Locating the Autonomous Voice: Self-Expression in Music-Centered Music Therapy
Abstract
It is a common, perhaps self-evident notion that people express themselves when they are engaged in musical activity. However, there seems to be little music therapy literature that deals explicitly with theories of musical expression. This paper examines some of the existing notions of self-expression in the music therapy literature, focusing on three models: Analytic Music Therapy, Guided Imagery and Music, and Nordoff-Robbins Music Therapy. Implicit assumptions about the self and musical expression are explored, the latter in light of well-known musicological theories. The paper then looks at music-centered music therapy and the role of self-expression in it. In particular, the role of musical structure in self-expression is considered. It is suggested that a theory of self-expression for a music-centered practice cannot detach expressive content from the lived performance of music.
Introduction
I am mid-way through a music therapy session at a nursing home with a group of 3 elderly women with dementia. After a few attempts at improvisation, I begin to sing "Let Me Call You Sweetheart." One of the women, who has advanced Alzheimer's, immediately sits up straight and sings out strongly. "She's so expressive now," I think to myself, "but what is it she's expressing now that she wasn't expressing in our improvisations?"
In an outpatient day program for women who have experienced trauma, a client asks me suspiciously, "what's music therapy going to do for me?" My initial, knee-jerk response is, "It can provide an alternative means of self-expression." The client nods, clearly satisfied, while I begin to wonder if my answer will help or hinder her participation in our group music-making.
It is my third month of work with a three-year-old boy with autism. He is active and extremely focused on his own actions - whether it's playing each consecutive note on the piano or gazing at the strings on the pentaharp as they vibrate after he plucks them. He seems to be propelled around the room by some kind of internal force that is finding expression through the instruments. I encourage this "free, self-expressive" playing as the key to reaching him, but ultimately wonder what role music plays in his efforts to express himself - would he do anything differently if this was a play therapy session?
It could be argued that the practice of music therapy hinges on music's alleged power as a medium of self-expression. Nearly all of my varied answers to the question, "what is music therapy?" involve some mention of self-expression, and it is uncommon for an inquirer to be dissatisfied with such a response. It seems self-evident that music communicates, makes external what is internal, and contains information largely emotional in nature. However, upon seeking music therapy literature that deals explicitly with theories of self-expression in music and/or music therapy, I was quickly disappointed. It appears that while "self-expression" may often be an underlying theme in music therapy publications and practice, the topic itself is not often rigorously investigated.
Though it seems music therapists have always been concerned with self-expression[1], we have not always linked our concerns to larger questions about musical expression in general. It seems we may have been content with a basic and uncomplicated notion of self-expression. Quite broadly, we may say that music therapists have conceived of musical self-expression as one's inner state manifested in an external form, that is, music. One's music expresses important truths about the music-maker. This is one way music therapists have been able to link musical with non-musical processes. Others have argued that self-expression is the release of inner feelings. Consider the words of Florence Tyson (1981): "Music is regarded as a language which gives symbolic expression to unconscious contents and strivings" (p.15). "Music is the only bridge from inner world to outer reality; the only means of expression of inner feelings" (p.24). The analytical tradition of music therapy (AMT) appears to treat self-expression in a more definitive sense (Priestley, 1975, 1994; Tyson, 1981), perhaps since verbal reflection on musical meaning is an important part of the process in AMT. Yet, it remains difficult to garner a clear picture of the foundational ideas about artistic expression upon which these notions are built.
What is behind our broad ideas about musical self-expression, and will these ideas do for a music-centered practice?[2] Because the musical experience is valued as an end in itself and not necessarily a means to a psychotherapeutic insight in a music-centered practice, it would seem an adequate theory of musical self-expression would not deem expressive content as something that could be detached from the music itself. Put another way, if music is viewed primarily as a transmitter of information, music is effectively rendered extraneous to the experience (Budd, 1985, 1989). Any theory of a one-way, causal relationship between emotional content and musical content cannot account for the primacy of the musical experience nor the interpersonal context in which music is made. As Ansdell (1995) has written: "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, emphasis in original). Traditional conceptions of self-expression do not fully account for what goes on in a music therapy session, as they do not consider the dialogical nature of musical activity (Garred, 2001, 2004). But what exactly are these traditional conceptions? Are we aware of the traditions we are drawing from when we speak of our clients expressing themselves? In this paper, I aim to examine some existing notions of self-expression in music therapy and consider their adequacy for a music-centered practice.
A Look at the Current Picture - the Self and Musical Expression
Existing Notions of Self-Expression in Music Therapy Models
A glance back to some of our pioneers may give us a bit more context to evaluate our current situation. Even if our practices are eclectic, guiding assumptions about musical self-expression can be traced back to major figures in the field. Any contemporary theory regarding the ways in which the self is embodied in music (such as Pavlicevic's (1997) Dynamic Form and Smeijsters' (2005) theory of analogy), even if not a theory of self-expression per se, is nevertheless built upon older premises of how the self communicates itself in music therapy. The following key themes can be found in the early work of Priestley, Bonny, and Nordoff & Robbins:
1. Psychological Realities Can be Heard in the Client's Music.
Fundamental to Analytical Music Therapy (AMT) is the premise that one's emotions, thoughts, and states of being can be symbolized through music and reflected upon verbally. Mary Priestley (1975, p.199) described this process in terms of an "inner music" - an internal reality that can be expressed: "Inner music is the prevailing emotional climate behind the structure of someone's thoughts. A person may not be aware of it but the manner of his actions will quite clearly express it." Inner music can be thought of as the "core of the psyche - where the unconscious resides" (Hadley, 2002, p.35). A client's patterns of communicating and interacting are influenced by unexpressed emotion, which take shape in nonverbal, unconscious processes and make up one's personality structure. In the releasing of previously unexpressed emotion through improvised music, the client is able to achieve catharsis, release the energy that unexpressed emotion has blocked, verbally reflect on the emotions and bring unconscious states to consciousness. In therapy, 'inner music' is ultimately fulfilled in its corresponding verbal analogues and intellectual insights.
In her early writings, Helen Bonny (Bonny & Summers, 2002) described the relationship between music's structural properties and emotional content in terms closely allied to the psychoanalytic view: emotions were conceived as delimited, objective states with direct analogues in music and language. Bonny referred to the work of Manfred Clynes, a neurophysiologist who developed the concept of "essentic forms" to account for a biological basis of musical communication. According to Clynes, corresponding to each primary emotion (such as love, joy, anger, etc.) is a brain program which determines the expression of that emotion. For example, when we hear sadness in music, it is because the musician is accurately reproducing the essentic form which the composer has chosen and written into the music. This view provided Bonny with a clear, scientific account of music's emotional content that appeared compatible with her method of Guided Imagery and Music.
Paul Nordoff spoke and wrote at length on the topic of music's inherent emotional qualities.[3] Though expressivity was a key theme in his work, he was careful to distinguish personal expression from musical expression: "We use very little expression in music. We use expressive components in music clinically. We must get out of the habit of being expressive as we play and sing so that we can direct it whenever it's necessary as a clinical necessity" (Nordoff, cited in Aigen, 1996, p.11). Nordoff believed that certain musical elements, such as scales and idioms, contain certain emotional qualities that can be directed therapeutically. For him, there was a direct relationship between musical structures and psychical structures, though at the same time, musical elements could never be used prescriptively. Aigen (1998), in considering this contradiction, explains that while music may contain certain objective qualities, they may not be universally experienced. Thus, the meeting of musical forces with the child's individual being-in-the-moment results in musical structures that are expressive of the child's encounter with music: "In a very broad sense.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" (Aigen, 1998, p.263). Even though the client's emotional life and the emotional qualities of music were always central to the work, in some cases, self-expression actually hindered the therapy process, as it deflected attention away from the music (pp.263-264).
2. Music Offers an Immediate Picture of the Client's Inner World.
In later writings, Bonny (Bonny & Summers, 2002) discussed music as the "language of immediacy" (p.105). In contrast to some of her earlier thinking, Bonny implied that verbal logic does not always capture the meaning of musical expression. Music as a language of immediacy is a language that goes beyond words, a language that expresses eternal truths that cannot be comprehended in any other way than through personal experience with music. Bonny gave a more prominent role to the subjective experience of listener and the necessity of the musical experience, not just the musical message. Priestley, from the perspective of an improvisational model, also emphasized music's direct, singular effect: "Part of the joy of free expression is that it has only the aim the client herself likes to put into it. As no purpose is being pushed in from outside, it is easier for some purpose to emerge from within" (1975, p.221). It can be inferred from such statements that authentic musical expression springs from a place within the self that is free from all external influence. One can accurately represent one's private, idiosyncratic inner states through the private, idiosyncratic use of music.[4]
3. The Role of Musical Form
Priestley maintained that the sounds uttered by the client are pure, unmediated correlates of her inner state of being: "The close semitones of the atonal dissonant tone cluster make its effect more catalytic than that of diatonic harmony" (Priestley, 1975, p.214). Because sounds could be understood 'in themselves,' musical dissonance was viewed as a correlate of psychological dissonance. In emphasizing that dissonance captures emotional distress, there was no clear positive role for traditional musical forms when confronting difficult emotions. The more ugly one's psychic pain, the more chaotic, disorganized, and unformed one's music must be. This implied that the more the music defies recognizable forms and conventions, the more intellectual processes are bypassed, the more subjective - and somehow authentic - the music is.
By contrast, the notion of self-expression could not be separated from the client's successful apprehension of musical form for Nordoff and Robbins. It seems that rather than there being a psychological conflict that the client needed to express through music, musical experiences motivated the client to become expressive in a distinctly musical way. Though self-expression appears to have been inseparable from musical structure for Nordoff and Robbins, these structures were not abstract forms, but rather, interactional musical patterns that emerged from the musical meeting of client and therapist.[5] Releasing a feeling (as in the case of a crying child) was never sufficient; expression needed to be transformed through musical form: "At the creative moment he feels with intuitive certainty the quality his activity must have and the expressive form it must take in the ongoing experience. Spontaneously, he perceives an artistic 'necessity' and becomes creative" (Nordoff & Robbins, 2004, pp.50-51).[6]
As it was established on great works of the classical canon, it is fair to say that musical form plays a key role in the Bonny Method of Guided Imagery and Music. However, whether the music expresses emotional content or merely presents a form which evokes emotional content seems to be an open question.[7] Consider these two seemingly conflicting statements made by GIM therapist Lisa Summer: "A great piece of music communicates specific archetypal messages which are the same in their significance for all of humanity..Individually, we determine its [Beethoven's opus 26] content. Beethoven only gives us the structure. He does not compel us to feel one way or another" (Summer, 1992, p.51, emphasis added).
It is clear that music therapy pioneers experienced music's capacity to express emotion (whether listening or playing), within, and likely outside of the music therapy session. Yet, each position on self-expression mentioned above poses more questions than answers! To the analytical music therapist we may ask, does music express something already in existence in another form? By what criteria do we evaluate the client's music and make the leap from the musical to the psychological? Is there a limited number of ways an emotion can sound? Do we not hear dissonance/consonance as relative, contingent upon the overall musical structure and the historical-cultural context in which it is embedded? To the Guided Imagery and Music therapist we may ask, is the relationship between musical structure and the listener's subjective state more than arbitrary? Is the expressive meaning of music contingent upon the individual listener's state of mind? Does the music contain emotion independently of the client's ability to reconstruct it according to her own subjective schemas? Does the music "express" whomever is listening to it? To the Nordoff-Robbins music therapist we may ask, what mediates the transition from affective reality to musical form? Do the interactional patterns found in musical structure comprehensively account for emotional content? What exactly is the relationship between the client's immediate emotional state and the musical form if not a direct, one-way relationship?
Notions of the Self
To evaluate these notions of self-expression, we must examine - albeit briefly - the conceptions of the self implicit in them. Any question arising in or about psychotherapy necessarily refers back to ideas and assumptions about what constitutes a self. The very fact that clients seek therapy to address certain problems implies that there is a certain standard of "selfhood" with which to be compared. But how is the self defined, and who defines it? In Sources of the Self (1989), Charles Taylor gives a helpful account of the self in its early-to-late modern development. Because Taylor links conceptions of the self with notions of artistic expression throughout his book, it is a useful resource for the discussion at hand.
Much of our current thinking about the "expressing self" is rooted in nineteenth-century Romanticism. The emphasis on feeling and sentiment which characterized this age (as opposed to the emphasis on pure reason which characterized the age of the Enlightenment) was more than fashionable: it was the obligatory path to truth. The universal was thought to be apprehended through personal experience, and so attention to one's subjective state was the means to knowledge and truth. Expression of one's subjective position, or self-articulation, brought forth a reality otherwise hidden, a reality not accessible any other way. The role of art, then, was no longer to imitate but to express; accordingly, the role of the artist was not to reflect reality but to complete reality by expressing what only the artist could see. Thus, originality - in terms of bringing something new into existence - became the goal of the Romantic artist. The more personal and idiosyncratic the vision of the artist, the more authentic and true the vision.
Eventually, the increasing importance of the individual's capacity for creation shifted the emphasis from the art object to the experience of the subject. As subjectivity came to be investigated and celebrated, the subject itself came to be seen as 'de-centered,' that is, seen as living on multiple levels (social, psychological, political, etc.). With growing attention given to the diverse and multi-layered levels of personal experience, it became more and more problematic to verify the claim that the self contained an essence within which could be expressed and revealed. In fact, in order to truly focus on the complexity of subjective experience, one had to shed the notion of a central, controlling faculty: "the liberation of experience can seem to require that we step outside the circle of the single, unitary identity, and that we open ourselves to the flux which moves beyond the scope of control or integration" (Taylor, 1989, p.462). Complete attention to one level of experience demanded that other levels were eclipsed or repressed. A unitary self would be a "repressive totality of meaning" (p.478), occluding the particulars of experience by giving prominence to a singular, overarching entity. A unitary self could be nothing but hegemonic.
Similarly, the idea that the art object contained a singular, embedded essence contradicted the multi-layered experience of art. Rather than exposing an essence, post-Romantic and modernist artists endeavored to unfetter objects from the depths that anchored them in static - even potentially oppressive - meanings. The art object was to instead present certain forces, or capture a certain energy. Art set the stage, so to speak, for people to reflect on their own experience and the forces which constituted their own subjectivity.
Following the shift from the unified to the differentiated self, we may then ask ourselves in the music therapy context: Do we view our clients' music as projective of a single (i.e., psychological) reality? What levels of experience does the music therapy session address? Which are we overlooking? Do we view our clients' music as projective of a reality that can be separated from the musical experience? What would justify such a claim?
Theories of Expression in Music
What assumptions about musical expression do we bring with us into the music therapy session? Just as the music therapist's theories of self-expression contain implicit notions of the self, they also reflect notions of what, how, and why music is able to express. In this section I will look at three traditional theories of musical expression as summarized by Higgins (1991). In addressing these three theories, I will discuss one in relation to a specific music therapy model. My intention is not to assert that these models draw exclusively from the corresponding theories, but to illustrate how these theories can be detected in different practices of music therapy.[8]
Imitation Theory and Nordoff-Robbins Music Therapy
To illustrate imitation theory - the idea that musical structures imitate emotional structures - Higgins presents the work of the philosopher Susanne Langer, who states that music is a symbol of emotional life.[9] Music, as a presentational symbol, "presents an image whose basic structure directly parallels that of the emotional world it symbolizes" (Higgins, 1991, p.100). The apprehension of emotional content in music, then, is a cognitive enterprise. We recognize the emotional life represented in the music, and gain satisfaction from that insight. However, it is not specific, differentiated emotions that music articulates. Musical structures are not directly tied to specific emotions; rather they imitate the subtleties of emotional life to which language does not have access. Music imitates the "forms of feeling" in a broad sense so that one might receive intellectual insight into emotion in general: "Music is not self-expression, but formulation and representation of emotions, moods, mental tensions and resolutions - a 'logical picture' of sentient, responsive life, a source of insight, not a plea for sympathy" (Langer in Higgins, p.101, emphasis in original). For Langer, the telos of music is not self-expression, since one would not need an artistic form to express oneself.
Principles of imitation theory, particularly that of Langer's, can be located in Nordoff-Robbins music therapy. In Paths of Development, Aigen writes that Nordoff and Robbins believed music had an essential identity apart from any idiosyncratic associations their clients could bring to it. Certain scales, modes, and intervals were said to represent emotions and states of being, although there was no direct, correlative relationship between particular musical forms and emotions. One scale held the potential to embody many different emotions, depending on the client, though this potential was circumscribed. In this way, music could be said to imitate emotional life, but in no fixed way. Nordoff's music functioned as a representation of the client, a sound-portrait in which she could recognize herself. The aim was not to delve into feelings but to give life to them, or highlight them, through musical form. His goal was not primarily to help the client express specific emotions, but perhaps to use the client's emotional energy as a means to engage the client in the external world as represented by his music.
Both Langer and Nordoff and Robbins stress that expressive content does not exist pre-musically, but emerges from exploration of musical materials. The idea that musical structures imitate emotional structures - though in no fixed way - allows us to speak of emotional content as inherent in music. However, the loose isomorphism of musical structure and emotional structure is both the strength and the weakness of Langer's and Nordoff and Robbins' theories. Both preserve the role of musical structure, but are caught when are called on to clarify how emotional content - even an undefined emotional content - can be located exclusively in the form of the music.
Arousal Theory and Guided Imagery and Music
Beever (1998) provides a concise summary of contemporary arousal theory: "a passage of music is expressive of an emotion if and only if it arouses that emotion, or possesses a tendency to arouse that emotion, in the listener" (p.82). For instance, if music is to be characterized as sad, it must make people sad. Higgins writes that one of the most persuasive arguments for arousal theory can be found in the work of Leonard Meyer (1956). In Emotion and Meaning in Music, Meyer states that emotion is aroused when our tendency to act is inhibited. When an intention to act is not followed by the act itself, our expectations are frustrated and we experience an emotion. In a musical context, we experience emotion when the music deviates from its expected resolution, determined by the conventions of the particular musical style.
It is interesting to note that, in this view, emotional content is directly observable through musical form. Theoretically, one could analyze a score, note the structural deviations according to the conventions of the style, and predict when emotion would be aroused in the listener. The occurrence of emotional content could be detected this way, but the particular emotion aroused would be a result of personal associations. In fact, the actual experience of the listener is not necessary to detect the presence of emotional content in this version of arousal theory. A person who does not respond to the music emotionally is listening incorrectly, or does not understand the conventions of the musical style. Though it appears that Meyer's theory is partially dependent on contextual factors (i.e., the listener's personal or cultural associations, the stylistic conventions of the music), he does not explore these factors as thoroughly as he could. The question to a structurally defined arousal theory such as Meyer's, is, then, what is the impetus and rationale for structure dominating context? If structural deviation from expectation arouses emotion, could the same not be said for contextual deviation?
In a GIM[10] session, the music chosen represents significant works of the classical canon that "most deeply access imagery of a healing nature" (Bonny & Savary, 1973, p.167).[11] Bonny also writes that the Hevner mood wheel has been one measure used to determine the expressive content of a musical work[12]. Since these works are chosen on the basis of their significance outside the clinical setting, it is fair to say that structure dominates context in their selection. The formal properties of a musical work heard outside the GIM session are sufficient criteria for prediction of emotional arousal inside the GIM session. Though a musical work may be emotionally arousing in a broad sense, the specific content of emotions experienced are dependent upon the client's background and personal associations. Music is chosen because it is evocative, and the general emotions associated with it are emotions aroused previously in people. One might say that music, in this view, possesses no emotion. It presents a form which evokes emotion[13].
The connection GIM has with arousal theory has to do with the locus of emotional content in music. If music is expressive of something, how do we know? We know because we experience it - it is aroused in us. The only way to determine emotional content is through our subjective reactions. What we really hear in music, then, is ourselves. Music functions as a catalyst to turn our attention to our emotional lives.
Expression Theory and Analytical Music Therapy
Higgins presents Peter Kivy (1989) as a contemporary theorist holding the expressionist position. Kivy, in his attempt to distance emotional content in music from the composer, performer, and listener, draws a distinction between expressing and expressive of. If we were to say that music expresses sadness, we would be compelled to tie that emotion to a sentient being that was sad - the composer would have to be sad in order to express sadness in her music. However, people compose music expressive of emotions they do not feel in the act of creation. Music may have expressive properties independently of any person's emotional state, just as a Saint Bernard's face is expressive of sadness even though it is not continuously experiencing sadness.
Kivy maintains that music can be expressive of distinct emotions (as opposed to Langer's "broad life of feeling"), and that our response to hearing specific emotions in music is foremost a cognitive response. We recognize sadness or anger or joy in music because of the structural detail we hear. We respond intellectually rather than emotionally to the specific emotions the music is expressive of. For example, we can say that the music reminds us of sadness without binding ourselves to the claim that the music expresses sadness, and without conceding that the emotion is produced entirely by the listener. The sadness is indeed a property of the music.
Elements of expression theory can be found in the practice of Analytical Music Therapy (AMT). Kivy's distinction between expressing and expressive of can be seen in the light of Priestley's concept of inner music. For example, when a client sets out to play a certain emotion (anger, for example) that she is not fully experiencing at the time, one might say that she is playing music expressive of anger. By using conscious intention and her (perhaps tacit) knowledge of the contour of "angry music" in her culture, she will begin to play in a certain manner. This begins largely as an intellectual endeavor, as she is playing based on her recollection of the music-structural forms of anger in her culture. However, what the music therapist is listening for is the inner music behind her intended music. The musical nuances underneath the forms the client has chosen to express herself is where the emotional significance resides. What is encouraged is the expression of these unintended sounds, as it is the direct expression of existing emotional material, without intellectual mediation, that facilitates the therapeutic process. True expression is separated from recognizable musical form.
What we have, then, is a potential separation of musical thinking and feeling based on musical structure. In AMT, emotional material is usually transmitted without the intentional use of conventional musical forms or structures[14]. Music which departs from stylistic conventions is the most directly expressive and the most emotionally authentic. Once the intentional use of familiar musical form comes into play, the music is no longer a direct expression. It is removed from the immediate emotional state of the client/composer. But, as Higgins asks, is it possible to express one's feelings in music without some kind of intellectual mediation? And, is it possible to create an object expressive of an emotion without some kind of personal emotional investment? Is there such a thing as music absent of either style and convention or emotional content?
This serves to illustrate how both Kivy and traditional AMT theory artificially separate the cognitive and affective aspects of musical expression. Even though Kivy privileges the cognitive apprehension of musical form (the emotions in music are perceived, not felt) and an analytical music therapist undermines musical form (listening beyond recognizable form for something more "pure"), both turn exclusively to music's structural forms to determine emotional content.
Despite their differences, common to all theories and music therapy models discussed above is a preoccupation with "the work," that is, the music as sound-structure. In music therapy, much of our analytical effort is spent on "the work" - taping our sessions, noting the tiniest structural variations and assigning them grand significance. While this may be for good reason (I would not for a moment suggest we stop!), is it possible we are neglecting anything in the process? Is there anything else that could help us to understand the nature of music's expressive content? Higgins notes that while they are undoubtedly useful, all three theories discussed above are ultimately embedded in a structural autonomy that occludes the nuances of musical experience. How does the context in which the music is experienced affect our judgment of music's expressive content?
Envisioning a Notion of Self-Expression for a Music-Centered Music Therapy
Music-Centered Music Therapy
If we were to accept that music as sound-structure held the key to music's expressiveness, we would have to view music as something concrete, fixed, and able to be experienced (even consumed) by an individual. However, as we have seen, it is difficult to pin down the identity of the work of art or the identity of the self. A music-centered music therapy begins with the lived experience of music; however, it treats music as something already informed by the many contextual layers of its construction. It does not exist to be experienced; it exists only in experience. Paradoxically, to be music-centered is to "de-centralize" music: it is to expand the boundaries of what we consider to be essential to the experience of music.
Much recent music scholarship has been devoted to "de-centralizing" the identity of the musical work. As Ansdell (1997, 2001) has written, in their realization that traditional analytic tools cannot account for music's emotional content or connection to culture, some music scholars have begun to study the ecologies which create and sustain musical objects. Recognizing that music is not free-floating but rather, embedded in socio-cultural process, context is viewed as an integral part of the identity of a piece of music (Ansdell, 2004). Consequently, when we de-centralize music, we cannot treat musical structure as the linchpin in our efforts to understand musical expression. Musical structure is not something self-contained, holding a kind of psychological code to be understood independently of the context it is heard in, nor is it something that must be transcended in order to achieve true expression. Emotional content in music cannot be satisfactorily derived by studying the music in isolation - the isolated musical structure or the isolated space of the music therapy session. Music that is made in the music therapy room is defined, in part, by the ecology which sustains it - not merely the client's immediate emotional state or the client-therapist relationship, but the broader musico-historical narrative which informs the musical experience (Stige, 2002).
In music-centered music therapy, music is viewed as already informed by its human context outside the immediate therapy space. Music is already "de-centralized," and cannot be reduced to nor subsumed under one overarching level of analysis, be it psychological, anthropological, music-structural, etc. As Aigen (2005) states, musical processes are primary because "the creation of music is itself the product of informed thought which is embodied in it. The music-centered position is not anti-intellectual or anti-theoretical, but locates the activity of intellectual processes within the musical ones" (p.67). A de-centralized music can be seen as affording certain experiences that are unique to music, as it's identity and content cannot be discerned other than through experiencing the musical moment.
Self-Expression in Music-Centered Music Therapy
If we maintain that a kind of self-expression occurs in music and in music therapy, what are the materials used to express, and what is it about the self that can be expressed? How can we conceive of a music-centered self-expression in music therapy?
Originality?
If we take self-expression in music to be a matter of music containing - by virtue of its form - the imprint of a "core self," the expressive process is too easily reduced to an essential structure. Yet, as we have seen, this does not fully account for the lived experience of music. In much of the music therapy literature considered above, there seems to be an underlying assumption that the more unconventional and original one's music sounds, the more authentic and personal it is. The more unfamiliar the music, the more one is expressing one's unique, subjective position. Conceived in this way, artistic self-expression is a sounding over and above the other - a deepening of the chasm between the individual and society, subject and object (Wolterstorff, 1980). For the artist to free himself from the constrictions of the world around him, he must separate his creation from that of the world. If his art is a direct representation of himself, it must be thoroughly original if he is to be thoroughly free.
Lawrence Kramer (2002) has done much to dispel what he terms the "myth of originality." Originality in music has been contingent upon a musical subjectivity associated with a single individual - the composer or performer. Yet when one unravels the subjective position of the individual, one finds that there is no pure source - subjectivity is constituted by many layers of forces and is found in their juxtaposition. Connecting the expression of music to a concrete individual identity has been the task of much music scholarship, but what happens to this task when there is no singular origin to which to trace the expression?
As we have seen, musical structure arises, in large part, out of musical context. The environment in which music is experienced partially determines its construction. Because of this, musical form is directly related to culture. As Stige (2002) notes, musical utterances are never "pre-conventional"; that is, one's music, however different, spontaneous or unconventional, never precedes cultural forms of music. There is a contingency between one's musical utterances and the socio-cultural nature of one's relationship to music. Any claims to originality are dependent upon the context in which one musics and the expectations of the listener.
Since music is made up of more than its structure, musical ideas are not necessarily technical ideas. According to Kramer, if we are to talk about the originality of musical ideas, we cannot limit our discussion to structure: "Compositional decisions on matters of technique are indeed to be understood as a response to musical ideas, but.these musical ideas are not necessarily technical ideas" (Kramer, 2002, p.260). Technical originality is more of a by-product when the musical work is stretched beyond itself into multiple contexts of meaning and actions. When we anchor a work in the idea of a unitary subjectivity, we are compelled to focus on its technical aspects, the aspects that can be traced as the intentional actions of the individual. But this is not a complete picture. One cannot be original using only the technical materials of music; those materials carry more significance than one can control and claim as one's own.
Kramer writes that we can always hear the musical past in the musical present. Inasmuch, music is a carrier of cultural memory. When a composer incorporates a musical idea of another in his own music (however unconsciously) or recontextualizes a kind of musical idea, cultural memory is enacted and the past is re-animated. The myth of originality has traditionally denied this, as it has been invested in a sovereign subjectivity. Revenants (Kramer's term for the musical past-in-present), in contrast, renounce this myth: "Revenants do not have to worry about originality. What they bring is not difference, but that estrangement within sameness by which sameness becomes compelling..The same returns in order to live on - differently" (p.264). In being performed in the present moment and context, musical structural material - cultural material - though technically the same, is experientially different.
"Originality" has traditionally implied that one must choose one's influences and resist others. Again, we find a priority given to musical structures that do not sound like any other, as though by creating music unlike any other, one could deepen the divide between oneself and the world, and, in doing so, define oneself more authentically. The concept of originality suggests that one's subjectivity can be controlled, and once controlled, be used to establish a kind of authenticity. Of course, culture is not something one can direct. We are made up of many influences, many voices present and past; there is no center controlling our subjectivities. When it comes to self-expression, then, who, what and where is the self being expressed? If I am engaging cultural materials when singing a melody, is it myself I am expressing?
When played or, especially, sung "with feeling," a melody can seem to make another subjectivity nakedly present to the listener, who may respond with an equally immediate sense of involvement..The self thus expressed may belong.to any or all of several persons: the composer, the performer, a dramatic character, someone for whom these figures come consciously or unconsciously to stand, or a nonspecific imaginary other who may envelop or supplant the rest, and who need not or cannot be explicitly recognized, localized, or identified. Melody in these cases is a quasi-material medium of intimacy and, through intimacy, of contact with subjectivity as origin and truth. Yet melody, nonetheless, is grounded in the capacity to be reproduced without regard for individual subjects..The voicing of a melody is never other than divided, its movement never other than a continuous flowing away from any possible origin. (pp.278-279)
The performance of melody - including improvised melody - in its absorption of the past, cannot be traced to a singular expressive origin. Incorporating something old into one's present subjectivity may be the most expressive and personal way to music: "Unoriginal music is one resource by which even the living may discover their capacity to live on in the present - only differently" (p.287).
This should not be taken as a case against making "new" music (as we sometimes do when improvising), however. As Benson (2003) has shown, improvisation is an integral part of the activity of composing and performing, just as the activity of improvising necessarily includes both composition and performance: "To improvise is to rework something that already exists.and thus transform it into something that both has connections to what it once was but now has a new identity" (p.45). Improvisation, however spontaneous or "new," is always "unoriginal," as the improviser is always re-animating what is already there. Benson puts it succinctly: "All performance is resuscitation" (p.179).
Tia DeNora (2000, 2003) has written about the ways in which people use music to organize and shape their lives, particularly in identity-building. Though she states that music has the ability to match and modulate affective states, DeNora emphasizes that the expressionist discourse is not helpful in understanding this practice: "Music is not simply used to express some internal emotional state. Indeed, that music is part of the reflexive constitution of that state; it is a resource for the identification work of 'knowing how one feels' - a building material of 'subjectivity'" (p.57). Rather than going through music to communicate how one feels, one goes to music to find out how one feels. In using musical materials, one is situating oneself, contextualizing oneself, and from there both discovers and creates how one feels - through the enactment of the self in music.
Self-expression can be thought of as an enactment of the self. In ordering the contexts in which music is experienced (not just the musical material itself), one is gathering, ordering, and defining emotional content. This way, the context in which the music is experienced is as much an expressive property of the music as its structural elements. I express myself musically through the choice of location, time and audience as much as through the choice of mode, tempo and meter. What is more, much of what I express is unintentional. I cannot express myself without invoking other voices. Emotional content in music arises out of the experience of music - out of the embeddedness and, at times, the collision, of the musical what with the musical where, when and how. Self-expression is what occurs - however unconsciously or unintentionally - in the process of this enactment.
The Quest for Self-Expression
If we emphasize the social and cultural nature of music and identity to the point of a kind of determinism and do not acknowledge some concept of individuality, we cannot speak of any kind of human agency. Yet, this appears to be a central theme in all kinds of musicing. Though the Romantic trope of music as a direct expression of one's core self is no longer tenable, is there anything from the Romantics worth preserving? Historically, the Romantics can be given credit for protecting music from those who wanted to censor its content, by maintaining that music had no content to speak of. Lydia Goehr (1998) has shown how the uniqueness of the musical "message" or "expression" can be preserved without slipping into a kind of essentialism. For Goehr, music's social nature is the path through which human individuality and freedom flourishes.
The Romantic era saw the emergence of both the formalist and transcendentalist approaches to aesthetics, the former personified by Hanslick and the latter by Wagner. Though very different in their methods (for the formalists, musical meaning resided solely in musical structure; for the transcendentalists, music was an expression of an ineffable metaphysical reality), both viewed music as a privileged artistic medium, and both claimed that music could not be definitively tied to non-musical concerns. Goehr writes that both groups maintained that music had no meaning apart from its musical meaning to escape censorship. Creative freedom demanded that music not be of service to any moral or political end. Ultimately, this was disempowering, as music was separated from real-life concerns. As music was pronounced autonomous, it was also deemed irrelevant. Yet both formalists and transcendentalists spoke of music bettering humankind. Hence, music had to be linked somehow to some kind of extramusical significance.
Goehr distinguishes the "extramusical" from the "nonmusical" (the "musical" being music's structural qualities):
Whereas the nonmusical might play no role in our understanding of the musical, the extramusical none the less does. Historically, the extramusical seems to have accommodated precisely those properties of the musical world that are not specifically musical, yet have given to pure music its broader human and expressive significance. (p.10)
The extramusical has always had a paradoxical status, as it is at once musical and nonmusical. Historically, extramusical significance allowed music to be simultaneously autonomous (protected from censorship) and relevant. Yet, the only way for music to have extramusical significance was for it first to have musical significance. The extramusical was achieved only through the musical; the musical at once concealed and revealed the extramusical.
In this way, the expressive content of music could conflict with the culture from which it emerged. The gap between the musical and nonmusical - held in the concealed extramusical - was the locus of music's acknowledged expressive freedom: "Music expressed the conflict itself, because while it asserted itself as a free or alternative means of expression, it would always also reflect (through its materials) the society that had given rise to it" (p.12). Goehr conceptualizes music's expressive freedom as follows:
One may say that music's freedom from external constraint gives music a freedom to express itself in, with, and on its own terms, which in turn gives it a freedom to express or reflect upon society at a critical distance. By combining music's freedom from with its freedom to, music achieves its desired position in society - its freedom within. The key to this notion of freedom within is the idea that music is immanent and social, but it is not merely or instrumentally social. Rather, it aspires to be resistantly social through its purely musical form. Again, this description captures music's demand .to be entirely formally significant and thoroughly socially empowered. (p.13, emphasis in original)
Music facilitates an individual's agency, but only when the individual aspires to a purely musical state. The extramusical significance music has cannot be predetermined or destined; it emerges out of the necessary illusion of "pure music." The "freedom from" Goehr writes of is the freedom from those who would censor music's content in an attempt to determine its function. By retreating to an idea of "pure music," music loses the danger of being harnessed as a means to a social or political end. A musical "work does not copy the world, it critically intervenes in it - and unnerves it - by claiming through aesthetic illusion that it has nothing to do with it" (p.15). Herein lies the paradox: for music to have extramusical significance, it must be autonomous. For music to say something beyond itself, it must do so in its own voice.
If we consider self-expression, we can see that an individual's musical expression cannot be defined in any way but by turning to the purely musical. The gap between the musical and nonmusical (or, the extramusical) cannot be accounted for through any reductive means. To do so would be to overdetermine music's content and risk tying it to ideological ends. Might the nineteenth century censors Goehr speaks of - those who sought to limit music's content in order to use it in service of moral or political ideals - find their equivalent in (among others) the social scientists of today? Those who limit and control music's extramusical significance by defining that significance in terms of direct links between music and reductive explanatory mechanisms (determined, ideal content) serve to limit and control the individual's expressive freedom. It could be argued that a psychological account of musical expression is a censored account. An anthropological account of musical expression is a censored account, and so forth.
But the autonomy of music Goehr speaks of is not located in its formal structure. Music's autonomy, and this is key, is contingent upon the connection between a work and its performance. The meaning of musical content is not found in its formal structure alone (though this too is important) but in its embodiment. A musical autonomy is dependent upon the autonomy of the individual that performs it. The focus here is on the performance rather than the work per se. By forging a link between musical structure and the particular context performed in, an individual is able to enact her self-expressive freedom. Her performed self-expression within the musical structure (with its cultural implications) is not the expression of an idea or feeling through musical material, it is the act itself. In the course of performance, the extramusical emerges and rises to the foreground, giving the illusion that the music is merely a tool. When the extramusical conceals the musical, we may think of the music in terms of extramusical things such as emotions; however, extramusical significance (such as emotional content) is only realized in the musical.
Because music's extramusical significance is in its connection to a human being, the musical act is necessarily an act of engagement. Yet to conceive of music's social nature in reductive terms is to neutralize its expressive power. A gap between musical and extramusical meaning must be maintained to protect the musical act from censorship and reduction, which lead to overdetermination of ideal content. We cannot engineer a musical performance to produce desired social effects, nor can we read the meaning of music post hoc as coded social realities. If we are to allow individuals their self-expressive freedom, we must keep our attention on the musical act, which means broadening musical autonomy. To definitively pin down the extramusical meaning of music is to limit its autonomy, and it is through this autonomy, and only through this autonomy, that music affords its extramusical self-expressive freedom.
Implications for Music Therapy
As we saw previously, people express themselves with music's contextual components as much as with its structural components. People organize the way in which music is experienced just as they organize pitches, meters and rhythms. In doing this, music is less something that acts on people as is it something people interact with. As such, contextual features must play a role in any personal significance we attach to the music. Therefore, it may not be useful to treat self-expression as something that emerges only from the creation of new musical structures. What is personally significant may not be what is new, but rather, what the client is doing with something old. David Ramsey (in Aigen, 2004) discusses this in relation to his work with a band in a hospital setting: "Some people can write an original song that follows conventional song writing dictates and styles and has very little self-expression. Others can do a cover tune, choose sounds that reflect a deep emotional connection, and sing in a way that is more personal than an original piece" (Aigen, 2004, p.188). It is not the abstract structure, but the re-animation of a musical structure, immediate to one's present context that makes the musical experience personally significant.
This was illustrated for me in my work with a music therapy group of four men struggling with mental illness. In most sessions, after one or more group improvisations, Brian, one of the group members, would play songs on the piano while the rest of us sang or played percussion instruments. Though he seemed to be concentrating hard on remembering and reproducing these songs for the enjoyment of the group, he also appeared to find it difficult to adjust his playing to the fluctuating group pace. What seemingly began as an effort to connect with the group often ended in disconnection, as Brian appeared to grow frustrated with not being able to play his songs as he had envisioned them. My co-therapist and I encouraged him to improvise at the piano, thinking that something other than his tried-and-true song repertoire might galvanize him toward a greater expressiveness. Songs were, in our view, too often keeping him from a more authentic mode of playing. Then, in one session, Brian began to play "Havah Nagilah." The expressiveness and personal investment Brian lacked in improvisations emerged in this song. Brian initiated "Havah Nagilah" several times after that session. Through it he was able to respond to the others in the group by changing some of its structural elements (such as tempi and dynamics) to match the energy of other group members. This song afforded a place for Brian to find and create an emotional connection to music and to the others in the group. Though it was precomposed and familiar, Brian was able to play more flexibly and responsively than in a free improvisation. "Havah Nagilah" may not have meant the same thing to him in other places in his life, but in this context it may have embodied Brian's efforts at sharing a part of himself with the group, and the revealing of his own unique musical voice.
Mediating personal significance through context may also mean that the most meaningful way for music to be experienced is in settings other than the closed music therapy space. For Ramsey's clients, the self-expressive power of music is enacted in a semi-public area of the hospital. As Finnegan (2003) demonstrates in her look at musical experiences in a variety of cultures, self-expression may not be spontaneous, impulsive and primal (as is commonly thought); it is often carefully constructed and rehearsed. In music therapy, a client may feel most expressive through a Beatles song performed publicly rather than through a musical wail behind closed doors.
In a large residential school and hospital for children and adults living with cerebral palsy, part of my work as a music therapist was to help organize talent shows that were held several times each year. Even though I helped clients write original songs, there were always several clients who chose to perform familiar songs - "unoriginal material." At the time, I encouraged the performance of self-written songs - what on earth could possibly be new about "Hey Jude?" I wondered. It was after these performances that it became clear what was new - a sense of accomplishment in performing a "real song," a sense of connection to one's peers through the fact that the song was a shared cultural artefact, experienced together in real time, and a sense of identity and location in time and space. My clients were not choosing these songs only because they expressed a specific feeling or message, but perhaps because through their choice of songs in that context of performance, they were able to articulate something about their relationships with their peers, the institution, and music itself.
The transcendence the Romantics aspired to in music was conceived in terms of separating oneself from the world. For music to be personally significant, it had to be different from anything heard before, and this difference had to hold its essential nature across various contexts of use. Expression was achieved in separation. Now that we have seen that the rift between the subject and her environment is an artificial one, we can conceive of self-expression as a cleaving to the world, an engaging of culture. The kind of self-expression music affords is one that helps clients to find themselves in the midst of their situations, not apart from them. As a client locates herself in music, she is locating herself in cultural material. As she gathers subjectivities (in Kramer's words) she is at once discovering and creating her position in a larger picture.
Again, the only path to this extramusical significance is through the musical. If the client is using music to achieve a nonmusical kind of expression, the music is tied to nonmusical ends and loses its expressive power. Only when the client is focused on the musical can extramusical (or, we may say in some instances, clinical) significance unfold. Even though the musical and clinical are inseparable, the musical does not contain a map of the clinical; music cannot be heard as a code to break. The disciplines of psychology, sociology and anthropology (etc.) facilitate this connection, but they can never provide an exhaustive account of music's extramusical significance. Perhaps the musical self-expressive act, in which one is able to exert self-reflexive power, works therapeutically precisely because it resists reduction.
In my work with a three-year-old boy with autism and language delays, self-expression was at once the goal and the obstacle of the music therapy process. In the first few months of our work together, Andrew played the instruments in an idiosyncratic manner, disconnected from any other music going on in the room. Being a supportive music therapist, I allowed him room to explore and "express himself." It was after several months of this strategy that I realized I was in fact enabling his tendency toward isolation. Andrew was trapped in a bubble where the only thing he could do was play according to what seemed to be an internal force. At this point, I conceived of his playing in terms of self-expression - free, unfettered playing of the instruments as he wanted to play them - yet it seemed in no way musical. At the same time, I was trapped in a bubble of my own intentions. I desperately wanted Andrew to do something differently, though I approached the music as something I could use to get there rather than as a place within which we could meet. When I finally dove into the music as music, and not a means of achieving an ideal, determined content, I was able to better listen to him. Gradually, Andrew was able to do the same. His rigid mode of "self-expression" was transformed into a thoroughly musical mode of expression - one focused on the musical act and utterly extramusical in its communicativeness. When I tried to deploy music to evoke specific responses, its meaning was ultimately lost or diluted, but when I allowed myself to experience the music as an end in itself, I could better listen and relate to Andrew. Paralleling that, when Andrew was able to trust the music, he was able to find his own expressive voice and reach out to others through it.
Andrew's story resounds of Goehr's freedom within. Just as music has the power to challenge the culture from which it emerges on a social level (by claiming that it has no nonmusical meaning to speak of), music also has the power to express different, perhaps conflicting, parts of an individual. Andrew, who could not make contact with certain parts of himself in other areas of his life, could experience different emotions in music when he was focused on the music as music.
Many music therapists speak of their work as helping a client "find her voice." Paradoxically, many clients found they have done just that when they have lost or surrendered their nonmusical voice to the purely musical act. In engaging in a musical experience, we find ourselves in a place "where the purely musical world frees us from our purely personal world" (Ansdell, 1995, p.128). Perhaps what we are expressing in music is our commitment to music itself, and our commitment to finding ourselves within that which is outside ourselves.
Conclusion
A theory of self-expression for a music-centered music therapy hinges on a simple concept already advocated[15]: the extramusical presents itself only through the musical.
Though I have been relentless in maintaining that musical structure be removed from its pedestal in our search for expressive meaning, it should be clear by now that in this view, music therapists need a renewed commitment to the actual music in their sessions. Because expressive meaning is embodied in the purely musical act, we must keep our attention on the music - the musical experience - and not on an emotion, thought, or relationship in the process of performance. It is not that music's structural components are irrelevant to expressive meaning; they are just not given exclusive priority. Likewise, it is not that the social and psychological needs of our clients are irrelevant; it is just that the music is not reducible to them. To read a client's music as the expression of coded psychological realities (emotions, conflicts, defenses, etc.) is to filter the musical experience, allowing one level of experience to repress other levels. To maintain a definitive nonmusical meaning of the client's musical expression is to censor the autonomous voice of the client and constrict her individual agency. Therefore, it is critical to reflect on musical structure in music therapy, but it is equally critical to reflect on what keeps those structures afloat. Musical autonomy is only possible through music's embodiment. In each act of musicing, the "purely musical" is newly defined.
Can we, then, still conceive of self-expression in music in terms of an inner reality manifested in a musical experience? The answer is both yes and no, or rather, the answer is - we're asking the wrong question! To begin with, and as we saw previously, our inner lives are not contained, private states of being. What is personally significant for us is, in part, what has been given to us. To manifest the inner life in music may be to articulate one's position - to articulate the many levels one lives on and create relationships between them (not necessarily integrate them) in the act of performance. Yes, there is a subjective position we can express in music, but that subjectivity is not completely "inner": it is thoroughly embedded, thoroughly worlded, and thoroughly irreducible.
Perhaps we feel so personally expressive in music because, in the act, we are drawing on an autonomy that cannot be reduced. We feel personally expressive because we are actively locating ourselves in that which is outside ourselves. We are not manifesting an essential identity through a musical structure; we are at once revealing and creating the truth of our social existence, finding and asserting our freedom within, as Goehr would say. The musical act may "say" many things, but in the end it cannot be reduced to any one of them, nor can it be separated from the music. To allow our clients the fullness of the musical experience is to invite the autonomous musical voice.
Notes
[1] For example, Gaston (1968) boldly and broadly stated near the beginning of his famous text that "music came into being because of man's interdependence, his need for expression and communication" (p.15). Self-expression also seems to be central to other original music therapy theories, such as Kenny's (1989) Field of Play: "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" (p.82).
[2] Although the term "music-centered music therapy" has been floating around music therapy discourse for some time, it has only been vaguely defined. Kenneth Aigen (2005) has recently provided a definition and outlined the foundations and implications of music-centered thought. I believe Aigen's project is unique and authoritative (as it is the only publication to address this topic in detail); therefore, in this paper I will draw from Aigen's definition: "in music-centered music therapy, the mechanisms of music therapy process are located in the forces, experiences, processes, and structures of music" (p.51, emphasis in original).
[3] See Robbins & Robbins (1998).
[4] More recently, the theme of "immediacy" can be found in Smeijsters (2005) theory of analogy. According to Smeijsters, musical forms are analogous to forms of feeling in their dynamic, kinetic aspects. Music is immediate in that it "goes directly into our world of feelings without the need of an intermediary process of remembering, thinking, associating, and imagining" (p.45). The client experiences the change in musical forms as analogous to changes in her forms of feeling, as opposed to understanding the music as a metaphor, which would require a greater degree of cognitive and rational mediation and distance the client from the actual musical experience.
[5] It is interesting to note that in both the relationship and communicativeness scales (Nordoff & Robbins, 1977), self-expressive ability and musical intelligence are intertwined.
[6] See Nordoff-Robbins trained music therapists Lee (1995, 1996, 2003) and Aldridge (1996) for examples of the importance of musical form in clients' musical expressions.
[7] See Goldberg (1992, 2002) and Perilli (2002) for examples of music evoking emotion in BMGIM.
[8] I also do not claim that music therapists have appropriated musicological and philosophical theories of musical expression intentionally and/or consciously. However, if their influence can be detected in music therapy theory, the criticism musicological and philosophical theories have received may also be useful to music therapy theorizing.
[9] The origins of imitation theory can be traced as far back as Plato and Aristotle. Higgins presents Langer as a recent version of imitation theory.
[10] There is no consensus among GIM therapists that emotional content is located in the listener rather than in the music. Bonny's early writings strongly suggest an expression position that contradicts arousal theory. However, certain aspects of arousal theory have emerged in the writings of some contemporary GIM therapists. While one could not conclude that arousal theory is GIM's only influence regarding music and emotion, one could certainly argue its increasing presence in the literature.
[11] Classical music is the predominant genre used, though GIM has expanded to include jazz and popular styles of music as well.
[12] Bonny's appropriation of the Hevner mood wheel is as follows: "To test individual musical pieces for the moods they communicate, a group of subjects listen to the selection, then check the mood adjective group that they feel most corresponds to the mood of the musical selection" (Bonny & Savary, 1973 ,p.162).
[13] Returning to the words of Lisa Summer: "Individually, we determine its [Beethoven's opus 26] content. Beethoven only gives us the structure. He does not compel us to feel one way or another" (1992, p.51).
[14] Hence Lecourt's stance against "aesthetic" music in the early stages of therapy: "The music (as an aesthetic form) stands separate from the patient as an idealized abstraction of his reality and the clinical situation while also denying the true nature of the patient-therapist relationship" (Lecourt, 1998, p.156).
[15] See Aigen (2005) and Ansdell (1995).
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