
Spanish music were suitable for Mike, these forms were used almost
exclusively. In the second half of Mike's therapy (the last nine sessions) there
was only one other musical element employed (whole-tone) and this only on
one occasion. Again, there were parallels to this in the use of the Middle
Eastern idiom with Terry in the first two stages of his treatment. Recall that
in the third stage of treatment, Consolidation, the therapist brings in novel
musical fonns to meet the client's breakthroughs in therapy and to consolidate
The Music 255
the new and emerging sense of self. The presence of a uniform idiom from the
beginning to the end of a course 9f therapy might then indicate that all of the
clinical process was contained within the parameters of a single stage of
therapy as described in Chapter 5.
THE OBJECTIVITY OF MUSIC: IMPLICATIONS

FOR CLINICAL PRACTICE
In considering Paul NordoiT's use of different types of music a seeming

paradox arises between the belief in the objectivity of music,62 a central tenet
of the Nordoff-Robbins approach, and the highly individualized nature of each
comse of therapy in the present study. By the term "the objectivity of music"
I refer to the belief that there are qualities inherent in music which give rise to
particular human experiences. In this view, music can be said to have an
essential identity which is neither created by the individual human conscious-
ness nor resulting from the association of particular forms of music with
different human events and experiences.
Thus the statement that a given piece of music is, for example, austere,
triumphant, tragic, or conflict-embodying is not fundamentally different from
saying that it is in the key of D: the difference is in the degree of certainty
rather than in the type ofjudgement being made. 63 The same can be said-and
this is even more relevant in terms of the present discussion of Nordoff-
Robbins thought-for statements such as "the Middle Eastern idiom embodies
suffering and survival," or "organum is serious and grounding," or "the
pentatonic has ethereal characteristics.'>64 In the Nordoff-Robbins tradition, it
is believed that one can make such statements about music and be talking
about the music itself, not just one's experience of it. This is consistent with
Zuckerkandl's belief that scale steps and chord cadences also have inherent
62 This is a different concept from the one by which songs can "objectity" a clinical
situation to make it more easy to work with, e.g., "Where Is Terry?", "Here Is A Boy,
Here Is a Drum."
63 This is further elaborated in Aigen (1994) under the discussion of the objectivity of
aesthetic perception.
64 Only the statement regarding the Middle Eastern idiom was made by the Nordoff-
Robbins team. The other examples are being used for illustrative purposes.
2S6 Paths ofDevelopment
qualities because of their relationship to the dynamic field which comprises the
fundamental reality expressed by tones.
The concept of music underlying NordofI-Robbins practice is not just that
our verbal desaiptions of music can be objective but that the music has a life
of its own in a sense. There are tensions, resolutions, anticipations, even
interactions, which inhere in the music and which our capacity for verbaliza-
tion can only touch upon. In essence, there are forces which reside in music
and which the artful manipulation of musical materials, through composition
and performance, can reveal. The inherently musical experience has an
objective quality which is not merely created according to arbitrary or
idiosynaatic factors within each individual. In the view that emotive language
can intelligibly apply to music itself and be true on an intersubjective basis
there is a basic consonance with the ideas of Peter Kivy (1989); in the view
that there are forces in music which the musician and composer can manipulate
there is a basic consonance with the ideas of Victor Zuckerkandl (1956).
Kivy (1990) articulates a theory of instrumental music that does justice to
the role of emotion while avoiding the inconsistencies of the traditional
"expression themy" which holds that the affect evoked in a listener is identical
to the one that the composer experiences and intends to communicate through
the music. Kivy draws a distinction between music expressing an emotion and
music being expressive ofan emotion, recognizes that music can do both, and
notes that it is the latter function of music which is most often what is at play
in the appreciation of music. Kivy's theory-which is discussed in greater
detail below-sbows how emotive predicates can apply to music with a sense
of objectivity, a characteristic which has important implications for music
therapy. Before going into more detail on this we will first look at the
implications for a model of music therapy of the belief that music can
objectively possess emotional qualities.
A belief in the objectivity of music would seem to go along with a
prescriptive approach to music therapy, where the client's need determined the
nature of the clinical music in a formulaic manner. Yet, as I discuss below,
there is no way in which the clinical work in these studies can be considered
in any way prescriptive in this fashion. 6s Moreover, it is clear that the music
(is GaJy Ansdell (1995) also recognizes that explanations of clinical processes through
invoking the fonnal characteristics of music "contains certain dangers" such as

supporting a reductionistic or prescriptive approach, both of which he considers
antithetical to the process of "simply making music together" (p. 86) which is the
foundation of Creative Music Therapy.
The Music 257
aeated in therapy is the music of the relationship. Paul Nordoff was clear on
the point that the music that the therapist creates for a client reflects that
therapist's unique experiencing of the client (Aigen, 1996). The question then
arises: If the therapist believes that music has objective qualities, and these
qualities determine the effectiveness of clinical interventions, how can this be
reconciled with the claim that each course of therapy is determined individually
and empirically? It would seem that once a client's problems are "diagnosed,"
music could be selected, according to its objective properties, which would
best remediate these problems. This is the apparent paradox. Before
discussing a possible resolution of the paradox we will first consider why
seeing this work as prescriptive is inaccurate.
The empirical nature of this work can be seen in the way that various types
of music were introduced to the different children until something was hit upon
that was clinically appropriate. This was a music that both engaged a given
child and that provided clinical possibilities for the work to develop. Consider
the Middle Eastern idiom with Teny as exemplifYing both of these characteris-
tics of what constitutes a clinically appropriate musical idiom.
The empiricism guiding their efforts also means that the determination of
what was clinically appropriate in a given situation was made primarily in that
situation with each individual client, rather than based upon an extrinsic theory
in which pathology or clinical need determined the nature of the music. This
is why I believe that one would be mistaken in believing that Paul Nordoff
used music in a prescriptive way. Extrinsic or a priori notions about the
efficacy of a certain kind of scale or interval in accomplishing a clinical goal
were clearly less relevant than was the therapist's intuition in the moment. 66
To return to the dilemma then, a possible solution is to accept the
possibility of musical objectivity, without granting these objective qualities the
status of universality. This means that the objective qualities of music will not
66 The lone exception was the use of contrary motion scales with Indu. Paul was
clearly following a rationale which matched this scale with different sung vowel
sounds on different days of the week. Moreover, this was the one example where, to
my ears. Paul was playing a scale as a scale, rather than using a scale as the basis for
creating music. This intervention seemed experimental and both its rarity and unclear
connection to Indu's clinical process militates against its importance in understanding
the early Nordoff-Robbins work taken in its entirety,
necessarily be perceived in the same way by different individuals. 67 To

understand how this can be, let us return to some of the basic rationales for
Nordoff-Robbins work.
All of the Nordoff-Robbins work can be conceptualized as an effort to
draw a child into an experience of creating and/or living in an aesthetic form.
It is a basic assumption of this work that the benefits of doing so are self-
evident There is a clear sense that the organizing entities of music-and this
includes intervals, melodies, chords, scales, styles, and idioms-and their
realization through specific song and compositional forms and improvisations
contains the potential for creating liberating and healing experiences. The
therapist's task can be conceived in terms of mediating the experiences latent
in these forms so that they can be made accessible to disabled and otherwise
in need individuals.
Familiarity with the different ways music can be tonally, harmonically, and
rhythmically organized helps to guide and explain clinical interventions.
Whether chosen deliberately or intuitively-both of which can be a by-product
of inspiration-the different styles68 comprising the therapist's resources are
all utilized with the belief that they contain objective, archetypal qualities that
can be employed toward clinical ends. In this study, there were numerous
occasions where the nature and potentials of a specific style were crucial
elements: some of the more prominent examples were the Middle Eastern
idiom with Terry, the pentatonic scale with Walker, the Dorian mode and
organum style with Indu, and the Spanish idiom with Mike. In each case, a
quality of the music was drawn upon that inhered in that musical style, and
which was essential to the growth process exhibited in each course of therapy.
The dissonance, clashing, and message of survival in a harsh environment
characteristic of NordoiI's use of the Middle Eastern idiom served a vital
fimction in Terry's therapy; the absence of tension in the intervals formed by
the tones of the pentatonic scale created the most appropriate musical
environment for Walker; the organum helped to create a sense of a sacred,
archetypal process with Indu; and the ability of the Spanish idiom to so clearly
convey the force of will led to the breakthrough in Mike's ability to develop
sustained drum beating.
67 Note the departure from Kivy who claims that the reality of the emotive aspects of
music is demanded by the fact of intersubjective agreement as its character.
68 Rather than repeat the list-intervals, scales, idioms, modes, and styles-I would
like to let the term "styles" stand for all of these for purposes of the present discussion.
The Music 259
What can be wliversally agreed upon is the description of the tones,

hannonies, and rhythmic patterns which comprise each style. What is more
problematic is the claim that the nature of these elements somehow encodes
or contains the potential for specific human experiences such as that of
suffering and survival, or the ability to access and stimulate one's will. And
further, if particular styles of music contain specific human experiences, how
can this be reconciled with the individuality and spontaneity which it is
claimed characterize this work?
As mentioned above, a way out of this dilemma, and a way of bringing
insight to how Paul Nordoff used various musical styles, is to see that music
can have objectivity without wliversality or singularity. This means that while
certain qualities may inhere in a style or piece of music, the fact that different
listeners will hear different things does not mean either that one listener is
incorrect or that all of the responses are internal, subjective ones.
In this view, the nature of the qualities perceived in a given style or piece
of music is uniquely determined by the interaction of many individual factors,
such as one's musical history and prior experiences with a type of music, or
the re.evance of the quality for one's own psychological situation. In other
words, the nature of the objective qualities are situationally determined. The
key to understanding this point is to realize that the fact that various listeners
perceive the music differently does not mean that one listener is incorrectly
perceiving or distorting the nature of the music. Instead, there are multiple
levels of meaning and multiple facets that reside in the music; those that any
given listener responds to are determined by aspects of that person's musical
biography, not by irrelevant or nonmusical factors. Thus the variation in
perception does not occur in an arbitrary way and is, in any case, limited to,
but not determined by the inherent qualities of the music.
That there is a contribution on the part of the listener to which aspect of
the music is experienced does not render it any less objective, which here
means that the quality inheres in the music rather than meaning that it is
universal. It does mean that the objectivity does not guarantee any intra-
subjective agreement over the nature of the external object. Universality or the
building of consensus is a way that we often determine if an aspect of an
experience resides within the external world or within the perceiver. But we
should not identify the means for determining the objective status of a
phenomenon with that status itself.
A visual analogy for this process can be taken if one considers a
holographic picture in which the subject's eyes seem to be looking in different
directions depending upon the angle from which the picture is viewed. A
viewer from one side of a room will perceive the subject looking to the left,
and a viewer from the other side will see the subject looking to the right. Each
viewer, because of his unique vantage point or stance, will experience the
picture differently, although the fact that their unique positions determine what
they perceive does not mean that the quality perceived is not part of the
picture-it is not any less objective for not being universal.
With music, the individual's stance is not determined by his position in
space but by his personal character and history; it is a psychological stance
rather than a physical one. And just as in the example of the picture, it is this
stance that determines how a style or example of music is experienced. Now
some may hold that it is just the play of these factors that characterize a
judgment as being subjective rather than objective; the position argued for here
is that an educated listener can distinguish between personal reactions and
feelings released by music from judgments about the more perennial aspects
of music, even though both may be, in some sense, mediated by one's unique
personality and life experience.
In Terry's study, it was observed that the "emotional climate" of the
Middle Eastern idiom was appropriate for Terry because it conveyed the sense
of active survival in the midst of a challenging environment. Many listeners
may perceive this quality in the music created for Terry and see how it
functioned to mirror his inner world and struggle as well as provide a means
for fruitfully engaging this struggle. On the other hand, the Middle Eastern
idiom is also considered to be a dance idiom and can often be used to stimulate
and support expression through movement,. as was also done with Terry.
Different listeners may or may not hear these qualities in the music created for
Terry. The point here is that if one accepts that music can have objective
qualities without these qualities being universal, then the lack of unanimity of
opinion on the qualities conveyed by a piece of clinical music has no bearing
on the objective nature of either the experience stimulated by it or its clinical
rationale.
The belief that the different styles of music reflect objective, archetypal
elements is what recommends them as tools to master as part of practicing
within the Nordoff-Robbins approach. Any general statements regarding
particular styles are beyond the scope of this study-this type of analysis
would require the study of the various styles across a much larger sample of
clients than was drawn here. Nevertheless, it can be said that in addressing
clinical goals Paul Nordoff clearly worked with what were considered to be
objective, archetypal aspects of music. Yet the differences in type and number
The Music 261
of styles used with these eight clients show that this was done in a highly
pragmatic, individualized way. The objective nature of the various styles may
have suggested their use for the various individuals but this appeared to be
done in such a way that a priori beliefs about the styles did not take precedence
over each unique client and over each unique clinical dyad or triad.
In sum, the judgment that a given style of music is objectively "right" for
a given client does not conflict with the recognition that different therapists
working with the same client would probably (although not necessarily) come
up with different kinds of music, all of which might be objectively "right." The
view here is that the presence of idiosyncratic factors-mediated by experi-
ence, intuition, and tacit knowledge-does not necessarily render a judgment
subjective in the sense of being arbitrary.
One can maintain a belief in the objectivity of musical experience and in
the objectivity of clinical-musical judgments without being pushed to a
position of uniformity, ifuniversality of judgment is not seen as a requirement
for objectivity. This is how the paradox discussed at the beginning of this
section can be dissolved in a way that honors the uniqueness of each course of
therapy.
THE ROLE AND IMPORTANCE OF PERSONAL

EXPRESSION IN MUSIC
None of the foregoing should be understood as claiming that significance in

music is determined solely by objective properties. Individuals clearly have
personal and idiosyncratic reactions to music (as listeners) and uses of music
(as players and composers) and these reactions may be equally important (or
even more important) than the objective properties described so far in
understanding the significance of musical experience and expression in society
in general. Thus, the focus of the present study on the objective properties of
music and their relevance for Nordoff-Robbins theory and practice should not
be taken as a general stand on the relative importance of objective and
subjective factors in musical experience in general or in music therapy.
Yet, because of the importance of the objective properties of music in the
Nordoff-Robbins approach, the role of personal expression in the music
Paths ofDevelopment
created between therapist(s) and client is an ambiguous one. 69 Paul Nordoff

IUd Clive Robbins have not specifically addressed this question through their
published works. 'O In his study of appljcations of Nordoff-Robbins practice
with adults, Gary Ansdell (1995) has staked out a position which holds that
there are more vital and essential processes in the clinical creation of music
than those involving the client's personal expression, especially if we consider
expression as the cathartic letting of emotion. I have taken a similar position
in recognizing that the cathartic release of emotion is not particularly relevant
in understanding the basic processes of the Nordoff-Robbins approach, while
choosing to define "expression" in a way that actually requires the presence
ofmediating entities which transform the music from catharsis into something
involving a more enhanced awareness on the client's part (Aigen, 1994). Thus,
in my judgment, ~ilitating the client's personal expression through music can
be comfortably included within the Nordoff-Robbins approach, although this
expression requires the presence of a heightened awareness of forms, tools
(musical instruments), and the presence of the musical contributions of other
people (therapists, other clients) not required by the mere venting of feelings.
One reason for this is because the client almost never plays alone but is
accompanied by the therapist. And the therapist is fully present in the joint
musical product, not content to merely support and reflect; instead, the
therapist is always a musical force to be reckoned with. The way in which the
therapist is fully present as an autonomous presence in the music forces the
client to enhanced levels of self-awareness and musical functioning.
This interactional, interpersonal essence of the work is one reason why a
theory centering on emotional catharsis is not particularly relevant for
Nordoff-Robbins practice. Ansdell (1995) has also come to this recognition:
In Creative Music Therapy there is, even at the simplest level, this give-
and-take both between the client and the music, and between the client and
69 For purposes of this discussion I am not distinguishing between the therapist's

music, the client's music, and the joint musical creation but am instead considering
"the music" taken in its entirety. Thus, although the client's musical contribution might
be on a drum and the therapist may be playing the piano, it may be that the therapist's
contribution is what makes the music personally expressive for the client through the
client's capacity to become absorbed in that music.
70 Although Paul Nordoffhas said, "We use very little expression in music. We use
expressive components in music clinically" (Aigen, 1996, p. 11).
The Music 263
therapist through the music. The dialogue we have with the material or
other people in making something new in the world is an exploration of
our thought and feeling, not just a simple expression. . . . Improvised
musical dialogue has its life between the personal worlds of two or more
people: as a totally authentic creation of both of us, whilst being a purely
personal 'self expression' of neither of us. (p. 127)
I would like to be clear that when we are discussing the role of self-
expression in music therapy we are not considering the role of affect or
emotion in general. The question of the client's emotional investment in the
music is a given and I agree with Ansdell's statement that "the basic emotional
involvement in music and musical communication which Creative Music
Therapy gives our clients is one of its central therapeutic strengths" (1995, p.
121). He goes on to identify the important problem as considering "how the
'expressive' aspect in music and music therapy is understood" (p. 121), not
determining if it is present.
In a very broad sense, if a therapist is capably drawing inspiration from
the client in the creation of clinical music and the client is drawn in to this
music and cooperating eagerly in its cocreation, then we can say that the music
is self-expressive for the client in that it is manifesting an aspect of the client's
affective reality through an outer form. Yet it may be more useful to consider
a more narrowly drawn conception of self-expression where the music is
manifesting a present feeling in the client rather than just a general or
pervasive attitude toward the world or oneself. It is this bringing to life of a
present feeling which is closer to the generally understood idea of self-expres-
sion. What role, if any, was there for this process in the courses of therapy in
this study?
This is one area where it may not be possible to make general statements
that go beyond what was done with each individual in this study. As the work
with Audrey, Terry, Indu, and to some extent Loren, shows, in no way can it
be said that the Nordoff-Robbins approach avoids actively engaging and
intervening with areas of conflict within the client-with these clients the
music penetrated to their core conflicts. On the other hand, except for the
dramatic examples with Audrey, there were almost no instances in this study
where a child came into a session feeling angry, sad, withdrawn, or depressed,
for example, and this feeling was then worked with clinically. Thus, while
entire courses of therapy involved directly exploring and confronting the
client's deep-seated and pervasive mechanisms for withdrawing from life, the
everyday feelings that might flow from or reflect this withdrawal were not
Paths ofDevelopment
particularly engaged or focused upon in the therapy. For the clients in this
study, there does seem to be a clear sense in which music was used as an
antidote to the isolation which characterized much of their lives rather than as
an expression of it.
The spectrum of approaches to working with personal expression seemed
as follows. With Audrey, her needs and abilities in this area were primary:
[Audrey] began to by to achieve a deeply personal self-expression in the

free use ofher singing voice. This proved to be a fundamental therapeutic
act for Audrey, one which she continued in therapy.
Her present affect was incorporated into her therapy as many of the
examples in her study show, especially when "she sang herself out of her
aisis" in Session 16 and in her singing in her fmal group session ("What shall
we do? My stomach hurts''). In short, personal expression, understood as
releasing and giving form to a present feeling, was an essential part of
Audrey's therapy.
Much of the fIrst third of Anna's therapy involved working with her
generally positive and buoyant mood, and the music was in this sense self-
expressive. And while much of their therapy was not so oriented, the work
with Terry and Anna progressed to a point where working with problematic
feelings (sadness, loneliness) seemed like a real option, one that was only
briefly taken up in the therapy.
Loren was a boy whose problems were primarily emotional, including
pervasive feelings of isolation and anxiety. He is one child with whom many
music therapists working within a psychotherapeutic frame might have worked
with these feelings directly, giving them a musical manifestation. However, the
clinical direction taken with Loren was instead to elevate him out of his
situation, "to get him out of this kind of negativism" in Paul's words. Helping
Loren to express the feelings he brought into the therapy room was clearly not
a focus. However, the feelings of triumph as Loren progressed in gaining
control over the music, and over his anxiety and excitement, were directly
expressed in the music.
With Martha, Walker, Indu, and Mike, although the clinical music was
clearly inspired by them and their presence and needs, it did not appear as if
personal expression, as we have been discussing it here, was an aspect of their
processes in therapy.
When we consider all eight clients in this study, a certain pattern emerges.
When negative or pathologically-rooted feelings (anger, despair, isolation,
The Music 265
depression) are encountered that seem to be a product of the client's general
c:ondition in life, these are either confronted directly or circumvented; they are
never merely reflected or gently supported by the therapist-in short, these
were phenomena to be either defeated or avoided, and only rarely explored. It
maybe that these were seen as products of the "condition child" (Robbins &
Robbins, 1991) and as such were necessarily growth inhibiting.
When these difficult emotions seemed to be more situation specific, such
as with Audrey generally and on one occasion each with Terry and Anna, the
feeling was supported and worked with by the therapists. Recall how Paul sang
"I am very sad today" and "I am going to cry today" to reflect and enhance
Audrey's mood in Session 15, as well as to help draw her into a more aesthetic
expression ofher mood with the aim of activating her musical intelligence and
sensitivities. Also consider Paul's singing "Terry is sad today" in Session 27,
and Paul introducing a minor key in Anna's therapy on a day when he
observed that she was sad. Making the determination as to the origins of the
problematic feeling is what may have guided the therapists' decisions
regarding which aspects of affect to work with and which to circumvent or
avoid.
Moreover, personal expression through music does not exhaust the
possibilities for the relation between music and affect. As was mentioned
above, Kivy (1989) draws a distinction between music expressing an emotion
and music being expressive of an emotion, a distinction which can be useful
in 1B1derstanding the role of personal expression in music in Nordoff-Robbins
practice and the larger role of affect in general. He uses the example of a
clenched fist and raised voice which are said to express anger while a Saint
Bernard's drawn and downward-cast face can be said to be expressive of
sadness-it is clear that there is a very different relationship between the
individual and the emotion of anger from that of the Saint Bernard and the
emotion of sadness. Kivy is concerned with a theory of music which shows
how music can be expressive of emotions; he does not deny that music can
express emotion, but asserts that the "expressive of' case is more enlightening
in generating an understanding of the general significance of music in the lives
of human beings.
As mentioned previously, Kivy believes that the emotional nature of a
piece of music is objectively part of its character. It is the power of music to
be expressive ofhuman emotion, which is also part of the Nordoff-Robbins
work studied here. This explains why much of Paul Nordoff's music, while not
necessarily personally expressive for either him or the client, was nonetheless
passionate, heartfelt, and full of emotion. Yet by being expressive of emotion,
a distance or objectifying took place which brought the client out of his or her
own immediate emotional reality to a more universal domain of human
expression. It was these universal musical forms, certainly influenced by
Nordoff's career as a composer, in which the emotive character of the music
was contained and the perception of which activated and integrated these
clients' emotional and intellectual processes.
ESTABLISHING A MUSICAL WORLD
Music is an enormous world to live in and to work in. It's the only world
we can conceive that can meet the variations ofpathology as one sees
them in any individual.
Paul NordojJ
(Aigen, 1996,p. 12)
You 've created an ongoing tonal world to which she is now relating.
Clive Robbins
(Aigen, 1996, p. 29)
Clinical music therapy improvisations have been looked at in terms of the

establishment of a mutually understood language between two or more
individuals (Ruud, 1986~ Aigen, 1991). What we see in the clinical studies
under discussion-some much more than others-appears to go beyond this
conceptualization and requires that we consider the process of therapy more
completely as the establishment of a mutually experienced world. I take this
global characterization because in the analysis of these sessions we see client
achievements which did not seem possible outside of the music: some of the
clients seemed able to work through pervasive inner conflicts~ others
functioned in music unfettered by the barriers imposed on them in nonmusic
situations~ new value systems and self-images were created~ and music was
used in a way that seems paradoxical when described verbally. Thus in many
dimensions, when entering their sessions these individuals did seem to be
stepping into a novel experiential realm characterized by its own language,
value system, epistemology, spiritual belief system, and metaphysic.
This characterization of the process of Nordoff-Robbins music therapy as
the establishment of a musical world was first discussed during the consider-
The Music 267
ation of Indu's course of therapy. It also seems quite apt when, for example,
we consider the processes of Teny, Mike, and Anna. Due to their disabilities,
Indu and Mike were significantly more socially isolated than were Anna and
Terry, yet the fact that the creation of a musical world was also an important
aspect of the latter two individuals' therapy shows that it is not a case of music
assuming greater importance just because words were unavailable.
Ansdell (1995) has identified a similar phenomenon which he calls the
"Between" after Buber's concept of the interpersonal realm in which
communication between individuals exists. He recounts an attempt to describe
music therapy to someone who understood it in the following way:
I see-it's like the difference between being on land and being in water.
Suddenly you feel different-freer, supported, you can do different things.
He elaborates on these remarks:
Changing the medium you are acting in, whether from land to water, or
from words to music, can give a different feeling of both yourself and how
you relate to other people. Within this "musical between" a relationship
can come about which is primarily in the music. (p. 68)
For Indo, the musical world was a place in which he could be differently,
act differently in a way that was less constrained by his condition in life. We
can only speculate that his experience was like that of someone being liberated
through being transported into a new medium which allows for other physical,
emotional, and interactive possibilities.
The way in which new possibilities for interaction were enabled by music
is one reason why I think that this establishment of a musical world is a more
appropriate description than merely that of creating a mutually understood
language. Providing someone with a new language may allow for the
communication of an inner state that was previously barred, yet it is the
establislunent of new experiential realm which allows for the transcendence of
disability characteristic of this practice.
In addition to Indu, Teny, Anna, and Mike entered a space from the
moment their sessions began that was transformed because of the rules,
values, sensory stimulation, and social acceptance they received. What they
were met with there seemed so unlike anything else in their environment.
Teny, rather than being gently supported or even ignored, now had his
unfocused, drifting consciousness challenged and directly confronted. Anna
Paths ofDevelopment
was 110 longer the visually-impaired, wheelchair-bound, language-impaired

girl. She was a aeative, interactive; aesthetically expressive being engaged in
an auditory world of intelligent musical improvisation and repartee. The
fragments of Mike's world, expressed in preoccupation with sensory
stimulation and isolated beats on the drum, were now taken up and trans-
formed into building blocks of experience and identity; the energy that was
formerly dissipated was now being constructively channeled. For these
children and adolesa:nts, entering their sessions meant entering music, or more
accurately, entering an individually-tailored musical world in which their
capacities were heightened and their tendencies to withdraw from life were
either not activated or directly confronted.
It might be tempting to consider Audrey's involvement with the Cinderella
story in this light, although it is open to question how closely her experience
of the symbolic fantasy mirrored that of the experience of the musical worlds
we are considering. For Audrey, the world inhabited by Cinderella completely
manifested the world in which she already lived. This is certainly similar to
how the music functioned for Terry, Indu, and Mike in particular. And the
music used in Cinderella certainly heightened Audrey's investment in the story
and thus enhanced its clinical value. Yet it does not appear that the music was
the agent of change in this aspect of Audrey's therapy in the same way that it
was with the other children being considered here. Similarly, with Loren it
seems that it was more a case of working through areas of conflict through
music than it was of the musical interaction representing a way of being with
which he was unfamiliar.
Some of the characteristics of the early Nordoff-Robbins work can be
W1derstood in terms of their fimction in helping to create such a musical world:
the minimizing of verbal interactions; the strong reliance on a session-long
aesthetic form; the importance of the beginnings and endings of sessions, both
in terms of maintaining the clinical, working stance until the end of the music
and in terms of having consistent, transitional musical structures at these
times; the consistent use of themes throughout the session; the way in which
a given musical scale, idiom, or mode-and, by extension, the corresponding
emotional landscape-was so fully explored and tleveloped; and finally, the
lDliqueness of each course of clinical-musical development. All of these factors
can be seen as supporting the creation of a unique, all-encompassing world for
the children to enter when coming to their music therapy sessions.
For Audrey, Loren, Walker, and Martha the concept under discussion
seems to have less relevance, although it might be something that was more
under the surface than an active guiding principle. This supports the notion
The Music 269
that for any of the constructs or principles that one tries to abstract from
studying the clinical work there will be important exceptions. My own belief
is that we should apply these concepts where they make sense given the reality
Ofthe clinical work, not go into contortions to fit the data to match the theory
just to make it all-encompassing or wUversally true, and remember that the
experimental, empirical essence of this work ensures that any concept inferred
from it will necessarily be oflimited application and utility. The challenge is
to determine where the concepts can be legitimately applied to help illuminate
some of the processes that underlie this work, both within the client and the
therapists, and in the musical "Between" which forms their meeting ground.
Development through the Exploration of Opposites
Theorists in child development frequently observe how the exploration of

polarities is an essential part of personality development. Interestingly, the
process of development for many of the children in this study incorporated an
exploration of polarities, most often through the manifestation of contrasting
musical qualities. Colin Lee (1992; 1996) has observed a similar phenomenon
in his clinical efforts with adults which he calls "antithetical expression." In
his work with Francis, an accomplished musician, Lee (1996) noted how his
own contribution to the music often opposed that of the client: "My music was
acquiescent and static, in contrast to his, which was powerfully rhythmic and
resolute. The few times we united were balanced against long periods of
contrast" (p. 34). The study of Paul Nordofrs music independently revealed
the presence of this clinical phenomenon. Perhaps then, the exploration of
opposites through music reveals a more wUversal aspect of improvisational
music therapy practice not limited to application with a specific population or
age group.
As was noted previously, the improvisations in Audrey's early sessions
involved this kind of structure in a variety of ways. These included treble-bass
dialogues on the piano, alternations between consonance and dissonance, and
sudden movements between starkly contrasting musical moods.
The music in Terry's early sessions was at times gentle and contemplative
although these were punctuated by intense dissonant clusters. Although much
of his early music was comprised of the intense, working, Middle Eastern
idiom, Paul would, at times, whistle with the piano improvisations bringing an
element of warmth and humanity into a music which could be quite barren of
these qualities. In Session 12, gentle diatonic music in a major key appeared
270 Palhs ofDevelopment
for the first time. This soothing waltz, which manifested Terry's emerging
sweet, playful, and gende side, alternated with the powerful Middle Eastern
idiom, the music ofhis process oftransfonnation. Terry's transformation was
by no means complete at this time and the tension brought about by the
dialogue of opposites fueled his process through the breakthrough. Also used
with Teny was the chromatic sequence of dominant-tonic chords which is also
a dialogue of opposites. There is the opposition between the two chords in
each key as well as a dialogue between the chromaticism and the diatonic tonal
cadence.
An essential first step in Martha's process involved her mastery of the
"Cymbal-Drum Song" in which she alternated between tempo and dynamic
cootrasts. Anna also demonstrated significant growth in her explorations with
damping the cymbal to Paul's pentatonic music. Here she flexibly explored
dynamic extremes. Moreover, the "Yes-No" duet was a musical structure
essential to her process of development that also involved this dialogue of
opposites.
The alternating major-minor music used with Indu also conveyed the sense
of a dialogue of opposites: with him, the musical polarities reflected an
ambivalence or conflict over the process of entering into consciousness, of
becoming more fully alive. Interestingly, this is another example where the
music performed a dual function, simultaneously manifesting the area of
coof1ict while the energy produced by the tension of the polarities moved the
conflict, and Indu, forward. There is a feeling of advance as the major chords
sound, and a sense of retreat that accompanies the minor chords. The tension
caused by the dialogue is not unlike the contractions produced in childbirth
which pushes the child into being.
Because many of the development processes for the children in these
studies are couched in terms of their increasing mastery and flexibility in
music, it is natural that musical extremes are explored: after all, the develop-
ment of coarse distinctions and perceptions must precede the acquisition of
finer ones. Yet to see the dialogue or exploration of opposites merely as a way
of gaining musical skills would lead to an incomplete understanding of this
important clinical strategy.
As Bettelheim attests, the process of exploring extremes is an archetypal
one which permeates many areas of development. It is natural that the inner
processes and dynamics of music-insofar as it provides a field for human
development-should use as a template these processes of exploration and
dialogue. The purpose of these explorations is not merely to stretch one's
capacities to experience opposites and the tension thus produced, but to be
The Music 271
able to transcend the polarities by integrating them into a greater whole, just
as the child explores moral extremes in order to create an integrated sense of
self with a moral center. In this approach, the "children order their being as
they order their beating" (Nordoff & Robbins, 1971, p.53), showing that the
exploration of musical polarities and tensions thus involves an exploration of
one's inner world as well.
There were many instances in the studies where Paul's abrupt changes in
music were jarring and unexpected, seemingly unsuited to the mood. He
appeared to be wanting to elevate the client out of a particular emotional state
through the sheer power ofhis will and aesthetic gift. Perhaps the rationale for
this can be seen in the following statement by Paul regarding the connection
between his music and the client's emotional state: "So music can express the
child's emotions. Music can contrast this emotion and perhaps change it.
Music can resolve the emotional conflict and change the mood of the child"
(Aigen, 1996, p. 28). The use of musical opposites may have been one way to
bring the children into areas of emotional experience typically closed to them.
Music Expressing the Paradoxical
Related to the way that the music often moved between opposites is the way
that the clinical functions of music appear paradoxical when described
verbally, such as when music was used to simultaneously express opposites.
Again, while this phenomena was noted in most of the courses of therapy in
this study, the way in which it was realized differed markedly, both from client
to client and from when the expression was that of the client to that of the
therapist.
Audrey, Martha, Terry, and Indu were quite different from each other yet
there was a similarity in their processes in this regard. Recall how Audrey's
singing of "I cleep" (I sleep) represented a statement of her desire to remain
unencumbered by the burdens of awareness yet is also the moment in which
her dawning awakening and consciousness of self makes a most dramatic step.
With Martha, the tension in Paul's music both expressed her inner tension
while allowing her to function in a way that was less constrained by it. And
when Martha trusts music enough to yield her will to it she gains in the
capacity to effect willful action. For Terry the extreme levels of tension and
dissonance in his early music both reflected his internal conflict and served to
awaken him from it. This was similar to the conception of Indu' s process in
which his participation in music that expresses his fundamental conflict also
transcends the conflict by bringing him more deeply into his being. In all these
cases, the music reflected the client's inner life while simultaneously
transcending the limitations inherent in it.
Much of the potency of Paul Nordotl's clinical music seems to draw from
his ability to infuse multiple levels of meanings into it, some of which are
directly contradictory when we describe them verbally. Thus in the opening
moments in Indu' s sessions we hear music which simultaneously conveys a
sense of the imminent occurrence of momentous events along with a sense of
calm and settled acceptance. With Indu, Paul also used the elements of music,
such as the tritone, in ways that created a sense of tonal ambiguity within the
fonn of a powerful clinical statement. Hence the music could affirm something
while still being open to being taken up in a variety of directions.
The verbal descriptions of these uses of music can, at times, lead us to
paradoxical statements. Although neither Paul nor Clive expressed the concept
injust this way, their teachings often contained cryptic statements which imply
their recognition of this paradox. Here, Paul answers a student's question
regarding whether the function of music is to support or disturb a child's
rocking:
It's to do both things. In supporting the rocking it [music] brings a new

element into his experience.... You can say the music is supporting the
rocking and at the same time it is disturbing the rocking because of the
very nature of the music. (Aigen, 1996, p. 18)
And Clive also communicated a similar idea:
You've got to be half-inviting and half-directing, a mixture of the two, so

that your direction at the same time is an invitation. The impression one
has is that the music is leading and the music is waiting and even in
waiting it's leading. (Aigen, 1996, p. 18)
Hence, it may be more fruitful to think of these musical communications

as having multiple layers of meaning. It appears that Paul's music could not
ooly be multiply interpreted, but that these multiple meanings could be quite
opposite to one another. The multiplicity of possible interpretations that any
musical communication can bear makes it more likely that one of them will be
perceived by the client and thus enhances the ability of the therapist to forge
an interactive relationship with the client. Studying Paul Nordotrs use of
music leads us to a conception where the multiple meanings any musical
1heMusic 273
expression may have are not only perceived between different individuals but
also within each individual.
Before concluding this discussion I would like to point out that the
musical statement does not contradict itself or appear paradoxical musi-
cally-this only happens when we translate the musical experience into the
categories of thought dictated by the use of words. I do not believe that the
client receives "contradictory" messages in this music, which would- certainly
not be a rec:ommended clinical inteIvention. In fact certain pathologies are said
to have an etiology from being exposed to just such types of communications.
Instead, the fact that Paul Nordoff could play music that could be both
supporting and challenging, for example, is certainly one of the factors which
led to the efficacy of his approach. It stimulated his clients to take significant
growth steps while still feeling supported in their efforts.
Transforming Resistiveness into Participation
One of the many important contributions of Nordoff-Robbins theory for music

therapy is the way in which the level of resistiveness, as well as the more
traditional measure of participation, is assessed in determining the quality of
the music therapeutic relationship. Resistiveness is seen as a response to the
clinical situation and the particular quality of the resistiveness indicates the
level of relationship, much in the same way that participation does (Nordoff
& Robbins, 1977).
Yet the goal of this therapy is not just to establish a relationship between
client and therapist but more importantly, to establish a relationship between
the client and music. This is why resistiveness and participation are not given
equal weight ultimately, although they are considered equally when using Scale
I to evaluate the "Child-Therapist Relationship in Musical Activity" (Nordoff
& Robbins, 1977, p. 182).
In the work with Anna, we saw how her resistive tendencies were re-
contextualized through being framed musically. The songs "Yes-No Duet,"
"She Dropped the Sticks," and "No Music for Anna," all served to transform
her resistive tendencies into participatory ones. There were similar phenomena
with other of the clients:
Recall how in Session 27 when Audrey was reluctant to play her song,
Paul sang
274 Paths o/Developmenr
She won 'I sing

She won 'I dance
She won 'I beal Ihe drum with me
Whal will I do with Audrey?
thus bringing her resistiveness into the music. This led to her to the significant
clinical achievement of creating her own song called "Audrey Can Work."
In Terry's foW1eenth session he enters unwillingly and is wailing "No!"
This is taken up musically by Paul, and while Terry's resistiveness is
seemingly at its highest point, in his next session he is led into the most
interactive musical exchanges up to that point in his therapy process. This led
Paul to introduce the lyric and motif of "Terry is Here!" Terry's highest level
of resistiveness was thus transformed into his breakthrough beating.
When Loren tried to avoid the musical working with Paul in Session 2 his
playing became disorganized and formless and he tried to engage Paul
verbally. To bring Loren back to the music Paul improvised "Here Is a Boy"
which played a pivotal role in Loren's growth process. In the subsequent
sessioo this song led to Loren's breakthrough in therapy celebrated in the song
"Loren's Listening to the Music."
Walker's resistiveness was manifest in continually breaking off musical
contact once he became aware of it Yet in Session 3 he was able to participate
in an extended way when Paul continued playing after the end of the "Good-
bye" song. Paul and Clive continued to play for approximately one minute
before Walker joined in. The point was made that Walker was able to join in
because it came after the ostensible end of the session and he no longer sensed
an expectation to participate.
With all five of these clients, we can see the power of music to bring
resistiveness into its equivalent level of participation. One way to look at this
is a transformation of a response. It may also be that in the musical world one
can transcend the duality of resistiveness and response and live in a more
unified sphere of relationship. Perhaps the same qualities of music that allow
it to give simultaneous expression to opposites allow one's living in it to be
both resistive and participatory. If we take seriously the idea that living in
music represents an alternative experiential plane then it would not be
surprising that there are unique properties to this plane of experience that
cannot be directly translated into nonmusical ways of conceptualization.
The Music 275
THE IMPORTANCE OF SINGING
One of the common notions regarding Nordoff-Robbins clinical practice is that

the child/client typically plays the drum and cymbal. The source of this
stereotype is difficult to understand as two of the most well-known examples
of the work (because of their prominence in the text Creative Music Therapy)
were Edward and Anna, both of whom engaged in their most dramatic and
important clinical work vocally.
One of the striking observations in this study is how important singing
was for most of the clients: Audrey "sang her way out of the crisis," and used
song to work through her difficulties with terminating. For Martha, her "step
into the world of melody and vocal freedom" facilitated her inner integration
as well as allowed her to have experiences unconstrained by her fear and
rigidity. It was felt that "Martha's motivation and desire to sing [was] of
utmost importance." Terry sang "Terry is here!" to announce his self-
awakening; in the third stage of his therapy, singing became his most
important clinical vehicle where he expressed his playful and gentle side and
his capacity for interactivity. His development was most apparent through his
singing. With Indu, it was Paul's singing that was essential in creating the
sense of invocation and expressing the depth of his working passion. And last,
for Anna singing was her primary expressive vehicle, field of interaction, and
domain in which growth was seen. 7J
Although it is not immediately apparent why singing was so important in
all of these cases, there does seem to have been a variety of factors at work.
First, it is true that in all the studies except Walker, tonal, melodic instruments
(except the piano on occasion) simply were not made available. This is
somewhat puzzling, both because of the importance of melody in the work in
general and because pitched percussion instruments were being used in the
group work at this time. Hence, singing was really the only way for these
clients to participate actively in the melodic and other tonal aspects of the
music in their therapy. Second, there was little or no relating done outside of
the musical interaction. Therefore, any communications that would normally
be spoken were instead sung. Last, singing is an all-encompassing activity
engaging affective, cognitive, physical, and physiological processes. All of the
processes that Paul and Clive sought to activate through their work would be
engaged through vocal work. Moreover, there may have been a spiritual
71 Although Clive Robbins points out that Anna' s drwn work was also very important.
component to the emphasis on singing. This was only seen on an overt level
with Indu, yet the voice and breath has traditionally had an important role in
meditative and other spiritual practices which some may feel are analogous to
the way music was used by Paul Nordoff. This dimension of the work could
be most naturally realized through singing.
Because of these observations it is clear that singing is at least as
important as rhythmic work in the early Nordoff-Robbins collaboration; any
other conception of the work would be an incorrect, or at least an incomplete,
one.
MUSIC FOR A CHILD (CLIENT)
The Nordoff-Robbins approach is an active one concerned with self-realiza-

tion within processes of doing rather than with the passive contemplation of
being. The clients are enlisted as active music-makers and are encouraged to
engage emotional, physical, and cognitive challenges directly and to work
through them. Indeed, the emphasis in the therapy seen in this study is on work
and developing one's capacity for intention-filled action through creating and
participating in expressive, aesthetic forms.
For all of these reasons, the phenomenon of "Music for a Child" first
observed with Indu is particularly striking. This is music created by the
therapist that is neither a reflection of the child's activity nor intended to
stimulate an active response. This is music which is intended to be listened to
and is offered without conveying the expectation of an active response.
After discovering this phenomena with Indu it was also retrospectively
revealed in the work with Audrey, Loren, Terry, and Anna showing its
widespread application. However, this was something that was done sparingly,
arising out of the moment as an expression from Paul Nordoff of reverence
and deep affection for both the client and the process of musical self-
actualization in which he and Clive were engaged with the child.
For Anna, this first occurred early in the first session when Anna, after her
singing of "Good Morning" and "I a' School" withdrew by sinking back in her
wheelchair. Paul Nordoff improvised the "Good Morning Song" for her to
listen to. It also occurred at the end of Session 21 as Paul played the "Good-
bye Waltz" with longing, wannth and love. The song is extended and
developed for two additional minutes. At the end of Session 3 Terry is waiting
to be picked up by an aide. Paul plays music which functions as an extended
coda to the session. It traverses a wide range of musical moods and includes
The Music 277
a dancelike section during which Terry danced with Clive. This music is also
warm and sentimental, expressing Terry's process and foreshadowing a
positive, if poignant, conclusion to it.
A question to consider here is whether or not something that I am
identifying as a component of the Nordoff Robbins approach, Music for a
Child, is instead considered more simply as a spontaneous human emotional
reaction by Paul Nordoff. On one hand, the emphasis on being active so
characteristic of the approach would seem to be well counter-balanced by the
respite from activity offered by such an intervention. However, the paucity of
use suggests that this may be one element of the work studied here that comes
more from a basic human reaction than from a planned clinical decision.
Regardless of its origins, this expression struck me as a powerful personal
statement by Paul that was nonetheless still centered on the client and his or
her growth process.
In subsequent years, this technique seems to have become a more
conscious element of the Nordoff-Robbins approach. Although not specifically
codified as a clinical technique, in his rmal teaching collaboration with Paul
Nordoff, Clive Robbins made the following suggestion to a student:
Why don't you adopt an attitude-we've done this, Paul-when you work
with a child and try to get something out of [him or her], try to reach the
child, and it doesn't reach the child, put all the instruments away. She
comes in and there's nothing to challenge, there are no demands-you are
just going to give her warmth, love, compassion, musical richness and
you're not going to care what you get back. So she goes out a warmed,
cared for child [and we have] at least given something into that life that
she can take with her. (Aigen, 1996, p. 23)
Although the focus is on listening rather than playing, the use of such a
technique does not fundamentally change the approach from an active to a
passive one, it just moves the locus of activity from the physical to the
cognitive realm. Again from this training course, Clive comments on the value
of listening:
It isn't the fact that it's a passive response to a quiet piece of music. It's
an active response to a beautiful experience. (Aigen, 1996, p. 27)
The practice of providing Music for a Child should be distinguished from

the technique used with Mike of playing music that cannot immediately be
responded to in order to evoke a subsequent active response from him. That

use of the n:ceptive experiencing of music is clearly a clinical technique. This
is one example where it might be fruitful to distinguish between a more
perennial aspect of the Nordoff-Robbins approach-seen in the technique used
with Mike-from the more idiosyncratic aspect of Music for a Child as an
element evoked from Paul through his clinical and personal engagement with
specific individuals.
PAUL NORDOFF'S MUSIOANSHIP: IMPLICATIONS

FOR TRAINING
There was one session where Terry does his Middle Eastern belly dancing.
. .. And what preceded that was a tremendous energy Paul discharged
into the piano. I can hear some of that music in my mind now. I think that
the piano never worked so hard in its life. The amount of energy and the
Middle Eastern and the chromaticism of the music was so driving. But I
think for Terry it was extraordinarily animating.
When I study Paul's music something happens to me in my makeup, a

new kind of zest comes into me, a new kind of energy. There is something
in the creative spontaneity of the music---even with its repetition and
development there is something so uncluttered about it, there is something
that is so clinically-musically directive that it changes the way I feel. It
makes me feel healthier, it makes me feel more confident, it gives me an
energy, a personal energy. Even from the recordings I derive that.
Clive Robbins
At the time of this writing I have been deeply involved with the Nordoff-
Robbins work for five years. Clive's feelings about Paul's music have been
echoed by a number of individuals I have encountered and corroborated my
own reactions. In assuming that Paul's music has a unique, powerful, healing
effect on individuals, the following question began to intrigue me: When we
are studying his clinical work, are we studying: 1) the musical gifts of a unique
individual-in other words, Paul as a musician; 2) the clinicaVmusical
gifts-Paul as a unique therapist; or 3) Nordoff-Robbins music therapy as an
approach formally distinguishable from the attributes of a particular
person(ality)?
The Music 279
In this study I have tri~ to distinguish some of the fonnal aspects of the
Nordoff-Robbins approach from the unique and particular aspects of the
courses of therapy resulting from the personalities involved. Yet it is also
important to consider the positive aspects of the work which were specific to
Paul and Clive as individuals. Should these aspects be considered part of
"Nordoff-Robbins music therapy" when we talk about the qualities which
derme the approach?
A reasonable question to ask is, What is the value of studying Paul's work
if its efficacy was determined by his unique personality and musicianship?
Some might say that we are studying his work to detennine the more universal
elements to abstract general principles, but this begs the question of whether
or not the efficacy of his work was determined by whatever it is possible to
recast into the form of "general principles" or whether the truly salient features
of his work were due to personal attributes not fonnalizable into guidelines,
practices, or principles.
My own belief is that we are studying the unique aspects of Paul's work
and musicianship because these are intrinsically interesting. We also study the
elements that can be abstracted because they are important in the continually
evolving communal conception of what Nordoff-Robbins music therapy is,
how it should be represented, how it should be implemented with clients, and
how it should be taught.
I would like to assume for the moment that it is true that Paul's music had
healing qualities and this was one reason for its clinical efficacy. We can still
look at the elements responsible for these qualities and detennine how relevant
they are in fonnulating a conception of the Nordoff-Robbins approach and in
training therapists in its use.
Although none of the following will come as a surprise to anyone familiar
with Paul Nordotrs music, four such elements have emerged from the present
study:
Aesthetic. Compositional Quality

This seems undeniable. Most, if not all, of his music is ofa high artistic and
aesthetic level. Much of is beautiful, emotionally moving, and satisfying. He
is ,able to transfer the varieties of human emotional experiences into music in
a way that is highly aesthetically pleasing. Equally important is his com-
positional gift. Even when improvising, Paul's music has an organization that
makes it all feel well composed.
Musiciaoship
This is also of an objectively high level. His playing is neat and precise, not
lazy. He is facile at making abrupt changes and there are no limiting, habitual
musical elements.
A Zenlilre Quality ofBeing-in-the-Moment

Paul's music is always alive, never automatic, and is played with clarity and
fon:efu1ness. For me, it portrays a quality of completing living in the moment,
in the music, with whatever child he was engaged with at the time. His entire
consciousness and being is living in the music at the time.
Ability to be Himself Fully

Paul's music and clinical stance has a clear character. It appears forceful,
definite, WlCOlllpromising, aystal clear, tender, compassionate, and full of
fury. In these ways, as a therapist he was fully himself It seems that the
important element here was his ability to be himself as fully as is possible,
rather than possessing one or another personality attribute and emphasizing
this over all others.
Now we can look at the issues of training and definition of the Nordoff-
Robbins approach based upon these elements.
One thing that we can learn from this study is that music of a high degree
of aesthetic quality facilitates the goals of the creative music therapist. This
does not necessarily mean complexity, although this is not ruled out when
clinically warranted. It does mean that Paul's work teaches that more general
aspects of music appreciation are relevant in the clinical milieu.
There is no problem in seeing that any conception of the Nordoff-Robbins
approach must refer to the necessity for an aesthetic awareness on the part of
the therapist and the ability to transfer this awareness into clinical practice. In
training, there should be an emphasis on developing this type of awareness
through learning to appreciate the aesthetic qualities of Paul's music as well
as any other, clinical or general, and learning about the musical choices that
impinge on the level of aesthetic quality.
Of course it is already generally recognized that musicianship is an
important component of the approach and this is not novel. What might be
ftuitful to pursue, however, are the particular aspects of musicianship that Paul
manifested and used so effectively. To me these had more to do with things
such as touch, clarity, precision, use of space, harmonic freedom, flexibility,
and the ability to make momentary changes, than to the ability to play difficult
The Music 281
musical passages, for example. These qualities could be elaborated through

further study md would have the advantage of being translatable to instru-
ments other than the piano. Thus, while musicianship is already a part of
conceptions of Nordoff-Robbins music therapy and its recognized training
programs, it may be possible to elaborate on the important aspects of
musicianship md to tie them to clinical purposes.
Something that has onJy been alluded to informally, but that was written
about in the text Being in Music (Aigen, 1996) is that the quality of Paul's
musici8nship and its clinical directedness and clarity seems to be derived from
his ability to live totally in the moment while still creating musical forms that
possess a sense of direction and purpose. It reminds me of the Japanese
painting style which demands that the artist not remove his brush from the
paper for to do would destroy the fragile paper-tbe work is thus created from
one continuous line with no margin for error. It demands a total concentration
characteristic of other endeavors such as athletics, something which Clive
Robbins has alluded through his concept of being "Poised in th~ Creative
Now." Although it may be difficult to formalize this quality of being we can
see how an analogue of mediational disciplines, such as Zen meditation or Tai-
Chi, could be encouraged in the training, not in a dogmatic or zealous way, but
taught with the same quality that one teaches musical exercises. This could be
similar to the way that certain training programs strongly support the idea that
the student should be in personal therapy but do not require it.
If living in the moment has something of a spiritual or transpersonal
quality, the complement to this is the psychological manner in which Paul
could so completely be himself as a therapist. The lesson to draw is not that
aspiring music therapists should strive to "be" Paul or be like Paul, but that
they should be themselves as deeply and as fully as Paul was himself. This
ability to live in one's feelings, humanity, insights, and intuitions, and to
manifest them clinically, is what gave Paul's clinical work its potency.
It is no secret that Paul Nordoff was in psychoanalysis in his thirties and
one can only speculate as to what degree this influenced his own personal
development in his adult years and how it influenced his work as a therapist.
Nonetheless, it can be seen that this goal of being more completely who one
is, is something that can be addressed through personal growth activities such
as formal psychotherapy, music therapy, clinical supervision, or peer groups
oriented toward furthering one's development past the point that therapy
typicaJly leads. The idea of personal growth is one that should be incorporated
into the conceptions and practices that underlie Nordoff-Robbins training,
although I would recommend that the ultimate form of this growth, or more
Paths ofDevelopment
accurately, the vehicle by which it is achieved, could be left to the individual.

The purpose is to emphasize the importance of being fully comfortable with
oneself and being able to conununicate our human personalities through music,
rather than supporting a particular activity, e.g., psychotherapy, analysis, or
cocoWlSCling. Thus by focusing on the purpose or the end product, different
Nordoff-Robins training centers could implement the policy in a way
consonant with their particular culture and values.
The important point is that one does not cOme to this state of being
automatically; it must be actively strived for. Those individuals responsible for
training therapists might consider the value of this development and support
its implementation through means of the trainee's choice.
It is important to emphasize that these last considerations were essential
components of Paul's effectiveness as a therapist. For if one's goal is for
clients to feel alive, to live in the moment, to develop their wills, to become
more conscious, to be themselves, to develop their personalities, to become
more human, to become alive, then clinical interventions must possess these
qualities. The clinical work studied here often centered on bringing experi-
ences to individuals that they could not have created for themselves. Without
the therapist embodying the values and qualities he/she would like the client
to acquire, there is no way for the client to take this leap. In some ways, Paul
and Clive embodied the state of being into which they endeavored to bring
their clients. This message comes through loud and clear in Paul's music and
interventions and Clive's support and direction of them.
Paul's and Clive's stance seems natural here. If a therapist wants children
to be alive, spontaneous, and acting willfully, then the therapist must embody
these qualities of being. And if the hope is for clients to overcome the growth-
inhibiting forces within them, then therapists must embody and offer forth the
fruits of the same struggle within themselves.
CHAPTER 15 Excerpt Two
The Clinical Process: Work, the Will,

Creating a Self
Kenneth Aigen
WORK
Perhaps no other concept is as central to understanding the early formulation

ofNordofI-Robbins practice as is the concept of Work. Many of the ideas,
attitudes, and practices discussed in this study can be derived from Paul
NordofI's and Clive Robbins's fundamental ideas about the nature of work
and its role in human functioning and development. These include elements
such as the emphasis on gaining musical skills; the directive, almost authori-
tarian approach; and the confrontational clinical stance. Work, even more than
play, appears as the process most central to the early formulation of the
NordofI-Robbins approach.
Without exception, the clients in this study were led into work of one form
or another. At times the evolving ways in which work was used and the
attitudes taken by the clients toward it charted the development of their
therapy processes. Often the work took the form of developing musical skills
in drum beating or singing. Work was used for a myriad of purposes: to
counteract a poor self-image (Loren, Martha); to enlist intelligence and
creativity against emotional instability (Audrey); to penetrate isolative
psychological states (Teny, Mike, Indu); and to consolidate important clinical
breakthroughs (Anna, Terry, Audrey, Loren).
Understanding the role of work in this therapy, and the importance placed
on it, necessitates an understanding of how it was conceived of by Paul
Nordoff and Clive Robbins. I would like to preface the exposition of their
ideas by observing that their emphasis was completely reflexive in the sense
that it applied equally to their clients and to themselves. They lived their work,
it was that simple. In the course of this study I listened to 189 sessions, most
of them twice. Outside of the fmal four sessions or so with Terry, there was a
working intensity emanating from the two therapists that never wavered or
flagged. They were there to work and expected as much from their clients. This
respect and reverence for their therapy work certainly carried over into the
many thousands ofbours spent reviewing and analyzing the recordings of the
284 Paths of Development
sessions. 1heir commitment to and belief in their work was certainly one of the
factors that led them to build their lives completely around it.
I used the term "reverence" deliberately, as Paul and Clive approached
their work with a fervor, love and commitment that conveyed the sense that
they believed in its sacred character. There was a clear indication that their
work was done with a total engagement and sense of caring because it reflected
spiritual strivings and beliefs. Paul and Clive's belief in the value of work did
not preclude it from also being joyful, fun, spontaneous, and, at times,
subversive.
Work, as conceived by Paul and Clive and implemented in the courses of
therapy comprising this study, has many qualities which underlie its impor-
tance in Nordoff-Robbins music therapy:
1) Work necessitates consciousness of one's activity

2) Work requires the selective inhibition of energy, affect, and impulse
3) Work requires frustration tolerance and the delay of gratification
4) Work is an expression of will
5) Work requires care, concentration, and reverence
6) The rewards of work build through time
and perhaps most importantly
7) The ability to engage in meaningful work is a necessary component

of psychological health because it gives meaning to life
This last observation is probably the most speculative one and bears some
discussion at this point. My inference here results from considering the
message given by the insistence on careful and systematic work. It says that
something is worth doing and worth struggling through because there is a
reason and purpose for it. In some sense, work fulfills our destiny as human
beings. It says that people matter, that what drives us and gives us satisfaction
matters, and that struggle and perseverance are necessary to gain anything
valuable.
The Nordoff-Robbins musical game "Pif-Paf-Poltrie" (Nordoff &
Robbins, 1969) is built on such a premise. The climax of the play involves the
main character constructing a broom to music and sweeping a floor full of
leaves from materials that have been scattered at the story's outset. The play
The Clinical Process 285
involves the experience of bringing an act of work to its completion. "Pif'

illustrates the core belief presently being discussed: that not only is therapy
work but that work is also therapy.
Loren's process illustrates this point. In discussing how Loren's resistive
tendencies reflected his fear of work because of the prospect of failure it
embodied, Paul and Clive explain their strong clinical stance:
Now it was not my aim to entertain Loren. to comfort him or to placate his
injured feelings. I had experienced his general level of intelligence and his
considerable musical resources. I felt that this avoidance of "work" was
a negative act of Loren's aimed at destroying the situation in which he was
sure he would fail. (Nordoff & Robbins, unpublished manuscript)
Because Loren's primary pathology was manifest in a fear of work,

developing a positive attitude to work or an ability to work was primary; we
could even say that successfully engaging in work was of secondary impor-
tance for his therapy. We might even go as far as to say that avoidance of work
is avoidance of life; embracing work is to embrace life in all of its struggles
and rewards. For children and adolescents who were clearly not being
challenged because of the attitudes then held toward the disabled, the music
therapy setting represented one of the only opportunities for these individuals
to achieving meaningful work, all the more meaningful because it was not
constructed on guarantees of success but on the promise of struggle.
Many of the working techniques in these studies seem oriented toward
enhancing the client's awareness of the music being created. The therapy
process often appears as the acquisition of a sequence of musical skills
requiring increasingly more sophisticated perceptive and expressive abilities.
Although not universally applicable,72 it is possible to see a developmental
sequence, with Loren for example, that included working on the Basic Beat as
a precursor to rhythmic patterns and melodic rhythms. Consider Paul's
explanation for his approach with Loren:
I decided to work for the antiphonal repeating of patterns because this

would require him to listen to a pattern before repeating it-while
preventing him from playing basic beating patterns.
72 I say "not universally"

because some clients will be able to play rhythmic patterns
and melodic rlIythms without being able to discern or participate in playing the Basic
Beat Wlderlying these elements.
Paths ofDevelopment
Thus, for someone who is not aware enough of the musical environment
to engage in basic beating, or whose expressive skills inhibit the expression
of this awareness, basic beating provides a clinical direction. Yct, Loren had
achieved this and, for someone like him, basic beating can take on an
automatic, rotc character. On the other hand, the antiphonal playing of
rhythmic patterns required, from him, a higher degree of awareness in the
mcxnent. His work necessitated a consciousness of what he was doing and how
it related to the music provided by Paul Nordoff.
Paul's explanation also illustrates how important the inhibitory processes
are in allowing one to engage in meaningful work. This is something that was
prevalent with almost all of the work with beating, except for Mike whose
excitatory processes required stimulation. Loren must check his impulse to
play the Basic Beat in order to repeat Paul's patterns; initially, Martha played
in a compulsive manner, unable to structure her beating into phrases or to
repeat Paul's patterns; and Indu's tremor prevented him from sustaining
participation in the cooperative creation of music. All of these examples show
how important awareness is in developing one's capacity for work.
Even when a client was not consciously engaging in work, Paul created
work out of the situation. In intervening with Mike's sensory preoccupation
with the resonance of the drum, Paul's created context produced the work
phenomenon and it is work which endowed the sensory preoccupation with a
meaningful focus and intent. For example, consider the example in the text
when Paul uses ascending chromatic scales that convey the sense of the
physical act of ascending, such as scaling a wall, until the climax into the
pentatonic which functions as the goal of the previous music-it sounds as if
we have reached the top of the ascent. Paul creates the sense of an organic
completion of a task. His music represents the process of willful, goal-oriented
action embodied in work. Here, the work process and goal is that of aesthetic
creation.
The focus of Anna's therapy evolved from spontaneous interpersonal
relating to developing her capacity for work by bringing "her inspiration,
intelligence, and sensitivity in music to a place where they could be con-
Sciously applied." Thus, even in a synthetic course of therapy, the concept of
work is still important, still central. Therapy is never just about creating
relationship, spontaneous relating in the moment, or the expression of
emotions: there is always an element where the will is focused on, where the
capacity for work is accessed because the ability to work is essential to self-
actualization. Moreover, work is tied to a human social context. The human
social context transforms activity (without meaning) into work (which has
meaning) much in the same way IS aesthetic fonns transform emotional

discharge into emotional expression.
THE WILL
The Concept ofWiU
Understanding the concept of willful action is also essential to fully under-

standing the courses of therapy in this study and true work cannot occur
without it. Before discussing its application to some of the actual clinical
work, let's hear what Clive has to say directly about this concept:
One of the concepts that was very important to us was ... this concept of
will. Not merely because Steiner73 has said that most of the problems that
handicapped children have are problems of the will. Not because of that
but because youfeel the will is so important in how you handle life, in
what you do in life. If you just look back to Audrey's early sessions, [you
can hear] the absolutely uncontrolled quality of her will, the terribly loud
beating, the impulsiveness, the wanting to rush out of the room, and yet
the evasiveness when directly challenged. The only way she could handle
the world was to dominate it. And then [as her therapy progressed] the
whole refinement that took place in her will through musicality coming in
and modulating, moderating, forming the energy.
It appears that "will" is being defined in this sense as incorporating the

power of conscious and deliberate action, but also going beyond it. After all,
it is not that Audrey, for example, is incapable of willful action. It is that the
manner in which her will was initially expressed lacked any kind of moderation
required in the shaping of artistic, aesthetic expressions. And we have already
discussed how, for Martha, it was not just that she gained control over her
body that was important, but that she could exercise this control through her
will as an expression of her knowledge.
These considerations require an exploration of some relevant
philosophical concepts. I do provide the caution, however, that the following
ideas are speculative, although consistent with what we have been discussing
73 "Steiner" refers to Rudolf Steiner, whose teachings fonn the foundation for the
spiritual and educational practices of anthroposophy.
so far about the Nordoff-Robbins approach. I am offering them in the belief

that illwninating some of the conceptual and historical foundations of Nordoff-
Robbins thought will help us to better understand its central constructs,
concepts, and practices.
One philosopher for whom the concept of the will was central was Arthur
Schopenhauer who lived in Germany during the nineteenth centwy. Rudolf
Steiner, whose ideas have had significant influence on Nordoff-Robbins
thought, was certainly conversant with Schopenhauer's writings. 74
Schopenhauer followed Kant in believing that there was a "distinction
between phenomena (what appears to a perceiving mind) and noumena
(things as they are in themselves)" (Gardiner, 1967, p. 327). Yet, in contrast
to Kant, Schopenhauer believed that humans had access to the noumena level
of reality-the reality behind appearances-because of the way that we are
conscious of our own nouminous existence through experiencing our will
directly. Schopenhauer used the term "will" in an even broader sense to refer
not only to the capacity of a single individual or even a nonhuman being but
to refer to the fundamental reality itself. Because of our capacity for inner
experience we are also aware of ourselves from within as self-moving, active
beings whose overt perceptible behaviors directly express our will. "This inner
consciousness that each one of us has of himself as will is primitive and
irreducible" (Gardiner, p. 327).
Schopenhauer's perspective is directly opposed to that of Cartesian
dualism as he posits a unity between will and physical existence-what one
does with one's body and what one wills are "one and the same thing, but
viewed from different standpoints" (p. 328). For Schopenhauer, the will was
much more than just the conscious intellect and included properties which in
contemporary psychological theory would be considered aspects of the
unconscious. Moreover, an act of will is identical with a movement of the
body.
In Schopenhauer's concept of aesthetic enjoyment "the world is seen in
abstraction from the various aims, desires, and anxieties that accompany our
normal apprehension of it" and aesthetic judgments cannot "be grounded upon
considerations of social utility, or even moral purpose" (p. 330). Music "has
as its subject the will itself, the nature of which it expresses directly and
immediately. Thus, of all the arts, music stands closest to the ultimate reality
of things which we all bear within ourselves" (p. 330).
74 While preparing this

manuscript for publication I became aware of a text (Steiner,
1963) in which Steiner engages in a long discussion of Schopenhauer' s ideas.
Schopenhauer's view of the tmderlying reality which the will allows access
to is one of an unbroken unity in which the nonnal categories of space, time,
and causality are transcended. In his discussion of the world as embodied
music, Malcom Budd (1985) notes that according to Schopenhauer, we have
two distinct experiences of our body: As an object of perception "it is subject
to space, time, and causality, the forms of representation" (p. 80). Yet when
we are aware of our body through self-consciousness we are only subject to
time. Schopenhauer's most relevant contribution-for the present discus-
sion-to thinking about music was his consideration of music "as an
impersonal, negotiable, real semantic, a symbolism with a content of ideas,
instead of an overt sign of somebody' s emotional condition" (Langer, 1942,
p. 178).75 Schopenhauer also believed that "the essential function of music is
to mirror the nature of the will" (Budd, p. 100). Melody is a "representation
of conscious goal-directed activity" seen in its constant tensions and
resolutions which provide an "analogue of the origination of new desires and
of their satisfaction" (Budd, p. 100).
Schopenhauer's aesthetic philosophy is consistent with the music-
centeredness at the heart of Nordoff-Robbins practice, particularly when one
considers how important developing the client's aesthetic sensitivities are in
this approach. Thus, when the client can identify with or become merged with
the jointly created music, it is not a loss of identity that is sought but an
expanded sense of self and the world Moreover, Paul NordoiT's ability to play
music which appeared to transcend standard concepts and to expand our ideas
of time and space seems to indicate that his focus was on providing access to
another plane of reality through his musical gifts. Giving direct expression to
the will through music appears to be one way in which Paul Nordoff was able
7S A brief clarification may be necessary regarding the quote from Langer referring to
music as not merely a sign of an individual's emotional condition. Those readers
familiar with the Nordoff-Robbins literature may consider things such as a the
Categcxies ofRespoose (Nordoff &. Robbins, 1971, p. 63) as being eminent examples
.of music as an indicant of an individual's emotional state and thus wonder how it can
be said that that particular philosophy of music is being presented as antithetical to the
me underlying Nordoff-Robbins work. These categories are more accurately seen as
resulting from the limitations of pathology rather than as true aesthetic expressions
which, in the Nordoff-Robbins approach, require the conscious mediation of aesthetic
vehicles. Thus, while a particular piece of music may be used to ascertain aspects of
an individual's inner life, this does not mean that music is in its essence an expression
of this life nor does it mean that music used in this diagnostic fashion is tapping into
the primuy fimction of music in the Nordoff-Robbins approach.
to bring disabled children into contact with a reality that was unfettered by the
bounds of their disabilities-they were offered access to a world where these
limitations did not exist. Recall how the focus in many of the clinical studies
involved interventions oriented toward freeing up the body in order to let the
child's will be more fully expressed. This was often done through working
with melody, whether by working on developing skill in playing Melodic
Rhythms on the drum (Audrey, Martha, Loren), singing melodies (Audrey,
Anna, Terry) or playing a melody on a tonal instrument (Walker). Developing
one's will and internalizing melody are both crucial elements of the Nordoff-
Robbins work. Schopenhauer's conception of the significance of melody
provides a rationale for their conjoining through the practice of Creative Music
Therapy. Schopenhauer's conception of music as including more than just
individual expression or personal catharsis is an essential aspect of the
Nordoff-Robbins work. The focus on quality composition and accessing
dynamic musical forces and transcendent forms, which is at the heart of this
work (Aigen, 1996), shows that its aesthetic philosophy demands more of
music than just being a vehicle for personal expression.
Theoretical Implications of Working with the Will
Recall that the focus of Audrey's therapy involved engaging her will in a
constructive way. In this context it was discussed how activity sustained
willfully is a function of the self and itself manifests self-actualization. Of
course the will can be nurtured and expressed in a multitude of ways including
productive work or resisting the same. It seems to be essential to the Nordoff-
Robbins approach to develop a capacity for willful action through work
because work can transform life-denying expressions of the will into life-
affmoing expressions. An important avenue for future investigations would
be to explore the attributes of an active, creative, improvisational music
therapy and how these qualities are able to stimulate willful action and develop
a capacity for work.
Some may see a contradiction between the active, directive clinical stance
taken with the clients, such as Audrey and Martha, and the emphasis on
developing the will as a central element of the Nordoff-Robbins approach. It
may be argued that being directive and leading the client cannot produce
willful action, but merely compliance with the therapists' wishes. Yet the
clients in this study-and by extension, the preponderance of the clients
engaged by Paul Nordoff and Clive Robbins-were not able to formulate
goals and act on them willfully. The nature of their pathology required the
therapists to perform this function, much in the way a psychotherapist takes
over ego-functions for a highly regressed,client while helping the client to
internalize these functions.
It is not my belief that the courses of therapy in this study can be described
as shaping client responses in a behavioral way to meet the therapists'
expectations. This is neither an accurate rendering of the therapists' rationale
nor is it an apt portrayal of how they hoped to be perceived by the clients. The
references to trusting music show that it is the music which Paul and Clive
endeavored to be seen as the demanding element in the therapy. In other
words, the nature of music and the ways in which it brings personal gratifica-
tion demands the expression of will through meaningful work. It is true that
the therapists are mediating this world of music, bringing it to the clients and
selecting the way it will be realized. Yet it is equally true that mutuality was
an important quality of the therapeutic relationship-albeit at different stages
of their therapy-with half of the clients in this study, specifically Audrey,
Terry, Loren, and Anna. Thus, when their clients spontaneously offered
productive clinical avenues to pursue these were taken up by Paul and Clive.
When these were not supplied by the clients or when Paul and Clive had strong
ideas or intuitions about the productive direction for a client they would
forcefully establish musical activities which would take the client in this
direction.
Given their beliefs about work and the will, it may be warranted to say
that Paul and Clive felt a moral responsibility to take an active, directive, at
times even authoritarian, clinical stance. I believe that the emphasis on work
was important to Paul and Clive in its own right, reflecting as it did, their own
life values. I also think that Paul and Clive saw the stimulation of will through
the active embracing of work as an expression of one's capacity to embrace
life and existence. With some of the clients, such as Martha, Walker, Anna,
and Mike, Paul and Clive's assuming the position of the "work-ideal" was
unproblematic; with other clients, e.g., Loren and Audrey, this led to a direct
conflict between the clients and the therapists; and with still others, such as
Terry and Indu, conflict was produced, yet it was primarily played out as an
inner struggle that was not manifest in the therapeutic relationship.
One of the key factors here was the degree to which the client was actively
committed to his or her own resistiveness. For Terry and Audrey, their
resistiveness to work and the degree to which their will was expressed in
withdrawing from an engagement with life was connected to a complex of
psychological factors regarding their familial relationships and self-image.
Thus. Paul and Clive's stance drew these clients into an active conflict For the
other clients this particular issue was not one that had an overlay of other
emotional issues and thus their struggles were either circwnvented or
expressed primarily in the music rather than through the dynamics of the
therapeutic relationship.
Developing the will is important for both excitory and inhibitory
processes. In the former Clive discussed how he felt that Terry "needed this
quality of will to cut through the fuzzy, cold cloud that he had surrounded
himselfin." It is through stimulating his will that Terry becomes motivated to
emerge from this isolative world. We can consider Indu's process as
strengthening his will so that he could overcome his physical tremor to play
music unencwnbered by it. Mike illustrates both sides of these seemingly
opposing set of processes. In the notes from his sessions the Basic Beat was
described as the ''will element" in music and it was observed how Mike
therefore wants to be absolutely sure of it before going ahead. Paul's music
functioned to stimulate his will while simultaneously inhibiting his possibility
for response (with its complexity) until there was enough force behind the will
for it to be translated into directed, conscious action.
This aspect of Nordoff-Robbins theory appears to be of global signifi-
cance. It is certainly relevant for the wide range of clients in the present study.
Moreover, Gary Ansdell (1995) has identified a similar phenomenon in his
study of Nordoff-Robbins work with adult clients. He terms this "musical
quickening" and his description of it is analogous to the concept of will:
For quickening is more than just stimulation; it is more than the effect of
sound on physiology. Its real gift is the unexplainable power to animate
not just the flesh but also the spirit-to give an impulse which makes
someone want to act, want to respond, want to create. (p. 87)
In his discussion of a neurologically-damaged client, Ansdell observes that

''the motion and emotion of the music ... quickened not only his action but
also his will to act" (p. 87). The way in which melody embodies motion was
suggested as one of the causal factors in the ability of improvised music to
have a profound impact on this client. Perhaps this observation helps to
explain the importance of compositional improvising, songs, and melody in the
Nordoff-Robbins approach, as it is through identification with the forces and
intentionality in tonal motion that one's motivation and capacity for willful
action is stimulated. 76
The WiD aad Its Relationship to tbe Forces in Music
Previously in this work we have discussed aspects of Zuckerkandl' s views on

music and their basic congruence with those held by Paul NordofT and Clive
Robbins. One additional aspect of his thought that is relevant in the present
discussion is the way in which tones exhibit characteristics of willful, goal-
directed. action. Zuckerkandl (1956) suggests th8t when they are placed in
scalar and melodic contexts, individual tones acquire a property that conveys
a sense of striving:
Successions of tones are motions in respect to the directions of the tonal

forces. The beginning (1)-(2) runs counter to the will of the tones: it is a
step against the forces in operation, "away from." The close (7)-(8) does
what the tones want to do: it is a step with the forces in operation,
"toward," a step that leads to the goal. (p. 96)
And:
The single tone was simply a tone; the same tone at the end of the phrase
in our melody is a tone that has become active, a tone in a definite state
of activity.... What we hear in this way we can best designate as a state
of distwbed equilibrium, as a tension, a tendency, almost a will. The tone
seems to point beyond itself toward release from tension and restoration
of equilibrium; it seems to look in a definite direction for the event that
will bring about this change; it even seems to demand the event. (p' 19)
It is not only individual tones which convey a sense of will but chords as
well:
The phenomenon is analogous to what we observed in single tones when

they became elements in a melodic context: a becoming active, the
manifestation of a defmite dynamic state, which expresses itself as a will;
76 1bese considerations do not address the impact of rhythm in augmenting the impact
of tonal motion in engaging the client's will.
the chord points beyond itself, appears to be attracted by something. (p.

110)
In desaibing the way in which music seems patterned after willful, goal-
c:Iirected human action, Zuckerkandl is illustrating his belief that the tensions
and resolutions that we experience in music are not merely cultural or
psycboIogiaIl artifacts, but result from the dynamic forces which are objective
properties of music and which inhere in it. In Schopenhauer's terms, they are
part of its noumenal and not just its phenomenal existence. Zuckerkandl' s
desaiption of the dyrwnic field of which tones are physical representations is,
however, not esoteric but seems to be inspired by commonly accepted
principles in physics. In discussing the resolution we experience when a
melody moves to its tonic he says the following:
What takes place here between the two tones is a sort of play of forces,
comparable to that between magnetic needle and magnetic pole. The
activity of the one is a placing itself in a direction, a pointing toward and
striving after a goal; the activity of the other is a dictating of direction, a
drawing to itself. (p. 20)
We can understand the use ofterms such as "will" and "striving" as apt
metaphors rather than as an anthropomorphizing of musical entities. The
important point is that the forces we perceive in music are no more created by
hwnans than are the forces of magnetism or gravity. Bringing a disabled child
into a relationship with the tonal aspects of music is thus to establish within
that child the capacity to have experiences of striving toward a goal and
achieving it, of formulating a goal and moving toward it, and of becoming
aware of one's capacity for willful action and acting on this awareness. As
noted above, Paul Nordotrs and Clive Robbins's beliefs about disability
entailed seeing it as partially caused by or resulting from deficits in a client's
will. Their music therapy approach was built upon a philosophy of music
which makes it an eminent vehicle for compensating for the vel)' thing these
client's conditions have deprived them of.
Zuckerkandl believed that music is based on continual processes of
agitation and equilibrium. When a well-constructed, aesthetically pleasing
melody moves to its root tone we have a unique experience where we "receive
the impression of perfect equilibrium, of relaxation of tension and satisfaction,
we might almost say of self-affirmation" (p. 20). It is this process of
consolidating and affmning the self that will conclude the present discussion.
CREATING A SELF
The idea that it is the formation of a person which is the ultimate goal of the
woO:: in these studies was alluded to in the discussion of Anna. After realizing
that Anna's process was one of synthesis I asked myself what it was that was
being put together through this process and the answer was clear: a self, a
person who could engage in willful, constructive, creative action. In addition
to Anna, this orienting focus can be seen overtly with Martha whose process
involved the "incipient formation of a self, built upon a constellation of
cognitive, expressive, and physical abilities," with Terry whose process
revealed the "birth of a personality," with Loren where Paul and Clive's
clinical focus was described as "developing and establishing his personality
through his own musical gifts," and with Walker where music was used to
aeate a new center for the personality around which it could constellate itself.
Thus, the focus is not conceived of as remediating pathology, alleviating
symptoms, or shaping behaviors. It is an intense delving into the deepest layers
of a person, finding a constellation of capacities that can be nurtured
musically, and then creating musical forms which can be used by the new
personality center to consolidate itself around and thus reach its fullest
potential.
Ifthis focus is so clear in the clinical work it is natural to consider why it
is even worth writing about here. After all, there have been a fair number of
publications on Nordoff-Robbins work and one would think that this would be
such an obvious component of the work that it would not bear observing or
conunenting upon. Yet this emphasis is one that has not been written about in
Nordoff-Robbins publications, thus leading to a misconception of the work
that sees it as being more narrowly focused than it in fact is. This more limited
view of the work has emerged for a few reasons.
First, in their own writings, Paul Nordoff and Clive Robbins were
extremely careful not to make clinical claims that went beyond that which they
could clearly document. Their case studies often detail development, but it is
usually the musical development that is stressed, such as an increase in vocal
range or tempo flexibility. They were much more modest in their claims of
generalization and did not discuss this layer of the work involving the
reorganization and even rebirthing of a new personality. Certainly one of the
factors here was that their work was quite revolutionary, even threatening, and
they must have felt a need to temper their true beliefs about its potency,
especially when such claims would have been more difficult to substantiate
than the purely musical development which was clearly observable.
Also important is that this is an active, action approach to therapy rather

than an interpretive or symbolic one. In many psychotherapies, observable and
reported feelings, thoughts, and actions are seen as representing an inner layer
of the self. Thus, one can interpret through these actions the real story of the
therapy concerning unconscious or latent content. In fact the focus of the
therapy can be on discerning the deeper level from the surface events.
In contrast, in the work in this study the music and musical expressions,
as the locus of intervention, are not seen as symbolic representations of
something else but instead as direct manifestations of the self. The growth in
the capacity to create and appreciate music does not symbolize a fundamen-
tally different process but is the process of interest itself. Even though it is the
musical details which are focused on and reported, it would be erroneous to
consider the focus of the therapy on only the music because it is the person in
the music that is being addressed and developed. It is as if music is not
something that the person does but something that the person is.
TIle way in which the details of the client's musical expressions tend to be
reported in studies by Paul and Clive can disguise the fact that it was the
essential center of the person that was the target of their clinical efforts. The
concept linking their focus on the musical abilities and their focus on self-
actualization is that "musicing" (Elliot, 1995) is an active manifestation of a
fully-functioning human being.
Finally, in the details of their case studies, both the published and
unpublished ones, Paul and Clive tended to emphasize the aspect of the work
that involved working with the client's activity and detailing the ways in which
this musical activity achieved observable, often quantifiable results. We can
speculate that one of the primary reasons for this was the eminently reasonable
strategy of gaining acceptance for their work. Moreover, it is also much easier
to describe and train students in intervening musically and ascertaining the
effectiveness of one's interventions than in the subtleties and inferences
involved in personality organization.
Yet in these studies we have seen how in many ways, even in its earliest
manifestations, the Nordoff-Robbins work has always been about much more
than working with and developing musical expressions. There were many
incidences where Paul's music reflected something other than the client's
activity: this included reflecting a deep-seated conflict or a more temporary
passing feeling; laying out music that was part of the exposition and
development of a clinical-aesthetic form; playing "music for a child" that was
not meant to stimulate or engage physical activity~ and, playing music that
could not be actively responded to because of its complexity and which
functioned to actually inhibit the client's response, if only temporarily.
All of these ways of clinically using music that must go into a formulation
of the nature of the Nordoff-Robbins approach have not really been a part of
published considerations on the essence of this approach until now. It seems
that the uses of music essential in the process of creating a self tended not to
be discussed precisely because of their more inferential and ephemeral nature.
Yet as the Nordoff-Robbins approach has developed in a way that validates
the original team's visions of what it could be, it seems more than fitting that
these less observable processes can be brought more directly into the
professional discourse over the values and processes that make this approach
such an effective one.
THE TIME FRAME OF THERAPY
Initially, I considered whether or not the original form of practice studied here
was primarily a mode of short-term therapy. I soon came to believe that the
boundaries of the process were not dictated in absolute terms by a length of
time but more by the process as delineated in the four-stage model best
exemplified in Terry's study. Thus, therapy begins in exploration~ areas of
strength and conflict are noted and worked with~ some kind of breakthrough
occurs~ the breakthrough is met and consolidated~ and finally, the therapy ends
after this period of consolidation. Hence, while I still see the construction of
a self as an apt description of the work, it is not the long-term aspect of this
project, which of course can take a lifetime, upon which these early clinical
efforts were focused. Instead in a very active, interventive, and dramatic
fashion, the foundation and blueprint was established for the clients to use as
a springboard for development in the rest of their lives.
This work was not necessarily short-term nor was it conceived of as a
maintenance therapy. The intensity of the work, both in the sessions and
through the indexing, seems to necessitate that therapy would proceed only as
long as the client was showing a clear developmental process. 77 Moreover, it
77 Interestingly, the one client who began work in this time period and whose course
of therapy was rated a significance level of one and who was not included in the
study-Rosita-had a course of therapy that lasted a number of years with the more
important period of therapy occurring in its latter half.
was a process that was defined solely in musical tenns. Once musical
flexibility, freedom, and mutuality was achieved the client was moved into a
group.
What did not seem to be part of this work was working upon personal
feelings and issues as they arose in the course of living one's life. As was
alluded to previously, the work with Audrey, Terry, and Anna could have
moved in this direction had Paul and Clive a conception of therapy which
incorporated working on personal issues and their manifestations in the
present, and a desire to work in this direction. Instead, the courses of therapy
for the children just mentioned ended without much focus on these types of
explorations.
This raises the question of whether the Nordoff-Robbins approach is, in
its essence, an approach whose intensity is best geared to an active and
interventive stance to stimulate a growth process rather than something which
supports a process of maintenance. It does seem true that most of the dramatic
gains were seen relatively early in each client's process. Thus the question
should be asked about whether there are different forms of Nordoff-Robbins
practice, some more geared to active, interventive, short-term therapy and
others oriented to longer-term work which can be better characterized as
maintenance or enrichment. Now that there are Nordoff-Robbins facilities
established on a permanent basis, this will make the possibility of long-term
work a reality and may alter the model in significant ways.
READING 6
Aigen, K. (2005). Three Excerpts: Music-Centered Music Therapy, pp.
47-75, 77-90, 91-128. Gilsum NH: Barcelona Publishers.
Excerpt One
Kenneth Aigen
Excerpt Two
Kenneth Aigen
Excerpt Three
Kenneth Aigen
READING 7
Steps Toward an Ecology of Music Therapy
A readers’ guide to various theoretical wanderings, 1990–2011
Gary Ansdell
Theories pass. The frog remains.

—Jean Rostand (1894–1977), French biologist
The desire for something more sustainable than decomposing materials is one of the sources
in Western civilization for the supposed superiority of the head over the hand,
the theorist better than the craftsman because ideas last.
This conviction makes philosophers happy, but shouldn’t.
1
—Richard Sennett, The Craftsman
I have not had a single idea which was new or surprising, but my old ideas have become so much more firm,
lively, and coherent that they could be called new.
—Goethe (noted during his Italian journey)
Introduction
Theory Street
After a research seminar in which a group of music therapy students was discussing what “theory” is,
a Greek student of mine came back from holiday with a photo she’d taken in her home city of Athens.
In the foreground, there’s a corner with a street-sign named (in Greek) “Theory Street.” The road leads
up a hill to a fine view of the Acropolis. Theory Street simply means “View Street.” Similarly, a
theory means “view this my way for a while.”2 Climb up from a road on the other side and the view
can be quite different. Theories are necessarily perspectival, partial, and historically situated. Ideally,
they are also communal and cumulative, as varying perspectives assemble a more inclusive and shared
understanding of a phenomenon.
Reading again my various writings during a 20-year period when I was usually a stimulating if
exhausting combination of music therapy practitioner, teacher, and researcher, I see myself wandering
around a variety of theoretical viewpoints but keeping my eye very much on a central feature under
view. There’s also an overall guiding theoretical perspective that comes from the Nordoff-Robbins
tradition in which I was trained, with its exemplary model of reflective practice. This tradition also
keeps me oriented single-mindedly toward the thing I’m still fascinated by and still trying to
understand better—music as a phenomenon that enhances the lives of many of us but for some
provides a specific form of help that is life-saving and life-transforming. How does music help in this
way?
In this chapter, I’m inviting you to follow my wandering steps around this phenomenon. I’m
inviting you to see the view in my way for a while, with its variety of viewpoints, adding up, I hope, to
something more comprehensive. But I’ll leave you to be the judge of that!
Because most of my writings are not published by Barcelona Publishers, I’ve had to limit this
chapter to a “reader’s guide” to my various articles, chapters, and books. Some of these are readily
available on the Internet; most others are still fairly accessible. This guide aims not just to summarize
the material, but also to trace some of the logic of my “Theory Street” wanderings.
Steps toward? Reading my writings again, it’s clear that they tread a particular path around
various subjects and preoccupations of mine (and perhaps of other music therapists in the 1990s–
2000s). Some of the subjects might relate more specifically to British professional and intellectual
factors, but I hope that there’s also a more general relevance. My thinking (and practice) does seem to
be leading toward somewhere, which I’m currently thinking of as an ecological perspective on music
therapy and its relationship to a wider understanding of music, and how most of us make use of
1
Richard Sennett (2008, p. 124).
2
Sennett explains: “Theoria shares a root in Greek with theatron, a theater, which means literally ‘a place for
seeing’” (ibid.).
1
musicking in the service of our well-being. I’m fairly satisfied with this as a direction (and possible
arrival point) of my thinking at the moment. But, as ever, it’ll be history’s judgment as to whether my
wanderings in this direction have been toward anywhere useful.
Gentle Empiricism: A Nordoff-Robbins stance on theory and research
One must not make up theories;

they must turn up like an unexpected guest in the house,
while one is busy enquiring into details.
—Freud
Reading my texts again, I realize just how much they’ve been guided by a clear if largely tacit stance
on what theory is and what theory does. I inherited this from Nordoff and Robbins, and they inherited
it in turn from a particular tradition with which they were involved. An irony here is that their overall
stance is perhaps best characterized as agnostic toward theory per se. By this, I mean that Nordoff and
Robbins never worked directly from an extant theory and were skeptical of such an approach, having
seen early music therapists (in the U.S.) attempt to shoehorn their work into behaviorist or
psychoanalytic norms. For Nordoff and Robbins, theory followed their work rather than led it.
They were guided in a more general way by a tradition that formed the hinterland of their
work and thinking. This was the tradition of anthroposophy, a spiritual philosophy3 that both men had
been associated with before they met and that provided an orientating source of value and method as
they discovered and developed their music therapy approach together from the late 1950s.
For this introductory section, I’ll start with a recent article I wrote with Mercédès Pavlicevic and pull
out some key aspects from this. These principles to a large extent undergird an attitude toward theory
from which I have worked in my subsequent practice and writing:
Ansdell, G., & Pavlicevic, M. (2010). Practicing “Gentle Empiricism”—The Nordoff-Robbins

Research Heritage. Music Therapy Perspectives, 28, 131–138.
This article suggests that there’s a characteristic Nordoff-Robbins “research stance” that
guided Nordoff and Robbins’s early work, as well as much of the research that’s been done by
Nordoff-Robbins practitioners since. Nordoff and Robbins inherited this mostly from anthroposophy,
under the influence of which they undertook much of their early music therapy work, mentored by
anthroposophical doctor Herb Geuter.
Some theoretical history is necessary here. The founder of anthroposophy was Rudolf Steiner,
who was also the first editor of Goethe’s scientific works. We now know Goethe mostly as a
poet/dramatist, but he also spent much of his life developing an alternative way of science—studying
plants, rocks, cloud formations, and color (and, to a lesser extent, music). His “qualitative science”
took particular issue with Newton’s quantitative and reductive account of “what color really was.”
Goethe has been dismissed as an amateur crank by mainstream science in general, but this has
changed in recent decades. He’s increasingly seen instead as a prophet of a “road less traveled,”
toward a qualitative and holistic science of natural and cultural phenomena. Goethe argued that when
researching and building theory, we should strive first to “save the phenomenon”—that is, as an
analytical principle, to not break it down, replace it with abstractions, or take it out of its natural
environment. Rather, we should also have confidence in the refined and disciplined experience of a
phenomenon that is gained by studying it in the right spirit and within its ecological conditions. Such
study can yield an intensity of experience that will enable us to understand a phenomenon more fully
and completely. The key to this approach is to attend to the qualitative and experiential dimensions of
a phenomenon by living with it, participating in it, beholding it, and taking a “reverential” stance
toward it. Goethe’s method dares to keep following “things” until understanding develops and to not
be sidetracked into following only others’ ideas about things. This stance has been summed up by the
phrase “gentle empiricism,” meaning that while we are indeed intending to build our understanding of
a phenomenon through the evidence of what our senses indicate to be there (not, that is, an idealism
that exists only in thought and is unverifiable), we are gentle in our method for encouraging it to
manifest all it can to our enquiring experience.
3
Steiner himself referred to it as a “spiritual science.” In all of its manifestations, it has maintained an orientation
to systematic inquiry, but one also informed by imagination and nonmaterial perspectives.
2
Rudolf Steiner passed on the baton of Goethe’s ideas to a further generation, mixing them
with some of his own somewhat more esoteric contributions. Twentieth-century Steiner philosophies
of education, medicine, and agriculture are heavily influenced by an approach to epistemology and
methodology initiated by Goethe (that is, how we can know things and how we can systematically
explore them).
Nordoff and Robbins in turn inherited this tradition of approaching something that you wanted
to find out more about. For them, it was the phenomenon of music and its potential help for people in
developing their lives and in offering potentials for healing and well-being. What the Goethe/Steiner
heritage taught them—and we can call this more technically an “empirical phenomenology”—was
how to follow and stay with something new that you are trying to understand. You can read about Paul
Nordoff’s early music therapy sessions in Clive Robbins’s historical account A Journey into Creative
Music Therapy (2005). In these sessions and during the following years, Nordoff and Robbins took
what Robbins calls a stance of “creative empiricism” in their work.
The following summary characterizes the values, attitudes, and methods that Nordoff and Robbins
took from the Goethe/Steiner heritage and which formed the basis of their style of theory. Most
subsequent Nordoff-Robbins practitioners and researchers have followed these in some sense, in
being:
1. Committed to a gentle empiricism—allowing the phenomenon (of people-in-music, therapy-in-music) to
show itself
2. Exploring the phenomenon within its natural setting as far as possible
3. Devoted to detail—“listening through a microscope” to the microlevel particularity of the phenomenon
of people in musical relationships
4. “Reverential”—allowing “love” and “will” to guide the work and its exploration
5. Idiographic—attending to the individuality of each case, of each manifestation of the phenomenon
6. Seriated—building a collection of exemplary cases for comparison and amplification
7. Theoretically “agnostic”—allowing theory to emerge, rather than fitting phenomena to extant theory
8. Holistic—searching for the varying circumstances in which the same (“archetypal”) phenomenon
occurs
To sum up: The aim of theory within this tradition is not to provide some normative and abstract
understanding of a phenomenon, but rather to raise thinking to the level of experience. This is an unusual
stance in our current culture of scientism! The key intention behind the Goethe-Steiner-Nordoff-Robbins
stance is to “save the phenomenon”:
This has involved … not beginning with theory or automatically adopting the consensus view of the time,
not sparing themselves the trouble of attending in close detail through an aural or visual microscope to
what is actually happening in a given situation, and not assuming that data and theory are easy to
reconcile or that theory may need reimagining each time the facts expand our understanding of the
phenomenon. (Ansdell & Pavlicevic, 2010, p. 138)
An initially puzzling remark by Goethe summarizes this stance: “The ultimate goal would be: to
grasp that everything in the realm of fact is already theory [. …] Let us not seek for something behind
the phenomena—they themselves are the theory” (in Naydler, 1996, p. 91). That is, theory is seen not
as that which analytically pries “behind” or “underneath” something, but that allows a phenomenon to
show itself in terms of itself—in action, in context, in the ecology of its coming-into-being within our
experience. Technically, this theoretical stance would normally be described as phenomenological,
with an added peppering of pragmatism and ecology that comes from the intention in Nordoff-
Robbins Music Therapy to give primacy to what is actually seen to work in practice and in real
settings, above any ideas of what should work in theory!
My own theoretical wanderings show strong echoes of this anti-theoretical theoretical tradition
that I’d been inducted into (but which has perhaps only belatedly been given a more explicit and
systematic genealogy). I’m now going to characterize the development of my own theoretical
viewpoints within four overall “steps”—all of which I think show something of the influence of a
theoretical stance of “gentle empiricism,” where theory follows rather than leads.
Step One: Mapping
Listening through a microscope—the devotion to musical detail
3
Out of the key “principles” mentioned earlier, “devotion to detail” was central to Nordoff and
Robbins, who said that they could not have developed their music therapy work at all before the
invention of the tape recorder. An everyday practice for them from their earliest work was the taping
and detailed study of sessions—what Robbins has called “listening through a microscope.” This
allowed them to study the musical/personal detail of what exactly was happening within the second-
to-second unfolding of a session. It also enabled them to chart in detail what was happening across a
series of sessions. Both axes of documented detail allowed them to compile their exemplary cases
(Nordoff & Robbins, 1977) from which emerged key aspects of the Nordoff-Robbins theory of music
therapy. Their method, in short, was one of participating experientially, documenting in great detail,
reflecting on this, and developing both therapy and theory from this systematic study.
My own training was based squarely on these principles, and they informed my early writing and
researching. I had the good luck to be mentored and supervised in my early work by Rachel Verney,
who was one of Nordoff’s main protégées. In supervision, she was a stickler for attending to the
precise musical/personal detail of what went on, stopping the tape recorder every few seconds to ask
me to describe a moment and to account for my musical-clinical thinking. It was a unique discipline,
which led me to be fascinated by exactly what we could hear when we listened in this depth to our
sessions: both about how a person manifested him/herself in music (and what this could potentially tell
us about their problems and potential) and about the nature of the music-therapeutic relationship.
Nordoff and Robbins had themselves initiated this way of thinking with the concept of “musical
portraits,”4 suggesting that when a child plays music, they say “Here I am; this is me; I can (only) do
this!” From this, the therapist gets an idea about both the child’s pathology (the limitations imposed
upon them from this) and their potential—what the therapy could help them work toward with music’s
help. Nordoff and Robbins formalized this idea in their famous Rating Scales, 5 which were based on
qualitative criteria established through their empirical work with many children and put into a more
formal quantitative format. I’d used these in my training and in my early posttraining work with
autistic children. The Scales had functioned well as an orientating device for my clinical work, helping
to cultivate my therapeutic judgment. What the Scales didn’t do so well was cope with adult clients
who already happily played complex and fluent music. These were the clients I was also working with
in the late 1980s, while being supervised by Rachel. I also had the good fortune to be mentored in my
academic work at that time (for a German diploma in music therapy) by the researcher David Aldridge
at the Universität Witten-Herdecke. He generously shared with me his then-pioneering
interdisciplinary approach to researching music therapy—showing me the real possibility of thinking
from the phenomenon of the work-in-action, understood through a largely qualitative analytic
perspective.
A small research project that I started working on at this time under David’s supervision was
an assessment model for higher-functioning adult clients in music therapy. This also helped to develop
my understanding of many of the “principles’ of Nordoff-Robbins theory and research mentioned in
the last section. I published this work in an article:
Ansdell, G. (1991). Mapping the Territory. British Journal of Music Therapy, 5(2), 18–27.
The underlying theory is Goethean (as described below): (i) attending to the microdetail of “people in
music” and allowing my experience of this phenomenon to gradually complexify and build up a
qualitative and synthetic understanding; (ii) producing a series of cases for comparison; and (iii) only
reluctantly proceeding to theory (rather than “jumping to conclusions”).
My research question was very practical and related directly to my own music therapy work
then: What can you hear in a person’s music? I’d also become clearer about the fact that one’s own
music (played in dialogic improvisation with another person) is itself a probing listening. So what you
hear back in your own responsive musicking with another person is also a clue to what is happening
with the person and within your relationship to them.
4
See Nordoff and Robbins’s Therapy in Music for Handicapped Children (1971/2004) and Creative Music
Therapy (1977/2007) for more on the concept of “musical portraits.” See also Robbins’s A Journey into Creative
Music Therapy (2005) and Rachel Verney and Gary Ansdell’s Conversations on Nordoff-Robbins Music Therapy
(2010).
5
See Part Four, “Evaluation,” of Nordoff and Robbins’s Creative Music Therapy (1977/2007) for more on the
“Rating Scales.”
4
I devised my own music therapy assessment model to cope with potentially complex playing
from both client and therapist. This involved organizing verbal descriptive statements coming from an
assessment session within a rather bizarrely overcomplicated “map” that took inspiration (as I
remember) from Tony Buzan’s “mind maps.” On one map in my scheme, you plot a client’s “musical
display” within categories of melody, rhythm, harmony, form, articulation, tempo, etc.; then, a second
map shows the relational qualities of shared direction, entrainment, form, etc. A final, third map
juxtaposes the two domains so that you can look for patterns of qualities and tendencies of individual
and relational musicking.
My students typically laugh politely at these maps when I teach music therapy assessment
models. The maps are indeed immensely impractical, taking too long to do and being too complex to
convey to anyone else! I see now that this model is less an everyday practical tool than a way to
sensitize thinking about what a music therapist can and can’t potentially know about a client through a
detailed musical listening and an attempt to systematically represent such knowledge for others.
As such, the model raises some good questions, although I’m not sure that it provides many answers.
The more concrete questions I initially had about this area (working as I was with many people with
chronic illness) were: Can you hear cancer in a person’s playing? Can you hear the difference in
someone’s music between a “real” case and a “hysterical” case of multiple sclerosis? I’m not sure
now that these are useful questions, and I’m certainly not sure that they can be answered. Even then,
my research came to the perhaps more useful conclusion that there was an important difference
between a medical-style diagnostic process (that had to be rigorously rational and differential) and
what a music therapy listening could potentially achieve—which is to add to the overall broad clinical
and human assessment of a person, their condition, and their life situation. Assessment is a more
qualitative, holistic enterprise (deriving from the medieval taxman, sitting with [ad sedere] a person in
order to get enough of an overall impression of them to assess their tax). So too a “musical hearing”
can be a valuable perspective as part of a multidisciplinary clinical and humanistic assessment of a
person. I found in practice that its detailed portrait of a person in dynamic forms of time, space,
motion, and expressiveness often gave a valuable and alternative picture—both of problems and of
potentials—just as Nordoff and Robbins had found out in their early work.
Theoretically, this work further convinced me of the value of building theory through careful,
detailed, inductive work—following where experience led and being prepared to accept modest
conclusions.
Telling musical stories
Ansdell, G. (1995). Music for Life: Aspects of Creative Music Therapy with Adult Clients. London:
Jessica Kingsley Publishers.
I published my first book, Music for Life, in 1995, after having had some transformative
experiences working with mostly adult clients in the period 1988–93—first in London and then for a
year and a half at the Gemeinschaftskrankenhaus in Herdecke, Germany, an anthroposophical general
hospital6 with a large Nordoff-Robbins department. At the time, not much had been written about
Nordoff-Robbins music therapy with adult clients, although quite a lot of practice was happening. I
wrote the book both to characterize this practice (both my own and that of some of my colleagues
whose work I admired) and to think around it from a variety of perspectives, but with the usual caveat
that theory should flow from the experiences of the work and not be pasted “onto” it.
In a sense, this book’s sandwich structure of small case stories alternating with theoretical chapters
was a continuation of my attempt to trace the links between how people were “in” music and those
vital musical/personal processes that Nordoff-Robbins Music Therapy was based on. The theoretical
chapters explore improvising, “meeting” in the music, quickening, listening, creating, “recalling,” and
so on. The style of the music therapy stories owes a lot to Oliver Sacks and his “romantic science”—
which, rather in the spirit of Goethe, attempts to keep the person at the center of the case, with their
uniqueness and individuality of response intact, and not reduce them to abstract typifications or
present them as a foil to theory.
6
Paul Nordoff died in this hospital in 1977.
5
The style of theory in Music for Life is thus mostly what Ken Aigen7 calls “bridging theory,”
which tries to look for “matching” perspectives from other disciplines in order to illuminate aspects of
our own, while being careful to incorporate non-indigenous ideas only if there was a good match.
There is also the odd bit of “indigenous theory” too (again, according to Aigen, this is theory that is
developed originally from practice). My overall attitude and intention was the very Nordoff-Robbins
one of ensuring that music didn’t disappear from the theoretical story. That is, my stance was music-
centered (or perhaps music-led), waiting for what kind of features manifested as interesting within the
particular practice of music therapy—but continuing on to ask what (if anything) these features told us
about music and people in general.
With this book, I was again attempting to “map out” the territory of Nordoff-Robbins Music
Therapy as I was experiencing it at that time. A lively controversy ignited a little later when the British
music therapist Elaine Streeter (1999) attacked the music-centered principle behind Music for Life and
also Colin Lee’s Music at the Edge (1996). Streeter was brave enough to put in print what others just
muttered about privately, and her challenge led to a series of spirited responses in the next edition of
the British Journal of Music Therapy8 and to an ongoing debate that still smolders today.
Although the argument seems quite historical now, for me and many others at the time it
highlighted the incommensurability of psychoanalytic and music-centered perspectives, and how this
was an issue of freedom and appropriateness of practice, not just theory. This theory-based incident
was probably one of the early seeds for developing Community Music Therapy in subsequent years.
I’ve also had plenty of nice feedback about Music for Life over the years. I’m happiest when people
tell me that it has indeed served to orientate (or reorientate) their practice and that it has sensitized
them to what’s possible in music therapy practiced and thought about this way, keeping an eye and ear
on how both therapist and client are fundamentally working together as musicians. As for its
theoretical aspect, it merely scratched the surface of the material—although when I look back, I think
that its compass wasn’t too far off course. It pointed toward several aspects of the work that were to
prove important to me in subsequent years.
Step Two: Exploring
New music theory
A sentence that many reviewers picked up in Music for Life was: “… the underlying principle remains
constant and effective whether the client is a handicapped child or a trained musician; namely that
Creative Music Therapy works in the way that music itself works, and that its ‘results’ are essentially
of the same kind as music achieves for all of us” (Ansdell, 1995, p. 5, emphasis added). This, of
course, begs two questions: whether it’s at all possible to get to the bottom of just “how music works”
and whether there’s any such thing as “music itself” anyway! But more straightforwardly, my
statement does raise a key consequence of taking a music-centered stance—that you need to keep your
eye on the latest thinking about music, regardless of what discipline this was emerging from.
My own college training in musicology (at Cambridge University in the early 1980s) had been
dismally old-fashioned and dusty. “Music” there meant notes on a page, ready for analyzing using a
formalist/structuralist methodology—i.e., the meaning of a musical work was contained fully within
its structure. Consequently, you didn’t even really need to listen to it or, especially, study it in “in
action” among people playing, listening, or arranging it. Even at that time, I found this disappointing!
Partly I turned to music therapy soon afterward because this offered me an entirely different
way of thinking about music, not just of using it in a useful way. But, for a while, I still didn’t manage
to find anything else outside of music therapy that helped me to think more rigorously but
imaginatively about music itself. The problem was that not much within music therapy was much help
either, at least not in terms of any systematic exploration of the varying connections between people
and music. Most music therapy theory at that time simply ignored the music in its attempt to be taken
seriously by other disciplines and professions, flattering them by hoovering up psychological theory
and producing musical versions of currently extant therapy theories.
7
See Aigen’s Music-Centered Music Therapy (2005), Gilsum, NH: Barcelona Publishers. The more technical
name for this variety of theorizing is “abduction” (rather than deduction or induction).
8
The responses by Kenneth Aigen, Gary Ansdell, Sandra Brown, and Mercédès Pavlicevic were all in the next
(1999) edition of the British Journal of Music Therapy, 13(2).
6
What little reference that was made to music theory within music therapy was largely to
outdated perspectives that relied on a quite different understanding of music than music therapists
actually used in practice. This suggested another case of the need to raise our theoretical level of
thinking (about music itself) to the level of our musical experience.
As part of my doctoral work (which involved being a part-time resident of London’s
pioneering City University music department in 1993–97), I began to hear of disciplinary tremors in
international musicological circles. What’s been called the “New Musicology” was being
disseminated and debated then, and it looked very interesting for my purposes. Here was a way of
thinking and talking about music that promised exactly what music therapy needed from music theory.
It was putting back onto the map a whole list of previously taboo topics: the body, sex, culture,
performance, politics, identity, communication, and social life. It argued that music wasn’t primarily
an autonomous museum object but a practice that was necessarily embedded and active in social and
cultural life. Its ideas began to newly link together previously separated disciplines and practices:
ethnomusicology, pop and jazz studies, performance studies, cultural theory. It even showed an
interest in music therapy and what its practices perhaps told us about the nature and culture of music!
It came out with trendy, outlandish questions and conference titles such as Was Schubert Gay? Was
Beethoven a Rapist (in the Ninth Symphony)? How Queer Is Country Music?
In a series of publications, I summarized aspects of this “new musicology” for the attention of
music therapists, and my excitement is clear! Would this not provide the musical theory that we were
looking for? Surely, wasn’t music therapy just the kind of “laboratory” that the new musicologists
were looking for with their questions about music, life, and society?
Ansdell, G. (1997). Musical Elaborations: What has the “New Musicology” to say to music therapy?,
British Journal of Music Therapy, 11(2).
Ansdell, G. (2001). Musicology: Misunderstood guest at the music therapy feast? In D. Aldridge, G.
di Franco, E. Ruud, & T. Wigram (Eds.), Music Therapy in Europe. Rome: ISMEZ/Onlus.
Ansdell, G. (2004). Rethinking Music & Community: Theoretical perspectives in support of
Community Music Therapy. In M. Pavlicevic & G. Ansdell (Eds.), Community Music Therapy.
Here’s a summary of the theoretical aspects that the “new musicology” helped to raise for theoretical
thinking about music therapy:
· “Music” is not an autonomous object—it is embedded in sociocultural process.
· Music is not a universal (or natural) phenomenon—it is a cultural phenomenon and lives in
and through locally defined contexts.
· Music's meanings are not “immanent”' to its internal situation—they are socially and
culturally constructed.
· Musicking is not just a mental phenomenon—it happens within and between bodies.
· Music is not just a notated artifact—its basic reality is lived performance.
· Music does not just express emotion and meaning—it enacts and constructs them.
· Music's expressive forms are as crucial as its structures.
· Music is seldom just a private pleasure—it is always already a social participation.
· Musicking can both reproduce the legacy of another and allow the performance of the self.
This “manifesto” for a new way of thinking and talking about music became popularized in a rightly
celebrated book by Christopher Small called Musicking, published in 1998. This presented in a clear
and imaginative way the author’s careerlong project of getting people to think of music not as a thing
but as an activity, something that people do and which has personal, social, and political consequences
for them when they participate. There have been many other statements of these ideas, but Small’s
concept and definition musicking is the neatest summary of this new current:
To music is to take part, in any capacity, in a musical performance, whether by performing, by
listening, by rehearsing or practicing, by providing material for performance (what is called
composing), or by dancing (Small, 1998, p. 9).
The so-called “new musicology” is necessarily aging and graying now, almost 20 years later! It has
also proved somewhat of a false dawn for music therapy theory—but a useful stepping-stone
nevertheless. We’ll pick up the story of my critique of it in the next section as it usefully leads on to
the next “step.”
7
I’ll finish this section by mentioning that one of the papers that I wrote on the new musicology
contained my first mention of the word and concept of ecology, intuiting, I think that this was a
missing link for music therapy:
I would like to suggest a change of metaphor for music itself (and hence for music therapy)—one that
sees music therapy as an “ecology” rather than a “structure.” An ecology is a balance of interlinking
forms and processes in a context that sustains them and guarantees diversity. This equates better with
the view of music we have arrived at. It also demands that any analysis of music therapy practice must
first and foremost be “local” and context-sensitive. (Ansdell, 1997, p. 44)
Step Three: Demapping
Questioning the maps
Reading my publications again, I’m noticing the “hidden connections” (or perhaps the forgotten
connections) between the phases of my work. An example of this is the conclusion to the paper I
discussed in the first section above—”Mapping the Territory” (1991). I conclude this with a story told
by the economist Fritz Schumacher, about how he was in 1950s Moscow with a tourist map, standing
in front of a big and impressive old Byzantine church, trying to orientate himself. He told someone
trying to help him, “I’m sure I’m here, but I can’t be, there’s no church on the map.” “Ah,” said his
helper. “Maps here don’t show churches!” I end the article by quoting a passage from David Aldridge:
In our attempts to find a common language, it is always important to emphasize that talking about
therapy is always at several steps removed from the actual activity in which we partake. Dancing,
painting, singing, acting, doing therapy, are different activities to talking about dancing, talking about
singing … talking about doing therapy. (Aldridge, 1989)
I was gradually realizing (too slowly, some might say!) that, to use Korzybski’s phrase, “the map is
not the territory; the name is not the thing named.”9 This became clear to me through the twin areas of
my then-current interest: how the “new musicology” was reintroducing to the music theory map a
whole host of things that had simply dropped off of the map of the “old musicology” and, second, the
crucial importance of how talking about music therapy determined (that is, limited or expanded) its
practice, theory, and research.
I was, of course, a latecomer here to a major current of intellectual thought that had been
sweeping the academy (in both humanities and social sciences) for the past 20 years under different
names: constructivism, relativism, social constructionism, critical theory, post-structuralism. 10 It
argued that our language does not just reflect our world and our thoughts and feelings; it actively
constructs them. Language is not primarily a mirror, but a building material. Theory is likewise a
building constructed through discourse—language in action, in working clothes, we could say. Attend
more closely to language, and you see how it is far from being the transparent medium that we might
naively assume. I explored the theory of semiotics and its then-recent application to the study of music
(Nattiez, 1990). Semiotics shows both everyday and theoretical communication “under construction”
at a practical level of detail that appealed to me (in contrast to the “airier” versions of the French
school of post-structuralists).
I began to think increasingly from this perspective about my personal experience with the
problems of talking and theorizing about music therapy and of the broader problem that our discipline
and profession seemed to have with this activity. A semiological approach suggested that it was
entirely natural that music therapists should struggle with how music could “mean” anything and that
the ambiguous and polysemic nature of music could in fact be crucial to how music therapy was
valuable to people in the first place.
A pilot project (published as an article) focused the research area for what became my
doctoral thesis. I designed a “qualitative experiment” to explore how colleagues talked about music
therapy. When I got research participants to talk in detail about small excerpts of music therapy that I
played them, they both verbally tripped up and skillfully jumped over the gaps in just the same ways
as people have always tripped up when trying to use words and concepts to talk about music and
musical experience. The father of American musicology (and father of Pete and Peggy), Charles
Seeger, helpfully pinpointed what he called the “musicological juncture” that we cross every time we
9
Korzybski, A. (1941). Science & Sanity. New York: Science Press.
10
I’m not suggesting that these traditions all boil down to the same thing, but rather that they share a critical or
skeptical perspective on the relationship between language and representation.
8
try to use verbal strategies to talk about musical processes. The crossing is perilous, wrote Seeger,
because we are trying to reconcile our music knowledge that operates “within” musical practice with
our speech knowledge, which is “outside” of music but about it. This problem is dubbed “Seeger’s
Dilemma” in his honor. “The gaps in our speech thinking about music may be suspected of being
areas of musical thinking,” wrote Seeger. Yes, this is it, I thought! But I also suspected that there was
more to this dilemma when it comes to a complex area such as music therapy—and just possibly this
added complexity might tell us some more about the dilemma itself.
To cut a 5-year research story rather short, I found and articulated a similar “Music
Therapist’s Dilemma,” which added the further dimension of “people in music” to Seeger’s problem.
Music therapists typically try (and often fail) to reconcile their “music therapy knowledge,” which is
not always verbal/conceptual, within their need to assemble a disciplinary and professional discourse
for everyday clinical communication, teaching, and theorizing. The following article and thesis trace
the research from the pilot project to the “results”:
Ansdell, G. (1996). Talking about Music Therapy: a dilemma and a qualitative experiment. British
Journal of Music Therapy, 10(1).
Ansdell, G. (1999). Music Therapy as Discourse & Discipline: A Study of “Music Therapist’s
Dilemma.” Unpublished Ph.D. thesis, Department of Music, City University, London.
The far from stunning conclusion of my doctoral research was that “Music Therapist’s
Dilemma” was a real and thorny problem: that talking about music therapy is difficult because talking
about music is difficult. The less obvious conclusion was just why this is so. It was not, I suggested, a
“technical” problem that we would solve with a little more experience (i.e., not a question of
developing more accurate music therapy terminology). What I increasingly understood from a more
critical perspective on music therapy as a discipline and profession was that the dilemma was inherent
in the way that music therapy had been (and was still being) constructed. I was, that is, beginning to
question the map (or rather, the map-making).
A broader article that I wrote a few years later started life as a presentation at the World
Congress of Music Therapy in 1999 in Washington, D.C. By this time, a wing of international music
therapy was also “going critical,” questioning the maps we had made up to this time, scrutinizing
music therapy increasingly from a culture-centered and metatheoretical perspective. This meant
acknowledging that theory was made, not found; that it emerged from a particular cultural and
historical situation and was inevitably perspectival and partial. Norwegians Even Ruud and Brynjulf
Stige were influential here. 11 I’d arrived at a similar perspective fairly independently through the
particular narrow focus of my doctoral project:
Ansdell, G. (2003). The Stories We Tell: Some meta-theoretical reflections on music therapy. Nordic
I was now writing about “music therapy stories” in a rather more knowing and skeptical way than I’d
done in Music for Life. Through my research and my thinking about its implications, I’d learned more
about how professional “maps” are crafted to link practice and theory—to communicate what we do,
how, and why. Seeing more of how people assemble a discourse showed me how relative, situated,
and political any current discourse necessarily is. Partly, this was a disillusioning experience, like
seeing the man behind the curtain operating the magic in The Wizard of Oz. Partly, it was also
liberating. By seeing how provisional and pragmatic theoretical maps are, you also get a sense of
possibility. We can all help draw up the map; we can all correct it, add to it, or point out where vital
features have been left off (whether by omission or commission). I’d learned how theory is always a
view from somewhere—though it is none the worse for this! I’d learned that as a discourse, music
therapy is not something discovered “outside” language and translated into language, but rather it is
constantly constructed, revised, and renewed in-and-through language and its complex relationship
with the flux of everyday practice, culture, and politics.
11
Even Ruud had begun to take such a comparative and constructivist view of music therapy as early as the
1970s with his small but influential book Music Therapy and its Relationship to Current Treatment Theories,
continuing with this in his subsequent eloquent guides to the field (1998; 2010). Stige’s influential Culture-
Centered Music Therapy (2002) continued this tradition.
9
I ended my presentation at the 1999 World Congress with a question as to whether we were on
the brink of a “new music therapy” along lines similar to the “new musicology”—that is, one that was
plural, “critical,” and paradigm-baiting. Ironically, the conference was a celebration of the
achievements and stability of the current “big theories” of music therapy. I’m not sure that my
question was a very welcome one at that event!
My next “step” professionally provided more of an answer to my own question than I think I
had expected in 1999. It also reflects my sense of possibility and pragmatism with regard to music
therapy maps and the pliability of its discourse. We should keep asking about the theoretical stories we
tell about music therapy this pragmatic question: “What do they make possible?”
This was the resolutely practical question that gave birth to Community Music Therapy.
Step Four: Remapping
Community Music Therapy and Trojan paradigms
Community Music Therapy happened by prepared accident. I’ve told the story many times of how
Rachel Verney and I were talking in her kitchen in February 2000 about the then-topical issue in the
UK of “community musicians” encroaching on traditional music therapy territory, working one-to-one
with dementia patients, but saying “this is not music therapy.” While we were nervous about this
professional challenge, we had also been saying for a long time that British/European music therapy
was both practically and theoretically too narrow and restricted, and it needed a can opener to pry it
open! Perhaps this was it? There was a pause in our conversation, and we both simultaneously
thought: “Community Music Therapy.” A little research suggested that Brynjulf Stige had used this
term a decade earlier, but it had never really caught on in the professional climate at that time.12
I wrote an article called “Community Music Therapy and the Winds of Change” for the newly formed
Web journal VOICES in July 2002, in which I used a heuristic formulation (or “thinking tool”) for
purposes of theoretical discussion. I referred to a “consensus model” of music therapy to characterize
an overall trend of thinking and practice that was orientated by psychotherapeutic theory, conventions,
and attitudes. A consensus had grown up in music therapy, I suggested (in the UK and Europe, but
also in parts of the United States and other continents), in relation to one theoretical understanding—
and this was serving to guide practice, education, and the legitimization of music therapy. I was (I
thought!) clear that the “consensus model” I outlined was an artificial distillation, not something that
anyone actually practiced. This strategy partially backfired, as people have since then talked of the
“consensus model” as if it were real!
My discussion in the article then contrasts the “fictional” consensus model with the emerging
practices, values, attitudes, and discoveries of Community Music Therapy, with the comparison
intending to highlight the features and contrasts between the two approaches. Here I was influenced by
philosopher Karl Popper’s maxim that in order to form a good critique, you have to make the best
characterization of something you disagree with and then present your own thesis. Confusion
subsequent to this article perhaps suggests that I didn’t succeed very well in this!
Publication of this article coincided with the 2002 World Congress of Music Therapy in
Oxford, UK, which Nigel Hartley had themed to profile the two marginalized areas of then-
contemporary music therapy: community and spirituality. There was a lot of debate and some outright
dispute there about both the practical and the theoretical consequences of these. One writer
subsequently questioned whether CoMT was a “big British balloon” (with the implication, I think, of
being full of hot air and hopefully short-lived and shot down), while another talked of CoMT as
“professional suicide” within the existing European professional climate.
Unexpectedly (to me, at least), 10 years later, the balloon still seems to be flying! Many
therapists, trainers, and researchers have adopted and developed it as a pragmatic and flexible
orientation to their music therapy work across a variety of institutional and cultural settings. CoMT
now has different strands stemming from its seemingly simultaneous flourishing amid various national
12
For a systematic history of the “roots and routes” of CoMT, see Brynjulf Stige’s published doctoral thesis
(2003) on the subject.
10
traditions (British, Norwegian, and Australian, especially), but it also has a unifying core
perspective.13
From my British perspective, CoMT has functioned somewhat as a “Trojan horse” in which to
smuggle fresh perspectives into a rather closed and limited music therapy scene. In particular, many
Nordoff-Robbins therapists saw the increasing necessity for different and more flexible ways of
working with settings and individuals across a broad continuum of private to public work.
Theoretically, we needed to introduce into the discipline contemporary psycho-sociocultural theory
about community, social experience, culture, and social theory. Retrospectively, it seems that the
Trojan horse unexpectedly has had legs!
More broadly and internationally, CoMT has functioned perhaps as a “Trojan paradigm.” By
this, I mean that it has introduced a more sociocultural orientation into a theoretical discourse in
Britain/Europe that used a relentlessly narrow psychological view of people and music. The newer
psycho-sociocultural view helps to both highlight and give theoretical tools to work with broader
issues that are key to a music therapist’s current professional work (the sociocultural nature of illness,
recovery, and well-being).
In particular, this theoretical adjustment has benefited from the exciting developments in the
“new sociology of music,” which has the potential to provide a much-needed theoretical reorientation
for music therapy toward a broader understanding of musical people in musical contexts. (More about
this in the next section.)
I’ll leave this particular strand of my wandering here, as you can follow up on all of these
dimensions of CoMT through a variety of publications. Some of the key ones are as follows, but this is
only a selection:
Ansdell, G. (2002). Community Music Therapy and the winds of change. VOICES–A World Forum
for Music Therapy, 2(2).
Pavlicevic, M., & Ansdell, G. (Eds.). (2004). Community Music Therapy. London: Jessica Kingsley
Publishers.
Ansdell, G. (2005). Community Music Therapy: A plea for “fuzzy recognition” rather than “final
definition” [On-line]. VOICES, Moderated Discussions, January 2005.
DeNora, T. (2005). The Pebble in the Pond: Musicing, Therapy, Community [Review]. Nordic
Ansdell, G. (2006). Against polarizing the individual and the social: from kernel to matrix [On-line].
VOICES, Moderated Discussions, January 2006.
Verney, R., & Ansdell, G. (2010). Conversations on Nordoff-Robbins Music Therapy. Gilsum, NH:
Barcelona Publishers. [Read the “Forward” at the end of the book for more on the CoMT story.]
Stige, B., Ansdell, G., Elefant, C., & Pavlicevic, M. (2010). Where Music Helps: Community Music
Therapy in Action & Reflection. Farnham, UK: Ashgate Publishing.
Ansdell, G., & DeNora, T. (in press). Musical Flourishing: Community Music Therapy, controversy,
and the cultivation of well-being. In R. MacDonald, G. Kreutz, & L. Mitchell (Eds.), Music, Health, &
Wellbeing. Oxford, UK: Oxford University Press.
The CoMT phase in my work also led me to some very interesting reflections on how theory
functions professionally in music therapy. In short (and not entirely unexpectedly), CoMT elicited
professional responses ranging from the positive to the outraged! This was not surprising, since it
tackled not a few sacred cows and threatened some only-just-established professional legitimacies in
British/European academic and healthcare structures. The academic and not-so-academic skirmishes
around CoMT in the period 2002–2010 give ideal material to meta-theoreticians wanting to see
theory-in-action within the internal politics of disciplinary and professional worlds.
There is, however, a rather obvious paradox (perhaps a contradiction, even) that runs through CoMT,
and this may either prove part of its success or the source of its demise. While its fundamental
philosophy is a local and contextual one—arguing that the music therapist should do what is locally
needed—it is now being adopted as a nonlocal international discourse. This paradox is not new, of
13
For a more detailed survey of all of this, see Brynjuf Stige’s forthcoming book Invitation to Community Music
Therapy (2011). New York: Routledge.
11
course—it conforms to what Edward Said (2004) wrote of as the dilemma of traveling theory, when a
theory with a particular local “charge” loses this when transported to other places and local situations.
The pattern of debate over CoMT could illuminate something of how the disciplinary and professional
organization of international music therapy was operating during the period 1980–2000. In particular,
it perhaps shows some of the characteristics of institutional power and persuasion that were then
dominant and which controlled the mechanisms of practice, theory, training, and research. I think that
such a full study has yet to be done—but a few scholars within music therapy as well as others
specializing in the sociology of professions have started to explore tantalizing data from this period.
Here are just a few publications to use for following up:
Barrington, A. (2008). Challenging the profession. British Journal of Music Therapy, 22(2), 65–73.
Ansdell, G., & Pavlicevic, M. (2008). Responding to the challenge: Converting boundaries into
borders? A response to Alison Barrington’s article “Challenging the Profession.” British Journal of
Music Therapy, 22(2), 73–77.
and the cultivation of wellbeing. In R. MacDonald, G. Kreutz, & L. Mitchell (Eds.), Music, Health,
& Wellbeing. Oxford, UK: Oxford University Press.
Reading this material, you might almost think that at least one of the agendas of CoMT was to
serve as an experiment in the social construction and critique of a new practice/theory. How does it
develop? How is it maintained? When and why does it end?
What do clients experience? What’s their theory of music therapy?
A dilemma that Nordoff-Robbins music therapists have always faced when attempting to develop
client-centered, experience-near theory is that many client groups they have worked with could not
report their experiences. Therapists have had to interpret these for them. This was certainly a problem
for Nordoff and Robbins’s early work and has only fairly recently been compensated for by NR
therapists increasingly working with adult clients who could often report both their experiences and
their priorities—articulating in what ways music and music therapy helped and what their needs were
with respect to this.14
Part of my dawning understanding of a wider ecological conception of music therapy was to
take seriously clients’ reports of their experiences of music therapy and their evaluations of what was
important to them about it. The following two articles report some detailed qualitative studies that I
did in the period 1999–2005 as part of my work in acute psychiatric settings. Patients reported strong
effects and benefits from music therapy, but these were not always meshing with what music
therapists (and referring clinicians) assumed they were (or should have been).
The first study, conducted with psychiatrist John Meehan, was a “qualitative outcomes” study
that simply asked why patients in an in-patient facility returned to music therapy sessions (while their
attendance at other therapies was often poor). We asked 19 of them who had attended at least 10 music
therapy sessions just to tell us why they came back. We explored through short interviews how they
understood music therapy and what (if any) benefits they reported. The data outlined what could be
called a client’s music-centered theory—that is, they mostly came for the music itself and found that
their participation in musicking was therapeutic in itself. They also generally understood that given
their situation and illness, they needed something as formal as “music therapy” to give them access to
musicking and to help them participate. However, most patients did not link the benefits of music
therapy directly with their symptoms—it neither improved them nor worsened them. They simply saw
it as something quite separate from their illness. The outcomes were a broad set of psychosocial
benefits flowing from “being in music with another.” The rather simple results of this study gave some
evidence for a hunch that I’d had for some time—that music therapy is often an alibi for simply
making music in situations where this would otherwise be impossible or professionally unsupported.
The outcomes of this “just making music” could, however, be profound, as the exemplary case of
14
Colin Lee’s pioneering and moving book Music on the Edge (1996) should be mentioned here for its
demonstration both of the potentials and the problems of reconciling client perspectives with music therapeutic
analysis.
12
Edwin in this study outlined. For him, music and music therapy was the one thing that gave him at a
time of suicidal depression the sense of “a little light at the end of the tunnel.”
A second detailed qualitative study, this time with a set of interdisciplinary colleagues from
psychiatry, psychology, and music therapy, explored one of the important reported client benefits of
music therapy—its ability to modulate affect in people with acute psychological states in relatively
short periods of time. In the words of the case study that provides the title to the article, the
modulation from “this fucking life” to “that’s better” was achieved in 4 minutes! The parallel tracking
of musical, relational, and affective process in this analysis accorded well with key interdisciplinary
theory and method in the area of relational/developmental psychology (Malloch & Trevarthen, 2009;
Schore, 2003; Stern, 2010). In short, the particular musical qualities of human companionship could
be used professionally to help people who are struggling to control their own affective process.
Working in music within an improvised relational dialogue gives a conciseness and speed to this effect
and benefit.
A third long-scale study with international colleagues (reported below) added to this mounting
body of evidence that showed me that we need far more interrelationship between professional
theories and the accurate and insightful “lay theories” that our clients and participants can offer us.
Ansdell, G., & Meehan, J. (2010). “Some light at the end of the tunnel”: Exploring users’ evidence for the
effectiveness of music therapy in adult mental health settings. Music and Medicine, 2(1), 41–47.
Ansdell, G., Davidson, J., Magee, W., Meehan, J., & Procter, S. (2010). From “this f***ing life” to “that’s
better” … in four minutes: An interdisciplinary study of music therapy’s “present moments” and their potential
for affect modulation. Nordic Journal of Music Therapy, 19, 3–28.
Toward an ecological understanding
Brynjulf Stige, in his book Culture-Centered Music Therapy (2002), pithily sums up his agenda for a
rejuvenated music therapy theory as “ABC”—that is, “Adding Biology and Culture” to a construction
that was too exclusively psychological. I see from the review of my work for this chapter that my
theoretical wanderings in the past 10 years (done as ever in parallel with a series of practical music
therapy projects) has roughly followed Stige’s formula. This has been in collaboration with an
inspiring collection of colleagues, especially Rachel Verney, Mercédès Pavlicevic, Simon Procter, Tia
DeNora, Brynjulf Stige, and Cochavit Elefant.
This work has been a series of steps toward what we are now calling an ecological
understanding of music therapy, which is in turn part of a broader understanding of people, music,
illness, health, and well-being. An ecological perspective is implicit in many of the key inspirations
behind Community Music Therapy and Culture-Centered Music Therapy. For example, Christopher
Small’s Musicking is heavily informed by biologist and systems theorist Gregory Bateson’s ecological
theory, with its famous slogan that we attend always to “the pattern which connects”—to the
continuity and interdependence of biology, culture, and the “sacred.”
A key misunderstanding (sometimes cued by the title “community,” sometimes a willful one)
has been that CoMT is only about communities and not individuals and their personal psychological
lives and needs. Of course not! Rather, its basic theoretical understanding is psychosocial and
ecological—a framework that is now shared by many care and treatment professions. You can picture
this as the “Russian dolls” model, which shows how an individual is always nested and interdependent
within all of the other levels of relationship, both proximate and at more abstract levels of society,
policy, and politics. No person is an island; their “inner life” is continually composed by their impact
and interaction with the whole ecology that surrounds them, even as they individually shape this
environment. In the following Web article, you can see me stressing just this point to a respondent
who has tried to snap back into an old-style separation between the individual and the social:
Ansdell, G. (2006). Against polarizing the individual and the social: from kernel to matrix [On-line].
VOICES, Moderated Discussions, January 2006.
My increased understanding of an “ecological” way of thinking about music in relation to people,

things, situations, and action stemmed from a serendipitous discovery in 2000 that has flowered into a
rewarding professional collaboration today. I found a then newly published copy of music sociologist
Tia DeNora’s groundbreaking book Music in Everyday Life and overran three stops on my train while
13
reading this on the first morning. Here was a theoretically grounded and empirically rigorous theory of
how music works for all of us in our everyday lives. It ranges over the whole gamut of types of people
and situations (including a music therapy case), giving equal weight to the specificity of people’s
situations and of the socially and culturally constructed musical materials and processes in which they
become caught up.
DeNora’s key conceptual tools have become commonplace since for music specialists: the
paired concepts of “musical affordances” and “musical appropriations.” A musical affordance is what
a particular musical property or process offers, but only insofar as our perceptual and cultural capacity
can pick this up (i.e., it is personal and situational, not general and abstract). Likewise, a “musical
appropriation” is our unique and active “taking” and working with what’s offered by a musical
situation/property. DeNora’s theory is of music resolutely in action, underpinned by the new
sociology’s insistence that cultural material is not just a reflective material (of social or psychological
reality) but an active constituent in building and maintaining our psychosocial life together. Indeed,
DeNora and her colleagues articulated a useful critique of the “new musicology” that I couldn’t quite
put my finger on when I’d been enthusing about this area some years previously. Unfortunately, as
DeNora pointed out, while the musicology of the “new musicologists” was “new,” their sociology was
“old”! In comparison, DeNora’s perspective has offered a new perspective for music studies that is
based on some of the latest thinking in sociocultural theory.
Increasingly, DeNora has been characterizing her perspective as an ecological one, which we
could define provisionally as acknowledging musick(ing) as the outcome of the dynamic
interdependence of human and “nonhuman” phenomena and resources (sounds, agents, actions, forms,
processes, purposes, “habitats”). DeNora’s work benefits from close study of her own texts (DeNora,
2000; 2003; 2010), but my summary of some of her ideas in the following chapter are aimed at a
music therapy audience:
Ansdell, G. (2004). Rethinking Music & Community: Theoretical perspectives in support of

Community Music Therapy. In M. Pavlicevic & G. Ansdell (Eds.), Community Music Therapy.
DeNora subsequently found that music therapy (and the broad-based practice and theory of
CoMT in particular) was an ideal workspace for the development of her perspectives.15 One strand of
her work has increasingly focused on music’s active interface with issues of health, illness, and well-
being and their reliance on social and cultural inclusion. This development has run in parallel with her
involvement in music therapy practice and research. I’ve been fortunate to collaborate with DeNora
since 2006 on a long-term ethnographic study of musicking within a pioneering mental health
community in London. As well as having been in a moving and fascinating place to study how music
helps people, we also hope that our work there will bear theoretical fruit.16
Another key theoretical underpinning for an ecological understanding has been the ever-
developing interdisciplinary theory of communicative musicality, which had been introduced into
music therapy primarily by Mercédès Pavlicevic in the 1990s, following her own doctoral studies with
one of its key originators, Colwyn Trevarthen. Mercédès and I both found that the synergy between
this psychobiological theory and Nordoff-Robbins Music Therapy was tantalizing and have worked on
this area in a series of joint theoretical publications.
You can see our attempts to clarify a theoretical “ABC” (“adding biology and culture”) for
music therapy in relation to communicative musicality in two commissioned book chapters that
Mercédès and I wrote during the mid- to late 2000s. These chapters are published in interdisciplinary
collections that themselves show an evolving interest in the relationship between music theory and the
continuum of musical practices (across education, therapy, performance, etc.). They represent a new
generation of “mapping” of great interest to us. Also of note has been their reciprocal interest in
15
See DeNora’s review article “The Pebble in the Pond: Musicing, Therapy, Community” (2006) and the
Introduction to her collected papers Music-in-Action (2010).
16
The longitudinal ethnographic study of the Chelsea Community Music Therapy Project is just coming to a
close. It will be written about in book form in G. Ansdell & T. DeNora (forthcoming), Musical Pathways in Mental
Health. Farnham, UK: Ashgate Publishing. An interim account of this work can be found in G. Ansdell & T.
DeNora (in press), Musical Flourishing: Community Music Therapy, controversy, and the cultivation of wellbeing.
In R. MacDonald, G. Kreutz, & L. Mitchell (Eds.), Music, Health, & Wellbeing. Oxford, UK: Oxford University
Press.
14
CoMT as a broadened practice that accommodates well to a contemporary view of musicking as a
psycho-sociocultural practice.
Ansdell, G., & Pavlicevic, M. (2005). Musical Companionship, Musical Community: Music therapy
and the process and values of musical communication. In Miell, MacDonald, & Hargreaves (Eds.),
Musical Communication. Oxford, UK: Oxford University Press.
Pavlicevic, M., & Ansdell, G. (2009). Between Communicative Musicality and Collaborative
Musicing: Perspectives from Community Music Therapy. In S. Malloch & C. Trevarthen (Eds.),
Communicative Musicality. Oxford, UK: Oxford University Press.
The two chapters illustrate our attempts to synthesize communicative musicality theory with the
developments of Community Music Therapy—to present, that is, a model that could accommodate the
continuum from individual to communal musical experience. The following diagram of three
cumulative concepts summarizes our perspective:
musicing
Situa tedness of …
AC TI VI TY o Occasion s
o Performances
Af f ordances /
musicianship appr opriati ons of
FAC ILITY o Mu sics
o Mu sicers
mu sic al it Mo bilisation of
o Cor e musicality
C APAC IT Y … via …
o Protomusicality
cor e
· MUSICALITY is a core human capacity, and a basic response to and engagement with the
human world. It is our “natural” relationship with music, though sometimes it needs to be
awakened and mobilized through protomusical aspects.
· MUSICIANSHIP is a cultivated facility of musicality in action within the sociocultural
world. It is our cultivated relationship to music, via skilled engagement with community and
history. Its “mechanisms” include musical affordances and musical appropriations.
· MUSICKING is a universal activity of musicianship in action—grounded in specific musical
occasions and performances.
Each of these “levels” is interdependent, both cumulative (developmentally) and also often
simultaneously occurring. In any real-life setting, each is continually stimulating and laying the
foundation for the other(s). This model is of course another type of map—beginning with a broad
concept of musick(ing) and subsequently applicable to the particular situations of music therapy.
On these simple foundations, I have been gradually assembling an understanding of various “aspects”
of a musical ecology, based on many of the musical and music therapy experiences I’ve already
written about above. Additional thinking also happened with colleagues Brynjulf Stige, Mercédès
Pavlicevic, and Cochavit Elefant as part of the Norwegian Research Council 5-year project “Music &
Health in Late Modernity” (2003–2008). We had the pleasure and luxury then of studying Community
Music Therapy in four geographically and culturally diverse settings—England, Norway, South
Africa, and Israel—and building an ethnographically grounded theory of what is happening when
music seems to help in these settings and conditions. The result of this project was the following book:
15
Stige, B., Ansdell, G., Elefant, C., & Pavlicevic, M. (2010). Where Music Helps: Community Music
Therapy in Action & Reflection. Aldershot, UK: Ashgate Publishers.
In short, I have found that music helps us broadly—whether clients in music therapy or when self-
administering musical help for ourselves—in relation to four domains: (i) identity and personhood; (ii)
communication, dialogue, and relationships; (iii) community and social action; and (iv) forms of
transcendence or epiphany. Musical experience moderates all of these.
In addition to all of the studies mentioned above, the following publications added the specific
areas of performance, belonging, and spirituality to the provisional synthesis:
Ansdell, G. (2005). Musicing, Time, & Transcendence: Theological Themes for Music Therapy.
British Journal of Music Therapy, 19(1).
Ansdell, G. (2005). Being Who You Aren’t; Doing What You Can’t: Community Music Therapy &
the Paradoxes of Performance [On-line]. VOICES, 5(3).
Ansdell, G. (2010). Belonging through musicing: explorations of musical community.” In B. Stige,
G. Ansdell, C. Elefant, & M. Pavlicevic (2010), Where Music Helps: Community Music Therapy in
Action & Reflection. Aldershot, UK: Ashgate Publishers.
Ansdell, G. (2010). Where performing helps: processes and affordances of performance in
Community Music Therapy. In B. Stige, G. Ansdell, C. Elefant, & M. Pavlicevic (2010), Where
Music Helps: Community Music Therapy in Action & Reflection. Aldershot, UK: Ashgate
Publishers.
I have realized that I have long been attempting to assemble both a conceptual and an experiential map
of this territory of “music’s help.” My approach to this has always been guided by the same
underlying principle: that any musical phenomenon explored and theorized should refer as closely as
possible to our everyday situations and experiences and mesh with people’s reports on their own
musical experiences.
I’m currently trying to synthesize this perspective in a book (currently in preparation) called
How Music Helps, which will be one of three commissioned books of a triptych on music, health, and
wellbeing with Tia DeNora. For this book, I aim to work from my understanding as a music therapist
and to hopefully convey something of the richness that so many clients and colleagues have shared
with me concerning the key relationships between music, health, and illness. I hope to put these into
what I now glimpse as a wider formulation that will be just as relevant to people outside of our
professional field.
Conclusions
Theory as practice
A problem shared by most “applied” areas like music therapy is the false separation that we make in
our minds between “practice” and “theory.” I stress “in our minds” here, because in practice our
theory is being constantly articulated by our hands and voices. Our music therapist’s craft is another
dimension of our theory, as our theory is a dimension of our craft. When, however, we come to talk
explicitly about theory, the two domains often peel apart like a chocolate bar and its wrapper. I suggest
that instead we consider a question by pioneer sociologist and music theorist Theodor Adorno: “Is not
theory also a genuine form of practice?”
I still retain a degree of skepticism about an exclusive “music therapy theory,” just as Nordoff
and Robbins did 50 years ago. I feel instead that there are many possible “Theory Streets”; many
possible perspectives on the “Parthenon” of music therapy. These are all, however, necessarily
historically and culturally situated and partial (some even as partial as counting as individual
theoretical perspectives created by a therapists’ unique work, situation, and personality).
However, this is not to say that I don’t value the activity of theory—theorizing—as a noble and
necessary endeavour for our discipline and profession. Theorizing as a practice means keeping
inquiry, reflection, dialogue, and debate in motion and action. It means looking both “downward” into
our own discipline and “across” to other parallel disciplines and professional knowledges. It means
16
taking part in the challenge and dispute of the dialectical process—which is perhaps the best guard
against prematurely final vocabularies and final theories. For each thesis, there’s usually a balancing
antithesis and the possibility at least of an emerging higher-level synthesis. Adorno, master
dialectician, battled for this and for its alternative, too, when necessary—a “negative dialectics” that
could hold the tension and avoid premature or artificial synthesis.
New/old threats
We still need rigorous theorizing in music therapy to deal with some new threats (which are mostly
old ones in disguise!). First, there’s a new wave of positivism riding the political horse of the
evidence-based medicine movement and its economic pieties. This is a new version of the first
response of music therapy to professional institutionalization in the 1950/60s—the search for simple
mechanisms and simple outcomes defined within and by a medical model. The humanistic
countermovement to this from the 1970s onward formed a counterattack to it but has proved too
limited in its psychotherapeutic model. But it at least acknowledged a more spacious conception of
people and music. We are now swinging back again to a medicalized reduction of music therapy, one
which simply excludes too much of what music therapy is and needs to be.
Related to this is a false hope that the discipline of neuroscience and its empirical explorations
through scanning will provide a satisfactory theoretical platform to support such an evidence-based
practice. Again a sophisticated theoretical debate is needed to balance and complexify this picture. A
critical counterargument is currently developing strongly outside of music therapy in relation what
Raymond Tallis has called “neuromania,”17 but this needs more systematic work within our own
discipline. To put it crudely: Brains don’t make music, people do! And, moreover (as I’ve outlined in
this chapter), only people considered within the ecology of their everyday situation of cultural and
interpersonal meaning systems, actions, and relationships.
Finally, theorizing is needed in the professional area, working out to what extent music
therapy is a distinct practice and heritage and whether it can any longer maintain its assumed
uniqueness. Music therapy has had something of a professional and disciplinary monopoly during the
period 1950–2000. Other related but distinct practices, disciplinary bodies of knowledge, and
professional organizations are now challenging this monopoly. This looks different in different parts
of the world, but the competitors are variously called “community music,” “music and health,” and
“music and well-being.” We are, in my view, now witnessing a reconfiguration of the umbrella field
of “people, music, health, and illness.” This could have both advantages and challenges on the levels
of practice, theory, and profession. What we can be sure of is that our own theorizing within music
therapy in relation to this situation is both necessary and urgent. It is by no means certain that music
therapy can (or should?) survive this latest challenge.
Some of these themes are tackled in a recent chapter written by me and Tia DeNora for an
edited volume by a variety of interdisciplinary scholars from the newly forming area of music, health,
and well-being.
Ansdell, G. (2006). Evidence & Effectiveness in Music Therapy: What’s appropriate? Why can’t it be
simple? (Five Complexities). A response to Tia DeNora’s “Evidence and Effectiveness in Music
Therapy: Problems, Power, Possibilities, and Performances in Health Contexts.” British Journal of
and the cultivation of wellbeing. In R. MacDonald, G. Kreutz, & L. Mitchell (Eds.), Music, Health, &
Wellbeing. Oxford, UK: Oxford University Press.
In addition, the following forthcoming “triptych” of books on music, health, and well-being is under
contract by Ashgate Publishers, UK. These will be published in 2012–2013.
Book 1: Ansdell & DeNora—Musical Pathways in Mental Health
Book 2: DeNora—The Music Asylum: Aesthetic Ecologies of Health in Everyday Life
Book 3: Ansdell—How Music Helps
17
See the latest work by physician and philosopher Raymond Tallis, Aping Mankind: Neuromania, Darwinitis,
and the Misrepresentation of Humanity (2011). Durham, UK: Acumen Publishing.
17
NEW SERIES: Ashgate has also commissioned a new interdisciplinary series called Music & Change:
Ecological Perspectives in Practice, Theory, & Policy, with G. Ansdell and T. DeNora as general
editors. This aims to publish key works in the newly evolving field of music, health, and well-being.
The “continuity principle”
I’m a fan of the key idea of American pragmatist philosopher John Dewey—his “continuity principle.”
Put simply, this counsels us to look for the continuity between things that we’re tempted to separate.
Not “mind” and “body,” but the continuity between them; not “me” and “you,” but what’s between us;
not “subject” and “object,” but what flows to mutually shape each.
My 20-odd years of theoretical attention to this strange hybrid called “music therapy” have led
me to passionately believe in it while also doubting its whole edifice. What I believe in is what I’ve
experienced as the radical potential of music to transform people’s lives and the role of a trained
therapist’s craft and discernment in helping this transformation to happen. What I’m not so sure about
is the boxing up of this within too tight and too certain a package, and its separation from other
musical practices. This theoretical and political move has, I think, limited the growth and influence of
music’s help for people and situations.
As a musician, I’d like to think more of the continuity of practice and theory across all of the
possible manifestations and situations of “music’s help.” I’ve always been inclined to think of music
therapy not as a special, musical type of (psycho)therapy that is somehow insulated against the
continuity of music within and across our lives, but rather as indicating a musician’s particular
expertise and craft in making musicking accessible to a range of people and situations under specific
challenges. This is by no means to devalue a music therapist’s professionalism. Rather, it locates a
music therapist’s skills and knowledge on a broader continuum that ranges from lay expertise with
music (including our own in relation to ourselves) to specialist professional expertise for particular
people and situations. Thinking this way highlights in a very practical sense exactly where the
technical skill and the specialist knowledge of a music therapist actually lie.
At the level of theory, this continuity perspective has similar implications: There can be no
insulated and unique “music therapy theory.” Rather, the particular situations and people a music
therapist works in and with refract and highlight those theoretical aspects of music and musicking that
are being increasingly convincingly articulated by an interdisciplinary theory that attends to the
ecology of the whole situation (as expressed above). Such a perspective discourages the development
of arcane theory sequestered by something called “music therapy” alone. Music therapy today is
merely the latest incarnation of a long and perennial story of the complex and necessary relations
between people, music, illness, health, and well-being.
A simpler theory?
At a medical conference a while ago, I listened to a music therapist give an eye-wateringly complex
presentation, trying to cram every possible theoretical dimension of music therapy into a 20-minute
slot. After this, a wise-looking elderly gentleman leaned over to me and said (assuming, I think, that I
was a fellow doctor), “These chaps need a simpler theory, don’t they?” I think that we do, although
with Einstein’s proviso: that we should make things as simple as possible, but no simpler!
It’s a delicate balance, and I think that we’re still a way off in terms of raising our thinking to
the level of our musical experience of people and their situations. But there’s good reason to go on
trying.
Selected bibliography (Gary Ansdell)
Books
Ansdell, G. (1995). Music for Life: Aspects of Creative Music Therapy with Adult Clients. London: Jessica Kingsley
Publishers.
Ansdell, G., & Pavlicevic, M. (2001). Beginning Research in the Arts Therapies–A Practical Guide. London: Jessica
Kingsley Publishers.
Pavlicevic, M., & Ansdell, G. (2004). Community Music Therapy. London: Jessica Kingsley Publishers.
18
Stige, B., Ansdell, G., Elefant, C., & Pavlicevic, M. (2010). Where Music Helps: Community Music Therapy in Action &
Reflection. Aldershot, UK: Ashgate Publishers.
Verney, R., & Ansdell, G. (2010). Conversations on Nordoff-Robbins Music Therapy. Gilsum, NH: Barcelona Publishers.
Selected articles and chapters
Ansdell, G. (1990). Limitations and Potential: a report on a music therapy group for clients referred from a counseling
service. British Journal of Music Therapy, 4(1).
Ansdell, G. (1991). Mapping the Territory. British Journal of Music Therapy, 5(2).
Ansdell, G. (1996). Talking about Music Therapy: a dilemma and a qualitative experiment. British Journal of Music
Therapy, 10(1).
Ansdell, G. (1997). Musical Elaborations: What has the “New Musicology” to say to music therapy? British Journal of Music
Therapy, 11(2).
Ansdell, G. (1999). Challenging Premises. British Journal of Music Therapy, 13(2).
Ansdell, G. (2000). Will the Real Edward Kindly Stand Up? A Fictional Response to the “Edward Commentaries.” Nordic
Ansdell, G. (2001). Musicology: Misunderstood guest at the music therapy feast? In D. Aldridge, G. di Franco, E. Ruud, &
T. Wigram (Eds.), Music Therapy in Europe. Rome: ISMEZ/Onlus.
Ansdell, G. (2002). Community Music Therapy and the Winds of Change. In C. Kenny & B. Stige (Eds.), Contemporary
Voices in Music Therapy: Communication, Culture and Community. Oslo: Unipub.
Ansdell, G. (2003). The Stories We Tell: Some meta-theoretical reflections on music therapy. Nordic Journal of Music
Therapy, 12(2).
Ansdell, G. (2004). Music, Noise, & Anger: A Response to Simon Frith’s Essay. Nordic Journal of Music Therapy, 13(1).
Ansdell, G. (2004). Rethinking Music & Community: Theoretical perspectives in support of Community Music Therapy. In
M. Pavlicevic & G. Ansdell (Eds.), Community Music Therapy. London: Jessica Kingsley Publishers.
Ansdell, G. (2005). Being Who You Aren’t; Doing What You Can’t: Community Music Therapy & the Paradoxes of
Performance [On-line]. VOICES, 5(3).
Ansdell, G. (2005). Musicing, Time, & Transcendence: Theological Themes for Music Therapy. British Journal of Music
Therapy, 19(1).
Ansdell. G. (2006). Community Music Therapy: Ein Neuer Alter Gedanke. Musiktherapeutischer Umschau, Heft 2006,
27(3).
Ansdell, G. (2006). Evidence & Effectiveness in Music Therapy: What’s appropriate? Why can’t it be simple? (Five
Complexities). A response to Tia DeNora’s “Evidence and Effectiveness in Music Therapy: Problems, Power, Possibilities,
and Performances in Health Contexts.” British Journal of Music Therapy, 20(2), 96–99.
Ansdell, G. (2010). Belonging through musicing: explorations of musical community. In B. Stige, G. Ansdell, C. Elefant, &
M. Pavlicevic (2010), Where Music Helps: Community Music Therapy in Action & Reflection. Aldershot, UK: Ashgate
Publishers.
Ansdell, G. (2010). Where performing helps: processes and affordances of performance in Community Music Therapy. In B.
Stige, G. Ansdell, C. Elefant, & M. Pavlicevic (2010), Where Music Helps: Community Music Therapy in Action &
Reflection. Aldershot, UK: Ashgate Publishers.
Ansdell, G., Davidson, J., Magee, W., Meehan, J., & Procter, S. (2010). From “this f***ing life” to “that’s better” … in four
minutes: An interdisciplinary study of music therapy’s “present moments” and their potential for affect modulation. Nordic
Ansdell, G., & DeNora, T. (in press). Musical Flourishing: Community Music Therapy, controversy, and the cultivation of
wellbeing. In R. MacDonald, G. Kreutz, & L. Mitchell (Eds.), Music, Health & Wellbeing. Oxford, UK: Oxford University
Press.
Ansdell, G., & Meehan, J. (2010). “Some light at the end of the tunnel”: Exploring users’ evidence for the effectiveness of
music therapy in adult mental health settings. Music and Medicine, 2(1), 41–47.
19
Ansdell, G., & Pavlicevic, M. (2005). Musical Companionship, Musical Community: Music therapy and the process and
values of musical communication. In Miell, MacDonald, & Hargreaves (Eds.), Musical Communication. Oxford, UK: Oxford
University Press.
Ansdell, G., & Pavlicevic, M. (2008). Responding to the challenge: Converting boundaries into borders? A response to
Alison Barrington’s article “Challenging the Profession.” British Journal of Music Therapy 22(2), 73–77.
Ansdell, G., & Pavlicevic, M. (2010). Practising “gentle empiricism”: The Nordoff-Robbins research heritage. Music
Therapy Perspectives, 28(2).
Pavlicevic, M., & Ansdell, G. (2009). Between Communicative Musicality and Collaborative Musicing: Perspectives from
Community Music Therapy. In S. Malloch & C. Trevarthen (Eds.), Communicative Musicality. Oxford, UK: Oxford
University Press.
Additional references
Aldridge, D., Brandt, D., & Wohler, D. (1990). Toward a common language amongst the creative art therapies. The Arts in
Psychotherapy, 17(1).
DeNora. T. (2000). Music in Everyday Life. Cambridge, UK: Cambridge University Press.
DeNora, T. (2003). After Adorno. Rethinking Music Sociology. Cambridge, UK: Cambridge University Press.
DeNora, T. (2006). The pebble in the pond. Nordic Journal of Music Therapy, 14(1), 57–66.
DeNora, T. (2010). Music-in-Action: Selected Essays in Sonic Ecology. Farnham, UK: Ashgate Publishers.
Lee, C. (1996). Music on the Edge: The Music Therapy Experiences of a Musician with AIDS. London: Routledge.
Malloch, S., & Trevarthen, C. (2009). Communicative Musicality. Oxford, UK: Oxford University Press.
Nattiez, J-J. (1990). Music and Discourse. Princeton, NJ: Princeton University Press.
Naydler, J. (1996). Goethe on Science: An Anthology of Goethe’s Scientific Writings. Edinburgh, UK: Floris Books.
Nordoff, P., & Robbins, C. (1971/2004). Therapy in Music for Handicapped Children. Gilsum, NH: Barcelona Publishers.
Nordoff, P., & Robbins, C. (1977/2007). Creative Music Therapy. Gilsum, NH: Barcelona Publishers.
Robbins, C. (2005). A Journey Into Creative Music Therapy. The Nordoff-Robbins Music Therapy Monograph Series, Vol. 3. St Louis,
MO: MMB Music.
Ruud, E. (1980a). Music Therapy and its Relationship to Current Treatment Theories. St Louis, MO: MagnaMusic-Baton.
Ruud, E. (1998). Music Therapy: Improvisation, Communication, and Culture. Gilsum, NH: Barcelona Publishers.
Ruud, E. (2010). Music Therapy: A Perspective from the Humanities. Gilsum, NH: Barcelona Publishers.
Said, E. (2004). Power, Politics, and Culture: Interviews with Edward W. Said. London: Bloomsbury.
Schore, A. (2003). Minds in the Making: Attachment, the Self-organising Brain, and Developmentally-oriented
Psychoanalytic Psychotherapy. In J. Corrigall & H. Wilkinson (Eds.), Revolutionary Connections: Psychotherapy &
Neuroscience. London: Karnac Books.
Sennett, R. (2008). The Craftsman, London: Allen Lane.
Small, C. (1998). Musicking. Hanover, NH: Wesleyan University Press.
Stern, D. (2010). Forms of Vitality: Exploring dynamic experience in psychology, the arts, psychotherapy, and development.
Oxford, UK: Oxford University Press.
Stige, B. (2002). Culture-Centered Music Therapy. Gilsum, NH: Barcelona Publishers.
Stige, B. (2003). Elaborations towards a notion of Community Music Therapy. Oslo: Unipub/University of Oslo.
Streeter, E. (1999). Finding a balance between psychological thinking and musical awareness in music therapy theory–a
psychoanalytic perspective. British Journal of Music Therapy, 13(1), 5–20.
Verney, R., & Ansdell, G. (2010). Conversations on Nordoff-Robbins Music Therapy. Gilsum, NH: Barcelona Publishers.
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READING 8
Paper presented at the annual conference of the Canadian Association for Music Therapy, May 1,
1991. Regina: Saskatchewan.
Musical Origins:
Developmental Foundations for Therapy
Kenneth E. Bruscia
Life is a continuous process of development and growth, beginning in utero and extending until
(and perhaps beyond) death. It is a universal process. That is, we all pass through the same or similar
stages of physical, mental, emotional, and social growth. But it is also a very unique process. Every
individual walks down his/her own developmental path, experiencing different events, with different
people, and encountering very different challenges, obstacles, and triumphs along the way.
As therapists, we recognize the need to understand a client within the context of his/her own
personal history; and as music therapists, we are aware of how important it is to know the client’s
musical background. One of the main purposes of examining the client’s history is to determine where
they are developmentally: whether they are in the stage typical of their age or whether they have
developmental delays, disabilities, or fixations. Although we tend to think that developmental goals are
particularly relevant when working with children, we are becoming increasingly aware of how valuable
a developmental approach can be in working with individuals of all ages.
When conceived as a developmental process, music therapy has three main aims: to facilitate
general development and growth by presenting experiences and learnings that a client needs at the
current stage (e.g., language activities for three-year olds); to remediate or compensate for specific
developmental disabilities (e.g., helping a mentally retarded or learning disabled adult learn how to
read); and to return the client to a recurring developmental problem so that it can be resolved (e.g.,
helping an adult go back and learn how to be playful).
Recent theorists have proposed that every developmental stage presents the individual with a
certain life challenge or developmental task, and that if these challenges or tasks are not accomplished,
a specific kind of pathology develops—one that is indigenous to a particular stage of physical, mental,
emotional, or social development. Furthermore, each kind of developmental pathology calls for a
different approach to treatment. Of special note are the theories of Kegan (1982), Grof (1988), and
Wilber, Engler, and Brown (1986).
For music therapists, these theories stimulate another layer of questions: What musical
challenges and tasks are indigenous to each developmental stage, and if these challenges or tasks are
not accomplished, what pathology and method of treatment within music therapy are indicated? The
purpose of this presentation is to summarize what happens musically in each developmental stage of
life and to speculate on what implications this has for music therapy practice. The main facts are drawn
from the references cited below.
1
Amniotic Period
Although not part of our everyday consciousness, our life begins as a fetus encased in amniotic
fluid. In such an environment, sounds are experienced as actual vibrations. The fetus experiences its
own heart as the central core and strongest source of vibration. However, this is immediately
experienced in relation to the heartbeat of the mother, who contains it. Thus, the fetus learns early that
a steady beat is an indication of one’s lifeline—one’s physical well-being—as dependent on the stability
and strength of the mother’s pulse. It is not surprising, therefore, that the musical pulse is the ultimate
“holding environment,” the life matrix, and the most noticeable signal of survival and aliveness.
Because the heartbeat is the ultimate connection to life, the pulse in music is the foundational element
by which we experience our physical or substantive selfhood.
The second strongest vibration in the amniotic fluid occurs at the umbilical cord, where the
fetus receives nourishment from the mother. This nourishment comes in periodic steady states,
reminiscent of musical phrases. Full and regular nourishment occurs when all of the internal organs of
the mother are functioning properly—in a healthy, rhythmic flow. The fetus is thereby sensitized to the
periodicity of phrases in the music of the mother‘s body, with phrase length and strength closely linked
to the health of the mother and the reliability of her nourishment.
Sounds external to the fetus that are not transmitted directly to the heart or umbilical cord are
experienced through generalized vibrations of the amniotic fluid. They are felt all around the body—at
every extremity. Sounds transmitted in this generalized way include the mother’s body (voice and
internal organs), the mother’s movements, and sounds in the mother’s environment. Rhythms are
experienced on a continuum of regular to irregular (pulse to complex rhythm) and are therein
associated with predictable and unpredictable movements of the mother or events in the mother’s
environment; high and low pitches are distinguished as fast or slow frequency vibrations and induce
corresponding levels of arousal.
Thus, two musical elements seem crucial to this developmental stage: pulse (and predictable
rhythms) and pitch. Through reflexive conditioning, these musical elements are associated with the
quality of the physical holding environment, the adequacy of nourishment, and various states of
arousal. All of these physical conditions are experienced in terms of basic survival needs and physical
pleasure/pain.
Descending the Birth Canal
When the amniotic fluid sac breaks and delivery is imminent, the fetus experiences alarming
chemical signals along with the mother’s contractions. No longer protected by the cushion of the fluid,
the fetus now experiences sound and vibrations separately. The body of the fetus is in closer contact
with the walls of the birth canal. The mother’s contractions are experienced directly, through periodic
states of pressure and release, which occur with various breathing rhythms. Outside the womb, the
voices of mother and all those involved in the birthing process are apprehended by the fetus. The most
relevant musical element is phrasing, as the shapes and length of contractions, breaths, and cries are
conditioned into the fetus’ consciousness, inextricably linked to pressure vs. release, and confinement
vs. freedom.
2
Birth
As the struggles between contraction and release come to an end, the fetus leaves the darkness
of the womb and enters the light of the outside world. Steady vibrational experiences are gone, the
mother’s heartbeat is no longer felt, contact with one’s own heartbeat is not as obvious, the umbilical
cord is cut, and breathing on one’s own becomes a necessity for survival. Then, with the help of a pat
on the back, the fetus clears its voice and sounds its first musical expression: the cry of rage and relief!
In that first cry, the breath of life (a responsibility of survival as a physical entity) and the experience of
separation (the responsibility of individuation as a psychological entity) are united.
0–6 Months
During the first six months of life, the baby’s vocal sounds are entirely reflexive, consisting of
various cries, coos, and oral sounds. Like the birth cry, these vocal reflexes are ways that the baby
expresses an inner state (i.e., the need for food or comfort) and thereby manipulates the caregivers to
respond. The motivation for vocal activity is therefore to satisfy basic needs, to obtain pleasure, and to
prevent or reduce pain. Another motivation is to be with others. According to Piaget, an infant
vocalizes “contagiously” (when others around it vocalize) and in mutual imitation (simple alternation).
The infant’s movements are also subject to outside influence. From birth, the baby seems
already wired to “entrain” or synchronize with rhythms in the environment. An important rhythmic
relation that a baby develops with the mother is through sucking—a very regular beat that coordinates
oral reflexive movements with receiving nourishment and breathing. Often this is experienced with the
accompaniment of a mother’s lullaby or simple rocking.
Instruments are not recognized as separate objects yet, but when placed in the infant’s hands or
attached to the body in some way, they become sound extensions of the body. This is important, as
instruments retain this basic physical significance throughout later periods—they extend the body and
are sounded through routinized motor-schemes. The only instruments the baby can play at this stage
are those that are sounded by holding, releasing, or random shaking.
Receptive skills are already developing, though evidenced only through reflexive responses to
listening. Changes or differences in pitch, rhythm, and sequence can already be apprehended reflexively
by infants during this period. Affective responses to listening can be inferred from changes in activity
levels and movement intensity.
Pathology originating in this developmental period stems from a failure to differentiate the
physical self. Treatment regimes most often require pharmacological or physiological interventions
(Wilber, Engler, & Brown, 1986). In music therapy, the most relevant treatment techniques involve
sensory stimulation and integration, and physiological approaches to music listening, including
biofeedback. Behavioral techniques are also relevant to the kinds of learning that need to take place
(e.g., conditioning).
6–24 Months
The infant exercises, varies, abbreviates, and generalizes vocal reflexes until they sound like
purposeful vocal “play.” Toward the end of the period, babbling appears in speech and music, and this
3
leads to short, repetitive tuneful utterances, (e.g., sing-song “Ma-ma” or “pat-a-cake”). Longer babbles
sound like “whale songs,” in that the main musical element is pitch contour. Meanwhile, the child is
beginning to learn syllabic fragments of precomposed songs.
As for instruments, the infant begins to actively explore their manipulation and discovers that
different sensory motor schemes produce different sounds. These primitive means–end connections
eventually lead to intentional, goal-directed behavior. The most important musical element in this arena
is timbre.
Receptively, the child begins to recognize a repertoire of tunes and exhibits associated
movements to them. Preferences are expressed by orienting the body toward or away from the sound.
The child becomes fascinated by his/her own voice, and begins to listen to it. Discrepancies in timbre,
pitch, and volume are perceived.
By the end of this period, the child recognizes objects as entities in themselves, not mere
extensions of self. Conversely, the child also recognizes him/herself as a psychological, emotional entity
apart from the rest of the world. These discoveries may lead to feelings of abandonment or separation
anxiety. Music bears witness to the child’s feelings, as both spontaneous and precomposed songs
provide a “transitional object,” something that reassures the child that s/he is not alone. The origins of
“whistling in the dark” are formed during this time.
Pathologies originating from this period reflect a failure to differentiate or maintain emotional
boundaries. These include narcissistic and borderline personality disorders (Wilber, Engler, & Brown,
1986). In the narcissistic disorders, the person incorporates or assimilates outside boundaries into the
self; in borderline disorders, the person is easily engulfed by others, being unable to maintain his/her
own boundaries.
Recommended approaches to therapy are those that build structures and boundaries, and
especially those that unite physical and emotional experiences. Thus, in music therapy, the emphasis
should be on: (1) nonverbal explorations of how body movements and sensations produce or relate to
different sound parameters (i.e., fast/slow, loud/soft, high/low); (2) exploration of the full continuum of
each sound parameter (i.e., very slow, slow, moderate, fast, very fast), with activities that emphasize
middle as well as extreme ranges; (3) association of pleasure to having many options (not just the
extremes); (4) differentiation of music belonging to the self and music belonging to the other. Generally
speaking, synchronous activities should be used to integrate physical and emotional experiences within
the self, while imitative or sequential activities should be used to differentiate self and other.
In working with adults still struggling with developmental tasks of this period, the music
therapist must continually distinguish the client’s musical offering or feeling from that of others.
Essentially, the client has to learn: My music is mine and not necessarily yours; your music is yours and
not necessarily mine.
When the narcissistic or borderline adult sings or plays precomposed music, care should be
taken to prevent overidentification with the composition, as this leads to a loss of personal boundaries
within the musical experience. In improvisation, clear differences in timbres should be maintained
between players, and synchronous activities should provide opportunities to explore conditions of
playing alike and different. In listening activities, the therapist has to monitor the extent to which the
client identifies with the composer or performer, goes into altered states, and relies too heavily upon
the music for determining feelings or images. In psychological terms, the music therapist has to use
musical experiences to undermine defenses of projective identification, engulfment, and splitting.
4
2–7 Years
With the physical and emotional selves now differentiated at a basic level, the child moves
toward differentiation of the mental self. Being physically and emotionally separate, the child struggles
to exert his/her independence through a “no” mentality, making sure that everyone else understands
what is “me” and “not-me.” Ambivalence, the ability to integrate opposites, and perception of “gray”
areas are not within the realm of possibility. Things are black, white, or undecipherable.
During this period, the child has to translate the sensorimotor and affective learning from the
previous periods into a representational system. Words become the expected method of representing
and expressing what is happening inside and what is taking place in the environment.
The child is beset with two major challenges: impulsive behavior and a perceptual system that
is easily tricked by appearances and illusions. By necessity, the child becomes very ego-centered—the
self becomes the central relay station for all information. Magical thinking becomes a method of
working through some of the overwhelming challenges being confronted. Another ploy is for the child
to act “as if” s/he understands by imitating adults—but the understanding is far from complete.
Musically, it becomes important to find a container for expressive impulses and to distinguish
between reality and illusion in what is heard. Vocally, the child begins to use speech chants and
movement chants to connect sounds with words and movements, and to order them through rhythm.
One vocal sound is allocated for each syllable or movement. From these chants, longer spontaneous
songs develop. The child builds his/her own songs using characteristic intervals that are repeated (e.g.,
descending minor third) with nonsense syllables or words. The child struggles to center the song within
a tonality and scale but needs considerable time before achieving any success. Singing precomposed
songs is also an enjoyable and useful means of expression. With each song mastered, the child develops
better tonal skills, learns how to interact with others, and also discovers how to identify with feelings
and impulses as expressed by others. The lyrics of the songs are important in exploring emotions;
however, the child also needs songs that involve motor action of some kind.
The child uses instruments not only for the sheer joy of physical activity, but also as an easy
means of representing and expressing fantasies, feelings, and magical thoughts. The sounds of
instruments become symbols of characters, and through various sequences of timbres, the child learns
how to create stories. Meanwhile, the sounds of instruments are also closely associated with various
parts of the body, either through how the instrument is sounded or through the resemblance between
the timbre of the instrument and a body sound. Given the nature of instruments within the motor
capabilities of children during this period (e.g., maracas, tambourines, drums, bells, etc.), the child
learns how to organize and maintain repetitive motor acts according to a rhythm. Thus, instruments
help the child to develop a “basic beat” and also introduce the need for synchronizing to the beat of
others (which is not fully accomplished until later).
The child moves to music both rhythmically (e.g., swaying, rocking, stamping as synchronously
as possible) and interpretively (e.g., like an animal depicted in the music). Receptively, the child
recognizes a repertoire of songs, distinguishes between musical figure-grounds (e.g., pulse/melodic
rhythm, melody/scale), and can report whether pairs of musical stimuli are same or different.
Pathologies originating in this developmental period include the various types of
psychoneuroses (borderline, obsessive-compulsive, depressive, hysteric, phobic, psychosomatic, etc.)
5
(Wilber, Engler, & Brown, 1986). Recommended therapies are those that employ uncovering
techniques (e.g., those aimed at bringing unconscious material into consciousness). These include
psychodynamic and Gestalt approaches.
In music therapy, the experiences may involve singing, playing, improvising, composing, or
listening, but in all cases, a “projective” approach is most relevant. For example, in singing or playing a
precomposed piece, the client is encouraged to “interpret” the music and shape the phrases to reflect
how s/he feels in that part of the music, and perhaps to explore how the body is involved in the singing
or playing. In improvising, the client is encouraged to “let go” and “play freely” until inner feelings
surface and then, afterward, to talk about how various aspects of the improvisation (physical,
emotional, interpersonal) reflect the inner and outer worlds of the client. The client can also be given a
feeling or expressive title to improvise around, thereby allowing him/her to project his/her feelings
musically rather than verbally. In listening activities, the client is encouraged to project his/her feelings
onto the song, the lyrics, or the instrumental composition, either through free-associating, imaging,
storytelling, expressive movement, or drawing. In songwriting, the client is encouraged to find a way of
expressing inner conflicts through the melody, accompaniment, or lyrics of the song.
7–12 Years
During this period, the child begins to think about things—but very concretely and dependent
upon whatever is in the here-and-now. Rules are mastered out of deference to authority, and roles are
learned from the same perspective. The child learns role behaviors that are advantageous and often
displays duplicity and hidden agendas. Embedded in self-concern, the child tries to modify his/her own
behavior to get what is desired. Sometimes this requires splitting or dissociation between parts within
the self or between overt and covert wishes and behaviors. Problems linked to this period involve what
Wilber, Engler, and Brown (1986) call “script” pathologies (conflicts between roles or rules that
govern one’s behavior). Relevant approaches to therapy are more cognitive in nature and focus
primarily on rational integration of dichotomies (e.g., Transactional Analysis, Rational Emotive
Therapy, Construct Therapy).
Musically, the child is ready to study music in a formal setting, either through school programs
(band or chorus) or private lessons on an instrument. Thus, it is during this period that a child will
demonstrate whether s/he has a special affinity or interest in music.
Vocally, the child gains considerable accuracy, both in singing intervals and in maintaining a
tonal center. The child can also learn role behaviors (e.g., singing solos while being accompanied,
accompanying others through ostinati or descants, and singing in rounds or canons).
The same roles can be taken in instrumental work. In addition, the child begins to display
focused attempts to physically master how to play an instrument. Usually, this involves complex types
of sensory-motor coordination. The idea of “practice” develops. The child is also ready to learn how to
play an instrument using notation.
Receptively, the most important skill gained during this period is the ability to conserve.
Previously, the child was particularly sensitive to discrepancies or differences between musical stimuli;
now the child can identify which elements stay the same despite changes or differences in other
elements. Movement responses to music become much more structurally related to specific musical
elements (e.g., moving in time to pulse and melodic rhythm, conducting meter, learning dance steps).
6
In music therapy, the most relevant approaches are those that emphasize the relationship
between the music and reality, and staying within the here-and-now: Is the music the way you wanted
or intended it to be? Does it express what you are feeling or reflect what you are thinking? How
pleased are you with what you did? How pleased are you with what others did? Does the other
person’s music fit him/her?
In singing and playing precomposed music, the client is encouraged to work on developing
his/her own interpretation of the composition and then to give an accurate rendering or performance of
that interpretation. The responsibility is to sing or play the music exactly as the client wants, while still
retaining the basic structure and meaning of the composition. The challenge is to mediate between what
the client wants as performer with what the composer intended for the composition, and once this is
accomplished, to match covert musical intentions as a performer with overt action or implementation.
Thus, important comparisons to explore are between performer and performance, performer and
composer, composer and composition, and performance and composition.
In improvisational therapy (and in songwriting), the client should work in dyads or groups, and
emphasis should be given to interactional dynamics. Improvisations or songs should be taped for later
analysis and reaction. For clients with “role pathology,” the musical process and product can be
analyzed in terms of: Who is taking what role? Is that the role intended and desired? What risks and
responsibilities are involved? For clients with “rule pathology,” the musical process and product can be
analyzed in terms of: Who provided the structure, direction, or guidelines? What kinds of structures are
preferred? How do these structures affect individual vs. group processes? Do you like these rules?
Listening activities should focus on improving accuracy in the perception of the various musical
elements and structures: Is this higher or lower, louder or softer? What’s different between these two
songs?
Lyric discussion is also relevant: What does the music say? What do the lyrics say? How do
your feelings and ideas relate to the music or lyrics? What would you like the music or lyrics to say?
It should be noted that although the child (or fixated adult) in this period may be capable of
musical interactions, these interactions are predicated on role and rule definitions within the music
rather than in the interpersonal process per se. Correspondingly, the most important element of music
to be explored is texture (e.g., homophony vs. polyphony, solo vs. accompaniment, leader vs.
follower), which legislates role behavior and rules for interaction.
12–18 Years
As the period of “formal operational” thinking begins, the adolescent becomes increasingly
concerned with principles, ideas, and abstractions, and can now think in past, present, and future
orientations. Sexual desires develop, and relationships based on reciprocity and mutuality are regarded
as most important. Self-sacrifice is possible. In fact, the self is not yet sufficiently formed to retain one’s
identity when challenged, and relationships formed during this period are characterized more by fusion
than intimacy. Kegan (1988) describes the individual’s identity during this period as “embedded” in
others and relationships with them.
According to Wilber, Engler, and Brown (1986), this is the period of “identity neuroses” (i.e.,
disorders related to the ability to free oneself from social roles and conventional morality, to develop
one’s own conscience and rationale, and to conceive of one’s own life both hypothetically and
7
philosophically).
During this period, the individual wants to break away from established rules and roles, and
music is the perfect place to start. Rock music encourages syncopations and cross-rhythms that
undermine or destroy the basic beat, thereby allowing the adolescent to move from the security of the
holding environment to a self-defined musical identity. All music must be loud, as the adolescent wants
to be heard and needs support to engage in the power struggles that must be won against authority
figures. Rock stars become idols, not only because they provide models of “distinct” identities who
have broken with the establishment, but also because they sing about love and sex—topics of
fascination and developmental significance. Their body gyrations also provide a model for sexual
liberation and encourage the adolescent to express suppressed libidinal energy—either through dancing
or actual sexual activity.
In music therapy, the subtleties of these dilemmas can be explored. In group activities (e.g.,
songwriting, music videos), adolescents can be given free rein to “break from the establishment” while
also meeting norms and expectations of their peer group. In individual activities, they can emulate their
idols, by playing the guitar or singing. They can also write or discuss songs that elaborate their views
about love and life, and they can project their feelings onto the songs without having to take ownership
for them. Listening to songs provides great solace, and the lyrics help the adolescent to grapple with
the enigmas of love and becoming a sexual being. In improvisation, rap, and dance activities, they can
freely release pent-up energies, while also expressing nonverbally the painful feelings and identity
confusions so characteristic of these years.
Several conditions contribute to effective music therapy experiences during this period: musical
structures or containers that are both needed and accepted by adolescents; musical freedoms that will
facilitate release of physical tensions; lyrics that will express inner concerns about love, relationships,
personal identity, sexuality, etc.; and interpersonal circumstances that focus on peer norms rather than
roles, rules and norms established by authority; ensembles that allow intimacy and encourage individual
expression with peer group support.
18+ Stage of Self-Definition
Kegan (1982) describes this period in terms of an “institutional self.” It is the time when one
determines one’s own identity, formulates one’s life goals, invests in the future, and sacrifices various
things to achieve one’s own personal dreams. These tasks are accomplished with the self as a point of
reference rather than within the context of an interpersonal relationship. During this period, the
individual talks about him/herself in structural terms, as if the personality was a carefully designed and
balanced system consisting of various parts, roles, norms, opinions, forces, etc.. The sure sign of
someone in this period is the catch phrase: “I’m the kind of person that....”
Musically, this is a period when people determine where music fits into their lives, and whether
it will be pursued for vocational and/or avocational purposes. It is also the period where each person
evaluates his/her own musical capabilities and preferences.
If chosen for a vocation, the person has to decide on the primary medium of expression, and
whether to pursue lessons privately or through a college program. The person also selects the types
and styles of music that will be studied seriously and used for recreational purposes. Specific career
goals are also formulated, along with employment objectives and financial ambitions.
8
If music is chosen as an avocational interest, the individual develops musical habits and
preferences: selecting different kinds of music for listening on different occasions or in different
situations; going to concerts for enjoyment and because that is what is expected of cultured self-
defining persons; taking music lessons to “meet people” or to have a hobby; going to bars or discos and
dancing the night away—to meet people and to release the stress of adult life.
Different musical activities and styles begin to meet different needs. The main needs for music
during this period are (1) aesthetic appreciation, (2) recreation and leisure, and (3) psychological
support. The individual can now be described as having a “musical personality,” which organizes,
directs, and balances the various musical habits and preferences to meet these needs.
Music therapy experiences must be geared towards each individual’s unique relationship to
music (or their musical personality). This includes factors such as: whether music is a vocational vs
avocational interest, what musical skills and preferences the individual has, and exactly what aesthetic,
recreational or psychological needs are fulfilled through music.
Stage of Intimacy
Characteristics of the institutional self may continue for many years—especially with regard to
one’s career. At the same time, the individual enters another stage of development which is concerned
with gaining intimacy in interpersonal relationships. During this stage, the person defines him/herself
interdependently, within the context of a love relationship: not dependently as in adolescence, nor
independently as in the self-definition period. The self is seen as a system (as in the previous period),
but one that interpenetrates the systems of others.
Getting married, committing oneself to a love relationship, having children, and maintaining
lifelong friends all contribute to the development of such interdependent relationships. The individual
becomes capable of giving up oneself for the other. Roles, duties, careers, institutionalized identities are
no longer ultimate, but can be used or discarded within a broader, more balanced life plan that includes
significant others. The self can be challenged and even criticized, because maintaining one’s identity is
no longer an end in itself but a means to an end.
In contrast to the previous periods, when the person adheres to certain patterns of musical
experience to meet various needs, the individual now begins to take a broader, more open approach to
music—appreciating what is there and accepting what is not, knowing one’s personal preferences but
listening with an open mind to other things, singing or playing not as self-expression but as renderings
of the music. Interpretations of compositions begin to blend personal feelings and viewpoints with
those of the composer. Improvisations are less idiosyncratic, and more subtly tuned to the nuances of
other players. Timbres blend, melodies are contrapuntal, harmonies are varied, textures are intricately
woven, rhythms are stable but rubato, and complexities abound.
Music therapy experiences likely to be relevant at this period are individual singing or
instrumental lessons that focus on music for its own sake but within the context of an intimate student-
teacher relationship; listening activities that expand one’s views of the world; improvisational activities
that explore musical and personal intimacy in various relational contexts (dyads, family, groups); and
songwriting activities that synthesize individual and group feelings.
Existential (Midlife) Crisis
9
The existential crisis can occur at any time during the two previous developmental stages (i.e.,
during years of self-definition or intimacy) and typically happens at midlife or in the forties. Wilber,
Engler, and Brown (1986) point out the importance of distinguishing between ordinary existential
crises and existential pathologies, the former being developmentally normal struggles and the latter
being disorders that are a culmination of failures in previous developmental tasks.
At the core of existential struggles are depression over the perceived meaninglessness of life,
confrontation of one’s own mortality, dread of aging, feelings of alienation and isolation, aborted self-
actualization, and anxiety over life’s realities. Often the person realizes that his/her way of life is
somehow inauthentic—that his/her overt behavior or manifest personality is not consistent with covert
processes or latent desires or wishes. Suddenly, the goals set forth by the “institutional” self are no
longer satisfying, and the intimacies developed with others become reminders of the fragility of life and
produce “existential” anxiety. Prochaska (1979) describes existential anxiety as a realization of our
finiteness: “Death reflects the finiteness of our time; accidents, the finiteness of our power; anxiety over
decisions, the finiteness of our knowledge; the threat of meaninglessness, the finiteness of our values;
isolation, the finiteness of our empathy; and rejection, the finiteness of our control over another human
being” (pp. 74–75).
The person in existential conflict relates to music as s/he does to life. Musical activities are
undertaken not because music is a significant or meaningful endeavor in itself but because it gives us
something to do. It serves the same functions as work or sports or entertainment or hobbies: It
occupies one’s mind and helps to pass the time. It is especially useful when one needs to escape
feelings of depression and confusion and when the hours of existential self-questioning or feelings of
alienation go on endlessly. Musical involvement is literally better than doing nothing, but it is difficult to
say why this is so. Individual musical expression may seem pointlessly self-centered, and the struggles
of working in an ensemble may not be perceived as worth the effort. Listening is most enjoyable when
it is done passively—without having to perceive or appreciate anything that is supposed to be
important and without having to attach feelings or images to the music in a significant way.
Music therapy experiences during this period should present music for what it is—nothing
more or less significant than anything else in life. The secret is to entice and re-engage the person’s
interest or to scintillate the senses or imagination in a new way—not because it is meaningful to be
excited about music, but simply because it is enjoyable.
Ultimately, this crisis will end when the individual can accept music for what it is and receive
what music has to offer—in and of itself, and without any undue existential significance—as a simple
gift of life. The person’s relationship to music will be more authentic and autonomous, and musical
activity will become intrinsically meaning. Music will also provide access to new levels of
interiorization.
Transpersonal Stage
The transpersonal stage moves the individual from self-actualization to transcendence of self,
from intimacy to spiritual union, from an understanding of the finiteness of time and space to
experiences of timelessness and spacelessness, from causal explanations to understandings of what is,
and from personal goals to spiritual surrender.
10
This is the period when musical experience approaches the sublime. One is no longer limited by
musical abilities and preferences; one’s musical personality is no longer a closed system; the existential
significance of music is no longer an issue. Music becomes the container of all life forms and all life
experiences. Each sequence of tones becomes a mere millimeter of spiritual space, and each rhythm
becomes a mere millisecond of spiritual time. Timbres are hues of white light, and textures are flat lines
within multidimensional depths. A simple repetition, variation, or recapitulation becomes a universal
process of transformation. And if we are open to any one of these minute musical experiences, we can
jump to the spiritual dimension: A sequence of tones can thrust us into spacelessness, a simple rhythm
can lead us into timelessness, a timbre can bring us light, a texture can plummet us into depths, a form
can make us formless. Through music, we can become one with ourselves (i.e., one mind-body-spirit),
and we can become one with our universe (i.e., one with others, one with matter, and one with God).
References
Bruscia, K. (1990). A Psychology of Musical Development. Unpublished lectures. Temple University.
Grof, S. (1988). The Adventure of Self-Discovery. Albany, NY: State University of New York Press.
Kegan, R. (1982). The Evolving Self. Cambridge, MA: Harvard University Press.
Prochaska, J. (1979). Systems of Psychotherapy. Homewood, IL: Dorsey Press.
Wilber, K., Engler, J., & Brown, D. (1986). Transformations of Consciousness. Boston: New Science
Library.
11
READING 9
Bruscia, K. (1998). Four Excerpts: Defining Music Therapy (Second
Edition), pp. 18–25, 113–125, 131–151, 157–173. Gilsum NH: Barcelona
Publishers.
Excerpt One
A WORKING DEFINITION
Kenneth E. Bruscia
CAVEATS
Given all of the challenges inherent in defining music therapy cited in the
previous chapter, it is very unlikely that a universally accepted or final defini-
tion will ever be formulated. Music therapy is too broad and complex to be
defined or contained by a single culture, philosophy, treatment model, clinical
setting, or individual definer. This is precisely why there are so many different
definitions of it, and why the present chapter is entitled “Working Definition!”
We are and we will always be in the process of defining, for the answers to the
diverse issues and questions raised here will always vary according to the
definer and the context in which the defining takes place. Furthermore, many
of the issues reflect the paradoxes and vagaries which are indigenous to music
therapy and which are impossible to resolve or clarify completely. The
important point is that the purpose of creating a definition is not to determine
once and for all what music therapy is, it is merely to establish a new perspec-
tive or approach to conceiving of it—another attempt to answer the basic core
questions. Thus, every definition is important because, when we examine how
the definer has answered all these questions and challenges, we have an
opportunity to broaden and deepen our understanding of music therapy.
The purpose of this chapter is to offer a working definition of music
therapy which attempts to address the many issues that have been raised so
far, and which also synthesizes to the extent possible the various definitions
found in the literature. Following this definition are brief explanations of each
word or phrase. These explanations provide an overview for the in-depth
discussions that follow in subsequent chapters.
The definition is a theoretical one. Its purpose is to enable professionals
and students to examine conceptual issues involved in defining music therapy.
It is not intended for lay audiences, and it may not be useful when describing
music therapy to other professionals for the first time.
WORKING DEFINITION
Music therapy is a systematic process of intervention wherein the

therapist helps the client to promote health, using music experiences
and the relationships that develop through them as dynamic forces of
change.
Systematic Process of Intervention
Music therapy is systematic in that it is goal-directed, organized,

knowledge-based, and regulated; it is not merely a series of unplanned, random
experiences that turn out to be helpful. Its three main procedural components
are assessment, treatment, and evaluation.
Music therapy is a process that takes place over time. For the client, the
time involves a process of change; for the therapist, it is a time-ordered
sequence of interventions. For both client and therapist, this process over time
can be described as developmental, educational, interpersonal, artistic,
musical, creative, or scientific.
To be considered therapy, this process requires intervention by a
therapist. An intervention is a purposeful attempt to mitigate an existing
condition in order to affect some kind of change. In therapy, interventions must
meet three criteria: the client must need outside help to accomplish a health
objective; there must be purposeful intervention, regardless of outcome; and
the intervention must be carried out by a therapist within the context of a
therapist-client relationship.
What makes music therapy interventions unique is that they always
involve both music and therapist acting as partners in the process. When
music is used as therapy, music takes the primary role in the intervention, and
the therapist is secondary; when music is used in therapy, the therapist takes
the primary role, and music is secondary. When music is used by a client
without a therapist, the process does not qualify as therapy; when a therapist
helps the client without using music, it is not music therapy. Music therapy
interventions are unique in that they focus on sound, beauty, and creativity.
Therapist Helps Client
A therapist is a person who offers his/her expertise and services to help

the client with a health concern. By definition, a music therapist must have the
necessary expertise to provide the service as well as recognition of such by an
appropriate authority. The music therapist may serve as adjunctive or primary
therapist, depending upon professional expertise and client need. The music
therapist uses principles of personal and professional ethics to guide work with
clients.
The music therapist is defined as the helper, and the client is defined as
the person being helped. The client-therapist relationship is not reciprocal in
this regard, though it is generally acknowledged that doing therapy affords
many opportunities for therapists to meet their own needs at an unconscious
level. Central to the client-therapist relationship is a contract for services that
focuses on the client’s health.
Music therapy provides very specific kinds of help to clients. Whether
taking primary or secondary roles in the process, music and the therapist
combine their resources to provide clients with opportunities for receiving
empathy, understanding, validation, and redress; for verbal and nonverbal self-
expression, interaction, and communication; for feedback on themselves and
insights about their lives; for motivation and self-transformation; and for direct
assistance and intervention.
A client is defined as a person who needs or seeks help from another
person because of an actual, imagined, or potential threat to health, whether
physical, emotional, mental, behavioral, social, or spiritual in nature.
To Promote Health
The goal of therapy is to promote health. Health encompasses and

depends upon the individual and all of his/her parts (e.g., body, psyche, spirit),
and the individual’s relationship with the broader contexts of society, culture,
and environment. There are two orientations to health: in the pathogenic
orientation, health is an either-or condition, defined by the presence of illness;
in the salutogenic, health is a continuum which includes all degrees of health.
Going even further, the definition of health proposed here is the process of
becoming one’s fullest potential for individual and ecological wholeness.
Using Music Experiences
Music therapy is distinct from other modalities by its reliance on music

experience as an agent of intervention. The way music therapists define
“music experience” is based on the clinical contexts in which they work. Of
particular importance is a nonjudgmental acceptance of whatever the client
does musically, and clear priorities with regard to the purpose, value, and
meaning of music within the therapy process.
Music is difficult to define for many reasons, and in therapy, the matter
is further complicated by the notion that therapy depends upon not merely the
music but the client’s experience of it. Every music experience minimally
involves a person, a specific musical process, a product of some kind, and a
context or environment. Thus, the music used for therapy is not merely an
object that operates on the client, rather it is a multifaceted experience
involving the person, process, product, and context. For purposes of this book,
music is defined as the human institution in which individuals create meaning
and beauty through sound, using the arts of composition, improvisation,
performance, and listening. Meaning and beauty are derived from the intrinsic
relationships created between the sounds themselves and other forms of human
experience, as well as the universe itself.
Four specific types of music experience serve as the primary methods of
music therapy: improvising, re-creating, composing, and listening to music.
These experiences can be presented with emphasis on various sensory
modalities, with or without verbal discourse, and in various combinations with
the other arts. Depending on how intrinsically musical the sounds and
activities are, the experience may be described as premusical, musical, extra-
musical, paramusical, or nonmusical.
And the Relationships Formed Through Them
These varied kinds of music experience provide the client with

opportunities to develop multifaceted relationships within and between the self
and its various worlds. Accordingly, these relationships can be described as
intrapersonal, intramusical, interpersonal, intermusical, and sociocultural. Of
central significance to the therapeutic process is the client’s relationships to the
therapist and to the music.
As Dynamic Forces of Change
Music therapy can be likened to chemistry. Its main elements are the
client(s), the music, and the therapist. These elements combine and interact in
may ways, depending upon how the therapist conceives and designs the
client’s music experience. Thus, the key compound—determining how all the
elements of the experience are related to one another—is the client-music
interaction. Consequently, to analyze the dynamics of music therapy is to
analyze the various ways in which the client experiences music. There are six
dynamic models used, depending upon whether the music experience is
objective, subjective, energetic, aesthetic, collective, or transpersonal.
The kinds of changes that can result from music therapy are myriad.
Two important criteria are that they are health-related and that they actually
result from the therapeutic process.
Excerpt Two
TYPES OF MUSIC EXPERIENCES:

THE FOUR MAIN METHODS
OF MUSIC THERAPY
Kenneth E. Bruscia
In the last chapter, music therapy was described as an experiential form of

therapy because it focuses on and utilizes the client’s music experience as its
primary methodology. Essentially this means that, in music therapy, the client
undergoes the processes of assessment, treatment and evaluation by engaging
in various types of music experiences.
In music, there are four distinct types of experience. They are:
improvising, re-creating (or performing), composing and listening. Each of
these types of music experience has its own unique characteristics, and each is
defined by its own specific process of engagement. Each type involves a
different set of sensorimotor behaviors, each requires different kinds of
perceptual and cognitive skills, each evokes different kinds of emotions, and
each engages a different interpersonal process. Because of this, each type also
has its own therapeutic potentials and applications. Thus for example,
listening to music has certain therapeutic potentials and applications, which
are different from those of improvising; and similarly, improvising music has
different potentials and applications from performing a composed work.
To understand how music therapy works, then, requires an
understanding of each type of music experience. The purpose of this chapter is
to identify and define the various ways that improvising, re-creating,
composing, and listening experiences are shaped by music therapists to meet
client needs.
Before we proceed, we have to clarify some terms related to
methodology that are often confused. In the literature, one often finds that the
terms method, approach, model, procedure and technique are used
interchangeably, as if they all mean the same thing. This has led to
considerable confusion and arguments over who has originated what method,
and which technique belongs to whom. While there is no obvious or singularly
correct way to define each of these terms, they do need to be differentiated.
And so, the selection of terms and definitions proposed here may be somewhat
arbitrary; what is more important is that they have been differentiated and
clarified. To understand the differences, we will use improvisation as an
example throughout the discussion.
A method is here defined as a particular type of music experience used
for assessment, treatment, and/or evaluation. Since there are four main types
of music experiences (improvising, re-creating, composing, and listening),
these are considered the four main methods of music therapy; and since there
are many different ways of designing these four experiences, each of the
methods have many variations. Thus, the various ways of engaging the client
in extemporaneous music-making fall under the category of “improvisational”
methods; the various ways of engaging the client in reproducing music fall
under the category of “re-creative” methods; the various ways of engaging the
client in composing are called “compositional” methods; and the various ways
of engaging the client in listening experiences are called “receptive” methods.
In order to engage the client in these music experiences, the therapist
uses various procedures. A procedure is an organized sequence of operations
and interactions that a therapist uses in taking the client through an entire
music experience. As such, procedures are the basic building blocks of a
music therapy session; they are the various things that a therapist does to
organize and implement the method. For example, if the method is
improvisation, and the variation is “instrumental group,” the therapist may use
the following procedural steps in carrying out the session: 1) clients select
instruments; 2) group experiments with instruments freely; 3) therapist
presents a structure or play rule for the improvisation; 4) group improvises
according to the play rule; 5) group discusses the improvisation; and 6) the
same steps are repeated until the end of the session.
Within each of these procedural steps, the therapist may use a variety of
techniques. A technique is a single operation or interaction that a therapist
uses to elicit an immediate reaction from the client or to shape the ongoing,
immediate experience of the client. Thus, a technique is a smaller, single
operation within a procedure, while a procedure can be viewed as a series of
techniques. In our improvisation example, the therapist may use a variety of
musical techniques when the group is improvising together, such as
“grounding,” “pacing,” “incorporating,” and so forth (Bruscia, 1987).
Similarly, when the group discusses the improvisation, the therapist may use a
variety of verbal techniques such as “probing,” and “reflecting.”
When a therapist begins to develop a systematic approach employing
one or more of the four main methods in a particular way, following specific
procedural sequences, and relying upon certain techniques, a model is being
developed. A model is a comprehensive approach to assessment, treatment,
and evaluation which includes theoretical principles, clinical indications and
contraindications, goals, methodological guidelines and specifications, and the
characteristic use of certain procedural sequences and techniques. Examples of
improvisational models of music therapy are: “Creative Music Therapy,” the
model developed by Nordoff and Robbins (1977) or “Analytical Music
Therapy,” the model developed by Mary Priestley (1994). Notice that a model
is much more comprehensive than a method; in fact, a model is the
specification of how a method can be used, usually with certain client
populations. Also notice that there are only four main methods of music
therapy, and that these methods vary endlessly with regard to procedures and
techniques, depending upon the model. Also, a method carries no particular
theoretical orientation, whereas a model always implies one. A therapist can
use improvisation within many different theoretical orientations, but as soon as
improvisation is implemented in a particular way, according to any kind of
principle, a theoretical orientation is implied.
To summarize: a method is a particular type of music experience that
the client engages in for therapeutic purposes; a variation is the particular way
in which that music experience is designed; a procedure is everything that the
therapist has to do to engage the client in that experience; a technique is one
step within any procedure that a therapist uses to shape the client’s immediate
experience; and a model is a systematic and unique approach to method,
procedure and technique based on certain principles.
With this in mind, we can now examine the four main methods of music
therapy in greater detail. What follows is a brief outline of each method,
including: definitions, uses, variations, and the clinical goals that are most
relevant to it, given its intrinsic nature.
IMPROVISATORY EXPERIENCES
Definition and Uses

In improvisation experiences, the client makes up music while playing or
singing, extemporaneously creating a melody, rhythm, song or instrumental
piece. The client may improvise alone, in a duet, or in a group which includes
the therapist, other clients, and sometimes family members. The client may use
any musical medium within his/her capabilities (e.g., voice, body sounds,
percussion, stringed or wind instruments, keyboard, and so forth). The
therapist helps the client by providing the necessary instructions and
demonstrations, offering a musical idea or structure upon which to base the
improvisation, play or sing an accompaniment that stimulates or guides the
client’s improvising, or presents a nonmusical idea (e.g., image, title, story) for
the client to portray through the improvisation.
The clinical goals of improvisation experiences may include:
· Establish a nonverbal channel of communication, and a bridge to

verbal communication
· Provide a fulfilling means of self-expression and identity
formation
· Explore various aspects of self in relation to others
· Develop the capacity for interpersonal intimacy
· Develop group skills
· Develop creativity, expressive freedom, spontaneity, and
playfulness with various degrees of structure
· Stimulate and develop the senses
· Develop perceptual and cognitive skills
Many different client populations manifest therapeutic needs in these areas:

from obsessive-compulsive children to adults with borderline or narcissistic
personality disorders; from autistic nonverbal children to aggressive
adolescents; from impulsive, acting out children to inhibited depressed adults;
and from developmentally delayed or physically disabled children to children
free of handicap.
Variations
Instrumental Nonreferential: The client extemporizes on a musical

instrument without reference to anything other than the sounds or music. In
other words, the client improvises music for its own sake, without trying to
make it represent or describe anything nonmusical. Three subtypes are: solo,
duet and group, each of which poses different kinds of musical challenges.
Instrumental Referential: The client extemporizes on a musical
instrument to portray in sound something nonmusical (e.g., a feeling, idea,
title, image, person, event, experience, etc.). Subtypes include solo, duet, and
group, each which has implications for how the nonreferential idea is
perceived and musically projected.
Song Improvisation: The client extemporizes lyrics, melody, and/or
accompaniment to a song. Subtypes are solo, duet and group song
improvisations. Given the prominence of melody in song, and the close
relationship between melody and lyrics, the addition of other improvisers can
significantly complicate the process.
Vocal Nonreferential Improvisation: The client extemporizes a vocal
piece without words or images. Subtypes are solo, duet and group.
Body Improvisations: The client improvises by making various kinds of
percussive body sounds (clapping, snapping, patschen). Subtypes include solo,
duet and group.
Mixed Media Improvisations: The client improvises using voice, body
sounds, instruments, and/or any combination of sound sources. Subtypes
include solo, duet and group.
Conducted Improvisations: The client creates an improvisation by
giving directive cues to one or more improvisers.
RE-CREATIVE EXPERIENCES
Definition and Uses
In re-creative experiences, the client learns or performs precomposed

vocal or instrumental music or reproduces any kind of musical form presented
as a model. Also included are structured music activities and games in which
the client performs roles or behaviors that have been specifically defined. The
term re-creative is used here rather than performing because the latter often
implies singing or playing a piece before an audience. Re-creative is a broader
term which includes rendering, reproducing, realizing, or interpreting any part
or all of an existing musical model, whether done with or without an audience.
Clinical goals may be to:
· Develop sensorimotor skills

· Foster adaptive, time-ordered behavior
· Improve attention and reality orientation
· Develop memory skills
· Promote identification and empathy with others
· Develop skills in interpreting and communicating ideas and
feelings
· Learn specific role behaviors in various interpersonal situations
· Improve interactional and group skills
Primary candidates for re-creative experiences are those clients who

need structure to develop specific skills and role behaviors. They are also
indicated for clients who need to understand and adapt to the ideas and feelings
of others while still retaining their own identity, as well as clients who need to
work with others toward common goals.
Variations
Instrumental Re-creation: The client may be involved in any of the

following kinds of experiences: sounding an instrument in a prescribed way,
sight-playing some kind of notation, performing precomposed instrumental
pieces, rehearsing in an instrumental ensemble, taking private lessons,
performing imitative tasks on an instrument, or playing an instrumental part
with a recording. The essence of all these tasks is the reproduction of
structured or precomposed musical materials using a musical instrument.
Vocal Re-creation: The client may be involved in any of the following:
vocalizing in a prescribed way, sight-singing, singing songs, chanting, choral-
speaking, rehearsing choral groups, taking voice lessons, vocally imitating or
learning melodies, or lip-synching recorded songs. The essence of all these
tasks is the vocal reproduction of structured musical materials or precomposed
songs.
Musical Productions: The client is involved in the planning and
performance of a talent show, musical play or drama, recital, or other kind of
musical production involving an audience. The essence of these tasks is
performing for an audience, and all the preparations involved.
Musical Games and Activities: The client participates in musical games
(e.g., name that tune, musical charades, musical chairs, etc.) or participating in
any activity that is structured by music.
Conducting: The client directs the live performance of music by
providing gestural cues to the players as dictated by a score or other notational
plan.
COMPOSITION EXPERIENCES
Definition and Uses
In composition experiences, the therapist helps the client to write songs,

lyrics or instrumental pieces, or to create any kind of musical product such as
music videos or audiotapes. Usually the therapist takes responsibility for the
more technical aspects of the process, and gauges the client’s participation to
his/her musical capabilities. For example, the client may generate the melody
on a simple bar instrument, while the therapist provides the harmonic
accompaniment; or the client may produce the lyrics while the therapist
composes the melody and harmony to go with them.
The main clinical goals are to:
· Develop organizational and planning abilities

· Develop skills in creative problem solving
· Promote self-responsibility
· Develop the ability to document and communicate inner
experiences
· Promote the exploration of therapeutic themes through lyrics
· Develop the ability to integrate and synthesize parts into wholes
Variations
Song Parodies: The client changes words, phrases, or the entire lyrics of
an existing song, while maintaining the melody and standard accompaniment.
Song-Writing: The client composes an original song or any part thereof
(e.g., lyrics, melody, accompaniment) with varying levels of technical
assistance from the therapist. The process includes some form of notation or
recording of the final product.
Instrumental Composition: The client composes an original
instrumental piece or any part thereof (e.g., melody, rhythm, accompaniment)
with varying levels of technical assistance from the therapist. The process
includes some form of notation or recording of the final product.
Notational Activities: The client creates a notational system and then
composes a piece using it, or the client notates a piece that has already been
composed.
Music Collages: The client selects and sequences sounds, songs, music,
and fragments thereof in order to produce a recording which explores
autobiographical or therapeutic issues.
RECEPTIVE EXPERIENCES
Definition and Uses
In receptive experiences, the client listens to music and responds to the

experience silently, verbally, or in another modality. The music used may be
live or recorded improvisations, performances, or compositions by the client or
therapist, or commercial recordings of music literature in various styles (e.g.,
classical, rock, jazz, country, spiritual, new age). The listening experience may
be focused on physical, emotional, intellectual, aesthetic, or spiritual aspects of
the music, and the client’s responses are designed according to the therapeutic
purpose of the experience.
The main clinical goals are to:
· Promote receptivity
· Evoke specific body responses
· Stimulate or relax the person
· Develop auditory/motor skills
· Evoke affective states and experiences
· Explore ideas and thoughts of others
· Facilitate memory, reminiscence, and regression
· Evoke imagery and fantasies
· Connect the listener to a community or sociocultural group
· Stimulate peak and spiritual experiences
Candidates for listening experiences are those clients who have the
attentional abilities and receptivity needed to take in the music, and who will
benefit therapeutically from responding to the music in a particular way (e.g.,
analytically, projectively, physically, emotionally, spiritually).
Variations
Somatic Listening: The use of vibrations, sounds, and music in various

elemental and combined forms to directly influence the client’s body and its
relationship to other facets of the client. Subtypes include:
· Entrainment: The use of vibrations, sounds, and music in

various elemental and combined forms to establish synchronicity
in autonomic or voluntary body responses: between client and
music, within parts of the client’s body, and between the client
and another person. The stimuli used may be recorded, or created
by therapist and/or client, instrumentally or vocally.
· Resonance (Toning): The use of vibrations, sounds, and music in
various elemental and combined forms to vibrate parts of the
client’s body at various frequencies or frequency patterns, and to
establish sympathetic vibrations between the stimulus and the
client. The stimuli used may be recorded, or created by therapist
and/or client, instrumentally or vocally.
· Vibroacoustic Music: The administration of vibrational
frequencies to the client’s body while listening to music; or the
application of the vibrational patterns of music directly to the
client's body (e.g., musical acupuncture).
· Music Biofeedback: The use of music to provide moment by
moment auditory feedback on autonomic body functions (e.g.,
blood pressure, heart rate, hormone levels, gland secretion, etc.).
The purpose is to facilitate the client’s use of biofeedback
technology and to thereby provide greater awareness and control
over the body. Music may also be used to facilitate the relaxation
process in biofeedback.
Music Anesthesia: The use of music listening: to enhance the effects of

anesthetic or analgesic drugs, to induce insensibility to pain without
anesthesia, to reduce or control pain, and to reduce anxiety associated with
pain.
Music Relaxation: The use of music listening: to reduce stress and
tension, to reduce or countercondition anxiety, to induce body relaxation, or to
facilitate entry into altered states of consciousness.
Meditative Listening: The use of music to assist in meditation or in the
contemplation of a particular idea. The music may be recorded or created live
by client and/or therapist, and used in the background or foreground of the
experience.
Subliminal Listening: The use of sounds or music to mask the delivery
of subliminal verbal messages or suggestions to the unconscious mind.
Stimulative Listening: The use of music listening: to stimulate the
senses, to bring alertness, to establish reality orientation or contact with the
environment, to increase energy level, to elicit sensorimotor activity, to
increase sensory perceptions, or to elevate mood.
Eurhythmic Listening: The use of music to rhythmically organize and
monitor the client's motor behaviors, including speech, breathing, fine and
gross movement sequences, body exercises, and formalized dance steps. Note
that in this method, the client’s motor behaviors are much more prescribed and
structured than in projective movement to music. The method is also different
from action listening in that the rhythm of the music is used to organize the
motor behavior rather than to cue or direct which motor behavior is to be
performed.
Perceptual Listening: The use of music-listening exercises to improve
skills in auditory attention, perception, discrimination, and conservation, and
the relationship between auditory and other sensory modalities.
Action Listening: The use of song lyrics or musical cues to elicit
specific behavioral responses (e.g., motor movements, daily living activities,
verbal responses).
Contingent Listening: The use of music listening as contingent
reinforcement for behavior change.
Mediational Listening: The use of music as a mediational strategy in
learning and recalling information. Music is paired to various types of
information or to a particular experience in order to make it more concrete,
memorable and retrievable.
Music Appreciation Activities: The therapist presents music-listening
experiences that will help the client to understand and appreciate the structure,
style, historical significance, and aesthetic value of the music.
Song (Music) Reminiscence: The use of music listening to evoke
memories of past events and experiences in the client’s life. The music may be
vocal or instrumental, recorded or performed live, and selected by either client
or therapist according to its association or temporal relationship to the time
period in the past of interest. After listening (or performing the music), the
client and therapist reminisce about the client’s past.
Song (Music) Regression: The therapist selects music that will enable
the client to re-experience the past, not as a reminiscence of it in the present,
but as a reliving of the past in the past. Often, the client listens to the music in
a relaxed, quiet state.
Induced Song (Music) Recall: When induced consciously, the therapist
asks the client what song (or music) comes to mind in reference to a particular
topic, issue, or event in the ongoing therapeutic process; when induced
unconsciously, a song (or piece of music) unexpectedly and spontaneously
comes into the therapist’s or client’s awareness in response to a particular
topic, issue, or event (Diaz de Chumaceiro, 1998a, 1998b).
Song (Music) Communication: The therapist asks the client to select or
bring in a recorded song (or other piece of music) which expresses or discloses
something about the client that is of relevance to therapy; or, the therapist
selects a recording that communicates something of relevance to the client.
Then both parties listen to the recording and explore what the music
communicates about the client, the client’s life, or therapeutic issues.
Song (Lyric) Discussion: The therapist brings in a song that serves as a
springboard for discussion of issues that are therapeutically relevant to the
client. After listening to the song, the client is asked to analyze the meaning of
the lyrics, and to examine (in dialogue with the therapist or other clients), the
relevance of the lyrics to the client or the client’s life.
Projective Listening: The therapist presents sounds and/or music and
asks the client to identify, describe, interpret, and/or free associate to them
through either verbal or nonverbal means. Specific projective listening
techniques include:
· Projective Sound Identification: The client listens to ambiguous

sounds and identifies what they are.
· Free Association: The client listens to sounds or music and
speaks or writes whatever comes to mind, paying no attention to
their cohesion or meaning.
· Projective Storytelling: The client listens to sounds and/or music
and makes up a story accordingly, either orally or in writing.
· Music Dramatization: The client acts out what s/he hears in the
music.
· Song Choices: The client selects and listens to favorite or
preferred songs, or song with which s/he has a strong
identification or connection. (See Song Communications and
Induced Song Recall.)
· Projective Movement to Music: The client listens to music and
extemporizes expressive movements accordingly.
· Projective Drawing to Music: The client draws while listening to
music.
Imaginal Listening: The use of music listening to evoke and support
imaginal processes or inner experiences, while in a nonordinary state of
consciousness. Specific types include:
· Directed Music Imaging: The client images what the therapist

presents while listening to music, usually in an altered state of
consciousness. The image may be selected by therapist or client,
and may be mental or physical in nature. The image may be
specific, personalized, or general, and the therapist’s guiding may
be spaced at various intervals.
· Unguided Music Imaging: The client images freely while
listening to music while in an altered state of consciousness
without direction or dialogue with the therapist. With or without
the focus, music is usually short.
· Guided Music Imaging: The client freely images to music while
in an altered state of consciousness and dialoguing with the
therapist.
· Guided Interactive Music Imaging: The client co-creates images
to music with other clients under the guidance of the therapist.
Self-Listening: The client listens to a recording of his/her own

improvisation, performance, or composition, to reflect upon oneself and the
experience.
Excerpt Three
DYNAMIC FORCES
Kenneth E. Bruscia
Although the term “dynamic” is usually associated with psychoanalytic

theory, every form of music therapy regardless of its orientation can be
described in terms of “dynamic” elements and forces. The reason is that music
therapy always involves the client in some kind of encounter or interaction.
For therapy to take place, someone or something must act in some way on the
client to effect an outcome, while the client is continually acting and reacting.
There is always a reciprocal exchange of action and reaction: the therapist
may act upon the client, the music may act upon the client, the client may act
upon him or herself, or the music may be the medium for therapist and client
to act upon one another, and so forth. These interactions or encounters
comprise what is commonly called the “dynamics” of therapy.
The dynamics of therapy can be likened to chemistry. Just as chemical
elements can be combined to form compounds, and then further combined to
produce various reactions and changes, so can the various elements of the
therapeutic situation. In music therapy, the basic elements that are used in
various combinations include: the client, the therapist, the music (in all of its
various manifestations), and in some cases, other clients. Also included may
be significant people in the client’s life, and other art forms and artifacts.
While these elements can combine and interact in many different ways,
the key element is music. In terms of our analogy to chemistry, music is the
most important ingredient; it determines how all the other elements and
compounds combine, interact, and affect one another. And even more
specifically, it is how the client’s music experience has been designed that
determines what reactions and relationships are possible between the other
elements and compounds. Thus, the client-music interaction lies at the very
core of music therapy, shaping the dynamics of all other relationships.
This has very significant ramifications. It implies that to analyze the
dynamics of music therapy is to analyze the various ways in which the client
experiences music! This makes perfect sense, because the whole premise of
music therapy, as a unique treatment modality, is that music experiences are
used in some systematic and purposeful way to meet specific therapeutic needs
of the client.
Upon analyzing clinical practices in music therapy, the author has
identified six basic models for designing the client’s music experience, with
each model casting the client, therapist, and music into a particular dynamic
configuration, and each model specifying their roles and functions in relation
to one another, as well as their desired interactive effects. What defines each
model is the particular aspect or property of music that is emphasized within
the client’s experience (regardless of whether the experience involves
improvising, composing, re-creating or listening). Specifically, the six dynamic
models are differentiated according to whether the client’s experience focuses
on the 1) objective, 2) universal, 3) subjective, 4) collective, 5) aesthetic, or 6)
transpersonal properties of music. Each of these will be discussed in detail,
however, before proceeding an overview may be helpful.
Figure 2 shows the six models in relation to one another. Models one
through four have been diagramed based on Wilber’s theory of evolution
(1996), which differentiates exterior and interior realms (the right and left
halves of the circle) of individual and collective development (the upper and
lower halves respectively). As shown:
· When the client’s experience is focused on the objective properties

of music (i.e., stimulus, organismic, or response variables), the
model is concerned with the exterior individual realm. The
exterior individual realm includes all those aspects of a person that
can be observed and measured, such as body structure and
activity, behavior, and so forth.
· When the client’s experience is focused on the subjective
properties of music (i.e., as a process or representation referring to
self/other), the model is concerned with the interior individual
realm. The interior individual realm includes all those aspects of a
person that are concerned with value and meaning.
· When the client’s experience is focused on the universal properties
of music (i.e., the natural, organic patterns inherent in sound and
music), the model is concerned with the exterior collective realm.
The exterior collective realm deals with all aspects of the
“objective” physical world that are shared by communities of
individuals.
· When the client’s experience is focused on the sociocultural
properties of music (i.e., as ritual, identity, or archetype of a
community), the model is concerned with the interior collective
realm. The interior collective realm deals with all aspects of the
“subjective” world that are shared by communities of individuals.
Superimposed over these four models are the aesthetic model and the
transpersonal model.
· When the client’s experience is focused on the aesthetic properties

of music (i.e., as an art object or artistic process), the model is
concerned with the appreciation of beauty and meaning either in the
music itself, or in any realm of life to which the music refers (e.g.,
exterior, interior, individual, collective). Thus, this model emerges
not only when the therapist specifically focuses the client’s
experience on the aesthetic properties of music, but also when the
music experiences in the other models become aesthetic in nature.
· When the client’s experience becomes transpersonal, the model goes
beyond any of these categories and differentiations, and becomes
unitive. The transpersonal experiences of music appear in the very
center to indicate that, in music therapy, they are accessed through
the aesthetic realm.
Before any further discussion, it should be noted that while each model defines
an entire school of practice with its own theoretical and methodological
perspective, the models are not mutually exclusive. A therapist can move from
one to another with the same client depending upon the situation, and as this
occurs the therapeutic process gains breadth and depth, thereby leading to
more pervasive changes in the client. This in turn moves the therapeutic effort
from adjunctive to more primary levels of intervention.
MUSIC AS OBJECTIVE EXPERIENCE
Music consists of organized sounds and vibrations; it is energy and matter

heard in motion. It therefore has specific physical and acoustical properties
that can be used for therapeutic purposes. When the therapist uses these
properties of music to directly influence the client’s body or behavior in some
observable way, or when the therapist uses nonmusical stimuli to induce
specific musical responses from the client, the dynamic can be described as the
use of music as an objective experience. The experience is objective because
the variables of primary interest (on both the stimulus and response sides of
the equation) can be operationally defined, observed, and measured.
In this dynamic model, qualities of the therapist, client, and music are
objectified, that is, operationally defined in terms of measurable stimulus,
organismic or response variables, and then utilized to produce the desired
effects on one another. Thus, the therapist, client, and music are seen as
separate entities that are related to one another in various stimulus-response
and cause-effect relationships. Two different configurations are most
commonly used: music as stimulus and music as response.
Music as Stimulus Condition
In this configuration of the objective model, specific properties of the

music are used as stimulus, mediator, or reinforcer to induce observable,
nonmusical responses in the client. The musical stimulus is designed to evoke
an immediate nonmusical reaction which either is therapeutic in itself or is
prerequisite to therapeutic change. In this dynamic, the therapist and music are
both located on the causal side of the exchange, as separate or combined
stimulus objects that have been designed to effect change, while the client is
located on the effect side as a separate object that has been targeted for
change.
Typical examples of this dynamic include: the use of music listening to
effect physiological changes, the contingent use of music to influence
nonmusical behavior, and the use of music as mediator in nonmusical learning.
Here the effectiveness of therapy depends upon the extent to which the
stimulus conditions can induce the desired response, and then be either faded
away or generalized.
Music as Response Modality
In this configuration of the objective model, the therapist uses either

nonmusical or musical stimuli, usually in the form of an activity, to elicit
specific musical responses from the client deemed to be therapeutic (e.g.,
imitation of a rhythm, pitch-matching). Notice that the target response is
musical, and that it is operationally defined as the therapeutic objective. Thus,
for example, correct imitation of all aspects of rhythm patterns of varying
lengths is used as an operational definition of short-term memory, and the
patterns themselves can be operationally defined to reflect different types of
mnemonic strategies. Here the effectiveness of therapy depends upon whether
the activity used as a stimulus can elicit the desired musical response, and the
extent to which the musical response can generalize to nonmusical areas of
functioning.
Therapist’s Role
In the objective model, the therapist needs considerable knowledge of the

research literature. Of particular relevance is an understanding of how
stimulus, organismic, and response variables are related. More specifically, the
therapist has to know how the various stimulus properties of music can be
therapeutically applied with different therapeutic problems and client groups,
as well as how various musical responses within a particular client group are
indicative of therapeutic change in nonmusical areas of functioning.
Within the session, the therapist has these main responsibilities: taking
all relevant organismic variables into account, to pinpoint and operationally
define the desired therapeutic response (whether musical or nonmusical), to
utilize the appropriate stimuli to produce that response, to establish the kind of
interpersonal and physical environment that is conducive to therapy, to
observe and whenever possible measure the client’s responses, and to
determine in an objective way client progress and the effectiveness of various
therapeutic procedures.
Given the nature of these responsibilities and the expertise needed to
carry them out, the therapist typically takes a more directive role in conducting
the session, while also being sensitive to the needs and wishes of the client. The
therapist is ideally warm and supportive toward the client, while also
maintaining objectivity and the appropriate professional distance. Essentially,
the therapist is a sensitively empirical clinician, who utilizes scientific research
on the therapeutic potentials of music as the basis for assessment, treatment,
and evaluation.
MUSIC AS UNIVERSAL ENERGY FORM
In the objective model, music is conceived as a human creation; an object

made by people with specific properties that can be used for therapeutic
purposes. In the present model, music is still part of the object world, but is
conceived as something more than a human creation; rather it is a condition of
the universe itself. Here music is a living energy form that precedes and
presupposes the earthly musical creations of individual human beings. With
this in mind, Kenny (1988) asked:
Could we image that music is at the root of our existence; that music
is the formative element, not an epiphenomenon; that music is not
something we create, but something we notice and record? Could we
imagine that the “creator” of the sound merely listens to a larger pulse
of natural life and informs us about these rhythms, patterns, textures,
and tones, providing a blueprint, a landscape of the greater pattern of
life? (p. 52).
Three basic notions underlie the use of music as a universal energy

form. The first is that the universe itself, like music, is patterned vibration,
George Leonard (1978) explains:
At the root of all power and motion, at the burning center of existence
itself, there is music and rhythm, the play of patterned frequencies
against the matrix of time . . . we now know that every particle in the
physical universe takes its characteristics from the pitch and pattern
overtones of its particular frequencies, its singing. And the same thing
is true of all radiation, all forces great and small, all information
(pp.2-3).
Inherent in this notion is that all matter is energy and all energy is matter; or as
Eagle (1991) says in his discussion of the quantum theory of physics, “all
being can be described equally as particle and wave at the same time”
The second basic notion is that all parts of the universe are integrally
related, and that every macrosm contains and is contained in a microcosm.
Bohm (1980) calls this concept “holonomy” and asserts that: “In the
‘quantum’ context, the order in every immediately perceptible aspect of the
world is to be regarded as coming out of a more comprehensive implicate
order, in which all aspects ultimately merge” (p. 156).
Putting all this together, Eagle and Marsh (1988) explain how the
universe, the person and music are all interrelated:
The laws of the universe “out there”— in the environment outside of

the human body---are equally applicable to the function of the
universe “in here”—inside the body. “Out there” and “in here” are
both composed of vibrations and vibro-magnetic fields, the analytical
and perceptual interpretative parts of which are frequencies/pitches,
intensities/loudnesses, wave forms/tone qualities (timbres),
durations/times, and locations/localizations. Of such stuff is the body
made and music composed (p. 23).
The third notion is that, because music is a manifestation of the order,

balance, and harmony inherent in the universe, it has the potential for restoring
such qualities to any part of the universe that becomes disordered, unbalanced,
or unharmonious through disease or illness. Thus, music and its basic
structural components (sound, vibrations) are inherently healing to all living
things.
These basic notions, taken together, have spawned two basic approaches
within the universal model, one which we will call “elemental” and the other
which we will call “musical.”
Elemental Approach
In the elemental approach, sounds and vibrations are used for healing
purposes in isolation, that is, without music or outside of a music experience.
Thus, healing takes place within the client’s experience of the structural
components of music rather than real music per se. As such, the client
experiences parts of the music which in no way resemble the whole. These
practices are best described as “sound healing” or “vibrational healing,” both
of which are defined in a later chapter. What is important to point out here is
that both practices are not concerned with music experience per se, and
therefore do not belong within the boundaries of music therapy or music
healing.
Musical Approach
In the musical approach, therapy or healing takes place within the

client’s experience of music and all of its components, including sound and
vibration as well as melody, rhythm, and harmony. The premise here is that all
the elements and relationships found in music created by human beings are a
replica of organic elements and relationships found in nature. Thus, a created
piece of music is an explication of the implicate order of the universe (see
Eagle 1991), and every experience of music is a re-creation of the universal
life experience. The practices in this approach are best described as “music
healing” and “music therapy in healing,” both of which are defined in a later
chapter.
Therapist’s Role
The therapist’s role in this model is similar to that when music is used as
a therapeutic stimulus and response. In fact, both music and therapist are used
in similar ways. Music is the primary agent of change, operating directly on
the individual within a cause-effect paradigm, while the therapist is a scientific
healer, who uses theory and research as the basis of practice. In this model,
however, the therapist needs special expertise in physics and metaphysics, and
an acute understanding of how energy forms within the universe relate to and
affect energy forms within the species under conditions of health and disease.
(See Summer [1996] for a comprehensive discussion of the knowledge base
needed in this model, and the many fallacies that have crept into that
knowledge base).
The client-therapist relationship is ideally warm and supportive, but is of
relatively less dynamic significance than music because it is not the chief
determinant of therapeutic change. The client is essentially “healed” by the
music of the universe, with the therapist in a secondary role. The dynamic is
sometimes considered “self-healing,” because the client responds naturally to
natural forces within the universe, but it can be argued that this is still an
intervention from an outside force, and thus would be more accurately called
“sound-, vibrational- or music-healing.”
MUSIC AS SUBJECTIVE EXPERIENCE
Making and listening to music are always uniquely personal experiences; no

two persons sing or play a piece in the same way, no two persons improvise or
compose in the same way, and no two persons hear a piece of music in the
same way. Thus, the way a person makes or listens to music is a direct
manifestation of that person’s unique identity as a human being, reflecting not
only who the person is but also how he or she deals with various situations as
exemplified in the music. Similarly, when two or more persons make or listen
to music together, their shared music experience is equally unique to
themselves; no other two persons will interact, communicate, and relate to one
another in the same way.
Because of this, therapists can use music to help clients experience and
explore various aspects of themselves and how they relate to the world. To use
music in this way, the therapist designs the music experience according to
whatever the client needs to explore and experience, or what might be more
accurately called, the therapeutic issue. For example, a therapist may ask a
client to improvise alone in order to explore how the client organizes and
relates various aspects of the self, or how the client makes decisions when
alone; in contrast, the therapist may improvise with the client to explore how
independent or flexible the client is making decisions when others are involved.
Two basic approaches may be taken in configuring the dynamics of
music within a subjective experience, one focusing on the process of making
or listening to music, which we will call “music-as-process,” and the other
focusing on musical products (i.e., the recorded or scored improvisation,
composition, or performance resulting from the musical process), which we
will call “music-as-representation.”
Music-as-Process
When music is used as process, the ongoing, moment-to-moment
experience of creating, re-creating or listening to music provides the client with
opportunities to discover, experience, and transform various aspects of the
self, others, and/or the self-other relationship. Music-as-process can also be
used to explore events, objects, images, symbols, inner experiences, or any
aspects of the client’s world. In this model, it is the process of making or
listening to music that is itself the process of therapeutic change. In
comparison to the previous models, this use of music is not predetermined
according to stimulus-response bonds and specific therapeutic outcomes,
rather it is exploratory, extemporaneous, and open to whatever emerges. The
process is also not necessarily aesthetically driven, as the main purpose is to
use music as a very personal expression or reflection of each individual
involved.
The primary focus for the client in music-as-process may be anywhere
along the continuum of self to other, depending on how the process is
designed. Thus, music may reflect the self-process or the self-other process.
· Music-as-Self-Process: On one end of the self-other continuum,

the process may be designed so that the client makes or listens to
music alone, that is, with the therapist (or other clients) present
but not participating directly in the experience, with the primary
focus being the intrapersonal self. Here the primary goal is to
provide the client with opportunities: to discover and experience
various aspects of the self (past and present); to examine and
work through feelings, thoughts, images, etc.; to identify and
explore alternate ways of being; and to work out and make the
necessary changes. Of course, even when the primary focus is on
the self, others are implicated, as are external events and objects.
The mere presence of others as listeners and the unfolding of the
musical process in the external world provides a broad context
for the client’s exploration, including both the world of others, as
well as the world of objects. In addition, the intrapersonal self
already includes and implicates others and objects, either because
the experience itself focuses on the self in relation to them, or
because the self always contains internal representations of them
(viz., introjects). Nevertheless, the dynamic is still music as “self-
process” because the client is accessing, expressing, working
through, and reintegrating all aspects of the music without the
help or influence of anyone else.
· Music-as-Self/Other-Process: On the opposite end of the
continuum, the client makes or listens to music with others
actively participating in the process, with the main focus being on
who the other persons are in relation to the self. Here too objects
and events may be implicated. In the middle of the continuum, the
client may make or listen to music alone or with others, with the
main focus on either the interpersonal self, or the self in relation
to others. Both of these variations can be called music-as-
self/other-process, because the unfolding of the music is the
unfolding of the self-other relationship, with possibilities for
focusing on self, other, or both sides of the relationship. In the
process, the client gains opportunities to discover existing
patterns, to explore alternative ways of relating, and to make the
necessary changes.
When music is used in either way, the therapist provides what is

sometimes called a “transitional [musical] space,” a term originating from
Winnicott’s theory (1953) of object relations, and later applied to the various
creative arts therapies. The concept of “music as process” goes beyond the
concept of transitional musical space in several ways, and though there is no
room to discuss these in detail, it is important to at least cite what they are.
The following are areas of “music-as-process” not traditionally included in
discussions of transitional musical space: solo music-making by the client, that
is, without active participation by the therapist; expression of all aspects of the
self instead of mere psychological projection of only unwanted parts; and
receptive as well as active forms of musical endeavor.
Music-as-Representation
Whenever music is used as process, the result is some kind of musical

product, such as an improvisation, composition, performance, score,
recording, perception, interpretation, and so forth. This musical product is a
reflection of everything that happened during the process; it documents
everything that has been externalized, worked on, and transformed by the
music-maker(s) or listeners. As such, this product of the experience provides a
musical image, symbol, metaphor, or projection of each person involved in the
process—their problems, resources, feelings, thoughts, solutions, and so forth,
while also giving a musical description of the relationships that emerged
between the various persons, objects, and events involved in the experience.
Thus, an improvisation provides a representation of the improviser and how
s/he relates to the world of self, other, and object, just as a composition and
performance provides the same kind of representation of the composer or
performer. Similarly, the listener’s responses to music provide a representation
of the listener and how s/he relates to the world of self, other, and object.
Like music-as-process, these musical representations can reflect self,
other, object, event, and relationships therein, depending on how they are
designed.
· Music-as-Self-Representation: An improvisation, composition,

or performance which has been recorded or scored serves as a
unique manifestation, metaphor, symbol, container, script, or
personal myth for the self and various aspects and experiences
thereof, involving object, events, or others. Here the music exists
as an externalized object of the self which mirrors the self and, as
such, is essentially psychological in nature.
· Music-as-Self/Other-Representation: An improvisation,
composition, or performance which has been recorded or scored
serves as a shared but interpersonally unique manifestation,
metaphor, symbol, container, script, or myth for the experiences
of and relationship between and self and other. Here the music is
a mirroring, externalized object of the self-other, and thus is
essentially psychological in nature.
Music-as-representation can be likened to Winnicott’s concept of the

“transitional object,” however, here again it extends beyond the original
parameters in the same ways already cited for music-as-process and
“transitional space.”
Therapist’s Role
In this dynamic model, the client, music and therapist are integrally
connected to and, in fact, inseparable from the musical process and product.
Unlike in other models, the three are not separate entities which can be taken
apart and examined scientifically. Rather, the client is a subject relating to
music with the therapist, who is also a subject relating to music with the client.
Here the emphasis is on personal, subjective meaning, rather than on objective
data.
The role of the therapist is to use his or her own subjective self to relate
to the client in a therapeutic way, using music either as therapy or in therapy,
depending on the roles and responsibilities given to it. To do this, the therapist
needs expertise in music, psychology, and psychotherapy, while also having
considerable personal experience in using the “self” with “music” as partners
in therapy. Meanwhile, the client’s main task is to commit to exploring
relationships within and between self, music, and therapist.
MUSIC AS COLLECTIVE EXPERIENCE
In addition to having relationships with significant others, every individual is

part of many layers of community, from nuclear family to extended family,
from friends and colleagues to social network, from town to state and country,
and from ethnic and religious groups to society and culture. Each of these
layers of community has its own identity as a whole and as part of a larger
whole; thus, each community shapes and is shaped by the individual identities,
and each community shapes and is shaped by the larger community which
contains it.
One of the most important elements that binds these various layers of
community together and contributes to each of their collective identities is
music. Throughout the history of humankind, music has served as an integral
part of rituals that a community creates and shares, it has provided a shared
identity of people who belong to a community, and it has provided a container
and reflector of the collective psyche of the species.
In this dynamic model, the therapist calls upon collective experiences of
music as a basis for therapy with either the individual or the community.
Music may be used in three ways: as a ritual, as a collective identity, or as an
archetype.
Music as Ritual
Most communities use some form of music activity as a ritual, either by
itself or as part of a larger ritual that includes other activities (e.g., the other
arts). A ritual is any sociocultural activity that is repeatedly and traditionally
carried out by a particular group of people, in a particular and set way, for a
particular purpose. Most often, music is an integral part of rituals dealing with
medicine, healing, and religion.
In therapy, music can be used as ritual in at least three ways. First, the
therapist can create a music ritual as an integral part of the therapeutic
process. An example is when certain music activities or pieces are used at
certain junctions of a session (e.g., same hello song, following by same
sequence of instrumental activities, followed by same good-bye song). Here
the music is being used as a therapy ritual specially designed for the client-
therapy community. An example is provided by Beer (1990).
Second, the therapist can re-create a ritual practiced by a particular
community as part of the therapy process. The most common example of this
is the use of shamanic rituals in music therapy (see Moreno, 1988; Winn,
Crowe & Moreno, 1989; and Aigen, 1991a). Another example is when the
therapist provides clients with music during religious services and other kinds
of ceremonies.
Third, the therapist can operate on or utilize a musical custom, tradition,
organization, or ritual of a community to induce change. An example is the
work of Stige (1993) who worked with an established community music group
to accept new members who were mentally retarded.
Music as Collective Identity
Whenever music activity is an integral part of community life, the

history and identity of the community becomes integrally linked to the music
activities practiced and to the unique repertoire of music that the community
creates and adopts over the years. When this happens, each music activity or
piece serves as a reminder of the community’s heritage. The music of the
community thus serves as a reflection of their collective identity.
Therapists often call upon the collective musical identity of their clients
as a means of initiating or facilitating the therapy process (see Henderson
[1991] and Bright [1993]). For example, when working with elderly clients,
therapists often use music that is part of their ethnic or religious heritage to
bring them together, to combat their feelings of alienation, to regain the anchor
of having roots, and to rebuild a new community and new sense of belonging.
Similarly, the musical identities of two different groups or communities can be
used as the basis for changing each in relation to the other, as when teenagers
and the elderly share their music with one another to create a new level of
understanding.
Therapists can also help groups of clients to build their own collective
identities. In this approach, rather than calling upon existing identities, the
group begins to build its own repertoire of music activities and pieces as a
means of expressing and shaping a new collective identity. Here the purpose is
not so much to reflect relationships within the group (as in music as subjective
experience), but rather to enhance the sense of belonging and community.
Music as Archetype
Music is experienced as an archetypal form or process whenever its

meaning is derived from the collective unconscious. Here the music re-enacts
or reflects human interior experiences that are universal, that is, experiences
that emanate from the inherited, collective psyche of the species. Archetypal
music experiences as defined here may be referential or nonreferential. When
they are referential, the music refers to, expresses, or depicts myths and
various parts thereof (e.g., the hero, the hero’s journey, the dragon, the dragon
fight), all of which have to some degree reached verbal levels of
consciousnesss; when they are nonreferential, the music reenacts energy forms
that precede and underlie myth, as indigenously nonverbal experiences of the
human condition (e.g., conflict, balance, tension, harmony) that come into
consciousness through reenactment.
Therapist’s Role
In this dynamic model, the therapist is the keeper of roots. The

therapist’s role is to remember with and remind clients of all that connects
them to one another and the many layers of community they share. Here the
expertise is more sociological and anthropological than psychological, as the
emphasis is always on the history of the group as a context of meaning for the
individual, with less attention given to psychological idiosyncracies of
individuals within the group. And even when the focus is psychological, the
emphasis is on how the collective unconscious shapes the personal
unconscious, rather than vice versa.
Here the music serves as both container for the past as well as space for
the present, providing the community with opportunities to create, re-create,
and preserve the bonds that keep them together and anchor them to their roots.
The client’s main task is to connect to and place oneself within the
communities in which s/he lives.
MUSIC AS AESTHETIC EXPERIENCE
Dynamically speaking, music can be considered a purely aesthetic experience

whenever the client or therapist creates or listens to music for its own sake,
that is, for no other purpose than the appreciation of music, either as an art
object or an artistic process. Here the music experience is not designed
prescriptively, according to therapeutic goals or stimulus-response bonds;
rather it is incorporated into the therapy process for its own intrinsic value.
Hence the dynamic motivation is experiencing music in and of itself, and for
its own sake, rather than for the sake of the therapy process or any of its other
extrinsic values for the client. For further discussion of these ideas, see Aigen
(1991a, 1995), Ansdell (1995), and Aldridge (1996).
It is important to realize that even when music is used only for its
intrinsic value, the experience can still be of considerable extrinsic value. In
other words, aesthetic experience, even when pursued for its own sake, still
has therapeutic implications. Art is therapy, even when not intentionally
undertaken for that purpose. Thus, providing the client with purely aesthetic
experiences still facilitates and enhances the therapeutic process. Salas (1990)
explains
Beyond finding new ways to express feelings, beyond achieving a

new sense of competence and self-worth, beyond discovering an
organized self, the client—playing or listening—is experiencing an
ontological coherence coded in the music’s beauty. Blocked in the
search for meaning by impairments, whether circumstantial, organic
or psychological, the client can find intimations of universal order and
purpose in music. Healing takes place within the aesthetic experience
itself (p. 9).
According to Salas, what makes this so is that every individual
continually seeks ontological meaning and beauty in life, and that music
provides both. Music imparts ontological meaning on two levels: from
within—as a rich texture of sounds in various relationships within one
another; and from without—as part of a larger pattern of human life and as a
manifestation of the larger order of the entire universe. Beauty is implicated in
that it “is no more or less than a phenomenon of universal order” that we
experience “as an affirmation of ontological meaning” (p. 4). “Beauty is the
quality of integrity of form that echoes, to a greater or lesser degree, the grace
and elegance of the patterns of existence” (p. 4).
It is also important to realize that music can be an aesthetic experience,
regardless of whether the process and product meet conventional standards of
artistry established by professional musicians and critics. See the chapter on
music for a discussion of this issue.
Music as Art Object
Music is experienced as an art object whenever the focus is on the piece

of music itself (e.g., the improvisation, composition, or performance) for its
aesthetic value or beauty as a work of art. This is possible not only when
listening to music; it also happens when improvising, composing, and
performing and the focus is on striving to make the product a thing of artistic
beauty. Hence it is the art work created that is aesthetically fulfilling, with
comparatively less concern over whether the process of creating it has been an
artistic one.
Music as Artistic Process
Music is experienced as an artistic process whenever the focus is on the

sheer aesthetic pleasure derived from the act of music-making or music
listening itself. Here aesthetic values and beauty are pursued and achieved
while improvising, composing, re-creating, or listening to music, in the
creative process itself. Hence it is the act of creating art as it is being created
that is aesthetically fulfilling, with comparatively less concern over the artistic
value of the resulting product.
Therapist’s Role
In this model, the therapist needs to be an accomplished musician

capable of infusing the client’s music experiences with artistry, beauty, and
aesthetic meaning. The therapist may also serve as a teacher, as clients often
need some form of instruction or practice to develop the musical skills needed
to find personal meaning and fulfillment within the music.
MUSIC AS TRANSPERSONAL EXPERIENCE
As the postmodern world has begun to rediscover the centrality of soul and
spirit to the human experience, there has been an increasing interest in the
spiritual values of music. The idea that music provides access to soul and
spirit is not a new one in philosophy, music, or religion, but its acceptance
within the music therapy community has been more recent. Certainly, the work
of Nordoff-Robbins (1977), and Bonny (1978) have been moving forces
toward that end.
Unfortunately, space does not permit an in-depth discussion of this
dynamic model of music therapy, except to say that transpersonal experiences
can be of two types: with music being the vehicle leading to the transpersonal
realm, and music being an integral part of the transpersonal space itself.
Music as Transpersonal Vehicle
Making or listening to music is a vehicle to the transpersonal when it

helps the individual access and enter the transpersonal realm which, when
reached, is not integrally related to the music experience. Essentially, the
music experience serves as a bridge between ordinary consciousness of
ordinary reality to nonordinary and expanded consciousness of the infinite. An
example of this is the use of music-making or music listening to facilitate
meditative states or rituals (e.g., shamanic journeys) involving music that lead
to transpersonal or spiritual worlds. In both cases, the music is not within the
expanded consciousness that evolves, nor is it an integral part of the
experience of the infinite.
Music as Transpersonal Space
Making or listening to music provides a transpersonal space when the

individual has a peak or unitive experience that suspends ordinary boundaries
between self/music or self/other to form a new larger, expanded whole. When
this occurs, the music is not a mirror of the self, the music is the self on the
way to becoming Self; similarly, the music is no longer a mirror of the other or
the self-other relationship, rather the three components (self, other, and music)
become indistinguishably one as part of the greater Self. Here the expanded
consciousness includes the music as an integral but indistinguishable part of
the infinite. This type of experience occurs in Guided Imagery and Music
(GIM), when the client is ready and the conditions are conducive to
transpersonal work.
Therapist’s Role
The therapist in this model has to know how to work with clients while
they are in nonordinary states of consciousness, while also being
knowledgeable about transpersonal work, both personally as a client, as well
as professionally as a therapist. The role of the therapist is essentially
facilitative and nondirective. In fact, the titles “therapist” and “client” are less
appropriate here, as the client is actively doing the healing and transformative
work, while the therapist is serving as supportive witness and eventually a
bridge for the client to return to ordinary reality.
Excerpt Four
DEFINING AREAS AND LEVELS

OF PRACTICE
Kenneth E. Bruscia
Music therapy is incredibly diverse. It is presently being used in many

different clinical settings, to address a variety of health concerns, with myriad
client populations. Its goals and methods vary from one setting and client to
another, and from one music therapist to the next, depending on the therapist’s
theoretical orientation and training. This diversity has important implications
for defining music therapy because a definition, by its very nature, has to make
room for the many variations of practice that rightfully belong within its
borders while also providing limits for identifying those variations that extend
beyond its borders. One way to do this is to organize and classify the various
practices according to similarities and differences, and in so doing, to establish
criteria for comparing and delimiting them. Toward this end, the clinical
literature in music therapy was surveyed and the various practices of music
therapy were defined and differentiated. The present chapter is a result of that
survey; its purpose is to present an overview of the various areas and levels of
practice identified, and to thereby provide a context for understanding the
definitions found in the next chapter.
AREAS OF PRACTICE
An area of practice is defined by what the primary clinical focus is, or

what is in the foreground of concern for the client, therapist, and clinical
agency. Of particular relevance are:
· The priority health concern of the client. When a client enters an

agency or program, it is because of a particular health concern;
when clients seek the services of a music therapist, it is always
for a particular purpose; and when professionals refer clients to
music therapy, it is usually to accomplish something specific. All
of these motivations for seeking help shape what the clinical
focus or foreground of therapy is, and because of this, they
usually shape the therapeutic contract, determine the types of
services to be provided, and indicate the conditions under which
therapy should terminate.
· The priority health concern for the agency serving the client.
Most clinical agencies focus on a particular client population or
health concern, and define their mission accordingly. Thus, when
a music therapy program is a service provided by an agency, it
already has a specific health focus. The foreground of music
therapy in a nursing home is quite different from that in a school
or psychiatric hospital.
· The goal of the music therapist. Notwithstanding the client’s
reason for being in music therapy, or the mission of the agency
serving the client, every music therapist conceptualizes the goals
of therapy differently, usually according to his/her theoretical
orientation and methodology. Therapists who use improvisational
methods within a psychodynamic orientation have a different
clinical focus than those using receptive methods within a
behavioral orientation.
· The nature of the client-therapist relationship. The roles of client
and therapist, their titles, and the nature of their relationship all
reflect a clinical focus. In a school setting, client and therapist are
likely to call one another student and teacher; in a hospital, the
titles are likely to be patient and therapist. These titles imply
certain roles and responsibilities, and with them, certain
parameters for their relationship. A therapist in a hospital setting
would address certain aspects of a client’s life that a teacher
would dare not address in a school setting.
Based on these criteria, six main areas of music therapy have been
identified: didactic, medical, healing, psychotherapeutic, recreational, and
ecological. An overview of each will be given in this chapter, then in later
chapters, specific practices within each area will be described in detail.
Didactic
Didactic practices are those focused on helping clients gain knowledge,

behaviors, and skills needed for functional, independent living and social
adaptation. In all of these practices, some form of learning is in the foreground
of the therapeutic process. This includes all applications of music therapy in
classrooms and private studios, as well as in other settings (general or
psychiatric hospitals, nursing homes) where the main goals of the program are
essentially educational in nature.
Practices in this area vary according to the area of learning emphasized
(e.g., musical or nonmusical), the therapeutic value of the learning, the extent
to which the goals and methods can be individualized to meet specific client
problems and needs, and the nature of the client-therapist relationship.
Five different orientations to learning are taken within this area of
practice, with varying emphasis given to musical versus nonmusical learning.
They are:
· to develop musical knowledge and skills for their own sake, as an

integral part of functional living and social adaptation;
· to develop musical knowledge and skills that involve or
generalize to nonmusical areas of functioning;
· to use music and related activities as an aid in nonmusical
learning;
· to use music learning as a context for therapy;
· to use music therapy experiences to educate, train, and supervise
students and professionals.
Medical
The medical area includes all applications of music or music therapy

where the primary focus is on helping the client to improve, restore, or
maintain physical health. This includes all those approaches that focus on
biomedical illness as the main target of change, as well as those that also
operate on psychosocial and ecological factors which influence biomedical
illness and wellness. Typical settings are hospitals, clinics, rehabilitation
centers, hospices, and nursing homes.
Practices in this area vary according to the differential roles given to
music and the client-therapist relationship, the medical significance of the
goals, the length of treatment, and the clinical setting.
Healing
The healing area includes all uses of the universal properties of

vibration, sound, and music for the purposes of restoring harmony within the
individual and between the individual and the universe. A central notion is that
music is a vibrational manifestation of the order, balance and harmony
inherent in the universe, and that because of this, music can be used to restore
such qualities to any part of the universe that is disordered, unbalanced, or
unharmonious through disease or illness.
Because of their reliance on vibrational energy forms, all healing
practices focus on what Wilber (1995) calls “exterior collective” relationships
between individuals and the universe. Exterior relationships are essentially
physical and behavioral in nature, however, a basic assumption is that as the
body comes into harmony, the psyche and spirit will follow, as all three are
interrelated forms within the energy field. Thus, the initial focus on the exterior
collective can extend to interior relationships within the individual and between
the individual and other sociocultural layers; nevertheless, what distinguishes
healing practices from ecological ones is that healing starts from the exterior
collective and moves to more interior concerns, while the ecological starts
from the interior collective and moves to more exterior concerns.
Healing differs from therapy in one fundamentally significant way: in
therapy, the agent of change is the client, the therapist, or the music that they
make or hear together; in healing, the agent of change is the universal energy
forms found in music, and its component sounds and vibrations.
Practices within the area vary according to: the role responsibilities
given to client, music, and therapist, the extent to which the practice involves
music (as contrasted to sound and vibrations), whether the practice focuses on
only one area of health (e.g., body only) rather than the synergistic
relationships between various areas of health, and whether the target is an
individual or an environment or context.
Psychotherapeutic
The psychotherapeutic area includes all applications of music or music
therapy where the primary focus is on helping clients to find meaning and
fulfillment. This includes all those individual and group approaches that focus
on the individual’s emotions, self-contentment, insights, relationships, and
spirituality as the main targets of change, as well as those which address
medical and didactic factors related to these issues. Typical settings are
psychiatric hospitals, counseling centers, and private practice.
Practices in this area vary according to the breadth and depth of
treatment, the role of music, and the theoretical orientation of the therapist
(e.g., psychodynamic, behavioral, etc.).
Recreational
The recreational area includes all applications of music or music therapy

where the primary focus is on personal enjoyment, diversion, or engagement in
social and cultural activity. This includes both institutional, community, and
individual programs aimed at helping individuals engage in leisure time and
social activities that will enhance the quality of life.
Practices in this area vary according to the degree of relevance a
particular recreational pursuit has to the client’s health needs (e.g., an art
pursuit, a personal pastime, social contact, participation in the community), as
well as the length and continuity of treatment.
Ecological
The ecological area of practice includes all applications of music and

music therapy where the primary focus is on promoting health within and
between various layers of the sociocultural community and between any
community and its physical environment. This includes all work which focuses
on the family, workplace, community, society, culture, or the attitudes that any
group has toward the physical environment, either because the health of the
ecological unit itself is at risk and therefore in need of intervention, or because
the unit in some way causes or contributes to the health problems of its
members. Also included are any efforts to form, build, or sustain communities
through music therapy.
All ecological practices focus on “interior” relationships between the
individual and the various collective contexts in which the individual lives (see
Wilber, 1995). Interior relationships are based on the ideas, attitudes, values,
feelings, behaviors, meanings, and traditions of individuals within various
layers of community, and ultimately the relationship of all communities to the
human species at large. Of course, these “interior” concerns can affect
“exterior” relationships between groups of people and their physical
environments. Nevertheless, what defines the ecological area is that the focus
of change is first and foremost interior in nature. This stands in contrast to
healing practices, which focus first and foremost on the exterior or physical
relationships between the individual and the universe, and then as indicated, on
the implications these have for interior matters. Thus, for example, while
healing practices are concerned with the energetic relationship between
individuals, groups and their physical environment, ecological practices are
concerned with the attitudes and values groups have toward their physical
environment.
Practices in this area vary according to whether the focus is on the
environment as client, or the environment of a client. Thus, the aim may be to
improve the health of the environment itself, or to alter those factors in the
environment which contribute to the client’s health problem while also helping
the client to deal with them. Since practices in this area are quite different from
those in the other areas, criteria for determining levels are also different. Of
greatest significance are the breadth of focus and the degree of change
resulting from the interventions.
LEVELS OF PRACTICE
Overview
Each area consists of clinical practices that vary according to level of

therapy. A level describes the breadth, depth, and significance of therapeutic
intervention and change accomplished through music and music therapy. More
will be said of specific criteria determining levels of therapy, but first it is
necessary to give a brief overview of the four levels identified in a survey of
the literature. They are:
· Auxiliary Level: all functional uses of music or any of its
components for nontherapeutic but related purposes.
· Augmentative Level: any practice in which music or music
therapy is used to enhance the efforts of other treatment
modalities, and to make supportive contributions to the client’s
overall treatment plan.
· Intensive Level: any practice in which music therapy takes a
central and independent role in addressing priority goals in the
client’s treatment plan, and as a result, induces significant
changes in the client’s current situation.
· Primary Level: any practice in which music therapy takes an
indispensable or singular role in meeting the main therapeutic
needs of the client, and as a result, induces pervasive changes in
the client and the client’s life.
Other writers who have defined similar levels of practice include Wolberg
(1967), Wheeler (1983, 1988); and Maranto (1993). The present author has
also offered other versions (Bruscia, 1987b, 1989a), and has related these
levels of practice to the content of education and training at the undergraduate
and graduate levels (Bruscia, 1989b).
Criteria
The following criteria were used to identify the above four levels of
practice, and ultimately, to classify the various practices within each of the
areas described above.
Relevance to Primary Health Needs. The first criterion used to
determine level of therapy is the relevance of the practice to the client’s health
status or primary therapeutic needs. Does the practice deal with health needs?
Are its goals therapeutic in nature? Is the focus peripheral, supportive, or
central to the client’s primary health needs?
When a practice is not concerned with health concerns or therapeutic
needs, it falls outside the boundaries of music therapy. When the goals are
peripheral or supportive to the client’s overall therapeutic program, or when
they address secondary health problems or less intense therapeutic needs, the
practice is more likely to be at the auxiliary or augmentative level. When the
goals are of central relevance, or when they address health problems or needs
of primary significance, the practice is more likely to be at the intensive or
primary level. Thus, the more severe, urgent, or significant the health problems
or therapeutic needs of the client, and the more responsibility taken by music
therapy in addressing them, the more intensive the level of therapy is likely to
be.
Clinical Independence. When music therapy shares responsibility for
priority goals with other modalities, or when it focuses on limited aspects of
the client’s total treatment plan, the practice is more likely to be at the
augmentative level. When music therapy takes major or sole responsibility for
key areas in the client’s program, addressing a broad spectrum of health
problems and therapeutic needs, it is more likely to be at an intensive or
primary level.
Role Relationships. Music therapy always involves a client, a therapist,
and music, working together to induce change, through specific role
relationships. Thus, when any of these three elements is absent, or not given an
appropriate role, the practice falls outside of the boundaries of music therapy.
For example, when the individual being helped is not defined as a “client,” or
when music is used alone, without the help of someone defined as a
“therapist,” the work cannot be considered music therapy per se, and is
therefore considered to be at the auxiliary level. When role relationships other
than client-therapist (e.g., student-teacher) are involved, or when the client-
therapist relationship effects change through indirect rather than direct means,
the practice is more likely to be at the augmentative level. When all role
requirements of client and therapist are met, and when the relationship itself
provides a direct means of effecting therapeutic change—equal to the role of
the music—the practice is more likely to be at the intensive or primary level.
Level of Music Experience. A major factor determining the boundaries
of music therapy is the extent to which the client’s experience involves music,
as defined in Chapter 11. In terms of the present levels, those practices that
depend primarily on premusical, paramusical, or nonmusical experiences (see
Chapter 12) are usually auxiliary to music therapy, but not part of the
discipline itself; whereas those practices that depend primarily on musical and
extramusical experiences are more likely to be augmentative, intensive, or
primary.
Comprehensiveness of Treatment. Related to all of the above criteria is
the breadth of the therapeutic process, or the extent to which the therapist and
music can address most, if not all, of the client’s health concerns. A major
factor in determining this is whether music is used as therapy or in therapy.
The issue here is how adaptable the music therapist is in addressing the full
spectrum of health problems or needs that a client presents. Does the therapist
use only music, or does s/he exploit the full range of experiences and
relationships that arise from the music? Does the therapist use other modalities
and methods when indicated? Or in more basic terms, to what extent is music
therapy client-centered and/or music-centered?
When music is used as therapy, the therapist focuses on the specific
needs of the client that can best be addressed by the music itself. When music
is used in therapy, the therapist focuses on the full spectrum of needs
presented by the client, and selects that particular component of music therapy
(e.g., music, the therapist, the relationships) that best addresses those needs
which are considered priority. This does not imply that music in therapy is
always an intensive or primary level of therapy and that music as therapy is
always augmentative. Although this is common, the reverse may also occur.
Sometimes a priority need can best be addressed by music as therapy, and
sometimes it is best addressed by music in therapy. Here again the ultimate
determinant is the nature of the client’s needs, and the extent to which either
music as or in therapy can address them.
In terms of the levels, when the therapist stays within the established
boundaries of his/her modality and method, and addresses only some of the
client’s needs (i.e., those that fit within the boundaries of the modality and
method), the practice is augmentative; when the therapist stays within the
modality and method, but is able to address most or all of the client’s needs,
the practice is intensive or primary. Similarly, when the therapist extends or
goes beyond the modality, but only addresses some of the client’s needs, the
practice is auxiliary or augmentative; and when the therapist uses the full
range of the modality and method, and extends them to address broad
therapeutic concerns, the practice is intensive or primary. In Piagetian terms,
the augmentative therapist assimilates the client’s needs into his/her modality
and method, while the intensive or primary therapist accommodates his/her
modality to the client’s needs.
Depth of Therapeutic Process. The level of therapy depends not only
upon breadth, but also upon the depth of treatment. How far does the inter-
vention process go, and how long does it take? When a practice does not
involve a systematic process of intervention over a sufficient period of time, it
falls outside of the boundaries of music therapy. When a practice involves
occasional or infrequent sessions, or if it extends for only a brief period of
time, or when the interventions deal with manifest problems and needs, the
practice is more likely to be augmentative. When a practice involves frequent
and regular sessions over a long period, and when the interventions address
both latent and manifest problems and needs, the practice is more likely to be
intensive or primary.
Degree of Therapeutic Change. An ultimate determinant of the level of
therapy is the degree of therapeutic change to be made by the client. Does the
practice aim at inducing any kind of change? If so, is the change therapeutic,
as defined in the previous chapter? Does the practice lead to overt and/or
covert therapeutic changes? What specific aspects of the client’s problems are
addressed—the symptoms, the disorder, the causes, or the resultant
difficulties? Are changes made at the conscious or unconscious level? To what
extent do the changes involve structural reorganization, adaptation, or
manipulation of the environment? Do these changes make the client more
independent in resolving or coping with the problem, or is change dependent in
some way on the treatment conditions?
Wheeler (1983, 1988) has offered a classification of music therapy
practices using degree of change as the criterion. Based on Wolberg (1967),
she identified three levels of psychotherapeutic practice for adult psychiatric
patients: 1) activity music therapy (the use of music-based activities to achieve
adaptive behavior goals); 2) insight music therapy with reeducative goals (the
use of music and other psychotherapeutic methods to help the client
understand and resolve problems at the conscious level); and 3) insight music
therapy with reconstructive goals (the use of music and other
psychotherapeutic methods to resolve unconscious conflicts and thereby
promote reorganization of the client’s personality).
Nature of These Levels
A few final points need to be made about how all of the above criteria
affect levels of practice. First, every criterion may not be relevant to every area
of practice. That is, a criterion may be relevant in determining levels of
practice in one area (e.g., educational) but not another (e.g., healing). As will
be seen in the chapters that follow, when determining levels of therapy,
different criteria apply to different areas of practice. Thus, the area of practice
shapes the levels within it.
Second, one criterion affects another. That is, the relevance of music
therapy to the client’s needs determines how much clinical independence it will
have, which in turn affects the depth of interventions and the degree of client
change. Similar interactions can be found between how intrinsically musical
the client’s experiences are, and whether music is used as therapy or in
therapy.
Third, as with the areas of practice, these levels frequently overlap. One
often finds music therapists who work at different levels of therapy with the
same client population, either because of stages in the therapeutic process or
differences in the type of therapeutic problem being addressed.
In the four sections that follow, each level of therapy is discussed in light
of the above criteria.
Auxiliary Level
The auxiliary level includes any application of music (or any of its
components) for nonmusical purposes which does not qualify as therapy,
either in goal, content, method, or relationship between provider and
consumer. Either individuals receiving the service do not qualify as “clients,”
or the service provider does not act in the capacity of a therapist, or the
interventions are not part of a therapeutic process leading to change. This level
also includes those practices that use premusical, paramusical or nonmusical
experiences for clinical purposes rather than musical or extramusical ones.
Auxiliary practices are peripheral to music therapy in that they do not
meet the criteria established, either for music experience or for therapy;
nevertheless, they often provide the foundations for many areas of clinical
work.
Augmentative Level
The augmentative level includes all those practices within the discipline
wherein music therapy augments the education, development, healing, or
therapy of individuals who meet the criteria for “client” given in the previous
chapter. In this context, “augment” means to add something unique, either to
the individual’s own efforts at therapeutic change, or to services, programs, or
treatment modalities that are also being provided to the individual. Of course,
the unique addition is music.
In this category, music is frequently used as therapy, and the role of the
therapist is often delimited by the setting and the specific functions given to
music therein. Typically, the therapist’s main functions are to enhance and
facilitate the direct effects of music experience on the client. The client-
therapist relationship is therefore primarily a musical or activity one, and in
most cases, it is not used as the main vehicle or agent of healing or therapy.
On the other hand, because music is used to augment other therapeutic
efforts, the role of music may be stretched on occasion to accommodate the
particular area of practice and the goals therein. Thus, for example, music
activity therapy may be extended to incorporate nonmusical activities; or the
contingent use of music may be extended to include nonmusical reinforcers.
Nevertheless, a criterion for this level is that the practice relies in large part
upon musical and extramusical experiences, and employs premusical,
nonmusical, or paramusical experiences only as indicated.
Similarly, the role of the music therapist at this level frequently includes
the role functions of other professionals (e.g., teacher, minister, or other type
of therapist). Generally, this is determined by what goals have been established
as priority within the area of practice or clinical setting.
Music therapy at the augmentative level frequently accommodates the
goals of other disciplines, and plays a supportive yet important role. Usually
that role involves enhancing, elaborating, expanding, reinforcing, or preparing
for what other therapists are striving to accomplish with the client.
In terms of other classifications, this level corresponds to Wheeler’s
“activity” level (1983) and Wolberg’s “supportive level” (1977) with respect
to psychotherapy. In synthesizing the two, Wheeler ascribes the following
characteristics to this level: 1) the achievement of goals through activities
rather than verbalized insight; 2) the suppression of feelings and impulses in
favor of developing adaptive behaviors; 3) a focus on behaviors rather than
covert processes or causal links; 4) the utilization of client resources; 5) a
positive relationship with the therapist who takes a highly directive role in
leading the session; and 6) a minimal need for the therapist to have insight into
his/her own feelings.
It also corresponds to the “adjunctive” level as previously described by
the author (Bruscia, 1987b). Augmentative was chosen as the term here rather
than adjunctive because of differences in connotation. Adjunctive often
connotes that the practice is nonessential or supplementary. The augmentative
level includes supportive services that are integral and important, and often
irreplaceable.
Intensive Level
The intensive level includes all those practices within the discipline
wherein the music therapist works in tandem with other treatment modalities
as an equal partner or as the major therapist. As mentioned earlier, the
essential differences between augmentative and intensive practices can best be
described in Piagetian terms of accommodation (adapting existing structures
to meet new demands) and assimilation (adapting new demands to fit into
existing structures). When used as an augmentative modality, music therapy
accommodates the goals of other treatment modalities, and thereby
assimilates the client’s needs into the framework of music. When used as an
intensive or primary modality, music therapy assimilates the goals of other
treatment modalities into itself in order to accommodate the client’s needs.
In terms of Wheeler’s and Wolberg’s classifications, this corresponds to
the “reeducative” level of therapy, in which the client undergoes intensive
supportive treatment aimed at learning new ways of solving problems and
thereby achieving a higher level of functioning, but not making changes which
are reconstructive in nature. Maranto (1993) calls this level “specific.”
Generally, music is used in therapy more often than as therapy, and the
role of the therapist is determined in large part by the client’s needs. The
therapist serves as an equal or dominant partner with music in the intervention
process. Music is typically used to establish or enhance the client-therapist
relationship, which is more therapeutic than musical in nature. That is, at the
intensive level, the client is likely to relate to the music therapist as therapist
more than musician, and verbal communication is likely to be an important
dimension of the client-therapist relationship. All varieties of music experience
may be used, with particular emphasis given to musical and extramusical
experiences.
Because this level is geared to address a broad spectrum of client needs,
assessment and treatment procedures in one practice often overlap with
practices in other areas. Thus, it is at this level that overlaps are often found
between didactic, psychotherapeutic, medical, and healing practices. The
reason for such overlaps are that there is more of a tendency to view the
client’s needs holistically, while also giving the therapist greater responsibility
for meeting them.
Primary Level
At the primary level, music therapy takes an indispensable or singular

role in meeting the main therapeutic needs of the client, and as a result, induces
pervasive changes in the client and the client’s life. The client undergoes the
most intense and comprehensive treatment aimed at altering basic structures
within the client and between the client and the environment, thereby
addressing core causes of the client’s health condition. In Wheeler’s and
Wolberg’s classifications, this level is called “reconstructive,” while in
Maranto’s, it is called “comprehensive.”
Music therapy at this level nearly always involves the integration of one
area of practice with another (e.g., healing and medical, didactic and
psychotherapeutic). As such, the areas of music therapy begin to merge so that
the full resources of the discipline can be applied to meet the client’s needs.
Thus, two criteria must be met for any practice to qualify as primary
music therapy: 1) when the work in one area of practice has the depth needed
to induce changes in the client that are fundamental, deep and pervasive and 2)
when the work has sufficient breadth so that the goals and processes of the
original area of practice have been extended to include another area of
practice. Thus, primary therapy has both depth and breadth in both process
and change.
Music is used both as therapy and in therapy; and the therapeutic
benefits of both client-music and client-therapist relationships are fully
exploited. All levels of music experience, as well as other therapeutic
modalities are used as indicated.
OVERVIEW
In summary, an area of practice is defined by the clinical focus of the client,

therapist, and clinical agency; a level of practice is defined by the breadth,
depth, significance, and autonomy of treatment and outcome, along with the
role of music.
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READING 10
Taken from: Stige, B. (2002). Culture-Centered Music Therapy, pp. xv-xviii. Gilsum NH:
FOREWORD
Kenneth E. Bruscia
The history of ideas in music therapy has been amazingly rich, despite its brevity.
Like psychology, our work has evolved through various “forces” of thought, but in
slightly different order. Our first force contributed discoveries about how music
influences human behavior and the physical world. Our second force unearthed
unconscious dimensions of music experience, and explored their implications for therapy.
Our third and fourth forces explicated the role of music in self-actualization and spiritual
development respectively.
This book heralds the coming of the fifth force in music therapy—culture-
centeredness. This will be the force that reminds us that all of our work, whether it be
theory, practice, or research, takes place within very specific and unique contexts—
contexts that not only shape the work itself, but also predispose us to attach our own
idiographic meanings to it. This will be the force that debunks many of our
uncontextualized generalizations about the nature of music, therapy, and music therapy
itself. This will be the force that reminds us that all interactions, musical and nonmusical,
clinical and nonclinical, are situated within many larger, frequently overlooked frames of
perception and communication. To be culture-centered is to be variously aware that there
are frames of history, frames of environment, frames of ethnicity, frames of language,
frames of belief and value, and the never-ending, shifting frames that evolve between
individuals through moment-to-moment interaction.
Through concepts like “reflexivity” (identifying one’s own frame of reference in
relation to another), and “local versus general knowledge” (recognizing that one’s
understandings are delimited by the contexts and cultures in which they were derived),
culture-centered thinking places considerable responsibility on the music therapist.
Whether operating within the domains of practice, research, or theory—music therapists
must continually act with a deep awareness of how culture and context “situate” each
party in every interaction and the meaning that is created therein. We must do this not
only by “locating” ourselves and those with whom we interact, but also by considering
how our individual and collective histories particularize our frames of reference. To
understand our ongoing interactions, we must disentangle and reweave our respective
pasts and presents, for history and culture are the backdrops in which every story unfolds.
Once these admonitions of cultural awareness are embraced, it becomes obvious
that all of our individual and collective ideas of and about music therapy have to be re-
contextualized and situated, both culturally and historically. This means that each music
therapist has to examine his or her own cultural embeddedness; in addition, the entire
profession has to examine the cultural embeddedness of its various constituencies. All
“forces” of thought that have arisen in the history of music therapy, whether consisting of
individuals or groups, have to locate themselves within their respective cultural and
contextual frames within the profession. And this goes for culture-centered thinkers as
well! They too must be reflexive of their own cultural and contextual frames, as
individuals, and soon as a viable group within the music therapy community. What will
culture-centered thinkers learn from reflecting upon their own contextual and cultural
frames (and limits thereof), and locating themselves within the history of ideas in music
therapy? What does each preceding force of thought in music therapy learn from culture-
centered thinkers, and what can culture-centered thinkers learn from each of its
predecessors?
One of the lessons we are learning as a profession is that one new idea does not
necessarily replace or surpass previous ideas; rather, each new idea enters into an already
existing culture of ideas, where all ideas begin to interact. Thus, when a new idea is
introduced, the entire culture is fertilized: existing ideas are influenced by the new idea,
and the new idea is influenced by its integration into the existing culture. Thus, culture-
centered thinking does not replace or surpass the behavioral, psychodynamic, humanistic,
or transpersonal forces of thought; rather, it catalyzes them to be more culture-sensitive;
in return, the established forces challenge culture-centered thinkers to somehow integrate
existing values into their thinking. The developmental process is more holistic than
linear, so that there is a place for every idea of continuing relevance.
For the profession to integrate the fifth force into its collective consciousness, all
kinds of ideational negotiations will have to take place. Behaviorists will have to become
more reflexive of their “received” view and the limits of their generalizations about the
world of objects. In return, culture-centered thinkers will have to acknowledge that there
are many real-world, cultural contexts in which objectivity and accountability are highly
valued; they will also have to admit that there are many contexts in which behavioral or
physical change trumps meaning, no matter how sensitively the meaning was derived.
The psychodynamic school will have to admit that their interpretations are one-
sided and context-bound rather than universally true or even interpersonally valid; and
like the behaviorists, they will also have to recognize that their way of thinking about
clients leads to “othering.” In return, culture-centered thinkers will have to take into
account levels of consciousness, and how they influence cultural self-awareness. They
will have to admit that, when the effects of the unconscious are considered, reflexivity is
not as easy or as possible as they propose. One might even ask culture-centered thinkers
whether their notions about the possibility of being reflexive are any less delusional than
claims of objectivity by the behaviorists, or confessions of countertransference by the
psychodynamic therapist. Perhaps, the goal of each force is not so different—we all have
to find a way of utilizing and managing our subjectivity.
Humanists will have to look at their empathy, unconditional positive regard, and
nondirectiveness, and ask whether such therapist attitudes are relevant in every context;
they will also have to admit that these attitudes, like their psychodynamic counterparts,
were pre-determined theoretically to be essential conditions for effective therapy. They
are stances to be taken with all clients, irrespective of individual differences in need and
culture, and regardless of moment-to-moment changes in situational context. Also, by
their very nature, empathy, positive regard, and nondirectiveness leave the client alone in
his or her quest for meaning; the therapist refrains from participation in the client’s
meaning-making process. Thus the meanings derived by the client in humanistic therapy
are decidedly more individually constructed (client-centered) than interpersonally co-
constructed (by client and therapist). Culture-centered thinkers will have to respond to the
humanists by recognizing that client-centered change is as important as community-
centered change, and that self-actualization is a pre-requisite to social change. They will
also have to extricate the individual (and free will) from the ongoing influences of
endless webs of context. Seeing the individual as embedded in culture can be just as
deterministic as seeing the individual as determined by bodily functions, reinforcement
schedules, or unconscious forces; only the agent of determination is different. How will
culture-centered thinkers negotiate the balance between free will, cultural embeddedness,
and social responsibility?
Transpersonalists will have to see that their very notions of spirituality are
culture-bound; conceptions of consciousness, divinity, energy, and ultimate power differ
not only from one individual to another, but also one community and culture to the next.
Sometimes these conceptions are individually constructed, and sometimes they are co-
constructed by like souls. Culture-centered thinkers have to somehow deal with the
reality that most, if not all cultures recognize or construct a spirit as part of their belief
system. Thus, no theory of culture-centeredness is complete if it has no place for
spirituality.
The emergence of the fifth force at this time in history is a good indication that we
are ready to integrate sensitivity to culture and context into our collective consciousness
of music therapy. The challenge of doing so is to find ways of assimilating this new idea
into existing structures, while also modifying existing structures to accommodate the new
idea. No one force or school of thinking can remain viable if it has not been enriched by
the other forces of thought operating within the community of ideas. And it is important
to acknowledge, that even when so enriched, no one force can ever dominate our
consciousness to the exclusion of another. There will be instances and contexts when
culture-centeredness is the most appropriate frame of reference, and other instances and
contexts when another frame must prevail.
Children play a simple game that teaches us all about the impossibility of ever
imposing the same solution on every problem. Two children play at a time, and on the
count of three, each child simultaneously makes a hand sign for either rock, paper, or
scissor. To determine the winner of each round, children follow these rules: rock crushes
scissor, scissor cuts paper, and paper covers rock. Thus, by nature, each object has its
area of advantage and its area of disadvantage. To use only one, then, is to insure one’s
own defeat.
In music therapy, our developmental task is similar: to discover the specific areas
of advantage and disadvantage of each force of thought, and to develop the flexibility
needed to apply all of them when appropriate. This book issues the challenge. Can we
open ourselves to accepting new ideas and using them to their best advantage?
Reading 11
Theoretical Notes on the Practice of

Guided Imagery and Music (GIM)
Kenneth E. Bruscia
Definitional and Boundary Issues

Since Bonny originated GIM in the early ’70s, her proponents have developed many
extensions and variations in both the individual and group forms. At the same time, many
techniques have evolved in other health professions that rely upon various forms of
“guided imagery,” some employing music (see Meadows, 2002). As a result, definitional
and boundary issues have arisen over the years, along with controversies over what to
name the various practices and modifications therein. These issues have been further
confounded by the fact that many different health professionals practice the model, and
therefore it has been applied within the context of many different disciplines and
orientations. Practitioners in GIM come from backgrounds in music therapy, counseling,
psychotherapy, healing, education, medicine, psychiatry, nursing, spiritual direction, and
transpersonal work.
Definitions and boundaries are not merely philosophical concerns—without them,
safe, competent practice may be jeopardized. If intensive training is to be required to
practice GIM, a fundamental question is which of the many variants of GIM should the
BMGIM therapist know how to practice? Should all variants of GIM be taught in the
training programs, or only the Bonny Method?
In an attempt to clarify these issues, Bruscia (2002) made a distinction between
GIM, the generic title for myriad related practices, and Bonny’s Method of GIM, which
includes the individual and group forms. The individual form is commonly called
BMGIM, and the group form is variously called “Group GIM” or “Music and Imagery.”
Already, the nomenclature difficulties should be obvious.
Bonny’s individual form can be distinguished from related approaches that go
beyond it by applying the following defining variables: BMGIM is defined as: “(1) an
individual form (2) of exploring consciousness (e.g., in healing, psychotherapy, self-
development, spiritual work), (3) which involves spontaneous imaging (4) in an
expanded state of consciousness (5) to predesigned (taped) programs of classical music,
(6) while interacting with a guide, (7) who uses nondirective, non-analytical, music-based
interventions (8) within a client-centered orientation, (9) all within a session that has the
following components: preliminary conversation, relaxation induction, guided music-
imaging experience, return, and postlude discussion” (2002, p. 46). If any of these nine
features is modified, the practice should be regarded as an adaptation of BMGIM, falling
under the generic umbrella of “GIM.” That is, if the individual form is used for other
purposes (e.g., educational), or if the imaging is directed by the guide rather than
spontaneously created by the client, or if the client does not enter an expanded state, or if
the music is extemporaneously selected by the guide rather than programmed beforehand,
or if the guide does not work within a client-centered orientation, or if the session does
not have all these components, the practice should regarded as an adaptation of BMGIM
and considered a variant under the generic umbrella of GIM.
The Bonny Method of Group GIM is defined as: “(1) a form of working with
individuals in a group setting, (2) for the purposes of exploring consciousness (e.g., in
education, training, self-development, or spiritual), in which (3) each member images
spontaneously, (4) while in an expanded state of consciousness, (5) to one or more pieces
of music (any style), (6) without ongoing direction or dialogue with the leader, (7)
working in client-centered orientation, (8) within a session form that includes: a
preliminary conversation, relaxation/induction, music-imaging experience, and postlude
discussion” (2002, p. 46). Once again, if any of these defining features is modified, the
method is an adaptation of the Bonny Method and therefore a variant of GIM. For a
discussion of specific practices or techniques in GIM that go beyond the Bonny Method,
see Bruscia (2002). Since the remainder of this paper deals only with the individual form
as designed by Bonny, the acronym BMGIM will be used throughout.
Continuua of Practices in BMGIM

Flowing out of the definitional boundary and nomenclature issues are differences in the
orientations of BMGIM practitioners (Bruscia, 2002). Orientations in BMGIM vary not
only according to theories of psychotherapy (e.g., humanistic, psychodynamic), but also
according to the role given to music vs. the other elements of the BMGIM process. “How
music is used may vary from one session to another, one client or population to another,
and one practitioner to another” (2002, p. 43). This can best be described as a continuum,
with one end representing the use of music as therapy or as the transformational agent,
and the other end representing the use of music in therapy or as one of many agents of
transformation.
When music is used as the transformative agent, the client’s needs are accessed
and addressed through the music listening experience, the client’s change process is
evoked, worked through, and completed through the music listening experience, and the
transformation that takes place in the music is the transformation that takes place in the
person. Throughout, there is very little reliance on other modalities (verbal discourse,
artwork, etc.) (Bruscia, 2002). In these cases, the music is not co-therapist; rather, it is
both therapist and therapy, and the guide is the co-therapist.
When music becomes the therapist and therapy, it becomes both process and
outcome. The musical change process is the client’s change process, and the musical
outcome is the client’s outcome. “When this happens, the imager steps into the structures
and processes unfolding in the music from moment to moment and begins to live within
them, generating images and inner experiences that arise directly out of the music. And
by living in structures and processes as they continually transform themselves, the
experiencer and the experience are similarly transformed. The entire phenomenon is
intrinsically musical in nature and similarly ineffable; and this seems to hold true, even
when the imager tries to describe the experience verbally, using nonmusical referents
(e.g., images of an animal, person, situation, etc.). In fact, often the nonmusical images
and the verbal reports of them seem like mere artifacts of an essentially musical
experience” (2002, p. 44).
These intrinsically musical experiences may arise spontaneously, initiated by the
client, or they may be evoked or facilitated by the therapist; they may also be an entire
approach to BMGIM, or an occasional way of working. Much depends on how the
therapist conceptualizes BMGIM and how it works, and how the therapist guides the
client. When music assumes the primary role of therapist during the listening period, the
therapist continually refers the client back to the music to guide the client’s moment-by-
moment experience; then, during the postlude discussion, the therapist helps the client to
acknowledge and anchor the ineffable musical/personal transformations that have taken
place. No attempts are made to superimpose additional interpretations or insights.
On the opposite end of the continuum, music is used to stimulate experiences in
other media (e.g., imagery, body work, artwork, verbal discourse), and these experiences
are used, instead of or in addition to the music, to facilitate the transformational process.
At this end, the client’s needs are accessed and addressed in nonmusical media, and the
client’s change process is evoked, worked through, and completed in these media, all
with the help of music as the background stimulus. “Here the focus is not on experiencing
the music as an intrinsically transformative experience in itself; instead, the focus is on
generating nonmusical images and experiences with the help of the music” (2002, p. 45).
BMGIM is therefore conceived of as the use of music-evoked imagery, rather than the
use of music per se. This is immediately apparent when the therapist tends to guide,
explore, and discuss the meaning of the imagery rather than the transformations
experienced in the music. Verbal segments of the session take on much more importance
than the music listening segment, because the meaning of the images and insights gained
from them are of paramount significance. It is also noteworthy that the insights gained
are more verbal than ineffable (musical).
Another important distinction that arises out of this continuum is an experiential
approach to BMGIM as compared to an insight-oriented approach (Bruscia, 1998). These
approaches differ in both process and outcome and very much resemble the previous
distinctions between music as vs. music in therapy.
In an experiential approach (also called transformational music psychotherapy),
the client relives and works through his problems within the music-imaging experiences
and the transformations that take place there constitute the therapeutic process, without
necessarily analyzing the transformations to gain insight about them. Here the aim is
experiential change or transformation in and of itself, which in BMGIM is the experience
of musical transformation; the process of reaching that aim is also experiential (i.e.,
music listening).
In an insight-oriented approach (also called insight music psychotherapy), the
client uses the full gamut of BMGIM experiences to gain insights into his problems and
to their possible solutions, and efforts are made to implement these insights in the real
world, with less attention given to whether the client actually experiences the problems
and their resolutions in the music and/or imagery. Once again, these approaches may be
used occasionally or as an entire approach. They may occur spontaneously within a
session, or the therapist may purposely facilitate one or the other.
Levels of Practice in BMGIM
The BMGIM process varies in direction and depth from moment to moment within the
session and from one session or phase of work to another. In this context, direction means
the domain or area of the client’s life that is a focus of the work, and depth is the degree
and range of change the client is called upon to make. These continuous variations in
direction and depth make BMGIM an expansive and responsive process. It is expansive
in that, at any moment, the focus of the work may enlarge from one domain to many
domains, and the depth of the work may intensify the work increasing the degree of
change the client is called upon make. BMGIM is responsive in that it expands in
direction and depth according to what the client needs in the moment, within the context
of what has arisen in the music-imaging experience.
It is essential to understand that, in an instant, the BMGIM process can expand
from positive to problematic aspects of the client and the client’s life, from comfortable
to uncomfortable situations or memories, from joys and pleasures to pain and trauma,
from strengths to weaknesses, and from easily managed experiences to very difficult and
sometimes unmanageable experiences. Though it was originally believed that BMGIM
was self-limiting—that is, that it does not bring forth anything the client cannot
manage—clinical practice has shown that this is not always the case. While BMGIM is
incredibly accurate in bringing forth what the client needs to grow or change, the
therapist has an ethical responsibility to ensure that the client is adequately prepared to
deal with what BMGIM brings forth. In short, the expansive and responsive facets of
BMGIM have profound implications for safe and ethical practice.
Safe practice can be achieved through a three-pronged approach: (1) adherence to
contraindication guidelines; (2) adaptation of the method when indicated; and (3)
utilization of levels of practice in establishing contracts with clients. All three safeguards
are interrelated. Contraindication guidelines indicate when BMGIM should be adapted so
that the direction and depth of the work is safely contained; adaptation of the method
helps to ensure that the client stays at the safest level of practice.
BMGIM is contraindicated whenever the client lacks (Bruscia, 1992):
1. The medical and physical stamina needed to undergo the music or the
images.
2. The emotional stability needed to undergo the feelings evoked.
3. The ego strength and boundaries needed to maintain one’s sense of self
and personal identity after deep experiences.
4. The intellectual abilities needed to understand one’s own experiences.
5. The verbal abilities needed to participate fully in the session.
6. Sufficient reality orientation to distinguish imaginary and real worlds.
When any of these contraindications are present, the therapist may adapt the
individual or group forms of BMGIM by:
1. Shortening the music

2. Using less challenging music
3. Controlling how deeply the client goes into an altered state of
consciousness
4. Directing the imaging rather than allowing the client to create it
spontaneously
5. Keeping the images positive
6. Monitoring the discussion afterward so that clients can handle the insights
7. Spreading out the sessions and limiting the total number
Based on whether any contraindications are present and taking into account the
goals of the client, the therapist and client may make a contract to work at a particular
level. In this context, levels refer to the “breadth, depth, and significance of therapeutic
intervention and change accomplished through music and music therapy” (Bruscia,
1998a, pp. 163–164).
The first level is auxiliary in nature and is concerned with self-development and
growth. The client is seeking GIM for any of the following purposes: to develop one’s
imagination, to promote creativity, to improve one’s learning skills, to learn how to relax
and reduce stress, to facilitate self-discovery, to enhance one’s spiritual life, and so forth.
At this level, the client has a healthy way of being in the world and is managing any
ongoing health threats without need for outside assistance. Thus, the focus is on self-
improvement rather than therapeutic intervention into a defined health problem. At this
level, the client is called a traveler and the therapist is called a guide. The therapist
maintains a nonintrusive, supportive stance that encourages the client to work
independently. The relationship is not usually a medium or agent of change but is
nonetheless important. Depending on client preference, the music may be of any genre
and style, though classical music is ideal. The programs are short, and the music is not
too challenging. The work is most often done in groups and is usually short-term or at
widely spaced intervals. This is the level of Bonny’s original Group GIM, which was
done in workshop settings. Individual sessions may be used at this level but usually
require adaptation to contain the amount and nature of material uncovered.
The second level is supportive or augmentative in nature. The aim is twofold: (1)
to discover, restore, and build upon existing structures and resources that an individual
needs to deal with a health threat of some kind; and (2) to stimulate and support
psychological adjustment and healing. Additional objectives may be to return the client to
psychological equilibrium as rapidly as possible; to ameliorate psychological, physical, or
behavioral symptoms; to strengthen existing defenses; to develop better coping
mechanisms; and to reduce the effects of negative influences, both from oneself and
one’s environment. Here the focus is on dealing with the health threat, taking a
deliberately positive and motivational approach that reframes problems. Thus, rather than
accessing or working through problems underlying the health threat, the therapist seeks to
help the client to rediscover and reclaim parts of the self that are needed to cope with the
present situation and either adapt to or improve it. Catharsis is not necessary but may
occur when needed. Efforts are made to bring resources into the conscious mind, rather
than to uncover hidden unconscious material that requires further work. The approach is
structure-building rather than deconstructive, focusing on resources rather than problems.
The primary clientele for this level are individuals who are recovering from a
psychiatric disorder and drug or alcohol dependence, individuals with a medical
condition (e.g., cancer), individuals in crisis, and clients who are preparing for or taking a
break from deeper levels of psychotherapy. The format of work at this level may be
individual BMGIM, if used intermittently or in short series with music programs that
invite positive and uplifting experiences; adaptation of individual BMGIM, so that it
minimizes the uncovering of conflictual material and capitalizes on the insightful and
healing potential of positive BMGIM experiences; or Group GIM therapy (see Summer,
2002). The music is easy, safe, and structure-building rather than challenging. Certain
BMGIM programs may be used in part; however, in most cases, efforts are made to limit
the length of the music. At this level, the traveler is a client and the guide is a therapist.
The client-therapist relationship is important in facilitating the music experiences and
enhancing the therapeutic value of the imagery; however, often, because of the length of
treatment, the relationship does not develop the depth needed for it to serve as a medium
or agent of client change.
The third level is intensive or re-educative. The aim is to help the client to
uncover and work through unconscious material and thereby gain insight into oneself and
the specific problems experienced by the problem. Specific objectives may be to examine
problematic childhood experiences and their effect on the present; to facilitate and
support self-expression and the release of feelings; to uncover and better utilize
unconscious defenses; to identify alternative ways of being in the world; to examine and
work through past and present relationships with significant others; and to facilitate
adaptive changes. Here the work usually focuses on resolving problems within a
particular domain of the client’s life, and this may require acknowledging and working
through certain resistances and defenses that impede progress.
The clientele for this level of therapy are those who have the ego strength needed
to confront and understand unconscious material. This includes nonpsychotic adolescents
or adults with affective, situational, anxiety, behavioral, or less severe personality
disorders; those with drug or alcohol dependence problems; individuals who have been
traumatized; and individuals who are neurotic or have problems in living. The format of
work at this level is the individual form of BMGIM, used over an extended period (9 to
24 months). The full range of BMGIM music programs is used in its entirety; thus, the
music is only classical and includes both supportive and challenging pieces. The client-
therapist relationship plays a significant role as both medium and agent of client change.
Relationship issues such as transference, working alliance, countertransference,
authenticity, and congruence may be examined, depending on the orientation of the
therapist and the relevance to the problem area.
The fourth level is primary or reconstructive. The aim is to stimulate pervasive
changes in the client’s personality, life, and way of being in the world. Specific
objectives may be to survey, uncover, and work through unconscious conflicts stemming
from the past, to integrate unconscious material into the conscious, to make pervasive
changes in the person’s identity (or personality structure), and to build new approaches to
psychological adaptation. Primary resistances are examined and resolved in a way that
allows the BMGIM process to go forward; primary defenses are also examined and
reorganized for healthier use.
The clientele for this level are the same as for the previous level—all must have
the ego strength needed to withstand this level of uncovering, along with the intellectual
ability to find and make meaning of the material. The format of the work at this level is
the individual form of BMGIM, used over an extended period. The BMGIM music
programs are used extensively, including the most challenging ones. The client-therapist
relationship is crucial, serving as the primary container for the client’s experiences.
The fifth level is transpersonal, where the work moves from any of the previous
levels to the transcendent level. Here the aim is to move beyond the world of the body,
beyond the world of the psyche, and beyond personhood to reach the world of the spirit,
the collective all-inclusive, the Self, or the Divine. Goals of insight and adaptation related
to physical, emotional, cognitive, and social problems are replaced with the human drive
for fulfillment of one’s potential as spirit. A client cannot simply come for a series of
transpersonal sessions, nor can a therapist plan for transpersonal experiences to occur;
transpersonal work emerges on certain occasions, when the conditions are ripe, and only
when the client is ready—almost like unexpected blessings that reward and encourage
work at the previous levels. Thus, a transpersonal experience may be a part of one
session, permeate an entire session, or occur over a few sessions; but there is no
manipulating them to happen, at least authentically. There is also no way to prevent them
from happening, as they seem to occur whenever the client is ready, regardless of at what
level the client and therapist are working. Moreover, transpersonal experiences in
BMGIM emerge directly out of the personal work done at the previous levels, and the
experiences themselves are often linked to the material that was worked through and
resolved.
The Dynamics of Consciousness

This theory evolved out of the author’s experience teaching GIM and is taken from the
training manual for Level II (Bruscia, 1998). The theory describes the many changes in
consciousness that take place for client and therapist during each phase of the GIM
session. The author defines consciousness as “a state of awareness maintained by any
psychological activity, including both covert and overt processes (e.g., sensation, affect,
behavior, thought, etc.)” (Bruscia, 1995, p. 167). A change in consciousness is any shift
or movement in the locus or focus of one’s awareness. A change in locus of
consciousness occurs when the person moves from one experiential space or position to
another, and attends from that perspective. When a person “locates” his consciousness
somewhere, that location serves as the center of his apprehension and perception. A
change in focus of consciousness is when the person moves the target of awareness and
attention from one place or thing to another. Thus, together, locus and focus pose the
questions: Where am I as I attend? And what am I attending from this place?
Changing the client’s consciousness is both the process and desired outcome of
BMGIM. Each phase of the BMGIM session effects very specific changes in the locus
and focus of the client’s consciousness and, as time passes, the cumulative changes in
consciousness that a client makes around significant life issues begin to effect a more
permanent change in the client’s way of being in the world. The essential change is that,
hopefully, BMGIM helps the client to gain the fluidity of consciousness needed to
continually find alternatives—in the way one perceives oneself, one’s problems, and
one’s resources, and in the myriad ways of being in the world that are adaptive, fulfilling,
and growthful. Every shift in consciousness brings a new possibility or alternative into
awareness: When one’s locus of consciousness changes, one becomes aware of new and
different perspectives that can be taken; when one’s focus changes, one becomes aware
of new issues to consider; and when both locus and focus change, one becomes aware of
alternative loci and foci that may be more relevant to the problem at hand, or even to life
in general.
This theory deals with the specific changes in consciousness characteristic of each
phase of the BMGIM session. The opening phase of the session, the preliminary
conversation, is a period of transitions of consciousness for both client and therapist. It
can be likened to a dance of consciousness between the two parties. The client is
continually moving and shifting locus and focus to be in relation to both self and
therapist, and the therapist is doing the same. When the client enters the therapy room,
the locus of his consciousness shifts from the outside world to a special space that has
been created for him in the therapy room. The environments are drastically different; the
perspectives and frames through which one apprehends the world are different. Driving a
car on the highway provides a different perspective for self-focusing than sitting in a
comfortable chair in the intimacy of a BMGIM therapy room. Then, as the dialogue
unfolds, the client’s focus of consciousness begins to change, moving from the outside
self operating in the outside world to the inner self operating in the inner world.
Once again, the client has an opportunity to change locus: He can locate himself
in the inner self and focus on the outer self; he can locate himself in the outer self and
focus on the inner self; he can locate himself in either location and focus on the therapist;
or he can locate himself in the therapist, focusing on his own inner or outer self. These
very same potential shifts of consciousness are also available to the therapist. So the
ultimate question for the client and therapist is, “Where are you, and how can we come
together in either locus or focus?” Metaphorically, there are two entities of consciousness
in the room searching for a way to meet one another in the same locus or focus. When
artwork is introduced (e.g., mandala), both parties have another possible focus for their
interaction.
The prelude comes to an end when the client and therapist have harmonized their
states of consciousness. Through the dance, they both share the same focus (or range
thereof), and they both understand where the client is located in relation to it. In more
concrete terms, the client and therapist have arrived at potential themes, emotions,
metaphors, or ideas that could be the focus of the music-imagery experience, and they
both have an understanding of where the client stands in relation to it. This information
leads organically into the induction.
In the induction, there are several more shifts of consciousness that may occur.
First, the client moves from an upright position to a reclined position—a completely
different attitude toward experience and even life itself. From opposing gravity and
standing or sitting upright, the client moves to surrendering to gravity and allowing
him/herself to be held up by the ground—from the vertical to the horizontal plane of
experience. During the relaxation, the client is also moving the locus of consciousness
away from the here-now of the therapy room to the there-then of the imaginary world.
Time and space locations change. In addition, the client is also moving the focus of
consciousness from the outer, active self to the inner, receptive self; from the world of
seeing to the world of listening; and from verbal dialogue to the experiencing of imagery
provided by the therapist as part of the induction.
Another major shift in consciousness occurring in the induction is when the
therapist synchronizes and entrains with the locus and focus of the client’s
consciousness—their joint consciousness becomes unified in point of departure and goal.
The coming together of consciousness that evolved in the prelude is now set into motion,
and both parties expend their energy together to transport the client’s consciousness in
the intended direction. Each person’s energy is enhanced by the other, and the rapport
that is built brings even more energy to the field in support of the client’s work. The
therapist also dips in and out of altered states of consciousness while helping the client to
deepen.
So far, the BMGIM session has taken the client and therapist through two spaces
of consciousness: the upright dialogue space and the induction space. As the music
begins, another space of consciousness emerges, this time one that contains many
additional elements: the client, the music, the imagery, the states of consciousness, and
the presence of the therapist. This is the music-imaging space.
In this space, these five elements continually shift between foreground and
background, each serving their own functions in the experience. At one moment, they
may be active agents in changing the experience; at others, they may provide a medium
or vehicle for another element to shape or change the experience. In the ideal situation,
these elements work synergistically, so that the presence of one enhances the others in a
way that goes beyond the potential of any combination of them. Thus, the music deepens
consciousness and elaborates the images, while the images deepen consciousness and
sensitize the client to the music, and the therapist’s presence supports the client, amplifies
the image, and deepens the client’s relationship with the music. There is no linear cause-
effect chain of events: All elements of the experience are in constant interplay with one
another, motivated and fueled by the immediacy of each unfolding moment. One never
knows the turns of consciousness that can take place, as music, image, client, and
therapist concentrate their efforts and contribute their energies to the ongoing experience.
The primary organizing and managing force within this space of consciousness is
the client. As the various elements interplay, coming into and leaving the foreground of
the client’s experience, the client is continually shifting the locus and focus of
consciousness—from the music, to the image, to the self, to the therapist’s presence,
depending upon what captures the client’s attention and upon what the client needs to do.
But this is not necessarily a fragmented or incoherent state; the advantage of
consciousness is that it is not limited to one space. A person can expand his
consciousness to be in more than one locus, attending more than one focus. This enables
the client either to focus very intently on one element in the music-imaging space and go
deeply into it or to focus simultaneously on more than one element, or even all of the
elements of the experience, as they move in and out of foreground and background.
The music-imaging experience is a Gestalt, with all elements continually sharing
figure-ground relationships, with all elements apprehendable within either a focused or an
expanded state of consciousness. Given this extemporaneous state of affairs, at any
moment, the client may choose to shift consciousness, continually producing an
unpredictable stream of foci or imagery; explore emotions, images, and/or metaphors in
short cycles; construct a coherent narrative for each piece of music or the entire program;
or resist the entire process. Several factors contribute to the way in which the client
organizes and manages the music-imaging space. These include his personality,
developmental level, personal needs and wants, defenses, anxieties, and degree of trust in
the process and therapist.
The secondary organizing and managing force within this space is the therapist;
however, it must be quickly stated that the therapist always follows the client’s lead and
then facilitates by leading or encouraging the client to go in that direction. The therapist
does not organize, manage, or direct the client while in this space unless, for some
reason, the client is unable to do so and the client’s safety is at risk. Nevertheless, the
therapist’s presence is an important factor in how the client manages this space and what
the client derives out of the experience. Ideally, the therapist takes a fluid approach to
sharing the music-imaging space with the client, music, imagery, and altered states.
Being fluid in this context means being able to move to various locations within
the space and focus on various things of import to the client, while also going with the
flow of the moment in terms of which element is in the foreground of the client’s
consciousness. When the music comes forth, the therapist can revert to the background;
when the image dominates, the therapist can help the client to further develop it. The
therapist has to be as fluid as the music, the images, and the states of consciousness,
which are always in a state of flux and transformation. For more details on the role of the
therapist, see the writer’s theory on the guiding process.
The return phase of the session occurs when the music is nearing the end and the
image is nearing closure at some level. Ideally, these two closures are synchronous. The
music brings closure to the image, and the image brings a sense of completion to the
music. As the music and image recede into the background, they usually continue to
resonate in the client’s consciousness—the music still resonates in the body and the
environment after it has gone, and the images remain as strong aftermath impressions of a
deep experience. What were previously strong foci in the client’s consciousness now
move out of the foreground to form a very richly configured background.
As these foci of consciousness shift, the therapist helps the client to also shift the
locus of his consciousness, moving the client out of the imaginal world to the real world,
from where he was located in the image to where he is reclining in the therapy room and
from internally stimulated experiences to an awareness of the environment and its
ongoing impingement upon the here-now experience of the client. The client moves from
a reclined position to an upright or seated position and from surrendering to gravity to
resisting it again. The client opens his eyes and perceives the therapist’s presence at a
different level of reality, not as merely a heard presence but now as a real person who can
be seen and heard in the flesh. Client and therapist are back in the “upright-seated”
relationship, as the client moves out of the space where he needed to be held and
supported to a position of equality and independence. The return is the opposite of the
induction: It moves the client from there-then space and time to here-now space and time,
from imaginary to real, from inner to outer experience.
Once these subtle and sometimes challenging transitions of consciousness are
accomplished, client and therapist move into the postlude discussion. Here the final
reversals of consciousness take place, completing the entire cycle of the session and
bringing the client back to the level of consciousness with which he entered the room.
During the postlude, the challenge is to make some kind of meaning out of the entire
experience. This meaning can be sensed in the body, felt in the heart, or understood in the
mind—it does not have to be, and in most cases will not be, a cognitive, linear
explanation of cause-effect relationships operating in the client’s life history. It can
simply be a holistic grasp of oneself, the conditions of one’s life, and the qualities of
one’s world.
No matter how ineffable or intangible the outcome, however, the meaning-making
process invariably requires some level or kind of self-reflection. Minimally, the client has
to move from “being” in the experience and “living” in the music to “observing” and
“recalling” what happened in the imagery and music. The client is being called upon to
consider the there-then in terms of the here-now—to reflect upon one’s lived inner
experiences so that they can be fulfilled or implemented in life. It is this repetition or re-
telling of one’s there-then in expanded consciousness in one’s here-now ordinary
consciousness that anchors the experience in the client’s being.
In some ways, this anchoring is a condensation process—the postlude helps the
client to remember the experiences in expanded consciousness by tagging them with a
particular locus and focus in the here-now. There has to be one thread that gives the client
access back into the full tapestry of the expanded experience; otherwise, it is easy to lose
in the vast sea of consciousness. This thread, then, is like a shortcut or expressway
connecting the inner and outer, imaginary and real worlds of consciousness, around a
particular issue or experience of import to the client.
Therapist Presence in BMGIM

This theory originated in a heuristic qualitative research study titled “Modes of
Consciousness in Guided Imagery and Music (GIM): The Therapist’s Experience of
Guiding” (Bruscia, 1995). This self-inquiry was a systematic examination of the author’s
experience while guiding one GIM session that posed particular challenges with regard to
“being there” for the client, or what is also called therapist presence. The purpose of the
theory was to explicate the many ways that a therapist can be present to the client and the
myriad factors that shape the quality and intensity of that presence.
Consciousness is defined as a “state of awareness maintained by any
psychological activity, including both covert and overt processes” (1995, p. 167). This
state of awareness is elusive to understand because it is not limited in space or time. The
author explains:
The idea of moving my consciousness through space without occupying it

is both challenging and freeing. I can be there without having to leave
here, and I can be here without having to leave there. Or if I so wish, I can
stay there without being here, or stay here without being there. Thus, I can
be transported to another space without moving there in the literal sense of
leaving where I was before. Hence I can be in more than one space at a
time, and the process of transporting myself can be described as one of
expansion rather than migration. Conversely, I can be in one space at a
time, and the process of staying there can be described as one of centering.
As my consciousness expands and centers, I also have the option of
varying its intensity. That is, I can be “less here than there” or “less there
than here,” thus shifting the weight of my consciousness just as I shift the
weight of my body from one side or part to another.” (pp. 167–168)
Continually Shifting Consciousness
Flowing from these conceptions of consciousness, the first proposition of the
theory is that guiding a client throughout the entire GIM session requires the therapist to
move, center, vary, and expand his consciousness.
· To move one’s consciousness is to change the locus and focus of
awareness.
· To center one’s consciousness is to stay in one locus and focus for an
extended period.
· To expand one’s consciousness is to occupy more than one locus and/or
maintain more than one focus at the same time.
· To vary one’s consciousness is to distribute one’s awareness across
different loci or foci with varying degrees of intensity.
Attending Three Experiential Spaces

The second proposition is that to remain present to the client, the therapist must
continually move, center, expand, and vary his consciousness in three experiential spaces:
the client’s world, the therapist’s personal world, and the therapist’s world as a GIM
practitioner.
The Client’s World. When the therapist moves his consciousness into the client’s
world, he tries to apprehend, experience, witness, and/or understand what the client is
experiencing from moment to moment. Minimally, this involves the therapist moving his
consciousness to the locus and/or focus of the client’s consciousness. That is, the
therapist moves his consciousness to where the client is located, either in the image or the
discussion or in relation to the music, and attempts to experience the image, music, or
discussion from that perspective; or the therapist focuses his consciousness on whatever
the client is attending in the image, the discussion, or the music and attempts to attend to
it in the same way. The therapist moves into and along with the client’s consciousness.
Therapist’s Personal World. When in one’s own personal world, the therapist
brings into awareness what he himself is experiencing, physically, emotionally,
cognitively, spiritually, and so forth, both independently (apart from the client) and in
response to the client. In this world, the therapist allows his attention to focus on what is
happening in his own body, or what emotions he is feeling, or what memories are being
aroused, and whence these reactions are coming. Here the therapist is finely attuned to
himself, his own private experiences, and his shared experiences with the client. As such,
it is an intense way of being in the world of the self in the here-now of the client’s
moment-to-moment unfolding. In addition to having thoughts and feelings arising from
within, the therapist becomes acutely aware of what the client is doing to him, or how the
client is making him feel on a personal level.
The Therapist’s World. When in the world of therapists, the therapist brings into
awareness what is happening within the GIM process and in the client-therapist
relationship. This may involve thinking about what the client’s imagery might mean or
sensing its effects on the client’s body, or it may involve intuiting what music would be
most appropriate or deciding what intervention to use. Or, the therapist may bring into
awareness his relationship with the client and its implications within the client’s ongoing
experience. Here the therapist is finely attuned to the therapeutic process and how both
client and therapist are contributing or detracting from it. As such, it is a way of being in
the client-therapist relationship as facilitator for the therapeutic process. In the example
above, when the therapist feels tension in his shoulders and had a memory of carrying his
sister, in moving his consciousness to the therapist’s world, he would be asking himself
whether the client is developing a dependency transference on him and whether he is
unwittingly falling into that dynamic. He may also realize that he sees his client like his
sister and, depending on his relationship with his sister, will have to manage his
relationship with this client carefully.
Four Levels of Experiencing

The third proposition is that the therapist’s experiences in these three worlds can
be described at four levels: sensing, feeling, thinking, and intuiting.
At the sensory level, the therapist uses his body to apprehend the experience
physically; there is no further elaboration of or reflection upon the experience, other than
simple description. For example, “I see the client’s body tension, I feel a knot in my
stomach, I see his face reddening, I feel my hand on his shoulder, I hear the music getting
louder” (p. 170).
At the feeling level, the therapist experiences affectively, bringing into awareness
feelings and emotions being aroused. Here the body sensations are elaborated until the
feeling or emotion is recognized with some degree of clarity. Thus, the client’s body
tension feels like fear rather than anger, or the knot in the therapist’s stomach feels like
frustration rather than anxiety.
At the thinking level, the therapist attempts to make meaning out of the sensory
and affective levels of experience, going beyond simple description and elaboration and
analyzing the experience more cognitively. This requires stepping out of the experience,
observing oneself, and reflecting upon the nature of the experience in order to find
possible meanings or explanations. Thus, the client’s body tension feels like a fear that
relates to his relationship with his father; the knot in the therapist’s stomach feels like
frustration that relates to his own ideas about what the client should be doing.
At the intuitive level, the therapist goes beyond the data, moving beyond the
sensory, feeling, and thinking levels, but yet integrating them into a new understanding
that is unverifiable. This understanding is a spontaneous “inner knowing” that is based on
the data available but not directly tied to it in any logical fashion.
“To summarize: The sensory level involves spontaneous description of immediate
physical experience with no elaboration of it; the affective level involves spontaneous
elaboration of immediate physical experience within the affective domain; the reflective
live involves self-observation and elaboration of sensory and affective experiences within
the cognitive domain; and the intuitive level involves spontaneous integration of sensory,
affective, and reflective responses” (pp. 171–172).
Relationship Parameters
As the therapist moves between these three worlds, experiencing the client and self in
sensory, affective, cognitive, and intuitive ways, various kinds of relationships are
formed among the therapist, client, music, and imagery.
The Client’s World. When entering the client’s world, the therapist has several
options with regard to how empathic or distant he will or can be with the client.
Theoretically, five positions (loci) can be taken by the therapist within the client’s world.
When “fusing” with the client, the therapist is experiencing what the client is
experiencing—entraining to the client’s body rhythms, being in the same body positions,
feeling the same sensations, going through the same emotions, thinking the same things,
being in the same images, reacting to music in the same way, and so forth. When the
therapist fuses with the client, he is in deep empathy and in direct rapport with the client.
Ideally, in this position, moving toward the client is the same as moving toward the self
in that the therapist neither loses his own boundaries nor has to adapt significantly to be
with the client. Thus, the therapist and client are fused but maintain separateness. The
danger of this position is that the therapist can lose his own boundaries in relation to the
client.
When “accommodating the client,” the therapist enters the client’s world and has
to adapt his own boundaries and structures to be in empathy with the client. The therapist
experiences what the client is experiencing, but because of differences between them, the
therapist has to move away from or against his own self to accommodate how and what
the client is experiencing. Here the therapist moves toward the client but away from or
against the self. The therapist experiences the client’s anger, but the client’s way of
experiencing anger is not innate to the therapist. This position takes more effort.
When “assimilating” the client’s experience, the therapist incorporates what the
client is experiencing into his own boundaries and structures. To experience the client,
the therapist moves toward the self, to be closer to the client in his own way. Here the
therapist recognizes the client’s experience as similar to his own and then uses his own
experience to understand the client’s. For example, the therapist experiences the client’s
anger in the therapist’s own way, because he experiences it the same way the client does.
When assimilating, the therapist has to be careful not to distort the client’s experience to
fit his own.
When “differentiating” from the client’s experience, the therapist enters the
client’s world but distances himself in some way from what the client is experiencing.
Here the therapist maintains his own identity, boundaries, and structures while still
“living in” the client’s world; in doing so, the therapist recognizes that the client’s
experience is quite different from his own. For example, the client is experiencing anger,
while the therapist witnesses it but does not identify with it or experience it.
When “objectifying” oneself in the client’s world, the therapist serves as an
object, target, or receiver for the client’s actions, images, or feelings. Here the client is
acting or impinging upon the therapist, and the therapist experiences being on the other
end of the client’s intent or effort. When the client interacts with the therapist based on
qualities or actions of the therapist (rather than significant others in the client’s life), the
interaction or relation is an authentic one; however, when the client projects qualities or
actions onto the therapist that actually belong to significant persons in the client’s past or
present life, and not the therapist, the interaction or relation is a transference. In a
transference, then, the client projects qualities and actions of others onto the therapist and
then relates to the therapist as if he were the other person.
The Therapist’s Personal World. When moving into one’s own personal world,
the therapist is attending to his own ongoing self-experiences—body sensations,
emotions, thoughts, and so forth. Sometimes these experiences are in direct response to
the client or the client’s images, and sometimes they are stimulated by the music or
emanate from within the therapist’s self.
These self-experiences provide valuable material for recognizing transference
reactions from the client. When the therapist is in his own personal world, it is easier to
recognize if the client is relating to him authentically (based on who the therapist really
is) or within a transference relationship (when the client is treating the therapist like a
significant other). Thus, moving into one’s personal world helps the therapist to question
what he is experiencing and whether that experience belongs to him or is being projected
onto him by the client. For example, if a therapist feels as if the client is depending upon
him too much, the question arises as to whether the client is reliving a dependency
relationship with another person or whether the client is actually depending on the
therapist because the therapist has invited this dependence.
This naturally leads to an examination of countertransference. Being in one’s
personal world is the mode of consciousness where the therapist can identify
countertransference. In a countertransference, the therapist replicates with the client a
previous relationship in either the client’s life or the therapist’s life.
For example, if a therapist feels tension in his shoulders and upon observing the
client realizes that the client has the same tension when speaking about a significant
person, an empathic countertransference has occurred. The therapist is fusing with the
client’s experience.
If, on the other hand, the therapist realizes that a character in the client’s imagery
has tension in the shoulders, then a complementary countertransference has occurred. The
client is making the imaginary person and the therapist both feel this tension. Another
scenario is if the therapist suddenly recalls that this is the same tension that he had when
he used to carry his baby sister around. Gaining further insight into these
countertransference reactions usually requires the therapist to move into the world of the
therapist.
The Therapist’s World. When moving into the world of the therapist, the therapist
takes a larger view of what is happening in the relationships between client, music,
entities in the imagery, and therapist. Thus, it is here that the therapist analyzes details of
the transference and countertransference interactions among and between all of the
components. It is also in the therapist’s world that client and therapist form the “working
alliance” where both parties work as equals to benefit the client’s life.
Media of Transportation
The act of moving one’s consciousness in GIM is relatively easy, as there are several
media that can be used. The main ones are altered states of consciousness, music,
imagery, physical interactions, and verbal interactions. Altered states of consciousness,
by definition, provide a space for exploring the various areas and layers of consciousness.
Thus, during a session, the therapist can go into and out of altered states of consciousness
in order to move from one world to another (client, personal, therapist) and from one
level of experience to another (sensing, feeling, thinking, intuiting).
In addition, like the client, the therapist is subject to the altering effects of the
music and the client’s imagery. The music provides a transitional or intermediary space
shared by both the client and therapist. It is within this space that client and therapist
interact with their respective imaginations. Thus, music provides a bridge between the
client’s world and the therapist’s worlds and from one level of experiencing to another.
At the same time, the client’s imagery provides a transitional or intermediary object.
“That is, it provides the occasion, container, and medium for multifaceted interactions
between client and therapist” (p. 183).
Physical interventions can also help to move the therapist from one world to
another. Such interventions “include the subtler forms of eye contact and body language,
as well as more direct forms, such as touching and holding” (pp. 183–184). Verbal
interventions, including the actual words as well as the tone of voice, phrasing, and
rhythm, also serve to connect the therapist’s and client’s worlds.
Implications for Therapist

In order to move one’s consciousness to address the ongoing demands of the client and
therapeutic process, the therapist must have both fluidity and timing. Fluidity in this
context is free access to the various worlds, levels of experience, and media. “Within
understandable limits of personal and professional boundaries, he should have no major
problems or limitations in moving—at will—anywhere within the worlds, levels, and
media” (p. 191). The therapist cannot get stuck in one world and not be able to move to
another, using any of the media, nor can the therapist be limited to only one level of
experience. To have fluidity also requires maintaining boundaries. “A therapist who
works in this way needs to have clearly defined yet flexible and permeable boundaries,
both as a person and as a therapist. At one moment, the therapist may need to maintain
clear physical and affective boundaries in his interactions with the client, and at another,
he may need to allow these boundaries to dissipate” (p. 196).
“Closely related to free access is timing. A therapist has to move not only
wherever the situation demands but also whenever it [so demands]” (p. 191). Thus, the
true skill of being a GIM therapist lies in knowing when to move from one world to
another or from one level of experience to another, while also knowing when to use each
media of transportation. Helpful cues are the client’s rhythms, the music, and one’s own
body. Most important, a therapist learns where, when, and how to move his
consciousness through experience. “Thus, it is the very process or expanding, centering,
and shifting consciousness that informs the therapist whether he is in the right place at the
right time” (p. 192).
Another essential quality is “the ability to go beyond either-or polarities. The
whole idea of expanding consciousness is that I do not have to be either here or there but
can transcend that distinction” (p. 196). This enables the therapist to manage challenges
to his boundaries while also staying open to whatever needs emerge in the moment.
Given the emphasis that this theory gives to consciousness and the art of using
one’s consciousness and imagination creatively in tandem with the art of music, the role
of the BMGIM therapist can be summarized as that of “an artist of consciousness who
uses his creativity and the creative process to ‘be there’ for the client, with the music as
the primary co-therapist” (p. 196).
Gender Orientation
Recognizing that his theory was based on a male therapist working with a male client,
and that the nature of moving one’s consciousness may be more male than “holding” or
“containing” the therapeutic space as espoused by female theorists in music therapy, the
author proposes the need for therapists to be aware of their own gender theories and
biases. Gender is an important consideration in all forms of psychotherapy for three
reasons: (1) Therapists have to acknowledge the unavoidable biases that their gender
brings to their ways of working with clients; 2) Therapists need to understand when or
under what conditions their client needs to work with male and/or female therapists; and
(3) Therapists often have to function from the opposite gender’s point of view; thus, male
therapists must have free access to their feminine sides, and female therapists, to their
masculine sides.
References
Bruscia, K. (1995). Modes of consciousness in Guided Imagery and Music (GIM): A

therapist’s experience of the guiding process. In C. Kenny (Ed.), Listening, playing, and
creating: Essays on the power of sound (pp. 165–197). Albany, NY: State University of
New York Press.
Bruscia, K. (2002). The boundaries of Guided Imagery and Music and the Bonny
method. In K. Bruscia & D. Grocke (Eds.), Guided Imagery and Music: The Bonny
method and beyond (pp. 37–62). Gilsum, NH: Barcelona Publishers.
Meadows, A. (2002). Distinctions between the Bonny Method of Guided Imagery and
Music (BMGIM) and other imagery techniques. In K. Bruscia & D. Grocke (Eds.),
Guided Imagery and Music: The Bonny method and beyond (pp. 63–83). Gilsum, NH:
Wohlberg, L. (1977). The technique of psychotherapy (3rd ed., Part One). New York:
Grune & Stratton.
READING 12
Taken from: Bruscia, K., & Grocke, D. (Eds.) (2002). Guided Imagery
and Music: The Bonny Method and Beyond, pp. 225-243. Gilsum NH:
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READING 13
Helen Bonny’s Foundational Theories

of Guided Imagery and Music (GIM)
Kenneth E. Bruscia
Guided Imagery and Music (GIM) is a model of therapy and healing developed by Helen
Bonny in the 1970s, initially based on her work on a team of LSD psychotherapy
researchers at the Maryland Psychiatric Institute. There are two forms: the individual
form (sometimes called the “dyad”) and the group form (sometimes called “Music and
Imagery” or “Group GIM”). Bonny (1983) defined the individual form as:
the conscious use of imagery that has been evoked by relaxation and
music [listening] to effect self-understanding and personal growth
processes in the individual. Used one-to-one with a trained guide, GIM
may be a powerful uncovering process to explore levels of consciousness
not usually available in normal awareness. To facilitate the process,
various elements of music—instrumental timbre, vocal color, rhythm,
dynamics of pitch, intensity, harmony—are used to contribute subtly and
powerfully to mood, emotional involvement, and insight introspection.
The musical selections used are chosen on the basis of their ability to
initiate and continue a mood and/or experiential state. Programming of
these selections on a cassette tape [or CD] not only involves an
understanding of matching the generalized mood state but considers
musical qualities which may facilitate the production of imagery in its
many forms. (p. 235)
Bonny’s Group GIM is different from the individual form in that each client does
not dialogue with the guide during the music-imaging experience, and in that efforts are
made to contain the client’s level of self-exploration. This is done by more directive
guiding, shortening the music program, and limiting the relaxation induction (Bonny,
1994).
Bonny has been a prolific writer, and though she has never laid out an organized,
complete theory, her writings do contain many important theoretical concepts. The
purpose of this chapter is to organize these writings and theoretical concepts by theme.
Ontology
GIM is such an expansive, ineffable process that it is natural to wonder what its founder
believed about the nature of things, or what her philosophy of life was. Interestingly, the
first full discussion of these topics came in a speech that Bonny gave to the American
Association of Music Therapy in 1983, titled “Cycles of Experience: Past, Present, and
Future.” This section on ontology lays out the central philosophical beliefs that Bonny
had evolved to that time (1983), as expressed in this speech, recently published for the
first time (Bonny, 2002).
Bonny (1983) believed that all things in the universe are interconnected. “Each
event in our lives has an effect on every other subsequent event, on our environment, and
on every other being in our environment” (p. 233). Thus, all beings are interconnected
with all other things in the universe, and as the least one of these changes, everything else
changes. Thus, life is never constant or stable, everything is constantly changing and
being changed by everything else. This gives every person the power to change
him/herself and the world in a mutually reciprocal way.
Change is therefore inherent in the universe. Taking from Prigogine’s theory,
Bonny proposes that our universe is constantly expanding and dissipating.
Ours is a self-organizing universe. Structures are formed which shed their

forms as they outgrow them. As the energy within them dissipates, new
creative forms evolve as a consequence. These are more complex, with
shorter periods of stability. Wavelike, cyclical forms of growth, stability,
and change are the norm. Disequilibrium is a prelude to creative
breakthrough; tension precedes satisfying relaxation. (Bonny, 1983, p.
244)
Change is not linear; rather, it is cyclic and cumulative. At every repetition through a
cycle of change (growth-dissipation-growth or tension-release-tension), more information
is integrated into increasingly more complex cycles (Bonny, 1983). Thus every growth
cycle is more complex and more integrated than the previous one; every new form is
more complex and more integrated than the previous one.
One of the greatest precipitators of change is consciousness. Consciousness is a
gift to humanity, a tool to change ourselves and the universe. “By being conscious, by
being here now, we can affect change. We can change our environment” (Bonny, 1983,
p. 234). And one of the greatest facilitators of consciousness is music. Music is the
medium par excellence for exploring and changing consciousness (Bonny, 1983).
Bonny (1983) links Prigogine’s theory of dissipative structures to Sheldrake’s
notions of morphic resonance. While Prigogine dealt only with energy and form (matter),
Sheldrake proposed that all systems or structures are regulated not only by energy and
matter, but also by invisible organizing fields, called morphic fields. Morphic fields are
created when any event or behavior is learned and then repeated. These morphic fields
are configured as causative links that resonate throughout the universe, affecting the
entire species. Thus, whatever one person discovers creates a morphic field that others
have access to through resonance. This idea reaffirms the notion of the
interconnectedness in the universe—all change is pervasive throughout the system, and
all knowledge or consciousness is shared through resonance. Human communication is
beyond the senses and beyond energy; it also takes place through morphic resonance. The
collective unconscious, then, does not consist of memories stored in the brain from
generation to generation; rather, it is the cumulative experience of the species continuing
to resonate in these morphic fields. Sheldrake’s theory also explains why musical
meanings within a culture are shared by all of those in the culture.
Finally Bonny sees the universe as hologistic. Every part of a whole is part of
another whole, which is part of another whole, and so forth, so that everything exists as
part of everything. Every cell of the body is enclosed in another cell, which is enclosed in
another cell, ad infinitum, so that a person’s body is enclosed in the species, which is
enclosed in the universe. In each person is all, and in all is every person.
Consciousness
Bonny (1983) believed that there are many levels of individual, collective, meditative,
and spiritual consciousness. Using a “cut log” as a metaphor, Bonny (1975) described
consciousness in terms of concentric circles moving out from the observing or directing
ego in the center. The center is ordinary, alert, or a normal state of consciousness, and the
layers or circles around it are various states of consciousness that become increasingly
altered or expanded. Those around the immediate center are preconscious states, layers of
awareness that are easily accessed by the conscious mind. These circles include mind-sets
during study, then come fantasies, daydreams, memories, dreams, and participation in the
arts. At the next levels are alpha brain waves, then imagination, prayer, fasting, mythical
experiences, and creativity. Then comes regression to childhood, orgasm, and theta
waves. Moving outward toward layers that are increasingly less accessible to the
conscious mind, the next states are sensory bombardment, ecstasy, unity, satori, noetics,
anesthesia, then bliss, mystical experiences, samadhi, and the collective unconscious.
These layers of consciousness continue infinitely outward to more expanded states,
approaching the Self (All-that-is).
Altered states of consciousness are essential to the GIM process. They are agent,
medium, and outcome, and, as such, not only facilitate the process, but also comprise one
of its important benefits. As an agent, altered states prepare the client to receive and
absorb the music more fully (Bonny, 1983). As a medium, altered states provide a
holistic perspective from which to access and work through problems. As the person
moves away from the normal ego, through increasingly deeper states, consciousness
expands outward, relating the self (ego) to the Self (All-that-is). This gives wide access to
many facets of self and Self and to the many perspectives and resources within each,
while also connecting them to one another. Finally, as outcome, learning how to deepen,
expand, and utilize one’s own consciousness more fully can enhance normal states of
awareness by providing more easy and immediate access to the richness of one’s
imagination and inner life (Bonny, 1983), to the collective unconscious, and to the values
of spirituality (Bonny, 2001).
Altered or expanded states of consciousness can be achieved through high
stimulation and states of hyperarousal or through relaxation and states of hypoarousal.
The methods used in BMGIM are relaxation, concentration, and music listening;
however, other means are sleep, meditation, exhaustion, drugs, hypnosis, biofeedback,
sex, and aesthetics (Bonny, 1975). Comparing music, hypnosis, and drugs, Bonny and
Tansill (1977) found that music had many advantages. In hypnosis, the therapist has
foreknowledge of the problem and its potential solution; the drawback is that it accesses a
relatively small portion of total consciousness. Drugs plummet the person into many
different areas and levels of consciousness and force direct access to problem areas of the
psyche. In contrast, music can evoke many layers and areas of consciousness and access
problem areas in a powerful yet gentle way. And when supported in a nondirective and
permissive way by a therapist or guide, clients have more control and help in working
through the material. Comparing music and meditation, Bonny (1987) points out that
music occurs in the auditory medium, consisting of both sound and silence, while
meditation occurs in complete silence.
Concepts of Music
One cannot find a writing wherein Bonny does not address the nature of music and its
therapeutic potentials. A synthesis of her writings reveals these general concepts of what
makes music listening therapeutic, and particularly in an altered state of consciousness
while imaging:
Music acts directly upon the entire body, reaching the brain not only through the
ear but through the skin, bones, tissues, viscera, and so forth. It releases endorphins, and
it evokes specific physiological responses, which in turn stimulate emotions and images
(Bonny, 1986). Music also stimulates different senses at the same time, thereby
facilitating synesthesia. It also helps to create associational links between and among the
senses, thereby providing a means of integrating one’s experiences (Bonny, 1986).
Music induces an entrainment response, where the periodicities in its rhythmic
structure elicit the same periodicities in the person’s body rhythms, mood states,
emotions, and so forth. The rhythms of music are related to the rhythms of the body,
which are in turn related to the rhythms of the universe (Bonny, 1986).
Bonny (1987) subscribed to the view of Merleau-Ponty, the phenomenologist,
regarding the four levels of “lived” sound experience. They are: (1) objective sound that
reverberates within its source (e.g., instrument), outside the listener; (2) atmospheric
sound that exists between the source object and the listener’s body; (3) the sound that
resonates in the listener; and (4) the after presence of sound as change in the body.
Music provides continuity to the experience when the sense of time is altered,
providing an anchor or stabilizing point of reference (Bonny & Pahnke, 1972). It
encapsulates time and space and allows the simultaneous experience of past, present, and
future (Bonny, 1979).
Music holds the listener in the here-now of All-that-is. It is a language of
immediacy, which helps us to stay with the moment, the now; it facilitates a total
attunement to the present and constant focusing and refocusing on the unending nows of
existence. Like meditative practice, music can open the person to all aspects of self while
also opening doors to the spiritual world (Bonny, 1987).
Music helps to focus the client’s attention on the inner world of experiences
(Bonny & Pahnke, 1972) and to attend to what is most significant to the person at the
time. In its continuous alternation between tension and release, disequilibrium and
equilibrium, music works like radar, scanning to detect the “psychic imbalances of
experience and to resolve these imbalances with the full support of the conscious mind”
(Bonny, 1983, p. 242). “Further, it [music] helps to focus high energy input and so
amplifies the possibility of positive fluctuations and allows for unique integration at new
levels of wellness . . . in other words, music is a gift for our integration (Bonny, 1983, p.
242).
Music has mind-expanding properties (Bonny, 1983) and is a primary tool for
opening, unfolding, and changing consciousness (Bonny, 1975). The multidimensional
aspects of music reflect and activate the multidimensional layers of consciousness, as
they unfold sequentially and as they relate to one another simultaneously. As the many
layers of music unfold in time, it scans and activates the myriad layers of consciousness,
which also unfold in time (Bonny, 1975). It is the movement of music—its expectations,
drives, surprises, and resolutions—that literally sweeps over the various layers of
consciousness, scanning them to gain an overview of the person’s past, present, and
future.
Music helps one to relinquish one’s usual controls and thereby allows a deeper
exploration of the unconscious. It is more successful than words in preventing resistance
to self-exploration (Bonny & Pahnke, 1972).
Music evokes diverse feeling states (Bonny, 1975) and facilitates the release of
intense emotions, both positive and negative (Bonny, 1972). At the same time, music also
allows the listener to establish emotional distance (Bonny & Pahnke, 1972), through the
mechanism of projection or attributing the emotion to the music rather than to the self.
The paradox of music, then, is that it can at once be close and far away from the core
emotions (Bonny & Panke, 1972). Music also influences mood (Bonny, 1979) and can
carry the listeners into many different states.
Music stimulates associations, images, memories, and fantasies (Bonny, 1986). It
also induces spontaneous regressions to important events and circumstances of childhood
(Bonny, 1979). “Associative or memory recall, facilitated by music listening, is less a
photographic coding and imaging of the original scene than a holologic representation” of
all aspects of it (Bonny, 1983, p. 237). Music does not simply evoke reduced or
condensed versions of the memory, but brings back the entire memory experience.
Music directs and structures experience, even while arousing emotion (Bonny &
Pahnke, 1972). The order of music also provides the framework needed to explore
conflicts and difficult aspects of the self (Bonny, 1979). It provides a supportive sound
presence to the listener and a safe container for exploring conflicts, disparities, or
inequalities in the personality (Bonny, 1989). It can also ground the person and provide a
center or core that can anchor the person’s emotions (Bonny, 1989).
Music presents ambiguity and is open to many interpretations, allowing the
listener to find and build alternative ways of perceiving and understanding oneself and
the world (Bonny & Pahnke, 1972).
Music provides a nonverbal medium for establishing rapport with the client
(Bonny, 1979).
Music contributes to peak, cosmic, or transcendental experiences (Bonny &
Pahnke, 1972). Music fosters positive, oceanic, and spiritual experiences that can be life-
changing (Bonny, 1979).
Music facilitates spiritual growth. Both require discipline and concentration, and
both suggest meditative states. Music uncovers our depths—our memories, emotions, and
struggles—all of which provide foundations for spiritual growth. Music and spirituality
are ways of working through conflicts and reaching forgiveness. Music also reminds us
that there are even deeper things to behold; there is more than we can imagine in the
beyond.
Principles of Music Programming
Bonny had three main considerations in selecting music for use in BMGIM and
sequencing them to create programs. First, Bonny (2002) relied upon her own intuition,
“a kind of direct and immediate knowing or learning without the conscious use of
reasoning” (p. 301). She achieved this intuition by listening to music in an altered state,
sometimes using mind-expanding drugs. Her intuitions were then evaluated according to
whether other practitioners had similar findings in their work.
Second, she considered the role of culture in responding to music. Bonny (1978b)
explained:
Although musical variables may not have universal connotations, there

seem to be culturally derived “meanings” which can determine therapeutic
usefulness. It was upon these meanings that we based our choices. For the
Western, American, or European white, middle- to upper-class listener, we
found that certain elements in sample music consistently stimulated
generalized meanings. These musical selections served as the affective
building blocks, which in turn suggested a direction for the GIM taped
programs and their corresponding emotional responses. (Bonny, 2002, pp.
301–302)
Third, she analyzed each piece of music using standard musical techniques. From
these analyses, she determined that the musical variables that seemed to be of greatest
significance in BMGIM were pitch, rhythm and tempo, media (vocal or instrumental),
melody and harmony, and timbre. Each of these was then examined on a continuum
ranging from one extreme to another—for example, pitch (high to low), rhythm (regular
to diverse), tempo (fast to slow), and so forth. From these analyses, Bonny created an
intensity profile for each piece and program.
The GIM Process

Bonny (1989) viewed BMGIM as a mode of “being with music … literally allowing
oneself to step into or to become one with the music” (p. 133). The key to success is to let
go and allow the music to take the client wherever she or he needs to go (Bonny, 2001).
In technical terms, the client’s ego needs to be receptive to exploring all areas of the
psyche, including those that are problematic (Bonny, 1979). This ability to let go is
facilitated by a relaxation induction, which leads the client into an altered state of
consciousness. The altered state of consciousness, in turn, opens the imagination, frees
the person from usual patterns of consciousness, and further encourages the ego to be
receptive to whatever emerges. As this happens, the music evokes imagery of all kinds
(e.g., memories, sensory experiences, metaphors, symbols, fantasies) and, most
important, their concomitant emotions. All images are reflections of the imager and hold
important messages from the unconscious. Through the music imaging experience, the
client has an opportunity to release emotions and feelings that have been repressed or
suppressed, gain new insights into problem areas, generate alternative ways of being in
the world and handling problems, and act upon the insights gained, first within the
session and then in the client’s world.
All aspects of the person are allowed to emerge in BMGIM, because all human
experiences are of value and all are interconnected. The clients are, therefore, always
accepted as they are and wherever they are in their journey toward healing and self-
actualization.
For Bonny, all healing comes from within. That is, each person has an inner
knowing of what he or she needs, and each person also has the inner will and resources
needed to be whole and healthy. Thus, the source of healing is the self.
Because the healing process is self-directed, BMGIM is nondirective. The client
has control and decides whether to enter or not enter difficult and challenging imaging
experiences. Thus, the client leads the experience, and the therapist follows.
The therapist and music work in tandem as co-therapists. The music is the co-
therapist, and its role is to generate images, integrate experiences, and provide a
supportive structure for difficult experiences,
The change process in GIM is akin to those described in humanistic and
transpersonal theories. Rather than referring to “therapeutic” change, Bonny describes
BMGIM as leading to healing, self-actualization, and growth. The client moves through
the change or growth process by achieving three important steps: (1) a release of
emotions and feelings that have been repressed or suppressed; (2) insight; and (3) action.
The process of healing moves toward self-actualization in a holistic way. It
addresses all aspects of the person—body, mind, and spirit, and both positive and
problematic areas. The music acts on the body by stimulating its entirety, activating the
central nervous system, evoking sensory experiences, inducing physical entrainment and
resonance between itself and the client, and operating on its energy fields and systems
(Bonny, 1986). The music acts on the mind by continually shifting the locus and focus of
consciousness, stimulating the imagination, presenting and working through life
metaphors, inducing regression and memories, and exploring alternative ways of being.
The music acts on the spirit by fostering positive transpersonal experiences that have life-
changing potentials (Bonny, 1979), by requiring discipline and concentration needed for
spiritual life, by fostering meditation skills, by providing a venue for worship and
adoration, by suggesting forgiveness, and by suggesting that there are deeper things in
life (Bonny, 2001).
In addition to being holistic, the process of healing is spiraling rather than linear,
moving in and out, from outside to inside, along the same pathways, and centered in the
heart. Similarly, life and growth move in nonlinear ways from personal to transpersonal,
from ego to spiritual concerns, from self to other to world to universe.
Role of the Therapist

Bonny (1978a) listed several qualities that were essential for BMGIM therapists. In
relation to the client, the therapist needs listening skills, empathy, sensitivity,
trustworthiness, intuition, and a desire to serve. As individuals, they also need to be self-
confident, courageous, imaginative, and flexible. BMGIM therapists have to be
comfortable being nondirective, and they have to have experience working through their
own problems before they can serve others.
The functions of the guide are both traditional or general and specific.
Traditional functions are to:

· Reflect and resonate the client’s affect
· Enter the emotional space of the client and be completely present
· Lead the client, when ready, into new and more productive ways of being
· Help the client to relax
· Listen to and converse with the client and what he or she brings into the
session
· Observe and record all aspects of the session
Specific functions are to:

· Open the client to new experiences
· Help the client to recognize and work through issues that arise in the session
· Provide a contact with consensus reality
· Help the client to deepen the experience when needed
· Help the client to review and integrate material from each session
References
Bonny, H., & Pahnke, W. (1972). The use of music in psychedelic (LSD) psychotherapy.
Journal of Music Therapy, 9(2), 64–87.
Bonny, H., & Savary, L. (1973). Music and Your Mind: Listening With a New
Consciousness. New York: Harper & Row.
Bonny, H. (1975). Music and consciousness. Journal of Music Therapy, 12(3), 121–135.
Bonny, H., & Kellogg, J. (1977). Mandalas as a measure of change in psychotherapy.
American Journal of Art Therapy, 16, 126–130.
Bonny, H., & Tansill, R. (1977). Music Therapy: A Legal High. In G. Waldorf (Ed.),
Counseling Therapies and the Addictive Client (pp. 113–130). Baltimore, MD:
University of Maryland School of Social Work and Community Planning.
Bonny, H. (1978a). GIM Monograph #1: Facilitating GIM Sessions. Salina, KS: Bonny
Foundation.
Bonny, (1978b). GIM Monograph #2: The Role of Tape Music Programs in the GIM
Process. Salina, KS: Bonny Foundation.
Bonny, (1979). GIM: Mirror of Consciousness or Avoidance of Reality: Processes and
Promises in the GIM Approach. Paper presented at the GIM symposium at the
University of California, San Francisco, May, 1979. See Bonny, 2002, pp. 93–102.
Bonny, H. (1980). GIM Monograph #3: Past, Present, and Future Implications. Savage,
MD: Institute for Music and Imagery.
Bonny, H. (1983). Cycles of experience: Past, present, and future. Keynote address
presented at the national conference of the American Association for Music
Therapy, March, Philadelphia, Pennsylvania.
Bonny, H. (1986). Music and Healing. Music Therapy: Journal of the American
Association for Music Therapy, 6A(1), 3–12.
Bonny, H. (1987). Reflections: Music: The Language of Immediacy. The Arts in
Psychotherapy, 12(3), 255–262.
Bonny, H. (1989). Sound as Symbol: Guided Imagery and Music in Clinical Practice.
Music Therapy Perspectives, 6, 7–10.
Bonny, H. (1993). Body Listening: A New Way to Review the GIM Tapes. Journal of the
Association for Music and Imagery, 2, 3–13.
Bonny, H. (1994). Twenty-One Years Later: A GIM Update. Music Therapy Perspectives,
12(2), 70–74.
Bonny, H. (2001). Music and spirituality. Music Therapy Perspectives, 19(1), 59–62.
Bonny, H. (2002). Music and Consciousness: The Evolution of Guided Imagery and Music.
Edited by Lisa Summer. Gilsum, NH: Barcelona Publishers.
READING 13
Taken from: Hadley, S. (Ed.) (2006). Feminist Perspectives in Music Therapy, pp. 227-244.
Chapter Nine
FEMINIST MUSIC THERAPY:

TRANSFORMING THEORY,
TRANSFORMING LIVES
Sandra L. Curtis
It’s revolutionary for women to sing the blues,

but it’s even more so to sing all the songs of life.
—Gloria Steinem, Revolution from Within
The widespread impact of feminism is undeniable, with a diverse array of fields

enriched by its contributions. Feminist therapy represents one of the most
significant of these contributions in the area of women’s wellness. Developing
in response to the second wave of feminism and feminist critique of traditional
therapy, feminist therapy has now established a rich tradition of theory, practice,
and research (Bricker-Jenkins, Hooyman, & Gottlieb, 1991; Brown & Root,
1990; Burstow, 1992; Worell & Remer, 2003). This tradition has influenced
those working in such fields as psychotherapy, counseling, and social work—
whether in choosing to practice feminist therapy directly or to use it to inform
their own practice. With its roots in the 1970’s, feminist therapy is still greatly
needed today: to address unique issues facing women; to provide a more
complete understanding of women in the sociopolitical context of ongoing
patriarchy and institutionalized oppression; to fill gaps in current theory and
research; and to provide creative therapeutic approaches which better meet
women’s needs (Worell & Remer, 2003).
At the same time as feminist therapy has been developing, music therapy
has been developing its own rich tradition of theory, research, and practice. This
tradition has, however, been relatively untouched by feminist therapy. While
some music therapists’ lives and practice may have felt the impact of feminist
therapy, until now this has been little reflected in music therapy writing, theory,
or research (Baines, 1992; Curtis, 2000; Hadley & Edwards, 2004). Yet each has
much to offer the other. Feminist therapy brings with it an understanding of the
silencing of women’s voices in the current sociopolitical context. Music therapy
228 Sandra L. Curtis
brings with it a creative approach which provides women a powerful and real
counterpart to the metaphor of voice. Both recognize women’s affinity for the
creative arts, particularly music (Curtis & Harrison, 2006; Herman, 1997).
Combined, they provide a dynamic new approach for empowerment—feminist
music therapy.
In this chapter I will look at the development of feminist music therapy—
as both a specific practice and as a process others may adopt should they be
interested in starting their own journey towards feminist music therapy practice.
Focusing initially on feminist therapy, I will outline its definition, principles,
goals, and techniques. A process for the feminist transformation of music
therapy will then follow. I will conclude the chapter with women’s own voices,
using examples from their individual experiences in feminist music therapy to
illustrate its theory and practice—to demonstrate the power of transforming
theory to transform women’s lives.
Feminist Therapy
Feminist therapy is a philosophy of treatment which is based on a feminist belief
system and which has as its purpose both personal and sociopolitical
transformation (Rosewater & Walker, 1985; Worell & Remer, 2003). As such, it
has many different definitions, just as feminism itself has many different
definitions (Hadley & Edwards, 2004; Lerman & Porter, 1990). There are also
many different types, such as liberal, womanist, cultural, and radical feminist
therapy (Brown & Root, 1990; Burstow, 1992; Johnson, 1983; Worell & Remer,
2003). Yet despite these differences, there is a strong consensus concerning the
basic principles of feminist therapy (Brown, 1994; Rosewater & Walker, 1985).
There are essentially three major and overarching principles from which all
others derive: 1) the personal is political; 2) interpersonal relationships are to be
egalitarian; and 3) women’s perspectives are to be valued (Bricker-Jenkins et al,
1991; Worell & Remer, 2003).
The principle that the personal is political is rooted in a feminist analysis
of women as an oppressed group in our culture and of the psychological effects
of such oppression, as well as its interaction with other forms of oppression such
as classism, racism, ageism, ableism, and heterosexism (Laidlaw & Malmo,
1990; Ballou & Brown, 2002). As a result, the focus of feminist therapy is both
internal and external. Its purpose is not to enable women to adjust to a
dysfunctional culture, but to seek social change for all women in order to
improve the situation, while at the same time seeking personal change for
individual women who have been harmed by the current situation (Laidlaw &
Malmo, 1990; Lerman & Porter, 1990; Worell & Remer, 2003). Feminist
Transforming Theory, Transforming Lives 229
therapy must be practiced not only as a healing art for individuals, but also as an
“intentional act of radical social change” (Brown, 1994, p.30).
The feminist therapy principle which stipulates that interpersonal
relationships are to be egalitarian applies to the client-therapist relationship, as
well as to the personal relationships of both client and therapist. Thus, clients
must be empowered within therapy and within their own individual lives.
Feminist therapists must not only empower their clients, but be empowered
themselves in their own lives. To be and to practice are one and the same in
feminist therapy (Bricker-Jenkins et al, 1991; Worell & Remer, 2003).
Similarly, the third overarching principle, that women’s perspectives are to
be valued, applies within the client’s life, the client-therapist relationship, and
the therapist’s life. Feminist therapists are to enable their clients to understand
and value women’s perspectives; they must also enable their clients to value
themselves. In order to do so, feminist therapists must also value themselves,
their clients, and other women, both in attitude and action (Burstow, 1992).
The goals common to all feminist therapy practice stem directly from these
overarching principles. As such, they include both personal and sociopolitical
transformation (Bricker-Jenkins et al, 1991). The focus of these goals is
threefold: to eliminate the oppression of women; to enable women to recover
from the specific harm of oppression; and to enable women to deal with the
internalization of this oppression.
Some of the specific goals within this focus are:
1) to empower women and increase their independence,

developing their personal and social power
2) to increase understanding of the sociopolitical context of
women’s lives and problems; to increase understanding of the
interaction of multiple oppressions (e.g. sexism, racism,
classism, heterosexism, etc.)
3) to achieve optimal functioning as defined by each individual
woman, rather than by the therapist or society; and
4) to initiate necessary social change (Burstow, 1992; Worell &
Remer, 2003)
To accomplish these goals, a number of feminist therapy techniques have

evolved. Although small in number, they are essential, distinguishing features of
feminist practice. The core techniques include: demystification, feminist
analysis of power, and feminist gender-role analysis (Laidlaw & Malmo, 1990;
Worell & Remer, 2003). Demystification, although not unique to feminist
therapy, is essential—only by providing clients with information about therapy
and in actively involving them in all its aspects, is it possible to establish the
necessary egalitarian client-therapist relationship. The feminist therapy tech-

nique of power analysis is unique and is used to increase clients’ understanding
of the relative societal powerlessness of women and the role that this plays in
their lives. This feminist analysis of power is not used to identify women as
helpless victims of society or as entirely powerless. Rather, it is used to enable
women to see both the personal and societal sources of their problems, to see
both their sources of powerlessness and of power, and to see both societal and
personal solutions to the situation (Hall, 1992; Laidlaw & Malmo, 1990; Lerman
& Porter, 1990). The feminist therapy technique of gender-role analysis is used
to identify and critically examine women’s and men’s socialization process—the
shared messages received by women and men (regardless of race, class, culture,
etc.) and the impact these have. These reflect institutionalized, integrated, and
internalized sexism and, while shared, they intersect with and are mediated by
other societal oppressions such as racism, classism, heterosexism, etc. As with
power analysis, feminist analysis of gender-role socialization identifies the
sources of strength as well as harm and involves personal and societal change
(Laidlaw & Malmo, 1990; Worell & Remer, 2003). With these core techniques,
stemming from the core goals and principles, it is clear that feminist therapy is
far more than a non-sexist approach; it involves a radical transformation of the
therapy process, with feminist analysis engaged in by client and therapist to
accomplish both personal and political change.
Transforming Music Therapy

Feminist therapists generally receive training within a traditional therapeutic
approach and only later undergo an individual process of feminist trans-
formation of their practice. It is this process, as it pertains to music therapy,
which will be outlined next. Judith Worell and Pamela Remer (2003) identify
five steps in this feminist transformation: 1) to identify sources of bias in the
theory; 2) to modify or eliminate any biased components; 3) to assess the
theory’s viability; 4) to determine its compatibility with feminist criteria; and 5)
to highlight its unique contributions to feminist therapy. In developing my own
practice of feminist music therapy (Curtis, 2000), these steps were most helpful
and will be briefly outlined here.
A search for specific sources of bias reveals music therapy’s history to be a
source of strength. Music therapy has been informed by a variety of other
theories concerning such issues as personality development, source of client
problems, and the client-therapist relationship. If we strip away these other
theories, their inherent biases can be eliminated, leaving a generally neutral
music therapy theory about the human response to music. The focus of this
neutral theory is on the capacity of music to evoke physiological, affective, and

cognitive responses, making it a unique and effective treatment medium. By
stimulating brain functions involved in memory, in learning, in motivation, and
in emotional states, music has considerable potential for use in therapy to
influence human personality and behavior, and to activate healthy thinking
(Thaut, 1990; Thaut & Smeltekop, 1990). This potential to elicit change is put
into action by means of the unique relationship established between client,
therapist, and music
In light of this neutral focus, music therapy proves to be especially
available for feminist transformation (Curtis, 2000). Music therapy meets, or can
be readily adapted to meet, feminist criteria. There is nothing specific in this
neutral music therapy theory which precludes it from being: gender-balanced (as
opposed to androcentric or gendercentric), multicultural (as opposed to
ethnocentric or heterosexist), interactionist (as opposed to intrapsychic), and
life-span oriented (as opposed to deterministic). While music therapy theory has
not traditionally included a specific focus on women in general or on women of
diverse races, cultures, classes, abilities, and sexual orientation, it is certainly
sufficiently flexible to be modified to include these. The neutral music therapy
theory does not address the issue of the source of the individual’s problems and
so, while it is not specifically interactionist or life-span oriented, it too can be
modified to become so. Finally, while this music therapy theory does not
necessarily or specifically adhere to feminist principles, neither does it
contradict them. To go further and embrace feminist criteria fully in the
development of a truly feminist music therapy requires transformation of the
client-therapist relationship, of the music therapist’s personal life, and of music
therapy principles, goals, and techniques.
The neutral music therapy theory, while acknowledging the importance of
the client-therapist relationship within the framework of music experience,
makes no specific stipulations concerning the nature of that relationship. Thus, it
must be transformed to incorporate the very important and specific stipulations
of feminist therapy for an egalitarian relationship—as much as is possible given
the inherent power differential in any therapeutic relationship. This issue of
power has been problematic for feminist therapists who increasingly accept that
power exists in all interpersonal relationships and that the eradication of all
power differentials, even in feminist therapy, is impossible (Lerman & Porter,
1990; Smith & Dutton, 1990). Feminist therapists, however, see the power
inequity in therapy as temporary—it is their task to make the therapeutic
relationship as egalitarian as possible and at least equal in respect and value, if
not in actual power. They must strive continually towards a greater balance of
power through their work with their clients within the therapeutic process and
through simultaneously working for social change (Lerman & Rigby, 1990;
Smith & Dutton, 1990)
To place such importance on the nature of the client-therapist relationship
highlights the importance of therapist attitudes. As a result, personal trans-
formation is required such that the personal relationships of feminist music
therapists themselves are characterized by equality and ongoing feminist
analysis. Furthermore, they must spend a portion of their personal lives in
actively advocating for social change in order to better the external world for all
women.
In the area of principles and goals, music therapy’s transformation is
readily accomplished through the straightforward adoption of all feminist
therapy principles and goals. This is not unreasonable to assume given music
therapy’s long tradition of adopting those of other theories. Feminist trans-
formation of music therapy techniques involves the integration of feminist
techniques within a music therapy context. The techniques of feminist analysis
of gender-role socialization and power are hallmarks of feminist therapy used to
accomplish a number of its major goals. Two music therapy techniques which
involve a combination of music and verbal processing are particularly well
suited for this: lyric analysis and songwriting. Music performance, composition,
and recording can also be used to accomplish the feminist goals of
empowerment and of reclaiming voices which have been silenced in patriarchy.
As well, the valuing of women and of women’s self-nurturance can be accomp-
lished through the music therapy techniques of music-centered relaxation, music
and meditation, and music and imagery.
The final step in feminist transformation is the identification of the unique
contributions music therapy can make to feminist therapy. These lie in the
dramatic power of music to change lives, in the unique medium music therapy
offers with its particular appeal to women, and in the rich resource of women’s
music well suited for feminist analysis of women’s lives in the current socio-
political context. Perhaps the greatest contribution lies in the opportunity it
provides for women to write and record their own songs. In listening to and
singing the words of women songwriters, women can explore the subversion of
the patriarchal message. In writing and singing their own songs, they can tell
their own stories and lay claim to their own unique voices.
Personal Contexts
In discussing the development of a new practice of feminist music therapy, it is
important to understand that this practice will reflect great diversity. While each
therapist will strive to incorporate an understanding of the complex interaction
of oppressions in our lives, we all view the world through our own lenses. Our
clinical practice and our writings are informed by our personal frame of
reference. Therefore, I would like to be transparent about my own perspective
by sharing a little about my personal background.
My personal context is characterized by the contrast of experiences of
privilege and of oppression. I am a white, middle-class, educated, able-bodied,
heterosexual woman born in the mid 1950’s. As such, I have experienced certain
privileges of dominant group membership, such as access to privileged places,
people and resources, including higher education. As a heterosexual woman, I
have been free to love whom I choose without fear of discrimination or hatred. I
have also, however, had the experience of being the “other,” of living on the
margins, and of being oppressed as a woman living in a patriarchal culture. The
nature and extent of such marginalization has been the topic of considerable
feminist literature (Anzaldúa, 1990; Brown & Gilligan, 1992; Chesler, 1990;
Gilligan, 1982; hooks, 2000). For me, it has run the gamut from feeling
constrained by gendered career stereotypes to being unable to find myself in any
of my readings which only made reference to men and mankind. Indeed it was
these readings which led to my initial interest in feminist literature during my
teenage years. It is, however, my personal experience of violence which has
been the most profound.
Violence in Women’s Lives

Violence is central to the lives of women living in a patriarchal culture
(Burstow, 1992). This violence can be both emotional and physical: Women are
violently reduced to bodies, bodies for men as seen in the widespread
objectification of women; these bodies themselves can then be violated. This
violence can be either actual violence itself or simply the fear of violence which
shapes our lives in a myriad of ways—from the way we dress and talk to the
times and places in which we walk. In whatever shape it takes, violence is
integral to women’s lives regardless of any differences such as race, class, etc.
(Curtis, 2000 & 1994).
In addition to the general experiences of any woman living in a patriarchal
culture, my personal experiences of violence have also played a part in creating
the lens through which I view the world. I have an on-going struggle with issues
of weight, body-image, and self-esteem; I believe this struggle to be partly a
direct result of a culture which violently reduces women to bodies and then
enforces increasingly unrealistic standards of beauty for those bodies. As well, I
have had personal childhood experiences of emotional and sexual abuse. The
insidious nature of some of the emotional abuse was such that it served to leave
me questioning the actual existence of the sexual abuse: Was it really “that
bad” that it should be called sexual abuse? It is only as an adult that I have come
to see it for what it truly was—sexual abuse prefaced by the ultimate betrayal by
a male adult authority figure.
Transforming Lives
Having examined the feminist transformation of music therapy and having
outlined my personal contexts, I will turn next to the actual experiences of
women in feminist music therapy. From the large number of women with whom
I have had the honor of working, I have chosen to focus on two here so that their
stories can be fully heard in all their contextualized richness and complexity.
While unique, the stories of these two women—Julie and Roslyn1—are
representative of the many women I have worked with in Canada and the United
States. Their experiences truly reflect the marvelous transformation I have
witnessed.
Julie and Roslyn participated in a feminist music therapy group with me at
a battered women’s shelter. Prior to working with these women, I had to do
some preparatory work—to ensure I had an in-depth feminist understanding of
the nature of male violence against women and to develop cultural competence
for working with diverse women. Feminist analysis of woman abuse within
intimate relationships identifies it as a gendered phenomenon deeply rooted in a
patriarchal culture which not only perpetuates the violence, but is in turn
perpetuated by it. This abuse is related to all types of male violence against
women (e.g. rape, incest, sexual harassment, etc.), each one being a
manifestation of male control of women and each one being condoned and
encouraged by patriarchy (Curtis, 2000; Marshall & Vaillancourt, 1993). While
women abuse survivors share much in common, their experiences also differ
because of the diversity of their backgrounds (Burstow, 1992). Subsequently, I
began a self-directed process of developing cultural competence for working
with the diverse women in my practice. This is a life-long process recommended
for any therapist working with clients of differing sex, race, class, sexual
orientation, etc. It involves an examination of one’s own cultural background
and attitudes, followed by the development of cultural literacy and skills (Curtis,
2004).2
1
For confidentiality purposes, the names used here are fictitious.
2
An excellent introduction to this important topic can be found in This Bridge Called My
Back by Cherríe Moraga and Gloria Anzaldúa (1983) and in Gloria Anzaldúa’s (1990)
Making Face, Making Soul: Hacienda Caras).
Julie
Julie’s Story
Julie, an African American woman, was 25 years old when she joined the music
therapy group. She was single, with a 6-month-old daughter. She came to the
women’s shelter seeking safety from an abusive boyfriend.
In describing her experience of abuse, Julie indicated that the abuse had
started in the first year of her 4-year relationship, escalating as time passed,
becoming particularly bad at the time she became pregnant. This is not
uncommon for abused women. Julie mentioned that the abuse included all types,
with control being an important part of it all:
“He would come home and he would bad-mouth me, call me fat, um,
bitch . . . and other words, you know, I’d rather not say . . . But you
know he controlled me so much to the point where I was really scared
to leave. He would threaten me, tell me that he would kill me if I left
him. And I really thought he would, so I wouldn’t.”
Julie’s Songs
Julie was involved in a feminist music therapy group with me twice weekly for
10 sessions. Because of the demands of infants present in the group on their
mothers, Julie was not able to do any relaxation to music. Her time in therapy
was spent doing feminist analysis of power and gender role socialization
through lyric analysis, singing, and songwriting. For purposes of lyric analysis,
Julie received a songbook and recording of a wide variety of songs written and
performed by women on a great diversity of themes such as love, romance,
violence, gender role socialization, healing, and empowerment. From Alanis
Morissette to the Dixie Chicks, from Tracy Chapman to Alisha Keyes, women
singer-songwriters are singing eloquently about women’s lives.3 Julie was very
articulate and participated enthusiastically in the discussions during lyric
analysis. She readily drew connections between issues addressed in other
women’s songs and her own experience. She also suggested some song titles—
R&B—which she thought would be good for the group to listen to and discuss.
These songs by Jody Watley, Mary J. Blige, and Chantay Savage, as well as
songs from the “Waiting to Exhale” movie soundtrack (1995), were particularly
3
A thematic listing of songs and a description of their use in feminist analysis can be
found in “Empowering Women through the Healing Arts: A Manual for Workers with
Survivors of Violence” (Curtis, 2003) and in Singing Subversion, Singing Soul: Women’s
Voices in Feminist Music Therapy. (Curtis, 2000).
effective for Julie and the other women in the group—they mirrored their
experiences as women of color.
In songwriting, Julie was much more hesitant initially. Her first song was a
genuine struggle for her. Yet by the next song, her progress in recovering from
the abuse began to become apparent. Written with the piggy-back technique to
the melody of “Hand in My Pocket” by Alanis Morissette (1995), it sings of
hope and resistance: “And what it all comes down to is I’ve finally got peace of
mind / I’ve got one hand in my pocket and the other’s thanking the Lord . . . /
What it all comes down to is the road’s not so rough anymore / I got one hand in
my pocket and the other’s shooting the bird.” Julie’s final song—her first with
original lyrics and music—clearly illustrates the changes in her thinking about
women’s and men’s relationships in general, and about her own relationship in
particular. “Not Anymore” provides a strong message of resistance and of self-
valuing.
Not Anymore
There comes a time in a woman’s life when she doesn’t want to be alone
She wants that peace of mind, the need to be touched
By a strong man with strong hands, the kind that turns her on
But not anymore
I thought I found that man of my dreams

But roses turned blue and milk got sour, the grass wasn’t green
Not anymore
Who do you think you’re calling bitch?

I was good to you from day one, and never stopped
I should have recognized the signs, but I was blinded by love, you see
But guess what baby?
Not anymore
You see I realized the day I left you

That roses are red, only violets are blue
So you can kiss my ass and the baby’s too
I don’t have to take your shit

I am Black, I am beautiful, I am strong, I am proud
And we don’t need you
No, not anymore.
Julie chose to do this song in the style of Jody Watley’s “When a Man Loves a
Woman” (1996)—spoken, with background music. Julie also chose to perform it
herself for the final recording—a very self-affirming experience for her.
Julie’s Transformation
Julie’s progress in feminist music therapy was notable. This was reflected both
in standardized measures and in Julie’s own words. Her self-esteem increased
from the 60th to the 80th percentile on the Tennessee Self Concept Scale (Roid
& Fitts, 1991). When asked in an exit interview about her efforts to recover from
the harm of abuse, Julie replied:
“You were one of them. Yeah. Because I love music and it helps for
me to get it out because [in a whisper] I never talked to anybody
about my problems . . . So I kept everything inside and it was killing
me . . . Just being here, talking to the girls, talking with you . . . It
really helped me out.”
Julie described her experience in music therapy saying:
“It was, uh, more emotional therapy, you know, because some part
was putting your feelings into music. It was just, it was the way I
expressed myself that made it good. And that really helped me out
emotionally. Made me sit down every Monday and every Wednesday
and just think a little more. You know, and uh, and [she starts
clapping as she sings:] “I don’t have to take this shit.” You know, you
know [laughter].”
In summarizing what she would take with her from her experiences in music
therapy, Julie commented:
“I won’t leave here and get involved with a man and go through the
same changes I been through before. It will never happen again. And
I know a lot of women say that and don’t follow up behind it. But I
think even if I didn’t have a child to live for . . . It’s not just because
of her, but it’s because of me . . . so I meant, “No. Not Anymore.”
Roslyn
Roslyn’s Story
Roslyn, a European American woman, was 45 years old when she started music
therapy. She was single, with grown children no longer living at home. Roslyn
came to the shelter seeking safety from an abusive boyfriend.
In describing her experiences of abuse, Roslyn indicated that her last two
relationships had been abusive. Roslyn described the abuse in her most recent
relationship as involving both physical and emotional abuse:
“It was 2 weeks ago he took me with a rope . . . I was asleep . . . I

woke up with a noose around my neck. And he was hollering, “Say
you want to live.” And he said, “If you want to die, I’ll kill you.” And
what’s sad is I never did ask him to stop . . . because he had me
convinced I was just an idiot, just totally stupid.”
Roslyn’s Songs
Roslyn was involved in feminist music therapy with me twice weekly for 8
sessions. Being in the same group as Julie, Roslyn’s time in music therapy was
spent doing lyric analysis and songwriting using the same collection of women’s
songs.
Although she was somewhat quieter than the other women in the group
(particularly in the earlier sessions), Roslyn listened attentively and then later
participated eagerly in the discussions during lyric analysis. For Roslyn, it
seemed that hearing women songwriters sing about abuse and hearing the other
women in the therapy group discuss their experiences helped break the isolation
and gave her permission to discuss her experiences. Initially she expressed her
feelings of fear and shame. When faced with a song which had women’s
righteous anger as a theme, Roslyn stated simply that she was not at a point
where she could express anger at her abusers, nor could she visualize herself
ever reaching such a point. Yet 2 weeks later, she eagerly and with much
laughter recounted to me in therapy how she had puzzled her counselor earlier
that day; to his question about what she hoped to become, she had replied, “a
bitch with a bad attitude,” making reference to the song of that title
(Adegabalola, n.d.). Roslyn finally felt that she had the right to be angry, to
express that anger, and to refuse to be abused or to be blamed for the abuse any
longer. As in one of her favorite lines from that song, “It’s better to be pissed off
than pissed on.”
This remarkable progress for Roslyn from victim to strong survivor is
clearly evidenced in the songs she wrote in music therapy. Roslyn took to
songwriting immediately. For her, the written word seemed a safe way to
express herself. In songwriting, Roslyn had no difficulty finding the right words
and those words clearly reflected her progress.
In a song with original lyrics written to the melody of “Hand in My
Pocket” (Morissette, 1995), Roslyn expressed some of her conflicting emotions
at that time—the harm she suffered, yet her hope for a new life, one with peace
of mind and serenity. Roslyn felt strongly about her repeated line, “I’ve closed
my mouth and opened up my ears,” commenting that it reflected her desire to
listen and learn from her mistakes. I believe it also reflects the stage Roslyn was
at during the time she wrote it—a time when she still felt considerable self-
blame for the abuse and a time when her voice was still silenced. This was also
reflected in one of her song’s lines—“And what it all comes down to is I’m
looking for me.” Her final song reflects a remarkable difference. In “Here
Comes Roslyn,” with its original music, no longer is Roslyn a silenced woman.
In good-humored fashion, Roslyn gives voice to her anger, holding the abuser
responsible for the violence. But “Here Comes Roslyn” is not just a song of
anger and resistance. It is a song celebrating her new found life and her new
found ability to value herself—“Watch out world ’cause here comes Roslyn /
I’m claiming my spot, gonna have me some fun.”
Here Comes Roslyn

I prayed to God and got away The burden on my heart is
Now son of a bitch you’re gonna pay no longer an ache
I’m signing your card and You controlled my life
putting it in the mail like a cancerous mole
Happy Mother’s Day babe, Now I have my life,
I hope you rot in jail but you’re still an asshole
I’ve got your name on the soul of my shoe
Watch out now, I’m happy, happy, having fun
you don’t know what I’ll do I’m happy, happy, having fun
Chorus: You say you teach tough love

Watch out world ’cause here comes Roslyn with every hit
I’m claiming my spot, I learned loser you’re full of shit
gonna have me some fun I’m out on my own and lovin’ Roslyn
Watch out world ’cause here comes Roslyn If I were a big man
I’m claiming my spot, you’d be totin’ a bruisin’
gonna have me some fun Your bridges you are burning out fast
I pray for all victims
Home, family, & friends are back so far that I was your last
Hopefully soon I’ll come up with a car
My psyche is strong, Chorus
another human won’t break I’m happy, happy, having fun
I’m happy, happy, having fun
In discussing the recording of her song, Roslyn had been adamant that I
record it for her, saying that she had no voice for it. At the very last minute,
having heard Julie record her own song, Roslyn asked if she might also record
hers. Although she had thought she would recite it as Julie had done with her
song, I suggested she try singing it in the blues style in which it had originally
been composed. With microphone in hand and with some initial trepidation,
Roslyn started to sing her song, surprising both of us with her deep and strong
voice. Roslyn had truly found her own genuine voice.
Roslyn’s Transformation
As remarkable as Julie’s progress was, Roslyn’s eclipsed it—both on the
standardized self-esteem test (with an increase from the 8th to the 46th
percentile) and as reflected in her final interview. In response to a request to
describe herself, she commented:
“Like I told you, I’m fixin’ to be [a moment of silence]. What the, the
[Interviewer: You can say it on tape], the bitch with an attitude. I’m
talking about . . . I, I have found so much of myself that I like and I
have found out that I have a lot of good in me.”
Discussing the experience of songwriting, Roslyn stated:
“Oh, you saw me glowing in there like a light bulb! I’m still lit up
now. I’m so excited I can’t stand it and it looks so professional. I
think if people heard it, they’d love my song! I do. Now you can see
I’m well . . . I’m strong.”
Finally in summing up what she would take with her from the music therapy
experience, Roslyn said:
“I really do feel nobody will ever be able to break my spirit again . . .

I’ve gotten it back a lot through this music.”
CONCLUSION
In this chapter, the transformation of theory has been examined, with an

opportunity to hear the voices of individual women and their own particular
experiences in feminist music therapy. In working with these women, I have
learned much—about their experiences, about the fragility of the human spirit
on the one hand and its resilience, when nurtured, on the other hand, and about
the transformative powers of music. I have seen women move from
unfamiliarity with feminist music therapy, uncertainty as to what it might offer
them, and even, for some, initial reluctance to participate in such a thing when
they were hurting so much, to eager anticipation and surprised delight in
themselves and their music. There were times when they were no more surprised
than I was at this transformation and at the power of music in their lives.
In exploring this new thing called feminist music therapy, the importance
of group work should not be overlooked. Some have argued that women do not
need therapy; they simply need to talk with other women friends about their
experiences. One therapist, Laura Brown (1994), agrees but goes further to say
that women of today rarely have the opportunity just to chat with other women
and so, rather than supplanting woman talk, feminist music therapy provides a
much-needed opportunity for it. Thus, it was when the women in my feminist
music therapy sessions perceived their experiences as simply time spent chatting
with good friends, that I believe they were most empowered. In feminist music
therapy, the women were able to participate as members in group song
discussions, as individuals within a group in writing and recording their
individual songs, and as a group in listening to each other’s original com-
positions—providing both validation and inspiration to each other in finding
their own voices.
When looking back at the women’s experiences in feminist music
therapy—their self-esteem, their songs, and their voices in interview, the
transformational power of music becomes clear. The testimony of these women
is compelling. They have moved in feminist music therapy from finding their
own voices and stories in the songs of other women, to finding the value of their
own voices such that they were able to write and record songs themselves. Their
experience has genuinely been one of finding their own true spirit. Since such a
great debt is owed to these women for their lessons to us about the power of
music to transform lives, it is only fitting that the final words belong to their
voices of subversion and of soul.
“My soul wasn’t gone, but my spirit was totally crushed. And I’ve
gotten a lot back through this music . . . I’m fixin’ to be a bitch with
an attitude . . . And nobody’s gonna take my spirit from me.”
—Roslyn
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Brown, Lyn M. & Gilligan, Carol (1992) Meeting at the Crossroads: Women’s
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READING 15
Chapter Sixteen
CONSIDERATION OF POTENTIAL
INFORMANTS FROM FEMINIST THEORY
FOR MUSIC THERAPY PRACTICE
Jane Edwards
INTRODUCTION
Elucidating aspects of feminist theory could be useful in developing some
deeper theoretical constructs to support the practice of music therapy. Since
many feminist theorists have contributed to debates about various forms of
representation within society, I would suggest that discussions of clinical and
community-based practices with music therapy clients benefit from reflection on
these views. I hope that music therapy students and practitioners seeking a
broader frame of reference by which to approach complex situations in their
own lives or in therapy work with their clients can be stimulated and encouraged
by reflection upon and reference to the ideas presented here.
I am a feminist. Since I am also an academic, I feel it necessary to ensure
that it is clear to the reader that I do not present myself here as a feminist
scholar. I have not undertaken any in-depth study of feminism in the way I have
studied music therapy. I use the term feminism to refer to a tradition of theory
and practice or even a way of perceiving the world that acknowledges that
injustices occur against individuals and groups because of systemic problems
that are broadly socially determined. My experience of contact with the varied
theoretical discourse that constitutes contemporary feminism has led me to
understand that feminists work to think about, deconstruct, disrupt, and
interrogate existing values that operate in the construction of social values with
the goal of emancipation and positive social change through encouraging and
valuing the human agency of all citizens. These existing “relations of power”
(Foucault, 1995) act to include and exclude, value and disenfranchise, privilege
and disengage, and can prohibit agency and self-determination. Inherent in this
view is the idea that all members of society participate in upholding or
maintaining these values whether they are considered to be members of
oppressing or oppressed groups.
368 Jane Edwards
These power values can operate consciously and unconsciously. Indeed,

oppressive mechanisms are more powerful if they operate unconsciously under
the guise of a neutral system, free of values or stratification. This determination
can be read or experienced in various fora such as in ones interpersonal
relationships, the media,1 scholarly writing, the law, and so on. Oppression can
occur against any group through preventing or limiting access to opportunities
for choice and power or even through negotiation in professional work, personal
life, division of labour in the home, in relation to identity, the body, and other
constructs concerning the self. Feminist theory often concerns itself with these
issues in relation to women, but it should be remembered that feminist
theorising usually gives consideration to a range of human experiences, with
critical appraisal of social norms that can be informed or even re-formed from
feminist principles.
My motivation to write this chapter comes from the view I hold that most
societies can and should “do better” in terms of their treatment of others.
Frequently fielding the accusation (or perhaps I mistake people’s admiration)
that I am a Utopian, or even more recently a “Pollyanna,” I find myself
constantly asking “what’s wrong with this picture?” and even “how did this
picture come to be painted or photographed in this way?” How is it possible, for
example, that at the time I am writing this, it is a fact that in the history of the
albeit relatively new university where I currently work, not one woman has ever
been promoted from my level to the next level? This cannot help but shape
something of the energy I bring to the topic of feminism, and the ideas around
power that inform this chapter.
The current circumstances for many of our clients, and those citizens we
feel concern for but do not necessarily work with, are unacceptable to my value
system. I consider that feminism offers one way to identify and question these
discourses, and believe that these ideas can be used to collectively re-view our
world of work, of power, of personal experience. Perhaps, like therapy,
engagement with feminist theory offers a way to “catch sight of ourselves,”
since our perceptions are complexly influenced from preexisting values, terrains
of knowledge, and ideas. We can hardly have a thought that should not be held
up to some kind of scrutiny as problematic or “biased.” Or to put it another way,
“We always ‘see’ from points of view that are invested with our social, political,
1
In Bowling for Columbine you might remember that Michael Moore asked the producer
of Cops why he didn’t show corporate thieves being arrested instead of poor non-white
people. The answer was basically that when the police arrest a magnificently wealthy
person they treat them with the greatest of courtesy and respect, and that would not be
interesting television.
Informants from Feminist Theory 369
and personal interests, inescapably -centric in one way or another, even in the
desire to do justice to heterogeneity” (Bordo, 2003, p.223).
As an example, I rarely have the experience of realising how many
“givens” are in unconscious operation for me, but recently I watched the film
Buena Vista Social Club (Wim Wenders, 1999). In the part of the film where the
Cuban musicians come to New York City, I was struck by the way that US
iconography was not etched on their mental landscapes. For example, they saw a
line up of doll mannequins of US Presidents in a shop window and decided that
the characters must all be famous people. Since the Clinton doll was holding a
saxophone they concluded he might have been a visiting musician they
performed with in Cuba. They pointed to Marilyn Monroe’s image nearby and
wondered aloud if she was famous but they had no name or context for her.
In reflecting upon and exploring existing and potential feminist informants
for music therapy, it is important to suggest and claim that I, like most of you
who will read this, have been brought up in an environment that has given heed
to feminist issues and has incorporated, even unconsciously internalised, a value
system that has an awareness of feminism in the same way that I, as an
Australian citizen who lives and works in Ireland and has only visited the US
five times can recognise images of Clinton, Nixon, Reagan, and Carter as well
as Bush Sr., and Bush Jr., among others. I suggest that feminism is present in
many points of view or debates for us even if it is not always called that; perhaps
sometimes instead it is just referred to as “rights” or “women’s issues.” It is not
possible then to reflect on the “inclusion” of feminist theory in this chapter as an
addition to thinking about ways of working in music therapy, since for someone
like myself feminism has been a surround or even a backdrop for all parts of my
life—particularly those which are political or professional, as well as, of course,
the personal. As I have suggested elsewhere:
I would argue that music therapy is always a socio-political work—in

simple terms, what we do with our clients and their families in turn
effects our society simply by being part of the warp and weft of the
fabric of our community behaviour . . . . Since the civil rights
movement and the movements that followed, including the many
strands of feminist theory and feminism, I think it is impossible to
live without consciousness of the ways in which our society and
community shape our perspective to “other” whether we understand
that in Marxist terms or perhaps even with reference to Kristeva’s
useful notion of abjection.2
2
Jane Edwards, Voices, August 6, 2002. See also, Julia Kristeva (1982) Powers of
Horror: An Essay on Abjection. New York, Columbia University Press.
370 Jane Edwards
It seems to me that it has not been possible to be a citizen of the first world
over the past forty years without being aware of terminology related to feminist
thought such as “patriarchy,” “subordination,” “oppression,” “minority,”
“identity” or “consciousness.” These words have been actively discussed and
used in writings about feminist theory; however, it is important to note their
origins and use in the struggle and achievements of the Civil and Human Rights
movements in the USA and beyond. I have elsewhere suggested that there is an
emerging consciousness of these ideas in music therapy, even if they do not
always take the shape and name of “feminism” and, as Susan Hadley and I have
argued, a book like this one in which these ideas are developed and acknow-
ledged is long overdue for our field (Hadley & Edwards, 2004).
In many of the feminist traditions which I find influential and interesting,
the oppression of women by a social construct described as patriarchy is a
primary arena for consideration of the revolutionary change needed in order for
all citizens to have self-determining lives. The concept underpinning reference
to patriarchal structures is that patriarchy is an inherited set of patterns that
become internalised “frames” of reference, collectively and individually. Like
any ideology,3 patriarchy’s mechanisms operate unconsciously and are difficult
to extricate as “givens” since they are presented as normal and “correct.”
A final introductory thought is that I understand, and use here, the term
feminism to refer to many different traditions and theories, with a range of
points of agreement and disagreement, solidarity and conflict. It is almost
impossible for me to imagine a contemporary feminist perspective that is only
prepared to accept one true way of knowing, living, and experiencing a feminist
identity, or purports to hold one “correct” feminist theoretical stance. I agree
with Susan Bordo’s observation that “contemporary feminism remains a diverse
and pluralist enterprise.” (Bordo, 2003, p.216). It is important to me that every
feminist can think about the potential as well as the limitations of a feminist
perspective in any critical scrutiny of public or private life. It would be a
misreading of this stance to consider that I find a personal and professional life
informed from feminist ideals a hopeless enterprise. I suggest that the multi-
faceted nature of feminism is no more problematic than what we think we mean
by terms such as democracy, psychoanalysis, or quantum physics. I especially
reject the use of “feminist” as a monolithic term, or “feminism” used as a
descriptor to identify a theory that is supposedly obvious, with the assumption
3
I like the example Nicholas Cook gave about this in Music: A very short introduction,
where he stated from a British perspective “During the Thatcher/Reagan years, it was
received wisdom that ideology was what the other guy had. Capitalist democracy wasn’t
an ideology, it was just the way things were; it was the Russians who had ideology and
look what happened to them.” (Cook, 1998, p.102)
that we all know what is meant by the employment of the term, and I dislike its
frequent use as a synonym for misandry.
AN OVERVIEW OF SOME ARENAS

OF FEMINIST THOUGHT
It is beyond the scope of this chapter, this book, our profession, and human
capacity to ever be able to provide comprehensive representation of any one
idea, approach, or experience. Rather, I wish to discuss and represent my own
view about a panoply of feminist theoretical arenas with which I have come into
contact and the way these are useful or at least interesting to the situation of the
work of therapy, offering the possibility to view interaction with clients in a
wider context than either a medical or wellness model. Many of these are
contested sites of dialogue and exchange and it is important to point out that in a
great number of cases theorists writing on the same topics do not agree with
each other. In fact there are some theorists, such as psychoanalyst and
philosopher Julia Kristeva (1984), often quoted in the feminist literature, who do
not identify themselves as feminist and find the term feminist problematic and
incongruent with their theoretical propositions.
Representation
The issue of representation has been a preoccupation of the various waves of

feminism, especially when looking at arenas where achievements of men have
been prized and acclaimed. In my daily life the question “Where are the
women?” can be asked in almost every glance at the newspaper (especially the
obituary section of the Irish Times newspaper where one is grateful for being
female since so very few of them ever seem to die in this country), every board
and committee meeting, and every government decision made on behalf of the
electorate. One must be careful however not to only focus on gender balance and
representation in engaging with feminist ideas. I am taken by Naomi Klein’s
observation that while her generation of student activists stood against the wall
challenging their professors over the poor representation of minority groups in
texts for course schedules they failed to notice that the wall was being sold off to
corporate interests (Klein, 2000). Feminism offers more than a way to critique
relations between men and women. It imagines and reinvents a world in which
the forces oppressing any citizen can be challenged, dismantled, and discarded.
372 Jane Edwards
In this section, I will look at various ways in which some feminist theory
has helped conceptualise issues around representation and discuss how, as music
therapists, we can give consideration to these ideas within our work. Of course
each of the topic headings intersects each of the others. The use of numbers and
a list of terms are used to assist the flow of the chapter and to spotlight some
particular theoretical domains of relevance to the discussion.
1. The Body
Kim Arnold and Kate Boulay presented a paper on the concept of beauty at a
recent Utopian studies conference at the University of Limerick. Taking the
television programme The Swan4 as their topic, they questioned what has gone
on in our society, not just that women will allow this to be done to them, nor that
there are medical personnel prepared to carry out procedures on these healthy
women, but that we, the viewers, are fascinated to watch this grotesque and
deforming process.
The problem with feminist critics and with us is that we wind up in an

either/or situation. Either the women participating in The Swan have
agency or they are misguided fools. Obviously it is preferable to think
of them as women with wit and agency and women who . . . are
making concerted efforts to improve their lives. Although, it is unfair
to expect these particular women to act in a non-atomized way when
almost all women do so all the time, we consider these women as a
microcosm of abstract femaledom. It seems intolerable that cultural
identity be so ruthlessly staged upon their bodies. (Arnold & Boulay,
2005)
It is not original to note that the capitalist consumer project requires that
we continuously feel anxious. In this way we will pay money for things we
don’t need in order to alleviate our anxiety; so “the economy” turns. If idealised
beauty is used as a means by which most women can think of themselves as
“nothing” and inadequate, a vast amount of money can be spent on making
adjustments that allay the anxiety, but cannot remove it, and encourage the
4
I had never heard of this program so in case there is a reader who also never watches
TV, women “win” the chance to have 16 plastic surgery procedures. The process is
filmed and edited. Women semifinalists are selected for a final beauty competition and
the winner takes home a large money prize.
buying into an ideal(ogy) which by its nature can never be achieved, therefore
requiring ongoing spending and effort.5
The more that products can be manufactured and advertised with promises
to the purchaser that beauty will be attained, and the more anxiety that can be
generated about whether or not one has it, the more money can be made.
However this awareness does not necessarily help women such as myself to feel
less compelled by the insistence that they make at least some effort to attain
ideal beauty; having perfect hair, working against wrinkles—I am sure these
themes are familiar to many.
As a therapist then, I take my own body, including my conscious and
unconscious conceptions of my body, its inadequacies, and my often-failed
expectations of it, into work with others where their own body is a site of
contested expectations and even failures. Working with children with severe
burn injury with no hope of ever being free of scar tissue in their adult lives, I
have become aware of norms about the intactness and smoothness of skin.
Working with adults with enduring mental illness, I am aware that their bodies
often are bloated and far too large from the effects of medications. These body
changes seem to defy the “improvement” the medication is bringing, as constant
media messages inform that the obese person is a liability to society, costing
more in health care in the long term and ensuring that a person will have a
shorter life expectancy. Every fashion magazine and television drama shows
beautiful, thin people having exciting and fulfilled lives. At the same time we
can find spaces to consider and be critical of our own preoccupation with what
we look like and how this preoccupation and resultant unease potentially stops
us from having time to be effective in wider domains of social and political
activity, or to be truly engaged with and responsive to our clients’ complaints of
the inadequacies of their own bodies in the “marketplace” of status-conscious
humans.
I suggest that our support of clients with injuries and disabilities through
creative expression and development has potential to create new spaces to
envision such domains as beauty, art, and personal representation, allowing
different self-constructs to emerge. We can monitor and support our clients’
expressions of difference, embracing their difference and their and our anger at
the variously operating corporate interests that construct their identity as
problematic and inferior.
5
A young friend preparing for her wedding showed me a magazine that caters to
“brides.” She had memorised the section devoted to “figure flaws” with advice on how to
buy a dress to overcome these for your special day. Virtually every female body shape in
the article was represented as being problematic and needing some help or “disguise” as
it was phrased.
374 Jane Edwards
2. Health
In writing about issues of representation and the body, some feminists have also
provided critical perspectives elucidating discourses of health and illness and
how these are formed and framed by patriarchy. Of course feminists are not the
only theorists to consider issues of health and illness and the power operatives
and assumptions playing out in personal and corporate arenas of health service
receipt and delivery; but feminist writers have exposed power frames in relation
to health and illness in uniquely interesting ways. As practitioners, students, and
health service recipients ourselves, we can use some of these ideas to interrogate
the structures of power that inform both the places of our work as well as impact
the experiences of those with whom we work, whether coworkers or patients.
In some feminist theorising around health concepts, the issue of scientific
perspectives to health and illness are challenged as leaving ordinary, non-expert,
self-knowledge without a place in contemporary health care. Bordo (2003) has
suggested that “Since the seventeenth century, science has ‘owned’ the study of
the body and its disorders. This proprietorship has required that the body’s
meanings be utterly transparent and accessible to the qualified specialist
. . . and utterly opaque to the client herself” (p.66). Health service provision
seems to require that we accept that we do not know, and are therefore
demystified by “expert” opinion. We must consider how it is that we as
“patients” play along with this. As music therapists also, we can give con-
sideration to how our own role as “expert” is constructed by ourselves and in
conjunction with the client, perhaps in a mutual fantasy that our expertise will
“cure” them. If we truly wish to engage with the life narratives of our clients,
their own lived identities and the framing of their experiences in relation to
these, we must be prepared to “learn” the patient by coming alongside them,
rather than starting from a position of authority and “knowing.” I have said
before in relation to patients with head injury that we may well know in an
“expert” way about brain functions and the deficits caused by lesions in certain
areas, however in a therapeutic relationship with a client, we must learn what
those deficits mean for that particular person’s communication, interests and
personhood (Edwards, 2005).
In a discussion of how it is that women’s health advocacy and feminist
theory have not had a stronger association, Ellen Kuhlmann and Birgit Babitsch
(2002) proposed that while “Feminist theories and women’s health research
share the common intention of reflecting critically on biology as a stable and
fixed framework for the categories ‘bodies’ and ‘gender’ . . . [the] mere transfer
of feminist concepts to women’s health research . . . can hardly be the goal of
future work” (Kulmann & Babitsch, 1999, p.441). Some radical feminist
approaches have put forward the idea that instead a revolution is needed, not just
some kind of reframing or seeing of the social and individual needs to which
health provision attends. For example, Carrie Klima (2001) writing about
women’s health stated that “. . . [in] a radical feminist approach . . . women
would be approached to determine how their health care needs might be met
based on their lives and their experiences, and the services would be designed to
meet these needs” (p.288). Should we be ashamed that this is being proposed as
a “radical” view?
It is possible however that some feminist discussion of the body leads so
far away from a medical essentialism of the body as a “thing,” or even a
container for the category “health,” that health service provision with its short-
term pragmatic agenda, does not have the capacity to consider these arguments.
As music therapists we might see how we can keep some of these ideas at play
in the health and treatment contexts in which we work, and also consider how
power in health care contexts is gendered, invested, and “played,” and how this
might influence which beans are counted into which pile or jar in allocation of
service funds; we should continue to be critical, responsive, and alert to these
phenomena.
I am not alone in suggesting that in the West we seem to have difficulty
developing systems of health care based on need that deliver the best possible
service to the widest number of people based on the best possible evidence of
benefits for individuals and communities. As music therapists, we need to help
our managers and administrators and project leaders to stand up for client needs,
to advocate rather than “dispense,” and we must resist the efforts of our systems
to create burnt-out automatons who have lost the capacity for creativity in our
own lives, and therefore might unconsciously resist the expression of creative
need in our clients.
3. Gender
As a species we are relatively homogenous. It is rare for a fully-grown human to

be twice as large as another for example whereas some breeds of dogs are three
times the size of others. Nonetheless, it seems to be a human proclivity to
obsessively define aspects of our difference from each other. Considering how
these “differences” are constructed, the basis on which they operate, and who
benefits from them has been a consistent theme in many areas of feminist
scholarship.
. . . men and women are caught up in a network of millennial cultural

determinations of a complexity that is practically unanalyzable: we
can no more talk about “woman” than about “man” without getting
caught up in an ideological theatre where the multiplication of
376 Jane Edwards
representations, images, reflections, myths, identifications constantly

transforms, deforms, alters each persons imaginary order and in
advance, renders all conceptualisation null and void. (Cixous, 1999,
p.443)
Many feminist theorists such as Hélène Cixous quoted here have proposed
that it is not just our internalisation of patriarchy that is problematic in trying to
imagine a different world in which we can breathe, but rather that within a
patriarchal system, the continuous use of binary oppositions as sense-making of
self constantly disrupts what is possible for individual freedoms. The terms
“woman” and “man” become instantly problematic when trying to use the
imagination to conceptualise and then develop a different system of human
experience than that which we have inherited. “‘Masculinity’ and ‘Femininity,’
at least since the nineteenth century and arguably before, have been constructed
through a process of mutual exclusion” (Bordo, 2003, p.174). Constantly
reinforcing the view that what women are and have cannot be anything like men
and vice versa. This is summarized by Andrea Dworkin in her often-quoted
statement “while the system of gender polarity is real, it is not true” (Dworkin,
1975).
We must increasingly realise that as we enter therapy relationships with
our clients, these relationships come laden with power differentials that include
those influenced by gender.6 There is no view from nowhere, to adopt Thomas
Nagel’s postmodern catch cry (Nagel, 1989). Instead, all of our experiences and
histories swim into therapy processes alongside us and there is always a power
dynamic operating that the best use of our own countertransference must
elucidate; not in order that one person has power and one person doesn’t but
rather that the ways the therapist has access to power are used to facilitate the
client’s recovery and the client’s use of power should be able to be thought
about by the therapist. It may otherwise be the case that a struggle ensues where
the unconscious recreation of previous power relations can violate attempts to
elucidate the current story. There is no Freudian blank screen upon which the
patient or client casts their shadow from which we interpret and “solve” their
misery and limitations—we inevitably become intertwined in a co-created
history of gender, power, and subjective value relations that we must always
give heed to in understanding what our clients are telling us as they story their
lives, as well as considering what we might be unconsciously relating to them
6
Of course these relationships are also impacted by the complexity of intersections
between gender and other influential registers such as culture, economic class, level of
education, access to education, and so on.
about the values that we perceive as important and necessary in generating

action and change in the way we are listening to them.
Feminism as I understand it asks us to be aware of the danger of perceiving
our middle class (mostly white) therapeutic training about health and illness, as
neutral and “objective,” and as a consequence unwittingly reducing or even
obliterating the authority of the client’s own experience. As an example, some
women with whom we work perhaps will not experience their depression as
something to do with being female despite evidence to show that many more
women are diagnosed with depression than men. Our knowledge that there may
be something about their femaleness or their experience of woman-ness in the
world which impacts upon their current place of being, could be a starting place
from which a mutual exploration can take place around how their circumstances
are responded to and constructed. However we must be aware that a client may
not experience her own individual circumstances as related to issues of gender
or gender construction. We therefore need to give time to understanding the
patient’s life narrative rather than trying to tell their story for them.
4. Sexuality
Some feminist theorists have disrupted our self-evident preconditioned notions

that our gender status informs our sexuality (e.g. Butler, 2004), helpfully dis-
engaging our notions of gender category from ideas about sexuality. Whether
able to be identified as gay, bi, hetero, trans, asexual, and other ways of viewing
sexuality, our gender alone does not, cannot, be a sole determinant of our sexual
experiences and preferences.
Similarly, some of our normative ideas about gender relations as derived
from the nature of genitalia have negatively impacted gendered role
expectations—that is, ideas such as the female is a “receptor” for the male.7 I
like the way the feminist ideas I was introduced to early in university life
questioned this assumption and asked whether it was possible to have an equally
valid view that the male was “enclosed” by the female in the sexual act; but of
course I now acknowledge that both views are problematic and bizarre.
Ultimately, the idea that the way sex is performed between men and women
dictates relations in other domains between genders has, for me, become less
and less relevant. I agree that existing “. . . discourses . . . construct female and
male bodies in ways that constitute and validate the power relations between
7
In writing this I have started to think about the inevitable redundancy of the metaphor of
“plug” and “socket” for male and female parts with the introduction of wireless
technology. Think how many generations we have laboured with the idea that plugs and
sockets are part of a natural system of how devices are connected.
378 Jane Edwards
men and women” (Gatens, 1999, p.231) and I am hoping that a radical agenda
for all citizens is to continue to interrogate and ultimately relinquish this peculiar
view.
Power does not operate in terms of “who’s on top” but who gains, who
loses, who has autonomy, for whom is the right to say “yes” or “no” available in
any given situation. To require women to abdicate power because of an
anatomical legacy has seemed to me one of the more absurd notions of the 20th
century. I wish we could use the genius of some psychoanalytic ideas in a more
enlightened way than to continue to perceive “female bodies as lacking or
castrated and male bodies as full or phallic” (Gatens, 1999, p.231).
As music therapists, we must be aware that we may have taken in and be
adhering to some of these normative assumptions about sexuality that do not
allow us to be open to client experiences outside those that are congruent with
our own. In addition, we are often obliged to work within systems that are
informed from frames holding pejorative views of the needs of people from
queer communities (e.g. DSM-IV), that is, not open to the expression of “other,”
but rather using the health or welfare system to reinforce social norms and
potentially as punishment for those who do not conform to agreed categories of
gender and sexual orientation.
I think then that some of our work in teams can be to offer reframing of
situations and events. We might question whether if most males in the world
were cross-dressers, would it be the case that men who did not engage in cross-
dressing were “abnormal”? We might question why we so readily accept that
wearing dresses as a little boy is considered a normal part of development and
even amusing, but continuing this behaviour past a certain age is completely
unacceptable in many sectors of society. As creative arts therapists could we
consider whether some actions considered pathological are inherently creative,
and encourage the telling and expression of these in different terms than
psychological pain where the person’s story warrants or requests it? Or consider
whether the psychological pain experienced is externally imposed as much as
internally experienced as shame for some of our clients. We can take
opportunities to question in every professional work place whether majority
status always requires the imprimatur of “normality.” For example, since there is
so much violence in society (especially through war), should we consider violent
behaviour normal, and pacifism and concern about violence as a neurotic trait
indicative of weakness and even pathology?
5. Music
The question of representation within music has been challenged (see Citron,
1993; McClary, 1991). What Nicholas Cook describes as the “vicious circle”
whereby the lack of compositions from women is not constructed as a social

phenomenon related to opportunity or existing conventions, but rather is
essentialised as a problem of the inadequacy of femininity in the face of the
creative task; the best explanation for the absence of women from the canon
must be that women are not capable of successful musical composition.8
One difficulty with pointing out issues of lack of representation is that it
engages assumptions that where women want to be is where men are, instead of
the idea that “a woman’s place is where she wants it to be.” The low or even
non-representation of women in some sectors of music is easily problematised to
be both about opportunities and about choices but it could be argued that
historically it has also been about perceptions of women’s ability in playing.
Here I am thinking of perceptions of who can play drums, electric bass,
trombone, or until relatively recently in the Berlin Philharmonic, who can play
classical music at all! The problem of sexism per se is rarely voiced in these
representations. It might not be that women are kept out because individual men
do not want them to be there, rather that if musical structures, for example rock
music, are created around aspects of male identity—that is, created by men to
demonstrate and play out some aspects of masculine experience and agency—
women will always be inadequately represented.
In terms of our own practice, we must become more aware of the ways
music itself conveys or reinforces social identity constructs and in a sense offers
ways to embed discrimination. Think of the many years of Western musicology
when music of the so-called Western canon was consistently represented as
superior to what was described as “ethnic” music; in simple terms the idea being
that Western classical music was free of cultural reference, it was just “good”
music.
We might consider whether clients and students we work with can think
about or deconstruct aspects of their music preferences and examine the extent
to which these preferences liberate or reinforce for them certain shackles of
representation. We might try to engage music therapy students with ideas about
representation in music, to ask them to read a couple of Susan McClary’s essays,
or require them to consider how they view human relations of power and how
they might see these reflected musically, politically, personally.
8
As recently as 10 years ago, a professor of music put this view to me as fact: “Since
there are no compositions from women in the past, you have to come to the conclusion
that women can’t compose.” In the same department another staff member confided his
“worry” that so many women were being appointed. I pointed out that we were nowhere
near 30% of the staff, and his response indicated that he thought 40% would be the
tolerable maximum. Or the professor in one of the physical science departments who told
me they had no gender issues in their department because they didn’t have any women.
380 Jane Edwards
6. The Voice
Ultimately, as music therapists, I believe we are concerned with how the client’s
voicelessness becomes sounded and heard. Sometimes I regard gender as
relatively neutral in the face of other barriers to access to power. I am therefore
compelled by some of the arguments that critically engage the preoccupation
with gender perspectives in feminist theory, for example Bordo’s statement:
If we wish to empower diverse voices, we would do better, I believe,

to shift strategy from the methodological dictum that we foreswear
talk of “male” and “female” realities . . . to the messier, more
slippery, more practical, struggle to create institutions and com-
munities that will not permit some groups of people to make
determinations about reality for all. (Bordo, 2003, p.225)
Mary Daly and Chiara Saraceno (2002) in a discussion of the notion of social
exclusion have suggested that adopting this frame of reference in examining
imbalances in women’s access to choice, and access to secure futures, allows for
an approach that “emphasizes participation, involvement and customary way of
life as against consumption, average income and well-being as primarily
financial” (p.87). They also suggest that this term social exclusion, which has
gradually replaced the term “poverty” in European Union (EU) legislation, has
the benefit that it does not treat people as “passive objects of social and
economic policies” but rather “social exclusion emerges as more dynamic,
actor-oriented, multifaceted and methodologically plural than poverty” (Daly &
Saraceno, 2002, p.87). It is possible to see in this example how feminist theory
can move from the domain of the abstract radical to the pragmatic, responding to
circumstances of all citizens, not just women.
Notions of inclusion and empowerment have appeared in some recent
music therapy writings (e.g. Daveson, 2001; Proctor, 2001; Rolvsjord, 2004); it
is wonderful to have the chance to read the study by Susan Baines (2003)
incorporating feminist principles as a means of promoting agency and
empowerment among participants in a community mental health programme,
especially because of her commitment to including client’s voices in the
reporting of the project. If I had to imagine what music therapy would be more
like if feminist voices and principles were stronger, Baines’s work would be an
exemplar. I like her conceptualisation of the music therapist as “paid
professional facilitator” (Baines, 2003). The qualified therapist is not the
“authority” on how this client or this group should do music therapy. At the
same time, an online journal with which I am associated, Voices
(www.voices.no), takes the theme of providing space for people in music
therapy from around the world to be heard in a forum which has different
expectations, but possibly a wider readership than a traditional academic journal
format.
Therapists who use terms such as “action research” and “empowerment”
are obliged to consider that theirs is not the only authorial voice that should be
included in publications, nor theirs the only observations that are relevant to
understanding client experiences. I am sure I am not the only person to feel that
there are potential difficulties for inclusion of clients in the reporting of our
music therapy work where their story has been central and where we have
advocated for and facilitated their agency, however in reading some of the
experiences of Alan Turry and his client Maria (Turry, 2005), I feel as if some
steps might be taken towards negotiating this territory successfully in some
cases.
In a parenting program for women abused in childhood who are either
pregnant or have children, Toni Day and Helen Bruderer (2002) provided song
writing as means to give voice to the experiences of this group of women. These
amazing songs are now part of a training resource for workers. The songs of
these women give voice to their pain, distrust, anxiety, and ultimately power and
determination to live and have different lives. Toni, a music therapist and Helen,
a social worker, ably employed feminist principles in providing a space for
agency and determination in this group. It is not necessarily easy to embrace
these principles as part of a therapeutic approach, especially when authority
about musical decisions, or about text that can be used, or ideas about who
decides what and how can and must get challenged constantly in a group process
where adherence to a feminist frame is negotiated successfully.
Advocating Feminisms
The more difficult task for me in writing this chapter has been to consider the
ways these theoretical discussions can become relevant in the practice of music
therapy. When I have tried to answer the question, “then what does this mean for
music therapy practice?” I have found myself expecting that I will know. I want
to write inherently loose statements such as “what I will find myself doing with
clients in response to this theorising will be different from you” however I think
that leaves the reader, and myself, with the idea that these are just thoughts and
writing, at risk of having nothing to do with practice. As I argued in the
introduction, the task I set for myself in this chapter was partly to explicate how
these ideas influence practice, rather than “introduce” them to the field.
382 Jane Edwards
It is important to me that we are not left with a hopeless and helpless

attitude to the big ideas of sociopolitical theory but instead can see the benefits
of opening up our work to the scrutiny of theoretical interrogation. At the same
time, I think it is my feminist leanings that make me so frustrated sometimes at
the insistent certainty of some writings in our field. We are potentially such an
uncertain practice and I wonder if that uncertainty is responded to sometimes
with an overstatement of authority in writing about topics in music therapy. I
would like us to be better able to embrace the gift of uncertainty that comes with
patients’ stories and experiences. I have elsewhere presented on this topic in
music therapy regarding my frustrations about researching in medical com-
munities (and the two times I have presented the paper, I have read this section
quickly):
. . . as a music therapist in health care . . . we do not have uncertainty.

We have proof, efficacy, knowing, evidence, statistical analysis, we
have significance, authority and completeness of knowing . . . we do
not have works in progress, we do not have creative not knowing . . . .
(Edwards, 2004)
In my view this inability to be creative, present, and calm in the face of the
uncertainty that music therapy interactions inevitably bring has limited what can
be known in our profession and forced us to adopt or even appropriate forms of
telling that do not allow for the range of complexities in our work to be
embraced.
To expand upon this idea, in metaphysical terms, “forms are not fixed
things, but temporary arrestations in continuous metastable flows, potentialities
or evolutionary events” (Battersby, 1999, p.351). I like these thoughts of
Christine Battersby around the way that body and self have been conceptualised.
She has suggested that “we need to theorize agency in terms of patterns of
potentiality and flow. Our body-boundaries do not contain the self; they are the
embodied self” (Battersby, 1999, p.355). It is so important to be able to engage
this potential and flow within our interactions with patients, but also in our
engagement with emergent ideas in our field.
I therefore do not find feminism “impossible” because of its inability to
offer a unilateral response to issues such as poverty, marginalisation, or
disability. I am more compelled by theories such as feminism that can provide a
way of seeing from different viewpoints, therefore creating dialectic instead of
reinforcing dogma.
When advocating for a feminist approach to music therapy, perhaps it is
most useful when we can try to keep in mind that power and its antecedents are
experienced in different ways by different individuals and groups. Something
that is evidence of an oppressive power operative in one context might be

necessary for freedom and safety in another.9 There can be no coherent “project”
of “our position” or “our stance” as feminists. As music therapists, if we want to
think about and even use feminist theory in our work, we must be able to
consider alternate points of view, challenge ourselves and each other, especially
when the thought-killer of hegemony makes an appearance, and we must try our
best to be self-critical without being self-destructive.
For the past two decades, bell hooks has been one of the voices arguing
this point that feminism can never be experienced or acted upon in the same way
by everyone. She has been a strong advocate for re-theorising feminism,
challenging white middle class women that our ideas about patriarchal power
and its redistribution need critical reappraisal. In particular, the critique of the
normative assumption of the objective mind being that of the white, educated
male by some feminist theorising does not stand up to scrutiny from hooks who
argues that in the new imaginary of self-within-society advocated by some
feminists, the normative male is just being replaced by the normative female.
One straightjacket replaced by another.
Voices of women such as hooks who are not white and/or middle class
have been asking “who is this revolution for?” The “solidarity project” of
second wave feminism—the view there is a sisterhood across the world and we
unite hands to stand together against oppression—has received serious criticism
on the basis that to be in solidarity one needs to have some experience that is
like the sisters one proclaims to stand for and beside. For women who have
more than one aspect of identity or personhood that jeopardizes their access to
power, focussing on trying to make one part better might even make another
worse.
While hooks offers a particularly difficult critique for the ears of white
middle class women such as myself who call ourselves feminists, she also
challenges the contribution of postmodernism which she points out is dominated
by white male intellectuals. For hooks, postmodern writing and thinking is
problematic as a means to pursuing a radical agenda, in spite of the alignment of
the postmodern theorist with the idea of “other.” In her view postmodernism is
caught in a bind: on the one hand it has limitless potential for liberating the
academy from its exclusivity and adherence to the idea of a superior master
9
I volunteered to attend a series of focus groups in one workplace where a staff conduct
manual was being developed. The members were absolutely convinced that raising your
voice was always undesirable behaviour and constituted bullying. I tried to make a case
that in a dangerous situation, shouting out a warning might save a person’s life and that
some people can be vicious and cruel with a low sounding voice and a smile on their
face. I could not persuade them to change their mind.
384 Jane Edwards
narrative, but on the other postmodernism is interpreted and claimed by the

expertise of the scholar. As she wrote about postmodernism (1990):
As a discursive practice it is dominated primarily by the voices of

white male intellectuals and/or academic elites who speak to and
about one another with coded familiarity. Reading and studying their
writing to understand post-modernism in its multiple manifestations, I
appreciate it but feel little inclination to ally myself with the academic
hierarchy and exclusivity pervasive in the movement today.
We might keep in mind however that hooks suggests that if we give up the
modern conception of the self as embodying an essence, we can begin to more
successfully emphasize the significance of the authority of experience,
especially the experience of oppressed people. Ultimately, if feminist practices
are to root their way more deeply into music therapy, this is possibly the best
gift awaiting our renewal as a professional group. A harnessing of the capacity
of music, whether precomposed, improvised, or composed in sessions to author
and honour the experience of our clients, is part of the unique power available
within music therapy processes. One of the greatest capacities of professional
therapy facilitation through music is to come alongside clients into a new realm
of self-determined agency, sometimes even from the source of our and their
anger and rage about their circumstances.
SOME FINAL THOUGHTS
Most feminists recognise that power is not just something one has and another
doesn’t but is something constantly negotiated between actors in a range of sites.
It is important that we can admit though that in many cases our clients have
almost no access to power as regards their circumstances or conditions.
Sometimes their very opportunities to have better circumstances might be
sabotaged by ideas of inferiority and nothingness that we have worked hard
alongside them to challenge and even re-form but nonetheless are perhaps
etched onto the visual landscape of the housing estates in which they live, the
newspaper headlines that reflect their identity as problematic, and the lack of
expectation from others about their future. You might ask whether you live
beside anyone who could be a potential client of yours?10 Do you socialise with
10
A New York colleague in feedback on this chapter wrote “in New York everyone is a
client” in response to this. I am however living in a country where the privileged and the
people who have the same difficulties as your clients? Are you in a church
group, social movement, local government committee with anyone from your
client group? How represented is your client cohort in your acquaintanceship, in
your life? I can ask myself exactly the same questions and squirm as I think
through my answers.
On the one hand we can talk about the importance of boundaries all we
like, but on the other we have to admit that they may have a self-serving
function as a way to turn around our discomfort that not only is it the case that
our clients do not have the same access to power that we have but, as well, they
have almost no chance of ever achieving economic or social equality with us.
Sometimes at social functions in Ireland, the UK, or Australia when people
mock or become angry about social inclusion measures, or measures to ensure
representation of women or minority groups, I can scarcely contain my rage and
anger and, ultimately, despair. It seems axiomatic that white middle class people
will see their own effortless privilege as normal. They worked hard for what
they have and if only others would work hard, they could have it too.
At the same time I can accept criticisms, such as those by Bordo (2003), of
an emerging non-reflexive postmodern view that finds all situations have
potential for resistance and subversion. This might seem perfectly reasonable for
the person sitting behind their laptop in the developed world, but for the Thai
prostitute indentured to a pimp from her early teens and beaten and demeaned
regularly with no chance to pay off her debt, resistance and subversion should
not be assumed as available options (see Bales, 2002).11
I also appreciate that many music therapists I come into contact with feel
disillusioned at their own lack of power as evidenced by their poor pay and
conditions, and poor access to arenas in which they can negotiate for change.
Often a music therapist will leave a poorly paid, inadequately resourced post and
another music therapist will apply for it. Thus, we seem to be reluctant to create
conditions that challenge this consciousness. Perhaps we need permission to see
the relationship between our own agency as professional and corporate citizens,
and the agency of our clients. It is therefore exciting to hear of new initiatives
for change such as that state-registered music therapists in the UK are now paid
on the same level as clinical psychologists, and the recent recognition of music
disadvantaged live completely separate lives, and where the music therapy work I am
helping to develop is concerned with professional service to a large degree within
disadvantaged communities.
11
Interestingly, in his chapter on child slavery and prostitution in Thailand, Bales
describes how the economic boom that caused the increase in demand for prostitutes has
also meant that Thai village girls, through watching the TVs bought with money made
from the sale of their older sisters or cousins, are no longer so easily duped into accepting
their family demands that they be sold to a dealer.
386 Jane Edwards
therapy as a professional organisation in the EU. I hope this recognition can help
us to feel more valued and heard, and in turn be more effective advocates for our
clients.
Naomi Wolf has proposed that women have inherited “power-shy reflexes”
(Wolf, 1993). Wolf’s thesis is that we/I retreat when we feel that our corporate
or professional likeability might be compromised by the collective aversion to
women being anything other than polite, demure, deferential, and constantly
fascinated by male opinion and behaviour. She suggested this is especially true
for middle class and wealthy women with our access to a voice in a range of fora
such as the workplace, the community, and political life, that is, arenas where
attitudes, opinions and even policy and legislation might be changed. I state this
here as a challenge to us to stop being so “nice.” If things are to change,
sometimes the political will get personal. I keep a card on my bookshelf that
states “well behaved women rarely make history,” a catchphrase coined by
Laurel Thatcher Ulrich. Perhaps we/I can take more opportunities to realise that
people who don’t like us probably dislike most other people who are considered
intelligent, influential, and are forthright in their expression of views.
A feminist approach to music therapy will not always be gentle, calm,
and/or polite. Perhaps this is why it has taken so long for many of us in music
therapy to name and claim a feminist stance. Let’s value what a feminist
perspective can bring to our professional lives remembering that for change to
happen, strong feelings might need to surface. We expect and support these
changes in our patients; it’s time to also expect them in our profession.
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Baines, Susan (2003) A consumer-directed and partnered community mental
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of feminist discourse(s) to music therapy theory [Online] Voices: A World
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388 Jane Edwards
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feminist theories and women’s health. Women’s Studies International
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READING 16
Garred, R. (2006). Four Excerpts: Music as Therapy: A Dialogical Perspective, pp. 1-38, 67-88, 102-126,
127-147. Gilsum NH: Barcelona Publishers.
Chapter 1
FRAME AND PICTURE

Rudy Garred
Within the field of music therapy there has for some years now been a
debate on the issue of music-centered therapy, what this implies, and
what the theoretical grounding for such therapy should be. In this book, I
want to relate to this discussion, and present a contribution. The thesis
that is put forward is that a dialogical perspective may serve to frame
such therapy, and to indicate its potentials. My aim is not to develop
some theory for all of music therapy, but to articulate theory specifically
for music-centered therapy, or for music as therapy, which is the term I
will prefer to use here. In the following introductory chapter, I will
present some of the different positions within the discussion as it has
developed thus far, and some of the main arguments used, to prepare the
ground for a further exploration.
THE TERM “MUSIC THERAPY”
Who may benefit from music therapy, and how? When and why should a
person be receiving music therapy? What would indicate a—more or less
acute—need for music therapy, and when would there no longer be any
such need? What indicates that music therapy is successfully completed?
There do not really seem to be apparent and ready answers to these
questions. The title of the profession of music therapy may lead to
confusion. Contrary, for instance, to speech therapy, physical therapy, or
even psychotherapy, for which in each case it is clear to where the effort
is directed—to the speech, the body, or the psyche—In broad terms,
music therapy does not have a clear such designated area (Ansdell, 1995).
It may seem that music therapy is another kind of story as far as therapy
goes. There is an inherently different logic of terms in this phrase, which
rests upon the direct focus on the therapeutic medium itself. Music
therapy, according to its own terms, is defined primarily by the medium,
2 Music as Therapy
rather than by the particular area of its application. The logic of the term
points to qualities of the medium itself as being therapeutic, rather than
what it specifically is therapeutic for. As a descriptive term music therapy
is about the benefits that may come from applying music therapeutically,
rather than it being directed specifically toward any particular, predefined
ills or problems.
This characteristic could probably account somewhat for the more or
less chronic identity problems very often, or almost invariably,
encountered by music therapists (Bruscia, 1998a). On the other hand, it
might also account for the creative diversity of application within a wide
and growing range of fields. The identity of music therapy may be
difficult to pin down or to explain in any simple terms, but it also seems
to have an inherent creative dynamism as an idea which apparently is far
from exhausted. Maybe the tensions of identification, which are not so
easy to resolve, at the same time also keep driving the field onward into
new uncharted territories?
Music-Centered Therapy
The difference in the internal logic between these terms of therapy is not
altogether clear-cut, though, because the term “psychotherapy,” for
instance, may be defined not only as a treatment specifically for the
psyche, but also as “the treatment of mental or emotional problems by
psychological means” (Merriam Webster's Collegiate Dictionary 1999).
Psychotherapy as a term not only indicates the area of treatment, but also
the means, which are psychological. Music therapy as a term likewise—
and primarily in this case—indicates the means, which are musical. But
what does this imply, a therapy by “musical means”?
A classic and recently reissued title within the field is Therapy in
Music for Handicapped Children by Paul Nordoff and Clive Robbins
(2004). As Kenneth Aigen (2005) relates, the wording “therapy in music”
in this title was a deliberate turn of phrase of the title of a much used
textbook at the time, Music in Therapy, edited by E. T. Gaston (1968). In
the book Music for Life: Aspects of Creative Music Therapy with Adult
Clients Gary Ansdell (1995) presents cases from his own work, which he,
in accordance with the approach of Nordoff and Robbins, considers as
Frame and Picture 3
“therapy in music,” supplementing with cases from several other music

therapists whom he considers to belong under this same heading. The
phrase “therapy in music” may indicate therapy coming as a direct result
of being engaged in musical activities, rather than music being a part of
some extrinsic system of therapy and playing a subordinate role or
function – in which case we would have “music in therapy,” according to
Ansdell.
Ansdell’s basic stance is that music therapy “works the way music
itself works” (p. 222)—that is to say, the results of music therapy are
essentially of the same kind as music achieves for all of us. A natural
consequence of this view is that the way music therapy works will be the
same for anyone, whether he or she be a handicapped child or a trained
musician.
A clear instance of “music in therapy,” according to Ansdell, in
contrast to his own approach, is music used within a psychotherapeutic
model. The main difference between these two, he finds, is in the role of
music in relation to words. In music psychotherapy, the function of music
is to facilitate words; the musical experience is seen as bringing forth an
occasion for verbalizing, in which the “real” therapeutic work takes
place. Psychotherapy, even when integrating music, still remains
essentially a “talking cure,” Ansdell maintains. His own brand of
“therapy in music,” on the other hand, is a “purely music” therapy, not
dependent on verbalization for its effectiveness.
Analysis and Synthesis
To clarify the difference regarding the role of words in therapy, Ansdell

makes a further distinction between processes of analysis and of
synthesis.He cites musicologist Victor Zuckerkandl: “Words divide, tones
unite. The unity of existence that the word constantly breaks up, dividing
thing from thing, object from object, is constantly restored in the tone”
(Zuckerkandl, 1973, cited by Ansdell, p. 30). Psychotherapy is rightly
called a process of analysis, using words to divide, to take apart our
personal construction of the world, examining our experiences, our
thoughts and feelings, by the use of verbal language. By working through
language, psychotherapy “works the way language works,” Ansdell
4 Music as Therapy
claims. The way words are used to tell about past experience through
verbal narrative, and subsequently to interpret, through redescription, is
characteristic of the way language works in taking apart, in analyzing.
In contrast to such analysis, Ansdell sets up a process of synthesis,
which may be found in the way music works. “If words take us apart,
then music puts us together – physically, emotionally, mentally, and
socially. It acts to synthesize, not to analyze,” Ansdell proposes (p. 31),
and he points out that it is not necessary for the client to have verbal
competence in order to receive therapy on this kind of basis. This was a
crucial characteristic of the model as it was initially developed, because
many of the handicapped and psychotic children that the originators Paul
Nordoff and Clive Robbins worked with often had little or no language.
Music became a nonverbal bridge to meaning and communication.
Ansdell does not simply maintain the possibility of a “purely
musical” therapy, where the therapeutic locus remains within the musical,
a therapy based on the power of music itself. He also regards this therapy
as a form of music-making, rather than a musical form of clinical therapy.
Therefore, it is not answerable to another system. Ansdell does not want
to depend on what he calls “extra-musical theory” to describe what
happens in music therapy, because the focus of attention then might move
away from the musical component of therapy and onto the conceptual
system of whatever approach was being used. He is worried that the
music then might tend to become “deleted.”
Music Problems
In a recent elaborate statement on music-centered thinking, Kenneth

Aigen (2005) picks up on Ansdell’s notion that music therapy works the
way music works, and extends it in the following manner: “In music-
centered music therapy, the mechanisms of music therapy process are
located in the forces, experiences, processes, and structures of music” (p.
51). Aigen thus centers on music from four dimensions: the
philosophical, related to the discussion of the nature of the musical
material; the psychological, related to aspects of musical experience; the
social, related to contexts of use; and the musicological, related to how
music is constructed and what this can tell about its clinical value.
Frame and Picture 5
In developing a music-centered theory, Aigen refers to Zuckerkandl,

and specifically his notions about how listeners hear dynamic qualities in
tonal relationships that create a sense of motion, through changes of
tension and equilibrium, within a dynamic field. Aigen juxtaposes this
perspective with Georg Lakoff and Mark Johnson’s linguistic schema
theory, which is based on the notion that all human conceptual thinking,
by which we understand and act in the world, is fundamentally
metaphorical in nature. He applies this theoretical perspective to music to
indicate how musical experience may be therapeutically relevant by
facilitating different basic experiences of schemata, which some clients
may not easily obtain otherwise, experiences that may be
developmentally and functionally significant to obtain.
Aigen furthermore argues that for the music-centered practitioner
“musicing”1 is considered an essential human activity, bringing unique
and valuable rewards. And a dearth of opportunity for music may itself be
considered a reason for coming to music therapy, he claims. It may
indicate a specifically musical problem. So instead of contrasting music
therapy with, for instance, speech therapy and physical therapy, Aigen
sees rather a clear analogy here:
No one questions the fact that a person goes to a speech therapist

or a physical therapist because of a deficit in the communication
and physical functioning. In a sense that is more than fanciful,
music-centered thinking can support the notion that a legitimate
reason to come to music therapy is because of a deficit of music
in one’s life. (p. 127)
In Aigen’s proposal for a music-centered thinking about music therapy,

musicing is the goal, not only the means, and does not need justification
beyond this. The area of therapy is thus actually indicated as being
1
Aigen uses music educator David Elliot’s term here (Elliott, 1995).
6 Music as Therapy
musical – music therapy as literally music therapy, related to what

actually must be considered music problems.
THE NEED FOR VERBAL PROCESSING
This is not a necessarily generally agreed upon position. The music-

centered stance has generated at times a rather heated debate. Elaine
Streeter (1999b) has delivered a stark critique of a music therapy that
confines itself to purely “musical awareness,” not taking into due
consideration what she calls “psychological thinking.” A balance is
needed between these two, she insists. And there are several
psychological theories to choose from, whether they are developmental or
psychodynamic.
To illustrate her point, she applies some basic psychoanalytic
concepts on two case studies from the literature, one from Ansdell’s book
referred to previously here, about a woman with Down’s syndrome, and
one from Colin Lee’s case study, Music at the Edge: The Music Therapy
Experiences of a Musician with AIDS (1996), which also represents a
music-centered position.
Streeter’s aim is to show how these cases might have benefited from
applying the concepts of transference and countertransference. She
actually questions the safety of the clients in therapy if the therapist is not
taking these matters into due consideration. A “purely musical”
perspective does not adequately address the distinction between therapist
and client, she claims. The therapeutic boundaries tend to become
blurred. Streeter takes Lee’s case study in particular as an example of
this, where the therapist during the course of therapy with a patient dying
from AIDS, on the patient’s request, concords to becoming a friend,
rather than continuing as a “therapist.” Streeter holds this to be untenable,
and sees it as a consequence of not having therapeutic boundaries held
sufficiently clear.
Instead of the “purely musical,” Streeter proposes alternatively that
musical improvisation can be likened to free association, and that just as
in the case of free association, the material coming out from this should
be processed verbally in order that insight could be gained, which is to
Frame and Picture 7
say, making the unconscious conscious, which is what she considers

therapy should be about.
Streeter is vehemently opposed to any music therapy being aimed at
“merging” with the client. Descriptions from case studies suggesting a
unity between the therapist and client in the musical improvisational
experience she considers alarming, because merged states may equally be
related to pathological as well as to developmental experience. She warns
that such merged states, though having a developmental function, if not
psychologically processed by the therapist, “are potentially dangerous
states of mind where no objective thinking can take place, and a loss of
self may result” (p. 11).
One might question whether Streeter, warning against a potential
“loss of self,” is here actually implying that Nordoff-Robbins music
therapy might lead to psychosis if not properly processed through the
application of psychological concepts. She does not report any instance or
record of this, although she continuously does refer to the “safety” of the
client if such processing is not included. What in any case is clear is that
she insists on the necessity of psychological thinking in balance with
musical awareness, a balance she finds lacking in much of the current
theory and practice of music therapy, based on what she calls “musical
awareness.”
Questioning the Need to Verbalize
Streeter’s critique has been met with objections. Sandra Brown (1999)
remarks that improvisation is not quite the same as “free association,”
needing to be monitored externally, but entails its own processes. In
music therapy, there may be moments when music appears to take on a
life of its own, through the experience of creative freedom. In this, she
finds that music may offer something more:
… an enabling of creative flow, of putting us in touch with our

larger ‘self,’ our creative source, and the possibility of bringing
that into balance with our rationality and ego (S. Brown, 1999, p.
67).
8 Music as Therapy
Brown sees two avenues of therapy, depending on client group and

individual needs, involving either the development of ego-structures or
else the loosening of these, bringing forth a “refinding,” as she terms it,
of the depths of the “self.”
In another reply, Aigen (1999) questions the relevance of the
psychoanalytic model as recommended by Streeter. Contrary to Streeter’s
accusation of music therapists not monitoring their own role as therapists,
Aigen points to the practice within Nordoff-Robbins music therapy of
reviewing the recordings of every session, and creating detailed written
indexes of these sessions. This brings about intense self-scrutiny, through
a “phenomenological, non-interpretive experiencing of the music”
(Aigen, 1999, p. 78). He also questions the validity of the psychoanalytic
outlook when it comes to creative experience. Along similar veins as
Brown, he takes up the issue of ego-boundaries, and maintains that
creative process has not been handled well by psychoanalysis,
particularly in its “classical” form, because the loosening of ego-
boundaries and the associated experiences of unity have tended to be
viewed as phenomena of regression. And although in more recent theory
the concept of “regression in the service of the ego” has been developed,
Aigen questions the use of the concept as such, stating that this is the
psychological process “to which many of humankind’s grandest
achievements often get reduced in psychoanalytic theory” (p. 80). Aigen
is on the whole not satisfied with any psychologically derived, imported
theory whose primary mechanisms relate to the analysis of relationship
dynamics or unconscious material, to explain how and why music therapy
works.
Aigen further remarks on Streeter’s critique of Ansdell’s (1995) case
study of Emanuella, a woman with Down’s syndrome who followed a
repetitive pattern of initial resistance before joining in on the musical
improvisation during each session. Streeter complains that no attempt
was made, evidently, to think in psychological terms about the biography
of the client, and of her relation to the therapist, and of how her resistance
might have been processed in such a way as to relieve her of anxiety.
Streeter regards this to be a crucial aim of therapy, and even though she
recognizes that there is a temporary experience of freedom from
resistance, she nevertheless proclaims: “Of course, many of us are aware
Frame and Picture 9
of the temporary nature of such freedoms, clients returning again and

again, as this one did, with their resistances unprocessed” (p. 7). To this
Aigen laconically replies: “I could make the opposite anecdotallybased
claim from Streeter: That is, that many of us are aware of clients who
have had their resistances analyzed ad nauseam without having any
concomitant personality change” (p. 81). Aigen otherwise questions
whether the insight into one’s unconscious dynamics actually is an
appropriate goal for a middle-aged woman with Down’s syndrome, or for
a man, as in the case story narrated by Lee (1996), facing the end of his
own life.
The stances have remained quite opposed to each other. On the one
hand the insistence on the necessity of “psychological thinking,” and of
verbal processing for actual therapy to take place, and on the other the
stress put on the significance of the musical experience itself.
“Psychodynamically Informed” Music Therapy
Could there be a middle ground? Helen Odell-Miller (2001) has

advocated what she terms “psychoanalytically informed” music therapy.
This is a position that recognizes music therapy as a “discrete entity in
itself,” within which therapy takes place. It is not just an adjunct to some
other kind of therapy. Psychoanalytic concepts may nevertheless be
drawn on, to inform the practice:
These concepts are integrally bound up in a method in which

music, thinking, and talking are of equal importance and are
bound together to produce an emergent music therapy approach
in its own right. Music can have a preverbal, a holding function, a
supportive function, an “action leading to thought” function, all
of which can lead to some change that otherwise may not have
occurred without the music. (p. 152)
Such an “emergent music therapy approach” is not simply another form

of psychotherapy, with music included, but an approach in its own right,
in which music remains central, according to Odell-Miller. She contrasts
this approach with a more traditional approach to “music psychotherapy,”
10 Music as Therapy
in which music serves merely a subordinate function to the words:

psychotherapy with music.2 For practicing as a psychoanalytically
informed music therapist one has to be both a highly trained musician and
a therapist, Odell-Miller points out, but not necessarily a fully trained
psychoanalyst. This brand of therapy is informed by, not completely
identified with, a psychodynamic approach. Odell-Miller in effect takes
sides with Streeter, in claiming the need for “psychological thinking” in
music therapy, but still aims to retain the uniqueness of the discipline.3
Still the question remains as to whether this attempt at reconciling
the two stances could be accepted by both sides as a solution. Free
improvisation in music therapy, according to Odell-Miller, as also
Streeter suggested, could be seen as similar to free association and to
free-floating attention in psychoanalytic work. And as such, she proposes,
it could be interpreted through a fluid movement between music,
thinking, and words, not dividing them into separate parts. But this is
precisely the point to which Ansdell presumably would object. There is a
crucial difference, he states, between music therapy in which music is
related to just as it is, and music-psychotherapy, which is directed toward
making interpretations of music through the use of words.
Implicitly opposing the “music only” position, Odell-Miller writes:
“However, my concern would be that, particularly when the patients can
speak, half the process is missing if there is no room for talking and
thinking” (p. 145). But this wanting to include both aspects, not just
“half” the process, although sounding rather plausible, is maybe too
simple, because the differences between the stances, apparently, are other
than just including “talking and thinking” to make therapy complete.
2
Odell-Miller sees this represented by the French psychoanalyst and music
therapist Edith Lecourt (1992).
3
A question that might be raised here, though, again regarding the “safety” of the
clients, which Streeter was much concerned about, is what applying
psychodynamic concepts for verbal processing, in an “informed” rather than
fully qualified way, actually implies for the clients.
Frame and Picture 11
What proponents of a “musical awareness” approach are seeking to

establish, it seems, is the possibility of a music therapy that does not
necessarily have to use words in a psychodynamic, analytic way, relying
more on what is considered to be the synthetic power of the nonverbal
medium of music itself. What the suggestion from this side then basically
amounts to is that not all music therapy necessarily has to be based on
such verbalization for its effectiveness.
Recent Analytical Developments
It has to be underlined that an insistence on the use of verbalization is not

necessarily representative of the whole psychodynamic field. Many
analytically oriented music therapists clearly have moved beyond the
position of classical psychoanalysis. Bonde, Pedersen, and Wigram
(2002) refer to a discussion within psychotherapeutic circles on whether
therapy can rightly be described as “analysis” when interpretation and
insight no longer are central curative factors. This actually resembles the
debate within music therapy on whether verbal processing is necessary
for therapy to take place. A more recent focus of psychoanalytic
treatment on regressive illnesses has caused some psychotherapists to
suggest that the classical understanding should be supplemented with a
developmental psychological frame of reference, implying an
understanding of the therapist/client relationship as a healing potential.
Rather than interpretation for insight, techniques such as “containing”
(Bion), “holding environment” (Winnicott), and “affirmation and
emphatic identification” (Killingmo) are used. This represents an
affirmative approach, which eventually may be followed by more insight-
oriented therapy.
These more recent approaches, representing a gradual paradigm shift
via object relations theories, ego-psychology, self-psychology,
interpersonal theories, and interactional theories, offer a more nuanced
picture with regard to the use and function of verbal processing in
therapy. “Implicit” or “tacit” knowledge becomes an important aspect of
the therapeutic process according to these newer developments, which
have contributed much to the understanding of relational processes in
psychotherapy.
12 Music as Therapy
Bonde, Pedersen, and Wigram consider that these new approaches

may be more easily applied to the practice of music therapy. They refer to
Daniel Stern’s theory about preverbal interaction, which contains many
of the same communicative elements as music, such as tempo, rhythm,
tone, phrasing, form, and intensity. This similarity, the authors suggest,
may support the assumption that musical improvisation and listening can
reflect and activate relational patterns and senses of self. And these
implicit experiences cannot be explicitly verbalized, they stress.
Language may actually create a distance to the preverbal sense of self.
Music as a nonverbal medium may well be better suited for expressing
these relational aspects:
The theory also implies that transformation of these basic

patterns can also take place without words. We believe, in
addition, that in some cases these patterns may actually be clearer
in a nonverbal or musical context (p. 88).
The issue of verbal processing as a necessity is clearly not as sharply

focused within the entire field of analytically oriented music therapy,
then. Still, there seems to be some way to go before a complete alignment
of a “purely musical” approach with an analytically oriented music
psychotherapy would be achieved and accepted by both sides. Music
may, in the light of these later psychodynamic developments, be
considered as associated or fused with relational aspects of therapy, but
though this certainly creates some space for musically based, nonverbal
processes within such therapy, it is hardly acceptable, as seen from the
music-centered side, as a solution to all that a “purely musical” approach
would entail. And certainly the use of music and verbalization is still a
crucial part of any analytically oriented approach.
DEVELOPMENT OF THEORY
If one approach is not simply subsumed under the other, either way, the
question is what kind of thinking to apply then to a music-centered
therapy. “Thinking” is not generally, or exclusively, the same as
psychodynamic conceptualizations, which of course are not in themselves

neutral and objective. Psychodynamic theory is not “thinking” simply, it
is a particular kind of thinking, a particular outlook. Granting that
psychodynamic concepts are not simply the truth, what alternative views
might serve as a basis for music-centered therapy? It is interesting to note
that Nordoff and Robbins (1972), in accounting for how they developed
their method, report a lack of psychological theory as an advantage for
their first work at Sunfield Children’s Home in Worcestershire:
The openmindedness of the professional staff to the research in

music therapy and the absence of any restricted system of
psychological thought facilitated a wide perception of the scope
of musical influence and the formulation of several working
concepts (p. 19).
An absence of “psychological thinking” was present right from the start

then, and happily so, apparently! Nordoff and Robbins actually did not
have any well-rounded, comprehensive theory at the outset. They
developed their approach mainly on a practical, creative basis, although
they did write books, naturally, and held courses, formulating notions
about what they were doing. And they necessarily did have some notions
about “therapy,” and certainly some notions about music and how it
might be applied in working with handicapped children.
But although they in a certain sense initially were atheoretical, at
least in not being unduly “restricted,” as they called it, by preconceived
notions, this state of innocence is hardly tenable in the long run within a
discipline. The task is to develop theory that “fits,” that contributes to
increasing the understanding of practice, and that may legitimatize
practice, and that even may serve to point directions for future practice, to
inspire, and to envision. And if theory is considered to just get in the way,
this is actually also a theory, about how certain notions and
preconceptions may contribute to confuse or misrepresent, to inhibit
rather than release creative practice.
14 Music as Therapy
Early Interaction Analogy
And indeed some theory has since been developed. Pavlicevic has made a
significant contribution, based on early infant interaction research. She
has proposed the concept of dynamic form, which she has developed over
several years (1990; 1995a; 1995b; 1997). In one of her more recent
statements of this theory, “Dynamic Interplay in Clinical Improvisation”
(2002), Pavlicevic also addresses more specifically the debate on the
position of words in relation to music in music therapy.
Pavlicevic refers to Stern’s theory of “vitality affects,” which are not
categorical feelings themselves, like fear, anger, joy, and grief, but rather
the forms of feelings, in a more abstract sense—how feelings may be
“surging,” “fading away,” “fleeting,” “drawn out,” etc. These are
crossmodal—that is to say, the same forms may be perceived as similar
across different expressive modalities, between sound and gesture or
movement, for instance. Pavlicevic says that she would like to call these
“dynamic forms,” and suggests that they may be found within musical
interchange. They may be considered as the basis for communicative
musical improvisation.
Pavlicevic also relates to Trevarthen’s concept of “intersubjectivity,”
which could be regarded as almost synonymous with playing music
together. Musical terms may be used to describe what is happening in
early interaction regarded as intersubjectivity:
When the relationship is intersubjective, both infant and mother

initiate, complement, and respond to one another in a highly fluid
and intimate dance, within which their internal states resonate
with one another through their apprehending one another’s
dynamic form. This “dance” has all the complexities and
subtleties of a musical improvisation duet, and includes
expressive features of tempo (e.g., accelerando, rubato,
ritardando, allargando, ritenuto); of dynamics (e.g., sforzando,
crescendo); of timbre (e.g., changes in voice quality), and of
pitch (melodic contours and harmonic colour). (Pavlicevic, 2002,
¶ 8)
“Dynamic form” is what is exchanged intersubjectively in musical

improvisation, and through which interpersonal relationship is
established. This relationship has no need for words, Pavlicevic
maintains. What is crucial is the interactive potential of the
improvisation, which may be sensitively “stretched” by the therapist, to
facilitate further development:
The joint improvisation provides an opportunity to make

dynamic form, to try out new bits of them, to recombine them
and to make new patterns. This is the therapeutic process in
clinical improvisation (¶ 28).
Pavlicevic regards it as a major strength of improvisational music therapy

that the dynamic form of emotion emerges instantly and in sharp focus
within the musical relationship, without having to assign referential
meaning to these forms, and she warns that in attempting to speak about
the improvisation, “the profound and complex emotional experience may
be reduced to satisfy the semantic limitation of words” (¶ 30).
In relating to the debate on the position of words in therapy,
Pavlicevic does not want to dismiss the value of spoken interchange, as
patients frequently do make spontaneous comments after improvisations,
but she regards verbal interchange as adjunct to the musical relationship.
It may be necessary to use words to check the patient’s experience and
feelings, not least in early sessions. Words as such are not prohibited or
ruled out from therapy. Still it is not a primary medium. Pavlicevic
maintains that an extensive verbal relationship may confuse the musical
relationship. Verbal relationship reveals its own dynamic forms, not
necessarily corresponding to those elicited through improvisations. And
attempting to develop two concurrent relationships may hinder both, she
maintains.
Pavlicevic nevertheless clearly acknowledges the possibility, on the
other side, of music being adjunct to verbal therapy. Music in this case
may serve as a vehicle for verbalization. The main point for Pavlicevic is
to establish a ground for the possibility also of music therapy in which
verbal interchange is adjunctive, as an alternative to verbal
psychotherapy, in which it is the music that is adjunct.
16 Music as Therapy
Not the Same as Music
I think that Pavlicevic has pointed very precisely here to a crucial issue
with regard to the relation between words and music within music
therapy and verbal psychotherapy, respectively. Still, there is more that
could be said about the difference between these two positions regarding
the necessity of verbalization. This is more than a question simply of
music being adjunct to words, or of words being adjunct to music,
switching these two whatever which way one may want. The difference
between the two media, language and music, as they relate in different
ways to the therapeutic process, must be explicated further, to meet the
challenge of the proponents of the necessity of verbal processing, I
believe. They are not simply interchangeable with each other, in such a
way that they both could be used alternatively to achieve the same results,
either way. There is somewhat more of a difference between them.
Furthermore, although the parallels to early infant interaction may be
striking, there may be reason to be cautious using this analogy. There
clearly are limitations to early interaction as a theoretical basis for music
therapy. Pavlicevic herself actually warns precautiously against too literal
a comparison. The nonverbal communication between mother and infant
is not the same kind as that between music therapist and client. And on
the other hand a music therapy situation does not recreate the early
mother-infant situation for the client (Pavlicevic, 1997).
It may be pointed out that although early interaction in many ways
resembles musical improvisation, it is not itself what is generally
considered to be music; it is not counted as a form of music in the general
usage of this term. It is maybe like music, and musical improvisation is
maybe like early interaction in some ways, but there is certainly more to
music as music than this resemblance or analogy to early mother-infant
interaction.
New Musicology
Ansdell (1997; 2001) has questioned why music therapists seemingly

have taken so little notice of the latest thinking about music itself. Too
little attention has been given to how the efficacy of music therapy is
determined by the specifically musical, he maintains. Musicology, as the
systematic study of music itself, would seem relevant to consider for
music therapy theory. Ansdell refers to Colin Lee’s writings on the matter
(Lee, 1992, 1995, 1996, 2000) as an exception. He acknowledges Lee as
being in the forefront of a musicological perspective as this relates to
music therapy, but nevertheless finds his approach to be problematic in
that it is bound up in what he terms “traditional musicology,” which
focuses on structural analysis of the music. This, in Ansdell’s view,
results in not managing to establish a sufficient link to the experiential
side of music therapy practice.4
But now, Ansdell points out, recent developments in musicology
have ventured to place music within a wider setting, as a process rather
than a structure, intimately tied to human affect and meaning. Music is
viewed as participatory and inherently social, determined by culture and
context. It is considered as performed, live, improvised, and personal.
And such assumptions are readily aligned with basic tenets of music
therapy, Ansdell suggests. He also points to the relevance the other way
around – of music therapy for the “New Musicology,” as a virtual
laboratory of new ways of practicing and understanding music. Ansdell
sees a great potential in the mutual awareness between music therapy and
New Musicology, which could bring about a cross-fertilization between
the two fields.
A concept which for Ansdell perhaps encapsulates the central thesis
of the New Musicology is Christopher Small’s Musicking (Small, 1998).
Regarding music as a verb rather than a noun quite effectively directs the
attention toward the performative rather than the structural aspect of
music, which makes this concept highly relevant for application in
theoretical perspectives on music therapy. The word “musicking,” in
Small’s terms, emphasizes the social practice of doing music, and one
4
Lee has since then made an extensive statement of his own approach in the
book, The Architecture of Aesthetic Music Therapy (Lee, 2003).
18 Music as Therapy
variety of musicking might well be music therapy. The term “musicking”

could therefore be a way of conceptualizing music therapy practice,
Ansdell suggests.5
Ansdell’s contention is that the theory of music therapy, in the
continuing struggle to demonstrate the efficacy and legitimacy of the
practice, has concentrated on allying musical practices to
psychotherapeutic, medical, and learning theories, showing more interest
in allying music therapy to established therapeutic and clinical models of
thinking rather than considering more closely the characteristics of the
musical aspect itself, which have been taken more or less as given. He
finds it vital to keep up with the latest critical thinking on the subject of
music, as many of the issues in music therapy theory have their origin at
least as much in issues within music as within therapy. In this way, he in
effect is actually taking the opposite stance regarding the balance of
music therapy theory as Streeter, and saying that the need is not so much
for more “psychological thinking,” as Streeter calls for, but for more
musicological perspectives, more musical thinking, finding the recent
development of New Musicology to be particularly relevant and
promising here.
Nevertheless, even though the concept of musicking is wider than
more structurally focused notions of music, as found within traditional
musicology, the question is whether this could be considered enough for
the kind of “thinking” needed within the practice of music therapy. The
relevance of the concept of musicking seems quite indisputable. But
music therapy is not simply just another form of “musicking.” The
concept of musicking, although it may considerably widen the view of
what music is about, does not itself entirely solve the “case” of music
therapy. No matter how comprehensively and elaborately such a concept
5
There is a somewhat different focus between Elliott’s term musicing, which
relates more to the personal significance of each individual engaging in music
activity, and Small’s term (spelled with an added “k”), which implies more of a
social, cultural perspective.
might be developed, it retains its primary focus on music, whereas music

therapy, after all, according to its own terms, presumably has to be
recognized as some kind of therapeutic practice.
Health Musicking
Stige (2002a) has apparently sensed such a limitation and launched the
term “health musicking” as part of a proposed (re-) definition of music
therapy. He relates this term to a distinction that needs to be made in
defining music therapy on the different levels of discipline, profession,
and practice. Stige would want different words to cover these different
levels, not just “music therapy” for discipline, profession, and practice,
and plays with the thought of what he would call the discipline level “if
there was no history and we could start all over,” proposing “health
musicology” instead of “music therapy” as a possible hypothetical term.
What he does come up with as a suggestion is the notion “music and
health,” as a term for the discipline upon which the profession and the
practice of music therapy could be built upon. And in line with this, the
term “health musicking” would constitute a part of the definition of what
music therapy on the level of practice would be about.
This notion is based on a wish for establishing a new discipline, or at
least a redefined one, widened and at the same time even more focused,
“music and health,” which nevertheless does not as yet actually exist (!).
It might seem that Stige is (deliberately?) confusing a critical sociological
term with a descriptive one. He states, for instance, that “the school in
fact could be seen as one of the more important ‘health institutions’ in the
life of children.” From a critical point of view this may be very valid, that
the way schools function in society, in numerous aspects, will have a
great impact on children’s health. But the school is not a “health
institution” in the descriptive sociological sense of the word. It is an
educational institution, to state the obvious.
A basic characteristic of modern society is its differentiation into
various sectors, from out of the confines of families in local communities,
in traditional societies, and into the relatively autonomized spheres of
production, education, health, and culture. Various social institutions are
placed within these larger sectors, which have their own particular
20 Music as Therapy
functions in society, viewed as a whole (Østerberg & Engelstad, 1995).

That the various institutions within different sectors of society may be
regarded critically as to whether they actually do function the way they
are “supposed” to, does not question the reality of this differentiation
within modern society. A distinction between a “health institution” as a
critical or descriptive sociological term has to be made in order not to
confuse this issue, I believe. And a designation such as “music and
health,” in modern society, needs to be related to such a distinction, in
what sense it should be regarded as a critical and/or descriptive term.
“Music and health,” as a discipline, would have to be not only culturally,
as Stige emphasizes, but also sociologically contextualized. A rather
complex matter, related not least to questions of recognition and
legitimatization, and to processes of institutionalization.
Stige’s concern is very much about broadening the field of music
therapy, so that it may become more inclusive, rather than delimiting it
unduly. His attempt at redefining music therapy is primarily about
encompassing the whole field (not least it seems, his own Community
Music Therapy approach), and not as much directed toward sorting out
specific differences between different approaches. The term “health
musicking” will in and of itself, then, not readily serve to entangle the
issues regarding, for instance, the necessity of verbalization within a
music-centered approach.
The Meaning of Words and of Music
Regarding the specific issue of the relation between words and music in
music therapy, Stige has addressed this matter elsewhere (Stige, 1998,
2002a). He refers to Norwegian philosopher Kjell S. Johannessen’s
Wittgenstein-inspired discussion of intransitive understanding, of which
music could be seen as a paradigmatic example. Such understanding
cannot be explained by arguments; the “reasons” that are to be given in
intransitive understanding are further descriptions, based on metaphors,
analogies, comparisons, gestures, etc., presupposing some familiarity at
the outset. Stige asserts that this kind of understanding could be applied
also to language, as well as to music, and on this basis he draws the
conclusion that language and music are not that different in the way
meaning is made. Both are contextual and based on meaning as use. He

refers to a particular sentence in Wittgenstein’s Philosophical
Investigations: “Understanding a sentence is more akin to understanding
a theme in music than one might think…,” and contends that
Wittgenstein thus indicated some similarities between music and words,
and that both might be “polysemic, open, and changing.” Stige then
infers:
So why should not words be an important part of Creative Music

Therapy? Verbal interaction – not as representation of inner
states of affairs, but as mutual construction of meaning – is not
only possible, but a “natural” and potentially fruitful part of
music therapy. (1998, p. 36)
I do think this interpretation of Wittgenstein regarding the difference, or

lack of difference, between language and music could be questioned. (It
is quite a leap from suggesting that there might be a certain similarity
between the way sentences and musical themes are understood, as
Wittgenstein suggests, and to equating the way music and language
acquire meaning.) This line of argument serves rather to blur than to
clarify any distinction between words and music in therapy. I think it is
very hard to come by that there are crucial differences between language
and music, and that these need to be taken into account in any theory of
the role of words and of music in therapy, and their relation to each other.
The aesthetician Susanne Langer (1979) has pointed to what she
regards as a crucial difference between verbal language and music. She
questions whether music has “meaning” in the restricted sense of the
word—that is to say, meaning in the sense usually recognized within
semantics, which includes the condition of reference. Music, contrary to
verbal language, has no assigned meaning to any of its parts in the way
words have, and therefore it lacks one of the basic characteristics of
language, which is fixed association, Langer claims. It does not have any
single, unequivocal reference. Music is not a language, because it has no
vocabulary.
Langer’s theory of language, which is derived from (the early)
Wittgenstein, has been critiqued (not least from the point of view of
Wittgenstein’s later theory, which Stige refers to), but I think her general
22 Music as Therapy
point as to the difference between verbal language and music still holds
in this respect, that the referential qualities of verbal language make it
possible to talk about something other than itself, discursively, which
music, whichever way you view it, cannot be regarded as being capable
of in exactly the same way. And this, I believe, is a crucial difference that
needs to be taken into account in the discussion on the use of words in
relation to music in therapy. That musical meaning is in some respects
also culturally contingent, as words are, is not in itself enough to
extinguish this basic distinction between language and music. Music is
not referential by convention in the way that verbal language is.
Clinical and Music-Based Theories
In his discussion on the meaning of words and of music, Stige does ask
the crucial question, though: “But is language a necessary part of music
therapy? In other words, is a therapy in music possible?” (Stige, 1998, p.
26). He recognizes that the problem or issue is still here. He states that
this cannot be answered with the help of Wittgenstein’s philosophy, but
needs to be related to clinical theories and research. He refers to what he
considers a parallel discussion in psychotherapy regarding the relative
importance of verbal interpretations versus relational experience
(Karterud & Monsen, 1997), pointing to an increased understanding of
the interaction between these two dimensions.
But has the issue then actually been resolved? It is hardly enough to
point to this particular discussion within psychotherapy, because the
specific role of music is not addressed here. Once again, this view implies
not taking into account the difference between language and music. There
remains a difference between therapy as a “talking cure” and music
therapy not necessarily being a talking cure, related to differences in
characteristics of the primary mediums used. I think some distinction is
still necessary to uphold, to account for differences in the role of music
and the role of words in therapy.
Bunt and Hoskyns (2002), in their recent Handbook of Music
Therapy, report that the theme concerning the spectrum between clinical
theories and various music-based theories still tends to engender much
passion, and appears to touch the profession deeply:
It is a dichotomy that challenges every music therapist who cares

to think more than casually about their work. .... The subject will
not go away, it will not leave us alone. It will continue to surface,
need framing and reframing, depending on context and the
different cultural and political demands. The topic is too
powerful a subject to defy any attempt to squash it. (Bunt &
Hoskyns, 2002: 24)
Bunt and Hoskyns make it clear that they expect further discussions on
the topic.
Community Music Therapy
And a new round in the discussion indeed has recently revolved around
the issue of “Community Music Therapy.” Ansdell once again has
fronted a music-based position in clear opposition to what he now terms
the “consensus model” (at least in the UK) of music therapy, which is a
psychodynamically oriented music therapy (Ansdell, 2002). In quite close
accordance with Stige, Ansdell argues for a broader practice of music
therapy, and for a broader theoretical model to support this. He
announces that a “paradigm shift” might be underway in the discipline, a
context-based and music-centered model highlighting social and cultural
factors. And this, he argues, is incommensurable with the current
“consensus model.” He accordingly looks forward to seeing the current
(psychotherapeutic) consensus model possibly being replaced by a new
one.
Ansdell refers to both previous (Ruud, 1998a) and more recent
discussions in the literature on the communal aspect of music therapy, as
found in Stige (2002a), stressing the cultural context of any music
therapy work. Ansdell presents several vignettes as examples of what he
considers could be characterized as Community Music Therapy. He
contrasts these cases with what he outlines as the consensus model, which
is termed “improvisational music psychotherapy.” He elaborates on the
differences between the approaches with regard to the role and identity of
the therapist, which in the “new paradigm” is not confined to the
“therapeutic relationship” as the psychotherapist would define and enact
24 Music as Therapy
this, but to a balance of the identity as musician and therapist in a broader

social and cultural context.Sites of the practice are expanded beyond the
literally closed doors of the therapeutic protected space and into
community, incorporating aims of enhancing the quality of people’s lives
within communities. The ultimate aim is to move people from therapy to
community. The focus is thus moved away from the exclusively
individual and intrapsychic to include also the community, the “outer”
aspects of the client’s life.
Ansdell continues to point to New Musicology as a promising field
from which such a necessary theory might be drawn. In a somewhat
similar vein as Stige, who, as seen previously, envisioned a “health
musicology,” Ansdell sees a future for a “clinical musicology,” which
will include musical ontology, musical phenomenology, musical
morphology, and musical sociology/anthropology. He admits to this
looking like some grand “totalizing” project but nevertheless asks to be
indulged a little “grandiosity” for the beginning of a “new current,” as he
puts it, in music therapy.
This stance has spurred further debate.6 One objection that has been
voiced is that this is really not something new – that many music
therapists have been working like this, across the individual-community
continuum, for a long time already, with others working in a
psychodynamically oriented way. Another issue has been what makes
“Community Music Therapy” different from Community Music. Jane
Edwards, teaching music therapy at a university center that also offers an
MA in Community Music, takes issue with the idea that there is such a
phenomenon as “community music therapy.” She is reluctant to mix
together the terms of these two different approaches of working musically
with people and wants to keep the name “music therapy,” and be proud of
6
See the Internet site Voices, A World Forum for Music Therapy, on which
Ansdell’s article first was published, and on which there has been a moderated
discussion on some of the issues that it brought up:
http://www.voices.no/discussions/discussionmod.html.
it, as she states, while at the same time fully recognizing the community
dimension of music therapy work (Edwards, 2002).
Ansdell and Pavlicevic (2004) have since edited a book with a series
of cases described and discussed by different authors who represent
different approaches to what they still prefer to term Community Music
Therapy. – Although by now the aspiration toward a whole new paradigm
for music therapy has been toned down. Instead, they stress the potential
for fruitful dialogue and debate between the “consensus model” and ideas
and practices of Community Music Therapy. They summarize their
stance as follows:
The argument, then, is not whether psychodynamic thinking

might be sometimes necessary, but rather whether it is sufficient
as a guiding theory for music therapy practice (p. 23).
It seems that we come full circle here back to the debate regarding what
kind of thinking is required for what kind of music therapy. As Aigen
(2005) notes as well, Community Music Therapy is to be considered a
music-centered approach, with concerns that are particular for this stance,
differing from the traditional model, which in this context means a
psychodynamic outlook and practice.
DIFFERENCES OF ASSUMPTIONS
In the recurring debate, back and forth, between the two sides of
“psychological thinking” versus “musical awareness,” I think it might be
well to consider whether the issue is not merely about which kind of
theory to use, or even of balancing the one side in a “right” proportion
with the other, but rather about the underlying assumptions of each
position, which is where I would suspect much of the actual basis for the
differences may be found. The opposing stances of clinical versus music-
centered theories are quite possibly about different frames of reference,
rather than differences of issue, and each frame has to be related to a
philosophical grounding, which may be more or less common between
them. The discussions actually may be considered to revolve around
26 Music as Therapy
some underlying—and to quite some extent nonexplicated—assumptions

and presuppositions, which presumably is what oftentimes makes them so
heated because changing views on such underlying assumptions and
suppositions is not necessarily easy to do. On this level it may tend to
approach conversion rather than a simple change of opinion on some
matter.
This is one reason why it would be hard to imagine
psychodynamically oriented music therapists giving up their concept of
therapy to convert to a new paradigm. On the other hand the question is
whether a music-centered concept of music therapy would succumb to
the necessity of having to adhere to any specific clinical theory, if this is
not perceived as being in accordance with the basic values and stances of
the approach.
General Theory
Some have propagated the need for a general theory of music therapy.
The question that could be posed, however, on the background of the
discussion referred to here is: Is a general theory really what we need, to
encompass all music therapy practice? In the article “Forms of Feeling
and Forms of Perception: The fundamentals of Analogy in Music
Therapy,” Smeijsters (2003) presents some concepts for a general theory
of music therapy. It may be instructive to see how such an attempt, in the
context of the present discussion, very soon could become questioned.7
Smeijsters relates that in previous writings he had used the terms
sound or sound progressions instead of music. By this usage he had
intended to indicate that he did not accept that music in music therapy
could be considered a cultural/artistic phenomenon, hence the use of the
7
Smeijsters has elaborated on his views in the book Sounding the Self: Analogy
in Improvisational Music Therapy (Smeijsters, 2005).
terms “sound” or “sound progression.” And furthermore, he actually still

holds this view. He makes his stance clear in the following statement:
I do not believe that the mere aesthetic experience of music in

itself is healing if the musical form does not sound the inner
processes and psychological changes of the client (p. 71).
Smeijsters, admits that this previous usage of the words had proved
controversial, and on this background he has decided to use the word
“music” after all, even though he actually still upholds the same position
regarding the role of music in music therapy.
It should be clear that proposing such a definition of music as a basic
concept for a general theory for music therapy will not necessarily find
support from those adhering to a music-centered view. A case in point
here could be Colin Lee (1996), who is concerned that what he calls
“extraneous nonmusical theory” may lead to the significance of music
itself becoming “diluted,” as he puts it. Lee terms his own approach
“Aesthetic Music Therapy” (AeMT), and his stance, which involves
aesthetics as a key term, entails a sharp contrast to that of Smeijsters, as
the following statement makes clear:
The inherent knowledge underlying AeMT is that music is

intrinsically healing; what must be learned during training, then,
is how to adapt one’s musical skills to develop resources which
are clinically, artistically, and aesthetically suitable for both the
client and the process (p. 7, italics added).
It would be hard to imagine Lee, or any of the other authors of a music-

centered position, subscribing to the view that music in music therapy
should not be considered a cultural/artistic phenomenon, and that “the
musical is the psychological,” as Smeijsters propagates. Smeijsters’
presentation of his theory as a “general theory,” and at the same time his
taking of a clear stance against any notion regarding the aesthetic
experience of music as being intrinsically healing, would seem to be
prescribing a generality to his own notions about therapy that is not
readily acceptable to all representatives from the field or discipline. As a
“grand” theory of music therapy as a whole, Smeijsters’ theory still
28 Music as Therapy
seems to be quite far off the mark. It may nevertheless work very fine
within the confines of his own and similar kinds of practices. It is trying
to encompass more in theory than what it in each case actually can hold,
which may be problematic here.
Recognizing and Accepting Difference
Any theory as such is general, naturally, or else it simply is not a theory.

The point is not so much that general theory is not possible or advisable.
It has to be recognized that there in any case will be a need for some
theory at some level of generality within a discipline or field. The point,
rather, is explicating in each case how general a theory is. A “grand”
theory may be criticized on the grounds of being too general, with a claim
to encompass more than it actually does hold.8
Carolyn Kenny (1998) emphasizes the importance of listening and
reflecting on difference, and actually states that it is only through
accepting and respecting differences that we may arrive at anything
“general.” This is precisely, I believe, what is most required with respect
to clinical versus music-centered music approaches: bringing out
differences rather than arriving at something altogether consensual. Not
to refute the other side, but to contrast, and to bring out what the contrasts
consist of. What I would propose is that in the present discussion this
particular kind of “generality” is what is needed, namely recognizing and
accepting differences.
And these differences, I believe, should be considered as differences
of frame rather than issue. I do not think one may expect to have the
differences between the different stances resolved through referring to
some common, overarching general theory, or by aiming for any all-
8
This, of course, has itself been a central theme of postmodern critiques of so-
called “grand narratives” tending to encompass more than closer scrutiny shows
they can hold.
inclusive definition of music therapy. I think a progress in the discussion

could be made through clearer explications of frames. The task instead
will not be trying to “refute” the other position, or attempting to subsume
one under the other, but trying to show the possibility and the relevance
of each side on its own accord.
On the background of this discussion, I want to make clear that what
I am concerned with in the present context is the possibility of a “therapy
in music.” I want to consider more closely the possibility of music
therapy based on the qualities of the medium itself—that is to say, a
music therapy that is not subsumed under a psychodynamic framework,
and that does not necessarily have to use verbal processing, “talking
cure” style, in order for it to be “proper” therapy.
But if not subsumed under such a framework, the crucial question
arises as to what theory it is to be based on. A music-based music therapy
that does not adhere to any established model of psychotherapy, and that
is not considered to be a method that may be accommodated to any such
particular model, will need to develop a corresponding theory of its own.
Indigenous and Imported Theory
Aigen (1991; 2003) has propagated the need for a unique or so-called
indigenous theory of music therapy, which may be contrasted to what he
terms recontextualized theory, which seeks to describe and explain the
processes and phenomena of music therapy in terms of other disciplines,
such as psychoanalysis, neurology, or behavioral learning theory. While
Aigen acknowledges the advantage of thereby being able to communicate
with other fields, he finds that these types of exposition tend to be
reductionistic in that music therapy phenomena may not be sufficiently
explained when being rephrased, or “recontextualized,” in imported
terms.
Indigenous theory, on the other hand, is based on the rationale that
all domains of inquiry have unique qualities, and that development of
theory within a particular discipline should proceed from these. Aigen
considers this kind of theory to be most appropriate when the primary
audience is music therapists, and the purpose is to advance developments
in the forefront of the profession. A prime example here, according to
30 Music as Therapy
Aigen, would be Nordoff and Robbins’ (1977) concept of the “music

child,” which he considers is not a concept that is drawn from elsewhere,
and which is not meant to explain other phenomena than those that gave
rise to it.
In between these two poles of indigenous and recontextualized
theory, Aigen places so-called bridging theory, which establishes
connections between terms and concepts from different disciplines, by
combining constructs from other areas with those that are specific to
music therapy. Aigen considers Pavlicevic’s development of the concept
of “dynamic form” as an instance of “bridging theory” based indirectly
on Susanne Langer’s aesthetic theory and more directly on infant
communication theory, as represented by Daniel Stern. Different
disciplines may offer their own specific perspectives on music therapy
phenomena, while at the same time not fitting music therapy in a neat
way. Therefore these perspectives, in the bridging process, should be
adapted and supplemented with considerations that are unique to music
therapy, Aigen argues.
Music-Centered thinking
More recently,Aigen (2005) has qualified the distinction between these

three types of theory, stressing that it should be the manner in which an
idea is applied, rather than the domain from which it originates, that
determines whether the theory should be characterized as
recontextualized, bridging, or indigenous.9 Aigen makes a case for
developing an indigenous music-centered theory of music therapy. His
basic stance is that a theory of music should serve as the basis for music-
centered therapy:
9
Aigen credits Kenneth Bruscia for the idea of characterizing theory by the way
it is used.
A theory of music serves a music-centered music therapy much

as a theory of personality serves a psychotherapy theory. Thus,
saying that music-centered music therapy theory should rest on a
conception of music is no different from saying that theories of
verbal psychotherapy must be supported by a credible,
underlying theory of personality. (p. 68)
This reflects a continuing adherence to a “purely musical” position with

regard to the development of theory—that is to say, music-centered
thinking, which remains in stark contrast to the call for more
psychological thinking, which Streeter (1999b) voiced. Aigen suggests
not making a divide between clinical and nonclinical uses of music. This
way, a theory of music should be considered relevant also for music
therapy practice.
The question is whether this after all does become one-sided. Is
music therapy about music as such? There is a difference to consider
between plain music and music therapy, or else there would hardly be a
need for the latter term. Music-centered theory does address the use of
music as a medium in therapy, which certainly needs to be accounted for.
But so, it could be argued, does the therapeutic use of music. It might
seem that in developing theory the coin has a tendency to flip either way:
to the side of music or to the side of therapy. It might be well to consider
in what way both music and therapy could be taken into account in a
theory for music therapy, as a composite term. This would imply
employing theory on a somewhat broader basis than a strictly musical
one.
It bears mentioning here that Aigen does recognize, and accept, that
indigenous theory of music therapy does not necessarily have to be
music-centered. There may be other sources of theory also to consider.
As Aigen now emphasizes, it is the way the theory is used which decides
whether it is to be considered indigenous. Aigen’s own use of schema
theory does seem to be somewhat wider than using a theory of music as a
basis for indigenous music therapy theory, though he argues that this is
still to be considered music-centered thinking, on account of schema
theory having been used also for developing musicological theory.
32 Music as Therapy
Insight and Transformative Therapies
Aigen compares his notion of music-centered therapy with the expression

“music as therapy.” This phrase was coined by Paul Nordoff and Clive
Robbins as an initial label for their work “The Art of Music as Therapy,”
which was also the title of an unpublished manuscript completed in 1965,
according to Aigen. It then appeared in the previously mentioned
publication Therapy in Music for Handicapped Children, from 1971,
republished in 2004.
Kenneth Bruscia (1987) has since made a further and much referred
to distinction between “music in therapy” and “music as therapy.” Music
in therapy is the use of music as a medium within another treatment
modality, in which case music is not the main focus, but rather serves a
facilitating purpose through the course of therapy. Music as therapy is
music serving as the primary medium, the client’s therapeutic change
being facilitated through relating directly to music.
Aigen intends the concept of “music-centered,” although closely
related, to be broader in its realm of application than the construct “music
as therapy.” The term music-centered, as Aigen regards this, includes
theory, clinical practice, approaches to education and training, and
research. He still holds that while there is a strong relation between the
two ideas, a main difference is that in music-centered therapy, musical
expression and experience are actually what the outcome of therapy is
about, whereas the notion of “music as therapy” opens for clinical
rationales aiming at extramusical outcomes, such as, for instance,
improving the immune system.
Aigen nevertheless refers to a later refinement that Bruscia (1998c)
has made in distinguishing between four levels of therapy, moving from
an exclusively musical process in “music as psychotherapy” through
“music-centered music therapy,” in which verbalization is used in
conjunction with music experiences, to “music in psychotherapy,” and
further on to “verbal psychotherapy with music,” with an increasing
stress laid on verbalization. The first three are all considered experiential
forms of therapy, in that they incorporate specifically designed forms of
activities and experiences rather than rely solely on verbal discussion.
A finer distinction that Bruscia makes is one between transformative

and insight therapy. The two lastmentioned forms of therapy, moving
increasingly toward verbalization, are considered as insight-oriented,
whereas the two first represent so-called transformative therapies. What
characterizes transformative therapy, according to Bruscia, is that “it is
the music experience itself that leads to change” (Bruscia, 1998c, p. 3).
Aigen sees a close correlation between the category of transformative
therapies (comprising both music as psychotherapy and music-centered
psychotherapy) and the notion of music-centered music therapy, in that
the therapist in both instances seeks to act on, rather than just through
music. He considers, however, that “for the moment, it is an open
question as to how the broader category of transformative therapies …
relates to the idea of music-centered therapy” (Aigen, 2005, p. 50). The
questions that are involved are about the matter of the necessity of
verbalization, and also whether using the therapeutic relationship as a
vehicle in therapy is required.
Music as Therapy
These are questions that I would want address further here. The
“solution” regarding terms that I would like to come up with, to do just
that, is actually to use the term “music as therapy,” taken to be
synonymous with Bruscia’s broader category of transformative music
therapy. I think Bruscia’s distinction between music as or in therapy may
still be useful, considered as coinciding with the two broader categories
within his four-leveled distinction between transformative and insight
therapy.
This term indicates a certain contrast to a more strictly defined
music-centered approach in that it, as Aigen suggests, implies taking into
account the therapeutic relationship, which I will regard as a crucial
aspect of transformative therapy. Verbalization may or may not be
included within the approach of music as therapy, but it should be clear
that if included, the role of verbalization will nevertheless be quite
different than within insight-oriented therapy. What I will be addressing
here particularly will be the possibility of a music therapy that does not
34 Music as Therapy
necessarily have to incorporate verbal processing, in the style of insight

therapy.
There may be many variants of music in therapy, according to which
kind or model of therapy that music is applied within. The frame of
understanding will in such cases be established within the approach itself,
as this is generally practiced. If insight-oriented music in therapy to a
large extent at least, has a theory to relate to (some adjustments of theory
using music as a medium within other, established forms of therapy will
in each case presumably have to be made), the question still remains as to
what theory an experiential, transformative, music as therapy approach is
to be based on.
As Aigen also indicates, music-centered therapy could be regarded
on the whole as congruent with a transformative music therapy. I would
like to add: As a practice considered. But I believe that a broader base of
theory is needed to illuminate what transformation, which is to say,
personal change, as a therapeutic outcome within music as therapy, is
about. Even though music may be at the core experientially, this does not
in and by itself account sufficiently for therapeutic outcome. “Music as
therapy” as a transformative kind of therapy is focused on personal
change, which needs to be accounted for beyond regarding music as such.
If music as therapy can be defined or designated as change through
music, or music experience leading to change, this is not just a musical
matter. It is not sufficient to state that this process itself is something
“musical” or even that musical change is therapeutic change. Beyond
postulation, this relation is something that would have to be accounted for
more closely, bringing out what it implies. And for this a broader theory
is needed, I believe.
Philosophy, Theory, and Practice
Regarding the need for theory, the question nevertheless, I will suggest, is
not just which theory to import, and from where, and how (that is to say,
indigenously or not), but on which basis. It is important to be aware that
on a philosophical, foundational level, issues are somewhat broader than
what adheres to one single discipline. Basic ontological, epistemological,
and methodological presuppositions are shared concerns between

different fields and disciplines.
In this respect, Kenny (1989) has made a simple but useful
distinction. She states that if theory serves as a foundation for practice,
philosophy serves as the foundation for theory. Every practice has a
theoretical foundation, which may be more or less explicit, but which
nevertheless is present in and through the practice that is made. Whether
or not it is articulated, the structure of some underlying theory or thought
gives sense to what we are doing in practice. And this underlying
theoretical structure is necessarily grounded in particular stances of
philosophy, whether one is aware of this or not. Kenny points to this
oftentimes-ignored intimate relation between practice, theory, and
philosophy. There is a constant creative movement between these; one
springs out from the other.
A Humanistic Foundation
As Even Ruud long since has shown, practices of music therapy may be
related to different theoretical and philosophical positions (Ruud, 1980).
And Nordoff-Robbins music therapy has historically been related to an
existential humanistic tradition, in contrast to both psychoanalytic and
behavioral models. The existential humanistic orientation, with its
emphasis on intentionality, spontaneity, and creativity has been perceived
to be more in accordance with fundamental stances and values within this
kind of practice.
Stephen Levine (1996) has written about the search for a foundation
for the expressive arts as a whole, and relates to the existential tradition
mainly as Heidegger (1996) represents this. Heidegger, in contrast to both
ancient and modern traditions, tending to view art and truth in a
contradictory relationship to each other, art being at a position somewhat
removed from reality (as Plato and some of his followers would uphold),
on the contrary considers art as a primordial way in which truth becomes
manifest. As an essential manifestation of truth, art is capable of giving
meaning and direction to human existence. This capacity Heidegger
terms “poiesis,” using the old Greek word for poetry and art making.
36 Music as Therapy
Levine finds this perspective relevant for the development of a

foundation in the expressive arts.
But Levine also draws attention to significant areas that are
neglected in Heidegger’s thought, as reflected by several authors.
Merleau-Ponty (1966) has pointed out the neglect of the body in
Heidegger’s thinking. It is through our lived bodily experience that we
sense and act in the world, Merleau-Ponty stresses. The philosopher
Emmanuel Levinas (1989) has delivered a critique of Heidegger on the
basis that the experience of the Other is not clearly visible in his thinking.
He suggests, as an alternative view, to begin with the appeal of the Other
to me, rather than with my own search for existence. Lastly, Levine refers
to Jacques Derrida (1973), who has expanded on notions in Heidegger’s
thought to include a perspective, otherwise missing, on community.
These three areas—the body, the Other, and community or
communality—are all of great importance, and need to be included in any
foundation of expressive arts therapy, Levine maintains.
Generally there seems to have been a clear individualistic trait in
existential thought, from Kierkegaard via Nietzsche and onward. One
exception to this has been Martin Buber, who formulated a philosophy of
reciprocity and mutuality in his now classic book I and Thou. This will be
the point of departure for the theoretical perspective that is to be
developed here. The basic concept to be applied here will be
“dialogue.”10
As a simple descriptive term, the word “dialogue” may as such not
be farreaching, but it may also be used on a broader basis. And the term
has actually had manifold applications within several fields, from
theology to sociology, to psychology, to arts and the humanities
(Friedman, 1996b). As a foundational concept, it may generally serve to
10
In a doctoral study I have developed a dialogical perspective on a music
therapy, based on Buber’s dialogical philosophy, of which this book is a
refocused, revised, partly reduced, and somewhat expanded version (Garred,
2004).
illuminate dynamics of interrelation. I chose to go to the roots of the

broader application of this term, namely Martin Buber, and in particular
his book I and Thou, from 1923, which clearly must be regarded as one
primary source for modern/postmodern dialogical thinking. His
formulation in I and Thou has come to stand as a central initial statement
of this kind of view, and the understanding of dialogue that may be
brought out from this initial source I will attempt to apply to the issues of
music therapy theory related here.
A Dialogical Perspective
Buber has been repeatedly referred to in music therapy literature. He was

first introduced maybe by Ruud (1980), who used Buber in a critique of
presentday behavioral models of music therapy. Gary Ansdell has a
section inspired by Buber in his book Music for Life: Aspects of Creative
Music Therapy with Adult Clients (1995). Ruud (1998a) has since then
made use of the social anthropologist Victor Turner’s theories in a
description of essential characteristics of music improvisation, within
both jazz and music therapy. The direct experience of meeting in Buber’s
sense constitutes Turner’s spontaneous, existential “communitas,” which
Ruud considers as an especially appropriate description of improvisation
in both jazz and music therapy, as a subject-subject relationship. More
recently Ansdell has made use of this same reference, also referring to
Turner, in his writings on Community Music Therapy (Ansdell, 2002,
2004).11
Even Ruud (1998d) has called for reflexivity in music therapy
writings, that we should bring out and make our basic stances clear. I find
Buber’s writings, and particularly I and Thou, to be a rich and suggestive
source, the relevance of which is still far from exhausted. I will maintain
that this work is a powerful and sharply focused statement, which lends
11
I have previously also written an article, in Norwegian (Garred, 1996).
38 Music as Therapy
itself to exposition, commentary, and critique, and also to further

developments and applications. Furthermore, I consider the concept of
dialogue to be in close accordance with a humanistic outlook. I regard it
as a nonmechanistic concept, which may be used in the development of a
nonreductionistic point of view. This should be considered a basis for my
choice of this concept in the present inquiry, and which I want to make
entirely clear. This is why I use it.
But this “metaphor,” as Ruud calls such basic concepts, will not just
form and color what is described and interpreted here. My intention is to
explicate it, to find more out about how it may itself contribute to ways of
seeing. I want to make explicit what a dialogical perspective on music
therapy entails, which I believe has not been sufficiently brought out,
although it may seem very much implicit in both music therapy practice
and theory.
The issue that is addressed here is how to develop theory for music
as therapy, as a transformative, experiential approach. If not based on a
psychodynamic framework, how can music as therapy make its case? The
thesis that is put forward here is that a dialogical perspective may serve
to ground such theory, both with regard to interpersonal relations within
therapy and with regard to the role of music, and furthermore to the
interrelation between these two aspects. Not just clinical/therapeutic
theory or musicological theory, then; both sides need to be addressed, and
interrelated, to frame such therapy, I believe. The assumption is that the
concept of dialogue may be used as a ground for the development of a
theory that addresses both these sides and relates them to each other,
which this book will be an attempt at trying to bring out.
Excerpt Two
Chapter 3
THE MUSIC THERAPY TRIAD

Rudy Garred
In this chapter, I will first of all try to bring out what a dialogical
perspective basically may imply in relation specifically to music. Then I
will consider more closely the position and status of music in music
therapy within the triad of client, therapist, and music. This will serve as
a frame for the further development of the argument in the chapters to
follow.
ENCOUNTER WITH MUSIC
Venturing now to develop a dialogical perspective on music as therapy, I

first of all want to bring out a crucial feature of a dialogical outlook as
this relates to the theme of the present inquiry, namely the possibility of
entering into the attitudinal mode of I-Thou specifically in relation to
music. Music belongs to the sphere of “spiritual forms”—in Buber’s
terms, as a product of human culture. According to the basic feature of
the dialogical principle, anything within any sphere may be related to
either in the manner of I-Thou or I-It. The question is what this implies
with regard to music.
It is of significance to note here that within the humanities, as a field
of study dealing with human artifacts, it has become a general usage to
talk about encountering a work of art. The study of the methodological
principles of interpretation within the humanities has been termed
hermeneutics. A main representative of hermeneutics in recent times is
Hans Georg Gadamer, who has written the seminal work Truth and
68 Music as Therapy
Method (1989).27 In this work, Gadamer is critical toward establishing

specific procedures of method within the humanities. He distances
hermeneutics from the search for general laws, as found within the
natural sciences, and also from a historical critical method that aims to
“reconstruct” the author’s actual intent. Gadamer likens the “text” or
the“work,” or, in the broadest sense, “tradition,” to a Thou, with which
the interpreter engages interactively.28 Gadamer says about a given text
within a tradition that it “expresses itself like a Thou” (H. G. Gadamer,
1989, p. 358). Understanding comes through turning toward a particular
work, and the work opening itself, in a way that cannot be fully predicted
or foreseen. From this, it may be regarded as having the character of an
encounter.
Gadamer developed the notion that the interpreter and work are
placed within different horizons. The horizon of the work, from the time
in which it was created, the questions and concerns it then was a response
to, are not necessarily identical to the horizon, the questions and concerns
of the present interpreter. Therefore, understanding the work may be seen
as a process in which there is a fusion of horizons between the work, and
what it represents, and the interpreter in the present context. Another way
of saying this is that the interpreter always has some pre-understanding
when entering into a relationship with a work. And as the work is
approached more closely, there may be a development of the perception
and understanding of it, resulting in a new understanding. Subsequent
interpretations will have this as an integral part of the new pre-
27
Published in the original German as Wahrheit und Metode (H.-G. Gadamer,
1965).
28
Although Gadamer does not explicitly refer to Buber here, his view does seem
to be in close accordance with Buber’s basic notions. Gadamer apparently was
well aware of Buber’s writings, and acknowledged his contribution, viewing his
treatment of the other as “the most poetic, if not the deepest analysis of that
topic” (personal communication with Gadamer referred to by Stewart, 1985, p.
333).
The Music Therapy Triad 69
understanding the work is met with. Thus there is a circular or spiral

process of increasing or developing understanding, the so-called
hermeneutic circle.
Gadamer emphasizes the dialogical nature of this process.
Understanding is the result of a dialogical process of interpretation in
which an interactive “conversation” between text and reader takes place.
There is no unprejudiced reading of a text, and therefore there is no
original or objective meaning to be extracted from it. And the reader does
not remain unchanged in the process of reading. His outlook melts, at
least to a certain extent, with the perspective of the text, thus making new
understanding possible.
In his book Hermeneutics, Palmer (1969) explains this particular
usage of referring to the work as a Thou, referring explicitly to Buber
here:
To put the matter in the familiar terminology of Martin Buber’s I-

Thou relationship, it is helpful to see the work not as an it that is
at my disposal but as a thou who addresses me, and to remember
that meaning is not an objective, eternal idea but something that
arises in relationships. (cited in Berkaak & Ruud, 1992, p. 48)
To elaborate somewhat on this general viewpoint, with regard

specifically to music: In any encounter with music, there will always be
something that is not entirely foreseen. This is the case even for an
already known work, because it is always in the given situation that the
work is encountered, and what listening to it brings is in some sense
unique each single time. Our response to a piece of music is not
completely and unambiguously given beforehand, because then,
presumably, there would be no meaning in listening to it. Nothing in
particular would be gained by doing so. Listening would simply have
become redundant. What a musical encounter entails is never really
apparent until it actually occurs. It is not something that may be deduced
by necessity from any given set of premises. How music affects us is not
predetermined. That a work of music will have such and such an effect
unconditionally, or mechanically, is not something that can be either
expected or guaranteed. An encounter with music is always open, which
gives it a quality of an address. Encountering music, we are being
70 Music as Therapy
“addressed” by it as well. In this way, music may be seen not as an It, but
as a Thou, as Palmer suggests.
Relating to, and Talking About
The understanding that is gained this way will nevertheless not actually
contain the whole story about the music. This could be further
illuminated by applying the contrast between the two basic attitudinal
modes of I-Thou and I-It as a difference between second and third person
relations, that is to say, as the difference between talking to, and talking
about. The encounter, it must be emphasized, is about the attitudinal
mode with which the music is met. Not distancing from, but relating to
the music in its immediate presence. And, having initially encountered
music, one may subsequently talk about it, in the third person mode,
making it into an object of understanding. But having talked about music
this way, not everything that could possibly have been said about it has
actually been said, which means that we can hardly expect to have made
it completely and exhaustively objectified.
Ultimately, nothing conclusive can be said about any given music. A
new encounter may always bring up something new. This is what
constitutes a second person relation. One may gain an increased
understanding each new time, but this does not at any given point become
final or definitive. Even though making objectifications will have a
natural drive, so to speak, toward completion, toward grasping the whole
picture, getting it right, actually arriving at this destination once and for
all, is really not to be expected. Musical knowledge and understanding, in
any variant and however elaborate, will not be able to pin down its object
of study to any final conclusion. This is to say: music will, as long as
there is any meaning whatsoever in approaching it, never become a
completely defined object, a total It, and nothing more.
If you do not actually encounter the music, you will not have much
to talk about. And if you merely talk about music, without acknowledging
its present reality through the encounter, there will hardly be much
substance to what is said. So this is what a view to the dialectics between
these two different attitudinal modes of I-You and I-It may help to keep in
focus: the encounter with music itself, subsequently leading to
objectifications of understanding, and then eventually a returning from

the objectifications made, and new encounters, without which any gained
understanding would lose its purpose and meaning.
The Creative Encounter
The focus so far has been on the receptive side of the encounter with
music, but there is also the side of creating music to consider. Buber
indicates that also in the creative act there is an I-Thou relation between
the maker and what is being made. The initial spark in the creative
process is an artistic form or gestalt, which appears for the maker,
proposing, or “demanding” as Buber phrases it, to be realized into some
work. And as the maker engages with this form that has “disclosed”
itself, a creative power is released, making possible a bringing forth of
the work to its completion.
Not a figment of his soul but something that appears to the soul
and demands the soul’s creative power. What is required is a
deed that a man does with his whole being: if he commits it and
speaks with his whole being the basic word to the form that
appears, then the creative power is released and the work comes
into being. (Buber, 1970, p. 60, italics added)
This creative bringing forth of the work is not something that pours out
unilaterally from the inside of the maker, as a traditionally romantic
notion of creativity would tend rather to assume, but comes about,
according to this outlook, through a dynamic relation with a disclosed
form or gestalt that appears for the maker, to make something out of it.
On the one hand it is necessary to bring the engagement of the whole
person toward bringing forth this suggestive form to its complete
realization. But at the same time, engaging in this process of making the
gestalt into a realized work itself releases creative power.
Engaging with the form that appears for the maker and realizing it
into a work may be regarded as a second person kind of relating, a
dialogical, “conversational” process. It is not like an “objective,” purely
technical course of action in which the outcome is dependably known and
72 Music as Therapy
counted on beforehand, as in some regular procedures for certain

predefined tasks dealt with on a regular basis in daily life. What comes
out of the creative act is never completely known beforehand. There is a
risk involved, an uncertainty. Making music can never be completely
predetermined, or else it was simply not creative, not something new that
was brought forth.
The Work Acted Upon, and the Person
What happens in the creative act, according to Buber (1970), is a sacrifice

of limitless possibility, the making of a suggestive form into something
definitive, a movement from limitless potential to a definitive realization.
The creative act is choosing from many options, or from endless options,
actually—in a process of discovery, eventually turning the apprehended
gestalt into a completed work:
Such work is creation, inventing is finding. Forming is discovery.

As I actualize, I uncover. I lead the form across – into the world
of It. The created work is a thing among things and can be
experienced and described as an aggregate of qualities. But the
receptive beholder may be bodily confronted again and again. (p.
61)
The dialectic of alternation between two attitudinal modes is also

reflected in the making of the work, in the creative act. Buber underlines
this:
The essential deed of art determines the process whereby the

form becomes a work. That which confronts me is fulfilled
through the encounter through which it enters into the world of
things in order to remain incessantly effective, incessantly It –
but also infinitely to become again a You, enchanting and
inspiring. (pp. 65–66)
The creative act, which is a forming process, results in a work. This

product, this object, becomes an It, and enters into “the world of things.”
But this It, through subsequent encounters, may again become a Thou in
the reception of it, whereby possibilities of new understanding and
appreciation open up. So the realization of the musical work is a dialectic
turning from a Thou into an It on the productive side, and from an It into
a Thou again on the receptive side.
There are consequently two aspects of “acting upon” here. One is the
maker acting on the work that is made. The other is the work itself acting,
remaining “incessantly effective,” as Buber puts it, on the receiver in the
subsequent receptive encounter with it. In the receptive process, the work
may then act on the person. In both cases, a “making of” is brought forth,
of the work and of the person, respectively.
Artistic and Musicological Objectifications
A difference that may be noted between these two sides, is that the work,
once made in the creative act, is something that is done and completed,
whereas the receptive encounter with it may happen again and again.
When a work is completed, it takes on a life of its own and becomes what
may be encountered again as an object turning into a musical Thou in the
reception of it. And for each time, a deepened understanding is made
possible. Thus for each new meeting the listener actually also may
change. This point of view is clearly reflected in Gadamer’s notion about
the melting of two horizons in the hermeneutic process, between the
horizon of the work and of the interpreter.
There are consequently two processes of alternation between the
modes of Thou and It to be seen here. First the work of art, which through
the creative act becomes an object, an It, and which may turn back into a
Thou for the listener in the reception of it. And this listening may actually
also produce an It in the objectification, the talking about the music, the
new understanding that may be constructed subsequent to listening to it.
This, in principle, is the actual product of musicology as the discipline of
gaining new knowledge and understanding about music, and which may
be brought back in renewed listening to it, with the music once again
appearing as a Thou.
There is a second objectification of music here, the first being the
artistic, and second the musicological. Through the objectifying mode,
74 Music as Therapy
knowledge about the music may be produced and new understanding

gained. On the basis of such knowledge and understanding, new
encounters with the music may take place, bringing it to life once again in
new ways. The creative endeavor, making music into a work, may be a
singular act, but the receptive beholding of it may be repeated in manifold
encounters, facilitating a possibility of a deepened appreciation on the
basis of increased understanding that is developed, but which is
nevertheless never complete and may be ever renewed.
THE MUSICAL WORK
What I have been trying to do so far is to explicate the basic “logic” of

the dialogical principle, as a distinction indicating an alternation between
the two modes of I-Thou and I-It, as this may be applied, within the
sphere of “spiritual forms,” to music. The matter is somewhat more
complex with regard to the status of the musical work. I want to bring this
out somewhat more, by relating to different genres of music, as a step
before trying to circle in more closely what the position of music in music
therapy entails.
In the tradition of classical music, the work from the composer’s
hand is completed through the writing of the score. Still, it is not
completely ready for reception, in the way a painting, for instance, can
be. The musical score, in the classical tradition, represents the work, of
which there may be many performances. And of course each performance
of the work itself represents an artistic statement, a work in its own right.
There are never two performances that are alike, the performance itself
being a personal interpretation of the work coming from the composer’s
hand. There is no singular solution to the playing of any work in all
details, even if every note and every marking (tempo and dynamics, etc.)
of the composer are meticulously followed. Performing a composition is
a dialogical process in its own right; it is not merely a technical or
mechanical matter of replaying the notes. Each performance is unique.
This, incidentally, is illustratively reflected in the applause after a
live performance. The applause is an expression of an essentially
indeterminable meeting—and here too there is a dialogical relation
between performer and audience, a tension of expectation that is released

in the applause, revealing something about the quality of the relation that
has developed during that unique performance event. If the outcome of a
performance was completely predetermined, there would be no grounds
for giving applause. This presumably is why it is not natural to applaud
after having played a CD, no matter how good it might be, because this is
a purely technical matter—namely, the reproduction of music through
sound equipment, which does not have the same element of risk and
surprise or of direct, present communication. Not that a recording may
not be highly valued and appreciated. The performance is nevertheless
related to indirectly here, through a purely mechanical reproduction.29
Other Ontologies of Music
Within the so-called New Musicology, it has become increasingly

common to include genres other than Western classical music in the field
of study. What then becomes apparent is the different status of the work
that may be found in various genres, different ontologies of music
(Bohlman, 1999), which is about different modes of being, the different
ways of music being realized. A contrast to the case of Western classical
music is jazz. Here the performance itself tends to acquire a first rank
position in relation to the composition. The composition may be a so-
called standard tune, which is a popular song used as a basis for
improvisation, and it is the improvisation on this tune that primarily
constitutes the work in this instance. The tune is just a frame, a form to
improvise upon. In some cases, the jazz musician may even create a new
melody on the chord changes of the tune, thus making it his or her own
29
The famous Canadian pianist Glenn Gould, incidentally, rather
idiosyncratically found applause at live performances to be a nuisance. He even
stopped performing in public and concentrated on studio recordings, through
which, he found, he could perfect his performances to an even higher degree.
76 Music as Therapy
composition (not least for royalty purposes). The chord changes of the
standard tune, in a reharmonized version, making them better fit for
improvising upon, is the basic starting point for the creative work, which
here too is dialogical in character in relation to the given frame. The work
of the jazz musician is the improvisation on the chord changes, as a
performance.
This is actually reflected in that the applause from the audience in
this case may come after each solo, within the same tune, in contrast to
the classical concert in which the custom is to wait with the applause until
the entire work, the entire “opus,” is finished, even when there are several
movements.
New technologies bring new possibilities for ways of realizing
different works of music. The recording technology has more recently
given many new possibilities. A rock group may spend quite some time
making a recording in the studio that is subsequently released for sale. In
the genre of rock music, the album has tended to acquire the primary
status of work,30 consisting of songs that may be performed on tours, and
played on the radio, or on private music reproduction equipment.
Music Embedded in Culture
The modes of being of music within different genres vary considerably,

then. And the picture becomes increasingly complex when non-Western
music is also considered. In some cultures, as has been often pointed out,
it may even be difficult to find a term according with our term “music.”
The phenomenon we recognize as “music” may be so embedded in
specific cultural practices as to not have acquired any single term of its
own (Bohlman, 1999).
30
A point made by Anne Danielsen in the paper “Presence and Pleasure: A study
in the Funk of James Brown” at the 13th Nordic Musicological Conference in
Aarhus, Denmark, 2000.
Ethnomusicologists have more recently also turned their attention to

diverse music practices within modern Western society and culture (not
just to so-called “primitive cultures”), and also toward practices that are
not considered at all to produce “works” of music as objects of art. Tia
DeNora (2000) represents this field. She has studied what she calls
“music in everyday life,” which includes the music of for instance
aerobic lessons or background music in stores, and music in music
therapy sessions. Stige (2001; 2002a) emphatically supports the notion of
music therapy as a culturally embedded, everyday-life social practice.
And he welcomes the “dethroning,” as he calls it, of music as high art in
music therapy that this perspective implies.
Music, Therapist, and Client
It does seem clear that the ontological status, the mode of reality of music
in music therapy, is different from music as a work. Whether the work is
an “opus” materialized in a score, as in classical music, and to be
performed on later occasions, or the performance of a jazz musician in a
particular club session, or the purchased rock album, music therapy is not
directed toward the production of a musical work in any of these senses.
Music considered as a work becomes an entity that continues in a
certain sense a “life of its own.” In the case of classical music, the score,
having been finished by the composer and then sent off for
publishing,may be played at occasions over which the composer has no
particular influence other than being the one having made the work. The
work may live on long after the composer, being performed in new
settings and circumstances and experienced and regarded in series of new
ways of interpretation. The work in this way becomes something of an
independent entity.
In contradistinction to all this, the music in music therapy is not
made primarily to become an end in itself, as a product on its own terms,
released, published, or broadcast, and thereby “sent off” on its own, as an
independent entity. Not to become an It, as Buber described the
completed work of art. But what is the status of music if not as a work?
What is the mode of reality of music in music therapy?
78 Music as Therapy
In music therapy, there is no objectification of music into a work, an

object in its own right, and a division between a producer of the work and
a receiver. In the case of music therapy, music remains within a situation
that also includes a therapist and client presently related to each other.
The question is how these are all interrelated. The ontology of music in
music therapy, its mode of being, will depend on its placement and role
within this basic setting.
MUSIC AS A MEANS
If it will not be appropriate to consider music acquiring an autonomous

and independent status in music therapy, being made into a work of art, to
be valued solely for its own inherent qualities. Another suggestion, very
close at hand, might be that music, instead of becoming an autonomous,
independent entity, that is to say, an end in itself, in music therapy serves
rather as a means toward some other end. The therapist applies music as
a means for the betterment of the client. The model in its most basic form
will look something like the following:
Therapist Music Client
Figure 3.1. A Linear Model
From a dialogical point of view, it is clear that music as a means pure and
simple fundamentally becomes an It, belonging to the technical and
practical mode of daily use, of expedient measures at hand to be applied
on a regular basis for certain predefined objectives or aims. And this, of
course, is not in itself wrong. The It-mode is both inevitable and
necessary in sustaining life. And music, as any other object, may
naturally be deliberately used as a means in various settings, like the
background music being played for easing nerves and/or countering

boredom and impatience for airplane passengers in the time period before
takeoff.31
The question may nevertheless be raised as to whether a strictly and
exclusively instrumental perspective actually brings out all the qualities
of music as a therapeutic medium. If the use of music within therapy is
legitimatized solely on the ground of it being a means for a predefined
end, music as such becomes just a means besides any other means. And
considered as a means, it is of no particular interest in itself. Its interest
lies in what can be accomplished through its use. Within a purely
instrumentalistic view of music being used solely for the purpose of
something else, music, as music considered, recedes to the background.
The distinctive qualities of the medium do not carry any weight on their
own accord within such a position.
The Logic of Means and End
The logic of using music primarily as a means for accomplishing some

extraneous end tends not to consider the particular qualities of music
itself, because as a means bare and simple it is not connected as such to
the outcome it is supposed to bring about. The pure logic of means and
31
See Tia Denora (2000) for various such examples of music as a “technology of
the self.” DeNora uses the term “technology” in the widest sense here as a tool or
device, and relates it to the psychologist J. J. Gibson’s (1966) concept of
affordance. “Objects ‘afford’ actors certain things; a ball, for example, affords
rolling, bounding, and kicking in a way that a cube of the same size, texture, and
weight would not,” she explains (p. 39). Inspired by Anderson and Sharrock
(1993), who have used the concept of affordance in ethnographic studies of
organizations, DeNora considers music as an “object” that may constitute
different affordances in different social settings within everyday life, the
characteristics of which may be brought out through ethnographic studies.
80 Music as Therapy
end does not presuppose any internal relation between the set aim and
means applied; rather, they are in principle split apart. This raises the
question: If you do not meet the music for it own inherent qualities, will
you then actually receive the full beneficial “effects”? If you do not put
the music first, on its own accord, will you gain the benefit that follows?
For instance, you would not on the whole decide to develop your social
skills and thereafter join an orchestra, band, or choir, irrespective of your
interest in these activities. You may join any of these and receive such
benefits. If you do not really care so much about the music activity, you
could hardly expect to receive the full positive gains connected with it.
For the client in music therapy, the primary motivation is likely to be
connected to the music activity itself, and if it were not, one could hardly
expect any improvement of functions following from this activity. Using
music solely as a means for improving functions will tend to overlook
this crucial intentional aspect of doing music.
Playing the Piano for Some Other Purpose
The means and end logic is nevertheless quite frequently referred to. An
example that may be reported is that piano playing, for instance, may
help develop fine motor skills. But if considered more closely, how
credible is this? The question is: Do people on the whole have some
specific problems with fine motor skills that piano playing might be
found to be a particularly effective means of alleviating, among other
means that might be sought for this specific purpose? The order of
reasoning here is crucial for deciding upon whether it is an ad hoc
argument or a true means-and-end logic that has been applied—that is,
whether one has started from a sought-for outcome and found an
expedient means, or actually decided on the means in advance (piano
playing) instead of selecting it subsequently and independently, as would
be required for this kind of logic.
There is a further question of credibility here. Is not developing fine
motor skills good for piano playing? Fine motor skills may relevantly and
meaningfully be developed precisely for playing the piano, a perfectly
legitimate end in itself. It would seem rather artificial to evaluate the
progress of learning to play the piano solely on the basis of the extent to
which the related fine motor skills have been developed for some other
purpose. One might all-in-all suspect that this kind of example is actually
proposed to comply (apparently, at least) with the strict and conventional
logic of means applied to an extraneous end, rather than emerging from
actual practice as having been found to be a well-suited means for a
certain defined end.
A Counterexample
Here I would nevertheless like to cite an example in which a man with

multiple sclerosis actually did ask a music therapist for piano lessons,
with the expressed purpose of trying to maintain as much as possible of
his functional level of fine motor skills of the hands.32 Another aspect
was that he wanted to learn some children’s songs, to play for his young
son. Engaging in such activity also had something to do with finding
something meaningful to do, despite the prognosis of his diagnosed
affliction. He was intent on not just giving up, and on taking an active
counterapproach to the consequences of the illness. Learning to play the
piano was about having such a project, he explained to the music
therapist, of still looking forwards, and of engaging in something that also
might be supportive of his relating to others, particularly his son. So the
aims here, after all, were wider than a singular intent toward fine motor
training. His playing would thus acquire a broader significance,
something with inherent value still.
This man continued his piano lessons with the music therapist for
several years. It turns out that he originally had approached the music
therapist because he assumed that she would have some competence in
adjusting the teaching to his specific needs. So initially his motivation
was actually not solely using piano for fine motor skills training. (One
32
Personal communication from the Danish music therapist Hanne Mette
Ochsner Ridder, Aalborg, 2001.
82 Music as Therapy
might even speculate that his citing of the development of fine motor
skills as a motivation could partly have been a way for him to get the
music therapist interested in teaching him to play the piano—having
heard, maybe, that this is something music therapists would be quite
concerned with. This at least is conceivable.) What this example in any
case could serve to illustrate is that even though there might be aspects of
music therapy based on a simple means-and-end logic—for instance, fine
motor training—restricting an account of the role of music in music
therapy to a means merely for an extraneous end very soon may become
too narrow.
Treating Human Beings as Things
A basic critique that may be raised from a dialogical perspective in using

music more or less exclusively in the manner of an It, an expedient means
merely, a tool for use, is that this will tend to bring about treating humans
in an objectifying way too, as that which this means or tool works upon.
To use music in a squarely technical, instrumental way in itself may
actually entail reification of the human being, a treatment of people too as
if they were things.
To illustrate this point, which is crucial, I would suggest a scenario,
based (mostly) on imagination, of an adolescent boy with cerebral palsy.
He is sitting in a wheelchair and having a music therapy session. The
therapist is playing the piano, and the co-therapist is assisting by placing
a cymbal so that he can manage to hit it with a stick held in his hand, in a
joint musical improvisation. He is becoming really excited and
enthusiastic, managing to hit the cymbal, despite his physical inhibitions
and limitations, with great and satisfying music effect related to what the
therapist is playing. The therapist is skillfully and imaginatively adapting
the music to the capabilities and response of this young person. He has a
broad smile on his face, and though he is not speaking, he is uttering
some sparse but intense vocal sounds that seem to express an utmost joy
in this activity. Then the co-therapist gradually places the cymbal higher
up, and then more to the side, and then somewhat backwards from where
he is sitting, making it gradually more difficult to hit the cymbal, by
placing it at farther distances and at increasingly more awkward
positions. The aim here is that this young boy in this way may receive
some gross motor training by having to stretch his arm more and more in
various directions to hit the cymbal.
There might be good reasons for having this young boy become
engaged in such gross motor activity, given his cerebral palsy condition.
Still, there is a fine line to be drawn here with regard to intentionality. A
serious question could be raised as to whether there might not be
something highly manipulative about this way of thinking and acting
toward another human being. The aim for the therapy becomes
inaccessible for him, because his own experience and intent presumably
is not primarily about performing gross motor training. For him, in this
case, it is obviously the music and playing together that is his primary
motivation, and that engages him. In this imagined example, the real aim
remains hidden; it is not immediately obvious to the young boy involved
what the therapy is about. And if he should in some way became aware of
what “really” was going on, of what the aim of the activity was supposed
to be, namely the repeated, steadily increased stretching of his arm in
different directions for the purpose of gross motor training, there
presumably would be more than a slight chance that his enchantment and
engagement with the activity would become reduced, because this would
not necessarily be in accordance with his own intention.
The critique that could be raised here is that this young boy’s own
will and intent is not taken into due consideration. If the real aim remains
hidden, even deliberately so by the therapists—luring him, so to speak,
into greater arm movement, the more eager he gets musically—then this
actually is disallowing the qualities of the music as he experiences it in
the given situation, and thereby undermining the integrity the person.
There is in such a case no intentional inner connection between means
and end as seen from the side of the client. And if there is no such
connection, the use of music as a means toward him becomes reifying.
He is treated as if he was a thing, his own will and experience bracketed
in favor of the two therapists’ decision as to what is best for him.
This raises some ethical issues about dealing with people who are to
a large degree at our mercy due to problems of physical and/or mental
inhibitions. Great caution is needed here. From a dialogical point of view
it is crucial that humans are not treated in a reifying manner, lest the
84 Music as Therapy
therapeutic practice itself simply becomes dehumanizing. A basic stance

of a dialogical perspective is that the treatment of human beings not be
conducted entirely in an It-mode, that is, not as a purely manipulative,
technical relation, but as a relation in which the one who is helping or
serving, meets the other as a human being in a direct person-to-person
relation, and not as something external, like to a thing.
Humanistic Critique of Reification
This is the basic—“classic,” one might almost call it—critique of strictly

technical modes of treatment of human beings, as has been brought
forward from a humanistic stance. In his book Music Therapy and Its
Relationship to Current Treatment Theories, Ruud (1980) contrasts the
behavioral and humanistic/existential views of therapy on the grounds
that the behavioral view, not taking human consciousness into due
consideration and actually striving for an “objective” approach, will miss
the dimension of human will and action, which is central from an
humanistic/existential point of view. Ruud applies Buber’s distinction
between I-Thou and I-It relations here, stressing that an objective attitude
from the therapist may not be conducive to bringing out the “real-self” of
the client. There is a therapeutic potential in the meeting itself between
therapist and client as real persons. The real self of the therapist,
characterized by spontaneity as an expression of “being oneself,” may
bring forth the real self also of the client. To further the client’s
responsible action and capacity to make own choices, the therapist has to
be humanly present. And this dimension will not be readily available
through a merely technical approach. It is only in the relation to the other
as a Thou that the relation may be spontaneous in character. Behavioral
learning principles, implying a technical and objective way of relating, do
not allow space for such spontaneity, Ruud purports.
I will not go any further into a discussion on a behavioral orientation
and variants of this. It should be noted here that Ruud does not at all
support any sweeping rejection or dismissal of a behavioral approach. His
intent seems to be, rather, to show some of the limitations of this kind of
approach. He recognizes that behavioral modification procedures have
proven effective in a variety of situations. It should be mentioned
furthermore that a behavioral approach, which of course has developed

much since the time of Ruud’s critique, will better fit in with a music in
therapy approach, using an already established theory and principles of
procedure in the application of music within this therapeutic mode. The
aim here, as has been made clear, is to contribute to develop theory and
principles for a music as therapy approach.
Otherwise, the overall aim of this discussion on reification has been
to show that from a dialogical point of view it must be considered too
simple to regard the role and position of music in music therapy as just an
It—as a bare means, a tool, a purely technical matter, and nothing else.
Legitimatizing the role of music in therapy on this basis becomes too
narrow indeed, in that it does not take sufficient care of the inherent
qualities of music as such and to how humans as intentional beings relate
to these.
Music as a “Physical Object”
Another aspect of seeing the position of music in music therapy along a

singular line of means and end, in which the therapist uses music for a
purpose directed toward the client, is the issue of cause and effect. A
means-and-end view in its strictest form will imply a cause-and-effect
relation between the means applied and the outcome or result. The effect
of music in this view comes from applying music as a cause with a given
predicted outcome. The question here is whether this is the kind of effect
to be expected from applying music, and whether music in this sense can
be considered a “cause.” Classic natural science has had as an axiom that
recurrence will produce equal conditions; that is to say, it will bring about
identical results. This has been the presupposition for conducting
experiments and for being able to discover universally valid laws of
nature, from which it is possible to make predictions. And this possibility
for prediction is what constitutes the basis for the application of these
laws in various forms of technology.
If one were to discover natural laws, in a similar way, for the effect
of music, this would mean viewing the reality of music, its mode of
existence, from this particular point of view. Within a natural science
paradigm based on physics, music will be regarded as sound waves, or
86 Music as Therapy
more precisely longitudinal pressure waves in air or other mediums.

These pressure waves are operationally measurable through an apparatus
registering the parameters of frequency, amplitude, duration, and
waveform. And this is what music, according to this perspective, will be
considered to consist of (Seashore, 1938). Stating that this also is the
reality of music would follow as a consequence of the so-called
“methodological monism” of positivism, which has claimed that only that
which can be researched by the methods of natural science, and by these
methods only, is what can be counted as valid knowledge of what is real
(von Wright, 1971). Within this “unity of science” paradigm, music thus
becomes a physical object, measurable as longitudinal pressure waves in
air.
But that this, and nothing else, is what music should be supposed to
be must lead to unreasonable consequences. For music, as sound, must be
regarded to be sound as heard. There is little meaning in claiming that
music “actually” consists of pressure waves in air. This does not at all
give any description of the music as music. One does not find melodies,
rhythms, timbres, and dynamic changes as musical qualities in
quantitative descriptions of frequencies, durations, waveforms, and
intensities of longitudinal pressure waves moving through air. These are
physical states of affair, which no doubt are necessary conditions for the
existence of music. There is of course no reason whatsoever to doubt the
physical basis of musical sound residing in just these longitudinal waves.
But to claim that this is music, “really,” would imply a physical reduction
that actually erases music, as music considered, quite out of the picture.
Sound waves may be registered, measured, and calculated as a
physical phenomenon, and of course there may be good reasons for doing
so. The field of acoustics, for instance, is both relevant and significant for
music. But to claim that this was the only true reality of music, and how it
works, would indicate a “scientism” that does not actually recognize
music as a sounding reality in our everyday life. And without taking this
into full consideration, it would be hard to carry on any meaningful
discussion at all as to how it “works.”
To view music as in reality a physical entity results in a reduction,
dislocates it, and makes it not at all recognizable as music. It becomes
turned into something different, an It and nothing more, distanced and
objectified. In contrast to this, holding open the possibility of relating to

music as a Thou places music directly into our life world, or within the
everyday, as Buber terms it. This is where we confront it and experience
it, and where it gives meaning to us. This is where we hear it. It is in this
life of the everyday that we may relate to music as music. It is not located
anywhere else, really, whether as pressure waves or as electrochemical
processes somewhere inside the brain.
Music viewed dialogically as an encounter implies that it cannot be
defined purely on a physical basis. And from this follows that the way
music works, or the effects of music, according to this point of view,
cannot simply be of the same sort as those found in the causal explanation
of physical phenomena. Such a view would have to be considered as a
mixing of terms on a basic ontological level, describing a given
phenomenon with a set of terms that belong to an altogether different
sphere of reality, literally a kind of “ontological confusion.” The effect of
music, as music, is not like the effect of a biochemical reaction coming
from taking a pill. It is a different kind of effect that needs to be
accounted for, on different terms than physical or biochemical cause-and-
effect schemes. The one is not simply reduced or equated with the other.
This of course is not at all to dispute any physiological effects of
music, nor of inherent acoustic properties of different scales, chords, and
rhythms. From a dialogical perspective, rather the matter is about not
confusing modes of reality. It is acknowledging the world of relation and
that the dynamics of relation are not meaningfully or entirely described in
terms of linear cause-and-effect schemes. The world of relation is a world
that must instead be described in terms of processes of mutuality and
reciprocity.
THE MUSIC THERAPY TRIANGLE
Having tried to show the inadequacy, from a dialogical point of view, of a

simple linear model of a therapist using music as a means to some
extraneous end for a client, I would now like to try to develop an
alternative perspective, based on terms of reciprocity and mutuality. I
want to suggest another kind of model than one moving in a one-way
88 Music as Therapy
direction along a single line. To set therapist and client in a direct

interrelation to each other, as well as to the music, three lines are needed
to interconnect these, not just a line directed from the therapist, via music,
toward the client at the other end. I will, instead of placing music in a
middle position on a unidirectional line from one side to the other,
suggest turning the single line into a triangle:
Music
Therapist Client
Figure 3.2. The Music Therapy Triangle
With two-way lines drawn between the three sides, the position of music
becomes altogether different when compared to placing it at the end of a
single line. A triangle makes it possible to bring out the connection
between all three sides in relation to each other. It indicates that both the
therapist and the client and their relation to music are reciprocally
interconnected, and thus a dynamic interrelation between each of these
poles is illustrated. Furthermore, and not least significant, such a model
may open a perspective showing the interrelations of one to the other
two: how one part mediates the relation between the two others. Three
aspects may be seen to this:
First of all, the relation between the therapist and the client is
mediated by the music. The music is not just sent in one direction. Within
this basic triangle model, a reciprocal relation between therapist and
client is indicated. The therapist may address the client musically and
may receive musical response. And the therapist may respond back to the
client’s address to him. This becomes a process of reciprocity. Music
between the therapist and client may facilitate a communication, a mutual
address and response, through music. The triangle in this way indicates
not simply a one-way connection between a therapist and a client, but a

relation between the two, mediated by music.
Secondly, the therapist in this perspective mediates the client’s
relation to music. The therapist is not simply engaging in some music
activity together with the client, but has an active responsibility, within
the given therapeutic setting, regarding how the client can relate to the
music. The therapist in this perspective may be seen to mediate how
music serves the therapeutic process of the client. Music is mediated
therapeutically, for the client, by the therapist.
The third pole in the triangle, the client, may be seen to mediate the
therapist’s relation to music, in an indirect, or in a certain sense passive,
way. The therapist is not engaging in music within this setting on his or
her own personal account. The focus of the music activity is serving the
needs of the client. The client, on the other hand, does not have a direct
and active role in mediating the therapist’s relation to music, but may
nevertheless be considered to functionally mediate the therapist’s relation
to music, in that it is the client’s needs that are the primary focus in the
therapist’s relation to the music.
An Illustrative Example: Annabel
There are a series of dialogical processes that are involved here. In the
following, I would like to give an illustrative example from my own
practice as a music therapist to elaborate further on these three sides or
aspects of mediation, as indicated above.
Annabel is a girl of about 14 years of age, with Rett syndrome. This
is a progressive neurological condition, almost exclusively contracted by
girls, in which the child from a very early age on starts losing basic,
already-acquired abilities, like walking and talking, and develops a multi-
handicap condition. Very often there is a characteristic movement of the
hands resembling hand washing. I am having individual sessions of music
therapy once a week with this girl, in a special education setting. The aim
for these sessions is trying to engage her in some meaningful activity. She
is very much in recluse, sitting quite self-absorbed in her wheelchair, and
with a rather incessant movement of the hands. She does not have any
90 Music as Therapy
functional verbal language, and remains very much in a world of her

own, not being easy to “reach” or contact.
I start by singing some songs for her. There is some response here, it
seems, but she is still rather withdrawn. I try to think about how to
engage her somewhat more. I then ask her if I may take her hand, gently
releasing one of her hands, which is “hand washing” with the other, and
holding it for a while. I then gradually lead it down toward her lap,
holding it here. She seems OK with this. The other hand is continuing a
more or less automatic movement toward the other hand though, which is
not right there anymore. I now take a tambourine and place it before her,
so that she hits the tambourine as she makes the movement with her hand.
This startles her, again and again. I then start singing a song, which I
make up on the spot, in a mode that seems to fit in with the overall “beat”
movement of the hand.
Figure 3.3. Annabel’s Tambourine Song

This engages her more. After some time, she apparently recognizes the
song and the activity quite well. When the activity is announced and
about to start, she is looking rather eagerly toward the instrument and
making some effort, it seems, to get her hand started. So even if this
initially was a quite automatic movement, she now seems intent on
hitting and making a sound on the tambourine.33
Eventually, as a further step in the development of this activity, I
deliberately just sing the first part of the first phrase of the song up to the
point “Annabel can play the tambou- …,” and then wait for her to
actually hit the tambourine with her hand. The moment she does, I
continue with the end of the word, and of the phase “-rine!” This creates a
musical suspension, which is released as she hits the skin of the
instrument. What happens now is that she bursts into a laugh. Her whole
face just lights up. I continue likewise through the song, singing part of a
phrase, and waiting for her to hit the tambourine before continuing the
song. And she just laughs and seems really to be delighted about this. She
raises her eyes, and looks up at me in what seems to be astonishment and
surprise, and when the song is finished, we just sit looking at each other.
She is smiling, bursting occasionally into a soft laugh. I am smiling, too,
having a very strong sense of contact in this moment. This has become a
favorite activity for her. She may be quite distant and withdrawn when
coming in to have the session, but really lights up whenever we start this
activity.
CHILD-THERAPIST RELATION MEDIATED BY MUSIC. Since this girl
does not use verbal language, one has to make some guess as to what gain
she might have had from this activity, by observing what happens in the
session. My own impression was that what really seemed to cause her to
light up and become available for contact was that she had a clear feeling
that what she did had some consequence for another person. She might
enjoy the song, and find playing the instrument rather fun in and of itself,
33
I later found out, reading some old reports in her file, that she had very much
liked playing the tambourine in kindergarten (functioning at a higher level then).
92 Music as Therapy
but the big change in her reaction came when I very markedly adjusted
the song to the tempo of her playing, creating a musical suspense that was
directly tied up with what she was doing, and that was released by an
action from her. The musical suspension that was built up was not
released until the moment she hit the tambourine with her hand. I had a
clear impression at that moment that this was what made her react with
such apparent amazement. And then she looked up toward me, and
smiled a big smile.
It turns out that she was capable of making contact when there
actually was some reason to! There were not many activities in which she
could interact on any kind of even level with someone else. Through this
activity we achieved some contact. As we were sitting afterwards, just
looking at each other, it seemed very clear to me that we were having
some mutual recognition of each other. Through the playing, she could
establish “Yes, here am I, and I mean something to you. You recognize
me for what I am, for what I am capable of doing.” And I could affirm,
“Yes, I see you, I see who you are. I see what you can do, and that we can
do something together.” In this activity, there seemed to be rather more
involved than what more narrowly could be defined as “learning to play
the tambourine.” It was a very simple activity in itself, but it gained a
wider significance.
This communicative interchange happened through music, and the
qualities of the medium are what facilitated it. Without music, I would
not have had this particular opportunity to reach through. Music became a
channel for me to reach through, to get across to her in some way. It was
possible for me as a therapist to address her in some way through music.
And significantly here, I believe, it was through the medium of music that
she herself was being made able to reach out and to respond. By her
attempting to play to the by now well-known song, and me adjusting the
song to her playing, we established a kind of musical interaction, a
playing together at a very basic level. The melody had become familiar to
both of us, and waiting for the song to be continued as the tambourine
was struck became musically exciting and meaningful. It was music as
something we shared in that made contact and interpersonal interaction
possible. The relationship between the child and therapist in this way was
mediated by the music.
CHILD-MUSIC RELATIONSHIP MEDIATED BY THE THERAPIST. As

mentioned, this girl could not use verbal language. Still, it became
possible for her to express herself, to make some kind of statement of
significance for another person that could be recognized for what it was:
her own. Music is very flexible when it comes to levels of proficiency. It
certainly allows for rising to exceedingly high levels of artistry, but it
may also be a powerful personal expression at a most elementary level,
which is what was aimed at in this case. This is a multi-handicapped girl,
with rather limited options for activity. Music proved to be a medium
flexible enough to facilitate participation at this level. Annabel was given
a possibility to manage, indeed to succeed, in this activity. Maybe she
would conventionally not be considered a probable candidate at all for
engaging in any kind of musical ensemble playing. But through taking
her movements of the hand to be intentional, or creating a frame in which
they might appear as intentional, the potential intentionality of the
movements were actualized in a way. The therapeutic task consisted in
facilitating the child’s participation in music by adapting the activity to
her capabilities and needs. She would not readily have had just this
possibility of relating to music without the active mediation by the
therapist. The therapist thus responsibly mediated the child’s relationship
to the music.
THERAPIST-MUSIC RELATION FUNCTIONALLY MEDIATED BY THE
CHILD. The song was a spontaneous creation in the moment, and would
not of itself have been made by the therapist outside of this particular
setting. It was the situation that called forth the song. This exemplifies the
third side, that of the therapist’s relation to music being mediated by the
relationship to the client. The way the song was made was related to how
it facilitated the participation of the child, and this is also what it should
be evaluated by. The rhythm, the melody, the text, and the playing
activity all go together in the overall simple structure of the song, and
also the way it was used, with fermatas inserted and extended in the
waiting for the girl to hit the instrument. The song was made for this
specific situation, for therapeutic purposes, naturally including all these
elements into a whole. The therapist’s relation to the making and
performing of this particular music was in effect mediated by its function
for the child.
94 Music as Therapy
Music as a Medium
The lines drawn here between the triad of therapist, client, and music,
indicating how each side mediates the relation between the two others,
suggest that any single cause-and-effect outcome between one side and
the other will be hard to find. Instead, reciprocity between all three sides
is found, rather than any unidirectional A leading to B. There is no
mechanical one-way connection drawn between music and client,
administered by the therapist, because one side related to the other is
mediated by the third. This implies that the workings of music in music
therapy, according to such a view, must be found in dynamics of
interrelations, rather than in one-to-one mechanical effects.
The position or status, that is to say, the ontology of music in music
therapy, according to the basic triangular perspective drawn here, is not
as an object aimed toward becoming an autonomous work of art, an
independent entity to be valued on its own terms. Nor is the status of
music to be defined solely as an external means, instrumentally applied
for some other predefined end. The position of music in music therapy
may be considered to be between these two. This suggests that the place
to look for the actual effect or power of music in music therapy may be
between means purely for an end, and an end in itself, which is to say, I
would suggest, as a medium.
A Medium for Therapy
The notion of music as medium has been introduced to music therapy

literature by Aigen (1995), who refers to John Dewey’s Art as Experience
(Dewey, 1980, first published in 1934). Dewey makes a distinction
between two kinds of means, those that are external to what is
accomplished and those that are incorporated in the outcome. An example
of the last kind is making a journey for the pleasure of it, rather than for
merely going from one place to another. As an external means for
arriving at the chosen destination—going to work, for instance—the
travel becomes something that one in principle could do just as well
without, and there would be no objection to making it shorter. Taking a
journey for its own inherent pleasure, the trip becomes a medium for
enjoyment. Here there is a unity between means and end. It makes no
sense to say that one could just as well do without the trip to accomplish
the goal, because the trip itself is the goal. Such a unity between means
and end, Aigen points out, is a defining characteristic of the aesthetic,
according to Dewey.
Although Aigen does recognize that in some instances music might
be used merely as an external means, he suggests that in addition to this,
in cases where music is not applied merely as a means, but where the
aesthetic dimension is also considered and included, music may more
accurately be considered as a medium (pp. 238–39).34
The perspective that has been sketched in the present context will
nevertheless imply a somewhat different notion of music as a medium
than the one suggested by Aigen. Dewey (1980) sought to bring
something of the aesthetic, as a quality of unity between means and end,
into daily life experience. He proposed this as one way of alleviating
alienating tendencies of modern society. And on the other side he
objected to the modern autonomy of art. Dewey thus sought a higher
integration of art with life and life with art. While it is easy to sympathize
with this notion, I think some distinction regarding the status of art as art,
in the more narrow sense of the term, is useful to uphold in this context,
for the purpose of not confusing the issue when it comes to the position
of music in music therapy. Not so much because of differences as of
likeness, taking note that resemblance is not the same as identity.
Aigen bases his argument on Dewey’s notion of a medium being a
unity between means and end. But this would be just as valid for a
general aesthetics of music. Aigen’s concept of medium does not
distinguish in principle any differences between music as art and its role
in therapy. This would seem to be in accordance with his music-centered
34
In his most recent book, Aigen (2005) elaborates further on the notion of music
as a medium of experience, contrasted with music regarded merely as a means,
as a one basis for a music-centered theory.
96 Music as Therapy
stance, in which he tends to equate clinical and nonclinical music-

making. As the subject matter of this inquiry and the approach dealt with
here is music as therapy, the focus will be somewhat different. I believe it
is significant to retain a certain distinction here between music as therapy
and music as art, because of a crucial difference in aim. There is a
purpose, an aim for music therapy, which is namely benefiting, and
helping the client.
Music as therapy, as has been emphasized here, is not about making
musical works of art as such. In music as therapy, according to the
perspective developed here, music becomes a medium because it is not
made into a work, made autonomous as an independent entity in itself.
Thus it remains within the setting of the therapist and client, as indicated
also by the triangle setup. It is by retaining its position as a “present
partner” within the therapeutic setting that music may obtain a status as a
medium. By not letting music objectify into a work, as an end in itself, it
remains within the present situation, and it is in this way that it may be
regarded to become a medium for the therapeutic process of the client.
Music as therapy is not primarily for having some music produced,
as an entity that continues a life on its own (as an autonomous object); it
is, in whatever which way one may apply it, for the sake of the client, for
the client to gain a life of his or her own. In “music as therapy,” music is
not simply a medium of experience, in general terms, but a medium for
therapy. It is a medium for therapy, in which its own qualities are adhered
to, but for another end than itself—namely, the betterment, in some way,
of the client.
Interpersonal and Musical Relational Fields
In the book Music for life: Aspects of Creative Music Therapy with Adult
Clients, Ansdell (1995) has a chapter titled “Meeting,” in which he
applies Buber’s concept of the “between” to what he terms the “musical
meeting.” This is relevant to consider here, regarding the role and
position of music related to a dialogical outlook, though I think there may
be some questions that could be raised regarding Ansdell’s application of
this term, as I will try to show in the following.
Ansdell relates that he finds it difficult to quote Buber, because of

the unusual vocabulary that is used in the development of the argument.
So he bases his application on an interpretation made by Danah Zohar in
the book The Quantum Self. Ansdell quotes from this source:
In intimacy, I and you appear to influence each other, we seem to

‘get inside’ each other and change each other from within in such
a way that ‘I’ and ‘You’ become a ‘We’. This ‘We’ that we
experience is not just ‘I+You’, it is a new thing in itself, a new
entity … the ‘We’ that appears to arise in intimate relationships is
the ‘I-Thou’ written about by Martin Buber. (Zohar, 1990).
(quoted in Ansdell 1995, p. 68)
There are manifold interpretations of Buber, given in a great variety of

settings and contexts. This particular interpretation is not a much-cited
reference in the secondary literature, and actually quite problematic, I
believe, in particular in making the construct “We” as “a new thing in
itself, a new entity”, as Zohar phrases it. Buber takes great pains not to
make any kind of “entity” of what is relational. It is actually a basic
feature of his philosophical outlook that the relational as such is
considered as non-objectified. Turning the I-Thou relation into a “We,”
designated as a kind of “new entity” or “thing in itself,” as Zohar also
phrases it, sounds more like what would belong to the world of It, in
Buber’s terms. Making objectifications of what is relational is arguably
precisely what Buber seeks to avoid. And basing a reading of Buber on
this particular interpretation, it might seem that Ansdell tends to run into
some problems with the constructs made.
Ansdell makes no claim to other than a suggestion of the
implications of Buber’s approach to dialogue as this may be applied to
music therapy. On the basis of the interpretation given by Zohar (1990),
with the I and You becoming a We, he presents a schema illustrating the
different levels of relationship within therapy, moving from an initial
98 Music as Therapy
attempt to make contact, and then making contact, the client responding,
mutual relating following this, and finally to meeting.
I will leave the idiosyncrasies in the use of Buber’s basic concepts
here.35 And also accept the description given through these series of the
different levels from contact via response to relating and meeting as itself
both relevant and meaningful. Still a problem remains concerning the
position of music within this schema. There is actually and quite
remarkably so, no specific role to music indicated, other than the
illustration of the piano on the therapist side and the drum on the client
side within the first figure, “Contacting” (p. 70).
This might seem to reflect that interpersonal relationship and music are
practically equated. This outlook may seem to accord with and give
expression to a basic music-centered position, in a strict sense of this
term. In the final figure, it seems that both the therapist and client and the
music as such become fused into the “We,” which Ansdell accordingly
terms the “musical meeting” (p. 73).
35
The series of figures have the following titles: Contact: “I”>”You” – “I” and
then “I”>”You” – “You”, responding: “I”>”You” – “I” (“You?”), relating:
“I”>”You” – “You”< “I”, meeting: “We” (Ansdell, 1995, pp. 69–74).
I will propose that a problem relating to an application of the dialogical

principle may be found here. Neither the interpersonal nor the relation to
music is clearly accounted for on their own terms in the insistence on
near identity between these two aspects. And neither is the relation
between them. For elucidating a music as therapy approach, I will prefer
to keep the lines that can be drawn between therapist and client, and the
lines from both of these to music, to get a view of the relational and inter-
relational fields between them instead of ultimately fusing them all into
one.
Ansdell otherwise refers to Buber’s concept of the “Between,” and
takes this to be synonymous with the notion of “We.” Applying this
concept, he writes:
In music therapy, the ‘Between’ is the music itself, where our

creative responses can draw an ‘I’ and a ‘You’ into an ‘I-You’
and finally perhaps into ‘We’ (p. 68, italics added).
I would like to point out that Buber developed the concept of “the
between” for designating the field bridging the gap between distance and
relation (Buber, 1961). Making an equation of the “Between” and “music
itself” would tend toward turning “the between” as a field of relation
rather into an entity, into some kind of thing, in this case the music itself.
Ansdell furthermore introduces a new conceptual construct along these
lines, the “musical between,” putting the two words together into a single
phrase:
Within this “musical between,” a relationship can come about

which is primarily in the music, established in the improvisation
from the first time a musical contact is made, and developed
through to the point where a true ‘meeting’ can come in the
music (p. 68, italics added).
Ansdell repeatedly uses phrases like “the relationship in the music,” or

“the relationship inside the music,” or “a musical meeting … within the
purely musical (pp.65, 67, italics added). The insistence on the
relationship residing within the music seems to be conceptually based on
the equation of music with the “Between”. Music is the “Between,” or the
100 Music as Therapy
“Between” is music in some sense. Music seems this way to be

positioned somewhere within the “Between,” according to Ansdell’s
constructs here.
Ansdell’s phrase “musical meeting” again implies a fused notion of
the interpersonal and the musical relationship. But this is what I think
may be questioned. Is the relationship as such “inside” the music? Is not
the relationship actually between people? Any meeting between people
must surely be an interpersonal affair, and not just residing somehow
within the so-called “purely musical”. “Musical meeting” may, thus
considered, seem a rather artificial conceptual construct.
The “Between,” in Buber’s sense, is the relational field as such, and
by ultimately fusing all the elemental ingredients of music therapy
together, the fields of relation and interrelation close together into one
single point, as illustrated in Ansdell’s final figure. In a clear contrast
with this, a triangular setup may indicate interrelations along three lines,
with different characteristics and roles in the way each side mediates the
relation between the two others. This is the main reason for keeping these
lines between open, rather than merging them all “in” the music. A
problem with “containing” the relationship “within the music” is that the
various aspects of each line of relation, interrelated with the other two,
may not be brought out clearly. The “Between” is not some fused entity.
It is no “thing” at all, it is the space in which relation is opened for. And
this space, I believe, should be kept open, not closed, in order to
distinguish what is in it, and what happens within it, and if some fusion
into a single point in some instance might occur, to see what is fused and
how this could have come about.
DIFFERENT SPHERES OF RELATION
A crucial aspect of the triangular setup that needs to be emphasized is that

the three poles represent among themselves two different spheres. The
relation between therapist and client is interpersonal, whereas the relation
of both of these to music is of a different sort; it is a relation within the
sphere of the “forms of the spirit” to which music belongs. It is a decisive
feature of the “dialogical principle” as interpreted here, that it allows a
relational view to be applied toward different spheres, and in this

particular case it is actually being applied for indicating interrelations
across two different spheres. I will consider this a major asset of a
dialogical outlook in this context, that it may be used to imply and
elaborate on interrelations across the spheres of the interpersonal and the
musical. It is precisely in the dynamics of interrelation across these two
spheres that—as the thesis here goes—the basis for regarding music as a
medium for therapy may actually be constituted. This is what I will now
set out to explore further.
Excerpt Three
Chapter 4
RELATIONAL KNOWING
Rudy Garred
Having now established a basis for further exploration, in positioning
music as a medium for therapy within a triangular setup including client,
therapist, and music, I will proceed to develop a dialogical perspective on
each of the two relational fields that are indicated this way, the
interpersonal and the musical, respectively. First, I will consider the
sphere of interpersonal relation more closely. I will consider some recent
theory that has been developed regarding the significance of the
relational aspect in the therapeutic process, which may be seen to be in
close accordance with a dialogical perspective, and relate this specifically
to music therapy. Then I will attempt to develop a theoretical perspective
on the significance of the musical relationship in music therapy, and also
to view the musical and the interpersonal in relation to each other, with
regard to the significance of this interrelation for the therapeutic process.
THE EARLY INTERACTION ANALOGY
There have been an increasing number of references over some time now
within music therapy theory to research on mother and infant interaction.
Music therapists have noted that several of the researchers into infant
interaction use musical terms in describing the early preverbal
communication, such as Bullowa (1985) writing aboutmovement, sound,
and rhythm making up much of the common experience infant and parent
bring to their meeting, seen in patterns of synchrony and of counterpoint
and syncopation. Leslie Bunt (1994) refers to Daniel Stern’s book, The
Interpersonal World of the Infant (1985), which has been a key reference,
in which terms like rhythm, dynamics, tempo, and orchestration are used
in a description of the playful vocal interaction between mother and
infant. Comparisons have been drawn, on the basis of an apparent
Relational Knowing 103
similarity, between this early interaction and clinical improvisation in

music therapy.36
Another early interaction researcher that has been much referred to
is Colwyn Trevarthen. Of interest to note here is that Trevarthen and
Malloch (2000), responding to this interest, propose to extend the concept
of nonverbal communication, which they find inadequate to cover the
broad spectrum of human interaction that it is actually intended to cover,
and introduce the alternative metaphoric term communicative musicality,
relating this to the Greek word “mousiké,” which applies to all the
temporal arts together. They suggest that such “communicative
musicality” is the source of the music therapeutic experience and its
effects, based on an inborn musicality that they regard as being
uncovered through acoustic analysis of parent/infant vocal interactions.
Therapy by ‘conversational improvisation’ of music is an art and

clinical technique that directly addresses human intersubjective
feelings and expressions in time. … It communicates a dance of
human well-being, an activity that taps the musicality of both
therapist and client (p. 14).
The musicality referred to here is both in the narrow sense, related to

music activity as such, and to “communicative musicality” in the wider
sense, which Trevarthen and Malloch view as more than just “nonverbal”
or “preverbal.” The use of music in therapy they consider to be based on
the human trait—which is life-long, and not belonging just to a preverbal
stage of human development—of “creating companionship with another
by structuring expressive time together” (p. 14).
Ulla Holck (2002) cautiously points out that early interaction, of
course, is not the same as music as a cultural form, but that music
nevertheless may be seen to rest on the same communicative elements as
36
(Bunt, 1994; Hughes, 1995; Oldfield, 1995; Pavlicevic, 1997; Rolvsjord,
2002).
early interaction between mother (parent) and infant.37 Holck summarizes

some of these elements of communication that are applicable to music
therapy, such as the appeal of sound, imitation, turn-taking, pausing or
“freezing,” building up expectation, variations on a theme, and small
musical-drama sequences. What is central from a therapeutic point of
view in all of these musical communicative elements, according to Holck,
is the development of relation through such communicative interplay.
The “Innate You”
It is interesting to note here, regarding a philosophical grounding for such

theory, that Buber uses the communicative capabilities of the infant as a
prime example in I and Thou to bring out basic features of a dialogical
outlook. He asserts (prior to the research initiated into this area) that the
newborn child has a communicative ability right from the start, and that
the child seeks immediately, that a fundamental human trait from the very
beginning is a longing for relation. And this is a given precondition,
Buber maintains. It is a fundamental basis for the development of every
kind of relation. It is the “a priori” of relation, as he calls it, or, in a rather
paradoxical phrase, the “innate You” (Buber, 1970, p. 78).
37
This point has also been put forward on an ethological basis by Ellen
Dissanayake (2001), who states that antecedents of musical behavior can be
identified in ritualized vocal, visual, and kinesic components of mother-infant
interaction, which, during human evolution, provided rudiments for the
development of music in ceremonial practices of culture. The question, of
course, is whether this is a sufficient explanation for the origins of music, though
this certainly is fylogenetically rather thought-provoking.
Affect Attunement and Connection
A crucial aspect in the comparison between infant research and music

therapy has been imitation and turn taking, which are basic forms of
interaction both within the early mother-infant communication and within
improvisational music therapy. Referring to Stern’s central concept of
affect attunement Bunt (1994), in a rather early exposition incorporating
these views, emphasizes that it is not sufficient for a real conversation to
take place just to imitate and take turns in a regular pattern. What is found
in the early interaction research is that the mother initially may notice
what the child does. Then she may well show and demonstrate that what
has been expressed has been perceived and registered, by imitating this in
sound and gesture. But something else needs to be added, something
more than a direct imitation, and this is done by giving a response that is
not purely imitative, but that still clearly resembles the child’s expression,
which the child can respond to, in his or her own way, in a similar
fashion. Thus a chain of interaction is brought about, and through this a
connection, as Stern terms it, on an emotional level between the child and
the mother. Through such interchange there is an experience that also the
emotional content behind the expression is reflected, which is not
achieved by any mere mechanical imitation. This presumably is what
makes it dialogical, what makes it into a “conversation” or a
“protoconversation” (first conversation), as it has also been termed.
This process may be transferred quite directly to the interplay of
improvisational music therapy, where different messages that resemble
one another and are related to each other can be interchanged between the
participants through the musical interaction. As the therapist is directed
toward giving a musical response, without just doing a pure imitation, a
give and take of emotional content behind the musical expression is
opened, and in this way “connection,” in Stern’s terms, may be
established.
Dynamic Form
Developing this theme further, Pavlicevic (1997), as mentioned in the

first chapter, has proposed the concept of “dynamic form.” Pavlicevic
uses the term to make a distinction between a purely musical
improvisation and one that uses music in order to create an interpersonal
engagement. Dynamic form corresponds to Daniel Stern’s term “vitality
affects,” but is explicitly musical in character. The term “vitality affects”
designates the nonreferential dynamic process underpinning various
feelings, rather than categorical emotional states as such, and are amodal
or cross modal in character, which may explain why the dynamic form of
emotions can be illustrated musically, namely through intermodal
correlation. Pavlicevic uses the concept “dynamic form” to bring out the
duality of musical and emotional process in clinical improvisation.
Hearing the music not only as music but also as an expression of the
feeling mode, or feeling state, of the client, the therapist is informed
about the qualities and present condition of the client, and is able to relate
directly to this through joint music-making. Dynamic form is a term that
focuses on the interface between music and emotion in clinical
improvisation, which is not just making music for its own sake, but for
relating to the other and in this way achieving contact and interaction.
As a research experiment, Pavlicevic and music therapist colleague
Sandra Brown conducted a study (1996) in which they recorded three
music sessions, in which each took turns at being client and therapist in
the first two, and in the third they just played together as musicians.
Playing these recordings for music therapists, and blind-rating the
recordings, it was possible for these therapists to distinguish between the
therapeutic and the playing sessions, in that in the therapy sessions the
listeners could hear that the improvisation was formed in order for the
therapist to follow and support the idiosyncrasies of the client’s
utterances, whereas in the music sessions the music followed a path that
was dictated by musical concerns and the playing was “musical” rather
than “personal.” Dynamic form is a concept that is intended to capture
this portrayal of one person in relation to another through musical sound.
As Pavlicevic sees it, it is dynamic form that the music therapist
“reads” and that both the client and therapist experience directly in
improvisational music therapy. It is a reading directed toward the

personal rather than purely musical qualities. The musical interaction is
regarded as revealing the communicative quality of the interaction. She
stresses that music and emotions are nevertheless not completely
contained within each other. They necessarily maintain their autonomy.
Dynamic form is about the interface between the two.
Pavlicevic points to the possibility of a direct kind of “knowing” of
another, through musical improvisation. And this is intuitive and
immediate rather than analytical and interpretive. It is a direct sense of
the other through musical expression:
“This relationship is a direct knowing by the therapist and client

through soundform—a knowing that may be highly intimate”
(1999, p. 61, italics added).
It is a way of both listening and playing where the therapist is focused on

the interpersonal aspect.
Spoken and Heard
This perspective on dynamic form in improvisational music therapy could

reflect a crucial aspect of the position of music as a medium, as proposed
in the previous chapter. This way of listening could be contrasted to
listening to a musical composition, completed and contained in itself.
Music—remaining non-objectified as an autonomous work—may acquire
an inherent quality of address and response within the music therapy
setting, which makes it intimate, as Pavlicevic describes it. In the music
therapy setting, music may mediate the presence of one toward the other.
This is in clear contrast to the statement of the composer, who makes a
public address to some audience, for their appreciation and evaluation of
the work. The client in music therapy is not expected to regard the music
made as a work of art in this sense, from the therapist’s hand, and with
this kind of public address implied. In the music therapy situation, music
may be perceived rather as being for someone, and as coming from
someone. With music remaining within the music therapy setting,
facilitating an address and response reciprocity, it attains a
“conversational” character. And dynamic form is what may be “read” out

of it, in Pavlicevic’s terms.
Or heard, rather. In music therapy, music could be regarded as
spoken; it is addressed to the other as “speech,” rather than as formed into
some “text” with an independent status—as the musical composition,
incidentally, actually literally is, as a score. “Speech” seems to be a more
fitting term than “text” for the mode of reality of music in music therapy.
This, of course, is also in closer accordance with the quality of musical
communication in general, which, as performed, is oral, not written.38
Change Processes in Therapy
Ruud (1998b) has referenced Stern,39 focusing particularly on Stern’s

discussion on how and why change occurs in psychotherapy, which
involves something more than making the unconscious conscious:
As psychotherapy research has shown, clients may recall, many

years after actual therapy sessions, that some special moments in
sessions, especially in their relationship with the therapist,
contributed to the change process. These meaningful moments, or
moments of presence, were linked to the client’s perception of
the relationship with the therapist as an authentic “real”
relationship. (p.160)
38
The Russian literary theorist Mikhail Bakhtin’s dialogical oral/aural concepts
of “speech act,” “utterance,” and “polyphony” are relevant to consider in relation
to music as “spoken.” See Weisethaunet (2000).
39
A keynote address at the 8th World Congress of Music Therapy, Hamburg,
Germany 1996: “Temporal Aspects of an Infant’s Daily Experience: Some
Reflections Concerning Music.”
Ruud refers to the notion of “hot present moments,” through which a new
intersubjective frame of interaction may be created, thereby facilitating
therapeutic change, and links this to the process of improvisation in
music therapy, in which just such “hot present moments,” he suggests,
may readily occur. This is a notion that may help in understanding how
people may change through “music as therapy,” Ruud proposes. And he
continues:
An important element in this relationship would have to be the

therapist’s courage to disclose himself, to be really present, much
in the same sense as Buber’s “meeting” (p. 160).
Ruud indicates a basic concordance of Sterns outlook with Buber’s views

here, and I will take this as a point of departure for a further development
of a dialogical perspective along these lines, relating particularly to the
crucial issue of change processes in therapy, which I think is of utmost
importance to bring out and account for in a theory of music as therapy.
Stern has since this time collaborated with a group of authors with a
background in developmental psychology and psychotherapy calling
themselves The Boston Change Process Study Group (Boston CPSG),
and who have been writing reports supplying theory for psychotherapy
based on results from early interaction research. These writings will be
relevant to consider in the development of such theory.
IMPLICIT RELATIONAL KNOWING
In the Boston CPSG’s first report (of three so far, and with one on press),
”Non-Interpretive Mechanisms in Psychoanalytic Therapy: The
‘Something More’ Than Interpretation” (D. Stern et al., 1998a), the
authors note that there has long been a consensus that for change to occur
in psychotherapy, something more is needed than interpretation, in the
sense of making the unconscious conscious. They differentiate between
two change-inducing or mutative phenomena: the interpretation and the
“moment of meeting,” the last of these representing the “something
more” that the authors attempt to elucidate in the paper. They point to
anecdotal evidence that shows that most patients after successful

treatment tend to remember two kinds of nodal changing events for
themselves, one concerning key interpretation that rearranged their
intrapsychic landscape, and the other the special “moments” of authentic
person-to-person connection with the therapist, that altered the
relationship and thereby the patient’s own sense of self.A clear distinction
between these two phenomena has to be made. One is not explicable in
terms of the other, the authors claim, and they present a conceptual
framework for understanding the “something more” that this moment of
meeting represents.
The Boston CPSG distinguishes between two kinds of knowledge;
declarative knowledge, which is explicit and conscious, and which is the
content matter of interpretation, and the procedural knowledge of
relationships, which is implicit and operates outside of both focal
attention and conscious, verbal experience. It is represented non-
symbolically in the form that the authors suggest may be called implicit
relational knowing. Such knowing integrates affect, cognition, and
interactive dimensions, and alters the relational field of relationship.
The Moment of Meeting
The concept, the authors relate, has been central in the developmental
psychology of preverbal infants, though it is not unique to infants. Such
knowing of the many ways of being with others continues throughout
life. And the authors make it clear that while such knowing is often not
symbolically represented, at the same time it is not necessarily
unconscious, in the sense of being defensively excluded from awareness.
They make the following claim:
Just as interpretation is the therapeutic event that rearranges the

patient’s conscious declarative knowledge, we propose that what
we call a ‘moment of meeting’ is the event that rearranges the
implicit relational knowing for patient and analyst alike (p. 906).
It is such a “moment” that takes on the role as the basic unit of change in
the domain of implicit relational knowing. Change in relationship is
precipitated by a “moment of meeting,” which brings forth a sudden shift

in implicit relational knowing of both analyst and patient. Such a moment
of meeting is inevitably well prepared for, but it is not determined. A new
intersubjective environment is created, through the altering of the
“implicit relational knowing.” The authors provide an example as an
illustration:
If, in the course of playing, a mother and infant unexpectedly

achieve a new and higher level of activation and intensity of joy,
the infant’s capacity to tolerate higher levels of mutually created
positive excitement has been expanded for future interactions.
Once an expansion of the range has occurred, and there is the
mutual recognition that the two partners have successfully
interacted together in a higher orbit of joy, their subsequent
interactions will be conducted within this altered intersubjective
environment. It is not the simple fact of each having done it
before, but the sense that the two have been here before. The
domain of implicit relational knowing has been altered. (p. 909)
This description of mother and infant playing seems readily applicable

also to the process of improvisation within music therapy. If the word
playing here was taken literally to mean playing music, and if the words
“mother and infant” were substituted with “therapist and client,” the
paragraph could well be read as a quite recognizable description of a
music therapy session, in which also new “heights” occasionally may be
reached. The immediate consequence of “moments of meeting,”
according to the Boston CPSG, is that through altering the intersubjective
environment they create an open space, where new initiative is possible.
The constraints of old habits and ways are loosened and new ways may
be found.
Three Phases of Transition
The process of change involves phases of transition. So-called “now

moments,” which are also called “present moments” and occur during a
basic “moving along,” can turn into “moments of meeting” if the
opportunity is seized upon. These “now moments,” which bear a hint of

possibility, are often accompanied by expectancy or anxiety because
there is a need of choice, beyond just taking refuge to some habitual
move. There is a sense of an opportunity that may be taken advantage of.
The authors distinguish between three phases of the “now moment”: first,
a “pregnancy phase,” filled with a feeling of imminence; second, a “weird
phase,” entering some unknown and unexpected intersubjective space;
and third, the “decision phase,” whether or not to seize the opportunity of
the moment. If it is seized, the “now moment” may lead to a “moment of
meeting.” The authors present these concepts as a descriptive
terminology for showing how this something more (than interpretation)
operates as a vehicle for change in psychoanalytic therapy. “Now
moments” must be considered as the threshold to an emergent property of
the interaction, which is the “moment of meeting.” During such a
meeting, a novel intersubjective contact becomes established. It is a nodal
event, the point at which the intersubjective context gets altered, which
means that the implicit relational knowledge in the patient-therapist
relationship has changed.
The Boston CPSG take great pains to distinguish this process from
interpretation. A moment of meeting can well occur if an interpretation is
made in a way in which the therapist also affectively participates. The
one may strengthen the effect of the other. It may also be that an excellent
interpretation is made, but that the opportunity to seize the moment
interpersonally, through a personal engagement, is not taken. The
consequence may very well be that the interpretation all in all becomes
much less potent. On the other side, an interpretation may actually close
out a now moment, which could potentially turn into a moment of
meeting, by explaining it too much or by elaborating or generalizing it.
Transference Issues Minimized
A significant point is that during the “moment of meeting,” transference

and countertransference issues are at a minimum, according to the Boston
CPSG. This is because the traditional therapeutic role is downplayed
during such moments. In the traditional interpretation involving
transferential material, the therapist is not called into the open as a person
and put into play, and the shared implicit relationship as such is not called
into the open. Instead the therapeutic understanding and response as it
occurs within the analytic role is what is involved. In the “moment of
meeting,” the personhood of the interactants is what is put into play,
relatively stripped of the regular role trappings. Thus an “open space” is
established,40 in which individual creativity becomes possible. This
happens as a consequence of the patient’s implicit relational knowing
having been “freed of constraints imposed by the habitual,” as the authors
put it (p. 915).
Each one has his or her own implicit knowledge, which is unique to
each individual. The overlap between each partner’s implicit knowledge
about the relationship the authors’ term the “shared implicit relationship”;
this shared implicit relationship is never symmetrical, they point out. The
authors summarize by stating that though interpretation traditionally has
been viewed as the nodal event of therapy, acting within and upon
transferential relationship to alter the intrapsychic environment,
“moments of meeting” may be viewed as nodal events altering implicit
knowledge, which is both intrapsychic and interpersonal. These must be
considered complementary processes, entailing different change
mechanisms.
A Change That Happens
The notion of “moment” in the expression “moment of meeting,” used by

CPSG, indicates a “happening” that is not the result of some technical
procedure from which the outcome will be expected as a matter of course.
The establishment and development of “implicit relational knowing” is
not a brick-at-a time building then, but appears discontinuous, in leaps
and sudden breakthroughs. This is in close accordance with the dialogical
40
The authors here refer to Winnicott’s much cited concept, usually referred to as
“potential space” (Winnicott, 1971).
principle as Buber presents this. Indeed, the expression “moment of

meeting,” indicating a change process, is actually literally to be found in
Buber’s text. He speaks of “der Moment der Begegnung” (Buber, 1958b,
p. 95), which is translated variously as the “moment of encounter”41 and
the “moment of meeting.”42 Whether CPSG’s expression directly or
indirectly in some way stems from Buber’s original formulation (or other
sources related to this) is not a direct concern here. But an affinity and
concordance of outlook is in any case readily apparent.
The “moment of meeting,” according to Buber, is a moment from
which the person emerges, being no longer the same as when entering
into it. It is not just entered into and nicely rounded off without further
consequence:
The moment of encounter is not a “living experience” that stirs in

the receptive soul and blissfully rounds itself out: Something
happens to man. At times it is like feeling a breath, and at times
like a wrestling match; no matter; something happens (Buber,
1970, p. 158).
Buber thus stresses that a change of the person is what comes out of such
a moment. And what this implies, he elaborates in the following way:
The man who steps out of the essential act of pure relation has
something More in his being, something new has grown there of
which he did not know before and for whose origin he lacks any
suitable words (p. 158, italics added).
Again, one may actually find the identical phrase, “something More,” as
in the article by CPSG, on the “something more” in psychoanalytic
therapy. (The translator has put in a capital letter for the word “More” for
41
Kaufmann’s translation (Buber, 1970, p. 157).
42
Smith’s translation (Buber, 1958a, p. 159).
emphasis, thus stressing the significance of this phrase. (The German “ein
Mehr” capitalizes anyway, of course.) This adds to the concordance of
outlook between CPSG and Buber, and if the authors were not directly
inspired (there is no reference to Buber in the article), this is quite a
concurrence of phrases. Buber’s text also accentuates the “lack of suitable
words,” which is something the same as saying that it cannot be put into
“declarative” propositions. The conclusion here, I think, is that there
seems to be a close concordance between this theoretical perspective and
Buber’s philosophy.
Psychodynamic and Humanistic Interdialogue
A basic postulate is that there is a “moment” through which change

occurs. And this moment is something that happens, which means that it
is not entirely predictable. Buber writes explicitly about this:
Wherever the scientific world orientation in its legitimate desire

for a causal chain without gaps may place the origin of what is
new here: for us, being concerned with the actual contemplation
of the actual, no subconscious and no other psychic apparatus
will do. Actually we receive what we did not have before, in such
a manner that we know: it has been given to us. (p. 158, italics
added)
The “something More” is received neither as a consequence of a

mechanical cause-and-effect chain, nor from some “psychic” mechanism.
Buber does not accept an explanation regarding the change brought about
through the moment of meeting as stemming from a “subconscious,” or
any “psychic apparatus.” It is given, he states, received, which means that
it happens rather through some condition of grace. Here we see a nuance
of difference from CPSG, who use psychoanalytic language terms in
talking about “non-interpretive mechanisms.” Buber would presumably
not concur with the expression “mechanism.” The moment of meeting,
and what comes out of it, is not to be considered as any kind of
“mechanism” in Buber’s view.
So is there a tension after all? Presumably there is. Stern has more
recently published a book, The Present Moment in Psychotherapy and
Everyday Life (Stern, 2004) in which he summarizes views developed
over the past few years, also within the collaborative effort of the Boston
CPSG. This book has stirred some debate, as reflected in a review article
by Heward Wilkenson (2003), in which the question is asked as to
whether Stern is still a psychoanalyst, and in which differences between
psychoanalytic and existential psychotherapies are brought out.
Wilkenson considers that Stern has engaged in a dialogue with
humanistic-existential “partners” as he calls it (including also music
therapists), and he supports this effort.
The present context represents a dialogue also, from the other side so
to speak, from an existential humanistic stance. And this has maybe been
made possible as a result of Stern approaching a humanistic outlook from
the side of a psychodynamic frame of reference. On the level of theory,
there may seem to be much of a concordance with a basic humanistic
philosophical stance.
APPLICATION TO EXAMPLES FROM THE LITERATURE
The Boston CPSG shows how a crucial interpretation in some instances

may open for a “moment of meeting” in psychotherapy, which also may
bring about therapeutic change. As Ruud (1998b) indicates,
improvisation may likewise bring about a “hot present moment.” The
thesis that is implied in this is that musical improvisation, as a mode of
therapy, may bring about this specific kind of therapeutic change, through
facilitating the occurrences of such moments. I will try to illustrate and
extend this point of view with some examples both from the literature and
from my own experience as a music therapist, and see how the Boston
CPSG’s conceptual constructs might be applied to these.
The Example of David
In her reply to Streeter’s challenge to therapy based on “musical

awareness,” referred to in the introductory chapter, Sandra Brown (1999)
actually refers to this particular article by CPSG, and finds that both in
terminology and logic it relates directly to a case from her own practice,
which she describes briefly. David, who had referred himself to music
therapy, had a very persistent need for control, and the work in therapy
consisted in “enabling him to allow access to his ‘creative self,’
unhampered by thought,” Brown writes. This was inordinately difficult,
she relates, but in one session, at the end of an improvisation on two
pianos, something happened. Brown writes in her notes:
Feeling of timelessness between us, … Directionless—endless

moving forward/round and round without moving. No
direction—just remaining in the same place, continually finding
and losing and refinding the place (p. 69).
In a summary of the session, she writes:
The constant holding myself in the openness of letting go, of

suspending direction, of endless consecutive “nows.” At one
point terror rising in me, desperate to move away, to—
resolution? From the not-knowing? The non-direction? (p. 69).
Brown informs that the poetic connotations of these written phrases were
quite unusual compared to the notes she usually made. The client also had
difficulties in finding any adequate expression for the experience, which
was shared by the two. This moment, Brown relates, became a turning
point in the therapeutic work.
If we apply CPSG’s constructs here and compare with the three
“phases” of the now moment, there is a “pregnancy phase” toward the
end of an improvisation on two pianos. Then there comes a “weird
phase,” as described in a new feeling of timelessness emerging, of no
direction, just returning to the same place. And even a feeling of
momentary terror, before in some way deciding to stay with it, to remain
in the open. Thus the third “decision phase” is seen moving into a
“moment of meeting,” the special, ineffable quality of which was

recognized by both parties. The experience, besides from being a turning
point in therapy, also left the therapist subsequently pondering about the
significance of the event, relating it to theory and also to poetry.
The Example of Mathew
Ansdell (1995) refers to a similar experience in the final case of his book
Music for Life. Actually there are two events that are reported with
Mathew, a man with Down’s syndrome who had become depressed,
withdrawn, and occasionally aggressive after his mother’s death, and
after subsequently having moved to a community hostel for adults with
special needs. I will try to apply the constructs to these examples, too.
The first event is when Mathew suddenly takes a drumstick from the
top of the piano, rises, and starts conducting. At first the therapist played
as might be expected, improvising music that can support the beating of
music in time, which might correspond to the “pregnancy phase.” But
then it became unclear as to who was leading and who was following.
Eventually it became apparent that Mathew was taking musical charge,
which might be seen to correspond to the “weird phase,” being something
highly unexpected and unusual. After having brought the co-therapist
who had been participating by singing to a stop, he turned toward the
therapist at the piano:
This was when the real change in the piece happened. A totally
different music emerged—I found myself singing a slow,
hymnlike melody, accompanied by rich chords in E major …
giving an almost reverential atmosphere. It seemed perfect for
Mathew, his body swaying as he conducted. But he was also
firmly in control, letting me sing the first phrase, then bringing
Cheow (the co-therapist) in for the second, the two dovetailing
perfectly. (p. 202)
Here again, a “decision phase” is followed by a “moment of meeting.”

Though there was no readily apparent sudden transformation of the
playing itself in the sessions to follow after this incident, Ansdell reports
that he and the co-therapist felt justified in making the sessions more of a
challenge to Mathew, who steadily developed through the work. A
reflection of this new way of conducting the sessions was that the room
was set up differently, with an array of instruments surrounding the
piano. Here we may see a very concrete result of change in the implicit
relational knowing. As CPSG points out, it is the nature of such change
that it is in both the therapist and client, and that the interactional
environment changes—in this case, even in the way the room was
arranged. This rearrangement could be seen as a concrete manifestation
of change in the shared implicit relationship, in CPSG’s terms.
The second of the events with Mathew, or “episodes,” as Ansdell
terms them, was a particular session that Ansdell finds significant enough
to date. It started off ten minutes late, and there was nothing beforehand
indicating that there would be anything extraordinary about it. As the
playing started, Mathew seemed especially concentrated and committed.
There was a certain intensity of atmosphere, Ansdell relates, which also
was picked up by the co-therapist. This could well be seen as a
“pregnancy phase.” Ansdell writes about the session as it developed:
There was an incredibly close connection between us in the

music—a real sharing of intention. But at the same time there
was something of the feeling that we were both testing one
another—that we were both trying too hard (p. 205).
There seems to be a move into some sort of “weird phase.” Mathew then
made an initiative toward the co-therapist that she should join on the
xylophone. The improvisation then changed character:
Many things seemed to change at the same time: Mathew’s

drumming seemed to take on a different quality, changing from a
heavy ‘down,’ it became a source of ‘up’ energy, giving a sense
of dance to the music. Around this Chew and I ‘danced’
syncopated pentatonic melodies and cross rhythms. My feeling
was of a sudden lightness of touch, a freedom from controlling
the situation or determining the music. I remember looking down
at my hands in disbelief and seeing them playing. (p. 205)
Here it seems that a transition to the decision phase had been made, by
deciding not to try so hard, to let it happen. Then there is an entering into
a “moment of meeting.” “Everything seemed to lift,” Ansdell recalls,
finding lightness the only metaphor that accurately could describe the
loss of effort and the joy of playing. He further relates:
The other feeling was that though none of us was doing anything
especially remarkable, that somehow the music had happened
itself and had taken off and taken us with it! Suddenly all the
parts seemed to connect and the music seemed to come through
… (p. 206).
Ansdell finds words poor to describe the experience, which he terms

“mystical.” It was genuinely beyond planning and controlling, he states,
and even beyond individuals: “—it was more than any one of us, but at
the same time included each of us totally.”
Ansdell considers that these special experiences with Mathew during
his two and a half years in music therapy surely were a significant part, at
least, of what helped to bring about a change that was reported. Mathew
was now generally in a happier mood, more confident, and more socially
active. It seems that a conclusion could be made, according to Ansdell’s
narrative, about a change that had occurred in the domain of implicit
relational knowledge, to use CPSG’s term here, within the music therapy
setting, having transference value to Mathew’s everyday life.
Relational Change
These examples may suggest that such incidents in music can be

described in terms that are meant to give a phenomenological description
of the “something more” in psychotherapy, and which it is considered
may induce relational change. It seems that the Boston CPSG’s terms
may be applied to illuminate this kind of process, as indicated through the
examples above, and may indeed serve to account for a possible process
of change through the “moment of meeting,” as these may occur also in
music therapy, as well as in psychoanalytic therapy.
The intention here, of course, is not to put up a scheme that is to

show how it is or has to be in each and every case. This is obviously not
possible, and the variations will always ensure that no schema itself can
be either final or complete. The point here is to show how a set of
conceptual constructs intended to show processes of change in
psychotherapy, with regard to the relational aspect, may be applied to
music therapy, analogously, to account for at least an important aspect of
change processes also in music therapy.
And this is particularly relevant considering the challenge that has
been put to music therapy that does not adhere squarely to a
psychodynamic outlook, that since it does not employ verbal
interpretations it cannot account for therapeutic change. It seems that
change through the relational aspect may be a highly relevant
consideration, then, for a theory of music as therapy.
AN EXAMPLE FROM MY OWN PRACTICE: LISA
I will supply an example from my own practice, too, to further illuminate

this kind of perspective, applying the conceptual constructs of the Boston
CPSG. I want to stress here that this is not presented as any kind of
empirical “documentation” or “evidence,” in any way. It is for illustrative
purposes.
Lisa was a 15-year-old girl with autism, with whom I had weekly
one-hour music therapy sessions at a special school. She was a strong and
robust girl, and very intense. She would sometimes have rather
outrageous fits, which were sometimes difficult for one single person to
handle. Therefore it was considered necessary to have two persons
following her up through the day. These fits were not part of the music
therapy sessions, though. This was one activity during the week in which
she showed a keen interest in attending. When it was mentioned to her
that it was time to leave, she would immediately and very eagerly put on
her shoes, and be anxious to leave from her base room, the staff reported
to me.
She liked singing, in her own way, and in the beginning this was a
good way to get to know each other more. When I suggested that we
could try playing the piano, she sternly refused having anything to do
with this. But after a while she got more amenable, showing more
interest, and one day she suddenly just sat down right in front of the
piano. I took a chair and sat beside her, to her right. We were just sitting
there in front of the keyboard. And I really did not know what to do, how
to start off. A “pregnancy phase” was moving very quickly, I felt, toward
some “weird” phase, in which I had to come to a decision. On the spur of
the moment, I picked out the two black keys c-sharp and d-sharp, and
played each one of them with the index fingers of left and right hand, in a
firm “back and forth,” two semi quavers and a quaver-note rhythm figure
(da-da-da). I made a pause, and then repeated this. This seemed like a
most simple gestalt, and I waited to see if and how Lisa would respond.
She sat a moment, perplexed but somehow delighted, apparently, and
then she herself seized the opportunity and with a big smile played the
same short motive with her two index fingers at her lower register on the
piano. I “answered” back, and she seemed utterly excited. From this, we
developed a joint improvisation at the piano.
In the sessions that followed we broadened the range, and Lisa
would try out new combinations of tones and rhythms, often using
sonorous open fifths, moving onto the white keys as well. The
improvisations would extend quite a lot, and when we really hit on
something, Lisa would display the broadest smile, occasionally looking
quite enthusiastically at my fingers when some particular phrase on my
side caught her attention. Occasionally we would return to our original
two-note motive before expanding again.
These improvisations could be seen to proceed through a succession
of “present moments,” occasionally moving into a “now moment” in
which there was a possibility of making something more out of it. When
this did happen, Lisa would invariably tune in and catch this up, and
respond to it. I was often amazed by her keen perception of nuances in
the improvisation. If we hit some swing or groove, or if the melody took
off in some unexpected way, she really sensed this and appreciated it.
One might say, applying the conceptual constructs of the Boston
CPSG, that that there had been an initial “moment of meeting,” through
the piano playing, at the outset, after a rather long “pregnancy phase,”
before taking position in front of the piano keyboard. Then, a short
“weird phase,” right at the start, occurred, before we hit on the rhythmic
two-note motive in a “decision phase,” going into a “moment of
meeting,” with an extensive development following this. It turned out that
the establishment of this playing together at the piano motivated her very
much to attend the sessions. When she came into the room, she would go
straight to the piano with very determined steps, put the chair resolutely
in front of the piano, and wait for me to sit down and join. A change in
the implicit relational knowledge had clearly occurred through our
playing together in this way.
A Drum-Playing Incident
But there is one other, somewhat later, particular incident that I want to
relate here. Lisa and I were playing drums together, as we had done on
several other occasions for quite some time by now. And then, as it
sometimes is with playing music, something happened. A special moment
occured. We were sitting and facing right toward each other, playing
djembe-type drums. As usual, her gaze was fixed somewhere between us,
and she was playing the drums in an engaged and concentrated manner,
while at the same time intently listening, it seemed, to what I was playing
in relation to her own beat. We came into a nice, steady groove. And
then, for my own part, I suddenly noticed a possibility, a sense that I can
break through something. It is as if a musical opening suddenly presents
itself. At the same time, I feel some kind of anxiety, something like: “Is
this in order, is this really allowed here, to make a move into this? Into
such a space, here, now?” It was like a feeling of “momentary terror,” as
Brown states it. And then, with no further deliberation, and with a great
sense of daring, I plunged into something new. Not that the playing
changed that much; it was more about the quality of the swing or groove,
which really interlocked with Lisa’s steady beat. There was suddenly a
much greater intensity to the playing, which in some way seemed hard to
comprehend. It had a kind of “unheard of” sound or quality to it, there
and then.
And Lisa sensed this immediately. Her expression changed. First she
just seemed stunned. And then, as the playing continued, and we were
really getting into something unprecedented, she became very serious-
looking, kind of shocked. Still, she was completely into the playing. And
then I sensed a growing tension. It seemed as though a questioning was
written all over her: “What is going on here? What is happening?” And
then, in a moment, it seems she just cannot resist, she just has to look up:
“Who is this guy playing here with me? What is he doing?” The strange
thing is that it was just as much a question for me. Our playing was
interlocked in a way that I did not feel I had any “control” over; it was
happening as if by itself. At this point my gaze was directed toward her,
while playing, and then, when she looked up, obviously much to her
surprise, or should I say off-guard, our eyes met. And now it becomes
difficult to describe. I can clearly say that I have never before
experienced such intensity in a brief moment of eye contact. Not in this
particular way, at least. It was almost like a physical sensation. I mean, I
actually felt some kind of physical sensation in my eyes as the gazes met.
It was so incredibly intense, it seemed like you could even hear a kind of
“swoosh” sound in the room. We were actually both taken by surprise.
She looked down again, quite perplexed, it seemed, or shaken, not
knowing really what to do or to make of it, apparently. As we continued
the playing, which now gradually cooled off and came to a natural close,
she seemed marked by the experience. And as the session ended, she
quietly left the room.
In retrospect, I have had to ponder on how this meeting of gazes
could acquire such an extraordinary intensity, for me at least—and I
cannot but assume—for her, too. By reflection it has occurred to me that
meeting each other’s gazes in our daily life is a very natural thing. There
is a vast specter of various modes of eye contact in interpersonal
communication, so much so that we hardly even think about it. It became
clear to me that Lisa, as part of her autism, on her part was investing a
considerable amount of energy in avoiding this. Eye contact being such a
natural and spontaneous response, a very high degree of attention is
actually needed to avoid it. When a person with autism is looking another
way, this is not just looking at something quite arbitrarily; it is actively
looking away from something, namely direct eye contact with another
person. And this is hard work, which has to be invested in with both
effort and determination, because eye contact is not easy to avoid. With
autism it is clearly not just a case of eyes wandering off in any other
involuntary or accidental direction. It seems to be directed, and very

intently so, in any direction but direct eye contact with another. And this
was what was jeopardized for a moment with Lisa. The intensity of the
music experience made her forget about this concern, enough at least to
be caught off guard. And in that moment, what she had invested so much
energy in avoiding was suddenly, and very powerfully, turned around. In
a way, this brief moment represented the other side of all that energy
usually put into the avoidance of such contact—which is, I suppose, why
it made such an immediate impact on both of us.
The Relationship Changed
The incident, or what one might call it, followed the process outlined by
CPSG, in broad terms. The pregnancy phase could be seen when the joint
drumming settled into a steady groove. And then the weird phase set in,
for me, in which I was feeling on the brink of something, not knowing
whether I could or even should take the decisive step musically. Then
there was a sense of making a decision, despite all this, and just plunging
into something of which the outcome was not known. And a “moment of
meeting” did occur. By engaging me in this way, Lisa also became
personally engaged, and provoked, by accident almost, to cross a border.
For just a single moment, she had to look up. And we had a brief contact
that was different and new.
I believe our relationship was changed. There was no way that it
could continue as before. Something had happened that could not be
overlooked. Some meeting had taken place. And in the following
sessions, if I noticed something, it was a greater quietness or stillness, or
possibly cautiousness. Probably so, I would guess, and I had to respect
that. The moment could not simply be repeated. I very soon realized that
what had happened did not imply that now we could start looking each
other in the eyes as we were playing together. Still, the sense of our
relationship had changed in some way. And I believe that it was
significant for Lisa to be given an opportunity for a brief glimpse into this
world of relation. We had moved into some uncharted relational territory.
And though it was necessary to retreat, we had been there, and both knew
it. This was something that we carried with us in the subsequent music
therapy sessions. Thus there was a sense of having had the implicit
relational knowledge changed.
A Meeting Through Music
The Boston CPSG developed the concept of “non-interpretive

mechanisms” in psychoanalytic therapy in connection with the
observation that one of the crucial factors in psychotherapy was, besides
interpretive breakthroughs, a change in implicit relational knowledge
between client and therapist, brought about by a “moment of meeting.”
These concepts have been applied here in an analogous way, in an
attempt to illumine the interpersonal aspect of music therapy. The focus
here then has been on the interpersonal relation through the music, a
meeting through music.
This itself is significant to emphasize. It was music that made the
interpersonal process with Lisa possible—the intensity of the musical
experience, which it seemed was not possible to remain distanced from
and which provoked, so to speak, immediacy, and some kind of intimacy
between us. It was a musical moment of meeting, too, which had a great
potency in affecting the relational aspect. In the next chapter, I want to
look at this side of the picture, the relation to music, and furthermore the
significance of the musical relationship to the interpersonal relationship.
Excerpt Four
Chapter 5
RELATING TO MUSIC
Rudy Garred
In this chapter, I would like to suggest further how this kind of
perspective regarding implicit relational knowing might also be applied
with a focus on the “music itself.” That is, I want to see how it could be
applied to the sphere of musical relation, in accordance with the basic
dialogical principle that it is possible to relate to any sphere, also to the
sphere of “forms of the spirit.” This assumption indicates that it is
possible to develop a relation not only on the interpersonal level, but also
to music. This is what the basic notion of an encounter with music
implies. Encountering music as a Thou is quite simply relating to music.
What I want to do is to attempt to develop a theoretical perspective on the
significance of the musical relationship in music therapy, along some of
the same lines as have been drawn so far here with the interpersonal
relation, applying the notion of implicit relational knowing, and change
in implicit relational knowing, to music as such.
COMING TO KNOW
But, having a relationship with music, what does this imply? How can
this be possible? Having a relationship generally means knowing
someone. The distinction between declarative knowledge and implicit
knowing could be applied with regard to music, too, which I will try to
elaborate on in the following.
If music is about more than can be put into words, the question is
what do we know then about music, beyond language? What “cannot be
said” is clearly not a mere blank; it is something of significance,
something of which one may have knowledge of some sort, something of
which one may know in some sense what it is. To explicate the
epistemological issue that is actually involved here, on what kind of
knowledge this represents, and how it is acquired, I will take as a point of
departure Buber’s example of an encounter—within the sphere of

nature—with a tree (!). He considers various ways it may be related to:
I can accept it as a picture: a rigid pillar in a flood of light, or

splashes of green traversed by the gentleness of the silver blue
background.
I can feel it as movement: the flowing veins around the
sturdy, striving core, the sucking of the roots, the breathing of the
leaves, the infinite commerce with earth and air—and the
growing itself in its darkness.
I can assign it to a species and observe it as an instance,
with an eye to its construction and its way of life.
I can overcome its uniqueness and form so rigorously
that I recognize it only as an expression of the law – those laws to
which a constant opposition of forces is continually adjusted, or
those laws to which the elements mix and separate.
I can dissolve it into a number, into a pure relation
between numbers, and eternalize it. (pp. 57–58)
These are all ways of viewing the tree in increasingly abstract ways, from
picture, movement, species, to law and number, as an object, within its
own time and place. But then a shift may occur:
But it can also happen, if will and grace are joined, that as I
contemplate the tree I am drawn into a relation, and the tree now
ceases to be an It. The power of exclusiveness has seized me (p.
58).
With the term “exclusiveness” here, Buber indicates that there is nothing
besides this; the whole attention is directed directly toward that unique
and particular tree. This does not mean, however, that all the previous
different ways of considering the tree must be forgone:
There is nothing that I must not see in order to see, and there is
no knowledge that I must forget. Rather is everything, picture
and movement, species and instance, law and number, included
and inseparably fused.
Relating to Music 129
All is included, the form and color, biological processes and species,
relations to the surroundings. Buber further asserts that the tree in this
encounter is no mere impression, or play of fantasy, or aspect of mood; it
is confronted as a body of its own. And though he insists on the mutuality
of relation, also toward such a tree, within the sphere of nature, this does
not imply that the tree has some kind of consciousness or “soul”:
“What I encounter is neither the soul of a tree nor a dryad, but the
tree itself.” (p. 59)
The tree is related to in its embodied and concrete uniqueness, not merely
as an item placed under a category of some sort, though its categorization
does not need to be disregarded, forgotten, or ignored. What is confronted
nevertheless is this unique tree, the reality of which is acknowledged as
such.
A tree may be objectified in any number of ways, as the example
here indicates, covering different kinds of aspects and characteristics. But
by entering into relation what comes into focus is just this tree, and
nothing else. All the different aspects may be included, but nothing is
extracted and made to stand out separately. That the tree does not itself
have a consciousness, as humans do, is no reason, Buber finds, for
“dividing the indivisible,” which is the simple and direct relating to the
tree itself as a whole. Buber points to the reality of the direct relation, not
splitting this up into any number of ascribed features of the object,
however comprehensive they might be. They will not themselves actually
sum up to a direct encounter with just this tree.
Entering into relation implies a different attitudinal mode, not
dividing up into subject and object, but relating directly to what is
encountered as a whole, unique, present, and immediate reality. And this,
according to the dialogical principle in its widest sense, may be done
toward any sphere, be it of inanimate or animate nature, the human
sphere, or with artifacts, products of culture.
Getting to Know Music
Taking the tree example as an analogy to ways of relating also to music,

one could distinguish between various fields and disciplines within
musicology as the discipline of the systematic study of music: history,
theory, analysis, psychology, anthropology, sociology, cultural studies,
acoustics, biology, physiology, aesthetics, technology, and more. These
would represent various aspects of music study, using different methods
and approaches. Both traditional and New Musicology approaches could
be included in this list, though there quite naturally would be discussions
both within and between the various subdisciplines of music study as to
the validity and relevance of each approach. Taken together (and
including the internal discussions), they all, following the proposed
analogy here, would say something about music. They would represent
different ways of studying music, and as such they could be expected to
contribute broadly and over time extensively to the total knowledge
within the field.
At the same time, music as such is not merely this, or even the sum
total of all this. Entering into a direct relation with music, all and any of
these aspects may be included, to varying degrees, but they will not in
themselves in any case fully replace the encounter with music itself as a
present, living reality. The main point from a dialogical perspective is
that there is really no way of coming to a complete and comprehensive
picture of music as an object. Still, there is the very real possibility at any
one time of encountering music as it presents itself in daily life. Music is
and remains a very vivid reality for us in our encounter with it, in its
living presence.
Buber makes his main epistemological point in the following
paradoxical way:
What, then, does one experience of the You? —Nothing at all.

For one does not experience it. —What, then, does one know of
the You? —Only everything. For one no longer knows particulars
(p. 61, italics added).
The You cannot be grasped, and yet it is possible to know the other. What
Buber may be hinting at could be that when you meet a person, for
instance, directly and immediately, you do not sort out particular aspects
that you attend to specifically and exclusively, ruling out other parts.
Engaging in a mutual encounter with another, you invest yourself wholly
and fully toward the other. In this way, you get to know the person, or
rather, you get to know each other. And this is not the same as the
knowledge about someone. This is also reflected in everyday language:
You may have heard about someone, but you would not claim to know
the other unless you had met him or her, on some occasion. Not even if
you had actually seen someone somewhere would you readily claim that
you knew the person, unless you actually had met him or her.
Relating this perspective now to ways of knowing music: How do
you know a piece of music? The simple answer is: By actually having
heard it. If you had not heard it in some way, you could hardly say that
you knew it. No matter how much data you might have gathered about
the music, you can hardly claim to know it if you have not actually
encountered it as a sounding reality. (Hearing it imaginatively through
reading a score constitutes a special case.) Hearing the music as a
sounding reality of course involves not only the sense of hearing
exclusively, but also body senses, in a total response of the person to the
music. And having heard it, there is just no way of giving anything like a
full coverage in a verbal account that would make another person’s
listening to it superfluous in getting to know it.
Change in the Relation to Music
And now, to relate this aspect of knowing music specifically to music

therapy, a crucial issue here will be about change in implicit relational
knowledge, because the decisive aspect regarding the “non-interpretive
mechanisms,” the “something more” of therapy, according to the Boston
CPSG, is the occurrence of a change in the “implicit relational
knowledge” between client and therapist, which happens in the “moment
of meeting.” What I would propose here is that in music therapy there
may also be a “moment of meeting” in the relation specifically to music,
and that this too may harbor potentials of therapeutic change.
This “something more” may occur when there is a sudden moment
of change in the relation to the music. Musical improvisation, for
instance, as a main method in music therapy practice, may be a steady

progression of what the Boston CPSG terms “present moments” of
moving along. But then a “now-moment” may occur, described as seen
here, as consisting of three phases, a pregnancy phase, a weird phase, and
a decision-phase. In relation to music the pregnancy phase might be when
playing as usual so to speak. But then something may present itself as a
possibility; there is a sudden opening, something new that might be
explored. The weird phase sets in in considering whether or not to follow
up on this. The decision phase is when this opportunity is seized, and a
new way of playing, which was not known before, is entered into, leading
to a “moment of meeting,” musically.
These kinds of processes will be readily recognizable for anyone
who has developed a facility in musical improvisation, I believe, and they
may be more or less dramatic, more or less vast in range. Referring back
here to the example cited previously of the mother and infant playing
together and unexpectedly achieving a new and higher level of activation
and intensity of joy, with the consequence that ”the infant’s capacity to
tolerate higher levels of mutuality-created positive excitement has been
expanded for future interactions” (D. Stern et al., 1998a, p. 909), we
might actually see a similar process in relation to music. Having reached
new heights, the player has come to know something more about how to
interact with music, with new possibilities thereby opened up. An implicit
relational knowing of music has been altered, with new ways of
interacting with music resulting from this. A drummer, for instance, may
speak of the day he “found the groove,” and from which time on his
playing changed.
It is important to take note that there is a change implied here in the
whole relationship, not merely some part, or variation on an established
practice. It is not merely about adding some new technical musical
device, which may be done otherwise on an on-and-off basis. And such
change, furthermore, happens in a moment. It is not just a matter of
building brick upon brick. Building methodically may naturally precede
such a moment, and be necessary, too. But what happens in such a
moment of a musical meeting is suddenly a new possibility of
improvising opening up, and the whole relation to playing music
becoming changed.
CHANGE IN THE SENSE OF SELF
The Boston CPSG emphasizes that a change in “implicit relational

knowledge” implies a change in the sense of self. The one does not
happen without the other. Thus there is no change in “implicit relational
knowing” without a change in the sense of self, which is what gives it its
crucial function in therapy. What I am suggesting here is that a relation
may be built up and established toward music as a “partner” in dialogue.
During the course of therapy, crucial moments may occur, in which there
is a decisive change in this relationship toward music, the “implicit
relational knowing” of music. And such change of implicit relational
knowing toward music may imply a change in the sense of self.
This may happen, for example, as suggested above, at the moment
one really embarks on the improvisational journey, having suddenly
come to realize how to do it, or how to do it one’s own way. Or it may be
in discovering, after having worked over some time with the voice, on
bringing it out, on making it sound, that suddenly: “I can sing! Now I
know how to sing! Like I never knew before! To really sing!” Or, after
some period of trying out, of building some facility, of painstakingly
getting some grip on it, in realizing to one’s own amazement and
astonishment: “I can beat that drum! I can make that drum sound! I can
really get into and join in on this music, and make something out of it in
my own way, that I couldn’t even imagine before!”
What is crucial to note here is that it is not only a discovery of how
to sing, for instance, but it is also a discovery that I can sing, or play, and
that I did not know how before. It is at the same time a self-discovery: “I
did not know that I could sing like that!” This is what the change in the
sense of self actually implies here, and, I would suggest, is what makes
this kind of process therapeutically relevant.
“Peak Experience”
This line of thought may be related to other theoretical perspectives that

have historically been applied to music therapy. One concept that has
been much referred to in literature related to the approach is the
humanistic psychologist Abraham Maslow’s “peak experience.” The

concept of the “moment of meeting” as a change within the implicit
relational knowledge, implying a change in the sense of self, might well
be seen to have a quite close affinity with this notion.
Maslow’s point of departure was to inquire into what was common
for people who had developed in a healthy way, rather than in a
pathological way. He wanted to research what constituted psychic health,
rather than illness. In this way, he wanted to see if there were any keys to
a rich and fulfilling life. One such key he found in what he termed “peak
experience.” He found that it was a common feature of people recognized
as having achieved a degree of self-realization that they had experienced
certain decisive “peak experiences.” These experiences had inserted a
decisive influence on the person’s view of the world, and his or her own
role in it, with consequences for the course of their whole life. From this,
a conclusion could be drawn that such experiences might be very positive
in the development of psychic health.
In the present context, it is worth noting that in his research Maslow
found that one of the most common sources that was reported as inducing
such experiences was music. He writes that musical as well as other art-
related peak experiences might have the same kind of effect or outcome
as a psychotherapeutic process:
Music and art in a certain sense can do the same; there is a

certain overlap, they can do the same there as psychotherapy ... .
We can certainly talk, on the one hand, of the breaking up of
symptoms, like the breaking up of clichés, of anxieties, or the
like; or on the other hand, we can talk about the development of
spontaneity, and of courage, and of Olympian or Godlike humor
and suchness, sensory awareness, body awareness, and the like.
(Maslow, 1973, p. 170)
It seems that the first part of this statement deals with the more regular
work of therapy, oriented toward the “breaking up of clichés, of
anxieties,” whereas the second part deals with what might belong on the
side of the “something more,” with the development of spontaneity,
courage, presence, humor, sensory and bodily awareness. Music (and the
arts in general), Maslow suggests, may help not only by loosening up
difficulties and problems, but also by directly enhancing positive life

qualities.
What this implies is the possibility of a direct and therapeutically
potent relation to music, which basically accords with what has been
suggested above. Maslow’s concept of “peak experience” could clearly
be considered to belong within the domain of “implicit relational
knowing.” And the application of this concept may support a notion of
change stemming from a change in the implicit relational knowing
toward music, through what might be called a specifically musical peak
experience. Such an experience with music implies a change in the
relation to it. Suddenly it opens up in a new way, exhibiting dimensions
not known before. The point is that after a musical peak experience, the
whole relation to music is not the same, and neither is the person having
experienced this. This suggests the potentials of the experiential aspect of
music within music as therapy, brought about by change in the relation to
the medium through a musical peak experience, and this contributing then
to a change in the sense of self.
Integrating the Experience
As this process is a change of implicit relational knowledge, it is not

required to take hold of it verbally for any particular processing of
declarative issues implied. It is experiential rather than insight-oriented.
Not needing verbal processing of declarative issues raises another
question, about how such experience of the “something more” in relation
to music is integrated. For though it is not verbally processed, it needs to
be integrated.
According to Maslow, the main limitation of entering into and
assimilating peak experiences has to do with how much the body, or the
whole organism of a person, in its actual state in any given situation is
able to receive. In an experientially oriented therapy the consideration
will be just as much whether the client will be overwhelmed as whether
there is avoidance in confronting the material. Bruscia actually points to
this aspect in a comment on peak-experiences in Creative Music Therapy,
as practiced by Nordoff and Robbins:
The child-therapist relationship is often propelled from one stage

to the next by a musical “peak experience” which brings the child
and therapist into an intimate therapeutic encounter. It can be a
wonderful moment of truth, acceptance, contact, achievement,
joy, or truce. Immediately after such an experience, however, the
child may feel threatened and various forms of resistiveness may
appear and even persist for some time. The resistiveness is a
natural and healthy means of defense the child uses to avoid
being overwhelmed and to gain the time needed to assimilate the
experience. (Bruscia, 1987, p. 63)
It is important to bring out here that this implies a different kind of

defense than the so-called “defense mechanism” within insight-oriented
verbal psychotherapy, which is about avoiding what is initially difficult to
confront. This is more a warding off of what appears too overwhelming
to handle. What seems to be crucial is the time needed, both to actually
prepare, and to assimilate the experience. The therapeutic process
necessarily extends beyond the moment, in time. As Maslow emphasizes,
a singular experience can release a long process of integration and
change, even throughout the perspective of a whole lifetime.
Incremental Changes
An important qualification to consider here is that the “moment” may be

more or less groundbreaking, and there may be degrees to the so-called
peak experience. A real peak experience is by nature a singular, unique
event. It is not part of the regular day-to-day affairs. In a later report, the
Boston CPSG qualifies its position regarding the “moment of meeting” in
therapy (Bruschweiler-Stern et al., 2002). They introduce the additional
notion of a step-by-step “fitting together” process taking place in therapy
on the interrelational level, and which may also prove to be significant in
the therapeutic change process:
What we did not previously emphasize, as we confined our

conceptualizations to charged moments, was that fittedness, or
the recognition of specifically fitted complementary actions, is
the central clinical notion that captures the tendency of systems

towards greater coherence. Fittedness is being evaluated
continually with respect to multiple levels of intentional activity
in the moving-along process and concerns issues along a
spectrum of import. Reaching fittedness leads to incremental
changes in implicit relational knowing, which are experienced as
“getting better.” (p. 1059)
It is important to take into account, as indicated previously, that it is not

possible to go for any complete presence of the moment toward music all
the time. The charged moments will naturally alter with more regular
ones of basic “moving along.” Actually, the charged moment cannot be
imagined without the other, by terms of contrast. There will always be
two sides or two aspects to this process. An alternation between a regular
“something” and a “something more” is both necessary and inevitable.
Musical Transference
Regarding the alternation between these two sides of a regular

“something” and a “something more” in relation to music, a further
aspect to consider in applying the conceptual construct of implicit
relational knowing is that in the “moment of meeting,” as mentioned
previously, issues of transference and countertransference are minimized,
according to the Boston CPSG (D. Stern et al., 1998b). Relationship in
such a moment approaches a mutuality and reciprocity that is not barred
by such issues. It is a characteristic of such moments that these
“mechanisms” tend to drop away, and become irrelevant.
A similar state of affairs may in an analogous way actually be seen
within the musical relationship, too. One might also think of conflict
issues with music, having difficulties in relating to it, “transferring”
personal issues onto the music—being angry at the music when it proves
difficult to perform, getting bored with having to exert oneself toward it,
finding it resistive and not willing to comply with one’s own immediate
wishes and needs, and so forth. The “moment of meeting” with music,
though, is not a moment of conflict and strife. It is not at this point that
one is exasperated from practicing, or feeling that one is not able to
perform for some reason, and that one does not find that one can relate to
the music in any fruitful and meaningful way. At the moment of meeting
such concerns will tend to fall away, becoming minimized, allowing the
potency of the moment to actualize fully and freely. This is what such a
moment implies, with regard to what might be called issues of “musical
transference.”
RELATING THE INTERPERSONAL AND THE MUSICAL
What I have been doing here is applying the Boston CPSG’s theory of the
“something more” of change in implicit relational knowledge, not only to
the interpersonal aspect, but also to the relation to music in music
therapy. The notion, furthermore, of a specifically musical peak
experience has been used to support a conception of a possible change in
implicit relational knowing of music, leading to a change in the sense of
self.
The question must be posed about how these two aspects, the
interpersonal and the musical, are related to each other. This could
become clearer through comparison with verbal psychotherapy.
According to the Boston CPSG, there are two kinds knowledge involved
in psychoanalysis; declarative, which deals with conflict issues and
facilitates interpretations leading to insight and change, and implicit
knowledge, which is relational and may also lead to change. And, as
mentioned previously, the authors point out that there is a relation
between these two. A crucial interpretation may lead to a moment of
meeting interpersonally, but not necessarily. The opportunity has to be
seized.
If the therapeutic mode of verbalization, as found in the
psychotherapeutic “talking cure,” is replaced with musical improvisation,
as in music as therapy, a different dynamic is found. Here, instead of one
declarative and one implicit relational aspect, we find two implicit
relational aspects, belonging to the two different spheres of the
interpersonal and the musical. The declarative aspect is for all practical
purposes omitted, and instead there is a dynamic process between two
spheres of implicit relational knowing. This could be seen as a
“weakness,” or a deficit, in that only the one type of knowledge is

involved in the process, but also as a possible strength, an asset, in that
this type of knowledge here becomes involved in a particularly dynamic
way.
Playing Together
An implication that follows from this two-sided implicit relational

therapeutic process is that there seems to be a more intimate relation
between the two aspects involved. The interpersonal “something more”
seems more closely connected to the medium of therapy, which is to say
music, which itself is of an implicit relational character. Making music
together may more readily then enhance interpersonal relationship, not
least because by using music as a therapeutic medium, therapist and
client are playing together.
There is a powerful interpersonal dynamic inherent in such playing
together. It invites a sharing of experience. But this does not happen
automatically. People might well remain distant to each other in
participating in music activity too, but the medium harbors its own
characteristic potentials for enhancing relationship, in particular when
there is something musically significant and engaging happening—if, that
is to say, there is a “moment of meeting” with music. A shared musical
moment may thus potentially lead to an interpersonal moment of
meeting.
“Communitas”
The interrelation between these two spheres could be further illumined by

relating to anthropological theory on rituals. Ruud (1998a) has developed
a theory on “communitas” in improvisational music therapy, based on
anthropologist Victor Turner’s concept of liminality. Turner builds on the
anthropologist Arnold van Gennep, who at the beginning of the 20th
century made the observation that what he coined “rites of passage,” that
is, rituals associated with movements or passages from one position to
another within a social structure, such as births, initiations, confirmations,
weddings, and funerals, tended to have a similar structure within diverse

cultures. First there is a separation phase, in which one leaves the
previous held normal position of everyday life. Then there is an
intermediary or transitional phase, between old and new worlds, and
lastly a reaggregation phase, leading back to the “normal” society, but
now with a new identity. Turner later developed these notions and
proposed that the second transitional phase is marked by what he termed
liminality, from the Latin word “limen,” which means threshold, a kind of
indeterminate state where there is a loss of the old identity, but in which a
new one has not yet been acquired. This state, according to Turner, often
induces a particular community between the participants in such a ritual,
which he termed “communitas,” characterized by direct and egalitarian
interpersonal relations outside of regular social distinctions and dividing
lines. As mentioned in the introductory chapter, Turner explicitly likens
this to Buber’s “I and Thou” relation.
Ruud suggests that improvisational music therapy may be regarded
to entail a liminal type of threshold experience outside of conventional
delimitations, in an “eternal now,” which may lead to such communitas
as a kind of I-Thou relation in Buber’s sense. Ruud regards it as a main
characteristic of such improvisational activity, that it may take place not
in the conventional coordinates of time and space, but rather in a flow, an
indefinable void:
Turner’s spontaneous or existential “communitas” is an

especially appropriate description of improvisation—the spirit of
community before the introduction of rules and social systems.
Buber’s view fits well with the humanistic ideology of music
therapy, which posits the subject-subject relationship as the norm
for therapeutic relations exactly as it is experienced in
improvisation. When we try to relate the specific musical aspect
of the improvisation to the liminal aspects of the I-Thou, we can
again focus on the aspect of “flow”—the timeless—that seems to
constitute the core of spontaneous “communitas.” (p. 132)
Ruud’s notion of the liminal aspects of improvisation leading to

communitas could well say something about how the special kind of
experience that musical improvisation entails, occasionally transcending
conventional delimitations and bonds, may lead to communitas, that is to

say, to a heightened sense of being together. It may say something about
the relation between the musical and the interpersonal moment of
meeting, how one potentially, and very much so, may lead to another.
Two Intercrossing Lines
I want to emphasize that the “moments of meeting,” musically and

interpersonally, are interrelated but not the same. The thesis that is put
forward here is that both the interpersonal and the musical relation may
harbor potentials for personal transformation. There is a two-sided
change of implicit relational knowledge that may occur: toward music
and interpersonally, two kinds of implicit relational knowledge that are
interrelated, and that may be mutually enhancing each other. And what is
crucial not to “forget,” according to a dialogical perspective, is that
though a shared musical experience may create a bond between people,
this does not happen in any mechanical way, but in a dynamic and open
situational way.
The analogy of music therapy with protoconversation shows its
limitations here, because music in music therapy, within the dynamics of
this two-sided process, is not merely or exclusively a means for
interpersonal interaction. It becomes itself of “interest.” The musical
dimension as such needs to be included. The dynamics of the music
therapy setting are to be found through the interrelations, the mediations
between all three sides of the triangle setup, with the therapist mediating
the client’s relation to music, approaching and sometimes maybe
touching upon special musical moments, and in this also potentially
moving toward an interpersonal meeting.
Replacing verbal language as a medium of therapy with music is not
just putting in some different means of communication. The modality of
music gathers the attention, so to speak, toward itself. Music is not so
much about something else, in the way verbal language is by its
referential function, as it is itself related to. Thus there is a relational
aspect to music itself, and a singular focus on the level of interpersonal
interaction in music therapy will not fully cover this aspect. In
accordance with the triangle of interrelations set up here, we have to

move across the spheres, also to the music side, to get a fuller picture.
This crucial interrelation across the two spheres of the interpersonal
and the musical within the music as therapy process could be indicated
by introducing a horizontal and a vertical line into the music therapy
triangle, crossed both ways and at the same time related to each other:
Music
Interrelated
spheres: Entering into the
Dynamic sphere of music
processes of
change
Therapist Client
The interpersonal sphere
Figure 5.1. Two Intercrossing Spheres Between Three Sides
The circles indicate movements across and between the lines of the
interpersonal sphere and the sphere of music, which may facilitate a
change process enhanced by the dynamic interrelations between these
two spheres as they are engaged in by therapist and client.
SUBSTITUTING WORDS WITH MUSIC
In music as therapy, one might say that music replaces verbal

interpretation as the main medium of therapy, playing, or musicking,
takes the place of talking. This “substitution” implies a different role to
the therapeutic medium, because of the different characteristics between
the two media. Music as a therapeutic medium is not applicable to the
treatment of specific issues in the way language is. The reason for using
it, according to the perspective that is drawn here, will not be for what it
says about something, dealing with declarative knowledge, but rather for
facilitating implicit relational knowing, both toward itself, and for the
mediation of a potentially powerful communal experience between client
and therapist. A dynamic between two aspects of implicit relation is
found, rather than a dynamic between on the one side a declarative and
on the other an implicit kind of knowing, as found in the psychoanalytic
“talking cure.”
Replacing words with music as a therapeutic medium actually
requires a somewhat different setup for the interrelations in therapy,
because music is not just about something, as a means for communication
between therapist and client, as words are; it is itself related to, for its
own qualities. This actually becomes a main reason for including music
as one side in the triangular setup of parts involved on the “scene” of
music therapy. Music itself acquires a role within the “play,” in that it is
itself related to, rather than just mediating some other content between
the two other actors of client and therapist.
Dynamic and Aesthetic Form
In this perspective, the concept of dynamic form, reflecting the client, and
the relation between the client and therapist in the making of music
between them, relates primarily to the interpersonal aspect of
improvisational music therapy. Dynamic form is a “reading,” or
“hearing” as suggested here, of the child through music, but which may
seem to underplay the role of music as music considered. Pavlicevic’s
concept of dynamic form, considered as an expression of vitality affects,
may seem to have somewhat of an interpersonal “bias” in this

perspective. In an article written in collaborating with Leslie Bunt, after
having stressed that the music therapist’s skill is not solely a “musical”
one, these authors state:
Rather music therapists’ skills lie in their capacity to interface the

personal and musical in music therapy improvisation; to ‘read’
music therapy improvisation as an interpersonal event (in the way
that mothers and babies read one another’s acts not as musical or
temporal, but as emotionally expressive and communicative); and
to support, develop, and extend the jointly created improvisation
according to personal and therapeutic, rather than musical-
aesthetic, needs and dictates. (Bunt & Pavlicevic, 2001, p. 194)
This seems to be a primarily interpersonally based concept of music, as

an analogue to mother and child reading each other’s acts as expressive
and communicative. Musical improvisation is considered as “an
interpersonal event.” But even though an interface with music is
purported, the concept of dynamic form does not seem to cover this
sufficiently. Based on the concept of vitality affects, it points to dynamic
forms of feeling. But music is not just “feeling” in this sense. The relation
to music, one has to assume, is quite a lot more than responding through
vitality affects. Explaining music this way would hardly suffice to
account for its appeal. The interpersonal relation is one aspect of doing
music together, but the role of music in music therapy is hardly just this
and nothing beyond this.
“Dynamic form” as a concept links music primarily to the
interpersonal process involved in making music, and quite successfully
so. But there is more to it, related to the aesthetic dimension. The concept
does not emphasize the aesthetic aspect as such, aesthetic form, which
actually points beyond the mere reading, or hearing of the person in the
music. The perspective that is developed here implies that the
“horizontal”—the interpersonally relational, as well as the “vertical”—
the transcending, entering into the sphere of music, both need to be
included in a theory of music as therapy. Music is not only
interpersonally “dynamic,” it is also, as music considered, aesthetic, the
qualities of which should be recognized in order to bring out its full

potential as a therapeutic medium.
It is only as an aesthetic object, as something more than a mere
communicative device, however potent, that music may be related to as
something in itself. Not that it has to be an object of art, or some kind of
autonomous work. Whatever its present mode of reality might be, relating
to music as such requires some recognition of its own inherent qualities
and characteristics, beyond being just a vehicle for interpersonal
interaction.
Three Sides Interrelated, Across Two Spheres
I do not think that music-centered therapists do not relate interpersonally,

and I do not think that music therapists incorporating early interaction
research and theory do not facilitate a relation to music for their clients.
Quite the contrary. I think both actually do both. The effort that is being
made here is to show how a two-sided perspective of doing music therapy
may be theoretically framed. Early interaction and music-centered
theoretical approaches that could be considered one-sided each on their
own might nevertheless be reconciled, I believe. In practice they are very
much the same, but theory that emphasizes only one aspect at the expense
of the other may become confusing or misleading, and not very well
suited to fit actual practice.
To be precise, practice may possibly tend toward emphasizing one
or the other sphere more, it may be directed toward the interpersonal or
the musical, but attempting to make it only one or the other will leave out
not only the other side as such, but also the support of the one side in
favor of the other, so to speak, which is portrayed here as a decisive mark
of music as therapy. Such one-sidedness is what the perspective and
model drawn out here is intended to counter, emphasizing a crossing,
within three sides, of the two spheres of the interpersonal and the
musical, indicating in this way the “cross-fertilizing” interrelation
between the aspects of dynamic form and aesthetic form. This is what the
logic of the triangle that has been set up here, as three sides interrelated,
across two spheres, basically implies.
Encounter With and Through Music
The theoretical proposition is that in music as therapy there is an

interrelation between two relational dimensions, the interpersonal and the
musical. The premise is that change in therapy may come about through
change in implicit relational knowing, leading to a change in the sense of
self. The argument that is developed emphasizes that in music therapy
this may happen both through the interpersonal relation and through the
relation to music. And that one may enhance the other. It is a process of
change across two different, but interrelated, mutually enhancing spheres.
The main characteristic of this form of therapy is that it does not use
the medium of verbal language for dealing with issues of declarative
knowledge for the development of insight, but instead relies on an
intensified relational process brought about through the dynamics of
relation between these two sides of the musical and the interpersonal.
Music as therapy entails an encounter with and through music.
Music and Words
A question still remains. What is the relation between music and words in
music as therapy? Are words even necessary, or should they be avoided?
What is gained, and what is lost using words? What are the different roles
that words may play, and how may these be related to the role of music?
The use of words within a music as therapy approach is a crucial
issue that has been much debated. This will be the theme for the next
chapter.
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Music as Communication
READING 17 43
Taken from: Unkefer, R., & Thaut, M. (Eds) (2005). Music Therapy
Musicinand
theSpeech
Chapter 3 Treatment of Adults with Mental Disorders: Theoretical Bases
and Clinical
Comparisons betweenInterventions, pp. 42-60. Gilsum NH: Barcelona Publishers.
Music and Speech
Music as Communication Music as a form of auditory information is often compared to speech and
language. Rita Aiello (1994) has enumerated key similarities and differences in
a chapter entitled “Music and Language: Parallels and Contrasts.” Both speech
Kate E. Gfeller and music are species specific and can be found in all known cultures. Both
forms of communication evolve over time and have structural similarities such
as pitch, duration, timbre, and intensity organized through particular rules (i.e.,
syntax or grammar) that result in listener expectations (Krumhansl, 1992). Both
Kate E. Gfeller
speech and music take on meaning within a cultural context and as a result of
the listener’s past experiences and neurological capabilities.
However, there are interesting differences in neural processing of speech
and music. For example, reception and expression of spoken communication
appears to be predominately lateralized in the left hemisphere of the brain (i.e.,
W W
hat is communication? According to Gillam, Marquardt, and Martin the Wernickeshat and Brocas areas). InAccording
is communication? contrast, to radiological studies ofand
Gillam, Marquardt, persons
Martin
(2000), communication is any exchange of meaning, whether with brain lesions indicate
(2000), that cognitiveisprocessing
communication any exchange of musicof cannot
meaning, be readily
whether
intended or unintended. Owens (2001) describes communication as localized. Rather, processing
intended of particular
or unintended. Owens aspects
(2001)of music
describes(e.g., perception of as
communication
pitch, rhythm, melody recognition) takes place in both right and left hemispheres,
the process participants use to exchange information and ideas, needs and musical behaviors
the process require use
participants thetocoordination of complex
exchange information andneural networks
ideas, needs
and desires. The process is an active one that involves encoding, trans- throughout andthe brainThe
desires. (Marin
process and Perry,
is an active1999; Peretz
one that et al.,encoding,
involves 1994). Functional
trans-
mitting, and decoding the intended message.… It requires a sender dissociations among
mitting, andspecific
decoding auditory abilitiesmessage.…
the intended (e.g., abilityIt to understand
requires a senderspoken
and a receiver, and each must be alert to the informational needs of the languageand while unable to
a receiver, and process
each mustmusical sounds,
be alert to theorinformational
vice versa) identified
needs ofthrough
the
other to ensure that messages are conveyed effectively and that intended neuroanatomical studies
other to ensure thatindicate
messagesthat some individuals
are conveyed whothat
effectively and have expressive
intended
meanings are preserved (p. 11). aphasia may retain receptive and expressive functions in musical communication
meanings are preserved (p. 11).
(Gottselig, 2000; Peretz et al., 1994). These differences in neural processing form
While these definitions were written with spoken, gestural, or written While basis
the theoretical these fordefinitions
therapeutic wereinterventions
written withsuch spoken, gestural,
as Melodic or written
Intonation
language in mind, music has long been considered a form of communication, as language
Therapy in mind,
(MIT), musicthe
in which hasintact
long been considered
abilities to process a form
melodicof communication,
contour may be as
well, despite the fact that musical sounds have no specific designative meaning. well, despite
exploited the fact
to facilitate that musical
speech production sounds have Helm,
(Sparks, no specific designative
& Martin, 1974).meaning.
This belief is supported by neurologists and psychologists as well as musicians. For ThisBoth
beliefspeech
is supported
and music by neurologists
have oral and andwritten
psychologists as well as musicians.
forms. However, the oral andFor
example, Pribram (1982) describes music as a language-like form by which humans example,
written Pribram
forms of spoken(1982) describes
language aremusic
used by as amost
language-like
persons inform by which humans
industrialized soci-
express themselves and communicate with each other. Berlyne (1971) states, “If a express
eties, whilethemselves and communicate
musical literacy and performance with eachis notother.
evenlyBerlyne (1971)among
distributed states,the
“If a
work of art can be regarded as a system of symbols, we can go farther and conclude work of art can be regarded as a system of symbols, we
general population in all cultures (Krumhansl, 1992). Both spoken and musical can go farther and conclude
that art fulfills the additional criteria for being classed as communication” (p. 59). that art fulfills exist
communication the additional
in spontaneous criteriainteractive
for being classed as communication”
forms (i.e., spoken conversation; (p. 59).
According to Kreitler and Kreitler (1972), there exists the broad assumption that inAccording to Kreitler and
music, improvisation andKreitler (1972),
jazz forms) thereasexists
as well the broad
in codified assumption in
performances that
a work of art is a vehicle for communicating meaning. a work
which theofperforming
art is a vehicle
artistfor communicating
interprets and transmits meaning.
a completed creative product
Communication of meaning is not a function of the stimulus or message producedCommunication
by another artistof (e.g., meaning is not
actors a functionthe
interpreting of works
the stimulus or message
of playwrights;
alone. Rather, meaning comes from a relationship between the symbol, that to alone. Rather,
performing meaning
musicians comes from
interpreting a relationship of
the compositions between the symbol,
composers). Speechthat and to
which it points, and the common observer (Meyer, 1956). A symbol must have which
music it points,
both transmit andsymbolic
the common meaning observer
and both(Meyer,are1956).
used toA express
symbol or must have
evoke
similar meaning for both the originator and the recipient (Berlyne, 1971, 1974). similar
affect. meaningone
However, forofboththethe
keyoriginator
differences and the recipient
between (Berlyne,
these two 1971, 1974).
communicative
Like speech, much of musical meaning is a function of cultural context. Thus, Likehas
forms speech,
to domuch of musicalparticularly
with function, meaning iswith a function
regard toof emotional
cultural context. Thus,
expression.
music of unfamiliar style may transmit little meaning to the listener. musiclanguage,
Spoken of unfamiliar which style may transmit
is considered little meaning
primarily referentialto (semantic)
the listener.in nature,
42 42
Music as Communication 43 Music as Communication 43
Music and Speech Music and Speech

Chapter 3
Comparisons between Music and Speech Comparisons between Music and Speech
Music as a form of auditory information is often compared to speech and
Music as a form of auditory information is often compared to speech and
Kate E. Gfeller
and music are species specific and can be found in all known cultures. Both
and music are species specific and can be found in all known cultures. Both
as pitch, duration, timbre, and intensity organized through particular rules (i.e., as pitch, duration, timbre, and intensity organized through particular rules (i.e.,
syntax or grammar) that result in listener expectations (Krumhansl, 1992). Both syntax or grammar) that result in listener expectations (Krumhansl, 1992). Both
speech and music take on meaning within a cultural context and as a result of speech and music take on meaning within a cultural context and as a result of
the listener’s past experiences and neurological capabilities. the listener’s past experiences and neurological capabilities.
However, there are interesting differences in neural processing of speech However, there are interesting differences in neural processing of speech
and music. For example, reception and expression of spoken communication and music. For example, reception and expression of spoken communication
appears to be predominately lateralized in the left hemisphere of the brain (i.e., appears to be predominately lateralized in the left hemisphere of the brain (i.e.,
W
the Wernickeshat and Brocas areas). InAccording
is communication? contrast, to radiological studies ofand
Gillam, Marquardt, persons
Martin the Wernickes and Brocas areas). In contrast, radiological studies of persons
with brain lesions indicate
(2000), that cognitiveisprocessing
communication any exchange of musicof cannot
meaning, be readily
whether with brain lesions indicate that cognitive processing of music cannot be readily
localized. Rather, processing
intended of particular
or unintended. Owens aspects
(2001)of music
describes(e.g., perception of as
communication localized. Rather, processing of particular aspects of music (e.g., perception of
pitch, rhythm, melody recognition) takes place in both right and left hemispheres, pitch, rhythm, melody recognition) takes place in both right and left hemispheres,
and musical behaviors
the process require use
participants thetocoordination of complex
exchange information andneural networks
ideas, needs and musical behaviors require the coordination of complex neural networks
throughout andthe brainThe
desires. (Marin
process and Perry,
is an active1999; Peretz
one that et al.,encoding,
involves 1994). Functional
trans- throughout the brain (Marin and Perry, 1999; Peretz et al., 1994). Functional
dissociations among
mitting, andspecific
decoding auditory abilitiesmessage.…
the intended (e.g., abilityIt to understand
requires a senderspoken dissociations among specific auditory abilities (e.g., ability to understand spoken
languageand while unable to
a receiver, and process
each mustmusical sounds,
be alert to theorinformational
vice versa) identified
needs ofthrough
the language while unable to process musical sounds, or vice versa) identified through
neuroanatomical studies
other to ensure thatindicate
messagesthat some individuals
are conveyed whothat
effectively and have expressive
intended neuroanatomical studies indicate that some individuals who have expressive
aphasia may retain receptive and expressive functions in musical communication
meanings are preserved (p. 11). aphasia may retain receptive and expressive functions in musical communication
(Gottselig, 2000; Peretz et al., 1994). These differences in neural processing form (Gottselig, 2000; Peretz et al., 1994). These differences in neural processing form
While basis
the theoretical these fordefinitions
therapeutic wereinterventions
written withsuch spoken, gestural,
as Melodic or written
Intonation the theoretical basis for therapeutic interventions such as Melodic Intonation
language
Therapy in mind,
(MIT), musicthe
in which hasintact
long been considered
abilities to process a form
melodicof communication,
contour may be as Therapy (MIT), in which the intact abilities to process melodic contour may be
well, despite
exploited the fact
to facilitate that musical
speech production sounds have Helm,
(Sparks, no specific designative
& Martin, 1974).meaning. exploited to facilitate speech production (Sparks, Helm, & Martin, 1974).
ThisBoth
beliefspeech
is supported
and music by neurologists
have oral and andwritten
psychologists as well as musicians.
forms. However, the oral andFor Both speech and music have oral and written forms. However, the oral and
example,
written Pribram
forms of spoken(1982) describes
language aremusic
used by as amost
language-like
persons inform by which humans
industrialized soci- written forms of spoken language are used by most persons in industrialized soci-
express
eties, whilethemselves and communicate
musical literacy and performance with eachis notother.
evenlyBerlyne (1971)among
distributed states,the
“If a eties, while musical literacy and performance is not evenly distributed among the
work of art can be regarded as a system of symbols, we
general population in all cultures (Krumhansl, 1992). Both spoken and musical can go farther and conclude general population in all cultures (Krumhansl, 1992). Both spoken and musical
that art fulfills exist
communication the additional
in spontaneous criteriainteractive
for being classed as communication”
forms (i.e., spoken conversation; (p. 59). communication exist in spontaneous interactive forms (i.e., spoken conversation;
inAccording to Kreitler and
music, improvisation andKreitler (1972),
jazz forms) thereasexists
as well the broad
in codified assumption in
performances that in music, improvisation and jazz forms) as well as in codified performances in
a work
which theofperforming
art is a vehicle
artistfor communicating
interprets and transmits meaning.
a completed creative product which the performing artist interprets and transmits a completed creative product
producedCommunication
by another artistof (e.g., meaning is not
actors a functionthe
interpreting of works
the stimulus or message
of playwrights; produced by another artist (e.g., actors interpreting the works of playwrights;
alone. Rather,
performing meaning
musicians comes from
interpreting a relationship of
the compositions between the symbol,
composers). Speechthat and to performing musicians interpreting the compositions of composers). Speech and
which
music it points,
both transmit andsymbolic
the common meaning observer
and both(Meyer,are1956).
used toA express
symbol or must have
evoke music both transmit symbolic meaning and both are used to express or evoke
similar
affect. meaningone
However, forofboththethe
keyoriginator
differences and the recipient
between (Berlyne,
these two 1971, 1974).
communicative affect. However, one of the key differences between these two communicative
Likehas
forms speech,
to domuch of musicalparticularly
with function, meaning iswith a function
regard toof emotional
cultural context. Thus,
expression. forms has to do with function, particularly with regard to emotional expression.
musiclanguage,
Spoken of unfamiliar which style may transmit
is considered little meaning
primarily referentialto (semantic)
the listener.in nature, Spoken language, which is considered primarily referential (semantic) in nature,
42
44
40 Psychomusical Foundations of Music Therapy Music
Physiological
44 as Communication
40 and Motor Responses to Music
Psychomusical
Stimuli Foundations of Music Therapy
45
41
provides an efficient way to impart discursive information. Thus, it is considered provides

Scartelli, an efficient
J. (1982). wayoftosedative
The effect impartmusic
discursive information. Thus,
on electromyographic it is considered
biofeedback assisted
an adaptive ability (i.e., necessary for survival). Many consider music’s most salient relaxation
an adaptive training
ability (i.e.,of spastic cerebral
necessary palsiedMany
for survival). adults. Journalmusic’s
consider of MusicmostTherapy,
salient
function its ability to instill moods and emotions (Aiello, 1994; Boltz, Schul- 19, 210–218.
function its ability to instill moods and emotions (Aiello, 1994; Boltz, Schul-
kind, & Kantra, 1991). Whether music is also adaptive is the subject of debate. Schachter,
kind, &J.Kantra,
(1957). Pain,
1991).fear, and anger
Whether in hypertensive
music normotensives.
is also adaptive is the subjectPsychosomatic
of debate.
If music is unnecessary for existence, it is curious that humans would need two Medicine, 19, 17–29.
If music is unnecessary for existence, it is curious that humans would need two
auditory forms of communication (Roederer, 1982). Some scholars have taken Schachter,
auditoryS.forms(1964).ofThe interaction of cognitive
communication (Roederer, and1982).
physiologic
Some determinants
scholars have of emo-
taken
tional states. Advances in Experimental Social Psychology, 1, 49–80.
an anthropological-historical approach to this issue by examining the origins of an anthropological-historical approach to this issue by examining the origins of
Sears, W. W. (1952). Postural responses to recorded music. In E. G. Gilliland (Ed.),
music and speech. music and speech.
Music therapy 1951 (pp. 197–198). Chicago: Allen Press.
Although the study of music in primitive societies offers some insight Although the study of music in primitive societies offers some insight
Sears, W. W. (1958). The effect of music on muscle tonus. In E. G. Gaston (Ed.), Music
into the origins of speech and music, the evolution of the two systems is into therapy
the origins
1957 (pp. of 199–205).
speech and music, KS:
Lawrence, the Allen
evolution
Press. of the two systems is
primarily a matter of conjecture (Radocy & Boyle, 1979). Among those proposed primarily a matter of conjecture (Radocy & Boyle, 1979). Among those proposed
Sears, W. W. (1960). A study of some effects of music upon muscle tension as evidenced by elec-
explanations is Darwin’s theory linking music to sexual instinct and mating and explanations
tromyographicis Darwin’s theory
recordings. linkingdoctoral
Unpublished music to sexual instinct
dissertation, and mating
University of Kansas.and
Nettl’s theory of impassioned speech (1956). In this theory music accentuates Nettl’s theory of impassioned speech (1956). In this theory
Shatin, L. (1957). The influence of rhythmic drumbeat stimuli upon the pulse rate music accentuates
speech intonation during emotional expression. speechandintonation during
general activity emotionalschizophrenics.
of long-term expression. Journal of Mental Science, 103,
It has also been suggested that early cultures used an undifferentiated It has also been suggested that early cultures used an undifferentiated
172–188.
method of communication that was neither speech nor music, but had common methodJ.of(1986).
Standley, communication
Music research that in
wasmedical/dental
neither speechtreatment:
nor music, but had common
Meta-analysis and
attributes of pitch, stress, and duration. According to Nettl (1975), language attributes
clinicalofapplications.
pitch, stress, and ofduration.
Journal According
Music Therapy, to Nettl (1975), language
23, 56–122.
acquired words and consonants, while music acquired fixed pitches through acquiredR.,words
Steinberg, Raith,and L., consonants,
Rossnagl, G.,while& Eben, music acquired
E. (1985). fixedpsychopathology:
Music pitches through
gradual differentiation and specialization. Bernstein (1976) suggests that initial Musical expression and psychiatric disease. Psychopathology,
gradual differentiation and specialization. Bernstein (1976) suggests that initial18, 274–285.
auditory communication was sung. Pribram (1982) supports this view, noting Stevens,
auditoryE. A.communication
(1971). Some effects wasofsung.
tempoPribram
changes (1982)
on stereotyped
supportsrocking movements
this view, noting
that vocalizations of nonhuman primates are essentially changes in pitch and that vocalizations of nonhuman primates are essentially changes inDeficiency,
of low-level mentally retarded subjects. American Journal of Mental pitch and
duration while articulation is a characteristically human ability. 76, 76–81.
duration while articulation is a characteristically human ability.
Although the evolution of speech and music remains a matter of specula- Stratton, Although
V. N., & Zalanowski,
the evolution A. of
(1984).
speechTheandeffect
musicof background music of
remains a matter on specula-
verbal
tion, obvious parallels and differences exist today in terms of syntax, semantics, interaction in groups. Journal of Music Therapy, 21, 16–26.
tion, obvious parallels and differences exist today in terms of syntax, semantics,
and social context. Both language and music are forms of communication Sutton, K. (1984).
and social The development
context. Both languageand implementation
and music are of a music
formstherapy physiological
of communication
measures test. Journal of Music Therapy, 21, 160–169.
processed by the auditory system. In both, we are able to perceive mistakes in processed by the auditory system. In both, we are able to perceive mistakes in
Thaut, M. H. (2000). Training manual for neurologic music therapy. Fort Collins: Colo-
content, structure, or humorous intent as a result of learning and enculturation. content, structure, or humorous intent as a result of learning and enculturation.
rado State University, Center for Biomedical Research in Music.
These similarities have sparked the interest of linguists, musicologists, and These similarities have sparked the interest of linguists, musicologists, and
Thaut, M. H., Kenyon, G. P., Schauer, M. L., & McIntosh, G. C. (1999). The connec-
psychologists alike. psychologists
tion between alike.
rhythmicity and brain function. IEEE Engineering in Medicine and
In his published lecture series, “The Unanswered Question” (1976), In his
Biology, 18, published
101–108. lecture series, “The Unanswered Question” (1976),
Leonard Bernstein draws parallels between syntactical structure of music and Leonard
Weld, H. P. Bernstein
(1912). An draws parallels
experimental between
study syntactical
of musical enjoyment.structure
American of Journal
music andof
language, based on linguist Noam Chomsky’s model of surface and deep structure language, based on linguist
Psychology, 23, 245–308. Noam Chomsky’s model of surface and deep structure
in language. This parallel has received mixed acceptance. For example, psycholo- in language.
Wolpe, J. (1965).This
The parallel
practice ofhas received
behavior mixedNew
therapy. acceptance. For example,
York: Pergamon Press. psycholo-
gist Diana Deutsch (1979) maintains that no fair comparison exists between gist Diana Deutsch (1979) maintains that no fair comparison exists between
music and the basic elements of speech such as nouns and verbs. Further, music, music and the basic elements of speech such as nouns and verbs. Further, music,
unlike speech, does not refer to specific thoughts, ideas, or events; rather, it com- unlike speech, does not refer to specific thoughts, ideas, or events; rather, it com-
municates embodied meaning (Benson, 1979; Deutsch, 1979). Other scholars municates embodied meaning (Benson, 1979; Deutsch, 1979). Other scholars
see comparison of language and music as productive (Campbell & Heller, 1981; see comparison of language and music as productive (Campbell & Heller, 1981;
Day, 1979), but suggest that past efforts may have failed as a result of invalid Day, 1979), but suggest that past efforts may have failed as a result of invalid
comparisons. For example, Campbell and Heller (1981) argue that conversation comparisons. For example, Campbell and Heller (1981) argue that conversation
cannot be meaningfully compared to a musical performance. cannot be meaningfully compared to a musical performance.
Music
48 as Communication
44 Psychomusical Foundations of Music Therapy
49
45 Music as Communication 49
45
Deriving Meaning
an aesthetic from Musical
and symbolic Communication
form, music transcends verbal expression and may Deriving Meaning from Musical Communication
evoke feelings.
For all the structural similarities that do exist (including a multitude of For all the structural similarities that do exist (including a multitude of
According to Berlyne (1974), aesthetic objects are regarded as collections
subfunctions within each system [Borchgrevink, 1982]), important differences subfunctions within each system [Borchgrevink, 1982]), important differences
of symbols and are distinguished by two characteristics: (1) iconic properties, and
remain that contribute to music’s uniqueness as a form of communication and remain that contribute to music’s uniqueness as a form of communication and
(2) ability to communicate value properties. Symbols function in three ways to
have implications for the therapeutic process. Perhaps the most notable differ- have implications for the therapeutic process. Perhaps the most notable differ-
communicate values (Kreitler & Kreitler, 1972): (1) unification, or the unifying
ence between spoken and musical communication is lack of referential meaning ence between spoken and musical communication is lack of referential meaning
of discreet entities (such as man and nature or man and society); (2) revelations,
in music. Unlike words in language, musical pitches do not denote or refer to in music. Unlike words in language, musical pitches do not denote or refer to
or reality revealed in deeper layers beyond logic; and (3) facilitating adaptation
the extramusical world in a specific fashion (Aiello, 1994; Meyer, 1956; Winner, the extramusical world in a specific fashion (Aiello, 1994; Meyer, 1956; Winner,
to reality, helping man understand, interpret, organize, and universalize the
1982). The nondiscursive symbols in music are abstract in nature and not readily 1982). The nondiscursive symbols in music are abstract in nature and not readily
human experience. All these functions relieve tension through environmental
translatable (Kreitler & Kreitler, 1972; Winner, 1982). How then, is it possible translatable (Kreitler & Kreitler, 1972; Winner, 1982). How then, is it possible
orientation. While symbolism may be less easily accomplished in music than
for music to convey meaning without explicit denotation? for music to convey meaning without explicit denotation?
in visual art (Merriam, 1964), auditory patterns can take on symbolic meaning
Scholars have long described what is called intrinsic or embodied meaning Scholars have long described what is called intrinsic or embodied meaning
through association by contiguity, cultural convention, and iconic properties
in music, which is derived from internal reference or intramusical organization. in music, which is derived from internal reference or intramusical organization.
(Berlyne, 1974; Meyer, 1956).
This embodied meaning is a function of our knowledge of musical style and This embodied meaning is a function of our knowledge of musical style and
expectations based on past listening experience (Krumhansl, 1992; Meyer, 1956; expectations based on past listening experience (Krumhansl, 1992; Meyer, 1956;
Association
Winner, by This
1982). Contiguity
intramusical organization, while limited in referential Winner, 1982). This intramusical organization, while limited in referential
semantics, is rich in meaning derived from pragmatic procedures. These semantics, is rich in meaning derived from pragmatic procedures. These
In some instances, musical materials and their organization become
procedures are based on structural qualities such as repetition, redundancy, procedures are based on structural qualities such as repetition, redundancy,
linked through repetition to a referential image (Cohen, 1990; Gottselig,
variation, and deletions, which activate recognition, habituation, and dishabitu- variation, and deletions, which activate recognition, habituation, and dishabitu-
2000). Over repeated encounters, connotations become habitual and automatic.
ation. According to Pribram, the prominence of pragmatic features such as ation. According to Pribram, the prominence of pragmatic features such as
Radocy and Boyle (1979) refer to this as the “Darling, they’re playing our
variation and redundancy is the key to meaning in music. Variations on musical variation and redundancy is the key to meaning in music. Variations on musical
song” phenomenon in which a particular selection or style of music, through
patterns evoke dishabituation, while repetition results in habituation and patterns evoke dishabituation, while repetition results in habituation and
classical conditioning, becomes associated with a particular feeling. According
recognition. These responses are associated with visceroautonomic responses recognition. These responses are associated with visceroautonomic responses
to Roederer (1982), even a partial reenactment of neural activity that occurred
and generation of feelings (Pribram, 1982). and generation of feelings (Pribram, 1982).
during the storage act suffices to release strong associative recall.
The ability to discriminate patterns of variation and redundancy in The ability to discriminate patterns of variation and redundancy in
Associative recall can be used within the therapeutic setting in a number
music is evident very early in human development. Research indicates that even music is evident very early in human development. Research indicates that even
of ways. One example is the use of familiar musical materials in reminiscence by
newborns in the first few weeks after birth are able to distinguish music they newborns in the first few weeks after birth are able to distinguish music they
geriatric or terminally ill patients (Bright, 1981; Munro, 1984). Reminiscence of
had heard in utero from unfamiliar musical selections (Butler, 1992). Studies had heard in utero from unfamiliar musical selections (Butler, 1992). Studies
important past events has been recommended as a therapeutic method for helping
using habituation paradigms with infants provide considerable evidence that using habituation paradigms with infants provide considerable evidence that
the elderly review life events, heighten awareness of past accomplishments, and
infants are sensitive to changes in structural features of music such as melodic infants are sensitive to changes in structural features of music such as melodic
facilitate social interaction. Through associative recall, the music therapist can
contour, rhythm, pitch range, timbre, and dynamics (Chang & Trehub, 1977; contour, rhythm, pitch range, timbre, and dynamics (Chang & Trehub, 1977;
help the clients access long-forgotten events within their lives. The recalling
Demany, 1982; Demany & Armand, 1984; Thorpe & Trehub, 1989; Thorpe, Demany, 1982; Demany & Armand, 1984; Thorpe & Trehub, 1989; Thorpe,
of significant events may also be effective in psychiatric care in which the
Trehub, Morrongiello, & Bull, 1988; Trehub, 1987). Studies by Krumhansl and Trehub, Morrongiello, & Bull, 1988; Trehub, 1987). Studies by Krumhansl and
client is encouraged to work through past events and feelings (Cassity &
Jusczyk (Jusczyk & Krumhansl, 1993; Krumhansl & Jusczyk, 1990) indicate Jusczyk (Jusczyk & Krumhansl, 1993; Krumhansl & Jusczyk, 1990) indicate
Cassity, 1996).
that infants as young as four months old are sensitive to structural features of that infants as young as four months old are sensitive to structural features of
Association by contiguity tends to be an individual response based
musical phrases (e.g., drop in pitch height or change in tone duration at the ends musical phrases (e.g., drop in pitch height or change in tone duration at the ends
on a personal experience. However, many musical themes and symbols are
of musical phrases) that can help them to perceive underlying phrase structure of musical phrases) that can help them to perceive underlying phrase structure
common to an entire culture, not just to an individual. For example, certain
in a musical sequence. The fact that even tiny infants are sensitive to structural in a musical sequence. The fact that even tiny infants are sensitive to structural
patriotic or religious musical themes have particular connotations that are
features of musical communication explains in part why music is such a potent features of musical communication explains in part why music is such a potent
based on cultural convention rather than classical conditioning (Gottselig,
form of communication between caregiver and infants around the world. form of communication between caregiver and infants around the world.
2000; Meyer, 1956).
Given the emphasis on pragmatic rather than referential meaning, Given the emphasis on pragmatic rather than referential meaning,
musical communication is less dependent on rational or intellectual response musical communication is less dependent on rational or intellectual response
46 as Communication Psychomusical Foundations of Music Therapy
47
(Krumhansl, 1992). Altshuler, in describing the therapeutic uses of music, and(Krumhansl,

early exposure 1992).
to culture-specific
Altshuler, in describing
music shapes theemotional
therapeutic response.
uses ofWhile music,
states that music “offers the advantage of encountering few or no intellectual perception
states thatof music
emotional “offerscontent
the advantage
in music can of encountering
certainly be attributed
few or notointellectual
training
barriers, as words do” (1956, p. 120). Similarly Berlyne (1971, 1974) suggests andbarriers,
enculturation,
as wordsstructural
do” (1956, elements
p. 120). within
Similarly
the musicBerlyne itself
(1971,
play a1974)
crucial suggests
role
that to some extent, appreciation of art may result from a privileged situation in inthat
effectively
to sometransmitting
extent, appreciationemotional of artmessages
may result (Gabrielsson
from a privileged
& Juslin, situation
1996;in
which pressure from reason and rational thought is alleviated. This reduction Gottselig,
which pressure
2000; from Hevner, reason1937; andNielzen
rationaland thought
Cesarec,is alleviated.
1981, 1982b;This reduction
Peretz,
of rational response has therapeutic implications for those clients with limited Gagnon,
of rational
& Bouchard,
response has 1998;therapeutic
Sloboda, implications
1992). for those clients with limited
intellectual capacity, as well as for interventions in which intellectualization by intellectual
Fried and capacity,
Berkowitz as well(1979)
as forfound
interventions
that soothing in which or aversive
intellectualization
music couldby
the client is considered undesirable. significantly
the client isalter
considered
not only undesirable.
participant mood, but also emotionally motivated
behaviors. They also found that participants in their study who had listened
to soothing, pleasant music showed significantly greater instances of helpful
Music, the Language of Emotions Music, the Language of Emotions
behaviors directly following the listening experience than did participants who
While emphasis on internal structure may explain how music can convey had beenWhile exposed emphasis
to aversiveon internal
music. structure
Similarly,may explain
Konecni how that
found music thecantypeconvey
of
meaning, the question still remains why an informational system unnecessary meaning,
music heard the could question
influence stillbehavior
remainstowardwhy anothers.informational
Specifically, system unnecessary
participants in
for survival is found in every culture known to man. In part, music’s value emanates anfor survival is who
experiment foundwere in every
exposedculture known to man.
to excessively loudInand part, music’ssongs
complex value emanates
tended
from its ability to “express the forms of vital experience which language is peculiarly to from
behaveits ability to “express the
more aggressively formsother
toward of vital experience than
participants whichthoselanguage
who ishad peculiarly
been
unfit to convey” (Langer, 1942, p. 32). A loss of words in particularly poignant unfit totoconvey”
exposed softer and (Langer,
simpler1942, p. 32).
melodies A loss of1982).
(Konecni, words in particularly poignant
moments is not an uncommon phenomenon, even for the verbally eloquent. moments
Theseisstudies
not an suggest
uncommon that phenomenon,
music, even without even forexplicitly
the verbally eloquent.
referential
According to Gaston (1968), there would be no need for music if it were possible to According
content, to Gaston (1968),
communicates some type thereofwould be no need
information for music
to the listenerif it were
that possible to
influences
communicate verbally that which is easily communicated musically. communicate
human behavior.verbally that which
It is important is easily
to keep communicated
in mind, however, musically.
that the relationship
Perhaps one of the reasons music, a nondiscursive form of communication, between Perhaps
music and oneaffective
of the reasons
response music, a nondiscursive
is not a simple one of form
causeof communication,
and effect.
is cherished as unique and valuable is due to its common association with is cherished
A number as ofunique
research andstudies
valuablehaveis investigated
due to its common the influenceassociation
of listenerwith
emotional response. Music, often referred to as the “language of emotions” emotional response.
characteristics on musical Music, often referred
response (Cantorto & as Zillman,
the “language 1973;ofFisher
emotions”&
(Langer, 1942; Winner, 1982), is commonly credited with the ability to evoke (Langer, 1942;
Greenberg, 1972;Winner,
O’Briant1982), is commonly
& Wilbanks, 1978;credited
Shatin, with 1970;theSloboda,
ability to evoke
1992;
emotional response (Boltz et al., 1991; Haack, 1980; Meyer, 1956; Pribram, emotional
Sopchak, 1955;response
Wheeler, (Boltz
1985). et al., 1991; Haack,
In particular, these1980;studies Meyer, 1956; Pribram,
have examined the
1982; Winner, 1982). According to Sloboda (1992), “There is a general consensus 1982;
effect of Winner,
prior mood 1982).
andAccording to Sloboda
taste or preference on(1992),
affective “There is a general
response to music. consensus
With
that music is capable of arousing deep and significant emotion in those who thethat music isofcapable
exception of arousing
the research deep and
by O’Briant significant (1978),
& Wilbanks emotionthese in those
studieswho
interact with it” (p. 33). interact with it” (p. 33).
have all supported Farnsworth’s (1969) view that mood response to music is
A number of studies have examined how music influences affective dependent A onnumber
many of studies
factors have examined
in addition to musical howform,music influences
including affective
the listener’s
response by comparing the effects of contrasting musical styles categorized response
mood set and byattitude
comparing toward thethe effects
music.of Thus,
contrasting
music musical
not only styles
evokescategorized
affective
through general descriptors such as stimulative, sedative, calming, or aversive throughbut
response, general
can alsodescriptors
be utilized such asas astimulative,
“canvas” upon sedative,
whichcalming,
a listener’sor aversive
prior
(Biller, 1973; Elam, 1971; Fisher & Greenberg, 1972; Greenberg & Fisher, (Biller,and
feelings 1973; Elam,are1971;
attitudes conveyed.Fisher & Greenberg, 1972; Greenberg & Fisher,
1966; Jellison, 1975; McFarland, 1984, 1985; Smith & Morris, 1976). These 1966; Jellison,
Given the 1975;
ability McFarland,
of music both 1984, 1985; Smith
to influence and&beMorris,
influenced1976). by These
the
studies have used both verbal report and physiological measures to indicate studies have
individual usedmood,
listener’s both verbal report and
music provides the physiological
skilled therapist measures
with an to indicate
excellent
emotional response. While the data are not always consistent concerning what emotional
tool to evokeresponse.
affectiveWhile responsesthe dataandare to not always
explore consistent
a wide rangeconcerning
of emotions. what
type of music will produce particular effects, it would appear that such contrasts type of music will produce particular effects, it would
In addition, the structural elements of music, though nonreferential, convey appear that such contrasts
in music do indeed influence mood (Abeles, 1980). in musicinformation
symbolic do indeed influence
and havemood (Abeles, to
the potential 1980).
evoke manifold meaning and
According to Winner (1982) and Gottselig (2000), listeners from similar According to Winner (1982) and Gottselig (2000), listeners from similar
flexible connotation.
cultures show remarkable agreement in categorizing music according to cultures show remarkable agreement in categorizing music according to
emotional labels. Studies by Trunk (1982) and Slattery (1985) note perception emotional labels. Studies by Trunk (1982) and Slattery (1985) note perception
Music as a Symbol
of emotional content in music occurring as early as the age of five. Greater of emotional content in music occurring as early as the age of five. Greater
accuracy and consistency of identification develop with increased age (Trunk, accuracy
Unlike andsigns,
consistency
which have of identification developreferences,
relatively specific with increased symbols age (Trunk,
evoke
1982). These findings are consistent with Roederer’s (1982) belief that training 1982).
less Theseand
specified findings
more are consistent
subjective with Roederer’s
meaning (Kreitler(1982) belief that
& Kreitler, 1972). training
As
Music
and(Krumhansl,
early exposure 1992).
to culture-specific
Altshuler, in describing
music shapes theemotional
therapeutic response.
uses ofWhile music, and early exposure to culture-specific music shapes emotional response. While
perception
states thatof music
emotional “offerscontent
the advantage
in music can of encountering
certainly be attributed
few or notointellectual
training perception of emotional content in music can certainly be attributed to training
andbarriers,
enculturation,
as wordsstructural
do” (1956, elements
p. 120). within
Similarly
the musicBerlyne itself
(1971,
play a1974)
crucial suggests
role and enculturation, structural elements within the music itself play a crucial role
inthat
effectively
to sometransmitting
extent, appreciationemotional of artmessages
may result (Gabrielsson
from a privileged
& Juslin, situation
1996;in in effectively transmitting emotional messages (Gabrielsson & Juslin, 1996;
Gottselig,
which pressure
2000; from Hevner, reason1937; andNielzen
rationaland thought
Cesarec,is alleviated.
1981, 1982b;This reduction
Peretz, Gottselig, 2000; Hevner, 1937; Nielzen and Cesarec, 1981, 1982b; Peretz,
Gagnon,
of rational
& Bouchard,
response has 1998;therapeutic
Sloboda, implications
1992). for those clients with limited Gagnon, & Bouchard, 1998; Sloboda, 1992).
intellectual
Fried and capacity,
Berkowitz as well(1979)
as forfound
interventions
that soothing in which or aversive
intellectualization
music couldby Fried and Berkowitz (1979) found that soothing or aversive music could
significantly
the client isalter
considered
not only undesirable.
participant mood, but also emotionally motivated significantly alter not only participant mood, but also emotionally motivated
behaviors. They also found that participants in their study who had listened behaviors. They also found that participants in their study who had listened
to soothing, pleasant music showed significantly greater instances of helpful to soothing, pleasant music showed significantly greater instances of helpful
Music, the Language of Emotions
behaviors directly following the listening experience than did participants who behaviors directly following the listening experience than did participants who
had beenWhile exposed emphasis
to aversiveon internal
music. structure
Similarly,may explain
Konecni how that
found music thecantypeconvey
of had been exposed to aversive music. Similarly, Konecni found that the type of
meaning,
music heard the could question
influence stillbehavior
remainstowardwhy anothers.informational
Specifically, system unnecessary
participants in music heard could influence behavior toward others. Specifically, participants in
anfor survival is who
experiment foundwere in every
exposedculture known to man.
to excessively loudInand part, music’ssongs
complex value emanates
tended an experiment who were exposed to excessively loud and complex songs tended
to from
behaveits ability to “express the
more aggressively formsother
toward of vital experience than
participants whichthoselanguage
who ishad peculiarly
been to behave more aggressively toward other participants than those who had been
unfit totoconvey”
exposed softer and (Langer,
simpler1942, p. 32).
melodies A loss of1982).
(Konecni, words in particularly poignant exposed to softer and simpler melodies (Konecni, 1982).
moments
Theseisstudies
not an suggest
uncommon that phenomenon,
music, even without even forexplicitly
the verbally eloquent.
referential These studies suggest that music, even without explicitly referential
According
content, to Gaston (1968),
communicates some type thereofwould be no need
information for music
to the listenerif it were
that possible to
influences content, communicates some type of information to the listener that influences
communicate
human behavior.verbally that which
It is important is easily
to keep communicated
in mind, however, musically.
that the relationship human behavior. It is important to keep in mind, however, that the relationship
between Perhaps
music and oneaffective
of the reasons
response music, a nondiscursive
is not a simple one of form
causeof communication,
and effect. between music and affective response is not a simple one of cause and effect.
is cherished
A number as ofunique
research andstudies
valuablehaveis investigated
due to its common the influenceassociation
of listenerwith A number of research studies have investigated the influence of listener
emotional response.
characteristics on musical Music, often referred
response (Cantorto & as Zillman,
the “language 1973;ofFisher
emotions”& characteristics on musical response (Cantor & Zillman, 1973; Fisher &
(Langer, 1942;
Greenberg, 1972;Winner,
O’Briant1982), is commonly
& Wilbanks, 1978;credited
Shatin, with 1970;theSloboda,
ability to evoke
1992; Greenberg, 1972; O’Briant & Wilbanks, 1978; Shatin, 1970; Sloboda, 1992;
emotional
Sopchak, 1955;response
Wheeler, (Boltz
1985). et al., 1991; Haack,
In particular, these1980;studies Meyer, 1956; Pribram,
have examined the Sopchak, 1955; Wheeler, 1985). In particular, these studies have examined the
1982;
effect of Winner,
prior mood 1982).
andAccording to Sloboda
taste or preference on(1992),
affective “There is a general
response to music. consensus
With effect of prior mood and taste or preference on affective response to music. With
thethat music isofcapable
exception of arousing
the research deep and
by O’Briant significant (1978),
& Wilbanks emotionthese in those
studieswho the exception of the research by O’Briant & Wilbanks (1978), these studies
interact with it” (p. 33).
have all supported Farnsworth’s (1969) view that mood response to music is have all supported Farnsworth’s (1969) view that mood response to music is
dependent A onnumber
many of studies
factors have examined
in addition to musical howform,music influences
including affective
the listener’s dependent on many factors in addition to musical form, including the listener’s
response
mood set and byattitude
comparing toward thethe effects
music.of Thus,
contrasting
music musical
not only styles
evokescategorized
affective mood set and attitude toward the music. Thus, music not only evokes affective
throughbut
response, general
can alsodescriptors
be utilized such asas astimulative,
“canvas” upon sedative,
whichcalming,
a listener’sor aversive
prior response, but can also be utilized as a “canvas” upon which a listener’s prior
(Biller,and
feelings 1973; Elam,are1971;
attitudes conveyed.Fisher & Greenberg, 1972; Greenberg & Fisher, feelings and attitudes are conveyed.
1966; Jellison,
Given the 1975;
ability McFarland,
of music both 1984, 1985; Smith
to influence and&beMorris,
influenced1976). by These
the Given the ability of music both to influence and be influenced by the
studies have
individual usedmood,
listener’s both verbal report and
music provides the physiological
skilled therapist measures
with an to indicate
excellent individual listener’s mood, music provides the skilled therapist with an excellent
emotional
tool to evokeresponse.
affectiveWhile responsesthe dataandare to not always
explore consistent
a wide rangeconcerning
of emotions. what tool to evoke affective responses and to explore a wide range of emotions.
type of music will produce particular effects, it would
In addition, the structural elements of music, though nonreferential, convey appear that such contrasts In addition, the structural elements of music, though nonreferential, convey
in musicinformation
symbolic do indeed influence
and havemood (Abeles, to
the potential 1980).
evoke manifold meaning and symbolic information and have the potential to evoke manifold meaning and
According to Winner (1982) and Gottselig (2000), listeners from similar
flexible connotation. flexible connotation.
cultures show remarkable agreement in categorizing music according to
emotional labels. Studies by Trunk (1982) and Slattery (1985) note perception
Music as a Symbol Music as a Symbol
of emotional content in music occurring as early as the age of five. Greater
accuracy
Unlike andsigns,
consistency
which have of identification developreferences,
relatively specific with increased symbols age (Trunk,
evoke Unlike signs, which have relatively specific references, symbols evoke
1982).
less Theseand
specified findings
more are consistent
subjective with Roederer’s
meaning (Kreitler(1982) belief that
& Kreitler, 1972). training
As less specified and more subjective meaning (Kreitler & Kreitler, 1972). As
48
48 as Communication
49
45
an aesthetic and symbolic form, music transcends verbal expression and may Deriving Meaning
an aesthetic from Musical
and symbolic Communication
form, music transcends verbal expression and may
evoke feelings. evoke feelings.
For all the structural similarities that do exist (including a multitude of
According to Berlyne (1974), aesthetic objects are regarded as collections According to Berlyne (1974), aesthetic objects are regarded as collections
subfunctions within each system [Borchgrevink, 1982]), important differences
of symbols and are distinguished by two characteristics: (1) iconic properties, and of symbols and are distinguished by two characteristics: (1) iconic properties, and
remain that contribute to music’s uniqueness as a form of communication and
(2) ability to communicate value properties. Symbols function in three ways to (2) ability to communicate value properties. Symbols function in three ways to
have implications for the therapeutic process. Perhaps the most notable differ-
communicate values (Kreitler & Kreitler, 1972): (1) unification, or the unifying communicate values (Kreitler & Kreitler, 1972): (1) unification, or the unifying
ence between spoken and musical communication is lack of referential meaning
of discreet entities (such as man and nature or man and society); (2) revelations, of discreet entities (such as man and nature or man and society); (2) revelations,
in music. Unlike words in language, musical pitches do not denote or refer to
or reality revealed in deeper layers beyond logic; and (3) facilitating adaptation or reality revealed in deeper layers beyond logic; and (3) facilitating adaptation
the extramusical world in a specific fashion (Aiello, 1994; Meyer, 1956; Winner,
to reality, helping man understand, interpret, organize, and universalize the to reality, helping man understand, interpret, organize, and universalize the
1982). The nondiscursive symbols in music are abstract in nature and not readily
human experience. All these functions relieve tension through environmental human experience. All these functions relieve tension through environmental
translatable (Kreitler & Kreitler, 1972; Winner, 1982). How then, is it possible
orientation. While symbolism may be less easily accomplished in music than orientation. While symbolism may be less easily accomplished in music than
for music to convey meaning without explicit denotation?
in visual art (Merriam, 1964), auditory patterns can take on symbolic meaning in visual art (Merriam, 1964), auditory patterns can take on symbolic meaning
Scholars have long described what is called intrinsic or embodied meaning
through association by contiguity, cultural convention, and iconic properties through association by contiguity, cultural convention, and iconic properties
in music, which is derived from internal reference or intramusical organization.
(Berlyne, 1974; Meyer, 1956). (Berlyne, 1974; Meyer, 1956).
This embodied meaning is a function of our knowledge of musical style and
expectations based on past listening experience (Krumhansl, 1992; Meyer, 1956;
Association by Contiguity Association
Winner, by This
1982). Contiguity
intramusical organization, while limited in referential
semantics, is rich in meaning derived from pragmatic procedures. These
In some instances, musical materials and their organization become In some instances, musical materials and their organization become
procedures are based on structural qualities such as repetition, redundancy,
linked through repetition to a referential image (Cohen, 1990; Gottselig, linked through repetition to a referential image (Cohen, 1990; Gottselig,
variation, and deletions, which activate recognition, habituation, and dishabitu-
2000). Over repeated encounters, connotations become habitual and automatic. 2000). Over repeated encounters, connotations become habitual and automatic.
ation. According to Pribram, the prominence of pragmatic features such as
Radocy and Boyle (1979) refer to this as the “Darling, they’re playing our Radocy and Boyle (1979) refer to this as the “Darling, they’re playing our
variation and redundancy is the key to meaning in music. Variations on musical
song” phenomenon in which a particular selection or style of music, through song” phenomenon in which a particular selection or style of music, through
patterns evoke dishabituation, while repetition results in habituation and
classical conditioning, becomes associated with a particular feeling. According classical conditioning, becomes associated with a particular feeling. According
recognition. These responses are associated with visceroautonomic responses
to Roederer (1982), even a partial reenactment of neural activity that occurred to Roederer (1982), even a partial reenactment of neural activity that occurred
and generation of feelings (Pribram, 1982).
during the storage act suffices to release strong associative recall. during the storage act suffices to release strong associative recall.
The ability to discriminate patterns of variation and redundancy in
Associative recall can be used within the therapeutic setting in a number Associative recall can be used within the therapeutic setting in a number
music is evident very early in human development. Research indicates that even
of ways. One example is the use of familiar musical materials in reminiscence by of ways. One example is the use of familiar musical materials in reminiscence by
newborns in the first few weeks after birth are able to distinguish music they
geriatric or terminally ill patients (Bright, 1981; Munro, 1984). Reminiscence of geriatric or terminally ill patients (Bright, 1981; Munro, 1984). Reminiscence of
had heard in utero from unfamiliar musical selections (Butler, 1992). Studies
important past events has been recommended as a therapeutic method for helping important past events has been recommended as a therapeutic method for helping
using habituation paradigms with infants provide considerable evidence that
the elderly review life events, heighten awareness of past accomplishments, and the elderly review life events, heighten awareness of past accomplishments, and
infants are sensitive to changes in structural features of music such as melodic
facilitate social interaction. Through associative recall, the music therapist can facilitate social interaction. Through associative recall, the music therapist can
contour, rhythm, pitch range, timbre, and dynamics (Chang & Trehub, 1977;
help the clients access long-forgotten events within their lives. The recalling help the clients access long-forgotten events within their lives. The recalling
Demany, 1982; Demany & Armand, 1984; Thorpe & Trehub, 1989; Thorpe,
of significant events may also be effective in psychiatric care in which the of significant events may also be effective in psychiatric care in which the
Trehub, Morrongiello, & Bull, 1988; Trehub, 1987). Studies by Krumhansl and
client is encouraged to work through past events and feelings (Cassity & client is encouraged to work through past events and feelings (Cassity &
Jusczyk (Jusczyk & Krumhansl, 1993; Krumhansl & Jusczyk, 1990) indicate
Cassity, 1996). Cassity, 1996).
that infants as young as four months old are sensitive to structural features of
Association by contiguity tends to be an individual response based Association by contiguity tends to be an individual response based
musical phrases (e.g., drop in pitch height or change in tone duration at the ends
on a personal experience. However, many musical themes and symbols are on a personal experience. However, many musical themes and symbols are
of musical phrases) that can help them to perceive underlying phrase structure
common to an entire culture, not just to an individual. For example, certain common to an entire culture, not just to an individual. For example, certain
in a musical sequence. The fact that even tiny infants are sensitive to structural
patriotic or religious musical themes have particular connotations that are patriotic or religious musical themes have particular connotations that are
features of musical communication explains in part why music is such a potent
based on cultural convention rather than classical conditioning (Gottselig, based on cultural convention rather than classical conditioning (Gottselig,
form of communication between caregiver and infants around the world.
2000; Meyer, 1956). 2000; Meyer, 1956).
Given the emphasis on pragmatic rather than referential meaning,
musical communication is less dependent on rational or intellectual response
Music
52 as Communication
49
53
CulturalRoederer
Conventions
(1982) suggests that elicitation of limbic function by the abstract Cultural Conventions
sounds of music contributes to our emotional response to music. More recent
Just as verbal interaction becomes conventionalized so that people may Just as verbal interaction becomes conventionalized so that people may
neuroanatomical studies of persons suffering strokes indicate that lesions of the
communicate more effectively, so also does musical communication of mood communicate more effectively, so also does musical communication of mood
right temporoparietal region are associated with impaired perception of emotion
and sentiments become conventionalized through standardized musical devices and sentiments become conventionalized through standardized musical devices
in music. It is interesting to note that depending on the location of the lesion
(Meyer, 1956). In Western music, for example, certain scales, harmonies, or (Meyer, 1956). In Western music, for example, certain scales, harmonies, or
some individuals may have impaired ability to recognize previously familiar
timbres symbolize particular states of being (Hevner, 1937; Merriam, 1964; timbres symbolize particular states of being (Hevner, 1937; Merriam, 1964;
music, yet they may retain an emotional reaction to music (Gottselig, 2000).
Peretz et al., 1998). Merriam cites television or film scores as the obvious example Peretz et al., 1998). Merriam cites television or film scores as the obvious example
This finding supports a neurological explanation for why, throughout history,
of how music evokes desired emotions through certain musical clichés. These of how music evokes desired emotions through certain musical clichés. These
people have used music to intensify emotional content of other forms of
connotations shared by a group of individuals within a culture are powerful connotations shared by a group of individuals within a culture are powerful
communication. The music brings to the textual or visual information additional
factors in communicating symbolic meaning. Within the therapeutic process, the factors in communicating symbolic meaning. Within the therapeutic process, the
meaning of a feelingful nature.
music therapist can take advantage of this factor, facilitating group cohesiveness music therapist can take advantage of this factor, facilitating group cohesiveness
Several empirical studies have investigated what results when visual
or relative unity of response by presenting particular selections or a musical style or relative unity of response by presenting particular selections or a musical style
and verbal communication is embedded in a musical setting. McFarland
that generally connotes a shared meaning (Plach, 1980). Some of these cultural that generally connotes a shared meaning (Plach, 1980). Some of these cultural
(1984) found that participant interpretations of ambiguous TAT pictures
conventions result in part from what Berlyne (1974) calls iconicity. conventions result in part from what Berlyne (1974) calls iconicity.
were significantly different in emotional content, depending on whether the
listener heard tension-producing or calming music or no music. He found that
Iconicity
participants who listened to tension-producing music interpreted the picture Iconicity
with emotional reports of anxiety and frustration. In contrast, music categorized
Iconicity implies similarity between auditory characteristics and some Iconicity implies similarity between auditory characteristics and some
as calming tended to reduce negative effects expressed in response to the picture.
referential event, feeling, or idea. This is similar to the Gestalt idea of physiognom- referential event, feeling, or idea. This is similar to the Gestalt idea of physiognom-
Thus it would appear that music can either intensify or reduce affective response
ics, or what some refer to as isomorphism, in which physical properties of the ics, or what some refer to as isomorphism, in which physical properties of the
to visual information, depending on the matching of emotional content of the
art object possess patterns similar to physical features (especially facial features) art object possess patterns similar to physical features (especially facial features)
music and visual stimulus.
associated with particular emotions (Gottselig, 2000). Other examples of iconic associated with particular emotions (Gottselig, 2000). Other examples of iconic
A study by Parrott (1982) describes the effect of music on emotional
meaning might be the use of auditory patterns that mimic a particular quality of meaning might be the use of auditory patterns that mimic a particular quality of
response to paintings as essentially additive, depending upon the “goodness/
sound in nature (e.g., sound of wind or birds) (Krumhansl, 1992; Meyer, 1956; sound in nature (e.g., sound of wind or birds) (Krumhansl, 1992; Meyer, 1956;
badness” of the match between the music and the painting. Parrott found
Roederer, 1982). For example, iconicity can facilitate motor activities in young Roederer, 1982). For example, iconicity can facilitate motor activities in young
that emotional judgments of the music were influenced more strongly by the
children. The therapist may select music with specific characteristics such as children. The therapist may select music with specific characteristics such as
painting (particularly those paintings of a complex nature) than the music
slow, plodding music to represent the movement of elephants, or melodically and slow, plodding music to represent the movement of elephants, or melodically and
influenced judgments of the paintings. Therefore the interaction of two forms
rhythmically disjunct music to encourage hopping movements. rhythmically disjunct music to encourage hopping movements.
of communication may vary, depending on factors such as complexity and
No matter how symbolic meaning is derived, it gives music communica- No matter how symbolic meaning is derived, it gives music communica-
type of information.
tive potential within the therapeutic context. According to Kreitler and tive potential within the therapeutic context. According to Kreitler and
A similar relationship between music and visual and verbal information
Kreitler (1972), Kreitler (1972),
was found by Wintle (1978) in his study of the emotional impact of music
on television commercials. Wintle found that supporting background music
confrontation with symbolic expression may give rise to insights that confrontation with symbolic expression may give rise to insights that
routinely intensified the qualities (i.e., level of activity, pleasantness, or potency)
enable the individual to transcend the suffering, embarrassment, and enable the individual to transcend the suffering, embarrassment, and
positively characterized by a commercial, while “counteracting” background music
dangers of specific situations… [symbols] deal with problems of uni- dangers of specific situations… [symbols] deal with problems of uni-
diminished in intensity that quality the commercial positively characterized.
versal human significance, ranging from life and love to suffering and versal human significance, ranging from life and love to suffering and
One common pairing
the fear of death (pp. of music and visual information is film soundtracks,
323–324). the fear of death (pp. 323–324).
which typically accompany film, video, and television productions. According
to Cohen (1990),
The extent of research regarding
association, music
cultural and film and
convention, fallsiconic
into four primary
properties The extent of association, cultural convention, and iconic properties
categories of inquiry: (1) an associationist approach to musical meaning,
within music can, to greater or lesser extent, affect specific connotations from (2) the within music can, to greater or lesser extent, affect specific connotations from
structure of musical and visual materials, (3) the impact of music on memory
auditory stimuli. Despite these guiding factors, music still remains nonspecific and auditory stimuli. Despite these guiding factors, music still remains nonspecific
awareness for the film, and (4) aesthetic properties of the music and film.
51
in meaning. Ultimately, it is the listener who establishes meaning, based on Eckert,

in meaning.
1991; Gfeller
Ultimately,
& Coffman,it is the1991).
listener
For example,
who establishes
in a study meaning,
in whichbased verbalon
cultural and individual experiences (Meyer, 1956). information
cultural andwas individual
paired with experiences
two contrasting
(Meyer, 1956). styles of music (i.e., relatively
This nonreferential abstraction allows for multiple organization and simple music
This withnonreferential
conventional abstraction
and highlyallows predictable
for multiple
melodicorganization
and harmonic and
multidimensional meaning (Kreitler & Kreitler, 1972). According to Kreitler sequences,
multidimensional
as opposedmeaningto more (Kreitler
complex & atonal,
Kreitler,
dissonant
1972).music),
Accordingnonmusicians
to Kreitler
and Kreitler, works of art can be grasped, elaborated, and experienced in several tended
and Kreitler,
to showworks moreofpositive
art can be affective
grasped, response
elaborated,to music
and experienced
paired withinmore several
systems of connected potential meaning. Aesthetic object’s capacity for more conventional
systems of connected
and predictablepotential music
meaning.(Gfeller,Aesthetic
Asmus, object’s
& Eckert,capacity1991). for more
In
than one interpretation contribute to richness of meaning as well as wide appeal, contrast,
than oneyoung
interpretation
adults who contribute
were advanced
to richness music
of meaning
majorsashad wellmore
as wide positive
appeal,
thus providing a fusion between the general and specific meaning. Berlyne affective
thus providing
response atofusionmore complex
betweenmusical the generalstylesandthanspecific
did nonmusicians,
meaning. Berlyne and
(1974) believes this ambiguity of meaning within art impels perceptual and were
(1974)
negatively
believes disposed
this ambiguity
to obviousofincongruity
meaning within between artthe
impels
verbalperceptual
message and and
intellectual effort of a pleasurable nature. affective
intellectual
tone effort
of theofaccompanying
a pleasurable nature.music (i.e., verbal information depicting a
The multilevel meanings of art allow the observer to shift points of view, harsh battle
Thescene
multilevel
pairedmeanings
with pleasantof artmusic)
allow the (Gfeller
observer
& Coffman,
to shift points
1991).ofThe view,
exchange one frame of reference for another, shift perceptual organization, or differing
exchange results
one attributed
frame of reference
to dependent for another,
variablesshift
of listener
perceptual
experience,
organization,
musicalor
even attempt integration, viewing levels simultaneously (Kreitler & Kreitler, styles,
even and
attemptverbalintegration,
inputs were viewing
explained levelswithin
simultaneously
the framework (Kreitler of &Berlyne’s
Kreitler,
1972). Shifting from one level to another has certain motivating factors. First, experimental
1972). Shiftingaesthetics,
from one namely,
levelthat
to another
people tendhas certain
to havemotivating
more positive factors.
affectiveFirst,
it overcomes a tendency toward satiation and subsequent lack of interest in the response
it overcomes
to aesthetic
a tendency objects
toward(e.g.,satiation
music, and visual
subsequent
art) at an lackoptimal
of interestlevelinofthe
object. Second, there is the expectation that another level in a work of art may complexity
object. Second,
and familiarity.
there is the(For more detail
expectation regarding
that another optimal
level in a work complexity,
of art may
engage unresolved problems untouched on previous experience levels. Third, seeengage
Chapter 5 in this book.)
unresolved problems untouched on previous experience levels. Third,
the most comprehensive level may provide the individual with significant and Several
the most studies have focused
comprehensive level may on neurological
provide the explanations
individual with for simultaneous
significant and
personal insights and suggestions, as well as new questions and answers to processing of speechand
personal insights andsuggestions,
music. Reineke as well (1981)
as new hypothesizes
questions and that answers
separateto
personal needs and problems (Kreitler & Kreitler, 1972). In short, although information-processing
personal needs and problems systems (Kreitler
may be used for music
& Kreitler, and speech.
1972). In short,Roederer
although
music cannot specify and particularize connotations, it carries flexibility of (1982)
musicbelieves
cannot that specifyhemispheric specialization
and particularize (dominance
connotations, of left
it carries or right of
flexibility
connotation, including multiple meanings that allow the individual to view the hemisphere
connotation, of the brain),multiple
including while not absolute,that
meanings is related
allow the to individual
different processing
to view the
human experience with unique insights (Meyer, 1956). strategies that are used
human experience withfor musicinsights
unique and speech.
(Meyer,He hypothesizes that holistic
1956).
analysis, so prominent in music, is a function of the right hemisphere while
sequential processing takes place in the language (left) hemisphere. As mentioned
Music in Conjunction with Other Forms of Communication Music in Conjunction with Other Forms of Communication
earlier in this chapter, more recent neuroanatomical studies also indicate
While music functions independently as communication, it is often differencesWhile musicprocessing
in neural functionsofindependently
speech and music as communication,
(Gottselig, 2000; it Peretz
is often
paired with poetry, prose, or art in serious and popular music as well as in et paired with poetry, prose, or art in serious and popular music as well as in
al., 1994).
advertising and other media. Historically, music has been utilized to intensify advertising and other
Contrasting music media. Historically,
and speech, Pribram music has been
(1982) utilized
describes to intensify
language as
the emotional content or text of the art form with which it is paired. Consider, the emotional
primarily content
referential or semantics)
(i.e., text of the art andformmusic with as which
primarilyit is paired.
evocative Consider,
(i.e.,
for instance, musica reservata, text painting, and other techniques in which for instance,
pragmatic). He musica
believesreservata, text painting,
that referential and other
and evocative techniques
types in which
of information
musical patterns reflect textual material. Early opera composers embarked aremusical
subject patterns
to different reflect
typestextual material. processing.
of neurological Early operaPribram composers explainsembarked
this
upon this new musical form in part to intensify the emotional impact of the upon this
difference in new musical form
the following way: in part to intensify the emotional impact of the
libretto (Kamien, 1984). The practice of pairing music with other art forms libretto (Kamien, 1984). The practice of pairing music with other art forms
is ubiquitous in contemporary music and musical theater as well. In recent is ubiquitous
Despite the in severely
contemporary
limited music
informationand musical
processing theater
and asresulting
well. In recent
decades, this historical tradition of pairing music and text has been the subject referential semantics, music is rich in
decades, this historical tradition of pairing music and text has meaning. This meaning
been the is subject
of empirical investigation. derived from pragmatic
of empirical investigation. procedures which also enrich natural language,
A perusal of extant studies investigating simultaneous processing of music especially
A perusal in of
their poetic
extant usages.
studies Pragmaticsimultaneous
investigating procedures areprocessing
based on of music
and speech points up the many factors that influence response to the pairing repetition, on variation of repetition,
and speech points up the many factors that influence response and on deletion of expected
to the pairing
of these two forms of communication. These include the participant’s level of repetitions. It is the processes such as these which
of these two forms of communication. These include the participant’s have been shown to level of
musical training, the type of verbal and musical stimuli, and the experimental be functions of the fronto-limbic formation of the
musical training, the type of verbal and musical stimuli, and the experimentalforebrain generally
methodology itself (Coffman, Gfeller, & Eckert, 1995; Gfeller, Asmus, & thought toitself
methodology be involved
(Coffman, in generation
Gfeller,and & control
Eckert,of1995;feelings (p. 31).Asmus, &
Gfeller,
Music
Eckert,
in meaning.
1991; Gfeller
Ultimately,
& Coffman,it is the1991).
listener
For example,
who establishes
in a study meaning,
in whichbased verbalon Eckert, 1991; Gfeller & Coffman, 1991). For example, in a study in which verbal
information
cultural andwas individual
paired with experiences
two contrasting
(Meyer, 1956). styles of music (i.e., relatively information was paired with two contrasting styles of music (i.e., relatively
simple music
This withnonreferential
conventional abstraction
and highlyallows predictable
for multiple
melodicorganization
and harmonic and simple music with conventional and highly predictable melodic and harmonic
sequences,
multidimensional
as opposedmeaningto more (Kreitler
complex & atonal,
Kreitler,
dissonant
1972).music),
Accordingnonmusicians
to Kreitler sequences, as opposed to more complex atonal, dissonant music), nonmusicians
tended
and Kreitler,
to showworks moreofpositive
art can be affective
grasped, response
elaborated,to music
and experienced
paired withinmore several tended to show more positive affective response to music paired with more
conventional
systems of connected
and predictablepotential music
meaning.(Gfeller,Aesthetic
Asmus, object’s
& Eckert,capacity1991). for more
In conventional and predictable music (Gfeller, Asmus, & Eckert, 1991). In
contrast,
than oneyoung
interpretation
adults who contribute
were advanced
to richness music
of meaning
majorsashad wellmore
as wide positive
appeal, contrast, young adults who were advanced music majors had more positive
affective
thus providing
response atofusionmore complex
betweenmusical the generalstylesandthanspecific
did nonmusicians,
meaning. Berlyne and affective response to more complex musical styles than did nonmusicians, and
were
(1974)
negatively
believes disposed
this ambiguity
to obviousofincongruity
meaning within between artthe
impels
verbalperceptual
message and and were negatively disposed to obvious incongruity between the verbal message and
affective
intellectual
tone effort
of theofaccompanying
a pleasurable nature.music (i.e., verbal information depicting a affective tone of the accompanying music (i.e., verbal information depicting a
harsh battle
Thescene
multilevel
pairedmeanings
with pleasantof artmusic)
allow the (Gfeller
observer
& Coffman,
to shift points
1991).ofThe view, harsh battle scene paired with pleasant music) (Gfeller & Coffman, 1991). The
differing
exchange results
one attributed
frame of reference
to dependent for another,
variablesshift
of listener
perceptual
experience,
organization,
musicalor differing results attributed to dependent variables of listener experience, musical
styles,
even and
attemptverbalintegration,
inputs were viewing
explained levelswithin
simultaneously
the framework (Kreitler of &Berlyne’s
Kreitler, styles, and verbal inputs were explained within the framework of Berlyne’s
experimental
1972). Shiftingaesthetics,
from one namely,
levelthat
to another
people tendhas certain
to havemotivating
more positive factors.
affectiveFirst, experimental aesthetics, namely, that people tend to have more positive affective
response
it overcomes
to aesthetic
a tendency objects
toward(e.g.,satiation
music, and visual
subsequent
art) at an lackoptimal
of interestlevelinofthe response to aesthetic objects (e.g., music, visual art) at an optimal level of
complexity
object. Second,
and familiarity.
there is the(For more detail
expectation regarding
that another optimal
level in a work complexity,
of art may complexity and familiarity. (For more detail regarding optimal complexity,
seeengage
Chapter 5 in this book.)
unresolved problems untouched on previous experience levels. Third, see Chapter 5 in this book.)
Several
the most studies have focused
comprehensive level may on neurological
provide the explanations
individual with for simultaneous
significant and Several studies have focused on neurological explanations for simultaneous
processing of speechand
personal insights andsuggestions,
music. Reineke as well (1981)
as new hypothesizes
questions and that answers
separateto processing of speech and music. Reineke (1981) hypothesizes that separate
information-processing
personal needs and problems systems (Kreitler
may be used for music
& Kreitler, and speech.
1972). In short,Roederer
although information-processing systems may be used for music and speech. Roederer
(1982)
musicbelieves
cannot that specifyhemispheric specialization
and particularize (dominance
connotations, of left
it carries or right of
flexibility (1982) believes that hemispheric specialization (dominance of left or right
hemisphere
connotation, of the brain),multiple
including while not absolute,that
meanings is related
allow the to individual
different processing
to view the hemisphere of the brain), while not absolute, is related to different processing
strategies that are used
human experience withfor musicinsights
unique and speech.
(Meyer,He hypothesizes that holistic
1956). strategies that are used for music and speech. He hypothesizes that holistic
analysis, so prominent in music, is a function of the right hemisphere while analysis, so prominent in music, is a function of the right hemisphere while
sequential processing takes place in the language (left) hemisphere. As mentioned sequential processing takes place in the language (left) hemisphere. As mentioned
Music in Conjunction with Other Forms of Communication
earlier in this chapter, more recent neuroanatomical studies also indicate earlier in this chapter, more recent neuroanatomical studies also indicate
differencesWhile musicprocessing
in neural functionsofindependently
speech and music as communication,
(Gottselig, 2000; it Peretz
is often differences in neural processing of speech and music (Gottselig, 2000; Peretz
et paired with poetry, prose, or art in serious and popular music as well as in
al., 1994). et al., 1994).
advertising and other
Contrasting music media. Historically,
and speech, Pribram music has been
(1982) utilized
describes to intensify
language as Contrasting music and speech, Pribram (1982) describes language as
the emotional
primarily content
referential or semantics)
(i.e., text of the art andformmusic with as which
primarilyit is paired.
evocative Consider,
(i.e., primarily referential (i.e., semantics) and music as primarily evocative (i.e.,
for instance,
pragmatic). He musica
believesreservata, text painting,
that referential and other
and evocative techniques
types in which
of information pragmatic). He believes that referential and evocative types of information
aremusical
subject patterns
to different reflect
typestextual material. processing.
of neurological Early operaPribram composers explainsembarked
this are subject to different types of neurological processing. Pribram explains this
upon this
difference in new musical form
the following way: in part to intensify the emotional impact of the difference in the following way:
libretto (Kamien, 1984). The practice of pairing music with other art forms
is ubiquitous
Despite the in severely
contemporary
limited music
informationand musical
processing theater
and asresulting
well. In recent Despite the severely limited information processing and resulting
referential semantics, music is rich in
decades, this historical tradition of pairing music and text has meaning. This meaning
been the is subject referential semantics, music is rich in meaning. This meaning is
derived from pragmatic
of empirical investigation. procedures which also enrich natural language, derived from pragmatic procedures which also enrich natural language,
especially
A perusal in of
their poetic
extant usages.
studies Pragmaticsimultaneous
investigating procedures areprocessing
based on of music especially in their poetic usages. Pragmatic procedures are based on
repetition, on variation of repetition,
and speech points up the many factors that influence response and on deletion of expected
to the pairing repetition, on variation of repetition, and on deletion of expected
repetitions. It is the processes such as these which
of these two forms of communication. These include the participant’s have been shown to level of repetitions. It is the processes such as these which have been shown to
be functions of the fronto-limbic formation of the
musical training, the type of verbal and musical stimuli, and the experimentalforebrain generally be functions of the fronto-limbic formation of the forebrain generally
thought toitself
methodology be involved
(Coffman, in generation
Gfeller,and & control
Eckert,of1995;feelings (p. 31).Asmus, &
Gfeller, thought to be involved in generation and control of feelings (p. 31).
52
52 as Communication
49
53
Roederer (1982) suggests that elicitation of limbic function by the abstract CulturalRoederer
Conventions
(1982) suggests that elicitation of limbic function by the abstract
sounds of music contributes to our emotional response to music. More recent sounds of music contributes to our emotional response to music. More recent
Just as verbal interaction becomes conventionalized so that people may
neuroanatomical studies of persons suffering strokes indicate that lesions of the neuroanatomical studies of persons suffering strokes indicate that lesions of the
communicate more effectively, so also does musical communication of mood
right temporoparietal region are associated with impaired perception of emotion right temporoparietal region are associated with impaired perception of emotion
and sentiments become conventionalized through standardized musical devices
in music. It is interesting to note that depending on the location of the lesion in music. It is interesting to note that depending on the location of the lesion
(Meyer, 1956). In Western music, for example, certain scales, harmonies, or
some individuals may have impaired ability to recognize previously familiar some individuals may have impaired ability to recognize previously familiar
timbres symbolize particular states of being (Hevner, 1937; Merriam, 1964;
music, yet they may retain an emotional reaction to music (Gottselig, 2000). music, yet they may retain an emotional reaction to music (Gottselig, 2000).
Peretz et al., 1998). Merriam cites television or film scores as the obvious example
This finding supports a neurological explanation for why, throughout history, This finding supports a neurological explanation for why, throughout history,
of how music evokes desired emotions through certain musical clichés. These
people have used music to intensify emotional content of other forms of people have used music to intensify emotional content of other forms of
connotations shared by a group of individuals within a culture are powerful
communication. The music brings to the textual or visual information additional communication. The music brings to the textual or visual information additional
factors in communicating symbolic meaning. Within the therapeutic process, the
meaning of a feelingful nature. meaning of a feelingful nature.
music therapist can take advantage of this factor, facilitating group cohesiveness
Several empirical studies have investigated what results when visual Several empirical studies have investigated what results when visual
or relative unity of response by presenting particular selections or a musical style
and verbal communication is embedded in a musical setting. McFarland and verbal communication is embedded in a musical setting. McFarland
that generally connotes a shared meaning (Plach, 1980). Some of these cultural
(1984) found that participant interpretations of ambiguous TAT pictures (1984) found that participant interpretations of ambiguous TAT pictures
conventions result in part from what Berlyne (1974) calls iconicity.
were significantly different in emotional content, depending on whether the were significantly different in emotional content, depending on whether the
listener heard tension-producing or calming music or no music. He found that listener heard tension-producing or calming music or no music. He found that
participants who listened to tension-producing music interpreted the picture Iconicity
participants who listened to tension-producing music interpreted the picture
with emotional reports of anxiety and frustration. In contrast, music categorized with emotional reports of anxiety and frustration. In contrast, music categorized
Iconicity implies similarity between auditory characteristics and some
as calming tended to reduce negative effects expressed in response to the picture. as calming tended to reduce negative effects expressed in response to the picture.
referential event, feeling, or idea. This is similar to the Gestalt idea of physiognom-
Thus it would appear that music can either intensify or reduce affective response Thus it would appear that music can either intensify or reduce affective response
ics, or what some refer to as isomorphism, in which physical properties of the
to visual information, depending on the matching of emotional content of the to visual information, depending on the matching of emotional content of the
art object possess patterns similar to physical features (especially facial features)
music and visual stimulus. music and visual stimulus.
associated with particular emotions (Gottselig, 2000). Other examples of iconic
A study by Parrott (1982) describes the effect of music on emotional A study by Parrott (1982) describes the effect of music on emotional
meaning might be the use of auditory patterns that mimic a particular quality of
response to paintings as essentially additive, depending upon the “goodness/ response to paintings as essentially additive, depending upon the “goodness/
sound in nature (e.g., sound of wind or birds) (Krumhansl, 1992; Meyer, 1956;
badness” of the match between the music and the painting. Parrott found badness” of the match between the music and the painting. Parrott found
Roederer, 1982). For example, iconicity can facilitate motor activities in young
that emotional judgments of the music were influenced more strongly by the that emotional judgments of the music were influenced more strongly by the
children. The therapist may select music with specific characteristics such as
painting (particularly those paintings of a complex nature) than the music painting (particularly those paintings of a complex nature) than the music
slow, plodding music to represent the movement of elephants, or melodically and
influenced judgments of the paintings. Therefore the interaction of two forms influenced judgments of the paintings. Therefore the interaction of two forms
rhythmically disjunct music to encourage hopping movements.
of communication may vary, depending on factors such as complexity and of communication may vary, depending on factors such as complexity and
No matter how symbolic meaning is derived, it gives music communica-
type of information. type of information.
tive potential within the therapeutic context. According to Kreitler and
A similar relationship between music and visual and verbal information A similar relationship between music and visual and verbal information
Kreitler (1972),
was found by Wintle (1978) in his study of the emotional impact of music was found by Wintle (1978) in his study of the emotional impact of music
on television commercials. Wintle found that supporting background music on television commercials. Wintle found that supporting background music
confrontation with symbolic expression may give rise to insights that
routinely intensified the qualities (i.e., level of activity, pleasantness, or potency) routinely intensified the qualities (i.e., level of activity, pleasantness, or potency)
enable the individual to transcend the suffering, embarrassment, and
positively characterized by a commercial, while “counteracting” background music positively characterized by a commercial, while “counteracting” background music
dangers of specific situations… [symbols] deal with problems of uni-
diminished in intensity that quality the commercial positively characterized. diminished in intensity that quality the commercial positively characterized.
versal human significance, ranging from life and love to suffering and
One common pairing of music and visual information is film soundtracks, One common pairing
the fear of death (pp. of music and visual information is film soundtracks,
323–324).
which typically accompany film, video, and television productions. According which typically accompany film, video, and television productions. According
to Cohen (1990), research regarding music and film falls into four primary to Cohen (1990),
The extent of research regarding
association, music
cultural and film and
convention, fallsiconic
into four primary
properties
categories of inquiry: (1) an associationist approach to musical meaning, (2) the categories of inquiry: (1) an associationist approach to musical meaning,
within music can, to greater or lesser extent, affect specific connotations from (2) the
structure of musical and visual materials, (3) the impact of music on memory and structure of musical and visual materials, (3) the impact of music on memory
auditory stimuli. Despite these guiding factors, music still remains nonspecific and
awareness for the film, and (4) aesthetic properties of the music and film. awareness for the film, and (4) aesthetic properties of the music and film.
Music
56 as Communication
53
57
A basic
Benson, tenetCited
W. (1979). of associationism
in Language and ismusic
that as one idea commonly
communication: paired with
A discussion. Music A basic tenet of associationism is that one idea commonly paired with
another can Educators Journal, 65,evoke
independently 68–71.the other in its absence (as described earlier another can independently evoke the other in its absence (as described earlier
inBerlyne, D. E. (1971).
this chapter Aesthetics and
as association psychobiology.
through New York:
contiguity). For Appleton-Century-Crofts.
example, the famous in this chapter as association through contiguity). For example, the famous
Berlyne, D. E. (1974). Studies in the new
theme of “dum da dum dum” from the television police drama experimental aesthetics. NewDragnet
York: Wiley.
can be theme of “dum da dum dum” from the television police drama Dragnet can be
Bernstein, L. (1976). The unanswered question:
used apart from that television show to signify impending suspense Six talks at Harvard. Cambridge,
or doom.MA: used apart from that television show to signify impending suspense or doom.
Harvard University Press.
Particular styles of music, as well as specific themes can also evoke particular Particular styles of music, as well as specific themes can also evoke particular
Biller,
ideas or O. A. (1973).
feelings. ForCommunication
example, the ofuse emotions
of highlythrough instrumental
dissonant musicmusic and the
is often ideas or feelings. For example, the use of highly dissonant music is often
music selection preferences of patients and nonpatients
associated with frightening scenes in horror films. In a study examining the experiencing various emotional associated with frightening scenes in horror films. In a study examining the
effects ofmoods.
musicUnpublished
on response doctoral
to a film,dissertation,
Thayer and University of Arkansas.
Levenson (1983) paired either effects of music on response to a film, Thayer and Levenson (1983) paired either
Boltz, M., Schulkind, M., & Kantra, S. (1991). Effects of background music on the
“horror” music or more neutral “documentary” music with a stressful film. “horror” music or more neutral “documentary” music with a stressful film.
remembering of filmed events. Memory & Cognition, 19 (6), 593–606.
Both the physiological measures (autonomic responses) and the psychological Both the physiological measures (autonomic responses) and the psychological
Borchgrevink, H. M. (1982). Prosody and musical rhythm are controlled by the speech
measureshemisphere.
(self-report) indicated that the contrasting musical styles were
In M. Clynes, (Ed.), Music, mind, and brain (pp. 151–158). New
measures (self-report) indicated that the contrasting musical styles were
successfulYork:bothPlenum
in increasing
Press. reported distress (horror music) and in decreasing successful both in increasing reported distress (horror music) and in decreasing
reported distress (documentary
Bright, R. (1981). Practical planning music).
in music Intherapy
addition, the
for the authors
aged. hypothesized
Lynbrook, NY: Music- reported distress (documentary music). In addition, the authors hypothesized
that the graphics.
intensification resulting from the “horror” music was more than that the intensification resulting from the “horror” music was more than
conditioned response
Butler, D. (1992). The to “stereotypic”
musician’s guide to music.
perception They proposedNew
and cognition. thatYork:
the Schirmer
music conditioned response to “stereotypic” music. They proposed that the music
also provided the
Books, 171–194.participants with an effective auditory cue that helped them also provided the participants with an effective auditory cue that helped them
anticipate the period of threat within the film.
Campbell, W., & Heller, J. (1981). Psychomusicology & psycholinguistics: Parallel paths anticipate the period of threat within the film.
Other studies
or separate have
ways. examined the2 structural
Psychomusicology, (2), 3–14. relations both within the Other studies have examined the structural relations both within the
elements
Cantor, J. ofR.,
the& same
Zillman,medium andThe
D. (1973). between
effect of patterns
affectiveofstateelements of the arousal
and emotional two elements of the same medium and between patterns of elements of the two
media (Cohen,
on music1990). For example,
appreciation. Journal ofin cartoon
General animation,
Psychology, 89 (1),it97–108.
is common to media (Cohen, 1990). For example, in cartoon animation, it is common to
mimic particular
Cassity, M. & Cassity,visualJ. dynamic elements psychiatric
(1996). Multimodal (e.g., jumping, hopping,
music therapy skipping,
for adults, adoles- mimic particular visual dynamic elements (e.g., jumping, hopping, skipping,
cents,music—or
falling) with and childrenthe (3rd ed.).
film St. Louis:
footage of anMMB open,Music.
quiet open meadow might falling) with music—or the film footage of an open, quiet open meadow might
beChang,
paired H. withW.,structurally
& Trehub, S.simple,
E. (1977). Auditory
“open” processing
sounding music.of relational information by be paired with structurally simple, “open” sounding music.
How young doesinfants.
music Journal of Experimental
influence recall forChild film Psychology, 24, 324–331.
events? According to Cohen How does music influence recall for film events? According to Cohen
Coffman,
(1990), D., Gfeller,
information is K.,
better& Eckert,
retained M.if(1995). Effects of
it is encoded textual
with setting,associations
elaborate training, and (1990), information is better retained if it is encoded with elaborate associations
and if it isgender
encoded on emotional response to verbal
vividly or concretely. Soundtracksand musical information.
that provide Psychomusicol-
relevant context and if it is encoded vividly or concretely. Soundtracks that provide relevant context
ogy, 14, 117–136.
evidently produce associations that facilitate encoding. For example, Boltz et al. evidently produce associations that facilitate encoding. For example, Boltz et al.
Cohen, A. J. (1990). Understanding musical soundtracks. Empirical Studies of the Arts,
(1991) found that music considered congruous with the affective content of the (1991) found that music considered congruous with the affective content of the
8 (2), 111–124.
film is helpful in recall. In contrast, music that foreshadows an event will enhance film is helpful in recall. In contrast, music that foreshadows an event will enhance
Day, R. (1979). Language and music as communication: A discussion. Music Educators
recall more effectively if there is incongruity between the affective content of the
Journal, 65, 68–71.
music and the actual event, thus resulting in expectancy violations.
Demany, L. (1982). Auditory stream segregation in infancy. Infant Behavior and Develop-
Studies focusing
ment, 5, 261–276. on the aesthetic properties of the film reflect that research Studies focusing on the aesthetic properties of the film reflect that research
subspecialty known
Demany, L., & Armand., as experimental
F. (1984). The aesthetics.
perceptualAccording
reality oftotone
many studies
chroma in
in early subspecialty known as experimental aesthetics. According to many studies in
that tradition,
infancy. people areoflikely
Journal to find aesthetic
the Acoustical Society of events
America, such
76,as music or film most
57–66. that tradition, people are likely to find aesthetic events such as music or film most
pleasant
Deutsch, when the structural
D. (1979). Languageproperties
and music are at an optimal level
as communication: of complexity
A discussion. and
Music Educa- pleasant when the structural properties are at an optimal level of complexity and
familiarity.tors This
Journal,issue
65, is68–71.
covered much more extensively in Chapter 5, which familiarity. This issue is covered much more extensively in Chapter 5, which
focuses
Elam, onR. W.the(1971).
function of aesthetic
Mechanism stimuli
of music as an in the therapeutic
emotional process.
intensification stimulus. Unpub- focuses on the function of aesthetic stimuli in the therapeutic process.
Alteration or augmentation
lished doctoral dissertation,ofUniversity
emotional of arousal is not the only psychologi-
Cincinnati. Alteration or augmentation of emotional arousal is not the only psychologi-
calFisher,
effectS.,of&music. Galizio
Greenberg, and
R. P. Hendrick
(1972). Selective (1972)
effectsagree
uponthatwomenmusical embedding
of exciting and calm cal effect of music. Galizio and Hendrick (1972) agree that musical embedding
of a verbal message
music. can increase
Perceptual and Motoremotional
Skills, 34, arousal.
987–990.However, the authors also of a verbal message can increase emotional arousal. However, the authors also
found that instrumental accompaniment to the textual information resulted in found that instrumental accompaniment to the textual information resulted in
55
significantly greater persuasion or acceptance of the message. It is interesting mentally

significantly
disturbedgreaterandpersuasion
those without or acceptance
mental disorders.
of the message.
However,It theis interesting
authors
to note that a sung version of the text did not have the same impact as the point
to note
out that whilea sungthe version
identifiable
of the trends
text did by not
diagnostic
have thecategory
same impact
tend toasbethe
instrumental accompaniment. weak,
instrumental
contrasting accompaniment.
characteristic responses are presumed to be more apparent
These studies indicate that, in some instances, music can alter or among participants
These studies of differing
indicatediagnostic
that, in some categories
instances,
than when music patients
can alterwithor
intensify the psychological and behavioral response to verbal and visual forms psychiatric
intensify the disorders
psychological
are compared
and behavioral
with normal response participants.
to verbal and Thesevisual
studies
forms
of communication. Either textual or visual media is commonly used in such give
of little
communication.
reason to assume Either that
textual
musicorcommunicates
visual media highly is commonly
unusualusedor deviant
in such
therapeutic activities as lyric analysis, song writing, or combined media activities. emotional
therapeutic content
activities
for the
as lyric
person
analysis,
with mental
song writing,
illness.orMusic
combinedappears
mediato act
activities.
as a
Therefore this intensification has important implications for music therapy viable
Therefore
form ofthis communication,
intensificationeven hasforimportant
persons with implications
psychologicalfor music
disorders.
therapy
if the therapeutic intent includes focusing on, or increasing awareness of, if the therapeutic intent includes focusing on, or increasing awareness of,
affective material. affective material.
Summary
These studies represent music as a form of communication (1) capable of These studies represent music as a form of communication (1) capable of
transmitting emotional messages; (2) able to influence or reflect the mood of Music, while
transmitting nondiscursive,
emotional messages;does(2)indeed
able totransmit
influence information,
or reflect the including
mood of
an individual; and (3) usable as a vehicle for intensification, amplification, or emotional messages.
an individual; andThrough
(3) usable association
as a vehicle by contiguity, cultural convention,
for intensification, amplification, andor
alteration of meaning of imbedded textual or visual information. As a result, structural
alterationproperties
of meaning (i.e.,oficonicity),
imbeddedit functions
textual orasvisual a symbol capable ofAsevoking
information. a result,
music makes an effective tool for evoking or reflecting emotional response, feelings. Music’san
music makes nonreferential
effective toolnature renders or
for evoking it capable
reflecting of manifold
emotionalmeaning
response,
identifying or heightening emotional awareness, and expressing or reflecting and flexibility.orAs
identifying a nondiscursive
heightening language,
emotional musicand
awareness, transcends
expressingintellectual,
or reflecting
themes relevant to group processes. rational
themesthought
relevantand to communicates
group processes. readily through high levels of redundancy. It
communicates human needs and values when words no longer suffice.
Because music can reflect, influence, and alter emotional response, it
Musical Communication in the Psychiatric Setting Musical Communication in the Psychiatric Setting
has particular merit as a therapeutic tool in those treatment processes that
Can a music therapist assume that music will convey similar messages include identification,
Can a music therapist awareness, assumereflection,
that music or expression
will conveyofsimilar
feelings and
messages
to psychiatric patients who suffer from disordered thought and affects as relevant issues. The
to psychiatric ease with
patients who which
suffer music can be usedthought
from disordered in conjunction
and affects with as
it does to those nondisabled persons who make up the bulk of those in the textual
it does or to
visual
thoseinformation
nondisabled further
personscontributes
who make to its
upvalue as a highly
the bulk of those flexible
in the
previously described studies? While the literature describing emotional effects therapeutic
previouslymedium.
described studies? While the literature describing emotional effects
of music in psychopathological states shows varied and occasionally conflicting Naturally,
of music the effectivenessstates
in psychopathological of this therapeutic
shows varied and tooloccasionally
is dependentconflicting
on the
results (Nielzen & Cesarec, 1982c), there are two primary viewpoints: (1) the skill of the
results music &
(Nielzen therapist.
Cesarec,Within1982c), thethere context
are two of primary
music therapy processes
viewpoints: (1) the
experience of music is comparable to that of normal participants; however, (2) such as song writing, improvisation, or lyric analysis,
experience of music is comparable to that of normal participants; however, (2) the therapist must
the musical experience is affected by the psychopathological state. utilize this unique
the musical communicative
experience is affectedformby the inpsychopathological
a manner consistentstate. with identified
Studies by Biller (1973) and Giacobbe (1973) support the view that music therapeutic goalsbyand
Studies be sensitive
Biller (1973) and to Giacobbe
the cultural and support
(1973) individual thecharacteristics
view that music
conveys emotional meaning with some uniformity to both psychiatric patients of conveys
the client.emotional meaning with some uniformity to both psychiatric patients
and normal participants. In addition, Biller noted a significant relationship and normal participants. In addition, Biller noted a significant relationship
between preferred music and the stated emotional mood for both groups. This between preferred music and the stated emotional mood for both groups. This
References
finding is reminiscent of the iso-principle (Altschuler, 1948), well known in finding is reminiscent of the iso-principle (Altschuler, 1948), well known in
music therapy literature. Abeles,
musicH.therapy
F. (1980). Responses to music. In D. Hodges (Ed.), Handbook of music psychol-
literature.
In examining the effects of pathological processes, Steinberg and Raith ogyIn(pp. 105–140).the
examining Lawrence,
effects KS: National Association
of pathological processes,for Steinberg
Music Therapy.
and Raith
(1985) hypothesized that psychomotor differences resulting from depressive Aiello, R. (1994). Music and language: Parallels and contrasts.
(1985) hypothesized that psychomotor differences resulting from depressive In R. Aiello (Ed.), Musical
disorders may be identified through perception of musical tempo as measured perceptions. New York: Oxford University Press, 40–63.
disorders may be identified through perception of musical tempo as measured
through a motor task. The authors concluded that tempo perception (called Altshuler,
throughI. aM.motor(1948). A psychiatrist’s
task. The authors experiences
concluded with music
that as a therapeutic
tempo perception agent.
(called
In D. Schullian and M. Schoen (Eds.), Music and medicine (pp. 266–281). New
intraindividual tempo) was stable not only in healthy people, but also in the intraindividual tempo) was stable not only in healthy people, but also in the
York: Henry Schuman.
greater majority of persons with mental disorders. greater majority of persons with mental disorders.
Altshuler, I. M. (1956). Music potentiating drugs. In E. T. Gaston (Ed.), Music therapy
In contrast, studies by Nielzen and Cesarec (1982a, 1982c) indicate In contrast, studies by Nielzen and Cesarec (1982a, 1982c) indicate
1955 (pp. 120–126). Lawrence, KS: National Association for Music Therapy.
some difference in emotional experience of music between individuals who are some difference in emotional experience of music between individuals who are
Music
mentally
significantly
disturbedgreaterandpersuasion
those without or acceptance
mental disorders.
of the message.
However,It theis interesting
authors mentally disturbed and those without mental disorders. However, the authors
point
to note
out that whilea sungthe version
identifiable
of the trends
text did by not
diagnostic
have thecategory
same impact
tend toasbethe point out that while the identifiable trends by diagnostic category tend to be
weak,
instrumental
contrasting accompaniment.
characteristic responses are presumed to be more apparent weak, contrasting characteristic responses are presumed to be more apparent
among participants
These studies of differing
indicatediagnostic
that, in some categories
instances,
than when music patients
can alterwithor among participants of differing diagnostic categories than when patients with
psychiatric
intensify the disorders
psychological
are compared
and behavioral
with normal response participants.
to verbal and Thesevisual
studies
forms psychiatric disorders are compared with normal participants. These studies
give
of little
communication.
reason to assume Either that
textual
musicorcommunicates
visual media highly is commonly
unusualusedor deviant
in such give little reason to assume that music communicates highly unusual or deviant
emotional
therapeutic content
activities
for the
as lyric
person
analysis,
with mental
song writing,
illness.orMusic
combinedappears
mediato act
activities.
as a emotional content for the person with mental illness. Music appears to act as a
viable
Therefore
form ofthis communication,
intensificationeven hasforimportant
persons with implications
psychologicalfor music
disorders.
therapy viable form of communication, even for persons with psychological disorders.
if the therapeutic intent includes focusing on, or increasing awareness of,
affective material.
Summary Summary
These studies represent music as a form of communication (1) capable of
Music, while
transmitting nondiscursive,
emotional messages;does(2)indeed
able totransmit
influence information,
or reflect the including
mood of Music, while nondiscursive, does indeed transmit information, including
emotional messages.
an individual; andThrough
(3) usable association
as a vehicle by contiguity, cultural convention,
for intensification, amplification, andor emotional messages. Through association by contiguity, cultural convention, and
structural
alterationproperties
of meaning (i.e.,oficonicity),
imbeddedit functions
textual orasvisual a symbol capable ofAsevoking
information. a result, structural properties (i.e., iconicity), it functions as a symbol capable of evoking
feelings. Music’san
music makes nonreferential
effective toolnature renders or
for evoking it capable
reflecting of manifold
emotionalmeaning
response, feelings. Music’s nonreferential nature renders it capable of manifold meaning
and flexibility.orAs
identifying a nondiscursive
heightening language,
emotional musicand
awareness, transcends
expressingintellectual,
or reflecting and flexibility. As a nondiscursive language, music transcends intellectual,
rational
themesthought
relevantand to communicates
group processes. readily through high levels of redundancy. It rational thought and communicates readily through high levels of redundancy. It
communicates human needs and values when words no longer suffice. communicates human needs and values when words no longer suffice.
Because music can reflect, influence, and alter emotional response, it Because music can reflect, influence, and alter emotional response, it
Musical Communication in the Psychiatric Setting
has particular merit as a therapeutic tool in those treatment processes that has particular merit as a therapeutic tool in those treatment processes that
include identification,
Can a music therapist awareness, assumereflection,
that music or expression
will conveyofsimilar
feelings and
messages include identification, awareness, reflection, or expression of feelings and
relevant issues. The
to psychiatric ease with
patients who which
suffer music can be usedthought
from disordered in conjunction
and affects with as relevant issues. The ease with which music can be used in conjunction with
textual
it does or to
visual
thoseinformation
nondisabled further
personscontributes
who make to its
upvalue as a highly
the bulk of those flexible
in the textual or visual information further contributes to its value as a highly flexible
therapeutic
previouslymedium.
described studies? While the literature describing emotional effects therapeutic medium.
Naturally,
of music the effectivenessstates
in psychopathological of this therapeutic
shows varied and tooloccasionally
is dependentconflicting
on the Naturally, the effectiveness of this therapeutic tool is dependent on the
skill of the
results music &
(Nielzen therapist.
Cesarec,Within1982c), thethere context
are two of primary
music therapy processes
viewpoints: (1) the skill of the music therapist. Within the context of music therapy processes
such as song writing, improvisation, or lyric analysis,
experience of music is comparable to that of normal participants; however, (2) the therapist must such as song writing, improvisation, or lyric analysis, the therapist must
utilize this unique
the musical communicative
experience is affectedformby the inpsychopathological
a manner consistentstate. with identified utilize this unique communicative form in a manner consistent with identified
therapeutic goalsbyand
Studies be sensitive
Biller (1973) and to Giacobbe
the cultural and support
(1973) individual thecharacteristics
view that music therapeutic goals and be sensitive to the cultural and individual characteristics
of conveys
the client.emotional meaning with some uniformity to both psychiatric patients of the client.
and normal participants. In addition, Biller noted a significant relationship
between preferred music and the stated emotional mood for both groups. This
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57
61
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Historical and Sociocultural

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S S
cholars from many disciplines, including anthropology, psychology, cholars From
disorders: fromscience
manytodisciplines, including
clinical practice. San Diego, anthropology,
CA: Singular psychology,
Publishing
musicology, and physiology, have long questioned why music, which has 25–61. and physiology, have long questioned why music, which has
musicology,
Group,
no apparent survival value, should have remained in our behavioral reper- Gottselig,noJ. apparent
M. (2000). survival
Humanvalue, should have
neuroanatomical remained
systems in ouremotion
for perceiving behavioral reper-
in music.
toire for thousands of years (Hodges, 1980; Winner, 1982). Music’s presence in toireUnpublished
for thousands of years
doctoral (Hodges,The
dissertation, 1980; Winner,
University of 1982). Music’s
Iowa, Iowa City,presence
IA. in
every culture known to man suggests strongly that it grows out of some funda- every culture
Greenberg, R. P.,known to S.
& Fisher, man suggests
(1966). Somestrongly thateffects
differential it grows out ofonsome
of music funda-
projective
mental neurological process (Berlyne, 1971; Hodges, 1980; Merriam, 1964; andneurological
mental structured psychological tests. Psychological
process (Berlyne, Reports, 28,
1971; Hodges, 817–820.
1980; Merriam, 1964;
Nettl, 1956b; Sloboda, 1985). Neurophysiological perspectives alone, however, Nettl, 1956b; Sloboda, 1985). Neurophysiological perspectives alone,
Haack, P. (1980). The behavior of music listeners. In D. Hodges (Ed.), however,
Handbook of
do not fully explain the ubiquity of music in our lives; we are not simply passive music psychology (pp. 148–150). Lawrence, KS: National Association
do not fully explain the ubiquity of music in our lives; we are not simply passive for Music
respondents to auditory signals. As humans, we are “symbolizing, culture bear- Therapy.to auditory signals. As humans, we are “symbolizing, culture bear-
respondents
ing, historical creatures who act in a frame of past and future, who can make Hevner, K. (1937).creatures
ing, historical The affective
whovalue
act inof apitch
frameandoftempo in music.
past and American
future, who can Journal
make
sense or nonsense to themselves” (Smith, 1978, p. 33). Even our perceptual and of Psychology, 49, 621–630.
sense or nonsense to themselves” (Smith, 1978, p. 33). Even our perceptual and
cognitive processes are influenced by culturally laden beliefs and expectations Jellison, J. (1975).
cognitive The effect
processes of music on by
are influenced autonomic
culturallystress responses
laden beliefsand verbal
and reports.
expectations
In C. K. Madsen, R. Greer, and C. H. Madsen (Eds.), Research in music behavior:
(Kreitler & Kreitler, 1972; Meyer, 1956b). Therefore, historical and sociocul- (Kreitler & Kreitler, 1972; Meyer, 1956b). Therefore, historical and sociocul-
Modifying music behavior in the classroom (pp. 206–219). New York: Teachers
tural perspectives help explain why music is an effective therapeutic agent. This turalCollege
perspectives
Press. help explain why music is an effective therapeutic agent. This
chapter will focus on therapeutic uses of music throughout history and music’s chapter
Jusczyk, will&focus
P. W., on therapeutic
Krumhansl, usesPitch
C. L. (1993). of music throughout
and rhythmic patternshistory andinfants’
affecting music’s
functions within present-day cultures, which have implications for therapeutic functions within present-day cultures, which have implications
sensitivity to musical phrase structure. Journal of Experimental Psychology: Humanfor therapeutic
uses of music in modern health care. uses Perception
of music in andmodern health19care.
Performance, (3), 627–640.
Kamien, R. (1984). Music: An appreciation (3rd ed.). New York: McGraw-Hill Book
Company, 142–156.
Music as a Therapeutic Agent: An Historical Perspective Music as a Therapeutic Agent: An Historical Perspective
Konecni, V. J. (1982). Social interaction and musical preference. In D. Deutsch (Ed.),
The belief that music can be a therapeutic agent is not a modern concept. The The belief that
psychology music
of music (pp.can be a therapeutic
497–516). New York:agent is notPress.
Academic a modern concept.
From records of early civilizations, we know that music has been attributed with From records
Kreitler, of early S.
H., & Kreitler, civilizations, we know
(1972). Psychology thatarts.
of the music has been
Durham, NC:attributed
Duke Uni-with
power over physical and mental well-being. For example, in ancient Egypt, priest versity Press.
power over physical and mental well-being. For example, in ancient Egypt, priest
physicians referred to music as “the physics of the soul” and included chant Krumhansl,
physiciansC.referred
L. (1992).toInternal
musicrepresentations
as “the physics for music
of theperception
soul” and andincluded
performance.
chant
therapies as part of medical practice (Feder & Feder, 1981). We also find biblical In M. R. Jones & S. Holleran (Eds.), Cognitive bases of musical
therapies as part of medical practice (Feder & Feder, 1981). We also find biblical communication
references to music’s soothing properties, and treatises regarding its influence (197–212).
references Washington,
to music’s DC:properties,
soothing American Psychological
and treatisesAssociation.
regarding its influence
on health and morality in ancient China (Tame, 1984). on health and morality in ancient China (Tame, 1984).
60 60
64 as a Therapeutic Agent
Music Psychomusical Foundations of Music Therapy
65
61 Music as a Therapeutic Agent 65
61
Music
nature. Musicwascanconsidered a special
evoke feelings forceasover
as well offerthought,
alternativeemotion, and physical
expression for clients Music was considered a special force over thought, emotion, and physical
health in ancient
who have difficultyGreece.
in verbalIn 600 expression
B.C . Thales
(Plach,was 1980).
believed to have cured a health in ancient Greece. In 600 B.C. Thales was believed to have cured a
plague inAsSpartawe consider
throughmusic’s musical affective
powersnature,
(Merriam, it is 1964).
important Healing
to realize
shrines
that plague in Sparta through musical powers (Merriam, 1964). Healing shrines
andthetemples
particular included
differentiation
hymn specialists,
of emotional and content
even then within
musicmusicwas prescribed
is a cultural and temples included hymn specialists, and even then music was prescribed
forphenomenon
the emotionally that isdisturbed
learned. In (Feder
addition,
& Feder,
emotional1981). response
This use varies
of from
musicculture
for for the emotionally disturbed (Feder & Feder, 1981). This use of music for
curing
to culture.
mental Therefore,
disordersitreflects
is critical theforbelief
the therapist
that music to use
couldmusical
directly
materials
produce that curing mental disorders reflects the belief that music could directly produce
emotion
will be and
culturally
form character.
meaningful Among(Meyer, the1956a,
notables 1956b).
of Greece who subscribed to emotion and form character. Among the notables of Greece who subscribed to
music’s power were Aristotle, who valued it as an emotional catharsis; Plato, music’s power were Aristotle, who valued it as an emotional catharsis; Plato,
who described music as the medicine of the soul; and Caelius Aurelianus, who who described music as the medicine of the soul; and Caelius Aurelianus, who
Music within Social Institutions
warned against indiscriminate use of music to fight madness (Feder & Feder, warned against indiscriminate use of music to fight madness (Feder & Feder,
1981; Strunk,
Music’s 1965).
social nature is apparent when we consider that music is 1981; Strunk, 1965).
While many of the ideals or beliefs of classical Greece were lost or While many of the ideals or beliefs of classical Greece were lost or
changed used during boththeasMiddle
a summatoryAges, markinterestof inmany
the activities
power ofand musicas anwasintegral
sustained changed during the Middle Ages, interest in the power of music was sustained
part ofstatesmen,
by influential many others which couldand
philosophers, notreligious
be properly executed,
leaders (e.g.,or executed who
Boethius) by influential statesmen, philosophers, and religious leaders (e.g., Boethius) who
claimed thatat all,music
without
either music.…
improved There is probably
or degraded thenomorals
other ofhuman cultural that
men. During claimed that music either improved or degraded the morals of men. During that
time period,activity
therewhich
wasisasoclose all-pervasive
tie between and the
which reaches into,
perceived powershapes,
of musicand and time period, there was a close tie between the perceived power of music and
religious often controls
and moral so much
ideas. of humanlike
Cassiodorus, behavior (Merriam,
Aristotle, 1964,music
considered p. 218).a potent religious and moral ideas. Cassiodorus, like Aristotle, considered music a potent
form of catharsis, and St. Basil believed that it could be a positive vehicle for form of catharsis, and St. Basil believed that it could be a positive vehicle for
Music takes
sacred emotion (Strunk,us from cradle
1965). Thetouse
grave—from
of music as oura first lullabyagent
cathartic to theappears
requiem sacred emotion (Strunk, 1965). The use of music as a cathartic agent appears
Mass. It fills our life with enjoyment and social
once again in the medical writings of the Renaissance. Music was described structure, expresses our deepest
as once again in the medical writings of the Renaissance. Music was described as
emotions, and contributes to our cultural stability
the sovereign remedy for melancholy, despair, and madness, which gave ease to (Merriam, 1964). Within the sovereign remedy for melancholy, despair, and madness, which gave ease to
complex
pain stratified cultures,
and a multitude of ills (Feder music can act1981).
& Feder, as a “social marker” or symbol of pain and a multitude of ills (Feder & Feder, 1981).
group affiliation. Listener preference
This ancient belief that music has cathartic value for particular stylesemerges
such asoncecountry
again music,
in This ancient belief that music has cathartic value emerges once again in
rock, jazz,
medical or opera
writings from is often associatedcentury,
the twentieth with different
this timeclasses,
withinlifestyles, and ethnic
the context of medical writings from the twentieth century, this time within the context of
groups (Abeles,
psychoanalytic 1980;
theory. Haack,
While Freud 1980; Radocy
himself & Boyle,
did not address1979;
music’sRussell, 1998).
therapeutic psychoanalytic theory. While Freud himself did not address music’s therapeutic
Music
value, has discussed
it was fostered group by his identification
psychoanalyticand cohesion
disciples. and provided
According to Noya (1967),
unifying value, it was discussed by his psychoanalytic disciples. According to Noy (1967),
uses of music within psychoanalytic therapy included (1) music as a means ofor
focal point for many social phenomena such as rebellious youth protests uses of music within psychoanalytic therapy included (1) music as a means of
national holidays
sublimation (Hargreaves
for channeling & North,
instinctual 1999;
drives in Russell,
a socially 1998).
acceptable manner; sublimation for channeling instinctual drives in a socially acceptable manner;
Social cohesiveness is an important
(2) music as a vehicle for increased insight into the unconscious; therapeutic issueand for(3)many
music music
as (2) music as a vehicle for increased insight into the unconscious; and (3) music as
therapy clients. For example, isolation has
a resource for strengthening the ego structure through mastery. been described as more debilitating to a resource for strengthening the ego structure through mastery.
olderThese
adultshistorical
than physical deterioration (Bright, 1991). Unsatisfactory
references to music as a therapeutic agent are based or inap- These historical references to music as a therapeutic agent are based
propriateinsocial
primarily relationships
philosophical are prominent
or spiritual beliefswithin
in the mostpoweremotional
of music.disturbances
Over the primarily in philosophical or spiritual beliefs in the power of music. Over the
(Paul,
span 1982).
of the Learning
twentieth to socialize
century, in anmethod
the scientific appropriate
became manner is a major
the driving force goal
in span of the twentieth century, the scientific method became the driving force in
for persons
modern medical with mental
care. Not retardation
surprisingly,(Carter, 1982). uses
contemporary It follows, therefore,
of music in health that modern medical care. Not surprisingly, contemporary uses of music in health
improved social interaction is a primary concern
care tend to emphasize experimentally tested biomedical principles. However, in many treatment programs. care tend to emphasize experimentally tested biomedical principles. However,
weEven
can within
still seepsychoanalysis,
vestiges of historical where convention
the intimateand interaction of psychiatrist
philosophical or spiritual and we can still see vestiges of historical convention and philosophical or spiritual
individual patient is paramount, ability to relate on a group
belief regarding music in our daily lives. Thus, historical inquiry helps us better level within the treat- belief regarding music in our daily lives. Thus, historical inquiry helps us better
ment milieu
understand thehas been emphasized
present-day prominence (Boenheim,
of music 1968; Kohut, 1956).
in religious and culturally understand the present-day prominence of music in religious and culturally
significant rituals through which we establish personalsocial
In addition to rhythmic structures that promote behaviors,
meaning and music
a sensehas significant rituals through which we establish personal meaning and a sense
of other characteristics that lend themselves to social opportunities. First, and most
community. of community.
important, music is readily recognized as a social art. The individual comes to the
60
62 as a Therapeutic Agent Psychomusical Foundations of Music Therapy
63
Music as a Therapeutic Agent: A Sociocultural Perspective Music

differs as a from
greatly Therapeutic Agent: A
that of preliterate Sociocultural
healing Perspective
rituals. Primitive cultures attribute
music’s power to supernatural forces, whereas the contemporary music therapist
In addition to documents and artifacts that illustrate past therapeutic uses In addition to documents and artifacts that illustrate past therapeutic uses
attributes change to the direct effect of music and its symbolic value on belief,
of music, we can better understand present-day uses of music through ethno- of music, we can better understand present-day uses of music through ethno-
attitude, and behavior conditioned by the individual’s past experiences and
graphic inquiry. According to Nettl (1956a, 1956b), a knowledge of primitive graphic inquiry. According to Nettl (1956a, 1956b), a knowledge of primitive
physiological responses (Nettl, 1956a). Over the past few decades, there has
musical style in contemporary preliterate societies is helpful not only in under- musical style in contemporary preliterate societies is helpful not only in under-
been increasing awareness of the impact that positive attitude and spiritual or
standing human response to music, it also provides insight into music as therapy standing human response to music, it also provides insight into music as therapy
community support have with regard to immune functioning and coping with
in prehistoric times. Of particular interest to the music therapy profession is (1) in prehistoric times. Of particular interest to the music therapy profession is (1)
illness (e.g., pain management). Thus, music as a source of personal or spiritual
the common attribution to music of supernatural powers, with consequent use the common attribution to music of supernatural powers, with consequent use
comfort and connection with a larger community has important implications in
in religious and healing rituals; (2) music as an expression of emotions; and (3) in religious and healing rituals; (2) music as an expression of emotions; and (3)
modern health care. According to Meyer (1956a), “just as belief in the significant
music as a part of social institutions. music as a part of social institutions.
and affective power of aesthetic experiences performs an important function in
activating the psychophysiological disposition to respond, so it would seem that
Music and Supernatural Powers Music and
a patient’s Supernatural
belief in the efficacy Powers
and power of music to heal may be a significant
element in the success of music therapy” (p. 33).
According to Nettl (1956a), members of many preliterate cultures believe According to Nettl (1956a), members of many preliterate cultures believe
For example, in using music as a strategy for pain control, Melzack (1973)
in the power of music to affect human behavior. Often, this belief is related in the power of music to affect human behavior. Often, this belief is related
found that the patient’s beliefs about music’s effectiveness significantly affected
to music’s relationship to the supernatural. For example, among such tribes to music’s relationship to the supernatural. For example, among such tribes
tolerance for pain. In summary, our cultural tradition of music as a healing
as the Basongye or some American Indian tribes, the songs used in important as the Basongye or some American Indian tribes, the songs used in important
power contributes to music’s effectiveness as a therapeutic agent.
rituals are believed to come from superhuman or unearthly sources (Merriam, rituals are believed to come from superhuman or unearthly sources (Merriam,
1964; Sachs, 1965). These songs, thought to hold preternatural energies, are 1964; Sachs, 1965). These songs, thought to hold preternatural energies, are
Music as an Expression of Emotion
used for entreating the gods and controlling power for all activities requiring used for entreating the gods and controlling power for all activities requiring
extraordinary assistance, such as religious or curing rites. The studyassistance,
extraordinary of primitive such and preliterate
as religious cultures
or curing rites.reveals music as an
According to Berlyne (1971), music has been an essential accessory to important emotionaltooutlet
According Berlyne (Merriam, 1964).has
(1971), music Forbeen
example, within accessory
an essential preliterate to
religious practice throughout the world. The importance of its use is highlighted tribes such practice
religious as the Tshui,
throughoutthe Maori, and The
the world. the Futana,
importance music is used
of its use is to express
highlighted
by the careful enforcement of ritualistic accuracy. For example, Sachs (1965) emotion. However,
by the careful the ethnomusicological
enforcement literatureFor
of ritualistic accuracy. is not clear on
example, whether
Sachs (1965)
noted that any mistakes in musical performance during a ritual could undermine music
notedcanthat actually produce
any mistakes or arouseperformance
in musical emotions (Merriam, 1964),
during a ritual a belief
could that
undermine
its power and divine acceptance. Such mistakes, therefore, may be punished by contemporary
its power andculture divineholds to be true
acceptance. Such(Hargreaves & North, may
mistakes, therefore, 1999).be punished by
stern measures, even death. In many preliterate cultures, the coupling of magical sternOne featureeven
measures, commondeath. Into many
both primitive
preliterate and industrialized
cultures, the coupling civilization
of magical
powers and music is commonly used in charms against sickness (Sachs, 1965). is powers
the use and of the arts isincommonly
music a “safety value
used function”
in charms (Merriam, 1964).(Sachs,
against sickness Within1965).
an
A medicine man or a shaman uses rattles, drums, and songs as an integral part aesthetic context, music is used to express publicly forbidden
A medicine man or a shaman uses rattles, drums, and songs as an integral part or taboo topics
of the ritual to heal and chase away evil forces. without
of the censure. It would
ritual to heal appearaway
and chase thatevil
content
forces.is subordinate to form: aesthetic
At first glance, these “magico-religious” uses of music may appear distance At (described in detail
first glance, thesein “magico-religious”
Chapter 5) provides uses a unique opportunity
of music may appearfor
unrelated to contemporary medical practice. However, we can see the influence expression.
unrelatedFor example, in Western
to contemporary medicalculture,
practice.many sexually
However, we explicit,
can see the forbidden,
influence
of these cultural traditions within contemporary music therapy. In modern orofpolitically sensitive
these cultural topics arewithin
traditions openlycontemporary
expressed within musicthe therapy.
format ofInpopular
modern
society, music is still integrally related to spiritual values and practice (Gaston, music (Russell,
society, music is1998). Such opportunity
still integrally for honest
related to spiritual andand
values even emotionally
practice (Gaston,
1968). In addition to the prominent role of music in religious services of many sensitive
1968). communication
In addition to the hasprominent
importantrole connotations
of music infor individual
religious and of
services group
many
denominations, music can express moral values and acceptable behavior (Kreitler psychotherapy
denominations, (Plach,
music 1980).
can express moral values and acceptable behavior (Kreitler
& Kreitler, 1972). The close relationship between music and religion may have We have
& Kreitler, also been
1972). The acculturated to view
close relationship the arts
between as anand
music appropriate vehicle
religion may have
particular therapeutic value in settings such as hospice care, where the client may forparticular
emotionaltherapeutic
expressionvalue or response (Kreitler
in settings such as&hospice
Kreitler, 1972).
care, whereAccording
the client may
to
use music as a vehicle for expressing or reaffirming religious belief in preparation Israel Zwerling
use music as a(1979),
vehicle the creative artsortherapies,
for expressing reaffirming through nonverbal
religious belief inmedia, tap
preparation
for death (Gilbert, 1977; Munro, 1984). emotional
for deathprocesses
(Gilbert, more1977; directly
Munro, and1984). immediately than do more traditional
While music still has similar uses in contemporary religious practices verbal therapies.
While music Therefore, musical
still has similarcontext
uses inmay allow a normally
contemporary “reserved”
religious practices
as it had in the past, the rationale for using music in modern music therapy orasrepressed
it had inindividual
the past, to theexplore or express
rationale for using feelings
musicofina modern
sensitivemusic
or personal
therapy
Music
Music
differs as a from
greatly Therapeutic Agent: A
that of preliterate Sociocultural
healing Perspective
rituals. Primitive cultures attribute differs greatly from that of preliterate healing rituals. Primitive cultures attribute
music’s power to supernatural forces, whereas the contemporary music therapist music’s power to supernatural forces, whereas the contemporary music therapist
In addition to documents and artifacts that illustrate past therapeutic uses
attributes change to the direct effect of music and its symbolic value on belief, attributes change to the direct effect of music and its symbolic value on belief,
of music, we can better understand present-day uses of music through ethno-
attitude, and behavior conditioned by the individual’s past experiences and attitude, and behavior conditioned by the individual’s past experiences and
graphic inquiry. According to Nettl (1956a, 1956b), a knowledge of primitive
physiological responses (Nettl, 1956a). Over the past few decades, there has physiological responses (Nettl, 1956a). Over the past few decades, there has
musical style in contemporary preliterate societies is helpful not only in under-
been increasing awareness of the impact that positive attitude and spiritual or been increasing awareness of the impact that positive attitude and spiritual or
standing human response to music, it also provides insight into music as therapy
community support have with regard to immune functioning and coping with community support have with regard to immune functioning and coping with
in prehistoric times. Of particular interest to the music therapy profession is (1)
illness (e.g., pain management). Thus, music as a source of personal or spiritual illness (e.g., pain management). Thus, music as a source of personal or spiritual
the common attribution to music of supernatural powers, with consequent use
comfort and connection with a larger community has important implications in comfort and connection with a larger community has important implications in
in religious and healing rituals; (2) music as an expression of emotions; and (3)
modern health care. According to Meyer (1956a), “just as belief in the significant modern health care. According to Meyer (1956a), “just as belief in the significant
music as a part of social institutions.
and affective power of aesthetic experiences performs an important function in and affective power of aesthetic experiences performs an important function in
activating the psychophysiological disposition to respond, so it would seem that activating the psychophysiological disposition to respond, so it would seem that
Music and
a patient’s Supernatural
belief in the efficacy Powers
and power of music to heal may be a significant a patient’s belief in the efficacy and power of music to heal may be a significant
element in the success of music therapy” (p. 33). element in the success of music therapy” (p. 33).
According to Nettl (1956a), members of many preliterate cultures believe
For example, in using music as a strategy for pain control, Melzack (1973) For example, in using music as a strategy for pain control, Melzack (1973)
in the power of music to affect human behavior. Often, this belief is related
found that the patient’s beliefs about music’s effectiveness significantly affected found that the patient’s beliefs about music’s effectiveness significantly affected
to music’s relationship to the supernatural. For example, among such tribes
tolerance for pain. In summary, our cultural tradition of music as a healing tolerance for pain. In summary, our cultural tradition of music as a healing
as the Basongye or some American Indian tribes, the songs used in important
power contributes to music’s effectiveness as a therapeutic agent. power contributes to music’s effectiveness as a therapeutic agent.
rituals are believed to come from superhuman or unearthly sources (Merriam,
1964; Sachs, 1965). These songs, thought to hold preternatural energies, are
Music as an Expression of Emotion Music as an Expression of Emotion
used for entreating the gods and controlling power for all activities requiring
The studyassistance,
extraordinary of primitive such and preliterate
as religious cultures
or curing rites.reveals music as an The study of primitive and preliterate cultures reveals music as an
important emotionaltooutlet
According Berlyne (Merriam, 1964).has
(1971), music Forbeen
example, within accessory
an essential preliterate to important emotional outlet (Merriam, 1964). For example, within preliterate
tribes such practice
religious as the Tshui,
throughoutthe Maori, and The
the world. the Futana,
importance music is used
of its use is to express
highlighted tribes such as the Tshui, the Maori, and the Futana, music is used to express
emotion. However,
by the careful the ethnomusicological
enforcement literatureFor
of ritualistic accuracy. is not clear on
example, whether
Sachs (1965) emotion. However, the ethnomusicological literature is not clear on whether
music
notedcanthat actually produce
any mistakes or arouseperformance
in musical emotions (Merriam, 1964),
during a ritual a belief
could that
undermine music can actually produce or arouse emotions (Merriam, 1964), a belief that
contemporary
its power andculture divineholds to be true
acceptance. Such(Hargreaves & North, may
mistakes, therefore, 1999).be punished by contemporary culture holds to be true (Hargreaves & North, 1999).
sternOne featureeven
measures, commondeath. Into many
both primitive
preliterate and industrialized
cultures, the coupling civilization
of magical One feature common to both primitive and industrialized civilization
is powers
the use and of the arts isincommonly
music a “safety value
used function”
in charms (Merriam, 1964).(Sachs,
against sickness Within1965).
an is the use of the arts in a “safety value function” (Merriam, 1964). Within an
aesthetic context, music is used to express publicly forbidden
A medicine man or a shaman uses rattles, drums, and songs as an integral part or taboo topics aesthetic context, music is used to express publicly forbidden or taboo topics
without
of the censure. It would
ritual to heal appearaway
and chase thatevil
content
forces.is subordinate to form: aesthetic without censure. It would appear that content is subordinate to form: aesthetic
distance At (described in detail
first glance, thesein “magico-religious”
Chapter 5) provides uses a unique opportunity
of music may appearfor distance (described in detail in Chapter 5) provides a unique opportunity for
expression.
unrelatedFor example, in Western
to contemporary medicalculture,
practice.many sexually
However, we explicit,
can see the forbidden,
influence expression. For example, in Western culture, many sexually explicit, forbidden,
orofpolitically sensitive
these cultural topics arewithin
traditions openlycontemporary
expressed within musicthe therapy.
format ofInpopular
modern or politically sensitive topics are openly expressed within the format of popular
music (Russell,
society, music is1998). Such opportunity
still integrally for honest
related to spiritual andand
values even emotionally
practice (Gaston, music (Russell, 1998). Such opportunity for honest and even emotionally
sensitive
1968). communication
In addition to the hasprominent
importantrole connotations
of music infor individual
religious and of
services group
many sensitive communication has important connotations for individual and group
psychotherapy
denominations, (Plach,
music 1980).
can express moral values and acceptable behavior (Kreitler psychotherapy (Plach, 1980).
We have
& Kreitler, also been
1972). The acculturated to view
close relationship the arts
between as anand
music appropriate vehicle
religion may have We have also been acculturated to view the arts as an appropriate vehicle
forparticular
emotionaltherapeutic
expressionvalue or response (Kreitler
in settings such as&hospice
Kreitler, 1972).
care, whereAccording
the client may
to for emotional expression or response (Kreitler & Kreitler, 1972). According to
Israel Zwerling
use music as a(1979),
vehicle the creative artsortherapies,
for expressing reaffirming through nonverbal
religious belief inmedia, tap
preparation Israel Zwerling (1979), the creative arts therapies, through nonverbal media, tap
emotional
for deathprocesses
(Gilbert, more1977; directly
Munro, and1984). immediately than do more traditional emotional processes more directly and immediately than do more traditional
verbal therapies.
While music Therefore, musical
still has similarcontext
uses inmay allow a normally
contemporary “reserved”
religious practices verbal therapies. Therefore, musical context may allow a normally “reserved”
orasrepressed
it had inindividual
the past, to theexplore or express
rationale for using feelings
musicofina modern
sensitivemusic
or personal
therapy or repressed individual to explore or express feelings of a sensitive or personal
64 Psychomusical Foundations of Music Therapy 64 as a Therapeutic Agent
Music Psychomusical Foundations of Music Therapy
65
61
nature. Music can evoke feelings as well as offer alternative expression for clients Music
nature. Musicwascanconsidered a special
evoke feelings forceasover
as well offerthought,
alternativeemotion, and physical
expression for clients
who have difficulty in verbal expression (Plach, 1980). health in ancient
who have difficultyGreece.
in verbalIn 600 expression
B.C . Thales
(Plach,was 1980).
believed to have cured a
As we consider music’s affective nature, it is important to realize that plague inAsSpartawe consider
throughmusic’s musical affective
powersnature,
(Merriam, it is 1964).
important Healing
to realize
shrines
that
the particular differentiation of emotional content within music is a cultural andthetemples
particular included
differentiation
hymn specialists,
of emotional and content
even then within
musicmusicwas prescribed
is a cultural
phenomenon that is learned. In addition, emotional response varies from culture forphenomenon
the emotionally that isdisturbed
learned. In (Feder
addition,
& Feder,
emotional1981). response
This use varies
of from
musicculture
for
to culture. Therefore, it is critical for the therapist to use musical materials that curing
to culture.
mental Therefore,
disordersitreflects
is critical theforbelief
the therapist
that music to use
couldmusical
directly
materials
produce that
will be culturally meaningful (Meyer, 1956a, 1956b). emotion
will be and
culturally
form character.
meaningful Among(Meyer, the1956a,
notables 1956b).
of Greece who subscribed to
music’s power were Aristotle, who valued it as an emotional catharsis; Plato,
who described music as the medicine of the soul; and Caelius Aurelianus, who
Music within Social Institutions Music within Social Institutions
warned against indiscriminate use of music to fight madness (Feder & Feder,
Music’s social nature is apparent when we consider that music is 1981; Strunk,
Music’s 1965).
social nature is apparent when we consider that music is
While many of the ideals or beliefs of classical Greece were lost or
used both as a summatory mark of many activities and as an integral changed used during boththeasMiddle
a summatoryAges, markinterestof inmany
the activities
power ofand musicas anwasintegral
sustained
part of many others which could not be properly executed, or executed part ofstatesmen,
by influential many others which couldand
philosophers, notreligious
be properly executed,
leaders (e.g.,or executed who
Boethius)
at all, without music.… There is probably no other human cultural claimed thatat all,music
without
either music.…
improved There is probably
or degraded thenomorals
other ofhuman cultural that
men. During
activity which is so all-pervasive and which reaches into, shapes, and time period,activity
therewhich
wasisasoclose all-pervasive
tie between and the
which reaches into,
perceived powershapes,
of musicand and
often controls so much of human behavior (Merriam, 1964, p. 218). religious often controls
and moral so much
ideas. of humanlike
Cassiodorus, behavior (Merriam,
Aristotle, 1964,music
considered p. 218).a potent
form of catharsis, and St. Basil believed that it could be a positive vehicle for
Music takes us from cradle to grave—from our first lullaby to the requiem Music takes
sacred emotion (Strunk,us from cradle
1965). Thetouse
grave—from
of music as oura first lullabyagent
cathartic to theappears
requiem
Mass. It fills our life with enjoyment and social structure, expresses our deepest Mass. It fills our life with enjoyment and social
once again in the medical writings of the Renaissance. Music was described structure, expresses our deepest
as
emotions, and contributes to our cultural stability (Merriam, 1964). Within emotions, and contributes to our cultural stability
the sovereign remedy for melancholy, despair, and madness, which gave ease to (Merriam, 1964). Within
complex stratified cultures, music can act as a “social marker” or symbol of complex
pain stratified cultures,
and a multitude of ills (Feder music can act1981).
& Feder, as a “social marker” or symbol of
group affiliation. Listener preference for particular styles such as country music, group affiliation. Listener preference
This ancient belief that music has cathartic value for particular stylesemerges
such asoncecountry
again music,
in
rock, jazz, or opera is often associated with different classes, lifestyles, and ethnic rock, jazz,
medical or opera
writings from is often associatedcentury,
the twentieth with different
this timeclasses,
withinlifestyles, and ethnic
the context of
groups (Abeles, 1980; Haack, 1980; Radocy & Boyle, 1979; Russell, 1998). groups (Abeles,
psychoanalytic 1980;
theory. Haack,
While Freud 1980; Radocy
himself & Boyle,
did not address1979;
music’sRussell, 1998).
therapeutic
Music has fostered group identification and cohesion and provided a unifying Music
value, has discussed
it was fostered group by his identification
psychoanalyticand cohesion
disciples. and provided
According to Noya (1967),
unifying
focal point for many social phenomena such as rebellious youth protests or uses of music within psychoanalytic therapy included (1) music as a means ofor
focal point for many social phenomena such as rebellious youth protests
national holidays (Hargreaves & North, 1999; Russell, 1998). national holidays
sublimation (Hargreaves
for channeling & North,
instinctual 1999;
drives in Russell,
a socially 1998).
acceptable manner;
Social cohesiveness is an important therapeutic issue for many music Social cohesiveness is an important
(2) music as a vehicle for increased insight into the unconscious; therapeutic issueand for(3)many
music music
as
therapy clients. For example, isolation has been described as more debilitating to therapy clients. For example, isolation has
a resource for strengthening the ego structure through mastery. been described as more debilitating to
older adults than physical deterioration (Bright, 1991). Unsatisfactory or inap- olderThese
adultshistorical
than physical deterioration (Bright, 1991). Unsatisfactory
references to music as a therapeutic agent are based or inap-
propriate social relationships are prominent within most emotional disturbances propriateinsocial
primarily relationships
philosophical are prominent
or spiritual beliefswithin
in the mostpoweremotional
of music.disturbances
Over the
(Paul, 1982). Learning to socialize in an appropriate manner is a major goal (Paul,
span 1982).
of the Learning
twentieth to socialize
century, in anmethod
the scientific appropriate
became manner is a major
the driving force goal
in
for persons with mental retardation (Carter, 1982). It follows, therefore, that for persons
modern medical with mental
care. Not retardation
surprisingly,(Carter, 1982). uses
contemporary It follows, therefore,
of music in health that
improved social interaction is a primary concern in many treatment programs. improved social interaction is a primary concern
care tend to emphasize experimentally tested biomedical principles. However, in many treatment programs.
Even within psychoanalysis, where the intimate interaction of psychiatrist and weEven
can within
still seepsychoanalysis,
vestiges of historical where convention
the intimateand interaction of psychiatrist
philosophical or spiritual and
individual patient is paramount, ability to relate on a group level within the treat- individual patient is paramount, ability to relate on a group
belief regarding music in our daily lives. Thus, historical inquiry helps us better level within the treat-
ment milieu has been emphasized (Boenheim, 1968; Kohut, 1956). ment milieu
understand thehas been emphasized
present-day prominence (Boenheim,
of music 1968; Kohut, 1956).
in religious and culturally
In addition to rhythmic structures that promote social behaviors, music has significant rituals through which we establish personalsocial
In addition to rhythmic structures that promote behaviors,
meaning and music
a sensehas
other characteristics that lend themselves to social opportunities. First, and most of other characteristics that lend themselves to social opportunities. First, and most
community.
important, music is readily recognized as a social art. The individual comes to the important, music is readily recognized as a social art. The individual comes to the
60 60
Music
64Function
The as a Therapeutic Agent
of Aesthetic Stimuli in thePsychomusical Foundations of Music Therapy
Therapeutic Process 65
69 Music
The as a Therapeutic
Function Agent
of Aesthetic Stimuli in the Therapeutic Process 65
69
music experience with a “preparatory set” (see Chapter 5) that he is engaged in music experience with a “preparatory set” (see Chapter 5) that he is engaged in
Chapter
a social event (Berlyne, 1971; 5 Kreitler & Kreitler, 1972; Meyer, 1956b). Second, a social event (Berlyne, 1971; Kreitler & Kreitler, 1972; Meyer, 1956b). Second,
music offers a unique and alternative form of communication to speech. Thus music offers a unique and alternative form of communication to speech. Thus
The Function of
music gives individuals with poor verbal skills an alternative for interaction.
Third, music is not a “monolithic” skill, but rather a collection of subskills (Slo-
Aesthetic Stimuli in the

boda, 1985). The individual can participate with a wide range of abilities, from boda, 1985). The individual can participate with a wide range of abilities, from
listening to adept performance. listening to adept performance.
For the individual with no musical skills, involvement is possible through For the individual with no musical skills, involvement is possible through
Therapeutic Process
listening activities in which the listener is encouraged to respond. Because
of music’s infinite variety of style and form, most musical tastes generally
can be accommodated to make the experience more meaningful. Even within can be accommodated to make the experience more meaningful. Even within
Kate E. Gfeller
musical performance, the skilled music therapist can modify musical materials musical performance, the skilled music therapist can modify musical materials
to accommodate the individual level of experience and cognitive development. to accommodate the individual level of experience and cognitive development.
This flexibility in form gives music tremendous potential for integrating a widely This flexibility in form gives music tremendous potential for integrating a widely
varied group of individuals in a common endeavor. varied group of individuals in a common endeavor.
M
Early writings
usic has about
been music
describedin hospitals describedofsocial
as the language activities
emotion, centered of
a generator Early writings about music in hospitals described social activities centered
around musicsocial as a diversion
fellowship, oraentertainment (Van desatisfaction,
source of intellectual Wall, 1936). anWithin
expressionthe of around music as a diversion or entertainment (Van de Wall, 1936). Within the
chronic-care joy, model of the past, this was an appropriate use for
and an activity that takes us out of the humdrum and into the music. In today’s chronic-care model of the past, this was an appropriate use for music. In today’s
world
realm of of
short-term
the ideal treatment
(Seashore,and community
1941). This beliefhealth centers,
in the music
inherent as diversion
value of music is world of short-term treatment and community health centers, music as diversion
hasevident
a limited role. therapy
in music Rather, literature
it providesthat a flexible
advocatesresource
aestheticfor experiences
integrating for persons
people has a limited role. Rather, it provides a flexible resource for integrating persons
with
withdisabilities
disabilities into the fabric
as a source of social existence.
of gratification, According
self-actualization, and to Zwerling
normalization with disabilities into the fabric of social existence. According to Zwerling
(1979),
(Gaston,one1968;
of theLathom,
primary1981).
offerings of thetocreative
According Nordoffarts,
andincluding music, “the
Robbins (1983), is (1979), one of the primary offerings of the creative arts, including music, is
theright
ability to involve
music, patients
perceptively in intrinsically
used, social- and reality-based
can lift the handicapped child out of the activities
confines the ability to involve patients in intrinsically social- and reality-based activities
that require
of his interaction
pathology and optimal
and place him on afunctioning. Music offers
plane of experience an opportunity
and response, where he that require interaction and optimal functioning. Music offers an opportunity
to isput into practice
considerably freethose insights that
of intellectual have been
or emotional discussed at(p.an239).
dysfunction” intellectual to put into practice those insights that have been discussed at an intellectual
level in traditional
These words verbal
havetherapy.
considerable face validity for those who love music and level in traditional verbal therapy.
In group
for music therapy,
therapists who music
havestimulates verbalization
observed firsthand and socialization
the satisfaction as
that clients In group therapy, music stimulates verbalization and socialization as
it derive
provides a common
through theme or
participation focal point
in musical for discussion
experiences. However, andthose
personal work
less familiar it provides a common theme or focal point for discussion and personal work
(Plach, 1980).therapy,
with music As an aesthetic
includingform, manymusicotherimparts meaning
health-care on a variety
professionals andofthe (Plach, 1980). As an aesthetic form, music imparts meaning on a variety of
levels (Kreitler
general public,&may Kreitler,
find the1972). Forthese
truth of example,
words inlessconjunction
self-evident. with lyrics,
Just what is it levels (Kreitler & Kreitler, 1972). For example, in conjunction with lyrics,
music
aboutcan communicate
music, some mightdenotative information
ask, that makes whiletherapeutic
it a suitable acting simultaneously
tool? music can communicate denotative information while acting simultaneously
on a connotative level. As
Other chapters symbolic
in this expression,
book address music can
this question by relate ideasmental
describing that areand on a connotative level. As symbolic expression, music can relate ideas that are
meaningful to an entire
physical responses to theculture;
acousticyetproperties
as nondiscursive
of music information, it allows to
(e.g., motor response meaningful to an entire culture; yet as nondiscursive information, it allows
individual
rhythmicinvolvement
patterns). This andchapter
interpretation.
will focus Because music relates
on the aesthetic meaningful
properties of musical individual involvement and interpretation. Because music relates meaningful
andartaffective
forms and information on both individual
how those properties and to
can contribute group levels, it provides
the therapeutic process.an and affective information on both individual and group levels, it provides an
excellent vehicle for group therapy. excellent vehicle for group therapy.
In summary, satisfactory human relationships are of major concern in In summary, satisfactory human relationships are of major concern in
Theoretical Perspectives on the Aesthetic Experience
contemporary health care. Music, through its infinite variety and adaptability, contemporary health care. Music, through its infinite variety and adaptability,
as well asDuring
its potent
the historical
second half andofcultural tradition,
the twentieth is a powerful
century, scholarshiptherapeutic
regarding as well as its potent historical and cultural tradition, is a powerful therapeutic
resource for emotional
aesthetics expanded expression
beyond more andtraditional
reality-based socialization.
aesthetic philosophy or psycho- resource for emotional expression and reality-based socialization.
analytical interpretations. New theories or paradigms emerged that broaden
and deepen our present understanding of aesthetic response with relation
68
67
Paul, D. W. (1982). Music therapy for emotionally disturbed children. In W. B. Latham
and C. T. Eagle (Eds.), Music therapy for handicapped children (Vol. 2, pp. 1–59).
Abeles, H. (1980). Responses to music. In D. A. Hodges (Ed.), Handbook of music psychol- Abeles,
St.H. (1980).
Louis: MMB Responses
Music.to music. In D. A. Hodges (Ed.), Handbook of music psychol-
ogy (pp. 105–140). Lawrence, KS: National Association for Music Therapy. ogy (pp. 105–140). Lawrence, KS: National Association for Music Therapy.
Plach, T. (1980). The creative use of music in group therapy. Springfield, IL: Charles C.
Berlyne, D. E. (1971). Aesthetics and psychobiology. New York: Appleton-Century-Crofts. Berlyne, D. E. (1971). Aesthetics and psychobiology. New York: Appleton-Century-Crofts.
Thomas.
Boenheim, C. (1968). The position of music and art in contemporary psychotherapy. Boenheim,
Radocy, R. E., C.&(1968).
Boyle,The
J. D.position
(1979).ofPsychological
music and art in contemporary
foundations psychotherapy.
of musical behavior.
Journal of Music Therapy, 5 (3), 85–87. Journal of Music Therapy, 5
Springfield, IL: Charles C. Thomas. (3), 85–87.
Bright, R. (1991). Music in geriatric care: A second look. Wahroonga, NSW, Australia: Bright,P.R.
Russell, A.(1991).
(1998).Music
Musicalin geriatric
tastes andcare: A second
society. In D.look. Wahroonga,
J. Hargreaves andNSW,
A. C.Australia:
North
Music Therapy Enterprises. Music Therapy Enterprises.
(Eds.), The social psychology of music (pp. 141–158). New York: Oxford Univer-
Carter, S. A. (1982). Music therapy for mentally retarded children. In W. B. Latham and Carter,
sityS.Press.
A. (1982). Music therapy for mentally retarded children. In W. B. Latham and
C. T. Eagle (Eds.), Music therapy for handicapped children (Vol. 2, pp. 61–114). C. T. Eagle
Sachs, C. (1965). The (Eds.), Music
wellsprings therapy(J.for
of music handicapped
Kunst, Ed.). New children
York:(Vol. 2, pp. 61–114).
McGraw-Hill.
St. Louis: MMB Music. St. Louis: MMB Music.
Sloboda, J. A. (1985). The musical mind: The cognitive psychology of music. Oxford:
Feder, E., & Feder, B. (1981). The expressive arts therapies. Englewood Cliffs, NJ: Feder, E., & Feder,
Clarendon Press.B. (1981). The expressive arts therapies. Englewood Cliffs, NJ:
Prentice-Hall. Prentice-Hall.
Smith, B. (1978). Humanism and behaviorism in psychology: Theory and practice.
Gaston, E. T. (Ed.). (1968). Music in therapy. New York: Macmillan. Gaston, E. T.of(Ed.).
Journal (1968).Psychology,
Humanistic Music in therapy. New York: Macmillan.
18, 27–36.
Gilbert, J. P. (1977). Music therapy perspectives on death and dying. Journal of Music Gilbert, J. P. (1977). Music therapy perspectives
Strunk, D. (1965). Source readings in music history. New on death
York:and dying.
W. W. Journal of Music
Norton.
Therapy, 14 (4), 165–171. Therapy, 14 (4), 165–171.
Tame, D. (1984). The secret power of music. New York: Destiny Books.
Haack, P. (1980). The behavior of music listeners. In D. A. Hodges (Ed.), Handbook of Haack, P. (1980). The behavior of music listeners. In D. A. Hodges (Ed.), Handbook of
Van de Wall, W. (1936). Music in initiations. New York: Russell Sage Foundation.
music psychology (pp. 141–182). Lawrence, KS: National Association for Music music psychology (pp. 141–182). Lawrence, KS: National Association for Music
Winner, E. (1982). Invented worlds. Cambridge, MA: Harvard University Press.
Therapy. Therapy.
Zwerling, I. (1979). The use of creative arts in therapy. Washington, DC: American
Hargreaves, D. J., & North, A. C. (1999). The functions of music in everyday life: Rede- Hargreaves, D. J., & North, A. C. (1999). The functions of music in everyday life: Rede-
Psychological Association.
fining the social in music psychology. Psychology of Music, 27, 71–83. fining the social in music psychology. Psychology of Music, 27, 71–83.
Hodges, D. A. (Ed.). (1980). Handbook of music psychology. Lawrence, KS: National Hodges, D. A. (Ed.). (1980). Handbook of music psychology. Lawrence, KS: National
Association for Music Therapy. Association for Music Therapy.
Kohut, H. (1956). Some psychological effects of music and their relations to music Kohut, H. (1956). Some psychological effects of music and their relations to music
therapy. In E. T. Gaston (Ed.), Music therapy 1955 (pp. 17–20). Lawrence, KS: therapy. In E. T. Gaston (Ed.), Music therapy 1955 (pp. 17–20). Lawrence, KS:
National Association for Music Therapy. National Association for Music Therapy.
Kreitler, H., & Kreitler, S. (1972). Psychology of the arts. Durham, NC: Duke Uni- Kreitler, H., & Kreitler, S. (1972). Psychology of the arts. Durham, NC: Duke Uni-
versity Press. versity Press.
Melzack, R. (1973). The puzzle of pain. Middlesex, England: Penguin Education. Melzack, R. (1973). The puzzle of pain. Middlesex, England: Penguin Education.
Merriam, A. P. (1964). The anthropology of music. Evanston, IL: Northwestern Univer- Merriam, A. P. (1964). The anthropology of music. Evanston, IL: Northwestern Univer-
sity Press. sity Press.
Meyer, L. B. (1956a). Belief and music therapy. In E. T. Gaston (Ed.), Music therapy 1955 Meyer, L. B. (1956a). Belief and music therapy. In E. T. Gaston (Ed.), Music therapy 1955
(pp. 26–33). Lawrence, KS: National Association for Music Therapy. (pp. 26–33). Lawrence, KS: National Association for Music Therapy.
Meyer, L. B. (1956b). Emotion and meaning in music. Chicago: University of Chicago Meyer, L. B. (1956b). Emotion and meaning in music. Chicago: University of Chicago
Press. Press.
Munro, S. (1984). Music therapy in palliative/hospice care. St. Louis: MMB Music. Munro, S. (1984). Music therapy in palliative/hospice care. St. Louis: MMB Music.
Nettl, B. (1956a). Aspects of primitive and folk music relevant to music therapy. In Nettl, B. (1956a). Aspects of primitive and folk music relevant to music therapy. In
E. T. Gaston (Ed.), Music therapy 1955 (pp. 36–39). Lawrence, KS; National E. T. Gaston (Ed.), Music therapy 1955 (pp. 36–39). Lawrence, KS; National
Association for Music Therapy. Association for Music Therapy.
Nettl, B. (1956b). Music in primitive cultures. Cambridge, MA: Harvard University Press. Nettl, B. (1956b). Music in primitive cultures. Cambridge, MA: Harvard University Press.
Noy, P. (1967). The psychodynamic meaning of music. Part V. Journal of Music Therapy, Noy, P. (1967). The psychodynamic meaning of music. Part V. Journal of Music Therapy,
4, 117–125. 4, 117–125.
Music
References
Paul, D. W. (1982). Music therapy for emotionally disturbed children. In W. B. Latham Paul, D. W. (1982). Music therapy for emotionally disturbed children. In W. B. Latham
and C. T. Eagle (Eds.), Music therapy for handicapped children (Vol. 2, pp. 1–59). and C. T. Eagle (Eds.), Music therapy for handicapped children (Vol. 2, pp. 1–59).
Abeles,
St.H. (1980).
Louis: MMB Responses
Music.to music. In D. A. Hodges (Ed.), Handbook of music psychol- St. Louis: MMB Music.
ogy (pp. 105–140). Lawrence, KS: National Association for Music Therapy.
Plach, T. (1980). The creative use of music in group therapy. Springfield, IL: Charles C. Plach, T. (1980). The creative use of music in group therapy. Springfield, IL: Charles C.
Berlyne, D. E. (1971). Aesthetics and psychobiology. New York: Appleton-Century-Crofts.
Thomas. Thomas.
Boenheim,
Radocy, R. E., C.&(1968).
Boyle,The
J. D.position
(1979).ofPsychological
music and art in contemporary
foundations psychotherapy.
of musical behavior. Radocy, R. E., & Boyle, J. D. (1979). Psychological foundations of musical behavior.
Journal of Music Therapy, 5
Springfield, IL: Charles C. Thomas. (3), 85–87. Springfield, IL: Charles C. Thomas.
Bright,P.R.
Russell, A.(1991).
(1998).Music
Musicalin geriatric
tastes andcare: A second
society. In D.look. Wahroonga,
J. Hargreaves andNSW,
A. C.Australia:
North Russell, P. A. (1998). Musical tastes and society. In D. J. Hargreaves and A. C. North
Music Therapy Enterprises.
(Eds.), The social psychology of music (pp. 141–158). New York: Oxford Univer- (Eds.), The social psychology of music (pp. 141–158). New York: Oxford Univer-
Carter,
sityS.Press.
A. (1982). Music therapy for mentally retarded children. In W. B. Latham and sity Press.
C. T. Eagle
Sachs, C. (1965). The (Eds.), Music
wellsprings therapy(J.for
of music handicapped
Kunst, Ed.). New children
York:(Vol. 2, pp. 61–114).
McGraw-Hill. Sachs, C. (1965). The wellsprings of music (J. Kunst, Ed.). New York: McGraw-Hill.
St. Louis: MMB Music.
Sloboda, J. A. (1985). The musical mind: The cognitive psychology of music. Oxford: Sloboda, J. A. (1985). The musical mind: The cognitive psychology of music. Oxford:
Feder, E., & Feder,
Clarendon Press.B. (1981). The expressive arts therapies. Englewood Cliffs, NJ: Clarendon Press.
Prentice-Hall.
Smith, B. (1978). Humanism and behaviorism in psychology: Theory and practice. Smith, B. (1978). Humanism and behaviorism in psychology: Theory and practice.
Gaston, E. T.of(Ed.).
Journal (1968).Psychology,
Humanistic Music in therapy. New York: Macmillan.
18, 27–36. Journal of Humanistic Psychology, 18, 27–36.
Gilbert, J. P. (1977). Music therapy perspectives
Strunk, D. (1965). Source readings in music history. New on death
York:and dying.
W. W. Journal of Music
Norton. Strunk, D. (1965). Source readings in music history. New York: W. W. Norton.
Therapy, 14 (4), 165–171.
Tame, D. (1984). The secret power of music. New York: Destiny Books. Tame, D. (1984). The secret power of music. New York: Destiny Books.
Haack, P. (1980). The behavior of music listeners. In D. A. Hodges (Ed.), Handbook of
Van de Wall, W. (1936). Music in initiations. New York: Russell Sage Foundation. Van de Wall, W. (1936). Music in initiations. New York: Russell Sage Foundation.
music psychology (pp. 141–182). Lawrence, KS: National Association for Music
Winner, E. (1982). Invented worlds. Cambridge, MA: Harvard University Press. Winner, E. (1982). Invented worlds. Cambridge, MA: Harvard University Press.
Therapy.
Zwerling, I. (1979). The use of creative arts in therapy. Washington, DC: American Zwerling, I. (1979). The use of creative arts in therapy. Washington, DC: American
Hargreaves, D. J., & North, A. C. (1999). The functions of music in everyday life: Rede-
Psychological Association. Psychological Association.
fining the social in music psychology. Psychology of Music, 27, 71–83.
Hodges, D. A. (Ed.). (1980). Handbook of music psychology. Lawrence, KS: National
Kohut, H. (1956). Some psychological effects of music and their relations to music
therapy. In E. T. Gaston (Ed.), Music therapy 1955 (pp. 17–20). Lawrence, KS:
National Association for Music Therapy.
Kreitler, H., & Kreitler, S. (1972). Psychology of the arts. Durham, NC: Duke Uni-
versity Press.
Melzack, R. (1973). The puzzle of pain. Middlesex, England: Penguin Education.
Merriam, A. P. (1964). The anthropology of music. Evanston, IL: Northwestern Univer-
sity Press.
Meyer, L. B. (1956a). Belief and music therapy. In E. T. Gaston (Ed.), Music therapy 1955
(pp. 26–33). Lawrence, KS: National Association for Music Therapy.
Meyer, L. B. (1956b). Emotion and meaning in music. Chicago: University of Chicago
Press.
Munro, S. (1984). Music therapy in palliative/hospice care. St. Louis: MMB Music.
Nettl, B. (1956a). Aspects of primitive and folk music relevant to music therapy. In
E. T. Gaston (Ed.), Music therapy 1955 (pp. 36–39). Lawrence, KS; National
Nettl, B. (1956b). Music in primitive cultures. Cambridge, MA: Harvard University Press.
Noy, P. (1967). The psychodynamic meaning of music. Part V. Journal of Music Therapy,
4, 117–125.
64Function
The as a Therapeutic Agent
of Aesthetic Stimuli in thePsychomusical Foundations of Music Therapy
69
READING 19
music experience with a “preparatory set”M.
(see(Eds.)
Chapter 5) thatMusic
he is engaged in in
Chapter 5 Taken from: Unkefer, R., & Thaut, (2005). Therapy
a social event (Berlyne, 1971; Kreitler & Kreitler, 1972; Meyer, 1956b). Second,
the Treatment of Adults with Mental Disorders: Theoretical Bases and
music offers a unique and alternative form of communication to speech. Thus
The Function of
Clinical Interventions, pp. 68-85. Gilsum NH: Barcelona Publishers.
Aesthetic Stimuli in the

boda, 1985). The individual can participate with a wide range of abilities, from
The Function of Aesthetic Stimuli
listening to adept performance.
For the individual with no musical skills, involvement is possible through
Therapeutic Process in the Therapeutic Process

can be accommodated to make the experience more meaningful. Even within
Kate E. Gfeller musical performance, the skilled music therapist can modify musical materials
Kate E. Gfeller
to accommodate the individual level of experience and cognitive development.
This flexibility in form gives music tremendous potential for integrating a widely
varied group of individuals in a common endeavor.
M M
usic has been described as the language of emotion, a generator of Early writings
usic has about
been music
describedin hospitals describedofsocial
as the language activities
emotion, centered of
a generator
social fellowship, a source of intellectual satisfaction, an expression of around musicsocial as a diversion
fellowship, oraentertainment (Van desatisfaction,
source of intellectual Wall, 1936). anWithin
expressionthe of
joy, and an activity that takes us out of the humdrum and into the chronic-care joy, model of the past, this was an appropriate use for
and an activity that takes us out of the humdrum and into the music. In today’s
realm of the ideal (Seashore, 1941). This belief in the inherent value of music is world
realm of of
short-term
the ideal treatment
(Seashore,and community
1941). This beliefhealth centers,
in the music
inherent as diversion
value of music is
evident in music therapy literature that advocates aesthetic experiences for people hasevident
a limited role. therapy
in music Rather, literature
it providesthat a flexible
advocatesresource
aestheticfor experiences
integrating for persons
people
with disabilities as a source of gratification, self-actualization, and normalization with
withdisabilities
disabilities into the fabric
as a source of social existence.
of gratification, According
self-actualization, and to Zwerling
normalization
(Gaston, 1968; Lathom, 1981). According to Nordoff and Robbins (1983), “the (1979),
(Gaston,one1968;
of theLathom,
primary1981).
offerings of thetocreative
According Nordoffarts,
andincluding music, “the
Robbins (1983), is
right music, perceptively used, can lift the handicapped child out of the confines theright
ability to involve
music, patients
perceptively in intrinsically
used, social- and reality-based
can lift the handicapped child out of the activities
confines
of his pathology and place him on a plane of experience and response, where he that require
of his interaction
pathology and optimal
and place him on afunctioning. Music offers
plane of experience an opportunity
and response, where he
is considerably free of intellectual or emotional dysfunction” (p. 239). to isput into practice
considerably freethose insights that
of intellectual have been
or emotional discussed at(p.an239).
dysfunction” intellectual
These words have considerable face validity for those who love music and level in traditional
These words verbal
havetherapy.
considerable face validity for those who love music and
for music therapists who have observed firsthand the satisfaction that clients In group
for music therapy,
therapists who music
havestimulates verbalization
observed firsthand and socialization
the satisfaction as
that clients
derive through participation in musical experiences. However, those less familiar it derive
provides a common
through theme or
participation focal point
in musical for discussion
experiences. However, andthose
personal work
less familiar
with music therapy, including many other health-care professionals and the (Plach, 1980).therapy,
with music As an aesthetic
includingform, manymusicotherimparts meaning
health-care on a variety
professionals andofthe
general public, may find the truth of these words less self-evident. Just what is it levels (Kreitler
general public,&may Kreitler,
find the1972). Forthese
truth of example,
words inlessconjunction
self-evident. with lyrics,
Just what is it
about music, some might ask, that makes it a suitable therapeutic tool? music
aboutcan communicate
music, some mightdenotative information
ask, that makes whiletherapeutic
it a suitable acting simultaneously
tool?
Other chapters in this book address this question by describing mental and on a connotative level. As
Other chapters symbolic
in this expression,
book address music can
this question by relate ideasmental
describing that areand
physical responses to the acoustic properties of music (e.g., motor response to meaningful to an entire
physical responses to theculture;
acousticyetproperties
as nondiscursive
of music information, it allows to
(e.g., motor response
rhythmic patterns). This chapter will focus on the aesthetic properties of musical individual
rhythmicinvolvement
patterns). This andchapter
interpretation.
will focus Because music relates
on the aesthetic meaningful
properties of musical
art forms and how those properties can contribute to the therapeutic process. andartaffective
forms and information on both individual
how those properties and to
can contribute group levels, it provides
the therapeutic process.an
excellent vehicle for group therapy.
In summary, satisfactory human relationships are of major concern in
Theoretical Perspectives on the Aesthetic Experience Theoretical Perspectives on the Aesthetic Experience
contemporary health care. Music, through its infinite variety and adaptability,
During the second half of the twentieth century, scholarship regarding as well asDuring
its potent
the historical
second half andofcultural tradition,
the twentieth is a powerful
century, scholarshiptherapeutic
regarding
aesthetics expanded beyond more traditional aesthetic philosophy or psycho- resource for emotional
aesthetics expanded expression
beyond more andtraditional
reality-based socialization.
aesthetic philosophy or psycho-
analytical interpretations. New theories or paradigms emerged that broaden analytical interpretations. New theories or paradigms emerged that broaden
and deepen our present understanding of aesthetic response with relation and deepen our present understanding of aesthetic response with relation
68 68
72Function of Aesthetic Stimuli in thePsychomusical
The Foundations of Music Therapy
69 The Function of Aesthetic Stimuli in the Therapeutic Process 73
69
toAesthetic Response
the therapeutic andThe
process. the work
Therapeutic Processhas achieved particular
of five scholars to the therapeutic process. The work of five scholars has achieved particular
prominence and influence: (1) Leonard Meyer, who developed the theory of prominence and influence: (1) Leonard Meyer, who developed the theory of
Music therapists provide services to clients diverse in age (chronological
expectations; (2) Daniel Berlyne, whose experimental aesthetics resulted in the expectations; (2) Daniel Berlyne, whose experimental aesthetics resulted in the
and developmental) as well as in ability across functional domains (e.g.,
theory of optimal complexity and hedonic arousal; (3) Hans and Shulamith theory of optimal complexity and hedonic arousal; (3) Hans and Shulamith
cognitive, motor, communication, social, emotional). Therefore, the functional
Kreitler, who proposed a model of homeostasis relative to aesthetic response; Kreitler, who proposed a model of homeostasis relative to aesthetic response;
areas that are the focus of therapy will differ depending on the age of the
and (4) Albert Bregman, who developed a subspecialty in cognitive psychology and (4) Albert Bregman, who developed a subspecialty in cognitive psychology
individual, the particular disability or illness, and the presenting problems and
known as Auditory Scene Analysis (ASA). This section provides a brief overview known as Auditory Scene Analysis (ASA). This section provides a brief overview
progress at any given point in the therapeutic process.
of their research. of their research.
Attention
Leonard Meyer’s Theory of Expectations Leonard Meyer’s Theory of Expectations
For a number of clients, control over attention can be a key therapeutic
In 1956 the book Emotion and Meaning in Music by theorist Leonard In 1956 the book Emotion and Meaning in Music by theorist Leonard
goal. Sternberg (1996) defines attention as “the cognitive link between the
Meyer was published. Meyer’s work, which was an outgrowth of information Meyer was published. Meyer’s work, which was an outgrowth of information
limited amount of information that is actually manipulated mentally and the
theory, has become a classic resource regarding aesthetic response to music. theory, has become a classic resource regarding aesthetic response to music.
enormous amount of information available through the senses, stored memory,
While comprehension of the subtleties of his theory of expectations requires While comprehension of the subtleties of his theory of expectations requires
and other cognitive processes” (p. 497). Examples of attentional problems among
perusal of his entire book, the primary position is that emotions are aroused perusal of his entire book, the primary position is that emotions are aroused
clients include difficulty coming to or maintaining attention, inability to focus
when a tendency to respond is arrested or inhibited. What does that mean? A when a tendency to respond is arrested or inhibited. What does that mean? A
on salient features, and/or low levels of motivation. These problems may result
piece of music evokes in the listener certain expectations, both those acquired piece of music evokes in the listener certain expectations, both those acquired
from chronological age (e.g., premature and very young infants), developmental
from past listening and those developed on the basis of repeated elements and from past listening and those developed on the basis of repeated elements and
delays (e.g., developmental disabilities), neurological deficits (e.g., traumatic
patterns in the music. Uncertainty occurs when expectancies are inhibited or patterns in the music. Uncertainty occurs when expectancies are inhibited or
brain injury, dementia, cerebral palsy, attention deficit disorder), emotional
when new expectancies are established. For example, listeners familiar with when new expectancies are established. For example, listeners familiar with
and behavioral disorders, or environmental circumstances (e.g., living in an
Western music will expect to hear a tonic note after the leading tone, or a tonic Western music will expect to hear a tonic note after the leading tone, or a tonic
environment of poverty and high risk). The ability to focus and maintain
chord after a dominant chord. If the resolution to the tonic is omitted or delayed, chord after a dominant chord. If the resolution to the tonic is omitted or delayed,
attention forms a foundation for many life functions such as establishing infant-
Meyer would say that our tendency to respond has been inhibited, and thus we Meyer would say that our tendency to respond has been inhibited, and thus we
parent bonding, completing self-help skills, learning academic information,
will have an emotional response such as surprise. will have an emotional response such as surprise.
and vocational and social competence, and is therefore a prerequisite to many
It is the balance of the expected and unexpected within a composition that It is the balance of the expected and unexpected within a composition that
other therapy goals.
helps bring meaning or emotion to music. Thus, when we are first confronted helps bring meaning or emotion to music. Thus, when we are first confronted
Berlyne’s (1971) experimental studies of aesthetics suggest that art can
with a highly novel musical style, we find it more difficult to anticipate what with a highly novel musical style, we find it more difficult to anticipate what
stimulate processes that effectively control attention and reinforcement. This
we will hear next. We can “hear” the musical sounds on an acoustical level, we will hear next. We can “hear” the musical sounds on an acoustical level,
in turn promotes many kinds of learning. Applied clinical research and many
but those sounds may lack meaning (Meyer, 1956). In short, Leonard Meyer’s but those sounds may lack meaning (Meyer, 1956). In short, Leonard Meyer’s
treatment methods illustrate Berlyne’s theoretical position, namely that music
theory of expectations attempts to explain how and why we derive meaning and theory of expectations attempts to explain how and why we derive meaning and
can reinforce attending behaviors in many persons with disabilities (e.g.,
emotions from music, even though it is a nondiscursive form of communica- emotions from music, even though it is a nondiscursive form of communica-
Carter, 1982). Aesthetic stimuli can aid focus through (1) dishabituation, (2)
tion. Leonard Meyer developed his theory through methods of logic and tion. Leonard Meyer developed his theory through methods of logic and
preparatory set, and (3) exploratory behavior.
persuasion, though his theory has subsequently been tested through a number persuasion, though his theory has subsequently been tested through a number
of experimental studies. of experimental studies.
Dishabituation
Daniel Berlyne’s Experimental
Habituation Aesthetics
is the result of either monotonous regularity or possibly Daniel Berlyne’s Experimental Aesthetics
too much contrasting and novel stimuli, both of which can be unpleasant
In 1971 Aesthetics and Psychobiology by psychologist Daniel Berlyne was In 1971 Aesthetics and Psychobiology by psychologist Daniel Berlyne was
and diminish response to sensory signals (Berlyne, 1971). In situations such
published. This book is now a classic resource for what has become known published. This book is now a classic resource for what has become known
as institutionalization or low sensory and intellectual functioning, reaction
as experimental aesthetics, or neo-behavioralism. Berlyne championed the as experimental aesthetics, or neo-behavioralism. Berlyne championed the
to familiar objects becomes automatic and unconscious (Kreitler & Kreitler,
use of experimental methods to examine and understand human response to use of experimental methods to examine and understand human response to
68
70 Psychomusical Foundations of Music Therapy The
Therapeutic Process
Foundations of Music Therapy
71
aesthetic objects or events such as music. He was critical of that branch of This
aesthetic
modelobjects
incorporates
or events Berlyne’s
such as theorymusic. of Hearousal,
was criticaladdressing
of that thebranch
role of
aesthetic philosophy known as speculative aesthetics, which is heavily dependent of aesthetic
optimalphilosophy
level of stimulation
known as speculative
(homeostatic aesthetics,
balance)which in isefficient
heavily dependent
human
on deduction from definitions of concepts, self-evident principles, generally functioning.
on deduction Thefrom balance
definitions
can be ofdisrupted
concepts,byself-evident
either too much principles,
or too generally
little
accepted propositions, and the individual’s beliefs and experiences. Berlyne stimulation.
accepted propositions,
In either caseand mobilization
the individual’srestores beliefs
equilibrium
and experiences.
and consequently,Berlyne
believed that basic psychological principles regarding perception and cognition pleasurable
believed that feelings.
basic psychological
Musical properties principles suchregarding
as rhythm,
perception
consonance
and cognition
and
could be applied to aesthetic experiences (e.g., viewing art or listening to dissonance,
could be and appliedmelodicto aesthetic
Gestalts (goodness
experiencesof (e.g., organization)
viewing can art evoke
or listening
tensionto
music). Therefore, by using experimental methods commonly used in cognitive andmusic).
relief Therefore,
as the listener by using
follows experimental
the unfolding methodsthematiccommonly
material. usedKreitler
in cognitive
and
psychology, we could gain insights into the appreciation and emotional response Kreitler
psychology,
furtherwemaintain
could gain thatinsights
participation
into theinappreciation
aesthetic experiences
and emotionalis motivated
response
to art forms. bytopotential
art forms. tension reduction (Kreitler & Kreitler, 1972).
As a result of numerous experiments in which he measured responses As a result of numerous experiments in which he measured responses
to various types of aesthetic objects, Berlyne developed his theory of optimal to various types of aesthetic objects, Berlyne developed his theory of optimal
Albert Bregman’s Auditory Scene Analysis
complexity, and arousal and hedonic value. In this theory, Berlyne proposed that complexity, and arousal and hedonic value. In this theory, Berlyne proposed that
the structural qualities of music (e.g., how complex or simple, how familiar or the structural qualities of music
In 1990, psychologist Albert (e.g., how complex
Bregman’s or simple,Scene
book Auditory how familiar
Analysis:or
novel) contribute to emotional response. According to this theory, we tend to Thenovel) contribute
Perceptual to emotional
Organization response.
of Sound wasAccording
published toand thisquickly
theory,became
we tenda to
feel pleasurable feelings when an aesthetic object such as music is at an optimal feel pleasurable
classic resource onfeelingshow humans when organize
an aesthetic andobject such as
make sense of music
a streamis at
of an optimal
auditory
level of complexity or familiarity. Music that is too complex or highly unfamiliar level of complexity
information. This book or familiarity. Music that isoftoomany
was the culmination complexyearsorofhighly unfamiliar
experimental
can leave the listener with a sense of confusion, chaos, and discomfort. In can leave
research on the listenerperception.
auditory with a sense of confusion,
Bregman developed chaos, and principles
several discomfort.ofIn
contrast, music that is too simple or that has been heard again and again may contrast,grouping
auditory music that is too simple
(invoking Gestalt or that has been
principles) heard again
according and again
to rules of how may
result in boredom and dissatisfaction. For example, consider the rapid rise and resultoriginate
sounds in boredom in theandenvironment.
dissatisfaction. ForFor example,
example, consider
sounds tend the
to berapid rise and
perceived
subsequent fall in popularity of songs pushed by disc jockeys on the radio. as subsequent
though they fallareinproduced
popularitybyofthe songs
samepushedsourcebyif disc
theyjockeys on thefrom
(1) originate radio.
Research by numerous other scholars continues to support and refine Berlyne’s theResearch by numerous
same location, (2) haveothersimilar
scholars continues
timbre, to support
(3) have similarand refine(4)Berlyne’s
pitch, have
hypothesis (e.g., Hargreaves, 1984; Heyduck, 1975; Gfeller, Asmus, & Eckert, hypothesis
temporal (e.g., Hargreaves,
proximity (occur in rapid 1984; Heyduck,over
progression 1975; Gfeller,
time), and/or Asmus,
(5) have& Eckert,
good
1991; Gfeller & Coffman, 1991). 1991; Gfeller & Coffman,
continuation—stay constant 1991).(e.g., a repeating note) or change smoothly (e.g.,
an ascending or descending scale). Sounds that have different onsets or offsets
(start or stop at different times) are perceived as being produced by different
Kreitler and Kreitler’s Cognitive Theory of Aesthetic Response Kreitler and Kreitler’s Cognitive Theory of Aesthetic Response
sources. Bregman’s principles are related to adaptive listening skills that were
Hans and Shulamith Kreitler’s book The Psychology of the Arts (1972) required Hansfor survival centuries ago.
and Shulamith For example,
Kreitler’s book The thesePsychology
perceptualoforganizational
the Arts (1972)
describes human response to a variety of creative arts, including music. In this principles
describeswouldhuman have helpedtoa acaveman
response variety oforcreative
cavewoman respond appropriately
arts, including music. In this
book, the authors critique prominent perspectives on aesthetic experiences that to book,
important environmental
the authors sounds (e.g.,
critique prominent the soundsonmade
perspectives by anexperiences
aesthetic approaching that
are essentially applications of general psychological theories (e.g., psychoanalytic, saber-toothed
are essentiallytiger).
applications of general psychological theories (e.g., psychoanalytic,
Gestalt psychology, behaviorism, and information theory) and then present their GestaltAlthough
psychology, his research
behaviorism, focuses on auditorytheory)
and information perception in general,
and then as
present their
own model, which they developed expressly to describe the aesthetic experience opposed
own model,to focusing
whichspecifically
they developed on music, one chapter
expressly to describeis dedicated to music
the aesthetic and
experience
of the listener or observer. According to Kreitler and Kreitler, behavior in relation how these
of the sameor
listener principles
observer.can be applied
According to music
to Kreitler andlistening: how we organize
Kreitler, behavior in relation
to an aesthetic object is not simply a result of the perceptual organization of pitch,
to anrhythm,
aesthetic timbre,
objectand intensity
is not simplyinto meaningful
a result patterns. With
of the perceptual regard to of
organization
the stimulus. Behavior is also directed by the knowledge and beliefs about that music, BregmanBehavior
the stimulus. emphasizes thatdirected
is also the listener by isthe
ultimately
knowledge responsible
and beliefsfor about
creating that
object, which are based on judgments and evaluations. By experiencing an theobject,
organization
which of arethe acoustic
based sequence. Inand
on judgments other words, he considers
evaluations. music toan
By experiencing
aesthetic object or event through cognitive orientation, we can view reality with beaesthetic
a “fiction” that or
object originates in the mind
event through cognitive of the beholder. we can view reality with
orientation,
heightened awareness. The art form provides a special view of reality, an “as if” or How doawareness.
heightened these perspectives
The art form on music
providesrelate to the therapeutic
a special view of reality,process?
an “asTheif” or
alternative conceptualization, not a replica. Through this unique, symbolic view, following
alternative section of this chapternot
conceptualization, willa replica.
illustrate application
Through of these symbolic
this unique, perspectives view,
we may perceive new solutions to old problems or realize new problems. to we
fourmaydifferent
perceive functional areas often
new solutions to oldaddressed
problems in or music
realizetherapy: (1) attention,
new problems.
In their book, Kreitler and Kreitler attempt to explain emotional response (2) perception,
In their(3) book,higher cognitive
Kreitler processes,
and Kreitler and (4)
attempt to emotion.
explain emotional response
to aesthetic objects through what they call a homeostatic model of motivation. to aesthetic objects through what they call a homeostatic model of motivation.
The
Therapeutic Process
This
aesthetic
modelobjects
incorporates
or events Berlyne’s
such as theorymusic. of Hearousal,
was criticaladdressing
of that thebranch
role of This model incorporates Berlyne’s theory of arousal, addressing the role
of aesthetic
optimalphilosophy
level of stimulation
known as speculative
(homeostatic aesthetics,
balance)which in isefficient
heavily dependent
human of optimal level of stimulation (homeostatic balance) in efficient human
functioning.
on deduction Thefrom balance
definitions
can be ofdisrupted
concepts,byself-evident
either too much principles,
or too generally
little functioning. The balance can be disrupted by either too much or too little
stimulation.
accepted propositions,
In either caseand mobilization
the individual’srestores beliefs
equilibrium
and experiences.
and consequently,Berlyne stimulation. In either case mobilization restores equilibrium and consequently,
pleasurable
believed that feelings.
basic psychological
Musical properties principles suchregarding
as rhythm,
perception
consonance
and cognition
and pleasurable feelings. Musical properties such as rhythm, consonance and
dissonance,
could be and appliedmelodicto aesthetic
Gestalts (goodness
experiencesof (e.g., organization)
viewing can art evoke
or listening
tensionto dissonance, and melodic Gestalts (goodness of organization) can evoke tension
andmusic).
relief Therefore,
as the listener by using
follows experimental
the unfolding methodsthematiccommonly
material. usedKreitler
in cognitive
and and relief as the listener follows the unfolding thematic material. Kreitler and
Kreitler
psychology,
furtherwemaintain
could gain thatinsights
participation
into theinappreciation
aesthetic experiences
and emotionalis motivated
response Kreitler further maintain that participation in aesthetic experiences is motivated
bytopotential
art forms. tension reduction (Kreitler & Kreitler, 1972). by potential tension reduction (Kreitler & Kreitler, 1972).
As a result of numerous experiments in which he measured responses
to various types of aesthetic objects, Berlyne developed his theory of optimal
Albert Bregman’s Auditory Scene Analysis Albert Bregman’s Auditory Scene Analysis
complexity, and arousal and hedonic value. In this theory, Berlyne proposed that
the structural qualities of music
In 1990, psychologist Albert (e.g., how complex
Bregman’s or simple,Scene
book Auditory how familiar
Analysis:or In 1990, psychologist Albert Bregman’s book Auditory Scene Analysis:
Thenovel) contribute
Perceptual to emotional
Organization response.
of Sound wasAccording
published toand thisquickly
theory,became
we tenda to The Perceptual Organization of Sound was published and quickly became a
feel pleasurable
classic resource onfeelingshow humans when organize
an aesthetic andobject such as
make sense of music
a streamis at
of an optimal
auditory classic resource on how humans organize and make sense of a stream of auditory
level of complexity
information. This book or familiarity. Music that isoftoomany
was the culmination complexyearsorofhighly unfamiliar
experimental information. This book was the culmination of many years of experimental
can leave
research on the listenerperception.
auditory with a sense of confusion,
Bregman developed chaos, and principles
several discomfort.ofIn research on auditory perception. Bregman developed several principles of
contrast,grouping
auditory music that is too simple
(invoking Gestalt or that has been
principles) heard again
according and again
to rules of how may auditory grouping (invoking Gestalt principles) according to rules of how
resultoriginate
sounds in boredom in theandenvironment.
dissatisfaction. ForFor example,
example, consider
sounds tend the
to berapid rise and
perceived sounds originate in the environment. For example, sounds tend to be perceived
as subsequent
though they fallareinproduced
popularitybyofthe songs
samepushedsourcebyif disc
theyjockeys on thefrom
(1) originate radio. as though they are produced by the same source if they (1) originate from
theResearch by numerous
same location, (2) haveothersimilar
scholars continues
timbre, to support
(3) have similarand refine(4)Berlyne’s
pitch, have the same location, (2) have similar timbre, (3) have similar pitch, (4) have
hypothesis
temporal (e.g., Hargreaves,
proximity (occur in rapid 1984; Heyduck,over
progression 1975; Gfeller,
time), and/or Asmus,
(5) have& Eckert,
good temporal proximity (occur in rapid progression over time), and/or (5) have good
1991; Gfeller & Coffman,
continuation—stay constant 1991).(e.g., a repeating note) or change smoothly (e.g., continuation—stay constant (e.g., a repeating note) or change smoothly (e.g.,
an ascending or descending scale). Sounds that have different onsets or offsets an ascending or descending scale). Sounds that have different onsets or offsets
(start or stop at different times) are perceived as being produced by different (start or stop at different times) are perceived as being produced by different
Kreitler and Kreitler’s Cognitive Theory of Aesthetic Response
sources. Bregman’s principles are related to adaptive listening skills that were sources. Bregman’s principles are related to adaptive listening skills that were
required Hansfor survival centuries ago.
and Shulamith For example,
Kreitler’s book The thesePsychology
perceptualoforganizational
the Arts (1972) required for survival centuries ago. For example, these perceptual organizational
principles
describeswouldhuman have helpedtoa acaveman
response variety oforcreative
cavewoman respond appropriately
arts, including music. In this principles would have helped a caveman or cavewoman respond appropriately
to book,
important environmental
the authors sounds (e.g.,
critique prominent the soundsonmade
perspectives by anexperiences
aesthetic approaching that to important environmental sounds (e.g., the sounds made by an approaching
saber-toothed
are essentiallytiger).
applications of general psychological theories (e.g., psychoanalytic, saber-toothed tiger).
GestaltAlthough
psychology, his research
behaviorism, focuses on auditorytheory)
and information perception in general,
and then as
present their Although his research focuses on auditory perception in general, as
opposed
own model,to focusing
whichspecifically
they developed on music, one chapter
expressly to describeis dedicated to music
the aesthetic and
experience opposed to focusing specifically on music, one chapter is dedicated to music and
how these
of the sameor
listener principles
observer.can be applied
According to music
to Kreitler andlistening: how we organize
Kreitler, behavior in relation how these same principles can be applied to music listening: how we organize
pitch,
to anrhythm,
aesthetic timbre,
objectand intensity
is not simplyinto meaningful
a result patterns. With
of the perceptual regard to of
organization pitch, rhythm, timbre, and intensity into meaningful patterns. With regard to
music, BregmanBehavior
the stimulus. emphasizes thatdirected
is also the listener by isthe
ultimately
knowledge responsible
and beliefsfor about
creating that music, Bregman emphasizes that the listener is ultimately responsible for creating
theobject,
organization
which of arethe acoustic
based sequence. Inand
on judgments other words, he considers
evaluations. music toan
By experiencing the organization of the acoustic sequence. In other words, he considers music to
beaesthetic
a “fiction” that or
object originates in the mind
event through cognitive of the beholder. we can view reality with
orientation, be a “fiction” that originates in the mind of the beholder.
How doawareness.
heightened these perspectives
The art form on music
providesrelate to the therapeutic
a special view of reality,process?
an “asTheif” or How do these perspectives on music relate to the therapeutic process? The
following
alternative section of this chapternot
conceptualization, willa replica.
illustrate application
Through of these symbolic
this unique, perspectives view, following section of this chapter will illustrate application of these perspectives
to we
fourmaydifferent
perceive functional areas often
new solutions to oldaddressed
problems in or music
realizetherapy: (1) attention,
new problems. to four different functional areas often addressed in music therapy: (1) attention,
(2) perception,
In their(3) book,higher cognitive
Kreitler processes,
and Kreitler and (4)
attempt to emotion.
explain emotional response (2) perception, (3) higher cognitive processes, and (4) emotion.
to aesthetic objects through what they call a homeostatic model of motivation.
72 Psychomusical Foundations of Music Therapy 72Function of Aesthetic Stimuli in thePsychomusical
The Foundations of Music Therapy
69
Aesthetic Response and the Therapeutic Process toAesthetic Response

the therapeutic andThe
process. the work
Therapeutic Processhas achieved particular
of five scholars
prominence and influence: (1) Leonard Meyer, who developed the theory of
Music therapists provide services to clients diverse in age (chronological Music therapists provide services to clients diverse in age (chronological
expectations; (2) Daniel Berlyne, whose experimental aesthetics resulted in the
and developmental) as well as in ability across functional domains (e.g., and developmental) as well as in ability across functional domains (e.g.,
theory of optimal complexity and hedonic arousal; (3) Hans and Shulamith
cognitive, motor, communication, social, emotional). Therefore, the functional cognitive, motor, communication, social, emotional). Therefore, the functional
Kreitler, who proposed a model of homeostasis relative to aesthetic response;
areas that are the focus of therapy will differ depending on the age of the areas that are the focus of therapy will differ depending on the age of the
and (4) Albert Bregman, who developed a subspecialty in cognitive psychology
individual, the particular disability or illness, and the presenting problems and individual, the particular disability or illness, and the presenting problems and
known as Auditory Scene Analysis (ASA). This section provides a brief overview
progress at any given point in the therapeutic process. progress at any given point in the therapeutic process.
of their research.
Attention Attention
Leonard Meyer’s Theory of Expectations
For a number of clients, control over attention can be a key therapeutic For a number of clients, control over attention can be a key therapeutic
In 1956 the book Emotion and Meaning in Music by theorist Leonard
goal. Sternberg (1996) defines attention as “the cognitive link between the goal. Sternberg (1996) defines attention as “the cognitive link between the
Meyer was published. Meyer’s work, which was an outgrowth of information
limited amount of information that is actually manipulated mentally and the limited amount of information that is actually manipulated mentally and the
theory, has become a classic resource regarding aesthetic response to music.
enormous amount of information available through the senses, stored memory, enormous amount of information available through the senses, stored memory,
While comprehension of the subtleties of his theory of expectations requires
and other cognitive processes” (p. 497). Examples of attentional problems among and other cognitive processes” (p. 497). Examples of attentional problems among
perusal of his entire book, the primary position is that emotions are aroused
clients include difficulty coming to or maintaining attention, inability to focus clients include difficulty coming to or maintaining attention, inability to focus
when a tendency to respond is arrested or inhibited. What does that mean? A
on salient features, and/or low levels of motivation. These problems may result on salient features, and/or low levels of motivation. These problems may result
piece of music evokes in the listener certain expectations, both those acquired
from chronological age (e.g., premature and very young infants), developmental from chronological age (e.g., premature and very young infants), developmental
from past listening and those developed on the basis of repeated elements and
delays (e.g., developmental disabilities), neurological deficits (e.g., traumatic delays (e.g., developmental disabilities), neurological deficits (e.g., traumatic
patterns in the music. Uncertainty occurs when expectancies are inhibited or
brain injury, dementia, cerebral palsy, attention deficit disorder), emotional brain injury, dementia, cerebral palsy, attention deficit disorder), emotional
when new expectancies are established. For example, listeners familiar with
and behavioral disorders, or environmental circumstances (e.g., living in an and behavioral disorders, or environmental circumstances (e.g., living in an
Western music will expect to hear a tonic note after the leading tone, or a tonic
environment of poverty and high risk). The ability to focus and maintain environment of poverty and high risk). The ability to focus and maintain
chord after a dominant chord. If the resolution to the tonic is omitted or delayed,
attention forms a foundation for many life functions such as establishing infant- attention forms a foundation for many life functions such as establishing infant-
Meyer would say that our tendency to respond has been inhibited, and thus we
parent bonding, completing self-help skills, learning academic information, parent bonding, completing self-help skills, learning academic information,
will have an emotional response such as surprise.
and vocational and social competence, and is therefore a prerequisite to many and vocational and social competence, and is therefore a prerequisite to many
It is the balance of the expected and unexpected within a composition that
other therapy goals. other therapy goals.
helps bring meaning or emotion to music. Thus, when we are first confronted
Berlyne’s (1971) experimental studies of aesthetics suggest that art can Berlyne’s (1971) experimental studies of aesthetics suggest that art can
with a highly novel musical style, we find it more difficult to anticipate what
stimulate processes that effectively control attention and reinforcement. This stimulate processes that effectively control attention and reinforcement. This
we will hear next. We can “hear” the musical sounds on an acoustical level,
in turn promotes many kinds of learning. Applied clinical research and many in turn promotes many kinds of learning. Applied clinical research and many
but those sounds may lack meaning (Meyer, 1956). In short, Leonard Meyer’s
treatment methods illustrate Berlyne’s theoretical position, namely that music treatment methods illustrate Berlyne’s theoretical position, namely that music
theory of expectations attempts to explain how and why we derive meaning and
can reinforce attending behaviors in many persons with disabilities (e.g., can reinforce attending behaviors in many persons with disabilities (e.g.,
emotions from music, even though it is a nondiscursive form of communica-
Carter, 1982). Aesthetic stimuli can aid focus through (1) dishabituation, (2) Carter, 1982). Aesthetic stimuli can aid focus through (1) dishabituation, (2)
tion. Leonard Meyer developed his theory through methods of logic and
preparatory set, and (3) exploratory behavior. preparatory set, and (3) exploratory behavior.
persuasion, though his theory has subsequently been tested through a number
of experimental studies.
Dishabituation Dishabituation
Habituation is the result of either monotonous regularity or possibly Daniel Berlyne’s Experimental
Habituation Aesthetics
is the result of either monotonous regularity or possibly
too much contrasting and novel stimuli, both of which can be unpleasant too much contrasting and novel stimuli, both of which can be unpleasant
In 1971 Aesthetics and Psychobiology by psychologist Daniel Berlyne was
and diminish response to sensory signals (Berlyne, 1971). In situations such and diminish response to sensory signals (Berlyne, 1971). In situations such
published. This book is now a classic resource for what has become known
as institutionalization or low sensory and intellectual functioning, reaction as institutionalization or low sensory and intellectual functioning, reaction
as experimental aesthetics, or neo-behavioralism. Berlyne championed the
to familiar objects becomes automatic and unconscious (Kreitler & Kreitler, to familiar objects becomes automatic and unconscious (Kreitler & Kreitler,
use of experimental methods to examine and understand human response to
68 68
The
72 Therapeutic Process
77
73
Leonard
1972). Meyer’stheTheory
Through use ofofnovel
Expectations
stimuli such as attractive musical sounds, 1972). Through the use of novel stimuli such as attractive musical sounds,
psychological and physiological readiness can result (Altshuler, 1956; Hodges, psychological and physiological readiness can result (Altshuler, 1956; Hodges,
Leonard Meyer’s theory of expectations (1956) exemplifies an expres-
1980). Shklovskij sees art as a new way of experiencing the world, thus facilitating 1980). Shklovskij sees art as a new way of experiencing the world, thus facilitating
sionistic position in aesthetic circles. According to expressionism, musical
dishabituation (quoted by Ehrlich, 1965, pp. 150–151). dishabituation (quoted by Ehrlich, 1965, pp. 150–151).
meaning does not come from extramusical associations (e.g., the sound of the
Because the easily manipulated variables of rhythm, melody, and harmony Because the easily manipulated variables of rhythm, melody, and harmony
music reminding the listener of nonmusical events, such as the sound of thunder
can provide optimal combinations of novel and familiar or redundant stimuli, can provide optimal combinations of novel and familiar or redundant stimuli,
or birds) but is intrinsic to the structural features of the music itself. Meaning
music provides a flexible resource for establishing attention, even in low- music provides a flexible resource for establishing attention, even in low-
is a function of our knowledge of a style and subsequent expectations about
functioning individuals. According to studies by Berlyne and others (e.g., Gfeller functioning individuals. According to studies by Berlyne and others (e.g., Gfeller
what sounds we anticipate. From listening to musical stimuli, we begin to notice
et al., 1991; Gfeller & Coffman, 1991), musical stimuli of a moderate level et al., 1991; Gfeller & Coffman, 1991), musical stimuli of a moderate level
certain musical groupings or clichés that occur frequently in a particular style.
have been found more pleasing than music that is either too low or too high in have been found more pleasing than music that is either too low or too high in
We develop expectations by comparing incoming sensory information with past
complexity or novelty. In some instances (i.e., adversely noisy environments), complexity or novelty. In some instances (i.e., adversely noisy environments),
listening experiences. These expectations facilitate effective processing of new
any sound, including continuous music, may be too much stimulus, thus silence any sound, including continuous music, may be too much stimulus, thus silence
information and help us develop internal references among the musical elements.
may be more novel and desirable (e.g., Clair, 1996; Wolfe, 1980). For example, may be more novel and desirable (e.g., Clair, 1996; Wolfe, 1980). For example,
Because of the importance of experience in this process, we may derive little
the presentation of continuous music in the common areas of a nursing home the presentation of continuous music in the common areas of a nursing home
meaning from music if we have no previous exposure to a particular style.
(even music as seemingly pleasant as Mozart) may increase agitation among (even music as seemingly pleasant as Mozart) may increase agitation among
Meyer (1956) notes that expectation frequently involves a high order
some adults with dementia. Thus, music is not inherently therapeutic. Some some adults with dementia. Thus, music is not inherently therapeutic. Some
of mental activity, including judgment and cognition of both the stimuli and
types of music, particular uses, or timing of presentation can be contraindicated. types of music, particular uses, or timing of presentation can be contraindicated.
the context in which the stimuli appear. This mental process can occur very
The judicious choice and application of music is important when utilizing music The judicious choice and application of music is important when utilizing music
rapidly at a conscious or unconscious level. Since our listening experiences are
to increase attention. The music therapist should carefully consider a variety to increase attention. The music therapist should carefully consider a variety
organized in part by memories, the memory process is critical to expectation.
of factors (e.g., the acoustical environment in which the client functions, the of factors (e.g., the acoustical environment in which the client functions, the
In fact, Meyer (1956) states, “without thought and memory there could be no
developmental age, chronological age, neurological stability, and past listening developmental age, chronological age, neurological stability, and past listening
musical experience” (p. 87).
experiences and preferences) when selecting and presenting musical stimuli of experiences and preferences) when selecting and presenting musical stimuli of
Meyer’s theory is particularly interesting in relation to musical response
appropriate complexity for the client’s level of functioning and interest. appropriate complexity for the client’s level of functioning and interest.
of individuals with significant cognitive deficits. People with mental retardation,
who make up approximately one third of the clientele served by music therapists
Preparatory Set States, are commonly reported to be very responsive to musical
in the United Preparatory Set
stimuli (Carter, 1982). In fact, music is often used as reinforcement in behavioral
In addition to dishabituation, aesthetic forms such as music can further In addition to dishabituation, aesthetic forms such as music can further
management programs because it is considered enjoyable and intrinsically
aid attention through what is called “preparatory set.” As listeners, we bring aid attention through what is called “preparatory set.” As listeners, we bring
rewarding for this population. Meyer’s theory would suggest some refinement
to the auditory experience not only the raw acoustic material but also our to the auditory experience not only the raw acoustic material but also our
of this general statement. Perhaps highly complex and novel forms of music that
own beliefs about music’s value. Generally, individuals believe that aesthetic own beliefs about music’s value. Generally, individuals believe that aesthetic
have an extensive memory load are less suitable as rewards. On the other hand,
experience should be both interesting and unique (Kreitler & Kreitler, 1972; experience should be both interesting and unique (Kreitler & Kreitler, 1972;
there are many musical compositions that contain predictable and redundant
Meyer, 1956). This belief contributes to music’s usefulness as a contingency Meyer, 1956). This belief contributes to music’s usefulness as a contingency
melodic and rhythmic patterns, which in light of Gestalt theory may be more
in behavioral programs (e.g., attending a concert or stereo use as a reward for in behavioral programs (e.g., attending a concert or stereo use as a reward for
easily perceived and encoded. If expectations based on memory for past musical
desired behaviors). An essential ingredient in successful operant conditioning desired behaviors). An essential ingredient in successful operant conditioning
experiences are an integral part of meaning in music as Meyer suggests, this
is the selection of a valued reward or reinforcement. Music’s usefulness as a is the selection of a valued reward or reinforcement. Music’s usefulness as a
would explain why very simple and redundant music can maintain a high level
reward is strengthened by cultural attitudes that aesthetic forms are valuable reward is strengthened by cultural attitudes that aesthetic forms are valuable
of interest for individuals with moderate retardation even after what seem to
commodities. commodities.
be infinite repetitions.
Preparatory set causes both conscious and unconscious adjustments in Preparatory set causes both conscious and unconscious adjustments in
According to Sloboda (1985), musical capacity (production and ability
the listener that facilitate and condition response to the expected musical sounds the listener that facilitate and condition response to the expected musical sounds
to comprehend) includes many independent subskills, which he hypothesizes
(Meyer, 1956). This encourages attention and elicits behavioral responses to the (Meyer, 1956). This encourages attention and elicits behavioral responses to the
are processed in different anatomical locations within the brain. Higgs and
stimuli (Kreitler & Kreitler, 1972). stimuli (Kreitler & Kreitler, 1972).
McLeish (1966) have also pointed to the subskills of music, noting that people
who are educationally subnormal may perform well on pure discrimination of
Therapeutic Process
75
Exploratory Behavior Exploratory

In music,Behavior
the components of rhythm, melody, and harmony provide
temporal organization of sound, which introduces order and allows the listener
A third effect of aesthetic stimuli is encouragement of exploratory A third effect of aesthetic stimuli is encouragement of exploratory
to “parse” acoustic information (Bregman, 1990; Berlyne, 1971; Krumhansl,
behavior, which helps in orientation to the environment. Such orientation, when behavior, which helps in orientation to the environment. Such orientation, when
1983). Rhythm, for example, provides temporal distribution in recurrent
it manifests itself as identification of food sources or potential sources of danger it manifests itself as identification of food sources or potential sources of danger
spatial/temporal organization, acting as an external stimulus for the structuring
is necessary for survival. But humans also demonstrate an orienting behavior is necessary for survival. But humans also demonstrate an orienting behavior
of time. This rhythmic organization, in addition to facilitating perception
known as diversive exploratory behavior in response to aesthetic stimuli. As far known as diversive exploratory behavior in response to aesthetic stimuli. As far
of musical information, is believed to aid memory and the understanding
as we know, diversive exploratory behavior is unnecessary to human survival. as we know, diversive exploratory behavior is unnecessary to human survival.
of incoming stimuli, including verbal information (Berlyne, 1971; Gfeller,
This behavior is particularly strong in extended periods of low environmental This behavior is particularly strong in extended periods of low environmental
1982; Sloboda, 1985).
stimulation (Berlyne, 1971; Kreitler & Kreitler, 1972). stimulation (Berlyne, 1971; Kreitler & Kreitler, 1972).
Gestalt psychologists consider perceptual organization a natural part of
Because to some extent, aesthetic objects are a source of learning, they Because to some extent, aesthetic objects are a source of learning, they
neurological processes. In recent decades, Albert Bregman’s research regarding
encourage exploratory behavior. In fact, any opportunity to learn about the encourage exploratory behavior. In fact, any opportunity to learn about the
perceptual organization specific to the auditory sense (Auditory Scene Analysis,
world can contribute to more effective coping mechanisms. Furthermore, world can contribute to more effective coping mechanisms. Furthermore,
Bregman, 1990) has advanced our understanding of how particular structural
extensive research shows that contact with and exploration of novel stimuli may extensive research shows that contact with and exploration of novel stimuli may
features of music are perceived at the peripheral (hearing mechanism) and
be intrinsically rewarding, providing incentive for new responses (Kreitler & be intrinsically rewarding, providing incentive for new responses (Kreitler &
central (brain) levels. The manner in which pitch, timbre, and intensity are
Kreitler, 1972). For aesthetic objects, this exploration may be further motivated Kreitler, 1972). For aesthetic objects, this exploration may be further motivated
organized over time (duration, rhythm) in various combinations will affect how
by the hedonic value (i.e., the pleasantness) of an art form (Berlyne, 1971). by the hedonic value (i.e., the pleasantness) of an art form (Berlyne, 1971).
we perceive the sounds. “Good Gestalts” are formed in such a manner that they
Once the client has focused on salient information, or engaged in a Once the client has focused on salient information, or engaged in a
facilitate perceptual processing. This has implications for persons who have
desirable interaction or task, there is still the need to process that information desirable interaction or task, there is still the need to process that information
difficulty with poor short-term memory or informational encoding, such as
so that it can be recalled and understood. Therefore, the next section addresses so that it can be recalled and understood. Therefore, the next section addresses
individuals with developmental or learning disabilities.
another important psychological process, perception. another important psychological process, perception.
While some musical patterns are more readily perceived than others,
Meyer (1956) attributes part of the value of “good Gestalts” to learning. He
Perception Perception
suggests that we have been taught or conditioned to perceive particular patterns
within our environment. Additionally, according to Piagetian theory, perception
Perception is defined by Sternberg (1996) as “the set of psychological Perception is defined by Sternberg (1996) as “the set of psychological
is related to the stages of child development. For example, some patterns may be
processes by which people recognize, organize, synthesize, and give meaning (in processes by which people recognize, organize, synthesize, and give meaning (in
inaccessible until conservation skills are in place. In terms of therapeutic practice,
the brain) to the sensations received from environmental stimuli (in the sense the brain) to the sensations received from environmental stimuli (in the sense
this means that the therapist should consciously evaluate the client’s previous
organs)” (p. 506). Thus, perception is a selective process; we cannot absorb organs)” (p. 506). Thus, perception is a selective process; we cannot absorb
musical experiences and developmental level as well as the organizational
the vast world of competing stimuli. Instead we filter, select, and organize the vast world of competing stimuli. Instead we filter, select, and organize
structure of music when selecting appropriate materials.
information for further processing. What we perceive is influenced by personal information for further processing. What we perceive is influenced by personal
While there can be little doubt that the perceptual process is enhanced
attitude, preference, and expectations based on previous experience. attitude, preference, and expectations based on previous experience.
through structural properties of music, some psychologists would argue that
In addition to intrasubject factors (e.g., personal attitude, expectations), In addition to intrasubject factors (e.g., personal attitude, expectations),
organizational properties alone cannot account for the psychological impact of
the organizational structure of the external stimuli plays a role in how readily the organizational structure of the external stimuli plays a role in how readily
aesthetic objects in terms of symbolism or musical meaning (Kreitler & Kreitler,
information is perceived. According to Gestalt psychologists, the organization information is perceived. According to Gestalt psychologists, the organization
1972). We must look further to higher processes of cognition.
of incoming sensory stimuli is facilitated through patterns or groupings known of incoming sensory stimuli is facilitated through patterns or groupings known
as “good Gestalts.” Although this term has not been specifically defined, as “good Gestalts.” Although this term has not been specifically defined,
organizational attributes believed to contribute to a “good Gestalt” include Higher Cognitive
organizational Processes:
attributes Knowledge,
believed Beliefs,
to contribute to aand Meaning
“good Gestalt” include
regularity, similarity, proximity, symmetry, and simplicity (Berlyne, 1971; regularity, similarity, proximity, symmetry, and simplicity (Berlyne, 1971;
The role of cognition in aesthetic meaning and enjoyment is explored in
Bregman, 1990). While the bulk of Gestalt theory and research has focused Bregman, 1990). While the bulk of Gestalt theory and research has focused
two principal aesthetic theories: Leonard Meyer’s theory of expectations (1956)
on visual perception, similar principles of organization can also be applied to on visual perception, similar principles of organization can also be applied to
and Kreitler and Kreitler’s theory of cognitive orientation (1972).
auditory stimuli (Berlyne, 1971; Bregman, 1990; Kreitler & Kreitler, 1972; auditory stimuli (Berlyne, 1971; Bregman, 1990; Kreitler & Kreitler, 1972;
Krumhansl, 1983; Meyer, 1956; Sloboda, 1985). Krumhansl, 1983; Meyer, 1956; Sloboda, 1985).
The
Therapeutic Process
Exploratory
In music,Behavior
the components of rhythm, melody, and harmony provide In music, the components of rhythm, melody, and harmony provide
temporal organization of sound, which introduces order and allows the listener temporal organization of sound, which introduces order and allows the listener
A third effect of aesthetic stimuli is encouragement of exploratory
to “parse” acoustic information (Bregman, 1990; Berlyne, 1971; Krumhansl, to “parse” acoustic information (Bregman, 1990; Berlyne, 1971; Krumhansl,
behavior, which helps in orientation to the environment. Such orientation, when
1983). Rhythm, for example, provides temporal distribution in recurrent 1983). Rhythm, for example, provides temporal distribution in recurrent
it manifests itself as identification of food sources or potential sources of danger
spatial/temporal organization, acting as an external stimulus for the structuring spatial/temporal organization, acting as an external stimulus for the structuring
is necessary for survival. But humans also demonstrate an orienting behavior
of time. This rhythmic organization, in addition to facilitating perception of time. This rhythmic organization, in addition to facilitating perception
known as diversive exploratory behavior in response to aesthetic stimuli. As far
of musical information, is believed to aid memory and the understanding of musical information, is believed to aid memory and the understanding
as we know, diversive exploratory behavior is unnecessary to human survival.
of incoming stimuli, including verbal information (Berlyne, 1971; Gfeller, of incoming stimuli, including verbal information (Berlyne, 1971; Gfeller,
This behavior is particularly strong in extended periods of low environmental
1982; Sloboda, 1985). 1982; Sloboda, 1985).
stimulation (Berlyne, 1971; Kreitler & Kreitler, 1972).
Gestalt psychologists consider perceptual organization a natural part of Gestalt psychologists consider perceptual organization a natural part of
Because to some extent, aesthetic objects are a source of learning, they
neurological processes. In recent decades, Albert Bregman’s research regarding neurological processes. In recent decades, Albert Bregman’s research regarding
encourage exploratory behavior. In fact, any opportunity to learn about the
perceptual organization specific to the auditory sense (Auditory Scene Analysis, perceptual organization specific to the auditory sense (Auditory Scene Analysis,
world can contribute to more effective coping mechanisms. Furthermore,
Bregman, 1990) has advanced our understanding of how particular structural Bregman, 1990) has advanced our understanding of how particular structural
extensive research shows that contact with and exploration of novel stimuli may
features of music are perceived at the peripheral (hearing mechanism) and features of music are perceived at the peripheral (hearing mechanism) and
be intrinsically rewarding, providing incentive for new responses (Kreitler &
central (brain) levels. The manner in which pitch, timbre, and intensity are central (brain) levels. The manner in which pitch, timbre, and intensity are
Kreitler, 1972). For aesthetic objects, this exploration may be further motivated
organized over time (duration, rhythm) in various combinations will affect how organized over time (duration, rhythm) in various combinations will affect how
by the hedonic value (i.e., the pleasantness) of an art form (Berlyne, 1971).
we perceive the sounds. “Good Gestalts” are formed in such a manner that they we perceive the sounds. “Good Gestalts” are formed in such a manner that they
Once the client has focused on salient information, or engaged in a
facilitate perceptual processing. This has implications for persons who have facilitate perceptual processing. This has implications for persons who have
desirable interaction or task, there is still the need to process that information
difficulty with poor short-term memory or informational encoding, such as difficulty with poor short-term memory or informational encoding, such as
so that it can be recalled and understood. Therefore, the next section addresses
individuals with developmental or learning disabilities. individuals with developmental or learning disabilities.
another important psychological process, perception.
While some musical patterns are more readily perceived than others, While some musical patterns are more readily perceived than others,
Meyer (1956) attributes part of the value of “good Gestalts” to learning. He Meyer (1956) attributes part of the value of “good Gestalts” to learning. He
Perception
suggests that we have been taught or conditioned to perceive particular patterns suggests that we have been taught or conditioned to perceive particular patterns
within our environment. Additionally, according to Piagetian theory, perception within our environment. Additionally, according to Piagetian theory, perception
Perception is defined by Sternberg (1996) as “the set of psychological
is related to the stages of child development. For example, some patterns may be is related to the stages of child development. For example, some patterns may be
processes by which people recognize, organize, synthesize, and give meaning (in
inaccessible until conservation skills are in place. In terms of therapeutic practice, inaccessible until conservation skills are in place. In terms of therapeutic practice,
the brain) to the sensations received from environmental stimuli (in the sense
this means that the therapist should consciously evaluate the client’s previous this means that the therapist should consciously evaluate the client’s previous
organs)” (p. 506). Thus, perception is a selective process; we cannot absorb
musical experiences and developmental level as well as the organizational musical experiences and developmental level as well as the organizational
the vast world of competing stimuli. Instead we filter, select, and organize
structure of music when selecting appropriate materials. structure of music when selecting appropriate materials.
information for further processing. What we perceive is influenced by personal
While there can be little doubt that the perceptual process is enhanced While there can be little doubt that the perceptual process is enhanced
attitude, preference, and expectations based on previous experience.
through structural properties of music, some psychologists would argue that through structural properties of music, some psychologists would argue that
In addition to intrasubject factors (e.g., personal attitude, expectations),
organizational properties alone cannot account for the psychological impact of organizational properties alone cannot account for the psychological impact of
the organizational structure of the external stimuli plays a role in how readily
aesthetic objects in terms of symbolism or musical meaning (Kreitler & Kreitler, aesthetic objects in terms of symbolism or musical meaning (Kreitler & Kreitler,
information is perceived. According to Gestalt psychologists, the organization
1972). We must look further to higher processes of cognition. 1972). We must look further to higher processes of cognition.
of incoming sensory stimuli is facilitated through patterns or groupings known
as “good Gestalts.” Although this term has not been specifically defined,
Higher Cognitive
organizational Processes:
attributes Knowledge,
believed Beliefs,
to contribute to aand Meaning
“good Gestalt” include Higher Cognitive Processes: Knowledge, Beliefs, and Meaning
regularity, similarity, proximity, symmetry, and simplicity (Berlyne, 1971;
The role of cognition in aesthetic meaning and enjoyment is explored in The role of cognition in aesthetic meaning and enjoyment is explored in
Bregman, 1990). While the bulk of Gestalt theory and research has focused
two principal aesthetic theories: Leonard Meyer’s theory of expectations (1956) two principal aesthetic theories: Leonard Meyer’s theory of expectations (1956)
on visual perception, similar principles of organization can also be applied to
and Kreitler and Kreitler’s theory of cognitive orientation (1972). and Kreitler and Kreitler’s theory of cognitive orientation (1972).
auditory stimuli (Berlyne, 1971; Bregman, 1990; Kreitler & Kreitler, 1972;
Krumhansl, 1983; Meyer, 1956; Sloboda, 1985).
76
77
73
Leonard Meyer’s Theory of Expectations Leonard

1972). Meyer’stheTheory
Through use ofofnovel
Expectations
stimuli such as attractive musical sounds,
psychological and physiological readiness can result (Altshuler, 1956; Hodges,
Leonard Meyer’s theory of expectations (1956) exemplifies an expres- Leonard Meyer’s theory of expectations (1956) exemplifies an expres-
1980). Shklovskij sees art as a new way of experiencing the world, thus facilitating
sionistic position in aesthetic circles. According to expressionism, musical sionistic position in aesthetic circles. According to expressionism, musical
dishabituation (quoted by Ehrlich, 1965, pp. 150–151).
meaning does not come from extramusical associations (e.g., the sound of the meaning does not come from extramusical associations (e.g., the sound of the
Because the easily manipulated variables of rhythm, melody, and harmony
music reminding the listener of nonmusical events, such as the sound of thunder music reminding the listener of nonmusical events, such as the sound of thunder
can provide optimal combinations of novel and familiar or redundant stimuli,
or birds) but is intrinsic to the structural features of the music itself. Meaning or birds) but is intrinsic to the structural features of the music itself. Meaning
music provides a flexible resource for establishing attention, even in low-
is a function of our knowledge of a style and subsequent expectations about is a function of our knowledge of a style and subsequent expectations about
functioning individuals. According to studies by Berlyne and others (e.g., Gfeller
what sounds we anticipate. From listening to musical stimuli, we begin to notice what sounds we anticipate. From listening to musical stimuli, we begin to notice
et al., 1991; Gfeller & Coffman, 1991), musical stimuli of a moderate level
certain musical groupings or clichés that occur frequently in a particular style. certain musical groupings or clichés that occur frequently in a particular style.
have been found more pleasing than music that is either too low or too high in
We develop expectations by comparing incoming sensory information with past We develop expectations by comparing incoming sensory information with past
complexity or novelty. In some instances (i.e., adversely noisy environments),
listening experiences. These expectations facilitate effective processing of new listening experiences. These expectations facilitate effective processing of new
any sound, including continuous music, may be too much stimulus, thus silence
information and help us develop internal references among the musical elements. information and help us develop internal references among the musical elements.
may be more novel and desirable (e.g., Clair, 1996; Wolfe, 1980). For example,
Because of the importance of experience in this process, we may derive little Because of the importance of experience in this process, we may derive little
the presentation of continuous music in the common areas of a nursing home
meaning from music if we have no previous exposure to a particular style. meaning from music if we have no previous exposure to a particular style.
(even music as seemingly pleasant as Mozart) may increase agitation among
Meyer (1956) notes that expectation frequently involves a high order Meyer (1956) notes that expectation frequently involves a high order
some adults with dementia. Thus, music is not inherently therapeutic. Some
of mental activity, including judgment and cognition of both the stimuli and of mental activity, including judgment and cognition of both the stimuli and
types of music, particular uses, or timing of presentation can be contraindicated.
the context in which the stimuli appear. This mental process can occur very the context in which the stimuli appear. This mental process can occur very
The judicious choice and application of music is important when utilizing music
rapidly at a conscious or unconscious level. Since our listening experiences are rapidly at a conscious or unconscious level. Since our listening experiences are
to increase attention. The music therapist should carefully consider a variety
organized in part by memories, the memory process is critical to expectation. organized in part by memories, the memory process is critical to expectation.
of factors (e.g., the acoustical environment in which the client functions, the
In fact, Meyer (1956) states, “without thought and memory there could be no In fact, Meyer (1956) states, “without thought and memory there could be no
developmental age, chronological age, neurological stability, and past listening
musical experience” (p. 87). musical experience” (p. 87).
experiences and preferences) when selecting and presenting musical stimuli of
Meyer’s theory is particularly interesting in relation to musical response Meyer’s theory is particularly interesting in relation to musical response
appropriate complexity for the client’s level of functioning and interest.
of individuals with significant cognitive deficits. People with mental retardation, of individuals with significant cognitive deficits. People with mental retardation,
who make up approximately one third of the clientele served by music therapists who make up approximately one third of the clientele served by music therapists
in the United States, are commonly reported to be very responsive to musical Preparatory Set States, are commonly reported to be very responsive to musical
in the United
stimuli (Carter, 1982). In fact, music is often used as reinforcement in behavioral stimuli (Carter, 1982). In fact, music is often used as reinforcement in behavioral
In addition to dishabituation, aesthetic forms such as music can further
management programs because it is considered enjoyable and intrinsically management programs because it is considered enjoyable and intrinsically
aid attention through what is called “preparatory set.” As listeners, we bring
rewarding for this population. Meyer’s theory would suggest some refinement rewarding for this population. Meyer’s theory would suggest some refinement
to the auditory experience not only the raw acoustic material but also our
of this general statement. Perhaps highly complex and novel forms of music that of this general statement. Perhaps highly complex and novel forms of music that
own beliefs about music’s value. Generally, individuals believe that aesthetic
have an extensive memory load are less suitable as rewards. On the other hand, have an extensive memory load are less suitable as rewards. On the other hand,
experience should be both interesting and unique (Kreitler & Kreitler, 1972;
there are many musical compositions that contain predictable and redundant there are many musical compositions that contain predictable and redundant
Meyer, 1956). This belief contributes to music’s usefulness as a contingency
melodic and rhythmic patterns, which in light of Gestalt theory may be more melodic and rhythmic patterns, which in light of Gestalt theory may be more
in behavioral programs (e.g., attending a concert or stereo use as a reward for
easily perceived and encoded. If expectations based on memory for past musical easily perceived and encoded. If expectations based on memory for past musical
desired behaviors). An essential ingredient in successful operant conditioning
experiences are an integral part of meaning in music as Meyer suggests, this experiences are an integral part of meaning in music as Meyer suggests, this
is the selection of a valued reward or reinforcement. Music’s usefulness as a
would explain why very simple and redundant music can maintain a high level would explain why very simple and redundant music can maintain a high level
reward is strengthened by cultural attitudes that aesthetic forms are valuable
of interest for individuals with moderate retardation even after what seem to of interest for individuals with moderate retardation even after what seem to
commodities.
be infinite repetitions. be infinite repetitions.
Preparatory set causes both conscious and unconscious adjustments in
According to Sloboda (1985), musical capacity (production and ability According to Sloboda (1985), musical capacity (production and ability
the listener that facilitate and condition response to the expected musical sounds
to comprehend) includes many independent subskills, which he hypothesizes to comprehend) includes many independent subskills, which he hypothesizes
(Meyer, 1956). This encourages attention and elicits behavioral responses to the
are processed in different anatomical locations within the brain. Higgs and are processed in different anatomical locations within the brain. Higgs and
stimuli (Kreitler & Kreitler, 1972).
McLeish (1966) have also pointed to the subskills of music, noting that people McLeish (1966) have also pointed to the subskills of music, noting that people
who are educationally subnormal may perform well on pure discrimination of who are educationally subnormal may perform well on pure discrimination of
The
77
81
structural newelements
tensionsbut whichfall are
below age-group
specific. norms in those
Our hypothesis musical skills
that preexisting structural elements but fall below age-group norms in those musical skills
tensions
that require memoryare involved in the process
and meaningful assumes thatFor
comparisons. tensions
example,may long musical that require memory and meaningful comparisons. For example, musical
persist and can be transferred from one domain
stimuli might be utilized primarily as novel sounds that can elicit attention. to another.… Since stimuli might be utilized primarily as novel sounds that can elicit attention.
all too often
More complex a person may
and extensive musicalbe prevented
materialsfrom mayperforming
lack meaning. the action
Thus the More complex and extensive musical materials may lack meaning. Thus the
appropriate for the reduction of tension,
individual with mental retardation may be responding to music using evoked tensions are subskills
not individual with mental retardation may be responding to music using subskills
reduced and may persist (p. 19).
that are relatively functional. It is also worth noting that there are persons with that are relatively functional. It is also worth noting that there are persons with
substantial mental deficits who have splinter skills in music, or there is the substantial mental deficits who have splinter skills in music, or there is the
exceptionalWhen obstaclesistooften
case—what reduction of tensions
referred to as thearise,
savantone(Winner,
may displace 1982). aggression exceptional case—what is often referred to as the savant (Winner, 1982).
by transferring tension from one domain to another. Thus an individual may
discharge
Kreitler and tension
Kreitler’sthroughTheory an activity similar
of Cognitive to the activity that has been
Orientation Kreitler and Kreitler’s Theory of Cognitive Orientation
obstructed. Further, Kreitler and Kreitler (1972) maintain that unresolved
According
tensions persisttoinKreitlerthe form andofKreitler
diffuse,(1972), behavior
directionless in relation
tension to anin
expressed According to Kreitler and Kreitler (1972), behavior in relation to an
aesthetic object is not simply a result of the perceptual
restlessness and emotionality, including a readiness to overreact. Diffuse tensions organization of the aesthetic object is not simply a result of the perceptual organization of the
stimulus. Behavior is also directed by the knowledge
can be absorbed into the more specific and directed tensions of an artwork. and beliefs about that stimulus. Behavior is also directed by the knowledge and beliefs about that
object,
Thesewhich
specificare based are
tensions on resolved
judgments and evaluations.
through aesthetic means. By experiencing an object, which are based on judgments and evaluations. By experiencing an
artwork Emotional
through cognitive responseorientation,
to embodied weproperties
can view reality
of music with heightened
is representative artwork through cognitive orientation, we can view reality with heightened
awareness. The art form provides a special view
of the expressionistic school of aesthetic philosophy. Probably moreof reality, an “as if” or alternative
prevalent awareness. The art form provides a special view of reality, an “as if” or alternative
conceptualization, not a replica (Kreitler & Kreitler,
in music therapy practice is the referentialist view, which states that musical 1972). Through this conceptualization, not a replica (Kreitler & Kreitler, 1972). Through this
unique,
meaning comes from music’s reference to extramusical concepts or actions. or
symbolic view, we may perceive new solutions to old problems unique, symbolic view, we may perceive new solutions to old problems or
realize new problems. realize new problems.
According to Kreitler and Kreitler (1972), the art form provides a favorable According to Kreitler and Kreitler (1972), the art form provides a favorable
Extramusical
context for expandingAssociations
cognitive orientation and confronting new ideas because context for expanding cognitive orientation and confronting new ideas because
of the intermingling
A common example of novel of stimuli with the association
extramusical familiarity of in either
affective referential
response of the intermingling of novel stimuli with the familiarity of either referential
objects or structural
to music is classical elements. This blending
conditioning, of the unfamiliar
or association by contiguity (and thus(for novel
further objects or structural elements. This blending of the unfamiliar (and thus novel
source of high arousal) with the familiar (a source
discussion of this term, see Chapter 3). In certain instances, musical stimuli of arousal moderation) source of high arousal) with the familiar (a source of arousal moderation)
replaces boredom ofresponse
evoke emotional habituation with interest,
not because curiosity,
of the music’s and exploration
structural properties, at but
a replaces boredom of habituation with interest, curiosity, and exploration at a
level of arousal palatable to the individual. As can be
because the music has in the past accompanied stimuli with emotional effects.seen, Kreitler and Kreitler level of arousal palatable to the individual. As can be seen, Kreitler and Kreitler
have
Theintegrated aspects of
“spine-tingling” musicBerlyne’s theory of
we associate arousal
with a horrorandmovie
hedonic value (1971)
provides a classic have integrated aspects of Berlyne’s theory of arousal and hedonic value (1971)
inexample
their theory of cognitive organization.
of this phenomenon (Berlyne, 1971). in their theory of cognitive organization.
InAthose
second schools
type of of psychotherapy that emphasize
extramusical association insightby
is produced as resemblance,
an important in In those schools of psychotherapy that emphasize insight as an important
goal of therapy,
which some physical expanding structure cognitive
within orientation
the music “mimics”has important therapeutic
similar properties of a goal of therapy, expanding cognitive orientation has important therapeutic
potential.
nonmusicalAn example in clinical
event or feeling. Forpractice
example,would be the music
the depressed motortherapy
responses procedure
of sadness potential. An example in clinical practice would be the music therapy procedure
known
mightasbelyric analysis (see
represented “Music
musically Psychotherapy”
through slow tempo in or
thedescending
taxonomy passageslater in this
(also known as lyric analysis (see “Music Psychotherapy” in the taxonomy later in this
book).
known as isomorphism) (Berlyne, 1971; Kreitler & Kreitler, 1972). video in
With this procedure, the therapist introduces a song or music book). With this procedure, the therapist introduces a song or music video in
which theInlyrics
all the present a situation or
aforementioned emotional
examples, expression
general moods on seem
a topictorelated to
be a more which the lyrics present a situation or emotional expression on a topic related to
thecharacteristic
client’s personal issues. As clients reflect upon the lyrics,
response than specific emotions, even though such general they may recognize the client’s personal issues. As clients reflect upon the lyrics, they may recognize
a familiar dilemma,may
mood responses situation, or feeling within
evoke reminiscence the song.
of specific pastAlthough the song&
events (Kreitler a familiar dilemma, situation, or feeling within the song. Although the song
mayKreitler, 1972). This leads to an important point: it is quite difficultmusical
tell of everyday feelings or problems, through the novelty of the to trace may tell of everyday feelings or problems, through the novelty of the musical
context, the listener
the relationship is ablespecific
between to bring new meaning
musical stimuli and andresulting
perhapsimagery
new insights
(Meyer, context, the listener is able to bring new meaning and perhaps new insights
to 1956).
his or her
Theown situation.
listener can attach very private and seemingly inappropriate imagery to his or her own situation.
It is as
to music important
a result of to the
recognize
music’s that cognitive
association withorientation
a personal may modifyIn
experience. It is important to recognize that cognitive orientation may modify
opinions or provide new insights; however, it does
addition, affective experiences themselves may evoke memories that in turn not necessarily result in opinions or provide new insights; however, it does not necessarily result in
corresponding behavioral changes (Kreitler & Kreitler, 1972). Therefore, corresponding behavioral changes (Kreitler & Kreitler, 1972). Therefore,
Therapeutic Process
79
an insight facilitated through an aesthetic experience is only one step in the sounds
an insight
the way facilitated
moods feel. through
Musicanis aesthetic
structuredexperience
in terms ofis tension
only one andstep
release,
in the
therapeutic process. Often the therapist must further guide the individual to motion
therapeutic
and rest, process.
fulfillment
Oftenand thechange”
therapist(p.must 211).further guide the individual to
integrating insights into meaningful behavioral adjustments. Meyer’sinsights
integrating theoryinto of music
meaningfuland emotion.
behavioralThe adjustments.
ability of nonreferential
information within music to evoke mood is also at the heart of Meyer’s (1956)
theory of expectation. Meyer’s belief about music and emotion is based on
Emotion and Mood Emotion and Mood
John Dewey’s conflict theory of emotions, which states “emotion or affect is
Music has been described as the language of emotions (Winner, 1982) Music ahas
aroused when been described
tendency to respond as is
thearrested
language or of emotions(Meyer,
inhibited” (Winner, 1982)
1956).
involving physiological and psychological reactions associated with mood and involvingtophysiological
According Meyer (1956), andmusic
psychological
arouses both reactions associated
consciously with mood and
and unconsciously
emotion (Hodges, 1980). According to Plutchik (1984), “an emotion is an emotion (Hodges,
expectations that may 1980).
or may According
not be directly to Plutchik (1984),satisfied.
or immediately “an emotion When isanan
inferred complex sequence of reactions to a stimulus and includes cognitive inferred complex
expectation sequencetheoftendency
is not satisfied, reactionstotorespond a stimulus and includes
is inhibited cognitive
and emotion
evaluations, subjective changes, autonomic and neural arousal, impulses to orevaluations,
affect is aroused. subjective changes,onautonomic
Therefore, an unconscious, and neural arousal, impulses
nonintellectual level,to
action, and behavior designed to have an effect on the stimulus that initiated the action,
music and behavior
evokes a feelingdesigned
response. to While
have anMeyer effect on the stimulusthe
acknowledges thatoccurrence
initiated the
complex sequence” (p. 217). Carlson and Hatfield describe emotional states as of complex
emotional sequence”
response(p.through
217). Carlson
referential and processes,
Hatfield describe
his theoryemotional states as
of embodied
more limited in duration than moods, which tend to be more persistent though more limited
emotions is the in duration than
cornerstone of hismoods,
research. which tend to be more persistent though
less intense than emotions. The term feeling refers to cognitive evaluations of less intense
Berlyne’s than emotions.
theory The term
of arousal and feeling
hedonic refers to cognitive
value. Like Meyer, evaluations
Berlyne of
our day-to-day world (Carlson & Hatfield, 1992). our day-to-day
(1971) world (Carlson
focuses on structural & of
features Hatfield,
music, which 1992).he calls collative properties,
While musical appreciation can be an intellectual endeavor, for the greater as a sourceWhile of musical
emotional appreciation
response.can be an intellectual
Berlyne’s theory isendeavor,
based onforempirical
the greater
majority of everyday listeners, music has a close tie with emotions or moods. majority of everyday
investigation listeners, music
of psychobiological has a to
response close tie with
formal emotions
elements or moods.
in aesthetic
For example, 1,007 Americans were asked in a poll what they do to relieve For example,
objects. He views1,007 Americans
affective responsewere as the asked in of
result a poll whatand
arousal they do to value
hedonic relieve
depression. Seventy-seven percent indicated that they listen to music (Gallup, depression.
(i.e., elements Seventy-seven
that are beautiful percent indicated that
or pleasurable in thethey
art listen
form).toThe music (Gallup,
combined
Jr., & Castelli, 1989). In another survey of 308 men and women (ranging in age Jr., & Castelli,
features, such as1989).complexityIn another
versussurvey of 308ormen
simplicity and women
redundancy (ranging
versus in age
novelty,
from sixteen to eighty-nine), 47% indicated they listen to music to change from sixteen
contribute to eighty-nine),
to arousal in the observer. 47%Berlyne
indicated they listenthat
hypothesized to pleasure
music toresults
change
a bad mood. Music was ranked the third highest among twenty-nine mood a bad
from an mood.
optimalMusic level was rankedwhich
of arousal the third highestfrom
emanates amongone twenty-nine
of the following mood
regulators identified by everyday people (note: “talking to or spending time with regulators(1)
conditions: identified
moderate byrise
everyday people
in arousal from (note: “talking
a point of lowtoarousal;
or spending time with
(2) reduction
someone” had the highest rank of 54%) (Thayer, 1996). Other evidence that of someone”
arousal from hada thestatehighest rank of 54%)
of unpleasantly (Thayer,or1996).
high arousal; Otherjag,
(3) arousal evidence
which thatis
music affects or expresses mood includes the remarkable degree of consensus anmusic
initialaffects
intenseorbuild expresses moodfollowed
in arousal includesimmediately
the remarkable degree ofresulting
by reduction, consensus
(both in naïve and trained listeners) about moods transmitted in musical in(both in naïve
pleasure. He also andlinks
trained listeners)
arousal activityabout moodsoftransmitted
to centers the brain that in musical
house
samples (Winner, 1982). samples (Winner,
emotional activity. 1982).
According to Langer (1953), musical stimuli do not result in direct According
Kreitler to Langerhomeostatic
and Kreitler’s (1953), musical model stimuli do not result
of motivation. This in direct
model
emotions; rather, they act as symbols for emotions. Since nondiscursive musical emotions; rather,
incorporates Berlyne’stheytheory
act as symbols
of arousal, for addressing
emotions. Since nondiscursive
the role of optimalmusical level
symbols do not translate literally, they can capture the f lux of sensation of symbols
stimulation do not translate literally,
(homeostatic balance) they can capture
in efficient humanthefunctioning.
f lux of sensationThe
and emotion perhaps more effectively than ordinary language (Winner, and emotion
balance perhaps by
can be disrupted more effectively
either too muchthan or tooordinary language In
little stimulation. (Winner,
either
1982). While Winner and Langer both ascribe emotional response to music’s 1982).
case While Winner
mobilization restoresand Langer both
equilibrium and,ascribe emotional
consequently, response feelings.
pleasurable to music’s
embodied elements, Altshuler (1956) attributes this response to the images and embodied
Musical elements,
properties suchAltshuler
as rhythm,(1956) attributes and
consonance this dissonance,
response to the andimages
melodic and
mental associations that music evokes. These two viewpoints exemplify the Gestalts (goodness of organization) can evoke tension and relief as the listenerthe
mental associations that music evokes. These two viewpoints exemplify
expressionistic and referentialist schools of aesthetic philosophy. expressionistic
follows the unfolding and referentialist schools of
thematic material. aesthetic
Kreitler andphilosophy.
Kreitler (1972) further
maintain that participation in aesthetic experiences is motivated by potential
tension reduction:
Intrinsic Characteristics of Music and Emotion: An Expressionistic Posture Intrinsic Characteristics of Music and Emotion: An Expressionistic Posture
From an expressionistic viewpoint, the acoustic elements of music are It From an expressionistic
is our contention viewpoint,
that a major the for
motivation acoustic elementswhich
art is tensions of music are
responsible for music’s emotional expressiveness. According to Winner (1982), exist in the
responsible for spectator of art to hisexpressiveness.
music’s emotional exposure to theAccording
work of art.toThe work (1982),
Winner
the structure of music mirrors the structure of emotional experiences: “Music of art mediates
the structure the mirrors
of music relief of the
thesestructure
preexisting tensions byexperiences:
of emotional generating “Music
The
Therapeutic Process
sounds
an insight
the way facilitated
moods feel. through
Musicanis aesthetic
structuredexperience
in terms ofis tension
only one andstep
release,
in the sounds the way moods feel. Music is structured in terms of tension and release,
motion
therapeutic
and rest, process.
fulfillment
Oftenand thechange”
therapist(p.must 211).further guide the individual to motion and rest, fulfillment and change” (p. 211).
Meyer’sinsights
integrating theoryinto of music
meaningfuland emotion.
behavioralThe adjustments.
ability of nonreferential Meyer’s theory of music and emotion. The ability of nonreferential
information within music to evoke mood is also at the heart of Meyer’s (1956) information within music to evoke mood is also at the heart of Meyer’s (1956)
theory of expectation. Meyer’s belief about music and emotion is based on theory of expectation. Meyer’s belief about music and emotion is based on
Emotion and Mood
John Dewey’s conflict theory of emotions, which states “emotion or affect is John Dewey’s conflict theory of emotions, which states “emotion or affect is
Music ahas
aroused when been described
tendency to respond as is
thearrested
language or of emotions(Meyer,
inhibited” (Winner, 1982)
1956). aroused when a tendency to respond is arrested or inhibited” (Meyer, 1956).
involvingtophysiological
According Meyer (1956), andmusic
psychological
arouses both reactions associated
consciously with mood and
and unconsciously According to Meyer (1956), music arouses both consciously and unconsciously
emotion (Hodges,
expectations that may 1980).
or may According
not be directly to Plutchik (1984),satisfied.
or immediately “an emotionWhen isanan expectations that may or may not be directly or immediately satisfied. When an
inferred complex
expectation sequencetheoftendency
is not satisfied, reactionstotorespond a stimulus and includes
is inhibited cognitive
and emotion expectation is not satisfied, the tendency to respond is inhibited and emotion
orevaluations,
affect is aroused. subjective changes,onautonomic
Therefore, an unconscious, and neural arousal, impulses
nonintellectual level,to or affect is aroused. Therefore, on an unconscious, nonintellectual level,
action,
music and behavior
evokes a feelingdesigned
response. to While
have anMeyer effect on the stimulusthe
acknowledges thatoccurrence
initiated the music evokes a feeling response. While Meyer acknowledges the occurrence
of complex
emotional sequence”
response(p.through
217). Carlson
referential and processes,
Hatfield describe
his theoryemotional states as
of embodied of emotional response through referential processes, his theory of embodied
more limited
emotions is the in duration than
cornerstone of hismoods,
research. which tend to be more persistent though emotions is the cornerstone of his research.
less intense
Berlyne’s than emotions.
theory The term
of arousal and feeling
hedonic refers to cognitive
value. Like Meyer, evaluations
Berlyne of Berlyne’s theory of arousal and hedonic value. Like Meyer, Berlyne
our day-to-day
(1971) world (Carlson
focuses on structural & of
features Hatfield,
music, which 1992).he calls collative properties, (1971) focuses on structural features of music, which he calls collative properties,
as a sourceWhile of musical
emotional appreciation
response.can be an intellectual
Berlyne’s theory isendeavor,
based onforempirical
the greater as a source of emotional response. Berlyne’s theory is based on empirical
majority of everyday
investigation listeners, music
of psychobiological has a to
response close tie with
formal emotions
elements or moods.
in aesthetic investigation of psychobiological response to formal elements in aesthetic
For example,
objects. He views1,007 Americans
affective responsewere as the asked in of
result a poll whatand
arousal they do to value
hedonic relieve objects. He views affective response as the result of arousal and hedonic value
depression.
(i.e., elements Seventy-seven
that are beautiful percent indicated that
or pleasurable in thethey
art listen
form).toThe music (Gallup,
combined (i.e., elements that are beautiful or pleasurable in the art form). The combined
Jr., & Castelli,
features, such as1989).complexityIn another
versussurvey of 308ormen
simplicity and women
redundancy (ranging
versus in age
novelty, features, such as complexity versus simplicity or redundancy versus novelty,
from sixteen
contribute to eighty-nine),
to arousal in the observer. 47%Berlyne
indicated they listenthat
hypothesized to pleasure
music toresults
change contribute to arousal in the observer. Berlyne hypothesized that pleasure results
a bad
from an mood.
optimalMusic level was rankedwhich
of arousal the third highestfrom
emanates amongone twenty-nine
of the following mood from an optimal level of arousal which emanates from one of the following
regulators(1)
conditions: identified
moderate byrise
everyday people
in arousal from (note: “talking
a point of lowtoarousal;
or spending time with
(2) reduction conditions: (1) moderate rise in arousal from a point of low arousal; (2) reduction
of someone”
arousal from hada thestatehighest rank of 54%)
of unpleasantly (Thayer,or1996).
high arousal; Otherjag,
(3) arousal evidence
which thatis of arousal from a state of unpleasantly high arousal; or (3) arousal jag, which is
anmusic
initialaffects
intenseorbuild expresses moodfollowed
in arousal includesimmediately
the remarkable degree ofresulting
by reduction, consensus an initial intense build in arousal followed immediately by reduction, resulting
in(both in naïve
pleasure. He also andlinks
trained listeners)
arousal activityabout moodsoftransmitted
to centers the brain that in musical
house in pleasure. He also links arousal activity to centers of the brain that house
samples (Winner,
emotional activity. 1982). emotional activity.
According
Kreitler to Langerhomeostatic
and Kreitler’s (1953), musical model stimuli do not result
of motivation. This in direct
model Kreitler and Kreitler’s homeostatic model of motivation. This model
emotions; rather,
incorporates Berlyne’stheytheory
act as symbols
of arousal, for addressing
emotions. Since nondiscursive
the role of optimalmusicallevel incorporates Berlyne’s theory of arousal, addressing the role of optimal level
of symbols
stimulation do not translate literally,
(homeostatic balance) they can capture
in efficient humanthefunctioning.
f lux of sensationThe of stimulation (homeostatic balance) in efficient human functioning. The
and emotion
balance perhaps by
can be disrupted more effectively
either too muchthan or tooordinary language In
little stimulation. (Winner,
either balance can be disrupted by either too much or too little stimulation. In either
1982).
case While Winner
mobilization restoresand Langer both
equilibrium and,ascribe emotional
consequently, response feelings.
pleasurable to music’s case mobilization restores equilibrium and, consequently, pleasurable feelings.
embodied
Musical elements,
properties suchAltshuler
as rhythm,(1956) attributes and
consonance this dissonance,
response to the andimages
melodic and Musical properties such as rhythm, consonance and dissonance, and melodic
Gestalts (goodness of organization) can evoke tension and relief as the listenerthe
mental associations that music evokes. These two viewpoints exemplify Gestalts (goodness of organization) can evoke tension and relief as the listener
expressionistic
follows the unfolding and referentialist schools of
thematic material. aesthetic
Kreitler andphilosophy.
Kreitler (1972) further follows the unfolding thematic material. Kreitler and Kreitler (1972) further
maintain that participation in aesthetic experiences is motivated by potential maintain that participation in aesthetic experiences is motivated by potential
tension reduction: tension reduction:
Intrinsic Characteristics of Music and Emotion: An Expressionistic Posture
It From an expressionistic
is our contention viewpoint,
that a major the for
motivation acoustic elementswhich
art is tensions of music are It is our contention that a major motivation for art is tensions which
exist in the
responsible for spectator of art to hisexpressiveness.
music’s emotional exposure to theAccording
work of art.toThe work (1982),
Winner exist in the spectator of art to his exposure to the work of art. The work
of art mediates
the structure the mirrors
of music relief of the
thesestructure
preexisting tensions byexperiences:
of emotional generating “Music of art mediates the relief of these preexisting tensions by generating
80
77
81
new tensions which are specific. Our hypothesis that preexisting structural newelements
tensionsbut whichfall are
below age-group
specific. norms in those
Our hypothesis musical skills
that preexisting
tensions are involved in the process assumes that tensions may long tensions
that require memoryare involved in the process
and meaningful assumes thatFor
comparisons. tensions
example,may long musical
persist and can be transferred from one domain to another.… Since persist and can be transferred from one domain
stimuli might be utilized primarily as novel sounds that can elicit attention. to another.… Since
all too often a person may be prevented from performing the action all too often
More complex a person may
and extensive musicalbe prevented
materialsfrom mayperforming
lack meaning. the action
Thus the
appropriate for the reduction of tension, evoked tensions are not appropriate for the reduction of tension,
individual with mental retardation may be responding to music using evoked tensions are subskills
not
reduced and may persist (p. 19). reduced and may persist (p. 19).
that are relatively functional. It is also worth noting that there are persons with
substantial mental deficits who have splinter skills in music, or there is the
When obstacles to reduction of tensions arise, one may displace aggression exceptionalWhen obstaclesistooften
case—what reduction of tensions
referred to as thearise,
savantone(Winner,
may displace 1982). aggression
by transferring tension from one domain to another. Thus an individual may by transferring tension from one domain to another. Thus an individual may
discharge tension through an activity similar to the activity that has been discharge
Kreitler and tension
Kreitler’sthroughTheory an activity similar
of Cognitive to the activity that has been
Orientation
obstructed. Further, Kreitler and Kreitler (1972) maintain that unresolved obstructed. Further, Kreitler and Kreitler (1972) maintain that unresolved
tensions persist in the form of diffuse, directionless tension expressed in According
tensions persisttoinKreitlerthe form andofKreitler
diffuse,(1972), behavior
directionless in relation
tension to anin
expressed
restlessness and emotionality, including a readiness to overreact. Diffuse tensions aesthetic object is not simply a result of the perceptual
restlessness and emotionality, including a readiness to overreact. Diffuse tensions organization of the
can be absorbed into the more specific and directed tensions of an artwork. stimulus. Behavior is also directed by the knowledge
can be absorbed into the more specific and directed tensions of an artwork. and beliefs about that
These specific tensions are resolved through aesthetic means. object,
Thesewhich
specificare based are
tensions on resolved
judgments and evaluations.
through aesthetic means. By experiencing an
Emotional response to embodied properties of music is representative artwork Emotional
through cognitive responseorientation,
to embodied weproperties
can view reality
of music with heightened
is representative
of the expressionistic school of aesthetic philosophy. Probably more prevalent awareness. The art form provides a special view
of the expressionistic school of aesthetic philosophy. Probably moreof reality, an “as if” or alternative
prevalent
in music therapy practice is the referentialist view, which states that musical conceptualization, not a replica (Kreitler & Kreitler,
in music therapy practice is the referentialist view, which states that musical 1972). Through this
meaning comes from music’s reference to extramusical concepts or actions. unique,
meaning comes from music’s reference to extramusical concepts or actions. or
symbolic view, we may perceive new solutions to old problems
realize new problems.
According to Kreitler and Kreitler (1972), the art form provides a favorable
Extramusical Associations Extramusical
context for expandingAssociations
cognitive orientation and confronting new ideas because
A common example of extramusical association in affective response of the intermingling
A common example of novel of stimuli with the association
extramusical familiarity of in either
affective referential
response
to music is classical conditioning, or association by contiguity (for further objects or structural
to music is classical elements. This blending
conditioning, of the unfamiliar
or association by contiguity (and thus(for novel
further
discussion of this term, see Chapter 3). In certain instances, musical stimuli source of high arousal) with the familiar (a source
discussion of this term, see Chapter 3). In certain instances, musical stimuli of arousal moderation)
evoke emotional response not because of the music’s structural properties, but replaces boredom ofresponse
evoke emotional habituation with interest,
not because curiosity,
of the music’s and exploration
structural properties, at but
a
because the music has in the past accompanied stimuli with emotional effects. level of arousal palatable to the individual. As can be
because the music has in the past accompanied stimuli with emotional effects.seen, Kreitler and Kreitler
The “spine-tingling” music we associate with a horror movie provides a classic have
Theintegrated aspects of
“spine-tingling” musicBerlyne’s theory of
we associate arousal
with a horrorandmovie
hedonic value (1971)
provides a classic
example of this phenomenon (Berlyne, 1971). inexample
their theory of cognitive organization.
of this phenomenon (Berlyne, 1971).
A second type of extramusical association is produced by resemblance, in InAthose
second schools
type of of psychotherapy that emphasize
extramusical association insightby
is produced as resemblance,
an important in
which some physical structure within the music “mimics” similar properties of a goal of therapy,
which some physical expanding structure cognitive
within orientation
the music “mimics”has important therapeutic
similar properties of a
nonmusical event or feeling. For example, the depressed motor responses of sadness potential.
nonmusicalAn example in clinical
event or feeling. Forpractice
example,would be the music
the depressed motortherapy
responses procedure
of sadness
might be represented musically through slow tempo or descending passages (also known
mightasbelyric analysis (see
represented “Music
musically Psychotherapy”
through slow tempo in or
thedescending
taxonomy passageslater in this
(also
known as isomorphism) (Berlyne, 1971; Kreitler & Kreitler, 1972). book).
known as isomorphism) (Berlyne, 1971; Kreitler & Kreitler, 1972). video in
With this procedure, the therapist introduces a song or music
In all the aforementioned examples, general moods seem to be a more which theInlyrics
all the present a situation or
aforementioned emotional
examples, expression
general moods on seem
a topictorelated to
be a more
characteristic response than specific emotions, even though such general thecharacteristic
client’s personal issues. As clients reflect upon the lyrics,
response than specific emotions, even though such general they may recognize
mood responses may evoke reminiscence of specific past events (Kreitler & a familiar dilemma,may
mood responses situation, or feeling within
evoke reminiscence the song.
of specific pastAlthough the song&
events (Kreitler
Kreitler, 1972). This leads to an important point: it is quite difficult to trace mayKreitler, 1972). This leads to an important point: it is quite difficultmusical
tell of everyday feelings or problems, through the novelty of the to trace
the relationship between specific musical stimuli and resulting imagery (Meyer, context, the listener
the relationship is ablespecific
between to bring new meaning
musical stimuli and andresulting
perhapsimagery
new insights
(Meyer,
1956). The listener can attach very private and seemingly inappropriate imagery to 1956).
his or her
Theown situation.
listener can attach very private and seemingly inappropriate imagery
to music as a result of the music’s association with a personal experience. In It is as
to music important
a result of to the
recognize
music’s that cognitive
association withorientation
a personal may modifyIn
experience.
addition, affective experiences themselves may evoke memories that in turn opinions or provide new insights; however, it does
addition, affective experiences themselves may evoke memories that in turn not necessarily result in
corresponding behavioral changes (Kreitler & Kreitler, 1972). Therefore,
The
arouse further
Kreitler, H., &images.
Kreitler,One image The
S. (1972). maypsychology
follow another, notDurham,
of the arts. because NC:of theDuke
music,
Uni- arouse further images. One image may follow another, not because of the music,
but becauseversity Press.
of the subjective content in the listener’s mind (Meyer, 1956). but because of the subjective content in the listener’s mind (Meyer, 1956).
Krumhansl,
WithinC.any (1983). Perceptual
cultural structures
context, for tonal
however, music.
there areMusic Perception,
so-called 1, 28–62.
collective Within any cultural context, however, there are so-called collective
Langer, S. K. (1953). Feeling and form. New York: Scribners.
responses common to an entire group. Individuals tend to concur regarding responses common to an entire group. Individuals tend to concur regarding
theLathom, W. B. (1981).
mood elicited Role oftypes
by certain music oftherapy in thestimuli.
musical educationForof example,
handicapped children and
descending the mood elicited by certain types of musical stimuli. For example, descending
youth. Lawrence, KS: National Association of Music Therapy.
chromatic passages in Western music are often associated with grief or despair chromatic passages in Western music are often associated with grief or despair
Meyer, 1956;
(Meyer, L. B. (1956).
Radocy Emotion and meaning
& Boyle, 1979). in music. Chicago: University of Chicago Press. (Meyer, 1956; Radocy & Boyle, 1979).
Nordoff, P., & Robbins,
Whether C. (1983).
music evokes Music therapy
emotional response in special
througheducation (2nd
intrinsic or ed.). St. Louis:
extramusi- Whether music evokes emotional response through intrinsic or extramusi-
cal events,MMB Music.to transport the listener into the affective domain gives it
its ability cal events, its ability to transport the listener into the affective domain gives it
Plach, T.place
a special (1980). The creative
among use ofmodalities.
therapeutic music in groupAs therapy.
Zwerling Springfield, IL: Charles
(1979) points out, aC. a special place among therapeutic modalities. As Zwerling (1979) points out, a
Thomas.
major goal of many forms of psychotherapy is to increase affective awareness and major goal of many forms of psychotherapy is to increase affective awareness and
Plutchik, R. (1984). A general psychoevolutionary theory. In K. Scherer & P. Ekman
expression. He maintains that the ability of the arts to tap directly the affective expression. He maintains that the ability of the arts to tap directly the affective
(Eds.), Approaches to emotion (pp. 197–219). Hillsdale, NJ: Erlbaum.
domain, as opposed to working through intellectual processes, makes them a domain, as opposed to working through intellectual processes, makes them a
Radocy, R. E., & Boyle, J. D. (1979). Psychological foundations of musical behavior.
particularly potent tool in psychiatric care. particularly potent tool in psychiatric care.
Springfield, IL: Charles C. Thomas.
While some might criticize the authenticity of musical expression of While some might criticize the authenticity of musical expression of
Seashore, C. E. (1941). Why we love music. Philadelphia: Oliver Ditson.
emotion due to music’s nondesignative nature, this lack of denotative meaning emotion due to music’s nondesignative nature, this lack of denotative meaning
Sloboda, J. A. (1985). The musical mind: The cognitive psychology of music. Oxford:
provides Clarendon
freedom of individual projection and identification in music therapy
Press. provides freedom of individual projection and identification in music therapy
(Kreitler & Kreitler, 1972).
Sternberg, R. J. (1996). CognitiveOne aesthetic object
psychology. New can
York:take on unique,
Harcourt Braceindividually
College. (Kreitler & Kreitler, 1972). One aesthetic object can take on unique, individually
relevant
Thayer,meaning whileThe
R. E. (1996). providing a more general
origin of everyday symbolicenergy,
moods: Managing message (Kreitler
tension, &
and stress. relevant meaning while providing a more general symbolic message (Kreitler &
Kreitler, New
1972). Musical stimuli permit
York: Oxford University Press. multiple interpretations, and the listener Kreitler, 1972). Musical stimuli permit multiple interpretations, and the listener
enjoys theW.
Winner, freedom
(1982). of defining
Invented what
worlds. the music
Cambridge, MA:means.
Harvard Kreitler andPress.
University Kreitler enjoys the freedom of defining what the music means. Kreitler and Kreitler
(1972) suggest that the subtle economy of art, which does
Wolfe, D. (1980). The effect of automated interrupted music on head posturing not provide full of (1972) suggest that the subtle economy of art, which does not provide full
disclosure, obliges the observer to supplement meaning with
cerebral palsied individuals. Journal of Music Therapy, 17, 184–206. personal experience disclosure, obliges the observer to supplement meaning with personal experience
and projection
Zwerling, of individual
I. (1979). Creativeneeds. Even inWashington,
arts therapies. more cognitively oriented approaches
DC: American Psychological and projection of individual needs. Even in more cognitively oriented approaches
to therapy, which
Association. emphasize intellectual rather than affective growth, the lack to therapy, which emphasize intellectual rather than affective growth, the lack
of designative meaning in musical stimuli provides opportunity for exercise in of designative meaning in musical stimuli provides opportunity for exercise in
problem solving, decision making, evaluation, and observation (Corey, 1986) problem solving, decision making, evaluation, and observation (Corey, 1986)
(e.g., rational-emotive and reality therapy models). (e.g., rational-emotive and reality therapy models).
Whatever the therapeutic application of music, the therapist must consider Whatever the therapeutic application of music, the therapist must consider
the importance of selecting music that is meaningful in terms of past experience the importance of selecting music that is meaningful in terms of past experience
and expectations, as well as in its potential for eliciting extramusical association. and expectations, as well as in its potential for eliciting extramusical association.
It is unrealistic to assume that a music therapist can systematically guide a It is unrealistic to assume that a music therapist can systematically guide a
specific cognitive or emotional response through the selection of a particular specific cognitive or emotional response through the selection of a particular
music excerpt. Responses will differ among individuals. The music therapist music excerpt. Responses will differ among individuals. The music therapist
should take pains to familiarize himself with the musical tastes and backgrounds should take pains to familiarize himself with the musical tastes and backgrounds
of the individuals in a group, taking into consideration age and other cultural of the individuals in a group, taking into consideration age and other cultural
differences (see Chapter 4). The therapist should also select music that readily differences (see Chapter 4). The therapist should also select music that readily
evokes nonmusical associations through structural “mimicry,” musical styles, evokes nonmusical associations through structural “mimicry,” musical styles,
selections associated with events of personal significance, or lyrics that are selections associated with events of personal significance, or lyrics that are
pertinent to client concerns. Music’s ability to evoke mood makes it a powerful pertinent to client concerns. Music’s ability to evoke mood makes it a powerful
resource for therapy. resource for therapy.
85 85
Therapeutic Process
83
Special Properties of Aesthetic Objects Special Propertiesaesthetic

In conclusion, of Aesthetic Objects
stimuli have therapeutic potential in terms of
attention, perception, higher cognitive processes, and emotion, when these
Because Kreitler and Kreitler (1972) consider aesthetic response to be Because Kreitler and Kreitler (1972) consider aesthetic response to be
properties are selected and applied by a skilled music therapist. While musical
unique, as opposed to an extension of general psychological processes, they unique, as opposed to an extension of general psychological processes, they
experiences in and of themselves may provide pleasure and feelings of well-
identify features common to most aesthetic experiences. Experienced music identify features common to most aesthetic experiences. Experienced music
being, the systematic usage of musical stimuli is of real importance to specific
therapists will recognize these features as potentially beneficial in the therapeutic therapists will recognize these features as potentially beneficial in the therapeutic
therapeutic direction. Without this direction, the music has no more specific or
process: (1) preparatory set, (2) aesthetic distance, (3) feeling into, or empathy, process: (1) preparatory set, (2) aesthetic distance, (3) feeling into, or empathy,
extended therapeutic value than the music in a concert or on the radio.
(4) identification, and (5) multileveledness. (4) identification, and (5) multileveledness.
1. Preparatory set. This feature, previously discussed as part of eliciting 1. Preparatory set. This feature, previously discussed as part of eliciting
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models.
normal students as an aid to retention. Unpublished doctoral dissertation, Michigan
3. Feeling into. This characteristic, sometimes called empathy, makes 3. Feeling
State University. into. This characteristic, sometimes called empathy, makes
possible intensification and personalization of elicited tensions through the possible
Gfeller, K. E.,intensification and personalization
Asmus, E., & Eckert, of elicited of
M. (1991). An investigation tensions
emotionalthrough
responsethe
reflection of emotions represented or implicit in the work of art. The empathic reflection
to music of emotions represented
and text. Psychology or implicit
of Music, 19 (2), in the work of art. The empathic
128–141.
response is an attenuated rather than realistic form of emotional response. response
Gfeller, K. E.,is &anCoffman,
attenuated rather than
D. (1991). realistic form
An investigation of emotional
of emotional response.
responses of trained
musicians to verbal and musical information. Psychomusicology, 10 (1), 3–18.
4. Identification. Repressed or ungratified wishes and imaginary fulfillment 4. Identification. Repressed or ungratified wishes and imaginary fulfillment
Hargreaves, J. D. (1984). The effects of repetition on liking for music. Journal of Research
are activated through sublimation, projection, or identification. are activated through sublimation,
in Music Education, 32, 35–47. projection, or identification.
5. Multileveledness. The richness and symbolic nature of art allows multiple Heyduck,5. R.Multileveledness.
G. (1975). Rated preference
The richness for musical composition
and symbolic natureas of
it relates to complex-
art allows multiple
(even simultaneous or contradictory) interpretations of the aesthetic event. This ity and exposure frequency. Perception and Psychophysics, 17,
(even simultaneous or contradictory) interpretations of the aesthetic event. This 84–91.
feature in part explains why one artwork can be meaningful to so many people and Higgs, G.,in&part
feature McLeish,
explainsJ. (1966).
why oneAnartwork
inquiry can
intobethemeaningful
musical capacities of educationally
to so many people and
take on very personal meaning for each observer. Multileveledness is particularly take on very personal meaning for each observer. Multileveledness Education.
sub-normal children. Cambridge, England: Cambridge Institute of is particularly
helpful in terms of group-therapy settings. For example, the therapist or group Hodges,
helpfulD.inA.terms(1980).of Neurophysiology and musical
group-therapy settings. Forbehavior.
example,Inthe D. therapist
A. Hodgesor(Ed.),
group
Handbook of music psychology (pp. 195–224). Lawrence, KS: National Association
facilitator may select musical stimuli either as a focal point for a theme centered facilitator may select musical stimuli either as a focal point for a theme centered
for Music Therapy.
interaction or to represent a common group tension (Plach, 1980). interaction or to represent a common group tension (Plach, 1980).
The
Therapeutic Process
Special Propertiesaesthetic
In conclusion, of Aesthetic Objects
stimuli have therapeutic potential in terms of In conclusion, aesthetic stimuli have therapeutic potential in terms of
attention, perception, higher cognitive processes, and emotion, when these attention, perception, higher cognitive processes, and emotion, when these
Because Kreitler and Kreitler (1972) consider aesthetic response to be
properties are selected and applied by a skilled music therapist. While musical properties are selected and applied by a skilled music therapist. While musical
unique, as opposed to an extension of general psychological processes, they
experiences in and of themselves may provide pleasure and feelings of well- experiences in and of themselves may provide pleasure and feelings of well-
identify features common to most aesthetic experiences. Experienced music
being, the systematic usage of musical stimuli is of real importance to specific being, the systematic usage of musical stimuli is of real importance to specific
therapists will recognize these features as potentially beneficial in the therapeutic
therapeutic direction. Without this direction, the music has no more specific or therapeutic direction. Without this direction, the music has no more specific or
process: (1) preparatory set, (2) aesthetic distance, (3) feeling into, or empathy,
extended therapeutic value than the music in a concert or on the radio. extended therapeutic value than the music in a concert or on the radio.
(4) identification, and (5) multileveledness.
1. Preparatory set. This feature, previously discussed as part of eliciting
attention, may also increase readiness for emotional involvement. Because
Altshuler,
society I.views
M. (1956).
art asMusic potentiating
a special drugs. Inemotionally
and generally E. T. Gaston (Ed.),
laden Music therapy it
experience, Altshuler, I. M. (1956). Music potentiating drugs. In E. T. Gaston (Ed.), Music therapy
1955 (pp. 120–126). Lawrence KS: National
facilitates expectations for emotional response. Association for Music Therapy. 1955 (pp. 120–126). Lawrence KS: National Association for Music Therapy.
Berlyne, D. E. (1971). Aesthetics and psychobiology. New York: Appleton-Century-Crofts. Berlyne, D. E. (1971). Aesthetics and psychobiology. New York: Appleton-Century-Crofts.
Bregman,2.A.Aesthetic
S. (1990). distance . One
Auditory feature
scene characteristic
analysis: The perceptualof most art is disinterested-
organization of sound. Bregman, A. S. (1990). Auditory scene analysis: The perceptual organization of sound.
ness,Cambridge,
or aestheticMA: distance. This may result in part from the physical remoteness
MIT Press. Cambridge, MA: MIT Press.
built into
Carlson, J. G.many art experiences
& Hatfield, E. (1992). The(such as frames
psychology around(pp.
of emotions pictures,
3–26).staging,
New York: and Carlson, J. G. & Hatfield, E. (1992). The psychology of emotions (pp. 3–26). New York:
concert hall structures)
Harcourt as wellCollege.
Brace Jovanovich as the art form’s separation from practical needs Harcourt Brace Jovanovich College.
and ends.
Carter, Aesthetic
S. A. (1982). Musicdistance
therapynot only tends
for mentally to inhibit
retarded the usual
children. In W. B. motor
Lathamresponse
and Carter, S. A. (1982). Music therapy for mentally retarded children. In W. B. Latham and
to affect
C. T. what
Eagle we experience
(Eds.), in reality
Music therapy (for example,
for handicapped we (Vol.
children do not run61–114).
2, pp. on stage C. T. Eagle (Eds.), Music therapy for handicapped children (Vol. 2, pp. 61–114).
St. Louis:
to accost MMB Music.
the villain in a play), but also facilitates emotional involvement. The St. Louis: MMB Music.
Clair, A. A. (1996).
observer, Therapeutic
even though uses of music
involved, can with
viewoldertheadults. Baltimore:
situation in a moreHealthobjective,
Profes- Clair, A. A. (1996). Therapeutic uses of music with older adults. Baltimore: Health Profes-
sions fashion.
removed Press. sions Press.
Corey, G.This
(1986). Theory andinvolvement,
intensified practice of counseling and psychotherapy
coupled with some (3rd leveled.). Monterey,
of objectivity, Corey, G. (1986). Theory and practice of counseling and psychotherapy (3rd ed.). Monterey,
CA: Brooks/Cole.
promotes insight and examination into personal problems or concerns without CA: Brooks/Cole.
Ehrlich, V. (1965). Russian
the subjective, emotionalformalism (2nd ed.).
reaction that New
mayYork: Humanities.
hamper judgment in real life Ehrlich, V. (1965). Russian formalism (2nd ed.). New York: Humanities.
Gallup, G., Jr., & Castelli, J. (1989). The people’s religion.
(Kreitler & Kreitler, 1972). As in the case of expanded cognitive New York: Macmillan.
orientation, this Gallup, G., Jr., & Castelli, J. (1989). The people’s religion. New York: Macmillan.
Gaston, E. T. (1968).
characteristic of theMusic in therapy.
aesthetic New York:
experience mayMacmillan.
be a useful tool in insight-oriented Gaston, E. T. (1968). Music in therapy. New York: Macmillan.
Gfeller,
therapyK. E. (1982). The use of melodic-rhythmic mnemonics with learning disabled and
models. Gfeller, K. E. (1982). The use of melodic-rhythmic mnemonics with learning disabled and
normal students as an aid to retention. Unpublished doctoral dissertation, Michigan normal students as an aid to retention. Unpublished doctoral dissertation, Michigan
3. Feeling
State University. into. This characteristic, sometimes called empathy, makes State University.
possible
Gfeller, K. E.,intensification and personalization
Asmus, E., & Eckert, of elicited of
M. (1991). An investigation tensions
emotionalthrough
responsethe Gfeller, K. E., Asmus, E., & Eckert, M. (1991). An investigation of emotional response
reflection
to music of emotions represented
and text. Psychology or implicit
of Music, 19 (2), in the work of art. The empathic
128–141. to music and text. Psychology of Music, 19 (2), 128–141.
response
Gfeller, K. E.,is &anCoffman,
attenuated rather than
D. (1991). realistic form
An investigation of emotional
of emotional response.
responses of trained Gfeller, K. E., & Coffman, D. (1991). An investigation of emotional responses of trained
musicians to verbal and musical information. Psychomusicology, 10 (1), 3–18. musicians to verbal and musical information. Psychomusicology, 10 (1), 3–18.
4. Identification. Repressed or ungratified wishes and imaginary fulfillment
Hargreaves, J. D. (1984). The effects of repetition on liking for music. Journal of Research Hargreaves, J. D. (1984). The effects of repetition on liking for music. Journal of Research
are activated through sublimation,
in Music Education, 32, 35–47. projection, or identification. in Music Education, 32, 35–47.
Heyduck,5. R.Multileveledness.
G. (1975). Rated preference
The richness for musical composition
and symbolic natureas of
it relates to complex-
art allows multiple Heyduck, R. G. (1975). Rated preference for musical composition as it relates to complex-
ity and exposure frequency. Perception and Psychophysics, 17,
(even simultaneous or contradictory) interpretations of the aesthetic event. This 84–91. ity and exposure frequency. Perception and Psychophysics, 17, 84–91.
Higgs, G.,in&part
feature McLeish,
explainsJ. (1966).
why oneAnartwork
inquiry can
intobethemeaningful
musical capacities of educationally
to so many people and Higgs, G., & McLeish, J. (1966). An inquiry into the musical capacities of educationally
take on very personal meaning for each observer. Multileveledness Education.
sub-normal children. Cambridge, England: Cambridge Institute of is particularly sub-normal children. Cambridge, England: Cambridge Institute of Education.
Hodges,
helpfulD.inA.terms(1980).of Neurophysiology and musical
group-therapy settings. Forbehavior.
example,Inthe D. therapist
A. Hodgesor(Ed.),
group Hodges, D. A. (1980). Neurophysiology and musical behavior. In D. A. Hodges (Ed.),
Handbook of music psychology (pp. 195–224). Lawrence, KS: National Association Handbook of music psychology (pp. 195–224). Lawrence, KS: National Association
facilitator may select musical stimuli either as a focal point for a theme centered
for Music Therapy. for Music Therapy.
interaction or to represent a common group tension (Plach, 1980).
80
80
Therapeutic Process
81
Kreitler, H., & Kreitler, S. (1972). The psychology of the arts. Durham, NC: Duke Uni- arouse further
Kreitler, H., &images.
Kreitler,One image The
S. (1972). maypsychology
follow another, notDurham,
of the arts. because NC:of theDuke
music,
Uni-
versity Press. but becauseversity Press.
of the subjective content in the listener’s mind (Meyer, 1956).
Krumhansl, C. (1983). Perceptual structures for tonal music. Music Perception, 1, 28–62. Krumhansl,
WithinC.any (1983). Perceptual
cultural structures
context, for tonal
however, music.
there areMusic Perception,
so-called 1, 28–62.
collective
Langer, S. K. (1953). Feeling and form. New York: Scribners. Langer, S. K. (1953). Feeling and form. New York: Scribners.
responses common to an entire group. Individuals tend to concur regarding
Lathom, W. B. (1981). Role of music therapy in the education of handicapped children and theLathom, W. B. (1981).
mood elicited Role oftypes
by certain music oftherapy in thestimuli.
musical educationForof example,
handicapped children and
descending
youth. Lawrence, KS: National Association of Music Therapy. youth. Lawrence, KS: National Association of Music Therapy.
chromatic passages in Western music are often associated with grief or despair
Meyer, L. B. (1956). Emotion and meaning in music. Chicago: University of Chicago Press. Meyer, 1956;
(Meyer, L. B. (1956).
Radocy Emotion and meaning
& Boyle, 1979). in music. Chicago: University of Chicago Press.
Nordoff, P., & Robbins, C. (1983). Music therapy in special education (2nd ed.). St. Louis: Nordoff, P., & Robbins,
Whether C. (1983).
music evokes Music therapy
emotional response in special
througheducation (2nd
intrinsic or ed.). St. Louis:
extramusi-
MMB Music. cal events,MMB Music.to transport the listener into the affective domain gives it
its ability
Plach, T. (1980). The creative use of music in group therapy. Springfield, IL: Charles C. Plach, T.place
a special (1980). The creative
among use ofmodalities.
therapeutic music in groupAs therapy.
Zwerling Springfield, IL: Charles
(1979) points out, aC.
Thomas. Thomas.
major goal of many forms of psychotherapy is to increase affective awareness and
Plutchik, R. (1984). A general psychoevolutionary theory. In K. Scherer & P. Ekman Plutchik, R. (1984). A general psychoevolutionary theory. In K. Scherer & P. Ekman
expression. He maintains that the ability of the arts to tap directly the affective
(Eds.), Approaches to emotion (pp. 197–219). Hillsdale, NJ: Erlbaum. (Eds.), Approaches to emotion (pp. 197–219). Hillsdale, NJ: Erlbaum.
domain, as opposed to working through intellectual processes, makes them a
Radocy, R. E., & Boyle, J. D. (1979). Psychological foundations of musical behavior. Radocy, R. E., & Boyle, J. D. (1979). Psychological foundations of musical behavior.
particularly potent tool in psychiatric care.
Springfield, IL: Charles C. Thomas. Springfield, IL: Charles C. Thomas.
While some might criticize the authenticity of musical expression of
Seashore, C. E. (1941). Why we love music. Philadelphia: Oliver Ditson. Seashore, C. E. (1941). Why we love music. Philadelphia: Oliver Ditson.
emotion due to music’s nondesignative nature, this lack of denotative meaning
Sloboda, J. A. (1985). The musical mind: The cognitive psychology of music. Oxford: Sloboda, J. A. (1985). The musical mind: The cognitive psychology of music. Oxford:
Clarendon Press. provides Clarendon
freedom of individual projection and identification in music therapy
Press.
Sternberg, R. J. (1996). Cognitive psychology. New York: Harcourt Brace College. (Kreitler & Kreitler, 1972).
Sternberg, R. J. (1996). CognitiveOne aesthetic object
psychology. New can
York:take on unique,
Harcourt Braceindividually
College.
Thayer, R. E. (1996). The origin of everyday moods: Managing energy, tension, and stress. relevant
Thayer,meaning whileThe
R. E. (1996). providing a more general
origin of everyday symbolicenergy,
moods: Managing message (Kreitler
tension, &
and stress.
New York: Oxford University Press. Kreitler, New
1972). Musical stimuli permit
York: Oxford University Press. multiple interpretations, and the listener
Winner, W. (1982). Invented worlds. Cambridge, MA: Harvard University Press. enjoys theW.
Winner, freedom
(1982). of defining
Invented what
worlds. the music
Cambridge, MA:means.
Harvard Kreitler andPress.
University Kreitler
Wolfe, D. (1980). The effect of automated interrupted music on head posturing of (1972) suggest that the subtle economy of art, which does
Wolfe, D. (1980). The effect of automated interrupted music on head posturing not provide full of
cerebral palsied individuals. Journal of Music Therapy, 17, 184–206. disclosure, obliges the observer to supplement meaning with
cerebral palsied individuals. Journal of Music Therapy, 17, 184–206. personal experience
Zwerling, I. (1979). Creative arts therapies. Washington, DC: American Psychological and projection
Zwerling, of individual
I. (1979). Creativeneeds. Even inWashington,
arts therapies. more cognitively oriented approaches
DC: American Psychological
Association. to therapy, which
Association. emphasize intellectual rather than affective growth, the lack
of designative meaning in musical stimuli provides opportunity for exercise in
problem solving, decision making, evaluation, and observation (Corey, 1986)
(e.g., rational-emotive and reality therapy models).
Whatever the therapeutic application of music, the therapist must consider
the importance of selecting music that is meaningful in terms of past experience
and expectations, as well as in its potential for eliciting extramusical association.
It is unrealistic to assume that a music therapist can systematically guide a
specific cognitive or emotional response through the selection of a particular
music excerpt. Responses will differ among individuals. The music therapist
should take pains to familiarize himself with the musical tastes and backgrounds
of the individuals in a group, taking into consideration age and other cultural
differences (see Chapter 4). The therapist should also select music that readily
evokes nonmusical associations through structural “mimicry,” musical styles,
selections associated with events of personal significance, or lyrics that are
pertinent to client concerns. Music’s ability to evoke mood makes it a powerful
resource for therapy.
85
READING 20
Taken from: Bruscia, K., & Grocke, D. (Eds.). Guided Imagery and Music: The Bonny Method
and Beyond, pp. 369-378. Gilsum NH: Barcelona Publishers.
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READING 21
EMBRACING FEMINISMS IN MUSIC THERAPY1
Susan Hadley
but i think the time is nothing

if not nigh
to let the truth out
coolest f-word ever deserves a f---ing shout!
i mean
why can’t all decent men and women
call themselves feminists?
out of respect
for those who fought for this
—Ani de Franco
(lyrics excerpt from “Grand Canyon”)
Introduction
Simone de Beauvoir stated that “one is not born, but rather becomes a woman” (Beauvoir,
1953/1989, p. 267). I understand this statement to mean that although I was born female in terms
of my biology, I have become the gendered person who I see myself as, and who others see me
as, through a complex process of socialization. 2 While I know aspects of that process of
socialization, much of it is invisible to me. In a similar vein to de Beauvoir, bell hooks states that
“feminists are made, not born” (hooks, 2000, p. 7). She goes on to say that “one does not become
an advocate of feminist politics simply by having the privilege of having been born female”
(hooks, 2000, p. 7). By this, she means that many females have been socialized in similar ways
as males in terms of sexist thinking and values and that just by being biologically female does
not automatically entail that one will be concerned with or take up feminist issues. Reflecting on
the extent to which the process of gender socialization was largely taken as a given, bell hooks
writes that “before women could change patriarchy, we had to change ourselves; we had to raise
our consciousness” (hooks, 2000, p. 7). For many, this consciousness raising needed to take
place in a safe space, away from the dominant (white male) group, a safe space in which to
explore issues specific to women. This need for a safe place to explore should not be seen by the
dominant group as a sign of opposition (or antimale). In some ways, this space is reminiscent of
the type of safe space that we create for our clients. The “safety” of the space encourages
honesty, acceptance, and shared insight.
Once the consciousness of the oppressed group (in this case, women) has been raised, it is
then important to encourage and support those in the dominant group (in this case, men) to
1
An earlier version of this article appeared as the introduction to Feminist Perspectives in Music Therapy (Barcelona, 2006).
2
Singer-songwriter Dar Williams describes this process of socialization that both males and females go through in her song
“When I Was a Boy,” on her album The Honesty Room (1995).
2 Susan Hadley
engage in a similar process of consciousness raising. Paulo Friere describes this process in
relation to his pedagogy:
The pedagogy of the oppressed, as a humanist and libertarian pedagogy, has two
distinct stages. In the first, the oppressed unveil the world of oppression and
through the praxis commit themselves to its transformation. In the second stage,
in which the reality of oppression has already been transformed, this pedagogy
ceases to belong to the oppressed and becomes a pedagogy of all people in the
process of permanent liberation. (Friere, 1970/2000, p. 54)
In this vein, when exploring feminism in music therapy, I first sought to engage with other
women in terms of consciousness raising (see Hadley, 2006b) and now seek to engage in broader
dialogues and increase the scope of consciousness raising. Later in this chapter, I will discuss the
role of men in feminism and how feminism can benefit boys and men in therapy.
According to hooks (2000), becoming a feminist involves both choice and action. And this
choice and action can be taken by females and males alike. The difference for males is that they
continue to benefit from patriarchal privilege whether or not they are feminist. And, just as many
aspects of white privilege remain invisible to white people, many aspects of male privilege
continue to go unnoticed by even the most well-intentioned, feminist-conscious males. While
men/whites/ heterosexuals/nondisabled “may grant that women/[nonwhites/ GLBTs/disabled]
are disadvantaged,” many are unwilling “to grant that they [men/whites/heterosexuals/
nondisabled] are overprivileged” (McIntosh, 1997, p. 291). Peggy McIntosh asserts that when we
belong to the dominant group, we are carefully taught not to recognize and even to deny the
unearned privileges of that group. She describes such privileges as “an invisible package [or
knapsack] of unearned assets which I can count on cashing in each day, but about which I was
‘meant’ to remain oblivious” (McIntosh, 1997, p. 291). It is challenging to admit the ways in
which we are oppressors, even if we can admit that certain groups are indeed oppressed. It is
easy to distance ourselves from these oppressive groups without realizing the benefits that we
continue to reap as members of the oppressor group. It takes continual critical self-reflexivity to
identify the daily effects of privilege in our lives and then to go about trying to challenge and
“weaken these hidden forms of advantage” (McIntosh, 1997, p. 299). Many white males feel like
they are now the most discriminated-against group, because of the efforts being made to “level
the playing field.” What has historically represented their “entitlement” is not so readily
accessible today. Many even suggest that minorities (women, nonwhites, disabled) are given
positions instead of white males simply because they are minorities, suggesting that in fact
minorities are inferior and are given “special” treatment (so-called reverse discrimination). This
denies the actual abilities and qualifications of minorities and downplays the lack of
educational/economic/social opportunities that disproportionately impact the lives of minorities.
As such, it is important that feminists continue to raise awareness about the complex ways in
Embracing Feminisms in MT 3
which the patriarchal system continues to restrict ways of being “human” and continue to support
oppressive practices.
My Path to Feminism
To trace my journey toward becoming a feminist, I must look at the context in which I grew up,
that is, make sense of my personal history. This approach accents the significance of social
context and situation as important media that impact what and how we come to know what we
know. It is not that I said to myself one day, stating in a formulaic fashion, “I want to be a
feminist and these are the steps I must take to become one.” I was born into a sociocultural
historical matrix that had already shaped or positioned me, as white, female, nondisabled,
middle-class, Christian, Australian, etc. Within this inherited framework, though, there are many
possibilities for how I narrate who I am. In other words, “we create as we are also created”
(Yancy & Hadley, 2005, p. 11). There are various discourses and belief systems that we may
adopt or reject that play a part in structuring our “personal” identities. These discourses and
ideologies also play a part in structuring societies. However, I believe that even if we are born
into a sociocultural historical framework in which the dominant ideology is one in which power
is gained through the exploitation and oppression of others, given that there are non-exploitative
and non-oppressive frameworks that are concurrently available that encourage mutual respect,
we can “choose” to re-narrate our identities in ways that shape our political praxes and thus help
to militate against the ways in which our gender, race, class, age, ability, sexual, religious, and
national privileges disadvantage others; indeed, we can engage in practices that strive to bring an
end to all types of oppression.
So, why do I find it important to share selective experiences from my personal history? How
will these first-person accounts function? Susan Brison notes that it is “not out of sloppy self-
indulgence,” but that “feminist theorists are increasingly looking at first-person accounts to gain
imaginative access [italics mine] to others’ experience” (2002, p. 25). Thus, I am writing the
following account not only to contextualize my own process of becoming a feminist and to give
you, the reader, a greater understanding of my evolving consciousness, but also in the hope that
you, too, will be encouraged to reflect on your own experiences, how they have shaped and
continue to shape your evolving consciousness and sense of self, and how they contribute to your
critical or uncritical investment in your gender, race, class, age, ability, sexual, religious, and
national identities.
I believe that aspects of my feminist consciousness were shaped by my maternal
grandmother, who was born at the turn of the twentieth century, during the “first wave” of
modern feminism. She was raised by her grandmother (who must have been unusually
progressive), who nourished my grandmother’s intellectual desires and encouraged her to pursue
a career before concerning herself with marriage and children. My grandmother became a
teacher and then traveled alone from England to Singapore, where she taught, married, and had
4 Susan Hadley
two daughters. During World War II, she was evacuated with her two young children to
Australia. Subsequently, my grandfather died as a prisoner of war and my grandmother raised
my mother and my aunt alone. As had her grandmother, my grandmother nourished her
daughters’ intellectual and creative desires and encouraged them to complete university degrees
and pursue their careers before having a family, if they so chose. Having grown up in an all-
female household and having attended an all-female school, my mother had a very healthy sense
of her identity as an independent woman. She studied science and mathematics, which were not
traditional areas for women of her generation to study, and became a high school mathematics
teacher. Teaching, of course, was a traditional career choice for women.
The status of women was different in my father’s family. My paternal grandmother,
although she, too, had been educated at an all-female school, believed that it was more important
for males to be educated than females. Thus, my father was sent away to a boarding school at the
age of 12, while his two sisters attended local high schools. In addition, his musical talents were
nourished. My father went on to obtain university degrees, including the Ph.D., whereas his
sisters did not.
I was born during the “second wave” of modern feminism, when my mother was in her mid-
30s and my maternal grandmother was in her 60s. When I was four, I began attending the all-
female school at which my mother taught. The following year, my father became the principal of
this school and my mother had to find another job because the school did not want the
appearance of nepotism. I could not comprehend the claim of nepotism, when my mother had a
history of working there prior to my father’s appointment. I remember always feeling incensed
that my mother’s position was “taken away” from her. Although she had been there first, she was
in the less powerful position, was working part-time, was earning less money, and therefore
obviously felt that it was her “duty” to comply.
My experiences at an all-female school allowed me to experience myself as full of
possibilities. Like my mother, I was drawn to mathematics, physics, and chemistry. Like my
father, I was drawn to music. Many of my teachers were progressive in their politics and
encouraged critical reflection on a range of topics. I remember that one of the first topics that I
explored on the debating team was a woman’s right to have an abortion. I also remember one of
my teachers, who had lived on a kibbutz, getting us to reflect critically on capitalism. One of my
teachers stimulated me to reflect critically on the hierarchical structures within our school when
she encouraged us to question long-standing traditions and call her by her first name. She also
had many other unique approaches to teaching that I did not realize at the time were feminist in
nature. Although many of my teachers obviously held to the liberal views with which, given the
political values of my family, I aligned myself, many of my fellow students did not. Most of
them were from white upper-middle-class families with conservative political values. Many were
outwardly racist and elitist. I found that in response to their dogmatic and myopic political views,
my political views became more progressive. There were many times when I questioned their
assumed right to class privilege, when I was appalled by their racist assumptions, and when I
critiqued their sexist practices. I began to question why women wore makeup, shaved, had their
hair styled and their nails manicured, etc., or at least for whom. I wondered why certain women
dressed the way they did and then began to look at the ways in which I, too, was adopting what I
now deem social practices that were/are oppressive toward women.
Of course, I did not create these questions or even the position I took in relationship to them
from thin air. There were already feminist, socialist, antiracist, etc., frameworks according to
which I could view the world. But, oddly enough, as passionate as I was in my views, I did not
realize the extent to which I was, and am still, in many ways, unwittingly upholding various
dominant oppressive ideologies. I remember several experiences where I found myself in a state
of cognitive dissonance, where what I assumed to be “a given” came up against a different
perspective that challenged my assumptions. I will provide three examples.
The first was my assumption that only “weak” women remained in abusive relationships.
When I found myself in an abusive relationship in my early 20s, my beliefs and understanding
shifted. I began to understand the complexities involved in abuse and in relationships. I began to
understand how the sexist discourses of males and females shape how we view the victim of
abuse as being partially, if not fully, responsible for the abuse. I found that these discourses
become internalized in detrimental ways.
My second example involves the way that I see the physical layout of the world and my
assumption that how I see it is how it actually is.3 One day, I was helping a friend rearrange her
bedroom in order to maximize the minimal space. I found a perfect solution and began to assert
my viewpoint. When she looked at me and asked how she would get her clothes out of her
wardrobe or get into bed, I replied that it was easy and proceeded to show her. As she looked at
me and shook her head in tolerant amusement, the ignorance of my suggestions became
embarrassingly clear. I had not taken into consideration that her wheelchair would not fit into the
tight spaces that my upright ambulatory body did! In retrospect, this experience helped me to
realize how certain (nondisabled) bodies take for granted various ways of moving in spaces that
are based upon assumptions that are exclusionary in relation to “other” (disabled) bodies.
My final example is from when I first moved from Australia to the USA. I moved into a
neighborhood in which the majority of the residents were African-American. For the first time in
my life, as a white woman, I was in the racial minority. I was struck by how I was constantly
aware of the color of my skin. I felt that negative assumptions were being made about me based
purely on the color of my skin, and I felt angry that I was not being seen for the person I felt I
was. For a while, I was under the erroneous assumption that I now understood what African-
Americans or Native Americans or indigenous Australians or other nonwhite people must
experience in North America, in Australia, and in other countries dominated by white ideology.
3
This is a possible indication that I was at an early stage of development in terms of my feminist identity. McNamara and Rickard
(1989) describe the stages of feminist identity formation as (a) “passive-acceptance” of stereotypical gender roles and constructs,
(b) “revelation” through consciousness raising, (c) “embeddedness-emanation”—developing feminist identity in connecting with
other women, (d) “synthesis,” which involves “the integration of personal and feminist values that result in an authentic feminist
identity,” and (e) “active commitment”—engaging in social change (pp. 68–69).
6 Susan Hadley
Of course, I came to understand that this was a naive assumption because I was still living in
white skin in a culture that privileges whiteness. To be in a context where one is the racial
minority does not entail that one is a member of an oppressed group. One only has to think of
South Africa to see the absurdity of such a belief.
I am often aware of how I am perceived as a woman in relation to men. It happens in various
social contexts in the form of not having my hand shaken; having my spouse spoken to rather
than me when in a discussion of a financial matter; being looked at, spoken to, or whistled at on
the street by men I do not know (an object of their gaze, something for their pleasure); having
people who are working on some part of the house ask to speak to my spouse in order to explain
the problem; having the restaurant bill handed to my spouse; etc. It also happens in healthcare
settings. One notable experience was when I went to the doctor because I knew I was seriously
ill. I was falling asleep all the time, even in the middle of teaching half-hour cello lessons. I had
had plenty of sleep but found it extremely difficult to get myself physically out of the bed. I
asked the doctor to give me a blood test. He felt that it was unnecessary and suggested that what
I really wanted was some time off work and implied that I was “just a stressed woman looking
for time off.” Angered by his implication, I insisted on the blood test. Continuing to believe this
was unnecessary, he mockingly asked what I thought was wrong. So, I diagnosed myself with
mononucleosis (also known as glandular fever). He adamantly stated that he doubted that this
was what I had and that even if it was, it would not show up yet on a blood test. In the end, he
begrudgingly allowed me to have the test that I was demanding. Sure enough, the results proved
my diagnosis to be correct.4
Sexism is also very evident in the academy. Although I have earned a high educational
“status” as a Ph.D. holder, this is regularly undermined by my “status” as a woman. Once, while
being interviewed for a teaching position, the provost of the university frequently called me
“sweetie,” “honey,” and “love.” When I had major difficulties in my first pregnancy and had not
yet accrued enough sick days to cover the months of bed rest that the doctors insisted on, with no
paid maternity leave available, the people in the head office told me that I should have planned
to have my children in the summer. Also, although titles can be argued to be problematic in
terms of power and privilege, it is disappointing to note that I have witnessed female colleagues
who have earned doctorates being referred to as “Ms.” and male colleagues who have not earned
doctorates being referred to as “Dr.” by students and faculty alike.
Gender stereotypes are constantly reinforced by the media. When I watch a movie, I see my
status as a woman in relationship to men. When I glance at magazines, I see how I am supposed
to look, I see what is beautiful. When I hear songs, I understand how I am to experience love and
loss. When I see music videos, my role as “woman” is ever reinforced. In all of these media, I
see how men and women are viewed from the spectatorship of men. The way women are
portrayed is not for my gratification. As singer-songwriter Dar Williams says in her song “When
I Was a Boy”:
4
It is interesting to note that the way that my illness was not taken seriously is not uncommon. See Joke Bradt (2006).
And now I’m in the clothing store, and the signs say Less is More
More that’s tight means more to see, more for them, not more for me
That can’t help me climb a tree in ten seconds flat.
(“The Honesty Room,” 1995)
Over the past decade, I have become more aware not only of how I am oppressed as a
woman, but also of the multiple ways in which I am a part of, and in many ways unconsciously
perpetuate, the dominant oppressive ideologies that I so passionately critique and wish to reject. I
find myself continually questioning my assumptions, my actions, my reactions, my practices of
Othering and oppressing others, overtly or covertly. I feel that it is my ethical obligation to do
what I can to contribute to ending sexism, racism, ablism, heterosexism, and other forms of
oppression. The desire to end such hegemonies partly defines me as a feminist. What we say and
what we do can perpetuate or disrupt existing oppressive ideologies. As music therapists, what
we say and what we play can perpetuate or disrupt oppressive ideologies. This is why I feel that
there is a great need for music therapists to embrace feminist insights that not only attempt to
uncover ways in which oppression continues to exist in overt and covert ways, but also instills a
critical consciousness to name and fight against forms of injustice. In order to provide a
historical framework for feminist music therapy, I will present a brief outline of the history of
feminism, describe some of the major approaches to feminism, and explore the impact of
feminism to date in the music therapy literature.
What Is Feminism?
It is difficult to define feminism because it is diverse and has many forms. Feminism is “a way of
thinking—of observing the world, asking questions, and looking for answers—that may lead to
particular opinions but doesn’t consist of the opinions themselves” (Johnson, 1997, p. 112). A
basic assumption of feminism is that gender inequality exists and that this is problematic.
Johnson (1997) distinguishes among branches of feminism according to the degree to which:
· they understand various aspects of social life—such as sexual domination and violence,
religion, warfare, politics, economics, and how we treat the natural environment—in
relation to gender;
· they explicitly recognize patriarchy as a system, as problematic, as historically rooted,
and in need of change; and
· they see men5 as a dominant group with a vested interest in women’s subordination, the
5
Of course, not all feminists see men as a monolithic group. There are differential levels of domination that are mediated by race,
class, disability, etc.
8 Susan Hadley
perpetuation of patriarchal values, and control over the political, economic, and other
institutions through which those values operate. (p. 112)
Thus, some forms of feminism do not have a strong focus on patriarchy and avoid challenging
men, while others view patriarchy, male privilege, and gender oppression as central. For some
forms of feminism, the focus is narrow (on certain select issues), while for other forms, the focus
is global and multidimensional. Although there are many strands of feminism, they are not
mutually exclusive. While there are significant differences, they share commonalities and have
grown from similar roots. One can find aspects of various forms of feminism useful in various
situations. Therefore, I like Johnson’s analogy of the various feminist approaches as “threads
woven together to form a whole. While the threads are distinctive in many ways, they are
strongest in relation to one another” (p. 113). Or as Alice Paul (1885–1977) stated, “I always feel
the movement is a sort of mosaic. Each of us puts in one little stone, and then you get a great
mosaic at the end” (Kroløkke & Scott Sørensen, 2005, p. 3).
Although there are many approaches to feminism and enactments of feminisms—liberal,
socialist, Marxist, radical, psychoanalytic, standpoint (identity and difference feminisms),
spiritual, ecofeminism, postmodern, poststructuralist, postcolonial, narratological, etc.—one can
say that feminism is an embodied, flesh-and-blood, sociocultural, political, philosophical
movement predominantly created by and for women’s liberation/emancipation from various
forms of male hegemony. Within each of these approaches to feminism there are diverse
instantiations due to the complexities of various interactions of race, class, gender identity, etc.
Some forms of feminism even call into question the definition of woman. A central goal of
feminism is to unmask forms of male hegemony at various sites (home, workplace, academy,
street, doctor’s offices, academic and non-academic professional settings, bedroom, in the media,
in the area of theory construction, research, methodology, epistemology, ontology, aesthetics,
theology, sexuality, identity formation, interaction with the Earth, interaction with other human
beings, and so on) that parade as neutral and/or objective when in fact they hide profound ways
in which men see and understand the world, ways in which their norms, interests, and value-
laden assumptions have been deemed true, as a given.
The feminist movement is most often referred to in terms of the three modern feminist
waves or movements, although it is better understood as existing along a continuum that spans a
far larger timeframe. If we start with the first wave, we risk silencing those women’s voices from
throughout earlier history. Eileen O’Neill discusses the absence of women in history, specifically
in the history of philosophy, and stresses that it was not that women scholars did not exist, but
rather that their work is treated as if it was written in disappearing ink (O’Neill, 1998). She
attributes the dramatic disappearance of women from the histories of philosophy in the 19th
century to the ideals that grew out of the French Revolution—ironically, ideals of humanism and
egalitarianism (pp. 37–39). Addressing this contradiction, she writes:
How to embrace the ideals of a common humanity and egalitarian social order while at
the same time preserving a system of sexual [and racial] difference that underpins
[white] masculine hegemony? Since reason was the property essential to human nature,
and since it was the sole requirement needed by a man to be admitted as a citizen, the
texts of this period are filled with debates about the precise character of a [white]
woman’s [and of a nonwhite man’s or woman’s] exercise of reason, and thus her [or
his] rightful role as citizen. (p. 37)
Within the context of the above quote, such texts revealed a widely held belief that white women
and nonwhite men and women were not capable of reason. There were widespread practices
preventing white females and nonwhite males and females from learning to read and from
participating in civic, economic, and political spheres. O’Neill (1998) writes:
Perhaps all of this should make us suspicious about our histories; about the implicit
claim that our criteria of selection justify our inclusion of philosophers [or composers,
music therapists, etc.] as major, minor, or well-forgotten figures; about our ranking of
issues and argumentative strategies [or compositions, etc.] as central, groundbreaking,
useful, or misguided. (p. 39)
The disappearance of certain histories has had a significant impact on how white women and
nonwhite men and women view themselves and their roles in relationship to white men. This
phenomenon is not specific to philosophy; it is also evident in music, music therapy, and most
other disciplines. Thus, the process of making these histories visible is a vital component in the
process of healing for historically oppressed groups. This is what we do in therapy: We
witness/listen to the oral history of those who we serve.
In order to make the history of the women’s movement more visible, Charlotte Kroløkke
and Anne Scott Sørensen state:
We could go as far back as antiquity and the renowned hataera of Athens, or we could
go even further back to prehistoric times in Mesopotamia and the Mediterranean regions
and discuss goddess religions and matriarchy. Or we could examine the European
Middle Ages and the mystical rhetoric of holy women like Hildegard von Bingen
(1098–1179). (Kroløkke & Scott Sørensen, 2005, p. 2)
Within the context of this historical retrieval process, a way of giving voice to those historically
important women whose voices have been silenced, there was also the French poet and author
Christine de Pizan, who wrote The Book of the City of Ladies in 1405, in which she questioned
the widely held assumption that women were inferior to men because of their sex. Pizan argued
that it was inequities in education and training that created the illusion of male superiority. In
10 Susan Hadley
short, she rejected male ideology masquerading as nature. In her work, Pizan gave attention and
credence to her own experiences and the experiences of other women instead of uncritically
accepting the opinions of male authorities. She trusted her own voice. She critically analyzed
attitudes about women and did research that uncovered the contributions of other women,
thereby modeling important feminist strategies characteristic of contemporary feminism. Other
notable figures are Olympes de Gouges (1748–1793), who drafted a Declaration of the Rights of
Women (1791) in response to the French revolutionaries’ The Declaration of the Rights of Man
(1789), and Mary Wollstonecraft, who wrote A Vindication of the Rights of Woman (1792) in
response to Edmund Burke’s Reflections on the Revolution in France.
In music therapy, we also have a history that seems to be written in disappearing ink. For
instance, E. Thayor Gaston is often described as the founder of the field of music therapy in the
United States because he created the National Association for Music Therapy, wrote one of the
first music therapy text books, and established one of the first programs in music therapy in the
early 1940s (Johnson, 1981). However, prior to Gaston, there were four women whose
significant contributions to music therapy need to be acknowledged more widely. 6 A few authors
in music therapy have helped to keep this history visible (Davis, 1993, 1996; Davis & Gfella,
2008; Hahna, 2011; Maranto, 1993). For example, as early as 1903, Eva Augusta Vescelius
founded the National Society for Musical Therapeutics; she later was influential in establishing
music therapy as a course of study (Davis, 1993; Maranto, 1993). In 1919, Margaret Anderton
taught the first college-level music therapy course at Columbia University in New York. At
around this same time, Isa Maud Ilsen worked as a music therapist in a medical setting; in 1926,
she founded the National Association for Music in Hospitals. And, very early on, Harriet Ayer
Seymour wrote what appear to be the first two music therapy books, What Music Can Do For
You (1920) and An Instructional Course in the Use and Practice of Musical Therapy (1944),
which were targeted toward music therapy clinicians and students, respectively (Davis, 1996;
Davis & Gfeller, 2008).
The Three Waves of Modern Feminism
While there is much to write about the history of feminism before and after the 1800s, I provide
only a synopsis of the three waves of modern feminism. Each wave of feminism became known
by the predominant issues it addressed. The first wave (mid-1800s–1920) has primarily been
associated with access and equal opportunities for women—specifically, the drive for women’s
suffrage. However, Judith Hole and Ellen Levine (1990) describe the women’s movement that
emerged during the 1800s as “a more multi-issued campaign for women’s equality” (p. 452). In
the 1800s, there was a growth of social reform movements and “a philosophical emphasis on
6
I would like to thank Nicole Hahna for stressing the importance of the inclusion of this disappearing history and for providing
such a contextual framing in her dissertation.
individual freedom, the ‘rights of man’ and universal education” (Hole & Levine, 1990, p. 453).
The “first wave” of modern feminism in the United States had its roots in the abolition
movement of the 1830s. Although some women were actively involved in the fight for the
abolition of slavery, there is evidence that they were not respected as equals by their male fellow
abolitionists. According to Hole and Levine, “the brutal and unceasing attacks (sometimes
physical) on the women convinced the Grimkes [Sarah and Angelina] that the issues of freedom
for slaves and freedom for women were inextricably linked” (p. 453). Some of the issues with
which the early feminists were concerned included challenging the assumption of the natural
superiority of man; challenging the social institutions predicated on that assumption, such as
religious dogma and the institution of marriage; challenging stereotypes of women (such as
claims of proper female behavior and talk); equal pay for equal work; state legislative reforms on
women’s property rights, rights to divorce, abortion rights, and rights to guardianship of their
children; non-legislative partnership; temperance (especially in terms of the physical and sexual
abuse that resulted from alcohol consumption by men); dress reform; and, women’s suffrage—
although some felt that suffrage was less important than some of these other issues (Hole &
Levine, 1990, pp. 454–455; Kroløkke & Scott Sørensen, 2005, pp. 5–7).
After the Civil War and the resulting abolition of slavery, though black people continued to
suffer under white supremacy, women were deliberately excluded in the amendments to the
Constitution. Women activists therefore came to see the vote as the means to achieving other
rights, and thus suffrage became the main focus of the women’s movement at that time. This
focus on suffrage was seen by many as more respectable and conservative than many of the other
issues, and support for the women’s movement grew. Results did not come quickly. “The woman
suffrage Amendment … introduced into every session of Congress from 1878 on, was finally
ratified on August 26, 1920” (Hole & Levine, 1990, p. 458).
The “second wave” of modern feminism (1960s and 1970s) grew out of related
emancipation movements in postwar Western societies, including the U.S. civil rights
movement, the Black Power movement, student protests, anti–Vietnam war movements, lesbian
and gay movements, and the Miss America Pageant protests. Women of the second wave of
feminism revived women’s political struggles for civil rights. They found that there was still a
large gap between what they were told women had achieved and their experiences of their own
situations. This was the time when expressions articulated by the radical feminist group
Redstockings became popular—expressions such as “sisterhood is powerful,” “consciousness
raising,” and “the personal is political” (Kroløkke & Scott Sørensen, 2005, p. 9). It was at this
time that various approaches to feminism, the seeds of which had been planted in the first wave,
developed (liberal, socialist, radical), each of which emphasized different explanations of and
remedies for patriarchy and androcentrism. 7 Many of the same issues that were of concern to the
early feminists continued to concern second-wave feminists. What many of the second-wave
7
By patriarchy, I am referring to male-dominated structures and social arrangements; by androcentrism, I am referring to that
which is male-centered, that is, when male norms become the standard.
12 Susan Hadley
feminists overlooked, however, was the significance of race, class, age, sexual orientation, and
ability in contributing to the intersectionist dimensions of oppression, and, thereby they
universalized the experiences of oppression had by middle-class white women. Moreover, given
the lack of critical attention to the differential ways in which male oppression operates along
lines of race, differential class positions, and such considerations, these middle-class white
feminists privileged the types of oppression enacted by men who were well-educated, white, and
occupied a middle-class position. In eventual reaction to such a monolithic presentation of
concerns, various strands of “identity” feminisms began to emerge. Womanism (black
feminism), Mujerista feminism (Latina feminism), Sephardic feminism (Israeli Jewish
feminism), Third World feminism, and lesbian feminism are some examples (Kroløkke & Scott
Sørensen, 2005, pp. 12–13). Thus, in the second wave, many feminist groups acknowledged that
patriarchal oppression is not experienced in a homogeneous fashion.
The “third wave” of modern feminism (1990s) has been marked by “the need to develop a
feminist theory and politics that honor contradictory experiences and deconstruct categorical
thinking” (Kroløkke & Scott Sørensen, 2005, p. 16). These authors have embraced the
significance of “acceptance of a chaotic world, while simultaneously embracing ambiguity and
forming new alliances” (Kroløkke & Scott Sørensen, 2005, p. 18). The third wave is marked by a
“performance turn.” This turn “marks a move away from thinking and acting in terms of
systems, structures, fixed power relations, and thereby also ‘suppression’—toward highlighting
the complexities, contingencies, and challenges of power and the diverse means and goals of
agency” (Kroløkke & Scott Sørensen, 2005, p. 21). Thus, there is a shift from what has been
defined as structuralism to post-structuralism. This wave of feminism includes postcolonial
feminism, which establishes a critical global perspective and creates alliances between diasporic
and subaltern feminisms; queer and transgender feminism, which attacks heteronormativity;
transfeminism, as articulated by Emi Koyama, which espouses that individuals should be free to
construct their own gender identities, rejecting medical and cultural (essentialist) notions of
gender; feminist disability studies, as articulated by Rosemarie Garland-Thomson (1996), Susan
Wendell (1996), and Simi Linton (2005), which considers feminist theorizing to be skewed
toward the nondisabled experience and disability studies to be skewed toward nongendered,
nonraced disability experiences, and which, blending the two, understands the complexity of
disability experience to be integrally related to other aspects of one’s life such as gender, race,
and class; Grrl feminism, as articulated by feminists such as Jennifer Baumgardner and Amy
Richards (2000), which has criticized sexist language while at the same time using mimicry and
subversion in terms of exaggerating stereotypes that traditionally have been used against them,
appropriating and resignifying the meanings of “derogatory” terms for women (such as “girl,”
“slut,” “bitch,” and “ho”), and also inventing self-celebrating words and forms of
communication; the “new feminism” in Western Europe, which is characterized by local,
national, and transnational activism in areas such as violence against women, trafficking of
female bodies, body surgery, self-mutilation, and the overall “pornofication” of the media;
performance third-wave feminism, as articulated by feminists such as Judith Butler, which

understands gender as a set of discursive practices that are linked to a hegemonic, social matrix
and that emphasizes a “performative gesture” with the power to disturb the chain of social
repetition and open up new realities; cyberfeminism, as articulated by Donna Haraway, which is
also aligned with post-structuralist thought and thus understands classifications between society
and subject, materiality and sociality, flesh and soul, and other demarcations to be arbitrary
rather than natural (Kroløkke & Scott Sørensen, 2005, pp. 15–21); hip-hop feminism, as
articulated by Joan Morgan, which is committed to “keeping it real,” which, like rap music,
“samples and layers many voices [sometimes hypocritical and contradictory], injects its
sensibilities into the old and flips it into something new, provocative, and powerful” (Morgan,
1999, p. 62); and postfeminism, a term which is sometimes used to describe a time when
women’s issues and feminism are no longer relevant and is sometimes used to describe the views
of a group of conservative women who define themselves in opposition to and criticize feminists
of the second wave (Heywood & Drake, 1997, p. 1; Rosen, 2001, pp. 274–276).
Some Major Approaches to Feminism
Although there are many different approaches to feminism, I will outline major approaches that
have had a significant impact on feminist thought—liberal, radical, Marxist/socialist,
psychoanalytic (Freudian, Lacanian), black/Asian/Latina/indigenous/Sephardic, postcolonial,
and postmodern feminisms.
In liberal feminism, the explanation for why women have a lower position in society is
because of “unequal rights or ‘artificial’ barriers to women’s participation in the public world,
beyond the family and household” (Beasley, 1999, p. 51). Liberal feminists believe that women
are basically the same as men but are not given the same opportunities. Thus, the solution is to
provide women with freedom of choice, to challenge sexist stereotypes, and to demand equal
access and treatment. The main aim of liberal feminism is to “accord to women the rights that
men hold ‘naturally’” (Whelehan, 1995, p. 29). This is primarily achieved through legal and
political avenues. The emphasis is on “reform of society rather than revolutionary change”
(Beasley, 1999, p. 52).
Radical feminism, by contrast, focuses on the underlying patriarchal system as that which
helps to maintain male privilege. Radical feminists see the problem as “a cultural ideology that
serves male privilege and support’s women’s subordination … it is prejudice plus the power to
act on it” (Johnson, 1997, p. 122). There is a strong emphasis on sisterhood based on the shared
oppression of women. According to Beasley (1999), they encourage “some degree of
‘separatism’ from men, which may range from simply supporting other women to living as far as
possible in the exclusive company of women” (p. 54). Sexual oppression is seen as the main
oppression of women and all men are viewed as having power over at least some women
14 Susan Hadley
(Beasley, 1999, p. 55). They critique heterosexuality as giving men power and priority. Radical
feminists call for revolutionary social change.
Marxist/socialist feminism emphasizes the hierarchical class relations as the main source of
other forms of oppression. Gender oppression is believed to be linked to capitalism, in that
women are exploited in terms of free or cheap labor. Marxist/socialist feminists emphasize the
complex combination of patriarchy and economic systems that need to be dismantled in order to
transform the existing social and economic order. They support the view that “only an alliance
that included women and men, black and white, poor and middle-class had the possibility of
developing a strategy, a program, and a vision that would lead to freedom and justice” (Chafe,
1991, p. 30). For Marxist/socialist feminists, it is the class system which creates divisions
between men and women (Beasley, 1999, p. 61).
Psychoanalytic feminism (Freudian) links “unconscious mental phenomena (sexed
subjectivities) … with conscious, concrete, macrosocial relations between men and women”
(Beasley, 1999, p. 69). Critically reassessing Freud and challenging Freudian notions of women
being deficient, psychoanalytic feminists, largely from the U.S., have described differences
between men and women in woman-friendly terms and explored both the positive and negative
consequences of these differences on women. Nancy Chodorow has suggested that “the feminist
political agenda should be directed toward feminizing men” by developing their nurturing
capacities and in sharing child-rearing responsibilities; Carol Gilligan described a “different form
of moral reasoning employed by women”; and Sara Ruddick writes about “maternal thinking”
(Beasley, 1999, pp. 67–68). They believe that in order to affect meaningful change, it is
imperative to intervene in the psychological development of girls and boys.
Psychoanalytic feminism (Lacanian & post-Lacanian) holds the view that “the self and
sexuality are socially constructed in that there can be no (sexed) self—no masculine or feminine
person—prior to the formation of the subject in language” (Beasley, 1999, p. 71). Psychoanalytic
feminists from France such as Hélène Cixous, Luce Irigaray, and Julia Kristiva explore the
possibility of a discourse that is capable of expressing women’s unique experience. This
approach is known as l’écriture feminine—embodied feminine writing or writing from the
position of the woman. This writing “challenges the way in which woman is construed in
language/culture” (Beasley, 1999, p. 71). The French feminists critique the hierarchical
binarisms of Western thinking, which they describe as “phallocentric” ways of thinking. They
“explored Western universalism [italics mine] and its paradoxical articulation through dualisms
such as mind/body, man/woman, and white/black and their hierarchical ordering, in which one
element is not only different from but also less than the other” (Kroløkke & Scott Sørensen,
2005, p. 14).
Black/Asian/Latina/indigenous/Sephardic feminisms share a critique of the universalization
of women’s experiences. Feminists within these strands assert that mainstream feminism has
been inattentive to race and ethnicity, exclusionary, and either implicitly or explicitly
racist/ethnocentric (Beasley, 1999, p. 104). They acknowledge their multiple identities and argue
that “race, class, and gender are interlocking systems of oppression, not additive” (Humm, 1992,
p. 122). They delineate their distinctive experiences of oppression by drawing on their particular
shared history of struggle.
Postmodern feminism holds the view that identities are discursively constructed and are
multiple and malleable in nature. It emphasizes the “positionality of subjectivity within history”
(Nicholson, 1997, p. 5). Postmodern feminism rejects grand and essentialist narratives of
“womanhood”—that is, it holds that even the understanding of the meaning of “woman” changes
in various contexts and at different points in history. Postmodern feminists also challenge
received notions of “reality,” “truth,” and “objectivity” and question suspect epistemological
standards for evaluating knowledge claims. Unlike standpoint feminists who take women’s
experience as the basis for knowledge claims, postmodern feminists emphasize discursive
constructions that shape experience that is then interpreted by the individual. Addressing and
critiquing this shift, philosopher Linda Martín Alcoff (2000) claims that “experience sometimes
exceeds language; it is at times inarticulate. … [So,] to claim that discourse is the condition of
intelligibility for all experience is to erase all of those kinds of experiential knowledges
unsusceptible to linguistic articulation” (p. 256).
Feminism and Music Therapy
Early Work
When I originally conceived of putting together a book examining feminist music therapy, it was
because I began to wonder in what ways we as music therapists might be unwittingly
perpetuating the oppression of our clients. I felt that given the contemporary social and political
importance of feminist thought both inside and outside of academia, it was not only surprising
but also disheartening that in the 21st century there was so little in terms of research in feminist
music therapy and that there was not a single book dedicated to demonstrating and exploring the
feminist dimensions of music therapy. Given that more than 80% of the music therapy profession
is made up of women, I thought that feminist perspectives in music therapy would have emerged
more strongly. Perhaps, however, because of the disproportionate number of females in the
profession, we had taken for granted that many of the assumptions operating within the
theoretical and practical spheres of music therapy had nothing to do with issues of male power
and hegemony. It is important to be aware, however, that sites of power are concealed through
norms that structure relationships as “natural,” as a given. This is why it is imperative that we
continue to make the effort to analyze our own cultural, ideological, and pedagogical practices.
Although Feminist Perspectives in Music Therapy was unprecedented in terms of its
exploration of approaches to feminist music therapy, there were earlier feminist explorations in
the music therapy literature. For example, Curtis (1990) surveyed 836 woman music therapists
16 Susan Hadley
with questions that examined role models, awareness of bias (in general and in their own work
situations), the effects of sex-role stereotyping, and general satisfaction with the profession of
music therapy. Curtis (1990) found that “their views and their perceptions were almost as diverse
as their work situations … [but that] [t]he most prominent concerns … were inadequate salary
and lack of advancement opportunities, leisure time, time or money for continuing education,
prestige, and professional recognition” (pp. 61–62). Curtis (1990) sees women’s issues as having
“an impact on both men’s and women’s lives, clinicians’ and academicians’ lives, and in our
personal and professional lives” (p. 65). In her conclusion, Curtis expressed her hopes that
through open dialogue, women would become more aware of how they are victims of gender
bias and, when denying its existence, perpetrators of it. She expressed her hope that such
dialogues will inspire women to become advocates for change. Ten years later, Curtis (2000)
developed a model of feminist music therapy for the empowerment of women, specifically for
increasing the self-esteem of women who have been abused by their intimate male partners. Her
model integrates principles and practices of existing feminist therapy with those of music
therapy. In this model, she advocates the use of innovative techniques of feminist analysis of
power and gender-role socialization through lyric analysis and songwriting.
Other music therapists influenced by feminist theory include Even Ruud (1998), who
mentions feminism as one of his theoretical influences in his book Music Therapy:
Improvisation, Communication, and Culture (pp. 15, 34); Sue Baines (1992), who describes a
feminist framing of music therapy as she encourages music therapists to take a sociological and
political perspective on their work in order to become aware of sexist biases, to accept the
clients’ perceptions as the most valid, and to establish egalitarian relationships with their clients;
Karen Estrella, Brynjulf Stige, and Cheryl Dileo, who all include feminist theory in their
approaches to supervision (see individual chapters in Forinash, 2001); Toni Day and Helen
Bruderer (2002), who employed feminist principles in order to provide a space for agency and
determination for women abused in childhood who were either pregnant or had young children;
Susan Hadley and Jane Edwards (2004), who articulated ways in which a feminist perspective
can help music therapy as a profession openly to question and elucidate some of its own hidden
assumptions; Michele Chestnut (2004), who explored family work in music therapy from a
feminist perspective; Nicole Hahna (2004), who examined the use of the Bonny Method of GIM
from a feminist perspective to empower women who had experienced intimate partner violence;
and Elizabeth York and Maureen Hearns (2005), who incorporated feminist perspectives in their
research with women survivors of intimate partner violence.
Although not explored from a feminist perspective, music therapists have written on topics
that are of interest to feminists, including:
· male violence against women (e.g., Cassity & Kaczor-Theobold, 1990; Rinker, 1991;
Curtis, 1994; Wallace, 1995; Whipple & Lindsey, 1999; Montello, 1999; Hahna &
Borling, 2003, 2004; Amir, 2004; Hernández-Ruiz, 2005; and Teague, Hahna, &
McKinney, 2006);
· abused children/adolescents (e.g., Clendenon-Wallen, 1991; Lindberg, 1995; Rogers,
1992, 1994, 1995, 2003; Purdon & Ostertag, 2000; Ostertag, 2002; Purdon, 2002;
Robarts, 2003; and Edwards & McFerran, 2004);
· eating disorders/body image (e.g., Parente, 1989; Nolan, 1989; Robarts & Sloboda,
1994; Ventre, 1994; Justice, 1994; Rogers, 1998; Robarts, 1998, 2000; Sloboda, 1998;
Hilliard, 2001; Trondalen, 2003; and McFerran, 2005);
· empowerment (e.g., Daveson, 2001; Proctor, 2001; Rolvsjord, 2004; and Rolvsjord,
Gold, & Stige, 2005);
· sexual orientation and related health issues (e.g., Bruscia, 1991; Lee, 1996; and Chase,
2004);
· gender (e.g., Bruscia, 1995; Brooks, 1998; Körlin & Wrangsjö, 2001; and Meadows,
2000, 2002);
· childbirth (e.g., Clark, McCorkle, & Williams, 1981; Hanser, Larson, & O’Connell,
1983; Allison, 1991, 1994; and Browning, 2001);
· culture and community (e.g., Troppozada, 1995; Bradt, 1997; Ruud, 1998; Darrow &
Molloy, 1998; Stige 2002, 2003; Kenny & Stige, 2002; Chase, 2003; and Pavlicevic &
Ansdell, 2004); and
· critical reflexivity (e.g., Kenny, 1989; Aldridge, 1996, 2000; Pavlicevic, 1997; Ruud,
1998; Ansdell, 1999, 2003; and Stige, 2002).
Feminist Perspectives in Music Therapy—the Book
In 2006, Feminist Perspectives in Music Therapy was the first book in music therapy for which a
group of music therapists came together to articulate how they understood the relationship
between feminism and music therapy. The book was divided into four sections.
The chapters in the first section were grouped together because of the sociological themes
that they explored. Jennifer Adrienne traced her departure from the field of music therapy for
what she describes as specifically feminist and sociological reasons. She applied ideas of
sociologists and feminist sociologists to the field of music therapy and proposed four principles
for a feminist music therapy. Envisioning a way of practicing music therapy that takes into
account sociological and feminist values, she suggested looking to Earth-based traditions. In
these traditions, the life cycle of birth, death, and regeneration is celebrated; the divine feminine
is still a part of the ceremonies or rituals; and, typically there are non-hierarchical forms of
shared leadership.
Lucy O’Grady and Katrina McFerran explored the potential of Community Music Therapy,
practiced within a feminist worldview, to free itself and its agents from the oppressive potential
of therapy, society, and the self. They suggested that the value of a feminist Community Music
18 Susan Hadley
Therapy is that it works with people within the context of their gendered social, cultural, and
political environments.
Coming from an Indigenous tradition, Carolyn Kenny described an ecological worldview
that grows out of the spiritual belief that the Earth is our Mother and that we are in relation to all
things. She showed that within this tradition, this ecological worldview informs all of our actions
as ethical human beings. She stated that women are viewed as special in Indigenous societies
because they are the same gender as the Earth and because they are the guardians of the children.
Kenny brings a critique to feminist theories that are advanced by white women academics and
especially to those who romanticize and commercialize Native American beliefs and practices.
Like Kenny, the feminist movement that was advanced by white women meant little to
African-American Frances Goldberg. Goldberg discussed her approach to music psychotherapy
from a feminist perspective and described how the ancient goddess tradition informs her work
with women clients. Throughout the chapter, she weaves stories of her personal feminist and
spiritual awakening. She illustrated how the archetype of the Great Goddess emerged in and
drove the therapy process in the Bonny Method of GIM sessions with one of her clients.
Seung-A Kim described the centrality of Han (sorrow and anger that grows) in the lives of
Korean women because of their oppressive life circumstances. She described the circumstances
of traditional Korean women and provided a brief overview of the feminist movement and
feminist therapy in Korea. Kim also provided a brief overview of the role of music in healing and
therapy in traditional Korean society, including shamanistic rituals and the folk music of healing.
This is followed by a brief history of music therapy in Korea. Finally, she explored the suitability
of music as a form of expression in therapy for Korean women and suggested various music
therapy methods that would work well for a Korean feminist music therapy.
ChihChen Sophia Lee explored feminist music therapy in Taiwan. Like Kim, she provided a
brief overview of the role of music in healing in Taiwan, distinguishing between the indigenous,
Chinese, and Western cultural traditions that make up Taiwanese culture as a whole. Again,
shamanism and folk medicine were prominent in the traditional approaches. The role that women
played in these rituals was central. Lee provided a brief history of the feminist movement in
Taiwan and a brief overview of music therapy in Taiwan, and explored what would be required
for the formation of feminist music therapy in Taiwan.
The second section of the book included chapters that were focused on clinical work. Terra
Merrill reflected on her work as a Caucasian music therapist with a West Indian woman who was
recovering from a cerebrovascular accident. Throughout the chapter, she integrated reflections
from her journal, which she then discussed using a feminist lens. Merrill emphasized the
importance of being fully cognizant of her own direct experiences as a woman and as a music
therapist who occupied multiple locations. She understood this to be integral to a feminist music
therapy approach. Some of the more explicitly feminist features of her work that she explored in
her chapter were reflexivity, power and influence, advocacy, activity, and voice.
Colleen Purdon described her clinical and community work in the area of violence against
women. She began by taking the reader on a journey through the various lenses that have shaped
her understandings over her life span: the “normal childhood” lens, the “traditional music
therapist” lens, and the “feminist” lens. Purdon not only works as a music therapist, but also is a
feminist counselor and community activist. In her chapter, she reflected on issues of violence
against women, one’s role as a music therapist, and her clinical music therapy work with three
abused teen girls using a variety of music therapy techniques.
Sandra Curtis described the process that she undertook in order to develop a feminist music
therapy practice. She outlined major principles, goals, and techniques of a feminist therapy
approach. She then outlined the steps necessary for a feminist transformation of music therapy.
Following this, she provided descriptions of her work with two women with whom she worked at
a battered women’s shelter.
Elizabeth York described her clinical work and qualitative research protocol with women
victims of domestic violence. Her work consists of a representative sample of eight months of
work with 40 women members of a support group run by a Community Abuse Prevention
Services Agency in Utah. Creative arts techniques used included vocalizing, song discussions of
women’s music, creative writing, movement, imagery, drawing, and journal writing. These
experiences culminated in the development of an ethnographic performance piece titled Finding
Voice. For these survivors of intimate partner violence, finding the courage to speak out was a
powerful aspect of the healing process.
Dorit Amir described her work with Israeli women who have suffered trauma in their lives.
She began by describing feminism in Israel and then briefly described how her feminist values
are interwoven into her work with women. She described her work with three women who have
suffered from traumas due to being Jewish and living in Israel—one who lost her lover when he
was killed during the 1967 Six Days War; one whose parents were killed by the Nazis during the
Holocaust, which she survived as a hidden child, to eventually emigrate to Israel; and one who
lost her husband in the Yom Kippur War in 1973 and later lost her daughter in a terrorist attack in
2001. The theme that runs throughout these stories is the loss of power due to traumas caused by
human beings, and the sense of regaining of power while being in music therapy.
Joke Bradt described her work with women suffering from chronic pain. She discussed socially
constructed, gender-based stereotypes related to chronic pain and the effect of these stereotypes
and stigmas on her clients. Bradt then described her process in working with these women and
how she came to use vocal toning, breathing techniques, and vocal improvisation as techniques
in order to help her clients to reconnect to their bodies and to their emotions. Through her work,
these women began to feel empowered, to find their voices.
The chapters in the third section of the book focused on significant aspects of music therapy:
discourse, music, music therapy techniques/approaches, and issues of representation. Randi
Rolvsjord examined the use and functions of the language that we use in music therapy—how
we talk and write about music, clients, pathology, the therapeutic relationship, and gender or
relationships. She believes that the way we use discourse in music therapy has political
20 Susan Hadley
implications. Her work is inspired by postmodernist and poststructuralist feminist traditions,

specifically the French feminist tradition, which focuses on language and power relations in
language. Using a destabilizing discourse analysis, she discussed the use of “mother” concepts in
music therapy literature and how these contribute to the conservation of traditional expectations
of gender roles.
Laurie Jones examined song selection for women’s empowerment in music therapy. She
suggested that it is crucial that we consider not only client preference and the relevance of lyric
content to client issues and treatment needs, but also the significant impact of the larger
environment/society on the welfare of our clients. She suggested that it is our responsibility as
music therapists to become aware of the sexist subtext found in much of the popular music that
we use in music therapy sessions—both the overt and covert messages that contribute to the
ways in which clients view themselves and/or their attitudes about and behaviors toward women.
Elaine Streeter explored the idea that the rise of capitalism has led to competitiveness, which
ultimately has led to the branding of various marketable products, including music therapy. She
noted that we have now defined many separate approaches to music therapy, within which we
separate out and name distinct techniques. This branding allows groups of practitioners access to
a specific theoretical and therapeutic marketplace and allows students to shop around for a brand
that they like before starting a training course. However, it can also lead to protection of the
brand and perhaps to a fundamentalism arising from the branding.
Jane Edwards explored ways in which we can improve as music therapists in terms of issues
of representation, not only through greater acknowledgement of the achievements of women
music therapists, but also through how clients’ bodies are viewed by themselves or others in our
discourse on health and illness and how these views are formed and framed by patriarchy in our
understandings of gender and sexuality, in how women are represented in music, and in hearing
the voices of, and advocating for, our clients.
The five chapters in the final section of the book focused on specific areas of training in
music therapy: pedagogy, supervision, assessment, research, and ethics. I reflected on how both
the content and the process of my teaching in music therapy have been influenced by my
feminist worldview. I described aspects of my evolving feminist teaching style and provided
examples from my classroom experiences. I also shared the risks, challenges, and rewards that I
encountered while developing my approach to teaching.
Michele Forinash addressed the topic of a feminist approach to music therapy supervision.
She looked at philosophies of feminist supervision and research in feminist supervision. She then
explored issues of openness, collaboration, biases, assumptions, reflexivity, multiple
perspectives, authority, power, advocacy, activism, and cultures of music as they relate to the
supervisory relationship in music therapy.
Sue Shuttleworth provided a brief orientation to assessment and the assessment process in
music therapy. She then described feminist-diversity therapy principles and assumptions
regarding assessment. She examined the philosophy, goals, design, and implementation of
assessment strategies that are of concern to feminist therapists. Finally, she suggested ways for
adapting and integrating feminist perspectives into music therapy assessment.
Barbara Wheeler presented information on feminist research and applied this to music
therapy research. She described existing music therapy research that is consistent with feminist
research. She suggested a number of possible topics for music therapy research from a feminist
perspective in the hope that these may provide a beginning for music therapy researchers in this
area.
Finally, Cheryl Dileo provided a brief overview of both feminist ethics and feminist therapy
ethics. She outlined several issues of relevance to feminist therapy: therapist self-disclosure,
dual/overlapping relationships, and power. She then suggested that the field of music therapy
would be enhanced significantly by an incorporation of feminist ethics within its approach to
professional ethics and recommended ways in which this can be accomplished in terms of the
various music therapy codes of ethics throughout the world.
Current Climate
Following the publication of Feminist Perspectives in Music Therapy (2006), there has been
more dialogue about feminism in music therapy and a shift to include feminist perspectives as a
significant theoretical framework in music therapy. The British Journal of Music Therapy
published a debate about music therapy and feminism in 2008 in Volume 22, issue 1. In the
previous issue, Clare O’Callaghan had provided a review of Feminist Perspectives in Music
Therapy. The journal then published an essay response by Tony Meadows in which he critiqued
the book and some of the conceptions behind it. Following this critique, they published a
response from me that brings a counter-critique to Meadows’s critique. This open dialogue,
which functioned as a critical space where ideas could be discussed, is necessary in music
therapy and one which I hope will spark further critical spaces for engaged dialogue.
Several music therapists continue to incorporate a feminist framework in their writings.
Lucy O’Grady’s (2009) doctoral research used a grounded theory analysis to explain the
therapeutic potentials of creating and performing music within the context of an Australian
maximum-security women’s prison. The research involved seven women in prison who
collaboratively created and performed a musical together with artists from a theater company.
She found that creating and performing music served as a bridge from the inside to the outside
for these women: from physical and symbolic “inside” places to “outside” places; from private to
public; from solitude to togetherness; from focus on self to others; and from subjective to
objective thought processes. Her feminist framing is seen in the way that she situates herself in
the research and in how she understands the complexity of the women in prison. It is also seen in
the non-hierarchical relationship with the women. Even Ruud (2010) discusses feminist
influences in his thinking on relationality, empowerment, reflexivity, and other postmodern
22 Susan Hadley
currents. And Randi Rolvsjord (2010) infuses her writings on resource-oriented music therapy
with feminist theory.
Other writings on feminism and music therapy include Hahna’s (2010) exploration of the
possibilities of a feminist-informed ethics model for the Bonny Method of GIM; Hahna and
Schwantes’s (2011) survey research examining the views and use of feminist pedagogy and
feminist music therapy by music therapy educators; Veltre and Hadley’s (2011) exploration of a
hip-hop feminist approach using rap and hip hop in order to promote collaboration and help to
build strong female communities, to help adolescent females to explore identity formation and
gender-role socialization, to empower young women to develop and honor their voices as
females, and to help to promote social transformation; and Hahna’s (2011) doctoral research on
feminist music therapy pedagogy. In this research, Hahna interviewed four feminist music
therapy educators in order to gain an understanding of the use of feminist music therapy
pedagogy from the perspective of music therapy educators’ lived experiences. This research
makes a significant contribution to the music therapy field, not only because of its focus on
feminism, but also because of its focus on pedagogy, an area that has been largely neglected in
the music therapy literature.
And while feminist music therapy is still in its infancy, it is significant that it is now being
classified as a major approach to music therapy. While it was not originally included under the
area of ecological practices in music therapy (Bruscia, 1998), McFerran (2010) includes it as one
of the major approaches under this area in her book on music therapy with adolescents. In
addition, Abrams (2010) includes it as a major approach under one of the four epistemological
domains of evidence in music therapy—the intersubjective (interior-collective) domain. Another
testament to feminist music therapy’s significance to the field of music therapy is its inclusion in
this current volume, Readings in Music Therapy Theory. Finally, in 2012, there are two
overlapping conferences that are being held in conjunction with each other in Montreal, both of
which have a large focus on feminist music therapy: The Canadian Music Therapy Association
conference, with its avant-garde theme, and a special international conference on Gender, Health,
and Creative Arts Therapies.
Questions I Feel Need to be Addressed in Music Therapy
Are there gender inequities in music therapy?
There are many unsettling statistics that can be obtained from the American Music Therapy
Association and the Certification Board of Music Therapists. In 2004, the ratio of females to
males in the AMTA membership was 88% to 12%. Of the 1,317 board-certified music therapists
with a master’s degree, 88% were female and 12% male, reflecting the ratio of females to males
in the AMTA membership. Of the 148 board-certified music therapists with a doctoral degree,
however, 74% were female and 26% were male. Similarly, of the 146 AMTA members who
indicated their job title as “Faculty (University/College)” on their most recent survey, 73% were
female and 27% were male. In both cases, there are a disproportionate number of males in music
therapy in the United States who earn doctorates and who hold university positions. Why this is
the case is something that needs to be addressed.
Furthermore, in terms of the salary of the survey respondents who indicated that they work
full-time (34 hours or more per week) and who provided an annual income estimate on their
most recent survey, the average for females was $41,265.35, as opposed to $52,500.00 for males.
For those who indicated their job title as Faculty (University/College), the average salary for
females was $50,690.91, as opposed to $61,166.67 for males. From these figures, it appears that
the average salary for males still exceeds that of females by about $11,000 within the music
therapy profession, outside and within academia, and that proportionally more males than
females hold faculty positions.
Along similar lines, in 1985, Mark James noted that in the music therapy literature in the
United States, women authored 10% more articles than men between 1974 and 1984; he came to
the erroneous conclusion that “general parity exists between men and women authors, with a
recent trend for more articles to be authored by women.” Sandra Curtis (2000) insightfully
turned this conclusion around by stating, “while this is indeed an improvement over the past, this
‘parity’ looks quite different if the 90:10 female to male music therapists ratio is taken into
consideration.”
Why are people resistant to the term “feminism”?
I am interested in the fact that many young women who have benefited substantially, whether
consciously or not, from the feminist movement have a negative view about it. Although they
readily admit only to understanding vaguely what feminism is, and although they believe that
there is still a lot of prejudice against women, they often had strong negative opinions about what
constitutes a feminist. I found that many of them characterized feminists in stereotypical ways—
for example, as extreme, aggressive, overly ambitious, unreasonable, men-haters, unfeminine,
unattractive, demanding, uptight, dogmatic, radical, and lesbian. From my own experience, I
found that this was widespread. In fact, although both males and females strongly support values
associated with feminism, feminists are often constructed in negative ways (Riley, 2001). Riley
argues that this decoupling of feminist values from feminists serves five major functions. By
negatively characterizing feminists and positioning them as extremists, it:
1) minimizes the impact that such individuals and associated social movements have had
on creating social change;
2) minimizes the historical oppression of women, thus masking the effects of this in
24 Susan Hadley
contemporary society;
3) minimizes the privileges that men have received in the past and the present;
4) marginalizes any voice for continued change as it is represented as not credible; and
5) allows for the reformulation of feminist values into gender-neutral constructions of
equality or discourses of liberal equality, which can function to maintain existing male
power and privilege.
A vast number of people believe that feminism (or pro-female) is antimale. bell hooks (2000)
states that “their misunderstanding of feminist politics reflects the reality that most folks learn
about feminism from patriarchal mass media” (p. 1).
What is the role for men in feminism and how does feminist music therapy help males?
As I wrote earlier, it is important in the beginning for women to have a space in which to raise
their consciousness about the impact of patriarchy on their values, beliefs, behaviors, and sense
of themselves. However, for widespread change to occur, it is also important for men to engage
in similar forms of consciousness raising. On becoming more and more aware of the oppressive
nature of patriarchy and how they unfairly benefit from such a system, there are men who want
to take a stand against patriarchy and who do not want to be complicit in this oppressive system.
This is not an easy process to be involved in, because unlike for women, there is less motivation
for men to want to dismantle a system that affords them privilege and power. What makes it even
more difficult is that the decision to fight against sexism does not erase a lifetime of sexist
conditioning. So, it is a lifetime struggle. Furthermore, men who claim a feminist identity may be
viewed by some women as less “manly” and by some men as just plain bizarre (Digby, 1998, p.
1). It is important, though, that men ensure that they do not colonize feminism, taking over a
space that was created to give voice to women’s experiences.
There are very important roles for men in feminism. First, men must “recognize their own
roles in sexist privilege and oppression and work for change, [and] men have to face the extent to
which fighting patriarchy means fighting themselves” (Kahane, 1998, p. 213). David Kahane
states that no matter how much men commit to be part of the solution, they need to be aware that
they can never cease being part of the problem (p. 213). This is a difficult stance to take,
especially as we desire to see ourselves as moral and decent human beings. I struggle with my
whiteness in this same way. In other words, even as I desire to see myself as a moral and decent
human being and to speak out against oppression of all kinds, I continue to exist within a white
hegemonic society that bestows privileges on me in virtue of my skin color. So, one important
process for men is to “critically and systematically … interrogate their advantaged social
situation and the power relations that perpetuate it” (Kahane, 1998, p. 220). Kahane (1998) goes
on to say that in this process a man will learn that he has “internalized patriarchal affects, habits,
and desires, in more ways than can be traced or changed … has benefited and continues to
benefit from male privilege … and that his every gaze and sentence and interaction is inflected,
in large or small ways, by sexism and patriarchal privilege” (p. 221). Understanding the
profound ways in which patriarchal power and sexism impacts the lives of men can be seriously
daunting, especially as men come to understand the subtle and pervasive ways in which they are
embedded within sexist and patriarchal structures.
Second, in order to sustain a male feminist identity successfully, it is important to
understand oneself as ethically complex and incomplete, to be open to criticism and self-
criticism, and to be engaged with other feminists, male and female (Kahane, 1998, p. 228).
Third, it is important for men to educate boys and other men about patriarchy and sexism. It
is important for boys and men to understand the complex processes of their gender socialization.
Such processes of socialization have been restricting not only for girls and women, but also for
boys and men.
Thus, some of the ways that feminism can help boys and men in therapy is for them to look
at the ways in which they have been socialized as boys and men and how that impacts the
decisions that they make and have made. It is also important to look at power relationships in
their lives and how they may have used power in order to subordinate others based on gender or
sexual identity. It may also be important to look at the ways in which the range of their
expressive repertoire may have been shaped according to patriarchal social norms. A lot of
important work can be done with males with emotional and behavioral disorders, as well as sex
offenders (Purdon & Ostertag, 1999), by using a feminist therapy approach.
Coda: Motivation for a Better Future
Knowledge about issues of oppression does not in itself lead to change without the desire to
change, the desire for something better. Philosopher Susan Babbitt (2005) points out that
“histories of marginalized groups are often known but play no role in national identities or
agendas. … [W]ithout such a role, such histories are not really understood.” Babbitt goes on to
explain that in order to deal maturely and honestly with the past, it is not a matter of just telling
our stories differently or incorporating aspects that have previously been omitted, but of having
expectations for a better future. She makes three important claims:
1) We can know many things intellectually and understand little if we do not

recognize how what we know bears upon who we are.
2) Expecting a better future is also an acknowledgement of the present and our
responsibility for it.
3) Histories, or the personal stories of others, are understood when they are relevant,
but they become relevant when there is a need, and there is only a need to fully
26 Susan Hadley
understand others’ histories when we recognize and take responsibility for where
we are now. We do not act upon the information that we possess unless we
recognize that it matters to who we are and where we want to go.
Thus, in order to be motivated to change, we need a reason to change. As long as we believe that
we are fine as we are, then there is no reason to change. We can know many facts, recognize
their significance, even be morally outraged by them, and yet still not be motivated to do things
differently, especially if we see them as about others and not about us as well. It is also very
difficult to own something that contradicts our expectations about ourselves. For example, we
can be outraged about racism and view ourselves as not racist. As such, we take no responsibility
for the perpetuation of racism and thus have little motivation to be different. The same can be
said of patriarchy. Indeed, the same can be said of our understanding of our clients. Again, to
quote Susan Babbitt (2005):
Trust is not built by knowledge of others’ stories; rather, it is built when such stories
motivate us, when they can become reasons for acting and can define the path of
development, individual or social. But stories cannot become reasons unless there is
something that needs to be understood, which is not likely if … we are fine as we are.
To challenge the status quo can frighten us and make us feel uncomfortable, but it can also be
exciting, challenging, and empowering because it is about having expectations for a better future.
I hope that incorporating feminism into music therapy does not just provide knowledge, but that
it also helps us all to imagine and desire a better future and as such motivate all of us to see how
we are responsible for both our present and our future. May it provide reasons to do things
differently—and especially for the betterment of us all.
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READING 22
IMPLICATIONS OF EMBODIED COGNITION

AND SCHEMA THEORY FOR DISCERNING POTENTIAL
MEANINGS OF IMPROVISED RHYTHM
James Hiller
Rhythm is an essential and therefore indispensable aspect of all music. Arguably,

rhythmic elements are the most accessible of all the musical elements for clients in music
therapy to produce and manipulate expressively (Hiller, 2011). Yet, theoretical
understanding of rhythm and its use in musical expression is a neglected area of both
music therapy (Bunt, 1994; Daveson & Skewes, 2002) and musicological inquiry
(Gabrielsson, 1993; Kramer, 1988; Mead, 1999). However, the area of psychological
investigation known as “embodied cognition” or “schema theory,” which has been
constructively applied to composed tonal music, may prove fruitful in deepening our
understanding of potential meanings of rhythm in music therapy, particularly in clinical
improvisation.
Aigen (2009) has astutely noted that music therapists must take responsibility for
providing theoretical explanations of the therapeutic meanings of all the musical elements
used in therapy processes. How do we explain a client’s rhythm? Where do a client’s
abilities to use rhythm for self-expression and to relate to others come from? Ansdell
(1997) supports the notion that music therapy and musicology can enhance each other’s
pursuits of knowledge regarding music. Significantly, Aigen (2005, 2009) has been a
leading author in bringing concepts from schema theory to music therapy toward
explaining tonal aspects of clinically improvised music. This chapter seeks to shed light
on the meaning potentials of rhythm in improvisation from the perspective of schema
theory and to briefly highlight implications for improvisational music therapy.
Embodied Cognition and Schema Theory
Musicologists concerned with studying how meanings may be derived from music
experiences have recently embraced concepts from an area of cognitive psychology
variously referred to as embodied cognition, schema theory, or metaphor theory (Brower,
2000; Dogantan-Dack, 2006; Iyer, 2002, 2004; Johnson & Larson, 2003; Krueger, 2009;
Phillips-Silver & Trainor, 2007; Saslaw, 1996; Seitz, 2005; Zbikowski, 1997). (The terms
“embodied cognition” and “schema theory” will be used interchangeably in this chapter
to represent these related models.) Much of the development of this highly significant
perspective on human cognition and language is based on the cognitive science, cognitive
linguistics, and neuroscience investigations of George Lakoff and Mark Johnson (1980,
1999).
Embodiment theorists posit that humans gain knowledge and comprehension of
the world not from purely thought-based cognitions, as per the Cartesian model (wherein
the mind is the locus of all knowledge and reasoning), but rather from bodily experiences
involved in interacting with the physical world. Cognitive processes used for
1
comprehending physical interactions include the use of metaphors—linguistic tools that
help an individual categorize experiences from a variety of domains. A metaphor is
commonly used to represent and thus comprehend one thing in terms of the attributes of
another thing. For example, the pile of paperwork on my desk may be described
metaphorically as a mountain—a huge structure that is in my way and that will take a
great deal of time and effort to traverse or conquer, with the word “conquer” also being a
metaphor for completing the task that I perceive as an enemy with whom I must do battle.
Additionally, the metaphors used to comprehend one type of experience are often
mapped onto other types of experiences that have constituently similar attributes, which
is a process known as “cross-domain mapping” (Lakoff, cited in Saslaw, 1996, p. 20).
For example, most adults can recall an experience from childhood of spinning themselves
around until dizzy and disoriented, even to the point of falling to the ground for lack of
balance control. I may map this bodily experience onto my experience of feeling
overwhelmed with having many projects active at one time—each needing my immediate
attention—by stating that my head is “spinning” from the “dizzying” amount of work I
have yet to do. The metaphoric concept or conceptual metaphor takes as the source
domain the embodied action of spinning that results in dizziness and disorientation (a
physical experience) and applies it to a target domain: that of feeling overwhelmed with
many disparate tasks, each requiring immediate attention (a psychological/mental
experience). Humans also use cross-domain mapping to conceptualize experiences of
emotions through metaphors related to embodied knowledge when we describe, for
instance, “falling” in love, feeling “down in the dumps” when depressed, or “flying high”
when feeling great joy or elation.
One powerful aspect of mapping a bodily experience onto another type of
experience through metaphor is that it helps us to categorize our experiences and thereby
gain the ability to draw on previous experiences to understand and respond to new ones.
Another useful aspect of cross-domain mapping is that it enables us to communicate with
others regarding various types of experiences. We are able to draw on our own collective
human bodily experiences, as conceived through conceptual metaphors, to understand
and perhaps empathize with another person’s experience. Recent research has begun to
support the notion that the use of metaphors in everyday understanding of human
experiences is a common and, in many instances, universal phenomenon across cultures
and languages (Narayanan, 1997; Reiger, 1996).
The foundations of our metaphoric concepts are found in what Johnson calls
image schemata (1987). He describes image schemata as “structures that organize our
mental representations at a level more general and abstract than that at which we form
particular mental images” (pp. 23–24). Thus, image schemata are not pictorial
representations of experiences, but are more fundamental. Image schemata are dynamic
constructs formed from bodily experiences in the world of objects and space, and they
represent experiences of interacting with and observing the attributes of objects and other
people, and of being and moving in space. Further, schemata possess internal consistency
of pattern and form in their construction, aiding in the human proclivity to order and
organize perceptions and responses to a wide variety of experiences in the world. While
preserving a level of consistency, Johnson stresses that image schemata are also dynamic
in nature rather than rigid, inflexible, and literal, and are therefore capable of
2
accommodating the natural variety of human embodied experiences that occur in
different, perhaps innumerable, contexts (p. 29).
To briefly illustrate, one key image schemata relevant to understanding music
experiences is the CONTAINER schemata. (The convention of using capital letters to
designate specific schemata is common in writings about schema theory and will
therefore be applied in this paper.) A container has a boundary that delimits what is inside
it from what is outside of it. We may understand the concept of a container first through
our bodily experiences of having an inside and an outside to our bodies, and second from
the act of going in and out of, for instance, a house, a room, a store, or an automobile.
The reader may also usefully imagine the CONTAINER schema as represented by a box
or a soup can. Things can be either inside the box or soup can or outside of it. Similarly,
certain actions or events may occur inside a particular container, whereas others typically
occur outside of it. With regard to a musical piece, let us consider a popular song with the
common AABA form. Each section of the form may be considered a container for
particular musical materials and the ways in which the materials are configured. The
musical structures found in the B section are typically organized differently than those in
the A sections that surround it, thus differentiating the sections from one another; each
contains different configurations of the musical materials. The chord progression,
melodic materials, rhythmic structures, and even lyric content that distinguish the B
section are considered “inside” the B section, whereas those that constitute the A section
are “outside” of the B section. However, we may also find a melodic motif from the A
section interpolated “into” the B section. Statements during a rehearsal of the song that
aid musicians in their orientation, such as “we are in the second A section” and “let’s get
through the B section,” allude first to the experience of being inside the A section and
second to the intent of moving through and eventually leaving the B section. Such
directives, conceptualized through the embodied orientation of in-out, are demonstrative
of applications of the CONTAINER schemata that occur quite naturally with regard to
performances of music (Johnson, 1987, pp. 30–37).
How have musicologists contemplated the application of embodied cognition
concepts to rhythm? Dogantan-Dack (2006) reports that current thinking regarding
embodied understandings of musical rhythm has roots in the 19th century within the early
psychology of music theorists. As evidence for this contention, she notes that the earliest
science-based psychology research of the 1800s was, in fact, performed by experimental
physiologists interested in human beings’ psychological experiences of sensations of the
moving body, or kinesthesis. Dogantan-Dack further notes that the early psychology of
music theories regarding rhythm also drew from the experimental physiology research of
the time and therefore applied motor theories to explain the nature of musical rhythm. It
seems apparent that, since the days of the early music psychologists, those interested in
musicology have been seeking answers to questions of rhythm through concepts
surrounding the embodied nature of rhythmic movement (pp. 452–453).
Conceptualizations of Time in Schema Theory
Most, if not all, definitions of rhythm refer to some aspect of its relationship to
time. So, to understand rhythm, we must first have a clear idea of the nature of time.
Lakoff and Johnson (1999) apply concepts from embodiment theories to provide a
3
detailed rendering of human beings’ conceptualizations of and ways of reasoning about
time, which are steeped in metaphor. The following descriptions are derived from Lakoff
and Johnson’s Philosophy in the Flesh: The Embodied Mind and Its Challenge to
Western Thought (1999) and Johnson and Larson’s (2003) article “Something in the way
she moves—Metaphors of musical motion” in the journal Metaphor and Symbol.
Time and Events
A human being’s life may be construed as a series of events. Events occur in time.
Every event has a starting point and an ending point. In order to measure the time
properties of an event, humans have devised instruments, such as clocks and stopwatches,
which are based on consistent, cyclical iterations of small events (i.e., seconds) that are
considered equal in their properties. A clock or stopwatch is used to track and categorize
iterations that occur according to the arbitrary system wherein sixty iterations of a second
equals one minute, sixty minutes equals one hour, and so on. Occurrences in succession
of the events known as seconds symbolize an interval of time. Inherent in the notion of
seconds occurring in succession is the inference of movement from one second to the
next and the next, and onward. In fact, it is the movement of a pendulum or spring-
loaded, cycling gears in a clock that produces realizations of time interval events for the
purpose of measurement. The use of a clock or stopwatch allows an event to be measured
from its beginning to its end. Therefore, it seems that we understand time via our
understanding of the properties of events; that is, the time of our lives progresses from
event to event. We also experience moving through the duration of each event.
Subsequently, we measure the time properties of events through comparison with other
events—the consequences being that our experiences of time are integrally linked to our
experiences of events, and our experiences of events are embodied experiences, all of
which occur in some form of space (Lakoff & Johnson, 1999, pp. 137–139).
Time and Movement in Space
Interestingly, the language we use to conceptualize and reason about time—which

reflects, in essence, our metaphoric thinking about time—takes movement in space as its
source domain. In other words, we map conceptualizations of motion in space onto the
target domain of time. It turns out that our experiences of time are conceptualized in
terms of physical orientation of two sorts: the Moving Times Metaphor and the Moving
Observer (or Time’s Landscape) Metaphor, both of which incorporate the Time
Orientation Metaphor. In the Time Orientation Metaphor, an observer in the present is
faced in a fixed direction, with future time conceived of as being in front of and past time
behind the observer. Examples of language used to describe experiences from this
orientation are “I’m looking forward to the concert,” “look ahead to next week’s
schedule,” “let’s not go back and revisit that issue,” or “those days are behind us now.”
The Moving Times Metaphor is a conceptualization in which times are an infinite series
of events moving past the observer who is located in the present. The times are oriented
facing the observer, who is oriented facing the future. Therefore, time passes by us or we
experience the passage of time. Linguistic phrases that demonstrate this metaphoric
conceptualization include the following: “time is flying by us,” “our performance date
4
will arrive soon,” “the due date has passed,” or “here come the staccato sixteenth-note
figures.”
In the Moving Observer (or Time’s Landscape) metaphor, on the other hand, the
observer is not in a fixed location, but rather moves on a path over the landscape that is
conceived of as time, and on which innumerable points of time (i.e., events and/or
structures) are found at different locations. Movement along the path is thus the passage
of time, and the distance traversed is the amount of time that has passed or is yet to be
experienced. Just as in the Moving Times metaphor, the future is conceptualized as being
in front and the past is behind. Linguistic phrases relevant to this metaphoric
conceptualization include the following: “we are fast approaching the scheduled
performance,” “we’ll soon reach the end of the semester,” we’ve passed the cutoff date,”
or “we are coming up on the swing eighth patterns.” With regard to long or short amounts
of time reflected in the metaphoric movement across the time landscape, we might say
any of these phrases: “we have quite a ways to go before we are ready for the recording
session” or “let’s move on quickly from this piece so we can get to the next one on the
list.”
An observation about these two key metaphoric conceptualizations is that they are
figure-ground reversals of each other, depending on what is taken as the moving subject
in a given scenario—either times (events/structures) or the observer (us) (p. 149). This
concept may have relevance for conceptualizations of rhythm in that figure-ground
relationships are found among the various rhythmic elements, particularly those of pulse
and rhythmic figures.
Rhythm Event-Structures
Lakoff and Johnson (1999) summarize their findings regarding time-oriented

metaphors by telling us that human beings use metaphors related to movement in space to
conceptualize time because of our day-to-day bodily experiences moving and physically
interacting with the world. The authors refer to these experiences as “motion-situations”
(p. 151). It seems that we automatically correlate our actions (i.e., motions during motion
situations, or observations of the actions of others) with the time-defining events that
endow us with our sense of time, such as the movement of clocks and our body rhythms.
The authors support their belief in these metaphoric conceptualizations, and the embodied
cognition concepts that undergird them, by explaining that humans “do not perceive time
independently of events. … We can only define time to be that which is measured by
regular iterations of events” (p. 154, italics original). The authors further conclude that,
“Motion-situations thus contain the literal correlations that are the experiential bases for
the Time Orientation, Moving Times, and Moving Observer metaphors” (p. 151).
A conceptualization that I would like to put forth here, and one that seems
important to experiences of rhythm related to time and movement metaphors, is the
notion of rhythmic structures (i.e., rhythmic figures) as rhythm events. For just as distinct
events such as a party, a business meeting, or a person telling a story have a temporal
shape with a beginning, middle, and end, so too do rhythmic structures, as they are
experienced by people. Therefore, we might, then, speak of rhythmic figures as rhythm
event-structures—that is, temporal structures with a particular form occurring in the
experiential space of time. Rhythmic figures are, simultaneously, events and structures.
5
(Rhythm event-structure is my own construction and is not related to Lakoff and
Johnson’s [1999, pp. 170–234] event-structure concepts that deal with metaphorical
understandings of causation. My conceptualization of rhythm event-structures is meant to
highlight the duality of a rhythmic figure metaphorically understood as both an event that
occurs over time and a structure akin to a building.)
If we relate the Moving Times and Moving Observer metaphors noted above to
perceptions of rhythmic music, we experience a series of rhythm event-structures. For
example, in the Moving Times metaphor, we experience rhythm event-structures moving
toward us, through or around us (depending on how directly we experience the rhythm),
and eventually past us, whereas in the Moving Observer metaphor, we move toward,
through, and eventually past various other rhythm event-structures. This notion is
demonstrated in the examples of a listener in the Moving Times metaphor who
experiences the approach of staccato sixteenth-note figures and a listener in the Moving
Observer metaphor who is approaching a section of music containing swing eighth
patterns. The staccato sixteenth-note figures and the swing eighth patterns are structures
that we can isolate and describe as distinct, but they are at the same time events that we
experience: as time, in the course of time, and through time. The concept of rhythmic
figures as discrete event-structures is certainly not foreign to musical processes, as
players often isolate particular figures and practice them repeatedly outside of the context
of a musical whole, thereby highlighting the structural unity and independence of each
pattern. Similarly, when improvising, a player may create a new pattern and subsequently
repeat, restructure, embellish, reduce, or expand it in various ways while holding in mind
the distinctive character of the initial pattern as a discrete event-structure with its own
temporal form.
A discrete rhythm event-structure may be a single beat or a rhythmic figure, or
even a rest (e.g., a beat or more of silence) that we as listeners experience as time moves
past us or as we move through it. A rhythm event-structure may also be a pattern that we
re-produce as performers or that we create through improvisation as we move
metaphorically over the landscape of time. From an embodied cognition standpoint, what
differences are apparent in the ways that rhythm is conceptualized within the process of
listening vs. re-creating vs. improvising?
Characteristics of Listeners, Performers, and Solo Rhythm Improvisers
Whereas the “lion’s share” of musicological interest, including that of

embodiment theorists, has historically focused on listeners’ perceptions of music, little
evidence exists for interest in the experiences of improvisers (Gabrielsson & Juslin, 1996;
Juslin & Persson, 2002; Nettl, 1998; Pressing, 1984). Notably, in recent decades
musicologists have begun to focus research on performers’ efforts in expressing aspects
of emotion while performing precomposed works. Interestingly, key machinations that
performers use toward expressing emotion in music have to do with timing, and therefore
rhythm is clearly implicated in this work (Juslin, 2001; Juslin & Laukka, 2003; Juslin &
Timmers, 2010; Laukka & Gabrielsson, 2000). Yet, a performer of a precomposed work
remains a significantly different subject of study from an improviser. Subsequently, in
seeking to understand improvised rhythm through schema theory, we must consider how
6
embodiment concepts apply from the vantage point of an improviser compared to that of
a listener or a performer.
Listeners
Johnson and Larson (2003) report that, for music listeners, there are two
perspectives from which to experience music on a landscape: as observer or as
participant. In the observer perspective, the observer-listener remains in place on the
landscape while musical event-structures move past her/him and she/he thus undergoes
and thereby experiences them. Contrarily, in the participant perspective, the participant-
listener moves along a path on the landscape of time, undergoing and experiencing
musical event-structures as they are encountered (pp. 72–73). In both perspectives, a
listener may either actively engage in the process or act as a passive subject to it. In both
the observer and participant perspectives, however, a listener plays no role with regard to
creating, sounding, and shaping the nuances of particular musical structures. Also,
whereas a performer plays the role of creating movement while playing, she/he does not
engage in creating musical event-structures, as does an improviser.
Performers
A performer’s perspective is as a participant. A participant does not simply await

musical event-structures as does an observer-listener, but exercises intentionality with
regard to the music sounded and therefore agency in the process of revealing or sounding
the prescribed musical event-structures of the piece. While sounding or giving voice to
composed materials, a performer also has opportunities to individualize the way the
materials are sounded, usually within a certain stylistic range. With regard to musical
agency, Johnson and Larson (2003) distinguish between the metaphorical concepts I am
moved and I move (p. 76). To be moved (“I am moved”) by the music is to be subjected
to musical forces that push or pull us in various ways (p. 75), such as the forces by which
an observer-listener is moved. Interestingly, a participant-listener moves toward the
musical forces found in various musical event-structures of a piece and therefore
experiences moving through them as well. To move musically (“I move”), on the other
hand, is to be the force that causes musical motion or movement. At the most basic level,
a performer, by the act of sounding composed materials from a page, lends human energy
to cause music to be sounded and therefore to move in the music. Yet, at another level, a
performer may exercise agency to shape and consequently aid in moving the music in
individualized ways. This is facilitated through varied use of tempo, dynamics, and
phrasing, while also reproducing the prescribed or composed event-structures of the
composition. At still another level, a performer also hears the sounds and feels her/his
own physical efforts while reproducing musical event-structures, and therefore may also
be moved by the music that is sounded. By possessing energy and a capacity for
intentionality to cause musical motion through human agency, a performer determines
whether and how musical event-structures are sounded, but not what the nature of each
event-structure is, nor where each is to be located on the unfolding path on the landscape
of musical time, since these are predetermined by the composition itself.
7
Rhythm Improvisers
Another perspective that has received little attention in the musicological

literature is that of the rhythm improviser. While an improviser’s experience may be
construed as moving over a landscape (like the experiences of a listener-participant or a
performer), the improviser does not encounter structures in particular locations on the
landscape, nor is it the improviser’s role to bring a composer’s musical event-structures
into existence through musical agency. Rather, the improviser creates or brings forth
rhythm event-structures, shapes them, and experiences their unfolding while moving at a
self-generated rate of speed along a self-created path on the landscape of time. The
improviser further responds in an individualized way to the improvised rhythm event-
structures while continuing to create more, until the improvisation ends. In this
perspective, the improviser is the sole agent in a unique cycle of creation, perception, and
reaction. The improviser is the source of energy that initiates improvising, the resource
for establishing and regulating the cyclical or noncyclical nature of the path over which
rhythm event-structures occur (i.e., pulse and tempo), the architect and expresser of all
rhythm event-structures that are formed (i.e., rhythmic figures), and the
supervisor/manager and experiencer of the unfolding processes. In the moments of
creation, along with the role as human agent for bringing sounds into being, an
improviser may also be considered a composer, a conductor, an arranger, an orchestrator,
and an audience to all that occurs in the improvisation.
In-time and Over-time Processes
The improviser’s perspective is one that Iyer (2004) describes as being grounded
in temporality, meaning that the individual (player) is part of an embodied process that
occurs either “over-time” or “in-time” (pp. 160–161). Processes that occur over time are
those that “are merely contained in time; the fact that they take time is of no fundamental
consequence to the result” (p. 161, italics original). Examples of over-time processes may
include composing an orchestral work or writing a song, short story, or novel. In-time
processes, on the other hand, are processes that are “embedded in time; not only does the
time taken matter, but, in fact, it contributes to the overall structure” (p. 161, italics
original). Rhythm improvisation epitomizes an in-time process. A rhythm improviser is a
framer of time—that is, an agent who utilizes the possibilities of time to create time-
oriented and time-dependent structures (i.e., rhythmic figures) while moving forward in
time, over the landscape of time, perhaps from one rhythm event-structure to where the
next will be created.
Returning to the Moving Times and Moving Observer metaphors, we note that an
improviser’s time orientation is the same in both perspectives (i.e., the future in front, the
past behind), but her/his nature as the subject of the metaphor is different than that of a
listener or a performer. Again, the Moving Times metaphor places the observer-listener
in a static position and receptive role, detached from the processes of creating or shaping
the event-structures encountered and undergone, and therefore subject to the music.
Musically, the Moving Times perspective makes logical sense for an observer-listener.
The participant-listener, in Johnson and Larson’s (2003) conceptualization, is also placed
in a receptive role, taking in the preordained structures she/he comes upon and living
8
through them on the journey over the landscape. Musically, the Moving Observer
perspective makes logical sense for a participant-listener, but also for the experience of a
performer of a composed work. The participant-listener receives the music as she/he
arrives at its location in musical time, whereas the performer reconstructs a composer’s
structures at their prescribed locations.
Compared with a participant-listener or a performer, a rhythm improviser is
indispensably involved in creating, forming, and locating rhythm event-structures as well
as bringing into existence the path on which they occur. A rhythm improviser also
determines the nature and character of the forward movement along the path over the
landscape of time. Due to the unique nature of an improviser’s role, she/he is not simply
an observer, but is a creator as well as an experiencer of the processes. The improviser
creates the experience and consequently also lives through it, along with each event
within it, by taking in the rhythm event-structures (i.e., receiving the auditory and
kinesthetic stimuli of the improvisation) and also by potentially being moved by the
musical constructions and forces. The improviser determines when improvisational time
begins and ends and also how time is marked and organized based on passed embodied
experiences of being and moving in the world or witnessing the movements of objects
and others. Therefore, according to embodied cognition concepts, the ways that pulse,
subdivision, tempo, rhythmic figures, meter, and accents are manifested in creating
rhythm event-structures in improvisations stems from and is constrained by an
improviser’s experiences of bodily movement in space and time.
Schemata Relevant to the Rhythmic Elements in Improvisation
Given the importance of embodiment in recent conceptualizations of music, it is

essential to attempt to describe the various rhythmic elements as they relate to bodily
movement schemata and their associated metaphors, all in the context of improvising.
Musical Pulse and Locomotion
Musical pulse, sometimes referred to as “basic beat,” is the division of time into
equally segmented and equally significant recurring events. Defined in this way, pulse
can be conceptualized by itself, without reference to subdivision, tempo, meter, and
rhythmic figure, and therefore warrants a separate discussion in terms of embodied
cognition constructs. Musical pulse may be understood through a few key schemata that
have to do with locomotion, including those for PATH, VERTICALITY, BALANCE,
CYCLE, GROUNDEDNESS, and GRAVITY.
As bipeds, humans, whose development is beyond infancy, ambulate most often
by walking—a form of locomotion. The left-right-left-right symmetry of the action of
walking is cyclical, like a rhythmic pulse. Simplistically, the machinations of walking
include the legs swinging from the hips in a cycle consisting of one leg swinging forward,
the forward foot striking the ground that supports the weight of the body as it vaults over
the leg that is now in contact with the earth, while the other leg begins to swing forward
and its foot subsequently strikes the ground, and so on (Farley & Ferris, 1998; London,
2006). As each leg “lifts up” and “returns down” to the earth in the cycle of steps, the
individual experiences VERTICALITY. This process carries the body in a forward
9
direction on a real or metaphorical PATH, a surface over which movement occurs and
that designates where on the landscape the walker is going, where she/he is, and where
she/he has been. The nature of a walking posture also invokes the VERTICALITY
schemata as the individual experiences the empowerment of being in an upright position,
affording the efficiency of ambulating bipedally rather than by crawling on all fours.
An individual’s legs are most often roughly equal in length, so a walking stride
creates an even rhythmic CYCLE of left-right, left-right—a completed cycle entailing the
execution of a step from each leg. In the process of walking, one foot always remains in
contact with the GROUND; in running, both feet may leave the ground simultaneously,
but they always return. Therefore, when walking (or running), we are, in a sense,
GROUNDED; we are supported, held up, maintained by the ground beneath us. Being
grounded in this way is also a function of the “pull” of GRAVITY—that is, the force of
nature that causes bodies in motion to return to the earth, to the ground. We experience
stability and support in our movement by being regularly connected with the surface over
which we travel, yet we must also assert effort toward maintaining our vertical posture in
the face of gravitational force. The muscular and skeletal movement scheme of walking
(and running) is also cyclical and therefore may be characterized as rhythmic. Therefore,
when walking or running evenly, we may say that we are moving in a rhythmically
grounded fashion (London, 2006).
Along with comprehension of the cyclical movement involved during the
experience of walking, humans also gain understanding of BALANCE. BALANCE, in
this case, is a dynamic concern of equal distribution of weight in various forms
necessitated by the influence of GRAVITY—the natural force that, in essence, pulls
physical objects downward toward the earth. In walking, unconscious adjustments are
continually made in the central nervous system for the weight of the torso, each arm and
leg, and the head, as these pivot over the axis formed by the foot and leg that is in contact
with the ground. BALANCE is, of course, important to the process of remaining upright
(VERTICALITY) so that the cycle of steps may continue as evenly as possible and the
body may therefore move forward in a controlled fashion (Farley & Ferris, 1998).
Given the above explanations of schemata related to walking, I wish to assert that
it is the experience of intentional movement schemes related to locomotion that provide
the basis for a human’s ability to reproduce a musical pulse. Briggs’s (1991) report on
musical development lends further credence to this claim. Her consolidation of findings
from musicologists and music education researchers indicates that a 10- to 14-month-old
child’s ability to intentionally play a steady beat develops concurrently with her/his
ability to walk, with improvement toward mastery of both continuing through the 36- to
72-months period (pp. 10–15). It should be noted that our ability to walk is, of course,
preceded developmentally by the locomotor scheme for crawling, which, once mastered
by an infant, is also a cyclical and therefore rhythmic action. The key to both schemes,
however, is the individual’s intentionality in the process, for it is through her/his
intentional actions in moving in and against the properties of the world that an individual
develops understanding of the nature of stable cyclical patterns of action and the
associated benefits for well-coordinated locomotion, and eventually for rhythmically
organized music-making.
Walking, it seems, is the most energy-efficient way for a human to ambulate
under her/his own power (Farley & Ferris, 1998). Other locomotion options exist, of
10
course, such as skipping, galloping, shuffling, hopping, and so on. But with a moment of
thought, we understand that all of these movement patterns require more cognitive and
physical energy of the typically developed human body than does the even, reciprocal
motion of walking. Numerous other rhythmic cycles occur in a functioning human
body—some more even and/or stable than others—such as in sleeping, respiration,
digestion, and menstruation. Historically, musicologists have related musical pulse with
the heartbeat, even naming this essential and most basic rhythmic element after it
(Spitzer, 2004). Yet, rhythmic biological imperatives such as heartbeat and respiration
largely occur unconsciously, with our attention brought to them most often only when
they are not even or stable, such as when affected by physical exertion or by
psychological responses to events (e.g., fright or joyful excitation). If heartbeat were in
fact the true basis for understanding and producing musical pulse, then it seems that
infants would be born with the ability to do so, which is not the case. I contend, on the
other hand, that the conscious and intentional embodied locomotor movement
experiences of walking (and crawling prior to walking) have greater import for the
development of embodied awareness and potential skill in playing pulse than the more-
often-than-not unconscious and unintentional experience of heartbeat. For just as a
musical pulse divides time into equally segmented, equally significant, recurring sound
events or cycles often made explicit when an object interacts with another (e.g., a mallet
striking a drumhead), the process of walking with an even gait requires equally
segmented recurring swings of the legs and feet striking the ground.
The cycles of pulses are balanced, as are steps when walking. Interestingly, the
cadence range (rate of speed) of human adult walking may also be roughly matched to
the typical tempo range of much Western music. Drawing on the work of Fraisse (1982)
and Todd (1994), Iyer (2002) substantiates a similar notion wherein listeners are thought
to comprehend rhythm in music by linking its attributes to that of bodily movement
schemes such as walking. Iyer posits that the relative cadence range of walking (in the
region of 60 to 180 bpm) has a musical correlate in the pulse rates or tempi of a large
portion of Western music. (It is quite likely that other musics of the world similarly draw
from this tempo range; however, no research was identified to support this notion.) More
recently, London (2006) has provided a thorough review of research on measured
relationships between walking cadence range and musical tempi, further sustaining Iyer’s
contentions. Presumably, the correspondence between tempi of Western musics and the
average range of adult walking cadences is not accidental but speaks to the embodied
nature of this indispensible rhythmic element. It also seems logical to assume that, since
listeners are believed to comprehend rhythm through their understanding of bodily
movement schemes, performers and improvisers likely gain this knowledge through
similar means and therefore draw from embodied knowledge when improvising with
rhythm (Mead, 1999).
Musical pulses may function in a figure-ground relationship with rhythmic figures
that, by definition (see below), divide time unequally yet often, but not always, in
mathematical relation to the cycles of the pulse. Similarly, a key attribute of the
experience of human locomotion, regardless of type, remains being in contact with the
earth; human agents are figures always supported by the ground, always in relationship
with it. And, whereas walking is the foundational scheme for human bipedal locomotion,
rhythmic pulse is the cyclical foundation for the experience of rhythmic movement—that
11
is, the GROUND over which rhythmic movement is experienced by both performer and
listener. The music theorist Mead (1999) adds support for the notion of a relationship
between walking and musical pulse by reminding us that “qualities of locomotion” as
well as tempo are reflected in familiar music terminology (i.e., tempo markings) (p. 5).
Examples may include agitato (“hurried, restless”), grave (“slow and solemn”), and
andante (“at a walking pace”) (Apel, 1969). Mead (1999) further explains his stance
thusly:
I suspect that further aspects of rhythm also derive from our physical
motion, however. We are extremely sensitive to the differences between
even and odd groups of pulses, whether they be at the level of the beat, its
subdivision, or numbers of bars in a phrase. It strikes me as not
unreasonable to reflect that our sensitivity to this difference is at least in
part derived from our sense of the difference between those cyclic actions
that involve reciprocal motion, such as walking, and those that do not. (p.
5)
It is important to recognize that a rhythmic pulse is often a covert experience for

an improviser rather than explicitly sounded when playing. An improviser may relate
rhythmic playing to an underlying pulse that is created and maintained internally but not
actually played or sounded explicitly. Thaut (2005) refers to the internalization of
rhythmic pulse as a “felt pulse” and notes that other rhythmic actions a player might
construct—regular or irregular—are somehow “referenced and synchronized against
underlying sensations of pulse patterns” (p. 7). Regardless of whether the pulse is
expressly sounded or its perception simply felt, its characteristic grounding aspects,
explained through schema theory, nonetheless impinge on an improviser. These
grounding aspects play a role in the achievement of cyclical movement forward on a path
wherein a gravitational pull toward the ground is experienced, requiring effort to
maintain balance.
Metaphorical linguistic phrases that evidence a link between notions of musical
pulse related to locomotion and the underlying structures of the PATH, VERTICALITY,
BALANCE, CYCLE, GROUNDEDNESS, and GRAVITY schemata may include any of
the following:
- “Here the music settles onto the beat”
- “Louis Armstrong was known for playing just in front of or behind the beat”
- “He laid down a steady beat throughout the entire piece”
- “Her playing was grounded in an even pulse”
- “His wildly expressive playing was ungrounded”
- “The insistent pulse of the bass supported the group’s cohesion”
- “He was able to stand up on his own as a new member of the rhythm section”
Subdivisions
Subdivisions are divisions of the time span of musical pulses into smaller, equally
spaced, equally significant events. They may be sounded or manifested as rests.
Subdivisions most often divide the pulse into equal cycles of halves, thirds, fourths,
12
sixths, eighths, sixteenths, and so on. The origin of any subdivision is the pulse, and
therefore a sense of the underlying or felt pulse is found in subdivisions. This being the
case, a subdivision cannot be separated from its direct relationship to the pulse. A series
of subdivisions may sometimes function similarly to the pulse—for instance, when used
as an ostinato. Notably, subdivisions occur more frequently than pulsations, yet they do
not signal a change of tempo. Pulse and subdivisions share the same temporal and
therefore metaphorical space. In summary, subdivisions fill the time between pulse beats
with more frequent events that are equally significant while also remaining measured
within the same metaphorical space as the underlying pulse beats.
Referring back to the discussion of pulse as related to walking, it seems prudent to
examine whether the same explanatory metaphor of locomotion may hold true for
subdivisions. Key differences between subdivisions and pulse, of course, are the
frequency with which the equally subdivided beats occur and the increased use of
physical and cognitive energy required to produce and organize them.
Pulse and Subdivisions: Walking and Running?
In terms of linking locomotor concepts, it may be tempting to state that, since

pulse is related to walking, then subdivisions relate directly to the act of running.
However, a moment of analysis of walking and running movement schemes suggests
that, within a small range, these two locomotor schemes can, in fact, share a similar rate
of occurrence (also variously referred to as speed, cadence, or, in music, tempo) (London,
2006). Therefore, we might say that walking and running are just two similar
metaphorical ways of articulating or representing a pulse. Yet, whereas walking and
running may potentially share a small cyclical range of cadences, the complexity of
movement involved in each scheme is different, as are the energy requirements of each.
In running, it frequently occurs that both feet simultaneously leave the ground as the
body works against gravity to propel itself both upward and forward, thereby demanding
more coordination and energy than in walking. Hence, the complexity of movement
patterning (coordination and organization) and energy required seems to differentiate
these two locomotor schemes.
A similar relationship seems to exist between the coordination, organization, and
energy requirements of pulse and subdivision playing. Yet, despite these apparent
similarities between walking-running and pulse-subdivisions, an issue that seems to
weaken the link is the metaphorical temporal space required among them, if in fact we
liken metaphorical temporal space to the characteristics of physical space. For unlike the
temporal and metaphoric space necessary for the realization of pulse and subdivisions of
the pulse (i.e., the same temporal and metaphoric space), running, in actuality, typically
moves a person forward over a landscape farther than the scheme for walking over the
same time period, thereby requiring more space or distance to accommodate the result of
running movements. When an individual needs or wishes to move forward quickly,
shifting the movement pattern from walking to running accommodates the energy
associated with the impulse to move faster. Correspondingly, the feet strike the ground
more frequently but also with greater expanse between them, and more distance is
traversed. It is here with regard to the metaphorical distance covered on the PATH, as
found in the equal relationship between pulse and subdivision playing, that the
13
metaphorical connection between walking-running and pulse-subdivision seems to lose
explanatory power.
Summarizing the above metaphorical concerns surrounding pulse-subdivisions
and walking-running, we can say of subdivisions that they accommodate an improviser’s
increases of energy from that typically expended by pulse playing. This occurs, however,
without changing the underlying time cycle or the underlying movement scheme (pattern)
of the felt pulse, but also without changing the amount of space on the metaphorical time
landscape that is traversed. Running, on the other hand, while potentially maintaining a
mathematical relationship to an earlier walking cadence such as by doubling or, less
likely but possibly, tripling or quadrupling the rate of previous walking steps, results in
greater distance traveled on a landscape during the same time frame as when walking,
and also expends a greater amount of energy. Thus, the potential metaphorical
relationship between pulse-subdivision and walking-running appears to be violated.
Returning to the schemas noted above relating pulse and walking, namely the
schemas for PATH, VERTICALITY, BALANCE, CYCLE, GROUNDEDNESS, and
GRAVITY, it is the PATH schema that is not accommodated in the attempt to
metaphorically link subdivisions to running. The PATH unfolds over the GROUND of
the felt or actuated pulse. Subdivisions, by definition, relate directly to the grounding
pulse, their realization being part of the pulse, and therefore their manifestation being in
the same time (and metaphorical space) as the pulse. How, then, do we differentiate
subdivision from pulse? What is the embodied nature of subdivisions, and what
metaphorical concepts help in our explanatory pursuit of this rhythmic element?
Subdivisions and Bilateralism
Human walking is a bipedal accomplishment. We are able to walk because we

possess the bilateral structures (left and right legs and feet) that allow it. We are also
bilateral with regard to our upper extremities (i.e., arms and hands) and, as humans, we
are incredibly creative when it comes to the seemingly infinite number and sorts of things
we can do with our bilateral upper extremities. One of these incredible feats is to
subdivide musical pulses into smaller, equally significant units. We typically accomplish
this through variously alternating the actions of our left and right arms and hands. We
might conjecture that this act has historical roots in pre–verbal human language
communication—for instance, when a person sought to communicate with another about
the speed of an animal as it moved nearby, of the rate of flow of a river or storm cloud, or
perhaps about the flow of energy of an emotion. Demonstrating these important “motion-
situations” (Lakoff & Johnson, 1999, p. 151) by striking an object with alternating left-
right patterns at different speeds with one’s hands could indeed be considered a creative
and efficient way of nonverbally communicating information about movement and
energy parameters of various phenomena. What I argue here is akin to this idea: Humans’
performance of subdivisions of a pulse is realizable because our cognitive and motoric
capacities allow us to use subdivisions as a means of expressing or communicating
something about temporal flow parameters of movement and energy. Said another way,
as humans, we take advantage of our embodied understanding of motion-situations and
bilateral upper extremity structures to create subdivisions and thereby express or
communicate about movement and energy.
14
In summary, I argue above that the comprehension and performance of pulse
playing have their bases in the locomotor scheme of walking. While it may seem logical
to metaphorically relate running to subdivisions of pulse due to certain inherent
relationships—that is, running and playing subdivisions both require increases in
complexity of coordination and energy compared with walking and playing pulse,
respectively—I have shown that the metaphorical relationship eventually fails, for pulse
and subdivision share the same temporal space on a metaphorical PATH, whereas a
runner and a walker, over time, will naturally end up in different places altogether. The
comprehension and playing of subdivisions of pulse is instead argued to be related to the
nature and possibilities of human bilateralism and cognitive abilities (and, perhaps, to a
human’s creative/aesthetic penchant) for coordinating and organizing bilateral
movements. This advantage may be applied in response to a need or desire to express
experiences or observations of motion-situations in the world that occur at various rates
of speed and with varying levels of energy.
Metaphorical linguistic phrases that evidence a link between subdivisions and
expressions of movement parameters of speed and energy are the following:
- “Her playing seemed to have a sense of urgency as her rapid sixteenth-note
subdivisions continued unabated for the duration of the improvisation.”
- “The unhurried feeling experienced earlier in the music returned when he
switched from playing a steady steam of eighth-note subdivisions to half
notes.”
- “While listening to her relentless subdivisions, I had the mental image of
someone trying to hurriedly flee from danger.”
Tempo: Measure of Energy
For any musical pulse to exist and to be recognized by an improviser or listener,

there must always be a measurable rate at which the pulse cycles occur, or a tempo
(London, 2006). Regarding tempo in improvisation, Bruscia (1987) expresses the view
that “Tempo is a gauge of energy, signaling the need to be held up by a ground …” (p.
451, italics added). To define and expand on this notion relevant to improvisation,
consider how when rhythmic playing begins, it evinces an expression of embodied
energy requiring some form of structure on which to emerge and to which other rhythmic
elements or events may potentially relate. Cooper and Meyer (1960) believe that tempo
“is not an organizing force”; rather, that it allows qualification of the rate of speed of the
pulse (p. 3). Tempo is also not something that simply happens when a pulse occurs, but it
is consciously or unconsciously established by an improviser and is one clear revelation
of energy manifested in a music improvisation. Fraisse (1982) reviewed research
indicating that individuals appear to possess a stable “spontaneous” or “personal tempo”
as observed and measured in various empirical movement tests such as measures of
finger-tapping speeds. Related to the above discussion linking pulse and locomotion,
Fraisse also noted that research subjects’ spontaneous tempi were highly correlated with
the typical range of adult walking cadences (pp. 153–154). Hence, it seems that the rates
at which an improviser plays are individualized and yet relative to her/his experiences of
human bipedal locomotion.
15
When improvising begins, a pulse cycle also potentially begins, establishing an
overt or covert ground over which other rhythmic events may take place. As noted above,
the tempo of pulse cycles is an indication of the energy expressed moment by moment in
an improviser’s rhythmic playing, and it may change freely according to various dictates
of the player. Summarily, some form of energy must always be implied and applied in
order for initial and subsequent beats to be sounded by a player, for a pulse cycle to be
realized, and for rhythmic expression to be sustained throughout an improvisation.
Returning to the PATH schema, we note that as an improviser moves forward on
a PATH, she/he does so always with a particular amount of energy that influences the
pulse cycles and that manifests as a particular (measurable) rate of speed or tempo. With
regard to rhythmic elements, Bruscia (1987) classified pulse, subdivisions, and tempi of
improvisations as “rhythmic grounds,” and stressed that rhythmic grounds signal a state
of equilibrium without an indication of a goal or other intention. Such energy flow related
to pulse might be characterized as inertia: steady forward movement that remains
unchanged until acted upon by another force. Therefore, when an improviser responds to
an impulse (internal drive or compulsion) to play beats that do not correspond with pulse
beats, the inertia is disrupted and a change occurs in the equilibrium, consequently
signaling a need for resolution (p. 451). It is at this point that a rhythmic figure may be
born.
As noted above, Mead (1999) reports that many of the terms used to describe
tempi—or in composed music, to suggest appropriate tempi—are based on metaphorical
linguistic terms regarding locomotion and/or deportment of locomotion. Above, I
highlighted the examples of agitato (“hurried, restless), grave (“slow and solemn”), and
andante (“at a walking pace”). A review of music theory texts will reveal an abundant list
of similar terms. Other metaphorical phrases that evidence a link between tempo and
qualified energy related to movement or locomotion in improvisations are any of the
following:
- “His tempo evolved from quick and restless to calm and relaxed before the
improvisation was finished.”
- “It became clear that the lumbering tempo established early on in the group
improvisation would not contain the high amount of anxious energy of many
of the members.”
Meter and Accent: Containers and Boundaries
Like tempo, meter is not a sound stimulus that an improviser “plays” as in pulse
beats, sounded subdivisions, or rhythmic figures. Rather, it is a cognitive organizational
tool for sorting rhythmic stimuli into manageable groups or “chunks” to assist in making
the world of time-based musical/rhythmic experiences comprehensible (Lerdahl &
Jackendoff, 1983; Radocy & Boyle, 2003; Thaut, 2005). The concept of “chunking,” first
introduced by Miller (1956), has long been established as a cognitive structuring strategy
for making sense of serial or sequenced bits of information (Gobet, Lane, Croker, Cheng,
Jones, Oliver, & Pine, 2001). When represented on a written score, metrical structures are
referred to as “measures,” reflecting their function as regular organizational structures.
Each measure holds a specific “measure of time,” that is, amount or number of pulse
beats. Most often in Western music, measures are organized in sets of two or three pulses
16
and the variety of possible subdivisions of those pulses (Cooper & Meyer, 1960; Radocy
& Boyle, 2003).
From a schema theory standpoint, meter may be conceptualized as a continuous
series of connected CONTAINERS with permeable walls that most often constrain the
amount of rhythmic stimuli permitted inside each container, while at other times allowing
an overflow of rhythmic stimuli to cross over into adjacent containers. Unlike when a
performer re-creates composed music, an improviser “creates” these organizational
containers for her-/himself during the spontaneous act of improvising and reinforces their
conceived existence and function through the use of accents or emphasized beats (Cooper
& Meyer, 1960; Radocy & Boyle, 2003). In this regard, Cooper and Meyer have noted
that an accent “is a stimulus (in a series of stimuli) which is marked for consciousness in
some way” (p. 8, italics original). Consequently, an improviser may play accents as a
means of remaining conscious of the metrical containers she/he has established or to
create rhythmic tension by accenting across metrical boundaries. Whereas a variety of
accent types have been described (see Creston, 1964), Lerdahl and Jackendoff (1983)
emphasize accents that reinforce meter, or “metric” accents, and those that function
toward grouping other sorts of rhythmic events, such as rhythmic figures. Concordantly,
in improvisation, accents often are created through the use of physical strength as an
improviser stresses particular beats that land inside the metrical containing structures,
their sound durations fitting inside the container, thereby reinforcing the meter—Lerdahl
and Jackendoff’s metric accent. Accents may also be improvised that permeate the
boundary of a metrical container by prolonging the sound stimulus or creating the
perception that the sound stimulus is prolonged, thereby crossing a metrical container’s
boundary into the next container and potentially disturbing the strength of the metrical
boundaries or walls of the containers. Consistently crossing the boundary may
subsequently alter the regularity of the metrical structure and potentially establish a new
meter with new containers that hold a different measure of time than the previous ones.
Metaphorical linguistic phrases that evidence a link between functions of meter
and the CONTAINER schema include any of the following:
- “Her rhythms landed squarely within the measure.”
- “He broke out of the meter and improvised freely.”
- “She ignored the established meter and played in her own time structure.”
- “The amount of syncopation blurred the boundaries of the meter.”
Rhythmic Figures: Structures and Events
A key metaphorical concept emerges from the musicological literature regarding

the potential embodied nature of rhythmic figures in rhythm improvisation, namely the
architectural notion of rhythmic figures as structures. Along with sound, silence, and
time as materials, the concept of forming or building rhythmic structures includes the
embodied factors of movement and energy in time and space, as well as the related
concept of events in our comprehension of time. We will examine below the defining
features of rhythmic figures before exploring their conceptualization as structures and
events.
A rhythmic figure, or that which other authors have variously referred to as
rhythm patterns (Bruscia, 1987), rhythmic groupings (Cooper & Meyer, 1960; Lerdahl &
17
Jackendoff, 1983), “objective rhythmization” (Fraisse, 1982), beat patterns (Thaut, 2005),
or quite generically as “a rhythm,” may be characterized as a division of time into a mix
of equal and unequal beat segments with equal and unequal durations (i.e., long and short
notes) and significances, (i.e., accented [strong] vs. unaccented [weak] beats). The
concept of rhythmic figures infers an ordering of musical time that differs in structural
quality from cyclical pulses or their subdivisions. Cooper and Meyer (1960) define a
rhythmic figure as “the way in which one or more unaccented beats are grouped in
relation to an accented one” (p. 6), a stance similarly held by Lerdahl and Jackendoff
(1983). Cooper and Meyer refer to rhythm as “architectonic” in nature, meaning that the
elements of rhythm, as well as various levels of rhythmic groupings, are used to build or
construct forms in the service of organizing composed tonal music. Fraisse (1982) reports
that in ancient Greek Ionian philosophy, rhythmos commonly meant form, “but an
improvised, momentary, and modifiable form. Rhythmos literally signifies a ‘particular
way of flowing’” (p. 150, italics and internal quotation marks original), thereby
referencing rhythm’s relationship to motion or movement. Consequently, given the
earlier discussion of embodied time conceptualizations, the notions of form and flowing
also draw on the concepts of events and space. Fraisse, who himself reports the non-
existence of an exact and generally accepted definition of rhythm, goes on to relate that
Plato defined rhythm as “the order in the movement,” stressing that the locus of human
beings’ perceptions of rhythm is movement of the human body (p. 150). Fraisse
conceptualizes the basis of rhythmic figures as “Any differentiation in an isochronous
series of identical elements” and notes, as do the other authors mentioned here, that the
differentiation may come from beats having different durations or accents, or from pauses
or rests in the flow of beats (p. 159). Thaut (2005) explains that rhythmic figures may (a)
take the form of either simple subdivisions of a pulse constrained by meter, (b) be quite
complex and highly syncopated but still organized within established metrical structures,
or (c) be asymmetrical in their relationship with a meter or an underlying sense of pulse,
or free rhythms (p. 11). Free rhythms “consist of extended or brief groups of rhythmic
events that are characterized and distinguished from each other by changes in contour,
timing, intervals, durations of sequences, tempo changes, or accent patterns” (p. 11). It
should be noted that, with regard to free rhythms, Thaut refers to the Free Jazz
experimental improvisation movement of the 1960s and 1970s that sought to set aside or
“free” improvisers from melodic, harmonic, and rhythmic structural conventions. (See
Bailey, 1988, for a detailed examination of this movement in improvised music.)
Rhythmic Figures as Event-Structures
It is clear from the above definitions that rhythm involves both structure/form and
movement. From the embodied cognition concepts of time described above, the playing
of rhythmic figures, it seems, also shares characteristics with experiences of human
bodily actions entailing energy and movement through time and space, while also
drawing from embodied understanding of time via events. Whether constrained by or free
from musical conventions (i.e., some level of pulse and/or metric stability), a rhythm
improviser is an agent who creates or forms distinct rhythmic figures that are different
from pulse beats or sounded subdivisions, while playing. Reflecting on my own
experiences of rhythm improvising and those of my clients and students, it seems that an
18
improviser may express different intentions when forming rhythmic figures. These
intentions may include manipulating the rhythmic elements and possibilities at one’s
disposal as guided by personal or cultural notions of aesthetic forms of expression, or
communicating in some way with a listener or fellow improviser.
As we seek to describe the process of an improviser manipulating the materials of
time (i.e., rhythmic elements) for aesthetic or personal satisfaction, it seems apt to
metaphorically relate rhythmic figures to an architectural metaphor in that we often
explain that an improviser constructs, makes, creates, generates, shapes, or forms
rhythms while improvising. Other terms used for the creation of rhythmic figures may
include the following: make up, produce, fashion, craft, build, assemble, develop,
compose, or structure. The concept of constructing is an embodied experience that
humans have shared at least since our ancestors began fashioning clothing and shelter
against the elements by using the bilateral and independent capabilities of upper
extremities to manipulate materials into useful forms—indeed, a sort of improvising.
As noted above, rhythmic figures or structures created by an improviser are
formed in time, using time and sounds as materials. Correspondingly, and according to
schema theory, these discrete rhythmic structures are also formed at certain locations on
an unfolding PATH on the metaphorical time landscape and are thus also associated with
our conceptualizations of events. An improviser creates and organizes rhythmic figures,
or what I have referred to as rhythm event-structures, as she/he traverses a metaphorical
PATH. The PATH is highlighted or brought into being through the creation of rhythm
event-structures, for without the formation of rhythm event-structures to mark it as
different from the GROUND, the existence of a PATH on which rhythm event-structures
may occur is unwarranted; the path’s proposed purpose otherwise goes unfulfilled.
Without rhythm event-structures to distinguish a path from the ground, all that exists is
the ground. Rhythmically speaking, to play pulse is to play the GROUND. However,
with the formation of a rhythm event-structure comes the possibility of movement from
one event-structure to another and another, thereby necessitating the existence of a PATH
between them, and with it the innumerable ways that an improviser may move between
each rhythm event-structure. In this regard, we may also reflect on the experience of an
observer or participant-listener who, depending on the tempo of movement via the music,
either experiences the music moving toward and past her/him or moves to and through
the music’s rhythm event-structures at varying rates of speed, thereby having her/his
experience of the event-structures influenced in one way or another.
To summarize, rhythmic figures as event-structures have to do with the embodied
concepts of constructing structures (i.e., rhythmic objects) using time and sound as
materials. Rhythmic figures, being constituently formed of time and space (via the
metaphorical relationship between the two), are distinct with regard to the parameters of
movement and energy they possess. Rhythmic figures are also constructed over the time
of an improvisation, making each also an event (with a beginning, middle, and end) that
the improviser subsequently moves through while creating them and moves away from in
order to construct more rhythmic figures or event-structures. The architectural metaphor
alludes to the agency of the improviser in the process of building or constructing the
event-structures of the improvisation.
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Metaphorical linguistic phrases that evidence a link between improvised rhythmic
figures, events, and metaphorical concepts of architecture may include any of the
following:
- “She built her improvisation by alternating the placement of a one-measure-
long and a two-measure-long rhythmic figure.”
- “He formed his rhythmic figures out of staccato sixteenth notes.”
- “Her improvisation was characterized by carefully placed rhythmic figures
assembled in various ways from the common ‘shave and a haircut’ motif.”
Summary: Embodied Cognition, Schema Theory, and

Meanings of Rhythm in Improvisation
In this chapter, an attempt has been made to draw on concepts from the cognitive
science domain known as “embodied cognition” and the related model of schema theory
to explicate a deeper understanding of humans’ proclivities to use rhythm in improvised
musical expressions. The key tenet of embodied cognition is that humans gain
comprehension of the world, and our experiences in it, through bodily interactions with it
and/or through our observations of objects and people moving and interacting in the
world. A key tenet of schema or metaphor theory is that humans’ metaphorical
conceptualizations of interactions with the world provide a means through which we
explain to ourselves our experiences of and in the world—meaning that we aid our
comprehension of life experiences by mapping experiences from one domain onto
another. For example, we may map the bodily experience of running into a large object
(“to crash”) onto the target domain of feeling overwhelmingly tired and needing to lie
down and rest.
Due to the nature of rhythm as a fundamentally time-based experience,
conceptualizations of humans’ psychological experiences of time were examined through
schema theory. Highlighted was the fact that humans’ experiences of time are
metaphorically understood through experiences of moving to and through events in
space; time is understood only through our knowledge of the properties of events,
including our experiences of enduring the ways that events unfold. In this regard,
important schemata for experiences of time were explained. These include the Time
Orientation, Moving Times, and Moving Observer schemata. From analyses of these
schemata, an assertion was made that rhythm shares conceptual aspects with our
experiences of structures found in particular locations on a landscape and also with our
experiences of moving to and living through events, leading to the concept of rhythm
event-structures. With regard to rhythmic improvising, it is theorized that the experience
of creating rhythm structures at varied locations on the metaphorical landscape of time
and the experience of living through each rhythm’s form as an event in time are not
separate.
The experience of a rhythm improviser and thus the ways that rhythm may be
conceptualized from this particular music engagement vantage point was found to differ
considerably from that of a listener or a performer of composed works. In explicating
differences inherent in the role of listener vs. performer vs. improviser, a rendering
emerged of the multilayered nature of an improviser’s role and the multifarious demands
of the improvisational process. Significantly, a rhythm improviser initiates improvised
20
sounds through capacities to focus physical energy, motor actions, and cognitive agency
on interacting with instruments. In so doing, the improviser creates rhythm event-
structures as well as the metaphorical path on the landscape of time on which the event-
structures occur or are located. The improviser also experiences applying her/his own
physical and cognitive energies and efforts to organize the resulting sounds that emerge
from the process. An improviser simultaneously appraises the sounds for their value to
the improvisational process while continuing to create and to variously construct
subsequent rhythm event-structures until the improvisation ends.
Thus, the picture emerges of rhythm improvising as a uniquely complex and
sophisticated endeavor that touches upon and draws from numerous aspects of human
functioning. Explaining the nature of the rhythmic materials involved in improvisation,
therefore, requires an orientation capable of accommodating the unique factors
implicated. With this in mind, embodied cognition and schema theory concepts were
brought to bear on explanations of the rhythmic elements of pulse, subdivisions, tempo,
meter, accent, and rhythmic figures used by rhythm improvisers.
Implications of Embodied Cognition Theory for Improvisational Music Therapy
Foundational thinking on implications of schema theory for music therapy can be

found in Aigen’s (2005) Music-Centered Music Therapy text and Journal of Music
Therapy article titled “Verticality and containment in improvisation and song: An
application of schema theory to Nordoff-Robbins Music Therapy” (2009). Paramount in
Aigen’s theoretical view of music therapy is that “all aspects of melody, harmony,
rhythm and meter, and texture that constitute one’s clinical-musical interventions should
have an underlying rationale” (2009, p. 242). Toward fulfilling the mandate understood
in this proposition, Aigen advocates the importance of embodied cognition theories “as a
tool in integrating musical content with the extra-musical clinical concerns that
characterize the focus of music therapy” (p. 244). Other significant implications for the
use of embodied cognition theories in music therapy are in how clients’ functional
capacities are revealed through their participation in various forms of musicking,
including improvising. Aigen (2005) notes that relevant image schemata can provide an
informative link between a client’s life experiences inside and outside of music, that the
metaphorical language used to describe music and musical experiences is useful toward
gaining insight into music and its importance in clinical processes, and “that image
schemata are not just of cognitive importance but also represent basic emotional,
psychological, and developmental needs and aspirations of human beings” (pp. 178–179).
Aigen also concludes that a key benefit of musical engagement revealed through
embodied cognition theory is the compensatory nature of metaphorical understandings
gained through musicking for clients whose disabilities limit their access to the cognitive,
emotional, psychological, and developmental benefits of directly engaging in moving and
physically interacting in the world (pp. 201–202).
Forces
In the findings described earlier regarding applications of embodied cognition

theory to rhythm improvising, I noted that, at a foundational level, a rhythm improviser
21
initiates and then maintains efforts in improvising sounds through embodied capacities to
focus physical energy, bodily action, and cognitive agency on the processes of interacting
with instruments. We may say, then, that in order for any rhythm improvisation to occur,
there must be application of some form of force in the process of moving one’s body with
and against instruments. Johnson (1987) tells us that any action or interaction among
objects and/or people implies the presence of forces (p. 42). The embodied experiences of
human beings, as we move through the world and interact with objects and each other
moment by moment, may thus be viewed as a series of force interactions or relationships
(p. 45).
Forces, we are told, evince certain general characteristics that are immediately
related to embodied understandings. Among these characteristics are the following: (a)
Humans’ basic awareness of forces is made evident through our experience of
interactions. Johnson emphasizes, “There is no schema for force that does not involve
interaction, or potential interaction” (p. 43); (b) Force is most often related to the
movement of an object in a particular direction through space; (c) An object in motion
usually follows a singular path; (d) Every force is derived from some source or origin
(therefore, due to the directionality of forces, agents may manipulate forces toward a
particular purpose or goal); (e) The strength, power, or intensity of a force is variable and
is in many instances measurable; and (f) Since forces are evidenced through interactions,
“there is always a structure or sequence of causality involved” (p. 44, italics original)—
“Forces are the means by which we achieve causal interactions” (p. 44). Johnson holds
that the characteristics just described constitute image schemata or Gestalt structures for
all forces. Further, our metaphoric understandings of actions, interactions and therefore
events, including improvising with rhythm, are conceptualized through the same image
schemata. Johnson also asserts that image schemata, such as those for FORCES related to
interactions and events, are implicated in the way meanings and inferences are developed
(pp. 44–45). What sorts of force Gestalt structures may be identified in rhythm
improvising, and how might FORCE schemata be useful to a music therapist toward
understanding and working with a client’s improvised rhythm? (For detailed expositions
on the nature of tonal forces, see Aigen [2005, 2009], Johnson & Larson [2003], and
Larson [1997, 1998].)
Johnson (1987) describes the following four general types of FORCE Gestalt
structures or relationships that may bear on the processes of rhythm improvising:
Compulsion, blockage, counterforce, and diversion. These structures may provide
conceptual foundations for music therapists toward comprehending a client’s improvised
rhythm in both solo and co-improvisation situations. In solo improvising, a client
generates, coordinates, and responds to improvisational and rhythmic forces of her/his
own, whereas in co-improvisation, client and therapist both generate, coordinate, and
respond to their own and each other’s improvisational and rhythmic forces. Improvisers’
playing may also be influenced in response to aesthetic, emotional/psychological, and
physical forces rather than to purely musical ones. It therefore becomes possible for a
therapist to witness and infer from a client’s rhythmic improvising aspects of embodied
experiences and understandings in relationship to self, to the world, and to others (Aigen,
2005). The therapist may also actively explore and subsequently work in treatment with a
client’s responses to various types of forces through use of clinical-musical techniques.
With regard to implications for improvisational music therapy, I will variously highlight
22
related concepts from the IAPs formulated by Bruscia (1987, pp. 403–496), analytical
music therapy (Priestley, 1994), and Nordoff and Robbins’s (2007) creative music
therapy models. I will also draw on notions related to the 64 clinical techniques found in
Bruscia (1987, pp. 533–557).
Compulsion
Given the above characteristics of forces, we may note that any force that results
in real or potential action must have a point of initiation from which it begins, or a
compulsion that then moves with a certain intensity in a particular direction along a path
(Johnson, 1987). For a rhythm improviser, the compulsion or urge to play may have its
origin in the impulse to create sound. The impulse may stem from, for example, an
emotion, an aesthetic idea, or a need or desire to enact a physical expression of energy or
to communicate with another. In such cases, the improviser may say that she/he is moved
to play. Johnson emphasizes that without compulsion, an assertion of force will not
occur. Therefore, at the most basic level, a client must experience an impulse from which
a movement or action might be initiated and, whether aware or not of the impulse, must
also be capable of responding to it with some form of action upon an instrument.
When a therapist witnesses the force of compulsion in a client’s rhythm
improvising, a sense of particular aspects of the client’s immediate functioning in various
domains may be gained. First, the presence of pulse in an improvisation is indicative of
the client’s experience of time (which is understood via movement in space) and the
capability of cognitively and motorically organizing it or organizing self in relation to it.
If pulse is present, the therapist may also infer something about the level of energy
inherent in the client’s ongoing impulses through the tempo and/or use of subdivisions.
Further, with the presence of pulse, the therapist may note the occurrence of metrical
organization and therefore something of the client’s organization or coordination of
expressive impulses. The immediate presence of rhythmic figures in an improvisation,
while inherently indicating relationships to pulse/subdivisions, tempo, and meter (i.e., the
organized flow of energy in time), may further provide for a therapist a more complex
view of the client’s experience of her-/himself as an agent who, in turn, comprehends the
self as an agent who moves in time through various events and participates in creating,
structuring, and experiencing events in the world. In other words, a rhythm improvisation
that uses the widest range of rhythmic materials available reveals immediately the
broadest perspective of the improviser’s cognitive, motor, and psychological functioning
in that moment. When pulse is not present in a client’s initial playing, on the other hand,
a therapist may note that the compulsion to create sound has revealed a force in response
to an impulse. However, the nature of the impulse will indicate quite different meaning
potentials having to do with a lack of organization in the client’s motoric, cognitive, or
emotional/psychological realms of experience or combinations therein. According to the
IAPs (Bruscia, 1987), in response to a client’s initial improvised offerings (i.e., her/his
compulsion), a therapist may begin to assess through the variability profile the range of
stability or instability or change with regard to the client’s use of tempo, meter, and
rhythmic figures toward later interpreting potential meanings (pp. 427–433). Further, the
therapist may be drawn to listen through the congruence profile as the client’s use of
23
tempo, subdivisions, and/or meter may exhibit differential relationships to each other as
revealed through tensions among these rhythmic grounding and organizing elements.
For Nordoff and Robbins (2007), witnessing a client’s compulsion in
improvisation is related to the concept of the music child that is described as
…that entity in every child which responds to musical experience, finds it

meaningful and engaging, remembers music, and enjoys some form of
musical expression, communication, and sharing. The music child is
therefore the individualized musicality inborn in every child: The term has
reference to the universality of human musical sensitivity—the heritage of
complex and subtle sensitivity to the ordering and relationship of tonal and
rhythmic movement—and to the uniquely personal significance of each
child’s musical responsiveness. (p. 3)
Hence, to witness the compulsion of an improvisational impulse is to witness the

manifestation of the music child’s impulse to engage musically with the world. (It should
be noted that the concept of the music child is not limited to children with disabilities, but
applies equally to all improvisers [Aigen, 2005].) For Nordoff and Robbins, most
improvisational experiences are co-created between client and therapist. Therefore, a
client’s impulse to create sound may stem from a need or desire to respond to the
therapist’s sounds as well as from her/his own internal expressive or communicative
impulses. Toward comprehending a client’s rhythmic expressions, a therapist working in
this model first assesses the nature of the client’s compulsion by attending to the
rhythmic character and quality of intentionality in the sounded impulse, with a particular
focus on pulse beating stability (p. 298). With the overarching aim of rhythmically (and
therefore interpersonally) connecting and relating with the improviser, Nordoff and
Robbins highlight the significance of pulse playing as an embodied experience in the
following statement: “Two individuals responding to the pulse together are experiencing
the most universally natural way of finding mutuality in being physically active to music”
(p. 298).
Blockage
Moving and therefore interacting in the world is not always a clear and
unrestricted process, for we encounter obstacles or blockages along our paths,
necessitating a redirection of our forces to circumvent the blockage. According to
Johnson (1987), we do this by going around, over, or through the blockage, or else we
must simply stop. In this regard, we may hear such metaphoric phrases related to
circumventing a blockage if one can only work around an issue or get over a hurdle or
through a bottleneck. It seems that there is evidence of intelligence and creativity in a
human’s process of determining how to get around a given blockage, as many options
may be at one’s disposal. Such is the case for a rhythm improviser. Let us explore the
types of blockages that may occur in rhythm improvising.
The blockages that a rhythm improviser may encounter exist in the form of intra-
and interpersonal experiences as well as intra- and intermusical experiences. For instance,
a solo rhythm improviser is always vulnerable to the intrapersonal-intramusical auditory
24
feedback loop while creating and responding to the improvised sounds. As a client
improvises and hears the improvised sounds, she/he may become aware of emotional
energies and related associations underlying the expressions. Should the client be
resistant to emotional awareness and the feeling implications of the emotion, the client
may consciously or unconsciously alter the forces that are entailed in the character of the
current improvising toward avoiding the emotion. The feedback the client thus receives
changes, and she/he may then move along in the improvisation unhampered by the
emotional blockage. An example of an interpersonal blockage may have to do with the
authenticity in a client’s improvising. This may be the case when a client recognizes that
the improvisation may reveal something about her-/himself that she/he wishes to conceal
from the therapist. In reacting to this potential blockage, she/he may consciously alter the
forces inherent in her/his rhythmic expressions in an attempt to hide the aspect in
question from the therapist while continuing to improvise. Along these lines, Priestley
(1994) writes of similar instances of clients attempting to hide or avoid revealing aspects
of themselves, but with a focus on implications regarding unconscious processes as
viewed psychoanalytically. Priestley refers to these events as types of resistance
occurring in a client’s improvising and/or verbal processing of improvisations and
leading to what she terms a resistance vacuum wherein a client unconsciously avoids
revealing, feeling, and/or addressing certain emotions and any related cognitive materials
via music, thoughts, or words (pp. 181–185).
A third example that crosses intra- and interpersonal as well as intramusical
perspectives is when an improviser recognizes being somehow limited (i.e., is blocked)
by the sensorimotor challenges required in improvising and how she/he or a listener may
feel about it. Here the improviser may seek to form a particular expressive structure
related to an aesthetic idea or one that suits an emotional expressive intent in the moment
but is limited in doing so due to physical constraints (e.g., lack of mastery on an
instrument). In attempting to create a particular structure, the client may misplay the
figure and hence consider it a failure of sorts. To avoid feeling inadequate, the client may
repeat the misplayed figure as if it were intended and thereby circumvent the blockage
while continuing to improvise via more physically accessible materials (i.e., simpler
rhythmic structures). By altering the forces inherent in playing and thereby moving on to
using less challenging materials, the client avoids feeling her/his own or the therapist’s
judgment of adequacy/inadequacy.
In the above scenarios, types of blockages in a solo rhythm improvisation are
metaphorically linked to combinations of a client’s intra- and interpersonal
emotional/psychological functioning, to sensorimotor capabilities, and/or to intramusical
responses based on aesthetic concerns. As noted for the compulsion schemata, a therapist
listening through the framework of the IAPs in the above scenarios may find significance
in the variability profile, noting the client’s tempo, meter, and rhythmic figure playing as
musical/rhythmic forces are altered in response to real or perceived blockages (Bruscia,
1987, pp. 427–433). The therapist may also note points of tension in the improvised
music as the variations occur over time and as alternate rhythmic materials, played in
order to bypass a given blockage, are found incongruous with tension levels in the
materials that preceded them (pp. 437–441).
Instances of blockage that occur via intermusical interactions depend on different
types of forces than the scenarios just described. In the case of co-improvisation, client
25
and therapist are vulnerable to each other’s rhythmic forces as each player forms
rhythmic materials in the improvisational situation. Here we refer to forces that are
inherent in the sounds or tones of a rhythmic utterance. We find support for the concept
of musical forces in the work of Zuckerkandl (1956), who held that musical tones,
including the sounds that constitute rhythmic expressions, “are conveyors of forces”—
and that “Hearing music means hearing an action of forces” (p. 37).
Nordoff and Robbins (2007) have noted that, depending on the level of
awareness, emotional status, and factors related to development and pathology, a client
might be more or less susceptible to the effects of certain musical forces in the therapist’s
improvised offerings. In the Tempo-Dynamic Schema (pp. 317–321), various extreme
qualities of a client’s use of tempo in beating—labeled Condition-Determined playing—
are described according to the ways in which they inhibit or block musical
communication with the therapist relative to a more “normal musical experience” (p.
318). In Scale III: Musicing (pp. 419–430), a client’s instrumental rhythmic responses to
aspects of the therapist’s structured rhythmic materials, including pulse, tempo variations,
and rhythmic figures, are assessed. Various condition-determined disorders in a client’s
rhythmic improvising may be considered blockages of the client’s musically free and
responsive playing. In particular, Nordoff and Robbins identify categories of potential
blockages, including Perseverative, Compulsive, Reactive, and Undirected/Unaware
beating, each of which a client may exhibit in the presence of the therapist’s
improvisational sounds, that is, in the presence of the therapist’s rhythmic forces.
Consequently, the authors have also sought to develop musical techniques through which
a client’s condition-determined improvising may become more freely directed and
relational with the therapist’s (p. 316). As the therapist attempts to alter a client’s playing
through various techniques, the client may be nonresponsive and continue on her/his
current beating path. In this case, we might say that the client does not respond by
bypassing the blockage at all, but rather drives directly through it without evidence of
being at all influenced by the therapist’s musical forces. According to the IAPs, a
therapist might focus examination of the improvisation through the autonomy profile.
Here the therapist may find that, due to the client’s resistance (or lack of awareness) to
being influenced by a co-improviser’s sounds, the client avoids taking a certain type of
role in the relationship (Bruscia, 1987, p. 447).
Counterforce
The impact of a counterforce is that it stops the progress of another force, as if a

head-on collision of forces occurs (Johnson, 1987). Counterforces in solo rhythm
improvising may take a similar form to blockages, depending on the improviser’s
interpretation of the force relative to her/his own musical/rhythmic forces and according
to the client’s proclivity to respond to such force relationships. For instance, a solo
rhythm improviser, when faced with the same sorts of intra- and interpersonal scenarios
as described above related to the blockage force schemata, may respond not by seeking a
way to get around or through a potential blockage, but rather by interpreting the blockage
as a force equal to her/his own improvisational activity and hence responding to its
impact by ceasing to play. This is not an uncommon experience, as humans have many
times described the experience of metaphorically being stopped in one’s tracks or halted
26
in one’s progress for some reason. Therefore, a rhythm improviser may interpret and
respond to intra- and interpersonal sorts of forces as counterforces. The client may
similarly respond to intra- and intermusical forces. For example, the client may be
confused, frustrated, or overwhelmed by the nature of her/his own improvised sounds or
those of another improviser and respond by ceasing to improvise, perhaps not knowing
how to continue or feeling incapable of doing so.
A therapist listening through the IAPs may hear the halted improvisation process
through the integration profile as an over-differentiation of a client’s playing in
relationship to her/his previous playing, that is, the client’s use of improvised sounds vs.
no sounds. Using the autonomy profile (which infers co-improvising), the therapist may
also note that the stopped improviser has chosen to resist, avoid, or obliterate the
development of any leader-follower relationship within the improvisation (Bruscia, 1987,
pp. 444–449). Nordoff and Robbins (2007), on the other hand, note in Scale II: Musical
Communicativeness that a client’s failure to maintain improvisational efforts has to do
with, for example, being noncommunicative with the therapist, lacking intentionality and
control in improvising, and/or using instruments in an infantile manner (p. 401).
Diversion
In the case of diversion, two forces converge, not head-on as is the case of a
counterforce, but from alternate angles, thus sending at least one of the forces in another
direction or trajectory and onto a new path, as in a ricochet effect (Johnson, 1987). Such
causal interactions occur frequently through the course of our daily experiences as we
approach situations that challenge our extant forces and purposes and cause us to be
moved in a different direction, with a new aim or goal and perhaps also with a different
attitude or energy. In rhythm improvising, a player may be diverted by her/his own
sounds as she/he hears, evaluates, and responds to them in the course of playing.
Depending on the impact of factors related to aesthetics, emotions, and/or physical
sensations experienced while playing, the improviser may be diverted, or moved, to make
adjustments. For example, the client may alter the nature of the tempo, meter, and or
rhythmic figures as the improvisation unfolds or alter the manner in which the rhythmic
elements are articulated. Diversion by aesthetic factors entails responding to musical
forces in accordance with the event-structures that the improviser creates and
experiences. Alternatively, the impact of emotional factors related to the improvised
rhythm may mean diverting one’s playing in response to memories and/or associations
elicited and/or to symbolic interpretations of the rhythm’s character that cause the
improviser to change the course and perhaps the character of the rhythmic materials. And
finally, as an improviser experiences the physicality of the forces of movement involved
in improvising, she/he may be moved to change the nature of the enactments performed
against the rhythm instruments. A therapist may again find the variability profile of the
IAPs to be of significance while hearing and seeking to understand the nature of the
client’s diversions of tempo, meter, and rhythmic figures within solo rhythm
improvisations (Bruscia, 1987, pp. 427–433). The therapist may also consider the
character of the new material as it relates to the rhythmic sounds that preceded it, in
accordance with the congruence profile (pp. 437–441).
27
In co-improvising—along with potentially being diverted in response to one’s
own aesthetic, emotional, and physical factors—an improviser also may experience the
impact of the other participant’s improvised rhythmic materials and/or the other
participant’s personhood, as between a client and therapist. In some models of
improvisational music therapy, therapists often assess the ways that clients respond
musically/rhythmically to particular musical offerings, with the assessment information
subsequently providing guidance to the therapist’s responses in treatment, such as in
creative music therapy (Nordoff & Robbins, 2007). A resource that also provides great
clarity regarding the notion of diversion via musical forces in clinical co-improvisation is
the taxonomy of 64 clinical techniques compiled by Bruscia (1987, pp. 533–557), and in
particular the 25 purely musical techniques that are implemented through a therapist’s
improvisational efforts. Bruscia defines a clinical technique as “an operation or
interaction initiated by the therapist to elicit an immediate response from the client, or to
shape her/his immediate experience” (p. 533). Not all of the 64 clinical techniques are
musical in nature. Some are verbal, some are structural or environmental, and some are
procedural. I will describe here a few examples of musical techniques, referred to as
“Redirection Techniques,” which are expressly designed to divert a client’s improvising
in a particular manner and which have immediate relevance for rhythm improvising (p.
545). For instance, the technique of Introducing Change entails the therapist introducing
new material such as rhythmic figures into a co-improvisation with the aim of helping the
client take her/his improvisation in a different direction than its current course (p. 545).
The technique titled Differentiating may be initiated when a client’s improvisational
tendency is to emulate or merge with the therapist’s rhythms and thereby avoid taking an
individualized and independent role or expressing from the client’s own impulses. In
Differentiating, the therapist improvises rhythmic materials that are clearly distinct and
contrast with the client’s sounds, with the aim of causing the client to change the nature
of her/his rhythmic playing and thereby recognize her/his own identity in the music as
separate from the therapist’s (pp 545–546). Lastly, the technique of Intervening is used
by a therapist to disrupt or break into a client’s perseverative or fixated rhythm
improvising. The goal of the technique is to provide the client with a stimulus to change
the inflexible or obsessive course and/or character of the client’s playing. For example, a
therapist may use strong syncopations or cross rhythms to destabilize the client’s
perseveration in a metered context (p. 547).
Summary: Embodied Cognition and Improvisational Music Therapy
With the long-held philosophical and musicological belief in a direct relationship

between rhythm and human experiences of movement, it seems natural to seek
understandings of improvised rhythm from embodied cognition theories. Application of
schema theory to improvisational music therapy draws on the fundamental idea that,
when an improviser plays on or interacts with rhythm instruments, certain FORCES are
enacted. Further, interactions with instruments result in other forces to which a player
becomes susceptible. These include (a) the forces of improvised sounds and the physical
forces of a improviser’s own actions with and upon the instruments played; (b) the
psychological forces of memories, associations, emotions, and aesthetic ideals that the
sounds may elicit; (c) the forces inherent in the interpersonal relationship with a listener
28
or co-improviser (i.e., therapist); and (d) the musical forces that a co-improviser may
enact. Finally, we can relate these particular forces with a group of Gestalt structures
considered universally characteristic of the ways that all forces interact in the world.
These include the schemas for compulsion, blockage, counterforce, and diversion.
When improvising rhythms and both product and process point to the client’s
metaphoric understandings of her-/himself as an agent on the world (i.e., self-perception),
an embodied cognition perspective seems most relevant to guide clinical decision-
making. As Aigen (2005) emphasizes regarding the application of schema theory to
music therapy, part of the benefits for clients may be the opportunities that music
provides for having experiences that compensate for the sorts of experiences that fully
functioning persons have and that clients, due to certain limitations, cannot provide for
themselves—a type of therapeutic helping that Bruscia (1998) refers to as “redress” (p.
68). Hence, in improvisational music therapy within a schema theory orientation, the
therapist might address a client’s need to experience the variety of forces that are
available in music experiences that the client may otherwise not be able to access.
Last, from an embodied cognition perspective, a therapist can begin to
comprehend the meaning of a client’s rhythm by comparing the client’s rhythms and the
client’s process of improvising to her/his own metaphorical understandings of embodied
movement and/or emotional energy movement. In listening to or co-improvising with a
client, a therapist might use her/his own experiences of forces related movement
schemata as points of comparison to understand the client’s rhythm or to challenge the
client in various ways toward helping the client gain experiences with and abilities to
respond to certain types of forces. For clients whose abilities to move and/or physically
interact are limited, experiences of rhythmic movement provided by the therapist in co-
improvising might be used to compensate for the client’s limited experience and to
therefore bring to the client opportunities to deepen understanding of the various forces in
the world, among which are the client’s own.
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READING 23
Kenny, C. (2006). Seven Excerpts: Music and Life in the Field of Play: An Anthology, pp. 5-9, 10-59,
60-61, 62-65, 80-122, 178-181, 236-244. Gilsum NH: Barcelona Publishers.
1
2
Kenny, C. (2011, May). Time for Integration: Journey to the Heartland. Paper presented at meeting of 3
Canadian Association for Music Therapy, Winnipeg, Manitoba. 4
5
Excerpt One 6
7
8
THE DEATH-REBIRTH MYTH AS 9
10
THE HEALING AGENT IN MUSIC* 11
12
Carolyn Kenny 13
14
15
Where have we left our sense of myth? We tend to The historian Cornelia Dimmitt-Church, in a 16
speak of myth only in nostalgic, poetic terms, rarely re- document entitled “Myth and the Crisis of Historical 17
lating it to bygone cultures. The journeys of heroes, the Consciousness,” offers a current interpretation of myth: 18
totem symbols, the divine stories are often considered 19
products of less rational, less civilized cultures. The Myth is a synthetic mode of experience and 20
myths served a function in primitive times that seems expression that derives from the right brain 21
to be outdated. Technology has eliminated the need for holistic mode of consciousness. It relates to 22
these mystical, magical tales. Myths were associated that part of man’s psyche that is largely in- 23
with magic and magic was only necessary when we accessible to the external empirical world, is 24
were unable to control the events of our lives — when largely non-verbal, and is more closely in 25
there were unknowns. touch with the repository of inarticulate, in- 26
Now under laboratory conditions and controlled stinctual patterns or archetypes that affect 27
experiments the conditions of human and environ- external life indirectly through symbolic ac- 28
mental behavior can be monitored and predicted within tivity but are not directly accessible to con- 29
some reasonable range of accuracy. We have outgrown sciousness. 30
myth. We have outgrown the need to create symbolic 31
forms which reassure us about the continuity of hu- Synthetic . . . experience and expression...holistic... non- 32
manity and the world as a whole. And what aspect of verbal . . . inarticulate, instinctual patterns . . . arche- 33
our personal and cultural development have we left be- types . . . symbolic activity . . . functions of the right 34
hind in sacrificing value for our mythology? brain 35
We have left behind an artistic way of being . . . These words guide us into an artistic, mythical 36
we have left behind the links, the patterns which con- framework. Within this framework music and myth 37
nect us to all humanity and nature . . . we have left be- share many of the same purposes. 38
hind a relational existence. We have specialized and As music therapists we are always consider- 39
isolated and alienated. We have left behind the colors, ing healing potential. For the sake of clarity let us put 40
the forms, the sounds, the symbols, the rituals, the cer- aside the terms, techniques, objectives, and goals in- 41
emonies, the magic, the mystery of life. And at the core herited from psychology and the behavioral sciences in 42
of all of this, we seem to have lost myth. general. Let us consider the more poetic, mythical qual- 43
ities of music which can be used for healing — the artis- 44
tic qualities. 45
*The original version of this paper was written in 1978 for one of Within a poetic, musical, mythical context, we 46
my master’s cultural anthropology classes at the University of
see the issues for health in a different light. 47
British Columbia, Vancouver, B.C., and provided the initial
theme for my subseqent master’s thesis and, eventually, my first 48
book, The Mythic Artery (1982). The version here was presented How do we allow ourselves to experience S 49
to the Canadian Music therapy Association Conference in 1980. beauty and fill our aesthetic needs? R 50
5
6 music and life in the field of play
1 How do we learn to survive . . . to adapt Music expresses the myth by making it available
2 to the changes in ourselves and our through sense perception. In a way it gives body to
3 environment? myth and gives it a workable form. In this way myth
4 How do we learn to accept death or loss travels to us through music.
5 and find new life from it? One of the basic considerations in musical com-
6 Can we recognize and accept the pat- position is the concept of tension and resolution. Most
7 terns which connect us to all of life, musical compositions contain the process of tension
8 when our own life resources seem de- and resolution within all the musical elements. One or
9 pleted? several of the components of the piece “build up” to a
10 Can we recognize and respect our place climax point, then resolve. This is also the pattern
11 in the continuity of life? taken by many life situations. We experience a type of
12 Can we hear the music? transformation through a peak level of intensity. This
13 life movement can be applied to many circumstances.
14 These issues cannot be categorized and labeled Each day is a series of transformations through our var-
15 according to disability. These issues do not allow us to ious activities, or as the many overlapping motifs in
16 consider ourselves separate from an autistic child or a some musical piece. One’s entire life might have one
17 90-year-old terminally ill cancer patient. These issues major transformation. Or both of these circumstances
18 connect us to the whole of life. Myth reminds us of our may happen simultaneously. There may be many peaks,
19 connection and music reminds us of our connection for climaxes, transformations within one life.
20 they both represent a relational influence on our being. The notion that a type of giving over or loss must
21 At the core of most rituals and ceremonies, occur, in order for change or growth to be accom-
22 whether traditional or modern, we find the concept of plished, constitutes the connection to myth. The musi-
23 transformation — a ceremony to both encourage and cal symbol serves as an example of regeneration,
24 celebrate some vital change. Transformation is a basic renewal, building, and transformation. It does not deny
25 concept meaning only that something or someone dies the passion inherent in these encounters, rather it ac-
26 and something or someone is reborn. Metaphoric and knowledges the tensions of pain, anger, hate, melan-
27 symbolic associations persist in both ancient and mod- choly, confusion, frustration, hurt, despair and the
28 ern societies. resolution of joy, love, fulfillment, clarity, hope. Musi-
29 Symbolic association forms the basis for the cal encounters allow the passion or feeling to become
30 Death/Rebirth Myth as the Healing Agent in Music. externalized, therefore providing form.
31 The task of the music therapist, when using this idea, is One initial example will illustrate this: a com-
32 to create an environment in which a patient or client is poser who manifests the death-rebirth myth through
33 allowed to make this symbolic association on their own musical tension and resolution is Chopin, especially in
34 terms. The music therapist as ritualist plays a support- his Etudes and Preludes. His Prelude in E minor pro-
35 ive role and presents a simple ritual structure which vides a simple example. The tension-resolution process
36 will serve as an inspiration for the patients to accom- in melody builds and resolves once in the Prelude. The
37 plish their own healing. The patients, no matter what music builds to one point of transformation, one cli-
38 the disability, are encouraged to recognize and develop max, in which death and rebirth occur in the same mo-
39 the mythical aspects of their being. ment. The movement changes from moving away from
40 In order to facilitate these associations, it is im- the tonal focus to a point which leads towards tonic.
41 portant to understand, in practical terms, how music At the point of transformation, one chord, or one
42 and myth are related. The musical process, which most moment in time and space, there is a resolution of the
43 clearly communicates the Death-Rebirth Myth, is the tension produced by the previous 15 measures.
44 process of tension and resolution. Levi-Strauss discusses the relationship between
45 The relationship between the Death-Rebirth music and myth within the context of structuralism. In
46 Myth and tension-resolution in music is one of reflection. an article on “The Homology of Music and Myth,” he
47 The music reflects the myth and vice versa. The music writes:
48 serves as a vehicle for the myth, placing myth in time
49 S and space by providing it with a living, symbolic form. Music and myth, while both untranslatable
50 R This can happen through the structure of the music. into terms other than themselves, are basi-
a mythic journey 7
cally structural, the component parts of each resolution patterns. Within these three modes we expe- 1
are infinitely convertible, each within its rience the elements of music: melody, harmony, rhythm, 2
own sphere. Each contains a basic dichotomy, meter, timbre, dynamics, and texture. 3
theme, counter theme, both of which can be How does the musical, mythical idea manifest it- 4
inverted, rhythmically distorted, modally self in a music therapy session? Theoretically, the tech- 5
transformed or presented in a new timbre. niques do not matter. Decisions about whether to use 6
improvisation and which instruments, music and move- 7
The point made by Levi-Strauss in reference to ment, music and painting, music education and appreci- 8
the dichotomies existing in music and myth are partic- ation or any other technique are left to the preference 9
ularly relevant to the death-rebirth myth. Music and and discretion of each individual therapist. The only 10
myth both acknowledge and accept paradox. The point influences necessary in order to suggest the myth in 11
of transformation in Chopin’s Prelude in E minor rep- music are the following: 12
resents both death and rebirth in the same chord, mo- 13
ment, or space. Both exist together and become one 1) Music used should have a strong and obvi- 14
another. For at the moment of rebirth another death ous movement of tension resolution; 15
has in fact begun. 2) Directions or techniques should encourage 16
These mythical, musical patterns often manifest patients or clients to symbolically identify 17
themselves despite the avowed intention of the com- with processes in nature. 18
poser. The Death-Rebirth myth is contained in a Bach 19
Fugue, the simplicity of Gregorian chant, the com- These two influences encourage poems like the 20
plexity of a Beethoven sonata, and the primitive vital- following: 21
ity of Mick Jaggar’s “Brown Sugar.” There is no need 22
to sacrifice our Western musical tradition in search 1) From a patient diagnosed as having an ad- 23
of myth. justment reaction, recently having had one 24
The link between human patterning and musical leg amputated: 25
patterning is stated by Terence McLaughlin in Music 26
and Communication: The seed is planted with loving care 27
The sun and the rain they are there 28
. . . the first step in explaining the meaning And the flowers that began the same 29
of musical patterns is the fact that they are protectively 30
translated in the brain into general lingua circle and care 31
franca of all other patterns — mental patterns But the seed remembers the cold 32
— such as grief, expectation, fear, desire and of life before 33
so forth, and bodily patterns such as hunger, and cries not to grow 34
pain, retention, sexual excitement, any of Just to be in nothingness 35
the tensions associated with a raising of the no more pain no more ache 36
adrenalin level in the blood — and the cor- no more life 37
responding resolutions — allow us to see the Gently the flowers give their 38
similarities between the musical patterns happiness away 39
and those more personal ones which form so that the new seed 40
the constant undercurrent of our thought. may forget the pain 41
and grow warm in their sun the 42
Patterns form the basic organizational structure of seed quivers 43
music. Hindemith and Meyer, as well as McLaughlin, and begins again. 44
discuss the importance of patterning in both the 45
composition of music and the subsequent effects. All 2) From a patient diagnosed as having depres- 46
three also emphasize the essential element of tension- sive neurosis: 47
resolution as it develops in the patterning process. 48
McLaughlin identifies pitch, time, and volume as The seed has its properties and message to S 49
the key modes which utilize and communicate tension- grow in a harsh world around a struggle too R 50
1 difficult to live and easy to die The anticipated product of ritual based on the Death-
2 it continues to fight for it knows why. Rebirth Myth is transformation, growth and change.
3 If we are able to consider this process in ourselves as
4 It uses the elements in short supply a reflection, and part of the world and universe around us,
5 with no question or doubt but just to try ontological questions are answered and added strength
6 to survive and flourish day to day, and resources received. Similarly, if we view the environ-
7 and flower and pass on the process this way. ment and fellow life around us as a reflection of and part
8 of ourselves, healing, or prevention, is reciprocal.
9 The question may come: Why bother to go back In order for this association to develop between hu-
10 and recreate mythical structures? We have so many man beings and our surrounding environment, nature,
11 finely tuned techniques, so many sophisticated meth- which surrounds us and is in us, connecting patterns must
12 ods already. Even though music therapy is a fairly be appreciated. As a noted Indian chief has said, “All
13 young profession, music therapy trainees are over- things are connected. Whatever befalls the earth befalls
14 whelmed by the amount of choices to make in selection the sons of earth.” Perhaps the metaphoric mind can see
15 of technique. They often feel like kids in candy stores, this vision more clearly than the logical mind. It does
16 wanting to sample and become enthused about all the threaten us for it beckons us to take some risks.
17 ideas that are placed before them. Although we may feel the ground shake under this
18 However the Death-Rebirth Myth in Music does approach when operating in our more familiar medical
19 not represent a new technique, but rather an approach, model, it is not a new idea. We have only avoided these
20 an attitude, a belief. It can be employed with almost any magical ideas, confined them to anthropological and
21 technique. It turns us into neophytes. It challenges us at a historical studies, because much traditional wisdom is
22 level which is not easily visible at the level of technique intertwined in complicated systems and rituals. It is a
23 or method. It is the subconscious, the preconscious, the task to identify the body of knowledge which can be ab-
24 primitive — the dreamlife of the music therapist. It car- stracted from the older structures and described in
25 ries us back to — the metaphoric mind and our intuition meaningful modern terms acceptable in this case both
26 sensibilities. While our intellect in some respects may be to the clinician and health care administrator.
27 highly tuned, our instinct may be starved. We have over- This problem might not exist if we had always em-
28 used a part of ourselves and underused another part. braced the wisdom of the past and kept the connecting
29 Again the question is: What have we left behind? This threads through the evolution of culture and society.
30 question, of course, applies not only to music therapy, but Because the pendulum of change can make such a sud-
31 also to other professions and the culture at large. den and extreme arch, throughout history many valu-
32 Grinder and Bandler in The Structures of Magic able ideas and approaches are rejected. Culturally, we
33 have said that the aim of all therapies is to explore al- are presently involved in wide-scale attempt to pick
34 ternatives — the paradox of life as a whole, the para- up some pieces and reintegrate many of the ideas of
35 dox of mixed feelings, the paradox of infirmity vs. the past.
36 genius or passion. At its best, the Death/Rebirth myth So we struggle to weave the medical approach
37 in music challenges creativity by encouraging people to and the mythical approach, using the best from each to
38 accept and benefit the paradoxes of life and move encourage a more balanced state. We no longer need to
39 on to exploring alternatives within this mythic di- hide the close association between music and myth.
40 chotomy. The patterns that link us to our past and help us to rec-
41 The Death-Rebirth Myth and its infinite number ognize our place in the present can guide us into a more
42 of analogies in life is an example of such paradox. Effec- complete health. As one schizophrenic woman wrote
43 tive ritual contexts for this myth have been left behind. to Pink Floyd’s “Echoes”:
44 Although there are some cultural rituals which, wit-
45 tingly or unwittingly, employ this myth and other myths, Stream of consciousness
46 there are not enough to reassure us or remind us of the Wending through open space
47 basic ever-constant patterns of life, which Schopen- Leaf-like cascading over around
48 hauer calls the elementary forms and human constants. Through pebbles
49 S Within therapeutic settings, there are even less mythi- Rocky surfaces submerged
50 R cal rituals because of purely scientific orientations. Water surface mirrors green
a mythic journey 9
Trees blue sky The spirit of self-destruction cries out for revenge 1
Swirling in the reflection of God’s country. But the natural self spirals deeper into itself, 2
reborn 3
Cast ashore, wind dried and tumbling over sweet Cast adrift again to challenge the natural element 4
smelling Of its own terms. 5
Earth, inhaling the warm sun, dancing death to 6
urban stress Not to win but to succumb successfully 7
Birth Painfully to the spirits of well-being Being one, strong in that natural partnership. 8
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1
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3 Excerpt Two
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9 THE MYTHIC ARTERY*
10
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12 Carolyn Kenny
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15
16 the beginning Then a quote came back to me from the Bible:
17 “When I was a child, I thought as a child and acted as a
18 One day I began to wonder about how I accumulated child. Now that I am a man, I have given up the ways
19 thirteen years of experience in music therapy. It was of a child.” Those of us who are parents certainly know
20 truly wonderful, for as in all things which one enjoys, what that means. But what innocent wisdom have I
21 the time had gone quickly. In the midst of all that won- also sacrificed by giving up the ways of a child? Then
22 derful and absorbing subjective appreciation, I was, as other questions came: What have we, as a civilization,
23 we all inevitably are, suddenly engaged in the more se- left behind with those primitive, primal, preconscious
24 rious and objective why’s, how’s, when’s, and where’s. ways of being from the clear morning of our begin-
25 Why did I choose music therapy for a career? Where nings? What have we left behind as individuals and as a
26 were the beginnings? What force had motivated me culture in terms of our original potential for develop-
27 throughout all those years to struggle within the med- ment? And how do music and music therapy really fit
28 ical community to bring the “healing arts” to people in into this development? With so many questions of
29 a state of dramatic need? These questions directed me what and why, I realized that I was quickly spinning
30 on a journey. This book is a description of that journey into the whirlpool of mind where one question leads to
31 and how it relates to the profession as a whole. many, and words lead to more words. I wanted to retain
32 It was easy to remember the “beginnings.” I began my original subjective absorption of appreciation, the
33 my career in music therapy as a child, when I spent dream-life of the music therapist. But I also wanted to
34 time with the magic of music, when I still remembered follow my insatiable curiosity into that whirlpool of
35 a liquid way of being. Music was a liquid form which why. For I am in many ways only a product of my cul-
36 nurtured and inspired me. It made me aware of the flow ture, a culture which has developed mind to amazing
37 of life. There was no question of known or unknown. lengths and created an ever-increasing hunger for that
38 But there was meaningful stimulation, learning about mind to be satisfied with intellectual insights and un-
39 the qualities of life through musical perception. There derstanding through an over-abundant assignment of
40 was spiritual freedom. As the Chinese say, music cap- word symbols. As all nature, mind is a thing of great
41 tures form and goes beyond form to the supernatural. beauty. We tend to get lost in words. We work to un-
42 And there was a unification of myself with all the derstand and describe the things we love. Music is a
43 things around me. There were other benefits that are mystery that defies description.
44 difficult to describe. However, I remember that these For years music therapy has been wearing a mask
45 musical encounters magnified my sense of well-being in because of our own inadequacy to describe and under-
46 a magical and trusting way. stand her fully. We disguise her in medically acceptable
47 terms. We speak only of observable data. We superim-
48 *This chapter was originally published in 1982 by Ridgeview pose statistical formulae, hoping that if we develop the
49 S Publishing Company as The Mythic Artery: The Magic of Music scientific side, the artistic, spiritual side will magically
50 R Therapy. emerge. We rarely mention that music goes beyond
10
a mythic journey 11
sign to spirit. We describe and develop the objective, derstanding by assigning words to something which is 1
knowing all along that the subjective has as much, if indescribable by nature and has the additional aspect of 2
not more, influence on our patients, our clients, and being something different every time it happens. Sev- 3
ourselves. eral times I have been tempted to answer: “music ther- 4
This book, in a sense, is paradox. It is an attempt apy is everything and it is nothing,” or “It is profound . . . 5
to touch the essence of music in the fullness of all her it moves me every time I do it . . . it works . . . it’s a 6
healing powers, to describe that which cannot be de- flower . . . it’s a waterfall . . .” and the list goes on and on. 7
scribed. This attempt is made in the spirit of apprecia- I find my definition being greatly influenced by the posi- 8
tion and perhaps as a tribute to the mind of man. tion of the person asking the question, just as much as 9
Words can never reach far enough into music to touch by my own attitude on that particular day. The lesson 10
her essence. However, with effort, our words will be- here is that music therapy is different to different people 11
come more musical, our respect and wonder more ab- at different times in different places. Although this is a 12
sorbing, our understanding of music deeper. difficult pill to swallow when developing a rationale for 13
My experience when writing about music is en- government funding, it is a welcome idea when listen- 14
tirely different than my experience when hearing or ing to music and absorbing music, the healer. 15
playing music. When music comes to me I sincerely be- What is music therapy? The term has two parts — 16
lieve that all my attempts at description will be futile, “music” and “therapy.” So let us try to describe each 17
and yet I am totally grateful that this is so. For the part. We have come to know of therapy as a treatment 18
reader, if you become lost in this vast forest of words, for some pathological condition. It usually involves a 19
listen to Eric Satie’s “Gymnopedies” or Samuel Barber’s set of goals and objectives, a treatment plan and some 20
“Adagio for Strings” or Ron Carter’s “Ballad” or the anticipated results. Most commonly, it is associated 21
Gamelan music of Bali. Or, if you are able, sit down at with medical treatment. Our ideas about psychological 22
the piano and play Chopin’s preludes or etudes. Allow treatment have branched off from our ideas about phys- 23
your soul to join the massive mythic artery which car- ical treatment. In fact, our word “therapy” is derived 24
ries us to the essence of life and the human spirit, con- from the Greek “therapeia,” which means medical 25
necting us to all of life, before and after, around and in treatment. However, as all words which come into gen- 26
us, from the first moment of creation through all the eral usage, the word therapy has developed broader, 27
transformations beyond time and space. For this is the colloquial meanings which go beyond the classification 28
healing experience of music. of medical treatment. Therapy has come to mean any 29
method of healing which seeks to alleviate suffering, 30
Music Therapy: Definition and Theory develop potential, and encourage rehabilitation. This 31
There are two questions which I am asked most com- broader meaning has caused quite a lot of controversy 32
monly. The first question is: What is your name? The in traditional professional circles. The primary argu- 33
second question is: What is music therapy? I can count ment takes the form of accusations about people who 34
on answering the first question with great consistency. call themselves therapists. The professionals, that is the 35
However, when the second question arises, I always find doctors, nurses, psychiatrists, and professional associa- 36
it difficult to give a satisfactory answer. Part of me tions, cry out “You cannot do therapy because you are 37
wishes that the textbook definition I learned so many not medical.” The recipients of these accusations call 38
years ago could just come automatically out of my out “You cannot do therapy because you are too med- 39
mouth and ring true. However, the biggest part of me ical.” These non-medical therapists often represent the 40
knows that if I had in fact given that definition, I would movement toward holistic health. It is often difficult to 41
not have lasted long as a music therapist, for the thrill of know whether concerns on both sides come from moral 42
doing the work has stemmed from the ever-changing or economic values. Of course, it is always hoped that 43
nature of the art. Even though I have studied, practiced, at the base of this controversy there is a genuine con- 44
taught, lectured, and written about music therapy all cern for human suffering. However, it is also true that 45
these years, every time someone asks me the question we have created a huge health business. Sometimes it 46
“What is music therapy?” I have to absorb the silence, becomes difficult to separate the means from the end. It 47
center myself, and think “My God, here it is again. is true that we have invented more and more therapies. 48
What am I going to say this time?” Every time it is a When I hear terms like “reality therapy” and “hug ther- S 49
challenge, a task, an invitation to increase my own un- apy,” I must say that my reaction is “Have we really R 50
1 gone this far off the deep end that we must call reality a • music can be reassuring.
2 therapy, or hugs therapy? Have we, as a culture, really • music provides a source of regeneration and re-
3 lost our grip on reality so much that we must invent a newal.
4 therapy to help us find it again? • music is centering or disintegrative.
5 This leads us to the second meaning of the Greek • music offers high motivational stimulation.
6 word therapeia — attendance, which means being pres- • music fulfills man’s creative instinct.
7 ent, stretching, giving heed to, looking after, listening • music represents a pre-verbal or premordial level
8 to, waiting for, directing attention to, and watching of communication and therefore broadens the
9 over the working of. This second interpretation of ther- possibilities for communication and eliminates
10 apy not only broadens the possibilities to include more boundaries.
11 than medical treatment, but it also liberates the quality • music is sign and goes beyond sign to spirit.
12 of treatment from a technological orientation provided • music is a place to come together.
13 us by the medical model. In the medical model, the • music is a place to be alone.
14 therapist does something to someone. Attendance im- • music provides an opportunity for release through
15 plies a mutuality, an alert, resourceful, caring, vigilant creation of symbolic form.
16 patience and guidance. It represents an attitude, a way • music contains solutions and resolutions which
17 of being. Attention concerns itself with intention. are metaphors of life.
18 Just as one might question the terms reality • music contains tensions which are metaphors of
19 therapy or hug therapy, the term music therapy might life.
20 also be questioned. One of the first things I write on the • music moves the whole man.
21 blackboard in teaching music therapy students is: “Mu- • music is profound.
22 sic.” Then I say, “Let’s talk about the inherent healing • music acknowledges suffering and joy.
23 aspects of music.” Music can be a natural healer, whether • music is a resource pool of images.
24 we realize it or not, both preventative and curative. • music is a reflection of the person and contains
25 Music is defined as the science or art of incorporating human impulses.
26 pleasing, expressive or intelligible combinations of vo- • music provides a framework from which to make
27 cal or instrumental tunes into a composition having choices.
28 definite structure and continuity. But our interest in • music is a sensual statement.
29 music goes far beyond this definition. What are the • music duplicates the prenatal existence of flow
30 healing qualities of music that tie it so mysteriously to and vibration, always a part of humanity.
31 the essence of the human condition? Learning how to • music is an existential reality, a celebration of the
32 answer this question and identify music in this way, moment, yet transcends time.
33 which is the aim of this book, is the most difficult and • music is magic.
34 most important task of the music therapist. Some of the • music is flexible and adaptable.
35 healing qualities of music might be: • music is an alternative.
36 • music combines art and science.
37 • music reflects Nature. • music provides a meaningful social context.
38 • music stimulates the emotions, the intellect, the • music is a bridge.
39 body. • music has an immediate and a delayed influence.
40 • forms and structure of music provide a symbolic • music is at once process and product.
41 order. • music is an intermediary object.
42 • music provides a relational context for man in the • music is solid and liquid.
43 world.
44 • music transcends situational conflict. Again we can see that music represents change and
45 • music communicates ideas and feelings beyond transformation. It is two things at once. It can and does
46 words. accept and embrace opposites. Music is never the same.
47 • music satisfies the need for aesthetic fulfillment. It constantly evolves. This is in fact the most general
48 • music reflects, dramatizes, and focuses on positive goal of healing or therapy — change. Rigidity, getting
49 S or negative connections between people and stuck or the inability to deal with a new situation, lack
50 R events. of adaptability, fear of the unknown — these are all the
a mythic journey 13
concerns of the disabled and, in fact, the concerns of or music do not specifically intend this usage, although 1
humanity as a whole. John Grinder and Richard Ban- some accomplish it without intention. However, music 2
dler, in their work of The Structures of Magic, consider therapists intentionally concern themselves with the 3
therapy as situations in which to experiment with alter- issues of healing. This means that the music therapist 4
natives. Such an experimentation with alternatives spends time developing skills of perception. The music 5
challenges our powers of creativity. We can envision therapist must learn to perceive those attributes in mu- 6
music as a resource pool of images . . . sic and needs in people which match and set us on the 7
road to health. 8
Music is a resource pool. It contains many things — images, With these thoughts in mind, music therapy is a 9
patterns, mood suggestions, textures, feelings, processes. If process and a form that combines the healing aspects of mu- 10
selected, created, and used with respect and wisdom, the sic with the issues of human need for the benefit of the indi- 11
clients will hear what they need to hear in the music, and vidual and society. The music therapist serves as a resource 12
use the ritual as a supportive context. person and guide, providing musical experiences which di- 13
rect clients toward health and well-being. 14
While struggling to define music, it is best to keep Now that we have established a general, rela- 15
in mind the advice of Gregory Bateson when he sug- tional definition, we must establish the place of music 16
gests that we develop relational definitions. Our at- therapy in the working world of health. Music therapy 17
tempts to isolate concepts and phenomenon tend to is often described as a complementary service. It adds 18
carry us further into cubicles of separation in terms of to existing services. Although it often shares common 19
our general cultural health. The connecting patterns goals and objectives with other therapies, its unique value 20
that unite us with all of nature, all of mankind, have comes with its more artistic or creative orientations. 21
healing potential of their own. With a relational defini- 22
tion in mind, perhaps the best way to define music is A Dearth of Creativity 23
through images . . . images that mysteriously speak of It is often difficult for music therapists to find satisfac- 24
our unity. We are never really alone. tory working environments. Since music therapy is an 25
Of course, everyone will have different images interdisciplinary field, it does not fit exactly into any 26
and this is part of the beauty. Music is different for other field. It is new, at least in modern clinical set- 27
everyone and can heal everyone in unique ways. In tings, and often not completely understood. In one 28
fact, people heal themselves through music. The at- of my first jobs as a music therapist, I found myself ex- 29
tending music therapist serves merely as a resource per- periencing many of the frustrations created by this 30
son and supportive guide. dilemma. Even though I was fairly pleased with the 31
It is difficult to develop a definition of music ther- work with patients, I found it difficult to describe the 32
apy without considering the therapist who facilitates work in medical terms required by a staff of doctors, 33
the therapy. By placing the word therapy on the end of nurses, and psychologists, and “official” charting. 34
music, we are qualifying the term in a way that relates I felt as though each day were a tightrope walk be- 35
to the therapist, i.e., we are sifting out the things about tween myself and the medical. I wanted to describe 36
music that we consider non-therapeutic. The therapist music therapy in terms which could be accepted, appre- 37
is the person who makes these choices. Specifically, we ciated, and integrated. But as I spoke or wrote the med- 38
are assuming that the music we use will be the kind ical language, the words seemed empty, not at all true 39
that will attend to the needs of the recipients of music to what had actually happened. Luckily, there was one 40
therapy. If one were to use the first meaning of therapy, psychiatrist who knew the therapeutic value of music 41
the music used would be music that would function as and the arts within the hospital. Even though he could 42
medical treatment. However, since the “attendance” not describe the effects, he sensed the balance pro- 43
definition allows a broader meaning and a meaning of duced by combining the medical and the mythical. 44
slightly different quality, we will consider ourselves mu- One day, during a particularly difficult staff meet- 45
sical attendants. This interpretation of a therapist im- ing in which this language problem was being dis- 46
plies that he or she will be a person of good will and cussed, I threw up my arms in surrender and said, 47
good intention. The music therapist intends to address “Okay, that’s it. I give up. What is my role here, what is 48
the issues of human need, especially growth and change my job here? No one has ever told me. You tell me, S 49
and alleviation of pain and suffering. All forms of art what am I supposed to be doing?” There was a long R 50
1 silence. Finally, my friend, the psychiatrist said, “There though these emotions have been ignored by contem-
2 is no model for you here. You are creating a role all by porary psychologists they are as real as hunger, fear, and
3 yourself.” We then engaged in a lengthy discussion rage and are manifested in our everyday life. They are
4 about how music therapy stimulated creativity among also essential to human life and health.
5 patients and staff, and encouraged them to explore alter- In so many therapeutic environments experiences
6 natives, as opposed to the more standard role-following encouraging creativity are thought of either as frills or
7 or stage-following procedures of other treatments. as troublemakers, when in fact they are essential to im-
8 One of our greatest enemies in the treatment of proving the quality of life. So essential that Carl Rogers
9 disability of any kind is rigidity. A rigid person is unable has said:
10 to adapt to difficult situations. Circumstance may be the
11 loss of an arm, the end of a love affair, memories of Unless man can make new and original adap-
12 abusive parents in childhood, contracting of a deadly tations to his environment as rapidly as his
13 disease. A primary objective of any therapist is to science can change the environment, our
14 encourage and inspire people to accept change, to ex- culture will perish. Not only individual mal-
15 periment with alternatives within an atmosphere of adjustment and group tensions but interna-
16 support. If therapists provide patients and clients with a tional annihilation will be the price we pay
17 cure which is rigid, it is like a Band-Aid, which comes for a lack of creativity (Rogers, 1954, p. 348).
18 off with the first shower.
19 Many of the present systems of therapy, across dis- There is cause to be concerned about the individ-
20 ability, represent rigid forms of cure and need the bal- ual as well. Since creativity is one of the basic instincts
21 ance of the arts. In the standard systems the patients of humanity, it must be satisfied in a constructive way
22 must follow all the rules and often they are not permit- or it will become destructive.
23 ted to question the purpose. Depth and understanding Rogers has five basic criticisms of how the culture
24 are sacrificed for convention. This type of treatment is manifests a dearth of creativity:
25 often justified under the title of acute care. A person
26 must quickly return to a socially acceptable functioning 1) In education we tend to turn out conform-
27 level. The rigid forms are also employed in chronic or ists, stereotypes, individuals whose educa-
28 long-term care. As long as the patients can learn the tion is completed, rather than freely
29 language of the system and play the game cleverly they creative and original thinkers;
30 are guaranteed a lifetime of custodial care as a career 2) In our leisure time activities, passive enter-
31 patient, mental or otherwise. tainment and regimented group action are
32 Creativity can counter rigidity. Although a great overwhelmingly predominant, whereas cre-
33 deal has been written about creativity in the last two ative activities are much less in evidence;
34 decades, much of it fails to capture the essence of cre- 3) In the sciences, there is an ample supply of
35 ativity. Researchers who test for creativity often mis- technicians, but the number who can cre-
36 lead, for they confuse quality and quantity. atively formulate fruitful hypotheses and
37 There may be a hidden cultural resistance to de- theories is small indeed;
38 scribing creativity in order to keep mystery, myth, and 4) In industry, creation is reserved for the
39 magic in our lives. But this resistance may also be due few . . . whereas for the many, life is devoid
40 to the nature of most scientific research and the elusive of original or creative endeavor;
41 nature of creativity itself. 5) In individual and family life the same
42 Poets were given the task of tending to the emo- picture holds true . . . to be original or
43 tional rainbow’s violet hues: the extremes of laughter, different is felt to be dangerous (Rogers,
44 tears, awe, and wonder, feelings of beauty and religious 1954, p. 348).
45 cravings. These were all rejected by the behavioral
46 sciences. Contemporary psychology views these violet Creativity cannot be separated from the processes of
47 emotions as stepchildren, perhaps because they are life. Mental patients and the “patients” in general, who
48 not always easily observed through concrete physical receive therapy, often are not encouraged to acknowl-
49 S movement. They are internalized in quietude, rever- edge or develop their creative inclinations, but instead
50 R ence, yearning, pain, grief, and aesthetic pleasure. Even to follow prescribed ways of being. The creative person-
a mythic journey 15
alities suffer the most. These people are misunderstood dividual and the culture. Of course, art can be used as a 1
and inhibited by therapeutic procedures. An accep- flight from reality, just as psychoanalysis can be a flight 2
tance of the value of creativity must be ever present for from reality. The difference is found in the “how,” the 3
these people to develop their creativity toward con- application. If the individual is encouraged to develop 4
structive ends. Throughout history, creative people are creative drives in a constructive manner, the reality of 5
seldom recognized for their opinions and products the world and the realities of the arts can be one in the 6
within their lifetime. This is probably due to the fact same. Many artistic types have been considered schizo- 7
that creativity, by its nature, implies a type of rebel- phrenic personalities. Such people seem to create a safe 8
liousness, a breaking away from the usual way of doing place in which to express themselves by traveling to a 9
things. Society, in order to preserve the status quo, separate reality, free from cultural convention, similar 10
maintains a resistance to change and will react on de- to the flight of the shaman. Of course, everyone needs a 11
fensive cue, considering the “novel” ideas and icono- safe place. The schizophrenic person runs the risk of 12
clastic personality deviant. Because artists are so finding the world meaningless, experiencing isolation 13
intimately involved in the creative process, they re- and anomie. This danger also can be generalized to in- 14
ceive a sizeable portion of the criticism. Ironically, as clude everyone. Thus the “existential vacuum” becomes 15
long as they are considered by society to be successful a cultural trend. 16
artists, they are permitted to be a bit more unusual than Although everyone has traces of creativity, the 17
the average man. If one of the assumptions of the ther- easiest place to identify the personal characteristics 18
apeutic arts is that Everyman is an Artist, this creates a necessary for creative inclination is with the creative 19
problem in society’s acceptance of the process and re- personality. Once discovered, these characteristics can 20
sults of therapeutic arts sessions as manifested by the then be recognized and encouraged in Everyman. 21
personality of the patient/client/artist. In a study done by Maduro with East Indian folk 22
Little doubt exists that in the sphere of psycho- painters (see Gordon, 1978), the highly creative group 23
analysis and psychiatry, Sigmund Freud has had consid- showed the following characteristics: 24
erable influence. His attitude toward artists represents 25
the general assumption that the personality of the artist 1) a particularly rich fantasy life; 26
is deviant and sick. 2) could tolerate ambiguity; 27
3) capable of very complex symbolic identifi- 28
The artist is an incipient introvert who is cation; 29
not far from being a neurotic. He is impelled 4) had more fluid and permeable outer and in- 30
by too powerful instinctive needs. He wants ner ego boundaries with a strong ego core, 31
to achieve honor, power, fame and the love requiring less unconscious defensive ma- 32
of women. But he lacks the means of neuvers. 33
achieving these satisfactions. So like any 34
other unsatisfied person, he turns away from Maduro also noted that in their works the artists were 35
reality and transfers all his interests, his li- able to reflect the culture and the environment, while 36
bido, too, to the elaboration of his imagi- still adding their own unique and “novel” personality 37
nary wishes, all of which might easily point to their work. It is this combination of inner and outer 38
the way to neurosis; it is well known how of- exploration that is necessary if the arts are to be useful 39
ten artists especially suffer from a partial inin therapy. The artists/patients should be free to com- 40
hibition of their capacities through neurosis ment on the condition or situations of their lives which 41
(Freud, 1920, p. 327). call for expression through their own perceptions and 42
interpretations. 43
Here, Freud implies that the thinking processes and Some claim that “passion” is the essential element 44
products of artists are results of pathological conditions. in the creative process. A psychoneurosis may repre- 45
Considering the far-reaching influence of Freud, it is sent a passion thwarted, a good creative work, a passion 46
not surprising that the arts are not widely accepted as a filled. It is this thwarting of passion which sometimes 47
therapeutic mode. He considered art primarily as a takes place in the name of medical treatment. 48
flight from reality instead of a symbolic representation “Self-actualization” is another ingredient of cre- S 49
that captures meaning and significance both for the in- ativity. Engagement in a creative process often depends R 50
1 on a person’s capacity to mobilize contradictory but Within a therapeutic environment a supportive

2 mutually reciprocal qualities. A person must be open to atmosphere must be provided. In other words, the indi-
3 new experiences, no matter how bewildering or un- vidual must have total freedom of choice and the right
4 knowable. Creativity, therefore, requires imagination to self-determination.
5 and free association. There are two types of creativity: Creative people are drawn to tensions between
6 opposites, and have a tolerance and ability to work
7 1) An accumulation of all information avail- with paradox. This tendency has been described as
8 able, then putting the information together “janusian thinking.” Opposites or antitheses are con-
9 into unrecognized relationships; ceived simultaneously. Taoism with its opposites of Yin
10 2) A more common process in which a new and Yang, and Buddhism with Nirvana being the end of
11 idea arises, almost spontaneously in the the cycle of rebirth, is similar to the concept of janusian
12 mind, often seemingly out of nothing and thinking of the creative individual. This approach has
13 at a time when a person might be thinking particular significance here. Paradox is often what
14 of something quite different. brings people into therapeutic environments. Because
15 of lack of insight, understanding, or problem-solving
16 This second type of creativity comes through meta- ability, they are immobilized by paradox instead of
17 phoric rather than logical classifications. The living challenged to grow through it. Janusian thinking is of-
18 human system exercises its ability to integrate and or- ten outside or beyond logic.
19 ganize a pattern out of formlessness, an achievement The relation between the arts and creativity is
20 that rational thought, being somewhat removed from not mutually exclusive. On the contrary, creativity
21 its primitive source and bound with habit and conven- lives in everyone, whether in a dormant and yet undis-
22 tion, may be incapable of doing. The striving of the uncovered stage or functioning at full capacity.
23 conscious to create patterns out of formlessness is the Artists, probably more than anyone else, have
24 same process used by the body so that mind and body been interested and concerned with the actual process
25 share this creative element. Creativity thus becomes an of creativity. It seems that the arts provide “easy access”
26 attribute of life (Sinnott, 1970, p. 107). This perspec- to creativity. By experiencing the therapeutic arts, pa-
27 tive does not separate physical and mental processes of tients/clients are able to participate in symbolic healing
28 creativity but considers them one vital life force. experiences, and may also apply these newly practiced
29 If an individual has the essential elements of cre- processes in creativity to other parts of their life for
30 ativity, which could be passion, imagination, a searching growth and change.
31 for meaning, a desire for self-actualization, a predilection The 1978 Task Panel for the Use of the Arts in
32 to free association, or consideration of creativity as a life Therapy and the Environment of the President’s Com-
33 force, it only remains to set up the conditions to foster mission on Mental Health has stated:
34 creativity. This is the job of the music therapist.
35 The client/patient should have an environment The arts, if presented in a setting of their own
36 that allows a person to move freely between control under the supervision and guidance of the
37 and surrender, activity and acceptance. A person must creative professional, can provide the neces-
38 have time for both application and reflection, or nour- sary opportunity for their inherent healing
39 ishing and being nourished. powers to support the innate strengths and
40 Creativity exists in every individual and awaits integrity of the patient. If such a healing ex-
41 only the proper conditions to be released and experience is made possible for the patient,
42 pressed. There are, in general, three conditions neces- he will carry the knowledge and strengths
43 sary for creativity to emerge: gained from the creative experience into
44 the life he will take up outside the hospital
45 1) lack of rigidity; (p. 1961).
46 2) an expressive situation and availability of
47 tools for expression; It is unfortunate to make distinctions between
48 3) spontaneous playing with patterns, shapes, science and art, for they can be considered one in the
49 S sounds, colors, ideas, relationships. same as a vehicle for discovery. However, in order that
50 R
a mythic journey 17
the life and potential of the “total person” be appreci- 1

ated, it is important to have an attitude of constructive 2
criticism. Such criticism is important to make use of 3
other vehicles of discovery which fall under the head- 4
ing of “the arts,” rather than under technology. 5
To be specific, it may be more useful for the indi- 6
vidual and society for us to utilize the processes, tech- 7
niques, methods, and attitudes of all the arts in more 8
areas, particularly those concerned with healing. Be- 9
cause of a consensus in the medical profession, society 10
has taken on certain fixed attitudes about what can and 11
cannot be considered therapy. Figure 1: Model for Creativity 12
In many cases, the arts could provide an alterna- 13
tive to this condition. Spinoza has said that emotional 14
suffering is no longer suffering when a clear and precise dom and respect, the potential for arts and therapeutic 15
picture is formed. The arts provide powerful ways in arts experiences to heal are great. 16
which to focus and clarify “pictures,” whether in sound, Value placed on the scientific discovery has fil- 17
movement, color, or shape. This is particularly true in tered down into all the levels of our lives. There has 18
the spectrum of emotions. “The arts can be considered been an emphasis on situations, interactions, and be- 19
the language of emotion. With their inherent ability to havior in general which are observable and quanti- 20
elicit involvement and personal action, the arts may be fiable. By observing these phenomena, data can be 21
employed as a counterforce to the widespread passivity obtained and conclusions can be drawn primarily 22
in our society, the unwillingness to exercise control and through statistical methods. 23
assume personal responsibility” (Task Panel Report). Neither the vehicle of the scientific method nor 24
Within the experiences offered in the therapeutic the exact and precise search for conclusions need be 25
arts there is not only meaningful expression of emo- criticized. However, the over-emphasis of these means, 26
tion, but also an invitation to personal action. The ef- perhaps even the misuse of them, deserves critical re- 27
fectiveness of various therapies cannot be separated view. 28
from the issue of creativity. Creativity is by no means 29
the only path to growth. But it can, and often does, In his enthusiasm for a new magic, modern 30
constitute far-reaching growth since both the individ- man has gone far in assigning to science — 31
ual and society at large receive the benefits. his own intellectual invention — a role of 32
The following illustration shows the relationship omnipotence not inherent in invention it- 33
between important considerations neglected in non-art self. Bacon envisioned science as a powerful 34
therapies and creativity. and enlightened servant — but neither the 35
This illustration indicates both an inward and master of man (Eiseley, 1971, p. 130). 36
outward movement. All of these qualities or functions 37
or phenomena feed creativity and in turn are fed by It is clear that science has contributed greatly to 38
creativity. They are all necessary for creativity, and the the quality of life for modern man. However, it is also 39
successful functioning of creativity builds on each par- becoming clear that it is only one means to search for 40
ticular category. Likewise, the side categories are gifts knowledge. It may be a case of the means distorting the 41
which society allows the patient to receive through an end. If discovery is the aim of science and its result 42
attitude of support and a spirit of discovery. The indi- technology, science/technology may appear to be the 43
vidual represents creativity. If the flow is permitted, most efficient means to that end. However, what other 44
both the individual and society benefit from any prod- means are we leaving behind? And, more importantly, 45
ucts of the creative process. how has our striving in the technological age molded 46
Every element of the model is inherent in experi- our cultural and philosophical values pertaining to 47
ences with the arts. Although these processes could health care services? 48
naturally be distorted by poor leadership or lack of wis- Primitive people have always recognized the S 49
R 50
1 power of a symbolic dimension, the setting of bound- self-actualization are greatly inhibited. As long as the
2 aries and limits. There have been no sacred limits on patient is willing to conform to the prescribed social
3 the use of tools in our industrial society. Ivan Illich has code in varying degrees of strictness, he/she will be-
4 called this overextension, licentious technology, which come cured. If the patient has ways of being and speak-
5 then becomes a moral issue, particularly when applied ing which fall outside of the prescribed behavior for a
6 to the medical community. The medical profession particular social code, these strange “behaviors” are
7 claims freedom from the broad world of law and reli- considered deviant and therefore symptoms of some ill-
8 gion, and is therefore immune to moral criticism by to- ness. The humanistic psychologists are an exception.
9 ken of its base in science. It does not lay itself open to But the influence of humanistic psychologists in educa-
10 criticism from society at large but only to its own inter- tional and therapeutic environments is not consistent.
11 nal codes. Perhaps the only thing “wrong” with the schizophrenic
12 In many cases, “health” is a one-dimensional con- patient is that he speaks in metaphors unacceptable to
13 cern and does not consider the whole man. Furthermore, his audience, in particular, his psychiatrist. In these
14 people are often deprived of their health because it is lit- cases the patient might be considered sick. Yet often no
15 erally taken out of their hands. In the case of contempo- effort is made to respect the novel thought patterns of a
16 rary psychoanalysis and dynamic psychiatry, professionals patient, or to interpret these patterns as a sincere effort
17 obscure and disguise moral and political conflicts as mere to communicate knowledge or feeling. The key to al-
18 personal problems. Thomas Szasz (1974) says: lowing self-determination is respect.
19 Once an individual has delivered him/herself into
20 . . . therapeutic interventions have two the hands of the medical profession, little choice re-
21 faces: one is to heal the sick, the other is to mains. Deterministic explanations of human behavior
22 control the wicked. Since sickness is often prevail. We need to reintroduce freedom, choice, responsi-
23 considered to be a form of wickedness and bility into the conceptual framework and vocabulary of psy-
24 wickedness a form of sickness, contempo- chiatry and health care in general.
25 rary medical practices often consist of com-
26 plicated combinations of treatment and According to the popular image of science
27 social control (p. 69). everything is, in principle, predictable and
28 controllable; if some event or process is not
29 Using medicine, and psychiatry in particular, as a predictable and controllable in the present
30 form of social control is an attempt to perpetuate the state of our knowledge, a little more knowl-
31 values of society at large and the individual therapist in edge and, especially, a little more know-
32 particular. Inherent in this process as it functions from how, will enable us to predict and control
33 day to day is the illusion that if a statement or treat- the wild variables. This view is wrong, not
34 ment has scientific grounding it is value free. Value-free merely in detail, but in principle (Bateson,
35 cure and care merely does not exist. Unfortunately, 1979, p. 40).
36 many health professionals have a deeper, culturally
37 health-denying effect insofar as they destroy the poten- Persons who are “different” fall into the category
38 tial of people to deal with their human vulnerability of “unpredictable persons.” In a general sense, one of
39 and uniqueness in a personal and autonomous way. We the postulates of the behavioristic model, one of the
40 unnecessarily become health care consumers. most widely used forms of therapy, is that human be-
41 This leads into the issue of self-determination. havior must be predictable or it is deviant. The illusion
42 The average person, encouraged by the trend to spe- of predictability currently reigns in medicine and the
43 cialization, is overwhelmed by the mystique of medi- behavioral sciences. This illusion has affected two par-
44 cine and has forfeited rights to his/her own health. ticular groups: patients and the general public.
45 Therefore little self-determination exists. The patient Various schools of psychology, psychiatry and
46 is in the hands of the doctor. some in psychotherapy have invented hundreds of sys-
47 Because treatments are decided through society’s tems that determine a standard “functioning level” or
48 value system and the therapist at that moment, the val- set of behaviors for both normal and “deviant” person-
49 S ues of the patient and rights to self-determination and alities. Even if one is considered “deviant,” he/she is ex-
50 R
a mythic journey 19
pected to follow prescribed patterns of being. A great In the hierarchy of conventional research, studies 1
deal of pressure is placed on patients from therapists, employing statistical methods carry more value than 2
family, and peers, to comply with these standards of descriptive methods. The assumption prevails that sta- 3
predictability. An individual is rarely encouraged to tistical studies are more objective than descriptive 4
discover or develop his own unique and perhaps cre- studies. This may or may not be true, depending on, 5
ative problem-solving devices. And the creative is the among other considerations: 6
innovative, the novel, the unusual. Therefore pre- 7
dictability often precludes creativity. This rigidity on 1) who is doing the study; 8
the part of therapists is in the interest of perpetuating 2) if they have an axe to grind; 9
the medical mystique. Some members of the health 3) if they are aware of their own biases and 10
care system imply that the individual does not have the values; 11
resources to aid in his/her own cure because, if left to 4) if they are ethical. 12
his/her own devices, a patient/client may encounter an 13
“unpredictable outcome.” This illusion is the belief by The point is that it is easier to mask values in statistics 14
society as a whole that this will not happen if left under than in descriptions. 15
the care of a “professional.” The more all-encompassing In general, statistical methods should be checked 16
effect of this illusion on society is the present inclina- and balanced by the following concerns: 17
tion to forfeit individual rights and support this system First, although some aspects of life can be observed 18
socially, economically, and intellectually. and behaviors quantified, there are many which are dif- 19
The overriding danger for society of the illusion ficult to observe but equally important when drawing 20
of predictability is that all behaviors, including death, conclusions about personality types, diagnoses, and learn- 21
can and should be predictable. ing. Emotions, feelings, values, attitudes, and philoso- 22
phies are not easily pinpointed with statistical accuracy, 23
Of course a treatment or set of therapeutic even if they are measured by standardized tests claiming 24
procedures may work when the theory is to describe the psyche. Therefore statistical methods 25
wrong; or the theory may be reasonable, but sometimes paint a superficial picture, ignoring the deeper 26
the techniques may be inefficient or inef- levels of existence, the unique individuality of person- 27
fective. The point to be made is that the alities that often pertain directly to difficulties in life. 28
individual practitioner has no sure way of Although mathematical procedures can verify quanti- 29
answering these questions since he/she must tatively, the important “shaping” characteristics of hu- 30
rely on the clinical method. Furthermore the man beings tend to be qualitative. There are few testing 31
history of science amply demonstrates that devices or quantifying systems of discovery which cap- 32
humanity’s capacity for self-deceptions may ture these powerful qualities. 33
persist for centuries (Strupp, 1977, p. 7). Second, to justify the use of a particular treatment 34
or method, therapists must provide examples of re- 35
Another major influence on the illusion of pre- search documenting the effectiveness of their chosen 36
dictability has been the widespread use of statistical treatment or method. In medicine, it is generally be- 37
methods. The general public and most health care pro- lieved that statistically analyzed research rarely lies. 38
fessionals believe: 1) experimental studies prove things; Generalization is common through the structures of in- 39
2) facts cannot be manipulated and distorted if under ferential statistics. In actual fact, the positive effect of a 40
the protection of experimental evidence and statistical certain method may very well apply only to the popula- 41
methods. Unfortunately, statistical methods and experi- tion tested in one study. Replication is rare, and not en- 42
mental findings are often misused, whether deliberately, couraged by publishers of journals. 43
ignorantly, or unconsciously. One rarely finds a study Third, statistics can be made to show a variety 44
without bias or hidden assumptions, whether it’s con- of results. In order for research not to reflect personal at- 45
tained in research design, screening of data or choice of titudes, bias, and values, a great deal of integrity must ex- 46
statistical method. The area of inferential statistics is ist in the researcher who uses statistical methods. This is 47
particularly hazardous in this regard. Value-free research next to impossible, yet these influences are seldom men- 48
is a difficult task and seldom if ever achieved. tioned in research literature. In addition, there are many S 49
R 50
1 statistical methods. If one does not show results, other Sometimes persons are given the choice of
2 methods are applied until one is found which perhaps whether or not to commit themselves to treatment pro-
3 does show the results sought. With the large percentage cedures. Often, in desperation, one turns to medical
4 of research published, researchers have a lot invested in treatment, including psychiatry. Due to social sanction,
5 the hope that their particular treatment or theory will these people accept everything which is prescribed
6 work. As a case in point, how often does one see non- with unfailing faith and religious fervor. The psychia-
7 significant statistical results reported in the literature? trist, in fact, is the new priest and pastor in the sce-
8 This criticism should not be construed to exclude nario. He is confronted often with human problems
9 inquiry, or even particularly scientific inquiry. Unbi- diagnosed as neurotic symptoms. All too often the psy-
10 ased inquiry is essential. The point is that statistical chiatrist has been trained to employ mechanical sys-
11 methods appear appropriate only for certain aspects of tems of treatment and is not concerned with a search
12 human personality and behavior. The use of these for meaning which adapts to changes and touches the
13 methods not only far exceeds the appropriate limits, depths of soul. The result is a kind of dehumanization
14 but also has inhibited other types of discovery methods of psychiatry. Again, we are faced with the conflict be-
15 which may be equally valuable and also more appropri- tween rigidity and creativity.
16 ate for certain aspects of the human condition. Case Viktor Frankl says the meaning of life changes
17 studies would be one example of an alternative. from man to man, from day to day, from hour to hour.
18 The fact that the arts are not presently widely What matters, therefore, is not only the meaning of life
19 used in therapy may be due to the difficulty in quantify- in general, but the specific meaning of a person’s life at a
20 ing artistic events, experiences, and products, except given moment. Current methods of therapy have little
21 within some standard of achievement — not always the concern with the issue of meaning. Instead, issues of
22 most important consideration in therapy. conformity, functioning level, and appropriate behavior
23 The Task Panel on the Arts in Therapy and the take precedent. Levels dealt with in therapy are usually
24 Environment for the President’s Commission on Mental only observable levels. The deeper levels of conscious-
25 Health (1978) states: “the measurement techniques of ness and meaning are most often not a consideration.
26 present statistical methodology are not enough to cap- Even the system of psychoanalysis, which has so greatly
27 ture the qualitative and effective gains made through ex- influenced psychiatric treatment for years, considers pri-
28 posure to the arts” (p. 1978). Although quantifiable marily psycho-sexual influences and maintains a rigid
29 research techniques have been used in the arts, results approach to interpretation of feelings and experience.
30 have not shown consistent significant change. Several Only “things” can be determined by others. Each
31 factors could influence these reports: person is unique and must take responsibility to find
32 meaning and to act. No situation repeats itself for each
33 1) Changes, especially internal, inspired by situation calls for a different response. The situation in
34 the arts therapies are not easily observed. which a person finds herself requires her to take respon-
35 Artistic experiences often strike a deeper sibility in shaping her own fate. The failure of the
36 level and change is more gradual and long- health care professional to encourage self-responsibility
37 term. Often action that occurs from insight and action helps to create the career patient. Rites
38 does not happen immediately; rather, a have been mentioned which serve to protect and per-
39 healing process is initiated; petuate this “professional” monopoly. The strongest in-
40 2) The spiritual qualities of artistic experi- fluence on keeping the system alive is the patient’s own
41 ences are vague and mystical, though loss of responsibility for self, succumbing to the seduc-
42 equally valuable even though they are diffi- tion of the medical mystique. This surrender has al-
43 cult to quantify; lowed the career mental patient to exist.
44 3) Since present research methods may measure
45 only a portion of the artistic experience, the Clinical psychology is a remnant of the
46 rest of the experience remains ignored. medical model. It may prove its worth in
47 case after case by dismantling pathological
48 Studies of the arts in therapy, therefore, are often viewpoint. For judging by results belongs
49 S seen as confusing, giving the feeling of trying to fit a to medical empiricism; besides, it assumes
50 R square peg into a round hole. what is to be established: that the soul’s
a mythic journey 21
pathologizings are to be dismantled. By rak- Creativity can address all of these issues and we can no 1
ing the soul’s sickness fantasy at face value longer accept its dearth in the field of health care. The 2
as clinical pathology, the clinical approach therapeutic arts can most dramatically address these 3
creates what it then must treat. It creates concerns. 4
clinical patients (Hillman, 1975, p. 3). 5
The Myth of Nature, Death, and Rebirth 6
Clinics, hospitals, and mental health centers are filled I am the tree. 7
with people who have given up responsibility for their And in this moment of being tree 8
own health and life. Instead of encouraging these I experience both the endless struggle and 9
people to take hold of their responsibility, the mental profound beauty of life in the same breath. 10
health business provides drug and other treatment We are engaged in a quest for survival and 11
regimes which rely totally on clinical methods. Patients balance. 12
come under regular surveillance by therapists. If they I hear the music of our dance even through 13
do not, they may become dangerous not only because the silence of dark hours. 14
of possible harm to themselves and others, but because, Soon the leaves on my brother will turn 15
in the patient’s ignorance, they may take exception to and leave . . . to replenish the earth again. 16
the prescribed treatment. This strict control is neces- I too change. 17
sary if treatments are to be effective. I sometimes die and am reborn, 18
As long as we share connecting patterns 19
. . . the medical monopoly . . . serves to legiti- we are One, 20
matize social arrangements into which many Not I, Nor He 21
people do not fit. It labels the handicapped as . . . but whole and sweet life. (Kenny, 1979) 22
unfit and breeds ever new categories of pa- 23
tients. People who are angered, sickened and Because the great body of traditional wisdom is 24
impaired by their industrial labour and leisure intertwined in complicated systems and rituals, it is a 25
can escape only into a life under medical challenge to identify the information that can be ac- 26
supervision and are thereby seduced or dis- knowledged from traditional structures and described 27
qualified from political struggle for a healthier in meaningful modern terms acceptable, in this case, to 28
world (Illich, 1976, p. 35). both the clinician and health care administrator. 29
This problem might not exist if we had always em- 30
Once a person is admitted to an inpatient ward braced the wisdom of the past and kept the connecting 31
the enforcement of the value system of the medical threads through the evolution of culture and society. Be- 32
treatment staff offers an added humiliation. An even cause the pendulum of change can make a sudden and 33
more powerful influence is discrimination by society. extreme arc throughout history, many valuable ideas and 34
The ill effects of lowered self-esteem become even more approaches were rejected. Culturally, we are now in- 35
difficult to “cure” than the initial causes of the “illness” volved in a rather wide-scale attempt to pick up some 36
which precipitated hospital admission in the first place. pieces and reintegrate many of the ideas of the past. 37
It is therefore apparent that within medical treat- The Mythic Artery draws information from a vari- 38
ments having the largest number of patients, psychiatry ety of disciplines and fields, old and new, in an attempt 39
included, there is a lack of these important considera- to make a contribution to a relatively new field, music 40
tions for the whole person: therapy. An attempt is being made to synthesize ideas 41
across disciplines to find the threads which connect 42
1) Freedom our past, our present, and our future. Although there 43
2) Choice are many threads that achieve this connection, music 44
3) Self-determination is one of the most powerful because it touches the 45
4) Responsibility whole person. 46
5) Action and self-expression One of the functions of the arts is to remind us of 47
6) Spiritual realization our connections. To a great extent, it tends to be 48
7) Philosophical realization mythic, symbolic, and archetypical. The artist has been S 49
8) Innovative thought and behavior left to dream and interpret his own dreaming, which R 50
1 has provided him with the freedom of shamanic-like to share ritual. There are many general ways in which
2 journeys of insight. Music, therefore, is not so much a music can stimulate this change. One specific example
3 connector as a vehicle of inspiration that reminds us is the death-rebirth myth as the healing agent in music,
4 that we are already connected. And this connected which represents the mythical approach to comple-
5 feeling forms the basis of whole health. ment already existing medical approaches of music and
6 Furthermore, this is an exploration into the musi- other therapies. Simply stated the forms and patterns
7 cal aspects of information from different fields to take of music can be used as symbolic representations of
8 the first creative step in the direction of developing the ongoing process of regeneration and renewal — the
9 useful ideas for the future. It is a cross-classification and death-rebirth myth — for healing in the therapeutic
10 connecting of fields of music therapy, anthropology, environment. The discovery of this relationship be-
11 philosophy, religious studies, natural history, and edu- tween music, myth, and people came about through my
12 cation. It is also dreams, visions, images, and spirits. work as a music therapist.
13 One of the specific problems in treatment today is I have noticed that patients often produce poems,
14 that we have lost the historical thread of the arts as movements, paintings, verbal descriptions, and musical
15 healers. Gradually, they are coming back. More and improvisations with the death-rebirth myth, or some
16 more people are taking up arts and crafts. However, situation that strongly suggests the death-rebirth myth.
17 when the arts are applied to therapy, they are often jus- These results have come without any suggestion on my
18 tified and rationalized into distortions of the original part. As guide in those sessions, I became curious about
19 benefits of the arts as healers. the influences on my own choice of music and instruc-
20 In our attempts to become more and more civi- tions to patients that may have been leading to death-
21 lized, we have stretched beyond the sacred limits of in- rebirth themes.
22 tellect and are only recently starting the journey back I have discovered two main influences directing
23 to center. On the one hand, we have the specialized the death-rebirth response:
24 artist a person removed and excused from the conven-
25 tions of society at large. The artist is free to dream 1) Directions often encouraged patients to
26 dreams, see visions, and hear voices and sounds of develop images of death-rebirth processes
27 spheres and spirits, as long as he produces art. On the in nature.
28 other hand, our clinics and institutions are filled with 2) Music always had an obvious tension/
29 clients who are dreamers and are denied the arts, as resolution element.
30 frills. As Jose Argüelles has said:
31 Pinpointing these two influences has encouraged me
32 What began as the history of art logically to examine them in greater depth. This approach was
33 must end as the history of man’s insanity, for not conceptualized and then applied. Rather, it has
34 the degree to which art becomes specialized emerged from patients and clients themselves, then for-
35 as fine art and dependent for its meaning on mulated into the present description.
36 art history, is the degree to which man loses Before developing an approach that would make
37 his innate wisdom. In recent times this use of the healthy functions of myth, we must clear up
38 process has been hastened by the machine. some misconceptions about the term itself. The most
39 Since expression is innate to the human simplified definition of myth is that it is a widespread
40 species in denying ourselves our expressive cultural story. There is usually a message in the myth
41 wisdom we have denied ourselves our own beyond the story, a helpful hint about how to live. Be-
42 humanity (Argüelles, 1975, p. 290). cause we experience myth through rituals and rituals
43 are associated with “magic,” modern man finds it dif-
44 One of the threads from the past that must be ficult to accept the concept of myth. Myth has been
45 connected to the present and the future is the concept distorted in general usage to mean an untrue story,
46 of art as a preventative and curative resource. The most something which only seems true.
47 profound and immediate need for this change is felt in Because of the scientific orientation of our cul-
48 the therapeutic environment. Other areas in which the tural attitudes, ideas about the nature of the universe
49 S same principles apply are in formal educational settings that cannot be verified by experiment are considered
50 R and other places where the community comes together myth. This is how we find ourselves in relation to myth
a mythic journey 23
at the present time. But we are coming into a time of ence myth. The beauty of myth is that it takes what 1
myth once again. “facts” it has and molds, shapes and utilizes these 2
“knowns” through an intuitive, emotional expression. 3
Against the background of history, the eye- One difference between the myth-makers of old and 4
opening years of our rational, scientific en- modern myth-makers is in the interpretation of the 5
lightenment seem a brief moment in the meaning of facts. As a culture, we generally believe that 6
morning of consciousness. We have cultur- we cannot know something to be a fact unless it has 7
ally yawned and stretched a little, but the been empirically proven. However, the ancients knew 8
shadow of the myth-susceptible dreamer is many things that they had not observed in the form of 9
still there just below the surface of our new- hard data. They knew things that they heard in dreams, 10
found awareness (Larsen, 1976, p. 3). the stories of their grandfathers, the coming of events. 11
Myth was a reality and ritual a response and affirmation 12
Myth can be considered a synthetic mode of of that reality. In other words, we go with what we have, 13
experience that travels through our holistic awareness. searching for the bare bones of mythic content left for us, 14
It connects us and relates us to our surrounding world the common territory that unites people, and also begins 15
through perception, that is not always empirically test- to create rituals in which to relive myth. 16
able. It comes to us through patterns and archetypes One of the results of myth and ritual is symbolic 17
that affect external life indirectly through symbolic healing. If we, in fact, are able to listen to the mythic 18
activity (Dimmitt-Church). Thus through myth we are messages coming through the symbolic codes contained 19
able to externalize our individual human hopes and in ritual, they have the power to change our lives. The 20
fears into the cultural context and experience them as symbols contained in ritual are many and complex. Mu- 21
“shared” phenomena. sic is a symbol of myth representing the past. It is also a 22
The same is true of music. Musical experience is symbol of every person present as well as the whole 23
also difficult to test and the benefits equally difficult to community. In addition to being all of these things in a 24
perceive. Music also allows us to externalize our human symbolic sense, it delivers the message, which evolves 25
feelings, by expressing and sharing them. through the ritual time. It is also unique each time it is 26
Regarding the function of myth, Joseph Campbell performed or perceived, influenced by the beliefs, char- 27
expresses one of the functions to be a shift of emphasis acter, and situation of the group and its members. 28
from the individual to the group. Myth is a wonder that Symbolic healing is integral to the use of the 29
man cannot easily explain, an informing energy, a re- myth. Within symbolic healing, the symbol, in this case 30
minder that the whole world is divine. For the Navaho the music embodying the death-rebirth myth, has some 31
people, myths affirm that there is rhyme and reason in a spiritual, psychological, and physical effects and inspires 32
world full of hazards. a healing of some damaged part of person. In this case, 33
If we always deal with the difficulties of life in iso- by stimulating the person to identify with the process of 34
lation, as the individual, and never relate ourselves to death-rebirth, the person is able to experience a meta- 35
the whole, any solution or cure is likely to be merely an phoric dying and rebirth. Metaphoric dying engages the 36
illusion, and short-lived. Many of the modern systems psyche on some level, whether through cognitive recog- 37
of therapy concentrate entirely on the individual. The nition or spiritual inspiration. This reaction is difficult 38
individual is brought into group therapy only after to monitor from behavior and may take the form of 39
there is a coming to grips with “self.” Even some of the learning from corrective experience, acquiring new 40
group therapies are ego-centered and deal primarily insight, identifying the similarities between symbolic 41
with each person’s individual needs as opposed to the death-rebirth and some present life dilemma. 42
concerns of the group as a whole. The priority of “I” is Since there are many interpretations of what con- 43
obvious, even in many therapeutic communities. As stitutes “symbol,” it is important to clarify its meaning 44
long as group members are making music, working in here. Whitmont, in The Symbolic Quest, defines symbol as 45
the garden or cooking together, a community spirit pre- “the expression of a spontaneous experience which points 46
vails. But the moment verbal psychotherapeutic groups beyond itself to a meaning not conveyed by a rational 47
begin, the shift is back to the “I.” term, owing to the latter’s intrinsic limitation.” (p.18) 48
There is an intimate relationship between myth Some consider symbolism to be a revelation of S 49
and ritual. Ritual is the form through which we experi- reality, a message that speaks of passage from one world R 50
1 of meaning to another, sometimes divine to human or biofeedback, altered states of consciousness, and neuro-
2 vice versa. For present purposes, all of these ideas shed physiology. It is becoming clear that mind and body are
3 some understanding on “symbol.” But Suzanne Langer’s part of the same whole and thus are mutually affected
4 (1953) simplified definition will serve both to clarify by stimulus. The category of illness pertaining to this
5 the meaning and to establish an important link that information is the area of psychosomatic “diseases.”
6 will be discussed later: Symbol is anything that may There is a relationship between symbol and substance,
7 function as the vehicle for a conception. In this case mind and body, psychological/ sociological phenomena
8 the music is the vehicle that establishes a relation be- and physical symptoms, mental acts, and physical life.
9 tween the mythic concept of death-rebirth and the Studies in neurophysiology have identified one of the
10 people participating in the musical experience. links between mind and body in the center of the auto-
11 For the Navaho, symbols not only provide a vo- nomic nervous system, the hypothalamus.
12 cabulary and an explanation but also change the psy-
13 che by converting energy into a different form, a form . . . the power of the metaphor, a “strategic
14 that can heal. A “sing” means a healing ceremony to prediction” can move us, that is, change our
15 the Navaho people. Describing a healing ceremony of minds and lead us to behavior change.
16 the Cuna Indians of Panama, Levi-Strauss says: Metaphorical structure, the system of mean-
17 ing of a healing discipline is decisive in its
18 Once the sick woman understands, she does effectiveness as much as drugs . . . as in Na-
19 more than resign herself, she gets well. But tive healing rituals where both drugs and
20 no such thing happens to our sick when the songs and dances are felt to have equal im-
21 causes of their diseases have been explained pact (Moerman, 1979, p. 60).
22 to them in terms of secretions, germs or vi-
23 ruses. We shall perhaps be accused of para- Since symbolic healing occurs both in and between
24 dox if we answer that the reason lies in the mind and body, the metaphoric and the physiological,
25 fact that microbes exist and monsters do it represents a holistic approach. The relation between
26 not. And yet, the relationship between symbolic healing and the death-rebirth myth is that the
27 germ and disease is external to the mind of whole person experiences or learns about the value of
28 the patient, for it is a cause and effect rela- the death-rebirth process, on its various levels from ac-
29 tionship; whereas the relationship between tual death to some temporary situational loss. The four
30 monster and disease in internal to his mind, basic forms or archetypical principles of symbolic heal-
31 whether conscious or unconscious; it is a re- ing in Navaho rituals are:
32 lationship between symbol and thing sym-
33 bolized, or between sign and meaning. The 1) a return to the origin or source, the cre-
34 shaman provides the sick woman with a lan- ation of the world;
35 guage, by means of which unexpressed, and 2) management of “evil”;
36 otherwise inexpressible, psychic states can 3) the restoration of a stable universe;
37 be immediately expressed. (p.19) 4) the theme of death-rebirth.
38
39 Symbols bring the patient to his inner resources. But symbol is more than all of this, for it is mean-
40 If the healing images are strong enough, if the medicine ing. It is reality that points to the ultimate realities of
41 man is skillful and unwavering in his purpose, and if life-death. It is release from suffering and a source of
42 the patient’s involvement is deep and urgent, then strength.
43 healing can be expected to occur. The same process can
44 be applied to current “therapies.” This brings up the The Regenerative Experience
45 question of specific disabilities. In light of present med- Within religious and cultural systems, the regenerative
46 ical knowledge, these nature cures could be read as experience has always been valued as healing. As will be
47 dealing with psychological or spiritual “lack of re- illustrated, the cycle of regeneration provides the reason
48 sources” only. However, enough research has accumu- for being, the essence of meaning to life.
49 S lated to safely conclude that the mind-body separation Buddhism is based on the continuous cycle of
50 R theory is on the wane. These areas of research include death and rebirth. One never really dies. One is born
a mythic journey 25
again many times until the achievement of Nirvana. provides a useful interpretation of the Christian approach 1
This process may take a person through many bodies to death, focusing on the similarities between Eastern 2
and many ages. Each life is related to the past lives and and Western thought. He says that one of the basic ap- 3
each life strives to complete the unfinished business of proaches to daily life in the monastery is to have death at 4
the past (karma). all times before one’s eyes. “It is seeing of every life against 5
Within the Zen system, dead and alive are not op- the horizon of death, and a challenge to incorporate that 6
posite conditions. According to the principles of Bud- awareness of dying into every moment so as to become 7
dhism, nothing ever really ends. Things and people are more fully alive” (1977, p. 22). He makes a distinction 8
simply in a constant flow of change. between purpose and meaning. We live by meaning and 9
In the Hindu tradition, the Bhagavad Gita tells us often lose the meaning by getting lost in purpose. This 10
that death is certain for the born, and birth is certain Christian interpretation echoes the non-attachment 11
for the dead. principles we hear so often with the Zen tradition. 12
The poet Maulana Jalaluddin Rumi, the most in- In the end, we have only what we give up. For 13
fluential figure in the development of Islamic thought, things live only in the flow of all things. In the rela- 14
states: tionship between mother and child, a child is “let go” 15
many times by the mother, through the stages of devel- 16
All follows the rule that sacrifice is neces- opment. This is a type of dying over and over again. 17
sary to reach a higher goal. The field must In the Navaho culture, death and rebirth are the 18
be ploughed, in order to receive the seed; mythological symbols for a psychological event. Like 19
the seed grows and is harvested and the the sun, the ego must prepare itself for a plunge into the 20
grains are crushed under the millstone; the darkness of the unconscious world, there to experience 21
flour, then, has to endure the process of bak- rejuvenation. The symbolic process of death and re- 22
ing in order to become bread, which will be birth is found wherever there is a life crisis necessitat- 23
crushed again by man’s teeth. But by this ing rites of transformation rechanneling psychic energy 24
constant succession of sacrifices the grain from old patterns to more functional new ones. 25
will finally become part and parcel of the Here we can identify the relevance of the death- 26
human nature and will thus participate to a rebirth myth for man today. The application would be 27
certain extent in the human soul and spirit the same. Not only does the myth have great meaning 28
(In Schimmel, 1978, p. 7). for each person in individual life, but it also serves the 29
other important group function through identifying 30
Another Eastern philosopher, Gurdjieff, suggests: what Joseph Campbell calls a human constant. This 31
second function adds depth and meaning and encour- 32
Attachment to things keeps alive a thousand ages people to consider themselves in relation to other 33
useless I’s in a man. These I’s must die in or- beings. One person is not alone in suffering, for suffer- 34
der that the big I may be born. Continual ing is an integral part of human life. If suffering is to be 35
consciousness of his nothingness and of his endured, it must have meaning. The death-rebirth 36
helplessness will eventually give a man the myth, if accepted and experienced through cultural 37
courage to “die,” that is, to die, not merely ritual of some kind, can be meaningful. Death and re- 38
mentally or in theory, but to die in fact and to birth connect the psyche to the ongoing processes and 39
renounce actually and forever those aspects rhythms of life. Any one of life’s situations can provide 40
of himself which are either unnecessary to a context for this universal myth. Victor Frankl speaks 41
the point of view of his inner growth, or of life in the concentration camp. He says that to sur- 42
which hinder it (In Schimmel, 1978, p. 7). vive and find some meaning for existence the prisoners 43
went through a phase of apathy or what he calls “emo- 44
Christian philosophy and practice is based on the tional death.” Once they had “died” and reduced their 45
model of Christ, who died, only to be born again, tran- psyche to the most basic level of existence, they were 46
scending life on earth, achieving a higher state of exis- prepared to be reborn again in the concentration camp. 47
tence. The baptism ritual allows a person to become Frankl suggests that people do not need a tensionless 48
born again by dying to original sin. state, but instead require a striving and struggling for S 49
Brother David Steindl-Rast, a Benedictine monk, some worthy goal. R 50
1 The Salish Guardian Spirit Dance Ceremonies, assumption is that death is one of the inevitable laws
2 like many Native rituals, provide an example of how of nature. Instead of thinking about death with fear and
3 the regenerative experience is used as a healer with a denial, it is possible to consider it as part of the ongoing
4 social/spiritual system. The initiates, who are usually process of life. Without death, there is no life, without
5 young people having some problem in life, are encour- life, there is no death. An attitude about death reflects
6 aged to die to the white man’s ways and be reborn again an attitude about life. It is hoped that if one comes to
7 as a true Indian. Through the rituals of Guardian Spirit accept the inevitability, necessity and even value of
8 Ceremonials, participants sing, dance, fast, costume, death, the same insight will apply to life and particular
9 train, and undergo a type of symbolic death which frees life situations.
10 them from both corrupt influences, such as drugs and
11 alcohol, and anomie resulting from a lack of cultural Discovering our dying is a turning point. Dy-
12 identity. Once a person has been initiated in these cer- ing evokes the helplessness, the unexpected,
13 emonials, he or she is eligible to dance every season in challenging the unknown. Dying establishes
14 order to renew personal healing. Guardian Spirit Dances new directions, gaining new powers, losing
15 are rituals that have been reinstated into the Longhouse the old; giving up action patterns, thought
16 by the Salish people to add healing for members of the patterns, being unsure, being excited, know-
17 band today. ing something is emerging but not knowing
18 Rituals of initiation, transformation, creation, and where it is going. Dying, like any turning
19 the hero myths all relate to death-rebirth. Each re- point, is a place of transition, a facing of the
20 enacted situation implies going through some difficult unknown and the emerging complexity of
21 experience, dying to part of self or letting go of some- new ways of being, new actions, thoughts,
22 thing or someone and being transformed, reborn, or feelings. Each turning point is the realiza-
23 greatly changed in some way. tion of loss, an encounter with the unknown
24 Initiation lies at the core of any genuine human (Keleman, 1974, p. 23).
25 life. And this is true for two reasons. First, any genuine
26 human life implies profound crises, ordeals, suffering, loss, The connection between physical death and sym-
27 and reconquest of self, “death and resurrection.” Second, bolic death and physical rebirth and symbolic rebirth
28 whatever degrees of fulfillment it may have brought him represents a level of acceptance and understanding
29 at a certain moment, every man sees his life as a failure. which allows for the nurturing of insight about con-
30 The hope and dream of these moments of total crisis are crete situations in life.
31 to obtain a definitive and total “renovation,” a renewal
32 capable of transmuting life (Eliade, 1954, p. 135). Nature as Teacher and Healer
33 Since the medical community functions primarily The human brain, so frail, so perishable, so
34 as a closed body or society, its own internal systems are full of inexhaustible dreams and hungers,
35 considered more relevant than the ways of the past — burns by the power of the leaf. A few mo-
36 certain esoteric psychologies or religious philosophies. ments loss of vital air and the phenomenon
37 These resources are rarely integrated into the scientific we know as consciousness goes down into
38 body of knowledge. The regenerative or transformative the black night of inorganic things. The hu-
39 experience as described here is not employed on a con- man body is a magical vessel, but its life is
40 scious level. Certainly the full potential of the death- linked with an element it cannot produce.
41 rebirth myth as a healer has not as yet been explored in Only the green plant knows the secret of
42 therapeutic settings. However, in the past five years, transforming the light that comes to us
43 the topics of actual death and symbolic death hive re- across the far reaches of space. There is no
44 ceived attention on a theoretical and in some cases better illustration of the intimacy of man’s
45 practical level. This change hopefully represents a cat- relationship with other living things (Eise-
46 alyst that in the near future will produce a direct result ley, 1978, p. 118).
47 in the world of “therapies.” The basic message of this
48 literature is to consider the act of physical death- Eiseley speaks of the “secret of transforming.” The
49 S rebirth as one step in many dying steps in life. The process of regeneration is evident at every turning as we
50 R
a mythic journey 27
meet our environment — the process of birth, maturity, pens to the beast also happens to man. All 1
decay, rebirth. Physical elements never die, but are al- things are connected. Whatever befalls the 2
ways recycled into another form. This process is visible earth befalls the sons of earth (In Green- 3
in a forest, a tidal pool, and in our own creations. In a peace Chronicles, 1979, p. 32). 4
sense these situations are metaphors of our life. Both 5
must learn how to survive by giving in to the process of The Indian considered nature, and humans as 6
life and death. Survival for a great percentage of the part of nature, divine and sacred. Chief Sealth’s com- 7
natural world is a matter of instinct. Every winter ments that “all things are connected” points to essen- 8
leaves will fall, decay and nourish new growth for tial needs in our psychological and physical well-being. 9
spring. Bears will hibernate, salmon will spawn. How- He implies that in order to survive people must appre- 10
ever, because of the nature of human intelligence, this ciate the link between themselves and the natural 11
survival instinct is not always so clear in humans. Men world. The power of nature is awesome. We have only 12
and women can manipulate their environment and of- to witness a storm at sea to know it. Instead of striving 13
ten do so without considering the consequences in to conquer, master, or manipulate this power, we can 14
terms of survival. Therapy can be considered as a type work with it to receive aid in resolving inner conflicts. 15
of training in survival skills for the human being. Na- The Native peoples accomplish this through sym- 16
ture allows people to learn about survival. But nature bolic identification and unfailing respect. Nature is not 17
does not simply represent reality. In the shapes of life, only that which can be observed, but a vital force which 18
nature prepares the future; it offers alternatives. An- somehow manages to keep the elements in balance and 19
other value of accepting nature as teacher is that by ap- harmony and must therefore have wisdom far beyond 20
preciating our connections to the earth and fellow our knowledge. 21
living creatures, we are able to shed our feeling of alien- The Navaho religion provides the ritual for heal- 22
ation. One can recognize that he or she is part of a ing through a profound meditation on nature and its 23
framework (of nature) and that the same processes, in curative powers. In fact, healing is the main focus of all 24
fact creative processes, going on around a person are religious activity. And healing is not directed toward 25
also going on in oneself. People realize that they are specific symptoms or bodily organs, but toward bringing 26
connected to their environment, are not alone, and in the psyche into harmony with the whole gamut of nat- 27
fact are part of a whole, shared existence of life. Indige- ural and supernatural forces around it. The medicine of 28
nous cultures actively acknowledge this vital link and the white man has often failed when competing with 29
the significance of appreciating the link for survival. this “Indian medicine” which encourages relational 30
well-being. 31
There is no quiet place in the white man’s The themes of nature as teacher and healer are 32
cities, no place to hear the leaves of Spring or themes of water, air, forest, wind, and growth. When 33
the rustle of insects’ wings. And what is there the death-rebirth myth is used in healing, it is rarely 34
to life if a man cannot hear the lovely cry of a identified as the “death-rebirth myth.” Instead, it is 35
whippoorwill or the arguments of the frogs contained in the images of nature suggested by the 36
around a pond at night? The Indian prefers therapist or participants themselves. This encourages 37
the soft sound of the wind darting over the the unity that is accomplished in the Navaho sings 38
face of the pond, and the smell of the wind it- and other ceremonials. 39
self cleansed by a mid-day rain, or scented 40
with a pinon pine. The air is precious to the Religion revolves around a great open secret 41
redman. For all things share the same breath which we all know but want to hear again 42
— the beasts, the trees, the man. The white and again. In this regard Navaho dogma 43
man does not seem to notice the air he connects all things, natural and experienced, 44
breathes. Like a man dying for many days, he from man’s skeleton to universal destiny, 45
is numb to the stench. which encompasses even inconceivable 46
What is man without the beasts? If all space, in a closely interlocking unity which 47
the beasts were gone, men would die from omits nothing, no matter how small or stu- 48
great loneliness of spirit, for whatever hap- pendous, and in which each individual has a S 49
R 50
1 significant function until, at his final disso- its coloring and in its death — the symp-
2 lution, he not only becomes one with the toms of being alive? Our appreciation for it
3 ultimate harmony, but he is that harmony is, to that extent, an appreciation of its sim-
4 (Sandner, 1978, p. 273). ilarities to ourselves (Bateson, 1979, p.
5 127).
6
7 Patterns Patterning also introduces the issue of creativity.
8 Two key concepts that emerge from the above discus- The unconscious strives to create patterns out of form-
9 sions of myth, death and rebirth, and nature are con- lessness.
10 nections and patterns. These two concepts are not
11 often heard in therapeutic models initiated by the med- The ability to integrate and organize a pat-
12 ical community; however, they represent key concepts tern out of formlessness is an achievement
13 in the ongoing healing, whether preventative or cura- which rational thought, being somewhat re-
14 tive, of Native cultures. moved from its primitive being source and
15 Patterning is an aesthetic process. We usually bound with habit and convention, may be
16 think of patterns as the business of artists. Artists see incapable of doing . . . the reason that such a
17 connecting patterns that we do not see. Composers hear frontal attack often fails seems to be that
18 connecting patterns that we do not hear. We have the free association present in the uncon-
19 learned that perception is largely a matter of selection. scious is blocked in various ways and the
20 In order for us to survive sensory overload, we select only really creative new relationships therefore
21 those things that our senses absolutely need. We cannot are not seen (Sinnott, 1970, p. 113).
22 possibly see and hear and feel and smell and taste all of
23 the things that exist or we would drown in sensory stim-
24 ulation. However, we do train ourselves, according to Music and the Mythic Artery
25 our priorities, to accept some things and reject others. Despite the great difficulty in describing music through
26 Unfortunately, both educational and therapeutic envi- words, we have tended to divide ourselves into groups
27 ronments neglect the development of the artist in that have rather extreme attitudes about the subject.
28 everyone. Connecting patterns break the barriers of lin- The first group is the analysts. These people are usually
29 ear thought and objective reality. They are concerned committed to describing music, musical experiences,
30 with a sensational reality having many benefits of which and musical response in precise, logical, and measurable
31 we are presently deprived. We can sense connections be- terms. The most obvious way to keep music within
32 tween ourselves, our environment, and our culture that these boundaries is to stick to formalized music theory as
33 bring us together through the sharing of patterns. the source of all things connected with music. The form
34 This relational way of viewing both self and cul- and structure of music contain beautiful examples of
35 ture provides a healing that was automatically built form and logic. Music and mathematics share similar
36 into the Native and Eastern cultures instead of the concepts and principles. Within this sphere, music truly
37 modern Western system of taking people out of the cul- can be considered a science, reflecting scientific princi-
38 ture and environment for healing. This modern rever- ples. This is part of the reassuring aspect of music. It does
39 sal sets up a type of deprivation that works against reflect the form and harmony in the universe. The dan-
40 healing. Detaching or separating in this way permeates ger comes in the over analysis of music.
41 our present systems and structures. Bateson sees it in Very few musical analysts have attempted to
42 the educational system: Children are taught at a tender tackle the problem of maintaining the integrity of the
43 age that the way to define something is by what it sup- scientific aspects of music while still giving equal con-
44 posedly is in itself, not by its relation to other things. sideration to the artistic and emotional side, which is
45 He stresses the importance of connecting patterns, of in practical terms the side that most people experience.
46 experiencing the world through relational definitions However, some theoreticians, musicologists, ethnomu-
47 of people, objects, and situations: sicologists, and researchers into the psychology of mu-
48 sic have made attempts.
49 S Is our reason for admiring a daisy the fact Leonard B. Meyer, MacDonald Critchley, and
50 R that it shows — in its form, in its growth, in R. A. Hanson have made useful efforts to unite these
a mythic journey 29
two aspects of music — the analytical and the emo- his dexterity as a craftsman, there is a region 1
tional. Meyer’s books, Emotion and Meaning in Music of visionary irrationality in which the veiled 2
and Explaining Music, represent the analysis of music secrets of art dwell, sensed but not under- 3
with an effort to acknowledge and come to terms with stood, implored but not commanded, im- 4
the emotional response initiated by music. Although in parted but not yielding. He cannot enter 5
these two works Meyer is primarily analyzing music, he this region, he can only pray to be elected 6
analyzes with reference to the effect on the total per- one of its messengers (Hindemith, 1979, 7
son. Critchley and Henson describe the scientific as- p. 257). 8
pects of music in terms of its neurophysiological effects 9
in the book Music and the Brain. This work considers These limitations of description seem to be a limitation 10
some of the important findings on split-brain research of our Western tradition. 11
and the importance of total brain functioning, espe- In the musical literature of India, Islam, China, 12
cially the right brain hemisphere in musical activity. Japan and other Eastern and Middle Eastern countries, 13
One outstanding characteristic of Meyer, Critch- the mysterious side of music is described at length. 14
ley, and Henson is that they approach their subject Some of these texts are laced with religious doctrine 15
matter with great humility, realizing the difficulty of which we may or may not believe. However, these au- 16
the task and encouraging criticism and analysis. Meyer thors come close to defining and describing the essence 17
states that through his studies and explorations of indi- of music. Perhaps it is because they do not fear violat- 18
vidual pieces of music, he hopes to illuminate as fully as ing the scientific aspects when exploring the spiritual, 19
possible the source and basis of the power of music to aesthetic, and emotional aspects that play a large part 20
engage and entrance us. in creating the mystery of music. Inayat Khan (1971), 21
Another group of musicians, music lovers, and the Sufi master, has written extensively on the myster- 22
even some music therapists refrain from discussing mu- ies of music. He speaks of music as a divine art because 23
sic in words because they feel that analysis takes away it is the exact miniature of the law working through the 24
from the enjoyment and effect of music. This group, whole universe. 25
surprisingly enough, is not solely composed of people 26
who would be considered emotional types. Quite often, Life depends upon the rhythmic working of 27
the most intellectual types remain firm in this attitude. the whole mechanism of the body. Breath 28
Music provides for them a release from words. The manifests as voice, as word, as sound; and 29
beauty of music is contained within this release. I have the sound is continually audible, the sound 30
met doctors, physicists, mathematicians, psychiatrists, without and the sound within ourselves. 31
and psychologists as well as many others whom I would That is music; there is music outside and 32
consider to be analytical types, who would not touch within ourselves. Music inspires not only 33
the subject. The best answer might be the standard the soul of the great musician, but every in- 34
“chills up my spine” reply. fant which, the instant it comes into the 35
The one group that more consistently tries to bal- world, begins to move its little arms and legs 36
ance the analytical and emotional sides of music is the with the rhythm of music. Therefore it is no 37
group of composers and performers who write about exaggeration to say that music is the lan- 38
music and about their lives with music in autobio- guage of beauty (p. 3). 39
graphical form. We have the letters of Beethoven, 40
Tchaikovsky, Mahler, descriptions of music by John To provide a comprehensive understanding of 41
Cage, Leonard Bernstein, and hundreds of others. One music, we need both Leonard Meyer and Inayat Khan. 42
representative of this group is Hindemith, with his The world of images, symbols, and metaphors can 43
book entitled The Composer’s World, in which he aptly provide a deeper understanding and, more important, a 44
describes the dilemma of description and the rationale relational understanding of music. Although often only 45
for our humility: used as an aside, images are used by most of the people 46
mentioned in the previous groups. Images are used by 47
The ultimate reason for this humility will be both Khan and Meyer. Meyer calls them extramusical, 48
the musician’s conviction that beyond all the whereas Khan interprets them as being part of the mu- S 49
rational knowledge he has amassed and all sic itself. In other words, nothing is really extramusical. R 50
1 There are musical qualities in and around everything and dict the influence of music on behavior. However, con-
2 everyone. Through this concept we are led to music as the sidering that images, symbolic associations, and sound,
3 mythic artery. which may not be monitored on laboratory equipment,
4 We have already described the necessity for will all stimulate and affect our senses, it is quite diffi-
5 humans to find sources of renewal, restoration, and cult to come up with laboratory tested theories that
6 revitalization. Our emotional, spiritual, and physical would have any relevance to practical, clinical envi-
7 resources become low at various stages of our lives, ronments.
8 whether we are patients or not. The two primary We must learn to heighten our levels of percep-
9 sources described previously to help us renew our tion toward healthy activity. For example, in a music
10 strengths were creativity and a symbolic death-rebirth. If therapy session, the therapist should use as many heal-
11 we consider everything to be musical, music, or music ing agents as possible and encourage clients to experi-
12 therapy, would play an intimate part in this renewal ence these influences to the depths of their experience
13 and transformation process. It is up to each of us to so that they can receive and maintain the benefits. A
14 identify the specific musical qualities contained within music therapy session that taps into the mythic artery is
15 ourselves and our environment to accomplish this task. a gestalt. There is no separating the complex aspects of
16 This would include our thoughts, our images, sit- the event or monitoring which stimulant has which ef-
17 uations and environment, and our history. This process fect. In most cases the effects are not immediately per-
18 of identifying and using music provides a unification ceptible in behavior change, but rather constitute a
19 and a connecting, in the healing sense described earlier deeper, soul-searching initiation for change which may
20 by Bateson. We search, anticipate, appreciate, and only become visible in the long-term results. It is a
21 bathe our consciousness in connections. In this way we move to encourage creativity and resourcefulness in
22 do not necessarily eliminate suffering, pain, disease, the truest sense, that is, finding strength where there
23 misunderstanding, but rather we come to accept these appears to be none and re-sourcing oneself or touching
24 things as part of the ongoing process of life and try to one’s source again.
25 find creative solutions whenever possible. It is the job of the music therapist to provide some
26 The mythic artery is an image, a way of thinking ritual that will allow the participants to accept the ex-
27 about music, which will aid us in our search for health. perience on a high and deep level of sense perception.
28 The mythic artery is liquid. It is vibrating. It is full of The symbol or image or metaphor of the mythic artery
29 life-giving nutrients and chemicals. It quenches our need not be a conscious one for the participants. In
30 thirst. It goes to and comes from the heart. It travels fact, it does not necessarily have to be a conscious in-
31 through all of time and contains the wisdom of the fluence on the therapist. “The mythic artery” is merely
32 ages. It restores. It recreates and cleanses. It brings us to the naming of a process that happens anyway, whether
33 the community and life as a whole. It gives us power, we care to acknowledge it or not.
34 strength, and humility. It is a stream that winds back In my work with psychiatric patients, I found that
35 through all the ages to the essence of our beginnings — many of these participants would tap themselves into
36 our first heart beat, the first story of our existence. It al- the musical mythical artery. It only took the smallest
37 lows us to be part of the whole and yet unique within amount of resourcefulness on their part. Patients actu-
38 the traveling undulations of time. It recycles. It purifies. ally came up with the mythic transformative themes on
39 It transforms. This is the music of life. their own. The therapist only brought the music and a
40 This is the true meaning of the expression that supportive atmosphere. The techniques themselves var-
41 music is a universal language. Although many techni- ied extensively. The message contained in this insight,
42 cians of music criticize the use of this expression and for me, was that the human animal, though we are
43 prefer the theory that music is not universal because it young, has a heritage of survival. The sickest person
44 is culturally derived, the notion that the whole of mu- may find this heritage and use it as a source of renewal,
45 sic unites us would be a feasible interpretation of the if merely guided into the right direction.
46 mythic artery and a universal language. Although we consider ourselves to be a highly
47 Music stimulates our senses. And our senses per- developed and sophisticated culture, our ancestors in
48 meate our whole being. It is very difficult to separate all time experienced many of our same basic tendencies.
49 S the different ways in which music stimulates us. Re- This is a fact to be used rather than discarded. In many
50 R searchers have attempted to isolate the variables to pre- ways we are the same as the Homo Erectus or the Aus-
a mythic journey 31
tralopithecines who roamed the savannahs searching could say it, he wouldn’t be singing it.” I thought about 1
for sustenance. We have flood, famine, illness, war, sur- that comment for a long time, and it helped me to have 2
vival. Myth is a connection to our past and our future. more respect for silence. 3
In ancient times, myths served as a stabilizer Of course it meant what it meant, and he had al- 4
within the culture, a sign that all things would pass and ready told me what it meant by singing and drumming. 5
return again with different names, a connection to the His music was a symbolic representation of some aspect 6
past, a hope for the future. Myths told stories which of his experience — pure and simple. It was also self- 7
balanced constancy and adaptability. The constancy contained and complete. 8
was represented by the presence of indigenous cultural It had already gone beyond words. It was an ex- 9
conventions, reference to history, and the gods. Adapt- pression of clarity and communication. Everyone in the 10
ability was represented by new situations — a scary group had been moved. I had been moved. He said it 11
journey, new and unfamiliar characters, a challenge in had made him feel better. What better occasion for cel- 12
some task that seemed impossible, but was undertaken ebration in silence? 13
nevertheless. At the core of mythic events was trans- We paint sound pictures in music: My life is like 14
formation. The heroes would return or die, but always this music, or my music is like a journey, or the sunrise is 15
transformed in body add/or spirit, endowed with new the music, or my music is my fear. We objectify our feel- 16
gifts. An entire people would begin life again, but in a ings, our situations. In this way they are expressed, which 17
new land, becoming transformed within their new en- is one large step toward healing, and they are shared, 18
vironment. With transformation, a type of death and which is a second large step toward healing. This can 19
rebirth are always implied. For this is the process of take place through playing a classical or jazz piece, Spon- 20
adaptability and change. taneous music or allowing a recorded piece to travel 21
Music carries messages that speak of our intimate through to create our expression in poem, paint, or clay. 22
involvement in the human condition and connects us The technique does not make a lot of difference. 23
to the historical stream of human existence and all of Expressing, then proceeding on to balance is a 24
nature. For music is the expression that focuses on the healing thing in itself. Much pain and disease could be 25
continuity of life. This is the mythic artery. prevented if we could only find adequate ways of 26
expressing ourselves. Obviously, words have limita- 27
Music as Metaphor and Symbol tion and do not always do the job. We are reminded of 28
Music as an expression functions as a metaphor and the saying “Music begins where words leave off.” All 29
symbol of our experience. It captures and focuses on a the arts provide these necessary resources for expres- 30
certain feeling, a particular situation or a relationship sion. Throughout history most cultures have maintained 31
and proceeds to describe these things in pure sound rituals and ceremonies that provide opportunities for 32
without the interference of word symbols that must expressing and sharing their deepest thoughts, feel- 33
travel through complex intellectual pathways. I was ings, and beliefs through ritual forms. We have lost 34
once put in my place by a patient who understood this most of these communal opportunities. Although 35
far better than myself. there are pockets of expressive ritual left in some com- 36
I often struggle with the inclination to bridge a munities, these are usually exclusive societies or 37
music therapy activity at the end through discussion, churches and do not extend to the needs of humanity 38
back to everyday life. Since each session is a journey into in general. 39
alternatives, I always feel I owe it to the patients to help When we use the arts to create metaphors and 40
them back through a transition and closure time, which symbols of our experience, we make an artifact or music 41
usually takes the form of “talking” about how we feel. that serves three main healing functions: 42
Once I was questioning a patient about what his 43
chant and drumbeat had meant. Like any good thera- 1) Works of art and music usually focus on 44
pist, I found different ways of asking the question. I first one outstanding theme or message. 45
asked directly what it meant. He said he didn’t know. It This differs from our usual inclination 46
just felt good to have done it. Then I probed a little when we are in a state of need, that is, 47
deeper: “Can’t you just give us a few words to describe bombarded by mixed emotions, confused, 48
how it felt, what it means to you now?” Then from the indecisive. A piece of music focuses on pain, S 49
group another patient called out to me, “Lady, if he joy, anger, peace, frustration, satisfaction, R 50
1 confusion, clarity, at any given time, and We see that we are connected. The
2 usually develops that theme for awhile. It processes of life, of nature, the situations,
3 also dramatizes the qualities of the one ex- the patterns, the shapes, textures, colors,
4 perience or feelings for intensification. This sounds of life are shared without restrictions
5 gives the person a chance to deal with one of time or space. We see also that appreciat-
6 emotion at a time and to feel the full depth ing these connections is a health-creating
7 of that emotion, rather than vacillating si- and health-maintaining activity. Music is a
8 multaneously from one to another. celebration of these connections.
9 Very few people allow themselves this
10 2) An artistic expression is an objectification. expressive privilege. Yet in the end, expres-
11 By participating in musical activities (and sive metaphor, symbol, and medicine are
12 this includes listening, since we know our equally essential to the health of man.
13 being is moved on every level, even in
14 what may seem like stillness), we symboli- Music as Tension and Resolution
15 cally experience situations other than the Since the process of tension and resolution symbolizes
16 one in which we presently find ourselves. death-rebirth and since death-rebirth represents change,
17 Since music is an expression of the beliefs, just as music is change, a great deal of our discussion
18 feelings, and attitudes of the times, when of the structure of music will consider the tension-
19 we hear music, in some significant way these resolution processes as reflected in music.
20 beliefs, feelings, and attitudes are passed on The relationship between the Death-Rebirth
21 to us. They therefore represent alternatives. Myth and tension-resolution in music is one of reflec-
22 In this passage the patient/client “hears” new tion. The music reflects the myth, and vice versa. In
23 ideas for solutions, experiences new feelings, practical terms, the music serves as a vehicle for the
24 is reassured by “sounds” which complement myth, placing the myth in time and space by providing
25 and re-affirm his or her own feelings. it with a living, symbolic form. This can happen
26 In Baroque music we are reassured about through the structure of the music. Music expresses the
27 order and return. In the music of Bach, we myth by making it available through sense perception.
28 learn that the same theme can have many In a way it solidifies myth and gives it a workable form.
29 variations without destroying the integrity In this way myth travels to us through music.
30 of the original theme. In the music of the One of the basic considerations in musical com-
31 Shakuhachi, we float and drift through gar- position is the concept of tension and resolution. Most
32 dens and streams and experience the cool- musical compositions contain the process of tension
33 ness of water, the scampering of tiny birds. and resolution within all the elements. One or several
34 We are inspired to ask: Is that me? Is that of the components of the piece “build up” to a climax
35 the depth of my love? In this way, one ap- point, then resolve. This is also the pattern taken by
36 preciates what should be retained and ex- many life situations. We experience a type of transfor-
37 amines ways of changing any negative or mation through a peak experience or feeling. This life
38 destructive influence. To hear one’s own movement can be applied to any number of circum-
39 improvised music played back on tape, or stances. Each day can be considered a series of transfor-
40 receive the reaction of a group audience mations through our various activities, or as the many
41 can often be a surprise and shock. Secrets overlapping motifs in some musical piece. One’s entire
42 come through the music that may never life might have one major transformation. Or both of
43 have been expressed before. these circumstances may happen simultaneously. There
44 may be many peaks, climaxes, or transformations within
45 3) Of course, the third healing benefit is to one life.
46 find out that you are not alone. You are not The idea that a type of giving over and loss must oc-
47 isolated from the ongoing processes of life. cur in order for change or growth to be accomplished
48 Others share the same fears and throughout constitutes the connection to myth. The musical symbol
49 S time have experienced the same myths. serves as an example of regeneration, renewal, building,
50 R This is the healing benefit of connections. and transformation. It does not deny the passion inherent
a mythic journey 33
no need to sacrifice our rich Western musical tradition 1

in search of myth. 2
Levi-Strauss’ example of this lack of intention is 3
Ravel and his classic “Bolero,” a repetitious building of 4
tensions and resolutions. It is known that Ravel never 5
took the piece seriously, considered it “empty of music” 6
and was extremely surprised at its popularity. This 7
brings up the possibility of myth traveling through 8
composers without their knowledge. Myths can be re- 9
flected in music without intent on the part of the com- 10
poser. The structure and patterns of the music are 11
Figure 2: Example from Chopin’s E minor prelude available to communicate myth whether program mu- 12
sic or not. Although Levi-Strauss does not discuss this 13
in these encounters. Rather, it acknowledges the tensions possibility, he considers the relationship between music 14
of pain, anger, hate, melancholy, confusion, frustration, and myth one of analogy within their common struc- 15
hurt, despair and the resolution of joy, love, fulfillment, tural patterning. He is interested in the pattern-forming 16
clarity, hope. Musical encounters allow the passion or feeling nature of the mind. Patterning again becomes an im- 17
to become externalized, therefore providing form. portant consideration. 18
One initial example will illustrate. A composer 19
who clearly manifests the death-rebirth myth through Music as Patterns 20
musical tension and resolution is Chopin, especially in . . . the first step in explaining the meaning 21
his etudes and preludes. His Prelude in E Minor proof musical patterns is the fact that they are 22
vides a simple example. The tension-resolution process translated in the brain into general lingua 23
in melody builds and resolves once in the prelude. The franca of all other patterns — mental pat- 24
music builds to one point of transformation, one cli- terns such as grief, expectation, fear, desire 25
max, in which death and rebirth occur in the same mo- and so forth, and bodily patterns such as 26
ment. The movement changes from moving away from hunger, pain, retention, sexual excitement, 27
the tonal focus to a point that leads toward tonic. any of the tensions associated with a raising 28
At the point of transformation, one chord, or one of the adrenalin level in the blood — and 29
moment in time and space, there is a resolution of the the corresponding resolutions — allow us to 30
tension produced by the previous 15 measures. see the similarities between the musical pat- 31
Levi-Strauss discusses the relationship between terns and those more personal ones which 32
music and myth. He states: “Music and myth are both form the constant undercurrent of our 33
structural and untranslatable. Each holds a basic di- thought (McLaughlin, 1970, p. 87.) 34
chotomy. They also hold themes and counter themes 35
which can be changed into an infinite variety.” Patterns of tension-resolution, melodic and 36
The point made by Levi-Strauss in reference to the rhythmic motifs and themes, repetitions, composi- 37
dichotomies existing in music and myth are particularly tional forms, and dynamics all combine to weave com- 38
relevant to the death-rebirth myth. Music and myth both plex patterns in sound. Pitch, time, and volume are 39
acknowledge and accept paradox. The point of transfor- the key modes that utilize and communicate tension- 40
mation in Chopin’s E minor prelude represents both resolution patterns. Within these three modes we ex- 41
death and rebirth in the same chord, moment, or space. perience the elements of music: melody, harmony, 42
Both exist together and become one another. For at the rhythm, meter, timbre, dynamics, and texture. In a mu- 43
moment of rebirth, another death has in fact begun. sical composition these modes often inter-relate, set- 44
These mythical, musical patterns often manifest ting up complex crossings of patterns. 45
themselves despite the avowed intention of the com- The appreciation of patterns is an aesthetic expe- 46
poser. The death-rebirth myth is contained in a Bach rience, even though people may not be aware of the 47
Fugue, the simplicity of a Gregorian chant, the com- theory and concepts of musical composition, they nev- 48
plexity of a Beethoven Sonata, and the primitive life ertheless do experience the feeling of patterns in the S 49
force trance of Mick Jagger’s “Brown Sugar.” There is music. The musical patterning establishes a connection R 50
1 and relevance to their being through common patterns. indigenous music. Although rattles, shakers, and other
2 In other words, as a person hears musical patterns he percussive sounds may be added with various pitch dif-
3 identifies or associates with the patterns, whether con- ferentiation, several drums provide either a drone effect
4 sciously or unconsciously, which share a common theme or repetitive rhythmic patterns. Often chants are added
5 or movement of his life or being. He hears cycles of giv- to these rhythmic patterns which serve to develop the
6 ing and taking, aggression and tenderness, a peak experi- ritual ceremonies. These chants also often have com-
7 ence and a period of rest. He hears pain and pleasure, loss plex patterns. However, the drum remains as the vital
8 and birth. The music may suggest pictures or concrete sit- carrier of the basic rhythmic message. The drum was
9 uations from the past or fantasies of the future. The over- invented by early man to communicate messages to fel-
10 all effect is: “I am the music” or “I am like the music,” or low humans beyond the distance range of normal,
11 at least that “Music is like a part of me.” So the music has everyday sound. The drum had two primary functions:
12 a deep connecting influence on man in that it expresses
13 and symbolizes patterns of the human condition. 1) It was an attempt to extend the sphere of
14 A pattern usually suggests a process. Here the communication for reasons of survival;
15 therapy goes into full action. As long as there is a con- 2) It was an attempt to connect men to fellow
16 necting pattern and process, there is hope. This pattern- men.
17 ing identification is an aesthetic perception and
18 experience. It is difficult to know when and where in All of the first instruments — primarily drums and
19 our society we lost our overall value for beauty. The horns — were used for these purposes. Music, when
20 concrete idea that beauty can bring healing, would be played on these most primitive instruments, expressed
21 considered useless — a frill, a token gesture — on the and communicated the most basic and primitive needs
22 back wards of most medical and psychiatric treatment of the early societies. This was the beginning of the
23 institutions. And yet the human animal longs for beauty Mythic Artery. We have, in fact, invented a musical tra-
24 as much as we long for life and breath. We need it as dition that began with the first chant, the first drum-
25 much as air, food, light, and shelter. If we are unable to beat, the first sound from a crude horn. In the evolution
26 experience beauty in concrete ways, we will surely die. of the thousands of musical traditions, which may be
27 The concept that human life is born to seek beauty considered indigenous cultural forms, we are all still
28 is a substantial ingredient to a healthy existence and connected across time and space to these primitive be-
29 goes beyond medical treatment. It is in a sense the step ginnings and all of our music contains these primitive
30 before and the step after. A great deal of illness, pain, beginnings despite the layers of development we have
31 and suffering can be both endured and fought if a deeper superimposed over the centuries. Although we may
32 meaning for this pain has been identified. A meaning, consider our music to be sophisticated and civilized, in
33 again, which goes beyond analytical and intellectual in- its essence it must retain this primitive core. For a tree
34 terpretations and which touches the whole human — does not disregard its core over the years, even though it
35 the soul of man — which is the representative of our receives layers of new growth. Rather, the core remains
36 body, mind, heart, psyche, emotions, hopes, and fears. as the center and the food route for the entire structure.
37 Patterns reach these depths. The patterns in music Within our culture we tend to think of our devel-
38 remind us of our connections to the whole of life. They opment in hierarchal terms. When we have achieved a
39 do not allow us to alienate ourselves. Furthermore, they new stage, we discard the previous stages, or at least
40 reassure us about the ongoing processes of life as a whole, consider the latest acquisition of greatest value. When
41 and the significance of each life within that whole. This a child becomes an adult, she must forget the childlike
42 aesthetic connecting constitutes a step toward meaning knowledge, for it is inferior. We often forget that our
43 in life — which is, after all, the only reason man wants beginnings are an integrated and vital part of our pres-
44 to live and subsequently endure any suffering at all. ent. We must constantly be aware of our primitive or
45 more basic needs and resources as we develop and re-
46 Music as Rhythm in Life fine our intellectual needs and resources.
47 Rhythm is one of the strongest components of music. A Through this channel we are connected to the
48 great deal of music is based solely on rhythmic con- first man who played the first drum. We are the first
49 S structs or perhaps one slight pitch variation with differ- drum player.
50 R ent sized drums. Rhythm is the central aspect of most This brings up the most controversial issue of mu-
a mythic journey 35
sical taste and “the Devil’s music.” Throughout the de- “Meditation” from Thais (Massenet) 1
velopment of music, from time to time a form will Air on a G String (Bach) 2
emerge which is considered to be “the Devil’s music.” “Intermezzo” from Cavalleria Rusticana 3
This has happened as early as the Renaissance and (Mascagni) 4
Baroque periods. It was one of the reasons for the estab- “The Swan” from Carnival of the Animals 5
lishment of the provisions of musica ficta, to protect (Saint Saens) 6
church music from evil influences. Prior to these peri- Andante Cantabile (Tchaikovsky) 7
ods, the Greeks and Romans had strict rules about “Panorama” from Sleeping Beauty 8
which modes were good and which were evil, which in- (Tchaikovsky) 9
struments were good and which were evil. The Chinese “Traumerei” from Scenes from Childhood 10
lute players fraternity had extremely rigid rules about (Schumann) 11
the when’s, where’s, and how’s of lute playing, even the Jewels of the Madonna (Wolf-Ferrqui) 12
who’s, in order to protect the player and the populace 13
from the lower instincts or evil influences. Dr. Morooka’s point was that these sounds form 14
Strauss, Beethoven, and hundreds of other inno- an intimate part of the unborn child’s world. He recom- 15
vative composers were accused of evil influences. Very mended that, if a baby is fussy and distraught, this 16
often these culprit influences were classified as the record would help to calm him. In his experiments, this 17
rhythmic elements. worked with 99% of the babies. 18
On the more contemporary modern scene, “the When I am listening to most disco music and dis- 19
Devil’s music” has been known to include jazz, soul, regard all the Hollywood, the lyrics, the hysteria, and 20
rock, blues, and, most recently, punk rock and disco. repetitious melodic forms, what comes to me as the 21
Most of these idioms contain the strong influences of strong, positive element of this music is the same 22
Black rhythmic pulse. Regardless of the multitude of rhythmic pulse as Bach’s Air in G, with more intensity. 23
harmonic and melodic structures which separate and Many people, including myself, have complained 24
classify these forms, when much of this music is stripped about the starving quality of popular music today. But 25
down to the rhythmic content, we hear the rhythmic the point remains that it is popular. It is a statement 26
pulse: Mick Jagger’s “Brown Sugar,” the Pointer Sisters’ from the culture, as music is an expression and reflec- 27
“How Long,” the voodoo music of Haiti, Art Blakey’s tion of the culture. Accepting it for this reason, we 28
“Tobi Ilu,” the music of the Sun Dance. It is most often must sincerely try to identify the value of the music 29
the main message of the music. And what is this impor- through its message. What is the music saying? What 30
tant message which travels through such a great variety does it mean? 31
of music across oceans and centuries? It is the beat. We The music is saying: Let the heart beat. This is all 32
must have the beat, the heartbeat. We must know the we have left — a heart beat, one massive mythic, rhyth- 33
pulse of life and experience it through dance, through mic stream which connects us vitally to life. And the 34
music, to reaffirm our own rhythmic existence from the beat goes on. Let us feel and experience this connec- 35
first drummer to ourselves. tion, these instincts, the beginnings. Let the juices flow. 36
Some time ago Dr. Hajime Murooka put together The beat of life must go on if we are to survive. 37
a record entitled “Lullaby from the Womb.” It was a What is the message of punk rock — an existen- 38
popular record, advertised in the windows of most pop tial vacuum and an important message. No transforma- 39
and rock record stores. Retailers had a hard time keep- tive vision for the future, but one solid statement: The 40
ing it on the shelf. heart continues to beat. This is all we have left. Reflect. 41
One side of the record was the actual sound of We are stripped down to our bare bones. All we have 42
what the unborn child hears in the mother’s womb left is a heartbeat. Can we not now build from a heart- 43
prior to birth — the sound of the main artery. The beat to accept and incorporate our primitive begin- 44
other side contained classical pieces, half of which were nings into the rituals of our lives — to celebrate and 45
superimposed over these natural sounds and then the dance the heartbeat? This is the life force of rhythm 46
same classical pieces with the same rhythmic meter, within the mythic artery. 47
without the sounds of the mother’s body. Rhythm and other time factors are realized through 48
The original pure sounds from the mother’s body sound, silence, duration, tension, and resolution. S 49
were strong, loud, and intense. The classical pieces were: R 50
1 The actual workings of the rhythmic patterns

2 Music as Time Tensions may be simple or complex. However, the basic pulse
3 Time tensions are realized through tempo and meter, concept remains. Regardless of the theoretical aspects
4 divisions of even duration. There is a universal ten- or complexity, the average person experiences the stim-
5 dency toward simple time units of two, three, and four ulation of rhythmic pulse. Regardless of our musical
6 steady beats across musical traditions. Any departure taste and preference, this rhythmic pulse, this life force,
7 from the normal pulse of the music comes as a point of endures as a valuable resource for the over-all health of
8 tension, e.g., when there are five, seven, or eleven beats man in his quest for survival.
9 in the bar, syncopated rhythm (where expected accent
10 is displaced) and cross-rhythm effects. The possibilities Music as Life Breath
11 for creation of tension become even more complicated We have forgotten how to breathe. Millions of West-
12 with the interplay between pitch and time. erners are learning how to breathe again through the
13 Another consideration in the creation of time practice of yoga — taking in the prana or life breath.
14 tension is the effect of rhythmic repetition in produc- Thousands more are learning to breathe in clinics of
15 tion of a trance state or altered state of consciousness. psycho-therapists through relaxation techniques. Even
16 The trance effect has been discussed by many, among in dance studios and books on running, athletes and
17 them George Leonard in The Silent Pulse and William dancers have to be reminded to breathe.
18 Johnston in Silent Music. The Chinese word ch’i is difficult to translate. It
19 The physical effects of music, associated to a great means vital breath, spirit, life. The Chinese say that in
20 extent with rhythmic tensions, have been documented order for a work of art or music to have value, it must
21 by many. Studies agree on the following conclusions on contain ch’i. Music, the mythic artery, brings us this vi-
22 the physiological effects of music: tal breath through the forms of melody and harmony.
23 We breathe in the tone and it brings us vital psychic re-
1) increase or decrease of metabolic rate;
24 sources that bring strength and cleanse as the prana, as
2) increase or decrease of muscular energy;
25 the ch’i. We need to breathe the music into our lungs,
3) acceleration or deceleration in breathing
26 into our blood stream, for health’s sake. Mozart’s “An-
and increase or decrease in its regularity;
27 dante Concerto No. 21 in C Major for Piano and
4) marked but variable effect on blood vol-
28 Orchestra,” Pachelbel’s “Canon,” the music of the
ume, pulse, and blood pressure;
29 Shachuhachi, the pure melody of Gregorian chants,
5) a lowering of the threshold for sensory
30 Oregon’s “Appear and Become,” John McLaughlin’s
stimulation of different modes.
31 “Goal’s Beyond” — these pieces of music flow into us as
32 The repetition of a rhythmic pattern can suggest air, bringing renewal and refreshment. They are a trans-
33 a type of transformation through a trance-like state. In fusion of fresh air. Whereas the rhythmic beat is solid,
34 other words, tension is created not so much through the melody and harmony undulate, cross, meet. They
35 deviation in regularity of beat, but rather through a are liquid. They vibrate in pitch variation. We soak up
36 contrast between a normal functioning state of con- their messages, patterns, tensions, resolutions, contrasts,
37 sciousness, experienced prior to adjustment to repeti- much as we absorb air and water.
38 tious rhythmic patterning, and different or altered state Pitch tensions include melody (intervallic ten-
39 of consciousness produced by that particular rhythmic sions and resolutions) and harmony (tonal tensions
40 pattern and its repetition. A person maintains a regular and resolutions). An intervallic tension represents the
41 or normal state of consciousness. Through experienc- distance between two or more consecutive notes. A
42 ing repetitious rhythmic patterning, one travels to and tonal tension represents the distance between two or
43 through an altered or transformed state of conscious- more notes played simultaneously. Both of these ten-
44 ness. At a certain point the music ends, the rhythmic, sions seek eventual resolution. In general, a tonal
45 trance-inducing stimulus is removed, and a person re- melody seeks a resolution of returning to the tonic
46 turns to the normal functioning state. This can consti- note, after building a series of “near” resolutions by re-
47 tute a death-rebirth or transformative experience. turning to other tones in the tonic chord, such as the
48 Musical examples of this type of rhythmic activity third or fifth. The tonal tensions seek some combina-
49 S are obvious in all of the forms mentioned above. Much tions of the tonic chord as a resolution. These pitch
50 R of this music combines rhythm for a syncopation effect. patterns are “archetypical patterns.” The series of unre-
a mythic journey 37
solved tensions are unconsummated until they do, in It is extremely difficult to disengage the complex 1
fact, resolve to tonic. Atonal music does not follow webs of musical patterning, and this task is better un- 2
these tendencies. However, quite often, atonal music dertaken by theoreticians, analysts, and musicologists. 3
does invent equally predictable rules that build tension However, for our purpose a small amount of analysis 4
and strive for resolution, e.g., Schoenberg’s tone row. will aid overall understanding of the joint functioning 5
A need for ultimate resolution builds as the false of myth and music. Perhaps the ability to extract the 6
resolutions to a third, or fifth, or other steps on a scale important pattern from a wealth of extraneous detail, 7
build more and more tension and anticipation. This to see the essentials of a situation stripped of superficial 8
may occur over the length of the entire piece, i.e., a differences, and to generalize from experiences is a key 9
melodic line would never return to the tonic until the to the whole coherency of our mental life. 10
end of a piece. Or it may occur in the form of repetition Musical elements of tension-resolution become 11
of motifs, phrases, or a rondo or bar form, i.e., a resolu- symbolic representations of some of the most basic life 12
tion to tonic comes many times. processes. They provide a reminder of our common and 13
An example of both intervallic tension-resolution profound collective condition. The processes of nature, 14
and tonal tension-resolution and the interplay between life, death, suffering, and release are remembered and 15
melody and harmony is illustrated in Yusef Lateef’s experienced symbolically within music. The music, as 16
“Lowland Lullaby.” It is a simple duet between flute and the vehicle to myth, also becomes the bridge between 17
bass. It provides slow melodic movement by the flute and the preventative and curative powers of myth and the 18
harmonic movement by bass, and each return separately concrete situations of life. 19
several times to tonic, but culminate in a tonal resolu- 20
tion with the flute and bass, both returning to tonic si- Music as Healing 21
multaneously. This is the point of transformation. Sufi Inayat tells us: 22
Volume tensions and resolutions are perhaps the 23
most obvious to hear. They take the form of dynamics, . . . health is a condition of perfect rhythm 24
timbre, and texture in a piece. Dynamics are mani- and tone. And what is music? Music is 25
fested in the p, pp, ppp, pppp (degrees of softness) and rhythm and tone. When the health is out of 26
the f, ff, fff, ffff (degrees of loudness), or crescendos and order, it means the music is out of order. In 27
diminuendos. A simplified example of how the tension all the occupations of life where beauty has 28
may build and resolve would be been the inspiration, where the divine wine 29
has been poured out, there is music (In 30
f, ff, fff, ffff, p, pp, ppp, pppp Khan, 1971, p. 2). 31
32
The 4f represents the point of transformation. This summarizes the Sufi philosophy regarding the heal- 33
The dynamics of a piece are rarely this simple, and, ing powers of music. Music is life and health, a reflec- 34
again, usually constitute a series of dynamic tensions tion of the grand scheme, divine itself. Many ancient 35
and releases. The more subtle effects of volume come cultures have used music as a healer. Certain processes 36
through the interpretation of timbre or color and tex- and qualities inherent in music have healing potential, 37
ture of a piece. These elements are often left to the dis- as we have seen. Beyond the organizational aspects of 38
cretion of the artist playing the piece. However, one music, there are more general considerations into the 39
piece that dramatically embodies the mythical, musical healing powers of music as used in music therapy. 40
forms in all their complexity and all their simplicity is The first is magic, or mystery, or perhaps the di- 41
Samuel Barber’s “Adagio for Strings,” which illustrates vine and spiritual aspect of music so often ignored in a 42
a beautiful interplay between pitch, time, and volume. clinical setting. The magical side of music comple- 43
It is a long piece that gradually builds in volume to one ments the clinical side. Unfortunately the words magic 44
intense peak with full strings in unison (adding the (in the anthropological sense), mystery, divine, and 45
pitch element, a change in direction toward tonic) in a spiritual do not get a positive response in clinical set- 46
full fortissimo. Barber strikingly employs a full rest after tings. However, there are other places within our cul- 47
this intense climax before savoring the resolution in de- ture where such concepts are accepted. The most 48
grees of softness. This piece communicates the death- obvious example is within a religious context. It’s ac- S 49
rebirth in the fullest sense. ceptable to hear voices, or speak in tongues in some R 50
1 situations. In other places, hearing voices or speaking artist,” a person removed and socially trained. In many
2 in tongues becomes a symptom and a sign for increase older cultures, leisure time was not a time for meaning-
3 of medication. To the Navaho, music is both a vehicle less activity. Leisure time was time given to aesthetic
4 to and a celebration of our divine collective nature. experiences such as playing or listening to music,
5 The Indian does not know that the magic of music will When native and traditional cultures made music,
6 bring healing, instead he trusts that it will. The cultural danced and costumed, they were usually performing rit-
7 difference emerges in the distinction between known uals necessary for the health and well-being of the com-
8 and unknown. munity, coming together to express their beliefs and
9 We find magic wherever the element of chance feelings about life. These activities were intimately tied
10 and accident and the emotional play between hope and to man’s search for meaning. The average Navaho male
11 fear have a wide and extensive range. We do not find spends 75% of his time in ceremonials and rituals. Our
12 magic whenever the pursuit is certain, reliable, and culture does not maintain these aesthetic values for the
13 well under the control of rational methods and techno- average man or the patient in the psychiatric ward, or
14 logical processes. Within our cultural context, one of the child with cerebral palsy. Many of our treatments
15 the vehicles for magic is religion and for science, ther- ignore the problem of man’s search for meaning, only
16 apy. This separation between religion and therapy has encouraging the return of alienation. These methods
17 taken us to our present unmagical state. Within the deal with changes on a superficial level, only what is
18 various therapeutic methodologies sanctioned by most seen, or can be observed by an outsider. Often behavior
19 of the medical community, magic is denied for the fol- is a reflection of one’s inner being. But it cannot be as-
20 lowing reasons: 1) it cannot be observed; 2) it often sumed that it is the total picture of man, or the only
21 cannot be analyzed or understood; 3) it often implies part that merits a response.
22 spiritual or psychic functioning levels; 4) it cannot be Aesthetics tends to be somewhat neglected. It’s dif-
23 defined; and 5) most important, it takes us to levels of ficult to define and resides largely in that gray right
24 depth for which there are no word symbols. No matter hemisphere. Aesthetic experiences are unique and per-
25 how elusive, it is still there. Music affects most people sonal. Aesthetics is interdisciplinary and crosses lines of
26 subjectively. It can also affect people objectively, but values, beliefs, personality qualities, perception skills, ed-
27 within the subjective reactions the magic is found. It ucation, and attitudes. But through aesthetic experience
28 conveys symbolic meanings that are difficult to de- it is possible for each man to find his own frame of refer-
29 scribe in verbal language and are intimately tied to our ence for the universe. Through valuing beauty, one can
30 emotions. In some ways, the symbolic meanings of mu- find ways of absorbing strength from the world in which
31 sic are similar to verbal language, but one difference is one lives. In a music therapy session, the tunes or expres-
32 the immediate power of music to move on an emo- sions may not always sound beautiful to a critic; how-
33 tional level. It directly affects our feelings, those human ever, the music therapist hears these expressions as
34 reactions which reside in the subjective parts of our be- profound representations of human experience. Through
35 ing, perhaps part of right brain hemisphere activity. the profundity comes beauty; an artist’s symbolization
36 A second characteristic often neglected is the through sound of the basic elements which make up life
37 aesthetic nature of musical experience. Music fulfills experience — pain, sorrow, joy, sadness, loss, rebirth. If
38 man’s need for beauty, and can satisfy his search for accepted with this attitude, such primitive expressions
39 meaning in the world. Many administrators, doctors, can form the foundation for a positive attitude toward
40 teachers, nurses, therapists, and some music therapists life for a person disabled in any way. The client and ther-
41 do not realize that aesthetic experience can have a pre- apist work together to create and experience beauty.
42 ventative and curative effect. They do not value the They find symbolic forms, patterns, shapes, and textures
43 use of arts in therapy. Sometimes they have not been in improvised music that convey significant meanings.
44 encouraged by society to develop their own artistic They hear healing themes in recorded pieces that trans-
45 drives. Occasionally, they may pursue artistic endeavors fer to life outside the music therapy session.
46 in their private lives, but classify art as play and therapy The third healing consideration in music therapy
47 as work, therefore leaving out this important vehicle sessions is the natural ability of music to provide experi-
48 for healing. One of the basic premises for the music ences in the creative processes. As mentioned earlier,
49 S therapist is that everyone is an artist, but society dic- Jung considered creativity to be one of our most basic
50 R tates that the living, working stuff of art is for “the instincts. It can be implied from his theory that we not
a mythic journey 39
only have the potential to develop creativity in some Ritual relates to the realities which are built 1
area, to some degree, but also that everyone has a drive around it, and which continue in their processes after 2
to be creative which must be satisfied. This drive can the completion of a ritual performance. Of course, this 3
create products beneficial both to the individual and to is the intended result of a music therapy session, that 4
society if the proper channels are discovered. If the cre- through symbolic associations and performance of some 5
ative instinct is not used or properly channeled, it can type, clients will become transformed not only within 6
have a harmful effect on both. Even though music may the context of the ritual or session, but within situations 7
not be the natural vehicle for everyone’s creativity, it in their lives as well. 8
can be an experimental ground in which to try out cre- Another important point made by Kapferer is 9
ative processes and apply them through a powerful that the transformation of a context must involve a 10
medium. Creative processes can be applied to anything. transformation of its constituent elements. This is ef- 11
The music therapist offers opportunities for a person fected by these elements being related in ways different 12
to try alternatives in problem solving, have corrective from their relation in a context in which they were pre- 13
experience in communication, and learn about new viously constituted. In terms of a music therapy session, 14
sources of regeneration and enrichment and develop this may mean a rearrangement of constituents, an ad- 15
new skills. The music therapist combines resources for dition or subtraction of constituents, changing the 16
maximum benefit to all, or in other words, creates the quality of certain elements. The ritual provides a differ- 17
most beautiful artwork. All participants engage in a jour- ent perspective as well as new information. The key 18
ney to discover the right sound quality, shape, or color to this simultaneous or contingent transformation is 19
that describes and symbolizes an important part of the found in objectification of problems, or illness, or even 20
beings in the session and that other kinds of symbols more specifically an externalization. Problems or illness 21
cannot adequately describe and communicate. The good receive a concrete form through performance. 22
therapist leaves adequate space and time for the clients This idea of transformation of context through 23
to fulfill their own creative process as part of the cre- the power of ritual relates directly to the mythical, mu- 24
ation. Many therapists and methods presume they have sical framework, since the death-rebirth myth rests at 25
all the knowledge about where and how a person must the base of transformation. 26
be healed. Many forms of therapy dictate exactly the way As a ritualist the music therapist must develop re- 27
a person must alter behavior, attitude, and mood to con- spect for both convention and spontaneity. The ritual 28
form with the culture. Within creativity there is a way provides a basic structure that should be specific, reas- 29
to adapt to the culture and express one’s uniqueness, if suring, and supportive, but not inhibitive to the indi- 30
clients have a safe place in which to experiment. The vidual needs of the participants. The human spirit at 31
Mythic Artery provides such a place. its most basic level desires to be healed. A person will 32
If music provides a vehicle for the myth, ritual identify with the healing elements of music and ritual 33
creates a context for any subsequent mythical, musical and venture toward growth and transformation. Music 34
event. At its most basic level ritual is defined as a pre- is only a reflection of man himself. In this sense music 35
scribed form or method for the performance of religious will not violate the impulses of man but provide instead 36
or solemn ceremony. From the tone of this definition a framework from which to make choices. 37
we can assume that ritual would be a serious and mean- 38
ingful event. The ritual performance relates strongly to the practice of musical ritual 39
the cultural and social context, which in fact would be 40
the object of a music therapy session. Ritual without One of the original purposes of ritual in ancient civi- 41
carryover into the practical concerns of day-to-day life lization was to order the life of the community in har- 42
would hold little meaning. mony with the forces of nature. We presently need this 43
type of ritual in our daily lives. Ritual reminds us of our 44
. . . many rituals derive their power to trans- place in the order of all things. Music reminds us. The 45
form identities and contexts of action and four elements in ritual and music that encourage har- 46
meaning, which are located in the mundane monic insight are: 1) patterns, 2) processes, 3) images, 47
order of everyday life, through effecting and 4) symbols. 48
transformations within the organization of Patterns, processes, and symbols have all been dis- S 49
their performance (Kapferer, 1979, p. 3). cussed in relation to music and myth. Images provide R 50
1 another necessary link in this healing journey. Images dream. For it should end in knowledge, corrective ex-
2 come to us to suggest processes and patterns. Images be- perience, and insight, thus change and transformation.
3 come symbols. Therefore the materials of music therapy
4 take on a significance. It is important to use materials Music and Sand
5 that will inspire and create meaningful images. Sand complements the music. It can be warm or cold,
6 It is also important, especially in groups or in the solid or liquid. It takes on form with water and human
7 first stages of individual work, to employ a great variety hands. It is the earth and the touching of the earth heals.
8 of materials, to encourage a variety of images. The qual- Sand is malleable. It also carries the mythical messages
9 ity of materials is extremely important. For example, it through thousands of journeys in sand paintings and
10 is better to have fewer instruments of better quality, deserts of windblown dunes. It contains the smell of the
11 fewer paints of richer tone, than a large number of poor sea and washes into the shore, yet does not resist when
12 quality tools. water calls it back. Sand is timeless and forever.
13 The idea of “image” itself must be expanded to in-
14 clude more than visual image. A sound image may be The Ritual Participants were asked to: “Breathe deeply.
15 equally important. Experience the quiet. Relax. Let yourself find a feeling
16 Although music used alone is powerful, it can be of nothingness in the quiet. When the music begins,
17 even more effective with the addition of one or more play with the dry sand. Think of the music as coming
18 other arts. This combination merely increases the pos- into the sand through your hands.”
19 sibilities for expression. In groups, such a combination The music was “Hergest Ridge,” by Mike Oldfield
20 offers a wider choice of resources. (21 minutes). After the music was over, participants
21 In some cases recorded music suggests use of a par- were asked to complete their sand sculptures and come
22 ticular medium. For example, some pieces suggest color together in a circle for discussion. One person would
23 and painting, some movement, some poetry or writing. describe his sculpture and each, in turn, selected an-
24 To work with this musical suggestion gives the entire other person to do the same. Each participant was
25 ritual a solid balance. The music therapist may use the given as much time as needed to describe the work. If
26 same piece of music two or three times in one session, someone could not find words to describe a sculpture,
27 once to movement, once to poetry, once with clay. she was not persuaded to do so.
28 Some people experience synaesthesia, or perceiv- Some of the verbal responses one week later were:
29 ing in several sensory modes simultaneously. For example,
30 a person may hear a C-chord and see red, and have an exploration
31 accompanying smell as well. Synaesthesia may be a playfulness
32 multi-mode that is possible for more people. This type movement
33 of integration can be useful if given the variety of mate- floating
34 rials needed to express multi-dimensional perceptions. building
35 In working with groups of individuals on a long- fun
36 term basis, the use of various art materials may help to secret
37 develop imagination in cycles of sessions that may end mysticism
38 with a session in musical improvisation. Some people traveling
39 claim they do not have an imagination. Of course, pain
40 everyone has an imagination. It is just a matter of de- space
41 veloping and using it for health. The textures and col- openness
42 ors of our materials can aid in this development. the onset of genesis
43 The following descriptions are examples of music strength
44 therapy that have been done with patients and music connections
45 therapy students. Each session was a journey — a myth- moving up
46 ical, musical ritual which employed the arts to describe melting
47 the patterns, processes, and symbols of the healing jour- joyous
48 neys of many people. Every music therapy session is a security
49 S journey, whether it be an initiation, a vision quest, a comfort
50 R
a mythic journey 41
trust The suggestion of the music traveling through oneself 1

permission to explore to the sand was so that one could lose oneself in order 2
develop and change to find oneself. 3
lightness The music contained many overlapping motifs of 4
unobtrusiveness tension and resolution. The sand represented nature. 5
Instructions were simple, and given in a spirit and form 6
Other extended responses were as follows: of ritual, with respect for the materials and the silence 7
of beginning. 8
a) It was a total experience — sand and music 9
creation. It was positive and energy-giving. Music and Shadow 10
The experience of building parts of me in the Shadow responds to music. It is the secret side, the 11
sand has stayed with me and brought some quiet, hidden side. It can be the dark side we mask so 12
“hidden” parts of me closer to the surface. easily — evil, fear, sorrow, pain. It can also be hidden 13
b) My words for my sand piece were: Paths joy and exuberance. It is self but not self an intermedi- 14
coming from different places converging ary puppet, with whom to play for a while. It is clear — 15
together to go up the mountain peak. A no features, only black against white. It brings clarity. It 16
cave to shelter in and holes to hide in, is magic. It cries. It touches another without touching 17
from life, but a path leading out to the flesh, as a symbol of encounter. It teases. It can fight 18
mountain. when we cannot. It cannot hide the dance within us. It 19
c) The feeling evoked by the sand — the is quiet, but speaks of “other” things than words. It is a 20
touch of its coolness, the memories child who never played, a baby who was never rocked. 21
consciously and unconsciously were called It is death and birth. It is larger than life, smaller than a 22
up through that touch to play a big part in seed. Without the shadow, there is no light. 23
the experience. They helped to lead into 24
myself — to forget and find myself. The Ritual — We combined shadow dancing with musi- 25
d) The sand! I have never felt so drawn to cal improvisation. A large theatrical spotlight was re- 26
and connected with any other material to flected onto a blank, white wall. All other lights were 27
date. It was all consuming. The music was turned off. A variety of musical instruments were set up 28
both incidental and yet fundamental to my in an orchestra form. Instruments included timpani, 29
experience. Incidental because I was already bass drum, bongos, two pianos, bell tree, gong, flutes, 30
one with the sand; fundamental, as I was cello, string bass, violin, silver flute, guitar, and tam- 31
aware of some aspects of it (e.g., floating bourine. Participants were also encouraged to use their 32
sequence), which directly influenced the voices in musical improvisation. Instructions were as 33
way I interacted with the sand. follows: 34
e) My sand sculpture was “Intermingling, “Form two groups. Those who feel like being alone, 35
Boundaries, the Sea.” and those who feel like being together. Those of you who 36
f) My piece was “Mountains and Valleys.” are ‘together-feeling’ form groups of pairs, threes, or 37
larger among yourselves. Today we work with the 38
Explanation of the Ritual It is obvious that the sand be- shadow. Become aware of your shadow side — perhaps 39
came a powerful vehicle for most participants. In this the dark side or secret side of yourself — whatever 40
particular session, the music was intended to be a subtle, ‘shadow’ suggests. Each person or group will have a turn 41
shaping influence that people could travel through, but creating a shadow dance. Start from a state of stillness 42
which would not inhibit any unique interpretations or or nothingness. Select a person or persons from the 43
forms that might emerge outside the musical sugges- group to improvise to your dancing. If you wish you 44
tion. It was meant to create a dream-like effect. The ex- may tell them which instruments to play. Instrumental- 45
perience was intended to be a solitary, introspective ists follow the dance or dancers, reflecting their move- 46
task, but with time left for discussion and sharing. ment in your music. If you need more of a musical 47
The suggestion of “nothingness” was intended to direction, think of making an ‘undulating’ sound.” 48
inspire a sort of temporary death in order to find life. Each shadow dance and improvisation was S 49
R 50
1 discussed by the performers immediately after the piece h) The polarities of sound produced by flute/
2 was completed. Group members were encouraged to tone bass and guitar/bongos. The long
3 share feelings of what it meant for them. breath of the flute inspired me, calmed
4 Some of the responses a week later: me, opened me. The bongos instigated
5 movement — agitation and direction.
6 mystery i) Perfection otherwise because it did not
7 chaos disturb my flow.
8 wind j) It was a stretching feeling, the interaction
9 joy between the music and my shadow, urging
10 struggling growth, building.
11 expanded
12 no contact Other extended responses were:
13 aggression
14 invitation a) I felt I could let loose and be supported by
15 present but withheld the music.
16 spooky b) I found this to be extremely powerful activity
17 togetherness and the things which happened were
18 playful meaningful. Playing for others to move also
19 death-rebirth had a great deal of meaning for me which
20 testing was extra to my own moving. It was not an
21 freedom easy activity for me to do, but was benefi-
22 peace cial. At one point, I almost didn’t complete
23 distance the activity, but am glad I decided to do so,
24 love and finished for myself. I felt a lot of support
25 the music was me from the music in that I trusted people
26 a struggle between two parts of myself playing for me and heard their support.
27 it simultaneously enveloped me and was c) My regret with this activity is that I did not
28 absorbed by me find a way to complete my encounter with
29 Responses to the question: Which instruments my own shadow. I was very aware, however,
30 inspired you? of how exhilarating and complete it was for
31 many other people, and feel excited at the
32 a) Spooky voices and cello. prospect of using it in my practicum with
33 b) The music supported me and allowed me to adolescents.
34 throw away things. d) This activity was one of the most exciting I
35 c) The tensions and releases in the music have ever taken part in. I have never given
36 affected me along with the silences and myself over to movement and music in
37 breaks. The instruments very much such a free way, in my life — a truly
38 matched my mood and feelings. I felt as treasured moment.
39 one with the music. e) The dance between myself and my partner
40 d) The gentleness and warmth in the flute merged together. I was more aware of the
41 sound, cello and bass. shadows than the music. Sometimes the
42 e) Beginning and exploring sounds, of flute, music was more inhibiting than calling out
43 dancing and twirling of percussion. I felt and I seemed to be working against it.
44 the driving energy of the congo right f) I would like to have danced alone in
45 through me. The music was for me and in retrospect, in relation to my own shadow. It
46 me at the same time — my body became seems to require some guts to look at
47 one with it. yourself so directly.
48 f) I was struck by a sense of support. g) Words from the dance: sorrow, covering,
49 S g) An interflow between dancers and musicians. need, forgiveness, strength.
50 R
a mythic journey 43
h) The most powerful for me was the oneness soul dances to the beat and breath of life, if we see and 1
with the music. hear the dance. Watch the tree. The stillness comes to 2
i) I chose the people to play and directed remind us of motion. 3
them to the instruments that expressed 4
what I had to say at that moment It was a The Ritual This session combined poetry and group 5
complete and total expression, with the movement with prerecorded music. Group members 6
music and my shadow as one. participated in a warm-up in which they were encircled 7
by a large material rope. They moved as a unit to some 8
Explanation of the Ritual It was hoped that through the of the lighter, quicker Chopin etudes. Then the lights 9
shadow and music, people would experience a symbolic were dimmed. This activity was used both as a warm-up 10
or metaphoric death-rebirth, which they could identify and to provide a playful give and take task. Instructions 11
with some specific situation or personality characteris- for the main activity were as follows: 12
tic. This activity encouraged a group or person-to- “Form a circle on the floor, head to the inside, 13
person interchange. each person in the curling leaf position, but holding 14
The musical improvisation added a new dimen- hands with those on either side. Relax. Take even, nor- 15
sion to the sessions. Whereas a recorded piece selected mal breaths. Empty your mind of all thoughts. Find a 16
by the leader for its strong suggestion of death-rebirth feeling of stillness or nothingness. Imagine yourselves 17
in a sense guides the results, the musical improvisation as one seed under the ground, if you wish. Only be 18
provides more freedom. The two key words in the in- aware of the warmth in the hands on either side. When 19
structions that suggested the death-rebirth direction the music begins, think of it as coming along the floor 20
were: 1) to the dancers, to find a state of “nothingness;” and into your body as nourishment. Let the music 21
2) to the instrumentalists, let your music “undulate.” move you, only when you are ready and as slowly as you 22
This new dimension is reflected in the comments, so wish, in your own time. Keep your eyes closed and con- 23
that thematic content reflected greater variety. The tinue to hold hands with the people on either side.” 24
musical improvisation also added a feeling of closeness During the movement, people were encouraged 25
between shadow dancers and instrumentalists. It also to move in their own time, slowly, gradually. They 26
provided a feeling of respect, nurturing, sharing, under- moved as one unit, some “growing” slower, some more 27
standing, and mutually creating. quickly. Chopin’s Etude in A flat major was played 28
Several participants mentioned dealing with a three consecutive times. After the third time, a brief 29
split in their personalities. Some mentioned coming period of silence and stillness followed. Then partici- 30
face to face with dark personality characteristics, which pants were asked to come to a sitting position in the 31
they feel resistant to change. In a sense, they engaged circle when they were ready. Each person was given pa- 32
in a confrontation with some shadowy side. Again we per and colored pen of their choice. The etude was 33
see that something must be lost, or greatly transformed, played again twice and people were asked to try to cap- 34
in order for new growth to occur. ture their feelings in poetic form — either in connec- 35
tion with previous movement or from the new 36
Music and Movement listening. 37
Music is movement and movement, music. Music sug- Members were then asked to share their poems 38
gests motion and through motion, growth and change. or any other feelings about the activity. The activity 39
It is an action that comes to one, rather than a forcing. seemed incomplete for some; so participants were 40
It is a sort of passive action. This is the motion between paired for more movement. The two criteria for pairing 41
music and movement and man. This mythic motive were: 42
was one of the first movements of man, not a frill, but a 43
utilitarian gesture. How can we live if we do not dance? 1) People who shared a common feeling 44
We dance the rain in times of drought. We dance pain would have a time free from the restriction 45
and birth. We dance our brothers and sisters, the ani- of group movement. 46
mals and trees and we are One. Life is Motion. A new- 2) People who would strike a balance — they 47
born dances to the beat of his own heart and develops would learn from each other through their 48
tiny muscles and touches the world. Every body and different qualities. S 49
R 50
1 Participants were asked to sit on the floor back to meaningful and fulfilling to experience the
2 back with arms joined as a starting position. Again they sensation of balance and oneness with the
3 moved to the Chopin Etude in A flat. music, my partner and myself. My body felt
4 A week later, the following responses were men- bigger, extended.
5 tioned: f) I like the idea of moving together, in a
6 circle — the suggestion to keep in touch
7 growing with others all the time restricted me. On
8 flight and flying the other hand, it is a life situation that
9 rising and falling occurs often.
10 calmness g) The activity seemed disjointed — in sense
11 lightness and solidarity of connection with each other and
12 death-rebirth experience of music. My paired movement,
13 relaxation on the other hand, was a very pleasurable
14 love experience. I think the writing enabled me
15 lifting and falling to leave a past experience clearly.
16 crescendos h) The more I am successful in experiencing
17 building these sessions with a deeper, preverbal
18 introspective consciousness, the more difficult I find it is
19 color in music to call it up and back to the surface, linear
20 spaciousness allowed for high sensitivity thought. I feel contented for the most part
21 circles in repetition with a strong to let the experience root deep and take its
22 directional undercurrent time coming up.
23 connected and alone at the same time
24 the quiet ending soothed me Explanation of the Ritual Many people were able to
25 contrast between high and low tones experience a feeling of growing, whether in a sense of
26 flowing cycles and circles soaring moving with the flow or struggling to maintain one’s
27 like an ocean with waves coming in own identity under the pressure of group movement.
28 swirling birth Several mentioned the feeling of being split and hav-
29 tender feelings ing to make decisions about whether to assert one’s
30 seclusion and breaking away own movements or conform with the group movement.
31 fluid Most experienced a sense of renewal. The theme
32 flowing of ability to accept nurturing or new life from others’
33 gathering and expanding activity was prevalent.
34 gentle and assertive The embracing of paradox was a major theme —
35 lightness giving and taking, self and others, pain and joy. This
36 Other extended responses were as follows: theme was contained in Chopin’s music as a result of his
37 contrasting forms. A strong suggestion of rebirth came
38 a) I found sharing my poem harder than the through the beginning positions of the participants —
39 rest of the activity. again in stillness, nothingness, each in a curling leaf or
40 b) My image was of fallopian tubes, leading to fetal position, holding hands in a circle. It was also the
41 the nourishing hands, another way to get suggestion of a seed that grows from nothingness and
42 full. absorbs the nutrients and growing elements of water,
43 c) I was aware of giving and taking. sun, music, and warmth of the hands of others — all
44 d) It was difficult to bring myself out of the healing aspects of the environment.
45 curled position, so I was glad to be holding
46 hands. That contact stopped me from Music and Poetry
47 losing connection with other people. I was Poetry is the music of the language. It sings, it rings, it
48 shaky and warm; introspective. plays with sound. It undulates and marches. It punctu-
49 S e) This activity was not introspective for me ates our thoughts more dramatically. It sends arrows
50 R as others had been. It was a very through unnecessary semantics. It gives permission to
a mythic journey 45
use words in different ways. It contains rhythm, har- Actually I like to see a unity amongst 1
mony, form, tension, and resolution. In this way it com- different parts based upon conjunction 2
plements music. The poet writes a song which becomes * * * 3
mythic legend, speaking for more than one. We are on another planet we are all friends 4
and 5
The Ritual The music therapy session that takes still strangers to each other back on earth 6
the least instruction is the combination of music and Let’s get to know each other in the time we 7
poetry. Even if the instructions do not say poetry, only have left 8
stream of consciousness, poetry emerges. The instruc- 9
tions were “Let the music come into your ears and out The men in this projectile die April 1, 1971 10
through your pen in the form of words.” on the planet Mars 11
The following are patient poems that were com- They were in a projectile grave and floated up 12
posed to different pieces of music. towards the sun 13
14
Patient poems to Pink Floyd’s “Medley” Spaceship higher and higher 15
Fear of the unknown is terrifying 16
Stream of consciousness To die, to be reborn, who knows? 17
Wending through open space * * * 18
Leaf-like cascading over around My time is long till I become reborn 19
through pebbles But it just happened weeks ago didn’t it 20
Rocky surfaces submerged So why are you fighting love, trust and 21
Water surface mirrors green friendship with words 22
trees blue sky Because I am being tortured by an unknown 23
Swirling in the reflection of God’s country. enemy 24
Hatred and revenge and words 25
Cast ashore, wind dried and tumbling over The journey ends 26
sweet smelling earth, But in the window comes air and out the 27
Inhaling the warm sun, dancing death to window goes air 28
urban stress * * * 29
Birth painfully to the spirits of well-being I would like to travel with all possible speed 30
the spirit of self-destruction cries out for from the confining environs of Mother Earth, be- 31
revenge. yond the stellar horizon of our Sun. Look back dis- 32
dainfully and sneer. 33
But the natural self spirals deeper into itself, Then, dividing my own destiny, turn my 34
reborn back and only remember the aquamarine, 35
Cast adrift again to challenge the natural shrouded elyise. Casting relative time aside, ease 36
element on its own terms. further on the Phobos and there find my place of 37
Not to win but to succumb successfully vantage. 38
Being one, strong in that natural partnership After cutting a chink in the armour of Pho- 39
Transcending self. bos, I would explore, with a sharpened eye; peer 40
* * * at the Crimson planet in her sleep. And watch 41
. . . and so they parted, the Blue Orb writhe and fade into indifference, 42
heading off to new, unexplored lands. consuming herself with envy and strife. 43
* * * * * * 44
So the little blobs on the I are kind of Ding, ding, the bells call us to a mysterious 45
mysterious land of enchantment. 46
I am reminded of something that I did in a Filled with fantastic images of flowers and 47
picture I ferns. The trail is long, over in the horizon one 48
painted in grade XI. can see the sun slowly rising. S 49
13 dated little parts, different parts of me? Clouds are traveling swiftly in the sky. R 50
1 Onward alone I travel to the sea. In the early morning walking by the sea
2 Down by the shore I see the waves sparkling in Sitting alone on a log by the sea
3 the sun. Wandering across Burrard St. Bridge
4 The water is inviting me to come in and re- Just walking downtown with no particular
5 lax in it. I remove my clothes and feel free to run place to go
6 along the sand barefoot. Walking down an endless highway
7 At last I run into the cool water. I can Watching the sailboats go by
8 see all sorts of fishes swimming and I swim Old man walking along by the sea
9 with them. * * *
10 I surface for air and refill my lungs. I dive Metallic sounds of an elfin forge
11 deeper this time, my curiosity is aroused. I want to Enchanted forests as a back-prop of
12 swim farther away. Shadows & Sounds
13 The current catches me and I am captured, The mood is broken by words that block
14 left at the ocean’s mercy. out the peace
15 I struggle to survive. I swim up to the surface with their harshness of everyday definitions
16 but it is of no use. I want to scream but the water
17 enters my mouth. In the distance I see one of The beat is stronger, a flowing & twirling
18 man’s creations. It is a submarine. I open the promise of the unexpected
19 hatch and step inside. There are no human beings Where is it leading me? Can I safely give up
20 inside, only robots which are made to follow my my resistance?
21 requests. I ask them to take me on a journey to a Perhaps some harsh contrast will jolt me
22 distant land. They do not move. back too unexpectedly from my calm
23 presence
24 Something is wrong, they don’t care. They
25 have not been used in two thousand years. I am Halloween visions of ghostly figures lured
26 the only human that exists since the nuclear war out of hiding by kind permission
27 in 1990. Pale blue icy cold engulfs the figures in haze
28 I exist only because God wills it. I lead a protecting the privacy of the moment
29 lonely life. Clouds racing in from a wide open mood
30 I repair the robots. which casts shadows of forms that are
31 They can speak to me. lost in their passing
32 My life revolves around them.
33 * * * A stillness and calm. Kind resolution. A
34 Walking along the beach as the waves hit reward for chance taking making the
35 the shore moment more significant through the
36 Lying in a meadow with all sorts of daisies experience.
37 Walking alone downtown, feeling sad
38 Drinking coffee at a restaurant alone A racing resistance to voices é meaningless
39 Walking alone in a darkened forest words. The wish to end with great
40 entering an enchanting forest resolution.
41 Watching the seagulls fly by * * *
42 Walking by a stream A magic garden
43 Listening to the crows caw Birds pop
44 Such a lonely cry Delicate — then stretching to reach the
45 Wind blowing through your hair warmth
46 Strangers parading on by Swaying thru light & dark, wet & dry
47 Feeding the pigeons at pigeon square Denser swamp life —
48 Watching old men sitting on benches at light moss above heavy wet sand
49 S pigeon square Romantic, misty touches of wind on grand
50 R Talking to strangers feeling lost and alone oaks
a mythic journey 47
Sand becoming denser — to heavy My mind wanders at wonders. A pearl, 1

Fingers light and tickled heavy with layered 2
As feet struggle with every step coatings man and his life. 3
I snap into a powerful rhythm of 4
determination There is a vision that comforts a return 5
Allowing me to walk on thru the muddy to the womb, warm, throbbing, enduring. 6
swamp glooy river. The residual warmth cools slowly in the head. 7
Fear surrounds me in sounds and winds The joining of lives, braids our collective soul. 8
unfamiliar as I 9
plod into a continuous walking, rhythmic Cold, empty blackened husk, its germ 10
trance shrivelled and burnt. 11
Suddenly no longer heavy, but light & lost * * * 12
a space walk through the swamp The seed has its properties and message to grow 13
As scary sounds embrace me piercing pain in a harsh world around a struggle so 14
and no ground difficult to live and easy to die 15
to hold me it continues to fight for it knows why. 16
Lost with no direction. At least there is my 17
friend the wind It uses the elements in short supply 18
Bats tease me with no question or doubt but just to try 19
Such a strange form passing through them to survive and flourish day to day, 20
An intense ray of sun bringing me a saviour and flower and pass on the process this way 21
in a heartbeat — * * * 22
the slowness forces me to appreciate the The seed is planted with loving care 23
nourishment The sun and the rain they are there 24
It gradually begins to warm me, giving me And the flowers that began the same 25
strength protectively circle and care 26
in my loneliest moment But the seed remembers the cold 27
Suddenly I am in the desert riding high & of life before 28
warm on a and cries not to grow 29
stallion in a slow motion. Just to be in nothingness 30
No longer the romantic but unfriendly, into no more pain no more ache 31
celebration 32
of motion rhythm, light, strength No more life 33
Rocking — inviting me to rise. Gently the flowers give 34
* * * their happiness away 35
Patient poems to Samuel Barber’s “Adagio for Strings” so that the new seed 36
may forget the pain 37
Man cold and grow warm in their sun 38
Child warm the seed quivers and begins again 39
Superman? Is torn into clouds * * * 40
As a seed under the ground I felt alone, 41
The sun rises and brings death to darkness. darkness was all around and I had no friends. 42
Gradually as I sprouted out of the ground I 43
The warmth of the womb. Growth hot, began to see how beautiful the world was. 44
vital strong. I saw the sun it was warm and good, I saw 45
There is an end. Slowly they become the trees swaying in the breeze, the clouds 46
stronger moving rolling in the sky all of nature was so friendly 47
to meet themselves. Alone, independent, and it felt so good just to be there. 48
attached by S 49
the pulse. R 50
1 Patient poems to Oregon’s “Become and Appear” Dancing in the light

2 of twilight the young
3 Lone wail as the sea rolls girls made a pretty
4 imprisoned by winding shores picture; pirouettes
5 jungles echo the mysterious and soft tip toeing.
6 rattle of snakes and dancing drums * * *
7 lonely strange world encircling Space beyond time
8 me with a stronger and stronger beat Reaching
9 I want to run but every exit is covered Forward, forever
10 Snake charmers and strange frenzied Hollow moon
11 native surround and enclose my space. given
12 The birds control the sky. Then I find myself time and again
13 alone. I begin to explore, less frightened now. The until
14 wind circles in a soft gesture and makes me feel I Nothing beyond.
15 belong. My spirit quickens to foreign sights and
16 sounds — the rattles lead me deeper into the jungle Growing, upward
17 — the drums beat a path for me — I begin to dance inward
18 the circle dance with the natives and take their mu- outward
19 sic into my soul — a piercing whining sound arrests extending.
20 my attention — is it a warning? — it passes and the Never reaching
21 music takes on a more sinister tone. I race around the forgotten
22 for exits, but once again the music soothes my fear past.
23 and now I rest.
24 * * * Reaching
25 reaching
26 The wind is roaring outside reaching
27 The snake hisses Extended time
28 The pitter patter of little feet And again
29 I run outside and the sun
30 is shining brightly; Nothing left
31 The tall trees, through them until tomorrow
32 I see the sun rays, the forever
33 The daisies are strewn here & there. beyond.
34 I stop for breath and lay
35 down to rest on the green grass. Dance left
36 until night
37 The tailor is cutting out fabric Given less
38 for suits; than move
39 He stitches them together too much
40 His fingers are so nimble. gone
41 and given.
42 The sun riseth in the early
43 morning, its rays shining on Dark descends
44 the little baby asleep in moonless hollow
45 a basket hollow moon
46 He awakens and cries home for
47 for his mother who comes many
48 out of the cottage to forgotten few
49 S pick him up given rest
50 R
a mythic journey 49
to the rest A summer sky was overhead with cumulus 1

Until never. clouds rolled into one end of it. There was in- 2
tense heat from the sun and it bathed the 3
Down the dark world about in all its glory. There was an in- 4
hollow tense quietness in the scene around us. A 5
dance out the ringed-pluner was circling high overhead giv- 6
rhyme. ing out its plaintive cry of kill-dear, kill-dear. 7
The rotten woods were standing tall and 8
Knowing but not strong in the bright sunlight. A farmer was 9
given quietly working his land with a plow — the 10
Death imparts a little boy was running barefoot along the road 11
grace which the plow left on the hot earth. He 12
G-race could feel the cool-damp earth on his bare 13
God race feet as he intently moved along the deep fur- 14
Given to row. Looking along the wide field your eye 15
none. moved to a clump of willow trees bending 16
* * * their branches close to the earth. A few 17
Winnowing, winding, whirling on blackbirds were flying quietly among the 18
and on thru the frozen air branches. In the distance the sound of a cow 19
blows the sailing wind. Unfurling bawling could be heard. Among the lowest 20
long billows of clouds that cover shrub a bush rabbit darted in search of his 21
the horizon like a carpet brothers and sisters. An eagle was sitting in a 22
of thick wavy mist. high poplar tree, his eyes searching for move- 23
ment along the grassy ground. It was a perfect 24
Thumping and trumpeting wildly summer day. The smell of sweet clover and 25
thru the thin air comes the honeysuckle permeated the air. Flies were fly- 26
triumphant trumpet as it shatters ing among the grasses, restless, searching, pes- 27
the turbid air with voluptuous tering a small mouse that had run from the 28
trills. thicket to the open meadow. A farmer’s boy 29
disturbed the lazy summer silence with the 30
Pounding, thumping as a massive sound of a pump handle squeaking up and 31
upheaval of earth ascends the down. A patch of yellow dandelions caught 32
atmosphere making all below the long rays of the sun and shone up yellow 33
cringe with disbelief. and gold from the meadow’s floor. 34
35
Stomping, jumping, running amid
* * * 36
the tiny rivulets.
MUSIC IS THE SADNESS OF THE 37
Watching, waiting for a chance to WORLD 38
escape the dark night in its flight. MUSIC IS THE SADNESS OF THE SEED 39
40
Running flirting flying thru the HOW DOES ONE HAVE TO RELATE 41
dark mist — waiting watching TO EACH OTHER 42
for the magic hour of repose WHEN YOU DON’T HAVE TO MEET 43
and rest. 44
YET MUSIC IS BETTER THAN EVER 45
Crashing symbols impart a feeling AND YET IT HAS TO MEET 46
of unique disbelief to the quiet 47
atmosphere. REASONING IS BEYOND REASON 48
* * * AND AS REASONING MEETS S 49
R 50
1 SO THE MUSIC GOES ON One piece used is Tchaikovsky’s “Overture of

2 SAME AS THE WORLD GOES ON AND 1812.”
3 ON The group painting was then discussed and appre-
4 * * * ciated. As in the finest form of art therapy, the painters
5 Dawn over the sea themselves assign meaning to color and form.
6 Whirling water This can also be done with individuals in a soli-
7 Birds wining tary painting instead of a group painting. Patients are
8 The sun burst — brilliant sometimes asked to improvise with musical instruments
9 dancing on the waves. to the paintings. The paint provides another way for
10 patients. Colors express the intensity of emotions, of-
11 Tension lightens ten diluted by words. In the community painting, se-
12 Going around, spiralling crets emerge, through the various interactions in paint.
13 letting go relating Anger, love, admiration, identification and other feel-
14 pink mountains ings are often shared through painting in and around
15 dancing skirts, multicoloured another’s work. This “first step” serves as the beginning
16 stamping feet. Scarves curling of communication.
17 over arms. Smiling eyes.
18 lace mantuas — mysterious sensual Music and Improvisation
19 There are hundreds of possibilities for musical improvi-
20 lonely shepherd in the hills sation. This technique represents a great deal of the
21 brown wrinkled skin — harsh work of musical therapists. Although the jazz or blues
22 lines — rocky sheep jumping musician interprets musical improvisation as being a
23 ledges — lonely bird in the sky mutual agreement on some basic form and variations
24 whirling — sun beating. and interpretations of that form (e.g., 12-bar blues pat-
25 tern, or a progression in G minor), musical improvisa-
26 Music and Color tion for the music therapist usually follows a more
27 If we can only see, music contains color. Therefore mu- spontaneous form. Development, interpretation, and
28 sic suggests color. Paint is liquid and flows like music. It variation of spontaneous music produced by the patient
29 can be poured, brushed, layered, and mixed. Color is or client becomes the focus. Every note, every sound ex-
30 vibration. It is what we sense about people — cool, presses something about that person. Although the mu-
31 electric, vibrant, textured, or smooth. Color allows us sic usually evolves into some form, the music in the
32 to experiment by filling in the gaps in our personality. beginning may be sustained in one or more tones, ran-
33 We try red. We softly approach blue. We pray purple. dom and chaotic. These sounds are all accepted by the
34 We see black that we have never cried until now. We therapist as an expression of part of the human condi-
35 laugh yellow. We place color in space. It has no time. tion. They must be heard, accepted and shared. They
36 We create and thus give new life to color. often express the most basic and primitive side of our
37 nature which becomes cluttered by more sophisticated
38 The Ritual One large roll of paper was stretched out music. If a child can find just the right instrument to ex-
39 for the group. Each person was provided with a brush, press some secret side of his being, some lonely or
40 chosen by each for its texture and thickness. Rich tones painful or happy side, even though he may not speak, he
41 of paint were provided — red, black, blue, yellow, green, expresses himself and therefore is free and grows, know-
42 brown, white, and a couple of shades such as purple, am- ing he can communicate and share, if he so desires.
43 ber, gold, etc. Combining paint and music, the group Many fine things have been written about musi-
44 created a community painting. cal improvisation in music therapy in the works of
45 Instructions were as follows: “This is a community Nordoff and Robbins, Mary Priestly, and Juliette Alvin.
46 painting. Let the music come in through your ears and The following examples stress the approach of rit-
47 out through your paint brush. Paint in your own space. ual within the music therapy improvisation and re-
48 If you wish, you may travel and paint in and around count two specific experiences. The first is a description
49 S other people’s space.” of guidelines written at the Preschool for Special Chil-
50 R
a mythic journey 51
dren. Children with multiple handicaps were inte- use of the child’s own natural intervals, songs, and 1
grated with normal children of the same age in the chants. The old proverb states: “That which cannot be 2
Serendipity program at the Preschool for Special Chil- said can be sung, that which cannot be sung can be 3
dren, University of British Columbia. danced.” It offers the child a chance to say, “I’m angry” 4
The second session was a teaching workshop with with a drum, “I’m happy” with a flute, or “I’m strong” 5
first-year music therapy students from Capilano Col- with a dance. Staff should be available for the sharing 6
lege in Vancouver. In this one and a half hour session, and expansion of feelings. One must be totally aware of 7
music therapy was presented as ritual. the child, what he is trying to communicate, his chang- 8
ing moods, and respond accordingly, either by express- 9
guidelines for a children’s ing that you know and understand the feelings by 10
spontaneous music workshop imitation, offering another alternative here and there, 11
or improvising on the theme offered by the child, all 12
Care should be taken to provide high quality tone from the while using the child’s body rhythms and chants as 13
instruments in each family. The children should have the base. There is also opportunity to make yourself 14
great variety available to them for each family of instru- known to the children, to offer direction when chil- 15
ments expresses different messages. In general, the fol- dren are asking, but never to impose it within the mu- 16
lowing instruments should be included: sic. Very often children will be creating an experience 17
which they would rather handle themselves without 18
1) Drums and percussion — tambourines, staff direction. It is wise to stop before entering the mu- 19
woodblocks, maracas, etc. sic area, take notice of what is happening and decide 20
2) Bells, gongs, sounding metals whether your presence is required or not. The children 21
3) Strings — guitars, harps, and string bass will have a way of letting you know, but you must be 22
4) Flutes, harmonicas, kazoos aware of this possibility. Their play and experimenta- 23
5) Xylophones, piano, marimba tion with the sounds will have a different focus when 24
an adult is present. 25
If funds are limited, it would be best to have one The workshops provide an opportunity for devel- 26
good instrument from each of the five categories. opment in many areas. The children learn about ex- 27
The music room should be arranged with simplic- pressive skills and communication. They also have a 28
ity and respect. Children will learn to respect the chance to develop motor skills. If they develop a spe- 29
instruments and their sounds if the therapist communi- cial affinity for a certain instrument, the children will 30
cates a feeling of ceremony. They will then be able to extend themselves beyond their limits to develop fine 31
use them as tools for meaningful expression. Instru- or gross motor skills. 32
ments are arranged in a semicircle with the gong and Speech can be developed through flutes, harmon- 33
flutes in the center, drums and percussion to one side, icas, kazoos, chanting, and singing. 34
and the strings and other melodic instruments on the One of the most important considerations while 35
other side. Simple instruments that do not confuse the playing spontaneous music is always to be ready to re- 36
child with mechanical difficulties are best for the very spond on any chants or sounds offered by the child. Of- 37
young, but never “toy” instruments. Chanting, singing, ten, though they may not have speech skills, these 38
and dancing should be encouraged and space made sounds are a beginning and even if they sound terrible 39
available for freedom of the dance. to your ear, are very important to the child and need to 40
be explored. Chant with her in imitation or add a bit of 41
The Role of the Adults your own here and there to see if you might expand her 42
Certainly everyone who is playing music is a person chant to include more sounds, tones, or intervals and 43
who has feelings, moods, and ideas to communicate. build from there. Or just share hers for a while. It may 44
This is an opportunity to “talk” about all these things take away from the loneliness she experiences through 45
without words. If the children feel that you are attend- physical limitations. 46
ing on this premise, they inevitably respond more Music is a good place to learn ordering, pattern- 47
openly and spontaneously. The musical experiences ing, and sequencing. Children begin to expect a certain 48
have much to offer in aiding development through the order, a particular progression in music, especially if it is S 49
R 50
1 something you have created together. Then it has a We spent 10 minutes in silence before someone
2 personal significance. The child feels a responsibility to gave the simple words that would constitute our theme-
3 develop the music if he has had a part in its formula- for the evening: “We are all involved in a profession
4 tion. in which we both express and transcend.” This seemed
5 Another significant aspect of the spontaneous to ring true for all. It was a good theme, for it ex-
6 music workshop was the smooth and unthreatening pressed one of the paradoxes of our work as music
7 structure offered for successful integration of all kinds therapists.
8 of children. The different types of children with all We gathered in a circle around the imaginary fire.
9 their problems and joys could share and exchange emo- We each symbolically cupped the theme in our hands
10 tions, sounds, dances, moods, and learn from each and placed it in the fire, returning slowly to the circle.
11 other whether they were developmentally delayed or Then we held hands, closed our eyes, and began
12 functioning normally. They had many positive experi- to chant. We hummed a few tones. The instructions
13 ences with each other in music and therefore had more called for one person to lead the chanting at a time,
14 reason to strive to eliminate their limitations between and the rest to complement. The leadership was to pass
15 each other. Through music they could share the core of from one to another in random form. Whoever felt he
16 themselves. was the leader would chant, we would all follow. The
17 chant was to express our theme in individual ways.
18 Music in the Haida House Next the group selected “dancers,” who were to
19 We met in the entrance hall of the Museum of Man, dance the theme. The others would follow the dancers
20 University of British Columbia. It was a slow night for with musical improvisation. If the voice came, it could
21 the museum. We seemed to be the only people there. come from the dancers or instrument players. The
22 With the absence of people, the spirits seemed more dancers danced on the dirt floor and the instrumental-
23 present. The totems spoke of timelessness, perhaps a ist played from the riser on the side. Flutes, drums,
24 greeting, an openness, a dignity. They certainly de- bells, and shakers accompanied birds, panthers, trees,
25 manded respect and acknowledgment. The building shamans, and mothers.
26 itself was a curious combination of spaciousness and Then the two groups switched.
27 containment, past and present. We came together and chanted again as we had
28 We gathered with our collection of musical instru- done in the beginning. On our final tune we sung the
29 ments for the walk to the Haida House. It was dark and sound of the foghorn from the mist, waiting through
30 foggy with a horn calling from the surrounding misty the silence. We broke hands and retrieved our individ-
31 bay. The walk through the forest was like a procession. ual themes from the fire. They were richer.
32 The Haida House itself was a small wooden struc- We took our instruments and left the Haida
33 ture, a miniature longhouse, similar to those used in House. No one wished to speak. The quiet said it all.
34 many Native bands and tribes for ceremonial ritual. We
35 had no fire in the center of the dirt floor. But small The Journey
36 beams of light from overhead lamps suggested a bit of We see that each music therapy session is a journey.
37 warmth and enough light to see each other and the in- The idea of presenting therapy as ritual increases sim-
38 struments. plicity and complexity. The ritual should not weave a
39 The Haida House was a surprise to most students, web of social value and convention, as do many rituals
40 not the usual classroom portable. It was a little awe- both present and past. It seeks only health and provides
41 some, but allowed us to experience some of the sense of certain artistic forms that help participants travel to
42 ritual as it was for the Native people. that health. We cannot write a script for another per-
43 We began in silence and seriousness. The students son’s life, especially those at risk. We cannot demand
44 were asked to come up with a theme that represented a what we might call a higher functioning level. We are
45 group belief. It had to be a theme agreed upon by the all prisoners of our circumstances, whether we happen
46 entire group for our ritual to have meaning. If this could to be a terminally ill cancer patient, an autistic child,
47 be accomplished we would grow with and in the theme or a therapist who got up on the wrong side of the bed.
48 through our symbolic representations. We would leave We can only seek to balance and express and experi-
49 S with a sense of renewal and commitment despite our in- ence our common human characteristics. Through this
50 R dividual differences. We would be community. sharing comes insight and regeneration. We can choose
a mythic journey 53
to accept suffering or fight disease if we remember the therapist must understand on a personal level the work- 1
strength of human constants. ings of human nature, as much as possible. 2
If we get disease out by externalizing and express- These requirements seem to indicate a mature 3
ing, we are in a better position to fight an enemy. person with a liberal arts background and some life and 4
The journey must be supported by a guide. The work experience. 5
ritual forms must be strong and solid, and the basic be- These factors should be taken into consideration 6
liefs only those common human processes that we in screening applicants for training in music therapy. 7
observe in all of nature, which surrounds us. Any be- In general, the music therapist must be the type of 8
havior required by therapist from patient that extends person who has respect for the following: 9
beyond these primitive truths, risks the dangers of de- 10
terminism. 1) his/her own personality resources 11
As therapists, we guide the journey, guard and 2) resources of the client 12
support the participants and aid them in identifying 3) processes inherent in music 13
meaningful themes. From there the materials of the arts 4) processes inherent in structure offered 14
do the rest, to touch the human spirit and inspire her to 5) silence 15
create the art of the people. 6) time 16
Each therapist must be challenged to create 7) space 17
meaningful ritual contexts that will be relevant to spe- 8) history 18
cific populations. There are degrees, levels, ways of pre- 19
senting that will change and must be adapted. The In addition, the ritualist must develop confidence 20
above are merely ideas from which to spring. An im- in self, others, and the process of growth; flexibility and 21
portant consideration is that often patients who cannot adaptability; empathy; strength; knowledge; humility; 22
speak or who seem inarticulate are not able to give us enthusiasm; humor and warmth; a sense of balance; 23
the verbal feedback and reassurance we think we need good intention; and objectivity. 24
in order to check ourselves. Related health profession- For the sake of liberation, the music therapist can 25
als are sometimes equally incapable of serving as a be considered a shaman. There are many references to 26
check, since it is so difficult to describe musical events the psychotherapist as shaman. Jerome Frank says that 27
and their benefits with patients. In addition, the effects the quiet, efficient attentions of today’s physician do not, 28
are often on the level of spiritual or intellectual insight at first glance, seem to have any relation to the dramatic 29
and therefore not easily observed. We must tune our- and emotion-filled rituals of the shaman. But a closer ex- 30
selves to see and hear the response that is most difficult amination indicates that the two have much in common. 31
to observe — the inner response. 32
The important aspect of the mythical musical rit- 1) Both derive their healing powers from their 33
ual in practice is that it does not allow us to separate status and role within the sufferer’s society. 34
and classify ourselves with disability nomenclature or 2) Both are evokers of healing forces. 35
job designation. For in its essence, it says that we are 3) Both are mentors. 36
One. The forms and variations change but we all expe- 4) Both are role models. 37
rience the human constants. We journey together into 5) Both mediate between the sufferer and 38
and through the music. their respective groups. 39
40
music therapy as ritual In general the task of both is to help the patient, 41
whether African tribesman or North American stock- 42
Although this approach to music therapy seems simple holder, to mobilize his psychological and spiritual as 43
enough, a serious question arises when considering well as bodily resources. Especially important for heal- 44
where and how to train these music therapy ritualists. ing is the element of faith and trust placed in the ther- 45
It is clear that music therapy is an interdisciplin- apist/shaman by the patient. Studies in the placebo 46
ary field. So the music therapist must be trained in many effect have shown us how important faith really is. But 47
areas: music, psychology, philosophy, religious studies, in addition to the similarities between the psychother- 48
art, drama, anthropology, sociology, ethnomusicology, apist and the shaman, the music therapist as a shaman S 49
etc. In addition to this academic training, the music is also an artist/music maker. R 50
1 Areas shared between the shaman and the music environmental qualities of the space, the time of day,
2 therapist would be the following: materials used (whether instruments, paints, record
3 player, or other), skills of all persons in the room, atti-
4 1) Both work with a magic phenomenon or tudes, cultural trends, history, beliefs, feelings, philoso-
5 art that is not totally understood. phies. In this situation the ritualist/artist becomes a
6 2) Both work in professions having responsi- facilitator.
7 bility to oversee the health of the commu- One of the most essential qualities of the music
8 nity, preventative and curative. therapist as artist is musical sensitivity. The ability to ex-
9 3) Both require the faith and trust of their plore sound and silence freely and encourage ritual par-
10 communities in order to achieve results. ticipants to do the same is essential. The artist should be
11 4) Both learn their skills and rely on their able to hear and interpret unspoken moods, trained in
12 own judgment and intuition about when both the form and flexibility of his instrument, able to
13 and where to apply them. They serve an combine his skills in unconventional ways, aware of the
14 apprenticeship and receive inspiration infinite variety of the language of music. She must use
15 leading to insight about their work. music as a meeting ground, a place in which to step out-
16 5) Both are dynamic personalities in that they side conventional roles and patterns.
17 are energetic and vigorous. Whether shy, If the music therapist considers herself an artist,
18 gregarious, conservative, or eccentric they fulfilling her own creative instinct, and each music
19 are still participating in activities initiated therapy session as a work of art, most probably clients
20 by themselves. will be inspired to follow suit. If this transfer is accom-
21 6) Both heal themselves by participating in plished, the clients also become artists involved in cre-
22 their shamanistic art, either prior to or en- ative processes. If allowed to be artists, it is possible
23 gaging in their vocation. that participants accomplish their own healing.
24 7) Both offer rituals and ceremonies inti-
25 mately connected to myth and various art The Visionary
26 forms — music, dance, costume, color, etc. If the music therapist does assume the character and
27 role of the ritualist/artist as mentioned above, it would
28 The Artist imply the responsibility of vision as well. For the artist
29 The music therapist is an artist by token of musical takes some initiative in the unfolding of the future
30 ability. But the value of the artistic nature of the musi- through vision. This vision constitutes a plan, a
31 cian within a context of ritual transcends technical and scheme, a method of facilitating transformation of indi-
32 interpretive competence. As an artist, the ritualist has viduals and the culture itself. There are an infinite
33 a certain way of perceiving the world that can be useful number of possibilities for visions — to see the visions
34 in healing and therapy. The sensual perceptions of the of others is an important skill. Vision endows the music
35 artist allow the ritualist to guide the ceremonies and ac- therapist with passion, conviction and moral responsi-
36 tivities into profound representations of myth and life. bility, a sense of destiny and purpose, charismatic lead-
37 Since objectification or externalization is impor- ership qualities, and an essential role in the evolution
38 tant in transformation, the music therapist must de- and improvement of culture and society. The presence
39 velop skills that encourage others to express: the music of alternatives is a sign of vision. Vision has some un-
40 therapist externalizes and guides others to externalize speakable spiritual quality which is hard to define but
41 feelings, thoughts, situational dilemmas, and personal- can be heard within the music of the artist, a ch’i (Chi-
42 ity dynamics, into musical form. The music is immedi- nese vital breath).
43 ate and constantly changing. The visionary must be strong, yet subtle; clear yet
44 As an artist the music therapist is a resource com- undogmatic; the visionary must respect the visions of
45 biner, experimenting and playing with alternatives. others.
46 The artist draws together all the resources and materi-
47 als which will create a music therapy ritual. These re- The Initiate
48 sources would include everything which can be in the The music therapist as ritualist requires a particular type
49 S room at the time of the creation of the work of art: of training. This training is not necessarily available
50 R the personality qualities of all persons in the session, the within the present academic institutions offering training
a mythic journey 55
in music therapy. Briefly, the music therapist as ritualist/ or extreme, but deep insight and understanding of the 1
artist/visionary must receive the following: transformational process must occur if she is to effec- 2
tively employ the mythical, musical framework. 3
1) Experiences in all the various musical ritu- 4
als presently available and encouragement integrative reflections 5
to create new rituals dictated by the situa- on the mythic artery 6
tional needs of each unique therapeutic en- 7
vironment. A trainee must personally As Argüelles speaks of our self-destructive urges toward 8
experience the power of music and ritual. apocalypse, Jerome Frank, in his book Psychotherapy and 9
2) Knowledge and skills in as many disciplines the Human Predicament, predicts the form of this even- 10
as possible, especially music therapy, music, tual disaster as nuclear destruction and the cause, a type 11
philosophy, psychology, religious studies, an- of social disease called technology. In Ivan Illich’s 12
thropology, history, creative arts, etc. Equally words, we have heard this social disease called licen- 13
important is a knowledge of one’s own per- tious technology. Because of this rampant technology, 14
sonal resources even before training begins. we are faced with the daily possibility of nuclear disaster, 15
3) Experiences in the field, i.e., in therapeutic controlled by the emotions of political risings and 16
environments, from the onset of training. fallings. While this cloud hangs over our daily lives, a 17
This gives the trainee many levels of under- fact that Frank sees in direct relation to the state of our 18
standing, which can be guided by clients, mental health, we observe the simultaneous disappear- 19
other music therapists, and professionals. ance of fellow life on earth through the increasing dis- 20
appearance of plant and animal species, including 21
There must be a balance between the technical human species, all around us. The sick and distressed 22
skills and information, and the character and personal- ones in our population are in direct relation to this situ- 23
ity who can accept and use the magic. ation. They are part of our essence. They are a reflection 24
At the core of the musical, mythical framework as and intensification of our own collective condition. 25
presented here is transformation. The ritualist must em- There are many who consider the solutions to 26
brace transformation before and during rituals that pre- these problems can be formulated primarily on the 27
sent this process to others. If a prospective music therapist drawing boards of nuclear physicists, in the halls of 28
applicant has not embraced the process of change prior congressional legislature, or in the laboratories of clini- 29
to training, this process is required during initiation/ cal psychologists. However, if we are to survive in a 30
training. Again we are reminded of the shaman. There is more total sense, we must also resurrect the most basic 31
a contrast between rigorous training and receipt of a vehicles and rituals of human expression and creativity 32
diploma or purification and transformation. — the arts. Music and color, myth and ritual must re- 33
The shaman and the yogi, the sorceress and the sound from every home and we should see and hear the 34
priestess, all derive their strength from an initiatory artists within. Some say we have already tossed away 35
death and rebirth experience they must each undergo the vital threads of survival, that we are “on the way 36
before they can truly be themselves. It is this transfigu- out.” As long as we can still hear the heartbeat, as long 37
rative experience that endows them with their unique as we can breathe, there is hope. The music reminds us. 38
vision. In traditional society this experience is highly We have created a dissociation of life from spirit. 39
valued and the right to undergo it was safeguarded reli- The question for some is: Where have we gone 40
giously. But modern techno-historical society abolished wrong? The question used in the present document is: 41
the right to vision as well as the ritual for gaining it What have we left behind? In this situation of lack 42
with a fearful self-righteous vengeance, thus ensuring of balance, which elements of knowledge can we re- 43
its own fantastic rise to power but also sealing its own integrate into today’s life in order to re-establish balance? 44
doom. In denying the validity of the vision and the The particular context used to address the question 45
vision quest, modern society denied itself any rebirth here is the therapeutic environment. But, as stated ear- 46
short of apocalypse — an event its own shamans and vi- lier, these settings are only a reflection of the culture at 47
sionary prophets, exiled to the sidelines, have continu- large; and the people within those settings, reflections 48
ally foretold and prepared for (Argüelles, 1975, p. 288). of the individuals outside. S 49
The transformation of the trainee may be slight What has been left behind by overuse of the R 50
1 medical model? The two predominant areas in this sec- strength and resources received. Similarly, if we view the
2 tion are a lack of spiritual freedom, which might even be environment and fellow life around us as a reflection
3 called a negation of spirituality, and a dearth of creativ- of and part of ourselves, healing or prevention is rec-
4 ity, which from most artists’ view is related to spiritual iprocal.
5 negation. In order for this association to develop between
6 Here again we find the word spirit. Spirit implies humanity and nature, which surrounds us and is in him,
7 mystical, magical and religious experiences. Unfortu- connecting patterns must be appreciated. A noted In-
8 nately the medical model has often ignored this side of dian chief says: “All things are connected. Whatever
9 the nature of man. Some interpretations of psychoanaly- befalls the earth befalls the sons of earth” (In Green-
10 sis have gone one step further and labeled religion as neu- peace Chronicles, 1979)
11 rosis. This has created unfortunate inadequacies in health Perhaps the metaphoric mind can see this vision
12 care. The word religion, derived from the Latin re-, more clearly than the logical mind.
13 “back,” and lingare, “to bind,” means in its broadest sense Music is osnly one vehicle in this framework, but
14 “a binding back together.” The opportunities for healing it does provide easy access because of its healing poten-
15 aspects of religion are obvious within this definition. tial. Unfortunately some of the processes inherent in
16 For the Navaho, medicine, religion, and art are wo- music that can be used for healing have been ignored
17 ven together in common purpose. Marvin Harris tells us entirely because of strictly clinical orientation. In gen-
18 that art, religion, and magic all fulfill the same basic hu- eral these are:
19 man needs. They break down the thin layer of ordinary
20 appearance and go beyond to actual cosmic significance. 1) Music contains magic.
21 A more formal definition states that religion is 2) Music is an aesthetic experience and there-
22 the mixture of beliefs, attitudes, emotions, and behav- fore conducive to patterning.
23 ior, constituting our relationship with the powers or 3) Music can introduce and develop creative
24 principles of the universe. This may or may not imply processes.
25 some function of deities. However, it assuredly does im-
26 ply a seeking of ontological structures and frameworks The music therapist as ritualist provides a context
27 that relate us to the broader universe. Frankl calls this for the transformative experiences of mythical musical
28 man’s search for meaning, and identifies this search as forms. In order to function in this role the music thera-
29 the essential ingredient in mental health or illness. pist must be not only clinician but also magician, artist,
30 The primary aspect of creativity that emerges as a scientist, and a visionary for the individual and the cul-
31 consideration in healing is acknowledgment and uti- ture. She must understand and know the process of
32 lization of paradox, being able to accept and use mixed transformation personally in order to encourage others
33 feelings or contradictory circumstances for growth and in this endeavor.
34 change. The mythic artery does not represent a purely sys-
35 The Death-Rebirth Myth and its infinite number tematic approach. Rather it represents a synthesized
36 of analogies in life, of course, is one example of such group of ideas that become alive within the use of the
37 paradox. Effective ritual contexts for this myth have mythical musical ritual. It does not provide answers to
38 been left behind. Although there are some cultural rit- questions, but rather insights that lead us to wisdom. It
39 uals which, wittingly or unwittingly, employ this myth is a framework to be suggested rather than imposed
40 and other myths, there are not enough to reassure us or within certain sessions, within certain therapeutic envi-
41 remind us of the basic ever-constant patterns of life, ronments when deemed appropriate by the music ther-
42 which Joseph Campbell calls the elementary forms and apy ritualist. It strongly advises a pervasive change in
43 human constants. Within therapeutic settings, there present systems of therapy — a move to implement cre-
44 are even less mythical rituals because of certain scien- ative arts therapies. It suggests the feasibility of employ-
45 tific, as opposed to spiritual, orientations. The antici- ing music as one of the vehicles for healing, in
46 pated product of ritual based on the Death-Rebirth particular, the Death-Rebirth Myth. It also suggests cer-
47 Myth is transformation, growth, and change. tain qualifications necessary in initiation and transfor-
48 If we are able to consider this process in ourselves mation of music therapists creating ritual contexts for
49 S as a reflection, and part of the world and universe around the mythical, musical structure. On a broader level it
50 R us, ontological questions are answered, and added suggests an equal emphasis on art and science, a learn-
a mythic journey 57
ing from, and incorporating of, certain traditional ideas There is no death 1
within our present situation, a binding back to nature. For this culture 2
It reminds us that we are not separate from the Who hears the heartbeat 3
suffering peoples. We relate to each other through that Across many miles. 4
which we share as humans. We come together through Where is the myth in our own music? 5
soul. Symbol, ritual, music and myth are a celebration Hear the beat 6
of this unity as well as a vehicle for practical growth. It is the same drum. 7
Through music, color, form, shape, texture, touch, we The cosmic tree 8
perceive this unification. We work on survival and im- Stretches across the Earth 9
provement. This is the healing power of the arts. As does the wind 10
Through the eyes of Angel Babies on backwards, Who knows no East or West. 11
through the anger of prisoners, through the silence of We assign names to space 12
autism, through the music of the therapist, we see this But the Earth has one core 13
vision and experience soul, sharing the same artery of which is always at the center. 14
life. Music and myth are suggested as only one of the 15
means through which to return to these considerations. Hear the mythic music which binds and 16
Sufi Inayat Khan says: heals 17
For sons and daughters 18
Music is the harmony of the universe in Mi- Of East and West. 19
crocosm; for this harmony is life itself, and 20
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R 50
1
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3 Excerpt Three
4
5
6
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9 MUSIC AND SPIRIT:
10
11 ACKNOWLEDGING A GREATER REALITY*
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14 Carolyn Kenny
15
16 Often we find ourselves traveling backward and forward chant and sing and long for some sympathetic reso-
17 through time, searching for something beyond the time- nance? We express a statement, a question, a desire,
18 bound moment — some source, some meaning, some rea- wish, hope, dream, or intention in song. Through ex-
19 son, direction, purpose. We search for the origins, the pressing, we long to communicate with and contact
20 beginnings to resource and renew, seeking some sense of both human community and the cosmic realm — to
21 the primordial, a connection to the original creative act, know that we are not alone, to diffuse our need, to begin
22 our roots. Then we seek the ultimate, the absolute, a des- the actualization, to consecrate the moment of origins.
23 ignation of path, some raison d’etre, a guiding light. Music provides an opportunity for transcendence
24 When we are lost in doubt, or dried up, or weary, or seized and individuation — finding the one in the many and
25 by pain, we reach backward and forward for strength and the many in the one — tapping our own creative re-
26 reassurance, to stretch beyond the present to some sources. The simultaneous task of music is to seek the
27 Greater Reality, some transcendental dimension. primordial/cosmic source and to celebrate and conse-
28 In our moments of traveling through the se- crate the human moment.
29 quence of daily events called history, music has come to In our current musics we have tended to concen-
30 help us establish these connections between the before trate on the latter process, separating ourselves from
31 and the now, the new and the beyond, our individual the spiritual dimension. The result has been an alliance
32 realities and the cosmic motion. For music is both of alienation, a deprivation from essential resources
33 time-centered and moves through time into vibrating needed for our own survival.
34 waves of sound which travel beyond the profane and There is a meeting ground for the sacred and the
35 will not be totally captured by the moment. A musical secular and unless we not only allow, but also encour-
36 note sounds and seems to vanish in our time, but moves age, the unconscious, spiritual insight, and nurturing
37 on to resound into the myriad undulations of space passion of the artist/musician to merge with the ra-
38 time, eluding our perception and understanding. tional clarity and finely tuned perception of the scien-
39 Music is “taking care of sound.” Through this mu- tist/technician, there is little hope to move forward
40 sic, this human expression, this response to the moment, from here.
41 the human condition, life on Earth, we cry out for whole- In moments of stillness, the emerging forms and
42 ness which can accommodate and contain our diverse patterns of this new language can be heard. Thanks to
43 realities and extend to some Greater Reality beyond each our technological development, our approach to the
44 unique human set — some unifier or connector. Greater Reality need no longer be one of fear. We can
45 It is said that the goal of the mystic is to eliminate now hear the resonating harmonies — the music which
46 disharmony. He seeks a sense of oneness. Why do we creates and is created between man and the vast sphere
47 of nature and the cosmos.
48 *This paper was originally delivered in French at the Congrès Our motivation for developing these relationship,
49 S Mondial de Musicothérapie Association Française de Musi- these connections, these activities, can be fed by
50 R cothérapie in Paris, France, July 1983. awareness that we are no longer alone in the planetary
60
a mythic journey 61
system. We are drawn, whether through our scientific • To consecrate and document the present; 1
curiosity or our desperate need for aesthetic enrich- • To allow the quality of music to permeate life it- 2
ment to the flowing colors, forms, and textures of self. 3
Jupiter — and stand eager to encounter even more — 4
the other side and beyond. Our awareness and appreci- This is a matter of survival. Unless there is a bal- 5
ation seek some knowledge that we are pressed to ancing and blending of thought and emotion, science 6
name, but reluctant to reduce — a unifying view, an at- and art, the here and the beyond, the apocalyptic futur- 7
titude which serves to decrease alienation. ists will witness their own prophecy. It is a challenge to 8
Music can be a meeting place, a healing place, a us to create and define purposeful action in our lives and 9
learning place, a time for ritual and celebration, a time our work and accept some responsibility for the future. 10
to acknowledge our human community, and a time to It is the time for the artists and spokesmen of mu- 11
reach out to the Greater Reality. sic to offer their resources with clarity, commitment, 12
Traditional music has spoken more clearly to these and action. It is no longer appropriate to mask the 13
issues, at least in intention. In our recent development processes and products of music and music therapy. It is 14
we have been afraid to speak the sacred words, to utter no longer feasible to be afraid of being moved in the 15
the sacred music. This profane orientation has perme- world or in the therapeutic environment. And it is no 16
ated all the various levels of musical involvement. But longer possible to deny the valuable resources of the 17
the most critical point where the loss of spirit is felt is unconscious, the natural mind and will — the motion 18
with those at risk. They are drawn to healing places, and emotion, the spirituality of music. 19
therapeutic environments. They come for resources, for In our practical work, our literature, our presenta- 20
guidance. Often our response is to objectify the object tions to the public about our field, we have an opportu- 21
to the extent that neither therapist nor client can iden- nity to create a bridge between the conscious and the 22
tify the subject. We offer resources that are reflections of unconscious, the scientist and the artist, the sacred and 23
our own alienation. Or perhaps we do offer resources in the secular, the moment and the infinite, our individ- 24
the spiritual dimension and then proceed to negate ual realities and the Greater Reality. We can create an 25
them in our descriptive language — a fear of saying what entrance, an invitation to a new language and knowl- 26
we know, or knowing what we say — the knowledge and edge and thereby honor the unique resources of the cre- 27
intelligence of the heart, the inner logic. ative endeavor and its potential contributions to human 28
In addition to our fear, we have not reached the growth and development. 29
stage in our own human development to truly mirror And our source, our contact with this new lan- 30
our experience in the spoken word — the theories, the guage is music, which goes to and comes from the hu- 31
concepts. Not only are we afraid to speak the truth, we man heart. The music is like a massive mythic artery, 32
do not yet have the language for the truth and the lan- which is liquid and vibrating. It is full of life-giving nu- 33
guage for beauty seems even farther still. Yet here is the trients and chemicals. It quenches our thirst. It travels 34
hope in music — that it dares to reach, to stretch, to through all of time and contains the wisdom of the ages 35
move beyond apparent limits. and echoes the future. It recreates and cleanses. It 36
Specifically, what is our goal in the development brings us to the community of man and life as a whole. 37
of music therapy? It gives us power, strength, and humility. It is a stream 38
that winds back through all the ages to the essence of 39
• To research, name, classify, and develop creative our beginning — our first heartbeat, the first story of our 40
alternatives; existence. It allows us to be part of the whole and yet 41
• To combat alienation; unique within the traveling undulations of time. It re- 42
• To develop a new language which bridges con- cycles. It purifies. It transforms and renews. It acknowl- 43
scious and unconscious, inner and outer, here and edges a Greater Reality that enfolds and engages our 44
beyond; human activity, yet expands our awareness and knowl- 45
• To travel among and through diverse realities — edge to embrace a vital spirituality, a mythic reality, 46
to spin, to gather, to acknowledge, and to remem- which waits as a resource for our life and work. Music 47
ber resources; and spirit linger to awaken our consciousness, our sense 48
• To celebrate the nurturing source, the origins of of Oneness. Music heals, if we will only hear . . . S 49
our existence; R 50
1
2
3 Excerpt Four
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9 THE MAGIC OF MUSIC THERAPY*
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12 Carolyn Kenny
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14
15
16 In definitions of music therapy, we read about a science a degree of legitimacy. The systems of accountability
17 and definers take great pains to describe a rigid disci- established by these sister disciplines had previously
18 pline which follows strictly prescribed laws of practice. aligned themselves to scientific models so widely estab-
19 When reading these definitions it seems music therapy lished methods of treatment in music therapy also be-
20 has no magic. came scientifically oriented. The development was not
21 It is true that in the never-ending search for jobs, harmful in itself, but for two reasons it had a negative
22 music therapists probably would not receive many of- effect on music therapy. First, the scientific method is
23 fers if they referred to their “therapy” as having a magi- greatly abused in the behavioral sciences. Accurate use
24 cal side. However, anyone who has felt the power of of the scientific method does not allow for claiming ab-
25 music would admit it has a magical side which, unlike solute truths, as do so many studies in behavioral sci-
26 “therapy,” has unpredictable results and cannot be ex- ences. Many times we read the results of one study or
27 plained or described in words. Why and how music another which claims results can be generalized any-
28 affects people, to a great degree, remains a mystery. where to anyone and therefore a new method is in-
29 Perhaps the music often cures in spite of our imposi- vented. The great scientists never claimed to discover
30 tions of techniques and methods of therapy, our at- absolute truth and perhaps have more respect for the
31 tempts to categorize, explain, and define, sometimes unknown than anyone, constantly observing the mys-
32 even in spite of our efforts. teries, magic and uncertainty of life. Good empirical
33 Within this article, a brief history of the develop- studies also do not imply absolute truth, and encourage
34 ment of understanding about music therapy will be de- replication. However, this is an era in which a proven
35 scribed. The concept of magic will be explored and theory is a greatly valued achievement in society. None
36 some magical characteristics of music therapy will be of the disciplines affected by empirical studies suffer
37 discussed. Then some recommendations for practical more from this trend than the ones concerned with suf-
38 applications of these ideas will be stated. fering humanity — the worst offender being the “men-
39 tal health business.” Most often music therapists refer
40 the history to their “art” as a science or a discipline to reassure the
41 medical community that they are exact, precise, always
42 Why has this magical side of music therapy been de- predictable, and, most of all, legitimate, and so partici-
43 nied throughout the development of the profession? In pate in perpetuating the myth of predictability. Second,
44 North America and to some extent in Europe, music in the medical community, science and magic do not
45 therapists have tended to position themselves with the mix. And so the magic side of music therapy is sacri-
46 behavioral sciences. These disciplines operated in the ficed.
47 same areas as music therapy and had already established Because of the nature of this development, many
48 of the processes inherent in musical experience have
49 S *This paper was originally delivered at the 1979 National Asso- been ignored entirely. The tendency of music therapy
50 R ciation of Music therapy Conference in Dallas, Texas. to be aligned with other disciplines has, in fact, built
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a mythic journey 63
the legitimacy of the profession. The important ques- liberation, the music therapist can be considered a 1
tion is: What has been left behind? Music therapy has modern-day shaman, adapting the concepts of shaman- 2
been in partnership with psychotherapy, with bliss sym- istic practice to modern contexts. There are qualities 3
bols, with recreation, with behavior modification, with that the music therapist and the shaman do not share, 4
education, T.A., Gestalt, and many other models. In but there are also similarities. 5
many ways these partnerships have been productive 6
and meaningful, and should always be an option for the aesthetic experience 7
music therapist. But what are the special characteristics 8
of music therapy? Another characteristic is the aesthetic nature of music. 9
The concept of beauty is often neglected in music ther- 10
magic apy. Music fulfills man’s need for beauty and can satisfy 11
his search for meaning in the world. Many admini- 12
The magical side of music therapy complements the strators, doctors, teachers, nurses, therapists, and, unfor- 13
clinical side. Instead of approaching the magic with tunately, some music therapists do not realize that 14
fear, it can be investigated. aesthetic experience can have a curative effect. They 15
Music affects most people subjectively. It can also do not value the arts in therapy. Sometimes they have 16
affect us objectively, but within the subjective reac- not been encouraged by society to develop their own 17
tions the magic is found. It conveys symbolic meanings artistic drives. Occasionally they may pursue artistic 18
that are difficult to describe in verbal language and are endeavors in their private lives, but classify art as play 19
intimately tied to our emotions. In some ways, the sym- and therapy as work, therefore leaving out this impor- 20
bolic meanings of music are similar to verbal language, tant vehicle for healing. One of the basic premises for 21
but one difference is the immediate power of music to music therapists is that everyone is an artist. But soci- 22
move on an emotional level. It directly affects our feel- ety dictates that the living, working stuff of art is for 23
ings, those human reactions that reside in the subjec- “the artist,” a person removed, specially trained, and 24
tive parts of man’s being. Recent brain hemisphere usually quite odd. 25
studies show language function in the left-brain hemi- In many older cultures, leisure time was not a 26
sphere surrounded by other functions requiring logic, time to waste in meaningless activity. Leisure time was 27
and music functioning in the right brain hemisphere, healing time, often given to aesthetic experiences such 28
surrounded by the more subjective phenomenon such as playing or listening to music. When native and tra- 29
as intuition. The functions of the right-brain hemi- ditional cultures made music, danced, and costumed, 30
sphere are hard to define, difficult to describe, but can they were usually performing rituals necessary for the 31
be most important to our lives. health and well-being of the community, coming to- 32
Because musical experience is surrounded by this gether to express their beliefs and feelings about life. 33
magic or these unknowns, the music therapist is re- These activities were intimately tied into man’s search 34
quired to take risks in therapy situations. At best s/he for meaning. 35
can be a resource person or guide through the journey Our culture does not maintain these aesthetic 36
of the musical encounter. Results of musical experi- values for the average man or the patient in the psychi- 37
ences cannot be precisely predicted. Usually, if given atric ward. 38
the opportunity and the support, clients will hear or ex- Many of our treatments ignore the problem of our 39
press what they need to hear or express, for example, search for meaning, only encouraging the return of 40
anger, joy, sorrow, pain, confusion, etc. In this way they alienation. These methods deal with changes on a su- 41
accomplish the first step to rehabilitation or growth. perficial level, only what is seen, or can be observed by 42
The music therapist must be highly skilled, alert and an outsider. Often behavior is a reflection of one’s inner 43
yet be able to relax and let the music do its work. being. It cannot be assumed that it is the total picture 44
There is a certain mystique about being a thera- of man, or the only part to which to respond. 45
pist and being in control of the therapeutic situation. Of all the areas of philosophy, aesthetics is the 46
Often the client must have his/her turn at control if most neglected, perhaps because it is the most diffi- 47
healing is to be accomplished. The music therapist is cult to define. It resides in that gray right hemisphere. 48
sometimes inhibited in the use of his creative instincts Aesthetic experiences are unique and personal, there- S 49
by society’s definition of the therapist. For the sake of fore difficult to assign theories and generalizations to. R 50
1 Aesthetics is interdisciplinary and crosses lines of cul- clients will be “inspired” to follow suit. If this transfer is
2 tures, values, beliefs, personality, qualities, perception accomplished, the clients also become artists involved
3 skills, education, and attitudes. But through aesthetic in creative processes. If allowed to be artists, it is pos-
4 experience it is possible for each person to find her own sible that, as the shaman, people accomplish their own
5 frame of reference for the universe. Through valuing healing.
6 beauty, one can find ways of gathering strength from The music therapist as an artist can be a resource
7 the world in which one lives. person, drawing together all of the resources and mate-
8 In a music therapy session, the tunes or expres- rials that will create a music therapy session. These re-
9 sions may not always sound beautiful to a critic; how- sources would include everything that can be in the
10 ever, the music therapist hears these expressions as room at the time of the creation of the work of art:
11 profound representations of human experience. Through the personality qualities of all persons in the session, the
12 the profundity comes beauty — an artistic symboliza- environmental qualities of the space, the time of day,
13 tion through sound of the basic elements that make up materials used, whether instruments, paints, record
14 life experience — pain, sorrow, joy, sadness, loss, etc. If player or other, skills of all persons in the room, atti-
15 accepted with this attitude, such primitive expressions tudes, cultural trends, history, beliefs, feelings, philoso-
16 can form the foundation of a positive attitude toward phies. In this situation the music therapist becomes a
17 life for a person disabled in any way. facilitator who combines resources for maximum bene-
18 With this philosophical base, the client and ther- fit to all, or, in other terms, creates the most beautiful
19 apist work together to create and experience beauty. art work. All participants engage in a journey to dis-
20 They find symbolic forms, patterns, shapes, textures in cover the right sound quality, shape, or color that de-
21 improvised music that convey significant meanings. scribes and symbolizes an important part of the beings
22 They hear healing themes in recorded pieces that in the session, which other kinds of symbols cannot ad-
23 transfer to life outside the music therapy session. equately describe and communicate. The adept thera-
24 pist leaves adequate space and time for the clients to
25 creative experience fulfill their own creative processes as part of the cre-
26 ation.
27 Another consideration often neglected in music ther- Many therapists and methods presume they have
28 apy sessions is the natural ability of music to provide all the knowledge about where and how a person must
29 experiences in the creative processes. be healed. Most forms of therapy dictate exactly the
30 Jung considered creativity one of our basic in- way a person must alter behavior, attitude, and mood to
31 stincts. It can be implied from his theory that everyone conform with the culture. Within creativity there is a
32 not only has the potential to develop creativity in some way to adapt to the culture and express one’s unique-
33 area, to some degree, but also that everyone has a drive ness, if clients have a safe place in which to experi-
34 to be creative that must be satisfied. This drive can cre- ment.
35 ate products beneficial both to the individual and to so-
36 ciety if the proper channels are discovered, and the an alternative approach
37 reverse is true. If the creative instinct is not used or prop-
38 erly channeled, it can have a harmful effect on both. Students in training courses seem most concerned to
39 Even though music may not be the natural ve- make sure they are doing therapy. The mystique of the
40 hicle for everyone’s creativity, it can be an experi- therapist is appealing to many. Perhaps the appeal comes
41 mental ground in which to try out creative processes from desiring power and position in society or through
42 and apply them to a powerful medium. Creative altruistic concern for the suffering of mankind. Music
43 processes can be applied to anything. The music thera- therapists work in places where therapy is a lifestyle.
44 pist can provide opportunities for a person to try alter- Everything a patient does is therapy, from reading a
45 natives to problem-solving, corrective experience in newspaper in the morning (reality therapy) to swimming
46 communication, learning about new sources of regener- (recreational therapy) to talking and answering ques-
47 ation and enrichment, learning new skills, etc. tions with a doctor in a group (psychotherapy) to play-
48 If the music therapist considers him/herself an ing a drum (music therapy). When striving to achieve
49 S artist, fulfilling his/her own creative instincts, and each this role of “therapist,” students might consider the fol-
50 R music therapy session as a work of art, most probably lowing questions:
a mythic journey 65
What is therapy besides goal-directed treatment 2) There must be new designs in research to 1
toward the cure of a pathological condition, or, in a accommodate music therapy instead of di- 2
general sense, simple growth and change? rectly applying designs created for other 3
More significantly, how many of these “therapies” disciplines. There are few good testing 4
really have the result they claim on a long-term basis? tools that reflect information accurately, or 5
What part of clients is sacrificed to achieve the that even consider the special information 6
goals of therapies? produced in a music therapy session. We 7
And lastly, why increase the number of therapies have borrowed the behavioral science 8
that, whatever their definition, usually do not empha- tools, which test some common areas, but 9
size creativity and take power of decisions about heal- leave a lot of information behind. 10
ing away from the clients? 3) A most important area that must be con- 11
This is where music therapy or music magic pro- sidered in light of the above ideas is the 12
vides an alternative. training of future music therapists. The fol- 13
lowing are qualities that should be recog- 14
recommendations nized and developed, both in screening 15
applicants and training therapist appli- 16
1) Some music therapists are already applying cants: 17
these processes, whether consciously or un- a) Musical sensitivity 18
consciously, but the reputation of music b) Knowledge of many resources — music 19
therapy does not reflect these traits. Prac- therapy, music, philosophy, psychology, 20
ticing music therapists must consider the religion, education, etc. 21
processes inherent in musical experience c) Flexibility and adaptability 22
and apply them to music therapy. Only four d) Empathy and respect for every 23
are mentioned above. There are others. individual 24
Any music therapy artist may come up e) Inspiring and optimistic attitude about 25
with an entirely different set of characteris- life and music 26
tics, as is common among artists. Forms f) Confidence 27
used may differ from music therapist to mu- g) Strength 28
sic therapist, but hopefully we will at least h)Humility 29
share a philosophical base. Discussion and i) Enthusiasm 30
debate over which techniques work where 31
and when is stimulating and productive if Perhaps then, in the future, we will hear more of 32
we share a somewhat common philosophy. the magic of music therapy. 33
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R 50
1
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4 Excerpt Five
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6
7
8
9 THE FIELD OF PLAY*
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11
12 Carolyn Kenny
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14
15
16 the beginning blending of sound in music — when all things
17 are not only possible, but are coexistent.
18 In our day we have the good fortune to observe and When you break the barriers of limitation,
19 participate in one of the most exciting and brilliant necessary limitations — through the barriers
20 transformations in the history of mankind. We are blos- of limitations into All — That — Is. It is then
21 soming into a world where art and science are coming that Music becomes the language of immedi-
22 to a table where there is a great feast. acy . . . (From Helen L. Bonny “Reflections:
23 The feast consists of the many processes and Music, the Language of Immediacy”)
24 products that will emerge out of a paradoxical dialogue
25 between two worlds, which on the surface appear to be The Burning Questions
26 a different as the sun and the moon, day and night. I suppose there are a handful of significant moments in
27 By nature, the music therapist is required daily to careers of music therapists when research questions are
28 walk between these two worlds, much as the ancient born. Sometimes these questions have a very short life —
29 shaman, who was required to dance the great dance be- something like five minutes or a day. Being inclined
30 tween spirit and matter. In the morning light there is a toward reflection and having an ongoing questioning
31 delicate and gentle sense of beginnings, a promise, a attitude, I have experienced many of these questions
32 song. It is in these first moments of time that we can springing out of the work.
33 touch and taste and hear the horizon of our tomorrows. Some questions have consumed and generated
34 The music therapist is one of the keepers of the more energy than others. A few have had a long life.
35 gate, one of the technicians of the sacred, one who sees Some have been posed from outside sources.
36 the vision and hears the song of the one and the many, Questions press the accountability button.
37 the one who dances on the edge of time, one who can For example, in order for the Canadian govern-
38 guard the threshold of being, one who waits for ment to fund a project demonstrating “the effective-
39 sound . . . ness of music therapy,” in institutions in Vancouver,
40 British Columbia, in the mid-1970s, it was necessary
41 introduction to the field of play for our music therapy practice to expand itself into a
42 full-fledged research project. Our team included two
43 It is in those moments of silence, just as they full-time music therapists, one full-time research psy-
44 begin to unfold into sound again — at the chologist, one half-time research psychologist/social
45 other side of the human vocabulary — It is worker, and another consulting research psychologist.
46 those moments of silence, after the perfect Our burning question was: Is music therapy effec-
47 tive?
48 *This chapter was originally published by Ridgeview Publishing This research question generated a 225-page doc-
49 S Company in 1989 as The field of play: A guide for the theory and ument entitled The Music Therapy Evaluation Study,
50 R practice of music therapy. filled to the brim with results of standardized tests,
80
field theory for music therapy 81
questionnaires, check lists, quotes from patient diaries, sic, in the relationships. A verbal language was not 1
and rating scales. In addition, there were approxi- available in my field of music therapy, or in others. 2
mately 50 hours of videotapes and one 16 mm docu- Second, in June of 1982 I participated in one of a 3
mentary film entitled Listen to the Musicmakers. series of international study groups, this one a sympo- 4
The question got answers not only on paper and sium at New York University entitled “Music in the Life 5
film, but certainly in the lives of many clients served of Man: Toward a Theory of Music Therapy.” Our task 6
through funding by Health and Welfare Ottawa. It also was “to develop principles on what is inherent in the 7
yielded results in helping to establish music therapy experience of music which makes it unique in therapy.” 8
training and practice not only in Vancouver, British Thirty-six music therapists and music psycholo- 9
Columbia, but across Canada as well. gists gathered from 20 countries to engage in a think 10
Then there are other questions, which remain on- tank about the state of the art in music therapy. We 11
going, or, even more often, merely generate more ques- each had written a position paper, which had been cir- 12
tions. These are the more difficult ones because they culated to the symposium members prior to the gather- 13
seem elusive, almost invisible and yet deeper. Just when ing. I had written about Debbie. 14
you think you’ve got it, something moves and every- One point of agreement, after our 6-day intensive, 15
thing changes. These are the questions that most chal- was the shared frustration of lack of language in which 16
lenge our creativity, our faith in the work. to discuss the music therapy experience. The statement 17
I have had a few of these questions as well. from the Research/Client Assessment group was: 18
For example: Why do patients in two psychiatric 19
clinics in the Health Sciences Centre Hospital at the In summary, there were no conclusions 20
University of British Columbia in Vancouver, in the drawn as to effective methods for analyzing 21
majority, consistently over a two-year period, express and presenting publicly the use of clinical 22
and communicate themes of death and rebirth regard- piano improvisation. There was a sense of 23
less of which music therapy technique is employed? frustration that this material was not being 24
This particular question catapulted me into the shared effectively. This seemed to stem from 25
mythic dimension — a study of transformation, ancient the difficulty of objectively describing what 26
healing rituals, the enduring developmental patterns of happened within the session. (Proceedings 27
human nature over time and a master’s thesis entitled from the International Symposium on Music in 28
“The Death-Rebirth Myth as the Healing Agent in the Life of Man, 1982) 29
Music.” This work, in turn, led to The Mythic Artery: 30
The Magic of Music Therapy. This problem was essentially due to the non- 31
Seven years later I met Debbie, and yet another verbal nature of the art. Yet we remained firmly com- 32
research question was born. mitted to the idea that there were essential elements 33
Debbie was an accident victim with severe physi- inherently contained in the music therapy experience. 34
cal disabilities and serious brain damage. She had been If we began the task of theory-building, however slowly, 35
sent to our convalescent hospital from a rehabilitation the result would reap rewards not only for music ther- 36
center because of her lack of response to rehabilitation apy but also for psychology and human development. 37
treatment. She had not spoken for 2 years. I worked This was the fuel I needed to motivate me in my 38
with her in music therapy, doing musical improvisation present research: a shared group commitment, a sup- 39
at the piano, 2 to 3 times a week, for half hour sessions portive network, a common information and experi- 40
over one and a half years. After a few months she began ence base, a sense of mystery and a global endeavor. 41
“sounding” with her voice. At the end of the first year, The third element is the continuation of previous 42
she began to speak. Her first word was “piano.” Then questions. I had satisfied my curiosity about “effects.” I 43
she progressed to singing, and so the story goes. I was had no outside funding sources demanding replication. 44
deeply moved by this experience. Now I could focus on inner questions — the difficult 45
There were four elements that contributed to the ones, the ones concerning “process.” This meant deal- 46
new question. First, I needed to find a way to share the ing with problems of language for description of systems, 47
process of that experience without distorting or taking designing of soft theoretical frameworks, recovering an- 48
away from it — without losing the immediacy and vi- cient concepts with an eye for future vision. S 49
brant movement of that dance we sounded in the mu- The fourth element is my desire to create ritual R 50
1 structures for the enactment of healing myths, musical true of all radiation, all forces great and
2 myths. In Myths to Live By, Joseph Campbell put forth a small, all information. (1978, p. 3)
3 rationale for the creation of new myths for out time. I
4 was challenged by this possibility. There is an exquisite beauty in patterns seemingly
5 My first book, The Mythic Artery: The Magic of unknown, yet sensed, felt, and experienced. These im-
6 Music Therapy was the first stage in this process for me. plied patterns are called forth when the intuitive func-
7 I had identified music as carrying implicit healing pat- tion has the safety and security of a supportive field,
8 terns for human development, identified spontaneously which encourages the “hearing” and “recognizing” of
9 by patients in a psychiatric setting. In this earlier work, these sound patterns. The creative process of human
10 I had subsequently focused on the “death-rebirth growth and change has a chance to soar within this
11 myth.” The field of play brings the content of myth (an field of loving and creating in sound. My experience in
12 exemplary journey or inspirational story communicat- music therapy provides a context in which to see this
13 ing human constants even in pure sound), into an ab- creative process in action — and it is my unique perspec-
14 stract ritual form, for use in healing, with a range of tive, my particular pair of phenomenological glasses,
15 techniques and clientele. that will view this experience as a field of play.
16 Eliade (1963) said that myths are in the realm of sa- By first examining the roots of the theoretical tra-
17 cred time and space and are exemplary models. Even dition in the field of music therapy, I hope that my per-
18 though the concept of myth is not discussed explicitly in spective will emerge partially through an appreciation
19 this work, it is implied in that ritual is a vehicle for myth. of that which has come before me. I have also searched
20 This theoretical framework is a structure, or, in effect, a for “our place” in the philosophy and theory of science —
21 ritual form, which hopefully can embody the myths of hu- a perch from which to fly.
22 man growth and change and provide a vehicle in which Yet hidden beneath the surface of every music
23 myth can enact itself over time in human experience. therapy practice of every music therapy practitioner is a
24 The background for the mythic dimension is con- unique theoretical foundation. We may share some soft
25 tained in The Mythic Artery: The Magic of Music Therapy. structural components, the same techniques, the same
26 So, my burning question is: Is it possible to formulate a methods. But the psyche or soul of the work is contained
27 language to describe the music therapy experience and in the individuality of each and every music therapist.
28 create one of many possible general models which accu- This individuality is a constant source of nourishment
29 rately reflect music therapy process, yet can be under- that enables our work to remain living, moving, and
30 stood and used by professionals in other fields? evolving as a form of therapy — much like music itself.
31 This question has brought challenge.
32 After five years of meeting this challenge, the The State of the Art
33 clearest point for me is the idea of the importance of lov- Music therapy is a process and a form that combines
34 ing and creating. The value of a loving and supportive the healing aspects of music with issues of human need
35 field which has as its goal the creation of beauty seems to to move toward the health and development of the in-
36 me a simple human idea that is clear and unequivocal for dividual and society at large. The music therapist serves
37 any type of development, therapeutic or otherwise. as a resource person and guide, providing musical expe-
38 The importance of sound and image are central to rience which directs clients toward health and well-
39 my ideas about healing. Sound moves. Sound forms. being (Kenny, 1982).
40 Sound changes. The field of music therapy began as a clinical
41 George Leonard, in the The Silent Pulse, has said: practice in the late 1940s with the return of World War II
42 veterans who were unmotivated and depressed. Music
43 At the root of all power and motion, at the emerged as an effective therapeutic tool to improve this
44 burning center of existence itself, there is condition (Gaston, 1968; Michel, 1976).
45 music and rhythm, the play of patterned fre- Over the next twenty-five years, music therapy
46 quencies against a matrix of time. We now became closely aligned with the behavioral sciences.
47 know that every particle in the physical uni- Literature was designed to promote and support the
48 verse takes its characteristics from the pitch acceptance of clinical practice, which was conducted
49 S and pattern and overtones of its particular primarily in state institutions, hospitals for the men-
50 R frequencies, its singing. And the same is tally ill and facilities for the developmentally disabled
(Jellison, 1976; Jorgenson & Parnell, 1970; Madson, edge in music and healing with current humanistic and 1
1975; Wolpow, 1976). transpersonal trends searching for the “inner state,” 2
Simultaneously, a more subtle strain of research which often eludes observation of behavior (see the dia- 3
was developing that reflected the movement of the cul- gram, on page 11, figure 2, taken from The role of taped 4
ture at large. music programs in the GIM process). This, too, reflected 5
There was a questioning of the validity of a reduc- the dilemma of the psychological sciences in general. 6
tionist approach, which encouraged the steady link to It was time for consciousness to emerge as a major 7
“observable behavior” (Task Panel Reports, 1978). This interest of psychology and related fields. Jonathon 8
movement was spearheaded by studies incorporating Miller described this dilemma of the psychological 9
the use of psychedelic drugs with music (Bonny, 1975; sciences: 10
Bonny & Walter, 1972; Eagle, 1972; Gaston & Eagle, 11
1970). Bonny further developed the psychedelic drug In its understandable effort to be regarded as 12
studies at the Maryland Psychiatric Institute, emphasiz- one of the natural sciences psychology paid 13
ing consciousness (1975; Bonny & Savary, 1973). She the unnecessarily high price of setting aside 14
implied that there could be something therapeutic or any consideration of consciousness and pur- 15
healing in our experience with music that was best de- pose in the belief that such concepts would 16
scribed in the realms of consciousness and therefore dif- plunge the subject back into a swamp of 17
ficult to observe in concrete and immediate behavior. metaphysical idealism. Research was designed 18
Bonny designed a model that incorporated her knowl- on “positivistic” lines, so that the emphasis 19
inevitably fell on measurable stimuli and 20
observable behavior. It soon became apparent 21
that such a program could not be sustained 22
and that psychology would begin to stagnate 23
if research failed to take account of the inner 24
state of the living being. (1983, p. 32) 25
26
The next step was to explore the inner state. Ac- 27
cording to Jung (1956), the “inner state” finds its en- 28
trance into consciousness through art. As early as 1959, 29
Aldous Huxley critiqued our separation from art and - 30
advocated a bridge-building between art and science: 31
32
We are on the horns of this dilemma: we 33
need to have the facts of science become 34
tinged with emotion before they can become 35
the material of art, but we need to have 36
them already transformed into the material 37
of art before they can become fully valuable 38
for us in emotional terms. The question is 39
finding a suitable vocabulary in which to 40
deal with these problems. (Huxley, 1973) 41
42
His concern was to develop a link between the emo- 43
tions and a new vocabulary. 44
The intellectual and professional climate has 45
changed since music therapy had its origins, since Hux- 46
ley stated his concerns and since Bonny presented her 47
controversial research. This has happened largely be- 48
Figure 3: The Bonny Model of Altered States cause of the inroads created by pioneers in humanistic S 49
of Consciousness and transpersonal psychologies, the new physics and R 50
1 the consciousness movement in general (McWhinney,

2 1984; Ornstein, 1972; Wilber, 1982).
3 In November 1985, Bonny presented a paper
4 entitled “Music: The Language of Immediacy” to the
5 National Creative Arts Therapies Association in New
6 York. She stated:
7
8 Information concerning musical stimulation
9 on body systems, neural, muscular, aural are
10 known, at least in relation to medical and bio-
11 logical science. But we are learning that there
12 are other ways in which to probe and investi-
13 gate the miraculous workings of the human
14 being. The carefully researched and discrete
15 paradigms underlying medical science daily
16 practiced and accepted by our society are not
17 truth per se but one of a number of explana-
18 tions. It occurs to me that the reason we music
19 therapists and other creative therapists cannot Figure 4: Eagle’s Model of Interdisciplinary
20 find a viable and acceptable modus operen- Nature of Music Therapy
21 dum in attaching our bandwagon to current
22 modalities may be because we are looking in about the experience and process of music that needs to
23 the wrong directions. Like the adventurer who be sought if we are in fact to allow this experience to
24 searches the world for treasure and finds it in help in the formulation of Huxley’s “new language” and
25 his own backyard, we may find the diamonds convey and describe Bonny’s “language of immediacy.”
26 we seek in our own house. (p. 255) There are challenges in naming and describing
27 the music therapy experience. The first is certainly the
28 At this point in time, the largest portion of music non-verbal nature of the art. This seems to be the over-
29 therapy literature that has accumulated over the last riding concern of groups such as the International Sym-
30 thirty-five years does not really say too much about the posium on Music in the Life of Man: Toward a Theory
31 inherent processes and experience of music and music of Music Therapy. The final recommendation of this
32 therapy. Typical articles reported in journals read as fol- group of music therapists, music psychologists, perform-
33 lows: “A Comparison of Music as Reinforcement for ers, and composers was that description be used as a
34 Correct Mathematical Responses versus Music as Rein- means to determine the foundations of music therapy.
35 forcement for Attentiveness” (Madsen, 1975). By describing the process, one could discover new
36 This young field does not really have a theory or a aspects of it, and understand it better. The group also
37 methodology. acknowledged the element of choice in theory-building:
38 Some groundwork for theory has been laid. In gen-
39 eral these studies indicate an interest in the creation of The principles of Music Therapy can either
40 models that are population specific (Asmus and Gilbert, be formulated by the support of philosophical
41 1981; Gfeller, 1984; James, 1984; LeBlanc, 1982; Troup, and scientific approaches or be determined
42 1979) and only a few general models. As Bonny has said, by our own independent theory of Music
43 we may “seek the diamonds in our own house.” We may Therapy (Proceedings from the International
44 look closely at music therapy experience and process and Symposium on Music in the Life of Man, 1982).
45 speak truly about it from our direct clinical experience,
46 not through the language of other modalities. They named the components of the musical ex-
47 According to Charles Eagle, one of the pioneers perience as the following:
48 in music therapy, this is an interdisciplinary field. (See
49 S figure 4). 1) Social/cultural aspects
50 R Yet there is also something inherent and unique 2) Neuro-physiological basis
3) Aesthetics Even Ruud, the Norwegian theorist and music 1

4) Musical personality of client/creative therapy educator states: 2
process 3
The field of Music Therapy can never estab- 4
The group agreed that, at least in terms of our lish theories and procedures separated from 5
field, these studies were in uncharted territory and ex- those within the field of psychology and 6
ploratory in nature. Most participants were committed philosophy. It is therefore necessary for mu- 7
to designing a musical language in words to describe sic therapists to be closely oriented towards 8
the musical process. This meant words with movement, these disciplines in order to maintain this 9
words of expansion, and an honoring of the process of relationship as well as to maintain their in- 10
the musical experience. tegrity. The field of Music Therapy differs 11
The field of play emphasizes the importance of aes- from that of psychology in that music thera- 12
thetics, creative process, and musical personality of both pists are concerned both with man and the 13
client and therapist. Although the language of the work relationship-man-music. In this connection 14
is not the language of personality theory, the creative it is to be mentioned that this aspect of the 15
process deals with the development of the whole person, field needs special care. The relation be- 16
and thus also the development of the personality. The tween man and music constitutes the unique 17
language is the language of music therapy. It does not part of the discipline and gives the field its 18
specifically cover the areas of society and culture or unique status. (1980, p. 70) 19
neurophysiology. There are also important links to the 20
fields of physics, biology and the natural sciences, which In 1980 Ruud described the field of music therapy 21
will not be developed here. as being in Thomas Kuhn’s “pre-paradigmatic phase” 22
and encouraged the designing of models that respected 23
Language and Description the interdisciplinary nature of the art yet emerged from 24
It is important to emphasize the non-verbal nature of the unique part of the discipline, the relation between 25
the music therapy experience. Trying to describe it or man and music. 26
explain it in the “terms” of verbal language, in a sense, The field of music therapy ought to be an open 27
must sacrifice some of its essence. And this language field where different models of understanding are given 28
and description process seeks “essence.” the possibilities to collaborate with each other; how- 29
The best we can expect is to translate our music ever, procedures within the field of therapy with music 30
therapy experience into the language of words, and vi- ought to be judged, not on the basis of whether they are 31
sual, conceptual images. In this process, we attempt to “humanistic,” “true,” or “scientific,” but rather on the 32
find appropriate scientific tools to link art and science basis of their consequences (Ruud 1980, p. 71). 33
for the benefit of the clinical community. Ruud proposed that only the testing and applica- 34
A hidden question is: What is the reality of the tion of models will prove their value. But the deeper and 35
music therapy experience? more elusive problem has to do with the element of con- 36
In an article entitled “Noetic Planning: The sciousness. How do sensation and expression relate to 37
Need to Know, But What?” Lionel Livesey Jr. states: feeling, idea, attitude, inspiration, and change? Can mu- 38
sic provide an expanding systems model? These questions 39
What “reality” ultimately is behind the phe- also emerge from issues of man in relationship to music. 40
nomenon of both subjective and objective A living system creates an energy flow of expan- 41
experience remains beyond the limitations sion, a primary field for growth and change. It is a life- 42
and even the interest of science. However, producing model. In Earth Ascending: An Illustrated 43
it may well be that we have other access to Treatise on the Law Governing Whole Systems, Argüelles 44
this reality in direct experience and its sub- addressed the global issue of art and consciousness: 45
limation in art, music and mystical knowl- 46
edge. (1972, p. 156) Art is a function of energy. Given the unity of 47
mankind as a single planetary organism, art 48
We also must consider the interdisciplinary na- is the expressive connective tissue binding S 49
ture of the art. together the individual organisms through R 50
1 energy transformations focused in the emo- stories. And, of course, there are many choices of “ab-
2 tional centers of those organisms. Properly stract cores.”
3 catalyzed through form, rhythm, color, light, A theory is something like an abstract core. We
4 sound and movement, emotional energy is learn about it through having many experiences. After
5 directly related to the establishment of a dy- a certain number of experiences in a certain field, we
6 namic equilibrium with the other forces of begin to notice constants, which pervade our experi-
7 the phenomenal world. (1984, p. 147) ences, no matter how varied those experiences may be.
8 The result of this process of observation, is that the
9 Argüelles took the whole systems perspective. How theory, or abstract core, or even schema, can then be re-
10 do the parts relate to the whole? Yet the field of play takes cycled back into experience and may assist us in moving
11 one step back into considerations of the field, created on to a new level of understanding and appreciation
12 by Ruud’s “man-relationship-music.” It concentrates on about our experiences, as we observe ourselves in them.
13 what is unique in the music therapy experience, and yet A theory implies a kind of architecture of thought —
14 may also be reflected in other experience if we can find a a structure of patterns, connections, shapes. In a way, a
15 way to translate this “language of immediacy.” theory can be imagined to be a symbol of our experience.
16 We might then interpret our symbol by translating
17 theory it into words as concepts, principles, elements, constructs.
18 There are many hazards in the process of theory-
19 The problem for any serious artist or educa- building. One of these hazards is particularly significant
20 tor is to recreate a common language for in the theory-building task for the field of music therapy.
21 the communication of knowledge. We don’t As we examine the roots of theoretical work in
22 have common language because we don’t music therapy it will bring us home again to another
23 have a common view of the universe we are variation in the problematic mind-body split — process
24 living in. We don’t share premises any more. versus product, linear versus circular, verbal versus non-
25 I don’t think we can resurrect any of the tra- verbal, logical versus intuitive, explicit versus implicit.
26 ditions in quite their old forms. But we can This is no surprise since by definition music therapy
27 re-explore these civilizations . . . retranslate walks between the two worlds of art and science.
28 their ideas into forms appropriate to the Yet it is time to begin the dialogue between
29 present. We will recreate our culture by go- worlds, those two worlds inside each one of us. It is
30 ing back to the roots. (From Kathleen Raines, time to begin the exploration into theory, to start the
31 “Recovering a Common Language”) foundation. In most cases, music therapy has looked to
32 outside theory for its support. Perhaps even because of
33 Why Theory? our position “between the worlds,” we will have some-
34 Theory serves as a foundation. thing to offer others, that part which is unique to our
35 Each individual operates from a theoretical base. experience as music therapists.
36 This base may not be articulated. It may remain unac- The global issue aside, it is important to remem-
37 knowledged, unspoken, unformed, barely in the imagi- ber that the primary purpose for a theory is to support
38 nation. Whether articulated or not, we each have an the field: music therapy practitioners, music therapy
39 underlying sense of structure at the base of our experi- educators, music therapy trainees, music therapy re-
40 ence. Whether articulated or not, music therapy, as a searchers, associations, and subsequently those who re-
41 field, also has an underlying structure. ceive our service.
42 In general, theory is abstract. Its goal is to de- For years now, whenever I have asked music ther-
43 scribe the constant elements of our experience. (Every apists in all of these categories, what they feel they
44 new situation brings new and varied elements into our need to support their work, their reply usually boils
45 structures that are specific to the context, yet exude the down to “a new language” to describe our experience.
46 unseen structure of our theory.) The discerning music therapist is cautious in the
47 Theory reflects the “big picture.” In Carlos Cas- use of language to describe the work. Perhaps this dis-
48 taneda’s book, The Power of Silence, the centerpiece of cernment comes from the non-verbal nature of our
49 S the work is a concept called “abstract cores.” This discipline, the aesthetic dimension, the importance of in-
50 R means the structure that can hold a million different tuition, the fact that music itself is another language. Per-
haps we are looking for words that express more clearly wonder aloud if . . . the expressive therapies should not 1
than usual words, the relationship between the human develop independent theoretical structures (p. 53).” 2
condition and music, mankind’s relationship to sound. This interest reflects the absence of well-grounded 3
This new language will take a kind of play, a new theory. True accountability cannot be satisfied by re- 4
creation, another aspect of being or dancing or singing search methods finding their source in theories that do 5
between two worlds. not address the essential elements of the experience of 6
The new language must be so soft and translucent the creative process, a fundamental aspect of the cre- 7
that it can hold a million variations. The process of ative arts therapies. 8
creation is at the heart of our work and therefore our 9
theories must represent dynamic forms. Solid cannot Music Therapy: The Theoretical Tradition 10
mean static. Clear cannot mean fixed. And we must 11
Despite this dearth, some theoretical fragments do exist
“hear” our experience in these theoretical forms, sym- 12
in the field of music therapy. Historically, these works are
bols that carry resounding themes. 13
discovered in conjunction with the development of
As we examine the roots of some of the theoretical 14
training programs at the University of Kansas. As is often
work in music therapy we ask this question: Can we hear 15
the case, such practical issues as training, the develop-
resounding themes of human experience in these words? 16
ment of employment opportunities, and clinical practice
Can we sense an underlying order? As we each begin the 17
are all inextricably linked with the design of theory.
process of exploring our own individual theoretical incli- 18
One of the first training programs for music thera-
nations, we can ask: Do our words resonate our life with 19
pists in this country was established at the University of
music and people in states of change, healing, human- 20
Kansas by music therapy pioneer E. Thayer Gaston. His
ness, beauty, struggle, resolution, disappointment, joy, 21
book, Music in Therapy (1968) still serves as a basic text
love? Is this like our encounter with man and music? 22
for some music therapy programs. Gaston’s text was the
23
Back to the Roots first collection of works to portray music therapy as a
24
field and thus greatly assisted the launching of music
Because the roots of music therapy are so firmly estab- 25
therapy as a profession.
lished in medicine, a general tendency of theory-building 26
Music in Therapy (1968) can be viewed as a highly
efforts has been to join forces with theories or models 27
paradoxical work. The book is essentially an anthology
which are grounded in the medical field itself and to avoid 28
of articles on practice. Gaston has very little to say
the discrete context of music therapy. Even Ruud, in his 29
about theory of music therapy and primarily embraces
text Music Therapy and Other Treatment Modalities, ex- 30
existing scientific theory in the form of behaviorism.
amines the relationship of music therapy to medical 31
Feder and Feder comment:
models, communication models, and general psycho- 32
logical models, many of which also have their origins in Despite Gaston’s disavowal of dependence on 33
medicine. a particular psychological theory, an examina- 34
Ruud describes music therapy as being in Thomas tion of the specific programs described in his 35
Kuhn’s “pre-paradigmatic phase” and encourages the collection and the research included, reveals 36
design of models which respect the interdisciplinary that operationally, the majority are based 37
nature of the art yet emerge from the unique part of the squarely on behavioral models. (p. 119) 38
discipline, the relation between man and music. Ruud 39
directs us to theory formation within the field of music A possible interpretation of the Gaston work is 40
therapy itself. that he had a sense of the theoretical movement, but 41
In the last few years, there has been growing inter- was torn between his belief in the unique potential of 42
est among creative and expressive arts therapists in gen- music therapy and pressures to lay the groundwork for 43
eral, to work toward theories that reflect the creative accountable clinical practice and employment for mu- 44
process of the arts in therapy. This interest to a large ex- sic therapy practitioners. 45
tent has been sparked through the lack of solid outcome However, the seeds of music therapy theory are 46
research in psychotherapy, which is a school often em- contained in the Gaston text. One of the articles in the 47
braced by music therapists seeking theoretical models. anthology is entitled “Processes of Music Therapy.” 48
Feder and Feder (1981) comment: “An increasing This article was written by William Sears, Gaston’s col- S 49
number of expressive arts therapists have begun to league and successor at the University of Kansas. R 50
1 Within this article, Sears clearly establishes the A theoretical formulation such as this may
2 theoretical roots of music therapy in “process.” suffer one of several fates: It may pass into
3 history having received little consideration. It
4 The Process of Music Therapy may be examined and found wanting, but be-
5 Sears describes three classifications that underlie the cause of the study it required, result in a differ-
6 processes of music therapy: “1) experience within struc- ent, more adequate formulation of theory.
7 ture; 2) experience in self-organization; 3) experience Finally, it may prove of enough interest and
8 in relating to others” (Gaston, p. 31). worth to be put to the test in practice and
9 On the theoretical level, Sears provides an envi- research to be modified, improved and ex-
10 ronmental approach — one that offers fields, conditions, panded. Hopefully, the latter fate will come to
11 relationships, and self-organization. Explicit within his pass. In any case, processes in Music Therapy
12 three classifications are self-organization and relation- take place by uniquely involving (author’s
13 ships (relating). Implicit are fields and conditions. italics) the individual in experience within
14 Operationally, this design breaks down in the structure, experience in self-organization and
15 dilemma of theoretical constructs versus pressures for experience in relating to others. (Gaston,
16 outcome studies in the acceptable language of behav- p. 44)
17 iorism — observable behavioral change.
18 For example, in his articulation of the experience Toward a Theory of Music Therapy
19 of self-organization, Sears lists his elements of self- Shortly after the death of William Sears, New York Uni-
20 organization: versity and the Musicians’ Emergency Fund sponsored
21 an International Symposium on Music Therapy, bring-
22 1) Music provides self-expression; ing together 36 music therapists, music psychologists,
23 2) Music provides compensatory endeavors for and musicians from 20 countries around the world. Bar-
24 the handicapped individual; bara Hesser, of New York University, organized this sym-
25 3) Music provides opportunities for socially posium and entitled the gathering “Music in the Life of
26 acceptable reward and non-reward; Man: Toward a Theory of Music Therapy.”
27 4) Music provides for the enhancement of After six days and nights of study groups, the sym-
28 pride in self. (p. 33) posium members issued critical assessments on the state
29 of the art for the field of music therapy. One of the
30 Perhaps the most dramatic item in this list is item 3. statements was:
31 This item was most readily accepted by advocates of be-
32 havioral research and reflects a significant development Music Therapy facilitates the creative process
33 in the interface between what little theory this field of moving towards wholeness by developing
34 had, clinical practice, and outcome studies. This ten- the ability and will to utilize the individual’s
35 dency toward behaviorism seems to be the result of a potential for wellness in areas such as inde-
36 profession’s need to survive and create accountability pendence, freedom to change, adaptability,
37 structures in a medical system, which at that time gen- balance and integration. The implementa-
38 erally avoided the aesthetic dimension, theories of self- tion of Music Therapy involves interaction
39 organization, inner development, self-reliance, and of the therapist, client and music. These in-
40 autonomy. teractions initiate and sustain musical and
41 In addition, the Sears’ list begs the question: Are non-musical change processes which may or
42 “self-expression” and “socially acceptable” mutually may not be observable. As the musical ele-
43 compatible? This is characteristic of the Sears’ style of ments of rhythm, melody and harmony are
44 ambiguity and paradox. In the final analysis, he stimu- elaborated across time, the therapist and
45 lates more questions and engages his reader in a process client can develop existential relationships
46 of self-examination. which optimize the quality of life. We believe
47 In Sears’ own final analysis, he must have had a Music Therapy makes a unique contribution to
48 sense of the consequences of his creative expositions. wellness because man’s responsiveness to mu-
49 S This is reflected in the closing statements of his article sic is unique. (Proceedings from the International
50 R on process: Symposium on Music in the Life of Man, 1982)
The New York group described music therapy as a term “sound presence” and “envelope of sound” (private 1
“creative process,” or, more specifically, the role of music conversation). Bonny describes this phenomenon as a 2
therapy as a creative process. Even though Sears does safe container or field of sound in which people feel sup- 3
not describe his processes specifically as “creative,” the ported in the process of healing. In Bonny’s view this 4
link between Sears’ processes and the New York group is supportive field guides the person into healthy change. 5
evident. Sears’ phrase “experience within structure” is Bonny was, at one time, a member of the Gaston 6
the key. For the music therapist, the structure of the mu- community. When it became clear that music therapy 7
sic, the “musical elements,” according to the New York would be following the path of the behavioral sciences, 8
group, is the guiding light of experience. Sears’ ap- Bonny broke with the general stream of development of 9
proach conforms to the statement of the role of music music therapy and took her own research in the direction 10
therapy from the New York Symposium group. The of consciousness and spirituality. The latest developments 11
symposium statement also notes the essential elements in the Bonny work represent her return to medicine and 12
of relationships and self-organization. This is indicated an integration of her consciousness studies into the med- 13
in the following description; “As the musical elements ical context. Her “sound presence” is a system designed for 14
of rhythm, melody and harmony are elaborated across hospitals, bringing her full circle back into medicine. 15
time, the therapist and client can develop existential re- Bonny’s “sound presence” and “envelope of sound” 16
lationships which optimize the quality of life.” are similar to Sears’ concept of “environment.” Music pro- 17
Within the structure of the musical experience, vides a safe field for change, growth, and recovery. Both 18
relationships develop — relationships to the music, re- Sears and Bonny are environmentalists, in this sense. 19
lationships between client and therapist, relationships Other fragments of theory are available to support 20
between sound, thought, and feeling, etc. These rela- the concept of the field or environment in music ther- 21
tionships determine the “conditions” of the field of ex- apy literature. 22
perience, actualized in music therapy as a field of sound Kenny (1985) offers a description of such an “en- 23
and the human person. The interactions, determined vironment” in an article entitled: “Music: A Whole 24
and defined through conditions, which are created Systems Approach.” Her context for practice is clinical 25
through the relationships, can “initiate and sustain mu- musical improvisation. 26
sical and non-musical change processes . . .” Thus there 27
is the implication of both conditions and fields. The time/space of musical improvisation is a 28
Music therapy, according to Sears, creates a “unique synthesizing time and space in which a per- 29
involvement.” The New York group goes further by son is naturally drawn to give form and pat- 30
stating: “Music Therapy makes a unique contribution to tern through musical expression. There is 31
wellness because man’s responsiveness to music in unique.” randomness and waiting and receiving the 32
William Sears created a significant piece of the the- authentic forms of human movement which 33
oretical picture, which would help to explore and define are both mirrored and actualized through 34
this uniqueness. The New York group expanded these rhythm, melody, dynamics, etc. . . . The mu- 35
fragments to include an even fuller architectural design. sical improvisation encourages a person to 36
identify a pattern or way of organizing 37
An Environmental Approach: which has personal significance and mean- 38
The Field of Sound ing for the music maker. Within the im- 39
Sears introduced the concept of environment and improvisation, this field of being and acting in 40
plied a field of sound. sound, ideas and feelings are allowed to float 41
In the earliest stages of his work, Sears had devel- freely until the deep natural patterns emerge. 42
oped five classifications of processes before refining In this way the Music Therapist creates an 43
these five into the three mentioned above. His original environment, a ritual space. (1985, p. 8) 44
formulation was: “1) gratification; 2) structured experi- 45
ence; 3) environment conducive to recovery; 4) rela- In an earlier work, Kenny (1982) implies this same sort 46
tionships; 5) diagnosis and evaluation” (p. 31). of field: 47
In this earlier articulation, item three expresses 48
Sears’ explicit interest in the field/environment. Music is a resource pool. It contains many S 49
Bonny, in some of her most current work, uses the things — images, patterns, mood suggestions, R 50
1 textures, feelings, processes. If selected and Boxill sees this process of interaction with the en-
2 used with respect and wisdom, the clients will vironment (physiologically and psychologically) begin-
3 hear what they need to hear in the music and ning with sensation. Her theoretical work finds its
4 use the ritual as a supportive context. (p. 5) origin in her practice with the developmentally dis-
5 abled. She describes music as a “tool of consciousness.”
6 The Nordoff/Robbins techniques of musical im- Boxill defines music as structured tonal sound moving
7 provisation are probably, as a group, one of the more ac- in time and space (p. 5).
8 cepted forms of music therapy. Although in their texts
9 (1965, 1971, 1977) Nordoff and Robbins concentrate on Organization and Self-organization
10 descriptions of practice, focusing on musical form and A large portion of the literature attempting to describe
11 ordering principles, they, too, imply an environment: music therapy experience, and therefore at least mov-
12 ing in a theoretical direction, focuses on the tendency
13 Music can become something rare, evoca- for music to encourage the human system to organize.
14 tive or consoling. It can become another Sears, the New York group, and others mentioned pre-
15 landscape for him (the child in therapy), viously have emphasized the importance of structure
16 one in which he will be able to find more and thus organization.
17 than the limits of his own being . . . It be- Given the behavioral orientation of many music
18 comes a secure, fertile landscape of experi- therapy practitioners, this tendency toward “organiza-
19 ence in which he feels himself quick — ened tion” often means that the therapist chooses music that
20 into communicative response — a new emo- will draw the patient into a particular type of organiza-
21 tional stream begins to flow, nourishing a tion that is “healthy.” Relaxing music may calm a hy-
22 new awareness of self and of expressive ca- peractive child. Stimulating music may activate a
23 pability. (1967, p. 56) depressed adult.
24 A considerable amount of research is now con-
25 McMaster (1976), a practitioner of the Nordoff firming that the human system does, in fact, adapt to
26 and Robbins techniques, also implies a creative process sound input on both physical and psychological levels,
27 within a safe environment or field. Commenting on her i.e., a “sound presence,” to borrow Bonny’s term, does
28 work with emotionally disturbed children, she observed change the person.
29 that the children learned the following in their musical One example of this research in the music ther-
30 improvisation experiences: “1) to stretch out past safe, apy literature discusses the importance of “rhythmic
31 familiar experiences; 2) to notice and value an expres- entrainment.” After describing his findings in a study
32 sive moment; 3) to invest concentration in an activity; exploring the relationship between music therapy and
33 4) to sustain an enjoyable activity.” learning, Rider (1985) stated strongly that “rhythmic
34 synchronization plays such an important role in learn-
35 This model affords a fluid role for the thera- ing that its function cannot be understated” (p. 19).
36 pist, a framework that can include many dif- Rider then proceeds to describe the possibility of match-
37 ferent levels of participation, a creative and ing the rhythmic synchronizations of the learner in
38 organic process stemming from and devel- order to initiate therapeutic change.
39 oping through the changing nature of its to- Rhythmic entrainment is often demonstrated in
40 tality. (p. 6) what music therapists call the “iso” principle, a term in-
41 troduced by Altshuler in 1948 in an article entitled: “A
42 Her totality represents a field of experience in musical Psychiatrist’s Experience with Music as a Therapeutic
43 improvisation. Agent.” The “iso” principle instructs the music thera-
44 Boxill (1985) defines her work through the “con- pist to match the patient at the patient’s own level of
45 tinuum of awareness,” borrowing from the Gestalt rhythm, melody, timbre, etc. It is assumed that if the
46 tradition, but still within the “field of sound.” She de- patient sees that the therapist is willing to “entrain”
47 scribes this as a creative process which uses music func- with him, or join him in his sound representations, this
48 tionally as a tool of consciousness to awaken, heighten, willingness encourages the patient to be more open
49 S and expand awareness of self, others, and the environ- to explore and entrain with the therapist’s rhythms,
50 R ment (p. 71). which ideally will reflect healthy patterns.
The “iso” principle conforms to the principles of further, music therapy as a self-organizing system, as 1
organization, however, it is questionable in terms of Kuhn’s “community of professionals.” Wheeler seeks 2
“self-organization.” This is a highly controversial issue the elements of the experience of music therapy, con- 3
among music therapists, and touches on questions of stituting a phenomenological approach, an eidic reduc- 4
intervention versus the right to express, or, even more tion. In her own theoretical language, she identifies 5
specifically, “compliance versus expression.” three elements in music therapy: 6
As we have demonstrated, there seems to be a 7
fundamental paradox about this issue in the music ther- One is that people are variable; each person 8
apy culture at large. Sears stresses self-organization, yet brings his or her own set of characteristics to 9
operationally sets up an entrance for positive reinforce- the situation. The second element is that 10
ment for socially acceptable expression only. music is complex; a piece of music consists of 11
Yet Sears still stated: “Experience in self-organizing different melodies, harmonies, rhythms, tim- 12
concerns inner responses that may only be inferred bres, dynamics, etc. And third, the process of 13
from behavior and has to do with a person’s attitudes, therapy means that, at any specific moment 14
interests, values and appreciations, with his meaning to in therapy, certain things are brought to bear 15
himself” (Gaston, p. 39). which are individual only to that moment. 16
Sears spoke of “inner responses,” yet opera- (Proceedings from the International Symposium 17
tionally, patients were rewarded only for “socially ac- on Music in the Life of Man, 1982, p. 1) 18
cepted responses” in the token economy. 19
Summary 20
The Dilemma of Uniqueness This exploratory review has studied some of the 21
The irony of the work of William Sears has to do with historical roots of the theoretical movement in the field 22
the clarity he expressed in terms of the creative process, of music therapy. There may not be a well-grounded, com- 23
the value of individual expression the accommodation prehensive theory. However, there are tendencies toward 24
to external systems. The field of music therapy perhaps theory, which constitute seeds for theoretical growth in 25
accommodated some of its own uniqueness in order to this field. Noted in this study are tendencies: 26
establish a foundation of acceptance for practice. How- 27
ever, in this process, perhaps some of the essential ele- 1) to consider music therapy as a creative 28
ments of music therapy were devalued, a result of the process; 29
natural process of consensus. Creative process was one 2) to imagine this process in a field; 30
of those elements. 3) to appreciate the significance of relation- 31
The context in which to observe and alter these ships in the field; 32
accommodations emerges as the theoretical tendency 4) to appreciate the power of organization and 33
of organization/self-organization. self-organization in the musical experience; 34
Wheeler, a member of the New York Symposium, 5) to consider the conditions in the field. 35
expresses this dilemma in her submission to the sympo- 36
sium papers: If we are prepared to consider music therapy as a 37
process-oriented art and science, we can thus identify 38
It seems that too often, Music Therapy re- four essential elements of the music therapy experience 39
searchers may have let the elements of indi- from this study of theoretical roots. These four ele- 40
viduality frighten us from even attempting ments are: 41
to classify or categorize but that, crude though 42
initial attempts may be, we must look for 1) conditions; 43
the relationships and explore them in a sys- 2) fields or environments; 44
tematic manner. (Proceedings from the Inter- 3) relationships; 45
national Symposium on Music in the Life of 4) organization/self-organization. 46
Man, 1982, Wheeler, p. 1) 47
Perhaps the first is the least explored of the ele- 48
Wheeler exposes the dilemma — the fear of individ- ments. Conditions are an important consideration in S 49
uality — the link to the self-organizing system, and any field. What conditions does the therapist place into R 50
1 the field by being and acting who s/he is in the context solid clear ground upon which to build our theoretical
2 of sound? There are many other questions about the structures.
3 condition factor. The sound expressions can be under- Philosophy asks questions of meaning.
4 stood to express the conditions that help to define the Many of the disciplines that address human suf-
5 field. It is important to consider these “conditions” even fering tend to ignore the intimate connections between
6 before the onset of the therapeutic relationship, since philosophy, theory, and practice. Sometimes in the face
7 they may constitute non-verbal cues in the field. What of burning issues of human needs, our awareness of
8 conditions does the client bring into the field? Condi- these necessary links is pushed aside for more practical
9 tions represent strengths and limitations. Conditions considerations. Subsequently, over time, we are left with
10 determine what is accepted or rejected in the field. ungrounded architectural structures and techniques of
11 Attention to the “field” is another significant fac- practice without meaning.
12 tor. This is Bonny’s “sound presence” and “envelope of Philosophy exists implicitly in each one of us,
13 sound,” Sears’ “environment,” Kenny’s “resource pool,” whether we acknowledge it or not and thus creates a
14 and Nordoff and Robbins’ “landscape.” This is the con- condition, albeit non-verbal, of our engagement in ex-
15 tainer for change, the supportive context. perience.
16 Both music and the human system are abstract There is a constant creative movement between phi-
17 and sensorial and both are relational systems. They op- losophy, theory, and practice that keeps a discipline and
18 erate in interplay with parts of their own system and each individual in the discipline secure and capable of on-
19 with many other systems. This is the context for going change in the work. One springs out of the other.
20 growth and change. Therefore it is critical to look into Each adjusts and learns from the others. There is a dia-
21 the aspect of “relationships” created in interplay be- logue, an interaction between explicit and implicit forms.
22 tween man and music. The heart and soul of our philosophy and theory
23 The aspect of organization is equally significant. come forth to serve as the wellspring of our practice.
24 Organization is consistently a topic of theoretical con- The noticing, acknowledging, and consistent develop-
25 cern among music therapists. Does the person organize ing of our philosophical base, as well as our theoretical
26 the music or does the music organize the person? When structures, brings a fullness and security to our work as
27 and where is each appropriate? music therapists.
28 One of the dilemmas of the philosophical en-
29 philosophy deavor is that intimate, soulful, and creative move-
30 ments are sometimes difficult to remember because of
31 Phenomenology is a revolution in man’s un- the pressures of explicit activity. Yet our direct experi-
32 derstanding of himself and his world. But ence and the way we view it, in other words, our philos-
33 the newness and radicality of this revolution ophy, have a direct connection. Our philosophy is the
34 is faced with a problem, the same problem source and therefore the cause of many of our actions in
35 which arises in the epiphany of any new our work. It informs our decisions.
36 phenomenon. What phenomenology has to And for the music therapist, as we have seen, the
37 say must be made understandable — but connection to direct experience is fundamental. In a
38 what it has to say is such that it cannot be sense we must be doing, or at least vividly remember-
39 said easily in a language already sedimented ing, music therapy experience while designing philoso-
40 and accommodated to a perspective quite phy and theory. It seems important that we call forth
41 different than that taken by the revolution- every resource we know as “memory” of our moving
42 ary. What eventually may be said must first moments with music and clients, while creating these
43 be “sung”. One only gradually learns to hear more abstract formulations. In this way our architec-
44 what sounds forth from the “song.” (From tural designs and our philosophical base are merely “re-
45 Don Idhe, Sense and Significance) membering” the musical moments.
46 Our words mirror, if not replicate, our music ther-
47 Why Philosophy? apy experience. We may think it rather strange to “play
48 If theory serves as a foundation for practice, philosophy into” the philosophy and theory of science. But as mu-
49 S serves as the foundation for theory. sic therapists that is what we do. We play a duet of mu-
50 R Metaphorically we can imagine a philosophy as sic and the person.
In the walk between the worlds of art and science, ence. Therefore research into the use of the arts would 1
this play must go on. It is a dance that will enable us naturally be tinted with artistic reflection. Eisner made 2
each to find our place upon which to build. an interesting point in his comparison between scien- 3
As we are carving out our place in the larger pic- tific and artistic approaches to research when he claimed 4
ture of human development, how can we find a way of that any artistic approach to research is fundamentally 5
articulating a philosophy that honors our direct experi- associated with the discovery of meaning, not necessar- 6
ence as music therapists? How can we find a method of ily truth. He stressed the importance of the creation of 7
inquiry into the nature of our work, which will keep us images that people will find meaningful and from 8
in the immediacy of our experience? which their fallible and tentative views of the world 9
This exploration is a great adventure for each in- can be altered, rejected, or made more secure. Truth 10
dividual and music therapy as a whole. implies singularity and monopoly. Meaning implies rel- 11
We can look for allies on our way, explorers who ativism and diversity (1981, p. 9). 12
have met the challenge of similar questions. These It seems sensible that an artistic researcher would 13
thoughts, insights, and creations are like musical inter- be concerned with the “creation of images,” which is 14
ludes, which guide or inspire us and help us to find a the modus operandi of the world of art. The image is 15
school in the philosophy and theory of science. We try created subjectively by the artist and presented as an 16
a phrase here, a melodic pattern there. We add our own object to the audience as a reference, a measurement in 17
formulations, until, as a whole, the composition res- the broad sense of the word, for alteration, rejection, or 18
onates to that which seems true to our experience. validation of the perceiver’s fallible and tentative views 19
This is the journey into the philosophy and the- (Eisner). The dilemma is to find research attitudes and 20
ory of science. methods that utilize the sensibilities of both artist and 21
scientist. This is particularly relevant in fields such as 22
Philosophy and Theory of Science music therapy in which art forms represent the mode of 23
If music can in fact be considered a language of imme- being and acting. Research that is both artistic and sci- 24
diacy, it seems obvious that any efforts in the design of entific would be concerned with issues of both truth 25
language and construction of models describing the and meaning, objectivity and subjectivity. 26
process of music therapy be closely connected to meth- 27
ods that keep us in touch with direct experience. In his Phenomenological Inquiry 28
work Personal Knowledge, Polanyi suggested a theory of The philosophy and theory of science that seems to suit 29
knowledge based on a critical link to direct experience. this orientation to research into the creation of images 30
In fact he claimed that we do not have knowledge out- is phenomenology. 31
side of our experience. Thomas Kuhn in his seminal Phenomenology is concerned with direct experi- 32
work The Structure of Scientific Revolutions used the term ence of a phenomenon. In its simplest form it is merely 33
paradigm as a reference word for the design of models a tool for flooding “light” onto a phenomenon. It exam- 34
for science. His use of the term implies tacit knowing as ines the appearances of things. Thus the phenomeno- 35
one of the major resources for the design of all models of logical endeavor is one that focuses on perceiving, on 36
science. He spoke of these resources as “shared posses- seeing, on illuminating. 37
sions of the members of a successful group” (p. 193). He Although the goal of phenomenology is one of 38
proposed that the way to start sorting out and manifest- description, on a more fundamental level, the task is to 39
ing these shared possessions is by the presentation of “reduce” all being to phenomenality (Husserl, 1965). 40
exemplars within a particular field and the subsequent The phenomenologists search for this phenomenality 41
comparison in the perception of “known experience” of through the discovery of essences. Merleau-Ponty de- 42
the phenomena represented in the exemplar. This way scribed phenomenology as the study of essences. For 43
the convergent and divergent perceptions of a com- him, all problems amounted to finding definitions of 44
munity of specialists will reveal themselves. This is the essences. This discovery, he claims, puts essences back 45
beginning of new paradigms. Kuhn stressed the impor- into existence. He saw all the efforts of phenomenology 46
tance of tacit knowledge and a type of community intu- as being concentrated upon re-achieving a direct and 47
ition that will eventually reveal similarities in thought. primitive contact with the world, and endowing that 48
Any research into the processes associated with contact with a philosophical status. S 49
music establishes a necessary link between art and sci- It is the search for a philosophy that shall be a R 50
1 “rigorous science,” but it also offers an account of space,

2 time, and the world as we live them. It tries to give a di-
3 rect description of our experience as it is, without tak-
4 ing account of its psychological origin and the causal
5 explanations that the scientist, the historian, or the so-
6 ciologist may be able to provide (1973A, p. 357).
7 Thus, we have the phenomenological link to tacit
8 knowledge, direct experience, and being in the world.
9 Merleau-Ponty claimed that all knowledge of the
10 world, even scientific knowledge, is gained from one’s
11 own particular point of view or from some experience of
12 the world without which the symbols of science would Figure 5: Interplay between mind, sensation, body
13 be meaningless. He was concerned about the dissassocia-
14 tive results of science and believed that the modern task verse of perception and comprehension — a subjective
15 of philosophy and theory of science is to begin a reawak- and at the same time objective universe. This occurs in
16 ening of the basic experience of the world of which sci- art. The analysis of the cognitive function of phantasy
17 ence is the second-order expression (1973, p. 73). is thus led to aesthetics as the “science of beauty”: be-
18 The phenomenological method carries this man- hind the aesthetic form lies the repressed harmony of
19 date. Through its link to direct experience it abandons sensuousness and reason (1962, p. 130).
20 the Cartesian mind-body split. It considers perception Marcuse was concerned with the development of
21 as a critical tool in “viewing” and illuminating the the seemingly paradoxical “science of beauty,” a universe
22 world and of being in the world. of perception and comprehension that is both subjective
23 and objective. He spoke of the repressed harmony be-
24 Existential Phenomenology tween sensuousness and reason. He sought to undo the
25 A study of the existential phenomenologists reveals a repression through the aesthetic dimension and to
26 clear link not only to perception, but also to sensation. demonstrate the inner connection between pleasure,
27 Although there is a distinction between thought or idea sensuousness, beauty, truth, art, function, and freedom.
28 and sensation, both are equally important in viewing
29 the world. Sensation is more closely associated with di-
Consciousness
30 rect experience because of its physicality. Examples of Having established the fundamental link to direct, and
31 sensations are colors, odors, tastes, sounds, tactual feel- what we might now call, sense experience we can con-
32 ings, heat, cold, etc. (Grossman, 1984). This places the sider the next significant point of phenomenology, i.e.,
33 train of thought once again in the realm of art and the consciousness. So important is the issue of conscious-
34 creation of image, whether in color, pattern, sound, ness that Grossman defined phenomenology as the
35 form, etc. In fact, sensation may be the critical link in study of the essence of consciousness (p. 144). We can
36 mind and body, because of its location in both. Sensa- assume that this is not a consciousness that represents
37 tions are experienced sensorily, in the body, whether pure abstract thought, but one that incorporates direct
38 these are subtle or gross sensations. Sensation is how we experience as its source. So phenomenology consists of
39 gather information about the world. It is direct experi- a reflection on consciousness, or ordinary mental acts
40 ence. It also translates into mental constructs such as of perception, experience, desire, fear, etc. He consid-
41 perceptions and thought forms as well as feelings. With ered the subject matter of phenomenology to be con-
42 this in mind we could consider sensation as an integra- sciousness itself (p. 144).
43 tive force connecting mind and body (see figure 5). It is important to remember that at its core phe-
44 Herbert Marcuse took another step, bringing phenomenology is a transcendent philosophy, dedicated to
45 nomenology even further into the realm of art when he the elevation of consciousness. Grossman reflected on
46 established the link between perception, sensation, the paradox and exquisite beauty of the philosophy
47 phantasy, imagination, and knowledge. Marcuse also when he said:
48 added the dimension of the global, mythic reality.
49 S The truths of the imagination are first realized There is the act itself and then there is its
50 R when phantasy itself takes form, when it creates a uni- object. Beyond these noemata, transcending
them, lies the non-mental world. This world ten this is demonstrated in detailed descriptions of the 1
is forever beyond the direct grasp of con- concrete events, situations, and behaviors of a particu- 2
sciousness. Both the self and the world are lar phenomenon. However, the method also provides 3
beyond our reach. But in the middle, be- for more than the elucidation of concrete events and 4
tween the two, dwells consciousness in observations. And in this more subtle form of percep- 5
splendid lucidity. (p. 146) tion we see an entrance for the artistic view. 6
The method of the phenomenological endeavor 7
In the aesthetic dimension, our senses are stimu- is called eidic reduction, or the search for essences. 8
lated by sound, color, pattern texture, etc. Through the These essences are considered links to direct experi- 9
senses, we perceive beauty and the doors of perception ence rather than universals (Grossman, p. 138). How- 10
open into the development of consciousness. Thus ever, essences are not always easily observed through 11
there is an intimate link between sensation and con- concrete data. The method provides a particular 12
sciousness, the space between self and world. In the vehicle for the vision or conceptualization of experi- 13
world of human development and healing, conscious- ence, as observed and perceived in the realm of abstract 14
ness is the gateway to change. thought about direct experience. This still conforms to 15
In this figure (see figure 6), the new element is Husserl’s concept of the “bracketing of the objective 16
consciousness, now joined to sensation. This link liber- world,” by providing a framework through which to 17
ates consciousness from the realm of the abstract and perceive concrete reality. 18
expands it to include the world of concrete experience The task is always to locate phenomenality. Ed- 19
or sensation. There is an interaction between sensation mund Husserl, the founder of phenomenology, intro- 20
and consciousness between the physical and the men- duced a vehicle whose purpose is to determine the 21
tal, which can trigger awareness, growth, and change. essences of a phenomenon through what he called “free 22
One of the possible limitations of the cognitive and phantasy variation.” It is neither purely inductive (em- 23
verbal psychologies is the abstraction created by the pirical) nor deductive (as is formal logic), but involves 24
separation from the world of concrete experience the use of intuition. Here “phantasy” retains the “ph” 25
through solely intellectual and verbal abstraction. This of the German phantasie to emphasize its relation to the 26
figure has as a primary aspect the fundamental aspect of Greek root phaino, meaning “to bring to the light of 27
the arts — sensation. Thus we see Marcuse’s ideal of a day,” from which phenomenology is derived. The heart 28
science of beauty with the marriage of sensation and of this method is examining various possibilities of what 29
the realm of abstract thought in the form of reason. If may be examples, pictures, or images of the phenome- 30
this link can be assumed we clearly realize the relation- non in order to determine what its essential elements 31
ship between the sensation of art (in this case music) are. These variations need not be restricted to the fac- 32
and the development of consciousness. tual or the possible, but may be purely imaginative, or 33
represent pure perception on the part of the observer 34
The Phenomenological Method (Hegel, 1977; Husserl, 1965). 35
The phenomenological method has to do with the dis- 36
covery of essences in some form of description. Very of- Importance of Hermeneutics 37
A particular area of phenomenological research pertinent 38
to the creative arts therapies is hermeneutics, the science 39
of interpretation. The central theme of hermeneutics, 40
as explained by Heidegger is “the modes of engage- 41
ment.” For Heidegger, the primary mode of engage- 42
ment is the “ready-to-hand” mode, which once again 43
demonstrates the phenomenological commitment to 44
direct experience. 45
When we carry out activities, our awareness is es- 46
sentially holistic. We are aware of the situation we find 47
ourselves in, not as an arrangement of discrete physical 48
Figure 6: Interplay Consciousness, Body, objects and not as a portion of the physical universe, but S 49
Sensation, Mind globally, as a whole network of interrelated projects, R 50
1 possible tasks, thwarted potentialities, and so forth. This 2) Acquisition (collection of data)
2 network is not laid out explicitly, but it is present as a Tacit knowing
3 “background” to the project we are concerned with, and Intuition
4 we can turn to aspects of the network and bring them Inference
5 into focus. There is no deliberate means-end framework Self-dialogue
6 (Packer, 1985, p. 1083). Self-disclosure
7 Hermeneutics supposes that it is through reflec- Significant-symbolic representation
8 tion on this Gestalt that we interpret our experience — 3) Realization (synthesis)
9 always keeping an eye out for the whole, yet in direct Intentionality
10 relation to experience, e.g., in the “ready-to-hand” Verification
11 mode. The hermeneutic science assumes that one can- Dissemination (1985, pp. 45–6)
12 not understand a particular act without understanding
13 the context in which it occurs — a systems principle. Their general description of this mode of inquiry
14 The ready-to-hand mode involves a complexly rings of the creative process:
15 woven network that Heidegger called the referential to-
16 tality (Packer, 1985, p. 1086). This referential totality It is difficult to describe the heartbeat of
17 in a sense is the ongoing source of our knowing, serving heuristic inquiry in words alone — so much
18 as a constant reference point to our direct experience. of the process lurks in the tacit dimension, in
19 The particular structure of a hermeneutic charac- mystery, in the wild promptings of imagina-
20 terization is a semantic one, not a logical or causal one. Its tion, and in edgings of subtlety. Heuristics
21 relationships are meaningful ones, sensible and necessary; encourages the researcher to go wide open
22 but only in terms of the particular historical and cultural and to pursue an original path that has its ori-
23 situation under investigation (Packer, 1985, p. 1089). gins within the self and that discovers its di-
24 rection and meaning within the self. It does
25 Heuristic Inquiry not aim to produce experts who learn the
26 Another aspect of phenomenological study that seems rules and mechanics of science; rather, it
27 relevent is the heuristic approach. This particular ap- guides human beings in the process of asking
28 proach mirrors the goals of the general phenomenolog- questions about phenomena that disturb and
29 ical inquiry, e.g., a search for the discovery of meaning challenge their own existence. (p. 53)
30 and essence in significant human experience. It also
31 seeks the disclosure of truth. Its unique aspects have to Systems
32 do with a belief that self-experience is the most impor- As organized sound, music itself is a system. A school of
33 tant guideline in the pursuit of knowledge. Once again, philosophical and theoretical thought which assists us in
34 this has to do with the link to tacit knowledge and di- our model-making is systems thinking. The most basic at-
35 rect experience. One only knows what one has experi- tempt of the systems theorist is the design of models that
36 enced in the self. The refreshing quality of this line of help us to understand and thus manage energy.
37 methodological thinking is the importance of the re- One of the major orientations of the systems
38 searcher in the process of the study. Any research proj- thinkers is their wholehearted acceptance of the chal-
39 ect can be considered a design of the researcher’s lenge to view the universe not as a collection of physi-
40 worldview, or some aspect of that view, because one cal objects but rather as a complicated web of relations
41 can only create out of what one knows to be true and between the various parts of a unified whole (Wilbur,
42 meaningful in the self, then in relation to the world. 1982). This, too, sounds like music.
43 Douglass and Moustakas (1985) presented a three- In this sense systems thinking is always a global
44 phase model representing the steps of heuristic inquiry: concern. According to Wilbur this shift in the scien-
45 tific spectrum has to do with the entrance of quantum
46 1) Immersion (exploration of the question, theory. Thus in modern physics the fields become pri-
47 problem or theme) mary, as opposed to Newtonian physics, in which forces
48 Indwelling arose from separate material bodies (Sheldrake, 1986).
49 S Internal frame of reference Lazlo (1972) saw this movement as a shift toward
50 R Self-search rigorous but holistic theories. This means a view of
facts and events within the context of wholes, forming understanding of a unifying principle or law. This re- 1
integrated sets with their own properties and relation- quires acknowledging our mutual resonance and inter- 2
ships. Looking at the world in terms of sets of inte- dependence, as well as interactive components of our 3
grated relations constitutes the systems view. systems. The importance of an awareness of the reality 4
Nature is the constant grounding for the systems and details of resonating fields is the key to Argüelles’ 5
perspective. The view of nature and man is nonanthro- thought. He believed the only way to accomplish this 6
pocentric, but it is not nonhumanistic. awareness is a sincere unified effort between aboriginal 7
continuity and civilization advance. 8
[systems] are goal-oriented, self-maintaining, Argüelles saw science as representing the mode of 9
and self-creating expressions of nature’s pen- civilization advance (CA) and art as representing the 10
chant for order and adjustment. Seeing him- mode of aboriginal continuity (AC) and attached great 11
self as a connecting link in a complex natural importance to the activities of art and creative process 12
hierarchy cancels man’s anthropocentrism, in order to do away with holonomic amnesia. 13
but seeing the hierarchy itself as an expres- 14
sion of self-ordering and self-creating nature The Field 15
bolsters his self-esteem and encourages his Field theory is a category of systems thinking. McWhin- 16
humanism. (Laszlo, 1972B, p. 118) ney (1984) described some of the discrete characteris- 17
tics of the field thinkers. Field thinkers carry the 18
Thus systems thinking is a vehicle for man to ap- imprint of the holonomic design from the general sys- 19
preciate and define his link to nature, and to use that tems tradition. However, their discrete characteristics 20
vision as a constant reference point in the design of have to do with their tendency to view boundaries as 21
natural structures for any human event. unnatural, and as mere assumptions created for the con- 22
A system is basically a scheme or structure. Eliade venience of understanding and articulation. Since the 23
considered fruitful structuralism the kind in which one field theorists consider the field infinite in many aspects, 24
is constantly asking oneself about the essence of a set of only aspects of it can be described and their influence 25
phenomena and about the primordial order that is the articulated at any point in time and space. 26
basis of their meaning (Eliade, 1963). He thus articu- A field theory describes the ways in which forces 27
lated the link between phenomenology and systems. are resolved, that is, how the impact of the various 28
Whole systems theorist Jose Argüelles sought the forces continually balance out and what paths a system 29
primordial order suggested by Eliade (Argüelles, 1985). follows in its response to those forces. The formal state- 30
Argüelles contended that we have lost the sense of the ments in field theories are about the distribution of 31
natural order through a state of holonomic amnesia. He conditions, qualities, or forces over certain dimensions 32
defined this amnesia as a state of forgetfulness of the (McWhinney, 1989, p. 54). 33
primordial order, the order that existed before techno- Field thinking represents the position of maxi- 34
logical advance. He claimed that this sense can be re- mum interdependence among elements. The field is al- 35
covered only through allowing our consciousness to ways an environment in which any point can represent 36
travel through what he called aboriginal continuity, an the whole, through the vision of an organic creative 37
intuitive level of awareness retains the sense and struc- process. The field theory is expressed in formative 38
ture of the primordial order and that is a necessary and terms, that is, in terms of patterns, relations, and ratios 39
critical compliment to the civilization advance, which as opposed to numbers and processes as opposed to ob- 40
reflects our logical and technological knowings. Ac- jects affecting each other. 41
cording to Argüelles, it is only through curing our holo- Field thinking was not easily accepted in the 42
nomic amnesia that we can in fact know and apply the world of science. McWhinney considered the cultural 43
primordial order, the natural order that is reflected in trends of the tumultuous decade of 1965–1974 as the 44
nature. starting place for acceptance and support of the field 45
He proposed a model of unified field theory as a approach. He named the following movements as criti- 46
universal resonant mechanism. He further believed cal to this change in the scientific climate: 47
that there is a critical need at this point in time for 48
what he called holonomic reciprocity, a type of inter- 1) the growing awareness of Eastern thinking S 49
action between subsets which unifies them through an (D. T. Suzuki and Alan Watts), R 50
1 2) the rebellion against allopathic medicine lary of this is that where playing is not possi-
2 and the emergence of holistic approaches ble then the work done by the therapist is
3 to health, directed towards bringing the patient from a
4 3) discontent with the prevailing theories of state of not being able to play into a state of
5 evolution, being able to play.
6 4) the emergence of the “third-force” psy- — (From D. W. Winnicott, Playing and Reality)
7 chologies and their use in the understand-
8 ing and design of work, Essential Elements of the
9 5) the existential psychologies of Peter Mar- Music Therapy Experience
10 cuse, Norman O. Brown, Martin Buber, What is a “field”?
11 and others, The term “field” brings to mind a concentrated
12 6) the rising awareness of danger to the ecol- area of earth covered with delicate yellow and white
13 ogy from human excesses (Rachel Carson), flowers called daisies or an alpine meadow surrounded by
14 7) the invention of the laser through which snow-capped peaks. It also brings to mind an empty,
15 the holographic ideas (founded in the late clear brownish or greenish area of earth surrounded
16 1940s) were made practical, by trees — a field of play. Instead of flowers this particular
17 8) and, perhaps more important and more subtle, field will hold humans who seem to move a bit like
18 an involvement with self-awareness which, flowers. The two differences are that they are usually
19 while exaggerated in the excesses of the “me kicking or chasing a round object about on this field and,
20 generation,” has now emerged as a deep en- second, they are not rooted to the earth. This makes
21 gagement with consciousness. (1989, p. 62) them freer to move about than flowers.
22 This mixed freedom allows humans to engage in
23 In general, support for field thinking came from other fields — fields of awareness, fields of study, fields
24 concern with biological phenomena, the sense of unity of thought.
25 of man with the ecology and the sense of the deep in- An entire field of thought has developed around
26 terrelatedness of the elements of a living organism — and about our curiosity about “the fields,” whether we
27 particularly human. are a physicist, a football coach, a child looking for deer,
28 In the 1940s and 1950s Kurt Lewin attempted to whatever. There must be something reassuring about the
29 design field theories for social science, including social idea of being in a field — whatever its constitution. Per-
30 systems and the dynamics of personality. But his work haps we remember something which pulls us back to
31 was not generally accepted and applied due to the cli- that type of space. A field seems to be a reasonable way
32 mate of the psychological sciences. Yet he offers a com- to perceive or imagine reality. If we can imagine that
33 prehensive theory and praxis of field thinking. He boundaries contain a space, we are not bombarded by
34 maintained the environmental perspective and de- sensory and psychic stimuli. The concept of “the field”
35 signed concepts such as personal life space, representing allows us to focus and appreciate that which is in the
36 spatial configurations over time around the individual field, and the conditions and relationships among the
37 and various social structures (Lewin, 1935). participants contained within this space.
38 He stressed the interdependence of parts, and the The term “condition” is a bit of a hard pill to
39 links to Gestalt psychology, and the establishment of swallow most of the time. For example, we seek “un-
40 pathways that create interconnecting networks in the conditional” love. I suppose a safe way to approach the
41 spaces of personality and group. topic is to find a point of agreement.
42
43 the field of play model* We are all in the human condition.
44 Who would deny that?
45 Psychotherapy takes place in the overlap of This condition can be used as we choose.
46 two areas of playing, that of the patient and It brings us home to paradox.
47 that of the therapist. Psychotherapy has to do
48 with two people playing together. The corol- We are prisoners of our conditions — limited and
49 S *See back cover of book for complete illustration of the holo- bound. Yet conditions are also paradoxically what al-
50 R graphic model of Field of Play. low us to grow, expand, and change.
Many people believe that there is a certain beauty non-verbal cues, which are communicated by the indi- 1
in the human condition and all the conditions that ac- vidual in being and acting and are perceived through 2
cumulate to create the human condition. the intuitive function. The aesthetic is an environment 3
After all, “beauty” has a rather broad definition in which the conditions include the individual’s human 4
when it comes to the “human condition.” It contains tendencies, values, attitudes, life experience, and all fac- 5
even suffering, pain, and loss. This is the ebb and flow tors that unite to create the whole and complete form of 6
of human life — love and loss, suffering and joy, pain beauty, which is the person. Furthermore, each therapist 7
and pleasure, and on and on. and client is a complete and whole aesthetic. In and 8
The Navaho help. The goal of Navaho life is to through the aesthetic domain, we express our human 9
“walk in beauty.” One of their daily prayers: conditions. The task of the therapist is to honor and no- 10
tice the conditions in the field of the client. The aes- 11
With beauty before me, I walk thetic of the therapist is significant and highly formative 12
With beauty behind me, I walk in the interplay that will come out of the mutual sharing 13
With beauty above me, I walk of space because the therapist, essentially, invites the 14
With beauty below me, I walk client into the broader field of play. Her conditions set 15
From the East beauty has been restored the tone, and in a sense determine that which is ac- 16
From the South beauty has been restored cepted and rejected as being and acting in the mutual 17
From the West beauty has been restored field-to-be-created in the relationship between therapist 18
From the North beauty has been restored and client. By nature, the aesthetic is open and expand- 19
From the zenith in the sky beauty has been ing, always available for input. (See figure 7). 20
restored 21
From the nadir of the earth beauty has been Principles of the aesthetic: 22
restored 23
From all around me beauty has been restored. 1) An aesthetic represents that which one 24
(Witherspoon, pp. 153–4) carries and communicates into the world 25
based on the screening system of choices 26
They describe a field of beauty that surrounds the hu- and judgments regarding that which one 27
man person. considers to be “beautiful.” (Assumption: 28
For music therapy it is a natural association. For As one moves toward beauty, one moves 29
“music” is in the aesthetic domaine, and restoration, re- toward wholeness, or the fullest potential 30
habilitation, and re-creation are our task. of what one can be in the world.) 31
So conditions exist — and they are part of the beauty. 2) An aesthetic represents the conditions one 32
The human person, the client or the therapist, is establishes by “being one who is” in rela- 33
a field full of conditions, an environment, similar to the tion to self and others. 34
alpine meadow, the swamp, or the prairie, and full of 3) In the therapeutic situation, the therapist is 35
beauty, surrounded by beauty. dominant in the field because the therapist 36
We can say that the client, being a field of beauty, is essentially invites a client into her field to 37
whole and complete, unique, an aesthetic. In a sense, the 38
process of development is to expand this field through in- 39
creasing or decreasing certain conditions, or merely re- 40
organizing or creating new patterns of conditions. 41
A great deal of thought has been put into the or- 42
ganizing aspect of this field. 43
But let’s fall back a bit into the undifferentiated field 44
of beauty— no patterns, no sound, no organization— pure 45
and undefined, vast, full of potential, hope, creativity. 46
47
Primary Elements or Fields 48
The aesthetic (blue) Definition: The aesthetic is a field of S 49
beauty that is the human person. This field contains all Figure 7: The Interplay of Aesthetics R 50
1 engage in actions designed by the therapist.

2 Since expression is a creative force, the ac-
3 tion actualizes the aesthetic. Therefore, her
4 conditions are highly formative in the new
5 field-to-be-created from the relationship be-
6 tween the aesthetic and the next primary
7 field, the musical space. The therapist will
8 attempt to equalize conditions through imi-
9 tation and modeling of the patient’s sound
10 forms. This also serves to educate the thera-
11 pist about the aesthetic of the patient, to
12 learn, to grow, and to expand.
Figure 8: The Interplay of Musical Space
13
14 So, therapist and client are each a whole and com-
15 plete, vibrating, rich, energy form, full of potential. This that space or field or environment which is
16 form or field is experienced on the intuitive level by both created through mutual intention and first
17 therapist and client before the onset of “therapy,” before action (engagement). It is a closed space,
18 the first word, the first sound. It is a kind of encounter in an intimate space based on the relationship
19 what we might call pre-sound. Yet it is a time for gather- between therapist and client.
20 ing significant information for the new field-to-be- 2) This origin represents the conception of re-
21 created through mutual participation in sound creation. lationship in a musical field, as well as rela-
22 tionships in all that is represented in the
23 What does the music therapist do initially? musical form (feelings, thoughts, sensa-
24 The music therapist provides the conditions for tions, behaviors).
25 the establishment of a musical space. 3) This is sacred space because of the nature
26 of its origins and represents a delicate and
27 The musical space (violet) Definition: The musical space powerful moment in time. It is the first
28 is a contained space. It is an intimate and private field time something new comes into being and
29 created in the relationship between the therapist and indicates a receptivity to creation (change)
30 client. It is a sacred space, a safe space, which becomes and thus to resources in the contained field
31 identified as “home base,” a territory that is well known of the musical space defined through the
32 and secure. In early childhood development, it is simi- relationship between therapist and client.
33 lar to the space created between mother and child. 4) When the two aesthetics of therapist and
34 Trauma necessitates the recovery of such a space for client merge, enough trust will develop to
35 growth and change. It is a time when a person must recreate a new field which through the musi-
36 organize and reintegrate him/herself after trauma, a cal play and expansion of the closed field,
37 break in natural and healthy development. Initial entry given the proper conditions, grows and ex-
38 into this space is gained when participants are moti- pands into the field of play.
39 vated to make the first “sound,” a creative gesture, a
40 risk, a self-motivated action from an intention to en- So the musical space is created through a mag-
41 gage. In a sense, the space is “sealed off ” or contained netic pull. That which can come together does come
42 when both participants have joined each other in these together to create a new field in the musical space.
43 first sounds. They get to know each other in the terri- After trust is established and the participants are
44 tory. In this field of musical being and acting, the familiar with the conditions in home base — perhaps
45 emerging process of delicate new beginnings in devel- expressed through a recurring melodic or rhythmic
46 opment is enacted in musical form. (See figure 8). form, a particular tonality or dynamic, they know each
47 other and there is security and confidence enough to
Principles in the musical space:
48 initiate a sense of play and experimentation.
49 S 1) The musical space has its source in the aes- At some point this experimentation bursts into
50 R thetics of the client and the therapist. It is an open space — the field of play.
one lacking definition. There is a new- 1

found freedom here to play and expand 2
into experimental forms offered in requisite 3
variety, through memory and action, from 4
the undifferentiated, unpatterned, and 5
open aesthetic. 6
3) This is multidimensional, expansive, dy- 7
namic play in a field of expressive sound 8
forms yielding a creative process. 9
10
So we play and fold in and fold out of the musical 11
Figure 9: The Interplay of Field of Play texture. We scout new territory — new sound forms, which 12
represent and express and create new ways of being. 13
Whereas the musical space and the field of play 14
The field of play (red) Definition: The field of play (see draw partially from concepts described in related fields 15
figure 9) is a space of experimentation, modeling, imi- of psychology and human development, the element of 16
tation in sound forms that express, represent, and com- field of play initiates relationships into secondary ele- 17
municate significant feelings, thoughts, attitudes, ments that represent ancient healing systems: ritual, a 18
values, behavioral orientations, issues of growth, and particular state of consciousness, power and creative 19
change. It is an open and expanding field and occurs process, the last of which brings us full circle into con- 20
only after safety has been established in the musical temporary issues of healing and therapy. (See figure 10). 21
space. It has the quality of “surprise,” playfulness, fluid- 22
ity, and confidence. It is analogous to the stage of hu- Secondary Elements or Fields 23
man development in which the secure infant reaches Ritual (green) [See back cover] Definition: Ritual has 24
out into the world, traveling beyond the mutual space a sacred quality, just as the musical space. It too, is 25
shared with mother to experiment with the world out- contained. It also serves as home base. It is an arena 26
side the mother/child relationship. of repeatable forms and gestures, the constants, which- 27
provide a ground base for innovation. Ritual, in musi- 28
Principles of the field of play: cal improvisation, constitutes sounds and behaviors that 29
30
1) The field of play has its source in the musi- 31
cal space and expands into an open field 32
that incorporates four secondary fields: rit- 33
ual, a particular state of consciousness, 34
power, and creative process. 35
2) This field anticipates the movement of the 36
self-organizing system, which naturally 37
moves toward wholeness and expansion, 38
given the strengths and limitations of the 39
conditions in the field. Representational 40
sound forms, or responses to sounds, 41
emerge that both reflect and create this 42
movement and change. This process is 43
constantly supported through the continu- 44
ing awareness of the relationships estab- 45
lished in the musical space, and the 46
randomly experienced sense of beauty in 47
the conditions of the field of the aesthetic. 48
This awareness provides the option of re- S 49
turning periodically to a field of security, or Figure 10: Secondary Fields in the Field of Play R 50
1 are repeated over the course of the session. Ritual inter- creative process to facilitate reorganization and re-
2 plays with a particular state of consciousness to create a integration. The process is the product.
3 feeling of existential time, so that all that can emerge,
4 does emerge, given the conditions in the field, within the field of play:
5 the time of the session. the holographic model
6 In ancient times rituals triggered trance states, a [See back cover]
7 state of being in which to fly — to gather, to journey.
8 The repeatable forms in music serve as rituals that can The holographic paradigm informs us that the brain is a
9 also initiate a sense of flight. They can alter brain hologram perceiving and participating in a holographic
10 waves and chemistry. They can, aesthetically, create a universe (Wilber, p. 3).
11 home base, a sense of security, so that one can feel safe Our brain mathematically constructs “concrete”
12 enough to fly into a particular state of consciousness. reality by interpreting frequencies from another dimen-
13 sion, a realm of meaningful, patterned, primary reality
14 A particular state of consciousness (dark blue) [See back that transcends time and space. The brain is a hologram,
15 cover] Definition: The particular state of consciousness interpreting a holographic universe (Wilber, p. 5).
16 opens the fields to more input. It is a state of deep con- We can imagine the music therapy experience to
17 centration and focused attention, yet deep relaxation. It be a reflection of the holographic universe as well as an
18 allows a receptivity to new experience, new forms, new essential part of that holographic universe. The field of
19 sound perceptions in the movement toward wholeness. play holographic model provides a visual description of
20 When one flies in the sound, a feeling of inner this process as it interplays through the course of a mu-
21 motivation can develop — an embodiment of newness, sic therapy experience.
22 growth, power. We see the opening and closing nature of the
23 model, in each of the fields, which alternate between
24 Power (orange) [See back cover] Definition: Power is opening and closing, reflecting the movement of nature
25 that cumulative energy which draws one into new pos- itself. The elements of musical space, ritual and power
26 sibilities in the arena of change. Power is experienced are contained visually within strict boundaries. The el-
27 through a dialogue between inner motivation, strength, ements of the aesthetic, the field of play, a particular
28 movement, and significant external resources in the ex- state of consciousness, and the creative process are
29 istent field. Because of its need to accumulate energy, open and expanding forms.
30 power is enacted through contact with threshold points. One of the frustrations of presenting such a holo-
31 Therefore it necessitates a containment for the accu- graphic model on a flat surface is that it is virtually
32 mulation of energy, which can then burst forth into ex- impossible to accurately depict the multidimensional as-
33 perimentation for growth and change. pects of the process. This is particularly true with the
34 When one feels powerful, one has the courage to third element, the field of play. It may be a stage process.
35 engage in creative process — to search in the vastness Yet each element is essential and continues to be so.
36 as well as the hidden recesses for the “right” sound in Conditions may change: some are retained, some are dis-
37 the process of creative self-organization. carded in the play, informed by the requirements of the
38 creative process. The so-called goal, the creative process,
39 Creative process (rose) [See back cover] Definition: The which in actuality is manifesting itself from the onset,
40 creative process is the interplay of forms, gestures, and and merely developing over time, reaches an intense
41 relationships, which as a whole constitute the context level of complexity by the end, which has initiated be-
42 for a movement toward wholeness. It is an existential ginnings and endings of simultaneous processes, which
43 being and acting which is not product-oriented and are impossible to picture on a one-dimensional surface.
44 which appreciates each emerging moment as the only As indicated in chapter two, this particular model
45 moment in time, yet acknowledges the past with atten- was designed to incorporate the established essential el-
46 tion for possible future movement. It is informed by ements identified within the theoretical tradition of
47 love, the intelligence of the heart, and thus the knowl- music therapy. These essential elements were discov-
48 edge of the self-organizing system. It assumes that given ered after an investigation of the work of William Sears,
49 S its creativity, a safe environment, and appropriate re- Helen Bonny, previous Kenny work, and other theoret-
50 R sources, after trauma, a person will naturally use the ical fragments from several music therapy practitioners.
Thus the elements of the music therapy tradition The four secondary fields contained in the third 1
form the basis for the field of play, which expands the primary field of play are: 2
elements in light of the clinical work of Kenny, ob- 3
served through the phenomenological method. 1) Ritual 4
Yet the four elements identified by Sears appear in 2) Particular state of consciousness 5
all seven of the essential elements described in the field 3) Power 6
of play. All four elements of conditions, fields, relation- 4) Creative process 7
ships, and organization are contained in all seven ele- 8
ments of the field of play. 9
For example, the aesthetic has conditions, is a Emphasis is on the continuity of fields as energy contin- 10
field, forms relationships, and is by nature in relation- ues to move, whether fields are open or contained. 11
ship and participates in organization, as essential ele- They proceed organically. Also, although there are 12
ments of its existing and functioning. The same is true stages in time, there is not a hierarchical value placed 13
for musical space, etc. on one field over another. All are essential and of equal 14
The aspect of organization that is developed here value. The music therapist strives to attain the third 15
is the result of the formation of “relationships,” one im- primary element, the field of play, because it is a space 16
portant aspect shared by both man and music. with maximum growth potential. However, if other 17
Certainly, as mentioned in chapter two, there has previous fields are forgotten, the high energy of the 18
been a great emphasis on the aspect of organization in field of play is minimized. Therefore the music therapist 19
previous theoretical and practical work in music ther- is challenged to constantly be aware of the essential na- 20
apy. The focus on other areas here has been a response ture of all seven fields simultaneously. 21
to the deficit of information on other aspects of the mu- It is not a linear process, but rather multidimen- 22
sic therapy experience. An overemphasis on organiza- sional. Relationships multiply exponentially. There are 23
tion has often resulted in detailed analysis of musical relationships between all the fields that are not de- 24
form and human behavior, as opposed to the more gen- scribed here. 25
eral feeling texture of the music, attention to the aes- For example, because the fields grow in number 26
thetic domaine, which gives a particular perceptual without discarding previous fields (although conditions 27
orientation toward “conditions.” are discarded), there is a relationship between the aes- 28
thetic and power. There are also multiple relationships 29
Narrative Description of the Field of Play between all the various elements, e.g., musical space, 30
In this model all seven essential elements are described field of play, ritual, creative process. Creative relation- 31
as fields. Each field provides an environment with con- ships create more relationships. 32
ditions. When fields overlap or come together, they It would be virtually impossible to name all the 33
form a relationship between fields that then creates conditions establishing a field. Within this framework, 34
new fields. The dynamic component of the model is an attempt is made to emphasize the importance of ac- 35
thus relationships between fields, and more specifically knowledging conditions. This is particularly true in the 36
conditions in the fields expressed in musical form. initial stages, when the aesthetic of the therapist is a 37
The first three fields can be considered stages in powerful field, which either supports or inhibits the pa- 38
time, although not necessarily chronological time. tient’s attempts at growth through establishing condi- 39
tions by her way of being and acting within the context 40
1) The aesthetic of the music therapy session. Some examples of condi- 41
2) The musical space tions in the seven fields are: 42
3) The field of play 43
1) Conditions in the field of the aesthetic: 44
They are primary fields. 45
The last four fields are contained in the field of value for beauty in changing places of 46
play and represent a four-fold interactive set. They are human development 47
not necessarily time-ordered and are determined more love 48
through personal tendencies, cultural orientation, and anticipation S 49
comfort of style. existential attitude R 50
1 value for the principles of the self- and discarding of conditions comes out of the logic of the
2 organizing system self-organizing system, and the necessary organizational
3 value for openness aspects for each new field coming into being.
4
5 2) Conditions in the field of the musical space: Hearing the Play
6 And how do we see this logic of the self-organizing sys-
7 belief in the power of sound to change tem, or, more importantly, how do we hear it?
8 and form First, it is important to state that the principle of
9 commitment self-organizing is an assumption inherent in the model
10 a value for relating — the drive in living matter to perfect itself.
11 containment It is implied in the Navaho inspired-phrase “a
12 movement toward beauty is a movement toward
13 3) Conditions in the field of play: wholeness.”
14 We assume that given the proper conditions, a
15 belief that through playing in sound, cre- client and therapist will:
16 ative development will occur
17 a value for play and modeling 1) move toward beauty
18 openness or
19 2) drive to perfect him/herself
20 4) Conditions in the field of ritual: or
21 3) self-organize in the best way possible, given
22 constants the conditions in any field, in a given mo-
23 repetition ment in time.
24 containment
25 Perhaps the easiest way to observe this process and hear
26 5) Conditions in the particular state of con- it is in the context of the musical improvisation. And
27 sciousness: the field of play, though a general model, was designed
28 from the context of spontaneous musicmaking.
29 fluidity It was also designed out of one-to-one work. The
30 the state itself (between the abstract and model can serve practitioners in a variety of situations
31 the concrete) through a variety of techniques. This is because the
32 openness world of our work is essentially musical, man in rela-
33 tionship to music. Even if we are using verbal tech-
34 6) Conditions in the field of power: niques, even if we are giving music lessons, or leading a
35 rhythm band, or a handbell choir, the music of our ex-
36 building up of energy to a threshold perience is essential. We can hear this music. In a sense
37 point this is the vision and hope of the holographic para-
38 actualization and action digm, the implied form, under the surface of our experi-
39 containment ence, which reflects the whole of our experience, no
40 matter what our explicate reality may be.
41 7) Conditions in the field of the creative The simplicity and clarity of the one-to-one work
42 process: helps us to focus on a relationship with only two indi-
43 viduals. This gives us a good foundation to then brain-
44 the process, including all previous condi- storm about contexts that contain more than two
45 tions participants.
46 Spontaneous or improvisational music provides a
47 It is important to remember that all newly forming context in which to experiment and play with sound
48 fields have their own conditions and also retain or discard and thus allow the participants to design an expressive
49 S previous conditions, depending on the requirements of form that reflects and actualizes their natural tendency
50 R the new field. That is to say, the sorting out, retaining, toward self-organization.
The musical improvisation provides a supportive anticipation for and belief in what is possible in the 1
environment in which they can experiment until they emerging moment, all this in reference to learning, 2
find authentic expressions that do in fact reflect and growth, and change. It has to do with stretching the 3
actualize deep growth and change. They receive the boundaries of what we consider our limitations — for 4
benefit of expression and communication in the imme- client and therapist. 5
diacy of the sound, which serves as an image and a The aesthetic forms a defined, yet open, space: 6
change agent. one that provides safety and support, one that receives 7
In this sense, the musical improvisation is both all being and acting as part of the ongoing process of 8
subjective and objective — subjective in that it reflects change (defined through the emerging relationship be- 9
the inner life — human feeling, thought and experi- tween client and therapist). 10
ence, and objective in that it creates an external ob- Anticipation is another important condition in this 11
ject, i.e., the music. field. The therapist is committed to maintaining a pos- 12
Thus one can “hear” the reflection of one’s own ture that waits enduringly for the slightest micromove- 13
being — appreciating, adapting, adjusting, and experiment, sound, or pattern indicative of a movement toward 14
menting and potentially moving toward the highest wholeness. This movement could be dramatic or subtle. 15
level of organization that one is capable of in that par- These movements are initiated by the client although 16
ticular moment in time. they may be inspired by the therapist. Movements toward 17
This is the relationship and the interplay between wholeness reflect the logic of the self-orgnanizing system. 18
man and music and in essence the nature of music The therapist notices, receives, and responds to this move- 19
therapy. ment, signified by patterns and textures of sound. If the 20
patient is willing to share, that is, not only express, but 21
the interplay of the fields also communicate this changing process, a step has been 22
taken toward communication, relationship, and rehabil- 23
It has become a sort of principle of modern itation. 24
thought that the two attributes of totality Fundamentally, the therapist is limited in terms of 25
and reflective consciousness cannot be asso- what s/he is able or willing to notice. But it is hoped 26
ciated with the same subject . . . Totality can that through her/his own human experience and skill, 27
only be grasped at the point where it gath- s/he will notice and respond to some significant aspect 28
ers. And such a point is perfectly conceiv- of the patient’s stretching boundaries in the direction 29
able since, in the realm of spirit-matter, of positive change. 30
nothing limits the inner complexity of a The field also resonates in many domains and di- 31
point. mensions. For example, even though it is moving toward 32
(From Pierre Teillard de Chardin, Human emotions in its primary intention it has effects in the 33
Energy) cognitive and sensori-motor areas as well. All expres- 34
sions are received, acknowledged, and valued. 35
Theoretical Description Each aesthetic is highly individualized and never 36
The first important step in the theoretical model of the value free. Values or beliefs, even though they may be 37
field of play is the acknowledgement of an aesthetic. non-verbal, constitute conditions in the field. In the 38
An aesthetic is a field or environment containing con- aesthetic of the therapist the following values and thus 39
ditions for the creation of beauty. In the music therapy conditions are present. They form a foundation for all 40
experience, the human person is an aesthetic and thus seven fields. 41
an environment of being and acting through relation- 42
ship and music, with a particular attention for human 1) Value for a particular form of beauty, which 43
growth and development. As an aesthetic, the human has to do with changing places, particularly 44
person holds love as an informing energy that provides in human growth, development and learn- 45
conditions in the field. ing, feelings of expansion, feelings of appre- 46
The process in the field of the aesthetic has to do ciation for all the variables in the field 47
with changing places acknowledged and developed (including attitudes, beliefs, behaviors, ob- 48
through musical experience. The field of the aesthetic servers, light, extra sound, etc.) inclusively, S 49
is a place that appreciates what is present, yet has an and openness; R 50
1 2) Value for an existential approach that music, as created by client and therapist together form
2 views each moment as the only moment in the space just as the aesthetic previously formed the
3 time in the given field; space prior to the engaging activity between therapist
4 3) Belief in the principles of the self- and client. Therapist and client come together in the
5 organizing system — that each human creative act of making music.
6 being is unique and that part of each The musical space is a self-contained safety zone
7 human, no matter how deeply traumatized, that develops out of the relationship between the two
8 holds the most logical and effective plan participants. This relationship, which becomes con-
9 for the whole of his/her development, tained in a mutually created space now becomes the
10 as well as each step in the sequence of most formative condition in the field.
11 development and change. Once the trust has been established in the musi-
12 cal space and the participants have developed a rela-
13 In the final analysis, the aesthetic represents a tionship through sound that creates a home base or
14 way of being that carries information and conditions. It constant, it is then possible for the musical space to ex-
15 stresses the importance of subtle, non-verbal cues com- pand into the field of play.
16 municated before the onset of concrete activity. It rep- The field of play is a new field, one that includes
17 resents the sum total of who we are, and transmits the aesthetics and the musical space. It grows out of
18 information about who we are on a subtle level before these two, yet expands into a field of experimentation,
19 the onset of relationship. Being “who we are” commu- play and modeling. It is an open space, which is more
20 nicates a field of being and establishes conditions to conducive to innovation and more fluid in nature.
21 which clients respond during improvisation. The con- Each participant plays and models forms that
22 ditions of the aesthetic also grant support and permis- hold meaning for the individual creating the sound.
23 sion for particular parts of the client to emerge and The client improvises and searches for meaningful pat-
24 evolve within the musical space and the field of play. terns and sounds. The therapist follows the patterns
25 When the aesthetics of client and therapist over- and forms of the client to intensify the texture — to ex-
26 lap, that which is able to come forth and create a rela- plore and develop the feelings or thoughts within the
27 tional field emerges. Once again, the logic of a natural improvisational form. Similarly, the therapist presents
28 self-organization is in play. A commitment is made to models of meaningful sounds that s/he determines may
29 this new field when there is a point of engagement in be useful to the client from her experience. When a
30 the musical gestures. This new field is called the musi- pattern or form is intuitively embraced by client, thera-
31 cal space. It is a space that is closed, i.e., a private space pist or both, the assumption is that this form holds
32 which is reserved only for therapist and client. The mu- meaning for the client and/or therapist and therefore
33 sical improvisation is the meeting place between the will be played or developed for a while — to investigate
34 abstract and the concrete. It represents abstract phe- meaning, communication, expression, and growth.
35 nomena such as ideas, emotions, attitudes, etc., yet is a Through this relationship of play and modeling
36 sensorial phenomenon in sound forms. within the musical improvisation, each selects the
37 In the musical space, the client and therapist pieces or parts or wholes of musical patterning that
38 merge into a pool of human expression and communi- make sense in the authentic expression of the self and
39 cation. They become equally significant participants in the mutually creative process. Again, this is a form of
40 and formers of the being and acting in this new field organizing sound.
41 through relationship of the two. The participants cre- Hopefully, the openness of the aesthetics and the
42 ate this space through their relationship to each other trust developed in the musical space continues to func-
43 represented in the music. The playing of music is a de- tion in the field of play as therapist and client engage in
44 velopmental action and represents whatever each se- spontaneous playing with patterns, rhythms and sounds,
45 lects to place into the field of the musical space, once harmonies and melodies, consonance and dissonance,
46 again demonstrating organization. The commitment to dynamics, etc. The assumption is that authentic sounds
47 play music together is the most consistent and reliable will emerge and provide the starting point for develop-
48 condition in this field. ment. Most often these authentic expressions have to
49 S The environment that was first formed by the aes- do with deep emotions, which, for whatever reason, are
50 R thetic is now realized through the musical space. The inexpressible in verbal language. The expression and
communication of these emotions initiates growth and of consciousness into a fluid reality that is not contin- 1
change. gent on circumstance, e.g., disability. The most out- 2
It is believed that within the process of the musi- standing condition in this field is the state itself. 3
cal improvisation development will occur. The process Power is a phenomenon that sets the patient in 4
is the product. motion. It represents the field that is created through a 5
The field of play contains four interactive ele- relationship between will and receptivity, which yields 6
ments or fields: ritual, a particular state of conscious- inner motivation and action. It is critical to human 7
ness, power, creative process. These fields overlap to growth and development and essential for change. If 8
also create conditions and relationships that develop the patient has been favorably inclined toward the pre- 9
the potential of the field of play over time. vious elements, the particular state of consciousness 10
Ritual is the set of repeatable forms created has prepared him or her for the inner motivation, the 11
through the conditions present at the time of the ses- ritual would have given him or her the ground base 12
sion. These forms can include the overall form of the needed for experimentation, and s/he has gathered and 13
session itself and all of the various musical forms ex- continues to gather substance through the ongoing mu- 14
pressed in the musical improvisation, and any other sical space and the field of play. Therefore it is possible 15
pattern that is repeated in the ritual space. The actual to allow interaction between the state of inner motiva- 16
playing of music is a constant. The circumstances are tion and receptivity in order to actualize power. 17
reliable, replicable, and constant — the room, entering Power is a contained phenomenon and is associ- 18
the room and greetings, the action of verbal and musi- ated also with the accumulation of enough energy to 19
cal dialogue, moments of silence and stopping, playing initiate change. Therefore it is a threshold point. It 20
again through several progressions, endings, goodbyes. builds over time until there is a natural breakthrough. 21
Hopefully, the ritual forms, which emerge organi- In the musical form, it is most easily recognized 22
cally from the experience, particularly in the musical through initiation of expression and assertiveness on 23
improvisation itself, will provide another ground base, the part of the client. The most important condition in 24
just as the musical space. This field of support allows the this field is actualization so that the client can experi- 25
participants to try out innovation within the security of ence the concrete results of his musical gestures, hear 26
constants, or within the framework of the repeatable his/her own power in this movement and thus main- 27
forms that have emerged in the field of play thus far. tain an ongoing feeding of the state of inner motivation 28
The most important condition in this field, then, and receptivity to new forms. 29
is the condition of constants. Once again, this emerging Creative process is the last field in the model. It is 30
structure demonstrates a tendency to organize through a result of the interplay among all the previous ele- 31
identifying these constants in the field. Once again rit- ments yet it is the process itself, as well as the product. 32
ual interplays with the aesthetic, the musical space and The process is field-creating but also self-creating or 33
the field of play, representing an organic process. self-actualizing. It is organic in that it emerges sequen- 34
A particular state of consciousness is a field of fo- tially from each previous influence and existential in 35
cused relaxation and intense concentration, yet play- that it proceeds from and to each moment in time. This 36
fulness. Once again, it is a state between the abstract is demonstrated in patterns of sound or receptivity to 37
and the concrete and thus bridges two realities. One is sound in the experience. This is the holographic nature 38
aware of feelings and thoughts yet also engaged in the of the model. 39
sensorial realm of creation of sound forms. This cre- 40
ation assumes an ability to select and screen input aes- Description of Music Therapy Session 41
thetically as it is presented through the results of Even before the onset of therapy it is very important to 42
musical improvisation. Some sound patterns and forms attend to comfort of the setting. Both the room and the 43
are accepted, some are rejected, depending on their therapist must indicate a safe and inviting environ- 44
success or failure as authentic expressions. In this state ment for the client. Some factors to be considered are 45
of consciousness one is self-motivated. It is a motiva- lighting, temperature, acoustics, privacy. There must be 46
tional state that plays itself into change through musi- easy access to the piano. 47
cal form. It thus reflects another type of organization The therapist should be pleasantly dressed and be 48
and also includes all previous fields and conditions. It is in a calm, confident and receptive state. It is important S 49
an open field that allows one to travel in the dimension to say a kind of prayer — to call forth the necessary R 50
1 skills and talents available in the vast range of possibili- “If you like a sound your hand just happens to
2 ties within the aesthetic of the therapist. It is hoped that land on,” I said, “you just fool around with it. If you
3 the resources that are most appropriate and will be most don’t like it, move on to some other sound combina-
4 life enhancing for the client will function to the maxi- tion. Mainly enjoy yourself. Go for as long as you want.
5 mum degree. In this spirit, it is also important that the Stop when you want.”
6 therapist clarify her/his intentions for the situation.
7 In the session with Jack I attended to these con- Jack continued to laugh intermittently through
8 siderations as much as possible. My intention for him this first bit of conversation to relieve his tension. I
9 was that he would feel safe enough to allow the best joined him in the humor, smiling and letting him know
10 steps in his human development to emerge within the that his laughter was totally acceptable to me.
11 session and that he would retain this growth with
12 enough insight and intuition to transfer it into other Then he said: “I don’t know where to begin.”
13 areas of his rehabilitation process. My secondary inten- I said: “Sometimes you can start just like this.”
14 tion was that I would be able, clearly and confidently,
15 to meet him in the music in order to best facilitate this At this point I randomly smashed down five con-
16 process as a guide and resource person. secutive notes simultaneously. This represented the
17 This was Jack’s first music therapy session. Ini- first piano sound.
18 tially he displayed an obvious level of anxiety. Since it Up to this point I would say that we were getting
19 was the first session, I was also a bit nervous. The pres- to know each other’s aesthetic through conversation,
20 ence of video cameras and equipment also probably tone of voice, body language, gesture, and intuition.
21 created tension in the room. The presence of the hospi- This was a form of personal play, finding a place to re-
22 tal staff psychologist was reassuring to Jack, since he late through our personalities. The initiation of sound
23 was a familiar, supportive person. on the musical instrument was my indication that I was
24 When Jack entered the room, I asked him where ready to engage in the second stage, the musical space.
25 he would like to sit. I gave him the choice of which side Jack then quite quickly began to play the piano,
26 of the piano to play from. indicating his intention to join the musical space.
27 He played very standard sequences of broken triads,
28 “Where would you feel the most comfortable,” I beginning with C, E, G and progressing to D, E, F
29 asked. with the same 1-3-5 sequences up the keyboard in my
30 Jack took his place at the bass end. direction.
31 Jack replied: “I very rarely play.” I imitated his sounds and forms in two octaves in
32 the treble range. Then on his fifth triad, I offered a simple
33 To me this indicated an initial fear of expecta- modification, 1-5-3 sequence in triad instead of 1-3-5.
34 tions. What would be required of him in this situation? I also played the two octaves in harmony with each
35 I attempted to create an atmosphere of maximum other once, maintaining the form of the third. Jack
36 flexibility to let Jack know that there were no rules per acknowledged the subtle change of mood created by
37 se and that the expectation level to perform was very these changes by a little chuckle, not of the nervous
38 low. I reiterated the invitation to sit wherever he liked kind. We “took turns” in our playing.
39 and proceeded to explain the soft structure that would I continued to follow his lead, yet modify here
40 create a container for the experience. and there slightly.
41
42 I introduced myself and said: “What has Cliff (the Then I said: “It doesn’t have to sound nice. Just if
43 psychologist) said to you about this?” you want it to.”
44 Jack replied: “Very little. He said I was going to Jack said: “I kind of do. I hope it does.”
45 play the piano. I don’t really play, but I said alright.” I reassured him by saying: “It sounds very nice.”
46 “This is literally ‘play,’ ” I said, “fooling around at
47 the piano . . . not to play by written music, or any set I hoped that this would give him permission to go
48 thing. Basically, just having fun. I’ll just follow you — on. But most importantly, it indicated to him that his
49 S complement, play along, or imitate.” goals were my goals and I thought he was accomplish-
50 R Jack laughed at this. ing his goals, e.g., to “sound nice.”
At this point Jack became more experimental and emerged from the field of play. In a sense I assumed a 1
broke away from the one previous octave range he had portion of Jack’s identity at this point. Hopefully, my 2
used. This indicated to me that he initiated the third playing created a supportive context that found its 3
stage, the field of play. The feeling was one of bursting source in his own choices. Thus my support mirrored 4
forth, going further afield. In the musical form this was Jack supporting himself. He could thus engage in the 5
indicated by moving beyond the fixed tonality, the 1-3-5 field of play in a new way. 6
broken triadic structure, extending across four octaves, The establishment of the tonality in G Minor 7
thus taking up more space on the piano. His dynamics created a “home base.” Hopefully, the security of hav- 8
also increased in volume. He made bigger sounds, more ing a home base in the sound would encourage Jack to 9
sounds. He was no longer tentative. Although he chose have more freedom of exploration. 10
to keep returning to the chordal emphasis, he would also This improvisational section in the middle of the 11
experiment with other possibilities — one note, un- session, based in G Minor, represents the core of the 12
usual combinations of notes beyond the safe 1-3-5 pat- therapy. Jack was in a particular state of deep concentra- 13
tern, etc. tion, yet relaxation (a particular state of consciousness). 14
Jack began to concentrate intensely, listening and He accepted the constant of the G Minor tonality and 15
judging the sounds. I continued to play with the idea of the chordal structures (ritual). His improvisation was 16
supporting his experimentation. When I felt that he strongest in this segment (power). Jack’s improvisation 17
was tensing up in a non-productive way, I played some was highly creative in this sequence, a great variety of 18
staccato sounds to break up the tension. sounds, combinations of sounds with varying texture 19
and dynamics (creative process). 20
Then I said: “Remember that there are no mis- This was the peak. 21
takes.” After a time, Jack ended the sequence. He broke 22
He played a soft sound and I said: “Nice. That’s away from the tonality and began to look for something 23
romantic.” else. In one of these experimentations, he said: 24
25
This was to reinforce his desire to have his sound “I’ve done those before. Let’s see . . .” (searching 26
be “nice” and to indicate that I was picking up a spe- for new sounds). He also said: “What else can I do 27
cific quality from his music. I wanted him to know that here?” 28
I was being informed about his aesthetic through his 29
sound creation and that I accepted and appreciated it These comments indicated to me the seeking of 30
as well as interpreted it in my own way. It seemed to me even more variety. He had “played out” the themes in 31
that Jack barely heard this comment because of his the G Minor tonality. My assumption was that these 32
deep concentration. sounds and moods were Jack’s implicate forms, pat- 33
Then Jack wanted variety. He kept extending his terns, and self-organizing order. I also assumed that 34
range of sounds and experimenting with different tonal the sounds implied meanings and were significant to 35
structures. Jack. At the time we did not verbalize the meanings, 36
However, I noticed that in his experimenting he and, in fact, the meanings may have gone beyond the 37
had a tendency to return to G minor tonality. At one reach of words. However, he found them and used 38
point when he was meandering through the options in them. Then he played a chromatic progression down to 39
this tonality, he spontaneously said “Hmm, nice.” This bass. I copied and followed his movement down the 40
was the one spontaneous explicit indication that he piano. 41
had been pleased with his creative efforts. I had already For awhile Jack returned intermittently to the G 42
noticed the G Minor tendency and his comment rein- Minor tones with a different texture than before — 43
forced its significance to Jack. To me that meant that, more bold. But he continued to move gradually away 44
at least for the time being, Jack considered this “terri- from these sounds for more variety. 45
tory” to be home base. He had established his own sup- Then Jack played some sounds he didn’t like. 46
portive field in a tonal range. He was getting tired and sighed. Jack stopped 47
I took this as a clear cue. My new improvisational playing and asked: 48
strategy was that I stayed primarily in the G Minor S 49
range to provide the new supportive context that had “What next?” R 50
1 I suggested that we switch sides of the piano. Jack Removing the color from the model demonstrates
2 went to the bass. I took the treble. Jack played solid F the complexity. It is difficult to describe the music ther-
3 Major tones. apy experience on a flat one-dimensional surface. If
4 we assume that this is an expanding, holographic sys-
5 Then he played another sound he didn’t like and tems model, it will expand in every direction, creating
6 said: “That was a sour sounding note from me.” more conditions, relationships, fields and organizations,
7 He said: “I’m getting worn out.” upon conditions, relationships, fields and organizations
8 exponentially. The field of play is a “field matrix” that
9 Then he took the back of his hand and ran it centers and holds a process.
10 down the entire keyboard. I did the same. It is an energy system.
11 We both laughed at an apparently good ending. The field of play invites the clinician into a heart-
12 I told him that if he was ready to end, then that felt examination of the “conditions” that he or she
13 was the end. brings into the music therapy experience. Conditions
14 I asked Jack if he enjoyed the session. He replied may be considered to be anything that determines the
15 in the affirmative. characteristics and features of the space that is the aes-
16 Then he asked Cliff if that was enough, and laughed. thetic. There are hundreds of non-verbal cues exuded
17 Jack left. by the music therapist in the realm of subtle sense. The
18 interior life is reflected in the external. The interior life
19 practice may include beliefs, attitudes, memories of life experi-
20 ences, etc. These are reflected in the more obvious con-
21 The healer had to be ruthless to create the ditions such as the behavior and style of the therapist.
22 proper setting for the spirit’s intervention. All are contained in “the field.” Clients not only see
23 (From Carlos Castaneda, The Power of Silence) and hear these conditions in the obvious expressions of
24 our personality and our use of tools such as musical
25 Clinical Work instruments, but they also sense them through more
26 Clinical Work with Individuals The model of the field of subtle expressions, such as tone of voice, body lan-
27 play is based on the simplest and most basic form of guage, posture, rhythm of speech, energy level, choice
28 clinical practice, that is, the one-to-one dialogue be- of technique, etc.
29 tween therapist and client in the music therapy experi- In addition these conditions are constantly reor-
30 ence. There are many applications to groups and the ganizing themselves with new input. Our form of beauty
31 model can be used with any technique of music therapy. is dynamic.
32 “Simple” here refers only to numbers of people. Every condition has an aspect of strength and an
33 Even though numerically we might think of this dia- aspect of limitation. It is our ability to embrace creative
34 logue as simple, geometrically, it is highly complex. paradox and ambiguity that allows us the possibility to
35 (See figure 11). manage our conditions. The way we recognize and tend
36 to a condition will determine its effect in the field.
37 The next consideration of the clinician involves
38 an equally heartfelt examination of the conditions of
39 the client. In this case, it is particularly important to
40 recognize conditions that are subtle and non-verbal.
41 When we work with people who have special needs
42 our tendency is to focus only on acute conditions or
43 chronic conditions or symptoms or disablements. This
44 limits our sense of wholeness and beauty.
45 Very often the quiet, more subtle conditions that
46 we choose to ignore are the ones that will assist our
47 clients the most in the music therapy experience. If we
48 as clinicians respond to these conditions, the ones that
49 S Figure 11: The Interplay of the fields are perhaps only implied, we encourage their stability
50 R in the Field of Play in the musical space, and thus healing can begin.
The next question for the clinician is: How can I Are there enough repeatable forms to as- 1
do my part in the design and establishment of the musi- sist the development of a safe space for 2
cal space? This is a consideration that will require a innovation — a ground from which to 3
great deal of discrimination on the part of the music fly? 4
therapist for s/he is essentially the guardian of the Is there a state of focused, yet relaxed 5
space. concentration — a vibrant, clear space 6
Practical considerations of level of distraction, that is waiting for sound, for creation? 7
comfort of style, selection of rhythmic and melodic pat- What are the patterns emerging from 8
terns, staff observation and participation are critical. each field that facilitate organization? 9
The containment of the environment is a necessary 10
step in the creation of the musical space. This contain- These are some of the questions for the clinician 11
ment allows for the development of trust and subse- working in a one-to-one setting in music therapy. 12
quently the movement into the field of play. 13
The therapist gives attention to changing condi- Clinical Work with Groups When the clinician en- 14
tions in each field as it emerges throughout the course counters a group, the complexity intensifies. Yet the 15
of a music therapy session on a subtle or obvious level. simplicity of the basic human one-to-one dialogue re- 16
This field of play contains four interacting fields — mains a constant. 17
ritual, a particular state of consciousness, power and cre- The group becomes an aesthetic in and of itself. It 18
ative process. This is the process in which the style and takes on a life of its own, a dynamic of its own. So each 19
individuality of the clinician exert the most authority and group member has a relationship to the aesthetic of the 20
creativity. The aesthetic, the musical space and the field group. 21
of play serve as primary fields, and stages. Ritual, a partic- All of the considerations that apply to an individ- 22
ular state of consciousness, power and creative process ual person as aesthetic apply to group as aesthetic. 23
serve as secondary fields and offer the therapist a chance What are the conditions of the field of “group?” A 24
to play with his or her own sequencing preference. musical space is also established between each group 25
A clinician may use more or less of these second- member and group, as well as a field of play with its sec- 26
ary fields. The order may vary, depending on each per- ondary fields of ritual, a particular state of conscious- 27
son’s style. What one clinician defines as ritual may be ness, power, and creative process. 28
totally unrecognizable as ritual to another. In case of In the theoretical model of the field of play, 29
induction in “guided imagery through music,” the par- whenever two aesthetics link, a sevenfold interactive 30
ticular state of consciousness may play a more domi- process begins. 31
nant and obvious role than in the use of behaviorist On a subtle level every person in a group is inter- 32
methods. Some improvisational music techniques, acting with every other person, even if this does not ap- 33
which focus on uncovering creative resources, may pear to be the case. In addition, just as each group 34
seem to place more value on creative process than member has a relationship to the aesthetic of “group,” 35
structured music lessons. Power may seem more obvi- each group member also has a discrete relationship 36
ous in a stage when a client “sings” a song or performs a with the clinician. 37
“skat” than in a more subtle stage of power when the Altogether, this makes group work in music ther- 38
person is not singing, yet the heart is pounding and still apy highly complex. Sometimes the powerful tendency 39
stuck in the throat. of music toward socialization, integration, and organi- 40
The important perception for the clinician is the zation has us leaving the resources of the subtle domain 41
underlying dynamic structure of the experience seen far too quickly. We forget to listen to the sounds before 42
through sound and silence as it is moving through the sound, the silent pulse. 43
space and time and his/her relationship to that moving The group music therapy clinician observes tim- 44
structure, the field of play. ing for opening and closing. In a closed structure, over 45
time, patterns become well defined, which is part of 46
Is it time for opening or closing? their great value. However, in order for there to be a 47
Is a threshold building to power? creative process, those closed structures must eventu- 48
Whatever technique I use, can I sense a ally open, thus the ongoing dynamic between opening S 49
creative process? and closing continues. R 50
1 In some forms of music therapy such as sponta- element of subjectivity is present in every research de-
2 neous musicmaking, it is equally important for the cli- sign. The researcher is part of the process. His or her
3 nician to observe the timing of when to close the field values and attitudes are present in the selection of re-
4 or to hear the client closing the field. For example, a search populations and methods. Assumptions that
5 period of cacophony may extend so far as to fall into a move and motivate a researcher bear a direct influence
6 terrifying chaos, instead of one which is exploring on design of studies. In a sense, subjectivity communi-
7 potential. Some cacaphony may serve as a healthy cat- cates our humanness because the expressions that em-
8 harsis, then the reorganizing can occur. It is the respon- anate from the subjective constitute our response to
9 sibility of the clinician to know how to design the space being human and inform our decisions about the tools
10 for a healthy movement toward wholeness. we use for work. The conditions of the researcher are
11 This is only the tip of the iceberg into clinical part of the work and always have an influence on the
12 considerations. results of the study.
13 Clinical work might be imagined as the heartbeat Many research methods that are used in music
14 of our profession. We want the human person to be therapy are borrowed from other disciplines. The field
15 able to function in his or her best quality of life. And of play offers a challenge to people interested in music
16 the way we do this is through music. therapy research. Can we begin to design our own re-
17 On a bad day, when we have a difficult session, search tools, which are informed by our direct experi-
18 we may come home and say, “Why am I doing this?” ence in music therapy?
19 Meaning seems vague, our sense of purpose challenged. In order to do this we need to gather more de-
20 On a day when we have had a particularly moving scription so that we can dialogue, compare, contrast,
21 music therapy session with an autistic child who played and search for underlying patterns in our experience.
22 only one note on the glockenspiel, but this being In my study of Native American systems I have
23 the first note ever, we may come home and be overcome to understand the great value of a “story.” Stories
24 whelmed with joy. describe life. They gather a tradition. They lay a ground-
25 The field of play says: This is a process. The highs work and reflect the implied patterns of experience.
26 and lows are expressed in the music therapy experience They inspire the imagination. They communicate “im-
27 in an ebb and flow, an inward and outward movement, mediacy,” the rhythm, tone, and texture of our life on
28 just like the overall rhythm of life on Earth, just like the Earth. In the ancient traditions, the terms story and
29 tides, like the seasons, like birth and death. It goes on. “song” were interchangeable. Song carries spirit.
30 The field of play attempts to support both the Often spirit is communicated through “process.”
31 clinical and more global needs of the music therapy Ideally, descriptive studies are not invested in outcome.
32 practitioner. The theoretical model can be applied to They have a pace and timing which allows a processor-
33 any population, used with any technique. It is a general ial structure to reveal itself over time. Proof is not the
34 model, a soft architecture to support the work. point. We need lots of description in all the different
35 media of communication — the written word, audio-
36 Research tapes, videotapes, photographs, conceptual designs, etc.
37 Music therapy research is an area that is greatly in need We must build a body of literature that explores
38 of expansion. Chapter three highlights many issues in the many aspects of description from theory to practice,
39 the philosophy and theory of science that refer to music in every population, in every technique, in every coun-
40 therapy. Most of these issues center around a search for try. Then we can have Kuhn’s dialogue in a community
41 harmony between logic and intuition, an attention to of professionals about a shared phenomenon.
42 process, an appreciation for the aesthetic dimension, I have attempted to establish a dialogue about a
43 sensation, consciousness, and, most important, the es- shared phenomenon in my own research. In my disser-
44 sential elements of our experience as music therapists. tation I was interested in the possibility of designing
45 The field of play invites researchers in music ther- new language. I’ve been testing out this language with
46 apy to investigate research methods such as phenome- many music therapists, particularly members of the
47 nology, which are descriptive in nature. Music therapy Phoenecia Music Therapy Retreat Community. The
48 constitutes an interplay between subjective and objec- type of question that is asked over and over again in
49 S tive realities. Often descriptive methods are not con- these encounters is: How would you describe this musi-
50 R sidered because of our fear of subjectivity. Yet the cal improvisation? How would you describe the inter-
action between therapist and client? Can you describe 1

the presence of the principles of music in verbal tech- Training 2
niques used by music therapist? Can you see and de- A good first step in the training of music therapists is a 3
scribe a process? commitment to theory — from the onset of training. 4
In a more formal aspect of the study, I also gath- There are certain questions that we can ask our students 5
ered a panel of professionals related to music therapy, in order to lay the groundwork for a healthy develop- 6
but not necessarily in the field. I wanted to know if this mental process of theory creation. For example: 7
new language would be comprehensible to others. My 8
panel included: 1) What are your underlying assumptions 9
about healing and therapy? 10
1) a dance/movement therapist 2) What is your general worldview? 11
2) a psychiatrist 3) What are your beliefs? 12
3) a neuropsychologist 13
4) an existential phenomenologist Even if trainees do not have answers to these questions, 14
5) a musicologist they begin a process of inquiry, which hopefully will 15
6) a composer initiate an awareness of the value of theory. These 16
7) an acupuncturist and practitioner of questions encourage a recognition of thought patterns 17
Eastern medicine. that will eventually lead them into designing a creative 18
theoretical basis for their work. This is the appreciation 19
Each panel member received: of one’s subtle music. 20
Trainees need, as well, to develop a whole person 21
1) a videotape of clinical improvisation, approach to function within the theoretical model of 22
which I felt demonstrated the seven fields the field of play. They need skills to manage the great 23
in the sound; paradox of a constant flux between open and closed sys- 24
2) a list of brief definitions of the seven fields; tems. They need to develop both logical and intuitive 25
3) a brief description of the client; skills. 26
4) a brief description of the hospital; The best way to learn about the process of change 27
5) a transcription of the verbal interaction is through personal experience. Yet it is difficult to 28
during the session as a guide to the video- build this into a university training program or require 29
tape; it as an admissions criterion. A person who has had to 30
6) a 21-item questionnaire. develop the strength and resources required in a trans- 31
formative life experience will have at least an implied 32
Through the questionnaire, each panel member was in- understanding of the field of play. 33
vited to participate in the phenomenological inquiry In general, the question of training challenges our 34
by wearing their own set of glasses to view the music systems as they are currently designed. This is an area 35
therapy experience on the videotape. They were asked that needs a great deal of attention from the music 36
if they could see or hear or sense or perceive in any way therapy community. 37
an aesthetic, a musical space, a field of play, ritual, 38
a particular state of consciousness, power or creative The Field of Music Therapy 39
process as described in my definitions. They were also The field of music therapy practices in the culture at 40
asked how each of their definitions would differ from large. As a body it interplays with many other fields, 41
mine. As well, there were questions that encouraged the most obvious of which provide human service and 42
open-ended feedback. generally are concerned with the human condition. As 43
This system served to refine and check the defini- a field we bring a unique set of conditions to interplay 44
tions of the fields and to create a discussion forum for the with society and culture. 45
new language. The research design created a dialogue. This position carries a responsibility for deep ex- 46
The holographic color model was designed when a panel amination of the influence we may have on the culture 47
member asked me to draw a “topography” of the process. at large. For almost a half century the clinical practice 48
This is an example of how research designs can of music therapy has been growing and changing, de- S 49
make good use of descriptive methods. veloping a body of research, building a professional R 50
1 identity. If we extend this professional identity to in- glasses, fashioned uniquely by “who we are.” With the
2 clude the more ancient uses of music for healing, our great diversity of these views, human objectivity and gen-
3 tradition extends back historically to some of the first eral theory-building seem insurmountable tasks. I like
4 human gestures on Earth. Joseph Campbell’s concept of “human constants,” and
5 If we apply even the smallest amount of future vi- Kuhn’s idea of a dialoguing community of professionals.
6 sion, we see increasing documentation in the sciences Through identifying the constants in our experience and
7 of psychoimmunology, neurophysiology, biology, physics, perceptions, perhaps there is some hope of establishing a
8 and general consciousness studies to support the inclu- home base in which to dialogue in a community of
9 sion of music therapy in delivery of any human service humans, who are indeed fragile and vulnerable creatures,
10 which encourages change — everything from cancer given the inadequacies of our communication systems.
11 to learning disabilities to the development of creativity Because of our great vulnerability and fear, we
12 in psychotherapy. The power of sound and image to have also, as a culture, avoided a commitment to the
13 facilitate change is being documented at an increas- creative process, a place full of nutrients for human
14 ing rate. growth and development, yet often too vast and un-
15 It is time for us to focus on the uniqueness of music controllable for our minds to comprehend. The field of
16 therapy experience so that we can bring this richness and play is about the creative process. It proposes one way
17 depth into the culture at large. When someone asks a for us to approach the process of human growth, which
18 music therapy clinician to describe his or her experience allows us our necessary security, and thus the freedom
19 in a language that does not come as close as possible to to “play” with creative alternatives.
20 describing our most direct experience, it is time to say A commitment to the creative process may be
21 “no.” It is time to say “No, that word or phrase or term one way of curing what Argüelles has described as “ho-
22 does not match. But come and observe my work and we’ll lonomic amnesia.” We might find our way back into an
23 brainstorm about how to describe what’s going on.” intuitive awareness that guides and informs our com-
24 We have worked for the time to develop descrip- munication. In order to follow this rather terrifying
25 tions of our inner life — the life of music therapy. The journey, humans need love.
26 time is now. The field of play focuses on non-verbal communi-
27 cation as a means to this intuitive source, a guide that
28 the field and beyond can help us to discover “implicit patterns,” subtleties
29 contained deep within the human psyche, which per-
30 “We are men and our lot is to learn and to haps defy our logical orientation, yet are moving us
31 be hurled into inconceivable new worlds.” toward wholeness more wholly.
32 “Are there any new worlds for us In chapter one, the question is put forth:
33 really?” I asked half in jest.
34 “We have exhausted nothing, you Is it possible to formulate a language to de-
35 fool,” he said imperatively. “Seeing is for im- scribe the music therapy experience and
36 peccable men. Temper your spirit now, be- create one of many possible general models
37 come a warrior, learn to see, and you’ll know which accurately reflect music therapy pro-
38 that there is no end to the new worlds for cess, yet which can be understood and used
39 our vision.” by professionals in other fields?
40 (From Carlos Castaneda, A Separate Reality)
41 The field of play is exploratory in nature. It con-
42 The search for the theoretical model of the field of play siders the primordial aspect of our experience, the
43 has been quite a humbling experience, yet an exciting largely undefined field of experience. The only use for a
44 and expanding one. The one thing that I have learned new language is that it somehow assists us in under-
45 overall from this experience is a validation of the com- standing a process that is not easily described by lan-
46 plexity of human communication. There seem to be an guage that is idiosyncratic to the culture and time. The
47 infinite number of variables that combine and organize to language developed here rings of Merleau-Ponty’s “wild
48 create the “aesthetic which is the human person.” I now meaning.” It seeks to contact Argüelles’ “aboriginal
49 S feel the beauty of communication in a different way. continuity,” our more primitive knowing that keeps us
50 R We each view the world through a different set of in touch with process, with Earth, with sense.
The birthing of new language that recovers this In an article entitled “Field Consciousness and 1
sense in a contemporary world may be difficult. Field Ethics,” in the book The Holographic Paradigm and 2
However, the research question ultimately will Other Paradoxes (Wilber), Renee Weber describes the 3
only fully be answered in the application of the lan- operating principle of David Bohm’s “implicate order.” 4
guage and the model to praxis — to clinical music ther- Weber states that Bohm’s basic contention is that “love 5
apy practice and research, to teaching and training is an informing energy.” 6
music therapists and other health professionals. I have always believed that if we can somehow 7
In chapter two a review of the tradition of theory manage to keep in touch with our “love of work,” we 8
in music therapy reveals tendencies to describe the will also manage to gather the appropriate pieces of in- 9
music therapy experience through conditions, fields, formation which center around, expand, and develop 10
relationships, and organization. These tendencies res- that work. In order to stay in contact with this loving, 11
onated with my own approach. My particular pair of informing energy, I have focused on whole memories of 12
phenomenological glasses may have colored my per- the direct experience of music therapy. If ever I became 13
ception, and guided me into seeking support for my lost in a maze of data and ideas, I returned to these 14
own theoretical model. The review identifies a starting memories as a clear and powerful lifeline to the heart 15
place in its search for “theoretical roots.” and soul of the work. In this lifeline, which travels 16
In chapter three a rationale is designed for the use across twenty years, particular clients, particular pieces 17
of phenomenological research in music therapy. Phe- of literature, particular observations of colleagues, par- 18
nomenological research, particularly when it is de- ticular dialogues with colleagues emerge as informa- 19
signed along existential, hermeneutic and heuristic tion. But there is another level of “information” which 20
lines, offers a place for the eye of the artist, a connec- I experience as “subtle sense.” It is non-verbal. It is a 21
tion to sense phenomena, and a structure for the cre- sensation that travels far beyond words. It is music. I 22
ative process. In addition, it is demonstrated that can only hope that this text communicates this mem- 23
systems thinking paves a healthy path for the Earth ory, this lifeline, this subtle sense. 24
connection, sensation, model-making. Both allow an We work with concepts and language as a means 25
entry for the development of consciousness. I would to understand the processes of human development. 26
conclude that this particular research style is highly ap- But concepts and language only describe. They cannot 27
propriate for music therapy. be our experience. They can only convey our experi- 28
Chapter four describes the theoretical framework. ence in a limited fashion. Concepts mediate the ab- 29
This framework embraces the four elements identified stract and the concrete, spirit and matter. 30
in chapter two and uses them as criteria for the seven The field of play is an ecological or environmen- 31
fields of the aesthetic, the music space, the field of play, tal model. It is an organic, process-oriented energy sys- 32
ritual, a particular state of consciousness, power and cre- tem. It is based on a definition of beauty and wholeness 33
ative process. All seven elements hold the foundation of that conforms closely to ancient healing concepts. 34
the theoretical field. This foundation is defined in chap- This is another tip of another iceberg that needs a 35
ter two and carried through to chapter four, primarily in lot of attention. I am firmly convinced that we need to 36
the work of William Sears, Helen Bonny, and my own come to terms with the conceptual level of ancient 37
previous work. Thus I believe that the model of the field healing systems that systematically employed the arts 38
of play is in harmony with the roots of theory in music for healing. Through this study, perhaps, we can re- 39
therapy. A visual holographic model offers a conceptual cover some our own lost sense. 40
design of the spatial interplay of the theory. An unfortunate situation in the contemporary 41
Chapter five offers both abstract and concrete ex- world is the commercialization of the “techniques” of 42
amples of how the field of play model can describe the these ancient healing systems. This, I feel, is a great 43
process of music therapy. tragedy, not only for the Native American peoples who 44
Chapter six provides some basic guidelines for the are once again commercialized in the name of progress, 45
music therapy clinician for both one-to-one and group but also for the contemporary culture who receives only 46
sessions. It also addresses important issues about re- the most fleeting and colorful benefit of ancient ritual 47
search. Training is briefly discussed. The place of the forms. If we take on a serious study of the underlying 48
field of music therapy in the culture at large completes concepts of these rituals, try to comprehend their mean- S 49
this section. ing in context, we may be able to design appropriate R 50
1 techniques for modern day life which recover our value tion of the vast beauty that does exist by the fragility of
2 for a sense of our connectedness to “environment,” the our human condition. We defend and hold back. We
3 Earth, and the human person. Likewise, it would be block. When we block, we often indiscriminately block
4 equally tragic for music therapy to develop as yet another our perception of beauty. Here we examine a way of
5 profane technology. Where is the soul of the work? opening the doors of perception of our therapeutic sys-
6 Eagle’s model of the interdisciplinary nature of the tems in order to allow the vision of this beauty to in-
7 art pertains to our dialogue beyond the field, our relation- form the manner in which we guide and facilitate
8 ship with other fields. We need to seek, describe, and de- human growth and development. In this sense, it is a
9 fine, the center of music therapy, the uniqueness, in order powerful commitment to human potential.
10 to come to the external dialogue with clear articulations. Beauty exists equally in those who are disfigured
11 Through our study of ancient healing systems we and traumatized as it does in a therapist, or any other
12 come to the worlds of anthropology and ethnomusicol- person whom the society may label as “healthy” or
13 ogy. We also come to the fields of philosophy and reli- beautiful according to standards set by society at large.
14 gious studies. The field of play finds its source in the creative process
15 All of these disciplines address the non-verbal, and how this process might facilitate an expansion into
16 the importance of communication systems of the arts, even more beauty. It appreciates the power of a sup-
17 the development of psyche and intuition, the develop- portive field of loving and creating in sound.
18 ment of perception through various states of awareness, The field of play suggests an attention to subtleties,
19 the subtle dimensions of reality. quiet and implicit non-verbal cues, which communicate
20 Perhaps the one music therapist who has most the natural healing patterns of the human person and
21 consistently created and developed a dialogue around imply an order that can guide and inform us into the best
22 issues of consciousness over the years is Helen Bonny. movement, which will lead us into wholeness.
23 Her written works contain many guideposts for us to
24 continue to follow. integrating the poetic
25 The new physics supports our work as well. It re-
26 defines time and space, and in so doing moves toward If language is to grow into a vehicle of
27 music. It focuses on “process.” Music therapists like thought, an expression of concepts and judg-
28 Charles Eagle and his associates are developing a ments, this evolution can be achieved only at
29 healthy dialogue in this community. the price of forgoing the wealth and fullness
30 The world of psychology will remain an obvious of immediate experience. In the end, what is
31 place for dialogue. In his work Music Therapy and its Re- left of the concrete sense and feeling content
32 lationship to Current Treatment Theories Even Ruud de- it once possessed is little more than a bare
33 scribes our connections to psychological, communication, skeleton. But there is one intellectual realm
34 and learning theories. We have gathered a portion of mu- in which the word not only preserves its orig-
35 sic therapy literature that views the music therapy experi- inal creative power, but is ever renewing it; in
36 ence through outside treatment models such as Boxill’s which it undergoes a sort of palingenesis, at
37 Music Therapy for the Developmentally Disabled and Mary once a sensuous and a spiritual reincarnation.
38 Priestly’s Music Therapy in Action. The journals of music This regeneration is achieved as language be-
39 therapy have many articles that address important links comes an avenue of artistic expression. Here
40 to psychological and educational models. it recovers the fullness of life; but it is no
41 Music therapists are quite naturally attracted to longer a life mythically bound and fettered
42 the worlds of personality theory, music education, hu- but an aesthetically liberated life.
43 man development, and the list goes on and on. (From Ernst Cassirer, Language and Myth)
44 There is a vast array of possibility for dialogue.
45 There will be a huge encyclopedia of information avail-
46 able if we continue to pursue these connections to other The Blue Room
47 fields. It is an exciting vista for our future development. I took my place in the Blue Room, wearing a white
48 The fundamental statement of the field of play is gown with soft folds. In a time beyond the edge, I was
49 S that beauty exists everywhere. It is essentially in the born to dwell there.
50 R nature of human form. We are limited in our percep- The Blue Room is a temple of another time. Does
it come to me in a dream or as a memory deep in the found as direct references and as indirect references. I 1
center of a Sacred Journey I left so long ago? am grateful to all of these authors for extending their 2
I am always waiting here with calm anticipation. ideas to me and I encourage you to explore them in 3
The temple is full of silent sound. I guard the space. I your own way. 4
walk this Beauty Way. I wait and breathe. The temple 5
is a chamber of sound. An alchemist has poured a mag- Achterberger, J. (1985). Imagery in healing. Boston and 6
ical fluid into the stones of the walls. No instruments London: Shambhala. 7
are necessary here — only prayer and breath and wait- Altshuler, I. (1948). A psychiatrist’s experience with 8
ing which lives on the other side of time. music as a therapeutic agent. In D. Schullian & 9
There are no gongs, no drums, no voices chanting M. Schoen (Eds.). Music and medicine. New 10
long into the night. Yet I can breathe the sound of the York: Books for Libraries Press. 11
cosmic soul. We all exist here. Alvin, J. (1982). Free improvisation in individual ther- 12
Everything is blue and the air is pregnant. It is a apy. British Journal of Music Therapy, 13(2). 13
container for loving and creating. Any healing sound American Psychiatric Association. (1979). The use of 14
that needs to be made lives here in these walls. Walk- the creative arts in therapy. Washington, D.C. 15
Argüelles, J. (1984). Earth ascending: An illustrated trea-
ing in the space, being in the space calls forth the great 16
tise on the law governing whole systems. Boulder
tone. To be is enough. To wait is enough. To love and 17
and London: Shambhala.
create is all that exists here. It is immediate and present 18
Argüelles, J. (1975). The transformative vision. Boulder
at all times. 19
and London: Shambhala.
Yet one would hear not a sound, would see not a Arnold, E. (trans.) (1885). Bhagavad Gita: the song ce- 20
thing. The air in the Blue Room is full of light and lestial. New York: The Heritage Press. 21
translucent in its hue. Asmus, E. P., & Gilbert, J. P. (1981). A client-centered 22
Within this room can be heard the sound of the model of therapeutic intervention. Journal of 23
stars and planets as they make their journey through Music Therapy, 18, 41–51. 24
space. There are sounds of children laughing. The Assagioli, R. (1965). Psychosynthesis. New York: Pen- 25
rustling of leaves in the wind. There is the sound of guin Books. 26
tears from the pool of grief. There is the sound of great Barclay, M. (1987). A Contribution to a theory of 27
anger as it rises out of the belly of the Earth herself. Music Therapy: Additional phenomenological 28
Even the sound of a rainbow is heard within these perspectives on Gestalt qualitative and transi- 29
walls. The ancient drums and chants. The water. tional phenomenon. Journal of Music Therapy, 30
Yet there is only soft breathing here. We breathe 24(4), 224–238. 31
sound. Bateson, G. (1979). Mind and Nature: a necessary unity. 32
I hear birds outside the temple now. There are New York: Bantam Books. 33
hundreds of birds of every kind and the Great Wind. Baumel, L. (1973). Psychiatrist as music therapist. Jour- 34
The Blue Room is a place beyond the Crystal nal of Music Therapy, 10, 83–85. 35
Edge. It is a healing space in the landscape of my imag- Bentov, I. (1977). Stalking the wild pendulum. New York: 36
inings. Grandmother has told me that it is a dream and Bantam Books. 37
many other things as well. Berg, R. E., & Stork, D. G. (1982). The physics of sound. 38
“And must you always strive to understand?” she New Jersey: Prentice Hall. 39
has said. “Can you not just believe the truth?” Bly, R. (1980). News of the universe. San Francisco: 40
Sierra Club Books.
In Blue Room we believe that Music is taking care 41
Bohm, D. (1980). Wholeness and the implicate order.
of Sound. 42
Boston, MA: Routledge and Kegan Paul.
43
Bonny, H. (1984). The musical lifeline: Present perspective
references 44
and future possibilities. Proceedings of the 11th
Annual Conference of the Canadian Associa- 45
This reading list is a collection of works that have influ- tion for Music Therapy Woodstock, Ontario. 46
enced the development of material in The Field of Play. Bonny, H. (1987). Music: The language of immediacy. 47
The writers and thinkers represented here have in- The Arts in Psychotherapy, 14, 255–261. 48
spired the ideas and concepts in both general and spe- Bonny, H. (1978). The role of taped music programs in the S 49
cific ways. Parts or pieces or wholes of their works are GIM process. Baltimore, MD: ICM Books. R 50
1 Bonny, H., & Savary, L. (1973). Music and your mind. De Chardin, P. T. (1959). The phenomenon of man. New
2 New York: Harper and Row. York: Harper and Bros.
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7 tally disabled. Rockville, MD: Aspen Systems Douglass, B., & Moustakas, C. (1985). Heuristic in-
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10 Braswell, C. et al. (1979). A survey of clinical practice Drury, N. (1985). Music for inner space. San Leandro,
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Burger, T. (1976). Max Weber’s theory of concept forma- Scribner’s Sons.
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Excerpt Six
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9 BEAUTIFYING THE WORLD*
10
11
12 Carolyn Kenny
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14
15
16 As music therapists we are confronted daily with hu- ical. But it is also palpable. I could touch it through my
17 man suffering. Our practices are the expressions that senses and feel it in my heart.
18 we offer to mediate this suffering. Music therapists offer I have been very fortunate to have a few limited
19 performance to elders in convalescent homes, musical experiences of getting to know the Eastern worldview.
20 improvisation to children and adults with developmen- While working toward my master’s degree, I studied
21 tal disabilities, and Guided Imagery and Music to pa- ethnomusicology, and therefore world music, which
22 tients and clients in music psychotherapy. These are provided a general understanding of the music of Asia.
23 only a few examples of the methods we use. As well, I studied the Shakuhachi for one year. I’m
24 Of equal importance are the theories that provide happy to say that I was able to learn to play one note
25 the foundation for these practices. A foundation is a set successfully after hundreds of hours of practice! Also, I
26 of assumptions and principles that helps to guide our have been a student of meditation, and even specifi-
27 practice. But they offer more than abstract ideas. They cally, for a period of time, Zen meditation practice.
28 define the territory of our intent. What is in our hearts, However, the primary influences, in terms of my gen-
29 minds, and spirits? What are our hopes and dreams to eral worldview and, subsequently, my ideas about music
30 improve the quality of life for those we serve? therapy theory and practice have emerged from the in-
31 When I was 16 years old and playing music for fluences around me in the Western world, especially my
32 cancer patients at Our Lady of Perpetual Care Cancer Native American roots.
33 Home, I began to understand the relationship between From a Native perspective, I learned from my el-
34 human suffering and the concept of beauty. Even ders, family members, and also from my continuing
35 though, at the time, I had not even heard of something studies, about the interconnectedness between all
36 called “music therapy,” this important experience set things. In traditional Native societies, there isn’t a con-
37 the tone for my music therapy practice, and eventually, cept of a self that is split off from the community or the
38 my ideas about theory for music therapy. society. The actions one takes are on behalf of the com-
39 So the basis of my practice and my theory is that munity. Self is always in relation. In a sense, every act
40 as human beings, we need beauty. This beauty can pro- should be a type of meditation on interdependence.
41 vide us with a necessary sense of coherence and give This translates to my work in music therapy through
42 strength in the most difficult of times. My definition of my intent. Even though I am working with one patient
43 beauty includes suffering. It includes conflict, pleasure, or client, I simultaneously have a profound sense of
44 sorrow, anger, disfigurement, even death. In other connection to all of the forces of the living universe be-
45 words, my definition of beauty is not superficial. It is cause I’m aware of the fact that they all interact in a
46 comprehensive and deep, elaborate, and even paradox- constant dynamic. This attitude weaves the music ther-
47 apy experience into a complex moral imperative. If one
48 accepts this approach, one must “beautify the world,”
49 S *Keynote Speech, Music Therapy Conference, Kunitachi Music which includes oneself, one’s patient, the setting, the
50 R College, August 2005. community, the society, and the world. “Thought, lan-
178
being native 179
guage and the arts are expressions that can help to ful- medicine about treatment and care. However, from my 1
fill the Navajo responsibility to beautify the Earth. For own cultural perspective, if I listened to what was in my 2
the Navajo, beautifying the Earth is a moral obligation own heart and soul, beauty made common sense. Every 3
and the essential goal of one’s life if one is to lead a element in Nature is a form of beauty. So the human 4
good life. For the Navajo, beautifying the Earth means being is also a form of beauty. This concept is reflected 5
keeping the world in balance” (Kenny, 2002, p. 157). in The Navajo Blessing Way. I constructed the defini- 6
In my consciousness I often recall a special prayer of tion of the first element of my music therapy theory: 7
the Navajo people called “The Blessing Way”: 8
The aesthetic is a field of beauty that is the 9
With beauty before me, I walk human person. The aesthetic is an environ- 10
With beauty behind me, I walk ment in which the conditions include the 11
With beauty above me, I walk individual’s human tendencies, values, life 12
With beauty below me, I walk experience, and all factors that unite to cre- 13
From the East beauty has been restored ate the whole and complete form of beauty, 14
From the South Beauty has been restored which is the human person. The aesthetic is 15
From the West beauty has been restored open. (Kenny, 1989) 16
From the North beauty has been restored 17
From the zenith in the sky beauty has been Redefining the human person may seem like a 18
restored radical step. But if we consider music therapy to be an 19
From the nadir of the Earth beauty has been “art,” this definition is in accord with a long tradition 20
restored in both the East and the West in the philosophy of aes- 21
From all around me beauty has been thetics. Our job as music therapists is to interpret the 22
restored. (Kenny, 1989) beauty as a whole and the many diverse aspects of the 23
beauty that is our patient or client, in other words, 24
When I remember “The Blessing Way,” I realize to understand, to analyze and respond, to participate, to 25
that we are already walking in beauty. And that my job elaborate, to present new possibilities in the sound, to 26
is just to continue walking on this path. My primary challenge, to comfort and support. Many practical 27
goal as a music therapist is to offer my patients and therapeutic gestures emerge from this theoretical 28
clients the best conditions to have an aesthetic experi- ground. Also, in this theory, we are not creating a hier- 29
ence that will enable “epiphanies,” moments of deep archy of sick and well. We are not imagining that our 30
transformation. This can happen in both active and patients are not whole or beautiful just because they do 31
passive music therapy. not conform to a predetermined notion of beauty. 32
Several music therapists have addressed the issue Of course, beauty is most often culturally defined. 33
of aesthetics, or the branch of philosophy that discusses And this is an important aspect of how we conduct our 34
beauty. Notable are Jo Salas, Kenneth Aigen, and work in music therapy if we adhere to a theory that be- 35
Colin Lee. My own decision to focus on aesthetic di- gins with aesthetics. It is important for our patients and 36
mensions of music therapy arrived in an epiphany of clients to experience harmony and coherence, which 37
my own. While working with a patient I was frustrated are both important concepts in aesthetics. We must re- 38
at the lack of progress. At the end of a difficult session I spect the cultural preferences that create the context 39
asked myself why I kept coming back to work with her. for a good life for our clients. What are the characteris- 40
The answer was because of the beauty. Even though my tic tones, colors, shapes, and materials of the familiar 41
patient was terribly disfigured, was fed by gastro/nasal environment of our music therapy patients? And when 42
tubing, could not speak and only moaned, was para- do we want to add new possibilities? Ellen Dissanayake 43
lyzed in three limbs, I experienced her as beautiful offers the concept of “making special” in Homo aestheti- 44
(Kenny, 1987, 1996). This realization led me to con- cus (1992). She asserts that making arts is not only an 45
struct the first element of my theory. I realized years emotional or cognitive necessity. It is also a physical 46
later that this first element, the aesthetic, was an exten- necessity. Therefore it is holistic. Making special is the 47
sion of my Native American worldview, a view that way we make the ordinary extraordinary. It is essential 48
had perhaps been threatened by my academic training in defining us as humans. Music, art, dance, weaving, S 49
and initiation into the concepts prevalent in Western and poetry are foods that sustain us. Native American R 50
1 scholar, Jamake Highwater, writes: “Art is so urgent, so Obviously, the therapist wants to continue to
2 utterly linked with the pulse of feeling in people that it learn and perfect his playing of instruments. And, hope-
3 becomes the singular sign of life when every other as- fully, the therapist will also learn other art forms such as
4 pect of civilization fails” (p. 15). dance, painting, weaving, sculpture, and other arts.
5 Highwater implies the necessity of the arts to sur- Often I listen to the tapes of improvisations after
6 vive and thrive. What an important idea for music the session has ended as a way to process the material. I
7 therapy. In an article addressing the possibility of a gen- will take the themes, modes, rhythms, feelings, and
8 eral theory for music therapy, one that is flexible harmonies and create more variations on the themes
9 enough to consider all populations and all music ther- my patient and I have played in the sessions. This helps
10 apy theories attached to specific methods such as Nord- me to understand deep feelings, ambiguities, conflicts,
11 off and Robbins improvisation or Guided Imagery in and passions that have been represented in the music of
12 Music, I also suggest that representation, in the form of my patients and my responses to them within the ses-
13 metaphor, analogy, and symbol, should really be part of sion. In essence, I am inspired by the music we make.
14 our conversations about general theory (Kenny, 1999). But then I need to make it my own. Sometimes I also
15 There are many more aspects of music therapy tape these improvisations and they occasionally be-
16 theory that we could discuss. come compositions.
17 But let’s turn to the important aspects of educa- Another way the arts continue for me is poetry. I
18 tion and practice. What do aesthetics and the concept write poems about patient sessions.
19 of beauty have to do with our day-to-day work in music
20 therapy? How can incorporating such a concept in the
21 foundation of our practice serve clients? And what im- example 1
22 plications are there in such a theory for training music
23 therapists?
24 In my concept of the human being as an aes- The clock is ticking
25 thetic, it is not only the client who is a form of beauty. Time goes by
26 It is also the therapist. And we must start here because Take the time to play
27 no matter what techniques or methods we use, in such Find a place
28 a theoretical approach, the primary contribution the Back
29 music therapist brings to the therapeutic encounter are Go back
30 her own qualities. The presence of the therapist com- Hesitate
31 municates these qualities even before the music ther- Measure each step
32 apy begins. So you must know yourself. You must come Find the time
33 to appreciate your own worldview, your own values and To play
34 human conditions, your moods, attributes, your states Now play
35 of mind, your own aesthetic preferences and what they
36 mean in the context of your life. You must be a reflec- I will be the hard ice
37 tive practitioner. Reflection and intention are two es- Upon which you skate
38 sential components of the successful music therapist in I will be the wall of sound
39 this model. You are not “doing something to” your pa- Upon which you throw yourself
40 tients and clients. You are “being with” them as an And wait
41 equal participant in “beautifying the world.” Breathe.
42 And the artistic processes must not stop when ses-
43 sions end. We always say that patients will only improve
44 if and when they take what they have experienced, re- example 2
45 paired, and learned beyond the therapy room and apply
46 it to their lives. If the music therapist and patient are
47 engaged in an aesthetic interplay rather than a hierar- Come play with me
48 chical relationship in which the therapist is well and Hold my hand
49 S the patient is sick, then the same must apply to the ther- Come walk with me
50 R apist. The artistic processes must continue for both. And we will go
being native 181
Skipping into the Wood terdependence, and ecology, thus providing a critique 1
Take a slow step here of Western approaches. 2
And yes jump there 3
Over the damp rolling logs I am the tree 4
Stumble lightly And in this moment of being tree 5
Fly I experience both the endless struggle and 6
Skip, laugh, scream, cry profound beauty of life in the same 7
I will be the wall of sound breath. 8
Upon which you reach to tickle the wind We are engaged in a quest for survival and 9
Chase a dream balance. 10
Run and play I hear the music of our dance even through 11
Chase me the silence of dark hours. 12
I chase you Soon the leaves on my brother will turn 13
Hide behind a dark tree And leave . . . to replenish the Earth again. 14
For a time. I too change 15
I sometimes die and am reborn, 16
So an important implication for music therapy As long as we share connecting patterns we 17
education and practice is that we must learn to appreci- are One. 18
ate ourselves as “forms of beauty” and continue to de- Not I, nor he . . . but whole and sweet life. 19
velop ourselves in our own arts expression. 20
Unfortunately, in the United States, music ther- references 21
apy theory has taken a long time to emerge. This is per- 22
haps because Americans might be characterized as Dissanayake, E. (1992). Homo aestheticus: Where art 23
pragmatists more than philosophers and theorists. The comes from and why. New York: The Free Press. 24
theoretical ideas that have been built into music ther- Highwater, J. (1981). The primal mind: Vision and reality 25
apy education and practice are most often expressions in Indian America. New York: Penguin Books. 26
of theories from psychology, medicine, and other fields, Kenny, C., & Stige, B. (Eds.) (2002). Contemporary 27
rather than theory that springs from music therapy it- Voices in Music Therapy: Communication, cul- 28
self. In order to appreciate the importance of concepts ture, and community. Oslo: Unipub forlag. 29
like intention, reflection, and aesthetics, the education Kenny, C. (1999). Beyond this point there be dragons: 30
must show a value for philosophy and theory by embed- Developing general theory in music therapy. 31
ding such disciplines into training structures. Indeed, if Nordic Journal of Music Therapy, 8(2), 127–136. 32
Kenny, C. (1996). The story of the field of play. In: M.
an aesthetic approach is perceived as something of 33
Langenberg, K. Aigen, & J. Frommer (Eds.),
value, the cultural dimension, as mentioned earlier, 34
Qualitative music therapy research: Beginning dia-
must be described and defined. That means that each 35
logues (pp. 55–80). Phoenixville, PA: Barcelona
country must take the responsibility to create a unique 36
Publishers.
expression of beauty and all its variations within a cul- Kenny, C. (1989). The field of play: A guide for the theory 37
ture, as these will have a direct relationship to the suc- and practice of music therapy. Atascadero, CA: 38
cess of music therapy practice in each region. Ridgeview Publishing Co. 39
In conclusion, I’ll share with you another poem Kenny, C. (1982). The mythic artery: The magic of music 40
that is included in my first book about music therapy therapy. Atascadero, CA: Ridgeview Publish- 41
titled The Mythic Artery: the Magic of Music Therapy ing Co. 42
(1982). This book is a historical and clinical treatment Witherspoon, G. (1977). Language and art in the Navajo 43
of music therapy from a Native American perspective universe. Ann Arbor: University of Michigan 44
and emphasizes the concept of interconnectedness, in- Press. 45
46
47
48
S 49
R 50
1
2
3 Excerpt Seven
4
5
6
7
8
9 THE EARTH IS OUR MOTHER:
10
11 REFLECTIONS ON THE ECOLOGY OF MUSIC
12
13 THERAPY FROM A NATIVE PERSPECTIVE*
14
15 Carolyn Kenny
16 My center does not come from my mind. It feels in me Music Therapy is not my only work. I continue my
17 like a plot of warm, moist, well-tilled Earth with the sun practice. But as an interdisciplinary scholar, I am inter-
18 shining hot on it. ested in many disciplines and fields. I only write and
19 publish in two fields — music therapy and indigenous
— Georgia O’Keefe
20 studies. Much of my work in indigenous studies is un-
21 known to my colleagues in music therapy. One of my
22 We return thanks to our mother, the Earth, who areas of expertise is gender-based analysis of policy for
23 Native women, or, as we say in Canadian policy work,
sustains us.
24 aboriginal women. I have conducted research and writ-
25 We return thanks to the rivers and streams, who supply ten policy documents for Status of Women Canada
26 us with water. (Kenny, 2002a; Kenny, 2004).
27 The words of Native elders and friends have al-
28 We return thanks to all herbs, which furnish medicines ways been and will always remain the primary influence
29 for the cure of our diseases. for all of my work.
30
31 We return thanks to the corn, and to her sisters, the When I listen to an Elder, I do not always
32 beans and squashes, which give us life. understand what is said. Yet there is a pres-
33 ence that holds me in aesthetic arrest. I do
34 We return thanks to the wind, which, moving the air has not move. I attempt a deep listening. I sense
35 banished diseases. qualities. I perceive the many lines on a
36 face. I open my heart to voice, to tone. I
We return thanks to the moon and stars, which have
37 watch arms move and laughter flash. I pay
38 given to us their light when the sun was gone. attention to regalia. When Elders depart,
39 We return thanks to the sun, that he has looked upon the not only have I gained information on prac-
40 tical things, but I also feel rejuvenated by
Earth with a beneficent eye.
41 their qualities, the echo of their spirits. No
42 Lastly, we return thanks to the Great Spirit, in whom is one can steal this from me. And this sense
43 embodied all goodness, and who directs all things for the does not diminish over time, nor is it altered
44 by new ideas, new technology. It is a con-
good of his children.
45 stant and persists. (Kenny, 1998, p. 80)
46 — Iroquois Prayer
47 Born in 1946, in the midst of one of the great
48 waves of feminist discourse, I came of age reading books
49 S *Chapter 1 was written for Sue Hadley’s book Feminist Perspec- like Rachael Carson’s Silent Spring (1962). When I de-
50 R tives on Music Therapy (2006). veloped as a scholar I became aware of certain essential
236
ecological music therapy 237
readings like Carol Gilligan’s In a Different Voice center of the ovals are fetuses in utero. The graphics are 1
(1993), and Mary Field Belenky, Blythe Mcvicker named sequentially as: 2
Clinchy, Nancy Rule Goldberger, and Jill Mattuck 3
Tarule’s Women’s Ways of Knowing (1986). Other texts • Total Symbiosis in the Sound Field 4
like Susan Griffin’s Woman and Nature (1978) and • Heart Beats Faster in the Sound Field 5
Charlotte Spretnak’s Dimensions of Spirituality (1986) • Fighting for Life in the Music 6
and States of Grace (1991) were important to me. These • Getting Born in the Sound 7
readings supported my struggles and helped to shape my 8
identity in what my Native mother called “a man’s In my own session notes I write poems to help me 9
world.” process the music therapy work. Often, I refer to myself 10
Yet, sitting in the presence of Native elders and and my music as a “wall of sound.” 11
participating in ceremonies were even more significant 12
because these were holistic influences that engaged my example 1 13
mind, but also my body, heart, and soul. Dancing at the 14
powwows reminded me that the Earth is indeed, our The clock is ticking 15
Mother. For Native peoples, there is an intimate rela- Time goes by 16
tionship with all of the forces of the living world. There Take the time to play 17
is an interdependence among these forces that sustains Find a place 18
us. Our lexicons are elaborate when it comes to schol- Back 19
arship. But the elegance of the Native experience of Go back 20
music, dance, and other arts is so powerful, so direct, Hesitate 21
that this has been the single most important influence Measure each step 22
in my life, including my work in music therapy. Find the time 23
As one of the few women working in the area of To play 24
theory in music therapy, I have become acutely aware Now play 25
of the different ways in which men and women describe 26
their experiences. Let me offer a few examples. I will be the hard ice 27
My own theoretical framework, the field of play, is Upon which you skate 28
about safe space for human growth and development. I will be the wall of sound 29
This field is similar in character to the spaces I create Upon which you throw yourself 30
for my children and grandchildren. In his classic treat- And wait 31
ment of modes of consciousness in Guided Imagery and Breathe. 32
Music (1995), Ken Bruscia brings up the gender issue. 33
He contrasts the conceptual and theoretical ideas of fe- example 2 34
male therapists with his own gender orientation as a 35
male therapist asserting that a spatial orientation like Come play with me 36
the field of play that creates a contained space for nur- Hold my hand 37
turing might indicate a female orientation to theory in Come walk with me 38
music therapy. He writes: “As a male therapist, the idea And we will go 39
of creating a musical space and locating a field of play Skipping into the Wood 40
is quite different from moving my consciousness in Take a slow step here 41
and out of various experiential spaces — they both And yes jump there 42
seem to come from different archetypal patterns of Over the damp rolling logs 43
helping others” (p. 195). Stumble lightly 44
In a text titled “Death and Rebirth Experiences in Fly 45
Music and Music Therapy” (1995), Benedikte Scheiby Skip, laugh, scream, cry 46
describes herself as a midwife in the music therapy I will be the wall of sound 47
process. She offers a series of four graphics to illustrate Upon which you reach to tickle the wind 48
her music therapy process with clients. The graphics Chase a dream S 49
are surrounded with staffs and notes in an oval. In the Run and play R 50
1 Chase me Native communities. Because I work in the policy area

2 I chase you with aboriginal women, I have seen statistics and
3 Hide behind a dark tree demographics used in unethical ways to shape policy
4 For a time and funding. Methods that reduce peoples’ lives to al-
5 gorhythmic formula are obviously offensive to people
6 marginalities and femininities who have experienced the taking away of their names,
7 their stories, their languages, their religions, even their
8 Most Native women have an ambivalent relationship children. Not only must these stories be told, but they
9 with feminist theories. The romanticizing and commer- must form the foundation of all future work.
10 cializing of Native beliefs and practices is apparent in Another constant is the spiritual belief in the
11 the women’s movement. Of course, these abuses are Earth as Mother. Oulette writes:
12 prevalent in many sectors of society. White women’s
13 use of Native ritual structures has been a source of dis- The most common theme and teaching is
14 comfort for Native peoples who are in a struggle to save a respect for nature, which means that all
15 their own languages and customs and who are reluctant things in nature are connected and depen-
16 to allow the marketplace to co-opt the very founda- dent upon each other. Everything in the uni-
17 tions of their cultures and societies. verse was put here for a reason by the
18 The overall perception of feminist theories is that Creator, and Mother Earth has to be taken
19 they were invented by white women academics. Hence, care of to ensure the survival of future gener-
20 many Native women intentionally distance themselves ations and the world. In the many conver-
21 from feminist ideas. sations that I have had with Aboriginal
22 Grace Ouellette (2002) conducted a study of women, this idea has often been referred to as
23 Canadian aboriginal women to learn something about “connectedness.” Therefore, it is no surprise
24 their views on feminism. She titled her work The that Aboriginal women think in these terms
25 Fourth World: An Indigenous Perspective on Feminism and about their relationships with men. Aborigi-
26 Aboriginal Women’s Activism (2002). In this study, there nal women believe that they were put on
27 was a range of responses to feminist theories. But the Earth for a purpose, to give life, but they also
28 majority of Native women distanced themselves in one believe that they cannot act alone. (p. 86)
29 way or another from the mainstream of feminism,
30 choosing instead to create a parallel movement, an Native women who are academics often have a
31 aboriginal women’s movement, in which they could rather cynical attitude about the self-in-relation theory
32 create their own discourses about how to improve the coming out of the feminist school of thought. White
33 lives of aboriginal women. feminist academics are perceived as claiming to have
34 In general, the aboriginal women’s movement is “invented” this idea, while all along it was an idea that
35 much broader in context than the feminist movement. has been at the heart of the Native worldview from the
36 It is not concerned solely with sexism and male domi- beginning. This might be one case in which the colo-
37 nance. And in the critique of society, colonization nizers made a big mistake, ecologically speaking. In the
38 takes a much higher profile than the dominating prac- Native world, there is no self, if not in relation. What-
39 tices of men, though colonization and domination by ever one does, one does on behalf of the others in the
40 men are undeniably related. There may be a great di- community. In healthy communities, there is a pro-
41 versity of worldviews and cultural practices among in- found sense of morality in the principle of connected-
42 digenous peoples around the world. But all indigenous ness. And when this principle is allowed its full
43 peoples share the experience of colonization. expression, it functions in a more comprehensive way
44 Maori scholar Linda Tuhiwai Smith has written a than feminist theorists have ever imagined.
45 very successful book titled Decolonizing Methodologies: Kim Anderson, a Cree/Métis writer, educator, and
46 Research and Indigenous Peoples (1999). In this work she leader in aboriginal women’s organizations in Canada
47 explains why “research” is a dirty word to many aborig- has written a wonderful book about the identities of
48 inal people. She favors qualitative methods, stories in Native women titled A Recognition of Being: Recon-
49 S particular, and documents how quantitative studies structing Native Womanhood (2000). In this work, she
50 R have only served to continue decolonizing processes in states:
Our relationship with creation involves con- countability structure. Though Native societies are fa- 1
necting with all that exists around us: plants, mous for being permissive when it comes to the raising 2
animals, land, water, sun, moon and the sky of young children, there are rules, and these rules are 3
world. Because the land is our Mother Earth, taught, usually, by example. Moreover, there is cer- 4
and the moon is our Grandmother, Native tainly a code of conduct exemplified by healthy and 5
women have a special relationship with strong elders and leaders in each community. Some of 6
these parts of creation. To many Native the most basic rules are: 7
women, reclaiming a relationship to land is 8
as important as recreating Indigenous social Know Yourself 9
and human relations, because the land is This is always the first rule. Permissive child-rearing 10
something through which we define our- practices are usually a way for children to find out who 11
selves, and it is essential in our creation. they are through their successes and through their mis- 12
Aboriginal women do not see the land as a takes. Opportunities always present themselves for you 13
wild material resource that needs to be de- to find out about your “true nature.” Every person is 14
veloped, possessed, or controlled; rather, the unique. The journey of a life is to discover who you are 15
land is a relative with whom we have a spe- and to remember who you are. 16
cial relationship. (p. 180) 17
Honor the Gifts the Creator Has Bestowed upon You 18
This interpretation of aboriginal women’s iden- It is always assumed that the first gift we acknowledge is 19
tity comes with a tremendous amount of responsibility. Mother Earth. Then beyond knowing oneself in a gen- 20
In my study for the Status of Women Canada, one of eral sense, in terms of our nature, we must recognize our 21
my participants quoted a very old Ojibway saying: individual talents and qualities and make an effort to 22
When the women heal, the family will heal. And develop those gifts to the best of our abilities for our- 23
when the family heals, the nations will heal. (Margaret selves and the members of our communities. 24
Lavalle) 25
Stay in Balance 26
Motherhood is an important concept in In the Native world, balance is an extremely important 27
Aboriginal thought and is inherent in the concept. Balance means that we give attention to our 28
Circle of Life philosophy. It is the women’s whole selves — body, mind, heart, and spirit. If we go 29
qualities that form the foundation of this too far in one direction or another, we can get into 30
belief. A Woman gives and supports life trouble. Staying in balance also means that we direct 31
through nurturing. She is important for the our sincere efforts to sustaining balance with all of the 32
continuance of future generations. By the living forces of the world. 33
same token, Mother Earth is seen as a woman 34
who gives and supports life to all people. Show Respect 35
Mother Earth is a nurturer, but she must also Respect for Mother Earth and all living things on the 36
be nurtured in return to ensure future genera- Earth is the imperative. We give particular respect to 37
tions and survival. A women’s role as child- elders too. And we try our best to give respect to all 38
bearer, nurturer and custodian is perceived as people. But most of all, respect yourself. If you decide 39
central to survival. (Oulette, p. 90) that you can’t respect someone, they can’t hurt you. 40
41
Stand Tall 42
standards of conduct
Always be proud in a good way because you are a beau- 43
My Choctaw mother always used to say: “Let people do tiful expression of the genius of the Creator. And you 44
what they want and things will always go better.” Yet represent all of your ancestors and relatives. But don’t 45
this was a woman with a strong and solid morality. In puff yourself up and act with self-importance. Wait un- 46
most indigenous cultures, women serve explicitly or til you are chosen as a leader. Never waive your own 47
implicitly as the moral guardians. Though they may not flag. Your voice is only one voice. And all voices are 48
be visible in positions of leadership, they stand in a cir- equal. S 49
cle around the male leadership creating a strong ac- These standards of conduct are examples of the R 50
1 teachings of the elders. Rules like these have been I understood this relationship as one of beauty.
2 passed down in a steady stream of succession for cen- And at sixteen, this beauty was transferred into my re-
3 turies. They have endured genocide, colonization, even lationships with patients at Our Lady of Perpetual Help
4 internalized oppression. They are not simple, as they Cancer Home when I sat beside the beds of patients
5 would appear to be. They are highly complex as moral to sing songs. The epiphany here was that I recognized
6 imperatives. In Native communities, the women are how beauty could be present, even in the face of tre-
7 the guardians of the morality of the people. mendous suffering, and that the music could help us to
8 In my music therapy practice and my scholarly recognize these possibilities.
9 work, as in all areas of my life, I try my best to embody After practicing music therapy for seven years,
10 these standards. once again, I found myself daily in the presence of
11 death. I was working at the Danish Convalescent Hos-
12 the ecological nature of pital in Atascadero, California. There I met a young
13 the field of play woman who was not an elder. In fact, she was a young
14 woman, aged 32, who had been in a seriously debilitat-
15 In the text, The Field of Play (1989), I invite music ing car accident. She was sent to our hospital because
16 therapists to imagine their patients and clients as biore- she did not respond to the standard rehabilitation treat-
17 gions. This is not a fanciful suggestion. Rather it is a ments. For many weeks, we sat at the piano together.
18 suggestion rooted in the ethical imperatives expressed I improvised and she remained hunched over in her
19 above. It is also in the spirit of the principles of the wheelchair. Then one day she reached up to the key-
20 Deep Ecology movement (Drengson, 1995). This board and began to play. After one year of working with
21 movement, initiated by Norwegian philosopher Arne Debbie intensively at the piano, and after she had
22 Naess in 1973, and greatly influenced by Rachael Car- started to speak again, another epiphany arrived. On
23 son’s Silent Spring as well as several ecofeminists, reflects this day, my hands could not write the standard med-
24 feminist principles and also principles that form the ical terms in her chart because these words did not ac-
25 foundation of the worldview of Native peoples around curately describe my experience with her. This was
26 the world. Deep Ecology is a commitment to being in the day when I realized that I would have to create
27 the world in the best possible relationship with the a new language to describe my music therapy practice
28 Earth. (Kenny, 1996).
29 For me, the articulation of the field of play is a A slow and steady disillusionment with the lan-
30 personal and professional imperative that was born out guage of psychology, medicine, and, in general, the
31 of a series of epiphanies1 about the state of our world clinical world, had been growing in me for many years.
32 and the state of our profession. It is difficult to identify Not only had I studied psychology at the graduate
33 a “first epiphany.” The fact that these epiphanies have level, but I had worked in psychiatric settings where I
34 existed for the duration of my memory may indicate a had opportunities to learn about the application of the
35 phenomenological attitude2 from the beginning of concepts, theories and general principles of psychology
36 memory. However, I am able to identify many of these as a practitioner. At Riverview Hospital in New Or-
37 moments in time. leans, I had worked in a milieu setting, supervised by
38 As a young child I came to know Nature as a safe several brilliant psychiatrists. At the University of
39 refuge. In times of trouble and in times of joy, I was British Columbia Health Sciences Centre, I had worked
40 compelled to enter the forest to surround myself with at a very innovative day treatment center called
41 the rich possibilities of mountain streams, bird songs, The Dayhouse, in which we had weekly staff supervi-
42 gentle breezes, rustling leaves, a myriad of colors and sion meetings (Knobloch and Knobloch, 1979). Both
43 sounds. Natural places became resource pools of images of these settings were guided by psychoanalytic ap-
44 that I carried around with me into the world. They proaches to treatment. Eventually, I developed a healthy
45 were always available internally. The social world was respect for psychological theories and other theories re-
46 an extension of these rich landscapes. And as I grew lated to treatment and care, but I felt that they were
47 and changed, I came to understand that both the social limited in their scope. I began to consider them as in-
48 and natural worlds could be turbulent and peaceful. My terpretive art forms, each fascinating in their own way.
49 S epiphany was that they were reflections of each other They were expressions of worldviews. But none of them
50 R and always in relation. represented a more holistic and elaborate approach to
care than any of the others. The epiphany arrived space. My earlier metaphor for the best conditions for 1
when I came to understand that all of these theories growth and change, and one which continued to em- 2
were based on an image of the person that was an “ideal brace me, was Nature. 3
type.”3 They were designed, not so much as emergent In 1995, while teaching students at Sandane Uni- 4
approaches, but as ways to control patients and clients versity in Norway, my colleague Brynjulf Stige asked 5
to make them more acceptable to society and to live me, while we were hiking near the largest glacier in Eu- 6
what society considered to be a better and healthier rope, to define what I meant by “Nature.” The question 7
life.4 was an epiphany and still has not been adequately an- 8
While working on my research for my Ph.D., I swered. However, it was partially answered when I real- 9
took a trip to England to observe Nordoff Robbins Mu- ized that my concept of Nature was deeply rooted in my 10
sic Therapy. I traveled around to many residential treat- feeling as a Native person, and as a woman. The senses 11
ment facilities and met many music therapists. I also are much more essential than we usually imagine. They 12
spent time at the Nordoff Robbins Music Therapy Cen- are part of who we are as Earth. 13
tre in London, observing the work of Sybil Beresford- Another epiphany arrived when I recently came 14
Pierce and Rachael Verny. While watching Rachael to understand the history of Western Civilization as 15
work with a young developmentally disabled boy, I one of control over Nature and over people. Though 16
began to see the music space that she created as a field there are many fine examples of cooperation and con- 17
of possibilities — an environment that was rich in sound. sensus, if you take a course in the history of Western 18
I observed the young child select various melodies, Civilization, you study war. We need theories that are 19
harmonies, and rhythms from this resource pool. Then non-hierarchical. We need theories that are about mu- 20
I observed Rachael and the child creating music to- tuality and respect. 21
gether. 22
During this period, I also participated in my own WOMEN MUST WAIT 23
Guided Imagery and Music sessions with Helen Bonny, 24
Sara Jane Stokes, Lisa Summer, and Fran Goldberg. Where is the man who in the middle of the 25
Many epiphanies arrived in these sessions. But the the- water goes while I meanwhile am crying 26
oretical notion of space was the outstanding feature of into the long Winter nights with screams 27
these sessions when I reflected on their many dimen- which barely cut through times in space 28
sions. Everything changed. where shifts of Earth surprise babes in the 29
As a scholar/practitioner, many ideas emerged in night and innocence of all souls? 30
these years that contributed to the field of play. After Is there the sound of blood on some 31
deciding that music therapy was an interdisciplinary distant fields of sand where gods are more 32
field, I had read the current literature in many fields re- human than we dare to imagine on desert 33
lated to our work. As a doctoral student, I had accumu- nights? 34
lated 250 pages for my dissertation literature review. I wait and shake 35
Another epiphany arrived while I was in the desert In long nights of grieving women who 36
working on my dissertation. I realized that it was time scream and thrash at old stories we thought 37
for music therapy to stand on its own two feet, in rela- would never return from ancient wounds of 38
tion to other fields, by building its own concepts and Earth our ground of being we thought long 39
principles from within its own discipline. I burned my would be healed now. 40
literature review in a ceremony in the desert, keeping Who are these men, my son? 41
only a few fragments of theory from our field. My pri- In your voice I hear the call of the old 42
mary source was the work of Bill Sears.5 drum that no longer need be played for kill- 43
While studying in the desert, reading the works of ing things. 44
Maurice Merleau-Ponty and also studying the New Go away you into the hills now from 45
Physics, I realized that the best way for theorists to the sound of blood spilling in spaces where 46
serve humanity and the future was to design theories we could embrace and eat Earth. 47
around concepts of space and time. And this was easy I am woman who wants to melt away 48
for me to imagine at this stage of my work and my stud- these killing metals though it be in an- S 49
ies because I had already come to know about safe cient screams and hot tears in caves where R 50
1 bewildered spirits crouch in fear of what and idealistic at best. However, if we don’t we are truly
2 man has made upon us the Earth. lost.
3 It is the longest night beyond the I started out my theoretical work long before the
4 Winter Solstice Feast beyond some babe field of play. In a graduate class in cultural anthropol-
5 who spoke of love and died beyond the Full ogy, I wrote a paper titled “The Death/Rebirth Myth as
6 Moon when mothers wait for signs of life the Healing Agent in Music.” This paper later formed
7 from distant lands where young men do the foundation of my Master’s thesis. The basic premise
8 some useless old piece of hopefully soon to of the paper was that the ecological processes of con-
9 be forgotten thing called war. stant death and rebirth in Nature were integral to our
10 Your eyes reach out for my anger at this experiences in life and in music therapy.8
11 You are not afraid.
12 Can you say the names of all of those I am the tree
13 who have died? And in this moment of being tree
14 My scream is reaching out into the I experience both the endless struggle and
15 night for existence in time itself and after profound beauty of life in the same breath.
16 the first rain a dewdrop comforts me and We are engaged in a quest for survival and
17 dolphins swimming in waters by my tent on balance.
18 that first day of some new hope for peace to I hear the music of our dance even through
19 the sound of tears of mothers of sons. the silence of dark hours.
20 Take me to salt and sea and the disso- Soon the leaves on my brother will turn
21 lution of old ways, of killing things. And leave . . . to replenish the Earth again.
22 Where is the man who waits for peace I too change
23 on sandy shores of quiet places and lights on I sometimes die and am reborn,
24 my fear in a boat where fog and mist cover As long as we share connecting patterns we
25 the edges of harsh words and the letting go are One.
26 of old ways? (Kenny, Voices, 2002b) Not I, nor He . . . but whole and sweet life.
27 (Kenny, 1982)
28 These are a few of the spontaneous epiphanies
29 that have helped to inform my work. They are emer- conclusion
30 gent ideas that continue to grow. I have often said that
31 theories are defense mechanisms for the therapist.6 When Native people say that the Earth is our Mother,
32 And I need my theory, just like everyone else. My the- it is true. A deep traditional ecological worldview
33 ory places my feet on the ground, literally. I am part of springs from this spiritual belief. It is one that informs
34 a constantly evolving and changing interrelated and all of our actions as ethical human beings. And it is one
35 interconnected ecological zone. My client and I consti- that women must relate to as a constant.
36 tute a small part of that zone when we meet. But we are Women have a special place in healthy tradi-
37 also an essential part of it. Every human encounter is a tional societies because they are the same gender as the
38 part of it. Though my work with clients can be inter- Earth and because they are the intimate guardians of
39 preted in many ways, and it is certainly complex, it is children, who are, in most Native societies, the center
40 also simple. It is an ecology that encourages my clients of the culture.
41 to survive and thrive, based on the conditions in the In 1969, I started my career using music in a spe-
42 space. These conditions can be imagined like a field of cial education setting. Then in 1970 I asked Walker
43 daisies, or any bioregion.7 Stogan, a Musqueum elder, if he thought I should take
44 My epiphanies have been triggered both by my my training as a music therapist. On this day, we had
45 direct experience and scholarly readings. But I find that just completed our work in the Longhouse on the
46 often, scholarly ideas relate only to each other, not to Musqueum Reserve in Vancouver, British Columbia
47 people, and certainly not to the Earth. In fact, there is a (Kenny, 1982). I had been playing music with the
48 prejudice about relating to the Earth. Relating to the Musqueum children in a project called The Children’s
49 S Earth is somehow considered to be primitive at worst Spontaneous Music Workshops. Walker took a long
50 R
draw on his cigarette and looked toward the river. He method for comparative study. “An ideal type is formed 1
didn’t speak for what seemed like a long while. Then he by the one-sided accentuation of one or more points of 2
said: “For you, it makes sense.” That same year, I began view and by the synthesis of a great many diffuse, discrete, 3
my music therapy education under Charles Braswell at more or less present and occasionally absent concrete indi- 4
Loyola University in New Orleans. vidual phenomena, which are arranged according to those 5
The worldview that I have brought into my music one-sidedly emphasized viewpoints into a unified analyti- 6
therapy practice has worked very well for me. I feel that cal construct” (Max Weber, http:www2. pfeiffer.edu/~ 7
I have honored the moral imperative of my elders and Iridener/DSS/Weber/WEBERW3. HTM). 8
ancestors. I can walk tall in my own communities. My 4. Of course, I was confirmed in my skepticism about 9
Haida mother, who adopted me several years after my the grand narratives of personality theory and psycho- 10
birth mother died, gave me the name Nang Jaada Sa- logical treatment by popular spokesmen like Thomas 11
Szaz and Ivan Illich, both of whom I had read and
ẽts, meaning “Haida woman with a mind of the highest 12
heard.
esteem.” 13
5. “Sears describes three classifications that underlie
My theoretical work in music therapy must stand 14
the processes of music therapy: ‘1) experience within
tall in front of the standards that I have learned from 15
structure; 2) experience in self-organization; 3) experi-
my Native mother and from all of the Native elders, ence in relating to others.’ On the theoretical level, Sears 16
particularly the women, who have taught me. The provides an environmental approach — one that offers 17
Earth is my Mother. And I am in relation to all things. fields, conditions, relationships and self-organization. Ex- 18
plicit within his three classifications are self-organization 19
notes and relationships (relating). Implicit are fields and con- 20
ditions” (Kenny, 1989, pp. 27–28). 21
1. In The Power of Myth ( 1988), Bill Moyers asks Joseph 6. This comment, in an article titled “The Dilemma of 22
Campbell about James Joyce’s definition of epiphanies. I Uniqueness: An Essay on Qualities and Consciousness” 23
completely agree with Campbell’s description of epipha- in the Nordic Journal of Music Therapy, was greatly crit- 24
nies, inspired by James Joyce. He replies: “Joyce’s formula icized. But we must remember the positive aspects of 25
for the aesthetic experience is that it does not move you to defense mechanisms. 26
want to possess the object. A work of art that moves you 7. This is the central metaphor in the theory of the 27
to possess the object depicted, he calls pornography. Nor field of play and in my understanding of an ecological 28
does the aesthetic experience move you to criticize and re- model of music therapy (Kenny, 1989). 29
ject the object — such art he calls didactic, or social criti- 8. In The Mythic Artery (1982) I emphasize the sensory 30
cism in art. The aesthetic experience is a simple beholding aspects of the music therapy experience in the elements 31
of the object. Joyce says that you put a frame around it and of the music. These sensory elements are our direct re- 32
see it first as one thing, and that, in seeing it as one thing, lation to the physical world, and therefore to the Earth. 33
you then become aware of the relationship of part to part,
34
each part to the whole, and the whole to each of its parts.
35
This is the essential, aesthetic factor — rhythm, the har- references
monious rhythm of relationships. And when a fortunate 36
rhythm has been struck by the artist, you experience a Anderson, K. (2000). A recognition of being: Recon- 37
radiance. You are held in aesthetic arrest. That is the structing Native womanhood. Toronto, On- 38
epiphany.” tario: Sumach Press. 39
2. The “phenomenological attitude” is a formal term in Belenky, M. F., Clinchy, B. M., Goldberger, N. R., 40
phenomenology. It indicates a perceptive capability Tarule, J. M. (1986). Women’s ways of knowing: 41
that is free from the mere appearance of things and fa- The development of self, voice, and mind. New 42
vors the lived experience of perception. It is distin- York: Basic Books. 43
guished from “the natural attitude,” which is more Bruscia, K. (1995). Modes of consciousness in Guided 44
influenced by sensory data or the limitations of the Imagery and Music (GIM): A therapist’s expe- 45
physical world. rience of the guiding process. In: C. B. Kenny, 46
3. An ideal type is an analytical construct that serves the Listening, playing, creating: Essays on the power of 47
investigator as a measuring rod to ascertain similarities as sound (pp. 165-198). Albany, NY: State Uni- 48
well as deviations in concrete cases. It provides the basic versity of New York Press. S 49
R 50
1 Carson, R. (1962). Silent spring. New York: Houghton Kenny, C. (1996b). The Story of the Field of Play. In: M.
2 Mifflin. Langenberg, K. Aigen, & J. Frommer (Eds.).
3 Dregson, A. (1995). The Deep Ecology movement: An Qualitative music therapy research: Beginning dia-
4 introductory anthology. Berkeley, CA: NorthAt- logues (pp. 55–80). Barcelona Publishers.
5 lantic Books. Kenny, C. (1989). The field of play: A guide for the theory
6 Gilligan, C. (1993). In a different voice: Psychological and practice of music therapy. Atascadero, CA:
7 theory and women’s development. Cambridge, Ridgeview Publishing Company.
8 MA: Harvard University Press. Kenny, C. (1982). The mythic artery: The magic of music
9 Griffin, S. (1978). Woman and nature: The roaring inside therapy. Atascadero, CA: Ridgeview Publish-
10 her. San Francisco: Sierra Club Books. ing Company.
11 Kenny, C. (2002a). North American Indian, Métis, Knobloch, F. & Knobloch, J. (1979). Integrated psycho-
and Inuit Women Speak About Culture, Edu- therapy. London and New York: Jason Aronson.
12
cation, and Work. Ottawa: Status of Women Ouellette, G. J. M.W. (2002). The fourth world: An in-
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Canada Web site: (http://www.swc-cfc.gc.ca/ digenous perspective on feminism and Aboriginal
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pubs/0662318978/index_e.html.) women’s activism. Halifax, NS: Fernwood Pub-
15
Kenny, C. (2002b). Women Music Wait. Voices: A lishing.
16 World Forum for Music Therapy. Retrieved June Scheiby, B. (1995). Death and rebirth experiences in
17 30, 2005, from http://www.voices.no/mainissues/ music and music therapy. In: C. B. Kenny Lis-
18 Voices2(3)editorial.html tening, playing, creating: Essays on the power of
19 Kenny, C. (2004). A holistic approach for aboriginal policy sound (pp. 199–216). Albany, NY: State Uni-
20 research. Ottawa: Status of Women Canada. versity of New York Press.
21 (http:www.swc-cfc.gc.ca/pubs/0662379594/ Smith, L. T. (1999). Decolonizing methodologies: Re-
22 index_e.html.) search and Indigenous peoples. London and New
23 Kenny, C. (2000). The Sense of Art: A First Nations York: Zed Books Ltd.
24 perspective. Canadian Journal of Native Educa- Spretnak, C. (1986). The spiritual dimension of Green
25 tion, 22(1), 77–85. politics. Santa Fe: Bear and Co.
26 Kenny, C. (1996a). The Dilemma of Iniqueness: An Spretnak, C. (1991). States of grace: The recovery of
27 Essay on Consciousness and Qualities. Nordic meaning in the postmodern age. San Francisco:
28 Journal of Music Therapy, 5(2), 87–96. Harper/Collins Publishers.
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Paper presented May 2011 at the meeting of the Canadian Association for Music Therapy
in Winnipeg, Manitoba, Canada.
Time for Integration: Journey to the Heartland
Carolyn Kenny
Let’s consider an important conference theme: “Music is the center of our work as Music
Therapists.” This is an important theme and one which could surely serve as a daily
mantra for Music Therapists. My talk this morning will focus on “being”. I will attempt
to give being its proper place within the context of our music therapy practice.
First I’ll offer a retrospective on some of my own work that relates to this theme of
being. In 1982, I wrote a book titled The mythic artery: The magic of music therapy
(now available in Music and Life in the Field of Play: An Anthology). In this book I
offered a litany that emerged from one of my contributions to the 1979 symposium on
music and man at Southern Methodist University, organized by Bill Sears and Charlie
Eagle. Bill had asked us to each write about what music meant to us. Then we shared.
Here is my slightly modified list:
· Music reflects nature.

· Music stimulates the emotions, the intellect, the body, and the spirit.
· The forms and structure of music provide symbolic order.
· Music provides a relational context for being in the world.
· Music transcends situational conflict.
· Music communicates ideas and feelings beyond words.
· Music satisfies our need for aesthetic fulfillment.
· Music reflects, dramatizes, and focuses on positive and/or negative connections
between people, places, and events.
· Music can be reassuring.
· Music can disrupt.
· Music provides a source of regeneration and renewal.
· Music is centering or disintegrative.
· Music offers motivational stimulation.
· Music provides a context for creative fulfillment.
· Music represents a pre-verbal or even primordial place and sense of being and
communicating.
· Music can eliminate or establish boundaries.
· Music is sign and goes beyond sign to spirit.
· Music is a place to come together.
· Music is a place to be alone.
· Music provides an opportunity for release through creation of symbolic forms.
· Music contains solutions and resolutions which are metaphors of life.
· Music contains tensions, which are metaphors of life.
· Music moves the whole being.
· Music is profound.
1
· Music acknowledges suffering and joy.
· Music is a resource pool of images.
· Music is a reflection of peoples and cultures and represents human impulses.
· Music is a framework from which to make choices.
· Music is a sensual statement.
· Music reflects our prenatal experience through flow and vibration, movement and
sound.
· Music is an existential reality—a celebration of the moment yet transcends time.
· Music is magic.
· Music is flexible and adaptable.
· Music is an alternative.
· Music marries art and science.
· Music provides a meaningful social context.
· Music is a bridge.
· Music has an immediate and also a delayed influence.
· Music is both process and product.
· Music is an intermediary phenomenon.
· Music expresses our human conditions.
If we study this litany of qualities, we can see very strong underpinnings about
“being” and what music can bring to this being.
In my own graduate studies while working in both a Western tradition of medicine at
the University of British Columbia Health Science Center Psychiatric Unit and on several
urban and rural Native settings, I discovered an important theme common to both
contexts—a theme or phenomenon I called “the death/rebirth myth as the healing agent in
music.” You might ask: How are these death/rebirth myths expressed in the music? We
hear them, play them, and feel them through the most basic elements of music—tensions
and resolutions in rhythm, melody, harmony, timbre, and the more general materials of
music—sound and silence.
Let’s think about the close relationship between myth and philosophy. Myths are
abundant in all indigenous societies. In fact, myths, or foundational and exemplar stories
were guides to life itself and served to keep Native peoples on the good road.
We see the intimate relationship between myth and philosophy, in fact, in the transfer
of mythology into philosophy with the Greeks. The stories of Orpheus, Phaedra, and all
of the gods began to be interpreted into more abstract themes like the nature of being,
ethics, justice, and love by Plato, Socrates, and many others.
Music has always played a crucial role in our human story. My own decision to focus
on the aesthetic and philosophical dimensions of music therapy arrived in an epiphany
when I had a particularly profound music therapy experience with my patient in hospital.
After this experience, I was no longer satisfied with the rather entrenched language I was
required to use while charting progress notes in hospital settings. I needed a deeper,
transformational language that more accurately described my experiences with patients.
One day at the end of a particularly difficult session when I questioned the progress, I
asked myself: “Why do I keep coming back?” The answer was “for the beauty.”
2
That day in the hospital, the seeds of my own theoretical map were sown. Now I
define the human person as an aesthetic, or field of beauty. She is an environment in
which the conditions include her human tendencies, values, feelings, life experiences,
thoughts, sensations, memories—and all elements, which cohere to compose the human
condition in being and manifest in presence.
Even though my patient was terribly disfigured, fed by a gastro-intestinal tube, could
not speak, was paralyzed in three limbs, and was not responding (seemingly), she was
beautiful to me. And the experience we were sharing was one of beauty. This was a
metaphysical experience— a true meeting of souls in Music Therapy and unexplainable
through science.
Two souls meet and create a space called the musical space. In this space, important
expressions of their human conditions interplay in the music therapy experience. This is
an opportunity for learning and growth through their relationship in the music. Since
music is an energy system, subsequently, five more fields are created over time that are
emergent and reflect relational horizons for continuing growth.
I call this set of interacting and emergent fields the Field of Play. It is intended to
offer a new language for the process territory of Music Therapy. This is an intensely
humanistic approach that focuses on the immediate relational experience between the
music therapist and the patient or client in the music.
The Field of Play can be described as a field of loving and creating in music, an
energy system that generates vitality, motivation, and initiative. It defines the human
being as an aesthetic who is composed of his or her human conditions—physical, mental,
emotional, psychological, and spiritual, all of which make up the character of the person.
Thus it addresses philosophically speaking, the soul. Philosophical inquires are
concerned with the soul, the character, ethics, the nature of existence, and the nature of
being itself.
These philosophical considerations that have a metaphysical nature are often pushed
aside in Music Therapy for the more practical considerations. Or perhaps the great
tsunami of science, often resistant to metaphysics, has covered them up for a time.
Philosophers who consider questions of aesthetics include Plato, Socrates, Marx,
Marcuse, Engles, Kant, Heidegger, Merleau-Ponty, Adorno, Langer, Meyer, Gadamer,
Dewey, Schiller, and many others. Notions of aesthetics in the literature include aesthetic
experience, aesthetic thinking, aesthetic values, aesthetic standards, aesthetic criteria,
aesthetic practice, aesthetic dimensions, and only occasionally, aesthetic imperative—the
ethical questions surrounding aesthetics.
Some rare philosophers do consider specifically, the aesthetic imperative. In his work
titled “The Aesthetic Dimension,” Marcuse describes the aesthetic imperative as
“opening the horizon of change or liberation.” Marcuse also writes, “Art, in general,
subverts the dominant consciousness, our ‘ordinary’ experience.”
We must also consider the important epistemological character of music as
knowledge, studied by quite a few philosophers. But let me offer an example here from
one of my Music Therapy clients.
When I was a new Music Therapists, having practiced for only five years, I was
facilitating a group Music Therapy session at the University of British Columbia Health
Science Center Psychiatric In-patient Unit. Our group had played a very intense
improvisation using many instruments, both percussion and melodic instruments. One of
3
my patients had done a very powerful drum lead. And he had mobilized the entire group,
who followed him through a 30-minute drum centered improvisation. At the end, when
we were processing our experience together in the improvisation, I asked this leader of
the improvisation what the music meant to him. He did not respond. Rather, he put his
head down and rocked. Well, I did what I was trained to do. I reframed. I said: “Can
you tell me how the music felt when you played it?” More rocking and head down. So I
kept reframing: “How did you feel when others responded to your music?” This painful
experience of questioning went on for about five reframes. Then, from across the room,
another patient spoke out. She said: “Lady, if he could say it, he wouldn’t have to play
it.” What a philosopher she was. And what a teacher she was to me!
So let’s consider music as knowledge from an academic philosopher. John Salas, a
contemporary philosopher states: “Music itself is proverbially resistant to being
expressed in words. How much more resistant to such expression is its effect on us?
Mere sounds that penetrate to what once would have been called ‘the depths of the
human soul,” to what today, we would perhaps call ‘drawing metaphorically on music –
our most fundamental attunement.”
Salas also emphasizes the important relationship between love, music, and the
beautiful, accepting as so fundamental to human existence, the darker sides of human
life: death, loss, sorrow, and anger, even madness. He notes that Plato and Socrates
would, because of such depth, refer to philosophical music. And he also notes, in the
very long tradition of philosophy, that music shapes the soul’s receptivity to beauty.
Several Music Therapy scholars have addressed the issue of aesthetics in Music
Therapy. Notable are Jo Sales, Mercédès Pavlicevic, E.T. Gaston, Edith LeCourt,
Brynjulf Stige, Lisa Summer, Colin Lee, Ken Aigen, and Ken Bruscia. A great deal of
this literature focuses on what we might call the transactional or pragmatic aspects of
Music Therapy rather than the transformational aspects, though Ken Aigen serves as the
exception here.
Aesthetic experience is a theme that has been conceived within Music Therapy for a
long time. The famous E.T. Gaston, in fact, gave it a brief consideration in his original
Music in Therapy (1968). Colin Lee (2003) proposes an approach to aesthetics that he
names an architecture based on Music theory, musicology, and in general, the great
Western European tradition. Having his source in the Nordoff/ Robbins approach, he
considers the important elements of intervals, scales, phrasing, chords, and idioms in
Music Therapy improvisations. In general, the Nordoff/Robbins approach focuses on the
elegance and beauty of The Music Child. But how about the therapist? One of the first
and most basic tenants of philosophy is “know thyself.” Reflect on your own being in the
world.
As Aigen critiques the more biological justifications of Gaston and the neo-
Darwinian justifications of Dissanayake and Grind, he also moves us toward a more
philosophical approach. In part two of his article in the Nordic Journal of Music Therapy
entitled, “In Defense of Beauty: A Role for the Aesthetic in Music Therapy Theory,” he
writes: “Music is inarguably an artistic medium that is defined by the elements of it that
give rise to aesthetic experience. Unless the elements that define music as music (and I
add – an aesthetic phenomenon) are central parts of clinical applications, it is difficult if
not impossible to understand why the discipline of Music Therapy exists as it does and
why it enjoys the dedication of the clients whose lives it was created to enhance.” (p. 17).
4
I believe that in Music Therapy we serve our clients through two strong imperatives
or ethical mandates that often conflict—the medical or educational imperative and the
aesthetic imperative—both equally important. My own concern is that in order to
become accepted in a professional context, we may have sacrificed too much of our
aesthetic imperative in face of the demands and accountability systems of the
medical/educational imperative. In a more direct way, we may have also sacrificed our
focus on an aesthetic imperative because, in the face of the suffering we encounter so
often in music therapy, we are compelled to take immediate action—to DO something—
no time for reflecting on BEING. No time for philosophy or aesthetics, especially in the
mountain of paperwork, policies, and procedures, other accountability systems that
require our attention.
So what does the aesthetic imperative mean for Music Therapy? It means that we
would make certain adjustments, giving our attention to the primary themes in
philosophy—the soul, the character, ethics, the nature of being, being in the world, the
nature of existence itself.
To make a beginning, let’s focus on three areas: Education and training, practice, and
research. For education and training, I suggest that we challenge our students to find
their own definitions of beauty. I recommend that we encourage them to stay committed
to their primary instrument of choice, which is an important expression of soul. I suggest
that we introduce them to the basic philosophical ideas about soul, character, and ethics
regarding aesthetics.
For practice, let’s look at our codes of ethics. Do they specifically address
philosophical imperatives? Also, as practitioners, do we continue to develop our
aesthetic beings through performance? And finally, do we balance the significance of the
medical/educational imperative and the aesthetic imperative in our practice, our language,
and our reports?
For theoretical research, in particular, our dilemma is in finding shared theories in our
practice. We serve so many different populations, each of which has its own needs. For
example, children with disabilities, patients in end-of-life care, clients in music
psychotherapy, clients battling substance abuse, all have different needs. Also, the
people we serve come from many different cultures, which have different values, musics,
and cultural practices. What is the common denominator in all of this diversity?
For research, let us consider the concept of evidence and its relationship to physics
and metaphysics. From the original Greek, the work evidence translates as “experience”.
This is experience in the broadest sense—experience of the soul—perhaps intuition, in
dreams, in memory, and a host of extraordinary human experiences that are often
dismissed because of the paucity of current definitions of evidence. Metaphysical
experiences cannot often be seen or quantified. Now we have a host of arts-based
research methods that can often describe these experiences and more accurately portray
the Music Therapy experience. Let’s use them.
Here are the questions and my own answers posed by our Canadian Association of
Music Therapy organizers here at our 2011 Winnipeg conference:
What is the center of our work?
Heart and Soul
How do we relate to the center of those we serve and work beside?
Through heart and soul
5
What expands from the center of music and music therapy?
Heart and soul
What is the center of our profession?
Heart and soul
And finally, how does the story of our lives told through music bring us to our
own center? It is this last question—the how—that troubles and disturbs because in order
to keep ourselves and our profession growing, we must pause enough to Be.
Ethical imperatives are always troubling and disturbing. My hope is that we can
take up these imperatives and work together toward balance and integration—the
medical/education with the aesthetic imperative—in equal parts—mutually balanced for
the sake of authenticity and coherence. It is only through such a balance that we will be
able to fulfill the authentic journey of the soul of Music Therapy itself.
In summary, how do we keep ourselves in balance? How do we stay in the
heartland and return to the center? My own sense is to return to the beauty. For this I
turn to the Navaho Blessing Way, and I invite you to take this journey with me.
With beauty before me, I walk.
With beauty behind me, I walk
With beauty above me, I walk.
With beauty below me, I walk,
From the East, beauty has been restored.
From the South, beauty has been restored.
From the West, beauty has been restored.
From the North, beauty has been restored.
From the zenith in the sky, beauty has been restored.
From the nadir in the Earth, beauty has been restored.
From all around me, beauty has been restored.
Remember that it was Raven who observed the tiny and frightened human beings
crouched in a giant clamshell on the beach of the Haida Gwaii so afraid. He teased us
into existence by singing his Raven’s song. Thank you for listening to my story.
References
Aigen, K. (2008). In defense of beauty: A role of the aesthetic in Music therapy theory:
Part II. Nordic Journal of Music Therapy, 17(1) 3-18.
Gaston, E.T. (1968). Music in therapy. London: Collier-Macmillan.
Kenny, C. (2006). Music and life in the field of play: An anthology. Gilsum, NH:
Barcelona Publishing.
Lee, C.A. (2003). The architecture of aesthetic music therapy. Gilsum, NH: Barcelona
Publishing.
Marcuse, H. (1977). The aesthetic dimension: Toward a critique of Marxist aesthetics.

Boston: Beacon Press.
6
Salas, J. (2008). The verge of philosophy. Chicago and London: University of Chicago
Press.
7
READING 24
Taken from: Bruscia, K., & Grocke, D. (Eds) (2002). Guided Imagery and Music:
The Bonny Method and Beyond, pp. 379-416. Gilsum NH: Barcelona Publishers.
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READING 25
Theoretical Notes on The Architecture of Aesthetic Music Therapy:
Toward a Music-Centered Indigenous Theory of Music Therapy
Colin Andrew Lee
The following chapters represent the beginnings of a music-centered theory of music therapy.
Initially, as a composer and Nordoff-Robbins therapist, I struggled with defining the role of music
in clinical practice. By deconstructing music, especially in clinical improvisations, I attempted to
find patterns of musical thinking that would answer the questions about links between outcome
and intent. This work has consumed me for 25 years, and now, contemplating future research, I
have come to realize the need for a music-centered indigenous theory that could inform
extramusical theories and give greater attention to the art of music in therapy. The answers that
have presented themselves during this time have given me the impetus to continue and be single-
minded in my focus and direction.
In essence, the arguments presented here do not come from a specific clinical way of
working but are applicable to all theories and approaches. AeMT advocates for greater attention
to music, whatever orientation or theory is being developed, looking within the parameters of
music itself to understand the building blocks of practice. Therefore, AeMT and how the
constructs of music are used could affect all contemporary developments in the field.
The last 10 years have seen an explosion in music therapy publications and research.
Therapists are now faced with a myriad of theoretical choices in bringing together a way of
working that is not only appropriate for the clients they work with, but also satisfies their own
skills and fulfillment as clinicians. It is foolish to think a therapist can devote their professional
life to a way of working about which they are not passionate. As a composer-therapist, I have
continued developing AeMT in tandem with my own personal development as a music therapist.
I have worked with professional musicians (Ahonen & Lee, 2011) and given concerts of
improvised music based on themes from clinical work. I have also developed my ideas on
building styles in improvising (Lee & Houde, 2011) and extracting the essence of precomposed
music for future resources. The musical landscapes and their potentials for therapy are limitless.
AeMT has been an essential part of my rite of passage as a music therapist. It was never
intended to be more than one person’s view. Now, some 8 years later, through teachings and
writings, I see the importance of developing theories that will reflect the contemporary questions
of therapists, whatever their beliefs and/or orientations. As more students, after training, identify
themselves as Aesthetic Music Therapists, a community of music-centered therapists is growing.
All theories have value and should be treated with respect regardless of the impact they
may have on the profession globally. Analyzing clinical improvisation in standard music notation
and the connections made through this process, I believe, are still relevant. This has always been
the main focus of research in AeMT. The musical “science” of how each tone is built, harmonic
progression developed, and rhythmic cell understood may never be answered in a way that
satisfies the strict parameters of quantitative research. Through musical microanalysis, however,
it is possible to produce results that are transferable and will complement the nonmusical indices
being produced though medicine and neuroscience.
The following chapters and the development of AeMT are based on a belief that the
creativity of clients and the musical responses made by the therapist are based on a strict set of
learned criteria. These criteria come from education and the therapist’s development in the field.
If we can understand the therapeutic/musical processes and if the therapist is aware of this
interface, then the development of music therapy will become more and more musically
scientific.
When I think of music therapy, I remember with clarity Francis1 standing alongside great
composers that influenced our work, such as Debussy. Debussy’s music acted as a conduit in the
therapeutic process and added a power and musical intent that could not have come from either
source alone. Musical components in therapy are influenced by the history of music, as well as
the individual voice of the therapist. Each feeds into the other to produce significantly focused
clinical/musical responses. AeMT embraces all styles of music, from Western classical and
popular to global and fusion. AeMT is one therapist’s road to find a music-centered indigenous
theory that will keep the importance and aesthetic qualities of music alive and at the forefront of
future developments in research, practice and theory.
References
Ahonen, H., & Lee, C.A. (2011). The Meta-Musical Experiences of a Professional String Quartet
in Music-Centered Psychotherapy. In A. Meadows (Ed.), Developments in Music
Therapy Practice: Case Study Perspectives. Gilsum, NH: Barcelona Publishers.
Lee, C. A. (1996). Music at the Edge: The Music Therapy Experiences of a Musician with AIDS.
London: Routledge.
Lee, C. A., & Houde, M. (2011). Improvising in Styles: A Workbook for Music Therapists,
Educators and Musicians. Gilsum, NH: Barcelona Publishers.
1See Lee (1996), Music at the Edge.

Lee, C.A. (2003). Five Excerpts: The Architecture of Aesthetic Music
Therapy, pp. 1-38, 69-86, 87-100, 147-158, 233-244. Gilsum NH:
Beginnings: On Music 1
Chapter 1
Excerpt One
BEGINNINGS: ON MUSIC
Colin Andrew Lee
How can music ever be a mere intellectual speculation or a series of
curious combinations of sound that can be classified like the articles
of a grocer’s shop? Music is an outburst of the soul.
– Frederick Delius,
Fenby, Delius as I Knew Him (1936) , quoted in Watson (1994)
The beginning of a piece of music is filled with expectancy and potential as

themes and counterthemes present the foundation for its developing structure. A
clinical improvisation is like the unfolding of a precomposed piece of music.
The structure is balanced with the intent of the client. As themes are presented,
the dialogue between client and therapist reflects both the relationship and aims
of the therapy. Just as a symphony reveals its form, so clinical improvisation
integrates the freedom of the client with the musical responses of the therapist.
As the improvisation unfolds, the nature of the musical relationship is revealed
and integrated with the therapeutic intent. Thus a clinical symphony emerges.
DEFINING AESTHETIC MUSIC THERAPY
Aesthetic Music Therapy (AeMT) considers music therapy from a musicological

and compositional point of view. Looking at theories of music to inform theories
of therapy, it proposes a new way of exploring clinical practice. AeMT is in part
a natural continuation from Paul Nordoff’s philosophy of music, aesthetics, and
music therapy. AeMT is also a reflection of my own personal philosophy and
life experiences and the writings of other theorists.
AeMT can be defined as an improvisational approach that views musical
dialogue as its core. Interpretation of this process comes from an understanding
of musical structure and how that structure is balanced with the clinical relation-
2 Colin A. Lee
ship between client and therapist. The therapist must therefore be a clinical
musician. Clinical musicianship includes:
• clinical listening
• clinical applications of aesthetics, music analysis, and
musicology
• clinical form and music form
• clinical understanding of seminal works
• clinical relationship and aesthetics
• clinical analysis from a composer’s perspective.
In music therapy we should always think both as a musician and as a clini-

cian. If we balance one above the other, or ignore one over the other, then we
are in danger of providing either a nonmusical dryness or a musical experience
with no therapeutic content or direction. The purpose of this book, then, is to
promote the development of clinical musicianship. All topics addressed relate to
this central theme.
During the 1980s John Cage challenged 20th century music to re-define
perceptions of sound, music, and notation and it is only now that his contribu-
tion to music is being accurately gauged. He offered new landscapes of sound,
improvisation, and “chance” that had been missing in music for centuries.
Cage’s music is unbounded and fresh–a revelation of creative thinking and ex-
pression. Does music therapy need a similar sense of renewed freedom? Do we
need contemporary and contentious ideas rather than the safety of aligning clini-
cal practice to extramusical theories?
Background
In his book Defining Music Therapy (Bruscia, 1998), Bruscia states that “every
definition of music therapy sets boundaries for the field” (p. 3). He further
articulates his belief that new definitions help to define and expand it; without
new and controversial ideologies the profession would stagnate. Music therapy
should never be “set in stone” and new definitions should never be introduced to
the exclusion of others. The relationship between music and people raises too
many questions and is too broad to be confined to specific beliefs. The ideas
expressed in this book set new perspectives for music therapy and raise more
questions than can ever be answered within the confines of a single publication.
Do definitions once defined become invalid? Can one definition be
authoritative? Are differing definitions mutually exclusive? Interpretation is a
never-ending process of balancing that which we think we know against that
which we surely don’t. AeMT celebrates and critiques the field of music therapy
and offers alternatives for contemporary thought. Clinical practice should al-
ways acknowledge a sense of the experimental, but never at the expense of
theoretical knowledge and progress. Clinical musicianship utilizes the innova-
tive AeMT archetype to understand new meanings, boundaries, and definitions
of clinical practice.
Looking at aesthetics as “beyond the beautiful” provided reflections that
strongly influenced the beginnings of AeMT. Gfeller (Davis, Gfeller, & Thaut,
1999) places aesthetic experience and entertainment side by side. On one hand
this suggests that the aesthetic is peripheral and on the other hand the authors go
on to describe Schoenberg’s A Survivor from Warsaw , suggesting that this piece
carries a disturbing message about the human condition and yet is also aesthetic
in nature. The power of the aesthetic experience is that it can appear either from
a spontaneous moment (Ansdell 1995) or as a carefully graded part of a process.
Beauty takes many forms and to deny elements of dissonance in therapy is to
deny the essence of the work itself. By expanding our views on the aesthetic, so
we will broaden our views on therapy itself.
In the concluding passages of Music for Life (1995) Ansdell states that
Bateson (1980)
. . . tried to show how the aesthetic gives an intuition of the unity

and fundamental connections between things: whether a Mozart
symphony, the structure of a leaf or the complexities of human com-
munication. He repeatedly came back to the concept of the aesthetic
(in which he included pattern, metaphor and symbol, creativity,
dream, myth) as the link between the natural and the human world,
between thinking and feeling, creating and knowing. It is absolutely
not a doctrine of “prettiness,” but an understanding of shared meaning
and value in the world. (pp. 216–217)
Rilke’s discourse on “terrible beauty” further elucidates this concept. Prettiness

shows only a limited understanding of aesthetics. The power of “terrible
beauty,” is as essential to the therapeutic process as that of “attractive beauty.”
Francis, the client in Music at the Edge (Lee, 1996), attempted to express
the possible link between beauty and pain within his music.
I’m expressing the way that I would rarefy or objectify the world. It’s
the song that emerges from the different elements that have played on
my soul. I think it’s partly a striving to express one’s inner sense
of harmony and beauty. This expression also reflects the knocks, de-
struction and pain that distort the very basic life-giving feeling of
4 Colin A. Lee
expansion, the ability to feel what’s going on around one. Is there an

inner harmony which one strives for? Can one get into harmony with
outer reality? Is that sometimes part of the struggle? That we [sic] . . .
the gap between the outer and inner is so great. The difference be-
tween the imposed world of inherited values is so distant from the
life-giving force, that wells up within you. This leads to jarring, de-
struction and violence. I think that when one is in touch with the
creative flow, the life-flow within art . . . creation isn’t a form of
compensation or waking up . . . I think you can latch on to an inner
message, almost like a genetic meaning that interprets the environ-
ment within the available language of tools. It’s not just
compensating form, it’s something that hasn’t been worked and
wasn’t there (pp. 115–116).
This expresses the idea that aesthetic musical creativity contains a myriad of
emotional levels. Francis’s struggled to find an avenue of expression that would
portray an authentic parallel with his physical and emotional deterioration was
caught in complex musical representations. That all were aesthetic in content
there is no doubt. What remains an enigma, however, is the balance between his
dissonant and harmonious expressions, and how they were placed within the
clinical setting.
Aigen (1995a, 1995b, 1998) explains that the reason music therapy has not
been more interested in researching or examining the aesthetic is because it is
beyond empirical analysis. With the emergence of qualitative design as an ac-
cepted form of research, however, the aesthetic of music therapy is now gaining
recognition. Aigen relates the philosophy of John Dewey (1934, 1958) to music
therapy. Dewey maintains that the aesthetic permeates all levels of human exis-
tence and adds meaning to life, and that it is the process and not only the
outcome that holds aesthetic fulfilment. Aigen (1995a) explains how resistance
to discharge becomes the means to aesthetic expression:
Unrestrained discharge is only therapeutic in the extent to which it

serves as precursor of further expressive capacities and thereby does
not facilitate self-awareness. Aesthetic considerations transforms dis-
charge into expression. Their manipulation provides the only possible
rationale for music therapy treatment. Why else would we employ an
artistic medium unless those factors that define it as such are integral
in its application? (p. 247)
With respect to “art,” Aigen (1995b) asks the following questions:
What is the essence of art? Are aesthetic judgments objective? Are

these judgments universal or culturally relative? What is beauty and
what is its relationship to art? (p. 468)
and regarding music therapy:
Are aesthetic considerations relevant in determining either clinical

interventions or client outcome? How and when do they come into
play? Which conceptions of aesthetics are consonant with clinical
practice or clinical theory? What are the healing properties of aes-
thetic experiences? Are they essential or incidental to the clinical
music therapy process? (p. 468)
These questions highlight the complexities of trying to understand the bal-

ance and connection between “clinical” and “aesthetic.” If we objectify
the creative essence of music therapy then we are in danger of misunderstanding
the nature of the phenomenon itself. This dilemma is at the heart of future re-
search. Aigen (1998) embraces these polarities in his illuminating research on
the role of music in Nordoff and Robbins music therapy. He examines the need
for the empirical nature of music to influence outcome, as well as the notion that
both are contained within the potential for creativity, freedom, and aesthetic
content.
A justification of the development of a theory which considers the role of
music in therapy is the basis of Ruud’s work (1998) on aesthetic theory.
An aesthetic experience produced by music implies the possibility of

creating a new category of experience, of experiencing the world in a
new way. (p. 79)
Verbal reflections and interpretations can only provide us with a finite amount
of information about the musical relationship. It is only through the musical
structures themselves that we can truly understand the process. Is it possible to
accurately state that any musical expression has any one specific meaning? The
transient nature of music means that no single interpretation can be definitive.
By placing human existence within the design of music we create new values
that don’t belong to the parameters of verbal specificity.
The Harvard Dictionary of Music describes musical aesthetics as being:
“the study of the relationship of music to the human senses and intellect”. This
definition inspired me to look beyond the classic notion of aesthetics as being
related only to the beautiful. I subsequently discovered words that described the
6 Colin A. Lee
aesthetic experience and began classifying them as they related to my clinical

work:
• clinical clarity: finite-precise-empathetic-expressive-

discriminating-refined
• consonance: delicate-beautiful-tender-exquisite
• dissonance: brutal-disturbing-intense-profound-powerful.
Aigen (1995a) supports these analyses when presenting his work on an evolving
aesthetic foundation of clinical theory:
I recognize that to infer that all music is generated from aesthetic

considerations would render the term “aesthetic” meaningless, and
this certainly is not the nature of my experience. Rather, I would say
that through music therapy practice my capacity for aesthetic experi-
ence has been expanded to include that which I formerly considered
to be monotonous, ugly, dissonant, clashing, disorganized, unrefined,
and aggressive. It is not that I no longer perceive these qualities in
music, but that they have acquired aesthetic value for me through
bringing to life the truth of an individual’s existence and the struggle
to give meaning to this existence. (p. 255)
So what connections could there be between aesthetics and music therapy,

and what would be the exact nature of aesthetics as related to clinical practice?
The following words were crucial in these beginning links. The aesthetics of:
• Listening
• Playing
• Disability and Pathology
• Meeting
• Being
• Expression
• Insight
• Release
• Emotion
• Form
• Tone
• Consciousness
• Intuition
• Capacity
• Outcome
• Process
NORDOFF AND ROBBINS AND

AESTHETIC MUSIC THERAPY
Using music as an aesthetic foundation for our understanding of music therapy

is not a new concept. For therapists educated in the Nordoff and Robbins ap-
proach, music is both the essential core and an extension of the clinical process
and therapeutic relationship. The inherent knowledge underlying AeMT is that
music is intrinsically healing; what must be learned during training, then, is how
to adapt one’s musical skills to develop resources which are clinically, artisti-
cally, and aesthetically suitable for both the client and the process. Aigen (1998)
describes how:
The Nordoff and Robbins approach is perhaps unique in emphasizing

the objectivity of music and the therapeutic value of this quality as it
becomes aesthetically realized. (p. 249)
The aesthetic realization of music is what makes Nordoff and Robbins so potent
and artistically dynamic, and separates it so clearly from other music therapy
approaches. Nordoff and Robbins was heavily influenced by the musical quali-
ties of Paul Nordoff’s symphonic-like improvising and his extensive composing
prior to entering music therapy. It was his previous experiences as a composer
that strongly influenced his musical bias toward the work. The balance between
composing, performing, and music therapy has always been the essence of my
actualization as a music therapist. Nordoff’s teachings most notably through
Healing Heritage (Robbins & Robbins, 1998) motivated and gave me the impe-
tus to establish further contemporary clinical connections with classical
precomposed music. My history and experience of music was quite different
from Nordoff’s yet we shared a sense of compositional form that intensely influ-
enced the structural content of clinical improvisation. It was this metamorphosis
of musical form and clinical form that culminated in the inception of AeMT.
AeMT is a continuation of the original Nordoff and Robbins approach and the
individual experiences of the author as a composer/music therapist. It is not
offered as an alternative to Nordoff and Robbins but rather is proposed as the
consolidation of one music therapist’s views and questions on music, therapy,
and aesthetics.
Distinguishing features of AeMT discussed below, that have been influ-
enced by Nordoff and Robbins, will help show the correlation and differences
between both approaches.
8 Colin A. Lee
The clinical application of seminal works
Paul Nordoff’s study of precomposed music was at the cornerstone of his explo-
rations on music and therapy. AeMT has continued and developed this
philosophy to consider critical works of the Western classical repertoire and
their influence on the development of clinical practice. By studying both specific
works and overall genres AeMT hopes to formulate qualitative techniques that
will balance the clinical and artistic in music therapy.
The clinical application of orchestral instruments
The original instrumental focus of Nordoff and Robbins was based on the thera-
pist’s work from the piano. Contemporary trends have extended to include the
use of guitar and other orchestral instruments. AeMT embraces all instruments
as essential clinical tools within the musical dialogue. The clinical application of
musical resources to include all instruments is dependent on the technique,
timbre, range, and tone quality of each instrument.
New contemporary components for the expansion

of musical resources
The Nordoff and Robbins approach to clinical improvisation is to build, de-

velop, and adapt musical resources for the clinical setting. AeMT proposes an
expansion of resources to include present-day trends in classical, popular, jazz,
dance, and world music.
Thinking architecturally
Considering the overall structure of music therapy architecturally was influ-

enced by Paul Nordoff’s compositional approach to improvisation. Taking this
one step further, AeMT attempts to understand the music therapy
process/session/improvisation in terms of its universal musical structure.
Assessing structure, then analyzing each component in terms of its architectural
whole, is an attempt to understand the many layers of the therapeutic relation-

ship in improvisation.
Clinical improvisation as composition and composer
Paul Nordoff approached music therapy as a composer. Thinking composi-

tionally and being a composer/music therapist influences one’s thinking as a
clinical improvisor. AeMT proposes that an understanding of compositional
form will help influence the therapist’s musical and therapeutic responses.
Musical composition and clinical process therefore become natural allies.
Musical form and clinical form
Generally speaking in music therapy clinical form influences musical form.

AeMT, however, is based on the philosophy that musical form influences clini-
cal form. Nordoff and Robbins. Understanding of musical form is in concert
with this view, the difference being that AeMT examines musical form from a
music analytic and compositional foundation first and foremost. Looking fur-
ther into the musical intricacies of clinical improvisation will inform our
understanding of clinical balance.
Disability as creativity
The Nordoff and Robbins humanistic philosophy believes in the potential of

every human being to be musically creative. AeMT extends this belief to regard
disability as a potentially creative force. Disability–a negative word in itself–as
imposed by a healthy society denies that human disorder can be positive. In
AeMT disability and creativity are not mutually exclusive. Each is musically
and humanistically influenced and neither is disregarded at the expense of the
other.
Nordoff and Robbins and AeMT have many similarities. To consider
AeMT, however, purely as an extension of Nordoff and Robbins is to belie its
focus. Defining a new approach to music therapy, one is constantly reminded of
the need for clinical clarity. Nordoff and Robbins and AeMT are inextricably
linked. Understanding music therapy in terms of music itself is the main focus
that differentiates the two philosophies. Looking to musical examples and re-
10 Colin A. Lee
joicing in the clinical impact of great musical works of the Western classical
repertoire is at the core of AeMT. In AeMT composing and clinical improvisa-
tion are allies, each being influenced and affected by their artistic and analytic
processes. Continuing the work initiated in Healing Heritage (Robbins & Rob-
bins, 1998) and exploring the historical wealth of music opens up panoramas for
the future of clinical practice that, in my opinion, may be unparalleled for the
future influence and learning of music therapy.
DESIGNING A SESSION: SONATA FORM

AS CLINICAL STRUCTURE
How does an AeMT session evolve? AeMT’s structure is influenced by the

organization of music. Fischer (date-unpublished) developed a method of
teaching the groundwork of clinical improvisation by basing the building blocks
of learning on sonata form. Considering the architecture of a session in terms of
classical sonata form is a natural progression that, like the work of Fischer, links
the ideologies and learning of music and therapy.
Exposition
The aim of the exposition is to introduce the main musical arguments. Two cen-
tral themes, with contrasting emotional content, are introduced with a
modulating bridge passage. The complexity of the exposition may be elaborated
on and extended by adding more corresponding themes.
The opening of a music therapy session is crucial in setting the scene for
the universal musical and clinical arguments. The client should be welcomed
with music as they enter the room. Improvising random intervals, listening to
the sounds, pitches, and timbres of the client as they enter the room can influ-
ence the harmonic and tonal center of a session. Finding the architectural tonic
of a session can determine the clinical and musical infrastructure inherent in a
client’s initiation and response. The architectural tonic should never be prede-
termined but rather created as a direct response to the client as they begin the
session. Discovering the architectural tonic is fundamental to a AeMT session.
The therapist must be flexible in musically and structurally guiding the session
from the evolving architectural tonic. Defined activities developed from pre-
vious sessions should be transposed accordingly as the architectural tonic finds

its balance and influence. It colors the music, reflects the clients needs, defines
the ongoing aims and objectives, and finds a balance between the general clini-
cal direction of the session and the ongoing musical foci.
The greeting song, a formulaic principle in music therapy, should be used
with care. If a greeting song has been used in previous sessions then its repeti-
tion may have clear clinical benefits. This does not mean, however, that in
AeMT a repetition of a greeting song is imperative. An alternative is to use its
theme as a developing motive. If the musical content of a greeting song is as
important as its nonmusical aim then its potential becomes much broader and
more inclusive within the opening of a session.
In the exposition the main musical arguments are introduced. It is essential
that the client be provided with a clear musical structure that allows the flexi-
bility to feel safe and yet is able to move forward within the creative potential of
the session. The exposition is normally where more structured sections of the
session are introduced. Working with children this may include a drum activity,
or naming song. Working in a freer improvisational style the music will be sim-
pler and more direct in content, setting the musical groundwork for the
potentially more complex structures of the development. The exposition re-
quires finite listening and response. It holds the key for critical clinical creation
and demands committed intensity from both client and therapist.
Development
The development section is at the core of classical sonata from. It allows the
composer the opportunity to develop musical ideas with total creative freedom.
Taking themes, fragmenting them, inverting them, and then freely integrating
them, adds to the essence that gives the development section its critical stance
within the overall composition of the movement.
The development section of an AeMT session is crucial as it provides the
opportunity for elaboration of aims and objectives as well as the overall compo-
sitional shape. Musically, once the architectural tonic has been ascertained the
therapist can offer other ideas that are related to and influenced by the critical
tone. In the development section the client and therapist develop ideas freely
while always being aware of the content expressed in the opening exposition.
Combining and interlinking activities and/or ideas from the exposition allows a
freedom that can facilitate the true essence of the developing therapeutic rela-
tionship.
12 Colin A. Lee
Recapitulation
The recapitulation repeats and adapts the material of the exposition. The move-
ment ends with a return to the tonic. The recapitulation is important because it
solidifies the main argument and growth of the therapeutic process. It gives the
client a sense of completion. Returning to the themes and ideas of the exposition
can mean either a reinstatement of an activity or the return to an opening theme.
It is essential in AeMT that the conclusion includes a return to the opening key
and/or the architectural tonic. This allows stability for the client, the therapeutic
process, and the session itself.
The therapist should consider the closing section of a session as a means to
embrace what has already occurred, providing an outlet that will allow the client
to come full circle in the musical experience. The client must perceive in the
recapitulation a sense of completeness–completeness in the clinical effectiveness
of the session and completeness in the musical dialogue and their part within it.
Returning to already established and understood musical inventions will give the
client a sense of completion and will allow the potential for the continuing
therapeutic process in sessions to come.
Coda
The coda can be either a small final supplement or be developed to be equal in

stature to the previous sections. In AeMT the coda can include a good-bye song
that then potentially leads to musical ideas as the client leaves the room. A
good-bye song should be used only if deemed essential to the closing of a
session and if appropriate to the individual needs of the client. The coda in
essence provides a closing musical statement that invites the potential for future
work.
Sonata form is only one way of considering the structure of a music ther-
apy session. An AeMT session can take many directions and is as flexible as the
process and the therapist’s ability to contain and reflect the client’s music. The
core of AeMT is based on the moment-to-moment creation of im-provisation.
Structure unfolds from creative spontaneity. A typical AeMT session may in-
clude greeting and good-bye songs, instrumental activities, and songwriting
techniques. Their composition may be similar to other approaches in the inclu-
sion of a beginning, middle, and end. What differentiates AeMT is that all
musical techniques originate from improvisation and are not pre-determined.
Improvisational motives thus move into themes and structures that can culmi-
nate in either songs and structured activities or simply remain as themes in the
ongoing dialogue. It is the therapist’s responsibility to understand, hear, and re-

flect the client’s music in a way that provides clarity and focus for the ensuing
aim(s) of the session(s). Songs, instrumental activities, and other structured
forms originate from the relationship in the musical moment of contact. Thera-
peutic significance comes from a musical originality that is unique to every
moment, session, and therapeutic process. It is not the compositional content
that differentiates an AeMT session but rather its architectural musical makeup.
The choice of key, harmony, melody, and texture for each improvisation and
their relationship to others is paramount. Considering musical connections as
improvisations develop defines the therapist’s understanding of the process.
Therefore each section/activity of a session should have a musical relevance to
the other. In an AeMT session there is no such thing as an arbitrary musical
choice.
ON BEING MUSIC CENTERED
What is it to be music centered in music therapy? How important should our

understanding of music be? Does being music centered denote a need for an
advanced level of musicianship? Should music therapists be first and foremost
musicians or clinicians? What can an understanding of musical components tell
us about the music therapy process? By being music centered is one in danger of
becoming therapeutically naive and unbalanced? Should music be the essence of
music therapy or a by-product?
To be music centered is to consider music as the core of therapy. That is
not to deny extramusical inferences as critical in our understanding but rather to
acknowledge music as the fundamental and inspirational essence. Historically
music therapy has drawn its clinical theories from extramusical sources. It is my
belief that there are flaws in this continued dialogue, especially if it is to the ex-
clusion of other more musical philosophies and theories. In molding our
investigations to fit other allied concepts, we cannot accommodate the subtle
nature of music itself. Extramusical theories are flawed because they consider
only the empirical nature of numbers and the interpretive assumptions of words.
Just as the argument against music analytic research is its musicality so it could
be suggested the argument against extramusical theories are their nonmusical
emphases. Have we not missed one essential connection, the theory of music
itself? As a profession we have discussed and debated the balance between the
“art” and “science” of our practice, but rarely have we acknowledged theories of
musicology or composition.
14 Colin A. Lee
As more classifications and subdivisions appear so music therapy becomes

stronger and richer. Whatever the nucleus of these current theories the signifi-
cance of music should always, at some level, have a role. Even the simplest
music is worthy of detailed investigation and interpretation. Music should never
be subservient but integrated with respect and knowledge within the ever-
shifting balance between music and therapy. Being inspired by music will keep
that sense of creativity that is necessary for continuous innovative practice.
There are no easy or direct answers in these pages but an overriding belief in
music as a tool to influence human growth.
MUSIC THERAPY AND MUSICOLOGY
The 5th European Music Therapy Congress held in Napoli, Italy (2001), devoted
one-third of its program to musicology. Even Ruud wrote on behalf of the scien-
tific commission’s rational for this decision:
There seems to be a constant need to focus on the value of music in

music therapy. As an interdisciplinary field of study, music therapy is
often presented with good clinical studies, relevant treatment theories
or discussions on methodological and practical aspects of doing
music therapy. The role of music in therapy is often given only
speculative and general comments, not reflecting the systematic
knowledge dealt with in the field of musicology. We also know how
music in contemporary society is taking upon itself new roles of mass
entertainment, identity building, search for authenticity and so on.
Lately, there has been an interesting development within the field of
musicology itself. Evolving as a new interdisciplinary field, musicol-
ogy has had to dialogue with new emerging knowledge from the field
of feminist studies, anthropology of music, popular music and cul-
tural studies, to name but a few important trends. As a result of this,
whole new concept and understanding of music as “musicking,” as a
performed activity is brought out. In this picture, music therapy may
itelf be an interesting producer of knowledge about music. It seems
the right time to start dialoging with musicology.
Ansdell has made some of the most important contributions in initiating

links between music therapy and musicology. In his first paper: “Musical Elabo-
rations. What has the New Musicology to say to music therapy?” (1997), he
poses the question why music therapy and the new musicology have had so little
contact and states that potentially both disciplines could learn from each other’s
theoretical developments. He offers the following fundamental questions:
a) What is music? – its nature as a phenomenon

b) Where is music?–its location in the person and culture
c) How is music?–its ways of meaning and affecting us
d) Why is music?–its ‘purposes’ (social/therapeutic etc) (p. 38).
Ansdell chooses specific pieces of literature for his argument (Cook, 1990;
Firth, 1990; Kramer, 1995; Nattiez, 1990; Said, 1991). All these texts speak di-
rectly to music therapy. In his conclusion (Ansdell, 1997) writes:
To the music therapist I would say that we live in interesting times.

Not only is the new musicological thinking beginning to give serious
attention to many of our own areas of concern, but musicology’s
interest in our work is significant. Music therapy finds itself in many
different clinical contexts, and it is clear that it must always keep
abreast of the latest clinical thinking in order to develop and legiti-
mate its practice. Is it not equally vital, however, that it also keeps in
touch with the latest serious thinking about music, in order to keep
this side of the discipline vibrant and contemporary? (p. 43)
In his keynote address at the 5th European Music Therapy Congress, Ans-
dell gives a more recent summation of his views and beliefs on the possible
connections between music therapy and the new musicology. He raises the on-
going question as to why music therapy has taken so little interest in studying
and researching the role of music. How do we facilitate practical and theoretical
links that will add to our growing understanding of the music therapy process
and be clinically and artistically important? In making links with traditional
musicology Ansdell considers my own research as belonging to the problem of
the “Music Therapist’s Dilemma (Ansdell, 1999).”
Lee’s work seemingly points to the nub of the music therapist’s di-
lemma. Because his analytical methodology remains fundamentally
rooted in the “traditional” formalist musicology it creates the same
dilemma as any structural analysis: how form translates into context–
in Lee’s case: how musical form translates into therapeutic content.
(p. 12)
16 Colin A. Lee
Ansdell looks to the new musicologists: De Nora (2000), and McClary (2000)
and the music therapists: Ruud (1998), and Stige (1998), as providing the
beginning links between musicology and music therapy:
. . . musicology in its contemporary form is a key discourse music

therapy cannot avoid engagement with in the future. Music therapists
need to be aware of the ground of their thinking and assumptions in
both therapeutic and musical dimensions. Fortunately the advent of
the New Musicology holds potential for a far better fit between the
phenomenon produced in music therapy practice and the available
analytic methodologies to examine this. It provides exactly the right
measure of both support and challenge to music therapy to foster in-
tellectual growth (p. 23)
In his book Music Therapy: Improvisation, Communication and Culture

(1998) Ruud critiques musicology, music and mass media studies, popular
music and cultural studies, anthropology, and poststructural theory. In
considering analysis and music therapy Ruud proposes that analysis should not
be separated from the clinical context from which the players originate. The
problem for him becomes:
To what extent can we expect a correspondence between the music as

heard and the experience as it occurred for the client? Is it possible to
translate from the analysis to the experience? Even if it were, is it
possible to generalize anything about the effects of music beyond the
particular situation? (p. 9)
In defense of my contribution to musicology and the focus of this book, is

my belief that if we are to evaluate the role of music in music therapy then we
must be prepared to use analytic theories of music, even if these are deemed as
“traditional musicology.” The pretext for writing this book, and my lifetime
commitment to research, is that music therapy needs to consider the “nuts and
bolts” of musical content in relation to therapeutic outcome. This means looking
in detail at musical notation and listening, acutely, for it is only through detailed
analysis that we will begin to understand how music works. It is not the pretense
of music analysis to make universal assumptions about the effects of music and
therapy. Rather, it attempts to examine each musical interaction in the belief
that by understanding the constructs of one, this will in turn illuminate our
knowledge of the others. The union of music and therapy is complex and to
study one or the other in isolation is a foolish notion. Music analysis, while
placing its emphasis on the music, also balances its findings withing the dy-
namics of the whole. The musicology literature relating to music therapy that
contains no essence of musical notation or audio recordings is, I believe, in dan-

ger of continuing the tradition of avoiding the core of our work. No amount of
intellectual, verbal, or written discourse will compensate for the need to analyze,
listen, and understand the musical composition of music therapy.
THE AESTHETICS OF MUSIC
It is not the intent here to cover the vast literature on the aesthetics of music.
Rather, the focus will be on those writers who have influenced the making of
specific theoretical and philosophical connections. The literature on aesthetics
deals primarily with listening–the capacity through which the qualities of com-
position are conveyed to the recipient through precomposed music. While not
directly applicable to the creative act of music therapy, the philosophical ideas
raised in the literature are highly relevant to the development of clinical practice.
Reading this literature and relating it to the music therapy relationship makes
absolute sense. The ideas presented therein raise many questions about the con-
nections between aesthetics and the clinical applications of music.
Perhaps the most important literary contribution, and the one that has the
greatest implications for music therapy, is Scruton’s comprehensive text The
Aesthetics of Music (1997). His writings strongly influenced the philosophical
underpinnings of AeMT. If we begin by examining some of Scruton’s opening
comments, we get a sense of what we might learn from this insightful literature.
He states that:
Aesthetic interest is an interest in appearances: its object is not the

underlying structure of things, but the revealed presence of the
world–the world as it is encountered in our experience. (p. 5)
The musical authenticity offered to clients–the pure reality of sound–is often a

reflection of the world in which they live. If the therapist’s sounds penetrate and
affect the client’s sense of his or her world, then Scruton’s views are directly
applicable to the intrinsic musical relationship between client and therapist. The
“revealed presence of the world,” as encountered through improvisation–the
aesthetic possibilities of the personal/musical connection–shows that the crea-
tion of direct experience is fundamental to musical communication. Scruton also
discusses:
18 Colin A. Lee
• the language of criticism–that which determines aesthetic char-

acter;
• aesthetic value–that which “lifts human feeling free of everyday
life, and endows it with artistic form”;
• aesthetic judgment–that which is decided through personal expe-
rience;
• musical competence–success and failure as a result of objective
musical content;
• judgment of taste–“do aesthetic values matter?”; and
• absolute music - music not directly connected to emotions.
These value-related issues are addressed in this book inasmuch as they have be-
come integrated into the practical realities of AeMT.
Levinson (1990) explains that a piece of music’s aesthetic character or
content is dependent upon its structure–the large-scale relationships blended
with the smaller individual components. The overall design of musical structure
is reliant upon the parts and how each affects the whole, and it is this intriguing
link–the manner in which both large and small structures are contained in the
design of clinical improvisation–that is one of the foundations of AeMT.
Levinson goes on to discuss aesthetic uniqueness, stating that:
Works of art taken individually are often said to be unique. What

does this amount to? Clearly it amounts to more than numerical
uniqueness, a distinction that fails to distinguish works of art from
anything else. Presumably, it is aesthetic uniqueness that is meant.
Works of art differ from one another aesthetically, one might say, be-
cause of differences in structure, every difference in structure
yielding an aesthetic difference. (p. 107)
There are many distinct aspects to music therapy: temporality, client, therapeutic
relationship, process, session, and improvisation/activity, among others, and
each of these should be informed by aesthetic uniqueness. The response of the
therapist to the unique aesthetic content of the client’s moment-to-moment
music-making is indicative of the degree to which he or she understands the
client’s therapeutic process.
What makes a piece of music aesthetically valuable? What of aesthetic
judgment and taste? Is musical competence important in creating the aesthetic?
How do we assess the therapeutic value of the aesthetic experience? These
questions speak to one’s musical philosophies and values. Scruton (1997),
shares his views that:
Our aesthetic preferences become values just as soon as we find our-

selves in them–just as soon, in other words, as they become part of
the attempt to create a place for ourselves in the world, and to situate
ourselves among our fellows. For many people, this process of value
formation–the transition from subjective preference to the judgments
of taste–exists only imperfectly and in truncated form. (p. 370)
Music therapists attempt to create a world which is balanced between aesthetic

reality and clinical intent. Placing ourselves in the vulnerability of musical crea-
tivity, we are open emotionally and practically to the aesthetic values that
condition good clinical practice. While this is in essence objective, our client’s
subjective musical tastes must also be taken into account. How we frame the
client’s musical preference speaks to our understanding of their music and their
potential for therapeutic growth. Does this mean that taste becomes a part of the
therapeutic relationship, and if so, how do we subjectively translate their aes-
thetic preferences into the process?
When we talk of the “beauty of music” in reference to music that is “ex-
hilarating,” “transcendent,” or “jubilant,” are we making value judgments based
on our perceptions and boundaries of the aesthetic? Are these the same percep-
tions as those of our client? Music therapists, for the most part, overlook music
that represents the “ugly” or “offensive.” The values of the client, however, may
include these musical representations as being “refreshing” or “joyous.” Aes-
thetic value becomes ever more complex when we introduce the therapeutic
relationship and the intended meaning of therapeutic growth. The aesthetic
qualities of music therapy affect all levels of expression, relationship, and out-
come. Contemplating the complex theories and philosophies of music aesthetics
and applying them to music therapy is, on one level, a huge paradigm shift. On
another level, it is the most natural of connections. If practitioners of music ther-
apy can be as open to theories of music literature as they are to those of
medicine, psychology, and psychotherapy, the profession at large can hope to
promote equilibrium between the “art” and the “science” of clinical practice.
MUSIC THERAPY AND AESTHETICS

IN CONTEXT
The value of the aesthetic has always been of interest to music therapy. The fact
that clinical music can facilitate observable change alongside the less discernible
dynamics of elegance and spirituality is a feature that makes our profession so
20 Colin A. Lee
unique. The debate between art and science, quantitative and qualitative re-
search, etc., has given rise to a compelling clinical potential. From early music
therapy literature (Gaston, 1968) to contemporary thinking (Lecourt, 1998),
aesthetics is a subject that has intrigued theorists. The reason is clear: aesthetics
and music cannot be separated, they are by nature and value as one. We cannot
eliminate the aesthetic potency of the musical relationship. Even the most em-
pirical and scientific music therapy research has intrinsic aesthetic content.
The classic definition of aesthetic relates to that which is beautiful and has
meaning. Ansdell (1995) states that “The traditional yardstick of the beautiful in
music involves a balance between form and feeling: the formal qualities of
unity, integration and coherence balanced against expressive authenticity and
taste” (p. 216). In The Field of Play, Kenny (1989) describes the aesthetic as
relating to the human person and that “each therapist and client is a complete
and whole aesthetic” (p. 75). She further proposes that “As one moves toward
beauty, one moves toward wholeness, or the fullest potential of what one can be
in the world” (p. 77). Aesthetic potential is not described in relation to the thera-
peutic musical process but rather as an innate human quality. The aesthetic as a
primary element or field is in preparation for the musical space (Kenny, 1996):
In the final analysis, the aesthetic represents a way of being which

carries information and conditions. It stresses the importance of
subtle, non-verbal cues communicated before the onset of concrete
activity. It represents the sum total of who we are, and transmits in-
formation about who we are on a subtle level before the onset of
relationship. (p. 69)
Separating musical from human-relational aesthetics is an interesting divide, and

separating musical aesthetics from other experiences is equally so. Are aesthet-
ics fundamental to the therapeutic process? Or as Bruscia (1998) suggests, are
they something other than the directly clinical:
. . . the dynamic motivation is experiencing music in and of itself, and

for its own sake, rather than the sake of the therapy process or any of
its other extrinsic values for the client. (p. 147)
Bruscia also suggests that the aesthetic is not dependent on expertise and there-
fore all clients have the ability to create beautiful music regardless of disability
or illness. Experiencing oneness and inner growth through the aesthetic is a
potentially powerful therapeutic force:
...we help our patients to articulate their inner realities as beautiful;

this is the manifestation of the aesthetic. (Aldridge, 1996, p. 18)
All humans seek ontological meaning and beauty in their lives and
music is able to provide expressions of both. (Salas, 1990)
Lecourt (1998) describes the role of aesthetics in countertransference as

“. . . that area of human experience concerned with beauty and artistic phe-
nomena” (p. 137). Fundamental to her argument is the warning that a
consideration of the aesthetic in music psychotherapy may potentially distort the
client/therapist relationship, that the therapist’s emphasis on the aesthetic can
allow merging but also separation. Lecourt describes “aestheticization” as dis-
tancing that allows the aesthetic to mask the potential distress of the authentic
and needed process. By transforming sounds of pain into music, it potentially
bypasses the core of therapy itself. A further danger is that by concentrating on
the quality and aesthetic content of the music, the therapist may move away
from the direct connection with the client to a purely musical dialogue (Turry,
1998). That the content of aesthetic music must be good, and that to collude with
this sense of artistry is to be untherapeutic, further adds to the debate between
the aesthetic and the clinical.
Lecourt’s evaluation of Nordoff-Robbin’s case study of Edward, I believe,
misinterprets the potential for aesthetic considerations and the use of clinical
music in the musical/therapeutic struggle. Nordoff’s music neither attempts to
contain Edward nor to place his painful cries within a more consonant, harmo-
nious context. Rather the music is a reflection of Edward’s anguish; the austere
improvisation allows Edward the emotional distance necessary for their devel-
oping relationship. The recent studies on Edward (Aigen, 1999; Ansdell, 2000;
Bergstrom-Nielsen, 1999; Forinash, 2000; Neugebauer, 1999; Robarts, 1999;
Rolvsjord, 1998) further highlight the complex nature of the process and show
how musical clarity and clinical expression interrelate. Lecourt’s interpretation
of consonance equaling tonality and aggressiveness equaling atonality are musi-
cally naïve. To enter the aesthetic is not inevitably to enter the rounded and
harmonic. Aggressive music can be aesthetic just as consonant music may not;
music is far more complex than her argument would suggest.
Aesthetic in Lecourt’s (1998) view denotes that which does not confront.
The therapist therefore needs to be aware that:
. . . the aesthetic aspects of music must not be used to fill the patient’s
narcissistic gaps or to meet the therapist’s narcissistic needs. The
idealization of music as providing such pleasurable gratifications is
quite dangerous. ( p. 157)
22 Colin A. Lee
While imbuing music with aesthetic content within the clinical/musical relation-
ship may indeed be a means for the client and/or therapist to fulfill their
egotistical needs. Most music therapists, however, are aware of this trap.
The aesthetic content of music therapy has always been considered impor-
tant although we have yet to fully understand the significance of its impact on
the therapeutic alliance. The actualization of the client’s aesthetic individuality
through music is at the center of AeMT. Understanding and interpreting aes-
thetic content is complex because it attests to the many strands that go to make
up individuality, process, and outcome. The therapist’s perceptions of aesthetic
content, relationship, pathology, and artistry span seemingly disproportionate
principles. Finding a balance between being clinical and being artistic is an on-
going dilemma. As music therapy has matured so the need for a self-sufficient
theory has, I believe, become essential–a theory not dependent on other theories,
but that finds a nexus accommodating the precision of creative artistry and the
pragmatic nature of being clinical. Until this genesis is found music therapy will
always be in debt to other philosophies.
IMPROVISATION AND COMPOSITION
Composition and improvisation are allies. One even might say they are one and
the same. Nettl (1974) suggests that improvisation and composition, rather than
being viewed as separate processes, should be seen as two points on a contin-
uum. Just as music therapy is located on a line between ‘art’ and ‘science’ so the
continuum between improvisation and composition should be open to and influ-
enced by the ongoing therapeutic direction. Composition is an ordered and
specialized process. It is also a concrete and refined form of improvisation.
Composition and improvisation are both crafted yet free from the potential of
preordained form. The spontaneous creation of improvisation produces a sense
of freedom that is acutely therapeutic. The foundations of improvisation and
composition are the same. Themes are stated and repeated, they are developed
and presented to make a coherent whole. It is interesting to see how the struc-
tures of improvising are defined in Javanese Gamelan music (Sutton, 1998).
Garap is to develop musical ideas, cengkok is the embellishment of melody, and
wiletan describes the intricacies and understanding of melody. These terms
show the importance of improvisational devices in other cultures and emphasis
placed on improvisation as a standard and accepted art form.
Form and structure balanced with freedom can be clinically captivating.
Kartomi (1991) states that “since improvising and composing both involve
workings and re-workings of creative ideas, they are essentially part of the same
process” (p. 55). The sparks generated from the compositional character of im-
provisation and the improvisational character of composition makes clinical
improvisation an exhilarating and compelling part of contemporary music. As
our ability to improvise develops, so our sense of composition becomes ever
more acute. Structure becomes embedded in the moment-to-moment expression
of freedom.
Many great composers including Bach, Mozart, Beethoven, and Liszt were
known as accomplished improvisors. Schubert’s style of composition can be
seen to be similar to the creative process of improvisation (Nettl, 1998, p. 9). It
is interesting to think of Schubert as a composer influenced by improvisation
and begs the question that if music therapy had been a profession in his day,
perhaps he may also have been a clinician. That some of the great composers
could have been music therapists is a fascinating notion and poses the further
question as to why there are no influential composer/music therapists today. I
believe the answer to this question lies in the fact that the clinical/musical and
clinical/compositional processes of music therapy are misunderstood
and disrespected by the field of music. If it is true that music therapists are ex-
ceptional musician and care deeply about the music they use with their clients,
why then are our links to the theories and profession of music so tenuous?
Begbie (2000) in his discussion on composition and improvisation suggests
that:
. . . the customary picture of improvisation as a discrete and rela-

tively frivolous activity on the fringes of music-making might need to
be replaced by the one that accord it a more serious and central place.
Instead of regarding throughly notated and planned music as the norm
and improvisation as an unfortunate epiphenomenon or even aberra-
tion, it might be wiser to recall the pervasiveness of improvisation
and ask whether it might be able to reveal fundamental aspects of
musical creativity easily forgotten in traditions bound predominantly
to extensive notation and rehearsal. (p. 182)
If improvisation is to gain more respect in Western music, then what implica-

tions will this have for music therapy? I would suggest that the issues for music
therapy in this equation are both complex and fascinating. There is a balance
among the acceptance of improvisation and the appreciation of clinical improvi-
sation as an art form and the scientific foundation necessary for the
substantiation of clinical practice. How do we bridge the gaps between the orga-
nizational requirements of composition, the creativity of the client’s expression,
and the need to quantify and validate? Further, how do we evaluate clinical
practice that does not deny the complexities of musical structure, innovation,
24 Colin A. Lee
and the boundaries set by extra-musical theories? These are en-grossing ques-
tions because they challenge all music therapy theories which do not embrace
music as essential to the process.
Berliner (1994) speaks of the division between jazz improvisation and
composition as the eternal cycle. In jazz, composition and improvisation are
allies. Improvisers learn and prepare “licks,” patterns, and harmonic progress-
ions that form the bases for the ensuing musical dialogue. In this regard jazz
improvisation and clinical improvisation are similar. Clinical improvisors must
have available a musical dictionary of ideas that can be used in the un-folding
musical exchange. Jazz improvisors practice and rehearse models of practice
that balance composition and improvisation dependent on their style. To be a
competent jazz improvisor, and also a clinical improvisor, is to have a rich
catalogue of formulas.
As soloists are perpetually engaged in creative processes of gen-

eration, application, and renewal, the eternal cycle of improvisation
and precomposition plays itself out at virtually every level of musical
conception. (Berliner, p. 242)
When music theorists speak of the structure of improvisation they are of

course speaking from an artistic viewpoint. It could be argued that this has
nothing in common with the complex dynamics of music therapy. It is my
counterargument however, that when comparing the building blocks of impro-
visation with composition, the musical and extra-musical elements combine to
produce illuminating results for both areas. Developing musical ideas as a result
of a therapeutic relationship or as a result of a musical relationship have simi-
larities. Paul Nordoff (Robbins & Robbins, 1998), as a composer and music
therapist, thought of improvisations as huge dynamic compositional structures.
These architectural constructions manifested them-selves through his many
styles of playing. He could be at once symphonic, emulate a sense of chamber
music, or provide lieder with operatic or show-tune accompaniments. I believe
that improvisation for Nordoff was a clear extension and influence of his own
composed music. Clinical improvisation and clinical composition are partners. It
is the balance between the two that leads to our understanding of the relationship
between organization and freedom and the impact this has on the therapeutic
process.
Improvisation as searching, rather than meandering, a term I recently de-
scribed through my writings on composition and improvisation, is an
illuminating phrase that speaks not only to the struggles of our clients but also to
the therapist in finding clinically and artistically appropriate music. Clinical im-
provisation, improvisation as searching, and the music therapy relationship
combine to produce an authoritative experience that reveals the potency of mu-
sic therapy. As the client searches to find their place in the world and in
the musical interchange, so improvisation is able to reflect this open, extempo-
raneous path. To enable the client the opportunity to freely explore, the music
therapist must be both spontaneous and ordered. This is the paradox of
the clinical/creative process. Improvisation as searching is the quintessential
experience between composition and improvisation, freedom and structure in
music.
AESTHETICS OF IMPROVISATION
Outside the clinical setting, the aesthetics of improvisation is a primary consid-

eration for the performer. Perfecting the musical content is balanced alongside
preserving the freedom that improvisation demands. The artist’s aesthetic re-
sponse to the unfolding musical dialogue is balanced with the moment-to-
moment creation of the whole. The aesthetic response is at once finely graded
and yet immersed in the complexities of the overall composition. How does an
improvisor perceive that sense of freedom and balance it with a coherent aes-
thetic experience? This is the key to great improvisations; the player integrates
expertise with intuition to form a sophisticated logical experience. Good clinical
improvisation is based on this premise.
In differentiating precomposed music from free improvisation, Scruton
(1997) notes that:
When musicians improvise together, obeying no instructions other

than those which they agree either explicitly beforehand, or tacitly in
the course of playing, an extraordinary feat of coordination occurs. It
is as though human movements were lifted free from the bodies in
which they originate and released into tonal space, there to achieve a
togetherness beyond anything that could qualify our bodily life. (p.
438-39)
This extraordinary quote is clearly relevant to music therapy. Allowing clients

the opportunity to be free of their pathology and/or illness is the cornerstone of
AeMT. I would suggest that this experience is clinically specific, spiritual, and
defies human logic.
The quality of music is not considered by most approaches in music ther-
apy to be the most important part of the process. It is expression in and of itself,
not the artistic content, that makes music therapy effective. Thus the aesthetic is
26 Colin A. Lee
secondary to the client’s articulation, be it “beautiful” or “ugly.” Begbie (2000),

in his exploration of improvisation and theology, throws new light on the sub-
ject. The intent of the improvisor–both clinical and artistic–and the coordination
between freedom and constraint suggests that:
. . . improvisation, by enabling a freedom in relation to a vast array

of constraints, can enable a freedom with respect to a fundamental
continuous constraint which permeates them all, namely the world’s
temporality, . . . the theological resonances of this are considerable.
(p. 201)
While it is not within the purview of this book to discuss the theological impli-
cations of such a passage, the key concept is that the tension between freedom
and constraint in improvisation mirrors that found in day-to-day living. As a
music therapist I believe in the humanity of music, that it has the ability to tran-
scend the bounds of our conscious existence. The “world’s temporality”
determines our clients’ experiences, and so the question becomes: “Can music
express that sense of temporality that speaks to illness, pathology, and human
pain?” Begbie proposes that the reason improvisation has been such a powerful
force in church music is because improvisation is “. . . not primarily a conceptu-
ality but a rich and multi-faceted practice . . .” (p. 270). Clinical improvisation
holds an essence of truth for all clients. The richness of its discipline as non-
verbal communication, as artistic release, and as a compensatory tool bestows,
as Begbie would suggest, a multifaceted experience. The aesthetics of improvi-
sation in music therapy then empowers the process, regardless of the content and
level of the expression.
IMPROVISATION AND MUSIC THERAPY
Music therapy has long tried to understand and quantify that which makes the
interpersonal and intermusical dynamics of improvisation so compelling. The
terms clinical, therapeutic, and creative all denote improvisation that is based on
a relationship. The qualities examined in the music therapy literature are easily
applicable to other aspects of improvisation and visa versa. Improvisation con-
tains the essence of music-making. It has the ability to transcend the reality of
music as a learned and practiced phenomenon. In Overduin’s treatise (1998) on
improvisation for organists he describes how
Even the simplest and shortest improvisation–in spite of labels such

as exercise or assignment–should be thought of as a piece of music,
striving for something beautiful. (p. 4)
As such, improvisation is therapeutic no matter under what guise it appears.

Improvisation, while based on relationship and intuition, is not a random
act of impulse. Good improvisation is a blend of free invention and pre-
meditated thought. For the client in music therapy the unexpected is balanced
alongside form and shape. Freedom can only make sense in improvisation if it is
equated with structure. Parker (1999) writes:
All the best improvised music balances processes of continuity (with

the inherent dangers of formuliac repetition) and change: an oral tra-
dition dies if it does not evolve. (liner notes)
The seemingly unpremeditated eloquence of improvisation is combined with

clarity of foresight as the musical direction unfolds. The challenge to the music
therapist is to consider various musical components as they impact and affect the
musical and therapeutic process.
Indeed, part of the challenge to the improvisor is to invent musically

coherent melodic lines over changing harmonic structures which, in
their specific realization, often cannot be anticipated; the similarly
unpredictable rhythmic dimensions also enforce spontaneity.
(Hagberg, 1995, p. 82)
Definitions of improvisation in musicology and music scholarship (Nettl,

1998) highlight different philosophical viewpoints. They focus on the compari-
son between organization and unpredictability, improvisation as composition,
and its ephemeral qualities that are beyond analysis and rational explanation. A
consideration which provides a bridge to music therapy is the belief that im-
provisation reflects human freedom and emotion (Nettl 1998). Improvisation
exclusively as an act of performance (Bailey 1992) highlights the disparities in
our developing theories, although if we substitute client for audience there can
be possible philosophical connections and avenues for learning. These contra-
dictions and similarities aside, clinical improvisation has a further challenge,
that of making theoretical and practical links with musicology. Until the musical
intricacies of music therapy are recognized and respected our work will always
remain outside the remit of allied developing theories. Pressing (1998) gives an
overview of improvisation in music therapy in Nettl’s (1998) comprehensive
overview of recent trends in improvisation:
28 Colin A. Lee
Musical improvisation continues to be used in therapeutic situations

to facilitate arousal and engagement and enhance social interaction,
and can succeed in drawing out patients, for example some autistic
children, who are otherwise nearly unreachable. (pp. 57–58)
Clinical improvisation is far more complex and survives on deeper emotional

levels than this summation suggests. How then do we explain to theorists the
sophistication of clinical improvisation and the links that could be made be-
tween our two disciplines when such a definition as described here is so overtly
simplistic?
PSYCHOLOGICAL IMPLICATIONS
A potential computational theory of improvisation has been developed mainly

through the work of Pressing (1978, 1984, 1987, 1988, 1992, 1997, 1998).
When discussing the psychological foundations of improvisational expertise
(1998), he raises interesting suggestions that are relevant for music therapists.
He explores the fact that information-processing and gesture for an improvisor is
a learned and precise skill:
For the improviser must affect real-time sensory and perceptual

coding, optimal attention allocation, event interpretation, decision-
making, prediction (of the action of others), memory storage and
recall, error correction, and movement control, and further, must inte-
grate these processes into an optimally seamless set of musical
statements that reflect both a personal perspective on musical organi-
zation and a capacity to affect listeners. (p.51)
Pressing (1984) suggests that improvisers “use a referent set of cognitive,

perceptual, or emotional structures (constraints) that guide and aid the produc-
tion of musical materials.” In music therapy the referent is taken from various
sources: spontaneous themes developed in the moment, themes as a source of
leitmotiv, activities developed from session to sessions, and song form. The mu-
sic therapist’s referent is an intricate balance of musical and therapeutic
responses interwoven with the cognitive and emotional responses and relation-
ship between client and therapist. A musical knowledge base is fundamental for
the music therapist and should include:
musical materials and excerpts, repertoire, subskills, perceptual

strategies, problem-solving routines, hierarchical memory structures
and schemas, generalized motor programs, and more. (Pressing, 1998,
p. 53)
Without a toolbox of resources it is impossible to provide relevant clinically and

aesthetically directed music.
The therapist’s ability to remember music themes and motives is another
required skill. Theorists recognize the complexities of music memory (Ericsson
& Charness, 1994) and propose thinking in broader strokes rather than precise
musical components (Smith, 1991). To accurately remember melodic phrases,
rhythmic patterns, or chord progressions that have been spontaneously impro-
vised takes many years of practice. This is a skill, however, all music therapists
should attempt to attain.
Also relevant for music therapy, Wolpert (1990) found there were differ-
ences in recognition tasks between musicians and nonmusicians. Non-musicians
responded mainly to instrumentation whereas musicians responded to melodic
structure and harmonic accompaniment. The role of the therapist is to facilitate
melodic, rhythmic, and harmonic creativity through which the client can articu-
late their abstract sense of their musical selves.
CLASSICAL MUSIC
Improvisation in classical western music from the 17th to 19th centuries was
a peripheral activity. Even though many composers improvised and used spon-
taneous music-making as central to their compositions, this aspect of their
musicianship has not often survived the passing of time.
We know . . . both from anecdote and from fairly trivial inference,

that a lot of the composer-performer’s musical compositions must
contain material that had its origins in improvisational performance…
(Kivy, 1995, p. 164-165)
Improvisation often preceded composition and acted as a source of inspiration

for developing themes and for the formation of refined compositional structures.
30 Colin A. Lee
In improvisation, the freedom of the performer is greater still–and

here notation follows performance, rather than proceeding it.
(Scruton, 1997, p. 111)
The historical analysis of improvisation in performance is now being explored

as a way to understand specific forms of historical practice. Magrini (1998) un-
wittingly makes links with music therapy:
. . . improvisation is one aspect of a complex of musical behavior

which is meant to activate and bring forth meaningful social relations.
(p. 194)
In Goertzen’s (1998) study of Clara Schumann’s improvised preludes we find

connections between the power of improvisation and its ability to influence the
growth of musicianship:
Improvisation was a fundamental part of Clara’s study of the piano

throughout her years of training, as a means of developing both tech-
nical mastery of the instrument and understanding of the musical
styles of her day. (p. 239)
In Paul Nordoff’s (Robbins & Robbins 1998) illuminating study, Healing

Heritage: Paul Nordoff Exploring the Tonal Language of Music, western classi-
cal music is analyzed and studied to facilitate the development of musical
resources in music therapy. As a music therapist educated in the Nordoff and
Robbins tradition my clearest recollections and moments of unadulterated inspi-
ration came from what were than called Talks on Music. Listening to Paul
Nordoff’s teachings and beginning to make links between music and therapy I
was constantly exhilarated by his lectures, at the potential music had when spe-
cifically geared toward therapy. The logic and clarity of Nordoff’s ideas,
investigating the structures of music alongside the structures of the therapeutic
process, is a natural evolutionary process. That this kind of detailed examination
of precomposed classical Western music in direct relation to improvisation did
not continue, to the best of my knowledge, after his death in this form, bears
witness to the potency of his ideas and musical foresight. The text has an impro-
visatory nature that gives a wonderful indication of what it might have felt to
have been there. Nordoff’s clarity and knowledge of musical repertoire leaves
one truly breathless. Healing Heritage is not only an historical document, it is as
alive and fresh now as when he delivered the lectures in 1974. I consider this
book to be the single most important document in the music therapy literature. It
is the only work that looks in-depth at the potential of Western classical music
on music therapy. That Schumann, Brahms, and Mompou can teach us about the
links and influence of clinical practice and aesthetics should be a source of in-
spiration for music therapists.
When you get a melodic idea . . . remember the tune. Write it down,
or play it over and over and over. Then find for it harmony that is
alive, a harmony that supports it, enhances it, moves it forward. And
we’ll begin to get some lovely, lovely harmonies in our improvisation
for the children. And they have just the same effect on them as that
wonderful harmonic change in the Schumann had on us. You can be
sure of that. (p. 87)
JAZZ
Improvisation and jazz are natural allies. Jazz originated as a response to the
constraints of western classical music. Syncopation, harmonic sophistication,
and freedom of musical thought have placed it as one of the most influential and
innovative forms of 20th-century music. Writings on jazz improvisation have
focused on the techniques and performances of specific musicians. Miles Davis
(Smith, 1998) developed an improvisational vocabulary that was manifested
through intricate musical communication and visual cues with players. The
complex intermusical relationships resulted in some of the most inspiring im-
provisations ever recorded. George Russell (Monson, 1998) developed modal
jazz, a tonal theory derived from the circle of fifths and the new harmonies of
bebop. Modal jazz allowed for greater freedom of improvising and when used
by Cecil Taylor and Ornette Coleman it evolved alongside western ideas of the
avant-garde.
Keith Jarrett, a more recent figure in jazz improvisation, has influenced
some music therapists, including the author, in the development of clinical
music. His sense of improvisation is altogether different. Solo improvisations
are built on broad thematic ideas that are emotional yet carefully controlled.
Interestingly Jarrett’s preparation for giving a concert is not dissimilar to the
concentration needed before an improvised music therapy session:
Before a concert, Jarrett would try to empty himself of all precon-

ceived ideas, and then allow the music to flow through and out of
him. He said that if he was not able to empty himself he would, al-
most invariably, have a concert that was not as good. (Carr, 1992,
p.65)
32 Colin A. Lee
Berliner’s major contribution, Thinking in Jazz (1994), explores aspects of

jazz improvisation with clarity and insight. Techniques, balancing structure and
freedom, composing in the moment, and precomposition are all areas of study
that can be directly related to the further understanding of clinical improvisation.
This inspirational work explores what it means to improvise, how improvising is
conceptualized, and the complex interpersonal and intermusical foundations that
encompass the process of jazz improvisation.
The influence of jazz studies on improvisation and music therapy has been
spearheaded by Even Ruud (1998). Ruud suggests improvising in music therapy
has fewer rules than jazz, though for the clinical improvisor and jazz musician
this is dependent on their musical and theoretical bias. Improvisation as a transi-
tional ritual is compared to the rite of the novice jazz musician and that of the
student music therapist in training. The experience of “flow”–unconscious pres-
ence–and “void”–empty space–further emphasizes the subliminal connection
between music-making in jazz and music therapy. Both jazz and clinical im-
provisation rely on spontaneity and can facilitate a state not unlike a “stream of
consciousness” and transcendence. In music therapy this sense of being
“beyond” often heralds an explosion in the therapeutic relationship and the
developing direction of the work. In jazz these moments of passage are the most
spiritual and intoxicating a listener can experience.
Free jazz has historically been discussed under the broad banner of jazz
though it cannot be easily classified and has equal connections with contempo-
rary classical music. Free jazz is usually improvised and is devoid of rules and
theoretical musical devices. It is in essence a form of musical liberation that on
first hearing can sound arbitrary. If one looks beyond the immediate, however,
subtle formations often appear. These less direct formations give it its musical
potency. Free jazz has potentially clear connections with clinical improvisation
and similarities can be found in the respective processes of music-making. The
freedom of musical dialogue and relationship in free jazz and music therapy
often produce similar musical and therapeutic results. That is not to say that a
group playing free jazz would want to emulate a music therapy scenario or that a
clinical improvisation would in any way be like a free-jazz performance. Rather,
the argument rests on the focus of musical interrelations and the freedom engen-
dered from each. There are occasions when music as “art” and music as
“therapy” can indeed find a natural merger that is informed and explored from
both disciplines. Derek Bailey and Evan Parker, two key figures in free jazz,
have developed a school of music that is beyond classification and theoretical
rationalization.
ETHNOMUSICOLOGY
The ethnomusicological implications for music therapy have been recognized as

important mainly through the work of Joseph Moreno (Moreno 1988, 1995,
Moreno, et al., 1990). Moreno (1988) observed that American music therapists
use music from a relatively small western musical pallette. He has urged music
therapists to look to the potential influence of world music on clinical practice,
and to broaden the music used in music therapy to include multicultural influ-
ences. Bradt (1997) also recommends that music therapists know and understand
the meaning of music in different cultures. Music therapists should be
knowledgeable about multicultural styles, and recognize the organization of
modes/scales and general theoretical makeup of different music from around the
world. Estrella (2001) in her impassioned chapter on multicultural music therapy
supervision raises some pertinent questions:
Music therapists have a unique responsibility to examine and research

the questions of culture’s influence on music. How does culture im-
pact the experience of mutual music making within music therapy
sessions? How does culture impact the experience of music, and the
definition of aesthetics? How does culture specifically impact the
music therapy supervision relationship? Are there special cultural
considerations to which the music therapy supervisor must attend? (p.
62)
Therefore, what of the studies on improvisation and ethnomusicology, and

what can music therapy learn from this work? Improvisation in the West has
taken second place to the ability to play precomposed music. The hallmark of a
musician in Western music is someone who has learned and practiced the art of
performing composers’ music. In the Middle East, however, improvisation is
revered because of musicians’ learned ability to be musically free and un-
predictable (Nettl, 1998). These different emphases of musicianship have
affected the development of music in each of these cultures. It is interesting
therefore to speculate how music therapy may have developed if it had begun in
the Middle East.
For a music therapist delving into the chapters on ethnomusicology in
Nettle’s edited book on improvisation (1998) there is a treasure trove of ideas,
philosophies, and analyses pertinent to all aspects of clinical improvisation. In
Arabic music the modern tarab style of the East Mediterranean world and Egypt
is a “style that emphasizes live musical performance, gives prominence to in-
stantaneous modal creations, and treats music as an ecstatic experience” (Racy,
34 Colin A. Lee
1998, p. 97). The improvisor must be able to communicate emotions, the “soul”
or “feeling” of the improvisors’ music, enabling the listener to become ecstatic.
It could be argued that a tarab music therapist should provide a musi-
cal/emotional environment for the client to express their sense of ecstatic
creation in creative music-making. This is the essence of what we hope to offer
our clients; an experience that is intrinsically healthy. The aesthetic of improvi-
sation in Latin music (Manuel, 1998) demands specific learned techniques and
“control and economy of style (p. 143)”–this resonated clearly with the demands
placed on the clinical improvisor. The raga (Viswanathan & Cormack, 1998), a
complex musical form, is fundamentally defined by its scale. Further:
. . . every raga has certain pitches that have specific functions. At the
svara level, these functional tones are a raga’s second most funda-
mental identifying feature. (p. 224)
The sophistication and development of musical scales, ideas, and ornamentation

and the music’s cultural background could be of enormous significance in the
future development of clinical improvisation. Improvisation in North Indian
music (Slawek, 1998), as in Arab music, is based on the assumption that the
improvisor is able to play freely and has the ability to facilitate heightened emo-
tions for the performer and listener. The ritual of playing can lead to levels of
catharsis and altered states of consciousness. Improvisation in North India is a
complex combination of precomposed pieces, rehearsed patterns, and creative
improvised material:
Every performance is a new exploration of a particular musical

experience that will lead both the performers and audience into
unchartered territory. (Slawek, 1998, p. 363)
The analyses of music material used by Middle East improvisors is engrossing

(Nettl & Riddle, 1998) and has connections with similar work achieved in music
therapy. Exploring the use of tetrachords, pentachords, and octave scales can
provide music therapists with a new range of musical ideas and flavors. Ana-
lyzing the use of melodic devices and sequences, ornamentation, and rhythms
can only enhance the evolution of clinical improvisation.
MUSIC AND EMOTIONS
The writings on music and emotions are theoretically and philosophically com-
plex. The literature is based on the supposition that music translates
emotions–the extent of which is determined by the receptivity and willingness of
the listener (Meyer, 1956). That music contains emotions would seem an obvi-
ous notion for music therapists. What is complex, however, is the nature of
emotion and the emotional sophistication that music has with which to commu-
nicate the human condition. If music can translate emotions, then the question
becomes, How does one evaluate that translation? Taking into account that
emotions conveyed through music are complex (Levinson, 1990), Scruton
(1977) states that by communicating an emotion, it becomes an actuality of ex-
perience. Walton (1997, in Robinson, Meaning and Music) describes how music
can influence the reality of feelings and sensations and Sharpe (2000) concludes
that “emotions are the starting point for our expressive description of music” (p.
59). Structural complexities allow musical emotion to be communicated not
only as a total experience, but also through the smaller parts that make up the
whole (Levinson, 1997).
These contemplations give a sense of the complex phenomena that music
therapists deal with on a daily basis. The questions become how and why does
music convey emotional states, and how do we interpret and make sense of
music as an emotional force. In his analysis of experiencing music as a cognitive
skill Sloboda (1985) writes:
. . . music is capable of arousing in us deep and significant emotions.

These emotions can range from the “pure” aesthetic delight in sound
construction, through emotions like joy or sorrow which music
sometimes evokes or enhances, to the simple relief from monotony,
boredom or depression which everyday musical experiences can pro-
vide. (p. 1)
We offer our clients a time to be free from the bounds of their illness and/or pa-
thology through the expression of emotions. It follows that if music can allow
emotions to be clearly and specifically expressed, then the potency of the music
therapy relationship is assured.
36 Colin A. Lee
MUSIC AND LANGUAGE
Does music mirror verbal language and, if so, what are the implications for
music therapy? Music is a language of emotions. What does this suggest for the
creative processes in clinical improvisation? The spoken (or written) word is a
way in which two human beings communicate, but in order to do so, both must
understand the logic of sentence construction and the subtleties of the language
in which they are conversing (Sharpe, 2000). For many clients these forms of
communication are not available. However, we do not need these prerequisites
to achieve discourse through music. Could it therefore be argued that communi-
cating musically requires less intellectual ability than communicating on a
verbal level? On what intellectual level do we require musical language to be
significant? Scruton (1997) says that “language is unique to rational beings.”
Taking that approach, and given the “nonrational” nature of many clients, music
therapy could then be described as a noncommunicative process. Of course this
is a ridiculous suggestion. Rationality is not required in order for music to be
perceived as a form of language. The paradox of music is that it can be both ra-
tional and nonrational within an instant, and that is why clients find it such a
powerful form of explicit and implicit communication.
Language is not as subtle as music (Treitler, 1997) and we should be care-
ful when comparing the two (Begbie, 2000). While Addis (1999) holds that
music and language are analogous in that each has a variety of forms, the spe-
cifics of which must be understood in order to achieve communication. This is
in direct contradiction to the underpinnings of AeMT. The power of the musical
dialogue is precisely that–participants can share language at an intricate and re-
fined level without understanding the complexities of style, grammar or syntax.
It is interesting to note that the words “style,” “grammar,” and “syntax” are ap-
plied to music, though all have their origins in language (Agawu, 1991).
Historically, the nonverbal nature of music has precluded the use of a verbal
model to describe it; Nattiez (1990) had problems in articulating the intricacies
of his work because music is fundamentally nonverbal. The most controversial
answer to this divide was prepared by Keller (1994), who devised a theory of
functional analysis where music was analyzed not through language but by
music itself. It is the nonverbal essence of music that places it beyond the
specifics-oriented nature of verbal language.
IS MUSIC REPRESENTATIONAL?
It would seem natural that music is representational–that it transmits ideas and

concepts. But not all theorists would agree (Kivy, 1991). How does our imagi-
nation respond to music. (Walton, 1997, in Robinson)? Unlike paintings, music
cannot depict the symbols necessary for specific representational images:
. . . when I step outside my game with music and consider the music
itself, all I see is music, not a fictional world to go with it. There is
just the notes, and they themselves don’t call for imagining anything.
(Walton, 1997, p. 82)
Addis (1999) proposes three kinds of representations:
• conventional–the representation “depends on neither the inherent

nature of the representation nor on that of the one who uses that
representation”;
• natural–the representation which “by its inherent nature, deter-
mines both that and what it represents”; and
• quasi-natural–a three-term relation involving the representing
object, that which is represented and the representer.
When attempting to understand music as representation, most theorists parallel

their discussions with the visual arts (Scruton, 1997; Walton, 1997). Scruton
concludes that while it is his view that music is not representational, there may
be other open questions:
. . . music is not representational, since thoughts about a subject are

never essential to the understanding of music. But, it might be said, I
have done nothing to show that we must understand music as we
presently understand it, nothing to show that there could not be a new
way of understanding music which yet had the character of an aes-
thetic interest, and which accorded to music the status of narrative. (p.
138)
Music therapy requires a new way of looking at music as communication and

representation. The narrative of the therapeutic relationship in creative music-
making presupposes that musical representation is significant. Whether we look
to the specific representations during the unraveling of the therapeutic process,
or the more fluid experiences of free-flowing nonrepresentational expression,
38 Colin A. Lee
the music in music therapy must include a representation of the relationship.

One must then ask oneself how to translate the complex forms of therapeutic
representation necessary for further understanding. In music therapy, then,
representation may be conventional–that the client and/or situation does not
require representational specifics, natural–that the therapeutic situation dictates a
specific and finite representation, and quasi-natural–involving the therapeutic
representation, that which is being represented and the client/therapist relation-
ship.
CLOSING THOUGHTS
How do we describe what happens in a piece of music, how do we describe the

musical relationship and musical events that happen in clinical improvisation,
and how is each related to the other? What makes Beethoven’s music so distinct
from Ravel’s (Blacking, 1974), and what makes one client’s improvising so dis-
tinct from another’s? If indeed a client characterizes their persona through music
then how could our understanding of these structures color our responses and the
potential musical worlds we make available? There are many forms of analysis
both musical and extramusical. If analysis is the key to understanding, then the
theoretical reasoning we adhere to will reflect both our questions and the enig-
mas we are trying to unravel. Because music therapy balances itself between
two beliefs, that of “art” and “science,” then we must address the potential of
each separately and also the connections between the two.
These questions point to the heart of AeMT. Without asking these essential
questions our understanding of clinical music will be limited. The essence of a
client’s playing and the musical relationship with the therapist is based on music
that is perceived, instantly analyzed, and responded to. Our understanding of
musical textures, interactive themes, and improvisational inventions between
client and therapist transpires to form the intensity of the musical and clinical
dialogue. By understanding music itself, its role in the therapeutic alliance, and
the interface between the knowing of music and relationship, we can begin to
understand the true nature of improvising in music therapy.
Excerpt Two
Chapter Four
TONE, FORM, AND ARCHITECTURE

Colin Andrew Lee
The single harmony produced by all the heavenly bodies singing and
dancing together springs from one source and ends by achieving one
purpose, and rightly bestowed the name not of “disordered” but of
“ordered universe” upon the whole.
–Aristotle (384–322 BC), Metaphysics, quoted in Watson
(1994)
To a layperson, the word “clinical” conveys images of white coats and medical
procedures. Considering the music therapy relationship as clinical seems at odds
with one’s usual beliefs and experiences of music. How can a music therapist
provide clinical music and how can a therapeutic relationship be clinical? In this
context, “clinical” denotes clarity rather than sterility. Clinical music is central
to AeMT because it substantiates the importance of music in the process. To be
a clinical musician is to be aware of every component, its content, and the po-
tential it has to affect the developing relationship and therapeutic direction.
Clinical music should have structure but also be structurally free, be able to
move into any key, change texture and transform as the therapy dictates. Clinical
interpretations, influences, and assumptions come from an understanding of
assessment and ongoing evaluation.
What makes music clinical is the intent with which it is used. Whether
using improvisational or precomposed music, the purpose of the music should
be carefully directed toward the client’s needs and the therapeutic process.
Neither aesthetic quality nor clinical direction should be allowed to overpower
the other under the therapist’s conscious and directed use of music.
Balancing the aesthetic and clinical features of improvisation is no easy
task. For these characteristics to be truly balanced we must know and understand
both music and therapy. In our quest to understand the medicine of music ther-
apy have we sacrificed our awareness of its art? Many music therapists read
clinical literature at the expense of music writings because they believe that such
literature is more important and relevant to their evolving work. Music therapists
converse on clinical theories at many levels, but rarely discuss the musical
makeup of their work.
Recent writings are now beginning to redress this imbalance (Aigen 2001,
Austin 2001, Bonny 2001, Bruscia 2001, Hesser 2001, Soshensky 2001), al-
70 Colin A. Lee
though there is a long way to go before the research of music therapy is equally
weighted between the art and science of its practice. Have music therapists
failed to recognize that most clients naturally find this balance in their work? If
indeed this is the case then are we perhaps not listening carefully or deeply
enough to our clients?
Paul, a seven-year-old nonverbal client with Down’s syndrome, taught me
the significance of balancing the artistic and the therapeutic. Embracing his ex-
plosions of creativity within a clearly directed process was difficult. To find
equilibrium between the freedom of inspiration and the precision of direction
was a constant challenge as we negotiated the twists and turns of the therapeutic
process. Paul would become caught in the discharge of his playing and resistive
to change. Our relationship battled between the inventiveness of music and his
resistance to any form of guidance. I could not move him beyond a certain point
without his becoming controlling and disturbed.
The strength needed to move along and yet keep the innovation that was at
the heart of our work came in the twenty-fifth session. After a long and thunder-
ous improvisation on drum and cymbal, Paul spontaneously sat next to me at the
piano. Continuing the intensity of his playing at the piano, he also began to vo-
calize–immense ascending phrases, which, along with hand-clapping rhythmic
phrases, added to the musical energy. As the intensity of the music decreased I
segued into his good-bye song. Paul immediately began to sing “Bye.” This was
the first time he had consciously vocalized specific words in response to a given
situation. The experience was now one of acute learning and direct musical
communication. For approximately ten minutes Paul and I worked at extending
his vocalization to “good-bye.”
We played with musical questions and answers and he experimented with
being able to sing and play simultaneously. The experience became balanced
between learning and the musical freedom that was the groundwork for his
musical expression. My role in facilitating this equilibrium came through
acceptance alongside a constant and step-by-step belief in Paul’s ability to focus
and to comprehend. The aesthetics of the music, our relationship, and his even-
tual enlightenment facilitated a genuine parity between the artistic and the
therapeutic in our work.
Tone, Form, and Architecture 71
THE AESTHETIC THERAPEUTIC

RELATIONSHIP
Relationship is fundamental to music therapy. In music-making, the relationship

between the players and the aesthetic outcome is fundamental to our under-
standing of the process. Just as my values and vulnerability as a human being
affect my responses, so my musical perceptions of the therapeutic relationship
influence the content of my improvisations. Boundaries and professional dis-
tance are necessary for the well-being of the therapist. Honesty and insecurity
also play important roles in the responses of the therapist to the client. There is a
danger in remaining too musically separate, making the client feel apart from the
process; there is also a danger in being too compassionate so that the client feels
overwhelmed by the well-meaning and often effusive style of the music. It is
easy in music to over-identify and to find oneself caught in playing improvisa-
tions that are more reflective of the therapist than the client.
What then of an aesthetic relationship that is agitated and unbalanced?
The aesthetic potential of therapeutic resistance and disturbance is

equal to considering the rounded expression of the beautiful. Aes-
thetic here means both the offensive and the beautiful. (Lee & Khare,
2001, p.268)
The aesthetics of the music therapy relationship are fundamental to our under-
standing of the client and his or her music. To consider the client, no matter how
disturbed or ill, as aesthetic and therefore see the relationship as fragile and ele-
gant is to transfer to music a sense of the comely that is at the heart of music
itself. Just as beautiful music is not dependent on consonance of sounds, so
beauty in the therapeutic relationship is not dependent on conformity and re-
finement. Sometimes to be musically aggressive is to be liberated, free, and
beautiful:
The periods of wild free playing are very important for me and bal-
ance the times when the music is more controlled. It is at these times
that I can lose control, be frenzied and let go of all my inhibitions. To
be angry, violent and not worry about what I do musically. I don’t
think however that we are ever completely chaotic. We accept the
chaos of our relationship but we don’t want it to be chaotic, (Eddie, a
client living with HIV).
72 Colin A. Lee
The aesthetics of all relationships have the potential to metamorphose. The

therapeutic relationship through music finds a balance, one that is reliant on yet
free from the constraints of pathology and illness.
Clients often refer to the release of musical expression as being like flying.
The aesthetics of musical flying and the therapeutic relationship can transcend
the bounds of living and dying:
Through music I fly. In improvising I leave behind the realities of my
illness, my tumor and the degeneration of my living. I portray my
anger and feelings of hopelessness. The music we make is not
pleasant and often feels intolerable. We do not try to “fix it,” we ex-
plore it and let it be. (Carol, a client with cancer)
Flying in music is, I believe, an ultimate experience. Musical flying can suggest
a progression in the developing process and the therapeutic relationship. Flying
in improvisation can be organized yet free; it is a representation of the client’s
growth and a need to express cathartically.
There are many ways that people make music. In the classical style there is
orchestral, chamber, or operatic music; pop music is created through singers and
bands; in jazz through small and large combos; and in music therapy through
group and individual work. All of these are comprised of common elements and
yet ostensibly music therapy would seem the odd one out. Why is this? When
we enter music-making we leave behind the laws of realities and conscious
logic. Whether there is union through a Beethoven violin sonata, a pop song, a
jazz duet, or an improvisation in music therapy, the dialogue between players
can be seen to be of a similar nature. Is music-making in music therapy dissimi-
lar to other forms? I would suggest not. The intertwining of clinical direction
and aesthetic value in music therapy is a manifestation of musical direction and
freedom. If we truly hear our clients in music, then the aesthetic flying in the
process may be the same as that of the string quartet’s spiritual connections in
Beethoven’s Op. 132 as analyzed in Chapter Nine. If we enable our clients to
experience the musical-spiritual connection, then perhaps in some small way we
have added to the richness of their existence.
In AeMT the role of the therapist is that of both clinical musician and
composer. All music therapists who improvise are composers and all music
therapists who think intensely about their work are clinicians. Does this also
mean that all clients are potential composers and clinicians? What distinguishes
AeMT is the idea of first understanding the nature of clinical music before inter-
preting the process:
Until we understand music itself we can never understand the effect it

has to change people’s lives. (Lee & Khare, 2001, p. 247)
The therapist’s first and foremost attribute is to be an accomplished musician.

Once musical fluency has been achieved the therapist can start adapting music to
the specifics of clinical situations. In AeMT it is music that is the genesis and
which remains the guide for the therapist’s developing work. Musicality is not
placed second to music’s clinical application. In fact, the emphasis on music
becomes stronger as the therapist perceives with greater detail the balance be-
tween the art and the science of their practice. The role of the clinical musician
is thus to:
• listen musically
• listen clinically
• evaluate sounds as part of the process
• respond to sounds as a musician
• respond to sounds as a clinician
• have a clear perception of musical aims
• have a clear perception of clinical aims, and
• respond with quality and aesthetically embodied music.
ASPECTS OF PROCESS
The process of music therapy has been researched and discussed at great length.
What is the music therapy process, how do we define and quantify it, and how
will our greater understanding of it increase the value of the work being done in
both the medical and artistic communities? The following subsections are con-
templations about areas that have been important to the development of AeMT.
They are aspects that have been developed through my teaching and clinical
practice. The answers to the mysteries of the music therapy process are to be
found in the music dialogue and relationship. The process is dependent on a
comprehension of the realities of musical structure, shape, and form.
If we allow for the intricate balance of the artistic dimensions that client
and therapist bestow on the process, then music and therapy will become an in-
tegral characterization of the client’s aspirations as creative musician and
composer. To understand the process of AeMT is in essence simple because
there is clarity in its musical intent. Taking music as the essence does not how-
ever, negate the potency of clinical analysis. In fact, it heightens it. Once a clear
comprehension of clinical music is established then extramusical theories can be
investigated with solidarity and insight. Analysis of the process without under-
74 Colin A. Lee
standing of the musical underpinnings that informs it will, I believe, be

inherently flawed.
Musical Choice
Why do music therapists use specific intervals, tones, melodies, rhythmic pat-
terns, or harmonic progressions? What is it about the therapeutic relationship
and ongoing aims of therapy that dictate the therapist’s musical choice? Musical
choice is a combination of assessment, inventiveness, structure, relationship, and
process. Why and how do we repeat musical themes and what learned resources
enable the therapist to improvise, remember, and repeat? Therapists must be
clear in their musical choices and be able to justify their specific musical/clinical
choices. Musical choice should not be indecisive but a finite decision made with
precision and insight. During every moment of an improvisation the therapist
and client are faced with musical choices. As the parameters expand, so do the
minutiae of musical dialogue that are open to creative and informed possibilities.
The client’s choices are dependent on the therapist’s ability to offer a range of
musical opportunities. As therapists develop their improvisational skills their
proficiency in facilitating choice will expand. The intersecting of musical abili-
ties enables the strength of the process to influence the developing relationship
and thus the course of therapy.
Therapists will initially offer wrong musical choices. This addresses the
importance of ongoing supervision. In supervision and through indexing the
therapist is able to look specifically at the musical paths taken and to reflect on
the clinical reasons for the choices made. Through guided reflection the therapist
will understand the significance of musical choice. Analyzing specific moments
and using them as a base to extend musical resources will result in an enrich-
ment of ideas that can be taken into future sessions.
Taking Risks
To live is to risk. Every therapeutic encounter contains risks. To enter a music

therapy session as client or therapist is to risk the unknown. To wait for the
client, to hear their first sounds, and to respond through spontaneous
improvisation is full of musical and human risks. If therapists decide they fully
know their practice and work only from the bounds of that approach they will
soon become stagnant. The strength found in acquiring knowledge and then re-
linquishing it to risk is a mystery. Like the process of therapy itself, risks are
balanced through knowledge and understanding. The music therapist must al-
ways be prepared to take risks from a base that is clinically clear and focused.
Taking musical risks is challenging and can be liberating for both therapist
and client. Preparation allows the therapist to bring to a therapy session that
which has been derived through assessing the direction from previous work. The
therapist’s need to rely on familiar music should be balanced with sections of
openness, unpredictability, and that essence of “not knowing” that is at the heart
of clinical improvisation. This does not mean that music should be unprepared
even in the freest of improvisations. From detailed evaluation of previous ses-
sions the therapist is given a myriad of themes and ideas to practice and
consider. The therapist should come to a session with a mental and aural ency-
clopedia of music that has been acquired and that is appropriate for the
particular client. Having this vast range of music available, the therapist must
then be prepared to relinquish these conscious themes and to place them in his or
her subconscious. Only then will the resulting music be a true reflection of the
moment-to-moment expression of the client.
Cues
Aural and visual cues in clinical improvisation are a sophisticated form of non-
verbal communication (Smith, 1998) necessary to balance the evolving musical
structure. The need for cuing comes from the belief that therapists should never
verbally converse with clients during music-making. Therapists working to-
gether must refine their relationship to include cues that are acutely
sophisticated. Nordoff and Robbins’s (in press) articulation of the roles of thera-
pist and co-therapist include sensitive cues that are central to the tripartite
relationship of individual work and the more complex dynamics of group work.
Therapist and co-therapist communicate through sophisticated visual cues that
include the glance of an eye or the nod of a head. The evolving relationship be-
tween therapist and co-therapist, therapist and client, and co-therapist and client,
is heightened by the subtleties of visual cues. Once the client becomes aware of
the potential for nonverbal visual direction they too will include visual cuing as
a part of their communication.
Musical cues are equally refined. As the structure of an improvisation de-
velops so musical form becomes clear for the direction of therapy. Cadencing,
pausing and tonal and melodic direction can all herald the segue into a new sec-
tion or the recapitulation of an idea that has already been developed. Each of
these acts as a cue that does not detract from the overall flow but help partici-
pants to understand their place within the music. The therapist must be keenly
aware not to exercise his or her ego within this context, as was previously dis-
76 Colin A. Lee
cussed. The combination of aural and visual cues provides a level of nonverbal
refinement that is essential for the complex musical manifestations of AeMT.
Just as jazz musicians use aural and visual clues to challenge their creative
playing so the client and therapist(s) will use cues in the moment-to-moment
expression of their therapeutic intention.
Keeping Going
One of the greatest fears for any improviser is the possibility of paralysis and the
inability to keep going.
Keeping it going means that something has to be there to do next.

And since what is there is not concrete or written down, it must be
something remembered and reproduced intact on the spot, or some-
thing created extemporaneously by recombining stored musical
information in a new way that is appropriate to the music situation of
the moment, (Slawek, 1998, p. 336)
The art of clinically applied improvised music is dependent on repertoire and

exacting assessment. In music therapy the music is kept going through: a) de-
veloping resources, b) responses and creativity of the client, c) the aims of the
moment and overall design of the session, and d) incorporating previous
material. I have found from experience that the music will rarely lose direction if
the therapist is knowledgeable about the music needed for the therapeutic
partnership and is free from inhibition.
Every therapeutic musical contact does, however, contain the possibility
that the therapist, for whatever reason, may not be able to keep going. Is this
a consequence of the therapist’s musical inability, the client’s resistance,
a reflection of the therapeutic relationship, or the need to musically rest? If the
therapist is unable to keep going these questions should be addressed during
assessment and supervision. What if the client needs to keep the music going but
is unable to do so? What role does the therapist play in facilitating a musical
experience that will allow the music to establish direction? The therapist must
listen to the strands and reconnect them so that the client can return to the musi-
cal dialogue. If the music fails because of the client’s lack of technique then the
therapist must improvise themes that will reestablish the music seamlessly.
Musical Equality
The Venda taught me that music can never be a thing in itself, and that all music
is folk music, in the sense that music cannot be transmitted or have meaning
without associations between people (Blacking, 1973 pp. x–xi).
Many folk, jazz, and pop musicians who do not have formal musical edu-
cation are adept and skilled. In light of this, clients can often be the musical
equals of the therapists. Music therapy challenges the hierarchical implication
that musicianship is about knowing and education. To envision clients as inher-
ent artists is to respect their creativity as equal to those of trained musicians.
AeMT derives its approaches from the musical equality of client and therapist.
Its philosophy is based on the assumption that music translates equality and that
a therapeutic dialogue in music is founded on different human principles and
logic rather than on the consciousness of words. A musical relationship will find
a level of human contact that cannot be premeditated in therapeutic terms from
the rationality of conscious and verbal logic.
Musical parity does not, however, mean that the boundaries of the thera-
peutic relationship are in danger of disintegrating. Rather, it emphasizes the
need to look beyond the inequality of the therapist as learned and the client
as uninformed participant. Music therapy does not require an educational imbal-
ance, yet it requires much education on the part of the therapist. I believe that to
fully understand therapeutic interaction through improvisation, we must look
further to what it means to be musically equal with our clients.
The myth that fully understanding music is for the intellectual few is a
view that has corrupted Western classical music. The concept that an autistic
child can create music comparable to that of a trained musician may at first seem
ludicrous. If we accept the possibility that a person with a disability can con-
tribute to music as much as a trained musician then where does this place music
therapy within the development of music? What does this also say about West-
ern “art” music and the lack of spontaneous creativity and improvisation placed
within the education of musicians?
Music therapy has helped broaden the definition of what constitutes being
musical. When Blacking (1973) asks “How musical is man?”, he raises a
fundamental question for music therapy:
We need to know what sounds and what kind of behavior different

societies have chosen to call “musical”; and until we know more
about this we cannot begin to answer the question, “How musical is
man?” (pp. 4–5)
78 Colin A. Lee
Are all human beings–and therefore clients–musical, and to what level of musi-
cianship can our clients aspire? The music therapist must hear every sound and
nuance of the client as being intently musical. If we are not clinical in our musi-
cal listening then we will miss crucial components of the therapeutic process. A
musician would probably not consider a spontaneous scream to be musical, but
music therapists will consider the scream as containing tone and musical inflec-
tion. They will attempt to place the quality of its sounds within the overall
structure of the music.
That all clients have the potential to be great musicians is what makes
music therapy such a driving force for the future of music and medicine.
Maggie, a thirty-year-old, nonverbal, quadriplegic blind woman, taught me that
disability and musical genius are not mutually exclusive concepts. Her musical
expression through voice and delicate cymbal playing was of the highest com-
positional order. She instinctively knew form and was able to create music that
was exquisitely crafted and designed. I believe that if Maggie had been born
without her profound disabilities she might have been a great musician. The
privilege and responsibility of considering clients as musical equals are the
characteristics that bestow upon music therapy its unique characterization and
contribution to society.
TONE
Tone is the genesis from which all possibilities of AeMT develop. The tone as
an intangible yet grounded experience helps to define the potential for the thera-
peutic relationship. By considering the nature of the tone, its relation to the
client, the music, and the therapeutic process, the therapist begins to understand
the complexities of clinical improvisation. “Tone is described here as a single
pitch that may also be described in terms of its quality, character, timbre, color,
and intensity of singing and/or playing” (Lee & Khare, 2001). As the tone pro-
vides the beginnings for composition, so in clinical improvisation it presents
endless possibilities for the musical and therapeutic alliance.
The tone exists as a question that calls to be answered and placed in con-
text by other evolving tones. The change that comes through the introduction of
a tone and the musical direction that ensues is dependent on quality, duration,
and pitch. The tone immediately searches for balance and development.
The tone seems to point beyond itself toward release from tension and
restoration of equilibrium; it seems to look in a definite direction for
the event that will bring about this change; it even seems to demand
the event. ( Zuckerkandl, 1956, p. 19)
The single tone, then, cannot survive unless it is placed alongside other tones,
leading to melody, harmony, and structure.
Tones seem to incline towards each other, fall away from each other,
as though they were complete entities which are magnetized by their
neighbors and eager to cling to them. (Scruton, 1997, p. 52)
The opening horn theme of Brahms Second Piano Concerto in B flat major, Op.
83, that moves so effortlessly away from the opening tone and the seemingly
disparate relation in Webern’s Konzert Op. 24, show the scope of possibilities
for the beginning tone.
In music therapy tone heralds the beginning of the process. Ansdell (1995)
describes how tone by succession leads to other tones and eventually larger
musical frameworks.
Each tone is not separate but contains a “force” (both melodic and
harmonic) which gives it direction towards and connection to the next
tone. Groups of tones then organize themselves into motifs and
phrases, which are themselves “nested” within larger phrases and
periods. (p. 139)
As the music then moves into compositional form an interpretation of the begin-
ning tone is essential.
The starting point for clinical listening is the identification and quali-
ties of the “tone” itself and its effect on the ensuing musical structure.
Once the opening tone is ascertained others can then be identified as
the evolving intervals become apparent. (Lee & Khare, 2001, p. 252)
From the foundation of the opening tone, the musical structure evolves creating
a “force” that has a life of its own. This act of creation, however, is not possible
without acute listening and response.
The client’s opening tone can often be embedded in complex vocal textures
or nonspecific instrumental playing. Spontaneous sounds reflect the emotions of
the client entering the session. If the therapist is improvising music as the client
enters, the opening tone either vocally or instrumentally will often be related to
the music being improvised. The therapist should therefore improvise music that
is open and tonally noninferred since the musical relationship begins the instant
the first sounds are created. Precisely hearing, reflecting upon, identifying, and
80 Colin A. Lee
moving forward from the tone into the core of the session is the therapist’s
challenge. To reflect the interpersonal links between creativity and expression
that emerge for client and therapist in the evolving relationship.
Tension and release are integral components of tone. As tone moves to-
ward melody and composition there are elements of tension. Where does the
musical direction need to go? How does tone speak to the developing music?
What aims are being evolved as tones emerge? The tension of an opening tone is
often followed by release; tension and release reveal the flexibility of the thera-
peutic process. Paul Nordoff’s exploration of tension and relaxation (Robbins &
Robbins, 1998) gives us a wonderful insight into the specifics of musical con-
struction and how this can affect musical direction in clinical practice.
The music you use in therapy must begin to have tension in its har-
monic form, and both harmonically and melodically, a sense of
urgency in the tonal direction . . . Now, there can be more or less ten-
sion, depending on the kinds of chords and the kinds of intervals you
use. And there can be more–there can be less–relaxation, depending
on the kinds of intervals and chords you use. (p. 111)
Just as human relationships contain equilibrium and disparity so the therapeutic

relationship is balanced between fragmentation and union. The tension and re-
lease of music is displayed through the human/musical contact of improvisation.
If we look at a distillation of the opening moments of an improvisation
with a client living with HIV (see Figure 5) we can see how the therapist an-
swers the clients’ opening tones. The tension and release of chords in response
to the client’s repeated B provides a sense of harmonic direction and openness.
To answer the tone with a consonant chord would have implied tonality and
therapeutic direction reflective of the therapist and not the client. The opening
7th (1) allows for many different tonal directions. The following chord (2)
moves closer to tonality and yet retains a sense of ambiguity by overlaying an
implied F# minor and G major without the thirds. The therapist’s choice of har-
monic stability and release (3) is interestingly a firmly rooted C major against
the client’s B. This provides consonance and release yet retains a sense of musi-
cal divergence. “Meeting” a client’s sound, however, does require that the
therapist play musically the same:
By “meeting” a client’s sound we remain separate, presenting our

own identity, our own voice, which ultimately supports the client but
does not impede or step upon their individual voice. (Lee & Khare,
2001, p. 259)
The movement from tension to release is repeated (4-6) through F# minor, G

major–with the added ambivalence and spice of D #–to C major. As the client’s
tone moves away from the B (7) the F#/G major overlay is repeated moving to
the opening 7th and then toward a two-part melodic invention (9-10). This
example demonstrates how the tone can be colored to reflect ambiguity and
subtle stability that was an expression of the shifting musical/therapeutic rela-
tionship.
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82 Colin A. Lee
FORM
Form surrounds all aspects of music and therapy–the form of the complete mu-
sic therapy process, the individual session, the improvisation within the session,
and every moment within each piece. How we perceive musical and clinical
form, how finitely we are able to hear, understand, and interpret reflects our un-
derstanding of form. This in turn informs our response to the client and the
musical style we use to translate form into clinical intent (see Figure 6).
Levinson (1997) in his study on listening and form suggests that:
The judgment that a piece has good musical form,…cannot rest di-
rectly on the presence of this or that large-scale formal relationship. It
must rather rest directly on registration of moment-to-moment
satisfyingness or cogency. (p. 161)
He argues that a listener does not need the comprehension of large-scale form to
understand the overall form of music and that “music’s real form, . . . is con-
tinuational and successional, not spatial and architectonic.” The deciding factor
that differentiates the client in music therapy from a music listener is that the
client not only listens but also actively responds. The client instinctively com-
prehends the nature of form dependent on the moment-to-moment realization in
conjunction with an overall sense of large-scale form. If, as Levinson suggests, a
global understanding of structure is not needed, then the therapist’s understand-
ing of the process and the client’s place therein may become misread. When
talking of new form Scruton (1997) puts forward the view that:
New forms in music cannot be created by fiat or convention. They

must grow from a new musical gesture, which means a new style–a
new way of hearing tones, and their organization. The successful in-
vention of form is a rare achievement. (p. 341)
AeMT requires a comprehension of the relationship between clinical tone and

clinical form. This is what differentiates music therapy philosophy from musi-
cology; AeMT is indeed a new way of considering form in the clinical context.
The level of maturation of the therapeutic process determines the form of an
improvisation, as well as its ingenuity, spontaneous structure, and development.
Landscape of the Conscious

Music Therapy Relationship
Form
(Musical and Theraputic)
Style
(Key - Idiom - Song)
Clinical Direction
Figure 6
Pavlicevic’s Theory of Dynamic Form (1997 & 2000) “clarifies the interface
between music and emotional form in Music Therapy improvisation (MT im-
provisation).” Paralleling Daniel Stern’s (1985) “Vitality Affects”, Pavlicevic
explores the stylistic and spontaneous qualities of music communication:
Dynamic Form is elicited within and as part of the clinical-musical

relationship, and needs both therapist and client to be engaged with
one another through jointly created sound form. Thus, the music
therapist generates Dynamic Form jointly with the client (rather than
play music with the client). This means receiving the client’s musical
utterances as a direct presentation of the client-in-the-world; and lis-
tening to the improvisation with a therapeutic mind–that is not
allowing (conventional) musical dictates to interfere with, or over-
ride, interpersonal ones. (Pavlicevic, 2000, p. 276)
84 Colin A. Lee
Dynamic Form is an important MT improvisational theory because it identifies

the need to consider the link between being expressive and being musical. Ex-
ploring further, Pavlecevic suggests there are similarities as well as distinctions
between the mother-infant relationship and the client/music therapist relation-
ship. In Dynamic Form the therapist seeks to answer the client’s music through a
balanced appreciation of the musical and therapeutic responses inherent in
music.
A music-centered approach to clinical form is derived from an under-
standing of musical form. The interface between the two is crucial, but the
musical essence of awareness is the element that differentiates AeMT from Dy-
namic Form. Until we know and understand the musical form of improvisation
we cannot link it accurately to clinical form. Illuminating our knowledge of the
client and his or her musical responses within the framework of musical form
requires clarity and awareness of musical structures. Comprehending a client in
a holistic manner will be achieved only by understanding and accurately inter-
preting his or her music.
ARCHITECTURE
What do we understand as the therapeutic process? What does it mean to pro-

gress therapeutically? What influence does music have on the therapeutic
process? Throughout my writings and research I have spent a great deal of time
considering what is meant by “the therapeutic process” and what impact music
has on this phenomenon. The music therapy process is intricate and delicate;
like music itself it is reflective and is illuminated through macro- and micro-
structures which constitute the basis of its power. The process is unique to every
individual’s growth, every session and moment; it is dependent upon the mo-
ment of contact, what has gone before and what may happen in the future (see
Figure 4). How can we, at the moment of contact, know what will occur in a
piece of improvised music? We can’t, of course. What we can know, however,
is the impact of that which has gone before and how it influences each moment
for the future. By understanding the past in context of the present, we can allow
the process to happen instinctively and insightfully.
Levinson’s (1997) argument that music needs only to be experienced in the
moment may be true from a client’s perspective, but for the improvising music
therapist it is not. The therapist’s sense, realization, and ongoing appreciation of
musical and therapeutic architecture are critical. Learning to distinguish the
moment in relation to the whole is a precise technique that comes from detailed
assessment, ongoing practice of musical resources, and direct experience from

clinical work.
Analyzing the architecture of precomposed music with which the therapist
is familiar, then linking it to improvisation, will help to clarify the clinical
structure of ongoing sessions. Taking significant pieces of music and inter-
preting their composition, as is the focus of Chapters 2, 7, and 11, will further
highlight the music-centered focus of musical and clinical architecture. Music
therapists as improvising composers must know the musical structure and ar-
chitecture of their work; just as composers learn the art of orchestration and
compositional form, so the music therapists must learn to craft the architecture
of music to suit the needs of the client and the process. The creativeness of the
therapist in the moment is balanced with the precise knowledge of universal
structure. We cannot break free from that which we do not know. The apprecia-
tion of Dynamic Form and architectural clinical form is dependent on study and
therapeutic insight.
Philosophical ruminations of life and what it means to share music are the
lifeblood of our work and influence our understanding and sense of the process.
While music therapists all share in the rich heritage of musical speculation,
learning, and personal debate, philosophical stance is influenced by training,
theoretical preference, individual bias, and musical motivation. As one’s clinical
work matures, so too the musical knowledge of the therapist must broaden. The
awareness of musical shape and form in the therapeutic setting is a crucial foun-
dation of AeMT.
All great and influential music is written by composers who are prepared to
take risks. New critical music therapy theories have come and will continue to
come from those who are able to challenge the status quo. Music therapy as art
needs innovation and speculation, whereas music therapy as science needs sta-
bility and replicability. That is the paradox. Pioneers of music therapy should be
educated, yet free in their thinking. Pioneers of music therapy should be af-
firmed not only through research and writing but also through the practicalities
of clinical work. Pioneers of music therapy should justify their status by sharing
work that will set future standards of musical excellence.
See, if you put a musician in a place where he has to do something

different from what he does all the time, then he can do that–but he’s
got to think differently in order to do it. He has to use his imagina-
tion, be more creative, more innovative; he’s got to take more risks . .
. .So then he’ll be freer, will expect things differently, will anticipate
and know something different is coming down .. . . Because then
anything can happen, and that’s where great art and music happens.
(Davis & Troupe, 1991, p. 220)
86 Colin A. Lee
MUSICAL ARCHITECTURE
Figure 7
Excerpt Three
Chapter Five
CLINICAL LISTENING
Colin Andrew Lee
If your mind is empty, it is always ready for anything; it is open to
everything. In the beginner’s mind there are many possibilities, in the
expert’s mind there are few.
–Shunryu Suzuki,
Zen Mind, Beginner’s Mind
Listening is at the heart of human relationships. How we listen reveals our sense
of the world. Listening to music can be inward experience as a means for per-
sonal reflection, or external experience as a means to relate to others. Clinical
listening is the art of the therapist’s attunement to the client’s sounds, listening
to reality and beyond; listening to every nuance from the client’s first utterances
to the final sounds as the session ends. Every sound, musical contribution, of an
improvisation is a moment of clarity and emotion that should be heard with ex-
actness and insight. Steele (1988) eloquently expresses the view that:
Perhaps the most primary service we offer our patients within space
and time of the therapeutic environment is our willingness and ability
to listen. (p. 3)
Our musical responses to listening determine the level we endeavor to attain as

therapists. Through the meaning of listening, music and its potential for healing
can become ever more discriminating:
• Listening to the client, their music, our music, and the musical
relationship
• Listening behind and beyond the music
• Listening to silence
• Listening to the client as personhood and musichood
• Listening as musicians and therapists
• Listening as sound and community
(Lee & Khare, 2001, p. 268)
88 Colin A. Lee
The musicologist Roger Scruton (1997) makes two interesting observations:
Music begins when people listen to the sounds that they are making,
and so discover tones. Of all musical experiences, there is none more
direct than free improvisation (whether vocal or instrumental): and
this should be understood as a paradigm of listening–the form of lis-
tening from which music begins. (p. 217)
Improvisation was used long before precomposed music appeared. Tones that
combine to form melody, harmony, and rhythm were reflective of the listening
necessary to form relationships at their most fundamental and mysterious level.
Listening in improvisation is precise and finite. In order for an improvisation to
make musical sense player(s) must be attuned to the sounds being created in the
moment-to-moment evolution of the improvisation. When more than one player
is involved there must be a community of listening for the music to make sense.
Improvisational listening and developing relationships reveal the origins of mu-
sic therapy as a nonempirical phenomena:
Music is heard as though breathed into the ear of the listener from an-
other and higher sphere: it is not the here and now, the world of mere
contingency that speaks to us through music, but another world,
whose order is only dimly reflected in the empirical realm. (Scruton,
1997, p. 489)
Expressive listening holds spiritual significance and provides for clients a depth
of experience that is beyond rationalization. Listening to specific levels of musi-
cal contact can inform our understanding of a client’s existence.
All musical relationships involve what Ansdell (1995) describes as listen-
ing-in-playing. To listen to another person, to accommodate another’s voice is to
be a part of a musical relationship. In clinical improvisation listening-in-playing
is even more essential for a successful musical and therapeutic outcome. In
Creative Music Therapy (Nordoff & Robbins 1977) listening is integral to an
understanding of its philosophy and theory:
Creative Music Therapy is able to use to therapeutic advantage both

music’s natural cultivation of the art of listening and improvisation’s
special emphasis on listening-in-playing. (Ansdell, 1995, p. 158)
Listening in Creative Music Therapy is further explored by Pavlicevic (1997)

who suggests that:
Clinical Listening 89
. . . we all listen differently as different times. During the act of play-

ing, our listening is colored by the immediate movement and
physicality of the act, which feeds that acts of playing as it unfolds.
(p. 162)
Performing a precomposed piece, a musician must know the content and detail
of the music as it unfolds. Listening to the moment-to-moment interpretation is
influenced by the listening quality of both the player and their interaction with
the audience. An audience that fails to listen with insight can dramatically affect
the performers’ ability to present the layers of content that will produce a worthy
expressionistic interpretation. The act of listening-in-playing during perform-
ance is therefore just as intricate as that of the dialogue in music therapy.
Listening is complex and hierarchical. Recreational listening colors one
part of our consciousness whereas clinical listening demands every facet of our
consciousness. When I listen intently to music I allow the music–its feeling and
design–to affect me at many levels depending on my state of mind. Listening to
a dense orchestral piece by Schoenberg requires a different kind of concentra-
tion than a Schubert piano sonata, yet both may have the same emotional
impact. For a client the act of listening-in-playing should be natural whereas for
the therapist it requires insight and sensitivity. Playing an instrument requires a
client to listen and physically respond. A client’s sense of physicality, as
Pavlicevic (1997) suggests, will influence their listening and therefore their level
of creation.
The therapist listens before, during, and after music. Sounds that preempt
the improvisation reflect the significance of the opening tones.
. . . the principle of waiting and listening, both at the beginning of and

during the musical dialogue, is of paramount importance for the thera-
pist’s attunement. (Lee, 1996, p. 89)
As an improvisation ends the therapist listens to the closing sounds and beyond.
Listening to the concluding silence, its quality and intent, can reveal the signifi-
cance of the session itself. Listening is not bound by the music and extends
throughout every second the client is in contact with the therapist.
In AeMT the following questions are raised: Why is it important that
clients are heard through both music and sound? What is the difference between
hearing and listening? How is clinical listening different from our general expe-
rience of listening? How do we identify levels of listening that will give a
greater understanding of the therapeutic relationship? These underlying ques-
tions point to the need to listen ever more deeply to our clients, the music, and
the timbre that lays between the notes. Clinical listening is both precise and
sonorous. Being heard is one of the most powerful experiences two human
90 Colin A. Lee
beings can share. For a client who has not had the experience of being heard, the
music therapist’s responsibility is to attempt to find an opening that will allow
this. The therapist should pause, wait, and allow an opening that will enable the
client to reevaluate their sense of themselves in relation to music and people.
Listening to both sound and silence can support an equality of relationship that
is inherently therapeutic. To hear can be abstract whereas to listen requires accu-
racy.
LEVELS OF LISTENING
The six levels identified below show the intensity necessary in evaluating lis-
tening skills in clinical improvisation.
1. Surface Listening–identifying fundamental musical form and

therapeutic relationship
2. Instinctive Listening–identifying and interpreting further com-
plexities of music form and therapeutic relationship
3. Critical Listening –identifying fundamental musical resources
4. Complex Listening –identifying and interpreting further musical
complexities of musical resources
5. Integrated Listening–identifying and interpreting links between
therapeutic and musical
6. Listening Beyond–identifying the incorporeal nature of the music
and relationship
The following clinical example (see Figure 8) shows an assessment of the thera-
pist’s levels of listening and response. The extract, an improvisation from the
eighteenth session with a client living with AIDS, comes 15:05 minutes after the
opening. Prior to this section the client explored different instrumental textures
on drum, cymbal, and bongos. Moving to the xylophone the improvisation be-
came gentle and delicate. The aims for the ongoing work were to: a) explore
personal defenses at receiving an AIDS diagnosis, b) translate feelings into
musical expression, c) use improvisation as a means for catharsis and thus stress
reduction, and d) enjoy the act of music-making with another person. The case
illustration contains information taken from the assessment and indexing notes.

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92 Colin A. Lee
Level One –Surface Listening
• client: explorative and focused playing

• therapist: simple supportive accompaniment (1-6)
• structural development of an earlier theme
• relational listening, based on the melodic song-like qualities of
the xylophone (client), supported with the piano accompaniment
(therapist)
• the musical dialogue between between players is sensitive
Level Two–Instinctive Listening
• the client’s melodic invention develops from motives (1-5)

moving toward recitative-like phrases (6-8)
• the therapist’s suspended chords (6-8) provide a background for
the melodic development of the client
• an acute sense of listening and response between players
• the musical and therapeutic relationship is refined
• in discussing this passage the client remarks: “our playing is to-
gether and yet separate . . . this perhaps reflects our (therapeutic)
relationship?”
Level Three–Critical Listening
• client: upward phrase (1) followed by two downward phrases (3

& 4); (6-8) free-flowing melodic invention with broader spaced
intervals as the phrase develops
• therapist: syncopated accompaniment (5/8) based on 2nds and
a descending bass line (1-5); suspended chords (6-8) around a
tonal center of G
Level Four–Complex Listening
• client: major 2nds followed by minor 3rd (1-2); 2nds followed by

descending major 6th (3) repeated with descending minor 7th; (6)
semitone and tones (6) move toward displaced intervals (7-8)
• therapist: descending bass line starting on B flat (A #) (1-5),
moves to a tonal center of C (5), resting on D (6), and finally set-
tling on G (7-8)
• the compositional form is sophisticated–tonally and rhythmically
the passage moves between a consonant accompaniment and
melody followed by a recitative
• musical interpretation reveals a sophisticated and intricate com-
positional form individually and collectively
Level Five–Integrated Listening
• this section meet the aims of our work and highlighted the link
between musical and therapeutic expression
• the quiet, tender, yet syncopated nature of the music was anti-
thetical to the more normal forthright dialogue–a powerful
expression of the clients intense emotions
• the music allowed a balance between simple structure and free-
dom that reflected the developing relationship and the client’s
need to find different forums of musical expression to translate
his precise feelings of helplessness and pain
Level Six–Listening Beyond
• the music held a transcendental quality that mirrored the inner

expression contemplating an AIDS diagnosis
• the movement of themes and exploration of melodic lines show
the spiritual nature of emotions being expressed
• a sense of deep listening pervaded this section of the improvisa-
tion
• listening to and beyond the sounds themselves
94 Colin A. Lee
These observations hopefully give a clear and detailed picture of the levels
of listening available in one section of music. Through detailed listening our
understanding of the moment-to-moment structure in relation to the complete
improvisation of the session and overall therapeutic process will become clearer.
Reflecting on these statements and interpretations will further color and affect
the empirical and reflective elements of listening and analysis.
CLINICAL LISTENING IN SUPERVISION
Clinical listening is the first of four levels in the supervision process of AeMT
(Lee & Khare, 2001). The other levels, clinical evaluation, interpretation, and
judgment–unfold from this core concept. The description of clinical listening is
initially presented by the supervisor:
One of the main tenets of music-centered supervision is hearing ob-

jectively and precisely the musical constructs contained within
the musical relationship. Music as a complex and multilayered phe-
nomena in music therapy should be precisely evaluated, considered,
and analyzed at all levels of its experience. Separating what we think
we hear from the reality of sound, music and the interrelationships
can provide a new basis and understanding for our work. Living in
the knowing of music can dramatically transform our sense of the
process. Music then is the starting point for our greater understand-
ing; not words or exterior clinical theories but the pure phenomena of
music itself.
Listening to audio recordings of sessions enable greater and
more detailed study of the musical building blocks in improvisation.
Clinical listening is the ability to determine the balance between the
actuality of music and the potential therapeutic constructs that con-
stitute the musical/therapeutic dialogue. The supervisee must extend
their aural skills to describe what they hear without bias–listening
without interpretation or reflection to describe chord progressions,
melodic lines, client’s responses, and their musical combinations. The
first stage of supervision is fundamental in providing the base from
which the supervisee can then move into more interpretive assess-
ments. In clinical listening there is re-examination of the boundaries
of knowing and understanding. Knowing the musical exchange as
pure data will give a greater sense of where the therapeutic relation-
ship is beginning and the possible clinical pathways that lie ahead.
The supervisee must learn to hear precisely and clinically before he or
she makes choices that are truly balanced and therapeutically
informed.
This stage of supervision is usually challenging, as supervisees
will instinctively feel the need to interpret. Indeed, the education of a
music therapist is built on postulates of observation, interpretation,
and clinical orientation. Music therapy could not survive without the
therapist’s ability to critique, interpret, and proceed. Supervisees may
wish therefore to select passages of improvisations for musical
discussion that are therapeutically significant and that relay to the
supervisor work that they feel is effective. As supervisor it is
important that these assumptions are challenged.
Initially, the most important segments of a tape to explore are
the beginning passages of the improvisation. The reasoning is that
these beginning passages will normally contain simpler musical
patterns. Here, therapist and client explore a musical groundwork
from which the ongoing musical relationship may develop. By accu-
rately describing these musical beginnings the supervisee will begin
to understand the importance of clinical listening and responding.
These opening moments also often contain generative musical seeds
from which improvisations develop. If we explicitly hear these gen-
erative musical cells expressed from the client, therapist, and musical
relationship, we may begin to unravel the complexities of the ensuing
therapeutic and musical direction. As the supervisee develops his or
her ability to clinically listen to these opening moments, so will this
be transferred to the ongoing work. (p. 251)
This is followed by reflections from the supervisee:
Music as emotions, is immediate. I never perceived these experiences

as separate. It was during supervision that I first began to understand
the clinical implications that my lack of conscious separation was
creating. In “clinical listening” the “I feel . . .” and “I think . . .” are
removed. The clinician’s personal and musical biases are stripped
away to reveal the musical intention and clinical direction. By di-
rectly dealing with the factual experience–what is actually happening
musically, rather than one’s own perception–the focus is shifted from
therapeutic presence to musical presence.
Initially it is frightening to listen at this level. Feelings of self-
doubt and inadequacy are shamelessly experienced. But that is not the
purpose in listening in this capacity. To listen “clinically,” not per-
96 Colin A. Lee
ceptually or even therapeutically, is shocking. We have rules and

fundamental concepts of the inherent nature of the medium, that when
disregarded can lead to a situation not unlike playing with fire. The
aesthetic of music is a combined effort of profound emotions and
fundamental clinical aptitude. Knowing the geography of one’s in-
strument can only support knowing the geography of one’s emotional
landscape. And in supporting a client’s growth toward self, we must
know the precise application of the music that affects the emotions.
Clinical listening brings you to the basics. What is the timbre
of the client’s instrument/expression, the pitch, the duration of the
tone? What is the attack, the phrasing of their rhythmic/melodic
work? Here is where we separate from style. We do not ask the “feel”
of the expression, but the precise measurement of it.
The next question for me was not “How can I match the
sound?” but rather “How can I meet the sound?” This concept is the
key in that I believe it is what helps the clinician continue to separate
clinical listening from perceptual listening. By “meeting” a client’s
sound we remain separate, presenting our own identity, our own
voice, which ultimately supports the client but does not impede or
step upon their individual voice. By “matching” we tend to “do the
same” which neither indicates our intention as clinicians or provides
direction for our clients. Matching can at times simply be repeating,
whereas meeting is a conscious choice. Meeting supports co-creating,
it motivates independent thinking and awareness of the present, im-
mediate moment. Listening can be cultivated. (p. 259)
Clinical listening can be learned and developed. Supervision is an essential

process in the therapist’s acquisition of the skills necessary to acquire precise
clinical listening. As illustrated in the above evaluations it demands discipline
and commitment. Cultivating clinical listening can also be liberating and crea-
tive. Hearing yourself being “heard” is one of the most dynamic forces client
and therapist can experience. To be heard is to be understood and to understand
being heard is to gain human insight. Once the exactness of clinical listening has
been mastered the therapist can move beyond pragmatic knowledge toward Lis-
tening Beyond (see: Levels of Listening on page 90) that holds the essence of
therapeutic truth. Hearing the client as musical essence is to hear their resonance
as they survive and mature in the world. Listening to the actuality of musical
existence will therefore inform our appreciation of sounds as expression and
discrimination. Through the exactness of clinical listening the therapist’s crea-
tivity will radiate.
Through supervision the music therapist must acknowledge that listening is
one of the most critical components in understanding clinical practice. If clinical
listening is compromised then interpretations and clarity of outcome may also be

compromised. Listening acutely will clarify our understanding of music, the
client, and the interface between musical expression and therapeutic outcome.
To listen clinically is to listen with every fiber and nuance as responding musi-
cians and therapists. In and through supervision the exactitude and inspiration of
clinical listening can be explored and matured.
CLINICAL RESPONSE
Clinical listening requires a clinical response from the therapist. A reality

response is a factual identification of musical, physical, short-term, and long-
term aims. An intuitive response is a more hermeneutic identification of the
client, music, and the overall therapeutic situation. How the therapist perceives
their intuitive response will result in their reality response as the session unfolds.
The intuitive response may also suggest something that is in direct opposition to
the therapist’s reality responses. When do we and when should we allow the
intuitive response to outweigh the reality response? Are there times when one
category is more important than another, and when and what grounds do we
base that decision? The ideal process is (a) clinical listening and (b) response
which leads to (c) developing dialogue and (d) clinical refinement. But therapy
is rarely that neat or tidy. Even the most accomplished therapist can misinterpret
the actuality of the moment and experience is not always proof of an accurate
response. How we respond discloses our professionalism and respect for the
client(s). Listening requires space and time. It is important never to crowd ex-
pression and response. The quality of clinical listening and responding will
result in the potential for quality reactions from the client. Through the thera-
pist’s intent of playing and listening the client’s contribution will become ever
more decisive in the developing musical and therapeutic dialogue. Anything less
will preclude the essence of true innovative involvement.
So what of the client’s response? What happens when we respond in a way
that does not fulfill the expectations of the client? The therapist must identify
and acknowledge this experience and make the necessary decisions to counteract
the predicament. There are times when the therapist is clear in their response but
the client struggles or is unable to find their place within the unfolding thera-
peutic structure. Response is based on understanding but we should also know
that we can often be wrong. This is natural in a healthy developing therapeutic
relationship and should not be misinterpreted as failure on the part of the thera-
pist. The therapist should, at these times, return to the theories of clinical
98 Colin A. Lee
listening as their anchor for reassessment and continuation. The therapist may
misinterpret the client’s musical responses if they are not open to the originality
of composition in clinical improvisation. Confusing musical responses of the
client and being unable to find a clarity of direction are elements that become
clearer as the therapist continues to challenge their insight and understanding.
Supervision and assessment are the keys to developing perceptive clinical re-
sponses and ultimately the client’s response will be reflective of the therapist’s
insights into the therapeutic process.
ACTIVE LISTENING
There are certain situations where either therapist or client do not come to play.
Their role thus becomes one of active listener. The reasons for active listening
can be many and complex and varies depending on the client focus and stage of
the process. For some clients active listening becomes a potent sense of activity
that, while silent, can be as creative as the actuality of a precise musical re-
sponse. In active listening it is possible to be connected yet apart from the
music. In performance there is an inherent distance between player and audience
that provides a foundation to be initially detached. The listener can move per-
sonally closer as they feel comfortable. Thus I can experience listening either
passively or actively depending on my mood and willingness to invest. In music
therapy intimacy is more integral to the experience. The client can feel exposed
within the ongoing potential exposure of musical expression and may feel the
need to pull away to the role of active listener.
The therapist as active listener is not common. In Music at the Edge (Lee,
1996), I describe my thoughts when the therapist becomes an active listener:
. . . gradually I learned to understand the importance of the receptive

role–not receptive in a passive sense, but as a real and continuing part
of the music, mute perhaps, but actively resonating (p. 156)
When the therapist becomes an active listener they revoke their active musical
role in favor of musical stillness. This dynamic can test the therapist’s role in
terms of input and therapeutic balance of power. It can also allow a direction in
the process that is innovative and necessary. Learning to be musically passive
and yet directed in the relationship can seem a daunting task, especially as in the
case of Francis, when the client is articulate and sure in their need to play alone:
The realigning in my relationship with Francis was simultaneously

unsettling and liberating. . . . (Lee, 1996, p. 156)
Francis explains how he considers his solo improvisations to be more influential

than our improvisations together:
When I’m improvising alone I’m entirely following my own rhythm.

My own inspiration. When you are working with someone else you
can unlock different doors that wouldn’t have been available on your
own. When we are improvising together I pick up some of your
rhythms. The sum of the two gives a different result: in a sense doing
things together, rather than the increased energy by support and soli-
darity. Ultimately, I think that duets are less of a personal document.
They are less revelatory because if I’m working on my own it’s a
very personal statement. (Lee, 1996, pp. 86–87).
The client as active listener is a more common occurrence. Through re-

flective improvisation music can be offered that does not necessitate a response
but that reflects the inner world of the client. Examples of this approach can be
found in Chapter 12 and the case studies of David and Lisa.
CLOSING THOUGHTS–LISTENING AND LIFE
Listening as relationship is the apotheosis of life. How we listen determines our

understanding of the emotional impact of living. To listen clinically means to
focus on the client’s revelations as a precise manifestation of their inner world.
It is the music therapist’s duty to listen on many levels:
• Listening as musicians
• Listening as therapists
• Listening as human beings
• Listening to music
• Listening to silence
• Listening to actuality
• Listening to creativity
If the music therapist listens deeply and creatively then they will hear the client
as a free musical spirit, and will respond with an informed balance of organiza-
100 Colin A. Lee
tion and freedom. If the music therapist is only able to hear peripheral sounds,
however, they will only be able to respond at a surface level. Learning to clini-
cally listen is a process that takes dedication and insight. Clinical listening skills
can be learnt. Taking one small section of a session and focusing on repeated
hearings will help the therapist find ever complex levels of music.
Mark, a client with HIV, improvised on the piano in a consistently per-
severative style. Perseveration is normally considered a “block”–dull, lifeless
playing that needs to be changed. The question, however, should not be “How
do we break perseveration?” but rather “What is perseveration telling us about
the therapeutic process and how will our understanding of it help us to hear the
client more clearly?” I consciously improvised with Mark’s perseveration and
did not attempt to break his playing. Even though on an exterior level the sounds
were regular there was a quality in his playing that called for more detailed lis-
tening. I attempted to hear behind his surface perseveration, and found to my
amazement a level and clarity of expression that Mark could only have ex-
pressed through these continuous sounds. It was only when I accurately heard
and accepted his perseveration that Mark allowed me in and behind his music.
Once this had occurred I found that his playing wasn’t as stuck or fixed as I had
originally heard. There were qualities, subtle changes in texture, that kept the
music alive and creative. As the clarity of my listening increased so Mark’s re-
sponses became ever more refined. This culminated in an eventual disintegration
of his perseveration. This happened not because of a direct intervention to chal-
lenge his playing but because I had accepted and intently heard his music. Once
this had happened Mark was ready to relinquish and move his perseveration and
move forward.
AeMT is based on the premise that the musical relationship is an essential
component of the therapeutic relationship. Being able to listen precisely without
inference is a further foundation of this approach. A common argument of this
book is that until music is understood in terms of itself then our interpretations
of it will remain flawed. Interpretations therefore only become valid if the phe-
nomena itself can be accurately and precisely described. In terms of AeMT this
means delineating the nuts and bolts of music. Once this has been achieved it is
then possible to relate this knowledge to our ongoing understanding of the
therapeutic process and the balance between music and words.
“Something sacred there is about listening

when the whole of our Being is tuned
to resonate with all that
enters our field of experience.”
(McMaster, 1995, p. 72)
Excerpt Four
Chapter Nine
MUSICAL FORM AND CLINICAL FORM

Colin Andrew Lee
There is no real creating without hard work. That which you would
call invention–that is to say, a thought, an idea–is simply an
inspiration for which I am not responsible, which is no merit of mine.
It is a present, a gift, which I ought even to despise until I have made
my own by dint of hard work.
Johannes Brahms (1833–97), quoted in Watson (1994)
What does it mean to consider music therapy in terms of musical form? What
are the links between clinical form and musical form? How can musical form
inform clinical form? Will a detailed understanding of musical form help us un-
ravel the enigmas of music therapy? Why is it important that music therapists
understand musical and clinical form equally? In research music therapy takes
methodologies from quantitative and qualitative sources (Wheeler, 1995), in
music psychotherapy from analysis (Foulkes & Anthony, 1990), transference
(Bruscia, 1998) and imaging (Bonny, 1978), in didactic practices through data
collection and analysis (Bruscia, 1998), and in music medicine through clinical
trials (Standley, 1986). These exterior influences have defined the field and pro-
vided validation for music therapy as an established and credible profession.
But what of music therapy influenced by theories of music? Paul Nordoff,
in his clinical applications of music and musical idioms (Robbins & Robbins,
1998), takes music as the essence of the process. In the editor’s introduction
music is clearly stated as the core of his teachings:
The musical foundations of clinical musicianship in therapy con-

cerned Paul Nordoff deeply. These lay not only in each student’s
clinical ability and musical skills, but in his or her musical awareness,
in the experiential knowledge of music and the understanding-feeling
for the expressive dynamics of its melodic, harmonic, and rhythmic
components. He believed such a perceiving knowledge to be indis-
pensable to the responsive, creative application of music in therapy.
(Robbins & Robbins, 1998, pp. xix)
148 Colin A. Lee
For Nordoff music was the inspiration and culmination of every nuance of music
therapy. How the child responded, the overall aims of the work, the expressive
qualities of music, and the child’s musical connections were all influenced by an
understanding and clinical appreciation of musical form. Nordoff’s influence on
this book is significant. Through the inspiration of clinical work and musician-
ship, his teachings showed that music and human potential are inextricably
linked. To consider music as therapy (Bruscia, 1998) is to know and understand
music. Therapeutic and musical both advocate precision and yet both contain the
creative freedom of living and relationship.
Through the countenance of illness and disability AeMT proposes a musi-
cal link between human condition and experience. As clients explore their life
situation the therapist must unravel a myriad of emotions. The therapist will not
find the musical articulation of autism per se until they explore the client’s own
autistic music. Until then the music will conform to the therapist’s perceptions
of autism. The autistic child occupies their worldview of music and in order to
understand their inventiveness the therapist must attempt to meet and find the
innate musical expression of autism. Autistic music then is dependent on
different factors:
• individual character
• clinical diagnosis
• musical preference
• emotional stability and instability
• cultural experiences
• life experiences
Just as Beethoven’s compositions are dramatically different from Mahler’s

so one client’s music will be different from another’s. Eddie, a client living with
HIV, used sophisticated complex music whereas Cory, an adolescent with
autism, used music that was uncomplicated and sparse. It was not the complex-
ity or sophistication that connected the two but the intent and clarity both bought
to their music. Cory’s music was equal to Eddie’s and as such the therapist met
both with the same sense of deep, active listening and response. Even though
Cory was a young autistic man the music in response to the therapeutic relation-
ship was no less complex than the musical manifestations of Eddie. It is a
mistake to separate the musical and therapeutic work of differing clients. Cory’s
single note on the piano was equal to Eddie’s complex atonal drum and piano
playing. It is the depth with which the therapist hears the client that separates the
relational content of music and not illness or disability. An understanding of the
client’s musical form must ultimately influence the therapist’s response.
Musical Form and Clinical Form 149
THE “TRISTAN” CHORD:

CLINICAL IMPLICATIONS
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Wagner’s Tristan chord (see Figure 16) is the most debated and analyzed har-
monic sequence in the music literature. Its attention comes from its
chromaticism, lack of key center, and potential move toward atonalism. The
melodic line moving from leaps (1) to chromaticism is underpinned with a so-
phisticated harmonic sense of tension (2) and resolution (3). There are many
different investigations from Schoenberg’s (1954) implication that the chord
was a precursor for atonalism to Chailley’s (1963) analysis that focuses on the
chord as the dominant of A minor. Analyses of the Tristan chord can be catego-
rized into two groups (Nattiez, 1990): functional analyses where the tonal
significance is based on a specific progression of chords and nonfunctional
analyses where the chords structure is privileged above its function. The Tristan
chord can be analyzed from a clinical perspective in three ways.
1. Harmonic Ambiguity
Improvisation should never be predictable. The therapist’s musical searching

can reflect the essence of the relationship and maturing therapeutic aims.
Improvisation should also be open to limitless possibilities, these being
evaluated as the therapist’s understanding of the process deepens. Analyzing the
harmonic ambiguity of the Tristan chord highlights possible connections with
clinical improvisation. The suspension (2) of the F, B, D#, G# chord moving
through the melodic A and A# to the final E major chord (3) provides a har-
monic movement that is intangible yet grounded. Ambivalence followed by
resolution can be a critical force in clinical improvisation. The harmonic uncer-
tainty (2) provides a sense that the music could go anywhere, leading through
150 Colin A. Lee
resolution can be a critical force in clinical improvisation. The harmonic uncer-

tainty (2) provides a sense that the music could go anywhere, leading through
the chromatic melody toward the inevitable resolution of the E major chord (3).
The Tristan chord as a harmonic resource and a basis for other progressions will
give the therapist a sophisticated palette of ambivalent musical expressions.
Clients often do not have the ability to move from ambiguity to stability either
musically or emotionally. Utilized as a clinical resource the Tristan chord has
the potential to redress a musical imbalance for the client and add continuity to
the therapeutic relationship.
2. Melodic Movement
The melodic movement of the Tristan chord is interesting and directly applica-
ble to clinical improvisation. As the melody moves upward the intervals become
smaller. The opening 6th (1), presumes an F major tonality. This inference is
thrown with the introduction of a major 3rdn (1-2) placing the melodic key
clearly in E major. The chromatic movement (2-3) from G# to the B balances
the broader opening. From a clinical perspective the balance between open and
chromatic intervals shows an understanding that could be significant in reflect-
ing a client’s expressive melodic imagination. Aldridge (1999) expresses the
significance of melody in music therapy:
The experience of an unfolding melody is an experience of whole-

ness, a gestalt, a creation that possesses more features than the sum of
its single elements would make up. (Aldridge, 1999, p. 151)
Taking Aldridge’s view into account the Tristan progression therefore has the
potential to illuminate our awareness of spontaneous melodic form. Thinking of
melody as a sophisticated expression of the client will give weight to the thera-
pist’s musical thinking. The movement toward smaller intervals expresses a
sense of openness that could have an impact if related to specific clinical situa-
tions. Studying, practicing, and directly relating significant progressions such as
illustrated in the Tristan chord can help illuminate the minutiae of a therapist’s
clinical and music thinking.
3. Tension and Release
The immediacy of tension and release available in improvisation is a deter-

mining factor in reflecting, and if necessary, directing the musical articulation of
clients. The Tristan chord is a perfect and refined example of moving from un-
certainty (2) to the clarity of a clear tonal center (3). These chords can be used as
a resource to initiate improvisations. Experimenting and exploring the progres-
sion will enable the therapist to find musical specifics that may be needed at
certain junctures in sessions. The Tristan chord and its resolution can provide a
musical palette for the therapist that can support and instigate aspects of tension
and release that may be pertinent in the developing therapeutic relationship.
MUSICAL STRUCTURES AND

THERAPUTIC STRUCTURES
In clinical improvisation creativity and freedom are essential, yet without struc-
ture music and the therapeutic process would not exist. Direction and
organization form the backbone of clinical practice. How can our understanding
of musical structures inform our understanding of therapeutic structures and vice
versa? In AeMT the balance between the two is essential in understanding the
therapeutic process. Music contains finite and controlled structures which are
used in random and ordered combinations. Music must adhere to–and then
break– rules that balance and give flight to the inventiveness of composition and
improvisation. Therapy also contains theories which like composing are affected
by, yet not reliant on, the outcome. The individuality of relationship is similar to
the creativity enforced through ordered and free compositional thought. Just as
the composer struggles to find his or her unique voice through the structures of
music, so the therapist struggles to give voice to the client’s eloquence within
the bounds of musical autonomy and design. The musical theories of intervals,
rhythm, harmonic balance, and tonal direction can all be related to the theories
of the therapeutic relationship. Intervals, how they relate, the combination and
direction of tones–similar and contrary motion–question and answer–can all be
paralleled with the client/ therapist relationship in improvisation.
What does the dialogue in a two-part invention, for instance, say about
musical connection and communication? When two melodic lines move apart,
when they leap and then return to a tonal closeness, how could this correspond
152 Colin A. Lee
to the musical/therapeutic relationship? The connection between client and

therapist in improvisation is a delicately balanced affair. Like a two-part inven-
tion there are gestural and personal cues as well as musical ones. It is structure,
however, that makes both the musical and therapeutic direction: structure in
music, structure in therapy, and structure in the relationship. Structure is what
makes clinical improvisation an ordered yet free experience. Clinical improvisa-
tion takes it structure from various sources:
• the structure of aims and objectives

• the musical structure of each session
• the therapeutic structure of each session
• the structure of each musical moment
• the developing structure of each improvisation
• the developing structure and architectural shape of each session
The clinical improvisor must balance structure within the moment-to-

moment development of the session. The therapist must pose the following
questions when he or she is improvising:
a) what is the structural content of the music?

b) what is the structure hoping to achieve?
c) how will the structure inform the creative nature of the process?
d) how is structure being balanced alongside freedom?
Musical and therapeutic structures must be allies, each independent yet inform-
ing the other.
By analyzing musical structures the therapist can begin to deduce infer-
ences about the connections between musical representation and therapeutic
outcome. That a client may improvise consonant melodic lines and then sud-
denly move into atonal playing is an important indicator. What might this say
about the developing relationship and the client’s need to express within oppo-
site musical polarities? What might this move tell us about the client’s emotional
state and how they are expressing it? AeMT is based on the belief that if the
therapist turns to the deep structures in the musical dialogue–those that are not
immediately aurally apparent–we may find important clues in understanding the
developing process.
Is it possible that by understanding the compositional perfection of a
Brahms’s symphony and relating this knowledge to clinical practice, we may
begin to better understand the connection between musical and therapeutic in-
tent? This does not mean that we need to spend hours analyzing Brahms’s
musical structures. By consciously appraising his sense of form, his perfection
of ideas and their development and the power of recapitulation we can gain a
greater understanding of how the structure of music works. Allowing this

knowledge to influence our musical reactions to clients in improvisation will
provide an ever more detailed and sophisticated catalogue of responses.
Brahms’s dialogue, answering phrases, sophistication of harmony, and contrasts
of shape and form all provide clues in understanding music and communication.
If we listen to Brahms as therapists, if we hear the musical dialogue in terms of
client and therapist, then one begins to realize that the gap between a Brahms
symphony and music therapy is not that great. Brahms’s music is both perfect in
design yet is highly emotional. How did he achieve this balance and what can
music therapy learn from his compositional designs? Music therapy has created
a distance between composers’ work and clinical practice, a distance that AeMT
believes does not, nor should not exist. The study of Western music as shown in
Chapters 4, 9, and 13 should be as natural to music therapy as the study of psy-
chological theories.
CLINICAL IMPROVISATION
AS SYMPHONIC FORM
The creation of an improvisation in music therapy is the same as a composer

writing a symphony. Each begins with a blank page and embraces endless pos-
sibilities. As a symphony and/or session begins the composer/therapist must
make choices from the vast horizons of potential. As the music/session develops
so the composer/therapist makes decisions based on inventions that have passed
and the influence these have on the future direction of the music/session. Each
moment is a reflection of the music played and motivates the formation of what
is to come. The inspiration of creativity and of artistic/therapeutic form in a ses-
sion is akin to the first performance of a new symphony. How will the
audience/client react to the music? What new musical perspectives can be
offered to give a contemporary sense of inspiration and originality? Just as
present-day music offers new and often contentious perspectives so each new
client is a unique and demands new clinical and musical thought.
Analyzing the opening of an improvisation for piano four-hands from a
session with a client living with HIV (see Figure 17), it is possible to consider
symphonic potential. The opening theme of a symphony, like the beginning of a
music therapy session, sets boundaries for the scope and magnitude of the work.
The improvisation begins with a clear and forceful theme suggesting the music
is to be large and expansive. The client’s opening 7th (1) is underpinned against
the therapist’s strong moving bass that culminates in a spontaneously judged G
154 Colin A. Lee
from both players. A repetition (2) of this idea gives credence to what becomes
an integral theme within the improvisation. The stabbing chord of the therapist
(3) adds color and therapeutically challenges the client’s single tones. The in-
ferred key of D flat improvised by the client (4) is colored with an added G, the
therapist again challenging the client by playing an accented white-note cluster
in the bass. Both players end this passage resting on a B. The improvisation
continued to develop this and two other counterthemes and was twenty-three
minutes in length.
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What can be deduced from this analysis in terms of musical meaning,

symphonic intent, and therapeutic potential? The improvisational strength of the
opening shows a link with symphonic thought. An opening theme is a genesis
that yearns for development and clarity. This is not unlike the inception of the
therapeutic process. The clients statement–musical, verbal or gestural–requires
reflection and maturation. The client and therapist are partners in the evolution
of emotions necessary for the client’s growth. Music as a reflective agent strives
to find a balance that will allow the client their fullest potential. In this example
and in many others, therapeutic and symphonic process are not dissimilar.
As a composer and music therapist I consider every session to be like that
of creating a symphony, each part of a session being like a different movement.
Thinking orchestrally in my responses to clients I strive to create the perfect
symphonic proportions within a session, emotionally and musically. As a com-
poser I have found the symphony to be perhaps the most perfect expression of
compositional craft. If I can transfer that knowledge of musical perfection to my
clients then what could this potentially achieve? The problem that ensues is that
music therapy is not only concerned with music but also the whole myriad of
therapeutic and clinical intricacies that constitute the overall music therapy
process. The idea that a session could be as complete as a symphony perhaps
places too high an expectation on the music therapist–that a sense of attaining a
musical Holy Grail may seem impractical and inconceivable. Attaining the
highest musical and therapeutic standards, however, should be a natural evolu-
tion of the field. I believe this musical challenge should be faced for the future
validation of the “art” of music therapy.
THE CLINICAL USE OF ORCHESTRAL

INSTRUMENTS
The prevalence of the therapist’s use of piano and guitar and the client’s use of
tuned and untuned percussion has resulted in a distinctive “music therapy
sound.” Many music therapists who study orchestral instruments in their music
education often abandon them as they enter the field. How might music therapy
have developed if the whole range of orchestral instruments and chamber music
combinations had been available for expression? To imagine a string quartet,
symphony orchestra or jazz band being able to respond as collective therapist,
brings into play a whole new world of musical possibilities. While these may
seem inappropriate speculations, opening the sound and textural world of music
for clients should always be a priority. Piano, guitar, and percussion have many
156 Colin A. Lee
timbres available but there are times when we should look outside and find fresh
and exciting sounds. AeMT urges that music therapy look to include all orches-
tral instruments in clinical practice. If a therapist has studied for many years and
is fluent on the cello, then they should use and adapt that instrument clinically
rather than trying to include instruments they are less comfortable and familiar
with. In order to achieve this, orchestral players must start defining specific
clinical techniques peculiar to their instrument.
Wind, brass, and string instruments offer immense possibilities for human
contact. The quality of the flute is substantially different to the bassoon, the
trumpet to the horn, as the violin is to the cello. Each of has the ability to pro-
vide the client with sensations of sounds and textures they may have never
experienced. Hearing an orchestral instrument live can be a powerful and one
that may have substantial significance for the therapeutic process. Moving a bow
over a string produces tones, overtones, textures, and qualities of sound that can
imitate and elaborate those of the voice. String instruments can articulate
phrases providing human/emotional content. Wind and brass instruments are
also closely associated with the voice. The breath needed to produce sounds are
a direct human extension from physicality to sound. Clients’ response to wind
and brass instruments can be strong due to their temporal and flexible texture.
What at first may seem a disadvantage for orchestral instruments–their ability to
produce single melodic lines–can also be their strength. Music therapists can get
caught in the need to offer full and complete music. This is often the antithesis
of the transparent qualities necessary for good clinical improvisation. Single-line
orchestral instruments have the potential to provide graceful clarity and sim-
plicity of musical line. It is possible also to play harmonies on orchestral
instruments which if used with precision can complement the impact of single
lines. The physical presence of a bassoon or trombone can provide tactile
stimulation that links the source of sound to the client’s reactions and potential
playing. Allowing a client to bow a violin or blow a trumpet or clarinet while the
therapist fingers is one of endless possibilities for the clinical use of instruments.
Music therapy should accommodate all orchestral instruments as standard
to clinical practice. Amplifying sound can provide instruments with more scope
for volume. Purchasing work instruments so that your Stradivarius is not dam-
aged is another important consideration! Taking certain musical and physical
practicalities into account, the potential for orchestral instruments in music ther-
apy is immense. Just as AeMT is drenched in the immediacy of music so every
instrument has the potential to provide new and inspiring soundscapes. It is the
innovative nature of these new clinical soundscapes, along with the develop-
ments in ethnomusicology and music technology, that will further open the
doors to the limitless possibilities for the use of music in therapy.
THE ARCHITECTURAL TONIC
The process of clinical improvisation is intricate. How the music therapist com-
bines music with therapeutic analysis indicates an understanding of the
cumulative process. Sessions that include fundamentally clinical improvisation
can seem daunting. To know and understand the design of a session while pay-
ing intricate attention to the detail of every moment is challenging. Recognizing
and interpreting clients’ music as music itself and then as a mirror of their psy-
chological and emotional presence constitutes the “science” of the process. The
therapist must practice, learn, and be free to take the many directions necessary
for an effective improvisation. As described in the definitions of AeMT during
Chapter one, clinical improvisation is based on the concept that the therapist
must understand the architecture of the complete session before analyzing the
parts. Through reflective supervision and assessment it is possible to interpret
and deduce musical and therapeutic meaning. But what of the moment? How
can we conceptualize musically the huge potential structures that an extended
clinical improvisation demands?
Through AeMT I developed an approach to clinical improvisation that was
based on an awareness of musical form. To describe and understand the musical
constructs of an improvisation before attempting a clinical analysis became
critical in this developing work. I began to consider and analyze how I musically
approached improvisations. What techniques did I use to present the musical
backdrop necessary for a developing musical dialogue? This question provided
a springboard for much creative and tangential thought. The architectural tonic
(AT) formed the main focus of my attention. I discovered during musical analy-
ses improvisations often originated from a single core tone. There seemed to be
a fundamental note which acted as an anchor in keeping a tonal sense of struc-
ture over the complete improvisation. It occurred to me that if I could identify
this core note, then what might I learn about the client, the client therapist rela-
tionship, and the overall developing work. Was there a connection between the
different ATs of each session and how did these affect an understanding of the
therapeutic process? Just as the tonal center of each movement of a symphony
reflects the core key of the complete work, so the tonal centers for a group of
improvisations in a session or group of sessions could equally influence our un-
derstanding of the larger therapeutic picture. The AT became an essential and
revelatory component in my continuing perceptions of clinical improvisational
structure.
Presenting and identifying the AT during a session intensely changed my
understanding of the emerging morphology of improvisation. The AT originated
from either: a) the client, b) the therapist, or c) as a product of both players.
158 Colin A. Lee
Once identified, the AT provided a structural foundation of stability and clarity

of music thought. Pinpointing the AT while improvising meant listening intently
and clinically as the music unfolded. Clearing extraneous sounds and hearing the
essential core became clinically enlightening and enabled me to dialogue with
the client at ever deeper levels. Identifying, generating, and creating an AT has
become the hallmark of AeMT. It is a simple yet I believe significant way of
thinking and articulating clinical improvisation. The AT provides security for
the therapist and client. It permits freedom and liberation of musical thought
because once identified the AT can easily be returned to, providing constant
coherence and stability. Modulating to and away from the AT is an important
technique because it develops other tones that are either closely or distantly re-
lated. The therapist can chose different ATs and then use them as a basis for
developing their musical resources.
The musical form of the AT answers many of the questions posed at the
beginning of this chapter. The “science” of music therapy is based on method-
ologies that explore the replicable and reductionist aspects of outcome. This
theory is based on the belief that by condensing and quantifying the core com-
ponents of music therapy it will be possible to understand how it works. The AT
is a musical equivalent of this empirical view. By reducing the process to its
skeleton form we can find why music and therapy are such close and effective
allies. To reduce musical understanding and response to its essence shows the
importance of fundamental tones in containing the whole. AeMT as a music
provides a connection between musical form and clinical form that is both music
centered and therapeutic.
Excerpt Five
Chapter Fifteen
REFLECTIONS AND NEW DIRECTIONS

Colin Andrew Lee
Music is the one incorporeal entrance into the higher world of
knowledge which comprehends mankind but which mankind cannot
comprehend.
–Ludwig van Beethoven,

quoted by Bettina von Arnim,
Letter to Goethe (1810)
Music and therapy are intrinsically linked. To be musical is to be therapeutic,

and to understand the nature of musical communication one must be prepared to
consider how and why music is such a passionate force. Music cannot exist in a
vacuum and must have human reactions to survive. Listening to music can cause
extreme emotions, creative music-making stimulating this reaction to be ever
greater heights. Understanding the complex strands of clinical improvisation has
been the focus of AeMT and the evolving arguments in this book. As music
therapy endeavors to understand and quantify the constructs of clinical outcome,
it should never forget that its creative nucleus is, and will always remain, an
enigma. It is this enigma that makes the power of the music therapy relationship
so affiliated with the human condition. Music and emotions are one and it is this
cohesion that influences the clients in making sense of their world. In music
there can only be consonance and normality. In music the client is free and em-
powered to be healthy and it is through creativity that healing occurs.
This chapter is subjective. It offers opinions on differing aspects of music
therapy and makes suggestions for the profession in the new millennium. AeMT
came from a personal need to identify an approach that would begin to under-
stand the processes of music therapy from a composer’s point of view. For many
years I fought conceptualizing AeMT because I considered it an extension of
Nordoff and Robbins. It was through my work in palliative care, however, that I
began to realize music therapy could be directly related to the compositional
process. Through analyses of precomposed music, I further came to understand
that there was a potential link of learning from the major works of the classical
Western repertoire. It was as if the field was missing a whole spectrum of musi-
cological and music analytic thought. I felt on the edge of a precipice and only
234 Colin A. Lee
now, as I look to drawing the strands of this work together, do I realize that in-
forming clinical practice from musical theories is an aspect of work that has
been sadly neglected.
Conceptualizing this book has been a revelation. Considering the creative
writing process similar to that of composing, I was able to free my thoughts,
associations, and beliefs. The many questions that have been posed are intended
not as puzzles to be solved, but rather as broad statements and challenges. Why
are aesthetics important and how can medicine/empirical evidence and the art-
istry of music connect more closely? What links lie between psychotherapeutic
and musical interpretation? As a profession the knowledge of music therapy is
still young. The field must look beyond the impermanency of its individual
members to realize that the affiliation between music and therapy, within our
life spans, will remain a mystery. It is for others to fully understand the building
blocks of clinical outcome and musical process. A balance, however, must be
found if music therapy is to begin articulating, quantifying, and understanding
why music is intrinsically healing.
This final chapter then returns to the core of AeMT, that of considering
music as the basis and crux of therapy:
• Music as tone
• Music as listening
• Music as relationship
• Music as learning
• Music as outcome
• Music as process
• Music as inspiration
• Music as creativity
• Music as spirituality
• Music as precision
• Music as freedom
• Music for the client
• Music with the client
THE AESTHETICS OF RESEARCH
Research is an attempt to understand the enigmatic qualities of music and rela-

tionship. What critical questions should contemporary music therapy be asking
and what methodologies are available to help forge an identity within the medi-
Reflections and New Directions 235
cal, psychotherapeutic, and artistic communities that will strengthen our position
in the new millennium? Music therapy research faces many challenges. Are
there specific questions the profession should be addressing and what of the bal-
ance between quantitative, qualitative, outcome, and process? Comparing
research to an aesthetic experience is to demystify its status. Research by its
nature denotes impartiality. The terms data, methodology, hypotheses, and
analysis are all objective and serve to alienate the reality of process. By extract-
ing that which can be interpreted and/or counted adds credibility to the field but
does not communicate the true emotional essence of music and relationship.
Considering research as creative and aesthetic is liberating because it opens the
doors of questioning and knowing.
As a struggling researcher, many questions have emerged with respect to
my ongoing speculations into clinical practice. How can an intrinsically artistic
focus to research help in our understanding of the process? Entering research
unwillingly I found myself within a mire of theorems and methodologies, none
of which seemed relevant to the questions I was formulating. Research appeared
remote from my day-to-day practical work and I wondered how nonmusical
methodologies could have implications for the music-centered approach that
was becoming fundamental in my work. Now, some ten years later and after
numerous experiments to find an authoritative musicological path relevant for
the analysis of clinical improvisation, I have found a sense of balance. It is my
belief that research should:
• be generated from clinical practice and not introduced as exterior

thought
• be creative and not bound by theories of methodology
• be an attempt to answer the most intimate of questions and as
such not constrained or reductionist
• be available to all music therapists who dare to challenge and
question
• serve both the needs of the profession and the questions of the
individual researcher
• be accessible and clear.
Articulating research takes determination and foresight. Once published,

the researcher lays oneself open for both accolade and criticism. Research and
therapy can often seem at odds as academics criticize and speculate their own
results at the expense of others. Findings then have the potential to illuminate
and also intimidate. The passionate researcher is essential if music therapy is to
continue pushing the relevant bounds of its knowledge. Someone who can con-
tribute authentically and honestly, without bias, the questions needed for the
profession integrated with the burning speculations of the individual. Research
236 Colin A. Lee
should not be elitist or deemed for those with superior intellect. Its essence is
to answer passionate, articulate questions through methodologies that are sym-
pathetic and clearly defined. Research, like therapy itself, demands honesty and
integrity. All questions are valid and all music therapists have the right to be
involved in research.
MUSICAL GENIUS AND PATHOLOGY
The idea that a client could also be a musical genius is intriguing. The savant
caught in pathology or illness, begs the questions:
• Where does genius originate?

• Does the purity of music allow it to be affected by disability?
• Is there such a thing as disabled music?
AeMT is based on the belief that all clients have limitless potential. How the
therapist is able to open this portal is the “art” of clinical experience and learn-
ing. That every client has the capacity to be a genius means that every
therapeutic encounter has the capacity to produce great and influential music.
The term “composer” denotes a role that is learned, a profession based on a
balance between scholarship and creativity. A composer has a respected role
to play in society and adds to the richness of contemporary culture. What then of
clients as composers and how does this potential change the therapist’s percep-
tion of their role? To consider clinical improvisation with the same intent as a
work by a present-day composer is to give music therapy the artistic status it
deserves. There are clients whom I have worked with that I believe, had it not
been for their pathology, could have been proficient composers or performers.
That there is the possibility for all clients to be outstanding musicians means the
therapists must strive, at all costs, to facilitate each potential. Every client there-
fore has the capacity to be a great composer or performer.
Does Western music protect its rights of normality and learnedness by cre-
ating titles such as composer and performer? Music therapists must believe that
music is an innate medium open to all. But to what level of musicianship can
clients attain? We couldn’t possible equate a profoundly disabled client with a
great composer. Or could we? I have experienced improvisations with clients
with profound intellectual disability that could be compared in stature and con-
tent with seminal pieces of music. These moments of musical greatness were
caught because of the musical and therapeutic needs of the client and the thera-
pist’s sensitive musical/clinical responses. All clients have the potential to create
great music and all music therapists should be aware and be ready to respond to
this potential with clarity and insight.
Most therapists would agree that the music clients create in music therapy
is valid, but to suggest that it could be artistically magnificent may be stretching
the bounds of what is understood as clinical practice. But why? Greatness can
come from the most unexpected of encounters. As described in Chapter Four
(see: “Musical Equality”, (p.76), the finely graded response of a physically dis-
abled client can hold a sense of distinction that far belies the actuality of the
response itself. When Beethoven wrote his symphonies, where did his genius
come from? I liken brilliance to a subliminal tap being turned–something that is
greater than the reality of the moment. Is there a possibility then, that there could
be the essence of Beethoven’s creativity in all clients? Taking the proviso that
when one sense is diminished another is heightened, could it be proposed that a
client with a disability may have an increased and developed sense of musical
creativity? If this is nurtured and developed, then is there further the possibility
that it that could evolve into genius? Music can reflect and translate emotions
but I believe music itself cannot be afflicted. Music is inherently healthy and so
if a client’s physical presence is affected this may in turn pronounce the healthy
musical side of their persona. This argument concludes that it is logical to think
of a client with a pathology or disability as a conceivable musical genius.
How is greatness defined and what makes a piece of music celebrated ? I
would suggest that a great piece of music is one that:
• is crafted beyond the norm

• can cause physical reactions
• endures time
• reflects intense human emotions
• reflects humanity
• has an essence of mystery
All of the above considerations can be related to music therapy. Taking this into
account, is there a danger in elevating too high, the spontaneous nature of a
client’s spontaneous creativity? It is important not to elevate musical outcome to
a level that may detract from the essence of the clinical process. Allowing the
possibility, however, that clients could be equal in stature to Beethoven could
possibly change the nucleus of what music therapy essentially means.
238 Colin A. Lee
THOUGHTS ON BEGINNING A SESSION
Entering a music therapy session takes courage, foresight, and tenacity. Music
therapists believe that music has the capacity to heal, find emotional liberation,
and affect aims. The varying balance between artistic inspiration and clinical
appraisal is the foundation of every philosophical and theoretical approach.
Psychotherapeutic, medical, educational, humanistic, and behavioral
perspectives all have one thing in common–that of an intervention based on
creativity and spontaneity. Music radiates through all of these and it is music
that determines the exact nature of therapeutic fortitude necessary for the
client’s maturation.
What does the therapist experience as an improvised AeMT session
evolves? What sensations and thoughts conspire to produce work that is bal-
anced and coherent? Developing the musical and therapeutic architecture of a
session is fraught with challenges. How does the moment-to-moment revelation
of creating relate to the specificity of aims and assessment? When does the
therapist take control and when do they relinquish in favor of the unhierarchical
nature of spontaneous music-making? The balance and continuous shift in im-
provising means the therapist must be aware on many levels. Creating structure,
leading to activities, and then relinquishing musical conformity toward the
potential for freedom and nonstructured playing is a complex continuum that
needs constant reevaluation in the moment of creation and through assessment.
The demands for the clinical improvisor can at times seem insurmountable. To
acknowledge, understand, and collate a myriad of musical and nonmusical
exemplars and then accommodate them into the musical/therapeutic dialogue is
indeed complex. To fully understand the multi-complex strands of clinical im-
provisation in AeMT is to understand the nature of human existence, music, and
the relation between the two. This lifetime’s commitment to the use of music in
therapy is what makes the raw yet precise originality of the work.
The possibilities and uncertainties of entering an improvised music therapy
session are not unlike that of a composer viewing blank manuscript paper before
a work is begun. Endless potential can seem liberating and daunting. Just as the
composer waits and attends for the inspiration of musical beginnings so the
therapist must wait for a dialogue that is communicative and motivating. By
beginning, the composer sets boundaries for the material that is to developed.
Similarly the therapist must find themes that reveal the client’s needs and that
can be used as a basis for the developing dialogue. As client and therapist step
into the unknown, the world of music and relationship is revealed. Waiting for a
client to enter the music therapy room one’s thoughts are filled with musical and
human expectancy. How will the session begin? How will the client present
themselves when they enter the room? Will the client find the strength to play
and enter the beginning relationship? Where might the music develop and will I,
the therapist, be able to adequately amplify the client’s inventiveness? It is that
sense of expectancy that allows the client to establish their intention and for the
therapist the inspiration that is at the cornerstone of AeMT. Waiting for a ses-
sion is like unlatching a spiritual window, a sense that all is possible and
available. Making accessible the entire breadth of music and relationship is, I
believe, why the artistic endeavor is such a powerful force in society. Music
when translated to the therapeutic context defines and redefines the nature of art
itself.
THE FUTURE OF MUSIC IN MUSIC THERAPY:

A THEORY FROM WITHIN
The inception and development of AeMT was a response to being at a musical

and therapeutic crossroads. Knowing significant events had occurred musically
in a session, and not having a foundation from which to assess them, I became
more and more frustrated. Finding a balance between music as “art” and music
as human connection became a constantly shifting concern. By defining an aes-
thetic approach to music therapy I initiated a path that acknowledged musical
structure as critical to the process. Redefining the roles of performer and com-
poser, rather than eliminating their intent as nonclinical, provided new
possibilities for balancing the “art” and “science” of practice.
This leads naturally to the idea of performing concerts based on themes
taken from music therapy sessions. The linking of art and clinical improvisation
developed from a need to return to my artistic roots as a music therapist. These
concerts have now become integrated into my professional life as a musician
and music therapist. Specific themes are balanced with general feelings and im-
pressions of therapeutic encounters. As improvisations develop, artistic and
clinical influences transform to produce music that is led from clients’ impres-
sions on my subconscious. Once I have transcribed the themes and know them
intimately I allow them to intermingle as the improvisation evolves. While per-
forming I try to step back from the actuality of the experience and allow the
clients and their impressions on me to dictate the direction of the music. I will
either base improvisations around a group of clients or focus on one individual.
The length of improvisations span from ten to fifty minutes.
The following extract is taken from a series of improvisations that were re-
corded one evening in the Maureen Forrester Hall at Wilfrid Laurier University.
240 Colin A. Lee
These were my first attempts at “art” improvisations based on clinical themes.

The improvisation is a reflection of my work with Lisa (see Chapter 12). The
central D minor theme portrays the intensity of our relationship and the deep
effect her presence had on my life. The movement between keys and tonality
further illustrates the complex balance in our short relationship. It is an out-
pouring of my emotions as I reflect on loss.
Audio Extract Ten: Solo Improvisation
Dr. Michele Forinash’s reaction to hearing the above recording during a presen-
tation raises specific questions with regard to how clients potentially receive
music therapy:
I had the strangest experiences on hearing the improvisation. It was as

if I didn’t know how to speak and that somehow I was mute. I was
having so many sensations and feelings simultaneously. They were
very intense, complex, and contradictory, yet it was good to be
experiencing them. It was as if there were multiple levels of
experience happening at once. All the sensations and feelings were
swirling around me as if in a whirlpool of air. I had no desire or
ability to reach out and touch these feelings and sensations –no desire
to pinpoint or hold onto the feelings, they were just swirling around
me. It was very intense, but it was OK to be experiencing this.
When the music was over, there was silence. A young man be-
gan talking. It was jarring. It was as if his words were strident and
harsh and I couldn’t get my mind to hear their meaning. It was if he
was speaking in another language. I stopped trying to understand him
and just listened to the sounds he made, the sound as such that I heard
in his talking. It hurt and was disorienting. It took me another fifteen
minutes before I could reconnect to the people talking.
Entering into intense experiences of improvisation can be emotionally and

physically disorienting. Logical thought is often abandoned, with true therapy
often occurring through this experience. The therapist’s responsibility at these
times, is to stay in the conscious logic of the here-and-now. Dr. Forinash’s
response shows that music can have the affect of abandoning coherent thought
and allow a person to feel disoriented after music has finished. Her comments
highlight the need for the therapist to be sensitive to the intense processes of
music and the time allowed for clients to disengage from music and the session
itself.
What new directions can contemporary music therapy take? What new
avenues are available? Are there contentious ideas that dare to challenge the
established norms of clinical practice? The future of music therapy must be held
in the belief that the field knows little and has much to understand. Whether
using scientific, humanistic, musicological, or psychotherapeutic models, the
field has only begun to unearth the complexities of its process. Has the time
come to consider a music therapy theory from within, one that is not reliant on
exterior thought but that comes from an understanding of music, creativity, and
a therapeutic focus idiosyncratic of music therapy? How might such a theory
develop and where might it originate? AeMT is an attempt to balance an under-
standing of music in the therapeutic framework. It speaks to my struggles and
challenges as a composer/music therapist. Its answers are primarily addressed to
therapists who are deeply concerned about the nature of music in clinical im-
provisation. A music-centered theory of music therapy may be considered
antagonistic because it takes its primary lead from the structures of music,
placing them into a clinical context directly from the musical dialogue. To
achieve a theory of music therapy the profession must first consider music-
centered approaches with equal weight to medicine and psychotherapy. Until
this occurs studies will be imbalanced–if music therapy can’t understand the
nature of the process, how valid in and of itself is the outcome? Celebrating
music celebrates communication, relationship, and artistic endeavor. Music
therapy has the ability to transcend conscious logic and enter areas of emotion
that profoundly affect the human condition. Let us hope that music therapists are
also able to transcend and open their senses to the potential of a theory from
within.
Coda: Sketches For A Clinical Symphony (see Figure 29)
During this book I thought of writing as composing–discovering themes, coun-

terthemes, and balancing consonance against dissonance. The result that has
emerged hopefully provides a view of music therapy that is unfettered and free.
As a composer, clinician, therapist, and teacher, formulating AeMT has been an
inspiration. As the writing developed and as I began to define my approach I
was constantly amazed at the possibilities available for new and controversial
thought.
I would like to end this book with the opening phrases of a clinical im-
provisation arranged for symphony orchestra. These beginnings are to be
developed into a three-movement clinical symphony taken from three separate
242 Colin A. Lee
improvisations from the work with one client. Each was transcribed via com-
puter thus ensuring accuracy of notation. It is my hope that by taking clinical
music into the arena of classical music that music therapy may begin to be
respected as an influential part of contemporary trends. That clients have the
potential to be great musicians, as discussed earlier in this chapter, is at the cor-
nerstone of this conviction. Combining the roles of composer and music
therapist are never more present than in arranging this clinical symphony. How
the final work will look and sound remains to be seen. What is evident in this
example, however, is the inspirational bridge between the artistic and clinical.
This bridge continues to consume my thoughts, actions, and research.
As I try to find a balance that will allow a true sense of the therapeutic
qualities of music I continually turn to my knowledge of music. Music identifies
music therapy and it is as a musician foremost that I enter every session. If I
trust music then I can trust the therapeutic process. If I understand music then I
can understand the therapeutic relationship. Finally, if I know music then I can
know the possible outcomes that music will have for the client and the develop-
ing work. Music is my life, my inspiration. It is the reason I continue to realize
my teaching, clinical practice, and research. If in some small way this book will
have added to the contribution of music-centered music therapy then it will have
achieved its purpose.
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Figure 29
244 Colin A. Lee

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Figure 29 (cont.)
ILJ
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READING 26
Theoretical Notes on Emotional Processes in Music Therapy
John Pellitteri
The function of theory in any clinical discipline is to structure the

therapeutic process and guide the intentions of the clinician. Music therapists are
guided by theory in terms of conceptualizing the client(s) and the presenting
clinical conditions, establishing goals for treatment and determining the
effectiveness of the outcomes. Theory determines the stance that is taken in
relation to the client, that is, how the therapist forms the therapeutic relationship
and the salience of the relationship itself in treatment. Every intervention,
technique and strategy is influenced at some level by the theoretical assumptions of
the therapist. An effective and intentional music therapist chooses empirically
sound theories as a basis for clinical work and adapts the execution of strategies for
the idiographic characteristics of each unique client. Thus, the use of theory in
clinical practice is both art and science. The science lays in the empirical support
and validity of the clinical treatment approach. The art of therapy comes from the
creativity of the therapist who must match the clinical interventions to the
immediate conditions of the client.
Even in the absence of a theoretical framework, clinicians make choices that
are based on their own assumptions at every moment in the therapy encounter. A
therapist who does not have a coherent and sound approach to treatment runs the
risk of being influenced by lay theories (as opposed to scientific theories) of
human behavior, inaccurate beliefs, and negative bias. Kurt Lewin, an influential
Gestalt psychologist is credited with saying, “There is nothing as practical as a
good theory.” The effectiveness of clinical work rests upon the integrity and
consistency of the therapist’s theoretical assumptions of human behavior and
human change processes. In this way theory is an essential foundation for clinical
music therapy.
In initial stages of professional clinical training, theories and assumptions
about therapy and human behavior may be more explicit in that the graduate
student or new therapist is highly conscious about the “why” of what is unfolding
in therapy. As theory becomes more internalized and ingrained, the assumptions
are less conscious and the theory exerts its influence through implicit
(unconscious) ways. The importance of the therapist’s self-awareness is critical
not only to understand the nature of countertransference but also to keep
theoretical frameworks at an explicit level. A sophisticated clinician is mindful of
the many intrapersonal and interpersonal factors that influence the therapeutic
process including one’s own assumptions, biases and theoretical concepts. Critical
thinking, which is necessary for any effective professional clinician, requires that
the therapist examine his or her own decisions, actions, and reasoning. It is in this
self-examination process that the therapist’s theoretical assumptions become
explicit and can be subject to tests of coherence and effectiveness.
There are usually numerous theories and/or constructs that interact to shape
the work of therapists in any discipline. Two categories of theories can be noted.
The first are clinical theories that directly dictate how the procedure of therapy
unfolds. Such theories can include psychodynamic psychotherapy, cognitive-
behavioral therapy, humanistic-existential therapy for example, and specifically
layout a course of human change through therapy. The second class of theories
can be labeled as general theories of human behavior. These frameworks, drawn
from psychology, sociology, neuroscience, etc., provide an understanding of
human development and functioning. While they do not inform therapy directly,
general theories contribute to how the therapist conceptualizes the client and form
the limits of expectations about clients’ capacities.
Within each of these two categories, the music therapist can overlay a third
category—theories of music/creative arts. Principles of music psychology
describe general human tendencies to respond to organized sound. Particular
theories of music therapy (i.e. Nordoff-Robbins Creative Music Therapy,
Priestley’s Analytic Music Therapy, and the Bonny Method of Guided Imagery
and Music) describe clinical processes. All creative arts therapists work within a
medium that adds a new dimension to clinical work and requires unique
framework s for understanding. While any theory of aesthetics or creative arts can
fall under the general theories of human behavior category, it is useful to examine
these theories and constructs separately as a third category.
For music therapists working in a holistic manner, the importance of
multiple perspectives both musical and nonmusical, becomes essential. Music
therapy may be one of several therapeutic modalities for an individual and its
effectiveness can have an impact throughout the client’s various areas of
functioning. It is necessary for example, that the therapist understands theories of
personality in order to determine how personality (a) plays a role in the clinical
music therapy process, (b) sustains and contributes to the clinical condition and
also (c) how the music therapy treatment alters dimensions of personality. A
sophisticated music therapist utilizes several theories and/or constructs that are
drawn from the clinical, general and musical categories. All of these interacting
perspectives inform and enrich the therapeutic encounter.
The three chapters presented here are from the book, Emotional Processes in
Music Therapy (Pellitteri, 2009). The first and third of these selected chapters can
be said to fall within the general theories of human behavior in that they look at
music therapy from various psychological perspectives. The formal theories and
constructs in these chapters include personality development, brain development,
and emotional intelligence. The second chapter creates a theoretical perspective
based on music, aesthetics and emotion and can be said to be in the musical
/creative arts theories categories.
The chapter Emotions and Music in Personality Development presents three
process-oriented, psychodynamic theories of personality. The examination of
brain development and maternal attunement with the child illustrates the
neuropsychological and interpersonal dimensions of development that underscore
personality theory. Implications for the therapeutic process are noted and the role
of music and emotions in the process of identity development is considered.
The next chapter, the Isomorphism of Music and Emotions examines
emotions and music in terms of common dimensions suggesting that emotions can
be represented by music due to the similarity of structure. An emerging theory
labeled the “aesthetic approach” to emotional representation is presented and
suggests that the aesthetic language used to describe music and other art forms can
also effectively describe emotional states. This perspective is supported by the
concepts of vitality affects and dynamic forms and enhanced by speculation of the
neurological processes related to musical-affective congruence in therapy. The
interpersonal emotional process within music therapy relationship is examined as a
means of engaging core aspects of a client’s self structure.
The third chapter, Emotional Intelligence and Music Therapy, relates to the
previous ones. The theory of emotional intelligence is related to personality as an
elaboration of ego functions and as a capacity for resiliency and personal
adaptation. The chapter also outlines particular abilities of emotional intelligence
that are essential for effective music therapy practice as well as for employing the
“aesthetic approach” in clinical practice. The use of music to develop emotional
intelligence in clinical and educational settings is described as well as the
importance of emotional intelligent abilities within the music therapist.
The theoretical frameworks presented in these selected chapters provide a
means of elaborating the music therapist’s understanding of human behavior by
considering personality processes as well as emotional intelligence abilities. The
emerging theory on the aesthetic language of emotional representation considers a
new way to think about music and emotions in the clinical process. The most
important consideration however, is the music therapist him or herself. Learning
about a theory is only part of the process. Critically examining that theory and
thoughtfully adapting it to the particular work with individual clients is the only
way to validate it and unlock its potential to guide the therapeutic process. A
theory is only as good as the therapist who applies it.
Pellitteri, J. (2009). Three Excerpts: Emotional Processes in Music Therapy,
pp. 119-146, 172-189, 190-209. Gilsum NH: Barcelona Publishers.
Excerpt One
Chapter 6 1
2
3
Emotions and Music in 4
Personality Development 5
6
John Pellitteri 7
8
Personality as a subfield within psychology has generated a wealth 9
of research and theorizing over the past century,, and has been an 10
important interest both in and outside of the discipline of psy- 11
chology. An understanding of an individual’s personality allows 12
one to predict tendencies toward certain behaviors, preferences, 13
interests, goals, and motivations. This predictive power has value 14
not only in clinical settings but in many facets of human func- 15
tioning. Personality theories aim to explain the organization and 16
stability of behaviors and personal experiences. Each theory offers 17
a different view of the structure of personality organization. A cen- 18
tral concept that is embedded within most models of personality is 19
the notion of an individual “self.” William James (1890) was one 20
of the first psychologists to discuss this concept. The term “iden- 21
tity” is often, but not always, used interchangeably with the terms 22
“self” and “personality,” thus this construct has far-reaching appli- 23
cations and uses throughout the field of personality psychology. It 24
should be noted however, that the actual concept of “self” is a 25
western, culturally based notion that will vary depending upon the 26
view of personality that one holds. Some philosophical views such 27
as Buddhism may even question the existence of an actual self. 28
Current views such as ecopsychology have extended the bound- 29
aries of the self to an extreme that include the natural ecology 30
(Hillman, 1995) 31
Sociocultural and family contexts play an important in the per- 32
sonality developmental of the individual. Each person develops 33
“in relation” to others and these relationships form the basis of 34S
personality and shape its evolution. Personality as a construct is 35R
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122 FOUNDATIONS
1 juxtaposed at the meeting point between the biological-genetic

2 forces within the individual and the socially constructed influences
3 from the environment, and depends on the patterns of interaction
4 between the two that unfold over time. Bronfenbrenner (1979)
5 introduced the idea of individual development as occurring within
6 multiple layers of overlapping ecological systems, such as the fam-
7 ily, school, community, and larger society. In this way, one’s per-
8 sonality reflects aspects of the layers of the environment where the
9 person developed. Clinical implications can be drawn here that
10 suggest the importance of the interpersonal therapeutic space of
11 the client-therapist encounter in personality change through
12 therapy.
13 Emotions as a central aspect of human functioning play an im-
14 portant role in the development of personality since affect is im-
15 bued within interpersonal interactions and social relationships.
16 The capacity to regulate emotions and the behaviors that result
17 from emotional states are central features in many models of per-
18 sonality. Disorders of personality and other clinical syndromes are
19 often defined and expressed in terms of emotional functioning (i.e.,
20 labile, emotionally constricted, acting out). Pervin (1993)
21 describes the role of emotions in various personality models and
22 suggests that emotions play a significant role in determining the
23 individual’s behavior and the situational context of that behavior.
24 “The data suggested that individuals have patterns of stability and
25 change in their behavior, and that these patterns can be under-
26 stood largely in terms of the affective meaning of situations for
27 them” (Pervin, 1993, p. 307). Personality factors will inevitably
28 influence the thinking and decision-making processes of the ther-
29 apist in the clinical situation. Particular aspects of clinical inter-
30 ventions may be based on the emotional needs of a client in light
31 of the client’s personality configuration.
32 The role of music in personality development, however, has
33 received little attention. In part this may be due to the variety of
34S musical styles across cultures, the diverse uses of music in different
35R societies, and the numerous ways in which a developing person
1st pass
Emotions and Music in Personality Development 123
may be exposed to music. While relationships are central to human 1

functioning and therefore have been a focus of research in per- 2
sonality psychology, music has been more diverse, elusive, and less 3
central than social relationships to human development. Nonethe- 4
less, as a facet of all human cultures, music can influence to vary- 5
ing degrees, the ecological systems within which individuals’ 6
personalities develop. Each individual is a cultural being who con- 7
tains and reflects aspects of his or her social and cultural worlds. To 8
this extent, the music of a culture will be internalized and can rep- 9
resent aspects of individual personalities. 10
This chapter will describe selected constructs from the broad 11
array of personality and developmental theories that have rele- 12
vance for clinical work. The models presented can be broadly de- 13
scribed as process oriented models of personality in that they 14
emphasize the interpersonal as well as the intrapersonal dynamic 15
processes in personality functioning. Structural models of person- 16
ality (i.e., trait theories) are less applicable to therapeutic ap- 17
proaches and are not considered here, although an examination 18
of musical processes within particular personality traits would most 19
certainly be a valuable investigation. The first three sections will 20
be based upon three dynamically oriented models: (1) ego psy- 21
chology, (2) object relations theory, and (3) attachment theory. 22
Section four will consider the importance of brain development 23
and interpersonal relationships. The next section will examine 24
music in the context of infant-mother relationships. Finally, emo- 25
tions and music will be examined together in the context of iden- 26
tity development. Implications for therapy can be drawn from the 27
emphasis on the importance of relationships in personality devel- 28
opment. 29
30
31
Ego Psychology and the Regulation of Emotion 32
33
One of the most notable contributions to personality is the work 34S
of Sigmund Freud whose psychoanalytic models dominated the 35R
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124 FOUNDATIONS
1 first half the twentieth century, influenced several lines of person-

2 ality theorizing, (Wiggins, 2003), and forms the basis for psycho-
3 dynamic approaches to therapy. The models based on
4 psychoanalytic thinking consider the unconscious processes of the
5 mind and the dynamic quality of intrapersonal forces within a
6 system. This model constitutes a “process” approach in that vari-
7 ous dynamic processes occur such as the interactions between the
8 child and caregiver, internal impulses in conflict with defenses
9 and social constraints, or the process of symbolic meaning attrib-
10 uted to people and objects (i.e., the transference of a client toward
11 a therapist).
12 Psychodynamic is a broader term that refers to any model de-
13 rived from the work of Freud whose own specific theory is referred
14 to as psychoanalysis. Although psychodynamic models are con-
15 sidered “process” approaches, personality structures do develop as
16 a result of continued interactions and experience. A central struc-
17 ture in the psychodynamic school is the ego (Blanck & Blanck,
18 1994). The ego is a broad hypothetical structure that includes var-
19 ious personality processes such as reality testing, rational thinking,
20 regulation of affect (i.e., impulse control), defense mechanisms,
21 sense of self, the capacity to integrate and synthesize experiences,
22 self-efficacy (i.e., sense of competence and mastery) (Bellak, 1984).
23 A major feature of the construct of ego, that is included in various
24 definitions, is the capacity for self-regulation. The capacity to con-
25 trol oneself is an important dimension of personality, especially
26 with regard to psychopathology and clinical work. An individual’s
27 ability to regulate the intensity and the expression of his or her
28 emotions is often a gauge of therapeutic progress.
29 Emotions are embedded within psychodynamic thinking with
30 regard to unconscious impulses striving for expression, defenses
31 mechanisms that work to contain and modulate such expressions,
32 and the symbolic meanings of actions that contain emotional
33 tones. For example, the defense mechanism of displacement in-
34S volves acting out aggressions toward a person or object that is dif-
35R ferent from the original object of aggression. Thus the emotional
1st pass
state (i.e., anger) would remain the same, however, the expression 1
of that state would be “displaced” from one object (i.e., an abusive 2
parent) to another (i.e., a peer). Projection involves the perception 3
of intentions, emotions, or traits in others that one finds unac- 4
ceptable in the self. The emotional quality of disgust would be 5
present in that a person would repel qualities in the self that are 6
disturbing (i.e., weakness, aggression) and “project” these quali- 7
ties onto others, even to the extent that they distort the realistic 8
perception of others. 9
The abilities of emotional intelligence (Mayer & Salovey, 10
1997) to be discussed in chapter 9 are conceptually similar with the 11
functions of the ego (Pellitteri, 2003). These abilities involve 12
openness and engagement with emotional states as well as socially 13
adaptive expression of emotions. The capacity to regulate emo- 14
tions therefore, is an indicator of “ego strength” and adequate lev- 15
els of ego functioning. It is interesting to note that many 16
psychodynamic processes have been examined in the context of 17
cognitive psychology (i.e., unconscious thought processes, regula- 18
tion, self-efficacy). Cognitive processes (for example self-talk) that 19
are subsumed within the construct of ego are means of regulating 20
and modifying emotions. 21
The child-parent relationship is critical in the development of 22
the ego. The parent serves as the child’s ego for the first several 23
years by providing regulatory functions (i.e., a mother holds and 24
soothes the distressed infant until he calms down). This parental 25
role gradually shifts and fades as the developing child slowly ac- 26
quires the capacities for self-soothing and self-regulation. Music, as 27
described below, can be used as a tool for the soothing function 28
that parents provide for infants. Lullabies create a calm and re- 29
laxed emotional tone in the environment that is important in the 30
infant’s emotional regulation. Noy (1979/1990) notes how the 31
form in music and other artistic mediums serves as an ego in the 32
process of adaptation of the individual to reality. 33
The work of the music therapist can foster ego development 34S
through increasing the capacity for impulse control and tolerance 35R
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126 FOUNDATIONS
1 for frustration. The therapist herself may need to function as an

2 ego for the client. Since the structure of music involves tensions
3 and release, prolonging the degree of dissonance and tension dur-
4 ing a musical improvisation will extend the amount of time and
5 self-control the client needs to exert. For example, in my work
6 with emotionally disturbed preschool children, one activity was to
7 place a drum in front of each child at different times during the
8 song, giving them the opportunity to strike it once to the beat of
9 the song. The children did not know when their turn would come,
10 which required that they be attentive and ready. For one boy with
11 impulse-control problems, I intentionally increased the amount of
12 time in between his turns in order to gradually extend the length
13 of time that he would wait. As the therapy progressed, it was noted
14 that he would be able to wait in his seat without getting up for
15 longer periods of time. This is an indicator that his capacity for
16 emotional regulation (and thus his ego strength) had increased.
17 (A behaviorist explanation of this intervention will be discussed
18 in chapter 7). It is important to note that during states of arousal,
19 children with dysregulation problems often have diminished self-
20 control. The capacity for this boy to wait his turn during the ex-
21 citement of the music making was especially significant. It is not
22 only the structure of the music itself, but the structure of music
23 therapy groups that can provide opportunities to practice self-
24 regulation. It requires adequate ego functioning on the part of each
25 member in order to participate cooperatively, to wait for one’s turn,
26 to respond to the musical input of others, and to express one’s feel-
27 ings within the appropriate confines of the music.
28
29
30 Emotions and Internalization in
31 Object Relations Theory
32
33 A personality theory that extends from psychoanalysis and is very
34S closely related to ego psychology is object relations theory. The
35R
1st pass
basic premise of this model is the examination ofsignificant others, 1

predominantly the mother in early infant development, who be- 2
come internalized and unconsciously represented in the child’s 3
mind. These internalized objects create the structure of personal- 4
ity, and influence future relationships with others and patterns of 5
interacting with the world. 6
7
What is generally agreed upon about these internal im- 8
ages is that they constitute a residue within the mind of 9
relationships with important people in the individual’s 10
life. In some way crucial exchanges with others leave 11
their mark; they are “internalized” and so come to shape 12
subsequent attitudes, reactions, perceptions, and so on. 13
(Greenberg & Mitchell, 1983, p. 11) 14
15
Emotions play a significant role in the internalization process 16
in that they determine if the object (i.e., significant person) is rep- 17
resented as a “good object” or a “bad object.” Significant inter- 18
actions over a period of time between the infant and caretaker that 19
are characterized by pleasant emotional qualities (calm, soothing, 20
happy, comfortable) will lead the internal representation of the 21
caretaker to be associated with positive emotions. Likewise, abu- 22
sive or negligent experiences between a child and caretaker will 23
arouse stress, anxiety, fear, pain, and helplessness in the child. 24
These emotional qualities will come to color the internal repre- 25
sentation of the caretaker as a “bad object.” Note that the emo- 26
tional world of infants is limited generally to a pleasant-unpleasant 27
pole since the cognitive capacity for more complex mental repre- 28
sentations has not yet developed. 29
The internal-object world of each individual comes to be the 30
core of the personality. The sense of “self” is comprised of these 31
internal images such that a client with a poor self-concept or neg- 32
ative self-image has a preponderance of negative internalized ob- 33
jects. That is, in the developmental process there were a greater 34S
35R
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128 FOUNDATIONS
1 number and/or a greater intensity of negative emotional experi-

2 ences within the child-caretaker relationship. It is not just the
3 image of the significant other, but the emotional tone of the rela-
4 tionship that is stored in memory and tagged onto the object
5 image. Relationships with others are influenced by the activation
6 of internal objects during the interpersonal exchange. A client
7 who has extreme difficulties relating to other people may have in-
8 ternal objects of poor quality that are unstable. Defense mecha-
9 nisms, aimed at reducing anxiety, can interfere with the accurate
10 perceptions of others. In an interpersonal encounter, a person with
11 severe psychopathology may be interacting with the projection of
12 his internal object more than with the real and actual person in
13 front of him. In this way, negative emotions enter the actual
14 interpersonal field but might appear irrational or unwarranted to
15 others since the emotional elicitors (i.e., the projected object of
16 the psychiatric patient) are not apparent.
17 Odell-Miller (2003) describe how music can be used within
18 psychodynamic frameworks. She emphasizes the benefits of spon-
19 taneous and creative interactions within improvisation, and the
20 development of an authentic relationship that is more in line with
21 current psychoanalytic treatment approaches. “Live musical
22 interaction through improvisation is like an active communica-
23 tion that requires some effort, but at the same time taps into the
24 spontaneous flexibility of the brain to adapt and even manipulate
25 its surroundings” (Odell-Miller, 2003, p. 165). The experience of
26 emotions through musical improvisation in the context of thera-
27 peutic relationships allows the client to externalize the introjected
28 objects. Priestly (1975) notes how improvisation can lead to an
29 emotional conflict with disavowed aspects of the self. Through an
30 analytic approach to improvisation, the client in relationship to
31 the therapist, can repair the quality of internal objects. More im-
32 portantly, the constructive process of mutual creative music mak-
33 ing allows for the client to internalize the therapist as a “good”
34S object and thus create a constant image with positive emotional
35R tones that can bring stability and more adaptive functioning.
1st pass
Emotions in Early Attachment Styles 1

2
The role of the mother in personality development is significant 3
since she is the primary relationship that begins even before birth 4
through the biological uteral connection. This primary relation- 5
ship with the main caretaker sets a structure for relationships that 6
influences future psychosocial development. To use a computer 7
metaphor, the primary relationship “formats” the computer pro- 8
gram of the infant’s brain and influences how data is stored and 9
processed. The brain is shaped by early relational experiences 10
(Schore, 1994). 11
The work of researchers John Bowlby and Mary Ainsworth has 12
found robust empirical support for the construct of attachment 13
(Cassidy & Shaver, 1999). Infants and young children develop at- 14
tachments to their primary caretakers and these attachments in- 15
fluence their relationships as well as adaptive behaviors later in 16
life. The patterns of “attachment behaviors” in young children 17
range from the degree of clinging to the parent to independent au- 18
tonomous exploration of the environment. The designs of initial 19
studies on attachment used the “strange situation” scenario that 20
involved observations of how the young child (1 to 2 years old) 21
reacted when the mother left the child alone in the laboratory 22
room and then how they reacted when the mother returned a few 23
minutes later. The patterns of reactions differed (from overt distress 24
to indifference) and were related to the emotional availability of 25
the caretaker. The children developed what is referred to as “in- 26
ternal working models” that are implicit cognitive structures of the 27
self and expectations of others. 28
There are several models of attachment that propose different 29
numbers of types. The Bartholomew model (as cited in Feeney, 30
1999) presented four main types of attachment that are based on 31
a combination of positive-negative beliefs about the self and oth- 32
ers. These attachment styles are labeled: secure, preoccupied, dis- 33
missing, and fearful. 34S
In a secure attachment style, the child would be slightly anxious 35R
1st pass
130 FOUNDATIONS
1 when the caretaker leaves but happy upon her return. This style
2 predicted the best psychosocial adjustment in later years. For a pre-
3 occupied style (also referred to as dependent), the child would be
4 extremely anxious upon the caretaker’s departure and clinging to
5 her upon her return. These children tended to stay close to the
6 caretaker and were hesitant to explore the environment for fear
7 of abandonment. In the dismissing style (also referred to as
8 avoidant), the child does not appear distressed upon the mother’s
9 departure and seems disinterested when she returns. Subsequent
10 studies indicated that in this style the child does not appear to
11 show any signs of distress, however, physiological measures re-
12 vealed that the children’s heart rates and other signs of anxiety in-
13 creased (Strouf et al., 2005). They therefore experience negative
14 and unpleasant emotions but use defense mechanisms to repress
15 these feelings as a means of protection from the expectation of
16 abandonment. The fearful attachment style (also referred to as dis-
17 organized) involves a mixture of the avoidant and dependent
18 styles. Children with this style tended to be the most maladjusted
19 and had higher incidents of psychopathology. Table 6.1 illustrates
20 each style and the accompanying beliefs of self and other.
21
22 Negative view of others Positive view of others
23 Positive view of self
24 Dismissing Secure
25 (Avoidant)
26 Negative view of self
27 Fearful Preoccupied
28 (Disorganized) (Dependent)
29
30 Table 6.1. Attachment styles based on cognitions of self and others
31
32 Each of the three insecure styles has been associated with dif-
33 ferent problems in the qualities of caretaker relationships and dif-
34S ferent emotional themes that characterize the interpersonal field
35R those relationships. In the preoccupied style, mothers tended to
1st pass
be overly anxious and would resist or inhibit the child’s natural 1

curiosity to explore the environment. Fear is a predominant emo- 2
tion in the child-parent relationship. In the dismissing style, the 3
parents tended to be neglectful or disengaged. The inconsistencies 4
in the emotional availability of the parent led the child to feel 5
abandoned or to expect abandonment. The defensive repression of 6
emotions in the avoidant child is a means of buffering further dis- 7
appointment and sadness. Dismissing children also appear to ex- 8
perience anger or resentment at the parent for not being 9
consistently available. Children who exhibited the fearful style of 10
attachment tended to have experienced abuse. The excessive de- 11
gree of stress and trauma overwhelms the young child’s capacity 12
for coping and creates severe deficits in personality organization. 13
Although attachment theory grows out of the psychodynamic 14
tradition, there are clear cognitive components within it. As a re- 15
sult of the child-caretaker relationship, each individual develops 16
positive or negative beliefs about the self and about others that 17
unconsciously affect all other relationships. The view of the self 18
determines if the person believes that he or she is worthy of love 19
from others. The views of others determine whether the individ- 20
ual believes that other people can be trusted and available. These 21
unconscious cognitive structures (internal working models) are 22
the same as the implicit memories described in chapter 4 and can 23
become internal elicitors of emotions in relational situations. At- 24
tachment behaviors are activated when a partner in an adult rela- 25
tionship perceives the other as either abandoning or being “too 26
close for comfort.” 27
A therapist working with a client can infer the underlying cog- 28
nitions based on the style of attachment that is presented. This 29
can guide the focus of clinical interventions toward restructuring 30
the underlying cognitions about self and/or others. A client with 31
a dismissing (avoidant) style would require experiences that build 32
the trust in the therapist and in others. A preoccupied (depen- 33
dent) client needs to experience him or herself as positive and to 34S
be able to function more autonomously and independently. A 35R
1st pass
132 FOUNDATIONS
1 client with a fearful (disorganized) attachment style would require

2 a particularly safe environment where positive experiences of the
3 self and others can occur.
4
5
6 Interpersonal Experiences and Brain Development
7
8 Ego psychology, object relations theory, and attachment theory are
9 based on the premise that the relationship with the caretakers is
10 central to the development of personality. The ongoing patterns of
11 transactions between child and caretaker over the period of these
12 formative years of life lead to the development of various person-
13 ality structures. In ego psychology the structure is the capacity
14 for self-regulation and adaptation to the world, in object relations
15 theory it is the internal images that become part of the self and in-
16 fluence perceptions of others, and in attachment theory it is the
17 cognitive template for self and others that guides future relation-
18 ships. These personality structures rest upon the neural networks
19 of various brain regions and processes. In other words, the mental
20 representations of self and the processes of regulatory capacities of
21 personality are processes of brain activation. The consistency of
22 these dynamic patterns of neurological arousal form the “structure”
23 of personality in these process-oriented theories.
24 It is commonly accepted that these patterns of brain processes
25 were shaped by the early relational experiences with caretakers.
26 Allan Schore’s (1994) seminal work on the neurobiology of emo-
27 tional development describes how the early relationships between
28 an infant and mother shape various regions of the brain that are
29 responsible for emotional regulation and personality functioning.
30 The structures of the brain are not set at birth but develop and dif-
31 ferentiate by the patterns of experiences in the early years of life.
32 The brain is “experience-dependent” in terms of its maturational
33 growth, that is, the environmental stimuli that impinge upon
34S infants’ senses stimulate the differentiation and development of
35R particular regions and networks of the brain. The caretakers are
1st pass
not only the moderators of the interactions between the infant 1

and his or her environment, but in some ways are the actual envi- 2
ronment for the newborn. 3
4
By mediating and modulating environmental input, the 5
primary caretaker supplies the “experience” required for 6
the experience-dependent maturation of a structural sys- 7
tem responsible for the regulation of the individual’s so- 8
cioemotional function. By providing well modulated 9
sociaffective stimulation, the mother facilitates the 10
growth of connections between the cortical limbic and 11
subcortical limbic structures that neurobiologically me- 12
diate self-regulatory functions . . . This regulatory ca- 13
pacity allows for a continued expansion of the affect 14
array—the emergence of more intense discrete affects 15
and then a blending of these affects into more complex 16
emotions—over the stages of childhood. The core of the 17
self lies in the patterns of affect regulation that integrate 18
a sense of self across state transitions, thereby allowing 19
for a continuity of inner experience. Dyadic failures [be- 20
tween mother and infant] of affect regulation result in 21
the developmental psychopathology that underlies var- 22
ious forms of later forming psychiatric disorders. (Schore, 23
1994, p. 33) 24
25
The primary caretaker therefore plays a significant role in stim- 26
ulating the brain of the infant to allow adequate capacity for emo- 27
tional regulation. This capacity to modulate the intensity of 28
affective states is critical for the formation of the self as a person- 29
ality structure. The caretaker as a surrogate “ego” for the infant 30
initially provides this regulatory function through soothing, 31
caring, and calming the infant when distressed, but also by pro- 32
viding stimulation, arousal, and exciting experiences as well. As 33
the child’s brain matures these regulatory capacities become 34S
autonomous and require less of the caretakers assistance. Thus the 35R
1st pass
134 FOUNDATIONS
1 ego structure of personality is developed. The young child has

2 learned to regulate his or her own affective states, to negotiate
3 between wishes and the constraints of reality, and to control im-
4 pulses and the expression of emotional states. These capacities are
5 essential for the preschool and school-age years when the psy-
6 chosocial demands that involve peer interactions and adherence
7 to social rules require the regulation of emotions.
8 Failures in the caretaker—infant relationship such as abuse,
9 neglect, extreme inconsistencies, confusing or mixed messages —
10 will damage the developing personality structures by formatting
11 the associated neural circuits in dysfunctional ways. Exposure to
12 stress and trauma activates the fight-or-flight response in the indi-
13 vidual by releasing the H-P-A hormones that mobilize the body
14 for such threats. Continued exposure to threat causes excessive
15 amount of H-P-A to be present in the physiological system that af-
16 fect the neural wiring in these developing children (Davies, 2004).
17 Therefore the brains of abused children will be different that those
18 of children who developed under adequate conditions.
19 The importance of infant-caretaker relationships for develop-
20 ment has been supported from research in various disciplines such
21 as neuroscience, infant research, and psychoanalysis (Schore,
22 1994). The role of emotion, particularly positive emotion, in these
23 interpersonal and developmental processes is central. The intri-
24 cate affective dimensions of the mother-infant interaction have
25 therefore been a focus of study. It is in this area where music can
26 be seen as having a direct and significant impact upon personality
27 development.
28
29
30 Music and Maternal Attunement
31
32 Maternal attunement requires that the caretaker is aligned emo-
33 tionally with the infant. There must be a receptiveness to the sub-
34S tle signs and signals that indicate the emotional state of the infant
35R and responsiveness to the immediate needs of the child in that
1st pass
moment. Communication involves multiple modalities: facial 1

gaze, vocal tones, eye contact, kinesthetic input. This multisen- 2
sory input enters the infant’s sensory channels and activates the 3
respective brain networks that process and integrate such infor- 4
mation. A mother’s smiling face will facilitate smiling in the in- 5
fant. Cross modal transfer occurs when the infant’s visual sense 6
modality receives input (i.e., seeing the mother’s smile) and trans- 7
fers this information to a motor modality (i.e., the infant moves 8
her facial muscles to create a smile) Likewise, vocalizations will 9
lead to the infant’s sound production. The infant and mother 10
mimic each other and reflect identical facial expressions and emo- 11
tional tones. The mother is influenced by the infant’s reactions 12
and therefore adjusts her expressions. The communication is re- 13
ciprocal and mutually influencing each participant. In this way 14
they are in synchrony, in “harmony” and “in tune” to use musical 15
terms (that are actually more than metaphorical). Siegel (1999) 16
describes such engagement as “resonance between two people’s 17
states of mind: mutual influence of each person’s state on that of 18
the other” (P.88). 19
Attunement requires more than just matching the infant’s 20
states. It requires that the caretaker disengage when too much sen- 21
sory input needs to be processed. At these moments, infant stud- 22
ies have noted, the infant exhibits a “gaze aversion” where he or 23
she looks away and the attuned mother discontinues the stimula- 24
tion at that moment (Schore, 1994; Siegel, 1999). When the in- 25
fant reestablishes a gaze toward the caretaker indicating the need 26
for more stimulation the mother reestablishes the connection. 27
Such modulations in the amount of stimuli allow the infant time 28
to process the multimodal sensory information. Too much contin- 29
uous stimulation may overwhelm the infant, who then becomes 30
distressed or disengages without attempts to reengage. Likewise, 31
too little stimulation will not reflect, amplify, or reinforce the af- 32
fective states of the infant, thus lessening the level of affectivity to 33
a suboptimal degree. 34S
This modulating function on the part of the caretaker is related 35R
1st pass
136 FOUNDATIONS
1 to complexity theory as described in chapter 5. An optimal degree

2 of sensory information input will maximize the individual’s capaci-
3 ties to process and integrate such information. Like attuned par-
4 ents, a music therapist must be highly sensitive to the subtle nuances
5 and cues in the client that indicate a need to increase or decrease
6 stimulation. Keeping the stimulation at an optimal level, whether
7 it is facial and vocal cues in a mother-infant engagement or musi-
8 cal stimuli during a clinical improvisation, also conveys to the in-
9 dividual that the environment is tolerable and not overwhelming or
10 uninteresting. In this way, the therapist in a clinical session and the
11 mother in an infant’s world are gatekeepers of the immediate envi-
12 ronment. A major role of each is to control the amount and type of
13 information flow impacting the developing person.
14 Attunement creates a resonance where each person is opened
15 to being influenced by the other. Shifts in the affect of one person
16 are followed by equivalent shifts in the other’s affect. Such inter-
17 personal processes convey to the individual that his or her emo-
18 tions have an impact upon the environment, specifically on the
19 other person who feels the emotion of the individual. Empathy al-
20 lows each mind to be in a congruent emotional state with the mind
21 of the other. “It permits the two individuals’ minds to enter a form
22 of resonance in which each is able to ‘feel felt’ by the other”
23 (Siegel, 1999, p. 89). This process of empathy is a critical com-
24 ponent in the emotional development of children as well as in
25 therapy. Various treatment approach include empathy as a central
26 component such as Humanistic therapy (Rogers, 1961), Self Psy-
27 chology (Kohut, 1977), Interpersonal psychotherapy (Teyber,
28 2006) and Martial Arts Therapy (Dealy, 1993).
29 The interpersonal engagement of attunement can be described
30 as a musical duet of the infant-mother dyad. Many of the dimen-
31 sions of this intimate interpersonal space have musical qualities.
32 The expressions of each participant in the dyad are “in tune” in the
33 way that musical tones are in tune and vibrate at the same fre-
34S quency. There is harmony suggesting a congruent and consonant
35R resounding of each person (or musically each tone) in a meaning-
1st pass
ful relationship. The mother is keeping “rhythm” with the changes 1

in the infant’s engagement and gaze aversions. The interactions 2
flow in a temporal sequence across time. Like the dynamics of 3
music, there are increasing and decreasing periods of emotional 4
intensity. The attunement moments parallel musical improvisa- 5
tions in many respects. 6
The use of music by mothers in their attunement with their 7
infants is universal and connects to our human heritage. Moth- 8
erese—the singsong type of speaking that mothers use to engage 9
infants—has a melodic quality and musical form (Dissanayake, 10
2000). The musical elements of mother-infant interactions, 11
whether in the melodic contours of speech or in actual lullaby 12
songs, convey emotional meaning to the infant. Dissanayake, 13
(2000) proposes the idea that music evolved predominantly be- 14
cause of these mother-infant interactions. With hominid evolu- 15
tion and the increased need for affiliation and attachment these 16
early relationships with caretakers became more significant. In this 17
way, music has the direct function of creating emotional experi- 18
ences for the infant and developing a rudimentary basis for emo- 19
tional regulation, which is a major facet of personality 20
development as well as for society’s evolution. 21
The caretaker is the “ego” for the infant, the first “object” and 22
the “secure base” of the primary attachment relationship. The 23
caretaker is the gatekeeper between the developing infant and the 24
environment. In this way, music in the mother-infant bond, serves 25
not only as the representation of the environment, but in many 26
respects the environment itself. The soft, gentle, and consistent 27
qualities of children’s lullaby songs influence the physiological 28
processes in the infant and create a calm and soothing emotional 29
tone. This in turn conveys the message that the environment is 30
safe. This feeling of safety is critical in the internalization process 31
of significant objects as well as the development of secure attach- 32
ments. In the same way, exciting and happy music stimulates and 33
arouses the infant in a controlled and structured manner. The 34S
arousal of positive emotions in the context of a safe environment 35R
1st pass
138 FOUNDATIONS
1 establishes a range of affective intensities and is necessary for the

2 regulation of affect as occurs in moments of maternal attunement.
3 Gohm and Clore (2002) emphasize how affect is information
4 about the environment. Music can be an important source of af-
5 fective information about the new and unknown world of the in-
6 fant. It not only establishes an emotional tone about the world
7 but, in many respects, it can also structure the world. The forms of
8 songs, with repetitive motifs, creates predictability and expecta-
9 tions. A steady rhythm establishes pulse and continuity. Melody is
10 a spatial feature that leads the listener through the narrative of the
11 song. Music establishes a regulatory pattern that creates expecta-
12 tions of what is to come, introduces variations that may disrupt
13 the expectation, and offers heightened affective moments that are
14 more salient than others (Dissanayake, 2000).
15 In sum, musical elements communicate emotional information
16 to the infant. Music structures moments of interpersonal interac-
17 tions and contributes to attunement with caretakers. It can serve
18 as a link between the infant and the larger environment, and
19 creates positive and safe qualities to the external world that will
20 become internalized as part of the infant’s sense of self.
21
22
23 Implications for the Client-Therapist Relationship
24
25 A basic clinical implication that can be drawn from process-
26 oriented personality models and the research in brain development
27 and attunement is that the client-therapist relationship is central. The
28 therapeutic encounter can replicate the parent-child relationship
29 through the attunement of the musical relationship. The concept
30 of a corrective emotional experience (Gill, 1982) suggests that as
31 a result of the experience of the relationship with the therapist,
32 the client will have learned new patterns of relating and a new ex-
33 perience of the self in relationship to another. These therapeutic
34S experiences will activate the brain processes associated with self
35R and others only with a more positive emotional tone allowing, to
1st pass
the extent possible, a restructuring of the mental representations 1

contained within the mind. Siegel (1999, p. 335) described how 2
the “resonance” that can develop within the interactions between 3
two individuals activates brain processes and influences the ca- 4
pacity for neural integration of brain regions. 5
However, if the client’s brain has developed differently to in- 6
corporate the dysfunctional interpersonal patterns of early child- 7
hood, then the tasks of the therapist are much more complicated. 8
Development has occurred despite early trauma or deprivation, 9
but has move along a dysfunctional trajectory rather than an op- 10
timal one. Clients will need to learn strategies for emotional reg- 11
ulation since the early emotional world was inadequately 12
unreliable or unpredictable. Emotions convey information about 13
the environment, especially about a “mismatch” between expec- 14
tations of the environment. A social world with excessive mis- 15
matches would lead to excessively negative and intense emotions 16
that would likely overwhelm the regulatory capacities of young de- 17
veloping children. The music therapist can use the subtle nuances 18
of emotional dynamics within the intricate interactions of the 19
immediate moment to provide increasingly challenging opportu- 20
nities to regulate emotional experiences. Slight moments of disso- 21
nance for example, can be tolerated by a highly sensitive client in 22
the supportive bond of the therapeutic relationship. Intentionally 23
creating and increasing the dissonance in the music challenges the 24
client and forces him or her to adapt to the emotional experience. 25
When the challenges come close to the edge of the client’s capac- 26
ity (the zone of proximal development), then the therapist needs 27
to reduce the challenge and reestablish stability. 28
29
A theory of emotional response to music in terms of 30
“musical expectations” has clear explanatory value in re- 31
lation to Frijda’s (1986) notion of emotions as a func- 32
tion of monitoring match and mismatch. Most 33
compositional systems, such as the tonal system, provide 34S
a set of dimensions that establish psychological distance 35R
1st pass
140 FOUNDATIONS
1 from a “home” or “stability point.” Proximity or ap-

2 proach to this resting point involves reduction of ten-
3 sion; distance or departure involves increase of tension.
4 Distance can be measured on a number of dimensions,
5 including rhythm and meter (strong beats are stable,
6 weak beats and syncopations are unstable), and tonality
7 (the tonic is stable, non-diatonic notes are unstable). . .
8 These features provide reference points against which
9 the emotional system can plausibly compute match or
10 mismatch in terms of envisaged end points. (Sloboda &
11 Juslin, 2001, p. 92).
12
13 The tonal center may be more than the “home” that estab-
14 lishes a reference point and harmonic meaning for the other tones
15 in the key. On a psychodynamic level, the tonal center may be the
16 emotional “home” of the therapeutic relationship. In attachment
17 terms it is the secure base from where the toddler explores the en-
18 vironment, but has the knowledge that he or she can return. In
19 this way, the therapist uses the musical system (and the projective
20 symbolic meaning that it can represent) to influence emotional
21 dynamics. The emotional processes at this level may be uncon-
22 scious for the client. However, as the restructuring of the client’s
23 inner emotional world takes place, noticeable changes become
24 overt in terms of behavior and musical patterns.
25
26
27 Emotions and Music in Identity Development
28
29 Identity consists of the multiple internalized experiences through-
30 out childhood and the life span. Erik Erikson (1968) was famous
31 for studying ego identity and described adolescence as a critical
32 period of the identity development. The intrapersonal structures of
33 identity rest upon self-representation (Harter, 2003) that are in-
34S fluenced by sociocultural forces. One cannot understand an indi-
35R vidual’s personality without considering the cultural and social
1st pass
context in which the person has developed. Family contexts are 1

particularly potent forces in that individual identity emerges 2
through the relationships and the separation process with family 3
members. Grotevant and Cooper (1998) describe the importance 4
the balance of individuality with interpersonal connections during 5
the process of adolescent identity development. 6
Narratives—the stories that individuals tell about themselves 7
to others and to themselves—have come to be viewed as the es- 8
sential substance of the elusive and almost indefinable construct 9
referred to as the “self” (Bruner, 2004). The life stories that indi- 10
viduals tell are constantly being revised and re-written over the 11
course of a life time. In this way, the self—one’s identity—is fluid 12
and ever changing with the impact of events and experiences in 13
one’s life. From this perspective, we are continuously inventing 14
and creating our selves. Since stories can change and emphasize 15
various aspects of a theme, they are filled not only with our histo- 16
ries, but also with the potential for future selves. Verbal psy- 17
chotherapies are, in many ways, opportunities for the individual 18
client to tell his or her story. The process of verbal exchange may 19
be therapeutic in that it allows the client to clarify aspects of her 20
narrative, take multiple perspectives of her story, elucidate under- 21
lying meanings, and ultimately rework her narrative to create a 22
more meaningful life. 23
Emotions serve a role in this complex process of identity de- 24
velopment in that they come to color the building blocks of self- 25
concept as well as the themes of life narratives. A developing child 26
internalizes the words and experiences of his or her world. The 27
emotions associated with others’ statements about the child even- 28
tually become associated with the child’s self-statements and later 29
the characteristics of the child’s self-concept. Throughout child- 30
hood, individuals are exposed to almost an infinite number of com- 31
ments from significant others in their environments. Statements 32
like: “He is a good athlete,” “She is so smart,” “You will never 33
amount to anything,” “She is so shy” will contain explicit and im- 34S
plicit emotional meanings that can be positive or negative. These 35R
1st pass
142 FOUNDATIONS
1 statements become internalized and slip into an unconsciously en-

2 coded format in the brain to construct an implicit cognitive ar-
3 chitecture of the self. Vygotsky (1978) emphasizes how language
4 precedes thought, that is, children repeat the words they hear in
5 their worlds and these words become the thoughts and beliefs of
6 the young child’s mind. Language, therefore, is a necessary capac-
7 ity for self-concept. Emotions are also central in the self-evaluation
8 process that forms the basis of self-esteem. A client with a poor
9 self-esteem has internalized messages with negative emotional as-
10 sociations. Therapists and other adults in the world of children
11 should be particularly sensitive to the language and messages that
12 are conveyed to children since these messages format the brains
13 and evolving personality structures. Controlling the emotional
14 tone of a child’s environment maximizes the opportunities for the
15 construction of a positive and healthy sense of self.
16 It is not only verbal information from others but feedback from
17 experiences that shape self-concept, self-esteem, and self-efficacy.
18 The feelings of pride after the accomplishment of a difficult task
19 become absorbed into one’s sense of self. Identity then, in many
20 ways is the container of a lifetime of experiences that are inter-
21 woven and integrated into the themes of one’s life story. With re-
22 gards to therapy, the emotional experiences of the therapeutic
23 process can become internalized into the self-system and exert an
24 influence upon the client and how he or she constructs narratives.
25 This process parallels (and in many ways is synonymous with) pre-
26 viously described internalization processes of ego psychology, ob-
27 ject relations, and attachment theories. One can conceptualize the
28 whole therapy phenomena as a contiguous series of experiences
29 that gradually influence the client’s way of being as these experi-
30 ences become integrated into the dynamic self-system of the client.
31 It is helpful to think not about one particular intervention during
32 a specific session that was therapeutic, but rather what impact will
33 the whole process of treatment have on the life of the individual.
34S Central to the success of the therapy is the emotionally rich ther-
35R apeutic relationship.
1st pass
Music can play varying roles in the identity construction 1

process. Since music is culturally based, it reflects the larger social 2
system that is the ecology of an individual’s development. Quali- 3
ties of particular musical genres represent a person’s world and may 4
come to influence how he or she perceives and approaches the 5
world. Consider the different worldviews of a Western-European- 6
Classical music tradition from that of American jazz music to the 7
various folk and indigenous styles of music from around the world. 8
The different feelings within each style both embody and come to 9
shape the culture. Since identity is culturally embedded, then 10
music has the potential to contribute to the complex tapestry of 11
the self. 12
Adolescence is a critical period for identity development so it 13
is no wonder that musical preferences are generally important to 14
many teenagers. During this stage, adolescents explore various 15
identities and work toward a decision of how they want to be in 16
the world. The choice of music is a public statement of one’s affil- 17
iation with a particular social group, value system, and worldview. 18
Musical preference is an expression of self in adolescent develop- 19
ment. The various types of identity—gender, sexual, racial, etc.— 20
become more pronounced at this stage. Regarding music Sloboda 21
and O’Neill (2001) refer to research on gender differences in the 22
uses of music in adolescence: “Girls were more likely to report that 23
music could be used as a means of mood regulation, whereas boys 24
reported that music could be a means of creating an external im- 25
pression with others” (p. 424). 26
For the therapist, musical preference and patterns of music 27
making can be reflective of the individual self. Given a basic prem- 28
ise of music therapy—that improvisation is an expression of the 29
self—the way the individual creates music corresponds to the way 30
that he or she approaches the world. It is important to keep a fluid 31
and dynamic view of each individual client, whose narrative can 32
(and most likely will) change over time to activate potential as- 33
pects of the self. In the same way that the client can be viewed as 34S
a multidimensional work of art, so must the clinician keep in mind 35R
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144 FOUNDATIONS
1 the undeveloped potential and “possible selves” of the client.

2 Musical improvisations are continually filled with possibilities.
3 When a client explores the world of sound and experiments with
4 the almost infinite ways to create music, she is practicing auton-
5 omy in the exertion of herself through the musical creations. Ex-
6 ploring the imagination through therapeutic improvisation
7 parallels the larger process of identity exploration and develop-
8 ment. Song writing activities can embody and directly express a
9 client’s identity, and be a means of telling a story about the indi-
10 vidual. Changes in the client’s style of making music and/or themes
11 in song writing can reflect development of identity, expansion of
12 the self, and progress in therapy.
13 Musical qualities can also be considered as representations of
14 personality. While theories of personality traits have not been ex-
15 amined here, the notion that each person is “musical” may be a
16 worthwhile consideration in the assessment of the client. Individ-
17 uals can be described more or less as predominantly “rhythmic—
18 either smooth or choppy in their movements as well as their
19 mannerisms, “melodic” in their speech as well as expressions, “dy-
20 namic”—as loud or soft in their presentations to the world, or as
21 having a “tempo” with regard to the rapidity or lethargy of their
22 energy and movement. Since the individual self is a dynamic sys-
23 tem and music is a dynamic medium, then the qualities of music
24 can more than represent the person, but actually be emotive and
25 energetic expressions of the individual’s being.
26
27
28
29
30
31
32
33
34S
35R
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Excerpt Two
1 Chapter 8
2
3
4 The Isomorphism of
5
6
Music and Emotion
7
8 John Pellitteri
9
10
11 Music as Emotional Metaphor
12
13 Music and emotions are isomorphic—that is, they share similar
14 underlying structures. The distinct elements that comprise
15 music—pitch, tempo, rhythm, loudness, timbre, and harmony—
16 can also represent the forms of emotions. This similarity of under-
17 lying structures explains the intimate connection between music
18 and emotions, and is the basis for music’s effectiveness in clinical
19 work. From an artistic perspective, music therapists can draw upon
20 this isomorphism and use music to capture the nuances of emo-
21 tions in a manner more accurate than words. This process can cre-
22 ate an experience where the client perceives externally (in the
23 musical production) affective qualities that are internal. In the
24 context of the therapeutic field, the externalization of inner emo-
25 tional states provides a reflection back to the client and establishes
26 congruence between the person and the immediate environment.
27 In this way, the music therapist uses the emotional isomorphism of
28 the music to convey empathy to the client. The reproduction of
29 emotional states within an auditory format, allows the client and
30 therapist to understand these emotional processes over time and in
31 a dynamic medium that closely parallels the ever-changing flow of
32 emotions.
33 In this metaphorical view, music “represents” a client’s emo-
34S tions. Wigram. Pedersen, and Bonde (2002) describe music as
35R analogy and metaphor. They note how “many music therapists talk
1st pass
The Isomorphism of Music and Emotion 173
and write about music based on the (more or less conscious) axiom 1
that the client’s music, expression, or experience is closely re- 2
lated—an analogy—to the client’s personality or pathology (p. 3
97). Applied to this current discussion, music can be an analogy for 4
the client’s emotional states. The application of the ISO principle 5
suggests that changes in the client’s music will lead to, or parallel, 6
a corresponding change in the client’s emotions. While there is a 7
clear metaphor between music and emotions, they may actually 8
reflect a deeper similarity. As will be discussed in a later section, 9
there are neurological processes involved in both phenomena. 10
There can be several structures that are used to understand 11
music and emotions. The four major dimensions used here will be 12
space, time, intensity, and dynamics. Analysis of the aesthetic lan- 13
guage used to describe music and emotions suggests that these di- 14
mensions underlie our experiences. Everyday references to feelings 15
and moods often contain such metaphors. Emotions can be de- 16
scribed as “high” or “low,” which implies a spatial dimension simi- 17
lar to the pitch of melodic phrase. In a sad emotional state, a 18
person will feel “down” and likewise sad music may include more 19
descending intervals and lower tones in contrast to joyful music 20
that is “up” and may build to a melodic climax in the upper regis- 21
ter pitches of an instrument. Happy or pleasant emotions tend to 22
be expansive, spreading into a larger space, while sad or depressed 23
emotions tend to constrict and turn inward into a smaller space. In 24
a dance medium, physical movement through space that is ex- 25
pansive (i.e., arms outstretched) or inward (i.e., closed as in a fetal 26
position) can respectively convey similar emotions. Emotions re- 27
late also to the cognitive space of mental activity. Isen’s (2000) 28
work on the influence of mood on cognitive processes indicates 29
that in mild positive moods, people are able to generate a greater 30
number of creative word associations, have increased flexibility, 31
and improved decision making. Thus positive mood “expands” the 32
possibilities and creative connections within the field of one’s men- 33
tal activity. 34S
In the temporal dimension, a particular emotion leads an 35R
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174 CLINICAL APPLICATIONS
1 individual to move at a certain pace—fast to slow, indicating the

2 tempo of the emotion. Happy music tends to be described as “up-
3 beat,” while calm or peaceful music is sedative and has a slower
4 pace. Psychomotor retardation is a clinical symptom of depression
5 and, likewise, certain negative emotional states are associated with
6 a slow tempo. However, the characteristics of fear, another type of
7 negative emotion, may lead one toward rapid movements as in
8 adaptive escape behaviors or nervous twitching. The experience of
9 emotion proceeds in a particular organized fashion similarly to how
10 rhythm structures and organizes a musical piece. Music with com-
11 plex syncopated rhythms will create a more complex, agitated, or
12 aroused feeling state than an even, continuous, and repetitive
13 rhythmic pattern. Recall Meyer’s (1956) notion of expectation
14 leading to emotion in music. Steady rhythmic patterns are pre-
15 dictable and less likely to lead to “surprise” or the type of affective
16 arousal that is elicited with sudden change. Fear, surprise, or ex-
17 citement, for example, suggest a sudden change in the rhythm of
18 physical and cognitive movement where calm, satisfied, content
19 emotions tend to be represented by smooth and steady rhythms.
20 A third point of comparison is the intensity dimension that par-
21 allels the vertical axis of the mood meter (see chapter 2). One
22 musical element in intensity is loudness. Emotional states can be
23 loud and energized in a physical manner as when a person screams
24 out of anger or fear. This would be contrasted with the whimpers
25 and soft sounds associated with disappointment or loneliness.
26 However, emotional intensity can be comprised of more than just
27 loudness. Rhythm can create intensity through pulse, syncopation,
28 and complexity. The primitive rhythmic patterns of Stravinsky’s
29 Rite of Spring contribute to the energized intensity of the piece. In-
30 tensity in music (and emotions) can also be created by the ten-
31 sions of conflict as in dissonant harmony where two or more tones
32 clash in the context of a tonal center. Again in line with Meyer’s
33 views, the tones do not fit into the expectations that were estab-
34S lished by the tonal key of the music. Harmony, like melody (pitch),
35R can be placed in a spatial dimension since there is distance be-
1st pass
tween two tones and also between a tone and the tonal center. 1
The relational nature of harmony can be a metaphor for interper- 2
sonal relations between humans as suggested when people are said 3
to be “in harmony” (presumably consonant harmony) and there is 4
a lack of tension or conflict. 5
The fourth structural similarity between music and emotions is 6
the dynamic dimension. Like the closely related dimension of 7
intensity, there are several musical elements that combine into dy- 8
namics. While intensity usually changes over time, it is pre- 9
dominantly the “amount” of something. Dynamics have fluid, 10
ever-changing qualities that proceed and unfold over time and also 11
have “direction”—forces that move. The constant change, flow, 12
and movement of emotions are metaphorical to the ocean that is 13
in a continuous flux where one can be carried by a current in a di- 14
rection through the water. In this way, dynamics portray the “en- 15
ergy” of music and emotions that motivate action and change. 16
There is room for increase or decrease in the energy level. Dy- 17
namics unfold upon the spatial dimension with the direction of 18
movement as well as the amount of space that is involved. Michael 19
Mahoney (1991) in his seminal book Human Change Processes 20
describes the oscillation between expansion and contraction that 21
occurs in the dynamic process of therapeutic development. 22
Several musical elements contribute to the overall dynamics of 23
music. Melody is often a salient stimulus in the tapestry of the 24
sound field that draws attention and leads the listener. The spatial 25
changes in pitch provide direction to the music. Harmony and or- 26
chestration can contrast with different layers of texture as voic- 27
ings change and there are multiple numbers of tones and/or 28
instruments sounding at different times. Loudness by nature is dy- 29
namic and provides the energy to the melody’s direction. As dy- 30
namics unfold through the space-time-intensity dimensions there 31
is a sense of “what is to come.” Music creates expectations, which 32
itself is an emotional state. The emotional metaphors include how 33
each particular emotional state has potential for motivation and 34S
movement and there is an anticipation of what is to come in the 35R
1st pass
1 emotional narrative. Emotions provide direction (like melody) and

2 are textured with meaning (like harmony and orchestration).
3 There is also the intensity dimension of emotion that becomes a
4 force in the dynamics. Annoyance is a lower level of intensity than
5 anger, which is lower than rage. Each intensity level carries with
6 it, the potential for action that will impact the environment. The
7 multicomponent construction of emotion itself is a dynamic in-
8 terplay of physiological, cognitive, social, and behavioral processes.
9 A clinical intervention that alters one of these components will
10 change the dynamics of the emotion—like the alteration of a
11 musical element changes the song.
12 In sum, the four major isomorphic dimensions are comprised of
13 musical elements that in turn contribute to an aesthetic under-
14 standing of emotional structure. Space includes pitch, melody, har-
15 mony; time includes rhythm and tempo; intensity results from a
16 combination of loudness, rhythm, and harmony and dynamics are
17 created by melody, harmony, orchestration, and loudness. While
18 these are descriptive terms and not empirically derived, they
19 provide the music therapist with an aesthetic language to under-
20 stand the qualities of affect and to relate the structures of music
21 and emotion.
22
23
24 Synesthesia and the Aesthetic Approach
25
26 While not a formal dimension per se, color is another aesthetic
27 quality that is useful in describing both music and emotion. Col-
28 ors are the visual tones that are comparable to the tonality and
29 timbre in music. Colors posses a range of degrees—hues that vary
30 from bright or dull, and deep or light. The degree of dissonance
31 and consonance in harmony can translate into the experience of
32 brightness or dullness. The texture of an orchestral chord with
33 many different tones sounding together over several octaves will
34S have more depth than a simple and light two-tone interval on a
35R keyboard. Color in music is also related to the timbre or tone qual-
1st pass
ity of the instruments. The timbre of gongs, string instruments, or 1

woodwinds creates distinct sound qualities that can also be de- 2
scribed with aesthetic language such as bright to dark and sharp to 3
dull. In the visual art modality, color is associated with emotion. In 4
psychodynamic projective methods of personality assessment (i.e., 5
Rorschach inkblot method) the identification of color is an indi- 6
cator of unconscious emotional processes (Exner, 1993). Bright 7
colors generally represent a greater degree of pleasantness (posi- 8
tive valence) and dark colors may represent more unpleasant emo- 9
tions. In using the two-dimensional mood meter the horizontal 10
axis (pleasant to unpleasant) could be represented by varying de- 11
grees of color. 12
The connection of visual and auditory modalities presents an 13
interesting line of inquiry that has implications for the music-emo- 14
tion isomorphism as well as for conceptualizing and measuring 15
emotions. Synesthesia has been a topic of study by psychologists 16
and artists and refers to a neurological capacity to experience cross- 17
modal senses, that is, there is a blending of different sensory chan- 18
nels (Cytowic, 1995). For instance a person may “hear” a color, or 19
“smell” a sound. Numbers may be in colors and shapes may have a 20
taste. Many artists and musicians throughout history have been 21
known to have this capacity, which is not considered a disorder, 22
but a sensory-perceptual tendency. There is no agreement between 23
individuals with synesthesia on the parallel of cross-sensory chan- 24
nels nor upon the qualities that are perceived, i.e., different people 25
with this ability will see varied colors in response to the same 26
musical tone. Alexander Scriabin, and early twentieth-century 27
Russian composer had synesthesia: 28
29
According to Scriabin, colors were associated with tonal- 30
ity, not with singular notes. He told Myers (1914), that 31
he often experienced a shift in color with the change of 32
tonality, but not always. He reported that his synesthe- 33
sia was not always of the same quality and intensity. Nor- 34S
mally, he would have a faint “feeling” of color when 35R
1st pass
1 listening to music. But as he got more emotionally in-

2 volved in the music, the synesthetic sensations of color
3 would become stronger, more intense, and pass over to
4 give an “image” of color. And not every piece of music
5 would elicit synesthetic responses in Scriabin.
6 Beethoven’s music was too intellectual and did not
7 evoke synesthesia, according to Scriabin, while modern
8 music, which was more psychological, i.e., more emo-
9 tional, evoked much better synesthetic sensations. Scri-
10 abin explained that: “the color underlines the tonality;
11 it makes the tonality more evident” (Myers, 1914, p. 8)
12 . . . Starting from the fact that his synesthesia had an
13 emotional basis that intensified his experience of music,
14 Scriabin explored the artistic possibilities of the simul-
15 taneous playing of colors and music. (van Campen,
16 1997, p. 3).
17
18 For Scriabin and presume-ably other synesthetes, there is a re-
19 lationship between emotions and sensory experiences. The blend-
20 ing of the auditory and visual sensations appears to be evoked by
21 the emotional characteristics of the music and enhanced by in-
22 creased emotionality in the individual. Scriabin describes how the
23 color is embedded within the tonality. Such cross-modal descrip-
24 tions of music are common. Many musicians, most who do not
25 have synesthesia, describe tonality as conveying a certain mood
26 and color—although the use of color in someone without synes-
27 thetic experiences is more likely an aesthetic and descriptive term.
28 Nonsynesthetes can imagine the color of music, where as a true
29 synesthete experiences the actual sensation. Nonetheless, synes-
30 thesia illustrates, at a neurological level, that sensation and per-
31 ception play a role in emotions. At a descriptive level, it suggests
32 that affect can be represented through different modalities and
33 that the aesthetic language used to describe music and emotions
34S may be more than merely poetic but contain underlying neuro-
35R logical processes. While synesthesia is relatively rare in the general
1st pass
population, the idea of multisensory channels for describing emo- 1

tion and music can be applied to all. This “broad” use of the term 2
synesthesia serves as a foundation for what I term the “aesthetic ap- 3
proach” to representing emotions. The use of aesthetic descriptive 4
language (i.e., colors, shapes, textures) creates an interface for 5
music and other arts in the process of emotional representation. 6
The area of emotional intelligence, as will be described in 7
chapter 9, involves emotional representation as part of emotional 8
knowledge. Aesthetic language was incorporated in the first abil- 9
ities-based measure of emotional intelligence—the Multifactoral 10
Emotional Intelligence Scale (MEIS) (Mayer, Salovey, & Caruso, 11
1999). One of the MEIS subtest is entitled “Synethesia” and re- 12
quired respondents to describe emotions along a semantic differ- 13
ential scale. For example, one item might ask to describe sadness 14
as being more blue or more orange. It may be a combination of the 15
two and the level on the 7-point scale (with blue and orange at 16
each end) will determine the respondent’s degree of particular 17
color used to represent that emotion. Anger could be described on 18
a scale as sharp or dull, happiness as light or heavy. Each emotion 19
on the MEIS synesthesia subtest is rated according to several 20
aesthetic qualities that included various sensory channels. Higher 21
scores on the subtest reflect the degree of agreement with 22
the choices from the normative sample group used in the test de- 23
velopment. The subtest is not a measure of synesthesia, but used 24
the word in this broader sense of a general representation of 25
emotions. 26
The aesthetic approach to emotional representation forms a 27
bridge between music and other creative art modalities in the use 28
of common descriptive language. Playing music that is “blue” and 29
painting or dancing to the image of blue can enhance the experi- 30
ence of this aesthetic quality and its associated emotions through 31
multisensory stimulation. A rich and complex representation of 32
emotion through the creative process expands one’s emotional 33
repertoire and emotional knowledge, leading to greater self- 34S
awareness. 35R
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1 Vitality Affects and Dynamic Forms

2
3 The use of aesthetic language to describe and represent emotions
4 is directly related to what Stern (1985) refers to as “vitality af-
5 fects.” While not emotions in the formal sense, vitality affects rep-
6 resent the underlying affective structures of our various
7 experiences. They are the isomorphs of emotions that are most
8 readily captured by the dynamics of musical forms. Sloboda and
9 Juslin (2001) provide a description:
10
11 Stern (1985) introduced the concept of vitality affects to
12 describe a set of elusive qualities related to intensity,
13 shape, contour, and movement. These characteristics are
14 best described in dynamic terms such as crescendo, fleet-
15 ing, explosive, diminuendo, etc. These qualities are not
16 emotions, but rather abstract “forms” of feelings that
17 occur both together with, and in the absence of, proper
18 emotions. The vitality affects are “amodal” in the sense
19 that they are common to all modes of expression. Stern
20 (1985) suggests that the vitality affects are of a particu-
21 lar importance in the early communicative acts of
22 mother and infant. Mother and infant respond to one
23 another by constantly adapting and adjusting the inten-
24 sity, timing, and contour of their expressive acts. This
25 process of constant matching of gestural events is re-
26 ferred to as attunement. (p. 79).
27
28 Vitality affects, like the aesthetic language needed to describe
29 them, relate to various art modalities as well as affective move-
30 ments of everyday actions. The quality of moment-to moment ges-
31 tures and the nuances of interpersonal interactions contain vitality
32 affects. Bunt and Pavlicevic (2001) describe how, “a ‘bursting’ into
33 tears (or laughter), a bursting watermelon, a musical sforzando, or
34S an athlete’s final ‘burst’ of speed may well share—in our minds—
35R the same ‘vitality affects’ in terms of intensity, motion, contour,
1st pass
and rhythm” (p. 194). While aesthetic language can provide ver- 1
bal labels to such “elusive qualities,” it is music than can capture 2
the dynamic reality of such affects. It is this capacity to create emo- 3
tional dynamics in an auditory field that enables music therapists 4
to work so intimately (and therapeutically) with client’s emotions. 5
The amodal qualities of vitality affects exist in our minds and 6
form the ways that we make sense of our worlds particularly our 7
emotional worlds. Stern’s work emphasizes mother-infant interac- 8
tions, and the vitality affects are likely the aesthetic structures that 9
an infant uses to understand the range of sensory stimuli that im- 10
pinge upon him or her. Maternal attunement, like a therapist’s em- 11
pathy, is critical for healthy development and aligning the 12
neurological structures of the developing brain (Schore, 1994). 13
The accurate representation of a client’s inner world in the inter- 14
personal field of the client-therapist musical improvisation allows 15
for a rich and deep type of empathy that might only be comparable 16
to the mother-child attunement experiences of early life. In this 17
way, the music therapist may have access to deeper levels of the 18
client’s personality than through purely verbal forms of therapy. 19
Several authors relate Stern’s (1985) concept of vitality affects 20
to Langer’s (1953) idea of dynamic form (Bunt and Pavlicevic, 21
2001; Gabrielsson & Lindstrom, 2001; Sloboda & Juslin, 2001). 22
While many do not consider dynamic forms as emotions in them- 23
selves, they are the isomorphism of music and emotions. It is the 24
underlying common structure that is described with aesthetic lan- 25
guage and expressed through musical elements. “The tonal struc- 26
tures we call ‘music’ bear a close logical similarity to the forms of 27
human feeling . . . music is a tonal analogue of emotive life” 28
(Langer, 1953, p. 27). Bunt & Pavlicevic (2001) have applied the 29
concept of dynamic forms to music therapy and assert that in the 30
clinical setting the “dynamic forms are both musical and rela- 31
tional” (p. 194). The emotions in the client come from both the 32
musical vitality affects as well as the interpersonal connections 33
with the therapist. 34S
Knoblauch (2000) implicitly draws upon the isomorphism of 35R
1st pass
1 music and emotion in suggesting that psychotherapists listen to

2 the rhythm, tone, and harmony of a client’s verbal and nonverbal
3 communications in the analytic encounter. The interpersonal re-
4 lation between the client and analyst, even though it is based on
5 a primarily verbal format, is a musical improvisation. Tuning into
6 the speech prosody and the “musical” qualities of the encounter
7 can increase the empathic and therapeutic connection with the
8 client.
9 The musical nature of vitality affects is illustrated in the re-
10 search of Silverman and Silverman (as cited in Rose, 2004) that
11 involved examining the audio recordings of suicidal individuals,
12 many of whom succeeded in their attempts. The analysis of the
13 vocal qualities revealed notable distinctions in prosody and musi-
14 cal tone between typically depressed but nonsuicidal individuals
15 and those that were highly suicidal:
16
17 Not surprisingly, some of the vocal patterns included fea-
18 tures commonly noted in depression: loss of energy and
19 power, and monotonous, repetitious, uninflected speech.
20 The most compelling finding, however, was that the
21 voice sounded hollow and toneless, as though lacking a
22 center, and irrespective of volume and tempo, already
23 “dead and gone.” In contrast to the hollowness of de-
24 pression, the lifelessness of near-term suicidal persons’
25 voices may reflect a decrease in harmonic overtones and
26 resonance, reflecting an internal state different from de-
27 pression . . . These persons reported an experience of
28 “falling into a hole”—suggesting radical disturbance in
29 representation and imagery. In contrast to the voice of
30 the depressed person, which strikes the listener as that of
31 one suffering from an illness, the high-risk near-term sui-
32 cidal person sounds as though already dying. Also in con-
33 trast to depression, and probably unique for suicidality, is
34S an absence of vocal patterns associated with anxiety,
35R such as tremulousness. (Rose, 2004, p. 10)
1st pass
The “lacking- a-center” quality of the toneless flat affect speech 1

prosody of a suicidal patient may be more than metaphorical, and 2
could actually reflect and directly indicate a musical-emotional 3
disturbance in the person’s being. A tonal center, that forms a 4
musical grounding and reference point, may be missing or silent in 5
the life of such seriously disturbed individuals. As verbally oriented 6
therapists are turning to musical form for such insights, music ther- 7
apists already possess the tools to relate to the core emotions and 8
to breath vitality back into the client. 9
10
11
Congruence in the Musical-Emotional Field 12
13
Synesthesia considers the blends of sensory channels related to 14
emotions and vitality affects are the dynamic forms that are iso- 15
morphic between emotions, music, and other experiences. The 16
aesthetic approach to representing emotions attempts to use lan- 17
guage to describe these underlying isomorphs. However, the con- 18
nection between affective structures and various sensory modalities 19
may be more than descriptive and in actuality reflect an underly- 20
ing neurological reality. For example, more intense colors may re- 21
flect more intense emotions. The intensity of a color stimulus 22
impacts the visual cortex to different degrees. Thus, the intensity 23
of an emotional experience parallels the intensity of the sensory 24
stimulation. With regard to the spatial dimension of melody, 25
higher pitches actually stimulate “higher” areas of the auditory cor- 26
tex in the right hemisphere (Liegeois-Chauvel, et al., 2003). Thus 27
space, in a melodic sense, may parallel the space of the brain region 28
involved in melody perception. The inner cortical reality of the 29
brain is isomorphic to the auditory-spatial perception of the 30
melody. The temporal dimension involves rhythm and tempo. 31
Music can create physiological conditions that are identical to the 32
physiological processes of particular emotions such as slower heart- 33
beat and breathing rates for sad or calm music. When the descrip- 34S
tive aesthetic word “calm” is used to refer to a person’s emotions, 35R
1st pass
1 it is describing the steady and sedate rhythm of the person’s heart

2 and breathing, as well as the rhythm of the music being produced
3 by that person. Again, the music and the physiological state are
4 synonymous.
5 Muscle tension has been one of the least ambiguous and con-
6 sistently established areas in music’s ability to directly arouse emo-
7 tions (Radocy & Boyle, 2003). Emotional “tension” perceived in
8 the music may result from the dissonance or other tensions cre-
9 ated by the combinations of musical elements that in turn has im-
10 pacted the physical tensions in one’s body. A client entering a
11 session feeling tense will reflect this emotion through various af-
12 fective physical cues that will in turn create tension in his or her
13 manner of playing. Recall the James-Lange theory of emotional
14 construction (see chapter 4) where behaviors and physical states
15 occur first and then influence the emotional state. In using the de-
16 scriptor tense one is describing the musical elements, physical
17 states, and emotional states simultaneously. There is thus, a blur-
18 ring of boundaries between the emotions of the music and the in-
19 dividual in that the aesthetic quality of tension (a vitality affect)
20 exists in all areas of the psychological field.
21 From personal experiences of creating music, most of us as
22 musicians and music therapists can relate to those moments of
23 deep involvement where one’s musical expression is intimately
24 linked to an inner feeling. This may not occur all the time but only
25 at certain states of mind when there is a synchrony and a flow be-
26 tween the resonance of our emotional states and our musical ex-
27 pression. There is a congruence between the inner and the outer
28 reality of the person. In such instances there can be a loss of “self”
29 within the music. Given the isomorphism between music and
30 emotions, during such deeply involved and highly congruent mu-
31 sical-emotional experiences (that are not confounded by distrac-
32 tions or other influences on expressive musical behavior) the music
33 of the client becomes more than a mere representation of emo-
34S tions. In such instances, the therapist can consider the music to
35R “be” the emotions since there are so many levels of synchrony. It
1st pass
is so important that the therapist allows the client the space to 1

create congruent moments and not interfere in the process. 2
So, in such states of congruence is the emotion in the person 3
or in the music or both? This question parallels the issues in re- 4
search on music and emotion that examines emotion as perceived 5
in the music or emotion as experienced in the self (Sloboda & 6
Juslin, 2001). There can be multiple influences on emotions and 7
multiple factors that shape musical expression during therapy. 8
When such an inner-outer congruence occurs between the person 9
and his or her musical expression then I claim that the answer is 10
both. The loss of self, or at least the deep involvement of self, in- 11
dicates that one is in an altered state of consciousness. The essence 12
of the musical creation is supported by the emotions activated 13
within the person. The music is embedded with the emotion as 14
the person is filled with the music. It is in these instances where a 15
client can experience healing through wholeness and complete- 16
ness even if only for the moment. A resonance exists where the 17
musical-emotional elements (the dynamic forms of rhythm, space, 18
direction, tone, etc.) are so perfectly in synchrony that an objec- 19
tive distinction is not possible. If the client or therapist in such in- 20
stances attempted to analyze the experience at that moment, then 21
the activation of the intellectual analytic functions in the brain 22
would remove the person from the deep emotional state. Thus, the 23
inner-outer congruence can only be perceived as such to someone 24
in such a state of receptive emotional attunement. To perceive the 25
music “as” the emotion, the perceiver must feel it as well. This 26
illustrates most exclusively the “art” of music therapy over the 27
“science” since there can be no objective stance for empirical 28
observation. 29
I find an interesting parallel between the inner-outer congru- 30
ence of a client with his or her immediate musical environment 31
and the tenets of ecopsychology as described in chapter 3. In 32
ecopsychology, the conceptualization of self is broad and lacks the 33
distinctions between an internal “self” and the external natural 34S
world (Roszak, et al., 1995). Thus, the health of the natural world 35R
1st pass
1 translates to individual health. Primitive humans were closely con-

2 nected to the states of their immediate environments as a matter
3 of survival. A balance between the person and the environment is
4 a significant indicator of mental health and adjustment (Conyne
5 & Cook, 2004). In the same manner, a client is sensitive to the
6 therapeutic environment created by the therapist. The mood and
7 emotions in the environment convey information as to whether
8 the immediate space is safe, which directly impacts the client’s
9 anxiety level. This in turn will motivate the client to either engage
10 in the therapeutic relationship and in music making, or take a
11 more defensive stance of self-protection. The environment will
12 influence whether a state of congruence can be attained. The emo-
13 tionally intelligent music therapist therefore, through awareness
14 of his or her own emotional states, musical expressions, and clin-
15 ical acuity, creates an environment that contains “therapeutic
16 emotions.” The emotional tone of the therapy session environ-
17 ment is the foundation for the clinical process. It opens the door
18 for the possibility of client transformation through emotional
19 experiences.
20
21
22 Affective Exchange and Engaging the Core Self
23
24 A client in the process of producing music is re-creating his or her
25 inner emotional states through outward behavioral expressions.
26 This has implications for the immediate moment-to-moment in-
27 teractions between a client and therapist during musical improvi-
28 sation. As the musical improvisation captures the vitality affects of
29 the client in the moment, the music therapist establishes an inti-
30 mate personal connection with the client, the nature of which is
31 the essence of therapy. The subtle responsiveness to the client’s
32 dynamic forms conveys empathy and communicates that the client
33 has been received emotionally by the therapist. “These musical
34S sounds correspond to the mechanism of ‘nonverbal communica-
35R tion,’ enabling the therapist to ‘receive’ and directly (and viscer-
1st pass
ally) experience the patient’s musical utterances as a presentation 1

of themselves—and also as a presentation of their clinical pathol- 2
ogy” (Bunt & Pavlicevic, 2001, p. 195). While pathology may be 3
evident in the musical and emotional patterns of clinical improv- 4
isation, the type of deep contact that can occur is with the core of 5
the person that, from a humanistic perspective, is essentially pos- 6
itive and healthy. Beyond pathology lies what Nordoff and Rob- 7
bins (1977, p. 1) refer to as the “music child.” The essence of 8
therapeutic change rests upon the deep interpersonal connect be- 9
tween the core selves of the client and therapist. Benezon presents 10
an approach to music therapy treatment based on the ISO princi- 11
ple as the assumption “of an internal sound that is characteristic of 12
each of us and individualizes us, a sound that is the sum total of our 13
sound archetypes” (as cited in Bruscia, 1987, p. 383). The notion 14
here is that there is a core existence of sound, an inner music, that 15
is part of each person’s uniqueness. 16
Musical improvisation is a means of connecting to the client’s 17
core self since the music bypasses verbal mediation, reflects the 18
deep vitality affects, and creates the dynamic forms of the client’s 19
emotions. The inner-outer congruence described above sets the 20
stage for the emotional engagement between the client and ther- 21
apist. The degree of musical-emotional congruence, that is, the 22
degree to which the client’s improvised music accurately repre- 23
sents his or her inner emotional states, determines the extent to 24
which change can be instituted in that moment of the therapy. 25
When there is congruence, alterations in the music can be direct 26
alterations of the emotions of the core self. The client responding 27
to a therapist during a musical improvisation is adjusting his or her 28
emotional state to produce a slightly different music output. This 29
process of adjustment to the demands of the immediate music mo- 30
ment is the therapeutic process at its essence. A highly skilled cli- 31
nician is deeply perceptive to the subtleties and nuances of the 32
client’s emotional state and can fine-tune intricate musical stim- 33
uli, which will create a mild disequilibrium that fosters the client’s 34S
adjustment. Deep contact, rapport, trust and a therapeutic alliance 35R
1st pass
1 must be established before the therapist can attempt such a bold

2 intervention that facilitates change.
3 For example, with a client that tends to play very simplistic
4 and steady beats and does not explore or expand (due to anxiety
5 perhaps), the music therapist may interject syncopated rhythms
6 that cut against the steady rhythm. The introduction of this new
7 music element creates a dissonance (on the rhythmic level) that
8 contrasts with the client’s steady and rigid beat. How does the
9 client respond to this? If the anxiety level is high, the client will
10 likely tend to be more rigid and defensive. A rhythmic pattern that
11 is too extreme will only reinforce the defensive position and close
12 the client off to the possibility of playing in a new way. The ther-
13 apist needs to consider the client’s zone of proximal development
14 (Vygotsky, 1978), that is, the capacity for the client to play slightly
15 outside his or her comfort zone with the support of a guide. A fine-
16 tuned intervention is important since challenging the client too
17 much at this point will go far from the comfort zone and increase
18 anxiety. Playing in a manner that is not challenging the client’s
19 music making will not offer an opportunity to expand or grow.
20 Such non-challenging and supportive playing is appropriate in an
21 early stage of therapy where rapport building takes predominance.
22 Once a trusting therapeutic relationship is established, then the
23 client associates a “safe” emotion with the therapist and is more
24 likely to take risks in the challenges of the middle stage of therapy.
25 The perceptive therapist gauges his or her interventions based
26 on feedback from the client. Are there physical affective cues—
27 facial expressions, physical tensions—that convey a sense of anx-
28 iety? Is the client’s music changing? Resistance to exploring more
29 expansive rhythms may manifest in louder music that maintains
30 the same rigid beat (on a drum for example) but indicates in-
31 creased tension through more forceful beating. Loudness tends to
32 be an immediate and consistent indicator of emotional tension
33 since sound production on instruments is usually highly sensitive
34S to physical force tht in turn is dependent on muscular tension as-
35R sociated with emotional states.
1st pass
In the immediate moment of the clinical encounter, the 1

ability to perceive the subtle cues of client affect is critical for re- 2
sponding in an effective manner that facilitates emotional move- 3
ment. It is important to determine where the client is regarding 4
the change process. Mahoney (1991) describes an oscillating 5
process between expansion and contraction that cycles through 6
the treatment process over time. A client in a phase of contraction 7
may need more supportive emotional nurturance from the thera- 8
pist, while a client in active expansion may need to be challenged 9
or amplified. In this way, the therapist is following the rhythm of 10
the client over time (in the session and across several sessions). 11
The type and degree of emotional energy provided by the therapist 12
can facilitate the therapeutic process and move the client further 13
into change. 14
When the emotional structure sustaining the core self is re- 15
aligned and transformed, then significant therapeutic change has 16
occurred (Dealy, 1993, personal communication 10-12-08). The 17
empathic therapist must develop a deep and genuine sense of his 18
or her own self in order to transform the client at a “core” emo- 19
tional level. The emotional depth of the therapist—the vitality, 20
the energy, the wellspring of positive affect—sets the range for the 21
potential depth of an existential therapeutic connection. “Only in 22
this ‘central experience’ is human reality, only here is aliveness, 23
only here is the basis for love” (Fromm, 1956, p. 103). Love is a 24
core emotion (Priestly, 1975), and can be a central factor in heal- 25
ing, therapy and well-being (Pellitteri, 1988). Such an essential 26
human connection, like a mother’s attunement, a lover’s presence, 27
or a therapist’s deep empathy can have an impact on the brain’s 28
neurological structure. Lewis, Amini & Lannon (2000) examine 29
the psychobiology of emotions and the brain: “In relationships, 30
one mind revises the another, one heart changes its partner . . . 31
Who we are and who we become depends, in part, on whom we 32
love” (p. 144). 33
34S
35R
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Excerpt Three
1 Chapter 9
2
3
4 Emotional Intelligence
5
6
and Music Therapy
7 John Pellitteri
8
9 Combining the concept of “emotions” with that of “intelligence”
10 narrows the focus of the current work from the general principles of
11 emotional processes and functions to a specific field of emotion-
12 related abilities. The construct of intelligence is well known and
13 is inherently associated with adaptation. People who are consid-
14 ered highly intelligent are considered to have superior abilities,
15 more efficient and effective skills, and greater knowledge (Stern-
16 berg, 1990). Emotional intelligence (EI) therefore, is a subset of the
17 larger field of emotions research and refers to a set of mental abili-
18 ties that involve the use of affective information for adaptive pur-
19 poses. EI involves emotional stimuli, states, expressions, and
20 experiences, and in addition considers how these emotional
21 processes can be utilized for purposeful and productive goals. In
22 this way, EI is naturally aligned with many of the outcome goals for
23 therapy.
24 The term emotional intelligence was first proposed as an or-
25 ganized theory by Peter Salovey and Jack Mayer in 1990. The four
26 main areas of EI abilities include: emotional perception, emotional
27 facilitation of thinking, the use of emotional knowledge, and reg-
28 ulation of emotions (Mayer & Salovey, 1997). Each of these four
29 skill sets can be related to various terms in the clinical literature
30 such as psychosocial adaptation, self-regulation, personal adjust-
31 ment, optimal development, healthy functioning, and well-being.
32 Since emotional processes are part of the coping and resiliency
33 processes that develop through therapy, then intelligence about
34S emotions would of course be a central facet. EI is inherent in many
35R
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Emotional Intelligence and Music Therapy 191
clinical approaches, although it may not be explicitly identified or 1

emphasized. 2
Given the intimate link between music and emotions, the use 3
of music to develop EI appears natural. Learning about emotions 4
requires the experience of emotions as a basis. Music can be used 5
to activate and/or alter emotional states and experiences that in 6
turn can be used to “teach” about emotional processes. The work 7
of the music therapist who chooses to focus on emotional processes 8
will inherently involve EI abilities in one or more ways. 9
This chapter will first outline the Mayer and Salovey (1997) 10
abilities-based model of EI. The second section will discuss how 11
EI abilities relate to clients’ adaptation and clinical goals. Section 12
three presents strategies for music therapists to develop EI abili- 13
ties in their clients. The last section addresses the EI of the music 14
therapist and its importance in effective clinical skills. 15
16
17
The Abilities Model of Emotional Intelligence 18
19
20
Distinctions from related constructs 21
EI has received a good deal of attention in the popular media, 22
which highlights its appeal and applicability but also served to cre- 23
ate distortions about the original construct. EI is a type of intelli- 24
gence that is distinct from the traditional, intellectual type of 25
intelligence commonly measured by standardized IQ tests (i.e., 26
Weschler Adult Intelligence Scales). IQ represents sets of verbal, 27
mathematical, and visual-perceptual abilities that are believed to 28
be necessary for academic success. By contrast, EI (which is also re- 29
ferred to as EQ or emotional quotient) is an intelligence in using 30
emotions and social information. The types of intelligence are 31
distinct but also related. The distinction lays in the information 32
involved (verbal and visual stimuli verses emotional). The 33
overlap is based on the cognitive processing associated with any 34S
35R
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1 intelligence, such as perception, evaluation, representation, and

2 transformation of information.
3 A construct that is closely related to EI is social intelligence.
4 Social intelligence is broader than EI in that it includes social
5 scripts and sociocultural rules and norms. Such information about
6 the social environment and cultural systems is extremely important
7 for adaptive social functioning. Since EI focused exclusively on
8 cognitive-emotional processes, then it is more circumscribed and
9 narrow than the broader construct of social intelligence. Histori-
10 cally, the construct of social intelligence was proposed early in the
11 twentieth century (Thorndike & Stein, 1937), but faced concep-
12 tual difficulties since its precise definition and measurement were
13 elusive. The narrow and specific focus of EI as a set of emotion-
14 related abilities has allowed the construct to be more easily meas-
15 ured and empirically validated (Salovey & Mayer, 1990; Mayer,
16 2006). While intelligence about the social world at large is
17 important, the capacity to perceive, understand, and regulate emo-
18 tions is a central and precluding aspect of the larger adaptation
19 process.
20 EI includes awareness not only of other’s emotions (interper-
21 sonal intelligence) but also of one’s own emotional states (intrap-
22 ersonal intelligence). In this way, it combines the two personal
23 intelligences of Gardner’s (1983) well-known theory of multiple
24 intelligence. The other types of intelligence in Gardner’s model
25 include linguistic, logico-mathematical, and spatial (which com-
26 prise traditional IQ intelligence) as well as musical and body kines-
27 thetic (which are unique types). Musical intelligence can be
28 considered related to innate musical abilities and basic capacities
29 for auditory discrimination and auditory processing. (Such abili-
30 ties, with regard to the clinical music therapy process, would allow
31 a greater degree of complexity in musical processing and expres-
32 sion, however, musical ability should not matter with regard to the
33 therapeutic relationship and clinical outcome).
34S Another important distinction in EI is between its own com-
35R peting theories. Goleman (1995) popularized the term emotional
1st pass
intelligence with a best-selling book that was based on Salovey 1

and Mayer’s 1990 EI theory. His claims about the predictive power 2
of EI as superior to IQ were overstated and premature. Recent re- 3
search, however, has proposed a more balanced understanding of 4
EI with regard to adaptive functioning (Mathews, Zeidner, and 5
Roberts, 2002; Mayer, Salovey & Caruso, 2000a). Goleman’s 6
current conceptualization of EI is considered a “trait-model” in 7
that EI is consider a fixed trait in the individual as opposed to a set 8
of abilities. Goleman’s model and another trait-based EI model 9
proposed by Bar-On (1996) are considered “mixed models” in that 10
they blend aspects of social intelligence and personality theory 11
with EI (Mayer, Salovey & Caruso, 2000b). While broad encom- 12
passing theories have an advantage of greater applicability, they 13
face the limitations and challenges of measurement and concep- 14
tual pitfalls. The mixed models are also limited in their conceptu- 15
alization of EI as traits that aligns them more closely with theories 16
of personality rather than as an actual intelligence. The abilities- 17
based model is much more relevant to clinical work since abilities, 18
unlike traits, are process oriented and are amenable to develop- 19
ment through interventions. 20
21
22
Definitions and components 23
The original definition of EI (Salovey & Mayer, 1990) was ex- 24
panded and revised in 1997. These four branches of EI, percep- 25
tion, facilitation, knowledge, and regulation, organize the range of 26
emotional abilities (see Table 9.1). The revised definition is: 27
28
Emotional intelligence involves the ability to perceive 29
accurately, appraise and express emotion; the ability to 30
access and/or generate feelings when they facilitate 31
thought; the ability to understand emotion and emo- 32
tional knowledge; and the ability to regulate emotions 33
to promote emotional and intellectual growth (Mayer & 34S
Salovey, 1997, p. 10). 35R
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1 Table 9.1 Components of Emotional Intelligence

2 I. Emotional Perception
3 1) Ability to identify emotion in physical states and thoughts
4 2) Ability to identify emotion in other people
5 3) Ability to accurately express emotion
6 4) Ability to discriminate between honest versus dishonest
7 expressions of emotion
8 (II)Emotional Facilitation of Thinking
9 1) Emotions direct attention and prioritize thinking
10 2) Emotions can be generated to aid in judgments
11 3) Emotional mood swings can change perspectives
12 4) Emotional states encourage specific problem-solving
13 approaches
14 (III) Using Emotional Knowledge
15 1) Ability to label emotions
16 2) Ability to interpret the meanings that emotions convey
17 3) Ability to understand complex feelings or blends of
18 feelings
19 4) Ability to recognize transitions of emotions and
20 intensities
21 (IV) Reflective Regulation of Emotions
22 1) Ability to stay open to pleasant and unpleasant feelings
23 2) Ability to engage or disengage from emotions
24 3) Ability to monitor emotions in oneself and others
25 4) Ability to moderate and enhance emotions without
26 repression
27
28 [Note: Roman numerals I–IV indicate the four main branches of
29 the Mayer & Salovey (1997) EI model. Each branch contains four
30 specific and related abilities.]
31
32 Emotional Perception includes the accurate identification of
33 emotions in oneself and in others. In this way EI is akin to self-
34S awareness, although the latter is generally broader to include non-
35R emotional aspects of the self (i.e., value, interests, belief systems,
1st pass
etc.). In their description of the emotional perception component, 1

Mayer and Salovey include the “ability to identify emotions in 2
other people, designs, artwork, etc., through language, sound, ap- 3
pearance, and behavior” (1997, p. 11). The first comprehensive 4
abilities-based EI measure, the Multifactoral Emotional Intelli- 5
gence Scales (MEIS; Mayer, Salovey & Caruso, 1999) included 6
several subtests of emotional perception that taken together com- 7
prised the overall emotional perception score for an individual. 8
These subtests included the identification of emotions in the char- 9
acters of written story scenarios, in visual designs/artwork, and in 10
short musical excerpts. The tasks required respondents to rate the 11
degree of emotion present in the stimuli (story, design, or music). 12
There is an acknowledgment of emotions in art in general and in 13
music in particular. The accuracy with which a person identifies 14
the emotions in music indicates a greater degree perception and a 15
higher overall level of EI. 16
In the clinical setting, music therapists may encounter partic- 17
ular disorders and conditions that are characterized by poor emo- 18
tional perception such as those falling on the spectrum of pervasive 19
developmental disorder, nonverbal learning disabilities, and other 20
conditions with extreme social impairments. Emotional percep- 21
tion appears to stand as a distinct ability across several studies 22
(Mathews, Zeidner & Roberts, 2002; Mayer, Salovey & Caruso, 23
1999). This area of emotional functioning is a foundation for the 24
other three areas of EI abilities. 25
Emotional facilitation of thinking reverses the historical assump- 26
tions about emotions as being disruptive to reasoning. It represents 27
the interaction between emotions and cognitions and considers 28
their reciprocal influence. This includes the ability to use emo- 29
tions to prioritize attention and thinking, such as when a child 30
expresses cues of emotional distress (i.e., cries) so others will im- 31
mediately pay attention. If a client in a therapy group setting 32
exhibits tones of anxiety in his or her voice this may direct the 33
clinician to address this concern before addressing another 34S
group member whose issues may be less emotionally significant. 35R
1st pass
1 Emotional facilitation also includes the capacity to gain access to

2 one’s own emotions such as remembering the feelings associated
3 with a past event in order to extract meaning and/or make judg-
4 ments. Recalling unpleasant emotions from a past experience can
5 be a tool to assist in directing current behaviors and choices.
6 Another aspect of emotional facilitation is to recognize how
7 one’s mood can influence thinking. Alice Isen’s (2000) research
8 indicates how positive mood increases the efficiency of cognitive
9 processes. When participants in her studies were induced into pos-
10 itive moods, they were able to generate a greater number of un-
11 usual and creative connections in word-association tasks. Negative
12 emotions, by contrast, require more resources in cognitive pro-
13 cessing and activate defense mechanism or coping skills in order to
14 reduce and contain the negative mood. Therefore, less attention
15 and thinking capacities are available. This research has implica-
16 tions for educational settings where the positive emotional tone
17 of a classroom will increase the capacities of the student to better
18 learn the academic material. Applications can also be made for
19 the clinical setting where the emotional tone of the psychological
20 field of individual or group therapy sessions will influence the
21 clients’ creativity and personal expressiveness.
22 Emotional knowledge involves the abilities to label emotions, to
23 interpret their meanings, to understand the blends of different
24 emotions, and to understand how emotions transition and change
25 over time (Mayer & Salovey, 1997). While knowledge itself is not
26 an ability, the abilities of this component refer to one’s capacity to
27 form emotion concepts and to use emotional knowledge. In this re-
28 gard, the emotional knowledge component is the most cognitive
29 by nature and most closely dependent on intellectual capacities. A
30 person’s level of cognitive development and capacities to create
31 elaborate mental representations will influence his or her under-
32 standing of emotions. Emotional meanings, for example, include
33 the ideas that sadness comes from a sense of loss, fear from some
34S type of threat, and happiness from the satisfaction of needs. Knowl-
35R edge about the transitions of emotions includes the understand-
1st pass
ing that emotions will likely diminish in their intensity over time. 1
Emotional blends consider how different emotions can be mixed, 2
like surprise and disappointment, or anger and hurt. 3
Research comparing EI to dynamic personality structures rep- 4
resented by ego functions found that emotional knowledge corre- 5
sponded more closely than other EI abilities to adaptive defense 6
mechanisms (Pellitteri, 2002) and to overall ego strength (Pellit- 7
teri, 2003). An accurate base of knowledge about emotions en- 8
ables an individual to function at a more adaptive level that will 9
support social relationships. As cognitive processes are a major psy- 10
chophysiological element in emotions, then cognitive structures 11
(i.e., emotion concepts) will naturally play a role. 12
Emotional regulation is the fourth component of the abilities- 13
based EI model and involves various skills regarding the manage- 14
ment of emotional states in oneself and others. The cluster of skills 15
includes the ability to maintain access to current emotional states 16
(i.e., stay opened to emotions) even if the emotions are unpleas- 17
ant. Such an ability will allow an individual to experience an emo- 18
tional state longer and allow opportunities to practice modulation 19
of the emotional state and intensity. Related to this is the ability 20
to detach from or engage with an emotional state, as when a client 21
needs to shift out of a negative mood or let go of an obsessive idea. 22
Emotional regulation involves reasoning about emotions, but not 23
just as concepts, as in the emotional knowledge component, but as 24
a reflective process in the self to examine if the emotions are clear, 25
reasonable, and how they are embedded in the social situation. 26
Managing emotions builds upon the other EI components in 27
that it requires recognition of the cues of the emotional state (per- 28
ception), examination of one’s thinking and meaning related to 29
the emotion (facilitation and knowledge), and then the use of 30
strategies to increase or decrease the emotional intensity. 31
Emotional regulation also refers to a person’s abilities to influence 32
the moods and emotions of others. Mayer and Salovey (1997) 33
describe this particular skill as the, “ability to manage emotion 34S
in oneself and others by moderating negative emotions and 35R
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1 enhancing pleasant ones, without repressing or exaggerating

2 information they may convey” (p. 11). In this way, decreasing
3 negative (unpleasant) emotional states is not a defensive process
4 like denial or projection, but allows the unpleasant emotion to
5 be under control without loosing the value that its meaning
6 may have.
7
8
9 Emotional Intelligence and Adaptation
10
11 As described in chapter 1, adaptation is a general overarching con-
12 struct that relates to all types of therapy outcomes. Adaptation re-
13 quires creativity, flexibility, and the capacity to take multiple
14 perspectives in order to perceive solutions to problems and reso-
15 lutions to conflicts. The process of adaptation involves accommo-
16 dation in thinking and behavior in order to attain desired goals.
17 The aim of music therapy, as well as other therapeutic approaches,
18 is generally to facilitate change associated with improved client
19 functioning, that is, an improvement in the person-environment
20 fit. Sometimes the clinical intervention is to alter the environ-
21 ment rather than the individual. In clinical music therapy prac-
22 tice, the therapist controls the immediate environment (i.e., the
23 psychological field) of the individual or group therapy sessions.
24 The creative arrangement of the therapeutic environment around
25 the needs and potentials of the individual client allows that per-
26 son to “fit.” Success in the context of the music therapy group is a
27 first step toward generalizing adaptive behaviors in other contexts
28 (i.e., school setting, family, psychiatric ward, work setting, etc.).
29 EI abilities are important in the creative process of fitting a
30 person to a context. Recall the evolutionary theories of emotions
31 that suggest that emotions provide information about the envi-
32 ronment. Accurate perception of emotions is essential then in de-
33 termining the immediate state of the environment by reading the
34S affective cues expressed by others. Emotions are indicators of the
35R degree of match between a person and the environment. For
1st pass
example, a child in a hyperactive state can be disruptive to others 1

in a school setting where the class is trying to study quietly. The 2
degree of negative emotions in others and the level of intensity of 3
emotions can indicate that there is a mismatch between the indi- 4
vidual child and the academic task at hand. The perception of an- 5
noyance in others is feedback that may or may not be perceived 6
and used by the individual child. 7
The ability to perceive emotions in others is necessary in order 8
to derive the affective information from the immediate social 9
environment. The expression of emotions establishes a communi- 10
cation process that allows other to understand our internal states 11
and to respond to our needs. Emotional expression then can lead 12
to the facilitation of thinking and intentional goal-directed be- 13
havior. Understanding how emotions influence thinking and the 14
meanings of emotions (emotional knowledge) enables an individ- 15
ual to accurately interpret others in the environment as well as to 16
understand how one’s own emotional state may impact others. 17
Finally, the regulation of emotions has been identified as a critical 18
ability in many types of adaptation (Gross, 2007). Such regulatory 19
capacities include impulse control and self-restrain persistence to- 20
ward a goal despite frustration or doubt, intentionally accessing 21
and being opened to experiencing emotional states, and modulat- 22
ing emotional intensities (without changing the type of emotion). 23
Progress in therapy may be determined by the extent to which one 24
has learned the cues of specific conditions and matched appropri- 25
ate and effective emotional responses to the environmental chal- 26
lenges at hand. Adaptive responses include not only the type of 27
emotion but also the degree of emotional intensity. The “intelli- 28
gence” of EI refers to the adaptive nature of the construct. 29
Mathews and Zeidner (2000) relate EI to adaptation in stating 30
that “adaptive coping might be conceptualized as emotional 31
intelligence in action, supporting mastery of emotions, emotional 32
growth, and both cognitive and emotional differentiation, allow- 33
ing us to evolve in an ever-changing world” (p. 460). The music 34S
therapist in establishing clinical goals will inevitably involve 35R
1st pass
1 emotional abilities either directly or implicitly. The adaptive

2 process may directly require an EI skill such as recognizing the
3 emotions in others and responding appropriately. In some cases,
4 however, the clinical goal may not be to develop a discrete EI skill,
5 but may require an EI ability to be accomplished such as when a
6 student must stay focused on an academic task and persistence
7 would mean regulating and restraining the impulse to stop.
8
9
10 Using Music to Develop Emotional Intelligence
11
12 There are two main areas where EI and music therapy can be in-
13 tegrated—the clinical process and in educational contexts. In the
14 context of clinical treatment, the music therapist uses opportuni-
15 ties in the sessions to specifically develop EI in clients. In educa-
16 tional contexts that may employ a Social-Emotional Learning
17 (SEL) curriculum, music can be used at an auxiliary or augmenta-
18 tive level to aid in teaching EI skills.
19
20
21
Emotional intelligence in clinical process
22 Since emotional processes are activated, or potentially activated,
23 at any moment in an interpersonal exchange, opportunities to
24 utilize one or more of the four EI abilities are always present. The
25 music therapist taking an EI approach to treatment will look for
26 these opportunities to engage and alter the clients’ abilities.
27 Developing EI may be accomplished through the music alone, but
28 at times will also require verbal interventions in order to make
29 connections and to encode the concepts more formally. Clinicians
30 may use both structured and informal methods to create such win-
31 dows of opportunity for learning and therapeutic change.
32 Pellitteri, Stern & Nahkutina (1999) describe a music
33 therapy program in a special-education setting with elementary
34S school children. Music activities were designed to increase the per-
35R ception and expression of emotion in music. In the game-like for-
1st pass
mat, clients had to recognize an emotion and express it through 1

improvised instrumental music. The other clients in the group had 2
to determine from the musical expression what the player (impro- 3
viser) was feeling. This required coordinated efforts and aesthetic 4
choices for the player and listening and interpretive skills for the 5
listeners. In one case, a boy played the drum in a loud, forceful, 6
and intense manner to which the other clients accurately labeled 7
as “angry.” In the follow-up discussion, the boy revealed that he 8
was feeling “sad.” This discrepancy between emotions was an in- 9
dication of deficits in EI and was an underlying factor in the boy’s 10
social adjustment difficulties and poor peer relations. The discrep- 11
ancy may have been due to difficulty with emotional labeling, dif- 12
ficulties in distinguishing mixed feelings, and/or limitations in 13
translating feelings through musical behaviors. The feedback that 14
the boy received from his peers highlighted this discrepancy and 15
indicated that what he experienced internally was notably dif- 16
ferent than what he expressed outwardly. Feedback is the first step 17
in providing a corrective process that leads to more accurate per- 18
ceptions expressions and knowledge of emotions. 19
The previous example illustrates a structured activity aimed at 20
increasing EI. At a more specific level, the structure of particular 21
songs creates opportunities for experiential learning. The chil- 22
dren’s song “Tinga Layo,” for example, has a natural pause for three 23
beats during the chorus section. During this pause the therapist 24
can choose to have the clients in the group be silent and then con- 25
tinue to play instruments or vocalize at the start of the next meas- 26
ure. This is especially effective for developing emotional 27
regulation. The clients are in an aroused and excited state since 28
the song is upbeat and energetic. Then at the precise moment they 29
must stop and restrain the tendency to play for the few brief sec- 30
onds of the three beats. This instance of self-control requires the 31
regulation of muscular tensions and movements as well as activat- 32
ing cognitive processes of restraint. It is direct and concrete feed- 33
back to the client that he or she can stop. Oftentimes, clients with 34S
dysregulation disorders become even more impaired during states 35R
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1 of arousal. Therefore the practice of stopping at precise moments

2 of arousal counteracts this tendency and builds self-regulatory
3 capacities.
4 Informal methods for developing EI through music therapy
5 come during improvised music. During interactive exchanges be-
6 tween the client and the therapist, the client is responding musi-
7 cally and therefore emotionally to the therapist’s created music.
8 The shifts in musical forms (i.e., slowing tempo, creating compli-
9 mentary melodies, matching alterations in dynamics and intensi-
10 ties) require that the client is perceptive to changes in the music.
11 Perception to musical cues in many ways parallels the perception
12 necessary for emotional cues. Speech prosody, for example, is the
13 musical quality (i.e., melody and rhythm) of the spoken expres-
14 sion that conveys emotion. Loudness, tempo, and dynamics are
15 also musical forms that convey affect through one’s tone of voice.
16 Research studies have indicated a relationship between musical
17 experiences and increased accuracy in reading speech prosody
18 (Thompson, Schellenberg & Husain, 2004).
19 At more advanced stages of the therapeutic process, the ther-
20 apist can create opportunities that move beyond a holding envi-
21 ronment and challenge the client to make adjustments. The
22 therapist can intentionally change his or her music during im-
23 provisation (i.e., increase tempo, introduce more complex or syn-
24 copated rhythms, change loudness, play variations of the melody).
25 The client must respond flexibly and adaptively in order to main-
26 tain the balance of synchrony and musical integrity. When a client
27 tries to “match” his or her music to the therapist it requires coor-
28 dinated, flexible, and self-regulated behaviors. Musical improvisa-
29 tion at the interpersonal level allows for the experience of
30 interpersonal exchanges that by nature involve emotional dimen-
31 sions. This is similar to a mother adjusting to an infant’s expres-
32 sions in the process of attunement (see chapter 6). Only in the
33 case of such advanced interventions, it is the client that is meet-
34S ing the demands of the therapist in the interpersonal situation.
35R Responding musically and emotionally to the therapist’s music is
1st pass
an indication of client maturity and personality development as 1

well as adaptive use of EI skills. 2
In therapy with high-functioning clients who have the cogni- 3
tive capacities for self-reflection and insight and the verbal capac- 4
ities for expression, music therapy can lead to more complex levels 5
of EI development. In moving beyond a pure music approach to in- 6
corporate verbal-cognitive methods, the clinician can impact a 7
broader range of psychological functions, including EI skills. 8
Verbal discussion of improvised music and/or responses to music 9
listening can generate a range of associations (i.e., images, 10
thoughts, memories, sensations) as in Analytic Music Therapy 11
(Priestly, 1975). Such associations are an illustration of the EI abil- 12
ity of emotional facilitation of thinking. Emotional dimensions of 13
the music can evoke a range of aesthetic and cognitive responses. 14
Discussion of such responses can lead to greater awareness of the 15
emotional-cognitive connections within the person. In a similar 16
way, the discussion phase of Guided Imagery & Music sessions can 17
lead to insight and greater emotional knowledge. The client can 18
become aware of the deeper meanings and emotions that are con- 19
tained in the images. In most cases, any degree of awareness 20
through musical-verbal methods will likely create potential to im- 21
prove client adaptation. Contained under the larger umbrella of 22
self-awareness are the EI abilities of emotional perception, facili- 23
tation, knowledge, and regulation. 24
25
26
Music in social-emotional learning curricula 27
SEL programs are important in schools and can be a means of im- 28
proving academic achievement (Zins, Weissberg, Wang & Wal- 29
berg, 2004). Emotions influence cognitive organization and 30
engagement in learning activities. In educational settings at the 31
auxiliary and augmentative levels of practice, music may be used 32
to enhance didactic goals (Bruscia, 1998). Music and other cre- 33
ative arts can be a means of teaching and developing EI skills 34S
whether through a formal SEL curriculum or as incorporated into 35R
1st pass
1 an existing academic curriculum (Brackett, Kremenitzer, Maurer,

2 Carpenter, Rivers & Katulak, 2007). In music education for ex-
3 ample, therapeutic interventions can be applied to address EI de-
4 velopment (Pellitteri, 2006). When music is used as part of an SEL
5 curriculum, it becomes secondary to the primary goal of teaching
6 social and emotional skills. The major intervention is psychoedu-
7 cational and may serve the purposes of prevention for clients fac-
8 ing at-risk conditions.
9 Music therapy, as used in this role, can employ many of the
10 same techniques as in more clinical roles. Music can be used as a
11 stimulus to induce emotions that become the point of discussion
12 about emotions. In examining the emotional qualities in a
13 recorded piece of music or a student’s emotional and aesthetic re-
14 sponses to music, participants are learning about emotional per-
15 ception. Such a discussion about music may take place in a music
16 education or general classroom context. Labeling emotions, using
17 the terms from the Hevner Mood Wheel for example, not only in-
18 creases emotional perception, but builds more complex emotion
19 concepts by associating the qualities of the music (i.e., dynamic
20 forms and vitality affects, see chapter 8) with the emotional
21 label. Richer emotion concepts form a basis for greater emotional
22 knowledge.
23 Emotional vocabulary is important for emotional knowledge,
24 facilitation, and expression. This can be illustrated from a clinical
25 example in the school-based project reported by Pellitteri, Stern &
26 Nahkutina (1999). The emotional vocabulary exhibited by the
27 inner-city special education fourth grade students was limited to
28 “happy,” “mad,” and “sad.” The verbal limitations led to concep-
29 tual and behavioral limits in social situations. Students could not
30 label other emotions such as embarrassed, disappointed, or frus-
31 trated, and likewise only reacted with angry or sad responses to un-
32 pleasant situations. The psychoeducational goal of increasing
33 emotional vocabulary and emotional knowledge can be aided by
34S musical examples. In combination with the aesthetic approach to
35R
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emotion representation (see chapter 8) and aesthetic education in 1

general (Greene, 2001), music therapy methods can form the ex- 2
periential basis for such emotional learning goals (Pellitteri, 2008). 3
Emotional vocabulary has also been incorporated into emerging 4
assessment methods of EI in children (Pellitteri & Stern, 2003). 5
A recent school-based emotional literacy curriculum that has 6
received empirical support has been developed by Bracket and col- 7
leagues (2007). The basic EI concepts are organized around the 8
acronym of RULER (Recognition, Understanding, Labeling, Ex- 9
pressing, and Regulating emotions). After teaching the concepts, 10
artistic activities, including music, are used to enhance the con- 11
cept. The multimodal experiences of using arts increase the num- 12
ber of stimulated neurosensory channels. In the brain this results 13
in a greater number of associations and more stable, encoded rep- 14
resentations of the emotional concept. 15
At a basic level, EI curriculum goals and clinical treatment 16
goals aim to develop adaptive coping mechanisms that can be ap- 17
plied in various contexts. While recognizing and labeling emotions 18
in oneself and others is a basic skill, larger attitudes and personal- 19
ity traits can also develop from and EI-focused approach. Opti- 20
mism, for example, can lead one to generate positive and hopeful 21
emotions in difficult situations. Looking on bright side rather than 22
be excessively negative keeps a greater range of possibilities open, 23
maintains persistence at tasks, and may lead to the discovery of so- 24
lutions that would have otherwise been missed. Optimism is also 25
counter indicative of depression and other mood disorders. Positive 26
affect provides a buffer for the stress of unpleasant affect. There 27
are times, however, when a more negative or serious emotional re- 28
sponse is required to reach a desired effect. An EI person can make 29
these distinctions and learn to respond with the “best” emotion at 30
the optimal level of intensity in a given situation. Many of the EI 31
skills that are desirable goals for clients are also abilities that need 32
to be developed in therapists as will be described in the next 33
section. 34S
35R
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1 Emotional Intelligence and the Music Therapist

2
3 If a clinician approaches treatment with an EI framework and aims
4 to increase EI abilities in clients, then ideally he or she should have
5 developed a notable degree of EI. The process of self-awareness
6 should be a central facet in any professional clinical training pro-
7 gram for this reason. Recognition of countertransference as well
8 as unconscious bias is essential for therapists to deliver effective
9 treatment. The ability to regulate the emotional tone of the ther-
10 apy environment as well as the emotional intensities of the client
11 is a hallmark of a skilled clinician. Many interpersonally based ap-
12 proaches to treatment rest upon humanistic foundations that are
13 naturally aligned with the tenets of EI (Pellitteri, Stern, Shelton
14 & Ackerman, 2006).
15 A clinician’s use of the four EI abilities during treatment can
16 lead to better clinical judgment and technique. At a basic level,
17 emotional perception is the essential nature of empathy, which is
18 a core condition in humanistic approaches (Rogers, 1961). The
19 music therapist, of course, must recognize what the client is feel-
20 ing in order to adjust the musical stimuli and clinical intervention
21 at the immediate moment. As mentioned previously, emotional
22 facilitation is necessary to prioritize the significance of emotional
23 stimuli, which determines who and what the therapist responds to
24 at any decision point in the session. It is one thing to recognize
25 and label the clients feelings, however a more advanced level of
26 skill requires that the therapist determine the client’s readiness to
27 be challenged and the degree of challenge or whether the client
28 needs a more nurturing, nondemanding, holding environment.
29 This determination can be made by considering the cues of anxi-
30 ety and any subtle changes in those indicators on a moment-to-
31 moment basis during the flow of the therapy session.
32 It is a novice therapist who rushes in to fix a problem before
33 fully understanding the nature and extent of the clinical condi-
34S tion. Such premature actions likely stem from the therapist’s own
35R anxiety about being effective and being a “good” therapist. These
1st pass
mistakes may be typical as a new therapist is at an early stage of de- 1

veloping self-efficacy as a clinician. The awareness and contain- 2
ment of one’s own anxiety in a clinical moment requires the EI 3
skills of self-perception and regulation, respectively. 4
It is built into human nature through evolution and reinforced 5
at times through socialization to direct more attention to negative 6
stimuli in the environment. This obviously had survival value for 7
primitive humans who could respond more rapidly to potential 8
threats. In many clinical and educational settings, however, this 9
tendency may result in focusing excessively on the “problem,” 10
namely, what is wrong, disordered, or disabled. Symptoms and dis- 11
abilities often carry a negative affective tone and therefore draw 12
more attention. The danger in this is that the positive assets and 13
strengths of the client may be overlooked or overshadowed by the 14
problems. The EI ability of emotional facilitation of thinking is 15
important because the clinician, aware that the negative affect 16
may bias thinking, will not limit the attention to problems or dis- 17
orders, but will seek to attend to the healthy and positive aspects 18
of the client that are resources for treatment. 19
Another common mistake for beginning therapists includes 20
the layperson’s assumption that therapy is just about “getting your 21
feelings out.” Again, the assessment of the client’s readiness to ex- 22
press emotions is important. The therapist must also consider the 23
client’s personality structures, particularly ego strength, which in- 24
clude the capacity to tolerate and to integrate intense emotional 25
states. Expressing highly aggressive or painful emotions may lead 26
the client to decompensate, become overly defensive, and/or to 27
disengage from the therapeutic connection as the emotions them- 28
selves may be perceived as threatening. Such a blanket applica- 29
tion of this simplistic assumption reflects rigidity in the therapist 30
and an inability to think through the purpose of therapy at a deep 31
level. Likewise, there may be a tendency in novice therapists to 32
overuse the technique of reflection and respond immediately to 33
every expressed emotion. Reflection and any type of attention to 34S
a client’s emotional expression will likely amplify that emotional 35R
1st pass
1 state. Seasoned therapists will carefully choose what emotions to

2 respond to and when to magnify such states. It is necessary to have
3 a clear intention behind a clinical technique, and the therapist
4 should ask him- or herself, “Will increasing the intensity of a
5 client’s emotion be therapeutic at this time?” Such clinical deci-
6 sions require the coordination of emotional knowledge about the
7 possible meanings of a client’s affective states with knowledge
8 about personality and stage of clinical process. The therapist
9 should also consider how the client’s emotions and cognition will
10 reciprocally affect each other.
11 It is important for therapists to be aware of how his or her emo-
12 tions can influence thinking with regard to their own assumptions
13 and clinical judgment. Garb (1998) identifies the confirmatory
14 hypothesis bias in clinical diagnoses. This is the tendency to make
15 an assumption about a disorder early on in the assessment process
16 before a sufficient amount of information has been attained. The
17 clinician is then biased for the rest of the assessment procedures to
18 seek out information that confirms the initial and premature hy-
19 pothesis and to ignore or minimize information that disconfirms
20 it. While this bias is in cognitive information processing it has an
21 emotional basis, namely, the therapist’s anxiety about bringing clo-
22 sure to whatever questions he or she is asking in the assessment. In
23 other words, a therapist may want to know something about the
24 client and as soon as some information is presented that may re-
25 solve this disequilibrium (i.e., the feelings of uncertainty underly-
26 ing the question) the therapist comes to a hypothesis. The EI
27 ability of emotional regulation, however, allows the clinician to
28 “stay opened” to the uncertainty and be calm during a state of dis-
29 equilibrium. Staying opened allows one to consider multiple pos-
30 sibilities and perspectives and to at least gather more complete
31 information before coming to a conclusion about what exactly is
32 the client’s issue or problem.
33 Emotional regulation is relevant in allowing one to disengage
34S from an emotion. This is important in clinical process when one
35R must let go of one possibility for the sake of another. (For example,
1st pass
in a group session you cannot allow each person an instrumental 1

solo if you are also working on a song that involves everyone 2
singing together). Both options may have clinical value and there- 3
fore be desirable, however, it is important to detach from one path- 4
way in order to follow another. Disengaging from emotions is 5
highly relevant with regard to the therapist’s own emotional states. 6
Stress, tensions, or negative emotions from our personal lives have 7
no place in the clinical space of the therapeutic encounter. Ther- 8
apists must be able to regulate their own moods in order to be fully 9
present and mindful with clients. Addressing countertransference 10
may require disengaging from a feeling and/or containing it so it 11
does not interfere with the emotional availability for the client. 12
The same, but reciprocal, skill of openness to emotions is nec- 13
essary for engagement with clients. The therapist must be willing 14
and prepared to empathize with negative and unpleasant emotions 15
in clients. If a client senses that the therapist is uncomfortable with 16
negative or intense emotions, then he or she may be reluctant to 17
share deep feelings in the future. A nonverbal message has been 18
communicated—that it is not safe or okay to feel this way in the 19
session. Therapy often involves alterations in emotional processes 20
and the therapist, working at such a deep level, must be fully will- 21
ing to respond and engage with the client’s emotions. This is not 22
meant to imply that every emotion must be addressed as it emerges. 23
If a client, in a transference reaction, expresses intense anger at 24
the therapist, it may or may not be effective to reflect and amplify 25
this emotional state. The therapist must consider the strength of 26
the therapeutic relationship, and whether it can tolerate such in- 27
tense interpersonal conflicts; the client’s capacity to modulate and 28
tolerate such emotions; and the meaning of the emotion in the 29
context of the clinical process. An effective intervention, in cases 30
of intense negative emotions, may be to modulate the emotion to 31
a more manageable level where the client can still be opened to it 32
(in order to work through it), but also have the cognitive, verbal, 33
or musical capacities to integrate the emotion. 34S
35R
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1
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Index
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READING 27
From Tacit Knowledge to Narrative Redescription

Through Music Psychotherapy:
A Perspective from Second-Generation Cognitive Science
Gabriella Giordanella Perilli and Roberto Cicinelli
Abstract
The framework of second-generation cognitive science includes interdisciplinary
contributions describing how human beings develop and function from a
neurophysiologic and psychological perspective. This complex system of knowledge on
the individual forms the basis of an integrated psychotherapeutic approach that has the
aim of responding effectively and flexibly to the various human processes, needs, and
resources. The present approach includes experiences with imagery and music to
facilitate the metaphorical representation of tacit or analog knowledge. Once
represented at a conscious level, the analog content can be treated with logical-
analytical and verbal methods to edit those forms of automated or nonrational thoughts
that retain painful memories and suffering and/or hold back the patients from their
potential growth.
Second-Generation Cognitive Science

Within the past 20 years, a new (second) generation of cognitive scientists has
recognized that human motivation and the activation of behavior are inextricably linked
and that each informs and explains the other. This position, also called bio-behavioral or
second-generation cognitive science, has found eloquent and forceful advocacy in the
works of psychologists John Donahoe and David Palmer, philosopher Mark Johnson,
linguist George Lakoff, neuropsychologist Antonio Damasio, and immunologist Gerald
Edelman. Their general position is that language, behavior, and value depend upon and
influence sensorimotor or bodily processes and that both motivational and activational
processes are based on neural patterns—all of which are susceptible to the effects of
reinforcement (Donahoe & Palmer, 1994).
Second-generation cognitive science includes various interdisciplinary
contributions that describe how human beings develop and function. This complex
system of knowledge forms the basis of the integrative process of music psychotherapy
proposed here to respond effectively and flexibly to various levels of development and
functionality. In this approach, music is used to facilitate imagery and the metaphorical
representation of tacit knowledge in the form of analog. Once represented at a conscious
level, the analogical tacit knowledge can be compared with what is already in
consciousness, and possible discrepancies can be identified. Then logical-analytical
thinking is employed to edit those forms of automated or nonfunctional thoughts that
retain painful memories and suffering and/or hold back the patient from their potential
growth.
The proposed psychotherapeutic approach attempts to take into account the
belief that human beings are complex systems and that their development and
functionality depends upon the integration of neurophysiological and psychological
processes, tacit and explicit levels of consciousness, and nonverbal and verbal codes of
meaning. This paper is concerned with how the proposed approach to music
psychotherapy integrates these neurophysiological and psychological processes with the
specific aim of exploring various levels of consciousness and ultimately developing a
level of self-awareness that is inherent in quality of life.
An Integral Approach to Psychotherapy
The European Association for Integrative Psychotherapy (EAIP) (2011) emphasizes that
for psychotherapy to be considered “integrated,” first of all it must take a holistic
approach to the client that includes intellectual, spiritual, emotional, behavioral,
physiological, and interpersonal areas of functioning, and therein recognize the inherent
complexity of human beings. Second, the methodology must include a coherent
combination of at least two orientations to theory and/or practice. According to EAIP,
there is not only one form of therapy that may be the best or appropriate for each
situation. Thus, psychotherapy must be flexible enough to work out problems with
different but consistent strategies, techniques, and theoretical constructs that have
proven to be effective.
The uniqueness of the proposed approach is that it is integrative in three ways: It
integrates neurophysiological and psychological aspects of the person, tacit and explicit
modes of consciousness, and nonverbal and verbal codes for meaning.
The integrated cognitive approach proposed here looks beyond the boundaries of
different psychotherapeutic orientations and seeks to identify common and shared
elements for an approach that is consistently responsive to the needs of the individual.
Among these common elements are using both analog and verbal modes for encoding
tacit and explicit knowledge, building an effective therapeutic relationship, and
providing an environment that fosters the growth and the health of the client, while also
taking into account the client’s characteristics, values, beliefs, and needs.
For the above reasons, the present approach addresses the complexity of human
beings by integrating theory and research based on second-generation cognitive science
and by utilizing different methods of psychotherapy, such as cognitive psychotherapy
(Beck, 1976; Ellis, 1962; Guidano, 1987, 1991; Lazarus, 1991; Liotti, 2007) and music
therapy, that is, Guided Imagery and Music (Bruscia, 2002).
It is in this same vein that the integrated cognitive approach refers to a
psychology of health based on autonomy, freedom, development of human
potentialities, and self-fulfillment, all of which involve the self-reflection needed to be
continually aware of one’s own characteristics and resources.
A common and general goal in psychotherapy is to help the person make those
changes that will lead to a state of well-being. The approach presented here aims to
achieve this goal by reducing the discrepancy between tacit and explicit knowledge.
Bringing tacit content into awareness enables a person to identify and change ego
dystonic issues and to construct (or reconstruct) self-narratives that are consistent with
one’s values and life goals. The present approach proposes the use of Guided Imagery
and Music (GIM) as the preferred method for exploring tacit knowledge and bringing it
into awareness.
Guided Imagery and Music (GIM)
2
GIM is a form of music psychotherapy that integrates nonverbal and verbal modalities
as a means of self-exploration. It is unique in that it engages the client in an exploration
of different levels of consciousness while listening to specially designed classical music
programs in a deeply relaxed state, all while dialoguing with the therapist. The typical
GIM session unfolds in five phases: In the “Preliminary Conversation” phase, the
therapist and client discuss the client’s current life situation or particular issues that the
client would like to explore in the session. Sometimes, the client may draw mandalas to
help identify an issue for exploration. Both client and therapist set goals for the session.
The therapist decides during this period how to proceed with the induction and selects a
music program suitable for pursuing the session goal. In the “Induction” phase, the
therapist helps the client to enter an altered state of consciousness, using various
relaxation procedures. The therapist also helps to focus the client’s attention on either
the music listening experience or a specific starting image. In the “Music Imaging”
phase, the client images freely and spontaneously to a classical music program
specifically designed for GIM and reports these inner experiences regularly to the
therapist. The images may be sensations, emotions, memories, and so forth. The
therapist follows the client’s unfolding experiences and assists with nondirective verbal
or nonverbal interventions intended to further develop or deepen the client’s music
imagery experience. The therapist makes a transcript of the dialogue. The “Return”
phase begins with the close of the music program. At this time, the therapist helps the
client to finish the imagery experience and then assists the client to return to an alert
state and an upright position. Finally, in the “Postlude” phase, the therapist and client
reflect upon the music imagery experience, often by reviewing the transcript. The main
goal is to gain insight into the client’s life and to help the client to understand what
implications the experience might have. Ultimately, the GIM sessions are intended to
help the client create a narrative that redescribes the client and the client’s world in a
way that facilitates development and change and enables the client to better cope with
life.
Several theoretical orientations have been applied to the practice of GIM,
including humanistic, psychodynamic, Gestalt, and spiritual. The purpose of the present
theory is to better understand the GIM process from a second-generation, cognitive
science point of view. A cognitive approach is particularly relevant because GIM offers
myriad opportunities for working effectively with different populations and problems.
The advantage of GIM over traditional verbal psychotherapy is that it is an integrative
approach to cognitive therapy. It integrates neuropsychological and psychological
processes and functions, different levels of consciousness, and nonverbal and verbal
forms of self-exploration and communication. This makes GIM especially helpful in
dealing with cognitive-behavioral problems that affect the quality of the spiritual, social,
and personal life of the individual. Such problems include: irrational ways of verbal
thinking (e.g., generalizations, absolute thoughts, inappropriate expectations of self and
others, perceptual distortions), rigidly ruled behavior (being compelled to think, feel,
and behave according to rules instead of being open to all appropriate alternatives,
options available), and similarly limited ways of coping with life.
Overview of the Present Approach

Several elements are essential to the present approach to GIM and are particularly
relevant to second-generation cognitive science.
3
1) The various stages of the session are intentionally designed to help the client
explore various levels of consciousness. In cognitive science terms, deeply relaxed states
are used to explore “primary” consciousness, and alert states are used to reflect upon the
material unearthed from primary consciousness and thereby bring the material into
“secondary consciousness.”
2) Music and imagery are used to access tacit knowledge (primary consciousness)
and thereby promote a metaphorical process.
3) The metaphorical process is used to bridge primary and secondary
consciousness, and tacit and explicit knowledge.
4) Music, imagery, and the metaphorical process are also used to help the client
develop alternative and preferred ways for experiencing, understanding, and coping
with life issues.
5) Music, imagery, and the metaphorical process are used at the tacit level to create
different narratives and descriptions of the self and outside world.
6) Language is used to integrate primary and secondary levels of consciousness and
thereby reflect upon and gain insight into one’s tacit knowledge and automatic ways of
being that maintain dysfunction and suffering.
7) Language is used to evaluate the coherence and viability of the various narratives
developed at the tacit level and to decide which alternatives are preferable.
8) Language is used to reflect upon one’s values and goals in light of the preferred
alternative narrative.
9) Narratives are used to redescribe or reconstruct the self in a coherent, integrative
way, thereby leading to appropriate changes in emotions, thoughts, and behavior.
Overview of the Paper

We will begin our discussion by examining different levels of consciousness. This will be
followed by an outline of the Dual-Coding Theory, to illustrate the two codes, analogical
and analytical, that humans use for tacit and explicit levels of consciousness. The two
ways of coding are important to understand how music and verbal experiences are
stored in individual memory and the reason why it is necessary to implement the GIM
method to evoke nonverbal memories at a tacit level of consciousness. Next will come a
description of the relationship between music and verbal language, both used by
humans to communicate meanings at different levels of consciousness and with
different purposes. We will provide research data on the neurophysiologic responses to
listening to music, and we will examine links in the brain processing of music and
emotion. Emotions provide the first organized system for understanding and developing
the self, whereas music seems to be a medium that uniquely taps into our emotions,
while also allowing the imaginative process to transfer content from a nonconscious
level to a level of awareness. Then, we will introduce the basic role of imagery in human
experiences. Afterward, we will describe how self-awareness develops through
metaphorical processes, that is, through the transfer between nonverbal and verbal
modalities and between tacit and higher-order levels of consciousness. This will be
followed by an examination of how the individual redescribes him- or herself within a
new narrative. We conclude with a summary of the therapeutic process that involves
verbal-logical reflections on the values that motivate and sustain behavior.
Preliminary Thoughts on Consciousness
4
According to the findings of neuroscience, two levels of consciousness can be identified:
primary consciousness and secondary consciousness. Primary (or core) consciousness is
stored and coded in nonverbal analogs and constitutes the most of what in cognitive
science is called tacit knowledge. Secondary (or extended) consciousness is stored and
coded verbally and constitutes the most of what in cognitive science is called explicit
knowledge. For Damasio (Marmion, 2011), the first sign of primary tacit consciousness
is organismic arousal. Subsequently, as the neocortex develops, emotional and thinking
areas of the brain are connected. Through these associations, complex or extended
consciousness evolves and awareness increases. Secondary consciousness, equipped
with reasoning skills and language, has the ability to extend memories of past events as
well as to plan for the future. This level of consciousness also sensitizes us to
sociocultural demands and helps us to learn how to regulate ourselves accordingly. This
in turn helps us to develop a new higher level of self-organization (Marmion, 2011).
Cognitive therapies are very concerned with the integration of these primary and
secondary levels of consciousness and with discrepancies in the content of tacit and
explicit knowledge. In fact, a challenge in cognitive therapy is to find ways of dealing
with those unaware cognitive processes or tacit aspects (sensory and preverbal
modalities) of human knowledge that direct and guide the conscious processes without
appearing in them. Lazarus (1991) stressed the importance of finding effective ways to
explore what lies beneath the surface, as this material relates to this awareness and how
it affects the entire emotional process.
It is the authors’ opinion that to better understand the relevance of the above
issue in order to achieve a permanent modification in human sufferance and
maladaptive modalities of coping with life, the therapist can use information from
neuroscience studies. Some studies show that memory is based on the reactivation of
certain brain circuitry with new links between neurons in different brain areas. By
consequence, the repetition of a physical or mental action is similar but not the same as
a previous action, that is, it is a reconstruction of the previous action (Edelman, 2006).
By focusing attention on their own experiential, metaphorical, and emotional content,
humans can develop new synaptic links between the neocortex, amygdala, and other
subcortical brain areas (Bailey, Kandel, & Si, 2004). To obtain therapeutic modification,
strengthening or weakening of already functioning synaptic circuits can happen through
new experiences. Neuroscientists notice that the weakening of synaptic circuits involved
in coding memories goes together with the contemporary disappearance of behaviors
controlled by the same memories (Bailey & Kandel, 1993). What is relevant for our
proposal is that only when long-term memory is evoked and reactivated by emotional
experience—as it happens in the GIM process—is it possible to modify synaptic linkages
and states (Alberini, 2005).
To broaden information on tacit knowledge, we can add that even in everyday
life, human beings manage a large quantity and variety of knowledge that is not directly
represented in consciousness but that nevertheless can exert considerable influence over
all aspects of their behavior and experience. As we will see later, tacit knowledge can
include both verbal and nonverbal information that can belong to the primary and
secondary stages of consciousness development. It is therefore essential in therapy to
help individuals become more aware of how they construct and evaluate themselves and
their worlds, and especially to bring to the surface what they store at the tacit level, since
until that content remains out of their awareness, people cannot manage it properly. To
achieve this goal, the therapist must find a way of focusing the client’s selective attention
on those important areas or aspects of his/her tacit knowledge and thereby develop a
kind of explicit representation of them, i.e., imaginative. We have found that music,
5
imagery, and the metaphorical process not only focus the clients on their tacit
knowledge, but also help them to identify those aspects and areas that require
therapeutic attention. Going through those processes, the individuals can gradually
approach the explicit meanings of their rules, beliefs, and values, tacitly known, and can
experience the concomitant emotions in a timely way. Going further, as the individual
imbues meaning into what is tacit, there is an opportunity to reconsider it, acquire
different meanings, and then rewrite them in a way more suitable to one’s lifestyle.
Upon modification of cognitive discrepancies, the individual can incorporate the new
meanings and narratives in a redescription in his own self-representation (Cicinelli,
2008). The above steps will be described in detail later when we discuss the
psychotherapeutic process.
From the foregoing, it can be understood that mere awareness of material stored
in the tacit knowledge is not sufficient to change situations of suffering or to impart
adaptive skills needed to deal with difficult situations in life. The process of therapy
must involve the client in consciously exploring and evaluating tacit content that has
emerged, using both nonverbal and verbal modalities.
Dual-Coding Theory
To understand the fundamental role of music in tacit knowledge and the role of verbal
language in explicit knowledge, we use the approach based on the Dual-Coding Theory
by Paivio, begun in 1971 and tested extensively today. The theory proposes that
information gathered from the sensory system can be represented in two symbolic ways,
one verbal and the other one nonverbal. After processing, sensory information is stored
in separate specialized systems. (1) Verbal information is maintained in analytical form,
in a system where human beings use abstract sequential and focused reasoning. This is
the world of words. (2) Nonverbal information is stored in analog/perceptual form,
using a synthetic method, and the Gestalt, where holistic concepts prevail. In general,
this is the world of images, sounds, sensations, and emotions (Paivio, 1971, 1986, 1991).
The units, called images, that make up the nonverbal symbolic system contain
the information needed to generate all kinds of imagery, including not only visual
images, but also internal imaginative, emotional, sensory-perceptive, motoric
representations. The various kinds of images occur together and coalesce to form
different patterns, combinations, and relationships; thus, when one kind of image is
accessed, the others are accessed as well or are at least made available for access.
The units, called logogens, relate verbal information and are organized
sequentially. They follow rules of logic and order and are concerned with reflexive
thought, interpretation, and meaning-making.
The two symbolic systems communicate with each other vis-à-vis experiences
that activate different areas of the brain. According to Damasio (2010), although analog
and propositional representations (i.e., nonverbal and verbal symbols) are separately
and differently stored in the brain (Paivio, 1971), our everyday experiences create
different brain maps or representations that intersect and form multidirectional
connections between these areas of the brain.
While these notions are widely accepted, we are proposing here that images,
which are important to the therapy process, can be evoked by and in music, and that it is
possible to verbally analyze and interpret the meaning and significance of these images.
This use of music and imagery in psychotherapy is important because the images that
emerge reflect internal working models that we use most in life. Thus images are
metaphoric representations of our internal working models. Internal working models
6
are structures of memory, with emotional valence, which involve learned expectations of
how others may react to one’s own demands, e.g., for help and comfort. These models
or patterns are reactivated in the management of interpersonal relationships and in
therapy, and contribute to the formation of the self (Liotti, 2007).
To summarize, images are evoked through musical experience. They are sensory
representations of the imagination, and as such are removed from formal logical
analysis and verbal processes. Thus, imagery is conditioned by primary processing,
which is more global, nonspecific, and even stereotypic, and certainly less self-reflexive
than secondary processing. It is also important to add that images are unique to each
person and, as such, express the person’s mental constructs in metaphorical ways.
The two processing systems, analytical-verbal and nonverbal-analog, are in a
close, ongoing, and dynamic relationship that allows the exchange and integration of
collected data. For example, configurations that were initially analytic may have, over
time, become analog, such as the verbal instructions given to us on how to learn to drive
a car. Similarly, analog configurations of a memory can be retrieved and brought to
analytical attention—for example, using musical stimuli. In other words, music allows
tacit content, stored in long-term memory as images, to become accessible to
consciousness.
Based on the theory of Dual Coding, herein lies the therapeutic value of
imaginative reenactment through music. Therapy proceeds by evoking imaginative
metaphors of implicit knowledge not directly accessible by verbal language. Only by
taking these images to a conscious level can individuals reach a state of analytical
processing wherein they can evaluate their thoughts, emotions, and behaviors and then
modify them through verbal cognitive restructuring. By exploring both primary and
secondary levels of consciousness and restructuring tacit and explicit knowledge,
humans give a new, coherent meaning to their own experience and to themselves.
Music and Language: Two Ways to Communicate Meaning

Johnson (2007) proposes that the mind is “embodied,” and that thought emerges as the
result of physical phenomena in a complex system. While the right hemisphere of the
brain collects information, the left hemisphere is responsible for organizing it
consistently and verbally with the subjective world of meanings. To create meanings,
human beings use many different forms. These include verbal language and music.
Music and language are two forms of communication. Given that they refer to
different areas of experience, language and music have different functions in human
culture. One of the main functions of language is to provide the means to symbolically
represent objects and relationships. Using these representations, we can direct the
attention of another person to things within the intended context (Tomasello, 1999) and
thereby prevent miscommunication. Language realizes the function of communication
through symbolic units that combine nouns and verbs with other parts of speech and
grammar.
Verbal language is accompanied by gestures, and these gestures can be divided
into iconic and metaphorical (McNeill, 2005). The iconic gesture is based on similarity,
while the metaphorical gesture can represent abstract thoughts and communicate
complex emotional states, especially when there are no adequate words.
In music, the basic formal unit could be called the "sonic analogs," as compared
to metaphors or symbols. These sonic analogs unfold in time and dynamically resemble
the unfolding of emotions and movements of one’s body in space (Zbikowski, 2009).
Whereas analogs resemble what is represented, symbols represent without being
7
similar, and metaphors are structurally similar to what is represented but different in
modality. Thus, while language is essentially symbolic, music is essentially analogical,
and these two forms of communication integrate through metaphor and metaphorical
process.
Different aspects of meaning in music may include: (a) forms of shared meaning
that emerges (e.g., sets of musical sounds that resemble gestures, prosodic components,
sound objects, etc.); (b) meaning that emerges from a particular emotion (e.g., sad,
happy); (c) extramusical associations of meaning (e.g., hymns, memories); and (d)
meaning emerging from musical structures that create tension and resolution (e.g., the
perception of chords progression). Since a sound can be described metaphorically as
“delicate,” “sour,” “warm,” and “clear,” these features can be used to provide experience
with a specific meaning (Koelsch & Siebel, 2005). Studies also report that the syntax or
structure of music is what leads to emotion and meaning in music. Music events that are
structurally irregular or arranged unpredictably can evoke emotional responses such as
“surprise.” Interestingly, an EEG study showed how N400 (the minimum
neurophysiological marker for verifying semantic processing) is evoked both when
participants were presented with verbal sentences followed by semantically unrelated
words and when listening to musical stimuli followed by semantically unrelated words.
So it seems that musical information can affect the semantic processing of words.
Moreover, the N400 marker occurred with words both with and without emotional
content, showing that the meaning in music is not limited to its emotional properties
(Koelsch et al., 2004).
The two representational modes, verbal and nonverbal, have led to the evolution
of two domains, primary and secondary consciousness. The primary level of
consciousness, which is tacit, emotional, sensory, and nonverbal, moves to a higher-
order logical, thoughtful, verbal level of consciousness. The two domains of evolution
use neural processes and functions that are partly distinct and partly interconnected and
integrated. For example, it seems that the brain’s memory circuitry for the production of
speaking and singing are similar and overlapping (ventrolateral premotor cortex,
including Broca’s area and Wernicke’s area; dorsal premotor cortex; the planum
temporal; the inferior parietal lobe; the cerebellum; and the insula anterior subcortical
structures—the basal ganglia and thalamus). When melody or verbal phrase
improvisations are used as stimuli, activation of similar brain areas are clearly seen
through positron emission tomography (Koelsch et al., 2004). Keep in mind that the
speech melody or prosody conveys the emotional aspect of the message by means of
overall pitch level and pitch range, pitch contour, loudness variations, rhythm, and time.
These are features that are found in music. In this vein, musical characteristics may be
the first aspect of language that infants learn. Thus, speech, language, and music are
interrelated because they each rely on the imitation of motor actions, which are then
represented in different ways to code meaning. This ability to imitate motor actions in
speech, language, and music can be explained through the same mirror neuron system
(Fogassi & Ferrari, 2007). Studies and research suggest that we use the body as a
template and that empathy is rooted in the body for which our brains resonate to the
intentional actions and emotions of others (Gallese, 2001) and share meanings.
It may have been that, in co-evolution with language and gestures, the ability of
thought to form perceptual and conceptual metaphors developed (Modell, 2003). In this
way the motor skills to communicate accurately through verbal language is enhanced by
the ability to think metaphorically (Modell, 2003). Through metaphors, humans are
able to understand, move, and transform their emotions and express something for
which they have no corresponding words.
8
Therefore, language conveys propositional, logical meaning, while music
expresses the meaning of experiences based on sensory-motor, emotional, and cognitive
structures, or “imaginative schemas.” The ways that each person uses language and
music for such purposes are directly linked to his/her individual characteristics, stage of
development, and ways of coping with life.
In summary, music and language are forms of communication that convey
metasymbolic and metaphorical representations. Music conveys different emotions and
feelings and language conveys specific thoughts (Levitin, 2006), while both contribute
for meaning-making.
Using Music to Access Tacit Knowledge

Human beings know that music has the power to evoke images, feelings, events, and
situations. It can bring vivid memories of past experiences, describe the present, and
imagine the future. Music is not just an aesthetic art form—it is the individual and
collective expression of humankind, it is present in every age and every culture, it
accompanies all human activities as a manifestation of emotions, as a stimulus for
motor activity, as a great communication tool, and as a means to develop group
membership (Tecumseh Fitch, 2006; Wallin, Merker, & Brown, 2000). Besides its
aesthetic value, music produces calming or stimulating effects in humans and can
induce melancholy or cheerful states. Music carries myriad associations with thoughts,
emotions, events, people, and so forth.
Music evolved as an attempt to depict or represent the world by mimicking the
sounds of plants, animals, and atmospheric events. Throughout history, music, the
organization of sounds over time, has evolved gradually from simple signs and symbols
to metaphorical representations of complex situations and more abstract concepts such
as emotions, love, and death.
Relative to this paper, it is especially important to understand how music fits into the
process of building knowledge. As stated above, music is a powerful stimulus for
triggering associations, memories, emotions, etc., but more important, according to
neuroscience, information and knowledge can be represented and stored through
mental images and/or defined representations or “maps” with sensory characteristics
(Damasio, 2010) such as music. This suggests that music is itself a way of knowing—a
nonverbal analog, which can also be overlaid with verbal content (as in songs, operas,
etc.). For this reason, music is considered an essential component in the method of
psychotherapy proposed here: As a stimulus, it accesses the contents of tacit knowledge;
as an experience, it evokes emotions and invites meaning-making and self-reflection;
and as an art form, that is re-created and re-experienced continuously, it reminds us of
previous narratives of our lives, illuminates present narratives, and breaks the barriers
to forging new narratives of great fulfillment.
Neurophysiological Foundations for Processing Music

The uniqueness of music and its relationship to language can be clearly seen in brain
research, and this research has implications for understanding how music and language
work together to integrate primary and secondary consciousness and tacit and explicit
knowledge. Some aspects of music and language are lateralized, while others seem to
depend on the same brain memory systems. Using the EEG, Levitin (2006) found that
the processing of musical structure, or musical syntax, is located in the frontal lobes of
9
both hemispheres and in the adjacent and partially overlapping areas of those regions
that process language syntax (e.g., Broca’s area). This holds true regardless of the
amount of musical experience one has had. Levitin also found that the brain regions
involved in musical semantics (which related tonal sequence with meaning) seemed to
be placed in the rear portions of the temporal lobe on both hemispheres, near
Wernicke’s area. Based on another study on patients with brain damage, Levitin found
that the music system of the brain seems to function independently from the language
system.
There are several areas of the brain that are activated to process music:
· The cerebral cortex analyzes the volume, height, speed, melody, and rhythm;
· The frontal gyrus is associated with the memory of sounds and words of music heard
or sung;
· The dorsolateral frontal cortex is stimulated when, listening to music, we keep the
song in a working memory, and we have images associated with sounds;
· The motor cortex helps to control body movements when you play an instrument or
simulate the movement of the performer;
· The cerebellum helps to create integrated and continuous rhythmic movements
while listening to music and contributes to the experience of pleasure when listening
to rhythm and being in the “groove.” In fact, the cerebellum synchronizes with the
beat and pleasure can be derived from being able to predict when the next beat will
come, or even when the song changes one’s expectations, surprising the cerebellum
(e.g., with the accelerating or slowing down). It seems that pleasure is derived from
adapting to the need to stay “synchronized” to the rhythmic pattern of the song
(Levitin, 2006);
· The limbic system (the ventral segmental area and nucleus accumbens) responds
emotionally to music by releasing dopamine, a substance related to a type of reward
system. The brain also releases dopamine when experiencing pleasure from food,
sex, and drugs.
· The limbic system responds to small variations in song tempo, and the frontal area
works to interpret the structure and the overall meaning of a song;
· The ventromediana, or prefrontal cortex, responds to emotions and memories
evoked by music. Because of this, brain areas connect cognitive and emotional
experiences with music, thereby seeming to facilitate the recovery of memories
(Eschrich, Altenmuller, & Munte, 2008).
Music listening has various effects on autonomic nervous system activity, as

demonstrated by studies of electrodermal activity and heart rate and studies on the
number and intensity of the sensations of “shivers” and “chills” in response to music
(Blood & Zatorre, 2001; Khalfa, Peretz, Blondin, & Manon, 2002).
Music listening also affects the immune system, as demonstrated by studies that
have examined changes in the concentration of immogluboline A in saliva in responses
to music (Hucklebridge et al., 2000; Kreutz, Bongard, Rohrmann, & Grebe, 2004).
Rhythm can be seen as a structuring principle, in that it synchronizes numerous
activities and functions in a human being. It organizes the temporal aspects of language,
gesture, movement, music, and cognition. Mauro (2005, 2006) suggests that the brain
uses neural codes consisting of patterns based on rhythms and frequencies that
resemble musical structures. Thus some properties of musical stimuli engage neural
mechanisms of the brain by dynamic entrainment. Data from a study on the
entrainment effect on cognitive function (Thaut, Peterson, & McIntosh, 2005) show that
10
external rhythms, such as music temporal structures, can lead to the formation of
internal rhythms in recurrent cortical networks for motor control and cognition
(learning and memory). In fact, the neural plasticity resulting from learning is
dependent on exact temporal coding of neural responses (Thaut et al., 2005). When the
brain is presented with a rhythmic stimulus, e.g., a drumbeat, the rhythm is reproduced
in the brain in the form of electrical impulses. If the rhythm becomes fast and consistent
enough, it can start to resemble the natural internal rhythms of the brain, called brain
waves. Then the brain responds by synchronizing its own electric cycles to the same
rhythm.
Emotions and Music

Based on the above, the relationship between music and emotions in humans is quite
evident. Now it is worthwhile to clarify, for the purposes of this paper, whether emotions
can be evoked by music and, if so, what kind of emotions. Then, we will illustrate
emotions and their role in human development.
A major contribution of neuroscience has been to provide a unified vision of the
human being, where mind and body are interacting and where the mind evolves from
biological embodied functions. Based on these concepts and recent findings in
neuroscience, it becomes easier to understand the type of emotions we feel when we are
doing or imitating movement in response to music. The correlation between music and
movement has been well defined. Affections in music arise largely from their
relationship with physical postures and gestures (Damasio, 2003). A large melodic arch
evokes continuous gestures, while “staccato” sounds evoke discontinuous movements.
Since much of the emotional experience is likely to be concentrated in the cortical
sensory maps (Damasio, 2003), the evocation of gesture by music could have a
considerable influence on the listener’s emotional experience (Bigard, Viellard,
Madurell, Marozeau, & Dacquet, 2005). From this perspective, the affective responses to
music seem to be due, probably, to the simulation mechanism involving mirror neurons
(Molnar-Szakacs & Overy, 2006).
Research reveals two perspectives on the perception and production of emotions
while listening to music. The “emotivists” believe that emotions evoked by music are
qualitatively similar to those emotions that are evoked nonmusically, whereas the
“cognitivists” believe that emotion is an expressive property of the music itself, and that
listeners recognize the emotion as a property of the music but do not directly experience
the emotion (Kivy, 1989).
Research on physiological responses to music had confirmed that the emotions
evoked by music are similar to others induced by different stimuli. The reason is that
emotions evoked by both kinds of stimuli involve the same mechanisms and neural
circuits (Juslin & Vastfjall, 2008), such as changes in heart rate activity and blood
pressure. Moreover, both types of stimuli produce other autonomic body reactions
associated with different emotions. In particular, responses of intense pleasure to music
correlate with activity in different regions of the brain (ventral striatum, amygdala,
orbitofrontal cortex and frontal median ventral prefrontal cortex) involved in the
rewards (food, sex, drugs) and emotions felt with other stimuli (Blood & Zatorre, 2001).
Additional research has shown that music automatically activates the autonomic
nervous system because it calls for a motor response, i.e., a tendency toward action and
a provision to energize the listener. The motor response is then associated with the type
of emotion evoked by a stimulus, e.g., fear at the sight of a wild animal is connected to
flight, while anger regarding an injury, received or perceived, is connected to fight. This
11
is especially important because, in general, negative emotions help the body to get out of
homeostatic balance, while positive ones allow a return to previous levels of homeostasis
(Kim & André, 2008). All living beings are endowed with mechanisms to maintain
homeostatic regulation and thereby help us live life to the fullest. In fact, homeostatic
regulation brings the feeling of well-being that we all actively pursue consciously
(Damasio, 2010). Because emotional responses to music, both positive and negative,
have their basis in fundamental bodily process, we propose that music can be used to
induce the desired emotions for therapeutic purposes.
Kim and André (2008) studied the physiological signals associated with listening
to music. In that study, volunteer participants personally chose songs that they already
knew which could evoke certain emotions in them. Based on the answers provided by
participants, the authors developed a model in two dimensions, grouping the emotions
evoked by listening to music and musical characteristics associated with tempo, pitch,
rhythm, etc. The two dimensions include positive and negative valence and high and low
arousal. Participants in that study reported a number of emotions, including very basic
ones: sadness, pleasure, anger, and joy. The physiological data collected while
participants listened to the song of their choice have shown that the results of skin
conductance and electromyography are linearly correlated with the change in emotional
activity arousal of the autonomic nervous system. The physiological data of
electrocardiogram and respiration gave the clearest evidence of differences in the value
given to the chosen songs (Kim & André, 2008).
In previous studies on emotional responses to music, a distinction has been made
between emotions perceived in the music as belonging to the music and emotions
actually felt and experienced by the listener in response to the music. Dalla Bella and
colleagues (Dalla Bella, Peretz, Rousseau, & Gosselin, 2001) examined the relationship
between the structural components of musical excerpts, the self-description of
experienced pleasure, activation, and several physiological measures (respiration, skin
conductance, heart rate). In general, there was a correspondence between musical
components, perceived emotions, and experienced ones. The data suggest that the
internal structure of music plays a major role in inducing emotions in relation to
extramusical factors (e.g. associations of memories). The researchers concluded that
high activation and positive valence are associated with fast tempo, as also suggested by
other studies on the expression of music. For example, Gomez and Danuser (2007)
found that major mode was associated with positive valence and minor mode with
negative valence, and that physiological responses depended on different structural
characteristics of music. In particular, faster tempos and more pronounced and
“staccato” rhythms were associated with shorter inhalations and exhalations and the
highest level of skin conductance. Faster tempos were also associated with higher heart
rates. This study confirmed that rhythm is a major determinant of some physiological
responses evoked by music. Our bodies work with rhythmic patterns that can be
modified by external rhythms (Gomez & Danuser, 2007), so the tendency for
synchronization of bio-physiological inside oscillators with external auditory rhythms is
another way to explain the emotional effect induced by music, along with others
previously described (e.g., emotional and motor responses).
While studying the quality and quantity of emotional responses to music, one has
to consider listener preferences. Blood and Zatorre (2001) observed that only when
people were listening to their favorite music did they have intense experiences, such as
"chills" and shivers down their spines. The increased intensity of these somatic
responses correlated with the increase in blood flow in brain regions thought to be
involved in reward and emotion (the insula, orbitofrontal cortex, ventral medial cortex,
12
and prefrontal and ventral striatum). Combined with higher intensity of the "chills,"
there was a decrease in blood flow in the amygdala and hippocampus. The study shows
that music can induce "real" emotions, as the activity of core structures of the emotions
being processed were modulated by the music. This finding reinforces the usefulness of
music interventions to evoke emotional content of tacit knowledge and bring it to
conscious level.
Another contribution to understanding how music evokes emotional response is
provided by some scholars who believe that musical structures express and induce
emotions due to an iconic relationship (Juslin & Sloboda, 2001; Juslin & Vastfjall,
2008). This iconic relation is provided by some formal similarity between the shape of
musical structure and events that convey an emotional tone, such as the human voice.
Fast and loud music shares elements with events characterized by high energy and,
then, may suggest emotions with high energy. In fact the speed (tempo) is similar in
music, walking, and talking, so that all of these behavioral-emotional and expressive
modalities require more energy for their implementation. This relationship between
music and action components is called emotional contagion (Juslin & Vastfjall, 2008). It
is a process by which the listener feels an emotion induced by music because he or she
perceives the emotional expression of music and mimics or simulates it internally. This
simulation involves feedback from the muscles and the peripheral autonomic nervous
system, along with a direct activation of emotional representations in the brain, with a
consequent induction of similar emotions in human beings. Recent research suggests
that emotional contagion can occur through the mirror neuron system, as this has a
crucial role in understanding and imitating intentional actions and emotional states of
other people. This system, in fact, is fired up when someone implements, imagines, sees,
or hears an action performed by another human being (Chapin, Jantzen, Scott Kelso,
Steinberg, & Large, 2010).
A confirmation of this brain function was demonstrated in a research study on
emotional and neural responses to musical performance. The researchers first recorded
an expert musician’s performance of Frédéric Chopin Etude in E-Major Op. 10, No. 3 on
a computerized piano (the “expressive” performance); then they synthesized a version of
the same piece using a computer, without the human performance nuances (the
“mechanical” performance). Differences were found between emotional, neural, and
dynamic responses, evoked in the listeners to the music played by the musician
(expressive performance), compared with responses to the mechanical performance. In
this study, Chapin and colleagues (2010) combined the behavioral analysis and the
assessment of emotional responses after listening with the functional magnetic
resonance imaging (fMRI) data taken during the listening experiences. The results
confirmed the hypothesis that the human touch of an expressive performance induces
the activity of neural areas related to emotions and reward system in all listeners, with
greater activation in musicians. The changes in the neural fluctuations were
synchronized to tempo and intensity of expression in the execution of this Chopin
Etude. The areas involved were cortical and subcortical areas related to the perception
of the beat (motor networks) and the brain’s mirror neuron system, which provides a
mechanism through which listeners feel the performer’s emotion, making musical
communication a form of empathy.
The amygdala seems to play an important role in music listening. Two studies are
particularly relevant. Koelsch and colleagues (Koelsch, Fritz, & Schlang, 2008)
examined via fMRI how the amygdala responds to music listening and found that the
amygdala can be activated by irregularities in the musical syntax. Griffith and colleagues
(Griffiths, Warren, Dean, & Howards, 2004) studied fMRI responses to music listening
13
by a patient with a lesion in the left amygdala and the left insula. This patient showed a
selective loss in the experiences of intense pleasure (chills) and autonomic responses
when listening to music that he had experienced before the injury, thus indicating the
role of the amygdala in deriving pleasure from music. This finding helps us to
understand how music is processed automatically by the amygdala system, so the
emotional response to music may initially be direct and not mediated by higher cortical
systems.
An important aspect to consider is the connection between music, emotional,
perceptual, and motor processes. The sensorimotor circuits belong to a network that
enables us to make representations while also providing the resources needed to
maintain the information in working memory and perception. Prinz (1990) explains that
the latter stages of perception overlap with the early stages of action, and thus
perception and action share a common neural code. It is interesting to add that the
perception-action mediation appears to be modulated by emotional processes evoked by
music (Koelsch, 2009). In fact, an fMRI study shows an increase in the blood-oxygen-
level-dependent (BOLD) signal within premotor areas of the participants while listening
to pleasant music and a decrease in the BOLD signal while listening to music considered
unpleasant. The premotor activities, including the mechanisms of mirror neurons while
listening to music, were clearly modulated by the preference value of music, suggesting
that the perception-action mediation is modulated by emotional processes (Koelsch,
2009). It should be added that the components that make up the basic musical forms
(e.g., organized rhythms and frequencies) are structurally similar to brain encoding
mechanisms, which also include temporal patterns and frequencies. For the above
reason, certain properties of musical stimuli engage the neural mechanisms by
entrainment. This phenomenon is common to biological systems, and it is evident in
dynamic interaction between the brain and external auditory and visual rhythms
(Mauro, 2005, 2006; Thaut et al. 2009). Based on this phenomenon, the spontaneous
oscillations of the brain frequencies are forced by external regular or rhythmic stimuli
(Mauro, 2005). Information is transmitted within and between areas of the brain via
frequency-based codes. These codes play a functional role in coordinating the activities
of the brain (Mauro, 2006). For example, Baroque music with a slow tempo (60 bpm)
induces alpha rhythm in the listener and slows heartbeat and breathing (respiration
rates), whereas a piece of music with fast tempos and driving rhythms, such as rock or
heavy metal, can stimulate beta waves and increase heart rate and respiration (Mauro,
2005). Beta waves (15–30 Hz) are associated with mental alertness, and theta waves (4–
7.5 Hz) are associated with sleep. Mauro suggests that the neural language of the brain
is based on principles that are reflected in the basic temporal parameters of musical
rhythm. At the base of the brain's sensitivity to music, then, is this relationship between
the music structure and rhythmic-temporal neural brain function (Mauro, 2006).
The importance of rhythmic-temporal aspects of the relationship between music
and the brain can be gleaned from two studies on the subjective temporal organization
in cognitive and emotional processes. The first study, which used participants with and
without psychiatric disorders, showed that humans have a subjective tempo that they
use internally to organize cognitive and emotional processes and externally to
synchronize, perceive, and/or reproduce rhythmic patterns. These temporal
organizations, unique to each individual, are more or less differentiated and flexible in
correspondence with the absence or presence of mental disorder (Giordanella Perilli,
1995). These organizations may underlie subjective time perceptions and may be
associated with music preferences and readiness for learning new songs. Based on the
previous study, Japanese researchers have conducted research with elderly patients with
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dementia. Functional EEG data showed that these patients were alert to familiar songs
sung or played with the individual’s subjective tempo and that they learned unknown
songs only if they were sung or played with the individual's subjective tempo (Saji &
Sugai, 2005).
Emotions, Human Development, and Self-Consciousness

Emotions are important to human development because they serve as the first self-
organized cognitive system that acquires knowledge about self and environment. As
such, emotions structure our experiences, enable us to make predictions, and help us to
promote effective adaptation (Guidano, 1987). From the early developmental stages,
children have basic feelings and the ability to communicate them through motor
expression; however, unlike discrete emotions, these basic feelings are undifferentiated
sensations. The primary source for these discrete emotions is the interaction between
infant and caregivers; these interactions arise from basic feelings and develop further
through perception, imagination, and motor activity (Guidano, 1991). Each discrete
emotion has its own pattern or brain map that integrates perceptual, motor, and
affective information; these patterns provide the basis for assimilating new experiences
into existing cognitive structures at the tacit level. Thus, the first reality of the child is
formed in primary consciousness.
Emotions are complex experiences in that they involve and develop in tandem
with perception, imagination, and memory. The first step in the development of
emotions is differentiation. Emotions are divided into two types: elementary (or
Darwinian) and complex (Johnson Laird, 2006). While the first type is basic and
developmentally more primitive, the second type, which develops from the first, is more
developmentally advanced.
Elementary or Darwinian emotions (the first type) are innate and serve the
biological function of survival. Included are emotions of happiness, sadness, anger, fear,
surprise, and disgust (Damasio, 1999). The perception of such emotions is based on the
biochemical changes associated with those emotions. This information follows a path
that connects the neural sensory thalamus to the amygdala. This type of emotion is
faster to process, as it is sent as a rough cognitive analysis and does not pass through the
cortex (LeDoux, 1992, 2000).
Elementary emotions have a regulatory function (pleasure/pain) that supports
goals of individual survival and bodily homeostasis. The neural circuits and the
neurophysiological mechanisms responsible for emotions include the limbic system
(hypothalamus, hippocampus, basal ganglia, anterior thalamus, and cingulate cortex)
and the amygdala, along with orbital and medial areas of the frontal lobe for the
regulation of emotional and social behavior (Phelps, 2005). These circuits form an
organized network of connections to higher cortical centers for integration between
physiological and cognitive processes (Purves et al., 2008).
Elementary emotions can be activated automatically without conscious
deliberation and are based on changes in the body (e.g., visceral and muscular system).
These emotions have an effect on cognitive processes such as attention, perception,
memory, mental representations, motivations, and decision-making (Damasio, 2010).
Damasio (1999) argues that emotions are constructed as sequences of events that
underlie physiological and psychological feelings and bodily movements in space. They
are complex sets of chemical and neural responses, forming patterns, or models. These
models have affective valences and therefore can influence decision-making, because
decisions and consequences from similar past situations come into play. Thus emotions
15
leave biological traces, or somatic markers. This body information is maintained in one’s
memory and provides signals facilitating our decisions, making them faster, although
sometimes not accurate.
The second type of emotion includes complex ones that are learned through
personal development and interaction with other people. The perceptual information for
complex emotions (regret, guilt, shame, compassion, admiration) characterizes the
human species. These emotions travel from the sensory thalamus to reach the amygdala,
passing through the cortex. This is a slower neural path because it is mediated by
cognitive appraisal.
The structure of both types of emotion helps us to differentiate one emotion from
another, as they unfold in time. If there are similarities between the experience of an
actual emotion and preformed patterns for various emotions, the individual will
recognize the emotion as previously experienced and therefore consistent with his/her
self-image. On the other hand, if there are differences, the individual will attempt to
maintain internal coherence by either forming a new emotion or suppressing the
emotion altogether.
Developmentally, elementary emotions are the first act of discrimination between
what is good and bad, which the individual performs in relation to his environment.
These acts are initially sensorimotor. As the child develops, the cognitive processes
come into play and interact more deeply with the emotional processes, influencing their
direction and management. Even taking into account that not all emotional processes
are subject to this direction and management, it is confirmed that the areas of the
prefrontal lobes are able to inhibit emotional responses. In other words, our neocortical
areas of the brain are capable of controlling emotional processes. As stated by LeDoux
(1992), it seems that the functions of the prefrontal lobes are more cognitively oriented
toward preventing inaccurate information about an emotion, whereas the amygdala is
more oriented toward an automatic, associative response, which may be based on
inaccurate information.
Damasio (2010) describes emotional experience in three stages that correspond
to the phases of a GIM session. First, a “real” emotion is experienced as a sensation felt
in the body in response to certain stimuli. This is the first step in developing
consciousness. Second, the emotion is mapped in the brain and brought into a higher
level of consciousness, so that it can be acknowledged and identified. Third, the emotion
is compared to other previous similar experiences, evaluated in terms of positive or
negative valence, and then reflected upon for further understanding. The first is a direct
behavioral mechanism based on the brain stem functioning, while the other two are
mediated by higher cortical mechanisms. The brain stem, where emotions lie, is in a
continuous dialogue with the cortex that allows humans to draw detailed maps with
neural memory, reasoning, and language. That is why in many circumstances feelings
involve the perception of a particular state of mind associated with them (Damasio,
1999). Therefore, according to Damasio (2010), emotions are actions or movements that
are manifested and visible. Feelings are hidden; they are mental images. Emotions
perform in the theater of the body; feelings are relegated to the mind.
From an evolutionary point of view, the effectiveness of this system is evident in
that it allows the gradual shift from automatic responses to semiautomatic responses to,
finally, modulated or adaptive responses. These are managed under the conscious
control of the individual.
We must therefore bear in mind that emotional arousal involves two interacting
subsystems. The oldest one, managed by the amygdala, is based on the associative
principle, so that if the experience shows some elements similar or comparable to those
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of past experiences, the system produces the same emotional response. It is obvious that
this system bases its activation on a few inaccurate items, and the usefulness of the
response is mainly based on its speed.
A more cognitively advanced system is processed in cortical areas. It does a
detailed context analysis, which determines whether the present experience is different
from previous ones. This system operates through sequential analysis and evaluation. As
such, it is much more articulate and precise than the older yet faster amygdala system.
The two systems are, however, interacting, allowing the individual to have, from time to
time, both accuracy and speed in decision-making.
The cognitive appraisal principle remains a fundamental element of emotional
processing found in both the primitive and more advanced systems described above. It
should be noted that very often people are unaware of the actual appraisal they have
given previously felt emotions. This may be because such evaluations are expressions of
the older form of processing, carried out automatically and less consciously. The cause
of an emotion may in fact be very different from the reasons that people give to explain
it (Frijda, 1993).
The archaic or prototypical emotional system assesses situations in a direct way
through quick and automatic associations; it takes less information into account and
sometimes makes an uncertain or confused configuration of the ongoing emotional
situation. On the other hand, the more advanced system mediates through more focused
and thorough attention, thereby providing details to the cause of the ongoing emotional
situation before initiating an emotional and behavioral response.
Here is an example to illustrate how the two systems operate: A person is walking
alone in a forest. He hears the noise of broken branches, initially hypothesizing that a
wild and dangerous animal is near. He feels a sense of fear and breaks into flight. But by
listening more carefully and perceiving human voices, he feels more reassured and
decides to walk toward the other people. For these reasons, the areas of the brain
collaborate in an evaluative process. However, the brain’s ability to perform a detailed
analysis makes it work more slowly. By consequence, it can only occur at a later time to
inhibit, if necessary, an emotion already activated automatically by the amygdala.
Emotional stimuli are detected very quickly by tacit-emotional assessment as the
associative process bypasses conscious processing and directly activates motor
behaviors. Cognitive processing of these same emotional stimuli gives rise to
differentiated feelings that allow us to partially operate a voluntary control over
automatic emotions. This view confirms an evolutionary perspective concerning
emotions (relating to automatic evaluation, basic and tacit) that give rise to feelings. The
latter is related to the mental capacity necessary to detect conceptual and evaluative
circumstances related to a broader environmental context.
Based on the foregoing discussion, the authors propose that while there are innate
emotional devices, the power of conscious thought to regulate, modulate, and inhibit
very intense emotional processes should not be underestimated. This regulatory
capacity is necessary to adjust emotions according to individual values, beliefs, and
goals, including quality of life and biological, psychological, and social well-being. In
fact, with the development of conscience and morality, human beings have acquired the
freedom to avoid emotional distortions and excesses detrimental to their survival and to
regulate their emotions and social life more appropriately (Marmion, 2011).
The connection between the two levels of emotional processing (elementary and
complex) suggests that psychotherapy should be designed to activate, in a protected
environment, the associative archaic channels, which have a decisive importance in
individual behavior. Once manifested through metaphorical images, these associations
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can be reinterpreted using the cognitive-cortical level. The consequent changes in
meaning and value will allow the individual to develop a higher-ordered emotional
structure to inhibit disruptive emotions. It should be noted that emotions and their
specific characteristics are components of tacit knowledge and that tacit knowledge
defines the type of emotional experiences possible for a given individual and contributes
to the construction of personal meaning and the development of self-awareness.
Self-Consciousness or Self-Awareness
Minsky (1988) proposes that consciousness means the organization of different ways of
knowing what is happening inside our mind and our body and in the world outside.
Thus, consciousness or awareness includes all aspects of body and mind processes and
functions. Of particular interest to the present is the question of how self-awareness
develops, since it is crucial to organize a person’s experiences and represent them in a
narrative story developed during the therapeutic process.
Rhythms of physiological and emotional patterns are the basis of consciousness
formation in infants. The sense of self is perceived with immediacy, and directly, as a
kinesthetic sense, organized in different prototypical emotional patterns according to
their relationship with caregivers (Guidano, 1991).
The idea that the mind is anchored to body actions and circumstances gives us a
perspective to better understand how we function as human beings, our emotional life,
our social behavior, and our cognitive activity (Glenberg, 2010). In this perspective, the
brain does not make a real difference between our physical interface with the
environment and high-level abstract thinking; instead, the mind uses the body to
understand abstract concepts, which is also what happens in the metaphorical process.
Therefore, we can assume that the phenomenon of cognition is embodied (embodied
cognition) and rooted in physical reality. This leads us to say that the brain gives
meaning to the world by simulating the actual experience (Barsalou, 2008). Even when
the brain thinks about emotions, it simulates the experience through the body (e.g.,
feeling relieved of a burden; thinking about a past event; moving forward toward a
future goal).
We believe that only when the mind relies upon the basic bodily experience can it
remember and represent the experience itself. From this simple embodied information,
or imaginative schema, the individual starts a complex process that involves high-level
neural networks through which he can develop the representation of self, or self-
awareness.
Consciousness or awareness is a general term that encompasses all of the
subjective aspects of mental activity. It can include the organization of different ways
that human beings know what is happening inside of themselves in their bodies and in
their surrounding environment (Minsky, 1988). The awareness of being conscious of
something is considered to be under cognitive control (Prinz, 2005). Awareness includes
both apprehending several mental images derived from cognitive, perceptual, and
proprioceptive activity and choosing images that are placed in the foreground by
selective attention. Consciousness is commonly referred to as the totality of a human
being’s experiences at a given time or for a certain period of time. Edelman and Tononi
(2000) think that consciousness is a process rooted in the physical body of every
individual and that every individual is unique and has a capacity to reflect on being
conscious, due to semantic and symbolic modalities developed in social interaction.
These processes require primary and higher-order consciousness. For Damasio
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(Marmion 2011), consciousness begins by experiencing physical, bodily states and does
not consider reason and emotion as being opposed to each other. The capacity for such
awareness is called primary consciousness by Edelman and core consciousness by
Damasio (Damasio, 1999, 2003; Edelman, 1989, 2004, 2006). The mark of this
awareness is a phenomenological presence missed in unconscious states. Besides this
ability, humans are able to reflect on their thought and to realize that they have thought
processes. This ability to consider the thought as an object is the key for higher-order
consciousness described by Edelman and extended consciousness proposed by
Damasio. Edelman and Damasio argue that the primary consciousness and core
consciousness are not unique to humans and that consciousness is an evolutionary
adaptation, as it provides benefits to deal with life events (e.g., having the ability to focus
on mental images most relevant to a certain situation).
According to Damasio (1999), the self-consciousness develops in stages. The
most primitive is the “proto-self,” which consists essentially of brain activity. Next
comes the “core self,” which is continually evolving through experience. The final stage
is the “autobiographical self,” which represents the individual’s identity and consists of
unique facts and ways of behaving, feeling, and thinking that characterize each
individual and depend upon autobiographical memories, cognitive inferences, and
language. While the first, proto-, self is unconscious, the latter core and
autobiographical selves are the main components of consciousness itself.
Taking into account the purpose of developing an integrated theory, it is
important to see how the above information (dual-coding theory, music, emotions,
imagery, and metaphorical process) may contribute consistently with the consciousness.
One aspect that the neurophysiological investigations tend to emphasize is that the very
basis of consciousness is the process of striving toward integration. Integration requires
different types of memory (sensory, working memory, long-term memory). The different
kinds of memory are dynamic, cognitive constructs that are limited by biological
mechanisms. They involve different brain structures and processes and are intertwined.
Consciousness seems to arise from an integration process that helps us to
perceive the different aspects of an experience (i.e., thoughts and emotions) in a linear
and coherent sequence. Thus, it is the process of integration that provides the basis for
the continuity and constancy of memories in spite of variations among similar
experiences.
Integration means that a person cannot break a state of consciousness into parts
or components so that each part may work independently. So in the moment, a state of
consciousness is integrated when all sensory channels are operating interdependently,
and the person is aware of his/her own emotions, thoughts, and behaviors.
Consciousness is also integrated when time periods are conceptualized on a continuum
in which the past precedes the present, which precedes the future, and vice versa. In
other words, the person is able to narrate the self in a historic way.
Another fundamental property of consciousness is that we can be conscious of
several things simultaneously and still maintain an integrated self. A key to this ability
to be differentiated and integrated at the same time is selective attention, that is,
focusing on one experience in awareness and not others. What a person selects to attend
depends upon the person’s self-concept, which eventually is mediated by language.
Edelman and Tononi (2001) argue that, once language is developed, every experience is
lived based on language, and this reliance on language enriches the capacity for
conceptualization of the experience. In addition, the connections established at the
neural level between the language brain areas and cognitive brain areas may promote
the continuity and consistency needed by the self to develop (Edelman & Tononi, 2000).
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Thus, verbal thinking is the glue that unifies consciousness, notwithstanding any
differentiations that may be occurring. The ability of verbal thought to produce a
narrative allows a human being to construct a story, his own integrated and coherent
story. In this way, humans are able to integrate the millions of different "states of
consciousness." It is also possible that the capacity for verbal reflection improves one’s
ability to discriminate and understand an experience more adequately.
At the same time, however, numerous cognitive procedures used in attention and
perception are automatized, which means that they are working at a tacit level of
awareness. Though these automated cognitive procedures may not be in full awareness,
they play an essential role in defining the content of an experience. The fact that
cognitive functions are operating out of awareness but at the same time determining the
content of our experience has many implications for psychotherapy and later will be
used to explain the interdependence of music and imagery (accessing tacit knowledge)
and verbal reflection (clarifying experiential content). What is important to understand
here is that at any moment in the flow of consciousness, we have access to tacit
knowledge not in awareness (which includes the tacit knowledge that is shaping the
experience), while we are consciously trying to understand those aspects of our
experience that are in awareness.
The neural complexity of the brain, which develops from interactions with the
external environment, allows integration of information, which the brain uses to
produce consciousness and meaning, intrinsically and spontaneously, as it happens in
dreams, imagination (Edelman & Tononi, 2000), and music imagery experiences, too.
This means that we have to give up the idea of a coherent and unified
consciousness; it is neither linear nor homogeneous. We should instead conceive of
conscious states as a complicated flow from one conscious equilibrium to another less
conscious one. Within this flow, we often find ourselves in a state of simply “being.” In
other words, we perceive ourselves operating cognitively, emotionally, and behaviorally
at a nonconscious level. As previously written, this perception is influenced by factors
that may be unconscious and that are consistent both with previous experiences of
childhood interactions (i.e., with the caregiver) or internal working models and with any
memories that might be elicited by the current situation (e.g., experience with the piece
of music).
Although conscious states occur to us as unified sequential segments, we float in
the consciousness experience from one state to another. We feel a sense of continuity
not because we perceive this continuity in what happens in the actual situation, but
because we rely upon the memories of how things were in the past—as stored in our
memory by language and sometimes associated with images and sounds. Without short-
term and long-term memory, everything would appear to be constantly new, and we
would not have any sense of continuity.
Primary and secondary consciousnesses are continually operating at the same
time; thus, consciousness must be integrated in a way that allows us to differentiate
between an extraordinarily large number of different states and levels of consciousness.
Consciousness is therefore not an all-or-nothing phenomenon; moreover, as we develop,
we can expand our capacity to access, experience, and integrate different states and
levels of consciousness.
If we abandon the idea of homogeneous consciousness, we have to accept the
premise of our many states of consciousness. In fact, this is not very different from the
way we commonly feel. If we reflect on our introspective ability, we realize that every
day we experience feelings of disunity, conflicting issues, and contradictory desires, and
we behave based on the many roles we play every day. Only when we suspend any
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judgment through the imaginative capacity is it possible to reconcile the contradictory
set of self-images, seeing the similarities and relationships between the various aspects
of self. Accepting all data, real or imaginary, objective or subjective, through
imagination allows human beings to suspend self-criticism and to create new
opportunities for re-describing one’s world.
Music contributes to the structuring of consciousness through sound elements,
which create analogs to psychological processes, emotional states, or physical
movements. More specifically, the sound elements of meter and tone stimulate the
metaphorical processes related to experiences of departure and return already stored in
memory (Zbikowski, 2011). Thus, listening to music activates memory systems
connected not only to the same music previously heard, but also to previous emotions
and motor functions, which further give rise to kinesthetic mental images. In short,
music activates the metaphorical process through sound analogs that combine emotions
and physical movements and therein contributes to the development of consciousness at
the tacit level.
It is quite evident that there is a need to have both music and language for the
different functions they perform in the development of the integration of consciousness:
music, for developing tacit knowledge, and language, for developing explicit knowledge.
In addition to music and language, the imagery they evoke contributes substantially to
the development of consciousness and acquisition of knowledge.
Imagery
An image is a structured dynamic model of our experiences, including somatosensory
(visual, auditory, gustatory, tactile) and proprioceptive characteristics (muscle tone,
body temperature, a sensation of pain, visceral organs, and feedback from the vestibular
system equilibrium) (Kosslyn, Ganis, & Thompson, 2009). These images can be defined
as representations or maps, stored in different areas of the brain. In processing
information, the human brain, using multidirectional connections, establishes a kind of
code. In this way, the neural areas involved in information processing learn that just as
they are activated simultaneously and linked together to encode complex experiences, in
the same way, they will reconnect together to rebuild in memories (Damasio, 2010).
Images are easily evoked through music listening. For Johnson (2007), music serves to
temporally represent and enact our experiences. Therefore music is significant in that it
reveals the flow of metaphorical images inherent in the human experience of time past,
present, and future.
Going further, of particular interest is that images evoked by music are very
different from mental images evoked by language. Images evoked by music are dynamic
rather than static, that is, they unfold and develop in time. Images evoked by language
reveal relationships between objects and events, which are static rather than dynamic
(Zbikowski, 2011). In fact, we can also say that thought can be considered as a
continuous flow of multimodal images, many of which are logically interrelated
(Damasio, 1999). Both music and language lead to the creation of imagery by combining
and/or modifying stored information; in other words, both music and language and the
imagery they evoke require the engagement of memory systems, which, in turn, are
essential for developing human consciousness.
Imagery is important to the therapeutic process because it enables the client to
identify, create, try out, and evaluate alternative ways of thinking, feeling, and behaving.
Through the imagination, we are able to see our emotions and inner states as they
unfold in the experience. The brain attunes and synchronizes progressively to the
21
continuous flow of music, modifying multidirectional connections and representational
maps through sensorimotor and emotional experience. During the simulation, the
imaginative experience allows a client to add new elements and encourages the
exploration, accessing, and developing of one’s resources.
The Metaphorical Process

The metaphorical process has been described by Lakoff (1993) as the creation of brain
maps. These brain maps are created from experiences stored in memory. Brain maps
exist at different levels of consciousness. Damasio (2010) talks about certain memory
maps as being automatic, fast, and unrefined, existing at the primary level of
consciousness. Examples include “imaginative schemas” such as walking, eating, and
speaking. In contrast, there are also maps that store recollections at a conscious level,
that is, secondary consciousness. An example would be recalling specific events from the
past.
The “metaphorical process” consists of projecting on multiple fronts: from one
area of experience or modality to another, from bodily to emotional to conceptual, from
nonverbal to verbal, and from tacit to explicit knowledge. The outcome of this dynamic
process is an imaginative structure, referred to as a “metaphor.” Metaphorical thought
develops through the cognitive process, which is pervasive, creative, and fundamental to
understanding new experiences (Lakoff & Johnson, 1980).
The metaphor is an imaginative structure that originates from the body function
while interacting with its environment. Metaphors are functions of operative symbolic
thought, developing from nonverbal (sensory, emotional) modalities and developing
into conscious awareness. Lakoff and Johnson (1980) think that the conceptual system,
through which people behave and think, is metaphorical.
In other words, human beings use metaphors to understand and experience one
type of event in terms of another. People transfer meaning structures from one familiar
area to an unknown area (Johnson, 1987; Lakoff, 1990; Turner, 1990). This cognitive
activity takes place with projections or metaphorical mappings across conceptual
domains (Lakoff & Johnson, 1980). It is useful to keep in mind that some aspects of the
metaphorical process may be only partially adaptable to reality and therefore can be
overlooked. The realization of this mapping between conceptual domains is its linguistic
or metaphorical expression (Lakoff, 1993). The metaphor, therefore, has not only a
linguistic, but also a fundamentally conceptual and rational aspect. Thus, it concerns
language and general cognitive abilities, including music behavior. It is the authors’
opinion that music is a product of metaphorical thinking and, therefore, can create
metaphors associated to emotion and tacit knowledge (Giordanella Perilli, 2002). In this
vein, it is possible that concept formation and metaphorical thinking precede verbal
language, as Edelman and Tononi (2000) hypothesize, and that music can contribute to
concept formation and metaphorical thinking even before language develops. These
kinds of prelanguage concepts and metaphors allow the child, lacking language
expertise, to represent and define new situations based on those he or she already
knows. The same holds true in adult life when people have no appropriate words to
communicate their experiences.
As explained above, experiences are stored as imaginative schemata, or ways to
construct meaning as a Gestalt. These experiences consist of sensorimotor images that
come initially from the experience of living in a human body in the environment. For
this reason, experiences shape kinesthetic patterns, like Damasio’s (2010) maps of
22
bodily responses and motor memory. The initial patterns evolve gradually toward more
conceptual schemes, maintaining their sense of their body.
As a consequence of this process, metaphors are part of a set of imaginative
mechanisms, which start from the concept of the physical body and move toward more
abstract concepts, e.g., the flow of time. As seen in this metaphor, moments in time are
conceived of as objects moving in space, moving toward and past a motionless observer.
This allows people to understand time as an abstract concept. This concept provides the
basis for a metaphorical projection in which the elements and the structure of a scheme
in a known area (the source domain) are transferred onto an unknown area (the target
domain). In this way, it is possible to reason about time, as an abstract topic, by using
our body knowledge of the source domain (i.e., space) and transferring it to the target
domain (i.e., time). Staying with the above metaphorical projection, we see how music,
an art organized in time, is also experienced as movement in space (for example,
harmonic progressions may be experienced as chords moving in space toward a goal,
rather than being perceived only as a succession of sounds following each other in time).
Thus “Time is Space” provides an imaginative schema for motor experiences humans
have when listening to music, along with experiencing the flow of time. As we explained
above, these motor experiences are associated with emotional responses, which help to
define the meaning of the music experience.
While most of our knowledge comes from our sense of sight, as visual images,
mental images include all sensory modalities, together with kinesthetic, bodily
sensations and body status. In any case, metaphorical mapping occurs by transferring
meaning and knowledge from the source image to the new narrative. This transfer, or
mapping, includes implicit characteristics and tacit evaluation processes, which use
both language and thought in a syncretic way. We should add that mental images are
also evoked by language. In fact, human beings are accustomed to interpreting reality
based upon their motor experiences—motor representations that include the mirror
neurons’ function and the metaphorical process. In this way, there is a transfer from
motor to conceptual knowledge. So when a patient says, “I am stumbling in the dark,”
he evokes this mental representation as if he were really stumbling in the dark. He
associates meaning, bodily sensations, cognitive appraisal, and emotional experience to
his narrative. The therapist understands empathically his patient by an intentional
attunement through mirror neuron functions, simulating the stumbling experience in
his imagery. By sharing a common experience, the therapist is able first to understand
and second to broaden the patient’s perspective using the client’s and his/her own
metaphorical abilities. In fact, the metaphor can be considered part of a process by
which new properties are attributed to something familiar (Ricoeur, 1977).
After considering some basic elements to contact and allow tacit knowledge to
become explicit and how humans develop self-knowledge by the metaphorical process,
we will illustrate how emerging material could be used and developed in accordance
with personal issues and goals. A fundamental step is the redescription of the self-
narrative.
The Narrative Re-description

Roth (2005) writes that if we can put into words what we feel, it belongs to us. At the
same time, we know that various kinds of memory (episodic, procedural, semantic, etc.)
are necessary to store and represent our experiences and to allow access to them. Thus,
to remember and talk upon, or narrate, our experience is a complex process that
involves high-level networks called self (Minsky, 1988).
23
We have already seen that not all processes, experiences, or behaviors are
consciously made. Over time, the mind tends to increase its knowledge, using
information stored with various modalities, e.g. verbal, imaginative. Thus, the mind
reconstructs its representations differently from each previous experience in a variety of
ways, such as tacit vs. explicit knowledge or nonverbal vs. verbal codes. By consequence,
the mind can reshape what is already encoded and stored, as it does when
reconstructing memories. When the mind reconstructs past events, redescription is
made according to a subjective narrative logic, melding together verbal and nonverbal
information. The mind structures these narratives in sequences that can be modified
and that consequently change their meaning.
A similar process occurs when making a movie. Some scenes zoom in to show the
main actor; other scenes are eliminated, and what was in the foreground can be put in
the background, changing the meaning of the story and its emotional effect on the
audience. The soundtrack can strengthen the action emotionally and, perhaps, be
remembered by itself apart from the movie.
A narrative can be real or imagined without diminishing its evocative power. The
narrative is a vehicle that humans use to develop a sense of identity over time, including
past, present, and future. It is a way of convincing oneself about one’s own
characteristics and resources and can be used as a method for maintaining awareness
about one’s self-identity.
Paul Ricoeur (1990) argues that the narrative belongs to human life in the
present historical condition. It represents the mimesis, that is, a metaphor of reality.
Thus, a narrative refers to reality, not to a copy thereof; at the same time, once created, a
narrative allows rereadings of itself in a new way. Karmiloff-Smith (1992) explains how
narrative redescriptions can be created. First, information is obtained in a purposeful
and autonomous way in an individual. Then, in a cyclical process, through
redescriptions, the same information is made available to other parts of the cognitive
system.
We know that the learning process uses two complementary modalities. The first
modality allows behavior and ideas to become automatic and, then, less accessible to the
consciousness. The second modality allows people to become more aware of tacit
knowledge. Mandler (1992) hypothesized that the formation of schematic image
representations, which mediate between perception and language, uses the process of
representational redescription to define the transition from one processing modality to
another.
Humans need procedural and conceptual automation in order to carry on daily
activities more quickly. Moreover, with automation people cannot use their higher
cognitive abilities—that is, intentionality, awareness, and analytical modalities—for
dealing with daily chores (driving a car, walking, writing). Besides facing time limits that
lead to fast, automatic, and inaccurate decisions, humans have limits due to data storage
as well. When we have to make a quick decision, we may not have all of the relevant
elements of a situation. In summary, this limit concerns (a) the time for deep analysis,
(b) the need to stay in a situation in order to gather data, and( c) the inability to care
about something else. Thus, to cope with ordinary tasks, humans need simplified,
automated procedures.
There are the same simplified and automated procedures in verbal expression. In
fact, language maintains syncretic or analogous modes that are not submitted to
conscious processes, and people use such syncretic words to speak to themselves, that is,
for self-instruction. At the same time, we must consider that language modifies our way
24
of thinking and broadens our awareness because it allows us to represent our world
verbally and thus be more aware of it.
Going back to narrative redescription, the transition from inner to explicit verbal
speech requires what Vygotsky (2008) called “deliberate semantics,” namely the
deliberate, conscious structuring of a topic or plot about the self or world. This way of
thinking allows people to conceptually represent the plot together while also
interpreting its meaning. In this regard, we especially appreciate the distinction made by
psychologist Frederic Paulhan (1929) clarifying the difference between what is called
significance and meaning in a word. The “significance” of a word can be described as all
possible meanings for the word, whereas the “meaning” of a word is the subjective
interpretation that a person gives to the word. The conceptual and emotional meaning
of the word also varies according to context. This same meaning-making process
happens when individuals describe themselves, as they often use words from their own
individual point of view and perspective and within a specific context.
The narrative is primarily the result of a hermeneutic modality through which
humans “choose” to give a certain meaning to an object (social action, emotional state,
etc.). The narrative arises from interpreting. From this, we can also infer that people do
not make the narrative in order to logically explain the causes of their life events, but
instead the narrative tells how individuals interpret their experiences in a given time
and in a given situation.
As each individual has a unique meaning-making process, which leads to unique
and idiographic meanings, so the narratives of an individual are also a reflection of one’s
individuality. It is important to understand, especially in a psychotherapeutic situation,
that a person’s narrative always includes individual structural limits that guide the
person’s behavior and choices. These structural limits include rules, motivations, beliefs,
emotions, etc., each unique to the individual, some of which are tacit and some, explicit.
Thus, the structural limits of a narrative by which a person lives may be in either
primary or secondary consciousness.
All narratives are driven by metaphorical processes, operating also at both
primary and secondary levels of consciousness, yielding both tacit and explicit
knowledge. New metaphors arise from the experiential process, representing the
continuous modification of self-image, which was previously stored in the cognitive
schema. Sometimes the metaphorical process produces metaphorical images that vary
in complexity. Some metaphorical images represent single objects or concepts, whereas
others form larger Gestalts composed of several objects or concepts. Both kinds of
metaphorical images form the basis of narrative.
Narratives are not always completely understood by the person who created
them. Sometimes, entire images or schemas in the narrative can remain at the tacit level
of knowledge and thus are not necessarily in consciousness and available for verbal
expression. Such images may appear in the narrative, but only in a metaphorical way
and most often implicit or confused. In addition, parts or specific details of an image or
schema may be at the explicit level, while others remain at the implicit level and thus
not fully available for inclusion in the narrative.
An important property of narrative is its sequencing of events, mental states,
situations, and emotions. As such, the narrative involves linear thought processes
necessary for bringing all of these contents into consciousness and giving an acceptable
meaning to our experiences, including those that are disordered.
As explained above, both music and imagery contribute to metaphorical
processes. Both access tacit knowledge that includes sensorimotor actions and
emotions. In addition, when combined, music and imagery create a temporal continuity
25
to the metaphorical process that promotes the creation of extended and coherent
narratives.
So far we have proposed a path describing how the individual: (1) accesses
images at the tacit level, (2) represents the images verbally at the explicit level; (3)
understands the meaning of the images; and (4) creates a narrative that explores
options for new meaning and a redescription of the self. The final step, to be discussed
later, is to verify the acceptability of the new meanings and redescriptions in accordance
to the individual’s personal system of beliefs and values.
The Psychotherapeutic Process

The Therapeutic Relationship
Respect, trust, authenticity, coherence, professional competency, empathy, ethical and

moral principles, together with an open-minded and resilient attitude, are basic
qualities that a therapist must have to build a comfortable environment for a secure
The authors believe that the therapist has to engage the client as a partner; they must
cooperate with one another to formulate and reach the goals of the therapeutic process.
The therapeutic process can include specific or more general goals, which can be
addressed in one or a few sessions or during the entire process. New goals can arise as a
consequence of previous therapeutic work. After a preliminary assessment has been
done and the client and the therapist have established specific and verifiable goals for
the therapeutic process, then the therapist will consider what will be addressed in each
session, based on the client’s needs, states, and resources in the here and now. Thus,
sometimes it is preferable to work primarily with emotions, while at other times it is
necessary to focus on irrational thought, which has been previously represented
metaphorically in the imagery experience with the music.
Goals and Methods
Within the frame of second-generation cognitive science, awareness is a primary

therapeutic goal because it is the very foundation of psychological health or dysfunction.
Because awareness evolves through the continuous oscillation between tacit and explicit
knowledge systems, psychotherapy is aimed at achieving a dynamic balance between the
two types of knowledge. The GIM session is so designed that it facilitates this oscillation
between types of knowledge and the achievement of a dynamic balance. Through this
process, individuals develop a greater capacity for complexity and a higher level of self-
organization, both of which are useful for self-continuity and self-integration.
A main challenge to this dynamic balance occurs when there is a discrepancy
between tacit and explicit self-image. In alternating between tacit processes (sensorial,
preverbal) and explicit processes (conscious verbal thought), discrepancies can occur
between self-images that are developed at these different levels. In other words, the tacit
self-image (and aspects thereof) may be very different from the explicit self-image. In
some cases, this same alternation between tacit and explicit can lead to a new
equilibrium that includes a more structured, integrated, and coherent self-image at a
higher level of the person’s awareness. However, when the discrepancies between the
tacit and explicit systems become too difficult to manage, the individual might not have
the capacity to integrate the self on one’s own. This can lead to the emergence of
disturbing and uncontrollable emotions because the individual would perceive
26
contradictory aspects of the self without being able to reorganize an integrated self-
image at a conscious level. This situation could then lead to an imbalance and cognitive
dysfunction, preventing the individual from maintaining a sense of personal uniqueness
and historical continuity. In this case, as proposed by this approach, the disturbing
sensory and emotional information could be represented and evoked via other
modalities or ways, such as imagery, metaphorical music experiences, motor patterns,
and viscero-muscular reactions.
Language and secondary consciousness enable humans to integrate their
emotions with their verbal thoughts and verbal evaluations of self and world. This
means that in therapy, it is often worthwhile to reflect verbally on the musical,
metaphorical, and emotional experience, to grasp what is beyond, and to elicit its
hidden source. Upon such reflection, the client and therapist can identify “stereotyped
thinking” (generalized rather than thinking based on the actual situation) and “rigid
rules” (e.g., thinking that because something happened in the past, it will happen again;
evaluating oneself as bad rather than one’s behavior or thought or emotion; maintaining
an idealistic self-image as perfect; having unrealistic expectations or a low frustration
tolerance).
Thus, the experiential aspect of GIM (i.e., imaging to music in an altered state of
consciousness while dialoguing with the therapist) is used to explore and evoke what is
at a tacit level of awareness. This part of the therapeutic process may include risk-
taking, attacking shame, lowering anxiety, diminishing phobias and panic attacks, and
similar experiential tasks. It is important to keep in mind that the images evoked by the
music in an altered state of consciousness are a product of the prototypical mental
constructions that unwittingly determine the behaviors of the individual. The
representations of these images, constructions, and behaviors are imaginative and
metaphorical and therefore initially removed from the formal logical analysis of the
verbal processes. Moreover, any interpretation of these representations while the client
is actually engaged in the music-imaging experience are usually made through primary
processing. Thus, such interpretations occur in a general and stereotypic manner and
rely upon interpretive schemes of which we have less awareness and which are less
reliable. Nevertheless, these analogical codes provide a cognitive bridge between tacit
and explicit knowledge.
The development of explicit knowledge begins in the “postlude” of GIM sessions,
when the cognitive GIM therapist uses verbal methods to help the client to understand
the images and metaphors and to identify, explain, and modify irrational or illogical
ways of thinking that maintain the client’s suffering. This self-reflection begins with the
therapist and client reviewing the transcript and the client assigning initial meanings to
the images and metaphors. The therapist and client then further contextualize the
images, metaphors, and meanings from this session by comparing them to previous
sessions. After sufficient time has passed to give the client sufficient distance, material
gathered in several previous sessions is analyzed using cognitive techniques (e.g., using
verbal constructs to depict oneself, debating irrational beliefs, employing metaphoric
and narrative devices, etc.). All of the verbal processing of the material arising from the
GIM experience serves several purposes: It enables the client to capture meanings and
insights that were unavailable at the actual time of the session; it brings the
metaphorical images closer to reality; it reveals the contradictions in one’s own self-
image; it helps to develop strategies for resolving these discrepancies; it facilitates the
construction of a more articulate and accurate narrative of oneself in the world; and it
enables a reconstruction of the self that is more consistent with one’s own system of
goals, values, beliefs, expectations, etc.
27
Regarding the discrepancies between tacit and explicit knowledge, it is good to
bear in mind that the distinction between comprehension and interpretation is greater
when the imaginative experience presents irregularities and vagaries when comparing
the real and imaginary worlds, the various meanings of a particular metaphor, and the
contrasting or even incongruent emotions attached to them. The understanding that
occurs immediately after the GIM experience is sometimes provisional and open to
revision upon further reflection on the written transcript of the session. In reading the
transcript, interpretive distancing permits the individual to take different perspectives
on the tacit knowledge accessed through the music imaging experience. In this way, the
client is able to evaluate parts of the experience using logic-emotive abilities and therein
focus on key issues. Only in this way is it possible to achieve an organized reworking of
the episodes in a coherent narrative structure.
Although initially represented in an indirect manner, the tacit content can now be
personally verbally contextualized. This is consequently the therapeutic value of
imaginative re-enactment through music. Via this method, recovery is possible through
imaginative metaphors, whose tacit knowledge constitutes the hierarchically superior
level of informational processing of every human cognitive system (Guidano, 1987). We
know that this kind of knowledge influences the very shape of the experience, but it is
not directly accessible through language. The imaginative music experience may blend
with aspects from the tacit level such as sensations, emotions, images, and motor
patterns associated with internal operational models. As a result, the tacit contents are
rendered amenable to analytical processing and, therefore, to a better understanding.
This last step is the key to the subsequent change via a cognitive restructuring.
Since in the actual perspective the therapist disposes him-/herself of a wide range
of verbal and nonverbal methods to address tacit and explicit knowledge, he/she can be
flexible in determining which could be the most appropriate methods or techniques for
the client to be used at that time. It is important to note that each step of the therapeutic
process is included in an expanded therapeutic plan; in other words, each session is part
of a meaningful and unique puzzle illustrating each individual identity.
To summarize the psychotherapeutic process: In the initial stage, the client
acquires nonverbal awareness during a music-imaging experience, which is then
enhanced by verbal analysis. Then, assisted by the therapist, the client begins to
understand how nonadaptive or maladaptive ways of thinking maintain a painful state
of being and prevent creative potentialities from developing. Through the metaphorical
process, the client transfers the imagery and its meaning from tacit to explicit
knowledge. Now the client is better able to evaluate and explain those behaviors,
emotions, and thoughts that limit his/her opportunities and choices. Then, based on
his/her own values, beliefs, and goals, the client has to work on modifying the behaviors,
emotions, and thoughts that negatively affect his/her quality of life. In the final step, the
client describes his/her own story in a new narrative that will illustrate the new,
purposefully modified self-image.
Conclusions
The motivation for this work is that, although it has often been widely thought that
integration is fundamental in psychotherapy, until recently, there has only been a partial
theoretical approach. It is our opinion that the present contribution provides a coherent
integrative approach to psychotherapy that takes into account the complexity of human
beings. Second-generation cognitive science has been used to support our point of view,
28
along with the presentation of multidisciplinary research connecting various
components into a unified picture.
With the present contribution, the authors would like to strengthen the proposal
that human beings are complex, nondetermined, whole systems interacting with their
environment. By consequence, during therapeutic interventions, we have to consider a
multidisciplinary perspective in order to be effective and efficient when integrating
these points of view into a unified theory and coherent methodology.
The present approach includes numerous methods and techniques that take
advantage of both verbal and nonverbal modalities that humans use to communicate
and make meaning. The different methods are interrelated to promote links between
tacit and explicit knowledge, in order to give rise to awareness about the client’s own
way of feeling, thinking, and behaving. Such awareness is an overall goal in
psychotherapy, since by becoming aware of one’s own limits, needs, values, motivations,
and resources, the human being increases his/her freedom and capacity to make
decisions for his/her own life.
This contribution has addressed several issues: (1) It has outlined how analogical
and analytic modalities work together to process information; (2) It has showed various
metaphorical methods to elicit tacit knowledge and its verbal representation; (3) It has
provided a body of evidence to support the idea that music does indeed have emotional
power for developing self-awareness; and (4) It has proposed an integrated
methodology to improve the efficacy and efficiency of therapeutic intervention, based on
the same processes and functions that human beings use in their own lives to promote
knowledge and development.
To verify this theoretical and methodological perspective, future studies need to
be directed toward (1) investigating whether psychological modifications would
correspond to synaptic modifications in the brain, and (2) using the present approach
with different populations in order to define its clinical validity.
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36
READING 28
Taken from: Hadley, S. (Ed.) (2006). Feminist Perspectives in Music Therapy, pp. 311-328. Gilsum NH:
Chapter Thirteen
GENDER POLITICS
IN MUSIC THERAPY DISCOURSE
Randi Rolvsjord
INTRODUCTION
As this book clearly demonstrates, feminism is not one unified political

movement or a unified approach to research. It is a label used to describe a
multiplicity of approaches, perspectives, and theoretical traditions. However,
some common themes or family resemblances might be identified such as 1) the
high valuing of women, positing women as worthy of study in their own right,
and 2) the recognition of the need for social change which must be understood
as having a political agenda related to gaining equal rights for women and men,
and defeating oppressions and inequalities. These two themes, it could be
argued, are common to most feminist theory and research (Wilkinson, 1997).
But these two themes, along with the postmodernist and constructivist third
wave of feminism, which focuses upon language and discourse, might also be
related to a historical progression, or used to identify different theoretical stands
(Baxter, 2003).
In this chapter, I will focus on music therapy discourse, the way we talk
and write about music therapy, inspired by postmodernist and poststructuralist
feminist traditions. The focus upon language and discourse, and the power-
relations intrinsic in language and discourse, are central in a postmodernist
feminist tradition. My aim is to ask critical questions about the gender politics in
music therapy discourse. To study discourse means putting a strong focus upon
the uses and functions of language, which is integral to postmodernist per-
spectives and poststructuralism. My own introduction and source of inspiration
to this tradition comes from the French feminist tradition, specifically Julia
Kristeva, who does not call herself feminist, but whose work has become very
significant in feminist approaches (Rolvsjord, 2004).
A feminist critique of music therapy research, theory, and practice has been
virtually absent from the discourse of music therapy to date. In a way, this is
surprising due to the large number of female music therapists (Hadley &
312 Randi Rolvsjord
Edwards, 2004), but it is perhaps also understandable for a small and young
discipline in development. But as meta-perspectives and critical reflexivity
evolve in music therapy, feminist critique should inform such critical reflexivity
and meta-perspectives. This chapter represents my effort toward a feminine
beginning of a feminist meta-perspective in music therapy discourse.
Political aspects of music therapy have been discussed previously by Even
Ruud (1996), who claims that music therapy has contributed to important
changes in Norwegian cultural politics. In addition, the elaborations of
community music therapy practice and theory (Ansdell, 2002; Stige, 2003;
Pavlicevic & Ansdell, 2004) raise questions about the role of music therapy vis-
à-vis change in communities. Furthermore, issues of gender politics have been
discussed by Sandra Curtis (1996), Dag Körlin and Björn Wrangsjö (2001),
Anthony Meadows (2002), and Susan Hadley and Jane Edwards (2004).
The basic assumption underlying the argument in this chapter is that music
therapy discourse is an arena for politics. How we talk and write about music,
how we talk and write about clients, pathology, gender, or relationships has
political implications. Music therapy is not an arena assured of political
neutrality (Rolvsjord, 2004b), not even from gender politics. I will start with an
all-too-brief introduction to the postmodernist and poststructuralist feminist
tradition, emphasizing particularly the focus upon language and of power-
relations in language. Then I will turn to the discourse of music therapy and,
inspired by the methodology of destabilizing discourse analyses, I will
specifically discuss the use of “mother” concepts in music therapy literature.
GENDER POLITICS IN DISCOURSE
One of the key themes in postmodernism is the centrality of discourse

(Alvesson, 2002). The postmodernist philosophical stand gives primacy to
discourse in terms of its constitutional power to structure not only the experience
of the world, but also the person’s social identity and subjectivity. The specific
locus of interest in poststructuralism, which could be understood as a branch of
postmodernism (Baxter, 2003), is in language as an arena for the construction of
social meaning. Languages and discourses are understood as systems that
provide particular unities, divisions, and distinctions. It is through this system of
distinctions that discourse has a constitutional effect (Alvesson, 2002). This
comprises a strong critique of materialistic (Marxist) or essentialist under-
standing that emphasizes the biological differences between men and women
(Henessy, 1993).
Discourse is a concept used in a variety of ways. It can refer to language in
use. However, as I have already pointed to the centrality of discourse, the use of
Gender Politics in Music Therapy Discourse 313
the term in this context must also imply elements of a context and of
constructive power. Discourse is often used, according to Michel Foucault, to
denote “practices that systematically form the object of which they speak”
(Baxter, 2003, p.7). A discourse then is more than a corpus of texts, it is a use of
language and practices that not only represent, but also form, reality. Thus, there
is a strong constructivist implication in this definition, which implies an under-
standing of reality not as an unmediated given, but as a process of constructions
and co-constructions. The notion of co-constructions impels us not to neglect the
material world totally. Such a neglect of the material world would be, as Mats
Alvesson puts it, an “‘essentialistic position’ against essentialism” (Alvesson,
2002, p.51). This would be a contradiction to the postmodern project which
emphasizes the fragmented identities and multiplicity of identities. The notion of
co-constructions must be related to the discursive context and to intertextuality.
It is important to note that the constitutive power of discourse, the constructive
force so to speak, lies in the way different texts are related and interact, the
transpositions or intertextuality (Kristeva, 1984; Fornäs, 1995) of discourses.
The constitutive, and thereby political, power is indeed not a possession in
somebody’s hand, but rather a net-like organisation (Baxter, 2003).
In poststructuralist and postmodern feminism this net-like organization of
political power has led into a discussion of power relations and constitutions of
positionality of gender, and especially of the feminine, in language. According
to Foucault, power resides in the discursive formation itself, and is related to the
power to define others (Alvesson, 2002; Foucault, 2001). The understanding of
discourse as a political arena is connected to the power of defining people and
values through distinctions and divisions in language. The constitutive element
in language is seen as binary oppositions (Kristeva, 1984; Irigaray, 1985) and
this inevitably implies the possibilities for dominant discourses to privilege one
pole of opposites over the other—objectivity over subjectivity in scientific
discourse or masculinity over femininity in patriarchal discourse (Baxter, 2003;
Pringle & Watson, 1992), for example. The constitution of language based upon
binary oppositions is said to conserve traditional (patriarchal) power structures,
due to the highlighting and construction of differences and oppositions between
the female and male sex (Kristeva, 1984; Moi, 1986; Alvesson, 2003). Thus, in
poststructuralist feminist research, the very basis of an oppositional relationship
in language is questioned, to a degree that calls into question our basic
understanding of a division between men and women, outlining the diversity and
multiplicity of gender identities (Gatens, 1992; Wilkinson, 1997; Baxter, 2003;
Alvesson, 2002).
Thus, the focus is moved from the discussion of sexual differences and
similarities, to the cultural expressions of gender. The basic idea is to call into
question the binary oppositions that seem to form the basis of our language and
314 Randi Rolvsjord
cultural thinking in western societies, and even question the notion of difference
itself, arguing that it is possible to be both different and alike (Barret & Phillips,
1992). This perspective then represents a critique of feminist as well as
patriarchal research that emphasizes or takes gender differences for granted.
Although some biological differences between men and women are acknow-
ledged, the use of “men” and “women” as research categories in social science,
as well as in music therapy research (although not yet explicitly criticised), is
questioned—which means that the “woman-man” distinction as a grand
narrative in research is challenged (Gatens, 1992; Alvesson, 2002; Haavind,
1998). Instead, local, fragmented, and multiple identities are emphasized and
researched. For this reason, it has been argued that postmodernist thinking is
contradictory to feminism, which advocates for social and political change
(Baxter, 2002; Barret & Phillips, 1992). However, destabilizing theory is a
concept that describes feminist aspirations from feminist postmodern and
poststructuralist works from the 1990s, and it points to the political dimensions
of feminist ideas. When the binary oppositions of our language are revealed and
questioned, this threatens the assumptions that are taken for granted in a culture
and that contribute to processes of change (Pringle & Watson, 1992; Kristeva,
1984).
How can Gender Politics Possibly be Part of Music Therapy

Discourse?
Let me now turn to the discourse of music therapy, and I admit to the reader at
this point that I suspect that we tend to think about music therapy as politically
neutral. Moreover, we are probably more likely to think about gender politics in
relation to music therapy in terms of salary for our female-dominated profession
or in terms of the femalization of music therapy just like other professions
concerned with “care,” than to think about gender politics related to music
therapy discourse. I must also stress that I do not think that the discourse of
music therapy is generally a patriarchal discourse. There is probably no need for
revolution, but for more feminist, as well as political, reflexivity in general.
The discourse of music therapy involves not only the music therapy
literature but also the stories and images about music therapy, the way we talk
about music and music therapy to colleagues, clients, and others. This discourse
not only reflects a practice, but music therapy discourse may even constitute
music therapy (Ansdell, 2003). Furthermore, music therapy discourse is
influenced by other academic, political and cultural discourses. The need for
meta-reflections and cultural awareness is obvious even if our own stories are
true. This must also include, as Gary Ansdell (2003) reminds us, reflexivity in
terms of a larger body of academic and political discourses. It is primarily in

such an intertextual relationship and interaction within a historical and cultural
context that music therapy is part of the co-constructions of our reality and thus
our political power.
Judith Baxter (2003) defines feminist poststructuralist discourse analysis as
“an approach to analysing the ways in which speakers negotiate their identities,
relationship and position in their world according to the ways in which they are
located by competing and intervowen discourses” (Baxter, 2003, p.1). The
following discussion is inspired from a methodology based on poststructuralist
ideas of destabilizing theories, the destabilization analysis of discourses
(Søndergaard, 2000), and the unpacking of dominant categories and notions
(Alvesson, 2002). In this analysis of discourses, the task is to reveal ideas that
are taken for granted in the culture and then question their value. The process of
such an analysis is to identify the processes that constitute the categories, in our
case the constitution of gendered categories, that is, the characteristics that we
attribute to humans who are gendered male or female. Dorte Marie Søndergaard
(2000) uses the concept “storyline” as a more concrete expression of the cultural
narratives or assumptions that are taken for granted.
Texts and practices, or discourses, can be regarded as stabilizing or
destabilizing in relation to such storylines. Any text or practice that is in
coherence with such a storyline will stabilize or conserve the idea, whereas any
text or practice that is contradictory to or questions the storyline will contribute
to destabilization and change. The clinical practices and theoretical perspectives
of music therapy are constantly in interaction with our culture. As part of the
culture, music therapy practice, research, and theory, can either be regarded as
conserving cultural values or reforming or even revolutionizing the cultural
values of a society. This cultural influence will also include gender issues.
Music therapy practices and texts about music therapy can either be
conserving in terms of stabilizing existing “storylines” of gender or gender
stereotypes, or they can destabilize and reform such storylines. Gender politics
in music therapy discourse might occur at different levels of the discourse. It
might be connected to the practice of music therapy in general, to the therapeutic
process and the communication between therapist and client, in presentations
and literature, theory, or in research methodology. I will give a few examples of
how music therapy discourse might be an arena for gender politics. These are
potential areas for feminist critique, defined only through the connections to
feminist critique upon other disciplines. I will briefly outline four different
domains:
316 Randi Rolvsjord
1. Choice and use of musical instruments, musical genres and musical

roles
It is pointed out by several researchers in musicology that rock music as well as
the use of electric instruments has been dominated by male musicians, and that
female musicians’ practice in this genre is often devalued. Instead, women’s
roles are conservatively understood as pop singers, pin-ups, groupies, or sex
objects (Bayton, 1997; Cohen, 1997; Coates, 1997). To what degree is music
therapy discourse conserving traditional gender roles and distinctions related to
use of musical instruments, musical genres, and roles in musical performances?
2. In clinical practice and literature connected to sexual oppression,

sexual violence, and trauma
The traditional medical and psychological focus upon psychopathology as
problems residing in the individual is questioned by feminists. Such individual-
isation of problems and pathology sweeps important political issues concerning
oppression and sexual violence under the carpet (Ballou & Brown, 2002; Worell
& Remer, 1996/2003; Goldstein 1997; Jordan, 1997). To what degrees are the
discourse(s) in music therapy conserving political and social systems that
revictimize survivors of sexual oppression and sexual violence?
3. Research methodology and actual research

Postmodern feminism questions the very notion of “woman” and “man” and
emphasizes the multiplicity and fragmentation of gender identities rather than
differentiations. A strong critique is waged against the enormous amount of
research designed to reveal differences between “women” and “men,” and the
use of such studies to generalize about gender (Haavind, 2000; Alvesson, 2002).
In much of music therapy research we find the grand narratives “man” and
“woman” as unquestioned categories, even if the biological sex of the
informants seems unimportant according to the issue of the research. To what
degree is music therapy research concerned with generalisations about gender,
or to what degree is music therapy research open in terms of the multiplicity of
gender?
4. Use of gendered conceptualisations and metaphors

The use of gendered conceptualisations in descriptions of music is pointed out
by Susan McClary (1991), who claims that music is not politically neutral, but
even constitutive of gender politics. In her thought-provoking and controversial
book Feminine Endings (1991), she discusses how music has been described and
analysed in gendered terms, built upon binary oppositions. The masculine is
connected to the strong, the aggressive, the dominant, whereas the feminine is
attributed to the more lyrical, gentle, romantic, weak. One example that she cites
is the schema of the sonata–allegro movement that is the traditional opening
movement in the classical symphony. According to this schema, the second,
weak, feminine theme will conform and adapt to the first, strong, and masculine
theme during the exposition part of the movement. According to McClary, we
tend to attribute gendered meanings to music in a way that conserve traditional
gender stereotypes based upon the binary oppositions in language. The problem
is the use of categories that automatically lead to the making of essential
connections between the body, specific processes of social construction, and a
set of characteristics (Alvesson, 2002). To what degree are gendered metaphors
used in music therapy discourse(s)? And to what degree are such gendered
metaphors consistent with a reconstitution of the binary oppositions between
“man” and “woman,” between “female” and “masculine” traits?
A DESTABILIZING ANALYSIS OF “MOTHER” CONCEPTS

IN MUSIC THERAPY DISCOURSE
In the second part of this chapter, I will discuss how feminine and masculine
gender categories are represented in music therapy discourses through the use of
the “mother” concept. This gendered metaphor is widely used in music therapy
discourse, but here I will only put forward a few examples from the literature.
My critique of the “mother” concept in music therapy is aimed at the use of the
concept in situations that are not related to actual situations including primary
caretakers of the female biological sex. As I have already emphasized that the
political power of discourse must be related to intertextuality and context and
history, it is important that we look at how Mothering and Motherhood are
understood in a wider cultural and historical context.
The Mother—In Western History and Culture
Marriage and motherhood have, throughout modern western history, been social
contracts in which the woman’s desires and wants did not figure at all. Marriage
has been a regulation of man’s desires and a consolidation of the family’s
economic situation and wealth. In much of the philosophical literature, gender is
described in terms of polarities. For example, Jean Jacques Rousseau, describing
Emile and Julie and their living together, describes Emile as the active, inde-
pendent, educated, social person, and Julie as the passive, dependent, un-
knowing and withdrawn person. Emile goes to work; Julie takes care of the
318 Randi Rolvsjord
children, making a home base for her husband and their children. The polarities
are even clearer in the description of their sexual life: They contribute to the
same goal, but he is active and strong and she just adds a bit of resistance.
According to Rousseau, masculine love is Eros, which is connected to the desire
for the other, but female love is Agape, the servile and self-sacrificing love
(Forna, 1998; Viestad, 1989). Julie’s task is to create a nurturing atmosphere for
her husband and her children.
This type of depiction is also evident in literature and films, and in other
media presentations where mothers who sacrifice (sometimes even their own
lives) for their children are seen as “good” mothers, whereas those who are
selfish, meaning the mothers who do not sacrifice their lives or careers, are
“bad” mothers. This is just another version of the story of the Whore and the
Madonna. Good mothers stay home and sacrifice their work and their own
private interests. Good mothers keep the house clean and make healthy food.
Good mothers remember all the birthdays and organize the day for the whole
family. Susan Walzer (1998) argues that women experience expectations toward
motherhood as a pressure that makes them feel guilty. It seems that culturally, in
western societies, mothers are thought of as having nesting instincts, whereas
fathers are thought of as having breadwinner instincts (Fornäs 1998, Walzer,
1998; Henessy, 1993).
The “Holding Mother”
In recent music therapy literature, the mother-infant dyad has been widely used
to describe qualities in the musical interplay between music therapist and client.
Research on early communication and inborn capacities for communication
have influenced our clinical thinking, as well as our concepts of music
and musical communication. The research of Colwyn Trevarthen, Ellen
Dissanayake, Steven Malloch, Daniel Stern, and Metchild Papousek, among
others, has, in this way, contributed to music therapy theory and our
understanding of the musical interplay, supplying useful and nuanced concepts
(Rolvsjord, 2002).
Furthermore, the mother concept has been used by several music therapists
during the last decade to describe the holding, supporting, and nurturing
qualities of music therapists, and the holding, nurturing, and supporting qualities
of music. Some of these draw on Donald W. Winnicott’s theories on early
development and his concept of the “good enough mother” (Summer, 1995;
Wärja, 1999). Similarly, in Carolyn Kenny’s book The Field of Play (1989), the
musical space is said to be similar to the space created between mother and
child. She identifies this space as a “home base,” a safe as well as a sacred
space. Further, this “home base” is identified as a contained space, private and
intimate:
The musical space is a contained space. It is an intimate and private

field created in the relationship between the therapist and client. It is
a sacred space, which becomes identified as “home base,” a territory
which is well known and secure. In early childhood development, it is
similar to the space created between mother and child. (Kenny, 1989
p.79)
A somewhat different perspective is explored by Kenneth Bruscia (1995).

In his article “Modes of consciousness in GIM,” he discusses the therapist’s
modes of consciousness and the therapist’s ways of “being there” with the
client. Bruscia is taking a gender-oriented approach, discussing how archetypal
differences between female and male represent tendencies to “be there” for the
client in different ways. He emphasizes that these female and male ways of
“being there” are not solely connected to biological sex. But nevertheless, the
qualities connected to the female are that of the container, to be holding and
creating a nest, whereas, the male therapist is more likely to be a penetrator.
Again, the female qualities are connected to reproduction, body, and more
implicitly to mothering:
It occurred to me that if there are archetypal differences between

female and male with regard to space, and if these differences center
around tendencies to be container versus contained, and penetrator
versus penetrated, then the idea of moving into and out of different
worlds may make quite different demands on male and female
therapists. (Bruscia, 1995, p.194)
These holding, nurturing, supporting, and containing qualities are pointed

to as significant aspects of the therapist’s role and the music’s role in the music
therapeutic process by these authors. And I agree! Holding, supporting, and
nurturing as well as containing are important aspects of the therapist’s role, as
they are for the mother. However, I do not think that describing these as
“mother” qualities is useful. The mother in western culture is traditionally a self-
sacrificing figure with no desire, which makes her unable to create a relationship
based on equality and mutuality. When focusing on the holding, supporting, and
nurturing abilities as “mother” qualities, or when relating these to the female
gender in general, we tend to conserve the traditional mother and woman,
ignoring the universal aspects of these abilities (that is, as they apply to men as
320 Randi Rolvsjord
well), and making indistinct other qualities of the female gender. First, the
“holding mother” concept contributes to the conservation of traditional
expectations of gender roles. Second, the mother qualities in these examples are
explicitly connected to the “home base,” which is another strong connection to
the traditional mother and woman based in the domestic sphere.
The Holding, Nesting, and Nurturing Mother Represents a

Re-establishment of Gender Stereotypes
Mother, described as holding, providing a home base, nurturing, and containing,

is consistent with a woman’s role in life as defined in terms of reproduction:
giving birth and raising children. And let me emphasize, these are important
things to do, they are good and wonderful—I have four children. But why are
these qualities and characteristics predominantly connected to the female sex?
The question of sexual difference is, of course, in this discussion, most
interesting in terms of motherhood. Motherhood is often related to nature, the
“mother” concept is even used to express nature itself. However, although
reproduction is a biological phenomenon, we must also admit that motherhood is
a construction and that it is the result of cultural shaping and technologies.
Adoption, surrogacy, lesbian mothers, and “test-tube-mothers” are the concrete
evidence of such cultural and technological aspects of motherhood (Ragonè &
Twine, 2000). In spite of such technologies, the significant “mother” is difficult
to escape regarding pregnancy, childbirth, and breastfeeding, but nature does not
tell us to divide primary caregivers into “mothers” and “fathers” (Alvesson,
2002).
Although what is often called “the traditional family,” one in which the
mother is the primary caregiver and housewife, and the father earns the money,
is not the only model of family structure, it is still influential on how new
mothers and fathers transition into parenthood (Walzer, 1998). In Daniel Stern’s
(1995) book Motherhood Constellation, he stresses the importance of the
parenting models that we have experienced as educative to our own practice as
mothers and fathers. He claims that parents need support from other parents
from the same sex, usually their own mothers and fathers. In this way, he argues,
patterns of mothering and fathering are socially inherited. Stern’s argument is
similar to that of Nancy Chodorow (1978) who argues that parenting styles are
created through children’s identification with their own parents. Perhaps having
a more feminist agenda, she claims that boys who have experienced a father who
does not play an important part in caretaking, will devalue caretaking behaviour
because this is associated with femaleness.
Furthermore, it seems that in “equal families,” families where the mother

and father share the responsibility and the daily care for the children, fathers
communicate with their children in the same ways as mothers. In Daniel Stern’s
and Nadia Bruschwiler-Stern’s more popular book The Birth of a Mother
(1998), the authors state that in traditional families the father, when he comes
home in the evening, will interact with the baby more playfully and less
sensitively than the mother. He will throw the baby in the air and show less
sensibility towards the regulation of the baby. It is likely that the mother will tell
him to slow down so that the baby will go to sleep in the evening. But this
difference is not gender-linked or innate, say the authors, because when the
father stays at home with the children, and the mother comes home late after
work, she is the one that will be more playful and less sensitive.
Colwyn Trevarthen (1997) makes a similar point in his article entitled
“What infants’ imitations communicate with mothers, with fathers and with
peers.” In this article, he reviews a great deal of research on how fathers
communicate with their children. He emphasizes that in traditional families, the
infants seem to imitate and tune into their mothers more than their fathers. On
the contrary, in studies where fathers are primary caregivers, it was found that
the infants equally imitated and tuned into their mothers and fathers. This
indicates that familiarity more than biological sex is a significant factor.
There are many institutions in society that conserve or stabilize the
traditional mother role. Let me just give a few examples. First, I find it difficult
not to mention the toy stores and the toy commercials directed toward parents
and children. Toys intended for girls are toys that emphasize being beautiful
(and let me add: for whom?) and toys that emphasize domestic life and tasks,
such as ironing, making food, and dolls. Even the Danish trademark Lego has a
special series for boys and one for girls—for girls, with houses, dolls, and
horses, and for boys, with fishing, firemen, police, spacemen, etc. Second, I
would like to mention the large number of popular books about pregnancy and
childcare. I read one written by Sheila Kitszinger (1992). In that book, it is
suggested that the pregnant wife should arrange for a friend to help her husband
shop for the groceries if this domestic task is too heavy for her to carry out late
in the pregnancy! Such conserving of traditional patterns of mothering and
fathering are still keeping mothers from their careers and are keeping fathers
from more contact with their children. It is also providing mothers with what
Walzer (1998) calls mental mother labour and guilt. This mental mother labour
and guilt involves an expectation of her having primary responsibility for the
children as well as for the domestic work. Walzer argues that there is both a
relational and an institutional context for gendered transitions into parenthood.
Institutional reinforcement exists, related to the labour market, birth and
322 Randi Rolvsjord
childhood education during pregnancy and early childhood, in media, film, and
literature.
The images of motherhood that I have explored here can be understood as
storylines, more or less conscious images that seem to be conserved or even
constantly constitute our understanding of and interaction as mothers and
fathers, and our relationship as parents. The music therapy discourse that
continually describes these holding and nurturing and nest-building motherly
therapists, or motherly music, will stabilize such storylines about parents’
engendered roles and sexual differences. Some authors in music therapy as well
as in psychoanalytical writing, for example, try to escape the gendered meaning
of the “mother” concept by explaining that people of both sexes could have
mother qualities, or by stating that when using concepts like “mother-infant
interaction” they really mean “primary caretaker-infant interaction.” However, I
think the concept of mother is so closely related to the female sex that our
associations will conjure up a female person, and then exclude the holding father
as well as the holding and nurturing male music therapist. The challenge for the
feminist music therapist must be to find non-gendered concepts to describe
general human abilities.
Rethinking the Therapeutic Relationship—Do We Need the

“Holding Mother”?
It needs to be emphasized that mothers are not self-sacrificing, desireless,

abjects (to use Kristeva’s terminology). Many mothers are not oppressed, but
equal to men in domestic life as well as in professional and other domains of
life. Other mothers are happy as traditionalists, and are even fighting in the
name of feminism to increase the value of the traditional mother role (Hennessy,
1993). But the position and representation of “mother” in language and
discourse is problematic independent of the actual situation of some or even
most mothers. If the gender stereotypes such as the nesting, nurturing, and
holding mother are preserved in language, the language might be used in a way
that normalizes inequality, and thereby restrains some women as well as some
men from important life experiences and possibilities. However, this is not
solely a question about gender politics, although this has been the main concern
in this chapter. It is equally important to ask whether the “holding mother” is a
good metaphor for the therapist’s role in the therapeutic setting.
If the “holding mother” metaphor is functioning as a model for the
therapist’s role, this might restrain the therapist from becoming a visibly
authentic person for the client. Such a distanced and unauthentic therapist role is
not consistent with the philosophy of feminist therapy that emphasizes

egalitarian relationships (Worell & Remer, 2003; Jordan, 1997). This is a
question about roles and relationships. Judith Jordan and Linda M. Hartling
(2002) argue that growth fostering relationships are characterized by mutual
empathy and mutual empowerment. They explain this mutuality stating that:
When individuals are engaged in mutually empathic and mutually

empowering relationships, both people are becoming more
responsive in fostering the well-being of the other and of the
relationship itself; both people are growing through connection.
(Jordan & Hartling, 2002, p.51)
Moreover, they argue that the outcome of such a mutual relationship is also a
desire for relationships that go beyond that particular relationship. Hence,
growth is not a development towards separation and individual autonomy, but a
development towards greater mutuality and empathic possibilities. In order to be
empowered in the relationship, people need to contribute to, as well as to benefit
from, relationships (Sprague & Hayes, 2001, p.683).
To actively strive to establish such a mutually empathetic, mutually
empowering relationship with the client is, however, not to disclose anything
and everything. It does not mean to abandon the asymmetry of the therapeutic
relationship in terms of the legal constraints or the economic and professional
basis. It does not imply that the client is going to take care of the therapist
(Surrey, 1997). Nor does such a mutual relationship represent a withdrawal from
professional competency and professional skills. Mutuality does not imply that
we are alike (identical) (Sprague & Hayes, 2001). Mutuality refers to a way of
being in the relationship, empathically attuned, emotionally responsive, authen-
tically present, and open to change, and is something that can also be
constructed between people with very different abilities (Surrey 1997; Sprague
& Hayes, 2001; Rolvsjord, 2004b).
CONCLUSION
In this chapter, I have argued that the discourse of music therapy is political. The
use of the “mother” concept that I have criticized is obviously not intended to
conserve the traditional gender roles and the patriarchal power structure that is
implicit in the female-male dichotomy. However, in ignorance of such
conservation of traditional and patriarchal (sexist) values and politics, music
therapists might reconstitute the traditional storyline of the self-sacrificing,
324 Randi Rolvsjord
caring woman situated in the domestic sphere. This “mother” concept is even
more problematic because it is the use of a gendered concept to describe general
human capacities and characteristics. Furthermore, the “holding mother” is also
questionable as a model for the therapist’s role in the relationship between
therapist and client, because it is believed that “she” is unable to go into equal
and mutually empowering relationships.
The political power in music therapy can be related to what is called
defining powers. This power makes music therapy discourse(s) constitutive of
music therapy and even influences the client’s experiences in therapy and the
outcome of the therapeutic processes. But it also urges us to be more reflexive
about larger political, academic, and cultural contexts and discourses and to be
aware of the intertextuality of discourses of which music therapy is a part.
The other day my daughter asked me if women can ride motorbikes. And
people question whether there is still need for feminism!
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READING 29
Rolvsjord, R. (2010). Four Excerpts: Resource Oriented Music Therapy in Mental Health Care,
pp. 18-37, 38-58, 59-72, 73-88. Gilsum NH: Barcelona Publishers.
Excerpt One
Chapter 1
MUSIC THERAPY AND THE POLITICS

OF MENTAL HEALTH CARE
Randi Rolvsjord
The practice, discourse, and research of music therapy are performed in a
cultural, social, and political context. The politics of music therapy are
interwoven with politics of science, politics of health, and cultural politics.
Even if therapy as such is commonly considered an apolitical activity, it is
inevitably connected to a web of politics. Any practice of music therapy is
linked with political conditions and decisions on various levels of the
institutional and cultural contexts, whether the music therapists are
involved with social activism or they comply with the ideological and
economical systems in which they are posited. Thus, on both practical and
theoretical levels, music therapy is performed in contexts that are molded
by various political conditions and ideologies regarding health, illness,
and therapy, as well as ideologies of music and science. In this book, a
strong emphasis will be put on a philosophy of empowerment that also
embraces the idea of therapy as being political per se and even
encourages political activism as part of therapeutic endeavors.
In this chapter, I will outline some recent discussions regarding
mental health care with strong political undertones that form an important
premise for the discourse in this book. The starting point for this will be
the implications of an “illness ideology” for mental health and mental
health care. Thus, the resource-oriented approach presented in this book
links with theoretical perspectives that to various degrees contain levels
of critique and political engagement. This level of critique involves:
 skepticism toward diagnostic systems;

 skepticism toward the belief in interventions as the exclusive
effective factor, and therefore critique of the evidence-based
medicine movement;
 critique of excessive focus on problems and pathology;
 critique of individualistic focus on health concerns; and
MT and the Politics of Mental Health Care 19
 critique of the power structures in psychiatric health services.
I will argue that the m edical model at the core of the illness ideology
has been and is a very strong model that has influenced and dominated the
discourse an d understandi ng of m ental health, of illness and disease, of
mental health care and psychotherapy, as well as of research in this field.
There have, however, in recent d ecades, been political and social
movements counteracting the illness ideolo gy related to health c are in
general and mental healt h care in spe cific that have yielded influences
over political levels of decisions.
An important political signal that broade ns up the conceptualizations
of health and health care is the World Health Organization’s (WHO)
constitutional definition of health, which states that “health is a state of
complete phy sical, menta l, and soci al well-being and not m erely the
absence of disease or infirmity” (World Health Organization, 1946). With
this constitut ion, m ental health con cerns are related to political, social,
and cultural l evels rather than m erely biological and medical ones. This
broadened scope has i n Norway cont ributed t o political decisions of a
conceptual change from psychiatry to mental health care, this imply ing a
change of di rection in m ental health care politics that involve s more
interest in social and cultural aspects, as well as in positive health.
Similarly, sin ce the 1970s, patient activists in the USA and Euro pe
have aggressively asserted their clai ms to be regarded as experts on their
own illnesses, with the rights to play an active role in health car e
decision-making. Today, this has become an important principle in mental
health care policy (Tomes, 2007). This emphasis on user participation has
been connected to a broader focus in society on the rights and possibilities
connected to dem ocracy and citizenship (Bra ye, 2 000). Terms such as
“user participation” have, however, be en used in ways with re gard to
mental healt h care that carry meanings vary ing from compliance t o
medical tre atment to us er-led servic es. Therefore, in practice, user
participation in health care may ofte n involve consumerism rather than
democratic p ossibilities. Thus we may ask if the language of patient
empowerment when used to justif y positions in political debates has
become essentially bankrupt (Becker, 2005; Tomes, 2007, p. 698).
20 Randi Rolvsjord
THE POLITICS OF AN ILLNESS IDEOLOGY
Over the pas t decades, th ere has be en an ever-wid ening definition of

psychological distress. The increasin g num bers of diagnostic labels
available in the diagnostic manuals DSM-IV ( American Ps ychiatric
Association, 2007) and IC D-10 (World Health Organization, 1999) serve
as a manifestation of this development. We m ay in s ome ways relate this
development to the evolvi ng com petence of the inv estigation of mental
health disorders, a developm ent that m akes possible m ore nuanced
categories of mental health problems an d might at th e best provide so me
better indications for available treat ments. As Maddux em phasizes in the
following q uote, however, this developm ent also ha s wider i mplications
related to the politics of m ental heal th care as well as to the wider
understanding of mental health problems in our society:
We are fast approaching the point at which everything that human

beings thi nk, feel, do, an d desire that is not perfectly logical,
adaptive, or effective will be labeled a mental disorder. Not onl y
does each new cat egory of m ental disorder trivialize th e
sufferings of people with severe psy chological difficulties, but
each new category becomes an opportunit y for i ndividuals to
evade m oral and legal res ponsibility f or their behavior (Resnek,
1997). It is time to stop the “madness.” (Maddux, 2002a, p. 18)
With reference to the field of ps ychology, Mad dux claim s the

existence of an illness ideology,8 an underlying model of thinking that has
become dominant in mainstream psychology. This ideology “narrows our
focus on wh at is weak and defective about peop le, to the exclu sion of
what is strong and health y” (Maddu x, 2 002a, p. 322). According t o
Maddux, t he illness ideology is cons istent with certain assum ptions
concerning t he field of psy chology an d the practice of psy chotherapy.
Within such a model or i deology, th e practice of p sychotherapy and the
field of psy chology in general are prim arily concerned with
psychopathology. Second, the illness ideology links with a discrete m odel
8
Other resea rchers use sim ilar conce ptualizations, s uch as “m edical model”
(Wampold, 2001), “d isease m odel” (Mech anic, 199 9), or “p athogenic
orientation” ( Antonovsky, 1 979; 1 987), t o descri be a si milar set of u nderlying
assumptions.
of mental health problems, describi ng clinical problem s and clinical

populations as differing in kin d, not just in degree of rem oval fro m
normality. Third, m ental health problem s and psy chopathology are
identified as so mething that resides in the indivi dual. Finall y, it follows
from the se a ssumptions that the therap ist’s task is to identif y (diagnose)
and prescribe an intervention (treat ment) that will eli minate or cu re the
disorder (Maddux, 2002a, p. 14).
I wish to emphasize that the notion of therapeutic practice in the field
of mental h ealth prom ulgated by t he medical model is a highl y
dominating discourse, as has been poi nted out by s everal critical voices
for decades (Engel, 1977; Furedi, 2005; Illich, 1975; Maddux, 2002a;
Seligman & Csikszent mihalyi, 2000; Szasz, 1979; Wam pold, 2001).
However, it is i mportant to em phasize that in ps ychotherapy (and also in
music therap y), the m edical model does not im ply a m odel that is
physiochemically based, but one that takes the sa me form as the medic al
model in medicine (Wampold, 2001):
To summari ze, the medical model presented herein takes the

same form as the medical model in medicine, but differs in that
(a) disorders, problem s, or co mplaints and rationale for change
are held to have psy chological rather than ph ysiochemical
etiology; (b) explanations for disorders, problems, or complaints
and rationale for change are psy chologically rather than
physiochemically based; and (c) s pecific ingredients a re
psychotherapeutic rather than m edical. Because the medical
model of psy chotherapy requires neither ph ysiochemical no r
mentalistic constructs, strict be havioral intervention s would fit
into this model. (Wampold, 2001, p. 16)
In this way, the critique of a medical model in mental health care and
psychotherapy is not primarily a critiq ue of t he biomedical model and its
relevance to psy chiatry, as is the foc us in some critical contr ibutions
(Engel, 1977; Szasz, 1979). The cr itique of the medical model b y
Wampold, Maddux, an d others do es not im ply a t otal rejection of
biological factors related to m ental health, nor does it im ply a
nonapproval of pharm acological treatm ents. The main point of this
critique of the medical model is related, rather, to a structural metalevel of
the model as explained by Wampold in the previous quote and si milarly
identified b y authors in fa vor of a m edical model (Oates, 1995; Shah &
Mountain, 2007). However, it is difficult to concei ve of an alternative
22 Randi Rolvsjord
approach wit hout appro val of the need for an understanding of mental
health and mental health problems involving biological, psy chological,
social, and cultural perspectives.
With a cons tructivist per spective, Maddux identifi es the illness
ideology as a strong discourse or a grand narrative (Alvesson, 2002) —
that is, a dominant and often inexplicit underlying theory. From the point
of the social constructivist, mental he alth, mental health problems, and
diseases are social constructions based in a set of values that form our
conceptions of m ental he alth and of diseas es. Ter ms that are commonly
used when talking about therapy, such as “illness,” “treatment,” “patient,”
“clinic,” “clinical,” “intervention,” and “symptom,” are all consistent with
the illness ideology . By using this lang uage, he claims, we enter into the
discourse of the illness ideology:
The terms em phasize abnorm ality over norm ality,

maladjustment over adjustment, and sic kness over health. The y
promote the dichotom y be tween norm al and abnormal
behaviors, clinical and no nclinical pro blems, and clinical and
nonclinical populations. The y situa te the locus of human
adjustment and m aladjustment inside t he person rat her than i n
the person’s interactio ns with the environment or in
sociocultural values and sociocu ltural forces such as prejudice
and oppression. Finally, these t erms portray the people who ar e
seeking help as passive victi ms of intrapsy chic and biological
forces bey ond their direct control, who therefore should be the
passive recip ients of an expert’ s “care” and “cure.” (Maddux,
2002a, p. 14)
One pertinent exa mple is the use of the term “intervention” (Bohar t
& Tallman, 1999, p. 13; Maddux, 2002a), a term that has been used rather
unreflectively in m usic therapy literatur e as a seem ingly “neutral term”
describing the therapist’s goal-direct ed use of techniques. Even in
Bruscia’s definition, m usic therapy is a “ systematic process o f
interventions” (Bruscia, 1998, p. 20). This term, which is also associated
with m ilitary language, i mplies that someone from the outside i s taking
action. This someone, who is dedicated to the interve ntion, is usually the
therapist, although I will argue in this book t hat the client takes similar
actions in the m utual interplay in music therapy . In m usic t herapy
discourse, I consider the use of the term “intervention ” to be connected to
a medical model because i t is a ter m that is exclusiv ely used to describe
the therapist’s actions, usually indicating the choice and subsequent use of
a technique in order to achieve a certain effect. This implies a discourse in
which the therapist’s actions are regarded as more important in relation to
the outcom e of therapy than the client’s, thus preserving the traditional
patriarchal power relation. This is not at all to argue that the therapist’ s
actions are unim portant, nor that the therapist is “not doi ng an ything.”
The term “intervention” is, however, problematic in a discours e
emphasizing equality and mutuality, and I therefore prefer to talk about
collaborations, negotiations, and inter actions when describing the process
of resource-oriented music therapy.
It is exactly s uch exaggeration of the professional expertise to which
medical sociologist Fure di points when discussing the societal and
personal im plications of the illness id eology. Furedi holds that we (in
Western soc ieties) are d eveloping a therapy culture, a culture tha t
involves a cultivation of vul nerability am ong people because we
increasingly tend to perceive people’ s life problems a s pathology in need
of pr ofessional expertise. Furedi po ints to a par adox related to the
therapeutic practice. Most ps ychotherapeutic traditi ons, he argu es, hold
up a therapeutic ideal related to self-determ ination and autonom y. This
ideal is, however, in shar p conflict with the mes sage that a pers on once
labeled with a mental hea lth diagnoses is in need of experts. Thus, the
helplessness, powerlessness, and vulnerability are emphasized, along with
the “promised” effect related to self-determination and autonomy:
With such high rates of prevalence o f illness and dam aged

emotions, the ideals of therapeutic self-deter mination are
negated by a powerful cultural narrative of hum an helplessness.
(Furedi, 2004, p. 114)
Receiving this double message, people beco me disem powered and

socially and culturally de pendent upon m edical ex pertise to solve their
problems. Following Fur edi’s argum ent, the developm ent of such a
therapy culture makes it more likely that people will perceive themselves
as ill9:
In practice, therapeutic culture hel ps individuals reconcile

themselves to a more “realistic” and more “vulnerable” versio n
of the self. T he self i s presented as constantly subject to grav e
9
See also Illich’s famous arguments about medical nemesis (Illich, 1975).
24 Randi Rolvsjord
injury and illness. Th e insistence that such risks are part o f

everyday life has the effect of heightening the individual’s sense
of vulnerability and disposition to illness. (Furedi, 2004, p. 107)
It has to be added here that the po wer of expertise that to an

increasing degree is merged with professionalism is also a social
construction that is connected not only to governmental recognition,
license, and legitim ization (Johnson, 2 001), but also to the interactions
between professionals and lay persons accepting the professionals’ rights
to authority (Purdy & Banks, 2001).
One of the most prominent aspects of mental health politics over past
decades has been th e evidence-based medicine movement and its siste r
movement, evidence-based practice in related disciplines. Wam pold
(2001) outlines two curren t examples of adherence to the medical model
in ps ychotherapy discour se — psy chotherapy treatm ent manuals and
empirically supported treatm ents — that we might relate to th e EBM
(evidence-based m edicine) m ovement. The EBM movement adheres to
the medical model in directing treatm ent toward a disorder, probl em, o r
complaint; in the use of therapy m anuals; and in requiring evidence
related to specificity — for exa mple, via the use of placebos. In this way ,
the EBM movement can be understood as one manifestation of the illness
ideology. I have to e mphasize here, however, that it need not necessarily
be so. I am not try ing to argue against effect studies per se; rat her, m y
concern is that these de mands for evidence-based research easily force us
into m edical-model thinking, b y the fundamental question, “What
works?” So even if the proposed hierarchy of evidence (Ansdell ,
Pavlicevic, & Procter, 2004; Goodm an, 2003) does not necessitate a link
between diagnosis and int erventions, the medical model is very often
taken for granted in the EBM movement.10
As outlined here, one of the main problems with the illness ideology
is connected to the underlying p ower relation involvi ng t he person
seeking help and the therapist, as well as to m ore s ystemic level s in the
organization of mental he alth care. Th ere ar e dile mmas rel ated to the
policy of t he EBM m ovement on t he one hand and t he call f or user
participation on the oth er hand. The EBM movement on o ne hand
enhances the possibilities for user participation as consumerism, but at the
same ti me, it is conserving the un equal power relation between experts
10
I hav e prev iously d iscussed th is along with co lleagues (Rolvsjord, Go ld, &
Stige, 2005a).
and clients and in this w ay lim its possibilities for (dem ocratic) user
participation.
THE PRESENCE OF A MEDICAL MODEL

IN MUSIC THERAPY
At this point, the reader might ask if there is such a thing as a n illness
ideology or a medical model in music therapy. To this, I will say “yes.”
The medical model in psychotherapy is more than a “straw man,” a fictive
model cr eated sim ply in order to present the resource-oriented approach
as an original contributio n, i.e., one that offers new k nowledge and ideas
about m usic therapy. Whe re I have already i n the i ntroduction c laimed
that resource orientation i s not a factor common to all traditions and
practices of theory , this is first of all because I se e the m edical m odel
alive and well in music therapy discourse.11 As the medical model also in
music ther apy m ight be a so-call ed grand narrative that is ta ken for
granted and not discussed explicitly , adherence to this model is often not
made explicit in texts.
Although a physiochemically based approach is not the core of a
medical model, as explained previous ly, a medical (ph ysiochemically
based) music therapy would be likely to adhere with such a m odel. The
clearest example of this in music therapy literature pertaining to t he field
of mental health is perhaps Unke fehr and Thaut ’s (2005) book, which
combines behavioristic ps ychological theory with neu rological
perspectives. Thaut (2005) describ es his theoretical model in the
following w ay, pointi ng out the specificity of the therapeutic
interventions as the main source of change:
Renewed efforts are un der way to develop a theoretical paradigm

of m usic therapy in ps ychiatry, in which the uniqueness,
efficiency, and specificity of th e therapeutic music interventions
can be conceptualized and r esearched with an e mphasis on a
cognitive neuropsychiatric framework (Halligan & David, 2001) .
Such a paradigm must be able to integrate m usical response
models in music perception and music cognition with concepts of
11
See also Ansdell’s description of a consensus model in music therapy discourse
(Ansdell, 2002; 2003), with many similarities to the medical model.
26 Randi Rolvsjord
music’s influence on nonm usical hum an behavior,

psychologically and neur obiologically, and with concepts of
behavioral learning and therapeutic change. (Thaut, 2005, p. 86)
More analogous to a phy siochemically based medical model, from a

behavioristic approach, are music act ivities and m usical inter actions
intended to provide posi tive reinforcement for appropriate b ehavior
(Silverman, 2003). The success of the music therapeutic interventions is
measured in t erms of the frequency of inappropriate behavior, as defined
by the m usic therapist. The result is a rather mechanical an d linear
understanding of the t herapeutic pr ocess in accordance with the medical
model. Musi c therapy interventions are decided by the therapis t, who
makes the decisions based upon her or his expertise.
Specific clini cal interventions are suggested in the last chapter of
Unkefer and Thaut’s (20 05) book in t he form of a manual (Houghto n,
Scovel, Smeltkop, Thaut, Unkefer, & Wilson, 2005). In accordance with
the medical m odel, this guide describes the sy mptomology of
schizophrenia, bipolar disorder, and General Anxiet y Disorder, an d links
music therapy programs as well as specific techniques to the pathological
symptoms via an identification of th e needs of a patient displ aying a
specific symptom or behavior characteristic.
A si milar e xample is the m ultimodal ps ychiatric m usic thera py
manual by Cassity and Cassity (2006), in whic h the y describe the
therapeutic process in terms of an accountability procedure that is in
accord with the General Standards of the AMTA, focusing on referral and
acceptance, assess ment, program planning, im plementation,
documentation, and termination of services. Several other articles suggest
interventions or techniques related spec ifically to a particular deficit or
problem (Silverm an, 2005; Sm eijsters & Cleven, 2006). Odell -Miller
(2007) sug gests that music therapists select their intervention s (i.e.,
choose ways of working) on the basis of the client’s diagnosis. Indeed, in
her literature review, she identifies only one article (Stige, 1999) that very
clearly states that the inter vention was not based on the client’s diagnosis
(Odell-Miller, 2007, p. 109). T his may indicate a m ore widespread
adherence to the medical model. Odell-Miller considers “that the presence
of diagnostic criteria serves to provide an understanding of what someone
might need in terms of an intervention” (2007, p. 84).
Finally, liter ature linking to psychoanalytic and psychodynamic
psychology a nd ps ychotherapeutic traditions represents a major part of
the music therapy literatur e in the field of adult m ental health and is in
many ways the dominant position in this field of practice. However, it is

not self-evident what we include i n this “big box” of t radition.
Psychoanalytically informed m usic the rapy is rather heterogeneo us, and
music therapists making use of psy choanalytically inform ed theo ry m ay
also belong to different traditions of music therapy such as those founded
by Priestley, Nordoff an d Robbi ns, or Benenzon . Furtherm ore, music
therapists using ps ychoanalytically oriented perspectives in the field of
psychiatry relate to a l arge spectrum of traditions and theories with in the
psychoanalytic landscape, such as Fr eud and Klein (Priestley , 1994;
Streeter, 1999), Jung (Austin, 1999; Pr iestley, 1994), Lacan and Bion (De
Backer, 2004; De Backer & Van Cam p, 2003), Winnicott (De Backer &
Van Cam p, 1999; Jensen, 1999; Stige, 1999), or Stern (Hannibal, 200 3;
Rolvsjord, 2001; Stewart, 1996), to mention just a few (see also Hadley ,
2003). The differences within these theories are considerable with regard
to perspectives on the causality of psychopathology, with regard t o
understandings of the therapeutic process, and not least with regard to the
The origins of ps ychoanalysis, h owever, lie in the medical model
(Pilgrim, 1998, p. 537; Wampold, 2001, p. 10), pointing to the practice of
Freud as a phy sician developing treatment for hysterics. There are indeed
also sever al aspects related to the tr adition of Analytical Music T herapy
(AMT, the P riestley m odel) that are analogous to a medical model. The
focus in AMT is intrapsy chic conflict (Priestley, 1994, p. 155ff.), and the
main ai m i s described in ter ms of regulation the patient’ s defense
mechanisms (Priestley, 1994, p. 170). Such aspects relate to a primary
focus on conflicts and resides the problems in the intrapsy chic. The
therapist’s role is also considerably analogous to the expert’s role in the
medical model, as AMT emphasizes t herapist expertise and skilled and
parental or even patriarchal 12 interventions as define d through several
specified techniques (Priestley , 1994, p. 37ff.) and i nvolving possibilities
for the therapist to directly access a nd understand the inner conflicts of
the client through t he symbolic music and processes of transfer ence and
countertransference. Thus, the traditional version of ps ychoanalysis and
analytical music therapy can be seen to align well with a medical model.
Psychoanalysis in general, as well as analy tically oriented m usic
therapy, has developed considerably since Freud. Indeed, a paradigmatic
12
Priestley ( 1994) con sequently n amed th e t herapist “h e” and th e clien t “she,”
which implies a disc ourse accepting a very patriarchal tradition. The patriarchal
tendency of psychoanalysis is also emphasized by De Backer (2004, p. 78).
28 Randi Rolvsjord
shift within psy choanalytic theori es in music ther apy from monadic to
dyadic forms has been des cribed (Wigram, Bonde, & Pedersen, 2002 , p.
83). Very i mportant in this concern are the persp ectives furnished b y
research into early infant development (by researchers such as Trevarthen,
Mead, Stern, and Bråthen, among others) that transformed developmental
theory in the 199 0s. This developm ent com prised a rejection of central
aspects r elated to Freud’ s libido theory , Mahler’ s concept of s ymbiosis,
etc., and resulted in greater focus upon the present moment (Stern, 2004),
relationship ( Alvarez, 1992; Stern, 2004; Stern et al., 199 8), re source
activation (Wöller & Kruse, 2001), and acting as well as talking (Johnsen,
Sundet, & Torsteinsson, 2000). The se develop ments obvious ly also
introduce more “positive” or strengths-oriented aspects to the therapeutic
interaction in m usic therapy . Pede rsen’s ego-supportive therapeutic
approach, “a reorganizing and holding method” (Pedersen, 1998; 1999) or
Metzner’s focus on interactions and scenic understanding (Metzner, 1999;
2004) can be seen as r epresentative in this regard. There are al so case
studies that clearly describe the results of an analytically oriented therapy
process in terms of the development of strengths and resources (Hannibal,
2003; Nolan, 200 3; Peder sen, 2003) and a few contributi ons moving
toward a more contextually orient ed use of ps ychoanalytic theory
(Maratos, 2004; Metzner, 2007). In t his literature, however, focusing on a
client’s strengths and potentials is still seen as a t ool for com ing into
contact with basic inner conflicts (Ha nnibal, 2003), rather than a primary
concern of the therapy . Further, the primary function of m usic see ms
predetermined as a symbolic display of the unconscious (De B acker &
Van Camp, 2003), co ntributing to maintain an expert-knower posit ioning
of the thera pist. So eve n with the r elational turn in psychoanalysis,
psychoanalytic approaches in several way s adhere to and stabilize the
discourse of the illness ideology.
WHAT IS MENTAL HEALTH?
How we conceive psy chological illness and wellness has wide-

ranging implications for individuals, m edical and mental health
professionals, government agencies and programs, and society
at large. (Maddux, Snyder, & Lopez, 2004, p. 321)
The illness ideology, as outlined previ ously, im plies that health and
disease are understood according to a discrete model. In such a discrete or
dichotomous model, health is seen as th e usual state of being and disease,
the un usual state. Thus, health is u nderstood as an either-or state.
Alternatively, in a continuum model, health and illness are seen as
opposite poles of a contin uum. According to such a model, m ental illness
is not a distinctly different categor y from mental health, and there ar e
instead vary ing degrees of sickness an d norm ality (Horwitz & Scheid,
1999, p. 1). With regard to m ental health and illness, the continuous
model is disputed. Ove r recent d ecades, biomedical rese arch has
increased its emphasis on a discrete model. We can also observe a similar
emphasis of a discrete model in research related to mental health with the
EBM movement. In m ost cases, however, the causes and conditi ons of
mental illness are disputed and the treatments uncertain (Mechanics, 1999,
p. 1 5). Am ong th ose who adhere to a discrete model, this problem is
usually seen as a weakn ess in the diagnostic sy stem rather t han an
argument for a continuous model.
The ps ychiatric diagnosti c manuals (DSM-IV an d ICD-10) are,
however, clearly based on conventions rather than on any objective reality
of discrete diseases. Thus, adherence to a continuous model will usually
lead to less emphasis bei ng put on making definite diagnos es, sin ce
treatment approaches are unlikely to differ on the basis of meeting
diagnostic cri teria (Mechanics, 199 9, p. 16). Horwitz and Scheid ( 1999)
argue, however, that we might not need to have an absolute answer to this
problem if we also allow the research questions being addressed to direct
our view of mental health and disorders (Horwitz & Scheid, 1999, p. 2).
Understanding health as a continuum is in many ways similar to the
dialectic appr oach to health describ ed by Jensen (1994). This approach
might help us disentangle another perti nent aspect of health. A d ialectic
approach im plies that understa nding is gen erated through the
transgressing of oppositi ons. The dialectic view of health em braces
oppositions such as life and death, pain and well-being, illness and health
(Jensen, 1994, pp. 19–20), and involves and interest in the positi ve-health
end of the continuum with regard to research as well as strategies for care.
Aspects of positive health and well-being are also em phasized as an
important part of health — for instan ce, in health psychology ( Blaxter,
2004; Marks , Murray , E vans, & Willig, 2000), and by the positive
psychology movement (Carr, 2004; Sn yder & Lopez, 2002). A basic
assumption in the dialecti c concept of health concerns the rel ationship
between well-being and pain and that between life and death. It is argued
30 Randi Rolvsjord
that well-being cannot b e experience d withou t th e feeling of pain or

illness. It is not so much the absence of illness that matters for a person to
be able to experience good health, as it is how illness affect s the person’s
life. Health then becomes a quality of human life, perm itting a variety of
ways in which the tensions between pleasant and painful aspects of life
can be managed. With such a dialectic concept of health, different
strategies for prom oting health can be acknowledged. Thus, i t seems
important to understand health in way s that may comprise both ph ysical
and psychological aspects of negative health (that is, disease) and positive
health (which would include nonphysiological aspects of well-being).
Finally, it is also important, as Stige (2 002; 2003a) emphasizes with
his definition of health that relates to “qualification for participation,” to
see health in general as well as mental health in relation to the social,
cultural, and economic/material context. Stige em phasizes that health, as
well as health problem s, are “due to com plex interactions betwee n
biological, cultural, socia l, and cultur al factors” (Stige, 2 003a, p. 20 3).
Thus, Stige argues for a position that allows for biological as well as
social and c ultural causes of illn ess as well as health being im puted
through the relationship between individual and community. This implies
an emphasis on the societal and community concerns for health. Although
bad health as well as good health are always experienced and situated in
the individual person, health, as well as health p roblems, are alway s
experienced and constructed in context, in relation to social, cultural, and
political aspects. With suc h a position, which we a lso m ight associat e
with the social disability m odel (Donoghue, 2003; Freund, 2001;
Simenski, 20 03), m ental health pro blems are at least to som e extent a
function of t he society involving cultural, societal, and political norms
and constraints for participation.
With regard to mental health, authors have pointed toward aspects of
our postmodern society t hat can be r egarded as constructive o f m ental
health and mental health pro blems (Cushman, 1995; Whitel y, 20 08).
Whitely ( 2008) argues that society in i ts post modern condition of rapid
sociocultural change is a ssociated with some psychosocial costs, or links
between this society’ s influence and mental health. Whitely argues that
tendencies in postm odern time such as individualization, social roles and
self-identity, the culture of expertise, the transformat ion of intim acy, and
future orientation are related to a person’s experience of m ental health as
well as to ideas of mental health care and psychotherapy.
STRATEGIES FOR MENTAL HEALTH CARE
Contemporary Western medicine is likened to a well-organized,

heroic, and technologically sophisticated effort to pull drowning
people out o f a raging river. De votedly engaged i n this task,
often quite well rewarded, the establish ment members never
raise their ease or minds to inquire upstream, around the bend in
the river, about who or what is pushing all these people in.
(Antonovsky, 1987, p. 89)
This metaphor, kn own as “the bias of the downstream focus,” 13 is

used by the I sraeli medical sociologist Aaron Antonovsky to position his
salutogenic orientation in the land scape of health-work traditions. To
explain his salutogenic orientation, he continues the metaphor:
To continue the metaphor, m y fu ndamental philosoph ical

assumption is that the river is the stream of life. None walks the
shore safely. Moreover, it is clear to me that much of the river is
polluted, literally and figuratively . T here are forks in the river
that lead to gentle stream s or to dangerous r apids and
whirlpools. My wor k h as been devoted to conf ronting the
question: Wherever one is in the stream — whose nature is
determined by historical, so cial-cultural, and phy sical
environmental conditions — what shapes one’s ability to swi m
well? (Antonovsky, 1987, p. 90)
Antonovsky holds that in attempting to approach an understanding of

health work, including health prom otion, prevention of diseas e, and
therapy, two fundamentally different strategies are possible. The first is
the traditional medical strategy that aims to explain wh y people beco me
ill and how to cure the illness. The other strategy , as a contrast, aims
toward explanations of w hy peo ple maintain good health. To cope with
illness, and to m ove toward hea lth through the strengthening and
development of resources that prom ote capabilities of assi milation and
coping, is the main therapeutic stra tegy. Antono vsky’s perspectives lead
13
The m etaphor was orig inally presen ted i n “m oderately an timedical
establishment literatu re.” A more ex act referen ce is not g iven in Antonovsky’s
text.
32 Randi Rolvsjord
us toward a direction that involves a mental health care practic e that is

engaged with coping a nd positive health as well as health problems and
illness. A problem , however, is that Antonovsky’ s strategy might be too
much involved with the indivi dual’s abilit y to adapt to a stressful
environment and is not taking into account the collective levels of human
existence (Stige, 2002, p. 189), and thus conforms to an individualization
of health concerns. 14 In th e continuati on of this, w e should also ask
whether the emphasis on adaptation in Antonovsk y’s m odel leads to an
approach in which the mentally ill person must him- or herself be blamed
for a lack of ability or effort to adapt.
I have alread y argued tha t one of the problem s with the m edical
model is the individualization of health concerns. It is to be e mphasized
that focusin g on positi ve health does not exclude the risk of
individualization of m ental health prob lems. Similar critiques are also
raised about the positive psy chology and resilience r esearch by Maracek
(2002). From a postm odern fem inist p erspective, Maracek argues that
resilience is a description of the indi vidual’s capabilities to assi milate to
the environment, mainly the capabilities to cope with stressors. T he slide
from there t o blam ing t he victim is all but ine vitable. Furnishing
examples from resear ch i nto women’ s ability to cope with and recover
from gender-linked vi olations, she say s that “the Resilient Wom an stifles
social critique; her im age replaces a focus on s ocial and econom ic
injustices with a f ocus on indivi dual trium ph thr ough personal will”
(Maracek, 20 02, p . 11). So b y too little focus on the contextual aspects ,
the risk of ending up with a “re-s ilent” wo man rat her than “resilient”
woman is ob vious. Hence, we are in ne ed of strategi es for mental health
work that take into consideration aspects of coping and positive health but
with a mindfulness to contextual aspects.
The challenge is perhaps to de vise theories that can be calle d
“both/and” theories, theories that see people both as constrained by their
circumstances and as casu al agents, as Suy emoto (2002) su ggests. She
emphasizes t hat people are actively involved in the construction of their
reality as well as co-constructing this with others. Suyemoto proposes that
identity is “actively self-constructed an d reconstructed b y an individual
situated in a sociohistorical and cultural context” (Suyem oto, 2002, p. 72).
In contrast t o traditional psychological theories concerning personalit y
and personality formation, the interplay and interdependence between the
14
It must be emphasized that Antonovsky in many articles discussed his theory on
aggregated levels (Antonovsky, 1987, p. 174; 1991a; 1991b; 1993).
individual and their so ciocultural context are taken into account.

Diagnostic manuals (ICD-10 and DSM-IV) locate mental health problems
within the indivi dual, although sometimes, as with the PTSD
(posttraumatic stress disorder) diagnoses, so mething outside the person is
acknowledged as the main cause of the illness. From a f eminist
perspective, the diagnosis and treatment of PTSD, pa rticularly where it is
related to sexual and domestic violen ce, is still problem atic because the
focus of the problem is nevertheless transferred from violence as a
societal, cultural, and political problem, to the individual (Maracek, 2002;
Worell & Remer, 1996/20 03). Sexual v iolation is more than a cause of
illness — it is also a cri me. Strengthening an individual’ s ability to cope
with life in the after math of such devastating viole nce is of course a
legitimate objective for mental health services, but this must never lead to
neglect of the contextual and political aspects of the person’s life situation
(Becker, 2005).
MUSIC POLITICS AND MUSIC THERAPY

IN MENTAL HEALTH CARE
Where does m usic fit into this picture ? So far in t his chapter we hav e
been discussi ng m ental health politi cs with the focus on the discourses
and political debates connected to ment al health and m ental hea lth care.
Obviously, music therapy also interacts with another political arena, that
of music politics. Music is (like ther apy) sometimes considered apolitical
in nature, but such an understanding is based on paradigms fro m
traditional musicology tha t are nowad ays much disputed, as I will argue
in a following chapter.
In his potent critique of musicolog y, Bohlman (1993) points o ut the
efforts that have been made to keep music “pure” and “value-free” as part
of a clearly political act of depoliticizing m usic. The failure within
musicology to see music as e mbedded in cultural c ontexts has led to an
ignorance of those political actions related to th e colonization and
Westernization of music, as well as an essentialization of music by means
of its separation from the body, language, dance, etc. In fact, so me very
interesting power relatio ns have be en revealed within m usic politics
(Bohlman, 1993). Music is connected to sexual politics (McClary, 1991, p.
27; Whitely, 1997) as well as to social movements (Eyerman & Jam ison,
1998). Music plays a role in the constitution of social class and social and
34 Randi Rolvsjord
cultural capital (Bourdieu, 199 8/2001; Green, 2003) . Thus, m usic is not
uninflected by politics but is, as Small suggests, always a political act:
Any performance, in fact, that the hearer has no choice but to

hear affirms a relationship of unequal power that leaves th e
hearer diminished as a human being; for whatever e lse it might
be, all m usicking is ultim ately a political act. (S mall, 1998, p.
211)
Here, however, I would like to focus on one pertinent aspect of

music politics that arguably i nteracts with mental health politics with
regard to m usic therapy, namely the elitist tendency of music culture and
music politics. Small (1998) points out that the music industry, whether in
Western art m usic or popular m usic, has tended to celebrate the m usical
genius and is structured around a few musical stars, co mposers,
performers, a nd “works.” The m usic industry seem s to have dev eloped
into a very elitist and com petitive soci al field, with television programs
such as Pop Idol and A merican Idol or perform ing com petitions as
obvious examples. There are, in other words, strong elitist tendencies in
Western societies with regard to m usic’s cultural politics. For m ost of us,
music is very m uch related to musical achievements. Small (1998) voices
a clear critiq ue of this tendenc y in society , whic h sends out a false
message to people about their possibilities in music and their rights to use
music at their own level. He points to t he culpability of music education,
and in partic ular music teachers, in ha ving killed of f in so m any children
the drive to learn to play an instrument or to sing by telling them that they
are not m usical. The elitist tendencie s in societ y have led people to
believe erroneously that music is only f or the especially talented few.
Similarly, Sl oboda (2 005) suggests that our society (and especially our
system of formal education) is very concerned with musical achievement,
but much less so with the emotional and sensual enjoyment of music. This
renders musical experience for m any people a m atter of anxie ty and
humiliation, leaving them “musically wounded” (Sloboda, 2005, p. 271).
As a musical practice, music therapy is inevitably participating in the
arena of music politics. It m ust be stated that in this arena, music therapy
has been on the forefront regardin g i mportant cultural values. Music
therapy involves a possibilit y for people to engage with music and have
few or no requirem ents as to their m usical skills. As Bruscia (1998)
emphasizes, the nonju dgmental persp ective of music is at the core of
music therapy practice. Music therapy is not lim ited to those clients who
have an extensive musical background or those who can demonstrate

specific abilities or skills . Rather, as em phasized by Bruscia, m usic
therapists strive to accept the client ’s m usic at whatever level it is
performed and seek to help the client to use her or his musical potentials.
In this way, music therapy may serve as one important counterpoint to the
elitist music culture. In a Norwegian context, Ruud (1996) has described
music therapy as being on the forefront of a cultural and political
movement ai ming toward possibilities for all people (regardless o f
disabilities or illness) to participate in music. The role of music therapy in
this “Music for All” movement h as in cluded personal engagement and
political activism fro m m usic therap ists. Even more im portant, m usic
therapy has dem onstrated the potential s and possibi lities of engagem ent
with music i n spite of disability or ill ness. In this way , Ruud (1996)
considers music therapy in terms of reformative politics.
Even if m usic therapy has, and still is, counteracting the elit ist
culture by providing people with access to music, the elitist tend ency of
music culture and music p olitics is still very present in Western society.
When couple d with the il lness ideology in m ental health care contexts,
new problems arise. The elitist culture, when interacting with illness
ideology, is forcing the music therapist into a double position of expertise.
Not only are we as ther apists experts on the client’ s disease and illness,
but as m usic therapists we also are experts on m usic. This im poses a
particular challenge with regard to power relations. If not solved and
counteracted, this might contribute to put our cli ents in specific and
people with mental health problems in general in a position creating m ore
vulnerability.
There is yet another side to this: When we engage in a music therapy
practice, we bring music into a health-related context, which wo uld be t o
some extent colored by the illness ideo logy. As a health resource, music
is related to positive health rather th an to ill health or pathol ogy, and I
think that it is i mportant to let music continue to have that role. There
could be a danger that m usic, initially connected with healthy and joy ful
dimensions of people ’s lives, could in a therapeutic practice focused on
pathology and problems be transfor med into som ething associated with
illness, problem s, and pathology. Ther e is a risk of inflicting problems
and even patholog y on an otherwi se healthy and sound relationship to
music by bringing music into therapy. The political and ethical concern of
music therapy must be to bring something “normal” and free from illness
into the il lness-dominated environm ent of a hospita l (Aasgaard, 2002;
36 Randi Rolvsjord
2004), while still not neglecting (ind eed, acknowledging) t he pain and
problems that the client is experiencing in her or his life.
THE POWER OF DISCOURSE
As a discou rse, music t herapy is not so mething discovered

“outside” language and subsequent ly described “inside”
language, bu t so mething actively constructed in and throug h
language. (Ansdell, 2003, p. 154)
How we perceive and understand music therapy is related to the larger

body of academ ic and political discourses. Music therapy is part of the
co-construction of our cul ture and hence our reality. The langua ges we
use not only are way s of representing objective truths, but also play an
important part in the construction of our reality. A practical implication of
such a notion of what is often called the centrality of discourse (Alvesson,
2002) is th at a differing discourse of therapeutic work does not
necessarily r epresent a fundam entally different r eality, but i t does
influence the way we understand it, and thus influences our actions.
Furthermore, the way s in which w e conceptualize music t herapy
processes influence not only our practice but also the broader political
discourse on organization al as well as co mmunity levels. Thus, our
practice, theories, and p hilosophies are not neutral. The discourse we use
either contributes to the stabilization and conservation of certain values in
the comm unity or else contributes to the destabilization of values and
politics by transgressing or challenging others (Ansdell, 2003; Rol vsjord,
2006b).
The discourse of m usic therapy — how we talk and write about
music therap y — above all influen ces both the depiction and perception
of the client and the m usic therapy process. The sto ries that clie nts tell
about their li ves are inevitably colored by the co ntext and b y the person
listening to the story . The stories of our lives are alway s “works in
progress,” and our stories also influence how we live our lives (Barker &
Buchanan-Barker, 2004) . I t is the same with the stories of therapy. The
stories that therapists, clients, and researchers tell about therapy can be
about victors or about victims, emphasizing on t he one hand weaknesses
and pathology or, o n the other, coping and resources (Duncan & Miller,
2000; Goldstein, 1997). The client’s story and the therapist’s listening, as
well as the therapist’s sto ries about th e client and t he therap y, must be
seen as co-c onstructive of the reality , always situa ted in a cultural and
political context.
Striving to fa cilitate empowerment thus i mplies acknowledging t he
client’s own resources and efforts in the music therapy process as well a s
in the discourses of music therapy. The therapist will have to listen for
stories about strengths and coping and t ell stories that give credit to the
client and make her or his resources become visible and audible. From my
point of vie w, this has the potential to transform music therap y into an
empowering political discourse. However, it m ust be em phasized that
words do not automatically lead into action. Sadly, the use of words such
as “user participation” and “collabora tion” does not alway s lead into a
practice in mental he alth care that i s e mpowering. Rhetoric (whethe r
professional, governmental, or m edical/psychological) is not the sam e as
experienced reality (Tomes, 2007).
Excerpt Two
Chapter 2
PATHS TOWARD A CONCEPTUALIZATION

OF THERAPY
Randi Rolvsjord
In this chapter, I will present perspectives that have informed and thus
represent a theoretical frame for the conceptualization of a resource-
oriented approach illuminated throughout this book. These informing
perspectives come from a variety of academic fields. They include
literature on a range of research methodologies and thus offer a range of
argument and documentation in relation to resource-oriented therapeutic
work in the area of mental health. Still, the approach presented in this
book is deeply rooted in a humanistic tradition and in humanistic values
related to humanity as well as to research. Further, I have intended to
align myself with forces counteracting the strong illness ideology of the
field of mental health discussed in the previous chapter and consequently
have drawn on literature and research that in various ways integrate
academic and political critique.
It needs to be emphasized that there exist alternative possibilities for
a theoretical foundation of a resource-oriented approach to therapy other
than the one explored in this book. Antonovsky’s salutogenic orientation
(Antonovsky, 1979; 1987) is one example that is already well known to
many music therapists. Other perspectives that are potentially relevant are
the resilience research, as well as perspectives in the tradition of
humanistic psychology, including client-centered and person-centered
approaches.
When exploring theoretical frameworks or foundations for a
resource-oriented approach, it is important to reflect on what such a
theoretical frame has to offer in terms of its implications for the practice
of music therapy. The relationships between philosophy, theory, and
practice are complex and interconnected, and a linear causal model
suggesting that a philosophy will articulate a theory that will guide our
practice would be at best an oversimplification. Rather, philosophy,
theory, and practice must be seen as interdependent aspects co-
constructing the discourse of music therapy (see Stige, 2003a). In this
way, the theoretical frameworks offered in this and the following chapter
Paths Toward a Conceptualization … 39
must not be s een as a recip e on how to work, but rather as a reso urce for
understanding and perspe ctives provid ing p ossible focus that in fluence
practical work.
Empowerment philoso phy, the comm on factors approach, and
positive psychology point in three different way s to some of the aspects
that I have co me to understand as essential to a resource- oriented
approach to music therapy. They point first to the therapeutic value of the
development of strengths a nd resources; second, t o the importance of the
client’s role in relation to the outcome of therapy ; third, t o collaborative
relationships and the need for self-d etermination and participation in
decision-making in the the rapeutic process; and finally, to the importance
of understanding health as well as illness in interaction with social ,
cultural, and political contexts. These themes, however, are illuminated in
various way s throug h the se perspectives, so that they t ogether bring
important nuances to the understandi ng and conceptualizatio n of a
resource-oriented approach to music therapy in mental health care.
THE CONCEPT AND THE PHILOSOPHY

OF EMPOWERMENT
Empowerment as a concept is related to community psy chology and the

preventive model. Born out of the civil rights m ovement in the 1960s and
‘70s, it has been linke d with the antimedical and antips ychiatric
movements as well as with fem inism and feminist approaches to therapy.
Moreover, it represents a philosophy connected to political, dem ocratic,
and hum anistic values (Renblad, 2003; Sør ensen, Graff-Iversen ,
Haugstvedt, Enger-Karlsen, Narum, & Nybø, 2002). As a paradigm, it has
been deploy ed within a variety of acade mic fields such as comm unity
studies, business and management, sociology, psychology, and pe dagogy
(Renblad, 2003).
Empowerment is a concept that is always situated in a context, a f act
that renders its definition dependent on the specific context within which
it occurs (Dalton, Elias, & Wandersman, 2001) . E mpowerment alway s
happens and unfolds i n culture and differs fro m situation to s ituation.
Thus, m ultiple definitions are possib le, each ten ding to emphasize
different aspects of em powerment. Finally, empowerment is a multilevel
construct, corresponding t o indi vidual, organization al, and comm unity
levels of analy ses and practices. Th ese levels are interdependent and
40 Randi Rolvsjord
interactive in the em powerment process (Cowger, 1997; Dalton, E lias, &

Wandersman, 2001; Per kins & Zimmerman, 1995; Schulz, Israel,
Zimmerman, & Checkoway , 1995). It see ms, however, that there is no
clear delinea tion between the various levels and dim ensions of the
concept of empowerment.
To describe the individual level, the concept of ps ychological
empowerment is used (Dalton, Eli as, & Wandersman, 2001; Zimmerman,
2000). Ps ychological em powerment involves changes in behavior,
cognitions, and em otions. We might suggest that a person who is
becoming more skeptical toward traditional author ity, m ore willing to
oppose i njustice, and more involve d in citizen participation is
psychologically empowered (Dalton, Elias, & Wandersman, 2001, p. 347).
Psychological em powerment includes belief about one’s competence,
efforts to exert control, and an understanding of the sociopolitical
environment (Zimmerman, 20 00). Thus, the ability to act and participate,
as well as t he feeling that one has the right to do so, is central to
empowerment (Renblad, 2003 , p. 28). Different dimensions of
psychological em powerment could be identifie d as intrap ersonal,
interactional, and behavioral. Aspe cts such as self-esteem, s elf-efficacy,
and locus of control might be s een as intrapersonal as pects of
psychological em powerment. The interactional d imension describes
people’s use of their analytical skills to influence their environment, while
the behavioral dimension describes ho w the individual takes control by
participating in the community (Zimmerman, 2000).
Empowerment can also e stablish meaning on aggregated levels. T he
organizational level of em powerment includes the op portunities
organizations provide for people to gain control and power in the ir lives.
Empowerment is connected to how organizations develop, ho w they
influence politics, and how the y offer alternative m odes of service
provision. W e may theref ore talk abo ut em powering organizations and
empowered organizations. Organizations characterized by shared
responsibilities, a supportive atm osphere, and s ocial activities are
regarded as em powering organizati ons. Em powered organizatio ns are
those that h ave an influ ence upon t he larger community . U sually,
empowered organizations mobilize economic resources and achieve their
goals successfully (Zim merman, 2000). The community l evel of
empowerment is described as one that “initiates efforts to i mprove the
community, responds t o threats of qualit y of life, and provides
opportunities for citizen participation” (Zimmerman, 2000, p. 54). An
empowering community, then, is usuall y connected with democracy, and
also with the provision of resour ces such as health care, schools,
information distribution, etc., to its residents.
Dalton, Elias, and Wander sman (2001) underline that empowerment
is a social as well as individual process. Empowerment therefore involves
individual ch ange as well as changes in the communit y. Alt hough the
levels are described as interacting and interdependent, this does not
necessarily mean that e mpowerment on one level lea ds to e mpowerment
on other levels. For exam ple, empowering an organization does not mean
that all members of that organization are e mpowered (Dalton, Elias, &
Wandersman, 200 1, p . 34 7). This is i mportant to bear in m ind when
therapeutic practice s are related to processe s of em powerment. The
philosophy of empowerment implies possibilities for therapeutic work at
various levels but also p oints to the i mportance o f aw areness of the
interaction between different levels of empowerment.
Another multidimensional aspect of the concept is we ll presented by
Renblad (20 03), who dra ws on an an alysis of the concept b y Dunst,
Trivette, and LaPointe (Renblad, 20 03, p. 3 1). Here, em powerment is
understood in terms of per spective, process, perfor mance, and indicators
of outcome. Empowerment is a perspective and a p hilosophy supporting
the idea that people are co mpetent and have equal value. Second,
empowerment is a proce ss connected to participatory activities and
collaborations. As a performance, e mpowerment is highl y related to a
person’s self-perception and to t he skills and knowledge that are
developed through enabli ng opportuni ties and relational experiences.
Finally, em powerment could refer to the outcome indicators of th e
process — knowledge, skills, personal st rengths, etc. However, other
authors point out a need for outcom e measures of empowerment that are
related to th e person i n context (Finf geld, 2004; Fitzsimons & Fuller,
2002).
It m ust be em phasized that em powerment is a politically loa ded
concept ref erring to power and power-relations. Critiques of
empowerment are often related to these power aspects, arguing that if one
individual or group gains more power, there is always somebody else who
suffers a loss of power. It is im portant, therefore, to differentiate between
two t ypes of power, “po wer to” and “power over” (Sprague & Hay es,
2000; Stang, 2003). “Power over” re fers to traditional patria rchal 15
15
Patriarchal power is not necessarily connected to the biological male sex but is
representative of a t ype of power t hat has bee n a nd i s co nnected with t he
oppression of women.
42 Randi Rolvsjord
patterns of power and is easily (or perhaps inevita bly) connected with
oppression. This t ype of power is not com patible with em powerment.
Power as “power to” is described as a form based upon values connected
with collaboration, m utuality, and r espect. Thus, empowerm ent practices
involve a di stribution an d prom otion of p ower t hat do not i mply the
oppression or powerlessness of other individuals and groups.
Empowerment of one marginalized group does not lead to reduction of
power (in t he meaning o f “power to”) for ot her g roups. T o e mpower
women does not necessaril y lead to an oppression of men. Secon d, it is
crucial not to see power a s a possessi on of the individual, rem oved from
the relationships that foster and accu mulate resources and control. This, it
is argued, leads to a displacement of the responsibility for people’s health
from the pu blic/governmental level t o the indi vidual level, u ltimately
contributing to an in dividualization o f community problem s (Dalton,
Elias, & Wandersm an, 2001; Sørensen et al., 200 2; Sprague & Hay es,
2000; Stang, 2003).
EMPOWERMENT IN PRACTICE
The concept of empowerment is discussed in two different articl es related

to m usic therapy (Daveson, 2 001; Procter, 200 2). Daveson (200 1)
suggests that e mpowerment is intrinsic to, and a consequence of, music
therapy practice in general. She argues that t his is primarily due to t he
“empowering action dim ensions” in m usic therapy practices (D aveson,
2001, p. 30). She also suggests that music therapy in general shares some
common features with e mpowerment, such as a participatory proc ess and
client ownership. In t his way , Daveson argues, m usic ther apy is
empowering to clients per se, and thus allowing the philos ophy of
empowerment to guide therapy would not result in any need for change in
music therap y practice. Althoug h I agr ee that the musical interaction i n
music therap y is potential ly em powering, I thi nk t hat her argument is
based on a vague and perhaps overly comprehensive understanding of the
concept of empowerment. Mutuality and active participation in musicking
may be important constituents of empowerment in music therapy, but this
does not necessarily mea n that m usic therapy is alway s em powering. A
much more r adical applic ation of the empowerment concept in music
therapy is to be fo und in an article b y Procter (2 002). In t his article,
empowerment is understood as an id eology that challenges existing
practices and reframes alternatives outside traditional medical institutions.

In contrast to a m edical m odel of therapy, Procter describes m usic
therapeutic work with t he users of a nonm edical health cent er as an
enabling and empowering process in which the music-making is “building
on people’s experiences of who they are and what th ey can do” (Procter,
2002, p. 96). In Procter’s article, empowerment is thus understo od as a
philosophy guiding the practical work of m usic therapy , having political
as well as relational dimensions.
In this way, em powerment can be un derstood as a metaphor for
therapy, offering way s of conceptualizing and representing m usic
therapeutic practices. However, viewing therapy as em powerment results
in a conceptualization of m usic ther apy very different from that derived
from medical or ps ychoanalytical disco urse. Em powerment philosoph y
brings with it differing — perhap s even conflicting — way s of
representing health, illness, problems, therapy, and even music, and I will
argue that such discursive distinc tions are related to political power.
Empowerment philoso phy challenges some very basic a ssumptions
concerning the process of music therapy. Music therapy is usually defined
as a process in which one person offers help to another person wit h some
kind of need for this help (Bruscia, 1998). Em powerment philosoph y,
however, challenges the very idea of professional helpers and, as
Townsend argues in the following quote, moves us toward interdependent
processes and egalitarian relationships:
Processes that enable participation can be described by adapting

an old prover b: You ca n c are for peop le for a day. But if you
educate peop le to become invo lved, you have helped them to
care for themselves and others for a lifetime. P articipation
engages people as a ctivists in shaping their own lives. In
contrast to t he one-way dependence underl ying caregiving,
participation is enabled in tw o-way, interdependent processe s
that generate empowerment for us all. (Townsend, 1998, p. 1)
To clarify th e practical im plications of em powerment philoso phy,

there are sev eral different m odels describing attit udes, techniques, and
interventions (Barker, Stevenson, & L eamy, 20 00; Fitzsimons & Fuller,
2002; Stewart, 199 4; To wnsend, 199 8; Worell & Rem er, 199 6/2003).
Focusing on the strengths and resources of the client, however, se ems to
be agreed upon as an im portant implication of em powerment philosophy
(Zimmerman, 2000). Therapy as em powerment has to do with
44 Randi Rolvsjord
collaborating with the client in the development of her or his ability to act
and to partic ipate in com munity. T his abilit y has t o do with individual
strengths as well as with the social, cu ltural, and econom ical resources
available and the use of such resources. Being able to keep your house
clean could, for instance, mean that you can afford to pa y som ebody to
clean it. Abil ity and participation are also connected to what is a vailable
for the client — such as support, close relationships, meaningful activities
in which to participate, etc. (Stewart, 1994). Thus, empowerment includes
access to val ued resources (Nelson, Lord, & Ochocka, 2001), and this is
why empowerment is so much concerned with politics.
This recogni tion of the client’s competences in relation to t he
therapeutic process co mpels us to put th e client “in the driver’s seat,” to
withdraw from every top-down asp ect of the therapeutic process
(Saleebey, 1 997; Stewart, 19 94; W orell & Remer, 19 96/2003). The
process of enablem ent and em powerment therefore i nvolves a tra nsfer of
definitional power from the expert therap ist to a client with the abi lity to
empower oneself. Thus, in several e mpowerment m odels, equal
relationships and collaborator y inte ractions are e mphasized (Barker,
Stevenson, & Leam y, 2000; Dalto n, Elias, & Wandersm an, 2 001;
Finfgeld, 20 04; Fi tzsimons & Fuller, 20 02; Spra gue & Ha yes, 200 0;
Stang, 2003; Townsend, 1998; Worell & Remer, 1996/2003).
Therapeutic effort within a philosophy of em powerment i mplies
focus on the client’ s resources and potentials rather than on their
weakness or pathology. It involves the recognition and acknowledgment
of resources and potentials as well as development and learning of skills
and competences that will promote self-determination and participation.
Although this focus upon the nurturing and development of strengths
is v ery imp ortant with in the p hilosophy o f emp owerment, it d oes n ot
necessarily lead to em powerment. We might explain this by referring t o
Foucault’s n otion of discursive power. According to Foucault, power is
connected to the distinctions and divisions in language that define people
and values (Foucault, 20 01). A focus on the client’s existing r esources
and the development of new resources could be considered to lead si mply
to yet anot her expert opin ion, dem onstrating power to define th e other
according to normality and pathology, strengths and weaknesses.
Thus, it is e mphasized that the process es of nurturing and
recognizing the client’s strengths as well as d eveloping new skills and
resources must be concern ed with helping the client to achieve what is
important for that person: a process of enablement (Procter, 2002; Stewart,
1994). Taking the client’s strengths ser iously compels us to recognize th e
knowledge and competences in relation to the process of therapy that the

client already possesses a s well as those that he or s he may yet develop.
From my point of view, this im pels us to recognize the client’s goals and
to acknowledge the ways in which they are usin g m usic and music
therapy to i mprove their qualit y of li fe. A resource-oriented approach
therefore not onl y im plies recognition and development of the client’s
musical skills and resources, but also e licits an attitude toward the client
as a resourced person who m ight otherw ise be considered to “i nterfere”
with the performance of music therapy.
There is an ongoing debate within m usic ther apy acade mia
concerning t he role of music therapy in instituti ons and comm unities
(Erkillä, 2003; Kenny & Stige, 2002; Pavlicevic & Ansdell, 2004; Stige,
2003a).16 The notions of community music therapy and practices situated
in culture are contrasted with traditi onal “clinical” music therapy situated
in institutions and in the music therap y room. Practices that are presented
as co mmunity music therapy accord wi th a philosophy of em powerment
in the sense that the y em phasize par ticipation in community a nd the
processes of enablement described. To infer from this that the relevan ce
of em powerment philosoph y is lim ited to co mmunity m usic therapy
might be erroneous. (A degree of uncer tainty is pe rhaps inevitable here,
given communit y m usic therapy’s a pparent determ ination to evad e
definition.) E mpowerment philo sophy is a culture-c entered17 perspective
(Stige, 200 2), but it doe s not exclud e traditional individ ual practice
settings. In fact, it has been emphasized that empowerment usually begins
at the individual level with the person acquiring the knowledge, skills,
and com petence required to address personal concerns (Fitzsi mons &
Fuller, 2 002, p. 49 1). M oreover, whi le it is i ncompatible with the
traditional model that sit uates problems in the indi vidual an d c onsiders
the role of t herapy to be the solutio n of pro blems throu gh t he use of
appropriate techniques, it nevertheless does not com promise the
individual’s use of ps ychotherapy or m usic therapy . It wou ld be
contradictory to the em powerment perspective to disregard the
individual’s right to choo se a specific ty pe of ther apy and her or his
ability t o m ake use of i t. In m y vie w, this is not a philosophy that
excludes individual music (psycho)therapy as a possibility for developing
empowering interactions.
16
See also discussions on community music therapy in www.voices.no.
17
The term “cu lture-centered” (Stig e, 2002) d enotes a p erspective on music
therapy more than a specific type of practice.
46 Randi Rolvsjord
A culture-centered perspective invol ves cultural reflexivit y an d an

awareness of cultural aspects related to hum anity, health, and m usic
(Stige, 2002a). How suc h a perspec tive can influence the therapeutic
process is e xplored in fe minist e mpowerment th erapy. In feminist
empowerment therapy, the political dimensions of the therapeutic process
are outlined by the focus on the in terdependent r elationship between
personal and social identities and the sl ogan, “The personal is pol itical”
(Sprague & Hayes, 2000, p. 675; Worell & Remer, 1996/2003, pp. 66ff.).
Traditional gender-role socialization and discrim ination against people
based upon gender, disabilities, race, phy sical characteristics, sexual
orientation, c lass, religion, etc., is s een as cruci al to the development of
social as well as personal identities. Feminist therapy therefore e mpowers
people by reframing pathology and problems in the cultural and political
context, by s eparating the individual s ense of pow erlessness fr om the
external aspects of discrimination an d oppression, and by initiating social
change. 18 The therapeutic relationship is seen a s a model of equal
relationships, thus implying a potential for changing other relationships in
the direction of mutuality and equality (Worell & Remer, 1996/2003).
THE COMMON FACTORS APPROACH AND THE

ARTICULATION OF A CONTEXTUAL MODEL
A second im portant theoretical framework for the resource-oriented

approach presented in this book is the so-called “co mmon factors
approach.” What is called a comm on factors approach has grow n up as a
result of interpretations of m eta-analyses of ps ychotherapy outcome
research that have revealed nonsignifi cant results of com parisons of
different ps ychotherapies. The common factors approach im plies a
change of interest and focus from the specific ingredients of
psychotherapy to the extratherapeutic factors and t o the factors that ar e
common to all psy chotherapeutic models. Thus, si milarly to
empowerment phi losophy, the comm on factors approach challenges the
18
See Curtis (1996) for an im plementation of th is within cli nical m usic therap y
practice.
19
medical model. As an alternative, a contextual model has been
articulated.
In the story of Alice in Wonderland, th e dodo bird j udging the race
proclaimed t hat “every body has won and all must have prizes. ” This
saying was introduced i nto t he disc ourse of psychotherapy b y Saul
Rosenzweig in 1936, in an article in which he hypothesizes that all
psychotherapies produce some benefit s for the patients, due to some
common factors of the different ps ychotherapies (Luborsk y, Si nger, &
Luborsky, 1976). Since then, the dodo bird verdict has been confirmed by
several studi es, co mparative studies, and m eta-analyses of comparative
studies (Lambert & Ogles, 2004; Lu borsky et al., 1 976; Luborsky et al.,
2002; Wampold, 2001).
These meta-analyses show first of all that m ost patients benefit from
psychotherapy, i.e., that p sychotherapy is effica cious (Lambert & Ogles,
2004). Not only is psychotherapy su perior to n o treatm ent, but the
benefits of psy chotherapy exceed the benefits accr ued through placebo
treatment. It is also worth noting that the effects of the placebo treat ment
comparisons are s maller when the placebo treat ments themselve s
emphasize the common factors (Lam bert & Ogles, 2 004). Second, meta-
analyses and co mparison studies show little or no significant differences
between the effectiveness of different bona fide psychotherapies (Lambert
& Ogles, 200 4; Luborgsky et al., 2002; Wampold, 2001). Earlier results
of m eta-analyses of com parative studies see med t o show significantly
better results for som e types of psychotherapies as treat ment for so me
specific conditions, such as CBT (Co gnitive Behavioral Therapy ) for
phobic disorders (Lambert & Ogles, 2004). It has been argued, ho wever,
that such difference s in outcom e may be relate d to the effects of
researchers’ allegiances a nd the inclusion of studie s that com pare one
type of ps ychotherapy wi th non –bona fide psy chotherapy. W hen these
factors are co ntrolled for, the studies pr ovide additional evidence for the
equivalence of bona fide treatments, i.e., treatments delivered by a trained
therapist apply ing a viabl e treatment m odel (Lambert & Ogles, 200 4;
Messer & Wampold, 2002; Wampold, 2001).
19
It must be emphasized that the concept of “context” within the common factors
literature seems slig htly different from the meaning of context in empowerment
literature. Th ere is a clear t endency th at empowerment ph ilosophy highlights
political, cultural, and social aspects with regard to contextual aspects more than
what is the case within the common factors approach.
48 Randi Rolvsjord
Several auth ors have dis cussed alt ernative explanations for the
nonsignificant results of co mparisons of the effects of different
psychotherapies. Either th e dodo bir d verdict is to be sup ported, and
explained by m eans of the characteri stics of ps ychotherapeutic practic e,
or the dodo verdict is regarded as a m ethodological question, suggesting
that the appar ent equivalence of treat ment is a result of limitations in t he
research methodology ( Chwalisz, 2 001; Lam bert & Ogles, 2004;
Luborsky et al., 2002). Depending on which argument the authors believe
is the m ore credible, differing recommendations for research s trategies
are outlined, such as i mproved reliabili ty and larger sam ples of clinical
trials to better study the effects of t he specific i ngredients (Chwalisz,
2001; Drisko , 20 04). Alte rnatively, m ore research into comm on factors,
and research that is not tied to specific diagnoses, is r ecommended
(Lambert & Ogles, 2004; Messer & Wampold, 2002). The implications of
the dodo b ird verdict for our therapeutic practice an d our un derstanding
thereof are of course also related to th e explanations of the results of the
meta-analyses of co mparative studies. If the equivalence of the outco mes
of different psy chotherapies is s een to be related to the lim itations in
research methodology, there seems to be no reason t o change practice. If
the dodo bir d verdict is accepted, it should inevitabl y lead to changes in
how psychotherapies are both conceptualized and practiced.
If the dodo bird verdict is to be regarded as more than a problem of
methodological reliability, then it poses a serious challenge to some of the
basic as sumptions of the Evidence-Based Medicine (EBM) movement,
not onl y in r elation to research methodology, but al so in relation to the
intimate ties between the medical model and the EBM m ovement as it is
applied to p sychotherapy (and m usic therapy ). A medical model in
psychotherapy is conceived as analogous t o th e medical model in
medicine but is distinguished b y the n ature of the explanations it offers.
The m edical m odel in me dicine is physioche mically based, whereas the
explanations in a m edical model of ps ychotherapy are primarily
psychological (Wam pold, 200 1). A s explained previousl y, what
Wampold as well as Bohart and Tallman (1999) ref er to as the medical
model of psychotherapy is a metaperspective referring to a basis in causal
relationships between problems, expl anations of the problem , specific
interventions, and outcomes. Thus, accord ing to this model, the therapist,
as an expert, identifies the problem and knows what the best procedure is
to use in order to change or mend th at particular problem or deficit;
whereas the client’s importance is limited to the provision of information,
motivation, and compliance with the treatment (Bohart & Tallman, 1999;
Nerheim, 1996). The evi dence-supported treatm ent m ovement within

mental health care is rooted in this kind of medical model, emphasizing
the specifici ty of interventions in r elation to p articular diagnoses
(Wampold, 2001, p. 19).
If the medical model of psychotherapy holds, one should expect that
the dodo bir d verdict is the exception to the rule, and that a multitude of
differences r elated to the outcome of different psy chotherapeutic
approaches would have been foun d. In contrast, Wampold (2 001) an d
Bohart and Tallman (1999 ) argue that t he findi ngs f rom psy chotherapy
research, the dodo bird verdict, are incompatible with the m edical model.
Wampold argues for a contextual m odel of ps ychotherapy (W ampold,
2001, p. 2). Such a contextual model, in accordance with the approach of
Frank (1989) and Frank and Frank ( 1991), emphasizes a holistic common
factors approach and enco mpasses t he whole therapeutic context or
situation as p roviding potentials for change and deve lopment related to
the client’s health. In such a contextual model, the specific ingredients are
not seen as the main source of change in the therapeutic process but are
necessary in order to construct a coherent treatment in which the therapist
has faith and that provides a rationale for the client to believe in.
Similarly, B ohart and T alman (1999) argue for a model with a
contextual and holistic framework, but one that puts the client at its center.
In their m odel of the clie nt as active self-healer, t herapy is essentially
seen as the provision of a suppor tive context within whi ch the
individual’s naturally occurring self-righting and s elf-healing capacities
can operate (Bohart, 2000 , p. 130; Bo hart & Tallman, 1999 , p. 18). In
sharp contrast with the mechanical (fundamentalistic) medical
understanding, they argue that the client her- or himself is the main factor
that promotes changes in therapy, by her or his use of the relationship and
the procedures that the therapist and the client are co-constructing. The
client uses the space provided by the he lp of the therapist to activate or
mobilize her or his resources for change.
COMMON FACTORS
The concept of co mmon f actors c an ap pear confusing when reading the

literature. Someti mes the concept is used widely , re ferring to any thing
that could have so me influence upon the therapeutic process and its
outcome, exc ept for the s pecific ingred ients that are seen as spe cific to
50 Randi Rolvsjord
one particu lar psy chotherapy ap proach. This would i nclude

extratherapeutic factors such as the soci al context and client’ s factors. In
other instances, it is used more specifically and comprises only the factors
that will be actively i nvolved inside t herapy but a re not regar ded as
specific to any particular psy chotherapy approa ch. In general, the
common factors include variables that are found in a variety of therapies
regardless of the therapist’s orientation (Lambert, 1992). Different sets o f
common fac tors are presented by different authors (Grenca vage &
Norcross, 1990; Jørgensen, 2004; Lambert, 1992; Lambert & Ogles, 2004;
Tracey, Lichtenberg, Goodyear, Clairborn, & Wampold, 2003).
A contextual model outlines various factors that can be related to the
effect of psychotherapy . These factors have been accounted for in th e
literature in several way s. Lam bert’s well-known estimation of the
comparative impact of dif ferent factors contributing to the outcome o f
psychotherapy (Asay & Lam bert, 1999; Lam bert, 1992; Lambert &
Barley, 2002) holds that as much as 40% of ps ychotherapy outco me is
due to factors outside therapy , m ainly to the client and to the client’s
environment. Expectancy effect s (placebo) and specific ther apeutic
factors each account for 15% of the t herapeutic outco me. And, finally,
Lambert attributes 30% of the therapeutic outcome to the common factors.
Wampold (2001) makes a different calculation based upon the results
of meta-analyses. As a starting point for his calculations, he considers that
13% of the effects of the variables in outcom es ar e actually related to
psychotherapy. From these percentages, he attributes as much as 70% to
common factors, includin g hope and expectancy effects, and 8% to
specific factors. The oth er 22% remains unexplained, but W ampold
suggests that client differences play an important role (Wampold, 2001).
The extrathe rapeutic fact ors are dis carded before he cal culates the
outcome variabilit y percentages, a move that p artially expl ains the
differences between the t wo sets of ca lculations. It see ms likely that the
different factors are uneq ually im portant when it comes to in dividual
cases.
According to both sets of calculations, the extrathe rapeutic fact ors
are very im portant and make even more significant contributions to th e
client’s health than p sychotherapy or other treatments. Such
extratherapeutic factors ar e factors tha t aid in rec overy regardless o f
participation in psy chotherapy. These factors c an be attributed to the
client as w ell as to the environm ent. The severity of the disturbance ,
problem or disorder; econom y; social network; and cultural participation
are aspects that are i mportant for health and recover y from mental illness
(Asay & Lam bert, 1999; Lam bert & Barley, 20 02). Drisko (20 04) also
emphasizes the contextua l im portance of health policy and agency in
terms of the accessibility of health ser vices. A considerable part of the
treatment effects are also attributed to t he client’s expectancy and hopes
related to the treatment. Hope is c onnected to the abilit y to envi sion a
pathway toward health or improved quality of life. Hopes and expectancy
are also connected to agency : the ability to m ove toward such a pathway
or g oal (Sn yder, Rand, & Sigm on, 2 002; Sn yder, Scott, & Cheavens,
1999). Further, Wampold (2001) argues that therapist allegiance, i.e., the
therapist’s be lief in the tr eatment, is also a critical com ponent for the
outcome. The role of specific factors is primarily ascribed im portance in
relation to presu med sp ecific ef fects, but also in connection with
expectancy and hope. The specifi c i ngredients and their theoretical
rationale are seen as very important both in order for the treatment to be
convincing f or the client and in term s of therapist allegiance, which is
considered to be a very important common factor (Wampold, 2001).
Lambert an d Ogles (2004) focus on the fa ctors inside the
psychotherapeutic setting as they structure the co mmon f actors i n thre e
categories: support factors, learnin g factors, and action factors.
Grencavage and Norcross (1990), on the other hand, categorize the
common factors into fiv e subgrou ps: client characteristics, therapist
qualities, change processes, treat ment structures, and relationship
elements. Building on the work of Grencavage and Norcross, Tracey et al.
(2003) present cluster analy sis resulting in t hree categories or clusters:
bonding, information, and structure. The first cluster of common factors is
connected to the bonding between therapist and client and comprises such
factors as motivation, positive relatio nship, em pathy and warmth, and
therapeutic alliance. The second cluster is information or explanation and
is connected to such aspects as therapist allegiance, feedback, information,
and the provision of treatment rationale. The third cluster is relat ed to the
latent and implicit structur ing of therap y, such as th e use of techniques
and rituals, the interaction between pa rticipants, or therapist and client
roles. They also place thes e clusters of common factors in relation to tw o
dimensions that describe emotional experiences (ho t processing versu s
cold processing) and activity (the extern al vs. internal basis of th erapy).
This model beco mes very co mplex, but it serves to depict so me of the
interrelatedness that gets lost in more simplistic lists of categories.
It is likely that several of the sam e comm on fa ctors that are
important for the outcome of psychotherapy also play an important role in
music therapy. Music, on the o ther h and, m ight be un derstood as a
52 Randi Rolvsjord
specific ingredient if m usic therapy were to be com pared with verbal

psychotherapy, but coul d alternatively be considered a co mmon factor of
all music therapy perspectives. My suggestion would be that musicking as
the basic form of interacti on in m usic therapy is inte rdependently related
to both comm on fa ctors and the specific ingredients in m usic t herapy.
Hallan (2004) suggests th at music play s an im portant role that is also
related to different co mmon factor s of ps ychotherapy. Dra wing on
qualitative interviews with music therapists from three countries and with
different orientations, she conclud es that music see ms to be very
significant in connection with Lam bert’s support fa ctors that prom ote a
good working alliance and bondi ng. She argues further that m usic
complements and am plifies the verbal commu nication related to
processes of learning, and that the musical interac tion alone see ms t o
involve important learning processes. S he also em phasizes the aspects of
action involved in music therapy , rel ating these to Lam bert’s action
factors and arguing that the active ac tion-oriented i nteractions in m usic
therapy stimulate such common factors.
In ter ms of the practice of m usic the rapy, the common factor s
approach impels us to increase our aw areness of the total situation of the
therapy, not l imiting our i nterests to the therapist’s use of techniques and
interventions. This has im plications in relation to both research and
therapeutic practice. The common factors illum inate some of the general
aspects of th e therapeutic situation that are potentially fruitful to nurture
also in the practice of music therapy . From my poi nt of view, t he shift
away from a medical model toward a c ontextual model of ps ychotherapy
that the co mmon factors approach supports is also very im portant when
considering music therap y. Analogous ly t o the critique of the medical
model outlined in the literature on common factors, it is reaso nable to
assume that music therap eutic techniques and the power of music itsel f
have been given too m uch attention in relation to the therapeutic process
(Rolvsjord, 2006a). The contextual model im pels us to refo cus our
attention away from the therapist and the music’s capabilities and toward
how clients make use of music and music therapy in their strivings toward
health and quality of life, and even toward music and musical experiences
and activities. This need not im ply that we should stop considering music
as a power ful source that can be used t herapeutically, but it em phasizes
the importance of considering also the client’s craft in term s of how they
use music in therapy and in everyday life.
PERSPECTIVES FROM THE

POSITIVE PSYCHOLOGY MOVEMENT
“Positive psychology” started as a critique of m ainstream psychology that

had largely become a sci ence of healin g, of repairin g dam age within a
disease model of hum an functioni ng (Maddux, 2002a; Seligman, 2002) .
In contrast, m ore interest in what makes people’ s lives worth living has
been called f or. Theory and research i n the field of positive ps ychology
have naturally been directed toward such positive aspects of human life in
general and in relation to psychotherapy in specific. This has resulted in a
rapidly growing amount of research re lated to themes such as happiness,
human well-being and life satisfactions, resilience, positive emotions, and
positive indi vidual traits and strengths (Selig man & Csikszent mihalyi,
2000). The field of positive psychology includes research into and theor y
development of the positive subjective levels of experience, such as well-
being, happiness, and hope; of indi vidual levels, including personal traits
and capaciti es; as well as of group levels, for exa mple, r egarding
institutions moving indi viduals towa rd better cit izenship (Seligm an,
2002). It is my impression, though, that the aggregated levels are the least
explored in t he field of positive ps ychology, although there are strong
political arguments regarding t he i mplications of the m ainstream
understanding of psychopathology as something residing in the individual
(Maddux, 2002). The ai m of positive psychology is related to the
importance of developm ent of hum an strengths and resources in r elation
to well-being in general as well as in illness prevention and therapy:
The ai m of positive ps ychology is t o cataly ze a change in

psychology from a preoccupation only with repairing the worst
things in life to also building the best qualities in life. To redress
the previous imbalance, we must bring the building of strengths
to the forefront in the treatment and prevention of mental illness.
(Seligman, 2002, p. 3)
It is important to note that the movement of positive psychology and

the resear ch engagem ents it offers is regarded as a supplement, and a
corrective, to m ainstream ps ychology more than as an alternative. It
attempts not to continue t o margina lize or exclude but to brin g in again
and revitalize the positive aspects o f hum an ex perience and nature
(Jørgensen & Nafstad, 2004; Seligm an, Steen, Park, & Peterson, 200 5).
54 Randi Rolvsjord
Thus, a balance between the orienta tion toward strengths and res ources
and that toward problems and weakness is emphasized (Lopez, Snyder, &
Rasmussen, 2003). Posit ive preven tion has been described as the
foreground of the posit ive ps ychology approach (Seligman, 200 2).
Seligman describes the en gagement in prevention as a discovery of the
buffering eff ects of hum an strengths, s uch as courage, ho pe, o ptimism,
capacity for flow, or interpersonal sk ills, in relation to mental health. A
strategy for positive ps ychology in relation to prevention is to contribute
to m ore kno wledge abou t how t o fos ter such preventive strengths in
children and youth (Seligman, 2002).
Of specific interest in relation to th e agenda of this book, to
conceptualize a resource-oriented ap proach to m usic therapy , is the
research and theory related to the fo stering of positive e motions and the
building of strengths rel ated to human growth. The role of positive
emotions has been explored in relati on to general well-being in dai ly life
as well as in prevention and therap y ( Fredrickson, 2000; Fredrickson &
Losada, 200 5; Seligm an, Steen, Park, & Peterson , 200 5). Ulti mately,
happy people live longer (Delamonthe, 2005; Seligman, 2003). This is of
special interest because we all know from experiences in music therapy as
well as in daily life that m usic is v ery often connected to positive
emotions, to experiences of pleasure, joy, contentment, or interest.
The “Broade n and Build” theory that is presente d by Barbara
Fredrickson (Fredrickson, 2000; 2002) provides us with an understanding
of the functions that positive emotions can have in daily life as well as in
therapy. In a ddition to the commonly recognized function of stimulating
us to continue with whatever is providing a pleasura ble feel ,
Fredrickson’s theor y holds that positive em otions broaden the t hought-
action repertoire and lead to a buildup of enduring resources. For instance,
joy urges play fulness and creativity; inte rest cre ates the urge to e xplore,
learn, and experience new things; and contentm ent urges seeing the wide
perspectives and the savoring of curre nt life circumstanc es. In contrast,
negative em otions are fou nd to narrow one ’s m omentary tho ught-action
repertoire by preparing us to act in a particular w ay (for example, to
attack when angry or to escape when afraid).
In additi on to t he br oadening ef fect of pos itive em otions,
Fredrickson’s resear ch has de monstrated that positive e motions can
correct or “undo” t he l ingering aft ereffects of negative em otions
(Fredrickson, 200 2; Fredri ckson, Ma ncuso, Braniga n, & Tugade, 200 0).
Positive em otions contri bute to effi cient em otion r egulation, to enhance
the ability to bounce back from negati ve em otional experiences, and to
flexibly adapt to stressful experiences. To be able to experience positive

emotions amid stress and negative emotions has advantages in processe s
of coping. Positive em otions and broadened thinking i nfluence one
another recip rocally and over tim e pr oduce an upward spiral in which
people become better ab le to cope and find posit ive meaning in life.
Therefore, this theor y is a strong argument for stim ulation of positive
emotions als o in a therapeutic setting. It is suggeste d that sti mulation of
positive em otions i n t herapy will e nhance the therapeutic learning
processes (Fredrickson & Joiner, 2002).
Also of inter est is the relationshi p between the use of strengths and
the experiences of mastery that is related to positive em otions and
experiences of meaningfulness, whic h is related to the so-called
eudemonic view of happi ness (Ryan & Deci, 2001; Selnes, Martinsen, &
Vittersø, 2004). Seligman (2003) emphasizes the importance of the use of
strengths rel ated to happiness, arguing that “[i]t is not just positive
feelings we want; we want to be entitled to our positive feelings”
(Seligman, 2003, p. 8). The t ype of strengths he discussed is m ost
characteristically descriptive of the person. These t ypes of strengths he
calls “signature strengths.” Through the use of our signature strengths, we
find energy and enjoy ment. A positive effect rel ated to happiness is
documented (Seligman, Seligman, Steen, Park, & Peterso n, 2005).
Similarly, in Csikszentmihalyi’s theory of flow, enjoyment is also related
to the experiences of a chievements, mastery, and self-actualiz ation. The
best m oments are happening when we work hard to accom plish
something difficult and w orthwhile. Such experiences of achie vement,
enjoyment, a nd flow are not to be seen as unim portant happy moments,
but deeply interwoven with well-being, happiness, and health issue s
(Csikszentmihalyi, 2002).
TOWARD A POSITIVE THERAPY
Treatment is not just fixing what is bro ken; it is nurturing what

is best. (Seligman & Csikszentmihalyi, 2000, p. 7)
Although prevention has been in the foreground for positive psychology

so far, implications for a positive therapy has been more and m ore clearly
articulated over recent y ears. Selig man and Csikszentm ihalyi emphasize
in this quote the im portance of a strengths-b uilding strategy in
56 Randi Rolvsjord
psychotherapy. Obviously, as e mphasized by Seligman and

Csikszentmihalyi, building on to people’s strengths is to some degree part
of what a com petent psychotherapist does no matter what his therapeutic
views ar e an d no m atter what techniques he uses. Positive psy chology,
however, suggests that this should be in the foregr ound of ther apeutic
endeavors.
It m ust also be said that research in positive ps ychology has be en
directed toward factors of great re levance for rese arch in the common
factors approach, such as hope and exp ectancy, empathy and m otivation.
Seligman (2 002) em phasizes that the use of positive psy chology in
psychotherapy has been a blind spot in outcome research due to the focu s
on validating specific techniques t hat repair damag e and n ot on those
therapies that nurture strengths. Th e building of strengths as an essential
part of the therapeutic process has b een invisible in outcom e res earches
that focus on the reduction of s ymptoms. There is, however, a growing
amount of research study ing specific positive interventions (Seligman et
al., 200 5). I ndeed, the u se of strengths as part of ps ychotherapeutic
interventions shows pro mising effects (Seligman, Steen, Pa rk, &
Peterson, 2005).
In this wa y, positive psychology and the conceptualization of a
positive therapy offer perhaps first of all a co mpletion of the field of
psychology, in term s of being a d iscipline involved with t he studies of
human beings and their b ehaviors, th oughts, em otions, and inter actions.
In relation t o m ental health care provisions, t his is crucial, not least
because the picture of the client and he r or his situation is incomplete if
we o mit half of t he hu man repertoire, that whi ch entails p eople’s
strengths (Snyder et al., 2003, p. 25).
However, specifically in relation to mental health and psychotherapy
within mental health care provisions, positive psychology offers a critique
of the extensive focus on psy chopathology and ps ychotherapy as a cure
for pathology, including sharp critiques of the diagnostic manuals (DSM-
IV and ICD-10). Wri ght and L opez (2002) argue in favor of a dia gnostic
focus on me ntal health problems that includes evaluations of hum an
strengths as well as environm ental resources. The current diagnostic
manuals suffer fro m a fundamental negative bias that involves “basic
propositions regarding the concept of saliency , value, and c ontext”
(Wright & Lopez, 200 2, p. 2 9). S everal other aspirations toward
strengths-inclusive assessments have been presented in order to contribute
to m ore balanced evaluations of mental health and m ental health
problems (Lopez & Snyder, 2003).
Even more radically, Maddux (2002a) emphasize the problems of the

focus on pat hology i n m ainstream clin ical psy chology, em phasizing t he
tendency of t he diagnostic manuals to construct mental health pr oblems
as disorders residing in the indi viduals. He argues that positive
psychology o ffers a new way of thin king abo ut h uman behavior, where
ineffective behaviors are seen as prob lems of living, not disorders or
diseases. He emphasizes: “These problems of living are located not inside
individuals but in the interactions between the individual and other people,
including so ciety at larg e” (Maddux, 200 2a, p. 15). T he dia gnostic
manuals repr esent the cor e, as well as the political power, of the illness
ideology tha t constructs hum an life problem s as pathologi es and
contribute to a discourse that em phasizes abnormality over normality and
that leads to a portray al of people with mental health problems that
focuses one-sidedly on their weakn esses and failures as hum an beings
(Maddux, 2002a; Maddux, Snyder, & Lopez, 2004).
What would be characteristic of positive the rapy? Positive
psychology i mplies that the interest is m oved from patholog y and
problems to well-being, health, and full functioning, according to Joseph
and Linle y ( 2004; 2006). The y clarify that positive ps ychology has
revitalized Roger’s proposals of th e human self-actualizing tende ncy and
organismic valuing process. They argue, however, that positive therapy
does not equ al person-centered theory (Roger’s view). A renewed belief
in the person’s abilit y t o know what i s im portant to them and what is
essential to fulfill their lives is at the core of the i mplications for
therapeutic practice. Centr al to the de velopments of t his ideological base
is also the self-determination theor y (R yan & Deci, 2000). Self-
determination theory posits three basic psy chological needs: autonom y,
competence and relatedness. It is e mphasized that the social environment
must provide nutrients to allow for such a fulfillment. The defining
features of p ositive therapy, according to Joseph and Linley, are first, the
focus on the client as the expert, an d second, that therapy is ab out t he
relationship rather than techniques:
Our stance, therefore, is that it is not what the therapist does

(i.e., their te chnique) that deter mines whether a therapy is a
good candidate as positive therapy . Rather, it is what the
therapist thinks (i.e., his or her fundamental assumptions) that is
important: T he crux of being a positi ve therapist is that the
therapist adopts the way of thinki ng t hat full y embraces th e
notion that his or her task is to facilitate the client ’s actualizing
58 Randi Rolvsjord
tendency. It i s our ideas about hum an nature that make us the

psychotherapists we are. (Joseph & Linley, 2004, p. 362)
Following Joseph and Linley’s ( 2004; 2 006) argument, we

understand that positive therapy is not so much about doi ng pa rticular
things, usi ng particular positive techniques, as much as it is about
attitudes and values. By outlining how things are done, the y point t o
positive ther apy as a relational approach based on som e fundam ental
positive assumptions of human beings’ capacity for change. Thus, at the
crux of being a positive therapist is a way of thinking that fully embraces
the idea of clients as competent and able to develop their strengths.
Indeed, as emphasized by Joseph and Linley, this would imply a real
change in he alth care sy stems if it wer e based on the view that it is the
client and no t the therapist who knows best (Joseph & Linley , 2 004, p .
365).
Excerpt Three
Chapter 3
PATHS TOWARD A CONCEPT OF MUSIC

Randi Rolvsjord
So far in this book, the frames for a resource-oriented approach to music
therapy have been rooted in psychological and sociological approaches to
health and therapy. The fields of theory that I have explored so far are,
however, essentially related to verbal therapy and do not take into
consideration the specific aspects related to music therapy as a therapy in
which musical interactions are a central element.
A call for more indigenous and music-centered theories of music
therapy that relate our understanding of music more to the studies of
music and to music therapy itself has been proposed in recent discourses
of music therapy (Aigen, 1991; 2005; Ansdell, 1995; Kenny, 1989; 1996).
In his book Music for Life (1995), Ansdell argues that we need to look
toward the music to understand how music therapy works, stating that:
“Creative Music Therapy works in the way music itself works, and its
‘results’ are essentially of the same kind as music achieves for all of us”
(Ansdell, 1995, p. 5). With reference to this quote, Aigen 10 years later
attributes the whole dynamic or mechanism of music therapy to the music,
identified as musical forces, musical experiences, musical processes, and
structures of music (Aigen, 2005, p. 51). Ansdell’s quote is interesting
also because it can be understood very differently according to what our
ontological understanding of music is. This accentuates the necessity of
exploring literature from the field of musicology and to reflect on
ontological questions of the concept of music in relation to the role of
music in resource-oriented music therapy.
The current, culturally informed, or so-called “new musicology”
represents a paradigmatic shift in the discipline of musicology that has led
to the recognition of subjective as well as contextual dimensions of music.
No longer is it common simply to equate music with musical works or to
regard meaning as embedded in musical structures. Instead, interest has
been directed toward contextualized processes of interpretation and
performance. This shift has its origins in feminist critique, as well as in
more interdisciplinary perspectives on music, in particular from sociology
and anthropology (Bohlman, 1993; Cook & Everist, 1999; Ruud, 2000;
60 Randi Rolvsjord
Williams, 2001). This par adigm shift involves several aspects that are of
immediate re levance to m usic therap y and in particular to how we
understand the role of music in music therapy, as recently emphasized by
several music therapy research ers (Ansdell, 1997; 2003; 2004; Ruud,
2000; Stige, 2002; 20 03a). According t o Ansdell (2 003), howev er, this
development has failed to impact significantly on music therapy resear ch
or practice, possibly because new musicology can a lmost be rea d “as a
manifesto for music therap y” (Ansdell, 2003, p. 15 6). So perhaps more
than changing our practices radically, this development in musicology has
provided m usic therapists with theoretical argu ments and a discourse to
which we can relate our thinkin g. It is, however, tem pting to connect the
increasing interest in and awareness of the cultural and social implications
of m usic ther apy practices to the f oothold these theoretical persp ectives
have gained within the discourse of music therapy.
In the f ollowing, I wil l use some discussions from curre nt
musicology in order to ex plore in greater depth questions concerning the
ontology of music. My intention is not to offer a comprehensive review of
current m usicology but rather to explore some perspectives t hat can
inform the role and concept of m usic within a resource-oriented approach
to music therapy. The role of m usic in music therapy, and specifically in
resource-oriented approaches, is inevitably related to our understanding of
music. Our understanding of the role of music — its functions, potentials,
or power — cannot be clarified and understood without an understanding
of what m usic “itself” is. But, as I wil l argue t hroughout th is ch apter,
there are very blurred distinctions between any possible features of music
as an autonomous object and how music is used in a certain practi ce. This
is apparently because music is al ways performed, percei ved, and
experienced by humans.
MUSIC “ITSELF”?
Music “itself ” is a for mulation that tends to indicate the existe nce of
music as an autonom ous object. The i dea of m usic as an auton omous
object is often related to formalism as well as to the positivist traditions of
musicology and has bee n the focus of num erous texts in the field of
musicology. The cultural turn in m usicology has introduced scope for
immense crit ical reflectio n. A vigorous critique, w hich can be said to
have led to a paradigmatic shift in the f ield of m usicology, was made of
Paths Toward a Concept of Music 61
the tendency to perceive music as sy nonymous with a musical work. The

idea of music as works is often related to the Western m usic tradition and
to the masterpieces or canons. In musicology, there has been a tradition of
studying the structures and meanings as embodied in the musical work (or
even in the s core) itself. This analy tical methodology, m ost commonly
represented by Heinrich Schenker, was coupled with a for malist
philosophy and the idea of absolute music.
As several music therapists have emphasized, conceiving of music as
autonomous works can be highl y problematic in music therapy because it
easily leads to a mechanical unders tanding of m usic therapy processes,
implying that the effectiveness of m usic therapy is related purely to the
properties of the specific m usic rather than also bei ng linked to the ways
in which music is part of larger interactive encounters (Ruud, 1990; 1998;
2000). It might also be felt to conflict with the nonjudgmental perspective
that is fundamental to the practi ce of m usic thera py (Bruscia, 1998),
because of th e implied concentration on achieve ments related to music’s
aesthetic qualities. The cultural turn i n m usicology is clearl y a strong
argument against essentialism in music therapy (Ansdell, 200 3; Ruud,
1998). At th e same tim e, the concept of m usical work is related to an
object chara cter of music to which we also rel ate in m usic therapy
(Schwabe, 2005, p. 52) or at least act “as if ” it existed (Ansdell, 1997).
This (pretended) object characte r of music, which may be our focus of
attention in music therap y, is related to aesthetic qualities of music and
can be considered useful in therapeu tic work (Aigen, 2005; Ansdell, 1997;
Schwabe, 2005).
At the begin ning of his very influent ial book , Musicking, Small
paraphrases the ensuing discussions concerning the meaning of music and
the function of music in human life by stating: “There is no such thing as
music” (Small, 1998, p. 2). In this assertion, he challenges the assumption
within traditi onal m usicology that m usic is sy nonymous with m usical
works and in particular with the works of the Western classical tradition.
Small, on the other hand, argues that music is not a th ing or a work at all,
but an activit y. He introduces the verb form “m usicking” and pr oposes
the following definition of it:
To music is to take part, in any c apacity in a musical

performance, whether b y perform ing, b y list ening, b y
rehearsing or practicing, by providing material for p erformance
(what is called composing), or by dancing. (Small, 1998, p. 9)
62 Randi Rolvsjord
“Musicking,” then, is a d escriptive ter m that cover s all kinds of

participation, active and passive, in all kinds of m usical performance s,
whether they are live or recorded. By this very wide, nonjudgmental, and
anti-elitist definition, Sm all’s concept of musicking differs fro m the very
similar concept of “m usicing” introd uced b y Ell iot (199 5). Elliot’s
concept is restricted to active music-making, although this still involves
listening. Small, on the other hand, even includes the actions of the ticket-
seller at the concert hall door as m usicking. B y means of this wide
concept, he highli ghts the contextual, relational, pol itical, and
technological aspects of musicking.
Arguing that m usic is an activity and not an object implies a turn
away from interest in m usical st ructures and toward interest in
performance and in the perception of music. This turn can be exemplified
by Keil’s much-cited article, “Motion and Feeling Through Music” (Keil,
1994). Keil argues that in any kind of music, meaning is related not only
to syntax and structures but to wh at he calls “engendered feelings.”
Meanings are not just em bodied i n m usical structures but are created in
the perfor mance, in the way the musicians att ack the tones an d in the
drive created through the participatory discrepancies.
Keil’s perspectives in this article are primarily connected to popula r
music and jazz, but the im portance of such performative aspect s is not to
be restricted to popular music. Performance is also frequently discussed in
relation to the questions of the aut onomous musical work (Bowen, 19 99;
Cook, 1999). The em phasis on performance contradicts the assu mptions
of a linear connection between the co mposer’s ideas of a composition and
the listener’s perceptions (Cook, 1999, p. 2 41). The concept of
performance inevitably demonstrates the action aspect of music and
thereby positions the musicians (i ncluding t he listeners) within the
explanations of music’s ontology.
The notio n of m usicking, with its em phasis on performance and
interpretation, needs not imply a total denial of musical works or objects.
To overlook these aspe cts of m usic wo uld be to neglect so me i mportant
aspects of meaningful musical experience. Treitler, one of the
musicologists credited for the turn in m usicology, argues that we are in
danger of reducing music to a signification of some extramusical meaning
and, in so doing, contributing to th e disappearance of the aesthetic object.
Treitler argues that we have to accept a provisional autonomous status for
the m usical work, a status that de mands that it be experienced
aesthetically without consi deration of t he practical purposes and context
(Treitler, 1999, p. 358). Acknowledgment of the social and c ontextual
aspects of musical m eaning need not exclude the significance of the

aesthetic:
And the concepts of aut onomy and of the aesthetic are not
hostile, but are, rather, necessary to interpretations of any depth
beyond that of superficial im pression. The y do no t stand as
obstacles to the development of the social and cultural meanings
of music, but as the means to assure int erpretations that are ric h
and have depth. That is, present needs c all for realignment: th e
re-aestheticization as well as the re-historicization of music. No
dogma, old o r new, shoul d be allowed to o ppose t heir unio n.
(Treitler, 1999, p. 377)
What could such a provisional au tonomous object be? In Treitler’s

article, the provisional au tonomous ob ject is related to som ething in
music its elf that de mands to be experienced aesthe tically without any
extramusical references — that is, an experience that need not be related
emotionally or intellectually t o something outside it self. Aksnes (2002)
draws on Husserl and Hei degger when she explores a si milar provisional
existence of m usic as an object, but she very clearly posits it in the
experience of the subject. Thus, for her, the object ch aracter would be the
temporal flux, the lived experience of the music, the meeting point of the
music and the individual:
First of all, Husserl’s analyses of constitution have made it clear

that it is futile to seek m usic as it is “in itself.” Music si mply
does not exist indepen dent of ex perience — thus, the
musicologist studies not com positions in thems elves, but
compositions as experien ces by the musicologist himself (cf.
Kant’s Erscheinungswelt). This, again, leads to an
internalization of m usical meaning: Meaning is not so mething
in the m usic itself, as many m usicologists and m usic
philosophers seem to believe, but som ething that arises through
individual subjects’ encounters with musical works. This
implies that one can neither make complete analyses nor grasp
the meaning of a musical work, in the sense of one final, all-
embracing e ntity. Musical meaning is episodic and e merges
from the totalit y of perspectives that the listener/ musicologist
takes at any given time. This is not to deny, however, that there
64 Randi Rolvsjord
are many aspects of musical meaning that are relatively constant

and shared (or shareable) within a culture. (Aksnes, 2002, p. 28)
The lived experience of m usic, the meeting point of the m usic and
the individua l, see ms to be the cl osest we can get to the autonom ous
“object” of m usic. The lived experience demands a m ode of
consciousness that can be characteri zed by confla tion rather than by
objectifying the distance between the music and the individual (Aksnes,
2002, p. 35). Aksnes emp hasizes the p rimacy of int erpretation, and thus
she posits the individual in a primary role in the process of the creation of
musical meaning. This im plies that primary interpretations are those
relating to contextual aspects of trad ition, cult ure, politics, and social
interaction.
CONTEXTUALITY
In his now classi c arti cle “The W eb of Culture,” To mlinson (1984)

describes contextuality as a web of cu lture in which meaning aris es. H e
outlines a strong argum ent for the necessity of know ledge about context
in relation to the interpretation of music. Tom linson em phasizes that
culture must not be seen as the cause of hum an actions but as a context of
which they form a part. Human actions such as their music and musicking
are not determined by culture but are a part of it and thus always part of
the process t hat create s it. It is only in a cultural context, however, that
music can have meaning. If we tr y to understand m usic without
understanding the context in which it occurs, ours will inevitably be an
ethnocentric interpretation that bases t he meaning in our own cultural
context (Tomlinson, 1984).
We must ask about the status of music in this web of culture. Clearly,
there are different possible perspectives that seem to be connected to how
much of the focus is on music as works (or, to use a more constructivist
term, “texts” ) and how m uch we fo cus upon m usic as a social/cultural
practice. The web of culture is itself a construction, as e mphasized by
Tomlinson himself (To mlinson, 1984, p. 357): It is a metaphor th at links
texts, m usical works, performances, an d hum an interactions together in
the construction we call culture. This is i mportant because it cl arifies that
culture is not a stable thing that molds people and music. Culture is, rather,
the result of continuous social interactions, a process of co-creations and

continuous development in which music plays a part.
McClary (1991; 2000) has al so very clearly highlighted m usic’s
situatedness in a cultural context. Her writings are a strong argum ent
against the autonom ous music object, the “pure music.” She elegantly
undermines any possibility of autonomous, or “pure,” music, pointing out
that the contextually situated c onventions that provide si gnificant
meanings not onl y are u nderstandable in a cultur al context b ut also
actually co-c onstruct the very context, the worl d or realit y. Through
analyses of m usic, of w orks as w ell as perfor mances fro m Western
classical music as well as from popular m usic, she explores how m usic
not onl y m aintains but also actively co nstructs narratives of gender and
sexuality i n particularly e ngendered power relations. Her main interest
lies in the relationship between music and other dis courses in social and
historical contexts.
Music is always dependent on the conferring social meaning —

as ethno musicologists have long recognized, the stud y of
signification in m usic cannot be undertaken in isol ation fro m
the hum an contexts that create, transmit, and respond to it.
However, this is not to suggest that music is nothing but an
epiphenomenon that can be explain ed b y wa y of social
determinism. Music and other discourses do not simply reflect a
social reality that exists immutably on the outside; rather, social
reality itself is constitut ed within such discursive practices.
(McClary, 1991, p. 21)
McClary clarifies the intertextu ality between different cultural

discourses, which is one important part of the m eaning of music, but her
writings focus to a m uch lesser degree on the interaction between the
subject, the m usicking person, and the m usic. She see ms to fail to take
into consideration the lived experience of the music, as Treitler points out
(Treitler, 1999). Another problem with her argu ment is that her human
subjects are either the com posers and performers of music that
intentionally or unintentionally say something through music or the more
passive listener who is affected by their music. As DeNora points out in
her critique of new musicology, it is probably too tightly committed to the
interpretation and critique of musical texts and so fails to explain how this
construction of reality can take place: t hat is, how we ar e aff ected by it
(DeNora, 2000, p. 30; 2003, p. 36).
66 Randi Rolvsjord
Obviously, c ontextuality is not onl y about intertextualit y. 20 The

concept seems to hide the hum an interaction involved. This m ust be the
most i mportant aspect wh en we apply the concept to m usic therapy .
Musicking is always a culturally situated practice, and m usic therapy will
always be one specific form of situat ed practice. In this context, the
individuals i nteract with one another as well as with the m usic. Small’s
concept of musicking is, a s we have alr eady seen, re lated to a social and
political cont ext. In his book, he expl ores in particular the event of
performance in a traditional concert ha ll but uses this as an exam ple of
what musicking is about. He claims th at social relationships are at th e
center of the meaning of music:
The act of m usicking establishes in the place where it i s

happening a set of relatio nships, and it is in those relationships
that the meaning of the act lies. They are to be found not onl y
between those organized sounds wh ich are conventionall y
thought of as being the stuff of m usical meaning but als o
between people who are taking part, in whatever capacity, in the
performance; and the y model, or stand as a metaphor for, ideal
relationships as the parti cipants in the perform ance i magine
them to be: relationships betw een person and person, between
individual and society, between humanity and the natural world
and even perhaps the supernatural world. (Small, 1998, p. 13)
Small emphasizes three aspects connected to relationships and soc ial

and cultural politics: exploration, affir mation, and celebration. These
aspects might exemplify some of the social and political powers related to
the contextuality of m usic. That is, music as a culturally situated practice
implies some health relat ed potentials that may be used in the co ntext of
music therapy.
20
There a re u ses of t he co ncept of “t ext” t hat i nclude human bei ngs, but t he
concept of “intertex tuality” o ften focuses on m usical wo rks and written tex ts
(Korsyn, 1999).
THE CONCEPT OF AFFORDANCES: BRIDGING THE GAP

AND POSITIONING THE INDIVIDUAL
DeNora (2000; 20 03) ex plains the i mportant role music can pla y in
people’s live s through the description of a twofol d process of musical
“affordances” and musical “appropriations.” Musica l affordances are th e
resources music and its materials provide in situations of use.
Appropriations are how the affordan ces are used — the “takings” and
“usings” of m usic (Ansd ell, 2004, p. 73). DeNora em phasizes that
understanding m usic as an affordance structure differs fro m
understanding m usic as a “cause” or “sti mulus” th at leads to action or
emotional re sponse, beca use what music affords emerges whe n it is
handled by its recipients. The con cept of affordance e mphasizes music’s
effects as dependent upon the ways in which it is used:
It posits music as something to be acted with and acted upon. It

is throug h t his appropria tion that m usic co mes to “afford”
things, which is to say that music’s affordances, while they
might be anticipated, cannot be pre-determ ined but rather
depend upon how m usic’s “users” connect m usic to other
things; how they interact with and in turn act upon m usic as
they have activated it. (DeNora, 2003, p. 48)
When talking about the on tology of music and musical meaning, we

are, as this text m ight be c onsidered to demonstrate, easily caught up in
the binar y either/or of nature/cultu re, context/indi viduality, extra- or
intramusical meaning. The concept of affordances, which originates fro m
J.J. Gibson, is currently used by sev eral authors in m usicology (Clarke,
2003), sociology (DeNora, 2000), and music therapy (Stige, 2002a; 2003a;
Ansdell, 2004). It is a concept that seems to bridge the gaps between such
binary oppositions, as the music psychologist Clarke suggests.
By considering music in terms of its affordances, discussions of

musical meaning (which have often been excessiv ely abstract,
or diverted into a considera tion of emotional responses to
music, or caught up in a di scussion of music’s relationship with
language) can com bine with a co nsideration of its social uses
and functions in a manner that recognizes the pluralities o f
68 Randi Rolvsjord
music’s social functions without bein g swept away b y total

relativism. (Clarke, 2003, p. 119)
In a similar way, Stige (2003a) also sees the concept of affordance as

bridging the gaps between , on t he one hand, the m eaning p otentials in
music that are related to both human biology and culture and, on the other,
the situated event of musicking, as when he refers to:
… the notion of affordance, which suggests that it is possible to

treat music as a situated event and activity without overlooking
the meaning potential of the musical material as based in human
biology and developed in cultural history. (Stige, 2003a, p. 180)
The connections between what music a ffords and how this musical
affordance is appropriated offer us an im portant perspective on our
understanding of m usic therapy processes. It is clear that such an
understanding of music cannot be com patible with a linear understanding
of music as a means that acts upon the indivi dual and of the therapist as
the expert kn owing which m usic would be m ost su itable to ind uce the
warranted change in the client. Rather, it e mphasizes the client’s own role
in constituting the use of music. As with the perspectives presented in
previous cha pters, this, albeit from a very different angle, positions the
client’s use of the music in the foreground of the music ther apeutic
process.
The cultural turn in musicology implies recognition of what might be
termed a “fundamental att ribution error” — the failure to see one’ s own
meaning as contextuall y s ituated, thus neglecting ot her possibilit ies for
the construction of meaning (Ruud, 2000). If the power of music is not so
much related to the m usic itself but to the subjective and contextualized
use of music, then we must ask quest ions concerning the equality of
access to music, within society in general as well as within music therapy.
Could it be that we have not o nly attributed too much of the m echanisms
of music therapy to an uncontextualized and autonomous “m usic object,”
but also erroneously attributed the pow er of music to the therapist rathe r
than to the client? I think that it is tim e that we acknowled ged the
centrality of t he client to t he musical interaction in m usic therapy. Music
is not simply an autonomous object with which interventions can be made:
it has to be appropriated b y t he client for her to experience it as
meaningful. And, further, it seems to m ake possible a plurality of
experiences a nd functions that the m usical interaction in m usic therapy

can afford.
PLURALITIES OF EXPERIENCES
AND MULTIPLE MEANINGS
When m usic has “lost” its autonom y, when its meanings are situated in
contexts and dependent upon appropriation by a pe rson, we have to live
with pluralit ies and multiple meani ngs. Thus, the em phasis on
contextuality, performance, and subj ectivity in new musicology does not
simply im ply a straightforward swit ch of view fro m music a s object to
music as pr ocess, but rather it has expanded and pluraliz ed our
conceptualizations of music (Williams, 2001). Similarly, McClary writes:
“We don’t re ally know what music is anymore” (McClary, 1991, p. 19).
This extends directly into the prac tice of m usic ther apy, where we find
ourselves encountering not only a variety of means of understanding what
music is but also a plurali ty of different kin ds and g enres of m usic, and
multiple ways of making use of these.
The plurality of music is very clearly argued for in Bohlman’s article
“Ontologies of Music” (Bohlman, 1999). Bohlm an starts from th e
traditional dualis m betw een music as an “object ” and music as a
“process”, but expands these two comm on conditions of m usic with two
more: the “em beddedness” of music in relation to ot her activities, and its
“adumbration” — that is, the recognit ion of m usic when m usic is not
present. Such pluralities of m usic are exemplified m usical pract ices i n
everyday life (Bohlman, 1999, p. 19). P luralities of music are related not
only to different cultures on a global lev el but also to local and individual
experiences and practices. Music is experienced as a process when shared
in a group or a comm unity b ut m ore recognized as an o bject when m y
music is separated from your music. It is more an object when it becomes
a work and when it is notated or recorded. It is a process when it beco mes
a language and comm unicates so mething. It is embedded in la nguage
when it bec omes songs, or when language sou nds like m usic. It is
embedded in movies and dance. It is part of our experience of religion or
nature when our m emories of m usic make us experience meaningfulness
(Bohlman, 1999).
Pluralities and m ultiple meanings are also related to different levels
of experience and to the use of music. Grasping these pluralities of music,
70 Randi Rolvsjord
Stige (2002; 2003a) outli nes three main concepts t o describe music in
relation to humankind: the hum an cap acity called “protom usicality,” the
historical plurality of “m usics,” and the social activit y of “m usicking”
(Stige, 2003a, p. 150). The term “musicking” points to the pluralities of
musical practices and acti vities that pe ople engage in within and beyond
music therap y. T hroughout t his te xt, I have argued that active
involvement with music is the most central aspect related to music,
musical meaning, and m usical experience. The ontolog y of music is not
separable fro m the practice of music but is related to m ultiple way s of
engaging wit h m usic. The different way s of relating to and acting with
music afford different experiences and meanings.
With Small (1998), we see that musicking is a concept that
comprises a multiplicity of way s of involvem ent with m usic. W e listen ,
dance, co mpose, im provise, perform ; we sing or play or act as ticket-
sellers. Ther e are also numerous differing way s of listening, such as
listening alo ne or toget her with ot hers, having the m usic in the
background, dancing or walking to music, or taking part in a GIM session.
The same goes for play ing and singing. We can rehearse scales in a roo m
alone, pla y i n a band at a rock concert, pla y in a symphony orchestra,
improvise, or play precom posed music. Musicking is also sometimes
apparently separated from the activities of daily life, as when we go to a
concert or perhaps a music therapy session, but more often it is embedded
in every day life activities, as de monstrated so clearl y by DeNora (2000)
and Sloboda and O’Neill (2001). We might listen to music while traveling
to work, sing while cleani ng the hou se, use music while working out, be
exposed to music when shopping or going to a pub.
Second, the different practices of “musics” are always situated in
cultural contexts and imply different traditions for musicking constitutive
of different genres of music and different styles of performance. “Musics”
is a concept that represents the cultural traditions of music-making (Stige,
2003a, p . 157). As culturall y sit uated, music alway s involves
understandings of m usic, roles of music, and way s of m usicking that are
representative of a cultural and historical tradition. This involves different
ways of understanding what music is, such as the different ontologies that
Bohlman (1999) presents, as well as the differing traditi ons of
performance, including those of com posing, listening and social
interaction. These traditions are, howev er, also articulated and m anifested
as different m usical genr es of musical works. So this is perhaps the
closest we come to a musical object, as it is related to different properties
of m usical works that can be said to offer affordances. It must be
emphasized t hat these are never unrelated to — indeed, they are alway s
embedded in — a culturally situated way of listening to or perform ing
music.
The human capacity of protomusicality is connected to phylogenesis,
and represents a very basic inherited human capacity:
If protom usicality is m usic as hu man capacity , evolved in

phylogeny, it will represent a potential for development in every
human being. The potentia l will be m ore or less developed, and
it will be sh aped in different directions, depending upon the
ontogeny of the individ ual, which again depends upon t he
cultural history of the gr oups and pers ons the ind ividual gets in
contact with. This then, I suggest, contextualizes th e moment-
to-moment lived experience of the musicking of a therapy
process. (Stige, 2003a, p. 151)
Protomusicality, or communicative musicality,21 is described as an

inherent, an d therefore universal, capacity t hat perm its hum an
communication and that is understood as a basis for the develop ment of
languages as well as musical intera ction. This capacity is further
developed in ontogen y an d thus conne cted to aspects of musicality t hat
are related to m usics and musicking. T he indi vidual’s appr opriation of
music involv es so me ty pe of m usicality that does not sim ply make
musical appropriations possible but also actually regulates or conducts the
ways in which we use music.
Small (1998) argues that everyone is bo rn capable of musicking, yet
it seems that many people in Western societies belie ve themselves to be
incapable of the si mplest musical a cts. Small suggests that they might
have been taught t o be u nmusical. So this is n ot so m uch a problem
related to lack of musical ability as it is a process of dem usicalization
(Small, 1998 , p. 2 12). In som e cultures, there is a greater tend ency to
think t hat everyone is capable of high levels of m usical expertise
(Davidson, Howe, & Sloboda, 1997). However, this is not only a matter
of viewing people’s capabilities and possibilities differently, but also is as
much a question of m usical values and the structural organization of
music in culture, as I have already argued.
21
The con cept of co mmunicative m usicality was i ntroduced by Trev arthen an d
Malloch (2000).
72 Randi Rolvsjord
When music is about aff ordances and appropriations , its resour ces
are both connected to what it affords and to how it is appro priated. The
appropriations are connected to both culture and society, but also involve
a capa city for m usicking. Obviously, there are different types of
qualifications and skills connected to musical appropriations. The
culturally mediated aspects of musicking are, for example, concretized by
Ruud as a process of learning m usical codes that belong to a certain
tradition of music (Ruud, 1990; 1998). Musicianship (Elliot, 1995;
Pavlicevic & Ansdell, 2009) inv olves formal and inform al musical (and
social) skills and knowledge that we use when pa rticipating i n m usic-
making or when going to a concert. I wish to point out yet another type of
musicality as musical experience skills. This is linked to the use of music
in everyday l ife, as well as to the u se of music in a therapeutic context.
These musical experience skills are representative of the co mpetencies
that people draw on when the y use m usic to regulate their em otions, as
motivation for working, as a device for social ordering, or as a m eans of
communication in a m usic therapy ses sion. Appropriations of music in
daily life as well as in music therapy require som e skills or knowledge
that seem to be based on musical experience more than on formal musical
training.
Excerpt Four
Chapter 4
TOWARD A CONCEPT OF
RESOURCE-ORIENTED MUSIC THERAPY
Randi Rolvsjord
So far in this book, I have offered a theoretical framework for a resource-
oriented approach to music therapy that draws on literature related to
theories from empowerment philosophy, the common factors approach,
positive psychology, and current musicology. These perspectives have,
except for the musicological perspectives, each in turn offered a strong
critique of traditional psychiatry and its understanding of mental health
and treatment of mental health problems.
In this chapter, we will take one further step toward a
conceptualization of a resource-oriented approach to music therapy. This
task comprises of levels of generalization, description, and definition. We
encounter several dilemmas when approaching this. First, the agenda of
defining and describing is inevitably connected to an expert position,
which is rather contradictory to the resource-oriented and participatory
perspectives illuminated. Besides this, the resource-oriented approach to
music therapy that I present in this book is oriented toward the varying
resources and strengths of the clients, the varying resources in
individuals’ contexts, the varying resources of the music therapists, and
the multiple affordances of music. Thus, it would in many ways be futile
to make generalizations or definitions about an approach that comprises
such vast variations.
Blumer argued that concepts of social theory in general allow only
for rough identifications, proposing the notion of sensitizing concepts. A
sensitizing concept lacks the specifications of attributes, but instead
provides a general sense of reference and guidance in approaching the
empirical instances. According to Blumer, sensitizing concepts on the one
hand hinder us in coming to grips with the social world, but on the other
hand mirror the complexity of the object of study, the social world.
“Since the immediate data of observation in the form of the distinctive
expressions in the separate instances of study are different, in approaching
the empirical instances one cannot rely on benchmarks or fixed, objective
traits of expressions” (Blumer, 1954, p. 5).
74 Randi Rolvsjord
These generalizations that I offer as I approach the question of wha t

characterizes a resource-oriented appr oach to m usic therapy are indeed
sensitizing in nature. The hope is that the idea of a resource-oriented
approach, even if exact definitions cannot be offered, will evoke a process
of further g eneralization in the reader and thus be useful for music
therapy researchers and music therapists in their practice. This is precisely
the poi nt e mphasized by Rappaport when he s omewhat informally
acknowledges the problems inherent in defining empowerment but argues
that the idea is what stim ulates us to pr omote it. This is perhaps the
function that sensitizing concepts and conceptual generalizations can have:
The idea is more i mportant than t he thing itself. We do not

know what e mpowerment is, but, like obscenit y, we know it
when we s ee it. The idea stim ulates attempts to creat e the thing
itself. (Rappaport, 1984, p. 2)
Therefore, despite the afore mentioned objections, I offer in this

chapter four statements c haracterizing a resource- oriented approach to
music therapy: (1) resource-oriented music therapy involves the nurturing
of strengths, resources, and potentia ls; (2) resource-oriented m usic
therapy involves collaboration rather than intervention; (3) resource-
oriented music therapy views the individual within their context; and (4)
in resource-oriented music therapy, music is seen as a resource. This will
hopefully give the reader a general sen se of reference and a suggestion of
a direction o f where to l ook in term s of understanding the ap proach
presented.
RESOURCE-ORIENTED MUSIC THERAPY INVOLVES

NURTURING OF STRENGTHS, RESOURCES, AND
POTENTIALS
It is perhaps self-evident to state th at r esource-oriented music the rapy is

concerned with the acknowledgment, stimulation, and develo pment of
resources. Nevertheless, it is not self-evident that t herapeutic work should
be about str engths and r esources. In a resource- oriented approach to
music therapy, the client’s resources are the center of attention, involving
more than an additional ele ment of r esource activati on in an otherwis e
problem-oriented interaction. Resources are s een as an essential part of
Toward a Concept of Resource-Oriented MT 75
the focus of therapy at every stage of the therapy : in other words, they
should be a significant part of t he assessments, of t he ther apeutic
collaborations, and of the evaluation of the therapy.
“Resource” is a concept borrowed from econo mics but is also
frequently used in sociology in a much broader sense, and often related to
health. This link to econ omics may, however, serve to highli ght the
relationship between access and possibilities for appropriation, in the
process inevi tably rem inding us of the political i mplications of such a
relationship. Access to resources invol ves possibilities and potenti als and
can be realized in diverse way s. It is something that indivi duals can gain
from, and it i s connected both wit h a political and e conomic system that
distributes resources, as well as with the individual’s varying abilities and
possibilities for enablement:
What we understand by resources i s more than personal

strengths and musical skills; it must b e connected to cultural
and political contexts. Resources are alway s related to
negotiations between individ uals and situation s; they are
“objects” of access, use, and possibility. The concept of
resources that we appl y must therefore be unders tood as a
sensitizing concept that includes social, cultural, and
economical aspects, such as social network and possi bilities for
participation in cultural activities. (Rolvsjord et al., 2005a, p.
18)
I want to e mphasize that this concept of resour ces involves the

person’s musical resources, including m usical competence and potentials
such as instrumental skills, knowledge of a repert oire of songs, and
singing ability. Musical com petence can also be connected to the use o f
music in everyday life. Further, it also involves the possibilities for access
to music such as a choir, a music café, technology for music listening, etc.
This in turn enables social particip ation and fosters social relationship.
Social relati onships are e mphasized as i mportant health resources in
relation to bo th social support (Morriso n & Bennett, 2006; Turner, 1999)
and social capital (Procter, 2006; P utnam, 2000; Turner, 200 4). It is,
however, important not to lim it our focus to musical skill s and
competence, as music t herapy can al so be an arena in whi ch other
strengths and resources are acknowledged and developed.
Using strengths and developing resources could be therapeutically
valuable in several ways, particular ly in the context of the dialecti c
76 Randi Rolvsjord
relationship between health and illne ss. Both the salutogenic model
(Antonovsky, 1987) and r esearch into resilience su ggest that resources
can be conne cted to t he prevention of mental health problems and illness
in a di versity of wa ys, as well as to th e ability to cope with stressors and
illness. “Resilience” is a concept that refers to the i ndividual’s ability to
tolerate stres s and com prises such as pects as har diness and power of
resistance. In the sociology of health, resources hav e been perc eived as
moderators o f the negative i mpact of stressors (Pearlin, 1999, p. 169).
Resources can have a moderating or buffering function, which reduces the
negative effe cts of life str ess. Thes e buffering effects have significanc e
only in stressful circu mstances. What is called a “ main effect, ” on the
other hand, is relevant in all circumstances. A main effect is related to the
function of the resources directly in relation to health and quality of life
(Morrison & Bennett, 2006; Pearlin, 1999; Turner, 1999).
Frank and Frank (1991) a lso describe the functions of therapy i n
terms of red ucing the dem oralization that follows illness. When illness
strikes, it is not only the effects of the illness itself that threaten our health,
but also the im plications of the illn ess on our total life situation. When
mental illness leads to hospitalization, this is often related to
stigmatization, and it also disturbs or hinders our p articipation i n social
activities that usually contribute to our sense of health and q uality of life.
Engagement with som ething that is not related to illness or treatment can
thus play an im portant role in the to tal health situation. From a resource-
oriented per spective, tho ugh, it is problematic, and perha ps even
paradoxical, if resources are valued exclusively in ter ms of the im pact
they have upon problems and pathology. Resources are clearly important
not only in relation to the negative and illness-relat ed aspects of health,
but also more directly in relation to well-being and quality of life (Ryan &
Deci, 2001; Seligman, 2003).
The concept of e mpowerment can al so be related to the process and
outcome of therapy with out i nterpolating problems, weaknesses, and
pathologies onto the agenda. The developm ent of r esources, strengths,
and enablement is an i mportant pa rt of em powerment. In the positive
psychology perspective, using st rengths is em phasized related to
experience of positive emotions and of happiness. As Selig man (2003)
emphasizes, t he use of strengths is ofte n tied up wit h positive e motions,
and in t his way it is perhaps inevitable that positive emotions will be an
important part of experiences in resource-oriented music therapy.
RESOURCE-ORIENTED MUSIC THERAPY INVOLVES

(EQUAL) COLLABORATION RATHER THAN
INTERVENTION
Focusing o n nurturi ng t he client’s strengths but at the sam e time not

taking into account the client’s strengths related to the therapeutic process
(i.e., her or his co mpetence and kn owledge about he r- or him self, about
ways of working, about how to use m usic, about problems and solutions)
would be paradoxical. The neglect of these co mpetences would be a
demonstration of the client’ s lack of ability and resources, or at least a
demonstration of the therapist’ s failure to see these resour ces. It s
functions would be that of a double bind communication (Bateson, 1972).
The focus upon the client’s use of wh atever the therapeutic settin g can
offer also le ads, I think, to a con ception of therapeutic actions more a s
collaborations than interventions. It is not only the therapist’ s expertise
that m akes therapy w ork. This understanding necessitate s shared
responsibilities throughout the pr ocess of music therapy and
collaborations related to goals for t he therapy , wa ys of working, and
evaluation of the outcomes of therapy.
With the c ontextual model of psychotherapy as a basis for
understanding the process of t herapy, it is relevant to seek greater
understanding both of h ow clients make therapy work and of how client
and therapist relate to each othe r. Through t he research into common
factors in psy chotherapy, the therap eutic value of the relationship is
emphasized. The thera peutic alliance, co mposed of collaboration,
emotional aspects, motivation, and ag reements about the goals and tasks
of therapy, is one of the m ost frequently mentioned common factors and
is found i n s everal studies as a critical factor related to the out come of
psychotherapy (Horvath & Bedi, 2 002; Wampold, 2001). In their review
of research, Tryon and Winograd ( 2002) found t hat goal consensus and
collaborative involvement are im portant in relation t o initial enga gement
as well as to the outcome of psychotherapy. Thus, a goo d colla borative
relationship seems to be directly r elated to change, grow th, and
developmental processes.
As I have em phasized previousl y, em powerment philosop hy
underlines th e im portance of equal re lationships, self-determ ination, an d
participation in decision-making processes in general. The im portance for
the individual, as well as for grou ps, of having a voi ce in society and of
participating in the community is strongly emphasized. This is understood
78 Randi Rolvsjord
as an i mportant health issue. The degree of partici pation in de cision-

making and s ocial support is related to a reduction i n psychological and
somatic symptoms and a reduction in perceived st ress l evels, whereas
powerlessness and lack of social suppor t are seen as a health risk factor
(Fitzsimons & Fuller, 2002). Participa tion in decision-m aking processe s
is se en as a valuable goal or outcom e as w ell a s pa rt of the process of
empowerment. We m ay s ay that i n t his way em powerment phil osophy
embodies a critique of the traditional e xpert-patient relationship, because
it takes aspects of self-determination directly into the core of therapy , the
Dreier (1994) points out the pa radoxical consequences o f
interventions that aim to prom ote self-deter mination and the
empowerment of another person, arg uing that su ch interventi ons are
doomed to failure. If I am an autonom ous person, able to take care of
myself and to make im portant decisions in my life, this is confirmed by
you not inter fering. If you tr y to help me to be ab le to m ake my own
decisions, you will lim it m y way s of influencing my own life (Dreier,
1994, p. 193). In this way, helping someone toward self-help could easily
become help ing them toward helple ssness. Dr eier’s solution for this
dilemma is t o regard the patient as actively in volved in prom oting h is
own health, which ne cessitates a genuine collaboration. Such
collaborations m ight also reduce the potential sh ame of dependenc y
constituted by the m odern ideal of the autonom ous indivi dual ( Sennett,
2003). Collaborations are unlikel y t o eliminate this problem , b ut may
reduce its eff ects by exchanging dependency for interdependenc y. It may
not be possi ble to em power the other, but it is possible to develop
empowering interactions with them . This invol ves a transfer of power
from the expert-therapist t o the client with regard to the identifi cation of
problems, goals, and solutions.
In the following section, I will outline three i nteracting and
interdependent aspects that I consider to characterize this collaboration in
therapy: equality, mutuality, and participation.
Collaboration is pri marily connected with aspects of equality. Stige
(2002) defines music therapy as a professional practice as “situat ed health
musicking in a planned process of collaboration between clie nt and
therapist” (Stige, 200 2, p. 200). According t o Stige , m usic therap y as a
process of collaboration underlines bot h the equality and the differences
between the two agents involved , as there is shared responsibil ity but
different role s. The conce pt of equalit y th us need not be o pposed with
difference. Rather, an equal relationship requires awarenes s, “a conscious
inattention to designated d ifferences” (Becker, 2005 , p. 104). Equality in

the relationship then must involve an active and conscious striving toward
ideals of equal rights, counteracting oppressive power relations. In m any
respects, neg otiations impl y t he perf ormance of equality, since the
precondition for negotiations is that both parties participate in the
decision-making process.
The concept of m utuality also describes a central aspect of
collaboration. Mutualit y is concerne d with engagement, with equalit y,
with shared responsibilit y, with aff ective responsiveness. Resear ch into
early interaction between babies and their primary caregiver ha s
contributed t o our understanding of mutuality and dem onstrated that
mutuality does not necessitate si milar roles and si milar capacities (Stern ,
1985; Trevarthen, 1988; Trevarthen, Kokkinaki, & Fiamenenghi, 1999).
In a therapeutic relationship, the emotional commitment and the desire for
a continuous relationship are for obviou s reasons different than they are
between a prim ary caretaker an d her or his child, but the
protocommunication, with its turn-tak ing and affect attunement, offers a
clear-cut model of mutuality. Even in a therapeutic relationship, mutuality
has to involve more than a one-way emphatic response fro m the therapist
to the client. Mutualit y in volves a person-to-person responsive
relationship in which bot h client and therapist are di rectly and pe rsonally
involved. Thus, mutuality and inte rdependency seem to be relational
qualities that are co mpatible with e mpowerment and pr obably even
promote em powerment. In order to be em powered in the relati onship,
people need to contribute to as well as benefit from relationships (Jordan
& Hartling, 2002; Sprague & Hayes, 2000, p. 683). In music therapy, this
also has a m usical co mponent t hat i nvolves m usical engagement and
perhaps even a musical desire in the direction of making the music
meaningful, aesthetic, and expressive. S ennett also describes mutuality in
connection with the recognition and a wareness of mutual needs required
for respect (Sennett, 2003, p. 55).
The third aspect that I will mention is participation. Participation in
music therap y is perhaps a very obvious aspect of collaboratio n. Both
therapist and client are active participants in the process of music therapy,
as they are musicking t ogether. Stige (2006a) describes two basic notions
of participation: participation as an individual activit y (which requires
simply that the client comes to th erapy and does something active) and
participation as a collaborative activity (which involves communal or/and
political activit y). In e mpowerment philosophy, the latter form of
participation is highlighted and connected to a politic al dimension related
80 Randi Rolvsjord
to the redistribution of power. Particip ation in decision-making processes

is em phasized, so t hat thi s kind of participation is concerned with self-
determination (Ryan & Deci, 2000) or citizen participation (Dalton, Elias,
& Wandersman, 20 01). I want to em phasize that it is crucial th at both
therapist and client take part in th e dec ision-making process in therapy .
Neither the role as an intervening th erapist, nor the role of “a bsent”
analytical therapist, nor the therapist role that leave s all decisions to the
client can stim ulate collaboration on its own. This as pect of partic ipation
can also be c larified by em phasizing the therapist as a role model. The
therapist has to be visible and to have a clear voice as a person, in order to
give space for the client t o do the same (Worell & Remer, 1996/ 2003).
Thus, taking part in decision-making processes does not necessarily mean
holding t he power to control all decisions, b ut rather ha ving the
opportunity to exert influence and make one’s voice heard.
RESOURCE-ORIENTED MUSIC THERAPY

VIEWS THE INDIVIDUAL WITHIN THEIR CONTEXT
As argued previousl y traditional (medical model) ps ychology an d

psychiatry are founded o n a concept of path ology as something that
resides solely in the individual. Consequently, these approaches t end to
obscure the interpersonal, structural , societal, and cultural aspects of the
problems. Diagnosis constitutes an individualization of the pr oblem,
defining it as a disea se and the individual as that which needs “f ixing”
(Furedi, 2004; Maddux, 2002a; Suyemoto, 2002). The growing gamut of
psychiatric diseas es such as posttraumatic str ess disorder, ga mbling
addictions, and sexual dis orders masks social and structural proble ms a s
pathology. As soon as pro blems are defined as patho logy, their solutions
are no longer political but therapeutic and medical.
The problem of individua lization can be seen as a problem rel ated
not only to t he understanding of pathology, but also to positive concepts
of health suc h as well-being and qualit y of life. In l ate modern society ,
well-being, happiness, and even health are part of individual “i mage
building” or “shopping for identit y.” Similarly to ill ness, the indi vidual’s
responsibility for well-being has to be seen in connection with structural
aspects. R esearch in positive ps ychology has show n that happiness is
related not so m uch to econom y and material welfare as to asp ects of
social relatio nship and possibilities to use our strengths (Carr, 2004;
Csikszentmihalyi, 2002; Keyes & Haidt, 2003; Seligmann, 2003).
Health is intimately linke d with resources as w ell as with pow er,
which is ulti mately about having access to and control over resources.
The social capital discourse has connected health differences to inequality
in resources, not only in ter ms of mate rial and econom ic resources, but
also in term s of social an d cultural pa rticipation an d networks. From a
sociological point of vie w, health ca n be seen as “a function of our
location within the system of social stratification” (Turner, 2004, p. 5). As
Turner (200 4) em phasizes, this links t he restoration of health of both
groups and individuals with empowerment. This understanding links with
the notion of “power to” rather than “power over” as the basic i dea of
empowerment. Thus, empowerment philosophy somehow bridges the gap,
or at least aspires to bridge the gap, between therapy and society, pointing
very clearly to the contextual aspect s related to he alth and li nking t he
therapeutic process to the i nteraction between individual and co mmunity.
Empowerment always unfolds in conte xt, and cannot be seen in isolation
from the interaction between indivi dual and societ y. This again r enders
the notion of empowerment through individual psychotherapy something
of a dilemma.
Becker (2005 ) poin ts out t his dilemma in relation t o the use of t he
concept of em powerment in femi nist therapy. She argues that
psychotherapy pr omises em powerment but off ers onl y a t ype of
compensatory power that supports and reproduces the existing power
arrangements because it neglects the need for social action to promote
change. The need for s tructural change has been m asked by the
individualistic discourse of therap y. Th e options f or making changes in
life have been reduced to that of i ndividual gr owth toward better
adaptation. A concept of “ purely” personal em powerment is, as Becker
sees it, one of the problems and paradoxes of therapeutic culture (Becker,
2005, p. 59). A problem we may encounter is that o ur good intentions of
empowerment m ay be ove rruled b y the organization al constraints of t he
medical healt h care sy stem at large as described by Townsend (1998).
This also co mpels us to ask whether in dividual psychotherapy, including
resource-oriented music therapy, can really be empowering for the client.
We have to ask if the idea of em powerment is com patible only with
therapeutic practices that ai m directly at change at structural levels, such
as community music therapy.
I feel tem pted to answer, paradoxica lly, “ yes” and “no” t o t his
question. In f eminist therapy, in individual as well as group form ats, the
82 Randi Rolvsjord
slogan “the p ersonal is pol itical” has been used to model an in direct way
of relating empowerment to social and political aspects of change, not just
to a “purely” personal brand of em powerment. Worell and Remer
(1996/2003) identify practical im plications of the fem inist slogan “the
personal is political,” including the separation of ext ernal fro m internal,
the refram ing of path ology as coping strategies, and the acqui sition of
skills for initiating environmental ch ange (Worell & Remer, 1996/2003,
pp. 6 8ff.). T he practical im plications of this sloga n or pri nciple would
involve talki ng and reflecting up on the contextual aspects of problems
with clients — for exa mple, talking about how society at large deals wit h
sexual violence. Becker argues, however, that in practice feminist therapy
has been “an often uni ntended translation of t he political into the purely
personal” (Becker, 2005, p. 136) . She argues that throug h the focus on
emotional and relational c ompetence, psychotherapy adds t o t he sum of
women’s responsibility for the contexts in which they live, thereby simply
constraining them to tolerate better an oppressive environment:
Psychotherapists’ attempts to “e mpower” their clients may well

be assisting women to experience an increased sense of control,
while those women remain firmly situated within an oppressive
social context. Without a corresponding increase in her actual
ability to make changes in that context, a woman may gain from
therapy only an illusory sense of agency in the worl d. (Becker,
2005, p. 139)
Becker’s crit iques are, however, i mportant as a re minder that any

therapy aiming toward e mpowerment has at the very least to i nvolve an
active and conscious awar eness of structural, social, and political aspects.
Contextual aspects may be brought into the verbal exchange — for
example, related to traumas and life situation. From a musical perspective,
an interest in the client’s use of m usic outside therapy also contextualizes
the therapy , providing possibilities for m aking use of the musical
experiences gained inside music therapy in everyday life.
IN RESOURCE-ORIENTED MUSIC THERAPY,

MUSIC IS SEEN AS A HEALTH RESOURCE
The concept of resources is in this book used as descrip tive not only of
the individual’s personal strengths, but a lso of those resources to w hich a
person has access. Thus, m usic as a h ealth resource must be understood
both o n an i ndividual lev el and on so cial and structural levels. In other
words, m usic as a health resource comprises the individual’s m usical
competences as well as being som ething that can be acces sed through
some kind of engage ment with m usic. The concepts of affordance and
appropriation may , as explained in t he previous chapter, help us t o
disentangle this com plexity. With DeNora’ s (2000; 2003) descriptions of
a twofold process of affordance and appropriation, m usical meanin g
becomes inti mately tied with the use of m usic. D eNora argues that this
leads to a dynam ic conceptualization o f music as a resource for “doing,
thinking, and feeling ‘ot her things ’” ( DeNora, 200 3, p . 5 7). Similarly,
Ruud also states that “in volvement in m usic is a potential resource for
obtaining a better quality of life” (Ruud, 1998, p. 57). Thus, m usic has
certain qualities that represent potentials that can only be actualized
through human engagement with music. As a resource, music can be used
in multiple way s that actualize various different meanings that we again
relate to aspects of health in differing ways.
From r esearch into people’ s use of music in daily life, it is, clearly
demonstrated that people engage with music in way s that are re lated to
health and quality of life. They use music to regulate their e motions, to
regulate their corporal activity . The y use music to construc t their
identities, to assist feeli ngs of em bodiment, or as an aid for social
ordering and social relatio nships (B utterton, 2 004; DeNora, 2000; Frith ,
2003; Ruud, 1997; 2005; Sloboda, 2005; Sloboda & O’Neill, 2001). We
can say that this resear ch has demonstrated that a “the rapeutic repertoire”
of way s of u sing m usic is not onl y used by m usic therapists in music
therapy settings, but also used extens ively by people in their every day
lives. The fact that clients use m usic in sim ilar way s outside m usic
therapy need not be seen as an argument against music therapy, but rather
as a contribut ion to our understanding of how m usic therapy works (see
Chapter 11). Through this type of resear ch, we learn that clients are likely
to have considerable co mpetence a s to how the y can use music s o as to
benefit their health in various wa ys. An im portant concern for music
84 Randi Rolvsjord
therapy in a resource-oriented pers pective m ust be to acknowled ge and

nurture such resources.
Understanding music as a resource does not mean only that we have
to consider its plurality of meanings and the multiple possibilities relating
to the use of m usic in therapy . It al so implies that we have to c onsider
access and “r ights” to m usic as a conce rn for m usic therapy. Thus, when
we understand music as resources, this obviousl y connects music, as well
as the practice of m usic therapy, to pol itics. Once music is considered to
be a health resource, access to music must be a concern for m usic therapy
— one that cannot be lim ited to the individual ’s musical capabilities but
is related to culture and politics. Ac cess to music must be understood in
terms of social, economical, political, cultural, and individual factors. One
important goal for music therapy, then, must be to provide an opportunity
for people to have access to music, as suggested by Aigen:
Music therapy consists of providing opportunities for m usicing

to people for whom special adaptations are necessary . The
functions of music for disabled indivi duals or for th ose in need
of therapy are the same as for other people. (Aigen, 2005, p. 93)
At this point, I must emphasize that, as f ar a s music therapy is

concerned, we are obviousl y ta lking about not onl y pr ofessional
engagement with m usic, but also the possibilities for appropriations of
music in everyday life. Several authors have e mphasized that we all have
musicality as a birthright (Davids on, Howe, & Sloboda, 1997; Sm all,
1998). Th is does not, h owever, im ply that we are all equal in t alent or
skills. Differ ences exist, but the y sh ould not restrain the m usic-loving
amateur from developi ng and using he r m usical skills. Music therapy is
concerned not with possibilities to use music at a pr ofessional level, but
rather with opportunities t o use m usic in ever yday li fe. This is indeed a
political concern. Viewed from this pe rspective, music therapy i s quite
often a process of regaining rights to music.
As Sm all (1998) has poi nted out , t here are structural constraints in
society that keep people a way from musicking. Such constraints may be
economic, social, or cultu ral. A poor economy m ight o n an in dividual
level li mit such forms of acce ss to music as buy ing CDs, owning a CD
player, paying for concerts or m usic l essons, or study ing m usic. On a
community l evel, a poor economy m ight lim it opportunities for there to
be professional orchestras, venues for m usical performa nce, or
instruments and music technology within schools. Even music therapeutic
practices ar e to a certain degree econom ically r estricted. Social and

cultural constraints might be connected to class, gender, or religion. When
access to music and the relationship to m usic a re matters of concern for
music therapy, a political and societal dimension is brought int o therapy.
We cannot engage in people’ s access t o music without having a concern
for the structural aspects of their possibilities for musicking.
There are also personal constraints that li mit people’s possibiliti es
for engagement with music. Personal constraints could be related to a lack
of m usical skills or of m usical and social co mpetence that makes it
difficult to participate in the arenas for music that exist in a comm unity.
There could also be ot her problems, such as phy sical disabilit y,
performance anxiety, social anxiety , lack of self-e steem, or depression,
which m ight make participation i n m usic difficult. However, individua l
constraints never exist in a vacuum : They are alway s connected to the
structural or societal/community levels. Obviously, there are also
capacious a spects of this, which are r elated to the roles and ar enas of
music — i.e., what music can be used for in different places (Persen, 2005,
p. 87). There are arena s for participation in music-making that are at leas t
more open to anyone who wants to par ticipate. As t hese musical arenas
are em bedded in social contexts, ther e are al ways unwritten rules that
restrict participation. You have to know how to play an instrument to play
in a marching-band; you have to be able to sing in tune to sing in a choir;
and you have to know when and how to applaud in a concert.
Rights to m usic are also about equal possibilities to define how to
music, why to music, when to music, and what music. For music therapy,
this question relates to t he cultural c ontext of which bot h clie nt and
therapist are part. Where acce ss and e nablement ar e concerns for m usic
therapy, these concerns d o not only a pply to m usicking in society (i.e.,
outside m usic therapy or in comm unity m usic ther apy), a lthough this is
certainly of i mportance. I wish to em phasize that music therapy, even in
individual psychotherapeutic settings, works because the client has access
to and an ability to use the musicking on offer in this setting in ways that
promote gro wth, develop ment, and change. Thus, in indivi dual music
therapy the concerns of access and the power of m usic are related to self-
determination of music within the therapy just as e mpowerment is related
to the use of m usic in every day life. The therapist cannot m ake all the
decisions about the music and musical activities in music therapy while at
the sa me ti me encouraging the client to use music i n the way she or h e
wants outside of music therapy.
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READING 30
Overview of My Writings
Even Ruud
When I was asked to contribute to this collection of theoretical studies, I had to

search through my main publications, as have been published by Barcelona
Publishers. Covering a time span of almost 40 years, I had to read again my
master’s thesis from Florida State University in 1973, which was later published
as Music Therapy and Its Relationship to Current Treatment Theories in 1980 and
in the following years in slightly revised editions in Spanish, Portuguese,
German, and Japanese. Although I still am pleased with the very idea of the
book— to show how music therapy is dependent upon or in close dialogue with
psychological theories— I would of course have liked to see most of the chapters
radically revised and rewritten. At the time of its formulation and, later,
publication, this theoretical study was important for the self-understanding of
the field of music therapy in the sense that it showed that the world of music
therapy could be seen in the light of major clinical theories or treatment
paradigms. Music therapy was not a self-sufficient musical treatment centered
on the genius of some of our founding therapists, but had to rely upon the
rationality and research within the field of medicine, learning theory,
psychoanalytic thought, and humanistic psychology and philosophy. I think that
the main insight I myself got from this study was the danger of reductionism
within any scientific field, which had man, or the individual, as its subject.
Reducing the individual to biology, his drives, his learning history, or idealistic
self-realizing struggles would simplify the complexity of human endeavor and
threaten our freedom to define ourselves.
Looking at this thesis today, I think that the chapter called “The
Humanistic/Existential Trend in Psychology” still can be read as a background
for the humanistic approach in music therapy. I also know that in the ’70s, my
idea of linking the Nordoff-Robbins approach to clinical improvisation to
humanistic psychology made some sense to Paul Nordoff and Clive Robbins
themselves. I remember Paul Nordoff commenting upon the chapter, expressing
his identification with Husserl’s idea of the transcendental ego, which he
probably saw in connection with the formulation of their idea of “the music
child.” Clive Robbins later wrote me how he had found great inspiration in the
work of Abraham Maslow.
However, rereading the chapter today also reveals some of the
weaknesses of this book. It is a massive import of external theories, and most of
the ideas are still not well integrated into a theory of music therapy. I would
agree with a critique, which emphasized its lack of indigenous theory, as Ken
Aigen has formulated it. Or, as Helen Bonny commented after she read the book,
it had a fundamental lack of understanding of the role of music in music therapy.
From my 1998 book Music Therapy: Improvisation, Communication, and
Culture, I have chosen two chapters. The chapter on “The Individual as an
Improviser: The Concept of the Individual in Music Therapy” expanded the idea
of a paradigm of complexity behind all approaches in music therapy. Looking at
the individual also as a organism, a person as well as a social being, will secure
how the field of music therapy will take into consideration the natural sciences
and its study of our physiological and neuropsychological reactions to music, as
1
well as our psychological and spiritual relations with music. But equally
important is to take into consideration our social embeddedness, the structural
forces that act upon and sometimes create and maintain unhealth. The idea of
the individual as an improviser is an attempt to suggest how the idiosyncratic
practice of music therapy may itself give an input to our understanding and
construction of “a concept of the individual.” The field of music therapy brings
forth a unique experience in human interaction and expression, which might
inform us as to how we might look upon ourselves.
From the 1998 book, I also chose the chapter on “Music and Identity.” My
research in music and cultural studies and my basic music anthropological
outlook lead to the idea of a strong connection between music and the way we
construct and narrate our identity. To me, it seems like a basic premise to all
music therapeutical work, to take departure from the personal identification
with music, to show a basic respect for the musical background and identity of
the persons we are working with.
In my latest book, Music Therapy: A Perspective from the Humanities
(2010), I continued this search for how meaning aspects in music are basic to our
combination of aesthetics and health work. Not only following the advice from
Helen Bonny and focusing more on the music in music therapy, but even
becoming a BMGIM fellow myself, I set out to design a GIM program (together
with my musicologist colleague Hallgjerd Aksnes) and transfer the ideas of how
“image schemas” (Mark Johnson) may influence our cognitions of music. Also,
ideas taken from music anthropologists Charles Keil and Steven Feld could
inform music therapists of how “music grooves” may be a part of the
relationships that grow out of musical improvisations.
The last chapter I chose—“Musicking as Self-Care”—points toward where
I am heading right now: to expand the role of music and music therapy into a folk
medicine. The use of music in health promotion in everyday life through new
digital electronic music media like smart phones and MP3 players opens up
possibilities for the field of music therapy. Since I entered the field of music
therapy around 1970, there has been a revolution in the use of music as
witnessed in the use of Internet downloading of music, personal libraries on
smart phones, etc. How we may use music to fight stress and pain, to regulate
our emotions and energies, will require both research and educational programs.
Music therapy seems to be the natural field to synthesize and actualize this
research, and music therapists will be the profession to transform this search
into an educational and cultural program.
2
Taken from: Ruud, E. (1978). Music Therapy and its Relationship to Current Treatment
Theories, pp. 43–59. St. Louis MO: MMB.
The Humanistic/Existential Trend in Psychology
Even Ruud
Introduction
During the last two or three decades a new trend has emerged in psychology. This trend has been
named "third force," humanistic or existential psychology and has won recognition as the third
emphasis in American psychology besides the psychoanalytical and behavioral approaches. It is
the purpose of this chapter 1) to present the main issues in this current development in the field
of psychology, 2) to present some research and procedures in therapy with music which can be
said to be influenced by this new development, and 3) to discuss some of the basic concepts and
procedures belonging to this approach.
"Third Force" Psychology
Humanistic psychologists have come to be concerned with a whole range of human phenomena
which they claim has been neglected by other approaches in psychology. The role of humanistic
psychology, according to the Articles of Association of the American Association for
Humanistic Psychology, has been defined as follows:
Humanistic psychology is primarily an orientation toward the whole of

psychology rather than a distinct area or school. It stands for respect for the
worth of persons, respect for differences of approach, open-mindedness as to
acceptable methods, and interest in exploration of new aspects of human
behavior. As a "third-force" in contemporary psychology it is concerned with
topics having little place in existing theories and systems: e.g., love, creativity,
self, growth, organism, basic need gratification, self-actualization, higher values,
being, becoming, spontaneity, play, humor, affection, naturalness, warmth, ego-
transcendence, objectivity, autonomy, responsibility, meaning, fair-play,
transcendental experience, peak experience, courage, and related concepts
(Severin, 1965, p. 4).
It is mainly through their choice of area of interest, as indicated above, that humanistic
psychologists can be said to represent a distinct school or movement. Concerning their scientific
open-mindedness, their "respect for the worth of person," respect for differences of approach,
and so on, they have to share emphasis with all other approaches or movements in the field of
psychology which claim to be scientific.
The growth of humanistic psychology has in many ways been a growth away from rigid
experimental procedures often prevalent in the field of scientific psychology. Humanistic
psychologists have found the experimental design, or the behavioral approach too narrow to
explain and understand the variety of human phenomena, or they have found the ideal of natural
science inappropriate in the study of man. Statements like or similar to the following are often
found in the literature of the humanistic/existential psychologists:
Toward the end of the Nineteenth Century, when psychology was separating from
philosophy and attempting to establish itself as a science, its leaders were eager
to be accepted as true scientists. Accordingly, they did their best to copy in their
own field the same methods which had won prestige for the older and more
advanced science of physics. To correspond with the physicist s atom as the most
elementary unit of matter, these early psychologists endeavored to identify
"atoms" of behavior—that is, irreducible elements of human activity which might
serve as building-blocks for more complicated reactions. They tried to do this by
employing as nearly as possible those methods of experimental analysis which
were used in physics. By present standards these early efforts were crude, but,
despite increased sophistication, present-day experimentalists still tend to lie
ultra-conservative in the selection of problems upon which to do research. Since
they are fearful of turning up data not at once countable or measurable by
techniques already at band, they have relatively little to contribute as yet to such
full-scale human problems as emotion and personality. Psychology, they say,
needs perhaps another fifty or a hundred years of development before it can deal
adequately with such complicated matters (Perls, Hefferline, and Goodman, 1951,
p. 17).
Basic Postulates of Humanistic Psychology
Bugental (1963) has presented five postulates of humanistic psychology that seem to represent
common elements in the perspectives of most writers identifying with this field.
1) Man, as man, supersedes the sum of his parts. When "man" is spoken of in humanistic
psychology, it is done with the intent of characterizing a person rather than an "organism."
Humanistic psychology is concerned with man at his most human, or to say it differently, with
that which most distinguishes man as a unique species. The first postulate states the keystone
position that man must be recognized as something other than an additive product of various part
functions. Part-function knowledge is important scientific knowledge, but it is not knowledge of
man as man. It is knowledge of the functioning of parts of an organism.
2) Man has his being in a human context. The second postulate says that the unique
nature of man is expressed through his always being in relationship with his fellows. Humanistic
psychology is always concerned with man in his interpersonal potential. This is not to say that
humanistic psychology may not deal with issues such as man's aloneness, but it will be evident
that even when so designating it as "aloneness," they are speaking of man in his human context.
It is further said that the psychology of part-functions is a psychology that mechanically and
incompletely handles this relatedness (actual or potential) of the human experience.
3) Man is aware. In the third postulate the focus is upon man's awareness. Awareness is
postulated to be continuous and at many levels. By so viewing it, humanistic psychologists
recognize that all aspects of man's experience are not equally available to man but that, whatever
the degree of consciousness, awareness is an essential part of man's being. The continuous nature
of awareness is deemed essential to an understanding of human experience. It is said that man
does not move from discrete episode to discrete episode, a fact overlooked by experiments of the
behavioristic orientation when they treat their subjects as though they had no prior awareness
before coming into the experimental situation. Their postulation also provides for
unconsciousness as a level of awareness of which there is not direct or immediate apprehension,
but in which awareness is nevertheless present. This is not the same as the Freudian concept of
the unconscious, but is said to be probably more valid within the humanistic orientation.
4) Man has a choice. This postulate states that choice is a given of experience. As man is
aware, he is aware that his choices make a difference in the flow of his awareness, that he is not
a bystander but a participant in experience. From this fact flows man's potential to transcend his
creature likeness, which is also to say that from this postulation man's capability of self-initiated
or willful change is derived.
5) Man is intentional. This postulate says that in his choices, man demonstrates his intent.
This does not mean "striving," but it does mean orientation. Man intends through having
purpose, through valuing and through creating and recognizing meaning. It is said that man's
intentionality is the basis on which he builds his identity, as it distinguishes him from other
species. It is further said that man intends both conservation and change, and that mechanistic
views of man frequently deal only with drive reduction and homeostatic conception. Humanistic
psychology states that man seeks rest but concurrently seeks variety and disequilibrium. Thus
they say that man intends multiplicity, complexity, and even paradoxicality.
The Influence from Existential

and Phenomenological Philosophy
Humanistic psychology has been deeply influenced by existential and phenomenological thought
throughout this century. Philosophers like Kierkegaard, Husserl, Heidegger, Marcel, Buber,
Sartre and others have, through their existential analysis of what it involves to be a human being,
in many ways laid the ground for the growth of humanistic psychology. A short presentation of
some of the major ideas of these philosophers will be given below.
Søren Kierkegaard. A century ago, the Danish philosopher, Søren Kierkegaard, offered
us a tremendously acute and prescient insight into problems like the significance of self-
consciousness, disintegration of identity, estrangement (self-alienation), utter loneliness and the
nature of anxiety. As Rollo May has remarked:
Kierkegaard's penetrating analysis of anxiety . . . would alone assure him of a

position among the psychological geniuses of all time. His insights into the
significance of self-consciousness, his analysis of inner conflicts, loss of self, and
even psychosomatic problems are the more surprising since they antedate
Nietzsche by four decades and Freud by half a century. This indicated in
Kierkegaard a remarkable sensitivity to what was going on under the surface of
Western man's consciousness in his day, to erupt only a half-century later
(Ruitenbeek, 1962).
It is impossible to deal with all aspects of Kierkegaard's works here; only some of his
viewpoints about the problem of anxiety will be presented.
In Freud's first theory, anxiety is the re-emergence of repressed libido, and in his second
theory, anxiety is the ego's reaction to the threat of the loss of the loved object. Kierkegaard, on
the other hand, described anxiety as the struggle of the living being against nonbeing. He went
on to point out that the real terror in anxiety is not death as such, but the fact that each of us
within himself is on both sides of the fight, that "anxiety is a desire for what one dreads, a
sympathetic antipathy," as he put it. In Kierkegaard's view, anxiety is likened to an "alien power
which lays hold of an individual, and yet one cannot tear one's self away, nor has a will to do so,
for one fears, but what one fears one desires" (See Rollo May, 1960).
Edmund Husserl (1859-1938) is regarded as the father of modern phenomenology.
Husserl started out as a mathematician, and not until after he was forty years did he start to work
out his phenomenology. In his twenties Husserl was a student of the philosopher, Brentano, who
won recognition because of his concept of intentionality. Brentano meant by intentionality that
consciousness is neither purely formal in the Kantian sense nor empty and passive in a Lockean
sense. On the contrary, to conceive of consciousness as empty or detached is to misconceive it.
Experience shows us that consciousness is always consciousness of something. The subjective
element of consciousness cannot be separated from its objective content. Intentionality denotes
the dynamic structure of consciousness which is inseparable from the objects that inform it
(Sadler, 1969, Chapter 2).
Sadler writes further that Brentano inspired the young Husserl to turn his aspiration from
a search for a foundation of mathematics toward an attempt to develop the foundations for
a truly scientific psychology and philosophy. The goal was to grasp clearly and firmly the
underlying structure of consciousness seen in the fullness of its intentionality. By exploring
consciousness in terms of intentionality, one would reach the foundation for knowledge of all
reality before a split between subject and object could occur. Husserl thus marked out "pure
consciousness" as the terrain for his exploration. Sadler writes:
By "pure consciousness" he meant the ego, or the center of the self which harbors
all of the individual's interests and recollections, and from which emerge his
thinking, acting, reacting, judging, etc. This center or core of the self is that
aspect of the personality, the pure ego, which stands in direct relation to the
world of essences, or universals, or ideas, which comprise all meaning and make
experience, as we understand it, possible. The purpose of his phenomenology is to
demonstrate the direct experience of these objective, self-revealing essences by
the pure ego, which had been ignored by the traditional science of consciousness,
psychology. (Ibid., p. 28).
Although Husserl's ideas about "the pure ego," or transcendental ego as it is also called, is much
debated among existential phenomenologists, Husserl laid the ground for a fruitful development
of the phenomenological method. For the purpose of this book, it is only necessary to grasp the
basic idea of phenomenology, that it is a method to be applied in a search for the presuppositions
of how knowledge is acquired. In the last and conclusive chapter this idea will be taken again in
relation to a discussion about experimental methods versus phenomenological methods.
Buber's contribution in terms of his concept of the I-Thou relationship has been dealt
with in Chapter Three. Another German philosopher, Heidegger, emphasizes the concept
"Dasein" ("being-there" or "being-in-the-world"). In a search of an ontological analysis of
"authentic" Dasein, he singles our three phenomena: "conscience," "guilt," and "resolve."
Conscience is related to man's selfhood and redeems him from the sheer anonymity of "das
Man." Guilt points to an intrinsic and original deficiency or privation of "Dasein." Only by
accepting the possibility of his entering into the landscape of guilt can man open himself to his
authentic potentiality for existence. And into this potentiality he projects himself by his
"resolve," thus imparting to his Dasein a valid "lucidity" (Ruitenbeek, 1962).
Rollo May says, "What an individual seeks to become determines what he remembers of
his has been." In this sense, the future determines the past. To the patient in therapy, the future is
not a remote contingency. Rather, as soon as he can rid himself of neurotic anxieties and
restrictions, he may begin to see himself and to realize himself in the present. Ruitenbeek writes:
True neurosis generally operates as the block which prevents the patient from
reaching that goal. Far too often he lacks self-awareness, what Heidegger calls
Seinsverstandnis, and thus cannot exert the ability to choose. This "ability to
choose" is an assumption fundamental to existential thinking. The
psychotherapist, however, must emphasize the Eigenwelt: a significant aspect of
his work is demonstrating the range of relationships between the patient's self and
the world, i. e., making the patient more familiar with the several modes of being-
in-the-world. As Binswanger states the problem, existential analysis tries to
understand the patient's life history, but it does "not explain this life history and
its pathologic idiosyncrasies according to the teaching of any school of
psychotherapy, or by means of its preferred categories. Instead, it understands
this life history as modifications of the total structure of the patient's being-in-the-
world . . ." Since neurosis may operate to limit a patient to Umwelt and Mitwelt,
past and present, the existential analyst's concern with Eigenwelt becomes even
more crucial, for, as we have said, the Eigenwelt is the gate into the future, and it
is in the future that cure may occur (Ruitenbeek, Op. cit., p. 26).
In this context, the contribution of Sartre is perhaps somewhat more difficult to evaluate.
Sartre has presented the most emphatic statement of human freedom and individual
responsibility. "I am my choices," he repeats again and again in various forms. He has given
some brilliant analyses of what he sees to be errors in the Freudian construction, especially the
concept of the unconscious. Sartre denies the existence of the unconscious, since even in self-
deceit "I know I am deceiving myself;" and the so-called "censor" which Freud postulated as
standing at the door of the unconscious must also be conscious in order to know what to repress.
Sartre has also been used by the humanistic psychologists in their attack upon
behaviorism. On the other hand it is also possible to take some part of Sartre's thought as a
defense of some of the aspects of the behavioral, especially the Skinnerian model. Following
Sartre's line of reasoning, where existence precedes essence, it is philosophical error to attribute
any "qualities" or essences to man. One does not say "he acted badly, hut he is a good fellow
(inside) anyway." Following Sartre, one's actions constitute one's life; you are good when you act
good and vice versa. Existence precedes essence. This can mean the same as to say that "all there
is is behavior." There is nothing "inside" you which excuses your actions; change your behavior
and you will change your "essence" or "personal qualities."
Relationship Therapy
There are many "schools" within humanistic psychology, for example, "Gestalt therapy," "non-
directive therapy," Victor Frankl's "logotherapy," Binswanger's "Dasein analysis," and more. Not
all of them bear direct implications for the field of music therapy, therefore there is no need in
this book to go further into these schools. Only one "school" will be dealt with more closely,
mainly because of its relationship to the work of two music therapists, Paul Nordoff and Clive
Robbins. There is no explicitly stated connection anywhere between "relationship therapy" and
the music therapy of Nordoff and Robbins, but the author has taken the liberty of drawing a
connective line between them. If this postulated connection should prove not to be valid, the
writer sees no reason why the method of "clinical improvisation" developed by Nordoff and
Robbins could not be more closely incorporated into the framework of relationship therapy, or be
used in such a setting.
Another reason for making this connection is to call attention to the possible relationship
of the work of Nordoff and Robbins to the field of child psychiatry, in other words to emphasize
the possible application of this particular music therapy procedure in the field of child psychiatry
or "relationship therapy." The following presentation of relationship therapy is based on the
works of Axline (1969, 1971) and Moustakas (1959).
Moustakas defines relationship therapy as a unique growth experience created by one
person seeking and needing help and another person accepting the responsibility of offering it.
In everyday life we observe what happens naturally to people as they grow and
live together. The intensified consciously structured growth experience which is
therapy can be understood by the same principle and seen as not essentially
different from any other life experience in which two people participate in a
genuine and fundamental way (Moustakas, Ibid., p. 1).
Moustakas says further that the word therapy comes from the Greek noun meaning
"servant." The verb is "to wait," thus he states: The therapist waits for the child to come to terms
with himself, to express his difficulties, and to find new ways of relating and living. He waits for
the child to be willing to face himself and to develop in accordance with his own individual
nature. Waiting is a positive force, a commitment of faith actively expressed by the therapist.
In relationship therapy there is a respect for the unique nature of the child. He is never
considered or talked about as an "it," as an object for study, but always regarded as a person with
individual integrity. The therapist does not view the child in abstractions, or from external
judgments. He relates with the child in alive, growth experiences. It is this heightened and
deepened experience in living which constitutes the heart of therapy (Ibid., p. 2).
About the child, Moustakas says that at the root of the child's difficulty is the submission
and denial of his self. Somewhere along the line of his growth and development, he has given up
the essence of his being and the unique patterns that distinguish him from every other person.
The growth of the self has been impaired because of the child's rejection in important personal
relationships. The child has been severely rejected by others and he has come to reject himself.
He is cut off from vital self-resources which would enable him to develop in accordance with his
own particular talents. In every aspect of relationship therapy, the child is therefore encouraged
to face himself, to make decisions, to regain touch with his real feelings. The freedom to talk, to
express himself, to make decisions, the constant recognition of his self, and the process involved
in these experiences enable the child to recover or discover a sense of self-esteem and to restore
his powers as an unique individual.
The Music Therapy of Paul Nordoff and Clive Robbins

There are many examples throughout the work of Nordoff and Robbins where they regard the
process of music therapy as a growth process to be initiated in the child. In the conclusion
of their book Music Therapy in Special Education, they write:
When you begin a music therapy program, be aware from the first session onward
that you are working in time and with time. Plan to hold regular music therapy
sessions throughout the month to come and anticipate them as "spaces" to be
filled with the richness of work and with development in the children. Carry the
sessions through consistently, repeating and developing the musical activities and
working resourcefully with the children 's responsiveness. You will then be
initiating and maintaining processes of therapeutic growth (Ibid., 197l, p. 237).
What is perhaps most important in the music therapy of Nordoff and Robbins is that they
have provided the field of music therapy with musical procedures, especially an improvisational
method, which in many ways transcend any theoretical framework. Their emphasis has been on
developing new musical methods to be utilized in the therapeutic process, their work has been a
research into the vast possibilities which music can offer as a therapeutic medium. Since their
principal method, also called clinical improvisation, is a live, musical procedure, it is only
possible here to describe the basic setting.
Their method involves creating a musical situation where the child actively participates,
e.g., playing the drum or cymbal while Nordoff improvises music at the piano. With his musical,
skills and his unusual openness and attention towards spontaneous musical responses from the
child, Nordoff manages to bring the child into a musical situation which the child will possibly
never forget. Robbins also participates in the situation, helps the child manage the instruments,
and supports the child in this new, and to the child often dramatic, experience.
In their method, music is of primary significance. As they write:
Music is a language, and for children it can be a stimulating language, a

consoling language. It can encourage, hearten, delight, and speak to the inmost
part of the child. Music can ask stimulating questions and give satisfying answers.
It can activate and then support the activity it has evoked. The right music,
perceptively used, can lift the handicapped child out of the confines of his
pathology and place him on a plane of experience and response, where he is
considerably free of intellectual or emotionally dysfunction (Ibid., p. 238).
Music Therapy and Experience in Self-Organization
Experience in various aspects of the self was discussed by Sears when he defined the processes
in music therapy and wrote:
Experience in self-organization concerns inner responses that may only be

inferred from behavior, and has to do with a person's attitudes, interests, values,
and appreciations, with his meaning to himself (Gaston, 1968, p. 39).
Sears further went on to say that music therapy procedures could be based on the following
rationale: 1) Music provides for self-expression, 2) music provides compensatory endeavors for
the handicapped individual, 3) music provides opportunities for socially acceptable reward and
non-reward, and 4) music provides enhancement and pride in self.
The concept of self, or ego, is a difficult one to grasp and has also been a subject of much
theoretical discussion. Earlier in this book, self has been defined, according to the existential
tradition, as one's ability to relate to one's own thoughts, feelings, memories, etc. One could
possibly think of other ways of describing the processes involved, the one given attention
here is outlined by the ego-psychologist Heinz Hartmann (Cummings and Cummings, 1962).
Hartmann enlarged Freud's original concept of the ego. He did not believe that it arose, as
Freud conceived it, in conflict between the id, superego, and reality, with only the function of
synthesizer. Hartmann recognized a "conflict-free portion," that is, a part which developed from
the natural endowment of the individual and which was not dependent on the classical
Freudian joust for its existence. This portion he conceived as being the individual's native
competences—his ability to walk and to speak, as well as the inborn talents that he brings to bear
on problems needing solutions. He believed that instrumental tasks were performed under the
direction of this conflict-free portion of the ego.
One could take a step further and postulate that in order to develop a consistent ego, or a
consistent concept of the self, it is necessary to develop a differentiated and flexible repertoire of
behavior. The self now, instead of becoming a sort of fixed "essence," will be sensitive to
changes in the environment, to actions initiated by the individual.
In line with this reasoning, musical activity involving an individual may have direct
implications for his self-image. This idea was explored by Michel and Martin in an experimental
study which tested the hypothesis of whether or not the learning of a popular music skill, such as
playing rhythm guitar, would influence self-esteem and academic achievement of disadvantaged
Black junior high school students. They concluded:
The development of musical skill may be an aid in increasing the self-esteem of

disadvantaged problem students, and consequently may generalize to increased
self-confidence in other tasks. Also it seems evident that the teaching of attending
behavior through music activities, and with music as both a continuous reward
(inherent in the activity) and as a consequence (or reward) may transfer to other
classroom situations and tasks requiring attending behavior (Michel and Martin,
1970, p. 124-128).
Music and Peak-Experience
Abraham Maslow (1970) who spent some time and research upon investigating what he called
healthy, self-rea1izing people was met by the fact that almost any man has had sometimes in his
life periods or moments of happiness and fulfillment—a peak experience. In Maslow's terms this
is an experience of being, which means for him a temporary, non-striving, non-self-centered,
purposeless self-validating end experience, a state of perfection and goal-attainment.
The concept of peak-experience has been utilized in therapy and it is reported in the
literature a study by Bonny and Pahnke (1972) where music and LSD together with other
psychedelic drugs were employed in a specific type of therapy called "psychedelic peak
psychotherapy." "Psychedelic peak" is referred to as a type of transcendental or "cosmic"
experience that can occur during the session. The rationale for this specific kind of setting is that
by giving patients with alcoholism, narcotic addiction, and psychological distress associated with
terminal cancer such "peak-experiences" it may act as a strong motivator which can possibly
initiate a new direction in those persons' lives.
The importance of this study is the way outlined which music can complement the
therapeutic objectives. An earlier study by Gaston and Eagle (1970) on the function of music in
LSD therapy concluded that the presence of music is more preferable to its absences as rated by
patient preference and treatment results. Bonny and Pahnke go further and say that music
complements the therapeutic objectives in five interrelated ways: 1) by helping the patient
relinquish usual controls and enter more fully into his inner world of experience; 2) by
facilitating the release of intense emotionality; 3) by contributing toward a peak experience; 4)
by providing continuity in an experience of timelessness; and 5) by directing and structuring the
experience.
An Evaluation of the Humanistic/Existential Method
One could perhaps criticize the humanistic approach in psychology because of its lack of
experimental, controlled studies. It is, however, important to remember that these psychologists
never claimed to be scientific in a positivistic sense. On the contrary, humanistic psychologists
set out to find new methods of investigating the complexity of human behavior, methods which
they claimed to be more fitting to the study of man. The positivistic ideal of science, they said,
can never lead to a complete understanding of man, it is a method of science intended to be used
in the study of natural phenomena, not living human beings.
Not only is the field of investigation different from that of natural science, but also the
relationship between the scientist and his field of study. The natural scientist is detached from the
situation he investigates, he stands "outside" trying to be as objective as possible. The
psychiatrist David Cooper states the following:
Experimental natural science is grounded in careful observation. Each

investigation must proceed from observed facts. In physical and biological
science these observed facts are usually inert facts; that is to say they are grasped
from the exterior by an observer who is not disturbed by them and does not
disturb them by his process of observation.
Even in microphysics where the uncertainty principle tells us that the
observational procedures disturb the field of the observed, there are
mathematical techniques which maintain the observer in some sort of relation of
exteriority to the observed and indeed to his observing techniques themselves. In
a science of personal interaction, on the other hand, mutual disturbance of the
observer and the observed is not only inevitable in every case but it is mutual
disturbance which gives rise to the primary facts on which theory is based, and
not the disturbed or the disturbing entities (1967, p. 14).
It is this situation which has led many psychologists and psychiatrists in a search for new
"modes of inquiry." They have refuted the old positivistic ideal, and claimed that the concept of
science,—the word originally meant "search" or "research,"—has to be broadened.
A Criticism of the Humanistic/Existential Approach

It has been said that humanistic psychology in many ways has grown out as a reaction against the
technological tendencies within the field of psychology. Psychologists affiliated with this trend
saw a need of seeking a philosophical foundation for their methods, and it was natural to go to
European existential thinkers, such as Heidegger and Sartre. It is, however, doubtful if
"existentialism" that is to be found among American psychologists has anything in common,
except some formulations and concepts with these philosophers. There are many examples that
the existentialism found in humanistic psychology leads into idealistic formulations where "self-
realization" or "self-actualization" become the realization of some sort of "inner potential" or an
"inner nature," or "the existence" which has become almost identical with the individual's
"personality-structure" (Johanson and Johanson, 1971).
Humanistic psychology could also be criticized because of its political bias. Its followers
never go outside the existing social conditions, and when Maslow develops his theory about
"self-actualization," he does not claim like Sartre, that self-realization is an infinite dialectic
movement, where the individual always defeats his material conditions through his activities,
but he mentions as examples of self-realizing people, "Mrs. Eleanor Roosevelt, and probably,
Truman and Eisenhower" (Ibid., p. 27).
The Consequences of the Affiliation of Music Therapy

to Humanistic Psychology for the Training of the Music Therapist
The specific music therapy methods and procedures applied by a music therapist will in certain
cases be influenced by the theoretical background of the therapist. For example, the introduction
of behavioral modification procedures into the field of music therapy has in many cases
seemingly transferred the emphasis that previously was laid upon the music and the musical
training of the therapist, to an emphasis upon the training in and the use of the principles of
behavior modification. Throughout the literature of research in this field music is treated as a
reward in one or another form and there is little evidence of music being used as a "living-
language," administered as a means of communication between the therapist and the patient.
In most of the studies in this field, the music is "dead," that is, it is presented either from a tape,
from a phonograph, or in the form of an already composed song or piece of music. One almost
never meets music composed or created "on the spot," music improvised to meet the special
demands of the moment.
This probably has to do with the behaviorist standards of predictability and control over
the variables involved in the situation. In an improvised musical situation there is room for
everything to happen—it may lead to a breakthrough in the therapeutic relationship or it may not.
This thinking is probably not in line with the behavioral model of the therapeutic process,
although there are no reasons why improvised music could not be viewed as a strong reinforcer
for various kinds of activities initiated by the patient. The therapeutic application of musical
improvisation represents, in the opinion of this author, a challenge to the behavioral music
therapist.
The method of clinical improvisation, as developed by Nordoff and Robbins, has
provided a challenge for music therapists working in the more "humanistic" or dynamic
traditions to be involved in serious musical education. A skillful mastery of their principal
instrument and vocal freedom seem to be necessary to obtain the musical and personal contacts
these procedures are based upon.
As a conclusion of this section it could be stated that the consequences of an affiliation of
music therapy to humanistic psychology implies that a great emphasis will be placed upon the
musical education of the therapist. Furthermore, in the behavioral school, more emphasis could
be placed upon applying the principles of learning theory or the principles of behavior
modification in an analysis of the effects of live or improvised music upon the therapeutic
process, as was done by Ponath and Bitcon (1972).
Summary
In this chapter the focus was upon the connection between music therapy and the
humanistic/existential trend in psychology. First, a general presentation of "Third-force"
psychology was given, followed by the basic postulates of this new trend in psychology. As a
summary it could be said that humanistic psychology is characterized by the following: 1) A
centering of attention of the experiencing person, and thus a focus on experience as the primary
phenomenon in the study of man. Both theoretical explanations and overt behavior are
considered secondary to experience itself and to its meaning to the person. 2) An emphasis on
such distinctly human qualities as choice, creativity, valuation and self-realization, as opposed to
thinking about human beings in mechanistic and reductionistic terms. 3) An allegiance to
meaningfulness in the selection of problems for study and of research procedures, and an
Opposition to a primary emphasis on objectivity at the expense of significance. 4) An ultimate
concern with and valuing of the dignity and worth of man and an interest in the development of
the potential inherent in every person.
After this presentation, an appraisal of the influence from some of the existential and
phenomenological philosophers was introduced. It was concluded that when it comes to the
philosophy of Sartre, he may sometimes be taken as a defense of behaviorism as well as for the
humanistic psychology. A short presentation of "relationship therapy" was followed by an
introduction to the music therapy of Nordoff and Robbins. Other examples of music therapy
procedures affiliated with the humanistic tradition were given—music therapy and experience in
self-organization as well as music and peak experiences.
Concerning the existential/humanistic method it was said it represented an alternative to
the positivistic ideal of science, claimed by its followers to be more fit in the study of man. A
criticism of the humanistic psychology revealed that it was sometimes not in accordance with the
original European theories, tending sometimes towards philosophical idealism. Lastly,
behavioral music therapists were challenged in their tendency to move away from live,
improvised music therapy procedures, and it was concluded that a music therapy education,
humanistic or dynamically oriented, ought to lay great stress upon the musical training part of the
education of the music therapist.
Ruud, E. (1998). Two Excerpts: Music Therapy: Improvisation,
Communication, and Culture, pp. 19-30, 31-48. Gilsum NH:
Excerpt One
Excerpt Two
Chapter 3
MUSIC AND IDENTITY

Even Ruud
All of us have had the feeling sometimes that there is a con-
nection between the music we prefer to listen to and the people we
are-perhaps not too literally, but metaphorically. We like to refer
to our collections of tapes or CDs or the music we prefer to listen
to as "my music" (Crafts et al., 1993). Sometimes we may also
have the feeling that music reaches deep into or mirrors our per-
sonalities--our "true selves," as some like to call it. We certainly
are offended if someone tells us we have bad taste in music. We
engage in the game of sorting other people into broad sociological
categories on the basis of their musical taste, often supported by
observations about the ways they dress, move, and talk. We act as
if such pigeonholing were possible: ''Tell me what kind of music
you like and I'll tell you who you are."
My theories grew out of the vague intuition that there
might be some connection between music and the way we look at
and present ourselves. After struggling with this idea for what
turned out to be more than 15 years, I would have to state the
hypothesis differently today. Listening to, performing, and talking
about music is not as much a reflection of identity as a way of per-
forming our sense of ourselves, our identities. This makes a dif-
ference in the way we perceive how a sense of identity is constituted.
Instead of engaging in speculations, I set out to design a
study. From Kenneth Bruscia at the 1982 symposium in New
York, Music in the Life of Man, I got the idea of asking my music
therapy students to write their musical autobiographies. In the con-
text of my teaching systematic musicology in the music therapy
training courses in Oslo and Sandane, I found this approach to be a
valuable teaching and learning technique. It allowed students to
apply academic knowledge to their lives; the emphasis was on
doing and learning instead of passively receiving ideas. Opportu-
Ruud for EB textn no line nos.:Layout 2 12/28/09 11:34 AM Page 54
Ruud, E. (2010). Two Excerpts: Music Therapy: A Perspective From

the Humanities, pp. 54-72, 157-179. Gilsum NH: Barcelona Publishers.
Excerpt One
Chapter 4
Musical Meaning in Music Therapy

Even Ruud
A music therapy based upon the values from the human-
ities underlines how we are users and interpreters of signs
and symbols. Within this horizon music itself will have
to be understood as a sign or symbol, as a narrative text,
which may give us access to realities, feelings, and the life-
world of other individuals. Related to the field of music
therapy, such a conception of music will determine how
meaning is produced, how it is interpreted and gives rise
to action. In other words, the question of musical mean-
ing is a main issue both in this chapter and the next chap-
ter, where broader issues of music and aesthetics are
discussed.
There are many ways of conceptualizing music in
music therapy. Music therapy and musicology are linked
through their sharing of some underlying assumptions
about the very nature of music, what Philip Bohlman calls
the “metaphysical assumptions of music” (Bohlman
1999). Ontologies of music, i.e., what we fundamentally
may think music is or is not, are constructed and articu-
lated differently within different music therapy traditions.
To the positivist music therapist, music is understood and
described as “regular vibrations” effected by energy pro-
ducing sound waves, while the New Age followers rather
musical meaning in music therapy 55
see music as a reflection of “cosmic vibrations.” To other

music therapists the essence of music is linked to sensu-
ality and feelings, while others see processes of cognition
at the heart of the musical experience.
Recently there has been a move within the field of mu-
sicology toward studying music as a sign and in the con-
text of the performance. This means that music is not
studied as a work present in a score, but must be studied
in the context of a performance, live or recorded, in order
to grasp its meaning-producing elements.
In summing up some of the recent trends within the
field of musicology, British music therapist Gary Ansdell
(Ansdell 1997) enumerates some of the views of music he
thinks of particular relevance for music therapy, that is
music:
• as a process rather than a structure

• as something intimately tied to human affect and
meaning
• as participatory and inherently social
• as determined by culture and context
• as performed, improvised, and lived as well as no-
tated and reproduced
• as personal, embodied and deeply human (p. 37)
In an article some years later, Ansdell (2003) elabo-

rates further on this theme, and came up with an addi-
tional list:
• Music is not an autonomous object — it is embed-

ded in sociocultural process.
• Music is not a universal (or natural) phenomenon
— it is a cultural phenomenon and lives in and
through locally defined contexts.
56 music therapy: a perspective from the humanities
• Music’s meanings are not “immanent” — they are

socially and culturally constructed.
• Musicking is not just a mental phenomenon — it
happens between bodies.
• Music’s meaning is not just in its internal structures
— meanings are generated by local sign-systems.
• Music is not just a notated artefact — its basic real-
ity is lived performance.
• Music does not represent emotion and meaning —
it enacts them.
• Music’s expressive form is as crucial as its structures.
• Music is seldom just a private pleasure — it is al-
ways already a social participation.
• Musicking can simultaneously reproduce the legacy
of another and allow the performance of the self
(pp. 155–156).
These issues are in many ways part of the everyday

concern of the music therapist. At the same time such a
focus clearly demands a sort of musicological approach,
which goes beyond looking into musical scores as “au-
tonomous organisms.” To the music therapist, the ques-
tion of musical meaning is not only a question of
“aesthetics”; how music affects us is a moral question, a
highly pragmatic issue in the sense that we need empirical
documentation rather than speculative arguments. To do
musical analysis of music therapy products and processes
we need to involve the listener and performer in a direct
way. What is “aesthetically significant” in music cannot be
decided from a disembodied analysis; it must take into ac-
count the particular situation, the clinical as well as the
cultural, as well as the particulars in the music. I will re-
turn to some of the methodological issues involved in an-
alyzing music therapy music in the next chapter.
As there are many ways to achieve health, there will

be many forms of music and musical activities, which can
provide resources to experience health. This means that
music in this context does not mean certain composers, a
specific genre of music, or a specific way to listen to or
perform music. How we experience music and how music
will affect us will depend on our musical background, the
influence of the music we have chosen, and the particular
situation in which we experience the music. In other
words, in such a contextual understanding, the music, the
person, and the situation work together in a relational or
mutual relation where changes in any of these compo-
nents will change the meaning produced.
This contextual understanding is an important prem-
ise for music therapy and health work through music. In
other words, we cannot buy music at the pharmacy that in-
dependent of a learning situation and manner of use will
have a positive effect. People are in many ways their own
experts when it comes to knowing what will affect them in
different situations. Music, which may relax one person in
a certain situation, may have provocative and destructive
effects on the mood of another. When I put forward the
value of making one’s own musical choices, I want to refer
back to the humanistic values I introduced earlier, where
autonomy and self-determination were underscored.
But as we also know, within our shared musical cul-
ture, most people will experience how music is made for
relaxation, to increase tension and drama, or to stimulate
us, will be interpreted in the expected way. Many hun-
dreds of years of film music has trained us to decode
music after quite specific norms. Slow tempo, steady
pulse, few leaps in the melody will be conceived by most
of us as calming music. In this way, we can say that
certain musical structures, performed in a certain way,
will afford a certain meaning. If we want to accept and

use this music to calm us, we can say that we appropriate
this meaning and live it out in practice. In this way, it is a
crucial difference between saying that a certain meaning
is inherent in music and saying that music affords a cer-
tain meaning and use.
When we take into consideration the context in which
music is chosen, it means that we consider the many fac-
tors that may affect the experience of music, i.e., the his-
tory of listening and the specific embodied ways of
listening that govern our perception, the situation where
music is produced and experienced, and, of course, music
itself and the way it is performed. This means that we
cannot speak about a certain musical meaning or a certain
effect of music independent of a certain situation. We
have all our idiosyncratic ways of listening to music, we
may create our own place in our homes or create certain
rituals of listening that will influence and give meaning to
the experience of music.
This contextual understanding of how music will in-
fluence us also makes possible many forms of musical
practice. It tells us how difficult it is to predict what mean-
ing people may deduce from different situations. This
again means that we cannot explain how music works
from a simple cause and effect model. Music therapy can-
not deliver a package of music that will affect all people
in the same way in a certain situation. To cultivate these
kinds of models is a way of adapting to biomedical mod-
els. Or, we could say that a certain medical culture enters
into our conceptions of how music may affect health.
Seen in the perspective of the humanities we will caution
that music therapy becomes another discipline that ob-
jectifies people’s musical taste and experiences by pre-
scribing a certain musical culture, and in this way colo-

nizes the individual’s musical lifeworld.
To claim how people themselves are experts about
which music they prefer and how this music will affect
their bodies and minds in different contexts, may leave
the choice of music to the listeners themselves. If we as
music therapists listen to the stories about how body and
emotion are affected by music, we will also discover how
people may take care of themselves through musical rit-
uals, bodily practices, and forms of experiences (Ruud
2002, 2005a).
The Concept of Musical Affordance

Earlier I introduced the concepts of “affordance” and
“appropriation” when speaking about musical meaning.
In order to avoid essentialist thinking about music, as if
musical meanings where mechanistically transferred from
a composer and into the score, and then further dissemi-
nated to the listener, we need a model of understanding
that sees the process of reception by the listener as neces-
sary for the construction of meaning.
Music therapists have traditionally resisted a concept
of music as “work” and instead embraced a conception of
music where contextual, music structure, as well as indi-
vidual circumstances influence the interpretation and ex-
perience of music. Lately, Christopher Small’s concept of
“musicking” (Small 1998), as well as the concepts of “af-
fordance” and “appropriation” (DeNora 2000; Clarke
2005) have been widely embraced by music therapists.
Small emphasized how “music” must be understood as a
practice and a process, as something we do, rather than
as an object. This has implication for our understanding
of how meanings are produced while engaging in music

and led Small to redefine music to “musicking,” that is, to
look at the concept of music as a verb.
As we have seen, contextual or situational circum-
stances will play a major role when meanings are negoti-
ated. With the word “affordance” musicologists are
referring to James J. Gibsons’s ecological theory of per-
ception (Gibson, 1979), which seeks to throw light upon
the interactions between perceiver and environment. Any
given environment affords a number of actions and per-
ceptions, according to Gibson. Musicologist Eric Clarke
writes that “the affordances of an object are the uses,
functions, or values of an object” — the opportunities
that it offers to a perceiver (Clarke 2003, p. 117). Clarke
emphasizes how perception and action are inextricably
linked, and he points to the dialectical relationship be-
tween an organism and its environment when he states
that it is “neither simply a case of organisms imposing
their needs on an indifferent environment, nor a fixed en-
vironment determining strictly delimited behavioral pos-
sibilities” (ibid. p. 118). This further implies that there
will always be a social component affecting the range of
possibilities inherent in socially embedded objects like
music (Clarke 2005, p. 38), which implies further that the
musical affordances offered by a specific piece of music
will be appropriated by the listener within the “ecology”
of the listening situation in question.
This understanding opens a further discussion con-
cerning what possible musical structures may give rise to
the experience of meaning. As we shall see in the follow-
ing, we will have to take into consideration how our bod-
ily schemata, or our embodied way of perceiving the
world, may lie at the root of musical perception.
Embodied Meaning in Music
The question of musical meaning is fundamental to music

therapy practice. Music therapeutic interventions are
based on the musical experiences “and the relationships
that develop through them as dynamic forces of change,”
as Kenneth Bruscia writes in his definition of music ther-
apy (Bruscia 1998, p. 20). When music therapists con-
sider possible outcomes of a session, in addition to
evaluating the situation of the client, they have to rely on
their knowledge about the nature of musical communi-
cation and their notions of how musical meaning is con-
stituted.
The study of musical meaning and how it is perceived,
interpreted, and communicated, is of major concern to
musicology, and has been subject to inquiry from philos-
ophy, music psychology, and the anthropology and soci-
ology of music. Questions of meaning are debated within
the field of musicology as one of several basic problems
within the philosophy of music. As Norwegian musicol-
ogist Hallgjerd Aksnes has remarked, a new interest in
musical meaning and musical expression is based on a re-
jection of philosophical theories that claim that meaning
is dependent upon representational or propositional con-
tent, i.e., verbal language (Aksnes 2002). Following Mark
Johnson (2007), such conceptual-propositional theories
of meaning are “far too narrow and too shallow to cap-
ture the way things are meaningful to people” (p. 8).
These are theories that state that sentences or utterances
with a subject-predicate structure are meaningful to the
extent that they express propositions that allow us “to
make assertions about the way the world is and to per-
form other speech acts, such as asking questions, issuing
commands, pleading, joking, expressing remorse, and so

on” (loc. cit.).
Such objectivist semantics puts forward a totally dis-
embodied theory on the nature of language and meaning.
Contrary to such a view, Johnson proposes that our con-
ceptualizations and reasonings are shaped by the nature
of our bodies, our sensory-motor capacities, and our abil-
ity to experience feelings and emotions (ibid., p. 9). Look-
ing at prelinguistic infants, we will find vast areas of
embodied meaning that are not conceptual and proposi-
tional in character, as we remarked in the chapter on
musical identities in development. In such an embodied
theory of meaning, meaning is relational, it connects to
other parts of past, present, and future experiences.
Meaning is about how things relate or connect with other
things, and verbal meanings are just one selective dimen-
sion of “vast, continuous process of immanent meaning
that involve structures, patterns, qualities, feelings, and
emotions” (ibid., p. 10).
In the following I will use the approach from Creative
Music Therapy as well as the Bonny Method of Guided
Imagery and Music (BMGIM) as paradigmatic examples
of meaning-producing situations in music therapy. Many
discussions around the role of music in therapy often
touch upon the issue of universality. I have chosen here to
discuss how our bodies, as embodied in our perceptions,
will come to influence our perceptions and experience of
meaning in music. As biological creatures we all have
some common experiences due to how our bodies per-
form in the world. Such bodily experiences may be the
closest we come to a “universal” way of perceiving the
world, and thus lay the ground for the perception of
sounds and music.
A Cognitive Perspective
Due to the special circumstances of musical communica-

tion within the BMGIM, the transcriptions provide in-
formation both about listeners’ experiences and about the
ways in which the images and narratives are communi-
cated and transcribed by the therapist as the session un-
folds. In a research project, Aksnes and Ruud (2008)
designed a new BMGIM program — Soundscapes — in
order to study how boy-based schemata may operate
through a process of “mapping” onto musical perception.
Such “image schemas” can be understood as recurring
structures or patterns, although hidden from us in our
everyday functioning, they operate to influence our per-
ception of the world. For instance Johnson (2007, p. 21)
suggests such typical image schemas of bodily movement
to include source-path-goal, up-down, into-out-of,
toward-away from, and straight-curved. From early on
in our life, we come to know and internalize such struc-
tures of experience through our bodily interaction with
our environment.
When we are listening to music, such image structures
are projected onto music, such as we will experience
movement in music, i.e., how the music (metaphorically)
is moving forward, toward a goal, or away from some-
thing, as if to follow a certain path. There are four such
basic dimensions of movement, Johnson argues (ibid., pp.
22–24), tension, linearity, amplitude, and projection.
When we listen to music, we are aware of tensions as
melody rises or harmonic tendencies are blocked; we rec-
ognize linearity when melodic curves are jagged or
smooth, and amplitude is felt when music fills up spaces
in various ways, for instance through changes in volume.
Through projection I can vary the dynamics of music

through the exertion of degree of force.
Such qualities of movement in music are felt and
experienced and constitute the basis for a meaningful ex-
perience. From our BMGIM program, we chose the intro-
ductory piece by the Norwegian composer Geirr Tveitt.
We then administered nine sessions, took detailed tran-
scripts from all the participant’s narratives, and analyzed
and compared the metaphors used in response to the piece
in question.
We did find a strong tendency among the participants
to use metaphors of movement connected to the experi-
ence of floating, staying on the water, and being held,
which was not surprising compared to the structural idio-
syncracities we found in the score of the piece in question
(for a detailed report, see Aksnes & Ruud 2008).
Music is meaningful, Mark Johnson states (2007, p.
236), because it can “present the flow of human experi-
ence, feeling, and thinking in concrete embodied forms.”
Music resonates deeply with what Daniel Stern calls our
vitality-affect contours, “the patterns or process and flow
of our felt experiences, such as the buildup of tension and
its release, the sense of drifting, the energetic pursuit of a
goal, the anxious anticipation of some coming event, and
the starting and stopping of a process” (ibid., p. 238).
Fundamental to our experience of music is the way we
project movement into music. There is a logic of physical
motion that structures our experience and understanding
of musical motion. Johnson writes that “part of that logic
involves the action of forces that aid or obstruct motion
toward some destination” (p. 257). And there seems to
be growing research in musicology that demonstrates
how image schemas for force dynamics, like compulsion,
blockage, attraction, enablement, and all of the structural

elements of paths, like starting points, paths, steps along
the paths, destination, progress towards destination, etc.
can be identified in musical pieces and are present in our
experience and conceptualization of music.
As I remarked earlier, bringing our bodily schemas into
the perception of music seems to acknowledge some kind
of universalism in musical experiences. However, although
as infants we may have an immediate nonconceptual,
prelinguistic experience of music, we later learn how to
listen as part of our enculturation. Our experience and un-
derstanding of music, though, is felt as “woven into the
fabric of our existence,” as part of our “way of being in
and making sense of our experience” (ibid., p. 256).
To avoid any essentialism in the understanding of
musical meanings, it is important to underscore what
Johnson call “the pluralistic ontology of musical motion.”
Although our body-based metaphors constitute of our
musical experiences, we will find that there are multiple
inconsistent metaphors for any given musical expression.
This may be evidence of the richness and complexity of
musical experiences, or as Johnsen writes:
The fact of multiple inconsistent metaphors for a

single concept also sheds light on the important
question of cultural difference and variation. The
grounding of metaphors in bodily experience sug-
gests possible universal structures (of bodily per-
ception and movement) for understanding music.
However, since there are multiple metaphors
available, and since there may be differing cultural
interpretations of bodily experience, metaphor
provides one important avenue for exploring
cultural and historical variation in significantly

different conceptions of musical experience that
might arise around the world (ibid., p. 259).
Based on this background, it seems reasonable to com-

bine such a theory of embodied meaning in music with the
concept of affordance and appropriation stated earlier.
Improvisation and Gestural Communication as

Being-in-Time-Together
Another important aspect of musical communication and
meaning may have to do with the experience of being syn-
chronized within time. Probably one of the worst effects
of ill health is the consequential social isolation many
people experience. Music therapists have drawn attention
to how musical improvisations enable client and thera-
pist to engage in a “mutual tuning-in relationship,” as
originally described by the sociologist Alfred Schütz. His
concept of “mutual tuning-in” points to how music may
create a situation “which originates in the possibility of
living together simultaneously in specific dimensions of
time (Schütz 1951, p. 78). Time is the keyword here, and
phenomenologically speaking, being able to synchronize
oneself with another within a musical improvisation, this
contact situation may be the first step from social isola-
tion to living in a relationship here and now (see Ruud
1998, p.148). Of course, Schütz was not aware of musi-
cal improvisations as they appear in music therapy. How-
ever, due to the specific techniques applied in music
therapeutic improvisations, this synchronicity may be ob-
tained through the flexible use of adaptive responses by
the therapist, and not least through the establishing of a
common pulse.
Ansdell and Pavlicevic (2005) have elaborated the rel-

evance of time in music therapy and improvisation and
look at emerging communication as “a mutual coordina-
tion of intention and action within concrete events in real
time” (ibid., p. 199). They argue how a possibly damaged
communicative musicality based upon parameters such
as pulse, dynamic quality, and musical narrative (ibid., p.
201) may be “repaired” through the techniques of im-
provisation developed by music therapists.
There are theories that look for internal musical struc-
tures as an explanation for how musical meaning arises.
As we saw in the previous section, music may be seen as
a dynamic field with forces of tensions, rooted in our em-
bodied perception. Because our perception is wired from
early on to feel the forces of gravity, due to our early bod-
ily experiences, composers may build in tensions and ex-
pectations in the musical structure to create a dynamic
behind music listening that we will recognize through our
embodied perception. Music therapists will utilize this po-
tential for tension or expectation when they improvise
and when they try to engage clients in musical interaction
by manipulating the musical parameters. Music therapists
use a variety of techniques to get people involved in mu-
sical improvisation (see Bruscia 1987).
In addition to the foundation of a common pulse, mu-
sical interaction may confirm and challenge this common
temporality through temporal deviances as experiences
when musicians are playing “on the top of” or “behind”
the beat (Keil 1994a). Keil suggested the term “partici-
patory discrepancies” (Keil 1994b) for those experiences
in the music that lead to involvement and participation
that originate from a mutual sense of playing around the
beat and out of tune (Ruud 1998, p. 158). Music thera-
pist Ken Aigen has convincingly demonstrated how these
grooves work in of one of his cases (Aigen 2002). Aigen

observes how (ibid., 57) “. . . to groove means to be to-
tally locked into the moment in time, the place, and the
individuals with whom one is grooving.”
The Body in Musical Communication

Much of the strength of music therapy comes from its
unique position in establishing contact and building rela-
tions through musical encounters. Musical improvisations
based on music cultural sensitivity enable the music ther-
apist to initiate, maintain, and further musical communi-
cation. This ability to react to music also seems to be
rooted in our common biological nature, in our embod-
ied responses to music. Recent research and theorizing
about the gestural nature of music (Gritten & King 2006;
Aksnes & Ruud 2008; Ruud 2007a) may help the music
therapist to understand how our bodies and our cultural
situatedness interact when musical communication comes
into play. This connection between music and body seems
to be mediated by our gestures, as they are manifested in
musical acts and expressions.
Following Iazzetta (2000), gesture may be taken in a
broad sense, “it does not mean only movement, but a
movement that can express something,” Iazzetta writes.
And he adds that gesture “is a movement that embodies
a special meaning. It is more than a change in space, or a
body action, or a mechanic activity: gesture is an expres-
sive movement that becomes actual through temporal and
spatial changes” (ibid., p.74).
In order to understand how music may come to play
such a role in the formation of a relation we have to seek
to understand how relations between the child and the
adult are established. If we go all the way back to early
social psychologist Georg Herbert Mead (1863–1931),

he maintains in a theory of gesture and communication
how the infant’s early “conversation with gestures” cre-
ates an orientation toward mutuality. In order to legiti-
mate the use of improvisations in music therapy, theories
and arguments have been found in the discourses about
the use of music as nonverbal communication, both in re-
lation to clients without language or when words have
not been available because of emotional difficulties. Lan-
guage, though, is of course an important aspect of our so-
cial forms of contacts. “Language is a part of social
behavior,” Mead writes, at the same time as he adds an
important footnote about gestures:
What is the basic mechanism whereby the social

processes goes on? It is the mechanism of gesture,
which makes possible the appropriate responses
to one another’s behavior of the different individ-
ual organisms involved in the social process.
Within any given social act, an adjustment is ef-
fected, by means of gestures, of the actions of one
organism involved to the actions of another; the
gestures are movements of the first organism
which act as specific stimuli calling forth the (so-
cially) appropriate responses of the second organ-
ism. The field of the operation of gestures is the
field within which the rise and development of
human intelligence has taken place through the
process of the symbolizations of experience with
gestures — especially vocal gestures — have made
possible. . . . (Mead, 1934, p. 13–14).
A gesture originates on a rudimentary level of biolog-

ical behavior at the same time as it initiates complex social
acts. Sound and movements from one organism influence

the other. Gestures stemming from one organism may be
taken as a signal that functions as a stimulus, which initi-
ates a process of adaptation and signification in the other
organism. All such responses may develop into mutual ges-
tures toward the opposite organism, which creates a se-
ries of interactions, adaptations, and changes in attitude.
This is what might be termed a “conversation with ges-
tures,” what is sometimes called protoconversations.
Musicologist Wilson Coker builds on Mead when he
points to an important aspect of this conversation, namely
the immediateness in the response. There is an immediate,
almost instinctive adaptation to the other, Coker writes
(1972, p.10). We also know today how recent infant re-
search has confirmed Mead’s understanding of how the
infant’s ability to adapt its responses is evidence of early
empathic activity. We know today how “taking the role of
the other,” which was Mead’s formulation of early inter-
subjectivity, does happen significantly earlier in the in-
fant’s life than earlier thought. So-called primary
intersubjectivity originates, according to developmental
psychologist Colwyn Trevarthen, from birth on. The im-
mediacy of response means that the musical act happens
on a prelinguistic level, in other words, without the self-
conscious attention or intentionality. On this level of in-
teraction, the exchange of gestures takes place without
the conscious intentionality, which is characteristic of lan-
guage or rule-governed behavior. In other words, we
could say that intentionality in musical response comes
after action. By the way of imitation, the person may pro-
duce meaningful musical responses only to realize after-
ward a sort of “intentionality” in retrospect (see Stensæth
2008).
In order to explain some of the biological or neu-
ropsychological background for this conversation with

gestures, i.e., protoconversation, researchers have pointed
toward how a group of so-called mirror neurons makes
early imitation possible. In his book, The Present Mo-
ment, Daniel Stern points to how these mirror neurons
are active when we try to read other peoples’ intentions,
take part in their emotions, experience something that the
other is experiencing, and take hold of an observed ac-
tion in order to imitate it — everything that is about em-
pathy and the establishment of interpersonal contact
(Stern, 2004, pp.78–79). We find these mirror neurons
beside the motor neurons, and they are activated within
an observer who only observes another person executing
an action, i.e., playing an instrument. And the particular
pattern of firing by the observer is exactly the same as the
pattern would have been had the observer himself per-
formed the action (ibid., p. 79). Or, as Stern writes:
In brief, the visual information we receive when

we watch another act gets mapped onto the equiv-
alent motor representation in our own brain by
the activity of these mirror neurons. It permits us
to directly participate in another’s action without
having to imitate them. We experience the other as
if we were executing the same action, feeling the
same emotion, making the same vocalization, or
being touched as they are being touched. . . . This
“participation” in another’s mental life creates a
sense of feeling/sharing with/understanding the
person, in particular, the person’s intentions and
feelings (loc. cit).
It seems reasonable to draw from these observations

when music therapists want to understand how and why
musical improvisation often succeeds when other forms of

communication have failed. Involvement in musical in-
terplay and interaction, as it grows out of the sensitive
recognition and responses from the therapist, may have
had its roots in the immediacy of gestural identification,
attunement, and interaction. In order to make this con-
clusion, however, we have to take into account the cross-
modal character of perception, how input in one sense
modality may be acted upon within another sense modal-
ity. Visual information may well be experienced and re-
acted upon as aural information. Or, as musicologist Rolf
Inge Godøy writes in his “triangular model” of motor-
mimetic music cognition: “Any sound can be understood
as included in an action-trajectory.” Images of sound-
producing actions will have visual and motor components
in addition to that of “pure” sound (Godøy 2003, p. 317–
318).
Excerpt Two
Chapter 10
Musicking as Self-care
Even Ruud
When music therapy is defined as a profession, most often
the role of the music therapist is underscored. There is no
questioning the necessity of the music therapist in music
therapy, and her musical skills, knowledge, and the re-
sponsibility for assessment, evaluation, and documenta-
tion of the therapeutic process. However, music therapy,
viewed as a discipline, and not only as a professional
practice, encompasses the whole interdisciplinary field of
study of the individual-health relationship. As we have
seen, music sociologists and music psychologists are also
now discovering how people are using music to regulate
and control their emotional behavior (DeNora 2000) and
take care of their health needs through music (Ruud
2002; Batt-Rawden 2007). Music is used for identity
building (Ruud 1997), relaxation, to cope with stress, to
release pain, or to regulate sleep patterns. People bring
their own soundtracks and personal stereo into the urban
landscapes to regulate their moods, attentions, and emo-
tional investments (Bull 2000; Skånland 2007). As a dis-
cipline, music therapy should provide knowledge and
reflection about how music can also serve therapeutic
functions in the everyday life of people. Music therapy,
as a laboratory of the study of musical effects, may pro-
vide theories and practical guidelines for how help people

to take care of themselves through everyday musicking.
This means that music therapy, taken as a discipline,
does not only restrict itself to the professional practice of
“doing therapy.” Music therapy also has to study the way
music is put to work in everyday life in order to regulate
what we may label “health.” When recognizing how lis-
tening rituals are shaped through the functional use of the
new music technologies in everyday life, we find how a
new area of music as an “immunogen practice” emerges
(Ruud 2002), where music is used as a health technology
in order to regulate emotions, moods, energies, to allevi-
ate pain and sleeping disturbances, or change negative
emotions. If we take this use of music as a regulator (and
definer) of health, as a medium for self-care, and recon-
textualize it within the new-media technologies, such as
MP3, iPod, and the new generations of smart phones, we
are entering a future where the old Pythagorean ideal of
music as a regulating device has become an ever-present
reality.
We could say that music plays a role in our health-
performing behavior much like other behavior or habits
prescribed by health authorities and media in order to
regulate our lives toward improved health. Of course,
when it comes to health-promoting behavior, most atten-
tion is directed toward physical exercise, food, drug, al-
cohol habits, or sexual behavior (Taylor 1995; Ogden
2000). Within the emerging field of health psychology,
the study of health behavior sometimes focuses upon be-
haviors that may protect health, called “behavioral im-
munogens” (Matarazzo 1984, in Ogden 2000, p. 13).
Music might be seen as a form of behavioral or cultural
immunogen along with other behavioral immunogens, or
health promotion activities, like brushing our teeth, the
musicking as self-care 159
use of seat belts, good sleeping habits, and so on. There

is emerging interview research that shows how people
may use music to regulate bodily and psychological im-
balance (see Bergland 2006; Batt-Rawden 2007; Batt-
Rawden, DeNora & Ruud 2005). I think this research
should be incorporated into the information music ther-
apists give to society along with information about pos-
sible harmful effects of sound, such as environmental
noise pollution and the damaging effects of excessively
high volume.
We have seen throughout this book how a humanities-
based health science could position itself in relation to a
natural science approach to medicine. Danish humanistic
medical researchers Peter Elsass and Peter Lauritzen write
that what is common to humanistic health research is the
wish to make their ideologies scientific on conditions from
areas of science other than the natural sciences. Such con-
ditions may be understood within the humanistic view of
human nature where thinking and acting subjects are ob-
jects of study, not physical matter (Elsass & Lauritzen
2006, p. 34).
It is important, however, as Elsass and Lauritzen re-
mark, that such an orientation in health science empha-
sizes the difference between a scientific practice and
everyday practice. This can mean establishing new “ob-
jects” and concepts that refer to new aspects of health
performance. When humanistic health researchers take
interest in such a “folk practice” it is an effort to create
counterbalance to medical research, which places the in-
dividual as an object of research and not an acting subject
with possibilities for greater responsibility for own health.
Historically, this use of music as a “self-care technol-
ogy” probably goes back to the roots of our Western cul-
ture. The philosophy of Pythagoras may have been more
pragmatic in its intent than we think today. Although we

know very little about the life and practice of Pythagoras
himself (West 2000), it is suggested that, as a religious
leader, he practiced a sort of musicking in the evening in
order to cleanse his mind from everyday noise and purify
his thought to restore balance or harmony before going to
sleep. Additionally, he used music in the morning to pre-
pare himself for the coming day (Schumacher 1958). In
other words, Pythagoras seems to have practiced a very
well-known functional use of music, musicking as a tech-
nology to regulate a body-mind relationship.
What we today might label a musical home pharmacy,
is exactly the new use of music technology to take care of
one’s energies, bodily states, emotions, cognitive orienta-
tions, memories, and moods. This is what I call “musical
self-care” when music is a part of the technologies of self
we use to define and perform health. I will later discuss
how we give music a selfobject function, as a source of
safety and continuity, to evoke memories, comfort our-
selves, and to provide good experiences and feelings.
Music is used to distract us from negative thoughts, and
subdue anxieties by providing a cognitive reorientation.
Or we learn to know how people use music to forget
chronic pain or create rituals, which prepare us for good
sleeping habits.
When music therapy moves into such areas, it also be-
comes important in the ongoing debate about the role and
function of music in society. It may sound trivial to claim
that music is a kind of technology, a means of achieving
something beyond itself — in this case, improved health.
In what has been named “the bourgeoisie art religion,”
music has been construed as one of the purest art forms
since the Enlightenment. Based on the idea that aesthetic
pleasure has been cleansed from practical concern, that
involvement in music is a way to trance and transcen-

dence, music therapists do not object to the idea that we
have a right to enjoy music as a form of aesthetic enjoy-
ment. However, it might be argued that such a practice is
just another instrumental way of using music, i.e., to reg-
ulate our existential needs.
Music as a Cultural Immunogen —

Three Narratives
As far as I know, the relevant literature contains no stud-
ies focusing on the use of music in everyday life as a type
of behavioral immunogen. I could not find any system-
atic studies on the use of music in our contemporary cul-
ture to maintain, improve, or change health status
administered in a nonprofessional setting, in other words,
musicking as a sort of “folk-medical practice.” In the fol-
lowing, I will present three narratives about how music is
given a regulatory device in life.
The Theologian Who Cured

His Asthma with Singing
The idea of initiating a study of everyday health musick-
ing occurred to me one day after I gave a presentation on
music therapy before the Norwegian Academy of Science.
Although I have given quite a number of lectures about
music therapy before, I was a bit worried about present-
ing before such a scholarly audience. Since this is a rather
interdisciplinary subject, there is a risk of inadvertent
slipups on historical or medical details. In the discussion
that came after my presentation, I was surprised to find
that some of the elderly participants were more interested
in giving a personal account of their own everyday use of
music rather than disputing any of the historical or

medical facts in my presentation. In particular, a retired
professor, a well-known theologian, spoke of how he sang
the song “Amazing Grace” every night to a disabled
friend over the telephone. I had no trouble recognizing
this as a story about music providing comfort and hope,
and maintaining friendship and relationships.
A few weeks later the retired professor called me. He
wished to elaborate on his narrative, and asked permis-
sion to sing me the song over the telephone. Despite his
considerable age, he had a very strong, expressive voice,
and I assured him that I found his song and singing ritual
both beautiful and meaningful. As the conversation con-
tinued, he also revealed that he had used singing all his
life, both to combat his own asthma and in various other
personal and professional situations. I became curious
about his musical biography and he allowed me to record
both his narratives and songs the next week.
As it turned out, my informant had, as a small child,
been victim to a serious lung disease that had developed
into asthma. When his family moved to a colder climate
in Norway during the 1920s, he often suffered from
asthma attacks. He told me how he had been deeply in-
volved in singing from early on. Influenced by his father,
who entertained him in a rich baritone voice while he was
bedridden with bronchitis, he discovered how his mood
changed positively when he sang himself. He was, of
course, unable to sing during an acute asthma attack,
when his ability to inhale was restricted. However, he got
the idea early on that he could do something to strengthen
his lung capacity and he started to practice singing and
breathing exercises systematically: “. . . singing, and it
was quite a lot, became a major part of my everyday life.
I learned to sing and to do breathing exercises and how

to use my lungs all the way down,” he told me, demon-
strating how his breath could move the lower part of his
stomach. “I can still be pretty flexible there, so I think this
had a great impact,” the eighty-five-year-old theologian
said. He added that his asthma disappeared at the age of
eighteen. Many years later, when he had a chest X-ray,
the medical examiner confirmed that not many would
keep up with him when he was walking in the forest de-
spite the traces of lung disease that could still be seen.
When I checked for “asthma and music” on the In-
ternet I found more than ten research articles, encom-
passing the use of treble and brass instruments in the
treatment of asthma. I became aware that this was an
area pretty well covered in the music therapy and medical
literature. It was interesting to note, however, that this
knowledge was known or discovered among people out-
side medical circles. In other words, this chronicled the
emergence of music as a cultural immunogen, a way to
practice better health habits.
My informant told me he had further cultivated his
voice when he became a student. So, his singing had be-
come greatly integrated in his adult life. When we dis-
cussed his vocal abilities and how his gift of absolute pitch
sometimes made him uneasy when he did not hit the right
pitch, he suddenly exclaimed: “It was enormously joyful,
life-confirming, encouraging . . . I don’t know how to ex-
press it. But my singing had a lot to do with my quality
of life.” Then he spontaneously performed Bach’s “Jesu
bleibet meine Freude,” before he assured me that he also
had a lot of popular tunes in his repertoire.
This turn of the conversation led to reflections about
how music is able to change our mood, to calm, to
brighten our state of mind, to comfort us, and bring us

hope. Not surprisingly, the theologian had an impressive
repertoire of hymns, which he could utilize to regulate his
mood. He had suffered from several serious diseases, even
a heart attack, and the awareness of a potentially sudden
death created a need for music as a supportive and nur-
turing object. When I asked him if his singing did some-
thing to his thoughts, if he felt that music changed
anything, he said yes. This opened the way for a narrative
where my informant told me how the Gestapo had visited
him during World War II, under suspicion of keeping
weapons in the house. This was, in his word, a “life-threat-
ening” experience, which revisited him in his dreams for
many years. During these nightmares, he was too dis-
turbed to be able to sing. “But I am able to sing while in
bed. I do that from time to time, with great pleasure,” he
added. I asked him if he did this in a conscious attempt to
change his mood. “Yes, definitely. But I have to wait for a
while. After a nightmare I have terrible heart palpitations
and my pulse is irregular. Sometimes even my ears are
throbbing.” Once his body has returned to its normal state
he is able to sing. “Yes, I use the singing. I lie in the bed
and sing. Usually I keep my hymnal in the bed next to me.
I nearly always keep the hymnal beside me.”
As this story illustrates, music is clearly used as a
means of expanding and strengthening lung capacity lit-
erally, as well as a means of regulating mood in order to
prevent anxiety or to return to a state of normal physio-
logical function after a nightmare. In both instances,
music serves as a type of cultural or immunological tech-
nology in the service of promoting or retaining health. In
this sense, music is a cultural immunogen, a type of aes-
thetic behavior, a way of musicking in the service of pro-
moting health, or even directly preventing ill health.
Musicking as a Catalyst for Stress and Anger
A woman told me how she took up a song-dance ritual

after she no longer could do her regular physical exer-
cises, i.e., running, which she had used as a way to regu-
late her level of stress. I asked her how she actually felt
when she was in a state of stress and if she could describe
her bodily state before and after singing. “Are you as con-
scious about this as you seem?” I asked her.
Yes. Music gives you a sort of release. You are in

a state of everyday stress because of your work or
because you demand something of yourself. . . .
First, I have to listen to some fast music and then
some more quiet music. I sing and dance at home
alone by myself to the fast music. I prefer to use
the headset in order not to disturb the neighbors
too much. And then, it seems, the adrenaline
comes and gives you a kick. And you get a sort of
release and then a sense in the body when the
stress has somewhat left the body and you can put
on some more quiet music. Sometimes I actually
sing so loud that I can feel in my vocal chords af-
terward that now I have really been shouting.
I then asked her if she could tell me more about this

self-absorbing feeling, “where” she is when she enters into
this state. “I enter the music totally. I forget everything.
And it is a very good feeling. Even though the headphones
may harm my ears.” I asked her if she feels the stress in
her head or in her body.
No, it is more in the body I feel the stress, for me

it is usually the stomach. But I get a fairly instant
bodily relaxation. I don’t get a headache; I’m not

that kind of person. But I have too many thoughts
and it feels good to get out of the thoughts. Music
takes control and it is such a good feeling because
you tend to forget everything you have been think-
ing about.
I tried to get a better understanding of the situation

and asked her to tell me more about her feelings.
I do actually listen when I am angry. Then I also

need the loud music to balance my anger. Even
though I have lost my anger during the last years,
it used to be a problem earlier. So, I do not need
that kind of music as much as I used to. Because
earlier, I had a real need to get it out, as a coun-
terweight to the anger I felt within. But it has be-
come less, though it is still there when I want to
relax. Earlier it was more anger, now I do it be-
cause I am stressed and it makes me feel good.
This is a good example of a strict procedure, a musi-

cal ritual in the service of health-performing behavior. A
state of stress is identified; music is selected and pro-
grammed according to a fast-slow/loud-quiet format. The
whole procedure is similar to a sort of mini “rite de pas-
sage” (Ruud 1995, 1998). Headphones are used to pro-
vide seclusion and high volume-stimulation, dancing and
bodily movement are combined with music to get into a
state of void and flow. This creates a sort of liminal state,
a space where the head is emptied and she is ready to
enter a new state of well-being. There has even been an el-
ement of self-administered musico-psychotherapeutic
work on anger. She has learned to sort out anger and to
handle it. Nowadays, anger is differentiated from more

general stress, and the adrenaline-stimulating music is di-
rected more toward the stomach, the body.
Overcoming Depression and Social Phobia

Sometimes music may also be of help to a person with se-
rious social and personal problems. My third informant
was brought to my attention by a music therapist col-
league who for many years has been working with the
rock band format with female inmates, both inside the
prison and in the community after their release. This proj-
ect inspired one of these women to start her own band.
Now in her forties, with serious social problems and
emotional difficulties, she was able to realize her adoles-
cent dreams about playing in a band, writing lyrics, put-
ting music to the text, performing in public, and recording
the product. When I called her to make an appointment,
she mentioned to me that she saw music as something,
which gave her “health.” I repeated this to her in our con-
versation, and she continued:
That’s right, because of my emotional problems;

it’s really affecting my health, especially when you
are feeling down. Sometimes it gets so bad I have
to pull down the curtains and go to bed or lay
down on the sofa with the blanket over me. You
don’t want to see anyone or talk to anyone or do
anything. The only thing that can get me up from
bed is if I can imagine the music. So for me, this is
a real help psychologically. Because then I can
manage. Sometimes it is a real pain to get off of
the sofa, to stand up, dress, and leave the house.
But when I finally have managed to get to the
rehearsal, even if it has been very hard sometimes,

I have managed because I have comforted myself,
telling myself I will feel much better when I have
left the house. Even my son has told me: “Mom,
get down to the rehearsal. You will feel much bet-
ter when you have been there.” At the time I feel
this as nagging, but he has actually encouraged me
to go — even if I didn’t have the energy. And I
have never regretted it, I have always been happy
I did go anyway. It feels like a personal victory . . .
and I was in a much brighter mood when I got
back home. And I also became more active; I did
not go back to the sofa. I can do a lot of house-
work when I come home, just because I have been
away.
Music has become the only means that sometimes can

get her up off the sofa and give her courage and energy to
go to the band rehearsal. This must have been a major
step to overcome for a person who was feeling confused
and depressed, who shut herself up inside her apartment
behind closed curtains. With the band, performing her
own tunes, she manages to forget her own problems, to
overcome her social phobias, enjoy the friendship of other
musicians, and to share some positive things in her life
with her teenaged son. “If it hadn’t been for music I
would have been even more depressed,” she added.
I asked her if she forgets her problems when she is re-
hearsing with the band.
I am not worrying about problems; I am just con-

centrating on the music. I concentrate on my own
texts, getting really involved because I am really
eager to find out how to construct the tune, how
to perform, and things like that. You tend to get so

involved in music that you forget your problems.
And to forget your problems for a couple of
hours, on a Monday, I felt wonderful. And I did
not worry anymore when I came home at night.
During the day, problems could lie there and grow,
but never after the rehearsal.
Besides the social and mood-enhancing effect of the

band rehearsal, she also emphasized how the act of com-
posing music and writing lyrics helped her to straighten
out her confusing thoughts. She told me she has emo-
tional problems, or is “confused” as she puts it. I asked
her what happens to her confusion when she is focused on
the music. “Does the confusion disappear?”
Yes, when I have got things down on paper, I feel

like I have lost ten pounds. I have many thoughts
spinning around in my head, and it helps me on
the psychological level to write these thoughts
down. Because I get to write down how I really
feel about things. It really helps me psychologi-
cally. So does going to the rehearsal and playing
the music.
It appears that music gives her a context in which to

be precise and honest about how she actually feels. She is
able to sort out what is important from among her
whirling and confusing thoughts. Further, she is able to
tolerate what she has become aware of, and to express
this through her writing. Going to the rehearsal enables
her to elaborate, express, and communicate her thoughts.
Composing music to the lyrics and performing the
piece of music transforms the text into a message. She has
created something to share with others, something that

others can recognize and identify with, she told me.
I also asked her if she sometimes listens to music con-
sciously to change her mood.
Yes . . . it helps me a lot to listen to music. Be-

cause, mentally, if you are able to get up from the
sofa and put on some music . . . with
something . . . I have consciously chosen music
with lyrics I listen to and which can remind me of
my situation. And then I start to cry in order to
really cry. Other times I can put on some music,
which puts me in a better mood, music with real
force, in order to change my thoughts into some-
thing else, and to forget about a lot of problems.
This because I actually manage to get involved in
the music I am listening to. So I am somewhat
conscious about what I actually listen to.
Again we can see how music is used to refocus atten-

tion, to address and align troubling memories in order to
create an emotional catharsis. Or, music is used to switch
mood, to forget about worries.
Musical Strategies
The field of music therapy can be seen as a laboratory,
studying how people may change under the influence of
music. Up until now, in order to understand and explain
how such changes are possible, music therapists have
turned to the social sciences, the natural sciences, and
the humanities. The import of theories from medicine,
psychology, sociology, or musicology have aimed at un-
derstanding how we may use music to effect an influence
upon our life. However, music therapy, itself becoming

a new interdisciplinary study of how we may use music
to promote health and well-being, has during the course
of its history gathered idiosyncratic examples and expe-
riences about how music is appropriated to effect
changes. Perhaps it is time to question music therapy it-
self about how it would explain the possible influence of
music upon our lives. In other words: What can we learn
from music therapy about the way music influences our
actions?
Improvisation, Composing/Songwriting, and

Performing Music
Music therapists have a tradition of using musical im-
provisation when approaching their clients. Within im-
provisation, music therapists have had the freedom to
meet and adapt to client’s idiosyncratic music cultural
cognition. Improvised music therapy thus lies at the core
of activities within the field, and thus may demonstrate
some of the operating principles behind the application
of music in human interaction. Studying improvisation,
we may learn how music affords social bonding through
listening to and playing music.
More common to everyday musicking, we find activ-
ities related to composing and performing music. We
know how music in music therapy is used as a means to
explore personal issues, to transform autobiographic ex-
periences into symbolic expressions, and to perform and
share with a larger audience. This musical practice is
widespread among music amateurs and musicians within
the field of popular music. Not least through songwrit-
ing, we are given the opportunity to transform the raw
material of our life into an artistic object, a symbol that
allows us to look at ourselves from some distance. Music

therapists have always recognized songs and singing as
one of their main approaches within their work. Along
with improvisation, listening, composing, and perform-
ing, songs have had their natural place in the music ther-
apist’s toolbox as a way of expressing and performing
aspects of oneself as part of a process on the way toward
better health. In music therapy, songwriting provides op-
portunities to deal with traumas and conflicts, to give po-
etic form to life experiences and thus create something,
which is possible to accept and share with others. The
same function of songwriting is also well known outside
the therapy room.
From childhood on, we all relate to songs and song-
writing in a personal way. Children improvise with their
voices, create mock versions of familiar songs, and en-
gage in a host of changing forms of identification with
songs and singers along their way to adulthood. The song
text often represents an early experience of how to sym-
bolically represent the world, and of how we can use the
metaphor to understand the meaning of what is happen-
ing to us.
Music therapists have become skilled in appropriating
popular culture in order to help clients formulate, venti-
late, express, and communicate some of their deepest
wishes and thoughts. It seems like the song gives the client
a new context, a freedom and strength to bypass their
own vulnerability. The song form not only affords a range
of possibilities for self-expression, but it equally allows
one to touch on and warm to themes and relationships
that have been deeply frozen for a long time. Songwriting
provides an aesthetic context inviting the client to ex-
plore, within a new play-frame, their own life, their pos-
sibilities — their losses, and their aspirations (Ruud 2005;

Baker & Wigram, 2005).
Performance
Music therapists view music as a social capital (Procter
2002), as a resource for networking and community
building. Performing is a way to gain access to symbolic
resources often highly regarded within society. To per-
form is a possible way to enhance the feeling of pride in
one’s self, to develop strategies of agency and self-efficacy.
A performance may give opportunities to listen to the
voices of disadvantaged people, to make the invisible
visible. Performing music has consequences for a person
in terms of becoming recognized and thus a possible
member of a community
Listening as Self-care
As we saw above, interviews with people demonstrate
how there is a reflexive use of music in the everyday
aimed at regulating both physical and mental balance
(Ruud 2002; Bergland 2006; Bratt-Rawden 2007). What
we could term “musical self-medication,” sometimes
based upon the new music technologies with personal and
portable soundtracks in MP3 players and smart phones,
involves taking care of one’s energies, bodily states, emo-
tions, cognitive orientations, memories, moods, in short
our physical and emotional well-being. In this is a new
form of musical self-caring; music is a part of the tech-
nology of self (DeNora 2000) directed toward defining
and performing health.
Concerning the psychological states, this musical
practice could be a way of giving music what psycholo-

gists call selfobject functions. Here, music represents a
source of safety and continuity; it brings back memories
of important events and persons in our life. As other self-
objects, music comforts and gives us access to positive
emotions and experiences. Music also allows dissocia-
tions from difficult emotions and thoughts, thereby sub-
duing anxieties by a cognitive reorientation. This may
result in bodily relaxation, the initiation of a new bodily
felt harmony.
Music is also used to reduce pain, either by redirect-
ing thoughts, blocking the pain impulses, or producing
endorphins, which give us sensations of pleasure. Our
music libraries then become much like a personal phar-
macy when used to reduce anxieties or prepare us for
sleep.
Within music therapy there is growing research on re-
ceptive music therapy, or how we may use listening to
music to further self-insight and/or bodily well-being.
There is a tradition of music psychotherapy based upon
music listening to a special selection of music “pro-
grams.” The Bonny Method of Guided Imagery and
Music (BMGIM) is a much-researched approach (Brus-
cia & Grocke 2002). I understand this method according
to Bruscia (2002), as “a modality of therapy involving
spontaneous imaging, expanded states of consciousness,
predesigned classical music programs, ongoing dialogues
during the music-imaging, and nondirective guiding tech-
niques” (p. 59).
The core of the BMGIM lies in the ability to create
images under the context and conditions that are main-
tained during the listening. These images, as we know,
emerge at different levels, as sensorial experiences, visual
scenes, or language and thought figures. As we know

from the literature, images may be placed in a number of
different categories. In order to understand how listening
to music under such conditions may have affective, cog-
nitive, as well as physiological consequences, we may turn
to the tradition of self psychology and recent research
concerning affect consciousness.
For a long time, much clinical and developmental psy-
chology did not acknowledge the idea of a “self,” and in-
stead used the concept of an “ego.” Psychologist Heinz
Kohut founded a self psychology that was based upon the
idea that it is something within us, a self, which we ex-
perience as a structure and that keeps things together in
our life. Within the theory of self psychology, music may
be understood as a selfobject, which may have important
self-sustaining functions for the individual. Kohut termed
any dimension of an object that had the function of sup-
porting ourselves as “selfobject.” Such selfobjetcs had to
do with the subjective aspects of anything that could
maintain, support, restore, or confirm the self. This sort
of a relational experience toward an object may awaken
and maintain the self or give us the sensation of having a
self. Not only could other persons serve such selfobject
functions, but also cultural objects, such as music.
This self thus contributes to the experience of being
whole and continuous in time and space. Such an experi-
ence of a self is related to the sense of having a center for
action, emotions, intentions, and plans. This self is both
a way of organizing our experiences as well as a structure
that makes it possible to experience. The idea of selfob-
jects points to the function other persons, objects, or
events may have in the maintenance of this feeling of
being the same and having a meaningful self. In other
words, music may serve selfobject functions in our life,

when we turn to music to regulate our moods, indulge in
memories, or recollect events and persons.
In this music therapy approach images are the out-
come of a multidimensional process where music, image,
client, therapist, and the state of consciousness mutually
influence one another. Images may be followed by the re-
lease of an affect, as well as affect may influence the pro-
duction and content of an image. There is no linear or
causal relationship between any components of the
BMGIM experience. To understand the role of music, we
could, in accordance with the concept of affordance say
that music has a phenomenological profile (Ruud 2003),
which affords affect to emerge. This again may be due to
the release of associations or external references made by
music or our experiencing structural expectations within
music itself. We know these affective responses in the
form of more or less delimited or categorical emotions,
vague states of feelings (vitality affects), or more lasting
moods.
Listening to music may then give rise to an affect con-
sciousness, which is beneficial to psychological health.
Kohut held the view that the integration of affective states
is central to the development of self-regulatory capacities
and to the structuralization of self-experience (Monsen
& Monsen 1999). Within the theory of affect conscious-
ness, it is basic to allow clients to experience and tolerate
their emotions fully, which is also important to the
BMGIM or MCGIM experience. In their work on affect
theory, Monsen and Monsen present a model of affect
consciousness and how it can serve the understanding of
therapeutic processes. The authors describe the concept of
affect consciousness (AC) as “the mutual relationship be-
tween activation of basic affects and the individual’s ca-
pacity to consciously perceive, reflect on, and express

these affect experiences. AC is defined and operational-
ized as degrees of awareness, tolerance, nonverbal ex-
pression, and conceptual expression of . . . nine specific
affects . . . (p. 288). These affects are listed as interest/
excitement, enjoyment/joy, fear/panic, anger/rage, humil-
iation/shame, sadness/despair, envy/jealousy, guilt/
remorse, and tenderness/devotion.
Possible forms of imaging while listening to music,
then, concern visual images, associations released through
listening, and the emotions and bodily processes going
on at the same time. While “images” may be seen as
“scenes” within this proposed theory, emotions released
may inform us about a possible “script” that is idiosyn-
cratic to the person experiencing the music. A script can
be understood as a sort of underlying principle, or as a set
of rules utilized by the person in handling various situa-
tions. A script is an underlying narrative that informs the
person how to act in a certain situation. Such prescrip-
tive narratives may sometimes be dysfunctional and need
correction. We could postulate then, that when scripts are
activated or “heated” during the BMGIM or the listening
process, possibilities arise to get to know some of the un-
derlying dynamics of the person. The person then may
gain some new information about herself. Musical expe-
riences may thus be more than supportive, that is, some-
times teach the person something about himself, what we
earlier spoke of as reeducative experiences. If music re-
ally would change the person, or give a strong transfor-
mative experience, we could say that the scripts or
narrative has changed. This may again open some other
possibilities to work in the verbal modality. In short, self
psychology, script theory, and the theory of affect-
consciousness, may offer a theoretical approach in order
to understand what is happening when we are listening

to music.
As we know from the study of imagery, autobio-
graphical imagery is only one among several ways to react
to music. Often images come to us in symbolic and
metaphorical form. In the reflective conversation the
client is given the opportunity to express and reflect upon
their images and scripts. An important skill for the ther-
apist is also to help individuals recognize how images may
be important metaphoric expressions about important is-
sues in their lives. Metaphorical integration leading to a
new understanding of a life narrative may be of primary
concern.
In this sense, self psychology as a theoretical approach
to the understanding of the process of music listening, al-
lows for transformation to happen through the music lis-
tening experience itself. When music is understood as a
selfobject, self-sustaining as well as transformative needs
may be taken care of. As we have seen, the function of a
selfobject is to maintain, support, and confirm the indi-
vidual. In this sense, this self-psychological frame allows
for music and images to shape the sustaining and trans-
formational process.
Music Affords New Actions

Although music always served everyday needs in our cul-
ture, such needs and functions were gradually placed in
the background. From the eighteenth century on we saw
the installation of an aesthetic of music that insisted upon
the pure and uncontaminated contemplation of the mu-
sical artwork as the paradigmatic relation to music. Music
was taken away from everyday life, and moved into con-
cert halls and conservatories through an aesthetic dis-
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4
READING 31
Music
120
116 Therapy within the Context of Psychotherapeutic
Music Therapy
Modelsin the Clinical Setting
121 Music Therapy within the Context of Psychotherapeutic Models 121
Taken from: Unkefer, R., & Thaut, M. (Eds.) (2005). Music Therapy in the
(position awareness) feedback from his body when playing an instrument and
Chapter 8
singing; and intuiting, to get into the very essence of the composer’s inspiration
Treatment of Adults with Mental Disorders: Theoretical Bases and Clinical
(Priestley, 1975).
Interventions, pp. 117-132. Gilsum NH: Barcelona Publishers.
Music Therapy within the Context

of Psychotherapeutic Models
Table 8–1 Psychotherapeutic Models
HUMANISTIC/
BIOMEDICAL PSYCHODYNAMIC
BEHAVIORALCOGNITIVE HOLISTIC
EXISTENTIAL of Psychotherapeutic
BIOMEDICAL BEHAVIORAL Models
HOLISTIC
Mary A. Sigmund
Scovel
Major Contributors Freud
(1856–1939)
Eric Berne (1910–
1970)
Fritz Perls (1893–
1970)
Susan C. Alfred
Gardstrom
1937)
Adler (1870– Albert Ellis (1913– ) Carl Rogers (1902–
Aaron T. Beck 1987)
Mary Scovel
Carl Jung (1875– 1921– ) Abraham Maslow
1961) Maxie Maultsby (1908–1970)
Susan Gardstrom
Erik Erikson (1902– (1932– )
Introduction 1994) William Glasser Introduction
(1925– )
M M
usic therapyDisorders
Definition clinical practice
are drivenoccurs at various
Disorders come levels. Disorders
Wheelerare (1983)
the usic therapy clinical practice occurs at various levels. Wheeler (1983)
has classifiedbythe treatment
hidden conflictsof adults
from with mental disorders
irrational outcomeinto three
of failure has classified the treatment of adults with mental disorders into three
types: musicwithin
therapy
theas an activity
personal- therapy,
thinking insight
about self music therapy
to grow, find with
mean- types: music therapy as an activity therapy, insight music therapy with
reeducative goals, and ityinsight music therapyand with reconstructiveing,
others goals.
and Activity-
be respon- reeducative goals, and insight music therapy with reconstructive goals. Activity-
based therapy is aimed at helping the client reach observable, measurable sible for self goals based therapy is aimed at helping the client reach observable, measurable goals
through various
Therapist Role forms Foster
of music experiences.Act
transference, In contrast, the two Offer
as guide, chal- remaining levels
total and through various forms of music experiences. In contrast, the two remaining levels
focus on facilitation of make interpretations
change lenge notions
through personal that gained
insight unconditional
via musical focus on facilitation of change through personal insight gained via musical
experiences and verbalization about thoseareexperiences.
self-defeating Insight-based
acceptance,music
focus experiences and verbalization about those experiences. Insight-based music
on here-and-now
therapy processes are ordinarily more intense and prolonged, in that deep therapy processes are ordinarily more intense and prolonged, in that deep
Therapist
emotions are evoked, Analysis
and in ofthe symbolic Rational challeng-therapy
case of reconstructive Hone expression to
unconscious emotions are evoked, and in the case of reconstructive therapy unconscious
Techniques material (dreams, ing, homework to
material is accessed. However, all three levels are valid treatment approaches.move
help person The material is accessed. However, all three levels are valid treatment approaches. The
imagery), free asso- test assumptions,
used in any given clinical situation willtodepend
type of music therapyciation higher level of
on the type of music therapy used in any given clinical situation will depend on the
change of language functioning
individual needs of the client population, the philosophical orientation of the individual needs of the client population, the philosophical orientation of the
treatment facility, and the therapist’s education and training (insight music therapy treatment facility, and the therapist’s education and training (insight music therapy
Evaluate Change Insight into and Problems elimi- Client identifies
obviously requiring more advanced training than activity-based treatment).
resolution of conflict nated by changing and addresses fac-
Music therapy clinical
leads to practice also occurs
personality thoughts within the framework
that proof many
tors that block Music therapy clinical practice also occurs within the framework of many
different psychotherapeutic
change models. A model is
mote them a device for generating
actualizationideas,
and different psychotherapeutic models. A model is a device for generating ideas,
for guiding conceptualization, and therefore, generating explanation freedom (Reed, for guiding conceptualization, and therefore, generating explanation (Reed,
1984). In particular, psychotherapeutic
Terminology conflict, analysis, models aid in scientificexperiential,
unconditional understandingrela- 1984). In particular, psychotherapeutic models aid in scientific understanding
of human response anddefenses,
guide therapeutic
id, ego, methods.
shoulds, absolutistic tionship, choice, of human response and guide therapeutic methods.
Diversity of practice is a psycho-
superego, strength ofmusts,
the music therapy discipline
self-defeat- in that
values, autonomy, Diversity of practice is a strength of the music therapy discipline in that
sexual, transference,
the therapist is not restricted ing, self-indoctri-
to one philosophical orientation, here-and-now,
but may base pur- the therapist is not restricted to one philosophical orientation, but may base
treatment approaches countertransference,
on the particular needs nation,of judging,
the clients and pose,
themeaning
demands treatment approaches on the particular needs of the clients and the demands
myths, archetypes, crooked thinking,
of the particular work shadow,
setting.persona, new self-statements
of the particular work setting.
No matter whatanima/animus,
level or model is espoused, the music therapy treatment
indi- No matter what level or model is espoused, the music therapy treatment
process involves referral, initial assessment of client strengths and deficits, and
viduation process involves referral, initial assessment of client strengths and deficits, and
117 117
118 Music Therapy in the Clinical Setting Music
Music Therapy
119
establishment of musical and nonmusical goals and objectives. With proper Psychodynamic
establishment ofModel
musical and nonmusical goals and objectives. With proper
training and guided by therapeutic intent, the music therapist selects and training and guided by therapeutic intent, the music therapist selects and
The psychodynamic treatment approach is based on theoretical constructs
implements various methods, procedures, and techniques (Bruscia, 1998a). implements various methods, procedures, and techniques (Bruscia, 1998a).
developed and refined by Sigmund Freud during the first quarter of the twentieth
Outcome evaluations will determine the effectiveness of such interventions. Outcome evaluations will determine the effectiveness of such interventions.
century; however, more modern views of this model exist today based on
Clinical decisions made during each phase of the treatment process must Clinical decisions made during each phase of the treatment process must
his work and that of Alfred Adler, Carl Jung, Erik Erikson, and others. The
be clearly guided by assessment, research data, the level of practice, and the be clearly guided by assessment, research data, the level of practice, and the
psychodynamic orientation holds that an individual’s psyche functions at various
psychotherapeutic model. psychotherapeutic model.
levels of awareness, including unconscious, preconscious, and conscious. Jung, who
Current models have limitations in explaining causes and symptomatology Current models have limitations in explaining causes and symptomatology
constructed an analytical personality theory based on the work of Freud and
of all mental disorders. However, no matter which model is used, the therapists of all mental disorders. However, no matter which model is used, the therapists
Adler, posited two different kinds of unconscious. The personal unconscious
working with a client who has been diagnosed with a psychiatric disorder will working with a client who has been diagnosed with a psychiatric disorder will
contains an individual’s repressed experiences since conception. In contrast, the
base their understanding of the features and etiology of the disorder on the base their understanding of the features and etiology of the disorder on the
collective unconscious, which Jung later termed the objective psyche, is comprised
various axes of the Diagnostic and Statistical Manual of Mental Disorders of the various axes of the Diagnostic and Statistical Manual of Mental Disorders of the
of inherited and shared human experiences and is made manifest in archetypal
American Psychiatric Association (DSM-IV-TR). American Psychiatric Association (DSM-IV-TR).
images, dreams, and symbols (Corsini & Wedding, 1995).
The six major models commonly used in the treatment of individuals The six major models commonly used in the treatment of individuals
According to Freudian theory, unresolved emotional conflicts relating to
with mental disorders are psychodynamic, cognitive, humanistic/existential, with mental disorders are psychodynamic, cognitive, humanistic/existential,
an individual’s instincts, early childhood experiences, and memories reside in
biomedical, behavioral, and holistic (see Table 8–1, p. 120). biomedical, behavioral, and holistic (see Table 8–1, p. 120).
the unconscious and are thought to be the source of personality abnormality.
The biomedical model, with its emphasis on biological processes, is The biomedical model, with its emphasis on biological processes, is
From this perspective, the reconstruction of personality structures is necessary
not literally a psychotherapeutic approach. However, it has been included not literally a psychotherapeutic approach. However, it has been included
for health to ensue. Thus, two fundamental goals of psychodynamic therapy
here because of its prominence in the treatment of mental disorders and here because of its prominence in the treatment of mental disorders and
are to bring repressed unconscious material into the individual’s awareness
the increasing interface of music therapy with medical protocols. Similarly, the increasing interface of music therapy with medical protocols. Similarly,
and to move toward corrective emotional experiences through the processes of
behaviorism in its purest form has as its focus overt and quantifiable responses behaviorism in its purest form has as its focus overt and quantifiable responses
transference and countertransference (Bruscia, 1998b).
rather than underlying psychological processes, yet is included here because of rather than underlying psychological processes, yet is included here because of
Simply put, transference occurs when a client transfers patterns of
the widespread use of behavioral techniques within other models. The sixth the widespread use of behavioral techniques within other models. The sixth
responding from one time period and/or context to another (i.e., the dynamics
paradigm, holistic, has been addressed because of the strong influence of the paradigm, holistic, has been addressed because of the strong influence of the
of significant relationships from the client’s past are replicated in therapeutic
holistic health movement with its emphasis on consideration of all relevant holistic health movement with its emphasis on consideration of all relevant
encounters). Likewise, countertransference is said to be operating “whenever a
information about the life of an individual as a biological, psychological, social, information about the life of an individual as a biological, psychological, social,
therapist interacts with a client in ways that resemble relationship patterns in
and spiritual organism. and spiritual organism.
either the therapist’s life or the client’s life” (Bruscia, 1998c, p. 52). Analysis of
Sometimes the various models are complementary, but often they are Sometimes the various models are complementary, but often they are
transference, which occurs many times and in many ways, sheds light on how the
incompatible in their attempts to understand and promote optimum health. incompatible in their attempts to understand and promote optimum health.
client relates to the present in terms of the past and helps him respond in a more
Terminology varies tremendously in descriptions of the tenets of each model Terminology varies tremendously in descriptions of the tenets of each model
mature and realistic manner (Corsini & Wedding, 1995).
as well as in language used by the therapist and/or client in clinical practice. as well as in language used by the therapist and/or client in clinical practice.
The therapist’s role in a psychodynamic treatment approach is to
For example, one therapist may refer to an individual as a “patient”; this same For example, one therapist may refer to an individual as a “patient”; this same
demonstrate qualities such as self-confidence and controlled emotional warmth.
individual may be called a “client,” “resident,” or “consumer” within another individual may be called a “client,” “resident,” or “consumer” within another
As the therapeutic focus shifts from the identification of conflicts to the working
approach (Bruscia, 1998a). Likewise, use of terms such as “abnormality,” approach (Bruscia, 1998a). Likewise, use of terms such as “abnormality,”
through of those conflicts, the therapist’s role may change from an analyst to
“disorder,” “disease,” and “maladaptation”—all designed to reflect a departure “disorder,” “disease,” and “maladaptation”—all designed to reflect a departure
that of an ally and active supporter. Techniques frequently used by the therapist
from or disruption in health—may vary according to treatment orientation. from or disruption in health—may vary according to treatment orientation.
include interpretation, dream analysis, free association, analysis of resistance,
(Where appropriate and feasible, language used in this chapter is congruent (Where appropriate and feasible, language used in this chapter is congruent
and analysis of transference and countertransference processes.
with terminology in the DSM-IV-TR.) with terminology in the DSM-IV-TR.)
Music experiences may be used in addition to or in place of typical verbal
This is a cursory description of the basic tenets of each of the six models. This is a cursory description of the basic tenets of each of the six models.
methods of psychoanalysis (Bruscia, 1998b). According to Jung, performing
The definition of disorder, mechanisms of change, and the therapist’s role within The definition of disorder, mechanisms of change, and the therapist’s role within
music requires all four functions of the psyche: thinking, to turn the notes into
each perspective are presented, along with music therapy methods, procedures, each perspective are presented, along with music therapy methods, procedures,
music; feeling, to give the music expression; sensing, in the person’s proprioceptive
and strategies aligned with each model. and strategies aligned with each model.
Music
Music Therapy
Psychodynamic
establishment ofModel
musical and nonmusical goals and objectives. With proper Psychodynamic Model
training and guided by therapeutic intent, the music therapist selects and
The psychodynamic treatment approach is based on theoretical constructs The psychodynamic treatment approach is based on theoretical constructs
implements various methods, procedures, and techniques (Bruscia, 1998a).
developed and refined by Sigmund Freud during the first quarter of the twentieth developed and refined by Sigmund Freud during the first quarter of the twentieth
Outcome evaluations will determine the effectiveness of such interventions.
century; however, more modern views of this model exist today based on century; however, more modern views of this model exist today based on
Clinical decisions made during each phase of the treatment process must
his work and that of Alfred Adler, Carl Jung, Erik Erikson, and others. The his work and that of Alfred Adler, Carl Jung, Erik Erikson, and others. The
be clearly guided by assessment, research data, the level of practice, and the
psychodynamic orientation holds that an individual’s psyche functions at various psychodynamic orientation holds that an individual’s psyche functions at various
psychotherapeutic model.
levels of awareness, including unconscious, preconscious, and conscious. Jung, who levels of awareness, including unconscious, preconscious, and conscious. Jung, who
Current models have limitations in explaining causes and symptomatology
constructed an analytical personality theory based on the work of Freud and constructed an analytical personality theory based on the work of Freud and
of all mental disorders. However, no matter which model is used, the therapists
Adler, posited two different kinds of unconscious. The personal unconscious Adler, posited two different kinds of unconscious. The personal unconscious
working with a client who has been diagnosed with a psychiatric disorder will
contains an individual’s repressed experiences since conception. In contrast, the contains an individual’s repressed experiences since conception. In contrast, the
base their understanding of the features and etiology of the disorder on the
collective unconscious, which Jung later termed the objective psyche, is comprised collective unconscious, which Jung later termed the objective psyche, is comprised
various axes of the Diagnostic and Statistical Manual of Mental Disorders of the
of inherited and shared human experiences and is made manifest in archetypal of inherited and shared human experiences and is made manifest in archetypal
American Psychiatric Association (DSM-IV-TR).
images, dreams, and symbols (Corsini & Wedding, 1995). images, dreams, and symbols (Corsini & Wedding, 1995).
The six major models commonly used in the treatment of individuals
According to Freudian theory, unresolved emotional conflicts relating to According to Freudian theory, unresolved emotional conflicts relating to
with mental disorders are psychodynamic, cognitive, humanistic/existential,
an individual’s instincts, early childhood experiences, and memories reside in an individual’s instincts, early childhood experiences, and memories reside in
biomedical, behavioral, and holistic (see Table 8–1, p. 120).
the unconscious and are thought to be the source of personality abnormality. the unconscious and are thought to be the source of personality abnormality.
The biomedical model, with its emphasis on biological processes, is
From this perspective, the reconstruction of personality structures is necessary From this perspective, the reconstruction of personality structures is necessary
not literally a psychotherapeutic approach. However, it has been included
for health to ensue. Thus, two fundamental goals of psychodynamic therapy for health to ensue. Thus, two fundamental goals of psychodynamic therapy
here because of its prominence in the treatment of mental disorders and
are to bring repressed unconscious material into the individual’s awareness are to bring repressed unconscious material into the individual’s awareness
the increasing interface of music therapy with medical protocols. Similarly,
and to move toward corrective emotional experiences through the processes of and to move toward corrective emotional experiences through the processes of
behaviorism in its purest form has as its focus overt and quantifiable responses
transference and countertransference (Bruscia, 1998b). transference and countertransference (Bruscia, 1998b).
rather than underlying psychological processes, yet is included here because of
Simply put, transference occurs when a client transfers patterns of Simply put, transference occurs when a client transfers patterns of
the widespread use of behavioral techniques within other models. The sixth
responding from one time period and/or context to another (i.e., the dynamics responding from one time period and/or context to another (i.e., the dynamics
paradigm, holistic, has been addressed because of the strong influence of the
of significant relationships from the client’s past are replicated in therapeutic of significant relationships from the client’s past are replicated in therapeutic
holistic health movement with its emphasis on consideration of all relevant
encounters). Likewise, countertransference is said to be operating “whenever a encounters). Likewise, countertransference is said to be operating “whenever a
information about the life of an individual as a biological, psychological, social,
therapist interacts with a client in ways that resemble relationship patterns in therapist interacts with a client in ways that resemble relationship patterns in
and spiritual organism.
either the therapist’s life or the client’s life” (Bruscia, 1998c, p. 52). Analysis of either the therapist’s life or the client’s life” (Bruscia, 1998c, p. 52). Analysis of
Sometimes the various models are complementary, but often they are
transference, which occurs many times and in many ways, sheds light on how the transference, which occurs many times and in many ways, sheds light on how the
incompatible in their attempts to understand and promote optimum health.
client relates to the present in terms of the past and helps him respond in a more client relates to the present in terms of the past and helps him respond in a more
Terminology varies tremendously in descriptions of the tenets of each model
mature and realistic manner (Corsini & Wedding, 1995). mature and realistic manner (Corsini & Wedding, 1995).
as well as in language used by the therapist and/or client in clinical practice.
The therapist’s role in a psychodynamic treatment approach is to The therapist’s role in a psychodynamic treatment approach is to
For example, one therapist may refer to an individual as a “patient”; this same
demonstrate qualities such as self-confidence and controlled emotional warmth. demonstrate qualities such as self-confidence and controlled emotional warmth.
individual may be called a “client,” “resident,” or “consumer” within another
As the therapeutic focus shifts from the identification of conflicts to the working As the therapeutic focus shifts from the identification of conflicts to the working
approach (Bruscia, 1998a). Likewise, use of terms such as “abnormality,”
through of those conflicts, the therapist’s role may change from an analyst to through of those conflicts, the therapist’s role may change from an analyst to
“disorder,” “disease,” and “maladaptation”—all designed to reflect a departure
that of an ally and active supporter. Techniques frequently used by the therapist that of an ally and active supporter. Techniques frequently used by the therapist
from or disruption in health—may vary according to treatment orientation.
include interpretation, dream analysis, free association, analysis of resistance, include interpretation, dream analysis, free association, analysis of resistance,
(Where appropriate and feasible, language used in this chapter is congruent
and analysis of transference and countertransference processes. and analysis of transference and countertransference processes.
with terminology in the DSM-IV-TR.)
Music experiences may be used in addition to or in place of typical verbal Music experiences may be used in addition to or in place of typical verbal
This is a cursory description of the basic tenets of each of the six models.
methods of psychoanalysis (Bruscia, 1998b). According to Jung, performing methods of psychoanalysis (Bruscia, 1998b). According to Jung, performing
The definition of disorder, mechanisms of change, and the therapist’s role within
music requires all four functions of the psyche: thinking, to turn the notes into music requires all four functions of the psyche: thinking, to turn the notes into
each perspective are presented, along with music therapy methods, procedures,
music; feeling, to give the music expression; sensing, in the person’s proprioceptive music; feeling, to give the music expression; sensing, in the person’s proprioceptive
and strategies aligned with each model.
120
116 Modelsin the Clinical Setting
Music Therapy 121
(position awareness) feedback from his body when playing an instrument and (position awareness) feedback from his body when playing an instrument and
Chapter 8
(Priestley, 1975). (Priestley, 1975).

PSYCHODYNAMIC COGNITIVE
HUMANISTIC/
EXISTENTIAL
of Psychotherapeutic Models
BIOMEDICAL PSYCHODYNAMIC
BEHAVIORALCOGNITIVE
HUMANISTIC/
HOLISTIC
EXISTENTIAL
Major Contributors Sigmund Freud
(1856–1939)
Eric Berne (1910–
1970)
1970)
Mary A. Sigmund
Scovel
Major Contributors Freud
(1856–1939)
Eric Berne (1910–
1970)
1970)
Alfred Adler (1870–
1937)
Albert Ellis (1913– ) Carl Rogers (1902–
Aaron T. Beck 1987)
Susan C. Alfred
Gardstrom
1937)
Adler (1870– Albert Ellis (1913– ) Carl Rogers (1902–
Aaron T. Beck 1987)
Carl Jung (1875– 1921– ) Abraham Maslow Carl Jung (1875– 1921– ) Abraham Maslow
1961) Maxie Maultsby (1908–1970) 1961) Maxie Maultsby (1908–1970)
Erik Erikson (1902– (1932– ) Erik Erikson (1902– (1932– )
1994) William Glasser Introduction 1994) William Glasser
(1925– ) (1925– )
M
Definition Disorders are driven Disorders come Disorders are the usic therapyDisorders
Definition clinical practice
are drivenoccurs at various
Disorders come levels. Disorders
Wheelerare (1983)
the
by hidden conflicts from irrational outcome of failure has classifiedbythe treatment
hidden conflictsof adults
from with mental disorders
irrational outcomeinto three
of failure
within the personal- thinking about self to grow, find mean- types: musicwithin
therapy
theas an activity
personal- therapy,
thinking insight
about self music therapy
to grow, find with
mean-
ity and others ing, and be respon- reeducative goals, and ityinsight music therapyand with reconstructiveing,
others goals.
and Activity-
be respon-
sible for self based therapy is aimed at helping the client reach observable, measurable sible for self goals
Therapist Role Foster transference, Act as guide, chal- Offer total and through various
Therapist Role forms Foster
of music experiences.Act
transference, In contrast, the two Offer
as guide, chal- remaining levels
total and
make interpretations lenge notions that unconditional focus on facilitation of make interpretations
change lenge notions
through personal that gained
insight unconditional
via musical
are self-defeating acceptance, focus experiences and verbalization about thoseareexperiences.
self-defeating Insight-based
acceptance,music
focus
on here-and-now on here-and-now
therapy processes are ordinarily more intense and prolonged, in that deep
Therapist Analysis of symbolic Rational challeng- Hone expression to Therapist
emotions are evoked, Analysis
and in ofthe symbolic Rational challeng-therapy
case of reconstructive Hone expression to
unconscious
Techniques material (dreams, ing, homework to help person move Techniques material (dreams, ing, homework to
material is accessed. However, all three levels are valid treatment approaches.move
help person The
imagery), free asso- test assumptions, to higher level of imagery), free asso- test assumptions,
ciation
used in any given clinical situation willtodepend
type of music therapyciation higher level of
on the
change of language functioning change of language functioning
individual needs of the client population, the philosophical orientation of the
treatment facility, and the therapist’s education and training (insight music therapy
Evaluate Change Insight into and Problems elimi- Client identifies Evaluate Change Insight into and Problems elimi- Client identifies
leads to personality thoughts that pro- tors that block Music therapy clinical
leads to practice also occurs
personality thoughts within the framework
that proof many
tors that block
change mote them actualization and different psychotherapeutic
change models. A model is
mote them a device for generating
actualizationideas,
and
freedom for guiding conceptualization, and therefore, generating explanation freedom (Reed,
Terminology conflict, analysis, unconditional experiential, rela- 1984). In particular, psychotherapeutic
Terminology conflict, analysis, models aid in scientificexperiential,
unconditional understandingrela-
defenses, id, ego, shoulds, absolutistic tionship, choice, of human response anddefenses,
guide therapeutic
id, ego, methods.
shoulds, absolutistic tionship, choice,
superego, psycho- musts, self-defeat- values, autonomy, Diversity of practice is a psycho-
superego, strength ofmusts,
the music therapy discipline
self-defeat- in that
values, autonomy,
sexual, transference, ing, self-indoctri- here-and-now, pur- sexual, transference,
the therapist is not restricted ing, self-indoctri-
to one philosophical orientation, here-and-now,
but may base pur-
countertransference, nation, judging, pose, meaning treatment approaches countertransference,
on the particular needs nation,of judging,
the clients and pose,
themeaning
demands
myths, archetypes, crooked thinking, myths, archetypes, crooked thinking,
shadow, persona, new self-statements
of the particular work shadow,
setting.persona, new self-statements
anima/animus, indi- No matter whatanima/animus,
level or model is espoused, the music therapy treatment
indi-
viduation process involves referral, initial assessment of client strengths and deficits, and
viduation
117
Music
120 Music Therapy
125
121
or idealistic
For a description
accounts of of human
music experiences
experience, that
songwriting
are usedmayto reorganize
be employed the to For a description of music experiences that are used to reorganize the
personality structure
dispute irrational of the and
thinking client, see Taxonomy
encourage rational II. Music Learning
thinking. Psychotherapy,
of new personality structure of the client, see Taxonomy II. Music Psychotherapy,
C.responses
“Catalytic Music
occurs whenGroup and/orreactions
emotional Individual Therapy.” by
are reinforced Techniques
repetition in
of this
lyrics. C. “Catalytic Music Group and/or Individual Therapy.” Techniques in this
Ultimately lyrics become associated with actual, logical, emotional, and physical
action (Maultsby, 1977).
Perilli
Table 8–1 (in Bruscia, 1991)
Psychotherapeutic describes the use of this creative method with a
Models
young woman diagnosed with schizophrenia. The songwriting helped the client
HUMANISTIC/
gain BIOMEDICAL
insight into her PSYCHODYNAMIC
irrational fears and engage in personal problem
solving.
EXISTENTIAL BIOMEDICAL BEHAVIORAL HOLISTIC
Other techniques used in cognitive approaches include homework to
Paul Ehrlich (1854–1915) B. F. Skinner (1904–1990) B. Siegel (1932– ) Paul Ehrlich (1854–1915) B. F. Skinner (1904–1990) B. Siegel (1932– )
test new assumptions, open-ended questions, role-playing, and imagery. In
A. Weil (1942– ) A. Weil (1942– )
this orientation, clients’ imagery is considered to beC. representative
Pert (1946– ) of cognitive C. Pert (1946– )
processes, including distortions, and is thus subject to modification (Corsini
& Wedding, 1995). See Taxonomy VI, Music and Relaxation, C. “Music
Imagery” for a description of music interventions that may be successful in
eliciting imagery.
The terminology used in cognitive approaches includes unconditional
shoulds, absolutistic musts, self-defeating, self-indoctrination, judging, crooked/
Disorders
stinking are illnessesand
thinking, of newLearning/relearning
self-statements. occurs orders result from lack Disorders are illnesses of Learning/relearning occurs orders result from lack
the body due to germs, when it is paired with conse- of unity of mind, body, the body due to germs, when it is paired with conse- of unity of mind, body,
genes, or biochemistry quence Dis- and spirit genes, or biochemistry quence Dis- and spirit
Humanistic/Existential
The humanistic/existential view of disorder has been described as an
Understand and recom- Act in directive manner, Enable client to be active in Understand and recom- Act in directive manner, Enable client to be active in
outcome
mend of the failure toprovide
treatment grow,treatment
find meaning
protocol in life, and beprocess
the healing responsible for mend treatment provide treatment protocol the healing process
oneself and others.
based on diagnosis Humanistic/existential
to attain goal theories are concerned with defining based on diagnosis to attain goal
the needs that are central to human functioning. Abraham Maslow, one of
the earliest
Address and most influential
relationship humanistic
Applied Behavior thinkers,
Analysis, stood
Promote in opposition
techniques to to Address relationship Applied Behavior Analysis, Promote techniques to
Freudian
between and behavioral
psychosocial and theories
modeling,ofcontingent
human nature
rein- (Corsini & Wedding, 1995).
develop self-awareness, between psychosocial and modeling, contingent rein- develop self-awareness,
He described human
neurophysiological pro- needs in terms of a pyramid, healthful
forcement a hierarchy of basic
nutrition, needs
proper neurophysiological pro- forcement healthful nutrition, proper
cesses rest, stress management,
ranging from biological necessities to self-actualization, that is, the tendency of cesses rest, stress management,
every human being to strive toward wholeness and fulfillment. and exercise The actualized and exercise
individual
Find is aor purposeful
germ, gene, bio- creature
Learning capable
generalizes to of Clientand
newmaking sees self as grow-
acting on plans, Find germ, gene, or bio- Learning generalizes to new Client sees self as grow-
chemistry causing
strategies, andthe When self-actualization isingthwarted,
choices. contexts and changing someand type of chemistry causing the contexts ing and changing and
disorder self-empowered, reduced disorder self-empowered, reduced
disorder may result, and the individual may be unable to successfully confront
level of stress and pain, level of stress and pain,
the most basic of all life questions: What is the meaning of life?
increased peaceHow can I live
of mind increased peace of mind
up to my fullest potential? How can I face death?
medical model, genet- operant conditioning, con- self-care, self-empower- medical model, genet- operant conditioning, con- self-care, self-empower-
This model does not offer specific technical procedures for the treatment
ics, germs, biochemistry, ditioned response, stimulus, ment, inner healing, intui- ics, germs, biochemistry, ditioned response, stimulus, ment, inner healing, intui-
of mental disorders;
psychoneuroimmunology, rather, it suggests a manner
modeling, shaping, cause oftive abilities, attitude
being, an toward
self-responsi- psychoneuroimmunology, modeling, shaping, cause tive abilities, self-responsi-
change, and
psychopharmacologya way of guiding
and effect, positive/negative bility, awareness training with
the client through the process of dealing psychopharmacology and effect, positive/negative bility, awareness training
the fundamental issues of human existence. The existing, immediate person,
reinforcement reinforcement
rather than a prepackaged theory about that client, is the focus of all therapies
claiming humanistic/existential roots, such as Gestalt therapy (Perls) and
Person-Centered therapy (Rogers).
Music Therapy
123
category are designed to stimulate intrapsychic material such as thoughts and disordered
category are thinking
designedabout to stimulate
oneself and intrapsychic
the world. material
Many cognitive
such as thoughts
models are and
feelings related to the client’s past and present life. Through catalytic music anfeelings
outgrowth related
of andto the
reaction
client’stopastthe and
behavioral
present perspective.
life. Through The catalytic
forerunner music
experiences, the patient is encouraged to learn and grow emotionally by tackling is experiences,
Rational Emotive the patient
Behavior
is encouraged
Therapyto(REBT),
learn anddeveloped
grow emotionally
by Albert by tackling
Ellis.
problems on a more realistic level (Tyson, 1981). Maultsby’s
problems Rational
on a moreBehavioral
realistic level Therapy,
(Tyson,Beck’s
1981).Cognitive Therapy, Glasser’s
Bruscia (1998b) identifies improvisation as one of three types of music Reality Therapy,
Bruscia and (1998b)
Berne’s identifies
Transactional
improvisation
Analysisasareone otherof specific
three typestherapeutic
of music
experience frequently employed within a psychodynamic orientation to therapy. approaches
experiencewith frequently
cognitive employed
roots. Each within
of these
a psychodynamic
models stresses orientation
the importance
to therapy.
of
In improvisation, the client creates music spontaneously with instruments cognitive
In improvisation,
processes asthe determinants
client creates of feelings
music and spontaneously
behaviors. with instruments
and/or the voice as an outlet for the expression of various emotional states (e.g., and/orREBTthe voice
is basedas anon outlet
the for
assumption
the expression
that human
of various beings
emotional
are bornstateswith
(e.g.,
frustration, elation, anxiety). Through improvisation, the client is free to express a potential
frustration, forelation,
both rational,
anxiety). self-constructive
Through improvisation, thinking the and
clientirrational,
is free to express
self-
any and all aspects of himself; hence, this method may be considered a means of destructive
any and allthinking
aspects of(Corsini
himself; hence,
& Wedding,
this method1995). may Furthermore,
be consideredemotions
a means of
“free-associating with or projecting oneself onto sounds” (p. 5). stem
“free-associating
from beliefs in, withevaluations
or projecting andoneself
interpretations
onto sounds” of, and(p. 5).
reactions to life
In Analytical Music Therapy, a specific approach developed by Mary situations. InMore
Analytical
specifically,
MusicanTherapy,
ActivatingaEventspecific
(A)approach
triggers a charged
developed emotional
by Mary
Priestley and colleagues in the 1970s, improvisation is combined with movement Consequence
Priestley and (C),colleagues
mediatedinbythe the1970s,
client’s
improvisation
Belief Systemis(B). combined
For example,
with movement
a client
and verbal processing. The therapist provides elementary musical structures or whoandhasverbal
beenprocessing.
diagnosed The with therapist
an anxiety provides
disorderelementary
(A) may believe
musicalthat structures
she willor
forms within which the client approaches and experiences difficult emotions. never
forms be within
able to secure
which employment
the client approaches
as a resultandof theexperiences
disorder (B); difficult
this mayemotions.
lead
The improvised music “moves into the body and works on a kinesthetic level toThe
feelings
improvised
of depression
music “moves
and further into the
anxiety
body(C). and Debating
works on irrational
a kinesthetic beliefs
level
to open up blocked feelings and give access to repressed memories” (Warja, (D)to isopen
the uppointblocked
of intervention,
feelings and andgive
New access
Effectto (E)
repressed
is a culmination
memories” of (Warja,
the
1994, p. 79). Ego strength, that is, reality-based conscious control, may therapeutic
1994, p. process
79). Ego (Bryant,
strength, 1987). that is, reality-based conscious control, may
be developed through improvisatory expressive techniques such as reality be developed
In REBT, through clients learnimprovisatory
skills that expressive
help them techniques
identify andsuch dispute
as reality
any
rehearsal, affirmations, and programmed regression. Priestley cites freer self- acquired
rehearsal,irrational
affirmations,
beliefs andthatprogrammed
are prolongedregression.
by habit or Priestley
self-indoctrination.
cites freer self-
expression, increased self-respect, diminution of symptomology, more satisfying Thus,
expression,
an important
increasedcomponent
self-respect,ofdiminution
the REBTofconceptualization
symptomology, more of satisfying
human
relationships, and increased energy as benefits to be gained through Analytical behavior
relationships,
is the detection
and increasedof such energy
irrational
as benefits
beliefs,tooften
be gained
referredthrough
to as “magical,”
Analytical
Music Therapy processes (Priestley, 1994). “crooked,”
Music Therapyor “stinking
processes thinking.”
(Priestley,The 1994).
“musts,” “shoulds,” and “oughts” in
Another technique frequently used in the psychodynamic approach is clients’ thoughts
Another and technique
words may frequently
reveal rigid,
used in unrealistic
the psychodynamic
thinking thatapproach
involves is
music imaging, including but not restricted to the Bonny Method of Guided self-imposed
music imaging, demands.
includingIn thinking
but not restricted
more rationally,
to the Bonny clientsMethod
are empowered
of Guided
Imagery and Music (GIM) (see Taxonomy II. Music Psychotherapy, C. “Catalytic to Imagery
change and self-damaging
Music (GIM) emotional
(see Taxonomy
responses II. Music
into more Psychotherapy,
positive reactions
C. “Catalytic of
Music Group and/or Individual Therapy”). In GIM, carefully selected and their
MusicownGroup
choosing. and/or Individual Therapy”). In GIM, carefully selected and
ordered classical music selections are used receptively to move the client into ordered
Theclassical
REBT therapist
music selections
serves asare a guide
used yetreceptively
does nottobelieve
move thatthe client
a warm into
altered states of consciousness where emotional themes may emerge through therapeutic
altered statesrelationship
of consciousness
is necessary wherefor emotional
effective personality
themes may change
emerge to through
occur
various forms of imagery. The therapist, specially trained, guides the client (Corsini
various&formsWedding, of imagery.
1995). The Thetherapist’s
therapist,role specially
is to identify
trained, andguides
challengethe self-
client
in a supportive fashion, reflecting, encouraging, and augmenting the imagery defeating
in a supportive
ideas thatfashion,
the clientsreflecting,
have come encouraging,
to accept asand absolute
augmenting
truth. The the clients
imagery
experience (Bonny, 1994). areexperience
then assisted (Bonny,
in adopting
1994). and practicing new, healthier responses.
Terminology used in the psychodynamic model includes unconscious A Terminology
cognitive-based usedmusicin therapist
the psychodynamic
might structure model experiences
includes that unconscious
allow
conflict, analysis, defense mechanisms, id, ego, superego, psychosexual development, forconflict,
verbal processing
analysis, defenseof individual
mechanisms, and/or
id, ego,
groupsuperego,
reactions psychosexual
to musicaldevelopment,
material,
oedipal stage, transference, and countertransference. Terminology common as oedipal
in guided stage,music
transference,
listening experiences,
and countertransference.
described in Terminology
Taxonomy II,common Music
to Jungian theory includes myths, archetypes, Self, ego, shadow, persona, Psychotherapy,
to Jungian A. theory
“Supportive
includes Music
myths,Group
archetypes,
and/or Individual
Self, ego, shadow,
Psychotherapy”
persona,
anima/animus, and individuation. andanima/animus,
B. “Interactive andMusic
individuation.
Group and/or Individual Psychotherapy.” Guided
music listening often leads to a discussion of lyric content, the music’s mood,
and associations with past experiences of personal relevance to the individual’s
Cognitive Model Cognitive Model
conscious conflicts. Maultsby (1977) maintains that the therapeutic value
There are several cognitive models used in the treatment of adults of musicThere residesareexclusively
several cognitive
in lyricalmodels
forms used and thatin the treatment
such forms must of adults
be
with mental disorders. Each of them holds that life disturbances spring from with mental
rational. As thedisorders.
lyrics of manyEach of them holds songs
precomposed that life disturbances
revolve spring from
around unrealistic
Music
Music Therapy
disordered
category are thinking
designedabout to stimulate
oneself and intrapsychic
the world. material
Many cognitive
such as thoughts
models are and disordered thinking about oneself and the world. Many cognitive models are
anfeelings
outgrowth related
of andto the
reaction
client’stopastthe and
behavioral
present perspective.
life. Through The catalytic
forerunner music an outgrowth of and reaction to the behavioral perspective. The forerunner
is experiences,
Rational Emotive the patient
Behavior
is encouraged
Therapyto(REBT),
learn anddeveloped
grow emotionally
by Albert by tackling
Ellis. is Rational Emotive Behavior Therapy (REBT), developed by Albert Ellis.
Maultsby’s
problems Rational
on a moreBehavioral
realistic level Therapy,
(Tyson,Beck’s
1981).Cognitive Therapy, Glasser’s Maultsby’s Rational Behavioral Therapy, Beck’s Cognitive Therapy, Glasser’s
Reality Therapy,
Bruscia and (1998b)
Berne’s identifies
Transactional
improvisation
Analysisasareone otherof specific
three typestherapeutic
of music Reality Therapy, and Berne’s Transactional Analysis are other specific therapeutic
approaches
experiencewith frequently
cognitive employed
roots. Each within
of these
a psychodynamic
models stresses orientation
the importance
to therapy.
of approaches with cognitive roots. Each of these models stresses the importance of
cognitive
In improvisation,
processes asthe determinants
client creates of feelings
music and spontaneously
behaviors. with instruments cognitive processes as determinants of feelings and behaviors.
and/orREBTthe voice
is basedas anon outlet
the for
assumption
the expression
that human
of various beings
emotional
are bornstateswith
(e.g., REBT is based on the assumption that human beings are born with
a potential
frustration, forelation,
both rational,
anxiety). self-constructive
Through improvisation, thinking the and
clientirrational,
is free to express
self- a potential for both rational, self-constructive thinking and irrational, self-
destructive
any and allthinking
aspects of(Corsini
himself; hence,
& Wedding,
this method1995). may Furthermore,
be consideredemotions
a means of destructive thinking (Corsini & Wedding, 1995). Furthermore, emotions
stem
“free-associating
from beliefs in, withevaluations
or projecting andoneself
interpretations
onto sounds” of, and(p. 5).
reactions to life stem from beliefs in, evaluations and interpretations of, and reactions to life
situations. InMore
Analytical
specifically,
MusicanTherapy,
ActivatingaEventspecific
(A)approach
triggers a charged
developed emotional
by Mary situations. More specifically, an Activating Event (A) triggers a charged emotional
Consequence
Priestley and (C),colleagues
mediatedinbythe the1970s,
client’s
improvisation
Belief Systemis(B). combined
For example,
with movement
a client Consequence (C), mediated by the client’s Belief System (B). For example, a client
whoandhasverbal
beenprocessing.
diagnosed The with therapist
an anxiety provides
disorderelementary
(A) may believe
musicalthat structures
she willor who has been diagnosed with an anxiety disorder (A) may believe that she will
never
forms be within
able to secure
which employment
the client approaches
as a resultandof theexperiences
disorder (B); difficult
this mayemotions.
lead never be able to secure employment as a result of the disorder (B); this may lead
toThe
feelings
improvised
of depression
music “moves
and further into the
anxiety
body(C). and Debating
works on irrational
a kinesthetic beliefs
level to feelings of depression and further anxiety (C). Debating irrational beliefs
(D)to isopen
the uppointblocked
of intervention,
feelings and andgive
New access
Effectto (E)
repressed
is a culmination
memories” of (Warja,
the (D) is the point of intervention, and New Effect (E) is a culmination of the
therapeutic
1994, p. process
79). Ego (Bryant,
strength, 1987). that is, reality-based conscious control, may therapeutic process (Bryant, 1987).
be developed
In REBT, through clients learnimprovisatory
skills that expressive
help them techniques
identify andsuch dispute
as reality
any In REBT, clients learn skills that help them identify and dispute any
acquired
rehearsal,irrational
affirmations,
beliefs andthatprogrammed
are prolongedregression.
by habit or Priestley
self-indoctrination.
cites freer self- acquired irrational beliefs that are prolonged by habit or self-indoctrination.
Thus,
expression,
an important
increasedcomponent
self-respect,ofdiminution
the REBTofconceptualization
symptomology, more of satisfying
human Thus, an important component of the REBT conceptualization of human
behavior
relationships,
is the detection
and increasedof such energy
irrational
as benefits
beliefs,tooften
be gained
referredthrough
to as “magical,”
Analytical behavior is the detection of such irrational beliefs, often referred to as “magical,”
“crooked,”
Music Therapyor “stinking
processes thinking.”
(Priestley,The 1994).
“musts,” “shoulds,” and “oughts” in “crooked,” or “stinking thinking.” The “musts,” “shoulds,” and “oughts” in
clients’ thoughts
Another and technique
words may frequently
reveal rigid,
used in unrealistic
the psychodynamic
thinking thatapproach
involves is clients’ thoughts and words may reveal rigid, unrealistic thinking that involves
self-imposed
music imaging, demands.
includingIn thinking
but not restricted
more rationally,
to the Bonny clientsMethod
are empowered
of Guided self-imposed demands. In thinking more rationally, clients are empowered
to Imagery
change and self-damaging
Music (GIM) emotional
(see Taxonomy
responses II. Music
into more Psychotherapy,
positive reactions
C. “Catalytic of to change self-damaging emotional responses into more positive reactions of
their
MusicownGroup
choosing. and/or Individual Therapy”). In GIM, carefully selected and their own choosing.
ordered
Theclassical
REBT therapist
music selections
serves asare a guide
used yetreceptively
does nottobelieve
move thatthe client
a warm into The REBT therapist serves as a guide yet does not believe that a warm
therapeutic
altered statesrelationship
of consciousness
is necessary wherefor emotional
effective personality
themes may change
emerge to through
occur therapeutic relationship is necessary for effective personality change to occur
(Corsini
various&formsWedding, of imagery.
1995). The Thetherapist’s
therapist,role specially
is to identify
trained, andguides
challengethe self-
client (Corsini & Wedding, 1995). The therapist’s role is to identify and challenge self-
defeating
in a supportive
ideas thatfashion,
the clientsreflecting,
have come encouraging,
to accept asand absolute
augmenting
truth. The the clients
imagery defeating ideas that the clients have come to accept as absolute truth. The clients
areexperience
then assisted (Bonny,
in adopting
1994). and practicing new, healthier responses. are then assisted in adopting and practicing new, healthier responses.
A Terminology
cognitive-based usedmusicin therapist
the psychodynamic
might structure model experiences
includes that unconscious
allow A cognitive-based music therapist might structure experiences that allow
forconflict,
verbal processing
analysis, defenseof individual
mechanisms, and/or
id, ego,
groupsuperego,
reactions psychosexual
to musicaldevelopment,
material, for verbal processing of individual and/or group reactions to musical material,
as oedipal
in guided stage,music
transference,
listening experiences,
and countertransference.
described in Terminology
Taxonomy II,common Music as in guided music listening experiences, described in Taxonomy II, Music
Psychotherapy,
to Jungian A. theory
“Supportive
includes Music
myths,Group
archetypes,
and/or Individual
Self, ego, shadow,
Psychotherapy”
persona, Psychotherapy, A. “Supportive Music Group and/or Individual Psychotherapy”
andanima/animus,
B. “Interactive andMusic
individuation.
Group and/or Individual Psychotherapy.” Guided and B. “Interactive Music Group and/or Individual Psychotherapy.” Guided
music listening often leads to a discussion of lyric content, the music’s mood, music listening often leads to a discussion of lyric content, the music’s mood,
and associations with past experiences of personal relevance to the individual’s and associations with past experiences of personal relevance to the individual’s
Cognitive Model
conscious conflicts. Maultsby (1977) maintains that the therapeutic value conscious conflicts. Maultsby (1977) maintains that the therapeutic value
of musicThere residesareexclusively
several cognitive
in lyricalmodels
forms used and thatin the treatment
such forms must of adults
be of music resides exclusively in lyrical forms and that such forms must be
with mental
rational. As thedisorders.
lyrics of manyEach of them holds songs
precomposed that life disturbances
revolve spring from
around unrealistic rational. As the lyrics of many precomposed songs revolve around unrealistic
124
120 Music Therapy
125
121
or idealistic accounts of human experience, songwriting may be employed to or idealistic

For a description
accounts of of human
music experiences
experience, that
songwriting
are usedmayto reorganize
be employed the to
dispute irrational thinking and encourage rational thinking. Learning of new personality structure
dispute irrational of the and
thinking client, see Taxonomy
encourage rational II. Music Learning
thinking. Psychotherapy,
of new
responses occurs when emotional reactions are reinforced by repetition of lyrics. C.responses
“Catalytic Music
occurs whenGroup and/orreactions
emotional Individual Therapy.” by
are reinforced Techniques
repetition in
of this
lyrics.
Ultimately lyrics become associated with actual, logical, emotional, and physical Ultimately lyrics become associated with actual, logical, emotional, and physical
action (Maultsby, 1977). action (Maultsby, 1977).
Perilli
Models Perilli
Models
young woman diagnosed with schizophrenia. The songwriting helped the client young woman diagnosed with schizophrenia. The songwriting helped the client
HUMANISTIC/ HUMANISTIC/
gain insight into her PSYCHODYNAMIC
COGNITIVE
solving.
EXISTENTIAL
gain BIOMEDICAL
insight into her PSYCHODYNAMIC
solving.
EXISTENTIAL
Other techniques used in cognitive approaches include homework to Other techniques used in cognitive approaches include homework to
Paul Ehrlich (1854–1915) B. F. Skinner (1904–1990) B. Siegel (1932– )
test new assumptions, open-ended questions, role-playing, and imagery. In test new assumptions, open-ended questions, role-playing, and imagery. In
A. Weil (1942– )
this orientation, clients’ imagery is considered to be representative of cognitive this orientation, clients’ imagery is considered to beC. representative
Pert (1946– ) of cognitive
processes, including distortions, and is thus subject to modification (Corsini processes, including distortions, and is thus subject to modification (Corsini
& Wedding, 1995). See Taxonomy VI, Music and Relaxation, C. “Music & Wedding, 1995). See Taxonomy VI, Music and Relaxation, C. “Music
Imagery” for a description of music interventions that may be successful in Imagery” for a description of music interventions that may be successful in
eliciting imagery. eliciting imagery.
The terminology used in cognitive approaches includes unconditional The terminology used in cognitive approaches includes unconditional
shoulds, absolutistic musts, self-defeating, self-indoctrination, judging, crooked/ shoulds, absolutistic musts, self-defeating, self-indoctrination, judging, crooked/
stinking thinking, and new self-statements. Disorders
stinking are illnessesand
thinking, of newLearning/relearning
self-statements. occurs orders result from lack
the body due to germs, when it is paired with conse- of unity of mind, body,
genes, or biochemistry quence Dis- and spirit
Humanistic/Existential Humanistic/Existential
The humanistic/existential view of disorder has been described as an The humanistic/existential view of disorder has been described as an
Understand and recom- Act in directive manner, Enable client to be active in
outcome of the failure to grow, find meaning in life, and be responsible for outcome
mend of the failure toprovide
treatment grow,treatment
find meaning
protocol in life, and beprocess
the healing responsible for
oneself and others. Humanistic/existential theories are concerned with defining oneself and others.
based on diagnosis Humanistic/existential
to attain goal theories are concerned with defining
the needs that are central to human functioning. Abraham Maslow, one of the needs that are central to human functioning. Abraham Maslow, one of
the earliest and most influential humanistic thinkers, stood in opposition to the earliest
Address and most influential
relationship humanistic
Applied Behavior thinkers,
Analysis, stood
Promote in opposition
techniques to to
Freudian and behavioral theories of human nature (Corsini & Wedding, 1995). Freudian
between and behavioral
psychosocial and theories
modeling,ofcontingent
human nature
rein- (Corsini & Wedding, 1995).
develop self-awareness,
He described human needs in terms of a pyramid, a hierarchy of basic needs He described human
neurophysiological pro- needs in terms of a pyramid, healthful
forcement a hierarchy of basic
nutrition, needs
proper
ranging from biological necessities to self-actualization, that is, the tendency of cesses rest, stress management,
ranging from biological necessities to self-actualization, that is, the tendency of
every human being to strive toward wholeness and fulfillment. The actualized every human being to strive toward wholeness and fulfillment. and exercise The actualized
individual is a purposeful creature capable of making and acting on plans, individual
Find is aor purposeful
germ, gene, bio- creature
Learning capable
generalizes to of Clientand
newmaking sees self as grow-
acting on plans,
strategies, and choices. When self-actualization is thwarted, some type of chemistry causing
strategies, andthe When self-actualization isingthwarted,
choices. contexts and changing someand type of
disorder self-empowered, reduced
disorder may result, and the individual may be unable to successfully confront disorder may result, and the individual may be unable to successfully confront
level of stress and pain,
the most basic of all life questions: What is the meaning of life? How can I live the most basic of all life questions: What is the meaning of life?
increased peaceHow can I live
of mind
up to my fullest potential? How can I face death? up to my fullest potential? How can I face death?
medical model, genet- operant conditioning, con- self-care, self-empower-
This model does not offer specific technical procedures for the treatment This model does not offer specific technical procedures for the treatment
ics, germs, biochemistry, ditioned response, stimulus, ment, inner healing, intui-
of mental disorders; rather, it suggests a manner of being, an attitude toward of mental disorders;
psychoneuroimmunology, rather, it suggests a manner
modeling, shaping, cause oftive abilities, attitude
being, an toward
self-responsi-
change, and a way of guiding the client through the process of dealing with change, and
psychopharmacologya way of guiding
and effect, positive/negative bility, awareness training with
the client through the process of dealing
the fundamental issues of human existence. The existing, immediate person, the fundamental issues of human existence. The existing, immediate person,
reinforcement
rather than a prepackaged theory about that client, is the focus of all therapies rather than a prepackaged theory about that client, is the focus of all therapies
claiming humanistic/existential roots, such as Gestalt therapy (Perls) and claiming humanistic/existential roots, such as Gestalt therapy (Perls) and
Person-Centered therapy (Rogers). Person-Centered therapy (Rogers).
Music
124 Music Therapy
129
125
in order
Rogersto help
posited
the aclient
numberlearnoftodistinctive
control aspects“therapist-offered”
of functioningconditions and achieve Rogers posited a number of distinctive “therapist-offered” conditions
thought
optimum to behealth.
critical for client development. These include empathy (getting thought to be critical for client development. These include empathy (getting
within and Theunderstanding
therapist’s primary the client’s
function experience),
in a behavioral
unconditional
approachpositiveis to design
regardand within and understanding the client’s experience), unconditional positive regard
(acting
implement
in a warm,
a treatment
accepting,
protocol
and that
caringenables
fashion),
the client
and congruence
to attain specific
(a willingness
goals and (acting in a warm, accepting, and caring fashion), and congruence (a willingness
toobjectives.
be open and Thehonest
therapistin sharing
assumesfeelings
an activearising
and directive
in the therapeutic
role that may context)
include to be open and honest in sharing feelings arising in the therapeutic context)
(Corsini
setting & upWedding,
a contingency1995). toThe
helptherapist’s
change abnormalrole is tobehaviors.
be immediately accessible (Corsini & Wedding, 1995). The therapist’s role is to be immediately accessible
to the client
The behavioral
and to focus music ontherapist
the here-and-now
is concernedexperiences
with manipulating createdthe in musi-
the to the client and to focus on the here-and-now experiences created in the
therapeutic
cal stimulirelationship.
to effect a change A respectful,
in observable,attentive,
measurable
caring, behavior.
and understanding
She may use therapeutic relationship. A respectful, attentive, caring, and understanding
attitude
Appliedwill Behavior
assist the
Analysis
client(ABA)
in breaking
techniques down in order
barriers
to design
and achieving
individual more
treat- attitude will assist the client in breaking down barriers and achieving more
satisfying
ment programs
levels of to personal
meet the functioning.
client’s needs. ABA involves observing, identifying satisfying levels of personal functioning.
the target
Again,behavior(s),
rather than establishing
prescribing specific
a baseline,methods
determining
or techniques
strategies
for treatment,
for change, Again, rather than prescribing specific methods or techniques for treatment,
theimplementing
humanistic/existential
the strategies,
paradigm
and evaluating
suggests a process
and documenting
that is groundedchanges in genuine
in behav- the humanistic/existential paradigm suggests a process that is grounded in genuine
care
iorand
(Hanser,
concern 1999).
for the immediate human needs of the client. The humanistic/ care and concern for the immediate human needs of the client. The humanistic/
existential Although
music therapist
used most usesfrequently
music as awith tool children,
to elicit anda behavioral
identify those approachneeds to existential music therapist uses music as a tool to elicit and identify those needs
as music
well astherapy
stimulate hasand
beensupport
appliedthe toactualization
adults with mental process.
disorders.
Various In methods,
an earlybothstudy, as well as stimulate and support the actualization process. Various methods, both
active
Hauck(creative,
and Martinrecreative,
(1970) anddemonstrated
improvisation) thatandtime-out
receptivefrom
(listening)
music experiences
(Bruscia, active (creative, recreative, and improvisation) and receptive (listening) (Bruscia,
1998a),
was effective
are thusinvalidreducing
choices theininappropriate
the service of mannerisms
these aims. of a woman diagnosed 1998a), are thus valid choices in the service of these aims.
withCreative
schizophrenia.
Music Therapy, developed by Paul Nordoff and Clive Robbins, Creative Music Therapy, developed by Paul Nordoff and Clive Robbins,
espouses Overt
the fundamental
actions andtenetscovertofbehaviors
humanism. (e.g.,
Creative
cognitive,
Musicsocial/emotional)
Therapists make can espouses the fundamental tenets of humanism. Creative Music Therapists make
extensive
be revealed,
use ofexamined,
improvisation
and modified
as a means through of fostering
music therapy
the emergence
treatment (Hanser,of the extensive use of improvisation as a means of fostering the emergence of the
essential
1999). core
For of example,
the human the being
opportunity
(Nordoff to &play
Robbins,
an instrument
1977). Incould this approach,
be used as essential core of the human being (Nordoff & Robbins, 1977). In this approach,
music
a reward
and musical
for improved expression
client isbehavior.
viewed See not Taxonomy
as “symbolic I, Music
representations
Performing,ofE. music and musical expression is viewed not as “symbolic representations of
something
“Individual elseInstrumental
but instead Instruction
as direct manifestations
(product oriented),”
of the self”
for an(Aigen,
explanation
1998, of something else but instead as direct manifestations of the self” (Aigen, 1998,
p. this
296).
technique.
AlthoughInevolving
addition, fromtheNordoff
client may andseek
Robbins’s
to learnwork
and with
develop children
a newwho musi- p. 296). Although evolving from Nordoff and Robbins’s work with children who
were
cal mentally
skill or exercise
and physically
and improveimpaired,
an existing
Creative musical
Musicskill.
Therapy
The has therapist
been usedinstructs
in were mentally and physically impaired, Creative Music Therapy has been used in
thethe
treatment
client inofplaying
adults with
techniques,
emotional using
difficulties
materials as for
wellthe
(Ansdell,
appropriate 1995).learning the treatment of adults with emotional difficulties as well (Ansdell, 1995).
level,Van
and Den
assigns Hurk
practice
and tasks
Smeijsters
of which (inthe
Bruscia,
client is1991)
capable. described
The therapist the use may Van Den Hurk and Smeijsters (in Bruscia, 1991) described the use
of use
improvisation
principles ofinreinforcement
Person-Centered to increase
work withdesiredan behavior,
adult diagnosed
both nonmusical
with a of improvisation in Person-Centered work with an adult diagnosed with a
personality
and musical. disorder.
Other techniques
Some aimsused of therapy
in this model
were toarehelp
relaxation
the client training,
abandon token personality disorder. Some aims of therapy were to help the client abandon
rigid
economies,
responsemodeling
patterns,methods,
take responsibility,
systematic desensitization,
make choices assertion
freely, enjoy training,
music and rigid response patterns, take responsibility, make choices freely, enjoy music
making,
self-management
and reduce programs.
interpersonal isolation. Techniques of empathy (e.g., making, and reduce interpersonal isolation. Techniques of empathy (e.g.,
imitating, Only
synchronizing,
behaviors that pacing,
can be andobserved
reflecting)and (Bruscia,
measured1987) quantitatively
were usedare imitating, synchronizing, pacing, and reflecting) (Bruscia, 1987) were used
throughout
evaluated within
treatment a behavioral
in order paradigm.
to create aOne safe criterion
environment for evaluating
and support changethe is throughout treatment in order to create a safe environment and support the
expression
the extentoftoemotions.
which learning See Taxonomy
generalizesI,toMusic new situations.
Performing, G. “Individual expression of emotions. See Taxonomy I, Music Performing, G. “Individual
Music Improvisation/Interaction
Terminology utilized in this (process
model includes
oriented)” operant
for anconditioning,
explanationcondi- of Music Improvisation/Interaction (process oriented)” for an explanation of
similar
tionedimprovisatory
response, stimulus,techniques.
modeling, shaping, cause and effect, and positive/negative similar improvisatory techniques.
reinforcement.
Success and accomplishment through music instruction and performance Success and accomplishment through music instruction and performance
experiences may contribute to a client’s sense of mastery and power, thereby experiences may contribute to a client’s sense of mastery and power, thereby
increasing confidence and self-esteem. It may benefit the individual to learn to increasing confidence and self-esteem. It may benefit the individual to learn to
Holistic Model
accept the responsibility of practice as a self-imposed task and relate personal accept the responsibility of practice as a self-imposed task and relate personal
effort to The holistic model
an aesthetically is based
satisfying on theresult.
musical assumption
Examplesthatofhealing comes from
these techniques effort to an aesthetically satisfying musical result. Examples of these techniques
arewithin.
found The body healsI,itself.
in Taxonomy MusicThe word holistic stems from the Greek holos, mean-
Performing. are found in Taxonomy I, Music Performing.
Music Therapy
127
One could assert that Guided Imagery and Music (GIM), although concomitantOne symptomatology
could assert that(Taylor,
Guided1997).
Imagery Recent
and Music
research(GIM),
indicates
although
that
associated most frequently with psychoanalytic constructs, is practiced from a music
associated
listening
mostmay frequently
be effective
with psychoanalytic
in altering body constructs,
chemistry. is practiced
For example,
from a
humanistic/ existential stance. In GIM, receptive methods are used to assist some
humanistic/
studies haveexistential
linkedstance.
receptive
In GIM,
methodsreceptive
with lowered
methodslevelsare used
of adrenal
to assist
the client in the development of self-awareness and insight, clarification of secretions
the clientpresent
in the in development
stress reactions,
of self-awareness
such as epinephrine,
and insight, norepinephrine,
clarification of
personal values, and exploration of religious and transpersonal realms, among andpersonal
cortisolvalues,
(Bartlett,
and exploration
Kaufman, & of Smeltekop,
religious and1993;
transpersonal
Miluk-Kolasa,
realms,1993;
among
other aims (Bonny & Savary, 1973). Furthermore, the individual “traveler” and Spintge
other aims
& Droh,
(Bonny 1987).
& Savary,
Receptive
1973).methods
Furthermore,
such astheguided
individual
music“traveler”
listeningand
his immediate experience of the music are of paramount importance at each arehisdescribed
immediate in experience
TaxonomyofII,the Music
musicPsychotherapy,
are of paramountA. “Supportive
importanceMusic at each
stage of the therapeutic journey. Group
stage and/or
of the therapeutic
Individualjourney.
Psychotherapy” and B. “Interactive Music Group
Change is evaluated by determining whether a client has achieved greater and/or Individual
Change is evaluated
Psychotherapy.”
by determining
Because whether
of the close
a client
relationship
has achievedbetween
greater
independence and personality integration. Progress toward self-actualization is adrenal
independence
corticosteroids
and personality
(stress hormones)
integration.
andProgress
the immune
toward system,
self-actualization
data suggest is
evident when the client is demonstrating an ability to identify factors that block a correlation
evident when between
the client
music-assisted
is demonstrating
relaxation
an ability
techniques
to identify
and factors
physicalthat
health
block
freedom and the spontaneous expression of feelings, as well as taking greater (Rider,
freedomFloyd,
and&the Kirkpatrick,
spontaneous 1985).
expression
For a description
of feelings,ofasthese
well techniques,
as taking greater
see
responsibility for choices and actions. Taxonomy
responsibility
VI, Music
for choices
and Relaxation.
and actions.
Terminology commonly used in this model includes experiential, Terminology
Terminology usedcommonly
in this model
usedincludes
in thismedical
model model,
includesgenetics,
experiential,
germs,
relationship, choice, values, personal responsibility, autonomy, here-and-now, biochemistry,
relationship, psychoneuroimmunology,
choice, values, personaland responsibility,
psychopharmacology.
autonomy, here-and-now,
purpose, and meaning. purpose, and meaning.
Behavioral Model
Biomedical Model Biomedical Model
The behavioral model was first developed in the early twentieth century.
The biomedical model defines mental disorder as a biologically based Between The 1920biomedical
and the middle modelof the century,
defines behaviorism
mental disorderdominated psychology
as a biologically based
illness. Biomedical researchers consider three possible causes of an illness: germs, inillness.
the United States and
Biomedical also hadconsider
researchers wide international
three possible influence.
causes of Thean initial
illness:effect
germs,
genes, and biochemistry (Rosenhan & Seligman, 1984). of genes,
behaviorism on psychology
and biochemistry was to &
(Rosenhan minimize
Seligman, the1984).
reflective study of mental
Medical theories tend to place the nature and cause of mental illness in processes,Medical
emotions, and tend
theories feelings. These
to place thecovert
natureprocesses
and cause were abandoned
of mental inin
illness
the person’s biological nature. It is believed that underlying the symptoms of favor
the of the study
person’s of objective
biological behavior
nature. of individuals
It is believed by means of
that underlying theexperimental
symptoms of
abnormal behavior are organic, physiological, or biochemical processes (Ruud, methods.
abnormal This orientation
behavior provided
are organic, a way to relate
physiological, or human and animal
biochemical processes research
(Ruud,
1980). In determining the etiology of psychological abnormalities, those who and to bring
1980). psychology the
In determining intoetiology
line with of the natural sciences
psychological such as those
abnormalities, physics,who
adhere to the biomedical model search for an organic basis. They look for a germ chemistry,
adhere toandthe biology
biomedical (Bijou,
model1996).
search for an organic basis. They look for a germ
that is causing the syndrome or study the client’s family history to see if genes that B. F. Skinner,
is causing thea syndrome
pioneer in the development
or study of this
the client’s model,
family viewstopsychology
history see if genes
might be the cause. They also explore the biochemistry, specifically the brain, for as might
the study
be theofcause.
the observable behavior
They also explore theofbiochemistry,
individuals interacting
specifically the with theirfor
brain,
any further insights that might explain the illness or abnormality. environment. Skinner’sthat
any further insights notion
might of explain
controlling and modifying
the illness behavior is based
or abnormality.
Within the biomedical model, the therapist’s role is to study the etiology, on the principles
Within the of operant
biomedicalconditioning,
model, thethetherapist’s
assumption rolebeing that changes
is to study in
the etiology,
work toward understanding the diagnosis, and recommend and provide treatment behavior are brought
work toward about when
understanding that behavior
the diagnosis, is followedand
and recommend by provide
a consequence.
treatment
based on a thorough understanding of the illness. Once the etiology is identified, Behavioral
based on atheory
thorough posits that learning
understanding or relearning
of the illness. Once occurs only when
the etiology some
is identified,
a biological treatment—often a drug—will be used to mitigate the symptoms. kind of consequence
a biological is paired with
treatment—often the learning.
a drug—will Reinforcement,
be used to mitigateeither positive
the symptoms.
For example, pharmacological treatment of an individual with chronic depression orFor
negative,
example, serves to increase behavior,
pharmacological treatment while punishment
of an individual withserves
chronicto decrease
depression
might include tricyclic antidepressants or monoamine oxidase inhibitors. ormight
extinguish behavior.
include tricyclic antidepressants or monoamine oxidase inhibitors.
Sometimes electroconvulsive therapy is used. A patient diagnosed with an Today, behavioral
Sometimes therapiststherapy
electroconvulsive apply learning
is used.theory
A patientto a variety
diagnosedof practical
with an
anxiety disorder may be prescribed antianxiety drugs typically classified as problems.
anxiety The mechanistic
disorder may be approach
prescribedofantianxiety
earlier behavioral
drugs practices
typically has largely as
classified
benzodiazepines. Psychotropic medication is frequently prescribed to reduce the been replaced withPsychotropic
benzodiazepines. a more functionalmedicationapplication of theprescribed
is frequently concept to of reduce
stimuli-the
distractions, confusion, hallucinations, and delusions typical of schizophrenia. response that has
distractions, meaninghallucinations,
confusion, and utility for andthedelusions
individual client.
typical For example,
of schizophrenia.
Music therapy, as a complement to traditional medical treatment, may in biofeedback, a modification
Music therapy, technique developed
as a complement to traditional in the 1940s,treatment,
medical the client may is
impact directly the biological processes related to illness or help manage the “fed back”directly
impact visual or theaudible signals
biological about what
processes relatedis occurring
to illness in or his
helpormanage
her bodythe
Music
Music Therapy
concomitantOne symptomatology
could assert that(Taylor,
Guided1997).
Imagery Recent
and Music
research(GIM),
indicates
although
that concomitant symptomatology (Taylor, 1997). Recent research indicates that
music
associated
listening
mostmay frequently
be effective
with psychoanalytic
in altering body constructs,
chemistry. is practiced
For example,
from a music listening may be effective in altering body chemistry. For example,
some
humanistic/
studies haveexistential
linkedstance.
receptive
In GIM,
methodsreceptive
with lowered
methodslevelsare used
of adrenal
to assist some studies have linked receptive methods with lowered levels of adrenal
secretions
the clientpresent
in the in development
stress reactions,
of self-awareness
such as epinephrine,
and insight, norepinephrine,
clarification of secretions present in stress reactions, such as epinephrine, norepinephrine,
andpersonal
cortisolvalues,
(Bartlett,
and exploration
Kaufman, & of Smeltekop,
religious and1993;
transpersonal
Miluk-Kolasa,
realms,1993;
among and cortisol (Bartlett, Kaufman, & Smeltekop, 1993; Miluk-Kolasa, 1993;
Spintge
other aims
& Droh,
(Bonny 1987).
& Savary,
Receptive
1973).methods
Furthermore,
such astheguided
individual
music“traveler”
listeningand Spintge & Droh, 1987). Receptive methods such as guided music listening
arehisdescribed
immediate in experience
TaxonomyofII,the Music
musicPsychotherapy,
are of paramountA. “Supportive
importanceMusic at each are described in Taxonomy II, Music Psychotherapy, A. “Supportive Music
Group
stage and/or
of the therapeutic
Individualjourney.
Psychotherapy” and B. “Interactive Music Group Group and/or Individual Psychotherapy” and B. “Interactive Music Group
and/or Individual
Change is evaluated
Psychotherapy.”
by determining
Because whether
of the close
a client
relationship
has achievedbetween
greater and/or Individual Psychotherapy.” Because of the close relationship between
adrenal
independence
corticosteroids
and personality
(stress hormones)
integration.
andProgress
the immune
toward system,
self-actualization
data suggest is adrenal corticosteroids (stress hormones) and the immune system, data suggest
a correlation
evident when between
the client
music-assisted
is demonstrating
relaxation
an ability
techniques
to identify
and factors
physicalthat
health
block a correlation between music-assisted relaxation techniques and physical health
(Rider,
freedomFloyd,
and&the Kirkpatrick,
spontaneous 1985).
expression
For a description
of feelings,ofasthese
well techniques,
as taking greater
see (Rider, Floyd, & Kirkpatrick, 1985). For a description of these techniques, see
Taxonomy
responsibility
VI, Music
for choices
and Relaxation.
and actions. Taxonomy VI, Music and Relaxation.
Terminology
Terminology usedcommonly
in this model
usedincludes
in thismedical
model model,
includesgenetics,
experiential,
germs, Terminology used in this model includes medical model, genetics, germs,
biochemistry,
relationship, psychoneuroimmunology,
choice, values, personaland responsibility,
psychopharmacology.
autonomy, here-and-now, biochemistry, psychoneuroimmunology, and psychopharmacology.
purpose, and meaning.
Behavioral Model Behavioral Model
Biomedical Model
The behavioral model was first developed in the early twentieth century. The behavioral model was first developed in the early twentieth century.
Between The 1920biomedical
and the middle modelof the century,
defines behaviorism
mental disorderdominated psychology
as a biologically based Between 1920 and the middle of the century, behaviorism dominated psychology
inillness.
the United States and
Biomedical also hadconsider
researchers wide international
three possible influence.
causes of Thean initial
illness:effect
germs, in the United States and also had wide international influence. The initial effect
of genes,
behaviorism on psychology
and biochemistry was to &
(Rosenhan minimize
Seligman, the1984).
reflective study of mental of behaviorism on psychology was to minimize the reflective study of mental
processes,Medical
emotions, and tend
theories feelings. These
to place thecovert
natureprocesses
and cause were abandoned
of mental inin
illness processes, emotions, and feelings. These covert processes were abandoned in
favor
the of the study
person’s of objective
biological behavior
nature. of individuals
It is believed by means of
that underlying theexperimental
symptoms of favor of the study of objective behavior of individuals by means of experimental
methods.
abnormal This orientation
behavior provided
are organic, a way to relate
physiological, or human and animal
biochemical processes research
(Ruud, methods. This orientation provided a way to relate human and animal research
and to bring
1980). psychology the
In determining intoetiology
line with of the natural sciences
psychological such as those
abnormalities, physics,who and to bring psychology into line with the natural sciences such as physics,
chemistry,
adhere toandthe biology
biomedical (Bijou,
model1996).
search for an organic basis. They look for a germ chemistry, and biology (Bijou, 1996).
that B. F. Skinner,
is causing thea syndrome
pioneer in the development
or study of this
the client’s model,
family viewstopsychology
history see if genes B. F. Skinner, a pioneer in the development of this model, views psychology
as might
the study
be theofcause.
the observable behavior
They also explore theofbiochemistry,
individuals interacting
specifically the with theirfor
brain, as the study of the observable behavior of individuals interacting with their
environment. Skinner’sthat
any further insights notion
might of explain
controlling and modifying
the illness behavior is based
or abnormality. environment. Skinner’s notion of controlling and modifying behavior is based
on the principles
Within the of operant
biomedicalconditioning,
model, thethetherapist’s
assumption rolebeing that changes
is to study in
the etiology, on the principles of operant conditioning, the assumption being that changes in
behavior are brought
work toward about when
understanding that behavior
the diagnosis, is followedand
and recommend by provide
a consequence.
treatment behavior are brought about when that behavior is followed by a consequence.
Behavioral
based on atheory
thorough posits that learning
understanding or relearning
of the illness. Once occurs only when
the etiology some
is identified, Behavioral theory posits that learning or relearning occurs only when some
kind of consequence
a biological is paired with
treatment—often the learning.
a drug—will Reinforcement,
be used to mitigateeither positive
the symptoms. kind of consequence is paired with the learning. Reinforcement, either positive
orFor
negative,
example, serves to increase behavior,
pharmacological treatment while punishment
of an individual withserves
chronicto decrease
depression or negative, serves to increase behavior, while punishment serves to decrease
ormight
extinguish behavior.
include tricyclic antidepressants or monoamine oxidase inhibitors. or extinguish behavior.
Today, behavioral
Sometimes therapiststherapy
electroconvulsive apply learning
is used.theory
A patientto a variety
diagnosedof practical
with an Today, behavioral therapists apply learning theory to a variety of practical
problems.
anxiety The mechanistic
disorder may be approach
prescribedofantianxiety
earlier behavioral
drugs practices
typically has largely as
classified problems. The mechanistic approach of earlier behavioral practices has largely
been replaced withPsychotropic
benzodiazepines. a more functionalmedicationapplication of theprescribed
is frequently concept to of reduce
stimuli-the been replaced with a more functional application of the concept of stimuli-
response that has
distractions, meaninghallucinations,
confusion, and utility for andthedelusions
individual client.
typical For example,
of schizophrenia. response that has meaning and utility for the individual client. For example,
in biofeedback, a modification
Music therapy, technique developed
as a complement to traditional in the 1940s,treatment,
medical the client may is in biofeedback, a modification technique developed in the 1940s, the client is
“fed back”directly
impact visual or theaudible signals
biological about what
processes relatedis occurring
to illness in or his
helpormanage
her bodythe “fed back” visual or audible signals about what is occurring in his or her body
128
124 Music Therapy
129
125
in order to help the client learn to control aspects of functioning and achieve in order
Rogersto help
posited
the aclient
numberlearnoftodistinctive
control aspects“therapist-offered”
of functioningconditions and achieve
optimum health. thought
optimum to behealth.
critical for client development. These include empathy (getting
The therapist’s primary function in a behavioral approach is to design and within and Theunderstanding
therapist’s primary the client’s
function experience),
in a behavioral
unconditional
approachpositiveis to design
regardand
implement a treatment protocol that enables the client to attain specific goals and (acting
implement
in a warm,
a treatment
accepting,
protocol
and that
caringenables
fashion),
the client
and congruence
to attain specific
(a willingness
goals and
objectives. The therapist assumes an active and directive role that may include toobjectives.
be open and Thehonest
therapistin sharing
assumesfeelings
an activearising
and directive
in the therapeutic
role that may context)
include
setting up a contingency to help change abnormal behaviors. (Corsini
setting & upWedding,
a contingency1995). toThe
helptherapist’s
change abnormalrole is tobehaviors.
be immediately accessible
The behavioral music therapist is concerned with manipulating the musi- to the client
The behavioral
and to focus music ontherapist
the here-and-now
is concernedexperiences
with manipulating createdthe in musi-
the
cal stimuli to effect a change in observable, measurable behavior. She may use therapeutic
cal stimulirelationship.
to effect a change A respectful,
in observable,attentive,
measurable
caring, behavior.
and understanding
She may use
Applied Behavior Analysis (ABA) techniques in order to design individual treat- attitude
Appliedwill Behavior
assist the
Analysis
client(ABA)
in breaking
techniques down in order
barriers
to design
and achieving
individual more
treat-
ment programs to meet the client’s needs. ABA involves observing, identifying satisfying
ment programs
levels of to personal
meet the functioning.
client’s needs. ABA involves observing, identifying
the target behavior(s), establishing a baseline, determining strategies for change, the target
Again,behavior(s),
rather than establishing
prescribing specific
a baseline,methods
determining
or techniques
strategies
for treatment,
for change,
implementing the strategies, and evaluating and documenting changes in behav- theimplementing
humanistic/existential
the strategies,
paradigm
and evaluating
suggests a process
and documenting
that is groundedchanges in genuine
in behav-
ior (Hanser, 1999). care
iorand
(Hanser,
concern 1999).
for the immediate human needs of the client. The humanistic/
Although used most frequently with children, a behavioral approach to existential Although
music therapist
used most usesfrequently
music as awith tool children,
to elicit anda behavioral
identify those approachneeds to
music therapy has been applied to adults with mental disorders. In an early study, as music
well astherapy
stimulate hasand
beensupport
appliedthe toactualization
adults with mental process.
disorders.
Various In methods,
an earlybothstudy,
Hauck and Martin (1970) demonstrated that time-out from music experiences active
Hauck(creative,
and Martinrecreative,
(1970) anddemonstrated
improvisation) thatandtime-out
receptivefrom
(listening)
music experiences
(Bruscia,
was effective in reducing the inappropriate mannerisms of a woman diagnosed 1998a),
was effective
are thusinvalidreducing
choices theininappropriate
the service of mannerisms
these aims. of a woman diagnosed
with schizophrenia. withCreative
schizophrenia.
Music Therapy, developed by Paul Nordoff and Clive Robbins,
Overt actions and covert behaviors (e.g., cognitive, social/emotional) can espouses Overt
the fundamental
actions andtenetscovertofbehaviors
humanism. (e.g.,
Creative
cognitive,
Musicsocial/emotional)
Therapists make can
be revealed, examined, and modified through music therapy treatment (Hanser, extensive
be revealed,
use ofexamined,
improvisation
and modified
as a means through of fostering
music therapy
the emergence
treatment (Hanser,of the
1999). For example, the opportunity to play an instrument could be used as essential
1999). core
For of example,
the human the being
opportunity
(Nordoff to &play
Robbins,
an instrument
1977). Incould this approach,
be used as
a reward for improved client behavior. See Taxonomy I, Music Performing, E. music
a reward
and musical
for improved expression
client isbehavior.
viewed See not Taxonomy
as “symbolic I, Music
representations
Performing,ofE.
“Individual Instrumental Instruction (product oriented),” for an explanation of something
“Individual elseInstrumental
but instead Instruction
as direct manifestations
(product oriented),”
of the self”
for an(Aigen,
explanation
1998, of
this technique. In addition, the client may seek to learn and develop a new musi- p. this
296).
technique.
AlthoughInevolving
addition, fromtheNordoff
client may andseek
Robbins’s
to learnwork
and with
develop children
a newwho musi-
cal skill or exercise and improve an existing musical skill. The therapist instructs were
cal mentally
skill or exercise
and physically
and improveimpaired,
an existing
Creative musical
Musicskill.
Therapy
The has therapist
been usedinstructs
in
the client in playing techniques, using materials for the appropriate learning thethe
treatment
client inofplaying
adults with
techniques,
emotional using
difficulties
materials as for
wellthe
(Ansdell,
appropriate 1995).learning
level, and assigns practice tasks of which the client is capable. The therapist may level,Van
and Den
assigns Hurk
practice
and tasks
Smeijsters
of which (inthe
Bruscia,
client is1991)
capable. described
The therapist the use may
use principles of reinforcement to increase desired behavior, both nonmusical of use
improvisation
principles ofinreinforcement
Person-Centered to increase
work withdesiredan behavior,
adult diagnosed
both nonmusical
with a
and musical. Other techniques used in this model are relaxation training, token personality
and musical. disorder.
Other techniques
Some aimsused of therapy
in this model
were toarehelp
relaxation
the client training,
abandon token
economies, modeling methods, systematic desensitization, assertion training, and rigid
economies,
responsemodeling
patterns,methods,
take responsibility,
systematic desensitization,
make choices assertion
freely, enjoy training,
music and
self-management programs. making,
self-management
and reduce programs.
interpersonal isolation. Techniques of empathy (e.g.,
Only behaviors that can be observed and measured quantitatively are imitating, Only
synchronizing,
behaviors that pacing,
can be andobserved
reflecting)and (Bruscia,
measured1987) quantitatively
were usedare
evaluated within a behavioral paradigm. One criterion for evaluating change is throughout
evaluated within
treatment a behavioral
in order paradigm.
to create aOne safe criterion
environment for evaluating
and support changethe is
the extent to which learning generalizes to new situations. expression
the extentoftoemotions.
which learning See Taxonomy
generalizesI,toMusic new situations.
Performing, G. “Individual
Terminology utilized in this model includes operant conditioning, condi- Music Improvisation/Interaction
Terminology utilized in this (process
model includes
oriented)” operant
for anconditioning,
explanationcondi- of
tioned response, stimulus, modeling, shaping, cause and effect, and positive/negative similar
tionedimprovisatory
response, stimulus,techniques.
modeling, shaping, cause and effect, and positive/negative
reinforcement. reinforcement.
Success and accomplishment through music instruction and performance
experiences may contribute to a client’s sense of mastery and power, thereby
increasing confidence and self-esteem. It may benefit the individual to learn to
Holistic Model Holistic Model
accept the responsibility of practice as a self-imposed task and relate personal
The holistic model is based on the assumption that healing comes from effort to The holistic model
an aesthetically is based
satisfying on theresult.
musical assumption
Examplesthatofhealing comes from
these techniques
within. The body heals itself. The word holistic stems from the Greek holos, mean- arewithin.
found The body healsI,itself.
in Taxonomy MusicThe word holistic stems from the Greek holos, mean-
Performing.
Music
132 Music Therapy
ingCrowe,
“whole” B., & orScovel,
“entire,”
M. which
(1996).relates to the words
Sound healing. heal andPerspectives,
Music Therapy health. 14 (1), 21–29. ing “whole” or “entire,” which relates to the words heal and health.
Unity
Gerber, of mind,
R. (1988). body, andmedicine.
Vibrational spirit isSanta
the fundamental
Fe, NM: Bear. principle of the holistic Unity of mind, body, and spirit is the fundamental principle of the holistic
health philosophy,
Hanser, S. (1999). wherein individuals
The new music arehandbook
therapist’s seen as physical,
(2nd ed.).emotional,
Boston, MA: mental,
Berklee. health philosophy, wherein individuals are seen as physical, emotional, mental,
and spiritual
Hauck, L. P.,beings.
& Martin,One major
P. L. (1970).tenet
Musicis that in order to
as a reinforcer in aactivate an individual’s
patient controlled duration and spiritual beings. One major tenet is that in order to activate an individual’s
own healing of time-out.
process,Journal of Music Therapy,
the individual must 7, 43–53.
take responsibility for all personal own healing process, the individual must take responsibility for all personal
Maultsby, M.
experiences (1977). Combining
including his or her own musichealth.
therapy Another
and rational
tenetbehavior
is thattherapy. Journal
only when experiences including his or her own health. Another tenet is that only when
of Musicincessant
an individual’s Therapy, 14 (2), 89–97.
thinking ceases and he or she experiences stillness of an individual’s incessant thinking ceases and he or she experiences stillness of
Miluk-Kolasa,
mind can spirit B. (1993).
inspire andEffects
work, of listening
openingtothe music on selected
blockages thephysiological variables
mind has created mind can spirit inspire and work, opening the blockages the mind has created
(Andrews, and1994).
anxiety level in pre-surgical patients. Unpublished doctoral dissertation, (Andrews, 1994).
A Medical
cornerstone University of Warsaw.
of alternative medicine is the idea that the mind influences A cornerstone of alternative medicine is the idea that the mind influences
Nordoff, C., & Robbins, C. (1977). Creative music therapy. New York: John Day.
the health of the body—positively and negatively. A principle objective is to the health of the body—positively and negatively. A principle objective is to
Perilli, G. (1991). Integrated music therapy with a schizophrenic woman. In K. Bruscia
identify those currents that generate creativity, healing, and love and to challenge identify those currents that generate creativity, healing, and love and to challenge
(Ed.), Case studies in music therapy (pp. 403–416). Gilsum, NH: Barcelona.
and release those currents that create negativity, disharmony, and violence and release those currents that create negativity, disharmony, and violence
Pert, C. (1997). Molecules of emotion. New York: Scribner.
(Zukav, 1989). Advocates of holistic models frequently advocate merging (Zukav, 1989). Advocates of holistic models frequently advocate merging
Priestley, M. (1975). Music therapy in action. London: Constable.
conventional and alternative medicine openly and intelligently. conventional and alternative medicine openly and intelligently.
Priestley, M. (1994). Essays on analytical music therapy. Gilsum, NH: Barcelona.
According to a well-publicized survey in The Journal of the American According to a well-publicized survey in The Journal of the American
Reed, K. (1984). Models of practice in occupational therapy. Baltimore, MD: Williams
Medical Association, the total number of visits to alternative-medicine practitioners Medical Association, the total number of visits to alternative-medicine practitioners
& Williams.
has leaped by some 50% since 1990. It now exceeds visits to all primary-care has leaped by some 50% since 1990. It now exceeds visits to all primary-care
Rider, M., Floyd, J., & Kirkpatrick, J. (1985). The effect of music, imagery, and relaxation
physicians onin the United
adrenal States (Weil,
corticosteroid and the1995).
re-entrainment of circadian rhythms. Journal physicians in the United States (Weil, 1995).
Siegel (1986) supports
of Music Therapy, 22 (11), 46–57. complementary and alternative medicine, Siegel (1986) supports complementary and alternative medicine,
particularly
Rosenhan,mind-body
D., & Seligman,healing. His medical
M. (1984). Abnormal practice evolved
psychology. New after he experienced
York: W. W. Norton. particularly mind-body healing. His medical practice evolved after he experienced
post-traumatic stress disorder, found nowhere to go, and
Ruud, E. (1980). Music therapy and its relationship to current treatment theories. no one to help
St.himLouis: post-traumatic stress disorder, found nowhere to go, and no one to help him
deal withMMB his feelings.
Music. In overcoming illness, he professes the importance of love, deal with his feelings. In overcoming illness, he professes the importance of love,
family
Siegel,structure,
B. (1986). and Peace,the
loveexperience
and healing.ofNew illness.
York:The patterns associated with
Harper. family structure, and the experience of illness. The patterns associated with
healing include a willingness to express feelings,
Spintge, R., & Droh, R. (Eds.). (1992). Music medicine. St. Louis: change life andMMBrelationships,
Music. healing include a willingness to express feelings, change life and relationships,
and deal with spiritual aspects (Siegel, 1986).
Taylor, D. (1997). Biomedical foundations of music as therapy. St. Louis: MMB Music. and deal with spiritual aspects (Siegel, 1986).
Pert
Tyson, (1997),
F. (1981). a supporter
Psychiatric of the New
music therapy. mind-body unityArts
York: Creative school of medicine,
Rehabilitation Center. Pert (1997), a supporter of the mind-body unity school of medicine,
assigns
Van den a keyHurk,roleJ. &toSmeijsters,
the biochemicalH. (1991).basisMusicalof improvisation
emotions. She asserts
in the that of
treatment assigns a key role to the biochemical basis of emotions. She asserts that
unexpressed a manemotion causes
with obsessive illness.personality
compulsive The “molecules
disorder. Inof K.emotion” travel
Bruscia (Ed.), Case unexpressed emotion causes illness. The “molecules of emotion” travel
throughout theinbloodstream,
studies music therapy hooking onto receptors
(pp. 387–402). Gilsum, NH:on cells in every corner of
Barcelona. throughout the bloodstream, hooking onto receptors on cells in every corner of
theWarja,
bodyM. (Pert, 1997).
(1994). Sounds Intestines are filled
of music through thewith neuropeptide
spiraling receptors;Ahence
path of individuation: Jungian the body (Pert, 1997). Intestines are filled with neuropeptide receptors; hence
the notion of “guttofeelings”
approach is not merely
music psychotherapy. a metaphor,
Music but an actual
Therapy Perspectives, biological
12 (2), 75–83. the notion of “gut feelings” is not merely a metaphor, but an actual biological
reality.
Weil, A.Pert asserts
(1995). that brain
Self-healing. Newchemicals
York: Alfred (neuropeptides)
A. Knopf. act as messengers reality. Pert asserts that brain chemicals (neuropeptides) act as messengers
between
Wheeler,the mind A
B. (1983). and the immune system
psychotherapeutic and ofnomusic
classification barriers
therapyexist between
practices. Music between the mind and the immune system and no barriers exist between
Therapy Perspectives, 1 (2), 8–12.
thoughts, feelings, and one’s biological healing system. Furthermore, Pert has thoughts, feelings, and one’s biological healing system. Furthermore, Pert has
Wilbur,
also proposedK. (1981). No boundary.
a connection Boston,
between MA: New
memory andScience
emotionLibrary.
and that emotion also proposed a connection between memory and emotion and that emotion
Zukav,the
creates G. bridge
(1989). between
The seat ofmindthe soul.
and New York:This
body. Simon & Schuster.
connection is demonstrated creates the bridge between mind and body. This connection is demonstrated
through experiments showing parts of the brain acting as the gateway into the through experiments showing parts of the brain acting as the gateway into the
whole emotional experience. whole emotional experience.
Perhaps the most difficult holistic principle to accommodate in clinical Perhaps the most difficult holistic principle to accommodate in clinical
practice is the spiritual dimension and belief in the concept of energies. Many practice is the spiritual dimension and belief in the concept of energies. Many
of the sound healing methods are based on theoretical beliefs involving energy of the sound healing methods are based on theoretical beliefs involving energy
133 133
Music Therapy
131
systems in the human body (Crowe & Scovel, 1996). Energy systems are pro- mean
systems
the expansion
in the human of one’s
body horizons,
(Croweoutwardly
& Scovel, in 1996).
perspective
Energyand systems
inwardly
are pro-
in
posed to be powerfully affected by our emotions and level of spiritual balance posed
depth to be powerfully
(Wilbur, 1981). affected by our emotions and level of spiritual balance
as well as by nutritional and environmental factors (Gerber, 1988). The holistic as well as by music
Ideally, nutritional and environmental
therapists factors (Gerber,
are able to communicate in the1988). Theofholistic
language the
model embraces vibrational healing as a way to balance such energies that are modeltheoretical
various embraces vibrational
models. Many healing as a way
clinicians opt to
forbalance
advanced such energies
training in that
orderare
not in equilibrium. to not in equilibrium.
practice within insight-oriented approaches. Some espouse a single theoretical
The trend toward a wide variety of experiential therapies has emerged The trend
model. Others, toward a private
particularly wide variety of experiential
practitioners therapies
with diverse has emerged
clientele, adopt
in the latter half of the twentieth century, their purpose being inner growth anineclectic
the latter halfusing
stance, of thea variety
twentieth century, environmental,
of medical, their purpose being inner growth
and psychosocial
and self-actualization. There is a burgeoning directory of practitioners of and self-actualization.
strategies and influences toThere help theiris a clients
burgeoning
achievedirectory
optimum of practitioners of
health.
various healing arts including acupuncture, Ayurvedic medicine, biofeedback, various healing
At the heart artsofincluding acupuncture,and
both unitheoretical Ayurvedic
diverse medicine, biofeedback,
clinical practice are
chiropractic, craniosacral therapy, herbal remedies, homeopathy, massage chiropractic,
carefully selected craniosacral
and implemented therapy,receptive
herbal remedies,
and activehomeopathy, massage
music experiences.
therapy, naturopathy, and meditation. therapy, naturopathy,
Ultimately, the value ofand meditation.
music therapy ought not be assessed according to
Holistic therapists view themselves as facilitators. Knowledge is freely whether Holistic
it reflectstherapists view themselves
psychodynamic, humanistic,as facilitators.
or scientificKnowledge
principles,is freely
but
shared on the assumption that understanding will enable the client to be active shared
rather onon thethebasis
assumption that understanding
of its success in demonstrating will enable
outcome thedata
client to be active
reflecting a
in the healing process. The therapist shares personal experiences, creating a more in the healing
patient’s recoveryprocess.
of healthyThefunctioning.
therapist shares personal experiences, creating a more
equal therapist-client relationship. The therapist’s techniques not only help the equal therapist-client relationship. The therapist’s techniques not only help the
client find information but promote techniques to develop self-responsibility, client find information but promote techniques to develop self-responsibility,
References
better nutrition, ample rest, stress management, and proper exercise. better nutrition, ample rest, stress management, and proper exercise.
The techniques used in this model encourage the client to look within Aigen, K.The (1998). Paths of development
techniques used in this in Nordoff-Robbins
model encourage music
thetherapy.
client toGilsum, NH:
look within
for his or her own healing. See Taxonomy II, Music Psychotherapy, D. “Catalytic Barcelona.
for his or her own healing. See Taxonomy II, Music Psychotherapy, D. “Catalytic
Music Group and/or Individual Therapy,” for a description of techniques American
Music GroupPsychiatric Association.
and/or Individual (2000). Diagnosticfor
Therapy,” anda statistical
description manual of mental
of techniques
aligned with the holistic philosophy. The emphasis here is to encourage the disorders (4th ed.). Washington, DC: Author.
aligned with the holistic philosophy. The emphasis here is to encourage the
client to reach and explore altered states of consciousness for the purpose of Andrews,
client to T. reach
(1994).andThe explore
healer’s manual.
altered St. Paul,ofMN:
states Llewellyn. for the purpose of
consciousness
allowing imagery, symbols, and latent feelings to surface from the inner self. Ansdell, G. (1995). Music for life. London: Jessica Kingsley.
allowing imagery, symbols, and latent feelings to surface from the inner self.
The aim is to help the client develop self-awareness, clarify personal values, Bartlett,
The aim D., Kaufman,
is to helpD., the&client
Smeltekop,
developR. (1993). The effectsclarify
self-awareness, of music listeningvalues,
personal and
release blocked intuitive energy sources, bring about deep relaxation, and foster perceived sensory experiences on the immune system as measured
release blocked intuitive energy sources, bring about deep relaxation, and foster by Interleukin-1
and Cortisol. Journal of Music Therapy, 30, 194–209.
spirituality and self-empowerment. spirituality and self-empowerment.
Bijou, S. W., & Ribes, E. (1996). New directions in behavioral development. Reno, NV:
Change is evidenced in a client’s reduction of stress level and removal Change is evidenced in a client’s reduction of stress level and removal
Context Press.
of pain or dysfunction, as well as an alteration of affect and a demonstration of pain or dysfunction, as well as an alteration of affect and a demonstration
Bonny, H. (1994). Twenty-one years later: A GIM update. Music Therapy Perspectives,
of more patience, harmony, and peace. The integrated client sees himself as a of more
12 (2),patience,
70–74. harmony, and peace. The integrated client sees himself as a
growing, changing person who is self-empowered. Bonny, H., & Savary, L.person
growing, changing (1973).who Music is and
self-empowered.
your mind. New York: Harper & Row.
Terminology used in this model includes self-care, self-empowerment, Terminology used in
Bruscia, K. (1987). Improvisational models this model includes
of music therapy.self-care, self-empowerment,
Springfield, IL: Charles C.
inner healing, intuitive abilities, self-responsibility, self-examination, self-healing, innerThomas.
healing, intuitive abilities, self-responsibility, self-examination, self-healing,
and awareness training. and awareness
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(1991). Case studies in music therapy. Gilsum, NH: Barcelona.
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Conclusion Bruscia, K. (1998b). An introduction to music psychotherapy. In K. Bruscia (Ed.), The
Conclusion
dynamics of music psychotherapy (pp. 1–15). Gilsum, NH: Barcelona.
Many theories have been developed to explain mental illness and guide Bruscia, K.Many theories
(1998c). have been
Understanding developed to explain
countertransference. mental(Ed.),
In K. Bruscia illness
Theand guide
dynam-
its treatment. Treatment protocols are designed to help the individual reduce or its treatment.
ics of musicTreatment protocols
psychotherapy are designed
(pp. 51–70). to help
Gilsum, NH: the individual reduce or
Barcelona.
alleviate psychosomatic dysfunction, address socioemotional difficulties, and/or alleviate
Bryant, psychosomatic
D. (1987). dysfunction,
A cognitive address
approach to socioemotional
therapy through music.difficulties, and/or
Journal of Music
conquer existential anxieties. In any case, each of the approaches presented above conquer existential
Therapy, 24 (1), anxieties.
27–34. In any case, each of the approaches presented above
has as its ultimate aim the growth and development of the individual, leading has as R.,
Corsini, its &
ultimate
Wedding,aimD.the growth
(Eds.). and Current
(1995). development of the individual,
psychotherapies. Itasca, IL: leading
F. E.
to a more satisfactory and satisfying adjustment to life processes. Growth may to a Peacock.
more satisfactory and satisfying adjustment to life processes. Growth may
Music
Music Therapy
mean
systems
the expansion
in the human of one’s
body horizons,
(Croweoutwardly
& Scovel, in 1996).
perspective
Energyand systems
inwardly
are pro-
in mean the expansion of one’s horizons, outwardly in perspective and inwardly in
posed
depth to be powerfully
(Wilbur, 1981). affected by our emotions and level of spiritual balance depth (Wilbur, 1981).
as well as by music
Ideally, nutritional and environmental
therapists factors (Gerber,
are able to communicate in the1988). Theofholistic
language the Ideally, music therapists are able to communicate in the language of the
modeltheoretical
various embraces vibrational
models. Many healing as a way
clinicians opt to
forbalance
advanced such energies
training in that
orderare various theoretical models. Many clinicians opt for advanced training in order
to not in equilibrium.
practice within insight-oriented approaches. Some espouse a single theoretical to practice within insight-oriented approaches. Some espouse a single theoretical
The trend
model. Others, toward a private
particularly wide variety of experiential
practitioners therapies
with diverse has emerged
clientele, adopt model. Others, particularly private practitioners with diverse clientele, adopt
anineclectic
the latter halfusing
stance, of thea variety
twentieth century, environmental,
of medical, their purpose being inner growth
and psychosocial an eclectic stance, using a variety of medical, environmental, and psychosocial
and self-actualization.
strategies and influences toThere help theiris a clients
burgeoning
achievedirectory
optimum of practitioners of
health. strategies and influences to help their clients achieve optimum health.
various healing
At the heart artsofincluding acupuncture,and
both unitheoretical Ayurvedic
diverse medicine, biofeedback,
clinical practice are At the heart of both unitheoretical and diverse clinical practice are
chiropractic,
carefully selected craniosacral
and implemented therapy,receptive
herbal remedies,
and activehomeopathy, massage
music experiences. carefully selected and implemented receptive and active music experiences.
therapy, naturopathy,
Ultimately, the value ofand meditation.
music therapy ought not be assessed according to Ultimately, the value of music therapy ought not be assessed according to
whether Holistic
it reflectstherapists view themselves
psychodynamic, humanistic,as facilitators.
or scientificKnowledge
principles,is freely
but whether it reflects psychodynamic, humanistic, or scientific principles, but
shared
rather onon thethebasis
assumption that understanding
of its success in demonstrating will enable
outcome thedata
client to be active
reflecting a rather on the basis of its success in demonstrating outcome data reflecting a
in the healing
patient’s recoveryprocess.
of healthyThefunctioning.
therapist shares personal experiences, creating a more patient’s recovery of healthy functioning.
equal therapist-client relationship. The therapist’s techniques not only help the
client find information but promote techniques to develop self-responsibility,
better nutrition, ample rest, stress management, and proper exercise.
Aigen, K.The (1998). Paths of development
techniques used in this in Nordoff-Robbins
model encourage music
thetherapy.
client toGilsum, NH:
look within Aigen, K. (1998). Paths of development in Nordoff-Robbins music therapy. Gilsum, NH:
Barcelona.
for his or her own healing. See Taxonomy II, Music Psychotherapy, D. “Catalytic Barcelona.
American
Music GroupPsychiatric Association.
and/or Individual (2000). Diagnosticfor
Therapy,” anda statistical
description manual of mental
of techniques American Psychiatric Association. (2000). Diagnostic and statistical manual of mental
disorders (4th ed.). Washington, DC: Author.
aligned with the holistic philosophy. The emphasis here is to encourage the disorders (4th ed.). Washington, DC: Author.
Andrews,
client to T. reach
(1994).andThe explore
healer’s manual.
altered St. Paul,ofMN:
states Llewellyn. for the purpose of
consciousness Andrews, T. (1994). The healer’s manual. St. Paul, MN: Llewellyn.
Ansdell, G. (1995). Music for life. London: Jessica Kingsley.
allowing imagery, symbols, and latent feelings to surface from the inner self. Ansdell, G. (1995). Music for life. London: Jessica Kingsley.
Bartlett,
The aim D., Kaufman,
is to helpD., the&client
Smeltekop,
developR. (1993). The effectsclarify
self-awareness, of music listeningvalues,
personal and Bartlett, D., Kaufman, D., & Smeltekop, R. (1993). The effects of music listening and
perceived sensory experiences on the immune system as measured
release blocked intuitive energy sources, bring about deep relaxation, and foster by Interleukin-1 perceived sensory experiences on the immune system as measured by Interleukin-1
and Cortisol. Journal of Music Therapy, 30, 194–209. and Cortisol. Journal of Music Therapy, 30, 194–209.
spirituality and self-empowerment.
Bijou, S. W., & Ribes, E. (1996). New directions in behavioral development. Reno, NV: Bijou, S. W., & Ribes, E. (1996). New directions in behavioral development. Reno, NV:
Change is evidenced in a client’s reduction of stress level and removal
Context Press. Context Press.
of pain or dysfunction, as well as an alteration of affect and a demonstration
Bonny, H. (1994). Twenty-one years later: A GIM update. Music Therapy Perspectives, Bonny, H. (1994). Twenty-one years later: A GIM update. Music Therapy Perspectives,
of more
12 (2),patience,
70–74. harmony, and peace. The integrated client sees himself as a 12 (2), 70–74.
Bonny, H., & Savary, L.person
growing, changing (1973).who Music is and
self-empowered.
your mind. New York: Harper & Row. Bonny, H., & Savary, L. (1973). Music and your mind. New York: Harper & Row.
Terminology used in
Bruscia, K. (1987). Improvisational models this model includes
of music therapy.self-care, self-empowerment,
Springfield, IL: Charles C. Bruscia, K. (1987). Improvisational models of music therapy. Springfield, IL: Charles C.
innerThomas.
healing, intuitive abilities, self-responsibility, self-examination, self-healing, Thomas.
and awareness
Bruscia, K. (Ed.). training.
(1991). Case studies in music therapy. Gilsum, NH: Barcelona. Bruscia, K. (Ed.). (1991). Case studies in music therapy. Gilsum, NH: Barcelona.
Bruscia, K. (1998a). Defining music therapy. Gilsum, NH: Barcelona. Bruscia, K. (1998a). Defining music therapy. Gilsum, NH: Barcelona.
Bruscia, K. (1998b). An introduction to music psychotherapy. In K. Bruscia (Ed.), The
Conclusion Bruscia, K. (1998b). An introduction to music psychotherapy. In K. Bruscia (Ed.), The
dynamics of music psychotherapy (pp. 1–15). Gilsum, NH: Barcelona. dynamics of music psychotherapy (pp. 1–15). Gilsum, NH: Barcelona.
Bruscia, K.Many theories
(1998c). have been
Understanding developed to explain
countertransference. mental(Ed.),
In K. Bruscia illness
Theand guide
dynam- Bruscia, K. (1998c). Understanding countertransference. In K. Bruscia (Ed.), The dynam-
its treatment.
ics of musicTreatment protocols
psychotherapy are designed
(pp. 51–70). to help
Gilsum, NH: the individual reduce or
Barcelona. ics of music psychotherapy (pp. 51–70). Gilsum, NH: Barcelona.
alleviate
Bryant, psychosomatic
D. (1987). dysfunction,
A cognitive address
approach to socioemotional
therapy through music.difficulties, and/or
Journal of Music Bryant, D. (1987). A cognitive approach to therapy through music. Journal of Music
conquer existential
Therapy, 24 (1), anxieties.
27–34. In any case, each of the approaches presented above Therapy, 24 (1), 27–34.
has as R.,
Corsini, its &
ultimate
Wedding,aimD.the growth
(Eds.). and Current
(1995). development of the individual,
psychotherapies. Itasca, IL: leading
F. E. Corsini, R., & Wedding, D. (Eds.). (1995). Current psychotherapies. Itasca, IL: F. E.
to a Peacock.
more satisfactory and satisfying adjustment to life processes. Growth may Peacock.
128
128
Music Therapy
129
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as a reinforcer in aactivate an individual’s
patient controlled duration
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take responsibility for all personal
Maultsby, M. (1977). Combining music therapy and rational behavior therapy. Journal Maultsby, M.
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tenetbehavior
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thinking ceases and he or she experiences stillness of
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identify those currents that generate creativity, healing, and love and to challenge
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and release those currents that create negativity, disharmony, and violence
Pert, C. (1997). Molecules of emotion. New York: Scribner. Pert, C. (1997). Molecules of emotion. New York: Scribner.
(Zukav, 1989). Advocates of holistic models frequently advocate merging
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conventional and alternative medicine openly and intelligently.
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According to a well-publicized survey in The Journal of the American
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emotions. She asserts
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compulsive The “molecules
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psychotherapeutic and ofnomusic
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thoughts, feelings, and one’s biological healing system. Furthermore, Pert has
Wilbur, K. (1981). No boundary. Boston, MA: New Science Library. Wilbur,
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emotionLibrary.
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creates G. bridge
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The seat ofmindthe soul.
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connection is demonstrated
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whole emotional experience.
Perhaps the most difficult holistic principle to accommodate in clinical
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of the sound healing methods are based on theoretical beliefs involving energy
133
READING 32
Sears, M. (Ed.) (2007). Three Excerpts: Music—The

Therapeutic Edge: Readings from William W. Sears, pp. 1–15,
16–41, 125–148. Gilsum NH: Barcelona Publishers.
Excerpt One
Processes in Music Therapy
William W. Sears
Editor’s Introduction
A “Re-vision and Expansion of Processes in Music Therapy,” Chapter 2,
being the centerpiece of the present work, begs the question, “What is the
original ‘vision’ upon which that chapter is based?” The answer: this
opening chapter, “Processes in Music Therapy,” Chapter 2 from E. Thayer
Gaston (Ed.). Music in Therapy. New York: Macmillan, 1968. Therefore, it
was determined that to enhance the reader’s understanding of the full
meaning of the processes in music therapy, the original Processes and the
“re-vision” should be placed alongside one another. Even more to the point,
many persons may not be familiar with Gaston’s text. (Some were not even
born when it was published!) Further, a comparison of the two should help
the reader gain insight into the developmental—actually evolutionary—
process which resulted in the latter.
More than 14 years lapsed from when the Processes first appeared in
print in Gaston and Schneider’s (1965) Analysis, Evaluation, and Selection
of Clinical Uses of Music in Therapy, a grant-supported work which was
the precursor to Music in Therapy (see Chapter 2 References for complete
citation) and the Dallas presentation in 1979. During that hiatus, Sears had
ample time to allow new concepts to evolve which invigorated and
strengthened the Processes, giving them greater clarity and an added
dimension.
[Prelude to the Processes]

Music therapy is closely related to the behavioral sciences because it often
concerns musically elicited behavior in therapeutic situations. Because
2
music therapy is a very young discipline, much of its data and knowledge
have been obtained through empirical observation, and sometimes the data
are not as factual and well organized as they should be. Nevertheless,
modern music therapy seeks to establish itself on acceptable scientific
observation.
To describe music therapy as being closely related to behavioral
science should not be thought presumptuous. Such a relationship implies an
orientation and method of approach to verified knowledge; it does not
declare that all, or even most, is known. The scientific approach does not
negate the presently mysterious beauty of music. When this beauty is gone,
there is no reason for music. It seems the nature of man to seek
organization, classification, and description until a system emerges. This is
the case in all sciences, and music therapy is no exception. To present such
a system, even if incomplete, is the purpose of this writing. It will classify
and describe processes in music therapy. The system can be characterized
as behavioral, logical, and psychological.
Specific discussion of the music therapist has been omitted, although
his presence is implied. This omission does not mean that his role is
unimportant. Because a therapist is a common factor in most therapeutic
situations, his adequacy as a therapist in the broad sense is, of course,
related to successful therapy. The intent here, however, is to help him be
more proficient as a music therapist by giving him a better theoretical
understanding of the function of music in therapy. Furthermore, this
discussion of processes in music therapy does not intend to tell the music
therapist what to do. “What to do” is left to the therapist and should be
based on his understanding of the theory and practice necessary to achieve
the goals of treatment.
No attempt is made here to describe how music or music therapists
can be used in combination with other therapeutic approaches. This does
not imply that music therapy is considered a cure-all or that it cannot be
used with other media. It signifies only that consideration of combined
therapeutic approaches is beyond the scope of this discussion.
Of most importance in any therapeutic situation is the person
receiving therapy. Only through the individual’s behavior, and changes
therein, can the success of a therapeutic endeavor be seen. Thus, behavioral
descriptions, insofar as possible, receive major consideration. The terms are
defined and used in a logical and consistent manner. This should permit
better communication among the individuals concerned. Finally, the
classifications and descriptions are consistent with pertinent and accepted
psychological principles and theories. No attempt is made, however, to
express the classifications and descriptions in the terminology of any
particular psychiatric or psychotherapeutic school of thought. Rather, a
definite attempt is made to express them free of such connections, to
3
express them as specifics, properly a part of music therapy. This is done not
to create the impression of a new school of thought nor to claim any special
status for music therapy, but to permit the fitting of what music therapy has
to offer into various orientations.
Classification, as used here, signifies a general idea, a broad concept
or category, concerning the use of music in therapy. In a sense, the several
classifications are broad answers to the question: What does music therapy
offer the individual? A construct attempts to propose formally, to define
and to limit, an explicit relationship between music and the behavior of an
individual. The process then attempts to describe the manner in which the
construct affects the behavior of the individual.
The various classifications and constructs with their processes are not
mutually exclusive. In any given therapeutic situation, several, or all, may
be operating; however, the various exemplifications were deemed both
significant and necessary to permit their delineation and to identify bases
for specific therapeutic action.
In most cases, only the word “music” has been used in reference to
musical situations, although it may have any of four designations: (1) the
music itself; (2) listening to music; (3) having music in the environment;
and (4) the making of music. The processes should permit the reader to
determine which of the four is meant. Furthermore, the use of the single
term, music, may lead some readers to think more deeply about the
application of a given construct to situations other than the obvious, thus
expanding the function of the construct. The three classifications that
underlie the constructs and processes of music therapy are (1) experience
within structure, (2) experience in self-organization, and (3) experience in
relating to others.*
*
At first, five classifications were formulated: (1) gratification, (2) structured
experience, (3) environment conducive to recovery, (4) relationships, and (5)
diagnosis and evaluation. After further analysis of the classifications, only three
were considered necessary. In all phases of the use of music in therapy, “diagnosis
and evaluation” should be constant activities. The principles originally placed under
that classification would also logically fall under “structured experience.”
Somewhat similarly, “environment conducive to recovery” implies a definite
structure, and “relationships,” although not strictly equivalent to, might be
considered as, socializing experience. Temporarily, the three classifications became
structured experience, gratifying experience, and socializing experience. Gratifying
and socializing, however, are commonly used terms and, in part, are associated with
certain psychiatric and psychotherapeutic schools of thought. To avoid
misinterpretations that might arise from the use of the more common terms and
because their meanings were not strictly what was desired, the terms self-organizing
experience and other-relating experience, to be defined later, were selected.
4
The words used to phrase the classifications were chosen purposely
and carefully. Each classification is defined later; however, at this point, the
word experience should be made clear. For most persons, this word
signifies events through which one has lived. Experience, however, may
also designate the actual living through, or undergoing, of events in the
present. Furthermore, it can be used either as a noun or a transitive verb—
the gerund and the present participle being “experiencing.” In a basic sense,
music therapy offers the individual the experiencing of events in certain
ways; the processes attempt to define those ways of experiencing.
Although past experiences of the individual may serve as a basis
(often a very important one) for organizing the therapeutic situation, that
situation always begins in the present and goes into the future. No therapist
can change the past experiences of the individual, but he can organize a
present situation so that the effect of the past is altered for a more adequate
future. It is in this sense—that of the present going into the future—that the
word “experience” has been selected for use.
Even though all the classifications might be considered equally well
as experience within structure, the term structure has been reserved for the
first classification in order to emphasize the uniqueness of music—the
structure demanding experiencing is inherent in the music. The order of
terms in the adopted classifications is important and indicative. A natural
order is evident in the progression—an individual must be aware of or have
some structure before an experience can become his or become organized.
Also, the individual must have organization (possibly in his own version,
when viewed by another individual) before he will use the experience
externally or overtly. Assuming this order, are there similar orders by which
to express the constructs under each classification? If so, on what bases?
Three such bases seemed appropriate.
One possible order was founded on the continuum from how much of
an individual’s behavior is required by the music itself to how much is
required by the situation in which music is used. Phrased in another way,
how much control of behavior is demanded by the music and how much by
the therapist’s manipulation of the environment? (This was thought to apply
to the major classifications, also.) A second basis was the consideration of
the directness with which the behavior might be observed—again a kind of
continuum, directly observable behavior to inferred behavior, for example,
“He played his note on time” to “He looks like the music made him sad.”
One further basis seemed logical: Could the behavior be graded on a
continuum from simple (almost reflex or conditioned response) to complex
(involving integration of several or many simple responses), for example,
from just beating a drum to beating it appropriately so that others might
play or dance with the beat?
5
The classifications and constructs are presented in outline form, both

for convenience and to show the influence on their development of the three
orders or bases described.
A. Experience within structure

1. Music demands time-ordered behavior.
a. Music demands reality-ordered behavior.
b. Music demands immediately and continuously objectified
behavior.
2. Music permits ability-ordered behavior.
a. Music permits ordering of behavior according to physical
response levels.
b. Music permits ordering of behavior according to
psychological response levels.
3. Music evokes affectively ordered behavior.
4. Music provokes sensory-elaborated behavior.
a. Music demands increased sensory usage and discrimination.
b. Music may elicit extramusical ideas and associations.
B. Experience in self-organization
1. Music provides for self-expression.
2. Music provides compensatory endeavors for the handicapped
individual.
3. Music provides opportunities for socially acceptable reward and
nonreward.
4. Music provides for the enhancement of pride in self.
a. Music provides for successful experiences.
b. Music provides for feeling needed by others.
c. Music provides for enhancement of esteem by others.
C. Experience in relating to others

1. Music provides means by which self-expression is socially
acceptable.
2. Music provides opportunity for individual choice of response in
groups.
3. Music provides opportunities for acceptance of responsibility to
self and others.
a. Music provides for developing self-directed behavior.
b. Music provides for developing other-directed behavior.
4. Music enhances verbal and nonverbal social interaction and
communication.
5. Music provides for experiencing cooperation and competition in
socially acceptable forms.
6
6. Music provides entertainment and recreation necessary to the
general therapeutic environment.
7. Music provides for learning realistic social skills and personal
behavior patterns acceptable in institutional and community peer
groups.
Experience Within Structure

Experience within structure refers to those behaviors of an individual that
are required by and are inherent in musical experience. Even though a
therapist must prepare the experience for the individual, the mere
commitment to the experience places the individual in a situation where his
(future) behavior is determined primarily by musical factors and not by
other factors or persons in his environment. The commitment to the
structured experience may be only temporary, for the duration of the music
or some part of it. This, however does not negate the possible continued
influence of the music on the individual; it refers mainly to the immediately
observable behavior of the individual. Furthermore, music is not considered
impersonal. (The meaning, or importance, of music to the individual
belongs in the next classification, experience in self-organization.) The
focus of concern, here, is on the musically structured experience and on the
behavior required by that structure. The motivation for this experience tends
to be an intrinsic quality of the music, which carries its own persuasion for
behavior.
At this level, the individual is involved in coming to terms and
getting along with a part of his environment, a musical part in this case. He
may be led to understand and respect certain laws of the environment, the
gaining of such understanding and respect possibly made easier because the
demands come from the music. His awareness of structures as useful and
necessary may take on an elaboration through the meaningful and objective
connecting of symbols and referents. Along with this elaboration, the
individual is required to expand his self, to discover some of his own
potentialities, and to govern himself—facets of development leading to the
next level, experience in self-organization.
Major goals in therapy are to lengthen the temporal commitment
(objectively measurable), to vary the commitment (objectively describable),
and to stimulate an awareness (inferred from behavior and directly related
to the next level) of the benefits derived thereby.
Music Demands Time-ordered Behavior

7
The unique structure of music—it exists only through time—requires the

individual to commit himself to the experience moment by moment. Except
for relatively minute deviations, music (whether an entire piece or merely a
measure or phrase in repeated practice) cannot be interrupted without losing
its intent. Participation in music is not ordinarily achieved by a note a day.
Once begun, music must be continued without interruption in order that a
completed idea or expression may result; regardless of its length or
complexity or the type and degree of skill it requires, the music must be
carried through in its time order.
The necessity for moment-to-moment commitment by the individual
rests in the music itself and does not derive from any other part of his
environment. The extent and rapidity of the commitment can be adjusted to
the individual by an appropriate selection of the level of skill required, the
length and complexity of the music, and the specific responses required,
including the number of responses per unit of time.
Time order, as conceived here, is a broader concept than rhythm. On
the most elementary level, it involves the sequence of sounds and no
sounds. On other levels, it concerns not only the making of sounds at the
correct times (rhythm), but also the correct sounds (pitches), the correct
emphases or stresses of those sounds (dynamics), the accuracy in making
several sounds together (harmony and ensemble), and the organization of
other kinds of sounds (timbre). Regardless of the organizations in music,
the underlying factor is time order.
This construct is considered fundamental to all the other constructs. It
might be called the working principle. Building on the time-ordered
structure inherent in music, the skillful therapist can involve the individual
in any of the relationships defined by the other constructs. An individual
develops through time; music develops through time—uniquely, the tempos
of life and music are quite comparable, possibly even congruent.
This construct also emphasizes the uniqueness of music when
contrasted with other approaches used in therapy. Even though all
experiences have beginnings and go into the future, the time order of music
requires the individual to structure his behavior in, relatively, the most
minute and continuous manner. No other form of human behavior both
demands and depends so completely on strict adherence to time-ordered
structure.
MUSIC DEMANDS REALITY-ORDERED BEHAVIOR. Once the individual
is committed to music, his behavior becomes reality ordered. Music
involves reality orientations in many forms and on such levels as the
situation requires—responses to, for example, aural stimuli, musical and
verbal; instruments; musical notation; conductor’s or therapist’s directions;
and the individual’s own body and its parts. The individual’s responses can
be judged for their appropriateness to the “real” stimuli, stimuli built on the
8
time-ordered necessities of a given musical situation and established in the
individual’s environment by the therapist.
A question concerning the place of free improvisation and the
possibility that it would not necessarily be reality ordered might be raised
here. (Improvisation is included in the next classification, experience in
self-organization.) Concern is for the individual’s evidenced behavior and
not for what the music means to him. Improvising implies doing something
that is meaningful to the person doing the improvising. The pursuit of
meaning in music is personal and internal. The ability to improvise, at least
meaningfully for others, demands a background of structured experiences
that permits the improvisation to take place. Thus, at this level and within
the meaning and intent here, the question is premature.
MUSIC DEMANDS IMMEDIATELY AND CONTINUOUSLY OBJECTIFIED
BEHAVIOR. Once committed to the music, the individual’s behavior is no
longer subjective, but becomes immediately observable or “objectified.”
The musical appropriateness of the behavior must always be judged with
reference to the ability of the individual. Furthermore, his behavior is
continuously objectified and observable, requiring attention to the music
through the duration of the musical experience, even if attention fluctuates.
Because the time order of music is continuous, the individual’s
responses must be continuous; and because the individual’s responses are
continuous, the appropriateness of his responses are immediately
observable, moment by moment.
Music Permits Ability-ordered Behavior

The behavioral requirements in music are uniquely adaptable to the
individual’s operational levels and capacities. Musical behaviors, the
specific functionings of the individual in specific musical situations, range
from the simple to the complex, from the awareness or performance of a
simple rhythmic beat to the awareness or performance of a highly complex
musical structure. Behaviors ranging from simple to complex may coexist
among several individuals, as in group performance where the behavioral
requirements of one musical part are of a more simple nature, such as
beating the bass drum, than those of another part, such as playing the
melody on a trumpet. Also, especially desired musical experiences, such as
playing a certain piece, can be modified or adapted (rearranged) to fit the
capabilities of each individual.
MUSIC PERMITS ORDERING OF BEHAVIOR ACCORDING TO PHYSICAL
RESPONSE LEVELS. Required musical behavior can be adapted to the
physical capacities and operational levels of the individual. The physically
handicapped can be helped to make music by the use of special devices,
9
such as especially designed mouthpieces or prostheses. Modifications of the

traditional positions for playing certain instruments, such as placing a bass
drum on its side or preparing a special stand for an instrument, can be made
to permit the use of the individual’s movement capabilities. The variety of
physical movements used in playing musical instruments or in singing
offers a wide range for structuring needed muscular movements. The
attainment of gratifying musical ends usually makes such exercises more
acceptable to the individual.
MUSIC PERMITS ORDERING OF BEHAVIOR ACCORDING TO
PSYCHOLOGICAL RESPONSE LEVELS. Required musical behavior can be
adapted to psychological capacities and operational levels. The
psychological levels may have several bases: (1) mood—such as sad to
happy, depressed to manic; (2) motivation—low to high desire to achieve;
(3) intellect—mentally retarded to gifted; or (4) levels of musical
knowledge. Partly through the motivation intrinsic to music and partly
through the appropriate structure provided by the therapist, the individual
can either be moved from a less desirable to a more desirable psychological
level or have the requirements of the activity suited and paced appropriately
to his capabilities, as the case may be.
Music Evokes Affectively-ordered Behavior

The general behavior of groups can be controlled, or at least influenced, by
appropriately chosen music. Slow tempos, smooth (legato) lines, simple
harmonies, and little dynamic change are characteristic of music that tends
to reduce or sedate physical activity and, possibly, to enhance the
contemplative activity of individuals; fast tempos, detached (staccato) lines,
complex and dissonant harmonies, and abrupt dynamic changes tend to
increase or stimulate physical activity and, possibly, to reduce mental
activity. Given a knowledgeable use of music, the desired result is usually
achieved with groups; prediction is less sure when dealing with an
individual because of the possible unique associations he may have with the
particular music or with music in general. These associations in themselves
can be significant.
Music Provokes Sensory-elaborated Behavior

Sensory stimulation and resulting awareness have been shown to be human
needs. Participation in music offers unique sensory experiences ranging
from just perceptible responses on the neuromuscular level to the highest
level of human behavior—intellectual mediation and contemplation—all of
which are essential to esthetic experience. Furthermore, both initiation and
10
recall of experiences involving sight, sound, odors, tactile sensations, and
so on, can be evoked by music. Experiences such as the smell of rosin on
the bow; the tactile sensation of vibration; and the auditory and visual
awareness of concerted efforts, such as identical phrasing, bowing by
stringed-instrument players, and breathing by wind-instrument players,
offer an elaborate world of sensations.
MUSIC DEMANDS INCREASED SENSORY USAGE AND DISCRIMINATION.
Involvement in music requires the individual both to become more aware of
and to refine his use of sensory data in a great variety of forms. Not only
must he increase his auditory discrimination of pitch, volume, rhythmic,
and quality differences, he also must bring into use and refine all other
sensory modalities: sight, for reading symbols, responding to visual
instructions, and seeing where different sounds come from; touch, for
contacting the instrument in what are sometimes very delicate ways and for
receiving temperature sensations from different instruments and their parts;
proprioception, for learning to breathe correctly, producing correct vocal
sounds, and controlling body parts; and smell and taste, which, although
less describable, are nonetheless involved. Music significantly demands the
integrated use of several or all of these sensory modalities at any given time
within the musical experience.
MUSIC MAY ELICIT EXTRAMUSICAL IDEAS AND ASSOCIATIONS.,
Music may often bring about certain pictures or ideas. When the
individual’s ideas fall outside the “normal,” his differences may reveal
significant insights into his particular structuring of his world. Such insights
have been used as the basis of several projective tests and also in
psychotherapy. In certain cases, the association-provoking quality of music
can be used to reinstate or remind the individual of healthy forms of
behavior, including ideas.
Experience in Self-Organization
Experience in self-organization concerns inner responses that may only be
inferred from behavior, and has to do with a person’s attitudes, interests,
values, and appreciations, with his meaning to himself. It includes most, if
not all, of what has been commonly termed gratification and also the strictly
personal factors in the esthetic experience. (Of concern here is not only
gratification, but also the fact that nearly all people like some kind of music
very much.)
At this level, the individual may come to discover what he really is—
to find his own ways of living, of valuing and appreciating himself as an
individual with potentialities. He may come to discover that these
11
potentialities have sufficient meaning to himself to be used for experience

in relating to others.
A common goal in therapy is to structure experiences (objectively
describable) so that the individual receives the satisfactions (inferred)
necessary for him to seek more such experiences (objectively measurable),
and to see that such experiences lend themselves to the maintenance of
better adjustment (objectively describable) with his environment.
Music Provides for Self-Expression

Whenever choice by an individual is involved, his behavior is a reflection
of his self-expressive needs. These needs, although not in themselves
directly observable, may give rise to consistent patterns of behavior. Such
patterns of behavior can become the bases for structuring activities in which
the person will be involved, in making possible or impossible (or at least
limiting) the continuance of certain behaviors. The adaptability of music
provides many avenues for self-expression in performance and listening;
they range from random to complex and highly organized. Such a wide
range also offers many socially acceptable ways of expressing negative
feelings, energetic behavior, and closeness, any of which may reduce the
need for expression in more overt, unacceptable forms. The movement from
random expression to organized, meaningful expression is the goal.
Music Provides Compensatory Endeavors

for the Handicapped Individual
By being helped to accomplish in music some of the same things that his
“normal” counterpart does, the handicapped individual may be led to a
healthy acceptance of his limitations. He may come to place his handicap in
perspective, as a limitation only of his means, as only one aspect of himself,
rather than his whole person.
Music Provides Opportunities for

Socially Acceptable Reward and Nonreward
When appropriately structured, musical activities may carry an inherent
pleasure found in the performance itself. The individual may, realistically,
receive commendation where indicated for musical and/or treatment
purposes; or commendation may be withheld. The adaptability of music
provides many opportunities for rewards, ranging from immediate to long
term. In music, it is generally the performance that receives negative
12
criticism, not the individual. In this way, the criticism need not become
rejection.
Music Provides for the Enhancement of Pride in Self

Positive learning experiences usually enhance an individual’s feelings of
worth. A foreseeable product or result often serves as its own stimulus to
learning. The adaptability of music to learning, on many levels of required
ability, makes it uniquely versatile for structuring situations leading to
feelings of pride. The individual is confronted with objective evidence
concerning the relationship of effort spent and goal achieved.
MUSIC PROVIDES FOR SUCCESSFUL EXPERIENCES. The individual may
choose, or have arranged for him, a level of musical participation almost
certain to ensure success. Careful guidance of the activity and the wide
range of experiences offered by music make this possible. The permissive
atmosphere of most musical group activities provides a continuum of
opportunities for successful experience, ranging from mere presence within
a group to a position of prominence.
MUSIC PROVIDES FOR FEELING NEEDED BY OTHERS. Successful
performance normally leads to enhancement of self-esteem. The feeling of
being needed by others, of giving the self to an important pursuit, and of
achievement, may be gained through especially structured musical
situations. Situations specifically structured toward this end (and under the
next construct) provide necessary support for the individual to commit
himself voluntarily to experiences in relating to others.
MUSIC PROVIDES FOR ENHANCEMENT OF ESTEEM BY OTHERS. A
person who shares successful musical experiences with others or
contributes to the success of others through a supporting role normally
receives the esteem of others. Due commendation can be given and
positions of leadership can be arranged in structured musical situations.
Experience in Relating to Others

Experience in relating to others deals with the behavior of the individual in
relation to other individuals, singly or in groups. Music provides
experiences for persons as group members. The music is the reason for
being together; the individual need not participate in the group except as a
musician, and he is usually accepted when doing so. Ensemble music,
however, requires the individual to subordinate his own interests to those of
the group if music is to result; this demand, although possibly enforced by
another person, objectively derives from the music and not from the other
person. Such experiences, considerately arranged, may support the
13
individual in his feeling of being needed by others—to gain identity in a

whole (group) larger than himself.
Also at this level, and possibly of greatest importance, the individual
is enabled to assess his identity. Only by self-comparison with the group
can the individual become aware of his identity and his accomplishments.
This comparison, if appropriately provided, may stimulate the individual to
further accomplishment; if inappropriately provided, the experience may
lead to a rejection of, or at least reduced desire for, similar experiences.
Thus, caution must be exercised by the therapist.
The goal is to increase the size of the group in which the individual
can successfully interact (objectively measurable and describable); to
increase range and flexibility of his behavior in those interactions
(objectively describable); and to provide experiences that will help him
relate to noninstitutional life (objectively describable).
Music Provides Means by Which

Self-Expression Is Socially Acceptable
Music provides a wide range of emotional expression. Positive, as well as
negative, feelings for others can be expressed through music, and social
acceptance is usually forthcoming or at least permitted. Ways to achieve
and excel through superior performance are abundantly provided and
accepted in music. Dance activities permit a closeness to other individuals
not normally possible in a different situation. Both transitory and continuing
feelings are expressible in music.
Music Provides Opportunity for Individual

Choice of Response in Groups
Optimum performance of each individual in a musical group is desirable.
However, the individual may wish to choose his own level of response.
Because it is desirable for the patient to wish to make choices, opportunity
to do so must be provided. Freedom to choose is sometimes more important
than the choice.
Music Provides Opportunities for Acceptance

of Responsibility to Self and Others
Music provides many opportunities for the individual to accept
responsibility. His arrival on time for lessons or other activities or his
14
participation as an important member of a group requires him to be
responsible to others. Music may be his reason, at first, for accepting
responsibility, but extension to acceptance in general is the goal.
MUSIC PROVIDES FOR DEVELOPING SELF-DIRECTED BEHAVIOR. The
wide range of experiences and levels of achievement offered in music
permits the individual a variety of choice in personal goals. Once a choice
has been made, the individual must initiate and maintain the practice
required to reach the goal. Although the situation may be structured to assist
the individual in attaining his goal—for example, helping him to establish
realistic expectations or arranging steps in his program that assure
success—he must increasingly assume more responsibility for directing
himself. Musical progress can, in the end, be made only through his own
efforts; it cannot be achieved for him.
MUSIC PROVIDES FOR DEVELOPING OTHER-DIRECTED BEHAVIOR. In
group settings, the individual must learn to subordinate his performance to
that of the group. An awareness of the performance of others, and of his
own in relation to theirs, is constantly required in the process of achieving
appropriate musical expression and interpretation. Control of the self in
relation to behavioral patterns of the group is necessary.
Music Enhances Verbal and Nonverbal

Social Interaction and Communication
Most social occasions are accompanied by music, which generally increases
sociability. With music in the background, many individuals find it easier to
talk with others. In psychotherapy, patients often talk more freely in the
presence of music. They may express in music or through musical
preferences feelings not otherwise expressible. Music may speak where
words fail.
Music Provides for Experiencing Cooperation

and Competition in Socially Acceptable Forms
The very nature of music makes possible the experiencing of socially
acceptable forms of cooperation and competition, singly or in combination.
Musical groups not only require the individual to cooperate, but also offer
him the opportunity to compete musically. Also, he may compete with
himself, striving always to improve his performance; no degree of
excellence of which he is capable and to which he might aspire is denied to
him.
15
Music Provides Entertainment and Recreation

Necessary to the General Therapeutic Environment
Diversional and recreational activities are a necessary part of institutional
routine. Performances by community musical organizations, individuals,
and stage groups can assist the patient in maintaining a general morale that
may make specific therapeutic goals easier to attain. Such activities also
permit him many experiences common to the world outside the institution.
Although these activities are desirable, they should not be confused with
formal music therapy procedures specifically designed with therapeutic
intent.
Music Provides for Learning Realistic Social Skills

and Personal Behavior Patterns Acceptable in
Institutional and Community Peer Groups
Music skills usually enable individuals to interact more successfully in
community groups. Dancing and other musical skills may help the patient
participate with more poise and less need for defense. Musical groups in the
community are becoming more available and usually require minimal
financial and social prerequisites.
Some individuals possess asocial characteristics of which they are
unaware. Others know very little about personal hygiene and acceptable
modes of dress. Musical situations can be especially structured and in many
cases provide the necessary motivation to bring about an improvement in
these areas of behavior; such matters often greatly influence the
individual’s success or failure in his environment.
[Summary]
Music therapy uses the methods of a behavioral science and, as such,
requires a theoretical formulation of its processes. To construct such a
formulation has been the purpose of this chapter. The formulation is not
proposed as a set of “true” laws and relationships. It is, rather, an attempt to
integrate into one system the best knowledge and thought presently
available concerning the function of music in therapy. Its orientation or
integrating focus is the behavior of the individual when involved in a
musical experience.
A theoretical formulation such as this may suffer one of several fates:
It may pass into history having received little consideration. It may be
16
examined and found wanting, but because of the study it required, result in
a different, more adequate formulation of theory. Finally, it may prove of
enough interest and worth to be put to the test in practice and research—to
be modified, improved, and expanded. Hopefully, the latter fate will come
to pass. In any case, processes in music therapy take place by uniquely
involving the individual in experience within structure, experience in self-
organization, and experience in relating to others.
17
Excerpt Two
A Re-Vision and Expansion of

William W. Sears
The teacher who walks in the shadow of the temple,

among his followers,
gives not of his wisdom but rather of his faith and his
lovingness.
If he is indeed wise he does not bid you enter the house of
his wisdom,
but rather leads you to the threshold of your own mind.
For the vision of one man lends not its wings to another
man.
Kahlil Gibran
This is the first of two papers presented at the National Association for
Music Therapy 30th annual conference, Dallas, TX, October 30–31, 1979.
For some years prior to delivering the present address, Sears had ruminated
over weaknesses in the original Processes. He had even challenged students
to design models to better express them. When new ideas began to emerge
in his head, he said they came from the unconscious as a “re-vision.” This
“re-vision” led him to a well-regarded theory of intelligence titled
“Structure of Intellect” developed by the late psychologist J. P. Guilford,
and opened the door to a new and different way of perceiving the Processes.
Origin and Purpose of

In 1964, twelve music therapists came together to codify the operating
processes and principles in music therapy. The profession had been in
existence for only twenty years or so, and a strong theoretical foundation
18
had not yet been established. During the course of this symposium the
group came up with all kinds of ideas by utilizing brainstorming techniques.
One of the documents that resulted became Chapter 2 in Music in
Therapy—“Processes in Music Therapy” (Sears, 1968).
At the time the book was written, music therapists were employed
primarily in mental hospitals, and were just beginning to gain access to
mental retardation facilities. That chapter tried to say that the music therapy
process does not depend upon a particular philosophy or treatment concept
within a given situation. Whether one would use the Processes as a gestalt
technique, behavior modification technique, or whatever other technique
one might choose, it seems that these things are in operation regardless of
the so-called climate in which music is being used. There is something
about music itself that is its own, and is not dependent upon being
connected to a specific therapeutic technique or system. The Processes
come pretty close to achieving that, but there are elements of Existentialism
in their expression. For example, the word “experience” is used like the
existentialists use “being,” meaning the experience of the moment or of
successive moments.
Over the years, as the Processes were evaluated and scrutinized, the
need for a major revision emerged, both in the way they were presented and
in some of the terminology. The essential ingredients, those being the three
types of experiences labeled classifications, which in the text are defined as
“broad concepts” or “categories” respecting the uses of music as therapy,
were still central to the entire concept. However, they presented a confusing
picture to some readers. To many people, it appeared as though there was a
linear relationship. Indeed, the configuration was linear—it was flat. It did
not show the interaction and interrelations among the three generic
classifications of structure, self-organization, and relating to others. The
notion of a three-dimensional activity was omitted. In addition, readers
found duplication between the self-organization and relating to others
classifications, although that may have been the result of inaccurate choices
of words in the outline rather than any cognitive misunderstanding I had
about the meaning of the classifications.
Originally, when the book was being prepared as part of a
government grant, each person who wrote a case history was supposed to
annotate back to the Processes chapter as to what seemed to be going on in
that particular case history. Looking at the Processes linearly, they never
really represented what the case history reported because the Processes as
presented were one-dimensional, whereas in almost every statement in the
case history, the three dimensions showed up in the same statement. So, if
one tried to cover a statement with one item of the Processes, only a part of
the statement in the history was being described. It became impossible to
use the Processes as an evaluative tool. Thus, Chapter 2’s main deficiency
19
is that because of the effect linearity gives, it is impossible to cross-

reference case history data with the Processes. This troubled me and
demanded correction if the Processes were to continue to be useful.
Original Processes in Music Therapy

and Time-ordered Behavior
The outline of the Processes which appeared in Chapter 2 of Music in
Therapy (Sears, 1968) should not be substituted for the entire chapter
because there is a lot of philosophy in the text which cannot be reduced to
an outline. In fact, to understand the outline, one must read the
accompanying text. For example, the musical experience itself assumes
many different forms—listening, active participation, and so on.
Yet even the text, at least in one instance, is vague at best or
misunderstood at the extreme, this being the section, “music demands time-
ordered behavior,” a component of the first classification, experience within
structure. It is doubtful that the reader comprehended the full meaning of
this pronouncement, tucked away, as it were, even though the first sentence
declares that music’s unique structure is its existence through time (Sears,
1968). It is the “art of time.”†
However, notwithstanding individual exceptions, the process itself
seems to have to work regardless of the character of the involvement. It is
not dependent upon a specific physical setting—specific people, specific
music, or any of the other attendant factors. It is a driving force unto itself.
Also, the chapter is limited to a discussion of the musical paradigm
itself. Those aspects of music therapy that are common to most therapies
are omitted to a large extent. This information is not found in the outline,
but rather in the discussion. It must be emphasized that the three Processes
classifications are not linear. This notion, which the chapter narrative fails
to dispel, continues to confound the reader. There is no pure progression
from lower to higher levels because a true rank order of the classifications
does not exist.
†
J. T. Fraser (1999) understood this when theorizing about the origins of
music. To simplify his erudite remarks, the “musical present”—which is the
only reality in music we are able to experience, is synchronous with the
organic and mental presents, e.g., the life process, the awareness of
existence. When the “musical present”, e.g., the composition or “piece,”
makes contact with the organic and mental present, i.e., the human being,
the result creates “musical memories and anticipations and, with them, the
musical experience of time’s passage” (p. 138).
20
There is always a constant mixture of experiences. When a client is
working alone in a practice room he would be experiencing certain parts of
self-organization. Assuming he is practicing music, which is the reason for
him being there, he would be experiencing the structure of the music. But,
he would not be relating to other people. Two of the three classifications
would be in operation. However, within the usual therapeutic session there
is a client, a therapist, and a structure. Thus, there would exist a mixture of
all three classifications. From these examples it is valid to assume that at
any one time at least two of the three experiences are in operation.
Although a limited degree of order of progression does exist, the
Processes are not classically hierarchical in structure or operation.
Certainly, the experiences within structure are foundational in character for
the other classifications. However, the constructs need not occur in the
order presented in the outline nor before one begins to work on any of the
constructs in the other two classifications. Nor, in all probability, will all of
the constructs be achieved in the course of therapy. Relating to others
implies some prior success in self-organization, but it is not necessary to
achieve all of the self-organization constructs before being able to relate to
others.
This chapter also fails to communicate clearly the most important
concept of the three experiences, this being the concept of relationship.
Specifically, there exists a music environment inhabited by therapist and
client. From this environment a relationship develops between the two
individuals which gradually expands to increasing numbers of people. It is
incumbent upon the therapist to create the appropriate environment and
shape the interaction so that a sound relationship can emerge. Upon this
hinges successful therapy. That is quite a burden for one person. Music
therapy is as much about relationships as about music.
The “Processes in Music Therapy” may have been misconstrued in
other ways over the years because they are not accurately presented in the
outline, nor does the source text clarify their meaning. As originally
presented in E. Thayer Gaston and Erwin H. Schneider (1965), An Analysis,
Evaluation, and Selection of Clinical Uses of Music in Therapy, the
Processes were expressed in a taxonomic format. Table 1 is a merger of that
with the outline. In this grant-supported work, the organizing system was
explained as follows: “The whole number shows the broad classification;
the tenth, the construct; and the hundredth [where it occurs], a sub-
construct. The processes are then presented as behavioral definitions for
each construct insofar as is possible” (p. 32).
Editor’s Note: Some numerical values in Table 1 have been changed
by the Editor. For example, in the original work, some tenth (construct) and
one-hundredth (sub-construct) figures were expressed in odd rather than
21
consecutive numbers. No explanation for original numbering has been

found.
Unfortunately, in the Macmillan publication, this explanation, which
is critical to the understanding of the system, was omitted and an outline
replaced the taxonomy. These alterations resulted in the erroneous
impression that each third level subsume (the hundredth) in the outline
represented a process rather than a sub-construct as was the actual case. To
correct this error, it must be understood that the process “describe[s] the
manner in which the behavior of the individual is affected according to the
construct [or sub-construct]” (Sears, 1965, p. 30). It is not contained within
the outline per se but, instead, constitutes the discussion of the constructs
which follows the outline. An example may serve to clarify. “Music
provides a means for self-expression,” a construct in the self-organization
classification, discusses the role music plays in influencing certain
behaviors such as choice, adaptability, transference, and decision-making,
all which are aimed toward a more positive self-image. Of course, all
discussion centers around behavior and experiencing.
At this point in the discussion, a review of the definition of terms
used to describe the organizing system in the original Processes texts is in
order. Classification, of which there are three, “signifies a general idea, a
broad concept or category, concerning the use of music in therapy. . . . A
construct [or sub-construct] attempts to propose formally, to define and to
limit, an explicit relationship between music and the behavior of an
individual” (Sears, 1968, p. 31). Specific constructs are identified as
inherent within each of the three major classifications. Process is defined in
the foregoing paragraph.
Table 1
Outline of the Processes in Music Therapy
Classifications and Constructs
1.00 Experience within structure
1.10 Music demands time-ordered behavior
1.11 Music demands reality-ordered behavior
1.12 Music demands immediately and continuously objectified
behavior
1.20 Music permits ability-ordered behavior
1.21 Music permits ordering of behavior according to physical
response levels
1.22 Music permits ordering of behavior according to
psychological response levels
1.30 Music evokes affectively-oriented behavior
22
1.40 Music provokes sensory-elaborated behavior
1.41 Music demands increased sensory usage and
discrimination*
1.42 Music may elicit extramusical ideas and associations
2.00 Experience in self-organization
2.10 Music provides a means for self-expression
2.20 Music provides compensatory endeavors for the handicapped
individual
2.30 Music provides opportunities for socially acceptable reward
and non-reward
2.40 Music provides means for the enhancement of pride in self
2.41 Music provides means for successful experiences
2.42 Music provides means for feeling needed by others
2.43 Music provides means for enhancement of esteem by
others
3.00 Experience in relating to others
3.10 Music provides means by which self-expression may be
socially acceptable
3.20 Music provides opportunity for individual choice of response
in groups
3.30 Music provides opportunities for acceptance of responsibility
to self and others
3.31 Music provides for developing self-directed behavior
3.32 Music provides for developing other-directed behavior
3.40 Music enhances verbal and nonverbal social interaction and
communication
3.50 Music provides means for experiencing cooperation and
competition in socially acceptable forms
3.60 Music provides entertainment and recreation necessary to the
general therapeutic environment
3.70 Music provides means for learning realistic social skills and
personal behavior patterns acceptable in institutional and
community peer groups
Adapted from Sears, 1968, pp. 33–34.
*Not included in Analysis, Evaluation, and Selection of Clinical Uses of

Music in Therapy. It was added later to Music in Therapy.
Processes in Music Therapy: Revised Model

23
The primary purpose for revising the Processes was to organize them into
an understandable and readily usable order. In fact, this is not a true
revision, but a progression from and a building upon the original.
It aims to permit the insertion of the particular therapist back into the
individual practice of music therapy—the “you” that only you can give. By
that is meant that so much of our practice has been modeled after that of
fine leaders, people who themselves have proven their therapeutic
excellence. However, much of what they present to us is them. They have
certain equipment, individualized charts, special techniques, and unique
styles. But that is not you nor me. Nor can a valid discipline rest upon such
a system.
To conceive an appropriate system which would dispel the linearity
misconception that the Processes presented did not come easily. Through all
the struggle the answer had to come from the unconscious as a re-vision. I
cannot consciously recall the thinking process that occurred. The stimulus
which seemed to be most compatible with my purpose finally came from a
three dimensional cube model—the Guilford Structure-of-Intellect model
(1967).
Using the Structure-of-Intellect (SI) as a model, I organized the
Processes into a circular configuration. That model is present in Figure 1.
This configuration has a practical value, which I will explain later.
Organizing the Processes around verbal descriptors is a completely
arbitrary system. The words themselves are not intended to be absolutes.
They should not mean anything specific, but instead should be concepts to
think about and to think with. Granted, the words do have meaning in the
therapeutic sense, and it is expected that they will be useful to the
therapists. However, they should serve primarily as springboards to launch
one into ever widening exploration into the uses of music as therapy.
The “Processes in Music Therapy” model is structured around time-
ordered behavior because that is fundamental to all of the factors inherent in
the musical experience. Thus, time-order is spread across all levels of the
Processes. To graphically show this, the model has been shaded. The
shading represents time-ordered behavior. The small arrows placed
arbitrarily at the edges of the circles in Figures 1–5 indicate that there is
always interplay among the three classifications.
In the original Processes outline, “time-ordered behavior” is placed as
a construct within experience within structure. If you ever perceived it in
that restricted sense, forget it now. Of course, the text of that chapter states
that it is fundamental to all the other constructs and describes it as the
working principle of music. However, because an outline is often digested
more easily than prose, many people accepted what they saw in the outline.
Taking the three classifications and considering any situation which
incorporates experiencing, it is possible to make all kinds of connections
24
with philosophy for thought. The Processes are a trinity of you, what you do
and how you go about it, and your relation to others or the environment.
That dictated the original use of the words structure, self-organization, and
relating to others.
Other Social Skills Self-Expression
Self/Other
Entertainment/ Singing Playing Directed
Recreation
Motor Affective
Cooperation/ Extra-
Listening musical Cognitive
Competition
Improvising Choice
Responding
Esteem Verbal
Interaction
Nonverbal
Interaction
Structure: inner circle; Self-organization: middle circle; Social Relations:

outer circle; : time-ordered behavior
Figure 1. Processes in music therapy model. Adapted from Sears (1968).
The word “experience” is further used mainly to signify the one

unique factor which exists in music, that being the beginning of a “now”
moment, and always being required to go into the future in the time-ordered
structure of the music. From there it required only a bit of logic to deduce
that the time-ordered concept must be expanded to the total inclusiveness of
the Processes. It is not a statement of process restricted to a single
classification—structure. Any theory of music automatically presupposes
time-order. We do not give it much thought while practicing, composing, or
listening to a concert. Of course, music does not exist without it, nor do a
myriad of other realities—the human body, for example. But, for music
25
therapy purposes, we must commit to the concept that time-order at the very
minimum is a theoretical posture. This is a major change in the Processes
which aims to clarify meaning.
The word “time” means, for the most part, what we experience
moving into the future. “Order” is how we chop time apart. I have come to
learn that in some mystical societies it is believed that the universe was
ordered and made solid, and space became because God, or whoever
created the universe, vibrated time. From that beginning, our concepts of
both time and space originated from the utterance of the first sound,
whether it was “Let there be light,” or some other pronouncement. It was
sound that brought the universe into being.
The Processes model has been designed as three concentric circles.
The inner circle denotes the musical structure of the therapeutic situation.
There is something the therapist hopes is occurring inside the client, which
is represented by the middle circle, self-organization. Social relations,
which seems to be our therapy purpose, is the outer circle.
In the original Processes (Table 1) this third classification is
identified as relating to others. All three classifications point to the center,
which is the therapist,‡ who must decide how to manipulate the total
arrangement to achieve the desired musical experience. Such physical
structure decisions as whether or not the drapes are pulled, whether the air
conditioner continues to run or not, how the furniture shall be arranged
must be made. Then the therapist must decide what he/she wants to start
happening and, in a sense, what features of these structures exist in the state
the client is in. There are so many decisions to make.
Each circle in the diagram should not be joined nor would it ever be.
That is, each circle should be drawn so that it is not closed, symbolizing
that the whole system of music therapy is still wide open, awaiting further
expansion and modification as new information about music and/or human
behavior surfaces. Each circle can expand with additional thought
possibilities. Nor are the circles fixed one to another. They are meant to be
rotated, thereby allowing each construct within a given classification to be
matched with another in each of the other two classifications.
Imagine, if you will, the model as a spiral—a double helical model
much like the DNA graphic design. [The late] Marie-Louise von Franz
‡
Sears did not show the therapist in the model, possibly because the model as
presented graphically is two-dimensional and thus does not readily lend itself to
such a display. The Editor has experimented with several three-dimensional designs
which place the therapist at the center of each classification. However, whether
Sears would find these acceptable cannot be confirmed. In full accord with his
philosophy, the reader is encouraged to design his or her own model to incorporate
the missing therapist.
26
(1978), world-recognized Jungian psychologist, suggests that the DNA
design of living organisms is an apt analogy “to the archetypal ideal of time
as a spiral, which reconciles the linear and cyclic aspects of time” (p. 19). J.
T. Fraser labeled these “aspects of time” as “knowledge” (linear) and
“passion” (cyclic) times, respectively (see “Time, the Servant of Music,”
“Fusion and Confusion,” Chapter 6). David Epstein (1981) also subscribes
to an open circular musical world, actually more like von Franz’s DNA
model. Through interconnections we are carried into deeper levels of
musical meaning. The key, he surmises, “lies in the structuring of time” (p.
197).
This configuration has a practical value as well. It visually shows the
interactions and interrelations among the classifications, which was a
deficiency of the original Processes. Specific descriptions of the
classifications and their related human behaviors and operations here
follow.
Description of Processes Classifications

Structure: human behaviors required by and inherent in musical experience
Motor: natural body responses to music; requires sensory input and
includes rhythmic response
Affective: pleasant or unpleasant influences based in part on past
experiences; physiological factors can contribute
Cognitive: process of intellectual learning; includes reflection which
is a product of learning
Extramusical: stimuli which surround the music both in external en-
vironment and musical accoutrements; thoughts evoked within
listener
Self-organization: inner responses; personal attitudes, interests, values, and
appreciation which are impacted by the musical experience; concerns
how one expects the client to operate
Responding: simplest form of behavior, is manifest in many ways,
both observable and inferred
Listening: intentionally attending to music in a passive manner
Singing: active music-making requiring highly personal involvement
and expression because production emanates from inner
physical and emotional levels
Playing (instrumental): high level operation requiring knowledge of
complex mechanics involved in producing musical sound
Improvising: ability to apply basic compositional (theory) rules to a
composition to produce a new and different musical product
based upon the original
27
Social Relations: behavior of individual within the musical experience in

relation to other individuals, singly or in groups
Self-expression: ability to express feelings, both transitory and
continuing, through music
Self/other directed: opportunity to accept responsibility in a musical
environment as this relates to self and others; goal-setting is
basic technique
Choice: opportunity for individual decision-making; freedom to
choose can be as (more) important as (than) the choice
Interaction factors:
1. Nonverbal: music is a vehicle of communication when
words are too threatening
2. Verbal: music in environment can enhance communication
by shifting focus/subject from sensitive, uncomfortable
areas which tend to shut down verbal interaction
Esteem: sharing or contributing to successful music experiences with
others produces praise from others; sense of worth received
from such praise
Cooperation/competition: ability to work with others to achieve a
common goal; to compete with self and others to hone music
skills is inherent in very nature of music
Entertainment/recreation: provides enjoyment either through
participation or observation/listening; nature of music is to
provide aesthetic experiences
Other social skills: ability to behave at a socially elevated level due to
the structure inherent in (required by) musical situation; public
performance requires specific mode of behavior and can teach
self-confidence, dress, and hygienic etiquette
Discussion of Processes Classifications

Structure classification. This classification “refers to those behaviors of an
individual that are required by and are inherent in musical experience”
(Sears, 1968, p. 34). The construct labeled motor connotes sensory input
and includes rhythmic response. Basically, however, it concerns our natural
body responses to music that we learned as children before we were forced
to cognize music.
Affective comes next because from the moment we learn anything,
whether it is so-called cognitive or not, we seemingly start to develop an
affective filter. The filter is determined by the addition of all of our pleasant
and unpleasant experiences. The moment eventually arrives when we do not
even allow certain notions into our head because they are so contrary to our
28
prior conditioning that we have developed preconceived biases and thus
block them from awareness. This is affective behavior plus emotional
behavior. Physiological behavior and physiological measures are included
in this construct.
The cognitive construct, which has been impressed upon us from the
day we were born, is the process of intellectual learning. This construct also
includes reflection, which is a product of cognition. Clients come to the
music situation from a variety of cognitive levels based upon prior musical
and nonmusical learning. This learning continues in any musical activity,
not only in a structured music therapy or appreciation class.
Extramusical factors would include the environment, for example,
the lighting, the furniture, the physical arrangement of the group, e.g.,
standing, sitting on chairs or floor. These factors are all of the stimuli that
surround the music. Although they are generally associated with the
environment, there are also cognitive processes that are extramusical, such
as when one recognizes that blowing into a horn at one end will produce a
sound from the other. That is not a musical factor. Rather, it is an acquired
item of information of an extramusical nature, which we think is so
obvious. We have been taught that this is part of the music, but it is not.
Music is the sound. This construct has been broadened from the original
Processes in which it pertained only to the thoughts that the music evoked
within the individual.
Self-organization classification. This second level concerns how one
expects the client to be operating. It is intended to verbally identify what the
word “self-organization” means in a musical context. The original
Processes avoided that, and instead presented only ideas about the affective
operations. It stated that self-organization “is concerned with inner
responses which may be inferred only from behavior, and has to do with a
person’s attitudes, interests, values, and appreciations, with ‘his meaning to
himself’” (Sears, 1965, p. 37). Through this omission (musical context), the
distinction between this classification and relating to others was vague. For
example, there is not much difference between the construct “music
provides for self-expression,” and the one in the experience in relating to
others classification, “music provides for self-expression in a socially
acceptable way.” These were too closely associated in meaning, and thus
people had trouble sorting them apart to see what the difference may be. By
shifting terminology to specific operations in which the client is engaged in
the process of becoming organized, e.g., listening, singing, improvising, it
is hoped the confusion is eliminated. The rationale will be pressed further in
the discussion of the Processes and another model, the Structure-of-
Intellect, later in this chapter.
The factors that impact upon self-organization are the possible ways
the music becomes operational: responding, listening, singing, playing,
29
improvising. The client is expected to be engaged in a specific musical

operation, the simplest being responding. Responding can be manifest in a
variety of ways, although not all are directly observable. Listening is the
next least complex factor. Singing and instrumental playing are distinctly
different from one another. The singing voice is the more personal of the
two, until, that is, we psychologically own our external instrument and it
becomes part of our being. When we psychologically own our instrument,
the sound we mentally want to produce emerges before we have time to
think about it. Through practice we have forgotten the technical factors
required to produce that pleasing sound. These technical factors have been
internalized, and thus we become the music. It is another time-order.
Improvising is the most sophisticated operation and probably the least
utilized in treatment. There is a reason, of course, because it requires
creativity, flexibility, and some analytical ability, all which do not come
easily for many clients. Yet, when one can dare to feel free enough to
impose one’s own musical ideas on established musical compositions, the
inner being will probably be free to express the self.
The constructs in this classification are somewhat hierarchical
although, as the arrows indicate, they do interact with the other
classifications. By analogy, one cannot ask an intelligent question without
having at least a feeling for the answer.
Social relations classification. At this third level, interaction among
individuals is involved, and it is toward this interaction that the constructs
are directed. This is the level of expressing self, taking self as a directive
process, and taking directions from others. Two constructs in particular,
verbal and nonverbal, have been specifically classified as interaction and
communication constructs.
The constructs are hypothesized to fall into one of two categories:
those that are (a) inherent within the music experience, that is, the dynamic
effects of the experience, and (b) potential outcomes of the musical
experience, that is, the residual effects the experience may have upon the
individual. Although an argument can be made that all constructs will
contain both attributes, it is feasible to conclude that the constructs
constitute a broad spectrum of relating-type experiences, and thus could
logically more frequently fall into one category or the other.
Therefore, based upon the premise that all constructs will fall
primarily into only one category—although not be excluded from the
other—an arrangement can be made as follows. Constructs which are
primarily inherent within the musical experience are nonverbal,
cooperation/competition, entertainment/recreation, and choice. Constructs
which are primarily outcomes of the musical experience are esteem, other
social skills, self-expression, self/other- directed, and verbal.
30
The primary criterion for assigning constructs was immediacy of
response. Those constructs which were most apt to occur immediately were
classified as inherent within the musical experience, while those which
generally would require long-range development were considered as
outcomes of the experience.
What this model seeks to show is that there is always something of
the musical structure present, which is essentially what structure means.
There is always something going on inside the patient—he is self-
organizing himself. Finally, there is always some relationship, at least with
the therapist.
The model resulted in a rather phenomenal number of thought
processes, as will be explained later in the combined SI-Processes in Music
Therapy models, (Figures 3–5). Suffice it to say that at this juncture, 180
different experiences are identified in the Processes. The constructs are
multiplied further by the very fact that each individual can take any one of
these words and produce many different instances of experiences, and
therefore multiply the whole model again by the number of people who
participate and all the separate ideas they have. It is a generative, not an
explicit system.
Structure-of-Intellect Model
The next step in the revision process was to correlate the Processes model
with Guilford’s theory of intelligence, the Structure-of-Intellect (SI) model
(1967) (see “Models for Thinking,” Chapter 3, for original model [Figure 2]
and complete discussion of SI). In order to more easily transfer concepts
between the two models, I redesigned Guilford’s model from its original
three-dimensional cube shape into a circular arrangement. Figure 2 is that
redesign.
Guilford organized his model into three categories of intellectual
abilities: contents, operations, and products. Contents applies to the raw
materials of information in the head (or the person), or what you want to put
into that organism. It is at least a bi-directional operation. The raw
information is then processed into major intellectual activities, or
Operations. The forms that this information takes as the individual
continues processing it is the products category. A combination of one item
from each of the three categories constitutes an intellectual factor or ability.
Table 2 explains the model in limited detail.
31
Systems Transformations
Productive
Thinking
Divergent Convergent
Semantic
Symbolic Behavioral Implications

Relations
Memory Evaluation
Figural
Cognition
Classes Units
Contents: inner circle; Operations: middle circle; Products: outer circle
Figure 2. Structure-of-intellect model. Adapted from Guilford (1967, p. 63)
Table 2
Structure-of-Intellect
Contents Kinds of information assumed existing or to be
presented
Figural Concrete information, the “thing” or phenomenon,
Symbolic Arbitrary denotative signs, numbers, codes, letters,
arrows, musical notations, etc.
Semantic Word meanings and combinations
Behavioral Primarily nonverbal information involved in
interaction, including emotions, social intelligence
Operations Individual’s internal actions on contents

Cognition Knowing, discovering, being aware of
information; comprehending
32
Memory Storing, retrieving information
Productive
Thinking:
Divergent Generating new information from given
information; emphasis is on number and variety of
responses
Convergent Generating unique, accepted solutions
Evaluation Reaching decisions, judging appropriateness of
information
Products Results of operations on contents; the way

information occurs
Units Single, segregated items of information
Classes Grouped information according to common
properties
Relations Connections between items and classes
Systems Higher level connections into large organized
wholes
Transformations Changes in information usually from one form to
another, music into painting, etc.
Implications Predictions, extrapolations, or conclusions drawn
from the information
Adapted from Guilford (1967).
The Combined SI–Processes in

Music Therapy Models
Taking the three-dimensional concept from the SI model and applying it to
the Processes brings forth some interesting comparisons. The Processes
term classification can be perceived in the same context as Guilford’s term
category. Thus, the behaviors required and inherent in experience within
structure bear similarity to what he identifies as content. Experience in self-
organization, or organizing oneself, can be closely related by analogy to the
operations one performs inside oneself. The product of music therapy is
experience in social relations, and this seems to be an apt comparison also.
By adopting the SI concept, the restrictions the linear attitude imposed upon
the original Processes is eliminated.
From these two models, the music therapy Processes model produces
180 possible different combinations of experiences, and the SI model, 120
intellectual abilities. A combination is formed by a structure, a self-
organization, and a social relation in the Processes model (4 structure
33
constructs x 5 self-organizations x 9 social relations), or a content, an

operation, and a product in the Guilford model (4 x 5 x 6 = 120).
The next step was to combine individual Processes classifications
with their SI counterpart categories. The structure-content combination will
produce sixteen thinking possibilities—four structure constructs times four
content abilities (4 x 4 = 16). Figure 3 shows the result. The small arrows
indicate that to make a combination you turn either circle so that a structure
will line up opposite a content. For example, a specific musical selection
which conjures up a specific event from one’s past would be a figural-
affective combination. Or, a musical selection which prompts one to get up
and dance would be labeled figural-motor. The generative nature of the
model is easily demonstrated when one considers the vast number of
experiences that fall within either of these combinations. And there are
fourteen more combinations in this classification alone!
Semantic
Motor Affective
Symbolic Behavioral
Extramusical Cognitive
Figural
Experience within structure: inner circle; Contents: outer circle
Figure 3. Combined Sears experience within structure classification and

Guilford contents category.
34
The five music therapy Processes of self-organization and the five
from Guilford’s operations category create self-organizing operations, as
Figure 4 demonstrates, and produce 25 combinations of thought.
This classification (self-organization) of the original Processes
seemed to be the weakest. The distinction between it and relating to others
was not clearly made. However, when related to Guilford’s operations, it
gave me some insight into a different way of expressing the constructs. Self-
organization is shaped by one’s inner responses to external stimuli or
experiences. Guilford’s operations are the “individual’s internal actions on
contents,” as stated in Table 2, or as Klausmeier (1966) puts it, “things that
the organism does with the raw materials of information” (p. 35). What are
the stimuli that create these inner responses upon which this classification is
built? I did not consider this a factor in the original Processes, but
comparing the constituents of the two categories indicated that the stimuli
which shape self-organization are integral to this classification. Thus, the
major change.
Cognition
Listening Singing
Memory
Evaluation
Responding Playing
Improvising
Divergent
Convergent
PRODUCTIVE
THINKING
Experience in self-organization: inner circle; Operations: outer circle
Figure 4. Combined Sears experience in self-organization classification and

Guilford operations category.
35
Improvising and divergent thinking have similar properties. They lead

in a different direction from the information given, and what is most
important, cannot be scored or rated as right or wrong. Guilford’s factor is
broader than the Processes construct, and would include composition,
arranging, and tonal experimentation, to mention a few musical creative
thinking activities. Thus, the two are not overlapping and do form a bona
fide combination.
The final classification/category is social relations from the
Processes and Guilford’s products, as shown in Figure 5. Guilford (1967)
defines products as the way information occurs. He also said the term
“conception” is an apt synonym for “products.” To carry this trend of
thought a bit further, how should we define the word “information” in our
model? Again I call upon Guilford. He states that “information,” in the
broadest term, is “that which an organism discriminates . . . within the
psychological field, with no implication that the field is entirely conscious”
(pp. 221, 249).
Systems Transformations
Self/Other
Directed
Self-Expression Choice
Other Social Verbal Implications

Skills
Relations
Non-Verbal
Entertainment/
Recreation
Cooperation/ Esteem
Competition
Classes Units
Experience in social relations: inner circle; Products: outer circle
Figure 5. Combined Sears experience in social relations classification and

Guilford products category.
36
Relating all this to the Processes, the product of the music therapy
experience is the ability to relate to others. Another way of thinking about
this concept is that the product is the relationship per se. There is a
difference in these two statements. Now, if we pick up on the word
“discriminates,” we can say that the factors in the product category—unit,
classes, etc.—specify the various contexts within the musical experience at
which social relations occur.
A unit is a “thing,” that is, it is a discrete entity with distinct
properties. It can exist without other products, whereas the opposite is not
possible. Choosing a particular recording in a music listening session would
be a possible units/choice combination.
An orchestra is an example of a class. It is a homogeneous group
having a common purpose—to make music. Different instruments in that
same ensemble have a relational factor to one another (violin + viola + cello
+ bass = string section). That same ensemble also could be classified as a
system, particularly when in the act of musical production, although
melody, harmony, and meter are more readily recognizable systems.
Distinguishing between classes and systems is not always clear-cut, and
Guilford’s definitions are not that helpful when trying to decide if an
orchestra is a class or a system. He states that classes are “recognized sets”
while systems are “organized aggregates” (1967, pp. 80, 91).
At first glance, this category appears to be hierarchical, at least until
we reach transformations and implications. However, except for unit,
which must exist before the products category can operate, even the first
four factors are not an absolute continuum. Relations between units can
exist without regard for classes; systems do not presuppose relations; and so
on. Transformations and implications are even less hierarchical in
character. Yet even here a continuum can be perceived. The important
argument against hierarchy in this category is that to make it so would
restrict it to something unrecognizable by its creator. The nine social
relations from the Processes with the six products from Guilford’s SI model
result in 54 combinations (9 x 6 = 54).
The combined SI-Processes models generate 21,600 specific thinking
units or bits (16 x 25 x 54 = 21,600). That figure may sound astounding,
particularly when one looks at these uncluttered and simplistic-appearing
models. This is simply further evidence of the efficiency that is inherent in
the models. Thinking with a model can allow for the amassing of more
ideas and make it possible to keep them in mind more effectively for a
longer period of time. How many more spoken words than have been set
down to this point would be necessary to explain this concept without the
benefit of these visual aids?
37
It is not necessary to memorize all of the individual items, although

even that task is made easier through the efficiency of the model. Another
advantage is that any new item of information can be added to the model
with ease.
These individual thinking bits or combinations are not self-
eliminating. All of the processes are operating concurrently, but the
therapist’s attention is concentrated upon a discrete selection in order to
attain a specific treatment goal. Emphasis will shift from among the
classifications/categories and between the combinations in each as the
client’s behavior changes. The interconnectedness of the total process is
expressed in Figure 6.
Treatment
Diagnosis
Self-Organization/ Social Relations/

Operations Products
Treatment
Decision
Structure/
Contents
Flowchart showing interconnections among elements of music therapy

process
Figure 6. Aids to Thinking.

38
Employing the model-building technique for music therapy would
help us reduce the momentary aspect of our thinking to comprehensible
dimensions. I selected Guilford’s SI as a model for the Processes because I
found it the most usable for me. However, one could insert almost any other
model into the Processes which has a comprehensible number of parts, such
as Gagné’s conditions of learning (see “Models for Thinking,” Chapter 3,
Figure 1) or B. F. Skinner’s operant conditioning. Other useful models to
consider are those of Jean Piaget (human development), William J. J.
Gordon (synectics creativity), E. Paul Torrance and Sidney J. Parnes
(creativity), and Benjamin S. Bloom, David R. Krathwohl, and Anita J.
Harrow (education).
Another shape this model can take is a technique called morpho-
logical analysis. To follow this technique, each classification/category item
is written on a separate 3x5 index card, using a different color for each
classification/category. The colored stacks are placed face down side by
side and one card from each stack is turned up. Reading across the three,
there will be one item each about structure-content, self-organizing
operations, and social relations products. For example, one possible
combination would be that “music provides a symbolically affective
structure for evaluative listening in a system of self-expression.” How
beneficial this technique is will depend on the individual. However, it does
expand our mental tool to incorporate some other kinds of concepts, and
forces us to think in more expansive realms. This card-sorting technique
does not require a computer. A colleague of mine went to the trouble to put
it on computer. The resultant product was ridiculously thick—630 separate
statements with all possible combinations of these 26 items. By contrast,
one could take nothing more complicated than a set of 26 index cards, and
play with them as long as one likes, and maybe come up with more and
better ideas than what have been expressed here.
The Processes are not a fixed system. Indeed, flexibility is central to
this revision, and without it its strength is diminished. Nor should the words
serve any greater function than as stimulants to your thoughts. You are not
supposed to think the way I did when I set them down. If it is confusing
when I claim that there are 21,600 chances to think about music therapy,
look at the model again. You will observe that at any one given time or
within any one combination there are only six items to consider. Compare
this with any page of music. Consider the number of notes on that page, the
number of simultaneous tones which comprise each chord, the dynamic and
metrical markings, and the nuances of the vocal and/or instrumental sound.
Now that’s complicated! Our stimulus of music is more complicated than
are the Processes.
The model is intended to clarify the Processes so that they may be
singled out and made personal to you, the therapist. It does not have to be
39
applied as outlined or as used by other therapists. It is intended to lend itself

to further expansion and modification by the user, while at the same time
expressing a single, unified system for music therapy.
The revision of the Processes is an ongoing project, always awaiting
further revision and improvisation. It is not finished today, and I hope it
never will be. The Processes are intended to help us think about our
stimulus, music, and make it so understandable to ourselves that two things
can happen: (a) we can put music into any situation, and (b) we can
individually put ourselves into the situation with our own individualized set
of skills, talents, understandings, and personalities. The point is, that we
must find ways of transmitting the excellence of many music therapists to a
system for all therapists, rather than an exclusive tool available only to a
few. Only then will we be able to provide all patients and clients with the
best health care possible.
Throw the Processes away just as you throw away a musical scale
when you are in the act of making music. That, not the act of memorizing a
number of related concepts, should be your purpose for studying them.
What confuses most of us is that we foolishly believe that if we can only
accumulate a large body of facts we will acquire knowledge. But we finally
come to the realization that the only fact which is certain is that facts do not
beget knowledge. Eventually we must forget the fact, because so long as the
fact is standing in front of us, we think of the fact and not the task at hand.
Barbara Brown (1980) stated this very well in “the Brownenberg
Principle,” a term she coined that is a play on words and modeled after the
Heisenberg principle of indeterminacy. The Brownenberg Principle states:
If you are busy processing information in your brain, you can’t know
you are processing the information because the information being
processed is occupying the same neuronal space that is needed to
become aware of what is being processed.
And of course, conversely, if you are aware of information that
has been processed, you can’t be processing new information at that
moment of awareness because the mechanisms for awareness occupy
the same neuronal space needed to process the new information. (p.
263)
That is, we human beings have no conscious awareness of the nature

of our own mental processes. It therefore follows that the body performing
the music cannot perform it while engaged in the process of thinking about
performing it.
This is patterned after the Heisenberg indeterminacy or uncertainty
principle in quantum physics, which shows that, simply stated, an electron
cannot look at another electron. Heisenberg’s uncertainty principle shook
40
the very foundations of the scientific community, for he proved that at the
subatomic level exact science does not exist. Instead, only probabilities
apply. It is upon this principle that the non-deterministic character of
quantum physics rests. “These limits are not imposed by the clumsy nature
of our measuring devices or the extremely small size of the entities that we
attempt to measure, but rather by the very way that nature presents itself to
us” (Zukav, 1979, pp. 132–133)—in a sense, hazy and ill-defined.
The whole of human science has this particular problem because
humans are trying to look at other humans. The time scales on which we
move, move together. Results in the basic sciences occur when the
everlastingness of something outlasts us or is smaller than us. The farther
these time distances are between the two relative scales, the better we can
control the scientific product.
The Heisenberg principle can be illustrated by the operation of the
electron microscope. In the electron microscope electrons are generated by
an interaction between a wire filament and a metal plate (or anode) close
by. The positive charge of the anode attracts the negatively charged
electrons from the filament. All of this occurs in a vacuum.
In the anode is a pencil-size hole through which the beam of electrons
flow. These, in turn, are focused by a set of lenses onto a specimen. The
electrons flow through the specimen, and the resulting pattern is projected
onto a fluorescent screen. Interactions occur in this entire process, and
certainly, modifications occur in the electron beam and in the specimen
observed by the observer (C.T. Eagle, personal communication, October
1982).
Nobody has seen an electron yet, but the effects on the thesis have
worked out. They weigh the same in theory. They tend to have the same
speed. However—and this is the essence of the uncertainty principle—it is
not possible to determine both the position and speed of an electron at the
same time. By observing its position, its speed is changed; and conversely,
the more accurately its speed is determined, the more imprecise its position
becomes.
Presumably, one of the strengths of the human being is that it has the
ability to know that it is the organism that is doing the knowing. This is
known as self-reflexivity, and so far as we know, only humankind among
the four levels of being that have been identified thus far on our planet
possesses this quality or power. Self-reflexivity is an awesome ability, and
bears heavily on much of the matter in this work. It is also referred to in
other chapters in different but related contexts. To the music therapist,
Brown’s law and the Heisenberg uncertainty principle can be simply
transformed to mean that every time you exchange glances with a client or
touch one another, both of you have moved from where you were. In music,
41
the participants are moved along the same time line. The experience of
oneness among many which results can be experienced in no other way.
Music is such a powerful tool! An eminent psychologist once
remarked that when a music therapist is at a loss for words in the therapy
situation, he is saved because he can go back to the music. The music is the
message! It should be learnable no matter from which direction one comes.
The importance, to me, is you the therapist first, your music second, and
your ability to put the two together so that when the therapeutic or teaching
situation is completed, you have forgotten what you did. Then, and only
then, will you have communicated.
Editor’s Summary
Like so many undertakings which metamorphose over time, Sears
continually mined the “Processes in Music Therapy” more deeply, and
eventually devised a revision, the present work. He created a more in-depth
approach to the three classifications: structure, self-organization, social
relations, around which the Processes are organized. But even if that had
not been necessary, the textual format mistakenly presented the appearance
of linearity, which is not the case, and which is corrected here.
Much more significantly, “music as time-ordered behavior”
originally was literally embedded in the classification “Experience Within
Structure.” In point of fact, time actually exists throughout all of the
classifications. It is the core of music and is in evidence under all musical
circumstances. “Time is both the essential component of musical meanings
and the vehicle by which music makes its deepest contact with the human
spirit” (1988, p. 2). So says Jonathan Kramer, author, composer, and music
professor at Columbia University. To not raise time to the pinnacle of music
making and show it throughout all aspects of the Processes would have
rendered a revision of the Processes meaningless.
Elevating “time-ordered behavior” was not the only change necessary
to expand the meaning of the Processes and, paraphrasing Sears, to insert
the particular therapist back into the practice of music therapy. A graphic
model designed as three concentric circles was deemed the best vehicle for
expressing the Processes. However, it was the Structure-of-Intellect model
developed by the late psychology professor J. P. Guilford that gave Sears
the seeds for a revision, and allowed it to take off to a higher and more
meaningful level. The merger of the two models, herein expressed visually,
produced a system that significantly expanded the music therapy processes
to incorporate not only situational experiences (e.g., affective behavior,
listening, self-expression) but also Guilford’s intellectual abilities (e.g.,
semantic, classes, memory). The modified classifications/categories became
42
“Experience Within Structure/Contents,” “Self-Organization/Operations,”
and “Social Relations/Products.” The combined system can generate an
astounding 21,600 specific thinking units or bits which an individual is
capable of producing. Although other models may be merged with the
Processes, Guilford’s SI model is so graphically explicit and comprehensive
that it renders Sears’ work more meaningful and inclusive of the actual
clinical music therapy situation.
Sears speculated on the possibility for further revisions in the future,
surmising that such depends upon the validity of this one and how well it is
received. If it generates the creative juices in some readers, and we
recognize that our thinking machine is continually evolving, other more
sophisticated renderings could emerge one day.
References
Brown, B. B. (1980). Supermind. New York: Harper and Row.
Epstein, D. (1981). On musical continuity. In J. T. Fraser (Ed.), The study of
time, IV. New York: Springer-Verlag.
Fraser, J. T. (1999). Time, conflict, and human values. Urbana: University
of Illinois Press.
Gaston, E. T. & Schneider, E. H. (Eds.). (1965). An analysis, evaluation,
and selection of clinical uses of music in therapy. (Cooperative
Research Project No. F–044). Lawrence, KS: The University of
Kansas.
Guilford, J. P. (1967). The nature of intelligence. New York: McGraw-Hill.
Klausmeier, H. J., & Goodwin, W. (1966). Learning and human abilities.
New York: Harper and Row.
Kramer, J. D. (1988). The time of music: New meanings, new temporalities,
new listening strategies. New York: Schirmer Books.
Sears, W. W. (1965). Processes in music therapy. In E. T. Gaston & E. H.
Schneider (Eds.), An analysis, evaluation, and selection of clinical
uses of music in therapy. (Cooperative Research Project No. F-044).
Lawrence, KS: The University of Kansas.
Sears, W. W. (1968). Processes in music therapy. In E. T. Gaston (Ed.),
Music in therapy (pp. 30–44). New York: Macmillan.
von Franz, M.-L. (1978). Time: Rhythm and repose. London: Thames and
Hudson.
Zukav, G. (1979). The dancing Wu Li masters. New York: William
Morrow.
43
Excerpt Three
Time, the Servant of Music
William W. Sears
Time doesn’t seem to pass here [in Rivendell]:
it just is.
J. R. R. Tolkien, Lord of the Rings
Time is the indestructible quality that exists

throughout eternity. . . . To waste time is to waste
your life away, for this unrecapturable quality has
no resale use. It cannot be reused, because it
never backs up or retreats.
Ruth Montgomery’s spirit guides,

A Search for the Truth
The subtext of this work is “Time,” as has been borne out frequently, one
chapter after another. It was apparent in the course of organizing Sears’
thoughts that “Time” was always at the forefront of his thinking. Simply
leaving his concepts sprinkled throughout the various chapters did not give
the topic the prominence warranted. Thus, I have pulled passages which
focus on “Time” from the aggregate, except where specific references
needed to be retained in their original locations. These are found in other
chapters.
Linking together statements from disparate sources to create a
homogeneous, coherent leitmotiv was challenging, although in time logic
broke through, an organizational thread was discovered, and pieces of the
puzzle began to fall into their proper places. The following chapter is the
result of that effort.
Very early in the process the title emerged. Unfortunately, I did not
know if the premise was accurate. Yes, I had acquired knowledge and
experience over time that confirmed for me that time is music’s servant.
Equally important, my “gut” feeling convinced me. But was that enough? I
think I need go no further than to quote from the late David Epstein: “More
44
than any other musical dimension, time depends on forces outside its own
proper domain [italics added]—that is, time depends upon sound” (1981, p.
184).
What’s to Come
Music demands time-ordered behavior. It exists only through time,
requiring the individual to commit himself to the experience moment by
moment. This is music’s uniqueness. Upon this concept, Chapter 2 in
Gaston’s Music in Therapy (1968) was built. An argument was made that
may or may not have been compelling to the individual reader of that work.
It was far from exhaustive. A number of powerful statements were made
which most music therapists could support on the basis of their experience,
yet these statements were neither amplified nor verified. A stronger case
needs to be made and will be attempted here, although no claim is made
that it will be exhaustive either, for that is beyond the scope of the present
work, as it was in the earlier one.
“Music is time-ordered behavior’ is a quite profound statement,
replete with many questions, some which are, as yet, unanswerable. Not the
least of these is, “What is time?” In spite of the volumes that have been
written on this exceedingly compelling theme, man still cannot pin down
the meaning of time. (It is curious that as yet no universally acceptable term
for the study of time has been established.) Yet the search for an answer
continues, and it is this search which must be undertaken if any
understanding is to be brought to the concept “music is time-ordered
behavior.”
The topic will be approached from three perspectives. First, we will
look at a number of ideas about time from the pens of some highly regarded
scholars. This discussion will center, of course, on man’s perceptions and
even misperceptions about time. From there the discussion leads directly
into temporal distortions in mental illness. Finally, the temporality of music
will be explored.
King Richard II, in Shakespeare’s so-titled play, soliloquizes shortly
before his untimely death,
Music do I hear?
Ha, ha! Keep time. How sour sweet music is
When time is broke and no proportion kept!
So it is in the music of men’s lives.
In the course of our present journey, we hope to learn why music goes sour
“when time is broke.”
45
Time—Fusion and Confusion

Time is associated with rhythm and change, speed and velocity, social
behavior, duration and sequence, yet is none of these. For eons, “What is
time?” has been the great question of philosophy and religion. It is
something outside us over which we have no control, something that
appears absolute, yet it is also internal and eternal. We are influenced by
earlier ideas, prejudices. What is commonly perceived as time is based on
false prejudice. Experiences in time are diverse. There is more than one
concept of time—so many, in fact, that man cannot claim to know them all,
let alone what they measure or describe. There is the time of the
philosopher, the psychologist, the physicist, the poet, the biologist, the
clock, the sundial, the calendar, the sun and all the heavenly bodies, and
even the time to boil rice.
Alvin Toffler and Frederick Melges have defined time in two
interesting and contrasted ways. “Two situations alike in all other respects,”
Toffler (1970) says, “are not the same at all if one lasts longer than another”
(p. 32). More erudite, but no more revealing, Melges (1982) claims, “In its
broadest sense, time can be considered as a construct that refers to the
perception or imputation of changes against some background that is taken
to be relatively permanent” (p. 7).
J. T. Fraser, the pre-eminent time scholar, has spent his entire life
attempting to unravel the secrets of time. His considerable knowledge
notwithstanding, he admits that “seeking a comprehensive view of time is a
task comparable to putting together a jigsaw puzzle whose pieces are alive
and moving” (1975, p. 5). What a colorful metaphor! Admitting that a
comprehensive view is not what we are after (nor does this author possess
Fraser’s knowledge of the subject), nonetheless, focusing on some of the
more salient features of time should lead us to a better understanding of
music as time-ordered behavior.
In Of Time, Passion, and Knowledge, Fraser (1975) states that time is
generally perceived as a single, understandable, and recognizable feature of
the world, when, in fact, it is instead “a hierarchy of distinct temporalities
corresponding to certain semiautonomous integrative levels of nature” (p.
435). This idea confounds us, and we do not understand its implications.
Incidentally, the Melges’ definition of time quoted above is attributed to
Fraser.
46
Simply stated, Fraser identifies five such temporalities or temporal
states. The most primitive and strange he calls atemporal, this being the
time of light—the world of electromagnetic radiation. The next level up in
the hierarchy is the world of elementary particles, prototemporality, which
is characterized by undirected, non-flowing, non-continuous events for
which precise location is meaningless.
The simplest form of continuous time is eotemporality, the reality we
know as the astronomical universe of massive matter. Biotemporality
encompasses all living organisms. The concepts of past, present, and future,
though limited, are introduced at this level. The ultimate level we can speak
about at this stage of identification is nootemporality, or noetic time, the
time of the human mind. This is the time which is signified by man’s long-
term memory.
Yet we are aware of the lesions of time (or better put, times), and
acknowledge that variations exist in our perception of the speed of time.
The time that is expressed on the clock, which is regular and predictable, is
knowledge time, or time understood, in Fraser’s terminology. Put another
way, it is one “thing” after another.
Quite a different experience is inner time—that time we feel within—
which Fraser calls passion or felt time. Passion time is the feeling that time
is either fast or slow based upon our experiences within a given time frame,
which can be characterized when we say, “Gee, that was a long hour,” or
“Is it already 3 o’clock?” It happens as we listen to music also. Conscious
attention to the passage of time can influence the perceived duration of a
composition, estimating it to be longer than when not attending specifically
to time. Kramer (1988) noted yet another musical example of this “time-
order error” in the “tendency to perceive the first of two durational spans as
either longer or shorter than the second simply because it was experienced
first” (p. 332).
Human behavior scholars identify this as psychological or the inner
time of the mind. It is not simply a perception by the mind, but rather a
significant component of self-awareness. Einstein said it best. “When a man
sits with a pretty girl for an hour, it seems like a minute. But, let him sit on
a hot stove for a minute—and it’s longer than an hour. That’s relativity”
(Barwick, 1970, p. 38). Felt time is relative. It is found in the flow of our
consciousness. More precisely, it is consciousness—thinking, if you will.
Toffler (1970) says that man’s temporal perceptions are linked to his
internal rhythms, whereas his responses to time are culturally conditioned.
Also important to the understanding of psychological time is Sam Keen’s
claim that the inner time sense records intensity and importance of
experience rather than duration (Keen & Fox, 1973). Keen, like Einstein
and Kramer, infers that “duration” is a slippery element which refuses to
47
stay put. Thus, it appears judicious that we leave it in the hands of our
imagination and memory.
Fraser (1975) systematically explains his theory of time as a conflict,
with the principal combatants being knowledge time and passion time.
Conflict is necessary to all systems—micro and macro—and thus it is
inappropriate to think of conflict in the negative sense. In living systems the
conflict/stress is between growth and decay. Yet it is unresolvable and
necessary to the life of the form. Life lasts only so long as the conflict lasts.
In reference to the mind, “this struggle may sometimes be described as that
between knowledge felt and knowledge understood [between passion and
knowledge] . . . knowledge untamed by passion is dangerous, while passion
uninformed by knowledge is useless” (p. 444). Marie-Louise von Franz
(1978) prefers Nicholas Cusanus’ definition of time, that being “a
coincidence of opposites” (p. 29). “A coincidence of opposites.” I like that.
Cusanus, also known as Nicholas of Cusa, was a well regarded 15th century
(1401–64) German philosopher, scientist, and Catholic cardinal whose
concepts continue to attract attention (Alexander, 1956, p. 604).
We understand conflict as a necessary symbiotic state in most
systems, so why should it not exist in time as well? The multiplicity of
temporalities, or time bases, while conflict-laden allows the continuation of
all systems, humans included. There are “times” in our dreams. There are
“times” in our altered states of consciousness. There are “times” which to
us appear to be simultaneous or instantaneous. There are “times” which
appear to us as infinity. But every kind of situation—everything we know
about—has its own time scale. A “hierarchy of distinct temporalities” may
not be so difficult to fathom after all, and its absence may produce
boredom, which to Keen is imprisonment in one time zone.
Knowledge time may be more recognizable as linear or monochronic
time, a concept associated with Western man specifically but not, by any
means, mankind in general. To bring this thought into even sharper focus,
linear time is of relatively recent origin. The ancients believed time to be
cyclical—heroes repeating themselves. Not until about 500 B.C. did
historians start writing in chronological historical time. Fraser (1987) would
push back that date to the ninth century B.C., and credit an unnamed Yawist
writer who set down the history of Israel, although not in exact
chronological order, from which the Old Testament of the Bible emerged.
Herodotus (c.484–c.429 B.C.) (1972), proclaimed as the “father of
history,” wrote, “here set down to preserve the memory of the past by
putting on record the astonishing achievements both of our own and of
other peoples . . .” (p. 1). This writing style would not be possible without a
linear or monochronic sense of time. As recent as is linear time in man’s
history, the mechanical clock—the most exact time measuring device we
48
know of to date—is a mere babe, having been invented by Galileo as
recently as 1642.
Monochronic time is linear, segmented, sequential, and spoken of in
tangible terms, such as “saved,” “spent,” “wasted,” “lost,” “made up,”
“expired,” and “handled.” We are inclined to view monochronic time sense
as if it were built into the universe rather than a learned, imposed, and
arbitrary perception. True, it is an efficient method of handling time, but not
necessarily the only useful way. Some cultures are polychronic, that is,
cyclical or nonlinear. Tasks and events follow their natural time rather than
that based upon externally imposed deadlines (Hall, 1976). Polychronic
cultures are spread throughout the globe—far and near East, North and
South America, Polynesia, Africa.
The language of a typical polychronic culture is characterized by an
absence of past, present, and future tenses. Inferences are not drawn from
the past upon which predictions of future events can be made. That is linear
thinking. Time appears to be a holistic pattern into which all experiences
and events are woven. In describing how the Pueblo Indian of the southwest
United States fits into this model, Frank Waters (1950) states that “his life
does not run on a railroad time schedule. Or between two fixed points.
Sunrise and sunset, summer and winter, birth and death; within these
arbitrary limits, life slowly revolves in a repetitive, timeless circle. The
future does not exist. The ancient past is constantly alive. Everything is
contained within the ever-living now. The Pueblo’s intense awareness of
this is a valid reality. Obsessed with the internal and eternal rather than the
external and transient, he lives in the core of time” (p. 381). Benjamin
Whorf (1956), whose linguistic research of the Hopi Pueblo Indians and
their language thrust the world into a new understanding of the relation
between human language and human thinking, discovered that their
language contains no reference to time, either explicit or implied.
Long-term futures and pasts are recently acquired levels of human
evolutionary development, and make up Fraser’s time understood (1987).
Drawing the connection with time felt (passion time), he observed that
feelings may be independent from time understood (knowledge time), but
not the other way around. That is, time felt and time understood are
hierarchical levels of man’s time bases, with time felt being the earlier, or
older.
A reality built on the “internal and eternal” yet devoid of a sense of
“future” does not appear to be an existence in a vacuum, but it is difficult
for the Western mind to comprehend. Past, present, and future, even though
they are illusions, have practical and technological value. They are the
backbone of the scientific method. Linearity is necessary to test scientific
hypotheses which can only be proven or rejected by plotting an
accumulation of recurrences or events. The scientific method has not been
49
achieved without a price, however. All of that questioning and probing have
stripped Western man of the rich world of myth and magic. Cultures which
operate in polychronic time appear to be more inclined toward a belief
system steeped in magic and prophesy, possibly because lacking a scientific
approach, fact and fantasy are not readily distinguishable (Melges, 1982).
Even as Western man takes past, present, and future for granted, there
is evidence that his concept of future is shrinking as the planet shrinks, in an
experiential sense, that is. In a society where technological advances are
streaking by at jet speed, a future that extends even beyond tomorrow is
becoming harder to hang on to, let alone to comprehend. Before a new
weapons system is off the drawing board it may be obsolete. Physicians
struggle to keep abreast of the latest medical wonders. The computer you
bought last year is not able to handle all the fancy programs available in the
current model. Children and adults alike want all their material desires
fulfilled immediately. Planning for the future is often a hollow cliché
(saving is even more meaningless), in spite of the fact that due to increasing
life expectancies that future is growing increasingly longer. Distinct
cultures are becoming endangered, being replaced by clones of the
technologically sophisticated Western world. The individual is being
absorbed by a social mechanism so complex that it no longer believes the
human being is necessary in the organizational plan. These are symptoms of
Fraser’s “time-compact globe,” a condition he claims will see society
replace the individual as “the measure and measurer of time” (1987, p.
310). If this is so, what happens to Melges’ assertion that our personal
experience of time relates closely to our measure of awareness into the
future. It is not beyond comprehension to perceive a time when
monochronic time will collapse upon itself.
In most avenues of Western life, we walk easily with a future
consciousness except one—education. Students receive a heavy dose of the
past in all subject areas, but when the present is finally reached, time stops.
“Future” is not in the core curriculum. Scholars know the past very well,
and even attempt to shape the future by cleverly approaching the present.
But who knows or is able to prepare the future? J. Samuel Bois would not
restrict that backward view to formal education, but to all humanistic
pursuits. Not so in technological realms, he asserts. “We accept evolution in
geological and biological development and in the technical aspects of our
culture, but we have not yet learned to conform our views to it when it
comes to the intellectual and moral achievements of our species” (1970, p.
42). Perhaps the “future” must be given over to students themselves. Or
perhaps it is necessary to feel the simultaneity of polychronic time to
understand how to teach future time while moving in present time. “The
future is purchased by the present,” to quote Samuel Johnson (1969, p.
174).
50
The time scale we humans live on is so different from that which
exists in the physical world. Each has its own temporal scale. Imagine with
me, if you will, that two rocks are sitting on a table philosophizing about
humankind. (They are gazing at us in our human endeavor). One rock might
say to the other, “Isn’t it sorrowful that their lives are so short?” A rock, in
this sense, for the span of a human life tends to stay a rock, so it remains
relatively stationary and unchanged to our position. Therefore, we can study
it with our clock time sense and make predictions about it much more
accurately. By contrast, in the behavioral sciences, the moment we impede
on another person’s environment, we are moving that person out of the
way, and using passion time to do it. What we thought we could accomplish
with him or her at the time we started changes because the person has also
moved away from the point at which he or she started. If I want to live
“long” in this world, let me be a rock!
Fraser (1987) says stones can tell us stunning tales about time, even
the time of universes too alien for human life. However, their eotemporal
world does not include the passage of time, even though from their view on
that table they can observe a parade of generations of humans passing by.
But if I want a richer life or, perhaps, reality, which allows me to
experience the passage of time, complete with all the possibilities that
entails, then let me remain a transient human being wandering around, often
seemingly totally lost, in noetic time. Yet there is much to be learned from
rocks, which the following poem by 8-year-old Craig confirms (Pearson,
1976).
Craig, age 8 (talking about a rock)

. . . I would be very big
and just lie in the sun
and get warm . . .
. . . After millions of years I
would have a lot of wrinkles. (pp. 43–45)
There are many different “times,” not just the time we experience or
have knowledge about. There are time-orders after time-orders, simply
restacked. In present-day physics theory, space, time, and matter now
become united into one inseparable structure that includes the whole of the
physical universe. We have come to know this as Einstein’s astounding
theory of relativity. According to his theory, space is not three-dimensional
and time is not a separate entity. There is only the space-time continuum.
In the new physics, Einstein’s space-time continuum gives way to his
more profound visionary concept of a unified field theory. To oversimplify,
unified field theory unites the laws of gravitation and the laws of
electromagnetism into one basic superstructure of universal law. Einstein
51
did not finish this work before his death, and the physics community has
not seen fit to continue where he left off. To the contrary, it claims that his
unifying experiments have not contributed significantly to present-day
knowledge—an evaluation not shared by the new breed of physicists—and
in the words of mathematician Cornelius Lanczos (1965), “denying even
the possibility of such an attempt being successful” (p. 118). Such a
parochial attitude is rarely productive.
I am prompted to contradict Einstein by saying that time is not the
fourth dimension but the first. In geometry, I was puzzled when it was
stated that time was the fourth dimension. The teacher demonstrated the
presence of a point and then would project it to get a line; the line was
projected to produce a plane; the plane was projected to produce a solid.
Yet it always took time to make each projection. So, we start out with time
as the first experience, and everything else is built from that base. We do
not talk about it exactly that way. If we could perhaps think of projecting
ourselves back to a point that is supposed to have no dimensions, that might
be the time we reach the speed of light. Of course, physicists are now
finding that there are events faster than the speed of light, which is
changing our science again.
In an attempt to refute quantum mechanics, which Einstein found too
uncertain to stand as a complete theory, he, Boris Podolsky, and Nathan
Rosen devised a thought experiment which proposed that if the theory of
quantum mechanics was correct, the spin of one particle in a two-particle
system would instantaneously affect its twin in another place. If the thought
experiment could be proven, communication between the particles would
travel faster than the speed of light. The very foundation of modern physics
rests upon the assumption that nothing in the universe can travel faster than
the speed of light, this being the law of local causes (Zukav, 1979).
The mathematical proof of the EPR effect, as the Einstein-Podolsky-
Rosen thought experiment came to be known as, was achieved by J. S. Bell
in 1964. This is the well-known Bell’s theorem. Less than a decade later,
John Clauser and Stuart Freedman confirmed that the statistical predictions
of the Bell theorem were correct. But they could not show how
communication between space-separated particles occurs. In a best-selling
overview of the new physics aimed for the layman, Gary Zukav (1979),
himself a layman, says, without question, “Bell’s theorem not only suggests
that the world is quite different than it seems, it demands it . . . something
very exciting is happening. Physicists have ‘proved,’ rationally, that our
rational ideas about the world in which we live are profoundly deficient” (p.
309).
Jack Sarfatti concurred, Zukav (1979) continues, when he proposed
his theory of superluminal transfer of negentropy (information) without
signals in 1975. Sarfatti claimed that the particles in the EPR and Clauser-
52
Freedman experiments are separated by space and are connected, but not by
signals. This connection, which is both intimate and immediate, transcends
space and time.
It is well and good to recognize the evidence for such exotic ideas in
the physics laboratory, but can it apply to the human experience? After all,
the distinction between micro and macro sciences must be respected. Yet
perhaps the connection is stronger than we suppose. For example, if you
want to be with someone you love, aren’t you already there?
Time and Man’s Behavior (Time and Mind?)

“If it is true . . . that time is closely related to the rhythm
of the inner god-image, the Self (i.e., the conscious-
unconscious totality of the psyche), then it is obvious that
every neurotic deviation from the rhythm of the Self
entails also a disturbed relation to time.”
Marie-Louise von Franz,

Time: Rhythm and Repose
That assessment by von Franz asserts man’s dependence on an undisturbed

time sense for the maintenance of sound mental health.
Knowing what we do about the linkage between physical and mental
health, we understand that biological clocks do not operate beyond the ken
of the psyche. When physiological processes lose their normal timing and
become arhythmical, the head knows. Time holds the key to normal
biological operations. Likewise, psychological or inner time of the mind
serves a coordinating role in mental functions, and thus is the binding
medium for mental health. This is consistent with contemporary physics in
the view of Larry Dossey (1982), who claims that if medical science is to
fall in line with modern physical thinking, we must admit that “time is
bound to our senses—it is part of us, it is not ‘out there’” (p. 43). It is what
we are. All else is elaboration on time, in time, through time. This means
revising the accepted paradigm governing health and disease since it is
dependent upon man’s view of time.
Time-binding is a human characteristic not available to the other
earthly levels of being. The term was originated by the distinguished
philosopher-semanticist Alfred Korzybski in the 1930s. Quite literally and
no less simply, to bind means to join or mix together—to cohere—to create
a new compound or substance that did not previously exist. Baking bread
and mixing concrete are apt examples of the binding mechanism. Man is
endowed with the ability to mix, sort, retrieve, digest, and reorganize
53
previous events, and make these available for the future. Not so for the
animal, plant, and mineral levels of being which must start each
“generation” anew with a blank slate. The experience of past generations is
available to man alone, allowing him to build and call upon a repository of
information about himself and his environment. This is then passed on to
succeeding generations. Time-binding, thus, allows civilizations to develop,
agriculture and technology to be invented, governmental systems to be
designed, that is to say, time-binding orders voluntary and intentional
change to occur.
Before we pursue time as the binding medium for mental health, we
need to understand the brain’s role in all of this (see “On Music, Mind,
Education, and Human Development,” “Man’s Brains,” Chapter 4). The
brain is a highly specialized time-binding organ. Although it is an organ of
specialized functions, there is no single area primarily responsible for
timing and temporal processes. Different areas seem to involve themselves
in temporal processing in different ways. First, however, it must be
understood that the human brain is a self-organizing system consisting of
three units—the reptilian brain, the mammalian (or paleomammalian) brain,
and the cerebral cortex (or neomammalian) brain. Each “brain,” or unit,
represents a major evolutionary leap in the development of the human
species. While viewing and analyzing each separately will serve to expand
understanding of the brain, per se, it must be understood that these three
units function as a single, interrelated, intermeshing whole.
The most primitive of the three units, the reptilian brain, has a limited
temporal capacity, involved mostly in biological rhythms. The mammalian
brain, which is of more recent evolutionary origin, can handle longer time
periods (Melges, 1982). This exceedingly complex and little understood
unit of the brain is also known as the limbic system. It is involved with such
diverse functions as emotions, feelings, attention, memory, and learning
sensations which we often erroneously prescribe exclusively to the human
species. Temporal involvement exists to a limited extent in all these
functions, but none so strongly as in the area of memory. For our present
purposes, the hippocampus is the most relevant component of the limbic
system, for it allows selective attention to only what is important among the
mass of stimuli that constantly bombard the human nervous system, playing
the same role in recall of stored information. Without this critical
selectivity, long- and short-term memory could not be separated from the
present, and for all practical purposes, we would be without memory (Rand
McNally, 1976). And finally, the cerebral cortex, which is the sophisticated
human brain, is the most highly developed, dealing with the more complex
issues of time.
Breaking down the functions of the cerebral cortex further, we note
that the left and right hemispheres appear to process time relationships
54
differently. The left hemisphere is primarily sequential, the right largely
simultaneous. Once again we encounter our friends knowledge time and
passion time, respectively. However, let us not forget that the corpus
callosum, that bridge which joins the two hemispheres, allows rapid
exchange of stimuli between the hemispheres. Why this duplication?
Melges suggests that processing information both sequentially and
simultaneously might enhance anticipation—i.e., future time. Seeing a
multitude of sequences simultaneously may allow a person a longer sense
of future. Time is such a powerful force, so it would seem, that the brain
gives over much of its space to temporal processing. Although our
knowledge of the brain is limited, and even what is known keeps changing,
there can be little doubt that time is central to its functioning, ranging from
conditioning to planning.
If psychological time is central to mental health, then does it not
follow that its (time) distortion contributes to mental illness? The causes of
personal time distortion are too numerous to chronicle, but whatever they
are, once distortion occurs, psychological reality is affected and
consciousness is altered. It is as though personal reality follows whatever
temporal road map is offered up by the cerebral cortex. We follow that map
and from it gain our personal identity and temporal perspective. Put another
way, “the sense of identity is related to the continuity of temporal
perspective, particularly future time perspective . . . [and] that temporal
disintegration appears to induce depersonalization . . .” (Melges, 1990, p.
265).
Continuing with Melges’ (1990) views on temporal perspective, he
believes that temporal distortions manifest themselves in a variety of
psychiatric syndromes. That is, the “disorganized thinking” and
“misconstrued expectations” manifest in mental illness may be the result of,
or, at the very least, involved in the temporal disorganization of the mind.
This disorder can be identified as disorganization of sequence, rate, and/or
temporal perspective, which are the basic components of psychological
time. It follows then that restoring temporal order should be the overarching
treatment goal. Does it not further follow that the most appropriate
treatment medium should be temporal in character? Music is the best
example, to my mind, for it addresses directly rate, sequence, and temporal
perspective, these being the basic components of music as well as
psychological time. We now turn to music to determine how these
components can be utilized in treatment.
Music—the Art of Time

55
Gotthold Ephraim Lessing, the 18th century German philosopher-dramatist,

opined that music is the art of time. If time is the primary “geometric
structure” which unifies the universe (with a little help from space and
matter), then is not music the unifying art? Fraser (1975) considers music to
be the ultimate of the arts—of expression, really—and that the most striking
effect the temporal arts exert on man is a sense of transcending time.
If music both transcends time and is time, are not both Fraser’s
passion and knowledge times required for music’s existence? To explore
this question further, four positions taken in the original discussion of
“music demands time-ordered behavior” (Sears, 1968) will be examined.
These are:
1. Music cannot be interrupted without losing its intent

2. The necessity for moment-to-moment commitment by the
individual rests in the music itself
3. Time-order extends beyond rhythm
4. The tempos of life and music are comparable
Music cannot be interrupted. You are listening to a favorite musical

selection on your stereo and the telephone rings. You are forced to direct
your attention away from the music and toward the voice on the other end
of the line. In this minor disruption, more has occurred than the simple
interruption of a pleasurable experience. A psychological process has been
short-circuited, and the future is different from what it would have been had
you been able to listen to the end of the piece. Music must be completed in
a single “sitting” to carry any meaning. The sequence of events must occur
in predictable succession, one upon the other, uninterrupted. For the
neurotic patient who is unable to plan ahead, music can crumble the time
disorientation in which he/she is trapped. Its time-ordered component is so
obvious to us that we forget the power inherent in it. One can mutilate the
time-order of a musical experience just so far before it becomes something
else.
Experiencing the present moment and going into the future is unique
to music. Time is the major difference between music and the other arts.
Dance probably comes the closest to being a temporal art, although this is
more because it moves in musical time, whether or not accompanied by
music. Dance addresses itself principally to the visual sense, and thus
belongs to the world of space. However, by Suzanne Langer’s reasoning
(1953), the space of dance is always illusory—a created element. That is,
the space (and time, as well) in which dance exists is not actual, but rather,
virtual.
There is another element of dance which we must recognize and that
Fraser (1987) terms “the ecstasy of the dance.” It is created from the
56
rhythmic motion upon which the dancer’s feelings are focused. But, and
this is the crux of Fraser’s point, this steady beat “has no preferred direction
in time, just as the ticks of the clock do not; . . . it is the absence of temporal
direction that the dancer notices” (p. 296–297). Yet another oddity found in
the “psyche” of the dance is that while dance is a temporal art, it can
become frozen in time. What a conundrum!
Even drama and poetry can be interrupted, slowed down, or speeded
up. A book is read chapter by chapter and usually is put aside several times
before completed. We can look at paintings from the top corner down, from
the side to the middle—any way we choose, any time we choose, and for as
long as we choose. We may better understand the message being
transmitted through the artist’s centering cues, and maybe in most instances
we are automatically drawn to the center. However, this is not required in
order to see, actually experience, the picture the artist has produced. We can
come back tomorrow and find for all of our lives the same picture.
We can modify or change our methods of experiencing other arts
media. But music is so basic a process, enjoying a direct channel to the
temporal lobe within the cerebral cortex without the need of transformation
or conversion from its original state, that the moment we commit ourselves
to it, we must be ordered in our behavior to some point in the future if
meaning is to result and reality prevail. You cannot stop the music
capriciously, or put it aside, and end up with anything but disparate tones. It
is this driving force, an adventure into the future, and the idea of being
successful and safe in the adventure that creates a unique personal contact
music therapists enjoy with their clients. Nothing else that I know of in life
is as temporally ordered. I think this is so basic that we cannot even ask the
right questions about what it means. We bypass it and insist upon the right
pitches, pleasing tone qualities, and strict tempi. Yes, George Bernard Shaw
was correct—the most difficult question to answer is the one to which the
answer is apparent.
Earlier I stated that distortions of personal time are a primary cause of
mental illness. Persons usually are hospitalized because they mishandle the
time-ordering of their society, and disorganized thinking results. Thus, to
restore mental health, a major therapeutic approach is to help people handle
time by removing the causes for the time distortions which plague them.
How to remove the time distortions which are firmly engrained? It stands to
reason that the treatment of choice should be temporally grounded, which,
of course, aptly describes music. The temporal demands inherent in music
are quite subtle. We are not aware in the act of music-making that our
behavior is being strictly engineered. By attending to the music, which is
the “now,” behavior becomes socially acceptable, and there is no room for
time distortions. Thus, each time an individual successfully “sees” a
musical selection through to completion, ordered time is being reinforced.
57
Moment-to-moment commitment rests in the music itself. The notion

of time-order starts when the patient is introduced to the music, and he/she
is immediately, although subtly, confronted with him- or herself. For some
patients, such as those suffering from affective disorders, committing to
anything that extends over time provokes stress because of their
disorganized concept of rate or duration of events. However, the music
totally determines duration of the commitment, and gradually the time
interval committed to the activity is elongated. But the process does not end
there. In fact, it does not even begin there, but rather with the music itself as
it exists through time in the environment. Time-order is the “stuff” of which
music is made. It is a fundamental element of the medium. Take a single
drumbeat, increase the speed and a tone will start to emerge. Add a few
syncopations to the beat, and a complex tone results. From complex tones
and combinations of higher orders of time-order, harmony is produced.
Slow down the impulse a bit, and the result is rhythm. All kinds of
manipulations are possible with time.
Perhaps the most powerful manipulation is the sense of motion built
into the music that propels it on into the future and makes the human
commitment ironclad. Epstein (1981) believes such motion must be
purposeful—controlled and directed—as the composer creates, and that
without this, music does not work, “lacking the ‘glue’ of real-time flow that
binds these parts into coherent movements, composed and heard from
beginning to end” (p. 186). It is almost as though the composer—and
eventually the performer—must be conscious of the time factor in music,
and must manipulate it in such a fashion that the listener will be compelled
to stay with the music until completed.
In Sound and Symbol, Victor Zuckerkandl (1956) presents a
compelling discussion of time in music. He claims that time in music is not
a “mere formality;” it is the “force.” That is, time is the energy, the power
that is music. He even goes beyond this by stating that if force were omitted
from the discussion about music, there would be little left to describe. Force
is no less real than is music itself. Time is not an abstraction—an empty
vessel into which tones, rhythm, and harmony are poured. No, he asserts,
time becomes solid experiential content through tones. Even that assertion
could be challenged if it were not for the rest—musical silence. If tones are
omitted and time is filled with silence, “what remains is not abstract, empty
form but a highly concrete experience; the experience of rhythm. There
would be no rhythm if time could not be experienced as such, in itself” (p.
203).
And what of that moment of silence that precedes the opening attack?
Lewis Rowell (1981) believes that this period of “no time” is an important
preparation for the new time (music) which is to come. “It is a highly
artificial, tensed silence,” he writes, “a way of erasing our previous
58
consciousness of time and of external events, a period of intense focus,
concentration, and pure expectation during which we are poised on the
brink of time, as it were, and are made ready to process the rapid succession
of temporal clues we are about to receive” (p. 201). Yes, silence is also in
the music, and its only medium of expression is time. Arthur Schnabel
(Peter, 1977) also recognized the weight of silence in music when he said,
“The notes I handle no better than many pianists. But the pauses between
the notes—ah, that is where the art resides!” (p. 350). I must wonder how
many artists and listeners have the remotest understanding of the enormity
of this seemingly radical statement, and more importantly, whether they
appreciate the virtue of silence in music.
At this point, it may be tempting to extend this discourse to other
properties of music which affect the personal commitment. Surely, the
melodic line drives the listener on. Meter provides an overarching
organization, and harmony is both foundation and movement. Yet we have
not digressed from the basic theme of time-order. We cannot separate the
basic elements of music into temporal and nontemporal components. Music
is temporality. Zuckerkandl (1956) maintains that “there is hardly a
phenomenon that can tell us more about time and temporality than can
music” (p. 152). Thus, the above examples should suffice for our present
purposes.
We cannot point to anything in the environment which gives music
its reality. By its very nature, music provides its own reality, not being
dependent upon external forces for meaning. Of course, the ideas, the
imaginings which the composer weaves into his work may be drawn from
the environment, but they are not one and the same with the resultant
musical product. Music is constructed from a purely dynamic nature, not a
static object. The laws of music do not dictate the course of events, but
instead show the way, allowing free choice of the path taken. All of this
reinforces what a powerful tool is music, not only for therapy but also
equally for so-called normal and maybe cosmic relationships.
Time order extends beyond rhythm. When the statement, “time order,
as conceived here, is a broader concept than rhythm” (Sears, 1968, p. 35)
was written in the mid-1960s, it may have been erroneously implied that the
prevailing opinion of the day credited music’s temporality primarily to
rhythm. Nothing could be further from the truth, as was explained later in
that paragraph. Yet the mere fact of its prominence there implies the
importance we have placed on rhythm’s temporal power.
Most listeners usually do not object when a slight mistake in a
musical rendition is made. No one objects, that is, except musicians, who
have been trained to care, to object, and to criticize. The one exception is
that most people are bothered by rhythmic errors. Perhaps you have
attended a church whose organist decides, for some reason, that the last
59
chord before the hymn commences should be held longer than the tempo
indicates. The introduction is played, the congregation is prepared to sing,
but the organist is not. Or listening to a very familiar selection performed
either too slow or too fast for the tempo we feel is correct. We cannot be
given three beats in proper tempo and then be made to wait for the fourth
without experiencing some discomfort because the normal expectancies
have been interrupted. We need to perceive that time is flowing clockwise
in equally measured cadence, not by fits and starts. This time-ordered
behavior is the feeling state that works so powerfully for music therapy.
Time is so “in” us. Man has yet to devise a verbal system which makes
cognitive sense out of time, but somehow we go ahead and substitute in our
heads the reality and feeling for which there are no words. The interruption
of time bothers us more than anything else. Patients experiencing acute
psychosis often have lost their temporal perspective. Time span has no
coherence. The melodic and rhythmic demands of music can provide a
strong therapeutic tool for correcting this temporal disintegration.
From the beginning of our musical studies, we have been taught
specific keyboard fingerings. Many of us must continually look back and
forth from fingers to musical notes because we never learned the
importance of time. The only reason for the instruction book is to remind us
of certain rules and techniques. However, we make the book more
important than the sound we produce. We concentrate more on playing the
right key than on the musical line moving through time. If this is the system
by which we were taught and we do not advance beyond technical facility,
we end up time butcherers instead of musicians. Yet this is not an altogether
accurate explanation of how we “learn” music, as [the late] Julian Jaynes
(1976) asserts in his powerful work, The Origin of Consciousness in the
Breakdown of the Bicameral Mind, the title of which is almost as lengthy as
is his message. Jaynes uses piano-playing as a fitting example of the role
consciousness plays in mental functioning. To move beyond butchering
time and to actually reproduce the music on the printed page, consciousness
fades into the background. It is literally impossible to be mentally aware of
all the tasks required to play even a simple musical piece. Certainly, we
must focus on these when learning the piece, but once beyond that,
consciousness is only fleetingly involved, if at all.
The sense of temporality is embodied in tone. It is even arguable to
assert that before rhythm comes tone, notwithstanding that musical rhythm
enjoys a much longer history. Returning again to Zuckerkandl’s admirable
treatise on the meaning of time in music (1956), he explains that even
before tone succeeds to melody the sense of movement exists, a concept
that has been expressed by others, such as Fraser (1975, 1987), Epstein
(1981), and Rowell (1981). It is not only that clock time passes as a tone is
sounded, but the need to move on in order to encounter completeness is
60
built into tone. A tone demands completion, which means, quite literally, to
cease being and let something else—something that is still in the future—
happen. The moment a tone sounds, time is opened to the listener, that is,
tone draws the listener to time. The tone is the present striving to become
the past so that the future can be. More will be said about past, present, and
future in the following sections.
To ignore any discussion of melody when speaking of tone denies the
relationship that exists between the two. However, a survey of the
psychology of music is beyond the scope of the present argument. Suffice it
to say, melody is organized sound which conveys meaning to a body of
people, and further, that such meaning is bound to cultural bonds among
people. Without this cultural unity, the result would be a parade of disparate
tones through time.
Harmony has some features which upon first glance appear to be
time-exempt. The structure of harmony is vertical. The notes of a chord
usually, although not always, appear simultaneously in time. Although we
do not deny that chordal progression, which creates harmony, is no less
temporal than all other musical elements, it is this frozen-in-time character
of the chord that is troubling. Nor is it valid to compare the tone/melody
development with the chord/harmony one. The difference appears to be the
dynamic quality inherent in a single chord which is absent from a lone tone.
There is something about the union of several tones, devoid of any outside
influence, that produces a dynamic sense and creates harmonic motion.
Thus, harmony best exemplifies the marriage of simultaneity and time.
Melody, harmony, meter, timbre, dynamics—all are time-ordered.
Frequency or pitch is a measure of cyclic time. Melody and harmony
become linear time. Formal structure of musical phrases are longer
extensions of linear time. The overtone series expresses compounded time
frequencies. Within music there exists the greatest collection of
multiplicities of time experience, appealing simultaneously to both the
conscious and unconscious. This, in Fraser’s mind (1975), is why music is
the “art of arts.” Whatever organizations exist in music, time-order is the
underlying factor—the constancy in a sea of change.
Tempos of life and music are comparable. Fraser (1975) speaks of the
“duality of time-in-music versus the time-of-life and the harmony of
dissonance between the two . . .” (p. 408). Von Franz (1978) recognized the
uniqueness of music when she said, “Man could be called a complex living
clock. In dance and music we express the rhythmicity of our whole
structure—these are arts through which we relate to time and give it
meaning” (p. 87). Langer (1953) states that music creates an order of
“virtual time,” that is, an intangible, illusory image. It exists in experiential
or “lived” time, Fraser’s passion time. Yet it becomes a perfect substitute
for clock time. Humans are not endowed with time perception nor a time
61
consciousness, only an awareness of change. Of course, change itself is not

an observable event that can be sensorily experienced but rather a series of
“states” contrasting with one another. Change creates time. Zuckerkandl
(1956) says this is not so for the music listener who observes that change
does not create time; rather, it is the other way, time creates change!
My own interpretation of all this is that music seems to happen to us
at about the speed that we feel life is moving. At times it may coincide with
clock time, while at other times will be totally experiential. Even this speed
is not exclusively a product of passion time, but is influenced by the music
itself—musical time, as it were. It is tempo that alters perception of time.
Time appears to move fast when listening or performing a musical selection
which contains many notes in close periodic sequence and which is
texturally rich. Conversely, if there are few notes which are drawn out over
a long period, time perception is extended. In these ways, it can be seen that
music, in fact, structures time.
Langer (1953) put this thought into more scholarly terms by declaring
that:
music spreads out time for our direct and complete apprehension, by
letting our hearing monopolize it—organize, fill, and shape it, all
alone [italics added]. It creates an image of time measured by the
motion of forms that seem to give it substance, yet a substance that
consists entirely of sound, so it is transitoriness itself. Music makes
time audible, and its form and continuity sensible [italics added]. (p.
110)
And, it must be noted, of the five physical senses, only hearing has direct
knowledge of time.
Subjectively, time has a fluid quality which much resembles a

running brook; sometimes bubbling past in a furious rush, sometimes
slipping by quietly unnoticed, and sometimes lying languid, almost
stationary, in deep pools. (Zukav, 1979, p. 170)§
§
Editor’s Note: In the course of organizing this section, I came across an
article written by the late MIT professor David Epstein in 1981. In it he
expressed ideas that W. Sears had espoused as far back as 1964. A brief
example is appropriate at this juncture. To quote Epstein, music “is a
temporal art in which flow, structure, and continuity are essential. However,
no . . . flexibility in its performance could be taken by musicians . . . [as is
possible with other arts forms] without wholesale distortion of the musical
text. In this sense music is perhaps unique not only among the arts but in
our experience of time itself. . . . Music actually structures time—and the
62
The speed with which we go into the future is where most of us

encounter difficulty, especially if we are still learning our craft.
Psychological problems usually develop in people who have lost control of
their futures and who cannot function within the flow of time dictated by
their society. We have to move into the future at about the same speed with
music as we live our lives. This reinforces my earlier remark. It is very
crucial that we understand this in order to comprehend what is happening in
the musical situation, and how to transfer this to the therapeutic setting. In
other words, the time-order which is built into music must match our
internal clocks to a degree that will allow us to cope with all the vicissitudes
life spreads before us—the greater the match, the stronger our coping
techniques.
This “times” match is Altshuler’s Iso-principle (1948), a homeostatic
concept which prescribes that the affective character of the music be in
equal, or “iso” relation to that of the listener-client. At the outset, the music
is selected to match the client’s mood. Gradually, the mood of the music is
altered to bring about a changed and more appropriate behavior in the
listener. Sadly, the Iso-principle is rarely referred to by name these days, yet
the process is used by some music therapists even though they may not be
aware of its history. If therapists would be made aware of the intrinsic value
of the Iso-principle, and used it regularly as a clinical technique, music
therapy would be strengthened. The Iso-principle is one tool in the music
therapist’s arsenal. It should be used, it should be written about, and most
importantly, it should be examined and tested. Until that occurs, we will
never know its true value. Actually, a form of the Iso-prinicple is regularly
applied when therapists obtain musical preference information from their
patients as part of the patient assessment battery.
flow of time—in precise quanta and proportions, controlling this flow, its
intensities, its direction, its speed, its goal orientation, to a degree
unmatched in other domains of our temporal experience” (p. 182).
“Music structures time” claims Epstein (and a few other renown
scholars), not the other way around. Essentially, this has been the premise
of this chapter. Even “music as time-ordered behavior” presupposes that
time-order is implicit in music, serving at the pleasure of the flowing music.
Can we exchange “creates” for “structures” in the above Epstein quotation?
It certainly follows, but what happens if “exists in” is substituted? This
turns the thesis around and removes the power of music which exists
because of its direct connection to the emotive self. No intermediary is
necessary, or more precisely, occurs between the aural source (ear) and the
interpretive center (brain).
63
Finding the client’s inner clock and determining how far it is from
what is acceptable to society and what is necessary to satisfactorily function
in that society, becomes the therapist’s task. However, we must understand
also that people can and do run on different times, societal dictates
notwithstanding, and recognize that they are able to handle exceptions to
their individual times much of the time. This is being demonstrated more
and more by business and industry, which will allow employees whose
work does not depend upon a set time schedule to determine the time period
they choose to work. This is called “flextime.”
Polychronic cultures, as was explained earlier, perceive time as a
patterned whole rather than proceeding linearly through past, present, and
future. Yet even monochronic cultures as our own cannot scientifically sort
out the distinction. For example, in geophysical clock time “now” is
relatively unimportant. In fact, there is no such thing as the present. There is
a little bit of time between the stimulus of “now” and the time the observer
can conceive of it or perceive it, as I discovered in high school geometry.
Therefore, we are always operating in the past.
Physicist David Bohm’s description of this phenomenon (Weber,
1982) goes something like this: the past is contained in the present in the
form of memory, and the future is projected from the present as a response
of memory. If the present is the dividing line between past and future,
which do not actually exist as such, then, Bohm asserts, the present also
cannot exist. This leaves us with an “unspecifiable” and “indescribable”
present. Another conundrum! However, all is not chaos; since we know that
the present recurs regularly based on the past, we can be fairly confident
that the pattern will continue.
This can relate to musical processes such as the speed with which we
perform music, the way we practice, and even our listening styles, all of
which are found in the therapy session. The object of the practice, by
following this concept, would be to try to make the future coincide more
closely with the present moment. In other words, when we are learning a
piece of music, we practice slowly, and then speed up as we become more
familiar with it through numerous repetitions. We are, in a sense, trying to
make the future coincide more closely with the present, which we are never
able to do because by the time we have awareness of the present moment, it
has already passed.
All of the profound statements made through the ages do not compare
with Bois’ (1966) down-to-earth logic about the origin of the meaning of
the concept “present.” The present exists sandwiched between past and
future, he says, “because somebody created it as a pattern of thinking about
a process-happening that had no definite place, borders, or size. Somebody
put it there long, long ago. Once the thinking pattern was invented and put
into circulation, nobody thought of inventing a different one to modify our
64
reaction to that process-happening” (p. 158). It is as simple as that! If Bois’
assessment is true, one must wonder what earth-shattering problems were
so consuming the minds of the great thinkers through the ages that they
could not energize their exceptional cerebral endowments to tackle the
“present” question.
Musical memory also has a part to play in this temporal drama. Roger
Jones (1982) wonders in what state is a musical work held in memory by
the listener thoroughly familiar with the piece? “It is not in time as in a
performance, any more than our ideas, recollections, and dreams may be
thought of as existing in objective time. . . . The apprehension of a piece of
music, held as a totality in the memory, gives us a glimpse of a different
kind of time consciousness . . . , in which experiences are not sequential . . .
, but are simultaneous, and amalgamated into an organic complex” (p. 92–
93). What may have (or may not have, for that matter) entered the head in
Fraser’s knowledge time now is transformed into a holistic pattern where
linearity is a stranger.
Time is our problem. If we could forget everything bad that has
happened to us and not project it into the future, we would be safe. It is not
the present moment—however abstract that concept may be—that bothers
us so much as worrying about what happened in the past, and what that may
have to do with the future. The objective in music therapy is to start in the
present—where it is not hurting—move into the future, and make whatever
has been troubling us not happen sooner. Maybe we even can forget about
it. Thus, through music we are led to an absence of memory.
In the course of [writing this chapter], I discovered numerous
statements scholars have written about the mysteries of time, aside from
complete volumes written by such persons as J. T. Fraser. Many statements
were so profound that paraphrasing seemed an injustice to the depth of
thinking that produced them. It would have been simple to string these
quotations together, and thus create a coherent and logical argument. Short
of that, I can only hope that I have piqued the curiosity of the [reader] to
search out the original sources and delve deeper into the astounding world
of times.
Editor’s Summary
This chapter’s premise that music is time-ordered behavior was tested by
exploring the meaning of time and the temporal nature of music. Time
cannot be expressed or even experienced in the singular, but instead exists
in many different states, both linear and nonlinear. Cultures, and even
individual human beings, operate on different time scales, demonstrating
the multiplicity of temporalities. Then there is the time of physics, which
65
had been successfully avoided until Einstein forced the issue in the early
20th century.
Man’s inner time is also a hierarchy of temporalities. How smart the
brain must be to keep track of all those ticking biological and psychological
clocks, thereby assuring that harmony reigns in the system. When
asynchrony develops, particularly in the psychological time pieces, mental
and physical health is jeopardized. Indeed, temporal distortion is a leading
cause of mental illness.
Music is the art of time. All of its elements—individually and
collectively—are the embodiment of temporality. Yet music also has the
ability to transcend time. We must thus say that music is endowed with its
own music-time (knowledge time) and listener/performer-time (passion
time). Music is a multiplicity of temporalities. Thus, we must conclude that
music is times-ordered behavior.
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READING 33
Sekeles, C. (1996). Two Excerpts: Music, Motion, and Emotion: The

Developmental-Integrative Model in Music Therapy, pp. 1–24, 25–62. Gilsum NH:
Excerpt One
THE ROOTS OF
MUSIC THERAPY IN
TRADITIONAL HEALING RITUALS
Chava Sekeles
INTRODUCTION
Traditional healing rituals serve as the most ancient origins of music therapy.
Archeological and anthropological evidence has revealed that such rituals
existed as far back as the Paleolithic culture of Ur of the Chaldese (La Barre
1970). La Barre refers to shamanic1 rituals in which to the best of our knowledge
music was a major and permanent element.
I have chosen to discuss this subject with examples from those societies which
even today do not possess a written culture (such as certain groups to be found
in remote regions of Africa, South America and Asia), as well as societies which
exist on the fringes of a literate world (such as certain groups of Moroccan
Berbers). In these societies it is the oral tradition which dominates and it is music
as a therapeutic agent which precedes the written word (amulets, inscribed
blessings, etc.).
Traditional medicine is known by a number of names such as primitive, ethnic,
rural, folk, shamanic and so on. There are also various subclassifications: Jane
Achtenberg (1985) speaks of two main types, technological and shamanic. In her
view the first consists of the use of herbs, piercing the skull, the removal of
tumors and so on, whereas the second is concerned with the spirit. If
technological medicine strives for the elimination of symptoms and a relief from
pain, shamanic medicine is devoted to the overall health of the whole being by
means of suggestion and fantasy.
Foster (1976, 1978), phrases it differently, his two chosen categories are
naturalistic and personalistic. The first takes into account the objective factors
such as natural forces, or obvious symptoms of imbalance such as fever or chill,
whereas in the second there is a deliberate intervention of various agents which
he further subdivides into human (witches and sorcerers), extrahuman (demons,
treatment. In this connection Foster presents an example from Sudan: the shaman
goes into an ecstatic trance in which he discovers the cause of the ailment and
how it came about. He then hands over the actual healing process to someone
else (ibid., 778).
It is held that disease attacks man because he has infringed certain taboos and
thus exposed himself to the invasion of evil spirits which are capable of stealing
his soul (as Eskimos believe), to rule over it (the North African belief in being
“possessed by the devil”), or to torment it by means of visions and dreams (North
American Salish Indians), and so on. evil spirits, ancestors), and superhuman (the
gods and their emissaries). Whereas naturalistic healing perceives only the
disease and its symptoms and treats them as best it can, personalistic healing is
rooted in the overall perception of the human being and therefore also touches on
religion and magic.
The healer or shaman engaged in personalistic healing is first and foremost
concerned with such questions as “Who caused this affliction, and to what
purpose?” For many the diagnosis is of graver importance than the actual
According to Foster’s definitions it would seem that the main role of music is in
personalistic healing. However there is evidence that music is not the only art
form utilized in healing rituals. There is an integration of movement, costume,
headdress, dramatic action, the ritual decoration of musical instruments (in Asia
and Africa for example), painted bodies and faces (North American Indian tribes)
as well as more unique phenomena (such as the sand drawings of the Navajo
Indians in the southwest of the United States). Indeed, in traditional societies, art
forms have a mainly magical significance; unlike in Western civilization they are
not solely devoted to aesthetics.
At this point I should like to comment that the integration to be found in such
traditional healing rituals could serve us well as a model for music therapy, and a
means of exploiting the basics of intercommunication and primal expression. An
example is included among the case histories to be discussed in later chapters
which touch on the natural and spontaneous links between music and other art
forms.2
As opposed to art music which might be employed in music therapy, the music
in healing ritual makes it easier for us to explore the degree to which both the
physiological organism and the emotional mood of the patient can be influenced.
This is due to the comparative simplicity of a musical texture based only on a few
components. Even in the Voodoo rites in Haiti, in which the drummers make use
of highly complex rhythms, a basic beat is maintained to serve as a framework
(“holder”) for both music and participants. It should also be noted that apart from
drumming and stick beating there are almost no additional musical elements.*
It is possible nowadays (as will be described later on) to assess under clinical
conditions the influence of drumming on the human brain and thus, to a certain
degree, the effect it has in healing ritual.
On the other hand, the music therapist wishing to evaluate the effect on his
patient of a complex musical work (such as a Beethoven Quartet, or Berlioz’
Symphonie Fantastique) must be prepared to break these down into their
components, to analyze, to raise questions both about the musical and
nonmusical aspects. What, for example, is the dominant element which influences
gross or fine locomotion? What influences breathing, and how? When were there
head movements, hip movements, or movements of the hands and feet? Which
sections or elements aroused personal associations in the patient, and just what
were they? What angered, what stimulated, what saddened, what gladdened?
The more complex the music, the heavier the task for the therapist (even after
the most detailed analysis) to truly assess its influence on the patient. Apart from
analyzing the music, the patient’s own personality must be taken into
consideration, his education and cultural background, his past and present
experience of music, the effect of his accumulated memories (and their content)
on his flow of free association, and so on. It is these questions which dictate a
fresh approach and prolonged observation as far as each and every individual
patient is concerned. This is, in my view, a crossword puzzle whose solution is to
be found in a combination of various and varied disciplines.
As has already been stated, the music of healing rituals contains very few
components: often it is only the rhythm, expressed by drums, hand clapping, foot
stomping, stick beating, and occasionally by jangling bracelets. Should there be
any semblance of melody, it is minimal and repetitive.
In ecstatic rituals in Asia, Africa and Australia for example, drumming is the
major component.* In certain rites, such as those of the Hamadsha in the
Moroccan Atlas Mountains, oboes are added; on the other hand in the hypnotic
rituals of the North American Indians it is singing which is dominant,
accompanied by rattles and now and then by a monotonous, repetitive drum
rhythm.**
In a comparative study of the components and typical developments of such
ecstatic rituals as opposed to the hypnotic, I found a remarkable similarity of
basic processes, despite vast geographical, cultural and other differences
between the groups examined (Sekeles 1981).
In all such ecstatic rituals (whether they last a few hours, a full day, or even
several days), the rhythmic and dynamic development is extremely similar. The
ritual begins with a drum (or other rhythmic means such as foot stomping, hand
clapping or stick beating) in a repetitive metronomic tempo of 60 to 80 MM
(between largo and andante), a tempo which matches the normal human
heartbeat. Gradually there is an acceleration which can advance to more than 200
MM; thus from a moderate tempo the music and the locomotion of the
participants reach the equivalent of presto–prestissimo.
Along with this acceleration comes an increase in volume, and at the climax of
the ritual we can hear a multirhythmic texture in which the melody (if there was
one) shatters apart as do the words (if there were any). An excellent example of
this is the Ahouache ritual from the Moroccan Atlas Mountains which moves from
76 to 200 MM, resulting in an inability to either reproduce or understand the
words, particularly if we take into consideration that the participants are in
continual motion, which increases in tempo all the time.*** (Later on we shall
examine the symptoms induced by intensive rhythmic stimulation combined with
movement from both a psychological and emotional point of view).
As far as hypnotic healing rituals are concerned, the musical aspects are
different. The beat begins in a moderate tempo suited to a relaxed heartbeat, and
maintains this throughout. Now and then stimuli may be inserted, by means of a
single drum, and often by rattles whose sound is more ambiguous.
Frances Densmore (1954), found that in North American Indian rituals of such
nature the rattles and drums maintain a steady rhythm while the melodic line is
irregular, characterized by a shift of both accent and duration. Densmore stresses
that this is an unusual phenomenon for a Western musician and concludes that it
is the maintenance of a steady beat which permits melodic freedom.3
I would like to present here a few comparative examples:4 At this stage we are
not taking into consideration the actual duration of each ritual—only its degree of
acceleration.
Ecstatic Healing Rituals
No. Location Musical Activity Start Peak

Tempo/MM Tempo/MM
1. Manchuria Drums, some singing 78 206

2. Siberia Drums, some singing 72 200
3. Borneo Drums, cymbals, 76 152
4. Haiti Drums, sticks, cymbals 80 208
5. Malagasy Hand clapping, 70 200
(Atandory)Foot stomping, singing
and hyperventilation
6. Guinea Drums, cymbals 72 205
7. Kenya Drums, singing, 72 184
(Gerengany) Natural horn
8. Ethiopia Drums, clapping, 72 192
(Zar) Stomping, singing
9. Morocco Drums, oboes 70 198
(Hamadsha)
10. Morocco Drums, singing 76 200
Atlas Mountains
(Ahouache)
Hypnotic Healing Rituals
No. Location Musical Activity Start Peak

Tempo/MM Tempo/MM
1. Dakota Singing, drumming 72 72

(Sioux)
2. Colorado Singing 88 88
(California)
(Yuman)
3. Nebraska Singing, rattles 74 74
(Pawnee)
4. U.S.A. Singing 82 82
N.W. Coast
(Kwakiutl)
5. Canada Singing, rattles 88 88
South Coast
(Chippewa)
6. Ecuador Singing, leaf rustling 84 84
(Napo) violin and whistle
Before going on to discuss the specific musical elements of healing rituals and
to analyze their effect from a psychophysiological point of view I should like to
furnish brief descriptions of four examples for purposes of clarification.
HYPNOTIC HEALING RITUALS
The Navajo Indians

The Navajo tribe has inhabited parts of the southwest of what is now the United
States ever since the year 1500. The Navajo adopted the agricultural methods and
well-known weaving skills of their neighbors the Pueblo. From the Spanish they
learned animal husbandry, and from the Mexicans (in the 19th century) the art of
the silversmith. The Navajo are the richest of all American Indian tribes and live
on a sixteen-million acre reservation which stretches over parts of Arizona, New
Mexico and the Utah desert. It is an area rich in oil, coal and uranium. Despite
having adopted the English language, the tribal chieftains nevertheless endeavor
to teach their offspring their original tongue, folk legend and tradition, and this
within the regular school system.
Modern Western-style medicine and the medical practitioner are the lowest on
the list of their priorities, together with the traditional herbalists. On the other
hand the tribal healer is still considered to be the best diagnostic, his advice and
medicines are considered to be extremely powerful, while his extranatural and
supernatural powers go totally unchallenged. Among the Navajo, both naturalistic
and personalistic medicine (Foster 1976), are accompanied by chants and song.
These are conducted over a nine-day period either by the healer himself or by a
specially-trained singer. The Navajo believe that singing and incantation are the
central means by which harmony can be restored both to the patient’s body and
soul and to his surroundings5 (Deloria 1974, 374).
It is interesting to note that the American establishment, including the National
Institute for Mental Health, recognizes the value of traditional healing methods,
and even provides partial financing for the training of traditional healers.
As mentioned, among the Navajo the use of herbal cures is considered to be the
simplest of all healing practices, and is much less widespread than in other
tribes. Far more esteemed are symbolic methods which employ singing and sand
drawings. These are executed on a bed of dry sand in colors produced from
plants, soils and minerals. Such drawings are composed by some fifteen people
during the course of a full day and comprise dozens of complex symbols. These
symbols together with the singing and chanting are designed to banish the
disease, or the misfortune which has befallen the tribe, the witchcraft or whatever.
The following example of such a hypnotic ritual describes the case of a sick
infant: The group of healers arrives at the home of the sick infant bearing sheets
of cloth on which the clean sand is to be spread. Once the area to be drawn has
been smoothed out, pinches of sand are grasped between finger and thumb, and
the design begins. The symbols are chosen according to the patient’s complaint,
and in this case they create a figure with arrows and lightning flashes radiating
from its outstretched arms. During the ritual, mother and child are seated in the
center of this picture,
and the figure portrayed in the sand transmits its healing powers to both. The
medicine man plays a rattle, prays and sings, laying hands on both mother and
infant with elaborate, stylized gestures. Both prayer and song have a quiet and
soothing dynamic. The vocal range is limited, the rhythm slow, and the rattle
provides a constant beat, leading to a sense of security and relaxation which,
combined with the magic thinking and faith of the participants, becomes a
formidable therapeutic force (Maxwell 1978, 239–241).
Frances Densmore (1927) stresses the soothing atmosphere of all the healing
rituals she witnessed in Indian tribes from British Columbia to Florida.6
The healer has been given the songs he employs in a dream or in a hypnotic
trance (experiences the Indians believe to be supernatural). The healer sings and
his patient listens, motionless. This example of receptive therapy can be seen as
a primeval example of Guided Imagery in Music as experimented with and
formulated by Helen Bonny (Bonny & Savary 1990).
Once the ritual is over, each one of the participants is permitted to take a
handful of sand from the drawing. From now on such sand is believed to possess
special healing powers. The remainder of the drawing must be swept away in a
northerly direction. The Navajo also use masks in those rituals which last a
number of days, and healing drugs in the most severe cases.
One of the most interesting phenomena of Navajo song and incantation is the
existence of the nonsense syllables (which seem to have no logic in speech). The
sequence of these must be painstakingly rehearsed otherwise the healing
process will not succeed. The tribes people believe that these syllables comprise
a magical structure, or charm, and must not be altered in any way lest they lose
their power (Herzog 1933). According to Ida Halpern (1967),7 who researched the
songs of Indian tribes on the Northwest Pacific Coast, such sounds (which are
also characteristic of this region) are actually derived from genuine words and
from the cries of animals, which may explain their magical powers.
Whatever the case it appears that despite the uniqueness of the Navajo sand
drawings, the atmosphere created by the music in their healing rituals is typical of
many other Indian tribes. It is prominent at every stage of the ritual and serves as
a basis for relaxation and soothing.
The Napo: Upper Amazon—Ecuador

In 1967 Neelon Crawford and Dan Weaks photographed and recorded a
shamanic healing ritual in the Napo River region of Eastern Ecuador. Since this
ritual involves the use of hallucinogenic drugs (as do other rituals in this region), I
have chosen it as an additional example of hypnotic ritual.
At the outset the shaman is seated on an ornate wooden stool in the shape of a
sea turtle which symbolizes the feminine force of water, and drinks a potion made
from Banisteriopsis Caapi (of the Malpighiaceous family).8 People in the region
refer to this in the feminine gender as “Beautiful Spirit” or “Mamma.” With the aid
of this drug the shaman is assumed to be able to enter a different world of
experience, to gain strength and clarity of thought, acquire knowledge and thus
be able to trade with the spirits.
The sick woman who has been brought before the shaman lies on a straw pallet
at his feet. The ritual begins with a prelude played on three-stringed musical
instruments, this is known as the “Visionary Song.” The two upper strings play
both the rhythmic and melodic pattern, while the lower string serves as a drone to
attract the spirits. The sick woman is also given a dose of the drugged potion,
and once it begins to take effect on her the shaman begins to play a bone flute
whose function is to summon up the Spirit of the Jungle and the Spirit of the Sea.
Later on the shaman speaks rapidly with the sick woman and the husband who
has brought her, reassuring them that he has the power to heal her, that the spirit
he has summoned appears in his visions and that the healing can proceed.
The shaman then takes a bundle of leaves, purifies them with water and uses
them to produce a soft, rhythmic rustling; he calls upon the spirits to emerge from
his stomach, sprinkles water and banishes the unwanted spirits by blowing his
breath at them. All this time the sick woman lies silent; all speech and music are
restrained and repetitive. The woman and the shaman experience visions which
are described by him in song. During this he swings his body from right to left
and back again in a steady rhythm, performing magical journeys from this world
to the world of spirits and returning.
From a musical point of view the melody consists of a single major chord,
alternating occasionally with a minor. The range of voice is confined to a fifth,
while the melody moves down from high to low (as in any typical lullaby). When
reaching the central tone the shaman plays a soft tremolo. It should be noted that
the style of playing, the singing accompanied by the rustling leaves, and the
melodic structure, are all typical of traditional societies in the indigenous cultures
of the South American Lowlands. The rattling, or rustling, which accompanies the
singing are, however, typical of all Indian tribes in both North and South America.
At a certain stage in the ritual the shaman snatches out harmful objects from
within the woman’s stomach, chews on them and spits them away.
Then the woman, for the first time since she has been brought before him,
suddenly informs him of what actually happened to her:
“I went to the garden to get Maniok” she says, “a stick of Maniok broke and hit
me in the side and I fell. The wound kept hurting and now I’m almost dead.”
The shaman reassures her that he knows the identity of the evil spirit who did
this, and will repay him in kind.
The ritual is conducted at night, and after some eight hours the shaman remains
alone with the woman, speaking to her gently and comfortingly with no musical
accompaniment (Whitten 1976).
During the entire ten hours of the ritual the soothing melody and andante tempo
is consistently maintained, even in the hallucinatory and terrifying passages.
It should be stressed that despite the vast differences between the Navajo
Indian healing ritual described earlier, and this one from the Jungle Quichua of
the Napo River Region, the hypnotic components of the music are common to
both and are integrated into all stages, with their purpose clearly understood by
both healer and participants alike.
The melodic range is limited, as are the dynamics. The rattles or the rustling
leaves which accompany the singing in both rituals, contribute to continuity and a
gentle flow. The Napo stringed instrument contains the same components as
those of the singing and can thus be included in the same melodic category. In
both rituals the patient remains passive, prone or seated, allowing the music to be
absorbed and to arouse visions. Some of these visions may be dictated by the
healer or the shaman, as is occasionally done in guided imagery. It may well be
that part of this imaging is personal, but we have no way of knowing this.
Whatever the case the ritual leads to soothing and relaxation, to a maximum
concentration on the patient, and to the summoning up of mental powers and
resources. Later, we shall be discussing the rationale of such therapy from a
psychophysiological point of view.
ECSTATIC HEALING RITUALS
The Vezo tribe—Madagascar

The Vezo live in the southwest of Madagascar and are a minority group within
the Sakalava. They are a seminomadic people who inhabit the forests along the
shores of the Mozambique Straits and subsist, in the main, from fishing.
According to their beliefs, disease and other disasters originate in a supernatural
world peopled variously by the kingly spirits, the spirits of important persons
drowned at sea, and the spirits of their ancestors who constantly look down upon
them and observe them. It is the first two categories of spirits who are most likely
to take possession of a personality and cause illness. The reasons for such
domination are a punishment for the transgression of social norms or family
unity. The penalty is an interference with the smooth progress of a normal
existence.
In order to pacify the punitive spirit, it has to be identified, contacted as soon as
possible, and negotiated with in order to ensure its exorcism.
The ritual itself resembles total theatre with a huge cast of characters, each of
whom is playing a well-rehearsed role. Each group of spirits has its own specific
musical repertoire.9
The roles played by the music are many and varied: to prepare the healer for his
task, to soothe the patient, to assist in diagnosis, to appeal to the spirits and the
gods, to act as emissary to and fro, to serve as a basis for the dancing, and so on
and so forth.
It should be noted that all other styles of music employed by the Vezo tribe,
which concern hunting, farming and similar matters, are limited to the singing of
poetry. It is only the tribal healing rituals which are characterized by a collective
musical endeavor within such an impressive theatrical format.
As in other parts of the world, here too the healer draws his strength, either in a
dream or in a vision, from a godly spirit or from the spirit of his ancestors, which
is henceforward acknowledged to be his own.
This particular ritual was recorded in the years 1967–9 by Koechlin from the
Ethnomusicological Department of the Musee de L’Homme in Paris. Like many
other ecstatic healing rituals, it takes place in the open air. In the area reserved
for the rites stands a kind of altar on which are laid out all the ritual paraphernalia.
The ritual is divided into four stages:
1. The patient is brought before the altar and faces east as he listens to the
instructions of the healer’s assistant. The women play and sing under the
guidance of a tribal music master; the melody is simple and repetitive, thus
permitting improvisation and the moulding of verbal phrases while seeking out
the spirits or demons; the singing itself is backed by the repetitive beating of two
drums and by hand clapping. By degrees this combination is joined by the
maruvaani (the local version of the lyre) and by the rattle. These are played by the
men. The role of the lyre is to attract the spirits. The participants react with
movement, which at this stage remains slow and relaxed in accordance with the
stimulus of the sounds. Once the evil spirit has been identified the overall tempo
advances to allegro, cries of encouragement are heard and incense is scattered.
2. At this stage the evil spirit brutally invades the body of the medium (usually a
member of the patient’s immediate family), causing him or her to lose
consciousness. The music ceases abruptly, signalling the beginning of the
process which the tribe defines as resurrection. Even after the medium has been
“restored to life,” he or she remains in an ecstatic trance. From here on the
dancing steadily accelerates to include spins and leaps and so on.
3. This is the stage in which the healer/shaman transmits his signals to both
spirits and patient. The music accelerates to presto and dancing is based on
twirlings and gyrations. Mothers dance their way up to the altar and absorb the
benevolent spirits which it houses. Occasionally the tempo is relaxed, only to
return to its former frenzy.
4. At this stage the spirits are banished by fast-paced music and dancing. The
spirit departs from the body as it entered it, aggressively and violently. The more
evil the spirit is considered to be, the more frenziedly dramatic the ritual
becomes, with the musical tempo reaching prestissimo.10 The music breaks off
entirely when the Medium emerges from his or her trance and returns to normal.
The Moroccan Berbers

In Morocco there are several Berber groups who conduct festivals,
circumcision rites and healing rituals. One of these, the Hamadsha, has been
vividly described by Crapanzano (1973). They are divided into two subgroups
named after Moroccan Saints whose tombs lie a few kilometers northwest of the
town of Mekness (Sidi Ali Ben Hamdush and Sidi Ahmed Dghughi). They see
themselves mainly as exorcists of the devil, thanks to the powers and special
blessings they have been granted by God, his servant Mohammed, and his Holy
Brethren.
According to Crapanzano the achievements of the Hamadsha are remarkable
even by the standards of conventional Western medicine. They successfully treat
a variety of syndromes including hysterical paralysis, mutism, sudden blindness
due to psychological causes, severe depression, anxiety, and more. Their aim is
not necessarily to restore the patient to his former ability as a member of society.
They frequently adopt him into their own, or a similar, group framework, giving
him new functions and new aims.11 In this way his life takes on a new meaning,
possibly more suited to his needs, and even altering his social status.12 The
Hamadsha impart to the patient their own interpretation of his affliction, and a
description of the proposed cure, by means of the accepted symbols of the
patient’s own society. Since the ecstatic rituals are conducted within an extremely
organized pattern, the participant has the constant opportunity of a release from
tension and pressure, while still feeling secure.
Music for the Hamadsha rites is provided by three guwwalla (an hourglass
shaped pottery drum), one tabbal (snare drum), and two oboes known as the
ghyyata. A major role is assigned to the leader of the ceremony and master of the
dancing (known as the Muqaddim), as well as to the two men who collect cash
contributions from the participants.
The group assembles in a semicircle with the musicians at one extreme, facing
them is a troupe of about twenty males ranged shoulder-to-shoulder. The dancing
(a reaction to the music of the oboes and drums), develops stage-by-stage
(according to the rules of ecstatic ritual we have already encountered), the
Muqaddim, serving as a kind of role model, directing the actions of the other
participants. His movements, as in other ecstatic rituals, include leaping (similar
to that of the Asian shaman), spinning and twirling (similar to that of the
Ahouache or the Vezo) and heavy landings on the heels which may sometimes be
accompanied by breast beating with his fists. When the women join in, their
movements are typified by bold gyrations of the hips and bowing backwards and
forwards with their loose hair flying in all directions.
The number of participants steadily grows, the drumming increases both in
dynamic and in tempo, and on this basis the ghyyata play the “Rih” (a tune
symbolizing the evil spirits) specifically aimed at the demon which has been
identified as the inflictor of the disease. It is here that the significant role of the
wind instruments comes into play. On occasions the identity of the evil spirit is
known in advance, but if this is not the case it must be sought by means of a
series of melodies (the “Ariah”). This might take hours until the patient displays
what the Hamadsha perceive as a positive response to the music.13
The more the ecstatic trance takes hold, social taboos (such as both sexes
dancing together, or the use of sexually suggestive movement and gesture)
diminish. At the climax of the ritual the Muqaddim and his followers are quite
likely to group together and slash their heads with knives in an act of self-
mutilation. The blood is believed to be sacred and strength giving, and so the
other participants daub themselves with the blood streaming from the Hamadsha
and beseech their blessing. At the climax of the ritual, the evil spirit is exorcised.
Like many other ecstatic healing rituals, all this takes place in the open air, often
in the market square—a venue for a variety of other rousing events. In addition to
the already described means of exorcism (the rhythmic stimuli, the Ariah on the
oboes, the ecstatic dancing, etc.) the Hamadsha prepare themselves beforehand
by drinking highly-sweetened tea, by snake charming, and at climactic moments
of the ritual by drinking boiling water and eating cactus fruit, spines and all. Such
phenomena and their possible explanations will be discussed later.
At the end of the ritual, which can last anything from hours to days, the
participants fall into a lengthy and well-earned slumber.
Despite the fact that the Moroccan intelligentsia and the Moslem authorities
openly disapprove of such events, and attribute them to marginal illiterate
groups, they turn a blind eye to their existence, and in so doing, it would seem,
display a discreet understanding of the psychological and social value of such
functions.
We have noted identical characteristics in two examples of hypnotic rituals, as
well as in ecstatic rituals, conducted a continent apart, or at a distance of some
six thousand kilometers one from the other.
For the purposes of this study, the essential similarities between the musical
components in ecstatic ritual consist of the rhythmic stimuli created by
drumming, hand clapping, stick beating, and rattles or cymbals (depending on
any given culture). Such rhythmic stimuli provoke and influence a motor response
which is systematically developed to a degree which allows the participant to
enter into an ecstatic trance without which the healing process would be
impossible. At the climax of this trance the evil spirit is exorcised.
On the basis of this rhythmic stimulus, as already mentioned, can be added the
playing or singing of melodies which have a therapeutic significance. In the
fastest-moving moments of the ritual the rendering of these melodies is often
taken over by nondancers, whereas sometimes it is the only role played by the
musicians and the singers. When the singing is integrated with frenzied
movement it becomes impossible to perform, hence in a ritual such as that of the
Ahouache Berbers, in which all participants both sing and dance, at the ecstatic
climax words and syllables become completely incoherent.
Following is a table of comparison between ecstatic and hypnotic rituals from
the point of view of their musical components, the characteristics of movement
and physiological phenomena, the psychological gain, and their spiritual
significance.
Comparison Ecstatic Ritual Hypnotic Ritual
a. Components 1. Stressed beat units, 1.Fixed beat units at a

of sound, increasing in tempo normal or low heart rate
rhythm and from larghetto to
dynamics presto prestissimo
2. Dynamic at peak 2.Same tempo until end
reaching fff of ritual
3. At climax: multirhythms 3.Moderate, repetitive
and a disorganization dynamic
of components
b.Musical 1. Drum, or drums 1.Rattle or leaf-rustle

instruments solo drum (occasionally)
2. Other percussion: 2.Occasional string
stick beating, rattles, instrument
hand clapping, hand/body
cymbals, foot stomping,
body slapping
3. Wind instruments:
flutes, conch shells,
natural horns
c. Vocality 1. Not always used: 1.A key element

breaks out at climactic
moments and may well be
transferred to a substitute
2. Yelling, yodelling, 2.Brief repetitive melody
hyperventilation
3.Occasional transfer of
melody from Voice to
Instrument
d.Vocabulary 1. If words are used they 1.Words are usually given

are generally in to the healer in a dream.
hypnotic ritual. 2.The origins of these
words are to be found in the
animal world, in mythology
and tribal history.
Words, syllables and phrases
are endowed with magic
meanings.
Some of these chants may be
composed of nonsense
syllables.
Comparison Ecstatic Ritual Hypnotic Ritual
e. Movements of 1. Participants form 1.Permanent seated or

healer and a circle prone position facing
movement- 2. Circular movements healer
reaction of 3. Jumping upwards and 2.Patient remains
participants. sideways motionless
4. Heavy descent onto 3.Healer moves with
heels caution, plays gently,
5. Pronounced hip touches patient in silent,
movement ritual gesture.
. 6. Pronounced shaking
of shoulders
7. Running
8. Strong head
movement
9. Healer drums, sings
and dances
f. Physiological 1. Increased muscle tone 1.Decreased muscle tone

phenomena up to spasm up to trance and sleep
among 2. Trembling, hands and 2.Pallor and sense of
participants feet in particular chill
3. Sweating, blushing 3.Slowing of pulse rate and
4. Accelerated heart- breathing tempo
beat and respiration 4.Sleep at ritual’s end
5. Fatigue and pain
(which diminish during
ritual
6. Lowering of blood-
sugar level to point of
hypoglycemia
7. Reduced sensitivity
to pain (self-mutilation,
fire, freezing, etc.)
8. Sleep at ritual’s
end
g. Spiritual 1. Total faith in healer As in ecstatic ritual

factors of and his powers
greatest 2. Magical meanings of
influence song given to healer in
his dream, of dance, of
the structure and iconography
of the musical instrument
3. Sense of security
bestowed by structured
ritual
h. Psychological 1. Psychophysiological 1.Experience of meditation,
benefits relief from oppression, relaxation, physical and
aggression, sexuality, mental tranquility
anxiety 2.Experience of passive
2. Sublimation acceptance
3. Catharsis 3.Satisfaction of primary
4. Group support for, needs in object-relation
and legitimization of, 4.Maximal attention during
vocal and physical the ritual process
behavior which is often 5.Possibly altered social
socially unacceptable status
5. Maximal attention
during the ritual process
6. Possibly altered social
status
To this should be added the observation that in both ecstatic and hypnotic
healing rituals, the patient enters into an altered state of consciousness (due
either to an ecstatic or hypnotic trance), and by way of this undergoes the
experience of beyond reality situations (according to traditional perceptions) and
intrapersonal experience (in terms of accepted therapeutic dogma in the Western
World).
We shall now discuss in further detail the physiological and psychological
aspects of healing rituals, as indicated briefly in these charts.
PHYSIOLOGICAL ASPECTS
In our examination of traditional healing rituals, we encounter two opposing

rhythmical processes: one of which steadily intensifies by means of a systematic
acceleration of tempo and an increase in dynamics, with the participants
responding with energetic movements as dictated by the musical development;
and the second, which preserves a constant rhythmic beat, generally with no
change of tempo or dynamics, and in which the participant remains in a state of
quiet receptiveness. In both cases, stimulus and reaction can lead to a state of
trance, typified by an altered state of consciousness.
This has been defined as a situation in which “The person experiences a clear
sensation of qualitative shift in the structure of his mental processes” (Tart 1969, 2).
This phenomenon, well known to music therapists as a result of Guided
Imagery in Music has been described in detail by Ludwig (1968) who observed it
in various, sometimes contradictory situations:
1. A decrease in exteroceptive stimulation.
2. An increase in exteroceptive stimulation (Crapanzano 1973; Sekeles 1996).
3. A decrease in the alertness of critical human faculties.
4. Selective and focused alertness.
5. Various psychophysiological conditions connected with hyperventilation,14
hypoxemia, hypoglycemia, dehydration, sleeplessness, and exposure to extreme
temperatures.
This last is a phenomenon to be found in many healing rituals. The drinking of
boiling-hot tea and water among the Moroccan Hamadsha, and the performance
of the ritual in the open market square under the blazing sun (Crapanzano 1973);
massaging the body with glowing coals as is done by the Kung in the Kalahari
Desert (Katz 1982); the inducement of fever by means of powerful metaphors
describing the sun in various parts of the body and a sun-kissed world, which is a
part of the technique of the Tibetan shaman (Evan S-Wentz 1967); the extensive
and continuous dancing which can continue for hours, and even days on end,
resulting in the symptoms detailed in #5 above—all these are characteristic of
ecstatic healing ritual.
On the other hand the experiencing of states of extreme cold is also a part of
many healing rituals. The dance of the spirits of the Salish Indians on the
northwest coast of the United States, opens with the patient situated in a
darkened tent watched over by “Nursemaids.” Here he undergoes a womb-like
experience15 while the shaman and his assistant seek the most suitable Demon
Song.
The song represents the healing process, and the dance of the spirit its
intensity and power. At a certain point the patient enters into a trance and
experiences dreams and visions which symbolize reincarnation and a new birth.
After four days of fasting and total isolation, the “Newborn” chants his new song,
accompanied by the drums and voices of his companions. He then rushes into
the forest to undergo the agonies of bathing in an icy stream. The shaman
breathes upon him the “breath of life” which symbolizes rebirth (Jilek 1982). All
participants in this rite are called upon to repeat it each winter.
This ritual decreases sensory stimulation and enables a return to the womb
simulation, as well as a symbolic purification in the icy waters—a parallel to
purification by fire.
Percussion possesses a tremendous ritual significance, due to the magic
thinking associated with it. The instruments are constructed from special
materials, they have specific shapes and forms, bear special and symbolic
decorations (iconography), and there are strict taboos regarding their use and
how they must be played (Sekeles 1995). According to Drury (1982), the drum is
the central ritual element since the sound of the drum acts as a focusing device
for the shaman. It creates an atmosphere of concentration and resolve, enabling
him to sink deep into trance, as he shifts his attention to the inner journey of the
spirit.
Apart from occasional Eskimo rites, the drum figures in all ecstatic rituals as an
essential instrument for the inducement of trance.16 The magic properties with
which it has been endowed (as already described) make of it a multipurpose tool.
Its shape enables it to be employed as a vehicle, and as a receptacle, as well as
serving its purpose as a musical instrument. The Asian shaman can use it as a
boat in order to reach the spirits under the sea, as a bird in order to reach the
heavenly spirits, or as a stag, a gazelle or a horse if he seeks spirits on earth (in
which case he makes use of the drumstick as a whip). Once the spirits are
captured, they can be trapped within the drum and brought back to earth.
Because of its special qualities the drum is often made from rare species of
timber. For example the “tree of the universe” which the Ostiak-Samoyed tribe
believe to sprout from the center of the world with its trunk linking humanity to
the upper spheres. Other examples of the sanctity of this instrument can be seen
as the result of dreams and visions. Crapanzano and Garrison (1977), describe a
Moroccan healer who was commanded in a dream to find a tree struck by
lightning, and construct his drum from such wood.17
The shaman believes that the drum has a soul, which must be awakened before
the instrument is played. The Altai shaman anoints his drum with beer (Rutherford
1986), whereas the Moroccan healer will expose his drum to fire, thus both
stretching the skin and at the same time breathing into it a spirit of life.
In addition to these spiritual attitudes, there are however various physiological
aspects connected with drumming and its influence on the participants in such
rites which also merit discussion.
In a pioneering work, Neher (1961) researched one of these when he exposed a
group of normally healthy people to low-frequency, high-amplitude drumming
under controlled laboratory conditions and recorded their EEG readings, in an
attempt to discover whether such percussion can lead to the reaction known as
auditory driving (an expanding reaction firing frequencies to surrounding
systems). Neher found that such a firing reaction did in fact occur with a stimulus
of 3, 4, 6 and 8 drumbeats per second, and that under these conditions the
subjects reported both visual and auditory imagery.
Furthermore it emerged that response to rhythmic stimuli increased according
to the degree to which the subjects were in a stress situation, or suffered from
metabolic imbalance (such as hypoglycemia or fatigue), symptoms typical of
ecstatic healing rituals.
Auditory stimulation which ranges between 4–6 cycles per second has been
found to be the most effective in healing rituals since these frequencies enhance
the Theta rhythms in the temporal-auditory regions of the cortex. Theta rhythms
can be registered under conditions of light sleep (particularly among adults) and
are apparently characteristic of the shift from full alertness to an altered state of
consciousness. Theta rhythms are also connected with states of creativity, and
imagery (Green & Green 1977). Despite the fact that in the actual rituals (such as
the Salish tribe’s “Spirit Dance Ceremonial”) more drums were employed and
more intensively than in the Neher experiments, the recorded frequencies were
nevertheless extremely close to the range of theta rhythms.18
In a further article (1962), Neher comments that in the majority of controlled
laboratory experiments conducted into the influence of rhythmic stimuli on
healing ritual participants, use was also made of visual rhythmic stimuli, whereas
in the actual rituals stimulus is confined to the drums.
Neher’s research led him to a number of conclusions:
1. One single drumbeat contains many frequencies. When transmitted to the
brain it activates a larger area of the auditory cortex.
2. A drumbeat contains mainly low frequencies (particularly the oversized drums
usually employed in healing rituals), and the low-frequency receptors within the
human ear are more resilient than those designed to receive high frequencies.
Hence the drum is capable of transmitting more energy to the brain than high-
frequency stimuli (such as that provided by flutes). In ecstatic ceremonies we find
a combination of low frequencies, intense volume, and an acceleration in the
tempo of the drumming.*
3. Reinforcement of the basic rhythm by additional rhythms increases
participatory response. (We have already seen how in ecstatic rituals use is made
of additional rhythmic structures such as hand clapping, idiophones and various
percussion instruments).
4. When the rhythmic stimuli are variegated in terms of sensory modalities
(sound, sight, touch, proprioception, kinesthesia) response becomes even
stronger. In ecstatic rituals we find such visual stimuli as the flickering of
candlelight (Zar, Ethiopia) and of course the kinesthetic stimuli of frenzied
rhythmic movement to be found in all societies which practice ecstatic healing
ritual.
Since it is this insistent stimulus which leads to a steadily growing physical
reaction, which in itself leads to the physiological symptoms already described,
one can say that in this chain of events music can be defined as the initial link
whose task it is to ignite and activate all the others.
Field researches by Jilek (1982) serve to authenticate Neher’s conclusions,
since they were conducted in the natural settings of such rituals. Nevertheless
Achterberg (1985) claims that Neher’s pioneering work suffers from a lack of
follow-up, and that his conclusions have never been verified by additional
research into the physiological effects of the drum. Achterberg supports the
views held by Drury (1982) concerning the role of percussion in concentrating the
shaman’s mind during his ventures into the Lands of the Spirits, and adds her
own hypothesis.
The auditory tracts enter the reticular system of the brain stem. This massive
nerve net acts as the coordinator between sensory input and muscle tone,
alerting the brain to incoming information. Sounds transmitted through the
auditory system are capable of activating the entire brain. Strong and repetitive
neuronal firing, as would be experienced from the drums, can theoretically create
a state of cognitive awareness. This is an hypothesis which contradicts the
Western belief which perceives trance as an illusory state similar to that of the
dreamer, and reinforces the theory that at least the shaman who conducts the
ritual is in fact capable of clear control of his thoughts and actions.
A significant contribution to the understanding of the shamanic phenomenon
comes from the ongoing and developing research into endorphins.19
Endorphins are endogenous healing mechanisms similar to morphine and other
opiates which act upon the brain as analgesics to relieve pain, to create euphoria,
as well as leading to alter consciousness. Their greatest concentration is to be
found in the extra pyramidal system of the brain which controls muscle and the
integration of movement. Other concentrations are to be found in the limbic
system (connected with conditions of amnesia, euphoria and altered states of
consciousness, as well in those areas responsible for transmitting pain impulses
and the perception of pain. Pain has always been a major research subject for all
those concerned with opiates. Prince (1982) differentiates between the “hypnotic
analgesia” of shamanic ritual20 (the lessening of stress, anxiety or pain), and
what he terms “endorphin suggestion” or “endorphin-related phenomena.”
In the first case (the hypnotic), there exists a psychological mechanism based
on belief (faith analgesia), unblocked by naloxone which neutralizes morphine.
The second case is a natural result of the interaction between various endorphins
(opiates) and their receptors. It is this which allows of changes in the sensation of
pain, of movement, of mood, and of the reactions of the autonomic nervous
system.
Interaction between an opiate and its receptor depends on pressures, or on
deep-tactile stimulation (such as acupuncture). Such stimulation can also be
originated by intensive rhythm and movement (as in ecstatic ritual).
Prince (ibid., 413) quotes the example of marathon runners who suffer from
pains and exhaustion during the first twenty minutes of the race and then enter
into a state of euphoria in which all pain is dispersed.
Appenzeller and others (1980) pointed out that during a marathon race the
endorphin level increases considerably.
According to Prince this ties in with the earlier works of Cannon (1957) and his
hypothesis regarding “FFF” (fright, flight, fight). Both man and beast share the
same system which regulates both pain and fear and finds its expression in
situations of danger and self-defense in which the choices are either to run away
or to do battle. An injured animal or man, even in a serious condition, is
nevertheless capable of self-defensive action. Today this is explainable by an
understanding of endorphin activity.
“The pain threshold rises slowly, reaching a maximum after approximately forty
minutes. It remains at a plateau while stimulation continues, and when it is
discontinued, the pain threshold falls gradually over a period of fifteen to twenty
minutes” (Prince 1982, 412).
We should bear in mind that ecstatic rituals involve extreme states of fatigue,
and certainly muscular pain, as well as other agonizing situations involving
extremes of temperature, self-mutilation with knives and needles, in addition to
the state of extreme anxiety experienced by the patient which is reinforced
(consciously or unconsciously) by the healer and the entire process of the ritual.
This is an anxiety which can be fed by actual causes and events but also by inner
fears and imaginings.
The organism experiences anxiety without any reference to its origins, and
activates a hormonal reaction (and according to recent researches, an endorphin
reaction as well). Incidentally, the realization of nightmares and horrific fantasies
triggers an intensive hormonal reaction to stress situations. This is something
practiced by various tribes as part of their maintenance of mental health (e.g., the
Iroquois Indians in Canada’s St. Lawrence River region) and serves as an integral
part of music therapy in which the patient is encouraged to express by way of
music, song, or any other artistic means, his own fearful fantasies (see Case
Histories: Rita and Alon).
Prince stresses that endorphin is especially active under extreme stress
situations. This is also true of hormonal activity, such as an increase of the
adrenaline level in the bloodstream.
In conclusion it can be stated that the above mentioned studies propose an
added dimension (widely researched over the last ten years) to the possible
function of the endorphins in the ecstatic rituals we have already described in
detail.
We shall now examine the physiological effects of the hypnotic ritual on its
participants.
We have already noted that the singing, accompanied by rattling or rhythmic
drumming, is characterized by repetition, by a very limited dynamic, by a steady
and moderate tempo, and by a general atmosphere of soothing and limited
movement. From the point of view of a music therapist such musical
characteristics, movement and surroundings, provide the ideal setting for the
total relaxation of the patient and his or her descent into slumber.
Both in the ecstatic ritual, as in the hypnotic, the rhythmic opening is
characterized by repetition and monotony, thus focusing the personal
consciousness inwards.
This is not simply a mental process. It is also affected by one’s physical posture
and the effort needed to counteract the force of gravity. During a hypnotic ritual,
the healer (mostly seated), and the patient (mostly seated or lying down) invest no
physical energy in movement or posturing. As a result (and also due to the
repetitive melo-rhythmic stimulation) they can restrain and slowdown their
breathing process, blood pressure is reduced, as is muscular tone and other
physiological parameters already described. Stage by stage the healer brings
both himself and the patient to a state of relaxation from which it is possible to
reach a hypnotic trance and an altered state of consciousness.
While it is true that some of the rituals include the use of hallucinogenic
substances, it would seem that pure relaxation without their use can also lead to
a state of hypnotic trance and to the emergence from it with no harmful
aftereffects (Bonny & Savary 1990).
The patient is exposed to music and suggestive words when in a totally passive
state, reacts with an inner ideo-sensory and ideo-motor activity. According to
Maurice Kleinhause and Pazit Sela:
Suggestion is an unqualified acceptance of an idea, an idea accepted by the
patient without any intellectual persuasion but rather due to a bypassing of all
intellectual-analytical processes. Any ideo-reaction can be transformed into
suggestion by means of neutralizing the normal physiological stimulus and
turning it into a reaction aroused by the therapist’s instruction. The suggestive
reaction of the patient is dependent to a large degree in his faith in his
therapist and his expectations that his therapist can help him (Kleinhause &
Sela 1986, 7).
The more suggestion suits the psychophysiological structure and social
characteristics of the patient, the easier it will be for the therapist to make use of
such suggestion. This is a feature of hypnotic ritual, in which both healer and
patient share an identical social and ideological background.
Kleinhouse and Sela further claim that:
The therapist must make suitable use of every aspect of communicative
behavior: tone of speech, musicality, mannerisms, the implied meanings of
words, movement and so on (ibid.).
All of these are to be found in hypnotic healing rituals.
Since traditional societies regard the majority of illnesses (even if they display
physical symptoms) as spiritual maladies, it is hard to differentiate between the
processes of physical and psychological relaxation. This is equally true of music
therapy as I perceive it in our day and age.
Above and beyond the psychophysiological relaxation and the imagery of
hypnotic rituals which employ music and other elements, there remains the
question (as in ecstatic ritual) of the influences which create the ability to
overcome pain and stress.
One explanation is provided by Prince (see above) who differentiates between
the easing of pain due to endorphin activity, and that due to hypnotic suggestion.
Another explanation can be found in one of Achterberg’s researches (1982)
concerning severely-burned infants.
Instead of anesthesia she used recordings of fetal heartbeats, very similar to
drumbeats. These rhythms (which probably match delta brain waves of 4–5 cycles
per second) created an effective sensory block against pain, which facilitated
even extremely painful treatments. Once the infants got used to the presence of
the tape recorder in their cots, they would fall asleep within a minute or two after
hearing the sound.
Achterberg bases this clinical research on the Gate Theory of Melzack and Wall
(1965) in which they claim that since pain sensations are transmitted by very
sluggish fibers, the perception of pain can be blocked, or limited, by rapid and
powerful counterstimuli. This could be acupuncture, mild transcutaneous
electrical stimulation, massage, and even repetitive percussion.21
The anesthetizing of infants, children and even adults, by means of monotonous
and repetitive pulses is recognized and accepted as effective in a variety of
schools of relaxation therapy. This is generally attributed to psychological causes
(see later), or to physiological causes associated with a loss of alertness due to
the continuous and monotonous stimulus which holds no changes and no
surprises.
Achterberg (as we have seen) presents another viewpoint in which she claims
that rhythmic stimulation can be employed not only as an anesthetic but also in
order to block, or delay, the sensation of pain (see Case History: Ron).
An additional theory regarding relaxation concerns that structure of brain matter
known as the reticular formation, which serves as a modulator between sensory
input and motor output. When stimulus (such as sound) is extensive, it can excite,
and when limited, can relax. In particular it is the ascending reticular formation
which influences the state of alertness; reduced activity of this portion leads to a
state of hypnosis, trance or sleep.
PSYCHOLOGICAL AND SPIRITUAL ASPECTS
Traditional healing is aimed at those individuals who sprang from the selfsame
cultural and societal roots as did the healer/shaman, and who share his own
philosophy and beliefs. It is these shared faiths and the confidence of the patient
in the abilities and powers of the healer which serve as the rock-solid basis of
traditional healing. Alongside these there exists a clear social code of the
forbidden and the permissible, any transgression of which can lead to imbalance
and hence to illness.
The healer is acknowledged by his patient as being possessed of an expert
knowledge of traditional law and an ability to restore equilibrium due to his
inherent powers and his ability to make contact with the forces of affliction. These
(at least as far as the personalistic category of illness is concerned) are part and
parcel of the magic thinking of traditional societies (see Foster).
It should be stressed that while such magic thinking which embraces the
concept of supernatural powers may be regarded by Western psychology as a
form of pathological regression, within traditional societies the supernatural
remains a concrete part of reality. Spirits, demons, ancestors, gods and
demigods all inhabit their surroundings and watch over them all the time.
Within this web of beliefs music is also considered to possess magical powers
due to the merits perceived in it over the centuries and the manner in which it
influences mankind. Accordingly, music makes its own special contribution in a
variety of functions:bladwijzer
1. As a means of return to primal object relationship during hypnotic healing
rituals. Vague, soothing and sleep inducing. In this context the patient returns to
infancy, the healer takes on the role of the mother, and the music serves as a
lullaby. In other words a regression to the oral stage of life.
2. As a release of sexual and aggressive energy during ecstatic healing rituals,
by means of strong rhythms which develop in an orgastic manner and elicit
energetic, cathartic movement. If we compare the hypnotic ritual to the symbiotic-
oral stage, then the ecstatic ritual can serve as a metaphor for adolescence in
which sublimation serves as the most effective defense mechanism (sport, music,
rock and so on). Statistics reveal that in most ecstatic rituals the healer is
generally a man (father figure), whereas in hypnotic rituals we can often find a
woman as healer (mother figure).
3. In all the rituals so far discussed, the group is an essential support for the
individual through spontaneous action, the acceptance of transgressing accepted
taboos (sexually explicit movement, shrieking and yelling, and so forth), and by a
tolerant and absorbent participation.
4. The first, or active, category, resembles the dynamics of doing in music
therapy. Here the patient initiates activity and takes part in creating the music.
The second category is similar to that of being, in which the patient is passive
and receptive. Both of these dynamics will be discussed within the case histories
yet to be presented. Both can be traced back to ancient times as part of the
history of healing and music as a meeting point.
5. In all the rituals so far described the major therapeutic factor was imagination
(generally guided by the healer). Imaging, visions, dreams, transport the patient
through experiences which differ from his day-to-day existence and release him,
momentarily, from routine struggles, awarding him the chance of experiencing
something out-of-the-ordinary. In some cases this could be described as rebirth
(the Salish tribe), or a journey of spiritual purification and catharsis. Very similar
phenomena can be observed when employing the technique of Guided Imagery in
Music which in some ways resembles that of the hypnotic ritual. Guided imagery
also involves collective symbolism (such as animals, structures, water, etc.), as
well as the possibility of eliciting threateningly-laden personal matters.
Collective symbols appear both in hypnotic ritual and in guided imagery;
however the music therapist encourages the awakening of personal issues,
whereas the traditional healer stresses the collective material.
6. Traditional healing deals with the body, mind and soul as if they were one
single entity. This is in fact a comprehensive therapy: suggestive stimuli provided
by music, song and the word, affect body and mind together. Energetic
movements exert their influence on both internal and external systems.
According to the Developmental-Integrative Model in Music Therapy, a patient

suffering from what are diagnosed as mental problems will be subject to therapy
aimed at strengthening the links between mind and body, whereas a patient
suffering from distinct organic problems will undergo treatment aimed at linking
body to mind.
A person is seen as a whole being, while affliction breaks this apart, causing
difficulties of constant communication between motion and emotion, or in
musical terms between the singing voice (which expresses emotion and
movement) and the speaking voice (which expresses logic and thought).
As already stated, traditional healing rituals serve as the historic roots of music
therapy. Despite the differences of concept, and in the therapeutic rationale which
exist between the shaman (healer or medicine man) and the music therapist, part
of their basic therapeutic activity appears to be remarkably similar. Not only that,
all possible explanations of those physical and psychological phenomena which
typify patients under treatment, and which are based on neurophysiological
researches and on a psychodynamic concept, hold good in the main both for
traditional healing ritual and for music therapy as we know it today.
Notes on Excerpt One
1. In ethnomusicological literature, as well as in recent writings concerning music

therapy, shamanism is employed as a general term for almost all forms of ethnic
healing. In this work I chose to include those healing rituals which match Eliade’s
definitions (1972) and which distinguish between healer, witch doctor, herbalist, etc.
and shamanism as it is known in Siberia and Central Asia. Eliade acknowledges that
such phenomena occur in other regions of the world, provided they conform to the
following principles:
a) The use of techniques by which the shaman falls into a trance (an altered state
of consciousness).
b) That when in this state of trance the shaman’s spirit is capable of leaving his
body and making magic journeys, ascending to the heavens or descending to the
depths of the sea and the bowels of the earth.
c) That the shaman’s studies include a knowledge of dreams, trance, ecstatic flights,
gods and spirits, the myths and genealogies of the ancestors, secret languages, and
the drumming, songs and dances of ritual.
The word shaman apparently comes from the dialect of the Manchurian Tungus tribe,
and “sha” (meaning “He who knoweth”) is to be found in other languages and dialects
throughout North and Central Asia. The shaman is never subject to the spirits, rather it
is he who rules over them, as well as over fire. In those tribes in which shamanism is
prominent (Eliade mentions in the main the Turko-Tatars, the Samoyed, the Tungus and
the Chuckchee), there is a common belief in a Heavenly God, with between seven and
nine offspring who inhabit the lower levels of the heavens. With these demigods the
shaman has a special relationship and it is they who assist him in his healings: in this
case spiritual healing in its broadest connotation, and not necessarily concerned with
the imbalance of the body’s biology. The shaman’s functions, in accordance with his
training, are not limited to healing alone, he is also a religious and political leader, a
musician and a dancer. He has inherited his role from the gods, or they have elected to
bestow it upon him. A self-proclaimed shaman is unacceptable, and no shaman may
perform his duties without the approval of the tribe and its ancestors.
Eliade stresses that on occasions the selection of the shaman may be preceded by an
overemotional or ecstatic event, and there are those who see a continuous process of
self-therapy in the role of the shaman. Indeed Eliade mentions the case of a shaman
from the Yakut tribe who began to sing at the age of twenty and when he had gained
sufficient confidence began to study shamanic ritual. At the age of sixty he was
described as possessing unlimited energy and to be capable of drumming and dancing
all night long. Were he not to perform ceremonies for any length of time he would begin
to feel unwell (Eliade 1972, 28).
On the other hand Eliade stresses that there are no grounds for the belief that the
shaman is prone to psychotic attacks: he is always in full control of his actions and is
capable of manipulating the participants in a masterly fashion. One example is a
shaman from the Tungus tribe who conducts his rituals in a circular tent of limited
capacity, densely packed with people. He performs in heavy garments with his eyes
closed, making broad movements, but nevertheless never bumps into anyone and finds
whatever or whomever he needs at any given moment with remarkable accuracy -
evidence of strict rehearsal and an acute sense of direction.
Even at the height of an ecstatic trance, Eliade notes, the shaman remains in
command of a number of his faculties: visual observation and clarity of thought,
accompanied by an intelligence higher than the tribal average, adaptability and a great
deal of knowledge (ibid., 29-30).
2. For examples of such integration between music and movement see the case
histories of Ron and Anat. An example of the integration of music, singing and drawing
is the case history of Rita, and of music combined with song and dramatic play acting,
Alon. In each case these were compilations of materials which emerged during therapy
according to the personal needs of the patient.
3. In music therapy today, this is one of the most accepted forms of conversing
through music, the therapist creates a fixed rhythmic and harmonic framework which
repeats itself, while therapist and patient converse in song on this given basis. This
technique is especially effective in cases of anxiety or of speech problems. See case
history of Alon.
4. In a previous unpublished work (1981), I compared the music of 46 ecstatic and 52

hypnotic rituals.
5. Traditional societies believe in the dispatching of extrahuman or superhuman

forces or agents as the harbingers of disease. Such belief is based on the religious
tenets regarding the unity of the world and the duality of the forces active within it.
Traditional healing therefore, holds that balance and harmony are expressed by the fact
that Man and Nature represent absolute goodness. Any imbalance which occurs
between the two can lead to a total disruption of this harmony which is typified by order,
health and perfection. Such imbalance can be caused by actions which go against
those taboos which clearly define the differences between good and evil (Yoder 1972).
6. Frances Desmond is considered to be one of the most important pioneers in the

research of Indian music. Between the years 1907ñ1957 she recorded some 2,000
examples from a vast number of North American tribes. Her collection is housed in the
Folklore Archives of the Library of Congress in Washington D.C. and includes examples
of healing rituals from fourteen tribes, some of which have been issued by the Ethnic
Folkways Library.
7. Ida Halpern, a musicologist from British Columbia, compiled this anthology in 1966
for the National Museum of Canada. It includes songs from seven tribes. Dr. Halpern
concentrated on the Kwakiutl (from the northern extremity of Vancouver Island) and the
Nootka (to the south).
8. According to Harner (1973, 155ñ175), this drug takes effect within minutes as an
overall stimulant to the senses which leads to haziness and a sense of levitation.
Visions are at first pleasing and aesthetic but soon develop into the horrific. Since the
shaman describes in detail his own sense of levitation and what he sees, it would seem
that certain visions such as snakes, jaguars, and other beasts of prey tend to repeat
themselves. An experiment conducted by Naranjo (1973, 176ñ190) on 35 volunteers in
Santiago, Chile, revealed that the symptoms the drug produces are not necessarily
culture dependent: 33 experienced the separation of the soul from the body, of these 10
experienced levitation and rotating movement, 7 saw beasts of prey and reptiles, 8
experienced their own death, 5 saw demons, and only 3 saw angels, Jesus or the Virgin
Mary (visions which are alien to the culture of the Napo). The remaining 2 reported a
feeling of well-being with no visions at all. Naranjo claims that the hallucinatory motifs
induced by the drug must be seen as universal, and that some of them exist in cultures
and parts of the world which neither the Chilean shaman nor some of the participants in
the experiment have ever seen. It should further be mentioned that the visions also
included music (in the main drums, whistles and flutes), as well as images of gods and
demons, singing and drinking the drug in the company of human beings. It should be
noted that these are the typical elements of the ecstatic healing ritual, while the one
under discussion is hypnotic or soothing.
9. This is a typical phenomenon of many healing rituals. The Hamadsha make use
of melodic structures (the Ariah), each of which is aimed at exorcising specific spirits
(Sekeles 1979). The same is true of the tunes played at the Zar ceremonies (ibid.).
Indian tribes employ rhythmic motifs in order to target specific ailments (Densmore
1927). The Sioux healer has special songs for each and every sickness. There are also
secret songs for particular afflictions which must never be applied to another. There can
be no doubt that within the framework of healing ritual, the attitude to song or music as
an influence on spirit or demon, is similar to that of a specific cure.
10. For a description of such acceleration see Siberian Tungus (Shirokogoroff

1935, 326, 329), Haitian Rituals (Courlander 1944, 45) and the Moroccan Hamadsha
(Crapanzano 1973, Chapter 12)
11. This transformation from patient to healer is a well-known phenomenon in

many brotherhoods, such as the Zar in Ethiopia, the Indian Salish and others. In the
San tribe who dwell in the northwestern regions of the Kalahari Desert, no less than ten
percent of both men and women become healers. This is a tribe which holds a weekly
healing ritual in which all the villagers take part. Song and ecstatic dance take on a
major role as an energy outlet (Katz 1982, 344-369). This phenomenon is also
perceptible in Western civilizations where people encountering and trying to tackle
certain problems come up with innovative therapy (Alexander, Feldenkrais), hence the
need for the therapist to undergo therapy in order to better comprehend the therapeutic
process, and to gain a personal insight.
12. A further example can be found in the Ethiopian Zar ceremonies (Messing
1956; Kahana 1983). Both researchers stress that the Sudanese (a minority in Ethiopia
and an enslaved people in the past), participate in the rites as equals. This is also the
case for women, whose social status in Ethiopia was always discriminatory.
13. This seeking of a healing melody which can reach out and touch the
patient, characterizes modern music therapy and the models it employs by making use
of improvisation as a central tool, for example in “The Creative Model of Music Therapy”
developed by Nordoff and Robbins (Bruscia 1987, 21ñ73). The essential difference is
that the Moroccan ghiyyta player has an already prepared repertoire, whereas the
music therapist must make his choices according to the therapy in progress. The
common denominator is the never ending need to follow the reactions of the patient as
music is performed, in order to know whether or not the musical material employed
touches on the genuine needs of the patient.
14. Unusually rapid breathing which leads to a lack of oxygen and a

consequent dizziness, muscular spasms and so forth. This is an accepted technique in
certain ecstatic rituals (Malagash Exorcising Evil Spirits, see charts).
15. See Vogel Technique (1984) and Case History: Ron).
16. Rutherford (1986) stresses that Eskimo Rituals do not employ the drum. I,
however, witnessed such a ritual in June 1980 performed by Eskimos from the village of
Sivuqaq in Alaska in which they made use of huge frame drums, ranging from a hand
spread in width to the height of a ten-year-old child. Such frame drums are held by bone
handles and accompany the Eskimo incantations.
17. During my work in a psychiatric hospital I instructed the patients how to

build their own drums (as well as other musical instruments), and to decorate them
according to their own imagination. These decorations consisted of objects attached to
the drum (as in Siberia) as well as drawings on the drum skin itself (as with the Indian
tribes). There could be no doubt that the emotional attachment of the patient to his own
handmade drum was much deeper and more significant than his attitude to any
acquired or purchased instrument; and this despite the fact that any belief in the drum
as a symbol was alien to his inherited culture, unlike that of traditional societies.
18. The frequencies of brain waves can be defined as follows:

Alpha: 8–13 Hertz (relaxation and inner concentration).
Beta: 14–30 Hertz (alertness).
Delta: 4–5 Hertz (deep sleep)
Theta: 4–7 Hertz (light sleep for adults, possibly "awakeness" for children). Children’s
brain waves usually stabilize around the age of eight (Greenfield & Sternbach 1972).
19. See Ethos (1982, 10:4) for researches into shamanism and endorphins (Montreal
1980). In 1974 John Hughes succeeded in isolating in the brains of large domestic
animals a material which resembled morphine blocked by naloxone. In 1976 a group of
researchers discovered Beta endorphin and Simon coined the definition Endogenous
morphine-like product.
20. It is possible that pain relief by means of blocking stimuli could explain the
playing of the Aulos (known for its strong vibrations) on the bodies of patients in Ancient
Greece who suffered from lower-back pains (Chomet 1875). Teirich (1958) also writes
of the use of music in autogenic exercises with the vibrations directed at the solar
plexus, in order to achieve deep relaxation. Similarly, at the First Scientific Seminar for
Music Therapy conducted by the International Society for Music Education at Bad
Honnef, Germany (1986), a treatment was displayed which could transmit music not
only through the regular auditory channels but could also direct the vibrations to
specific areas of pain in the body.
Excerpt Two
THE DEVELOPMENTAL
INTEGRATIVE MODEL IN
MUSIC THERAPY
(D.I.M.T.)
Chava Sekeles
INTRODUCTION
In 1962 I went abroad for supplementary studies in music therapy, and was employed in
a major psychiatric hospital. The majority of the residents were chronic patients who
had been there for literally scores of years, mostly diagnosed as schizophrenic. The
hospital also housed an alcoholic ward, a day clinic, and an open ward for patients of
various ages with a variety of psychiatric ailments. This encounter with severe chronic
patients, almost totally cut off from reality and virtually incapable of verbal
communication, forced me to reassess the well-known saying that music is an
“international language,” nonverbal and bypassing the need for speech. In fact this
reassessment continues to this day, since the majority of my patients suffer from
difficulties in verbal communication due to either physical and/or psychological causes.
The most severe schizophrenics had been hospitalized for periods as long as forty
years and bore the characteristic symptoms of the illness. Linguistically, most of them
possessed some kind of a personal language which emerged as incommunicative, with
echolalic characteristics and neologism, incoherent mumbling and even a total
abandonment of speech.
Behaviorally, the majority displayed a rigidity of movement, a compulsive sense of
ceremony, a lack of physical coordination, and tended to catatonic states (stupor, rigid
or excited). Many suffered from tactile, visual, somatic, olfactory and auditory
hallucinations. Some of those undergoing music therapy displayed a paranoid anxiety
when confronted with the recording equipment and its wiring, fearing that these might
“transmit their thoughts,” and thus endanger them.
My previous therapeutic experience either with handicapped patients in rehabilitation,
or with nonhospitalized neurotics, was of no avail in treating these chronic cases—
normal communicative speech was limited, even faulty, and so there was an urgent
need to find ways of establishing confidence and trust between patient and therapist. As
already mentioned, therapy can make significant progress only within a personal
rapport between the two, hence the supreme importance of the links and interactions
which can be expressed through music.
Music therapists tend to make free use of such expressions as creativity, creative
freedom and creative joy. In my experience with a variety of patients, I have learned to
regard such definitions with a certain wariness. The schizophrenic suffers from
confusion, from sensory and mental flooding, from organizational difficulties and from
flat effect. He is in need of an extremely clear and comprehensible supportive
environment within which he may be able to function, to improvise, and to adapt to
gradual change. Over-creativity on the part of the therapist can inadvertently sabotage
such a process. The concept of beautiful and expressive, refined music as a
predetermined positive influence is inexact, to say the least.
The patient’s acceptance of music is not automatic. It demands emotional investment
and patience on the part of both patient and therapist alike. Indeed, as opposed to
traditionally accepted beliefs, D.I.M.T. does not see music as a magic formula for
performing miracles.
In most cases, as in any therapy based on change and development, music therapy
consists of a lengthy and exhausting exploration of advance and retreat, often of pain
and sadness, sometimes of joy and relief. The more the patient reveals a greater
interest in music, finds within it a means of self-expression and subconsciously senses
its significance, the more it becomes effective for him as a means to be exploited on a
level of consciousness and awareness.
By studying chronic cases I learned to observe both the integration and lack of
integration of the personality and its various systems; to analyze developmental gaps;
and to comprehend the psychological influences of the malady on the physiological
being. I also learned that the patient’s internal condition could not always be defined
purely by means of psychological symptoms. Physiological blocking had also to be
taken into consideration, such as surrender to the force of gravity, vocal pathologies,
and more. It also became clear that the very nature of music, which enables it to affect
vital human functions, is what gives it its genuine therapeutic power.
The influence of music on the senses, sensations, vocality, motion, emotion, and
cognition, enables it to be used in Integrative Therapy when applied to such functions
either in whole or in part. D.I.M.T. perceives this as one of the unique advantages of
this profession. On the other hand, care must also be taken to avoid superficiality in
these spheres, of which the music therapist has only limited experience.
However, I would like to stress that even with the most nonverbal patients (psychotic,
retarded, autistic, mute, etc.) D.I.M.T. still advocates the use of speech. Thus the link
with emotion is the role of music as a primary language, while the link with
consciousness is the role played by words as a secondary means of communication.
Just as the music therapist cannot analyze and understand the therapeutic process
purely on the basis of music and body language, the patient also needs verbal
expression in order to organize his thoughts and to link emotion with awareness,
however primitive and limited his use of language may be.
If the aim of such therapy is to expand the consciousness and awareness of the
patient, the therapist needs training in psychology and psychodynamic supervision, just
as the treatment of physiological problems demands from him adequate medical
training and supervision.
By treating chronic psychiatric patients (and later autistic children, psychotic children
and neuropsychiatric cases), I became keenly aware of the power of music to penetrate
the veils of the incommunicative and the inarticulate. The variegated influences of
music therapy, and the results of detailed observation and other processes over a
period of some twenty-five years, persuade me that there are clear conclusions to be
drawn regarding the development of the patient and his ability to express himself during
music therapy, as well as his psychological progress in his daily life outside of the clinic.
This in no way resembles the accepted norms of a musical education aimed at an
improved hearing technique, cognition and so forth, but rather a development within a
human relationship. There are, after all, two major agents in music therapy, the first is
the music itself which serves as a link between patient and therapist (interrelationship),
as well as between the patient and himself (intrarelationship), the second agent is the
therapist whose task it is to assist the patient to undergo musical experiences both
actively and receptively in order that he may acquire those skills essential to his health
and well-being.
DEFINITIONS
The term “Developmental-Integrative” demands a certain clarification. Developmental

implies a basic concept of Man as a being who passes through various stages of
development during his lifetime, including certain vital functions (senses and
sensations, vocality, motion, emotion, cognition). Developmental psychology and
physiology maintain that growth is characterized by supracultural or universal
processes. Science seeks to describe, investigate and Despite the apparent differences
between various present-day psychological approaches1 it would seem that rather than
contradicting each other, their different accentuations tend to support the overall
accepted view of infant development.
As a result of long-term observation (making use of music) of infants, children,
adolescents, adults and the elderly, D.I.M.T. arrived at the following conclusions
regarding its definitions:
DEVELOPMENTAL
1. Part of human health is determined by the degree of maturity and integration which
exists within and between the vital systems which contribute to development.
Observation by means of music can pinpoint deficits, gaps, regression and fixation. This
is because music itself influences these very same life systems.
2. Should there be any health malfunction this must be examined according to its
developmental significance. Identifying the developmental stage is an essential part of
the intake and observation phase of music therapy. Without such data the therapist is
unable to evaluate and consider any form of treatment.
3. There exists a certain parallel between the development of the persona in general
and its development in music therapy. By observing musical activity we can identify
stages of physical, psychological, cognitive and societal development.
4. D.I.M.T. sees each hour of therapy as a developmental microcosm and follows the
patient’s development as if it were a parallel of the life continuum.
5. D.I.M.T. stresses the need to stimulate and develop the surviving and healthy
functions of the patient, without ignoring deficits and gaps, in order to bring about
positive changes and to improve the quality of life.
INTEGRATIVE
1. The integrative treatment of deficits and gaps.
2. A holistic treatment of the complete individual (sensory-motor integration, motion-
emotion integration, etc.).
3. The integration of the physiological and psychological persona, and the treatment of
the whole person as far as music permits, whether or not the handicaps are defined as
either physical or emotional.
4. Integration between the problems as diagnosed and the therapeutic approach,
techniques, and the musical and verbal means at the disposal of the therapist.
5. Integration of methods and techniques in music therapy with knowledge acquired
from relevant fields (musicology, psychology, medicine, etc.), in order to render as
effective a treatment as possible.
This model can be either active or receptive, depending upon the needs of the
individual patient, however the most desirable aim is to achieve a balance between
receptive (being) and active (doing). Since development is perceived in terms of human
relationships, even a receptive approach finds its fullest expression in the contact
established between therapist and patient.
MUSICAL ACTIVITY AS IT AFFECTS VITAL HUMAN FUNCTIONS
Listening to and creating music may indeed affect specific vital human functions, but
in fact all of these functions interact naturally. For purposes of clarification we shall
discuss them separately.
1. Senses and sensations2 play different roles in so far as the receptive or active
music experience is concerned.
A 4–5-month-old embryo can already hear and move in reaction to auditory
stimulation (Olds 1984; Pannenton 1985; Shetler 1985). In fact it responds to internal
body sounds such as the mother’s heart beat, as well as to external sounds.
Verny and Kelly (1981) assume that the infant has auditory prenatal memories which
explain why it relaxes when embraced close to the breast, or when exposed to a steady
rhythm. They also give numerous, often far reaching, examples in order to justify their
claims regarding early memories of rhythmical beats within the womb as an influence on
later tendencies in the musical development of the human being.3 Among others they
base their ideas on Michael Clements’ research into embryo reactions to soothing or
stimulating music, as well as his conclusions regarding the effect of prenatal memories
on musical preferences and prejudices in later life.
Verny and Kelly further claim that apart from a physical reaction by the embryo to both
internal and external sounds, it is particularly sensitive to the human voice. It would
seem that the pitch and timing are what most attract the attention of the newborn and
together with the sense of touch serve as an important element in primary object
relation.
Music therapy, similar to the approach developed by Alfred Tomatis,4 continues to
take into account the in utero auditory experience, particularly as regards relaxation and
soothing, and the recollection of previous experiences which may have led to
neurological and psychological injuries in childhood.
Today there can be no doubt about the significance of in utero sound and rhythm.
Verny and Kelly found that infants exposed to music gained weight and grew well, and
Murooka’s research (1976), emphasizes the relaxing and soothing effects.
The sense of hearing improves when it is integrated with other senses, sensations,
movement and the process of learning. For example, in his earliest months the infant
learns to respond to certain auditory stimuli (his mother’s voice, his father’s voice, a
doorbell) by turning his head. He thus visualizes the world from a new viewpoint and so
discovers the source of the sound. In one simple action he integrates sight, sound,
movement, proprioception and the vestibular system. This is one of the first stages of
learning, without which normal development will be impossible.
Playing a musical instrument also demands an integration between the sense of
hearing and other senses; one needs sight before touch and spatial awareness will be
sufficiently developed. Only then can one scan the notes and be able to play like the
blind man who relies only on his sense of touch and of space. A variety of coordinations
are required while playing an instrument—eyes-hands, hands-hands, ears-hands, etc. 5
In other words, optimal musical activity involves a number of senses and sensations
and demands a certain degree of maturity and integration between them. However, if
we encounter deficits, or a lack of senses, we are still able to create alternatives. The
degree of maturity and of integration plays a central role in considering and planning
therapy.6
2. Movement is linked with musical expression in two ways:
a) By spontaneous or by directed reaction to musical stimuli which has a prenatal
origin. The more the human being develops, so does his ability to react smoothly to
musical stimuli. This is also true of the repertoire of movement, both in quality and in
complexity.
b) By movement while playing, which is dictated by the actual production of sounds,
and the aims, abilities and skills of the performer.
Whereas the first form of activity consists of perceiving and consequently physically
reacting to musical stimuli, the second involves the active creation of music. Both of
these undergo a process of development and improvement according to the degree of
maturity and sensory-motor integration.
During both intake and therapy it is essential to be aware of the fact that spontaneous
locomotor reaction is mainly composed of gross motor function, whereas movement in
playing depends on fine motor ability.7
3. Vocality is the key factor in human communication, despite the fact that other means
of expression can be utilized, such as body language, mimicry, graphic symbols, and so
on. Voice is a movement with sensory feedback (in the main auditory and
proprioceptive). When a baby is born it screams and simultaneously makes movements.
Motor potential is inborn, as is vocal potential.
Quite apart from the very practical reasons which have made the human voice the
central element of communication (due for example to its nondependence on visual
contact, and its ability to be heard despite physical obstacles or by means of long
distance transmission equipment), there is also a psychological reason—the human
voice is endowed with a flexibility which allows it to express emotion, even without the
use of specific words. The musical parameters which influence emotion can be
expressed vocally by means of changes in tempo and continuity, accentuation, pitch
and range, timbre and dynamics. All of these are characteristics of primary vocal
communication and continue to perform their emotional role even after the acquisition of
the powers of speech, the secondary means of communication.*
Careful listening to vocality helps in diagnosing various physiological problems
(stammering, faulty diction, respiratory difficulties, etc.), as well as in the diagnosis of
psychological complaints (limitations of vocal range, dynamics, tempo, etc.).
Within the therapeutic process the act of singing permits a wide range of expression
which in normal speech would be considered either unacceptable or even ridiculous,
but is nevertheless totally legitimate in song.8
4. Emotion. The art of music is endowed by its very nature with the ability to give
expression to human feelings. Such expressiveness characterizes both physical and
psychological situations and can therefore be exploited in order to evoke both kinds of
reaction.
Emotional elements in music are basically expressed by changes of tempo, pitch,
range, dynamics and timbre. Unblocked emotional excitation affects the tempo,9
expands the vocal range and increases the volume and intensity. Should the patient
improvise music containing these characteristics it would be logical to assume that he is
expressing rage, joy, ecstatic trance, or so forth. In other words, this combination of fast
tempo, increased volume and extended range, can be diagnosed as an expression of
emotional excitation, but its exact nature should still be examined by additional means,
such as analyzing the form and character of the melody, its harmonious development,
its rhythmic structure, in addition to taking into consideration extra-musical information
before risking a direct translation of music into emotion.
Susanne Langer (1979), who is critical of what she sees as the baseless assumption
that music serves as a medium of emotional expression, quotes for example the
differing emotional interpretations which performers and audiences can apply to the
very same work, and it is certainly true to say that emotional interpretation of music is a
many-faceted process. Even the most up-to-date research into this subject has been
unable to provide an unequivocal answer to the question of why a low pitch, a moderate
melodic range, a moderate tempo and a soothing dynamic, arouse feelings of sadness
in one listener, of longing in another and of tranquility in a third. In this connection
music therapy demands both an empiric and pragmatic approach which must examine
each and every patient in an individual light. What are the personal motifs which best
express his or her personality? What kind of music can arouse repressed emotions? In
what tonal and rhythmic framework can the patient best find an associative expression
for his or her feelings? What kind of music arouses metaphorical associations and can
elicit subconscious content? And so on.
There are no specific scientific explanations for music’s emotional power, but the
model presented here sees in the subjective attitude of each individual patient toward
music more of an advantage than a disadvantage. On the other hand, at the basic level
of musical parameters we do have certain fairly clear answers concerning their physical
and emotional functions, this from observation and analysis of similar musical
parameters in traditional healing rituals (see Chapter 1), and the concept of their being
basically a product of the human organism (Appendix 2).
Susanne Langer, like many others, is concerned with the emotional impact of art
music, whereas the music therapist who employs an active approach is concerned with
the emotional impact of the music created by the patient himself, and with his emotional
ability to create inter- and intrapersonal reactions by means of that music.
For example, when Alon (see Chapter 7) first started to react emotionally during music
therapy, he gave vent to his passive aggressiveness by massive drum beating, thus
initiating a new self-dialogue by means of which he was able to acknowledge his
aggression and to dare give vent to it without feeling endangered. From a purely
musical point of view his rhythmic creativity was of little value at this stage, but from a
therapeutic aspect the drum provided him with a way of confronting his existential
anxiety, expressing it, releasing it, and eventually coming to terms with it.
Anat (see Chapter 4) was a very erratic singer due to the vocal defects which
characterize her syndrome. Her playing was also extremely irregular and she had
difficulty in maintaining a simple drum rhythm due to muscular hypotonia. Nevertheless
it was music which brought her into close contact with such emotions as anger and
sadness, after which she was eventually able to phrase in words and even comprehend,
despite her being classified as mentally retarded.
Concerning the emotional impact of art music Susanne Langer makes a salient point.
“Music is not self-expression, but formulation and representation of emotions, moods,
mental tensions and realizations—a ‘logical picture’ of sentient, responsive life, a
source of insight.… A composer not only indicates but articulates subtle complexes of
feelings that language cannot even name…he knows the forms of emotion and can
handle them, ‘compose’ them” (1982, 222).
Such emotional forms succeed in arousing within the listener/patient an emotional
identification which might stimulate self-searching. According to Helen Bonny (1990) it
is quite possible that the very alienation of a certain musical piece from the here-and-
now experiences of the listener is just what enables such individualistic identification
with it. Pieces based on concrete metaphors (such as bird song, train whistles, thunder)
merely arouse predictable visions in the mind of the listener rather that those uniquely
personal reactions which we seek in therapy
With the mentally retarded, however, it may be preferable to employ such obvious
stimuli in order to provoke any kind of reaction, as unabstracted it may be.
5. Cognition. The Cognitive System is more relevant to musical education than to
music therapy. It is important, however, to note that there are often side effects to music
therapy in the form of indirect learning such as acquiring the language of music, using
music to symbolize an event or an emotion: conceptualization (short-long, fast-slow,
duration, etc.), as well as analysis, memory and abstraction.
In treating the mentally retarded the cognitive system can be developed by the use of
music in play situations (depending upon the degree of retardation) since the
perception of music is not necessarily an analytical process and can exist on various
levels of intelligence. One of the most amazing examples is that of Lesley (the boy
described in “May’s Miracle” 1980), who despite blindness and severe mental
retardation from birth developed such an ability for absorbing musical structures that he
could, by ear and with no musical training, repeat whole passages from piano concertos
and play them quite well.
Whatever the case, in treatment D.I.M.T. accentuates the senses, vocal ity, motion and
emotions. The fundamental assumption of the developmental concept is that a mature
basis of these functions facilitates the development of the cognitive faculties. We must,
however, insist that this is not a therapeutic model concerned with only one single
aspect of the patient’s health: it is an overall approach which takes into account all the
various levels of development and maturity.
PSYCHOACOUSTIC QUALITIES OF MUSICAL PARAMETERS AND THEIR

THERAPEUTIC RELEVANCE
1. Rhythm. Time expresses the duration of notes and pauses as well as

including various other aspects such as beat-unit, rhythmical patterns, meter,
tempo, etc. As in other musical parameters, the manifestation of time plays a
cardinal role in music therapy due to its inherent linkage with the human organism.
Here we shall concentrate on three basic rhythms—the biological, the movemental
and the cyclical.
The innermost circle, the biological rhythm (beat-units), originates from the activity of
such vital organs as the brain, heart, lungs, bowels, sexual organs, and so on. It is
characterized by repetitive beat-units which are controlled by the brain stem. These
beat-units serve as a primitive basis for both the organism and in the art of music (or at
least did so up until the beginning of the 20th century when new concepts of
composition changed the traditional role of rhythm). Within the human organism this
inner rhythm is the first to exist and the last to be destroyed, even in vegetative
conditions in which the patient is in coma.
In music, the beat is the cornerstone, whose degree of audibility varies from
composition to composition. We have already noted that in traditional healing rituals,
both ecstatic and hypnotic, it plays the major psychophysiological role; we have also
noted various research which explains this phenomenon. The biological beat-unit can
be altered by internal causes (such as illness, changing states of consciousness, etc.)
as well as by external causes (such as excessive physical activity, time lag, climate,
etc.). In other words, such change can be caused within the inner rhythmic circle in the
same way it can occur within the middle or outer spheres.
Research has shown that the inner rhythmic circle can be reinforced by means of
continuous action after birth (Murooka 1976). This can be both vocal and movemental,
and bears a varied degree of significance which depends on the development and
individual needs of the infant. For example, a mother who cradles her offspring in her
arms and rocks it back and forth while crooning a lullaby does so in order to soothe it to
sleep. Sleep is an important activity for a newborn infant and during the cradling
ceremony and the lullaby it experiences the integration of several functions which are
essential to its development: touch, movement, vestibular stimulation, hearing, and the
exercising of its future means of communication.10
The use of a steady rhythmic beat at this stage in life fulfills the need for a soothing
vestibular stimulation. On the other hand, when we consider the way beat is employed
in rock music, which typifies adolescent culture, we perceive that energetic movement
stimulated by strong beat-units serves a totally different purpose. Here too we find
repetition (which therapy accepts as a holder) but its orgastic character and the
movements it invokes are aimed at releasing sexual and/or aggressive energies. In this
case the integration is between the biological beat-rates, the movemental, and the
cyclical spheres (the adolescent phase and its special demands). In addition the
adolescent is also capable of identifying with the lyrics which are generally composed
by his societal contemporaries and deal with subjects which answer his urgent needs.
In both cases, that of the infant and that of the adolescent, we are witness to a
combination of auditory stimuli and spontaneous physical reaction. In the first example,
both actions are carried out by the mother, while the infant plays a receptive role. In the
second example both music and movement can be performed by the same individual, or
there can be a player and a dancer who reacts. These can be seen as equivalent to the
events described in traditional healing rituals (Chapter 1), with the mother-infant
dynamic likened to the hypnotic and the rock dance to the ecstatic.
Isaac Sadai, the Israeli composer and musicologist, regards the infant’s discovery of
sound and its repetitive realization as an essential stage in the development of musical
epistemology. According to Piaget’s theories (1958) the discovery of sound occurs
during the sensory-motor phase which extends over the first eighteen months of life.
The infant pounds with his hands and feet either on his own body or on some other
object, and if he enjoys the sound or the rhythm he will repeat them again and again.
This process of repetition by way of the sensory-motor feedback cycle “represents a key
factor in the creation of rhythm and the structuring of form in every existing sort of
music” (Sadai. 1988). By so saying, Sadai transports us from the sphere of inner or
biological rhythm, to that of the rhythm of motion, beginning with the embryo’s reactions
in the seventh or eighth week of pregnancy (Hooker, in Payton, et al. 1977).
Generally speaking the infant’s physical development follows two basic directions:
a) Head to tail (cephalo-caudal), which means it first moves its head, and by
degrees the shoulders, the trunk, the hips, the knees and then the ankl es.
b) From the inside out (proximo-distal), which means that the differentiation of
movement begins in the center of the body and is transmitted in stages to the arms and
legs. As progress is made toward the extremities and the more refined movements
develop (the ability to separate and spread the fingers and to tap with one finger at a
time), there emerges a more complex ability suited to the playing of musical
instruments. It is the maturity of the physical-motor rhythm which dictates the degree of
sophistication which can be employed to produce musical rhythm.
The motor development of voluntary movement achieved by professional musicians is
so amazing that it defies comparison with almost any other day-to-day functioning.
Furthermore, when these motor skills are developed to such a degree that each limb is
capable of creating a different rhythm (such as playing a church organ), and the
independence of the fingers has matured, complex polyphonic music can be performed.
In other words the ability to perform music which is rhythmically complex is a natural
outcome of motor skills and efficient praxis (motor planning). On the other hand, when
there are defects in the motor system resulting in apraxis, these can in fact be improved
by the use of various instruments (according to specific needs) and motor response to
music.
Both movement response to music and movement while playing share an identical
pattern of development: reflex reaction, repetition and improvement, complex voluntary
movement, skilled movement which becomes automatic. The more the rhythmic motion
becomes automatic, the more the mental and listening processes are free to acquire a
greater awareness.
In the same way as the biological rhythms which are controlled by the brain stem can
be compared to the basic rhythms (beat-units) of music, so can the rhythms of motion,
which are controlled by the cortex, be compared to the variegated rhythmic events
which occur in musical compositions. They exert a mutual influence one upon the other
and both are influenced by the cyclical rhythm. This is a sphere which could well be
compared with parts or whole movements of musical compositions—both embrace the
extremities and the transformations within a given continuity. Both are perceived as an
“overall timing” within which different rhythmic events occur, sometimes strict,
sometimes flexible, and subject to influence.
Time (rhythm) is a parameter both of extreme exactitude and of dynamic flexibility.

Pathological symptoms as far as rhythm is concerned find their expression either in
extreme pedantry or in extreme flexibility. In the first case this means compulsive
repetition and perseverance, whereas in the second case this results in disorder,
disorganization and incoherence. Examples of extreme pedantry can be found among
neurotics who make use of rhythm as a defense mechanism, as well as with psychotics
who tend to enter into movemental and rhythmic perseverance.
Eric11 provided us with an extreme example of rhythmic obsession during music
therapy when he would annotate his compositions with such exaggerated directions as:
“20x,” which means to repeat twenty times.
During therapy it was possible to observe a direct correlation between his improved
psychic condition and the reduction of these repetition signs to the normal two.
For an example of organizational problems we can refer to the case history of Alon.
Due to muscular hypotonia and passive-aggression he had difficulty playing in a steady
rhythmical continuity. When his hypotonia was treated by ecstatic music thus enabling
him to express his aggressions, his rhythmic control improved to a remarkable degree.
This was not the result of rehearsal and practice, but rather a direct consequence of
treating his basic problems.
Another example is that of Jacob, who participated in music therapy for rehabilitation.
Jacob was a cantor who, as the result of a stroke, suffered from left hemiplegia. He
underwent a lengthy and agonizing process of restoring his sense and performance of
rhythm, especially the basic beat-unit in order to rebuild his melo-rhythmic abilities
which had been almost completely destroyed.
Indeed, the various rhythmic spheres are perceived by D.I.M.T. as emerging from the
human being himself. They facilitate both observation and diagnosis during music
therapy, as well as treatment and reassessment during all stages of the process.
As a basic parameter, it is rhythm in its simplest form which serves as the central
musical component of traditional healing ritual, just as it does in present day music
therapy. The case histories which follow will illustrate, among other things, the various
roles played by rhythm in music therapy, and also their links with the origins of the
profession as described in Chapter 1.
In music therapy, as in complex musical works, the rhythmic elements (in all their
various forms) serve as a unifying force (beat, rhythmic structure, meter), and as a
linkage between excitation and relaxation (tempo, acceleration, deceleration).
Organization, unification, excitation and relaxation, are viewed by D.I.M.T. as essential
psychophysiological elements.
2. Pitch mainly depends for its psychoacoustic effect on a basic frequency, the
number of vibrations per second. (Pitch is currently used to designate the psychological
experience, whereas frequency designates the physical vibration). In purely musical
terms a single sound generally has very little significance, whatever its psychoacoustic
qualities (volume, pitch, timbre), may be due to the fact that significance in the art of
music emerges from the relationships of such qualities within the composition itself. In
music therapy, however, the individual sound can sometimes be endowed with specific
content and meaning. Whatever the case, the human organism’s source for the creation
of pitch lies in the throat, from the very moment of birth the vocal system utilizes
changes of pitch as both a primary and secondary means of communication.
Changes in pitch modulation which ultimately create melody, originate with the infant’s
first attempts at self-expression, and from the intervals which his vocal chords produce
spontaneously. The development of voluntary movement within the vocal apparatus
leads to stabilization in the production of sounds and intervals. Thus, along with the
development of speech (which is not so dependent on the control of precise pitch), the
ability to sing develops.
D.I.M.T. defines speech as verbal vocality and singing as musical vocality. The ability
to translate pitch from the human voice to that of a musical instrument in accordance
with accepted musical standards is an essential part of music development. In therapy
this provides for an externalization of inherent internal elements in the same way that
percussion provides an outlet for the internal psychobiological rhythms.
To sum up, music contains the ability to link internal and external processes, and as
we shall see when we discuss the meaning of the Therapeutic Space, great importance
is attached to this linkage in the process of development and growth.
3. Timbre “is determined primarily by the number, the order and the relative intensity
of the fundamental, and its overtones as expressed in the Wave-Forms” (Seashore
1967, 20). It allows us to distinguish, for example, between A on a piano and A on a
flute.
So far we have been discussing only two of the psychoacoustic qualities of music,
duration and pitch, both of which are essential to the organization of musical
composition. As we have seen, they both originate within the human organism and in
therapy serve the need for order, continuation, stability, and emotionality.
From a therapeutic point of view it is important to note the patient’s reactions to the
timbre of certain musical instruments, as well as to that of the voice as this can prove to
be a severe disadvantage if the therapist’s singing and speech (strident, nasal, etc.)
repels the patient. This critical question of matching the therapist’s voice to the
sensitivities of the patient deserves a more thorough investigation.
I have observed specific emotional reactions, due to neurological over-sensitivity
among autistic patients, schizophrenics, and occasionally among minimal brain-
damaged children to timbre, pitch and volume. In only two cases did I discern anxiety as
a result of increased tempo, apparently due to traumatic associations (Sekeles 1989).
4. Intensity. Volume is expressed in terms of decibels. The decibel is a psychological
unit representing the degree of loudness. Its physical counterpart, intensity, is
expressed in terms of units of electrical energy.
The variety of intensities which can be employed in music is called dynamics. The
expressive source of volume within the human organism is again the voice, and its
emotional effectiveness is determined (apart from by the factors already mentioned) by
dynamic change, which in everyday life consists of the whole range of volume between
a whisper and a scream. Different degrees of volume can also be achieved by means of
body-sounds, as we have seen in the case of other parameters; such expression begins
at birth and remains active both in the art of music and in everyday life.
We have already noted how ecstatic healing rituals are characterized in part by
steady increases in volume in a manner which serves to release aggressive and/or
sexual energy, whereas in hypnotic ritual a moderate, unchanging dynamic is preserved
throughout. The entire ritual remains relatively quiet from beginning to end, creating
relaxation and a sleep-inducing effect, since the dynamics resemble those of the
lullaby.
In therapy we must pay great attention to the gaps which may exist between emotional
content and its vocal expression, with volume (or intensity) being one of our major
guidelines. For example, Alon or Rita (see Chapters 6 and 7). While both of them
suffered from an inability to express anger, their body language revealed obvious
symptoms of passive aggression. They hardly ever made use of vocal expression, and
even when they did the volume or dynamic they employed was a mere p/ppp
(piano/pianissimo). One of the ways in which their therapeutic progress could be
measured was by their ability to play musical instruments at extreme volume with a
matching vocal energy.
D.I.M.T. observes and takes into account the free flow and balance between the
dynamics of voice and body movement. For example Ron, (see Chapter 3), when
suffering from a state of great anxiety would turn rigid, increasing the spasticity of the
paralyzed part of his body, and scream. One of the first signs of improvement was his
ability to master to a certain degree the dynamics of both voice and movement.
D.I.M.T. also attaches great importance to the fact that music is endowed with vast
change and flexibility. It ranges from disciplined continuity to lack of continuity and
order; from fast to slow tempo; from sudden, surprising changes and innovations to
predictability and repetition; from broad to narrow vocal range; and from unexpected
variations in volume to unity and a minimum of change.
The following chart attempts to show the relationships between the above-mentioned
musical elements according to their vertical and horizontal flow.
Characteristic Elements Characteristic
Irregularity, BEAT Regularity,

inconsistency Consistency
Irregularity, METER Regularity

asymmetry symmetry
Variegated, RHYTHMIC Fixed,

nonrepetitive, STRUCTURES repetitive,
unpredictable predictable
Unpredictable ACCENTS Predictable
Accelerated, TEMPO Slow, repetitive

changeable and predictable
High, with sharp PITCH Low, repetitive

variations and predictable
Extremely variable, MELODIC Limited, repetitive
unpredictable RANGE and predictable
Extreme variation VOLUME— Unity, minimal

within a brief DYNAMICS variation
time-frame
In this partial list (to which one could add further combinations such as musical
texture) we can perceive certain principles. In the left column we find irregularity,
asymmetry, acceleration, sharp variation and high pitch, all of these being qualities
which arouse interest and identification in some, irritation and psychomotor unease in
another, incomprehension in a third, and so on.
In the right column we find regularity, consistency, repetition, unity, and a moderation
of tempo, pitch and volume, each of which can arouse boredom in some, and in some
tranquility, somnolence, etc.
As has already been noted, ecstatic healing ritual commences with some of the
elements defined in the right column, and by a steady increase of both tempo and
volume reaches the extremes of the left column, whereas hypnotic ritual remains rooted
in the right column.
The Developmental-Integrative Model in Music Therapy makes deliberate use of
these principles in order to create mood, excitation, relaxation, an altered state of
consciousness, etc. As already emphasized, this is no simple task and it demands a
profound understanding of the patient and of his individual needs.
Despite certain disagreement between researchers (Sekeles 1990, Chapter 2)
regarding the exact psychophysiological influence of complex musical works, I should
like to make my own contribution to this ongoing argument. This is based on numerous
observations and reports which I have accumulated over the years.
A balanced combination of elements within any given musical composition can often
induce a psychophysiological equilibrium within the listener and/or performer. Such
equilibrium consists of a flexibility of movement in both vertical and horizontal axes and
a balance between tension and relaxation, expressed in changes of rhythm, melody,
harmony, dynamics, etc.
In music, just as in physical and emotional existence, we can observe the pressures
and releases of tension, of conflict and its resolution.
Existing in a state of constant relaxation and a consistent limitation of tension has
been proved to be antidevelopmental. Erik Erikson (1950) emphasizes the necessity for
a certain degree of anxiety in order to progress from one developmental stage to
another.
Pinhas Noy discusses art from a psychoanalytical point of view using the approach of
Ego-Psychology which claims that artistic activity is by its very nature an act of mastery.
“Just as in children’s games, the ego in such activity, recreates those agonizing
situations in which it used to be helpless, and by overcoming them, the painful
experience becomes one of pleasure.… Impressive art makes its effect due to its ability
to sweep the audience off its feet into emotional states of tension and anxiety, while at
the same time ensuring the conditions under which they will finally be able to organize
their experiences and get them under control” (Noy 1983, 351).
Such experience which induces tension and anxiety is recognized in music therapy as
a result of musical structures which can lead to a certain identification in a certain
patient at a certain time and in certain surroundings, but not necessarily in anyone else.
A balanced musical composition can help the patient to identify with the musical
solutions it offers, and might also afford the listener or the performer a sense of power
and control.
It is this aspect which leads us directly from music per se and the definition of its
therapeutic elements, to the Dynamics of D.I.M.T.
THE DYNAMICS OF THERAPY
THE THERAPEUTIC TRIAD (Patient, Music, Therapist)

The reality of therapy reveals that almost all the usually accepted generalizations
regarding the influence of music on the human being do not necessarily apply in
specific cases. Bonny (1969), and Eagle & Gaston (1972), arrived at totally
contradictory conclusions regarding the exact same patient community. Indeed, the
more complex the music, the greater the need for wider information regarding the
patient in order to understand the possible influences it may have on him.
Despite this, however, the realities of therapy show that a number of overall
characteristics are relevant for many patients, provided of course that these are
anchored in a style which suits the patient’s personality and cultural background. Music
of a soothing nature, for example, exists in a wide and contrasting variety of cultures,
styles, categories and even periods. We have observed the influence of such basic
characteristics of music in the hypnotic healing rituals, and they have been examined by
music therapists in a variety of clinical situations (Borling 1981; Scartelli 1982).
Obviously in order to relax an Arab-Moslem patient we should employ a musical style
with which he is familiar and which he is accustomed to hear, just as we should with a
patient of Polish, or Anglo-Saxon origin. D.I.M.T. denies on principle the existence of an
“International Language of Music” and instead puts a major stress on the cultural and
personal background of the patient in the selection of appropriate music for therapy.
There exists a parallel in verbal psychotherapy, regarding the use of a language and
lexicon which match the cultural experience of the patient.
So far our remarks have concerned receptive music therapy. In active music therapy
great attention must be paid to listening to the nuances of the patient’s musical
expression, and to cooperating with him and identifying with his own particular musical
culture (Sekeles 1983). Such identification can demand a familiarization with a style
which might well be outside the therapist’s usual repertoire and knowledge. For
example, the world of music for Jacob (see Chapter 5) was rooted in his religious
background and his education as a cantor. Most of his cantillation and prayers were
foreign to me and forced me into a new field of study, and identification with a new kind
of experience.
Similarly Rita (see Chapter 6), whose Netherlands background comprising the songs
she learned in school within a certain age group and the music she knew at home, were
also not a part of my own musical education. In order to help her I had to become
acquainted with what was familiar and meaningful to her, to internalize it and then be
able to make free use of it. This is more than simply understanding manuscripts and
scores. It means fully comprehending the musical origins and the patient’s cultural
roots. This is especially true since D.I.M.T. lays stress on the fact that after the initial
confrontation with the medium most of the musical material to be employed in therapy is
produced by the patient himself and consists of rhythmic and melodic motifs,
organization of the material, extra-musical connotations, the associations of music with
emotions and events, the choice of instruments and their symbolism, etc.
According to D.I.M.T., the music is inspired by and emerges from the patient’s
personal world, both in receptive and in active therapy. It is up to the therapist to
understand and contain this world, to analyze it and to make use of it in an ongoing
therapeutic dialogue. During this dialogue the musical material will often undergo a
metamorphosis and occasionally (as in the case of Eric) be transformed from mere
improvisation into a comprehensible composition. In other words, alongside emotional
and physical development there may well be a purely musical development. Despite the
fact that this is not the declared aim of music therapy, the acquisition of skill and control
in music can contribute to an overall sense of confidence.
Because it is so difficult to research and define the exact extent to which music can
influence man, the music therapist often finds him or herself facing a professional
existential dilemma—can a therapeutic process exist even when someone sits at home
alone, listening to or creating music by himself? If so, why apply for professional
advice?
Similarly, can the musical dialogue which takes place between the players in a
chamber or symphony orchestra be defined as therapeutic? And if so, can such players
who conduct such a continuous musical dialogue be defined as a symbol of health in
body and soul?
Another point to be clarified is the day-to-day dynamics which may characterize
individual or group activity in music as opposed to the dynamics of the music therapy
space. Music to which someone listens at home, or plays at home, can be excellent and
extremely moving for the listener, or for the performer. This does not mean, however,
that it necessarily opens up a window for self-awareness, or for a strengthening of
personality. The potential is there, but in reality people tend either to cling to a
professional analytical frame of mind (especially musicians) or to float on clouds of
emotional experience, and no more than that. In the first case there exists a certain
educational experience and intellectual approach to music, while in the second it is a
purely sensuous experience. There remains no evidence of a therapeutic process, or
the essential linkage which therapy seeks between emotion and intellect.
There also exists the phenomenon of professional players, in both large and small
orchestras, who display a marvelous capacity for interaction and mutuality of sound in
performance as a unified whole, and yet are extremely disharmonious in human
relations when not on stage.12 It is for these very reasons that D.I.M.T. perceives music
therapy as a stage upon which the main purpose is to achieve a balance between the
various personality needs of the patient. It is the therapist’s task to assist in such
linkage by means of mirroring, holding, elaborating the process of transference, and so
forth.
Such techniques, adopted from psychodynamic therapy, are exploited in D.I.M.T. by
way of music, words, and a combination of both. It would appear that without the
mediation of the therapist such aspects would be hard to accomplish. It would also be
difficult for any person, or his companion, to comprehend during musical activity the
messages emanating from his body (fixation, distortion, pain), or the psychological
expressions of repression, aggression, inability, and to exploit these by use of music in
order to achieve efficient and satisfactory change.
Therapy demands an intimate framework within which one can work both physically
and/or psychologically and focus on any possible change. Despite the fact that this
model emphasizes an overall approach, it is not my intention to enter into the complex
arguments regarding the links between body and mind, nor to prove their scientific
existence.
From a philosophical point of view Prof. Isaiah Leibowitz, in an article concerning the
apparently obvious and accepted links between body and mind claims that “Our mental
powers are incapable of grasping the inevitable fact that the psychophysical link, which
every one of us reveals in his own personality, is a logical impossibility” (Leibowitz
1982, 75–76). Logic, from a scientific point of view maintains that physical realities are
measurable, while realities of the mind are not. Neither will we discuss here the
viewpoints adopted by countless researches into psychoneuroimmunology (Lloyd et al.
1987, Pelettier et al. 1988). Possibly in the future such research will be able to provide
us with a new approach regarding the powers of music as part of the body’s struggles
against illness.
At this stage we are not concerned with mind or body, nor with the immune systems,
but with patients: Ron, Anat, Jacob, Rita, Alon (see Case Histories), paying attention to
the special needs of each individual, in an attempt to enable them to achieve musical
expression which includes not only words but also the experiences of music and that
primal communication which preceded speech.
The psychodynamic process of music, according to D.I.M.T., shows us that from out of
the musical chaos which often typifies the start of therapy, there emerges a dual
conversation which the patient begins to conduct both with himself and with the
therapist, and it is from this that order can develop. It is my contention, based on many
years of experience, that the basic elements (such as rhythmic cycles) contain within
themselves a basic urge for organization and balance, due to their parallels with the
equilibrium achieved by the vital functions of the organism. Likewise, such organization
has a reciprocal effect on those vital functions and vice versa. When there exist
blockages or regressions in natural development, be these due to cerebral palsy,
blindness and retardation (Ron), muscular hypotonia and the Down’s Syndrome (Anat),
emotional blockage of speech (Alon), regression and a state of confusion (Rita), or the
loss of vocal-musical skills (Jacob), it is our task as therapists to locate the problem by
a diagnosis of the visible symptoms as well as the invisible causes. We must treat it
with the means at our disposal, which are mainly the art of music and its components.
Should use be made of elements from other art forms, or from the fields of psychology
or medicine, it should be done according to the special needs of the individual patient
and a strict adherence to the professional responsibilities of the music therapist. The
use of words does not make us psychologists; the use of movement does not turn us
into dance- or physiotherapists, or indeed into anything else. Music therapy is a
discipline within itself, and D.I.M.T. takes a grave view of the employment of elements
from other disciplines without sufficient professional knowledge and experience. Even
so, the demands for interdisciplinary knowledge as outlined in the Preface are difficult
enough to implement.
THE STRUCTURE AND SIGNIFICANCE OF THE THERAPEUTIC SPACE

D.I.M.T. sees the therapeutic space first and foremost as a “potential area for free
choice,” rather like Winnicott’s “Potential Space,” an area for activities whose roots lie
in children’s play activities, and whose nature depends on the ability of the child, or
adult, to undergo experience. Winnicott sees the religious experience, the artistic
experience, and the therapy room as an extension of the space between mother and
infant: when in a state of satisfaction and a sense of safety the infant can allow himself
to draw away from the mother and play by himself. “In the Potential Space between
baby and mother there appears the creative playing that arises naturally out of a
relaxed state. It is here that the child develops a use of symbols which stand at one and
the same time for external world phenomena and for the phenomena of the individual
person who is being looked at.” (Winnicott 1971, 128)
Winnicott defines this potential space as an intermediate area of experiencing, and a
resting place for the individual in the perpetual human task of keeping inner and outer
realities separate yet interrelated (ibid., 3). The therapeutic space embodies these
characteristics since it serves as a place in which playing is possible. As artistic
activities are on a personal level, the symbolic use of music creates a place which
allows emotional experience to link the inner and outer world and develop a dialogue
between them.
In practice the Therapeutic Space should be large enough to allow freedom of
movement for at least six people. The floor should be close-carpeted and the musical
instruments be moved to the side or be hung on the walls in such a way as not to inhibit
movement, and at the same time attract attention and encourage the will to try using
them. This allows the patient to choose his own area of activity, the instruments which
interest him, what pieces he would like to hear, the physical posture he prefers (sitting,
lying down, moving about), and so forth. This element of free choice is essential for
learning the patient’s problems and his latent strengths (initiative, self-control,
responsibility, independence, etc.), and is especially important in gaining his
cooperation and in strengthening his motivation for therapy.
The musical instruments themselves are of especial significance not only in terms of
practical use, but also because of their symbolic significance (see Appendix 1).
Because of this there should be the widest possible range of choice, including the usual
selection (piano, guitar, a full set of Orff instruments, wind instruments, etc.), as well as
folk drums and rattles, flutes and so on.
Special attention should also be paid to the patient’s own self-made instruments which
he decorates with his own personal symbols (see Chapter 1, Note 17), electronic
instruments, and a vast and varied collection of discs and tapes. High-standard
recording equipment is essential, and the space itself should be totally sound proof,
thus ensuring the intimacy so important in therapy.
Summing up, the therapeutic space should be totally isolated from any outside
disturbance, furnished spaciously without undue fuss, with a variety of high-tech
equipment. It should offer a free choice of activity and serve as an intimate potential
space for emotional and movement experiences through music.
THE TRAINING OF THE MUSIC THERAPIST

At the very outset formal training must include the professional study of music A
physician or psychologist who is also a music lover and makes use of music in his
treatments is not yet a music therapist, just as a music therapist who is familiar with and
makes use of the basics of psychology is not yet a psychologist. It is the language of
therapy which must serve as the initial basis for training. The demands made on the
therapist to employ music in a flexible manner make it essential that music be a Calling,
studied from an early age and springing from a natural desire.
The second stage of training should consist of studies in the fields of medicine and
psychology of all aspects which concern the normal and abnormal development of vital
functions.
Stage three should concern the development of self-awareness and an understanding
of the therapeutic aspects of music and their relevance to the trainee himself.
Stage four should be devoted to the integration of these subjects into the specific field
of music therapy. It should be stressed that stages two, three and four should not be
taught one after the other but simultaneously, with a balance and integration between
theoretical studies, workshops, and supervised apprenticeship in clinical settings.
After concluding these stages, the way is open for additional training which can
optimally embrace music therapy for music therapists, psychodynamic therapy, other
forms of artistic therapy, as well as intensive supervision of clinical procedures.13
ESSENTIAL SKILLS
The patient and his therapist are each burdened with his own set of values, cultural
background, life-experience, musical preferences and prejudices. Indeed, the music
therapist will be capable of authentic expression only insofar as he employs a musical
language which is most familiar to him and permits him the greatest degree of flexibility.
He must, however, be capable of transforming music into words and vice versa; and he
must have the ability to select and improvise the kind of music which will influence the
patient as and when required. He must also, at the same time, be able to objectively
comprehend the therapeutic process.
Just as one of the aims of therapy is to expand the patient’s scope of expression and
range of experience, so must the therapist be open to an understanding of musical
cultures which may be totally foreign to his or her own education. The therapist must be
ready, willing and able to invest vast amounts of energy in improving and expanding his
musical knowledge of styles, categories, unfamiliar instruments and vocal expressions
in order to absorb and contain the patient’s mode of expression and thus establish a
dialogue.
The music therapist must learn to listen with patience and tolerance. The vast majority
of patients arrive for treatment as nonmusicians who must undergo a process of chaotic
trial and error which the therapist must accept at face value. Even though the therapist
may have acquired vocal and instrumental techniques which could assist a patient who
lacks any formal training, he must avoid any invasive intervention at this stage as it may
well overwhelm the patient and sabotage the continuity of the therapeutic process.
From a therapeutic point of view even the most primitive, limited and confused attempts
at self-expression bear a physical and emotional significance. The therapist must be
capable of a dichotomous analysis not only of the musical events, but also of additional
phenomena (body-language, mimicry, physical and emotional blockages, verbal
expressions, etc.), and recognizing the relationship between them. Listening must also
be a dichotomous process, analytical (purely musical), and emotional (identifying with
the messages the music attempts to convey). Listening not endowed with both of these
abilities cannot be effective in therapy.
The music therapist must develop a dual sensitivity to the patient, both to his musical
efforts and at the same time to his extra-musical activities. It is by no means an easy
task to arrive at a swift answer to a patient’s musical expression as it demands a
developed ear,14 the ability to transfer from ear to instrument, as well as the dangers of
overloading due to excessive creativity on the part of the therapist, or the opposite—
superficiality due a lack of sufficient creative input.
To sum up, the characteristics and development demanded of the music therapist are
flexibility and broadening of interest in all fields of music and personality, which will
enable him or her to listen with both patience and tolerance; to absorb, contain and
understand the dynamics of transference and counter-transference: to be aware of and
sensitive to the patient’s musical and extra-musical forms of expression, and to be able
to analyze them from both musical and extra-musical viewpoints.
To this end, in addition to possessing initial and essential personality traits, the
therapist must learn to form an integration between music, medicine and psychology,
and must undergo supervision in a clinical setting as well as in verbal therapy or any
other psychotherapy through art-modality.
THE PATIENT COMMUNITY

Since D.I.M.T. operates on a variety of levels of insight and employs music for a wide
range of aims, I would like to stress that in the realities of therapy, in addition to the
question of which patient is suited to music therapy and in what form, there is also the
personality of the therapist to be taken into consideration. Not everyone can necessarily
deal effectively with the retarded, the psychotic, or with the sufferer from severe
neurological damage, just as not everyone can work in a significant manner with
neurotics. It is my experience that D.I.M.T. is most suited to those applicants who during
their initial interview and observation show a genuine interest in experiencing the
medium, even if this is limited to certain aspects of it.
This opens the door for the treatment of those patients who suffer from verbal
communication problems (either psychological or organic), from various levels of
retardation, neurological problems, the psychotic, the neurotic, and even the healthy.
The music therapist must, however, be cautious with schizophrenics who suffer from
auditory hallucinations, patients with musicogenic epilepsy, hypersensitivity to sound,
echolalia, and certain respiratory problems which can lead to fainting (a symptom which
dictates extreme care when employing wind instruments). Such cases can in fact be
treated by D.I.M.T., but only on condition that the problems and the musical resources
are fully understood and appropriately dealt with.
D.I.M.T. believes in the study and application of verbal techniques combined with
music or applied separately even when the patient may be of extremely limited insight,
or even severely retarded. This is possible by matching verbal expression with the
comprehensive ability of the patient. Even in the treatment of organic problems D.I.M.T.
believes in explaining the motor action to the patient, in mirroring, summation, and in
the active involvement of the patient in the entire process.
INTAKE PROCEDURES
Referral. As far as children are concerned, referral is generally instigated by a
psychologist, school counselor, occupational therapist, art therapist, physiotherapist,
family doctor, neurologist, mental health center, social worker, and so on. With adults it
may originate with the family, some other therapist or with the individual.
In the majority of cases such referral is indicated by difficulties in verbal
communication, inhibition of emotional expression, or a rejection of verbal therapy. On
occasions, when referral is made by a neurologist, the indication may include specific
requests aimed at the treatment of the fine motor system, eye-hand and hand-hand
coordination, defects of auditory memory, speech problems, etc. In all such cases,
therapy is devoted to the W hole Being, not to its separate parts.
Initial interview and observation. The initial interview can be conducted with the
minimum of advance information about the applicant, and since this is mainly based on
musical activity, it increases the chances of unprejudiced observation.
Apart from certain details which may be considered essential to the specific case, in
this first encounter the prospective patient is given a free hand in selecting his own form
of musical expression (even though the therapist may support by modeling and by
transforming the expressive use of music into a norm). The temptations, or stimuli,
available in the music therapy space, as opposed to those in the premises of the
psychologist or psychiatrist, can be seen as a means of diverting the applicant’s
awareness from internal to external interests.
From this point of view, whether we are discussing the treatment of children or of
adults, it should be recalled that we perceive the therapeutic space as an “Intermediate
Area of Experience.” Thus the musical equipment might serve to express inner content
and to create a suitable atmosphere for the reduction of anxiety.
During the initial interview observation is carried out according to the D.I.M.T.
evaluation procedure (see Appendix 3) motor development, sensory development,
sensory-motor integration, vocality, rhythmicity, the use of musical instruments, hearing
and listening habits, as well as emotional, cognitive and societal characteristics. All this
through music and techniques which will be briefly discussed later.
With the applicant’s agreement the initial interview is recorded in toto, as are all
ensuing therapy sessions. After this interview the therapist summarizes his evaluation
and submits it to the referral authority together with his recommendations regarding the
suitability of the applicant/referred-patient for music therapy.
As already mentioned, these considerations are a direct outcome of the potential
patient’s readiness to express himself through music and sound, or for those incapable
of active expression, their willingness to undertake receptive therapy (see Case
Histories Rita and Eric, Chapter 2, Note 11).
During the initial interview the music therapist makes use of speech combined with
music according to his or her own judgment, and the session concludes with a summary
conversation matched to the potential patient’s level of comprehension and insight.
The Therapeutic Contract. In his book, Man Encounters Himself, Eliyahu Rosenheim
writes, “therapist and patient undertake a joint journey to the unknown regions of the
patient. They are ready, with all mercy, to enter that forest of the soul in which the
hidden is far greater than that which can be seen.… As they set out upon their way both
sides are in need of an initial agreement of cooperation. Whatever they may discover
(e.g., the meaning of inner content) is yet unknown, but the means of search demand
clarification. It is worthwhile defining the basic principles of their work and behavior—in
professional jargon, a Therapeutic Contract” (Rosenheim 1990, 44–45). It should be
noted that this refers to a contractual agreement in psychoanalysis which deals in the
main with neurotics.
The contract offered by D.I.M.T. differs in both content and phraseology as regards an
applicant with physical complaints, a retarded person with a limited vocabulary, or a
neurotic who possesses insight. While it is true that therapeutic contracts can be made
with any client and under almost any terms, the D.I.M.T. contractual agreement takes
into account the expectations of the applicant along with the clarification of possibilities
on the part of the music therapist. Where minors are concerned, the parents must also
be partners to the agreement. One of the most common misunderstandings made by
parents, educational authorities, and occasionally by applicants themselves, is to ignore
the therapeutic aspect and to relate to the healthy side of music. This tendency to view
music therapy as music teaching is worthy of further clarification, particularly in respect
to the emotional expectations which underlie it.
Effective therapy demands mutual agreement, understanding and goodwill on all
sides, from the beginning. It should be clear to all sides that the contractual agreement
embraces music as a means of communication, expression, clarification and
elaboration. The same holds true for those physical aspects of therapy which are
simultaneously concerned with more than mere improvement of movement, diction and
so on, but also with the emotional aspects. Children must be taught the rules of what is
“Permissible and Forbidden” regarding their conduct when handling musical
instruments as the therapeutic space contains not only sturdy instruments which may be
forcibly beaten with no restraint, but also delicate, fragile instruments which serve a
different form of expression. Experience shows that even violent children swiftly learn
respect for the instruments and understand that they have a speci al role to play which is
important to the child.
Part of the contract clarifies the confidentiality of whatever takes place in the therapy
room and that all recordings (which are standard procedure from the outset) remain
there, unless the patient (particularly if this is a child) expressly asks for a copy of a
certain piece so that he may listen to it again at home.
Another aspect of the contractual agreement which may appear purely technical but is
extremely important in ensuring stability, and a mutual sense of responsibility and
obligation is the definition of the framework of therapy (individual, group, pairs, family),
fixed days and their frequency (once or twice a week), and the duration of sessions (an
hour or hour-and-a-half.)
Naturally the terms of the agreement may well undergo changes according to the
dynamics and development of the therapeutic process.
THERAPEUTIC CONSIDERATIONS
If after the initial interview, observation, the contractual agreement and initial
conclusion, it is decided that the applicant is suitable for music therapy and a
therapeutic framework has been planned, there now comes the stage of therapeutic
consideration and assessment and the determination of short, medium and long-term
goals. This does not signify any rigid adherence to a preset program, nor does it
necessarily insure against possible mistakes in judgement on the part of the therapist,
but any therapeutic consideration without clearly defined goals may well miss the mark.
Since music therapy is concerned with emotional disturbances, speech impediments,
as well as sensory and motor problems, etc., the therapist must weigh carefully just
what are the specific possibilities which the patient can be offered, and which cannot at
this stage be provided by, for example, psychotherapy, speech therapy, physiotherapy
or occupational therapy. Music therapy can be either the sole treatment, or part of a
wider process. This should not be left to chance nor dictated by technical limitations;
great attention should be paid to determine which would be the most advantageous.
The first stage of therapeutic consideration is concerned with those aspects which can
lead to an understanding of the applicant’s problem (previous theoretical and/or
practical experience), the determination of therapeutic goals, a consideration of the
techniques to be employed, a practical approach to the use of music itself (even if at
this stage this is purely hypothetical), and the therapist’s own personal preparation for
his role.
The major problem involved in D.I.M.T. in the primary stages of therapeutic
consideration, and indeed during the entire course of therapy, is taking into account
both physical and psychological problems and determining an order of priorities. What
can achieve a breakthrough to what? Should both physical and psychological aspects
be treated simultaneously? Should there be a preparatory process?, Might it not be
better to deal with these aspects separately?
The answers are seldom unequivocal and are dependent upon the individual needs of
the patient. For example, in the case of Anat (see Chapter 4, 82–85) we shall see that
whereas (1), (2), and (4) work on the body with no verbal instruction, (3) works on the
body while demanding comprehension of such verbal instruction, (5) works on vocal
expression, and (6) combines all of these with emotional aspects. Within such a
program a wide range of variations can occur according to the current situation at any
given moment, such as the overall progress of therapy, and the patient’s own initiatives,
which can include preferences and/or rejections.
The process of therapeutic consideration repeats itself according to the various
stages of therapy. As therapy proceeds we have more and more documentation at our
disposal (recordings, transcripts, summaries, reports and video tapes), as well as an
overall view of the entire process. Therapeutic consideration and assessment facilitate
the therapist’s ability to examine the stage at which both the patient and the therapeutic
process are situated, to verify or to annul the approach, as well as to discern various
aspects of the therapist-patient relationship.
THE THERAPEUTIC ENCOUNTER

Despite the wide variety of possibilities which may occur during therapeutic sessions,
the therapeutic encounter is structured according to certain principles and techniques of
music therapy which are outlined below.
Framework. Due to the specific potential of music to create a suitable atmosphere, the
actual therapy session is often characterized by a musical opening or closing, which
can be with or without words and either vocal or instrumental. The opening can serve a
variety of functions, the threshold crossed from the outside world into the therapeutic
reality, also the prelude to a dialogue. Sometimes this prelude is relaxing, sometimes it
serves as a stimulant. The opening aids both patient and therapist to concentrate on the
job in hand, and frequently serves as a bridge between one session and another.15
The opening can be either recorded or performed live; the closing usually represents
a summation of the particular session, according to the patient’s degree of insight. It is
occasionally purely verbal but might also consist of instrumentally accompanied song,
in which both patient and therapist take part. In this way words and their meaning
combine with music and its meaning, reinforcing one another. When the session has
been a difficult one, raising problematic issues, the musical closing may serve to create
a more relaxed atmosphere, something which has a positive effect, especially in the
treatment of children. The opening and closing give the sessions a form of permanence
and stability, despite their often varying content, and aid in the establishment of mutual
trust within accepted boundaries (see all Case Histories).
Developmental therapy, as the term implies, means that the approach, the materials
and the means employed, are determined according to a diagnosis of the patient’s
problems and stage of development in order to advance normal growth. On occasions,
when the case concerns a severe physical ailment or disability, it is the therapist who
initially determines the material and the means. However, after a certain period of
individual adjustment the patient himself learns to select the most effective means for
his own case and the therapist assumes the role of guide and empathetic companion.
I would like to present a few examples:
Treatment of organic problems. Orit suffered from Cerebral Palsy with severely
spastic legs (at the age of seven she was still unable to walk), but her hands and arms
were slightly less spastic. On the other hand she suffered from hypotonia of the pelvic
muscles. She could not speak and had difficulty in vocalizing even single syllables. She
was, however, an intelligent girl, something which accentuated the gap between her
physical, as opposed to her emotional and intellectual development. Physically she
needed to improve her motor skills (relaxation and motor planning), and her vocal
potential. Emotionally it was necessary to deal with her physical handicaps, to
strengthen her ego and her ability to confront her vast array of problems, and to bring
her to acknowledge the fact that she possessed a charming personality and could in
fact contribute something to the world around her.
The therapist’s initial proposal was to make use of musical techniques which could
develop a sense of equilibrium in order to facilitate her ability to walk, reduce the
spasticity, and improve her vocality.
Orit swiftly adjusted to the opportunities being offered her and soon took the initiative
in defining her own course of treatment. For example, she readily grasped the
importance of prosody16 and enjoyed working with it, since it led to repetition and an
eventual genuine improvement of diction to the extent of actually voicing clear syllables
and even simple sentences. Her steadily growing control over her ability to walk and
express herself in speech helped her to overcome many of the frustrations emanating
from her disabilities and to close certain gaps in her development. At this stage the
treatment of her physical problems became a matter of routine, and the emphasis
shifted to her emotional difficulties.
It should be emphasized here that one of the major advantages of music therapy in
relation to speech improvement (particularly with children and the severely
handicapped) lies in music’s natural quality of repetition and variation which permits a
pleasant neurological exercise which is both playful and creative. Further, the
legitimization of free and primal vocal expression rewards the patient with a sense of
ease and freedom in which he or she can enjoy an infantile experience with no sense of
guilt or frustration.*
Examples of developmental therapy with emotional problems. During one single

session similar in form to several consecutive years of therapy, Ron, a blind
multihandicapped child (see Chapter 3, 68–69), passed through a “Prenatal” posture to
independence, commencing with a “Quasi-Symbiotic” posture on the carpet, gradually
rising in control of his faculties (movement, playing, singing), and achieving the creation
of his own songs which expressed both his difficulties and the encouraging aspects of
his life. In Ron’s case, despite certain periods of withdrawal, each session was marked
by a slow but steady process of growth. In other cases progress can be gauged only by
an overall review of the therapeutic sessions. Examples include Rita (see Chapter 6),
and the case of Noa.
Noa was hospitalized at the age of 35 due to major depression which was manifested
by lack of appetite, insomnia, total apathy to her surroundings, lethargy in her daily
actions, feelings of worthlessness and suicidal fixation accompanied by actual suicide
attempts.
Noa underwent both psychiatric treatment and music therapy. Two entire weeks were
devoted solely to respiratory problems with the aid of recordings made by a lip
microphone. Such recordings of inhalation and exhalation can reflect both pathological
and normal processes. In this case the recordings revealed a lack of continuity and a
withholding of energy, but gradually greater relaxation which was expressed by a
rhythmic unity and a fixed dynamic. After some two weeks of such exercises, there was
a spontaneous outburst of modest vocality which eventually developed into a form of
dialogue with the music therapist, and after a few months into a genuine cooperation
between equals in which there was no leader or follower but rather a total musical
equality between patient and therapist.
Noa would improvise tunes and lyrics which expressed great distress, and would ask
the therapist to accompany her on the piano. In this instance, an analysis of the musical
process both reflects and symbolizes Noa’s own psychological development, while the
musical interaction expresses the development of object-relation. Starting with breath
control (and the consequent sense of self-control as opposed to a panic situation), as
well as trust in the therapist, there emerged a voice, as well as a rhythmic-dynamic-
melodic development within the framework of a musical dialogue. In this dialogue one
could observe the transition from monophony to imitation, to a form of responsive
singing, to monophonic singing, and in the end to the initiation of vocal and instrumental
polyphony. Quite apart from the personal aspect, one can see in this growth a parallel
to the philogenic development of music itself, from vocal solos with short rhythmic units,
to complex polyphonic structures.
Psychologically this represents a passage through the phases of “trust, autonomy,
creative initiative and identity” (Erikson 1960). Almost from the very beginning of a strict
discipline of respiratory exercises, (20-minute exercises 3–4 times a day), Noa’s
posture became less yielding to the force of gravity, and her quiet unstable voice
gained in volume as well as in a variety of rhythms and dynamics.*
The representation of stress situations in sound and in music is not necessarily
immediate or spontaneous. There is usually a need for the investment of time, which
varies according to the individual, in which the patient may freely experience music,
both actively and passively, with the support of a certain modeling on the part of the
therapist. Apart from making use of existing compositions, the most effective
demonstrative technique is improvisation. This can be done on a variety of instruments,
as well as vocally and with the aid of the piano, which is considered to be the key
instrument due to its wide expressive range and symbolic qualities. The representation
of stress situations in sound and music extends over an extremely wide range of
possibilities, from the expression of overt emotional states such as anger, aggression or
misery, to more complex expressions of conflict, passive aggressiveness, or anxiety.
It should be emphasized even here that improvisation and the individual’s own
creation of words and music at various levels of expressiveness are a part and parcel of
all stages of music therapy, from the initial interview and first patient-therapist
encounter, through the revelation of the problem (either consciously or unconsciously),
its realization (and transformation from passive to active), its elaboration in music
and/or words, its summarization, and in the closing of the therapy session.
One can employ various means in order to represent an emotion, a problem, or
indeed any other issue during therapy: musical instruments, motifs, entire compositions,
etc. A few examples may serve to illuminate this:
Example one: representation of “splitting” by way of musical instruments. Michael
(aged 8) was diagnosed as a borderline personality and was referred for music therapy
due to his limited ability to cooperate in psychotherapy. He was prone to sudden
outbursts of rage (temper tantrums) which found their expression in extreme violence
against children and adults alike (stone throwing, knife wielding, kicking and biting).
During his initial interview Michael emerged as a true “Music Child” with a marked
ability to express himself, and to be guided by, and respond to, musical interactions.
During this interview, when it was made clear to him that the choice was entirely his
own, he took a large drum and a cymbal on a stand, playing alternately on both with
tremendous aggression and a chaotic structure.
After about ten minutes of this, his playing resolved itself into a variety of clear
rhythmic patterns, the drum was gradually abandoned, the cymbal continued alone for a
further few moments and then also fell silent. Following this, on his own initiative, he
produced a structured, gentle tonal melody and used this to verbally describe the war
between the cymbal and the drum, the cymbal’s victory, and how the drum and the
cymbal can never be friends. Michael had undergone a process of moving from chaotic
outburst to catharsis, then to gradual organization, which eventually led to an
expression of gentleness and a description of the subject represented. This question of
splitting, revealed here in the very first encounter is defined by Melanie Klein (1946) as
one of the earliest ego-mechanisms and defenses against anxiety.
Klein saw the child’s play as a symbolic expression of its experiences, fantasies and
anxieties. Technically she used it in a similar manner to that of free-association as
practiced in adult psychoanalysis. In play, as in music, one can give expression to
archaic themes, project inner threats and dangers, gain control, and so on. Splitting is
rooted in the early infant’s concept of the mother’s breast as the source of both
gratification (Good) and frustration (Bad). Childhood fantasies can be either restored or
distorted in object relation. Normal development depends on gratification being more
dominant than frustration, and on a synthesis within the splitting mechanism.
At the intake stage, with the aid of two simple instruments, Michael had already
succeeded in expressing a problem of splitting which appeared to disturb him, and at
the same time, due to the physical activity involved in playing them, in achieving
sublimation and a sense of satisfaction and reconciliation which were essential for his
growth.
Example two: representation of characters by means of a leitmotif.17 Naomi (aged 7)
suffers from severe psychological problems resulting from brutalization during infancy,
she also has a mild neurological disorder. Naomi has been undergoing music therapy
for three years now and is capable of free musical expression in a creative and
significant manner. During a certain period she felt threatened by a family crisis and
had difficulty in talking about it. Instead, during one of her therapy sessions, she picked
out three glove puppets, cast them in their roles (King, Queen, Monster), composed a
leitmotif for each, and asked her therapist to provide suitable accompaniment.
She then improvised the roles in an operatic fashion, developing the motifs and the
libretto on her own initiative. During this “performance” (with only very slight mirroring
on the part of the therapist) she began to realize that she was in fact talking about, and
staging, her own family situation. This served as the threshold for further ongoing
elaboration.
This form of representation is much more advanced than the one previously
described, since it involves both thought and preparation, as well as the composition
and setting of the leitmotifs. It also seems to have led to a certain deeper insight.*
Example three: representation of an emotional state by means of musical elements.
Tal (age 30) is a clinical psychologist who decided to undergo music therapy in order to
enrich his personal and professional potential. Despite the fact that he is not a pianist,
he nevertheless chose to experiment spontaneously with the opportunities the piano
offers. Within a short space of time, and on his own initiative, he had already
familiarized himself with various elements of the instrument and was capable of freely
exploiting them (chords, clusters, tonality, atonality, chromatic scale, harmonic tension
and release, and so on). For some time he was occupied with chromatic structures with
no verbal intervention on our part. At a certain stage he linked these chromatic
structures, which were characterized by increasing volume, with relaxing solutions.
Since his was an essentially verbal personality, I decided to let him experience music
without any analysis or interpretation on my part for as long as possible. At a certain
stage he spoke of his ambivalent feelings about the emotional and musical significance
of the chromatic steps (which are devoid of direction or any anchorage in a central tone)
as opposed to tonal solutions by which he would conclude his chromatic phrases. This
sudden understanding opened a window to a critical problem in his own life at that time,
and he was especially fascinated by this new way in which his subconscious was
speaking to him.*
In these few examples (selected from countless others) we see that in every case
music served as a representation of subconscious psychic material, aided in the
experiencing and development of such material, and in the achievement of a certain
degree of insight. In D.I.M.T. we approach such musical representation in terms of
personal symbolism; nevertheless there do exist certain musical structures whose
recurrence in various past and present cultures and styles point to the possibility of
“collective archetypes,” to adapt Karl Jung’s terminology (1966).
Where music is concerned, it would seem that such archetypes exist within us as
latent musical patterns 18 which are aroused into activity only by cultural or other life
experiences. Isaac Sadai (1988, No. 2) describes these as “precomposed elements”
and goes on to prove their existence, and the fascinating similarity which exists
between them from the most ancient musical heritage up to today’s avant garde.
On the other hand, “Highly complex musical composition is not generally based on the
primal symbolism of certain sounds” (Sadai 1988, No. 3) This would seem to be the
major reason why in the simple creations or improvisations of the nonmusician patient,
primary symbolism is quite apparent and can thus be perceived as an analogy of
subconscious psychic experience.
In a similar approach to that of Sadai, Shulamit Kreitler quotes Rank, Sachs and Jung,
who view such symbols as “the subconscious imprints of a primitive means of
adaptation.” These sources claim that the invention of symbols is a process which
involves the active participation of the human being during which he descends to a
lower level of “thinking in images as a result of partial abandonment (as in artistic
ecstasy) or total abandonment (as in dreams) of any conscious adaptation to reality”
(Kreitler 1986, 43).
As far as music therapy is concerned, the symbolic representation of psychic
processes serves to fulfill a number of functions:
a) A temporary distancing from consciousness in order to link by way of music with
feelings of stress and to comprehend them stage by stage.
b) The realization of distress and conflict by means of creative expression, and
hence the possibility of channeling these into release and sublimation, and at the same
time to transform them into an aesthetic product. In this we can perceive a combination
of two psychoanalytical approaches to art, the Freudian and the Kleinian (Noy 1983).
c) Control: perhaps arising in the human inclination to organize those basic musical
elements originating in the organism and thus overcome those hidden anxieties and
conflicts which distress arouses.
Noy proposes a synthesis between three psychoanalytical approaches to the arts
(Freud, Klein and Ego-Psychology): “Any artistic activity reflects both unconscious
desire, internal taboos and the efforts of the Ego to overcome these conflicting forces
and to organize them.… There are works of art in which the fulfillment of hidden desires
and their almost openly displayed gratification is prominent, whereas in others the
element of control and restrained satisfaction gains the upper hand” (Noy 1983, 352).
True, the subject under discussion here is complex works of art and not spontaneous
free improvisation, but from a psychological point of view (as opposed to that of a
musicologist) our attitude to the works of a nonmusician patient is identical with our
attitude to the works of any famous composer.
THE ROLES OF THE THERAPIST

Even when the treatment is for a physical disorder, the music therapist does not
present himself or act as omnipotent, as is sometimes the case in certain medical
models, but rather as the patient’s guide in a search for the best path for him to tread
along the way to self-improvement. This requires a basic attitude of respect for and faith
in the patient from two points of view. First attention to the personality of the patient
which permits him to experience and express his own feelings in his own way, even if
these may seem to be extremely distorted in the eyes of the therapist. He must
nevertheless respect the patient’s personality and trust his abilities. In any case
personal independence, which is after all the primary aim of therapy, is not achieved by
way of omnipotence or dominance on the part of the therapist.
Secondly and unique to music therapy, is the acceptance of the patient’s musical
efforts as they are, with no attempt at intervention in order to qualitatively correct or
improve, and with no value judgments. The music therapist can respect the patient by
adopting motifs he produces, however primitive they may be, and through them creating
a therapeutic dialogue, as if they were equal to the finest musical pearls of Mozart,
Mahler or Stravinsky.
During initial experimentation with the medium (which for us marks the beginning of
the working through process), respecting the patient consists of accepting and
containing whatever material he produces on all the various levels of his activity.
Respect can also be given by composing a piece based entirely on the patient’s own
words and music, in whole or in part. For Naomi for example (see earlier), a special
song was composed which summarized her dealing with her family crisis. It was based
on the characters she invented, the manner in which she portrayed them, and the
leitmotifs which represented them. Trust and respect can also be instilled by the
therapist’s close attention and exclusive interest in the patient. This requires both the
physical and spatial conditions needed for the establishment of intimacy (as described
earlier) and the concentration (as opposed to dispersal) of all one’s energies on the
patient. The key to such concentration lies in empathy.
“Basic human similarity allows the therapist to approach and absorb the patient’s
emotional world. This empathetic process is fed as much by the content of the patient’s
expressions as by the way in which he expresses himself. Empathy is based on a
carefully controlled use of the projection mechanisms” (Rosenheim 1990, 90–91).
In D.I.M.T. empathy operates on two levels, the personal and the musical. In order to
establish the framework which will permit a potential space for creation and self-
expression, the patient must trust in his therapist’s ability to accept and understand his
own means of expression and at the same time to maintain ethical standards. Since it is
routine practice in D.I.M.T. to record therapy sessions, the patient must be reassured
that the tapes are confidential and will remain complete and unaltered under the
therapist’s care.
Such a confidence-building framework can also be reinforced by a musical structure.
A characteristic example is the use of a tonal or modal theme (either adopted from the
patient’s own repertoire or composed by the therapist) upon whose continuity the
patient can mold his or her own musical and/or verbal content. Such a tonal framework,
or the harmonic accompaniment of a repetitive musical pattern, provides the patient with
a sense of security, and in our experience reduces both anxiety and defense-
mechanisms. It was on such a basis, for example, that Ron (see Chapter 3) began to
talk freely and openly, without anxiety or denial, about his severe problems as a blind,
epileptic, retarded and C.P. child.
The role of the therapist in such a case is to be supportive, both by musical and
nonmusical means. Making music together, while adopting the patient’s own themes, is
one of the best ways of displaying empathy.
Accompanying and setting clear boundaries are of tremendous importance in treating
children who suffer from anxiety and lack an awareness of limitations. It is often
necessary to stress this verbally, as well as musically; or to draw up a possible time
schedule for the child, and to use repetition in order to encourage self-confidence. As
has already been stressed, D.I.M.T. works on the principles of elaboration and on the
expansion of insight which take place in the treatment of both emotional and organic
problems. Whatever the case, body-language and the various levels of body and
movement experience should be observed and interpreted in order to locate the focal
points of difficulties and emotional problems (Yonah Shahar-Levi 1989).
Insight means that a person has discovered something new about himself, discovering
early subconscious processes which hindered any adaptation to new environmental
experiences. Rita (see Chapter 6) underwent severe suffering as an infant. This can
never be changed, but her perception of those events within a different perspective, and
her grasp of the opportunities offered by present-day reality could be influenced.
Change came about when such early memories were elicited and expressed (in her
case through a variety of artistic modalities), and her ego and belief in herself were
strengthened by the discovery of her creative energies. The role of the therapist was to
serve as her “mirror,” and to help her decipher and interpret her creations.
Such mirroring and its interpretation can be either verbal or musical and can on
occasions shift from one artistic modality to another. This kind of mirroring serves to
legitimize emotions.
Alon (see Chapter 7) started beating his drum with tremendous energy and the
therapist joined in on the piano in a similar style. Once this musical mirroring had given
him the feeling that his therapist had perceived his emotions, further verbal mirroring
was added for purposes of clarification. It should be stressed that mirroring is more
descriptive than explanatory and should therefore be accompanied, when needed, by
translation and interpretation.
Translation and interpretation can also be expressed in music provided that this
includes meaningful words.19 For example, Alon improvised a musical narrative about
an Animal School with a Snake Pupil and a Lion Headmaster. His voice was soft, weak
and virtually unintelligible. During the narrative it became clear that he regarded himself
as the snake and his father as the lion. The lion banishes the snake from the classroom,
accusing him of being “Lazy and Crazy.” The snake then takes his revenge by biting the
lion and poisoning him with his venom. At this stage of the narrative Alon’s voice rose
and he began to display physical signs of emotion. At first, mirroring consisted of a
simple reflection of his own musical expression. Later it was brought to his attention that
when he allowed himself to be angry, his voice rose, and finally, in conversation, he
himself arrived at the conclusion that he was the snake and that the lion was his father.
At the end of this session Alon composed a song about the relationship between the
Child Snake and the Father Lion, and then went on to devote several ensuing sessions
to revamping and improving it until he managed to express his exact feelings.
Rehearsing a song is seldom an exact repetition. There are variations and changes of
nuance, both musical and verbal. On occasions a song can achieve its full and
complete meaning only after a long series of repetitions and variations. There is also
the possibility that the words composed by the patient at the outset of the process can
gain their full emotional significance only after the challenge of composing a melody,
provided of course that in this the patient is left to his own devices with no intervention
on the part of the therapist.
Daniel (age 18) was hospitalized after repeated attempts at suicide. During music
therapy he wrote the following words (translated from the Hebrew):
Silence and stillness return twice to abide

Within that uproar where we walk side by side
Here on the street, amidst the pell-mell
Only that silence between us shall dwell*
He sat for more than an hour devising a tune for these words and eventually the melody
he managed to voice emerged from a single tone and a quiet, inhibited vocalization,
into a wide tonal range and a complete vocal expression:
The therapist intervened only when the patient had succeeded in defining the melody
and asked for instrumental accompaniment.
It would seem, therefore, that development during music therapy frequently springs
from those same accepted concepts which hold good for psychotherapy. The main
difference lies in the medium employed, and the achievement of aims by its specific use
(as well as by verbal means). Just as the psychologist must be sensitive to the
positioning and timing of reflection and interpretation during the therapeutic process, so
must the music therapist beware of musical and verbal intervention. It should also be
stressed that music by its very nature invites a kind of mutual conversation by playing
together, singing together (and even listening together), which can lead to an extremely
emotional experience dimension within the patient-therapist relationship. An example of
this is the case of Noa (see above).
All of the these developmental techniques are conducted by the therapist in an
improvisational manner, indeed the ability to freely improvise is one of the main skills
demanded of any music therapist in all active models of music therapy (Bruscia 1987).
Improvisation can serve a variety of functions, all in accordance with the patient’s
various levels of development, and the progress of the therapeutic process: imitation,
dialogue, simultaneous dialogue, supportive accompaniment, mirroring, reinforcement
of verbal interpretation, time out for relaxation, physical stimulation, the establishment of
a pretherapeutic atmosphere, eliciting free-association, the interpretation of feelings or
the representation of issues, summation of therapy, and more.
These are only a few aspects of improvisation, but it would seem that even this brief
definition of the roles of the therapist clearly shows that the music therapist must be first
and foremost a musician, easily familiar with his medium, flexible in his approach, and
capable of retrieving appropriate material from his musical knowledge whenever
necessary.
PROCEDURES FOR DOCUMENTATION, TRANSCRIPTION, INTERPRETATION AND

EVALUATION
1. A recording of every therapy session.
2. Video coverage whenever possible.
3. Transcriptions of musical material at critical stages of therapy.
4. Musical analysis of such material.
5. Analysis of extra-musical activity and its relevance to (4)
6. Registration of the focus of each therapy session: The problem, the dynamics,
etc., and the approach and techniques employed.
7. Maintenance of a continuous therapy report.
8. Editing down a summary recording of any specific patient.
9. Editing down cross-reference recordings.
10. Regular self-examination on the basis of these recordings:
The therapist’s vocal ability, the guidance provided, his improvisations, the
musical and verbal techniques employed, processes of transference and
counter-transference.
11. Utilization of observational and assessment documentation during the
entire course of therapy (see Appendix 3) for the purposes of both interim and
final reports.
CONCLUSION
This chapter has presented the basic principles of the Developmental-Integrative

Model in Music Therapy (D.I.M.T.) emphasizing the following aspects:
1. It concentrates on physical and psychological problems in accordance with priorities
which are determined by the needs of the individual patient
2. It is suited to a varied patient-community in relation to the patient’s problems: age,
insight and intelligence, and stage of development.
3. It is a combination of music, medicine and psychology, in which music serves as the
direct and primary language of therapy, medicine as a basis for understanding the
human body, and psychology as a secondary language for the treatment of emotional
aspects.
4. It perceives the basic parameters of music as a product of the human organism, and
hence music itself as activating that organism’s vital functions, this being the source of
the medium’s therapeutic potential.
5. It makes use of any musical means at its disposal, according to the individual choice
of the patient, together with the therapist’s assessment of the patient’s cultural
background, skills and insight.
6. It recommends flexibility within a supportive framework (both musically and
otherwise) in order to encourage growth and development.
7. It approaches music as a powerful artistic medium, which is nevertheless open to a
variety of interpretations, and hence concentrates on analyzing its influence on each
and every individual patient, as well as on the relationships established between
patient, therapist and music itself.
Notes on Excerpt Two
1. See Jean Piaget (1952), where he focuses on the developmental sequence of

thought and intelligence, Freud’s views regarding the psychosexual stages, and the
theory of learning which claims that behavior, or the potential for behavior is acquired
through experience and can therefore be conditioned (Bachrach 1981,†378).
2. Sense: in which the receptors are located in specific organs (ear, eye, nose and the
vestibular canals). Sensation: in which the receptors are dispersed, such as tactile
sensation or proprioception.
3. See also Case History Ron: The importance of repetitive beat-units in achieving
relaxation, and Case History Jacob: the rehabilitation of input and output of beat-units in
advanced age.
4. Alfred Tomatis: Otolaryngologist, who established the Institute of Cannes-Sur-Mere

on the French Riviera, and lectures on psycholinguistics. Dr. Tomatis concludes that
there exist links between hearing/speech, and psychological problems, and between
traumatic pregnancy and childbirth. In his form of therapy the patient undergoes a
repeated simulation of the birth process through the use of recordings of sounds similar
to those heard in the uterus whose volume is gradually increased. After birth, treatment
proceeds through play and art therapies in order to enhance the infant’s growth.
5. An example of integration while playing may be found in the case of an Israeli

guitarist who was injured in the spine (D-1) and became paraplegic below the level of
the injury. Although the head and arms remained functional, he had difficulty playing the
guitar due to imbalance and instability of the torso. In the absence of the senses,
sensations and locomotion needed for optimal performance, alternatives had to be
sought, in this case external support and a suitable seating accommodation succeeded
in solving the problem.
6. On the subject of Sensory-Motor Integration see the works of Ayres (1970b, 1972b,
1970).
7. See Appendix 1: Analysis of Instrumental Performance from a Therapeutic

Viewpoint.
8. For example, constant repetition of a single motif, the use of nonsense syllables,
drastic expansion or limitation of the vocal range, sudden dynamic changes and
accentuations, and so on. All of these permit the transmission of emotional messages
by vocal means, and open up therapeutic possibilities.
9. Increase of tempo holds good not only for amateur musicians, or in our case
patients, but also for professional musicians who perform the same work at different
hours and on different occasions in a different tempo, sometimes for objective, but
generally for subjective reasons.
10. Auditory communication is based on teleception, which also characterizes

other sense organs located in the head (nose, eyes), as opposed to tactile
communication between mother and infant, which demands physical contact.
11. Eric, a paranoid schizophrenic, was treated with receptive music therapy
for a full year due to his inability to communicate verbally or by any other means,
including active music. After about a year of total mutism (during which he nevertheless
regularly and punctually attended individual sessions) he began to cooperate verbally,
and on his own initiative to compose his own music. His compositions sprang from
within his private world, as did certain special annotations he would employ in addition
to the standard principles of scoring (Sekeles 1978)
12. In his book Creativity and Disease (1985) Philip Sandblom quotes
numerous examples of artists who suffered from various maladies. These quotations
suit Freud’s viewpoint of the artist as a personality which invests its neurotic symptoms
in its creative work (Freud 1908, 1909). For example Beethoven, who wrote that only his
art prevented him from fulfilling his suicidal tendencies, or Paul Klee who wrote that he
“created in order not to weep,” or Grahame Greene who defined writing as a form of
self-therapy, and expressed amazement that anyone who does not write, paint or
compose music can escape the madness, melancholy, panic and fear which are part of
the human condition.
13. The number of clinical and supervised hours is officially anchored in the
constitution of the Israel Association of Creative and Expressive Therapies (1985),
something which guarantees professional advancement. On the other hand no one can
be forced into undergoing therapy so this is no more than a recommendation. Alongside
the familiar reasons why the therapist himself should undergo therapy, lies the fact that
the transformation from being a musician to becoming a music therapist is something
that requires a considerable psychological investment which can be greatly helped by
verbal and/or artistic psychotherapy.
14. I have frequently encountered patients for whom the exact reproduction of any
motif they produced was of the utmost importance. This demands either absolute
hearing or a relatively sensitive ear. One example is that of Naomi who was
hypersensitive to sound and music, and extremely sensitive to pitch. The establishment
of mutual trust between us involved first and foremost a completely faithful response to
her music. Since this is not a phenomenon involving a high degree of intelligence, I
have also observed it in the retarded, the autistic, and on occasions among cases of
neurological damage and immature sensory development.
15. One example is Dan (aged 12), an autistic child who makes partial use of
body language as alternative communication. He is unable to speak and is severely
retarded, but is nevertheless capable of comprehension when addressed in simple
phrases. In order to forge a link between sessions, at the Opening, he will listen intently
to a recording of the previous Closing (always jointly performed in song accompanied
by the piano and additional instruments of his own choosing). On arrival Dan, who can
be restless and aggressive, is always impatient for this Opening to which he listens in
absolute silence, utilizing it to enter into a state of concentration and creativity. Another
example is that of Naomi (aged 8) who suffers from extreme emotional disturbances. On
arriving for a session she will await the therapist’s playing and has invented the saying
“I’ve entered the magic room” This is a slogan which helps her to enter and cooperate in
the elaboration of subjects which are not necessarily always enjoyable.
16. Both speech and song contain prosodic sound qualities considered critical
to the voicing and understanding of language. The sounds produced by the larynx are
characterized by volume, basic frequencies and by their quality. They are capable of
altering the significance of a single word or an entire sentence, and it is they who are
responsible for the transmission of vocal-emotional messages. D.I.M.T. works on the
prosodic elements of language, similar to the vocal play of the infant, as a prelude to
verbal-vocality. We have already noted that in the syllabic singing of the Navajo Indians
(see Chapter 1), use is made of prosodic elements for a soothing and relaxing effect.
17. Leitmotif: a term coined by Wagner’s friend Von Wolzogen in 1878 to

define a phenomenon he perceived in the composer’s later operas by which characters,
concepts and typical situations are represented by musical motifs, which can
nevertheless be adapted according to any given dramatic situation (Apel 1969,
466ñ467).
18. Such models, or basic structures, which are an analogy of the collective
archetypes of the unconscious, could be perceived as originating from inherent musical
codes, similar to the linguistic codes referred to in the theories of Chomsky. Sadai views
such codes as part of a natural system which permits an intuitive perception of music.
The more the child is exposed to musical stimulation, the greater the development of his
intuition and musical perception. Sadai bases his theories on extensive research of
such musical phenomena as tonality, modality, etc. (Sadai 1988, No. 4). Sadai’s theory
might well serve to explain why patients who have no experience whatsoever of musical
creativity can, in their own time and after sufficient stimulation, express themselves in a
variety of ways, mainly vocally but also by the use of instruments, as if they had been
formally trained. It could be said that such progress is the result of inherent musical
structures.
19. The linkage between words and music differs between the various
therapeutic models. In D.I.M.T. the linkage is wide and variegated, for example:
a) Music as a substitute for words (such as in cases of severe or profound
retardation).
b) Music as a breakthrough to speech (Case History: Rita).
c) Music as an arouser of emotion and speech, and as a link between emotion and
awareness (see all case histories).
d) Music as a major medium (as in the case of the terminally ill, when the need for a
sense of optimal well-being takes precedence over the need for verbalization and
awareness).
e) The balance between words and music, when words might prove to be
threatening or the music might tend to overwhelm.
f) Mirroring, expansion, interpretation, etc., by either musical and/or verbal means.
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READING 34
Chapter Nineteen
VIEWING MUSIC THERAPY ASSESSMENT

THROUGH A FEMINIST THERAPY LENS
Sue A. Shuttleworth
A crucial challenge for feminist assessment is to incorporate

contextual variables beyond that of gender that define women’s lives
(e.g., race, culture, sexual orientation, age, immigration status) in a
manner that reflects the meaning of that context for the particular
woman for whom an assessment is being conducted.
—Santos de Barona and Dutton, 1997, p.53
On a personal note, I entered into this project as a novice in the field of

feminism and feminist therapy, with minimal readings on the subject. With
extensive experience as a music therapy educator, and prior to that, as a music
therapy clinician, I have been interested in both clinical and educational
assessment for a number of years. I saw this project as a wonderful means of
expanding my knowledge and providing creative stimulation.
During my doctoral study, I had the opportunity to investigate women as
leaders. This area was interesting to me as I have experienced a variety of
leadership styles through different university department chairpersons, including
two female leaders. One of my research projects was a case study, analyzing the
leadership around a significant event within the department. I chose an event
occurring under the leadership of the first female chairperson, and highlighted
differences in her leadership style, as compared to her male predecessors.
Leadership characteristics included a focus on collaboration, an optimistic
outlook, and an involvement-focused initiative to empower the departmental
faculty members. At the time, these leadership characteristics were unfamiliar
within the context of the department and some resistance was encountered.
Because she actively demonstrated trust and respect for her co-workers, had a
clear vision, and communicated with positive energy and enthusiasm; her
innovative project was accepted and a transformation in the faculty members’
perceptions of themselves and the department occurred. Analyzing her
leadership style from a feminist perspective highlighted some of the assets of
430 Sue A. Shuttleworth
women leaders. Some of these same characteristics can be found within the
feminist-diversity approach to therapy.
Following a brief orientation to assessment and the assessment process in
music therapy, this chapter will describe feminist-diversity therapy principles
and assumptions regarding assessment. To understand the feminist therapy
approach more fully, specific areas that may concern the feminist therapist
regarding the philosophy, goals, design and implementation of assessment
strategies will be presented. I know of no writings that are specific to music
therapy assessment from a feminist perspective. However, there is much in the
music therapy literature that supports the basic assumptions of a feminist-
diversity approach and allows for adaptation and integration of the feminist
perspective into music therapy assessment.
OVERVIEW OF ASSESSMENT
General Definitions and Functions

Varied definitions and interpretations of the term assessment exist dependent
upon the perspectives of the user. From the creative arts therapist’s perspective,
assessment can refer to either the process of discovering an individual’s
strengths, need areas, and background, as well as monitoring progress; or only
considered to be the initial step of information gathering (Feder & Feder, 1998).
Functions of assessment in psychotherapy and counseling may vary from
identifying the goals of therapy and the client’s problems, to increasing
understanding of the client and facilitating the client’s self-understanding, to
identifying appropriate therapeutic interventions.
Oftentimes, assessment and evaluation are used interchangeably (Meyer et
al., 2001; Worell & Remer, 2003). Although actions involved with both terms
form the basis for decision making, the term evaluation is most frequently
applied to the process of monitoring client progress, and in turn, making
judgments about the efficacy of treatment (Feder & Feder, 1998).
Assessment within a Music Therapy Context

Assessment in the music therapy literature has been described as the process of
appraising the client’s needs, strengths, background, present functioning level,
concerns, and resources in preparation for treatment (AMTA, 2003b; Hanser,
1999; Bruscia, 1998; Davis, Gfeller, & Thaut, 1999). The American Music
Music Therapy Assessment 431
Therapy Association (AMTA) delineates music therapy assessment as

identification of the client’s current functioning level to be completed prior to
music therapy service (Standards of Clinical Practice, 2003b). Kristin Cole
(2002) labeled assessment as a general term that designates varied methods for
gathering information in regard to a client or student. She further delineated
three types of music therapy assessment: informal, formal, and standardized.
The music therapy assessment may be designed for a variety of therapist
objectives; such as descriptive, evaluative, diagnostic, interpretative, or
prescriptive (Bruscia, 1998, pp.27–28), and be reflective of the therapist’s
purpose and philosophical orientation (Isenberg-Grzeda, 1988). Tony Wigram
(2002) made a distinction between three different forms of music therapy
assessment (p.247). The function of the “music therapy assessment” is to gather
evidence that demonstrates the need of music therapy as an intervention. The
“initial period of clinical assessment in music therapy” occurs over the initial
two or three sessions and evaluates the most appropriate therapeutic approach
for work with the client. The “long-term music therapy assessment” is then
distinguished by its use of evaluation of music therapy effectiveness over time.
Richard Scalenghe and Kathleen Murphy (2000) described music therapy
assessment in the context of the managed care setting. They reported that
managed care organizations, accrediting bodies, and regulatory bodies look at
assessment as an ongoing process, occurring across time. From referral to initial
client contact, through each session, and at periodic intervals, assessment is
implemented to identify problems, strengths, and needs, and to report progress
and outcomes.
Feminist Definition of Assessment

Maryann Santos de Barona and Mary Ann Dutton (1997), discussing psycho-
logical assessment from a feminist perspective, provide a very broad working
definition of assessment: “Assessment is the act of identifying and naming
human experience relevant to the questions asked, and to that end it integrates
the theory, science, and practice of psychology” (p.38). Although there are
divergent approaches to assessment, Judith Worell and Pamela Remer (2003)
identified common goals in feminist approaches to assessment and diagnosis.
These are to develop and use assessment and diagnostic procedures:
▪ that highlight the impact of sexism and oppression in women’s lives

▪ that reveal women’s strengths and personal resources
▪ that make our reality visible to ourselves and others, and
▪ that validate our experiences (p.13)
In order to more fully understand Worell and Remer’s stated goals, a discussion
of factors affecting the assessment process follows.
Assessment Concerns from the Feminist Perspective

A problematic area for the feminist therapist is the use of diagnostic labels and
category descriptions as found in the Diagnostic and Statistical Manual of
Mental Disorders (DSM). Feminist practitioners criticize the DSM for
minimizing the effects of oppressive circumstances and culture and applying a
classification system that reinforces societal stereotypes and is sexist (Worell &
Remer, 2003). However, the feminist therapist in the United States, where a
DSM diagnosis is expected, finds herself in a bind when needing to obtain third-
party reimbursement for services. For most clients, failure to use a DSM
diagnosis results in no services, unless the therapist provides free services.
Beyond this difficult issue, when the therapist is involved in assessment, at the
very least there are specific considerations that must be observed. A multitude of
psychological and social variables can be overlooked or unwittingly mishandled
when making decisions stemming from assessment methods. Assessment
approaches from both a multicultural and a feminist perspective view some of
these variables in a similar way.
Sources of Bias
Bias in testing
One such variable is bias. One source of biased assumptions and values may be
a formal or informal test. First, tests may have biased items if the language is
culture-bound, including terms of sexism, ethnocentrism, ageism, ableism,
racism, classism, and heterosexism (SEARCH variables). An example of sexist
terminology is policeman instead of police officer when administering a career
interest inventory.
Second, bias may occur if the test items are based on experiences specific
to some groups in a culture more than to other groups, resulting in a group-based
experience advantage. An example might be assessing skills and characteristics
of a woman from a male perspective, such as looking at early life responsibility
with regard to having a paper route, typically a male experience. Third, biased
items may assume the perspective of a particular group. For example, life
history questions may assume a heterosexual orientation. Charles Ridley, Lisa
Li, and Carrie Hill (1998) confirm that testing instruments are almost always
culture-bound.
A third way that biased assumptions are incorporated into tests is through
inappropriate norm groups for comparison of scores. Many formal tests are
normed on Caucasians, and the scores of diverse ethnic group members are
interpreted on these norms. For a less biased approach, test scores can be
normed on diverse groups and even provide separate norms when possible
(Ridley, Li, & Hill, 1998; Santos de Barona & Dutton, 1997; Worell & Remer,
2003). However, Worell and Remer indicated that there is general agreement
that using cross-sexed norms on career interest inventories restricts women’s
exploration of nontraditional careers.
Therapist’s beliefs
The belief system of the therapist can provide another source of bias.
Stereotypical beliefs may include preconceived ideas of symptoms of a certain
group of individuals. For example, a therapist may “see” dependency more often
in females, believing that females are economically dependent on males, as well
as fitting the traditional female-gender stereotype. Whereas dependency may be
more likely ignored in males, not considering that the male may be dependent on
the female for maintaining the household. Oftentimes, these preconceived
beliefs are so ingrained in society and accepted as the norm that the biased
nature is out of the awareness of the therapist. The result may be a misjudgment
about the client.
In addition, the theoretical orientation of the therapist may present a source
of bias, especially in regard to determining what symptoms are pathological and
in whom the symptoms are pathological (Worell & Remer, 2003, p.124). In turn,
the assessment methods for gathering information about the symptoms may be
biased. The therapist may want to analyze aspects of a theoretical orientation to
determine possible bias points. Worell and Remer proposed looking at areas of a
theory using four criteria:
1) Is the theory gender-balanced or gender-free? If so, the theory

will view women and men as similar in psychological makeup
with any differences attributed to socialization, the development
of cognitive and affective processing, and the strategies that a
person uses to present him or herself.
2) Is the theory flexible and multicultural? The theory allows for a
broad range of healthy lifestyles and requires that constructs and
interventions are selected based on sensitivity to the ethnic and
cultural values of the client.
3) Is the theory interactionist? If so, it is considered that there is a
reciprocal interaction between individual variables (i.e.
behavioral, cognitive, affective) and environmental variables,
such as institutional and cultural. Multiple variables must be

considered in order to understand the individual.
4) Does the theory look at development as a lifelong process? If so,
this life span view allows for changes in behavior at any time
and at all ages. (p.95)
In addition to considering sources of bias, another area of concern for the

assessment process from a feminist perspective is that of environmental and
contextual factors.
Contextual Factors
Sometimes sex bias may occur within the assessment process when the
individual’s environmental context is not considered in the analysis of individual
behavior. The environmental context (e.g. poverty, patriarchy), how the individ-
ual interacts with the environment, and the effects of the environment on the
individual are often minimized. For example, if a therapist does not believe that
women live in an environment that may discriminate against them, then the
woman’s response to her situation may be judged as overreacting or even
abnormal. As in Gestalt psychology, one must look beyond a narrow area of
functioning to a broader view of the individual’s life in order to have a more
holistic picture of the person. A multidimensional approach to the assessment
process would allow for a more thorough analysis of the effects of the environ-
ment on the client’s behavior. Also necessary would be the consideration that
environmental stressors could be sources of pathology. A multifaceted approach
to assessment is also important to accommodate the variety of socio-cultural
factors that affect testing.
Socio-cultural Factors
Ridley, Li, and Hill (1998) supported a definition of culture that attempts to
separate itself from the concepts of race and ethnicity. They agree that culture
includes both external referents, such as institutions, roles, and artifacts, and
internal referents, including attitudes, values, beliefs, and consciousness. This
interpretation indicates that almost every aspect of a person’s experience is
affected by culture. Therefore, accurate assessments would include a broad
range of data. Also important is to validate the client’s cultural belief systems,
which may differ from that of the therapist’s, with regard to the assessment
process. This validation may facilitate client-therapist rapport and encourage the
client to expand on the problem from a cultural perspective.
From this perspective of culture, the assessor must take both referents into
consideration, with some aspects of the client’s psychological state being
evident (external) and other aspects less obvious (internal). For example, a
single working mother of three children presents with depression which began
about the time she was laid off from work. The layoff was a direct result of
downsizing and not work performance. She has been unsuccessful in finding
new work. One of her external cultural referents might have included the
expectations of her family to be a good mother and to meet the needs of her
children. The external referent may then become internalized into the woman’s
perception of herself—I am a bad mother because I can’t provide for my
children.
Additional sociocultural factors that can impact assessment methods
include differences in communication styles, health beliefs, variations in
learning styles, and an individual versus a collective orientation. Santos de
Barona and Dutton (1997) emphasized the importance for the psychological
assessor to be familiar with the sociocultural context of the client in order to
avoid a misdiagnosis or misinterpretation of assessment results.
Styles of communication
The assessor’s awareness about styles of communication among diverse cultures
can also prevent inaccurate interpretation of assessment results. Nonverbal
communication methods, such as the use of silence, facial expressions, and
gestures may be interpreted in a variety of ways dependent upon the particular
cultural meaning. For example, a woman whose ethnicity differs from that of the
therapist may appear reticent and verbally unresponsive during the initial music
therapy assessment. The music therapist, a Caucasian American, may negatively
interpret the woman’s nonverbal cues, unaware that in the woman’s culture it is
appropriate and expected to not seek attention and say little with persons other
than family members.
Health beliefs
Like cultural sensitivity and awareness of differences in communication styles,
the assessor should also understand that different cultures have quite different
beliefs about illness, disability, and treatment. Certain illnesses may be seen as a
stigma and the therapist may need to be sensitive in interactions with family
members, as well as the client.
Variations in learning style

In some cultures, persons are taught to listen to and obey an authority figure
rather than challenge. Information may be sought in a more indirect and quiet
manner. Other cultures may encourage learning through observation and
imitation rather than discovery learning. These examples of passive learning are
quite common in Asian and Hispanic cultures. Awareness of these diverse
learning styles would be extremely helpful for the therapist during the assess-
ment process.
Individual versus collective orientation

The values of a culture may focus on the importance of serving the group and
the group’s needs and goals rather than focusing on individual achievement.
Traditional Asian, Native American, and Hispanic families may be more
concerned with social norms and group cooperation than traditional Anglo-
American families where the emphasis is on individual pleasure and success.
All of the above areas are important for the therapist-assessor to become
familiar with in order to avoid inaccurate findings and recommendations. Just as
important, the therapist-assessor may more easily facilitate the understanding of
the client if a multicultural perspective is in practice.
Epistemology
Epistemology or methods of knowledge generation become critically important
during the assessment process when diverse populations are considered. A
broad-based strategy has been recommended where multiple data-gathering
methods are utilized (Ridley, Li, & Hill, 1998). Both a multi-method and a
multi-level assessment may decrease the chances that language or reading
barriers may underestimate the capabilities of the client or create
misunderstandings of personality. Mary Ballou (1990) suggested that a feminist
approach to clinical practice “…incorporates diverse methods that derive
knowledge from multiple sources through varying methods of inquiry” (p.41).
ASSESSMENT IN FEMINIST THERAPY
Principles of Empowerment Feminist Therapy

From a feminist perspective, the areas of concern in clinical assessment that
were described above can be ameliorated, in part, by following eight
assumptions about assessment and diagnosis. These assumptions form the
foundation for the Empowerment Feminist Therapy (EFT) developed by Worell
and Remer (2003). Let me first describe the four guiding principles of EFT:
1. Personal and social identities are interdependent. This principle

implies that clients are understood in the context of their
sociocultural environment. Every social location (or identity) of
the client is considered; including age, gender, ethnicity, social

class, sexual orientation, physical abilities, and characteristics.
Once the social locations are identified, the relevance or
importance of each to the client is assessed. The identities are
then looked at in reference to their dominant and subordinate
cultural expectations (e.g. privilege, injustice, oppression).
2. The personal is political. This principle holds that a good deal
of the client’s pathology is due to social and political influences,
with the external environment being a main source of problems.
Pathology, then, is reframed and symptoms are viewed as
coping strategies for an unhealthy environment. Another aspect
of this principle is to initiate social change so that society is free
of sexism and oppression of minority groups.
3. Relationships are egalitarian. Referring to client-therapist
relationships, the egalitarian therapeutic relationship minimizes
the power base of the therapist, thus making it more difficult to
impose one’s values on the client. Through this balanced and
collaborative client-therapist relationship, clients are considered
experts on themselves and become empowered. Worell and
Remer (2003) do note that achieving an egalitarian relationship
is very difficult and often is the ideal, not the reality. (p.73)
4. Women’s perspectives are valued. This principle states that
women should acknowledge and own their personal
characteristics, define themselves, and validate their woman-
centered views of the world (Worell & Remer, 2003, p.74).
Characteristics such as empathy, nurturance, intuition, and
relationship-focus become valued and respected.
EFT Assumptions about Assessment and Diagnosis

When conducting assessments, the following assumptions can be made when
following the Empowerment Feminist Therapy approach (Santos de Barona &
Dutton, 1997; Worell & Remer, 2003).
1. In order to have accurate assessment and diagnosis, information

about the client’s personal and social identities and cultural
contexts should be collected, and then utilized to guide the
therapy process (Worell & Remer, 2003). As in multicultural
assessment (Ridley, Li, & Hill, 1998), the first step is to begin
with a clear understanding of the client’s cultural influences and
experiences. As suggested by Worell and Remer (2003), EFT
clinicians assess for (a) acculturation; (b) identity development

level for each relevant social location; (c) client cultural values;
(d) client experiences with oppression, discrimination, and being
stereotyped; (e) experiences with gender-role socialization;
(f) access to societal resources (e.g. health care, good nutrition,
educational opportunities, social support); and (g) power
arrangements in the home (Phinney, 1996; Ridley, Li, & Hill,
1998; Santos de Barona & Dutton, 1997). (p.131)
2. Assess women’s lives in reference to their cultural contexts and
apply this information in interpreting other assessment and
diagnostic information (Worell & Remer, 2003). As stated
earlier in the chapter, EFT therapists look at the environment for
causes of pathology, with most cases having a combination of
individual and environmental factors contributing to the client’s
problems. There are many everyday stressors (poverty, living
and/or working in a sexist, racist, or otherwise oppressive
society) for women, as well as being the victims of rape,
domestic and intimate partner violence, and sexual abuse, that
could lead to problem behaviors. When the client and therapist
view her behaviors in the context of her real life, the behaviors
begin to make sense as reasonable responses or coping strategies
to her chaotic and often traumatic environment.
3. Create assessment strategies to be used to promote social change
(Worell & Remer, 2003). Social change may be addressed in
both subtle and overt manners. For example, subtle ways within
assessment strategies may include assumptions made and not
made about client’s lives or the nature of the client’s close
relationships (e.g. how the client defines her “family,” etc.)
4. Create environmental context assessment strategies. A variety of
methods to assess environmental contexts include gender-role
analysis (gender socialization experiences)—a process to
identify the gender-role messages one has received throughout
life (either directly or indirectly), identify them as negative or
positive, determine how they have been internalized, and then
develop a plan for any desired change. Power analysis, another
contextual assessment strategy, facilitates awareness of power
differentials in society and the ability to access resources for
personal and external change. Other environmental contextual
assessments include personal and social identity analysis and the
Power and Control Wheel (Domestic Abuse Intervention
Project). The Power and Control Wheel was created by battered
women from their personal experiences. Further descriptions of

these assessment strategies can be found in Worell and Remer’s
book, Feminist Perspectives in Therapy: Empowering Diverse
Women (2003).
5. Utilize a collaborative approach with clients for assessment,
diagnosis, and interpretation. Found in both multicultural and
feminist therapy, the strategy of clarifying the assessment
process and its purpose to the client is of paramount importance.
Results of assessment procedures and tests are shared with the
client who is encouraged to contribute her interpretations (as the
expert on herself). In addition, if a diagnostic label is selected,
then it and its potential consequences are examined in dialogue
with the client.
6. “Reframe symptoms as ways of coping with oppressive
environments” (Worell & Remer, 2003, p.130). Women’s
“symptoms” are reinterpreted into behaviors, reactions, coping
strategies, signs, or indicators that are exhibited for good
reasons and as a reflection of a pathological environment.
7. “Assess for client strengths and resiliencies” (Worell & Remer,
2003, p.130). Through implementation of this strategy, a
balance can be achieved with the deficit/symptom approach to
assessment. By identifying client survival strengths through
initial assessment, the goal of EFT—“to help clients access
internal and external resources to accomplish both internal/
personal and external/societal change” (Worell & Remer, 2003,
p.137)—is addressed.
8. “Value and use multiple ways of knowing” (Worell & Remer,
2003, p.130). Throughout the assessment process and the
subsequent analysis of assessment data, utilization of objective,
subjective, rational, and intuitive means of knowing are
encouraged.
ANALYSIS OF MUSIC THERAPY ASSESSMENT

A review of the music therapy literature through the lens of feminist therapy
highlights some commonalities with the basic principles. Cultural diversity,
awareness of one’s biases, a collaborative attitude, valuing women’s ways of
knowing, and feminist transformation of music therapy are areas that have been
indirectly or directly addressed in the music therapy literature.
Cultural Diversity and Sensitivity

The utilization of culturally sensitive assessment methods and content has been
addressed over the last few years. The AMTA’s Standards of Clinical Practice
(2003b) include culturally appropriate methods of assessment as the standard for
quality services. Additionally, content of the assessment may include cultural
and spiritual background. Cultural background, along with spirituality, is
defined as “[a]n interrelationship among a client’s musical experiences, personal
belief system, and cultural background, which may be influenced by the client’s
geographical origin, language, religion, family experiences, and other
environmental factors” (AMTA, 2003b, p.22). This definition supports the
feminist therapy principle of viewing the individual within the context of his or
her sociocultural environment, developing an understanding of the client’s
cultural influences, and acceptance and understanding of cultural diversity.
This culturally sensitive perspective has been supported in writings on
multicultural training for music therapists (Troppozada, 1995; Darrow &
Molloy, 1998), music therapy assessment (Chase, 2003a; Chase, 2003b; Adler,
2001; Cole, 2002), music therapy implementation (Chase, 2003b; Bright, 1993),
music therapy ethics (Dileo, 2000), and feminist music therapy (Curtis, 2000).
Manal Troppozada (1995) upheld the interdependence of personal and social
identities in a discussion of the definition of culture, indicating that membership
in a variety of cultures (e.g. socioeconomic, religious, racioethnic, etc.) creates
changing interactions throughout one’s lifetime. In reference to oppressions
experienced by women, Sandra Curtis (2000) reported that a combination of
oppressions interact, depending on each woman’s unique experience (e.g. racial
oppression, ethnic oppression, gender oppression, etc.). Cheryl Dileo (2000)
stated in her chapter on multicultural and gender perspectives in reference to
ethical thinking in music therapy, “…the client’s unique blend of cultural issues
influences all aspects of music therapy treatment” (p.149).
Primary to the music therapist is the impact that gender and culture has on
music behavior, whether it be a macro-culture of ethnicity or a micro-culture of
family or peer group (Bright, 1993). Ruth Bright (1993) advises the music
therapist to view and understand “culture” from a multilayered perspective when
considering music preference and music behavior.
One method of gathering cultural background information is through a pre-
assessment format (either written or verbal) that may include cultural history
and determination of how cultural membership impacts the client’s life (Cole,
2002; Chase, 2003b). This preliminary assessment procedure—generally
including medical history, general behavioral characteristics, medications, other
therapies, and music preferences—then assists the therapist in determining areas
to address in the assessment. Kristen Chase (2003b) provided excellent
suggestions for adapting such a tool to meet the needs of diverse clientele,
including the use of inclusive language.
Chase (2003b) also suggested an alternate format, integrating cultural
considerations within the music therapy assessment rather than a separate pre-
assessment format. Communication patterns, family and gender roles and
organization, high-risk behaviors, health care practices, death rituals, and
religious practices are all important considerations for inclusion in either a pre-
assessment tool or during the assessment itself.
Self-awareness of Bias
Although one can never be completely bias-free, we are often unaware of biases
that we hold. An awareness of our biases that may impact the assessment
process is an important goal for our development as culturally sensitive feminist
music therapists. Bias may enter into the music therapy assessment process via
two of the factors identified by Connie Isenberg-Grzeda (1988)—therapist’s
beliefs and the client population—that influence the music therapy assessment
design. The first factor, the therapist’s beliefs, worldview, and theoretical
orientation, may limit interpretation of data and lead to misjudgments or analysis
errors. For example, if interpreting a client’s musical improvisation is based
solely on the therapist’s gender and cultural norms rather than inclusion of the
client’s, an error in interpretation may occur when those norms are different, the
therapist views his or her beliefs as the correct ones, or there is a lack of
understanding of the client’s cultural perspective. How one views health and
illness, and normality and pathology also impact the assessment protocol
(Isenberg-Grzeda, 1988). As discussed earlier, are certain client behaviors
symptoms of pathology or ways of coping with the environment? Dileo (2000,
p.151) described the traditional Western/American standards and values found
in therapy, identified as predominantly male-oriented, that are present in client
assessment and diagnosis. As such, they have an impact on our views of
pathology and may raise questions in regard to gender issues.
The second factor, the client population, may be perceived by the therapist
from a biased viewpoint. The therapist’s perceptions of the client in reference to
a specific client group (e.g. persons with HIV-AIDS, gay and lesbian clients,
women) may impact how the assessment is conducted. For example, assump-
tions and prejudgments regarding a client’s music preferences based on the
individual’s gender, ethnicity, religion, sexuality, etc., may be detrimental to
establishing a trusting relationship and providing a successful music experience.
Linda Gantt (2000) encouraged creative arts therapists to enter the assessment
process with an open mind and without preconceived notions as to what will be
found. Specific suggestions for an unbiased psychosocial assessment in therapy

with gay and lesbian clients include using appropriate terminology, more
broadly defining “family” to “family of origin” and “family of choice,” and
discussing client’s living arrangements (Chase, 2003b; Chase, 2004). When
biases are eliminated or at least in the therapist’s awareness, and each person is
treated as an individual, new information will be found and a trusting therapist-
client relationship can develop.
Self-awareness of potential biases (such as religious bias, heterosexual
bias, and ethnic bias) is a component of a competent music therapist (Dileo,
2000), especially in working with persons from diverse cultures. Toward this
end, Dileo (2000, p.169) offered a variety of thought-provoking exercises and a
self-assessment to facilitate increased awareness of these potential biases. Chase
(2003b) also encouraged self-awareness activities to expand one’s cultural
awareness. She presented a Cultural Self-Assessment for Music Therapists,
including questions to facilitate an analysis of one’s cultural perspectives in
regard to personal and musical history (2003b, p.62).
A Collaborative Attitude
Several music therapists write about the importance of developing a trusting
relationship during the assessment process (Wigram, 2000; Hintz, 2000; Chase,
2003b). To this end, it is often necessary and/or desirable to conduct the
assessment over several sessions if the therapist is not constricted by
institutional time parameters. A collaborative approach to the assessment can
assist in building trust with the client.
Some components of what we typically do in music therapy assessment
consist of collaborative efforts. Successfully determining music preferences,
regardless of the method, cannot be done without the collaboration of the client
or family members. Varied music therapy methodology used during the assess-
ment process may incorporate collaborative efforts, such as musical improvisa-
tion or songwriting. The feminist therapy view of collaboration extends beyond
these examples of protocol collaboration. A collaborative stance is crucial to the
quality of the assessment, validating the client’s self-knowledge and facilitating
empowerment. Collaborative efforts should encompass the total assessment
process, from determining what to assess and what methods to use, to inter-
pretation of the results.
Communicating the results of the assessment to the client, when
appropriate, is one of AMTA’s clinical practice standards (AMTA, 2003b). This
is a beginning toward demystifying the therapy process, one of the techniques
utilized in feminist therapy to develop an egalitarian client-therapist relationship
and empower the client (Curtis, 2000; Worell & Remer, 2003). The collab-
orative approach can also provide some balance to the power inherent in the
therapist’s role. Curtis (2000) and Dileo (2000) both addressed the issue of
power, Curtis from a feminist music therapist perspective and Dileo from a
multicultural and gender perspective. Feminist therapists accept that the
elimination of all power differentials is impossible but the therapist should work
toward a therapeutic relationship that is equal in respect and value (Curtis,
2000). From the multicultural and gender perspective, power becomes an issue
when the client has experienced some form of oppression or discrimination from
others in power, brings these issues to therapy, and the therapist reinforces them
(Dileo, 2000). The therapist becomes “one of them” and a trusting relationship is
derailed.
Multiple Sources and Valuing Women’s Ways of Knowing

The use of observation, interview, nonverbal and verbal interaction, testing, and
collection of information from other disciplines or sources are all recognized
music therapy assessment methods acknowledged by AMTA (2003b). Multiple
means of collecting and interpreting music therapy assessment data for one
client have been advocated, including the integration of quantitative and
qualitative methods (Wigram, 2000). The simultaneous implementation of
formats such as a checklist, rating scale, and narrative were suggested for use
with “culturally” diverse clients (Chase, 2003b). With a multilayered approach
to assessment, a more complete and accurate picture is possible. In addition,
varied methods may allow the client to participate more actively in the assess-
ment process, thereby empowering the client and indicating respect for the
client’s self-knowledge.
Another assessment area that relates to valuing women’s knowledge is the
gathering of information regarding strengths, assets, and resources. Within the
AMTA Professional Competencies (2003a), assessing the client’s assets is
identified as part of the music therapy assessment process. Standard assessment
practice includes the identification of family and other support systems (AMTA,
2003b). Chase (2003b), in presenting cultural considerations for music therapy
assessment, includes identification of family roles, gender-related roles of men
and women in the family, views of sexual orientation and nontraditional
families, and client’s sources of strength.
Feminist Transformation of Music Therapy

Curtis (2000) investigated the possibility of transforming music therapy theory
into a feminist model of therapy. A model for feminist theory transformation
(Worell & Remer, 1992) was applied to Michael Thaut’s (2002) theoretical
model of music therapy, focusing on the human response to music (i.e.
neuropsychological processes in music perception) and how those responses can
be used in therapy. Curtis analyzed the music therapy theory against five criteria
for transformation: the theory must be “. . . gender free, flexible, interactionist,
life-span oriented, and such that it does not violate the three major principles of
feminist therapy (e.g. the personal is political, the client-therapist relationship
should be egalitarian, and the female perspective is to be valued)” (p.176). She
found that music therapy theory meets or could be easily adapted to meet Worell
and Remer’s five criteria. Due to the flexibility inherent in music therapy theory
(i.e. a focus on human response to music), a modification of music therapy
theory to include a specific focus on women—women of diverse cultures, races,
classes, abilities, sexual orientation—and on women’s issues could easily be
integrated. Curtis also suggested that the music therapy theory could be
modified to be interactionist and life-span oriented. Although music therapy is
not based on feminist principles, Curtis concluded that it does not contradict or
violate them and that it is compatible with feminist therapy (Curtis, 2000,
p.180).
INTEGRATION OF THE FEMINIST PERSPECTIVE

INTO MUSIC THERAPY ASSESSMENT
A Process-oriented Model
The feminist perspective is a sensibility, a center that, if adopted, pervasively
informs the complete therapeutic process (Hill & Ballou, 1998). This look at
assessment through the lens of feminist therapy has been an attempt to
demonstrate this perspective from an initial step of the therapeutic process.
Although there are specific feminist therapy techniques, the suggestions for
integration of the feminist perspective into music therapy assessment are
primarily attitudinal and philosophical, based on feminist and culturally
sensitive therapy principles.
Santos de Barona and Dutton (1997) formed an assessment working group
to identify principles that should inform a feminist analysis of psychological
assessment. The group identified five areas of importance:
1) In order to capture an adequate understanding of the client, the

day-to-day factors within his or her life should be integrated into
each component of the assessment process. Factors to be con-
sidered include developmental issues; life history, including ex-
periences with oppression and privilege; socioeconomic status;
physical condition; ethnic and cultural factors including accul-
turation, sexual orientation, geographical influences, spiritual or
religious influences, physical strengths and challenges, age,
social support (and barriers to support); kinship grouping; and
household arrangements (Santos de Barona & Dutton, 1997,
p.48).
2) Collaboration is fundamental, accomplished by combining the
client’s knowledge with the therapist’s, and acceptance of joint
responsibility for the assessment process so that the client is
actively involved in a forthcoming manner or in data collection
to document well-defined behavior.
3) Diverse means to gather knowledge (e.g. testing, personal
knowledge, intuition) are deemed valuable. The basis on which
various assessment decisions are made is acknowledged.
4) When assessment procedures are misused, social, political,
professional, or personal action is taken.
5) Assessment conclusions and the formulations about them must
be considered as a snapshot of the client at the time of the
assessment, not necessarily long-lasting realities.
Based on the above ideas, Santos de Barona and Dutton (1997) presented a
process for feminist assessment, identifying five stages where application of the
principles would be warranted. They encourage continuous and active involve-
ment of the client. 1) Initially, the therapist collaborates with the client to reach
an understanding about the assessment’s purpose and agree on the referral
question. 2) Then, the therapist and client jointly determine multiple methods
and multiple sources for collecting assessment information. 3) Involve the client
as much as possible in collecting data, such as through sharing anecdotal in-
formation regarding specific life events or being taught to record the frequency
or duration of a specific behavior. 4) Analyze the data within the context of the
client’s life (based on sociocultural factors) and the referral question, integrating
knowledge of the client with the collected data. 5) Determine a conclusion in
regard to the referral question, communicating with the client to ensure
understanding of recommendations.
Suggestions for Music Therapists

The review of literature has indicated that there are commonalities between a
culturally sensitive, feminist-oriented assessment approach and current and/or
proposed music therapy assessment practice. In synthesizing the material on
music therapy assessment, transformation of feminism into music therapy,
multicultural assessment, and assessment in feminist therapy, several sugges-
tions are proposed for the music therapist considering adopting a feminist
approach to music therapy assessment.
A good starting point is to engage in self-reflection on your personal
biases, gender norms, cultural identities, cultural values and attitudes, and
theoretical orientation (Chase, 2003a; Dileo, 2000; Ridley, Li, & Hill, 1998;
Worell & Remer, 2003). Since the music therapy assessment is when the
therapeutic relationship begins to develop, an awareness of what you are
bringing to the process is invaluable. Utilization of cultural self-assessments
(Chase 2003b; Dileo, 2000), a gender-role analysis, and a power analysis
(Worell & Remer, 2003) can facilitate this self-exploration. You may also wish
to analyze your theoretical orientation for personal bias by applying the Worell
and Remer (2003) model described earlier.
Become familiar with assumptions, principles, and goals for assessment in
feminist therapy and determine your stance toward them. This chapter has
attempted to provide current information and additional sources in these areas.
In designing therapist-constructed assessment tools or utilizing formal or
standardized instruments, be watchful for bias in language and assessment
content. If a formal instrument is used, document any alterations of standard
administration procedures along with the rationale for the modifications (Santos
de Barona & Dutton, 1997).
Approach each client as a unique individual with a multifaceted history
and current life situation. In collaboration with the client, consider the internal
and external sociocultural factors impacting the client’s life (including gender-
role socialization, cultural identities and experiences with oppression), the
environmental stressors and their effects on the individual, and the interaction of
these factors. Assess from the cultural context of the woman’s real life and
reframe, where appropriate, her symptoms as coping strategies for an unhealthy
environment. Additionally, integrate assessment procedures that reveal the
personal and social resources available to the client. This aspect of the assess-
ment may be implemented through a pre-assessment protocol or within the
actual music therapy assessment, perhaps utilizing multiple assessment methods.
Power and gender-role analysis, a focus in feminist therapy, can also be part of
the assessment. How in-depth the assessor goes in these areas at this initial stage
may be determined by the circumstances of the client. For example, a more
thorough assessment would be warranted for an abused client where it is

important to determine how the client sees herself in regard to the presence or
lack of power and her gender-role in relationship to events in her life. The power
and gender-role analysis may additionally be integrated with music therapy
treatment approaches and/or as pre-post tests.
Involve the client actively and in collaborative efforts during the
assessment to validate his/her own knowledge, to strive for a more egalitarian
relationship, and to empower the client. Informing the client of the purpose of
the assessment and procedures, as well as assessment decisions, can assist in
establishing the collaborative stance.
In work with clients from diverse ethnic and sociocultural groups, become
culturally literate by expanding your knowledge of the client’s cultural norms,
beliefs, values, healing practices, view of music, and music preferences (Chase,
2003b; Chase, 2004; Curtis, 2000; Dileo, 2000). This lengthy process may occur
through reading, listening to music, meeting with people from other cultures,
and consultation with resource agencies (Chase, 2004; Curtis, 2000).
The final suggestion for the music therapist considering a feminist
approach to music therapy assessment is to create assessment strategies with
social and political change in mind. One subtle way this could be accomplished
is to follow many of the feminist therapy principles previously discussed,
especially striving toward an egalitarian relationship and a collaborative stance.
PERSONAL REFLECTIONS
Through the process of looking at music therapy assessment from the
perspective of a feminist-diversity approach, I was surprised to find so many
areas of commonality with my philosophies of music therapy and music therapy
education. Although this chapter did not address assessment for the music
therapy university student, aspects of Worell and Remer’s approach to assess-
ment from the feminist-diversity perspective could easily be applied. Utilizing a
collaborative attitude and viewing the student as a unique individual with a
multitude of internal and external sociocultural factors that impact their daily
lives may be approaches that already exist in current practice among some
educators and clinical training supervisors. The music therapy educator might
also find several of the other suggestions for the music therapy clinician
presented in this chapter to be helpful when considering the assessment process.
As Marcia Hill and Mary Ballou (1998) suggested, the feminist perspective
is a sensibility that pervades all that a feminist therapist does, informing each
step of the therapeutic process.
By looking at one aspect of music therapy, clinical assessment, support has

been found for Curtis’s (2000) analysis that music therapy is compatible with
feminist therapy and can be adapted for integration.
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Tony Wigram (eds.) Music Therapy in Health and Education. London:
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READING 35
Smeijsters, H. (2005). Three Excerpts: Sounding the Self: Analogy
in Improvisational Music Therapy, pp. 55–64, 65–86, 87–110.
Excerpt One
ANALOGY: A CORE CATEGORY IN

THE WRITINGS OF MUSIC THERAPISTS
Henk Smeijsters
INTRODUCTION
From Chapter Three, we can conclude that developing a “theory of music
therapy” is an enterprise with several obstacles. From a qualitative point of
view, theory is suspect. It makes no sense to proclaim universal laws when one
tries to describe an ever-changing human context that gives rise to multiple
subjective perspectives. And if someone wants to look at the many-sided human
nature, it is impossible to reduce it to isolated variables. Therefore, some music
therapists doubt the possibility of a general theory. However, even music
therapists working with a qualitative paradigm adopt a theory—for instance,
humanistic psychology—that is closely linked to the qualitative paradigm.
Maybe it is not theory as such that is debatable, but what theory should look
like.
The discussion about the possibility of a general theory of music therapy
includes two other discussions. The first is centered on the topic of whether we
should use a qualitative or a quantitative research paradigm. The second
discussion, still going on, is about the question of whether music therapy should
be connected to an already existing psychological theory of therapy, or instead
should develop its own alternative theory.
Let me first explain my own perspective as a researcher. As a researcher, I
am convinced that we need the qualitative paradigm and the quantitative
paradigm as well. Because quantitative research is reductionistic, music
therapists in this paradigm often miss what they feel belongs to the essence of
music therapy. However, the discussion about research paradigms sometimes
seems to become narrowed down to a normative one where qualitative research
is glorified as “good,” and quantitative research is labeled as “bad and ugly.” In
my view, both paradigms give answers to very different questions.
Maybe the intermediate position I advocate looks somehow like a paradox.
If someone adopts the qualitative paradigm, how is it possible at another time to
look through a quantitative pair of glasses? But, as in music listening, I believe
and have experienced that it is possible at one time to listen to the “figure” and
at another time to listen to the “ground” (or “essence”) of human existence.
Concerning the discussion of whether we should develop our own theory
or make connections with already existing theories, I say yes and no. I say yes,
because we need a theory of music therapy that describes the analogy of musical
and psychological processes in such a way that the essence and typical
characteristics of music therapy are highlighted.
I say no, because we do not need our own theories of pathology and
therapy. What we need is a theory of music therapy, not a theory of pathology
and a theory of therapy. Music therapists should use the knowledge that has
been gathered in other therapeutic professions. A music therapist working in
psychiatry, for example, should be informed about diagnostic descriptions put
forward by the American Psychiatric Association or the World Health
Organization. Music therapists also should adopt knowledge about therapeutic
processes that have been described in other therapeutic models. Of course, this
cannot be the whole story, because if music therapists do not add knowledge, if
they do not describe how disturbances and handicaps are expressed in music, if
they are not able to describe musical processes that can cure disturbances and
develop handicaps, then music therapy cannot be therapeutic.
Claiming a theory of music therapy does not mean refusing knowledge
from other sources, but stresses the fact that music therapy can provide
additional assessment data and therapeutic strategies. These data should be
linked to already existing data from different sources. If not, the music therapist
will be a Robinson Crusoe inventing his own very primitive tools.
In this chapter, I shall report the genesis of a theoretical perspective that
can be part of a theory of music therapy. I do not claim to give a universal
theory. I present one perspective, which first arose intuitively when I studied the
work of my colleagues. At that time, I did not intend to develop a theory, and I
did not have a pre-fixed qualitative research design to get there either.
At the start of my theoretical voyage of discovery, it was not clear at all
that there could be a shared theoretical perspective. When I took off, I thought
that music therapy should be divided along the lines of existing therapies, or
disturbances and handicaps. However, gradually it became clear to me that in all
those different perspectives there exists some shared idea about how music
therapy works, and what is essential to music therapy.
First, I will go into some details of the qualitative research method, which I
describe in retrospective. Next, I will describe the results of my research,
especially the definition of the theoretical concept.
RESEARCH
In qualitative research, the researcher works without existing theories. He adopts

no theory that gives him a priori statements. There are no prefixed concepts and
no hypotheses by which relationships between concepts are proclaimed. No
experiment is used to test hypotheses, and there are no measuring instruments to
assess the values of the operationalized concepts.
The advantage of not using these procedures is that the naturalistic context
is not distorted, and the descriptions of subjective experiences within this
context are not reduced. The openness to the natural context makes it possible to
develop new concepts that fit closely the natural context. Perhaps this fit is so
close that generalization to other contexts is impossible.
The qualitative researcher does not believe there is an objective reality “out
there,” and is interested in subjective perspectives people develop to describe
what they experience as their reality. Thus the qualitative researcher tries to find
constructed meaning, and knows that constructed meaning is different from
“truth.”
The data I used are written-down descriptions and definitions music
therapists themselves use when they communicate about music therapy. Music
therapists are influenced by theories like humanistic psychology, psycho-
analysis, morphology, behaviorism, and others, but to me it was a challenge to
see whether, in spite of these different frameworks, there is some sort of a
shared idea about music therapy.
There is one problem in doing this, because when concepts from different
frameworks are put together, some aspects of the original meaning may be lost.
However, something is won also when different concepts can become connected
to each other.
The Core Category
When listening to music therapists, the listener is confronted with different

concepts music therapists use to describe the music therapy processes. Concepts
are verbal labels attached to the therapeutic phenomena to give them a name.
Using a concept goes further than merely describing what is happening.
Concepts are more abstract notions the concrete actions are subordinated to,
such as, for instance, concepts such as “to assist,” “to execute,” and “to
mediate.” These concepts do not describe the concrete actions of a secretary. A
concrete action, for example, is “taking notes.” This action can be subordinated
to the more abstract concept of “to assist.”
Concepts can be grouped in categories. Strauss and Corbin (1990, p. 61)
define a category as a classification that is discovered when concepts are
compared and appear to belong to a similar phenomenon. Concepts are grouped
together in a category, which itself is a more abstract concept. For instance, the
concepts “to assist,” “to execute,” and “to mediate” can be part of the job
description for “secretary.” A core category is a central phenomenon around
which several other categories can become integrated (Strauss & Corbin, 1990,
p. 116). Let me give you some criteria for a core category that I developed
myself:
· Many music therapists should use the core category

· The core category acts as a metacategory, and thus should include
other categories and have a central position between other catego-
ries
· Music therapists who use the core category should not belong to a
single therapeutic school of music therapy
· The core category should be able to be applied to different
disturbances and handicaps
Research Method
Doing qualitative research means working with an ever-developing design.

When I give you the phases of research I went through, please realize that they
developed spontaneously during the process of research.
The following research activities have been undertaken:
· Reading descriptions and definitions of music therapists

communicating about their own work
· Identifying concepts that reflect the essential aspects in each
individual’s description
· Cross-analyzing and comparing the essential individual concepts
of different music therapists
· Integrating these concepts into one category and signifying the
category by means of a more abstract concept
· Using this category concept as a sensitizing concept when
investigating new data
· Analyzing whether the category and the properties it signifies can
fulfill the criteria of a core category
· Defining and redefining the properties of the core category
This chapter describes the research steps by which the core category has been
developed. The final step, defining and redefining the core category, will be the
topic of Chapter Seven. Chapter Six will be used to ground the core category in
psychology and art theory.
EXAMPLES OF CONCEPTS
USED BY MUSIC THERAPISTS
First, I’ll give, in a chronological order, several examples of descriptions I found

while exploring personal theories of music therapists:
· “The nature of the therapy session is best understood when thought

of as analogous to a family or home situation” (Edith Hillman-
Boxill, 1985, p. 23 )
· “Improvisation is an analogous training space” (Gertrud Katja
Loos, 1986, p. 162)
· “The building bricks of music (melody, sound, rhythm, dynamics,
and form) are analogies of our way of thinking, feeling, and acting,
and in our improvisations is expressed how we think, feel, and
behave” (Isabelle Frohne-Hagemann, 1986, p. 18)
· “The multitude of sounding and rhythmic manifestations of music
corresponds with the multitude of human existence in general”
(Paulo Knill, 1987, p. 11)
· “For me there is no more clear prototype for the many paradoxes
of the Gestalt development of the human soul as the phenomenon
of a musical composition” (Rosemarie Tüpker, 1988, p. 48)
· “It may be inferred then that people become aware of the ground of
their being not in verbal logic, but in a logic analogous to the
ground of their own functioning (i.e., music)” (David Aldridge,
1989, p. 94)
· “Although the efforts take place within a musical framework, they
are seen as a metaphor for what the client needs to learn or
accomplish in life” (Ken Bruscia, 1989, p. 27)
· “The field of play is a space of experimentation, modeling,
imitation in sound forms that express, represent, and communicate
significant feelings, thoughts, attitudes, values, behavioral
orientations, issues of growth and change” (Carolyn Kenny, 1989,
p. 82)
· “The Nordoff-Robbins approach emphasizes the congruence
between musical form and the Self” (David Aldridge, Gudrun
Brandt, & Dagmar Wohler, 1990, p. 189)
· “There are analogies between the music therapeutic improvisation
and the adaptation to body handicap” (Silke Jochims, 1990, p. 116)
· “The expressive features (of music), correspond with the dynamic
forms of emotions” (Mercedes Pavlicevic, 1990, p. 6)
· “There was such a striking concordance between his musical
exploration and the quality of our relating” (Edith Lecourt, 1991,
p. 93)
· “Music therapists hold the proposition that the musical expression
of a patient and the musical interaction with the therapist reflect
the central personality aspects of this patient” (Tonius
Timmermann, Nicola Scheytt-Hölzer, Susanne Bauer, & Horst
Kächele, 1991, p. 386)
· “The same way the fundamental values of mankind are founded on
the category of temporarity (life/dead), so every musical composi-
tion in its temporarity is a precise model of human life” (Kimmo
Lehtonen, 1994, p. 10)
· “This [the range of feelings expressed by group members]
occurred primarily through the therapists’ ability to improvise
music that matched the feeling tone of individual group members’
expressions, and this improvised, musical analog served both to
convey the nature of the emotion that was communicated verbally
and to compensate for what could not be expressed verbally”
(Kenneth Aigen, 1995b, p. 350)
· “The components of music touch mental disturbances” (Fritz Hegi,
1997)
· “The processes of resonance and their misfits, which later on lead
to psychopathology, are represented in a music therapy that is
understood as psychotherapeutic, and are herein repeated”
(Barbara Gindl, 2001)
There are a lot more of these descriptions (in music therapy and the other arts
therapies as well), and I am sure that this short sample can give only a limited
impression. But this limited impression is enough to demonstrate my point of
view that music therapists share a central idea of how music therapy works.
From the music therapists’ descriptions, basic concepts were deduced,
which have been put in italics. Several music therapists use the concept of
analogy. Other music therapists use concepts such as correspondence, prototype,
metaphor, representation, congruence, concordance, reflection, model, and
touch. In the next section, I tie all these concepts together in one category, which
will be named “analogy.”
ANALOGY AS A CORE CATEGORY
In a previous part, I gave four criteria for a category to be a core category. The
first criterion (many music therapists should use the core category) has been
illustrated with quotations in the previous section. Here, we will focus on the
other three criteria and start with the criterion that a core category should
include other categories and have a central position between other categories.
When different concepts are put into one category and subordinated under
one central abstract concept, we must ask ourselves if these different concepts
indeed “… appear to belong to a similar phenomenon” (Strauss & Corbin, 1990,
p. 61), and what the central concept of this category of concepts should be.
All quotations in the previous section and the concepts that have been
deduced from them signify somehow the link between the musical processes and
the intra- and interpersonal processes. Some of them state more explicitly that
the context of music therapy is a playspace where a client in the context of
musical activities can explore intra- and interpersonal processes.
Because of these two reasons, in my opinion the quotations belong to a
similar phenomenon and can be put into one category. I haven chosen the
concept of analogy as the central concept to signify this category because in the
quotations “analogy” is used by several music therapists, and because it is used
also in Stern’s developmental psychology that is of great help in constituting the
link between the musical processes and the intra- and interpersonal processes
(which I will define as the link between the forms of perception and the forms of
feeling; see next chapter).
Now let us focus on the important question of why analogy should be a
core category in the theory of music therapy. There are several reasons to
nominate analogy as a core category.
First, because “analogy” implies “same and different”: There is a context
in which actions are different from outside life reality but the experiences that
are evoked by these actions are real. “Same and different” is basic to what
happens during music therapy.
Second, it can take a central position between other categories to which it
can be linked. To illustrate the last argument, take one example. The concept of
creativity, which itself signifies a category, is less central than analogy. Maybe
to music therapists who call themselves creative music therapists this looks
strange. In a general view, of course, they are right, because in music therapy the
client and the music therapist create music, and thereby “…develop and expand
both their own (the therapist's) and their clients' responses” (Forinash, 1992, p.
130). This definition makes every therapy a creative therapy.
However, if we want to use a more focused description of “creativity” and
take a view that is based on client-centered indications and rationales, our
thoughts will be different. Then the creative process can be described as one
type of a process that enables the client to become more creative, which means
that he frees himself from fixed ideas, behaviors, and feelings. This creative
process can be indicated with particular types of neurotic disturbances, but
cannot be used anytime, anywhere, anyhow. Take, for example, the treatment of
clients with early childhood disturbances that need to be expressed and worked
through. Is it appropriate to take changing fixed ideas, behaviors, and feelings as
treatment goals? To give expression to what is suppressed seems to be a more
appropriate goal. Concepts such as expression, transference, empathy,
symbolization, structuring, and others are reflected incompletely in the category
of creativity. This explains why not every music therapist wants to call himself a
creative therapist.
If one looks at treatment modalities such as supportive, palliative,
developmental, re-educative, and reconstructive, and their methodical
implications (see Chapter Two), it becomes clear that the creative process in a
more focused definition cannot be the appropriate method for all these different
treatment modalities. Therefore, the category of creativity cannot be a core
category of music therapy. Concepts such as creativity, expression, transference,
empathy, symbolization, structuring, and others all are categories. Let me give
you several examples to illustrate that these categories can be subsumed under
the core category of analogy.
In transference, the client experiences the relationship to the therapist as a
relationship stemming from previous experiences. The client projects charac-
teristics of a significant person in his life on the therapist and experiences the
therapist as being that person. The client perhaps expects or claims the therapist
to behave as the significant person. Let us suppose that the therapist is
experienced as a nurturing mother. In music therapy, this process of transference
comes to birth in music. Nurturance is possible because the musical interaction
is similar to the very first mother-child interaction. In other words, the musical
process is an analogy of the early mother-child interaction. One also could say
that because an important part of the mother-child interaction in essence is
musical (see next chapter).
Symbolization in music therapy often is made possible because of analogy.
Symbolization means that something refers to something else. In music therapy,
musical instruments, musical parameters, and musical processes can have
symbolic meaning. For instance, playing on a conga can represent a parent who
is upset and reacts angrily to a child’s behavior. In this case, this symbolization
is made possible because there is analogy between the musical form and
characteristics of the parent’s behavior.
Take another example (taken from Tüpker, 1988/1996). A musical impro-
visation that is made up of broken-off parts that are unconnected with each other
symbolized the childhood of a child raised in an orphanage without continuous
care and holding. As an adult, the client’s musical form symbolizes his discon-
tinuous life development. The musical form can symbolize this life development
because of the analogy between musical form and psychological development in
time. The temporal forms of both phenomena (music and psychological
development) are alike.
Symbolization can happen by analogous processes, but it can also happen
merely by a process of association without analogy. Then there is no
resemblance between the music process and its meaning. However,
symbolization in itself cannot be a core category, because it is used only in
particular treatments.
Distinct psychological schools of music therapy—the humanistic, the psy-
choanalytic, the morphologic, the Gestalt, the behavioral, and others—each
describe important psychological processes and musical processes that can be
used in treatment. They all represent important perspectives on the human being,
on therapy, and on music therapy more particularly. But none of these concepts
can claim supremacy. What has been said about creativity, then, should be said
about transference and symbolization, too. Transference and symbolization can
be put into music, but both concepts are not universal to music therapy, which
means that they are not part of most methods and treatments of music therapy. If
there is no transference or symbolization, there still is analogy, when musical
action in music therapy sounds the intra- and interpersonal process.
Two other criteria I put forward were that music therapists who use the
core category should not belong to a single therapeutic school of music therapy,
and that the core category should be able to be applied to different disturbances
and handicaps.
The quotations I gave are from music therapists with divergent views: from
Gestalt therapy, integrative therapy, psychoanalysis, expressive therapy,
morphological psychology, humanistic psychology, developmental psychology,
and anthroposophy. The quotations also are representative of working with the
developmentally disabled, the autistic, the bodily handicapped, and the mentally
disturbed.
I do not want to play down these differences. I think that these differences
can be very fruitful. What I am saying is that in spite of these differences, there
seems to be a shared fundamental understanding about music therapy. Some of
the music therapists use the concept of analogy explicitly, whereas others use it
more implicitly.
Finally, I want to mention that I am not claiming that this core category
can be used in every context, or can subsume every music therapy process.
Nevertheless, in my opinion it signifies one of the important core categories of
music therapy.
EPILOGUE: TRIANGULATION
It has been shown that many music therapists share the idea that the client’s
thoughts, feelings, and behaviors are sounded in musical processes. As we shall
see in the next chapter, this is the case because musical processes and
psychological processes are composed of the same basic (amodal) parameters.
The same holds true for processes of change and development. Because musical
processes sound the basic parameters of psychological processes, music therapy
is possible. This sounding of intra- and interpersonal processes in music has
been conceptualized in the core category of “analogy.”
Future research is needed to compare the psychological processes of
mental disturbances and handicaps, and the processes of curing and
development with musical processes. Music therapists from different roots,
working with different client groups, should describe the musical processes used
by them in an intermediary language that links the parameters of music to the
parameters of the psyche.
What we need is a worldwide exchange and discussion by clinical experts.
We need a triangulation of research methods; of sources; of clinical methods,
rationales, and theoretical perspectives. Perhaps then it will be possible to
generate a theoretical overview of music therapy in which core categories and
categories are described that are differentiated but also integrated, so that we can
offer our clients the best music therapy treatment there is, and successfully
explain to everybody who wants to know just why and how music therapy
works.
Excerpt Two
FORMS OF FEELING
AND FORMS OF PERCEPTION1
Henk Smeijsters
INTRODUCTION
When I started developing concepts for a general theory of music therapy, I

originally used the words “sound” and “sound progression” to illustrate that in
music therapy it is not music as a cultural/artistic phenomenon (the music of the
concert hall) that is relevant, but sounds and sound progressions as expressions
of the client’s psyche. I defined “sound” to include all musical parameters:
rhythm, dynamics, melody, harmony, timbre, and so on.
However, I gave it a second thought and decided not to continue using the
words “sound” and “sound progression,” because these words can easily be
misinterpreted as methods of sound therapy and sound healing, which in my
view lack the therapeutic relationship.
What is more, in the discussion with my colleagues it became clear to me
that for music therapists the statement that music in music therapy does not refer
to the cultural/artistic phenomenon is controversial. Such a statement seems to
exclude the methods of receptive music therapy and seems to exclude the
possibility that the well-formed can be therapeutic.
What I intended to say, when making the statement that in music therapy it
is not music as a cultural/artistic phenomenon that is relevant, was that in music
therapy the essence of music is the psychological process it sounds.2 In other
words, not the well-formed as such is healing, but the correspondence of the
formed musical process and the psychological process of change of the client.
This can be a well-formed musical process or not. I do not believe that the mere
aesthetic experience of the well-formed in itself is healing if the musical form
does not sound the inner processes and psychological changes of the client. Still,
1
This chapter has been published also in the Nordic Journal of Music Therapy
(2003) in the series “Theory Building in Music Therapy--An International
Archive.” Parts of it have been presented during conferences and were prepared
in earlier publications.
2
As said before, I use the word “sounding” instead of “reflecting.”
because my statement seems to obscure my intention, I decided to keep using
the word “music.”
In this chapter, I will ground the core category of analogy in psychology
and art theory. I will discuss two perspectives, one taken from psychology and
one from art, which can be of help to construct the connection between the
musical and the psychological, between the arrangement of musical elements
and the psychological meaning of these arrangements.
TO BEGIN WITH:
THE HYPOTHESIS AND ONE EXAMPLE
Hypothesis
The fundamental characteristic of music therapy in my opinion is that playing,

singing, and listening to music “sounds” the inner psyche of the client who
plays, sings, and listens. In music therapy, the client expresses his psyche in
music. The music therapist meets the client in his music.
Basic to music therapy theory is the concept that there is a correspondence
between intra- and interpersonal experiences and expressions in music, and that
there is a mutual correspondence between daily life experiences and expressions
in music.
Example
Let me first give an example of these correspondences. Say that a person has a
need to overcompensate his feelings of inferiority (intrapsychological). This
need will affect his behavioral expressions when fulfilling his job tasks, when
communicating with other people, and when expressing himself in activities
such as improvising in music. When fulfilling his job tasks, he might force
himself to be engaged in problems that are difficult to tackle. During
communication, he might put himself into a very dominant position, talking with
a loud voice, in a high speed, without rests, interrupting others. Driving his car
from home to work can be fast and agitated. Improvising on musical instruments
can be impulsive, complex, loud, and fast.
The expressions in different modes of behavior are not exactly identical.
There is no linear correspondence between the inner experience and the outer
expression, or between all outer expressions. However, in many cases there will
be some expressions that correspond with the inner psyche and with other
expressions. Because there are no linear correspondences between inner
experiences and outer expressions, a therapist needs to focus on the individual
expressions of each client, to find out. If he observes the client carefully, he will
find characteristic expressions from which he can infer the client’s inner
experiences. And, of course, he should help the client to understand the match
between inner experiences and outer expressions.
A PERSPECTIVE FROM PSYCHOLOGY
Introduction
The arts therapies should develop theories that are art-based. Nevertheless, these
theories should be supported by evidence from psychology and therapy, because
the arts therapies are meant to cure psychological diseases and handicaps. In this
section, I’ll focus on this supportive evidence from psychology. More
particularly, I’ll focus on evidence that is able to explain the correspondence
between a person’s inner experiences and his expressions in music.
One of the most important theories for music therapists is the
developmental psychology of Stern (1985, 1995). It is important because it is
music-based, and thus is able to secure the essential characteristics of music
therapy. In this part, I want to elaborate on perception and vitality affects and
show that the equality of the amodal characteristics of vitality affects and the
musical parameters can explain the connection between the musical expression
and the person’s intra- and interpersonal processes.
Stern’s concepts of amodal perception and vitality affects give us a
perspective from developmental psychology that shows that the musical is the
psychological and vice versa.
Cross-modal and Amodal Perception
Cross-modal perception refers to the possibility to perceive qualities (properties)

that belong to one modality of perception (for instance, vision) in another
modality of perception (for example, hearing). There are several examples of
these cross-modal transpositions.
· Cross-modality of physical form between the tactile and the visual

modality. It has been proved by Meltzoff and Borton (1979) that when
the baby has a nipple in his mouth (tactile modality) before seeing it,
he recognizes the physical form of the nipple when it is shown to him
afterwards (visual modality).
· Cross-modality of intensity between the auditory and the visual
modality. A correspondence between the auditory modality and the
visual modality is possible when in both modalities intensity is
concerned (Lewcowics & Turkewitz, 1980). If a flash of lightning has
the same intensity form as a sound that previously has been heard,
then the baby will be able to recognize the correspondence between
sound and light.
· Cross-modality of temporal form between the auditory and the visual
modality. Lewcowics (1992) showed that babies could recognize the
correspondence between a temporal form in the auditory modality
when it is presented in the visual modality. The rhythm of a sound is
experienced as equal to the same rhythm of a flash of light.
From the fact that babies are able to transpose a form from one modality to
another, that they are able to recognize the visual analogy of a tactile form, the
visual analogy of an auditory form, and vice versa, Stern concludes that they are
able to represent tactile, visual, and auditory forms without words and symbols.
The transposition from one modality to another modality is possible because the
baby has an abstract amodal representation of the physical form, intensity, and
temporal form, which acts as an intermediary bridge from one to another
modality.
Important for the theory of analogy, which is the topic of this book, is that
Stern states that the infant’s experiences are beyond words and symbols.
Concerning early parent-infant interactions, Stern tells us: “The actions do not
symbolize anything. They are what it is about” (1995, p. 64).
Also important is that there exist amodal representations that can be
recognized in any perceptual modality, and, as we shall see in the next section,
that there exist “analogies” between the forms of perception and the forms of
feeling, and that the parameters that make these analogies possible are art-based.
Vitality Affects
Until now, we have focused on cross-modality, the transposition between

modalities of perception, which is made possible by amodal representations.
However, in the interaction between the mother and the baby, and also in
therapy, the most important transposition takes place from feeling to perception
and vice versa. In music therapy, there is a transposition from feeling to
perception in the music. How can forms of perception be transposed into forms
of feeling and vice versa? Let us go back where it all starts, the nonverbal and
nonsymbolic communication of the baby and its mother.
When a baby experiences joy (form of feeling), he will express this joy in a
smile on his face (visual modality). The mother then can answer by smiling too
(same modality). What Stern found out is that mothers are used to answer in
different modalities. For instance, they make a sound (auditory modality) that
lasts as long as the smile and goes up and down like the baby’s lips and cheeks.
The baby “understands” that the mother’s sound is an empathic answer to his
smile and thus his joy. Stern tells us that it is this cross-modality and not the
imitation in the same modality that communicates empathy to the baby.
Essential to this example is the fact that an inner experience, the feeling of joy,
corresponds with a perceptual form (smiling), which then is transposed to the
auditory modality (sounds) to communicate empathy.
According to Stern (1985, p. 56), the infant experiences this as empathy,
not knowing the denotative meaning of his mother’s behavior. The baby does
not interpret the mother’s behavior. Sterns describes the communication of
mother and baby as an abstract dance or piece of music. They are not “talking
about” something else by means of verbal symbols, nor

Readings On Music Therapy Theory (Bruscia, Kenneth)

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READINGS ON

Copyright © 2012 Barcelona Publishers

All rights reserved. No part of this book may be

Kenneth Aigen, DA, MT-BC

Jennifer K. Adrienne, M.A., M.M.T.

Gary Ansdell, PhD

Kenneth E. Bruscia, PhD, MT-BC

Sandi Curtis, PhD, MT-BC, MTA

Jane Edwards, PhD, RMT

Rudy Garred, PhD

Kate E. Gfeller, PhD

Frances Smith Goldberg, MA, MT-BC

Susan Hadley, PhD, MT-BC

James Hiller, PhD, MT-BC

Carolyn Kenny, PhD, MT-BC

Däg Korlin, PhD

Colin Andrew Lee, PhD, MTA

Gabriella Giordanella Perilli, PhD

Randi Rolvsjord, PhD

Even Ruud, PhD,

Mary Scovel, MM, MT-BC

Margaret Sears, MME in Music Therapy

William W. Sears, PhD, RMT (1922–1980)

Chava Sekeles, PhD, RMTI/OTR

Sue A. Shuttleworth, EdD, MT-BC

Henk Smeijsters, PhD

Brynjulf Stige, PhD

Michael H Thaut PhD

Bruscia, K. (2005). Developing Theory. In B. Wheeler (Ed.), Music Therapy Research

West, M. (2000). Music Therapy in Antiquity. In P. Horden (Ed.), Music as Medicine

Taken from: Wheeler, B. (Ed.) (2005). Music Therapy Research (Second

A theory is way of thinking about what we do or what we know. It usually consists of

The Place of Theory

Methods of Developing Theory

The Nature of Theory

Kenny, C. (1996). The dilemma of uniqueness: An essay on consciousness and qualities.

The fierce controversies between contending philosophies disturb not a single

1 This quotation is from Danto (1989), p. xv.

Characteristic Procedures of Philosophy

At first glance, it may not be apparent why creating definitions is an example of

Exposing and Evaluating Underlying Assumptions

general strengthening of the ego structure of the patient along lines of

Relating Ideas as Systematic Theory

Using Argument as a Primary Mode of Inquiry

Contexts in Which Philosophizing Arises

Evaluating and Comparing Theories, Theoretical Systems, and

Addressing Typically Philosophical Questions

In music therapy, ontological concerns can be formulated more specifically: What is

Through music therapy techniques like clinical improvisation, a therapist can

A Detailed Examination of One Philosophical Study

This strategy illustrates another important aspect of philosophical argument: It is not

Therapy is the professional practice of employing various processes to help

The Proposed Theory

An argument for a relationship-based theory of music therapy is built upon these

Premise 1. Being-as-persons ontologically means being-in-relationship.

Corollary 1a. Health, insofar as it specifically concerns health on a level

Corollary 1b. Any human therapy must be understood as a practice of

Premise 2. Music is a temporal-aesthetic phenomenon, ontologically rooted in

Corollary 2. Music essentially comprises temporal-aesthetic ways of being-in-

Premise 3. Based upon Premise 1 and 2, music therapy, insofar as it is a strictly

Premise 1: Being-as-Persons Ontologically Means Being-in-Relationship.

The existential philosopher Martin Heidegger (1962), in Being and Time,

Being-with existentially determines Da-sein even when an other is not factically