I thouroughly enjoyed reading Salmon's paper on music and psychoanalytic therapy, on both an educational and informative level, and it had me pondering over the bridge that exists between the two. What I was left with were thoughts that she raised regarding a questionable need for music therapists to have in-depth training in psychotherapy to advance their clinical skills as music therapy practicioneers. As a newly trained music therapist, at times I feel that this would be of benefit to me and indeed, my clients, but on deeper reflection I feel that my two years on the MA course in Music Therapy have provided me with adequate skills to work effectively with all that occurs between clients and therapist. In this discussion I wish to put forth a few reponses to questions that Salmon raises, and also my thoughts on the “bridge” that exists between music therapy and psychoanalytic therapy, particularly focusing on the phenomena of transference and countertransference.
During my final semester as a student on the MA in music therapy programme at the Irish World Academy of Music and Dance at the University of Limerick, we were required to write a paper on transference and countertransference for a module in clinical music therapy. Well, where do you start with such a broad topic! We had some criteria of what needed to be included in the paper but I went to the library with an open mind and was really astounded at the amount of literature on not only the principals of transference and countertransference, but also how these principals are incorporated into the field of music therapy. One of the guidelines for writing the essay was to describe how an understanding of these dynamic phenomena assists in working with clients in individual music therapy. It was during the writing of that essay, particularly in reference to the above statement that I began to reflect deeply on psychoanalytic theories and how the phenomena of transference and countertransference can be manifested musically.
In the concluding paragraph of her paper, Salmon (2008) asks the question:
how might we best train music therapists to recognise and make use of unconscious processes such as transference and countertransference, both within musical interactions such as clinical improvisation, and within our verbal exchanges?"
I do not have an answer for this but I have some thoughts on what aided me during my training as a music therapist. She also poses the question of what psychoanalytic theory and technique can contribute to music therapy, and through broad reading on the topic a few thoughts spring to mind, which I will share as this discussion continues, as well as putting forth the definitions of transference and countertransference that I found very helpful. The purpose of defining transference and countertransference in this response is to highlight how an understanding of these, as a music therapist with no formal training in psychotherapy, can positively impact on the therapeutic processes that occur in the musical and verbal exchanges between therapist and client.
Transference is defined as "the displacement of feelings, attitudes, or impulses experienced towards figures in a persons life onto current figures to whom they do not realistically apply" (Weiner, 1998, p. 196). Weiner (1998) develops his definition further by stating that ‘transference provides vivid cues to the nature of a patient's past and current interpersonal relationships' (p. 196). The interpersonal nature of transference is that it gives rise to the clients interpersonal problems with significant others and objects, which are enacted in the here and now with the therapist (Strupp, 1989). In other words, transference occurs when a client interacts with the therapist in a manner, which resembles patterns from previous interactions in real-life relationships towards people or objects (Bruscia, 1998a).
The role of transference in the therapeutic alliance between therapist and client was first exposed by Sigmund Freud, who originally saw transference reactions as a vital source of gaining information about the client, but also as a process that could impede upon the therapeutic process (Freud, 1912). Psychoanalytic theory is based on the idea that clients express conflicts, defences, motives and interpersonal patterns in their relationship with the therapist (Westen & Gabbard, 2002). A crucial aspect of transference according to Eysenck (2004) is that the therapist responds to the client's emotional outpouring in a neutral manner, allowing the client the freedom to express any repressed anger or hostility. This enables the client to understand that the repressed emotions are associated with past experiences, and not ones that arise as a result of the relationship with the therapist (Eysenck, 2004).
According to Odell- Miller (2005), "music therapists have become more concerned with finding a theoretical framework in order to understand therapeutic process in more depth" (p. 91). Music therapists have drawn on psychoanalytic theory in their practice and in their writings (Priestely, 1994; Streeter, 2000). Within analytical music therapy, transference includes the client's projections on to or into the music or musical instrument (Hadley, 2002).
During the course of a music therapy intervention with a client, various levels of transference can occur. The music can become a space for the client to project their feelings onto (Warja, 1999). The therapist and the client can share the musical space together and "there is a co-transference to the music, and to the images the music evokes" (Warja, 1999, p. 188).
Streeter (1999) defines and describes the use of the musical transference relationship. She states that "if we invite a therapeutic relationship built on free association, it is more or less bound to include transference, and as transference cannot be avoided, we therefore need to discover ways of understanding it, therapeutically, in musical terms" (Streeter, 1999, p. 89). Streeter (1999) describes a musical experience with a client during free improvisation. The musical transference showed how "in playing with me, the same obstacles A experiences within herself were experienced in the music made" (Streeter, 1999, p. 94).
Countertransference has been a controversial concept in the field of psychology since the early writings of Freud (Gray, 1994). According to Priestley (1994) there are only four references to countertransference in the complete writings of Freud, compared to seventy-seven references to transference. Early thought was that countertransference was a hindrance to the therapy process that prevented progress to occur (Weiner, 1998), and was seen as an interference to the treatment process (Gray, 1994). Countertransference has since been defined as the therapist's internal and external reactions to a client, which are related to the therapist's unresolved conflicts. (Gelso & Hayes, 2002). It is also understood as ways in which a therapist interacts with the client, which resemble patterns of interaction from the therapist's previous relationships, or ones that reflect patterns from the client's way of interacting (Bruscia, 1998b). Bruscia (1998b) mentions that countertransference may be activated by the client's transference, or by the client's projective identification. Countertransference can involve feelings that are "mild or intense, conscious or unconscious, pathological or non-pathological, transference- or non-transference based" (Richards, 1990, p. 233).
Musical countertransference takes place in a shared clinical improvisation (Odell- Miller, 2001). Streeter (1999) describes musical countertransference as the actual music of a therapist, which incorporates his/her feelings. During improvisation with a client, the music therapist plays by following the movements and direction of the client's playing. This allows the therapist to follow their feelings and use these to inform their music and to find expression within it. In an analytically oriented approach to active music therapy, the aim of the therapist is to observe what transpires in the area of transference and countertransference (Eschen, 2002). The transference and countertransference in the therapeutic relationship can be understood as, "the subconscious contacts between patient and therapist [that] creates, quite often, a solid basis for understanding and mutual esteem" (Eschen, 2002, p. 24).
Priestley explains classical and emotional/empathic countertransference in her writings (Priestley, 1994). She refers to classical countertransference as c- countertransference, and to the latter as e- countertransference (Priestley, 1994). Classical countertransference in the musical sense consists of "sound patterns that reflect the music therapist's own unconscious transference distortions of what is going on in the relationship with the client" (Scheiby, 1998, p. 217). Scheiby (1998) states that these are activated by the client's musical and non-musical presence. If the music therapist does not identify these, they can be harmful to the process (Priestley, 1994). Emotional countertransference in the musical sense consists of "sound patterns that reflect the music therapist's sympathetic resonance with the client's feelings through emotional and/or somatic awareness" (Scheiby, 1998, p. 218). Priestely (1994) describes this type of countertransference as empathy towards the client's repressed emotions that may not be in the client's conscious yet.
Understanding these phenomena is vitally important for any type of therapeutic work with individual clients. In music therapy, these phenomena have been explored in depth by those trained in analytic music therapy, but regardless of your school of thought, these concepts help shape your perception of the client, provide you with information regarding their conscious and unconscious thought, and help to provide a resolution to any conflicts that emerge.
As a newly qualified music therapist, with a large case load of clients per week, I am now more aware than ever of the importance of making use of transference and countertransference in both the musical and verbal exchanges with clients. In response to Salmon's (2008) question on how best a music therapy student can achieve this, I feel that any well organised music therapy training course provides some training in this, but it is through broad reading on the topic and with clinical practice and supervision that a student can fully understand and work with these unconscious processes. In my opinion, being made aware of the importance of these concepts and how one might identify them is the best advice a lecturer can give to a trainee music therapist. It is also helpful and useful to read literature that extends beyond the realm of music therapy, so one can get a more rounded understanding of psychoanalytic concepts and theories.
Salmon (2008) also asks what psychoanalytic theory and technique can contribute to music therapy. Purdon (2002) describes how "music acts as a bridge" and it is this bridge, in my opinion, that allows transference and countertransference to co-exist. Purdon (2002) describes how music, as a bridge, acts "as a connection between individual worlds of experience", as a "link between ambivalent thoughts and feelings" and how it acts "as a primal connection offering opportunities for deep shared experience, deep levels of empathy, acceptance and understanding" (Purdon, 2002, p. 107). Here, we see how psychoanalytic theory and music therapy work in union with one another and what the music therapy situation can give rise to, once you identify and use psychoanalytic theory and techniques appropriately.
As with Salmon, the question of words come into play in many sessions that I conduct weekly. Working with children affected by violence-related trauma, it seems that at times music expresses what words cannot, or with others, they need verbal reassurance after a musical episode which leaves them feeling bewildered, possibly by the emotional outpouring that occurred. Whatever the case, music is my tool and words are a support that are drawn upon when needed. The two work hand in hand at times, and the bridge the connects the two is a strong one, and as I become more confident in my practice, one that gets stronger with each client I see.
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