- I am no stranger to Alan Turry's skillful work as a music therapist. I was also present at one (perhaps the first) of Maria Logis' performances. I have had, and continue to have, some qualms about musical products that emerge from music psychotherapy sessions with self-referred clients, being performed by the client and therapist outside of the school, clinic or therapeutic environment in which they originated.
- I do not feel this is an all or nothing issue, and do agree it needs to be considered on a case by case basis, however, when roles and boundaries change, I believe the relationship between client and therapist has to be discussed and examined thoroughly and an agreement reached by the pair regarding renegotiation of the contract or termination. Although Turry addresses this issue, he does so after he has been performing and co-facilitating workshops with Maria for quite some time, ". and this new way of working together may signal the beginning of the end of our original contract" (p.26). I don't think these dual relationships were part of their original agreement. Turry describes the change in roles as emerging gradually out of the client's needs.
- There are many occasions when meeting a client's authentic needs is inherently beneficial. Such occasions can provide the client with a corrective emotional experience. There are, of course, ethical considerations. One problem is that clients don't always know what they need. The therapist's job is to discern the client's true needs versus what the client may think he or she needs and to help the client discover the conscious or unconscious meanings underlying the need.
- An example of this concerns a client I have been working with in music psychotherapy who feels strongly that he needs to have a sexual relationship with me in order to heal his intimacy issues with women (Austin, in press). These sexual feelings first arose when we were singing together at the piano. The client, a 'normal' 38 year old man, is obviously not in a position to know what he needs from me, as his therapist. It is my job to help him explore his transferential feelings toward me and work through them so that he can eventually achieve intimacy with an appropriate partner.
- Confidentiality is another concern when clients or therapists perform or present music from therapy sessions. Often clients do not fully realize all they are revealing or the implications of what they are sharing about themselves at the time. Much later, feelings of shame or exposure may surface. An example from my own experience took place at a music therapy conference. I had written permission from a client to play a tape of the two of us singing improvised music and lyrics about the abuse she suffered during childhood. Even though I disguised the details of the case study, someone in the audience recognized my client's voice. The news got back to her and she was quite upset. She wanted to share this tape to help others who had experienced pain similar to her own. When she granted me permission to use the tape, neither she nor I was aware of her unconscious ambivalence and neither of us considered the possibility that she might feel exposed.
- In reading Turry's article, I was very curious about the transference and countertransference dynamics between Turry and Maria. Many clients have a conscious or unconscious desire to be 'special' to their therapists, to be the favorite client or to extend the relationship beyond the therapeutic frame. As Turry himself asks, "Was she motivated in part by her desire to be important and special to me?" (P.11). In my experience, this desire to be special often masks a deeper need to have one's authentic feelings acknowledged and accepted by the therapist in order to heal early narcissistic injuries to the self. Being special for some clients, entails making the therapist feel important by taking care of his or her unmet needs for mirroring and approval and by abandoning one's own feelings and needs in order to perform well so that the therapist will feel good about his or her work. This situation is further complicated when the therapist and clients are literally performing together and the client is indeed special because of the contributions he or she makes to the therapist's career, in the form of articles, presentations, fund-raising, etc. The therapist may feel compromised as a result and become overly compliant with a client's wishes, thus colluding with the client to avoid looking at the deeper implications of what is happening in the relationship.
- I enjoyed reading Turry's article and found his questions probing and provocative. His courage and willingness to open himself up to the community about a very intimate and perhaps controversial relationship is admirable. Many of his questions deserve further exploration. For example, I would like to know more about the difficult aspects of this course of music psychotherapy. Was there any sexual tension in this relationship? As many of us have experienced, making music with a member of the opposite sex can stir up all kinds of intense feelings, ranging from closeness, physical attraction to love. (Austin in press) Did Maria experience any negative transference reactions? Any resistance? Did Turry have any countertransferential feelings?
I could say more, but am running out of space and time. I would be delighted to hear other people's opinions on this subject.
Alan Turry's article and work with Maria were incredibly intriguing to me. I admire his courage to go out on a limb which has yet to be thoroughly defined in this community. Turry discussed a number of things that I had been questioning myself. The role of the therapist in a public performance setting seems a daunting task. I realize that your main role is to support your client through the process. But as Turry pointed out, a number of other things arise. For instance, the discussion of what occurs if the therapist makes a mistake. How will that affect the client-therapist relationship? What sort of expectations has your client placed upon you in this setting? The performance in front of his colleagues was one I was especially interested in. Turry voiced a number of his own fears, so it appears that this was a more difficult performance for him to do personally. How about professionally? Turry stated that
I realize this must have been incredibly difficult, but is it more so than the number of potential pitfalls that could happen within the client-therapist relationship that Turry discussed. Do therapists ever have any uncertainty with the performances due to the members of the audience? We know that Turry had his own fears, but from the therapeutic standpoint, when and how does a therapist know that this form of performance will work for their client and be a positive experience. What I see as one of the hardest things for a therapist in this situation is self assessment and realizing what is for the client and what is for the therapist. The unconscious is a master in manipulation and I still wonder where the line is drawn from what is 'too big' a risk.
Diane Austin's response to Alan Turry's article discusses projections and suggests techniques of managing these in the context of transference theory - a psychoanalytic concept that here in the UK we understand as central to the practice of psychotherapy. I enjoyed reading her response. It is difficult to write about critical issues, particularly in the context of a web based exchange, but in order to keep our profession moving forward I feel it is important that texts such as the one she discusses are responded to within a clear theoretical framework. As Turry offers his description of this work within a psychotherapeutic frame it is from this perspective that I too would like to offer some thoughts..
However, I want to move the discussion several steps on from the named participants referred to in Turry's article, and that particular clinical material he describes. I want to focus on some general issues arising from his text and Austin's response to it.
Music therapy is a limited form of practice with ethical responsibility, monitored by supervision. Music making and audience response to music can both be experienced as therapeutic, but neither has a therapeutic goal as such. For example; musicians do not attempt to limit the experience of the audience to that which the musician judges as helpful. Hence from time to time performances of new works so upset audiences that they attempt to escape the auditorium (as happened in the first performance of Stravinsky's The Rite of Spring.)
Some clients also need to escape the boundaries of therapy when staying within them is too much to manage. Under these circumstances the therapist is faced with a challenge: Accommodate acting out on the part of the client or stay in place. Maintaining therapeutic boundaries, whilst attempting to understand and work with projections, is the recognised psychotherapeutic technique; enabling the therapeutic alliance to remain available for the client to re-engage with when, and if, they are able, and/or willing, to do
so. Yet the 'lets run away together' projection is often so heavily disguised that it is
difficult to catch sight of and thus work with. And this is where music therapy supervision comes in an objective means of helping a therapist monitor and think about the psychodynamics between themselves and their clients.
As with other work that I critiqued extensively in my paper ' Finding a Balance between Psychological Thinking and Musical Awareness in Music Therapy Theory-a Psychoanalytic Perspective' (Streeter, 1999), the technical question these writers are concerned with is how to maintain the 'container' in a sufficiently robust yet creatively responsive way? Not an easy task and particularly difficult when sharing music.
If, without consciously realising it, one begins to collude with the breakdown of therapeutic boundaries, it can become very difficult to focus one's attention on working in depth with other clients, let alone maintain healthy personal relationships beyond work. And this is where psychological pressures on a therapist can become intense. In extreme cases maintaining 'the container' may need to include working towards an ending with the
client, so that other relationships can survive.
The concept of projective identification, which I referred to in my chapter 'Definition and Use of the Musical Tranference Relationship' (Streeter, 1999) is a useful one to keep in one's back pocket for it helps one detect, with the help of a supervisor, that something unusually difficult is going on, even though it may not feel like it at the time.
As Austin points out, the therapist's task is to help the patient find fulfilling relationships beyond the consulting room. I would add; to help the patient develop sufficiently strong boundaries to withstand challenges to their well being and sense of self. By modeling boundaries we help patients realise these for themselves so that they can say 'no' when they need to.
References
Streeter, E. (1999). Definition and Use of the Musical Tranference Relationship. In DeBacker, J., & Wigram T., Clinical Application of Music Therapy in Psychiatry (pp. 84-101). London: Jessica Kingsley Publisher.
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.
The article by Alan Turry provokes many interesting issues concerning music psychotherapy and community music therapy. I am interested in music therapy as way to access the therapeutic process in members of a community, but have never had to consider the risks and vulnerabilities involved.
I agree that each case should be examined individually, but the main issues that strike me are confidentiality, unconscious needs of the therapist and client, and individual vs. group music therapy.
Confidentiality is one of the most powerful aspects of therapy. The therapist is the supporter and protector of what is revealed by the clients, both verbally and nonverbally. I think that it is important for the client to understand that by taking material from private sessions into public, issues that haven't been dealt with in therapy can be exposed. I realize how important it is for both therapist and client to stay updated and loyal to the therapy process. It can become a high-publicity relationship, extremely vulnerable to other people's judgement and opinions.
Next, unconscious needs of the therapist and client on a deeper level can arise, especially if the therapist hasn't resolved personal issues him/herself. I wonder how, beside through personal therapy, a therapist prepares themselves to be in a vulnerable position when the therapeutic relationship relies on the outcome.
Another issue that Diane Austin addressed in her response to this article is sexual tension between therapist and client of opposite sexes, or for that matter, the same sex. I don't consider myself knowledgeable enough to address this accurately, and I don't assume that any of this took place with Mr. Turry, but how do you draw the line emotionally and ethically? In long-term therapy where therapist and client have learned to accept each other, have performed together, and made music together, it is hard to not become close friends. This might be more of an issue in situations where the clients are generally normally functioning people, like Maria. I think that most of it relies on the maturity of the therapist as the professional, and the communication between the two. If it is presenting a major hindrance, does that discussion become part of the therapy? What if those feelings are apparent to the public? This can fuel the controversy, but some very important growth for the therapist and client can develop as a result, as was the case in the article.
I commend Mr. Turry for taking the steps and opening his experience to discussion among music therapists and students who may end up in similar situations.
This article caught my attention because it talked about a situation that was different from "normal" music therapy situations. The whole article was about exploring the line between therapist and friend, and between therapy and just plain escape. It also explored the idea that the type of therapy needed for one person will be completely different from the therapy needed for another person.
It seems that some of the performances of Mr. Turry's client were met with resistance. Some people thought he was crossing the line of the therapist. However, I think that in this situation he was doing what was best for the client. As I stated before, therapy for one person may be completely different that therapy needed for another person, and I believe that Mr. Turry had the client's best interests in mind when he decided to allow her to perform her music as a part of her therapy. She knew that she wanted to perform in front of people to be able to tell her story, and through that she was able to accept the fact that she was sick and know that she had to learn to deal with it.
I don't think that Mr. Turry crossed the line at all. True, at some points it seemed like their sessions were less therapy sessions and more rehearsals for performances, but I don't think that this had a negative effect on the client.
Music in itself is therapeutic, and I know this from being a musician and performing in many different concerts and recitals. For example, when I finally performed my senior cello recital at the University of Kentucky this past spring, I felt a great sense of accomplishment. I worked very hard and I saw great results. Plus, my family and friends were there to support me, and it was wonderful to know that they were all proud of me. Of course, performing with the UK Symphony Orchestra was always a therapeutic experience. When performing with an orchestra, you can let go and get into the music. In these performances you are being supported by your fellow musicians, while giving support back to them at the same time. There is lots of interaction between the musicians in an orchestra, so I personally felt closer to the people I was playing with as a result.
Performing music can give you a sense of self-worth, responsibility, pride, and accomplishment. Of course, if things don't go well you also have to deal with the feelings of shame and failure. I can see how this was a risky thing for Mr. Turry to do. By letting his client go out and perform her original music, he was opening up the possibility of failure to her. However I think Mr. Turry knew that his client had enough confidence and drive to keep her from getting discouraged, even if something didn't go the way she wanted.
The performances in themselves were therapeutic. They made his client realize that she was an artist and she could create art and share it with others in order to tell her story. She realized how freeing it is to open up to an audience, and she seemed to feed off the audience and try to make her performances an even more powerful experience for the listeners. Even though this isn't what "normally" happens in a music therapy session, I believe this was just what Mr. Turry's client needed.